Interpretative Phenomenological Analysis Approach Research Articles

Financial Toxicity Experiences of Patients With Cancer in Indonesia: An Interpretive Phenomenological Analysis

ObjectivesFinancial toxicity (FT) is an important adverse effect of cancer. Recent systematic reviews have shown that FT may lead to treatment nonadherence and impaired health-related quality of life, both of which may adversely influence the survival rates of patients. However, less is known about how patients endure FT, particularly in low- and middle-income countries. The purpose of this study was to explore how patients with cancer experience and cope with FT in Indonesia. MethodsSemistructured in-depth interviews were conducted to explore the experiences of Indonesian patients with cancer. Qualitative data were analyzed using interpretive phenomenological analysis approach. We purposefully recruited 8 patients undergoing active treatment (aged 27-69 years) who had been diagnosed of cancer over 5 years before and possessed health insurance at the time of diagnosis. ResultsWe identified 2 main themes: (1) the experienced financial burden, with subthemes underinsurance, out-of-pocket nonhealthcare cancer-related costs, and negative income effect from employment disruption, and (2) the financial coping strategies, with subthemes reallocating household budget, seeking family support, rationalizing treatment decisions, and topping up insurance for family members. ConclusionsThis is the first interpretive phenomenological study on FT in the literature and the first qualitative FT study in Indonesia. Our findings provide insight into the occurrence of FT and coping strategies used by Indonesian patients with cancer. The subjective experiences of patients may be considered to further improve oncology care, support the need for measurement of FT, and provide mitigation programs for patients.

"It is not all glowing and kale smoothies": An exploration of mental health difficulties during pregnancy through women's voices.

This study aimed to explore the experiences of women with moderate-to-severe mental health difficulties during pregnancy, with a focus on establishing their psychological needs. Psychological distress caused by mental health difficulties during pregnancy is common and can significantly impact women and their babies. However, women's subjective experiences of difficulties with their mental health throughout pregnancy, alongside their experiences of staff, services and treatments are less well understood. In this qualitative study, an Interpretive Phenomenological Analysis (IPA) approach was used. Semi-structured interviews were conducted with participants recruited via a regional Perinatal Mental Health Service. Interviews were transcribed and analysed following the IPA methodology. Five superordinate themes were identified which represented the lived experiences of the 11 participants on their journey through pregnancy whilst living with mental health difficulties and subsequent psychological distress: (i) Feeling the 'wrong' feelings, (ii) Societal pressures and a desire for greater acceptance, (iii) Searching for answers despite a lack of resources, (iv) What made a difference and (v) Experiences and expectations of service provision. Within these themes, 13 subordinate themes were also identified. These themes highlight the need for greater awareness and acceptance of mental health difficulties during pregnancy as well as postnatally. While perinatal mental health services are evolving, there is still an urgent requirement for services to continue to develop to meet women's needs, as well as to develop the role of clinicians as facilitators of engagement with needs-matched care.

Conspiracy of Silence in Oncological Palliative Care: Perspectives and Strategies of the Healthcare Team

Introduction: Silence about dismal news is common in palliative care, involving patients, family and the healthcare team. This phenomenon of hiding the truth – conspiracy of silence – has negative consequences and deserves attention from professionals. Objective: This study investigates and explores the strategies used by healthcare professionals to prevent and intervene in the conspiracy of silence in the context of oncological palliative care. Method: Cross-sectional qualitative study using the Interpretative Phenomenological Analysis approach. The participants were nurses, doctors and a psychologist who work in the palliative care unit of a cancer center. A semi-structured interview was applied to a sample of 12 healthcare professionals. Results: The age of the participants varied between 31 and 64 years old, mostly females, ten nurses, one physician and one psychologist. From the analysis of the interviews, the following themes emerged: perceptionof the phenomenon of the conspiracy of silence; difficulties and challenges in dealing with the conspiracy of silence in palliative care; professionals’ feelings about the conspiracy of silence; strategies to intervene and prevent the conspiracy of silence. Important strategies were reported such as honest communication without impositions, listening to the motivations that led to the silence. Conclusion: Professionals are aware of the ethical duty to tell the truth when faced with a conspiracy of silence. However, continuous training is needed to develop skills for communicating dismal news in clinical settings and in medical education.

Compassionate care during the COVID-19 pandemic

BackgroundThere was a substantial documented call for healthcare professionals to provide compassionate care during the COVID-19 pandemic and significant criticism voiced when it was lacking. This study aimed to explore perspectives on compassionate care among healthcare professionals providing care during the COVID-19 pandemic. The study focuses on healthcare professionals who participated in a wide range of COVID-19 measures, including testing, quarantine, diagnosis, and care provision (patients with COVID-19 or patients with other illnesses and comorbid with COVID-19).MethodsA qualitative design with an interpretative phenomenological analysis approach was used. Twenty frontline healthcare professionals (15 nurses and five physicians) who had worked in COVID-19 facilities in China were interviewed individually.ResultsParticipants stated that a commitment to ‘offering oneself’ and ‘balancing the advantages/disadvantages’ in providing care during the pandemic were key to alleviate population-level suffering. On a personal level, they described a desire for obtaining ‘mutual support’ and improving ‘professional competencies’ to safeguard their physical and mental well-being. Two professional competencies were notable: coping with grief and implementing infection control across the organization. Additionally, they emphasized the importance of receiving support from the health care organization, the public, and leaders in creating an ‘environment conducive to fostering compassionate care.’ConclusionHealthcare professionals recognized the centrality of compassionate care during the pandemic which entailed a commitment to offering themselves, the balancing of advantages and disadvantages in order to find the best solution, as well as the need to safeguard themselves using professional competencies. Such findings can enrich the contemporary understanding of compassion, including when it is lacking. Support from the healthcare organization, the public, and leadership were crucial in fostering compassionate care in healthcare professionals during the pandemic and in moving the field forward in the future.

From Siege to Survival: Exploring the Multi-Faceted Traumas of Meranao Internally Displaced Persons

The 2017 Marawi Siege in the southern Philippines resulted not only in a city’s physical devastation but also in a profound psychological impact on its internally displaced residents, mainly from the Meranao community. This research aims to understand the trauma endured by these Meranao IDPs, linking it with paradigms of forced migration, cultural displacement, and post-conflict collective memory. Using the American Psychiatric Association’s definition of trauma and Herman’s Trauma Theory as a guiding framework, six IDP survivors from the Sagonsongan area were interviewed. The study adopted the Interpretative Phenomenological Analysis (IPA) approach to explore the participants’ experiences. This qualitative method involves a detailed examination of personal lived experiences, attempting to understand how individuals make sense of their major life experiences. The IPA approach was particularly suitable for this study as it allowed the researchers to examine the personal stories of trauma, providing a rich and detailed first-person account of the psychological struggles faced by the Meranao IDPs. The data collection involved in-depth, semi-structured interviews that enabled the participants to share their stories in a flexible yet comprehensive manner. The interviews were transcribed verbatim and analyzed following the principles of IPA, which involve a cyclical process of reading and re-reading the transcripts, coding for themes, and looking for connections between themes across the different narratives. The researchers remained cognizant of their preconceptions and engaged in a reflective process to minimize bias. The findings revealed several themes, such as the traumatic implications of familial dislocation, economic hardships, persistent trauma, feelings of exhaustion, and a compromised sense of safety. These findings not only intersect with established theories but also provide unique insights into the Meranao community’s post-siege challenges. The trauma narratives contributed to a nuanced account of the Meranao IDPs’ psychological struggles after the siege. Keywords: Meranao community, internally displaced persons, Marawi Siege, trauma

Humanising case-based learning

Purpose of the article Medical undergraduates at St George’s, University of London (SGUL) study a weekly clinical case during their clinical science years. Audit of the human stories demonstrated lack of diversity, mono-professionalism, and objectification of some patients. A collaborative partnership with staff, student and patient representation implemented curriculum change, including an inclusive case-writing initiative. We explored whether the reformed written cases supported the development of positive attitudes by sampling perceptions of the cases amongst students. Methods Sixteen semi-structured interviews were conducted (Feb–November 2022) with first year medical students. We applied an interpretative phenomenological analysis approach. Verbatim transcripts were coded and analysed to elucidate themes. Results Four themes were identified: (i) effective learning, (ii) clinical authenticity, (iii) authentic human stories, and (iv) opportunity for rehearsing the role of a doctor. Students perceived the cases as an effective, contextual learning method, with a high degree of clinical authenticity, allowing mentalisation of doctor attitudes and behaviours in relation to patient-centredness, multidisciplinary team working and diversity. Conclusion The results suggest the reformed cases created positive attitudinal change amongst students and supported transition to clinical roles. Memorable human stories had the greatest impact. Dynamic, inclusive, and collaborative case writing initiatives which integrate realism, diversity and multi-professionalism may help to foster positive experiences in students undertaking CBL sessions.

Exploring experiences of online ‘pro‐ana’ networks: An interpretative phenomenological analysis approach

AbstractObjectiveOnline pro‐ana communities encourage, rather than denounce, eating disorder (ED) behaviours. Most research analyses online pro‐ana content. Fewer studies have interviewed bloggers directly. To the authors' knowledge, no previous studies have analysed both posts and interview data from pro‐ana bloggers. This study aimed to explore bloggers' experiences of online pro‐ana communities, analysing posts and interview data.MethodFive pro‐ana bloggers participated in semi‐structured interviews over Skype or Telegram. Bloggers' posts and interview data were analysed using interpretative phenomenological analysis, a qualitative method of analysis that emphasises the detailed exploration of participants' individual experiences and how they make sense of these experiences.ResultsFive superordinate themes were identified: ambivalence towards pro‐ana; social support; ‘Ana’ way of life; body/weight desperation; and hidden ED identity. Participants reported hiding their pro‐ana blog, for fear of judgement from offline others. In contrast, participants experienced online pro‐ana communities as a source of understanding, connection and solidarity that counteracted stigma experienced in the offline world. All participants idealised ‘Ana’ (anorexia), either as an admirable lifestyle or as the idealised, personification of anorexia, named ‘Ana’. Simultaneously, participants experienced pro‐ana communities as deceptive and/or harmful, demonstrating ambivalence towards pro‐ana.ConclusionsFindings suggest that community and shared understanding are important to individuals accessing pro‐ana content. Therapists may explore this further with clients, alongside any ambivalence towards pro‐ana and/or alternative supportive environments, such as online support groups. This may reduce isolation, without idealising ED behaviours. Future research could explore bloggers' relationships with the personified ‘Ana’ and experiences of non‐Western and male users.

Triage practices for emergency care delivery: a qualitative study among febrile patients and healthcare workers in a tertiary care hospital in Nepal

BackgroundImproving screening and triage practices is essential for early severity assessments at the first point of contact and ensuring timely attention by healthcare workers (HCWs). The main objective of this study was to explore the triage process among febrile patients and HCWs in the emergency department (ED) of a tertiary care hospital in a resource-constrained setting.MethodsThis qualitative study was conducted from March to May 2023 at the ED of Tribhuvan University Teaching Hospital (TUTH), Nepal. The study included in-depth interviews with febrile patients (n = 15) and HCWs (n = 15). Additionally, direct observation notes (n = 20) were collected to document the triage process and patients’ experiences in the ED. Data underwent thematic analysis using the Interpretative Phenomenological Analysis (IPA) approach.ResultsThe ED of TUTH offered comprehensive triage services with clear delineation for the severity of febrile patients in line with the World Health Organization (WHO) guidelines. Nonetheless, challenges and constraints were identified. In the ED, evenings were generally the busiest period, and the triage process was not thorough during night shifts. Perception of triage was limited among patients and variable among HCWs. Digitalizing recordings of patient information including payment was deemed necessary for effective management of patients’ waiting times at the triage station. High patient throughput added pressure on HCWs and had a potential influence on the delivery of services. Availability of medical equipment and space were also identified as challenges, with patients sometimes compelled to share beds. There were constraints related to waste disposal, hygiene, cleanliness, and the availability and maintenance of washrooms. Febrile patients experienced delays in receiving timely consultations and laboratory investigation reports, which affected their rapid diagnosis and discharge; nonetheless, patients were satisfied with the overall healthcare services received in the ED.ConclusionsImproving current triage management requires resource organization, including optimizing the waiting time of patients through a digitalized system. Urgent priorities involve upgrading visitor facilities, patient consultations, laboratory investigations, hygiene, and sanitation. HCWs’ recommendations to resource the ED with more equipment, space, and beds and a dedicated triage officer to ensure 24-hour service, together with training and incentives, warrant further attention.

The reunion with my patients: their journey and experience 30 years after their intervention for adolescent idiopathic scoliosis via CD instrumentation.

Our objective was to collect the experience and current attitude of those patients, now adults, operated on for adolescent idiopathic scoliosis (AIS) more than 25years ago with CD instrumentation (CDI). Prospective qualitative cross-sectional study with interpretive phenomenological analysis approach of AIS patients operated in a single center with CDI between 1985 and 1995. Patients underwent a semi-structured interview with their original surgeon. Seven agreed themes were open for conversation, and several subthemes emerged related to their experience during their journey in life. Filed notes were recorded and transcribed verbatim. We used the method of content, semantic and pragmatic analysis. We contacted 103 patients, 100 agreed to participate. Mean age was 47.5 ± 3.3, mean follow-up was 30.9 ± 2.7years. Three fundamental concerns stood out: discomfort with self-image; low back pain with daily activities; and lack of spinal flexibility. 50% were engaged in continuous physical exercise, and only some referred limitations with load-bearing work. Patients commonly described negative memories of the conservative treatment, but positive memories of the surgical process. In general, there was a good adaptation to social life (occupation, social and family relationships). Two-thirds were married, and 65 women had offspring. A frequent concern was the excess of radiographs over the years, and three developed breast cancer. Factors such as dissatisfaction with self-image, low back pain, and spine stiffness were relevant to patients throughout their journeys. Despite this, the great majority were satisfied with the treatment received, which allowed them to lead an integrated life in society. Level II.

“It’s a learning curve throughout your entire life”: Experiences and impact of FASD in adolescence explored in online photovoice research

BackgroundResearch into the lived experience and disability of Fetal Alcohol Spectrum Disorder (FASD) is sparse in adolescence, despite its relevance to supports and life outcomes. AimsThe study explored adolescents’ lived experiences of FASD and access to support across home, school, and community. Methods and ProceduresAn online photovoice study was undertaken with eight young people (age 12–19, in education), integrating an Interpretative Phenomenological Analysis (IPA) approach. The research process comprised two individual interviews, group training, individual photo-taking, and group sessions for photo analysis/ dissemination. Outcomes and ResultsParticipant-led analysis of their photos identified how activities at home and in the community had functions of relaxation, sensory gratification, and enabled concentration. Researcher-led analysis found that young people identified with the disability of FASD through experiences at home and school. While they acknowledged the value of support and relationships, education was not always an inclusive experience. Conclusions and ImplicationsParticipatory online research allowed insight into the impact of FASD as a disability and underlines a consistent need for support in adolescence and the transition into adulthood. Young people with FASD require explicit support to develop their advocacy skills to improve educational outcomes.

Providing compassionate care via eHealth.

eHealth was widely used during the COVID-19 pandemic. Much attention was given to the technical aspects of eHealth, such as infrastructure and cost, while the soft skill of compassion remained underexplored. The wide belief in compassionate care is more compatible with in-person interactions but difficult to deliver via e-platforms where personal and environmental clues were lacking urges studying this topic. to explore the experience of delivering compassionate care via an eHealth platform among healthcare professionals working to contain the COVID-19 pandemic. A qualitative study design with an interpretative phenomenological analysis approach was used. Twenty healthcare professionals (fifteen nurses and five physicians) who provided care using technology platforms, such as telephone hotlines, mobile apps, and social media, were interviewed individually. Permission to conduct the study was obtained from the Institutional Review Board. Participants stated that "eHealth enabled compassionate care during the pandemic" by ensuring patient care availability and accessibility. They shared experiences of "communicating compassionate care via eHealth" with suggestions of addressing patients' needs with empathy, adopting a structured protocol to guide eHealth communication, and using more advanced visual-media methods to promote human-to-human interaction. They recommended "setting realistic mutual expectations" considering the limitations of eHealth in handling complex health situations and staffing shortages. Participants considered "low eHealth literacy hinders compassion." Additionally, they recommended the need for "institutional/system-level support to foster compassionate care." Participants recognized the importance of integrating compassion into eHealth services. Promotion of compassionate care requires standardization of eHealth services with institutional and system-level support. This also includes preparing adequate staffing who can communicate compassionate care via eHealth, set realistic expectation, and adjust communication to eHealth literacy level while meeting the needs of their patients.

Proficiency of independent directors: an Indian corporate governance perspective

Purpose Independent directors (IDs) in India are required to qualify for the online proficiency self-assessment test to acquire or retain their position on the corporate boards. The purpose of this paper was to examine the perceived positive and negative aspects of the new mandate for the overall quality of corporate boards in India. Design/methodology/approach This study used a qualitative methodology and applied the interpretative phenomenological analysis approach. Data was collected from board members using semi-structured interviews. Findings This study revealed the positive and negative perceived aspects of the mandatory policy prescription of proficiency test for IDs. It was found that the participants emphasized training and mentoring programs for the IDs. Practical implications Drawing upon the actual board experiences of the participants, this study has the potential to assist policymakers in making regulations that are more effective in enhancing the quality of corporate boards. The example of action taken as well as the criticism or positive aspects pointed out can generate interest in other legislators. Originality/value The concept of proficiency test for IDs is unique to India. A review of literature did not reveal the existence of any regulatory provisions for a mandatory uniform test for examining the proficiency of IDs, in any corporate law jurisdiction apart from India.

Exploring individuals' experiences of hope in mental health recovery: Having a sense of possibility.

WHAT IS KNOWN ON THE SUBJECT?: Mental health recovery is acknowledged as a process of transformation and a way of living a meaningful life despite the presence of mental ill-health. Experiencing hope has been articulated as intrinsic to service users experience of a meaningful life. The social construction of mental illness and stigma are recognised as barriers to experiencing hope. Mental health professionals have responsibility to positively influence the experience of hope. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: Individuals in mental health recovery experience hope as the embodiment of having a sense of possibility in life. Individuals' sense of possibility in life is underpinned by a belief and confidence that they will be ok. This belief is informed by 'feeling safe' and 'feeling connected'. This article generates an increased understanding of the dynamic relational processes that unpin hope generation. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Mental health stakeholders need to be more explicit in exploring 'hope' and uncovering its therapeutic potential. Mental health practitioners need skill in enabling individuals to feel safe and connected while understanding its role in cultivating hope. ABSTRACT: Introduction The experience of hope is widely acknowledged and empirically supported as a key catalyst of mental health recovery. Lived experience accounts of hope are critical in accessing data on what has been termed a nebulous concept. This article is the second presentation of data from this study and provides further context to improve understanding of hope and optimise its therapeutic potential. Aim To explore how individuals describe and make sense of their experience of hope in mental health recovery. Method A qualitative Interpretative Phenomenological Analysis (IPA) approach was used. Results This article explores the second of three experiential group themes: Hope as Having a sense of possibility 'I will be ok' which is informed by feeling safe and feeling connected. Discussion Having a sense of possibility is easier when basic needs are met and people feel connected to self, others and the universe. The use of creativity as a pathway to the imagination is positively experienced. The role of family, friends and healthcare professionals as hope reservoirs is critical. Finally, the framing of medication use emerged as significant. Implications for Practice It is important that all stakeholders appreciate the interpretation of hope and use the understanding and skill in harnessing its therapeutic potential.

Becoming a father: a qualitative study on the journey to fatherhood.

The transition to fatherhood represents one of the most significant changes in a man's life and brings many challenges. Despite the great importance of this period, empirical data on it are not abundant, with only a small amount of psychological research on fatherhood available in the Czech Republic; this topic is also rather marginalized abroad. This qualitative study aims to explore men's unique experiences with the process of becoming a father and to understand how paternal identity is shaped. Four men who had recently become fathers participated in the research. A semi-structured interview was conducted with each of them. Using the interpretative phenomenological analysis (IPA) approach, an in-depth analysis of the data identified five significant categories that emerge during the transition to fatherhood: responsibility and commitment to the child, father identity formation, fatherhood and motherhood, changes in the partner relationship and coping with the father role. The research suggests that the process of becoming a father is a long-term dynamic process, in which father identity is shaped and consolidated through a variety of situations and experiences. Within this process, paternal identity is also shaped through repeated comparisons and definitions of the role of the mother. Process of becoming a father involves developmental, identity, personality, partnership and family aspects.

Anxiety during the Corona Virus Disease (COVID-19): The Lived Experience of Older Adults

This qualitative study explored the lived experience of Maltese older adults experiencing symptoms of anxiety during the coronavirus disease pandemic. The study was carried out through an interpretative phenomenological analysis approach. The participants (7 Maltese older adults) were recruited through purposive and snowball sampling, and semi-structured interviews were utilised to collect data. A cluster of 4 emergent Group Experiential Themes comprising of 13 subthemes highlighted the high levels of fear, as well as the different cognitive processes and attitudes that led to and maintained the experience of anxiety. The challenges of living through the pandemic included social isolation, safety measures, the long-term living outcomes of the pandemic and reflections on vulnerability. Resilience, coping strategies, and support systems played crucial roles throughout this period. Results framed within a Dynamic Biopsychosocial Model revealed that biological, psychological and social factors influencing anxiety evolved with the pandemic, shaping participants' perceptions. Measures supporting older adults to soften the negative mental health outcomes and possible traumas due to death of loved ones or long-term hospitalization should be prioritized.

Promoting Safe and Supportive Health Care Spaces for Youth Experiencing Racism

ObjectiveThis qualitative study applies a community-based participatory research approach to elicit formative data on pediatric patient experiences of racism in the health care setting and to explore clinic-based opportunities for supporting pediatric patients experiencing racism. MethodsThe study is situated within the outpatient practice of a large tertiary academic medical center in a midsize Midwestern city. Community partners were involved in all aspects of the research, including research protocol design, recruitment, data analysis, community dissemination, and manuscript preparation. Participants were youth between 11 and 18 years, in middle or high school, self-identifying as a person of color, Latinx or Indigenous who answered yes to the question “have you ever experienced race-related prejudice and discrimination?” Parent/guardians of youth meeting inclusion criteria participated in separate focus groups. Data were analyzed using an interpretative phenomenological analysis approach. ResultsMajor findings were divided into 2 categories: 1) racism-related experiences in the health care setting; and 2) patient and parent/guardian recommendations to support pediatric patients experiencing racism. Among health care setting experiences, primary emerging themes included racism experienced in the health care setting, patient-clinician communication around racism, patient-clinician concordance, and high-quality clinical care. Recommendations were presented within the 4 domains of racism: intrapersonal, interpersonal, structural, and institutional. ConclusionsRacism experiences worsen child biological, psychological, and behavioral functioning, yet research is lacking on how health care professionals may best support pediatric patients experiencing racism. Study findings suggest opportunities for providing safer and more supportive health care spaces for youth experiencing racism.

EXPLORING AI ELDERS’ CULTURAL PERCEPTIONS OF DISASTERS AND THE ROLE OF GENERATIVITY IN PREPARING FUTURE GENERATIONS

Abstract Natural and man-made disasters have a great impact on human health, especially for AI Elders. As keepers of cultural and community knowledge, AIAN Elders also serve as guides on how to best support their communities. This study focuses on a Midwestern Tribe’s cultural perceptions of disaster management, specifically being generative, or passing down disaster management knowledge and practices to future generations. In-person semi-structured interviews were conducted with eighteen Elders from the Midwestern Tribe. Recordings were transcribed, de-identified, and coded thematically using an interpretive phenomenological analysis approach. The study received approval from the Tribe’s Department of Emergency Management and the interview guide was reviewed and approved by a Community Advisory Board of six individuals. Elders described past experiences with natural and man-made disasters, including what they did before, during, and after disasters. Elders also explained how people cared for one another, including the importance of interconnectedness with all beings, caring for grandchildren, and the role of the Tribal Government in disaster management. Elders also described how culture shaped disaster management practices, such as traditional practices to follow during a storm, and the important role of Elders in teaching communities what to do when disasters happen. Exploring the role of generativity in passing on disaster-related information is one way to learn how Elders’ knowledge is valued by the community. Findings suggest that Elders can provide important guidance to Tribal governments and public health systems to determine effective disaster management strategies for AIAN communities.

EFFECTS OF BEING FORGOTTEN ON ADULT CHILDREN OF MOTHERS WITH DEMENTIA

Abstract Mothers with dementia sometimes do not recognize their adult children. Yet, research on the effects of being forgotten by a mother with dementia is scarce. Object relations theorists posit that healthy development of a child’s sense of self is linked to being remembered by a primary caretaker. Further, being held in mind by a primary caregiver allows the child to form a cohesive identity. It is unclear how adult children’s identities are impacted by being forgotten by their mothers. To investigate this phenomenon, this qualitative study explored the effects of being forgotten on adult children in the context of dementia. The aims were: 1) to develop an in-depth understanding of what it means for adults to be forgotten by their mothers with dementia, and 2) to gain insight on the effect of being forgotten on adults’ identities. Data were gathered through 12 interviews. Data was analyzed following an interpretative phenomenological analysis approach. Preliminary findings suggest adult children of mothers with dementia experience being forgotten as both a threat to their identity and forewarning of continued poor disease outcomes. The following themes illustrate this: 1) The sense that one’s existence was not important enough to be remembered, 2) Feelings of failure due to the inability to spark recognition of themselves in their mother’s mind, and 3) Dread for the disease progression. While research regarding adult children of parents with dementia largely focuses on practical aspects of caregiving, clinical implications of these findings suggest that this population suffers silently from being forgotten.

Preparedness for the transition to medical registrar from senior house officer-What's the problem?

Transitions in clinical training are a hallmark in medical trainee's careers. The transition from senior house officer (SHO) to the role of medical registrar is often viewed as one of the most challenging, but to date, there is little research exploring why the transition is proving problematic for so many learners. The aim of this study was to explore the experiences of trainees preparing to make this transition. Using an interpretative phenomenological analysis (IPA) approach, this qualitative study employed semi-structured interviews to explore the lived experiences of transition in a purposive sample of trainees on the cusp of transition from SHO to registrar or who were in their first year of being a medical registrar. Interviews were recorded, transcribed verbatim and analysed using an IPA approach. Six trainees participated in this study, four of whom were currently in SHO positions, with the remaining two in their first year of medical registrar. Two main themes emerged from data-perception of the medical registrar and barriers in transition. The role of the medical registrar was perceived to represent a strong leadership role, with barriers created due to increasing expectations, lack of support and uncertainties regarding the job. The role of the medical registrar is a challenging one, representing periods of uncertainty, increased expectations and reduced supports. Within this, there is potential to further support SHOs in transitioning to the role of medical registrar.

Social Entrepreneurship Education for Orphans Through Chicken Farming : A Case Study from Yogyakarta

This research aims to explore in depth the social entrepreneurship education activities of Omah Pak Cilik, the Gerakan Kebaikan community in livestock-based entrepreneurial activities for orphans, including constructing the meaning and reality behind the emergence of these programs and collaboration. The research method used was phenomenological with a qualitative approach. For collecting the data, this research used interviews, direct observation, and directed dialogue with the founder of Omah Pak Cilik, the Actor for the Good Movement, and Orphans. The validity of the research data was obtained through triangulation and then analyzed using the Interpretative Phenomenological Analysis (IPA) approach. This study found that 1) Omah Pak Cilik cooperated with the kindness movement community to organize a KUB Chicken Farm business to solve economic problems, starting with providing understanding related to entrepreneurship to orphans so that an entrepreneurial spirit grows, 2) Orphans were given education and training related to business management and sales skills. 3) The result changed the mindset of orphans for entrepreneurship, improving the economy, and establishing partnerships.