Narrative Case Research Articles

Regulation as a force for hybrid organization: evidence from the Bonneville Power Administration (1980–2012)

PurposeThis case study highlights state-logic influence on hybrid organizations and institutionally complex environments through acts of regulation (and deregulation).Design/methodology/approachThis study presents a 30-year narrative case focused on the significant social achievements of the Bonneville Power Administration within the Northwest United States. It combines the analysis of historical documentation, annual reports issued by the organization and interviews with firm management to observe the wax and wane of regulatory influence through time.FindingsThe presented case suggests two ways regulation projects state-logic influence onto hybrid organizations. First, it imposes a “floor” level of baseline social activity that must be met despite pressure from market logic stakeholders. Second, it imposes formal administrative procedures that require interaction with, and often approval from, key social stakeholders. Administrative procedures provide a series of public forums used to promote additional social resource allocation in excess of baseline regulatory mandates.Research limitations/implicationsA narrative case covering a 30-year period will by necessity have to prioritize breadth of analysis over depth. This is a limitation of the analysis presented, but it also provides an opportunity to observe the oscillating impact of state and market-logic influence through time.Originality/valueThe study findings have several implications for the growing accounting literature on institutional complexity and hybrid organization. First, the authors highlight the ways regulation shapes institutionally complex spaces and, as a result, the hybrid organizations formed within those environments. Second, the exogenous nature of regulatory mandates indicate hybrid firms could emerge as both a voluntary and an involuntary adaptation to institutionally complex environments. Finally, this study highlights opportunities to further one’s understanding how state logics influence hybrid organizations through the study of state-owned enterprises (SOEs).

Lost voices part 1: A narrative case study of two young men with learning disabilities disclosing experiences of sexual, emotional and physical abuse

Accessible Summary Two young men who have learning disabilities were students at a college. While they were there, they were sexually abused by people who were meant to care for them. When they tried to tell people, some people would not listen. Some people listened but could not understand them. They became mentally ill because of the abuse. Then, some people started to listen and help them tell their stories. Then, the police and the courts said that the two young men could not give evidence in court because of their learning disabilities. This paper matters because it writes about ways to protect people with learning disabilities from people who abuse them. We need to try and help people who have been abused to tell their stories. We need to make sure those stories are listened to. AbstractTwo young men disclosed emotional, sexual and physical abuse while attending college and living with Shared Lives carers in the UK. This paper provides a narrative account of the period when the two men were exposed to the abuse, the disclosures, the investigation and the legal and safeguarding investigation outcomes. A second paper describes the therapeutic response and outcomes for the men. A review of the literature on abuse and learning disabilities highlights the difficulties in conducting research in this area. Authors find significant barriers exist to disclosing abuse and to being believed. Prosecutions are rare despite evidence that abuse may be widespread towards people with learning disabilities. This paper considers the narrative experience of the two young men, the barriers they faced to being heard and believed and how their personal accounts were discounted and eventually lost to the investigation. Lessons for practice are considered for learning disability mental health and social care professionals, education, police and legal services. Further research suggestions are made.

Military integration and intelligence capacity: informational effects of incorporating former rebels

ABSTRACT Military integration seeks to improve counterinsurgency and peacebuilding outcomes by incorporating former rebels into preexisting or new state security forces during or after civil wars. While peacebuilders continue to promote military integration, there is mixed evidence about its effectiveness and the mechanisms through which it affects counterinsurgency and peace duration. One underexplored mechanism is the effect of military integration on intelligence capacity and the information available to security forces. Information is key to successful counterinsurgency and peacebuilding efforts, and I argue that military integration of ex-rebels can improve intelligence capacity by providing gains in knowledge of human and physical geography, access to preexisting social networks and informants, and knowledge of the relative effectiveness of government and rebel tactics. I illustrate these improvements with evidence from conflicts across time and space and brief case narratives from the Philippines, Uganda, and Rwanda. I conclude by discussing policy implications, cases of unsuccessful integration and negative effects on intelligence, and questions for future research on the intelligence aspect of military integration.

Economic Determinants of Sexual Debut among In-School Adolescents in Rural Kenya

Most people are driven by material gains and adolescents are no exception. We set to determine the influence of economic factors on sexual debut among in-school adolescents through the lens of the Marxist theory. A mixed-method design, quantitative and qualitative data collection methods, was used. Three sets of adolescents were targeted in the study: mixed-sex day secondary schools, girls-only boarding and boys-only boarding secondary schools, where, a sample of 400 (200 females and 200 males) aged 14 - 18 years were drawn for purposes of a quantitative survey. Focus group discussions (FGDs), Case Narratives and Key Informant interviews were used to collect qualitative data. The results indicate that 61% had ever had sex, more students (63.5%) in mixed day schools had ever had sex compared to single sex schools (58.5%). Male students were more likely to have ever had sex compared to female students [OR = 1.59 (95% CI 0.83, 1.85), p = 0.03]. Most of the students got spending money (89%) and gifts (60%) from their parents. However, those receiving gifts from boy/girlfriends had four times the odds of ever having sex (OR 4.04, 95% CI 1.36 - 11.97). Qualitative data on the other hand revealed that the need for money for basic needs and also for pleasure played a significant role in early sexual debut among adolescents. In conclusion, the majority of the in-school adolescents in Nyamira county had ever had sex. Most students got sustenance from their parents, implying a high likelihood of a pluralist environment where peer pressure, cultural norming and popular culture on social and mainstream media also contributed to early sexual debut. Those with money were seen to have power over another’s autonomy and a person’s economic environment was seen to influence their decisions collaborating the Marxist theory.

A Gay Epidemiologist and the DC Commission of Public Health AIDS Advisory Committee.

Based upon the lead author's deep personal and professional experience, this case narrative illustrates the importance of engagement between public health practitioners and members of affected populations and their advocates. The case underscores the need to build strong coalitions to address serious public health and social issues. It also illustrates how decisions about control groups in research raise ethical issues. In addition, the case illustrates the reality that public health and social services are sometimes inadequate in the face of dire circumstances. Justice in public health has both a distributive aspect (how to allocate limited resources and distribute potential benefits as fairly as possible) and a procedural dimension (ensuring public participation, especially of those most affected). Frameworks for public health ethics, which post-date the events detailed in the autobiographical case narrative, highlight both distributive justice and procedural justice.

Partnered innovation to implement timely and personalized care: A case study.

Understanding how to translate research discoveries into solutions for healthcare improvement is a priority of NIH-funded Clinical and Translational Science Awards (CTSA). This study, supported by one CTSA, aims to capture one process of shaping and implementing innovations to advance the timeliness and patient-centeredness of cardiovascular care. Specifically, we sought to understand a partnership between a private digital health startup company, a university innovation lab, and an academic health system's cardiology program pursuing this goal. The collaboration proceeded through clear phases to address the questions and challenges: problem definition, exploration and formalization of the partnership, innovation co-creation and pilot test, and scale-up planning. Phases were punctuated by key decisions, such as forming the partnership, negotiating terms of the partnership, iterating form and features of the innovation, and exploring sufficiency of its value-add for scale-up and sustainment. Key implementation concepts were apparent, including implementation strategies (e.g., champions and iterative trialing) and the implementation outcomes of acceptability, sustainment, and scale-up. Participants identified potential risks of collaboration, reflected on their co-creation process, and the value of engaging stakeholders in innovation design. Findings may inform subsequent collaborations between innovators and translational researchers. We conducted a case study to understand the partnership; characterize the questions they pursued, their decision points, information and data sources; and identify the challenges and risks. Data were collected through a series of four focus groups with members of each partnering organization. A transdisciplinary research team iteratively worked to condense and synthesize data from audio recorded transcripts into a case narrative.

Labor Economics and Career Development in the Context of Globalized World

Research background: The paper uses labor economics and career theory to design an integrative approach to career research focusing on new occupations and career development. Purpose of the article: The purpose of this paper is to call for an integrative approach to career research aiming to characterize labor market trends and discuss perspectives on careers using highly skilled migrants from Central and Eastern Europe as a case. The paper discusses the specificity of career development in the context of the Industry 4.0. and an integrative approach vs. other approaches. Methods: The methodology insists on several ways that enable a triangular analysis. The research combines in-depth-analysis of bibliographic data in the Web of Science database, unstructured interviews with top managers/co-owners of multinational companies in August and September 2020 as a base for writing two narrative cases. Findings & Value added: Findings show the tendency of career theory to provide a narrow view of a career. They highlight the trends in considering the wide variety of career situations, which results from the fact that careers locate in time and space. The paper provides examples to explore career differences better and seek for alternative explanations to career experiences. Because career dynamics are influenced by individual characteristics and career development practices, a more integrative approach to career research must address the complexity of labor markets. The added value is to encourage discussions about career theory focusing on a wide range of issues.

Low-dose systemic thrombolysis in patient with recent major abdominal surgery and high-risk pulmonary embolism: Case report and narrative review

Introduction: Systemic thrombolysis is the treatment of choice for hemodynamically unstable patients with acute pulmonary embolism (PE) while for the intermediate-high risk ones the possibility of severe bleeding seems to outweigh the benefits. Surgical or percutaneous therapy is an option in case of contraindication/failure of fibrinolysis but they are not available in every hospital.

Small and Medium Enterprises (SMEs): Key to Socio-Economic Development of Nigeria

In Nigeria, as in many other developing and emerging economies, Small and Medium Enterprises (SMEs) contribute to their socio-economic development and growth hence, successive governments have invested resources in intervention programs aimed at stimulating the sector to achieve sustainable development. The main objectives of the study are to; review the role of SMEs to the socio-economic development of Nigeria, identify current government efforts and challenges to stimulating SMEs performance especially as it relates to wealth creation and employment generation. The study found that; SMEs play a key role in socio economic development of the country especially in the area of employment generation and wealth creation. However, there are prevailing economic and political conditions that have not given room for SMEs to thrive, as evidenced in the internal and external challenging factors they are currently facing in the country despite the enormous government intervention initiatives. It is recommended that government should reform the implementation of these initiatives, ensure programmes continuity due to change on government, fight corruption and insecurity, improve on the business environment and evolve youth re-orientation programme to cause them to embrace entrepreneurship. The methodology adopted for this work is narrative textual case study.

Neuroprogression in post-traumatic stress disorder: a systematic review.

Introduction Neuroprogression has been proposed as the pathological rewiring of the brain that takes place in parallel with clinical and neurocognitive deterioration in the course of psychiatric disorders. This study aims to review the biological underpinnings and clinical outcomes related to neuroprogression in post-traumatic stress disorder (PTSD).Methods We performed a systematic review by searching PubMed, Embase, and Web of Science for articles published between January 1, 1960, and January 6, 2020. Inclusion criteria were met when articles assessed brain changes, neurocognition, functioning, inflammation, oxidative stress, and neurotrophins in patients with PTSD. Narrative review articles, case reports, and preclinical studies were excluded.Results A total of 965 abstracts were identified and 15 articles were included in our systematic review. It seems that for a subset of patients whose symptoms worsen or are maintained at a high intensity there is a progressive change in the frontal lobe, especially the prefrontal cortex, and worsening of both neurocognition (verbal memory and facial recognition) and functioning (physical, psychological, social and environmental).Conclusion Although current findings associate progressive reduction in frontal lobe size with neurocognitive impairment, further research is needed to characterize PTSD as a neuroprogressive disorder.

Globalization, Institutions, and Ethnic Inequality

AbstractRecent research has shown that inequality between ethnic groups is strongly driven by politics, where powerful groups and elites channel the state's resources toward their constituencies. Most of the existing literature assumes that these politically induced inequalities are static and rarely change over time. We challenge this claim and argue that economic globalization and domestic institutions interact in shaping inequality between groups. In weakly institutionalized states, gains from trade primarily accrue to political insiders and their co-ethnics. By contrast, politically excluded groups gain ground where a capable and meritocratic state apparatus governs trade liberalization. Using nighttime luminosity data from 1992 to 2012 and a global sample of ethnic groups, we show that the gap between politically marginalized groups and their included counterparts has narrowed over time while economic globalization progressed at a steady pace. Our quantitative analysis and four qualitative case narratives show, however, that increasing trade openness is associated with economic gains accruing to excluded groups in only institutionally strong states, as predicted by our theoretical argument. In contrast, the economic gap between ethnopolitical insiders and outsiders remains constant or even widens in weakly institutionalized countries.

Recollections of Who We Were: Nostalgic Retrospective Perceptions of Japanese Society Following a Visit to a Shōwa‐era Museum

AbstractUnderstanding visitors' retrospective perceptions in museums as they connect objects with their personal identities and life stories, as well as their collective social identities, is of considerable interest to the museum field. This study employed a multiple case narrative methodology to understand the common perceptual themes of post‐World War II Japanese society between 1955 and 1970 (Shōwa 30–45) held by older Japanese adults following their visit to a Shōwa‐era social history museum. From an inductive analysis of n = 29 face‐to‐face interviews, five sustaining characteristic themes emerged which were later interpreted through the historical backdrop of the period together with Carstensen's socioemotional selectivity theory (SST) to provide deeper interpretation of the themes. Through their museum experiences, the visitors recalled a society characterized by; (1) close human relationships; (2) strong values and morals; (3) freedom, openness, and peace; (4) struggles and poverty, which could be overcome with patient effort; and, (5) hopes and dreams. These themes were key to the visitors' own identity and values – both personal and collective. This study contributes to a broader understanding of the power of museum experiences to evoke strong nostalgic recollections by Japanese citizens of their unique personal and collective identities, and the characteristics their retrospective memories from the perspective of the present day vantage point. It speaks to the power of the museum, not as a learning or knowledge acquisition experience, but rather in its power to affirm both personal and collective identity and the values that were retrospectively important for these visitors looking back.

The learning experience of a visually impaired learner at a higher education institution regarding emergency blended teaching and learning

Disability or impairment in general does not deprive one of the rights to basic human needs and care. However, often people with disabilities encounter barriers such as unfriendly infrastructure to access basic services such as education and health care. In this paper the authors explore the experiences of learners with visual impairment on the implementation of blended learning to thwart the challenges of COVID-19 in institutions of higher education. This narrative case study employed a telephonic semi-structured interview guide to collect data on a visually impaired learner enrolled with the University of Eswatini (UNESWA). There were two research questions that the study sought answers for: what was the learning experience of a visually impaired learner regarding blended learning during COVID-19? And, how did a visually impaired learner cope academically during the emergency blended learning and teaching? The study found the following: a) incompatible devices; b) poor internet connection; c) challenges to log onto and manoeuvre Moodle and d) a need for a step-by-step guide to help the visually impaired learner to master the Moodle platform. Thus, the study recommends a) awareness creation on disability issues; b) installation of JAWS software in the computer labs; c) intensive Moodle training for visually impaired learners; d) a need for a resource centre that caters for different impairments, e) technologically savvy lecturers to troubleshoot and f) institutional opportunities for learners to procure affordable devices.

Discourse of Sexuality as a Way of Signifying Practices and Identities

The study analyses the current state of sexuality research in post-classical science. The social dimension of sexuality as a socio-cultural transformation is considered, in which the postmodern polyphony of social practices and the phenomenon of sexual identity are analysed. It is emphasised that with the transition of sexuality from the private to the public sphere, research in psychology, sociology, and philosophy became relevant; the liberalisation of sexual behaviour has intensified discussions related to identity and gender. The purpose of the study is to analyse the discourse of sexuality as a way of defining the semantic polyphony of discursive practices of partnership and sexual identity. Discursive representation of sexuality in the studied practices was carried out based on the results of qualitative analysis of text fragments of narrative interviews and cases from the Internet. The strategy of empirical research is based on the use of a discursive approach, the basis of which provides a socioconstructivist view of social reality. It is substantiated that in the process of constructing practices the discourse of sexuality activates the mechanism of semiotisation of sexuality, which is interpreted as free, open self-disclosure of sexuality. Semiotisation of sexuality enables an individual to objectify his or her experience of constructing discursive practices and to define his or her sexual identity in them. It follows that the discourse of sexuality affects the construction of partnership practices and the constitution of sexual identity. A set of signs of sexuality that objectify the categories: value; functionality; sexuality; relationships; meaning/motive; identity. It is concluded that the discourse of sexuality is formed by a combination of social and personal meanings that denote discursive practices and identities. The practical significance of the study is that the results obtained can be used in further research on the role of sexual discourse in the disclosure of female/male sexuality in partnership practices

Stories of the Experience of Searching for Long-Term Care and Eldercare: Case Study and Narrative Perspectives

With over 40 million individuals aged 65 years and older in the US, and by 2050 rising to an estimated 89 million, age matters, driving an increased need for long-term care/eldercare. Coupled with the higher costs of care, the search for long-term care/eldercare services can be a difficult prospect for adult children decision-makers. We present the experiences of adult children decision-makers in the US, using two methodological approaches: narrative and case study using autoethnography. In a narrative inquiry of 9 caregivers responsible for making long-term care/eldercare decisions for their parent(s) the zoom model was applied to conduct the analysis. Findings suggest that decision-makers have a strong sense of duty towards helping their loved ones find long-term care solutions. Decision-makers searched for many types of care solutions ranging from home health care to nursing homes. The experiential response most consistently stated by the participants was stress. These results are augmented by an autoethnographic case study in “six acts” illustrating how sense of agency in the caregiving journey can be enhanced. Participants with industry experience had a minimal advantage over those with no experience when it came to navigating the search for long-term/eldercare. We highlight why stories of family search for long-term care/eldercare matter, and how they can be leveraged for fundraising, advocacy, and healing. Implications for policy, research, education and practice are highlighted.

Estimating the Frequency of Suicide Related to Driving Cessation Among Older Adults: A Data Science Approach

Up to 35% of older adults in the United States engage in partial to complete driving cessation. Suicide risk is highest among older adults, and driving cessation can precipitate psychosocial changes linked with elevated risk of suicide, such as loss of independence, mobility, and socialization. Little is known about the association between suicide and driving cessation among older adults. We developed a supervised machine learning natural language processing algorithm to estimate the frequency of and characterize suicides associated with driving cessation from restricted-access case narratives in the National Violent Death Reporting System (NVDRS, 2003-2015) from suicides and undetermined deaths among adults 55 years and older in 27 states. Among 47,759 decedents, preliminary results identified 972 deaths associated with driving cessation, with a mean age of 71.4, 91.5% White, and 78.3% Male. 13.8% of the decedents of driving cessation-associated suicide had a crisis contributing to the suicide within 2 weeks of death. This analysis assesses the relationship between contextual geographic features such as population density and the distribution of driving cessation-associated suicides across the US. Government and clinical stakeholders should invest in public transportation infrastructure catered to older adults and implement policies to reduce the burden of driving cessation. Increased accessibility of technological innovations such as self-driving cars may also enhance quality of life for a growing older adult population.

Learning from child welfare case narratives: A directed content analysis of indicators for human trafficking

Human trafficking involves the use of force, fraud, or coercion to facilitate commercial sex, labor, involuntary servitude, peonage debt bondage, or slavery. Youth within the child welfare system are considered to be at risk for sex trafficking victimization. Additionally, the experiences of youth in the child welfare system, particularly abuse and neglect, have been identified as risk factors for youth sex trafficking. One way to further address human trafficking is by understanding what vulnerabilities may put individuals at risk of being a victim of human trafficking. This study analyzed indicators that are believed to increase the risks for sex trafficking among youth in the child welfare system. A qualitative directed content analysis was conducted to analyze child welfare case narratives (N = 167) to examine the extent to which common vulnerability factors for human trafficking (e.g., trading sex for things of value, unwanted physical contact, previous sexual abuse) were present in substantiated child welfare cases flagged for human trafficking. A total of 75 unique items across 10 assessments were used to create the deductive codebook based on existing human trafficking screening tools (e.g., Trafficking Victim Identification Tool, Adult Trafficking Screening Tool). Findings demonstrated that although there was wide variance across narratives, sexual abuse and sex exchange were the most common vulnerability factors expressed in the case intake narratives. Further, the vast majority of screening variables were not represented in the narratives. These findings call for the use of standardized screening tools, as well as a universal definition of human trafficking, in the child welfare system.

An overview of and approach to selecting appropriate patient representations in teaching and summative assessment in medical education.

Medical education has a long tradition of using various patient representations in teaching and assessment. With this literature review we aim, first, to provide an overview of the most important patient representations used to teach and assess clinical skills, considering in particular “summative exams” that have a pass or fail outcome; second, to provide arguments for choosing certain patient representations; and third, to show the advantages and limitations of different patient representations, especially simulated patients (SPs) and real patients (RPs). Typical patient representations include case narratives, anatomical models, simulators and mannequins, as well as SPs and RPs. The literature indicates that there are multiple ways of using various patient representations in teaching and that the intended didactical purpose informs the choice of representation. Early in the educational programme, even low-fidelity patient representations can be a good fit for assessment purposes if chosen to match the educational level. The use of RPs in summative, high-stakes assessments (exams with particularly important consequences for the examinee) is limited for methodological and ethical reasons. The methodological implementation of summative exams also entails specific challenges, such as ensuring measurement reliability and fairness towards the examinees. Carefully prepared, SPs can perform their roles with a sufficient degree of authenticity, making summative exams more manageable, and imposing no strain or risk on RPs. The ongoing debate concerning the use of SPs and RPs in summative assessment highlights perceived limitations of SPs in relation to RPs that are often not supported by research. Evidence shows that SPs, in combination with additional simulation modalities as needed, represent the first choice for summative clinical assessment. We also consider the strengths and limitations of this review and reflect on the applicability of our findings. We conclude that in order to select the right patient representations in clinical teaching and/or assessment, a number of perspectives must be considered: (i) the learning goals, aligned with the stage of study, (ii) the corresponding requirements of the clinical task itself (e.g., performing a phlebotomy or a communication task), (iii) the level of authenticity required and (iv) the resources needed, taking patient safety and feasibility into consideration.

Melanated minds and diasporic bodies: Womanist curricular praxis as radical intervention in study abroad

While university-based study abroad programs have become a core component of multicultural education, I argue that in many ways the dominant model of study abroad is rooted in a white masculinist episteme predicated on anthropological consumption of the “Other” without, and largely opposed to, meaningful examinations of the self. The present study is a critical exploration of a study abroad program created by Black women for students of African descent. Through two conceptual frameworks—Black Atlantic Consciousness and Womanism—I note the ways in which the study abroad program departed sharply from traditional programming found at historically white institutions. Utilizing narrative thematic case study analysis, findings reveal both the program designers’ goals and intentions for this study abroad program, as well as the ways those goals translated into pedagogical and curricular praxis. Three subthemes comprise the larger theme related to goals and intentions: self-awareness and communal awareness, African diasporic gendered identity, and deconstruction with student support. Four subthemes organize the theme curricular and pedagogical praxis: spiritually detoxing experiences, Afrocentric role-playing and storytelling/making, integration of counseling and emotional support resources, and institutional subversion. The article concludes with reflections on and implications for culturally relevant study abroad programming.

The language of mental images: Characterizing hippocampal contributions to imageable word use during event construction

Accumulating evidence suggests that the hippocampus plays a critical role in the creative and flexible use of language at the sentence or discourse level. Yet it is currently unclear whether the hippocampus also supports language use at the level of single words. A recent study by Hilverman et al. (2017) found that amnesic patients with hippocampal damage use less imageable words when describing autobiographical episodes compared to healthy controls, but this deficit was attributed to patients' deficits in episodic memory rather than impairments in linguistic functions of the hippocampus per se. Yet, in addition to affecting word use by way of its role in memory, the hippocampus could also impact language use more directly. The current study aimed to test this hypothesis by investigating the status of imageable word use in amnesia during two different types of language production tasks. In Experiment 1, participants constructed narratives about events depicted in visually presented pictures (picture narratives). In Experiment 2, participants constructed verbal narratives about remembered events from the past or simulated events in the future (past/future narratives). Across all types of narratives, patients produced words that were rated as having similar levels of imageability compared to controls. Importantly, this was the case both in patients' picture narratives, which did not require generating details from episodic memory and were matched to those of controls with respect to narrative content, and in patients’ narratives about past/future events, which required generating details from memory and which were reduced in narrative content compared to those of controls. These results distinguish between the quantity and quality of individual linguistic details produced in amnesia during narrative construction, and suggest that the use of imageable linguistic representations does not depend on intact episodic memory and can be supported by regions outside the hippocampus.