Qualitative Empirical Studies Research Articles

Identity, agency and institutional work in higher education: a qualitative meta-synthesis

PurposeThe purpose of this paper is to synthesize a body of research addressing changes in academic identity brought on by neo-liberal university management while proposing a new interpretation based on the institutional work theory and a relational approach to agency.Design/methodology/approachThe authors analyzed 19 qualitative empirical studies regarding the impact of new public management policies on academic identity within universities from different countries to support a qualitative meta-synthesis.FindingsThe meta-synthesis established a classification of work identity and self-identity that reflects variable but globally difficult experiences with the universities’ neo-liberal management. The results also indicate that, paradoxically, academics contribute to the perpetuation of managerialism through protection strategies and institutional maintenance work while acknowledging their painful effects on their identity. Despite the control and monitoring measures put in place by university administrations, academics have assumed a pragmatic approach to identity by using the prevailing spaces of autonomy and engaging in constant self-questioning. Those involved could make better use of these free spaces by adopting projective agency, that is by expanding the areas of support, collaboration and creativity that, by their own admission, make up the academic profession.Originality/valueThis meta-synthesis sheds light on the limits of current academic identity research while advancing studies conducted on institutional work, primarily by highlighting the type of agency used by actors during institutional change; at a practical level, this research promotes discussion on the manner in which academics could use their agency and reflexive skills by pushing their institutional work surrounding identity recreation further.

Políticas públicas de educação do campo: Revisão sistemática das publicações brasileiras

Esta pesquisa objetivou investigar as características das publicações contemporâneas sobre políticas públicas de educação do campo, o que permitiu monitorar os avanços científicos da área e os assuntos abordados pela academia em periódicos brasileiros. Para tanto, utilizou-se de revisão sistemática de literatura na base de dados “Periódicos Capes” através dos descritores “educação do campo” e “políticas públicas”, com data “2009/2017”. Os critérios para inclusão na análise foram metodologia claramente definida e possibilidade de enquadramento temático. Ao todo, 93 trabalhos foram analisados, 52 selecionados para análise descritiva geral e 10 discutidos em profundidade. Constatou-se a predominância de estudos de natureza qualitativa, de caráter empírico e a tendência temática de maior representação foi a “trajetória e contexto regional ou microlocalizado”, com 16 (31%) artigos estudados. Assim, foi possível verificar uma forte tendência para a publicação de artigos que esclareçam fenômenos contemporâneos aplicados à realidade do cidadão do campo.

The role of the dietitian in the management of malnutrition in the elderly: A systematic review of current practices.

The prevalence of age-related malnutrition is increasing in almost all Western countries. Because of their expertise, dietitians should have a central role in the management of malnutrition. This review aimed to synthesise the literature on the role of the dietitian in the management of malnutrition in the elderly in comparison with other health professionals. In November 2018, a search of Embase, Medline Ovid, Cinahl Ebscohost, Cochrane Central, Web of Science and Google Scholar was undertaken using 'dietitian', 'elderly' and 'malnutrition' as the main search terms. Qualitative and quantitative empirical research studies that focussed on the role of dietitians as the (main) subject of the study were included. Data extraction and data synthesis were performed by the three authors using a thematic synthesis approach. Three themes emerged from the coding and synthesis of the 21 included studies. The first theme demonstrates that other health professionals' time for, and knowledge of, screening policies negatively affects the role of the dietitian. The second theme demonstrates that the importance of nutritional care is acknowledged. However, this does not always imply familiarity with dietetics nor does it always mean that other health professionals think involving dietitians is worth the effort. The third theme demonstrates that issues of workload appeared to be especially important in crossing or guarding role boundaries. The role of dietitians in managing age-related malnutrition is not always clear and coherent. Therefore, how dietitians shape their role to provide optimal management of malnutrition in the elderly is open to debate.

Multiple Stakeholders’ Perspectives of Involuntary Treatment Orders: A Meta-synthesis of the Qualitative Evidence toward an Exploratory Model

Involuntary treatment orders (ITOs) represent coercive leverage for treatment adherence against the will of individuals incapable of providing consent. ITOs have failed to demonstrate benefits in quantitative studies, but little attention has been paid the growing body of qualitative evidence on ITOs. The current study is an interpretative meta-synthesis designed to integrate qualitative evidence and enhance our understanding of stakeholders’ perspectives (service users, relatives, professionals, psychiatrists) of ITOs in the context of mental health care. Forty-four studies met the following inclusion criteria, peer-reviewed empirical qualitative studies, and focus on perspectives and experiences of ITOs in a mental health context. Themes resulting from the analysis are: an ITO as leverage to manage compliance and risk; legal concerns; learning to play the game; building a therapeutic relationship in a coercive context; positive and negative impacts of ITOs; family involvement; and discharge. Based on these themes, an exploratory model of ITOs is proposed.

Designing in-depth semi-structured interviews for revealing meaning reconstruction after loss

The recent upsurge in the use of qualitative empirical studies, aiming to provide a deeper understanding of human reactions to loss, requires a methodological account of how to conduct better qualitative research with regard to data collection. This paper offers six general interview guidelines aimed at assisting researchers to achieve quality interviews in qualitative bereavement studies, based on the theoretical framework of meaning (re)construction in loss.

Human factor in software requirements engineering: Preliminary review of qualitative empirical studies

Software requirements engineering is a field insoftware engineering that highly depends on human factor sinceit includes knowledge and skills from domain of softwareengineering and from the domain of problem where software willbe used, but also from both organizational and social sciencesaspects. Therefore, researching human factor is very importantfor understanding industrial practice and identifyingimprovement directions. Deeper understanding of human factorinfluence on software requirements engineering practice assumesthe use of qualitative research methods. This paper presents apreliminary review of literature that investigates human factor insoftware requirements engineering by using qualitative researchmethods. The presented study contributes to the research field bypresenting a clearly defined process of preliminary literaturereview, and as a pilot study, it will be used for planning detailedand systematic literature review.

Patient prioritization tools and their effectiveness in non-emergency healthcare services: a systematic review protocol

BackgroundWaiting lists should be managed as fairly as possible to ensure that patients with greater or more urgent needs receive services first. Patient prioritization refers to the process of ranking referrals in a certain order based on various criteria with the aim of improving fairness and equity in the delivery of care. Despite the widespread use of patient prioritization tools (PPTs) in healthcare services, the existing literature on this subject has mainly focused on emergency settings. Evidence has not been synthesized with respect to all the non-emergency services.MethodsThis review aims to perform a systematic synthesis of published evidence concerning (1) prioritization tools’ characteristics, (2) their metrological properties, and (3) their effect measures across non-emergency services. Five electronic databases will be searched (Cochrane Library, Ovid/MEDLINE, Embase, Web of Science, and CINAHL). Eligibility criteria guiding data selection will be (1) qualitative, quantitative, or mixed methods empirical studies; (2) patient prioritization in any non-emergency setting; and (3) discussing characteristic, metrological properties, or effect measures. Data will be sought to report tool’s format, description, population, setting, purpose, criteria, developer, metrological properties, and outcome measures. Two reviewers will independently screen, select, and extract data. Data will be synthesized with sequential exploratory design method. We will use the Mixed Methods Appraisal Tool (MMAT) to assess the quality of articles included in the review.DiscussionThis systematic review will provide much-needed knowledge regarding patient prioritization tools. The results will benefit clinicians, decision-makers, and researchers by giving them a better understanding of the methods used to prioritize patients in clinical settings.Systematic review registrationPROSPERO CRD42018107205

Family involvement in managing medications of older patients across transitions of care: a systematic review

BackgroundAs older patients’ health care needs become more complex, they often experience challenges with managing medications across transitions of care. Families play a major role in older patients’ lives. To date, there has been no review of the role of families in older people’s medication management at transitions of care. This systematic review aimed to examine family involvement in managing older patients’ medications across transitions of care.MethodsFive databases were searched for quantitative, qualitative and mixed methods empirical studies involving families of patients aged 65 years and older: Cumulative Index to Nursing and Allied Health Literature Complete, Medline, the Cochrane Central Register of Controlled Trials, PsycINFO, and EMBASE. All authors participated independently in conducting data selection, extraction and quality assessment using the Mixed Methods Appraisal Tool. A descriptive synthesis and thematic analysis were undertaken of included papers.ResultsTwenty-three papers were included, comprising 17 qualitative studies, 5 quantitative studies and one mixed methods study. Families participated in information giving and receiving, decision making, managing medication complexity, and supportive interventions in regard to managing medications for older patients across transitions of care. However, health professionals tended not to acknowledge the medication activities performed by families. While families actively engaged with older patients in strategies to ensure safe medication management, communication about medication plans of care across transitions tended to be haphazard and disorganised, and there was a lack of shared decision making between families and health professionals. In managing medication complexity across transitions of care, family members perceived a lack of tailoring of medication plans for patients’ needs, and believed they had to display perseverance to have their views heard by health professionals.ConclusionsGreater efforts are needed by health professionals in strengthening involvement of families in medication management at transitions of care, through designated family meetings, clinical bedside handovers, ward rounds, and admission and discharge consultations. Future work is needed on evaluating targeted strategies relating to family members’ contribution to managing medications at transitions of care, with outcomes directed on family understanding of medication changes and their input in preventing and identifying medication-related problems.

Facilitating informed choice about non-invasive prenatal testing (NIPT): a systematic review and qualitative meta-synthesis of women\u2019s experiences

BackgroundNon-invasive prenatal testing (NIPT) can be used to accurately detect fetal chromosomal anomalies early in pregnancy by assessing cell-free fetal DNA present in maternal blood. The rapid diffusion of NIPT, as well as the ease and simplicity of the test raises concerns around informed decision-making and the potential for routinization. Introducing NIPT in a way that facilitates informed and autonomous decisions is imperative to the ethical application of this technology. We approach this imperative by systematically reviewing and synthesizing primary qualitative research on women’s experiences with and preferences for informed decision-making around NIPT.MethodsWe searched multiple bibliographic databases including Ovid MEDLINE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and ISI Web of Science Social Sciences Citation Index (SSCI). Our review was guided by integrative qualitative meta-synthesis, and we used a staged coding process similar to that of grounded theory to conduct our analysis.ResultsThirty empirical primary qualitative research studies were eligible for inclusion. Women preferred to learn about NIPT from their clinicians, but they expressed dissatisfaction with the quality and quantity of information provided during counselling and often sought information from a variety of other sources. Women generally had a good understanding of test characteristics, and the factors of accuracy, physical risk, and test timing were the critical information elements that they used to make informed decisions around NIPT. Women often described NIPT as easy or just another blood test, highlighting threats to informed decision-making such as routinization or a pressure to test.ConclusionsWomen’s unique circumstances modulate the information that they value and require most in the context of making an informed decision. Widened availability of trustworthy information about NIPT as well as careful attention to the facilitation of counselling may help facilitate informed decision-making.Trial registrationPROSPERO 2018 CRD42018086261.

Study on engaging characteristics of wet friction pair with copper-based powder metallurgical friction material

Copper-based powder metallurgy (Cu-PM) has become quite common as the frictional material for clutches in transmission system. However the traditional research on friction pair is still limited to the static, qualitative and semi empirical studies. Based on the study of the physical properties of Cu-PM materials, the mathematical model of the wet friction pair is established. Through a simulation example, the transmission torque and the oil film pressure are obtained. Furthermore, a test bench has been set up to test the wet friction pair with Cu-PM friction materials. The correctness of the mathematical model was proved by comparing the experimental data and simulation data.

Race-Evasive White Teacher Identity Studies 1990–2015: What Can We Learn from 25 Years of Research?

Background/ContextWith a rationale informed by the demographic imperative, the resegregation of public schools, and our positionalities as researchers, we understand both the high stakes and the complexity of capacitating White preservice and in-service teachers capable of anti-racist praxis and race-visible teaching and learning in public school classrooms.Purpose/Objective/Research Question/Focus of StudyDeploying the framework of colorblind racism, we systematically reviewed race-evasive White teacher identity studies and answered the question: What can we learn from 25 years of research?Research DesignIn using the method called the synoptic text, we engaged electronic databases, with special emphasis on ERIC EBSCOhost. The simple and general search term “White teachers” conducted using year-by-year parameters provided the most systematic net for capturing relevant studies. In narrowing our focus, we developed the following criteria: (a) White teachers as central topic, (b) analytical emphases on colorblind racism, (c) publication in peer-reviewed journals, (d) use of qualitative and/or narrative research methodologies, and (e) publication date between 1990 and 2015.Data Collection and AnalysisOur general search yielded 136 (N = 136) peer-reviewed empirical qualitative and/or narrative studies between 1990 and 2015, and after narrowing our criteria, we found 47 race-evasive White teacher identity studies (n = 47, 47/136) that we reviewed here. Each study in the document universe was abstracted by authors, added to a spreadsheet, and categorized by emergent themes.Findings/ResultsThe following five themes emerged and developed over the last 25 years: (a) racialized silence and invisibility (9/47), (b) resistance and active reconstruction of White privilege (12/47), (c) whiteness in institutional and social contexts (8/47), (d) fertile paradoxes in new research (9/47), and (e) reflexive whiteness pedagogies (9/47).Conclusions/RecommendationsWe believe our literature review identifies the complex contours of White preservice and in-service teachers’ silence, resistance to, engagement in, and pedagogical grappling with racism, whiteness, and White privilege. The importance of pre-service and in-service teachers being able to engage, understand, and challenge these issues becomes critically important at our crossroads in the present, especially given the recent election that bolstered open and tacit White supremacists into power. If White teachers are to engage racism, whiteness, and White privilege, they must do so with as opposed to for their students, in a Freirean sense. If teaching for social justice is important, renewed interest and investment in White teacher identity studies and related whiteness pedagogies is key for the next 25 years.

‘Cold intimacies’ in parents’ negotiations of work–family practices and parental leave?

This article aims to assess the contention that a ‘feminist’ ideology is associated with a ‘cooling’ of intimacy in heterosexual relationships, as argued by scholars such as Arlie Hochschild and Eva Illouz. According to this thesis, such an ideology, ‘abducted’ by a commercial spirit, encourages women to disengage from warm intimate bonds with others and to prioritize their own personal fulfilment and parity in care and housework. Drawing on two qualitative empirical studies exploring couples’ intimate lives and their feminist and egalitarian preferences and practices in leave, care and housework, this article examines in detail the basis of this thesis, and its effectiveness in explaining the lived experiences of parent couples’ negotiations of this terrain. The data were collected through focus group discussions with parents not sharing leave and a detailed ethnography with couples sharing leave. The comparison shows that, far from observing a clear dichotomy between ‘cold’ feminists and ‘warm’ traditional couples, both sets of parents present a more complex picture of ‘warm’ and ‘cold’ relations. The analysis enables a critical appreciation of sociological theorizing about gender equality and intimacy, contributing to sociological debates around individualism, feminism and family life.

What influences women\u2019s movement and the use of different positions during labour and birth: a systematic review protocol

BackgroundWomen want to give birth in a safe and supportive environment where they are free to move and adopt different positions. Moving freely and using different positions in labour results in a range of physical and psychological benefits for women. However, many women report that they are restricted from moving freely during labour and birth and it is important to understand the factors that are influencing this.MethodsA mixed-methods systematic review will be undertaken. Qualitative, quantitative and mixed-methods primary empirical studies will be identified by systematically searching seven electronic databases using a search strategy that includes medical subject headings (MeSH) and keywords to cover synonyms and related terms. In addition, reference-tracking will be undertaken, and expert researchers will be contacted to locate relevant studies. Two reviewers will be involved in the assessment of the studies against eligibility criteria, formal quality appraisal and data extraction. A results-based convergent synthesis will be undertaken, using narrative synthesis if the quantitative data are too heterogeneous for meta-analysis, meta-ethnography for the synthesis of the qualitative data and the production of a line of argument synthesis. Finally, confidence in the findings will be formally assessed and conclusions drawn.DiscussionThe findings of this review will allow researchers, practitioners and policy makers to better understand the factors influencing women’s movement and the use of different positions during labour and birth. This will inform future research and the development of maternity services designed to implement best-evidence concerning movement and positioning during labour and birth into clinical practice.Systematic review registrationIn accordance with the PRISMA-P guidelines (Moher et al. Syst Rev 4:1, 2015), the systematic review protocol was registered with the International Prospective Register of Systematic reviews (PROSPERO) on July 17, 2018 (CRD42018103354).

From an uncomfortable conversation to a productive strategic dialogue

From an uncomfortable conversation to a productive strategic dialogue

Understanding the customer benefits of customisation: Case surfboard

Customisation is one strategy to involve customers in the design process. However, qualitative empirical studies on customisation in different product contexts are scarce. This paper investigates the benefits customers perceive in craft customisation where they are actively involved in the customisation with the designer. The case of this study is a high involvement custom product, a surfboard. Findings derived from qualitative interviews with surfers (N=22) reveal the perceived benefits in the three distinct phases of customisation: pre-customisation, during which the decision to customise is made; customisation process, during which the product is customised; and product usage. The source of the found benefits are the product, process or customisation itself and they can be classified to functional, emotional, experiential, symbolic, aesthetic, personal, social, epistemic, creative, and hedonic. The benefits vary in occurrence during the different customisation phases. Based on the findings, we present a model for the benefits in the three phases of customisation. The model can be used when implementing craft customisation as a design strategy. Keywords: customisation, benefits of customisation, phases of customisation, high-involvement product, surfboard.

A systematic review of the literature on ethical aspects of transitional care between child- and adult-orientated health services

BackgroundHealthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services (CAMHS). Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative.MethodsA wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced.ResultsEighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence.ConclusionsThere is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area.

Optimising eHealth tools for older patients: Collaborative redesign of a hospital website.

Most hospital websites have not been developed in collaboration with patients and, therefore, rarely take into account the preferences and abilities of older patients. This study describes the systematic redesign of an existing hospital website in a co‐design process with patients and professional stakeholders (e.g. researchers, physicians, nurses, department heads, policymakers, website designers), with the aim to make it more user‐friendly for older patients with colorectal cancer (CRC). The redesign process consisted of three phases, where (I) both existing content and design were evaluated among CRC patients; (II) a prototype website was developed based on these insights; which (III) was evaluated again before making final adjustments. Mixed research methods were used for the redesign process. Specifically, insights from existing literature, outcomes from qualitative and quantitative empirical studies conducted by our team, and expert knowledge from relevant stakeholders, were collected and discussed in multidisciplinary consensus meetings, and served as input for the redesigned website. While the existing website was evaluated poorly, the qualitative evaluation of the prototype website in phase 3 showed that the newly redesigned website was usable for older CRC patients. A practical roadmap on how to collaboratively redesign and optimise existing eHealth tools to make them suitable for and operational in clinical settings is provided.

Lifelong Learning at Universities: Future Perspectives for Teaching and Learning

This paper examines practices of teaching and learning in the era of digitalization. More specifically, it addresses practices of teaching and learning for students with professional experience who work alongside their studies. Based on the assumption that digitalization is a means of allowing more open and flexible pathways for teaching and learning in higher education, the paper focusses on the perspectives and perceptions of both students and teachers in digital supported teaching and learning environments as forms of blended learning. It brings together findings from two qualitative empirical studies: one focused on students’ perspectives of their development over the course of their studies; the second addressed teachers’ perspectives and their teaching strategies and activities. Based on the findings of these two research studies, the paper outlines future perspectives for teaching and learning and the role of digitalization, with a particular emphasis on programs of lifelong learning at universities.

Examining clinical leadership in Kenyan public hospitals through the distributed leadership lens.

Clinical leadership is recognized as a crucial element in health system strengthening and health policy globally yet it has received relatively little attention in low and middle income countries (LMICs). Moreover, analyses of clinical leadership tend to focus on senior-level individual leaders, overlooking a wider constellation of middle-level leaders delivering health care in practice in a way affected by their health care context. Using the theoretical lens of ‘distributed leadership’, this article examines how middle-level leadership is practised and affected by context in Kenyan county hospitals, providing insights relevant to health care in other LMICs. The article is based on empirical qualitative case studies of clinical departmental leadership in two Kenyan public hospitals, drawing on data gathered through ethnographic observation, interviews and focus groups. We inductively and iteratively coded, analysed and theorized our findings. We found the distributed leadership lens useful for the purpose of analysing middle-level leadership in Kenyan hospitals, although clinical departmental leadership was understood locally in more individualized terms. Our distributed lens revealed medical and nursing leadership occurring in parallel and how only doctors in leadership roles were able to directly influence behaviour among their medical colleagues, using inter-personal skills, power and professional expertize. Finally, we found that Kenyan hospital contexts were characterized by cultures, norms and structures that constrained the way leadership was practiced. We make a theoretical contribution by demonstrating the utility of using distributed leadership as a lens for analysing leadership in LIMC health care contexts, revealing how context, power and inter-professional relationships moderate individual leaders’ ability to bring about change. Our findings, have important implications for how leadership is conceptualized and the way leadership development and training are provided in LMICs health systems.

Relationship between Organizational Culture and the Use of Psychotropic Medicines in Nursing Homes: A Systematic Integrative Review.

Psychotropic medicines are commonly used in nursing homes, despite marginal clinical benefits and association with harm in the elderly. Organizational culture is proposed as a factor explaining the high-level use of psychotropic medicines. Schein describes three levels of culture: artifacts, espoused values, and basic assumptions. This integrative review aimed to investigate the facets and role of organizational culture in the use of psychotropic medicines in nursing homes. Five databases were searched for qualitative, quantitative, and mixed method empirical studies up to 13 February 2017. Articles were included if they examined an aspect of organizational culture according to Schein's theory and the use of psychotropic medicines in nursing homes for the management of behavioral and sleep disturbances in residents. Article screening and data extraction were performed independently by one reviewer and checked by the research team. The integrative review method, an approach similar to the method of constant comparison analysis was utilized for data analysis. Twenty-four studies met the inclusion criteria: 13 used quantitative methods, 9 used qualitative methods, 1 was quasi-qualitative, and 1 used mixed methods. Included studies were found to only address two aspects of organizational culture in relation to the use of psychotropic medicines: artifacts and espoused values. No studies addressed the basic assumptions, the unsaid taken-for-granted beliefs, which provide explanations for in/consistencies between the ideal use of psychotropic medicines and the actual use of psychotropic medicines. Previous studies suggest that organizational culture influences the use of psychotropic medicines in nursing homes; however, what is known is descriptive of culture only at the surface level, that is the artifacts and espoused values. Hence, future research that explains the impact of the basic assumptions of culture on the use of psychotropic medicines is important.