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PubMed2002

A concordance-based study of metaphoric expressions used by general practitioners and patients in consultation.

BACKGROUND: All languages use metaphoric expressions; some deliberately chosen, some (for example, 'digesting information') not usually perceived as metaphoric. Increasingly, it is suggested metaphoric expressions constrain the way we conceptualise the world, as well as being a means of achieving stylistic effect. AIM: To study metaphoric expressions used by doctors and patients in general practice. DESIGN OF STUDY: Concordance-based language analysis of spoken data. METHOD: A database containing transcriptions of 373 consultations with 40 doctors in a UK general practice setting was scrutinised for metaphoric expressions, using 'concordancing' software. Concordancing enables identification of strings of text with similar lexical properties. Comparators (for example, 'like'), selected verb-types (for example, of feeling), and the verb 'to be' were used as starting points for systematically exploring the data. Quantitative and qualitative thematic methods were used in analysis. RESULTS: Doctors and patients use different metaphors. Doctors use mechanical metaphors to explain disease and speak of themselves as problem-solvers' and 'controllers of disease'. Patients employ a range of vivid metaphors, but fewer metaphors of machines and problem/solution. Patients use metaphors to describe symptoms and are more likely to use metaphoric language at the interface of physical and psychological symptoms ('tension, 'stress'). CONCLUSION: The different patterns of metaphoric expression suggest that doctors make limited attempts to enter the patients' conceptual world. This may not be a bad thing. One function of the consultation may be to reinterpret vivid and unique descriptions as accounts of the familiar and systemically comprehensible. Doctors may use different conceptual metaphors as a reassuring signal of expertise.

Communication↗
PubMed1997

The introduction of generic workers into the ward team: an exploratory study.

This study arose from a quantitative study that defined the role and resources required for the introduction of generic workers into the ward team. A month's trial was conducted to explore the staff attitudes and perceptions associated with such an introduction, thereby identifying potential problems and benefits that may influence successful introduction into the ward team. A small convenient sample that included trained, untrained and domestic staff was used. The methodological strategies in the study were semi-structured interviews, pre- and post-trial, and non-participant observations during the trial. The data obtained were transcribed and analysed using 'thematic content analysis' and 'within method triangulation'. The findings indicated positive support for the introduction of such workers and the transfer of responsibility from a central domestic team to the ward manager. The ward environment improved and nursing staff were freed from non-nursing activity, leaving more time for patient care. Recommendations to facilitate the smooth introduction of these workers are stated within the study and are now in place within the Trust. The introduction of these workers has been agreed and a staggered roll out of the project is underway in all wards across the Trust.

Adult↗
PubMed2005

Negotiating relationship contexts in gerontological social work practice.

OBJECTIVES: The objective of this study was to demonstrate the role of social workers in addressing the complex relationship and problem solving contexts typical of practice in multi-service geriatric care settings. METHODS: We conducted a thematic analysis of the work of five social workers with five clients, their families, and the professional healthcare team, and extracted common themes across cases that illustrate the nature and timing of the interventions depending on the relationship context addressed. RESULTS: While there were problems and issues common across relationship contexts, intervention strategies that were essential for optimizing client care and wellbeing were specific to resolving relationship conflicts in one or more of the identified relationship contexts.

Aged↗
PubMed1997

Exploring the everyday world of the patient in isolation.

PURPOSE/OBJECTIVES: To explore the phenomenon of isolation from the perspective of patients cared for in reverse isolation for bone marrow transplant (BMT). DESIGN: Interpretive, phenomenologic. SETTING: Hematology and bone marrow transplant unit of a large teaching hospital in Brisbane, Australia. SAMPLE: Seven patients undergoing BMT. METHODS: Phenomenologic interviews and thematic analysis of transcribed data. MAIN RESEARCH VARIABLE: Patient's day-to-day experiences of reverse isolation. FINDINGS: Although appreciative of the physical care and attention given to them, participants did not convey a sense that healthcare professionals understood the experience of the BMT recipient's isolation or illness from their perspective. Major themes elicited from analysis of the transcripts included (a) striving to take charge, which refers to participants' attempts to maintain control in a seemingly out-of-control situation. (b) intellectualizing the need for isolation, and (c) being in touch: contact with family and staff. CONCLUSIONS: Elements of caring for the patient appeared to dominate the comments associated with staff contact. Other forms of care (e.g., caring about) emphasize the importance of nurses understanding and connecting with peoples' meanings and experiences of their illness and treatment. IMPLICATIONS FOR NURSING PRACTICE: Although all participants were aware that they could ask for information about their diagnosis and treatment at any time, most had not been offered the opportunity to describe their feelings or experiences before. Unless nurses take more initiative to gain insight and a greater appreciation of the patient's understanding of his or her situation, they will continue to focus on unidimensional aspects of care and neglect the multidimensional or holistic nature of nursing care.

Adaptation, Psychological↗
PubMed1998

The nurse manager as a professional-managerial class: a case study.

AIM: This study set out to capture the work dynamics and impact of nurse managers during healthcare restructuring. BACKGROUND: The nurse managers are instrumental to healthcare reform in which the ultimate goal is the promotion of a cost-effective healthcare delivery system. METHODS: A case study approach was used. Interviews were conducted with 12 nurse managers working in an acute hospital in Hong Kong. The data was analysed initially by thematic analysis, followed by the extended case method. FINDINGS: This study showed that the coalition of the nurse and manager role gives rise to the professional-managerial class (PMC). These nurse PMCs enjoyed the kind of power, job satisfaction and work autonomy that frontline nurses did not experience. They managed nurses who predominantly occupied the workforce and managed nursing care that composed the main bulk of work in hospital service. CONCLUSIONS: The emergence of a group of nurse managers is essential to a cost-effective service, and to maximize nursing efforts in healthcare.

Cost-Benefit Analysis↗
PubMed2004

Reclaiming the everyday world: how long-term ventilated patients in critical care seek to gain aspects of power and control over their environment.

Critical care nurses are increasingly seeking to base patient care on evidence derived from research studies. The purpose of this study was to explore the meanings former patients attributed to being on long-term mechanical ventilation in a critical care unit (CCU) in Australia. Using Heideggerian phenomenology, unstructured interviews were undertaken with nine participants. Data were analysed thematically using the method developed by van Manen. Thematic analysis revealed four major themes. This article presents the findings from the theme titled: Reclaiming the everyday world, which describes how the study participants gained comfort from the presence of nurses and their families, sought control over their treatments, and questioned and interpreted the environment, in order to reclaim self. The study highlighted the central role of nurses in patient care, and served as a basis for a number of recommendations, which include recognising the significant role of nurses and family in patient care, and being aware that patients may want more control over their environment and instigate ways to facilitate this. Further research is warranted to examine CCU patients' perceived level of control and power, and to investigate the extent and type of involvement CCU patients would like to have in their care.

Adaptation, Psychological↗
PubMed2005

The experience of agency nurses working in a London teaching hospital.

This Husserlian phenomenological study explored the lived experience of eight full-time agency nurses working in the environment of intensive care in London, United Kingdom. In-depth interviews were used to ascertain the participants' experiences of full-time agency nursing in intensive care. Colaizzi's [Colaizzi P. Psychological research as the phenomenologist views it. In: Vale R, King M, editors. Existential-phenomenological alternatives for psychology. London: Oxford University Press; 1978, p. 48-71] method of data analysis was utilised. Thematic analysis identified three cluster themes: the shared experience of lacking confidence; the shared experience of deskilling; and the shared experience of feelings of isolation. The theme of the shared experience of lacking confidence identified the importance of support and understanding of agency nurses' needs in the ICU. The theme of the shared experience of deskilling illuminated participants concern at not having the opportunity to care for patients of higher acuity. The theme of the shared experience of feelings of isolation highlighted that often participants did not feel they "belonged to a team". Study findings suggest the need to include: the implementation of protocols within the clinical setting; the provision of performance feedback to agency nurses; and the consideration of ongoing structured professional development and education for ICU agency nurses.

Attitude of Health Personnel↗
PubMed2006

Exploring experiences of "participation" among individuals living with chronic pain.

The aim of this paper is to advance our understanding of participation and its relation to occupation, by analysing the daily occupational experiences of six men and women living with chronic pain. Open-ended interviews are used in conjunction with a constant comparative method of analysis. The findings are thematically presented as: "taking initiative and making choices", doing something physical", "doing something social", and "doing something for others". Furthermore, a short vignette is presented in which the authors attempt to juxtapose theoretical constructs with individual experiences in order to illustrate another level of contextual richness of the data. Methodological implications are discussed in relation to the findings, analytic presentation, and previous research.

Adult↗
PubMed2006

'Two sides of the coin'--the value of personal continuity to GPs: a qualitative interview study.

BACKGROUND: Continuity is thought to be important to GPs but the values behind this are unknown. OBJECTIVES: To explore the values that doctors working in general practice attach to continuity of patient care and to outline how these values are applied in practice. METHODS: In-depth qualitative interview with 24 GPs in England. Participants were purposefully sampled according to personal and practice characteristics. Analysis was thematic, drawing on the constant comparative method. RESULTS: The majority of doctors valued doctor-patient, or personal, continuity in their everyday work. It was most valued in patients with serious, complex or psychological problems. GPs believed that through their personal knowledge of the patient and the doctor-patient relationship, personal continuity enabled them to provide higher quality care. However, the benefits of personal continuity were balanced against problems, and GPs identified personal, professional and external constraints that limited its provision. GPs seemed to have resolved the tension between the benefits, limits and constraints they described by accepting an increased reliance on continuity being provided within teams. CONCLUSION: Personal continuity may offer important benefits to doctors and patients, but we do not know how unique its values are. In particular, it is not clear whether the same benefits can be achieved within teams, the level at which continuity is increasingly being provided. The relative advantages and limits of the different means of delivering continuity need to be better understood, before further policy changes that affect personal continuity are introduced.

Adult↗
PubMed2006

Long-term mechanical ventilation in a critical care unit: existing in an uneveryday world.

AIM: This paper reports a study to describe and interpret the meaning of being on long-term mechanical ventilation. BACKGROUND: Patients who require mechanical ventilation in a critical care unit for prolonged periods of time are typically sicker than those who are ventilated for shorter periods. Despite advances in treatment modalities for critically ill patients, many still require long-term mechanical ventilation for 7 days or more. Therefore, caring for a long-term ventilated patient is often an everyday occurrence for critical care nurses; however, there is insufficient evidence of the meaning of this experience from a patient perspective. METHOD: We used an ontological phenomenological approach informed by the ideas of Heidegger. Data were collected using unstructured audio-taped interviews with nine former patients from critical care units unit in Queensland, Australia. The data were collected between January 2000 and December 2001 and analysed thematically using the method developed by van Manen. FINDINGS: Thematic analysis revealed four themes. This paper presents the findings from the theme titled 'existing in an uneveryday world', which revealed what it meant for participants to exist, live through and survive the many physiological and psychological effects arising from their critical illness episode. For the most part, this was an unpleasant and frightening experience that involved bizarre nightmares and inability to distinguish time, place and the familiar body; disagreeable effects from the technology used and patient care activities; and reliance on external agents for survival. In addition, participants reported how they questioned their chances of surviving the critical illness ordeal. CONCLUSION: There is a need for further research in the areas of sedative and analgesic management in critically ill patients, methods of communicating with intubated and mechanically ventilated patients, and debriefing and follow-up support services for survivors.

Adult↗
PubMed2026

A comparative systematic review of pharmacist education systems and pharmacy service quality in ASEAN-5: Indonesia, Malaysia, Thailand, the Philippines, and Singapore.

BACKGROUND: The global transition toward patient-centered pharmaceutical care has exposed structural disparities in ASEAN pharmacy workforce training and deployment. This review examines four research questions: how pharmacy education systems and accreditation standards differ across Indonesia, Malaysia, Thailand, the Philippines, and Singapore (collectively, the ASEAN-5); the extent to which pre-registration education influences clinical service scope and professional confidence; how education reform and regulatory change have shaped pharmacist clinical roles; and what barriers and enablers exist for regional qualification harmonization. METHODS: A systematic literature review following PRISMA 2020 was conducted. Searches of PubMed/MEDLINE and Scopus, supplemented by grey literature, were completed in May 2026. Of 78 unique records screened, 46 studies published between 2005 and 2026 met inclusion criteria. Quality appraisal used an adapted Mixed Methods Appraisal Tool; synthesis employed narrative thematic analysis. RESULTS: The five countries represent four structurally distinct pharmacy education architectures: Thailand's standardized six-year Doctor of Pharmacy with dual specialization tracks; four-year Bachelor of Pharmacy programmes in Malaysia and the Philippines with institutional variation; Indonesia's clinically underdeveloped system despite rapid expansion; and Singapore's four-year Bachelor of Pharmacy followed by a nationally mandated one-year pre-registration pathway. Evidence links deeper clinical training to broader practice scope, higher confidence, and improved patient outcomes. Reform produced uneven results: Thailand's PharmD transition improved clinical recognition but exposed deployment paradoxes; Singapore achieved the strongest training-to-practice alignment; Indonesia's health insurance reforms were not absorbed by an underprepared workforce; the Philippines lacks a national competency framework. No binding mutual recognition arrangement was identified; divergent qualification structures, incompatible accreditation systems, and an asymmetric evidence base remain the primary barriers. DISCUSSION: These findings indicate that clinical service scope is bounded less by national policy ambition than by the depth and clinical orientation of the pre-registration education that precedes it, and that credentialing reforms which outpace a health system's capacity to absorb new clinical roles, or the reverse, do not by themselves translate into expanded practice. CONCLUSIONS: Pharmacy education across the ASEAN-5 remains nationally distinct and clinically uneven. Clinical service scope is directly bounded by pre-registration education quality. No country has fully closed the education-practice gap. Regional harmonization requires national-level educational reform as a prerequisite.

Humans↗
PubMed2006

It's beyond water: stories of women's experience of using water for labour and birth.

PURPOSE: This study aimed to give 'voice' to women's experiences of using water for labour and birth. PARTICIPANTS: Five women from a large urban region in New Zealand, who used water for labour and birth, at home and in hospital. METHODS: The study employed an interpretive design using audio-taped conversations as the method of data collection and a thematic analysis of the women's stories. FINDINGS: Data analysis produced two core categories; 'Getting to the water' which revealed the impact of preparing for and anticipating the water; and 'Getting into the water' which provided a sanctuary and a release from pain. CONCLUSION: The all-encompassing warmth associated with being enveloped in warm water cradled, supported, relaxed, comforted, soothed, sheltered and protected the women; it created a barrier and offered a sense of privacy. Water can be used in any form, even the act of thinking about, preparing for and anticipating the water opened possibilities for these women. The women used water to reduce their fear of pain and of childbirth itself; to cope with pain, not necessarily to remove or diminish pain; and to maintain control over the process of birth. The women indicated that it was not necessary to actually give birth in the water to achieve these benefits. Listening to the stories of women provides us with insights into what is important to them. Women's knowledge contributes an important part of the evidence on which we base our practice.

Adult↗
PubMed2000

The parallel rural community curriculum: an integrated clinical curriculum based in rural general practice.

INTRODUCTION: In an attempt to address the rural medical workforce maldistribution and the concurrent inappropriate caseload at the urban tertiary teaching hospitals, Flinders University and the Riverland Division of General Practice decided to pilot, in 1997, an entire year of undergraduate clinical curriculum in Australian rural general practice. This program is called the Parallel Rural Community Curriculum (PRCC). This paper is a discussion of the aims of the programme; student selection; practice recruitment; curriculum structure, and academic content, together with lessons learnt from the evaluation of the first cohort of students' experience of the course. METHODS: Independent external evaluators undertook a thematic analysis of a series of structured interviews of students and faculty involved in both the PRCC and the traditional curriculum. The mean examination results were determined and a rank order comparison of student academic performance was undertaken. RESULTS: The eight selected volunteer students reported greater access to patients and clinical learning opportunities than their mainstream counterparts and learned clinical decision making in the context of the whole patient, their family, and the available community resources. They identified patients with 'core' clinical conditions and had a longitudinal exposure to common diseases, whereas hospital-based peers had a cross-sectional exposure to highly filtered illness. The PRCC students' academic performance improved in comparison with that of their tertiary hospital peers' and in comparison to their own results in previous years. CONCLUSION: The PRCC curriculum has cut across the traditional clinical discipline boundaries by teaching in an integrated way in rural general practice. It has affirmed the potential role of true generalist physicians in undergraduate medical education.

Community Medicine↗
PubMed2004

[The street: a deceitful shelter to the children living in it].

The paper focuses on the child in a street situation, through the address by a group of school-age children who used to frequent two public São Paulo city shelters. The purpose was to apprehend its representation on its reality. The data, gathered by means of interviews, were organized and analyzed according to the method of the Analysis of Contents. The thematic theories detached from the speech transcript were grouped into meaningful experiences for the children, among which "the street". The synthesis of the analyzed categories showed clearly that violence permeates the lives of children of/in the street, resulting in experiences that restrict their full development. The street represents a refuge to the child coming from a needy family and also to the one who has a history of abuse from its family.

Brazil↗
PubMed2026

Acceptability of capillary point-of-care testing: a systematic review.

OBJECTIVE: To identify and synthesise evidence on the acceptability and perceived experience of finger-prick point-of-care testing (POCT) among patients and clinicians across healthcare settings. DESIGN: Systematic review conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. DATA SOURCES: Medline, Embase, PsycInfo, CINAHL, Cochrane and Web of Science were searched from inception to January 2024 and re-run in July 2025, supplemented by citation tracking of relevant studies. ELIGIBILITY CRITERIA: Studies reporting patient and clinicians' experiences, perceptions, satisfaction or acceptability relating to finger-prick POCT for any health condition or blood parameter were eligible. Quantitative, qualitative and mixed-methods designs were included. DATA EXTRACTION AND SYNTHESIS: Data were extracted independently by two reviewers and synthesised using thematic analysis and narrative synthesis. Methodological quality was appraised using the Mixed-Methods Appraisal Tool. RESULTS: 21 studies met the inclusion criteria, encompassing 9128 participants (17 quantitative, 3 qualitative, 1 mixed methods). Across diverse clinical contexts, finger-prick POCT was reported as generally acceptable, less distressing and perceived as a convenient alternative to venous sampling in comparative studies. Thematic synthesis identified two major themes: (1) enhancing the patient-clinician relationship through improved engagement, communication and understanding of care and (2) clinical implications of finger-prick POCT on clinicians' workflow, confidence and skill acquisition. Finger-prick POCT was perceived to promote personalised consultations, enable immediate discussion of results and streamline decision-making. Clinicians highlighted its potential to expand task sharing, improve efficiency and strengthen continuity of care, although concerns regarding training, reliability and quality assurance were identified. CONCLUSIONS: Finger-prick POCT is generally acceptable to patients and clinicians, improving comfort, convenience, engagement and perceived efficiency. Implementation should prioritise training, infrastructure and quality assurance frameworks to maximise clinical and experiential benefits. PROSPERO REGISTRATION NUMBER: CRD42024512130.

Humans↗
PubMed1999

Emergency contraception: an anomalous position in the family planning repertoire?

Emergency contraception (EC) can be used up to 72 h after sex to prevent pregnancy. Internationally there is wide variation in the availability of EC. In the USA it has only recently (1997) won approval from the FDA, while the UK and New Zealand have seen calls for over the counter availability. In recent years surveys, editorials and opinion pieces in medical journals have pointed out that increased access to EC could help to tackle the unwanted pregnancy rate, especially among teenagers, and concluded that lack of knowledge of EC is the major barrier to use. However, women in a UK study have expressed concerns that it is not safe to use the method repeatedly and cited general practitioners (GPs) as one of the sources of this belief, which contradicts the professional guidelines and the rationale for de-regulation. A subsequent study sought to seek the views of GPs about prescribing EC and explored reasons for the gap between the views of women using UK family planning services, GPs and professionals at the public policy level. Data from two studies are presented. In the first study, 53 women seeking emergency contraception were interviewed at two family planning clinics. In the second, semi-structured telephone interviews were completed with a random sample of 76 GPs from three English health authorities. Interviews were recorded, transcribed and thematic analysis was conducted using the constant comparative method. EC was rarely described, by users or GPs, as an acceptable contraceptive option. Consultations for emergency contraception were viewed by GPs as an important opportunity to discuss the woman's future contraceptive needs. Repeated use of EC was not encouraged and a discussion of contraceptive needs could range from a mild enquiry to quite forceful messages contrasting EC to 'regular' and 'proper' methods. The medical literature suggests that EC is underused because of a lack of awareness. Commentators have recommended educating health professionals and women about EC and increasing availability through de-regulation. The data presented in this paper show that British GPs are not enthusiastic about the de-regulation of EC, but the reasons are complex and related to concerns about planned contraception and sexual behaviour. It is suggested that it may be because EC is used after sex that it seems to occupy an uncomfortable place within the contraceptive repertoire.

Attitude↗
PubMed1999

A situation-specific theory of Korean immigrant women's menopausal transition.

PURPOSE: To extend the previous model of transitions by including the experiences of low-income Korean immigrant women in the United States during their menopausal transition. The extension results in a situation-specific theory of Korean immigrant women's menopausal transition. DESIGN: Findings from a study of menopausal transition among Korean immigrant women were used as a main source for modification of the conceptual properties of transitions, conditions shaping the transitions, and indicators of healthy transitions. The study was cross-sectional with methodologic triangulation. Quantitative analysis was based on data from 119 first-generation Korean immigrant women who engaged in low-status or low-income work outside their homes; qualitative study using theoretical sampling method included 21 women. METHODS: Analyses included descriptive and inferential statistics and thematic analysis. Integrative conceptual analysis using deductive and inductive reasoning was conducted to determine modifications in theory based on the descriptions of menopausal transition of Korean immigrant women. FINDINGS: Three main themes were identified: (a) the women gave their menopausal transition far less attention than they did to their immigrant and work transition; (b) menopause was a hidden experience in cultural background; and (c) the women "normalized," ignored, and endured symptoms. The findings indicated additions of the following concepts: (a) number, seriousness, and priority of transitions; (b) socioeconomic status; (c) gender; (d) context; (e) attitudes toward health and illness; (f) interrelationships among all conditions shaping transitions; and (g) symptom management. CONCLUSIONS: The proposed situation-specific model is limited in scope. However, it provides understanding of the menopausal transition of Korean immigrant women in context, and is a guide for nursing interventions for immigrant women experiencing transition.

Adaptation, Psychological↗
PubMed2006

What do nurses do in response to their predictions of aggression?

Nurses working with people who have an acquired brain injury report a high incidence of verbal assault and physical aggression directed against them. The aim of the current study was to identify the responses nurses make to such predictions of aggression. Twenty-eight nurses from 10 inpatient brain injury rehabilitation units in Australia participated. Participants were selected because of their expertise in predicting and minimizing aggression. They were interviewed one-on-one using the Critical Decision Method of interviewing. Transcripts were analyzed using thematic analysis. Nurses identified three general responses to predictions of aggression: paying attention, planned nonintervention, and planned intervention. The nurses were able to respond to predictions of aggression in a clinically effective way. Knowledge of the individual patient and experiences with other brain-injured patients informed their practice.

Adult↗