Qualitative Research in Medicine and Healthcare https://pagepressjournals.org/index.php/qrmh <p><strong>Qualitative Research in Medicine and Healthcare</strong> represents an interdisciplinary and international forum for qualitative research in healthcare settings.&nbsp;The journal is conceived as a site for the emergence of dialogue between researchers and academics and healthcare practitioners; it allows an exchange between multiple parties in the health and social service professions, patients and clients as well as graduate students and researchers who practice qualitative methods. Qualitative research approaches healthcare in a completely different way from quantitative research, providing important insights into health-related phenomena, generating new avenues for empirical questions. Qualitative research examines lived experience and relational processes as the basis of social phenomena, including those related to health. Therefore, it can answer to questions that quantitative research cannot, such as why people do not adhere to a life-saving treatment regimen or why a certain healthcare intervention is so successful, or fails. It uses many methods of data collection and numerous approaches to data analysis that range from systematic coding to phenomelogical and inductive approaches. Each issue of <strong>Qualitative Research in Medicine and Healthcare</strong> provides readers with a varied array of material and commentaries on important people and issues in healthcare as well as peer-reviewed articles that address and examine: the illness experience from multiple and varied perspectives; constructions of health, illness and healthcare that highlight relational and cultural contexts; healthcare policies in various organizational and institutional settings; attention to the communicative dynamics of the patient-provider relationship; narrative approaches to health.</p> PAGEPress Publications, Pavia, Italy en-US Qualitative Research in Medicine and Healthcare 2532-2044 <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="http://creativecommons.org/licenses/by-nc/4.0/" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li>the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li>a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> Editor's Introduction https://pagepressjournals.org/index.php/qrmh/article/view/7817 Not available. Mariaelena Bartesaghi ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2018-09-10 2018-09-10 2 2 10.4081/qrmh.2018.7817 The introduction of the medicinal partner in direct-to-consumer advertising: Viagra’s contribution to pharmaceutical fetishism and patient-as-consumer discourse in healthcare https://pagepressjournals.org/index.php/qrmh/article/view/7646 Pfizer, manufacturer of the erectile dysfunction prescription treatment Viagra, has been a staple in the pharmaceutical advertising arena since broadcast versions of such ads became legally permissible in the United States in 1997. Given that the patent for Viagra is soon set to expire, it is important that research take a look back in an attempt to contextualize the brand’s place in shaping medicinal marketing culture. Of particular interest is the period beginning in 2014, when Viagra’s most unconventional campaign yet began using a tactic that was the first of its kind for the pharmaceutical industry. By removing the actual consumer of the medication from these ads (males), Viagra has paved the way for pharmaceutical advertising to target the <em>medicinal partner</em>. This manuscript reviews the first use of the medicinal partner in the pharmaceutical advertising sector, conducting a textual analysis of Viagra’s use of this mediated relationship. The medicinal partner is the pharmaceutical industry’s attempt to target a patient’s social circle in an effort to promote a discourse that suggests a medicinal remedy for a problem. This analysis describes how social meaning and relationships underlie the market transaction of obtaining a prescription, as has been previously established through the processes of medicalization and pharmaceutical fetishism. These advertisements create belief in the larger sense, meaning Pfizer is infiltrating upon the patient’s process of choice and consumption of medicinal remedies. Viagra is simultaneously encouraging male consumers to celebrate the brand while using female ambassadors to influence the decision to request medicinal intervention. Janelle Applequist ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2018-08-31 2018-08-31 2 2 10.4081/qrmh.2018.7646 Perspectives of meaningful work in a high-burnout academic medical center: a discourse analysis https://pagepressjournals.org/index.php/qrmh/article/view/7572 We conducted a discourse analysis of meaningful work from the perspective of healthcare workers in an academic medical center where we previously observed relatively high levels of personal burnout (52.7%) and work-related burnout (47.5%), all based on the Copenhagen Burnout Inventory survey. Burnout is often studied as psychological condition characterized by exhaustion, depersonalization, and feelings of inefficacy or lack of career achievement, but as demonstrated in this analysis, burnout loses its meaning because healthcare professionals provide a robust account of what makes work meaningful to them despite their prevalence of burnout. Healthcare professionals exhibit a higher level of burnout compared to workforce members in other organizations. Physicians specifically are at high risk for exhibiting symptoms of burnout and work-life imbalances. In addition, burnout manifests itself early in the physician’s career compared other occupations, and in our sample was prevalent among nurses, too. In this discourse analysis of written answers to the survey question,<em> In ten words or less describe what makes your work meaningful?</em> healthcare professionals provide an account of meaningful work that maintains its value in this environment despite the level of burnout, especially when healthcare professionals can use their hard-earned knowledge to make a difference in the lives of people, and observe the results of their work, which is beyond just <em>taking care of patients</em>. Nurses accounted for meaningful work in terms of close connections with patients, while being closely focused on ability to provide professional care and experiencing the outcomes associated with that care, and knowing that they have done a good job. Physicians were patient focused, and they expressed meaningful work in terms of making a difference, and using their abilities to help patients. Basic scientists accounted for meaningful work in terms of their training and abilities to use science for the betterment of others in society. Timothy Atkinson Molly Gathright James Clardy Carol Thrush Erick Messias ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2018-08-31 2018-08-31 2 2 10.4081/qrmh.2018.7572 A qualitative study of illness identity: schizophrenia and depression https://pagepressjournals.org/index.php/qrmh/article/view/7420 Illness identity refers to the interpretation of having mental illness in persons who regard themselves as mentally ill. Illness identity can impact people diagnosed with mental illness negatively. However, little is known about the background of illness identity. This study aimed to investigate the process whereby mental health service users accept their diagnosis and develop an illness identity and to compare the processes between schizophrenia and depression. Twenty persons with schizophrenia and depression were interviewed, and the data were analysed using grounded theory approach. The major findings were as follows: i) while those with schizophrenia were shocked by their diagnosis and took time to accept it, this was not true for those with depression; ii) for participants with depression, it was relatively easy to accept their diagnosis, as they thought that depression was a <em>normal illness</em>; participants with schizophrenia needed to learn about their illness, know the efficacy of psychiatric medication and reduce their prejudice against mental illness to accept their diagnosis; and iii) participants’ illness identity encompassed <em>sickness</em> and <em>normality</em> with <em>sickness</em> being related to taking psychiatric medication and <em>normality</em> being associated with having regular work, acting as other people do or living in the community. These findings suggest the influence of social attitudes to each illness on illness identity and the complex nature of illness identity. Namino Ottewell ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2018-08-31 2018-08-31 2 2 10.4081/qrmh.2018.7420 A qualitative study of urban hospital transitional care https://pagepressjournals.org/index.php/qrmh/article/view/7216 This study is part of a mixed methods evaluation of a large urban medical center transitional care practice (NMG-TC). The NMG-TC provides integrated physical and behavioral health care for high need patients referred from the hospital emergency department or inpatient units and who lack a usual source of primary care. The study was designed for internal quality improvement and sought to evaluate staff perceptions of successful transitions for their medically and socially complex patients, and alternatively, the obstacles most likely to negatively impact patient outcomes. All 16 NMG-TC patient care staff were interviewed in a collaborative effort to produce empowered testimony that might go beyond expected clinical narratives. The interview schedule included questions on risk stratification, integrated mental health care, provider to provider handoffs, and how staff deal with key social determinates of patients’ health. The constant comparative method was used to deductively derive themes reflecting key domains of transitional care practice. Seven themes emerged: i) the need to quickly assess patient complexity; ii) emphasizing caring for major mental health and substance use issues; iii) obstacles to care for uninsured, often undocumented patients; iv) the intractability of homelessness; v) expertise in advancing patients’ health literacy, engagement and activation; vi) fragmented handoffs from hospital care and vii) to primary care in the community. Respondent stories emphasized methods of nurturing patients’ self-efficacy in a very challenging urban health environment. Findings will be used to conceptualize pragmatic, potentially high-impact transitional care quality improvement initiatives capable of better addressing frequent hospital use. Joe Feinglass Samuel Wein Caroline Teter Christine Schaeffer Angela Rogers ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2018-08-31 2018-08-31 2 2 10.4081/qrmh.2018.7216 Stress and burnout in anesthesia residency: an exploratory case study of peer support groups https://pagepressjournals.org/index.php/qrmh/article/view/7417 Stress and burnout are alarmingly prevalent in anesthesiologists, with the highest risk occurring during anesthesia residency training. To better understand this phenomenon, we conducted a mixed methods case study of our anesthesia training program to explore the residents’ accounts of stress and burnout and the potential value of peer support groups. Eight out of thirty eight residents participated in nine monthly peer support group (PSG) meetings followed by a focus group interview about stress and burnout in training and the value of PSG. We compared the participants’ mean pre-and post-PSG Maslach Burnout Inventory® (MBI) and Perceived Stress Scale® (PSS) and analysed the focus group interview for recurring themes. We captured the perspectives of twenty seven out of thirty residents who did not participate in support groups (non-participants) through an online survey on stress and burnout. We found evidence of a high prevalence of stress and burnout from the MBI and PSS scores and survey responses. Analysis of the focus group interview showed that the specific stressors of anesthesia training included: an individually-based model of training that predisposes to isolation from peers, an over-reliance on the quality of the faculty-resident relationship and the critical, high stakes nature of the profession. Residents strongly endorsed the value of PSG in decreasing isolation, enhancing validation, and support through the sharing of experiences. Lack of dedicated time and integration into the training program were major barriers to PSG participation. These barriers need to be overcome in order to fully realize its role in mitigating stress and burnout. Jessica Spence David Smith Anne Wong ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2018-09-03 2018-09-03 2 2 10.4081/qrmh.2018.7417 Above and beyond: an exploratory study of breast cancer patient accounts of healthcare provider information-giving practices and informational support https://pagepressjournals.org/index.php/qrmh/article/view/7387 This qualitative study examines breast cancer patients’ accounts of the characteristics of healthcare providers’ supportive information- giving practices. Twenty-two women diagnosed with breast cancer participated in semi-structured in-depth interviews designed to understand their experiences receiving supportive information from healthcare providers (<em>e.g.</em>, oncologists, surgeons, nurse practitioners). Participants’ accounts suggest that providers who spend extensive time discussing cancer-related information and who explain that information thoroughly so that patients can understand their medical situation, are communicating informational support in contrast to merely presenting factual information related to cancer diagnosis and treatments. Participant accounts further suggest that the supportive nature of provider information-giving practices results from message framing, or the provider’s metacommunication. Andrea L. Meluch ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2018-08-31 2018-08-31 2 2 10.4081/qrmh.2018.7387