Many children within the autism population also have food selectivity, and it is not clear how this comorbid difficulty affects the mealtime experience for families. The purpose of this qualitative interview study was to gain an understanding of the mealtime experience of mothers of children with autism and food selectivity. The transcribed interviews were analyzed using a phenomenological approach. Mothers in this study described mealtime as difficult and stressful. Reasons for mealtime stress included the child's self-restricted diet and difficulty sitting at the table. The mothers described attempts to improve mealtime but little success. Implications of the findings are discussed in the context of the literature.
For nurses of the nineteenth and early twentieth centuries, cleanliness was often seen as a virtue next to godliness. For missionary nurses, this analogy took on multiple meanings. This study focuses on discourses of cleanliness at one site of missionary nursing in the early twentieth century: the Rehoboth Mission and its hospital, which provided health-care to the Navajo in the southwestern USA from 1903 to 1965. Data sources included denominational publications, institutional records, correspondence, questionnaires and interviews of the Dutch-American missionary nurses who practiced at the Rehoboth Mission. Discourse analysis was conducted on references to cleanliness, hygiene and sanitation in these texts. Secondary discourses of embodiment in daily practice, initiation and assimilation, caring, ignorance, environmental factors and gendered work were identified and analyzed. The study interrogates the whiteness of the nurses' dominant culture and sheds light on nurses' relationships with normative discursive frames that reflect and perpetuate inequalities, discredit non-dominant practices, and leave little room for competing discourses. It also illustrates a blurring of religion and health-care, and the need for a reflective and informed stance as a basis for cultural competence.
Nurse middle managers are in an ideal position to facilitate patient-centred care. However, their contribution is underexposed in literature due to difficulties to articulate this in practice. This paper explores how nurse middle managers contribute to patient-centred care in hospitals. A combination of time-use analysis and ethnographic work was used to disclose their contribution to patient-centred care at a micro level. Sixteen nurse managers were shadowed for over 560 hours in four hospitals. Some nurse middle managers seldom contribute to patient-centred care. Others are involved in direct patient care, but this does not result in patient-centred practices. At one hospital, the nurse middle managers did contribute to patient-centred care. Here balancing between "organizing work" and "caring work" is seen as a precondition for their patient-centeredness. Other important themes are feedback mechanisms; place matters; with whom to talk and how to frame the issues at stake; and behavioral style. Both "hands-on" and "heads-on" caring work of nurse middle managers enhances their patient-centeredness. This study is the first of its kind to obtain insight in the often difficult to articulate "doings" of nurse middle managers with regard to patient-centred care through combining time-use analysis with ethnographic work.
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