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Transformative service in healthcare: understanding secondary vulnerability and coping mechanisms in end-of-life care
Abstract
Purpose
This study aims to investigate the notion of secondary vulnerability among transformative service providers, particularly frontline healthcare professionals (HCP), during the provision of end-of-life care. It seeks to understand how stressors and coping mechanisms influence vulnerability and subsequently impact service outcomes for patients and frontline employees.
Design/methodology/approach
The research framework, based on the Transactional Model of Stress and Coping, was used to explore secondary vulnerability among frontline healthcare providers. A qualitative, interpretive approach was employed involving semi-structured interviews for data collection. The interview transcripts were analysed using a two-stage process, starting with inductive analysis and followed by deductive analysis.
Findings
Secondary vulnerability is conceptualized along with its implications, shedding light on the role of stress and coping mechanisms in responding to vulnerable situations. It identifies the interplay between situational and personal factors that influence service outcomes for both HCPs and patients.
Practical implications
By recognizing stressors and coping strategies, organizations can implement support programs to enhance HCP well-being and improve care quality for patients experiencing vulnerability. Training programs can equip HCPs with effective coping mechanisms to mitigate the impact of secondary vulnerability on service outcomes.
Originality/value
This research contributes to the literature by addressing a gap in understanding regarding secondary vulnerability among transformative service providers. By integrating theories from various fields, including consumer vulnerability, transformative service mediation, healthcare services, and stress and coping mechanisms, it offers a novel perspective on the dynamics of vulnerability in end-of-life care in a healthcare setting.
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Journey research has primarily analyzed agentic, solo travelers making rational single-purchase decisions. In contrast, we examine a journey where consumers and their traveling companions are vulnerable and must navigate an unfamiliar service system. We explore how vulnerability shapes consumer journeys, how service and system factors impact vulnerability, and how traveling companions influence agency and vulnerability. Using data from an extensive study into end-of-life care, our results reveal novel insights into the role of consumer vulnerability throughout a journey. We show how the ebb and flow of consumer vulnerability shapes the journey, and how the journey shapes vulnerability. Traveling companions, themselves vulnerable, play a major role in influencing vulnerability and the journey itself. We offer managerial implications for organizations whose consumers are in vulnerable situations.
Thematic analysis is a highly popular technique among qualitative researchers for analyzing qualitative data, which usually comprises thick descriptive data. However, the application and use of thematic analysis has also involved complications due to confusion regarding the final outcome’s presentation as a conceptual model. This paper develops a systematic thematic analysis process for creating a conceptual model from qualitative research findings. It explores the adaptability of the proposed process across various research methodologies, including constructivist methodologies, positivist methodologies, grounded theory, and interpretive phenomenology, and justifies their application. The paper distinguishes between inductive and deductive coding approaches and emphasizes the merits of each. It suggests that the derived systematic thematic analysis model is valuable across multiple disciplines, particularly in grounded theory, ethnographic approaches, and narrative approaches, while also being adaptable to more descriptive, positivist-based methodologies. By providing a methodological roadmap, this study enhances the rigor and replicability of thematic analysis and offers a comprehensive strategy for theoretical conceptualization in qualitative research. The contribution of this paper is a systematic six-step thematic analysis process that leads to the development of a conceptual model; each step is described in detail and examples are given.
Background
Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted.
Aim
The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care.
Design
A rapid umbrella review was conducted and informed by the Joanna Briggs Institute’s methodological guidance for conducting umbrella reviews.
Data sources
Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care.
Results
A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature.
Conclusions
This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
Transformative Service Research (TSR) highlights the fundamental importance of resource integration for consumer well-being. However, recent research suggests that resource integration can be problematic and imperfect, particularly for vulnerable consumers with complex and ongoing resource requirements. Such vulnerable consumers may face transition challenges and end up in an uncertain “in-between” experience of liminality, where the linkage to resource integration remains under-researched. In response to recent service prioritization challenges, we explore how vulnerable actors experience liminality and resource integration in service systems. The vulnerable actors highlighted in this study are parents in families of children with life-long conditions (e.g., autism spectrum disorder/ASD and Down syndrome). We reveal a new form of liminality as a persistent, relational phenomenon that interdependent vulnerable actors with ongoing complex resource needs collectively experienced within service systems. Further, we identify the dynamics of persistent liminality as Precipitating, Subsisting, and Resisting. Finally, in line with TSR, we shed light on the resource constraints that decrease the well-being of vulnerable consumers. We also identify implications for theory, practice, and future research.
Purpose
The current research aims to introduce the concept of frontline employee (FLE) vulnerability and examine its antecedents and consequences using a framework grounded in Job Demands-Resource theory (JD-R).
Design/methodology/approach
A systematic review and meta-analysis guided by PRISMA is utilized to review previous FLE literature (204 studies) and develop a conceptualization of FLE vulnerability. The meta-analysis then examines the antecedents and consequences of FLE vulnerability and provides generalizable findings including the identification of critical areas for future research.
Findings
The meta-analysis provided support for the proposed conceptualization of FLE vulnerability. Specifically, job demands and individual characteristics were observed to increase FLE vulnerability, conceptualized as an individual's susceptibility to experience state-based harm. Job resources were seen to minimize FLE susceptibility to vulnerability. FLE vulnerability was also observed to significantly strengthen negative outcomes and decrease positive outcomes.
Originality/value
This research addresses calls for greater investigation into how negative events may impact FLE vulnerability. This is achieved by defining FLE vulnerability as a concept which represents one's susceptibility to experience state-based harm as a result of job and/or individual characteristics. The research also provides greater understanding of the health impairment process within JD-R through the introduction and expanded definition of harm that moves beyond physical considerations to also include emotional and psychological harms. Finally, the research adds to the small body of meta-analytic research in the field of service management.
Introduction
Providing bereavement support and care to families is an aspect of critical care nursing practice that can be rewarding, yet emotionally and psychologically challenging. Whilst significant research has focused on end-of-life care in critical care, less is known about nurses’ experiences after patient death.
Aim
The aim of this study was to synthesise research evidence on the experience of registered nurses after patient death in adult critical care.
Design
A structured integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings were used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Ovid Medline, PsycInfo, Embase, and Emcare databases. Records were independently assessed against inclusion and exclusion criteria. A process of forward and backward chaining was used to identify additional papers. All papers were assessed for quality. Narrative synthesis was used to analyse and present the findings.
Results
From the 4643 records eligible for screening, 36 papers reporting 35 studies were included in this review, representing the voices of 1687 nurses from more than 20 countries. Narrative synthesis revealed three themes: (i) postmortem care, which encompassed demonstrating respect and dignity for the deceased, preparation of the deceased, and the concurrent death rituals performed by nurses; (ii) critical care nurses' support of bereaved families, including families of potential organ donors and the system pressures that impeded family support; and (iii) nurses’ emotional response to patient death including coping mechanisms.
Conclusions
Whilst a focus on the provision of high-quality end-of-life care should always remain a priority in critical care nursing, recognising the importance of after-death care for the patient, family and self is equally important. Acknowledging their experience, access to formal education and experiential learning and formal and informal supports to aid self-care are imperative.
The notion of vulnerability is relevant to much of social marketing as interventions often involve people seeking support or people experiencing disadvantage. However, the deficit-framing of people experiencing vulnerability is problematic. We propose that the alternate strengths-based approach will improve social marketing success and illustrate this with data from a project aimed at widening participation in tertiary education. Using data from interviews and co-design workshops with 87 school students and recent school leavers, we offer a new evidence-based definition of customer/consumer vulnerability that is strengths-based. We also present a five-step, evidence-based process for how social marketers can use a strengths-based approach (SA) to elicit deep insights (I) from the tacit knowledge of customers/consumers experiencing vulnerability (V). We term this process SAIV and demonstrate the value of tacit knowledge in intervention innovation and how a strengths-based approach can draw out tacit knowledge. We encourage social marketers to adopt a strengths-based approach, definition of vulnerability and process to enhance intervention efficacy.
Aim:
To systematically identify, appraise, aggregate and synthesise qualitative evidence on family members' experiences of end-of-life care (EoLC) in acute hospitals.
Methods:
A systematic review and qualitative evidence synthesis based on the Joanna Briggs Institute methodology. Primary research, published 2014 onwards was identified using a sequential strategy of electronic and hand searches. Six databases (CINAHL, Medline, Embase, EMCare, PsycINFO, BNI) were systematically searched. Studies that met pre-determined inclusion/exclusion criteria were uniformly appraised using the Critical Appraisal Skills Programme checklist for qualitative research, and synthesised using a meta-aggregative approach. The ENTREQ statement was used as a checklist for reporting the review.
Results:
Sixteen studies of European, Australasian and North American origin formed the review. The quality of each study was considered very good in view of a 'yes' response to most screening questions. Extracted findings were assembled into 12 categories, and five synthesised findings: Understanding of approaching end of life; essential care at the end of life; interpersonal interactions; environment of care; patient and family care after death.
Conclusion:
Enabling and improving peoples' experience of EoLC must remain part of the vision and mission of hospital organisations. Consideration must be given to the fulfilment of family needs and apparent hallmarks of quality care that appear to influence experiential outcomes.
Relevance to clinical practice:
This review of qualitative research represents the first-stage development of a family-reported experience measure for adult EoLC in the hospital setting. The synthesised findings provide a Western perspective of care practices and environmental factors that are perceived to impact the quality of the care experience. Collectively, the review findings serve as a guide for evidence-informed practice, quality improvement, service evaluation and future research. A developed understanding of the families' subjective reflections creates reciprocal opportunity to transform experiential insights into practical strategies for professional growth and practice development.
Background and Objectives: To evaluate the efficacy of coping strategies used to reduce burnout syndrome in healthcare workers teams. Materials and Methods: We used PubMed and Web of Science, including scientific articles and other studies for additional citations. Only 7 of 906 publications have the appropriate inclusion criteria and were selected. A PRISMA 2020 flow diagram was used. Results: The most common coping strategies that the literature studies showed were efficient, in particular social and emotional support, physical activity, physical self-care, emotional and physical distancing from work. Coping mechanisms associated with less burnout were also physical well-being, clinical variety, setting boundaries, transcendental, passion for one’s work, realistic expectations, remembering patients and organizational activities. Furthermore, it was helpful to listen to the team’s needs and preferences about some types of training. Conclusion: We suppose that the appropriate coping strategies employed in the team could be useful also in the prevention of psychological suffering, especially in contexts where working conditions are stressful. Studies about coping strategies to face burnout syndrome in healthcare workers should be increased.
Even as transformative service initiatives promote greater well-being, they may also create unintentionally negative consequences. Research investigates boundary conditions and boomerang effects that wash out or reverse the intended effects of service initiatives. However, such research generally advances greater depth of insight about unintended consequences in a particular stream rather than bridging this knowledge across service domains. Thus, service research lacks integrative frameworks, theory, and empirical insight to advance more generalizable knowledge about unintended consequences. The purpose of this editorial is to clarify the importance of investigating unintended consequences across service contexts and propose pathways as a catalyst for research. Using theory on unintended consequences, we delineate the types of unintended consequences and discuss the underlying mechanisms. We identify themes that span papers in the special issue and illuminate negative spillover consequences. The editorial concludes with an overview of future research avenues with potential to accelerate important transformative service research.
Patient death in critical care is not uncommon. Rather, the provision of end-of-life care is a core feature of critical care nursing, yet not all nurses feel adequately prepared for their role in the provision of end-of-life care. For this reason, the Australian College of Critical Care Nurses (ACCCN) supported the development of a Position Statement to provide nurses with clear practice recommendations to guide the provision of end-of-life care, which reflect the most relevant evidence and information associated with end-of-life care for adult patients in Australian critical care settings. A systematic literature search was conducted between June and July, 2020 in CINAHL Complete, Medline, and EMBASE databases to locate research evidence related to key elements of end-of-life care in critical care. Preference was given to the most recent Australian or Australasian research evidence, where available. Once the practice recommendations were drafted in accordance with the research evidence, a clinical expert review panel was established. The panel comprised clinically active ACCCN members with at least 12 months of clinical experience. The clinical expert review panel participated in an eDelphi process to provide face validity for practice recommendations and a subsequent online meeting to suggest additional refinements and ensure the final practice recommendations were meaningful and practical for critical care nursing practice in Australia. ACCCN Board members also provided independent review of the Position Statement. This Position Statement is intended to provide practical guidance to critical care nurses in the provision of adult end-of-life care in Australian critical care settings.
We aimed to identify the level of prognostic disclosure, type of prognostic information and delivery format of prognostic communication that older adults diagnosed with a life-limiting illness or caregivers prefer to receive. We developed and pilot tested an open-ended survey to 15 older patients and caregivers who had experience in health services for life-limiting illness either for a relative, friend or themselves. Five hypothetical clinical scenarios of prognostic options were presented to ascertain preferences. The preferred format to receive prognostic information was verbal delivery by the clinician with a written summary. Photos and videos were less favoured, and a table with numbers/percentages was least preferred. Distress levels to the prognostic scenarios were low, with the exception of a photo. We conclude that older patients/caregivers want end-of-life prognostic information delivered the traditional way, verbally by clinicians. Options to deliver prognostic information may vary across patient groups but empower clinicians in introducing end-of-life discussions with patients/caregivers. Our study illustrates the feasibility of involving terminal patients and caregivers in research that contributes to eliciting prognostic preferences. Further research is needed to understand whether the prognostic preferences of hospitalized patients with life-limiting illness differ.
Purpose
The purpose of this paper is to develop a process model for the role transformation of vulnerable consumers through support services.
Design/methodology/approach
The study is based on four years of participant observation at a community-based support service and in-depth interviews with the consumers. Visual ethnography was used to document the process of the consumers' role transformation through service exchanges.
Findings
The main outcome of this study is a consumer transformation model, describing consumers' role transformation processes, from recipients to generic actors. The model demonstrates that vulnerable consumers will transform from recipients to quasi-actors before becoming generic actors.
Social implications
Vulnerable consumers' participation in value cocreation can be promoted by providing social support according to their dynamic roles. By enabling consumers to participate in value cocreation, social support provision can become sustainable and inclusive, especially in rural areas affected by aging and depopulation. Transforming recipients into generic actors should be a critical aim of service provision in the global challenge of aging societies.
Originality/value
Beyond identifying service factors, the research findings describe the mechanism of consumers' role transformation process as a service mechanics study. Furthermore, this study contributes to transformative service research by applying social exchange theory and broadening service-dominant logic by describing the process of consumer growth for individual and community well-being.
La violence en milieu de travail est un facteur de risque connu pour la chute de la santé mentale et les intentions de quitter leur emploi. Pourtant, à ce jour, les chercheurs ne savent toujours pas comment les travailleurs victimes s’en sortent avec le temps ou comment les organisations peuvent les aider à se rétablir. Cette étude visait à documenter l’évolution de la détresse psychologique chez un échantillon de professionnels récemment victimes (N = 81) immédiatement après l’événement et au cours de l’année suivante. La modélisation mixte a été utilisée pour évaluer les scores de détresse à 4 moments différents (3, 11, 27 et 52 semaines). Les résultats indiquent que la violence faite par les patients a eu des répercussions graves sur la santé mentale du personnel, avec près de 35% des femmes et 11% des hommes souffrant de détresse grave après leur retour au travail. De plus, 15% des participants ont dépassé le seuil diagnostique de trouble de stress aigu (TSA). Les taux de détresse psychologique ont diminué de façon constante au fil du temps, mais sont toujours restés au-dessus de la moyenne nationale. Bien que le soutien organisationnel perçu s’avère un bon facteur de protection contre la détresse, son effet s’est érodé avec l’exposition cumulative à la violence. Étant donné le risque élevé de violence dans certains milieux de travail, cet article conclut par une discussion sur la façon dont les organisations peuvent être plus attentionnées face aux besoins des travailleurs traumatisés. Les employeurs devraient dépister les travailleurs victimes afin de s’assurer qu’ils reçoivent l’aide dont ils ont besoin.
Data saturation is the most commonly employed concept for estimating sample sizes in qualitative research. Over the past 20 years, scholars using both empirical research and mathematical/statistical models have made significant contributions to the question: How many qualitative interviews are enough? This body of work has advanced the evidence base for sample size estimation in qualitative inquiry during the design phase of a study, prior to data collection, but it does not provide qualitative researchers with a simple and reliable way to determine the adequacy of sample sizes during and/or after data collection. Using the principle of saturation as a foundation, we describe and validate a simple-to-apply method for assessing and reporting on saturation in the context of inductive thematic analyses. Following a review of the empirical research on data saturation and sample size estimation in qualitative research, we propose an alternative way to evaluate saturation that overcomes the shortcomings and challenges associated with existing methods identified in our review. Our approach includes three primary elements in its calculation and assessment: Base Size, Run Length, and New Information Threshold. We additionally propose a more flexible approach to reporting saturation. To validate our method, we use a bootstrapping technique on three existing thematically coded qualitative datasets generated from in-depth interviews. Results from this analysis indicate the method we propose to assess and report on saturation is feasible and congruent with findings from earlier studies.
The present study examined the relationships between character strengths and psychological resilience and psychological vulnerability. The sample consisted of 381 high school students (164 males and 217 females) ranging in age from 14 to 18 years (Mean = 15.63, SD = 1.12). Character Growth Index, the Brief Resilience Scale and Psychological Vulnerability Scale were used as measures to collect the data. Structural Equation Modeling and bootstrapping methods were used to examine the mediating role of psychological resilience in relationships between character strengths and psychological vulnerability. In the structural model, certain character strengths i.e. wisdom, courage, optimism, and, calmness were found to increase psychological resilience, and psychological resilience decreased psychological vulnerability. Also, psychological resilience fully mediated the relationship between the character strengths of wisdom, courage, optimism, and calmness and psychological vulnerability. The results of the bootstrapping analysis showed that the indirect effects of the character strengths of wisdom, courage, optimism, and calmness on psychological vulnerability were significant. Based on these results, we conclude that high levels of wisdom, courage, optimism and calmness accompanied by psychological resilience may lead to decreased psychological vulnerability. The theoretical and practical implications for researchers and practitioners and limitations are discussed.
As qualitative research becomes increasingly recognized and valued, it is imperative that it is conducted in a rigorous and methodical manner to yield meaningful and useful results. To be accepted as trustworthy, qualitative researchers must demonstrate that data analysis has been conducted in a precise, consistent, and exhaustive manner through recording, systematizing , and disclosing the methods of analysis with enough detail to enable the reader to determine whether the process is credible. Although there are numerous examples of how to conduct qualitative research, few sophisticated tools are available to researchers for conducting a rigorous and relevant thematic analysis. The purpose of this article is to guide researchers using thematic analysis as a research method. We offer personal insights and practical examples, while exploring issues of rigor and trustworthiness. The process of conducting a thematic analysis is illustrated through the presentation of an auditable decision trail, guiding interpreting and representing textual data. We detail our step-by-step approach to exploring the effectiveness of strategic clinical networks in Alberta, Canada, in our mixed methods case study. This article contributes a purposeful approach to thematic analysis in order to systematize and increase the traceability and verification of the analysis.
Denham and Onwuegbuzie (2013) provided evidence that relatively few qualitative researchers include any mention of nonverbal communication in their empirical articles. Of those who do include this information, the vast majority of qualitative researchers devote as little as one sentence to nonverbal communication data in their published articles. However, this lack of reporting of nonverbal communication data likely stems from the scant guidance in this area given by authors of qualitative research textbooks. Thus, the purpose of the present article is to provide a framework for collecting, analyzing, and interpreting nonverbal communication behavior. This framework yields guidelines for students to collect, to analyze, to interpret, and to report nonverbal communication data. Underlying this framework is a 13-step nonverbal communication process that serves as a conceptual framework that we use in our qualitative research methodology courses to help students develop a nonverbal communication way of thinking. This 13-step nonverbal communication process occurs at the following three stages: the Conceptualization Stage, the Planning Stage, and the Implementation Phase. Rather than representing a linear process, the nonverbal communication methodological steps within each stage and across stages are interactive and recursive. After providing this framework, we present an exemplar for reporting nonverbal communication data.
The aging population is an important consumer policy concern. Therefore, a relevant question to ask is: are there reasons to worry about consumer vulnerability among older people? The aim of the project was twofold: First, to gain insight into what makes people vulnerable as consumers, more precisely to reveal significant vulnerability drivers. Second, if possible, to distinguish particularly vulnerable consumer groups and their needs for targeted consumer policy measures.The project builds on a qualitative pilot study among older people, followed by a large nationally representative survey among people living in Norway, between 18 and 95 years old. Based on the analysis of 2100 telephone interviews, this paper rejects our a-priori assumption, that older people constitutes a vulnerable consumer group. Although older people have several reduced capabilities that could act as vulnerability drivers, older people appeared to be less likely than other age groups to make unfortunate decisions in the markets. Older people also show a much more environmentally friendly consumption pattern than younger generations. The main individual vulnerability drivers appeared to be; poor economic awareness and lack of time. The results also indicate that people who lack calculating skills, as well as people living in households with scarce financial resources, are more likely than others to make economically unfortunate consumer choices. This article is protected by copyright. All rights reserved.
Stress is one of many impacts on host community residents that can result from tourism development. Unmitigated stress can lead to a variety of negative health and behavioral outcomes. Factors like personality, social support, stress appraisal, and coping play a role in how stress affects individuals. This research conceptualizes the psychologically based stress and coping process in a tourism development context. Measurements of each element in the process are tested for construct validity in the context of cruise tourism development in Jamaica. Construct validity was supported for measures of social support and secondary stress appraisal. A measurement of coping was found to have a different factor structure in a tourism context than theoretically predicted. Valid measurement is critical to future research examining relationships within this psychological process and ultimately understanding how individuals' emotional and psychological quality of life is affected by tourism development.
This article conceptualizes and presents a research agenda for the emerging area of transformative service research, which lies at the intersection of service research and transformative consumer research and focuses on well-being outcomes related to service and services. A conceptual framework provides a big-picture view of how the interaction between service entities (e.g., individual service employees, service processes or offerings, organizations) and consumer entities (e.g., individuals, collectives such as families or communities, the ecosystem) influences the well-being outcomes of both. Research questions derived from the framework in the context of financial services, health care, and social services help catalyze new research in the transformative service research domain.
We examine the literature on emotional labor and health care to demonstrate the potential for emotional labor research to inform how social and medical scientists think about health care and how examining healthcare contexts has contributed to the scientific understanding of emotional labor processes. In doing so, we first review the key terms and definitions that are used within the emotion management perspective and evaluate the ways in which power differences have remained largely implicit features of research on emotional labor in healthcare settings. Finally, we explore how the increasing economic rationalization of health care may be influencing the emotional experiences of today's healthcare professionals and the implications of this trend for future research on emotional labor and the health and well-being of care providers and their patients.
Transformative service systems (TSSs) are designed to uplift human well-being. Yet, paradoxically, by necessity and in design, TSSs can also generate unintended harms for system actors. Our conceptual paper builds on recent service literature, as well as that on unintended consequences from a range of fields, to advance an integrative framework of harms in TSSs. Through the enabling theory of the doctrine of double effect, our framework organizes harms in the transformative service context, identifying that unintended harms can be both foreseen and unforeseen. Additionally, we find that the mechanism underlying these harms is system emergence. Emergence arises from the relative complexity of the service system and the relative dynamism of the issue the TSS aims to address. Our framework demonstrates that greater service system complexity increases the likelihood of foreseen harms, while greater relative dynamism increases the likelihood of unforeseen harms arising. Furthermore, we show how these two factors combine to promulgate the emergence of harms. We find that in instances where harm arises, greater service system adaption is required to mitigate such harms. However, some TSS harms are an inevitable and unfortunate secondary outcome of doing good, and these harms necessitate acknowledgment and acceptance by service designers.
Purpose
The aim of this research is to provide insight into how organizations can co-create value with family members engaged in service journeys of customers experiencing vulnerabilities, thereby paying attention to their organizational practices (i.e. recursive or routinized patterns of organizational actions and behaviors).
Design/methodology/approach
To investigate, this research relies upon a multiple case study in a group of nursing homes in Flanders that had the ambition to engage family members in service journeys of their loved ones while measuring their value perceptions as a performance indicator (here, satisfaction with nursing home services).
Findings
The case evidence shows that nursing homes co-create value with family members through caring practices that focus on their role as secondary customers (i.e. welcoming, connecting and embedding) and empowering practices that focus on their role as partial employees (i.e. teaming up, informing and listening practices). However, the way in which the different caring and empowering practices are enacted by the nursing home and its staff affects their value co-creation potential.
Originality/value
By focusing on the practices with which organizations can co-create value with family members engaged in service journeys of their loved ones, this research bridges the service literature with its attention for value co-creation practices and the literature on customers experiencing vulnerabilities with its focus on extended customer entities.
Purpose
The increasing financial burden and complexity of health-care services, exacerbated by factors such as an ageing population and the rise of chronic conditions, necessitate comprehensive and integrated care approaches. While co-created service design has proven valuable in transforming some service industries, its application to the health-care industry is not well understood. This study aims to examine how health consumers are involved in health-care service co-creation.
Design/methodology/approach
The study searched 11 electronic databases for peer-reviewed articles published between 2010 and 2019. Additionally, hand searches of reference lists from included studies, Google © citation searches and searches for grey literature were conducted. The Whittemore and Knafl integrative framework guided the systematic review, and Callahan’s 6 Ws framework was used to extract data from the included articles, facilitating comparisons.
Findings
The authors identified 21 articles, mainly from the UK, North America and Australia. Despite the need for more research, findings reveal limited and geographically narrow empirical studies with restricted theory and method applications. From these findings, the authors constructed a conceptual model to enhance nuanced understanding.
Originality/value
This study offers four contributions. First, it introduces the Health Service Design Transformation Model for Comprehensive Consumer Co-Creation, illustrating health consumers’ multifaceted roles in shaping services. Second, consumer vulnerabilities in co-creating services are identified, linked to diverse consumer groups, power dynamics and decision complexity. Third, this study suggests broadening participant inclusion may enhance consumer-centricity, inclusivity and innovation in service design. Finally, the research agenda explores consumer experiences, organizational dynamics, value outcomes and co-creation theory for health-care service advancement.
Healthcare organizations around the world are striving to find the right balance between using their resources effectively and providing personalized care to patients. Health care is shifting from a reactive, towards a more person‐centric approach to improve health outcomes. To achieve quality improvements and efficiencies, health care organizations are forming inter‐organizational relationships. Despite the benefits, little is known about how organizations capture value from strategic partnership. In this context, this paper aims to examine the processes that occur as part of a public and non‐profit sector relationship within health care that directly relate to how the partnering organization acts to capture value. Using a qualitative case study of an Australian public‐sector health service partnership, the study employs a value mapping framework to distinguish between different types of value (captured, missed, destroyed, and opportunity), and presents an integrated model consisting of three process phases: (1) inter‐organizational cooperation effort, (2) organizational effect, and (3) social value. The study highlights the potential for negative and unintended consequences and discusses implications for management.
Background:
Depression, anxiety, and burnout are an epidemic in the nursing profession. Unlike nurses in clinical settings, little is known about the mental health of doctorally prepared nursing faculty in academic settings, especially when separated by degree type (Doctor of Philosophy in Nursing [PhD] vs. Doctor of Nursing Practice [DNP]) and clinical or tenure track.
Aims:
The study aims were to: (1) describe the current rate of depression, anxiety, and burnout in PhD and DNP-prepared nursing faculty and tenure and clinical faculty across the United States; (2) determine if differences exist in mental health outcomes between PhD and DNP-prepared faculty and tenure and clinical faculty; (3) explore whether wellness culture and mattering to the organization influence faculty mental health outcomes; and (4) gain insight into faculty's perceptions of their roles.
Methods:
An online descriptive correlational survey design was used with doctorally prepared nursing faculty across the U.S. The survey was distributed to faculty by nursing deans and included: demographics; valid and reliable scales for depression, anxiety, and burnout; an assessment of wellness culture and mattering; and an open-ended question. Descriptive statistics described mental health outcomes; Cohen's d was used to determine effect sizes between PhD and DNP faculty for the mental health outcomes; and Spearman's correlations tested associations among depression, anxiety, burnout, mattering, and workplace culture.
Results:
PhD (n = 110) and DNP (n = 114) faculty completed the survey; 70.9% of PhD faculty and 35.1% of DNP faculty were tenure track. A small effect size (0.22) was found, with more PhDs (17.3%) screening positive for depression than DNPs (9.6%). No differences were observed between tenure and clinical track. Higher perceptions of mattering and workplace culture were associated with less depression, anxiety, and burnout. Identified contributions to mental health outcomes yielded five themes: lack of appreciation, role concerns, time for scholarship, burnout cultures, and faculty preparation for teaching.
Linking evidence to action:
Urgent action must be taken by college leaders to correct system issues contributing to suboptimal mental health in both faculty and students. Academic organizations need to build wellness cultures and provide infrastructures that offer evidence-based interventions to support faculty well-being.
Background
Intensive care units (ICUs) are emotionally demanding workplaces. Exposure to stress can negatively impact ICU staff members' emotional resilience, health, and capacity to provide care. Despite recognition of the benefits of promoting “healthy workplaces”, there are limited interventional studies aimed at improving the well-being of ICU staff.
Aim
The aim of this study was to assess the effectiveness of a multifaceted intervention for improving well-being of staff working in a tertiary ICU.
Methods
A before-and-after interventional study was conducted over a 2-year period, between 2019 and 2021. Interventions included social activities, fitness, nutrition, and emotional support. An electronic version of the PERMA-Profiler questionnaire was used to assess the well-being of a convenience sample of ICU staff before (n = 96) and after (n = 137) the intervention. Ten focus groups (each involving 12–18 nurses) were held to explore nurses' perceptions of the intervention's effectiveness.
Results
After the intervention, a significantly greater proportion of participants described their work week as draining (32% vs 19%, χ² = 4.4 df + 1, P = 0.03) and at least a bit harder than normal (38% vs 22%, χ² = 6.4 df + 1, p = 0.01) compared to baseline surveys. However, well-being scores after the intervention (mean = 6.95, standard deviation = 1.28) were not statistically different (p = 0.68) from baseline scores (mean = 7.02, standard deviation = 1.29). Analysis of focus groups data revealed three key categories: boosting morale and fostering togetherness, supporting staff, and barriers to well-being.
Conclusions
After the intervention, there was a preserved level of well-being from baseline despite a statistically significant increase in staff reporting the work week as draining and at least a little bit harder than normal. These findings must be considered in light of the COVID-19 pandemic, which started after baseline data collection and continues to impact the community, including staff workload and pressures in intensive care. The study findings may inform strategies for improving ICU staff members' well-being.
Background
Despite a growing body of research into end-of-life care (EOLC) in intensive care units (ICUs), few studies have concurrently explored the perspectives of families and clinicians.
Objective
The objective of this study was to identify the characteristics of high-quality EOLC in the ICU from family and clinician perspectives and by examining the care documented in medical records.
Methods
A convergent mixed-methods study incorporating electronic health record audits (n = 20), structured interview surveys with families (n = 20), clinician surveys (n = 189), and focus groups (n = 10) was undertaken at a 30-bed, level 3 ICU at a metropolitan public adult teaching hospital in Australia. Descriptive statistics were calculated from quantitative data, and inductive thematic analysis was used to analyse qualitative data.
Results
Overall, families were very satisfied with EOLC and the quality of communication yet, felt that earlier, clearer communication that the patient was dying was required. Families spoke of the attentiveness, or lack thereof, by ICU clinicians and the opportunity to be present for the patient's death. The majority of ICU clinicians felt EOLC could be improved. Nurses highlighted communication challenges when family meetings were delayed. Some nurses expressed a lack of clarity of how to withdraw care, resulting in hesitancy to cease potentially inappropriate care, and to provide EOLC outside ICU practice norms. In many instances, observations, invasive monitoring, and interventions were documented after EOLC commenced. A lack of documented personal cares was also noted.
Conclusions
This study provides new insights into EOLC from the dual perspectives of families and clinicians. There is a need for institutional guidelines to support ICU clinicians’ EOLC practices and education to improve clinician confidence with communication.
Purpose
The purpose of this paper is to provide a state-of-the-art review of research on consumers experiencing vulnerability to describe the current situation of the consumers experiencing vulnerability literature and develop an up-to-date synthesised definition of consumers experiencing vulnerability.
Design/methodology/approach
This systematic review, guided by the PRISMA framework, takes a multi-disciplinary approach to identify 310 articles published between 2010 and 2019 examining consumers experiencing vulnerability. Descriptive analysis of the data is undertaken in combination with a thematic and text mining approach using Leximancer software.
Findings
A definition of consumers experiencing vulnerability is developed- “unique and subjective experiences where characteristics such as states, conditions and/or external factors lead to a consumer experiencing a sense of powerlessness in consumption settings”. The findings reveal consumers experiencing vulnerability have often been classified using a uni-dimensional approach (opposed to a multi-dimensional), focussing on one factor of vulnerability, the most prevalent of these being economic and age factors. A lack of research has examined consumers experiencing vulnerability based upon geographical remoteness, gender and sexual exploitation.
Originality/value
This paper is one of the first to examine consumers experiencing vulnerability using a systematic approach and text mining analysis to synthesise a large set of articles, which subsequently reduces the potential for researchers’ interpretative bias. Further, it is the first to generate a data-driven definition of consumers experiencing vulnerability. It provides targeted recommendations to allow further scholarly, policy and practical contributions to this area.
Provides the essential information that health care researchers and health professionals need to understand the basics of qualitative research Now in its fourth edition, this concise, accessible, and authoritative introduction to conducting and interpreting qualitative research in the health care field has been fully revised and updated. Continuing to introduce the core qualitative methods for data collection and analysis, this new edition also features chapters covering newer methods which are becoming more widely used in the health research field; examining the role of theory, the analysis of virtual and digital data, and advances in participatory approaches to research. Qualitative Research in Health Care, 4th Edition looks at the interface between qualitative and quantitative research in primary mixed method studies, case study research, and secondary analysis and evidence synthesis. The book further offers chapters covering: different research designs, ethical issues in qualitative research; interview, focus group and observational methods; and documentary and conversation analysis. A succinct, and practical guide quickly conveying the essentials of qualitative research Updated with chapters on new and increasingly used methods of data collection including digital and web research Features new examples and up-to-date references and further reading The fourth edition of Qualitative Research in Health Care is relevant to health care professionals, researchers and students in health and related disciplines.
Transformative changes in the societal and service context call out for the service discipline to develop a coherent set of priorities for research and practice. To this end, we utilized multiple data sources: surveys of service scholars and practitioners, web scraping of online documents, a review of published service scholarship, and roundtable discussions conducted at the world’s foremost service research centers. We incorporated innovative methodologies, including machine learning, natural language processing, and qualitative analyses, to identify key service research priorities that are critical to address during these turbulent times. The first two priorities—technology and the changing nature of work and technology and the customer experience—focus on leveraging technology for service provision and consumption. The next two priorities—resource and capability constraints and customer proactivity for well-being—focus on responding to the changing needs of multiple stakeholders. Further, we identified a set of stakeholder-wants from the literature and include research questions that tie key stakeholder-wants to each of the four priorities. We believe the set of research priorities in the present article offer actionable ideas for service research directions in this challenging environment.
Objectives
To examine the effectiveness of end-of-life educational interventions in improving nurses and nursing students' attitude toward death and care of dying patients.
Design
A systematic review and meta-analysis of randomized controlled trials and controlled clinical trials.
Data sources
English language studies were sourced from five electronic databases (PubMed, Embase, CINAHL, PsycINFO and ProQuest Dissertations & Theses Global) to November 2020.
Review methods
A meta-analysis was conducted using the random-effect model. Standardized mean differences with 95% confidence intervals were used as the effect measure under the inverse-variance method. Heterogeneity was assessed using the I² statistics and Cochran's Q chi-squared test. The Cochrane risk of bias tool conducted quality appraisal at the study level while the Grades of Recommendation, Assessment, Development, and Evaluation approach conducted quality appraisal at the outcome level.
Results
Nine studies were included. Meta-analyses showed that end-of-life educational interventions were effective in improving attitude toward death and care of dying patients among nurses and nursing students at post-intervention. The sustainability of improvement of both attitudes could not be determined due to the lack of follow-up assessments by the included studies. Subgroup analyses revealed that both nurses and nursing students showed similar attitude improvement, online educational courses were feasible and attitude toward death may require longer interventions (more than 2 months) to show improvement.
Conclusions
Future trials could be improved by organizing both group-based segments and combined sessions for nurses and nursing students. Online components could be incorporated for convenience. Topics related to spirituality and grief management should be included. Future research is needed to examine the sustainability of nurses and nursing students' improvement in attitude toward death and care of dying patients, as well as how the change in their attitude affects their clinical practices.
Drawing from transformative service and intergroup contact theory, as well as research into the impact of the arts, this article explores the power of Integrative Art Projects among refugees and citizens to foster integration. A mixed method approach, with a representative panel survey of 702 German citizens and qualitative interviews with 30 refugees and 38 arts managers, reveals the positive association of Integrative Art Projects with citizens and refugees’ well-being. The Integrative Art Projects’ value co– creation enhances hedonic and eudaimonic well-being, when four pre-requisites are met: contact, equal status, common goal, and a social authority. This study accordingly advances understanding of the value co-creation in transformative services through the intergroup contact theory and confirms Integrative Art Projects as transformative services that foster integration. Consequently, arts managers should maintain co– creation as a collaborative, customer-specific process and provide space for equal- level exchanges to ensure the integrative power of art projects.
A case study is one of the most commonly used methodologies of social research. This article attempts to look into the various dimensions of a case study research strategy, the different epistemological strands which determine the particular case study type and approach adopted in the field, discusses the factors which can enhance the effectiveness of a case study research, and the debate surrounding the role of a case study in generating theoretical propositions with broader applicability. The prime focus of this article is to engage the reader with the intention of stimulating them to contribute their own bit, in order to add greater novelty and freshness to the methodology of case study.
Purpose – The ongoing pandemic caused by the COVID-19 virus has severely influenced lives and livelihoods. As service organizations either face hibernation or continuity of their business operations, the impact of social distancing measures raises major concerns for the wellbeing of service employees. In this paper, we develop a conceptual framework to examine how different social distancing practices impact an organization’s service continuity or service hibernation, which in turn affects different dimensions of their employees’ subjective wellbeing during the COVID-19 pandemic.
Design/methodology/approach – We draw on macroeconomic data and industry reports, linking them to theoretical concepts to develop a conceptual framework and a research agenda to serve as a starting point to fully understand the impact of this pandemic on employee wellbeing.
Findings – This article develops an overarching framework and research agenda to investigate the impact of social distancing practices on employee wellbeing.
Originality/value – We propose two opposing business concepts—service continuity and service hibernation—as possible responses to social distancing measures. By bridging different theoretical domains, we suggest there is a need to holistically examine macro, meso, and micro factors to fully understand the impact of social-distancing-related measures on employee wellbeing.
Purpose
The purpose of this paper is to examine the influence of social support on young adults with disabilities (YAWDs) independent mobility behavior with the aim of understanding how better to support this vulnerable consumer segment in their transition into the workforce.
Design/methodology/approach
A survey was conducted which examined how social support (high and low) influenced YAWD’s path to independent mobility behavior. The data were analyzed using partial least squares-SEM.
Findings
It was identified that different factors were more effective at influencing independent mobility behavior for high and low socially supported YAWDs. For high social support individuals, anticipated positive emotions and perceived behavioral control were found to drive attitudes to independent mobility with perceived behavioral control significantly stronger for this group than the low socially supported group. For the low socially supported group, all factors were found to drive attitudes which then drove individual behavior. One entire path (risk aversion to anticipated negative emotions to attitude to behavior) was found to be stronger for low supported individuals compared to high.
Originality/value
This study is unique in that it is the first to identify the theoretical constructs that drive vulnerable consumer’s independence behavior and understand how these factors can be influenced to increase independence. It is also the first to identify that different factors influence independent behavior for vulnerable consumers with high and low social support with anticipated negative emotions important for consumers with low social support and perceived behavioral control important for those with high social support.
Purpose
The purpose of this study is to identify the role of mediators in supporting value co-creation for vulnerable consumers in a service context. The authors propose that in transformative services, the roles of actor mediators facilitate control and empowerment for the vulnerable consumer – labelling these transformative service mediators (TSMs).
Design/methodology/approach
The authors develop a theoretical framework for the activities of mediators in value co-creation considering the interrelationships of vulnerability, structure and agency. The authors then use Prahalad and Ramaswamy’s DART (Dialogue, Access, Risk Assessment and Transparency) model as the integrating framework to describe the TSM roles in the context of the foster care service ecosystem.
Findings
The authors introduce a future research agenda regarding TSM roles in transformational service experiences and value co-creation with vulnerable consumers. Service researchers and providers are encouraged to explore effective training and motivation of TSMs.
Research limitations/implications
Understanding value co-creation for vulnerable consumers is an emerging area in service research. The TSM concept introduces a new approach to explore how value co-creation and transformative outcomes can be enhanced in service contexts where consumers experience vulnerability.
Practical implications
This paper presents an agenda for future research. The outcomes of future research based on TSM roles may help guide service providers in identifying opportunities for enhancing well-being and reducing vulnerability in service delivery.
Originality/value
This paper suggests that exploring the role of TSMs in the service process offers new insights into reducing vulnerability in service relationships.
Baker, Gentry, and Rittenburg’s (2005) model of consumer vulnerability outlines the personal, social, and structural characteristics that frame consumers’ experiences of vulnerability in the marketplace. Later applications and enhancements have expanded consumer vulnerability theory. While the theory has been applied in numerous settings, to date it has not been used to examine the ways that gender identity may intersect with market factors to produce vulnerability. Application in this setting also allows for the integration of various model enhancements, and the examination of vulnerability using a more complete formulation of the theory. Based on in-depth qualitative interviews and collages, along with examples from current marketing practice, our research shows consumer vulnerability to be a useful lens for understanding gender variant consumers’ experiences and the ways in which marketing systems can be engaged to reshape those experiences.
The influence of Lazarus and Folkman's (1984) transactional theory of stress and coping is remarkable and remains the cornerstone of psychological stress and coping research across multiple fields. In this chapter we review the key components of this theory, focusing specifically on the effectiveness of the problem-focused and emotion-focused coping taxonomy. We describe the three criteria required for the accurate classification of research concepts: that factors should be conceptually clear, mutually exclusive, and exhaustive, and discuss how well (or not) the problem-focused and emotion-focused coping taxonomy meets these criteria. We also review two alternative coping taxonomies: Edwards and Baglioni's (1993, 2000) cybernetic coping and Skinner, Edge, Altman, and Sherwood's (2003) hierarchical classification of coping according to adaptive function. Finally, we discuss recent refinements to the transactional theory, most notably, future-oriented coping. It is apparent that stress and coping research has been recently rejuvenated and we eagerly anticipate further advancements within this field.
The context in which service is delivered and experienced has, in many respects, fundamentally changed. For instance, advances in technology, especially information technology, are leading to a proliferation of revolutionary services and changing how customers serve themselves before, during, and after purchase. To understand this changing landscape, the authors engaged in an international and interdisciplinary research effort to identify research priorities that have the potential to advance the service field and benefit customers, organizations, and society. The priority-setting process was informed by roundtable discussions with researchers affiliated with service research centers and networks located around the world and resulted in the following 12 service research priorities:
The present study was designed to assess whether or not a transactional model of stress could predict low mood following childbirth in a sample of primiparous women. The research used a two-wave longitudinal design--data were collected during the last trimester of pregnancy (n = 306) and at approximately 6 weeks postpartum (n = 223). Depression vulnerability, social support, appraisal and coping style were assessed at Time 1, and concurrent levels of social support, stress and appraisal were assessed at Time 2. The proposed model was generally upheld: High Edinburgh Postnatal Depression scores were predicted by women's predisposition to depression, negative appraisals of an anticipated childcare stressor, perceptions of low antenatal support and a high use of avoidance coping. In addition, a high number of daily hassles reported since the beginning of pregnancy, stressful childcare events, perceptions of low postnatal social support and negative postnatal appraisals contributed to the onset of low postnatal mood. This model extends the utility of the diathesis-stress account of Postnatal Depression (PND) and has important implications for how PND is treated.
Health care is an enormously expensive, highly complex, universally used service that significantly affects economies and the quality of daily living. Service management, operations, and marketing scholars have much to offer to a critically important, intellectually challenging, but deeply troubled health care service sector. In this article, the authors use the opportunity they had to study at one of the world's most admired medical institutions--Mayo Clinic--as the basis for discussing the similarities and dissimilarities between health care and other services. The article takes the reader "inside" health care. The authors challenge service scholars to consider health care for their research activities and propose areas for future research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)