Resistiveness to care is common in older adults with dementia. Resistiveness to care disrupts nursing care, increasing costs of care by 30%. Elderspeak (infantilizing communication used by nursing staff) may trigger resistiveness to care in individuals with dementia. Videotaped care episodes (n = 80) of nursing home residents with dementia (n = 20) were coded for type of staff communication (normal talk and elderspeak) and subsequent resident behavior (cooperative or resistive to care). Bayesian statistical analysis tested relationships between staff communication and subsequent resident resistiveness to care. The probability of resistiveness to care varied significantly with communication (Bayes P = .0082). An increased probability of resistiveness to care occurred with elderspeak (.55, 95% CrI, .44-.66), compared with normal talk (.26, 95% CrI, .12-.44). Communication training has been shown to reduce elderspeak and may reduce resistiveness to care in future research.

/pdf/elderspeak-communication-impact-on-dementia-care-49lrl4n9r1.pdf

Elderspeak communication: impact on dementia care.

Archival storage of data sets from qualitative studies presents opportunities for combining small-scale data sets for reuse/secondary analysis. In this paper, we outline our approach to combining multiple qualitative data sets and explain why working with a corpus of 'big qual' data is a worthwhile endeavour. We present a new approach that iteratively combines recursive surface thematic mapping and in-depth interpretive work. Our breadth-and-depth method involves a series of steps: (1) surveying archived data sets to create a new assemblage of data; (2) recursive surface thematic mapping in dialogue with (3) preliminary 'test pit' analysis, remapping and repetition of preliminary analysis; and (4) in-depth analysis of the type that is familiar to most qualitative researchers. In so doing, we show how qualitative researchers can conduct 'big qual' analysis while retaining the distinctive order of knowledge about social processes that is the hallmark of rigorous qualitative research, with its integrity of attention to nuanced context and detail.

/pdf/big-data-qualitative-style-a-breadth-and-depth-method-for-46lflhrocr.pdf

Big data, qualitative style: a breadth-and-depth method for working with large amounts of secondary qualitative data

Model checking is a critical part of Bayesian data analysis, yet it remains largely unused in systematic studies. Phylogeny estimation has recently moved into an era of increasingly complex models that simultaneously account for multiple evolutionary processes, the statistical fit of these models to the data has rarely been tested. Here we develop a posterior predictive simulation-based model check for a commonly used multispecies coalescent model, implemented in *BEAST, and apply it to 25 published data sets. We show that poor model fit is detectable in the majority of data sets; that this poor fit can mislead phylogenetic estimation; and that in some cases it stems from processes of inherent interest to systematists. We suggest that as systematists scale up to phylogenomic data sets, which will be subject to a heterogeneous array of evolutionary processes, critically evaluating the fit of models to data is an analytical step that can no longer be ignored. (Gene duplication and extinction; gene tree; hybridization; model fit; multispecies coalescent; next-generation sequencing; posterior predictive simulation; species delimitation; species tree.)

/pdf/poor-fit-to-the-multispecies-coalescent-is-widely-detectable-57bzxkl70c.pdf

Poor Fit to the Multispecies Coalescent is Widely Detectable in Empirical Data

Touch mediates health professionals' interactions with patients. Different professionals have reported their practices but what is currently lacking is a well-theorized, interprofessional synthesis. We systematically searched eight databases, identified 41 studies in seven professions-nursing (27), medicine (4), physiotherapy (5), osteopathy (1), counseling (2), psychotherapy (1), dentistry (1)-and completed a meta-ethnographic line-of-argument synthesis. This found that touch is caring, exercises power, and demands safe space. Different professions express care through the medium of touch in different ways. They all, however, expect to initiate touch rather than for patients to do so. Various practices negotiate boundaries that define safe spaces between health care professions and patients. A metaphor-the waltz-integrates the practice of touch. Health care professionals connect physically with patients in ways that form strong relationships between them while "dance steps" help manage the risk that is inherent in such an intimate form of connection.

/pdf/experience-of-touch-in-health-care-a-meta-ethnography-across-386tg6841s.pdf

Experience of Touch in Health Care: A Meta-Ethnography Across the Health Care Professions.

Vaccines are some of the most cost-effective public health interventions for reducing disease burden and mortality However, in recent years, health systems have faced a growing challenge with increasing number of parents who choose not to vaccinate their children This decision has important implications for the health of communities worldwide, and despite a considerable amount of research that reinforces vaccine effectiveness and safety, there is uncertainty surrounding the factors that may encourage vaccine hesitancy in parents In this interpretive review of 34 qualitative studies, we examine the factors that bolster vaccine hesitancy, rejection, and delay, and identify the overlaps and relationships between these factors We depict our findings using the metaphor of a gear train where each gear represents one of seven factors: previous experiences; "natural" and "organic" living; perceptions of other parents; experiences interacting with health care providers; information sources, challenges, and preferences; distrust in health system players; and mandatory vaccine policies

The Factors That Promote Vaccine Hesitancy, Rejection, or Delay in Parents:

The use of metaphors in qualitative research provides an opportunity to examine phenomena from a unique and creative perspective. Metaphors can be used to provide structure to the data; to understand a familiar process in a new light; to identify situation-specific interventions; and to evoke emotion. Misuse of metaphors may detract from the intended research message. Mixing metaphors, failing to follow through with metaphors, and using metaphors that do not fit the data can misrepresent the data. The choice to use metaphors should not become a self-serving attempt at creativity that supersedes subject and substance. At their best, metaphors illuminate the meanings of experiences; at their worst, metaphors distort or obscure the essences of them.

Metaphors in qualitative research: shedding light or casting shadows?

Issues affecting CNAs' ability to do the job can affect resident care quality. The purpose of this study was to explore the meaning of CNAs' experiences in the nursing home. A naturalistic design using qualitative methods guided data collection and analysis. Data were analyzed using qualitative content analysis. Four themes emerged: Transitioning Between Two Worlds, Responding to the Call, Living the Job, and Transcending the Job. The challenge is to create strategies that identify CNAs'passion for the job, support their ability to balance daily tasks with relationships, and value their knowledge and contributions to the care team.

CNAs’ Experiences in the Nursing Home: “It’s in My Soul”

Background: Bayesian inference provides a formal framework for updating knowledge by combining prior knowledge with current data. Over the past 10 years, the Bayesian paradigm has become a popular analytic tool in health research. Although the nursing literature contains examples of Bayes' theorem applications to clinical decision making, it lacks an adequate introduction to Bayesian data analysis. Methods: Bayesian data analysis is introduced through a fully Bayesian model for determining the efficacy of tai chi as an illustrative example. The mechanics of using Bayesian models to combine prior knowledge, or data from previous studies, with observed data from a current study are discussed. Results: The primary outcome in the illustrative example was physical function. Three prior probability distributions (priors) were generated for physical function using data from a similar study found in the literature. Each prior was combined with the likelihood from observed data in the current study to obtain a posterior probability distribution. In each case, the posterior distribution showed that the probability that the control group is better than the tai chi treatment group was low. Discussion: Bayesian analysis is a valid technique that allows the researcher to manage varying amounts of data appropriately. As advancements in computer software continue, Bayesian techniques will become more accessible. Researchers must educate themselves on applications for Bayesian inference, as well as its methods and implications for future research.

Bayesian data analysis: estimating the efficacy of T'ai Chi as a case study.

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Metaphors in qualitative research: shedding light or casting shadows?

CNAs’ Experiences in the Nursing Home: “It’s in My Soul”

Bayesian data analysis: estimating the efficacy of T'ai Chi as a case study.