Organic feeling

Everything has come to an end… After participating in the course “Cultural awareness in health and social research”, I would hereby like to declare myself as being cultural aware! This course have for sure given me whole new perspectives. It doesn’t make sense, but the new perspectives and the feeling I have about it is hard to explain. The feeling is in a deeper dimension, it almost feels “organic”. Nevertheless, I love the course design since it has impelled me to experience cultural differences AND to overcome them.

I think that we in struggle a bit with how to team up and work effectively together. I also think that we manage to overcome our differences and that we mastered the challenges when it came to connecting and collaborating. We succeeded to discuss and to exchange cultural experiences. Very rewarding and it was definitely worth the effort! Being part of this course have been like sweet music in my ears…

You know when you here a song and you keep playing it on repeat again and again. That’s how it been for me since I woke up this morning and heard charming Mason Ramsey sing “Famous”. It’s of course a love song and he sings that he wants to be famous for loving his girl. During my morning walk, that made me think of – what if I was famous… What would it be for? I wish that if I’m gonna be famous for something, I wanna be famous for being frank, fearless and loving. My ambition is to be accepting, curious and respectful towards my fellow human beings, in the spirit of being cultural competent.

After dwelling around in this creative social media forum (where I’m pretty confident) I now have to step up and challenge myself. Guess I have to become more serious and dig into the scientific aspect of this topic and deepen my knowledge about how this will affect my research plan. For this purpose, my assessment paper comes in handy.



Moving beyond a colorblind perspective

Here´s another reflection regarding the course I participate in about cultural awareness. I believe that the current paradigm in Sweden in some ways are built upon those early psychological research that is described in the article of Awad et al. (2016). The assumptions are based on a humanistic belief that we are all equal and should be treated the same way… which is of cause correct! But, maybe we tend to forget and acknowledge the cultural impact on our behaviours. This week I have thought about this a lot. Is it right to treat everyone the same? Now, after learning more about culture in this course, I think that I think, that it is NOT right. That we actually should treat each other differently depending on what cultural behaviours we possess. In fact, it would be unethical not to do so. And here comes the tricky part… How do we know what cultural behaviours our fellows or participants have? Suddenly, I do understand why my teacher asked the questions that she had written in her presentation from last webinar.

·         How do assumptions influence what questions we ask and how we ask?

·         What influence may our values or beliefs have on the methodologies we use?

·         How may participants react to our questions based on their culture?

I have no answers to the questions but if we don´t ask, we have to trust what we know and what we see. I assume a great deal of things about a person I have in front of me just from looking at the person. I guess they do the same with me. We as humans (including nurses and PhD students), are inclined to sort individuals into boxes constructed out of e.g. religion, language, ethnicity, clothing style, diagnosis and gender. Could it be that the huge variety makes it too difficult for us to handle? Is the global diversity overwhelming and does it make us feel small and insecure? I think it sometimes does. We have to be fearless and curious about cultural differences. I do think that this quotation from the article of Awad et al. (2016) is fabulous (in fact I love it),

“Moving beyond a colorblind perspective towards embracing multiculturalism”

It´s time to take off the shades and to call on all our courage to face the challenge of cultural diversity by being bold and brave.

After writing this first part of my reflections I got tired of myself… It´s sooooo easy to write nice words and so much harder to act upon them. I like that Awad et al. (2016) gave us some key recommendation of how to conducting culturally sensitive research. On the webinar I tried to make a comment about stigmatisation and the first recommendation is regarding how to “avoid using the comparative research framework”. Last autumn, I participated in an ethical PhD course, were the students from the Department of Criminology talked a lot about not stigmatise minority groups even if the result showed that they for instance had a high rate of crime. I am amazed that the academy takes this huge society dilemma on its shoulders and withhold the results. I want to know, discuss and think more about this stigmatisation problem regarding nursing research. Does it exist in our field and how does it occur?

Awad G H, Patall E A, Rackley K R, Reilly E D, (2016) Recommendations for Culturally Sensitive Research Methods. Journal of Educational and Psychological Consultation, 26(3), 283-303.


Study abroad

I know I wrote about this in my last blog post but today I got this study material in my mailbox so I got a little excited. I have a dream to study abroad. When I was young I never traveled or anything. I worked, took my nursing degree and continued working. And to be honest, I have worked ever since. Now when I’m a PhD student I think that I have increased opportunities to study abroad and the first step to defeat is an English exam. The test is held is Lund which is small town approximately 30 km from my home. The IELTS test consists of four elements, reading, listening, writing and speaking and test dates this spring is on May 5th or June 2nd. I would like to apply to the University of Leicester and there requirement are an IELTS score 7.0 with a minimum score of 6.5 in each element. I will try to study hard and hopefully I will succeed and if not… I will just try again and again…

Photo: My own…

Linguistic proficiency

So I have been struggling with my research proposal, which is of cause written in English. Finally, my supervisors approved it and now I´m in the phase of writing my ethical application. Luckily (for me) the application ought to be written in Swedish! At first I experience such a relief to write in my own native langue. I felt that I was able to be free, to seize, and express different nuances by the help of the Swedish language. That feeling was intense and may I say short… When I write in English I have to be pleased if I can come up with two different options of how to write a sentence. Suddenly, I have, at least, ten different choices of how to write a sentence in Swedish. Now, I’m kind of stuck in a mud bath that gets me nowhere. I’ve spent two whole working days with my ethical application and so far the result of it is disheartening. I never thought I should say this but, in a certain sense, it is easier to write in English…

I have a dream to study abroad and I’ve found a course about “Quality and Safety in Healthcare” in Leicester (UK)  that I think could fit my “PhD profile”. The University has an English language requirement, so in order to be able to apply for this course I have to take an English exam. To prepare myself I take lessons each Monday evenings. I aim to take the exam in May or June this year. So, the linguistic struggle continues!

Wish me luck! (…with both the ethical application AND the English exam)



Not even close baby

Right now, as a PhD student, I´m a participant in a course named “Cultural awareness in health and social research”. This course is a great collaboration between La Trobe University (Australia), The Hong Kong Polytechnic University (Hong Kong) and Malmö University (Sweden). We have meet once in a Zoom meting. At this webinar we presented us for each other and one of the instructor held a short opening introduction to the topic “cultural awareness”. As a common digital space our competent instructors have made us a Facebook group were we have been asked to post our personal reflections after this first webinar.

I guess we are all products of our experiences… I´ve participated in the ONL course and that have of course made me to who I am today 😉 No, but really… The experiences I had in this ONL course goes beyond oral explanations. The more I think of it… it has helped me and shaped me and my digital literacies in an amazing way (both personal and professional).

So, back to the course about cultural awareness. I was surprised by reading the other participants reflection since most of them dealt with the idea of coming together and interact with fellows worldwide. I am trained in the spirit of ONL and started with great joy to comment the other participant reflections, eager to discuss cultural awareness. I got an answer to all of my comments but then… nothing happened… ABSOLUTELY nothing! Until this day, no one else have made a comment and the Facebook group is a “dead” place for posting reflections and there is zero interaction.

We are a total of 18 participant and we have been divided into three smaller groups. And here comes trouble again… I find it extremely hard to get a group discussion going and a productive atmosphere to appear. It´s not that it is hostile, absolutely not, it just isn´t… it is nothing, as I said, lack of activity. Some of my dear group fellows don´t even return with answers about suggested times to meet. Some of it has probably to do with absent motivation but I am quite sure it also has something to do with digital literacies.

Lastly, I am utterly thankful for the time I spent in the ONL community! And you know what…? Today, I´ve been accepted into another Facebook group – the ONL alumni 🙂


Cultural awareness

Last autumn I started as a PhD student and I had absolutely no clue of what to expect and do. At the moment I believe that I have adopted to my new role a little bit better.

I´ve just started as a participant in a PhD course called “Cultural awareness in health and social research”. It´s a course that is held as a collaboration between three universities; La Trobe University (Australia), The Hong Kong Polytechnic University (Hong Kong) and Malmö University (Sweden).

Me as a PhD student are supposed to broaden and deepen my understanding of cultural awareness in order to critically appraise research and the research process in health and social sciences. I have participated in the first webinar and really… I can feel it in my bones, this course is a real eye opener for me! In this blog post I will share my reflections so fare.

The diversity is broad and profound, right? The globalisation gives us diversity everywhere in the population and in the society. It´s all over, among nursing students, PhD candidates, professors and of course our patients and study participants/informants.

As I was reading about cross-cultural communication, I came to think about my clinical experiences. When I work as a clinical nurse it often happens that I meet patients from other countries and cultures. If the patient is ill (I mean really sick) they seem to experience insecurity and anxiety in a Swedish hospital care system they don´t know how to orient in. If, luckily, a healthcare professional from their own culture, speaking their own language comes and interact with them, the patient usually calms down and express comfort and peace. I believe that when we are “fragile”, the culture that we are familiar with is most important. A unit with a diversity of healthcare professionals is a strong cultural competent workplace and have prerequisites for individual and unique communication and interaction.

To be honest, I still struggle a bit with the meaning of cultural awareness. That´s probably because, until now, I have been unaware and,  I do have to enhance my knowledge regarding the concept cultural competence and the different “subcategories” of it. According to Hadziabdic et al. (2016) cultural awareness is about being aware that a person’s cultural background affects the person’s behaviours and attitudes. Furthermore, cultural awareness is described as an affective dimension and the lowest level of cultural competence (Rew et al., 2003). As I see it, this course is my first steps towards becoming more aware of culture and how it affects me and my fellows. But, actually, I wonder why we choose to focus on cultural awareness and no on the overall ultimate cultural competence. I´m very curious to learn more about this topic and how it will affect my studies. Looking forward to the future of this course and the interaction with all of you!

Hadziabdic et al. (2016) Swedish version of measuring cultural awareness in nursing students: validity and reliability test. BMC Nursing, 15(25), 1-9.

Rew et al. (2003) Measuring cultural awareness in nursing students. Journal of Nursing Education, 42(6), 249-257.

Photo: (CC0 1.0)

Lady Fortune

I have absolutely no intention to be disrespectful and I fear that my English skills is my shortcoming. Despite of this, I feel an urge of sharing my thoughts and I will try to express myself carefully.

It turns out, that in my research area there is a huge gap. I found peer-reviewed articles from the early 1990 were they (the researchers) literally went to the patients and asked them how it was to undergo a colonoscopy and how they (the patients) perceived it. Since then… not much has happened in the field. A handful of articles, but not many, have included the patient in studies about their (the patients) experiences of the gastrointestinal procedure. Remarkable! How is this gap even possible in the year of 2017? Now I feel like I am disrespectful… I’m not! Astonished, yes I admit… The need of efforts and considerations of how to bridge the gap of knowledge is most important.

At first I blamed the doctors, and that this chasm was caused by deficient knowledge or perhaps, lack of acceptance for descriptive qualitative research methods. This assumption of mine is unfair, unclear and not pertinent to discuss further. Dear doctors, I beg your pardon!

Nurses are familiar with different research traditions and are used to move between quantitative, mixed-methods and qualitative methodology.

Now I hold my own sisters, the nurses, responsible for it… or actually, I don’t. Who am I to have complains? I haven’t played a part in a lot of research have I? A lot of excellent endoscopic nursing research has been conducted in areas such as; documentation, communication, decontamination, screening, sedation, bowel preparation and so on…

Nevertheless, “someone” forgot to ask the patients about there experiences.

It turns out, I feel like Lady Fortune and I believe that my qualitative research skills can come in handy now when I’m about to do this thesis. Future contributory research should focus on designing qualitative studies, with conscientiously described methodology, that present patient-derived data, in order to further increase the knowledge about what patients’ experiences during colonoscopy (Brown et al, 2015; Tierney et al, 2016).

Brown S, Bevan R, Rubin G, Nixon C, Dunn S, Panter S, Rees CJ, (2015) Patient-derived measures of GI endoscopy: a meta-narrative review of the literature. Gastrointest Endosc, 81(5), 1130-1140.

Tierney M, Bevan R, Rees CJ, Trebble TM, (2016) What do patients want from their endoscopy experience? The importance of measuring and understanding patient attitudes to their care. Frontline Gastroenterol, 7(3), 191-198.

Photo: Pixabay

Wait a minute…

Yesterday I thought a lot of patient experience vs patient satisfaction and I felt I was going in circles – round and round and round. Made me dizzy! Today, I come to think of it again… The thing is, I think I got it… Funny enough, it was my dysfunctional marriage (2017) that gave me the final clue.

Early in life many of us learn to lower our expectations in an attempt to reduce the chances of getting disappointed, right? It’s kind of a life hack – to go around with not too high expectations and then when you least expect it to happen, it surprises you, and – voilà! – suddenly you’re extremely happy and satisfied. Just because you had no expectations and this experience was more then you expected 🙂 If you for example have high hopes and expectations on your marriage and believe it’s going to be like in the romantic comedy films, then you (sadly) probably going to experience something else and be terribly disappointed.

Consider these two scenarios:

  1. The patient is an anxious younger woman and she expect the colonoscopy to be painful and embarrassing and in the end it turns out to be quite “OK” since the sedation made the pain go away and also added a bit of amnesia. Given those circumstances, we can suspect the experience of the colonoscopy in this case to be over expectations and a pretty “good” experience. We have a satisfied patient.
  2. The patient hasn’t heard anything negative about colonoscopy and has a strong believe in the health care system. There will be no need for sedation since the patient is a calm elder male. Under the procedure, at the end of it, he gets nausea and hypotension due to visceral pain. It all goes away in 2-3 minutes but the patient ends up with a feeling of betray and loss of control. This patients experience was not align with the expectations and it ended up with an unsatisfied patient.

The conclusion: The satisfaction is closely connected with the expectations of the experience. Research on satisfaction much include both expectations and experiences meanwhile research on experiences can “stand alone”. Regarding my choice, the focus must be on the experience instead of satisfaction!

You made it clear to me, Stefan. Thank you for marrying me 16 (long) years ago!

My dysfunctional marriage (ongoing) Real life marriage. Yours 4ever and ever… and ever, until death do us part, Sweden.

Photo: Pixabay

New dimensions

Still trying to adapt to my “new” life as a PhD student. The hardest part is to prioritize which “task of the day” I’m should lay hold of. There are so many of them… so how do I select them in a good, structured and effective way? I find myself doing list of what I’m about to do… spending time to organize my tasks instead of actually do them. But I’m doing “things” all the time, every day of the week and still… it is not enough. Every so often, I think I’m on the wrong path but then I remember that the path never is straight forward. The path is supposed to be winding and that the path is the journey and that the process have to take time… and then I’m back in my loop again, trying to figure out what to do next. Maybe a blog post…?

Earlier I wrote about six dimensions of quality, according to the report “Crossing the quality chasm”. Today I’ve learned about new dimensions but this time it is regarding “Patient satisfaction”. Ware et al. (1978) argued for 8 dimensions of patient satisfaction in a proposed taxonomy:

  • Art of care
  • Technical quality of care
  • Accessibility/convenience
  • Finances
  • Physical environment
  • Availability
  • Continuity of care
  • Efficacy/outcome of care

It amaze me that some truths still remains. The taxonomy is complex and two weeks ago I got the suggestion or may I say an advice not to center my attention towards patient satisfaction and instead focus on patient experiences since it is an “easier” topic to define and thereby study. I’m in an early stage of my research and now, I have the opportunity to choose, so obviously I’ve been thinking a lot of this ever since.

I looked attitude up on the internet and is says “A settled way of thinking or feeling about something“. Our expectations is “A strong belief that something will happen or be the case“. My instant thought is that this must be very individual, I mean which attitude and what expectations we have. And then we experience something “An event or occurrence which leaves an impression on someone” and perceive it “A way in which something is regarded, understood, or interpreted“.  Again, extremely individual how an event is interpreted by my attitude. So were does satisfaction fit into all this? The internet says that satisfaction is “A fulfillment of one’s wishes, expectations, or needs, or the pleasure derived from this“. I don’t know about this pleasure thing according to my research topic, colonoscopy, but definitively needs. This is align with Cleary & McNeil (1988) who states that patient satisfaction builds upon the individuals needs. So, is a patient satisfied if their individual needs are fulfilled? Then I have to identify which needs are the most common to patients undergoing a colonoscopy in order to know if the patients is satisfied with the experiences from the procedure, right? Easy Peasy!

Or… Why not choose satisfaction, why is experiences (and for that matter needs) “easier”? Is experiences more single dimensional? Maybe, I don’t have to go all the way around…? Some may define patient satisfaction in the gap between the patient expectation and the actual experience (Beattie et al., 2015). There are many definitions of patient satisfaction and one reasonably definition is made by Maciejewski et al. (1997) who suggests that it represents:

“A patient’s cognitive or emotional evaluation of a health care provider’s performance and the evaluation is based on relevant aspects of the patient’s experience.”

I guess I’m back with patient experience. I realize that yet another task for me, is to define patient experience. One way to consider patient experience is in terms of the determinants (factors) of the experience, its components and/or the outcomes of the actual experience (de Silva, 2013). In the report de Silva refers to a study by Lau et al. (2012) who indicates the need of, not only focusing on the experience but also ask patients about their levels of experience and how they want to see it improved. I believe I’m back again with the outcome – patient satisfaction…

*BIG sigh & rolling my eyes*

Beattie M, Murphy DJ, Atherton I, Lauder W, (2015) Instruments to measure patient experience of healthcare quality in hospitals: a systematic review. Syst Rev, 23, 4:97.

Cleary P, McNeil B, (1988) Patient Satisfaction as an indicator of quality for care. Inquiry. 25, 25-36.

de Silva D, (2013) No 18: Measuring patient experience. Evidence scan, The health foundation.

Lau RL, Gandhi R, Mahomed S, Mahomed N, (2012) Patient satisfaction after total knee and hip arthroplasty. Clin Geriatr Med, 28(3), 349-365.

Maciejewski M, Kawiecki J, Rockwood T, (1997) Satisfaction in understanding health care outcomes research. Gaithersburg, Aspen Publishers Inc.

Ware J, et al. (1978) The measurement and meaning of patient satisfaction: a review of the literature. Health Med Care Serv Rev. 1(1), 3-15.

Photos: Pixabay

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