N Armstrong
Datos Biográficos
| ID | 55479 |
|---|---|
| NOMBRE | N Armstrong |
| NOMBRES | N |
| APELLIDO | Armstrong |
| FIRMA | ARMSTRONG N |
| AFILIACIONES | University of Leicester |
| ORCID | 0000-0003-4046-0119 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 37 |
| TOTAL DE CITAS | 171 |
| TOTAL COMO AUTOR | 37 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 2005 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2025 |
| ÍNDICE H | 9 |
Disclosing the Decision to Decline Breast Screening and/or Breast Cancer Treatment Due to Concerns About Overdiagnosis and Overtreatment
BACKGROUND OR CONTEXT: Overdiagnosis and overtreatment have been acknowledged as harms of the NHS Breast Screening Programme (BSP) due to the uncertainty around if, or how, non-invasive and invasive cancers identified through screening will progress. Importance is therefore placed on encouraging individuals to make an informed choice about whether to participate in screening and any follow-on interventions. Even though all screening programmes ge…
Deteriorating care home residents as 'matter out of place' in both care homes and hospitals
Parenting through place‐of‐care disruptions
INTRODUCTION: Neonatal care is complex, involving multiple people and technologies within a community of care. When preterm babies are cared for far from home and/or transferred between units, the whole community of care (and particularly parent participation) is disrupted. Although previous studies have captured subjective experiences of parents, there has been little research exploring the material practices undertaken by parents as a consequen…
Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation
INTRODUCTION: While screening uptake is variable, many individuals feel they 'ought' to participate in screening programmes to aid the detection of conditions amenable to early treatment. Those not taking part in screening are often presented as either hindered by practical or social barriers or personally at fault. Why some people choose not to participate receives less consideration. METHODS: We explored screening nonparticipation by examining …
Organising work in neonatal transfer
The organisation of neonatal units into geographically-based networks that offer different levels of care is intended to ensure babies receive the care they need via transfers between different units. In this article, we explore the significant organisational work required in practice to accomplish such transfers. Conducted within a wider study of optimal place of care for babies born between 27 and 31 weeks' gestation, we draw on ethnographic wo…
Curating the digital space
Digital health occupies an increasingly important role within the context of managing risk and safety in pregnancy. Women routinely use websites, mobile phone apps and social media platforms to learn about ‘normal’ pregnancy related changes and potential signs of a complication. This paper shifts attention from women's digital experiences to explore staff responsibilities in relation to women's online practices during pregnancy. We draw on Thomas…
Hospital transfers from care homes
When making decisions about whether to transfer residents to hospital, care home staff consider the possible benefits and risks of different courses of action. However, to date, an in-depth and theoretically informed engagement with these decision-making processes and their associated behaviours has been lacking. We conducted an ethnographic study of care home staff’s decision-making about resident hospital transfers in England between May 2018 a…
Understanding knowledge brokerage and its transformative potential
Background: Knowledge brokering is promoted as a means of enabling exchange between fields and closer collaboration across institutional boundaries. Yet examples of its success in fostering collaboration and reconfiguring boundaries remain few. Aims and objectives: We consider the introduction of a dedicated knowledge-brokering role in a partnership across healthcare research and practice, with a view to examining the interaction between knowledg…
Overdiagnosis and overtreatment
Overdiagnosis and overtreatment are increasingly discussed as a significant problem in contemporary healthcare but are yet to receive any significant sociological attention, over and above that which is arguably transferable from the medicalisation literature. Overdiagnosis and overtreatment are often constructed as problems best addressed by educating patients and clinicians, and improving the relationships between them. The emergence of tools s…
Taking sides with patients using institutional ethnography
PurposeThe main purpose of this paper is to document the first author's experience of using institutional ethnography (IE) to "take sides" in healthcare research. The authors illustrate the points with data and key findings from a study of cardiovascular disease prevention.Design/methodology/approachThe authors use Dorothy E Smith's IE approach, and particularly the theoretical tool of "standpoint".FindingsStarting with the development of the stu…
Parents' decision-making following diagnosis of a severe congenital anomaly in pregnancy
Understanding and managing uncertainty in health care
In this collection we revisit the enduring phenomenon of uncertainty in health care, and demonstrate how it still offers coherence and significance as an analytic concept. Through empirical studies of contemporary examples of health care related uncertainties and their management, our collection explores the different ways in which uncertainty may be articulated, enacted and experienced. The papers address a diverse range of healthcare contexts -…
They don't know themselves, so how can they tell us
When a baby is diagnosed with a condition needing surgery they, and their family, start down an uncertain and unknown path. Living with uncertainty underpins every stage of the journey from hospital to home. These journeys span the highly technical to the mundane. They are likely to involve, at crucial points, medicalised and specialised neonatal and surgical care in paediatric centres of excellence where parents are mere spectators. Yet ultimate…
Overruling uncertainty about preventative medications
In this article, we draw on an institutional ethnographic (IE) study of cardiovascular disease prevention in general practice, exploring the work of healthcare professionals who introduce a discussion of risk and preventative medications into consultations with patients. Our aim is to explicate, using IE's theoretical ontology and analytical tools, how troubling patient experiences in this clinical context are coordinated institutionally. We focu…
Influence of gender on the tactical skill and motivational aspects in invasion sports in Physical Education
The main purpose of the present study was to compare the objective, perceived and conceptual tactical skill in invasion sports (indoor football and basketball) between male and female elementary schoolchildren; and secondarily was to compare between genders, physical activity ́s levels, intention to be physically active, perceived coordination/competence, intrinsic satisfaction in sport and climate task in Physical Education. A total of 104 eleme…
Diagnosis of a severe congenital anomaly
OBJECTIVE: To explore parental decision making following diagnosis of a severe congenital anomaly, and implications for healthcare encounters. DESIGN: Qualitative semi-structured interviews with 38 parents-to-be were collated and triangulated with data generated from consultation recordings. ANALYSIS: Data were analysed using a constant comparative-based approach. SETTING: Recruitment was undertaken across four fetal medicine sites in two tertiar…
Navigating the uncertainties of screening
Taking the heat or taking the temperature? A qualitative study of a large-scale exercise in seeking to measure for improvement, not blame
Measurement of quality and safety has an important role in improving healthcare, but is susceptible to unintended consequences. One frequently made argument is that optimising the benefits from measurement requires controlling the risks of blame, but whether it is possible to do this remains unclear. We examined responses to a programme known as the NHS Safety Thermometer (NHS-ST). Measuring four common patient harms in diverse care settings with…
Optimising the community-based approach to healthcare improvement
Community-based approaches to healthcare improvement are receiving increasing attention. Such approaches could offer an infrastructure for efficient knowledge-sharing and a potent means of influencing behaviours, but their potential is yet to be optimised. After briefly reviewing challenges to community-based approaches, we describe in detail the clinical community model. Through exploring clinical communities in practice, we seek to identify pra…
When choice becomes limited
Choice and patient involvement in decision-making are strong aspirations of contemporary healthcare. One of the most striking areas in which this is played out is maternity care where recent policy has focused on choice and supporting normal birth. However, birth is sometimes not straightforward and unanticipated complications can rapidly reduce choice. We draw on the accounts of women who experienced delay during labour with their first child. T…
Trial participation as avoidance strategy
BACKGROUND: Trial participation decisions are often influenced by expectations of potential benefit. Attention has focused on trial participation as a means of securing something seen as desirable, such as experimental treatment. In contrast, we consider a case in which one trial arm involved receiving less than usual care. We explore how this influenced participants' decisions to participate. METHODS: Semi-structured interviews with 29 women par…
Consent revisited
BACKGROUND: Increasingly, the sharing of study results with participants is advocated as an element of good research practice. Yet little is known about how receiving the results of trials may impact on participants' perceptions of their original decision to consent. OBJECTIVE: We explored participants' views of their decision to consent to a clinical trial after they received results showing adverse outcomes in some arms of the trial. METHOD: Se…
Professionalism Redundant, Reshaped, or Reinvigorated? Realizing the 'Third Logic' in Contemporary Health Care
Recent decades have seen the influence of the professions decline. Lately, commentators have suggested a revived role for a 'new' professionalism in ensuring and enhancing high-quality health care in systems dominated by market and managerial logics. The form this new professionalism might take, however, remains obscure. This article uses data from an ethnographic study of three English health care improvement projects to analyze the place, poten…
Incidental findings from clinical sequencing in Greece
Unprecedented progress in sequencing technologies and decreasing cost have brought genomic testing into the clinical setting. At the same time, the debate in the literature concerning the return of incidental findings (IFs) has made this an important issue internationally. These developments reflect a shift in genetics that will also affect smaller countries, such as Greece, that are just starting to implement these technologies and may look to o…
Doing diagnosis
Diagnosis is fundamental to the practice of medicine and mastery of it is central to the process of both becoming and practicing as a doctor. We focus on diagnosis as a process, in particular from the perspective of clinicians performing it. We explore how UK clinicians exercise discretion about whether and how to use a diagnostic tool (invasive urodynamic tests - IUT) for which there is, currently, no clear, high-quality evidence. Interviews wer…
The sociology of medical screening
Medical screening raises fundamental issues for sociological inquiry, but at present a well-developed sociology of medical screening is lacking. This special issue on the sociology of screening brings together an exciting collection of new work that tackles medical screening from a variety of theoretical and methodological approaches. In this opening paper, we begin by explaining what we mean by screening, and why we believe screening merits soci…
Understanding and managing uncertainty in health care
In this collection we revisit the enduring phenomenon of uncertainty in health care, and demonstrate how it still offers coherence and significance as an analytic concept. Through empirical studies of contemporary examples of health care related uncertainties and their management, our collection explores the different ways in which uncertainty may be articulated, enacted and experienced. The papers address a diverse range of healthcare contexts -…
Doing diagnosis
Diagnosis is fundamental to the practice of medicine and mastery of it is central to the process of both becoming and practicing as a doctor. We focus on diagnosis as a process, in particular from the perspective of clinicians performing it. We explore how UK clinicians exercise discretion about whether and how to use a diagnostic tool (invasive urodynamic tests - IUT) for which there is, currently, no clear, high-quality evidence. Interviews wer…
Oh dear, should I really be saying that on here
We explore peer-to-peer discussions which took place in a UK-based diabetes 'Virtual Clinic' online community. In particular, we seek to understand the rhetorical nature and content of exchanges over a period of six months from the community's inception. Data were captured weekly and analysis based on thematic discourse analysis. Two key issues emerged regarding how the community shaped the nature of the discussion forum. First, the identity of t…
Professionalism Redundant, Reshaped, or Reinvigorated? Realizing the 'Third Logic' in Contemporary Health Care
Recent decades have seen the influence of the professions decline. Lately, commentators have suggested a revived role for a 'new' professionalism in ensuring and enhancing high-quality health care in systems dominated by market and managerial logics. The form this new professionalism might take, however, remains obscure. This article uses data from an ethnographic study of three English health care improvement projects to analyze the place, poten…
Conceptualizing resistance
The 1990s saw a proliferation of sociological work applying Foucault's ideas on governmentality to health promotion and public health. This work characterized public health discourses as regimes of power and knowledge employed in the regulation and surveillance of individuals and populations. This article is concerned with the question of how and to what extent those who are subject to such regimes are able to resist them. We seek to identify the…
Taking sides with patients using institutional ethnography
PurposeThe main purpose of this paper is to document the first author's experience of using institutional ethnography (IE) to "take sides" in healthcare research. The authors illustrate the points with data and key findings from a study of cardiovascular disease prevention.Design/methodology/approachThe authors use Dorothy E Smith's IE approach, and particularly the theoretical tool of "standpoint".FindingsStarting with the development of the stu…
Overruling uncertainty about preventative medications
In this article, we draw on an institutional ethnographic (IE) study of cardiovascular disease prevention in general practice, exploring the work of healthcare professionals who introduce a discussion of risk and preventative medications into consultations with patients. Our aim is to explicate, using IE's theoretical ontology and analytical tools, how troubling patient experiences in this clinical context are coordinated institutionally. We focu…
Weaving meaning? An exploration of the interplay between lay and professional understandings of cervical cancer risk
Energy intake and appetite following exercise in lean and overweight girls
Twelve 11-year-old girls (six lean, six overweight) were given meals in the laboratory and at school for 5 days, with exercise imposed for 2 days and sedentary activities on another 2 days in counterbalanced sequences. During a preliminary visit, the FLEX heart rate method was used to predict individual exercise durations eliciting 1.5 MJ energy expenditure. Morning and afternoon cycling exercise was subsequently imposed in the laboratory on 2 co…
Navigating the uncertainties of screening
Overdiagnosis and overtreatment
Overdiagnosis and overtreatment are increasingly discussed as a significant problem in contemporary healthcare but are yet to receive any significant sociological attention, over and above that which is arguably transferable from the medicalisation literature. Overdiagnosis and overtreatment are often constructed as problems best addressed by educating patients and clinicians, and improving the relationships between them. The emergence of tools s…
Taking the heat or taking the temperature? A qualitative study of a large-scale exercise in seeking to measure for improvement, not blame
Measurement of quality and safety has an important role in improving healthcare, but is susceptible to unintended consequences. One frequently made argument is that optimising the benefits from measurement requires controlling the risks of blame, but whether it is possible to do this remains unclear. We examined responses to a programme known as the NHS Safety Thermometer (NHS-ST). Measuring four common patient harms in diverse care settings with…
Institutionalising knowledge brokering as a sustainable knowledge translation solution in healthcare
In healthcare, translating evidence into changed practice remains challenging. Novel interventions are being used to address these challenges, including the use of ‘knowledge brokers’. But how sustainable these roles might be, and the consequences for the individual of enacting such roles, are unknown. We explore these questions by drawing on qualitative data from case studies of fulltime roles in research-practice collaboration. We suggest that …
Discourse and the individual in cervical cancer screening
The official discourse on cervical screening, disseminated to women through the information material they receive when called to attend, is important for the ways in which it presents screening to women and encourages them to think about it. However, because this material is nationally produced it is designed to address a large number of women and, as a result, is necessarily general and uniform in nature. This article uses qualitative interview …
They don't know themselves, so how can they tell us
When a baby is diagnosed with a condition needing surgery they, and their family, start down an uncertain and unknown path. Living with uncertainty underpins every stage of the journey from hospital to home. These journeys span the highly technical to the mundane. They are likely to involve, at crucial points, medicalised and specialised neonatal and surgical care in paediatric centres of excellence where parents are mere spectators. Yet ultimate…
Do informed consent documents for cancer trials do what they should? A study of manifest and latent functions
Though patient information leaflets (PILs) are provided to those invited to take part in medical research, they usually fall short in facilitating informed decisions about participation. We aimed to explore why there is an enduring requirement for a process that seems not to 'work', and to explain why the problems have proven resistant to correction. We analysed applications for ethical approval for 13 oncology trials and related official guidanc…
Parents' decision-making following diagnosis of a severe congenital anomaly in pregnancy
Optimising the community-based approach to healthcare improvement
Community-based approaches to healthcare improvement are receiving increasing attention. Such approaches could offer an infrastructure for efficient knowledge-sharing and a potent means of influencing behaviours, but their potential is yet to be optimised. After briefly reviewing challenges to community-based approaches, we describe in detail the clinical community model. Through exploring clinical communities in practice, we seek to identify pra…
Resistance through risk
This paper explores how individual women deal with, and react to, the very general information on cervical cancer risks they receive when invited to attend for cervical screening, and the general ‘at risk’ position that is suggested to them through the official discourse on screening and re-enforced by the uniform approach taken by the UK programme. By presenting data from a qualitative interview study it demonstrates how women respond to the pre…
Discourse and the individual in cervical cancer screening
The official discourse on cervical screening, disseminated to women through the information material they receive when called to attend, is important for the ways in which it presents screening to women and encourages them to think about it. However, because this material is nationally produced it is designed to address a large number of women and, as a result, is necessarily general and uniform in nature. This article uses qualitative interview …
Energy intake and appetite following exercise in lean and overweight girls
Twelve 11-year-old girls (six lean, six overweight) were given meals in the laboratory and at school for 5 days, with exercise imposed for 2 days and sedentary activities on another 2 days in counterbalanced sequences. During a preliminary visit, the FLEX heart rate method was used to predict individual exercise durations eliciting 1.5 MJ energy expenditure. Morning and afternoon cycling exercise was subsequently imposed in the laboratory on 2 co…
Weaving meaning? An exploration of the interplay between lay and professional understandings of cervical cancer risk
Patient perspectives on health advice posted on Internet discussion boards
Background Use of the Internet for health information by patients is growing, and there have been diverse responses to this both within the research community and the medical and health‐related professions. The use of Internet discussion boards are one way that people living with long‐term conditions can interact with their peers and offer and seek advice, support and information. We report patient perspectives on using a discussion board within …
Conceptualizing resistance
The 1990s saw a proliferation of sociological work applying Foucault's ideas on governmentality to health promotion and public health. This work characterized public health discourses as regimes of power and knowledge employed in the regulation and surveillance of individuals and populations. This article is concerned with the question of how and to what extent those who are subject to such regimes are able to resist them. We seek to identify the…
Oh dear, should I really be saying that on here
We explore peer-to-peer discussions which took place in a UK-based diabetes 'Virtual Clinic' online community. In particular, we seek to understand the rhetorical nature and content of exchanges over a period of six months from the community's inception. Data were captured weekly and analysis based on thematic discourse analysis. Two key issues emerged regarding how the community shaped the nature of the discussion forum. First, the identity of t…
Do informed consent documents for cancer trials do what they should? A study of manifest and latent functions
Though patient information leaflets (PILs) are provided to those invited to take part in medical research, they usually fall short in facilitating informed decisions about participation. We aimed to explore why there is an enduring requirement for a process that seems not to 'work', and to explain why the problems have proven resistant to correction. We analysed applications for ethical approval for 13 oncology trials and related official guidanc…
The sociology of medical screening
Medical screening raises fundamental issues for sociological inquiry, but at present a well-developed sociology of medical screening is lacking. This special issue on the sociology of screening brings together an exciting collection of new work that tackles medical screening from a variety of theoretical and methodological approaches. In this opening paper, we begin by explaining what we mean by screening, and why we believe screening merits soci…
Optimizing patient involvement in quality improvement
INTRODUCTION: Patient and public involvement in healthcare planning, service development and health-related research has received significant attention. However, evidence about the role of patient involvement in quality improvement work is more limited. We aimed to characterize patient involvement in three improvement projects and to identify strengths and weaknesses of contrasting approaches. METHODS: Three case study quality improvement project…
Stakeholders’ positions in the breast screening debate, and media coverage of the debate
Against the backdrop of new research evidence suggesting breast screening causes avoidable harms and that women are not being given enough information to make informed decisions, we sought to explore the positions on breast screening adopted by a range of stakeholders and the coverage of this debate in the media. We sampled material from national newspapers, charity bodies’ websites and official bodies’ websites over a two-year period, and analys…
Institutionalising knowledge brokering as a sustainable knowledge translation solution in healthcare
In healthcare, translating evidence into changed practice remains challenging. Novel interventions are being used to address these challenges, including the use of ‘knowledge brokers’. But how sustainable these roles might be, and the consequences for the individual of enacting such roles, are unknown. We explore these questions by drawing on qualitative data from case studies of fulltime roles in research-practice collaboration. We suggest that …
Incidental findings from clinical sequencing in Greece
Unprecedented progress in sequencing technologies and decreasing cost have brought genomic testing into the clinical setting. At the same time, the debate in the literature concerning the return of incidental findings (IFs) has made this an important issue internationally. These developments reflect a shift in genetics that will also affect smaller countries, such as Greece, that are just starting to implement these technologies and may look to o…
Doing diagnosis
Diagnosis is fundamental to the practice of medicine and mastery of it is central to the process of both becoming and practicing as a doctor. We focus on diagnosis as a process, in particular from the perspective of clinicians performing it. We explore how UK clinicians exercise discretion about whether and how to use a diagnostic tool (invasive urodynamic tests - IUT) for which there is, currently, no clear, high-quality evidence. Interviews wer…
Consent revisited
BACKGROUND: Increasingly, the sharing of study results with participants is advocated as an element of good research practice. Yet little is known about how receiving the results of trials may impact on participants' perceptions of their original decision to consent. OBJECTIVE: We explored participants' views of their decision to consent to a clinical trial after they received results showing adverse outcomes in some arms of the trial. METHOD: Se…
Professionalism Redundant, Reshaped, or Reinvigorated? Realizing the 'Third Logic' in Contemporary Health Care
Recent decades have seen the influence of the professions decline. Lately, commentators have suggested a revived role for a 'new' professionalism in ensuring and enhancing high-quality health care in systems dominated by market and managerial logics. The form this new professionalism might take, however, remains obscure. This article uses data from an ethnographic study of three English health care improvement projects to analyze the place, poten…
Trial participation as avoidance strategy
BACKGROUND: Trial participation decisions are often influenced by expectations of potential benefit. Attention has focused on trial participation as a means of securing something seen as desirable, such as experimental treatment. In contrast, we consider a case in which one trial arm involved receiving less than usual care. We explore how this influenced participants' decisions to participate. METHODS: Semi-structured interviews with 29 women par…
Optimising the community-based approach to healthcare improvement
Community-based approaches to healthcare improvement are receiving increasing attention. Such approaches could offer an infrastructure for efficient knowledge-sharing and a potent means of influencing behaviours, but their potential is yet to be optimised. After briefly reviewing challenges to community-based approaches, we describe in detail the clinical community model. Through exploring clinical communities in practice, we seek to identify pra…
When choice becomes limited
Choice and patient involvement in decision-making are strong aspirations of contemporary healthcare. One of the most striking areas in which this is played out is maternity care where recent policy has focused on choice and supporting normal birth. However, birth is sometimes not straightforward and unanticipated complications can rapidly reduce choice. We draw on the accounts of women who experienced delay during labour with their first child. T…
Diagnosis of a severe congenital anomaly
OBJECTIVE: To explore parental decision making following diagnosis of a severe congenital anomaly, and implications for healthcare encounters. DESIGN: Qualitative semi-structured interviews with 38 parents-to-be were collated and triangulated with data generated from consultation recordings. ANALYSIS: Data were analysed using a constant comparative-based approach. SETTING: Recruitment was undertaken across four fetal medicine sites in two tertiar…
Navigating the uncertainties of screening
Taking the heat or taking the temperature? A qualitative study of a large-scale exercise in seeking to measure for improvement, not blame
Measurement of quality and safety has an important role in improving healthcare, but is susceptible to unintended consequences. One frequently made argument is that optimising the benefits from measurement requires controlling the risks of blame, but whether it is possible to do this remains unclear. We examined responses to a programme known as the NHS Safety Thermometer (NHS-ST). Measuring four common patient harms in diverse care settings with…
Influence of gender on the tactical skill and motivational aspects in invasion sports in Physical Education
The main purpose of the present study was to compare the objective, perceived and conceptual tactical skill in invasion sports (indoor football and basketball) between male and female elementary schoolchildren; and secondarily was to compare between genders, physical activity ́s levels, intention to be physically active, perceived coordination/competence, intrinsic satisfaction in sport and climate task in Physical Education. A total of 104 eleme…
Parents' decision-making following diagnosis of a severe congenital anomaly in pregnancy
Understanding and managing uncertainty in health care
In this collection we revisit the enduring phenomenon of uncertainty in health care, and demonstrate how it still offers coherence and significance as an analytic concept. Through empirical studies of contemporary examples of health care related uncertainties and their management, our collection explores the different ways in which uncertainty may be articulated, enacted and experienced. The papers address a diverse range of healthcare contexts -…
Medicine (29 obras) · Psychology (25 obras) · Political science (23 obras) · Sociology (23 obras) · Nursing (16 obras) · Computer Science (15 obras) · Health care (15 obras) · Public relations (14 obras) · Qualitative research (11 obras) · Epistemology (10 obras)