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Background: Cultural competence is considered one of the criteria for high‐quality nursing care. Aim: This study aimed to analyse cultural competence in nursing. Methods: This study was performed using the hybrid concept analysis approach in three phases. In the theoretical phase, literature was reviewed by searching Persian and English language databases, and 94 articles were included. In the second or fieldwork phase, 11 semi‐structured interviews were conducted with purposefully selected nurses. The results of both theoretical and fieldwork phases were analysed using conventional content analysis, and in the final analysis phase, the results of the previous phases were triangulated. Results: The attributes of cultural competence were obtained in the theoretical phase in six and the fieldwork phase in three categories. In the final phase, the categories obtained in both previous phases were triangulated: cultural competence in nursing is a continuous, developmental, flexible, extensive and complex process that is patient‐ and justice‐oriented and emerges through learning and skills acquisition, including cultural knowledge, attitudes and practices. Conclusion: Managers and planners of nursing education can use the results of this study to educate nursing students and nurses and evaluate outcomes as one of the criteria for quality care. Summary statement: What is already known about this topic? There is a concern in nursing that the profession needs a unified definition of cultural competence.What this paper adds? This study showed that cultural competence in nursing is a continuous, developmental, complex, and extensive process that is patient‐ and justice‐orientated and emerges through learning and skills acquisition, including cultural knowledge, attitudes, and practices.The implications of this paper: The findings help identify and present the definition of cultural competence in nursing and be used in the training of nursing students and the continuous education of nurses. [ABSTRACT FROM AUTHOR]

Bereavement and mourning are arguably one of the research interests of psychologists, psychoanalysts, and psychiatrists since Freud's publication of Mourning and Melancholia. This paper is a qualitative case study that sought to examine the mourning experience of the participant from childhood until his adolescence. For theoretical foundation, the four tasks of mourning primarily developed by James Worden was utilized for the proper direction of the research inquiry; namely: a.) accepting the reality of death; b.) experiencing the feeling of grief; c.) adjusting and creating new meanings in the post-loss world; and d.) reconfiguring the bond with the lost person. The paper finds that the participant's cognitive attitude, emotional experiences, and personal observations of the environment enable him to overcome actively (in an overlapping manner) the three tasks of mourning. However, the failure to find an enduring connection with his deceased parents is not a result of strong attachment but with the absence of personal belief about the meta-existence of God. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Stigma associated with care homes has been found to influence residents' lives, and it is a known risk factor for depression among older adults worldwide.Older residents in Asia and particularly, in Thai care homes commonly experience stigma due to being strongly influenced by a traditional cultural paradigm of filial piety.The understanding of how residents perceive and experience the stigma associated with residing in care homes, as well as its link to the development of depression, remains very limited. What does the paper add to existing knowledge?: This research explains the dynamics of the process of the stigma associated with living care homes among Thai older residents.This research highlights the various ways in which stigma impacts residents, their families and care home staff.This study identifies mitigating stigma factors, including social support, coping strategies (karma, mindfulness and religious devotions) and activities that may mitigate perceived stigma associated with care home residency. What are the implications for practice?: There is a compelling need to improve the well‐being of older people living in care homes and to combat the cultural stigma associated with living in care homes through promoting positive attitudes and educational interventions in society, communities and care homes themselves and involving residents' families in the planning and delivery of care for residents. We advocate that the government promotes security and sustainable life for all Thai older adults. Introduction: Stigma associated with living in care homes is a known risk factor for depression among care home residents in Asia, including Thailand. However, little is understood about how such stigma is experienced among residents and care home staff. Aims: To examine older adults' perceptions of stigma and to understand how stigma associated with living in care homes causes or exacerbates depressive symptoms. Methods: A qualitative case study approach was used to gain an in‐depth view of stigma, from two public care homes in northeast Thailand. Data were collected by in‐depth interviews with 50 participants (30 older residents and 20 care home staff), and non‐participant observation was conducted over 1 month. Thematic analysis was used to analyse the data. Results: The study identified three major themes of stigma, comprising the causes of stigma, reactions toward stigma, and mitigating factors. Discussion: Negative beliefs about care homes and residents, contribute to stigma. Residents exhibited negative emotions and behaviours, including depressive symptoms. Residents reported using particular coping strategies that helped them cope with their perceptions of stigma. Implications for Practice: Future research should focus on strategies or research to combat stigma in order to prevent depression and reduce perceptions of stigma. [ABSTRACT FROM AUTHOR]

Context: Athletic trainers (ATs) recognize patient care documentation as an important part of clinical practice. However, ATs using 1 electronic medical record (EMR) platform reported low accountability and lack of time as barriers to documentation. Whether ATs using paper, other EMRs, or a combined paper-electronic system exhibit similar behaviors or experience similar challenges is unclear. Objective: To explore ATs' documentation behaviors and perceived challenges while using various systems to document patient care in the secondary school setting. Design: Qualitative study. Setting: Individual telephone interviews. Patients or Other Participants: Twenty ATs (12 women, 8 men; age = 38 ± 14 years; clinical experience = 15 ± 13 years; from National Athletic Trainers' Association Districts 2, 3, 6, 7, 8, 9, and 10) were recruited via purposeful and snowball-sampling techniques. Data Collection and Analysis: Two investigators conducted semistructured interviews, which were audio recorded and transcribed verbatim. Following the consensual qualitative research tradition, 3 researchers independently coded transcripts in 4 rounds using a codebook to confirm codes, themes, and data saturation. Multiple researchers, member checking, and peer reviewing were the methods used to triangulate data and enhance trustworthiness. Results: The secondary school setting was central to 3 themes. The ATs identified challenges to documentation, including lack of time due to high patient volume and multiple providers or locations where care was provided. Oftentimes, these challenges affected their documentation behaviors, including the process of and criteria for whether to document or not, content documented, and location and timing of documentation. To enhance patient care documentation, ATs described the need for more professional development, including resources or specific guidelines and viewing how documentation has been used to improve clinical practice. Conclusions: Challenges particular to the secondary school setting affected ATs' documentation behaviors, regardless of the system used to document care. Targeted professional development is needed to promote best practices in patient care documentation. [ABSTRACT FROM AUTHOR]

Aims: We aimed to investigate the perspective of primary care nurses on their role with patients who have chronic cardiovascular disease and to identify cultural elements shared by nurses caring for people with chronic cardiovascular disease. In primary care, the role of the nurse is essential to promote self‐efficacy in cardiovascular self‐care. Individuals with chronic cardiovascular disease need to integrate the disease into their life, together with the health recommendations for management and follow‐up. Methods: A qualitative, focused ethnographic study was conducted. Purposeful sampling was used to include nurses who were working in primary care during the study. Data collection took place between 20 January and 20 May 2014 and consisted of semi‐structured interviews. A thematic analysis was applied using the data. Results: Eleven participants were included. Cardiovascular care forces nurses to reflect on their identity and role in primary care. The relationship between the nurse and people with chronic cardiovascular disease is a complex process, which may cause nurses to feel a sense of failure and monotony in their work. Conclusions: Our findings may help to understand the role of the nurse and the care provided in patients with chronic cardiovascular disease. Summary statement: What is already known about this topic? Primary care nursing is necessary for the improvement of cardiovascular risk factors.Chronic cardiovascular patients need training in self‐care.The organizational culture confers different forms of care to patients. What this paper adds? The vision of the socio‐cultural role of the family and community nurse is shown regarding cardiovascular prevention.Information is provided on the differentiating approach to chronic cardiovascular patients in primary care.Our study reflects the influence of routine care in nursing consultations, and what it entails to provide improved nursing care in cardiovascular patients. The implications of this paper: These findings can be used to understand the need to change the focus of nursing care in cardiovascular prevention.The implementation of a follow‐up protocol for the care of cardiovascular patients can improve patients' self‐care and reduce monotony in the nursing consultation.Further training and research is necessary regarding comprehensive chronic cardiovascular care within primary care services. [ABSTRACT FROM AUTHOR]

Despite a history of critique, concentrated discussion and improved assessment processes, neglect continues to be a major challenge for child protection services. This paper draws on findings from a government‐commissioned analysis of 'serious case reviews' (SCRs) in England, arising from incidents of serious child abuse in 2017–2019. There were 235 cases, for which 166 final reports were available. Alongside a quantitative analysis of the whole cohort, we undertook an in‐depth qualitative analysis of 12 cases involving neglect. A key challenge in responding to neglect in its different forms is that it can be so widespread amongst families that practitioners no longer notice its severity or chronicity – it becomes normalised. In this paper we explore two dimensions of the 'paradox of neglect' where it seems to be everywhere and nowhere simultaneously. The first is that neglect is so closely bound up with the prevalence of poverty that little action is taken to address it. The second is that the overwhelming nature of neglect can blind practitioners to other forms of maltreatment that may also be present within a family. Practitioners, now more than ever, need to recognise the dimensions of this paradox to protect children from neglect. [ABSTRACT FROM AUTHOR]

Introduction: Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well‐being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well‐being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. Methods: Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus‐based summaries, arriving at a preferred service model. Findings: This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well‐being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. Public Contribution: This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions. [ABSTRACT FROM AUTHOR]

Summary: Gardening has the potential to enhance health and well-being, through increased physical activity and social connectedness. However, while much is known about the benefits of garden activities, less is known about the potential health implications of more passive forms of engagement with gardens, for example, viewing gardens. In addition, much garden research is undertaken in urban settings, leaving little known about potential health impacts for rural populations. The present study explored these research gaps by gaining an understanding of the experiences and perspectives of members of a gardening appreciation group in rural Australia: The Colac Horticultural and Marvellous Property Appreciation Society (CHAMPAS). A phenomenological, qualitative methodology was applied, using semi-structured interviews for data collection. Eleven participants were selected using purposive and snowball sampling and the data were analysed by applying interpretive, reflexive thematic analysis. Four main themes and supporting sub-themes were generated. The four main themes were: (i) motivations for maintaining participation in CHAMPAS; (ii) social connections and friendships, formed from membership; (iii) sense of community and structure of CHAMPAS and (iv) the perceived health and well-being benefits of continued involvement in this group. This study found that members perceived health and well-being benefits stemmed from CHAMPAS facilitation of social connectedness, function as a community group and a way for members to share a love for home gardening. This study provides insights into the perceived and potential health-promoting effects of garden appreciation groups for rural populations. Lay Summary: There are many health and well-being benefits of gardening. However, research is predominantly focused on the active practice of gardening in urban environments, and little is known about the passive activity of garden appreciation, nor about the benefits of this activity in rural areas. This paper explores the health promotion potential of garden appreciation groups through the experiences of members of a rural group called CHAMPAS. Eleven members of CHAMPAS were asked to talk about what kept them attending, and what health and well-being benefits the group provided them. The study found that CHAMPAS benefits stemmed from its function as a social group and a way for members to share a love for home gardening. The findings suggest that garden appreciation groups potentially provide health promotion benefits for people in rural areas. A recommendation of this paper is to undertake further research to map and analyse these benefits across rural Australia. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, South Africa implemented a national lockdown including a ban on the sale of alcohol. This paper describes adults' perspectives on this alcohol ban, focusing on whether they support or oppose this regulation. As part of a longitudinal study that documents South African's experiences of the COVID-19 lockdown, qualitative data were collected from 49 adults and analyzed thematically. Perspectives are framed around the overarching theme of "lives versus livelihoods," presented as support and/or opposition to the ban. Participants who endorsed the ban, as preserving "lives," thought that it facilitated social distancing and therefore limited the spread of COVID-19. Those who opposed the ban suggested that it undermined the "livelihoods" of South Africans, in the context of an already-strained economy. Our findings show that decisions around whether to support or oppose the alcohol ban were informed by critical reflections on the wider socio-behavioral and health implications of such regulations. Further implications are discussed. [ABSTRACT FROM AUTHOR]

Objectives: This paper aimed to explore the experiences of depressed adolescents who completed but did not 'respond' to standard psychotherapy, based on a lack of improvement in pre‐post symptoms scores. Design: This was a qualitative study employing interpretative phenomenological analysis (IPA). Method: Seventy‐seven adolescents with moderate to severe depression were interviewed as part of a qualitative arm of a randomised controlled trial. Five adolescents' post‐treatment interviews were purposively sampled, based on lack of improvement on pre‐post symptom scores, and adolescents still scoring above the clinical threshold for depression. The interviews were analysed using IPA. Results: Adolescents made sense of their depression as part of their identity and held negative expectations of therapy. Some aspects of therapy brought up intolerable feelings that contributed to disengagement in the therapeutic process and culminated in disappointing and hopeless endings. On the other hand, where a stronger therapeutic relationship was developed, some participants experienced certain improvements. Conclusions: Findings highlight how actively exploring the adolescent's therapy expectations, developing a strong early therapeutic relationship and being mindful of the potential impact of endings are important in therapeutic work with adolescents with depression, especially where they may have a strong sense of hopelessness and self‐criticism. Moreover, the finding that adolescents experienced improvements in other domains despite a lack of symptom reduction highlights the need to review how treatment outcomes are currently defined. Integrating individual perspectives of therapy with quantitative outcome measures can provide a more nuanced insight of treatment effects. [ABSTRACT FROM AUTHOR]

Schizophrenia is a global concern, and, this paper, describes the caring roles of health professionals who are mothers of adult children with schizophrenia. A thematic analysis of data from a doctoral study identified a blending of expertise into an informed care model. Caring roles included: constant carer; coordinator carer; watchful bystander carer; and life coach carer. Previous research has not explored these dual roles. This paper elucidates their responsive approaches and contributions to mothering and caregiving roles. Informed by a fusion of professional and mothering knowledges, their insights into mental health care have been forged by their experiences and is an untapped resource. [ABSTRACT FROM AUTHOR]

Background: The management of medicines towards the end of life can place increasing burdens and responsibilities on patients and families. This has received little attention yet it can be a source of great difficulty and distress patients and families. Dose administration aids can be useful for some patients but there is no evidence for their wide spread use or the implications for their use as patients become increasing unwell. The study aimed to explore how healthcare professionals describe the support they provide for patients to manage medications at home at end of life. Methods: Qualitative interview study with thematic analysis. Participants were a purposive sample of 40 community healthcare professionals (including GPs, pharmacists, and specialist palliative care and community nurses) from across two English counties. Results: Healthcare professionals reported a variety of ways in which they tried to support patients to take medications as prescribed. While the paper presents some solutions and strategies reported by professional respondents it was clear from both professional and patient/family caregiver accounts in the wider study that rather few professionals provided this kind of support. Standard solutions offered included: rationalising the number of medications; providing different formulations; explaining what medications were for and how best to take them. Dose administration aids were also regularly provided, and while useful for some, they posed a number of practical difficulties for palliative care. More challenging circumstances such as substance misuse and memory loss required more innovative strategies such as supporting ways to record medication taking; balancing restricted access to controlled drugs and appropriate pain management and supporting patient choice in medication use. Conclusions: The burdens and responsibilities of managing medicines at home for patients approaching the end of life has not been widely recognised or understood. This paper considers some of the strategies reported by professionals in the study, and points to the great potential for a more widely proactive stance in supporting patients and family carers to understand and take their medicines effectively. By adopting tailored, and sometimes, 'outside the box' thinking professionals can identify immediate, simple solutions to the problems patients and families experience with managing medicines. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Advanced clinical practitioners (ACPs) are, typically, non‐medical healthcare professionals, who possess advanced clinical skills, a master's level qualification and evidence of leadership, management and research abilities.Most ACPs are nurses and new ACP roles are increasingly being established around the world.The views of senior staff towards new mental health nursing roles in organizations are likely to influence their introduction and sustainabilityResearch on mental health nursing ACP roles is sparse. What the paper adds to existing knowledge?: The paper uniquely provides specific information as to factors perceived by senior staff as affecting the implementation of ACP roles in mental health services.A wide range of mental health services were perceived as potentially benefiting from ACPs.Establishing role clarity for MHN ACPs is perceived as being as essential to successful introduction of the role, as has been found for other specialities. What are the implications for practice?: Participants identified a need for early engagement with service users and professions about new ACP roles and for processes that can evaluate ACP roles once they established.Some mental health nurses may require long‐term developmental pathways to help prepare them to take on a master's level course and then the ACP role. Introduction: Advanced clinical practice (ACP) roles are increasingly being developed internationally. Identifying factors perceived as affecting the development of ACP can support effective implementation. Aim: To understand the views of senior health service staff as to factors influencing the development of ACP roles in mental health services. Method: Focus group and semi‐structured interviews. Participants were directors of nursing (n = 10) and other senior staff from roles important to workforce development (n = 10). Results: Content analysis suggested seven categories: understanding the role and national guidelines, attitudes to the role, learning from implementing other roles, understanding prerequisites for development, challenges, opportunities and future support/actions. Prerequisites for success would include early engagement with stakeholders. Medical attitudes towards ACP roles were perceived as generally more positive than previously. Discussion: The study provides unique information regarding perspectives of senior staff regarding the implementation of ACP roles in mental health services. A wide range of mental health services were perceived as potentially benefiting from ACPs, with the importance of role clarity being highlighted and long‐term developmental pathways for staff. Implications for practice: Successful Implementation of ACP roles may require clear role definition, early engagement with stakeholders and processes to evaluate role outcomes. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to understand the perspectives of frontline health and social care professionals in relation to delays in discharge from community hospitals.Design/methodology/approach A qualitative approach was taken, using semi-structured interviews and non-participant observation, within three community hospitals in NHS Scotland. In total, 12 frontline health and social care professionals were interviewed and observation of the multi-disciplinary team meeting was completed. Thematic content analysis was used to analyse the data produced.Findings The key findings were delayed discharge as an issue, lack of resources and capacity, difficulties in the relationship between acute and community health staff, silo working between health and social care, conflicting pressures on staff, and influence over services and external factors. There were perceived different ways of working within acute health, community health and social work, which were suggested to reduce efficiency, cause tension and ultimately result in delays. All professionals perceived an inability to influence any of the factors causing delays in discharge.Practical implications The internal issues regarding inter-professional working could potentially damage integration, indicating a need to teach collaborative team skills as well as quality improvement training to support staff to challenge and change current ways of working.Originality/value The paper contributes to the evidence base of community hospitals. There are implications for both health and social care policy. [ABSTRACT FROM AUTHOR]

Background: Speech disorders in children with a cleft palate with or without a cleft lip (CP±L) are complex given the magnitude of influencing factors. Providing intervention to eliminate these speech errors is often challenging. Speech–language pathologists (SLPs) might have negative perceptions of the treatment of children with a CP±L. Aims: To explore how community SLPs perceive and experience the provision of speech intervention to children with a CP±L. Methods & Procedures: A total of 18 female community SLPs, aged between 23 and 62 years, were included in this study. Semi‐structured interviews were conducted. The interviews were analysed using an inductive thematic approach aiming to identify themes driven by the data. Trustworthiness of the data was achieved by including researcher triangulation (involving three researchers with different research backgrounds) and deviant case analysis of two cases. Outcomes & Results: Initial responses demonstrated that the community SLPs were excited and enthusiastic to treat children with a CP±L. Expanding on these initial reports, however, they revealed that their excitement turned into professional self‐doubt and insecurity when confronted with the treatment challenges inherent with this population. To cope with this self‐doubt, they outlined several responsibilities for the cleft team SLPs. They expressed a strong desire to receive confirmation and approval on their treatment practices from more experienced SLPs (i.e., the cleft team SLPs). Their perceptions were dominated by a polarized thinking pattern. Treatment approaches were divided in categories as 'right' or 'wrong' and 'good' or 'bad'. Conclusions & Implications: The community SLPs are lacking professional confidence when treating children with a CP±L. They put themselves in a subordinate position towards the cleft team SLPs and expect the latter to provide ready‐made answers to problems and questions. This expectation can perhaps be explained by their fear of making mistakes during therapy preventing treatment progress. If they handle in accordance with the experts' advice, they cannot blame themselves in cases where no treatment progress is seen. Educational programmes need to pay more attention to gaining professional confidence (in the search for the most optimal treatment approach for each individual patient) rather than merely focusing on competency‐based learning tools. What this paper adds: What is already known on the subject: Speech disorders in children with a cleft palate with or without a cleft lip (CP±L) are complex given the magnitude of influencing factors. Providing intervention to eliminate these speech errors is often challenging. What this paper adds to existing knowledge: This study explored how community SLPs' perceive and experience the provision of speech intervention to children with a CP±L. The perceptions of community SLPs are dominated by a polarized thinking pattern. Treatment approaches are divided into categories as "right" or "wrong" and "good" or "bad". They lack professional confidence when they treat children with a CP±L. The community SLPs put themselves in a subordinate position towards the cleft team SLPs and expect the latter to provide ready‐made answers to problems and questions. What are the potential or actual clinical implications of this work?: Educational programs in speech‐language pathology need to pay more attention to gaining professional confidence rather than merely focusing on competency‐based learning tools. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to identify barriers and benefits in establishing a model for integration of palliative care of cancer patients in daily clinical practice in tertiary health institutions. Methods: This was a qualitative design study using in‐depth interviews with four stakeholders and focus group discussions with 19 nurse managers using purposive sampling to select the participants, utilizing interpretive paradigm method. Need was ascertained for a model that would guide nursing care for cancer patients. Results: Barriers identified in relation to integrating palliative care in daily clinical practice included lack of hospital policies about palliative care activities, cultural influences, denial or rejection of diagnosis by patients, inappropriate attitude of health care workers, patients failing to keep check‐up appointments and financial implications of setting up a dedicated palliative care team. Benefits of the model were twofold: hospital outcomes and patients/family outcomes. Conclusions: Quality care for cancer patients/families calls for the adoption of clearly set out principles of palliative care as an integral component of daily practice. Challenges to implementation of palliative care services in hospitals can be overcome by establishing workable policies and allocating adequate funds for palliative care activities. SUMMARY STATEMENT: What is already known about this topic? There is high incidence rate of cancer globally and Nigeria is not an exception.Diagnosis of cancer brings about fear and psychological distress to patients and their families.There is absence of health policy in Nigeria on prevention, control or even care of conditions such as cancer. What this paper adds? Barriers to adapting a palliative care model can be overcome by instituting policies, guidelines and palliative care teams to monitor all patients diagnosed with cancer.General positive attitude of health care professional towards cancer patients and families.Barriers to palliative care model implementation can be overcome by proper follow‐up of patients on first diagnosis. The implications of this paper: Hospital management can develop and implement interventions based on patients identified needs.Nurses should be properly trained on palliative care principles.There should be medium of educating patients and families after diagnosis of cancer to avoid negative cultural influence. [ABSTRACT FROM AUTHOR]

Clandinin and Connelly’s narrative inquiry methodology was used to understand the lived and told stories of two emerging adult women (aged 18–29) living with chronic pain. The aim of this paper is to share the experiences of the first author—a graduate student and novice researcher—of creating relational spaces with emerging adult women living with chronic pain, and the experience of co-creating knowledge through the methodological lens of narrative inquiry. There are 12 qualitative touchstones that narrative inquirers attend to when using narrative inquiry, and we present the experiences of a novice narrative inquirer in relation to selected touchstones. Narrative inquiry can greatly contribute to nursing knowledge, and implications for nursing practice and research are discussed. [ABSTRACT FROM AUTHOR]

Dual Sensory Loss and learning disability is a historically neglected area of social work practice. This paper presents one element of a research study conducted with a health and social care provider in Northern Ireland. It explored staff experiences of assessing adults and children with a dual sensory loss and learning disability. Two sensory disability team managers, eight social workers and two rehabilitation officers were interviewed across sensory disability, learning disability and children with disability teams. Current levels of engagement and ways in which more inclusive services and practices could be developed were explored. Staff views indicate that there is minimal engagement between staff and service users with unique, complex needs. Staff use a range of tools, resources and skills in an attempt to promote inclusion and engagement. The paper concludes that to promote engagement staff need to develop their practice, making effective use of tools and resources. Staff skills and knowledge can be enhanced through training which is targeted, relevant and specific. There needs to be commitment to sharing good practice and cascading learning throughout teams. This will enable service users to have input into their own assessments which will form the cornerstone of all ongoing interventions. [ABSTRACT FROM AUTHOR]

Decades of collective and cumulative work by practitioners, activists and researchers have made violence prevention an important part of international development agendas. However, violence prevention and response work addressing women and children has historically been siloed. Those working at the intersection of violence against women (VaW) and violence against children (VaC) have wrestled with the age–gender divide. Addressing the historical and political influences that underpin this divide will likely enhance progress towards more integrated strategies. This paper examines the origins and development of this polarisation and potential strategies for a more coordinated and collaborative agenda. This paper draws on the insights gained from eleven (11) semi-structured interviews conducted with key violence prevention actors in VaW and VaC from across the globe, alongside relevant published literature. Informants were purposively sampled on the basis of their expertise in the field. Findings reveal key differences and tensions between the two fields, including in collection and use of research and evidence, core conceptual frameworks, and the development, funding and implementation of policy and practice. Potential opportunities for future synergies between the two fields are highlighted, particularly through a focus on the adolescent girl. [ABSTRACT FROM AUTHOR]

Objective: To explore the perceptions of rural health professionals who use telehealth services for cardiovascular health care, including the potential role of telehealth in enhancing services for this patient group. Methods: Semi-structured interviews were conducted with ten rural health professionals across a range of disciplines, including medicine, nursing and allied health. All study participants were based in the same rural region in New South Wales, Australia. Results: Participant responses emphasised the importance of including rural communities in ongoing dialogue to enhance telehealth services for cardiovascular care. Divergent expectations about the purpose of telehealth and unresolved technology issues were identified as factors to be addressed. Rural health professionals highlighted the importance of all stakeholders coming together to overcome barriers and enhance telehealth services in a collaborative manner. Conclusion: This study contributes to an evolving understanding of how health professionals based in regional Australia experience telehealth services. Future telehealth research should proceed in collaboration with rural communities, supported by policy that actively facilitates the meaningful inclusion of rural stakeholders in telehealth dialogue. What is known about the topic?: Telehealth is frequently discussed as a potential solution to overcome aspects of rural health, such as poor outcomes and limited access to services compared with metropolitan areas. In the context of telehealth and cardiovascular disease (CVD), research that focuses on rural communities is limited, particularly regarding the experiences of these communities with telehealth. What does this paper add?: This paper offers insight into how telehealth is experienced by rural health professionals. The paper highlights divergent expectations of telehealth's purpose and unresolved technological issues as barriers to telehealth service delivery. It suggests telehealth services may be enhanced by collaborative approaches that engage multiple stakeholder groups. What are the implications for practitioners?: The use and development of telehealth in rural communities requires a collaborative approach that considers the views of rural stakeholders in their specific contexts. To improve telehealth services for people living with CVD in rural communities, it is important that rural stakeholders have opportunities to engage with non-rural clinicians, telehealth developers and policy makers. [ABSTRACT FROM AUTHOR]

Objectives: GrandSchools is a new concept which co-locates retirement villages with secondary schools in one physical environment. Designed to enhance the health and well-being of both younger and older generations, this intergenerational-shared campus model promotes intergenerational inclusivity and active learning and living. In this paper, we explore stakeholder experts' perceptions of current opportunities and impediments to this proposed intergenerational learning and living model. Methods: A qualitative study reporting on findings from an industry seminar (n = 50) and key interviews (n = 10) from stakeholders in education, health, higher education, the management and operation of retirement villages, and design firms. Results: Three key themes summarised participants' assessment of the value, risks and what needs to change in order for intergenerational living and learning to become a reality. Conclusions: By bringing younger and older generations together in one shared campus location, GrandSchools is a novel idea to promote intergenerational inclusivity, enhancing the health and well-being of our whole community. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic has resulted in major disruption to economic, health, education, and social systems. Families with preschool children experienced extraordinary strain during this time. This paper describes a qualitative study examining the experience of parents of preschool children in Hawaii during the COVID-19 pandemic. Sample: Thirteen (N = 13) parents of preschool children living on the island of Oahu, Hawaii, participated in small group discussions occurring in February and March 2021, approximately 1 year after the start of the pandemic in the state. Discussion transcripts were coded and sorted into themes. Results: Four themes emerged: stressors due to the COVID-19 pandemic, family coping and resources, meaning of the COVID-19 crisis to the family, and family adaptation patterns. Themes mapped to the Family Adjustment and Adaptation Response model. Conclusion: Families relied on various resources to cope with stressors experienced due to the COVID-19 pandemic, and adopted new patterns related to seeking healthcare and household emergency preparedness. Findings may inform policies and interventions to support families during the ongoing COVID-19 pandemic and future public health emergencies. [ABSTRACT FROM AUTHOR]

Several health research organisations whose work focuses on international collaboration outline guidelines that support ethical practice in health research partnerships including building consensus around good collaborative research practice. This paper explores researcher's perspectives, experiences, and reflections on the elements of successful health research partnerships between Northern and Southern countries/institutions. The study adopted a qualitative research approach using in-depth interviews to explore what an authentic partnership is as experienced and aspired by stakeholders in health research partnerships in Zambia. Interviews were conducted with stakeholders implementing various health research activities in the country. Our findings revealed that Southern partners aspired for equal status and participation, transparency, and accountability, interdependency, and reciprocity, commitment to shared goals, open dialogue and sustainability in partnerships. While to some extent these aspirations overlap with the categories covered throughout the different partnership guidelines, some key aspects go beyond what is included in existing recommendations such as status and recognition which are salient in the broader guidelines. An important aspect in dismantling power structures that causes inequality in partnerships is through generating knowledge and innovation using local resources in the South to address local needs which can be subsequently re-used to address challenges at the global level. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Family‐focused interventions in Adult Mental Health Services (AMHS) address the needs of families where a parent is diagnosed with a mental illness. One of these interventions is the "Let's Talk about Children" programme (Let's Talk) (Solantaus & Toikka, 2006 International Journal of Mental Health Promotion, 8(3), 37).There is limited implementation knowledge on family‐focused interventions.A body of research to better understand the transfer of evidence‐based interventions into everyday practice has identified multiple influencing elements. The Consolidated Framework for Implementation Research (CFIR) has combined these known elements from research into five domains of influence.Elements that influence the implementation of evidence‐based practice are inter‐related and need to be understood in combination.Understanding different stakeholder perspectives on implementation in real‐world settings helps to understand uptake, challenges and opportunities. What the paper adds to existing knowledge?: As the first study to document leadership's perspectives of implementing Let's Talk, this paper contributes to the evidence base on their role in implementing family‐focused practice models in mental health.There are specific roles of leadership that need to be addressed to support implementing Let's Talk in changing environments.Leadership's knowledge of Let's Talk and approach to change influences implementation.Questions are raised about the role the readiness of the parent and the impact that the dynamic process between the practitioner and parent has on implementing Let's Talk. What are the implications for practice?: Engaging leadership needs to address the influence of their different organizational roles in shaping implementation for Let's Talk.Further research is needed to understand the dynamic process between parent and practitioner that influences readiness for trialling Let's Talk. Introduction: Different stakeholder's perspectives are needed to understand challenges and opportunities in implementing and sustaining evidence‐based practices (EBP) in real‐world settings. Aim/Question: To identify leadership perspectives on key elements influencing the process of implementation of Let's Talk about Children (Let's Talk), a family‐focused practice for practitioners working with parents diagnosed with a mental illness. Method: Semi‐structured interviews were conducted with 16 service managers and implementation leads, to establish their views on key elements influencing implementation of Let's Talk during a randomized controlled trial. A thematic analysis applied both inductive and deductive approaches, using the Consolidated Framework for Implementation Research (CFIR). Results: Impacts to effective translation to practice were grouped into three broad themes with eight subthemes: inner and outer setting impacting organization, leadership affecting readiness and parent and practitioner readiness. Discussion: The findings suggest that specific roles for leadership are vital to implementation within an environment of constant change, and more attention is needed to understand the dynamics of parent and practitioner readiness for delivering Let's Talk. Implications for practice: Different leadership roles need to be engaged to sustain Let's Talk in changing real‐world environments. The dynamic processes between parent and practitioner are suggested to influence readiness and need further research. [ABSTRACT FROM AUTHOR]

Purpose: Approximately 20 per cent of Australian children live with a parent who experiences mental illness. These children have poorer health and psychosocial outcomes than their peers. While family-focused practice (FFP) can improve these outcomes, family-focused service provision is inconsistent. The purpose of this paper is to understand clinicians' experiences of FFP and associated workplace factors. Design/methodology/approach: In-depth interviews were conducted with ten community mental health clinicians. Interviews were audio recorded and transcribed. Data were analysed using thematic analysis. Findings: A global theme of "navigating rocky terrain" captured clinicians' experiences of working with families. The rocky terrain encompassed both family complexity and workplace barriers to FFP. Clinicians navigated this terrain by using multiple strategies to support families, working in partnership with families and other clinicians and services, and drawing on personal resources. Interactive approaches to enhancing knowledge and skills were preferred over paper-based information. While an organisation-wide approach to support FFP was beneficial, clinicians continued to feel challenged in implementing FFP. Research limitations/implications: Working with families in which parents experience mental illness is affected by systemic issues at the family and organisational levels. Systemic approaches to both delivering and supporting this work are required. Partnership working and organisation-wide capacity building strategies emphasising interactive approaches to learning appear to have positive effects. Originality/value: This study explores the challenges of FFP in a real-world multidisciplinary context where there has been a systemic approach to enabling this work. It highlights the challenges clinicians face in family-focused practice in spite of substantial organisational supports and suggests some approaches that might be effective. This is a topic which has received minimal attention in the literature. [ABSTRACT FROM AUTHOR]

Dementia affects majority of older residents in nursing homes and physiotherapists are regularly involved with this population. However, little is known about the role of physiotherapists who treat residents with dementia in nursing homes. The aim of this paper was to report on an interpretivist qualitative exploration of the perceptions of both the providers of and referrers to domiciliary physiotherapy for residents with dementia in nursing homes in London. In 2015, we conducted semi‐structured interviews with 10 purposively sampled participants – two were providers of physiotherapy for residents with dementia in nursing homes, five were referrers to these providers and three occupied dual roles. A thematic analysis of the verbatim transcripts identified three main themes. First were perceptions of a multifaceted but unclear role, focused on both conventional 'physical' physiotherapy interventions and specialist care, the latter being reliant on knowledge and confidence that physiotherapists did not always feel they possessed. Second were the stated challenges to the role, including the focus and organisation of the nursing home setting, with perceived lack of emphasis on rehabilitation; the progressive and demanding nature of dementia itself; a lack of continuity of nursing home and visiting health professional staff with associated need to entrust physiotherapy intervention to multiple others and the final challenge was the difficulty measuring impact. Third, despite the challenges, enablers of the role were experienced, namely collaborative working and positive previous experiences of referrers. Joining these themes were underpinning concepts of complexity and uncertainty in relation to the physiotherapy role in this setting. This paper highlights a need for enhanced collaborative working in clinical practice, enabled at organisational level, to help address some of the uncertainties expressed around the physiotherapists' role with residents with dementia in nursing homes and thereby enable improvements to processes and outcomes of their interventions. [ABSTRACT FROM AUTHOR]

Child undernutrition is responsible for 45% of all under‐five deaths in low‐ and middle‐income countries (LMICs) and numerous morbidities. Although progress has been made, high levels of child undernutrition persist in Zambia. Existing studies have explored primary caretakers' (PCs) explanatory models of child undernutrition in LMICs, without comparison with those of health care providers (HCPs). This paper examines and compares the perceived causes of child undernutrition among PCs and HCPs in Zambia. We conducted a qualitative study, using semistructured one‐to‐one and group interviews, with 38 PCs and 10 HCPs to explore their perceptions of child undernutrition and its perceived causes in Lusaka district, Zambia. Interview data were analysed with thematic analysis. Our findings indicate that PCs and HCPs in Lusaka district have divergent explanatory models of child undernutrition and perceive parental agency differently. In divergently framing how they conceptualise undernutrition and who is able to prevent it, these models underpin different attributions of causality and different opportunities for intervention. PCs highlighted factors such as child food preferences, child health, and household finances. Contrarily, HCPs stressed factors such as 'improper feeding', only highlighting factors such as wider economic conditions when these impacted specifically on health care services. One factor, identified by both groups, was 'inadequate mothering'. To accelerate the reduction of child undernutrition, interventions must address divergences between PCs and HCPs' explanatory models. Additionally, attention needs to be paid to how wider socio‐economic and cultural contexts not only impact childhood undernutrition but shape attributions of causality. [ABSTRACT FROM AUTHOR]

The aim of this paper was to understand the needs of family caregivers and professionals supporting people living with dementia with eating and drinking difficulties towards the end of life and the strategies they use to overcome them. A total of 41 semi‐structured interviews with family caregivers (n = 21) and professionals (n = 20) were conducted in London and surrounding areas of England. Interviews were audio‐recorded and transcribed verbatim. Four themes were identified: caregivers accessing and seeking help, perceived priorities of care, professionals' supportiveness and educational role, and strategies. Caregivers often struggle as they are not aware of the eating and drinking difficulties associated with dementia's progression. Care can change over time with families prioritising a person's comfort towards the end of life rather than ensuring a particular level of nutrition. Mutual support is required by both professionals and caregivers to enhance the care of the person living with dementia. Cognitive difficulties are often behind initial eating and drinking challenges in dementia, whereas physical challenges take over towards the later stages. Flexibility and creativity are key to adapting to changing needs. There is a need to raise awareness of the eating and drinking challenges associated with the progression of dementia. Professionals can help caregivers embark on the transition towards focussing on comfort and enjoyment of eating and drinking near the end of life rather than nutrition. This is particularly relevant for those caring for a relative living at home. Caregivers' input is needed to tailor professionals' recommendations. [ABSTRACT FROM AUTHOR]

Objective: Allied health structures and leadership positions vary throughout Australia and New Zealand in their design and implementation. It is not clear which organisational factors support allied health leaders and professionals to enhance clinical outcomes. The aim of this project was to identify key organisational contexts and corresponding mechanisms that influenced effective outcomes for allied health professionals. Methods: A qualitative realist evaluation was chosen to describe key aspects of allied health organisational structures, identify positive outcomes and describe how context and processes are operationalised to influence outcomes for the allied health workforce and the populations they serve. Results: A purposive sample of nine allied health leaders, five executives and 49 allied health professionals were interviewed individually and in focus groups, representing nine Queensland Health services. Marked differences exist in the title and focus of senior allied health leaders' roles. The use of a qualitative realist evaluation methodology enabled identification of the mechanisms that work to achieve effective and efficient outcomes, within specific contexts. Conclusions: The initial middle range theory of allied health organisational structures in Queensland was supported and extended to better understand which contexts were important and which key mechanisms were activated to achieve effective outcomes. Executive allied health leadership roles enable allied health leaders to use their influence in organisational planning and decision-making to ensure allied health professionals deliver successful patient care services. Professional governance systems embed the management and support of the clinical workforce most efficiently within professional disciplines. With consistent data management systems, allied health professional staff can be integrated within clinical teams that provide high-quality care. Interprofessional learning opportunities can enhance collaborative teamwork and, when allied health professionals are supported to understand and use research, they can deliver positive patient and business outcomes for the health service. What is known about the topic?: A collective allied health organisational structure encourages engagement of allied health professionals within healthcare organisations. Organisational structures commonly include management and leadership strategies and service delivery models. Allied health leaders in Queensland work across a range of senior management levels to ensure adequate resources for sufficient suitably skilled professional staff to meet patient needs. What does this paper add?: Literature to date has described how allied health professionals operate within organisational structures. This paper examines key aspects of allied health management, governance and leadership, together with mechanisms that support allied health professionals to deliver effective clinical and business outcomes for their local community. What are the implications for practitioners?: Health service executives and allied health leaders should consider supporting executive allied health leadership roles to influence strategic planning and decision-making, as well as to deliver outcomes that are important to the health service. When allied health leaders implement integrated professional and operational governance systems, executives described allied health professionals as influential in supporting team-based models of care that add value to the business and improve outcomes for patients. When allied health leaders use consistent data management, executives reinforced the benefit of aligning activity data with financial costs to monitor, recognise and reimburse appropriate clinical interventions for patients. When allied health leaders support allied health workforce capability through educational and research opportunities, clinicians can use research to inform their clinical practice. [ABSTRACT FROM AUTHOR]

Scotland is faced with pernicious health inequalities, which stem from inequalities in living conditions and the societal structures that create them. While action is needed to address the wider structural causes of health inequalities, the role of general practitioners (GPs) merits attention due to health care's potential to mitigate or exacerbate health inequalities. Minimal research, however, has explored how GPs understand the fundamental causes of health inequalities nor how they conceptualise their role in mitigating these. This paper aims to fill this gap using in-depth qualitative interviews with 24 GPs working in some of Scotland's most socio-economically disadvantaged, urban areas. Using Raphael's SDH discourse framework, this paper found clear linkages between GPs' perceptions of their patients, how they defined the 'problem' of health inequalities, and what they thought could be done to tackle them in disadvantaged areas. In general, there was convergence on how interviewees viewed their role in mitigating health inequalities through their work with individual patients. However, greater variation was found when describing the boundaries of their role and how far these extended beyond individual encounters. Specifically, only those GPs fluent in discussing structural causes of health inequalities discussed obligations to change local systems via strengthening community linkages and to influence higher level policies related to the SDH. This suggests that while there is a degree of what Metzl and Hansen deem 'structural competency' amongst some GPs working in disadvantaged areas, the scope remains to deepen this competency more broadly. [ABSTRACT FROM AUTHOR]

Purpose There is a recognition in Europe and in the western world of a demographic shift in the ageing population. While the overall ageing of the general population is growing, the numbers of immigrants getting old in their host countries is also increasing, thereby increasing the racial and ethnic proportion of older people in these countries. This changing landscape calls for understanding of issues related to health care provision, policy and research regarding ethnic minorities. Communication is seen as a key factor in understanding the needs of ethnic minority elders (EMEs). The purpose of this paper is to explore health care workers’ (HCWs) perceptions and experiences of communication with EMEs. In this paper the term HCW includes qualified nurses and health care assistants.Design/methodology/approach A descriptive qualitative study design using semi-structured interviews was employed. Ten HCWs, who had ethnic minorities in their care were individually interviewed to explore their perceptions and experiences of communication when caring for EMEs.Findings Analysis of data revealed that in common with all older people, EMEs experience stereotyped attitudes and difficulties in communication. However, EMEs face particular challenges, including cultural differences, different language and stereotyping of care based on misunderstood needs of EMEs. Facilitators of communication included appropriate training of HCWs and appropriate use of interpreters.Research limitations/implications Only homes willing to take part in the study gave permission for their staff to be interviewed. In addition, the HCWs came from various settings. Therefore, views of staff in homes who did not give permission may not be represented.Practical implications The diversity of older people needing care in nursing homes and the community calls for training in culturally competent communication for effective provision care provision for EMEs.Originality/value Training of health care staff in culturally appropriate communication requires effective practice. [ABSTRACT FROM AUTHOR]

This paper examines the impact of disruptions to the organisation and delivery of healthcare services and efforts to re‐order care through emotion management during the COVID‐19 pandemic in the UK. Framing care as an affective practice, studying healthcare workers' (HCWs) experiences enables better understanding of how interactions between staff, patients and families changed as a result of the pandemic. Using a rapid qualitative research methodology, we conducted interviews with frontline HCWs in two London hospitals during the peak of the first wave of the pandemic and sourced public accounts of HCWs' experiences of the pandemic from social media (YouTube and Twitter). We conducted framework analysis to identify key factors disrupting caring interactions. Fear of infection and the barriers of physical distancing acted to separate staff from patients and families, requiring new affective practices to repair connections. Witnessing suffering was distressing for staff, and providing a 'good death' for patients and communicating care to families was harder. In addition to caring for patients and families, HCWs cared for each other. Infection control measures were important for limiting the spread of COVID‐19 but disrupted connections that were integral to care, generating new work to re‐order interactions. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There is body of knowledge available about the harms associated with restrictive interventions used in behaviour management, service users' perceptions of the use of restraints, and staff competence in behaviour management. The staff perspective has been studied in terms of staff exposure, responses to and prevention of aggression, staff‐related factors associated with service user aggression, and staff attitudes and perceptions towards violence.The definitions of competence in behaviour management provided in training interventions are fragmented and based on unilateral measurements.Training interventions with the purpose of enhancing staff competence in behaviour management are organized regularly, yet there is a lack of clarity on how effective these interventions are. Inadequate conceptual understanding of behaviour management can weaken the effectiveness of these interventions. What this paper adds to existing knowledge?: Our study produced new knowledge by providing a preliminary conceptual framework that can be used to comprehensively describe and assess competence in managing challenging behaviour and to cover safely the whole care process. Humane care and ethical sensitivity should be the premises of interaction with people in distress. We also pointed out the needs for conceptual clarification of the concepts of confidence, support and restraint.We provide important new insight into the leadership and cultural issues of behaviour management that is relevant for patients, staff members and healthcare organizations. We found that staff members do not consider service user safety and workplace safety as opposing issues.Further, we provide new perspectives for prevention, the risk assessment process and effective communication in the context of behaviour management. What are the implications for practice?: A comprehensive understanding of the competences related to behaviour management will foster universal definitions for "support" and "restraint," which can then be used to ensure that the best practices are used for behaviour management.Organizational culture and participative leadership on behaviour management should be developed with a special focus on safety issues, common understanding of comprehensive competence, risk assessment and prevention, views regarding the use of restraints, and teamwork. Introduction: Previous research concerning staff views of behaviour management has not considered instructors' views. The definitions of competence in behaviour management are fragmented, which can undermine the effectiveness of training interventions. Aim/Question: This study aimed to describe Finnish and British Management of Actual or Potential Aggression instructors' perceptions of safety and behaviour management‐related competences and create a conceptual framework for comprehensive competence. Method: An explorative‐descriptive qualitative approach with purposive sampling (N = 22), semi‐structured interviews and abductive content analysis. Results: Conceptual framework of comprehensive competence in managing challenging behaviour includes five categories—knowledge, skills, attitude, confidence and ethical sensitivity—and 21 subcategories. Competent staff and supportive leadership ensured safety, while inconsistent risk management culture, the health and behaviour of service users, and inadequate staff orientation endangered safety. Discussion: The study produced new knowledge of safety issues and competences from the perspective of the instructors who deliver behaviour management training. Implications for practice: Competence to manage challenging behaviour should be developed based on our conceptual framework to provide an effective and safe training. Prevention, the risk assessment process, alternative communication, and the definitions of "confidence," "support" and "restraint" should all be sufficiently addressed in future training. [ABSTRACT FROM AUTHOR]

Evidence suggests that physical activity (PA) programmes promoted via healthcare settings worldwide may not currently meet the needs of many patients and healthcare professionals (HCPs). This paper describes the outcomes of a qualitative enquiry into the perspectives of patients and professionals from multiple healthcare services regarding the role of PA. 19 patients and 22 HCPs were purposively recruited from physiotherapy, podiatry, chronic pain, diabetes and continence services at a community-based healthcare clinic in the United Kingdom. Participants' views were explored using semi-structured interviews and analysed using thematic analysis. Results identified five themes: differences between the social and medical rationales underpinning PA promotion; the impact of the patient-professional relationship on patient activation, self-management and PA; a risk culture surrounding PA; challenges to meet variation in patients' needs and preferences; and lack of formal role for PA as a core part of routine healthcare. The study highlights tensions between needs and aspirations, and the reality of delivering advice and support for PA. Challenges resonated with patients and HCPs across different care groups and were not condition-specific. This highlights a need for sharing good practice across healthcare services and system-level interventions to address organisational barriers to the promotion of PA. [ABSTRACT FROM AUTHOR]

Purpose: People with mental disorders experience higher rates of disability and mortality disproportionately than the general population. Until recently, psychiatric palliative care (PPC) for people with serious mental illness (SMI) was not explored as a treatment option. This paper aims to explore the feasibility of PPC as a supportive care model for people with serious mental illness. Design/methodology/approach: Fifteen health-care professionals' in the USA and Europe participated in semi-structured phone interviews regarding PPC for people with SMI. The Qualitative Analysis Guide of Leuven (QUAGOL) was used to conduct thematic analysis of the data. Findings: PPC was identified as a supportive care model that could improve quality of life and enhance patient autonomy for people with SMI. While PPC was endorsed as a possible new standard of care, it is imperative that the model be piloted to determine its efficacy as a viable treatment option among adults. Originality/value: There are limited studies that investigate the perceptions of health professionals' regarding the use of PPC as a treatment option for people with SMI. [ABSTRACT FROM AUTHOR]

Employees are a very important source of innovation and essential for the generation, dissemination and implementation of these ideas throughout the organization. This is especially relevant when considering innovation in services during service (co-) creation such as within the healthcare sector. However, perceived employee involvement in innovation (EII) and between stakeholder group interactions in hospitals has not yet been studied in detail. This paper addresses the following research questions: "How do different employee groups perceive their involvement in the innovation process in hospitals and how do their actual involvement levels differ?" and (2) "How do different employee groups perceive their interaction with other employee groups in the innovation process and how do their actual interactions differ?" We analyzed a single typical German research hospital and conducted episodic interviews with employees representing different staff groups. We revealed that while all groups of employees are involved in innovation activities, perception of their involvement in innovation activities differs widely. There is a gap between perception and actual involvement particularly for lower level employees such as nurses. Further, their interaction differs among employee groups and innovation takes place in-group, rather than through group interaction. With our paper, we add to the understanding of perceived EII in hospitals and discuss measures for hospital management to increase EII. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore and capture workforce perceptions, experiences and insights of the phenomena of integrated care (IC) in a community health and care NHS trust in England; including whether there are any associated factors that are enablers, barriers, benefits or challenges; and the level of workforce engagement in the process of integrated health and care. Design/methodology/approach: A qualitative design based on an interpretivist research paradigm was used with a purposive sampling technique. Five in-depth semi-structured interviews were conducted with community nursing, social workers and allied health professionals. Colaizzi's (1978) descriptive phenomenological seven-step method was applied to analyse data, with the emergence of 170 significant statements, 170 formulated meanings and 8 thematic clustering of themes to reveal 4 emergent themes and 1 fundamental structure capturing the essential aspects of the structure of the phenomenon IC. Findings: This study revealed four interdependent emergent themes: (1) Insight of IC and collaboration: affording the opportunity for collaboration, shared goals, vision, dovetailing knowledge, skills and expertise. Professional aspirations of person-centred and strength-based care to improve outcomes. (2) Awareness of culture and professionalism: embracing inter-professional working whilst appreciating the fear of losing professional identity and values. Working relationships based on trust, respect and understanding of professional roles to improve outcomes. (3) Impact of workforce engagement: participants felt strongly about their differing engagement experience in terms of restructuring and redesigning services. (4) Impact of organisational structure: information technology (IT) highlighted a barrier to IC as differing IT platforms prevent interoperability with one system to one patient. Shared positivity of IC, embracing new ways of working. Originality/value: This study proposes considerations for future practice, policy and research from a local, national and global platform, highlighting the need for any IC strategy or policy to incorporate the uniqueness of the "voice of the workforce" as a key enabler to integration developments, only then can IC be a fully collaborative approach. [ABSTRACT FROM AUTHOR]

Purpose: This paper explores the perceptions of a small cohort of participants in the "Involving People" programme. This 35-week course recruited staff from across statutory, voluntary and charity sectors who aimed to lead and develop change initiatives within their respective organisations. The study captured staff views on the extent to which their training in co-production enabled them to deliver sustainable service improvement within their organisations. Design/methodology/approach: This was a small scale, qualitative study, using a purposive sampling approach. Of the 18 staff participants, 5 agreed to participate in face-to-face semi-structured interviews. Through a process of free text analysis, several themes and sub-themes were identified. Findings: Several barriers and opportunities were highlighted coupled with suggestions on changes to public service delivery based on equal and reciprocal relationships between professionals, service users and their families. Organisational structures and silo working still act as an inhibiter for real change. Research limitations/implications: Additionally, it was demonstrated that training in the area of co-production can act as a catalyst for wider service improvements. It can enhance staff confidence to profile the importance of service user involvement, persuading their colleagues of its benefits and challenging practice where co-production is not happening. However, a collective leadership and a shared language on co-production are still needed to develop inclusive organisational cultures. Originality/value: This was the first study of its kind in Northern Ireland which highlighted that there was a need for a collective leadership and a shared language on co-production to develop inclusive organisational cultures. [ABSTRACT FROM AUTHOR]

Zambia has one of the highest cervical cancer rates in the world. This paper explores the acceptability of the Human Papillomavirus vaccine administered in girls (9–13 years) in Zambia. A qualitative case study was conducted in two schools in Lusaka district, which participated in the pilot for the Human Papillomavirus vaccine rollout. The study revealed that community level health systems factors such as knowledge levels about the vaccine, sexual morality concerns, conflicting views from parents on the vaccine, rumours that the vaccine contained cervical cancer and that it causes infertility in girls, previous bad experience with other vaccines, religious beliefs such as belief that God protects against illness, the nature of the school environment as well as faith in doctors shaped the uptake of the vaccine. Furthermore, formal health system factors such as availability of health workers and nature of collaboration between the Ministries of Health and Education influenced acceptability of the vaccine among the girls. Strengthening collaboration between community and formal health systems can play a vital role in supporting uptake of vaccines at community level as factors that hinder uptake of the vaccines emanate from both the community and health sector. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the implementation of a physical activity (PA) scheme - Let's Motivate (LM) - within private care homes (CHs) in Dumfries and Galloway (D&G), Scotland; aiming to provide an insight into the different factors which might contribute to its success and further sustainability. Design/methodology/approach: A qualitative study is described in which one-to-one semi-structured interviews were carried out with eight key staff involved in implementing the project within two purposively sampled CHs; in order to explore their views and experiences of implementation. Findings: The paper provides an insight into the different factors which stand to both promote and impede the successful implementation of LM, within the two CHs involved. Originality/value: This paper explores a new and innovative PA initiative in CHs in D&G, Scotland. Studies exploring the factors which can both promote and impede implementation are important as they can help to usefully inform the implementation and sustainability of initiatives. [ABSTRACT FROM AUTHOR]

Background: Family planning (FP) has the potential to improve maternal and child health outcomes and to reduce poverty in sub-Saharan Africa. However, substantial unmet need for modern contraceptive methods (MCMs) persists in this region. Current literature highlights multi-level barriers, including socio-cultural norms that discourage the use of MCMs. This paper explores women's choices and decision-making around MCM use and examines whether integrating FP services with childhood immunisations influenced women's perceptions of, and decision to use, an MCM. Methods: 94 semi-structured interviews and 21 focus group discussions with women, health providers, and community members (N = 253) were conducted in health facilities and outreach clinics where an intervention was delivering integrated FP and childhood immunisation services in Benin, Ethiopia, Kenya, Malawi and Uganda. Data were coded using Nvivo software and an analytical framework was developed to support interpretative and thematic analyses on women's decision-making about MCM use. Results: Most women shared the reproductive desire to space or limit births because of the perceived benefits of improved health and welfare for themselves and for their children, including the economic advantages. For some, choices about MCM use were restricted because of wider societal influences. Women's decision to use MCMs was driven by their reproductive desires, but for some that was stymied by fears of side effects, community stigma, and disapproving husbands, which led to clandestine MCM use. Health providers acknowledged that women understood the benefits of using MCMs, but highlighted that the wider socio-cultural norms of their community often contributed to a reluctance to use them. Integration of FP and childhood immunisation services provided repeat opportunities for health providers to counter misinformation and it improved access to MCMs, including for women who needed to use them covertly. Conclusions: Some women chose to use MCMs without the approval of their husbands, and/or despite cultural norms, because of the perceived health and economic benefits for themselves and for their families, and because they lived with the consequences of short birth intervals and large families. Integrated FP and childhood immunisation services expanded women's choices about MCM use and created opportunities for women to make decisions autonomously. [ABSTRACT FROM AUTHOR]

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Accessible summary: What is known on the subject?: There have been some studies on the experience and community life of mental health clients receiving integrated community mental health service (ICMHS).Evaluation of ICMHS suggests that the service could have positive clinical and social outcomes, but the results are inconclusive. What does the paper add to existing knowledge?: Research studies have focused on clients and/or staff of the ICMHS, while in this study, the experiences and perspectives of family members are also explored. More comprehensive knowledge about the work for, and community life of, people previously under the services of ICMHS is added to the existing knowledge.This study found that with "timely support" and "family presence," people who had received the services of ICMHS continued to engage in more social activities ("expanding social networks"), had "better family relationships," were "letting go" of thinking too much and more able to relax, and had "better self‐efficacy and self‐caring" in the community.Professional contact after ICMHS through continuous conversations (e.g. home visits and follow‐up calls) and social activities are essential for both clients and their families to carry on living with the illness.Timely support, family presence, support to family members in the community and better social networks are key experiences of ICMHS clients. What are the implications for practice?: Although the ICMHS' resources are limited, better promotion is urgently needed for the public to realize the services and to support mental health clients.Mental health professionals may develop practice models through exploratory and confirmatory factors analyses of the themes identified from this study as the outcome measures. The cost‐effectiveness of services and relapse rates over time should also be evaluated for future practice development.Further studies for practice on the difference that family support can make to the community life of former ICMHS clients are warranted. This may be achieved through research designs that compare people with, and without, family members. Introduction: More comprehensive understanding, from the experiences and multiple perspectives of the clients, families and staff, about the community life of former clients of the integrated community mental health service (ICMHS) is scarce. Aim: To explore the community life experiences of people after their discharge from the ICMHS. Method: A qualitative approach with an interpretative phenomenological analysis was utilized for this study. Data were collected through individual semi‐structured interviews of 37 participants, including people discharged from an Integrated Community Centre of Mental Wellness, their family members and staff members. Results: Six themes emerged from the analysis: "timely support," "family presence," "better family relationships," "expanding social networks," "letting go" and "better self‐efficacy and self‐care," under the main theme of "walking with the illness and life." Discussion: Over and after the ICHMS, with timely support and family presence, there was a positive trend in the experiences of clients in expanding social networks, having better family relationships, letting go of thinking too much and being more able to relax, and improving self‐efficacy and self‐caring. Implications for practice: The study provides a more comprehensive understanding of the experiences of clients, family and staff about the community life of people post‐ICMHS, providing insights and clearer directions for research and practice development. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Mental health nurses provide care within an environment that is often threatening.The environment is often threatening because: (a) patients' needs are complex and highly emotional, (b) nurses often do not have the time and resources they would wish for and (c) caring for patients can be emotionally exhausting and distressing.Compassionate care involves providing a welcoming environment, promoting bidirectional compassion, providing training in compassion and creating supportive organizations.To date, there is no study evaluating compassion interventions for the high‐threat profession of mental health nursing and no study qualitatively evaluating compassion training and implementation. What the paper adds to existing knowledge?: This study looked at what happens if compassion training delivered by the originator of Gilbert's model of compassion is given to mental health nurses.Nurses were interviewed 1 year later to see how relevant and useful the training was, and whether they had been able to use it in their daily work.Consistent with previous studies, the study found a reduction in professionals' self‐criticism and an increase in self‐compassion, which in this study extended to increased compassion and reduced criticism of colleagues and patients; and professionals applying the training directly to reduce patient self‐criticism. What are the implications for practice?: Nurses felt that more training and supervision was needed to build the confidence to use the training regularly at work.They felt it had been difficult to use the training because of the threatening environment in which they worked.Nurses recommended that the whole organization would need the training to make it part of their everyday work. Introduction: Compassionate care involves providing a welcoming environment, promoting bidirectional compassion, providing training in compassion and creating supportive organizations. To date, there has not been a study evaluating compassion interventions for the high‐threat profession of mental health nursing. Neither has there been a study providing an in‐depth qualitative evaluation of training and implementation. The current study aims to address these gaps in the literature. Aim: The aims were to evaluate Compassionate Mind Training‐CMT for mental health nurses and to assess implementation. Method: Focus groups were conducted (N = 28) 1 year later to evaluate CMT and implementation. Results: Content analysis revealed four training themes: (a) Useful framework; (b) Thought‐provoking and exciting; (c) Appreciation of person‐centred approach; and (d) Need for ongoing training and supervision. Three implementation themes emerged: (a) Applied approach with patients and staff themselves; (b) Environmental challenges to implementation; and (c) Attitudinal challenges to implementation. Discussion: Consistent with previous studies, professionals experienced reduced self‐criticism and an increased self‐compassion, which extended to increased compassion and reduced criticism of colleagues and patients; and professionals applying training directly to reduce patient self‐criticism. Implications: For successful implementation, formal adoption of compassion approaches is needed with strategic integration at all levels. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assist hospitals contemplating digital transformation by assessing the reported qualitative effects of rapidly implementing an integrated eHealth system in a large Australian hospital and determining whether existing literature offers a reliable framework to assess the effects of digitisation. Methods: A qualitative, single-site case study was performed using semistructured interviews supplemented by focus groups, observations and documentation. In all, 92 individuals across medical, nursing, allied health, administrative and executive roles provided insights into the eHealth system, which consisted of an electronic medical record, computerised decision support, computerised physician order entry, ePrescribing systems and wireless device integration. These results were compared against a known framework of the effects of hospital digitisation. Results: Diverse, mostly positive, effects were reported, largely consistent with existing literature. Several new effects not reported in literature were reported, namely: (1) improvements in accountability for care, individual career development and time management; (2) mixed findings for the availability of real-time data; and (3) positive findings for the secondary use of data. Conclusions: The overall positive perceptions of the effects of digitisation should give confidence to health services contemplating rapid digital transformation. Although existing literature provides a reliable framework for impact assessment, new effects are still emerging, and research and practice need to shift towards understanding how clinicians and hospitals can maximise the benefits of digital transformation. What is known about the topic?: Hospitals outside the US are increasingly becoming engaged in eHealth transformations. Yet, the reported effects of these technologies are diverse and mixed with qualitative effects rarely reported. What does this paper add?: This study provides a qualitative assessment of the effects of an eHealth transformation at a large Australian tertiary hospital. The results provide renewed confidence in the literature because the findings are largely consistent with expectations from prior systematic reviews of impacts. The qualitative approach followed also resulted in the identification of new effects, which included improvements in accountability, time management and individual development, as well as mixed results for real-time data. In addition, substantial improvements in patient outcomes and clinician productivity were reported from the secondary use of data within the eHealth systems. What are the implications for practitioners?: The overall positive findings in this large case study should give confidence to other health services contemplating rapid digital transformation. To achieve substantial benefits, hospitals need to understand how they can best leverage the data within these systems to improve the quality and efficiency of patient care. As such, both research and practice need to shift towards understanding how these systems can be used more effectively. [ABSTRACT FROM AUTHOR]

This paper explores the different ways in which informal carers for people with dementia negotiate their care-giving role across the changing organisational and spatial landscape of care. In-depth qualitative data are used to argue that the decisions of carers are socially situated and the result of negotiations involving individuals, families and wider cultural expectations. These decisions affect where care occurs. In addressing these issues this paper draws attention to the lack of choice some carers may have in taking on the care-giving role; how and why carers draw upon support; and the different expectations of the care-giver's capabilities across the different sites of care, specifically at home and in nursing homes. It concludes that research and policy attention should focus on how the expectations about the role and abilities of carers are affected by where, and how, care is delivered. In doing so this paper contributes to the emerging health geography literature on care-giving as well as developing the spatial perspective in the established gerontological literature. [ABSTRACT FROM PUBLISHER]

This paper examines Ghanaian young people's perceptions of the determinants of HIV- and AIDS-related stigma and discrimination, and how these perceptions may influence the de-stigmatisation process. Drawing on findings from an in-depth, multi-method qualitative study involving 104 school and street young people aged between 14 and 19 years, the paper presents young people's accounts of HIV and AIDS. The paper provokes discussion on how language and images associated with existing educational programmes on HIV and AIDS place young people in a dilemma. It also argues that fear and secrecy associated with the disease not only consolidate stigmatisation and discrimination, but also create the desire for retribution. It concludes by challenging health educators to pay particular attention to the language and images used in future educational programmes. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to present the unreported phenomenon of migrants with sight loss who experience unsupportive behaviour and attitudes from their own ethnic community due to their disability. In presenting specific case studies from a wider PhD study which investigated the previously undocumented experiences of migrants with sight loss in Ireland, the intention is to raise awareness among service providers of the additional vulnerability of this minority group. Design/methodology/approach – Migrants representing diverse ethnicities (Angolan, Algerian Nigerian, Zambian, Polish, Czech Republic, Malaysia Bangladeshi) described their experiences accessing disability services Ireland and discussed comparative attitudes towards disability in their home and host country. Service providers from the national organization working with people with sight loss were interviewed to gain an understanding of their attitudes and views on access and provision for migrants. By adopting a qualitative method following a constructivist grounded theory approach, migrants' own perceptions, beliefs, views and experiences of the sensitive subject of adjusting to sight loss while away from home were prioritised. Analysis of data was facilitated through qualitative software Atlas.ti and three core interrelated categories emerged most prominently: cultural perceptions of disability; support networks; and cultural barriers. The focus for this paper draws most significantly from the second category, support networks, most specifically the impact of absence or withdrawal of support for the migrant at the most vulnerable time of sight loss away from home. Findings – From grounded theory data analysis, three core interrelated categories emerged most prominently. They are: cultural perceptions of disability; support networks; and cultural barriers. This paper focuses most directly from findings related to support networks specifically highlighting two migrant case studies to report the impact of absence or withdrawal of support for migrant at the most vulnerable time of sight loss away from home. Service providers interviewed report inadequate information about migrants with sight loss. Evidence of stigma related to cultural perception of disability in the home community as trigger for discrimination from migrant's own network is reported by service providers. Findings are examined within an interdisciplinary theoretical framework, combining intercultural studies theories with disability models to facilitate a holistic understanding of the migrants' experience. Practical implications – The challenge of coping with disability for a migrant whose ethnic community network is absent, or withdraws its support owing to an individual's disability, have implications for alerting service providers to increased vulnerability of migrant service users. Consequently, this study has implications for programs and policies and can inform the development of culturally sensitive and appropriate services. Social implications – This study raises awareness of the compounded challenge for migrants with sight loss who are unsupported by their own ethnic group while living in a host country. Originality/value – This study reveals the previously unreported case of migrants who experience unsupportive behaviour from their own ethnic community following acquired disability. Evidence from migrants and their service providers demonstrates the impact of cultural perceptions of disability to influence the level of ethnic community support offered. [ABSTRACT FROM AUTHOR]

Three decades since the onset of HIV/AIDS, 33.2 million people worldwide are infected and prevalence in Kenya is on the rise. This paper contributes to discussions about HIV/AIDS education and draws on the health promotion approach and the emancipatory theory of Paulo Freire. Freire argued that through dialogue people unveil their world. The researchers used the method of dialogue to facilitate parents' and teachers' reflections on sexuality education for the children. The dialogues seemed to facilitate some reflection and showed the attitudes of the community to matters that impact on sexuality education (e.g. gender and sexuality). This paper illustrates how dialogic processes can be useful to the process of constructing realistic and contextually relevant HIV/AIDS education. The challenges for the researcher as an outsider are also discussed. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study exploring and comparing the experience of men and women with colorectal cancer at diagnosis and during surgery. Background. Men have higher incidence and mortality rates for nearly all cancers and frequently use health behaviours that reflect their masculinity. There has been minimal investigation into the influence of gender on the experience of a 'shared' cancer. Methods. From November 2006 to November 2008, a qualitative study was conducted involving 38 individuals (24 men, 14 women) with colorectal cancer. Data were generated using semi-structured interviews at four time points over an 18-month period. This paper reports the participants' experience at diagnosis and during surgery (time point 1) with the purpose of examining the impact of gender on this experience. Findings. In general, men appeared more accepting of their diagnosis. The majority of females seemed more emotional and more affected by the physical side effects. However, there was variation in both gender groups, with some men and women portraying both 'masculine' and 'feminine' traits. There was also individual variation in relation to context. Conclusions. It appears that many men may have been experiencing side effects and/or psychological distress that they were reluctant to discuss, particularly as some men portrayed typical 'masculine' traits in public, but felt able to open up in private. Nurses should not make assumptions based on the traditional view of masculinity, and should determine how each man wants to deal with their diagnosis and not presume that all men need to 'open up' about their illness. [ABSTRACT FROM AUTHOR]