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Objective: To determine impact of undertaking an international educational program during a nurse's or midwife's pre-registration program on subsequent practice, focusing on how nurses and midwives were transformed personally through participation in such programs. Background: Participation in international educational programs has been reported to enhance nursing and midwifery students' personal and professional development, however long-term impacts remain unclear. This paper presents findings drawn from a larger grounded theory study. Study design and Methods: Charmaz's grounded theory methodology was used to elicit experiences from 13 general nurses, two mental health nurses, three midwives and four dual qualified nurse/midwives across eight different countries. Data analysis led to the creation of three categories, with this paper reporting on the category of Developing as a Person. Findings: Participation in international educational programs can be transformative for nurses and midwives with long-lasting impacts, contributing positively to their personal growth and development. Discussion: The study findings underscore significant long-term impacts of international educational programs for nurses and midwives. These outcomes highlight the importance of incorporating international experiences into healthcare education. Conclusion: By providing opportunities for healthcare professionals to engage with diverse settings and populations, organisations and educational institutions can foster the development of well-rounded and globally competent practitioners. Implications for research, policy, and practice: The study's findings hold significant implications for research, policy, and practice in healthcare education. To deepen our understandings, additional longitudinal research across diverse countries is warranted. Policymakers have an opportunity to acknowledge the positive impact of these programs on the personal growth and development of nurses and midwives, potentially leading to the integration of global competency requirements into licensure programs. In order to provide comprehensive education, educational institutions should consider the inclusion of study abroad opportunities, cultural exchanges, and global clinical placements within nursing and midwifery curricula. What is already known about the topic? • International educational programs are widely used as a way of developing nursing and midwifery students' cultural understandings. • Previous studies have reported on short-term impacts of international educational programs. What this paper adds: • Long-term impacts of participation in an international educational program on nurses and midwives are described. • Personal development and subsequent transformations occur for nurses and midwives as a result of participation in international educational programs. [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]

Little is known about the lived experience of the dyad following a fetal death and the impact on relationships. The purpose of this paper is to explore the dyadic relationship between partners, with health care providers, and with the baby's memory after birth. This qualitative study utilized hermeneutic phenomenology. The sample included 10 heterosexual dyads from the United States and Canada. All experienced a fetal death between 6 months and 7 years prior to their interviews. The data revealed three themes: (a) The Dyad Relationship: Moving Through the Experience Together; (b) Keeping the Memory Alive: Memorializing the Baby; and (c) Relationships With Health Care Providers: A Spectrum of Caring. The findings from this study provide the beginning knowledge needed to improve the care of dyads who have experienced a fetal death and for future studies to improve care delivery for dyads as their relationships change after fetal death. [ABSTRACT FROM AUTHOR]

The internationalization of universities and the aging of the global population are two current issues that converge and challenge undergraduate gerontology curriculum development in Canada. One response to this challenge is to envision an intercultural gerontology curriculum. What might this curriculum encompass? How might it be taught? An exploratory study was undertaken to address these two questions. This paper presents findings from this study based primarily on interviews with university-based stakeholders from Canada, the United States, and Europe. Thematic analysis of the interviews resulted in five themes: multiple perspectives on cultural diversity; the dynamic nature of cultural diversity and aging; flow of an intercultural curriculum; institutional culture and intercultural curricula; and principles and practice for intercultural gerontology. Framed by principles of gerontology theory and educational approaches, this paper focuses on the principles and practice suggested by study participants. Scaffolding learning, active learning strategies, experiential learning opportunities, teacher modelling, and internet-based learning are discussed as key to intercultural learning. An appendix includes a list of resources that may be useful to developing an intercultural gerontology curriculum. [ABSTRACT FROM AUTHOR]

cook c. (2012) Email interviewing: generating data with a vulnerable population. Journal of Advanced Nursing 68(6), 1330-1339. Abstract Aims. This paper describes online recruitment and the email interviewing data collection method with women diagnosed with a viral sexually transmitted infection. The paper highlights the advantages of the method to researchers and participants when conducting research where face-to-face participation may difficult. Background. Online recruitment and in-depth email interviewing have been used by only a small number of nurses internationally. The method enables inclusion of people who might otherwise be excluded from research, for reasons such as geographical distance, incompatible time frames, clinicians''gate-keeping' and participants' desire for anonymity for physical or emotional reasons. Methods. In-depth email interviews were conducted with 26 women in New Zealand, United States of America, Canada and England who had a diagnosis of either human papilloma virus or genital herpes simplex virus. Data were collected during 2007-2008 and analysed using a poststructuralist, feminist thematic analysis. Results. Participant retention was high. Women emphasized satisfaction with the process. Asynchronous interviews allowed for additional reflexivity in the researcher's responses and rich data generation. Conclusion. This method has the potential to enable nurses to include vulnerable and relatively inaccessible participants in 'sensitive' research. In-depth email interviews may generate rich data through a process participants deem to be of personal value. [ABSTRACT FROM AUTHOR]

This paper uses qualitative interview analysis conducted online with adults to examine links between self-injury and creative writing. It concentrates on why an individual who self-injures may write creatively and what this could mean for professional practice. The research shows that writing about self-injury and associated trauma can be helpful for controlling 'internal chaos' and allowing the individual to communicate their experiences in different ways, as controlled by the writer. This creates the potential for an escape from their 'encaptive conflict', facilitating a move from pseudo-independence to forming containing relationships with professionals and others. [ABSTRACT FROM AUTHOR]

This article presents emerging findings from the first year of a two-year study, which employed ethnographic methods to explore the culture of interprofessional collaboration (IPC) and family member involvement in eight North American intensive care units (ICUs). The study utilized a comparative ethnographic approach - gathering observation, interview and documentary data relating to the behaviors and attitudes of healthcare providers and family members across several sites. In total, 504 hours of ICU-based observational data were gathered over a 12-month period in four ICUs based in two US cities. In addition, 56 semi-structured interviews were undertaken with a range of ICU staff (e.g. nurses, doctors and pharmacists) and family members. Documentary data (e.g. clinical guidelines and unit policies) were also collected to help develop an insight into how the different sites engaged organizationally with IPC and family member involvement. Directed content analysis enabled the identification and categorization of major themes within the data. An interprofessional conceptual framework was utilized to help frame the coding for the analysis. The preliminary findings presented in this paper illuminate a number of issues related to the nature of IPC and family member involvement within an ICU context. These findings are discussed in relation to the wider interprofessional and health services literature. [ABSTRACT FROM AUTHOR]

Personalisation has now become centre-stage in adult social care and continues to have an enduring level of political commitment and on-going appeal for many disabled people. And yet its roll-out has taken place during a time of austerity where central governments in many neo-liberal countries are re-imagining (read: shrinking) their role in social care provision. This paper reports on findings from an empirical study of relevant government officials from different countries which have advanced personalisation: Canada, England and the US. It reports on their views on personalisation and the remaking of adult social care, and managing expectations for change. Despite the relative success of personalisation, the findings reveal a tempered, cautious account, with respondents aware of the pitfalls and risks inherent in self-led support, government limitations in changing systems and an end to the primary involvement by the state in the creation of a social care market. With this in mind, the study's findings make a strong case for forms of ‘progressive localism’, as imagined by Featherstone et al. (2012), in galvanising local community resources alongside more radical politics in order to make self-led support achieve its desired outcomes on the ground. [ABSTRACT FROM PUBLISHER]

This paper analyses a series of interviews, undertaken in Australia, Canada and the United States, with capital gains tax (CGT) experts on the preferential taxation of individual capital gains. The interviews explored their views on the taxation of capital gains in their jurisdictions. The interviewees were from academia, government advisory organisations and private practice. This paper focuses on two thematic areas covered in the interviews: the level of convergence or divergence of the experts' views on the benefits, disadvantages and need for CGT rate preferences and the experts' views on how the individual CGT should be reformed. [ABSTRACT FROM AUTHOR]

Recent Canada–US ‘Beyond the Border’ negotiations have been accompanied by a highlighting of the issue of unauthorised crossings at the Canada–US border. In this paper, I offer some grounded contextualisation of this current politicisation by drawing upon press reports and interviews to document Canadian border-resident and press constructions of unauthorised crossings in one Canada–US border region in the late 1990s to mid-2000s. The evidence suggests that there is widespread local awareness of these crossings, including the dangers and sometimes death faced by would-be migrants. The analysis explores why this knowledge has not served to challenge still-dominant constructions of a ‘benign’ Canada–US border and/or ongoing projects of border securitisation. [ABSTRACT FROM AUTHOR]

Aim: To assess the feasibility of collecting electronic pain data from thalassaemia patients, based on its acceptability and convenience to the participants and study team. Methods: Participants in the Thalassemia Clinical Research Network Assessment of Pain Survey Study completed the Brief Pain Inventory (BPI) quarterly by paper or phone interview. Participants in a substudy completed the BPI Short Form daily over three non-consecutive transfusion cycles through an automated telephone system. Results: The consent rate for the main study was 93%, with 93% retention. The substudy had 75% retention, with more than 75% of scheduled calls completed. Regular monitoring of enrolment, missed calls, data quality, and the performance of the subcontractor for the automated system was crucial to fulfillment of the study goals. Conclusions: Use of electronic data collection for patient-reported outcomes was convenient for both patients and study personnel but required human interactions beyond the automated system to maximise data quantity and quality. [ABSTRACT FROM AUTHOR]

Purpose – The paper's aim is to determine whether the SAFE (acculturative stress), PHQ-9 (depressive symptoms) and MSPSS (individual social resources) scales are considered acceptable measures to be used in the Spanish-speaking Latin American immigrant population in Toronto. Design/methodology/approach – The PHQ9, MSPSS and SAFE were completed by a group of ten Spanish-speaking Latin Americans recruited through an organization that offers services to immigrants in Toronto. The need for clarification of questions was noted as well as the comments that respondents made to the process. Findings – Participants felt comfortable responding the questionnaire. There was little duplication when the three scales were used together. The average time to complete the survey was 21 minutes. Originality/value – There has been no community based quantitative study of mental health in the Spanish-speaking community in Toronto that has used the SAFE (acculturative stress), PHQ-9 (depressive symptoms) and MSPSS (individual social resources) scales. This pilot study tested the suitability of these scales with this population. The PHQ9, SAFE and MSPSS are acceptable scales to be used in surveys in the Spanish-speaking Latin American population in Toronto. [ABSTRACT FROM AUTHOR]

Purpose: Pregnancy and birth is often a joyous period for a dyad. In the instance of fetal death, however, dyads are met with a devastating loss of their child, the hope for the future, and the new reality of becoming a bereaved parent. The purpose of this qualitative study was to investigate the lived experience of the dyad following a fetal death and capture the essence of the grief journey. Study design and methods: A hermeneutic phenomenological study was performed using van Manen's method for data collection and analysis. Semi-structured interviews were conducted via Zoom. Participants were recruited from national and local agencies providing education and resources about perinatal loss. Data analysis utilized the Dedoose software platform to track qualitative coding. Results: Ten dyads (20 individuals) from the United States and Canada participated. The data revealed four major themes with several subthemes. The major themes were as follows: "The child I'll never really know": Pregnancy loss grief; "You're on a rollercoaster, just hold on": The emotional journey; Climbing uphill: Barriers to healing ; and Resurfacing from grief: Healing after loss. Clinical implications: The death of a fetus over 20 weeks gestation provides a unique experience of grief. The findings support the need for additional resources needed beyond the hospital by nurses or other providers to facilitate healing and minimize complicated grief. Furthermore, the findings support the need for increasing awareness among healthcare providers and peers about how to communicate and care for dyads experiencing fetal death. [ABSTRACT FROM AUTHOR]

Research to date on heterosexual couples that have never been able to engage in penile-vaginal intercourse (PVI) has been conducted almost exclusively outside of Canada and the United States and is primarily problem-focused, examining biomedical treatments of sexual dysfunction that cause the inability to have PVI (or unconsummated marriage as it is referred to in the literature). Almost nothing is known about the experience of the individuals affected by this phenomenon. This study used a phenomenological approach to answer the question: what is the lived experience of individuals in heterosexual relationships who have been unable to have penile-vaginal intercourse despite wanting to do so? The focus of this paper is on answering the following questions: (1) what is the meaning of PVI? and (2) what is the impact of the inability to have PVI on the relationship and sex life of individuals in heterosexual relationships who have been unable to have PVI? The study involved semi-structured interviews with 17 individuals residing in Canada and the United States. Study findings indicated that although all of the participants expressed a desire to be able to have PVI, the majority described satisfying relationships and sex lives without PVI. However, even participants who described satisfying sex lives tended to view PVI as having special significance over other sexual activities. Implications for healthcare providers and future research are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Sociology is the property of Canadian Journal of Sociology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The World Health Organization identified health to be the most important social goal and the 1978 Declaration of Alma Ata placed primary health care central to its attainment and the UN Sustainable Development Goals (SDGs) as the template. The Astana Declaration called on a change of focus in primary care, from treatment of specific diseases to the prevention and inclusion of both scientific and traditional knowledge. Such objectives require public–private partnerships in providing health care, including traditional and complementary medicine systems such as naturopathy that align. However, there is limited understanding of global regulatory frameworks and officially recognized training for naturopathy. Materials and Methods: This descriptive study employs an adapted mixed-methods explanatory framework to examine naturopathy regulation and education. Analysis merges data arising from a descriptive policy analysis of regulation from 36 countries and survey analysis from 65 naturopathic organizations from 29 countries. Results: Four types of workforce regulation were identified within 107 countries where naturopathy was practiced—statutory registration or occupational licensing, coregulation, negative licensing, and voluntary certification. No form of naturopathic regulation was most common. Higher graduate/postgraduate education and access to a broader range of practices were more frequently reported in countries where naturopathy is statutory regulated. Government audits were more frequently reported where naturopathy was statutory regulated or coregulated. Discussion: Naturopathic philosophy and practice align with primary health care goals outlined in the Declaration of Astana. The naturopathic workforce represents an untapped health care resource with a demonstrated track record of translating these aspirational goals into practice. However, naturopathy remains inconsistently regulated globally, serving as a significant barrier to partnering with other health system actors to attain the health-related SDGs. Workforce regulation for the naturopathic profession offers increased standards, reduced risks, integrative health workforce planning, and assistance to countries toward achieving the promise of the Declaration of Astana. [ABSTRACT FROM AUTHOR]

Bias pervades every aspect of healthcare including admissions, perpetuating the lack of diversity in the healthcare workforce. Admissions interviews may be a time when applicants to health profession education programs experience discrimination. Between January and June 2021 we invited US and Canadian applicants to health profession education programs to complete a survey including the Everyday Discrimination Scale, adapted to ascertain experiences of discrimination during admissions interviews. We used chi-square tests and multivariable logistic regression to determine associations between identity factors and positive responses. Of 1115 respondents, 281 (25.2%) reported discrimination in the interview process. Individuals with lower socioeconomic status (OR: 1.78, 95% CI [1.26, 2.52], p = 0.001) and non-native English speakers (OR: 1.76, 95% CI [1.08, 2.87], p = 0.02) were significantly more likely to experience discrimination. Half of those experiencing discrimination (139, or 49.6%) did nothing in response, though 44 (15.7%) reported the incident anonymously and 10 (3.6%) reported directly to the institution where it happened. Reports of discrimination are common among HPE applicants. Reforms at the interviewer- (e.g. avoiding questions about family planning) and institution-level (e.g. presenting institutional efforts to promote health equity) are needed to decrease the incidence and mitigate the impact of such events. [ABSTRACT FROM AUTHOR]

To identify the patient classification systems used to classify nursing intensity in the assessment of nursing staffing resources currently used in home health care, with a special emphasis on validity, reliability and staff allocation. Scoping review of internationally published and grey literature, based on a methodological framework by Arksey and O'Malley. Searches of the electronic databases Cinahl, Medline, Embase and SweMed, the websites Google and Google Scholar and hand searches of reference lists occurred. Eligibility criteria included (A) a focus on patient classification systems measuring nursing intensity and workload in home health care and (B) published in English between January 2007 and March 2019. In level one testing two team members screened titles and abstracts, in level two testing two team members determined which papers should undergo a full text review. Data were extracted using structured extraction by one team member and verified by two other members. Thirteen peer-reviewed articles and grey literature documents were identified, from Canada, Ireland, the UK, the USA, Scotland, Turkey and the Netherlands. Four patient classification systems had been tested for both validity and reliability. Validity was tested through face validity, predictive validity, concurrent validity or content validity index. Reliability was tested through stability, internal consistency, observer agreement or inter rater reliability. One patient classification system had been tested only for reliability, through interrater reliability and observer agreement. Two patient classification systems had been evaluated through summative evaluation; one qualitatively through focus group interviews and one through semi-structured interviews. Only one patient classification system had been validity and reliability tested and evaluated. Overall, the patient classification systems in the included papers (13) were considered to have benefits and to be appropriate for the measurement of patients' needs, workload and allocation of staff, although specific information was not always given. Little has been published on validity or reliability tested patient classification systems linked to staffing allocation in home health care in the past decade. Limited research was seen where a patient classification system was considered to be fully operational in home health care. [ABSTRACT FROM AUTHOR]

This article reports findings from a large mixed-method study exploring the migration to the United Kingdom (UK) of social workers trained in Australia, Canada, India, Romania, South Africa, the US, and Zimbabwe, and the migration of British trained social workers to Australia. The project aimed at exploring the motivations for migration, the experiences of integration, and the impact of culture on these. This article focuses on the quantitative findings and will use some of the qualitative data to further explain and interrogate the differences between these groups based on their country of origin. The findings show the greater challenges migrants from developing countries have experienced, including lack of recognition of their qualifications and experience, and discrimination. The findings also show that contrary to common assumptions, the migration experiences of social workers coming from Australia, Canada and the US are not as easy as expected. American social workers who migrated to the UK turned out to be the group least professionally satisfied. The British in Australia on the other hand, were the most satisfied. Implications for practice and future research are explored. [ABSTRACT FROM AUTHOR]

Childhood sexual abuse (CSA) can result in devastating and long lasting consequences. Differences in the nature of the abuse differ for males and females and this difference potentially influences recovery. However, studies of recovery from CSA, especially among men, are relatively few, especially for ethnic minority men. The study explored the lived experience of recovery from CSA among African-Caribbean Black male survivors of CSA living in Canada, the United Kingdom and the United States. The theoretical framework was the transactional model of stress and coping, which proposes that stress is an ongoing transaction between the demands of life and a person's psychological ability to address those demands. The study was qualitative in design, using an interpretive phenomenological approach, involving purposeful sampling, in-depth semi-structured interviews, and interpretive phenomenological analysis of the data informed by a critical race theory lens. The results showed that Black male survivors are situated in unique historical/sociocultural interrelationships that complicate recovery from CSA, including institutional racism and discrimination, restrictive narratives of masculinity, and other cultural norms. These findings can be used to influence policy makers, service providers, and communities, to more effectively support and address the needs of CSA survivors and their affected families. [ABSTRACT FROM AUTHOR]

Empowerment Self-Defense (ESD) has been shown to be effective in reducing risk of sexual assault victimization among women, but because research in this area is still in its infancy, less is known about additional intervention outcomes that may explain how and why the intervention is effective and about other ways that ESD affects students. The purpose of this study was to examine ESD instructor perspectives about intervention outcomes they perceive to be most important for their students. Using qualitative case-study methodology, interviews from 15 ESD instructors from the United States and Canada were conducted and analyzed using thematic analysis, which yielded six themes: Agency, boundaries, core beliefs, health and healing, somatic experiences, and gender and intersectionality, with each theme having two or more subthemes. Although some of these outcomes have been quantitatively evaluated in previous ESD studies, over half (n = 10) have not yet been empirically measured and are the focus of this article. These 10 outcomes include enactment, self-determination, nonverbal communication, relationship quality, self-worth, healing, physical strength and power, downregulation, support and solidarity, and societal-level changes. In addition to developing standardized tools to measure these outcomes, future research should quantitatively evaluate these outcomes across diverse student populations and explore their effect on producing the profound outcome associated with ESD, which is reduced risk for sexual assault victimization. [ABSTRACT FROM AUTHOR]

Background: Retransitions in youth are critical to understand, as they are an experience about which little is known and about which families and clinicians worry. Aims: This study aims to qualitatively describe the experiences of youth who made binary social transitions (came to live as the binary gender different from the one assigned at birth) in childhood by the age of 12, and who later socially transitioned genders again (here, called "retransitioning"). Methods: Out of 317 participants in an ongoing longitudinal study of (initially) binary transgender youth, 23 participants had retransitioned at least once and were therefore eligible for this study. Of those youth, 8 were cisgender at the time of data collection, 11 were nonbinary, and 4 were binary transgender youth (after having retransitioned to nonbinary identities for a period). Fifteen youth and/or their parent(s) participated in semi-structured interviews (MYouthAge = 11.3 years; 9 non-Hispanic White; 3 Hispanic White; 3 Multiracial; 10 assigned male; 5 assigned female). Interviews gauged antecedents of transitions, others' reactions to transitions, and participants' general reflections. Responses were coded and thematically analyzed. Results: Participants described various paths to retransitions, including that some youth identified differently over time, and that some youth learned about a new identity (e.g., nonbinary) that fit them better. Social environments' responses to retransitions varied but were often neutral or positive. No participants spontaneously expressed regret over initial transitions. Conclusions: These findings largely do not support common concerns about retransitions. In supportive environments, gender diverse youth can retransition without experiencing rejection, distress, and regret. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article explores the impact of online Irish traditional singing sessions on health and well-being during the COVID-19 pandemic. Singing sessions are unique facets of Ireland's music tradition that saw dramatic closure, interruption and digital transition in response to COVID-19 social distancing measures. This study highlights a gap in health promotion literature with regard to traditional singing sessions as a group singing activity and examines the potential for online group singing activities to have positive impacts on the health and well-being of participants. While traditional singing sessions foreground solo performances, they are quintessentially group activities, and include community engagement and active participation from singers and listeners alike. Through an online survey (n  = 108), and ethnographic interviews (n  = 3), this study explores potential health and well-being implications of online traditional singing sessions, and reveals four main areas of impact: social connection, enjoyment, cognitive motivation and timekeeping. The study suggests that online traditional singing sessions can promote health and well-being in participants, particularly during times of isolation. [ABSTRACT FROM AUTHOR]

This investigatory study sought to explore the range and variation of well-being initiatives on a select cross-section of college campuses across the United States and in Canada. This whitepaper seeks to highlight innovative practices that may inspire institutions to consider new ways of promoting well-being for both students and employees. In this whitepaper, we report findings from 10 participating higher education institutions across three major categories: student-serving programs, employee-serving programs, and hybrid programs. The qualitative data collected from key stakeholder interviews and focus groups were analyzed for trends between and across institutions. Importantly, the results of this study are intended to be hypothesis-generating as opposed to hypothesis-testing. In an effort to describe the state of the field with respect to both common and innovative practices the findings have generated additional questions for further research. Several themes emerged from this study: (1) Campuses have not adopted a universally-accepted definition of well-being; (2) While many institutions are using iterations of the wellness wheel and its various dimensions (e.g. physical, emotional, intellectual, social, spiritual, financial) to guide their efforts, there is not a dominant model for structuring or measuring well-being initiatives on campus; (3) There appears to be a systematic shift from use of the term "wellness" to "well-being"; (4) While many institutions are still utilizing traditional health education practices, there appears to be a movement toward more systemic, environmental approaches to well- being, including structural, organizational, and financial strategies, in addition to a range of policy initiatives; (5) There is a range of engagement in well-being initiatives, with significant variance based on institutional philosophy; and (6) Many institutions are designing well-being initiatives that address health disparities—particularly among underrepresented or marginalized populations. [ABSTRACT FROM AUTHOR]

Background: There appears to be considerable variation between different national jurisdictions and between different sectors of public policy in the use of evidence and particularly the use of randomised controlled trials (RCTs) to evaluate non-healthcare sector programmes. Methods: As part of a wider study attempting to identify RCTs of public policy sector programmes and the reasons for variation between countries and sectors in their use, we carried out a pilot study which interviewed 10 policy makers and researchers in six countries to elicit views on barriers to and facilitators of the use of RCTs for social programmes. Results: While in common with earlier studies, those interviewed expressed a need for unambiguous findings, timely results and significant effect sizes, users could, in fact, be ambivalent about robust methods and robust answers about what works, does not work or makes no difference, particularly where investment or a policy announcement was planned. Different national and policy sector cultures varied in their use of and support for RCTs. Conclusions: In order to maximise the use of robust evaluations of public programmes across the world it would be useful to examine, systematically, cross-national and cross-sectoral variations in the use of different methods including RCTs and barriers to and facilitators of their use. Sound research methods, whatever their scientific value, are no guarantee that findings will be useful or used. 'Stories' have been shown to influence policy; those advocating the use of RCTs may need to provide convincing narratives to avoid repetition about their value. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the structural and construct validity, and internal consistency of the Quality of Life Scale among Canadian women with histories of intimate partner violence. Methods: Consistent with COSMIN Guidelines, a secondary analysis was conducted using data from a community sample of 250 adult (over 18 years) Canadian women with histories of partner violence and who participated in Wave 5 of the longitudinal Women’s Health Effects Study. Data were collected 4 years after baseline using structured interviews that included the Quality of Life Scale and two mental symptom scales (Center for Epidemiological Depression Scale and Davidson Trauma Scale) used to assess construct validity of the Quality of Life Scale. Results: Confirmatory factor analysis in MPLUS 8 with maximum likelihood estimation supported the hypothesized unidimensional structure of the 9-item Quality of Life Scale based on acceptable fit indices. Internal consistency, estimated using Cronbach’s alpha and composite reliability, were .91 and .92, respectively, with item-total correlations ranging from .46 to .84. Inter-item correlation coefficients (range=.30–.79), suggesting that all items contribute to the total score. As hypothesized, the quality of life total score was negatively related to the total scores on both the Center for Epidemiologic Studies-Depression (r=–.739) and Davidson Trauma Scale (r=–.537), providing evidence of construct validity of the Quality of Life Scale. Conclusion: The Quality of Life Scale is a brief, reliable, valid, unidimensional self-report measure appropriate for use with women who have experienced partner violence. By addressing an important measurement gap, results of this study have potential to advance research on women’s quality of life in the context of partner violence, including improving the evaluation of a growing body of advocacy and health interventions designed to support women’s healing and well-being. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to understand the experiences of nurse managers during the COVID‐19 pandemic. Background: There is a growing body of knowledge about the experiences of clinical nurses during COVID‐19. However, there is less evidence about the experiences of nurse managers during the pandemic. Methods: Eight nurse managers, from acute care and outpatient settings, completed semistructured interviews about how their roles had changed during the pandemic, how they felt about these changes, and what had gone well or been difficult. Each participant was interviewed once, for 20–60 min. We used thematic analysis methods to analyse the interview transcripts. Findings Nurse managers had to coordinate care in a context of uncertainty and guidance that changed frequently. Participants found that their roles and responsibilities either expanded to include more duties, or they were asked to take on a completely new role, with no orientation or training. Nurse managers were expected to provide support to their staff and patients, but did not necessarily receive support themselves. Participants were expected to plan simultaneously for care during the pandemic and for a return to normal working conditions. These factors contributed to challenging and difficult participant experiences of managing during COVID‐19. Conclusion: Nurse managers' experiences during COVID‐19 are influenced by changes to their roles and the support they received. Nurse managers continue to support high‐quality care despite working a difficult context. Implications for nursing management: Where possible, nurse managers can be supported to extend their roles or receive additional education and support if they are required to take on new responsibilities. Nurse managers require support in order to be a resource for their staff. [ABSTRACT FROM AUTHOR]

Background: Rapid implementation of Medical Assistance in Dying (MAiD) across care settings has challenged providers and organizations, including hospices, to develop and implement new modes of practice. The aim of this study was to examine the effects that legalization of MAiD has had on hospice care provider roles within the non-provider context. Methods: Eight in-depth semi-structured interviews were conducted and a qualitative descriptive approach used to examine hospice care providers experiences in a small western Canadian city. In the study context, patients who choose MAiD are cared for until immediately prior to the procedure when they are transferred off-site to undergo MAiD. Inductive and thematic analyses were undertaken. Results: Participants experienced practical, philosophical, and professional challenges. Despite the overwhelming desire to support patient autonomy and decision-making, some interpreted patient choice for MAiD as rejection of the natural death experience at the hospice. Patient choice for MAiD initiated a new and different pathway of end-of-life care. While participants felt uncertain how best to support patients undergoing MAiD, they shared mixed optimism on how their care provider roles were evolving as their level of experience broadened. While implementation of MAiD was rapid, the introduction of practical and professional supports has remained slow to materialize, leaving many providers to navigate their own personal and professional positions and practices. Conclusion: Care providers require a multi-faceted range of clinical, legal, and logistical supports at the practice, organizational, and health system levels, to facilitate care delivery to those requesting and undergoing MAiD and to promote coordinated and holistic patient-centered care. The different pathway for those who chose MAiD may lead care providers to struggle with relational challenges and interpersonal unease. Further research may address how to support those undergoing MAiD within the hospice context. [ABSTRACT FROM AUTHOR]

Background: Family caregivers of persons with dementia often feel unprepared for end-of-life and preparedness predicts caregiver outcomes in bereavement. Existing questionnaires assessing preparedness have limitations. A multi-dimensional questionnaire assessing family caregiver preparedness for the end-of-life of persons with dementia is needed to identify caregivers at risk for negative outcomes in bereavement and evaluate the quality of strategies within a palliative approach. Aim: To develop a multi-dimensional questionnaire titled 'Caring Ahead' to assess feelings of preparedness for end-of-life in family caregivers of persons with dementia. Design: A mixed methods, sequential design employed semi-structured interviews, a Delphi-survey and pilot-testing of the questionnaire, June 2018 to July 2019. Setting/population: Participants included five current and 16 bereaved family caregivers of persons with symptoms advanced dementia from long-term care homes in Ontario, Canada; and 12 professional experts from clinical and academic settings in Canada, Europe, United States. Results: Interviews generated three core concepts and 114 indicators of preparedness sampling cognitive, affective and behavioural traits in four domains (i.e., medical, psychosocial, spiritual, practical). Indicators were translated and reduced to a pool of 73 potential questionnaire items. 30-items were selected to create the 'Caring Ahead' preparedness questionnaire through a Delphi-survey. Items were revised through a pilot-test with cognitive interviewing. Conclusions: Family caregivers' feelings of preparedness for end-of-life need to be assessed and the quality of strategies within a palliative approach evaluated. Future psychometric testing of the Caring Ahead questionnaire will evaluate evidence for validity and reliability. [ABSTRACT FROM AUTHOR]

Background: Lower limb deformities include conditions such as leg length discrepancy, lower limb deficiency and associated angular and rotational deformities of the hips, knees, ankles and feet. Children with lower limb deformities often have physical limitations due to gait irregularities and pain. The differences in the appearance and function of their lower limbs can discourage participation in social, recreational and leisure activities, which may result in behavioural, emotional, psychological and social adjustment problems. The health-related quality of life (HRQL) of these children is often impacted due to the factors discussed above, as well as by the complex surgical procedures. Surgical treatment options for limb deformities in children vary from limb lengthening and reconstruction to amputation. The lack of evidence demonstrating superiority of either treatment options and their effect on HRQL limits the ability of healthcare providers to counsel families on the best evidence-based treatment option for them. This manuscript describes the international qualitative study which guided the development of a new patient-reported outcome measure (PROM). Individual semi-structured face-to-face interviews with children with lower limb deformities and their parents were conducted at five sites: Canada (2 sites), Ethiopia, India and the USA. Results: Seventy-nine interviews were conducted at five international sites. Five main themes emerged from the qualitative interviews and formed the basis of the conceptual framework. These themes were: 1) appearance, 2) physical health, 3) psychological health 4) school and 5) social health. Conclusions: Lower limb deformities have a substantial impact on the HRQL of children. The concepts of interest identified in our study were similar across children from all countries. The conceptual framework guided the development of outcome scales specific to these patients. The information about the impact of various treatment options on the HRQL of children with lower limb deformities, collected using this new PROM, could be used to inform parents and children about outcomes (physical, social, psychological) associated with specific treatment options. This information could supplement other objective outcome information (e.g., complication rates, how the leg will look, etc.) to help families to come to a more informed decision on a child's course of treatment. [ABSTRACT FROM AUTHOR]

The current article presents a series of commentaries on urgent issues and prospects in reforming interrogation practices in Canada and the United States. Researchers and practitioners, who have devoted much of their careers to the field of police and intelligence interrogations, were asked to provide their insights on an area of interrogation research that they believe requires immediate attention. The submitted independent commentaries covered a variety of topics – from police recruitment, interrogation training, use of proper interrogation practices, and the treatment of confession evidence in court. Common concerns from the contributions pertained to the lag between scientific knowledge on interrogations and the application of such knowledge in the justice system, and the glaring disparity between the treatment of similar issues in the interrogation context versus other criminal justice contexts. A primary intent of this collection of commentaries is to serve as a resource pointing researchers in the direction of the fundamental areas that require immediate consideration and encouraging them to simultaneously pursue solutions to the overarching concerns that emerged from this project. [ABSTRACT FROM AUTHOR]

Context: Despite widespread acceptance, there is currently no consensus on the definition, components, and the specific techniques most appropriate to measure and quantify core stability. Objective: To develop a comprehensive core-stability model addressing its definition, components, and assessment techniques. Design: Delphi technique. Setting: University laboratory. Participants: 15 content experts from United States and Canada, representing a variety of disciplines. Main Outcome Measure: The authors distributed an open-ended questionnaire pertaining to a core-stability definition, components, and assessment techniques specific to each expert. They collected data over 2 rounds of telephone interviews. They concluded data collection once a consensus was achieved that equated with 51% agreement among respondents. Results: The authors developed a working definition of core stability as the ability to achieve and sustain control of the trunk region at rest and during precise movement. Eighty-three percent of the experts considered the definition satisfactory. Therefore, the definition was accepted. Furthermore, the experts agreed that muscles (14/15 = 93.3%) and neuromuscular control (8/12 = 66.7%) were components of core stability. Assessment techniques were identified and inconsistencies were highlighted; however, no consensus was established. Conclusions: A consensus core-stability definition was created and 2 components were identified. However, of the initial definitions provided by the experts, no 2 were identical, which revealed the inconsistencies among experts and the importance of this study. Nonetheless, the goal of obtaining a consensus definition was obtained. Although a consensus for the assessment techniques of core stability could not be reached, it was a beneficial starting point to identify the inconsistencies that were discovered among the content experts. [ABSTRACT FROM AUTHOR]

Background: The United States (US) spends more on health care than any other high‐resource country. Despite this, their maternal and newborn outcomes are worse than all other countries with similar levels of economic development. Our purpose was to describe maternal and newborn outcomes and organization of care in four high‐resource countries (Australia, Canada, the Netherlands, and United Kingdom) with consistently better outcomes and lower health care costs, and to identify opportunities for emulation and improvement in the United States. Method: We examined resources that described health care organization and financing, provider types, birth settings, national, clinical guidelines, health care policies, surveillance data, and information for consumers. We conducted interviews with country stakeholders representing the disciplines of obstetrics, midwifery, pediatrics, neonatology, epidemiology, sociology, political science, public health, and health services. The results of the analysis were compared and contrasted with the US maternity system. Results: The four countries had lower rates of maternal mortality, low birthweight, and newborn and infant death than the United States. Five commonalities were identified as follows: (1) affordable/ accessible health care, (2) a maternity workforce that emphasized midwifery care and interprofessional collaboration, (3) respectful care and maternal autonomy, (4) evidence‐based guidelines on place of birth, and (5) national data collections systems. Conclusions: The findings reveal marked differences in the other countries compared to the United States. It is critical to consider the evidence for improved maternal and newborn outcomes with different models of care and to examine US cultural and structural failures that are leading to unacceptable and substandard maternal and infant outcomes. [ABSTRACT FROM AUTHOR]

• Despite consensus on importance of relationships in RCC, theorisation is limited. • Relational practice most prominently identified as threshold in transatlantic study. • All 5 characteristics of threshold concepts were reflected across interview data. • There was an emphasis on the troublesome nature of relationship boundaries. • The relational nature of teaching and learning relational practice was identified. Despite growing international consensus around the complex and demanding nature of residential child care for children and young people, consensus is lacking around how to develop a workforce equal to the task. Similarly, there is near unanimity about the essential nature of relationships, particularly the relationship between practitioner and child, for good residential care. At the same time, theorization on how those relationships are enacted and how to support practitioners' related development of practice is underdeveloped or even absent in some contexts. This second of a two-part paper discusses stage two of a two-stage, transatlantic study aimed at identifying and exploring threshold concepts in residential child care. Threshold concepts are central concepts in a given discipline which are transformative but troublesome for many. They are important to their given discipline because they shape thinking and practice, but they are often difficult to master. In stage one, relational practice was the most prominently discussed potential threshold concept in focus groups comprised of educators and practitioners who had studied, practiced and/or taught in the UK, Canada and/or the US. In stage two, in-depth individual interviews were carried out with practitioners around their threshold experiences of relational practice. Analysis found all five characteristics of threshold concepts reflected in the data, with a particular emphasis on the troublesome nature of relationship boundaries. A further theme around the relational nature of teaching and learning relational practice was identified, raising important parallels between the relational experiences practitioners have as part of their training, and their relational practice in the field. Implications are discussed, including the misfit between the demarcation of professional boundaries as applied by cognate fields and the actual requirements of ameliorative relationships in residential child care. [ABSTRACT FROM AUTHOR]

• Threshold concepts are core concepts in a given field that are transformative. • They are important because they shape thinking and practice. • A transatlantic study was carried out to identify them in residential child care. • Relational Practice and Use of Self were prominently identified. • They have explanatory power in guiding workforce development. Despite growing international consensus around the complex and demanding nature of residential child care for children and young people, consensus is lacking around how to develop a workforce equal to the task. Threshold concept theory casts a light on related issues of training and education, and offers direction in addressing them. Threshold concepts are central concepts in a given discipline which are transformative but troublesome for many. They are important to their given discipline because they shape thinking and practice, but they are often difficult to master. This first of a two-part paper discusses the first of a two-stage, transatlantic study aimed at identifying and exploring threshold concepts in residential child care. Using focus groups and individual interviews with participants who had studied, practiced and/or taught in the UK, Canada or the US, it explored the views and experiences of educators who have contributed to knowledge production in the field, as well as front-line practitioners who have completed a dedicated course in child and youth care, residential child care or therapeutic child care. Findings included unanimous agreement about the relevance of threshold concept theory to their experiences, and strong support for its utility in considering how curricula should be taught. There was a greater degree of commonality than divergence between educator and practitioner views about what might be threshold, with relational practice the most prominently discussed. A theme around the self of the learner was identified in discussions of threshold concept theory more generally, particularly across the educator focus groups. Implications for pedagogical practice are discussed, including the concept of praxis which provides a useful counterpoint for conceptualising the relationship between threshold concept theory and the use of self in practice, especially in fields where the self is a primary instrument of the work. [ABSTRACT FROM AUTHOR]

Adolescent suicide is a preventable health problem; however, warning signs are often missed. In this study we developed a grounded theory to explore the process of how adolescent girl suicide attempters escape suicide in a sample of 12 young female adults ages 18-25. Using grounded theory methods of constant comparison, memo-writing, axial, and theoretical coding, searching for a sense of place emerged as the core process encompassing social process stages of: (1) existing in a toxic environment; (2) seeing suicide as the only way out; (3) seeing new ways to escape. Implications for nursing practice, education, and research are discussed. [ABSTRACT FROM AUTHOR]

Purpose: To explore participants' experiences in a group-based yoga with psychoeducation intervention designed to facilitate community integration for people with traumatic brain injury and their caregivers. Materials and methods: We conducted semi-structured interviews with 13 people with traumatic brain injury and three caregivers who had completed LoveYourBrain Yoga, a 6-session, manualized, group-based yoga intervention that incorporates breathing exercises, yoga, meditation, and psychoeducation. Interviews were analyzed using content analysis. Results: We identified seven themes: ease of participation, belonging, sustaining community connection, physical health, self-regulation, self-efficacy, and resilience. All participants valued the community-based yoga studio environment and multifaceted structure of the program. Participants reported improvements in strength, balance, flexibility, and attention control, and a greater sense of belonging, community connection, and ability to move forward with their lives. Participants reported ongoing use of tools (e.g., breathing exercises) to cope with negative emotions and stress. About half of participants sustained relationships built during LoveYourBrain Yoga and felt more capable of accessing other activities in their community. Conclusions: LoveYourBrain Yoga successfully promoted community integration for people with traumatic brain injury. It also facilitated diverse and meaningful physical, psychological, and social health benefits, which suggest that it may be an effective mode of community-based rehabilitation. Traumatic brain injury survivors often struggle to participate in their community, the ultimate goal of rehabilitation Yoga is a holistic therapy with many benefits, yet is not accessible to the traumatic brain injury population at the community level Participants in a community-based yoga with psychoeducation intervention in six states experienced diverse and meaningful physical, psychological, and social health benefits Group-based yoga with psychoeducation may be an effective mode of community integration and community-based rehabilitation for traumatic brain injury survivors [ABSTRACT FROM AUTHOR]

Background: The resources used in treatment for sex offenders with intellectual disabilities have had much research attention, but less has been written about how participants are expected to respond (programme mechanisms). Methods: A realist evaluation of seven programmes from the UK, Canada, USA, Switzerland and Germany was conducted. In semi‐structured interviews, programme designers elucidated how they are intended to work. The data analysis was driven by the realist concern to expose programme mechanisms and intended outcomes. Results: Two main outcomes are increasing risk management capacities and cultivating prosocial identities. These are achieved through developing insights into a person's risks, work on (sexual) self‐regulation skills, sexual boundaries and personal values and by developing meaningful social roles and positive relationships. Conclusions: Over time, there have been changes to some of the treatment resources used. However, there were little differences in terms of the intended programme mechanisms and outcomes, which remained surprisingly consistent. [ABSTRACT FROM AUTHOR]

Introduction: An occupational repertoire is the array of occupations that an individual has the perceived capacity to perform at a specific point in time. The Occupational Repertoire Development Measure – Parent is a new tool that uses parent report to identify the occupations children can and do perform and their interests in and opportunities for doing them. This study aimed to test the face validity, comprehensiveness, and internal consistency of the Occupational Repertoire Development Measure – Parent as a tool to measure the occupational repertoire of children aged between 2 and 12 years. Method: Twenty-nine occupational therapists completed an online questionnaire about the Occupational Repertoire Development Measure – Parent, and 27 parents completed it and then provided feedback via a structured interview. Descriptive statistics, content analysis, and the content validity index guided data analysis. Results: Participants view the Occupational Repertoire Development Measure – Parent as practical, simple, and supportive of occupation-centred practice to optimize children's development of a meaningful repertoire. Overall, self-care occupations were rated highly relevant. Lower-scoring occupations were those perceived as performed only by older children, nonessential for children with disabilities, or culturally unimportant. Conclusion: Results indicate value in the further development of the Occupational Repertoire Development Measure – Parent and validate that it asks relevant questions to understand a child's performance, engagement, and opportunities, leading to optimal repertoire development. [ABSTRACT FROM AUTHOR]

This qualitative study was conducted with a convenience sample of 20 South Asian women experiencing domestic violence in the United States. The results explore the patterns of abuse as well as the factors and circumstances (i.e. turning points) that motivated South Asian women to change in the context of the stage that they were in as per the Landenburger model (binding, enduring, disengaging, and recovery). The four themes that emerged from the interviews and analysis are (1) 'Timing and Frequency of abuse', (2) 'Methods of control – financial, isolation and suspicion', (3) 'Cycle of Abuse', and (4)' Turning Points – motivation to change'. Implications for practice and policy-level changes for abused South Asian women in the United States are discussed. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The patient‐centred medical home (PCMH) is an innovative approach to health care reform. Despite a well‐established process for recognizing PCMH practices, fidelity to, and/or adaptation of, the PCMH model can limit health care and population health improvements. This study explored the connection between fidelity/adaptation to the PCMH model with implementation successes and challenges through the experiences of family and internal medicine PCMH physicians. Methods: Interviews were conducted at two academic PCMH clinics with faculty and resident physicians. Data were transcribed and coded on the basis of an a priori code list. Together, the authors reviewed text and furthered the analysis process to reach final interpretation of the data. Results: Ten faculty and nine resident physicians from the Family Care Centre (FCC; n = 11) and the Internal Medicine Clinic (IMC; n = 8) were interviewed. Both FCC and IMC physicians spoke positively about their clinic's adherence to the PCMH model of enhanced access to care, coordinated/integrated care, and improvements in quality and safety through data collection and documentation. However, physicians highlighted inadequate staffing and clinic hours. FCC physicians also discussed the challenge of providing high‐quality care amidst differences in coverage between payers. Conclusion: There remains significant variability in PCMH characteristics across the United States and Canada. This qualitative analysis uncovered factors contributing to fidelity/adaptation to the PCMH model in two academic PCMH clinics. For the PCMH to achieve the Triple Aim promise of improved patient health and experience at a reduced cost, policy must support fidelity to core elements of the PCMH. [ABSTRACT FROM AUTHOR]

Aims and objectives: To compare the communication and practice experiences of migrant nurses in geographically distant, culturally dissimilar countries in Eastern and Western contexts. Background: Considerable research has focused on the experience of acculturation of migrant nurses into geographically diverse locations. However, there remains scant comparative research which considers the ways in which migrant nurses interpret their experience through making "sense" of events encountered in their practice. Design: An exploratory qualitative study was conducted using face‐to‐face interviews with 36 migrant nurses currently practising in New Zealand and 20 migrant nurses practising in the United Arab Emirates. Methods: The same question schedule was used to explore influences on communication and practice in both settings. Thematic analysis and sensemaking theory guided coding and analysis of data. COREQ guidelines informed the reporting of qualitative data. Results: Qualitative analysis resulted in five representative themes, three illustrating similarities across diverse cultures and two that demonstrate the differences migrant nurses require to navigate across contrasting cultural environments successfully. Conclusion: Cultural value‐based differences in both locales caused both systemic and interpersonal sensemaking challenges for migrant nurses that emphasise the importance of orientation and education programmes for internationally qualified nurses. However, cultural conflicts also exist within groups. Orientation programmes should address culturally patterned responses among different groups of internationally qualified nurses. Relevance to clinical practice: Findings demonstrate a need for migrant nurses to be willing to embrace ambiguity in order to acculturate into a collaborative team culture in each of the geographical locations in this study. As registered nurses (RNs) also carry their cultural imprint, orientation interventions targeting the cultural variations of nurses in less standardised orientation programmes may be more beneficial in enhancing acculturation and in turn, staff retention. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transportation accidents are a global health concern and a leading cause of death. OBJECTIVE: A pragmatic way to decrease these accidents is to examine the routine opportunities that lead to them. Opportunities for accidents were identified by qualitatively examining the tacit knowledge possessed by truck drivers who observe unsafe driving behaviors near their trucks. METHODS: Face-to-face interviews were conducted with 158 truck drivers from 30 states in the United States (US) and three Canadian provinces. During the interviews, truck drivers made 703 observations of unsafe actions they routinely observe car drivers doing near their trucks. The observations were coded and analyzed with the assistance of a qualitative data analysis software program. RESULTS: The findings revealed 20 unsafe driving behaviors that lead to elevated risk for car drivers. The most common unsafe action (observed by 89% of truckers) involved cars passing trucks and then cutting back into their lane too soon – the 'front no zone' safe space. Driving distractions comprised the second group of most commonly observed risky behaviors. CONCLUSIONS: The findings reveal that new drivers should receive truck driver awareness training as part of their licensing process and that public health campaigns be developed on the risks of driving near trucks. [ABSTRACT FROM AUTHOR]

The flipped classroom continues to garner increasing interest in nursing education; however, few research studies fully document faculty experiences with its implementation. This study's purpose was to explore undergraduate nurse educators' transition from traditional teacher‐centered, content‐driven strategies to the flipped classroom and describe perceived successes and challenges during the process. A qualitative approach using interpretive description gave voice to a purposive sample of sixteen undergraduate nurse educators across the United States and Canada. Semistructured interviews, audio‐recorded and transcribed verbatim, yielded a set of experiential themes. Participants revealed marked challenges as they rethought classroom design in relation to evidence‐based educational principles, and met a surprising level of resistance from students and faculty colleagues. Still, faculty observations reflected increased student problem solving, self‐determination and a greater correlation between teacher‐made and standardized test scores. Participants advocated continued integration of flipped classrooms into nursing curricula and recommended greater collegial and administrative support from academic environments. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to better understand the benefits of self-help group involvement by adults with hearing loss. Design: A secondary content analysis of interview transcripts of participants from a previous study on the impact of stigma on help-seeking was carried out. Study sample: Ten members (aged 55-76 years) of self-help groups for persons with hearing loss in the United States of America and Canada participated in the interviews. Results: Three themes describing the benefits of self-help group participation emerged: (1) Practical and accessible information about hearing loss; (2) Social belonging leading to personal transformation; and (3) A new and mutually beneficial direction. Conclusions: The findings are discussed in relation to the "helper therapy principle", as well as group audiological rehabilitation. [ABSTRACT FROM AUTHOR]

In the last decade, transnational surrogacy has attracted world-wide attention for making babies and pregnancies exchangeable with money. Involuntarily childless couples and individuals travel abroad and pay to have the desired child and to become parents. Acknowledging the importance of asking into the consequences of this monetization of reproduction, the author takes issue with universalistic assumptions about money and markets, and their presumed universal effects on social relations. Instead, it is argued that we need to explore how money works, and, by extension, how transnational surrogacy works out and becomes viable to people as a way to become parents. Putting together insights from economic sociology, and the assisted reproductive technology and parenting culture literature, the author employs the notion of accounting to grasp how people make sense of the money involved in making them parents. Based on a study involving 21 interviews with Norwegian gay and straight couples and single men and women seeking surrogacy abroad, the author explores how money is accounted for in three cases, set in three different countries; India, the United States and Canada. The analysis shows how money is accounted for in particular ways to confirm parenthood. These ways differ depending on the local context and transnational relations; ultimately making differentiated monetized parenthood. This is of significance when we try to conceptualize contemporary parenthood and how money seemingly sustains parenthood in ever more radical ways. [ABSTRACT FROM AUTHOR]

Background: Music therapists in palliative and cancer care settings often use singing and vocal interventions. Although benefits for these interventions are emerging, more information is needed on what type of singing interventions are being used by credentialed music therapists, and what goal areas are being addressed.Objective: To assess music therapists' perceptions on how they use singing and vocal interventions in palliative and cancer care environments.Method: Eighty credentialed music therapists from Canada and the United States participated in this two-part convergent mixed-methods study that began with an online survey, followed by individual interviews with 50% (n = 40) of the survey participants.Results: In both palliative and cancer care, singing client-preferred music and singing for relaxation were the most frequently used interventions. In palliative care, the most commonly addressed goals were to increase self-expression, improve mood, and create a feeling of togetherness between individuals receiving palliative care and their family. In cancer care, the most commonly addressed goals were to support breathing, improve mood, and support reminiscence. Seven themes emerged from therapist interviews: containing the space, connection, soothing, identity, freeing the voice within, letting go, and honoring.Conclusions: Music therapists use singing to address the physical, emotional, social, and spiritual goals of patients, and described singing interventions as accessible and effective. Further research is recommended to examine intervention efficacy and identify factors responsible that contribute to clinical benefit. [ABSTRACT FROM AUTHOR]

The article discusses various aspects of the regulatory frameworks that govern pharmaceutical promotion and visits by sales representatives in places such as Canada, the U.S., and France. The World Health Organization’s 1988 Ethical Criteria for Medicinal Drug Promotion guidelines are addressed, along with the U.S. Food and Drug Administration's rules and the legal aspects of drug marketing. The French Public Health Code, deception, and the Health Canada agency's authority are assessed.

Background and Aims Questions about drinking 'yesterday' have been used to correct under-reporting of typical alcohol consumption in surveys. We use this method to explore patterns of over- and under-reporting of drinking quantity and frequency by population subgroups in four countries. Design Multivariate linear regression analyses comparing estimates of typical quantity and frequency of alcohol consumption with and without adjustments using the yesterday method. Setting and Participants Survey respondents in Australia ( n = 26 648), Canada ( n = 43 371), USA ( n = 7969) and England ( n = 8610). Measurements Estimates of typical drinking quantities and frequencies over the past year plus quantity of alcohol consumed the previous day. Findings Typical frequency was underestimated by less frequent drinkers in each country. For example, after adjustment for design effects and age, Australian males self-reporting drinking 'less than once a month' were estimated to have in fact drunk an average of 14.70 (± 0.59) days in the past year compared with the standard assumption of 6 days ( t = 50.5, P < 0.001). Drinking quantity 'yesterday' was not significantly different overall from self-reported typical quantities during the past year in Canada, the United States and England, but slightly lower in Australia (e.g. 2.66 versus 3.04 drinks, t = 20.4, P < 0.01 for women). Conclusions People who describe themselves as less frequent drinkers appear to under-report their drinking frequency substantially, but country and subgroup-specific corrections can be estimated. Detailed questions using the yesterday method can help correct under-reporting of quantity of drinking. [ABSTRACT FROM AUTHOR]