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Accessible Summary: What is known on the subject?: Most studies have focused on whether hospital admissions have been reduced by the introduction of crisis services, rather than focusing on how these services are employed. Research has also shown that home assistance decreases costs and increases the level of patient satisfaction, thereby being more efficient in terms of the cost/effectiveness ratio than is traditional hospital care.Patient satisfaction with nursing care has long been identified as a key element of quality of care; however, satisfaction with nursing care among patients and families receiving crisis resolution at home has not been studied yet. What the paper adds to existing knowledge?: There is limited research on patient satisfaction with CRHTTs. This study provides new insights and data including that on relationships between patient satisfaction and the teams' attention to person‐centred mental health care.The difference between this study and other studies on patient satisfaction with crisis resolution home treatment teams is that this study focused on patients' and families' satisfaction with the nursing care provided by crisis resolution home treatment teams rather than with the general service provided. This study is the first of its kind with such a focus. What are the implications for practice?: This research has both academic and clinical implications. Patients' and their families' satisfaction with nursing care is an integral aspect for evaluating mental health services, and this is especially important regarding services provided by crisis resolution home treatment teams because such teams are currently being introduced in countries such as Spain.Closely examining patients and families' satisfaction with nursing care can also foster improvements in current practices. Nurses in crisis teams might need to focus on equalizing power relations, which the data gathered in this study suggests is most important to patient satisfaction. Introduction: Crisis resolution home treatment teams (CRHTT) provide short‐term, intensive home treatment to people experiencing mental health crises. Patient satisfaction has long been identified as a key element of quality of care; however, satisfaction with nursing care as part of this service has not been studied yet. Aim: To assess patients' and their families' satisfaction with the nursing care provided through a home care program offered by a hospital in Catalonia which administers person‐centred care. Method: A mixed methods research design was conducted. A cross‐sectional study including quantitative survey data and qualitative interview data with a phenomenological focus was conducted. Results: Twenty interviews were conducted. Patients and relatives reported high satisfaction that seems to be related to the person‐centred nature of the care. Discussion: The findings provide new insights, including how home treatment tends to equalize power relations between nurses and patients/the patient's family members, and how nurses increase sensitivity when focusing on service users' needs and priorities, leading to high patient and family satisfaction. Implications for practice: This research has both academic and clinical implications. It highlights what mental health patients and their families value most about home care and interactions with nurses, and also drives improvements in current practices. [ABSTRACT FROM AUTHOR]

Purpose: In the present era of modernization, the social group members interact with each other with selfish and unselfish intents. However, the unselfish means and ends build a long term relationship among people. On the other hand, selfish ends bud out unethical means such as abuses, violence and fights. The situation becomes tough when the same becomes evident among the family relationship and as a consequence the elderly are being treated unfairly. Out of such cases, some are reported and the majority of them remain unreported, which eventually becomes the cause of concern for the social welfare agencies. Thus, this paper aims to examine the elder abuse (EA) tendency in metro, non-metro and religious cities. Design/methodology/approach: For this study, a mixed-method approach is used to develop survey instruments, validate findings using qualitative and quantitative data sources for better generalization of results. The present study explored and confirmed the related factors using exploratory factor analysis and confirmatory factor analysis for the establishment of a valid scale of EA. Further, the difference of perceptions among the elders for abuse across the metro, non-metro and religious cities was statistically checked using the ANOVA and post hoc techniques. Findings: The present study identified the traces of EA and created a comprehensive understanding of it. The present study manifests the prevailing practices of EA in society by discussing the demerits of dependency and modernization. Moreover, the present study assesses the pervasiveness and the repercussion of dependency and the impact of modernization on EA followed by a discussion on how the victim elders may handle the situation. In the present study, a scale is developed to identify EA because of the dependency of the elderly and the modernization of society. Originality/value: Some exclaiming thoughts such as the dependency of elders elevate the chances of EA on one side, while modernization of society hampers the social/family bonding leading to EA. The inconsistent development across the region has created modernization as a significant factor for EA. The level and depth of modernization across locations such as metro, non-metro and religious cities are the cause for varying degrees of EA. Based on the literature review, the present study has sensed the presence of EA in society at large by developing a scale for the aforesaid purpose. [ABSTRACT FROM AUTHOR]

Overall, adult men are less likely to seek and receive health care than women, but male circumcision for HIV prevention has been successful in engaging men in health services. The purpose of this paper is to examine the relationship between masculine norms and health care-seeking among men participating in a voluntary male medical circumcision (VMMC) programme in the Dominican Republic (DR). We employed a mixed methods approach integrating survey data collected 6–12 months post-circumcision (n = 293) and in-depth interviews with a sub-sample of these men (n = 30). In our qualitative analysis, we found that health care-seeking is connected to masculine norms among men in the DR, including the perceptions of medical facilities as feminine spaces. Participants' narratives demonstrate that male circumcision programmes may facilitate men overcoming masculinity-related barriers to health care engagement. In quantitative analysis, we found that being concerned about being perceived as masculine was associated with health care-seeking behaviour in the past five years, though this association was not retained in multivariable analyses. Findings indicate that male circumcision programmes can familiarise men with the healthcare system and masculinise health care-seeking and utilisation, easing associated discomfort. [ABSTRACT FROM AUTHOR]

Aims: The TTM2-trial is a multi-centre randomised clinical trial where targeted temperature management (TTM) at 33 °C will be compared with normothermia and early treatment of fever (≥37.8 °C) after Out-of-Hospital Cardiac Arrest (OHCA). This paper presents the design and rationale of the TTM2-trial follow-up, where information on secondary and exploratory outcomes will be collected. We also present the explorative outcome analyses which will focus on neurocognitive function and societal participation in OHCA-survivors.Methods: Blinded outcome-assessors will perform follow-up at 30-days after the OHCA with a telephone interview, including the modified Rankin Scale (mRS) and the Glasgow Outcome Scale Extended (GOSE). Face-to-face meetings will be performed at 6 and 24-months, and include reports on outcome from several sources of information: clinician-reported: mRS, GOSE; patient-reported: EuroQol-5 Dimensions-5 Level responses version (EQ-5D-5L), Life satisfaction, Two Simple Questions; observer-reported: Informant Questionnaire on Cognitive Decline in the Elderly-Cardiac Arrest version (IQCODE-CA) and neurocognitive performance measures: Montreal Cognitive Assessment, (MoCA), Symbol Digit Modalities Test (SDMT). Exploratory analyses will be performed with an emphasis on brain injury in the survivors, where the two intervention groups will be compared for potential differences in neuro-cognitive function (MoCA, SDMT) and societal participation (GOSE). Strategies to increase inter-rater reliability and decrease missing data are described.Discussion: The TTM2-trial follow-up is a pragmatic yet detailed pre-planned and standardised assessment of patient's outcome designed to ensure data-quality, decrease missing data and provide optimal conditions to investigate clinically relevant effects of TTM, including OHCA-survivors' neurocognitive function and societal participation. [ABSTRACT FROM AUTHOR]

Aims and objective: To capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer. Background: Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting. Method: An exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward‐based nurses (n = 64) and nurse unit managers (n = 8). This paper follows the COREQ guidelines for reporting qualitative health research. Results: Qualitative data analysis revealed three themes central to the nurses' experience: (a) lack of clarity (subthemes: procedures and leadership accountability); (b) confidence in the workforce (subthemes: knowledge and skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and (c) complexity (subthemes: complexity as the new norm and suitability of the mental health environment). Conclusion: The themes found in this study can be used to guide and inform healthcare policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer. Relevance to clinical practice: Findings provide a rich data set for the generation of measurement tools and protocols to guide physical health care and evaluate performance. [ABSTRACT FROM AUTHOR]

Background: Ecological momentary assessment (EMA) is a method of collecting real-time data based on repeated measures and observations that take place in participant's daily environment. EMA has many advantages over more traditional, retrospective questionnaires. However, EMA faces some challenges to reach its full potential. The aims of this systematic review are to (1) investigate whether and how content validity of the items (i.e. the specific questions that are part of a larger EMA questionnaire) used in EMA studies on physical activity and sedentary behaviour was assessed, and (2) provide an overview of important methodological considerations of EMA in measuring physical activity and sedentary behaviour. Methods: Thirty papers (twenty unique studies) were systematically reviewed and variables were coded and analysed within the following 4 domains: (1) Content validity, (2) Sampling approach, (3) Data input modalities and (4) Degree of EMA completion. Results: Only about half of the studies reported the specific items (n = 12) and the source of the items (n = 11). None of the studies specifically assessed the content validity of the items used. Only a minority (n = 5) of the studies reported any training, and one tested the comprehensibility of the EMA items. A wide variability was found in the design and methodology of the EMA. A minority of the studies (n = 7) reported a rationale for the used prompt frequency, time selection, and monitoring period. Retrospective assessment periods varied from 'now' to 'in the last 3.5 hours'. In some studies there was a possibility to delay (n = 6) or deactivate (n = 10) the prompt, and some provided reminders after the first prompt (n = 9). Conclusions: Almost no EMA studies reported the content validation of the items used. We recommend using the COSMIN checklist (COnsensus-based Standards for the selection of health Measurement INstruments) to report on the content validity of EMA items. Furthermore, as often no rationale was provided for several methodological decisions, the following three recommendations are made. First, provide a rationale for choosing the sampling modalities. Second, to ensure assessment 'in the moment', think carefully about the retrospective assessment period, reminders, and deactivation of the prompt. Third, as high completion rates are important for representativeness of the data and generalizability of the findings, report completion rates. Trial registration: This review is registered in PROSPERO, the International prospective register of systematic reviews (registration number: CRD42017077996). [ABSTRACT FROM AUTHOR]

Objective: As part of a large mixed-method study aimed at capturing understandings of dignity, and care expectations of community dwelling older women from Black and minority ethnic (BME) backgrounds living in Wales, the aim of this paper is to compare service providers' perceptions of their care and support provided to older people in general, and to older women from BME backgrounds in particular, with a focus on two dignity indicators: care and support needs, and effective communication. Design: A survey design was used. Results: A total of 124 responses from service providers in Wales were received. Perceived inequalities in care and support were found. Although most respondents reported that care and support provision was generally acceptable, more respondents believed that compared to older people in general, older women from BME backgrounds were seldom or never offered opportunities and support to express their needs, were involved in their own care, were provided appropriate information, had their key needs especially less visible needs (psychological and religious needs) been taken into account, or were communicated with effectively (all p < 0.05). In some cases, respondents tended to report more positively in areas related to their own practice. Conclusion: We suggest that learning from the views and perceptions of service providers, as well as older people and their families, remains key to developing services for the UK's increasingly diverse and ageing population. A better understanding of how inequalities may occur, their impact on older people and their families, and how they may be minimised can inform the development of high quality care for older people regardless of their ethnic and cultural backgrounds in Wales, other parts of the UK and beyond. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Health systems in many low‐ to middle‐income countries (LMICs) are heavily underfunded, and staff training opportunities are limited.There is a lack of empirical data on the development and use of sustainable training programmes in aggression management skills in LMICs. What does this paper add to existing knowledge?: After RESPECT, participants showed greater agreement with statements about the role of environmental and relational factors as antecedents of aggression and described favouring the use of non‐physical techniques to manage aggressive behaviour.Attitudes towards management practices of seclusion, medication and restraint remained unchanged after RESPECT training. What are the implications for practice?: Training programmes like RESPECT may be useful to improve attitudes towards causes of aggression and its management in LMIC hospitals. However, further evidence is required to demonstrate whether these results can be sustained over time and whether these attitudinal changes are associated with reduction of workplace violence.Mental health nurses and other mental health professionals can play a key role in establishing hospital‐wide training and sharing skills across geographical boundaries. Introduction: Occupational violence has been demonstrated to impact negatively on the well‐being of nurses and patients. Staff attitudes towards causes and management of patients' aggression influence their practice. Training is likely to influence attitudes towards aggression; however, Uganda's health system lacks adequate resources to provide aggression management training for staff. Aim: To assess the impact of a training programme (RESPECT) on staff attitudes towards causes and management of patient's aggression in a Ugandan hospital. Methods: This study used a mixed‐methods convergent design. A convenience sample of nurses and support staff employed in the psychiatric ward and other services across the hospital (N = 90) completed the Management of Aggression and Violence Attitude Scale (MAVAS) pre‐ and post‐training. The views of a smaller sample (n = 35) were captured via interviews and focus groups and analysed using thematic analysis. Results: Participants reported greater agreement with patients' physical and social environment (external and situational causative models) as factors influencing patient's aggression. Qualitative findings substantiated the results identified in the survey. Attitudes towards seclusion, restraint and medication remained unchanged. Discussion and implications for practice: RESPECT has the potential to change staff attitudes towards aggression in the short term. Further research is needed to investigate long‐term effects and impact on incidents of aggression. [ABSTRACT FROM AUTHOR]

Objectives: Food insecurity (FI) has serious academic, social, and physical health consequences for children. A recent clinical recommendation suggests FI screening during child well visits. While FI screening research has considered clinician feedback, little is known about caregivers' experience of disclosing FI to health care providers. Our paper explores caregivers' barriers and facilitators to FI disclosure. Methods: A survey on factors influencing FI disclosure was completed in a pediatric clinic waiting room in St. Louis, MO. Among households with FI, 15 caregivers participated in a qualitative interview. Caregivers were asked about experiences discussing FI with health care providers. We calculated frequencies for survey responses and analyzed interview data using thematic content analysis. Results: Caregivers highlighted stigma, fear of child being taken away, and shame as barriers to FI disclosure. Caregivers identified strong interpersonal skills, open body language, and empathy as facilitators to disclosure at the interpersonal level. Provider initiated conversations, consideration of FI disclosure in the presence of a child, and normalization of FI discussions within the clinic were described as ways to encourage FI disclosure at the organizational level. In response to FI disclosure, caregivers would like providers to offer resources including referrals to community-based resources extending beyond food. Conclusions for Practice: Our study identifies considerations for FI screening in health care settings, spanning the social-ecological model, from the perspective of caregivers. To successfully screen and address FI, multifaceted health care interventions should address barriers and promote facilitators across multiple levels and in consideration of multiple social needs. [ABSTRACT FROM AUTHOR]

This study applies Kuhlthau's Information Search Process stage (ISP) model to understand bilingual users' Internet search experience. We conduct a quasi‐field experiment with 30 bilingual searchers and the results suggested that the ISP model was applicable in studying searchers' information retrieval behavior in search tasks. The ISP model was applicable in studying searchers' information retrieval behavior in simple tasks. However, searchers' emotional responses differed from those of the ISP model for a complex task. By testing searchers using different search strategies, the results suggested that search engines with multilanguage search functions provide an advantage for bilingual searchers in the Internet's multilingual environment. The findings showed that when searchers used a search engine as a tool for problem solving, they might experience different feelings in each ISP stage than in searching for information for a term paper using a library. The results echo other research findings that indicate that information seeking is a multifaceted phenomenon. [ABSTRACT FROM AUTHOR]

School-based comprehensive sexuality education (CSE) programmes play an important role in reducing young people's sexual risk behaviour and promoting health and well-being. There is limited evidence regarding the attitudes and beliefs of parents towards the implementation of school-based CSE programmes in Islamic cultural settings, including Oman, which this mixed-method study set out to explore. A convenience sample of 250 parents, with equal numbers of mothers and fathers of children aged 12–14 years (grades 7–9) at two urban public pre-secondary schools in Saham, completed a paper-based self-administered questionnaire in Arabic. We found most parents (72.8%) supported school-based CSE programmes that conformed to Islamic requirements of pre-marital sexual abstinence, but there was some opposition. Almost all parents supported comprehensive age-appropriate CSE being taught to students aged 10–15 years, including topics perceived as controversial in Omani culture, except for birth control and safer sex. Most parents considered themselves, school teachers and school nurses to be important sources of CSE. The study findings which suggest strong parental support for CSE programmes can facilitate education policy, CSE curriculum decision-makers and school healthcare-providers in Oman, other Middle Eastern countries, and countries with Muslim immigrant populations. [ABSTRACT FROM AUTHOR]

Aims and objectives: This qualitative study explored the experiences of neonatal nurses with facilitating closeness between parents and babies with congenital abnormalities in the neonatal intensive care unit (NICU). Background: Babies with congenital abnormalities often require admission to the neonatal intensive care unit. Parents may experience emotional distancing from their baby, due to their response to their baby's congenital abnormality, as well as physical separation due to their baby's hospitalisation in the NICU. NICU nurses can help facilitate the development of closeness between babies and parents in the NICU. Method: This qualitative interpretive description study involved face‐to‐face, semi‐structured interviews with twelve neonatal nurses following which the data collected were thematically analysed. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in preparing this paper. Results: Three major themes emerged from the analysis—"Everyone copes differently," "You have to focus on what is the normal thing" and "It's very much an individualised approach." Participants often felt unprepared to care for babies with congenital abnormalities and implemented coping mechanisms to overcome the emotional labour they experienced. Skin‐to‐skin cuddles were considered the most beneficial strategy for parents to develop closeness with their baby. Participants recognised that they sometimes "pushed" parents into engaging with their baby. Participants highlighted the importance of individualised, supportive care for these parents. Conclusions: Neonatal nurses require increased education about congenital abnormalities and individualised care to support them in caring for babies with congenital abnormalities. Relevance to clinical practice: Further research is needed on parental experience of developing closeness with a baby with a congenital abnormality in the NICU. [ABSTRACT FROM AUTHOR]

Uganda suffered four Ebola and five Marburg virus outbreaks from 2000 to 2012 with significant health worker mortality. This paper describes findings from 41 interviews with health workers from three outbreaks. Interviewees frequently encountered stigma from their communities, sometimes accompanied by mistrust and violence. These difficulties were defined as 'challenges of society.' Health workers also suffered emotional trauma, depressive symptoms, and fear classified as 'challenges of psyche.' As the incidence of such outbreaks will likely increase due to ecological and economic trends, health workers require greater access to personal protective equipment (PPE) and knowledge of viral containment. Such improvements would create an optimal psychosocial climate for managing infectious patients ultimately decreasing the severity of future outbreaks. [ABSTRACT FROM AUTHOR]

Young people with a parent or parents who have mental illness are at a higher-than-average risk of experiencing emotional and behavioural difficulties. Notwithstanding the difficulties experienced by these young people, opportunities to interact with and obtain support from peers living in similar families can be beneficial. While young people face several barriers to participating in face-to-face peer support programs, online approaches potentially provide a different way of obtaining peer support. This paper aims to explore service providers' perspectives on current Victorian peer support programs, as well as the strengths and weaknesses of online approaches to peer support. Semistructured interviews were conducted with 17 mental health professionals who work with families affected by parental mental illness. Participants recognised that many young people miss out on face-to-face peer support programs, and were highly supportive of the idea of online programs. This study suggests that online peer support programs for young people could occupy an important position in the evolving suite of services for Australian families affected by mental illness. Online approaches to peer support should be included among services for Australian families affected by mental illness. Social workers are well-placed to develop online programs that address the mental health needs of families and young people. [ABSTRACT FROM AUTHOR]

Learning letters is an important area of language learning, conducive to the beginning of reading and writing. Indeed, today's generation prefers to learn through digital games rather than through formal teaching processes. Inspired by this need, the researcher designed this study (a) to test the effectiveness of an instructional digital game, "Kes Sesi," designed to teach letter recognition skills and (b) to briefly present its instructional development process, which was based on the ADDIE model. This was a quasi‐experimental study with two treatment groups and a control group involving 87 kindergarteners. Treatment groups played the game for 12–6 weeks for learning, 6 weeks for practice. The control group continued with its regular class activities. One treatment group played the game based on predefined sound categorization, the other without any categorization. A test on children's sound recognition abilities was administered three times as a pretest, a midtest, and a posttest. The treatment groups performed significantly better than the control group. The game enhanced the kindergarteners' ability to practice uncategorized content while it enhanced their ability to learn categorized content. The results are promising in that Kes Sesi can be useful in self‐supported learning contexts with little adult input and with minimum outside interference. Lay Description: What is already known about this topic: Learning letters is an important area of language learning, conducive to the beginning of reading and writing.There is a variety of research studies on digital games for learning in the literature.It is a challenge to teach preschool children letters. What this paper adds: There seems to be a gap when it comes to experiments on kindergarteners' early reading skills.Although there are many relevant games in the market, there are no studies investigating kindergarteners' sound recognition skills through game playing on mobile technology.This study has its unique feature in terms of providing a sample article on "Design, development and application of learning tools and systems," which is a topic within the Journal's scope. Implications for practice and/or policy: Digital educational games such as "Kes Sesi" can be useful in self‐supported learning circumstances with little adult input or intervention.Similar educational games can be designed by taking the current research study as an example, and it is believed that it will encourage production of many similar games.Students' performances reach an optimal level when educational games are used after the teacher helps them construct their learning and guide them in this endeavor. [ABSTRACT FROM AUTHOR]

Little is known about cross-cultural supervision dynamics between Black, female supervisors who provide clinical supervision of White supervisees. This study examined transference enactments which occurred between Black, female clinical supervisors (N = 57) and White supervisees. The results show that White supervisees' racist and sexist behaviors towards the Black, female supervisors demonstrated remnants of stereotypical images historically attributed to Black women (i.e., Mammy, Jezebel, and/or Sapphire). Moreover, the findings highlight the need to initiate multicultural awareness, knowledge, and skills to enhance clinical skills. The paper concludes with recommendations for cross-cultural supervisory dyads and implications for future research. [ABSTRACT FROM AUTHOR]

Lack of a valid and reliable women's empowerment tool was reported by previous studies in Iran. The authors of this paper, accordingly, intended to fill this gap by developing a valid questionnaire. 600 women in Dezful city, southeast of Iran, took part in the study in 2014-2015. Multistage sampling method was used to recruit the participants. Our exploratory factor analysis revealed that 18 items of the model loaded on 4 factors. Internal consistency of the questionnaire was suitable as Cronbach's alpha coefficient was 0.77. Considering high validity and shortness of the questionnaire, it can be used as a trustful and comprehensive tool to measure women's empowerment in future studies. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known about the subject?: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002 under strict conditions of careful practice. UMS euthanasia occurs fairly rarely in Belgium, but the frequency has increased substantially over the past few years. Although most mental health nurses play an important role and are supportive of euthanasia in general, their role, attitude and knowledge when it comes to UMS euthanasia were unknown until now. What this paper adds to existing knowledge?: Most mental health nurses in Belgium appear to be supportive towards UMS euthanasia and where UMS euthanasia is carried out, mental health nurses are often involved in the preceding decision‐making process. Mental health nurses critically reflect on the interpretation and application of the legal euthanasia criteria as experienced in their daily work with their patients, and identify several problems. After a rather quiet period in Belgium, the public ethical debate regarding UMS euthanasia has recently been reopened and intensified. What are the implications for practice?: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia. This applies at several levels: legal, healthcare policy, bedside care and education. Specific attention must be paid within the UMS euthanasia process to ensure adequate cooperation between physicians, nurses and patients. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions. Abstract: Introduction: Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002, under certain circumstances that govern careful practice. Despite the legal framework, there are specific difficulties and concerns regarding UMS euthanasia. Mental health nurses are often involved in the process, but little is known about their attitudes towards UMS euthanasia, their role and their knowledge. Aim: To determine the attitudes, role and knowledge of mental health nurses regarding UMS euthanasia. Methods: A cross‐sectional survey was performed at a convenience sample of four psychiatric hospitals in Belgium (n = 133) as a pilot study. Self‐administered questionnaires were provided to mental health nurses. Results: Half the nurses in our sample had been involved at least once in the process of UMS euthanasia. A large majority of mental health nurses were supportive of UMS euthanasia. Nurses show differences in attitudes related to the different psychiatric pathologies of the patients, and in whether or not minors are involved. In some cases, they believed that the mental suffering of psychiatric patients can be unbearable and irreversible and that psychiatric patients can be competent to voluntarily request UMS euthanasia. Nurses stated that they have an important role in the UMS euthanasia process, but also demanded more knowledge and clear guidelines to implement the procedure. Discussion: Nurses have a key role regarding UMS euthanasia but face several challenges: the recent process, resistance to a multidisciplinary approach by psychiatrists and an unclear role defined by the legal framework. Nurses do not appear to have a common voice on the topic and the development of clear guidelines appears to be essential. Social recovery can offer a way out of an UMS euthanasia request, but it will not always offer a solution. Implications for Practice: Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia at various levels: bedside practice, healthcare management, education and policy. A form of systematic cooperation between nurses, physicians and patients can contribute to the utmost careful decision‐making process needed in these cases. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions. [ABSTRACT FROM AUTHOR]

Religious-spiritual (R/S) education helps medical students cope with caregiving stress and gain skills in interpersonal empathy needed for clinical care. Such R/S education has been introduced into K-12 and college curricula in some developed nations and has been found to positively impact student’s mental health. Such a move has not yet been seen in the Indian education system. This paper aimed to examine perspectives of teachers and parents in India on appropriateness, benefits, and challenges of including R/S education into the school curriculum and also to gather their impressions on how a R/S curriculum might promote students’ health. A cross-sectional study of religiously stratified sample of teachers and parents was initiated in three preselected schools in India and the required sample size (N = 300) was reached through snowballing technique. A semi-structured questionnaire, with questions crafted from “Religion and Spirituality in Medicine, Physicians Perspective” (RSMPP) and “American Academy of Religion’s (AAR) Guidelines for Religious Literacy,” was used to determine participants’ perspectives. Findings revealed that teachers’ and parents’ “comfort in integrating R/S into school curriculum” was associated with their gender (OR 1.68), education status (OR 1.05), and intrinsic religiosity (OR 1.05). Intrinsic religiosity was significantly (p = 0.025) high among parents while “intrinsic spirituality” was high (p = 0.020) among teachers. How participants’ R/S characteristics influence their support of R/S education in school is discussed. In conclusion, participants believe R/S education will fosters students’ emotional health and interpersonal skills needed for social leadership. A curriculum that incorporates R/S education, which is based on AAR guidelines and clinically validated interpersonal spiritual care tools would be acceptable to both teachers and parents. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of the Paediatric International Nursing Study was to explore the utility of key performance indicators in developing person-centred practice across a range of services provided to sick children. The objective addressed in this paper was evaluating the use of these indicators to benchmark services internationally. Background This study builds on primary research, which produced indicators that were considered novel both in terms of their positive orientation and use in generating data that privileges the patient voice. This study extends this research through wider testing on an international platform within paediatrics. Design The overall methodological approach was a realistic evaluation used to evaluate the implementation of the key performance indicators, which combined an integrated development and evaluation methodology. Methods The study involved children's wards/hospitals in Australia (six sites across three states) and Europe (seven sites across four countries). Qualitative and quantitative methods were used during the implementation process, however, this paper reports the quantitative data only, which used survey, observations and documentary review. Results The findings demonstrate the quality of care being delivered to children and their families across different international sites. The benchmarking does, however, highlight some differences between paediatric and general hospitals, and between the different key performance indicators across all the sites. Conclusions The findings support the use of the key performance indicators as a novel method to benchmark services internationally. Whilst the data collected across 20 paediatric sites suggest services are more similar than different, benchmarking illuminates variations that encourage a critical dialogue about what works and why. Relevance to clinical practice The transferability of the key performance indicators and measurement framework across different settings has significant implications for practice. The findings offer an approach to benchmarking and celebrating the successes within practice, while learning from partners across the globe in further developing person-centred cultures. [ABSTRACT FROM AUTHOR]

This paper examines the ways in which older people's residential and nursing homes can constitute heteronormative environments – social spaces in which the same-sex attractions and desires of residents are disregarded in the provision of everyday care. The aim of this discussion is to examine the synergies and differences between older lesbian, gay and bisexual (LGB) adults' expectations for future care home provision and the expectations of care staff and managers in providing residential services to older people with diverse sexual backgrounds. We present qualitative evidence from research into the provision of care environments in Wales. In this paper, we present findings from two cohorts: first, from five focus groups with care and nursing staff and managers; and second, from 29 semi-structured interviews with older LGB adults (50–76 years) residing in urban and rural locations across Wales. We argue that residential care environments can constitute heterosexualised spaces in which LGB identities are neglected in comparison to the needs and preferences of other residents. To this extent, we discuss how care staff and managers can be more attentive and responsive to the sexual biographies of all residents and argue against the separation of care and sexual orientation in practice. [ABSTRACT FROM PUBLISHER]

Aims and objectives. To describe nurses' perceptions concerning their professional practice environment in mainland China and identify factors associated with these views. Background. Globally, the environments in which nurses work influence the quality of nursing practice and health care. Design. A cross-sectional descriptive survey using both paper- and online-based delivery modes was used. Method. A convenience sampling method was used. The survey questionnaire was composed of sociodemographic items and the 38-item Chinese version of Professional Practice Environment survey. The content of the paper-based questionnaire was identical to the online survey. Pearson's chi-square test was conducted to compare the demographic characteristics of these two data sets. Descriptive statistics analysis included frequency, percentage, mean and standard deviation. Multiple linear regression analysis using the Backwards method was applied to identify independent predictors of each subscale of the 38-item Chinese version of Professional Practice Environment. Results. A total of 573 questionnaires were analysed. The mean score of each subscale of the 38-item Chinese version of Professional Practice Environment in this study ranged from 2-66-3-05. All subscales except work motivation (3-05, standard deviation: 0-44) scored less than 3-0. Areas rated as most in need of improvement included control over practice, interpersonal interaction, supportive leadership and handling conflict, and staff relationships with physicians and autonomy. Conclusion. This study has identified nurses' perspectives regarding their workplaces in contemporary China. These data have provided an important baseline for developing and implementing culturally appropriate strategies to improve the working environment of Chinese nurses. Relevance to clinical practice. A supportive and enabling work environment promotes professional development and the safety and quality of health care. Addressing these factors is important in optimising work place environments. [ABSTRACT FROM AUTHOR]

Aim To discuss and provide examples of how mixed-methods research was used to evaluate the integration of nurse practitioners (NPs) into a Canadian province. Background Legislation enabling NPs to practise in British Columbia (BC) was enacted in 2005. This research evaluated the integration of NPs and their effect on the BC healthcare system. Data sources Data were collected using surveys, focus groups, participant interviews and case studies over three years. Review methods Data sources and methods were triangulated to determine how the findings addressed the research questions. Discussion The challenges and benefits of using the multiphase design are highlighted in the paper. Conclusion The multiphase mixed-methods research design was selected because of its applicability to evaluation research. The design proved to be robust and flexible in answering research questions. Implications for practice/research As sub-studies within the multiphase design are often published separately, it can be difficult for researchers to find examples. This paper highlights ways that a multiphase mixed-methods design can be conducted for researchers unfamiliar with the process. [ABSTRACT FROM AUTHOR]

Background: Professional nursing practice is informed by biological, social and behavioural sciences. In undergraduate pre-registration nursing programs, biological sciences typically include anatomy, physiology, microbiology, chemistry, physics and pharmacology. The current gap in the literature results in a lack of information about the content and depth of biological sciences being taught in nursing curricula. The aim of this study was to establish what priority is given to the teaching of science topics in these programs in order to inform an understanding of the relative importance placed on this subject area in contemporary nursing education. Method: This study employed a cross-sectional survey method. This paper reports on the first phase of a larger project examining science content in nursing programs. An existing questionnaire was modified and delivered online for completion by academics who teach science to nurses in these programs. This paper reports on the relative priority given by respondents to the teaching of 177 topics contained in the questionnaire. Results: Of the relatively small population of academics who teach science to nursing students, thirty (n = 30) completed the survey. Findings indicate strong support for the teaching of science in these programs, with particular priority given to the basic concepts of bioscience and gross system anatomy. Of concern, most science subject areas outside of these domains were ranked as being of moderate or low priority. Conclusion: While the small sample size limited the conclusions able to be drawn from this study, the findings supported previous studies that indicated inadequacies in the teaching of science content in nursing curricula. Nevertheless, these findings have raised questions about the current philosophy that underpins nursing education in Australia and whether existing practices are clearly focused on preparing students for the demands of contemporary nursing practice. Academics responsible for the design and implementation of nursing curricula are encouraged to review the content of current programs in light of the findings of this research. [ABSTRACT FROM AUTHOR]

Background: Male drivers in the 16- to 19-year age group have a nine-fold increase in their crash risk compared with 25- to 34-year-olds who have a relative risk of 2.3. Crash risk in young drivers has been directly linked to risk-taking behaviour. This paper reports the development of a video risk assessment tool for use with drivers. Aim/objective: This paper reports on the process of validating and investigating the reliability of the Occupational Therapy Risk Propensity Test (OT-RiPT) to measure risk-taking propensity. Material and methods: 20 healthy male participants were recruited. OT-RiPT scores were correlated with driving experience. Internal consistency was investigated using Cronbach's alpha. Face validity was established. The OT-RiPT and a validated driver behaviour questionnaire were administered and the results correlated to establish discriminant validity. Results: There was no significant correlation between driving experience and OT-RiPT scores. Good internal consistency was established. OT-RiPT has high face validity. Discriminant validity was demonstrated. Conclusion and significance: Pending further testing, OT-RiPT shows promise as a reliable and valid measure of risk-taking propensity in young drivers. [ABSTRACT FROM AUTHOR]

Consumer-directed care (CDC) is increasingly widespread among aged care service options in Organisation for Economic Co-operation and Development (OECD) countries. However, the evidence base regarding the programmatic and contextual factors that affect the outcome of CDC interventions is surprisingly small. This paper reports on a self-directed care approach for older Australians with complex care needs. A multimethods longitudinal comparative cohort study was employed comprising 4 survey tools and 56 semi-structured interviews. Participation rates were around 20%. A total of 185 (98 in the intervention and 87 in the control group) older people and carers were recruited at baseline. Eleven months later, 109 participants (59 in the intervention and 50 in the control group) completed the repeat measure. Attrition rates were around 40%. Data collection occurred between July 2010 and April 2012. The data suggest that intervention group participants were likely to be more satisfied with the way they were treated (P = 0.013), their care options (P = 0.014), the 'say' they had in their care (P < 0.001), the information they received regarding their care (P = 0.012), what they were achieving in life (P = 0.031), that the services changed their view on what could be achieved in life (P = 0.020) and with their standard of living (P = 0.008). The evaluation suggests that while only a very small segment of older people is interested in a voucher or cash option, a substantially larger group would like to have greater say over and more direct access to their care, without, however, assuming administrative and financial responsibilities. The paper concludes that a stepped capacity-building approach to CDC may improve the acceptability of CDC to older people and generate synergies that improve older people's care outcomes. [ABSTRACT FROM AUTHOR]

Aim: To explore nurses' perceptions of their practice environment in acute care hospitals in Sharjah and North Emirates in the United Arab Emirates (UAE). Background: The health of the environment in which registered nurses' work is critical to nursing outcomes. The interest to examine the practice environment extended to the Gulf area which has a complex healthcare system including the UAE. Methods: The study used an exploratory descriptive designwith a qualitative part using two focus group interviews. The sample sizewas 450 nurses selected through a random sampling method. A self-administered questionnaire including the Practice Environment Scale of NursingWork Index (PES-NWI) was used. In addition, semi-structured interviews for two focus groups were done. Results: The results showed that UAE practicing nurses reported favorable perceptions of most aspects of their practice environment. Unfavorable perceptions were only reported for Staffing and Resource Adequacy. The analysis of focus group discussions resulted in different emerged themes such as Lack of Recognition and Career Promotion, and Nurses' Workload due to Paper and AdministrativeWork. Conclusions: The findings of this study suggest that strategic interventions are needed to secure adequate staff and resources and implement an effective system for evaluation of performance. [ABSTRACT FROM AUTHOR]

Many adolescents have hopes of college graduation, independent living, and satisfying careers. Career preparation is an important component that can facilitate these desires. However, many adolescents do not achieve these hopes in their desired timeframes due to interruptions, such as unplanned pregnancies. As illustrated by the Theory of Adolescent Sexual Decision-Making Influencing Teen Pregnancy (Weiss, 2012. Who will listen? Rural teen pregnancy reflections. The Journal for Nurse Practitioners, 8, 804-809. doi:10.1016/j.nurpra.2012.02.028), desiring future success can promote low-risk decision-making. Based on this theory, a Getting Plans Started (GPS) Timeline Tool (GPS Timeline©) was developed to help adolescents plan for future success by using a time perspective and, thereby, avoid interruptions. The purpose of this paper is to describe the GPS Tool©, how it might be used, and a study to determine the feasibility of using the GPS Tool©. Thirty adolescents found the tool easy to use and effective in helping them plan for the future. Their responses indicated almost unanimous desires for college graduation and independence with strong confidence in achieving their plans, but their responses also indicated a need for more effective planning to achieve their desired goals. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Many nursing students have inadequate preparation for practice in mental health nursing in the United States and China. The concept of mental illness has different connotations in different cultures. Studies differ from country to country concerning the influence of nursing education on students’ knowledge about and attitudes towards mental disorders. There is a lack of cross‐cultural research that takes a broad perspective to explore how nursing students’ knowledge and beliefs about mental disorders are influenced by the culture within education and healthcare systems. What this paper adds to existing knowledge?: Nursing students in the United States and China shared similar views on a broad range of intervention options including professional help, psychotropic medications and activity interventions for managing depression and schizophrenia. The major difference between the two nursing student groups was that the Chinese students showed more preference to occasional alcohol consumption and specialized therapies including cognitive‐behavioural therapy and electroconvulsive therapy and the US students held less skepticism towards traditional and religious practices as possible treatment options for depression and schizophrenia. What are the implications for practice?: The Chinese nursing students need to be educated about safe alcohol consumption guidelines adopted by the National Health and Family Planning Commission. The US nursing students need to increase their awareness of national practice guidelines for managing mental disorders, particularly with respect to the use of specialized therapies such as cognitive‐behavioural therapy and electroconvulsive therapy. We support professional and psychosocial interventions in caring for patients with mental disorders. Abstract: INTRODUCTION: Nursing students in the United States and China have reported inadequate preparedness for practice in mental health nursing. It is important to investigate nursing students’ mental health literacy levels for a better understanding of their practice readiness in mental health field upon completion of their education. Aim: This study was aimed at developing an understanding of American and Chinese nursing students’ mental health literacy regarding the effectiveness of specific interventions for managing depression and schizophrenia. Method: The “Australian National Mental Health Literacy Survey” was completed by a group of 310 nursing students including 152 Americans and 158 Chinese between April 2016 and April 2017 to compare students’ rated intervention options on two provided vignettes. Results: The two student groups reached consensus on many intervention options. However, the Chinese students showed more preference to occasional alcohol consumption and specialized therapies and the US students held less skepticism towards traditional practices as treatment options for depression and schizophrenia. Discussion and implications for practice: The findings support professional and psychosocial interventions in caring for patients with mental disorders. There is a significant need for specific education on safe alcohol consumption guidelines for Chinese nursing students and clinical practice guidelines for managing mental disorders for American nursing students. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? People admitted to psychiatric facilities have high rates of tobacco use and hospitalizations present an opportunity for patients to have conversations about tobacco use treatment., Clinicians may believe that people with mental illnesses are not interested in quitting or that they do not understand the importance of treatment., Positive attitudes towards tobacco treatment, viewing that participating in treatment is normal care, and feeling that one is quite able to participate in such treatment predicts intentions to participate in treatment, which, in turn, predicts actual participation., What does this paper add to existing knowledge? Psychiatric patients who use tobacco use report poor prior involvement with tobacco treatment., Positive attitudes towards, encouraging opinions of other people about, and having a sense of control over taking part in tobacco treatment increases plans to engage in treatment., Having a sense of control in taking part in tobacco treatment is strongly associated with prior experiences with evidence-based treatment., What are the implications for practice? Because psychiatric hospitalizations are an opportunity for addressing tobacco use and treatment, clinicians should be prepared to support willing patients, especially those with prior substance use histories., Support should include providing them with information regarding tobacco treatment options during their hospital stay and ways that they can continue to receive care after discharge., Clinicians should be promoters of pro-tobacco treatment attitudes and supporting patients' sense of control over participating in treatment during hospitalization., Abstract Introduction Hospitalized tobacco users with mental illnesses ( MI) may face several barriers to stopping smoking. However, motivational factors that affect the intention to engage in tobacco treatment have been shown to predict actual engagement. Aim To use the Theory of Planned Behavior to assess intentions to and prior experiences of engaging in evidence-based tobacco treatment among hospitalized individuals with MI. Method A cross-sectional survey was conducted among 115 patients in a state psychiatric hospital. Multivariate analyses were used to examine associations with the intentions and prior experiences of engaging in tobacco treatment. Results After controlling for demographic and smoking history, attitudes, subjective norms and perceived behavioural control towards engaging in tobacco treatment were significantly associated with intentions towards treatment engagement. Only higher scores on perceived behavioural control and lower education levels were associated with reported prior experiences of tobacco treatment. Discussion The low prior treatment engagement scores, but relatively higher intention to engage scores among participants suggests the need for deliberate support for evidence-based tobacco treatment during psychiatric hospitalizations. Implications for practice Clinician training in tobacco treatment can promote self-efficacy to engage patients while supporting patients' control so that tobacco treatment is an expected component of psychiatric care. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus is associated with cognitive dysfunction and an increased risk of dementia. Linagliptin is a glucose-lowering agent of the dipeptidyl peptidase-IV (DPP-IV) inhibitor class that is of particular interest for the prevention of accelerated cognitive decline, because it may potentially benefit the brain through pleiotropic effects, beyond glucose lowering. This paper presents the design of a study that aims to establish if linagliptin is superior to the sulfonylurea glimepiride in the prevention of accelerated cognitive decline in patients with type 2 diabetes mellitus.Methods: The cognition substudy is an integral part of the ongoing event-driven, randomised, double blind CARdiOvascular safety of LINAgliptin (CAROLINA®) trial, which evaluates the effect of treatment with linagliptin versus glimepiride on cardiovascular outcomes. CAROLINA® includes patients with type 2 diabetes mellitus with sub-optimal glycaemic control at elevated cardiovascular risk. The substudy will evaluate patients randomised and treated who have a baseline Mini Mental State Examination (MMSE) score ≥ 24, documented years of formal education with at least one valid cognitive assessment at baseline and during follow-up. The primary cognitive outcome is the occurrence of accelerated cognitive decline at the end of follow-up. The two treatment groups will be compared by using a logistic regression. Accelerated cognitive decline is defined as a rate of cognitive decline that falls at or below the 16th percentile of decline for the whole cohort on either the MMSE or a combined score of the trail making and verbal fluency test. Potential confounders are taken into account at an individual patient level, using a regression based index.Discussion: Between December 2010 and December 2012, 6042 patients were randomised and treated with either linagliptin (5 mg) or glimepiride (1-4 mg) once daily in CAROLINA®. Cognitive tests were conducted in nearly 4500 participants at baseline and are scheduled for two subsequent assessments, after 160 weeks of follow-up and end of follow-up. This substudy of the ongoing CAROLINA® trial will establish if linagliptin is superior to glimepiride in the prevention of accelerated cognitive decline in patients with type 2 diabetes mellitus. Final results are expected in 2019.Trial Registration: ClinicalTrials.gov Identifier: NCT 01243424 . [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To adapt the Canadian Diabetes Risk Assessment Questionnaire for the Chinese population and to evaluate its psychometric properties. Design and Sample: A cross‐sectional study was conducted with a convenience sample of 194 individuals aged 35–74 years from October 2014 to April 2015. Methods: The Canadian Diabetes Risk Assessment Questionnaire was adapted and translated for the Chinese population. Test–retest reliability was conducted to measure stability. Criterion and convergent validity of the adapted questionnaire were assessed using 2‐hr 75 g oral glucose tolerance tests and the Finnish Diabetes Risk Scores, respectively. Sensitivity and specificity were evaluated to establish its predictive validity. Results: The test–retest reliability was 0.988. Adequate validity of the adapted questionnaire was demonstrated by positive correlations found between the scores and 2‐hr 75 g oral glucose tolerance tests (r = .343, p < .001) and with the Finnish Diabetes Risk Scores (r = .738, p < .001). The area under receiver operating characteristic curve was 0.705 (95% CI .632, .778), demonstrating moderate diagnostic value at a cutoff score of 30. The sensitivity was 73%, with a positive predictive value of 57% and negative predictive value of 78%. Conclusions: Our results provided evidence supporting the translation consistency, content validity, convergent validity, criterion validity, sensitivity, and specificity of the translated Canadian Diabetes Risk Assessment Questionnaire with minor modifications. This paper provides clinical, practical, and methodological information on how to adapt a diabetes risk calculator between cultures for public health nurses. [ABSTRACT FROM AUTHOR]

This comparative descriptive study sought to determine the impact of glocalization on international social work education. Using quantitative methods, this study reports objective findings for a randomly selected, non-probability, purposive sample of 178 faculty members who were geographically distributed among faculties and departments of social work at 22 universities in eight Arab countries. The primary research instrument used was a standardized paper and pencil questionnaire. Data analysis of the responses of the faculty members found that participants’ attitudes were equally weak on the track of glocalization and international social work education. This could be attributed to the variables of faculty members, social work students, university textbooks, quality of library services, methods of teaching, field practicum, and quality of student evaluation. In contrast, the attitudes of the faculty members averaged on the track of glocalization and international social work education, which could be attributed to the variable of social work curricula. The analysis also revealed a marked absence of sustained contact with social work professionals and scholars from other regions and societies of the world. [ABSTRACT FROM AUTHOR]

Aim To validate the European Health Literacy Survey Questionnaire ( HLS- EU-Q47) in people with type 2 diabetes mellitus. Background The HLS- EU-Q47 latent variable is outlined in a framework with four cognitive domains integrated in three health domains, implying 12 theoretically defined subscales. Valid and reliable health literacy measurers are crucial to effectively adapt health communication and education to individuals and groups of patients. Design Cross-sectional study applying confirmatory latent trait analyses. Methods Using a paper-and-pencil self-administered approach, 388 adults responded in March 2015. The data were analysed using the Rasch methodology and confirmatory factor analysis. Results Response violation (response dependency) and trait violation (multidimensionality) of local independence were identified. Fitting the 'multidimensional random coefficients multinomial logit' model, 1-, 3- and 12-dimensional Rasch models were applied and compared. Poor model fit and differential item functioning were present in some items, and several subscales suffered from poor targeting and low reliability. Despite multidimensional data, we did not observe any unordered response categories. Conclusion Interpreting the domains as distinct but related latent dimensions, the data fit a 12-dimensional Rasch model and a 12-factor confirmatory factor model best. Therefore, the analyses did not support the estimation of one overall 'health literacy score.' To support the plausibility of claims based on the HLS- EU score(s), we suggest: removing the health care aspect to reduce the magnitude of multidimensionality; rejecting redundant items to avoid response dependency; adding 'harder' items and applying a six-point rating scale to improve subscale targeting and reliability; and revising items to improve model fit and avoid bias owing to person factors. [ABSTRACT FROM AUTHOR]

This paper reports finding from a nested qualitative study designed to elicit the views and perceptions of those who participated in a randomised controlled feasibility trial testing a non-pharmacological intervention, Respiratory Distress Symptom Intervention (RDSI), for the management of the breathlessness-cough-fatigue symptom cluster in lung cancer. Semi-structured interviews were conducted with 11 lung cancer patients, three caregivers and seven researchers involved in recruitment, consent, RDSI training and delivery and participant follow-up. Thematic analysis identified key considerations including: the importance of informed consent emphasising commitment to completion of paperwork and raising awareness of potential sensitivities relating to content of questionnaires; ensuring screening for the presence of symptoms reflects the language used by patients; appreciation of the commitment required from participants to learn intervention techniques and embed them as part of everyday life; conduct of interviews with patients who decline to participate; and conduct of serial interviews with those receiving RDSI to further inform its routine implementation into clinical practice. This study will inform the development of a fully powered follow-on trial testing the hypothesis that RDSI plus usual care is superior to usual care alone in the effective management of this symptom cluster in lung cancer. [ABSTRACT FROM AUTHOR]

Background: Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores.Methods: The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14.Results: On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound.Conclusions: Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care.Clinical Trial Registration: NCT02492191. [ABSTRACT FROM AUTHOR]

Background: Communities of practice are based on the idea that learning involves a group of people exchanging experiences and knowledge. The e-MPODERA project aims to assess the effectiveness of a virtual community of practice aimed at improving primary healthcare professional attitudes to the empowerment of patients with chronic diseases.Methods: This paper describes the protocol for a cluster randomized controlled trial. We will randomly assign 18 primary-care practices per participating region of Spain (Catalonia, Madrid and Canary Islands) to a virtual community of practice or to usual training. The primary-care practice will be the randomization unit and the primary healthcare professional will be the unit of analysis. We will need a sample of 270 primary healthcare professionals (general practitioners and nurses) and 1382 patients. We will perform randomization after professionals and patients are selected. We will ask the intervention group to participate for 12 months in a virtual community of practice based on a web 2.0 platform. We will measure the primary outcome using the Patient-Provider Orientation Scale questionnaire administered at baseline and after 12 months. Secondary outcomes will be the sociodemographic characteristics of health professionals, sociodemographic and clinical characteristics of patients, the Patient Activation Measure questionnaire for patient activation and outcomes regarding use of the virtual community of practice. We will calculate a linear mixed-effects regression to estimate the effect of participating in the virtual community of practice.Discussion: This cluster randomized controlled trial will show whether a virtual intervention for primary healthcare professionals improves attitudes to the empowerment of patients with chronic diseases.Trial Registration: ClicalTrials.gov, NCT02757781 . Registered on 25 April 2016. Protocol Version. PI15.01 22 January 2016. [ABSTRACT FROM AUTHOR]

Aims: There is limited literature on the challenges encountered during household surveys on alcohol consumption in low- and middle-income countries. This paper aims to describe the problems encountered during data collection for the IAC study in South Africa and put forward recommendations for addressing identified challenges.Methods: Data on methodological and other challenges emerged from feedback sessions held with fieldworkers, supervisors, observations made of and follow up meetings with project investigators, based on the pilot and main study of 2844 adults and adolescents in Tshwane (South Africa).Results: Challenges identified included the following: delays in software development which resulted in postponement of data collection with subsequent budgetary implications; difficulties in identifying the full range of alcohol beverages during the adaptation of the questionnaire as manufacturers sometimes changed quantities and packaging to enhance sales; a resultant lengthy questionnaire which negatively impacted on participation; potential participants sometime being afraid to allow fieldworkers onto premises due to high crime rates in many participating areas and religious beliefs concerning alcohol consumption that prevented some parents from consenting to their adolescent children’s participation.Conclusion: When planning community surveys on alcohol use, it is important to anticipate and prepare for these and other challenging conditions that arise in the preparation for, and execution of fieldwork. [ABSTRACT FROM PUBLISHER]

Realistic planning for a nutrition intervention is a critical component of implementation, yet effective approaches have been poorly documented. Under the auspices of 'The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,' 3 working groups were formed to summarize experiences and lessons across countries regarding micronutrient powders (MNP) interventions for young children. This paper focuses on programmatic experiences in the planning stages of an MNP intervention, encompassing assessment, enabling environment and adaptation, as well as considerations for supply. Methods included a review of published and grey literature, key informant interviews, and deliberations throughout the consultation process. We found that assessments helped justify adopting an MNP intervention, but these assessments were often limited by their narrow scope and inadequate data. Establishing coordinating bodies and integrating MNP into existing policies and programmes have helped foster an enabling environment and support programme stability. Formative research and pilots have been used to adapt MNP interventions to specific contexts, but they have been insufficient to inform scale-up. In terms of supply, most countries have opted to procure MNP through international suppliers, but this still requires understanding and navigating the local regulatory environment at the earliest stages of an intervention. Overall, these findings indicate that although some key planning and supply activities are generally undertaken, improvements are needed to plan for effective scale-up. Much still needs to be learned on MNP planning, and we propose a set of research questions that require further investigation. [ABSTRACT FROM AUTHOR]

An effective delivery strategy coupled with relevant social and behaviour change communication (SBCC) have been identified as central to the implementation of micronutrient powders (MNP) interventions, but there has been limited documentation of what works. Under the auspices of 'The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,' three working groups were formed to summarize experiences and lessons across countries regarding MNP interventions for young children. This paper focuses on programmatic experiences related to MNP delivery (models, platforms, and channels), SBCC, and training. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that most countries distributed MNP free of charge via the health sector, although distribution through other platforms and using subsidized fee for product or mixed payment models have also been used. Community-based distribution channels have generally shown higher coverage and when part of an infant and young child feeding approach, may provide additional benefit given their complementarity. SBCC for MNP has worked best when focused on meeting the MNP behavioural objectives (appropriate use, intake adherence, and related infant and young child feeding behaviours). Programmers have learned that reincorporating SBCC and training throughout the intervention life cycle has allowed for much needed adaptations. Diverse experiences delivering MNP exist, and although no one-size-fits-all approach emerged, well-established delivery platforms, community involvement, and SBCC-centred designs tended to have more success. Much still needs to be learned on MNP delivery, and we propose a set of implementation research questions that require further investigation. [ABSTRACT FROM AUTHOR]

Continual course correction during implementation of nutrition programmes is critical to address factors that might limit coverage and potential for impact. Programme improvement requires rigorous scientific inquiry to identify and address implementation pathways and the factors that affect them. Under the auspices of 'The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,' 3 working groups were formed to summarize experiences and lessons across countries regarding micronutrient powder (MNP) interventions for young children. This paper focuses on how MNP interventions undertook key elements of programme improvement, specifically, the use of programme theory, monitoring, process evaluation, and supportive supervision. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that although much has been written and published about the use of monitoring and process evaluation to inform MNP interventions at small scale, there has been little formal documentation of lessons for the transition from pilot to scaled implementation. Supervision processes and experiences are not documented, and to our knowledge, there is no evidence of whether they have been effective to improve implementation. Improving the efficiency and effectiveness of interventions requires identification of critical indicators for detecting implementation challenges and drivers of impact, integration with existing programmes and systems, strengthened technical capacity, and financing for implementation of effective monitoring systems. Our understanding of programme improvement for MNP interventions is still incomplete, especially outside of the pilot stage, and we propose a set of implementation research questions that require further investigation. [ABSTRACT FROM AUTHOR]

Background: The PARAMEDIC cluster randomised trial evaluated the LUCAS mechanical chest compression device, and did not find evidence that use of mechanical chest compression led to an improvement in survival at 30 days. This paper reports patient outcomes from admission to hospital to 12 months after randomisation.Methods: Information about hospital length of stay and intensive care management was obtained through linkage with Hospital Episode Statistics and the Intensive Care National Audit and Research Centre. Patients surviving to hospital discharge were approached to complete questionnaires (SF-12v2, EQ-5D, MMSE, HADS and PTSD-CL) at 90days and 12 months. The study is registered with Current Controlled Trials, number ISRCTN08233942.Results: 377 patients in the LUCAS arm and 658 patients in the manual chest compression were admitted to hospital. Hospital and intensive care length of stay were similar. Long term follow-up assessments were limited by poor response rates (53.7% at 3 months and 55.6% at 12 months). Follow-up rates were lower in those with worse neurological function. Among respondents, long term health related quality of life outcomes and emotional well-being was similar between groups. Cognitive function, measured by MMSE, was marginally lower in the LUCAS arm mean 26.9 (SD 3.7) compared to control mean 28.0 (SD 2.3), adjusted mean difference -1.5 (95% CI -2.6 to -0.4).Conclusion: There were no clinically important differences identified in outcomes at long term follow-up between those allocated to the mechanical chest compression compared to those receiving manual chest compression. [ABSTRACT FROM AUTHOR]

This paper outlines Buddhist-based meditation in terms of its spiritual, psychotherapeutic, physiological and neuroscientific perspectives. In the latter part of this paper, a pilot study is discussed, in which Japanese university students volunteered to practice meditation at home and complete questionnaires. T-tests were performed to compare with the non-meditated control group. Although only a small number in the experimental group completed the study, our analyses demonstrated that students benefited from meditation and showed significant increases in their sense of coherence, self-esteem and purpose in life. Lastly, practical implications of meditation in contemporary Japanese society are discussed. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to discuss the extent to which the impact of the information unit (IU) is felt within the parent organisation. Design/methodology/approach – The paper opted for mixed methods approach combining two survey methods: a quantitative questionnaire with a follow-up set of qualitative interviews. Findings – The IU was felt to have an impact; however, the definition of impact was very difficult to pin down. There is a need to promote the work of the IU. Research limitations/implications – Because of the chosen research approach, the research results may not be replicable. Additionally, there is a risk of researcher bias. Practical implications – The paper could be used to help study impact in other special libraries. Originality/value – This paper seems to be unique in studying the impact of a corporate library using this approach. It will be of use to other corporate librarians and possibly those looking at mixed methods. [ABSTRACT FROM AUTHOR]

Background: As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems. Objectives: To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey. Design and settings: We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe. Participants: Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field. Methods: The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context. Results: The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation. Conclusions: The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across health systems and language translation. [ABSTRACT FROM AUTHOR]

This paper explores the role of perturbance and attractor, two key nonlinear features described by the Neuro-occupation model in shaping human behavior. A convenience sample of eleven Iranian participants who had both strokes and demonstrated high resilience were recruited for this study. To explore the process of how participants fell under the influence of the perturbance and attractor, the content analysis with pre-determined categories using deductive reasoning was used. The findings suggest that perturbance and attractor exerted considerable influences on adaptation to stroke and assist in the understanding of the Neuro-occupation model. [ABSTRACT FROM AUTHOR]

Participation has a subjective and private dimension, and so it is important to hear directly from youth about their experiences in various activity settings, the places where they “do things” and interact with others. To meet this need, our team developed the Self-Reported Experiences of Activity Settings (SEAS) measure, which demonstrated good-to-excellent measurement properties. To address the needs of youth who could benefit from graphic symbol support, the SEAS-PCSTM,1was created. The purpose of this paper is to describe the development of SEAS-PCS and the preliminary study that explores the equivalency of the SEAS and SEAS-PCS. The SEAS and SEAS-PCS were compared in terms of the equivalency of meaning of stimulus items by 11 professionals and five adults who used augmentative and alternative communication, were familiar with PCS, and were fluent readers. Out of 22 items, 68% were rated as highly similar on a 5-point scale (M = 4.14;SD = .70;mdn = 4; range: 2.81–5.00). Subsequently, the 32% of the SEAS-PCS items that were rated below 4 were modified based on the participants’ specific comments. Further work is required to validate the SEAS-PCS. The next step could involve exploring the views of youth who use AAC. [ABSTRACT FROM PUBLISHER]

This paper describes the factor analysis testing and construct validation of the Japanese version of the Caffrey Cultural Competence Health Services (J-CCCHS). The inventory, composed of 28 items, was translated using language and subject matter experts. Psychometric testing (exploratory factor, alpha reliability, and confirmatory factor analyses) was undertaken with nurses (N = 7494, 92% female, mean age 32.6 years) from 19 hospitals across Japan. Principal components extraction with varimax rotation yielded a 5-factor solution (62.31% variance explained) that was labeled: knowledge, comfort-proximal, comfort-distal, awareness, and awareness of national policy. Cronbach α for the subscales ranged from 0.756 to 0.892. In confirmatory factor analysis using the robust maximum likelihood estimator, the chi-square test was as follows: χ2(340) = 14604.44, P < .001. After correlated errors were introduced, there was evidence of improved model fit (χ2(335) = 8681.61, P < .05) but the other indices showed improvement (RMSEA = .058 [90% CI, 0.057-0.059], TLI = .891, CFI = .903, and SRMR = .059). The discriminating power of the J-CCCHS was indicated by statistically mean differences in J-CCCHS subscale scores between predefined groups. Taking into consideration that this is the first foray into construct validation for this instrument, and that fit was improved when a subsequent data driven model was tested, and it has the ability to distinguish between known groups that are expected to differ in cultural competence, the instrument can be of value to clinicians and educators alike. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine Korean registered nurses' level of perceived knowledge and practice of venous thromboembolism risk assessment as well as prevention, self-efficacy in venous thromboembolism care and actual knowledge of venous thromboembolism. Background For hospitalised patients, venous thromboembolism is a preventable clinical disorder. Caring for venous thromboembolism patients requires coordination across multiple providers and settings. Clinical nurses can play a major role in improving venous thromboembolism prevention care, assessing venous thromboembolism risks and providing appropriate prophylactic measures to those who are at risk for venous thromboembolism. Design A cross-sectional descriptive study. Methods Anonymous paper-based surveys were conducted for a convenience sample of registered nurses' ( n = 452) from two university-affiliated hospitals in South Korea. Results The majority of participants indicated that their overall self-rated venous thromboembolism knowledge was 'fair', while only 2·4% rated it as 'very good' or 'excellent'. The overall mean score of the venous thromboembolism knowledge questions was 50·9 (±13·0) of a possible score of 100. The mean score of self-efficacy in practising venous thromboembolism prevention/prophylaxis was 3·0 (based on a one to five Likert scale). The self-reported venous thromboembolism assessment performance on patients varied among clinical units. Only 9·3% of participants reported having received in-service venous thromboembolism education from their hospital. Conclusions The findings showed that overall venous thromboembolism knowledge and self-efficacy in venous thromboembolism prevention practices of Korean registered nurses' were not highly rated. Korean nurses demonstrated a lack of knowledge about venous thromboembolism, particularly in the areas of venous thromboembolism prophylaxis measures and venous thromboembolism diagnosis methods. Relevance to clinical practice Focused education on venous thromboembolism prevention and risk assessment should be considered a component of continuing education for Korean nurses. [ABSTRACT FROM AUTHOR]

Young bisexual women experience worse mental and sexual health outcomes in comparison to their heterosexual and lesbian peers. These disparities are associated with stigma and devaluation of bisexual identities. The current paper addresses a community-based focus group project in which participants discussed bisexual stigma in regard to bisexual erasure and other stereotypes. Specifically, participants detailed experiences of feeling pressured to provide evidence of their bisexual identity, modifying their relationship or sexual behavior to conform to these expectations, as well as feeling excluded from queer community. Further, participants discussed how these experiences were related to decreased mental and sexual health. Future research should further investigate the relationship between bisexual stigma, pressure to provide evidence of bisexual identity, and negative mental and sexual health outcomes. [ABSTRACT FROM PUBLISHER]