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Background: There has been a persistent increase in clients' dissatisfaction with providers' competencies in maternal and child healthcare (MCH). Existing interventions have failed to address the complexity of provider-client relationships. Therefore, targeted, contextualized innovative solutions that place providers and clients at the forefront as agents of change in optimizing intervention design and implementation are needed. The study team adopted a co-design strategy as part of Human- Centered Design (HCD) approach, where MCH nurses, clients, and stakeholders partnered to design an intervention package to improve provider-client relationships in rural Tanzania. Objective: This paper explored nurses', clients', and MCH stakeholders' perspectives following participation in a co-design stage of the HCD study to generate interventions to strengthen nurse-client relationships in Shinyanga Region. Methods: A qualitative descriptive design was used. Thirty semi-structured key informant interviews were conducted in the Swahili language with purposefully selected nurses, clients, and MCH stakeholders. The inclusion criterion was participation in consultative workshops to co-design an intervention package to strengthen nurse-client relationships. Data were transcribed and translated simultaneously, managed using NVivo, and analyzed thematically. Results: Three main themes were developed from the analysis, encompassing key learnings from engagement in the co-design process, the potential benefits of co-designing interventions, and co-designing as a tool for behavior change and personal commitment. The key learnings from participation in the co-design process included the acknowledgment that both nurses and clients contributed to tensions within their relationships. Additionally, it was recognized that the benefits of a good nurse-client relationship extend beyond nurses and clients to the health sector. Furthermore, it was learned that improving nurse-client relationships requires interventions targeting nurses, clients, and the health sector. Co-designing was considered beneficial as it offers a promising strategy for designing effective and impactful solutions for addressing many challenges facing the health sector beyond interpersonal relationships. This is because co-designing is regarded as innovative, simple, and friendly, bringing together parties and end-users impacted by the problem to generate feasible and acceptable interventions that contribute to enhanced satisfaction. Furthermore, co-designing was described as facilitating the co-learning of new skills and knowledge among participants. Additionally, co-designing was regarded as a tool for behavior change and personal commitment, influencing changes in participants' own behaviors and cementing a commitment to change their practices even before the implementation of the generated solutions. Conclusion: End-users' perspectives after engagement in the co-design process suggest it provides a novel entry point for strengthening provider-client relationships and addressing other health sector challenges. Researchers and interventionists should consider embracing co-design and the HCD approach in general to address health service delivery challenges. [ABSTRACT FROM AUTHOR]

Background: Nursing education starts in the classroom environment with a focus on the nurse educator-nursing student relationship. 'Presence' is defined as "a practice where the caregiver relates her/himself to the other in an attentive and dedicated way, by doing so learns to see what is at stake for the other; from desires to fear, and, in connection with this, come to understand what could be done in this particular situation and who she/he can be for the other". 'Presence' forms an integral part of the nursing profession and the value thereof should be facilitated during teaching and learning. Reflective practices may offer a teaching–learning strategy to facilitate presence in nursing students by nurse educators in large class settings. Having large classes presents challenges including from nurse educators' lack of knowledge about alternative teaching approaches; time demands for designing, implementing and testing new teaching methods; a lack of confidence in implementing new teaching approaches in the classroom; selecting and grading assessments; as well as feelings of discomfort and anxiety. A model to facilitate presence through reflective practices has already been developed and published by the present authors. The model relies on well-established steps in theory development covering concept analysis, model development and description (published in two papers by the present researchers) and model evaluation (the subject of this paper). The evaluation was carried out by a panel of experts and nursing participants. Methods: An explorative and descriptive qualitative design was followed. The developed model was evaluated and refined in two steps (covered in this paper). In Step 1, the model was evaluated by a panel of experts in model development, reflective practices and presence. The panel used critical reflection resulting in the refinement of the model. Step 2 involved an empirical phase where the model was evaluated by participants through participatory evaluation. Participants were selected through purposive sampling. Data collection methods included online semi-structured focus group interviews with nurse educators and virtual World Café sessions with nursing students. Content analysis was done through open coding. Results: Five themes emerged from the empirical phase, namely: Theme 1: understanding of the model; Theme 2: benefits of the model; Theme 3: limitations of the model; Theme 4: pre-existing conditions needed for successful implementation of the model; and Theme 5: recommendations for further development of the model. Conclusions: The results produced a refined model to be implemented into the curriculums of undergraduate, postgraduate and continuous professional development programmes across nursing education institutions. This model will significantly contribute to the body of knowledge and increase nurses' awareness of presence by transforming the way they feel, think, care and act in practice, which contributes to personal and professional development. [ABSTRACT FROM AUTHOR]

Background: Home based care is a vital, and growing, part of the health care system that allows individuals to remain in their homes while still receiving health care. During a disaster, when normal health care systems are disrupted, home based care remains a vital source of support for older adults. The purpose of this paper is to qualitatively understand the barriers and facilitators of both patients and providers that influence the provision of home based care activities in two hurricane affected communities. Methods: Using qualitative inquiry informed by the social ecological model, five focus groups were conducted with home based care providers (n = 25) in two settings affected by Hurricane Irma and Hurricane Harvey. An open-source database of home health agencies participating in Centers for Medicare and Medicaid Services programs was used to identify participants. Data were manually coded and larger themes were generated from recurring ideas and concepts using an abductive analysis approach. Results: Twenty five participants were included in one of five focus groups. Of the 22 who responded to the demographic survey, 65 % were registered nurses, 20 % were Licensed Vocational Nurses (LVN), and 15 % were other types of health care providers. 12 % of the sample was male and 88 % was female. Five themes were identified in the analysis: barriers to implementing preparedness plans, adaptability of home based care providers, disasters exacerbate inequalities, perceived unreliability of government and corporations, and the balance between caring for self and family and caring for patients. Conclusions: This study provides qualitative evidence on the factors that influence home based care provision in disaster-affected communities, including the barriers and facilitators faced by both patients and providers in preparing for, responding to and recovering from a disaster. While home based care providers faced multiple challenges to providing care during and after a disaster, the importance of community supports and holistic models of care in the immediate period after the disaster were emphasized. We recommend greater inclusion of home health agencies in the community planning process. This study informs the growing body of evidence on the value of home based care in promoting safety and well-being for older adults during a disaster. [ABSTRACT FROM AUTHOR]