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Aim: To explore the effectiveness and acceptability of a pilot mentoring program for alcohol and other drug (AOD) nurse practitioners (also known globally as addiction nurse practitioners). Design: Mixed method evaluation. Methods: Two‐phase evaluation comprising survey (demographics, pre‐ and post‐program perceived competency and confidence) with 15 participants completing the pre survey and 10 participants completing the post survey, and qualitative interviews after the program with 10 participants. Results: The quantitative results indicate statistically significant increases in some domains of perceived competence and confidence in treatment. Qualitative findings indicate that participants valued peer support and mentoring from experienced nurse practitioners. Where formal residency or internship programs for nurse practitioners do not exist, informal mentoring programs may address issues inherent in nurse practitioner transition that may impact retention. We recommend further exploration of mentoring programs with larger sample sizes to determine if self‐reported clinical improvements are noted. Implications for Profession and/or Patient Care: Nurse practitioners are a vital part of the healthcare system; their advanced skills and knowledge place them in an ideal position to address prescriber shortages and access to care for populations underserved by healthcare. However, literature indicates that they are often underutilised, and transition to autonomous practice remains a challenge. Our exploration of a pilot mentoring program for nurse practitioners shows that their knowledge and perceived skills are high, yet peer assistance is valued in transitioning from advanced practice registered nurse to autonomous nurse practitioner. We recommend further trialling and evaluation of nurse practitioner mentoring programs to both increase supply of nurse practitioners and provide greater access to quality healthcare for underserved populations. Impact: What problem did the study address?: The ability of nurse practitioners to offer advanced practice interventions such as diagnosis and medication management potentially provides a solution to healthcare resource shortages. However, current literature indicates that advanced nurses transitioning to nurse practitioner roles suffer transition shock, leading to burnout and poor retention. What were the main findings?: Although this pilot mentoring program shows significant improvements in survey responses on confidence and capability, qualitative data shows that neophyte nurse practitioners value peer support and mentoring from more experienced practitioners. Participants described maintaining ongoing connections with both mentors and fellow mentees, which aided transition to the role of autonomous nurse practitioner. Where and on whom will the research have an impact?: The results of this pilot mentoring program indicate that there is benefit to these programs for neophyte nurse practitioners in many specialties. This paper indicates that mentoring programs for nurse practitioners may provide a community of practice and may have a positive impact on transition shock. Reporting Method: Good Reporting of a Mixed Methods Study (GRAMMS) checklist. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Crisis Resolution Teams (CRTs) offer home-based care for people in mental health crisis, as an alternative to hospital admission. The success of CRTs in England has been variable. In response to this, the CRT Optimization and RElapse prevention (CORE) study developed and trialled a 12-month Service Improvement Programme (SIP) based on a fidelity model. This paper describes a qualitative evaluation of the perspectives of CRT staff, managers, and programme facilitators. We identify barriers and facilitators to implementation, and mechanisms by which service improvements took place. Methods: Managers and staff from six purposively sampled CRTs were interviewed, as well as six facilitators who were employed to support the implementation of service improvement plans. Semi-structured focus groups and individual interviews were conducted and analysed using thematic analysis. Findings: A majority of participants viewed all components of the SIP as helpful in improving practice, although online resources were under-used. Perceived barriers to implementation centred principally around lack of staff time and ownership. Support from both senior staff and facilitators was essential in enabling teams to undertake the work associated with the SIP. All participating stakeholder groups reported that using the fidelity model to benchmark their CRT work to best practice and feel part of a 'bigger whole' was valuable. Conclusion: CRT staff, managers and programme facilitators thought that a structured service improvement programme helped to increase fidelity to a best practice model. Flexibility (from all stakeholders) was key to enable service improvement actions to be manageable within time- and resource-poor teams. [ABSTRACT FROM AUTHOR]

Background: Globally, it is estimated that one in three adults live with two or more long‐term conditions (multiple long‐term conditions, MLTCs), that require self‐management. People who experience socioeconomic deprivation face significant health inequalities due to a range of interrelated characteristics that lead to a lack of resources and opportunities. Previous research with underserved populations indicate low levels of trust towards primary care providers and potential barriers for developing patient‐healthcare professional relationships. The purpose of this paper is to explore the barriers and facilitators to self‐managing MLTCs, amongst people who experience socioeconomic deprivation. Methods: Semistructured one‐to‐one interviews with adults (n = 28) living in London and Sheffield, United Kingdom with MLTCs who are experiencing socioeconomic deprivation. Participants were recruited through general practices, community channels and social media. Data were analysed in NVivo using reflexive thematic analysis methods. Findings: Four analytical themes were developed: (1) challenges in accessing healthcare services, financial assistance, and cultural awareness; (2) empowerment and disempowerment through technology, including digital exclusion, and use of technology; (3) impact and causes of exclusion on self‐management, including social isolation, area‐based and economic exclusion, and health‐related stigma and (4) adapting self‐management strategies, including cost‐effective, and culturally/lifestyle appropriate strategies. Conclusions: Future health interventions and services need to be developed with consideration of the combined complexities of managing MLTCs while experiencing socioeconomic deprivation. Increased awareness in practitioners and commissioners of the complexities surrounding the lives of people experiencing socioeconomic deprivation, and the need for targeted strategies to promote self‐management of MLTCs are of great importance. Patient or Public Contribution: A patient advisory group contributed to all stages of the study, including providing important feedback on study documents (topic guides and recruitment materials), as well as providing critical insights surrounding the interpretation of interview data. [ABSTRACT FROM AUTHOR]

Background: Given the developmental vulnerability of justice-involved youth, providing a safe environment in secure facilities is a paramount, yet challenging task. Within this complexity, a sound security framework is key. The security framework exists on three dimensions: physical, procedural and relational security. Existing knowledge points at the importance of a shift in focus on physical and procedural security towards relational security as the core of the security framework. At the same time there is a dearth of knowledge on relational security, particularly in the context of youth justice. This paper explores relational security and its working mechanisms in practice. Methods: This paper draws on findings of a comprehensive three-year evaluation of three small-scale, community-embedded facilities that are grounded in relational security. The approach of the evaluation was derived from action research, involving a cyclic process alternating between action, research and critical reflection, while engaging all stakeholders in the research process. The action research cycle involved qualitative research (a total of 63 semi-structured interviews) incorporating the perspective of staff, youth and parents. Results: Relational security is grounded in three distinct, but interrelated, elements – staff's basic attitude, a constructive alliance between staff and youth, staff presence – and promotes a safe and therapeutic environment through several mechanisms. Conclusions: Relational security can be defined in a practical conceptualization; outlining a way of working that guides staff in how to establish a safe and therapeutic environment in secure facilities. This conceptualization finds support in the well-established literature covering the therapeutic alliance and can be substantiated by two aligning theories concerning youth justice strategies: social-ecological theory and self-determination theory. Relational security is not only a way of working, but also a way of being. It encompasses a vision about security and mentality towards justice-involved youth that sees them not merely as 'risks to be managed', but primarly as 'resources to be developed'. [ABSTRACT FROM AUTHOR]

Background: Experiences of living with and seeking care for multimorbidity is a relatively under-researched field. By analysing experiences of people with multimorbidity, caregivers and care professionals, we can better understand the complex care needs of those with multimorbidity and identify improvements to care management. This paper reports findings from research that elicited the views of key stakeholders to inform future care practice and policy. Aim: To elicit care recipient and care provider views to understand the care needs of those living with and seeking care for multimorbidity. Method: A qualitative interview study using purposive sampling of those living with and providing care in multimorbidity. Results: Increased support to those with multimorbidity and caregivers to navigate care systems was advocated. Establishing trusting care relationships featured prominently in participants accounts. Fragmented care, inadequate coordination and poor communication between care providers, were identified as system-wide challenges. There was agreement that integrated care models were needed, which delivered personalised care, such as shared decision-making, choice in care options and accessing services, and individualised care plans. Conclusion: We found significant agreement among stakeholders on care need and management in multimorbidity. Understanding the experiences of those with multimorbidity, caregivers and care professionals, can inform future improvements in care management. [ABSTRACT FROM AUTHOR]

Medical Assistance in Dying (MAID) legislation has evolved rapidly in Canada with significant impacts on nursing practice. The purpose of this paper is to describe evolving complexities in legislative context and practice standards that influence the experiences nurse practitioners and registered nurses have with MAID. Qualitative interviews were conducted with 25 registered nurses and 10 nurse practitioners from diverse contexts across Canada. Participants described their practices and considerations when discussing MAID as part of advance care planning; their use of, and challenges with, waivers of consent; their practice considerations in negotiating the complexities of clients for whom death is not reasonably foreseeable; and their moral wrestling with the inclusion of MAID for persons whose sole underlying medical condition is mental illness. Findings illustrate the moral complexities inherent in the evolving legislation and the importance of robust health and social care systems to the legal and ethical implementation of MAID in Canada. [ABSTRACT FROM AUTHOR]

Background: People with Parkinson's disease (PD) do not always access specialist outpatient services in a timely manner in Ireland. The perspectives of people living with PD, relating to service access, are largely absent in the existing literature. Aim: To explore experiences of PD service access for people living with PD, using a qualitative approach. Methods: Purposive maximum variation sampling was used. Semi‐structured telephone interviews were conducted with 25 service users, including people with PD (n = 22) and supporting carers (n = 3). Informed consent was obtained from all participants. Interviews ranged in duration from 30 to 90 min. Data were managed in NVivo 12 and interpreted inductively using thematic analysis. The researchers were reflexive throughout the research process. The Consolidated Criteria for Reporting Qualitative Research checklist was employed to maximise transparency. Results: The findings highlight several key barriers to and facilitators of equitable and timely service access. Three key themes were identified comprising experiences of PD service access including 'geographical inequity', 'discriminatory practices', and 'public and private system deficits'. Together, these themes illustrate how a two‐tiered and under‐resourced health system lacks capacity, in terms of infrastructure and workforce, to meet PD needs for both public and private patients in Ireland. Conclusions: These findings point to problems for PD care, relating to (i) how the health system is structured, (ii) the under‐provision and under‐resourcing of specialist outpatient PD services, including medical, nursing, and multidisciplinary posts, and (iii) insufficient PD awareness education and training across health settings. The findings also show that telemedicine can provide opportunities for making access to certain aspects of PD care more flexible and equitable, but the feasibility and acceptability of technology‐enabled care must be assessed on an individual basis. Implications for policy, practice and research are discussed. Patient or Public Contribution: The design and conduct of this study were supported by an expert advisory group (EAG) of 10 co‐researchers living with PD. The EAG reviewed the interview schedule and the protocol for this study and provided detailed feedback from their perspective, to improve the methods, including the interview approach. The group also reviewed the findings of the study and contributed their insights on the meaning of the findings, which fed into this paper. [ABSTRACT FROM AUTHOR]

Purpose: This exploratory study investigated worker experiences of utilising the Before During After (BDA) harm reduction instrument to engage well with service users in a residential mental health service setting. Stakeholder interviews were conducted with a purposive sample of two senior nurses and one senior allied health staff at the study site to explore the impacts of BDA implementation on their work after 3 years of its use. A thematic analysis was conducted, including two-level coding. Five major themes were discussed. Of particular interest, and the focus of this paper, are the themes of effect on service users and effect on staff. The study found improved engagement between staff and service users, reduced stigma and more holistic care that was collaborative. In regard to staff, it was found that staff knowledge and confidence increased in addressing harm reduction issues with consumers and this was sustained over 3 years. Use of the BDA clinical instrument and package was reported to enhance worker engagement, knowledge and confidence in dual diagnosis work with service users. [ABSTRACT FROM AUTHOR]

Addressing equity in healthcare is fundamental for delivering safe care to vulnerable patients, especially during COVID-19. This paper aims to identify barriers and enabling factors for general practitioners (GPs) in delivering safe and equitable care during the COVID-19 pandemic. Semi-structured interviews took place during May–July 2020 among 18 Flemish and 16 Dutch GPs. Thematic analysis of the interviews demonstrated that while GPs acknowledged a smooth information flow by governments and professional organizations on care guidelines, the fast-changing information challenged them to stay up to date. Media communication facilitated information dissemination but also fueled misinformation and miscommunication, creating unrealistic patient expectations. Certain guidelines and patient reluctance delayed necessary care. A shortage of personal protective equipment made GPs concerned about patient safety during face-to-face contacts. Teleconsultations became a popular alternative, but posed increased patient safety risks. GPs struggled to identify and reach vulnerable patients. Equitable care was hindered by time constraints; thus, having the appropriate materials facilitated such care. An interprofessional collaboration involving paramedical, social, and city services benefited patient safety and equity in healthcare. However, limitations in this collaboration pressured GPs. The unprecedented and resource-constrained environment challenged GPs' capacity to provide the healthcare quality they aspired to deliver. A well-structured collaborative network involving all stakeholders could benefit safe and equitable care in future pandemics. [ABSTRACT FROM AUTHOR]

The assistive equipment provision process is routinely carried out with patients to mitigate fall risk factors via the fitment of assistive equipment within the home. However, currently, over 50% of assistive equipment is abandoned by the patients due to poor fit between the patient and the assistive equipment. This paper explores clinician perceptions of an early stage three-dimensional measurement aid prototype, which provides enhanced assistive equipment provision process guidance to clinicians. Ten occupational therapists trialled the three-dimensional measurement aid prototype application; think-aloud and semi-structured interview data was collected. Usability was measured with the System Usability Scale. Participants scored three-dimensional measurement aid prototype as 'excellent' and agreed strongly with items relating to the usability and learnability of the application. The qualitative analysis identified opportunities for improving existing practice, including, improved interpretation/recording measurements; enhanced collaborative practice within the assistive equipment provision process. Future research is needed to determine the clinical utility of this application compared with two-dimensional counterpart paper-based guidance leaflets. [ABSTRACT FROM AUTHOR]

Objective: The Samoan community has a disproportionately higher incidence of gestational diabetes mellitus (GDM). We explored consumer and healthcare providers' insight into perceptions of risk, attitudes to lifestyle behaviour change and experiences of GDM among Australian Samoan women in South Western Sydney. Methods: Semi-structured interviews and a focus group with Samoan women recruited through three churches, a diabetes and pregnancy clinic in South Western Sydney and via social media were conducted. Semi-structured interviews with healthcare providers' were also conducted. Main themes were thematically analysed to identify recurring patterns using Quirkos software. Identified themes were framed against the constructs of the Health Belief Model. Results: One focus group (n=4) and 12 one-to-one interviews were conducted among Samoan women. Eighteen semi-structured interviews with healthcare providers' were also conducted. There was a high concordance between Samoan women and healthcare providers' regarding perception of risk and barriers to maintaining a healthy lifestyle. However, Samoan women reported negative interactions with healthcare providers' that hindered their behaviour change, while healthcare providers' reported that normalisation of diabetes, confusion of GDM with type 2 diabetes and spiritual health beliefs were deterrents to behaviour change among Samoan women. Conclusion: Cross-cultural factors can influence the uptake of a healthy lifestyle. Future research should consider use of culturally tailored strategies when developing educational resources targeting Samoan women. Implications for research, policy and practice: The participants' viewpoints expressed in this study suggest a critical need for the development of culturally-tailored health promotion strategies for Samoan women and cultural training for healthcare providers', to improve GDM care and subsequent pregnancy outcomes. What is already known about the topic? * There is limited data and research on GDM particularly among the Australian-Samoan community though the available data highlight the significant morbidity and mortality due to diabetes in this population. * Samoan women are at an increased risk of gestational diabetes mellitus. What this paper adds: * This paper provides knowledge and understanding on ways to prevent and manage GDM by investigating the perception of risk and experiences of GDM among Australian Samoan women and healthcare professionals in Sydney. * It provides current evidence base for policy makers and researchers to develop health promotion strategies and interventions that are relevant to the Samoan and other culturally and linguistically diverse (CALD) communities in Australia. [ABSTRACT FROM AUTHOR]

This paper reports findings from a national, qualitative study in England that investigated if young adult carers services are facilitating young people's transitions to adulthood, including considering a future beyond caring. Semi-structured, online interviews were conducted in 2022 with a purposive sample of managers or lead workers of eleven young adult carers services in England. We discuss the consideration given in assessments to young people's caring preferences and the availability of support to facilitate them to relinquish their role, if they so wished. The majority of young adult carers services gave young people the opportunity to express their views on this issue. Although the Care Act 2014 aimed to provide choice over caring in adulthood to young adult carers, this was not matched by the necessary service provision to facilitate their preferences. A new national carers strategy is urgently required to ensure that young people, particularly women, have a credible choice over their future lives. [ABSTRACT FROM AUTHOR]

Background: Shared decision‐making has been shown to improve the quality of life in metastatic breast cancer patients in high‐literacy and high‐resource settings. However, limited studies have examined the cultural preferences of metastatic breast cancer patients with shared decision‐making implementation and the barriers encountered in an Asian setting where societal norms predominate and physician decision‐making is at the forefront. This paper aims to identify (1) barriers to practising shared decision‐making faced by healthcare professionals and patients and (2) strategies for implementing shared decision‐making in the context of metastatic breast cancer management in Malaysia. Methods: We conducted a qualitative study involving 12 patients diagnosed with metastatic breast cancer, 16 healthcare professionals and 5 policymakers from surgical and oncology departments at public healthcare centres in Malaysia. Semi‐structured in‐depth interviews and focus group discussions were conducted. The interviews were recorded, transcribed verbatim and analysed using the thematic approach. Nvivo software was used to manage and analyse the data. Results: Five main themes emerged from the study: healthcare provider–patient communication, workforce availability, cultural and belief systems, goals of care and paternalism versus autonomy. Other strategies proposed to overcome barriers to implementing shared decision‐making were training of healthcare professionals and empowering nurses to manage patients' psychosocial issues. Conclusion: This study found that practising shared decision‐making in the public health sector remains challenging when managing patients with metastatic breast cancer. The utilization of decision‐making tools, patient empowerment and healthcare provider training may help address the system and healthcare provider–patient barriers identified in this study. Patient or Public Contribution: Patients were involved in the study design, recruitment and analysis. [ABSTRACT FROM AUTHOR]

Introduction: Despite digital health tools being popular for supporting self‐management of chronic diseases, little research has been undertaken on stroke. We developed and pilot tested, using a randomized controlled design, a multicomponent digital health programme, known as Inspiring Virtual Enabled Resources following Vascular Events (iVERVE), to improve self‐management after stroke. The 4‐week trial incorporated facilitated person‐centred goal setting, with those in the intervention group receiving electronic messages aligned to their goals, versus limited administrative messages for the control group. In this paper, we describe the participant experience of the various components involved with the iVERVE trial. Methods: Mixed method design: satisfaction surveys (control and intervention) and a focus group interview (purposively selected intervention participants). Experiences relating to goal setting and overall trial satisfaction were obtained from intervention and control participants, with feedback on the electronic message component from intervention participants. Inductive thematic analysis was used for interview data and open‐text responses, and closed questions were summarized descriptively. Triangulation of data allowed participants' perceptions to be explored in depth. Results: Overall, 27/54 trial participants completed the survey (13 intervention: 52%; 14 control: 48%); and 5/8 invited participants in the intervention group attended the focus group. Goal setting: The approach was considered comprehensive, with the involvement of health professionals in the process helpful in developing realistic, meaningful and person‐centred goals. Electronic messages (intervention): Messages were perceived as easy to understand (92%), and the frequency of receipt was considered appropriate (11/13 survey; 4/5 focus group). The content of messages was considered motivational (62%) and assisted participants to achieve their goals (77%). Some participants described the benefits of receiving messages as a 'reminder' to act. Overall trial satisfaction: Messages were acceptable for educating about stroke (77%). Having options for short message services or email to receive messages was considered important. Feedback on the length of the intervention related to specific goals, and benefits of receiving the programme earlier after stroke was expressed. Conclusion: The participant experience has indicated acceptance and utility of iVERVE. Feedback from this evaluation is invaluable to inform refinements to future Phase II and III trials, and wider research in the field. Patient or Public Contribution: Two consumer representatives sourced from the Stroke Foundation (Australia) actively contributed to the design of the iVERVE programme. In this study, participant experiences directly contributed to the further development of the iVERVE intervention and future trial design. [ABSTRACT FROM AUTHOR]

Creating a learning health system could help reduce variations in quality of care. Success is dependent on timely access to health data. To explore the barriers and facilitators to timely access to patients’ data, we conducted in-depth semi-structured interviews with 37 purposively sampled participants from government, the NHS and academia across Scotland. Interviews were analysed using the framework approach. Participants were of the view that Scotland could play a leading role in the exploitation of routine data to drive forward service improvements, but highlighted major impediments: (i) persistence of paper-based records and a variety of information systems; (ii) the need for a proportionate approach to managing information governance; and (iii) the need for support structures to facilitate accrual, processing, linking, analysis and timely use and reuse of data for patient benefit. There is a pressing need to digitise and integrate existing health information infrastructures, guided by a nationwide proportionate information governance approach and the need to enhance technological and human capabilities to support these efforts. [ABSTRACT FROM AUTHOR]

Introduction: British South Asians have a higher prevalence of overweight and obesity than the wider population. Bradford (UK), with its high Pakistani presence and levels of economic deprivation, has exceptionally high instances, especially in deprived areas where many Pakistanis reside. British Pakistani women in Bradford are more likely to be overweight and obese. There is uncertainty on how these women can be aided to manage their weight. Therefore, the objective of this study was to explore the obesity concerns of Pakistani women living in deprived inner‐city areas of Bradford. Methods: Three focus groups interviews were carried out with 23 Pakistani women living in deprived areas of Bradford. Data were analysed thematically. Results: This exploratory study identified a wide range of concerns that women had around managing their weight. Participants disclosed distrust in information given around medication, conflicting dietary information and reported low levels of trust in women‐only organized physical activities. Cultural barriers were identified, which included the gender role of the woman, the lack of culturally appropriate dietary advice, cultural misunderstandings of what constitutes a healthy diet and healthy weight, the lack of culturally suitable exercise facilities and conforming to family and community expectations. Other concerns were language barriers around a lack of understanding, the inability to read Urdu and reliance on others to translate information. Conclusion: These findings have implications for researchers, local authorities, policy makers and others with an interest in reducing the rates of obesity in this population. Recommendations include training health practitioners to be culturally aware of the diet and eating practices of this community, exploring different ways to support socially isolated women to be more physically active at home, addressing physical activity and diet misconceptions and designing obesity management information materials appropriate for a range of literacy levels. Patient or Public Contribution: Public contributors were involved in the development of the interview guide and design of the research. A pilot focus group with participants not included in the present paper was used to help test and refine the focus group questions. Interview transcripts were member checked by participants, and participants assisted with data analysis. [ABSTRACT FROM AUTHOR]

Background: Nurses contribute the largest portion of Uganda's health workforce providing care to individuals of all ages and communities. However, despite the growing number of the elderly population in Uganda with improved life expectancy, there is hardly any study that has looked at the elderly health care competencies in the nursing training programs at various levels. This paper provides an overview of the gaps in elderly health care competencies in nursing education in Uganda. Methods: We conducted a descriptive qualitative cross-sectional study that involved document review, Key Informant Interviews (KIIs) with nursing leaders, and Focus Group Discussions (FGDs) with faculty at all levels of nursing training and nurses in practice. Data was analyzed using latent and manifest content analysis with Open Code software 4.03. Common categories were identified and incorporated into a matrix to create themes. Results: Almost all the curricula and minimum standards for training nurses at certificate, diploma, and degree levels lack a module and nursing competencies on elderly nursing care. This is aggravated by a lack of faculty trained in elderly health care skills, and a lack of specialized wards for nursing elderly care clinical training among others. Conclusions: There is hardly any elderly health care training module and elderly nursing competencies at all levels of nursing training in Uganda. [ABSTRACT FROM AUTHOR]

Background There is a strong national drive within the UK government and National Health Service for social prescribing. Previous research studies have mainly focused on service user perspectives and evaluating their experiences. There is limited evidence on how the general public perceive and understand what social prescribing is and how these views could influence service planning and delivery. This paper seeks to understand perceptions of social prescribing within the wider community. Methods Semi-structured focus groups were conducted with 37 members of the public in four areas in north-west England. We explored public awareness and understanding of social prescribing. Results Limited knowledge of the term social prescribing was found amongst participants as well as limited involvement in community discussions of the topic. Concerns were raised about the short-term nature of activities and the need for adequate resourcing to support continuity of service provision. The social prescribing link worker was considered to be important in supporting engagement with services and it was preferred this role was undertaken by people with local knowledge. Conclusions The findings provide evidence of public perspectives on social prescribing and highlight how wider community perceptions can supplement service user feedback to support social prescribing service planning, commissioning and delivery. [ABSTRACT FROM AUTHOR]

Background Preventative interventions may be effective in reducing and preventing symptoms of mental ill health in children and young people. However, there is a paucity of research in this area that explores the views of young people. This paper reports on a qualitative study to inform the future development of attractive and appropriate early and preventative school-based mental health interventions. Methods Semi-structured interviews were conducted with a purposive sample of 12 young people aged 14–17 in North East England. Interviews were audio-recorded, transcribed, anonymised and analysed following a thematic approach. Results Four key themes were identified, relevant to those providing, designing and commissioning early and preventative mental health interventions in schools: 'mental health literacy', 'risk factors for wellbeing decline', 'experience of school-based support' and 'recommendations for future support'. Conclusions Young people have varying levels of mental health literacy, but are able to identify academic stress, bullying and the transition from primary to secondary school as leading causes of worry. Young people want more regular and in-depth mental health education, tailored levels of support in school and improved training for teachers. [ABSTRACT FROM AUTHOR]

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

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

Background: Trans‐identifying individuals experience unique barriers and challenges in negotiating health‐care systems due to the cisnormative attitudes and practices which obstruct the receipt of trans‐inclusive care. To date, there has been little exploration of older trans consumers' experiences of contemporary health‐care services when seeking to transition medically in later life. Objectives: Qualitative findings are presented from a study of trans ageing and trans‐related health and social care needs in Wales, UK (2016‐18). The objectives are to (1) examine supportive and obstructive points of interaction with health‐care professionals, and (2) identify key learning messages for improving trans‐related health care from the perspectives of trans‐identifying adults in later life. Design: Trans‐identifying participants self‐selected to take part in two interviews—a life‐history interview and a semi‐structured interview. Interview data were analysed thematically using the framework method approach. Setting and participants: This paper focuses on the accounts of 19 participants (50‐74 years of age) who identified as trans and were seeking to transition medically in mid‐ to later life. Results: Findings indicate how older trans patients are positioned as reluctant educators for GPs in primary care settings and illustrate the transphobic practices and cisnormative assumptions encountered across health‐care interactions and systems that impede their journey of transitioning in later life. Discussion and conclusions: Messages from this study speak to the importance of improving professionals' knowledge of gender identity diversity across the life course and making changes at a systemic level in redressing cisnormative assumptions and systems that reinforce inequities on the basis of gender identity. [ABSTRACT FROM AUTHOR]

Background: Electronic Health Records (EHRs) were introduced to all Iranian medical universities in 2015 with the launch of Integrated Electronic Health System (which is known as SIB: a Persian backronym in Persian meaning apple), and a number of studies were conducted on SIB. However, most of these studies did not consider the benefits and challenges of adopting SIB in Iran. Therefore, the present study aimed to identify the benefits and challenges of SIB in health centers of Khuzestan Province, Iran. Methods: This was a qualitative study using qualitative conventional content analysis conducted on 6 experts and 24 users of SIB in six health centers of three cities in Khuzestan province, Iran. The participants were selected using a purposeful sampling method. Maximum variation was considered in selecting the group of users, and snowball sampling was used in the group of experts. Data collection tool was semi-structured interview. Data analysis was performed using thematic analysis. Results: Overall, 42 components (24 for benefits and 18 for challenges) were extracted from the interviews. Common sub-themes and themes were identified for challenges and benefits. The components formed 12 sub-themes, and they were placed in 3 main themes, namely structure, process and outcome. 1) Structure included four sub-themes of Financial resources, Human resources, Facilities, and Access to the Internet; 2) Process involved three sub-themes of Training, Providing services, and Time and workload; and 3) Outcome incorporated five sub-themes of Quality of health services, Access, Safety and personal distance, Screening and evaluation, and Research. Conclusions: In the present study, the benefits and challenges of adopting SIB were examined in three themes: structure, process, and outcome. Most of the identified benefits were related to the theme of outcome, and most of the identified challenges were related to the theme of structure. Based on the identified factors, by strengthening the benefits of SIB and also trying to eliminate or reduce its challenges, it is possible to institutionalize and use it more effectively in order to solve health problems. [ABSTRACT FROM AUTHOR]

Background: Critical care bed capacity per capita in Ireland is among the lowest in Europe. The COVID‐19 pandemic has put additional strain on an over‐stretched healthcare system. COVID‐19 community assessment hubs (CAHs) were established to prevent unnecessary admission to acute hospitals and to reduce infection spread. Objective: The aim of this study was to assess the effectiveness and acceptability of CAHs and identify how the service might be improved or adapted for possible future use. Design: This was a mixed methods study, incorporating co‐design with clinical stakeholders. Data collection was via an online survey and semistructured telephone interviews with staff and patients conducted between January and May 2021. Setting and participants: Thirty‐one patients completed the survey and nine were interviewed. Twenty interviews were conducted with staff. Results: The findings suggest that the CAH model was successful in providing a dedicated pathway for assessing patients with COVID‐19 symptoms, whilst mitigating the risk of infection. Patients were particularly positive about the timely, comprehensive and holistic care they received, as well as the accessibility of the clinics and the friendly attitudes of the staff. Staff welcomed the training and clinical protocols which contributed to their feelings of safety and competency in delivering care to this cohort of patients. They also highlighted the benefits of working in a multidisciplinary environment. Both staff and patients felt that the hubs could be repurposed for alternative use, including the treatment of chronic diseases. Discussion: This study describes staff and patients' experiences of these hubs. An unexpected outcome of this study is its demonstration of the true value of effective multidisciplinary working, not only for the staff who were deployed to this service but also for the patients in receipt of care in these hubs. Conclusion: This multidisciplinary patient‐centred service may provide a useful model for the delivery of other services currently delivered in hospital settings. Patient or Public Contribution: An earlier phase of this study involved interviews with COVID‐19‐positive patients on a remote monitoring programme. The data informed this phase. Several of the authors had worked in the CAHs and provided valuable input into the design of the staff and patient interviews. [ABSTRACT FROM AUTHOR]

Background: Pneumonia contributes to about 15% of child deaths globally, with 20% of the overall deaths occurring in India. Although WHO recommends the use of pulse oximeters (PO) in first-level facilities for early detection of child pneumonia in low- and middle-income countries (LMICs), this has not yet been implemented in India. We aimed to assess the feasibility and acceptability of introducing PO in integrated management of neonatal and childhood illnesses (IMNCI) services at primary health centres (PHC) in the rural Pune district. Methods: We identified medical officers (MO) and auxiliary nurse midwives (ANM) from six PHCs as study participants due to their involvement in the treatment of children. We developed in-depth interview (IDI) guides for both groups to explore their IMNCI knowledge and attitude towards the program through a qualitative study. We conducted interviews with MOs (n = 6) and ANMs (n = 6) from each PHC. The PO module was added to explore perceptions about its usefulness in diagnosing pneumonia. After baseline assessment, we conducted training sessions on adapted IMNCI services (including PO use) for MOs and ANMs. PO devices were provided at the study PHCs. Results: At baseline, no PO devices were being used at study PHCs; PHC staff demonstrated satisfactory knowledge about paediatric pneumonia management and demanded refresher IMNCI training. They also felt the need to reiterate the PO use for early diagnosis of pneumonia in children and highlighted the challenges encountered in managing pneumonia at PHCs, such as health system-related challenges and parents' attitudes towards care seeking. There was positive acceptance of training and PO started to be used immediately in PHCs. There was increased confidence in using PO at endline. PO use in examining symptomatic children increased from 26 to 85%. Conclusions: Paediatric PO implementation could be integrated successfully at PHC levels; we found pre-implementation training and provision of PO to PHCs to be helpful in achieving this goal. This intervention demonstrated that an algorithm to diagnose pneumonia in children that included PO could improve case management. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic has underscored the importance of remote healthcare and home-based interventions, including pulmonary rehabilitation, for patients with chronic respiratory diseases (CRDs). It has also heightened the vulnerability of individuals with underlying respiratory conditions to severe illness from COVID-19, necessitating exploration and assessment of the feasibility of delivering home - pulmonary rehabilitation (home-PR) programmes for CRD management in Malaysia and other countries. Home-based programmes offer a safer alternative to in-person rehabilitation during outbreaks like COVID-19 and can serve as a valuable resource for patients who may be hesitant to visit healthcare facilities during such times. We aimed to assess the feasibility of delivering a home-PR programme for patients with CRDs in Malaysia. Methods We recruited patients with CRDs from two hospitals in Klang Valley, Malaysia to a home-PR programme. Following centre-based assessment, patients performed the exercises at home (five sessions/week for eight weeks (total 40 sessions)). We monitored the patients via weekly telephone calls and asked about adherence to the programme. We measured functional exercise capacity (6-Minutes Walking Test (6MWT) and Health-Related Quality-of-Life (HRQoL) (COPD Assessment Test (CAT)) at baseline and post-PR at nine weeks. We conducted semi-structured interviews with 12 purposively sampled participants to explore views and feedback on the home-PR programme. The interviews were audio recorded, transcribed verbatim, and analysed thematically. Results We included 30 participants; two withdrew due to hospitalisation. Although 28 (93%) adhered to the full programme, only 11 (37%) attended the post-PR assessment because COVID-19 movement restrictions in Malaysia at that time prevented attendance at the centre. Four themes emerged from the qualitative analysis: involvement of family and caregivers, barriers to home-PR programme, interactions with peers and health care professionals, and programme enhancement. Conclusion Despite the COVID-19 pandemic, the home-PR programme proved feasible for remote delivery, although centre-based post-PR assessments were not possible. Family involvement played an important role in the home-PR programme. The delivery of this programme can be further improved to maximise the benefit for patients. [ABSTRACT FROM AUTHOR]

Aim: To construct evidence-based sensitive quality indicators for patients' rapid rehabilitation care after combined pancreaticoduodenectomy (PD) and to provide a reference for clinical nursing professionals to scientifically evaluate the quality of patients' rehabilitation post-PD. Background: Since PD is associated with higher surgical risk and anastomotic complications, it leads to higher complication rates and longer postoperative recovery cycles. This reiterates the need for rapid recovery of patients after PD; however, the evaluation of sensitive nursing care indicators regarding rapid recovery post-PD has not yet been established to date. Methods: Based on the Donabedian structure-process-result theory model, we used available literature, semi-structured interviews, the Delphi method, and hierarchical analysis to establish a sensitive indicator system for patients' rapid rehabilitation after PD and evaluate the importance of such indicators. Results: There were two rounds of expert correspondence, and the effective recovery rate of the questionnaires of these rounds was 100%. The expert authority coefficients, as well as the Kendall coordination coefficients of the expert opinions, were 0.859 and 0.872 as well as 0.423 and 0.431, with statistically significant differences (p < 0.05), respectively. Consequently, we developed a sensitive quality index system for patients' rapid rehabilitation care after combined PD, including 3 first-level, 12 s-level, and 23 third-level indexes, respectively. Conclusion: The constructed sensitive quality index system developed for patients' rapid rehabilitation nursing care after combined PD is standardized, practical, and aligned with the specialty characteristics. Furthermore, this might help greatly in improving the quality and safety of patients' rapid rehabilitation nursing care after combined PD, standardizing nursing management skills, and enhancing nursing quality. [ABSTRACT FROM AUTHOR]

Background: When doctors seek medical care, there is evidence that the treating doctor can struggle to provide optimal treatment. Guidelines state that doctor-patients should be treated like any other patient, but this is challenging for the treating doctor. This study set out to explore both the positive experiences general practitioners (GPs) have when caring for doctor-patients, and the challenges they confront. It sought to identify whether GPs believe they treat doctor-patients differently to other patients and if so, in what ways, for what reasons, and how this impacts their provision of care. The study also aimed to develop a model that makes sense of GPs' experiences when caring for a patient who is also a medical doctor. Method: Qualitative in-depth interviews with 26 GPs were carried out, with analysis of de-identified transcripts using pragmatic grounded theory. Evolving understandings were used to develop a model to make sense of GPs' experiences caring for their doctor-patients. Results: The core aspects of GPs' experiences of treating fellow doctors centred around concepts of respect and collegiality. These play a central role in mediating how a treating doctor experiences a consultation with a doctor-patient, influencing the quality of care provided. GPs shared that the use of medical language (and assumptions about the doctor-patient's knowledge/behaviours), testing, the exploration of sensitive issues, and the degree of shared decision-making were areas where their treatment might vary when treating a doctor-patient. Treating doctors often experience anxiety about errors and the likely scrutiny from the medical, and wider community. The decision to treat the doctor-patient differently was driven by a desire to maintain a sense of collegiality, to not offend, to meet their doctor-patient's expectations, and to appear competent. Conclusion: The professional socialisation of doctors, with its emphasis on collegiality and respect, plays a significant role in the dynamics of the therapeutic relationship when a doctor treats a doctor-patient. Current guidelines make little reference to these dynamics with the over-simplified 'keep it normal' recommendations. Treating doctors need evidence-informed training to navigate these challenges and ensure they can effectively deliver quality care to their doctor-patients. [ABSTRACT FROM AUTHOR]

Background: General hospitals in China have been establishing General Practice Departments (GPD). Although General Practice Nurses (GPNs) are an important part of this medical system, their training has not been synchronised. This study explored the working status of nurses in GPDs in general hospitals in Beijing to provide a theoretical basis for the training and development of GPNs in China. Methods: We conducted in-depth, individual interviews with outpatient nurses at 19 hospitals in Beijing between March and April 2021. We employed a qualitative analysis to interpret participant narratives and used a codebook thematic analysis to analyse the interview data and extract themes. Results: The analysis revealed four themes: (i) a lack of full-time GPNs in GPDs of most tertiary hospitals, (ii) the inability of GPNs to fully express their potential and skills owing to their limited roles, (iii) insufficient standardised patient education provided by nurses in GPDs, and (iv) a lack of systematic and relevant training for nurses working in general practice settings. Conclusions: To promote the development of GPNs, GPDs in general hospitals in China should hire full-time GPNs, define their job duties in alignment with their values, and provide standardised training to strengthen their core competencies. [ABSTRACT FROM AUTHOR]

Background: Chronic, non-malignant diseases (CNMD) like chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and dementia in advanced stages are very burdensome for patients. Timely palliative care with strong collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams can reduce symptom burden, hospitalization rates, hospitalization costs and overall healthcare costs. The KOPAL-study on strengthening interprofessional collaboration for patients with palliative care needs tested the effect of an intervention comprising of a SPHC nurse assessment and an interprofessional case conference. This qualitative evaluative study explores patients', proxies' and their associates' motivation to participate in the KOPAL-study and views on the (benefits of the) intervention. Methods: We interviewed 13 male and 10 female patients as well as 14 proxies of patients with dementia and six associates of study participants using a semi-structured interview guide. All interviews were digitally recorded, transcribed verbatim and analysed with deductive-inductive qualitative content analysis. Results: Motivation for participation was driven by curiosity, the aim to please the GP or to support research, respectively to help other patients. Few interviewees pointed out to have expected positive effects for themselves. The nurse visit was evaluated very positively. Positive changes concerning health care or quality of life were reported sparsely. Most study participants did not prepare for the SPHC nurse assessment. They had no expectations concerning potential benefits of such an assessment, the interdisciplinary case conference and an early integration of palliative care. The majority of interviewees reported that they did not talk about the nurse visit and the interprofessional case conference with their GPs. Conclusion: Our results lead to the conclusion that SPHC nurses can serve as an advocate for the patient and thereby support the patients' autonomy. GPs should actively discuss the results of the interdisciplinary case conference with patients and collaboratively decide on further actions. Patient participation in the interdisciplinary case conference could be another way to increase the effects of the intervention by empowering patients to not just passively receive the intervention. Trial registration: DRKS00017795 German Clinical Trials Register, 17Nov2021, version 05. [ABSTRACT FROM AUTHOR]

Background: The field of traditional medicine encompasses a wide range of knowledge, skills, and practices that are deeply rooted in the theories, beliefs, and experiences of different cultures. The research aimed to identify traditional medicinal plants used in Guraferda District and assess the threats they face. Method: A total of 96 individuals, 80 males and 16 females, were interviewed to gather ethnobotanical data. Statistical tests like independent t tests, ANOVA, correlation, and regression were conducted using R software version 4.3.2 to compare informant groups. Result: The study found 81 medicinal plant species in the district from 71 genera and 38 families, with Asteraceae and Solanaceae families having the most species. Leaves were the most commonly used plant part for medicine. Significant differences in plant knowledge were observed across genders, age groups, education levels, and experiences. The highest ICF value was for Dermal and Cutaneous ailments, and Cissampelos mucronata A. Rich and Bidens pilosa L. had the highest fidelity levels. Conclusion: The study highlighted the importance of traditional medicinal plants in treating ailments but noted threats like overharvesting, habitat destruction, and climate change. Conservation efforts and sustainable harvesting practices are crucial to ensure the availability of these plants for future generations. Further research is needed to explore their potential for modern medicine and develop sustainable use strategies. [ABSTRACT FROM AUTHOR]

Aim: Patients living with chronic obstructive pulmonary disease (COPD) are challenged with managing the medical, social, and emotional consequences of the disease. Self-management of the disease plays a major role in actively preventing a deterioration such as an acute exacerbation (AECOPD). The aim of this study was to explore patients’ perspectives on self-management, for both participants who received a complex multicomponent behavior-focused intervention (e.g., physical activity) after hospitalization (intervention group) and participants who did not (control group). Design: A qualitative descriptive study design was used. Methods: Semi-structured one-to-one interviews were conducted (n = 10). A newly implemented counselling program conducted by an Advanced Nursing Practice (ANP) care team was introduced as part of the study. Participants in the control group received standard treatment for hospitalized AECOPD, while the intervention group received counselling focused on patient self-management from the ANP care team over a 13-week period. Control and intervention group narratives were compared using framework analysis. Results: The predominant four topics in both groups were deducted from Lorig’s conceptualization of self-management. These were: the management of burdensome emotions, the management of life roles, the management of medical regimen and recommendations, and the perception of self-management needs. The participants in the intervention group reported that counselling by the ANP team helped motivate them to sustain physical activity. They also found it reassuring to have a contact person they could easily reach out to in case of any queries or uncertainties, which provided them with a sense of security. Conclusion: There is a need for support in several areas of self-management after hospitalization for AECOPD. The newly introduced nurse-led self-management support was immediately well-received. Indeed, all participants appreciated the contact with their respective health professionals. [ABSTRACT FROM AUTHOR]

Health care challenges in remote rural municipalities (RRMs) emphasize the importance of primary health care (PHC) and require an expanded scope of practice. Doctors are key actors in this context. The aim of this study was to explore the level of integration of doctors in RRMs and working practices. We conducted a qualitative study involving semi-structured interviews with 46 PHC doctors working in 27 RRMs in Brazil. Content analysis was performed, resulting in the identification of categories of analysis grouped under three core dimensions: doctor training and experience; comprehensive care and timely access; and the community-based approach. Doctors working in RRMs were mainly recent graduates with limited experience who had undertaken their degree outside Brazil, and care was focused on the individual. The findings also revealed weak sociocultural adaptation and a harsh working environment and issues related to social status that reinforced prejudice against rurality and poverty. Practice was limited in scope and care tended to be oriented towards acute problems, disease-centered and focused on the biomedical model of medicine. Barriers to the delivery of comprehensive care include both structural constraints, such as poor facilities and centralization of services in administrative centers, and the lack of professional competencies necessary for PHC in these areas. The findings point to the need to promote an expanded scope of practice in PHC delivery in RRMs, with major public investment in the promotion of training and strengthening career pathways in these areas. [ABSTRACT FROM AUTHOR]

Aim. To understand the current situation of upward bullying in the Chinese nursing field and explore the manifestations, reasons, and outcomes of upward bullying experienced by Chinese nurse managers. Background. Workplace bullying, a serious social problem, is characterised by recurring incidents of intimidating, aggressive, and hostile behaviour. Bullying in the nursing profession exhibits all or some of the above traits. The evidence of upward bullying by subordinate nurses against nurses in positions of authority or power is limited in China. Methods. This qualitative study was conducted with semistructured, in‐depth interviews involving 12 hospital nurse managers in Wuhan, Hubei Province, between June and August 2023. The data were analysed using the Colaizzi seven‐step analysis method with Nvivo 12.0 software as a support. Results. We grouped our findings into three main categories: manifestations of upward bullying; reasons for upward bullying; and outcomes of upward bullying. Conclusions. Nurse managers in China are exposed to upward bullying in many forms and for complex reasons. More emphasis needs to be given to creating a positive work environment for them to facilitate their managerial role. Implications for Nursing Management. This study probes the realities of upward bullying against Chinese nurse managers and highlights the need for managers to develop the skills needed to identify, manage, and prevent bullying from subordinates. By contributing to the development of interventions and strategies that address workplace bullying, this study shows promise for enhancing managerial effectiveness and improving the nursing practice environment. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic, drought and internal conflict have worsened Ethiopia's already weak healthcare system. Antenatal and intrapartum care are especially prone to interruption under these circumstances. Objective: To explore women's experiences receiving antenatal and intrapartum care during the pandemic. Design: A descriptive qualitative approach was utilised. Methods: We conducted in-depth interviews with 17 women and held 4 focus group discussions with women who gave birth at 4 public hospitals during the pandemic. A study was conducted at four public hospitals in the Sidama region of Ethiopia, during which data were collected from 14 February to 10 May 2022. Thematic analysis was performed to generate themes. Results: The peak of the COVID-19 pandemic in Ethiopia presented several barriers to access and uptake of antenatal and intrapartum care at public hospitals. Four themes and 10 subthemes emerged from the thematic analysis. The themes were 'Barriers to maternity care uptake during COVID-19', 'Shortage of resources during COVID-19', 'Delays in maternity care uptake during COVID-19' and 'Mistreatment of women during maternity care during COVID-19'. The subthemes included 'Fear of contracting COVID-19', 'People in the hospital neglecting COVID-19 prevention', 'Women losing their job during COVID-19', 'Shortage of beds in the labour ward', 'Shortage of medical supplies', 'Delays in seeking care', 'Delays in receiving care', 'Complications during childbirth', 'disrespectful' and 'suboptimal care'. Conclusion: The findings of this study underscore the impact of COVID-19 on antenatal and intrapartum care, leading to delays in seeking and receiving care due to reduced rapport, resource shortages, companion restrictions, disrespectful care and suboptimal care. These factors contribute to increased obstetric complications during COVID-19. It is imperative for policymakers to prioritise essential resources for antenatal and intrapartum care in the present and future pandemics. Moreover, healthcare providers should maintain respectful and optimal care even amid challenges. Plain Language Summary: Women's experiences in receiving antenatal and intrapartum care during COVID-19 The COVID-19 pandemic has posed a significant challenge in seeking and receiving care of antenatal care and institutional childbirth. Women could experience delays in booking antenatal care appointments, postponing antenatal care visits, and facing delays in receiving care at hospitals, which has disrupted their access to routine antenatal care and institutional birth during the pandemic. This study highlights a range of barriers that hinder access to and utilisation of antenatal care and institutional birth, including lack of transport, shortage of resources, fear of contracting the virus, companion restrictions, disrespectful care and suboptimal care that leads to increased obstetric complications during COVID-19. This study provides recommendations for policymakers to prioritise resources and enhance respectful and optimal care for pregnancy and institutional birth to lessen the indirect impact of present and future pandemics on pregnant women and their unborn babies. [ABSTRACT FROM AUTHOR]

Background: Due to the unique working environment and nature of work in emergency departments, nurses are prone to experiencing compassion fatigue (CF), leading to job burnout and attrition. As more Generation Z (Gen Z) nurses enter the emergency department with distinct personality traits compared to previous generations, studying their experiences with CF will inform future management strategies. Methods: The qualitative phenomenological research method was utilised to investigate CF among Gen Z emergency nurses at a hospital in Shanghai, China. Data were collected through face-to-face semi-structured interviews and analyzed using Colaizzi's seven-step phenomenological analysis method. Study participants were purposively selected. Results: Three main themes and nine sub-themes emerged from the study: secondary traumatic stress, including physiological symptoms, psychological symptoms, and behavioral changes; cumulative effects, including impaired empathy, interference with family life, and post-traumatic growth (PTG); coping strategies, including cognitive reconstruction, seeking support, and facilitating action. Conclusions: The aim of this study is to investigate the experience of CF among Gen Z emergency nurses, providing managers with a reference for future management strategies. The significance of multi-dimensional support for Gen Z emergency nurses is underscored by our findings. Additionally, interventions that enhance resilience and competency can facilitate their psychological transformation after experiencing CF and promote accelerated personal growth. [ABSTRACT FROM AUTHOR]

The "SmartCaregivers" 1.0 mobile application is a beacon of hope for caregivers (CG) in rural areas, often facing limited access to facilities and support. This study, conducted from February to August 2021, aimed to comprehensively analyze the need for developing a database system and a mobile application tailored to enhance caregiver support and resource management for long-term dependent individuals in the rural areas of Maha Sarakham province, Thailand. The research followed a rigorous research and development (R & D) approach, specifically the ADDIE model (analysis, design, development, implementation, and evaluation). Data were collected from 402 caregivers and 10 key informants through surveys and interviews, as well as from 402 caregivers during the implementation and evaluation phases. The application's impact was assessed using a quasi-experimental design with a one-group pre–post-test, and its acceptance was evaluated through the technology acceptance model (TAM). The application significantly improved caregivers' knowledge scores, with a mean increase from 10.49 ± 2.53 to 12.18 ± 2.76 post-intervention. High scores for perceived usefulness (4.36 ± 0.62) and ease of use (4.31 ± 0.59) reassure the audience about the application's effectiveness in providing rapid access to health information, aiding decision-making, and improving care coordination. The system quality was also highly rated, with users appreciating the variety of functions and structural design. This potential for transformation and improvement instills hope and optimism for the future of caregiving in rural areas. [ABSTRACT FROM AUTHOR]

Background: An ethnozoological study of medicinal animals in the Kucha district, Gamo zone, Southern Ethiopia, was conducted to investigate and document the use of traditional medicinal animals and the associated indigenous knowledge. Tribal people still make abundant use of animals and their parts to manage diseases in humans and even livestock. Method: A cross sectional study design and purposively sampling techniques were used. Data were collected from 132 respondents based on semi structured questionnaires. Focus group discussions (FGD) and Key informant interviews (KII) were conducted; Fidelity level (FL), Relative frequency of citation (RFC) and Informants' consensus factor (ICF) were used to analyze species preference and importance. Results: A total of 24 medicinal animals were identified with 13 species (54.2%) being mammals of which 5 species (20.8%) dominated. They were followed by arthropods, reptiles and fishes. Seven out of the total were domestic species (29%) and 17 (70%) were wild animals. The majority of these animals, i.e. 22 (91.7%), were used to treat human ailments; whereas 2 (8.3%) were used to treat livestock ailments. The ICF values varied from 0.8 to 1.The highest FL value (98%) was linked to the cow (cattle), the lowest (1.5%) to the scorpion. The RFC value (1.0) was highest for the cow and lowest (0.02) for the scorpion. Honey, milk, and butter were the most commonly used therapeutic animal products, but regarding direct uses, fresh/raw meat dominated. Out of ten ailment categories, headaches had the lowest ICF value (0.8). All others scored at least 0.9. Conclusions: In rural areas, sick people often do not only have limited access to modern medical facilities, they actually prefer traditional treatments considering them to be more reliable and effective. It is therefore important to focus on documenting, conserving, and safeguarding the indigenous knowledge so that strategies to manage the traditional wisdom can be implemented in the future. To achieve these goals, it is important to make sure that medicinal animal species are available in sufficient numbers and neither threatened by habitat changes or overexploitation. [ABSTRACT FROM AUTHOR]

Background: Promoting the work adaptation of nurses returning to work after childbirth is key to improving their physical and mental health and ensuring the quality of nursing care. Although postpartum nurses have reported high work stress and poor adaptation after returning to work, little is known regarding the experiences, problems and further needs. This study aimed to explore the adaptation experiences of postpartum nurses returning to work. Methods: This was a qualitative study with descriptive phenomenological approach. Individual semi-structured interviews were conducted between March and May 2023 in four tertiary hospitals in Changsha, mainland China, which were selected using convenience sampling. A total of 16 postpartum nurses returning to work within one year were recruited using purposive sampling and maximum variation sampling. The interviews were analysed using the Colaizzi's 7-step method. Results: 'Breakdown and healing' is a strong thread in postpartum nurses' work adaptation. It links 13 subthemes in the interview data, which can be grouped under three overarching themes: (a) changes and challenges of multiple roles; (b) self-coping and social support; and (c) further needs after returning to work. The phrase 'breakdown and healing' reflects the mutual relationship between stress and coping among postpartum nurses. The changes and challenges associated with being required to fulfil multiple roles of mothers, wives and nurses make the subjects feel on the verge of 'breakdown'. When returning to work, most of them move slowly towards 'healing' through positive self-management and support from their partners, families, supervisors and colleagues. Moreover, their ongoing demands and unsolved problems – such as their desire for a workplace that is friendly and serves their needs – were generated by the constant process of 'breakdown and healing'. Conclusions: Understanding how postpartum nurses returning to work perceive adaptation experiences is essential for nursing managers, who can use the findings to implement targeted measures to shorten postpartum nurses' maladaptation period after returning to work and promote their work adaptation. This study underscores the critical importance of personalized return-to-work training, flexible work arrangements, support from colleagues and managers, well-established maternal facilities and services, and targeted policy efforts in enhancing postpartum nurses' work adaptation. [ABSTRACT FROM AUTHOR]

Objectives: Patient reported experience measures (PREMs) are tools often utilised in hospitals to support quality improvements and to provide objective feedback on care experiences. Less commonly PREMs can be used to support consumers choices in their hospital care. Little is known about the experience and views of the Australian consumer regarding PREMs nor the considerations these consumers have when they need to make decisions about attending hospital. This study aimed to explore consumer awareness of PREMs, consumer attitudes towards PREMs and the utility of PREMs as a decision-making tool in accessing hospital care. Methods: Qualitative study involving semi-structured interviews conducted over the phone. Participants (n = 40) were recruited from across Australia and purposively sampled according to key characteristics: holding private health insurance, > 30-years of age, may have accessed private hospital care in the past year, variety of educational and cultural backgrounds, and if urban or rural residing. Interviews were audio-recorded, transcribed, and analysed thematically. Results: Four overarching themes and six subthemes were identified from the data. Major findings were that prior awareness of PREMs was limited; however, many had filled in a PREM either for themselves or for someone they cared for following a hospital stay. Most respondents preferred to listen to experience of self or family/friends or the recommendation of their physician when choosing a hospital to attend. Participants appeared to be more interested in the treating clinician than the hospital with this clinician often dictating the hospital or hospital options. If provided choice in hospital, issues of additional costs, timeliness of treatment and location were important factors. Conclusion: While PREMs were considered a possible tool to assist in hospital decision-making process, previous hospital experiences, the doctor and knowing up-front cost are an overriding consideration for consumers when choosing their hospital. Consideration to format and presentation of PREMs data is needed to facilitate understanding and allow meaningful comparisons. Future research could examine the considerations of those consumers who primarily access public healthcare facilities and how to improve the utility of PREMs. [ABSTRACT FROM AUTHOR]

Background: As one of the world's biodiversity hotspots, Indonesia contains over 25,000 plant species, including unconventional food plants (UFPs). These plants are integral to the dietary practices of rural communities, providing essential nutrients often overlooked in modern diets. However, the use of UFP is declining, with both their dietary and cultural values being undermined. In rural West Java, this decline in UFP biodiversity coincides with public health challenges related to malnutrition. This study aims to document the diversity of UFPs used by local communities in rural West Java, assess their nutritional value, and explore their consumption practices. Methods: Data were collected using mixed methods, including interviews with 20 key informants and food frequency questionnaire administered to 107 women in three villages in the area. The nutritional compositions of documented UFPs were obtained from literature and analysis. Bivariate correlation was used to analyze the relationships between UFP consumption frequency and potential correlates. Results: The study documented 52 species of UFPs from 29 families, many of which are rich in nutritional value. About half of respondents (56%) consumed UFPs moderately (2–3 times a week). UFP consumption frequency had a strong correlation (r = 0.70) with associated knowledge (r = 0.70, p < 0.01) and a weak correlation with age (r = 0.240, p = 0.015), livestock possession (r = 0.260, p = 0.008), and family size (r = − 0.220, p = 0.02). Motivations for UFP consumption included availability as free food (33%), medicinal value (26%), nostalgic value (23%), and preferred taste (18%). Most respondents (92%) agreed that consumption has declined compared to the past, with perceived reduced availability and lack of knowledge cited as the primary reasons for the declining trend. Conclusions: UFP use is common in the study area, where local communities value these plants for their critical roles in diet, medicine, and culture. Given their significant potential to meet dietary needs, educating and raising awareness about UFPs can enhance their consumption and contribute to food and nutrition security. [ABSTRACT FROM AUTHOR]

Background: Interventions within preschool settings have gained prominence due to the need to increase physical activity (PA) in early childhood. We first developed a 10-week preschool-based behaviour change intervention, guided by the UK Medical Research Council's framework for complex interventions. We then conducted a cluster feasibility randomised controlled trial (RCT) among young children. Aim: This process evaluation was embedded within the cluster feasibility RCT and aimed to assess the acceptability of the 10-week IAAH intervention among both preschool staff and parents. Methods: The study utilised a mixed method, involving post-intervention questionnaires completed by preschool staff (n = 4) and children's parents/caregivers (n = 9) and focus groups with preschool staff (n = 3) and parents/caregivers (n = 7). Quantitative data were analysed using SPSS to calculate acceptability scores, while qualitative data underwent thematic analysis using NVivo 12. Results: The intervention was well-received, with preschool staff reporting a 94.5% acceptability rate (mean score of 10.4 out of 11) and parents/caregivers indicating an 86% acceptance rate (mean score of 5.2 out of 6). Thematic analysis of focus group discussions revealed facilitators to intervention delivery, such as user-friendly materials and alignment with preschool curricula, and identified barriers, including time constraints, spatial limitations, and policy conflicts. Parental engagement was hindered by time restrictions, although the intervention materials were praised for their clarity and visual appeal. Conclusions: The findings suggest that the IAAH programme was acceptable to both preschool staff and parents. However, the identified barriers to intervention delivery and engagement should be addressed in the planning of a future cluster RCT to evaluate the efficacy of the intervention. [ABSTRACT FROM AUTHOR]

Aim. This study aimed to (1) describe the perceived level of role transition from education to practice of new graduate nurses in Oman and (2) explore the barriers to and enablers of a successful transition. Background. The transition from a familiar academic environment to becoming a professional nurse is stressful and challenging. Exploring the transition barriers and enablers is instrumental in designing an effective experience. However, studies exploring the transition experience from academia to practice among new graduate nurses working in Oman are limited. Design. This study used a mixed method research design. Methods. Data were collected from nurses working for no longer than two years. Role transition was assessed using the Casey‐Fink Graduate Nurse Experience Survey. Barriers to and enablers of transition were explored through a focus group interview. Results. The total sample consists of 405 nurses working in 13 public hospitals. The majority (68.89%) of the participants had worked as a nurse for less than 6 months. The average score of the comfort and confidence subscale was 2.96 (SD = 0.38). Findings showed that the amount of workload and unclear role expectations were the most frequent difficulties new graduate nurses were experiencing in their transition from a student to a staff nurse. Findings from focus group interviews revealed a number of barriers and enablers that affected the transition experience of the new graduates. The barriers were fear, insufficient academic preparation, bridging the knowledge‐practice gap, and limited nurse‐physician interactions. The enablers were teamwork, organizational support, and the internship phase. Conclusion. The findings illustrate the need for healthcare organizations to design effective internship programs to ensure a successful transition experience. Providing staff with preceptorship training and enhancing nurse‐physician communication are important strategies for creating a comfortable work environment and ultimately ensuring a successful training experience for new nurses. [ABSTRACT FROM AUTHOR]

Aim: This study adopted the qualitative research method, aiming to explore the learning experience of nursing graduate professional curricula in China from the perspective of students and provided a basis for the continuous improvement of nursing graduate training. Design: A qualitative study. Methods: A purposive sampling method was employed to conduct semi‐structured in‐depth interviews with 14 nursing master's students enrolled in professional curricula from September 03, 2021, to December 8, 2022. The Colaizzi seven‐step analysis method was utilized for data analysis, summarization and extraction. Results: Four themes emerged from the study findings: (i) The study of professional curricula is the cornerstone of scientific research work, but it is relatively boring; (ii) The teaching methods and assessment methods of postgraduate education need to be diversified; (iii) The postgraduate education needs to increase the study time of specialized courses and highlight the specialty characteristics; (iv) the study of professional curricula can enhance the comprehensive ability of postgraduate students. Conclusion: The study of professional curricula for post‐graduate nursing students plays an important role in the development of post‐graduate research and can statistically significant improve their comprehensive ability, but there are some problems such as boring courses, single teaching assessment methods and insufficient time. In the future teaching reform, it is necessary to highlight the specialty characteristics of nursing scientific research, optimize curriculum education and improve students' scientific research knowledge and thinking. Patient and Public Contributions: We thank all participants for their valuable input throughout the study. [ABSTRACT FROM AUTHOR]

We investigated nurses' experiences of hospital‐acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence‐based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital‐acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self‐blame related to PI identification, and exacerbating impacts of the COVID‐19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital‐acquired PI. [ABSTRACT FROM AUTHOR]

Background: Family caregivers (FCs) encounter a variety of health problems in older people with chronic illness, necessitating a certain level of health literacy to access, understand, appraise and apply health information and services. This study aimed to develop and validate a scale for measuring health literacy among FCs of older people with chronic illness. Methods: Concept mapping was first employed to develop a conceptual model of health literacy of FCs. Scale domains were derived from the conceptual model, and item generation was performed using deductive and inductive methods. Quantitative methods, including merging scale dimensions and items, expert reviews, cognitive interviews, and item reduction analysis, were used to refine the scale. Confirmatory factor analysis was employed to validate the scale's structure. Concurrent validity, internal consistency, and test-retest reliability were also examined. Results: A 20-dimension conceptual model was developed, and 60 items were generated for the scale. Expert review (content validity index > 0.85) and cognitive interview with FCs confirmed the relevance and clarity of the majority of the generated scale items. Confirmatory factor analysis with 451 FCs of older people with chronic illness supported a 5-factor structure (symptom management, daily personal care and household tasks, care coordination, communication and relationship with the care recipient, and self-care of caregivers) with 42 finalized scale items, including four levels of health literacy skills (accessing, understanding, appraising and applying health information). Concurrent validity with the European Health Literacy Questionnaire (HLS-EU-Q47) was satisfactory (r = 0.67, p < 0.01). The Cronbach's α coefficient of the scale was 0.96, with subscales ranging from 0.84 to 0.91. The two-week test-retest reliability was 0.77 (p < 0.01). Conclusion: This study developed a conceptual model explaining the concept and factors of health literacy among FCs of older people with chronic illness that could provide the groundwork for future studies in developing relevant evidence-based interventions. A new Health Literacy Scale-Family Caregiver (HLS-FC) with satisfactory psychometric properties was developed in this study, which can be utilized to identify caregivers with insufficient health literacy and facilitate timely interventions by healthcare professionals. [ABSTRACT FROM AUTHOR]

Background Transient ischaemic attack (TIA) is characterised by its transient nature with symptoms of neurological dysfunction resolving within 24 hours. The occurrence of TIA is a major risk factor for stroke with 10-15% of TIA patients going on to have ischaemic stroke. Internationally, recommendations for the management of TIA focus on the need for early diagnosis and medical management of the acute increased risk of ischaemic stroke. However there is a limited amount of evidence that some patients suffer enduring consequences as a result of this 'transient' event. This paper focusses on patients' long term lived experience following a TIA. Methods Semi structured interviews were carried out with patients who had a TIA between two and 24 months previously. Participants were asked about their TIA, the advice and management received and any changes made as a result of the TIA. Interviews were recorded and transcribed verbatim. Thematic content analysis involved scrutinising transcripts to look for links and associations within and between accounts in a process similar to the grounded theory approach of open coding. The category of transience emerged and was explored in more detail to examine the enduring consequences of TIA. Results Thirty nine patients aged between 31 and 89 years were interviewed. Accounts detailed the long term impact of the TIA and the subsequent 'at risk' status, on the physical and psychosocial wellbeing of participants. Some participants sought to proactively manage the consequences of their TIA but found it difficult to obtain the information and support they needed, whereas others felt that no further action was needed to prevent future stroke. Conclusion Current definitions conceptualise TIA as a transient event however our study suggests that some patients experienced long term consequences as a result of their TIA. These included anxiety and uncertainty in the light of their increased stroke risk. TIA patients need access to detailed, evidence based stroke prevention information from a credible source, and support to help them understand and apply the information over time, if they are to effectively selfmanage the long term consequences of TIA and reduce their risk of future stroke. [ABSTRACT FROM AUTHOR]

A quality relationship between caregiver and care-receiver is an essential issue since it not only motivates the family to take on a caregiving role but also impacts all caregiving processes. Before this study there was no Thai instrument that measured this concept. This study aimed to develop the Thai Quality Relationship Scale for Family Caregivers of People with Cancer and test its psychometric properties. This paper focuses on the testing of the scale. The conceptual model and content domains were derived from a comprehensive literature review and semi-structured interviews. The instrument was verified for content validity by three experts and examined for clarity by 15 family caregivers. The construct validity of the revised scale was tested by exploratory factor analysis with 220 family caregivers of persons with cancer from the central part of Thailand. Results revealed that the scale was composed of four factors and accounted for 54% of variances, including feeling of love, concern about disease and treatment, sympathy for suffering, and concern with daily activities. The Cronbach's alpha coefficient of the total items was 0.87, and each factor was in an acceptable range. This instrument has good construct validity and reliability and would help measure quality relationships for family caregivers of people with cancer in Thailand. Future research is needed to confirm its adequate validity and reliability in other groups of family caregivers. Nurses can use this tool and the newly proposed conceptual structure of quality relationships to assess, design, and test nursing intervention to support family caregivers to continue providing good care for their care-receivers. [ABSTRACT FROM AUTHOR]

This paper presents findings from a qualitative case study that explored long term integration of internationally educated nurses in an Ontario healthcare facility. Using critical social theory as the philosophical underpinnings for this research, we selected the case based on the hospital's history of employing and supporting internationally educated professionals. Data sources included: documents review, twenty-eight interviews, socio-demographic survey and five focus groups involving IENs and other stakeholders. An overarching theme points to a 'two-way' notion of workplace integration whereby efforts are required on the part of the employer as well as the IENs. An in-depth analysis of the data reveals sub-processes of two-way integration: respecting diversity and difference, adopting inclusive practices and striving to achieve equity. Challenges in achieving two-way integration are discussed. Implications for nursing leaders to tap into IENs' diverse talents for the benefit of their local healthcare systems are highlighted. [ABSTRACT FROM AUTHOR]

Abstract: Caregivers make decisions about how to feed their infants and young children based on complex interactions of knowledge, beliefs, and values, as well as assessments of situational determinants, including economic and social constraints and opportunities. Because of the relationship of these factors to the adoption of new feeding behaviours, the development of nutrition interventions for this age group must be grounded in knowledge about the target population. This paper presents the results of a study that used cognitive mapping techniques to gain insight into mothers' knowledge and perceptions of foods for infants and young children and examine their significance for feeding decisions in Saint‐Louis, northern Senegal. Guided by mixed‐methods protocols from the Focused Ethnographic Study for Infant and Young Child Feeding Manual, in‐depth interviews that included qualitative discussions and cognitive mapping techniques were conducted with 46 mothers in rural and peri‐urban communities. We explored mothers' perceptions about five dimensions that affect food decision‐making—healthiness, convenience, child acceptance, appeal, and modernity—and the relationship of these dimensions to 38 local food items. Data analysis entailed a combination of qualitative thematic analysis and descriptive statistics. In both communities, “healthiness” was the most valued dimension for food decision‐making by a large margin, followed by child acceptance, appeal, modernity, and convenience. We explore how different interpretations and definitions of these dimensions, and their relationship to specific local food items, may influence the design and planning of nutrition interventions. The results support the importance of mixed‐methods formative research to illuminate the emic perspectives of caregivers. [ABSTRACT FROM AUTHOR]