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Purpose: Sociometric studies and adult reports have established that children with Language Disorder (LD) are at risk of peer relationship difficulties. However, we have limited knowledge of how children with LD understand friendship, whom they deem as a good or bad friend, and what role their friendship concepts play in their relationships with peers. This exploratory study aimed to conduct a qualitative investigation into the friendship concepts that children with LD hold and to explore their strategies for making friends. Methods: We conducted multiple, art‐informed interviews on the topic of friendship with 14 children with LD at the age of 6–8 years. Participating children were based in the United Kingdom and Republic of Ireland. They attended enhanced provision, specific speech and language classes and mainstream classrooms. We used framework analysis to map children's responses to Selman's (1979) developmental model of interpersonal understanding, which espouses a theory of children's social development within the context of peer relationships. Results: The understanding of friendship formation in children with LD varied from physical presence to mutual support and sharing. Children's ideas about a good/bad friend represented the lowest developmental stage. Participants from the mainstream classroom demonstrated the highest stages of interpersonal understanding. Children with LD did not mention their language abilities as a barrier to making friends. Conclusion: There are limited studies exploring friendship directly from children with LD, and this study provides insights into this gap, by utilising art‐informed interviews. Children's immature understanding of a good/bad friend points towards a potential susceptibility to false friends, which we suggest needs further empirical validation. We also found that children with LD did not pay attention to their language difficulties when making friends, which raises questions about the ways diagnoses are shared with children. WHAT THIS PAPER ADDS: What is already known on the subject: Children with Language Disorder (LD) are at risk of peer relationship difficulties. Studies to date are based on sociometrics and adult reports. Only a few studies employ participatory approaches to research with children, directly engaging children with LD when exploring their friendships What this paper adds: This paper directly asks children with LD about their understanding of friendship and strategies for making friends.Physical proximity and play are important to children.s understanding of friendship especially in recognising good and bad friends. This indicates potential reasons for children with LD being susceptible to false friendsAdditionally, children with LD do not perceive language and communication as a barrier to making friends. What are the potential or actual clinical implications of this work?: Concepts around friendship and good/bad friends should be routinely assessed and targeted (if appropriate) in interventions. The study highlights the need to continue discussing practices around sharing diagnoses with children with LD. [ABSTRACT FROM AUTHOR]

This paper explores the ways in which health care professionals, family carers, and older persons expressed attitudes and opinions on using Paro, a social robot designed to stimulate patients with dementia. Thereafter, we critically evaluate existing prejudicial views toward Paro users to provide recommendations for its future use. Using an exploratory qualitative interview method, we recruited a total of 67 participants in Switzerland. They included 23 care professionals, 17 family carers, and 27 older persons. Data obtained were analyzed thematically. Study findings present general agreement that Paro is an appealing and beneficial social robot, but it is not a tool that everyone feels comfortable with. Because it is perceived as "child play," it would be demeaning for competent adults to play with such things. Consequently, Paro is appropriate only for persons with dementia. These findings brought forth ethical concerns about deception, infantilization, and respecting older persons' dignity. The idea of who is an appropriate Paro user led to our discussions on predicting future Paro users. The meaning of using social robotics in nursing homes can be conditioned by a rigid interpretation of adulthood and playful behavior. To protect future selves when one is living with dementia from prejudices, it may be useful for older persons and their loved ones to plan their future care situations to ensure that they are treated in accordance with their delineated decisions. [ABSTRACT FROM AUTHOR]

Background: Aphasia, a common consequence of stroke, which affects both communication and social functioning, and in turn, quality of life, is on the rise due to increases in stroke prevalence and survival rate. The rehabilitation of post‐stroke aphasia primarily falls within the purview of speech‐language pathology and research supports the effectiveness of such services. However, provision of aphasia rehabilitation services in sub‐Saharan Africa is associated with challenges. Aims: This study aimed to examine rehabilitation services for individuals with post‐stroke aphasia in Ghana by exploring the roles of the stakeholder groups involved in the assessment and treatment of post‐stroke aphasia in Ghana, as well as the challenges they encounter in providing or identifying services. The stakeholder groups included educational institutions, interdisciplinary healthcare professionals, and family caregivers of individuals with post‐stroke aphasia. Methods & Procedures: A qualitative case study approach was used to collect and integrate from multiple sources data such as demographic information, interview responses and program syllabi to develop a holistic image. Fifteen respondents from the stroke and speech therapy units at Komfo Anokye and Korle‐Bu Teaching Hospitals, University of Ghana, and University of Health and Allied Sciences, Ghana were purposively sampled. Interview questions were developed and centred on aphasia education and training, knowledge of speech‐language pathology services, speech‐language pathology service delivery, access to speech‐language pathology services, challenges in both delivery and access to speech‐language pathology services and suggestions for improving speech‐language pathology services. In‐person and virtual interviews were conducted after demographic information was collected. Interviews were analysed thematically, and demographic information and program syllabi were triangulated with the interview data collected. Outcomes & Results: All stakeholder groups identified concerns with current aphasia services in Ghana. Issues raised included the insufficient number of speech‐language pathologists, lack of awareness of speech‐language pathology services for post‐stroke aphasia (among healthcare professionals and the public), absence of aphasia management information and clinical training in educational programming, lack of interest in speech‐language pathology training programs, financial challenges, spiritual and traditional beliefs and geographic barriers (i.e., speech‐language pathology services are currently available in only a few cities). Conclusions & Implications: These findings emphasised the need to improve post‐stroke aphasia rehabilitation in Ghana. The process of data collection itself educated respondents on the importance of post‐stroke aphasia rehabilitation, and by identifying barriers, strategies to improving services, such as designing standardised aphasia assessments for the Ghanaian context, can now be initiated. WHAT THIS PAPER ADDS: What is already known on the subject: To address post‐stroke aphasia, evidence‐based speech‐language pathology services are provided. However, there is a paucity of studies on post‐stroke aphasia services in Ghana, preventing an accurate report of services and practices in the country. What this study adds: This study provides an overview of the existing rehabilitation services for post‐stroke aphasia in Ghana. It highlights challenges facing the existing services and suggested strategies to improve post‐stroke aphasia services. What are the clinical implications of this work?: The study created awareness among healthcare professionals and general public (study participants) about the importance of rehabilitation services for post‐stroke aphasia. Based on the study findings, appropriate stakeholders such as policy makers, researchers, and healthcare professionals can further design assessments and interventions to improve rehabilitation, including speech‐language pathology services, for post‐stroke aphasia in Ghana. [ABSTRACT FROM AUTHOR]

Background: People with post‐stroke dysphagia often require informal care from family to facilitate safe swallowing, modify food/drink or administer tube‐feeds. Previous survey studies have found dysphagia may increase family caregiver burden. However, the experiences of family members in this population have not been fully explored. Aims: To explore family members' experiences of living with a spouse with post‐stroke dysphagia. Methods & Procedures: This exploratory qualitative study used one‐to‐one semi‐structured interviews to explore family members' experiences. They were asked open questions about previous eating routines, dysphagia onset, their role and future hopes. Interviews were audio‐recorded, transcribed and analysed thematically with an inductive approach to determine key features of family members' experiences. Outcomes & Results: Five spouses aged 70–93 years participated. Their relatives' strokes happened 3 months to 3 years before the interview. Five themes were identified: 'I do all of it'; making sense of dysphagia; emotional responses; reflecting on relationships; and redefining lifestyle. Conclusions & Implications: It is important to consider family members' perspectives as they often provide vital care to loved‐ones with dysphagia. In relation to eating and drinking, maintaining elements of previous routines seems important to families. Healthcare professionals should consider these when making recommendations for rehabilitation. Family members have differing perspectives of the comparative impact of dysphagia; patient and family priorities should be explored for healthcare professionals to provide better‐targeted support. What this paper adds: What is already known on the subject: Informal caregivers, often spouses, play a vital role in supporting the health and well‐being of older people with health conditions. The presence of post‐stroke dysphagia may present increased challenges for the informal caregiver. There are limited studies qualitatively exploring the experiences of informal caregivers in this population. What this paper adds to existing knowledge: Current health and social care provision for this population leaves informal caregivers feeling they have been left to manage dysphagia alone. Informal caregivers demonstrate a breadth of knowledge about their spouse's dysphagia, problem‐solving effective solutions. Informal caregivers have a range of interpretations of the nature and cause of dysphagia; leading to miscommunication with health professionals and complex emotional responses. What are the potential or actual clinical implications of this work?: Healthcare professionals might consider ways in which to support dysphagic patients' families later in their care pathway, through scheduling reviews or running dysphagia patient and family groups. Health and social care professionals and policymakers should learn from informal caregivers' expertise to promote better health and quality‐of‐life outcomes for the patient and caregiver. Equal, open conversations between health and social care professionals and patients/families on their understanding of dysphagia may help informal caregivers to better voice their concerns and support mutual understanding. This has implications for adherence to recommendations, psychological well‐being and patient safety. [ABSTRACT FROM AUTHOR]

Background: Artificial Intelligence (AI) literacy is a crucial part of digital literacy that all individuals should possess in today's technologically advanced world. Despite the potential benefits that AI education offers, little research has been done on how to teach AI literacy to children. Objectives: This study aimed to fill that gap by investigating how children were engaged in AI literacy activities that are supported by intelligent agents. These activities were implemented in a Hong Kong kindergarten with a class of six 5‐year‐olds (Mage = 62.83 months, SD = 2.91) over a 6‐week period. Methods: The study gathered data from multiple sources, including classroom observations, teacher interviews, and documents/artefacts. Results and Conclusions: The results showed that children could learn about AI through interaction with intelligent agents in embodied learning contexts. The findings of this study have implications for the broader field of digital technology education, particularly in the context of early childhood education. Lay Description: What is already known about this topic: Artificial Intelligence (AI) literacy is essential in today's world.Little research exists on engaging young children in learning AI literacy. What this paper adds: Technology‐enhanced embodied learning approach affords multimodality in enabling young children's learning with AI‐related agents.Project‐based learning and real‐life examples can enhance children's learning. Implications for practice and/or policy: Early exposure to AI can help children navigate the increasingly digital world.Practical approaches, such as embodied and multimodal learning, seem to be effective.Teachers can enhance children's digital learning by using pedagogical strategies like project‐based learning and real‐life examples. [ABSTRACT FROM AUTHOR]

Background: Treatment fidelity refers to the degree to which an intervention is implemented as intended. Promoting treatment fidelity is important to achieve a valid comparison in intervention research. However, it is often underreported: few studies detail the use and development of fidelity measures. This study aims to promote the treatment fidelity of a modified version of the Derbyshire Language Scheme (M‐DLS), a manualised intervention for children with language difficulties, by exploring participants' opinions on training and intervention delivery. Results inform development of a checklist and scoring system to monitor and promote treatment fidelity in a comparison trial. Method: Ten student speech and language therapists (SLTs) and two research assistants (RAs) participated in the study. All received training on the M‐DLS, and 10 were video‐recorded completing role‐plays of an M‐DLS session in small groups. Feedback was gathered after training and role‐plays in focus groups and interviews. Feedback was interpreted using the constructs of the Theoretical Domains Framework (TDF). A treatment fidelity checklist was then developed using the feedback. The first author and two RAs rated role‐play videos using the checklist to trial it to inform amendments and to promote interrater reliability. Interrater agreement was calculated using Spearman's test of correlation. Results: Participants discussed the importance of having clear materials and time to practise sessions. They suggested amendments to the materials and training to promote treatment fidelity. The checklist and scoring system accounted for participants' suggestions, with amendments detailed in a log. Spearman's correlation results suggested agreement between the raters was strong. Conclusions: Results emphasise the importance of training quality, practice and reflective opportunities and clear materials to promote treatment fidelity. The construction of the checklist and scoring system was described in detail, informing the development of future checklists. After further trialling, the checklist can be used to ensure the M‐DLS is delivered with high treatment fidelity in the comparison trial. What this paper adds: What is already known on this subject: Treatment fidelity is an essential component of intervention effectiveness and efficacy studies, ensuring the intervention is delivered as intended. It is also an essential component of evidence-based clinical practice. However, few research studies report the treatment fidelity process or publish the checklists used, depriving clinicians of useful information for implementation. What this study adds: This study describes in detail the iterative process of treatment fidelity checklist development, engaging those implementing the intervention in development. This ensured clarity and interrater reliability of the checklist. Furthermore, a novel scoring system was developed so that accuracy of implementation can be easily compared across users and across practice attempts. What are the clinical implications of this work?: The importance of treatment fidelity when implementing effective and efficacious interventions cannot be overstated. The treatment fidelity checklist developed for research can be easily adopted to support accurate implementation in clinical practice through an audit process. [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: The Danish version of Health Care Students' Attitudes towards Addressing Sexual Health (SA‐SH‐D) is a questionnaire for measuring the attitudes of health care professional students' towards addressing sexual health in their future professional practice and care. Aim: To assess content validity and reliability of the SA‐SH‐D. Method: Following COSMIN guidelines, the study consisted of a cognitive interview study and a questionnaire study. Health care students from nursing, physiotherapy and occupational therapy programmes participated; seven were interviewed following the 'Think Aloud' method and 111 responded to two paper‐based SA‐SH‐D administered with a two‐week interval. Results: The SA‐SH‐D was found to be relevant, comprehensive and comprehensible. Three suboptimal wordings were identified. Floor and ceiling effects were found for six items. Cronbach's α for the total scale was 0.84 indicating good internal consistency. After a two‐week interval, the percentage of agreement per item ranged from 88.2% to 100% when allowing for a one‐point difference. The mean agreement percentage for the overall scale was 95.2% when allowing for a one‐point difference. Conclusion: The Danish version of Health Care Students Attitudes towards Addressing Sexual Health is a valid and reliable questionnaire for measuring health care professional students' attitudes towards addressing sexual health in their future professional practice and care. [ABSTRACT FROM AUTHOR]

Background: Patient and Public involvement (PPI) has rapidly evolved into a key component in shaping the delivery of health services. However, little is known about what it is like to participate in involvement procedures that include representatives of multiple groups and in the context of developing new interventions for Child and Adolescent Mental Health Services (CAMHS). Objective: This study explored participants' experiences of PPI, following attending a 'consensus conference', during which their views were sought in relation to the development of a proposed staff‐based intervention and key questions about its design and implementation. Design: Qualitative, semi‐structured interview study. Setting and Participants: Six participants, including service users and various frontline clinical staff team members, who had experience of CAMHS were present at the consensus conference and then asked about their experiences of being involved via semi‐structured interviews. The data were analysed using Interpretative Phenomenological Analysis (IPA). Young people, carers and frontline staff have been involved in the design and implementation throughout the broader programme of work of which this study forms part, although these groups were not directly involved in the design and implementation of this paper. Results: Three key narratives were present: (a) Previous Experiences Driving Expectations, (b) 'We are all in the same boat' and (c) The Realization of Multiple Identities. The results suggest that PPI involvement is a complex process that may be driven by positive/negative expectations, but that individuals value learning about others and recognizing different perspectives while reaching shared goals in improving services. Discussion and Conclusion: This study demonstrates the complexity of experience that service users and clinical staff face when engaging in involvement activities in CAMHS. The findings demonstrate the value in engaging multiple stakeholder groups while also highlighting the importance of proper consideration of the procedures involved and facilitators of engagement. [ABSTRACT FROM AUTHOR]

Introduction: Poor medical information transfer across healthcare visits and providers poses a potential threat to patient safety. Patient‐held health records (PHRs) may be used to facilitate informational continuity, handover communication and patient self‐management. However, there are conflicting opinions on the effectiveness of PHRs, other than in maternal and child care. Moreover, the experiences of users of PHRs in low‐ and middle‐income countries are critical in policy decisions but have rarely been researched. Aim: This study aimed to explore similarities and differences in the perspectives of patients, carers and healthcare providers (HCPs) on the current PHRs for diabetes and hypertension in Kerala. Methods: A qualitative design was used comprising semistructured interviews with patients with diabetes/hypertension (n = 20), carers (n = 15) and HCPs (n = 17) in Kerala, India. Data were analysed using thematic analysis. Results: Themes generated regarding the experiences with PHRs from each user group were compared and contrasted. The themes that arose were organized under three headings: use of PHRs in everyday practice; the perceived value of PHR and where practice and value conflict. We found that in the use of PHRs in everyday practice, multiple PHRs posed challenges for patients carrying records and for HCPs locating relevant information. Most carers carried all patients' past PHRs, while patients made decisions on which PHR to take along based on the purpose of the healthcare visit. HCPs appreciated having PHRs but documented limited details in them. The perceived value of PHRs by each group for themselves was different. While HCPs placed value on PHRs for enabling better clinical decision‐making, preventing errors and patient safety, patients perceived them as transactional tools for diabetes and hypertension medications; carers highlighted their value during emergencies. Conclusion: Our findings suggest that users find a variety of values for PHRs. However, these perceived values are different for each user group, suggesting minimal functioning of PHRs for informational continuity, handover communication and self‐management. Patient and Public Involvement: Patients and carers were involved during the pilot testing of topic guides, consent and study information sheets. Patients and carers gave their feedback on the materials to ensure clarity and appropriateness within the context. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to explore the perceived benefits and challenges of online distance education and computer‐based testing (CBT) among registered nurses and midwives in a sample of government‐owned health facilities and health training institutions in Ghana. Design: Exploratory descriptive qualitative design. Methods: Individual semi‐structured interviews were conducted with 45 participants (i.e. 25 nurses and 20 midwives). The data were manually processed and analysed using Braun and Clarke's thematic analysis approach (November 2019‐February 2020). Results: Nurses and midwives prefer online distance education for three reasons: convenience, cost‐effectiveness and learning centre proximity to the workplace. The course schedule's flexibility allowed participants to work and study simultaneously. Others acknowledged online distance education as a viable option for overcoming the challenges of obtaining study leave. However, the lack of recognition of certificates by some employers, poor Internet connectivity and perceived excessive course load were noted as deterrents. Regarding the CBT, many of the participants said that it was useful. Among the advantages of CBT are: (1) a decrease in examination malpractices, (2) a decrease in examination costs and (3) a rise in students' interest in information, communication and technology (ICT). This finding emphasizes the necessity of integrating ICT into nursing and midwifery education and examinations, as well as maximizing its benefits. [ABSTRACT FROM AUTHOR]

Objective: This paper reports findings from a study that sought to better understand the experiences of parents and their children with emergent mental health challenges following the parent's participation in a nurse-led therapeutic group. Design: This was an explorative qualitative study using semi-structured interviews which were then thematically analysed. Setting: Findings from this single-site study are drawn from regional Australia. Participants: Twenty parents and seven of their children aged between 13 and 24. Interventions: Family systems based therapeutic group intervention delivered to the parents of young people attending headspace. Main outcome measure: In line with qualitative research approaches, the participants lived experience was the outcome measure. Result: Three key themes were found in the data: (a) improved parent-child relationships, (b) understanding and being understood and (c) multi-generational perspectives. Conclusion: Regional and remote regions are challenged with comparatively fewer and less diverse services for youth mental health than in urban centres. Findings from this exploratory study highlight that young people can experience therapeutic gains where their parents are the recipients of the intervention. Recommendations from these findings include pursuing further research on the therapeutic gains of parental family system-based groups. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) have been associated with negative mental and physical health consequences. Neighbourhood police officers (NPOs) are thought to be well placed to identify and support children experiencing ACEs. Within this paper, we describe a qualitative exploration of an initiative deployed by a large UK police force which aimed to aid early identification of young people with ACEs using police data and provide subsequent support given by NPOs. A thematic analysis was conducted using transcripts from three focus groups of NPOs, supplemented by questionnaires. Key themes identified in both sets of data offer reflections for policing and other public service provision seeking to target on the basis of ACEs, including: limitations in the usefulness of police data to identify childhood adversity; challenges using the ACEs framework as a means to target such 'early intervention'; and debates regarding the appropriate role of the police in supporting young people in adversity. Prior to replication of this intervention elsewhere, there are several points to consider: whether police data alone are sufficient in identifying ACEs; ensuring clarity regarding the role of the public sector agencies in such intervention; and determining an apt measure of success for the scheme. Key practitioner messages: Modelling using only police data can provide insight into the population of children who may have suffered from ACEs but may not provide significant opportunities for early interventionThere is a clear need for defining the role of UK police forces in the delivery of early interventionIt is evident that multi‐agency working/data sharing is crucial to preventing the duplication of referrals and interventions conducted with young people who have experienced ACEs 'There is a clear need for defining the role of UK police forces in the delivery of early intervention' [ABSTRACT FROM AUTHOR]

Introduction: Indigenous women experience high rates of family violence‐related head injuries. At present, lived experience accounts from Indigenous women are absent, which results in incomplete understandings and inadequate responses that have detrimental impacts on them and their families. The aim of this study was to gain insight into Indigenous women's personal and family perspectives regarding violence‐related traumatic brain injury (TBI), including impacts on life, as well as decision‐making processes about healthcare access and engagement. Methods: Purposeful sampling was used to complete semi‐structured interviews with 18 Indigenous women living in regional and remote Australia who had experienced TBI from family violence. The data from these interviews were augmented by data from interviews and focus groups with 28 community members, including family members or carers of Indigenous women living with TBI from family violence. Results: Three themes were conceptualised based on the data and research aims: interweaving of the past and the present—ways women experience brain injury; factors that inform decision‐making to access healthcare; and managing everyday changes that result from TBI from family violence. Indigenous women described living with a range of symptoms following repeated head injuries including problems with memory, cognition and concentration. A range of strategies to manage long‐term symptoms of TBI were used by Indigenous women and when they did seek healthcare, Indigenous women were required to navigate a range of barriers. Conclusions: The findings identify a range of gaps in healthcare and housing supports for Indigenous women with TBI from violence, highlighting the significant investment needed to develop responsive and appropriate pathways of care in regional and remote areas. A range of suggestions are discussed including development of a specialised workforce who can provide apppropriate follow‐up support, co‐designed concussion clinics and educational resources. TBI must also be a key aspect of policy and practice for services working with Indigenous women who have experienced violence to ensure appropriate responses are provided. Public or Patient Contribution: Indigenous women shared their views and experiences of TBI from family violence as well as decision‐making about accessing healthcare and managing TBI symptoms. As such, study participants provided public contributions to the research. [ABSTRACT FROM AUTHOR]

Policy makers in Sweden and other European Member States pay increasing attention as to how best support working carers; carers juggling providing unpaid family care for older family members while performing paid work. Exploring perceived benefits and challenges with web-based information and communication technologies as a means of supporting working carers' in their caregiving role, this paper draws on findings from a qualitative study. The study aimed to describe working carers' experiences of having access to the web-based family care support network 'A good place' ( AGP) provided by the municipality to support those caring for an older family member. Content analysis of interviews with nine working carers revealed three themes: A support hub, connections to peers, personnel and knowledge; Experiencing ICT support as relevant in changing life circumstances; and Upholding one's personal firewall. Findings indicate that the web-based family care support network AGP is an accessible, complementary means of support. Utilising support while balancing caregiving, work obligations and responsibilities was made easier with access to AGP; enabling working carers to access information, psychosocial support and learning opportunities. In particular, it provided channels for carers to share experiences with others, to be informed, and to gain insights into medical and care issues. This reinforced working carers' sense of competence, helping them meet caregiving demands and see positive aspects in their situation. Carers' low levels of digital skills and anxieties about using computer-based support were barriers to utilising web-based support and could lead to deprioritising of this support. However, to help carers overcome these barriers and to better match web-based support to working carers' preferences and situations, web-based support must be introduced in a timely manner and must more accurately meet each working carer's unique caregiving needs. [ABSTRACT FROM AUTHOR]

This paper reports on the findings from a qualitative study into the experiences of parents who were involved in the English child protection system in 2013. Seventeen in-depth interviews were conducted involving 19 parents and/or partners, and a framework approach was used to analyse the data. There were positive experiences of individual social workers and some positive experiences of the child protection system. However, the overwhelming theme of the parents' experiences was that the system was uncaring, inflexible and for some harmful to both themselves and their children. Despite being included in the child protection process, parents felt they were not afforded the same rights as a participant, as a decision-maker or as a partner in seeking to improve the situation. The threat of consequences silenced parents who felt unable to speak out or challenge the things they disagreed with or coerced others into signing agreements they did not agree to. Such experiences related to a sense that they were being treated as 'less than human'. These findings are considered within the context of recent reforms within the English child protection system. [ABSTRACT FROM AUTHOR]

Many children are exposed to intimate partner violence against their mothers. Countering assumptions that abused women 'fail to protect' their children, this paper presents the results of a Canadian qualitative study that examined the protective strategies of 18 abused mothers, most of whom are Aboriginal. Half of these women were living in a large city and half were living in remote, northern communities. Despite geographic location, abused mothers engage in acts and behaviours to not only protect their children from immediate physical violence but also to mitigate the potential emotional harms of exposure to violence and to prevent their children from continuing the violence in their own future relationships. Relying on informal supports, such as family, was especially important for mothers living in northern, remote communities, and is not surprising given the few services available. Professionals must be aware of the range of strategies and approaches that mothers use, including those that do not involve formal systems (i.e. the police or shelter). Focusing on their strengths and protective capacities will help to empower abused mothers and limit unnecessary, inappropriate, or intrusive interventions. Recognising mothers' capacities will also lead to better outcomes for children, who fare best when their mothers are appropriately supported. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages Abused mothers engage in acts and behaviours to protect their children from the harms of exposure to violence, and these may differ for mothers living in remote, isolated communities., Mothers' protective acts extend beyond calling the police or going to shelter, and include informal supports., Professionals must inquire about mothers' protective strategies and incorporate into case plans., Professionals must support abused mothers so that they can help strengthen the mother-child relationship and help children recover from violence. [ABSTRACT FROM AUTHOR]

Introduction: People should have access to healthcare services that are effective, safe and secure, patient‐centred, and coordinated and continuous. One group that has consistently reported negative experiences and feels dissatisfied with services are patients with Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS). The objective of this study was to develop a deeper understanding of the experiences of dissatisfaction among ME/CFS patients and explore the reasons for such dissatisfaction. Methods: We conducted in‐depth interviews with 48 people from 24 households (comprising patients and family members), providing insight into the experiences of 37 ME/CFS sufferers in Norway. The participants were purposively sampled and included persons of different ages, genders, time since having the condition (3–30 years), and severity. Results: Four main themes were developed: (1) 'Nonexistent services' cover patients' experience that healthcare services had nothing to offer them after receiving their ME/CFS‐diagnosis. (2) 'Nonpersonalised services' documents experiences where patients did receive services, which in theory was appropriate for relieving a specific health problem, but in practice were experienced as inappropriate because they were not adapted to the patient's need. (3) 'Slow services' address patients' experience of getting services too late (or too little) to be useful. (4) 'Wrong services' comprise patients' experiences of being offered and/or 'forced' to accept services that they felt were inappropriate for their health problems. Conclusions: Providers' lacking knowledge of the condition and lack of precise recommendations for follow up may partly explain unsatisfactory experiences. Providers' belief (or disbelief) in the condition could furthermore influence caregiving. Also, systemic issues in the healthcare sector, like high workloads and bureaucracy, can negatively affect care provision. Finally, users' unsatisfactory experiences may also be due to a lack of patient involvement in the design of such services. Further research should investigate how patients can be involved in service design, and also providers' perspectives on caregiving and the barriers they experience for providing high‐quality care. Patient or Public Contribution: The ME‐patient organisation suggested research topics to the call from which this study got funding. Patients and caregivers provided feedback during analysis and interpretation of data. [ABSTRACT FROM AUTHOR]

Aim: To understand and report on the perceptions and experiences of registered nurses in the aged care sector. Design: An exploratory qualitative study. Methods: Semi‐structured telephone interviews were utilised as the primary data collection method. Fifteen registered nurses were interviewed. All interviews were recorded, transcribed verbatim and analysed using conventional content analysis. Participants were quoted verbatim to ensure authenticity. Results: The results indicated a demand for increased administrative and staffing support in the aged care workplace. Poor morale and unethical practices contributed to negative perceptions and attitudes among nurses towards aged care. Managing and communicating with older people was reported as challenging, which impacts nursing staff recruitment and retention. Future work is needed to ensure that outstanding clinical role models and leadership support nursing staff recruitment and retention. Incorporating aged care content into the nursing curriculum and providing professional development opportunities to aged care professionals would be the foundation towards solutions, as the study primarily explored nurses' perspectives. [ABSTRACT FROM AUTHOR]

Background This paper reports part of the findings of a study which exposed sexual violence in schools for learners with mild intellectual disability in South Africa. Special attention was paid on factors contributing to such a problem. Methods Data were collected using focus groups and individual interviews with 16 learners with mild intellectual disability at two special schools in South Africa. This was followed by individual interviews with the school nurse and social worker, and an analysis of schools' books of incidents. Results Factors contributing to sexual violence at schools for learners with mild intellectual disability included: (i) peer pressure, (ii) concealment of reported incidents of sexual violence, (iii) unsupervised areas linked to schools and (iv) arranged relationships. Conclusion The following suggestions are put forth: (i) awareness programmes, (ii) sensitization of teachers about the consequences and prevention of sexual violence, (iii) boundaries within which the arranged relationship occurs, (iv) intensification of sexuality education and (v) supervision around the school premises. [ABSTRACT FROM AUTHOR]

Background Welfare for the disabled is becoming an important issue in China and care for people with intellectual disability is challenging because of the inadequacies in formal support and the social service system. Material and Method Based on ethnographic research in two villages in North China, this paper analyses the dilemmas of family care for people with intellectual disability. The essential data is the ethnographic record of three cases. Results Rural families strive to provide care through a set of arrangements and bear tremendous stress in the process. Conclusion Family care for people with intellectual disability in rural China has been increasingly challenged by the forces of labour migration, demographic changes and the ever-growing processes of commoditization. The role of the state has to be strengthened in welfare provision to balance the weakened family care ethos in transforming societies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore the experiences and perceptions of Dutch postdoctoral nurses working in research with leadership and career development. Methods and Design: A generic explorative qualitative design with semistructured in‐depth interviews was used. A criterion sample of 13 postdoctoral nurses working in research in the Netherlands was included. The data were analyzed using thematic analysis. Findings: Three themes were identified: (a) developing leadership and identity as a PhD nurse, (b) becoming a valuable member in the scientific world of academe, and (c) continuous search for progression while balancing worlds and tasks. Postdoctoral nurses experienced their leadership and professional development as a serious and conscious process. Their vision of nursing, health care, and research was an important motive regarding future career choices. Although the scientific world of academe was perceived as honorable, the nurses experienced it as a complex work environment. All the postdoctoral nurses had to deal with the demands and pressures of the scientific world. Coping with the tension between enjoying work and handling high workloads and academic achievements was described as challenging. Searching for balance was important, especially because of the different part‐time employment or working activities with various commitments. Conclusions: This study demonstrates that postdoctoral nurses do show considerable progression in their leadership and career development; however, they experience the scientific working environment as challenging. The findings of this study indicate the need for more academic positions, the strengthening of the infrastructure for nursing research, and the development of supportive leadership and mentoring programs for postdoctoral nurses to provide optimal evidence‐based and high‐quality care for patients. Clinical Relevance: Postdoctoral nurses need to develop strong leadership competencies to strengthen research, education, and evidence‐based practice in clinical care to improve patient and healthcare outcomes. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to explore and describe the barriers affecting Registered Nurses in undertaking clinical teaching in clinical settings. The exploration was based on the experiences of Registered Nurses at a selected teaching hospital in Namibia. The researcher intended to identify strategies that could be used to mitigate the negative effects of barriers to effective clinical teaching. Design: A qualitative explorative, descriptive and contextual research design was used. Methods: Purposive sampling was used to select 16 participants. Data were collected through in‐depth, semi‐structured interviews, which were audio‐recorded and transcribed verbatim. Data were analysed using thematic analysis. Results: Clinical teaching is negatively affected by several barriers that hamper clinical teaching and nursing students' learning outcomes. Seven main themes were identified: (1) participants' understanding of clinical teaching; (2) organizational barriers; (3) patient barriers; (4) Registered Nurse barriers; (5) student barriers; (6) training institution barriers; and (7) strategies to mitigate barriers to clinical teaching. Conclusion: The findings revealed that several barriers negatively affect clinical nursing education and hamper the clinical teaching and learning of nursing students. Patient or Public Contribution: This study may assist in the development of targeted interventions that address the barriers that hinder clinical teaching at teaching hospitals. Additionally, this study could assist in improving the health care that is provided by nursing students to patients. The findings may assist with improved quality by reducing nursing students' theory‐practice gap and by promoting collaboration between Registered Nurses and nurse educators in clinical settings. [ABSTRACT FROM AUTHOR]

Aim: To explore nurses' experiences of using the Integrated Palliative care Outcome Scale (IPOS) as a communication tool in specialized palliative care. Design: This study employed a qualitative inductive approach. The Standards for Reporting Qualitative Research were followed for reporting. Methods: Five focus groups were conducted with nurses from four specialized palliative care units, and the discussions were analysed with quality content analysis. Results: Using IPOS for communication with the patient gave an opportunity to understand the patient's care needs and to let these care needs guide care interventions. Prerequisites in terms of relation, atmosphere, skills and flexibility were needed to establish an interactive communication. It was challenging to communicate about issues that evoked emotional reactions in the patient. There was a balancing act between the use of a structured scale and overcoming communication challenges. Nonetheless, when the two complemented each other, IPOS was a useful tool for nurses to promote person‐centred care. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of Nigerian nurses in research and scholarly endeavours. Design: Descriptive phenomenological qualitative study design. Method: In‐depth interviews were conducted among 30 nurses until data saturation was reached. Data were analysed using the thematic analysis method, and consolidated criteria for reporting qualitative research guidelines (COREQ) were adhered to in reporting this study. Results: Three themes emerged: (1) challenges of nurses with research; (2) the state of nursing research in Lagos state; (3) strategies to improve the state of nursing research in Lagos state. Some challenges nurses in Lagos State encounter with research include heavy workload and nursing shortage due to brain drain, faulty research foundation, lack of continuing education in research and the stressful nature of conducting research in Lagos. Conclusion: As research is essential in addressing healthcare challenges, policymakers are encouraged to employ more nurses to reduce the workload and provide time for research activities. Training and continuing education in research can be incorporated into professional development programmes. Lagos State will benefit from nursing research units in the hospitals, and a coordinating centre for the units should be provided with adequate funding. Support could be obtained from the Institute of Nursing Research Nigeria in establishing these structures. Hospital management should embrace and welcome research output from nurses and ensure such results are implemented to improve patients' care. Nurses who excel in research might be recognised with awards and other incentives to inspire their peers. [ABSTRACT FROM AUTHOR]

Background: The problem of a lack of nurses is expected to worsen in the future. With an ever‐increasing number of elderly patients with multimorbidity and a shortage of healthcare professionals, primary care must innovatively organise their services to offer more sustainable healthcare services. Organising healthcare services in a community virtual ward has been found to improve the quality of life for vulnerable elderly populations. Aim: The aim of the study was to explore healthcare professionals' experiences of interprofessional collaboration in care for patients with multimorbidity in a community virtual ward in the Norwegian context. Methods: Focus group interviews were conducted in this qualitative exploratory study. A purposive sample of 17 healthcare professionals working in a community virtual ward in Norway was interviewed. Data were analysed using thematic analysis. Results: The study results show that healthcare professionals recognise a need for patient involvement in the community virtual ward to offer more sustainable healthcare services at home. Furthermore, the results show how healthcare professionals experience the use of assessment tools and whiteboard meetings as useful tools for facilitating interprofessional collaboration. The study results also describe how interprofessional and holistic follow‐up with patients with multimorbidity contributes to increased focus on health promotion in the community virtual ward. Conclusion: We found that interprofessional collaboration in community virtual wards may be a sustainable way of organising healthcare services for patients with multimorbidity living at home. Interprofessional collaboration with a patient‐centred and health promotion approach, seems to increase the quality of the follow‐up for patients with multimorbidity living at home. Additionally, mutual interprofessional trust and respect seems to be essential for making use of the unique expertise of different professions in the follow‐up for patients with multimorbidity. In the future, both the patient's voice and opinion of their next of kin should be considered in the development of more sustainable homecare services. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to gain insight into nurses' perspectives on the shift‐to‐shift handover in relation to providing Person‐centred care (PCC) in nursing homes. Background: PCC is perceived as the gold standard for nursing home care. To preserve the continuity of PCC, an adequate handover during the nurses' shift change is essential. There is, however, little empirical evidence for what constitutes best shift‐to‐shift nursing handover practices in nursing homes. Design: An exploratory qualitative descriptive study. Methods: Nine nurses were selected purposively and through snowball sampling from five Dutch nursing homes. Semi‐structured face‐to‐face and telephone interviews were conducted. Analysis relied on Braun and Clarke's thematic analysis. Results: Four main themes were identified related to enabling PCC informed handovers: (1) knowing the resident to be enable to provide PCC was key, (2) the actual handover, (3) additional ways of information transfer and (4) nurses' knowledge of the resident prior to start shift. Conclusion: The shift‐to‐shift handover is one way that nurses become informed about residents. Knowing the resident is essential to enable PCC. The fundamental underlying question is to what extent nurses have to know the resident in order to enable PCC. Once that level of detail has been established, in‐depth research is needed to determine the best method for conveying this information to all nurses. Only then can we start to rethink the role of the shift‐to‐shift handover in conveying PCC‐driven information. No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

As mixed methods research approaches become increasingly more common, it is imperative they are conducted in a thoughtful and rigorous manner to yield useful results. While researchers have begun to explore the use of various qualitative research methodologies in mixed methods research, there is a gap in literature discussing the philosophical congruence of using interpretive description in mixed method studies, and how to ensure rigor while integrating interpretive description results. Our purpose in writing this article is to discuss the issues of fit, purpose, process, context, and design when using interpretive description in mixed methods research approaches by drawing on examples from the literature. Further, we explore the contributions that interpretive description can make in a mixed methods inquiry. This article offers a first step in using a purposeful approach to mixed methods interpretive description studies to increase transparency and rigor in this relatively new methodology. [ABSTRACT FROM AUTHOR]

Background: In this time of global nursing shortages, investment in nursing is vital, and hospitals need to apply a range of strategies to attract and retain nurses. Rewards are an effective strategy for the retention of nurses and help improve the performance and productivity of hospitals. In rural and remote communities, however, nurses may not have access to the rewards that urban‐based nurses have. Aim: To explore the preferred rewards of registered nurses in rural and remote community hospitals in Thailand. Methods: An explanatory mixed‐methods design was employed for the overall study, and the results from the qualitative descriptive phase are reported here using the COREQ checklist. We collected data during in‐depth interviews with 24 informants from 8 community hospitals. Thematic analysis was used for data analysis. Findings: Four major themes regarding reward types were preferred by the nurses: reasonable pay, good benefits, accessible learning and development, and a favorable work environment. Conclusion: A package of total rewards that best suit nurses working in rural and remote areas needs to be implemented, for a combination of different types of rewards has a greater impact than a single reward at both individual and organizational levels. Implication for nursing and health policy: It is crucial to identify those rewards to attract and retain nurses. In Thailand, nursing and health workforce policies need to be based on nurse preferences regarding salary, benefits, and recognition commensurate with other healthcare professionals, including civil servant status, as well as improving the work environment. [ABSTRACT FROM AUTHOR]

Aim: The main aim of the present study is to examine the expectations and feelings of people awaiting lung transplantation. Background: The assessment of the benefits of lung transplant should consider, among other things, the subjective perceptions of patients about the procedure, especially in relation to the context and to their values, goals and expectations. This is an issue that has not been studied in depth, especially in Spain. Design: Exploratory qualitative study. Methods: Data were collected through semi‐structured interviews during the period of being on the waiting list for transplantation. Thematic analysis of the data was supported by the Atlas.ti software. Results: The study population comprised 16 patients awaiting lung transplant, a number sufficient to reach data saturation. Four categories were identified to describe patients' feelings and expectations: (1) reasons for undergoing the transplant, (2) expectations about life post‐transplant, (3) emotional state, and (4) relationship with the healthcare team. Conclusions: Patients have high expectations of lung transplantation. They see it as offering them a second chance at life, although the future creates uncertainty. The healthcare professionals are identified as key actors, providing essential support and information throughout the various stages of the process. Future research should explore recipients' experiences of lung transplant at later stages. Relevance to clinical practice: It is important to adapt care through all the lung transplant process, which is accompanied by intense and complex emotions since the beginning. Thus, providing social and psychological support from the beginning may contribute to their health status, helping them deal with all the emotions and feelings experienced, and find balance between expectations and reality. Patient or public contribution: Sixteen patients awaiting lung transplant were interviewed. Interview transcripts were returned to participants to check for accuracy with their experiences. [ABSTRACT FROM AUTHOR]

The Safewards model is used across various mental health settings to reduce incidents of conflict and containment and its efficacy in reducing the use of seclusion and restraint, improving patients' experiences of care, and enhancing safety within clinical settings is well documented (Bowers, Journal of Psychiatric & Mental Health Nursing, 21, 2014, 499). However, there are barriers to successful implementation, including level of staff buy‐in (Baumgardt et al., Frontiers in Psychiatry, 10, 2019, 340; Price et al., Mental Health Practice, 19, 2016, 14). This mixed‐method study assessed the impact of adopting a Safewards model within a clinical supervision framework in an approach, named Group Reflective integrated Practice with Safewards (GRiP‐S), which integrates Safewards theory within the clinical supervision framework. Both quantitative and qualitative data were collected using the questions derived from the Manchester Clinical Supervision Scale −26© (Winstanley & White, The Wiley International Handbook of Clinical Supervision. John Wiley & Sons Ltd, 2014). A total of 67 surveys and eight interviews were completed by nursing staff. Overall, the results showed that the GRiP‐S approach improves the implementation of Safewards and nurses' clinical practice. Nursing staff satisfaction with clinical supervision and Safewards improved post GRiP‐S pre‐GRIP‐S‐ 69.54 (SD 16.059); post‐GRIP‐S 71.47 (SD 13.978). The survey also identified nursing staff's perception of GRiP‐S in the restorative and formative domains of clinical supervision improved. The restorative mean score pre‐GRiP‐S was 28.43 (SD 5.988) and post‐GRiP‐S 29.29 (SD 3.951). The formative mean score pre‐GRiP‐S was 20.10 (SD 5.617) and post‐GRiP‐S 20.63 (SD 13.978). The qualitative results further explained the satisfaction levels and the changes seen in perception domains. The GRiP‐S approach reported (i) improved therapeutic relationships and patient centred care, (ii) improved staff communication and teamwork, (iii) barriers to GRiP‐S engagement, and (iv) assistance with the change process. The results indicate that the GRiP‐S approach had a positive impact on Safewards delivery and supports ongoing change of practice. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare professionals, particularly nurses, have negative attitudes towards individuals with opioid use disorder (OUD) and these attitudes can contribute to suboptimal care. The aim of this study was to identify stigma, barriers and facilitators experienced by members of the OUD community when interacting with the healthcare system. Design: A qualitative exploratory design used semi‐structured focus group interviews to address the study aim. Methods: Following IRB approval, purposive sampling was used to recruit participants with a history of OUD, family caregivers of individuals with OUD, and support group leaders from regional recovery groups to provide a broad perspective of stigmatizing issues and barriers to care. Focus group discussions were conducted, and video recorded using web‐based conferencing software. Transcripts from the focus groups and field notes were analyzed and coded into themes. Results: Both structural and social determinants of health were identified by participants as stigmatizing and/or barriers to care. Thematic content analysis resulted in eight themes: stigmatizing language, being labeled, inequitable care, OUD as a chronic illness, insurance barriers, stigma associated with medications for OUD (MOUD), community resources, and nursing knowledge and care. Conclusion: Members of the OUD community are challenged by both internal and external stigma when seeking healthcare. Stigma negatively affects public support for allocation of resources to treat OUD. Interventions aimed at reducing stigma are critical to support effective OUD treatment and prevent barriers to OUD care. Clinical Relevance: Understanding the complex relationships between stigma and structural determinants of health will allow nursing science to develop educational interventions that provide the next generation of nurses with the knowledge, skills, and attitudes needed to advance health equity for individuals with OUD. [ABSTRACT FROM AUTHOR]

Aim: This study aims to explore the perception of nurses on the use of mobile phone SMS for managing diabetes in rural Ghana. Design: Exploratory Descriptive Qualitative Design. Methods: Purposive sampling was used to recruit (13) participants relative to data saturation after ethical clearance (REDACTED); using a semi‐structured interview guide. All interviews were transcribed verbatim and analysed using thematic content analysis. Results: Participants believe SMS was useful in facilitating interaction between nurses, clients, family and statistically significant others; improving medication adherence and supporting blood glucose monitoring. The use of infographics was preferred to traditional SMS among digitally literate patients and voice calls for those who were illiterate. Participants had limited knowledge of downloadable diabetic applications. Participants were willing to accept and use SMS for the management of diabetes mellitus. Patient or Public Contribution: Thirteen nurses actively participated in the study. [ABSTRACT FROM AUTHOR]

Aim: To describe how Swedish emergency nurses experience the preconditions of providing safe care during the COVID‐19 pandemic when collecting blood culture in the emergency department. Design: A qualitative exploratory design using content analysis with a manifest approach. Method: Semi‐structured interviews were conducted with 13 emergency nurses working in the emergency department. Results: The analysis resulted in one main category: unprecedented preconditions create extraordinary stress and jeopardize safe care when collecting blood culture. This main category includes four additional categories: organizational changes, challenges in the isolation room, heavy workload creates great stress, and continuous learning. Conclusion: The COVID‐19 outbreak has made the emergency department a workplace where constant changes of routines combined with new information and reorganization risk jeopardize safe care during blood culture sampling. Accordingly, high workload and stress have been identified as a reason for emergency nurses not following guidelines. It is therefore necessary to optimize the preconditions during blood culture sampling and identify situations where there are shortcomings. [ABSTRACT FROM AUTHOR]

Background: Health care providers (HCPs) in the emergency department (ED) frequently must decide whether to conduct or forego confidential conversations with adolescent patients about sensitive topics, such as those related to mental health, substance use, and sexual and reproductive health. The objective of this multicenter qualitative analysis was to identify factors that influence the conduct of confidential conversations with adolescent patients in the ED. Methods: In this qualitative study, we conducted semistructured interviews of ED HCPs from five academic, pediatric EDs in distinct geographic regions. We purposively sampled HCPs across gender, professional title, and professional experience. We used the Theoretical Domains Framework (TDF) to develop an interview guide to assess individual and system‐level factors affecting HCP behavior regarding the conduct of confidential conversations with adolescents. Enrollment continued until we reached saturation. Interviews were recorded, transcribed, and coded by three investigators based on thematic analysis. We used the coded transcripts to collaboratively generate belief statements, which are first‐person statements that reflect shared perspectives. Results: We conducted 38 interviews (18 physicians, 11 registered nurses, five nurse practitioners, and four physician assistants). We generated 17 belief statements across nine TDF domains. Predominant influences on having confidential conversations included self‐efficacy in speaking with adolescents alone, wanting to address sexual health complaints, maintaining patient flow, experiencing parental resistance and limited space, and having inadequate resources to address patient concerns and personal preconceptions about patients. Perspectives divided between wanting to provide focused medical care related only to their chief complaint versus self‐identifying as a holistic medical HCP. Conclusions: The factors influencing the conduct of confidential conversations included multiple TDF domains, elucidating how numerous intersecting factors influence whether ED HCPs address sensitive adolescent health needs. These data suggest methods to enhance and facilitate confidential conversations when deemed appropriate in the care of adolescents in the ED. [ABSTRACT FROM AUTHOR]

Introduction: Antimicrobial resistance is one of the biggest threats facing global humanity. In 2014, Public Health England (now the UK Health Security Agency) launched the Antibiotic Guardian (AG) campaign as a national health promotion initiative to increase public and health professionals' commitment to reducing the threat of antibiotic resistance (ABR). The aim of this research study was to gain a snapshot of public AG attitudes towards antibiotic use, the AG campaign and illness postpledge. Methodology: This research used an exploratory study design using thematic and framework analysis of semistructured, in‐depth interviews. A purposive convenience sampling strategy was used to recruit 10 participants; adults in the general population who had registered with and chosen an AG pledge via the AG online platform during November 2020 were eligible for inclusion. Interviews were conducted via Zoom. Results: Six main themes were identified: campaign awareness, motivators to pledge (uncertainty about the future of ABR, personal gratification, personal responsibility, moral obligation and COVID‐19), perceptions of personal responsibility (and patient perspectives of moral obligation in clinicians), the impact of the campaign and campaign promotion. Pledging appeared to solidify existing perceptions AGs held. Behavioural motivations for responsible antibiotic behaviours stemmed from perceptions of personal responsibility, moral obligation and concerns about ABR. AGs attributed responsibility to variable patterns in overprescribing. Perceptions towards COVID‐19, coinciding with the previously established study period, appeared mixed. AGs were keen to promote responsible perceptions in relation to antibiotics, resistance and the AG campaign. However, poor social acceptability of ABR concern was raised as a barrier to campaign promotion. Discussion: The AGs' longstanding commitment to antimicrobial resistance demonstrates the importance of a pre‐existing interest in the public's self‐reported judicious behaviours and decision to pledge to an ABR‐focused campaign. Presenting the local and global threat to human mortality and morbidity in a more relatable format in public messaging should be considered in future strategies promoting ABR awareness and shifts in public perceptions. More frequent messaging to existing AGs is further recommended to propagate positive behaviour change among a wider audience. Patient or Public Contribution: This study was based on interviews with adult members of the public who had pledged to be AGs via the website www.AntibioticGuardian.com. Interviews were based on the public's perceptions of the AG campaign, antibiotic use and ABR. [ABSTRACT FROM AUTHOR]

Aim: Nurse leaders influence workplace culture; however, little is known about ethnic cultural influences on nurse leader development. This research aims to identify personal strategies promoting effective leadership by nurse leaders from European small island countries. Design: Descriptive qualitative study. Methods: In 2017, nineteen semi‐structured interviews with nurse leaders from England, Greece, Republic of Ireland and Malta explored leadership journeys, strategies employed to support their growth and development, and how cultural identity played a role. Transcripts were analysed using reflexive thematic analysis. Results: Four main themes and 12 subthemes captured the strategies and approaches of the nurse leaders: (1) Influences, (2) Communication, (3) Process and (4) Relationships. These findings reflect and validate the five transformational leadership practices of the Exemplary Leadership Model. While cultural island identity was discussed, there was a shared cultural identity within the role of "nurse leader" that spanned all islands. Patient or Public Contributions: Nineteen nurse leaders contributed to this study. [ABSTRACT FROM AUTHOR]

Background: Childhood cancer is proportionately higher in Africa and these result in increased demands on caregivers. The inability of affected children to take care of themselves; coupled with prescribed medical interventions presents physical and social burdens on family caregivers. Aims and methods: This study used a qualitative exploratory design to explore the physical and socioeconomic challenges for family caregivers of children diagnosed with cancer and receiving care at one of the biggest tertiary hospitals in Ghana. A total of thirteen family caregivers of children with cancer were interviewed. Findings: Two major themes were identified: Burden of care on Physical Health and Socioeconomic burdens of caregiving on the family caregiver. It was reported that family caregivers encounter physical challenges such as Aches and Pains when performing caregiving activities, Loss of Appetite, Fatigue, Compromised Functional State and Sleep Disruption. The second theme, Socioeconomic burdens of caregiving on family caregivers account for the consequences of caregiving on social lives, family relationships, finance and employment. Conclusions and recommendations: The study recommends that measures that provided relief for the caregivers such as teaching them to adopt local measures of pain relief such as massage should be encouraged. Policies should adopt measures that encourage caregivers to have some days of rest whiles providing care to their children with cancer. Also, health insurance packages that provide relief for the cost of accessing healthcare, should be extended to children with cancers to support their caregivers. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Nasogastric feeding is becoming commonly used to support patients with medically compromised eating disorders. Previous research has demonstrated the safety of this approach, however there is limited evidence as to how adult patients and staff perceive this feeding method. This study aimed to describe the acceptability of a nasogastric refeeding protocol with adult patients with medically unstable eating disorders and the staff involved in their treatment. Method: This was a qualitative exploratory study using semi‐structured interviews conducted in acute medical wards of a tertiary hospital where nasogastric nutrition is the sole source of nutrition for the first 7 days of the eating disorder admission. Data were analysed using the Framework method. Results: Eight patients (100% female, median: 22 years old, n = 6 diagnosed with anorexia nervosa) and 12 staff members (medical n = 5, nursing n = 5, dietitians n = 2; median: 8.5 years clinical experience) were interviewed. Patients reported that nasogastric feeding was tolerable, however concerns were raised regarding communication and the desire for concurrent oral feeding. Acceptability from staff was influenced by perceived competence, confidence, tensions around patient‐centred care, and working with stigma and ambivalence. Conclusions: Consideration needs to be given as to whether a 'nil by mouth' status during nasogastric feeding further impacts recommencing an oral diet to progress treatment. Improvements are required within the current service, including improved communication, additional educational resources for patients, and allowing patients to partake in decision‐making as able. [ABSTRACT FROM AUTHOR]

Background: Family‐centered care (FCC) has been successfully incorporated into daily practice in many neonatal intensive care units (NICUs) worldwide. However, the implementation of FCC in lower‐resourced settings, such as Thailand, can be challenging and needs to be further explored. Aims: To identify parents' and interdisciplinary professionals' perceptions of FCC and to describe the opportunities to improve FCC in a Thai NICU. Design: An exploratory qualitative approach was used. Methods: The data were collected through face‐to‐face, semi‐structured, individual interviews based on an interview guide. This study was conducted before the outbreak of coronavirus disease 2019 (February 2020) in a hospital in southern Thailand. Inductive thematic analysis was used to analyse interview data. Results: Participants were parents (n = 9) and interdisciplinary professionals (n = 8). The results revealed four key themes: (a) Recognizing and responding to individual families' different readiness and their rights and values, (b) working in a parent‐interdisciplinary partnership to provide care, (c) lacking resources and motivation and (d) understanding of care requirements and providing help/sympathy. Conclusions: The interdisciplinary professionals accepted that FCC is necessary for clinical practice, but there are some challenges in the Thai NICUs context because of the system of health care delivery. The findings highlighted that interdisciplinary professionals often viewed parents' involvement as an obstacle to providing neonatal care. Relevance to clinical practice: Further research is recommended to investigate how FCC is operationalized by interdisciplinary professionals and how hospital administrators can be supported to implement the FCC approach into clinical practice in Thai NICUs. [ABSTRACT FROM AUTHOR]

Aim: This study aims at exploring Saudi newly graduated nurses' perspectives on the facilitators and barriers for successful transition from being a student to being a nurse. Design: A phenomenological qualitative methodology was employed. Methods: Focus group discussions were carried out among 35 Saudi nurses at one major university hospital in Saudi Arabia. Results: Under the theme of barriers to transition three main subthemes emerged, namely "Fear of making medical errors," "Intense Workload and Expectations," "Bullying and lack of support," while under the facilitators of transition the subthemes which emerged were "Supportive preceptor," "Training workshops," "Need for transition programs." This research found that formal and informal techniques for strengthening institutional variables and improving individual factors are critical for new graduate nurses' effective transition into professional responsibilities. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore how patients with neurological disease experienced a COVID‐19 visitor ban and to identify ways of improving the quality of care. Background: In March 2020, a temporary visitor ban was introduced in Danish hospitals to reduce the spread of COVID‐19. This led to changes in clinical practice, leaving patients without their loved ones beside them. Since neurological patients are already considered vulnerable due to physical, and sometimes cognitive impairment, we urgently wished to investigate these circumstances to facilitate appropriate support. Design: This study was conducted using a qualitative explorative design. Methods: Fourteen patients with neurological disease were interviewed using a semi‐structured interview guide. Data were analysed through inductive thematic analysis. Results: For most patients, being hospitalized during the COVID‐19 visitor ban was a painful experience with the potential to negatively influence both their mental and physical health. [ABSTRACT FROM AUTHOR]

Introduction: The transition process from the intensive care unit (ICU) to hospital ward may impact the illness trajectory and compromise the continuity of safe care for ICU survivors. ICU and ward nurses are involved with the transition and are responsible for the quality of the transitional care. Aim: The aim was to explore ICU and ward nurses' views on assignments in relation to patients' transition between ICU and hospital ward. Methods: We conducted a qualitative study with 20 semi‐structured interviews with ICU nurses and ward nurses and analysed data by content analysis. Setting: A university hospital with 690 beds and an 11‐bed mixed medical/surgical ICU. Findings: The overarching themes were (1) 'Ritual of hand over' with the categories: (a) 'Ready, able and willing', (b) 'Transfer of responsibility' and (c) 'Nice to know versus need to know' and (2) 'From lifesaving care to rehabilitative care' with the categories: (a) 'Complex care needs persist', (b) 'Fight or flight mode' and (c) '"Weaning" the family'. Nurses were highly focused on the ritual of the actual handover of the patient and discussed readiness as an indicator of quality and the feeling of passing on the responsibility. Nurses had different opinions on what useful knowledge was and thus necessary to communicate during handover. Although patients' complex care needs may not have been resolved when exiting the ICU, ward nurses had to receive patients in a setting where nurses were mostly comfortable within their own specialty – this was worrying for both type of nurses. Patients could enter the ward very exhausted and weak or in 'fight mode' and demand rehabilitation at a pace the ward was not capable of delivering. ICU nurses encouraged families to be demanding after the ICU stay, and ward nurses asked them to trust them and steep back. [ABSTRACT FROM AUTHOR]

Objective: To explore participant experiences of an online co‐design process to develop a web‐based preventative mental health and well‐being intervention targeting primary producers in rural Australia. Setting: Rural Victoria, Australia. Participants: Participants from a primary producer background, including horticulture, fisheries, animal cultivation and farm consultancy, were eligible for the study if they had participated in both the co‐design and beta testing processes for a primary producer platform. Design: A qualitative study using semi‐structured phone‐based interviews was undertaken. A reflexive inductive approach to data analysis was employed to develop themes. Results: Eleven participants were interviewed, with an average age of 51 years, of which 7 were female. Five main themes were developed. These included: (1) participant diversity, (2) impact of online delivery on co‐design participation, (3) experiences of the co‐design process, (4) maintaining a shared vision and goals and (5) acting on the co‐design recommendations. Use of online methods was a clear enabler to engage participants who were geographically dispersed and offers an alternative to more conventional approaches to co‐design using face‐to‐face methods. Some aspects of participant engagement may need a greater focus when conducted online compared with face‐to‐face. Conclusions: Using an online co‐design method to develop a preventative mental health and well‐being web‐based platform for primary producers was novel. Findings address a gap in the literature around the experience of participants engaging in a co‐design process and identify opportunities to improve participant engagement and experience with the online format. [ABSTRACT FROM AUTHOR]

Introduction: Delayed discharge from inpatient mental health units is the continued hospitalisation of consumers after being assessed as ready to be discharged. This is common in adult inpatient mental health services and is usually due to a lack of appropriate housing for discharge. Research indicates a range of possible negative impacts, but no studies have explored consumers' perspectives on this issue. This study explores consumers' perspectives of the experience of housing related delayed discharge (HRDD). Method: Using a grounded theory approach, in‐depth interviews were conducted with 10 consumers. All consumers were experiencing HRDD from inpatient mental health units in one Sydney local health district. The data were analysed using constant comparative analysis. Findings: A lack of choice and control was the central theme that characterised participants' experiences. The combined experience of being delayed in hospital and being homeless led to a lack of choice and control over the basics in life, how consumers spent their time and with whom, and their futures. This lack of autonomy was shaped by the features of the hospital and participants' personal circumstance. The hospital features included rules and routines, physical and social environments, resources, and support from staff. Personal circumstances included individual situations, social networks, and support from community organisations. Participants described a variety of impacts, including reduced mental and physical well‐being, and anticipated difficulty transitioning back into the community. Conclusion: This study is the first of its kind and provides consumer perspectives on the impacts of HRDD on their well‐being and recovery. The inability to participate in meaningful and necessary occupations is an occupational injustice and implies the need for occupational therapists to advocate for both the prevention of HRDD through government investment in affordable and readily available housing and the mitigation of its effects through modified hospital environments and practices. [ABSTRACT FROM AUTHOR]

Aim: To explore and describe critical challenges in current dementia care practice as perceived by healthcare professionals (HCPs) in old age homes (OAHs) in Kathmandu, Nepal. Background: In Nepal, the number of older people with dementia is rapidly rising, and there is a need for knowledge of how to provide quality dementia care in OAHs. Methods: An exploratory hermeneutic design, employing qualitative interviews with eleven HCPs caring for residents with dementia in a total of five OAHs. Findings: The analysis showed that HCPs found limited educational training in dementia‐specific care to be a critical challenge leading to reduced quality in caregiving practice. Insufficient HCP competence in dementia‐specific care undermined adequate coping with residents' cognitive disturbances and the behavioural and psychological symptoms in dementia (BPSD). Poor HCP/medical doctor (MD)‐to‐patient ratio was perceived as a critical challenge preventing proper diagnostic examination, treatment and dementia‐specific care practice. Conclusions: Limited educational training, sparse competence in mastering residents' cognitive disturbances and BPSD, and insufficient resources to ensure sufficient numbers of HCPs and MDs for proper diagnostic examination, treatment and dementia‐specific care were identified as critical challenges restricting quality dementia care in these Nepalese OAHs. Implications for practice: The study findings indicate a need for a clear Nepalese policy and a national plan for dementia care in OAHs that includes strategies for HCP educational training and how to provide resources to ensure a sufficient workforce of HCPs and MDs for proper diagnostic examination, treatment and dementia‐specific care. [ABSTRACT FROM AUTHOR]

Background: Rapid weight gain is common with antipsychotic medication. Lost confidence, low mood and medication non‐adherence often follow. Yet, the dynamic interactions between the physical and psychological consequences of weight gain, and implications for intervention, are unknown. Objectives: We examined first‐person accounts of weight gain to identify preferences for weight change interventions. Design: A qualitative design was used to explore patients' experiences of weight change in the context of psychosis. Method: Semi‐structured interviews, analysed using grounded theory, were conducted with 10 patients with psychosis. Sample validation was conducted with peer researchers with lived experience of psychosis. Results: Patients described that initially the extent and speed of weight gain was overshadowed by psychotic experiences and their treatment. This led to a shocking realisation of weight gain. The psychological impact of weight gain, most strikingly on the self‐concept, was profound. Loss of self‐worth and changed appearance amplified a sense of vulnerability. There were further consequences on mood, activity and psychotic experiences, such as voices commenting on appearance, that were additional obstacles in the challenging process of weight loss. Sedative effects of medication also contributed. Unsuccessful weight loss left little hope and few preferences for interventions. Early information about common weight gain trajectories and working with experts‐by‐experience were valued. Rebuilding self‐confidence, efficacy and worth may be a necessary first step. Conclusions: The journey of weight gain in patients with psychosis is characterised by loss of self‐worth, agency and hope. There are multiple stages in the journey, each with different psychological reactions, that may need different treatment responses. [ABSTRACT FROM AUTHOR]

Background: Perioperative experience can be very distressing in adolescence if not managed properly by healthcare professionals. In the clinical context, the emotional expression of the adolescent is less spontaneous, which makes the assessment of anxiety, pain or even the desire to be involved in the perioperative process, difficult. Listening to their perioperative experiences will permit an understanding of their difficulties and expectations, regardless of the surgical intervention undergone. Aim: To explore the adolescents' perioperative experiences in relation to inpatient and outpatient elective surgery. Methods: Qualitative exploratory study, with thematic analysis approach. A purposive sample of 40 adolescents aged 14–18 years and in the perioperative period, from two paediatric surgery settings in a university hospital, was questioned from January to July 2020. Data were collected using a semi‐structured interview and analysed inductively with qualitative thematic analysis. Results: The data yielded one major theme, five themes, and 14 sub‐themes. The major theme, Adolescent in perioperative period, included the five themes: (1) emotional and psychological aspects; (2) physical aspects; (3) social aspects; (4) organizational aspects; (5) previous surgical experience. Adolescents expressed fear of the unknown, anxiety, difficulty in pain control, and feelings of autonomy loss. Issues related to withdrawal from school and friends is also a focus of adolescent concern during the perioperative period. Despite showing satisfaction with the way they were cared for, they complained about the lack of pre‐ and post‐operative preparation. Conclusion: There are aspects that should be considered when caring for adolescents in perioperative period. As far as possible, programmes to prevent adolescents' anxiety in perioperative period should be designed in a holistic perspective, with aim at the psychological, physical, sociocultural, and organisational aspects. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this research was to identify the needs of older persons waiting for elective open‐heart surgery. Design: A qualitative exploratory design methodology, using Focus Groups. Methods: A purposive sampling technique was used. Three interviews were conducted with experienced nurses, individuals waiting for open‐heart surgery (≥65years) and individuals having had open‐heart surgery (≥65years); enrolling up to 17 participants from October 2019 to January 2020. Qualitative data analysis was conducted using the iteractive model and MaxQDA® software, and EQUATOR COREQ guidelines were followed. Results: Three themes were identified from the analysis of all three Focus Groups: (i) Needing health information; (ii) Needing emotional support; and (iii) Needing access to care. [ABSTRACT FROM AUTHOR]