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Social care Personal Assistants (PAs) are directly employed by individuals to assist with activities of daily living such as help or support with personal care, shopping, household tasks and community participation. This option is encouraged by UK public funding. In England, disabled people's support organisations initially offered assistance with such arrangements, although numbers doing this have declined. The Covid‐19 pandemic provided the opportunity to ask those remaining organisations providing support for PA employers about their activities during this time and the questions being posed to them by PA employers. This paper reports data from 15 interviews undertaken March–July 2021 with disability support organisation representatives. We identified one overarching theme 'Working to prevent and challenge marginalisation of PA employers', with three related subthemes: (1) Advocating for the voice of a forgotten group; (2) Needing to be proactive and (3) Adapting to new tasks and ways of working. Participant accounts focused on representing the needs of disabled people to the authorities and providing concise, timely and accurate information to PA employers, particularly around the use of public funds during Covid‐19. Remote working amplified the digital‐divide, resulting in these organisations working hard to ensure PA employers received important information about their support options. Befriending services and Covid‐hubs were established by some organisations to reduce isolation and risks of poor mental health amongst PA employers. Many of the challenges facing PA employers existed pre‐pandemic but were perceived to have been heightened during it, reflecting the value of and need for the work of these local support organisations. Our findings suggest areas where effective contingency planning drawn from closer collaboration between disability support organisations and central and local government might usefully be focussed. The potential for specific services or organisations to be commissioned to provide such support is discussed. [ABSTRACT FROM AUTHOR]

Individuals who experience a traumatic injury or an acute illness are often reliant on initial healthcare assessment and support from a pre‐hospital emergency medical service (EMS). These community‐based support models perform a vital role in the provision of life‐saving support, but research indicates that the availability, accessibility and resources of EMS are not equivalent in rural and urban areas, and there has been little recognition of the issues facing rural EMS provision outside of the USA, Europe and Australia. The purpose of the current study was to examine the lived experiences of Saudi Arabian EMS personnel, defined as emergency medical technicians, paramedics and local station managers. A semi‐structured interview approach was used to collect data from 20 interviewees (10 each with rural and urban personnel) in the Riyadh region of the Kingdom of Saudi Arabia. This methodology was used to identify the key issues that these staff face in their day‐to‐day work practice and ascertain factors that may lead to service delivery issues in rural and urban areas. Data analyses identified three thematic categories impacting EMS delivery; two of these, Personnel Factors and Patient Factors, are the focus of this paper. The participants noted a number of key issues, including a lack of appropriate local training and limited resources in rural areas, as well as general areas of concern regarding the wider EMS staff demographic makeup and poor public awareness about the exact role of the EMS. Three key recommendations arising from this study include specialised training and ongoing accessible education for rural EMS staff to allow for better support for patients; consideration of supplementing the current EMS with additional external specialist staff; and the development and implementation of national public education programmes focusing on the role of the EMS within the community. [ABSTRACT FROM AUTHOR]

This study explores the experiences of professionals who worked with care home residents with impaired mental capacity in England and Wales during the COVID‐19 pandemic. It explores (i) how competing risks were balanced and (ii) how the Mental Capacity Act (MCA) functioned in care homes under pandemic conditions, with particular focus on its associated Deprivations of Liberty Safeguards (DoLS) and Independent Mental Capacity Advocacy (IMCA) systems. Between March and May 2021, we held an online survey and five focus groups aimed at professionals who worked in or with care homes during the pandemic. The study explored issues pertaining to residents with impaired mental capacity, alongside several other topics on which we report elsewhere. For this paper, we filtered data to only include responses from 'capacity professionals'. The resulting sample comprised 120 (out of 266) survey participants and 18 (out of 22) focus group participants. We performed manifest content analysis on the filtered data and found that (1) participants reported a 'massive discrepancy' between the ways different care homes balanced the risk of COVID‐19 infection with the risks associated with severe restrictions. (2) Some suggested this was due to vague guidance, as well as care home type and size. Participants told us the pandemic (3) obstructed smooth operation of statutory safeguards designed to protect residents' human rights and (4) resulted in confusion about the remit of the MCA during a public health crisis. Our findings raise concerns about the impact of pandemic‐related measures upon care home residents with impaired mental capacity. We urge further exploration and analysis of (a) the variability and inconsistency of restrictions applied at care homes, (b) the strain placed on key safeguards associated with the MCA, (c) uncertainty about the remit of the MCA during a public health crisis and (d) the human rights implications hereof. [ABSTRACT FROM AUTHOR]

There is a global recognition that the homeless in different clusters are isolated social groups. They are highly susceptible to loneliness and related psycho‐physical health outcomes owing to their less supportive and fragmented social networks. The conditions are worse in the case of chronic or lifetime homelessness. Beyond this popular notion, other critical perspectives are also there. This paper attempts to analyse the differences in inter‐personal social networks between the chronic and the non‐chronic homeless groups at a railway junction in India. The data have been collected through structured and semi‐structured questionnaires from 28 homeless people (15 chronically and 13 non‐chronically homeless) of Burdwan Railway Junction – a vital railway junction of West Bengal, India. The chronically homeless group displays more supportive and compact inter‐personal networks in this study than the non‐chronic homeless group. Living in the station area for a long time, they have formed a society of their own. Barring some psychological stress and social abuse, the livelihood scenario of these people is relatively stress‐free and social networks relations are more intensive and supportive. Considering the outcomes, instead of the housing‐first approach of rehabilitation, we favour the development of community shelters with minimum basic amenities close to their present location. [ABSTRACT FROM AUTHOR]

Informal caregiving for a person living with glioma can be both rewarding and multidimensionally challenging, given the potential for debilitating symptoms, cognitive impairment or personality changes, as early as diagnosis. There is growing evidence that, due to the demands of care, experiences and feelings of loneliness and isolation among informal caregivers are widespread, and opportunities for quality or meaningful social connectedness are lacking. While considerable research has quantified the causes and effects of loneliness and isolation in informal care contexts, the lived experience of loneliness has received relatively little attention. The aim of this study was to better understand the everyday experiences of a group of home‐based informal caregivers of people living with glioma in Queensland, Australia. Drawing on in‐depth interviews with 32 informal caregivers, purposively sampled, and recruited through a tertiary hospital, in this paper, we explore how the various experiences, demands, and social and relational dynamics in/of informal care (re)produce forms of isolation and loneliness. Using the framework approach to thematic analysis, we derived four themes: (a) the 'need' to be near the care recipient, and the implications for caregiver mobility; (b) the strong sense of responsibility for care, and the virtues of 'good' caring; (c) experiences of loneliness in the company of others and (d) postponement of social connection and minimising the self. The findings, we argue, are reflective of broader social and moral norms and expectations within experiences of home‐based informal care. [ABSTRACT FROM AUTHOR]

Informal carers provide the majority of care to older Australians and play an essential role in assisting older people with complex care needs to remain living in their own homes. As such, carers are increasingly faced with systemic responsibilities, including coordinating services across multifaceted health and aged care systems and negotiating treatment and supports. The aim of this study was to explore how systemic complexity and associated work is experienced by carers of older adults and what personal capacities carers draw on in managing the systemic work. A descriptive phenomenological approach guided the research. Semistructured interviews were conducted with 16 carers of community‐dwelling older adults with complex care needs recruited through a local health service. Giorgi's phenomenological data analysis methods (1997) was utilised for the data analysis. Two main themes were derived from the analysis: Becoming part of the caring system and Mastering the caring system. The findings indicate that the majority of carers perceived the work of interacting with multiple systems and services as a burden and an onerous obligation. Furthermore, change in the health or social circumstances of the older adult amplified differences in the nature of the systemic work and concomitantly revealed differences in carers' capacities. This paper reveals that the caring system is in some sense disposed to create disparities, as carers' specific capacities were integral to mastering the systemic work. An understanding of informal care work that supports older people to live in the community can assist health care professionals and service providers to better identify carer requirements and assess carer capacity to manage the work. [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. Nurse emigration, often termed "brain drain," poses significant challenges to Ghana's healthcare sector. Aim. This study explores nurse managers' perspectives on determinants and strategies for mitigating nurse emigration in Northern Ghana. Methods. Sixteen nurse managers were interviewed using semistructured interviews between October and December 2023. Purposive sampling was used to select the participants. QDA Miner Lite version 6 was used for systematic coding and thematic data analysis, following the conventional content analysis approach. Results. Following data encoding and classification, the study identified three primary categories: determinants of brain drain, impact of brain drain on the healthcare system, and mitigating factors of brain drain. Conclusion. The study reveals that various factors, including inadequate pay, limited opportunities for career growth, and lack of access to technology, drive the brain drain among Ghanaian nurses. These lead to negative impacts on the healthcare system, such as increased workload, reduced patient satisfaction, and a shortage of skilled nurses. To tackle this issue, solutions including offering career advancement opportunities and improving salaries and working conditions among others have been highlighted to mitigate the brain drain among Ghanaian nurses. [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]

Introduction. Pain in Parkinson's disease (PD) is common but poorly understood, with most research to date taking a mechanistic approach. This mixed methods study takes a broader biopsychosocial approach to assess and describe contributors of pain and explore pain management and the relationship between pain and physical activity in people with PD (PwPD) and chronic pain. Methods. A structured survey evaluated respondents' contributors of pain using standardized, self-report assessments of the following: pain, peripheral neuropathy, central nociplastic change, emotional dysregulation or pathology, and maladaptive cognitions. Semistructured individual interviews were conducted with purposively sampled survey participants and analyzed using inductive thematic analysis. Results. Eighty-nine PwPD (mean age 67 years, 55% female) completed the survey. The most common pain contributors were maladaptive cognitions (62%), central nociplastic change (49%), and emotional dysregulation (44%). Approaches to pain management and the response to physical activity were variable within and across individuals with different pain contributors. Four themes emerged from interviews with 24 participants: (1) causative perceptions of pain are diverse; (2) sense of control influences disease acceptance and exercise self-efficacy; (3) belief in the value of therapy; and (4) pain as the unspoken PD symptom. Physical activity was used by PwPD for pain management; however, the relationship between pain and physical activity varied based on sense of control. Conclusions. Clinicians should screen for pain and assess its contributors to provide individualized, multidimensional pain management that considers the biological, psychological, and social factors of pain in PwPD. It is plausible that such an approach would promote a better sense of control for PwPD. [ABSTRACT FROM AUTHOR]

Purpose. Breast cancer is considered a huge health problem among women all over the world due to its increased mortality rate. Breast cancer deaths are decreased by 28–34% due to improvement in treatment and early detection. In order to detect breast cancer early and provide the best possible therapy, knowledge and awareness are essential. So, this study aimed to assess risk of breast cancer among nurses, the knowledge and practices of breast self-examination (BSE) and determine its barriers, and implement an educational program for them. Design. A quasiexperimental research design was used. Methods. This study was conducted at two university hospitals (main university hospital and woman's health hospital). A purposive sample of 280 nurses with age more than thirty-five years were included in the study using three tools, namely, structure interview questionnaire, breast cancer risk assessment tool, and a structured breast cancer knowledge and practice questionnaire. Nurses' knowledge and practices regarding breast cancer and BSE were first assessed and then they were provided with two educational courses covering theoretical and practical information. One month after the program ended, the nurses' knowledge and practices were assessed again. Results. About 3.2% of the participants have five years high risk of developing breast cancer according the risk assessment tool, the main barriers of do not do BSE did not find any symptoms and scared from finding any abnormality. There was a significant increase in knowledge and practice of breast self-examination posteducation compared to pre-education (73.2 and 98.2%, respectively). Also, there was a statistically significant difference between pre- and postprogram with a p value of 0.0001. Conclusion. This study concluded that 3.2% of the nurses with high risk of developing breast cancer needed a follow-up; more than half of them do not perform breast self-examination because they think that do not have any symptoms in the breast and the educational program with a significant effect on knowledge and practices of nurses. So, the researchers recommend the nurses need for an empowerment program and support by providing assistance in places of work as done free clinical examination and mammography by female specialist for privacy. [ABSTRACT FROM AUTHOR]

Background. One in 5 people in the United States live with disability; however, the public health needs of this community have been largely overlooked. Although U.S. law mandates the availability of accessible medical exam equipment, people with mobility disabilities (PWMD) frequently encounter barriers that require self-advocacy to receive basic primary care. Objective. The purpose of this study was to qualitatively explore the impact of healthcare access barriers—specifically, the experiences of the need to self-advocate and factors that inform decisions to make accommodation requests—for PWMD. Methods. Qualitative semistructured interviews were performed across two phases of data collection with each of the 6 participants. Interpretative phenomenological analysis was used to highlight the essence of participants' experiences in making decisions to request healthcare accommodation. Results. Participants included a purposive sample of self-advocates with physical disabilities (3 men and 3 women). While individual approaches to self-advocacy varied, participants identified a process of "recognizing the normalization of disability discrimination and disability stigma" which necessitates the development of "agency in self-advocacy." This process has a lasting impact on people that includes a shared embodied experience of disability, as well as a sense of empowerment based on their collective and individual identities. Conclusions. Findings have implications for supporting individual disability consumer advocacy efforts as well as the need to address the normalization of disability discrimination within healthcare systems levels. [ABSTRACT FROM AUTHOR]

Introduction. Rural nursing careers offer a multitude of benefits for individuals. Despite this, there continues to be a growing deficit in the number of nurses choosing to practice in rural areas. As the first 12–18 months of a nursing career are fundamental in shaping career location decisions, it is important to explore factors that influence early career nurses' employment decisions. Methods. A phenomenological study was undertaken to explore early career nurses' experiences during their first year of rural practice and describe how the nurses' experiences influenced their decision to remain in rural employment. Data were collected via semistructured interviews and underwent inductive thematic analysis. Results. Seven early career nurses practicing in rural locations were interviewed and described several influences on their career location decisions, particularly related to whether they would stay in or leave their rural employer. The themes derived from the nurses' stories included the effect of their vulnerability entering a new workplace, the importance of connection to person, place, and profession and the nuances of rural nursing rhythms. These had implications on their employment decisions. Conclusion. This research demonstrates the distinct form of nursing practice that occurs in rural areas which was experienced by the early career nurses as a breadth of skills, volume of presentations, and continuity of care. The nurses described the importance of establishing connections to person, place, and their profession. These connections can support nurses through a period of vulnerability entering a new workplace. [ABSTRACT FROM AUTHOR]

Purpose. This study aimed to study the challenges and ways of coping with living with chronic lymphocytic leukemia (CLL) before the initiation of treatment. Methods. Semistructured interviews were carried out with 8 people living with CLL (4 males and 4 females) who had never received any treatment. Interpretative phenomenological analysis was utilized for the analysis of the data. Results. The following three themes were developed: (1) "Still waters run deep" highlights the contrast between living with minimal symptoms while experiencing high anxiety for the future, (2) "Surviving uncertainty" portrays participants' supportive networks, communication challenges, and internal coping mechanisms to face the threatening overtones of CLL, and (3) "Turning over a new leaf" delineates participants' realization of life's finiteness and the way this acts as a nudge for psychological growth. Conclusion. Despite the limited physical discomfort, the CLL diagnosis and the watch-and-wait phase bring about psychological distress, which drives meaning-making efforts and an array of coping mechanisms, potentially leading to posttraumatic growth processes for people living with CLL. [ABSTRACT FROM AUTHOR]

Hand rehabilitation delivered to underserved South African communities is often the responsibility of novice or generalist occupational therapists. Novice therapists typically work with restricted supervision, support, and resources. Little is known about how these therapists should be supported in order to strengthen the services that they deliver. This study is aimed at understanding how novice occupational therapists in their first year of practice describe their experience of delivering hand rehabilitation in order to identify their support and development needs and propose interventions to address these needs. A qualitative instrumental case study design was used. Data were collected from novice occupational therapists (n = 9) who participated in an online community of practice. Data collection techniques included photoelicitation, facilitated reflection activities, and case discussion. Reflexive thematic analysis was employed. Trustworthiness strategies included reflexive writing, prolonged engagement, data source triangulation, member checking, and peer audit. Analysis generated three themes: (1) "submerged: I had to drown a little" captured participants' experience of being saturated by contextual features including poverty and poor basic management of hand injuries. (2) "Starting somewhere" captured participants' journey of treating patients with hand injuries. They transitioned from an initial sense of having "no idea" to developing "some idea"; their clinical reasoning was challenged when working with no diagnosis, unfamiliar presentations, or when contextual features rendered traditional approaches to therapy inappropriate. Finally, (3) "dynamics of 'surthrival'" captured elements that contributed to participants either thriving or merely surviving their hand rehabilitation experience. The proposed strategies identified in this study to address the support and development needs of novice therapists include interventions focused on systems and health services; learning opportunities to support competency and physical resources; and emotional support. Beyond application to the South African context, these strategies may be considered for supporting generalist or novice therapists delivering hand rehabilitation in other low- to middle-income countries. [ABSTRACT FROM AUTHOR]

Aim. To explore the perception of executive nurse leaders regarding the implementation of advanced practice nursing in Saudi Arabia. Design. An exploratory, descriptive, and qualitative design was used. Methods. Purposive sampling was used to recruit chief nurse officers and executive nurse directors from government, private, and military health systems in tertiary, secondary, and primary settings. Data were collected from July to November 2022 using virtual semistructured interviews, which were recorded and transcribed. Thematic analysis was conducted manually. Results. Eleven participants were included in the study. The following themes were identified: unique characteristics of advanced practice nursing, impacts of advanced practice nursing in nursing profession, challenges to utilize the advanced practice nursing roles, opportunities to foster the proper implementation of advanced practice nursing, and recommendations to move forward with fitting advanced practice nursing in Saudi health system. Participants characterized advanced practice nursing as specialized, advanced, and autonomous and reported that it increases access to care, provides efficient and cost-effective care, and expands nursing career pathways. The lack of job description, fragmentation of implementation efforts, lack of training programs, and resistance from physicians, nurses, and patients hinder its implementation. The Saudi Vision 2030, gaps in health care, the growing population, and the familiarity of the healthcare system with advanced practice nursing were viewed as opportunities. The following subthemes emerged under recommendations: establish, train, and implement. Conclusion. Executive nurse leaders perceived advanced practice nursing as a promising initiative to improve healthcare delivery and the nursing profession. Several opportunities make "now" the right time to implement it. [ABSTRACT FROM AUTHOR]

Aim. To evaluate the knowledge, attitudes, and practices of Chinese bedside nurses regarding antimicrobial stewardship, as well as to identify factors that influence nurses' engagement in antimicrobial stewardship. Background. Antimicrobial resistance is a pressing global health threat. Antimicrobial stewardship is crucial in combating this issue. Nurses play a key role in implementing antimicrobial stewardship. However, little is known about the involvement of Chinese nurses in antimicrobial stewardship. Methods. An explanatory sequential mixed-methods design was employed. A self-developed questionnaire was administered between March and August 2021 (N = 463), followed by semi-structured interviews with 17 nurses between March and July 2022. Descriptive statistics and qualitative content analysis were used to analyze the data. Results. The study found that nurses scored 75% in knowledge, 82.8% in attitude, and 84.1% in practice domains. There was a moderate correlation between nurses' knowledge, attitudes, and practices. It revealed that knowing local antimicrobial stewardship programmes information and the frequency of receiving antimicrobial stewardship training had a significant impact on nurses' knowledge scores. The willingness to participate in related training influenced nurses' attitude scores. Being a clinical teacher and the frequency of receiving related training influenced nurses' practice scores. The qualitative phase identified three themes: insufficient knowledge of nurses' engagement, diverse attitudes towards engagement, and limited scopes and absence of standards in nurses' participation. Conclusions. Our findings emphasize the importance of enhancing nurses' perception and involvement in antimicrobial stewardship. While nurses exhibit positive attitudes and practices, addressing the existing knowledge gap is crucial. To achieve this, it is necessary to clarify the role and responsibilities of nurses in antimicrobial stewardship, provide regular training and innovative methods, strengthen communication and collaboration, and foster a positive work environment. Additionally, actively promoting the development of guidelines and evaluation criteria will enable nurses to more effectively participate. Implications for Nursing Management. Regular training of nurses in antimicrobial stewardship needs to be enhanced. Nursing managers should strive to create positive, empowering, and supportive work environments, participate in policy formulation and implementation, and provide clear expectations for nurses' engagement in antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are traumatic events experienced before the age of 18 and include experiences of abuse, neglect, and household dysfunction. Exposure to ACEs early in life is a risk factor for adverse physical and mental health outcomes in adulthood, which may lead to subsequent child abuse, neglect, and household dysfunction. This study examined a rural community's barriers and facilitators to addressing ACEs in families with young children from the perspective of organizations serving children and families. The Innovation Corps (I-Corps) methodology was used to develop an ecosystem map of 64 community stakeholders, including 12 government, 13 healthcare, 27 early childhood education (ECE), and 12 community-based organizations, involved in the community's system of care for families with young children. Representatives from the stakeholder organizations identified in the ecosystem map were then recruited via purposeful and snowball sampling, and semistructured interviews were conducted with 37 participants. Transcribed notes and direct quotes were analyzed using a constant comparison analysis approach, and five themes emerged from the analysis. Barriers to addressing ACEs included limited mental health resources in ECE settings for both children and teachers, stigma, and limited access to local healthcare, while facilitators included establishing trusted relationships between organizations and families and using strengths-based approaches with families. This study characterized facilitators and barriers to addressing ACEs in families with young children residing in a rural community and provides guidance to inform future community-level ACEs interventions and policies. [ABSTRACT FROM AUTHOR]

Background. The issue of identity has been widely explored among migrant populations in western countries in the context of cultural integrations and acculturations. However, there is less evidence on identity as a determinant of health and social wellbeing. This study reports on identity as a determinant of health among the South Sudanese community who arrived as refugees through an Australian humanitarian program in the early 2000s. Methods. A qualitative study was undertaken, underpinned by a phenomenological framework that characterised the lived experiences of adult South Sudanese in Sydney, Australia. Semistructured in-depth interviews explored how 26 participants identified themselves in Australia, including changes in their experiences over time, their social and general life situation in Australia, and how they felt perceived in Australia. Data were audio-recorded using a digital voice recorder, transcribed verbatim, coded, and categorised into themes using interpretive thematic analysis. Results. Participants described a multiplicity of interconnected domains that governed the negotiating and making sense of identity, in turn mediated by other interwoven personal and structural factors that shaped experience and perception. Expressions of hope, pride, and achievement were threaded through several of the interviews, particularly in relation to their children. There were also frustrations related to employment challenges and discrimination that limited identity ownership. Conclusions. The evolving and often conflicting factors identified by participants can shape their sense of belonging, integration, and social and mental wellbeing. A deeper, more nuanced understanding of bicultural identity within a strengths-based framework is needed, with improved partnerships and services to support and strengthen South Sudanese community integration, belonging, and acculturation in Australia. [ABSTRACT FROM AUTHOR]

Background. Cognitive impairment is common in Parkinson's disease (PD) and associated with lower quality of life. Cognitive impairment in PD manifests differently to other dementia pathologies. Provision of optimal care requires knowledge about the support needs of this population. Methods. Eleven people with PD and cognitive impairment (PwP), 10 family caregivers, and 27 healthcare professionals were purposively sampled from across the United Kingdom. Semistructured interviews were conducted in 2019–2021, audio-recorded, transcribed, and analysed using reflexive thematic analysis. Results. Cognitive impairment in PD conveyed increased complexity for clinical management and healthcare interactions, the latter driven by multifactorial communication difficulties. Techniques that helped included slow, simple, and single messages, avoiding topic switching. Information and emotional support needs were often unmet, particularly for caregivers. Diagnostic pathways were inconsistent and awareness of cognitive impairment in PD was poor, both contributing to underdiagnosis. Many felt that PwP and cognitive impairment fell through service gaps, resulting from disjointed, nonspecific, and underresourced services. Personalised care was advocated through tailoring to individual needs of PwP and caregivers facilitated by flexibility, time and continuity within services, and supporting self-management. Conclusions. This study highlights unmet need for people with this complex condition. Clinicians should adapt their approach and communication techniques for this population and provide tailored information and support to both PwP and caregivers. Services need to be more streamlined and collaborative, providing more time and flexibility. There is a need for wider awareness and deeper understanding of this condition and its differences from other types of dementia. [ABSTRACT FROM AUTHOR]

Background. Community engagement is crucial for effective and sustainable sexual and reproductive health and rights (SRHRs) promotion. Community engagement in community-based health promotion initiatives is contextual and influenced by individual, community, and societal factors. In South Africa, community engagement in SRHR promotion is challenging due to numerous historical and contemporary factors including the socionormative community context and socionormative perceptions regarding SRHR matters. There is little empirical literature to guide community-based practitioners working in health promotion in understanding the contextual influences on community engagement with SRHR promotion generally or in South Africa specifically. Objective. This research aimed to explore the influences on community engagement in community-based SRHR promotion initiatives in the Eastern Cape, South Africa. Methods. An ethnographic and multiqualitative study was conducted in the Eastern Cape, South Africa, involving 78 purposively and conveniently sampled participants. Findings. Three superordinate themes influence community engagement with SRHR promotion in South Africa (i) representations of the issues; (ii) perceived relevance of SRHR issues and SRHR promotion; and (iii) the relational environment, often operating in interactive ways. The themes are presented in a conceptual framework. Conclusions. Influences on community engagement in SRHR promotion in the Eastern Cape of South Africa are highly contextual. The conceptual framework arising from the study's findings could be used in community-based health promotion and primary health care in other settings to develop the understanding of factors influencing community engagement in SRHR or other sensitive or emerging health issues, and inform relevant and appropriate design and implementation of community-based initiatives. [ABSTRACT FROM AUTHOR]

Background. Strong evidence supports the beneficial impact of exercise on cancer patients. However, the provision of exercise programs in Germany is highly heterogeneous. Therefore, the network OnkoAktiv (OA) enables patient consultations and referrals from coordinating regional OA centers (RE) into community-based exercise programs (CBEP). Objective. The aim of this study was to identify barriers and facilitators for the implementation of OA network structures from the perspective of RE and certified CBEP. Methods. This evaluation was executed in a sequential mixed methods design. We conducted 16 qualitative interviews with each leader in RE and the certified CBEP. Then, 89 certified CBEP were invited to a quantitative, cross-sectional survey. Results. We identified 11 facilitators each for RE and certified CBEP, 7 barriers for RE and 5 for certified CBEP. Barriers dealt with, for example, financing OA network structures, a lack of knowledge of exercise trainers, inadequate patient referral, and missing collaborations by healthcare professionals (HCPs). Most of the named facilitators were adequate internal organizational resources, support and reachability of OA staffs, and collaboration with HCPs. Conclusion. Our findings indicate different challenges for the implementation of OA network structures. Future implementation efforts should consider the evaluation of individual barriers and the development of specific solutions. [ABSTRACT FROM AUTHOR]

Many cities across the United States are experiencing homelessness at crisis levels, including rises in the number of unhoused emerging adults (18–25). Emerging adults experiencing homelessness may be at higher risk of experiencing negative outcomes, given that being unhoused increases risk for a variety of behaviors. To better understand the current living circumstances of emerging adults with a history of homelessness, as well as their perceptions about associations between housing stability and quality of life (QOL), we conducted 30 semistructured in-depth interviews with individuals recruited from drop-in centers for youth experiencing homelessness. At the time of recruitment, n = 19 were stably housed and n = 11 were unstably housed. Two coders analyzed these data inductively and deductively, using preidentified domains and open coding. Coding reliability was assessed. Three main themes emerged, each with subthemes: (1) housing quality (neighborhood safety, convenience, and housing unit characteristics); (2) QOL before stable housing (physical and mental wellbeing, social wellbeing, and other determinants of QOL, such as encounters with law enforcement); and (3) changes in QOL after stable housing (same subthemes as for prehousing stability QOL). Findings indicated a pattern of perceived relationships between housing stability, housing quality, built and social environments, and QOL in the context of emerging adults who experienced or continued to experience homelessness. However, results were mixed with regard to the perceived effects of housing stability on alcohol and other drug use. Taken together, results indicate several areas of challenge but also highlight opportunities to facilitate improvements in QOL among vulnerable emerging adults who experience homelessness. [ABSTRACT FROM AUTHOR]

An estimated 1.3 million stroke survivors living in the United Kingdom (UK) currently rely on family caregivers for daily support. The needs of stroke family caregivers are, however, not routinely assessed by most clinical services. Early identification of their needs and support is crucial to maintain their well-being and caregiver role. At present, stroke-specific caregiver screening tools are lacking. This mixed method, the multiphase study aimed to develop a Carers' Alert Thermometer for stroke family caregivers (CAT-S) by adapting the CAT, a short screening tool developed in the context of end-of-life care. Underpinned by principles of action research, qualitative and quantitative data were collected sequentially between February 2016 to December 2017 from purposive samples of stroke family caregivers (n = 76) and staff working within stroke services (n = 238) in the UK. Semistructured interviews were conducted to inform the contents of the CAT-S. Key items for inclusion were identified through a modified Delphi survey and consultation with an expert panel. The CAT-S was then piloted in North West England to test its usability and usefulness in practice to identify the needs of stroke family caregivers. Thematic and content analysis were used to analyse qualitative data. Quantitative data were analysed using descriptive statistics. The CAT-S comprises the key challenges that are experienced by stroke family caregivers. Two additional items not present on the original CAT were identified and included; training needs of family caregivers to provide care and support for caregivers' emotional needs. The CAT-S was found to be useful and acceptable by both staff and stroke family caregivers and resulted in action plans and support being provided. The CAT-S is a supportive tool for achieving person-centred care and prioritising stroke family caregivers requiring comprehensive assessments. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the perception of family caregivers in the care process of patients with COVID-19. This study was conducted on 19 family caregivers, who were selected using purposive sampling from 2021 to 2022. Unstructured interviews were used to collect data. The data were analyzed using the Kyngas conventional content analysis approach. The analysis of data led to three main themes, including unremitting efforts in physical care in the light of traditional medicine, accuracy, and intelligence in psychological attention and trying to maintain environmental health. According to the results, family caregivers provide high levels of self-sacrificing, continuous, and comprehensive, combined with fear and loneliness care in different dimensions with little or no support from the family, community, and health team. [ABSTRACT FROM AUTHOR]

Aims: We aim to explore the perceptions of registered nurses undergoing the advanced practice nurse preparatory programme and of advanced practice nurses towards the recruitment of men into the advanced practice nursing workforce. Background: Given the need to expand and diversify the advanced practice nursing workforce, it is important to recognize the potential implications of gender disparity. It is critical to understand why few males are recruited into the advanced practice nursing preparatory programme and to determine whether gender‐related bias is present in the professional development of nurses. Method: We use a descriptive qualitative design. Semi‐structured interviews were conducted via Zoom (April to August 2021). Results: Three themes were generated: 'The odds are eventually in the favour of men', 'The APN career‐track is unpopular among men', and 'Balancing the gender gap in the APN workforce'. All themes are supported by three subthemes. Conclusions: Although males in nursing enjoy opportunistic advantages in entering the advanced practice nursing workforce, they are not interested in the role and not staying long enough in the nursing profession to become advanced practice nurses. Implications for Nursing Management: Nurse managers should be more cognizant of the different social stereotypes faced by males and females in nursing. With such awareness, they can be more supportive and less biased in career counselling and job appraisals. [ABSTRACT FROM AUTHOR]

Information and communication technology (ICT) can empower the older people and improve their quality of life by sustaining functional independence and effective communication. Nonetheless, in developing countries like India, technology acceptance and use among the older people is limited. Therefore, there is a need to systematically understand the plausible difficulties limiting technology use and the expectations of the older people regarding ICT use. Hence, the present study is a qualitative inquiry to explore the needs, attitudes and perceived limitations of the ICT platforms among the older people. Twenty healthy volunteers across various states of India, between 60 and 75 years were recruited online via purposive sampling. A brief demographic survey was administered online using Google Forms, followed by telephonic semi‐structured interviews. Thematic Analysis using inductive and deductive coding was employed to analyse the interview transcripts. Thematic analysis yielded four overarching themes‐ (i) Usability of ICT, (ii) Anxiety and privacy concerns, (iii) Self‐perception of technology use and (iv) Need for technology literacy. The emerging themes reflected the perceptions of the older people towards ICT and identified several psycho‐social factors impacting technology acceptance among the older people. The findings suggest that several psychological factors like anxiety, motivation, interest and self‐efficacy play a role in technology acceptance among the older people. Additionally, user‐friendly interfaces and training on technology use may enhance technology acceptance among older users. [ABSTRACT FROM AUTHOR]

The objective of the study was to identify whether creating a responsive, respectful and trustworthy environment that provides free dental care for clients who are homeless using volunteer dental professionals was effective in meeting their oral health needs in Fremantle, Western Australia. Qualitative research conducted between October 2018 and August 2019 was guided by a social constructivist paradigm to gather and analyse data. Semi‐structured interviews were conducted with adults experiencing homelessness accessing a community dental clinic and health providers and other stakeholders involved in its establishment, management and service delivery. An inductive approach to analysis was used to organise themes under the categories of 'establishing the oral health clinic' (OHC) and 'responses to the implementation of the clinic' Thirty‐nine semi‐structured interviews were conducted across eight participant groups: clients, executive management, the oral health clinical reference group, volunteer dentists, employed staff, nursing students, volunteer staff and other stakeholders. Key findings across all groups included positive responses to the establishment and implementation of the OHC, the quality of care and the safe and respectful environment in which services were delivered. Challenges related to sustainability include uncertainty around ongoing funding and recruitment of dental professionals. Whilst volunteer dental services fill a gap in meeting the complex needs of this population group, mainstream services must consider and address issues of equity in this context. Findings can be used to guide this process that includes creating environments of respect and trust where adults who are homeless or at risk of homelessness feel safe, welcomed and more likely to return to the service. [ABSTRACT FROM AUTHOR]

Although Indigenous groups continue to experience extensive health disparities, little research explores the role of structural barriers in contributing to health disparities for state‐recognised tribes, who do not receive healthcare services from the Indian Health Service. In addition, much research focuses on discrete physical health outcomes, without utilising community‐based approaches to allow participants to identify healthcare priorities and needs in their own voices. In partnership with a community advisory board, a qualitative descriptive methodology was used to conduct 31 life‐course interviews with participants of a state‐recognised tribe in the Gulf South region of the United States to explore healthcare experiences. Participants identified unmet healthcare needs and healthcare infrastructure barriers. Some of the most common barriers and unmet healthcare needs included: Long Distance to Healthcare Services and Difficulty in Accessing Specialists, Need for Increased Communication, Long Hospital or Appointment Wait Times, Unmet Mental Health Needs, Need for Substance Use or Abuse Prevention Programs and Need for Health Education. These findings highlight some of the structural barriers that exacerbate existing health disparities and suggest important areas of intervention, such as including a focus on mental health needs. Increased healthcare resources and recognition of sovereignty for this state‐recognised tribe are also needed to begin to address these barriers. In addition, because of the long history of exploitation of Indigenous communities, healthcare interventions should meaningfully include Indigenous tribes in the development and implementation of any healthcare programs. [ABSTRACT FROM AUTHOR]

Anxiety during pregnancy is highly prevalent in low‐ and middle‐income countries. The relative importance of different sources and types of perceived support in the Pakistani context is unknown. We explored social support during pregnancy and the role of social isolation in Pakistani women's experiences of antenatal anxiety. We conducted semi‐structured interviews with 19 pregnant women with symptoms of anxiety and 10 female healthcare providers at a public urban hospital. We used inductive and deductive thematic coding to analyse the data. Many pregnant women reported feelings of physical and social isolation, even when living in joint families with larger social networks. Often fearing censure by their in‐laws and peers for sharing or seeking help with pregnancy‐related anxieties, women reported relying on husbands or natal family members. Normative expectations around pregnancy such as male gender preference, perceived immutability of wives' domestic responsibilities and expectations of accompanied travel by women may serve as sources of disconnectedness in the antenatal period. Providers viewed social isolation and deficits in social support during pregnancy as contributing to worse anxiety symptoms, reduced access to care and poorer health behaviours. One limitation is that the hospital setting for this study may have resulted in underreporting of abuse or neglect and limited inclusion of pregnant women who do not utilise facility‐based antenatal care. In conclusion, husbands and natal families were key in reducing social isolation in pregnancy and mitigating anxiety, while in‐laws did not always confer support. Targeted strategies should enhance existing support and strengthen in‐law family relationships in pregnancy. [ABSTRACT FROM AUTHOR]

This research aimed to explore the needs, potential roles and implementation of Bilingual Community Navigators (BCNs) in providing navigation support for patients in general practice settings in Australia. A total of 19 participants (general practitioners, practice managers, practice nurses and receptionists) from five general practices in Sydney where most of the patients spoke a language other than English were interviewed about their views on needs, potential roles and implementation of BCNs in general practice settings. Data were collected between August 2019 and July 2020. The interview transcripts were inductively analysed for themes. Themes emerged across four broad categories: patients' barriers to access health and social care services; potential roles of BCNs; recruitment, training, and employment of BCNs and considerations and anticipated barriers to BCNs' role. Many barriers both at the patient and at the service provider levels in accessing healthcare and social care services were consistent with the Levesque et al. access framework including lack of understanding of the health system, language and cultural barriers, hesitancy to approach general practice and problems navigating services. Participants believed that BCNs would be able to help overcome these barriers through health education, support in booking appointments, arranging transport, providing language and cultural support and improving communication with the health services. Conditions for effective implementation of BCNs in practice included proper training of the navigators to ensure patient confidentiality and addressing organisational/system barriers such as lack of a funding mechanism, a clear role definition of BCNs and acceptance of BCNs by patients. BCNs potential role in facilitating access to appropriate care by culturally and linguistically diverse (CALD) patients in general practice warrants further evaluation in the context of the Australian healthcare system. [ABSTRACT FROM AUTHOR]

Hospital discharge for people experiencing homelessness is a perennial challenge. The Homeless Reduction Act 2017 (HRA) places new responsibilities on hospitals, but it remains unknown whether this has affected discharge practices. This qualitative study explores stakeholders' views on the challenges around hospital discharge for people experiencing homelessness, in the context of a deprived English city. Semi‐structured interviews were conducted with 27 stakeholders. Participants were purposively recruited from local authority, third sector and the National Health Service. Interviews were transcribed and thematic analysis conducted. Analysis generated three main themes. First, a need for better planning and communication with the third sector, particularly around medication, prescriptions and information sharing. Second, the need to improve awareness and 'upskill' hospital staff to work more effectively with people experiencing homelessness, including understanding their needs, the wider support available and HRA requirements. Third, there were calls for (re)investment in a different approach to better support this population, based on outreach and flexibility. The need for improved partnership working and investment was emphasised. Whilst recognising the challenges faced by hospitals, especially within the context of funding cuts, this study highlights the need to recognise the third sector's contribution in supporting people experiencing homelessness in the community. Developing site‐specific checklists for practice before discharge (and as early as possible) may help to ensure appropriate measures are in place. Improving legal literacy in the context of what an appropriate discharge is for people experiencing homelessness may help develop staff confidence to challenge the focus on 'quick' discharges. [ABSTRACT FROM AUTHOR]

Supported living has been shown to improve functioning and social inclusion in people with severe and persistent mental health problems, reduce hospitalisation and provide secure accommodation in a population where housing needs are often unmet. Conversely, living in supported accommodation has been depicted by some as depersonalising, marginalising and an ordeal to survive. Discussions regarding housing and support often lack a thorough consideration of individual experiences, with a reliance on quantitative surveys. The question remains how to assure that supported accommodations actually are supportive of the residents' ongoing recovery process. The present study sought to shed light on the experiences of residents in an enhanced supported living service in the United Kingdom. Semi‐structured interviews were conducted with nine residents of the service between July 2020 and February 2021. Transcripts were analysed using thematic analysis and indicated three superordinate themes of experiences considered valuable to residents: (1) support from care staff which was readily available; (2), a sense of community and daily activity offered by the residence and on‐site activities; and (3) the experience of supported living as a stepping‐stone in an ongoing recovery process. Findings indicate the power of comprehensive care with supportive staff, peer‐relations, autonomy and fostering hope in empowering individuals in their ongoing recovery. [ABSTRACT FROM AUTHOR]

Many people living with dementia choose to remain in their own homes, supported by home‐care workers, who provide care that is specified in care plans. We explored how care plans of clients living with dementia, compared with ethnographic observations of home care they received. In a secondary, reflexive thematic analysis, we reviewed care plans for 17 clients living with dementia and transcripts from 100 h of observations with 16 home‐care workers delivering care to them. Our overarching theme was: Care plans as a starting point but incomplete repository. Clients' care plans provided useful background information but did not reflect a wealth of knowledge home‐care workers built through practice. Two sub‐themes described: (a) Person‐centred care planning: whether and how the care plan supported tailoring of care to clients' needs and (b) Filling in the gaps: home‐care workers often worked beyond the scope of vague, incomplete or out‐of‐date care plans. We found considerable inconsistencies between care plans and the care that was delivered. Care plans that were comprehensive about care needs, and rich in person‐specific information aided the delivery of person‐centred care. Lack of documentation was sometimes associated with observed failures in person‐centred care, as helpful information and strategies were not shared. Including information in care plans about how, as well as what care tasks, should be completed, and frequently discussing and updating care plans can create more person‐centred plans that reflect changing needs. Electronic care planning systems may support this. [ABSTRACT FROM AUTHOR]

The health behaviours related to chronic diseases experienced by South Asian immigrants are interrelated with their culture and socioeconomic conditions. South Asian immigrants experience a disproportionate burden of chronic disease compared with non‐immigrants Australian‐born general population. The primary aim of this study was to gain an in‐depth understanding of health behaviours and healthcare access in the South Asian immigrant population of Australia. Five focus group discussions (FGDs) were conducted with South Asian immigrants (n = 29; 18 females) aged 27–50 years in Brisbane, Australia. Separate FGDs were conducted for males and females in the English language. Semi‐structured guided questions related to the perception, barriers and facilitators of health behaviours. Data were analysed with Nvivo‐12 following a thematic analysis. A conceptual model is proposed to provide a summarised understanding of barriers and facilitators of health behaviours in South Asian immigrants. The major reported constraints for participating in physical activity were cultural beliefs, lack of time, work stress and high fees of fitness activities, while parks and peer modelling were mentioned as a strong motivator for walking, cycling and participating in group sports activities. The cultural and religious connections, cost of cigarettes and drink driving penalties were the most mentioned facilitators for a healthy lifestyle. The important factors related to unhealthy eating habits were the traditional cooking methods, social interactions and the high cost of fruits and vegetables. Community perceptions and language barriers were also acknowledged as the main factors for the decrease in accessing health care services. This study illustrates that cultural beliefs, high cost of healthy food and facilities and social circumstances are mainly linked with the health behaviours and healthcare access in South Asian immigrant's lifestyles. [ABSTRACT FROM AUTHOR]

This qualitative study describes the impact of the first wave of the COVID‐19 pandemic on the provision of care by Australian primary health care (PHC) nurses. Participants were purposefully recruited following completion of a national survey about PHC nurses' experiences during the pandemic. Twenty‐five semi‐structured interviews were conducted by two experienced researchers and professionally transcribed. The mean duration of interviews was 38.5 min. Thematic analysis revealed three themes about the impact of COVID‐19 on PHC nurses' provision of care. These were: workplace adjustments, changes in healthcare delivery and concerns about long‐term health impacts of COVID‐19. The sudden disruption and de‐stabilisation of care delivery was reported as significantly impacting on initial service provision, although participants reported adapting quickly and finding new ways to deliver care. The impact of the pandemic on high risk communities and mental health support needs of clients created additional challenges, although some participants reported positive outcomes such as increased confidence of some clients to provide self‐care. There were concerns about the potential long‐term health impact on communities due to reduced levels of cancer screening, disrupted management of chronic conditions and reduced opportunistic health assessments. Findings from this study demonstrated how PHC nurses played an important role in the continued provision of PHC by adapting quickly to changed circumstances, adjusting and modifying clinical activities, and by monitoring for future potential negative outcomes from the pandemic. These findings are important for the future management of pandemics and inform the long‐term planning of PHC services. [ABSTRACT FROM AUTHOR]

This article explores the understanding of community to families living in insecure housing in one Australian state during the COVID‐19 pandemic. Five female‐headed families were interviewed during the pandemic and asked to identify what community meant to them. All participants were referred by an agency caring for families experiencing homelessness or housing insecurity. Community was defined using Bourdieu's concept of social capital, allowing for both bonding and bridging relationships to be explored. Bonding relationships refer to close emotional ties with family and friends, while bridging ties establish networks that provide individuals with access to resources. Two themes emerged that shed light on how community is understood during times of crisis: The first suggests that for families experiencing housing insecurity, particularly women escaping family violence, their links with community were primarily maintained by welfare and church agencies. These organisations provided bridging social capital during the pandemic that allowed the women and their children to cope with the isolation and to maximise opportunities. The second themes point to traditional notions of community as family and geographical space. Here the findings are mixed. Resources provided by government, and mediated through the welfare agency, allowed these families to create a safe and comfortable space. However, for First Nations women, the lockdown meant that it was difficult to maintain community obligations, while children who appeared to identify community with attendance at school found the lockdown confusing because of the disruption to their normal social space. [ABSTRACT FROM AUTHOR]

Family caregivers are an important source of support for older people living with dementia, especially when faced with a new diagnosis of cancer. Little is currently known about the caregiver role in facilitating treatment discussions, and the factors that underpin breast cancer treatment decision‐making in older patients. This study used a sequential explanatory mixed method approach to explore the role of family caregivers in making cancer treatment decisions for older women (aged over 70 years) with pre‐existing dementia and primary operable breast cancer. Thirteen caregivers participated in the study (13 completed a postal questionnaire; eight questionnaire respondents participated in a semi‐structured interview). Quantitative data were analysed descriptively, and the Framework Approach was used to analyse qualitative findings and identify themes. Three themes were generated: (a) Clinical interactions, information and support; (b) Treatment decision‐making processes and (c) Influences on treatment choice. These findings highlight the complexities that caregivers face when navigating cancer treatment options and their role in facilitating treatment decisions. [ABSTRACT FROM AUTHOR]

Carers of loved ones with Borderline Personality Disorder (BPD) often present to Emergency Departments (ED) during acute crisis situations. The initial contact for the carer and consumer in distress is often an emergency nurse. By gaining a greater understanding of carers (18+) perspectives on ED nursing practices when consumers with BPD are requiring crisis support, knowledge about preferred and best practice can be gained. To obtain this knowledge, four semi‐structured focus group interviews were undertaken with a purposive sample of 13 carers through existing carer networks. Transcripts were analysed thematically to identify shared experiences and perspectives across interviews. Four key themes emerged: challenges in accessing crisis support, the need for communication, stigmatising practices, and different levels of care. Findings highlight the ED is viewed as a frontline service which has the capacity to link with another specialist supports when in crisis. Despite this; Communication, confidentiality issues and stigmatising practices continue. The results of this study have implications for nursing practice in the ED, providing important insights that can potentially benefit the carer, consumer and the ED to improve the quality of care offered for people in crisis. [ABSTRACT FROM AUTHOR]

Studies have shown a need to consider environmental factors to best support the rehabilitation and recovery process after a stroke. In addition, despite intentions to increase individuals' participation in care and rehabilitation, patients and family members report weak participation. The aim of this study was to explore how the environment was integrated into rehabilitation at home from the perspective of patients after a stroke. We conducted as a qualitative study with 17 patients rehabilitated at home. Data on the participants' experiences of the rehabilitation process and their perceptions of how the environment was considered in the process were collected via interviews and analysed using qualitative content analysis. The main category that was constructed from the data was "Partial integration of person‐ environment dynamics in the rehabilitation", which was informed by three subcategories: (a) I recover in my home: Challenges and opportunities in the environment, (b) Following a generic approach to therapy: Limited integration of the environment, and (c) Informed more than involved. Our study showed that the environment was integrated in a limited manner. The participants were more informed about than involved in their planning of the rehabilitation. The results are important for informing the ongoing development of rehabilitation at home and person‐centred care strategies. [ABSTRACT FROM AUTHOR]

The current study aimed to identify the educational and support needs of family carers of people with dementia in the early stages of dementia by employing a qualitative approach with retrospective semi‐structured interviews with family carers of people in the later stages of Alzheimer's disease (AD). Semi‐structured individual interviews were conducted via telephone or Microsoft Teams video call. Purposive sampling was used to recruit twelve family carers of people with moderate or severe AD. An interview guide was used to explore the retrospective views of the carer's educational and support needs in the early stages of AD. The interviews were audio‐recorded transcribed and analysed using thematic analysis. Three overarching themes were identified. Theme 1 highlighted that family carers experienced frequent and overwhelming need to fulfil a family obligation and feelings of guilt to seek help, which acted as barriers to seeking support, in the early stages. In theme 2, family carers rarely received support in the early stages and available resources were limited to self‐help materials. Finally, in Theme 3, family carers wanted to receive interpersonal tailored support to seek practical advice and to learn psychological skills to build resilience in the early stages to overcome emotional challenges. The development of interventions that are specifically designed for family carers in the early stages is critical. The key components to be considered for future interventions are discussed. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work is to evaluate nurses' experiences, barriers, and facilitators in participating in digital storytelling workshops Background: Nurses face ever‐increasing demands and work time spent in isolation, leading to burnout. Storytelling—narrative skills of listening and creativity—may encourage meaningful connections with others, especially during the COVID‐19 pandemic. However, evaluation of the user experiences of storytelling among nurses has been limited. Method: The methods used are semistructured individual interviews with 13 nurses from a public health nursing organization who participated in a 3‐day digital storytelling workshop in 2019. The interviews were audio‐recorded, transcribed verbatim, and thematically analysed using NVivo12. Results: All participants were women and half were white. Healing, human connection, and nursing pedagogy were the three main themes. Participants highlighted the organizational support in providing a safe and dedicated "space" for nurses' well‐being. They also expressed desire and willingness to participate in additional workshops outside of work hours. Conclusion: Further studies using a larger sample are needed to examine the scalability and efficacy of storytelling at work. Implications for Nursing Management: Nurses rated storytelling positively and suggested a brief version to be incorporated into nursing practice. Establishing the culture of organizational support and psychological safety was identified as the necessary antecedents. [ABSTRACT FROM AUTHOR]

Aim: To come up with a newly developed survey tool that will measure the students' level of quality in writing nursing care plans (NCPs). Background: Exploring various challenges of students in writing NCP would enlighten educators to design innovative strategies on how to mitigate gaps between nursing education and practice. Methods: This study utilized an exploratory sequential mixed‐methods design in three stages. In phase 1, qualitative semi‐structured interviews of 22 students were conducted, and the data were analysed using the Colaizzi method. In phase 2, qualitative results were transformed into survey components, constructs and items, and the data were developed into a new survey tool based on the nursing process system (NPS) model. In phase 3, a quantitative cross‐sectional survey of 195 nursing students was conducted to measure their level of quality in writing NCP, and the data were analysed using descriptive statistics of the SPSS software. Results: In the first (qualitative) phase, five themes emerged from various challenges of nursing students in writing care plans: (a) data gathering; (b) identifying clients' problems; (c) formulating sustainable goals; (d) providing appropriate interventions; and (5) recognizing client's outcomes. In the second phase, a valid and reliable tool called the Student Survey on Writing Nursing Care Plan (SSW‐NCP) was developed and tested. Lastly, in the third (quantitative) phase, the nursing students have shown a 'very good' level of quality in writing NCP. Conclusion: Determining students' level of quality in writing NCP would come up with comprehensive ways of improving student competencies in patient care management. Implications for Nursing Management: The survey tool that is formulated from the study will provide relevant information for nurse educators and managers in managing students' and registered nurses' capabilities in writing an excellent care plan. [ABSTRACT FROM AUTHOR]

Functional impairment in people diagnosed with depression is common, although the domain of personal hygiene and grooming has received limited attention in the scholarly literature. While issues concerning personal hygiene and grooming by those experiencing depression have been reported in personal narratives, they are rarely included in symptom lists or treatment guidelines, or as an outcome indicator in research studies. The aim of this research was to better understand how mental health practitioners assessed, understood and worked with, service users diagnosed with depression who had previously exhibited declining personal hygiene and grooming standards. In‐depth interviews (n = 16) explored the views of professionals experienced in this area of mental health practice. A qualitative descriptive methodology was utilised. Findings indicated that for some service users, personal hygiene and grooming issues were an integral aspect of their depression, which negatively impacted recovery, particularly in areas concerned with overall functioning, mood, social and vocational engagement, motivation, self‐worth and esteem, and engagement with treatment. Study results supported the benefits of a person‐centred approach to assess, engage with and intervene effectively when a decline in personal hygiene and grooming was noted. However, lack of pertinent research is a barrier to appropriately assessing specific skill or performance difficulties when declining standards are observed. This impedes the provision of interventions which might support the person to develop and maintain of personal hygiene routines, which conform to socially acceptable standards. Difficulties with personal hygiene and grooming presented both a barrier to recovery and an opportunity for timely and salient intervention. Further investigation is needed to build the research evidence needed to develop appropriate and acceptable interventions, and to inform effective treatment strategies. [ABSTRACT FROM AUTHOR]

This study aims to determine economic burden or cost of human immunodeficiency virus (HIV) and its consequences from patient perspective and to examine factors influencing the cost. This is a prevalence‐based cost‐of‐illness (COI) study. A cross‐sectional survey was carried out in Yangon, Myanmar during March and April 2018. Face‐to‐face structured interview was conducted among 264 people living with HIV (PLHIV) who were members of the selected four self‐help groups (SHGs) that provided HIV peer support. Micro‐costing approach was adopted for the cost calculation. Direct medical cost, direct non‐medical cost and indirect cost were considered. Cost of HIV per patient in the year 2017 was estimated at 228.2 international dollar (Int$). Direct medical cost was only small portion of the total cost (5.6%). Indirect cost or cost of time loss was the largest contributor among the cost components, accounted for 61.2% of the total cost. First year of the antiretroviral therapy (ART) initiation and second line drug regimen have positive effect on the costs. HIV resulted in substantial economic burden for the patients. Effective interventions aim at reducing the economic burden on patients by providing compensation on transportation cost and providing job opportunity are essential. Further researchers examining cost from provider and societal perspectives are warranted to provide complete picture of the economic burden of HIV in Myanmar. [ABSTRACT FROM AUTHOR]

Cyberbullying is a global and growing phenomenon, which affects the wellbeing of millions of adolescents around the world including Chinese adolescents. However, there is a lack of valid and reliable measures of cyberbullying behaviours in Chinese. To address this research gap, this study aims to adapt and validate a well‐known, reliable and validated instrument: the European Cyberbullying Intervention Project Questionnaire (ECIPQ) among Chinese adolescents. A 14‐item (seven for cyber aggression and seven for cyber victimisation) of the Chinese version of ECIPQ was developed based on its relevance and appropriateness to the Chinese culture. After its cultural and linguistic adaptation, the measure was norm with a sample of Chinese adolescents. A total sample of 452 adolescents was randomly split into two evenly subsamples for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The EFA results indicated that the Chinese version of ECIPQ had a good convergent validity and satisfactory discriminant validity, and a two‐factor model was identified. CFA results showed a good fit of the measurement model in assessing cyber aggression and cyber victimisation. This adapted Chinese version of ECIPQ can be used to facilitate future research on cyberbullying screening, and that research may in turn promote proactive screening and better coordination of community responses for victims as well as perpetrators. Future comparative studies may use the validated scale to assess the prevalence of cyberbullying and the results of interventions to reduce cyberbullying among Chinese adolescents. [ABSTRACT FROM AUTHOR]

Background: In response to the COVID‐19 pandemic, Tennessee's Governor issued executive orders temporarily suspending certain practice restrictions on advanced practice registered nurses (APRN), which expired after 2 months as the pandemic worsened. Purpose: This purpose of this qualitative study was to analyze APRN interview data to evaluate how prepandemic APRN practice barriers, executive orders, and the pandemic affected APRN practice in Tennessee. Methods: Fifteen Tennessee APRNs who completed the National APRN Practice and Pandemic study also completed follow‐up interviews via a HIPAA‐compliant Zoom platform. Given the unprecedented circumstances associated with the COVID‐19 pandemic, we conducted a qualitative descriptive study seeking descriptions and unique perspectives of Tennessee APRNs. Consistent with qualitative study design, we conducted an atheoretical study that featured interviews, purposeful sampling with maximum variation sampling, and content analysis. Results: The major themes were practice changes, impact of executive orders, and ongoing care barriers. The data revealed that patients, APRNs, and other health care providers were strained in new and profound ways during the pandemic. An underlying theme was Tennessee APRNs' frustration with continued regulatory and other practice barriers despite their state's health and health care disparities and under resourced health care system. Conclusion: These findings indicate the need to improve care access and health outcomes, advocate for full practice authority for APRNs, support telehealth expansion, address transportation deficiencies, and respond to the pandemic‐precipitated mental health crisis. [ABSTRACT FROM AUTHOR]

Background: Regardless of the fact that reflection has been documented in nursing literature for several years and is recognized in the nursing profession to improve learners' knowledge and mindfulness, this topic requires investigation in Gulf countries from a student perspective, as no studies have been published in the gulf regarding nursing students' perspectives on reflective practice. Methods: A total of 261 nursing students from the third and fourth academic years at one major educational institution were recruited using a quantitative cross‐sectional study design. Results: The participating nursing students reported high scores on the level of all domains of reflective practice as well as on the level of student satisfaction, where 3rd year students scored higher on the level of reflection with others (p =.03), as well as the reflection on action domains (p <.01). A significant correlation was found between reflection and satisfaction (p <.01), where reflection explained 6.87% of the changes in variance of satisfaction. Conclusion: Nursing students who took part in this study has demonstrated a positive regard towards reflective practice and indicated high correlated satisfaction with learning. [ABSTRACT FROM AUTHOR]

Around 246 million people globally suffer from depression. Physical activity (PA) can reduce the risk of depression by 30% and is recognised as an effective treatment for mild‐to‐moderate depression (MMD). However, a high proportion of patients with MMD are currently inactive and the implementation of PA as an adherent treatment for MMD is not well understood. This study contributes to a growing body of research exploring how to support people who are experiencing MMD to increase their PA levels (i.e. initiation and maintenance). It investigated which factors individuals with MMD perceived to be important for integrating PA into the treatment of depression in adults. In‐depth interviews were carried out with individuals with MMD (N = 6), and data were analysed using thematic analysis. Two main theories of social capital that of Bourdieu and Putnam informed the discussion of findings. The initiation and maintenance of PA were linked to individual factors including health (i.e. nature of depression; comorbidities); abilities and tastes; socioeconomic status (e.g. financial position) and positive encouragement. In addition, maintenance emerged as dependent upon the choice, enjoyment, and meaningfulness of PA itself, and, for those who engaged in group PA, on social capital. PA interventions need to be personalised. This goes beyond a simple exercise prescription based on functional ability, but instead takes into account the needs, desires and capabilities of the whole person. The nature of MMD, the wider physical and socio‐economic context and the social capital that is available to the individual also need to be harnessed. [ABSTRACT FROM AUTHOR]

Little is currently understood about the nature of nurses' knowledge in the context of wound management or the impact of limitations in evidence and education on clinical and educational outcomes. Aim: The purpose of this study was to gain a rich and detailed understanding of the origins and nature of knowledge in generalist and specialist nurses with a key role in the delivery of wound management. Design: A qualitative reflexive thematic analysis was carried out on data gathered. Method: Semi‐structured interviews with five wound management specialists and five wound management generalist nurses were carried out between July 2019 and May 2020. Chinn and Kramer's patterns of knowing (2015) was applied as a conceptual framework from which to explore nursing knowledge in the context of wound management. Results: Seven main themes and 16 subthemes were generated: the bigger picture; the smaller picture; it all comes together at the bedside; show me the evidence; industry: a political football; do good not harm; the power isn't ours; and I'm not that creative...but. Conclusion: The knowledge that nurses apply in wound management is multidimensional, contextual, and highly integrated; with components that are unique from nursing knowledge in the wider sense. Although the patterns of knowing in wound management are well integrated, they are not equally represented and the types of knowledge that nurses demonstrate is not consistently aligned with those that they value. Impact: Significant distinctions were not found between wound management specialist and generalists, however specific traits were identified in the knowledge development of those working in a community role and industry represents a unique influencing factor in the context of wound management knowledge formation. [ABSTRACT FROM AUTHOR]