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Introduction: Using the COVID‐19 pandemic as an example of a national and international crisis, it has been possible to show how critical care nurses (CCNs) were affected by their work situation with impact on health and wellbeing. This study sought out to investigate how CCNs stress was affected and to provide some answers as to how to react and organize care in a future crisis. The specific focus was CCNs' stressors related supervision of nurses untrained in intensive care and how these were handled in a salutogenic perspective. Aim: The aim of this study was to analyze CCNs' experiences of supervision of nurses without training in intensive care during the COVID‐19 pandemic, and to analyze these experiences with the help of the salutogenic concept sense of coherence. Materials and Methods: The phenomena under study were explored during the years of 2021–2022 through in‐depth interviews and interpreted using deductive content analysis. Results: By analyzing CCNs experiences of supervising nurses without training in intensive care with the lens of sense of coherence, it was possible to show in what way these concepts influenced how to cope with the demanding situation. Sense of coherence was influenced by the inevitable prioritization of patient care and nursing interventions. This prioritization caused moral distress, but was also enhanced or decreased by CCNs sense of coherence. Conclusion: When recruiting and introducing new personnel in a future crisis to any field of healthcare, but particularly to the intensive care, we would, on the basis of these findings, suggest that well‐established plans are vital for how to move personnel throughout the organization, and for how to introduce the field of intensive care. Plans for how to model care with the help of RNs without specialist training should be put in place. A communication plan for the organization is also of importance to enhance transparency. [ABSTRACT FROM AUTHOR]

Aim: To develop and psychometrically test the triage decision‐making instrument, a tool to measure Emergency Department Registered Nurses decision‐making. Design: Five phases: (1) defining the concept, (2) item generation, (3) face validity, (4) content validity and (5) pilot testing. Methods: Concept definition informed by a grounded theory study from which four domains emerged. Items relevant to the four domains were generated and revised. Face validity was established using three focus groups. The target population upon which the reliability and validity of the triage decision‐making instrument was explored were triage registered nurses in emergency departments. Three expert judges assessed 89 items for content and domain designation using a 4‐point scale. Psychometric properties were assessed by exploratory factor analysis, following which the names of the four domains were modified. Results: The triage decision‐making instrument is a 22‐item tool with four factors: clinical judgement, managing acuity, professional collaboration and creating space. Focus group data indicated support for the domains. Expert review resulted in 46 items with 100% agreement and 13 with 66% agreement. Fifty‐nine items were distributed to a convenience sample of 204 triage nurses from six hospitals in 2019. The Kaiser–Meyer–Olkin measures indicated that the data were sufficient for exploratory factor analysis. Bartlett's test indicated patterned relationships among the items (X2 (231) = 1156.69). An eigenvalue of >1.0 was used and four factors explained 48.64% of the variance. All factor loadings were ≥0.40. Internal consistency was demonstrated by Cronbach's alphas of.596 factor 1,.690 factor 2,.749 factor 3 and.822 for factor 4. Conclusion: The triage decision‐making instrument meets the criteria for face validity, content validity and internal consistency. It is suitable for further testing and refinement. Impact: The instrument is a first step in quantifying triage decision‐making in real‐world clinical environments. The triage decision‐making instrument can be used for targeted triage interventions aimed at improving throughput and staff education. Statistical Support: Dr. Tak Fung who is a member of the research team is a statistician. Statistical Methods: Development, validation and assessment of instruments/scales. Descriptive statistics. Reporting Method: STROBE cross‐sectional checklist. Implications for the Profession and/or Patient Care: The TDI makes the complexity of triage decision‐making visible. Identifying the influence of decision‐making factors in addition to acuity that affect triage decisions will enable nurse managers and educators to develop targeted interventions and staff development initiatives. By extension, this will enhance patient care and safety. [ABSTRACT FROM AUTHOR]

Emergency department (ED) HIV screening is a key component of the strategy to end the HIV epidemic, reaching populations with limited access to care for screening and early diagnosis. Many screening programs rely primarily on participation from ED nurses; however, little is known about the factors affecting nurse participation in screening. Guided by the Consolidated Framework for Implementation Research, 20 semi-structured interviews were conducted with ED nurses to explore perceptions of HIV screening, barriers and facilitators to participation, and implementation insights. Nurses were categorized as either high adopters or low adopters based on the number of HIV tests ordered 3 months prior to interviews. The Stanford Lightning Report Method, a rapid qualitative analysis approach, was used to analyze field notes. All participants generally agreed that the ED was an appropriate location for screening and that frequent, multimodal education about screening was needed. Integration of screening into standard workflows, education about the public health impact of screening, and the use of peer champions and mentors were identified as important strategies to increase participation. By incorporating these findings into implementation strategies, EDs may be able to increase nurse participation in screening, addressing important health equity issues in HIV diagnosis. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization Astana Declaration of 2018 sees primary healthcare as key to universal health coverage and gives further support to the goal of building sustainable models of community palliative care. Yet evaluating the benefits of such models continues to pose methodological and conceptual challenges. Objective: To explore evaluation issues associated with a community-based palliative care approach in Kerala, India. Design: An illuminative case study using a rapid evaluation methodology. Methodology: Qualitative interviews, documentary analysis and observations of home care and community organising. Results: We appraise a community palliative care programme in Kerala, India, using three linked 'canvases' of enquiry: (1) 'complex' multi-factorial community-based interventions and implications for evaluation; (2) 'axiological' orientations that foreground values in any evaluation process and (3) the status of evaluative evidence in postcolonial contexts. Three values underpinning the care process were significant: heterogeneity, voice and decentralisation. We identify 'objects of interest' related to first-, second- and third-order outcomes: (1) individuals and organisations; (2) unintended targets outside the core domain and (3) indirect, distal effects within and outside the domain. Conclusion: We show how evaluation of palliative care in complex community circumstances can be successfully accomplished when attending to the significance of community care values. Plain language summary: Where are the values in evaluating palliative care? Learning from community-based palliative care provision The evaluation of any intervention or service will inevitably involve a series of decisions on what we measure, what criteria we use to judge whether the intervention has been successful (or not), what type of data we actually collect and what methods we use to do this. When evaluating a range of palliative care interventions, we suggest that these decisions have often been taken in a concealed way and tend to favour relatively narrow quantitative measures linked to end outcomes. Our paper reports on the evaluation of a community-based palliative care intervention on Kerala, India. In it, we suggest that such complex work requires a broader approach to evaluation that: makes the values being used to assess success explicit; draws on a range of data types; is interested in delivery processes; and places the voices of participants at the heart of the assessment. The paper concludes with some broader observations on how these principles might be applied more widely within palliative care. [ABSTRACT FROM AUTHOR]

Background: Fall risk and incidence increase with age, creating significant physical and mental burden for the individual and their care provider. Lift assistive devices are used in multiple healthcare facilities, but are generally not portable nor self-operational, limiting their use outside of medical supervision. The RaymexTM lift is a novel lift assistance device within a rollator to address these limitations. We aim to gather user-centered feedback on the RaymexTM lift, set up instructions, safety protocols to improve feasibility and usability, and explore the potential usability as a fall recovery or prevention device. Methods: Four older adults, two informal caregivers and 16 formal caregivers (clinicians and continuing care assistants) participated in a focus group. Participants provided feedback on the RaymexTM lift after viewing a demonstration and using the device. Qualitative and quantitative data were analysized using thematic and descriptive analysis respectively. Results: Participants highlighted three major themes: (1) Design features requiring improvement, (2) Positive feedback and suggestions to optimize the RaymexTM lift and (3) Pricing vs. social utility. Participants suggested widening the seat, changing the braking button layout, and lowering the device weight to improve usability. Participants believed the main device feature was fall recovery and had implications for social utility by reducing the need for ambulance visits to the home. Price point led to a concern on affordability for older adults. Conclusion: The feedback gained will advance the development of the RaymexTM lift and may highlight cost-effective design choices for other developers creating related aging assistive technologies. [ABSTRACT FROM AUTHOR]

The transitional care model for people who have suffered brain injuries is a relatively recent addition to the Thai healthcare system. The aim of this study was to explore experience of Thai Isan older stroke survivors and their family caregivers across different points of transition from hospital to home. Fifteen dyads of older stroke survivors and their family caregivers were recruited following the inclusion and exclusion criteria. Data were collected through participant observations and semi-structured interviews. Forty-seven participation observation field notes and twenty-four interview transcriptions were analyzed using the Four Phases of the Data Analysis Enabler and the Leininger–Templin–Thompson Ethnoscript Coding Enabler. Three themes emerged: I feel lost with managing care at home; it has been challenging for our family to maintain continuity of care; and it is a matter of who fits in and is convenient for family care responsibilities. The findings of this study have highlighted the dispersion of care among Thai-Isan people during the patient's transition to home. Therefore, a transitional care plan should be developed that specifies who is responsible for monitoring and supporting patients and families throughout this period. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore parents' experiences of their relationships and interactions with healthcare professionals (HCPs) during care related to prenatal diagnosis and termination of pregnancy for foetal anomaly (TOPFA). Methods: A qualitative approach was used. Participants included 33 parents (23 women and 10 men) from Northern Ireland (n = 11) and Ireland (n = 22) who had a TOPFA. Data collection methods included semi‐structured interviews and written narrative accounts. Data were analysed using thematic analysis. Results: Findings confirmed that TOPFA was a traumatic, life‐altering experience for parents, impacting their health and well‐being. The actions, behaviours and words of HCPs impacted how parents perceived and interpreted their healthcare experiences and their access to services and supports. In relation to this, five themes are presented: (1) the importance of compassionate and non‐judgemental care, (2) the value of effective information and communication, (3) the desire for compassionate care for baby and facilitation of memory making, (4) the need for continuity of care and (5) parents' experiences of healthcare relationships during times of legislative change. Conclusion: This research reveals the important role HCPs play in helping parents cope with prenatal testing and TOPFA. Parents who had a positive relationship with an HCP, in which information was communicated effectively and compassionate and non‐judgmental care was provided, felt more supported and more able to accept and adapt to their loss. Patient and Public Contribution: An advisory group composed of parents who had experienced TOPFA and HCPs with experience in caring for such families were involved in the study from the outset, contributing to the design and development of data collection materials, interpretation of the findings and design of dissemination materials. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis is an irreversible autoimmune disease with significant physical, psychological, and social impacts. Understanding the lived experiences of pregnant women with multiple sclerosis is vital for healthcare professionals to provide better care to these women. Purpose: This study was designed to explore the lived experiences of pregnant women with multiple sclerosis. Methods: A descriptive phenomenological study was conducted at the University of Jaén and included 17 women from different Spanish provinces who were recruited using intentional and snowball sampling methods via national patient associations and social networks. In-depth interviews were conducted, audio-recorded, transcribed, and analyzed using Martins' three steps. The ATLAS.ti 7.0 program was used for data analysis. Results: Two themes and seven subthemes were identified that highlighted the experiences of women in pregnancy with multiple sclerosis: (a) the influence of the disease on the decision to be a mother, with subthemes “The disease determines when to be a mother” and “Considering alternatives to spontaneous pregnancy”, and (b) the vision of motherhood with multiple sclerosis, with subthemes “Worry about how the disease can affect the pregnancy”, “Worry about how the pregnancy can affect the disease,” “Concerns about childbirth”, “Difficulty with breastfeeding”, and “Worry about the transmission of the disease.” Conclusions/Implications for Practice: Women with multiple sclerosis often face a difficult decision regarding whether to become pregnant. The period of pregnancy and puerperium can be fraught with anxiety, especially in terms of concerns about their ability to raise children. In light of the limited scientific evidence regarding the relationship between multiple sclerosis and pregnancy and the conflicting advice often given to these women, the findings of this study may be used to help improve the quality of the care provided to this population. [ABSTRACT FROM AUTHOR]

In the Brazilian Amazon, snakebite envenomations (SBEs) disproportionately affect Indigenous populations, and have a significantly higher incidence and lethality than in non‐Indigenous populations. This qualitative study describes the Indigenous and biomedical healthcare domains for SBE care from the perspective of the Indigenous medical and nursing students in Manaus, Western Brazilian Amazon. In‐depth interviews were conducted with five Indigenous students from the Amazonas State University, between January and December 2021. The interviews were analyzed using inductive content analysis. We organized an explanatory model with five themes: (1) participants' identities; (2) causality levels in Indigenous and biomedical systems; (3) therapeutic itineraries in Indigenous and biomedical systems; (4) ideological implications of adding biomedical devices to Indigenous healing systems; and (5) therapeutic failure in and efficacy of Indigenous and biomedical systems. From a noncolonial perspective and seeking to increase the quality and acceptability of health care for the Indigenous populations of the Brazilian Amazon, the training of Indigenous health professionals presents itself as a promising strategy. For this goal, universities should serve as empowering settings for Indigenous health students that support them in their growth and development, raise their awareness of injustice, and catalyze change toward a culturally adapted and effective service for the users. [ABSTRACT FROM AUTHOR]

How does class affect one's propensity to trust? Previous research finds higher-status actors express less trust than lower-status actors in interpersonal and institutional contexts. Scholars explain this finding as an outcome of structural dependence—when people have few alternative means for accessing valuable resources. In contrast, I find dependence inadequate to explain the relationship I observe between class and institutional trust among black families whose children were recommended for special education and other remedial program placement in an affluent, predominantly white school district. Drawing on retrospective interviews from a community ethnography, findings show that real-world trust decision processes also involve domination. Empirical studies of trust have overlooked the ways trustees—those being given trust—exercise power to achieve deference in trust exchanges, and how trustors—those placing trust in others—deploy their power to withstand trustees' influence. I argue that trust might best be conceptualized as a two-part decision process, because class and other status resources affect trustors' freedom to choose at two key junctures: (1) in weighing options and costs of trust errors, and (2) in communicating distrust in face-to-face interactions, where the potential for domination is high. Focusing on intersecting systems of power in authentic trust exchanges, this study shows how middle-class black trustors use symbolic resources to "go up against" the institutional power of educational experts and refuse placement, whereas working-class trustors consent to placement. [ABSTRACT FROM AUTHOR]

Background: Pathology services represent an ideal setting to integrate absolute cardiovascular disease (CVD) risk estimation when patients attend for routine cholesterol testing. This study aimed to explore the process of implementing CVD risk estimation into point‐of‐care service delivery by pathology staff to inform future implementation and sustainability. Methods: A new service for CVD risk estimation via a self‐directed screening station was implemented into 14 pathology service sites across Tasmania, Australia. Before implementation, observations at pathology services (n = 26) and semi‐structured interviews were undertaken with 26 pathology staff (88% female, 77% aged 41–60 years) to identify factors that could impact implementation of the service. The process of implementation was then evaluated using participant observations and clinical trial recruitment data. Transcripts and field notes were analysed thematically according to the Medical Research Council Framework and used to develop a programme logic model to understand how the service could be adapted to be successfully integrated into routine workflow at pathology services. Results: Eight key themes were identified during the pre‐implementation phase as important factors that could impact upon integration of CVD risk estimation into pathology services. Themes related to factors within the organisation, including available resources, logistics and workflow, as well as having sufficient time to complete the intervention. Additional factors related to the individual motivations of staff, collaborative leadership and patient characteristics. Success of implementation varied among sites, requiring the trialling of different strategies to support uptake of the service and patient recruitment. Conclusions: Implementing CVD risk estimation into point‐of‐care pathology services required an understanding of the core implementation components specific to each context, and for implementation strategies to be targeted to the individual and organisational contexts. The generated programme logic model may be useful in guiding future implementation endeavours within these services and aiding the selection of apt implementation strategies. Trial Registration: ClinicalTrials.gov Identifier: NCT04896021, registered 19/05/2021, https://clinicaltrials.gov/study/NCT04896021. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe.Patients are often the first to know when the atmosphere on a ward becomes tense, but often, no one asks them for their views.Patients and staff are experts and should be included in discussions about how to make wards safer. What this paper adds to existing knowledge: We got together with some service users and staff, and made an app that helps patients to tell staff when they are not feeling safe on a mental health ward. We tried it out on six wards and we asked patients and staff what they thought.The app was easy to use and most people liked the look of it.Patients said staff did not talk with them enough and so they liked using the app. However, some staff said they could tell how patients were feeling without an app and so they did not need it. Ward managers told us that staff were often very busy and did not always have time to use the app. What are the implications for practice: This app could help staff know straightaway when patients do not feel safe on the ward, so that they can act quickly to calm things down.To make the most of the app, staff need to get used to it and bring it into ward routines. Introduction: Safety improvement on mental health wards is of international concern. It should incorporate patient perspectives. Aim: Implementation and evaluation of 'WardSonar', a digital safety‐monitoring tool for adult acute mental health wards, developed with stakeholders to communicate patients' real‐time safety perceptions to staff. Method: Six acute adult mental health wards in England implemented the tool in 2022. Evaluation over 10 weeks involved qualitative interviews (34 patients, 33 staff), 39 focused ethnographic observations, and analysis of pen portraits. Results: Implementation and evaluation of the WardSonar tool was feasible despite challenging conditions. Most patients valued the opportunity to communicate their immediate safety concerns, stating that staff had a poor understanding of them. Some staff said the WardSonar tool could help enhanced ward safety but recognised a need to incorporate its use into daily routines. Others said they did not need the tool to understand patients' safety concerns. Discussion: Foreseeable challenges, including staff ambivalence and practical issues, appeared intensified by the post‐COVID‐19 context. Implications for Practice: The WardSonar tool could improve ward safety, especially from patients' perspectives. Future implementation could support staff to use the real‐time data to inform proactive safety interventions. [ABSTRACT FROM AUTHOR]

Introduction: People living with young-onset dementia and their care-partners are at risk of a range of adverse mental health outcomes and social isolation. There are few interventions aimed at supporting couples affected by young-onset dementia, which poses unique psychosocial challenges for younger people. Methodology: This pre-post interventional mixed methods pilot study aimed to assess the feasibility and acceptability of an online group program for people with young-onset dementia and their care-partners living at home in Australia. The Music And Psychology and Social connections (MAPS) program aimed to address: (1) the challenges and changes associated with young-onset dementia; and (2) coping and wellbeing. The program involved six weekly two-hour sessions co-facilitated by a psychologist and music therapist, and a private Facebook group. The primary outcomes of feasibility and acceptability were assessed through a post-program focus group, separate individual feedback sessions with each couple, and a program evaluation questionnaire. Thematic analysis was conducted on the focus group transcripts and field notes from couple feedback sessions. We also examined the preliminary utility of MAPS in improving mental health and social connectedness, using quantitative pre-post-measures. Results: Five couples completed the MAPS program. The most common dementia type was Alzheimer's Disease. Participant attendance was 87% across all sessions. Qualitative findings supported acceptability of the program with four emergent themes: being connected to others with shared experiences; reframing thoughts and feelings about dementia; music as a therapeutic tool; and benefits of MAPS. Conclusion: The high retention rate, qualitative findings and positive program evaluation suggest MAPS may be a promising, feasible and acceptable program for couples affected by young-onset dementia. [ABSTRACT FROM AUTHOR]

Background: The nursing work environment is often stressful and can lead to burnout. The use of humor may help nurses adapt and cope. Although most would agree that, in general, humor can help build camaraderie and ease tense situations, little is known about how nurses use humor in their professional lives. Purpose: The study's main purpose was to explore how humor is used and perceived by nurses in the workplace. Methods: A sample of LPNs, RNs, and advanced practice RNs was recruited in the United States. Participants were interviewed via the videoconferencing platform Zoom. Data from the video recordings, audio transcripts, and investigators' field notes were analyzed using reflexive thematic analysis. Results: Sixteen nurses were interviewed about their use of humor, whether intentional or spontaneous, in the workplace. Three main themes were identified: entertainment , influencing others , and well-being. Participants reported using humor with self and others, including patients, families, and colleagues. Reported benefits include emotional regulation, relationship building, and work enjoyment. Some participants noted feeling insecure over when and whether the use of humor was "appropriate." Conclusions: The results indicate that nurses' use of humor in the workplace had many benefits. Participants reported that humor could relieve tension, create bonds and strengthen relationships, and enhance both learning and work environments. Many recognized that humor can also be maladaptive and harmful, and that sensitivity and caution are part of using humor skillfully. Still, the benefits of humor appear to outweigh the risks. We conclude that humor is a useful tool nurses can and should use to optimize their nursing experience. This qualitative study explores how humor is used and perceived by nurses in the workplace, including what situations it's used in, how it's deployed, and what outcomes are associated with its use. [ABSTRACT FROM AUTHOR]

Children who are looked after by the state are some of the most vulnerable in society and have usually experienced neglect, abuse and other trauma. As a result of their experiences, many exhibit challenging and/or aggressive behaviour. Currently, in England, around 68% of the children entering the care system are placed with foster carers, many of whom also have their own children living in the home. This study used narrative interviews to gain the views of the biological children of foster carers about their experience of being brought up in a fostering family. Twelve participants aged 18 and 54 were recruited using convenience and snowballing sampling strategies. Findings revealed that the foster carers own children and fostered children often developed close relationships and that fostered children frequently shared detailed accounts of the abuse they had experienced before entering care. Knowledge of the abuse often left the carers' own children both troubled and in a dilemma about what to do with the information. They also revealed that some of the foster carers' own children had been abused by their foster siblings and had chosen not to disclose this information to their parents or others. Several of the participants expressed ongoing feelings of distress when discussing their experiences and those of their foster siblings, which raises questions about how best to support this important group of children and young people. Key Practitioner Messages: Care‐experienced children sometimes confide in foster carers' own children about traumatic experiences before entering the care system. The birth children of foster carers do not always tell their parents what they have heard, which can leave them confused and/or distressed.Birth children can experience abuse at the hands of their foster siblings and do not always tell their parents or other adults when they experience abuse. [ABSTRACT FROM AUTHOR]

This paper describes name-related literacy practices in a multilingual preschool classroom and their implications for emergent biliteracy. We draw on a translingual framework to understand children's name-writing activities and how bilingual children's early literacy interacts with, and at times disrupts, the written conventions of named languages. Drawing on fieldnotes, observations, and artifacts from a preschool classroom serving Spanish-English bilingual children, we examined how children and teachers used names as resources for early literacy learning. We found that names are (potential) gateways to letter-sound relationships across languages, that names teach that some features of writing are shared across languages and some are different, and finally that names differ from other kinds of words children encounter across languages. We discuss what those instances prompt us to (re)consider about name-related teaching and emergent biliteracy. [ABSTRACT FROM AUTHOR]

The focus of this article is on exploring the rationales behind social workers' decision-making in everyday tasks that involve handling new referrals regarding children and families. Such decisions are made in a legal context, but at the same time require the use of discretionary space and reasoning based on sources of professional knowledge. Drawing on qualitative data compiled through an ethnographic approach, this study provides an insight into everyday practice, reasoning and decision-making. The study demonstrates that one of the important rationales for decision-making is derived from the social worker's direct experience of interacting with parents and children. A particular aspect of the interaction, parents' reactions to being referred, is scrutinized and serves as a form of validation for legal action. [ABSTRACT FROM AUTHOR]

Unmet health-related social needs contribute to high morbidity and poor population health. Improving social conditions are likely to reduce health disparities and improve the health of the overall U.S. population. The primary objective of this article is to describe an innovative workforce model, called Regional Health Connectors (RHCs), and how they address health-related social needs in Colorado. This is a program evaluation that analyzed field notes and interview data from 2021-2022. We applied our findings to the framework developed by the National Academies of Sciences, Engineering, and Medicine's (NASEM's) report on strengthening social care integration into health care (2019). We found that RHCs address the following health-related social needs most commonly: food insecurity (n = 18 of 21 regions or 85% of all regions), housing (n = 17 or 81% of all regions), transportation (n = 11 or 52% of all regions), employment opportunities (n = 10 or 48% of all regions), and income/financial assistance (n = 11 or 52% of all regions). RHCs interacted across many sectors to address health-related social needs and provided multiple types of support to primary care practices at the organizational level. Examples of emerging impact of RHCs are described and mapped onto the NASEM framework. Findings from this program evaluation add to the growing landscape of knowledge and importance of detecting and addressing health-related social needs. We conclude that RHCs are a unique and emerging workforce that addresses multiple domains needed to integrate social care into health care. [ABSTRACT FROM AUTHOR]

Background: Previous research identifies organisational culture as one of a number of factors associated with the quality of life outcomes of group home residents' with intellectual and developmental disabilities. This study aims to elaborate on the dimensions of group home culture in settings in England. Method: Participant observations and semi‐structured interviews with staff were carried out in two group homes. Field‐notes, interview notes and transcripts were analysed using inductive thematic analysis by a researcher naïve to the project and the previous literature. Initial coding was re‐examined after sensitisation to theorised models in previous literature to identify the most parsimonious fit. The two settings were rated and compared using a five‐point Likert scale for each of the dimensions. Results: The findings describe group home culture across seven dimensions. There were mixed ratings across the different dimensions reflecting inconsistencies in culture that were reflected in staff practice. The challenge in assigning a global rating of culture in group homes, which includes interactions across multiple staff and multiple residents over time, was highlighted. Conclusion: The development of an observational measure of culture is highlighted as potentially helpful in understanding and responding to culture in services for individuals with intellectual and developmental disabilities. [ABSTRACT FROM AUTHOR]

Introduction: The experiences of living with Parkinson's disease (PD) from the perspective of newly diagnosed persons with PD (PwPD) have not been previously described. Aim: This study aimed to gain a better understanding of the impact of living with the early stages of PD. Methods: A qualitative interview study was conducted among nine persons, seven men and two women, from southern Sweden. Participants had a median age of 71 (min–max, 64–77) years and had been diagnosed with PD for a median of 5 (min–max, 2–12) months. Interviews were recorded and analysed using systematic text condensation. Results: The analysis resulted in one core category, Facing and dealing with emotional turbulence, and four categories with 2–3 subcategories each: Something is wrong (Vague signs of change; Losing control); The going gets tough (Recalling; Lack of motivation); Losing direction (Uncertainties; Frightened of disease progression) and Dealing with life (Avoiding social situations; Hope and despair; Ease worries). Conclusion: Newly diagnosed PwPD face emotional turbulence with increasing challenges in managing everyday basic needs. Impaired functioning affects self‐esteem and identity, which calls for strategies to overcome emotional reactions of embarrassment, frustration and worry. A sense of lost control and direction increased as the future became more uncertain. The participants' emotional burden and struggle to find a reason to go on or some solution to their new situation left them with both hope and despair. Our results suggest that a person‐centred needs‐based approach may help newly diagnosed PwPD deal with their new life situation. [ABSTRACT FROM AUTHOR]

Purpose: Person-centred care is widely accepted as being central to high quality care, but little is known about how physiotherapists implement person centred rehabilitation in Intensive Care. This study explores the self-reported experiences and interpretations of physiotherapists delivering person-centred rehabilitation in this setting. Methods: A qualitative study using Interpretative Phenomenological Analysis explored the lived experiences of physiotherapists and students who have worked in Intensive Care. Three focus groups, with four participants in each, were conducted. Data were fully transcribed, analysed and managed using NVivo software. Results: Participants shared similar interpretations about the principles of person-centred care. Operationalising person-centred rehabilitation during early recovery was not easily achievable. As the person's clinical condition improved, participants moved away from routine physiotherapy and their practice became more person-centred through the development of a partnership. Participants connected as humans to understand the person and respond to their needs within a culture that valued person-centred care. Conclusions: Physiotherapists aspire to develop a partnership with their patients by connecting on a human level with them and addressing their biopsychosocial needs. Physiotherapists with experience of developing patient partnerships influence the culture of the Intensive Care team and are role-models to facilitate collaborative person-centred activity in others. IMPLICATIONS FOR REHABILITATION: Physiotherapists can move from a biomedical approach towards becoming partners with patients in an Intensive Care Unit (ICU) as they become cognitively aware. Physiotherapists become person-centred by connecting as humans to the patient and moving towards a biopsychosocial approach that addresses the physical, psychological and instrumental needs of the patient in ICU. When aiming towards a person-centred approach on ICU, physiotherapists contribute to a culture that nurtures the unique patient and works collaboratively with the family and the health care team. Experience working with patients in ICU, allows physiotherapists to identify opportunities to be person-centred and facilitate other team members in becoming so. [ABSTRACT FROM AUTHOR]

Hospitals frequently introduce new medical devices. However, the process of clinicians adapting to these new vascular access devices has not been well explored. The study aims to explore clinicians' experience with the insertion of a new guidewire peripheral intravenous catheter (PIVC) introduced in the emergency department (ED) setting. The study was conducted at two EDs in Queensland, Australia, utilising a qualitative explorative approach. Interviews were conducted with guidewire PIVC inserters, including ED doctors and nurses, and field notes were recorded by research nurses during insertions. Data analysis was performed using inductive content analysis, from which themes emerged. The study compiled interviews from 10 participants and field notes from 191 observation episodes. Five key themes emerged, including diverse experience, barriers related to the learning process, factors influencing insertion success, and recommendations to enhance clinicians' acceptance. These themes suggest that the key to successful adoption by clinicians lies in designing user-friendly devices that align with familiar insertion techniques, facilitating a smooth transfer of learning. Clinician adaptation to new devices is vital for optimal patient care. Emergency nurses and doctors prefer simplicity, safety, and familiarity when it comes to new devices. Providing comprehensive device training with diverse training resources, hands-on sessions, and continuous expert support, is likely to enhance clinician acceptance and the successful adoption of new devices in ED settings. [ABSTRACT FROM AUTHOR]

Mothers experiencing homelessness are seldom asked about past trauma that may be causal to housing instability and poor health. There are also few validated trauma-focused interventions in family shelters. To address this gap, we tested the feasibility and acceptability of the trauma-focused clinical ethnographic narrative intervention (CENI-TF) in increasing mothers' trauma disclosure, appraisal of its meaning in their lives, and help-seeking behaviors. We also present the qualitative findings to contextualize the intervention. Findings are organized under three major domains and nine subthemes that capture participants' voices and experiences. The CENI-TF has the potential to promote help-seeking behaviors and interrupt recurring cycles of trauma and housing instability in this at-risk population. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic significantly interrupted the grieving experiences of bereaved families and drastically changed their ways of dealing with loss. Our study aims to gain an in-depth understanding of the experience of bereaved relatives of patients who died in palliative care units during the COVID-19 pandemic. The phenomenological research design included sixteen family members of hospitalized palliative patients who died from November 2021 to June 2022. The study involved conducting qualitative in-depth semi-structured interviews with family members 12–24 months after the death of their loved ones. The interviews aimed to gather information about the experiences of the families both before and after the death. The COREQ guidelines were applied in the study. Participants were mainly female (n = 13) with a mean age of 47.25 (SD = 12.58). Data were analysed using the Interpretative Phenomenology Analysis (IPA). The following three categories were identified: (1) navigating loved ones' final weeks and days (troubled deaths); (2) the last farewell was robbed; (3) looking for adjustment after loss. One overall main theme emerged, which was as follows: "Struggling between stolen moments and painful losses to get back into the flow of life". This study provides novel insights into end-of-life care and bereavement from the perspectives of family. Our findings suggest that developing and promoting family-centred culture can lead to compassionate palliative care focused on a myriad ways of affirming that their loved one matters. [ABSTRACT FROM AUTHOR]

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Research proficiencies for nurses include the ability to search for and evaluate evidence, disseminate findings, and apply findings to practice within the context of caring. Aim: This study explored the experiences of distant postgraduate nursing students in Limpopo Province, South Africa. Methods: The population consists of all students registered for postgraduation studies in a nursing programme at two South African universities in Limpopo Province. Purposive sampling was used to select 23 registered postgraduate nursing students. Data were collected through unstructured one-on-one interviews, including an audio recorder and field notes. The narrative data from interviews were analysed qualitatively through Tesch's open coding descriptive qualitative data analysis method. Results: Three main themes emerged: the reasons behind engaging in postgraduate studies, factors impacting postgraduate studies' success, and a description of challenges associated with conducting research. Conclusions: The students generally have varied experiences about whether or not completing a research project is a valuable learning experience. The relationship between a postgraduate student and their research supervisor is crucial to ensuring that the students advance consistently and complete their theses on time. The study will, therefore, assist HEIs offering postgraduate programmes in nursing in realising the challenges faced by students and coming up with strategies to combat the challenges. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore healthcare professionals' (HCPs) perceptions and experiences related to 3D scanning and 3D printing for fabricating lower limb prosthetic sockets. Materials and methods: This study used a qualitative descriptive approach. Participants were recruited through HCPs' professional associations, social media posts, and snowball sampling. Purposive sampling was used to attain variation in provider type. One-on-one telephone interviews were conducted using a semi-structured interview guide. Inductive thematic analysis was performed to identify the main themes. Results: Three themes were identified: (1) 3D scanning of the residual limb for designing prosthetic sockets is perceived as clean, quick, and convenient; (2) concerns about the strength and safety of 3D printed sockets for long-term use; (3) Adoption of 3D scanning and 3D printing technology for fabricating prosthetic sockets. Conclusion: We identified perceived benefits and challenges with digital technologies for fabricating prosthetic sockets. To increase adoption, more research demonstrating its efficacy compared to conventional methods, increasing 3D printing material quality, and improving software training programs are needed. Implications for Rehabilitation: 3D printing and 3D scanning are emerging digital technologies that can be used as alternative methods for prosthetic socket manufacturing in the field of rehabilitation. Our research identified perceived benefits of using digital technologies for fabricating prosthetics sockets (3D scanning is perceived as clean, quick, and convenient) and perceived challenges (concerns about the strength and safety of 3D printed sockets for long-term use and a prolonged learning curve). To increase adoption of these digital technologies, more training should be provided to prosthetists and support provided to integrate new processes into staff workloads. [ABSTRACT FROM AUTHOR]

Background: Primary care is often described as slow to change. But conceptualized through complexity theory, primary care is continually changing in unpredictable, non-linear ways through self-organization processes. Self-organization has proven hard to study directly. We aimed to develop a methodology to study self-organization and describe how a primary care clinic self-organizes over time. Methodology: We completed a virtual case study of an urban primary care clinic from May-Nov 2021, applying methodological insights from actor-network theory to examine the complexity theory concept of self-organization. We chose to focus our attention on self-organization activities that alter organizational routines. Data included fieldnotes of observed team meetings, document collection, interviews with clinic members, and notes from brief weekly discussions to detect actions to change clinical and administrative routines. Adapting schema analysis, we described changes to different organizational routines chronologically, then explored intersecting changes. We sought feedback on results from the participating clinic. Findings: Re-establishing equilibrium remained challenging well into the COVID-19 pandemic. The primary care clinic continued to self-organize in response to changing health policies, unintended consequences of earlier adaptations, staff changes, and clinical care initiatives. Physical space, technologies, external and internal policies, guidelines, and clinic members all influenced self-organization. Changing one created ripple effects, sometimes generating new, unanticipated problems. Member checking confirmed we captured most of the changes to organizational routines during the case study period. Conclusions: Through insights from actor-network theory, applied to studying actions taken that alter organizational routines, it is possible to operationalize the theoretical construct of self-organization. Our methodology illuminates the primary care clinic as a continually changing entity with co-existing and intersecting processes of self-organization in response to varied change pressures. [ABSTRACT FROM AUTHOR]

The conception of what science is is built throughout the subject's interaction with the world. In order to investigate how future teachers of Exact Sciences and Biological Sciences understand the nature of Science (NdC). The research was carried out throughout 2022 and early 2023, based on the Views of Nature of Science Questionnaire (VNOS-C), with some adaptations and applied within a Google Forms form. The students responded to the questionnaire in the History and Philosophy of Science (HFC) and Epistemology and Science Teaching (EEC) subjects, at the end of them. The data allows us to raise evidence that there does not seem to be much progress in the conceptions of graduate students. Their conceptions of science are still rooted in a positivist and empiricist perspective, which sometimes recognizes a single method of producing science, that linked to experimentation. There is no clarity between the idea of theory and scientific law. And little value is given to the role of creativity in scientific practice. Therefore, from this specific study, we can infer, together with readings in the area, that some notes for the field of research in Science Education are appropriate in the initial training of teachers. sociology and psychology of sciences, or metasciences in teacher training. These conceptions take time to be (re)constructed and require a greater workload that is relative to the entire curriculum and not just concentrated in one or two subjects in each course. [ABSTRACT FROM AUTHOR]

Aims The recent rise in the number of nonagenarians (age ≥ 90 years) undergoing percutaneous coronary intervention (PCI) has revealed gaps in research, in particular on patients' experiences. Therefore, the aim of the study was to explore and describe nonagenarians' internal resources and their experiences of the in-hospital pathway. Methods and results Nineteen nonagenarian patients (women n = 9), mean age 91 years, 9 acutely, and 10 electively treated, were consecutively enrolled from a tertiary university hospital from June 2021 to February 2023. In-depth interviews were conducted during hospitalization, audiotaped and transcribed. The interviews were analysed using qualitative content analysis. Three sub-themes emerged from the nonagenarians' experiences with the PCI treatment trajectory: (i) Taking lifelong responsibility for own physical and mental health describes a population striving to live a healthy life and to stay independent. Physical and mental activities including healthy food choices had been an integral aspect of their lives from early childhood. (ii) Individual internal resources influenced the PCI pathway describes how their internal resources were used, from actively engaging in the decision-making process to withstanding discomfort during the PCI procedure. (iii) The post-PCI pathway was multifaceted describes a short stay at the cardiac ward with individual post-procedural experiences, close monitoring, and preparation for discharge including cardiac rehabilitation. Conclusion Nonagenarians undergoing PCI demonstrated a personal incentive to stay healthy and independent. Their internal resources of independence, stoicism, and resilience were used during their in-hospital stay contributing to a successful PCI procedure. Individual cardiac rehabilitation strategies were highlighted after discharge from hospital. [ABSTRACT FROM AUTHOR]

Intersectoral collaborations are recommended as effective strategies to reduce health inequalities. People most affected by health inequalities, as are people living in poverty, remain generally absent from such intersectoral collaborations. Community-based participatory research (CBPR) projects can be leveraged to better understand how to involve people with lived experience to support both individual and community empowerment. In this paper, we offer a critical reflection on a CBPR project conducted in public housing in Québec, Canada, that aimed to develop intersectoral collaboration between tenants and senior executives from four sectors (housing, health, city and community organizations). This single qualitative case study design consisted of fieldwork documents, observations and semi-structured interviews. Using the Emancipatory Power Framework (EPF) and the Limiting Power Framework (LPF), we describe examples of types of power and resistance shown by the tenants, the intersectoral partners and the research team. The discussion presents lessons learned through the study, including the importance for research teams to reflect on their own power, especially when aiming to reduce health inequalities. The paper concludes by describing the limitations of the analyses conducted through the EPF–LPF frameworks and suggestions to increase the transformative power of future studies. [ABSTRACT FROM AUTHOR]

Background: Chronic conditions may limit older peoples' social engagement and wellbeing. Reduced social connections can result in loneliness and social isolation. This study aimed to explore the experience of social connection in older people living with chronic conditions, and the factors influencing their social participation. Methods: A purposive sample of 19 community-dwelling older Australians (mean age 75.5 years) with one or more chronic conditions participated in a qualitative descriptive study. Semi-structured interviews explored participants' perceptions of their social connections and the potential impact of their chronic conditions. Views about the role of general practice in supporting older persons' wellbeing were discussed. Data were analysed inductively using thematic analysis. Results: Five themes were identified: (1) the experience of loneliness, (2) managing diminishing social contacts, (3) living with chronic conditions, (4) barriers to social connection, and (5) facilitators of social connection. Participants felt that ageing with chronic conditions contributed to loss of function and independence, which limited social connections, and increased loneliness and social isolation. Barriers to social connections included issues with mobility, transport and forming new networks. Families were a primary support, with continued community engagement and general practice support crucial to staying well and socially connected. Conclusions: Understanding older peoples' experiences, and the barriers and facilitators of social connections can guide clinicians' interventions. General practice is a promising intervention point because of its high use by those with chronic conditions to stay well. General practice nurses are well-placed to collaboratively address the barriers older people face in maintaining social connections. Chronic conditions may limit older peoples' social engagement, with diminished social connections leading to loneliness, social isolation and other serious health consequences. This study explored the experience of social connection in older people living with chronic conditions and factors influencing their social participation. Older people identified the importance of family, community engagement and staying well through primary care support. Understanding the barriers and facilitators of social connections for older people can guide the general practice team in developing appropriate interventions. [ABSTRACT FROM AUTHOR]

Inequitable pregnancy care experiences and outcomes disproportionately affect refugee background women in Australia. Culturally safe care is essential for achieving health equity, however, cultural safety can only be determined by the person receiving care. To our knowledge, women of refugee background in Australia are yet to be asked what culturally safe pregnancy care is to them. Specifically, this study aimed to explore what culturally safe pregnancy care is to Karen women (from Burma) of refugee background. A photovoice study founded on community-based participatory research principles was undertaken with a Karen community of refugee background living in Victoria, Australia. A community advisory group was established, guiding study design and conduct. Five S'gaw Karen-speaking women with experience of pregnancy care in Australia were invited to take photos within their community. Participants shared their photos and stories with each other in four online discussion groups. Reflexive thematic analysis guided by a critical constructionist lens developed three themes: Building foundations for belonging; cultivating reciprocal curiosity; and storytelling as an expression of self and shared power. These themes sit within the overarching theme When I can be my whole authentic self, I feel safe and know that I belong. When Karen women can embrace their cultural and spiritual identity without fear of discrimination, including racism, culturally safe pregnancy care is possible. This study contributes to the design and delivery of maternity services by providing insights that can enhance equitable and culturally safe pregnancy care for Karen women of refugee background. [ABSTRACT FROM AUTHOR]

Aim: To obtain an in‐depth understanding of the lived experiences, values, and beliefs of Taiwanese women with breast cancer who withdrew from cancer treatment. Background: Fear of side effects, negative experiences and personal beliefs were identified as reasons for withdrawing from cancer treatments. Body–mind consciousness and body autonomy play a crucial role in cancer treatment decisions. Design: Descriptive phenomenological approach. Methods: We conducted semi‐structured, face‐to‐face and in‐depth interviews with 16 women diagnosed with breast cancer. Participants were purposefully selected from the Cancer Registry database. Employing a phenomenological approach, our aim was to explore the lived experiences of these individuals. Data analysis followed Giorgi's five‐step process. To ensure a comprehensive report the COREQ checklist was applied. Findings: 'The Determination to Preserve Me' is the essence of treatment withdrawal, identified by three themes and seven sub‐themes. 'Raising Body‐Mind Consciousness' was generated using body autonomy and preventing repeated psychological trauma from the participant's view. Their lifestyles, maintaining the family role, and returning to a normal trajectory help develop 'Maintaining Stability for Being a Patient and a Family Carer'. 'Self‐Defending Against the Body Harm' was generated by concerns about maintaining health and preventing harm. Conclusion: Women's behaviours became transformed by suffering. Actions were influenced by physical and psychological distress, misconceptions about treatments, and appearance changes by self‐determination through self‐protection. Relevance to clinical practice: Healthcare professionals should respect women's autonomy and work collaboratively to ensure their decision‐making with accurate information and awareness of the potential risks and benefits of treatment withdrawal need to concern. [ABSTRACT FROM AUTHOR]

Aim: To explore Remote Area Nurses' experiences of the implementation of workplace health and safety policies and risk mitigation strategies in Australian very remote primary health clinics. Design: This qualitative study used online semi‐structured interviews, with participants purposively sampled to maximize variation in work location and service type. Data were analysed using a reflexive thematic analysis approach. Coding was carried out inductively, with NVivo 12 aiding data management. Setting: The interviews were conducted from 24 Februrary 2021 to 06 March 2021 with Remote Area Nurses from very remote primary health clinics in Australia. Participants: Fifteen Remote Area Nurses participated in the study. Results: Thematic analysis revealed varied approaches to workplace safety among the different health services and regions. While the spread of 'never alone' policies in many clinics addressed one of the significant risks faced by Remote Area Nurses, gaps remained even for hazards specifically highlighted in existing work health and safety legislation. Meaningful collaboration with staff and the community, local orientation, preparation for the role and providing quality care were protective factors for staff safety. Understaffing, unsafe infrastructure and inadequate equipment were common concerns among Remote Area Nurses. Conclusion: Health services need to prioritize workplace safety and take a continuous quality improvement approach to its implementation. This will include ensuring safety strategies are appropriate for the local context, improving infrastructure maintenance, and establishing sustainable second responder systems such as a pool of drivers with local knowledge. Implications for the Profession: Poor personal safety contributes to burnout and high turnover of staff. Nurses' insights into the barriers and enablers of current workplace safety strategies will aid policymakers and employers in future improvements. Reporting Method: COREQ reporting guidelines were followed. PIPE Statement: A panel of six Remote Area Nurses collaborated in the development of this project. [ABSTRACT FROM AUTHOR]

Introduction: Social prescribing offers a formal pathway of connecting patients in the health system with sources of support within the community to help improve their health and well‐being. Since its launch in March 2022, the Canadian Institute for Social Prescribing has acted as a collective impact network to identify, connect and build upon established social prescribing initiatives using a co‐design methodology. The institute received input from a participant advisory council, co‐design partners and several communities of interest groups. This study aimed to describe the perceptions of the Canadian Institute for Social Prescribing's role in advancing social prescribing using a co‐design approach and the barriers and facilitators to implementing social prescribing in Canada. Methods: We used a qualitative descriptive study design, document analysis, participant observation and semi‐structured individual interviews (n = 7) with members of the Canadian Institute for Social Prescribing co‐design group and the institute's leadership. We also analysed documents, field notes and transcripts using codebook thematic analysis. Results: Four themes were developed representing the facilitators of implementing the Canadian Institute for Social Prescribing to support social prescribing: Creating relational mechanisms (i.e., partnerships and connections), Bringing awareness to social prescribing and contributing to the evidence (i.e., values and beliefs), Addressing systemic conditions (i.e., having a common language for social prescribing and organizing the community health sector) and Enabling funding and policy to drive social prescribing initiatives (i.e., shifting evidence into policy and securing sustainable funding). Conclusion: Participants' reflections on the co‐design process demonstrated that the Canadian Institute for Social Prescribing development provided networking opportunities and shared resources relevant to social prescribing. Co‐design efforts also fostered relational and informational support, which laid the necessary groundwork in Canada to overcome the complex interplay between the macro‐ and micro‐level settings in which social prescribing is practiced. Patient or Public Contribution: The interviews and observations involved participants with lived experience of delivering, receiving or advocating for social prescribing. [ABSTRACT FROM AUTHOR]

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

Physiotherapists working in hospitals have a key role in decisions about when a person with stroke is safe to walk independently. The aim of this study was to explore the factors influencing decision-making of physiotherapists in this situation. A qualitative design with semi-structured interviews and reflexive thematic analysis was used. Fifteen physiotherapists with recent experience working in inpatient stroke rehabilitation participated. Multiple factors influence decision-making about walking independence after stroke in hospitals. Four themes were identified: (1) Assessment of walking safety involves observation of walking function and consideration of complex individual factors; (2) Perspectives on risk vary, and influence whether a person is considered safe to walk; (3) Institutional culture involves background pressures that may influence decision-making; and (4) Physiotherapists adopt a structured, individualised mobility progression to manage risk. Physiotherapists consistently use observation of walking and understanding of attention and perception in this decision-making. There can sometimes be a conflict between goals of independence and of risk avoidance, and decisions are made by personal judgements. Decision-making about independent walking for people in a hospital after a stroke is complex. Improved guidance about clinical assessment of capacity and determining acceptable risk may enable physiotherapists to engage more in shared decision-making. Regaining independence in walking after a stroke comes with the potential risk of falls. Assessment of walking safety should be specific to the complexity of the situation and consider perception and cognition. Benefits of activity and autonomy, and the risk of falls need to be considered in decisions about walking independence. Patients with the capacity to understand consequences and accept risk can be active participants in determining what is sufficiently safe. [ABSTRACT FROM AUTHOR]

Describe the adaptation, implementation, and perceptions of Kids SIPsmartER's classroom component during the coronavirus disease-impacted 2020–2021 school year. Mixed methods process evaluation. Seven rural Appalachian middle schools (US). Middle-school teachers (n = 14) and principals (n = 6). Kids SIPsmartER was a multilevel, school-based intervention designed to decrease sugar-sweetened beverage intake. The 12-lesson classroom component was supported by an implementation protocol. Implementation protocol adaptations, program perceptions, and the school context were assessed using teacher and principal interviews, teacher-completed fidelity checklists, and researcher-maintained field notes. Adaptations were mapped to the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). Qualitative data were content coded. Quantitative data were summarized using descriptive statistics. All schools maintained Kids SIPsmartER and delivered 100% of lessons. Ten adaptations were made to the implementation protocol. Schools used adapted delivery approaches to meet individual needs. Teachers and principals identified more benefits than barriers to implementing the program. Using a strategically adapted implementation protocol that was flexible to schools' individual needs allowed all middle schools to deliver Kids SIPsmartER during the 2020–2021 school year. Findings identify adaptation considerations that other school-based evidence-based interventions could incorporate to facilitate delivery during high-stress times. [ABSTRACT FROM AUTHOR]

This study presents a strengths-based framework for designing virtual reality experiences tailored to the needs and abilities of autistic individuals. Recognizing the potential of virtual reality to provide engaging and immersive learning environments, the framework aligns the strengths and preferences of autistic users with the affordances of virtual reality platforms. Drawing on the existing literature and empirical findings, the framework highlights key areas of alignment, including visual perception, anxiety management, attention to differences, concrete thinking, and response to positive feedback. The framework emphasizes the importance of involving autistic individuals in the co-design and co-creation of virtual reality technologies to ensure a more tailored and preferred user experience. By adopting a strengths-based approach and actively involving autistic individuals, the design and implementation of virtual reality interventions can better address their unique needs and foster positive outcomes. The study concludes by advocating for continued research and collaboration to advance the field of virtual reality technology for autistic individuals and to work toward shared goals with the autistic community. Virtual reality has been studied for its potential in supporting individuals with autism, but existing research often focuses on deficits and lacks consideration of individual preferences and strengths. This article introduces a framework that emphasizes the strengths and abilities of autistic individuals when designing virtual reality interventions. It builds upon an existing taxonomy of educational technology affordances and extends it to align with the unique needs of autistic individuals. The framework provides guidance for incorporating virtual reality technology that supports and amplifies autistic strengths, such as visual perception and response to positive feedback. The framework has implications for practice, research, and policy. For practitioners, it offers a tool for designing virtual reality experiences that cater to the strengths of autistic individuals, enhancing engagement and educational outcomes. Researchers can utilize the framework to guide the development of user-centered virtual reality interventions and expand our understanding of the potential benefits of virtual reality for autistic populations. Policymakers and educators can consider this framework when incorporating virtual reality into educational settings, ensuring that virtual reality technology is used in a way that aligns with the strengths and needs of autistic learners. Overall, the framework promotes a strengths-based approach in utilizing virtual reality technology for individuals with autism, fostering inclusivity and maximizing the benefits of immersive experiences. [ABSTRACT FROM AUTHOR]

Active service members and Veterans with a combat-related traumatic brain injury (TBI) are four times more likely to attempt suicide than those without a TBI. TBIs are the signature injuries of the Post-9/11 conflicts and Combat Veterans (i.e., current and former service members who deployed in support of a combat mission) with these injuries are entitled to receive the Purple Heart medal. However, potentially tens of thousands of Combat Veterans did not receive, or were denied the Purple Heart during the first decade of the Global War on Terrorism because a TBI was not documented during the deployment. To our knowledge, this is the first study to explore the meaning of the Purple Heart and examine the impact of the Purple Heart on Army Combat Veterans with a combat-related TBI. Findings from this mixed methods study revealed that not receiving the Purple Heart is associated with increased suicide risk and lower quality of life after a brain injury. Additionally, thwarted belongingness, perceived burdensomeness, and perceived military institutional betrayal are associated with increased suicide risk in Army Combat Veterans with a TBI. This mixed methods study provides important insights into how Army culture is perceived and the power of the Purple Heart among this high-risk group of Combat Veterans. [ABSTRACT FROM AUTHOR]

The effectiveness of work performed through interprofessional practice is contingent on the nature and extent of communication between professionals. To date, there is little research exploring how the patterns of communication may impact interprofessional work. This study focused on communication during interprofessional meetings to better understand the interprofessional work performed through these encounters. Specifically, it examined how interactional discourse, that is, the patterns of language, influenced work performed during interprofessional meetings. A series of four interprofessional meetings in a rehabilitation unit were observed. Twenty-one participants were observed, including medical, nursing, allied health clinicians, and health professions students. Follow-up stimulated-recall interviews were conducted with five meeting participants. The data collection consisted of video and audio recordings and detailed field notes. Data were analyzed using a combination of genre analysis, a form of discourse analysis, and activity system analysis, drawing on Cultural Historical Activity Theory. This facilitated an in-depth examination of the structure of discourse and its influence on meeting outcomes. The meeting structure was defined and predictable. Two distinct forms of discourse were identified and labeled scripted and unscripted. Scripted discourse was prompted by standardized documents and facilitated the completion of organizational work. In contrast, unscripted discourse was spontaneous dialogue used to co-construct knowledge and contributed to collaboration. There was constant shifting between scripted and unscripted discourse throughout meetings which was orchestrated by experienced clinicians. Rather than fragmenting the discussion, this shifting enabled shared decision making. This research provides further insights into the interprofessional work performed during interprofessional meetings. The scripted discourse was highly influenced by artifacts (communication tools) in meetings, and these were used to ensure organizational imperatives were met. Unscripted discourse facilitated not only new insights and decisions but also social cohesion that may influence work within and outside the meeting. [ABSTRACT FROM AUTHOR]

Quality early care and education (ECE) presents an unparalleled opportunity to avert disadvantage and promote children's development. Mealtimes are essential daily routines, yet are often overlooked in research on ECE quality. This paper crystallises a composite case study of ECE mealtimes in highly disadvantaged communities by combining Departing Radically in Academic Writing (DRAW) methodology with parent surveys, scorings of educator‐child interactions (inCLASS), and field notes. Poverty is perpetuated in these centres: children do not have enough food, and educator‐dictated feeding practices restrict children's opportunities to exercise their agency and learn. Systemic policy action is needed to address poverty in ECE. [ABSTRACT FROM AUTHOR]

Research on foster youth often focuses on risk, rather than adaptation, strengths, and assets. Some researchers have shifted the narrative by examining resiliency, but there is limited understanding on how to define and measure resilience specifically among current and former foster youth. This study begins with a meta-synthesis of the qualitative research (n = 31, 1990-2020) that discuss resilience with foster youth. We then examine data from twenty-two qualitative interviews regarding resilience with key stakeholders in child welfare. The findings inform an understanding of resiliency that is inclusive and culturally responsive to current and former foster youth. [ABSTRACT FROM AUTHOR]

Engaged communication between mother and a child in their early developmental stages is one of the predictors of children's development of higher-order thinking skills. For deaf children, this engaged communication between mother and child hinges on the home language environment (HLE) being fully accessible to the child. This research uses agogical phenomenology in exploring the lived experiences of participants' HLE where sign language is used, with particular focus on the opportunities for extended discourse. Data were collected via semistructured interviews with the deaf children and their parents and observations in the HLEs of five signing families with at least one deaf child in the southwestern United States. The aim of this study was to document and provide insights into how language use in deaf children's HLE can impact their knowledge development; these insights uncovered the essence of reciprocal and contingent family interactions as a central aspect of the deaf child's HLE. It is hoped that the qualitative phenomenological findings will frame subsequent quantitative investigations of the variability in language access to home language components. [ABSTRACT FROM AUTHOR]

Social prescribing link workers are recently introduced roles in English primary care. One of their intended functions is to support patients with conditions influenced by the wider, social determinants of health. Their main purpose is to connect people to community resources to meet their nonmedical needs. However, our research reveals that link workers provide not only connections but also what we have described as "holding" for individuals with complex needs, who lack informal networks of support or who are waiting to access services. We explore the concept of holding, its meaning and significance in this context, and consider its consequences. As part of a realist evaluation, we observed seven link workers in GP practices in England during focussed ethnographies over a 3‐week period. We took field notes and interviewed 61 patients and 93 healthcare and voluntary sector professionals. Nine to twelve months later, we carried out follow‐up interviews with forty‐one patients, seven link workers, and a link worker manager. We identified four functions of holding: supporting patients waiting for services, sustaining patients as they prepare for change, reducing the emotional burden of primary healthcare professionals, and bearing witness to patients' distress. Holding appears to be a vital but often overlooked aspect of social prescribing. Patients benefit from having a reliable and consistent person to support their emotional needs. However, similar to the impact of holding on other primary care professionals, there are unintended consequences: some link workers exceed their capacity, become overburdened, experience burnout, and leave their job. Recognizing the importance of holding and understanding its role in link workers' primary care responsibilities are critical. If holding work is accepted as a role for link workers, providing training and support to them should be prioritised to ensure successful implementation and positive outcomes for patients, link workers, and primary healthcare staff. [ABSTRACT FROM AUTHOR]

The death of a child in the intrauterine stage has legal, psychological, spiritual, and health-related connotations that condition the woman's experience. To understand better the processes set in motion around early pregnancy loss, this ethnographic study explores the experiences of miscarriage in a group of 15 women. The following themes are analyzed: Experience of losing the child, spirituality, health care, and the need to physically recognize the child. The study shows that the need women have to honor the child who did not live may be conditioned by the perception of an uncertain loss and by the absence of a place to honor him/her. Attitudes among professionals are revealed that could be perceived as gender-related abuse. The care of women places emphasis on physical aspects, underlining the lack of comprehensive care during the grieving process. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to contribute to an understanding of the role deployment of advanced practice nurses (APNs) in French healthcare settings. Introduction: The introduction of APNs was formalised in France by the decrees issued on 18 July 2018, which described the areas, activities and training of APNs. Background: A qualitative study on the role implementation of APNs was conducted between July 2021 and May 2022 following a call for projects launched by the Île‐de‐France Regional Health Agency to evaluate the deployment of APNs in the area. Methods: Data were collected through field observations and semi‐structured interviews in order to explore both the APNs deployment processes in nine healthcare structures and the roles played by APN networks and associations with regard to the deployment of APN activities in their working environments. Results: The projects proved to be evolutionary, and their development was marked by various forms of APN isolation and multiple obstacles that were specific to their professional practice settings. Some APNs relied on a variety of forms of mutual assistance and advocacy deployed throughout APN networks and associations. Discussion: The deployment of APNs' role was impacted by diverse configurations of professional power relations and the nature of the obstacles that were structural for APNs in primary care. Their experience of isolation derived from the novelty of their role, the challenge they posed to the cohesion of the nursing profession and a lack of supportive policies for their deployment. Their participation in APN networks and associations enabled them to access advocacy and manage the uncertainties and unknowns related to the deployment of their activities. Conclusion: The results suggest that the formalisation of schemes for mutual assistance among APNs and advocacy should be integrated into the guidelines for the implementation of their role. Implications for nursing policy: APN policy should strengthen a bottom‐up approach, relying in particular on the development of different forms of collaboration and communication between APN networks and associations on the one hand and the public authorities on the other. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to develop a clinical support tool for osteoporosis clinic providers to support risk assessment and referrals for evidence‐based exercise therapy programs. Methods: A sequential Delphi method was used with a multidisciplinary group of national falls experts, to provide consensus on referral to exercise therapy for patients at risk for falls. The Delphi study included a primary research team, expert panel, and clinical partners to answer the questions: (1) "What patient characteristics are needed to develop a clinical support tool?"; (2) "What are the recommended exercise referrals for patients with osteoporosis at risk for falls?" The consensus process consisted of two rounds with 8 weeks between meetings. Two qualitative researchers analyzed the data using a modified version of a matrix analysis approach. Results: The following were the most important variables to include when determining exercise therapy referrals for patients with osteoporosis: Patient history and demographics, falls history over the last year, current physical function and balance, caregiver and transportation status, socioeconomic and insurance status, and patient preference. Potential exercise therapy referrals included one‐on‐one physical therapy, group physical therapy, home health, community‐based exercise programs, and not acceptable for exercise therapy. Conclusions: Patient characteristics including patient history, physical function and balance performance, socioeconomic and insurance status, and patient preference for exercise therapy are important to inform both the medical provider and patient with osteoporosis to choose the most appropriate exercise therapy referral. Adoption of the algorithmic suggestions may have a significant impact on uptake and adherence to exercise therapy, ultimately improving patient physical function and reducing falls risk. [ABSTRACT FROM AUTHOR]

In this article, we describe the exploration of the content and quality of annual goals included in the Individualized Education Programs (IEPs) of students with disabilities in one rural U.S. school district. We utilized content analysis to understand the district's service delivery model comprehensively. Findings revealed disparities between inclusive placements and special education service delivery, suggesting that, despite high rates of inclusive placements noted on IEPs, most services occurred outside general education classrooms, especially for students with intellectual and developmental disabilities (IDD). We evaluated the quality and rigor of 546 annual goals using a rubric adapted from Kurth et al. Only 37.7% of goals were rated as rigorous, highlighting a need for clearer, more specific, and applicable goals. Notably, communication goals for students with IDD were largely absent, raising concerns about support for meaningful participation in general education settings. In addition, special factors related to communication and assistive technology were not consistently addressed in IEPs. We discuss implications for improving educational experiences for students who qualify for special education services under IDD in rural schools and highlight the value of further research and actions in this area. [ABSTRACT FROM AUTHOR]