Search

Migration to South Africa is motivated by the pursuit of employment, safety, and improved living conditions. However, immigrants encounter significant challenges, such as restricted access to essential services, which were exacerbated by the COVID-19 pandemic. This paper investigates the impact of the COVID-19 pandemic on Malawian immigrants in South Africa, addressing the lack of attention given to this immigrant population by highlighting their vulnerabilities. Using a qualitative exploratory and descriptive approach, in-depth interviews were conducted with 24 Malawi immigrants who were over 18 years old and had established residency in South Africa before the onset of the COVID-19 pandemic. Five key stakeholders were also interviewed for additional perspectives and to ensure triangulation and improve data reliability. The interviews were transcribed verbatim and analyzed using thematic analysis strategies and coding with Nvivo12 software. The study highlighted the exacerbated struggles of Malawian immigrants in South Africa amid the COVID-19 pandemic, uncovering systemic discrimination in healthcare, marked by longer wait times and reluctance from health workers to treat undocumented immigrants. The study also revealed a dire security situation, with immigrants living in high-crime areas and feeling particularly targeted due to their foreign status, a situation worsened by the pandemic's economic effects. Additionally, the economic downturn induced by COVID-19 significantly impacted employment opportunities, with many immigrants facing prolonged unemployment and job losses, especially in sectors where they traditionally found work. The detailed accounts of participants highlight not only the multifaceted challenges imposed by the pandemic but also the critical need for inclusive policies and support systems that ensure healthcare access, safety, and economic resilience for immigrants, particularly during global health emergencies. Future research should focus on effective interventions for socioeconomic integration and well-being, particularly for immigrants from other African countries. [ABSTRACT FROM AUTHOR]

The last three census data highlighted that UK Bangladeshi communities have the worst health outcomes. This includes a higher risk of type two diabetes and heart diseases; both are risk factors for developing vascular dementia. However, little is known about Bangladeshi community members' understandings of dementia, including cultural myths. This paper focuses on the cultural myths, superstitions, and stigma surrounding dementia in an English Bangladeshi community from the direct experiences of people living with dementia, their caregivers, and the views of dementia service providers/stakeholders. This qualitative research was undertaken with three distinct participant groups using semistructured interviews (n = 25), who were recruited from community settings. The first and second participant groups explored the experiences of people with dementia (n = 10) and their family caregivers (n = 10). The third group examined stakeholders'/service providers' views (n = 5). Interviews were recorded digitally and transcribed verbatim. Findings were reached using an interpretive approach, emphasising the sense people make in their own lives and experiences and how they frame and understand dementia. The study revealed that participants with dementia and their caregivers have "alternative" knowledge about dementia and do not necessarily understand dementia in a Westernised scientific/biomedical context. Misconceptions about dementia and belief in various myths and superstitions can lead people to go to spiritual healers or practice traditional remedies rather than to their GPs, delaying their dementia diagnosis. This paper concludes that there is a lack of awareness among the Bangladeshi participants and a need for targeted awareness about dementia to help dispel cultural myths and combat the stigma surrounding dementia within the Bangladeshi community. [ABSTRACT FROM AUTHOR]

Given the aging population, finding solutions to retain optimal cognitive capacity is a research priority. The potential of physical activity to reduce the risk of cognitive decline and to enhance cognitive functioning is established. Combining physical with cognitive activity has been put forward as a potentially even more effective way to promote healthy cognitive aging. Most studies on combined interventions have however been conducted in laboratory settings. This paper reports on a two-phased pilot study evaluating the acceptability and feasibility of a newly developed real-life cognitively enriched walking program for adults aged 65+ years. In Phase I, the feasibility and enjoyability of the cognitive tasks was evaluated by conducting walk-along interviews with older adults (n = 163). In Phase II, the cognitively enriched walking program was piloted in two groups of older adults (n = 19), and the feasibility and acceptability of the program and cognitive tasks was evaluated by means of questionnaires and focus groups. The cognitive tasks (i.e., median scores of ≥3 on a total of 4 (Phase I) and ≥6 on a total of 10 (Phase II) for most of the tasks) and the cognitively enriched walking program (i.e., median scores of ≥7 on a total of 10) were considered feasible and acceptable. Based on the input of the participants, key considerations for a feasible and acceptable program were defined: participants should be sufficiently challenged cognitively and physically, social interaction is an important motivator, cognitive tasks should make use of stimuli reflecting daily life and be conducted in group, the rationale for the tasks should be explained to participants, the frequency of the group sessions should be maximum 2 times a week, and the program should be supervised by a trained coach. These results warrant future research to establish the effectiveness of this program. [ABSTRACT FROM AUTHOR]

There has been an increasing acknowledgement in the UK of the importance of recognising frailty as a condition that leaves older people vulnerable to dramatic, sudden changes in health triggered by seemingly small events. In policy, the approach to managing frailty is often an emphasis on staying well with limited consideration to frailty as an end-of-life phase. Meanwhile, discharge from hospital continues to be complex. Overstretched acute hospitals are juxtaposed with community and social services that struggle to keep up with the demand of those being discharged and the labelling of older people as "bed blockers" at the centre of delayed discharges. This paper reports a study underpinned by constructivist grounded theory methodology, with the aim of exploring the experiences and perceptions of stakeholders. Semistructured interviews were conducted with 57 participants including patients, their informal carer(s), community hospital staff, community health professionals, and care home managers. The core category of "the drive to discharge conveyor belt" was derived from data analysis. A significant finding of this study was that of the carer, their burden, and their intrinsic role in facilitating discharge, filling in gaps in services, coordinating services, and enabling the patient to stay at home, with little consideration of their choices or autonomy. The "drive to discharge" impacts older people, their informal carers, and health professional. This study suggests how they may be supported, through an ethical lens. [ABSTRACT FROM AUTHOR]

Social participation is positively related to mental health recovery and wellbeing, yet people with mental health problems are often socially isolated. This article investigates how social participation was incorporated into an Australian-integrated program that aimed to improve the wellbeing of people with chronic mental health needs. The data are from a longitudinal evaluation of the integrated program, including data linkage (5533 participants) and interviews (111). The paper uses concepts from the network perspective of social capital (bonding, bridging, linking, horizontal, and vertical) as lenses to re-examine the evaluation's findings about the consumers' social participation in life areas (social, leisure, and productive) facilitated by the program. This social capital perspective offers a lens to examine the breadth and intensity of participation experienced by the consumers taking part in the support program. The article adds to the literature about how service providers can improve social participation and therefore consumers' opportunities for recovery and wellbeing. The analyses found that the support increased people's social interaction and their capacity in the community. Their social interaction was mostly with other people in the service. Often their interactions in the community were only transactional. Few consumers participated in activities in productive life areas, and few of the activities promoted vertical social capital in social networks outside the service. The implications are that service providers need greater attention on facilitating a variety of social participation activities that can extend mental health consumers' horizontal and vertical social capital and so further contribute to their current and future recovery and wellbeing. [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]

Internationally, community healthcare is provided by personal health budgets or personalised schemes as part of a consumer-directed care emphasis. Although the introduction of a personalised scheme in Australia has improved the lives of many, people with psychosocial disability (PSD) and their families have experienced many challenges with service integration. Six focus groups with 17 National Disability Insurance Scheme (NDIS) support workers were conducted between June and November 2022. Participants were asked semistructured questions about their engagement with emergency department (ED) clinicians when presenting with a person with PSD and NDIS plan. They were also asked how they contribute to service integration to improve communication practices between the two services. A qualitative, descriptive thematic analysis approach was used. Results indicate there is a need for improved service integration pathways between the ED and NDIS services. The thematic analyses identified five main themes: the ED is harmful and not safe, but nowhere else to go; make the ED safe; further training for ED staff; improving communication across services; and alternatives to the ED. This study reports NDIS support worker's experience when supporting a person they are caring for in the ED. NDIS support workers have an understanding of the needs of the people they care for;their wisdom can contribute greatly to ED clinical responses in crisis care. Recommendations are offered to assist with service integration between the two systems. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic significantly endangers the development of at-risk young adults across various life domains, with potential enduring consequences. Despite prior reporting on the pandemic's adverse effects on these individuals, there is a lack of the empirical literature regarding their resilience. Building upon the stress process model (Pearlin, 1978), we explored the challenges of 20 at-risk young adults (aged 18–25 years) and the strategies and resources they employed to cope with these challenges during this period. Thematic analysis revealed that these young adults struggled with worsened family relationships, loneliness, mental health issues, and setbacks in their quest for independence and autonomy. However, resources and character strengths that facilitated coping strategies during this period also emerged, specifically the motivation to become a role model within their family, personal abilities, and the use of formal and informal support. Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

Moving into a nursing home is a significant transition for older people which can be emotional and stressful. The literature on the decision to move and subsequent residential stress focuses on the time after admission; however, there is less understanding of older people's management of the process. To fully understand and possibly reduce negative consequences and health-related risks, the aim of this article is to explore how older people manage the transition from home to nursing home. The study is based on 21 longitudinal interviews with seven older people during the process of moving. Following Dorothy Smith's theory of work, the analysis finds three types of work—practical, relational, and emotional—that older people engage in during the transition process. The results highlight the importance of considering the entire transition process, not only experiences before or after, if we are to reduce the negative, stress-related consequences of relocations of this kind. The findings have practical implications for professionals in health and social care and point to the need to develop practical, relational, and emotional support for older people throughout the transition process. [ABSTRACT FROM AUTHOR]

Background. During the COVID-19 pandemic, people affected by cancer were in need of information about the virus and about the (self-) management of cancer symptoms and treatment. It is important to understand how patients with cancer navigated through the pandemic and to explore their experience relating to their supportive care needs. Aim. This study aimed to describe the experience of Swiss oncological patients during the COVID-19 pandemic with additional supportive cancer care. Methods. A single-center study was conducted in 2021. Patients with melanoma, breast, lung, or colon cancer who received active systemic anticancer treatment at the time of the COVID-19 pandemic and who were additionally seeing either oncology clinical nurse specialists, integrative medicine physicians, or both were included. We conducted semistructured interviews alongside the patient-reported quantitative assessment of distress and resilience. Thematic analysis was performed for the qualitative data and descriptive statistics for the quantitative data. Results. Eighteen patients with cancer were interviewed. Patients seeing an integrative medicine physician highlighted that they positively felt being addressed as a whole person during the consultations. The oncology clinical nurse specialists were perceived as the first point of contact for the patients and had more time during the pandemic compared to what the patients normally received. In general, patients did not experience delays or disruptions in their cancer treatment. As immunosuppressed and fatigued patients with cancer, they felt supported by the restrictions and hygienic measures. Access to vaccination reassured patients against the risk of infection. These results were reflected in the quantitative data, as we found moderate distress levels (M = 4.1; SD = 2.5) and high resilience scores (M = 7.5; SD = 0.9) in this patient population. Conclusion. During the COVID-19 pandemic, patients with cancer felt particularly supported by integrative medicine and cancer nurse consultations. Secured resources for nursing consultations and integrative medicine services can help to address the supportive care needs of patients with cancer. [ABSTRACT FROM AUTHOR]

Despite efforts to acknowledge diversity among unpaid caregivers, Canadian research, advocacy, practice, and policy tend to be based in and to reproduce dominant social and institutional expectations and assumptions about who provides unpaid support and why, and what this support looks like. The objective of thtudinal, qualitative research study. In that study, qualitative case study interviews were conducted with twelve home care clients, their identified family or friend caregiver, home care aide, case coordinator, and agency supervisor (129 interviews in total). Case study profiles compiled over time generated deeper information about the availability and capacity of informal sources of support for these clients, which prompted abductive analysis in relation to dominant assumptions typically made about caregivers in research, policy, and practice. Specifically, only one case (participant) had a caregiver whose profile closely matched dominant conceptualizations. In the remaining eleven cases, we found situations wherein: (a) caregivers grappled with physical or mental health challenges limiting their participation in care (sometimes meaning the client is themselves a caregiver, or the caregiver is also receiving home care services); (b) caregivers facing burnout sought to delimit their participation in care; (c) caregivers' participation was limited by older adults' reluctance to accept their help; (d) caregivers were largely unavailable, unreliable, or peripheral; or (e) client's unpaid support networks were diffuse without a clearly central or identifiable "caregiver." Findings are used to nuance and problematize widely held assumptions about caregivers, particularly their availability and capacity. Discussion highlights the need for research, policy, and programs related to unpaid caregiving to better reflect the lived realities of this support for older adults and often overlooked sources of diversity in caregiver circumstances and roles. [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]

Community engagement (CE) has long been endorsed by policy makers and health practitioners. However, uncertainties remain about the workings and outcomes of CE. This study aims to provide in-depth insights into them. In a multiple case study, we investigated three participatory health promotion projects for families in vulnerable situations in the Netherlands. We adopted a realist approach combined with a theory of change (ToC) model. We then analysed the qualitative data for context–mechanism–outcome (CMO) configurations to refine this ToC. Results show that CE can strengthen social networks, empower families, and increase perceived health. However, specific contexts in combination with CE project approaches may or may not trigger positive responses. Participants may feel that they matter when asked to actively contribute to a project, which in turn can enhance their self-confidence. In another context, we found that families were overwhelmed by the responsibilities given to them in the project, leading to feelings of stress and withdrawal from the project. We present a list of CMO configurations and refine the ToC accordingly. Our main conclusion is that flexibility is key when CE is implemented in health promotion. Also, our findings question physical health outcomes as a realistic ambition for CE projects with groups in vulnerable situations. [ABSTRACT FROM AUTHOR]

Dementia is recognised as one of the major global health and social care challenges of present times. When the onset of dementia occurs in midlife, there is an increased possibility that there are children and young adults involved who are dependent on the parent concerned. The aim of the study was to describe health and social care professionals' experiences of identifying and supporting children and young adults with a parent with dementia. A qualitative descriptive approach was carried out with individual interviews of health and social care professionals, using a semistructured interview guide. Thirteen participants in rural and urban areas in Sweden were interviewed. The overarching theme, advocating a forgotten group with three categories were identified. They combine and reflect health and social care professionals' experiences of identifying and supporting children and young adults with a parent with dementia. Health and social care professionals who encountered children and young adults with a parent with dementia described how they were not sufficiently trained in supporting this group and identified a general shortage of available appropriate support services. The children and young adults were also described as a forgotten and overlooked group in need of affirmation and support in a more systematic way. [ABSTRACT FROM AUTHOR]

Background. Improving the recruitment and retention of healthcare workers in the continuing care sector is critical to ensuring adequate care for older adults, which was highlighted following the COVID-19 pandemic. Purpose. The purpose of this study was to understand the perceptions of prospective registered nurses about working in the continuing care sector and identify workplace attributes that attract prospective nurses to the sector. Methods. A sequential mixed methods study was conducted with nursing students at Ontario Tech University. Focus groups (n = 14) asked students to comment on views about working in the continuing care sector, and job attributes that may attract them to the sector. Focus group data were analyzed using thematic analysis. Subsequently, a cross-sectional survey asked students to respond to elicited choice job scenarios that varied job attributes. The job attributes were shaped by the focus group interview data. To assess respondent's preferences, the survey data (n = 139) were analyzed to generate willingness-to-pay (WTP) values for each job attribute. Results. Focus group interviews suggested that fair compensation, optimal client-to-staff ratios, unionized work environments, comprehensive benefits packages, and flexible work arrangements were important job attributes. In survey results, 18.0% expressed interest in working in the continuing care sector compared to 75.5% in acute care. Regression analysis suggested that higher amounts of paid vacation (WTP: −5.983; 95% CI: −13.749 and −0.037) and higher risk of injury (WTP: 0.684; 95% CI: 0.124 and 1.208) were associated with work in the continuing care sector. Impact. Continuing care workplaces can attract nurses by offering flexible options such as part-time positions and paid vacation and by taking actions that can mitigate the risk of workplace injury, violence, and abuse. Nursing students should be shown the positive aspects of working with older adults and dispel negative perceptions about the continuing care sector. Further research is needed to understand the preferences for work and risk perceptions among currently employed nursing staff. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, the well-being of older adults has been highlighted as a significant public health concern. In this study, we investigated the role of psychological resilience in mediating the relationship between positive self-perceptions of aging (SPA) and the subjective well-being (SWB) of community-dwelling older adults in Taiwan during the pandemic. We collected data through face-to-face interviews conducted from October 2021 to February 2022, involving 1,095 participants aged 50 years or above residing in a southern city in Taiwan. More than half of the study participants were female, aged 65 or older, and had less than a high school education. More than two thirds were married and/or living with partners. More than a third had two or more noncommunicable diseases. We calculated scores for SWB, positive SPA, and psychological resilience and examined correlations among the outcome and predictor variables. Our findings indicated that higher positive SPA was significantly associated with better SWB among community-dwelling older adults in Taiwan and that this association was mediated by psychological resilience. Specifically, after controlling for covariates, structural equation modeling (SEM) analysis revealed a significant main effect of positive SPA on SWB (b = 0.412, β = 0187, and p < 0.001), while bootstrap mediation analysis showed a statistically significant indirect mediating effect from positive SPA on SWB via psychological resilience (0.597, 95% bootstrap CIs = [0.445, 0.749], and p < 0.001). These findings highlight the potential importance of cultivating positive self-perceptions of aging and implementing resilience-centered interventions to promote well-being among Chinese older adults in the community. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected all aspects of professional disciplines including occupational therapy; however, little is known about how much of an impact the COVID-19 pandemic affected occupational therapy practice in Ghana. This study examined the impacts, coping strategies, and COVID-19 pandemic lessons for occupational therapy practices in the future. A descriptive qualitative design was employed with a purposive and convenience sampling methods to recruit occupational therapists from four practice settings in Ghana. Semi-structured interviews were conducted with seven participants. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Four major themes were identified from the analysis enlightening stakeholders on the impact and preparation for minimizing the impact of future pandemics on the workloads of an occupational therapist. The major themes are (1) impacts of the COVID-19 on occupational therapy practice and practitioners; (2) aspects or domains of work significantly affected by the pandemic; (3) the existing strategies employed to handle the challenges; and (4) strategies to minimize these challenges in the future. The current study has enlightened stakeholders on the need to make alternate preparations including telehealth, continuous support for telehealth infrastructures, training of practitioners, and research to adapt intervention strategies effectively. [ABSTRACT FROM AUTHOR]

The recruitment and retention of in-patient psychiatric mental health registered nurses (PMH-RNs) remains a challenge. This qualitative study sought to identify factors impacting the recruitment and retention of PMH-RNs in acute-care settings. Participants (N = 15) were recruited for focus groups including one with in-patient unit administrators (n = 4), two with current PMH-RNs (n = 7), and two with nursing students (n = 4). Data were analyzed using a directed content analysis approach. Participants were informed about the study's purpose, procedures, potential risks, and benefits, and they provided verbal consent before participating. Administrators emphasized a focus on retention and described a variety of supports they provided PMH-RNs, including formal and informal support and education. PMH-RNs' most prevalent concerns were their safety, co-worker and/or management challenges, and emotional and/or physical exhaustion. Students also expressed concerns about safety in psychiatric settings and desired more interaction with PMH-RNs. They were also interested in learning more about the specialty as they valued the opportunity to see change in patients. All three groups mentioned a need for more interaction between students and PMH-RNs, while safety concerns were expressed by both PMH-RNs and students. Because PMH-RNs play a critical role for in-patient psychiatric care, recruiting and retaining specialist nurses can focus on increasing student engagement with the PMH-RNs, attending to PMH-RNs' management and staffing concerns, and providing additional resources for responding to events that threaten safety in the workplace to prevent burnout. [ABSTRACT FROM AUTHOR]

Background. The goal of qualitative research is to learn more about the opinions and experiences of the subjects being studied in relation to a particular question. There is a paucity of information on opportunities and challenges encountered to conduct qualitative research among the academic staffs in the health sciences. The purpose of this study was to examine the opportunities and challenges of conducting qualitative research among academic staff of health sciences in Ethiopia. Methods. A descriptive qualitative study design was conducted among health sciences academic staffs of selected public universities in Ethiopia. The study was conducted at three universities' health sciences colleges, namely, Addis Ababa University, Dilla University, and Wolaita Sodo University. Data were collected using focus group discussions, in-depth interviews, and key informant interviews. MAXQDA 2020 software was used for coding and data management. A thematic analysis approach was followed to present the results. Both inductive and deductive coding approaches were used. Results. Three main themes have been identified as follows: general research practice, opportunities for qualitative research, and challenges to conduct qualitative research. Participants indicated that the availability of research opportunities will have a good impact on qualitative research engagement. Availability of grants, funding, and other incentives and demand for qualitative research in healthcare were described as opportunities for qualitative research practice. Despite the available opportunities, study participants uncovered different challenges that encountered by health academic staffs in conducting qualitative research. Resource limitations, lack of knowledge, negative attitudes or beliefs, publication, and language issues were raised as main challenges. Conclusion. Qualitative research practices were found to be low among health sciences academics. Lack of resources, training, and expertise, problems associated with publication, a lack of funding, and a shortage of experts were the main challenges in conducting qualitative research in health sciences academic settings in Ethiopia. [ABSTRACT FROM AUTHOR]

This research sought to explore the meaning of, preferences for, and involvement in social participation for older people living in nursing homes in Victoria, Australia. A qualitative descriptive study using semistructured interviews with twenty older people living in four geographically and ethnically diverse nursing homes was conducted between 2020 and 2022. Interview transcripts were thematically analysed. All the older people had been very socially active before moving into aged care and had participated in leisure and volunteering activities. Five themes emerged from the data analysis related to the meaning of, preferences for, and involvement in activities for social participation. The meaning of social participation among these older people varied. Some participated in group activities to keep active and busy, while others were content with interests of their own. Social participation in group activities provided older people with a connection to others and assisted in maintaining existing, or developing new, relationships. However, the ability to participate in group activities that offered opportunities for social participation was limited by age-related decline for some older people. The COVID-19 pandemic restrictions constrained activities, which provided opportunities for social participation for some older people living in nursing homes, but not all. These perspectives highlight the need for individualised person-centred opportunities for social participation in nursing homes. Group activities should enable older people to remain active and facilitate social connections that provide meaning and purpose. Respect for individual choice is important, as older people are not a homogeneous group, and opportunities to pursue individual activities should be facilitated. [ABSTRACT FROM AUTHOR]

Introduction. According to the Global Climate Risk Index, Pakistan is ranked as the fifth-most vulnerable country to climate change. Most recently, during June-August 2022, heavy torrential rains coupled with riverine, urban, and flash flooding led to an unprecedented disaster in Pakistan. Around thirty-three million people were affected by the floods. More than 2 million houses were damaged, leaving approximately 8 million displaced and approximately 600,000 people in relief camps. Among those, 8.2 million women and 16 million children are the worst affected, with many requiring urgent medical and reproductive healthcare. To plan an efficient healthcare program and a climate-resilient health system, it is crucial to understand the issues that the affected people face during floods. Methodology. This rapid assessment included the population in the most severely affected districts across the four provinces of Pakistan. A mixed methods approach using qualitative and quantitative techniques was utilized. A total of 52 qualitative, in-depth interviews were conducted with community-level healthcare providers, national and provincial government departments, and development partners involved in relief activities. Using a structured questionnaire, the quantitative cross-sectional survey was conducted with a final sample of 422 women, married and unmarried (15-49 years old), residing in the relief camps in the flood-affected areas. The outcome variable of the survey was the access to sexual and reproductive health services faced by the women in the flood-affected districts. Data collection took place four months postfloods during Nov-Dec 2022, while the data analysis was conducted between Dec 2022 and Jan 2023. The quantitative data was analyzed using SPSS (Statistical Package for the Social Sciences) version 20, and qualitative data was analyzed using NVivo 12. Ethical consent was sought from all the participants. Ethical approval was also sought from the ethics committee of the Health Services Academy, Government of Pakistan. Results. The findings indicated that, overall, all the provinces were unprepared for a calamity of such a large magnitude. Access to services and health data reporting from the flood-affected areas was challenging mainly due to a shortage of trained health workforce because of the displacement of a large volume of the health workforce. Overall, equipment, medicines, supplies, and food were scarce. Women residing in the camps were markedly affected, and 84% (375) were not satisfied with the flood relief services provided to them. The floods impacted their monthly income as 30% (132) of respondents started depending on charity postfloods. Almost 77% (344) reported limited access to sexual and reproductive health services and had yet to receive sanitary, hygiene, and delivery kits, while 69% (107 out of 154) of girls stopped schooling postfloods. Almost 77% (112) of the married women reported having a child less than one year of age. Yet, only 30% (44 out of 144 currently married women) were using any form of family planning method—damage to the health facilities affected access to overall maternal care services. Conclusion. The findings concluded that there was no planning for sexual and reproductive health services in the flood-affected areas. Several barriers were identified. The government and development partners needed to prepare to cater to women's needs during the floods. The findings highlight the need for collaborative efforts between the government, civil society, and development partners to address the challenges faced in disaster management and strengthen disaster management capacity. [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]

Background. As nursing interns enter challenging clinical settings, evaluating their preparation and readiness is vital for adaptation success. Sufficient real-world experience and patient care are crucial preparation components that enable effective practice and higher competencies. Aim. This study aimed to assess nurse interns' perception of clinical preparation and readiness for clinical internship experiences. Methods. A self-administered questionnaire was distributed, comprising three sections on demographics, clinical preparation requirements, and the Casey–Fink Readiness for Practice Survey. Descriptive statistics as the mean and standard deviation, numbers and percentages, linear regression model, and Pearson correlation coefficient were used for reporting normal distribution, categorical variables, and relationship between a scalar response and one or more explanatory variables and to calculate statistics between two continuous variables. Results. The participants were 130 nurse interns who were involved in an internship between 2016 and 2020, 50% of the nurse interns. They had a moderate level of clinical preparation, and 28.5% of them exhibited a low level. In addition, 53.8% were found to be moderately ready for practice, while 22.3% had a low level of readiness Conclusion. The observed significant positive correlation between perceived preparation and readiness underscores the pivotal role of clinical preparation in influencing practice readiness. Implications. These findings emphasize the importance of targeted interventions aimed at enhancing clinical preparation to directly bolster overall readiness for professional practice among nurse interns. [ABSTRACT FROM AUTHOR]

Background. Chemotherapy can cause a range of side effects including nausea, vomiting, diarrhea, and infection, which can have a significant impact on an individual's quality of life. Survival outcomes can be impacted when side effects are poorly managed, leading to failure to complete the defined dose of treatment. Objective. This study presents clinicians' experiences with a shared care model involving home-based community nurse (CN) support to improve side-effect management of individuals receiving chemotherapy as an outpatient. Methods. A qualitative study was conducted with CNs, cancer nurses, medical oncologists, and a general practitioner involved in the CN intervention delivered as part of a randomized controlled trial (RCT) aimed at reducing unplanned presentations to hospital of cancer patients receiving outpatient chemotherapy. Semistructured individual and focus group interviews were conducted. Key themes were identified using thematic analysis. Findings. Twenty-three healthcare professionals were interviewed. Three themes were identified: (1) being able to enhance patient-centered care and clinical practice during chemotherapy; (2) importance of effective communication and collaborative relationships between different care settings; and (3) ways to adapt the intervention for implementation in routine clinical practice. Participants reported that it was feasible for CNs to care for this patient group, and their home visits enabled preemptive symptom management. Suggestions to improve and modify the intervention to implement this care model within existing clinical care included a flexible approach, such as a blended delivery with face-to-face visits and telephone calls; a risk- or needs-based approach to prioritize patient groups more likely to benefit from the intervention; and sharing of electronic medical records for more effective collaboration and communication. Conclusions. A CN-delivered shared care model provided a feasible approach to the provision of individualized support for outpatients receiving chemotherapy. This study suggests ways to adapt this care model into existing clinical workflow and structures. This trial is registered with ACTRN12614001113640. [ABSTRACT FROM AUTHOR]

Background. Nepal, currently facing a high burden of noncommunicable diseases (NCDs), including cardiovascular diseases (CVDs), which poses the highest mortality rate in the country, does not seem to have a proper referral strategy. This study explored the wide range of factors and challenges that affect the referral system of CVD cases in Nepal. Methods. In this qualitative study, we conducted face-to-face and telephone interviews with purposely selected 57 key participants which included 35 healthcare professionals from tertiary, secondary, and primary levels from Bagmati Province and 22 CVD patients (myocardial infarction and stroke) from Bagmati and Madhesh Provinces. We interviewed them using an interview guide with open-ended questions for in-depth information in a local language and in a private space. The interviews were audio-recorded, transcribed verbatim, coded, and analyzed using the thematic approach. Results. The findings indicated that the referral system for CVD cases from primary- to secondary- to tertiary-level care is inadequate and malfunctioning. The major factors affecting referral of CVD cases are centralization of CVD-specific services in few urban areas, inadequate systematic communication between the centers, self-referential, lack of human resources for CVD care, and obstacles to patient transfer due to geographical and financial reasons. Conclusion. A referral system for CVD patients is absent in the context of Nepal. Understanding and addressing key factors that affect the referral system of CVD patients may help to improve cardiac outcomes and ultimately save lives. [ABSTRACT FROM AUTHOR]

The aim was to explore why registered nurses (RNs) in Sweden choose to quit their jobs in hospitals, also in relation to experienced patient safety. Previous research has shown that nurse turnover, especially in hospital settings, is a serious challenge for society and health care globally. Insufficient staffing of RNs is linked to poorer patient outcomes and a general patient safety at risk. It is, therefore, important to continually explore how nurses describe their reasons for quitting their jobs. The study was conducted using a qualitative descriptive design, based on 11 semistructured interviews with RNs. The analysis generated four categories describing the results: Feeling that the profession is not valued; Psychological and physical symptoms related to work; An insufficient and unsupportive organization; and Unsatisfying leadership and teamwork. Specifically, the RNs participating in this study described a range of reasons for quitting, where the feeling of not being valued and treated as a respected and autonomous profession was a common thread throughout the results. RNs experienced that, overall, the insufficient work conditions, also resulting in lower patient safety, ultimately led to their decision to quit. The findings highlight the crucial need for employers to develop working conditions for RNs, to make sure that the profession is valued according to professional standards and provide the potential for autonomous nursing practice. To reduce nurse turnover, and instead attract and retain nurses, leadership and management in nursing need to be adjusted to meet the demands of a modern academic profession. [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]

Background. Compared to nurses in other hospital departments, intensive care unit (ICU) nurses have more frequent exposure to patient deaths, potentially rendering them more susceptible to experiencing professional grief following patient fatalities. Objective. To explore the coping experiences of ICU nurses following their encounter with professional grief. Methods. This study utilized a qualitative research design based on Heideggerian phenomenology. A purposive sample of 18 ICU nurses was selected from six tertiary hospitals in Guangdong Province, China. Individual semistructured interviews were audio-recorded and transcribed verbatim. The transcribed texts were analyzed using interpretative phenomenological analysis. Results. Two main themes emerged: (1) short-term dual coping with professional grief and (2) long-term cumulative changes from professional grief. These themes reflect the dynamic coping processes experienced by ICU nurses amidst frequent encounters with loss and grief during their clinical work. Conclusions. ICU nurses employ both adaptive and maladaptive coping strategies to address professional grief, significantly impacting their personal and professional well-being. It is advisable to offer targeted education and organizational support systems for ICU nurses to promote positive cumulative growth when they repeatedly encounter patient deaths. [ABSTRACT FROM AUTHOR]

Bereaved mothers with a deep bond to their sick child experience a distinct grieving process. This study delved into how Korean bereaved mothers come to terms with their child's death from cancer by exploring their bereavement and adaptation processes. In-depth interviews with 15 bereaved mothers yielded 14 subthemes within three overarching themes. These themes included the diverse coping mechanisms employed by the participants, attribution of meaning to their children's deaths, and personal growth intertwined with their experiences. These findings underscore the critical need for professional support to assist these mothers in their search for meaning and coping with the loss, particularly in the context of the unique cultural context of Korea. Understanding cultural variations is crucial for expanding the knowledge base in this field and advancing culturally informed interventions to support mothers who grapple with the loss of a child due to cancer across varied cultural settings. [ABSTRACT FROM AUTHOR]

Background. There are many different haematological malignancy subtypes. Most follow chronic pathways that are uncertain and unpredictable, which may lead to feelings of anxiety and distress. The provision of information can ameliorate such difficulties, but patients are known to have unmet needs in this regard. The aim of this study is to explore experiences of information sharing among patients with chronic blood cancers and the factors impacting this process. Methods. The study is set within a UK cohort of blood cancer patients, where care is provided across 14 hospitals according to national clinical guidelines. Purposive sampling was used to identify expert participants (based on experience), and in-depth qualitative interviews were conducted with 35 patients, 10 with a relative present. The study was intended to inform practice and utilised qualitative description, with thematic content analysis and systematic data coding. Results. Experiences of information sharing varied. Most patients described this positively, but not all. Several barriers and facilitators were identified, which are discussed within five themes: (1) shock affects ability to process information, (2) the importance of time to facilitate information exchange, (3) personal relationships have an impact on meeting information needs, (4) HCP interpersonal skills are central to good information sharing, and (5) communication skills and terminology. Conclusions. Patients with chronic blood cancers prefer to engage in information sharing when they are not in a state of shock, and when they have adequate time to process material that is effectively and sensitively delivered, by HCPs they know and trust. [ABSTRACT FROM AUTHOR]

Purpose. To examine attitudes regarding acute hospital at home (AHaH). Materials and Methods. A SWOT (strengths, weaknesses, opportunities, and threats) questionnaire was developed to interview 14 managers from health management organizations (HMOs) and hospitals. A mixed-method (qualitative/quantitative) analysis was used. Results. AHaH was provided by hospital or HMO staff or outsourced (private suppliers). Differences in service pertained mainly to on-site testing and imaging tools. All agreed that AHaH is favorable for patient outcomes and experience and that AHaH promotes medical service and clinical development. Barriers expressed were as follows: choosing the right patient; burden for caregivers and family; unclear financial incentive for providers; insufficient standardization, risk management, and quality control (expressed mainly by hospital representatives); and limited on-site testing, imaging, and telemonitoring (mainly expressed by HMO representatives). Conclusions. To increase use of AHaH, further development of on-site testing, imaging, telemonitoring, standards, and financial planning is needed. Research regarding quality and quantity, mid- and long-term medical implications, caregiver implications, and long-term systemic financial implications is required. Evaluating the fit between AHaH service provider (hospital/outsourced/HMO), patient group, and diagnosis is advised. [ABSTRACT FROM AUTHOR]

Chinese government promoted a family physician contract service system in order to establish a tiered healthcare system in June 2016, but there was little evidence to assess the policy performance. This study aimed to examine the association of family physician contract services with the healthcare utilization of community residents in urban China. A cross-sectional face-to-face survey was conducted from July to September, 2019, in four advanced and exemplary cities for family physician contract services in China. A multistage cluster random sampling method was adopted to recruit residents aged 18 and above, and a total of 1508 participants were included in this study. The count model and logit regression were adopted to examine the associations between family physician contract service and healthcare utilization, and the potential bias was addressed using the propensity score matching (PSM) method. There was an increase in number of monthly primary care visits and annual referrals for contracted residents compared to noncontracted residents. Participants who had contracted with a family physician were more likely to choose a primary healthcare facility after illness than those who had not. However, no significant change was found in the number of annual hospital admissions between contracted and noncontracted residents. Family physician contract services may effectively strengthen the use of primary care facilities by community residents and promote the formation of a tiered healthcare system in China. [ABSTRACT FROM AUTHOR]

To address recognized gaps in community rehabilitation service coordination and advance delivery of rehabilitation services for adults living outside of institutions, we have developed a conceptual framework to inform the design of community rehabilitation policy, planning, care, and research. Employing a multimethod qualitative approach, we developed a draft framework based on a document review as well as interviews with community rehabilitation service and system providers, older people receiving community rehabilitation services, and family caregivers. We then consulted with community rehabilitation service and system providers, older adults, and family caregivers to revise the framework. We identified 194 relevant documents and 30 programs, and we analyzed interview data from 29 service and system providers as well as 6 dyads of older persons and family caregivers. We developed a definition of community rehabilitation and identified 11 components for the draft framework, which was presented to 16 participants for consultation. We used their feedback to revise the terms and definitions for the 11 components. We organized the final set of components into two categories: principles (culturally safe; equity-focused; evidence-informed; person and family-centred; restorative) and organization (appropriate; coordinated; continuity; evaluated; stepped; team-based). The contextualized, action-oriented conceptual framework for adult community rehabilitation (CFACR) is supported by older people, family caregivers, and community rehabilitation health system providers. Continued work to refine and validate the components in more population groups and contexts will facilitate implementation and application of the CFACR. [ABSTRACT FROM AUTHOR]

Foodborne diseases, resulting from poor food handling and sanitation practices, are common public health problems globally. The primary contributing factors to potential foodborne disease outbreaks are often attributed to the poor perception and practices of food handlers regarding food safety. This study is aimed at assessing the knowledge, attitude, and practices of food handlers working in public food service establishments in Lemi Kura subcity, Addis Ababa, Ethiopia. A cross-sectional study was conducted from December 2022 to September 2023, involving 400 food handlers from 20 randomly selected public food service establishments. Data were collected using a structured interview-administered questionnaire and an observational checklist. The collected data were entered into Microsoft Excel and then transferred to SPSS version 20 for analysis. Descriptive statistics were employed to summarize the data, and Pearson's chi-square test was used to evaluate the association of sociodemographic factors with the knowledge, attitude, and practices of food handlers towards food safety. Of the 400 food handlers, 65.5% had good knowledge about food safety. All food handlers were knowledgeable that washing hand before handling food will reduce risk of poisoning, bacteria are the main cause of food poisoning, and temperature plays a big role in bacterial growth. This study also revealed that 65.3% of the food handlers had good attitude towards food safety and 55.3% of food handlers had good food handling practice. Based on the observation, 38.5% of food handlers had good food handling practice. Taking training, age, and work experience of food handlers have statistically significant (P < 0.05) association with good attitude towards food safety. Additionally, taking training, educational level, employment, and work experience of food handlers have statistically significant (P < 0.05) association with good practice towards food safety. However, there was no statistically significant association between all sociodemographic factors and knowledge about food safety. Good knowledge and attitude were also associated with good food handling practices of the respondents. Based on the observation, there was a statistically significant association between employment status and good food handling practice. In conclusion, the findings suggest the necessity for implementing formal educational and training programs aimed at positively influencing the knowledge and attitude of food handlers, subsequently improving their food handling practices. [ABSTRACT FROM AUTHOR]

Although grandparents play a significant role in caring for their grandchildren in Asian culture, few studies have examined how grandparents from skipped families care for their children in rural areas. This study aims to explore grandparents' perceptions and experiences in providing care for their grandchildren in rural Thailand, where support is limited. Utilizing a qualitative approach, in-depth interviews and focus group discussions were conducted with 20 grandparents caring for children under 5 years old. The coding of interview transcripts was followed by thematic analysis. In this study, the participants shared their experiences about raising and caring for their grandchildren in rural areas. "We were held in bondage" is the overarching theme. Interviews revealed two main themes: (1) feeling of burden, divided into the following three subthemes: lack of parenting skills, worries regarding grandchildren's health and well-being, and emotional stress and financial/physical strain; (2) maintaining family bonds, which were further divided into the following subthemes: supporting adult children, being parents again, and becoming more loving and bonded. According to the findings, healthcare providers may be able to anticipate the needs of grandparents in rural areas and provide support, culturally relevant interventions, and training programs for grandparents to care for their grandchildren. Further research is essential to explore the dynamics of family bonding and responsibilities in Thai families and to develop interventions supporting these families. [ABSTRACT FROM AUTHOR]

When older people move into a care home, family members often continue to be involved in caregiving. This can include contributing to discussion and decisions about care and treatment, especially when the resident lacks capacity. However, families may not know what to expect as their relative's condition progresses and may not have a good understanding of their relative's end-of-life care and treatment wishes. Therefore, although often willing, families may feel unprepared for making decisions in advance of or at the time of deterioration and end-of-life. The study aimed to explore the potential role that peer-mentors might have in supporting families to prepare for discussion and decisions about care and treatment and to understand what participants would consider to be important characteristics of an effective peer-mentor and peer-mentoring program. The study was guided by the philosophical assumptions of social constructionism. Data from semistructured interviews with 14 current and 15 bereaved family members and 11 senior members of care were analysed thematically. Findings suggest that peer-mentors could help to empower families to prepare to be involved in discussions and decisions about the types of care their relatives might receive as their health deteriorates and they reach the end-of-life. However, it was seen as important that peer-mentors have lived experience of supporting a relative in a care home, strong interpersonal and communication skills, and the ability to discuss deterioration and end-of-life in a compassionate but factual manner. Although peer-mentoring is often time-limited, introducing mentors to families earlier in the care journey, for example, before admission into a care home, could enable a trusting relationship to develop. This, in turn, could facilitate open discussions about what to expect and different care choices as the person's health changes. [ABSTRACT FROM AUTHOR]

Home care (HC) is recommended for older adults who want to live at home as long as possible despite life-limiting conditions. It is more convenient and cost-effective than institutionalization and hospitalization. However, HC for older adults in Iran faces many challenges. The purpose of this study was to explore the perspectives of different stakeholders involved in HC for older adults about their experiences and suggestions for HC improvement. This qualitative study was conducted based on the explorative content analysis approach between 2021 and 2022 in Tabriz, Iran. The participants were selected using the purposeful sampling method, and the data were collected through in-depth semistructured personal interviews. A total of 27 individuals who participated in individual interviews were family members, HC workers (including nurses and unqualified paid caregivers), heads of counseling and nursing care at home centers, and experts who had clinical or research experience in the field of geriatric care. Collected data were categorized into three main themes: defects in home care governance, concern about the efficiency of home care, and caregivers' job security concerns. These themes reflected the problems of HC, such as conflicts between multiple trustees, lack of evaluation and monitoring, inadequate competence and financial barriers of families and caregivers, and poor integration and coordination of services. Therefore, it is recommended to develop a national model for HC for Iranian older adults and allocation of different financial resources for HC, implementing quality improvement and evaluation tools, enhancing the training of caregivers, providing them with adequate compensation and benefits, and ensuring the safety and quality of services. These findings can inform the policymakers and planners of care services about the needs and challenges of this population and facilitate the collaboration among different stakeholders to provide better HC for older adults. [ABSTRACT FROM AUTHOR]