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Contemporary healthcare for those experiencing mental illness requires healthcare practitioners (HCPs) to effectively incorporate the prescription of exercise in their treatment, in accordance with clinical guidelines. However, there has been a lack of effective implementation of such recommendations. The purpose of this review was to identify barriers to exercise prescription in the treatment of people diagnosed with mental illness as perceived by HCPs. APA PsycINFO, CINAHL, MEDLINE, and PubMed electronic databases were searched for relevant articles published in the period from January 2005 to September 2023. A total of 18 papers were included for thematic synthesis. Four key themes were identified across the qualitative (8), quantitative (6), and mixed method (4) papers, including a lack of knowledge and confidence of HCPs in prescribing exercise; role and responsibility; HCPs' misconceptions of client barriers; and systemic issues impacting exercise prescription practices. A lack of knowledge or confidence was the most common barrier. Some HCPs indicated a desire to develop their skills in exercise prescription, while others indicated a preference for an exercise professional to take responsibility for this aspect of treatment. Systemic barriers were spread across a range of issues, with lack of time, excessive workload, and difficulties accessing qualified staff most commonly cited. This review provides further insight into the barriers to exercise prescription faced by HCPs and makes recommendations regarding how to address these barriers in order to better implement clinical guidelines and thus improve the quality of treatment provided to people diagnosed with a mental illness. [ABSTRACT FROM AUTHOR]

This integrative review aims to evaluate the experiences of health and social care practitioners with regard to how they exercise professional curiosity in child protection practice. Professional curiosity gained significant currency following the Munro Review of Child Protection (2010) in England, as a means of seeking clarity on what is happening within a family. However, a recurrent finding from child safeguarding practice reviews is that practitioners continue to struggle to exercise curiosity. This is evident within both the United Kingdom and international literature, although descriptors for the concept may differ. This study attempted to identify facilitators and barriers to applying professional curiosity to provide a greater understanding of this theoretical concept. Title and abstract review of 1428 articles identified from databases and 11 from other sources resulted in 52 papers for full‐text review. The quality of each article was appraised using the Critical Appraisal Skills Programme tool for qualitative studies, the Mixed Methods Appraisal Tool (MMAT) for quantitative/mixed method studies and the Joanna Briggs framework for theoretical/opinion papers. Key findings were recorded in the Summary Table of Literature Reviewed. Data extracts were thematically analysed. Twenty‐four papers predominantly from the UK, but also from Australia, Italy, Sweden and USA formed the data set. Overarching themes that emerged from the thematic analysis included: noticing dissonance, emitting curiosity, constructing meaning, facilitators, individual professional challenges, organisational and macro‐level influences and conceptual development. This review demonstrated that professional curiosity is multifaceted and involves a whole system approach, from empowered, knowledgeable and competent frontline practitioners to creative, innovative and empathic organisations, that value staff contributions and place the child's best interests at the forefront of service development. Recommendations are made for practice and further research. [ABSTRACT FROM AUTHOR]

Aim: We aim to explore healthful leadership practices in nursing and midwifery evident within the COVID‐19 pandemic in the United Kingdom, the contextual facilitators, barriers and outcomes. Background: Globally, the health and care sectors are under pressure and despite nurses and other professionals, demonstrating resilience and resourcefulness in the COVID‐19 pandemic; this has negatively impacted on their health and wellbeing and on patient care. Evaluation: Two searches were conducted in July 2021 and December 2021. Inclusion/exclusion criteria were identified to refine the search, including papers written since the beginning of the pandemic in 2020. A total of 38 papers were included principally from the United States and United Kingdom. Ten were research papers; the others were commentaries, opinion pieces and editorials. MS Teams literature repository was created. A unique critical appraisal tool was devised to capture contexts, mechanisms and outcomes whilst reflecting more standardized tools, that is, the Critical Appraisal Skills Programme and the Authority, Accuracy, Coverage, Objectivity and Date tool for reviewing grey literature to refine the search further. Key issues: Six tentative theories of healthful leadership emerged from the literature around leadership strategies, which are relational, being visible and present; being open and engaging; caring for self and others; embodying values; being prepared and preparing others; and using available information and support. Contextual factors that enable healthful leadership practices are in the main, created by leaders' values, attributes and style. The literature suggests that leaders who embody values of compassion, empathy, courage and authenticity create conditions for positive and healthful relations between leaders and others. Nurse and midwives' voices are however absent from the literature in this review. Conclusion: Current available literature would suggest healthful leadership practices are not prioritized by nurse leaders. Perspectives of nurses' and midwives' about the impact of such practices on their wellbeing is also missing. Tentative theories are offered as a means of identifying healthful leadership strategies, the context that enable these and potential outcomes for nurses and midwives. These will be explored in phase two of this study. Implications for Nursing Management: Nurse leaders must be adequately prepared to create working environments that support nurses' and midwives' wellbeing, so that they may be able to provide high‐quality care. Ensuring a supportive organizational culture, which embodies the values of healthfulness, may help to mitigate the impact of the COVID‐19 pandemic on nurses' and midwives' wellbeing in the immediate aftermath and going forward. [ABSTRACT FROM AUTHOR]

Paediatric Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) is a disabling condition. Schools play a key role in adolescents' experiences with managing ME/CFS. However, little is known about the experiences of adolescents with ME/CFS (and their families) in schools. This paper is an incidental qualitative study, which combines data from two independent ME/CFS studies: study 1 researched ethnic minority adolescents with ME/CFS; study 2 explored Acceptance and Commitment Therapy for adolescents with ME/CFS who had not recovered after one year. Participants included: adolescents with ME/CFS; their families; and medical professionals (ME/CFS specialists and non‐specialists). Adolescents, their families, and ME/CFS medical professionals were recruited from a UK specialist paediatric ME/CFS service. Non‐ME/CFS medical professionals were recruited from the same region. Semi‐structured qualitative interviews and focus groups were undertaken. Participants' views on schools from each study were combined and thematic analysis was used to identify themes. Fifteen adolescents with ME/CFS (11–17 years old), sixteen family members, and ten medical professionals (GPs, school nurses and ME/CFS specialists) were interviewed. Four key themes were found: (1) adolescents identified school was important for aiding ME/CFS recovery, especially educationally and socially; (2) families described varying levels of support from schools and local authorities with help managing ME/CFS – some described significant practical and emotional difficulties to accessing education, whereas others recounted examples of positive supportive strategies, particularly when teachers had previous experience or knowledge of ME/CFS; (3) parents thought three‐way communication between schools, healthcare and families could improve support; (4) participants felt schools were an appropriate place for knowledge building and raising awareness of ME/CFS amongst teachers and pupils, to aid improved supportive measures. In conclusion, this paper provides rich data that highlights the importance of education and the realistic fears and hurdles for adolescents with ME/CFS remaining engaged in education and the impact on their future. Some families described positive strategies in school, which were viewed as helpful to manage ME/CFS in the classroom. These strategies could be implemented alongside knowledge building initiatives and improved communication between healthcare and education. There is a need to further investigate useful strategies and determine how teachers can be best supported in implementing them. [ABSTRACT FROM AUTHOR]

Background. Cancer diagnosis is a complex and multifaceted process that can be stressful and anxiety-provoking for patients. Evidence-based tools and information aids that can be used for guiding and supporting patients during cancer investigations and after diagnosis are limited. This paper presents a user-centred codesign project that aims to develop a cancer pathway support tool for patients, carers, and healthcare professionals. Method. A mixed-method codesign approach was used including prototype development (January–March 2022), three online codesign workshops (April–June 2022), one-to-one feedback, and beta testing informed by the standardised Theoretical Framework of Acceptability (TFA) questionnaire (July–October 2022). Nine individuals with lived experience of cancer contributed to the project and are referred to as codesigners. Results. The codesigners valued the potential importance of a tool that can be used by the patients and carers if they want specific information about cancer investigations, diagnosis, and treatment. The ability to select what they need as opposed to long leaflets and generating their own questions for the healthcare providers were highlighted as important aspects of improving patient care. The tool was collectively designed to provide clear definitions of the cancer care pathway and easily accessible links from trusted resources and includes practical information to minimise the burden that can be experienced from preparation for appointments and tests. Beta testing results with a small sample of potential users including patients, carers, and healthcare providers (n = 23) showed high acceptability of the guide (range = 7–35, mean = 28.52, and standard deviation = 3.88) based on the TFA questionnaire. Conclusion. A cancer pathway support tool called "Your Cancer Pathway Support Guide (YCPSG)" was developed as a result of an iterative codesign process aiming to improve patient experience and outcomes for people referred on a suspected cancer pathway or who have been diagnosed with cancer. The tool provides information and support in both digital and PDF formats. Further studies are needed to evaluate the potential impact of "Your Cancer Pathway Support Guide" on patient outcomes and experience and the wider system. [ABSTRACT FROM AUTHOR]

Personal Assistants (PA) or client‐hired workers are directly employed by people needing care and support, often making use of government funding. In the context of Covid‐19, questions emerged about how this workforce is supported to practice safely. This paper reports PAs' understanding and views of infection control during the early months of the Covid‐19 pandemic in England. Telephone interviews were undertaken with 41 PAs between 16th April and 21st May 2020. PAs were recruited from a sample that had participated in a previous study in 2014–16. Interview questions focused on changes arising from the pandemic. Data were transcribed and analysed using Framework analysis. This paper focuses on PAs' perceptions of their role and responsibilities in preventing and managing infection. Arising themes were identified about barriers and facilitators affecting infection control in five areas: accessing information, social isolation, handwashing, hygiene, personal protective equipment and potential attitude to vaccines. Infection prevention and control are under‐researched in the home care sector generally and efforts are needed to develop knowledge of how to manage infection risks in home settings by non‐clinically trained staff such as PAs and how to engage home care users with these efforts, especially when they are the direct employers. [ABSTRACT FROM AUTHOR]

Introduction: Systemic barriers impacting smoking cessation in pregnant women may include nicotine replacement therapy (NRT) access and training. Aim: Assess general practitioner (GP) and obstetrician's agreement with system-based changes to improve the management of smoking in pregnancy; compare group responses. Methods: National cross-sectional survey with two samples: (1) online survey emailed to a random sample of 500 GPs from Royal Australian College of General Practitioners (RACGP); (2) paper survey posted to 5571 GPs and obstetricians from Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Percentages agreeing that specified changes would improve the management of smoking in pregnancy were calculated. Pairwise comparisons used Kruskal–Wallis tests (RACGP/RANZCOG GPs/obstetricians). Results: N = 378 participated. Response rates 8.4% (N = 42; online survey) and 6% (N = 335; paper survey), respectively. Total percentages agreeing with system-based changes: 79% training, 64% oral NRT subsidy, 62% Medicare item for smoking cessation, 54% improved access to NRT patches. Within RANZCOG, more GPs (73.1%) agreed that oral NRT should be subsidised (P = 0.001) than obstetricians (53.7%). Conclusion: GPs and obstetricians agreed that system changes would improve their management of smoking in pregnancy. Oral NRT subsidy was the only pairwise group difference. Subsequently, oral NRT has been subsidised; in time, this may influence prescribing and quit rates. [ABSTRACT FROM AUTHOR]

Debates over the value and contribution of community hospitals are hampered by a lack of empirical assessment of the experience of patients using these services. This paper presents findings from a study which included a focus on patient and family‐carer experiences of community hospitals in England. We adopted a qualitative design involving nine case study hospitals. Data collection included interviews with patients (n = 60), carers (n = 28) and staff (n = 89). Through patients and carers highlighting the value of community hospitals feeling 'close to home', providing holistic and personalised care and supporting them through difficult transitions, the study confirms the importance of functional and interpersonal aspects of care, while also highlighting the importance of social and psychological aspects. These included having family, friends and the community close, maintaining social connections during periods of hospital treatment, and feeling less anonymous and anxious when attending the hospital due to the high levels of familiarity and connectedness. Although the experiences uncovered in this study were not uniformly positive, patients and carers placed a high overall value on the care provided by community hospitals, often arguing that these were distinctive when compared to their experiences of using other health and care services. The study suggests the need to weigh the full range of these dimensions of patient experience—functional, interpersonal, social and psychological—when assessing the role and contribution of community hospitals. [ABSTRACT FROM AUTHOR]

Translation of evidence into practice in healthcare is challenging, particularly with new innovations. Indocyanine Green (ICG) lymphography is a novel innovation where the superficial lymphatics are imaged to provide information about lymphoedema diagnosis and to guide individualised therapy for a person's long‐term chronic management of lymphoedema, supporting care across the continuum to the community setting. Despite the unique information ICG lymphography provides, the technology itself is complex and highly specialised and currently has limited adoption in clinical practice. This paper sought to determine the barriers and enablers to establishing an ICG lymphography clinic within an outpatient lymphoedema service by exploring staff perceptions and experiences. An interpretive descriptive design was used with semi‐structured interviews of key staff participants from a quaternary public hospital six months after ICG lymphography clinic establishment. An interview guide was developed, underpinned by the Consolidated Framework for Implementation Research (CFIR), to guide the inquiry. Interview data were transcribed, inductively coded and analysed to identify themes. All eligible management, clinical and ancillary staff were included (N = 8). Four key themes were identified from the data as essential to implementation success. These were support is critical for implementation; beliefs about the technology; practicalities are achievable; and sustainability for ongoing success. Themes were found to be interrelated and centred around support from staff and the organisation as a critical process facilitator. The study demonstrated an ICG lymphography clinic can be successfully established as part of an outpatient lymphoedema service. Key enablers related to positive staff attitudes and beliefs about ICG lymphography and its application. Future implementation sites may consider that although the complexity of this innovation creates process challenges, the use of an implementation framework can assist in identifying determinants of success for effective implementation to practice. [ABSTRACT FROM AUTHOR]

Cognitive behavioural therapy (CBT) is an effective treatment for depression. There are established education programmes which prepare specialist mental health workers to practice CBT. CBT is a complex treatment requiring intensive preparation and clinical skill to deliver. An alternative and simpler psychological treatment, behavioural activation (BA), may be as effective as CBT. An advantage of BA over CBT is that you do not need to be a specialist mental health worker nor require lots of training to deliver it. The relative simplicity of BA and the brief education required for workers to deliver it may increase access to psychological treatments for depression. In 2020, we developed an online educational programme in BA targeting non‐specialist healthcare workers. In this paper, we wanted to understand healthcare workers' perceptions and experiences of completing a professional certificate programme which prepares them to deliver BA for people living with depression. We report the feedback from seven non‐specialist mental health workers who completed the online education programme in BA. Twelve workers were invited to enrol on the programme, of which four declined. All but one of the eight participants lived and worked in rural South Australia. A thematic analysis of the interview data identified three themes: Course was simple to follow, Ease of integration into clinical practice and Ongoing support and supervision. The overall meta‐theme was 'Easy to train and easy to apply'. Participants reported that the online training prepared them to practice BA and they were able to apply the skills in their clinical practice. Future work needs to examine if online training for healthcare workers in BA translates to clinical outcomes for people living with depression. [ABSTRACT FROM AUTHOR]

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

The Healthy Eating, Active Living Matters (HEALing Matters) program is being scaled up across residential out‐of‐home care (OOHC) in Victoria, Australia and is providing young people with the knowledge, skills and resources to promote better health through healthy eating and activity. HEALing Matters was piloted as the HEAL program, a dual‐intervention program that aimed to provide young people living in residential care with education and opportunities to improve their eating and physical activity habits, while simultaneously building the capacity of their carers to promote, encourage and role model healthy lifestyle behaviours. Qualitative findings indicated that HEAL resulted in increased participation in community sport, increased availability of sports equipment, healthy meal preparation and healthy food availability and improvements in perceived young person self‐esteem and independent living skills. Findings also revealed some limitations of the program. Following the pilot, a participatory methodological approach was used to better understand how to align the HEAL program with individual and community needs. This approach engaged diverse stakeholders to better understand the barriers and enablers, address limitations, identify key intervention points and build trust and a shared vision to co‐design the HEALing Matters program. HEALing Matters is now delivered within a framework that is informed by attachment, trauma and resilience theories. This paper outlines the HEALing Matters journey from what matters, to what works, to what translates in relation to a healthy eating and active living intervention in OOHC. [ABSTRACT FROM AUTHOR]

Objective: This survey aimed to analyse healthy citizens (HC), cancer patients and their caregivers (CP&CG) perception about cancer care among six different Italian regions. Methods: The survey for HC was conducted by a multinational market research institute (IPSOS) through a computer‐assisted web interviewing system, using a dataset of people who had consented to be interviewed for previous studies. CP&CG were interviewed by patient advocates using paper questionnaires. Results: HC completed 1831 questionnaires between May and June 2019; CP&CG filled 1779 questionnaires between May and October 2019. 55% of all interviewees felt they were adequately informed about cancer, with no disparities between regions. Overall, population was satisfied with the National Health Care System (HCS), CP&CG more than HC, probably for their personal positive experience. There were different satisfaction levels between regions regarding components of the pathway of care, but agreement about health workers' 'human component'. Forty‐three per cent of the interviewed were informed about genetic tests, 47% about innovative drugs. The percentage was greater among CP&CG (51% and 61% respectively). Conclusions: Italian people were overall satisfied with HCS although with significant different perceptions between regions. Moreover, some critical issues were highlighted as low adherence at screening invitation and genetic tests. Understanding people's perception regarding HCS is crucial to support health policies and to improve the performance of HCS. [ABSTRACT FROM AUTHOR]

According to the existing, extensive scientific evidence in the literature, men on average are living sicker and dying younger at a higher rate compared to women. The causes of men's infirmities are complex and multifaceted, contributing to increased morbidity and mortality rates and decreased life expectancy. Despite the statistics of the doomed health status among men, interests to eliminate their health disparities remain inconsistent and ill‐defined. Therefore, efforts to eradicate men's health disparities should be positioned in interdisciplinary health education, research, and policy using sex and gender‐based health frameworks. The purpose of this paper is to explore men's health generally by discussing common health disparities, the causes of the gender gap in men's health outcomes, proposing some strategies for advancing men's health, and finally providing nursing implications for education, practice, research, and health/public policy. Notably, interdisciplinary, gender‐based health education potentially has significant impacts on men's health. The promotion of such initiatives can consequently address the intricacies of men's health, which will provide future healthcare professionals with the knowledge, attitude, and skills necessary to improve men's health. [ABSTRACT FROM AUTHOR]

There is a dearth of research on how negative religious attitudes towards LGBTQ people inform professional practice. This paper reports on a scoping review of 70 selected studies from 25 different countries. It explores key issues and knowledge gaps regarding the delivery of services to LGBTQ adults by religious healthcare, social care and social work organisations and/or practitioners with faith‐based objections to LGBTQ people and their lives. The review identified four main themes: (1) a close connection between religious affiliation and negative attitudes towards LGBTQ people, among both students and professionals; (2) a heightening effect of religiosity, particularly among Christian and Muslim practitioners/students; (3) educators' religious attitudes informing curriculum design and delivery, and some highly religious students resisting and/or feeling oppressed by LGBTQ‐inclusivity, if present; (4) examples of practice concerns raised by professionals and lay LGBTQ people. The article considers the ethical, practical, educational and professional standards implications, highlighting the need for further research in this area. [ABSTRACT FROM AUTHOR]

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

Shortly after the COVID‐19 pandemic reached Aotearoa New Zealand, stringent lockdown measures lasting 7 weeks were introduced to manage community spread of the virus. This paper reports the findings of a qualitative study examining how lockdown measures impacted upon the lives of nurses, midwives and personal care assistants caring for community‐based patients during this time. The study involved nationwide surveys and in‐depth interviews with 15 registered nurses employed in community settings, two community midwives and five personal care assistants. During the lockdown, nurses, midwives and personal care assistants working in the community showed considerable courage in answering their 'call to duty' by taking on heightened care responsibilities and going 'the extra mile' to help others. They faced significant risks to personal and professional relationships when they were required to take on additional and complex responsibilities for community‐based patients. Despite the hypervigilant monitoring of their personal protective equipment (PPE), the need to safeguard family and community members generated considerable stress and anxiety. Many also faced personal isolation and loneliness as a result of lockdown restrictions. Moreover, the negative impacts of experiences during lockdown often continued to be felt once restrictions had been lifted, inflecting life during periods in which community transmission of COVID‐19 was not occurring. This article makes five core service delivery and policy recommendations for supporting community‐based nurses, midwives and personal care assistants in respiratory disease pandemics: acknowledging the crucial role played by community‐based carers and the associated stress and anxiety they endured by championing respect and compassion; demystifying the 'heroism' or 'self‐sacrifice' projected onto care workers; the timely provision of adequate protective equipment; improving remuneration, with adequate provision for time off; and regular counselling, peer support groups and education on work‐life balance delivered by support workers in recognition of stressors arising from these complex and isolated working conditions. [ABSTRACT FROM AUTHOR]

This paper presents findings from the evaluation of an Australian trial of self‐managed home aged care. The self‐management model was codesigned by advocacy organisation COTA Australia, consumers and service providers. The primary aim of the evaluation was to examine whether self‐management improved consumers' perceptions of their choice, control, and wellbeing. The secondary aim was to examine whether provider prior experience with self‐managed packages significantly influenced consumers' perceptions of choice, control and wellbeing, thereby confounded trial effects. A pre‐test post‐test quasi‐experimental design and mixed‐methods design were used to collect data over nine months in 2018–2019. The pre‐trial methods and findings have been published. The post‐trial evaluation replicated the pre‐trial data collection method of an online survey (n = 60) and semi‐structured telephone interviews with consumers (n = 9), family carers (n = 13), and consumers and carers jointly (n = 2), totalling 24 interviews. Semi‐structured telephone interviews were also conducted with CEOs and senior managers from each of the seven providers (n = 14). Three providers had prior experience supporting self‐management. Parametric and non‐parametric tests examined the statistical data. Qualitative data were analysed thematically and framed according to self‐determination principles and ecological systems theory. Both datasets demonstrated that consumers reported greater choice and control at post‐trial than pre‐trial. This finding was not affected by providers' prior experience with self‐management; therefore, it was not a confounding factor. Participants reported improved wellbeing in interviews, however this was not reinforced statistically. Key desirable features of self‐management included greater autonomy and control over spending, recruiting support staff and paying lower administration fees. There was no evidence of increased risks or fraud. The research limitations included a small sample size, convenience sampling with providers recruiting interview participants, no control group and differences in trial implementation. The findings support the expansion of self‐management opportunities and more comprehensive evaluations that use mixed methods. [ABSTRACT FROM AUTHOR]

The importance of supporting unpaid carers for people living with dementia (PLWD) is recognised in adult social care policy both nationally and internationally. In the UK, social care legislation emphasises care and support should help people achieve the outcomes that matter to them in their life; this includes the opportunity to take a break from caring routines and responsibilities. Accordingly, there is growing policy and practice interest in short breaks provision to address the diversity of carer break needs and preferences and deliver meaningful outcomes for carers and those they support. This paper reports findings from qualitative staff interviews that offered strategic and operational insights into short breaks provision. It presents a dynamic model of the short break landscape in a region of Wales, describing factors shaping local and regional decision‐making. The model identifies key challenges (barriers) and opportunities (enablers) that shape the planning, commissioning and delivery of bespoke short breaks for spousal carers and their partner living with dementia. Through highlighting the interplay between complex context‐specific processes and contingences, the model informs initial theory development in short breaks provision. [ABSTRACT FROM AUTHOR]

Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this issue, women often do not receive the care they need and fall between the gap of maternity and mental health services. To address this, there is a call for reform in the way in which perinatal mental healthcare is delivered. This paper responds to this by exploring the role and competence of midwives in delivering mental healthcare. Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question 'what is the nature of the evidence relevant to the provision of mental health interventions by midwives?' To identify studies, the databases PubMed, Maternity and Infant Care, Science Citation Index, Social Sciences Citation Index, Medline, Science Direct and CINAHL were searched from 2011 to 2018, and reference lists of included studies were examined. Studies relevant to the role of midwives in the management and treatment of perinatal mental health issues were included; studies focussed on screening and referral were excluded. Thirty papers met inclusion criteria, including studies about the knowledge, skills, and attitudes of midwives and student midwives; the effectiveness of educational interventions in improving knowledge and skills; the delivery of counselling or psychosocial interventions by midwives; and barriers and enablers to embedding midwife‐led mental healthcare in practice. Synthesis of the included studies indicates that midwives are interested in providing mental health support, but lack the confidence, knowledge and training to do so. This deficit can be addressed with appropriate training and organisational support, and there is some evidence that midwife‐led counselling interventions are effective. Further research is needed to test midwife‐led interventions for women with perinatal mental health problems , and to develop and evaluate models of integrated perinatal mental healthcare. [ABSTRACT FROM AUTHOR]

Introduction: Many countries are enacting tobacco treatment training, guidelines and policies in order to fulfil Framework Convention on Tobacco Control (FCTC) treaty agreements. This study tapped the perspectives of international treatment providers to identify challenges and recommendations for improvement. Methods: The cross-sectional survey included closed- and open-ended items. Distribution included professional listservs (ATTUD; Global Bridges; ENSH Global) and word-of-mouth. The survey collected data using an open-source platform (Enketo Smart Paper/Ona). We used R for quantitative analysis and Google Sheets to categorize open-ended responses. Results: There were 155 respondents from 49 countries. Most (78.6%) provided direct services. Almost half (48.1%) reported receiving less than 6 hours of tobacco treatment training; respondents from low and lower-middle income countries (LMICs) received significantly less training (Fisher's p < 0.014). Likewise, among all respondents, 43% rated poor access to treatment; this rose to 100% among LMICs (Fisher's p < 0.001). To improve treatment and training, respondents suggested increasing government funding for pharmacotherapy and behavioural services; providing training in local languages and in the treatment of smokeless tobacco forms; trainee certification and access to online support for providers. Conclusions: Globally, half of front-line treatment providers reported having poor access to training; this was true for all providers in LMICs and most in upper middle-income countries. Existing online trainings, available mainly in English, could be migrated to open-access formats to permit countries to tailor them to their local needs and languages. Countries in geographical proximity or historical linguistic/political alliances could forge cross-country mentoring relationships and mutual support for training. [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. Electronic-prescribing (e-prescribing) is the most recent technological advancement in the medication use process. Its adoption and consequent realization of its potential benefits, however, mainly depend on the healthcare professionals' perception, willingness to accept, and engagement with the technology. Objectives. This study is aimed at assessing the perception of healthcare professionals towards e-prescribing at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, from June 1 to August 30, 2021. Method. A cross-sectional study was conducted using a simple random sampling technique. A self-administered questionnaire was used for data collection. Data were entered into and analyzed by using the Statistical Package for the Social Sciences (SPSS® (IBM Corporation)) version 24. Both descriptive and inferential statistics like the Kruskal-Wallis and Mann–Whitney tests were used for data analysis. A statistical significance was declared at a p value < 0.05. Result. From 401 participants, the majority of study participants had a neutral perception of e-prescribing. More than two-thirds (68.8%) of them had a neutral perception towards the perceived usefulness of e-prescribing with a median (interquartile range (IQR)) perceived usefulness of 43.0 (7.0) (maximum score = 60). The perceived ease of use of e-prescribing was also neutral in the case of more than three-fourths (79.8%) of participants with a median (IQR) perceived ease of use of 49.0 (6) (maximum score = 75). Similarly, more than half (56.6%) of the participants had a neutral perception towards the perceived fitness of e-prescribing with a median (IQR) perceived fitness of 15.0 (2.5) (maximum score = 15). The perception of the participants showed a significant difference based on their qualifications and work and computer use experience. Participants who heard about e-prescribing and e-prescribing software had a significantly higher mean rank score of perceived usefulness, perceived ease of use, and perceived fitness of e-prescribing. Participants who previously used e-prescribing had also a significantly higher mean rank score of perceived usefulness. Conclusion and Recommendation. The majority of healthcare professionals had a neutral perception of e-prescribing. The perception of healthcare professionals differs based on their qualifications, work and computer use experience, and their exposure to e-prescribing. The hospital should take all expectations and concerns of all HCPs into consideration and provide experience-sharing opportunities for all healthcare professionals who may potentially be involved in e-prescribing. [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. Few studies have analyzed the negative outcomes of disruptive behaviors in the nurse-physician relationship in patient care and their impact on patient safety. These multicausal studies significantly relate to organizational, institutional, and professional attitudinal risk factors. Aim. Analyze healthcare professionals' perceptions of disruptive behavior and factors associated with patient safety climate in the nurse-physician relationship at the hospital level. Methods. A multicenter cross-sectional study was conducted with a sample of 370 nurses and physicians assigned to different public hospitals in the Murcia/Spain region, applying the adapted and validated Spanish version of the Nurse-Physician Relationship Scale: Impact of Disruptive Behavior on Patient Care. The analysis used proportions or means (standard deviation (SD)), univariate and multivariate linear regression models, and the chi-square test. Results. Disruptive behavior was more prevalent in the ICU (81.6%) and the emergency department (67.8%). Professionals indicate that fear of reprisals is the main barrier to the reporting system. Likewise, stress and frustration are more associated with disruptive behavior and influence the safety climate. Conclusion. Professionals indicate that disruptive behaviors can have a negative impact on clinical outcomes. Age and type of service were identified as the most relevant socio-occupational factors. Stress, frustration, and communication problems are the factors that most influence the safety climate. [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. Artificial intelligence (AI) applications are rapidly advancing in the field of medical imaging. This study is aimed at investigating the perception and knowledge of radiographers towards artificial intelligence. Methods. An online survey employing Google Forms consisting of 20 questions regarding the radiographers' perception of AI. The questionnaire was divided into two parts. The first part consisted of demographic information as well as whether the participants think AI should be part of medical training, their previous knowledge of the technologies used in AI, and whether they prefer to receive training on AI. The second part of the questionnaire consisted of two fields. The first one consisted of 16 questions regarding radiographers' perception of AI applications in radiology. Descriptive analysis and logistic regression analysis were used to evaluate the effect of gender on the items of the questionnaire. Results. Familiarity with AI was low, with only 52 out of 100 respondents (52%) reporting good familiarity with AI. Many participants considered AI useful in the medical field (74%). The findings of the study demonstrate that nearly most of the participants (98%) believed that AI should be integrated into university education, with 87% of the respondents preferring to receive training on AI, with some already having prior knowledge of AI used in technologies. The logistic regression analysis indicated a significant association between male gender and experience within the range of 23-27 years with the degree of familiarity with AI technology, exhibiting respective odds ratios of 1.89 (COR = 1.89) and 1.87 (COR = 1.87). Conclusions. This study suggests that medical practices have a favorable attitude towards AI in the radiology field. Most participants surveyed believed that AI should be part of radiography education. AI training programs for undergraduate and postgraduate radiographers may be necessary to prepare them for AI tools in radiology development. [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]

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]

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]

Background. People with disabilities face considerable obstacles when exercising, which precludes them from the social and health benefits of physical activity. Especially for individuals with paraplegia with spinal cord injuries, it is necessary to maintain continuous participation in physical activity even after discharge, as it helps to maintain mobility and daily living activities through upper body strength. However, the participation rate of people with disabilities in physical activity in Korea is still low, mainly due to the lack of exercise equipment and facilities. Objectives. The aim of this study is to identify aspects that can be improved for better accessibility to exercise equipment for individuals with paraplegia with spinal cord injuries and to reach a consensus on possible guidelines for accessible exercise equipment. Methods. This study reviews and evaluated the usability of four existing upper-body exercise equipment for individuals with paraplegia with spinal cord injuries. To assess usability, task performance scores and time were measured, and a survey was conducted on safety and satisfaction. Based on these results, areas for improvement were identified. Through literature review, usability results, and opinions from various stakeholders, eight requirements for universal accessibility were proposed. Results. It is necessary to consider how wheelchair users access the exercise equipment. The access method to the exercise area (facility regulations, auxiliary equipment to be provided, etc.) and placement of exercise equipment should also be considered. Information such as explanations of the exercise equipment and how to use it should be located within the wheelchair user's field of vision. Considering the participation rate in sports for people with disabilities in Korea, it is necessary to explain the exact exercise equipment and exercise method. It is also necessary to consider how wheelchair users transfer from the wheelchair to the seat of the exercise equipment. Parts that require manipulation of each exercise equipment must be within the wheelchair user's range of motion. Various supports or assistive devices that provide body support according to each piece of equipment are needed. In addition to the wheelchair's own brake, it is necessary to provide a fixing device so that the wheelchair does not move during the exercise. Conclusion. For people with spinal cord injuries, the arm ergometer, aerobic exercise equipment, showed higher scores in performance, stability, and satisfaction compared to other exercise equipment. Among the strength exercise equipment, shoulder press had an effect on performance, seated lat pull-down had an effect on stability, and seated chest press had an effect on satisfaction. Therefore, when selecting exercise equipment, it is necessary to recommend aerobic and strength exercise equipment according to the preferences of people with spinal cord injuries. When developing strength exercise equipment, it is necessary to consider usability evaluation factors for individuals with spinal cord injury. [ABSTRACT FROM AUTHOR]

Rationale. Contribute to the understanding of DNR decision-making and conducting end-of-life conversations, about which there is a paucity of data available in the current literature. Aims and Objectives. Assess how the decision-making process to determine a DNR code is implemented in the day-to-day clinical practice in a tertiary teaching hospital. Familiarity with the use of different scores as a possible objective support for DNR decisions and the influence of various elements on a DNR decision was explored. Method. A cross-sectional survey study was conducted between February 2021 and April 2021 for all doctors and doctors in training, working in the Antwerp University Hospital during the COVID-19 pandemic. Results. 127 doctors participated in this study. The familiarity with the different scores used in the triage during the COVID-10 pandemic was 51% for the Clinical Frailty Scale (CFS) and 20% for the Charlson Comorbidity Index (CCI). Participants indicated that their DNR decision is based on various aspects such as clinical assessment, comorbidities, patient's wishes, age, prognosis, and functional state. Conclusion. The familiarity with the different scores used during triage assessments is low. The total clinical picture of the patient is needed to make a considered decision, and this total picture of the patient seems to be well encompassed by frailty measurement (CFS). Although many participants indicated that the different scores do not offer much added value compared to their clinical assessment, it can help guide DNR decisions, especially for doctors in training. [ABSTRACT FROM AUTHOR]

Background. Older people are one of the groups particularly vulnerable to loneliness due to factors such as deteriorating health, widowhood and death of friends/family, fewer confiding relationships, and being more likely to live alone. In the United Kingdom, services to alleviate and/or prevent loneliness can be classified as foundation services, direct interventions, gateway services, and structural enablers. Service managers and personnel involved in the delivery of interventions for older people are well-positioned to report on the mechanisms that contribute to the effectiveness of interventions. This study aimed to elicit from the perspective of a range of service providers, the barriers and facilitators of successful service provision, and the reduction of loneliness among older people. Methods. Semistructured interviews were conducted with 23 service managers of services providing an intervention to older people in Northern Ireland. Services were eligible for inclusion if they reported a goal of preventing or reducing loneliness and/or social isolation among older people. Transcripts were analysed using thematic analysis. Results. Eight themes were produced representing barriers or facilitators of successful service delivery, including characteristics of the service (person-centred approach, empowerment of service users and staff/volunteers, personal qualities of staff and volunteers, and funding for service provision) and characteristics of the wider community were services were located (hard to identify and/or reach lonely people; education and awareness of services; family and community structures; and accessible, affordable, and safe public transport). Conclusion. Developments in this area should prioritise integrated, systemic solutions that harness capacity and partnership working within communities, grounded in the principles of empowerment, inclusion, self-determination, and collective action. [ABSTRACT FROM AUTHOR]

Introduction. "Evidence-based practice" (EBP) is the process of incorporating clinical expertise and taking patient values and preferences into consideration when making clinical decisions. It is used to describe the provision of high-quality patient care. Objective. This study is aimed at assessing evidence-based practice and associated factors among health professionals working at public hospitals in Illu Aba Bora and Buno Bedele Zones, Oromia Region, Southwest Ethiopia, in 2022. Methods. An institution-based cross-sectional study design was conducted from May 8 to June 20 at public hospitals in Illu Aba Bora and Buno Bedele Zones, Oromia Region, Southwest Ethiopia. A total of 423 health professionals were included, using proportional allocation and simple random sampling. The data were collected using a self-administered questionnaire. Data was entered using EpiData version 4.6, and the collected data was cleared, arranged, coded, and then analyzed using Statistical Package for the Social Sciences version 26. Descriptive statistics and bivariable and multivariable analyses of logistic regression with AOR (95% CI) were performed at p < 0.05. Result. The study revealed that 36.2% of health professionals had good evidence-based practice. The factors found to be significantly associated with good EBP include having training in EBP (AOR = 5.43 ; 95% CI: 4.323, 9.532), good knowledge (AOR = 1.91 ; 95% CI: 1.065, 3.541), a favorable attitude (AOR = 1.91 ; 95% CI: 1.884, 2.342), and work experience greater than 5 years (AOR = 1.58 ; 95% CI: 1.482, 2.437). Conclusion. The evidence-based practice of health professionals was poor. Evidence-based practice should included in the curriculum, and also planned trainings need to be delivered to all health professionals, inorder to enhancing their knowledge as well as their attitudes by motivating them to increase evidence-based practice. [ABSTRACT FROM AUTHOR]

Objective. Lung cancer is commonly diagnosed and is the leading cause of cancer-related death, morbidity, and burden of disease globally. There is an ongoing need to ensure patients receive optimal evidence-based care and to identify and reduce unwarranted clinical variation to achieve best possible outcomes. The EnRICH program has developed evidence-based clinical quality indicators to measure processes and outcomes of lung cancer care, and a feedback dashboard to report comparative performance data, which highlight variation in both care and outcomes. The aims of this study were to evaluate the acceptability and utility of the quality indicators and feedback dashboard and identify benchmarks for performance monitoring and priorities for future quality improvement interventions to address observed clinical variation. Method. Clinicians from lung cancer multidisciplinary teams (MDTs) at six tertiary clinical sites across regional and metropolitan NSW were invited to participate in evaluation interviews. Interviews were conducted via videoconference and recorded with consent. Data were analysed thematically using framework methods. Results. Thirteen clinicians participated in interviews, with representation from each clinical site and specialty. All participants considered the quality indicators to be clinically meaningful. Three main themes were identified: (i) the importance of timely, local, quality data; (ii) implementable versus nonimplementable clinical practice changes; and (iii) the need for ongoing performance monitoring. Clinicians prioritised two areas of unwarranted clinical variation that could be immediately addressed through easily implementable quality improvement interventions to positively impact patient care: (i) a process to ensure that all stage III patients are discussed by a multidisciplinary team prior to commencing treatment; (ii) a referral pathway to palliative care within eight weeks for patients diagnosed with stage IV disease. The importance of lung cancer nurse specialists for improved care coordination was highlighted. Conclusion. Clinicians would like to continue to receive close-to-real-time quality data for ongoing performance monitoring to identify and address unwarranted clinical variation. [ABSTRACT FROM AUTHOR]

Introduction. Some medical centers and surgeons require patients to stop smoking cigarettes prior to elective orthopaedic surgeries in an effort to decrease surgical complications. Given higher rates of smoking among rural individuals, rural patients may be disproportionately impacted by these requirements. We assessed the perceptions and experiences of rural-residing Veterans and clinicians related to this requirement. Methods. We conducted qualitative semistructured one-on-one interviews of 26 rural-residing veterans, 10 VA orthopaedic surgery staff (from two Veterans Integrated Services Networks), 24 PCPs who serve rural veterans (14 VA; 10 non-VA), and 4 VA pharmacists. Using the knowledge, attitudes, and behavior framework, we performed conventional content analysis. Results. We found three primary themes across respondents: (1) knowledge of and the evidence base for the requirement varied widely; (2) strong personal attitudes toward the requirement; and (3) implementation and possible implications of this requirement. All surgery staff reported knowledge of requirements at their institution. VA PCPs reported knowledge of requirements but typically could not recall specifics. Most patients were unaware. The majority of respondents felt this requirement could increase motivation to quit smoking. Some PCPs felt a more thorough explanation of smoking-related complications would result in increased quit attempts. About half of all patients reported belief that the requirement was reasonable regardless of initial awareness. Respondents expressed little concern that the requirement might increase rural-urban disparities. Most PCPs and patients felt that there should be exceptions for allowing surgery, while surgical staff disagreed. Discussion. Most respondents thought elective surgery was a good motivator to quit smoking; but patients, PCPs, and surgical staff differed on whether there should be exceptions to the requirement that patients quit preoperatively. Future efforts to augment perioperative smoking cessation may benefit from improving coordination across services and educating patients more about the benefits of quitting. [ABSTRACT FROM AUTHOR]

The delivery of acute health care has changed with the adoption of new technologies to meet changing community needs. In response to this, hospital systems and governments have invested in alternative models of care, including hospital in the home (HITH), where acute care that would typically require inpatient treatment is provided in the patient's home. The academic literature presents evidence for comparable or improved patient outcomes associated with HITH interventions. However, it is currently unknown how consumers and providers view the model in the context of a new healthcare facility. This study aimed to elicit consumer and provider views about HITH and how the implementation of a HITH model of care in a new hospital could meet their healthcare needs. We adopted a qualitative approach for this research. Semistructured workshops and interviews were conducted via Zoom, where we presented patient vignettes of different models of care to consumers and providers and recorded their responses using scribes. Qualitative data were independently coded by pairs of researchers to identify themes and subthemes, and demographic data were aggregated. A total of 51 consumers and 35 providers attended the workshops. Consumers and providers frequently described similar themes, particularly accessibility, patient factors, and the health system consequences of HITH. However, the importance and focus of these topics varied across participants. Participants endorsed HITH as a flexible, patient-centred model with potential for wellbeing benefits. However, they noted the potential need for additional resources and increased anxiety among patients with lower health literacy. To address this, participants described the need for clear escalation protocols, communication channels, and expectations around HITH care. In conclusion, HITH is an established model that brings acute care into the homes of patients. The findings of this study support the provision of flexible acute care delivery to meet consumer needs and address the challenges encountered during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The value that carer peer workers may offer family members with lived experience of BPD has not been investigated thoroughly to date. This study aims to investigate the unique contributions of carer peer workers in supporting family members who care for consumers with BPD. Mixed method questionnaires were completed by family members, consumers, carer peer workers, and clinicians (N = 24) at five mental health services. Qualitative responses were analysed using thematic analysis. Family members felt understood due to the personable, reciprocal approach of carer peer workers, which differentiated carer peer workers from clinicians. Carer peer workers benefitted from their role by finding purpose and found hearing about similar experiences of family members challenging. Through interactions with carer peer workers, clinicians gained insight to the carer role. This study provided evidence that carer peer workers may play a unique role in supporting family members with lived experience of BPD. [ABSTRACT FROM AUTHOR]

Being holistic is often used by occupational therapists to describe their practice and philosophy worldwide. This study explores the perspectives of 33 occupational therapists, working in 13 different countries, on their understanding of holistic epistemology and practice and how they seek to incorporate holism in their work. On the basis of a qualitative study design, individual interviews were conducted with the participants by 18 Norwegian undergraduate occupational therapy students, supported by their supervisors. The authors subsequently analyzed the transcribed data, using a thematic analysis approach. Three principal themes emerged: (1) holism as a broad and narrow concept, (2) being holistic spans from treating body parts to teaching marginalized children, and (3) being holistic is a lot to ask. When talking about holism and holistic practice, participants described their holistic practices in various ways, and their accounts reflected different understandings and cultural contexts. Participants characterized a holistic approach as one emphasizing the importance of occupations and activities and helping patients regain independence in their everyday lives. However, they also highlighted the specific challenges they faced, including cultural factors and inadequate resources. Significantly, participants from both Western and non-Western contexts emphasized the importance of holistic practice, suggesting that a dichotomous understanding of Eastern versus Western philosophical approaches does not necessarily make sense in occupational therapy interventions. Therapists' degree of commitment to client-centered practice appears of greater relevance. With its international perspective, our study sheds light on important areas of contemporary occupational therapy practice, including the difficulties occupational therapists face when seeking to cover "everything" in an effort to be more holistic. [ABSTRACT FROM AUTHOR]

Aim. To describe the process of developing a resource, the "Prostate Cancer Outcomes Report Card," that provides information for men with prostate cancer and their family members about the outcomes of different treatment approaches. Methods. The project consisted of two phases. The first phase involved analysis of real-world data and translating outcomes into a format that consumers found easy to understand and interpret. The Report Card was developed in consultation with a consumer advisory group (n = 8). The second phase involved refinements of the resource through exploratory qualitative interviews with consumers (n = 14), an online survey among the general public (n = 134), and clinician feedback (n = 8). Results. Consumer engagement to explore preferences about the content and visual presentation from the end-users' perspective was crucial in designing this report. Consumers required trustworthy, comprehensive, simple, and up-to-date information collated in one place to help them understand the risks and benefits of their treatments. Presenting survival, cancer recurrence, and functional outcomes by treatment type and risk category was highly commended while data on high survival rates were considered reassuring. We identified high levels of unmet psychosocial and supportive care need, with differences in individual preferences around extent of information required. Conclusions. Communicating registry data about real-world outcomes in a consumer-friendly way may help fill a gap in information needs among prostate cancer survivors. Providing relatively simple and easily understandable evidence in a single consumer-oriented report may help prostate cancer survivors become better informed and facilitate patient-provider communication and shared decision making. [ABSTRACT FROM AUTHOR]

The retention and recruitment of care providers are ongoing concerns in healthcare globally. Examining intention to leave (ITL) as a measure of retention, the existing literature has focused on nurses working in hospitals, with less attention paid to other care providers and other areas of practice. The purpose of this study was to gain a better understanding of the unique factors influencing ITL among three categories of care providers in home care: registered practical nurses, registered nurses, and personal support workers. This study assessed and compared predictors of ITL, including organizational commitment, job satisfaction, perceived supervisor support, burnout, role stress, work/family conflict, and community satisfaction. A convenience sample of home care staff working in one agency in a Canadian province was sent an electronic survey by e-mail in 2021. Responses (n = 185) underwent data analysis including descriptive statistics, analysis of variance, and multiple linear regression, as well as thematic analysis of two open-ended items. The results of the study indicated that 54% (n = 99) of respondents were considering leaving their job, and respondents were dissatisfied with their salary and benefits. Role stress, work-family conflict, and burnout differed significantly between groups. Several themes emerged for strategies to promote employees to stay with the agency, with the overwhelming strategy being higher wages/salary. Themes for why employees stayed with the agency included love for clients and commitment to their care, as well as fondness for the teams within which respondents worked. The findings of the study lead to several important implications and recommendations for the home care sector. Advocating for wage parity among healthcare sectors and other opportunities for compensation for home care workers is necessary. Additional strategies include supportive and innovative approaches for scheduling, teamwork, and working with staff to identify barriers and solutions in home care. [ABSTRACT FROM AUTHOR]

This study explores the perceptions and experiences of Korean occupational therapists (OTs) about their role in managing elderly patients with orthopedic conditions. The goal is to inform policy discussions for better integration of OT services in orthopedic care settings in Korea. A survey was conducted among Korean clinical OTs to gather data on their perceptions, experiences, and challenges in providing orthopedic OT services. Snowball sampling was used, and the survey addressed general characteristics, orthopedic OT status, perceptions, and competence. The data were analyzed using frequency and percentage calculations in SPSS 22.0. Out of 171 respondents, only 18 had experience working in orthopedic departments, while 78 (45.6%) had provided occupational therapy to orthopedic patients. Rehabilitation medicine physicians were the primary prescribers of orthopedic OT. Key challenges included a lack of awareness among professionals, an absence of appropriate fees, and insufficient knowledge among OTs. The majority of respondents agreed that providing OT in orthopedic departments was appropriate and expressed a need for education and clinical guidelines. The study examines the current state of orthopedic OT in Korea, showing low levels of experience and highlighting challenges, such as a lack of professional awareness, inadequate fees, and insufficient knowledge among OTs. Respondents mostly agreed on the necessity for education and clinical guidelines to improve their capabilities in orthopedic settings. This study emphasizes the need for healthcare system improvements that allow OTs to participate more widely without being confined to specific medical disciplines, promoting a more comprehensive approach to OT, especially as the aging population continues to grow. [ABSTRACT FROM AUTHOR]

A range of professionals and services are often involved in supporting parents with mental health needs where there are child protection concerns. However, they do not always meet the needs of this population who tend to experience inadequate support and mistrust of services. This review aimed to synthesize parent and practitioner experiences of support for parents with both mental health needs and children's social services involvement. We performed electronic searches of the following databases: PsycINFO, CINAHL, HMIC, MEDLINE, Embase, Social Policy and Practice, Social Services Abstracts, Social Science Citation Index, OpenGrey, Social Care Online, and ProQuest. Following searching and screening, 41 studies were identified including 359 parents and 1370 practitioners. We worked with a Lived Experience Advisory Group to develop the following themes: (1) a downward spiral of service intervention; (2) working with parents, not against them; (3) support wanted versus support provided; and (4) constrained by service rigidity. We found that families were often parenting amidst trauma and adversity. However, service involvement could trigger a "downward spiral" of stressful processes over which parents felt they lacked control. Instead of improving their situations, support sometimes added to families' difficulties, worsening parents' mental health and making them feel marginalised, criticised, and retraumatised. There were, however, also examples of positive practice, where practitioners and parents developed trusting, open, and mutually respectful relationships. Practitioners often felt that they were limited in their ability to offer collaborative, holistic care because services were fragmented, underfunded, crisis driven, and inflexible. Difficulties mentioned most often by parents, such as financial issues, tended not to be a focus of available interventions. We conclude that the key issues identified must be targeted to improve support. [ABSTRACT FROM AUTHOR]

Objective. The role of health professionals in the decision making process of patients is usually heard or seen from the perspective of the patients. This paper gives the usually silent and invisible health professionals voice and visibility. It describes their views and attitudes towards reproduction by couples who are HIV positive and attempts to understand their perspectives. Methods. In-depth interviews were conducted with twelve health professionals at an opportunistic infections clinic. Transcribed interviews were analysed using the grounded approach to identify patterns and themes concerning views and attitudes of health professionals towards reproduction by HIV positive people. Results. The study found that most health professionals generally had a negative attitude towards childbearing by HIV positive couples. Their views and approaches on the issue were based mainly on biomedical considerations. The main discourses on childbearing that emerged from the study were the conditional choice, the antichildbearing, and the prorights. Conclusion. Most of the health professionals interviewed tend to take a generally negative stance towards reproduction by people with HIV/AIDS. There is a need for a clear set of guidelines for health professionals (HPs) on how to deal with HIV positive people who may desire to reproduce. [ABSTRACT FROM AUTHOR]

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

Increasing evidence of the effects of the COVID-19 pandemic on healthcare workers' mental health and wellbeing has prompted concerns about the longer-term impacts on healthcare delivery and health workforce sustainability. For rural health services and communities, the pandemic has compounded existing challenges including workforce shortages, potentially leading to further health inequalities. This qualitative interview study aimed to explore factors within and external to the health service environment that influenced health service staff mental health and wellbeing in rural and regional Victoria, Australia, during the first two years of the COVID-19 pandemic (2020-2021). Participants were recruited from nine publicly funded rural and regional health services. Semistructured interviews were conducted via videoconference, audio-recorded, and transcribed. Data were analysed using a five-stage framework approach. Eighteen health service staff from four rural areas participated in the study. A range of factors that were perceived by participants to influence their wellbeing were identified. These were coded to four main themes: (1) rural community relations, (2) the nature of the health workplace, (3) self-care and supportive networks, and (4) public health measures and the unpredictable nature of the pandemic. Factors coded to these themes were described as both positive and negative influences on health staff mental health and wellbeing. Optimising the mental health and wellbeing of rural health staff is imperative to the sustainability of this workforce during and beyond the COVID-19 pandemic. Rural health services must consider the community and health service (meso-level), individual (microlevel), and broader pandemic context (macrolevel) when developing and implementing strategies to promote staff wellbeing. Strategies must encompass the development of senior leadership capabilities, mechanisms to support effective leadership, and optimal communication processes within health services. Given the potential for community support to positively influence rural health staff wellbeing, community engagement should be a feature of health service wellbeing strategies. [ABSTRACT FROM AUTHOR]

Rationale. During the COVID-19 lockdown in Spain, healthcare workers have experienced productive work overload, as well as an increase in reproductive work, which has worsened their mental health. Little research has been done on nonhealthcare essential workers although they have been exposed to similar conditions. Objective. To explore the experiences of essential workers after the first year of the COVID-19 syndemic in Spain on work-life balance, considering different professions and reproductive work responsibilities. Methods. Exploratory qualitative study using a gender perspective. Eighteen semistructured interviews were conducted via telephone or videoconference between January and March 2021. Interviews included essential workers in healthcare, social work, food related, and other settings, eleven women and seven men. A thematic analysis was conducted. Results. The disposition of essential workers for reproductive work, task sharing, and work-life balance differed according to gender. Reproductive work was predominantly the responsibility of women; work-life balance was especially challenging for single-mother families and families with children. Being an essential worker, performing face-to-face productive work during lockdown seemed to allow a sense of "normality" and personal space. However, it appeared to lead to feelings of exhaustion due to unsustainable working conditions and pressure on reproductive work during the first year of the COVID-19 syndemic. A lack of social recognition was perceived, especially among social workers. Conclusion. This study raises awareness of the difficulties of combining productive work that has become essential with reproductive work in a context of extreme social isolation and little social and institutional support. It questions the role of women in reproductive work, brings visibility to professions such as social work, and highlights the need to improve their working conditions. It is urgent to implement policies to mitigate effects on mental health and its determinants in the short term and long term to reduce gender inequity. [ABSTRACT FROM AUTHOR]

Background. Self-awareness is seldom formally assessed by occupational therapists among individuals with traumatic brain injury (TBI). However, impaired self-awareness is prevalent and has a significant impact on rehabilitation outcomes. There is a need to understand clinician perspectives on self-awareness assessments and promote evidence-based practice in clinical settings. Aims. (1) Explore how an education session impacts knowledge and use of self-awareness assessments in occupational therapists working with people with TBI; (2) Understand the barriers that occupational therapists experience when assessing self-awareness in clinical practice. Materials and Methods. A single-group pre-post session design with an integrated knowledge translation approach was used. Occupational therapists working in neurorehabilitation were recruited from two rehabilitation centres through convenience sampling. Participants completed questionnaires before, after, and three months following an education session about the Self-Awareness of Deficits (SADI) assessment. Results. 14 occupational therapists participated in this study. A statistically significant increase in knowledge and confidence in using the SADI was observed both post-session and at 3-month follow-up. Conclusion. Targeted and ongoing education promotes confidence and knowledge retention among occupational therapists. Further research should explore strategies to promote behaviour change. Significance. The barriers identified in this study can provide insights for knowledge translation across clinical contexts. [ABSTRACT FROM AUTHOR]

A trauma-informed approach is a framework for organisational (synonym system) change interventions that address the universal prevalence and impact of trauma. This mixed methods systematic review assessed the effects of trauma-informed approaches on psychological, behavioural, and health outcomes in health-care providers and adult patients in primary care and community mental healthcare. We searched five databases and grey literature and consulted experts for reports published in January 1990 to June 2021. The quantitative descriptive and qualitative framework syntheses were integrated through a line of argument and mapped onto a logic model. We included six nonrandomised studies that evaluated eight interventions with varied theoretical developments, components, and outcomes. The most common components were budget allocation, workforce development, identification/response to violence and trauma, and evaluation. Evidence for intervention effects was limited and conflicting. Four studies reported improvement in provider readiness and sense of community, while three reported conflicting effects on provider behaviour regarding delivery of trauma-informed care. Four studies reported some improvement in patient readiness for disease management and access to services; however, the evidence for patient satisfaction was conflicting. Two studies found that patients and providers felt safe. While one study reported improvement in patient quality of life and chronic pain, another found no effect on substance use, and three studies reported conflicting effects on mental health. Intervention mechanisms included a package of varied components, tailoring to the organisational needs, capacities and preferences, staff education and self-care, creating safe environments, and shared decision-making. Intervention effects were moderated by contextual (health system values, policies, governance, business models, trauma-informed movement, organisational culture, and social determinants of health) and intervention factors (buy-in from all staff, collective learning through conversations, equal attention to staff and patient well-being, and sustainable funding). No studies measured adverse events/harm, cost effectiveness, or providers' health. We need more methodologically robust evaluations of trauma-informed organisational change interventions. [ABSTRACT FROM AUTHOR]

Background. Electronic medical record (EMR) systems have become essential for the proper management of patients' information. Electronic medical record systems are on the rise in developing countries due to the need to ensure improved quality of healthcare. However, EMR systems can be ignored, if users are not satisfied with the implemented system. User dissatisfaction has been associated with the failure of EMR systems as a primary factor. There is also limited research done in the Ethiopian context on EMR user satisfaction at private hospitals. This study is aimed at assessing user satisfaction with electronic medical records and associated factors among health professionals working at private hospitals in Addis Ababa. Methods. Institution-based cross-sectional quantitative study was conducted among health professionals working at private hospitals in Addis Ababa, from March to April 2021. A self-administered questionnaire was used to collect the data. EpiData version 4.6 and Stata version 25 were used for data entry and analysis, respectively. Descriptive analyses were computed for the study variables. Bivariable and multivariable logistic regression analyses were carried out to assess the significance of independent variables on dependent variables. Results. A total of 403 (95.33% response rate) participants completed all the questionnaires. More than half of 214 (53.10%) of the participants were satisfied with the EMR system. Factors associated with user satisfaction with electronic medical records were good computer literacy (AOR = 2.92 , 95% CI: [1.16-7.37]), perceived information quality (AOR = 3.54 , 95% CI: [1.55-8.11]), perceived service quality (AOR = 3.15 , 95% CI: [1.58-6.28]), perceived system quality (AOR = 3.05 , 95% CI: [1.32-7.05]), EMR training (AOR = 4.00 , 95% CI: [1.76-9.03]), computer access (AOR = 3.17 , 95% CI: [1.19-8.46]), and HMIS training (AOR = 2.05 , 95% CI: [1.22-6.71]). Conclusions. In this study, health professionals' EMR satisfaction was moderate. The result showed that EMR training, computer literacy, computer access, perceived system quality, information quality, service quality, and HMIS training were associated with user satisfaction. Improving computer-related training, system quality, information quality, and service quality is an important intervention to improve the healthcare professional's satisfaction towards using electronic health record systems in Ethiopia. [ABSTRACT FROM AUTHOR]