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Direct Care Workers (DCW) provide both personal care to patients and emotional support to patients and caregivers in hospice and palliative care. DCWs often develop close ties and are then expected to work with new clients immediately following a care transition, with little or no time to grieve. A qualitative pilot study (n = 24) was conducted to explore the experience of DCWs during care transitions. Data was collected via focus groups and individual interviews. Thematic analysis was used. Results suggest DCWs managed their experiences (n = 19), by anticipating and accepting grief and loss (n = 21), employing personal coping strategies (n = 19), and saying good-bye (n = 15). Relational factors impacted the experience of care transitions (n = 22), including building and maintaining the relationship (n = 14), and the strength of perceived connections (n = 15). Increased organizational support and training to help address grief and loss will better support DCWs and the direct care workforce. [ABSTRACT FROM AUTHOR]

This qualitative study explored the perspectives and experience of New Zealand O&M instructors in the use of tactile maps with people with vision impairment. In-depth, open-ended, and semi-structured interviews were used to gather information from four participants, who were qualified O&M instructors. The interviews were analysed using thematic analysis. Three inter-related themes emerged from the data that effected the O&M's tactile map usage: (1) the tactile map and the O&M instructor, (2) student needs and experiences, and (3) time and resources. Microcapsule and thermoform maps were the least used map medium, with collage map techniques used frequently by half of the participants. The most preferred tactile maps were ready-made tactile map kits, and instructors drawing directly on the students' hand or back. Tactile maps were used mostly by the participants to meet the orientation needs of motivated students, who were blind, had no visual memory, or did not use their vision for orientation purposes. Tactile maps were considered a vital orientation tool when the participants were teaching such students, and the participants did not believe Global Positioning System (GPS) applications would fully replace tactile maps. However, in general, the participants revealed that tactile maps were used infrequently as an orientation tool in New Zealand because of caseload makeup, limited time, and limited resources. In order to increase the use of tactile maps, tactile map resources may need to be more readily available. In addition, further research is needed about the characteristics of people with a vision impairment, who benefit from tactile maps, along with the effect of tactile maps usage on an O&M instructor's caseload and time, so that O&M instructors can plan accordingly and people with a vision impairment can continue to benefit from this important orientation tool. [ABSTRACT FROM AUTHOR]

Background: Paramedic practice is diversifying to accommodate evolving global health trends, including community paramedicine models and growing expertise in palliative and end-of-life care. However, despite palliative care specific clinical practice guidelines and existing training, paramedics still lack the skills, confidence and clinical support to provide this type of care. Aim: To elicit paramedics', palliative care doctors and nurses', general practitioners', residential aged care nurses' and bereaved families and carers' experiences, perspectives, and attitudes on the role, barriers and enablers of paramedics delivering palliative and end-of-life care in community-based settings. Design: A qualitative study employing reflexive thematic analysis of data collected from semi-structured online interviews was utilised. Setting/participants: A purposive sample of 50 stakeholders from all Australian jurisdictions participated. Results: Five themes were identified: positioning the paramedic (a dichotomy between the life saver and community responder); creating an identity (the trusted clinician in a crisis), fear and threat (feeling afraid of caring for the dying), permission to care (seeking consent to take a palliative approach) and the harsh reality (navigating the role in a limiting and siloed environment). Conclusion: Paramedics were perceived to have a revered public identity, shaped by their ability to fix a crisis. However, paramedics and other health professionals also expressed fear and vulnerability when taking a palliative approach to care. Paramedics may require consent to move beyond a culture of curative care, yet all participant groups recognised their important adjunct role to support community-based palliative care. [ABSTRACT FROM AUTHOR]

This discourse analytical study explores how health professionals (HPs) construct burnout as a form of mental distress in the context of Finnish burnout rehabilitation framed with a particular rehabilitation ethos. Burnout is a fuzzy concept and lacks a disease status. Therefore, it calls for context-specific definition and justification. By highlighting the socially and interactionally produced character of categories of mental distress, the study investigates the kinds of discourses HPs use to formulate "the problem" and its solutions, and how people dealing with burnout are categorized in these discourses. The data consists of field notes from the observation of group discussion sessions in two 1-year burnout rehabilitation courses. As a result of the analysis, five partly overlapping discourses were identified: psychological, evolutionary, healthy lifestyle, biomedical, and welfare. Within these discourses, people who experience burnout were categorized as over-conscientious employees, "good girls," "primitive people," self-responsible rehabilitees, patients, and (aging) employees with social and legal rights. Burnout rehabilitation and HPs' views reproduce a cultural and clinical discourse around burnout in which work-related problems are treated as individual-level problems and individuals are responsibilized for the management of mental distress. Based on the results, it is concluded that the hybrid type of interventions that attempt to influence both individual- and work-related problems behind burnout would help to prevent people dealing with burnout from being over-responsibilized for solving problems at the workplace. [ABSTRACT FROM AUTHOR]

Background: Over the last decades, patient-reported outcome measures (PROM) have been developed for a better understanding of patient needs. The Integrated Palliative Care Outcome Scale (IPOS) is an internationally recommended PROM in palliative care. The validated electronic version of IPOS (eIPOS) was implemented in four German specialist palliative home care (SPHC) teams for use in everyday clinical practice. Patients reported symptoms and concerns via eIPOS, which were transmitted directly to the electronic patient record of the respective SPHC team. Objectives: The aim of the study was to describe and explore the health care professionals' (HCPs') experiences regarding acceptance and use of eIPOS in clinical practice in SPHC. Design: The mixed-methods sequential explanatory design comprised an anonymized quantitative online survey followed by qualitative focus groups. Methods: The online survey asked in both closed and open questions for HCP's experience with eIPOS. Ambiguous results from the survey were discussed in two focus groups. Survey data were analysed with descriptive and univariable statistics, and the framework approach was used for qualitative data. In a further step, we conducted integrated analysis of quantitative and qualitative results using joint displays. Results: All HCPs of the four SPHC teams (n = 52) were invited to participate. HCPs participating in the survey (n = 32) and the focus groups (n = 7) saw potentials for implementing ePROM in palliative home care – as far as it is technically easy to handle and can be easily integrated into clinical practice. Conclusion: Successful use of ePROMs is affected by the possibility of easy integration into the teams' different structures and processes and the HCPs' perceptions of potentials regarding ePROM use in SPHC. Registration: The study is registered on clinicaltrials.org (NCT03879668). Plain Language Summary: The use of electronic patient-reported outcome measures in specialist palliative home care: what do professionals think about it? A mixed-methods study Patient-reported outcome measures (PROMs) are short questionnaires developed to assess a patient's health status at a particular point in time. The Integrated Palliative Care Outcome Scale (IPOS) is such a questionnaire, and eIPOS is an electronic version of IPOS. IPOS asks about patients' symptoms and problems when they suffer from advanced diseases. We conducted this study to understand what health care professionals (HCPs) think about electronic PROMs (ePROMs) in palliative home care. We first asked the HCPs to answer questions in an online survey. Then, HCPs discussed the use of eIPOS in small discussion groups. This study design is called 'Mixed-Methods sequential design'. We found that all HCPs used the information they received through eIPOS – some frequently and some less often. Many HCPs see potential in using ePROMs to support care. For example, because ePROMs help them to understand patients' symptoms and problems better. However, they also pointed out that eIPOS needs technical improvement. Also, the procedures of eIPOS need to fit into the work routine of the palliative care team. The findings demonstrate the perspectives of HCPs on ePROM. These are valuable to understand how ePROM can be implemented in palliative home care. We can also learn about how to implement other digital tools in other settings of palliative care. [ABSTRACT FROM AUTHOR]

Gendered differences in workload distribution, in particular who spends time on low-promotability workplace tasks—tasks that are essential for organizations yet do not typically lead to promotions—contribute to persistent gender inequalities in workplaces. We examined how gender is implicated in the content, quality, and consequences of one low-promotability workplace task: assessment. By analyzing real-world behavioral data that include 33,456 in-the-moment numerical and textual evaluations of 359 resident physicians (subordinates) by 285 attending physicians (superordinates) in eight U.S. hospitals, and by combining qualitative methods and machine learning, we found that, compared to men, women attendings wrote more words in their comments to residents, used more job-related terms, and were more likely to provide helpful feedback, particularly when residents were struggling. Additionally, we found women residents were less likely to receive substantive evaluations, regardless of attending gender. Our findings suggest that workplace assessment is gendered in three ways: women (superordinates) spend more time on this low-promotability task, they are more cognitively engaged with assessment, and women (subordinates) are less likely to fully benefit from quality assessment. We conclude that workplaces would benefit from addressing pervasive inequalities hidden within workplace assessment, equalizing not only who provides this assessment work, but who does it well and equitably. [ABSTRACT FROM AUTHOR]

Background: Recovery concepts were conceived by, and for, people living with mental health issues. Practitioners are key in translating recovery principles into action. Therefore, practitioners' perceptions should be routinely assessed to facilitate in-service training, professional development, and curriculum redesign. Aim: To explore practitioners' and trainees' current perspectives regarding the concept of recovery. Methods: The study used a qualitative exploratory design with in-depth interviews to explore ten fully trained practitioners and eight trainees' perspectives on recovery. Results: The findings revealed a shared understanding of recovery among practitioners and trainees. Many responses explained recovery as a process involving internal and external conditions, however, some revealed medically oriented perspectives and/or were unclear about recovery terminologies. Conclusions: There is convergence and growing acceptance of the recovery practice principles among practitioners and trainees. However, the results suggest that the recovery principles/terminologies have not yet been universally adopted. Implications for practice and research: Continuous training on recovery principles is needed, incorporating emerging terminologies and principles. Also, education providers are encouraged to continue to review their training to incorporate emerging issues and trends in recovery-oriented practice. Finally, research is needed to enhance the development and delivery of recovery-focused practice. [ABSTRACT FROM AUTHOR]

With the COVID-19 pandemic necessitating the adoption of telepractice for providing speech and language therapy services, this study investigated the factors affecting the perceptions and the implementation of telepractice for school-age children by speech-language pathologists (SLPs) in the Philippines. Sixty-four SLPs completed a 36-item online survey assessing the adoption of telepractice, implementation concerns, student candidacy, continuous training in telepractice, and the SLPs' demographics. The SLPs reported that they quickly adopted telepractice in their services for school-age students at the start of the pandemic. Multiple linear regression analyses revealed that SLPs' perceptions of the effectiveness of telepractice were significantly affected by implementation difficulties while SLPs' future use of telepractice was significantly predicted by training and resource availability. These results suggest that professional training and other therapeutic resources are needed to alleviate SLPs' concerns about difficulties in implementing and continuing use of telepractice. [ABSTRACT FROM AUTHOR]

Staff in the National Health Service (NHS) are under considerable strain, exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. We interviewed 48 healthcare workers from 18 NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking, such as manager training and peer support facilitated by building in time for this during working hours, but this will require long-term strategic planning to address workforce shortages. [ABSTRACT FROM AUTHOR]

Background: Despite an increase in methamphetamine use and subsequent hospitalizations, the majority of Canadian hospitals currently lack harm reduction strategies for substance use. This can mean that people with lived experience of methamphetamine use are faced with a number of difficult decisions to make when admitted to hospital. Caring for people with lived experience of methamphetamine use can also be problematic with zero tolerance policies requiring abstinence to be maintained. This analysis set out to understand potential health care issues due to a lack of harm reduction strategies from the prospective of people with lived experience of methamphetamine use as well as health care/service professionals. Methods: Based on a larger study, this secondary analysis explored issues discussed by people with lived experience of methamphetamine use and health care/service professionals regarding the challenges of providing harm reduction approaches in the hospital setting. A total of 108 individuals with lived experience of methamphetamine use completed a qualitative component of a mixed-method interview. In addition, 31 health care/service professionals participated in virtual focus groups and one-to-one interviews. Responses were analyzed using an ethnographic thematic approach. Results: People with lived experience of methamphetamine use reported 3 choices upon admission: leave or avoid the hospital, stay but experience unsupported withdrawal, or stay but hide their substance usage from health care professionals. Health care/service professionals described 2 options: uphold zero tolerance that can lead to stigma and a lack of knowledge regarding addiction, or accept harm reduction but be unable to implement such strategies. This could lead to health being compromised due to policy and practice that requires abstinence. Neither group of participants described a good choice for them. Conclusion: Current policy and education related to substance use needs to be revised. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the effect of transformational and transactional leadership styles on organizational readiness for change among health professionals in the case of selected public hospitals in the North Showa Zone, Oromia Region, Ethiopia. Methods: The institutional-based cross-sectional study design was employed for one month in April 2021. The data were collected from a sample of 212 subordinate health professional staffs. Multi-factor leadership surveys and organizational readiness for change questionnaires were used for data collection. Data were analyzed using descriptive statistics and exploratory factor analysis, run on the SPSS 23 version. Pearson correlation and multiple regressions were used. Multiple regression results were expressed using the statistical values R 2 and β-coefficient. Statistical significance was declared at a P -value of <.05. Result: The Pearson product correlation of organizational readiness for change was found to be low positive and statistically significant for both transformational leadership behavior (r =.49, P <.01) and transactional leadership behavior (r =.39, P <.01). Both transformational leadership behavior (t = 5.32, P =.00) and transactional leadership behavior (t = 2.08, P =.034) were found to be significant contributors to the variance of organizational readiness for change among health professionals, according to the findings. However, transformational leadership behavior style appears to make a more significant contribution (β = 0.39) than transactional leadership style (β = 0.15) in predicting organizational readiness for change among health professionals. Conclusion: The study revealed that whenever transformational and/or transactional leadership behaviors are exhibited by the administrative staff, readiness for organizational change (commitment and efficacy) increases among health professionals. The study also concluded that a quarter of the readiness for organizational change can be affected by the two leadership styles. [ABSTRACT FROM AUTHOR]

Background: Availability of personal protective equipment (PPE) and its effective use may influence safety climate perceptions among health care personnel (HCP). It is unclear how health care organizations can leverage the effective use of respiratory protection to engage in continuous improvement of their safety climate, which can inform opportunities for employee education and engagement. Methods: After using an elastomeric half mask respirator (EHMR) as their primary form of respiratory protection for several months, 1,080 HCP provided feedback in an electronic survey about respiratory protection training, confidence in EHMR use, barriers during use, and perceived safety climate. Ordinal logistic regressions were used as nonlinear models to test relationships between these variables. Findings: We observed that an increase in user confidence (p <.013), training content (p <.001), training formats (p <.001), and a decrease in EHMR barriers (p <.001) were associated with a statistically significant increase in proactive safety climate. In the second model, an increase in user confidence (p <.006) and training content (p <.001), and a decrease in barriers (p <.001), was associated with a statistically significant increase in compliant safety climate. Conclusions/Application to Practice: HCP EHMR confidence was positively associated with safety climate perceptions, underscoring the value of competency building by respiratory protection leaders prior to implementation. Because fewer barriers experienced while using an EHMR were associated with a more positive perception of safety climate, it is important to first communicate with end users about potential barriers and, second, to continue research with end users and manufacturers to improve the design of EHMRs moving forward. [ABSTRACT FROM AUTHOR]

The coronavirus (COVID-19) pandemic represented a critical moment for technology use within rehabilitation counseling. This study explored trends in the beliefs and behaviors of certified rehabilitation counselors (CRCs) regarding the ethical use of technology before and during the pandemic. Specifically, this study compared two groups of CRCs regarding the degree to which they engaged in 59 technology behaviors and whether they viewed each behavior to be ethical. Overall, group comparisons suggested an increased use of telephone, videoconferencing, and email to deliver counseling, assessment, and supervision services during the pandemic. Furthermore, supervision via videoconferencing and email in the pandemic were rated as more ethically appropriate than before the pandemic. As a general trend, synchronous modes of communication such as the telephone and video conferencing were rated as more ethically appropriate than asynchronous modes such as social networking and text messaging. Indicating a high degree of congruence between beliefs and behaviors, the technology practices viewed as most ethical were used the most often. Implications address the revisions to the Code of Professional Ethics for Rehabilitation Counselors regarding the ethical use of technology in rehabilitation counseling. [ABSTRACT FROM AUTHOR]

This commentary is a response to the article by Lappaman and Swartz, "How gentle must violence against women be in order not to be violent?" in which the term "obstetric violence" is critiqued. The authors argue that the term is harmful and does violence (to health care workers and even birthers themselves) and is not helpful to efforts to improve or reform maternity care. They suggest that we abandon the term and use less inflammatory descriptions (i.e., such as "mistreatment") instead. While recognizing the inevitable risks involved in naming and writing about obstetric violence, I argue that these risks are necessary in the interests of struggling against unjust systems. I unpack the authors' critique and argue that it ultimately works to minimize experiences of obstetric violence, silence the voices of those that have been speaking out on this issue for a very long time, and casts doubt on the legitimacy of a concept that has only recently received global recognition (after a long and transnational struggle). These harms and dangers are not necessarily the direct intentions of the authors but are embedded in wider structures of power that are often incredulous, disbelieving, and dismissive in the face of testimonies and evidence of gendered and racialized pain/violence. [ABSTRACT FROM AUTHOR]

Background: Although published studies have examined the perceptions of caregivers who are attending to older adults with dementia concerning the values of human dignity and/or autonomy in institutional settings, none have explored the possible differences in actual behavior that relates to these values for caregivers from diverse ethno-cultural backgrounds. Aims: Explore how caregivers with varied cultural backgrounds may differ in their real-time behavior regarding the autonomy and dignity of older adults with dementia and thereby determine whether that real-time behavior reveals new aspects of respect and disrespect for both the autonomy and dignity of those older adults. Research Design and Methods: A qualitative research based on non-participatory observations, was meticulously recorded using a written journal and a rigorous microanalysis to analyze the collected data. We made 58 shift-based observations (morning and evening) of 29 caregivers from 3 ethno-cultural groups working in 3 nursing homes in Israel. These groups included Israeli-born Jews (Sabras), Israeli Arab-Muslims (Arabs), and immigrants from the Former Soviet Union (IFSU). Results: (1) IFSU caregivers demonstrated more respect for autonomy and dignity, but also demonstrated disrespect for these values. (2) the main difference between the IFSU caregivers and other caregiver groups pertained to respect for their autonomy. The main specific facets of autonomy where IFSU caregivers surpassed their colleagues were information provision and persuasion. (3) toward both autonomy and dignity of these older adults, previously unaccounted for in the models we used, were discovered among the varied groups of caregivers, with only minor gaps between these groups. Discussion and Implications: This study—the first of its kind to focus on the real-time behaviors of caregivers from diverse ethno-cultural backgrounds—reveals the potential effects of culture on applying practices related to dignity and autonomy during daily care. The findings may have important implications for caregiver training in multicultural societies. [ABSTRACT FROM AUTHOR]

Relatively little is known about readiness of urban health systems to address health needs of the poor. This study explored stakeholders' perception of health needs and strategies for improving health of the urban poor using qualitative analysis. Focus group discussions (n = 5) were held with 26 stakeholders drawn from two Nigerian states during a workshop. Urban areas are characterised by double burden of diseases. Poor housing, lack of basic amenities, poverty, and poor access to information are determinants of health of the urban poor. Shortage of health workers, stock-out of medicines, high cost of care, lack of clinical practice guidelines, and dual practice constrain access to primary health services. An overarching strategy, that prioritises community-driven urban planning, health-in-all policies, structured linkages between informal and formal providers, financial protection schemes, and strengthening of primary health care system, is required to address health needs of the urban poor. [ABSTRACT FROM AUTHOR]

Background: Despite the reported importance of rapport, there are knowledge gaps in the ways rapport is developed and experienced by health professionals during telehealth calls in palliative care. Aim: To gain an understanding about developing rapport during telehealth calls by exploring the experiences of health professionals in community palliative care. Design: A qualitative Interpretive Description study was conducted with semi-structured interviews and focus groups between November 2020 and May 2021. Data was audio recorded, transcribed, and analysed using Reflexive thematic analysis. A COREQ checklist was completed. Setting/Participants: Thirty-one palliative care professionals who had participated in telehealth calls were recruited from four hospice locations in Aotearoa, New Zealand. Results: There were two themes identified: (1) 'Getting on together', which included how rapport shows up in telehealth, with examples of calls with rapport and without rapport, and (2) 'Rapport is a soft skill', which identified health professionals using body language and listening in specific ways in telehealth, while being aware of the privacy of calls, and lack of training concerns. Conclusion: Based on health professionals experiences of rapport it was determined that rapport is vitally important in telehealth calls, as it is in-person interactions. Rapport is a soft skill that can potentially be learned, practiced and mastery developed, although rapport in each interaction is not guaranteed. Patient and family experiences of rapport in the palliative telehealth area warrants further research and there is some urgency for health professional training in telehealth interpersonal skills. [ABSTRACT FROM AUTHOR]

Black Americans face a multitude of problems in the healthcare system, including challenges during interactions with healthcare providers. The present study examined the quality of healthcare provider–Black patient interactions in a sample of Black American women with a breast cancer diagnosis. More specifically, the study examined potential contributors to Black Americans' current healthcare experiences and lack of trust by identifying their specific negative and positive encounters in the healthcare system. Three in-person Gatherings (i.e., culturally curated focus groups; N = 37) were conducted as part of a community–academic research partnership, Project SOAR (Speaking Our African American Realities). Four themes were identified through reflexive thematic analysis: Individual and Systemic Injustice Directed at Black Breast Cancer Survivors; Protecting Myself from an Untrustworthy Medical System; Stereotypes Interfered with My Care; and Good Care Should Include Compassion, Respect, Shared Decision Making, and Tailored Support. The present findings highlight the importance of addressing systemic and individual injustice toward Black Americans in healthcare settings generally, and Black women diagnosed with breast cancer specifically. [ABSTRACT FROM AUTHOR]

In the Netherlands, as in many other countries, victims of intentionally committed violent crimes may apply for state compensation if the offender is unknown or unable to pay for the damages of the crime. This state compensation scheme is run by the Dutch Violent Offences Compensation Fund (VOCF). Lawyers who work for this fund need to evaluate applicants' eligibility for state compensation on the basis of two criteria: (1) the plausibility of the applicant's victimization story and (2) the severity of the injury sustained by the applicant. Whether these criteria are fulfilled is largely left to the discretion of the lawyer who evaluates the application. This discretionary power makes the decision-making process prone to biased outcomes. Inspired by previous research, this study investigated whether information from mental health care providers, such as psychiatrists or clinical psychologists, serves as a potential source of bias. Although this type of information may or should sometimes be used to evaluate an applicant's eligibility for compensation, in most cases it should not affect the outcome of this evaluation because of its potential unreliability. A statistical association between availability of information from mental health care providers and adjudication of state compensation is therefore not to be expected. Analyzing 246 applications submitted to the Dutch VOCF between July 1st 2016 and July 1st 2017, this study tested the empirical validity of this expectation. Results indicated that the availability of information of mental health care providers was associated with adjudication of state compensation. This finding was discussed in view of the literature on heuristic thinking and biased decision making and the study's limitations. [ABSTRACT FROM AUTHOR]

Objectives: Research suggests that higher Body Mass Index is associated with improved survival in people with Amyotrophic Lateral Sclerosis (pwALS). Yet, understanding of the barriers and enablers to increasing calorie intake is limited. This study sought to explore these issues from the perspective of pwALS, informal carers, and healthcare professionals. Methods: Interviews with 18 pwALS and 16 informal carers, and focus groups with 51 healthcare professionals. Data were analysed using template analysis and mapped to the COM-B model and Theoretical Domains Framework (TDF). Results: All three COM-B components (Capability, Opportunity and Motivation) are important to achieving high calorie diets in pwALS. Eleven TDF domains were identified: Physical skills (ALS symptoms); Knowledge (about high calorie diets and healthy eating); Memory, attention, and decision processes (reflecting cognitive difficulties); Environmental context/resources (availability of informal and formal carers); Social influences (social aspects of eating); Beliefs about consequences (healthy eating vs. high calorie diets); Identity (interest in health lifestyles); Goals (sense of control); Reinforcement (eating habits); and Optimism and Emotion (low mood, poor appetite). Discussion: To promote high calorie diets for pwALS, greater clarity around the rationale and content of recommended diets is needed. Interventions should be tailored to patient symptoms, preferences, motivations, and opportunities. [ABSTRACT FROM AUTHOR]

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Background: Italy was the first European country to be involved with the COVID-19 pandemic. As a result, many healthcare professionals were deployed and suddenly faced end-of-life care management and its challenges. Aims: To understand the experiences of palliative care professionals deployed in supporting emergency and critical care staff during the COVID-19 first and second pandemic waves. Research design: A qualitative descriptive design was adopted, and in-depth interviews were used to investigate and analyse participants' perceptions and points of view. Participants and research context: Twenty-four healthcare professionals (physicians, nurses, psychologists, physiotherapists, and spiritual support) from the most affected areas of Italy were recruited via the Italian society of palliative care and researchers' network. Ethical considerations: The University Institutional Board granted ethical approval. Participants gave written informed consent and agreed to be video-recorded. Findings: The overarching theme highlighted participants' experience supporting health professionals to negotiate ethical complexity in end-of-life care. Crucial topics that emerged within themes were: training emergency department professionals on ethical dimensions of palliative and end-of-life care, preserving dying patients' dignity and developing ethical competence in managing end-of-life care. Conclusions: Our study showed palliative care teams' challenges in supporting health professionals' ethical awareness in emergencies. However, while they highlighted their concerns in dealing with the emergency staff's lack of ethical perspectives, they also reported the positive impact of an ethically-informed palliative care approach. Lastly, this study illuminates how palliative care professionals' clinical and ethical competence might have assisted a cultural change in caring for dying patients during COVID-19 and future emergencies. [ABSTRACT FROM AUTHOR]

Introduction: Hip fractures among older people are common worldwide, and it is often associated with preoperative pain. Due to increased comorbidity and high age, traditional pain relief can be a challenge. An alternative to traditional pain relief is a femoral nerve block, which is safe and suitable for anesthesia and analgesia for hip fractures among patients with or without dementia. It is essential to provide adequate pain management, and nurses report negative attitudes toward opioids and seem to prefer alternative pain management. To our knowledge, no study has focused on staff's experiences of nursing care for patients treated with femoral nerve block. Aim: To describe staff's experiences providing nursing care in preoperative pain and pain management to older patients with a hip fracture who received a femoral nerve block. Design: A qualitative exploratory design. Method: Semistructured interviews with 19 nurses or assistant nurses in an orthopedic ward or emergency department. They were experienced in caring for patients with hip fractures who received treatment with a femoral nerve block. The interviews were subjected to qualitative content analysis. Results: Staff described the femoral nerve block as setting the agenda when caring for older patients with hip fractures in the preoperative phase. The outcome of the femoral nerve block affected nursing care, depending on if the femoral nerve block was successful or not. Nursing care requires timing, with a need for staff orienting to time and customizing their communication. Further, staff faced ethical challenges regarding doing good and not harm, relieving pain, and avoiding side effects. Conclusions: The femoral nerve block was an important issue for nursing staff in patients with hip fractures in the preoperative phase. Our results point toward the benefits of giving femoral nerve blocks as soon as possible to facilitate nursing care, however, this should be studied in future research. [ABSTRACT FROM AUTHOR]

During the outbreak of the COVID-19 pandemic, Norwegian health authorities introduced social distancing measures in nursing homes. The aim was to protect vulnerable residents from contracting the potentially deadly infection. Drawing on individual interviews with nursing home managers and physicians, and focus groups with nursing staff, we explore and describe consequences the social distancing measures had on nursing home residents' health and wellbeing. The analysis indicates that most residents became socially deprived, while some became calmer during the nursing home lockdown. Nursing home staff, physicians and managers witnessed that residents' health and functional capacity declined when services to maintain health, such as physiotherapy, were put on hold. In conclusion, we argue that although Norwegian health authorities managed to keep the infection rates low in nursing homes, this came at a high price for the residents however, as the social distancing measures also negatively impacted their health and wellbeing. [ABSTRACT FROM AUTHOR]

Background: Tobacco-related illnesses are among the leading preventable causes of death for Latinos/as in the United States. Latino/a groups are less likely to receive advice to quit from health professionals or use tobacco cessation strategies. The position of community health workers (CHWs) warrants further attention to address tobacco-related disparities in Latino/a communities. The objective of this study was to describe CHWs' roles to inform future smoking cessation training to ensure relevance and accessibility. Methods: A needs assessment survey, including a 10-item tobacco knowledge questionnaire, was conducted with 29 Latino/a CHWs serving Latino/a communities in a metropolitan area to assess their roles, tobacco related services, attitudes, and knowledge. Results: All CHWs were Spanish-speaking and mainly employed part time (55%) in community organizations (67%). They offered various services, primarily health education. Most of the CHWs (58.6%) assessed and discussed tobacco use, yet half (51.7%) reported low confidence in this area. Some CHWs (41%) expressed that their clients/patients would use evidence-based nicotine replacement therapies as a smoking cessation treatment if offered and identified "Financial Cost" (31%) as a deterrent of use. CHWs' score on a tobacco knowledge questionnaire indicated low knowledge in areas related to tobacco (4.03 out of 10; SD = 1.92). Conclusions: CHWs reported low tobacco related knowledge and confidence, and would benefit from tailored tobacco cessation training to decrease tobacco cessation disparities. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence to support the use of ultrasound as a tool for the assessment and treatment of speech, voice and swallowing disorders across the Speech and Language Therapy profession. Research has shown that development of training competencies, engagement with employers and the professional body are vital to progressing ultrasound into practice. Methods: We present a framework to support translation of ultrasound into Speech and Language Therapy. The framework comprises three elements: (1) scope of practice, (2) education and competency and (3) governance. These elements align to provide a foundation for sustainable and high-quality ultrasound application across the profession. Results: Scope of practice includes the tissues to be imaged, the clinical and sonographic differentials and subsequent clinical decision-making. Defining this provides transformational clarity to Speech and Language Therapists, other imaging professionals and those designing care pathways. Education and competency are explicitly aligned with the scope of practice and include requisite training content and mechanisms for supervision/support from an appropriately trained individual in this area. Governance elements include legal, professional and insurance considerations. Quality assurance recommendations include data protection, storage of images, testing of ultrasound devices as well as continuous professional development and access to a second opinion. Conclusion: The framework provides an adaptable model for supporting expansion of ultrasound across a range of Speech and Language Therapy specialities. By taking an integrated approach, this multifaceted solution provides the foundation for those with speech, voice and swallowing disorders to benefit from advances in imaging-informed healthcare. [ABSTRACT FROM AUTHOR]

End-of-life care in long-term care facilities for older adults requires numerous skills. However, many professionals, including occupational therapists, feel unprepared to deal with death and dyingand have difficulties to attend to the real needs of the older adults and their families.This is a qualitative study anchored in phenomenologywhich had the objective to understand the perception of occupational therapists regarding death and dying inlong-term care facilities. Data were collected through focus groups and analyzed by thematic content analysis. A total of 12 occupational therapists participated in this study, and two themeswere generated: "The Experience of Death and Dying" and "The Occupational Therapist's approach in Facing Death and Dying". These results may contribute to improvingthe care provided to older adults in the process of death and dying. [ABSTRACT FROM AUTHOR]

Clinical judgement is a crucial part of autism and attention deficit hyperactivity disorder (ADHD) assessments. This study aims to harness insights from psychology and sociology to explore clinical perspectives and assessment practices of autism and attention deficit hyperactivity disorder. Qualitative interviews were conducted with health care professionals (n = 17). Interviews were conducted between January and May 2019. Data were analysed using a thematic approach. Themes were sorted into two interrelated categories (1) approaches to diagnosis (2) elements of diagnosis. Approaches to diagnosis were comprised of the following subthemes: nature of diagnosis, application of diagnosis: natural and pragmatic, revisiting conceptualisations: sub-optimal practice & unhelpful diagnoses, autism and attention deficit hyperactivity disorder. Elements of diagnosis contained three related subthemes: contextualising standardised assessments, triangulating material, organisational factors. There is sometimes a pragmatic as well as nosological dimension to diagnosis. Competing desires for consistency and utility add further complexity to neurodevelopmental assessment. Autism and attention deficit hyperactivity disorder are common behaviourally diagnosed conditions. One of the key aspects of diagnosis is clinical judgement. Yet despite decades of research, it is only in recent times that researchers have started exploring clinicians' perspectives on diagnosing these conditions. We aimed to add to this body of knowledge by conducting interviews with 17 experienced health care professionals in the United Kingdom to hear their perspectives on diagnosing autism and attention deficit hyperactivity disorder. Clinicians reflected that for some children and young people, diagnosis is reasonably straightforward; however, in other situations, decisions are made on more pragmatic grounds (i.e. will this be helpful). We identified some differences of opinion between professionals and organisation which adds to the complexity of applying a diagnosis. We recommend several areas for future research and point to some practical and philosophical implications of the work. [ABSTRACT FROM AUTHOR]

While animals have long been a focus in therapeutic spaces for young people via approaches such as animal-assisted therapies, there is a sense in which such approaches overlook the broader contribution that animals play by being present in young people's lives. In this article, we explore how the presence of animals (both physical and psychological) in interactions with healthcare professionals may hold specific meaning for trans young people living in Australia. Participants were recruited through Parents of Gender Diverse Children. Interviews were conducted in November 2021 with 17 trans young people and one of each of their parents living in Australia. All interviews were audio recorded, transcribed, and analyzed using thematic analysis. Two main themes were developed: (1) how healthcare professionals respond to conversations about animals and (2) the beneficial role of the presence of animals. The article concludes by discussing the importance of thinking about the presence of animals beyond existing frameworks and recognizing the value placed on the presence of animals by trans young people. [ABSTRACT FROM AUTHOR]

The article presents the discussion on describing barriers and facilitators for implementing standardized outcome measurement in cleft care internationally. Topics include identifying difficulties in getting patients for physically attending follow-up clinics within working hours as a barrier for implementing standardized outcome measurement; and automating data processing and accommodating remote data collection as part of the clinical workflow.

Objective: To explore the knowledge and attitudes of psychiatrists about psychedelics therapies. Method: Access to a cross-sectional survey was distributed to psychiatrists through social media channels. Attitudes and knowledge about psychedelic therapies were recorded using Likert scales and ranking questions. Results: Fifty-eight complete responses were collected (44 fully trained +14 trainee RANZCP members). Greater than 85% of respondents agreed there is a shortfall in effective psychiatric treatments, and greater than 65% agreed that psychedelic therapies might address this shortfall. The psychiatrists did not consider themselves knowledgeable about psychedelic therapies, with 60% showing interest in further training on this topic. About 70% of the sample hold various concerns about psychedelic therapies, and more believe that the prescription of psychedelics should be limited to psychiatrists in the future. Conclusion: Considering these results in the context of a rapidly changing landscape relating to psychedelic research and regulations, we suggest there is scope to develop up-to-date education about psychedelics for psychiatrists. [ABSTRACT FROM AUTHOR]

Family violence (FV) is a universal public health problem in South Asia with negative-health outcomes for South Asian women. Health care providers (HCPs) play a pivotal role in identifying and supporting women experiencing FV, but little is known about their experiences with South Asian women. A systematic review was conducted to explore and address health care providers' views on identification and response to South Asian women experiencing FV. Nine online databases, reference lists were searched, and a priori inclusion and exclusion criteria were applied independently by two reviewers. A meta-synthesis approach was utilized to integrate findings from qualitative studies. Eight studies involving 250 participants met the inclusion criteria. Studies were published between 2007 and 2020 within South Asian countries (Pakistan, India, and Sri Lanka) and one study from the USA and UK. The meta-synthesis identified three themes: Context of societal norms and attitudes towards women in South Asia; Influence of family honor, Privacy and shame; and Concern about health care provider's personal safety. Findings revealed that FV is often perceived as a normal routine issue and is considered a "private issue" in South Asian society. Family honor and values play a pivotal role in silencing women experiencing FV as disclosure is considered shameful and disgrace to family honor. Furthermore, health care providers avoid intervening in FV cases due to risk for their personal safety. Finally, this review provides the evidence to support a specific framework for FV interventions among south Asian women for policy makers and practitioners. [ABSTRACT FROM AUTHOR]

Online research methods have risen in popularity over recent decades, particularly in the wake of COVID-19. We conducted five online workshops capturing the experiences of participatory health researchers in relation to power, as part of a collaborative project to develop global knowledge systems on power in participatory health research. These workshops included predominantly academic researchers working in 24 countries across Africa, Asia, Europe, and the Americas. Here, we reflect on the opportunities, limitations, and key considerations of using online workshops for knowledge generation and shared learning. The online workshop approach offers the potential for cross-continental knowledge exchange and for the amplification of global South voices. However, this study highlights the need for deeper exploration of power dynamics exposed by online platform use, particularly the 'digital divide' between academic partners and community co-researchers. Further research is needed to better understand the role of online platforms in generating more inclusive knowledge systems. [ABSTRACT FROM AUTHOR]

Background: To fulfil the desire for evidence-based practice, there is impetus for occupational therapy (OT) to make research a priority and to encourage research engagement. Purpose: This study's aim was to explore occupational therapists' reasons for and for not getting involved in research and to determine potential barriers and enablers to engaging in research. Methods: Three focus groups were conducted with five participants each. Data were thematically analysed. Findings: Occupational therapists' reasons for expressing interest in getting involved in research were having an interest in the condition and/or the symptoms being studied; promoting client support and service development; and 'upskilling'. Three themes emerged from the thematic analysis: (1) motivation to get involved in research can be influenced; (2) 'firefighting': barriers and organisational culture; and (3) The nature of research needs consideration from an occupational therapist perspective. Implications: Findings suggest that though occupational therapists are able to get involved in research, it remains that there are difficulties in doing so (e.g., organisational culture); and such difficulties may outweigh both reasons and enablers to such involvement. Reasons for expressing interest, enablers, barriers and the relationships among them warrant further investigation and consideration with respect to involving occupational therapists in research. [ABSTRACT FROM AUTHOR]

This study surveyed a national sample of victim service professionals (N = 222) and compared rural versus urban/suburban participants' perceptions of a variety of issues, such as the impact of the pandemic on gender-based violence victimization and safety advice for isolated victims. Increased interference with victim employment and the abuser monitoring of online activities were reported by participants across all communities. However, urban/suburban participants rated the magnitude of all victim challenges as greater, while more rural participants noted child abuse as a particular problem in their communities. The results highlight the importance of community context for improving coordinated responses to gender-based violence (n = 101). [ABSTRACT FROM AUTHOR]

Emerging evidence suggests that the COVID-19 pandemic disproportionately impacted survivors of domestic violence and sexual assault (DV/SA). This research note explores DV/SA service providers' (n = 20) perceptions of how their organizations responded to the pandemic. Results of a thematic content analysis indicated that survivors were adversely affected by sheltering with abusive partners and by external environmental conditions. Organizations responded to shifting community needs by adapting face-to-face services to virtual formats and revising pre pandemic safety planning protocols. School-based prevention programming required significant adjustments. Therefore, the pandemic catalyzed the integration and optimization of emerging technologies and provided opportunities for organizational innovation. [ABSTRACT FROM AUTHOR]

Background: Voluntary and community sector bereavement services are central to bereavement support in the UK. Aim: To determine service providers' perspectives on access to their support before and during the COVID-19 pandemic. Design: Mixed methods study using an explanatory sequential design: (1) Cross-sectional online survey of UK bereavement services; (2) Qualitative interviews with staff and volunteers at selected services. Settings/participants: 147 services participated in the survey; 24 interviews were conducted across 14 services. Results: 67.3% of services reported there were groups with unmet needs not accessing their services before the pandemic; most frequently people from minoritised ethnic communities (49%), sexual minority groups (26.5%), deprived areas (24.5%) and men (23.8%). Compared with before the pandemic, 3.4% of services were seeing more people from minoritised ethnic groups, while 6.1% were seeing fewer. 25.2% of services did not collect ethnicity data. Qualitative findings demonstrated the disproportionate impact of the pandemic on minoritised ethnic communities, including disruption to care/mourning practices, and the need for culturally appropriate support. During the pandemic outreach activities were sometimes deprioritised; however, increased collaboration was also reported. Online provision improved access but excluded some. Positive interventions to increase equity included collecting client demographic data; improving outreach, language accessibility and staff representation; supporting other professionals to provide bereavement support; local collaboration and co-production. Conclusions: Service providers report inequities in access to bereavement support. Attention needs to be paid to identifying, assessing and meeting unmet needs for appropriate bereavement support. Identified positive interventions can inform service provision and research. [ABSTRACT FROM AUTHOR]

Background: Lack of access, late engagement and limited referral for palliative care remain critical issues in supporting Indigenous Australians with life limiting illness. Aim: To explore the experiences and perspectives of Indigenous and non-Indigenous health professionals regarding the provision of palliative care for Indigenous people with advanced disease. Design: Qualitative study involving semi-structured focus groups/interviews with analysis following an inductive thematic approach. Setting/participants: A purposive sample (n = 54) of medical, nursing, allied health and Indigenous Hospital Liaison Officers engaged in caring for Indigenous patients at a metropolitan teaching hospital in Australia. Results: Four overarching themes were identified regarding provision of palliative care for Indigenous patients. These were (1) the intersection of cultures – Indigenous peoples, health and palliative care, (2) bridging the cultural divide: the integral role of Indigenous Hospital Liaison Officers, (3) health professionals devolve their responsibility to provide culturally appropriate care and (4) building towards a more holistic, culturally aware provision of palliative care. Conclusions: For many Indigenous people, the health system may be experienced as inflexible, narrowly focused and even prejudiced and traumatising. For Indigenous patients at the end of life, these challenges are heightened. The Indigenous Hospital Liaison Officers, working at the intersections of these two cultures, are key to negotiating such challenges as they seek opportunities to facilitate communication and understanding between firmly held cultural needs. [ABSTRACT FROM AUTHOR]

An important gap in the literature is how clinicians feel about patient-centered technologies and how clinicians experience patient-centered technologies in their workflows. Our goal was to identify clinician users' perspectives on facilitators (pros) and barriers (cons) to using 1 digital texting innovation to promote family centered care during patients' hospitalizations. This qualitative study was conducted at a tertiary care center in Houston, consisting of 7 hospitals (1 academic hospital and 6 community hospitals), involving analyzation of 3 focus groups of 18 physicians, 5 advanced practice providers, and 10 nurse directors and managers, as well as a content analysis of 156 real-time alerts signaling family dissatisfaction on the nursing unit/floor. Thematic analysis methods were used. We selected these participants by attending their regularly scheduled service-line meetings. Clinician feedback from focus groups resulted in 3 themes as facilitators : (a) texting platforms must be integrated within the electronic medical record; (b) texting reduces outgoing phone calls; (c) texting reduces incoming family phone calls. Clinician feedback resulted in 3 themes as barriers : (a) best practice alerts can be disruptive; (b) real-time alerts can create hopelessness; and (c) scale-up is challenging. The analyzation of facilitators (pros) and barriers (cons) pertains only to the clinician's feedback. We also analyzed real-time alerts signaling family dissatisfaction (defined as "service recovery escalation" throughout this manuscript). The most common selection for the source of family dissatisfaction, as reflected through the real-time alerts was, "I haven't heard from physicians enough," appearing in 52 out of 156 alerts (33%). The second most common selection for the source of dissatisfaction was "perceived inconsistent or incomplete information provided by team members," which was selected in 48 cases (31%). Our findings indicate that clinicians value inpatient texting, not only for its ability to quickly relay updates to multiple family members with 1 click, but also because, when used intentionally and meaningfully, texting decreases family phone calls. [ABSTRACT FROM AUTHOR]

This qualitative study evaluates physician training and experience with treatment and prevention services for people who inject drugs (PWID) including medications for opioid use disorder (MOUD) and HIV pre-exposure prophylaxis (PrEP). The Behavioral Model of Healthcare Utilization for Vulnerable Populations was applied as a framework for data analysis and interpretation. Two focus groups were conducted, one with early career physicians (n = 6) and one with mid- to late career physicians (n = 3). Focus group transcripts were coded and analyzed using thematic analysis to identify factors affecting implementation of treatment and prevention services for PWID. Respondents identified that increasing the availability of providers prescribing MOUD was a critical enabling factor for PWID seeking and receiving care. Integrated, interdisciplinary services were identified as an additional resource although these remain fragmented in the current healthcare system. Barriers to care included provider awareness, stigma associated with substance use, and access limitations. Providers identified the interwoven risk factors associated with injection drug use that must be addressed, including the risk of HIV acquisition, notably more at the forefront in the minds of early career physicians. Additional research is needed addressing the medical education curriculum, health system, and healthcare policy to address the addiction and HIV crises in the U.S. South. [ABSTRACT FROM AUTHOR]

Introduction: During the COVID-19 pandemic, substance use disorder (SUD) treatment settings experienced several abrupt changes, including decreased admissions, reduction in services, and modified requirements for medication for substance use disorder. While these changes were implemented to facilitate the maintenance of important treatment options, the ethical consequences of such changes remained unknown. The current study aimed to explore ethical issues related to COVID-19-related changes reported by counselors in SUD treatment facilities. Method: From May to August 2020, we conducted 60 to 90 minutes in-depth interviews with 18 front-line staff in 1 residential and 1 outpatient treatment program, exploring issues drawn from the ethical principles of the national organization representing SUD counselors. Counselors volunteered to participate via phone or email, and participation was confidential. Interviews were conducted via videoconferencing. Topics included day-to-day experiences of ethical dilemmas in the workplace, particularly during the COVID-19 era. Interviews were recorded, transcribed, and checked for accuracy and a trained team of analysts then coded transcripts using thematic analysis. Results: As a result of the COVID-19 pandemic, SUD treatment programs quickly modified procedures to adhere to public health mandates while also continuing to offer care to clients. SUD counselors reported several ways their programs adapted new and creative procedures to reduce the risk of COVID-19 transmission. SUD counselors also identified several novel ethical dilemmas that occurred during the COVID-19 pandemic, often resulting from the counselor balancing the needs for responding to public health mandates with providing services to clients. There were several ways that COVID-19 related changes resulted in therapeutic challenges for some clients, and the SUD counselors highlighted ways that changes resulted in more flexible services for other clients. Conclusions: This study highlights the quick response to COVID-19 that occurred within SUD treatment. While these changes resulted in novel ethical dilemmas, they also offered more flexible and client-centered approaches to treatment. [ABSTRACT FROM AUTHOR]

Background: Prenatal health promotion includes the provision of evidence-based information and practical skills to optimize maternal–fetal outcomes. Increasingly, prenatal education is delivered by both healthcare professionals and allied childbirth educators, in community- or hospital-based group classes, targeted outreach programs, and online modules. Objectives: To better understand how prenatal health promotion relates to a diverse urban community, we assessed the perspectives of Ottawa, Canada prenatal key informants. Design: This is a qualitative research with key informant interviews. Methods: Semi-structured interviews were conducted with 11 prenatal key informants, responsible for the design, delivery, or promotion of publicly available prenatal health services. Interviews explored concepts and delivery of prenatal health promotion, strategies to address existing and emerging prenatal topics, identification of barriers to prenatal health services, and recommendations. Results: Key informants recommended a lifespan approach to prenatal health promotion, with an emphasis on healthy behaviors, emotional health, labor and delivery, and postpartum/early parenting. Recognizing community health disparities, key informants used community outreach, and intersectoral collaborations for Indigenous and other at-risk communities to mitigate barriers to prenatal service uptake. Conclusions: Ottawa key informants conceptualized prenatal health promotion as inclusive, comprehensive, and as an extension of preconception, school-based sexual education. Respondents recommended the design and delivery of prenatal interventions as culturally safe and trauma informed, using online modalities to complement in-person activities. The experience and intersectoral networks of community-based prenatal health promotion programs represent potential capacity to address emergent public health risks to pregnancy, particularly among at-risk populations. Plain Language Summary: A broad and diverse community of professionals deliver prenatal education to help people have healthy babies. We interviewed Ottawa, Canada experts in prenatal care/education to learn about the design and delivery of reproductive health promotion. We found that Ottawa experts emphasized healthy behaviors beginning before conception and through pregnancy. Community outreach was identified as a successful strategy to promote prenatal education to marginalized groups. [ABSTRACT FROM AUTHOR]

Objectives: Public health detailing is an intervention in which a public health professional visits health care providers to educate them about evidence-based approaches to improve health. The San Francisco Department of Public Health conducted a public health detailing program from 2016 to 2018 to improve sexual health care and preexposure prophylaxis services in the city. Methods: We conducted a mixed-methods study to understand the implementation of detailing and explore examples of changes to clinicians' clinical behaviors. We surveyed 203 clinicians, conducted 60-minute qualitative interviews with 7 clinicians and 4 detailers, and analyzed tracking forms. We used descriptive statistics to assess associations in the surveys. We used qualitative thematic analysis to understand facilitators and barriers to detailing and identify ways to improve the process and identify its potential benefits. Results: In interviews, both clinicians and detailers had a favorable view of detailing as a tool to connect health department expertise to clinicians. Detailers cited challenges such as limited clinic time, provider turnover, and policies that limit their access to clinicians. These challenges may attenuate the real-world benefits of detailing. Clinicians offered examples of how detailing altered their behaviors, such as taking sexual health histories, building knowledge and confidence about sexual health, and using health department services. Matched surveys (n = 21) showed preliminary changes to prescribing preexposure prophylaxis. Conclusions: Public health detailing is a promising approach to increase clinicians' knowledge and confidence to offer sexual health care services, build buy-in, and support connection to health departments. Detailing programs require sufficient investment and staff support to build lasting and collaborative relationships between clinicians and public health departments and to assess the impact of the intervention. [ABSTRACT FROM AUTHOR]

Positive attitudes and a sense of competence toward end-of-life care are the key to adequately support terminally ill patients. This qualitative study aims to explore healthcare students' attitudes toward caring for terminally ill patients. Eleven students from the University of Applied Health Sciences in Switzerland participated in focus groups. Attitudes were overall positive. Most participants felt that supporting dying patients was a way to achieve professional fulfillment. However, most students felt not competent in palliative care and lacking experience. They wanted to receive better training, more specifically in good practices and appropriate behaviors. Our study fills a knowledge gap regarding the opinions and pedagogical needs of healthcare students, and highlights the importance of experiencing end-of-life care during the educational process. We recommend early exposure to terminally ill patients and appropriate attitudes toward death and dying as part of the bachelor's curriculum, accompanied by benevolent guidance from teachers and health professionals. [ABSTRACT FROM AUTHOR]

The aim of this research was to conduct a risk assessment and management of psychological, structural, social and economic determinants (PSSED) in a suicide attempt. The sample consisted of 353 individuals who had a recorded history of suicidal attempt; and 20 professional individuals by purposive sampling method within a descriptive cross-sectional design. Worksheets for RAM and AHP were used for data collection in this study. The rate of suicide attempt was 7.21 per 100,000 population in this study. Analysis showed that depression and mental disorders; personality disorders; family problems; socio-cultural and economic problems; lack of awareness; and low level of education have a high level of risk for suicide attempts. Psychiatric and psychological services; awareness and knowledge of life skills; medical services to dysfunctional families; development of community-based planning for PSSED of suicide; and employment and entrepreneurship services may lower suicide attempt risk. [ABSTRACT FROM AUTHOR]

Objectives: Therapeutic patient education improves numerous health and psychological outcomes in patients with chronic diseases. However, little is known about what makes a therapeutic patient education intervention more effective than another one. This study aims to identify in healthcare professionals the perceived determinants of therapeutic patient education efficacy at the individual level. Methods: Semi-structured individual interviews have been conducted with healthcare professionals (HCP, n =28, including 20 nurses) involved in therapeutic patient education programs (n =14) covering various chronic conditions (kidney and cardiovascular diseases, chronic pain, diabetes, etc.). A thematic content analysis following an inductive approach was used (Nvivo.11 software). Results: Five themes were retrieved for patient characteristics: understanding and education, personality, readiness and motivation, social environment, and misinformation and beliefs. Four themes were retrieved for healthcare professionals' characteristics: medical knowledge, appropriate attitude and relational skills, pedagogical skills, and training. Discussion: Patient personality is rarely discussed in the literature. Patients who are introverted, lack curiosity, or are not compliant might benefit from specific therapeutic patient education practices or formats. All these potential determinants regarding patients and healthcare professionals should be routinely assessed in future studies about therapeutic patient education efficacy to understand precisely what makes an intervention successful. [ABSTRACT FROM AUTHOR]

Introduction: Handgrip strength (HGS) is commonly measured to assess hand function, however, little is known about how and why occupational therapists assess and interpret HGS. This study aimed to explore the experiences of occupational therapists who work with HGS. Additionally, the study explored what biological and functional factors occupational therapists believe influence adult HGS. Method: A qualitative study design utilising purposive sampling identified occupational therapy clinicians within Queensland, Australia who assess HGS. Data were collected from 19 participants using a semi-structured interview process. The interviews were transcribed verbatim and analysed using thematic analysis. Results: Variations of the American Society of Hand Therapists HGS testing procedure were used by the participants based on experience. When evaluating HGS, comparison to normative data was not always completed or seen to be valuable. Biological and functional factors such as height, hand length, occupation and lifestyle factors were considered to influence HGS. Conclusion: The results of this study provide insight into the various ways occupational therapists assess and evaluate HGS according to experience and practice context. These variations in assessment and evaluation of HGS along with the influence of an individual's biological and functional factors need to be considered when interpreting HGS results. [ABSTRACT FROM AUTHOR]

Summary: Social workers' eating disorder mental health literacy (ED-MHL) is essential to the detection, assessment, and treatment of eating disorders (EDs) and disordered eating (DE) in clinical practice. This study explored social workers' ED-MHL, particularly the assessment practices of EDs on intake forms, and within the first two therapy sessions. Participants in this national survey were N = 316 outpatient masters-level social workers in the United States. Participants completed an online survey measuring ED assessment practices in clinical practice. Findings: Results showed that 42.4% (n = 133) of respondents did not routinely assess for EDs/DE on clinical intake forms, and 53.2% (n = 165) did not assess within the first two therapy sessions. However, those with recent training related to EDs were more likely to assess. Participants reported low to moderate perceived comfort levels with the assessment of EDs, and training and education were identified as needed resources. Social workers reported deficits in their own assessment practices of EDs. Barriers included: lack of training about EDs/DE; uncertainty about process questions to ask; and perceptions that EDs/DE are rarely the client's primary presenting problem. Applications: Difficulties with detection and screening practices appeared contingent on gaps in existing education and training related to EDs/DE. These findings suggest that future research may serve to increase social workers' ED-MHL, as underscored by the noteworthy finding that 86.1% (n = 229) of the sample reported that they would make proactive changes in their clinical practice, as a direct result of participating in this study. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation and subsequent care are subject to various ethical and legal issues. Few studies have addressed ethical and legal issues in post-resuscitation care. Objective: To explore nurses' experiences of ethical and legal issues in post-resuscitation care. Research design: This qualitative study adopted an exploratory descriptive qualitative design using conventional content analysis. Participants and research context: In-depth, semi-structured interviews were conducted in three educational hospital centers in northwestern Iran. Using purposive sampling, 17 nurses participated. Data were analyzed by conventional content analysis. Ethical considerations: The study was approved by Research Ethics Committees at Tabriz University of Medical Sciences. Participation was voluntary and written informed consent was obtained. For each interview, the ethical principles including data confidentiality and social distance were respected. Findings: Five main categories emerged: Pressure to provide unprincipled care, unprofessional interactions, ignoring the patient, falsifying documents, and specific ethical challenges. Pressures in the post-resuscitation period can cause nurses to provide care that is not consistent with guidelines, and to avoid communicating with physicians, patients and their families. Patients can also be labeled negatively, with early judgments made about their condition. Medical records can be written in a way to indicate that all necessary care has been provided. Disclosure, withdrawing, and withholding of therapy were also specific important ethical challenges in the field of post-resuscitation care. Conclusion: There are many ethical and legal issues in post-resuscitation care. Developing evidence-based guidelines and training staff to provide ethical care can help to reduce these challenges. [ABSTRACT FROM AUTHOR]

Sex trafficking is serious form of gender-based violence that results in profound adverse health outcomes, yet one that is poorly understood. New York City is a major hub for sex trafficking, with a significant but unquantified number of victims originating from East Asian countries and trafficked via illicit massage businesses. Peer-reviewed studies among Asian survivors of international criminal sex trafficking do not exist. The aim of this study is to qualitatively examine the factors at various levels of influence that impact the recovery and reintegration process of Asian criminal sex trafficking survivors in the United States from the perspective of survivors and front-line service providers. The study was guided by community-based participatory research and trauma-informed approaches, leveraging a collaboration with a well-established service provider organization. Ten in-depth interviews were conducted between 2018 and 2019 with three Korean survivors and seven key informants who were anti-trafficking service providers working with East Asian clients. Data were analyzed using a grounded theory approach. Survivors and service providers vocalized factors at multiple levels that either facilitate or impede recovery and well-being. Levels of influence included structural (e.g., poverty/debt bondage, immigration status, limited English proficiency), cultural (e.g., fatalism, collectivism), institutional (e.g., lack of culturally appropriate, trauma-informed care), interpersonal (e.g., exploitation, social support), and individual (e.g., resilience). Stigma was a crosscutting factor that spanned all levels of influence. This study highlights the voices of survivors and front-line service providers to understand the lives of an under-researched population of Asian sex trafficking survivors. Ultimately, the root, structural causes of survivor marginalization need to be addressed, which stem from the intersection of class-, gender-, and race-related inequities. While survivors continue to experience exploitation and marginalization post-trafficking, they also carry an enormous amount of resilience that must be leveraged in their path to recovery from trauma. [ABSTRACT FROM AUTHOR]