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ABSTRACT Introduction Having a lower extremity amputation is a life‐changing decision for people living with a diabetes‐related foot ulcer. Although previous research has described both positive and negative lifestyle and function outcomes of diabetes‐related amputations, limited research has been conducted on the decision‐making processes leading up to the amputation. This study aimed to explore the perspectives of persons, healthcare practitioners and experts (including academics and specialists) on decision‐making for people with a diabetes‐related foot ulcer who may require a non‐emergency amputation. Methods A qualitative descriptive study using semi‐structured interviews enabled people to share their thought processes when making decisions for amputation. Twenty‐six participants were interviewed, including nine people with a diabetes‐related foot ulcer or amputation, nine health practitioners and eight experts located across five countries. There were 13 female and 13 male participants. Thematic analysis was used for data analysis. Results Four themes described the decision‐making considerations for amputation: ‘Balancing the evidence in decision‐making’, ‘Trust, respect and timing of conversations inform decision‐making’, ‘Tailoring decisions for individual circumstance’ and ‘Reaching the tipping point in decisions for the future’. Work commitments, functional and lifestyle impacts of amputation, the presence of support networks and clinical wound features formed the evidence for a decision for amputation. Conclusion Understanding quality of life needs ensured that decisions for amputation addressed expectations and lifestyle needs. Living with a diabetes‐related foot ulcer presented daily challenges that pushed people to a tipping point, at which amputation was considered to overcome these hardships and enable them to move on to the next chapter of their life. Further research is required to understand how person‐centred factors can be better incorporated alongside objective clinical assessments in decisions for amputation. Patient or Public Contribution People with diabetes‐related foot ulcers, health practitioners and experts shared their perspectives on the decision‐making process for amputation through one‐to‐one interviews. Consideration of the person in the context of their life, environment and personal needs alongside the pathological factors is warranted.

ABSTRACT Aims This study aimed to describe nurses' experiences caring for patients who use medicinal cannabis. For the purpose of this study, the term ‘medicinal cannabis’ is used to describe cannabis‐based products that are sourced legally or illegally. Design Qualitative study using thematic analysis. Methods Eleven registered nurses explored their experiences caring for patients using medicinal cannabis in the Australian healthcare sector. Semistructured interviews were via telephone, Zoom or face to face. Transcribed interview data were analysed using the six phases of thematic analysis. Results The nurses' experiences of caring for patients who use medicinal cannabis were described in three themes; ‘Searching for predictable processes of regulation, access and use of medicinal cannabis’, ‘One conundrum after another’ and ‘There is a lot to learn’. Overall, nurses described feeling underprepared to care for patients who use or want to use medicinal cannabis in the Australian healthcare sector. Conclusion The results indicate that nurses want to have meaningful discussions with patients about the use of medicinal cannabis, yet do not always have the confidence to do so. Nurses sought their own education on how to better support patients. All participants echoed the need for education. The nurse's role in caring for and supporting patients using medicinal cannabis could improve the patient experience. Implications for the Profession and/or Patient Care Nurses play an essential role in improving the patient's experience and advocating for those using or wanting to discuss medicinal cannabis as a part of holistic care. Defining the nurse's role in effectively caring for patients can begin by providing evidence‐based education to nurses. Including nurses in policy development and beginning to understand the legal and regulatory implications for nurses are important. Impact This is the first study presenting current issues for nurses who care for patients using medicinal cannabis in Australian healthcare systems. Reporting Method COREQ guidelines were adhered to for this study. No Patient or Public Contribution For this research project on the experiences of registered nurses caring for patients using medicinal cannabis, we did not engage members of the patient population or the general public.

Abstract Aim The main aim of the study was to understand student nurses’ views around shift patterns. Design Qualitative study. Method We held a Tweetchat in May 2019, where we asked questions around the frequency of 12‐hr shifts working on placement; schedule flexibility while on placement; which shift patterns they preferred and why. Data from the Tweetchat were analysed using reflexive thematic analysis to generate themes from initial codes. Results Seventy‐three nursing students participated in the Tweetchat. The majority reported that they work 12‐hr shifts on placements, particularly when based in a hospital. We identified three themes: ‘Achieving a personal equilibrium’; ‘Meeting the needs of the care environment’; ‘Factors affecting negotiation capacity’. Data highlighted a conflict for most students, where they preferred 12‐hr shifts because of more time off for study, paid work and leisure, while acknowledging 12‐hr shifts negatively affected their fatigue, exhaustion and led them to follow a poor diet and neglect exercise and sleep.

Abstract Background Tailoring therapeutic education consists of adapting the intervention to patients' needs with the expectation that this individualization will improve the results of the intervention. Communication is the basis for any individualization process. To our knowledge, there is no guide or structured advice to help healthcare providers (HCPs) tailor patient education interventions. Objectives We used a data‐driven qualitative analysis to (1) investigate the reasons why HCPs tailor their educational interventions and (2) identify how this tailoring is effectively conducted. The perspective aimed to better understand how to individualize therapeutic patient education and to disentangle the different elements to set up studies to investigate the mechanisms and effects of individualization. Design Individual semistructured interviews with 28 HCPs involved in patient education were conducted. The present study complied with the COREQ criteria. Results Why individualization is necessary: participants outlined that the person must be thought of as unique and that therapeutic education should be adapted to the patient's personality and cognitive abilities. The first step in the individualization process was formalized by an initial patient assessment. Several informal practices were identified: if needed, giving an individual time or involving a specific professional; eliciting individual objectives; reinforcing the relationship by avoiding asymmetrical posture; focusing on patients' concerns; leading sessions in pairs; and making the patient the actor of decisions. Conclusion From our thematic data analysis, a model for tailoring patient education interventions based on the Haes and Bensing medical communication framework is proposed. The present work paves the way for evaluation, then generation of recommendations and finally implementation of training for individualization in educational interventions. Short Informative Tailoring in therapeutic education consists of an adaptation to patients' needs. Communication is the basis for any individualization process. There is no model of patient‐centred communication in educational interventions. From semistructured interviews with HCPs, we propose a patient‐centred communication model for tailoring patient education intervention.

Abstract Objective To qualitatively explore the broad set of preferences and attitudes patients have about thyroid nodules, which influence the decision‐making process. Study Design A descriptive survey design was administered as interviews. Setting Outpatient thyroid surgery clinic. Methods Semistructured interviews were conducted with 20 patients presenting for initial evaluation of thyroid nodules at a surgeon's office. Probative, open‐ended questions were posed regarding diagnosis, treatment, risk attitudes, and the decision‐making process. Thematic analysis was used to develop code‐transcribed interviews, and an iterative refinement resulted in underlying themes. Results During the diagnostic process, patients integrated emotional responses (fear, anxiety, and shock) with rationale concerns (likelihood of cancer, risk assessment), and ultimately relied heavily on expert opinion and recommendation. Contextualization with other personal or familial health problems served as helpful touchstones for decision‐making. Overtreatment and overdiagnosis were not commonly discussed. When thinking about potential therapies, there was a strong bias to action rather than surveillance among patients. Surgical risk and the possibility of lifelong medication, however, were strong motivators for a subset of patients to seek nonsurgical alternatives. Conclusion Patients describe a decision‐making process that incorporates emotional response and rational consideration of risks, contextualized within the personal experience and physician expertise. The bias for action and intervention is strong, and most patients strongly weighted physicians' recommendations. Themes from this qualitative analysis may serve as the backbone for future stated preference research pertaining to thyroid disease.

Abstract Background Plantar fasciopathy is the most common cause of heel pain, and is associated with decreased physical activity level and quality of life. There has been limited research on the experiences of patients with plantar fasciopathy. This study seeks to gain more in‐depth understanding and knowledge by exploring the lived experiences of people with persistent plantar fasciopathy. Methods We included 15 participants with longstanding plantar fasciopathy. Face‐to‐face, semi‐structured interviews were audio recorded, transcribed verbatim and analysed using Braun and Clark's reflexive thematic analysis. We used an inductive approach led by a phenomenological theoretical framework. Results We identified three core themes and ten sub‐themes. The first theme was ‘Struggling to stay active’ with sub‐themes ‘Struggling with pain and how to adjust it’, ‘ Finding alternative activities' and ‘Longing for the experience of walking’. The second main theme was ‘Emotional challenges' with the sub‐themes ‘Feelings of frustration and self‐blame’ and ‘Worries of weight gain and related consequences'. The third main theme was ‘Relations to others' with the sub‐themes ‘Participation in family and social life’, ‘ Visible in new ways', ‘ Striving to avoid sick leave’ and ‘Bothering others'. Conclusions Participants revealed how their heel pain led to inactivity and emotional and social challenges. Pain when walking and fear of aggravating it dominated the participants' lives. They emphasised the importance of finding alternative ways to stay active and avoiding sick leave. Treatment should focus on holistic and individually tailored approaches.

Background Following a diagnosis of a small unruptured intracranial aneurysm (sUIA), patients often experience psychological ailments which may be attributable to the neurovascular consultation, referral pathway, or long‐term imaging surveillance. Here, we aim to characterize the early sUIA patient journey and evaluate their psychosocial status. Methods A mixed‐methods analysis of sUIA patients attending a large tertiary neurosciences center was performed. For patients presenting to the neurovascular service in 2020, this included: (i) a thematic analysis of patient perspectives extracted from semistructured telephone interviews, (ii) a quantitative assessment of psychological status using the Hospital Anxiety and Depression Scale and (iii) an evaluation of functional independence using a customized activity of daily living questionnaire. The relationship between service or clinical factors, and Hospital Anxiety and Depression Scale subscale scores was statistically tested. Results The sUIA patient cohort (n=105) had a mean age of 56.8 years (SD=15.8, female=69). Thematic analysis of interview responses (n=33) identified 5 recurrent themes underpinning the sUIA patient experience: referral, diagnosis and information sharing, imaging surveillance, psychological impairment and coping strategies, and activities of daily living, all of which contributed to patient concerns. A total of 53.6% of patients achieved a Hospital Anxiety and Depression Scale score signifying at least mild anxiety and/or depression. Lifestyle changes most frequently affected after diagnosis included avoidance of straining‐intensive exercise, change in patterns of substance use, and work‐related performance. Multivariate analysis revealed no significant service or clinical predictors for anxiety or depression. Conclusion For some patients, an sUIA diagnosis appears to be associated, at least qualitatively, with a psychological burden. This is likely mediated through stressors related to the referral, diagnosis, neurosurgical consultation, and image surveillance. In the absence of evidence‐based guidelines regarding these aspects of the early patient journey, we offer suggestions aimed at improving both the neurovascular service and sUIA patient experience.

Abstract Addressing ongoing biodiversity loss requires collaboration between conservation scientists and practitioners. However, such collaboration has proved challenging. Despite the potential importance of tracking animal movements for conservation, reviews of the tracking literature have identified a gap between the academic discipline of movement ecology and its application to biodiversity conservation. Through structured conversations with movement ecologists and conservation practitioners, we aimed to understand whether the identified gap is also perceived in practice, and if so, what factors hamper collaboration and how these factors can be remediated. We found that both groups are motivated and willing to collaborate. However, because their motivations differ, there is potential for misunderstandings and miscommunications. In addition, external factors such as funder requirements, academic metrics, and journal scopes may limit the applicability of scientific results in a conservation setting. Potential solutions we identified included improved communication and better presentation of results, acknowledging each other's motivations and desired outputs, and adjustment of funder priorities. Addressing gaps between science and implementation can enhance collaboration and support conservation action to address the global biodiversity crisis more effectively.

Objective: For people with type 2 diabetes who are overweight, weight loss increases the likelihood of achieving diabetes remission. The aim here was to draw on the experiences of people living with type 2 diabetes and coaches who deliver type 2 diabetes prevention and remission programmes. This was done to develop a service that increases the proportion of people who achieve remission by identifying an effective weight management service., Research Design and Methods: A qualitative researcher and co-researcher with type 2 diabetes conducted 37 narrative interviews with adults with type 2 diabetes (October 2022-June 2023) and 16 semi-structured interviews with health coaches delivering type 2 diabetes programmes in England. Data were analysed using Reflexive Thematic Analysis. Participants were diverse in ethnicity, socioeconomic status, age, gender and years since diabetes diagnosis., Results: Four themes were generated relating to moments in a person's diabetes care: (1) coming to terms with diagnosis, (2) lightbulb moments, (3) sustaining change as normal and (4) becoming expert/building confidence. These four themes were united under a high-level interpretivist theme: 'Same journey, different experience', capturing the mismatch between a linear rigid care pathway described by coaches and the diversity of experience of people living with type 2 diabetes., Conclusions: Coaches and people with type 2 diabetes are aligned on their reports of key moments in adapting to diabetes. Participants' desire for flexibility in their care contrasted with coach reports of rigid service provision. These insights may enable more people with type 2 diabetes to engage and adhere to weight management services aimed at diabetes remission., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Background: Waiting is an important topic in healthcare debates, mostly discussed in the form of waiting lists and waiting times. In this discourse, the experiential element of waiting stays hidden. Understanding the waiting experiences of patients can help to better understand healthcare waiting practices, which have a large impact on patients., Methods: We performed a thematic analysis on 12 patients' books of women with breast cancer. We focused on the theme of waiting within these stories, through an abductive analysis., Results: We identified three themes within the waiting practices of patients with breast cancer: (1) Thickening of time, (2) contaminated time and (3) navigating time. The theme thickening of time highlights waiting moments where time is experienced as moving at a very slow pace with intense emotional impact. The theme of contaminated time highlights the waiting processes as an ongoing component of experiencing illness. The theme of navigating time highlights patients' temporal agency, showing their waiting work in the form of strategies for dealing with practical and emotional aspects of waiting., Discussion: The waiting experiences of patients provide insights into the burden of waiting, which is partly connected to the way healthcare services are organised and the experience of illness. Understanding these multifaceted experiences of patients helps pinpoint areas for healthcare quality improvement., Patient or Public Contribution: The choice for the theme and approach of this research, waiting, was developed with a citizen science initiative of collecting patient stories., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

In Korea, genetic counseling services began with the opening of genetic clinics in the early 1990s; in recent years, demand for these services has increased. However, genetic counseling is not an officially recognized healthcare service under the Korean national health insurance system; further, its certification is not recognized as a medical qualification. To clarify the role and significance of genetic counselors, this study examined their field experiences. To this end, we conducted focus group interviews with 11 certified genetic counselors, six advanced practice nurses, and four regular nurses. The interviews were transcribed verbatim and examined using thematic analysis. We found that even though Korea did not recognize their roles, the participants met their responsibilities and primary duties. In addition, they faced challenges during counseling due to a lack of formal education in genetics and genomics. Moreover, they encountered dilemmas related to the legal and ethical aspects of decision support for family testing or prenatal diagnosis due to the complexity of rare genetic disorders. However, they attempted to acquire the specialized knowledge needed to support patients with rare genetic disorders and their families, gradually developing practical experience and specialized knowledge. Therefore, it is necessary to develop manuals, establish systems, and improve working environments to provide high-quality and specialized genetic counseling. Additionally, there is a need for national support, such as establishing set wages for genetic counselors, developing a national qualification certification system, and securing dedicated personnel., (© 2024 The Author(s). Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.)

Introduction: Having a lower extremity amputation is a life-changing decision for people living with a diabetes-related foot ulcer. Although previous research has described both positive and negative lifestyle and function outcomes of diabetes-related amputations, limited research has been conducted on the decision-making processes leading up to the amputation. This study aimed to explore the perspectives of persons, healthcare practitioners and experts (including academics and specialists) on decision-making for people with a diabetes-related foot ulcer who may require a non-emergency amputation., Methods: A qualitative descriptive study using semi-structured interviews enabled people to share their thought processes when making decisions for amputation. Twenty-six participants were interviewed, including nine people with a diabetes-related foot ulcer or amputation, nine health practitioners and eight experts located across five countries. There were 13 female and 13 male participants. Thematic analysis was used for data analysis., Results: Four themes described the decision-making considerations for amputation: 'Balancing the evidence in decision-making', 'Trust, respect and timing of conversations inform decision-making', 'Tailoring decisions for individual circumstance' and 'Reaching the tipping point in decisions for the future'. Work commitments, functional and lifestyle impacts of amputation, the presence of support networks and clinical wound features formed the evidence for a decision for amputation., Conclusion: Understanding quality of life needs ensured that decisions for amputation addressed expectations and lifestyle needs. Living with a diabetes-related foot ulcer presented daily challenges that pushed people to a tipping point, at which amputation was considered to overcome these hardships and enable them to move on to the next chapter of their life. Further research is required to understand how person-centred factors can be better incorporated alongside objective clinical assessments in decisions for amputation., Patient or Public Contribution: People with diabetes-related foot ulcers, health practitioners and experts shared their perspectives on the decision-making process for amputation through one-to-one interviews. Consideration of the person in the context of their life, environment and personal needs alongside the pathological factors is warranted., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Abstract Aim This study describes the examination practices and clinical evaluation processes that Registered Nurses in Norway perform in the community healthcare sector. Design A qualitative exploratory design. Methods Twenty interviews were conducted with Registered Nurses employed in the community healthcare sector in Norway. The data were analysed using a thematic analysis. Results We found four major themes: (1) evaluations are embedded in nurses’ daily work, (2) significance of a Registered Nurse's clinical competency, (3) different tasks require various roles and (4) access to resources and equipment. Registered Nurses possess several skills in a range of different examination techniques and clinical evaluation processes in the community healthcare sector. They perform complex assessments in their daily work and must rely on other healthcare professionals, facilities and equipment to provide high‐quality care. Ongoing education and training will enable Registered Nurses to complete accurate assessments in their community healthcare practice.

Abstract Background People with lived‐experience of the phenomenon under investigation are seldom involved in the analysis of qualitative data, and there exists little guidance for those wishing to involve contributors at this stage of research. Aims To critically reflect on the process of involving people with lived‐experience in a thematic analysis and to offer direction to other researchers. Methods An individual with lived‐experience of residing in prison contributed to a co‐analysis of qualitative data using thematic analysis. This paper reports on involvement at each stage of a thematic analysis and follows an established reporting checklist. Results A number of challenges and benefits were encountered in the process of co‐analysing the data. These are discussed in relation to previous research and how to overcome the challenges encountered. Conclusions The paper concludes by giving recommendations and guidance for future researchers wishing to involve people with lived‐experience in qualitative data analysis.

Abstract Background Historically, safety mental health research has tended to focus on risks of homicide, suicide and deaths. Although wider safety issues are now recognized in regards to mental health services, the safety of mental health transitions, a key research and policy priority according to World Health Organisation, has not been explored. Objective The purpose of this study was to investigate perceptions of safety in mental health transitions (hospital to community) amongst five stakeholder groups. Design and setting An online, international cross‐sectional, open‐ended questionnaire. Participants There were five stakeholder participant groups: service users; families/carers; mental health‐care professionals; researchers; and end users of research. Results Ninety‐three participants from 12 different countries responded. Three overarching themes emerged: ‘individual/clinical’, ‘systems/services’ and ‘human, behavioural and social’ elements of safe mental health transitions. Whilst there was a great focus on clinical elements from researchers and healthcare professionals, service users and carers considered safety in terms of human, behavioural and social elements of transitional safety (ie loneliness, emotional readiness for discharge) and systems/services (ie inter‐professional communication). Discussion Safety in mental health‐care transitions is perceived differently by service users and families compared to healthcare professionals and researchers. Traditional safety indicators for care transitions such as suicide, self‐harm and risk of adverse drug events are raised as important. However, service users and families in particular have a much wider perception of transitions safety. Conclusion Future quality and safety research and policy should consider including a service user voice and consider integration of psychosocial elements in discharge interventions.

Abstract Aim To explore the experience and perception of pressure ulcers in a group of nurses caring for older patients. Design A qualitative study based on interviews with (N = 6) nurses working with older patients. Method A qualitative approach was applied using thematic analysis influenced by Braun and Clarke. Results The findings comprised one main theme “Prevention of pressure ulcers is important” and four sub‐themes “Nursing resources on the ward,” “Basic nursing skills—lift the duvet,” “Introduction of new nurses on the ward—bedside teaching” and “Missing articulation of pressure ulcers.” Bedside teaching and experienced nurses may create a culture on the ward where basic nursing skills and observations are articulated.

Abstract Background Diabetes related foot ulcers can have physical, social, emotional, and financial impacts on the daily life and wellbeing of many people living with diabetes. Effective treatment of diabetes related foot ulcers requires a multi‐faceted, multi‐disciplinary approach involving a podiatrist, other healthcare professionals, and the person with diabetes however, limited research has been conducted on the lived experience of podiatric treatment for diabetes related foot ulcers to understand how people are engaged in their ulcer management. Therefore, this study aimed to explore the lived experience of receiving podiatric treatment for diabetes related foot ulcers in a tertiary care outpatient setting. Methods Ten participants were interviewed. All were male, with mean age of 69 (SD 15) years and currently undergoing podiatric treatment for a diabetes related foot ulcer in a tertiary care setting. Participants with diabetes related foot ulcers were purposively recruited from the outpatient podiatry clinic at a tertiary hospital in a metropolitan region of South Australia. Semi‐structured interviews were conducted to gain insight into the lived experience of people receiving podiatric treatment for their foot ulcer and understand how this experience impacts their regular lifestyle. Data were analysed using a thematic analysis method. Results Four themes were identified that add an understanding of the lived experience of participants: ‘Trusting the podiatrists with the right expertise’, ‘Personalised care’, ‘Happy with the service, but not always with prescribed care’, and ‘It's a long journey’. Participants described professional behaviour including high organisation and hygiene practices and demonstrated expertise as key factors influencing their trust of a podiatrist's care. Information tailored to individual needs was helpful for participants. Offloading devices and ulcer dressings were often burdensome. Podiatric treatment for foot ulcers was a lengthy and onerous experience for all participants. Conclusions The findings of this study suggest podiatrists can use practical strategies of maintaining consistency in who provides podiatry care for the person, demonstration of high organisational and hygiene standards, and using innovation to adapt information and equipment to suit an individual's lifestyle to support positive experiences of podiatric ulcer care. There is a need for further research to understand how a person's experience of podiatric ulcer care differs amongst genders, cultural groups, and healthcare settings to facilitate positive care experiences and reduce treatment burden for all people with diabetes requiring podiatric ulcer treatment.

One of the roles of a genetic counselor, when returning genetic test results for Parkinson's disease (PD), is to provide emotional support to the patient. However, whether or not these needs are being met in the genetic counseling setting is unknown. In this cross-sectional qualitative study, semi-structured interviews with 15 PD research participants were conducted to evaluate their emotional needs and expectations throughout the genetic counseling process. Interview questions assessed participants' background understanding of genetic counseling, informational and emotional expectations prior to the genetic counseling session, and experience with emotional support throughout the genetic counseling process. Through reflexive thematic analysis, we defined four major themes: (1) knowledge of genetic counselors' role in education but not in emotional support, (2) limited expectations for emotional support, (3) emotional support is not sought from genetic counselors, and (4) emotional support from genetic counselors was viewed ambivalently. One of the most important findings from this study was that regardless of whether participants had previously heard of genetic counseling, none of the participants knew that the provision of emotional support was an aspect of the genetic counselor's role. Although the majority of participants did not expect emotional support from their genetic counselor, over 60% of participants recognized that receiving emotional support is or could be important to them. Collectively, these findings highlight the necessity for enhanced patient education pertaining to the informational and emotional support that genetic counselors are trained to provide. We suggest that clarifying the role of emotional support with patients may increase comfort in disclosing their emotional needs with genetic counselors, improving patient-centered care overall., (© 2024 The Author(s). Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.)

Background: Ethical conflict is embedded in healthcare and is common in critical care setting. However, there is a paucity of research on the nature of ethical conflict in China. Ethical conflict has cultural and context sensitivity. Therefore, evidence is needed from different backgrounds to help discuss this issue across borders., Aim: This study aimed to qualitatively identify the experience of ethical conflict in critical care professionals in China., Study Design: From December 2021 to February 2022, we performed semi-structured, face-to-face interviews with 21 critical care professionals from five intensive care units in a tertiary general hospital in China. A thematic analysis approach was used to analyse the data., Results: Five themes and 14 sub-themes emerged from the data. Critical care professionals probably felt unable to navigate uncertainty, torn by family issues, outraged by unprofessional behaviours of medical staff, being trapped in a socioeconomic dilemma when having experience of ethical conflict. In addition, they also perceived that they could turn struggle into growth., Conclusions: The experience of ethical conflict in critical care professionals involved a mixture of feelings. This study builds a comprehensive understanding of how ethical conflict affected their perceptions of themselves and their profession and provides implications to develop effective coping strategies., Relevance to Clinical Practice: The identification of critical care professionals' experience of ethical conflict would help identify what might trigger the ethical issues and what would be the potential target to optimize in critical practice., (© 2024 British Association of Critical Care Nurses.)

Background: Family-centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana., Aim: To describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers., Study Design: The study employed a descriptive qualitative design. The researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist., Results: Perceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes., Conclusion: The findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice., Relevance to Clinical Practice: Health facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Despite the high prevalence of bilingualism in the United Kingdom, few speech and language therapists (SLTs) are bilingual themselves. Most SLT research on bilingualism has generated knowledge to inform service delivery for bilingual clients, but few studies have investigated how being a bilingual SLT influences one's professional experiences and practices. Better understanding the unique positionality of bilingual SLTs can yield critical insights to meaningfully address issues of diversity, inclusion and equity in the profession., Aims: To investigate the experiences and practices of bilingual paediatric SLTs in the United Kingdom through the lens of Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF), a new theoretical framework developed to conceptualise the activities of professionals working in the field of disability., Methods: In this qualitative study, 19 bilingual paediatric SLTs practising in the United Kingdom were interviewed individually. Participants were recruited through a snowball sampling strategy, and semi-structured interviews conducted online. The data were analysed using reflexive thematic analysis and following a hybrid inductive-deductive approach to map the results onto the CHAT-ICF framework., Results: Six overarching components of the CHAT-ICF framework hosted the 12 sub-themes identified to capture the experiences and practices of bilingual SLTs: (1) Subject (intersectionality); (2) Tools (language skills, education, clinical resources); (3) Rules (systemic barriers, sense of responsibility); (4) Community (sense of inclusion); (5) Division of labour (parents, colleagues); and (6) Practice (empathy with children, holistic mindset, flexible approaches). The use of the CHAT-ICF theoretical lens revealed two fundamental structural phenomena: (1) the distribution of sub-themes across many components of CHAT-ICF demonstrated that being a bilingual SLT is a multifactorial experience; and (2) the chain reactions between sub-themes illustrated the dynamic nature of bilingual SLTs' experiences which can be harnessed to challenge marginalisation and promote equity in the profession., Conclusion & Implications: This is the first qualitative study to date to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. These insights can be mobilised to inform the meaningful inclusion of bilingual SLTs in workforce planning efforts and service development. Recommendations include using intersectional lenses, providing cultural and anti-racism awareness training to SLTs, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in recruitment processes and increasing accountability at the leadership level. Research giving voice to bilingual SLTs, and other underrepresented demographics in the SLT workforce, can catalyse action to promote a more diverse and inclusive profession in line with the Royal College of Speech and Language Therapists' strategic vision 2022-2027., What This Paper Adds: What is already known on the subject Most research on bilingualism in speech and language therapy is focused on issues related to service provision and delivery for bilingual clients with little consideration for bilingual speech and language therapists' (SLTs) unique positionality. A few survey studies have shown that bilingual SLTs report significantly higher competency and greater confidence when working with clients who speak multiple languages, but there are significant gaps in understanding how bilingualism impacts other aspects of their professional experiences. What this paper adds to existing knowledge This is the first study to provide in-depth insights into the experiences and practices of bilingual SLTs in the United Kingdom. We show that being bilingual profoundly impacts many aspects of their professional experiences, including their clinical identity, skillset, sense of inclusion in the workplace, work relationships and clinical approaches. Bilingual SLTs expressed developing trust relationships with bilingual families and adopting flexible approaches to account for their clients' environmental factors, all of which can contribute to more equitable SLT services. This study also makes a novel contribution by proposing and using the Cultural-Historical Activity Theory-International Classification of Functioning, Disability and Health (CHAT-ICF) framework to conceptualise and investigate SLTs' experiences and practices. What are the potential or actual clinical implications of this work? This study provides evidence-based recommendations to inform progress towards the Royal College of Speech and Language Therapists' strategic vision 2022-2027 and the diversification of the profession. Actions to support bilingual SLTs and diversify the profession include shifting a rigid mindset of linguistic and cultural `competence' to self-growth and awareness, developing more diverse clinical resources and flexible approaches for bilingual families, valuing bilingualism in SLT recruitment processes and career progression and increasing accountability and leadership around issues of diversity in the workplace. The novel CHAT-ICF framework has the potential to be used to support therapists' reflexivity in their practice or structure audits of rehabilitation services. Intersectionality theories and transformative processes can catalyse positive change in clinical services and research around bilingualism., (© 2024 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Aim: To describe the life situation of spouses having a partner with heart disease and adolescents living at home., Design: Qualitative inductive design., Method: Participants (n = 22) were included from three Scandinavian countries. Semi-structured interviews were analysed using thematic analysis with an inductive and latent approach., Results: Three themes were derived. 'Being in spousal and parental role transition' described how daily life had been affected and parental responsibilities had been doubled due to their partner's heart disease. 'Living with unpredictability and insecurity' included how the unpredictable illness trajectory caused worries and affected the well-being of the family. 'Managing a challenging life situation' highlights how spouses coped with their partners' heart disease and adapted to a new life situation., Conclusion: Young spouses' life situation was greatly affected by their partner's heart disease, resulting in increased responsibilities and double parenthood. Having a positive attitude and mindset towards life was used as a strategy to cope with the changed life situation and find a new way of life., Implications for the Profession And/or Patient Care: All family members are affected by heart disease. Spouses needed additional professional support and guidance on how to involve the children when a parent is ill., Impacts: This study highlights how young spouses, with adolescents living at home, experience their life situation. The life situation is unpredictable due to the partner's heart disease, as they must handle both caring for their partner and taking on double parenthood. Research involving family members can improve person- and family-centred care and treatment outcomes in health care and society., Reporting Method: COREQ checklist was used preparing the manuscript., Patient or Public Contribution: Data collection included interviews with spouse. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: By highlighting the spouses changed life situation due to heart disease and the importance of including them in health care., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Abstract Background Foot pain and deformity are common in people with rheumatoid arthritis (RA). Previous research has identified that women with RA seek retail footwear to alleviate their foot problems. The specific footwear features that women with RA require, and what would help them to find shoes that meet these requirements, are unknown. This study aimed to determine the factors that influence the choice of appropriate retail footwear by women with RA. Method An overarching qualitative approach was taken, using reflexive thematic analysis of conversational style interviews. The interviews explored experiences and use of retail footwear in 20 women with RA. The interviews were digitally recorded transcribed verbatim and analysed using a reflexive thematic framework. Results Women with RA sought retail footwear which had adequate cushioning, width, a flexible sole, lightweight, were made from breathable materials and were easy to put on and take off. However, this choice was driven by the need for comfort, cost and usability, with aesthetics being less of a priority. Despite having opinions on what criteria they felt that they needed, these women did not feel empowered to make good choices about purchasing retail footwear for symptomatic relief. Furthermore, they did not receive the necessary support from podiatrists and shoe shop staff. Conclusion Women with RA have clear ideas about what features a retail shoe should have to achieve comfort. There is a constant compromise between achieving comfort and their feelings about their appearance and how they feel others perceive them. Women with RA describe negative experiences with shoe shop assistants and podiatrists leading to poor footwear choices. Both retail staff and podiatrists need increased understanding about the particular problems that women with RA experience.

Background: Disease outbreaks present a significant challenge to horse health and welfare and the economic stability of horse industries internationally. This is a particular concern in Ontario, Canada, where there have been frequent outbreaks of respiratory infectious diseases among horses. Despite these risks, there has been limited research on whether Ontario horse owners engage in biosecurity measures sufficient to mitigate risk of equine diseases, and whether current events such as the COVID-19 pandemic influence attitudes towards equine biosecurity practices., Objective: To explore Ontario horse owners' perceptions, attitudes and experiences relating to on-farm biosecurity during the COVID-19 pandemic., Study Design: Qualitative study using virtual semi-structured interviews., Methods: Participants (horse owners, frequent horse riders and part boarders) were recruited using social media snowball sampling where advertisements were shared by equine and veterinary organisations. Interviews were conducted virtually between June and September 2022 and were analysed using reflexive thematic analysis., Results: Three key themes relating to biosecurity perceptions among the 14 participants were identified. Participants relied on minimal preventative measures (such as vaccines) where perceived risk of disease was low, but implemented additional measures including quarantine and handwashing when perceived risk of disease was high. Participants' choice of biosecurity practices often mirrored those recommended by the barn manager. Moreover, participants felt that responsibility for biosecurity was not shared equally across horse owners, with more emphasis placed on those engaging in high-risk situations for disease spread. Despite experiencing biosecurity during the COVID-19 pandemic, horse owners were not consistently applying these practices to their horse care routines., Main Limitations: The perspectives reported here are from a small sample of horse owners and may not be generalisable to all populations., Conclusions: Our findings indicate that horse owners need improved access to and engagement with educational initiatives that emphasise the importance and purpose of all biosecurity measures., (© 2024 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.)

Objective: This novel study sought to understand lived experience and carer perspectives on the use of adaptive trials to evaluate interventions for eating disorders, in addition to understanding the factors and outcomes of most importance in eating disorder research and treatments from a lived experience perspective., Method: A total of 73 people with either lived or carer experience consented, 70 started the questionnaire, and 36 (51%) completed all questions. Participants were asked Likert scale and open-ended questions to understand what factors and outcomes of eating disorder interventions were most important to them and understand their pre-existing knowledge of clinical trials. Two videos were then used to explain randomized controlled trials (RCTs) and adaptive trials and participants were asked their opinions, including perceived benefits and concerns, of each trial type., Results: The thematic analysis found two key themes regarding factors important in eating disorder treatment: Person-centred care and Evidence-based and effective treatment; and two key themes regarding outcomes of treatment: Sustained, full recovery and The bigger picture. Both RCTs and adaptive trials were viewed favorably, however, there was a slight preference for adaptive trials. Key themes for both demonstrated perceived benefits and ethical, practical, and scientific considerations unique to each., Discussion: Findings demonstrate the support of adaptive trials in eating disorder interventions from people with lived experience and their carers. It is recommended that researchers consider the use of adaptive designs and the incorporation of lived experience perspectives when designing future intervention trials., Public Significance: This novel study found that the use of adaptive trials in eating disorder intervention research is supported by people with lived experience and carers. Furthermore, the factors and outcomes of most importance to participants in this study are comparable to those previously identified in the emerging literature. The use of adaptive designs and the incorporation of lived experience are recommended in further clinical trials., (© 2024 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)