Search

Patient-centered care is recognized as a key element in recent healthcare management strategies. However, the integrated collection of patient feedback capturing the entire journey of patients with complex medical conditions remains understudied. Herein, we aimed to describe the development of an instrument prototype for the collection of PROMs and PREMs that would encompass a whole patient journey at a single time point. We further describe the process of its integration into a hospital's information system (HIS) and the results of a pilot feasibility study in adult patients with kidney and hematological diseases. We developed an instrument consisting of original PREM and generic EQ-5D-5L questionnaires. E-questionnaires were handled with REDCap software (version 12.5.14) and integrated into the HIS. Patients refusing to use e-questionnaires (48%) were offered paper administration and were older (64 vs. 50 years). The overall response rate for e-questionnaires was 57.1% with a median completion time of 2.0 and 3.7 min for PROM and PREM, respectively. Psychological and social services and primary care setting (diagnosis establishment and involvement in continuous care) were identified as most problematic. The majority of PREM dimensions encompassing different levels of care significantly correlated with PROM responses. Our data indicate the feasibility and potential relevance of the proposed approach, although wider-scale studies in diverse settings are needed. [ABSTRACT FROM AUTHOR]

Background: Presbyopia is a progressive condition that reduces the eye's ability to focus on near objects with increasing age. After a systematic literature review identified no existing presbyopia-specific patient-reported outcome (PRO) instruments meeting regulatory guidance, a new PRO instrument, the Near Vision Presbyopia Task-based Questionnaire (NVPTQ), was developed. Results: To explore the patient experience with presbyopia, concept elicitation interviews were conducted with 20 presbyopic participants. The most frequently reported impacts were difficulty with reading menus/books/newspapers/magazines, reading on a cell phone/caller ID, and reading small print. Based on these results, a task-based PRO instrument (the NVPTQ) was developed instructing participants to complete four near-vision, paper-based reading tasks (book, newspaper, nutrition label, menu) under standardized settings, and subsequently assess their vision-related reading ability and associated satisfaction. The draft NVPTQ was cognitively debriefed with a sample of 20 presbyopes, which demonstrated that most participants interpreted the items as intended and endorsed the relevance of the concepts being assessed. After the qualitative research, the draft instrument was psychometrically tested using data from a Phase 2 study. Based on item-level analyses, all items in the NVPTQ demonstrated expected response option patterns and lacked substantial floor or ceiling effects. The reliability, validity, and responsiveness of the NVPTQ Performance and Satisfaction domain scores were assessed. All domains scores had large Cronbach's coefficient α values and good test–retest statistics, indicating that the scores are internally consistent and produce stable values over time. The pattern of correlations with a concurrent measure of visual functioning (National Eye Institute Visual Function Questionnaire 25) demonstrated that the NVPTQ domain scores were related to an alternative assessment of near-vision activities. The NVPTQ domain scores were able to distinguish between groups that were known to differ on the clinical outcome of uncorrected near visual acuity, supporting the construct validity of these scores. The NVPTQ domain scores showed evidence of responsiveness to change by being able to distinguish between groups defined as improved and not improved based on patient-reported and clinical outcomes. Conclusions: This research has resulted in a content-valid and psychometrically sound instrument designed to evaluate vision-related reading ability and satisfaction with vision-related reading ability. Trial registration: ClinicalTrials.gov NCT02780115. Registered 23 May 2016, https://www.clinicaltrials.gov/ct2/show/NCT02780115?term=NCT02780115&draw=2&rank=1. [ABSTRACT FROM AUTHOR]

This paper aims at describing the eating experience of people diagnosed with and treated for laryngeal cancer. Going beyond the mere conceptualization of "after-effect" or the quantification of the disease's impact on the basis of standardized questionnaires, we present a qualitative analysis of the narratives of such experiences. Ethnographic study. Data is obtained from conversations, semi-structured interviews, participant observation, and written documents. A discourse analysis of the narrative information was conducted, with process coding and using the constant comparative method, inductive content analysis, category analysis, units of meaning associated with each other, and triangulation. The impact of cancer on eating processes is not limited to nutrition, but also affects the social and cultural value of food, which is put into question. The symbolic and social values which accompany the traditional way of eating are modified, which is connected with impaired quality of life. The impact on the eating process and its relationship with quality-of-life impairment are clear and connect with the importance of eating ways in culture and social organization. Greater attention should be paid to these contexts in clinical practice, which can affect even more than the impact on communicative processes. [ABSTRACT FROM AUTHOR]

Introduction: The extent of development of a country is determined by research indicators such as the number of published articles. Many factors can cause a lack of research. Objective: The present study aimed at identifying obstacles to the implementation of the research from the viewpoint of faculty members of Guilan University of Medical Sciences in 2018. Materials and Methods: In this combined research, the quantitative data were collected by the faculty members of the research pathology questionnaire. The appropriate statistical indices were used to describe the data. In the qualitative section, sampling was purposeful and continued until data saturation. Data were collected through semi-structured interviews and data analysis was carried out using a seven-step content analysis approach. The accuracy and accuracy of the data were also determined by Lincoln & Guba's proposed criteria. Results: In the quantitative part, the most important inhibitor factors include management factors (low communication between university and foreign universities), empowerment factors (lack of familiarity with relevant statistical techniques), administrative rules (length of paper publishing stages), and personal factors (teaching too much), social factors (inadequate intellectual incentives) and economic factors (inadequate research budget and lack of research facilities). In the qualitative section, the four main categories (individual challenges, dysfunctional infrastructure, Limited Research Partner, and discouragement of the research result) and fifteen sub-floors were extracted. Conclusion: According to the results of this study, in order to improve the quantitative and qualitative research among faculty members, it is suggested that the respective authorities consider such issues as strengthening the research motivation of faculty members taking advantage of research facilities and special privileges, and also equivalence of research tasks. [ABSTRACT FROM AUTHOR]

Introduction/Objective: The objective of the study was to develop an understanding of the perceptions of people with Parkinson's disease and clinical academics on the implementation of a regional interdisciplinary model of care. Methods: A qualitative descriptive study was undertaken. A PD interdisciplinary clinic was conducted in an Australian regional location. As a novel variation, in this clinic, 4 clinical academics consulted simultaneously offering a long, 3-h appointment. Following the clinic, we conducted 2 focus groups with all clinical academics and 6 semi-structured interviews with people with PD and carers. Data were analyzed using Elo & Kyngäs' inductive content analysis approach. Results: An overarching main category namely, "interdisciplinary care proved valuable to regional people with PD and clinical academics," and 3 generic-categories including "identifying interdisciplinary care as a viable option in regional locations," "current care provision is disempowering and burdensome," and "regional residing people with PD and their carers seek locally accessible healthcare with PD skilled clinicians" were identified. Conclusion: Our findings suggest the implementation of interdisciplinary care to regional healthcare systems is valued by clinical academics and people with PD and carers. Further research is required to establish how interdisciplinary care can be implemented in regional Australia and its effects on practice changes, patient outcomes, and quality of life. [ABSTRACT FROM AUTHOR]

Aim: Individual experiences shape perceptions of illness. Post-Soviet migrants have different expectations of chronic disease treatment than German patients. This study aimed to delve into perceptions of diabetes mellitus, a topic of increasing importance in global migration. Design: Qualitative, semi-structured interviews were conducted with 26 post-Soviet migrants with diabetes and three Russian-speaking diabetes counselors, mainly recruited through a snowball system. Methods: The research data were analyzed using a hermeneutic approach. The categories of the common-sense self-regulation model and developed subcategories were scrutinized by means of content analysis, ensuring a comprehensive understanding of the data. Results: The perception of diabetes mellitus varied depending on the country where the diagnosis was made. This included the individual recording of symptoms, the expected time course, and the allocation of different competencies. Opportunities for access to the local healthcare system in the former Soviet Union influenced these expectations. Conclusion: The study’s findings underscore the importance of healthcare access in the country of origin and the patient’s knowledge of diabetes mellitus in shaping their perception and treatment. These factors, influenced by the social environment and the patient’s level of education, continue to play a role even after immigration to Germany. [ABSTRACT FROM AUTHOR]

Background: This study aims to describe the Libyan oral health care system in terms of its structure, function, workforce, funding, reimbursement and target groups. Methods: A single descriptive case study approach and multiple sources of data collection were used to provide an in-depth understanding of the Libyan oral health care system. A purposeful sample of the key informants (Managers of oral health centers, dentists of various specialties with experience in the field, dentists, nurses, dental technicians, and officials in the affairs of medical insurance) was recruited. The case and its boundaries were guided by the study's aim. Both qualitative and quantitative analyses were conducted. Descriptive statistics were used for quantitative data. Framework analysis, informed by the study objectives, was used to analyze interviews and documents. Results: The analysis showed that oral health services are integrated into medical services. The provision of dental care is mainly treatment-based, in the private sector. The oral health services in the public sector are mainly emergency care and exodontia. The dental workforce included in the study were mostly dentists (89% General Dental Practitioners (GDPs), 11% specialists), with a marked deficiency in dental technicians and nurses. Around 40% of dentists work in both the private and public sectors. The government provides the funding for the public sector, but the private sector is self-funded. No specific target group(s) nor clear policies were reported. However, the system is built around primary health care as an overarching policy. Dental caries is the most common oral problem among Libyan preschool children affecting around 70% and is the most common cause of tooth loss among adults. Conclusion: The oral health care system in Libya is mainly privatized. The public health services are poorly organized and malfunctioning. There is an urgent need to develop policies and plans to improve the oral health care system in Libya. [ABSTRACT FROM AUTHOR]

(1) Background: The nursing profession has undergone a significant transformation not only in a formal context but also in terms of the increased educational competencies required of nurses and their preparedness to adapt to evolving roles and statuses. The aim of our study was to examine the experience of advanced practice nurses who conduct independent consultations on patients and to identify the main challenges they face in their practice. (2) Methods: We carried out 22 semi-structured interviews with nurses responsible for conducting independent consultations across three urban polyclinics located in Aktobe, Almaty, and Astana. All interviews were audio-recorded, transcribed verbatim, and subjected to qualitative content analysis. (3) Results: The content analysis revealed three main themes: "People awareness of the role of an independent nursing appointment", "Adaptation of the work environment", and "Confidence of nurses to provide independent services". (4) Conclusions: Limited competency among nurses and the absence of quality metrics for autonomous nursing consultations present substantial obstacles to assessing and enhancing the quality of care delivered by nurses in their independent roles. Developing and implementing quality indicators for independent nursing appointment, as well as additional training within the framework of interprofessional continuous education for nurses, are important steps toward enhancing the effectiveness, safety, and accessibility of nursing care. [ABSTRACT FROM AUTHOR]

Aim. This study aimed to (1) describe the perceived level of role transition from education to practice of new graduate nurses in Oman and (2) explore the barriers to and enablers of a successful transition. Background. The transition from a familiar academic environment to becoming a professional nurse is stressful and challenging. Exploring the transition barriers and enablers is instrumental in designing an effective experience. However, studies exploring the transition experience from academia to practice among new graduate nurses working in Oman are limited. Design. This study used a mixed method research design. Methods. Data were collected from nurses working for no longer than two years. Role transition was assessed using the Casey‐Fink Graduate Nurse Experience Survey. Barriers to and enablers of transition were explored through a focus group interview. Results. The total sample consists of 405 nurses working in 13 public hospitals. The majority (68.89%) of the participants had worked as a nurse for less than 6 months. The average score of the comfort and confidence subscale was 2.96 (SD = 0.38). Findings showed that the amount of workload and unclear role expectations were the most frequent difficulties new graduate nurses were experiencing in their transition from a student to a staff nurse. Findings from focus group interviews revealed a number of barriers and enablers that affected the transition experience of the new graduates. The barriers were fear, insufficient academic preparation, bridging the knowledge‐practice gap, and limited nurse‐physician interactions. The enablers were teamwork, organizational support, and the internship phase. Conclusion. The findings illustrate the need for healthcare organizations to design effective internship programs to ensure a successful transition experience. Providing staff with preceptorship training and enhancing nurse‐physician communication are important strategies for creating a comfortable work environment and ultimately ensuring a successful training experience for new nurses. [ABSTRACT FROM AUTHOR]

It is recommended that health promotion activities in the community focus on residents' strengths. Hence, this study explored the community strengths perceived by older adults living alone in a semi-mountainous rural region of Japan. A qualitative, descriptive approach was used. Content analysis was performed using data obtained through face-to-face interviews. Interview data were coded; codes were classified based on similarity to create subcategories and categories. The strengths within the community, as perceived by older adults living alone in a semi-mountainous rural region, were revealed in four categories related to ten subcategories: "loose connections with others", "active community participation", "close relationships with community professionals", and "familiarity with the living environment". Strengths within the community perceived by older adults living alone in a semi-mountainous rural region were cultivated in an environment formed by their past lives. Utilizing these resources may help support community-based societies in semi-mountainous rural regions where depopulation and aging are expected to continue in the future. This study was not registered. [ABSTRACT FROM AUTHOR]

Background: A sustainable point-of-care (POC) diagnostic testing implementation in low-resourced facilities enhances quick diagnostic investigation and halts unnecessary referrals. This study identified the barriers impeding the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana; as well as explored potential solutions that could enhance the accessibility and effectiveness of POC diagnostic testing, ultimately improving the quality of healthcare delivery. Methods: A total of twenty-eight participants were purposively selected from health facilities in low-resourced settings in the Bono Region for a descriptive qualitative study. Of the twenty-eight participants, seventeen including ten healthcare providers from CHPS facilities, six district health depot managers, and one regional depot manager were engaged in in-depth interviews. Additional eleven including nine healthcare providers and two district depot managers were also engaged in focus group discussions. NVivo version 12 software was employed for condensation, labelling, and grouping of themes. Data was analysed narratively. Results: Work overloads, limited POC testing services, stock-outs of POC tests at the facilities, and supply-related challenges of POC test kits were identified as major barriers to POC testing services. To solve these barriers, adequate funding, an effective delivery system, stakeholders' engagement and advocacy, and in-service and refresher training courses were suggested as potential solutions to POC diagnostic testing services implementation by the stakeholders. Conclusions: This study's findings emphasize the need to address the barriers hindering the implementation of POC diagnostic testing in health facilities without laboratories in the Bono Region of Ghana. The suggested solutions provide a roadmap for improving the accessibility and effectiveness of POC testing, which has the potential to enhance the quality of healthcare delivery, reduce unnecessary referrals, and ultimately improve patient health outcomes in underserved settings. [ABSTRACT FROM AUTHOR]

(1) Background: Patient safety culture (PSC) encompasses the values, attitudes, norms, beliefs, practices, perceptions, competencies, policies, and behaviours of professionals that determine organisational commitment to quality and patient safety. Few studies use mixed methods to analyse patient safety culture, and none offer the richness of using a mixed methodology to develop their theoretical model. This study aims to identify the factors nurses believe contextualise and influence PSC in relation to existing theoretical frameworks. (2) Methods: This study employed a sequential explanatory mixed-methods design combined with the Pillar Integration Process for data integration. (3) Results: In the final data integration process, 26 factors affecting nurses' PSC were identified. Factors nurses related to PSC not being assessed with the tool used in phase 1 were notification system, flow of patients, patient involvement, resources and infrastructure, and service characteristics. (4) Conclusions: This mixed-methods study provides an opportunity to identify the weaknesses and strengths of currently developed theoretical frameworks related to PSC and offers content for its improvement. Even though multiple studies aim to assess PSC using existing quantitative method tools, the development of this study offers a glimpse of some aspects relevant to nurses' PSC not included in the theoretical framework of the said tools, such as patient involvement, the flow of patients, and service infrastructure. [ABSTRACT FROM AUTHOR]

Objective: No fatigue‐specific programs exist for people with systemic sclerosis (SSc) despite the burden of fatigue and negative impact on daily activities. This study used a convergent parallel mixed methods design to evaluate the impact of an adapted virtual intervention, Fatigue and Activity Management Education in Systemic Sclerosis (FAME‐iSS), in the United States. Methods: Eighteen people with SSc participated in three separate six‐week FAME‐iSS programs. Participants completed the modified Fatigue Impact Scale (m‐FIS), the Self‐Efficacy for Performing Energy Conservation Strategies Assessment (SEPESCA), the Patient‐Reported Outcomes Measurement Information System (PROMIS) Self‐Efficacy for Managing Symptoms, and the Hospital Anxiety and Depression Scale (HADS) before, immediately after, and three months post intervention. Data were analyzed using descriptive and nonparametric inferential statistics. Participants' perceptions of the program and their use of fatigue management strategies were qualitatively analyzed using content analysis. Results: Eighty‐nine percent of participants were women with a mean ± SD age of 52.0 ± 11.6 years and a mean ± SD disease duration of 13.7 ± 14.5 years, and more than 70% had a college degree. Significant improvements were observed for self‐efficacy on the PROMIS Self‐Efficacy for Managing Symptoms (P = 0.002) and SEPESCA (P = 0.016) immediately post intervention, which continued to significantly improve up to the three‐month follow‐up (P = 0.006 and 0.035, respectively). Significant improvements were also observed for the m‐FIS between baseline and the three‐month follow‐up (P = 0.029). Participants reported a deeper understanding of fatigue and that they liked sharing strategies and experiences with each other along with the facilitator, citing that "there was a power in our group because we had a common condition." Conclusion: FAME‐iSS resulted in improvements in the impact of fatigue and self‐efficacy for managing symptoms and performing energy conservation strategies. Feedback was positive, and the virtual format allowed for greater accessibility and sharing of strategies. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health & Nursing Management / Sağlık ve Hemşirelik Yönetimi Dergisi is the property of Logos Medical Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Moral distress is a multifactorial and complex phenomenon influenced by various individual, cultural, and systemic factors. This study aimed to investigate the frequency and intensity of nurses' moral distress, explore their experiences, and develop the conceptual model of risk factors of moral distress in surgical units and operating rooms. Method: This is a sequential mixed-method study conducted at four teaching hospitals affiliated with the Qom University of Medical Sciences. In the first step, the moral distress of nurses in surgical units and operating rooms was investigated by a survey. The participants included nurses who worked in the operating room and surgical units. (n = 180). The data was collected by a Moral Distress Scale-Revised (MDS-R) questionnaire. In the second step, the experiences of nurses regarding risk factors of moral distress were explored using semi-structured interviews and analyzed using the conventional content analysis by Graneheim and Lundman's approach. Results: One hundred eighty nurses participated in this study. The mean total moral distress scores ranged from 12 to 221, with a mean (SD) of 116.8 (42.73). The causes of moral distress cited with the highest frequency and intensity related to the 'role of healthcare providers'. The experiences of the participants in the theme 'Inductive process of moral distress development' were categorized into three categories: 'Melting into the faulty system', 'Power and the system as distress promotors', and 'Perceived unpleasant consequences'. Conclusion: The results indicated that the frequency of moral distress in operating rooms and surgical units was at a moderate level and the distress intensity of nurses was at a moderately high level. The results indicated that in the investigated system, the "inductive moral process of distress development" was continuously understood by the participants. This process was influenced by systemic and individual factors. Weak assertiveness, conservative compromise, and desensitization to unprofessionalism as individual factors were effective in causing distress. Risk factors at the systemic level led nurses to melt into the faulty system and created adverse outcomes at the individual level. The lack of systemic support and the stabilization of mobbing by powerful system members had a negative impact on the individual factors of distress development. Also, these factors directly cause negative consequences. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the study was to describe the preparation of children for day surgery from the parent's viewpoint. Design: Empirical Research Mixed Method. Methods: The research applied a mixed‐methods study design. The study was conducted at the Paediatric Day Surgical Department of one REDACTED between 2018 and 2020 at the same time as an associated randomised controlled conduct trial. Parents of 41 children (ages 2–6 years) completed measures assessing their preparation for day surgery and satisfaction with the procedure. Semi‐structured interviews were conducted with 15 parents to better understand their experiences. Results: According to the results, most of the parents (95%) told their children about the upcoming day surgery procedure. The child was prepared for the surgery with cognitive and sensory information, and the preparation usually started at home well before the surgery. The parents' experiences with the most critical aspects of preparing their child included three main categories: (1) usability of the preparation method; (2) content and timing of the preparation method and (3) consideration of the family perspective. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends the use of donated human milk (HM) as the second-best option for mothers who are temporarily unable to provide sufficient breast milk to meet the needs of their infants. However, HM donation is yet to become an accepted practice in Uganda. We assessed the level of, and factors associated with acceptability to donate HM among postnatal mothers at St. Francis Hospital Nsambya (SFHN). Methods: A cross-sectional sequential explanatory mixed method study was conducted between October 2018 and March 2019. A questionnaire on sociodemography, awareness and likely acceptability to donate HM was administered to 410 postnatal mothers at SFHN. Multivariate logistic regression analysis was undertaken to determine factors associated with acceptance of HM donation. Focus Group Discussions (4) and Key Informants Interviews (4) were used to explore factors influencing behaviours to donate human milk. Qualitative data were analysed using a content thematic approach. Results: Overall acceptance of donating the HM was 77.6%, and the significant factors were: willingness to express the HM (AOR 7.5; 95% CI 3.01, 18.68); wet-nursing knowledge (AOR 2.3; 95% CI 1.1, 5.0) and visit to under-5 years' clinic (AOR 21.3; 95% CI 2.3, 196.9). The major themes in relation to accepting to donate HM were wet nursing experience, and confidence in donating the HM, and its perceived effectiveness. There were concerns about the safety and adequacy of HM and fear of transmitting criminal behaviours and mental illness through human milk. Conclusions: Acceptance to donate HM among postnatal mothers at St. Francis Hospital Nsambya was very high. Willingness to express and store human milk, prior knowledge about wet nursing and a visit to an under-five outpatient clinic were associated with acceptance. Thus, establishing a human milk bank is feasible in the study setting. [ABSTRACT FROM AUTHOR]

Background: Different mental disorders may be associated with many work-related factors to which primary health care workers (PHCWs) are exposed. The current research aims to measure the rates of depression, anxiety, and stress among PHCWs, and their associated causes in primary health care (PHC) settings. Methods: An explanatory sequential mixed methods design was employed in this research from January 2021 to January 2022 in Tabriz, Iran's PHC centers. First, this study followed an online-based cross-sectional survey using a self-reported questionnaire. The Depression, Anxiety and Stress Scale-21 Items (DASS-21) and questions on demographic and work-related characteristics were completed by 303 frontline PHCWs during the quantitative phase. In the qualitative phase, a semi-structured interview was held with 12 PHCWs who had the highest level of depression, anxiety, and stress to identify the reasons and sources of mental health prevalence. Quantitative data were analyzed using descriptive statistics via SPSS-26. A content analysis was performed to analyze qualitative data. Results: The results showed that self-reported stress, anxiety, and depression had a prevalence of 40.3%, 42.9%, and 42.6%, respectively. Symptoms of at least one mental disorder were experienced by 54% of respondents, while 28% had all three. Major sources of stress, anxiety, and depression among PHCWs were working environment conditions, organizational policies, job-related reasons, and interpersonal relations. Conclusions: The results of current study indicated that PHCWs experienced high levels of depression, anxiety, and stress. The main factors and reasons that contributed to these mental health issues among PHCWs were work environment conditions, organizational policies, job-related reasons and interpersonal relations. Therefore, interventions should be implemented to promote mental health of PHCWs. This can include measures such as psychological screening, supportive care, workload management, flexible scheduling, and access to mental health resources. Additionally, training programs can be implemented to enhance resilience and coping skills among healthcare professionals. [ABSTRACT FROM AUTHOR]

Aim. To evaluate the knowledge, attitudes, and practices of Chinese bedside nurses regarding antimicrobial stewardship, as well as to identify factors that influence nurses' engagement in antimicrobial stewardship. Background. Antimicrobial resistance is a pressing global health threat. Antimicrobial stewardship is crucial in combating this issue. Nurses play a key role in implementing antimicrobial stewardship. However, little is known about the involvement of Chinese nurses in antimicrobial stewardship. Methods. An explanatory sequential mixed-methods design was employed. A self-developed questionnaire was administered between March and August 2021 (N = 463), followed by semi-structured interviews with 17 nurses between March and July 2022. Descriptive statistics and qualitative content analysis were used to analyze the data. Results. The study found that nurses scored 75% in knowledge, 82.8% in attitude, and 84.1% in practice domains. There was a moderate correlation between nurses' knowledge, attitudes, and practices. It revealed that knowing local antimicrobial stewardship programmes information and the frequency of receiving antimicrobial stewardship training had a significant impact on nurses' knowledge scores. The willingness to participate in related training influenced nurses' attitude scores. Being a clinical teacher and the frequency of receiving related training influenced nurses' practice scores. The qualitative phase identified three themes: insufficient knowledge of nurses' engagement, diverse attitudes towards engagement, and limited scopes and absence of standards in nurses' participation. Conclusions. Our findings emphasize the importance of enhancing nurses' perception and involvement in antimicrobial stewardship. While nurses exhibit positive attitudes and practices, addressing the existing knowledge gap is crucial. To achieve this, it is necessary to clarify the role and responsibilities of nurses in antimicrobial stewardship, provide regular training and innovative methods, strengthen communication and collaboration, and foster a positive work environment. Additionally, actively promoting the development of guidelines and evaluation criteria will enable nurses to more effectively participate. Implications for Nursing Management. Regular training of nurses in antimicrobial stewardship needs to be enhanced. Nursing managers should strive to create positive, empowering, and supportive work environments, participate in policy formulation and implementation, and provide clear expectations for nurses' engagement in antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Objective: Dental records and forensic odontology play an important role in both healthcare and the legal system, aiding in personalized patient care, human identification, and legal proceedings. This study aims to investigate dental record-keeping practices and assess the awareness of forensic odontology among Pakistani dentists over 12 months. This study aims to collect data from 500 dentists, identify areas for enhancement, and develop a strategic action plan to improve record-keeping quality and forensic odontology application, culminating in a comprehensive dental data repository to support legal and criminal investigations in Pakistan. Methodology: This study employed a mixed-method approach conducted at Hamdard Dental College from January to March 2023. The quantitative phase involved distributing questionnaires to 463 dentists, chosen through stratified random sampling. Out of these, 413 responded, yielding an 86% response rate. These questionnaires focused on dental record-keeping practices and dentists' awareness of forensic odontology. Subsequently, based on the questionnaire results, face-to-face interviews were conducted with 20 purposively selected dentists to gain deeper insight into the challenges and potential solutions. Data from both phases were integrated and analyzed accordingly. Results: The study included 413 participants, mainly females (79%), with ages ranging from 27 to 65 years and an average age of 46.4 years. Most dentists had 5–20 years of work experience (53%), and most (87.4%) were practicing in private clinical settings. All the dentists generated medical and dental records, but the duration of their record-keeping varied, with some maintaining them for up to a year and others for two years or longer. Five themes were generated from the qualitative content analysis. These themes were dentists' perceptions, barriers and challenges, knowledge and awareness, and improvement strategies. Conclusion: Our study revealed that local practitioners in Pakistan exhibit subpar practices in dental record-keeping and maintenance of patient history, irrespective of whether they use a digital or traditional file-based system. Even though dentists are cognizant of the importance of record-keeping, they do not actively maintain comprehensive records. This suggests the need for improved training and system improvements to address the gaps in record-keeping practices. [ABSTRACT FROM AUTHOR]

Background: Exergames provide a promising new approach to implement simultaneous motor--cognitive training, which may support preventing the decline in cognitive functioning in older adults who have a mild neurocognitive disorder (mNCD). Objectives: To evaluate feasibility, system usability, and acceptance of "Brain- IT", a newly developed training concept combining exergame-based motor-cognitive training and heart rate variability (HRV) guided resonance breathing for the secondary prevention of mNCD. Methods: A pilot randomized controlled trial (RCT) with an allocation ratio of 2:1 (i.e., intervention:control) was conducted. The control group proceeded with usual care. The intervention group performed a 12-week training according to the "Brain-IT" training concept implemented with the "Senso Flex" (Dividat AG) exergaming system in addition to usual care. Feasibility and usability outcomes were analyzed using descriptive statistics. User acceptance was analyzed qualitatively and using Friedman analysis of variance (ANOVA), as well as Wilcoxon signed-rank tests. Results: Eighteen participants (77.3 ± 9.8 years; 44.4% females) were included. On average, we recruited 2.2 participants per month, and 35.3% of the individuals contacted were included. The intervention group had an attrition rate of 20% and mean adherence and compliance rates of 85.0 and 84.1%, respectively. The mean system usability score, measured with the system usability scale, was 71.7. High levels of exergame enjoyment, an increase in exergame enjoyment, and internalization of training motivation with large effect sizes (p = 0.03, r = 0.75 and p = 0.03, r = 0.74, respectively), as well as acceptable perceived usefulness, were observed. Preliminary data on the effects of the "Brain-IT" training are promising. Conclusion: The feasibility and usability of the "Brain-IT" training are acceptable. However, frequent occurrences of technical problems and difficulties in using the exergame training system were identified as barriers to performing the "Brain-IT" training. To optimize feasibility, either improvements or alternative solutions are required in the hardware and software of the exergame used to implement the "Brain-IT" training. The "Brain-IT" training itself was well-accepted by older adults who have mNCD. Therefore, the effectiveness of the "Brain-IT" training concept should be investigated in future studies. Trial registration: clinicaltrials.gov/ct2/show/NCT04996654. [ABSTRACT FROM AUTHOR]

Background: Tobacco usage has been identified as a leading preventable cause of mortality and is responsible for six million fatalities per year globally. India had enacted COTPA in 2003. Tobacco vendors are one of the key stakeholders for Cigarettes and Other Tobacco Products Act (COTPA) implementation. Objective: To assess the knowledge gap on COTPA and to explore the perceived factors influencing implementation of COTPA among tobacco vendors in Puducherry. Materials and Methods: A mixed-method study was conducted among tobacco vendors from Point of Sale (PoS) around 230 educational institutions (schools and degree colleges) in Puducherry for three months. Simple random sampling was applied to select educational institutions and the tobacco vendors from PoS located around these institutions were included. Data capture was done using a pretested, face-validated questionnaire incorporated in Epicollect software 5 and data analysis by SPSSv24. Purposive sampling was employed to conduct in-depth interviews among tobacco vendors till the point of saturation and manual content analysis performed. Written informed consents were sought. Institutional Ethical Committee approval was obtained. Results: Majority (95.7%) reported that they were aware of tobacco control legislation, but only one person had heard of COTPA. Awareness about the display of signage boards at PoS was observed in 75.7% vendors. Around 41.7% reported that they should not advertise any kind of tobacco products. Three major themes were identified: facilitators, barriers, and suggested measures for COTPA implementation. Conclusion: Tobacco vendors in Puducherry were aware of tobacco control legislations but not familiar with the COTPA and its provisions. It is necessary to put forth efforts to educate these important stakeholders to be more cognizant of COTPA and to effectively include them in anti-tobacco programs. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy should be dealt as an important issue as it carries both individual- and community-level risks; however, it lacks proper assessment in particular among the indigenous tribal population. A community-based sequential explanatory mixed methods study was conducted among 238 eligible individuals in Ri-Bhoi district, Meghalaya. The quantitative part involved a cross-sectional study to determine the proportion of vaccine hesitancy and the qualitative part comprised in-depth interviews among the eligible residents and key informant interviews among the health workers providing the vaccination services, to explore the facilitators and barriers of vaccine uptake. A total of 113 [47.5% (95% confidence interval [CI]: 41.0%-54.0%)] participants were found to be hesitant to vaccination, among which 16.8% (95% CI: 12.4%-22.3%) were initially hesitant and 30.7% (95% CI: 24.9%-37.0%) had vaccine refusal. The themes generated through qualitative interviews were individual-related, disease-related, vaccine-related, healthcare system and provider related and socio-cultural and religious. The main barriers for the likelihood of action were perceived susceptibility and perceived severity under the individual perception along with ambiguity aversion, scepticism about the efficacy, mistrust, concerns on side effects, rumors, and socio-cultural and religious misbeliefs. Vaccine hesitancy is found to be considerably higher and it depends on complacency toward the vaccine, confidence in its safety, perceived susceptibility to the disease and perceived severity to the disease coupled with modifying factors for cues for action. Healthcare workers should better communicate to improve the uptake of vaccines by reducing the barriers to the vaccine acceptance. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Enfermagem e Atenção à Saúde (REAS) is the property of Revista de Enfermagem e Atencao a Saude - Reas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. Strong evidence supports the beneficial impact of exercise on cancer patients. However, the provision of exercise programs in Germany is highly heterogeneous. Therefore, the network OnkoAktiv (OA) enables patient consultations and referrals from coordinating regional OA centers (RE) into community-based exercise programs (CBEP). Objective. The aim of this study was to identify barriers and facilitators for the implementation of OA network structures from the perspective of RE and certified CBEP. Methods. This evaluation was executed in a sequential mixed methods design. We conducted 16 qualitative interviews with each leader in RE and the certified CBEP. Then, 89 certified CBEP were invited to a quantitative, cross-sectional survey. Results. We identified 11 facilitators each for RE and certified CBEP, 7 barriers for RE and 5 for certified CBEP. Barriers dealt with, for example, financing OA network structures, a lack of knowledge of exercise trainers, inadequate patient referral, and missing collaborations by healthcare professionals (HCPs). Most of the named facilitators were adequate internal organizational resources, support and reachability of OA staffs, and collaboration with HCPs. Conclusion. Our findings indicate different challenges for the implementation of OA network structures. Future implementation efforts should consider the evaluation of individual barriers and the development of specific solutions. [ABSTRACT FROM AUTHOR]

Waiting rooms provide an ideal location to disseminate health information. In this mixed-methods study, we evaluated waiting room–based health education talks at two clinics in the Dominican Republic and explored recommendations for implementing this intervention in similar settings. The talks addressed noncommunicable diseases, sexually transmitted infections, family planning and gender-based violence. We conducted pre- and posttests to assess attendees' change in knowledge and conducted semi-structured interviews with a subset of them. We conducted a semi-structured focus group with educators. Analyses included Wilcox Signed Rank Tests and McNemar tests for pre- and posttests, conventional content analysis for individual interviews and transcript coding for the focus group. Patient participants were 69.3% female aged 39.6 years (SD = 13.5) on average at one clinic (n  = 127) and 100% female aged 17.4 (SD = 1.3) on average at the second clinic (n  = 24). Focus group participants (n  = 5) had 4.8 years (SD = 3.3) of health educator experience on average. Pre- and posttests showed significant improvement (P  < 0.05) across all talks. Qualitative interviews emphasized engaging, clear and brief content delivery with visual aids. The focus group highlighted the importance of patient-centered design with culturally concordant delivery and identified implementation challenges. Findings demonstrate that waiting room–based education talks improve knowledge and provide suggestions for similar interventions. [ABSTRACT FROM AUTHOR]

We developed a pandemic telephone outreach protocol to identify risk for social isolation, health destabilization, medication issues, inadequate services and supports, and caregiver stress among older adults at high risk of destabilization. Screening, conducted between April 1, 2020, and May 8, 2020, was targeted to those who had previously been screened as frail or who were identified as vulnerable by their family physician. This study describes the implementation and results of this risk screening protocol and describes patient, caregiver, and health professional perceptions of this outreach initiative. Mixed methods included satisfaction surveys and interviews completed by patients/caregivers (N = 300 and N = 26, respectively) and health professionals (N = 18 and N = 9, respectively). A medical record audit collected information on patient characteristics and screening outcomes. A total of 335 patients were screened in the early weeks of the pandemic, of whom 23% were identified with at least one risk factor, most commonly related to the potential for health destabilization and medication risk. Follow-up referrals were made most frequently to physicians, a pharmacist, and a social worker. The outreach calls were very well received by patients and caregivers who described feeling cared for and valued at a time when they were socially isolated and lonely. The outreach calls provided access to trusted COVID-19 information and reassurance that health care was still available. The majority of health professionals (>86%) were "very" or "extremely" satisfied with the ease of completing the screening via telephone and value for time spent; for 79% the protocol was "very" or "extremely" feasible to implement. Health professional interviews revealed that patients were unaware they could access care during the pandemic lockdown but were reassured that care was available, potential crises were averted, and they supported future implementation. Risk screening provides a significant opportunity to provide information, support, and mitigate potential risks and is an important and feasible component of pandemic planning in primary care. [ABSTRACT FROM AUTHOR]

Introduction: In 24/7 disability care facilities, patient‐reported experience measures (PREMs) are important to help healthcare professionals understand what matters to care users and to improve the quality of care. However, the successful implementation of a PREM is complex. In a Dutch disability care organization, stakeholders cocreated tailored implementation strategies aimed at improving the use and integration of a qualitative PREM. This study gives insights into the uptake and experiences with these cocreated implementation strategies and the perceived impact of the set of strategies. Methods: We performed a prospective process evaluation between February 2020 and February 2021. We collected data in three disability care facilities from 35 care users, 11 professionals, 3 facility managers and 4 organization representatives. Data collection included observations during kick‐offs and learning goal meetings and several attendance checklists. We collected 133 questionnaires (Time 0 and Time 1). We conducted 35 individual semistructured interviews and an online focus group interview. Quantitative data were analysed using descriptive statistics and qualitative data using directed content analysis. Results: The exposure to and adoption of strategies was between 76% and 100%. Participants were positive about tailoring the strategies to each facility. Implementation was hindered by challenges in care users' communication and COVID‐19. The perceived impact referred to an improved understanding of the goal and added value of the PREM and better preparation and execution of the PREM. The impact of the set of strategies was mainly experienced on the micro level. Conclusion: The uptake of the cocreated implementation strategies was acceptable. The participants valued the tailored approach, which enabled them to focus on facility‐specific learning goals. Stakeholder engagement and co‐created strategies may have strengthened the adoption of and experiences with the implementation. Patient or Public Contribution: In this article, we present the process evaluation of implementation strategies for the integrated use of a PREM in disability care. A development group consisting of communication vulnerable care users, trainers and professionals developed the implementation strategies. The disability care organization was responsible for the planning and organization of the implementation process. During the process evaluation the end users, trainers, professionals and managers tailored the implementation strategies to their own settings and needs. Researchers observed this implementation process and interviewed the stakeholders about their experiences and the perceived impact. [ABSTRACT FROM AUTHOR]

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Despite the advances in stigma research, measuring health-related stigma continues to be challenging and knowledge gaps remain. This study gained insight into challenges and research priorities related to the assessment of health-related stigma. Interviews were conducted with 14 stigma researchers, followed by a survey that was completed by 36 respondents. The findings showed a diverse range of research priorities. Among the top ranked priorities were the need for robust measurement properties of existing scales (content validity, responsiveness, validation across settings), exploration and assessment of subtle changes in stigma, and investigation on ways to assess actual behaviour and discrimination. Various challenges with the cross-cultural use of measures were identified, along with a research opportunity to shorten the cross-cultural validation process. Other identified research priorities related to: studying multi-level intersectional stigma; focusing on positive features that counter stigma; rephrasing negative and offending scale items; developing generic measures; and, the further development of practical tools to support researchers with scale implementation. The defined research priorities can guide future studies to advance stigma measurements and, as our ability to measure is critical for our understanding, enhance our knowledge about the complex stigma processes. [ABSTRACT FROM AUTHOR]

Most older adults have unique needs and are suffering from chronic diseases. It is important to have quick and easy access to emergency medical services. Three-phase action research aimed to develop and assess the feasibility of implementing the Emergency Medical Service Hub for Older Adults Model in Upper Northern Thailand was conducted. In phase I and phase II, 27 emergency healthcare providers and 10 older adults were purposively recruited, and in phase III 16 emergency healthcare providers evaluated the feasibility of the model. The framework guided the study was based on action research methodology and six emergency medical services system functions. Data were collected via in-depth interviews, observation, and self-report of the implementation feasibility questionnaire. All research instruments were validated by three experts, yielded a content validity index of 0.80-1, and the reliability test of the implementation feasibility questionnaire revealed a Cronbach's alpha coefficient of 0.81. Data were analyzed using descriptive statistics and content analysis. The final model consisted of six components: effective communication, registry and database, geographic information system, effective emergency medical service team, one-stop service emergency department for older adults, and continuum of care. Overall, the possibility of the model implementation was rated as high. The benefit and safety aspect of implementing the model was at the highest level, followed by its applicability. The use of the model is likely to benefit older adults. Effective implementation requires proper resource support and future study to examine the effectiveness of the model in a full-scale clinical trial is recommended. [ABSTRACT FROM AUTHOR]

Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Recreational therapists in Michigan and Pennsylvania were interviewed on their perceptions of the impact of COVID-19 on practice with older adults, including changes to their roles and responsibilities as well as the impact on older adults. Social distancing requirements, limitations on visitors and restrictions on groups transformed programming and practice, as well as negatively impacted older adults living in a variety of residential and community-based settings. This qualitative study included 14 recreational therapists. Related to practice, identified themes included the impact on programming, changing roles and responsibilities, how recreational therapists coped with adversity, and their considerations for future practice. Regarding impact on older adults, the resulting themes noted: 1) lack of socialization, 2) emotional and behavioral responses, 3) physical decline, and 4) cognitive decline. The challenges of working with clients living with cognitive impairments and barriers for older adults living in the community are discussed. Recommendations for practice and research to address the long-term effects of COVID-19 in recreational therapy with older adults are presented. [ABSTRACT FROM AUTHOR]

The wellbeing of care home staff and the need to support them at work was highlighted with devastating clarity by the COVID pandemic. This small study explores what online and at work wellbeing resources were available to frontline care home workers during the first wave of the pandemic. A mixed methods study was undertaken May and July 2020. A multi-disciplinary team undertook a rapid review of online wellbeing information and resources relevant specifically to the care home sector and its non-nurse staff. Qualitative data comprised of digital recordings of semi-structured interviews with six care home managers of five care homes, and an online survey sent to 55 Scottish care homes with a response rate of 18%. Five overarching lessons were identified from the data. The first two ('managing information overload' and 'medium not appropriate for the message') relate to the awareness and use of the online wellbeing resources by frontline care workers. Three others ('visible and supportive leadership', 'building team camaraderie' and 'maintaining a focus on wellbeing beyond a crisis response') highlight the in-house, practice-based issues of supporting the wellbeing of staff. Although small, the findings from this study are of relevance and use by those in the UK and beyond working develop and sustain more effective ways to support and retain of this vital workforce. [ABSTRACT FROM AUTHOR]

Introduction: Māori, Pasifika and Asian women are less likely to attend cervical screening and Māori and Pasifika women are more likely to be diagnosed with later‐stage cervical cancer than other women in Aotearoa New Zealand. This study—with under‐screened women taking part in a randomized‐controlled trial comparing self‐testing and standard screening—explored the acceptability of a human papillomavirus (HPV) self‐test kit and the preferred method for receiving it. Methods: Māori, Pasifika and Asian women (N= 376) completed a cross‐sectional postal questionnaire. Twenty‐six women who had not accepted the trial invitation were interviewed to understand their reasons for nonparticipation. Results: Most women found the self‐test kit easy and convenient to use and reported that they did not find it painful, uncomfortable or embarrassing. This was reflected in the preference for a self‐test over a future smear test on the same grounds. Most women preferred to receive the kit by mail and take the test themselves, rather than having it done by a doctor or nurse. There was a range of preferences relating to how to return the kit. Phone calls with nonresponders revealed that, although most had received the test kit, the reasons for not choosing to be involved included not wanting to, being too busy or forgetting. Conclusion: HPV self‐testing was acceptable for Māori, Pasifika and Asian women in Aotearoa New Zealand. HPV self‐testing has considerable potential to reduce the inequities in the current screening programme and should be made available with appropriate delivery options as soon as possible. Patient or Public Contribution: This study explored the acceptability of HPV self‐testing and their preferences for engaging with it among Māori, Pasifika and Asian women. Thus, women from these underserved communities were the participants and focus of this study. [ABSTRACT FROM AUTHOR]

Background: Practice based research networks (PBRNs) are increasingly used as a tool for evidence based practice. We developed and tested the feasibility of using software to enable online collection of patient data within a chiropractic PBRN to support clinical decision making and research in participating clinics. Purpose: To assess the feasibility of using online software to collect quality patient information. Methods: The study consisted of two phases: 1) Assessment of the quality of information provided, using a standardized form; and 2) Exploration of patients' perspectives and experiences regarding online information provision through semi-structured interviews. Data analysis was descriptive. Results: Forty-five new patients were recruited. Thirty-six completed online forms, which were submitted by an appropriate person 100% of the time, with an error rate of less than 1%, and submitted in a timely manner 83% of the time. Twenty-one participants were interviewed. Overall, online forms were preferred given perceived security, ease of use, and enabling provision of more accurate information. Conclusions: Use of online software is feasible, provides high quality information, and is preferred by most participants. A pen-and-paper format should be available for patients with this preference and in case of technical difficulties. [ABSTRACT FROM AUTHOR]

Background: Twins and late preterm (LPT) infants are at an increased risk of being breastfed to a lesser extent than term singletons. This study aimed to describe the initiation and duration of any and exclusive breastfeeding at the breast for mothers of LPT twins and term twins during the first 4 months and to explore the breastfeeding experiences of mothers of LPT twins. Methods: A sequential two-sample quantitative–qualitative explanatory mixed-methods design was used. The quantitative data were derived from a longitudinal cohort study in which 22 mothers of LPT twins and 41 mothers of term twins answered questionnaires at one and four months after birth (2015–2017). The qualitative data were obtained from semi-structured interviews with 14 mothers of LPT twins (2020–2021), based on results from the quantitative study and literature. Analysis included descriptive statistics of quantitative data and deductive content analysis of the qualitative data, followed by condensation and synthesis. Results: All mothers of LPT twins (100%) and most mothers of term twins (96%) initiated breastfeeding. There was no difference in any breastfeeding during the first week at home (98% versus 95%) and at 1 month (88% versus 85%). However, at 4 months, the difference was significant (44% versus 75%). The qualitative data highlighted that mothers of LPT twins experienced breastfeeding as complex and strenuous. Key factors influencing mothers' experiences and decisions were their infants' immature breastfeeding behaviors requiring them to express breast milk alongside breastfeeding, the burden of following task-oriented feeding regimes, and the lack of guidance from healthcare professionals. As a result, mothers started to question the worth of their breastfeeding efforts, leading to changes in breastfeeding management with diverse results. Support from fathers and grandparents positively influenced sustained breastfeeding. Conclusions: Mothers of LPT twins want to breastfeed, but they face many challenges in breastfeeding during the first month, leading to more LPT twins' mothers than term twins' mothers ceasing breastfeeding during the following months. To promote and safeguard breastfeeding in this vulnerable group, care must be differentiated from routine term infant services, and healthcare professionals need to receive proper education and training. [ABSTRACT FROM AUTHOR]

Objectives: Mothers of young children have been identified as a particularly vulnerable group during the COVID-19 pandemic. We aimed to explore how occupational, psychosocial and partnership-related factors were associated with their self-reported mental well-being during the first COVID-19 wave. Methods: Five hundred fifty participants of the BaBi cohort study (est. 2013, Bielefeld, North-Rhine Westphalia, Germany) were invited to complete an online survey and to take part in email interviews (April–May 2020). With survey data, we assessed self-reported mental well-being through validated instruments (eight-item Patient Health Questionnaire; short version of the Symptom Checklist) and ran linear regression models for occupational, psychosocial and partnership-related factors. We performed content analysis on the interviews' data to further understand the determinants of the women's mental well-being. Results: One hundred twenty-four women participated in the survey; of which 17 also participated in the interviews. A perceived lack of support in childcare was associated with higher levels of depressive symptoms, while having a higher internal locus of control was associated with lower levels. Psychological distress was higher in those reporting lack of emotional or childcare support. Interviews confirmed the interplay of potential stressors and highlighted the difficulties to reconcile different expectations of motherhood. Discussion: Occupational, psychosocial and partner-related factors can act (to varying degree) both as resources and stressors to the self-reported mental well-being of mothers of young children. These impacts took different forms and created opportunities or challenges, depending on specific life circumstances, such as work or family situations, relationships and own psychosocial resources. Although not representative, our study contributes to building the COVID-19 evidence base, delineating the mental health toll of the pandemic on mothers of young children and the factors that contribute to it. [ABSTRACT FROM AUTHOR]

Background: Rates of participation in HIV care, medication uptake, and viral suppression are improving among persons living with HIV (PLWH) in the United States. Yet, disparities among African American/Black and Latino PLWH are persistent, signaling the need for new conceptual approaches. To address gaps in services and research (e.g., insufficient attention to structural/systemic factors, inadequate harm reduction services and autonomy support) and improve behavioral interventions, we integrated critical race theory, harm reduction, and self-determination theory into a new conceptual model, then used the model to develop a set of six intervention components which were tested in a larger study. The present qualitative study explores participants' perspectives on the study's acceptability, feasibility, and impact, and the conceptual model's contribution to these experiences. Methods: Participants in the larger study were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City (N = 512). We randomly selected N = 46 for in-depth semi-structured interviews on their experiences with and perspectives on the study. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. Results: On average, participants were 49 years old (SD = 9) and had lived with HIV for 19 years (SD = 7). Most were male (78%) and African American/Black (76%). All had taken HIV medication previously. Challenging life contexts were the norm, including poverty, poor quality/unstable housing, trauma histories exacerbated by current trauma, health comorbidities, and substance use. Participants found the study highly acceptable. We organized results into four themes focused on participants' experiences of: 1) being understood as a whole person and in their structural/systemic context; 2) trustworthiness and trust; 3) opportunities for self-reflection; and 4) support of personal autonomy. The salience of nonjudgment was prominent in each theme. Themes reflected grounding in the conceptual model. Participants reported these characteristics were lacking in HIV care settings. Conclusions: The new conceptual model emphasizes the salience of systemic/structural and social factors that drive health behavior and the resultant interventions foster trust, self-reflection, engagement, and behavior change. The model has potential to enhance intervention acceptability, feasibility, and effectiveness with African American/Black and Latino PLWH. [ABSTRACT FROM AUTHOR]

Background: Patient participation in patient safety activities in care processes is a fundamental element of safer care. Patients play an important role in preventing patient safety incidents and improving health outcomes. Therefore, healthcare providers need to develop and provide educational materials and actionable tools for patient participation. Objectives: This study aimed to develop a mobile application for health consumers' participation and evaluate the effect of the mobile application on improving health consumers' participation in patient safety. Methods: A quasi‐experimental design was adopted. We developed a mobile application on the basis of a needs assessment, literature review, compilation of patient safety topics, and validity testing of the application. The target population included Korean adults aged between 30 and 65 years who had visited a medical institution more than once within the most recent 6 months. The intervention group received patient participation training by using the mobile application, Application for Patient Participation in Safety Enhancement, for 2 months. The primary outcome variables were patient safety knowledge, self‐efficacy of participation, willingness to participate and experience of patient participation in patient safety activities. End‐user satisfaction was assessed using a questionnaire. To assess participants' experiences with the intervention, qualitative data were collected through a focus group interview and open‐ended responses to an end‐user satisfaction survey. Results: The intervention group (n = 60) had significantly higher overall average scores than the control group (n = 37) with regard to patient safety knowledge (p <.001), self‐efficacy of participation (p =.001), willingness to participate (p =.010) and experience of participation (p =.038) in the post‐survey. The total mean end‐user satisfaction score was 3.56 ± 0.60. The participants expressed the realization that patients could play an important role in improving patient safety. Conclusions: This study demonstrated that educating health consumers through a mobile application with useful information improves patient participation in patient safety activities. Educational materials and patient participation tools could motivate health consumers' health‐related behaviours. Patient or Public Contribution: Patients were involved during the programme development and evaluation. [ABSTRACT FROM AUTHOR]

Breastfeeding mothers have had limited access to breastfeeding support throughout the COVID-19 pandemic. This study aims to investigate breastfeeding practices during the COVID-19 period and to determine the factors associated with supporting exclusive breastfeeding. A sequential explanatory mixed methods approach was adopted, including a quantitative method in the first phase and qualitative method in the second phase. Mothers whose babies were aged over 6 months to 24 months old from July to September 2021 in Pekanbaru City were selected as research subjects. Data analysis was performed with multivariate and deductive content analysis. Of 156 participants, 97 mothers (62.2%) exclusively breastfed their babies. Of those, mothers who delivered exclusive breastfeeding worked less than eight hours per day, were aged 17–25 and had low education. Though by using exclusive breastfeeding practice as a reference, associated supports, including emotional, instrumental, appraisal and information regarding exclusive breastfeeding practice were insignificant; however, mothers who practice exclusive breastfeeding had higher information support. During the COVID-19 pandemic period, the informational support factor was found to be important to achieve the successful exclusive breastfeeding practice. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is estimated to impact one‐in‐three children with cerebral palsy (CP). Psychological interventions including behavioral and cognitive strategies play a key role in chronic pain management, but there is a paucity of research exploring their use in children with CP. Aim: To investigate the acceptability and feasibility of biofeedback assisted relaxation training (BART) for chronic pain management in children with CP using a mixed‐methods study design. Methods: Biofeedback assisted relaxation training was delivered via BrightHearts, an iOS application. Inclusion criteria were as follows: CP; self‐reported chronic pain; age 9‐18 years; and fluent English speaker. Children used BrightHearts for ten minutes daily, over four weeks. Qualitative post‐intervention interviews were undertaken (child, parent) and quantitative pre‐post measures (child) were gathered including pain intensity (numerical rating scale), and anxiety intensity (numerical rating scale). Content analysis was conducted for qualitative data. Descriptive statistics and exploratory analyses were performed for quantitative data. Results: Ten children participated (n = 3 male, mean age = 13.1 years SD = 2.5 years, GMFCS level I = 4, II = 2, III = 3, IV = 1). Predominant movement disorder was spasticity (n = 7) and dyskinesia, mainly dystonia (n = 3). Content analysis suggested an overarching theme "BrightHearts is a good thing to put in my toolbox" providing an overall representation of participants' experiences. For many, BrightHearts was a valuable supplement to children's pain management strategies: "The source of the pain is still there, but the actual effect of the pain isn't so relevant." Four sub‐themes were identified: "Managing my pain;" "Managing my anxiety and stress," "Helping me do what I need to do;" and "Fitting it into my life." Some participants reported improvements in their anxiety management, and others described benefits in sleep and school following improved pain/anxiety management. A range of practical and personal factors within this heterogeneous group presented barriers to using BrightHearts including limited time, attention, and boredom. Seven‐out‐of‐eight children would recommend BrightHearts to others with chronic pain and six‐out‐of‐eight noticed a difference in their pain since using BrightHearts (n = 2 missing data). Non‐significant reductions in pain or anxiety intensity scores were found following the intervention. Conclusion: This pilot suggests BrightHearts is an acceptable and feasible intervention for chronic pain management in children with CP and may be useful for some children as part of a multimodal approach. [ABSTRACT FROM AUTHOR]

Background: Liver transplantation is a life-saving intervention for many patients with end-stage liver disease. In the past, evaluation of successful liver transplantation was based on patients' survival rate. However, in recent years this evaluation has been based on patients' quality of life. Various instruments have been developed to evaluate patients' quality of life. Nonetheless, scholars still believe that it is crucial to develop a standardized and disease specific instrument for evaluating the quality of life in liver transplant recipients. Objectives: The aim of this paper was to describe the development and psychometric testing process of a quality of life instrument specific to liver transplant recipients. Materials and Methods: Initial items of this instrument were extracted from a conventional content analysis study, and then were completed with findings of related international literature. The face validity was assessed by interviewing with four liver transplant recipients, and the content validity was evaluated by eleven experts in the field of transplantation. The construct validity was achieved by involving 250 liver transplant recipients through exploratory factor analysis method, and reliability was calculated by Cronbach's alpha. Results: Three main factors with 40 items were extracted from the exploratory factor analysis: Health Satisfaction, Concerns, and Complications. Reliability of the instrument was confirmed (alpha = 0.922). Conclusions: Given the special considerations regarding liver transplant recipients, this questionnaire is more accurate in evaluating the success of liver transplantation. [ABSTRACT FROM AUTHOR]

Introduction: Good preconception and interconception health are fundamental to optimizing women’s health and reducing risk factors for adverse maternal–infant outcomes. Although rural women in the United States tend to experience health disparities, no published qualitative studies have focused on their preconception/interconception health. The purpose of this study was to determine what rural, Midwestern women perceive to be their most pressing health needs and effective ways to provide outreach and education regarding preconception/interconception health and care. Methods: Non-pregnant, reproductive-age women in Hardin County, Ohio, regardless of parity, were recruited through convenience sampling. Semi-structured interviews with four domains (beliefs and behaviors; perceived needs; knowledge and information sources; barriers to care) were conducted in May–June 2021 until saturation was reached. Qualitative methods were used to analyze data and determine themes. Binomial tests were used to compare selected demographic characteristics of participants to the county’s reproductive-age residential female population. Results: Nineteen women aged 20–44 years were individually interviewed. Comparing race/ethnicity, education, and insurance status, participants appeared to be representative of the county population. Four themes were identified: (1) needs regarding healthcare and other resources; (2) lack of preconception/interconception care and perceived unimportance due to intergenerational knowledge transfer and paucity of healthcare providers; (3) difference in understanding of the term “women’s health” and low health literacy; and (4) suggested interventions including education and outreach. Conclusion: Interviews with rural Midwestern women revealed needs regarding preconception/interconception health and care and potential ways to raise awareness. These findings can inform strategies to improve rural women’s health and birth outcomes. [ABSTRACT FROM AUTHOR]

Background: With increasing interest in direct access to physiotherapy, it is important to consider the physiotherapists (PTs) ability to make correct management decisions, because identification of differential diagnostic pathologies and timely referral for specialist care is vital for patient safety. The aims of the study were to investigate PTs ability to make correct management decisions in patients presenting with musculoskeletal conditions and to identify explanatory factors associated with this ability. Furthermore, we wanted to explore the PTs views on the identified factors. Methods: The study was a mixed methods study with an explanatory sequential design consisting of a questionnaire survey and semi-structured interviews. The questionnaire comprised 12 clinical vignettes describing patient scenarios for musculoskeletal conditions, non-critical medical conditions and critical medical conditions. Based on this, the PTs indicated whether the patient should be managed by the PT or were in need of medical referral. Associations between correct decisions and explanatory variables was analyzed by mixed- effects logistic regression. Interviews were performed with nine PTs to explore their reactions to the results. A directed content analysis was performed. Results: A total of 195 PTs participated in the questionnaire survey and 9 PTs were interviewed. Overall, PTs were more likely to make correct management decisions in the musculoskeletal conditions category, whereas wrong decisions were more often chosen for underlying medical conditions categories. Positive associations between correct management decision in the critical medical category were found for experience: odds ratio (OR) 2.73 (1.33;5.57) and passed quality audit OR 2.90 (1.50;5.58). In the interviews, PTs expressed concerns about the differential diagnostic abilities. They all noted, that experience is immensely important in the clinical reasoning process because the ability to recognise diagnostic patterns evolves over time. Furthermore, the quality audit seems to address and systematize the clinical reasoning process and workflow within the clinics. Conclusion: The lack of ability to make correct management decision in critical medical categories and the uncertainties expressed by PT's should raise concern, as direct access to physiotherapy is already well-established and the results indicate that patient safety could be at risk. The findings that experience and passed quality audit was associated with correct management decisions highlights the need for ongoing awareness and education into differential diagnostics. [ABSTRACT FROM AUTHOR]

Although general practitioners (GPs) are often the first contact for patients' sexual issues, little is known about how German GPs approach, diagnose, and treat sexual problems and disorders. Therefore, the present qualitative study explores approaches and management of sexual health issues used by GPs. The sample included 16 GPs from Kiel and surroundings and Sachsen-Anhalt. The in-depth, semi-structured interviews were coded according to the qualitative content analysis by Mayring using MAXQDA. The results revealed 5 main themes, 2 of which are explored in more detail in relation to the study objective (2 and 4): (1) sexual issues that arise in general practice, (2) addressing sexuality, (3) influencing factors in doctor-patient communication about sexuality, (4) diagnosing and treating sexual dysfunctions, and (5) changes in the approach to sexuality over time. Most GPs did not routinely ask their patients about sexual problems. Common barriers included lack of time, suspected embarrassment on both sides, and fear of offending patients. Almost all GPs tended to diagnose sexual problems individually adapted to patients' issues, not following a standardized approach. Medication was offered as the main treatment for sexual problems. For complex disorders, most GPs lack sexual medicine knowledge, and they requested a better range of training courses in sexual medicine. [ABSTRACT FROM AUTHOR]

As a professional value, the love of the profession can significantly affect nurses' professional practice, behaviors and commitment. Many different factors can affect the love of the profession. The exploration of nurses' experiences of these factors can provide valuable data for development of the love of the profession. The aim of this study was to explore nurses' perceptions of the factors contributing to the development of the love of the profession. This qualitative study was conducted in 2020–2021 using the conventional content analysis approach. The participants were thirteen nurses with different organizational positions purposively recruited from different settings in Iran. The data were collected via semi-structured interviews, and were analyzed via the conventional content analysis approach proposed by Graneheim and Lundman. The factors contributing to the development of the love of the profession were categorized into four main categories, namely the public perception of the profession (with three subcategories), educational variables (with two subcategories), the characteristics of the profession (with four subcategories), and nurses' self-evaluation (with three subcategories). The love of the profession is affected by a wide range of personal, educational, professional and social factors. The manipulation of these factors would help to develop nurses' and nursing students' love of the profession, and encourage people to choose nursing as a career. [ABSTRACT FROM AUTHOR]

Copyright of Rev Rene is the property of Rev Rene and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)