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Because people living with environmental sensitivities are poorly acknowledged in our society, we still know very little about their experiences navigating in the health care system, especially with respect to dental services. Our objective, therefore, was to describe their dental care pathway and better understand their experiences accessing oral health services. A qualitative descriptive study was conducted in partnership with organizations supporting people with environmental sensitivities. Through a criterion sampling technique, 12 people living with environmental sensitivities in Quebec (Canada) were invited to participate in individual semi-structured interviews. These interviews lasted around 90 min and were transcribed to be thematically analysed. Participants faced major barriers accessing dental services and thus lived for long periods of time with unmet dental needs. Their dental care pathways were often delayed or even interrupted for several reasons. First because they were exposed to pollutants upon leaving their house, which rendered their trip to the dentist perilous. Second because dentists lacked knowledge about environmental sensitivities and seemed reluctant to accommodate them. We invite governments, dental professionals, and researchers to develop policies and clinical approaches for improving people living with environmental sensitivities' quality of life and access to dental services. Although environmental sensitivities are recognized as disability in several countries such as Sweden and Germany, people with these conditions face major barriers to access healthcare services. Dental professionals, for instance, are reluctant to acknowledge environmental sensitivities as a disability and seldom accommodate sufferers' special needs. We invite dentists to foster holistic and person-centered approaches and be receptive to the health conditions and needs of people with environmental sensitivities. Dentists could address oral health needs of people with environmental sensitivities by doing home-visits with portable dental equipment as this removes barriers related to their exposure to pollutants. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder (ASD) affects one in 66 children in Canada, and its symptoms may be particularly challenging for parents from a Chinese background. Further, when working with Chinese families, Western-educated service providers may experience difficulty in applying culturally relevant and family-centered care. This study examined the experiences of one Chinese-Canadian family as they receive intervention services for their two children with ASD. This pilot, single-case design, qualitative case study included semi-structured interviews with the parents, grandparents, as well as three service providers' views. Three major themes emerged from the data in the form of tensions: (1) within the family members; (2) within the therapeutic relationships, and (3) in addressing culture in therapy. Results suggested that although the family identified key cultural differences, service providers did not sufficiently address these within the therapeutic relationship, and the need for culturally-relevant and family-centered care was not fulfilled. Chinese-Canadian parents for children with autism spectrum disorder adopt both Chinese and Western values that fit best for their circumstances. Service providers and family members can have conflicting priorities, making family-centered care, culturally-relevant care challenging. Culture plays an important role in family expectations, and should be incorporated with more intention in the rehabilitation process. [ABSTRACT FROM AUTHOR]

This study aims to investigate whether the treatment effects, in terms of goal attainment, transfer effects and impact on executive functions, of an intervention in children with cerebral palsy or spina bifida using the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach are maintained over time, from immediately after the intervention to three months afterwards. A three-month follow-up study, from an intervention using CO-OP. Thirty-four children (7–16 years) each identified four goals (one untrained to examine transfer) and participated in an eleven-session intervention. Assessments were performed at baseline, immediately after the intervention and at a three-month follow-up using the Canadian Occupational Performance Measure and the Performance Quality Rating Scale. Executive function and self-rated competence were assessed at the same timepoints. Statistically significant and clinically relevant improvements in goal achievement were demonstrated for both trained and untrained goals after the intervention and were maintained at follow-up. The clinically relevant improvement in untrained goals continued to increase until follow-up. Self-rated competence increased after the intervention and was maintained at follow-up. The CO-OP intervention was effective in achieving and maintaining the children's own goals over time. The transfer effect was confirmed by higher goal attainment for the untrained goals. The children's self-defined goals were achieved after the Cognitive Orientation to daily Occupational Performance (CO-OP) intervention and remained so at the three-month follow-up. The CO-OP Approach is useful for children with cerebral palsy or spina bifida. A transfer effect was demonstrated for untrained goals by both subjective and objective assessments. Using children's self-defined goals is effective. [ABSTRACT FROM AUTHOR]

Background and Objectives Paradoxical lucidity is defined as an instance of unexpected lucid behavior in a person who is assumed to be noncommunicative due to a progressive and pathophysiologic dementing process. To inform studies of the prevalence, characteristics, and impact of these behaviors, this interview study examined caregivers' experiences of witnessing paradoxical lucidity. Research Design and Methods Participants were family caregivers of persons living with advanced dementia caused by a neurodegenerative disease producing significant impairments in communication. Semistructured interviews elicited the caregivers' experiences of plausible lucid episodes. Data analysis used a thematic analysis approach. Results Most caregivers reported at least 1 episode of lucidity. Episodes were typically brief. Most involved utterances, but nonverbal behaviors were also common. The mental capacities associated with these behaviors included recognition, awareness of surroundings, recognizing others' emotions, and goal-directed behavior. Most caregivers' reactions were positive. Episodes did not lead to changes in major medical decisions but instead to efforts to either modify or reinforce daily caregiving efforts. Discussion and Implications Episodes of lucidity were common, a finding seen in other studies. If prevalence studies confirm this, the qualifier "paradoxical" should be eliminated. The caregivers' familiarity with the person living with dementia allowed them to attribute meaning to subtle behaviors that might not otherwise be detected or considered lucid. Clinicians who care for persons with advanced-stage dementia should routinely ask caregivers about episodes of lucid communication and their emotional reactions. [ABSTRACT FROM AUTHOR]

Coaching in medical education facilitates learners' growth and development through feedback, goal-setting and support. This study explored how coaching relationships evolve throughout medical school and the impact of longitudinal coaching relationships on medical students' approach to feedback and goal setting in the clinical years. In this qualitative study using a constructivist paradigm, authors purposively sampled 15 senior medical students at University of California, San Francisco, to participate in individual semi-structured interviews (October–November 2021). The authors used an inductive approach to thematic analysis. The authors identified four themes: First, the student-coach relationship deepened over the course of medical school. Second, students identified factors that sustained and strengthened the student-coach relationship over time: a strong foundation to the relationship, the non-evaluative nature of the relationship, coach supportiveness and responsiveness, and coach knowledge of the institutional landscape. Third, coaches provided individualized advice, assessed trajectory, and guided feedback interpretation. Lastly, students applied skills of soliciting and responding to feedback and creating learning goals, originally learned through coaching experience. Coaching relationships, grounded in trust, evolve to meet students' changing needs as they grow into physicians. Students apply feedback and goal-setting skills learned with the coach in clinical settings with other supervisors. [ABSTRACT FROM AUTHOR]

Objective: Statin treatment compliance and achieving target levels differ between populations. This study aimed to determine the status of achieving the lipid targets and evaluate patients' compliance to statin treatment in type 2 diabetic patients with dyslipidemia. Method: This cross-sectional study included type 2 diabetes mellitus (T2DM) patients with dyslipidemia who applied for treatment at our polyclinics. Statin compliance was evaluated using the Modified Morisky Adherence Scale (MMAS-8) through a face-to-face interview. Cardiovascular (CV) risk was calculated according to the 2019 ESC (European Society of Cardiology) criteria by evaluating the patients' individual risk factors. LDL targets were determined according to risk categories with the same criteria. Results: A total of 504 patients (F/M: 274/230) were included. The serum LDL levels were 102.6 ± 39.2 mg/dL. Of the patients, 56.1% were under statin treatment. CV risk was very high in 73.6% of patients. LDL levels were significantly lower in users than in non-users (91.2 ± 26.0, 117.3 ± 38.4, p < 0.0001). The rate of reaching the LDL target was 14.8% in statin users. Treatment compliance was low for 40.6% of statin users. Discontinuation of statin treatment due to side effects was 15.7% (n = 14). N = 49 patients willingly discontinued statin treatment. They reported that 40.8% considered the treatment unnecessary. Conclusion: It was observed that 56.1% of type 2 diabetic patients were on statin therapy. A small percentage of them 14.8% (n = 42) reached the LDL target. Statin non-compliance and a lack of awareness of the statin treatment are the main reasons for high LDL levels in type 2 diabetic patients. [ABSTRACT FROM AUTHOR]

This qualitative study explores the opportunities and challenges of collaboration experienced by social workers and police officers when dealing with cases of intimate partner violence (IPV) and stalking. The study aims to examine their collaborative approaches in risk assessment and risk management by identifying the structures, supports, and foundations crucial for effective collaboration. Our data, collected from twelve interviews and one focus group interview with social workers and police officers, reveals that collaboration was facilitated by assigning specific roles to involved parties, proximity, structure and professionalism. These key factors emerged as crucial and contributing to the effectiveness of the collaborative efforts. Practitioners should consider integrating these key elements into their practices to enhance and improve collaboration when addressing cases of IPV and stalking. The study underscores the need for a well-defined framework and support structures to optimise the collaborative response to such complex and sensitive issues. [ABSTRACT FROM AUTHOR]

Differential attainment (DA) in post graduate medical training is a recognised challenge and refers to unexplained variation across groups when split by several protected characteristics. The Royal College of Radiology is committed to fostering diversity, inclusivity, and equality with the goal of narrowing existing gaps and improving training outcomes. This was a mixed methods study aiming to understand the causes of DA with view to helping the RCR develop strategies to address this. A cross-sectional survey was completed by 140 clinical oncology trainees in September 2022. Trainees and trainers (17 and 6 respectively) from across England, Scotland, Wales and Northern Ireland, took part in focus group and interviews from August to December 2022. Quantitative and qualitative data merged and interpreted. Results showed international medical graduates and trainees from ethnic minority backgrounds were more likely to encounter challenges. The qualitative findings were used to identify three themes through which these problems could be framed. The trainee as a "space invader," the hidden curriculum of clinical oncology training and the process of navigating and tacking the training journey. Differential attainment is the product of a complex interplay between the trainee, trainer, and the training environment. Therefore, interventions must be tailored to different people and contexts. At a national level, the RCR can adopt general policies to promote this such as mentorship programmes, protected time for supervision and cultural competency training. Efficacy of proposed interventions for trial and their impact on DA should be evaluated to drive evidence-based changes. • The GMC and Royal Colleges are committed to bridging existing gaps and addressing differential attainment. • A mixed-method research approach to provide a holistic understanding of differential attainment in Clinical Oncology. • Analysis of exclusionary mechanisms identified three main themes: space invaders, hidden curriculum and navigating. [ABSTRACT FROM AUTHOR]

Background: Chronic disease (CD) accounts for more than half of the overall global disease burden and physical activity (PA) is an established evidence-based strategy for the prevention and management of CD. Global policy emphasises the value of embedding PA into primary healthcare, highlighting the positive effects on PA behaviour. However, there is limited implementation of PA protocols in primary care, and research is needed to guide its integration into routine practice. The voice of the patient is underrepresented in the literature, resulting in the absence of critical insights into determinants of PA promotion in primary care. The purpose of the research was to identify the perspectives of people at risk of or living with CD on the determinants of PA promotion in primary care and to map these determinants across the six COM-B constructs. Methods: Semi-structured interviews (n = 22), guided by the COM-B model were conducted with people aged 35–60 years, at risk of or living with CD and not meeting the PA guidelines. A hybrid analytic approach of thematic inductive and deductive analysis was applied to the participant transcripts guided by a COM-B informed coding framework. Results: In total, 37 determinants across constructs related to capability, opportunity and motivation were prominent, examples include; physical capability constraints, the conflation of exercise with weight management, credibility of the health services in PA advice, communication styles in PA promotion, expectations of tailored support for PA, social support, accessibility, and integration of PA into routine habits. Conclusion: Exploring the determinants of PA promotion through the lens of the COM-B model facilitated a systematic approach to understanding the primary care user perspective of the healthcare professional (HCP) broaching the topic of PA. Findings emphasise the value of HCPs being supported to broach the issue of PA in a therapeutic and patient-centred manner using diverse and flexible approaches, while highlighting the importance of tailored, accessible PA opportunities that build self-efficacy and foster social support. The research provides valuable learnings to support PA promotion and the development of strategies in primary care through encompassing the perspective of those living with or at risk of CD. [ABSTRACT FROM AUTHOR]

Purpose. Breast cancer is considered a huge health problem among women all over the world due to its increased mortality rate. Breast cancer deaths are decreased by 28–34% due to improvement in treatment and early detection. In order to detect breast cancer early and provide the best possible therapy, knowledge and awareness are essential. So, this study aimed to assess risk of breast cancer among nurses, the knowledge and practices of breast self-examination (BSE) and determine its barriers, and implement an educational program for them. Design. A quasiexperimental research design was used. Methods. This study was conducted at two university hospitals (main university hospital and woman's health hospital). A purposive sample of 280 nurses with age more than thirty-five years were included in the study using three tools, namely, structure interview questionnaire, breast cancer risk assessment tool, and a structured breast cancer knowledge and practice questionnaire. Nurses' knowledge and practices regarding breast cancer and BSE were first assessed and then they were provided with two educational courses covering theoretical and practical information. One month after the program ended, the nurses' knowledge and practices were assessed again. Results. About 3.2% of the participants have five years high risk of developing breast cancer according the risk assessment tool, the main barriers of do not do BSE did not find any symptoms and scared from finding any abnormality. There was a significant increase in knowledge and practice of breast self-examination posteducation compared to pre-education (73.2 and 98.2%, respectively). Also, there was a statistically significant difference between pre- and postprogram with a p value of 0.0001. Conclusion. This study concluded that 3.2% of the nurses with high risk of developing breast cancer needed a follow-up; more than half of them do not perform breast self-examination because they think that do not have any symptoms in the breast and the educational program with a significant effect on knowledge and practices of nurses. So, the researchers recommend the nurses need for an empowerment program and support by providing assistance in places of work as done free clinical examination and mammography by female specialist for privacy. [ABSTRACT FROM AUTHOR]

Although there is a growing literature on the use of telepresence robots in institutional dementia care settings, limited research focused on the perspectives of frontline staff members who deliver dementia care. Our objective was to understand staff perspectives on using telepresence robots to support residents with dementia and their families. Guided by the Consolidated Framework for Implementation Research, we conducted four focus groups and 11 semi-structured interviews across four long-term care (LTC) homes and one hospital in Canada. We included 22 interdisciplinary staff members (e.g., registered nurses, social workers, occupational therapists, recreational therapists) to understand their experiences with telepresence robots. Thematic analysis identified three key themes: 1) Staff Training and Support; 2) Robot Features; 3) Environmental dynamics for Implementation. Our results underscore the imperative of structural support at micro-, meso- and macro-levels for staff in dementia care settings to effectively implement technology. This study contributes to future research and practice by elucidating factors facilitating staff involvement in technology research, integrating staff voices into technology implementation planning, and devising strategies to provide structural support to staff, care teams, and care homes. [ABSTRACT FROM AUTHOR]

Youths with physical disabilities experience various obstacles in their transition to adulthood which can contribute to poorer health and socioeconomic outcomes in later life, compared to their non-disabled peers. Transitional care offers these youths the necessary support to overcome such obstacles. The objective of this study was to explore participants' experiential learning in the development of life skills within the transitional care program TranXition, and their perceived contribution of the program to their goal attainment. Data were collected using photo-elicitation. Five participants were recruited from the TranXition program to audio-visually record (photographs or videos) their meaningful experiences in the program and to reflect on them during interviews. Participants felt the TranXition program helped them build their self-awareness and self-efficacy, and to feel more confident and skilled, whether at home, in school or in the community. Moreover, they appreciated the program's group cohesion which facilitated learning life skills from others in order to achieve their goals. Finally, results suggest that group interventions, while important, may need to be complemented by individual consultations. Rehabilitation programs in real-world settings, such as the TranXition program, may be a promising adjunct to traditional transitional care for youths with physical disabilities. [ABSTRACT FROM AUTHOR]

We examine the use of a custom iPad application, the Rehab Portal, to provide clients in an inpatient brain injury rehabilitation service with access to short videos where clinicians—or the clients themselves—discuss their current rehabilitation goals. We developed an initial version of the Rehab Portal app based on our previous co-design with service users, their families, and clinicians. This was examined in a field trial with a series of six clients over the course of their stays in inpatient rehabilitation, collecting quantitative data on clinician and client engagement with the Rehab Portal, alongside a thematic analysis of qualitative interviews with clients and clinicians at the point of discharge. Engagement with the platform was high for two clients while it was limited with four more. In our thematic analysis we discuss how introduction of the Rehab Portal disrupted practice, changing how things are done, causing deviation from usual routines, adding burden, and threatening professional integrity. At the same time, where it worked well it led to a repositioning of goal planning away from being clinician directed and towards an ongoing, dynamic collaboration between clinicians, clients and their families. Finally, in some cases we identified a reverting to the status quo, with client demotivation having an unexpected impact on clinician behaviour leading to the process being abandoned. The current findings do not provide wholesale support for this approach, yet we continue to feel that approaches that support clinician-client communication using asynchronous video may offer considerable future value and are worthy of further investigation. The use of a novel technique to communicate rehabilitation goals via video disrupted practice, changed how things are done, caused deviation from usual routines, added burden, and threatened professional integrity for clinicians. Where it worked well it led to a repositioning of goal planning away from being clinician-directed and towards an ongoing, dynamic collaboration between clinicians, clients and their families. Approaches that support clinician-client communication using asynchronous video may offer considerable future value and are worthy of further investigation. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of environment-based intervention on participation outcomes and parent efficacy in autistic children. Twenty-one autistic children 6–10 years old and their parents were randomized to environment-based intervention (n = 11) or usual care (n = 10). The environment-based intervention targets individualized participation goals in leisure and community activities through changing environment and activity demands. The study outcomes were Canadian Occupational Performance Measure (COPM), Goal attainment scaling (GAS), and Parent Empowerment and Efficacy Measure (PEEM). Assessments included baseline, 12 weeks (post-test), and 24 weeks (follow-up). Mixed ANOVAs were used to examine within-group and between-group effects in outcome variables. The COPM performance and satisfaction scores and GAS T-scores increased after environment-based intervention from baseline to 12 weeks and 24 weeks (p < 0.001) but did not significantly differ from usual care. The medium to large effect sizes of COPM performance and GAS T-scores favored the environment-based intervention. For the PEEM scores, no significant differences were found. Environment-based intervention may support school-age autistic children to participate in self-chosen activities over time. The intervention effects on participation goals and parent efficacy, however, were inconclusive and need further research. Environmental barriers are important attributes to participation restriction in autistic children. Interventions focusing on modifying the task and environment is viable in supporting the participation of autistic children. The environment-based intervention appears to improve the participation goals in leisure and community-based activities over time. The environment-focused strategies may include providing social support, enabling access to a sensory-friendly environment, finding inclusive programs, adapting task demands, and managing routines. [ABSTRACT FROM AUTHOR]

Achieving cooperation between individuals is challenging and often driven by self-beneficial motives. On the other hand, people also seem capable of subordinating their personal interests and of engaging in cooperation for motives other than their own, i.e. out of altruistic impulses. One context in which both motivational facets can be observed is multiplayer online games. However, there is a lack of knowledge about how cooperation based on altruism and egoism develops in games, which also prevents us from transferring this knowledge as a form of gamification. In this study, we explore which game features are accountable for altruistic and egoistic sentiment, and how these distinctive demeanours induce cooperation in games, with the intent to also derive implications for gamification. We employ we-intention and I-intention theory and conduct a survey among players of the game Ingress (N = 206). Our findings imply that (1) cooperative game design can give rise to within-group altruism in form of enjoyment in helping others and cooperative goals, (2) altruism can lead to the formation of we-intentions, and (3) individualistic game features invoke I-intentions and self-centered motivations in games in the form of recognition-seeking. Theoretical and practical implications are provided for cooperative game and gamification design. [ABSTRACT FROM AUTHOR]

This article seeks to fill the research gap on the psychosocial and integration needs of unaccompanied children and the challenges they encounter to reach autonomy and social integration. To address this issue, the study utilized a qualitative research survey interviewing 18 field professionals, which indicated that the key challenges include insufficient preparation, institutionalization, uncertainty about the future, asylum procedures, and social exclusion, while proposing the implementation of an integration plan focusing on education, vocational training, and contact with the local community. This article aims to offer a better understanding of children's needs and how practitioners could protect children more effectively. [ABSTRACT FROM AUTHOR]

Home automation technology comprising of Internet of Things and Smart gadgets is a rapidly growing industry that is projected to have a major scope for ageing-in-place and caregiving. This study examined the feasibility and cost-benefits of a personalized home automation intervention for care of individuals with Alzheimer's disease and related dementia (ADRD) with emphasis on their safety and independence, and reduction of care burden. A mixed method intervention study was conducted with five dyads each comprising of a caregiver and care recipient with ADRD. Each dyad received personalized home automation intervention with individualized goals centred on home safety, activity engagement, and caregiver-recipient connectivity. The goals were created and monitored using goal attainment scaling (GAS). The dyads were followed up after three months with a home visit and interview. Goal attainment scoring and thematic analysis of the interviews were conducted to examine the findings from the study. All dyads indicated positive goal attainment between pre and post intervention. Goals that were met were complimented by the categories of peace of mind, self-efficacy, and care recipient engagement, while unmet goals as well as complexities with the technology were elucidated under challenges. Overarching and conceptually linked themes from the study were unfamiliarity, value, and timing. Home automation technology has the potential to be adapted to promote independence and safety of individuals with ADRD while relieving care burden. Nonetheless, we propose an early intervention framework to overcome identified challenges and optimize the technology's usability and sustainability. Home automation involving Internet of Things and Smart gadgets has gained rapid popularity owing to the comfort and connectivity they provide to mainstream consumers. The technology has an emerging significance to ageing-in-place and care of individuals with Alzheimer's Disease and Related Dementia (ADRD) as it can be adapted and implemented to enhance home safety and activity engagement of the care recipients while also strengthening their connectivity with the caregivers. Unfamiliarity with the technology compounded by the progression of ADRD can, however, be detrimental to its adoption. Individualized focus and early integration of the technology for caregiver-care recipient dyads can mitigate these challenges and optimize its usability and long-term value in relation to ageing-in-place and caregiver wellbeing. [ABSTRACT FROM AUTHOR]

Religion and spirituality are powerful social forces in contemporary South Africa. Traditional Health Practitioners (THPs) are commonly consulted for both spiritual and medical ailments as a first line of care. Many studies have assessed African traditional health seeking behaviors but few have examined beliefs, practices, and behaviors of THPs themselves. This study sought to explore spiritual worldviews among South African THPs. Semi-structured in-depth interviews were conducted with 18 THPs in Johannesburg, South Africa between January and May, 2022. Interviews were transcribed and translated into English. Data were managed using NVivo 12 software and thematically analyzed. The majority of THPs interviewed indicated that initiation as a THP was almost always preceded by a sickness accompanied by dreams/visions that represented an "ancestral calling" to become a healer. Most THPs also trained as both sangomas—who healed according to traditional beliefs—and prophets—who healed according to Christian beliefs. This reflects a syncretic relationship between traditional African beliefs and Christianity. However, not all churches are accepting of traditional beliefs and subsequently these THPs are members only at non-Pentecostal AIC churches who blend both African and Christian practices. Similar to these forms of religious pluralism melding Christianity and traditional beliefs, many THPs also often practice medical pluralism, mixing Western treatments with traditional practices/medicines. THPs are able to adapt elements of Western and African beliefs into healing practices that span multiple religious and medical fields. Thus, collaborative and decentralized healthcare services may be highly acceptable among such a pluralistic community. [ABSTRACT FROM AUTHOR]

Background: Various professional groups are involved in the daily work of the central operating room with the aim of providing the best possible treatment for each individual using modern medical technology (sociotechnical system) in a cost-effective manner. Ensuring perioperative patient safety is of particular importance. At the same time, the efficient use of the central operating room is essential for the economic success of a hospital. Preoperative preparation is a complex process with many substeps that are often difficult to manage. Historically, the focus has been on retrospective learning from errors and incidents. More recent approaches take a systemic view. A central idea is to consider the mostly positive course of treatment and the adjustments to daily work that are currently required by the people involved (Safety-II). By taking greater account of how the many components of the system interact, processes can be better understood and specific measures derived. This strengthens the system's ability to adapt to changes and disturbances, thus ensuring that goals are achieved. The functional resonance analysis method (FRAM) is an internationally recognized method for modelling work as done compared to work as imagined. This paper presents the application of FRAM to preoperative preparation in a major regional hospital. Objective: Is FRAM suitable for improving process understanding in preoperative preparation? Material and methods: An interdisciplinary project team identified relevant functions of preoperative preparation through document analysis and walkthroughs. Based on this, more than 30 guided interviews were conducted with functionaries. The results were presented graphically and specific information, such as safety-related statements or reasons for the variability of functions, were also presented textually. In the next phase, statements were evaluated and compared with the target model and the job descriptions. Results: The FRAM revealed the process as a complex network of relationships. During the modelling process, a varying degree of centrality and variability of certain functions became apparent. From the observations, the project team selected those with high relevance for patient safety and for the efficiency of the overall process in order to prioritize starting points for deriving measures to increase resilience. These starting points relate either to single functions, such as surgical site marking or to multiple functions that are variable in their execution, such as delays due to nonsynchronized duty times. Conclusion: The FRAM conducted provides valuable new insights into the functioning of complex sociotechnical systems that go far beyond classical linear methods. The awareness of operational processes gained and the resulting dynamic view of interactions within the system enable specific measures to be derived that promote resilient behavior and reduce critical variability, thus contributing to increased patient safety and efficiency. [ABSTRACT FROM AUTHOR]

Purpose: Individuals with Disabilities Education Act guidelines for Individualized Education Programs (IEPs) require that students with disabilities should, to the fullest extent appropriate, receive services that promote academic achievement that are delivered within the general educational environment. In this clinical focus article, we will demonstrate how the inclusive practice service delivery model can assist speech-language pathologists (SLPs) with the development of educationally relevant IEPs. Method: Twelve SLPs who saw at least 30% of their students in a general education context shared their perspectives on inclusive practice. Their responses were transcribed and coded using deductive qualitative analysis. Their insights were combined with relevant literature to demonstrate how inclusive practice promotes educationally relevant IEPs. Results: We provided practical examples of using curriculum-based assessments and academic standards to gauge students' present levels of academic and functional performance. We next described how engaging with the school community and observing students in the educational environment assists with determining the effects of a student's disability on academic achievement and functional performance. We concluded by describing how an inclusive mindset helps to align services to meet students' needs. Conclusion: An inclusive framework can help create IEPs that promote students' access, engagement, and progress in age or grade-level curriculum, instruction, and environments by highlighting the impact of a disability on academic achievement and functional performance. [ABSTRACT FROM AUTHOR]

Background: Evidence to guide intrapartum care when an unborn baby has died is limited. Aims: To explore parents' experiences of care during labour of an antepartum stillbirth. Materials and Methods: Semi‐structured interviews with 18 bereaved parents from across Australia. Content analysis was conducted. Findings: Two broad themes were identified: 'explaining every step' and 'helping us feel like parents.' Sub‐themes under the first broad theme, 'explaining every step', were 'how and when information was given' and 'what happens next.' 'Like any other parent', 'feeling the pain' and 'everything is clouded' were sub‐themes of the second broad theme. These findings mapped to current Australian clinical practice guidelines for bereavement care around stillbirth and neonatal death, ie good communication, recognition of parenthood, shared decision making and effective support. Conclusions: This study on parents' experiences of labour with a fetal death in utero brings an important perspective to intrapartum care for this group. As far as we are aware, this study is the first to focus solely on this aspect of care. Our findings could be readily mapped to the four perinatal bereavement care goals. Parents wanted care providers to facilitate their choices, their sense of control, their autonomy and their agency. They wanted to feel that they had received the 'best' care available. [ABSTRACT FROM AUTHOR]

Adolescents go through a critical process of identity formation. This time in their life can be confusing and having a mentor to provide support and guidance has proven to be helpful and may increase self-esteem, self-efficacy, problem-solving and coping skills in youth. In this qualitative narrative study, at-promise youth from historically oppressed communities (ages 12 to 15) who participated in a 12-week therapeutic youth mentoring program, were interviewed utilizing a creative method called photo-elicitation. Photo-elicitation and semi-structured questions facilitated the narrative interview process allowing the youth to share experiences surrounding identity formation through photographs. Significant findings are presented in narrative form utilizing participant quotes to capture the emotion, language, and perspective of the participants' perceptions of self and identity. Implications for mental health professionals working with adolescents during a time of self-exploration and identity formation, and recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

Research on foster youth often focuses on risk, rather than adaptation, strengths, and assets. Some researchers have shifted the narrative by examining resiliency, but there is limited understanding on how to define and measure resilience specifically among current and former foster youth. This study begins with a meta-synthesis of the qualitative research (n = 31, 1990-2020) that discuss resilience with foster youth. We then examine data from twenty-two qualitative interviews regarding resilience with key stakeholders in child welfare. The findings inform an understanding of resiliency that is inclusive and culturally responsive to current and former foster youth. [ABSTRACT FROM AUTHOR]

Strategy training is a rehabilitation intervention that aims to enhance problem-solving skills with respect to daily activity–related challenges and has achieved favorable results in Western countries. This study explored the perspectives of individuals with acquired brain injury (ABI) in Taiwan who received strategy training. Semi-structured interviews with community-dwelling adults with ABI were conducted, and reflective memos made by research team members were recorded. Interviews and memos were analyzed through thematic analysis This study included 55 participants. The analysis of the participants' interview responses and memos yielded nine themes under three categories: 1) expectations regarding strategy training, 2) perceived benefits of strategy training, and 3) barriers affecting the process and outcomes of strategy training. All the participants endorsed strategy training through different gains. Most participants' expectations before the intervention were uncertain. Including family members into the strategy training is of key importance for a successfulness of their goals. The participants' experiences about strategy training were affected by various barriers (i.e., health and medical problems, the physical environment, and natural events). Clinicians and researchers should consider these expectations, benefits, and barriers when studying and implementing strategy training in non-Western contexts. Strategy training provides clients the opportunity to actively engage in their own goal setting and decision making. Strategy training increases the client's confidence in their ability to participate in the community, communicate, and perform daily living and physical activities. Therapists should consider the health conditions and physical environment of clients when helping them set goals and before facilitating their engagement in the community. Taiwanese family members play a crucial role in supporting acquired brain injury survivors in strategy training. [ABSTRACT FROM AUTHOR]

Background/Aims: In studies exploring the effectiveness of physical therapy treatment for painful musculoskeletal conditions, interventions appear to improve patient-reported outcomes. The interventions adopt different approaches, but there is a lack of agreement about which approach is most effective. Thus, research is needed to look at the potential influence of other variables present, such as common factors. Common factors are elements present across different treatments, which are necessary conditions for forming a therapeutic alliance and providing patient-centred care. While there is a positive relationship between common factors and patient outcomes noted in physical therapy, the mechanism through which these factors influence patient outcomes is less understood. The aim of this study was to explore participants' perceptions of the influence of common factors on physical therapy outcomes. Methods: Interviews were undertaken with seven individuals participating in physical therapy. The contextual model provided the framework to move beyond defining common factors to discussing how these elements contribute to the therapeutic changes seen in physical therapy. Results: Participants discussed how the therapeutic relationship is influenced by perceived trust and credibility, enhanced by goal setting, and individualised care. When these common factors are present, the potential for engaging in the work of physical therapy and enacting healthy behaviours and actions by patients were enhanced. Conclusions: By understanding common factors in physical therapy, a more complete view of the effects of interventions may be possible. Implications for practice: This study sheds light on the clinical impact of common factors in physical therapy, highlighting the pivotal role of therapeutic relationships built on trust, credibility, and individualized care. Recognizing and integrating these common factors into practice may enhance patient engagement and foster better therapeutic outcomes in musculoskeletal conditions. [ABSTRACT FROM AUTHOR]

To ascertain the feasibility and acceptability of delivering a job retention vocational rehabilitation intervention [MSVR] for people with multiple sclerosis (pwMS) in a community setting. Secondary objectives included determining whether MSVR was associated with changes in quality of life, fatigue, mood, cognition, workplace accommodations, work instability, work self-efficacy, and goal attainment. Single-centre mixed-methods feasibility case series. 15 pwMS and three employers received 8.36 (SD = 4.48) and 1.94 (SD = 0.38) hours of MSVR respectively over three months. The intervention predominantly addressed managing cognition, fatigue, and negotiating reasonable accommodations. Four healthcare professionals were recruited to clarify clinical information. The intervention was feasible to deliver, and there was a significant positive impact on goal attainment immediately following MSVR (t(14) = 7.44, p =.0001, d = 1.9), and at months 3 (t(13) = 4.81, p =.0001, d = 1.28), 6 (t(11) = 4.45, p =.001, d = 1.28), and 12 (t(9) = 5.15, p =.001, d = −2.56). There was no impact on quality of life, fatigue, mood, cognition, workplace accommodations, work instability, and work self-efficacy. In post-intervention interviews, participants reported that MSVR was acceptable. Four themes were derived regarding the context, employer engagement, empowerment through knowledge, and intervention components and attributes. It was feasible and acceptable to deliver MSVR. Participants better understood their MS, became more confident managing problems at work and attained their work-related goals. People with multiple sclerosis (MS) experience problems at work because of the interaction between symptoms and environmental factors (e.g., co-workers' attitudes). Vocational rehabilitation for people with MS and their employers should be tailored in terms of content and intensity. People with MS can be empowered at work by learning about MS and how their symptoms fluctuate over time. Understanding legal responsibilities and examples of accommodations at work can be beneficial for employers. [ABSTRACT FROM AUTHOR]

This paper examines how older adults interact with fitness trackers and how that interaction influences their physical activity. We carried out qualitative interviews with 22 individuals between the ages of 55 and 72 who had used fitness trackers as part of a six-week field experiment investigating the effects of feedback from fitness trackers and the social influence of their spouses. From their comments, we derived an explorative process model explaining the mechanisms and the four stages of effects arising from personalised feedback, namely, cognitive, affective, conative, and intuitive. These effects were grouped into internal and external dimensions. Three types of goal-related decisions determined whether interviewees moved from the internal responses of cognition and emotion to the external response of behaviour change. The findings from this study elucidate how real-time personalised feedback can motivate physical activity among older adults and highlight the goal-related factors that influence this effect. [ABSTRACT FROM AUTHOR]

Objective: To explore healthcare professionals' experiences of the development and delivery of Early Supported Discharge for people after stroke, including experiences of the COVID-19 pandemic. Design: Qualitative descriptive study using one-to-one semi-structured interviews. Data were analysed using reflexive thematic analysis. Setting: Nine Early Supported Discharge service sites in Ireland. Participants: Purposive sampling identified 16 healthcare professionals. Results: Five key themes were identified (1) Un-coordinated development of services, (2) Staff shortages limit the potential of Early Supported Discharge, (3) Limited utilisation of telerehabilitation post COVID-19 pandemic, (4) Families need information and support, and (5) Early Supported Discharge involves collaboration with people after stroke and their families. Conclusions: Findings highlight how Early Supported Discharge services adapted during the COVID-19 pandemic and how gaps in the service impacts on service delivery. Practice implications include the need to address staff recruitment and retention issues to prevent service shortages and ensure consistent access to psychology services. Early Supported Discharge services should continue to work closely with families and address their information and support needs. Future research on how telerehabilitation can optimally be deployed and the impact of therapy assistants in Early Supported Discharge is needed. [ABSTRACT FROM AUTHOR]

Acquired brain injury (ABI) is a leading cause of lifelong disability, but access to treatment in the chronic stages has significant barriers. Group-based, remotely delivered neurorehabilitation reduces costs, travel barriers, and infection risk; however, its feasibility for patients with ABI is not well-established. To investigate the feasibility of remotely group-based cognitive and mood therapies for persons with chronic ABI. Three hundred and eighty-eight adults with chronic ABI participated in group tele-neurorehabilitation modules comprising Cognitive Behavioral Therapy, Goal Management Training®, Relaxation and Mindfulness Skills Training, and/or a novel Concussion Education & Symptom Management program. Assessments comprised quantitative metrics, surveys, as well as qualitative semi-structured interviews in a subset of participants. High retention, adherence, and satisfaction were observed. Facilitators of treatment included accessibility, cost-effectiveness, and convenience. Adoption of technology was high, but other people's technological interruptions were a barrier. Self-reported benefits specific to group-based format included improved mood, stress management, coping, interpersonal relationships, cognitive functioning, and present-mindedness. The present study examined chronic ABI patients' perceptions of telerehabilitation. Patients found remotely delivered, group-based mood, and cognitive interventions feasible with easy technology adoption. Group format was considered a benefit. Recommendations are provided to inform design of remotely delivered ABI programs. Group-based mood and cognitive telerehabilitation is feasible for persons with chronic acquired brain injury, with high reported satisfaction. Screening for technical proficiency and providing ongoing technical support improves therapy adherence and retention. Integration of clinical care and research is feasible for delivering remote therapies to persons with brain injury. [ABSTRACT FROM AUTHOR]

To develop an online self-management program for individuals with recent lower limb loss, called Self-Management for Amputee Rehabilitation using Technology (SMART). We used the Intervention Mapping Framework as a blueprint and involved stakeholders throughout the process. A six-step study was conducted including (1) needs assessment using interviews, (2) translating needs to content, (3) applying the content into a prototype using theory-based methods, (4) a usability assessment using think-aloud cognitive testing, (5) planning for future adoption and implementation, and (6) assessing feasibility using mixed-methods to generate a plan to assess the effectiveness on health-outcomes in a randomized controlled trial. Following interviews with healthcare professionals (n = 31) and people with lower limb loss (n = 26), we determined the content of a prototype version. We then tested usability (n = 9) and feasibility (n = 12) by recruiting individuals with lower limb loss from different pools. We modified SMART to be assessed in a randomized controlled trial. SMART is a six-week online program with weekly contact of a peer mentor with lower limb loss who supported patients with goal-setting and action-planning. Intervention mapping facilitated the systematic development of SMART. SMART may improve health outcomes, but this would need to be confirmed in future studies. Learning new coping strategies and habits are essential after lower limb loss. Given the limitations and inaccessibility of educational and rehabilitation programs, online self-management education can assist patients in their recovery. Self-Management for Amputee Rehabilitation using Technology (SMART) has the potential to augment the self-management behaviors in individuals with lower limb loss through an improvement in access to educational content, skill-based videos, and support of a peer. [ABSTRACT FROM AUTHOR]

The article provides information on the key differences between interviewing for a faculty versus clinical specialist position based on personal experience and available literature. Topics discussed include way many institutions conducts screening interviews, how interviews for clinical specialist positions may be conducted, and differences between faculty interviews and clinical specialist interviews.

The United States Department of Agriculture expanded the Supplemental Nutrition Assistance Program (SNAP)-Ed program to all 50 states in 2004. In 2010, the Healthy, Hunger-Free Kids Act required that agencies implementing SNAP-Ed support policy, systems, and environmental (PSE) strategies, in addition to providing direct education (DE). Research has evaluated the impact of PSEs on health, but few studies have investigated the process of PSE implementation. The objective of this study was to identify facilitators and barriers to PSE implementation at SNAP-Ed partner sites from the perspectives of site contacts and SNAP-Ed implementers. This study employed a qualitative longitudinal design. The PSE planning and implementation process was observed over 1 year at SNAP-Ed partner sites. Semistructured interviews were conducted with site contacts and SNAP-Ed implementers throughout the year. Participants were SNAP-Ed implementers (n = 8) and site contacts (n = 18) from 18 partner sites where both PSE and direct education were occurring. SNAP-Ed implementers were debriefed once, and site contacts were interviewed three times over the course of the study. This study was conducted in a Southern US state with SNAP-Ed partner sites that intended to implement PSEs. The duration of data collection was October 2017 through September 2018. A thematic analysis of barriers and facilitators to PSE implementation across sites was conducted. The PSE implementation barriers were lack of site or implementer readiness or capacity; breakdowns in communication; and DE prioritized over PSE. Facilitators were effective communication; site capacity or readiness; and alignment between site and SNAP-Ed goals. Communication, capacity, and coordination between SNAP-Ed and partner sites were key components over the timeline of PSE planning and potential implementation. [ABSTRACT FROM AUTHOR]

Background: Codesigned interventions are becoming more common in health services and, in particular, in the design and development of mental health programmes and interventions. However, previous research has established that the transition from codesign to implementation can experience several challenges and that this transition process has received little research attention. Objective: The aim of this study was to explore the experience of staff members charged with the implementation of a codesigned intervention for young people and adolescents at risk of suicide. Setting and Participants: Five staff members involved in the implementation of the new codesigned programme took part in semi‐structured interviews. Method: The study involved qualitative evaluation of staff experiences during the implementation of a new child and youth suicide intervention. Interviews were analysed using reflexive thematic analysis. Results: The analysis identified four themes of 'disconnect', 'operational challenges, 'service user' and 'being authentic'. 'Disconnect' captures the difficulties of implementing a codesigned programme which leads to 'operational challenges' in meeting broader expectations while ensuring the feasibility of the programme. The third theme, 'service user', captures the realisation that the young people accessing the new service were different to those involved in the codesign process. The final theme, 'being authentic', highlights how staff needed to be responsive and flexible while remaining true to the principles proposed in the codesign. Discussion: This study yielded some valuable insights into the challenges around the implementation of a codesigned intervention, an under‐researched area. The findings suggest that adaption of the design may be necessary, if it is not informed by implementation constraints, making it necessary for the implementation team to be well‐briefed on the initial design and given plenty of time to make the necessary adjustments in a coproduction process. Limitations for the generalisation of the results include a small sample of staff and particular challenges that may be unique to this study. Conclusion: The present study highlights that for health services undertaking codesign approaches, appropriate time and resources need to be considered for the implementation phase of an initiative, to ensure that there is effective translation from design to implementation and that new codesigned services can be effective within operational constraints. Patient and Public Contribution: The authors would like to thank and acknowledge the young people with a lived‐experience and their carers who participated in the codesign process and research evaluation component of this study. We also wish to thank the clinical staff, peer workers and family peer workers who participated in the evaluation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study examined how frontline nurse managers (FLNMs) perceive and experience formal and informal social support and how personal factors and social support relate to their transformational leadership (TL) behaviors, BACKGROUND: Ineffective leadership by FLNMs is associated with costly outcomes. Evidence suggests that leadership development is a function of personal and social factors; however, a better understanding of this process is needed. METHODS: A convergent mixed-methods design was used. The quantitative strand included a cross-sectional survey in a sample of FLNMs. The qualitative strand used a semistructured interview and a descriptive qualitative approach with a subset of this sample. RESULTS: Formal and informal social support is positively related to the TL behaviors of FLNMs as evidenced by the convergent data. The influence of family members in the work-related decisions of FLNMs has been underreported in the literature and is an area for consideration in supporting retention and desired leadership behaviors. CONCLUSION: The findings of this study imply a need for organizations to establish systems that endorse the growth of FLNMS, create opportunities for career advancement, and integrate members of the FLNMs' personal support systems into recognition initiatives. [ABSTRACT FROM AUTHOR]

Mortality salience refers to a state of conscious awareness of death and the inevitable conclusion of life, associated with psychological terror. The COVID-19 pandemic generated increased awareness of illness and death, and effectuated changes in death cognitions and people's experiences around psychological or sociocognitive domains of media and life goals. To understand these changes, this study administered the Multidimensional Mortality Awareness Measure (Levasseur et al., 2015) to 103 emerging adults in India, post which 6 participants proceeded for a semi-structured interview exploring pandemic experiences, news consumption and goal prioritization, to examine specific areas in relation to death cognition. The thematic analysis demonstrates psychological effects, and discusses developments in health and death-related psychological processes. Focus on career goals and health maintenance, cautious news consumption and disadvantageous impacts on mental health are seen, significant in navigating healthcare measures for emerging adults, as we move forward into this 'new normal'. [ABSTRACT FROM AUTHOR]

Using a mixed-method approach, this present study examined the roles of calling and the relation between life goals and spiritual values among early childhood professionals in New Zealand. Among the 102 participants who completed the surveys, 24 participated in the follow-up individual interviews. In line with previous research, results showed that the five spiritual values—conformity, universalism, tradition, benevolence, and security—positively correlated with at least three intrinsic life goals, but showed a negative correlation with at least three of the four extrinsic goals. In addition, all non-spiritual values—self-direction, stimulation, hedonism, achievement, and power—correlated negatively with at least three of the intrinsic life goals. A similar pattern was found between the correlation between all non-spiritual values and extrinsic life goals. Interview data showed that participants who self-identified as having experienced a call to work with young children actively engaged with their calling. They also affirmed that their calling was experienced at a deeply personal and emotional level. Participants also recognized the important impact of life goals, personal and spiritual values on their work. This paper concludes with implications for future research and practice. [ABSTRACT FROM AUTHOR]

Team collaboration is an essential component of augmentative and alternative communication (AAC) services that directly impacts outcomes for students in special schools. Given the central role of the Special Education Teacher (SET) in the AAC team, there is a need to explore and understand SETs' perceptions to support effective team collaboration. This study explored the perceptions of SETs on team working and collaboration in AAC service delivery in Ireland during a period of significant systemic change. A qualitative interview approach was utilised to explore the perceptions of five SETs working with students who use AAC in special education settings in Ireland. The dataset was analysed through the process of reflexive thematic analysis and identified four themes. Participants valued team collaboration but perceived it as inconsistent or non-existent in current practice. The impact of recent service changes on collaboration was highlighted, with all participants recognising a need for enhanced collaboration. Facilitators to collaboration identified included child centredness, shared goals, role clarity, sharing of knowledge and resources, and effective working relationships. [ABSTRACT FROM AUTHOR]

The strengths of model of case management is a recovery‐oriented model of community mental health care that has been linked to positive consumer outcomes. The aim of this qualitative study was to explore the consumer perspective of the strengths model of case management using a descriptive phenomenological approach. Data were collected through in‐depth, semi‐structured interviews. In total, six consumers from a metropolitan community mental health service were interviewed. Interview transcripts were analysed using Colaizzi's phenomenological method. Three major themes were identified: the relationship between the consumer and the case manager is valuable, the strengths assessment supports identifying strengths and areas for action and the strengths model of case management promotes recovery and goal achievement. Implications for practice include an increased understanding of consumer preferences and promoting the consumer voice, thereby supporting the provision of higher quality evidence‐based practice. [ABSTRACT FROM AUTHOR]

Background: Nutrition counselling is characterised by a collaborative approach where the patient and the dietitian establish goals that promote health and self‐management. Little is known about goal‐setting in nutrition interventions of patients at risk of malnutrition. The present study aims to describe the perspectives and needs of patients at risk of malnutrition regarding goals of nutrition interventions. Methods: Semi‐structured interviews were conducted with 15 patients from three primary care centres and one hospital in mid‐Sweden selected through purposive sampling. Interview transcripts were analysed using reflexive thematic analysis following the six‐phase guidelines of Braun and Clarke to identify patterns of shared meaning and themes in the data. Results: The findings highlight that the participants rarely reflected on their personal goals of the nutrition intervention. Instead, they strived to maintain strength and energy, with the nutrition counselling being seen as supportive in managing nutrition impact symptoms. They described discrepancies between their perspectives and the dietitian's regarding weight goals and the diet prescribed to gain weight. Conclusions: The study findings suggest that elucidating patients' goals is key to counteracting the discrepancies between the dietitians' clinically oriented goals and patients' perspectives. Goal‐setting is part of the dietitian's structured working process, whereas the patient's lifeworld is complex and unstructured. To provide person‐centred nutrition care, new strategies and tools are needed to facilitate collaborative goal‐setting. These approaches will bridge the gap between clinical goals and patients' individual needs, promoting better alignment and improved outcomes. Key points: Patients at risk of malnutrition described rarely considering their own goals for nutrition interventions.Nutrition counselling was seen as valuable in managing nutrition impact symptoms and maintaining strength and energy.Understanding and incorporating patients' goals in nutrition interventions might bridge the gap between dietitians clinically oriented goals and patients' perspectives. [ABSTRACT FROM AUTHOR]

Background: Despite well-established guidelines to treat diabetes, many people with diabetes struggle to manage their disease. For many, this struggle is related to challenges achieving nutrition-related lifestyle changes. We examined how people with diabetes describe barriers to maintaining a healthy diet and considered the benefits of using a harm reduction approach to assist patients to achieve nutrition-related goals. Methods: This is a secondary analysis of 89 interviews conducted with adults who had type 1 or type 2 diabetes. Interviews were analyzed using a content analysis approach. Themes regarding food or diet were initially captured in a "food" node. Data in the food node were then sub-coded for this analysis, again using a content analysis approach. Results: Participants frequently used addiction language to talk about their relationship with food, at times referring to themselves as "an addict" and describing food as "their drug." Participants perceived their unhealthy food choices either as a sign of weakness or as "cheating." They also identified food's ability to comfort them and an unwillingness to change as particular challenges to sustaining a healthier diet. Conclusion: Participants often described their relationship with food through an addiction lens. A harm reduction approach has been associated with positive outcomes among those with substance abuse disorder. Patient-centered communication incorporating the harm reduction model may improve the patient-clinician relationship and thus improve patient outcomes and quality-of-life while reducing health-related stigma in diabetes care. Future work should explore the effectiveness of this approach in patients with diabetes. Trial registration: Registered on ClinicalTrials.gov, NCT02792777. Registration information submitted 02/06/2016, with the registration first posted on the ClinicalTrials.gov website 08/06/2016. Data collection began on 29/04/2016. [ABSTRACT FROM AUTHOR]

Young adults (YAs), defined as individuals between the ages of 18 and 39 years, experience unique challenges when diagnosed with advanced cancer. Using the social constructivist grounded theory approach, we aimed to develop a theoretical understanding of how YAs live day to day with their diagnosis. A sample of 25 YAs (aged 22–39 years) with advanced cancer from across Canada participated in semi-structured interviews. Findings illustrate that the YAs described day-to-day life as an oscillating experience swinging between two opposing disease outcomes: (1) hoping for a cure and (2) facing the possibility of premature death. Oscillating between these potential outcomes was characterized as living in a liminal space wherein participants were unsure how to live from one day to the next. The participants oscillated at various rates, with different factors influencing the rate of oscillation, including inconsistent and poor messaging from their oncologists or treatment team, progression or regression of their cancer, and changes in their physical functioning and mental health. These findings provide a theoretical framework for designing interventions to help YAs adapt to their circumstance. [ABSTRACT FROM AUTHOR]

AIMThis study explored the experiences of prelicensure nursing students for whom English is an additional language when preparing for and taking course examinations. BACKGROUND English-as-an-additional-language students face challenges related to language comprehension on nursing examinations. Recognizing their unique obstacles may assist in designing equitable assessments and processes that improve outcomes. METHOD Responding to 14 semistructured, guided questions, 16 students discussed their experiences preparing for and taking nursing examinations. RESULTS Three primary themes related to student academic success emerged: psychological factors, perseverance, and factors affecting outcomes. Data revealed language as a factor that affected outcomes. Positive factors of note included self-confidence and diligence to succeed. CONCLUSION The results outline challenges faced by nursing students for whom English is an additional language and include strategies for promoting equity and academic success. [ABSTRACT FROM AUTHOR]

This study explored the acceptability of Children and Teens in Charge of their Health (CATCH), a program for children with spina bifida or cerebral palsy to enhance their physical activity and diet. Qualitative interviews were conducted with children (n = 6) and their parents (n = 6) who participated in CATCH. Analysis used an environmental systems framework. Microsystem factors impacting acceptability of the program were: Children's motivations for change, their age, and their physical health. Mesosystem factors were: Use of virtual coaching and the relationship between coach and child. Macrosystem factors (e.g. Covid-19), did not impact acceptability, but affected some goal attainment strategies. CATCH was broadly acceptable to children and parents and shows promise as a health promotion program tailored to children with disabilities. An environmental systems framework can potentially help other health promotion programs enhance their acceptability and success. [ABSTRACT FROM AUTHOR]

We conducted a service evaluation of the medical support worker (MSW) role at Oxford University Hospitals NHS Foundation Trust following the Coronavirus 2019 (COVID-19) pandemic. The aim was to explore the roles of MSWs, their contributions to the NHS, factors influencing their career choices, and the goals of the MSW position, to inform quality improvement in relation to their integration into the Trust. The perspectives of MSWs, their supervisors and recruiters were analysed through nine semi-structured interviews and two focus group discussions involving 18 participants. Results were categorised into micro-, meso-, and macro-levels of the health system. At the micro-level, MSWs were recognised as a diverse group of highly qualified international medical graduates (IMGs) who had a crucial role during the pandemic. At the meso-level, participants emphasised the importance of a comprehensive induction by the hospital, to clarify responsibilities and familiarise MSWs with the health system. At the macro-level, the role facilitated MSW integration within the NHS, with the aim of practising as doctors. The importance of comprehensive hospital induction, with role clarity for both MSWs and their teams, supportive supervision and assistance with applying for registration with the General Medical Council, were highlighted as key quality improvement areas. [ABSTRACT FROM AUTHOR]

OBJECTIVES: With this study, we aim to describe transgender and nonbinary adolescents and young adults' stated gender treatment goals at the time of initial presentation to medical care. METHODS: This is a retrospective chart review of transgender and nonbinary patients aged 10 to 24 seeking specific gender-affirming health care. Charts were reviewed for specifically stated goals of future hormonal or surgical care for gender and analyzed by the experienced or asserted gender (man, woman, nonbinary, eclectic) of participants. RESULTS: In total, 176 patient encounters were reviewed. Of these, 71% were assigned female at birth. Most participants experienced a masculine gender (46.6%), identified as white (65.3%), and had private health insurance (73.3%). Most patients had a goal of initiating hormone therapy (97.4%) and eventual surgery (87.1%). Of those who had a surgical goal, most (87.5%) desired surgery of the chest or breast, and a minority (29.3%) desired eventual genital surgery. The second-largest gender group was patients who either declined to state an asserted gender or felt unable to describe their gender experience (eclectic, 23.3%), and this group's treatment goals did not mirror any other group's goals. CONCLUSIONS: At the time of initial presentation to medical care for gender-specific needs, many adolescents are capable of asserting specific treatment goals. Most do not desire genital surgery. A large minority of patients decline to state an asserted gender or feel unable to assert a specific gender, and this population appears distinct from more traditional genders in terms of treatment goals. [ABSTRACT FROM AUTHOR]

Faculty development in learning-centred medical education aims to help faculty mature into facilitators of student learning, but it is often ineffective. It is unclear how to support educators' maturation sustainably. We explored how and why medical educators working in learning-centred education, more commonly referred to as student-centred education, mature over time. We performed a qualitative follow-up study and interviewed 21 senior physician-educators at two times, ten years apart. A hierarchical model, distinguishing four educator phenotypes, was employed to deductively examine educators' awareness of the workplace context, their educational competencies, identity, and 'mission,' i.e. their source of personal inspiration. Those educators who grew in awareness, as measured by advancing in educator phenotype, were re-interviewed to inductively explore factors they perceived to have guided their maturation. A minority of the medical educators grew in awareness of their educational qualities over the 10-year study period. Regression in awareness did not occur. Maturation as an educator was perceived to be linked to maturation as a physician and to engaging in primarily informal learning opportunities. Maturation of medical educators can take place, but is not guaranteed, and appears to proceed through a growth in awareness of, successively, educational competencies, identity, and mission. At all stages, maturation is motivated by the task, identity, and mission as a physician. [ABSTRACT FROM AUTHOR]

OnTrackNY provides early intervention services to young people with early psychosis throughout New York State. This report describes the impact of the COVID-19 pandemic on community participation of OnTrackNY program participants and their families. Thirteen participants and nine family members participated in five focus groups and three individual semi-structured interviews. Data were analyzed using a summary template and matrix analysis approach. Major themes highlight the negative impacts of the pandemic with reports of decreased socializing or using online means to connect, unemployment, challenges with online learning and a decrease in civic engagement. Positive impacts include more time to deepen connections with family and valued friendships and engage in activities that promote wellness and goal attainment. Implications for coordinated specialty care programs include adapting services to promote mainstream community integration and creating new strategies for community involvement of young people within a new context brought forth by the pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Exiting sex work is a complex process which can be facilitated by integrated action on health and its social determinants such as housing and employment. Few programs offer such coordinated support, and even fewer have been evaluated. We assessed if and how Exit Doors Here, a program anchored in the Critical Time Intervention (CTI) model, facilitated women's progress towards their goals, and exit from sex work. Description: We performed a contribution analysis by combining pre-post questionnaire and administrative data from 55 women enrolled in the program (2018-2021), yearly interviews with program staff and peer mentors, and literature reviews to assess program outcomes and mechanisms as described in the theory of change. Discussion: We found evidence that the program contributed to participants progressing on their pre-employment, housing, income, and sex work exiting goals. We identified four "key ingredients" facilitating success: trust building, collaborative goal setting, connecting with community supports and weekly drop-in sessions. Conclusion: This rigorous theory-based evaluation provides much needed evidence on the process and effectiveness of an integrated sex work exiting program. Findings regarding key program ingredients can inform other interventions serving similarly marginalized populations. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to gain a comprehensive understanding of adolescent's experiences of individual school social work counselling in Swedish elementary schools. Design/methodology/approach: The study encompasses interviews with 16 adolescents about their experiences of individual counselling with school social workers (SSWs). The data was analysed using conventional content analysis. Findings: The main result was the adolescents' desire "to navigate to shore" to speak freely about their whole lives with a professional SSW and find a " safe haven," [...] where a trusting professional cared for and comforted them in counselling. The counselling contact contributed to increased knowledge about oneself. The results reveal the importance of the SSWs paying attention and listening to the adolescents' narratives. The creation of a coherent life narrative enables to finally end counselling and "Cast off." Originality/value: The results highlight the importance of Swedish SSWs focusing on individual counselling sessions with adolescents to provide a setting for growth. [ABSTRACT FROM AUTHOR]

Coaches' experiences of stress are influenced by their perceptions of personal resources to meet situational demands. This study examined the impact of challenge and threat feedback on coaches' instructional behaviors using an experimental manipulation and behavior analysis. We used a single-case experimental design consistent with the principles of applied behavior analysis and conducted follow-up interviews. The Arizona State University Observation Instrument (ASUOI; Lacy & Darst, 1989) was employed to systematically observe coaches' instructional behaviors pre- and post- manipulation, which was delivered by random assignment of challenge or threat feedback to 10 novice coaches. A total of 1,084 instructional behaviors were recorded across both conditions. In the challenge condition, two coaches exhibited relatively large increases in instructional behavior, while three coaches showed small decreases. Coaches in the threat condition demonstrated greater within condition variance as two coaches showed relatively large increases in instructional behavior, two coaches showed large decreases, and one coach showed minimal change. Interview data highlighted the mediating roles of coaches' emotional responses, resource perceptions, and goal orientation in the challenge and threat appraisal process. Implications for practice include the use of reflection to promote coaches' resource perceptions and facilitate adaptive responses to stress. [ABSTRACT FROM AUTHOR]