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Background: People who use illicit drugs cumulate medical and psychosocial vulnerabilities, justifying a rounded health approach. Both caregivers and patients can form barriers to accessing care, leading to inadequate care. This study aimed to identify the needs and expectations of such patients in general practice. Methods: Qualitative research was conducted using semi-structured interviews with 23 people with illicit substance use disorder in Brussels in 2020. Multicentric recruitment was conducted to obtain a heterogeneous mix of sociodemographic profiles and care trajectories. Thematic analysis was performed using RQDA package software. Results: Participants highlighted several vulnerabilities. These include the presence of significant self-stigmatization and guilt, sometimes to the extent of self-dehumanization, even after years of care, and overdoses masking suicide attempts and early memory disorders. Multiple substance use, smoking in almost all participants, and misuse of benzodiazepines were also noted. The majority of participants expressed the need for an open-minded, non-stigmatizing and empathic GP with a holistic approach that could guide them throughout their life course. The competencies of the GPs in the field of addiction seemed secondary to the participants. Knowledge and good collaboration with the mental health network were assets. Conclusion: Participants expressed the need for GPs with good interpersonal skills, including a non-stigmatizing attitude. The care coordinator role of the GP was highlighted as a key element, as it was a holistic approach focusing on global health (including the social determinants of health) and not only on substance use disorders. [ABSTRACT FROM AUTHOR]

Social workers often fail to engage fathers in child protection investigations (CPIs), especially when they involve domestic abuse (DA) by fathers. The aim of this study is to examine the strategies used by social workers to achieve cooperation with fathers in CPIs that involve the father being suspected of DA against the child's mother. With the use of qualitative methods, we conducted 31 semi‐structured interviews with 15 social workers during their work on 12 CPI cases. Through thematic analysis, two main strategies for achieving cooperation were created: (1) Securing an Initial Bond, which involved reducing the tension in CPI proceedings and affirming the father; (2) Maintaining the Bond while addressing the father's abusive behaviour, which involved negotiating with fathers about the DA and helping them shift their perspective on how their behaviour has impacted the victims. This analysis is rooted in the framework of shame, guilt and social bonds. However, there is a risk that these strategies may lead to the DA being minimized or overlooked. Striking a balance between building a bond and addressing abuse is crucial, and the timing of addressing DA plays a central role. [ABSTRACT FROM AUTHOR]

This pilot cross-sectional study was designed to determine the profile of obstetric violence in Ecuador in recent years. An online survey was conducted between March 2022 and April 2022, including women over 18 years who granted their informed consent to participate (n = 1598). We used non-probabilistic sampling to obtain our sample. Fisher's exact test was performed to assess the association between violence and type of birth, healthcare facility, and education level. Out of the women who participated in the study, 89.2% (n = 1426) identified themselves as Mestiza. Additionally, 88.3% (n = 1411) had completed university-level education. The majority of the participants, specifically 63.6% (n = 1017), received their care in public institutions, and 98.2% (n = 1569) reported structural negligence, while 74.5% (n = 1190) reported violation of their right to information. The entire sample affirmed to have experienced violation of the right of presence. This report shows that obstetric violence is present in Ecuador in different ways and that women experience negligence and violation of their right to receive ethical healthcare during childbirth. [ABSTRACT FROM AUTHOR]

BACKGROUND: Long-term care (LTC) facilities were hard hit by the COVID-19 pandemic in Canada. Using life course theory concepts, we looked for conditions that led to worker moral distress –i.e. pain or anguish over not being able to take right action - and how life stage may influence experiences. OBJECTIVE: To illuminate the experiences of adults under the age of 30 who stepped into, and/or persevered in, working in LTC during the pandemic, recognizing that this emerging workforce represents the future of LTC in Canada. METHODS: This secondary analysis uses interview data from a sub-sample of 16 young workers between 18 and 29 years of age who had been working in Canadian LTC facilities for between 8 months and 7 years. RESULTS: Young workers expressed feeling guilt about mourning the loss of socially significant milestones as these milestones paled by comparison to the loss of life and consequences of resident isolation they witnessed at work. To manage feelings of moral distress, young workers attempted to maintain high standards of care for LTC residents and engaged in self-care activities. For some workers, this was insufficient and leaving the field of LTC was their strategy to respond to their mental health needs. CONCLUSION: The life stage of young LTC workers influenced their experiences of working during the COVID-19 pandemic. Interventions are needed to support young workers' wellbeing and job retention. [ABSTRACT FROM AUTHOR]

Commitment to culturally sensitive practice is an ethical obligation that requires knowledge and skills specific to the practice context. Research shows that incorporating religion and spirituality into mental health practice is central to working effectively with Muslim communities. Practitioners need to consider the unique positionality and intersectionality when promoting mental health among Muslim women living in Western countries. This paper explores the trauma-informed, counseling approach and the integration of spirituality and religion when working with Muslim women living in Western Australia. Using the critical reflection approach, the research focuses on the concept of guilt about mental health and summarizes the main points considered in the counseling framework such as the centrality of spirituality and religion in perceiving guilt. The paper presents some practical strategies to incorporate cultural, religious, and spiritual concepts into the counseling relationship. [ABSTRACT FROM AUTHOR]

Background: Medication errors in health care are prevalent. Nurses play an important role in reporting; however errors remain underreported in incident reporting systems. Understanding the perspective of nurses will inform strategies to improve reporting and build systems to reduce errors. Purpose: The purpose of this study was to explore nurses' perceptions and attitudes of medication error reporting practices. Methods: This qualitative study used direct content analysis to analyze interview sessions with 21 total nurses. Results: Participant's description of medication error reporting practices fell into 2 themes. Internal factors described circumstances within nurses themselves that affect reporting. External factors described outside influences from processes or places. Conclusions: Medication error reporting is a multidimensional phenomenon with internal and external factors impacting nurses' attitudes and willingness to report errors. Nurses need support from leadership to understand that reporting medication errors can improve practice and impact patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Legalization of assisted dying is progressively expanding worldwide. In Canada, the Medical Assistance in Dying Act became law in 2016. As assisted dying regulations evolve worldwide, comprehending its subjective impact and broader consequences, especially on family members, becomes pivotal for shaping practice, policy, and training. Aim: The goal of this study is to understand the experience of family caregivers on the assisted dying procedure day. Design: Qualitative, thematic analysis, research using semi-structured interviews. Setting/participants: Family caregivers of patients who received assisted dying in two hospitals in Canada were recruited. Interviews were conducted at least 6 months after patient death. Conceptual saturation was achieved after analyzing 18 interviews. Results: While caregivers expressed gratitude for the availability of Medical Assistance in Dying, they also described the procedure day as potentially jarring and unsettling. We identified five aspects that shaped their experience: attuned support from the clinical team; preparation for clinical details; congruence between the setting and the importance of the event; active participation and ceremony; and pacing and timing of the procedure. Together, these aspects impacted the level of uneasiness felt by caregivers on the procedure day. Conclusions: This study emphasized the importance of a family-centered approach to delivering Medical Assistance in Dying. It underscored recognizing the needs of family caregivers during the procedure day and offering strategies to ease their experience. Healthcare providers in jurisdictions where assisted dying is legal or deliberated should consider the applicability of these findings to their unique context. [ABSTRACT FROM AUTHOR]

Up to 25% of people with type 2 diabetes (T2D) may binge eat which is almost 10 times as many as in the general population. Binge eating is associated with depression, anxiety, and social isolation. Moreover, binge eating may increase the risk of obesity and high blood glucose levels, both of which can accelerate the onset of complications to diabetes and death in people with T2D. Still, little is known about the experiences, needs, and preferences of people with T2D and binge eating that can inform and develop current and future treatment efforts. The aim of the study was therefore to gain in-depth insights into the experiences and biopsychosocial support needs of women and men with T2D and binge eating. Twenty semi-structured individual interviews (65% with females) were conducted and analyzed according to the methodology of Interpretive Description. Four themes were identified: (a) T2D and binge eating: Feeling trapped in a vicious circle; (b) Unwanted outcasts: Responding to continuous criticism; (c) Biomedical relief: Blaming and adjusting the body; and, (d) Silent struggles: Wanting to cease the secrecy. Pertinent to all themes were the guilt, shame, and worries about developing complications that the participants experienced when binge eating despite having T2D. Although binge eating triggered emotional distress, binge eating was at the same time a way of coping with such distress. Implications for treatment and future research are discussed, including the need to systematically assess and address binge eating in routine T2D care. [ABSTRACT FROM AUTHOR]

This study examines the thematic content of four negative affective tones—frustration, anger, anxiety and guilt—expressed by mothers in treatment for opioid use disorder (OUD) as they describe their relationships with their preschool-aged children. The sample included 150 African American women with children between 36 and 63 months of age (M = 48.5, SD = 7.4). The Working Model of the Child Interview was used to generate mothers' narratives of their children and of themselves as parents. Transcripts were rated on the degree to which specific affective tones were present. Follow-up thematic analysis was conducted on transcripts where high levels of four affects were expressed: frustration (n = 13); anger (n = 6); guilt (n = 9); and anxiety (n = 7), with frustration and anger combined in the final analysis given overlap in content themes. The findings, which included mothers' anger/frustration about their child's challenging behavior; guilt about the impact of their substance misuse on the child; and anxiety about the child getting hurt or becoming ill, reflected mothers' desires to be good parents. Some themes cut across multiple negative emotions, including managing child behavior, the consequences of substance misuse, and co-parenting with family members. Also underlying all the affective tones was a sense of powerlessness. The findings underscore the importance of providing supports for parents who are in treatment for SUD that center parents' emotions. Highlights: Research has highlighted the complexity of parenting among people with substance use disorder, but less is known about parents' emotional experiences, particularly among those who are caring for preschool-aged children. Analysis of the narratives of parents in treatment for opioid use disorder found that they expressed negative emotions – frustration, anger, guilt, and anxiety – most often when speaking about managing their child's behavior, consequences of their substance misuse, and co-parenting with family members. Underlying the themes was a desire to be a good parent and a perception of powerlessness; the emotional themes highlight support needs that merit attention in interventions for parents with substance use disorder. [ABSTRACT FROM AUTHOR]

The article examines the experiences of family caregivers engaged in the provision of long-term care for their relatives with complex health needs within the Latvian context. Semi-structured interviews were conducted with seven caregivers who provide care in cases of dementia, depression, schizophrenia, opioid use, Down syndrome and mild cognitive impairment. A thematic analysis of interview transcripts revealed common themes, such as the initial experiences when encountering a family member's disorder and the subsequent reactions, as well as the quest for support and resources. Variations mainly centered around differences in formal aspects and childhood experiences of care. Caregivers reported risk factors such as guilt, lack of support from family and friends, financial difficulties, deficiency of professional care and ignoring the caregiver's own needs. Awareness of personal resources, values and limits, coping with personal stigma and improved overall quality of life were identified as protective factors. The findings underscore several preventive measures that social and mental health services could implement to mitigate the adverse effects of caregiving on caregivers' lives. [ABSTRACT FROM AUTHOR]

Soul Injury is defined as a wound that separates a person from their real self, caused by unmourned loss and hurt, unforgiven guilt and shame, and fear of helplessness or loss of control. Tools and interventions have been developed to guide people impacted by Soul Injury. This study assessed the effectiveness of 12 tools and interventions provided during a 4-day Soul Injury Leadership Institute. This 2-part investigation included an online survey of participants who had attended a 4-day Institute training and a post-Institute narrative inquiry conducted as virtual structured interviews. Ninety-one professionals completed the online survey, which inquired about the impact of specific Soul Injury tools and interventions on the respondents' personal and professional life. The Anchor Your Heart tool was the most frequently used tool and had the most enduring utilization across time and settings. Qualitative data collected in virtual interviews with 15 volunteers demonstrated the power of the Write/Tell Your Story technique in which storied narratives permit an individual to integrate powerful experiences such as traumatic events, serious illness, and even death, providing further validation that Soul Injury is an important human phenomenon. [ABSTRACT FROM AUTHOR]

Background: Psychiatric nurses often face patient safety incidents that can cause physical and emotional harm, even leading to s econd victim syndrome and staff shortages. Rumination—a common response after nurses suffer a patient safety event—may play a specific role between the second victim experience and turnover intention. Understanding these mechanisms is crucial for supporting psychiatric nurses and retaining psychiatric nursing resources. Objectives: The study aimed to explore the associations among second victim experience, rumination, and turnover intention in psychiatric nurses and confirm how second victim experience influences turnover intention through rumination and its subtypes. Methods: A descriptive, cross-sectional study was adapted to survey 252 psychiatric nurses who experienced a patient safety incident at three hospitals in China between March and April 2023. We used the Sociodemographic and Patient Safety Incident Characteristics Questionnaire (the Chinese version of the Second Victim Experience and Support Tool), the Event-Related Rumination Inventory, and the Turnover Intention Scale. Path analysis with bootstrapping was employed to accurately analyze and estimate relationships among the study variables. Results: There was a positive association between second victim experience and turnover intention. In addition, both invasive and deliberate rumination showed significant associations with second victim experience and turnover intention. Notably, our results revealed that invasive and deliberate rumination played partial mediating roles in the relationship between second victim experience and turnover intention in psychiatric nurses. Discussion: The negative experience and turnover intention of the psychiatric nurse second victims are at a high level. Our results showed that invasive rumination positively mediated the relationship between second victim experience and turnover intention, and deliberate rumination could weaken this effect. This study expands the knowledge of the mechanisms underlying the effect of the second victim experience on turnover intention. Organizations must attach importance to the professional dilemmas of the psychiatric nurses' second victims. Nurse managers can reduce nurses' turnover intention by taking measures to reduce invasive rumination and fostering deliberate meditation to help second victims recover from negative experiences. [ABSTRACT FROM AUTHOR]

Prenatal depression affects approximately 10% to 15% of women. Guidelines recommend supporting women to make informed treatment decisions; however, minimal evidence exists regarding this decision-making process. This study aimed to develop a constructivist grounded theory of prenatal antidepressant treatment decision-making. Semi-structured interviews were conducted with purposively sampled women from the community or specialty clinics (N = 31). Iterative data collection and analysis, theoretical sampling, and member checking supported model sufficiency. In the Creating Comfort in Choice theory that we developed, participants were highly conscious of societal stigma toward mental illness and prenatal medication use, so fear, anxiety, and guilt dominated decision-making. Participants navigated dynamically among three clusters of decision-making activities: seeking information, making sense of information, and self-soothing. "Seeking information" included internal and external processes. In "making sense of information," participants appraised available evidence. In "self-soothing," participants engaged in coping strategies to try to alleviate painful emotions. The Creating Comfort in Choice theory can support patient-oriented decision-making regarding prenatal mental healthcare. [ABSTRACT FROM AUTHOR]

This article focused on the experiences of women who underwent medical termination of their pregnancies. The study adopted a qualitative phenomenological research design with a sample of 20 pregnant women. Data were collected between April and June 2022 using a personal information form and a semistructured individual interview. The qualitative data were analyzed into 4 categories: "psychosocial impacts," "impacts on functionality," "coping," and "expectations." These categories comprised 8 themes and 24 subthemes. Nurses play a crucial role in adopting family-centered approaches to offer holistic care. They should prioritize providing physical care throughout the medical termination, while also assessing the psychological impact of fetal loss. Perinatal palliative care and bereavement counseling should be integrated into care practices. [ABSTRACT FROM AUTHOR]

Background: In the United States, the incidence of substance misuse among pregnant women has been steadily increasing. While pregnant women with substance use disorder (SUD) are in critical need of support during the prenatal period, they enter prenatal care stigmatized and facing the possibility of punitive responses. Little research has been done about how women with SUDs themselves experience pregnancy and the transition to motherhood. The aim of this study was to examine women's internal experiences of pregnancy in the context of SUD. Methods: Semi‐structured interviews were conducted with n = 19 postpartum women with SUD. Data were analyzed using a semantic, thematic approach. Results: Participants expressed their thoughts and experiences about their pregnancies in four main themes: (1) fear of harming the baby; (2) fear about child welfare involvement; (3) guilt informed by recovery stage; and (4) mixed feelings about pregnancy amidst complicated circumstances. The women expressed fear about their children's well‐being, coupled with motivation to protect their child and the need for clear medical information. Their expressions of guilt depended on the severity of their SUD and their stage in recovery during their pregnancy. Women entered prenatal care with mixed emotions about their pregnancy, such as guilt and excitement, in the midst of complicated life circumstances. Conclusions: These findings suggest a complexity of internal experiences for pregnant women with SUDs. Participants' feelings and experiences during pregnancy can inform practitioners' approaches to prenatal care in the context of SUDs. [ABSTRACT FROM AUTHOR]

Aim: To explore nursing students' moral distress (MD) experiences in clinical settings. Design: An interpretative phenomenological analysis (IPA) design was employed. Methods: Purposive sampling was used. In‐depth semi‐structured face‐to‐face interviews were conducted from December 2020 to June 2021 with nursing students who were taking the internship course in clinical settings. Data analysis was conducted following Dickman et al.'s (1989) method. Results: Ten nursing students participated in this study. Three main themes were identified, including (1) negative learning environments, (2) internal disgust and (3) threats to professional identity. Conclusion: Findings showed that value conflict, lack of knowledge of ethical standards and its application, and unprofessional approaches result in negative environmental learning perceptions from the nursing students. Therefore, due to being unable to change the situation, they start to feel guilt and shame and, as a result, decide to escape the problem instead of managing it. These feelings lead to internal disgust. This issue indicates the importance of improving the knowledge and perception of these situations. Thus, nursing students must be prepared for the real world, where their ideals are constantly challenged. MDs were experienced as threats to dignity, inequality, distrust, and change of mentality towards nursing, characterised as threats to professional identity. It is suggested to inquire about the process of nursing students' resiliency in morally disturbing situations to deduce the suitable approach for clinical education. [ABSTRACT FROM AUTHOR]

Older adults who are abused by their offspring often find it difficult to cooperate with professionals to end the abuse. In these situations, social workers face an ethical dilemma between respecting the older adult's right to autonomy and intervening in a paternalistic way to prevent harm. This qualitative study aimed to examine the effect of interpersonal factors on the decision-making ability of older adults who do not experience significant cognitive and mental decline and choose to remain in abusive relationships. Twenty-one social workers specialising in the field of aging participated in a semi-structured interview based on a vignette. The analysis was encoded inductively, informed by the principles of content analysis. Two themes emerged: (i) Older adults' feelings towards their abusive adult children, including love and concern, shame and guilt and relationships with symbiotic characteristics; (ii) Older adults' motivation to stay in the abusive relationships, based either on utilitarian motivation or on their fear of the abuser. The study's findings can serve as a foundation for the development of a tool for evaluating the influence of abusive relationships on older adults' decision-making ability, which considers not only their personal characteristics but also their interactions and relationships with their surroundings. [ABSTRACT FROM AUTHOR]

Background: Children affected by tethered cord syndrome (TCS) encounter multifaceted challenges encompassing educational, familial and social spheres, underscoring the significance of a holistic comprehension of their subjective emotional well‐being and life encounters. Nonetheless, healthcare professionals tend to prioritise the physical functionality of the afflicted individuals throughout the treatment and rehabilitation process, often neglecting the emotional experiences and requirements of these children as they transition into posthospitalization phases. Aim: To advance the subjective experiences and perceptions of children with TCS upon reintegration into their families, educational institutions and wider societal contexts subsequent to their discharge from medical facilities. Methods: The study was conducted at the Children's Hospital in Zhejiang. Twelve children aged 8–15 with TCS were included in the study. The research design used an interpretative qualitative approach, utilising semi‐structured interviews as the primary data collection method. Data analysis was performed using reflexive thematic analysis, facilitating a comprehensive exploration of emerging themes and patterns. Results: Four major themes (and seven subthemes) were identified from the findings: (1) growing pains (a shameful secret, distance between ideal and reality); (2) inappropriate expressions of familial affection (knowing is not understanding, unspeakable guilt); (3) social estrangement (uncomfortable distinctions, familiar stranger) and (4) striving for independence and consistency. Conclusions: Children affected by TCS exhibit internal sensitivity and challenges in self‐development, family dynamics and social interactions. They aspire to attain a future characterised by independence and freedom, akin to that of their typically developing peers. These findings can help health professionals, families and educators gain a deeper understanding of what it takes to be a child with TCS, and the findings can also serve as a platform for interventions that seek to promote self‐expression in these children so that they can experience life as a meaningful and positive process. Patient or Public Contribution: This study received support from children with TCS and their guardians during data collection, as well as from the head nurse of the unit. Coresearchers also contributed to design, data collection, analysis and writing. [ABSTRACT FROM AUTHOR]

Introduction: Feelings of shame and guilt are seen in a wide range of psychological disorders, and these feelings are of high importance in disorders related to eating and obesity. Aim: The present study was conducted with the aim of investigating the psychometric properties of the Persian version of the Guilt and Shame Questionnaire. Method: This study was applied in terms of aim and in terms of methodology in the field of descriptive-correlation researches of psychometric type, respectively. The statistical population included all individuals with high Body Mass Indexes (BMI > 25) who referred to nutrition clinics affiliated to Iran University of Medical Sciences in 2022, 573 of whom were selected using convenience sampling. Data were collected using External Shame Scales (1994) and Body Image Flexibility Questionnaire (2013) and Guilt and Shame Questionnaire (2022). In order to analyze the findings, the internal consistency method with Cronbach's alpha was performed, and to check the construct validity with confirmatory factor analysis, SPSS version 25 and Lisrel version 8.8 were employed. Results: The results showed that this scale has desirable psychometric properties. There is a significant positive correlation (r=0.66) between the current Questionnaire and the Scale of External Shame, and a significant negative correlation (r=-0.63) with the Scale of Flexibility Body Image. Also, Cronbach's alpha coefficient for the total scale was 0.87. Conclusion: Considering the desirable psychometric features of the Shame and Guilt Scale and the short form of the questionnaire (8 questions), this questionnaire can be used in people with high body mass indexes and people with eating disorders. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to examine the reflection of Eric Ericson's psychosocial theory in nursing care in the approach of nurses working in pediatric clinics to patients aged 0-18. Methods: This was a descriptive cross-sectional study. The study was conducted with 30 nurses who were working in pediatric clinics. Results: The nurses stated that it was necessary to perform the following practices while providing care for their patients: "promptly changing the patient's diaper when it gets dirty" in the "trust and mistrust" stage (83.3%); "taking care not to use expressions such as cutting-bleeding" in the "initiative vs. guilt" stage (86.7%). Conclusion: Our findings highlight that nurses working in pediatric clinics should reflect Ericson's psychosocial theory in their care to support the psychosocial development of children. Keywords: Psychosocial theory, pediatric nurse, child, Ericson's theory, nursing care [ABSTRACT FROM AUTHOR]

In recent years, there has been increased awareness of obesity as a condition that carries a high level of stigma, as well as growing recognition of its prevalence and harm. Despite the increasing body of research on this topic, there is a gap in the literature regarding mechanisms that generate or exacerbate perceptions of weight stigma, especially within families and pediatric healthcare settings. The present study aims to identify potential stigma-generating mechanisms by focusing on inter-relational dynamics within these contexts. We conducted in-depth, semi-structured interviews with 11 families and analyzed the data by applying sociological theories on health identities and authenticity. Our study found four themes that represent potential stigma-generating mechanisms by being explicitly related to familial health identities and healthcare authenticity: (1) negotiating and reconstruction familial self-understanding, (2) between guilt, shame and conflicts, (3) navigating weight perceptions, and (4) the necessity of positivity and relevance. Our study shows the complexities of weight stigma within family and pediatric healthcare settings, emphasizing the need for sensitive and tailored support, as well as the value of working authentically as crucial aspects in preventing and/or reducing stigma. [ABSTRACT FROM AUTHOR]

The study aims to provide insight into the lives of parents to adult children with drug addiction. We focus on how the parents' social life and interactions were affected by feelings of guilt and shame, and how they dealt with the stigma that often accompanies drug addiction. 32 semi-structured interviews were conducted with parents (age 46–70) of adult children (age 18–47) with drug addiction in Sweden. Three themes emerged (1) Experiences of guilt, shame, and courtesy stigma, (2) Impact on social life and relationships and, (3) Strategies to reduce guilt and shame. Guilt, shame, and courtesy stigma complicated and restricted the parents' social interactions. Many parents applied a selective openness, carried experiences of alienation and in some cases isolated themselves. At the same time, several parents described that they were open about their child's addiction in certain contexts. For some parents, this meant a relief from guilt and shame and an opportunity for increased social interaction. Both informal and professional support for family members of individuals with drug addiction is vital to reduce experiences of guilt, shame, and courtesy stigma. [ABSTRACT FROM AUTHOR]

Objective: Health care workers have been exposed to a variety of practical and emotional challenges because of the Covid‐19 pandemic, leaving them vulnerable to experiencing moral injury and distress. However, there is currently sparse research which directly explores such experiences. This study aimed to explore and characterise the experiences and impacts of moral injury and distress among health care workers during the pandemic. Methods: Twenty semi‐structured interviews were conducted with health care workers employed across both mental and physical health care services. Interviews were analysed from a critical realist perspective using thematic analysis. Results: Three key themes were identified: attitudes towards moral injury, experiences of moral injury and consequences of moral injury. Participants appeared to identify with the idea of acting against their morals to varying extents based on their job roles. Participants experienced a range of potentially morally injurious and distressing events throughout the pandemic and many ultimately felt that they provided sub‐standard levels of care due to extreme pressures on services. Detrimental impacts upon wellbeing were commonly reported, including high levels of emotional distress and feelings of guilt and shame. Some reported a loss of enthusiasm for their job and a desire to leave the profession entirely. Conclusion: Moral injury and distress presents a real concern for staff wellbeing and retention within the profession. During and beyond the Covid‐19 pandemic, there is an urgent need for health care providers to implement wider strategies to target moral injury and distress, and support staff within health care settings. [ABSTRACT FROM AUTHOR]

Background: The incidence of early-onset colorectal cancer (EOCRC) in adults aged <50 years has increased in several Western nations. National surveys have highlighted significant barriers to accessing timely care for patients with EOCRC, which may be contributing to a late stage of presentation in this population group. Aim: To explore awareness of the increasing incidence of EOCRC, and to understand the potential barriers or facilitators faced by GPs when referring younger adults to secondary care with features indicative of EOCRC. Design & setting: Qualitative methodology, via virtual semi-structured interviews with 17 GPs in Northern Ireland. Method: Reflective thematic analysis was conducted with reference to Braun and Clarke's framework. Results: Three main themes were identified among participating GPs: awareness, diagnostic, and referral challenges. Awareness challenges focused on perceptions of EOCRC being solely associated with hereditary cancer syndromes, and colorectal cancer being a condition of older adults. Key diagnostic challenges centred around the commonality of lower gastrointestinal complaints and overlap in EOCRC symptoms with benign conditions. Restrictions in age-based referral guidance and a GP 'guilt complex' surrounding over-referral to secondary care summarised the referral challenges. Young females were perceived as being particularly disadvantaged with regard to delays in diagnosis. Conclusion: This novel research outlines potential reasons for the diagnostic delays seen in patients with EOCRC from a GP perspective, and highlights many of the complicating factors that contribute to the diagnostic process. [ABSTRACT FROM AUTHOR]

The abrupt cessation of school and sport participation during the COVID-19 pandemic may have negative implications for adolescent mental health. To (1) compare mental, physical, and social health and behaviors during pandemic-related stay-at-home mandates with the same measures collected 1 to 2 years earlier and (2) evaluate the relationships between physical activity and sleep during the pandemic and changes in anxiety, fatigue, and peer relationships between assessment times. Cohort study. Pediatric sports medicine center. A total of 39 high school athletes (25 adolescent girls, 14 adolescent boys; age = 16.2 ± 0.9 years). Patient-Reported Outcome Measurement System anxiety, fatigue, and peer relationships short forms and the Pittsburgh Sleep Quality Index were completed twice (initial assessment in May 2018 or 2019, follow-up assessment in May or June 2020). Frequency and duration of physical activity and frequency of interaction with other individuals (family, peers, sport coaches, etc) were self-reported at follow-up assessment for the 2 weeks before school or sport closure and the 2 weeks before questionnaire completion. Higher levels of anxiety (5.5 ± 4.0 versus 3.6 ± 3.4 points; P =.003) and fatigue (5.4 ± 3.7 versus 2.3 ± 2.5 points; P <.001) and worse sleep quality (6.6 ± 2.9 versus 4.3 ± 2.3 points; P <.001) were observed during the pandemic compared with previous assessments. Reductions in physical activity were noted between assessments (exercise duration: 86.4 ± 41.0 versus 53.8 ± 30.0 minutes; P <.001). Sleep quality but not physical activity during the pandemic predicted changes in fatigue (P =.03, β = 0.44 [95% CI = 0.06, 0.83]) and peer relationships (P =.01, β = −0.65 [95% CI = −1.16, −0.15]) from initial to follow-up assessment. Mental and physical health declined during stay-at-home mandates compared with assessments 1 to 2 years earlier. Physical activity behaviors and sources of social interaction underwent changes after school and sport cessation. Sleep quality may have provided some protection against declining adolescent mental health during the pandemic, although this relationship requires further investigation. [ABSTRACT FROM AUTHOR]

Sibling sexual harmful dynamics (SSHD) is a term used, in this study, to refer to childhood sexual behaviors that are inconsistent with age-appropriate curiosity, including sibling sexual abuse (SSA). Although SSA is a prevalent and long-lasting form of intrafamilial sexual abuse, it is the least reported, studied, and treated. This study aims to deepen the understanding of the disclosure process of this phenomenon in the Israeli Orthodox Jewish society, as perceived by those involved. Participants were adults from the Orthodox communities in Israel who experienced sexual interactions/abuse with one or more of their siblings. This qualitative constructivist-grounded theory study was based on semi-structured interviews with 24 adults from the Israeli Orthodox Jewish communities. Seven barriers to disclosure were identified and organized into three main categories: intrapersonal, including denial of the acts, guilt, and shame; interpersonal, including the sibling relationship and perceiving the sexual acts as routine; and cultural, including lack of sexual knowledge, the concept of modesty, and marriage prospects. In addition, we highlight the intersectionality between the different contexts of the SSHD. This study explored the barriers to disclosing SSHD in the siblings' context and the context of the Jewish Orthodox communities. The findings contribute to understanding the unique aspects of the disclosure, as expressed in religious and cultural contexts, the sibling context, and their intersectionality. Cultural and religious sensitivity is crucial for practitioners, especially as issues of sexuality and sexual understanding stem from the related norms and values. [ABSTRACT FROM AUTHOR]

Introduction: Fear of guilt is a characteristic of obsessive-compulsive disorder, which confirms the centrality of guilt in obsessive-compulsive symptoms. Aim: This study aims to investigate the psychometric properties and factor structure of the Iranian adaptation of the Fear of Guilt Scale. Method: This study was applied and developmental in terms of aim and psychometric type,respectively. The population included all the people of the three company in Tehran, Iran, in the year 2022 from which 520 adults, were selected by availabile sampling. The Vancouver Obsessional Compulsive Inventory (2004) and the Fear of Guilt Scale (2016) were used to collect the data. Besides, mean, standard deviation (SD), exploratory and confirmatory factor analysis, convergent validity and construct validity, SPSS version 26 and AMOS version 24 were run to analyze the data. Results: Confirmatory factor analysis revealed the existence of two factors: "punishment" and "prevention of harm." The scale demonstrated favorable convergent validity. Concerning scale reliability, the Cronbach's alpha coefficient was calculated at 0.90 for the entire scale, 0.88 for the "punishment" subscale, and 0.75 for the "prevention of harm" subscale which revealed the convergent and construct validity of this questionnaire. Conclusion: This study confirms the psychometric properties of the Fear of Guilt Scale in terms of evaluating the features of fear of guilt in obsessive-compulsive disorder .Future researches can use this tool for the purposes of evaluating and investigating the fear of guilt in patients with obsessive compulsive disorder. [ABSTRACT FROM AUTHOR]

Objectives: The authors aimed to develop a moral intervention and to determine whether it was more effective in preventing doping than an educational (i.e., knowledge-based) intervention; their primary outcome was doping likelihood, and the secondary outcomes were moral identity, moral disengagement, moral atmosphere, and anticipated guilt.Methods: Eligible athletes (N = 303) in the United Kingdom and Greece took part in the study. The authors randomly assigned 33 clubs to either the moral or the educational intervention. They measured outcomes pre- and postintervention and at 3- and 6-month follow-up.Results: Athletes in both interventions in both countries reported lower doping likelihood and moral disengagement and higher guilt from pre- to postintervention. These effects were maintained at the 3- and 6-month follow-ups. There were no effects on moral identity or moral atmosphere.Conclusions: In addition to disseminating information about doping, doping prevention programs should include content that focuses on moral variables. [ABSTRACT FROM AUTHOR]

Background: Stigma toward those with non-medical substance use may present as anticipated, perceived, enacted, or internalized stigma. Objective: The purpose of the study was to describe the role of stigma on health care professionals with non-medical substance use, from the perspective of treatment providers. Soliciting information about stigma from treatment providers is a unique perspective lacking in current literature. Methods: A qualitative descriptive design was used with semi-structured interviews of treatment providers (N = 16) in Colorado. Inductive content analysis was used to identify concepts and themes across interviews. Results: Findings showed that stigma is a major concern and a barrier for health care professionals seeking substance use treatment. Nurses and physicians demonstrate shame and guilt (internalized stigma) around their substance use. These professionals also experience fear around their reputation (perceived stigma) and challenges around re-entry to the workforce after treatment (anticipated stigma). Conclusions: The awareness of existing stigma as well as internalized stigma impacts how health care professionals approach treatment, recovery, and returning to work. [ABSTRACT FROM AUTHOR]

The sense of guilt in informal caregivers has been associated with lower levels of overall life-satisfaction, an increase in feelings of overwork, stress, and health problems, including anxiety and depression. Even though women who care for dependent relatives have higher levels of feelings of guilt than male caregivers, little research has been done on the dynamics of guilt from a gender perspective. This study examines the dynamics of this moral emotion in women caregivers' psychosocial health. This study is based on semi-structured interviews with nineteen Spanish women who are informal caregivers looking after dependent family members. The interviews were subsequently transcribed and subjected to thematic analysis. Three themes emerged from qualitative analysis: first, doing more for the people being cared for than for oneself; secondly, being demanding on oneself; and thirdly, controlling one's own desires. The results show dynamics of self-control that seem to function as mechanisms for the women caregivers to avoid feelings of guilt, but at the price of taking on greater caring responsibilities, denying their own desires, and endangering their psychosocial health. We consider that intervention to help women reduce anticipatory guilt is essential, as these feelings put women caregivers' psychosocial health at risk. [ABSTRACT FROM AUTHOR]

Rates of detection and disclosure of childhood sexual abuse (CSA) are believed to be lower in males due to gender socialization fears. The experience of CSA is thought to increase negative self-conscious emotions (shame, guilt, embarrassment, anger, and fear). Such self-conscious emotions have been associated with a range of mental and public health issues. As there has been no research to date that has explored the experience of shame and guilt within the wider context of self-conscious emotional states for males, this research aimed to explore men's experiences of self-conscious emotions following CSA. Nine semi-structured interviews with males were completed. Interpretative Phenomenological Analysis identified three themes: "Invisible In This World" captures participants' isolating circumstances surrounding their CSA, and how this impacted their perception of not being protected or able to speak out; "The Emotional Fallout" describes the overwhelming emotions experienced as a result of the CSA and how such emotions have impacted participants lives, and "Learning To Live With The Wound That May Never Heal" addresses how participants have spent their lives living with the abuse and how it's a process to learn how to adapt and live with the abuse. Findings suggest there is a clear need to recognize the role and power of self-conscious emotions in male CSA, especially for healthcare professionals and services supporting males with CSA. Without addressing such self-conscious emotions, males who have experienced CSA are at risk of enduring the emotional fallout throughout their lives. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre 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: Persistent enteral tube feeding beyond the point of medical and/or physical necessity provides important nutrition to a child but may have implications for their development, gastrointestinal tract and quality of life. Tube dependency can affect parent–child relationships and sibling and family dynamics and place additional medical demands upon parents. It is therefore important to transition children from tube to oral eating and drinking as soon as is medically safe to do so. Tube weaning requires a skilled team to support the transition to oral intake; however, access to experienced teams is inconsistent. Without transparent discussions with their treating teams, many parents are left to navigate tube weaning options independently. Methods: Fourteen parents were interviewed using semi‐structured interviews. We explored the experiences of parents across their child's progression towards oral feeding, from the decision‐making process to undertaking an intensive multi‐disciplinary tube weaning programme. Thematic analysis of the parents' stories shaped the development of seven themes. Results: Parents were unaware that tube weaning would be required and how that would be facilitated. They expressed a strong belief that their child could learn to eat—if afforded an opportunity. Furthermore, parents are prepared to disengage from current services if they feel they are not respected members of their child's therapeutic team. Three key learnings were identified relating to the need for tube exit plans, parents as key team members and parents as change agents. Conclusions: Parenting a tube‐fed child, initiating and engaging in tube weaning, is a stressful and emotional journey. However, by establishing care partnerships, parents are willing to put trust in a process if provided with options and afforded autonomy, empowerment, acknowledgement and relevant support. [ABSTRACT FROM AUTHOR]

The shame reaction is a highly negative emotional reaction shown to have long-term deleterious effects on the mental health of clinicians. Prior studies have focused on in-hospital personnel, but very little is known about what drives shame reactions in emergency medical services (EMS), a field with very high rates of post-traumatic stress disorder, burnout, anxiety, and depression. The objective of this study was to describe emotions, processes, and resilience associated with self-identified adverse events in the work of prehospital clinicians. We conducted a qualitative study using a modified critical incident technique. Participants were recruited from two EMS agencies in North Carolina: one urban and one rural. They provided an open-ended, written reflection in which they were asked to self-identify particular events in their EMS careers that felt emotionally difficult. In-person or video in-depth interviews about these events were then conducted in a semi-structured fashion using an iterative interview guide. The codebook was developed through a mix of inductive and deductive analysis strategies and discussed within the research team and a content expert for validation. Interviews were transcribed and data were analyzed following a thematic content analysis approach for types of cases identified as emotionally difficult, common emotional responses and coping mechanisms, and the lingering effects of these experiences on study subjects. Eight interviews were conducted with EMS personnel: five from an urban agency and three from a rural agency. Participants commonly identified complex medical cases as being emotionally difficult, which led to the most robust shame reactions. Shame reactions were more common when EMS clinicians committed self-perceived errors in patient care, whereas guilt reactions were more common when patient outcomes seemed "inevitable" despite any intervention. Common themes related to coping mechanisms included both personal mechanisms, which tended to be less successful compared to interpersonal mechanisms, particularly when emotions were shared with colleagues. This reflected a perceived culture change within EMS in which sharing emotions with colleagues was seen as a departure from the "old school" where emotions tended to be kept to oneself. Feelings of inadequacy, low self-worth, and being "not good enough" were frequently identified as lingering emotions after difficult cases that were hard to move on from, corresponding to longstanding shame in these clinicians. Recovery and resilience varied but tended to be positively associated with a culture in which sharing with colleagues was encouraged, along with personal introspection on root causes for the sentinel event. EMS clinicians often identify complex patient cases as those leading to emotions such as shame and guilt, with shame reactions being more common when a perceived error was committed. Coping mechanisms were varied, but individuals often relied on their coworkers in a sharing environment to adequately process their negative feelings, which was seen as a departure from past practices in EMS personnel. Our hope is that future studies will be able to use these findings to identify targets for intervention on negative mental health outcomes in EMS personnel. [ABSTRACT FROM AUTHOR]

Theories of development point out that childhood experiences are relevant across the lifespan, and that the parent-child relationship is essential for a child's physical and psychological wellbeing. The aim of this study is to investigate whether parental abandonment influences self-conscious emotions such as guilt and shame. This quasi-experiment included 230 adolescents and teenagers (M = 17.1, SD = 1.82), and data were collected via a self-reported questionnaire administered online. We used the Guilt Inventory, the Experience of Shame Scale, the Childhood Trauma Questionnaire, and the Parental Acceptance/Rejection Questionnaire. Results indicated that the child's environment was significantly associated with feelings of shame. Abuse is associated with both guilt and shame, while paternal rejection is associated with guilt. The environment in which children and teenagers develop is associated with how they perceive themselves in relation to others. This study underlines the importance of considering child development conditions and the paramount importance of social work assistance for abandoned children and teenagers. [ABSTRACT FROM AUTHOR]

Introduction: The age of diagnosis is crucial for optimal health outcomes; however, some individuals with Autism Spectrum Disorder (ASD) may not be diagnosed until adulthood. Limited information is available about the lived experience of receiving a diagnosis during adulthood. Thus, we aimed to investigate stakeholders' experiences about the ASD diagnosis during adulthood. Method: We interviewed 18 individuals including 13 adults with ASD who had received a late diagnosis during adulthood and 5 parents of individuals with ASD from various Canadian provinces. Results: Using a thematic analysis, three main themes emerged: (a) noticing differences and similarities, (b) hindering elements to diagnosis, and (c) emotional response to diagnostic odyssey. Conclusion: This study adds to the literature about experiences of receiving ASD diagnosis in adulthood. Given the impact of diagnosis on individuals, it is important to minimize the barriers to ensure individuals who require ASD-related supports can access them in a timely and effective manner. This study highlights the importance of receiving an ASD diagnosis and facilitates positive health outcomes. The findings from the current study can be used to guide adult diagnostic processes and practices to help make ASD diagnosis more accessible. [ABSTRACT FROM AUTHOR]

Phenomenon: Transformative learning is a theory in which individuals construct new or revised interpretations of the meaning of an experience. COVID-19 offers a rare opportunity to better understand how individuals respond to and make meaning within the shared context of an extraordinary event. We aimed to examine if and how residents and fellows engaged in transformative learning when caring for COVID-19 positive patients during the initial peak of the pandemic (Spring 2020). Approach: We conducted an interpretive qualitative study to identify themes pertaining to transformative learning. We used semi-structured interviews of residents and fellows who were directly or indirectly involved in the care of COVID-19 positive patients admitted to the inpatient wards or the intensive care units during the first peak of the pandemic (defined as March 11th – May 28th, 2020) at our Mid-Atlantic academic health system. We used the medium of comics to depict select interviewees' experiences during the pandemic as a novel way to represent themes from the interviews. Findings: Three main themes arose from our qualitative analysis. These included "a sense of guilt," "the impact on training," and "venues and processes for reflection." In comparing their experiences with colleagues and friends at other institutions with higher COVID-19 case volume, trainees reflected on how they felt lucky, and this led to guilt, although not necessarily transformation. The impact of COVID-19 on the training environment had transformative potential. Trainees challenged their previously held assumptions on the necessity of various surgeries, in-person visits, and physical examination maneuvers when COVID-19 posed a barrier. Finally, while trainees recalled multiple situations throughout the pandemic when they believed they were engaging in reflection, such reflection did not appear to reach so deep as to alter participants' underlying assumptions until the research interview itself, suggesting that transformation was incomplete. Insights: Our purposive sample of residents and fellows who cared for COVID-19 positive patients during the initial peak of the pandemic made meaning of their experience in multiple ways. The largest shift in worldview due to the pandemic appeared to be related to the instrumental utility of certain common medical practices or procedures. This, in turn, was the most prominent influence on how these trainees felt they would practice in the future, and translated to a shift in how they appraised evidence. However, lack of opportunity for reflection may have adversely impacted the ability for transformation to take place. Given that multiple trainees showed appreciation for the critical reflection venue that was the research interview, academic leadership should ensure similar venues exist during training, even after the pandemic ends. [ABSTRACT FROM AUTHOR]

Objective: Loss of control (LOC) eating following bariatric surgery remains insufficiently understood, reflected in a lack of clear conceptualization, valid measurements, and effective treatments. This study explored patients' perspectives on LOC eating post‐bariatric surgery, focusing on the relevance of the Diagnostic and Statistical Manual of Mental Disorders‐5 (DSM‐5) indicators of impaired control, and patients' experiences before (precipitating factors), during (eating patterns, perpetuating factors), and after the episodes (strategies used to stop eating). Methods: This was a qualitative study using descriptive phenomenology. Participants were adults who have undergone gastric bypass or sleeve gastrectomy and self‐reported recent LOC eating. Data were collected by semi‐structured interviews and analyzed using a combined inductive and deductive approach. Results: Participants were all women (N = 15; age: 34.5 ± 9.2 years). Results suggested that (1) except for feeling disgusted, guilty, or depressed after eating, other DSM‐5 indicators did not seem to be highly relevant to this bariatric cohort; (2) LOC eating could occur across contexts, with food access, boredom, and food craving being consistent triggers; (3) the food amount consumed during a LOC episode was not necessarily considered excessive; (4) "mindlessness" and "satisfying hedonic, physiological, and mental needs" were the main perpetuating factors of LOC eating; and (5) self‐talk and distracting attention were the most adopted strategies to stop eating. Discussion: Study findings have implications concerning the conceptualization, measurement, and intervention of LOC eating among bariatric patients. For example, results suggested the need for more data to determine the appropriate indicators of LOC eating and the inclusion of boredom as an intervention target in bariatric patients. Public Significance: Loss of control (LOC) eating is characterized by a sense of being unable to stop while eating. LOC eating is prevalent in patients who have undergone weight loss surgery and is associated with worse surgical outcomes. This qualitative study that explored post‐bariatric surgery patients' experiences of LOC eating will inform efforts to better assess and intervene in this disordered eating behavior, thus ultimately optimizing patients' health following weight loss surgery. [ABSTRACT FROM AUTHOR]

Objective: Individuals with eating disorders (EDs) often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating) which maintains eating pathology. Maladaptive exercise has been theorized to help individuals with EDs regulate emotions by enhancing positive affect (PA) and reducing negative affect (NA) associated with binge episodes and poor body image. However, no research has considered the presence of non‐maladaptive exercise or evaluated this theory in binge‐spectrum EDs. Methods: This study evaluated affective trajectories pre‐ and post‐exercise and examined exercise type (maladaptive or non‐maladaptive) as a moderator. We recruited adults with binge‐spectrum EDs (N = 107; n = 84 endorsed exercise) to complete a 7‐ to 14‐day ecological momentary assessment protocol assessing NA (anxiety, guilt, and sadness), PA (excitement and cheerfulness), and exercise. Results: There was a significant quadratic trajectory of PA pre‐exercise, suggesting that the upward trajectory of PA leveled out as it moved closer to an exercise episode. Exercise type significantly moderated the cubic trajectory of PA post‐exercise, such that the upward trajectory of PA accelerated in the hours following non‐maladaptive exercise episodes while the downward trajectory of PA accelerated in the hours following maladaptive exercise episodes. No trajectories of NA demonstrated significant effects. Conclusions: Pre‐exercise trajectories of PA may reflect positive expectancies around exercise. Post‐exercise trajectories of PA suggest that non‐maladaptive exercise promotes increased PA. Future research should evaluate when, and for whom, exercise serves to regulate affect and examine other momentary risk factors of exercise in EDs. Public Significance: Individuals with EDs often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating). Maladaptive exercise has been theorized to help individuals with EDs regulate emotions. This study evaluated affective trajectories pre‐ and post‐exercise and examined whether exercise type (maladaptive or non‐maladaptive) changed these trajectories. Pre‐exercise trajectories of PA may reflect positive expectancies around exercise. Post‐exercise trajectories of PA suggest that non‐maladaptive exercise promotes increased PA. [ABSTRACT FROM AUTHOR]

There is increasing research interest in the experiences of new fathers taking paternity leave, but less insight into men's experiences of returning to work after the birth of their first baby. For many men in the UK context, this could take place immediately after the birth or after one or two weeks of paternity leave. This paper utilizes data from a UK-based study whilst also drawing on international literature and policy contexts. A constructivist grounded theory method was adopted to generate theory from the data gathered. Twelve new fathers shared their experiences in this study by participating in audio-recorded, semi-structured interviews. This paper focuses on fathers' experiences of negotiating the workplace as part of an overall theoretical framework related to broader transitions to fatherhood and sheds light on the distress, guilt and psychological challenges that the participants experienced when they initially returned to work. Whether fathers did or did not explicitly describe distress at this time, they all described a change in their worker identity, which for some participants led to uncertainty in the workplace. Men returning to work at this time in the postnatal period are vulnerable to experiencing distress. Flexibility and support in the workplace could be protective of their mental health. Finally, policy and practice developments are offered to support men's transitions to fatherhood in the workplace context. [ABSTRACT FROM AUTHOR]

This qualitative study aimed to discover whether experiences of sexual violence suffered by a sample of adolescents and young-adults at a Brazilian public health had been disclosed or detected, why or why not, and what happened after disclosure or detection. Seventy-one (8.3%) students were victims of sexual violence, and 52 (73.2%) were females. The researchers interviewed 22 participants to obtain an oral history of these abuse experiences. The 22 interviewees had experienced 29 episodes of violence. Acquaintances had perpetrated 26 of these attacks, and of these 26 only four (15.4%) occurrences were never disclosed. Twenty-two experiences were disclosed or detected, of which four (18.2%) were promptly revealed (days after the event), resulting in a discontinuation of the violence. Unfortunately, molestation continued without intervention in nine (41.0%) of the revealed situations, despite disclosure or detection. The authors find that children or adolescents disclosing their experiences of sexual violence cannot end the attacks. This study identifies an urgent need to educate society about how to respond appropriately to revelations of sexual violence. Children or adolescents must be oriented to disclose their abuse and seek help from as many people as necessary until they are heard, believed and the violence is ended. [ABSTRACT FROM AUTHOR]

Work-family guilt (WFG) is sometimes perceived as an adaptive characteristic, since it has been found to encourage working parents to engage in more activities with their children in off-work time (Cho & Allen, 2012). However, while it may be an adaptive characteristic for the parent-child relationship, the same may not be true for parents' psychological health. Using insights from the work-home resources model (W-HR), this study aims to determine WFG's influence on parents' life satisfaction. This study also investigates if parents' belief regarding the investment of their spouse in recreational activities with their children is a resource that could foster their life satisfaction. A cross-sectional design was used with a sample of 289 working parents with at least one child aged between 5 and 10. A path analysis shows a significant moderated mediation model. Parent-child activities were found to partially mediate the relationship between strain-based work interference with family and parents' life satisfaction. Furthermore, WFG moderated this mediation. Specifically, it worsened the detrimental effect of doing fewer parent-child activities on parents' life satisfaction. Results also show that a spouse's investment in activity with their child is a resource that motivates parents to invest more in their children and directly contributes to parents' life satisfaction. Highlights: Level of parental engagement mediates the link between strain-based work interference with family and life satisfaction. High work-family guilt combined with low parent-child activities is detrimental to parents' life satisfaction. High spouse-child activity has a direct and indirect positive relationship to parents' life satisfaction. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to explore and describe the mothers' perspectives on issues associated with caring for Ghanaian children aged 0–14 years living with tuberculosis. Design: Exploratory descriptive qualitative design. Methods: Semi‐structured individual interviews were conducted face to face with 15 purposively sampled mothers from two health facilities in the Greater Accra area. Transcribed data were analysed using computer‐enhanced thematic analysis. Results: Findings were grouped into (1) physical burden on the mothers and (2) psychological burden on mothers. The eight subthemes indicate that mothers of children living with tuberculosis experienced tiredness, sleeplessness, body pains, weight loss and sicknesses as they cared for their children. In addition to worrying, mothers experienced stigma and negative emotions such as sadness, guilt, fear and loneliness. Conclusion: Mothers of children diagnosed with tuberculosis in Ghana experience physical and psychological health problems related to their caregiving roles. Nurses and other healthcare providers should identify specific problems and offer broad‐based emotional and other support for these women. [ABSTRACT FROM AUTHOR]

Background: Participation in physical activity improves health in individuals with congenital heart disease. However, most do not sufficiently engage in physical activity. The aim of this study was to collect information regarding the experiences of adolescents with congenital heart disease who practiced physical activities. Methods: French adolescents aged 13–18 years, diagnosed with congenital heart disease, class I or II dyspnoea on the NYHA scale and authorized physical activity were interviewed individually about their physical activity experiences using a semi‐structured format. The qualitative interview transcript data were analysed using a phenomenological approach; data analysis was performed independently by three researchers and merged at each step until saturation. Results: Eleven adolescents with congenital heart disease participated. Three main themes emerged: 'own representation', 'physical activity (PA) set‐up' and 'environment'. Adolescents had a generally positive view of physical activity, which was associated with positive experiences. However, they reported that their physical condition limited PA, and they wished for adapted activities. The results revealed the importance of environmental factors, for example, within the social and school environments. The participants indicated that they appreciated the social interactions that PA afforded, but that integration into a group could be difficult, especially in school, with some participants describing feelings such as anxiety, frustration or guilt when they could not participate fully. PA facilitators included familial support. However, participants noted a lack of clear medical guidance to help them choose suitable activities based on their circumstances and personal preferences. They wished for the public to be better informed about congenital heart disease to reduce stigmatism. Conclusions: This study provides valuable information for clinicians, physical educators and policy makers to help them promote physical activity and support adolescents and their families in understanding their own condition, maximizing their potential and in their choice of activities. [ABSTRACT FROM AUTHOR]

Objective: To understand the mechanisms of mindfulness' impact on migraine. Background: Promising mindfulness research demonstrates potential benefit in migraine, but no data‐driven model exists from the lived experiences of patients that explains the mechanisms of mindfulness in migraine. Methods: Semi‐structured qualitative interviews were conducted with adults with migraine who participated in two mindfulness‐based stress reduction (MBSR) clinical trials (n = 43). Interviews were audio‐recorded, transcribed, and summarized into a framework matrix with development of a master codebook. Constructivist grounded theory approach was used to identify themes/subthemes. Results: Participants who learned mindfulness techniques through MBSR experienced altered pain perception, altered response to migraine attacks and disease, increased awareness of external and internal experiences, improved overall well‐being, and group benefits. Mindfulness resulted in earlier stress‐body awareness and increased interoceptive awareness resulting in earlier attack recognition, leading to earlier and more effective management. Interictal factors of self‐blame, guilt, and stigma decreased while migraine acceptance, hope, empowerment, self‐efficacy, and self‐compassion increased. Improved emotion regulation resulted in decreased fear of migraine, pain catastrophizing, anticipatory anxiety, and pain reactivity. Although taught as prevention, mindfulness was used both acutely and prophylactically. We created a conceptual model hypothesizing that MBSR skills led to an infusion of mindfulness in daily life, resulting in altered pain perception and experience, ultimately leading to improvement in overall well‐being, which may positively feed back to the infusion of mindfulness in daily life. The therapeutic benefit of learning mindfulness in a group setting may moderate these effects. Conclusions: This study identified several new potential mechanisms of mindfulness' effect on migraine. After learning MBSR skills, participants reported altered pain and migraine perception and experiences. Increased stress‐body and interoceptive awareness resulted in earlier migraine awareness and treatment. Mindfulness may target important interictal factors that affect disease burden such as fear of migraine, pain catastrophizing, and anticipatory anxiety. This is the first data‐driven study to help elucidate the mechanisms of mindfulness on migraine from patient voices and can help direct future research endeavors. [ABSTRACT FROM AUTHOR]

BACKGROUND : Pregnant women are one of the special groups most affected by the COVID-19 pandemic. The aim of this study was to analyze how the COVID-19 pandemic influenced the feelings, thoughts, and behaviors of pregnant women. METHOD : A descriptive phenomenological approach was employed to explore the experiences of 15 pregnant women. Data were gathered by using semi-structured interviews focusing on pregnant women's feelings, thoughts and behaviors. Word cloud analysis and content analysis were performed. FINDINGS : Data analysis revealed three main themes: emotions, hardships, and coping. Emotions were grouped into five categories: fear, anxiety, disappointment, loneliness, and regret. Hardships were grouped into two categories: physical and financial. Coping was grouped into four categories: social support, normalization, religious practices, and positive thinking. According to word cloud analysis, the most frequently mentioned words were pregnant, COVID-19, anxiety, fear, positive thinking, hardships, regret, stress, affect, and alone. CONCLUSIONS : Women experienced feelings of fear, anxiety, disappointment, loneliness, and regret in the prenatal period. They also faced physical and financial hardships and benefited from social support, normalization, religious practices, and positive thinking to cope with these hardships. [ABSTRACT FROM AUTHOR]

Men's emotions in intimate partner relationships have received little research attention. The current interpretive descriptive study included 30 Canadian‐based men to address the research question: What are the connections between masculinities and men's emotions in and after intimate partner relationships? Three inductively derived themes included emergent distressing emotions wherein participants' predominance for holding in abeyance their concerns about the relationship manifested varying levels of emotional stoicism. Within this context most men denied or downplayed and did not express their emotions. When the relationship broke, men were overwhelmed by mixed and weighty break‐up emotions comprising diverse and often‐times discordant emotions, including sadness, shame, anger, regret and guilt, calling into question men's rationality for deciphering and expressing what was concurrently but inexplicably felt. Shame and anger were prominent emotions demanding the participant's attention to all that happened in and at the end of the relationship. In the third theme, understanding and transitioning after‐burn emotions, participant's grief levered their efforts, including soliciting professional help for deconstructing, reframing and expressing their emotions in the aftermath of the partnership ending. The findings contextualise and in some instances counter claims about the utility of men's emotional stoicism by mapping participants' feelings in and after intimate partner relationships. [ABSTRACT FROM AUTHOR]

The purpose of the authors in this paper is to investigate the effects of negative experiences during delivery and postpartum period on the relationship between the mother. The quantitative part of this study was conducted with 289 mothers and the qualitative part with 40 mothers. It was found that experiencing upsetting problems during delivery (p = 0.006) and in the postpartum period (p = 0.002) had an effect on separation anxiety. Based on the examination of the feelings experienced during annoying or distressing situations in the postpartum period, it was determined that there was a significant correlation between guilt (p = 0.000), fear of not being a good mother (p = 0.035), and feeling weak (p = 0.001) and separation anxiety. Blues of birth is fear and anxiety that the baby will be harmed if the mother is separated from it, and it is attributed to negative experiences during delivery and the postpartum period. [ABSTRACT FROM AUTHOR]

Objective Families with mentally-retarded children need more support than other families in overcoming crises and achieving social adjustment. So, it seems necessary to pay special attention to these families durinzg the COVID-19 pandemic and identify their experiences and challenges to provide more support for this vulnerable group. Therefore, the present study was carried out in care centers under the supervision of the Tehran state welfare organization of Iran (SWO) during the COVID-19 pandemic to identify the challenges of families with mentally retarded children. Materials & Methods The present study was conducted with a qualitative approach and contractual content analysis method of Granheim and Lundman (2004). The participants were 18 families with mentally-retarded children living in care centers under the supervision of the Tehran State welfare organization of Iran (SWO), who were selected by purposive sampling. Sampling was continued until data saturation. Data were collected and analyzed using in-person or online (telephone) in-depth semi-structured interviews from July 11 to September 22, 2021. To evaluate the data strength, four criteria of credibility, transferability, dependability, and confirmability of Guba and Lincoln were used. Results Based on data analysis, 6 main categories and 23 subcategories were obtained. The main categories and subcategories included 1) constant worry about their children getting COVID-19 (inability of the child to protect against coronavirus, not observing protocols by the staff, underlying diseases and deficiency in immune system, few preventive measure for under 18 years people, conflicting information about children and adolescents' infection), 2) disconnection and intensification of stress (agitation and irritability of the disabled, worry about the future, parent's mental confusion, fear of losing child), 3) conflict with family tensions and contradiction (intensification of family guilt, overlooking other children, couple's self-blaming, tension in family interactions, intensification of family melancholia), 4) non-supportive community (further social stigma, social exclusion, lack of supporting vulnerable groups, the limitations of social distancing), 5) family economic crisis (costs of keeping child in the center, losing job and lower income of the family head, poverty and intensification of unstable economic conditions), and 6) care and educational concerns (decreasing the quality of care for the disabled, suspension of rehabilitation and educational activities, restrictions on leisure activities and communication for the disabled). Conclusion The results showed that the families of mentally-retarded children had encountered many challenges and concerns during the COVID-19 epidemic, some of which were related to the intensification of psychological pressures and some due to insufficient support from governmental and non-governmental institutions for these families. The study findings can be used to provide services and design support programs and policies for children with mental disabilities and their families. In this regard, it is recommended to pay special living allowances, strengthen the communication system between parents and children living in care centers, prepare a care and health packages for parents, design and implement psychological interventions to reduce parents' anxiety and stress, and provide free counseling. [ABSTRACT FROM AUTHOR]

Exposure to violence in childhood and adolescence may lead to negative self-identity construction in young women. These phenomena are exacerbated in the context of Arab young women, who belong to both a national minority in Israel and to a gender subject to exclusion, oppression, and discrimination in society in general and in Arab society in particular. The aim of this qualitative study was to examine how Arab young women abused in childhood construct their self-identity within their gender, cultural, class, and national context. The study was based on 20 semi-structured interviews with Arab young women in Israel, who were victims of violence in childhood (aged 18–26). Construction of self-identity, as described by participants, included: harmed self (self under guilt; lack of confidence in one's abilities and giving up; insecure self; belittling of self); self divided between loyalty to the family and society and a desire for self-realization; the self versus the other. In addition, some participants, later in young adulthood, were able to change their perception of self and see themselves as capable, strong, and not guilty of the violence directed against them. These women transitioned from absent to present femininity. The study provides a broader definition of self-identity construction among young women abused in childhood, including Arab young women in Israel in their intersecting contexts and the limitations imposed by multiple marginality. This broader understanding enables the design of context-informed therapeutic intervention practices. [ABSTRACT FROM AUTHOR]