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The world population is ageing, and China is no exception. The Chinese government attaches great importance to older adults' mental health in the increasingly ageing society. This study adopts a qualitative research approach to investigate how Narrative Therapy is applied from three dimensions in geriatric social work in the Chinese Mainland. There follows a discussion of the relationship between the three dimensions. It concludes with a recommendation on how to improve indigenization and specialization and build an evaluation tool combining qualitative and quantitative modes to promote better application in geriatric social work. [ABSTRACT FROM AUTHOR]

Introduction: There still remains a significant gap in understanding the sexual and reproductive health challenges faced by adolescents, particularly in the context of early sexual activity, teenage pregnancy, and sexually transmitted diseases. This study seeks to fill this gap by exploring the initial sexual experiences of Cambodian adolescents, highlighting the complex interplay of cultural, social, and personal influences that shape their sexual health decisions and outcomes. Methodology: A descriptive qualitative research design was used. Thirty Cambodian adolescents were interviewed from March to June 202 and data were analyzed using thematic analysis. Results: Participants met their sexual partners in school and through friendships and social networking sites. Their motivations for sexual activities ranged from intrinsic desires to influences of inebriation, love, and trust. Consent was crucial but some were influenced by partners. Awareness of sexual protection varied, affecting condom use and information-seeking behaviors. After initial encounters, participants grappled with complex emotions and physical changes. Discussion: The findings suggest the need for educational interventions that address substance use; promote safe behavior, consensual conduct, open communication, and mutual respect; and provide coping strategies. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to gain insight into the facilitators, barriers, and support needs of Dutch self-employed workers when returning to work (RTW) after sick leave. Methods: Three focus groups were conducted, involving 15 Dutch self-employed workers who were on sick leave due to health problems. The transcripts were analyzed through thematic content analysis. Results: Five main themes regarding barriers, facilitators, and needs of self-employed workers to RTW were identified: autonomy, social support, client management, financial security, and information on sick leave. Having autonomy was considered a facilitator for RTW. However, the participants expressed a need formore financial support, additional guidance from occupational health professionals, and tailored information regarding RTW. Conclusions: The results of this study emphasize a need for optimizing national policy and support for self-employed workers regarding sick leave and RTW. [ABSTRACT FROM AUTHOR]

Background : Tractors and quad bikes pose a significant risk of fatal injuries among farmers, particularly affecting older farmers. This study aimed to explore the barriers and facilitators to the adoption of machine related safety behaviors among older farmers in Irish farm settings. Method: Four focus groups were conducted via Zoom in February 2021. Nineteen Irish farmers from four farm types participated. The discussions were audio-recorded, transcribed verbatim, and analyzed using an inductive, reflexive thematic analysis approach. The themes identified were then mapped to the COM-B (Capability-Opportunity-Motivation) model, providing a systematic theoretical basis for designing a future intervention to reduce machine-related accidents. Results: The analysis identified five inductive themes that encompassed both barriers and facilitators in farm safety practices: (1) Capability to manage competing responsibilities; (2) Characteristics of the farm and its work environment; (3) Availability and affordability of resources; (4) Prevailing sociocultural opportunities; and (5) Perceived likelihood and cost-benefit analysis in safety decision-making. These themes captured the complex interplay of capability, opportunity, and motivation in farmers' decision-making processes. The study also revealed limitations in existing interventions, such as voluntary guidelines and educational methods, in effectively addressing these barriers. Conclusions: Farmers' abilities (capability), prevailing sociocultural factors, resource availability (opportunity), and their perceived consequences and benefits (motivation) affect how safely they work with machines. The study emphasizes the need for comprehensive, theory-driven approaches that consider the interplay of capability, opportunity, and motivational factors that may support or impede machine safety. Understanding the challenges faced by Irish farmers highlights potential strategies for safety intervention, and these strategies should be co-designed with farmers and attentive to the local context. Practical applications: The study provides a template for understanding farmers' perspectives using the COM-B model. The findings can inform the development of theoretically informed intervention strategies based on the Behavior Change Wheel framework. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals (HCPs) face a myriad of ethical challenges during the coronavirus disease 2019 (COVID-19) pandemic. However, there is limited literature examining the ethical challenges faced by HCPs in low- and medium-income countries. The research was designed to explore the ethical challenges experienced by HCPs in a Malaysian hospital setting during the pandemic. Methods: Semistructured interviews were conducted via video calls with 10 Malaysian HCPs across different clinical disciplines involved in managing patients diagnosed with COVID-19 infections. The calls were audio-recorded, transcribed verbatim and checked. Thematic analysis with constant comparison across transcripts was carried out to identify categories and themes. Results: Three main themes emerged. Firstly, there was deprioritisation of care for non-COVID-19 patients resulting from resource limitations. HCPs raised concerns that there was curtailed access to various healthcare services by non-COVID-19 patients. There was also a trade-off between protecting individual patient safety and public health interests. Secondly, patients were disempowered from decision-making; the decision to segregate suspected COVID-19 patients to high-risk areas without seeking patients' approval may result in an increased risk of infection. Lastly, HCPs expressed internal conflicts when balancing the professional duty of care against concerns about contracting COVID-19 and spreading it to their family members. Conclusion: The study highlighted ethical issues faced by HCPs in Malaysia during the pandemic. It underscores the need for clinical ethics consultation services in hospitals to navigate the various ethical dilemmas. [ABSTRACT FROM AUTHOR]

Objective: To explore their perceptions and attitudes toward condom use and the underlying reasons for the low usage frequency among Chinese older adults. Methods: A qualitative study design utilizing interpretive phenomenological analysis was employed. Data were collected through field observation and face‐to‐face in‐depth interviews among older adults aged 50 years or above and having engaged in sexual activities within the previous year. Results: Three main themes emerged: perceiving unnecessary due to misconceptions and low awareness, interactive stereotypes rooted in sociocultural beliefs, and stigmatized social norms including gender inequity and economic unbalance. Conclusions: Tailored interventions focusing on addressing misconceptions, increasing awareness, and reducing culturally ingrained stereotypes and stigma surrounding condom use are essential to promote condom use among older adults in order to prevent HIV transmission in China. [ABSTRACT FROM AUTHOR]

Objectives: This qualitative study aimed to comprehend the psychological well-beings and available interventions of current Chinese infertile patients, as well as investigate more integrated and effective patient support interventions, if necessary. Background: It is well known that infertility is a difficult struggle. Assisted reproductive technologies (ART) provide patients with the hope of having a child, but they also cause them pain and stress. There is a dearth of research on the mental health of infertile patients, particularly in developing nations such as China. Method: Individual interviews were conducted with eight experienced clinicians at the Reproductive Medicine Center from five different hospitals. On the basis of the grounded theory, interviews were transcribed and recursively analysed with the NVivo 12 Plus software by a research team. Results: 73 categories were created, which were then grouped into 12 subthemes that were combined to form the following themes: Theme I: Psychological Distress; Theme II: Sources of Distress; Theme III: Protective Factors; and Theme IV: Interventions. Conclusions: The themes of subjective experience identified in the study reveal infertile patients' emotional disturbance and resources of distress, consistent with previous related studies. Despite limitations such as the relatively small number of participants and the exclusively self-report nature of qualitative study, the findings of the study imply the importance of emotional and physical support networks for infertile patients at Reproductive Medicine Centers, consistency of psychological awareness and adequate professional supports. [ABSTRACT FROM AUTHOR]

Objective: To explore how clients in psychodynamic or psychoanalytic psychotherapy, conducted in the traditional in-person setting, experience the transitions in time and space between psychotherapy sessions and everyday life. Method: Twelve semi-structured interviews were analyzed with inductive experiential thematic analysis, focusing on how the participants experience and make sense of the phenomenon in focus. Results: The participants described therapy as a sheltered space where they could be open, vulnerable, receptive, and present. Approaching and leaving psychotherapy sessions, the participants established different behavioral patterns and routines dealing with their anxieties and resistances. In this in-between area, the participants could handle interconnections and differences between therapy and everyday life. Participants stressed the clinical impact of transitions: transitions affect both therapy and everyday life; disturbed transitions have an adverse impact; transitions are insufficiently addressed in therapy. Conclusion: Transitions between therapy and life appear to be an essential but seldom recognized part of the therapy process beyond the borders of therapy sessions. Implications of these findings for psychotherapy training and practice are discussed, and a tentative transtheoretical framework for further research is proposed. [ABSTRACT FROM AUTHOR]

It is assumed that many adolescent gamers who play intensively are highly engaged rather than problematic gamers and that they mostly do not experience negative consequences. This study aimed to explore how highly engaged adolescent gamers integrate gaming into their lives, how they experience gaming motivation, and how they view the effects that gaming has on them. Semi-structured interviews were conducted with 37 adolescent gamers who played intensively and attended high schools. The interviews were analysed with thematic analysis and two main themes were extracted from the data: The integration of games into one's life and What drives adolescent gamers to play. Adolescent gamers were found to be active integrators of gaming into their lives, mostly managing to balance gaming with other daily activities and tasks. Although a few of them experienced problematic gaming, they managed to recover, and were generally aware of the dangers. Gaming was purposeful and useful for them, for example for socialising, competition, learning English, becoming more 'tech-savvy', and coping with everyday stress. However, it was important for them to engage in other purposeful activities in addition to gaming and not to use gaming as an exclusive coping tool. Theoretical and practical applications are laid out. [ABSTRACT FROM AUTHOR]

Background: With frequent conflicts, natural disasters, and public health emergencies globally, mobile medical teams (MMTs) are becoming increasingly critical. Importantly, the competency of critical care nurses in MMTs can substantially affect the effectiveness and quality of its rescue efforts. Yet, these nurses' competencies are not well understood. Aim: This study examined the competencies of critical care nurses in MMTs using the Onion Model. Study Design: A qualitative descriptive method was used to describe the competencies of Chinese MMT critical care nurses. From April to May 2022, a convenience sample of 18 participants (14 critical care nurses and 4 surgeons) from 10 MMTs was recruited for semi‐structured interviews. Deductive and inductive coding methods were combined for content analysis. Results: In total, 29 competencies were identified, which were grouped into four major domains using the Onion Model. From the outer to inner layers, these domains were knowledge and skills, professional abilities, professional quality, and personal traits. Several novel competencies emerged, including field medical equipment operation skills, on‐site hazard identification and safety prevention skills, triage knowledge, and field survival skills. Conclusions: Using the Onion Model, this study furthers the understanding of the competency of critical care nurses in MMTs, especially by revealing the novel competencies. Further, the results can be used to recruit, evaluate, and train critical care nurses for MMTs. Relevance to Clinical Practice: Understanding MMT critical care nurses' competencies can help managers plan and provide relevant training and education before deployment, which can improve nurses' performance, and especially reduce the mortalities and disabilities from trauma. [ABSTRACT FROM AUTHOR]

Purpose: The patient-centered communication principles in Western countries are widely esteemed. In Eastern countries, a family-centered approach to medical decision-making is preferred. However, the predicaments faced by attending physicians and their coping strategies in the process of truth-telling about cancer are unknown. Therefore, this study aimed to understand attending physicians’ predicaments and coping strategies in implementing truth-telling for cancer in Taiwan. Methods: This study used a qualitative description approach to conduct in-depth interviews with attending physicians. Data were collected from two medical centers in Taiwan. Purposive sampling was also conducted. A total of 17 attending physicians participated in individual semi-structured interviews. All interviews were audio recorded and transcribed verbatim. Inductive content analysis was used to analyze and develop the subcategories, generic categories, and main categories. Results: Four main categories emerged: (1) Causing harm to the patient: Family members’ cooperation is needed. (2) Family members’ request to conceal the truth: Physicians should judge based on the patient’s disease condition. (3) Delayed treatment: Physicians should prioritize establishing confidence. (4) Delivering bad news about relapse: Physicians have different coping strategies. Conclusion: Physicians in Taiwan face challenges but prioritize family-centered care despite having coping strategies to protect patients. When faced with a scenario in which family members request concealment of truth, most physicians cooperate with them to determine the level and method of disclosing unfavorable news to patients. Physicians should prioritize patients’ psychological needs when they experience relapse or metastasis or face strong negative emotions. [ABSTRACT FROM AUTHOR]

Aims: To explore how parents experienced their child with delirium and how parents viewed our delirium management bundle. Design: We conducted a qualitative exploratory descriptive study using semi‐structured individual or dyad interviews. Methods: Twelve semi‐structured interviews with 16 parents of 12 critically ill children diagnosed with delirium in a paediatric intensive care unit were conducted from October 2022 to January 2023 and analysed through a reflexive thematic analysis. Findings: We generated five themes: (1) knowing that something is very wrong, (2) observing manifest changes in the child, (3) experiencing fear of long‐term consequences, (4) adding insight to the bundle, and (5) family engagement. Conclusion: The parents in our study were able to observe subtle and manifest changes in their child with delirium. This caused fear of lasting impact. The parents regarded most of the interventions in the delirium management bundle as relevant but needed individualization in the application. The parents requested more information regarding delirium and a higher level of parent engagement in the care of their child during delirium. Impact: This paper contributes to understanding how parents might experience delirium in their critically ill child, how our delirium management bundle was received by the parents, and their suggestions for improvement. Our study deals with critically ill children with delirium, their parents, and staff working to prevent and manage paediatric delirium (PD) in the paediatric intensive care unit. Reporting Method: The consolidated criteria for reporting qualitative research guidelines were used to ensure the transparency of our reporting. Patient or Public Contribution: No patient or public contribution to the research design. What does this Paper Contribute to the Wider Global Community?: ‐ It increases awareness of the parent's perspective on PD in critically ill children.‐ It shows how PD might affect parents, causing negative emotions such as distress, frustration, and fear of permanent damage.‐ It shows that the parents in our study, in addition to the care bundle, requested more information on delirium and more involvement in the care of their delirious child. [ABSTRACT FROM AUTHOR]

Prior studies on Japanese parents raising children with developmental disorders have predominantly emphasized negative psychological aspects like parenting conflicts and challenges. Purpose of this study was to construct a conceptual model to aid mothers in parenting children with developmental disorders by identifying effective parenting strategies. In this qualitative study, participants were mothers who engaged in a home program through individual outpatient occupational therapy. Therapy sessions occurred biweekly, totaling 12 sessions, each lasting 40 min. Data collection involved semi-structured interviews, and the data were analyzed through the Modified Grounded Theory Approach. Analysis of mothers' narratives revealed heightened physical burden, psychological distress, severe stress, and social isolation. Our findings highlight those mothers who engaged in the home program navigated the intricate parenting landscape through problem-solving, including managing negative emotions, their demanding schedules, and societal norms. This study offers insights into the perceptions, experiences, and behaviors of families in supporting the development of parenting strategies within the family. Occupational therapy should prioritize evaluating a mother's parenting context and her interactions with her environment. Furthermore, it is crucial to provide support for her to independently formulate suitable parenting strategies that resonate with the specific circumstances of her family. [ABSTRACT FROM AUTHOR]

The aim of this qualitative study, nested in a randomized controlled trial, was to assess the mechanisms of the effects in both arms through examining perceptions of the participants about changes in their drinking behavior and their attributions for any perceived changes. We conducted semi-structured interviews with a sub-sample of trial participants. We used thematic analysis to analyze the data. Self-perceived change, mostly positive, was reported regardless of the objectively measured remission status. Participating in the trial itself was a major catalyst for change. Participants in both arms used a variety of similar strategies to make these changes; additionally, for those who received the intervention, both the style of the counselor (for example, the non-judgmental stance) as well as specific elements of the intervention were seen to influence change in drinking behavior. Absence of self-reported change was relatively uncommon and primarily related to the felt need for alcohol (e.g., drinking was perceived to be necessary to maintain good health), or the belief that one did not need to or want to change. Experiences of participating in a trial, the counselor style, and specific elements of a brief psychological treatment, play a role in influencing change in harmful drinking behaviors. • Positive change may be reported in the absence of objectively measured remission. • Trial procedures themselves become a major catalyst for modifying drinking behaviors. • Counselor style and specific elements of the intervention influence change in drinking. [ABSTRACT FROM AUTHOR]

Preschool is a particularly opportune time to introduce measures that promote parental school-based involvement, as this is when the initial contact with the school is made. In Québec, a French-speaking province in Canada, voluntary school-based preschools for 4-year-olds have been offered to families in disadvantaged neighbourhoods. A component for parents comprised of 10 activities was developed specifically to promote parent involvement from the beginning of their child's schooling. However, some parents are more likely than others to encounter barriers that curtail their participation in these activities. Seventeen teachers working in preschools for 4-year-olds in targeted areas and 25 of their parents participated in this qualitative study. The study's objective was to identify the barriers to participation among parents whose involvement in school activities during the school year was low. Based on Hornby and Lafaele's conceptual model, a phronetic iterative analysis was used to describe the experiences reported by teachers and parents. Finally, the four main findings emerging from this study were formulated, and avenues for reflection by school-based preschool personnel were put forward. [ABSTRACT FROM AUTHOR]

Background: The rationale for screening for cardiovascular disease (CVD) is debated as a prevention strategy. However, research shows that when preventive medication is initiated after screening for CVD, mortality rates decrease, especially among men. When implementing screening programmes, facilitating citizens' informed decisions and empowering their autonomy in the decision‐making process are crucial. We therefore aimed to explore citizens' perspectives on and decisions regarding initiating cardiovascular preventive medication for screen‐detected CVD. Methods: We employed an exploratory qualitative design using semi‐structured interviews to investigate participants' perspectives on and decisions regarding initiating cardiovascular preventive medication for screen‐detected CVD. Twelve interviews were conducted and analysed using thematic analysis following Braun and Clarke's six‐step approach. Findings: We found one overall theme, Being on a continuum between wellness and illness, with two underlying sub‐themes. Sub‐theme (1) Navigating mixed feelings and pathways reflects participants' perspectives on CVD preventive medication, which were positioned on a continuum with shifting perspectives. The state between wellness and illness was experienced as liminal and characterised by uncertainty and concerns about CVD risk. (2) Navigating medication decisions: a negotiated process. Pivotal medical decisions hinged on trust in authorities or own judgement, influenced by attitudes towards the need for medication, perception of meaningfulness, asymptomatic condition, age, family responsibility and predisposition. Participants' medical decisions were supported and impacted by significant others. Conclusion: We uncovered a continuum of shifting perspectives ranging from feeling improved health to experiencing fear of CVD. For certain citizens, it is like navigating between these contrasting feelings. The perceived necessity and meaningfulness, in particular, shape medical decisions. Providing support for informed decisions is crucial and includes significant others. Shared decision‐making with healthcare professionals as facilitators is needed. Future research is warranted to investigate how to embrace the various perspectives on initiating CVD preventive medication in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Disease‐related malnutrition is prevalent among hospitalised patients, but not all patients achieve the needed nutritional care. At a Danish University Hospital, focus has been on implementing nutritional practices based on clinical guidelines, but there is continuously variation between the wards regarding the quality of nutritional care. Aim: The aim of this study was to identify the potential barriers and facilitators for implementation of the clinical guidelines for nutritional practices and to recommend suggestions for development of nutritional practices, using a theoretical implementation strategy. Method: The design was a qualitative interview study of employees at a Danish University Hospital, using a semi‐structured interview guide. The participants were nurses, nurse's assistant, nurse nutrition expert, head nurse and dieticians. We recruited 11 employees, representing eight different wards. Findings: The analysis identified six themes: (1) clear allocation of responsibilities and committed management enhances nutrition practices, (2) leadership support is essential, (3) physical settings and tools affect possibilities for action, (4) selection of equivalent staff is core, (5) teaching promotes the knowledge and skills and (6) a dietitian in the ward facilitates implementation of nutritional care. Barriers and facilitators among the themes were identified and has led to suggestions to strengthen nutritional care, based on implementation theory. Conclusion: Various factors were identified as having impact on the implementation of nutrition practices and different suggestions have emerged to accommodate those factors, as well as to apply an implementation strategy to facilitate change in practice. [ABSTRACT FROM AUTHOR]

Introduction: Medical errors are among the most important factors that threaten patient safety. Therefore, nurses' perspectives and experiences about medical errors are important for this manner. Aims: The aim of this study was to determine in depth the perspectives and experiences of nurses related to how they define medical error, as well as its causes, management and reporting. Design: This descriptive, exploratory study involved a qualitative design. Methods: A total of 15 clinical nurses from eleven provinces were reached by snowball sampling method. In the study, nurses' perspectives on medical errors were obtained through semistructured in‐depth online interviews conducted based on phenomenological methods. Descriptive analysis was used in the analysis of the data obtained from the interviews. The research was conducted following the COnsolidated criteria for REporting Qualitative checklist. Results: The resulting 26 codes were categorized under seven themes: "Definition of medical error", "Experience of medical errors", "Frequency of medical errors", "Causes of medical errors", "Reporting of medical errors", "Medical error approach" and "Prevention of medical errors". Conclusions: The results show that it is still necessary to increase the awareness of nurses about medical errors and the importance of error reporting. In addition, it reveals the need for leadership to eliminate the negative approach to medical errors and shows that nurse managers should be empowered accordingly. Implications for Nursing Practice and Policy: It is the first step of quality and safe care to reveal nurses' perspectives on medical errors, their thoughts about medical errors and their experiences about errors in their institutions. In this study, nurses' knowledge, opinions and experiences regarding medical errors were revealed in this qualitative study. Therefore, this study offers important clues to nursing services, hospital managers and policy makers for clinical and institutional arrangements. [ABSTRACT FROM AUTHOR]

Although opportunities for online learning in higher education have increased, variations in the quality of online teaching are likely. Instructors at some institutions might be new to online teaching and/or may lack the necessary supports for creating successful virtual learning environments. Therefore, the purpose of this qualitative study was to identify the most valuable skills faculty need to teach successfully online. Instructors (N = 33) with ten or more years of online teaching experience at a highly ranked institution for online education were interviewed about their online teaching experiences. Participants’ responses to the question, “What skills do you think are most valuable for online instructors to have?” were analyzed using a grounded-theory approach with six major themes emerging. These themes are discussed within existing frameworks that have shaped the conceptualization of online teaching skills, including the Community of Inquiry framework (COI), the faculty readiness framework, and the Technology Acceptance Model. [ABSTRACT FROM AUTHOR]

Based on the involvement of qualified educators in its design, the Learning-by-Concordance tool aims to promote the learning of reasoning in contexts of uncertainty. However, data are still scarce on the experience of educators in terms of sharing and exposing their reasoning processes using this tool. This study sought to explore the beliefs and experiences of educators when involved in the design of a Learning-by-Concordance tool. This research used a descriptive qualitative design. Four dialogue groups were conducted with educators with different roles and responsibilities while designing a Learning-by-Concordance tool. A descriptive interpretative analysis of educators' verbatim quotes was done. A total of 14 participants took part in the study. The results show the discomfort of educators despite their recognized expertise. Three themes emerged: 1- the need to be reassured by the opinions of colleagues; 2-feeling like impostors; and 3- concerns for the quality of instructional supports. The role taken by educators for teaching reasoning in contexts of uncertainty is to draw on practical experience where different types of knowledge intersect and are mobilized, to overcome feelings of insecurity, and to engage in close and authentic conversation with learners. • Little is known about how to teach reasoning in contexts of uncertainty. • Learning-by-Concordance tool specifically targets this cognitive task. • Educators feel uneasy when designing a learning tool for contexts of uncertainty. [ABSTRACT FROM AUTHOR]

This study aimed to explore the experiences of Jordanian mothers of children with cerebral palsy (CP) in order to better understand the challenges they face while caring for their children. A qualitative descriptive study was applied, using semi-structured face to face interviews with a purposive sample of 10 mothers of children with CP. Mothers caring for children with CP embark on a challenging journey. Navigating the diagnosis begins with shock and disbelief, followed by emotional struggles as they deal with the new reality. This initial phase also involves caregiving challenges and hardships. Mothers may experience societal stigma and feelings of rejection, which can contribute to social isolation. Additionally, the physical demands of care can lead to financial hardships. These financial constraints can further limit access to specialized care, creating a frustrating cycle for mothers. Throughout this process, mothers demonstrate resilience by adapting to the illness . This encompasses making changes in their lives, actively seeking support, and developing expertise in managing their child's specific needs. The results shed light on the emotional, physical, and social challenges faced by mothers of children with CP. The findings show a narrative of adaptation, resilience, and strength, encompassing adjustments to the diagnosis, substantial life changes, seeking support, and addressing challenges such as social stigma, isolation, and various hardships. Our findings lay the foundation for tailored interventions and empathic support for mothers caring for a child with CP. • Jordanian mothers face shock, disbelief, & challenges adjusting to child's CP diagnosis. • Mothers navigate stigma, rejection, isolation, and limited care access. • Mothers show resilience, adapting life, seeking support, and managing child's needs. [ABSTRACT FROM AUTHOR]

Hospitals frequently introduce new medical devices. However, the process of clinicians adapting to these new vascular access devices has not been well explored. The study aims to explore clinicians' experience with the insertion of a new guidewire peripheral intravenous catheter (PIVC) introduced in the emergency department (ED) setting. The study was conducted at two EDs in Queensland, Australia, utilising a qualitative explorative approach. Interviews were conducted with guidewire PIVC inserters, including ED doctors and nurses, and field notes were recorded by research nurses during insertions. Data analysis was performed using inductive content analysis, from which themes emerged. The study compiled interviews from 10 participants and field notes from 191 observation episodes. Five key themes emerged, including diverse experience, barriers related to the learning process, factors influencing insertion success, and recommendations to enhance clinicians' acceptance. These themes suggest that the key to successful adoption by clinicians lies in designing user-friendly devices that align with familiar insertion techniques, facilitating a smooth transfer of learning. Clinician adaptation to new devices is vital for optimal patient care. Emergency nurses and doctors prefer simplicity, safety, and familiarity when it comes to new devices. Providing comprehensive device training with diverse training resources, hands-on sessions, and continuous expert support, is likely to enhance clinician acceptance and the successful adoption of new devices in ED settings. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was aimed to explore the trajectory of thoughts and feelings related to religiosity and spirituality using a holistic approach following attendance at group—Quran Recitation (QR) sessions among annual flood victims. Design: This is a qualitative study with an in-depth retrospective interview conducted data in 2019. Methods: The purposive sampling was applied to conduct face-to-face individual video-recorded semistructured interviews. Seventeen participants followed six QR chanting sessions in Bandung, Indonesia. Data were transcribed verbatim and analyzed using inductive analysis. Findings: After extracting evidence expressions of participants, the research team generated the central theme of "Holism of Religiosity and Spirituality," using three influential sub-themes, including obedience to God's will, growing a positive mindset through spirituality and life started to be delighting from nine categories. Conclusion: The relationship of body-mind concepts of holism through QR among flood sufferers was explored. The effect of QR chanting is beneficial to change awareness about the wisdom of spirituality. The holistic approach of religiosity and spirituality in nursing care is recommended to promote all service settings, especially community and disaster nursing in the Indonesian context. Future research is needed to develop QR chanting activities among multiethnic and socio-cultural groups as alternative therapy quantitatively. [ABSTRACT FROM AUTHOR]

The study assesses the status quo of SDG 2 implementation in South Africa. The study further examines the obstacles to achieving SDG 2 within the nation's framework. The study also looks at and assesses several national programmes related to food security. A few interventions are discussed and considered to enhance and augment the extent of food security in South Africa. The study employed a qualitative approach and used the literature review to compile information related to SDG 2 and food security interventions, which was further analyzed through document and conceptual analysis. The findings show that there are issues with the implementation of policies pertaining to food security initiatives. The study aims to answer the following questions: What obstacles need to be overcome for SDG 2 to be implemented effectively, and what measures are necessary to ensure the success of food security interventions in South Africa? Thus, the study aims to evaluate South Africa's progress toward food security (focus). It also seeks to assess the accomplishments and shortcomings of food security initiatives implemented in South Africa (locus). The sustainable livelihoods approach (SLA) is considered a theoretical framework for the study. Suggestions for improving policy are made as a contribution to the public management and governance field. [ABSTRACT FROM AUTHOR]

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Purpose: Strategic alliances play a key role in a company's growth strategy. They are an alternative to the organic option of creating a new company from scratch and a less risky option than conducting a merger or an acquisition. For five years, most recently in 2022, the results of PwC's 22nd Annual CEO Survey have shown that 40% of U.S. CEOs plan to enter into a new strategic alliance or joint venture to boost their company's growth or profitability in the coming year. These operations demand a high level of trust, collaboration and equitable risk-sharing, as well as autonomy granted to both firms. Through an in-depth case study, this study aims to reveal how an alliance was formed between two companies, navigating between entrepreneurial experience and the co-construction of a network to share a technological tool. Design/methodology/approach: The author conducted several interviews with one of the founders of Beta France, and the author had access to a large amount of information on the launch of the entrepreneurial project. Findings: The author presents the reasons for Beta France to join a network of alliances rather than entering into a joint venture. In doing so, the author emphasizes the importance of independence between actors as a key element triggering innovation. Originality/value: This study points out how a fintech startup opens up perspectives for new digital market participants. The author lists the risks that CEOs joining an alliance must be aware of, and the author details how to avoid falling into an asymmetrical alliance by keeping a center of expertise that cannot be duplicated by other partners. [ABSTRACT FROM AUTHOR]

In 2020, Bhutan pioneered a school-based gender-neutral human papillomavirus (HPV) vaccination program, achieving an impressive 96% vaccination coverage rate by 2021. This study, conducted through 49 in-depth interviews with community leaders, policymakers, parents, teachers, and health workers, and 12 focus group discussions with boys who received HPV vaccination. We used conventional content analysis to analyze the data. Enablers of the extension of gender-neutral HPV vaccination included social mobilization and advocacy efforts, which encompassed community engagement and leadership and collaborations with schools. Equally crucial were proficient program management and the strategic use of digital interventions. Challenges included tracking and reaching eligible adolescents. Vaccinated boys perceived school-based vaccination to be a key enabler of vaccine update. The study concludes that extending a girls-only HPV vaccination program to gender-neutral is feasible and acceptable in Bhutan. Findings related to challenges and ways for overcoming them can support other countries interested in gender-neutral HPV vaccination program. [ABSTRACT FROM AUTHOR]

BACKGROUND: Due to the changing environment and responding to the needs of the society, change in the traditional education system is inevitable. Also, the occurrence of events such as the COVID-19 pandemic showed that the existence of a virtual education system to prevent the cessation of education is the need of today's society. OBJECTIVE: This study aimed to investigate the students' experiences of virtual education in Iranian universities of medical sciences during the COVID-19 pandemic. METHODS: This qualitative study was conducted on 28 students studying in Iranian universities of medical sciences from October 2021 to January 2022 to investigate their experiences of virtual education during the COVID-19 pandemic. The participants were selected by purposive sampling. An interpretive phenomenological approach and semi-structured, face-to-face, in-depth interview were used to collect the data. The data were analyzed by Colizzi's seven-step method. RESULTS: Students' experiences of virtual education during the COVID-19 pandemic were categorized into three themes and seven sub-themes, including the strengths of virtual education (sub-themes: individual and educational dimensions), the weaknesses of virtual education (sub-themes: infrastructural, educational, tests and assignments fields), and suggestions to improve virtual education (sub-themes: infrastructural development and educational planning). CONCLUSION: According to the study results, the virtual education during the COVID-19 pandemic led to students staying away from the crowded centers. However, some weaknesses were also mentioned by the participants. Therefore, by anticipating requirements and needs, planning and policy making, and seriously reviewing human, financial, and support resources, virtual education can be developed and used as a supplement to face-to-face education in the future. [ABSTRACT FROM AUTHOR]

This study was aimed at exploring the lived experiences of out-of-school children engaged in begging and scavenging in Pakistan. There is a dearth of existing literature in the context of Pakistan on out of school children who are engaged in begging, scavenging and other hazardous activities. The research also offers an extensive understanding of the responsible factors and possible consequences of engagement in these activities on out-of-school children. In this qualitative study, 21 out-of-school children of district Swat Pakistan aged 5 to 18 years, comprised of both boys and girls engaged in such activities were recruited through a purposive sampling. The respondents were interviewed using an interview guide, and the data was analyzed through a thematic analysis technique. The study was guided by poverty theories, including 'structure theory' and 'culture of poverty theory,' which served as the theoretical framework. The research findings reveal that child begging and scavenging are primarily caused by poverty, high inflation, forced labor, and earning responsibilities. The findings further suggest that these children are exposed to maltreatment, scolding, abuse, and exploitation which also create detrimental effects on their health. We also found some positive aspects of their experiences related to their contribution towards their families, their adaptability, and resilience in the face of many challenges. The study findings make a significant contribution to the existing literature on out-of-school children and their engagement in begging and scavenging activities in a less-explored cultural context of Pakistan. The study findings can be used to inform stakeholders, including policymakers, educational practitioners, and child welfare specialists about the requisite awareness, protection, and needs of at-risk children in Pakistan. [ABSTRACT FROM AUTHOR]

Becoming a healthcare professional is a complex process, where learning occurs in various ways. This study explores an extracurricular learning approach, called the Social Health Bridge-Building Programme, designed to address health inequities. Student volunteers accompany persons in a socially vulnerable situation to healthcare appointments. Operating outside the realms of health education, the programme intends to provide an alternative road to training healthcare students to become capable of engaging with diverse populations, and reducing barriers to healthcare access. Based on an ethnographic fieldwork, using interviews and participant observation ("walking along") as methods, the aim of the study was to explore the learning processes and learning outcomes associated with bridge-building, as experienced by students. Our findings show that this extracurricular learning complemented the formal curriculum, and bridged the gap from theoretical knowledge to practice and to real persons, preparing students for their future roles. The particular positioning of walking alongside or sitting beside persons made the invisible visible, enabling student volunteers to see the variety of persons in need of bridge-building, ways of living in a socially vulnerable situation, inequity in health, and see the persons, beyond initial impression, fostering a deeper understanding and empathy among the students. Learning outcomes included communicational, relational, and observations skills, and a more comprehensive grasp of the healthcare system's complexity. We conclude that a non-governmental organization, independent of the healthcare system, may have found a novel way of providing extracurricular learning about health inequity to students. Demonstrating how the Social Health Bridge-Building Programme complements formal curricula, the concept could be applicable in other settings. [ABSTRACT FROM AUTHOR]

Despite increasing attention to gender diversity on corporate boards, we have only limited understanding of what occurs within the boardroom when women are present. Prior empirical research has used various theories to infer how board gender diversity may influence firm outcomes, but without identifying the theoretical mechanisms underlying women directors' influence on the board. To address this gap, we conducted interviews with women and men who have collectively served as directors with over 200 publicly listed companies in the United States and Europe. While prior research has suggested that the diverse cognitive perspectives women directors bring influence board decision-making, our study reveals novel insights as to the underlying mechanisms. Specifically, we contribute to the board gender diversity literature with the finding that women behave in ways contrary to existing board norms. By coming to board meetings highly prepared, being willing to acknowledge that they do not know something, asking questions, and getting things on the table, women impact the dialogue and interactions in the boardroom. Thus, our study sheds light on how the presence of women influences board dynamics, which has implications for corporate governance. Our findings also challenge prevailing gender theories as to how women are likely to behave, in that we do not find that women conform to gender stereotypes. Yet, we also find impediments to women directors' ability to gain influence, in that men directors may not always acknowledge them or afford them respect as equal board members. [ABSTRACT FROM AUTHOR]

This study investigated constructs concerning the adjustment of the students regarding the transition from the online to the face-to-face mode of learning during the COVID-19 pandemic period. The research participants included all twenty teachers at the junior high school department of Saint Theresa's College of Cebu during the academic year 2022-2023. The research instrument employed was a set of questionnaires with open-ended questions referring to the three constructs of the study. A thematic analysis of the qualitative data gathered from the questionnaire was done. The results of the data gathered consisted of the different themes that emerged from the clustering of the significant statements revealed by the teacher participants about the adjustment in school of their students during the transition period. For the construct on attitude and behavior of the students, two themes emerged, namely, desirable and undesirable attitudes and behavior of the students. The emergent themes for the construct on problems and challenges have the following categories: academic; disciplinary; financial; and psychological. The third and last construct of the study on the coping mechanisms of the students has its emergent themes with the following categories: academic; recreational; discipline and organization; and socialization. The results of the study obtained would help in the needs assessment and the provision of background information for the teachers and the guidance counselor's assistance in enabling the students to adjust during the transition from online to face-to-face mode of learning. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences and needs of postgraduate nursing students within the Nigerian context. Design: This qualitative study was conducted using a descriptive phenomenological approach. Method: Data were collected between February and April 2022 using a purposive sampling method and telephone semi‐structured interviews. Colaizzi's method of Qualitative data Analysis was utilized. Twenty‐two Nigerian postgraduate nursing students were interviewed. Results: Three themes emerged: challenges of Nigerian postgraduate students before the pandemic, the impact of the pandemic on postgraduate education, and innovations to improve postgraduate education in Nigeria. The challenges include the burden of physical lectures, lack of infrastructure, and poor mentorship of postgraduate nursing students. The impact of the pandemic on postgraduate education includes abrupt disruption of the academic program, a prolonged academic calendar, and a communication gap between students and their research supervisors. Innovations to improve postgraduate nursing education in Nigeria also include adoption and sustainability of e‐learning, upgrading post‐basic to postgraduate nursing programmes, proper structuring of postgraduate nursing education, commencement of postgraduate nursing programmes in more universities and provision of financial aid for students. Our primary finding is that funding, mentorship and infrastructure were issues peculiar to all the respondents. Conclusion: This study concludes that efforts should be made to maintain a seamless educational program by ensuring an uninterrupted flow of learning through virtual means, thereby enhancing effective teaching and learning. Implications: Graduate nursing studies is one of the suggested solutions in the WHO strategic direction for nursing and midwifery globally to achieve Universal Health Coverage. The reason is that nurses can practice with more and better skills in any work setting, thus improving the quality of health care services. Our study provides insights into the experiences of postgraduate students and how these could discourage other nurses who might have thought about furthering their studies. Efforts should be made to provide all the support that these students need, using evidence from this study and similar studies to ensure they have a good learning experience and others can be motivated to learn at the graduate level as well. This will increase the proportion of nurses and midwives honed with better skills to provide more standard quality services that will improve patient care outcomes. [ABSTRACT FROM AUTHOR]

Background: With the ageing of the population intensifying, the implementation of advance care planning (ACP) in nursing facilities is especially crucial. Objective: This study aimed to search and synthesise qualitative studies exploring the perspectives of older people in nursing facilities about ACP discussions. Methods: The researchers conducted searches of PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, VIP and CBM between the time of inception and October 2023. The PICo model was used to build the inclusion and exclusion criteria. Following the inclusion and exclusion criteria, two researchers screened the literature, extracted data and then integrated the literature using the integrative synthesis. Results: A total of 12 articles were included, 47 themes were extracted, and three research integrations were summarised: (1) understanding of ACP; (2) attitude towards ACP; and (3) influencing factors of participation in ACP. Conclusion: This study offers guidance for the future development of ACP on the participation of older people in nursing facilities. Implications for Practice: It is necessary to strengthen the education of ACP‐related knowledge in conjunction with the cultural characteristics of different countries, to provide interdisciplinary support for older people through professional teamwork and to promote the development and improvement of ACP‐related practices. [ABSTRACT FROM AUTHOR]

This study addresses the need to enhance the quality of Intelligent Environments, recognizing their unique characteristics and the absence of adequate guidance on quality management during development. It pursues three primary objectives: proposing a novel quality-in-use model, presenting an enhanced version of the User-Centered Intelligent Environment Development Process, and reporting on the application of these approaches through a multiple case study. To embed quality into systems, we advocate for the integration of quality characteristics from ISO/IEC 25000 standards with functional requirements. Stakeholders collaboratively define targets using measures from quality standards, and metrics enable early problem detection and resolution during development. The proposed quality-in-use model provides an insightful and objective perspective on system capabilities, guiding development and ensuring stakeholder involvement. However, challenges such as shortening development cycles for early and regular stakeholder feedback and managing an increased number of system tests were noted. Our study makes a significant contribution to the field of Intelligent Environments by providing a structured approach to embedding and managing quality throughout the development lifecycle. The multiple case study offers empirical evidence of the effectiveness of the proposed approaches, with ongoing considerations for challenges in the development process. [ABSTRACT FROM AUTHOR]

The WHO suggests that different societies should investigate the causes of elder abuse in their culture. This study was conducted to investigate the risk factors for elder abuse in Iran using an ecological approach at the microsystem level. This qualitative research had a direct content analysis approach with 66 older adults and caregivers as participants. The data were collected using interviews. Analysis of data was conducted simultaneously with data collection, using the MAXQDA10 software, and results were reported based on Elo's recommendation. Two main categories of data analysis were obtained, Issues related to care recipients and care and caregiver's challenges. This study was unique owing to its extensiveness and attention to the underlying factors of abuse in the socio-cultural context of Iran. Results can help health policymakers design strategies to prevent elder abuse. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic significantly interrupted the grieving experiences of bereaved families and drastically changed their ways of dealing with loss. Our study aims to gain an in-depth understanding of the experience of bereaved relatives of patients who died in palliative care units during the COVID-19 pandemic. The phenomenological research design included sixteen family members of hospitalized palliative patients who died from November 2021 to June 2022. The study involved conducting qualitative in-depth semi-structured interviews with family members 12–24 months after the death of their loved ones. The interviews aimed to gather information about the experiences of the families both before and after the death. The COREQ guidelines were applied in the study. Participants were mainly female (n = 13) with a mean age of 47.25 (SD = 12.58). Data were analysed using the Interpretative Phenomenology Analysis (IPA). The following three categories were identified: (1) navigating loved ones' final weeks and days (troubled deaths); (2) the last farewell was robbed; (3) looking for adjustment after loss. One overall main theme emerged, which was as follows: "Struggling between stolen moments and painful losses to get back into the flow of life". This study provides novel insights into end-of-life care and bereavement from the perspectives of family. Our findings suggest that developing and promoting family-centred culture can lead to compassionate palliative care focused on a myriad ways of affirming that their loved one matters. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic created a sense of unsafety and uncertainty in various industries and occupations. The aim of this study was to explore the experiences of the employees of Golgohar Mining and Industrial Co. during the COVID-19 epidemic. Methods: This qualitative content analysis study was conducted on 20 employees of the Golgohar Mining & Industrial Co. in Sirjan, Iran, recruited through purposeful sampling from March 2021 to January 2022. After gaining informed consent, semi-structured interviews were conducted and continued until data saturation was achieved. The interviews lasted for 35-50 minutes and were recorded and transcribed. Data were analyzed by MAXQDA software, version 2020. Results: Three categories emerged from the qualitative data analysis: “Challenging work environment,” “unsafe workplace,” and “crisis management.” These categories formed the main theme, “encountering a crisis,” which refers to the very difficult situation that the workers experienced with the emergence of COVID-19. Conclusion: The workers did not fully comprehend the seriousness of the pandemic and lacked sufficient information about the disease, which contributed to the spread of infection. Teaching problem-solving strategies and behavior control, combined with training on disease prevention, can be effective in crisis management. [ABSTRACT FROM AUTHOR]

IntroductionThe Coronavirus Disease 2019 (COVID-19) pandemic has had devastating consequences for persons with opioid use disorder (OUD). Yet, little is known about how people seeking treatment for OUD perceive the risks of COVID-19 and how their perception interplays with their health behaviours.MethodsIn-depth interviews were conducted from September 2021 to March 2022 with 32 patients seeking medication treatment for OUD (MOUD) in Southern California. All interviews were conducted virtually and lasted between one and two hours. Interviews were recorded and transcribed verbatim. Two qualitative researchers independently conducted a content analysis of the transcripts to identify themes.ResultsThree primary themes were identified: (1) perceptions and beliefs about COVID-19 susceptibility and severity; (2) perceptions of COVID-19 risk compared to substance use behaviours; and (3) vaccine hesitancy. Participants were mixed in their beliefs of susceptibility to contracting COVID-19 and the severity of the disease if contracted. Some participants reported taking precautions to mitigate their chances of acquiring COVID-19, and other participants reported that COVID was not a big concern as substance use took priority. For many of the participants, COVID-19 concerns were overshadowed by the risk of overdosing on substances and other risky substance use behaviour. Most of the participants (n = 23; 72%) had received at least one COVID-19 vaccine by the time of the interview, but over half (n = 19; 59%) expressed vaccine hesitancy. Vaccine hesitancy was driven by concerns about the unknown long-term side effects and potential interactions of the vaccine with MOUD.ConclusionsOur study provides insight into COVID-19 prevention measures as well as vaccination perceptions and hesitancy among people who received treatment for OUD.Key messagesParticipants expressed diverse perceptions of the seriousness of COVID-19, with some taking precautions to mitigate their chances of acquiring COVID-19 and others perceiving that the risk of contracting COVID-19 was less than the risk of overdosing.Substance use, social isolation, vaccine hesitancy and COVID-19 risk behaviours should be studied as co-occurring phenomena that have potentially overlapping relationships that can influence behaviours that impact health and well-being.

BACKGROUND: Patients diagnosed with low-risk prostate cancer (PCa) are confronted with a difficult decision regarding whether to undergo definitive treatment or to pursue an active surveillance protocol. This is potentially further complicated by the possibility that patients and physicians may place different value on factors that influence this decision. We conducted a qualitative investigation to better understand patient and physician perceptions of factors influencing treatment decisions for low-risk PCa. METHODS: Semi-structured interviews were conducted among 43 racially and ethnically diverse patients diagnosed with low-risk PCa, who were identified through a population-based cancer registry, and 15 physicians who were selected to represent a variety of practice settings in the Greater San Francisco Bay Area. RESULTS: Patients and physicians both described several key individual (e.g., clinical) and interpersonal (e.g., healthcare communications) factors as important for treatment decision-making. Overall, physicians perceptions largely mirrored patients perceptions. First, we observed differences in treatment preferences by age and stage of life. At older ages, there was a preference for less invasive options. However, at younger ages, we found varying opinions among both patients and physicians. Second, patients and physicians both described concerns about side effects including physical functioning and non-physical considerations. Third, we observed differences in expectations and the level of difficulty for clinical conversations based on information needs and resources between patients and physicians. Finally, we discovered that patients and physicians perceived patients prior knowledge and the support of family/friends as facilitators of clinical conversations. CONCLUSIONS: Our study suggests that the gap between patient and physician perceptions on the influence of clinical and communication factors on treatment decision-making is not large. The consensus we observed points to the importance of developing relevant clinical communication roadmaps as well as high quality and accessible patient education materials.

The United States Preventive Services Task Force (USPSTF) recommends that cervical cancer screening end in average-risk patients with a cervix at 65 years of age if adequate screening measures have been met, defined as having 1) at least three normal consecutive cytology (Pap) tests, or 2) two normal cytology tests and/or two negative high-risk human papillomavirus tests between ages 55-65; the last test should be performed within the prior 5 years. Up to 60 % of all women aged 65 years and older who are ending screening do not meet the criteria for adequate screening. The objective of this study was to understand the process and approach that healthcare clinicians use to determine eligibility to end cervical cancer screening. In 2021 we conducted semi-structured interviews in San Francisco, CA with twelve healthcare clinicians: two family medicine physicians, three general internal medicine physicians, two obstetrician/gynecologists and five nurse practitioners. Thematic analysis, using inductive and deductive coding, was utilized. Three major themes emerged: following guidelines, relying on self-reported data regarding prior screening, and considering sexual activity as a factor in the decision to end screening. All interviewees endorsed following the USPSTF guidelines and they utilized self-report to determine eligibility to end screening. Clinicians' approach was dependent in part on their judgement about the reliability of the patient to convey their screening history. Sexual activity of the patient was considered when making clinical recommendations. Shared decision-making was often utilized. Clinicians voiced a strong reliance on self-reported screening history to end cervical cancer screening.

Abstract Background In aging societies, emergency departments (ED) face an increasing number of older, geriatric patients. Research shows that older emergency patients have a greater burden of comorbidities and a higher risk of adverse events. It has been questioned whether contemporary ED structures can meet the specific needs and characteristics of older patients. Little is known about how professional health care providers perceive and experience ED care for older patients. This study aimed to get insight into the perspective of healthcare providers working with older ED patients and to explore the challenges they experience in their daily work. Methods The study used a qualitative research design with a social-constructivist perspective and a Grounded Theory based methodology. Data were collected through qualitative interviews with N = 25 healthcare providers from different urban EDs in Berlin, Germany, and adjacent healthcare institutions. Following the Ground Theory approach, categories and central themes were identified, analyzed, and interpreted to gain a comprehensive understanding of the healthcare provider perspective. Results The interviews revealed a significant and increasing relevance of geriatric ED patients for healthcare providers. However, there was no shared definition of ‘the geriatric patient’. Most interviewees found ED structures to be inadequate for older patients. They described specific challenges, such as information gathering and safety risks in the ED, as well as an increased use of resources (both time and personnel) when caring for older patients. In addition, specific problems in the collaboration with other professions and institutions were addressed, namely nursing homes, hospital wards, consultations, and the hospital social service. Conclusion Healthcare providers experience a structural mismatch between contemporary EDs and the specific needs of geriatric patients. They are aware of the vulnerabilities of geriatric patients and try to compensate for inherent structural shortcomings. Such structures and limited resources often cause practical, organizational, and ethical problems. There is a great need to develop, implement, and evaluate systematic approaches and care concepts that address the specifics of ED care for geriatric patients.

Abstract Objectives To describe the essential competencies required for patient engagement in their own safety. Method We adopted a phenomenological approach in qualitative research to conduct semi-structured interviews with nurses (n = 14) and adult patients (n = 13) from different departments. By deeply exploring their experiences and feelings about patient engagement in patient safety, we sought to understand their views on the qualities that patients need to possess in order to participate in their own safety. Results From the interviews, we identified six major themes, including competence of information sharing, competence of taking patient engagement as responsibility and right, competence of making equal communication, competence of maintaining trust relationship with health personnels, competence of accepting non-punitive safety culture, need of resource support, five of them showed essential competences for patients and one of them showed patients’ need for promoting their engagement. Conclusion The findings of this study show necessary competence and needs in patient engagement process of patient, offer a foundational reference for constructing a measurement tool for patient engagement in patient safety competence in the future, so that medical staff and patients can provide reference for the future targeted construction of patient competence improvement programs. At the same time, improving patient competence and engagement to better achieve safety goals requires the joint efforts of patients, medical staff, medical institutions, the government, and society.

Background/Objectives: Physiotherapists face significant challenges in managing chronic pain; a complex condition best addressed through a biopsychosocial (BPS) approach. Although substantial evidence exists globally, research specific to Spain remains limited. This study explores the experiences and challenges Spanish physiotherapists encounter in integrating BPS elements across public and private healthcare settings. Methods: Semi-structured interviews with 12 experienced physiotherapists were conducted, using a qualitative approach with purposive sampling and reflexive thematic analysis. The analysis, grounded in a constructivist/interpretivist framework, allowed themes to emerge naturally from the data, supported by relevant quotes. Results: Three primary themes were identified: (1) challenges in implementing the BPS approach, including patient resistance and limited training; (2) facilitators for adopting the BPS model, such as multidisciplinary support and positive patient outcomes; and (3) emotional and psychological aspects of the physiotherapists. The findings highlight the complexities of chronic pain management in physiotherapy, emphasizing the need for enhanced psychological training, integrated multidisciplinary care, early diagnosis, and effective family involvement. These insights are critical for improving both patient care and physiotherapist well-being. Conclusions: This study provides valuable guidance for future strategies, focusing on educational enhancements, multidisciplinary collaboration, healthcare policy reform, and emotional support for physiotherapists within the Spanish healthcare context.

Abstract Background The single-child issue is a significant contributor to population decline, which adversely affects both parents and children. Despite government-approved incentives, the single-child problem remains a major population challenge. This study was conducted to explore the perceptions and experiences of single-child couples regarding childbearing incentives. Methods This qualitative study used conventional content analysis and was performed on 21 single-child couples in Mashhad, North East Iran, selected through purposive sampling from urban health centers. Data were collected using semi-structured interviews until saturation was reached. The data were analyzed using the Elo and Kyngas (J Adv Nurs 62(1):107-15, 2008. 10.1111/j.1365-2648.2007.04569.x) method with MaxQDA10 software. Results Two generic categories emerged from the data analysis including (1) “Advertising and providing information as an influencing factor to encourage childbearing”, which included two subcategories of “Attention to the key lever of advertising” and “Necessity of adopting advertising policies and creating a culture of respecting maternal role”, and (2) “Focusing on effective incentive policies”, which consisted of three subcategories of “Adopting incentive policies to reduce people’s financial problems”, “Avoiding punitive policies” and “Need to adopt incentive policies for working women and elites”. Conclusions Incentive policies should focus on the culture building of the general public, implementing effective incentive policies, and addressing economic challenges, particularly for specific groups such as working women and higher education students. In addition, a public mobilization effort is needed to effectively implement population laws.

Abstract Background This study explored the career development experiences of Korean medical educators who have forged their paths amid dynamic medical education landscapes. Additionally, it explored their career development process by introducing a protean career theoretical framework, that is, an individual-led career development theory. Methods This study employed Interpretative Phenomenological Analysis (IPA) to gather in-depth insights regarding the experiences of medical educators who have successfully built their careers in Korea. Semi-structured interviews were conducted with nine medical educators to investigate the significance of these experiences. The emerging themes were categorised based on the protean career theory during data analysis. Results The findings revealed that medical educators navigated their careers in line with the protean career development model, characterised by protean career orientation, process and outcomes. Their experiences in the medical education domain were aligned with eight factors of the protean career model – self-direction, intrinsic work values, awareness, adaptability, agency, subjective career success, objective career success and organisational commitment. Conclusion In the context of less structured career pathways and a rapidly evolving regional environment, medical educators have developed individual-driven careers with self-direction and intrinsic values, formed their identities and demonstrated flexibility and proactive strategies. Hence, the protean career model successfully explains the characteristics of self-directed career development for medical educators, while emphasising the need for organisational support.

Abstract Background Inappropriate prescribing (IP) is a common problem in the older population. Despite numerous attempts to tackle this issue, it remains a public health concern. In most European countries, general practitioners (GPs) are responsible for global primary care and are thus gatekeepers for the adequacy of medicines, specifically for older people. An in-depth analysis of the situation is necessary to understand why this phenomenon is still prevalent and to identify solutions that could help avoid IP in primary practice. Method A qualitative study based on five focus groups (FG) comprising nine to thirteen general practitioners was conducted in the French-speaking part of Belgium. Participants were recruited among the Local Medical Evaluation Groups (LMEG) and selected to guarantee heterogeneity in working organisations, years of professional experience, gender and age. All interviews were recorded with prior agreement and transcribed in verbatims. The transcripts were coded and analysed to highlight the primary themes, considering dominant and marginal discourses. Results Fifty four GPs participated in the study, with an average experience of 30 years. IPs are perceived as a significant problem in the older population, leading to dangerous health situations. The issue is associated with polypharmacy and multimorbidity, and GPs stated to manage IP using their clinical experience. Most of the study participants faced difficulties managing IP, mostly due to the specificity and complexity of elderly care. Indeed, managing an older patient is challenging due to medical complexity, poor adherence to drug regimes, or low medical literacy. In addition, the medical environment of general practice is challenging, with multiple providers, lack of time, prescribing routine and the absence of effective communication with specialists or other care providers. Additionally, the tools and support available to help medication management in primary care are inadequate. Enhancing collaboration with pharmacists is perceived as a strong potential facilitator. Conclusion This article addresses the complex management of IP in the old age, from the point of view of GPs. Interesting clues were highlighted, like the need to clarify roles of healthcare providers, the better fit of tools to facilitate medication’s review with particularities of GPs needs and the empowerment of pharmacist collaboration.

Abstract Background Patients with Fabry disease (FD) consider their quality of life to be significantly affected. The majority of studies evaluate the quality of life using quantitative measures and standardised scales that offer relevant information about experience with the disease in multiple aspects. The main objective of the research was to examine in depth the quality of life and unmet needs of patients diagnosed with FD in relation to their disease and treatment. A qualitative and transversal study was carried out in two stages: (a) nine semi-structured qualitative interviews with patients and one representative of the patient association, conducted individually by phone; (b) a focus group was set up with three patients diagnosed with FD and one relative. A deductive, thematic analysis approach was used for data coding and analysis. Results The analysis of the interviews revealed various relevant themes: experience with the disease, impact on daily activities, experience of the family and work environment, experience related to treatment and healthcare professionals, and unmet support needs. Diagnosis has a significant impact on both those suffering from the disease and on the family environment. The symptoms and evolution of the disease are highly variable among the patients interviewed and depend on the years diagnosed as well as the time taken to receive the diagnosis. The families of the interviewees have to go through an adjustment process in light of the significant psychological impact brought about by the disease. Patients show various unmet needs. The need mentioned most is to have more information, support, and understanding from people around them and society, improving empathy and raising awareness about the difficulties faced by people with FD while giving the disease visibility. A lack of social understanding is highlighted as one of the main challenges, as this does not only affect the emotional management of the disease but also has repercussions on working life and social relationships. Conclusions It seems necessary to define possible strategies that help to improve the quality of life of patients and their experience with the disease. Some recommendations obtained from the study include: facilitate access to mental health professionals for patients and their families; improve training for specialists and coordination among them; and carry out actions to raise awareness of the disease that are aimed at the general public, the patients themselves, and the people around them.

Braeden A Terpou,1 Marissa Bird,1,2 Diya Srinivasan,1 Shalu Bains,3 Laura C Rosella,1,4 Laura Desveaux1,2 1Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; 2Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; 3Mississauga Hospital, Trillium Health Partners, Mississauga, Ontario, Canada; 4Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, CanadaCorrespondence: Laura Desveaux, Institute for Better Health, Trillium Health Partners, 2085 Hurontario Street, Mississauga, ON, L5B 1B8, Canada, Tel +1 437772-6836, Email Laura.Desveaux@thp.caPurpose: As the COVID-19 pandemic recedes, the importance of population health has come into sharp focus, prompting many health systems to explore leveraging population health data (PHD) for operational planning. This approach requires that healthcare leaders embrace the dual priorities of maintaining excellence in patient care while promoting the overall health of populations. However, many leaders are new to population-based thinking, posing a threat to successful operationalization if mental models are not aligned.Patients and Methods: This qualitative case study explored the alignment of mental models among 13 senior leaders at Trillium Health Partners (THP), one of Canada’s largest community hospitals, as they embark on embedding PHD within operational workflows.Results: All leaders recognized the necessity of adopting a population health approach amid resource constraints and growing pressures. When discussing the operationalization of PHD, two distinct mental models emerged among leaders: one focused on patient care and the other on population health. While executive leaders demonstrated a fluidity in their thinking between the two, programmatic leaders favoured one over the other. For example, some viewed the organization’s focus on PHD as competing with their patient care responsibilities, while others saw the use of PHD as a solution to the organization’s operational pressures. Despite these divergences, leaders unanimously stressed the importance of increasing the organization’s risk tolerance and devolving decision-making as a necessary precursor to realizing the transformation to a PHD-driven approach.Conclusion: These divergent mental models highlight a need to clarify the shared vision for the use of PHD along with its impact on leadership roles and accountabilities. These findings illustrate the current state from which THP aims to evolve and underscore the importance of aligning leaders’ mental models as a critical step to facilitating successful integration of PHD and advancing a collective vision for healthcare transformation.Keywords: health equity, population health management, healthcare leaders, qualitative study