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Unmet health-related social needs contribute to high morbidity and poor population health. Improving social conditions are likely to reduce health disparities and improve the health of the overall U.S. population. The primary objective of this article is to describe an innovative workforce model, called Regional Health Connectors (RHCs), and how they address health-related social needs in Colorado. This is a program evaluation that analyzed field notes and interview data from 2021-2022. We applied our findings to the framework developed by the National Academies of Sciences, Engineering, and Medicine's (NASEM's) report on strengthening social care integration into health care (2019). We found that RHCs address the following health-related social needs most commonly: food insecurity (n = 18 of 21 regions or 85% of all regions), housing (n = 17 or 81% of all regions), transportation (n = 11 or 52% of all regions), employment opportunities (n = 10 or 48% of all regions), and income/financial assistance (n = 11 or 52% of all regions). RHCs interacted across many sectors to address health-related social needs and provided multiple types of support to primary care practices at the organizational level. Examples of emerging impact of RHCs are described and mapped onto the NASEM framework. Findings from this program evaluation add to the growing landscape of knowledge and importance of detecting and addressing health-related social needs. We conclude that RHCs are a unique and emerging workforce that addresses multiple domains needed to integrate social care into health care. [ABSTRACT FROM AUTHOR]

Background: Previous research identifies organisational culture as one of a number of factors associated with the quality of life outcomes of group home residents' with intellectual and developmental disabilities. This study aims to elaborate on the dimensions of group home culture in settings in England. Method: Participant observations and semi‐structured interviews with staff were carried out in two group homes. Field‐notes, interview notes and transcripts were analysed using inductive thematic analysis by a researcher naïve to the project and the previous literature. Initial coding was re‐examined after sensitisation to theorised models in previous literature to identify the most parsimonious fit. The two settings were rated and compared using a five‐point Likert scale for each of the dimensions. Results: The findings describe group home culture across seven dimensions. There were mixed ratings across the different dimensions reflecting inconsistencies in culture that were reflected in staff practice. The challenge in assigning a global rating of culture in group homes, which includes interactions across multiple staff and multiple residents over time, was highlighted. Conclusion: The development of an observational measure of culture is highlighted as potentially helpful in understanding and responding to culture in services for individuals with intellectual and developmental disabilities. [ABSTRACT FROM AUTHOR]

Introduction: The experiences of living with Parkinson's disease (PD) from the perspective of newly diagnosed persons with PD (PwPD) have not been previously described. Aim: This study aimed to gain a better understanding of the impact of living with the early stages of PD. Methods: A qualitative interview study was conducted among nine persons, seven men and two women, from southern Sweden. Participants had a median age of 71 (min–max, 64–77) years and had been diagnosed with PD for a median of 5 (min–max, 2–12) months. Interviews were recorded and analysed using systematic text condensation. Results: The analysis resulted in one core category, Facing and dealing with emotional turbulence, and four categories with 2–3 subcategories each: Something is wrong (Vague signs of change; Losing control); The going gets tough (Recalling; Lack of motivation); Losing direction (Uncertainties; Frightened of disease progression) and Dealing with life (Avoiding social situations; Hope and despair; Ease worries). Conclusion: Newly diagnosed PwPD face emotional turbulence with increasing challenges in managing everyday basic needs. Impaired functioning affects self‐esteem and identity, which calls for strategies to overcome emotional reactions of embarrassment, frustration and worry. A sense of lost control and direction increased as the future became more uncertain. The participants' emotional burden and struggle to find a reason to go on or some solution to their new situation left them with both hope and despair. Our results suggest that a person‐centred needs‐based approach may help newly diagnosed PwPD deal with their new life situation. [ABSTRACT FROM AUTHOR]

Purpose: Person-centred care is widely accepted as being central to high quality care, but little is known about how physiotherapists implement person centred rehabilitation in Intensive Care. This study explores the self-reported experiences and interpretations of physiotherapists delivering person-centred rehabilitation in this setting. Methods: A qualitative study using Interpretative Phenomenological Analysis explored the lived experiences of physiotherapists and students who have worked in Intensive Care. Three focus groups, with four participants in each, were conducted. Data were fully transcribed, analysed and managed using NVivo software. Results: Participants shared similar interpretations about the principles of person-centred care. Operationalising person-centred rehabilitation during early recovery was not easily achievable. As the person's clinical condition improved, participants moved away from routine physiotherapy and their practice became more person-centred through the development of a partnership. Participants connected as humans to understand the person and respond to their needs within a culture that valued person-centred care. Conclusions: Physiotherapists aspire to develop a partnership with their patients by connecting on a human level with them and addressing their biopsychosocial needs. Physiotherapists with experience of developing patient partnerships influence the culture of the Intensive Care team and are role-models to facilitate collaborative person-centred activity in others. IMPLICATIONS FOR REHABILITATION: Physiotherapists can move from a biomedical approach towards becoming partners with patients in an Intensive Care Unit (ICU) as they become cognitively aware. Physiotherapists become person-centred by connecting as humans to the patient and moving towards a biopsychosocial approach that addresses the physical, psychological and instrumental needs of the patient in ICU. When aiming towards a person-centred approach on ICU, physiotherapists contribute to a culture that nurtures the unique patient and works collaboratively with the family and the health care team. Experience working with patients in ICU, allows physiotherapists to identify opportunities to be person-centred and facilitate other team members in becoming so. [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]

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Mothers experiencing homelessness are seldom asked about past trauma that may be causal to housing instability and poor health. There are also few validated trauma-focused interventions in family shelters. To address this gap, we tested the feasibility and acceptability of the trauma-focused clinical ethnographic narrative intervention (CENI-TF) in increasing mothers' trauma disclosure, appraisal of its meaning in their lives, and help-seeking behaviors. We also present the qualitative findings to contextualize the intervention. Findings are organized under three major domains and nine subthemes that capture participants' voices and experiences. The CENI-TF has the potential to promote help-seeking behaviors and interrupt recurring cycles of trauma and housing instability in this at-risk population. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore healthcare professionals' (HCPs) perceptions and experiences related to 3D scanning and 3D printing for fabricating lower limb prosthetic sockets. Materials and methods: This study used a qualitative descriptive approach. Participants were recruited through HCPs' professional associations, social media posts, and snowball sampling. Purposive sampling was used to attain variation in provider type. One-on-one telephone interviews were conducted using a semi-structured interview guide. Inductive thematic analysis was performed to identify the main themes. Results: Three themes were identified: (1) 3D scanning of the residual limb for designing prosthetic sockets is perceived as clean, quick, and convenient; (2) concerns about the strength and safety of 3D printed sockets for long-term use; (3) Adoption of 3D scanning and 3D printing technology for fabricating prosthetic sockets. Conclusion: We identified perceived benefits and challenges with digital technologies for fabricating prosthetic sockets. To increase adoption, more research demonstrating its efficacy compared to conventional methods, increasing 3D printing material quality, and improving software training programs are needed. Implications for Rehabilitation: 3D printing and 3D scanning are emerging digital technologies that can be used as alternative methods for prosthetic socket manufacturing in the field of rehabilitation. Our research identified perceived benefits of using digital technologies for fabricating prosthetics sockets (3D scanning is perceived as clean, quick, and convenient) and perceived challenges (concerns about the strength and safety of 3D printed sockets for long-term use and a prolonged learning curve). To increase adoption of these digital technologies, more training should be provided to prosthetists and support provided to integrate new processes into staff workloads. [ABSTRACT FROM AUTHOR]

Background: Primary care is often described as slow to change. But conceptualized through complexity theory, primary care is continually changing in unpredictable, non-linear ways through self-organization processes. Self-organization has proven hard to study directly. We aimed to develop a methodology to study self-organization and describe how a primary care clinic self-organizes over time. Methodology: We completed a virtual case study of an urban primary care clinic from May-Nov 2021, applying methodological insights from actor-network theory to examine the complexity theory concept of self-organization. We chose to focus our attention on self-organization activities that alter organizational routines. Data included fieldnotes of observed team meetings, document collection, interviews with clinic members, and notes from brief weekly discussions to detect actions to change clinical and administrative routines. Adapting schema analysis, we described changes to different organizational routines chronologically, then explored intersecting changes. We sought feedback on results from the participating clinic. Findings: Re-establishing equilibrium remained challenging well into the COVID-19 pandemic. The primary care clinic continued to self-organize in response to changing health policies, unintended consequences of earlier adaptations, staff changes, and clinical care initiatives. Physical space, technologies, external and internal policies, guidelines, and clinic members all influenced self-organization. Changing one created ripple effects, sometimes generating new, unanticipated problems. Member checking confirmed we captured most of the changes to organizational routines during the case study period. Conclusions: Through insights from actor-network theory, applied to studying actions taken that alter organizational routines, it is possible to operationalize the theoretical construct of self-organization. Our methodology illuminates the primary care clinic as a continually changing entity with co-existing and intersecting processes of self-organization in response to varied change pressures. [ABSTRACT FROM AUTHOR]

Aims The recent rise in the number of nonagenarians (age ≥ 90 years) undergoing percutaneous coronary intervention (PCI) has revealed gaps in research, in particular on patients' experiences. Therefore, the aim of the study was to explore and describe nonagenarians' internal resources and their experiences of the in-hospital pathway. Methods and results Nineteen nonagenarian patients (women n = 9), mean age 91 years, 9 acutely, and 10 electively treated, were consecutively enrolled from a tertiary university hospital from June 2021 to February 2023. In-depth interviews were conducted during hospitalization, audiotaped and transcribed. The interviews were analysed using qualitative content analysis. Three sub-themes emerged from the nonagenarians' experiences with the PCI treatment trajectory: (i) Taking lifelong responsibility for own physical and mental health describes a population striving to live a healthy life and to stay independent. Physical and mental activities including healthy food choices had been an integral aspect of their lives from early childhood. (ii) Individual internal resources influenced the PCI pathway describes how their internal resources were used, from actively engaging in the decision-making process to withstanding discomfort during the PCI procedure. (iii) The post-PCI pathway was multifaceted describes a short stay at the cardiac ward with individual post-procedural experiences, close monitoring, and preparation for discharge including cardiac rehabilitation. Conclusion Nonagenarians undergoing PCI demonstrated a personal incentive to stay healthy and independent. Their internal resources of independence, stoicism, and resilience were used during their in-hospital stay contributing to a successful PCI procedure. Individual cardiac rehabilitation strategies were highlighted after discharge from hospital. [ABSTRACT FROM AUTHOR]

Intersectoral collaborations are recommended as effective strategies to reduce health inequalities. People most affected by health inequalities, as are people living in poverty, remain generally absent from such intersectoral collaborations. Community-based participatory research (CBPR) projects can be leveraged to better understand how to involve people with lived experience to support both individual and community empowerment. In this paper, we offer a critical reflection on a CBPR project conducted in public housing in Québec, Canada, that aimed to develop intersectoral collaboration between tenants and senior executives from four sectors (housing, health, city and community organizations). This single qualitative case study design consisted of fieldwork documents, observations and semi-structured interviews. Using the Emancipatory Power Framework (EPF) and the Limiting Power Framework (LPF), we describe examples of types of power and resistance shown by the tenants, the intersectoral partners and the research team. The discussion presents lessons learned through the study, including the importance for research teams to reflect on their own power, especially when aiming to reduce health inequalities. The paper concludes by describing the limitations of the analyses conducted through the EPF–LPF frameworks and suggestions to increase the transformative power of future studies. [ABSTRACT FROM AUTHOR]

Background: Chronic conditions may limit older peoples' social engagement and wellbeing. Reduced social connections can result in loneliness and social isolation. This study aimed to explore the experience of social connection in older people living with chronic conditions, and the factors influencing their social participation. Methods: A purposive sample of 19 community-dwelling older Australians (mean age 75.5 years) with one or more chronic conditions participated in a qualitative descriptive study. Semi-structured interviews explored participants' perceptions of their social connections and the potential impact of their chronic conditions. Views about the role of general practice in supporting older persons' wellbeing were discussed. Data were analysed inductively using thematic analysis. Results: Five themes were identified: (1) the experience of loneliness, (2) managing diminishing social contacts, (3) living with chronic conditions, (4) barriers to social connection, and (5) facilitators of social connection. Participants felt that ageing with chronic conditions contributed to loss of function and independence, which limited social connections, and increased loneliness and social isolation. Barriers to social connections included issues with mobility, transport and forming new networks. Families were a primary support, with continued community engagement and general practice support crucial to staying well and socially connected. Conclusions: Understanding older peoples' experiences, and the barriers and facilitators of social connections can guide clinicians' interventions. General practice is a promising intervention point because of its high use by those with chronic conditions to stay well. General practice nurses are well-placed to collaboratively address the barriers older people face in maintaining social connections. Chronic conditions may limit older peoples' social engagement, with diminished social connections leading to loneliness, social isolation and other serious health consequences. This study explored the experience of social connection in older people living with chronic conditions and factors influencing their social participation. Older people identified the importance of family, community engagement and staying well through primary care support. Understanding the barriers and facilitators of social connections for older people can guide the general practice team in developing appropriate interventions. [ABSTRACT FROM AUTHOR]

Inequitable pregnancy care experiences and outcomes disproportionately affect refugee background women in Australia. Culturally safe care is essential for achieving health equity, however, cultural safety can only be determined by the person receiving care. To our knowledge, women of refugee background in Australia are yet to be asked what culturally safe pregnancy care is to them. Specifically, this study aimed to explore what culturally safe pregnancy care is to Karen women (from Burma) of refugee background. A photovoice study founded on community-based participatory research principles was undertaken with a Karen community of refugee background living in Victoria, Australia. A community advisory group was established, guiding study design and conduct. Five S'gaw Karen-speaking women with experience of pregnancy care in Australia were invited to take photos within their community. Participants shared their photos and stories with each other in four online discussion groups. Reflexive thematic analysis guided by a critical constructionist lens developed three themes: Building foundations for belonging; cultivating reciprocal curiosity; and storytelling as an expression of self and shared power. These themes sit within the overarching theme When I can be my whole authentic self, I feel safe and know that I belong. When Karen women can embrace their cultural and spiritual identity without fear of discrimination, including racism, culturally safe pregnancy care is possible. This study contributes to the design and delivery of maternity services by providing insights that can enhance equitable and culturally safe pregnancy care for Karen women of refugee background. [ABSTRACT FROM AUTHOR]

Aim: To obtain an in‐depth understanding of the lived experiences, values, and beliefs of Taiwanese women with breast cancer who withdrew from cancer treatment. Background: Fear of side effects, negative experiences and personal beliefs were identified as reasons for withdrawing from cancer treatments. Body–mind consciousness and body autonomy play a crucial role in cancer treatment decisions. Design: Descriptive phenomenological approach. Methods: We conducted semi‐structured, face‐to‐face and in‐depth interviews with 16 women diagnosed with breast cancer. Participants were purposefully selected from the Cancer Registry database. Employing a phenomenological approach, our aim was to explore the lived experiences of these individuals. Data analysis followed Giorgi's five‐step process. To ensure a comprehensive report the COREQ checklist was applied. Findings: 'The Determination to Preserve Me' is the essence of treatment withdrawal, identified by three themes and seven sub‐themes. 'Raising Body‐Mind Consciousness' was generated using body autonomy and preventing repeated psychological trauma from the participant's view. Their lifestyles, maintaining the family role, and returning to a normal trajectory help develop 'Maintaining Stability for Being a Patient and a Family Carer'. 'Self‐Defending Against the Body Harm' was generated by concerns about maintaining health and preventing harm. Conclusion: Women's behaviours became transformed by suffering. Actions were influenced by physical and psychological distress, misconceptions about treatments, and appearance changes by self‐determination through self‐protection. Relevance to clinical practice: Healthcare professionals should respect women's autonomy and work collaboratively to ensure their decision‐making with accurate information and awareness of the potential risks and benefits of treatment withdrawal need to concern. [ABSTRACT FROM AUTHOR]

Aim: To explore Remote Area Nurses' experiences of the implementation of workplace health and safety policies and risk mitigation strategies in Australian very remote primary health clinics. Design: This qualitative study used online semi‐structured interviews, with participants purposively sampled to maximize variation in work location and service type. Data were analysed using a reflexive thematic analysis approach. Coding was carried out inductively, with NVivo 12 aiding data management. Setting: The interviews were conducted from 24 Februrary 2021 to 06 March 2021 with Remote Area Nurses from very remote primary health clinics in Australia. Participants: Fifteen Remote Area Nurses participated in the study. Results: Thematic analysis revealed varied approaches to workplace safety among the different health services and regions. While the spread of 'never alone' policies in many clinics addressed one of the significant risks faced by Remote Area Nurses, gaps remained even for hazards specifically highlighted in existing work health and safety legislation. Meaningful collaboration with staff and the community, local orientation, preparation for the role and providing quality care were protective factors for staff safety. Understaffing, unsafe infrastructure and inadequate equipment were common concerns among Remote Area Nurses. Conclusion: Health services need to prioritize workplace safety and take a continuous quality improvement approach to its implementation. This will include ensuring safety strategies are appropriate for the local context, improving infrastructure maintenance, and establishing sustainable second responder systems such as a pool of drivers with local knowledge. Implications for the Profession: Poor personal safety contributes to burnout and high turnover of staff. Nurses' insights into the barriers and enablers of current workplace safety strategies will aid policymakers and employers in future improvements. Reporting Method: COREQ reporting guidelines were followed. PIPE Statement: A panel of six Remote Area Nurses collaborated in the development of this project. [ABSTRACT FROM AUTHOR]

Introduction: Social prescribing offers a formal pathway of connecting patients in the health system with sources of support within the community to help improve their health and well‐being. Since its launch in March 2022, the Canadian Institute for Social Prescribing has acted as a collective impact network to identify, connect and build upon established social prescribing initiatives using a co‐design methodology. The institute received input from a participant advisory council, co‐design partners and several communities of interest groups. This study aimed to describe the perceptions of the Canadian Institute for Social Prescribing's role in advancing social prescribing using a co‐design approach and the barriers and facilitators to implementing social prescribing in Canada. Methods: We used a qualitative descriptive study design, document analysis, participant observation and semi‐structured individual interviews (n = 7) with members of the Canadian Institute for Social Prescribing co‐design group and the institute's leadership. We also analysed documents, field notes and transcripts using codebook thematic analysis. Results: Four themes were developed representing the facilitators of implementing the Canadian Institute for Social Prescribing to support social prescribing: Creating relational mechanisms (i.e., partnerships and connections), Bringing awareness to social prescribing and contributing to the evidence (i.e., values and beliefs), Addressing systemic conditions (i.e., having a common language for social prescribing and organizing the community health sector) and Enabling funding and policy to drive social prescribing initiatives (i.e., shifting evidence into policy and securing sustainable funding). Conclusion: Participants' reflections on the co‐design process demonstrated that the Canadian Institute for Social Prescribing development provided networking opportunities and shared resources relevant to social prescribing. Co‐design efforts also fostered relational and informational support, which laid the necessary groundwork in Canada to overcome the complex interplay between the macro‐ and micro‐level settings in which social prescribing is practiced. Patient or Public Contribution: The interviews and observations involved participants with lived experience of delivering, receiving or advocating for social prescribing. [ABSTRACT FROM AUTHOR]

Background: Promoting the work adaptation of nurses returning to work after childbirth is key to improving their physical and mental health and ensuring the quality of nursing care. Although postpartum nurses have reported high work stress and poor adaptation after returning to work, little is known regarding the experiences, problems and further needs. This study aimed to explore the adaptation experiences of postpartum nurses returning to work. Methods: This was a qualitative study with descriptive phenomenological approach. Individual semi-structured interviews were conducted between March and May 2023 in four tertiary hospitals in Changsha, mainland China, which were selected using convenience sampling. A total of 16 postpartum nurses returning to work within one year were recruited using purposive sampling and maximum variation sampling. The interviews were analysed using the Colaizzi's 7-step method. Results: 'Breakdown and healing' is a strong thread in postpartum nurses' work adaptation. It links 13 subthemes in the interview data, which can be grouped under three overarching themes: (a) changes and challenges of multiple roles; (b) self-coping and social support; and (c) further needs after returning to work. The phrase 'breakdown and healing' reflects the mutual relationship between stress and coping among postpartum nurses. The changes and challenges associated with being required to fulfil multiple roles of mothers, wives and nurses make the subjects feel on the verge of 'breakdown'. When returning to work, most of them move slowly towards 'healing' through positive self-management and support from their partners, families, supervisors and colleagues. Moreover, their ongoing demands and unsolved problems – such as their desire for a workplace that is friendly and serves their needs – were generated by the constant process of 'breakdown and healing'. Conclusions: Understanding how postpartum nurses returning to work perceive adaptation experiences is essential for nursing managers, who can use the findings to implement targeted measures to shorten postpartum nurses' maladaptation period after returning to work and promote their work adaptation. This study underscores the critical importance of personalized return-to-work training, flexible work arrangements, support from colleagues and managers, well-established maternal facilities and services, and targeted policy efforts in enhancing postpartum nurses' work adaptation. [ABSTRACT FROM AUTHOR]

Physiotherapists working in hospitals have a key role in decisions about when a person with stroke is safe to walk independently. The aim of this study was to explore the factors influencing decision-making of physiotherapists in this situation. A qualitative design with semi-structured interviews and reflexive thematic analysis was used. Fifteen physiotherapists with recent experience working in inpatient stroke rehabilitation participated. Multiple factors influence decision-making about walking independence after stroke in hospitals. Four themes were identified: (1) Assessment of walking safety involves observation of walking function and consideration of complex individual factors; (2) Perspectives on risk vary, and influence whether a person is considered safe to walk; (3) Institutional culture involves background pressures that may influence decision-making; and (4) Physiotherapists adopt a structured, individualised mobility progression to manage risk. Physiotherapists consistently use observation of walking and understanding of attention and perception in this decision-making. There can sometimes be a conflict between goals of independence and of risk avoidance, and decisions are made by personal judgements. Decision-making about independent walking for people in a hospital after a stroke is complex. Improved guidance about clinical assessment of capacity and determining acceptable risk may enable physiotherapists to engage more in shared decision-making. Regaining independence in walking after a stroke comes with the potential risk of falls. Assessment of walking safety should be specific to the complexity of the situation and consider perception and cognition. Benefits of activity and autonomy, and the risk of falls need to be considered in decisions about walking independence. Patients with the capacity to understand consequences and accept risk can be active participants in determining what is sufficiently safe. [ABSTRACT FROM AUTHOR]

Describe the adaptation, implementation, and perceptions of Kids SIPsmartER's classroom component during the coronavirus disease-impacted 2020–2021 school year. Mixed methods process evaluation. Seven rural Appalachian middle schools (US). Middle-school teachers (n = 14) and principals (n = 6). Kids SIPsmartER was a multilevel, school-based intervention designed to decrease sugar-sweetened beverage intake. The 12-lesson classroom component was supported by an implementation protocol. Implementation protocol adaptations, program perceptions, and the school context were assessed using teacher and principal interviews, teacher-completed fidelity checklists, and researcher-maintained field notes. Adaptations were mapped to the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). Qualitative data were content coded. Quantitative data were summarized using descriptive statistics. All schools maintained Kids SIPsmartER and delivered 100% of lessons. Ten adaptations were made to the implementation protocol. Schools used adapted delivery approaches to meet individual needs. Teachers and principals identified more benefits than barriers to implementing the program. Using a strategically adapted implementation protocol that was flexible to schools' individual needs allowed all middle schools to deliver Kids SIPsmartER during the 2020–2021 school year. Findings identify adaptation considerations that other school-based evidence-based interventions could incorporate to facilitate delivery during high-stress times. [ABSTRACT FROM AUTHOR]

This study presents a strengths-based framework for designing virtual reality experiences tailored to the needs and abilities of autistic individuals. Recognizing the potential of virtual reality to provide engaging and immersive learning environments, the framework aligns the strengths and preferences of autistic users with the affordances of virtual reality platforms. Drawing on the existing literature and empirical findings, the framework highlights key areas of alignment, including visual perception, anxiety management, attention to differences, concrete thinking, and response to positive feedback. The framework emphasizes the importance of involving autistic individuals in the co-design and co-creation of virtual reality technologies to ensure a more tailored and preferred user experience. By adopting a strengths-based approach and actively involving autistic individuals, the design and implementation of virtual reality interventions can better address their unique needs and foster positive outcomes. The study concludes by advocating for continued research and collaboration to advance the field of virtual reality technology for autistic individuals and to work toward shared goals with the autistic community. Virtual reality has been studied for its potential in supporting individuals with autism, but existing research often focuses on deficits and lacks consideration of individual preferences and strengths. This article introduces a framework that emphasizes the strengths and abilities of autistic individuals when designing virtual reality interventions. It builds upon an existing taxonomy of educational technology affordances and extends it to align with the unique needs of autistic individuals. The framework provides guidance for incorporating virtual reality technology that supports and amplifies autistic strengths, such as visual perception and response to positive feedback. The framework has implications for practice, research, and policy. For practitioners, it offers a tool for designing virtual reality experiences that cater to the strengths of autistic individuals, enhancing engagement and educational outcomes. Researchers can utilize the framework to guide the development of user-centered virtual reality interventions and expand our understanding of the potential benefits of virtual reality for autistic populations. Policymakers and educators can consider this framework when incorporating virtual reality into educational settings, ensuring that virtual reality technology is used in a way that aligns with the strengths and needs of autistic learners. Overall, the framework promotes a strengths-based approach in utilizing virtual reality technology for individuals with autism, fostering inclusivity and maximizing the benefits of immersive experiences. [ABSTRACT FROM AUTHOR]

Active service members and Veterans with a combat-related traumatic brain injury (TBI) are four times more likely to attempt suicide than those without a TBI. TBIs are the signature injuries of the Post-9/11 conflicts and Combat Veterans (i.e., current and former service members who deployed in support of a combat mission) with these injuries are entitled to receive the Purple Heart medal. However, potentially tens of thousands of Combat Veterans did not receive, or were denied the Purple Heart during the first decade of the Global War on Terrorism because a TBI was not documented during the deployment. To our knowledge, this is the first study to explore the meaning of the Purple Heart and examine the impact of the Purple Heart on Army Combat Veterans with a combat-related TBI. Findings from this mixed methods study revealed that not receiving the Purple Heart is associated with increased suicide risk and lower quality of life after a brain injury. Additionally, thwarted belongingness, perceived burdensomeness, and perceived military institutional betrayal are associated with increased suicide risk in Army Combat Veterans with a TBI. This mixed methods study provides important insights into how Army culture is perceived and the power of the Purple Heart among this high-risk group of Combat Veterans. [ABSTRACT FROM AUTHOR]

The effectiveness of work performed through interprofessional practice is contingent on the nature and extent of communication between professionals. To date, there is little research exploring how the patterns of communication may impact interprofessional work. This study focused on communication during interprofessional meetings to better understand the interprofessional work performed through these encounters. Specifically, it examined how interactional discourse, that is, the patterns of language, influenced work performed during interprofessional meetings. A series of four interprofessional meetings in a rehabilitation unit were observed. Twenty-one participants were observed, including medical, nursing, allied health clinicians, and health professions students. Follow-up stimulated-recall interviews were conducted with five meeting participants. The data collection consisted of video and audio recordings and detailed field notes. Data were analyzed using a combination of genre analysis, a form of discourse analysis, and activity system analysis, drawing on Cultural Historical Activity Theory. This facilitated an in-depth examination of the structure of discourse and its influence on meeting outcomes. The meeting structure was defined and predictable. Two distinct forms of discourse were identified and labeled scripted and unscripted. Scripted discourse was prompted by standardized documents and facilitated the completion of organizational work. In contrast, unscripted discourse was spontaneous dialogue used to co-construct knowledge and contributed to collaboration. There was constant shifting between scripted and unscripted discourse throughout meetings which was orchestrated by experienced clinicians. Rather than fragmenting the discussion, this shifting enabled shared decision making. This research provides further insights into the interprofessional work performed during interprofessional meetings. The scripted discourse was highly influenced by artifacts (communication tools) in meetings, and these were used to ensure organizational imperatives were met. Unscripted discourse facilitated not only new insights and decisions but also social cohesion that may influence work within and outside the meeting. [ABSTRACT FROM AUTHOR]

Quality early care and education (ECE) presents an unparalleled opportunity to avert disadvantage and promote children's development. Mealtimes are essential daily routines, yet are often overlooked in research on ECE quality. This paper crystallises a composite case study of ECE mealtimes in highly disadvantaged communities by combining Departing Radically in Academic Writing (DRAW) methodology with parent surveys, scorings of educator‐child interactions (inCLASS), and field notes. Poverty is perpetuated in these centres: children do not have enough food, and educator‐dictated feeding practices restrict children's opportunities to exercise their agency and learn. Systemic policy action is needed to address poverty in ECE. [ABSTRACT FROM AUTHOR]

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

Engaged communication between mother and a child in their early developmental stages is one of the predictors of children's development of higher-order thinking skills. For deaf children, this engaged communication between mother and child hinges on the home language environment (HLE) being fully accessible to the child. This research uses agogical phenomenology in exploring the lived experiences of participants' HLE where sign language is used, with particular focus on the opportunities for extended discourse. Data were collected via semistructured interviews with the deaf children and their parents and observations in the HLEs of five signing families with at least one deaf child in the southwestern United States. The aim of this study was to document and provide insights into how language use in deaf children's HLE can impact their knowledge development; these insights uncovered the essence of reciprocal and contingent family interactions as a central aspect of the deaf child's HLE. It is hoped that the qualitative phenomenological findings will frame subsequent quantitative investigations of the variability in language access to home language components. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe.Patients are often the first to know when the atmosphere on a ward becomes tense, but often, no one asks them for their views.Patients and staff are experts and should be included in discussions about how to make wards safer. What this paper adds to existing knowledge: We got together with some service users and staff, and made an app that helps patients to tell staff when they are not feeling safe on a mental health ward. We tried it out on six wards and we asked patients and staff what they thought.The app was easy to use and most people liked the look of it.Patients said staff did not talk with them enough and so they liked using the app. However, some staff said they could tell how patients were feeling without an app and so they did not need it. Ward managers told us that staff were often very busy and did not always have time to use the app. What are the implications for practice: This app could help staff know straightaway when patients do not feel safe on the ward, so that they can act quickly to calm things down.To make the most of the app, staff need to get used to it and bring it into ward routines. Introduction: Safety improvement on mental health wards is of international concern. It should incorporate patient perspectives. Aim: Implementation and evaluation of 'WardSonar', a digital safety‐monitoring tool for adult acute mental health wards, developed with stakeholders to communicate patients' real‐time safety perceptions to staff. Method: Six acute adult mental health wards in England implemented the tool in 2022. Evaluation over 10 weeks involved qualitative interviews (34 patients, 33 staff), 39 focused ethnographic observations, and analysis of pen portraits. Results: Implementation and evaluation of the WardSonar tool was feasible despite challenging conditions. Most patients valued the opportunity to communicate their immediate safety concerns, stating that staff had a poor understanding of them. Some staff said the WardSonar tool could help enhanced ward safety but recognised a need to incorporate its use into daily routines. Others said they did not need the tool to understand patients' safety concerns. Discussion: Foreseeable challenges, including staff ambivalence and practical issues, appeared intensified by the post‐COVID‐19 context. Implications for Practice: The WardSonar tool could improve ward safety, especially from patients' perspectives. Future implementation could support staff to use the real‐time data to inform proactive safety interventions. [ABSTRACT FROM AUTHOR]

The death of a child in the intrauterine stage has legal, psychological, spiritual, and health-related connotations that condition the woman's experience. To understand better the processes set in motion around early pregnancy loss, this ethnographic study explores the experiences of miscarriage in a group of 15 women. The following themes are analyzed: Experience of losing the child, spirituality, health care, and the need to physically recognize the child. The study shows that the need women have to honor the child who did not live may be conditioned by the perception of an uncertain loss and by the absence of a place to honor him/her. Attitudes among professionals are revealed that could be perceived as gender-related abuse. The care of women places emphasis on physical aspects, underlining the lack of comprehensive care during the grieving process. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to contribute to an understanding of the role deployment of advanced practice nurses (APNs) in French healthcare settings. Introduction: The introduction of APNs was formalised in France by the decrees issued on 18 July 2018, which described the areas, activities and training of APNs. Background: A qualitative study on the role implementation of APNs was conducted between July 2021 and May 2022 following a call for projects launched by the Île‐de‐France Regional Health Agency to evaluate the deployment of APNs in the area. Methods: Data were collected through field observations and semi‐structured interviews in order to explore both the APNs deployment processes in nine healthcare structures and the roles played by APN networks and associations with regard to the deployment of APN activities in their working environments. Results: The projects proved to be evolutionary, and their development was marked by various forms of APN isolation and multiple obstacles that were specific to their professional practice settings. Some APNs relied on a variety of forms of mutual assistance and advocacy deployed throughout APN networks and associations. Discussion: The deployment of APNs' role was impacted by diverse configurations of professional power relations and the nature of the obstacles that were structural for APNs in primary care. Their experience of isolation derived from the novelty of their role, the challenge they posed to the cohesion of the nursing profession and a lack of supportive policies for their deployment. Their participation in APN networks and associations enabled them to access advocacy and manage the uncertainties and unknowns related to the deployment of their activities. Conclusion: The results suggest that the formalisation of schemes for mutual assistance among APNs and advocacy should be integrated into the guidelines for the implementation of their role. Implications for nursing policy: APN policy should strengthen a bottom‐up approach, relying in particular on the development of different forms of collaboration and communication between APN networks and associations on the one hand and the public authorities on the other. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to develop a clinical support tool for osteoporosis clinic providers to support risk assessment and referrals for evidence‐based exercise therapy programs. Methods: A sequential Delphi method was used with a multidisciplinary group of national falls experts, to provide consensus on referral to exercise therapy for patients at risk for falls. The Delphi study included a primary research team, expert panel, and clinical partners to answer the questions: (1) "What patient characteristics are needed to develop a clinical support tool?"; (2) "What are the recommended exercise referrals for patients with osteoporosis at risk for falls?" The consensus process consisted of two rounds with 8 weeks between meetings. Two qualitative researchers analyzed the data using a modified version of a matrix analysis approach. Results: The following were the most important variables to include when determining exercise therapy referrals for patients with osteoporosis: Patient history and demographics, falls history over the last year, current physical function and balance, caregiver and transportation status, socioeconomic and insurance status, and patient preference. Potential exercise therapy referrals included one‐on‐one physical therapy, group physical therapy, home health, community‐based exercise programs, and not acceptable for exercise therapy. Conclusions: Patient characteristics including patient history, physical function and balance performance, socioeconomic and insurance status, and patient preference for exercise therapy are important to inform both the medical provider and patient with osteoporosis to choose the most appropriate exercise therapy referral. Adoption of the algorithmic suggestions may have a significant impact on uptake and adherence to exercise therapy, ultimately improving patient physical function and reducing falls risk. [ABSTRACT FROM AUTHOR]

In this article, we describe the exploration of the content and quality of annual goals included in the Individualized Education Programs (IEPs) of students with disabilities in one rural U.S. school district. We utilized content analysis to understand the district's service delivery model comprehensively. Findings revealed disparities between inclusive placements and special education service delivery, suggesting that, despite high rates of inclusive placements noted on IEPs, most services occurred outside general education classrooms, especially for students with intellectual and developmental disabilities (IDD). We evaluated the quality and rigor of 546 annual goals using a rubric adapted from Kurth et al. Only 37.7% of goals were rated as rigorous, highlighting a need for clearer, more specific, and applicable goals. Notably, communication goals for students with IDD were largely absent, raising concerns about support for meaningful participation in general education settings. In addition, special factors related to communication and assistive technology were not consistently addressed in IEPs. We discuss implications for improving educational experiences for students who qualify for special education services under IDD in rural schools and highlight the value of further research and actions in this area. [ABSTRACT FROM AUTHOR]

Background: The ability to self‐advocate or have a say in one's care is integral to personalised care after acquired brain injury (ABI). This study aimed to understand what constitutes self‐advocacy and associated barriers and facilitators throughout hospital transitions and into the community. Method: Qualitative methodology was employed with semistructured interviews conducted with 12 people with ABI and 13 family members. Interviews were conducted at predischarge (in‐person or via telephone) and 4 months postdischarge (via telephone) from the brain injury rehabilitation unit of a tertiary hospital. Data were thematically analysed using a hybrid deductive–inductive approach. Results: Self‐advocacy reflects the process of reclaiming agency or people's efforts to exert influence over care decisions after ABI. Agency varies along a continuum, often beginning with impaired processing of the self or environment (loss of agency) before individuals start to understand and question their care (emerging agency) and ultimately plan and direct their ongoing and future care (striving for agency). This process may vary across individuals and contexts. Barriers to self‐advocacy for individuals with ABI include neurocognitive deficits that limit capacity and desire for control over decisions, unfamiliar and highly structured environments and lack of family support. Facilitators include neurocognitive recovery, growing desire to self‐advocate and scaffolded support from family and clinicians. Conclusion: Self‐advocacy after ABI entails a process of reclaiming agency whereby individuals seek to understand, question and direct their ongoing care. This is facilitated by neurocognitive recovery, growing capacity and desire and scaffolded supports. Research evaluating approaches for embedding self‐advocacy skills early in brain injury rehabilitation is recommended. Patient or Public Contribution: Two caregivers with lived experience of supporting a family member with ABI were involved in the design and conduct of this study and contributed to and provided feedback on the manuscript. [ABSTRACT FROM AUTHOR]

Background: Implementing person-centred care (PCC) in nursing homes is challenging due to a gap between theory and practice. Bridging this gap requires suitable education, which focuses on learning how to attune care to the values and preferences of residents and take moral, relational, and situational aspects into account. Staff's stories about the care they provide (i.e. caring stories) may deliver valuable insights for learning about these aspects. However, there is limited research on using staff's narratives for moral learning. Objective: This study aims to provide insight into the perspectives of nursing staff on using their caring stories to learn about PCC. Research design: In this qualitative research, we conducted two rounds of interviews with 17 participants working in nursing homes. We wanted to obtain nursing staff's perceptions of working with their caring stories and the impact on PCC. Ethical considerations: Participation was voluntary, and participants provided written consent. The study protocol is approved by The Institutional Review Board of the Medical Ethical Committee Leiden-Den Haag-Delft. Findings: Working with caring stories enables nursing staff to provide PCC and improves job satisfaction. It increases awareness of what matters to residents, fosters information rich in context and meaning, and enhances voice and vocabulary. Through in-depth team reflections, nursing staff discussed the significant moments for residents, which centralizes the discussions on the moral quality of care. Discussion: Working with caring stories fosters dialogue on PCC and enhances reflection on ethical situations in daily encounters, contributing to the moral development of nursing staff. Putting nursing staff's narratives at the centre of learning suits their daily practice and intrinsic motivation. Therefore, the outcomes of this study are an addition to the existing literature about using narratives in long-term care. Conclusion: Using nursing staff's narratives contributes to PCC and positively impacts nursing staff. We recommend using staff's caring stories as a vehicle for moral learning in the transition to PCC. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to explore the meaning of work for the subjective well-being of autistic adults with and without paid (competitive) employment and to evaluate the differences and similarities between these groups. Methods: Eight focus groups were conducted, including a total of 64 autistic adults. Four groups entailed participants with current paid employment (including part-time) and four groups entailed participants without paid employment. All discussions were audiotaped and transcribed verbatim to enable inductive thematic content analysis. Data were analyzed using ATLAS.ti 9. Results: Generally, both groups viewed paid employment as very important for well-being, albeit for different reasons. Three themes were found: (1) Not having paid employment was associated with lacking societal recognition, and subsequent low self-esteem, which was a dominant theme in those without work; (2) Work can seriously damage (mental) health and well-being, found in both groups; and (3) Paid employment provides many benefits for well-being, with subthemes: 'purpose,' 'social contacts,' 'growth and use of talents,' 'structure and calmness,' and 'income and freedom', which was a dominant theme in those with paid employment. Conclusions: Both groups found paid employment highly important for their well-being, albeit for different reasons. However, both also agreed that paid employment can be very harmful to (mental) health and well-being. Suitable, well-supported jobs are important for well-being, may help to buffer stress in other life areas, and may even prevent autistic burnout. More studies are needed on how healthy jobs can be created where autistic individuals get positive energy and experience high well-being. This will also help to reduce socio-economic inequality. [ABSTRACT FROM AUTHOR]

Background Tuberculosis (TB) is a highly transmissible infectious disease killing millions of people yearly, particularly in low-income countries. TB is most likely to be transmitted in healthcare settings with poor infection control practices. Implementing TB infection prevention and control (TB-IPC) is pivotal to preventing TB transmission in healthcare settings. This study investigated diverse stakeholders' perspectives relating to barriers and strategies for TB-IPC in rural hospitals in Papua New Guinea. Methods Multiple qualitative case studies were conducted with 32 key stakeholders with experience in TB services. Data collection drew on three primary sources to triangulate data: semi-structured interviews, document reviews and field notes. The data were analyzed using hybrid deductive-inductive thematic analysis. Results Our results reveal that key stakeholders perceive multiple interdependent factors that affect TB-IPC practice. The key emerging themes include strategic planning for and prioritizing TB-IPC guidelines; governance, leadership and accountability at the provincial level; community attitudes towards TB control; institutional capacity to deliver TB care, healthcare workers' safety, and long-term partnership and integration of TB-IPC programmes into the broad IPC programme. Conclusions The evidence suggests that a multi-perspective approach is crucial for TB-IPC guidelines in healthcare institutions. Interventions focusing on addressing health systems strengthening may improve the implementation of TB-IPC guidelines. [ABSTRACT FROM AUTHOR]

There is growing evidence on the prevalence and impact of loneliness, particularly among older people. However, much less is known about the personal origins of loneliness and how it persists, or not, over an individual's life course. This study aimed to increase understanding of the personal experiences of loneliness among older adults across the life course. Central to this study was giving voice to the participants and allowing them to define loneliness, what it meant to them, and how it affected them throughout their lives. This qualitative study employed 18 life story interviews with older adults attending a mental health service. We explored their personal experiences of loneliness and the situations and factors associated with loneliness across the life course. We identified three distinct typologies of loneliness: those who experienced (1) chronic loneliness since childhood, (2) chronic loneliness after a life-changing event in midlife, and (3) loneliness which remained situational/transitional, never becoming chronic. This study found the seeds of chronic life course loneliness are often determined in childhood. Early detection and intervention may prevent situational loneliness from becoming chronic. More research is needed from a life course approach to help understand and address the causes and consequences of loneliness. [ABSTRACT FROM AUTHOR]

Background: While healthcare policy has fostered implementation strategies to improve inclusion and access of under-served groups to clinical care, systemic and structural elements still disproportionately prevent service users from accessing research opportunities embedded within clinical settings. This contributes to the widening of health inequalities, as the absence of representativeness prevents the applicability and effectiveness of evidence-based interventions in under-served clinical populations. The present study aims to identify the individual (micro), organisational (meso) and structural (macro) barriers to clinical research access in patients with comorbid alcohol use disorder and alcohol-related liver disease. Methods: A focused ethnography approach was employed to explore the challenges experienced by patients in the access to and implementation of research processes within clinical settings. Data were collected through an iterative-inductive approach, using field notes and patient interview transcripts. The framework method was utilised for data analysis, and themes were identified at the micro, meso and macro levels. Results: At the micro-level, alcohol-related barriers included encephalopathy and acute withdrawal symptoms. Alcohol-unrelated barriers also shaped the engagement of service users in research. At the meso-level, staff and resource pressures, as well as familiarity with clinical and research facilities were noted as influencing intervention delivery and study retention. At the wider, macro-level, circumstances including the 'cost of living crisis' and national industrial action within healthcare settings had an impact on research processes. The findings emphasise a 'domino effect' across all levels, demonstrating an interplay between individual, organisational and structural elements influencing access to clinical research. Conclusions: A combination of individual, organisational and structural barriers, exacerbated by the COVID-19 pandemic, and the socioeconomic landscape in which the study was conducted further contributed to the unequal access of under-served groups to clinical research participation. For patients with comorbid alcohol use disorder and alcohol-related liver disease, limited access to research further contributes towards a gap in effective evidence-based treatment, exacerbating health inequalities in this clinical population. [ABSTRACT FROM AUTHOR]

Background: The growth of medical knowledge and patient care complexity calls for improved clinician access to evidence-based resources. This study aimed to explore the primary care clinicians' preferences for, barriers to, and facilitators of information-seeking in clinical practice in Singapore. Methods: A convenience sample of ten doctors and ten nurses was recruited. We conducted semi-structured face-to-face in-depth interviews. The interviews were recorded, transcribed verbatim, and analysed using thematic content analysis. Results: Of the 20 participants, eight doctors and ten nurses worked at government-funded polyclinics and two doctors worked in private practice. Most clinicians sought clinical information daily at the point-of-care. The most searched-for information by clinicians in practice was less common conditions. Clinicians preferred evidence-based resources such as clinical practice guidelines and UpToDate®. Clinical practice guidelines were mostly used when they were updated or based on memory. Clinicians also commonly sought answers from their peers. Furthermore, clinicians frequently use smartphones to access the Google search engine and UpToDate® app. The barriers to accessing clinical information included the lack of time, internet surfing separation of work computers, limited search functions in the organisation's server, and limited access to medical literature databases. The facilitators of accessing clinical information included convenience, easy access, and trustworthiness of information sources. Conclusion: Most primary care clinicians in our study sought clinical information at the point-of-care daily and reported increasing use of smartphones for information-seeking. Future research focusing on interventions to improve access to credible clinical information for primary care clinicians at the point-of-care is recommended. Trial registration: This study has been reviewed by NHG Domain Specific Review Board (NHG DSRB) (the central ethics committee) for ethics approval. NHG DSRB Reference Number: 2018/01355 (31/07/2019). [ABSTRACT FROM AUTHOR]

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

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

Physical distancing measures to limit contagion in the COVID-19 pandemic made it difficult to care for older persons with dementia. Non-essential home visits were prevented and family caregivers took over most of their care. The aim of our study was to describe the lived experience of peoples living with dementia caregivers during the pandemic regarding the care provided and the person cared for. A qualitative phenomenological design was used. Participants were recruited using purposeful sampling. Informants were selected from primary healthcare centers, day centers, and a community mental health unit. The study participants comprised 21 caregivers. Semi-structured in-depth interviews by telephone were used, and field notes were collected from the researchers. A thematic analysis was conducted. The criteria used to control trustworthiness were credibility, transferability, dependability, and confirmability. Three main themes and six related sub-themes were identified: (1) care for the person with dementia during the pandemic, including lockdown, associated with difficulties in coping with restrictions, deterioration in health, and the impact of the closure of health and social resources; (2) health and social care provided to people with dementia after the disruptions and the care received from primary care prior to hospital or residential admission; and (3) the caregiver's perspective on the effects of the psycho-emotional impact, and coping strategies adopted in caring. Interventions for people with dementia should be planned in order to prevent the worsening of their health and cognitive status, while also developing programs to prevent stress and alleviate caregiver burden in case of health crises. [ABSTRACT FROM AUTHOR]

Members of Korean American communities have displayed an increasing interest in volunteering opportunities with individuals with severe disabilities that promote social interaction and community engagement among them. However, little is known about community volunteer experiences and how Korean American volunteers can be better supported. In this qualitative study, we documented the voices of Korean American volunteers who work with individuals with severe disabilities. Adopting a phenomenological approach, we interviewed and observed ten Korean American community volunteers to explore the meaning of their experiences and their perceptions of severe disability as well as the social inclusion of individuals with severe disabilities. Through the data analysis, three main themes were identified: changing views on individuals with severe disabilities, inclusion in multifaceted communities, and identified needs of the Korean American community and volunteering system. The results show that the volunteers' initial perceptions of disability evolved during their experiences with individuals with severe disabilities. The data provides practical information about the ethnic community and volunteering system, which foster social integration among the participants and community members regardless of their abilities, race/ethnicity, language, and immigrant status. [ABSTRACT FROM AUTHOR]

Background: Caregivers of children who require medical technology of tracheostomies and feeding tubes provide intensive and specialized care at home. They have extensive training in the hospital prior to their child's discharge; however, there is limited education about their child's care once they are at home. The Creating Opportunities for Personal Empowerment: Symptom and Technology Management Resources intervention focused on commonly experienced symptoms and technology used at home by caregivers. Objective: We present the findings from the intervention exit interviews to gain insight about the intervention from caregiver perspectives, notably their perceptions of usefulness, ease of use, and acceptability. Methods: A qualitative descriptive design was used to examine caregivers' perceptions of the intervention in exit interviews. These interviews were conducted upon completion of the intervention as part of feasibility testing. Results: Sixteen caregivers completed the study and participated in exit interviews. Caregivers described the themes of the best that you can do, a reminder that I am doing it the right way, and I wish I had these when my child first had the tracheostomy and feeding tube. Caregivers also provided feedback about the intervention's usefulness and suggestions for further refinement and future adaptations of the intervention. Conclusions: Caregivers provided valuable insights about the intervention, describing its usefulness to them, the potential for usefulness for other caregivers of these children, and their experiences with care of their children at home. Future plans include efficacy testing and modifications to enhance the intervention based on caregiver feedback. [ABSTRACT FROM AUTHOR]

Aim: To gather and understand the experience of hospital mealtimes from the perspectives of those receiving and delivering mealtime care (older inpatients, caregivers and staff) using photovoice methods to identify touchpoints and themes to inform the co‐design of new mealtime interventions. Methods: This study was undertaken on acute care wards within a single metropolitan hospital in Brisbane, Australia in 2019. Photovoice methods involved a researcher accompanying 21 participants (10 older patients, 5 caregivers, 4 nurses and 2 food service officers) during a mealtime and documenting meaningful elements using photographs and field notes. Photo‐elicitation interviews were then undertaken with participants to gain insight into their experience. Data were analysed using inductive thematic analysis, involving a multidisciplinary research team including a consumer. Results: Themes were identified across the three touchpoints: (1) preparing for the meal (the juggle, the anticipation), (2) delivering/receiving the meal (the rush, the clutter and the wait) and (3) experiencing the meal (the ideal, pulled away and acceptance). Despite a shared understanding of the importance of meals and shared vision of 'the ideal' mealtime, generally this was a time of tension, missed cares and dissatisfaction for staff, patients and caregivers. There was stark contrast in some aspects of mealtime experience, with simultaneous experiences of 'the rush' (staff) and 'the wait' (patients and caregivers). There was an overwhelming sense of acceptance and lack of control over change from all. Conclusions: This study identified themes during hospital mealtimes which have largely gone unaddressed in the design of mealtime interventions to date. This research may provide a framework to inform the future co‐design of mealtime interventions involving patients, caregivers and multidisciplinary staff, centred around these key touchpoints. Practice Implications: Mealtimes are experienced differently by patients, caregivers, nurses and food service officers across three key touchpoints: preparing for, delivering/receiving and experiencing the meal. Improving mealtime experiences therefore necessitates a collaborative approach, with co‐designed mealtime improvement programs that include specific interventions focusing each touchpoint. Our data suggest that improvements could focus on reducing clutter, clarifying mealtime roles and workflows and supporting caregiver involvement. Impact: What problem did the study address?: Mealtimes are the central mechanism to meet patients' nutritional needs in hospital; however, research consistently shows that many patients do not eat enough to meet their nutritional requirements and that they often do not receive the mealtime assistance they require.Interventions to improve hospital mealtimes have, at best, shown only modest improvements in nutritional intake and mealtime care practices. Gaining deeper insight into the mealtime experience from multiple perspectives may identify new opportunities for improvement. What were the main findings?: Patients, caregivers and staff have shared ideals of comfort, autonomy and conviviality at mealtimes, but challenges of complex teamwork and re‐prioritisation of mealtimes in the face of prevailing power hierarchies make it difficult to achieve this ideal.There are three discrete touchpoints (preparing for, delivering/receiving and experiencing the meal) that require different approaches to improvement.Our data suggests a need to focus improvement on reducing clutter, clarifying mealtime roles and workflows and supporting caregivers. Where and on whom will the research have an impact?: The research provides a framework for multidisciplinary teams to begin co‐designing improvements to mealtime care to benefit patients, caregivers and staff, while also providing a method for researchers to understand other complex care situations in hospital. Reporting Method: This manuscript is written in adherence with the Standards for Reporting Qualitative Research. Patient or Public Contribution: Patients and caregivers were involved in the conception and design of the study through their membership of the hospital mealtime reference group. A consumer researcher (GP) was involved in the team to advise on study conduct (i.e. recruitment methods and information), data analysis (i.e. coding transcripts), data interpretation (i.e. review and refinement of themes) and manuscript writing (i.e. review and approval of final manuscript). [ABSTRACT FROM AUTHOR]

Background: Health disparities in osteoarthritis (OA) outcomes exist both in the occurrence and treatment of functional limitation and disability for Mexican Americans. Although the effect of self-management of chronic illness is well established, studies demonstrate little attention to self-management of function or disability, despite the strong potential effect on both and, consequently, on patients' lives. Objective: The purpose of this study pilot was to develop and test key variable relationships for a measure of disability self-management among Mexican Americans. Methods: In this sequential, two-phased, mixed-methods, biobehavioral pilot study of Mexican American women and men with OA, a culturally tailored measure of disability self-management was created, and initial relationships among key variables were explored. Results: First, a qualitative study of 19 adults of Mexican American descent born in Texas (United States) or Mexico was conducted. The Mexican American Disability Self-Management Scale was created using a descriptive content analysis of interview data. The scale was tested and refined, resulting in 18 items and a descriptive frequency of therapeutic management efforts. Second, correlations between study variables were estimated: Disability and function were negatively correlated. Disability correlated positively with social support and activity effort. Disability correlated negatively with disability self-management, pain, and C-reactive protein. Function was positively correlated with age, pain, and depression. Liver enzymes (alanine transaminase) correlated positively with pain and anxiety. Discussion: This mixed-methods study indicates directions for further testing and interventions for disability outcomes among Mexican Americans. [ABSTRACT FROM AUTHOR]

Amid recent political conflicts and the implementation of the national security law, Hong Kong society has undergone tremendous changes. Among other effects, the new law has spawned controversial social discourses, including about social workers' responsibility to uphold human rights and promote social justice per the Hong Kong Social Workers Registration Board's Code of Practice. This article, based on an analysis of interviews with six social workers in Hong Kong, examines how social workers understand social justice according to those discourses. The findings and this article's discussion of them offer insights into social workers' roles in an increasingly turbulent sociopolitical context. [ABSTRACT FROM AUTHOR]

Specialised functional neurological disorder (FND) clinics are emerging as the preferred way of providing best practice care to people with FND. However, questions remain around optimal care pathways, service provision, and resources. This study aimed to identify (1) service characteristics of Australian FND models of care; (2) barriers and enablers to implementing a specialised FND service; and (3) enablers and barriers to providing best practice management for people living with FND. Clinicians were recruited from Australian public and private healthcare organisations identified as leading best practice for adults with FND. Clinicians completed a structured interview via phone. A descriptive content analysis was used. Five out of 12 healthcare organisations interviewed had a specialised multidisciplinary FND service. All specialised FND services were outpatient programs, but the structure and referral pathways varied. Barriers identified by organisations with an FND service included "funding" and "staff and service fragility," while enablers included "engaging stakeholders" and having a clear "service driver." "Diagnosis delay" and "insufficient access to staff" were identified as barriers to implementing best practice by organisations without a specialised FND service. Despite specialised clinics being recognised as a practical way to deliver care to people with FND, only a few services operate in Australia. Timely and educated diagnosis and access to an interdisciplinary team consisting of neurology, physiotherapy, and psychology are central pillars for FND services. Further work to establish clinically and economically effective delivery models is required to facilitate the provision of best practice care for people living with FND. [ABSTRACT FROM AUTHOR]

Cervical cancer has a significant impact on the lives of caregivers of cervical cancer patients, including male partners. Disturbances in physical, psychological, sexual, spiritual, and socioeconomical aspects of life are reported by male partners of cervical cancer patients. To reduce the impact associated with cervical cancer, adaptive coping mechanisms are needed. In this regard, little is known about the coping mechanisms used by male partners of women diagnosed with cervical cancer in sub-Saharan African countries. Therefore, this study aimed to explore the coping mechanisms used by male partners of women diagnosed with cervical cancer at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania. A descriptive cross-sectional study design with a qualitative approach was employed to explore coping strategies used by male partners of cervical cancer patients between December 2022 and March 2023. Participants were selected using a purposeful sampling technique guided by the principles of saturation. In-depth interviews with thirteen male partners of cervical cancer patients were carried out, and the interviews were audio-recorded and transcribed verbatim. The data were then analyzed using a thematic analysis approach. Four themes highlighting coping mechanisms used by male partners of cervical patients were identified after data analysis. They include religious coping, emotional expression and regulation strategies, support-seeking strategies, and problem-solving strategies. Male partners of cervical cancer patients used various mechanisms to cope with the stressful situations they encountered. While most of the coping mechanisms used by male partners of cervical cancer patients were adaptive, some were maladaptive. Therefore, regular assessment among this population needs to be done to identify maladaptive coping and provide relevant support. [ABSTRACT FROM AUTHOR]

Background: Residents in long-term care homes (LTCHs) are often diagnosed with chronic, life-limiting illnesses, and it is now a common site to provide high levels of care and eventual death. There is an urgent need to address communication gaps and uncertainties surrounding resident's end of life preferences. Nurses are well situated to be key facilitators of necessary advance care planning (ACP), ensuring residents have discussions with family, substitute decision-makers and healthcare providers regarding future health and personal care preferences. However, LTCHs present unique challenges for nurses due to not only complex comorbidities but also staffing dynamics. Purpose: This study explored the experiences and perceptions of Registered Nurses (RNs) and Registered Practical Nurse (RPNs) in LTCHs regarding their role in engaging residents and families in ACP discussions. Methods: Qualitative interpretive descriptive methodology was used. Data were collected from two LTCHs in Southern Ontario with a sample of 15 nurses (7 RNs and 8 RPNs). Analysis involved review of semistructured interviews, field notes, and utilizing constant comparison within an inductive approach. Results: Power and authority dynamics in LTCH's was an overarching theme in the data, with four subthemes: (1) Nurses lacking clarity about ACP, (2) nurses' uncertainty regarding their role in ACP, (3) nurses feeling uncomfortable engaging in ACP discussions, and (4) nurses struggling to support families in ACP discussions. Conclusion: Recommendations for nurses, healthcare providers, LTCH administrators, and policy makers include: (1) development of policies which support, from a systemic level, nurses to feel safe while engaging in ACP; (2) reassessing LTCH's hierarchical structure, and clarifying RN, RPN, and interdisciplinary team members roles in ACP; (3) developing culture change that allows a team and person-centered approach to ACP; and (4) providing ongoing education and mentorship for nurses to manage family dynamics and expand their understanding of ACP beyond a biomedical lens. [ABSTRACT FROM AUTHOR]

Purpose: Falls are a major issue for people with neurological conditions, and the evaluation of falls prevention interventions is of high priority. To date, the views of patient groups regarding outcomes of importance have been largely overlooked. The purpose of this study was to explore outcomes of interest among people with Multiple Sclerosis (MS), Parkinson's disease (PD) and stroke upon completion of falls prevention interventions to inform the development of a core outcome set (COS). Materials and methods: Five online focus groups and one semi-structured interview were conducted among people with PD (n = 10), MS (n = 7), and post-stroke (n = 3), one of whom also had PD. Transcripts were analysed using reflexive thematic analysis. Results: Four themes were developed; (1) Fall events are not homogeneous, (2) Exercise-based programmes are beneficial but falls services are not meeting user needs, (3) Programme success beyond the reduction in falls, and (4) Acquisition of skills to self-manage falls beyond the life of the programme. Conclusions: This study presents new perspectives across patient groups regarding important outcomes upon completion of falls prevention interventions. Taken together with the findings of a literature review, this data will inform the development of a COS. People with multiple sclerosis, Parkinson's disease and stroke consider the success of a falls prevention intervention to be dependent on improvements across a wide range of outcomes. The design and implementation of falls prevention interventions should align with patient preferences. Clinicians and researchers should consider the use of multidomain interventions to facilitate improvements in the desired outcomes of patients. [ABSTRACT FROM AUTHOR]

Background: Insufficient physical activity is a growing public health concern and is closely linked to obesity in both adults and children. Swedish physical activity on prescription (PAP) is effective in increasing physical activity levels in adults, but knowledge about how PAP is used in paediatric healthcare is lacking. Therefore, this study aimed to explore experiences of working with PAP for children with obesity amongst paediatric staff and managers. Methods: Seven focus group discussions with 26 participants from paediatric outpatient clinics in western Sweden were conducted. Data were analysed both inductively and deductively, framed by the Normalization Process Theory's four core constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Results: The PAP work for children with obesity was experienced to be about helping children to become physically active, and less about losing weight. Identified barriers for using PAP were the non-uniform nature of the work and a perceived lack of guidelines. Collaboration with physiotherapists and physical activity organisers outside the organisation was identified as an important facilitator. An important contextual factor for implementing PAP is the collaboration between paediatric clinics and physical activity organisers. In the transition between these stakeholders, maintaining a family-centred approach when working with PAP was experienced as challenging. Conclusions: PAP is a well-known intervention that is inconsistently used for children with obesity. The intervention should include a family-centred approach for this patient group. It also needs to align better with existing collaborations with other healthcare units as well as with new forms of collaboration with physical activity organisers in the community. [ABSTRACT FROM AUTHOR]