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Introduction: Bhutanese refugees may exhibit psychological distress (PD), post-traumatic stress (PTS), and suicidal ideation (SI), but little is known about predictors of these mental health problems. Purpose: To examine rates and predictors of PD, PTS, and SI among Bhutanese refugees. Methods: Cross-sectional correlational study of 209 Bhutanese refugees in Midwestern United States. Data were collected using the Hopkins Symptom Checklist/Nepali version and Refugee Health Screener-15/PTS subscale and then analyzed using simultaneous multiple regression. Results: Rates of PD, PTS, and SI were 18.7%, 8.1%, and 7.7%, respectively. Significant predictors of PD were a history of mental health treatment ( pDiscussion: Health providers should routinely assess Bhutanese refugees’ mental health status for timely further assessment and treatment.

Background:Rising rates of opioid abuse worldwide have led to the implementation of policies to curb opioid prescribing. It is unknown what impact these policies have on prescribing within the setting of hospice and palliative care.Objectives:To determine the current state of the science of opioid prescribing in hospice and palliative care in relation to the opioid epidemic and associated policies.Methods:A systematic integrative literature review was conducted using the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest Central and SCOPUS.Results:Most of the existing literature examines physician perspectives related to opioid prescribing in primary care settings. Ample evidence exists that policies can and do affect rates of opioid prescribing in specialties outside of hospice and palliative care. There is limited evidence to suggest how these policies affect opioid prescribing in hospice and palliative care. However, the available evidence suggests that opioids are necessary in hospice and palliative care in order to manage pain.Conclusion:Further research is necessary to examine the possible negative impact of the opioid epidemic on opioid prescribing in hospice and palliative care.

Nursing workforce retention is critical to provide quality healthcare, raising concern as nurse turnover rates continue to increase. In this study, we examined older Registered Nurse (RN) perceptions of their work experiences during the COVID-19 pandemic to identify facilitators and barriers in workplace environments that relate to RN workforce retention. The methods section describes our study population that included RNs aged 50 years and older (n=195) who completed surveys containing open and closed-ended questions between August 2020 and January 2021. Our study results indicate that most respondents (86.2%) worked during the COVID-19 pandemic in moderate-to-high patient acuity settings and felt their employers provided employees adequate Personal Protective Equipment (73.3%). The discussion section notes implications for nursing and study limitations. In conclusion, workforce retention facilitators included offering resources and implementations that made experienced, older RNs feel included, valued, supported, and protected. Workforce retention barriers were short/rushed workplace orientation, unsafe patient assignments, micromanaging, perceived ageist policies, and implementing pay and benefit-related policy changes without RN input.

Introduction: Female genital cutting/mutilation (FGC/M) is a ritual to remove any or all of the external female genitalia. Educational strategies regarding the teaching of FGC/M for nursing students are scarce. The focus of this article is to describe the development, implementation, and evaluation of a virtual, FGC/M-related dramatization simulation with a standardized patient (SP). Methods: This educational intervention used an East African immigrant woman as the SP with 35 undergraduate nursing students in two nursing schools in the Midwest United States. Results: Participants appraised the simulation as an effective way to teach and learn about FGC/M. Debriefing was a key part of the simulation. Discussion: Students felt the simulation was novel and engaging for a highly sensitive topic. The SP thought the virtual setting made it more comfortable for her to reveal sensitive facts. The researchers confirmed that the simulation required extensive time commitment to develop, critique, and implement.

Which interventions reduce stigma for pregnant or postpartum women with HIV?

Which interventions could reduce stigma in pregnant or postpartum women with HIV?

Purpose: To date, no studies have examined the association between gender-driven power dynamics and the decision-making process for condom use in South Korea. This study aimed to identify predictors of condom-use behaviors among female emerging adults in South Korea. Participants and methods: A cross-sectional survey was conducted using social network services, and the participants comprised 169 female college students aged 18‒25 years who were actively engaging in sexual intercourse. Results: The results showed that attitudes toward condom use was a stronger predictor of condom-use behaviors than sexual double standards. A significant implication of this study is the need for novel approaches to address condom use in female emerging adults. Potential approaches should consider gender dynamics and have cultural and social relevance for South Korean society. Conclusion: The current findings offer insight into developing future interventions tailored to the population to promote condom use, thereby preventing STDs/HIV, unwanted pregnancies, abortions, and other negative consequences in female emerging adults in South Korea.

Advance care planning (ACP) is a cornerstone of self-determination for the type of care provided at the end of life. Despite many national efforts to improve American adults' engagement in ACP, statistics indicate low engagement. Low engagement, especially among racial and ethnic minority populations, immigrants, people with lower socioeconomic status, young adults, rural residents, or non-English speakers, is common. Advance care planning engagement among Muslims living in the United States has been minimally studied. The purpose of this study was to explore Muslims' engagement in ACP. A cross-sectional descriptive design was used. Participants were recruited from Islamic organizations through convenience and snowball sampling. Engagement in ACP was measured by the Advance Care Planning Engagement Survey. A sample of 148 Muslims (18-79 years of age) participated in the study. The average engagement scores ranged from 1.97 to 2.09, with about two-thirds in the precontemplation stage. Significant differences in engagement scores were found according to health condition and end of life experiences. Results suggest a need for further collaborative efforts by health care providers, policymakers, and researchers to mitigate the disparities in ACP engagement in the American Muslim community.

In recent years, the promotion of healthy relationships at the community level has been widely and rapidly increased. However, the lack of a comprehensive definition of healthy relationships has resulted in potential difficulties in comparing community-based research findings, thus likely hindering the advancement of science and practice in this area. Defining healthy relationships is complex due to diverse personal and cultural backgrounds and types of relationships among individuals in diverse communities. In this article, a definition of healthy relationships and a new research-driven framework, the Happy, Healthy, Safe Relationships (HHSR) Continuum are presented. This HHSR Continuum is designed to be adaptable to different types of relationships, perspectives, and needs of subpopulations within communities. Although additional research is needed to further refine the HHSR Continuum, this framework potentially holds significant implications for theory and community-based practice in the promotion of healthy relationships.

PURPOSE Peripartum cardiomyopathy, a traumatic life-threatening type of heart failure, occurs in the last trimester of pregnancy or shortly after childbirth. Little is known about psychological or emotional conditions women experience with peripartum cardiomyopathy. The purpose of this study was to examine relationships among post-traumatic stress, depression, and quality of life in women with peripartum cardiomyopathy. DESIGN AND METHODS This cross-sectional, correlational survey study included 28 participants recruited via public notice on Facebook. Participants completed the Horowitz Impact of Events Scale, the Center for Epidemiology Scale-Depression 20, and the Ferrans & Powers Quality of Life Index-Cardiac Version-IV. RESULTS Post-traumatic stress correlated significantly and positively with depression (r = .809, p < .001). Post-traumatic stress and depression correlated significantly and inversely with quality of life (r = -.455, p = .015), (r = -.544, p = .003), respectively. All participants measured positive for depression. Participants with lower education scored higher on post-traumatic stress and depression, whereas those unemployed or disabled registered a lower quality of life. CLINICAL IMPLICATIONS Nurses, midwives, and physicians caring for women with cardiomyopathies must be vigilant for evidence of post-traumatic stress, depression, and poor quality of life. Targeted antenatal and postnatal support could be vital to emotional and psychological recovery.

Advance care planning (ACP) enables people to discuss their physical, psychological, social, and spiritual needs before nearing death. Most literature examining the determinants of ACP engagement is limited and does not include minority faith communities in the United States, including Muslim communities. The purpose of this cross-sectional correlational study was to examine ACP engagement determinants among Muslims in the United States. Using the Social Ecological Model, we conceptualized the determinants of ACP engagement into intrapersonal, interpersonal, and community factors. The study self-administered questionnaires were distributed using convenience and snowball techniques. Multiple linear regression was used to predict ACP engagement. The total sample was 148 Muslim adults. The age range was 18 to 79 years. Among all tested factors, being Asian American, knowing a deceased person who had received aggressive or minimal medical treatments near death, being born in the United States, having knowledge and awareness about ACP, and being accepting of the American culture were the determinants of ACP engagement. Engagement in ACP is a multifactorial behavior. Several intrapersonal and interpersonal factors, but none of the community factors, were associated with ACP engagement among Muslim adults. Future ACP interventions targeted toward Muslim Americans should be planned with an understanding of the multifactorial nature of ACP engagement.

BackgroundBhutanese refugees’ mental problems are relatively high. The Hopkins Symptom Checklist-25 (HSCL-25) has been used widely in examining refugees’ mental health, but its psychometric properties in Nepali version is unknown.PurposeTo examine psychometric properties of the HSCL-25/Nepali version.MethodsBhutanese refugees (n = 209) responded to demographic questionnaire, the HSCL-25/Nepali, and the Refugee Health Survey-15. Exploratory factor analysis (EFA), convergent validity, and internal consistency were performed.ResultsAfter three rounds of EFA, item 14 was deleted resulting in HSCL-24/Nepali with good construct validity and excellent internal consistency (α = .94).ConclusionsThe HSCL-24/Nepali version is reliable and valid and can be used to culturally, appropriately assess psychological distress of Bhutanese refugees as it omits item 14 that captures individual’s sexual interest.

Female genital cutting is a culture bound ritual involving excision of the female genitalia. Little is known about nursing students' knowledge and perceptions of female genital cutting and no studies using simulation to teach this topic exist.The aim of this study was to examine the impact of a dramatization simulation on nursing students' knowledge about and perceptions of female genital cutting.A quasi-experimental pretest posttest study with a convenience sample.Two Bachelor of Nursing schools in Northeast Ohio, United States.35 third year undergraduate students.Students were divided into an intervention group (n = 14) and a wait list control group (n = 21). The intervention group took a pre-test, did a reading assignment and then attended a virtual, dramatization simulation session with a standardized patient; a Muslim woman with a personal history of female genital cutting. They took the posttest within the next week. The control group took the pretest, did the reading assignment, and then took the posttest, followed by the simulation. The survey instrument used for pretest and posttest was the Knowledge, Perceptions, and Practice Questionnaire on Female Genital Cutting for Healthcare Professionals in the United States. Debriefing was a critical part of the simulation.The knowledge of female genital cutting of the nursing students in the intervention group increased more than that of the students in the control group (change score 3.57 and 2.05 respectively). Students' perceptions of female genital cutting were not significantly changed by intervention type.This study was the first of its kind to measure nursing students' knowledge and perceptions about female genital cutting before and after a dramatization simulation. A standardized patient dramatization simulation including focused debriefing may be an effective education strategy to teach nursing students about female genital cutting.

This study aimed to investigate the working hazards and health problems among rubber farmers in the southern part of Thailand. A cross-sectional survey questionnaire was employed to identify the workers’ working hazards and health problems, workers’ postures, and the measurement of the intensity of light, lung function, and eye vision. Results indicated that 45.5 % of the rubber farmers were exposed to a chemical substance, 87 % were exposed to a scorpion, and 27.6 % had a high job strain. Furthermore, 43.8 % of the rubber farmers had a high ergonomic risk when collecting the rubber latex. However, the intensity of the headlamp had met the standard. Findings also revealed some common health problems among rubber farmers. These were musculoskeletal disorders (87.7 %), depression symptoms (15.7 %), and hand eczema (8.9 %). Additionally, nearly half of the Thai rubber farmers had an accident at work (45.1 %, while 22 % reported to have bitten by a poisonous animal. Lastly, 78.4 % of the rubber farmers had a low level of visual requirement and half of them had an abnormal lung function (57.2 %). These findings suggest a need for work process modifications to prevent health hazard in Thai rubber farmers.

BackgroundWomen with infertility in different cultures, especially those in West African countries, are viewed as inferior. They tend to experience discrimination and have suboptimal mental health outcomes. However, recent evidence shows that social pressure for pregnancy, not infertility, is a significant predictor of depression. Yet, instruments that measure social pressure for pregnancy are scarce. Existing instruments to measure social pressure for pregnancy show no evidence of psychometric properties.PurposeTo assess the psychometric properties of a new tool, the Social Pressure for Pregnancy Scale (SPPS), among Malian women in West Africa.MethodsExploratory factor analysis, and analyses of convergent validity, discriminant validity (known-groups technique), and reliability.Results and conclusionThe SPPS has good psychometric properties and can be used in future infertility studies especially in relation to depression.

Objective: to describe the use of the Mixed Methods Appraisal Tool to appraise and to strengthen the methodological rigor of mixed methods studies in nursing. Method: a theoretical essay was used to describe the application of Mixed Methods Appraisal Tool to support the development and assessment of mixed methods research in nursing. Four mixed methods articles in nursing were purposely chosen and evaluated based on the Mixed Methods Appraisal Tool criteria. Results: Mixed Methods Appraisal Tool is a tool for evaluating primary mixed methods studies based on five evaluation criteria: 1) justification for adopting mixed methods methodology; 2) integration between the quantitative and qualitative components; 3) interpretation of integrated findings of quantitative and qualitative data; 4) presentation of divergences between quantitative and qualitative results; and 5) compliance with the methodological rigor of each individual approach in mixed methods research. Conclusion: Mixed Methods Appraisal Tool is an instrumental resource that can be used to appraise mixed methods research and strengthen the methodological rigor in planning and conducting future mixed studies in nursing research. RESUMEN Objetivo: describir el uso de la Mixed Methods Appraisal Tool para evaluación y fortalecimiento del rigor metodológico de estudios de métodos mixtos en enfermería. Método: se utilizó un ensayo teórico para describir la aplicación de la Mixed Methods Appraisal Tool para apoyar el desarrollo y evaluación de la investigación de métodos mixtos en enfermería. Se eligieron y evaluaron intencionalmente cuatro artículos de enfermería de métodos mixtos con base en los criterios del instrumento. Resultados: la Mixed Methods Appraisal Tool es una herramienta para evaluar estudios primarios seleccionados a partir de revisiones de literatura mixta, que evalúa cinco modalidades / categorías metodológicas, incluida la investigación de métodos mixtos. En la evaluación de estudios vinculados al paradigma de investigación mixta, se emplean cinco criterios de evaluación: 1) justificación de la adopción de métodos mixtos; 2) integración entre los componentes cuantitativo y cualitativo; 3) interpretación de la integración entre datos cuantitativos y cualitativos; 4) presentación de divergencias entre resultados cuantitativos y cualitativos; y 5) cumplimiento del rigor metodológico de cada enfoque de investigación mixta, de modo particular. Conclusión: la Mixed Methods Appraisal Tool es un recurso instrumental que puede fortalecer el rigor metodológico en la planificación y realización de estudios mixtos de investigación en Enfermería. RESUMO Objetivo: descrever o uso da Mixed Methods Appraisal Tool para avaliação e fortalecimento do rigor metodológico de estudos de métodos mistos em enfermagem. Método: foi utilizado um ensaio teórico para descrever a aplicação da Mixed Methods Appraisal Tool no desenvolvimento e avaliação da pesquisa de métodos mistos em enfermagem. Quatro artigos de métodos mistos em enfermagem foram intencionalmente escolhidos e avaliados com base nos critérios do instrumento. Resultados: a Mixed Methods Appraisal Tool é uma ferramenta para avaliar estudos de métodos mistos primários com base em cinco critérios de avaliação: 1) justificativa para a adoção da metodologia de métodos mistos; 2) integração entre os componentes quantitativos e qualitativos; 3) interpretação de resultados integrados de dados quantitativos e qualitativos; 4) apresentação de divergências entre resultados quantitativos e qualitativos; e 5) conformidade com o rigor metodológico de cada abordagem individual na pesquisa de métodos mistos. Conclusão: a Mixed Methods Appraisal Tool é um recurso instrumental que pode ser usado para avaliar a pesquisa de métodos mistos e fortalecer o rigor metodológico no planejamento e na condução de futuros estudos mistos na pesquisa em enfermagem.

Advance care planning (ACP) is a cornerstone of self-determination for the type of care provided at the end of life. Despite many national efforts to improve American adults' engagement in ACP, statistics indicate low engagement. Low engagement, especially among racial and ethnic minority populations, immigrants, people with lower socioeconomic status, young adults, rural residents, or non-English speakers, is common. Advance care planning engagement among Muslims living in the United States has been minimally studied. The purpose of this study was to explore Muslims' engagement in ACP. A cross-sectional descriptive design was used. Participants were recruited from Islamic organizations through convenience and snowball sampling. Engagement in ACP was measured by the Advance Care Planning Engagement Survey. A sample of 148 Muslims (18-79 years of age) participated in the study. The average engagement scores ranged from 1.97 to 2.09, with about two-thirds in the precontemplation stage. Significant differences in engagement scores were found according to health condition and end of life experiences. Results suggest a need for further collaborative efforts by health care providers, policymakers, and researchers to mitigate the disparities in ACP engagement in the American Muslim community.

The Dutch Eating Behavior Questionnaire (DEBQ) appraises overeating styles that may contribute to weight gain in adults. The purpose of this analysis was to assess the psychometric properties of a Chinese version of the DEBQ (C-DEBQ) in a sample of parents of school-age children in Taiwan. The C-DEBQ encompassing three subscales that including emotional eating, external eating, and restrained eating. Each subscale's reliability was assessed with Cronbach's alpha internal consistency. Confirmatory factor analysis (CFA) was conducted to validate the model fit. A total of 340 normal weight and overweight parents of school-age children from various geographical locations in Taiwan participated in the study. Each subscale, emotional, external, and restrained eating, displayed good-to-excellent internal consistency (Cronbach's alphas: .94, .81, and .89, respectively). CFA showed that the three-factor solution had close goodness-of-fit to the data for supporting the factorial validity (x2=1239.03, df=488, p

Background and Purpose: The World Health Organization Quality of Life BREF (WHOQOL-BREF) has been used in various populations and cultures. However, its psychometric properties are unknown among women who experienced intimate partner violence (WIPV). This study aimed to explore the reliability and validity of the WHOQOL-BREF among Thai WIPV. Methods: Two hundred eighty-four female patients receiving care at a northeast hospital in Thailand responded to the WHOQOL-BREF and intimate partner violence (IPV) questions. Exploratory factor and consistency analyses were applied. Results: Different from the original study, this study generated 5 factors, 1 of which is Medical Care Needs. The resulting scale and subscales showed good reliability and construct validity. Conclusion: The 5-factor scale can be used among WIPV by health care professionals to assess their quality of life (QOL) and appropriately address their needs.

Background A mentally-healthy nursing workforce is vital to providing quality healthcare. While there has been research conducted internationally on depressive symptoms in nurses, most studies have lacked a theoretical framework. Purpose The purpose of this article is to describe the development of a situation-specific theory, the Systemic Assessment of Depressive Symptoms among Registered Nurses (SAD-RN). Methods The SAD-RN was developed through theory synthesis using the Roy's Adaptation Model (RAM) as a framework. Sixty-four research articles were selected to abstract relevant concepts based on a priori RAM concepts. Findings Using depressive symptoms as the anchor concept, related emergent concepts of SAD-RN include context, stressors, protective factors, negative health outcomes, and low patient care quality. Discussion SAD-RN is an evidence-based comprehensive model that offers researchers a guiding theory to be used in their future research on depressive symptoms among RNs.

Fall among older adults is a concern in Thailand. The challenge for primary care physicians is to deliver effective interventions potentially adhered to by older people. This research employed a mixed-methods design to understand factors leading to fall reporting by community-dwelling Thai elders and their expectations regarding fall prevention education. Participants ( N = 305) who had fallen in the last year completed a questionnaire in the quantitative phase, and 50 of these were interviewed in-depth in the qualitative phase. Results revealed that only 39% reported their fall. Participants with comorbidities were 1.6 times more likely to report falling than those without (odds ratio = 1.61, confidence interval = [1.01, 2.58]). Post-fall pain (84%) was the strongest reason for reporting. Some participants believed that falling is an inevitable life event. It is crucial to encourage older adults to report falling, to provide targeted education, and to focus on improving the overall health status of older adults.

Stress affects the well-being of both nursing students and the individuals with whom they work. With the theory of cognitive appraisal as a framework for this study, it is proposed that mind-body self-care strategies promote stress management by stabilization of emotions. Outcomes will be a perception of less stress and more mindful engagement with the environment. Objective of the study was to describe an evaluation of student perceived stress and mindfulness to 1-hour per week of class time dedicated to mind-body self-care (yoga, mindful breathing, Reiki, and essential oil therapy). It was a quasi-experimental study; data collection took place at 4 time points. Participants were entry-level accelerated nursing students from 3 US universities: 50 in the treatment group, 64 in the comparison group. Data included health-promoting practices using Health-Promoting Promotion Lifestyle Profile II as a control variable, stress and mindfulness (Perceived Stress Scale [PSS] and Mindful Attention Awareness Scale [MAAS]), and demographic information; analysis using mixed-design repeated-measures analysis of variances. There was a statistically significant interaction between intervention and time on PSS scores, F(3, 264) = 3.95, P = .009, partial η(2) = 0.043, with PSS scores of the intervention group decreasing from baseline to T3 when intervention ended whereas PSS scores of the comparison group increased from baseline. The average scores on the MAAS did not differ significantly. Evaluation of an embedded mind-body self-care module in the first nursing course demonstrated promising improvements in stress management. The findings support the appropriateness of integrating mind-body self-care content into nursing curricula to enhance students' ability to regulate stress.

Relatively little is known about infertility and its consequences in Mali, West Africa where the context and culture are different from those of previously studied settings. This study therefore aimed to specifically examine infertility induced psychological distress and coping strategies among women in Mali. A convergent mixed-methods design-correlational cross-sectional and qualitative descriptive-guided the study. Fifty-eight infertile Malian women participated: 52 completed the Psychological Evaluation Test specific for infertility and a question on general health status, and 26 were interviewed in-depth. Over 20% scored above the cut-off point for psychological distress, and 48% described their general health as poor. There was no significant difference between women with primary vs. secondary infertility. The study found that infertile women lived with marital tensions, criticism from relatives, and stigmatization from the community. They experienced sadness, loneliness, and social deprivation. Coping strategies included traditional and biomedical treatments, religious faith and practices, and self-isolation. Health care professionals should provide holistic care for infertile women to meet their physical, spiritual, psychological, and social needs.

Objective: to examine and describe the relationship between nursing leadership and the quality of care in the hospital environment. Methods: this concurrent convergent mixed methods study incorporated cross-sectional correlational design and grounded theory. Data were collected among staff nurses at a hospital. Quantitative data were collected using the Brazilian Nursing Work Index-Revised/Leadership subscale with 105 nurses and analyzed by descriptive and inferential statistics. Qualitative data were collected through intensive interviews with 64 participants and analyzed by Charmaz’s method. Subsequently, results from both arms were integrated to generate mixed methods findings. Results: better nursing leadership resulted in better quality of care. Qualitative results supported quantitative results and showed that effective nursing leadership yielded quality of care through different processes: collaborating with nursing staff, encouraging patient advocacy, and enhancing care through research. Conclusion: through mixed methods, the findings can be generalized with a deeper understanding about the phenomenon. Implications are also discussed. Objetivo: examinar e descrever a relação entre liderança em enfermagem e qualidade do cuidado no ambiente hospitalar. Métodos: estudo concomitante e convergente de métodos mistos que incorporou um delineamento correlacional transversal e teoria fundamentada. Os dados quantitativos foram coletados por meio da subescala Liderança do Brazilian Nursing Work Index-Revised, com 105 enfermeiros de um hospital e analisados por meio de estatística descritiva e inferencial. Os dados qualitativos foram coletados por meio de entrevistas com 64 participantes e analisados pelo método de Charmaz. Posteriormente, os achados foram integrados para gerar os resultados dos métodos mistos. Resultados: os resultados qualitativos apoiaram os quantitativos e mostraram que a liderança de enfermagem eficaz gerou qualidade de atendimento por meio de colaboração com a equipe de enfermagem, incentivo à advocacia do paciente e melhoria do atendimento. Conclusão: o uso de métodos mistos possibilita uma compreensão mais profunda do fenômeno. As implicações também são discutidas.

RESUMO Objetivo: descrever a experiência da integração entre dados quantitativos e qualitativos, por meio de uma pesquisa de métodos mistos. Método: trata-se de um relato de experiência da utilização dessa abordagem metodológica em um estudo de tese de doutorado em enfermagem sobre a governança da prática profissional de enfermagem no ambiente hospitalar. Resultados: o texto apresenta três tópicos principais: fundamentação teórica sobre as características e tipologias dos estudos de métodos mistos; procedimentos de coleta, análise e combinação dos dados; e benefícios e desafios da realização desse tipo de estudo. Conclusão: sustenta-se que a realização de uma pesquisa de métodos mistos permitiu a identificação de convergências e divergências entre os dados qualitativos e quantitativos, contribuindo para a produção de resultados que se complementam entre si. RESUMEN Objetivo: describir la experiencia de la integración entre datos cuantitativos y cualitativos, a través de una investigación de métodos mixtos. Método: se trata de un relato de experiencia de la utilización de ese enfoque metodológico en un estudio de tesis de doctorado en enfermería sobre la gobernanza de la práctica profesional de enfermería en el ambiente hospitalario. Resultados: tres temas principales se delinean en este artículo: las bases, características y tipologías de la investigación de métodos mixtos; recopilación, análisis e integración de datos cuantitativos y cualitativos; y los beneficios y desafíos de la investigación de métodos mixtos. Conclusión: se apoya que la realización de una investigación de métodos mixtos permitió la identificación de convergencias y divergencias entre los datos cualitativos y cuantitativos, contribuyendo a la producción de resultados que se complementan entre sí. ABSTRACT Objective: to describe our experience integrating quantitative and qualitative data in a mixed methods study. Methods: we described our experience through real-life examples based on a nursing doctoral thesis on professional practice governance within a hospital environment. Results: three main topics are delineated in this article: the foundation, characteristics, and typologies of mixed methods research; quantitative and qualitative data collection, analysis, and integration; and the benefits and challenges of mixed methods research. Conclusion: it is supported that a mixed method research allowed for the identification of the convergence and divergence between the qualitative and the quantitative data, contributing for the production of results that complement each other.

Depressive symptoms negatively impact the lives of HIV-infected individuals and are correlated with faster progression to AIDS. Our embedded mixed methods study examined and described the effects of telephone support on depressive symptoms in a sample of HIV-infected pregnant Thai women. HIV-infected pregnant Thai women ( n = 40) were randomly assigned to either the control or the intervention group. A registered nurse provided telephone support to the intervention group. Depressive symptoms were measured at three points in both groups. In-depth interviews were conducted at Time 2 and Time 3. Results show that depressive symptoms in the intervention group decreased over time. Qualitative results describe how telephone support can work, but also reveal that telephone support did not work for everyone. We recommend that a larger mixed methods study be conducted to examine the effects of telephone support on depressive symptoms among HIV-infected women, including the costs and benefits of such support.

Little is known about HIV disclosure among perinatal women, although we do know that disclosure can facilitate timely initiation of appropriate interventions for infected individuals and their families. This study, therefore, examined predictors of HIV disclosure among perinatal Thai women. Data (N = 207) were extracted from two larger studies of depressive symptoms in HIV-positive pregnant or postpartum women in Thailand in which participants completed questionnaires. Most participants had low socioeconomic status. Logistic regression indicated that significant predictors of disclosure included older age, employment, and high family support. Psychiatric mental health nursing interventions to promote family support are critical during this time.

Childhood sexual abuse is a prevalent social and health care problem. The processes by which individuals heal from childhood sexual abuse are not clearly understood. The purpose of this study was to develop a theoretical model to describe how adults heal from childhood sexual abuse. Community recruitment for an ongoing broader project on sexual violence throughout the lifespan, referred to as the Sexual Violence Study, yielded a subsample of 48 women and 47 men who had experienced childhood sexual abuse. During semistructured, open-ended interviews, they were asked to describe their experiences with healing from childhood sexual abuse and other victimization throughout their lives. Constructivist grounded theory methods were used with these data to develop constructs and hypotheses about healing. For the Sexual Violence Study, frameworks were developed to describe the participants' life patterns, parenting experiences, disclosures about sexual violence, spirituality, and altruism. Several analytic techniques were used to synthesize the findings of these frameworks to develop an overarching theoretical model that describes healing from childhood sexual abuse. The model includes four stages of healing, five domains of functioning, and six enabling factors that facilitate movement from one stage to the next. The findings indicate that healing is a complex and dynamic trajectory. The model can be used to alert clinicians to a variety of processes and enabling factors that facilitate healing in several domains and to guide discussions on important issues related to healing from childhood sexual abuse.

Depressive symptoms have been linked to faster progression to AIDS in HIV-positive individuals. The purpose of this correlational, cross-sectional study was to examine the prevalence and predictors of depressive symptoms among postpartum women in Thailand who are HIV-positive. Data were collected at postpartum outpatient units in four hospitals in Thailand from June 2005 to December 2007. Eighty-five HIV-positive postpartum women completed questionnaires on depressive symptoms, self-esteem, emotional support, physical symptoms, infant health status, and demographics. Results showed that 74.1% of the participants reported depressive symptoms. Self-esteem, infant health status, and education were negatively associated with depressive symptoms. Because of the high rates of depression in our study, all HIV-positive postpartum women in Thailand should be screened for depressive symptoms.

The link between Zika virus infection during pregnancy and microcephaly and other neurodevelopmental defects in infants, referred to as congenital Zika syndrome (CZS), was recently discovered. One key question that remains is whether such neurodevelopmental abnormalities are limited to the recently evolved Asiatic ZIKV strains or if they can also be induced by endemic African strains. Thus, we examined birth registries from one particular hospital from a country in West Africa, where ZIKV is endemic. Results showed a seasonal pattern of birth defects that is consistent with potential CZS, which corresponds to a range of presumed maternal infection that encompasses both the peak of the warm, rainy season as well as the months immediately following it, when mosquito activity is likely high. While we refrain from definitively linking ZIKV infection and birth defects in West Africa at this time, in part due to scant data available from the region, we hope that this report will initiate broader surveillance efforts that may help shed light onto mechanisms underlying CZS.

A qualitative metasynthesis was conducted to identify the essence of healing from sexual violence, as described by adults who experienced it as children or as adults. Based on the findings of 51 reports, four domains of healing were identified: (a) managing memories, (b) relating to important others, (c) seeking safety, and (c) reevaluating self. The ways of healing within each domain reflected opposing responses. The dialectical process identified for each of the four domains include, respectively: (a) calling forth memories, (b) regulating relationships with others, (c) constructing an "as-safe-as-possible" lifeworld, and (d) restoring a sense of self. These complex processes resulted in a new reality for the participants that was based on a greater sense of agency and provided a more satisfying life course.

We describe the life story of an HIV-positive pregnant Thai woman--part of a larger action research study--with a case study methodology. The participant was chosen because of her unique and complex life story involving HIV infection, pregnancy, and former sex work. Bua (pseudonym), interviewed five times during 2001-2002, was a former sex worker who got married and later became infected with HIV through a sexual relationship with a man other than her husband. The significant events in Bua's life are outlined chronologically, and the social and cultural dimensions contributing to her depression are described.

Fall among older adults is a concern in Thailand. The challenge for primary care physicians is to deliver effective interventions potentially adhered to by older people. This research employed a mixed-methods design to understand factors leading to fall reporting by community-dwelling Thai elders and their expectations regarding fall prevention education. Participants ( N = 305) who had fallen in the last year completed a questionnaire in the quantitative phase, and 50 of these were interviewed in-depth in the qualitative phase. Results revealed that only 39% reported their fall. Participants with comorbidities were 1.6 times more likely to report falling than those without (odds ratio = 1.61, confidence interval = [1.01, 2.58]). Post-fall pain (84%) was the strongest reason for reporting. Some participants believed that falling is an inevitable life event. It is crucial to encourage older adults to report falling, to provide targeted education, and to focus on improving the overall health status of older adults.

The purpose of this paper is to present a framework for dialogue for university-based nursing programmes that are planning and developing international research programmes. Future trends will continue to drive the need for international research due to the globalisation of healthcare issues. Nursing, as one of the main providers of healthcare services, can play a larger role in improving healthcare globally, by leading the way in international collaborative research. A definition of international nursing research is offered, as well as a framework consisting of three broad issues for discussing international work. The three foci of the framework are (a) international nursing research priorities, (b) rewards of international nursing collaborations and (c) challenges of these collaborations. Examples of international collaborative nursing research experiences with nurses in Haiti, Taiwan, Thailand and the United Kingdom are examined, along with lessons learned