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Why you should read this article: • To enhance your understanding of civility and incivility in the workplace and the associated consequences • To read an action plan for nurse managers to assist their colleagues, team and organisation recognise and act on workplace incivility • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Incivility is a major concern in healthcare, and it is vital that uncivil behaviour is recognised and addressed. Manifestations of incivility are wide ranging and can take the form of microaggressions, which are difficult to pinpoint but have significant repercussions. Research has demonstrated the negative effects of incivility on staff and patients. Uncivil acts and behaviour can create conflict, reduce performance, affect morale, decrease retention and jeopardise patient safety. The role of nurse managers in reducing incivility and promoting civility includes providing leadership, fostering psychological safety, creating a shared understanding of civil behaviour and managing uncivil behaviour as soon as it occurs. The input of employers is crucial to promote a compassionate and inclusive organisational culture and to support nurse managers to acquire the knowledge, skills and confidence to prevent and reduce incivility. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusions Implications for the Profession and/or Patient Care What Problem Did the Study Address? What Were the Main Findings? Where and on Whom Will the Research have an Impact? Reporting Method Patient or Public Contribution To explore the perceptions and experiences of midwives caring for couples who experience a stillbirth.Qualitative study based on Gadamer's hermeneutic phenomenology.This study was conducted with midwives (n = 18) at the birth unit of a third‐level public hospital in Jaén (Spain) in 2023. Personal semi‐structured interviews were recorded in audio for later transcription by two researchers following steps described by Fleming.Two themes were identified as important aspects of the practise of midwives in a situation of the birth of a stillborn child: (1) the importance of each action of the midwife, and (2) the availability of resources determines the care provided.Having a stillbirth is a very complex experience, in which the psychological support and human and material resources involved are the basic tool for the care of these families. Acknowledging limitations of the available resources, the assistance and care provided by midwives are in line with the clinical practice guidelines, which can have an emotional impact on them.The care to be provided in stillbirth requires appropriate human and material resources for these families. Midwifery and nursing professionals are in a unique position for acting in cases of families with a stillbirth, updated protocols and, in general, the coordination of the different agents involved within the healthcare system.The midwives´ experiences in cases which end with the delivery of a stillborn.Each action of the midwife is as important as the availability of resources to offer the most appropriate care.In each woman who receives the care of a midwife who attends the birth of a stillborn.COREQ checklist.No patient or public contribution occurred for this study as this research focused on exploring staffs' perspectives from the specific viewpoint of their personal experience. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the principal components of ethical leadership • To be aware of what constitutes deviant workplace behaviours • To enhance your understanding of the relationship between deviant workplace behaviours and ethical leadership in managers. Background: There is increasing research interest in the relationship between ethical leadership and deviant workplace behaviour. Ethical leadership encompasses altruism, courage, ethical orientation, integrity and fairness. Examples of deviant workplace behaviours include theft, fraud, sabotage, assault, abuse, manipulation and bullying. It appears that when leaders are fair and emphasise ethical conduct, followers are less inclined to engage in deviant workplace behaviour. Aim: To investigate the relationship between nurses’ self-rated levels of deviant workplace behaviour and perceived levels of ethical leadership in managers. Method: For this descriptive correlational study, 355 nurses from one university hospital in Egypt responded to an online questionnaire comprising the Ethical Leadership Scale and the Workplace Deviance Behavior Scale. Descriptive and inferential statistics were used to explore results and examine the relationships between study variables. Results: There was a statistically significant negative relationship between respondents’ self-rated levels of deviant workplace behaviour and their perceptions of levels of ethical leadership in managers. The results appeared to confirm previous research. Nurses who feel that they are treated fairly by their managers tend to have positive attitudes towards work, colleagues and management. Conclusion: Ethical leadership on the part of managers is a significant determinant of nurses’ behaviour in the workplace and should therefore be fostered by healthcare organisations. [ABSTRACT FROM AUTHOR]

Although opioid agonist treatment (OAT) has several beneficial effects, the issue of optimal treatment length remains unresolved. It is plausible that caregivers' attitudes toward treatment length are of importance to whether, how and when tapering off will take place. In this study, we investigated caregivers' attitudes toward treatment length by interviewing 15 caregivers from a variety of professions working in seven OAT treatment programs in Sweden. Data were analyzed using applied thematic analysis. The participants were generally hesitant concerning the idea of tapering off. Few of them had experiences of patients tapering off successfully. Many of them never brought up the subject unless the patient did so her-/himself. Only younger, socially stable patients were perceived to be suitable for tapering off. Participants also expressed a need among staff for education and ethical discussions on treatment length. A person-centered focus may be promoted by recurrently discussing treatment goals and by co-operating with patients to map the recovery capital of those interested in tapering. To further support caregivers in developing person-centered care, more knowledge of opioid use disorder and professional and interprofessional discussions of caregivers' own attitudes and beliefs are paramount. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand why vaso-occlusive crises in sickle cell disease should be treated as a medical emergency • To increase your awareness of why patients with sickle cell disease often receive suboptimal care • To acknowledge the need for staff education on sickle cell disease so that patients receive appropriate care. Most patients with sickle cell disease (SCD) need support from healthcare services to manage their condition, including painful vaso-occlusive crises. Vaso-occlusive crises should be treated as a medical emergency, but the quality of the care patients receive when they present to the emergency department (ED) is often suboptimal. This article reports the findings of a literature review on the views of ED nurses and doctors about patients with SCD. The review included four studies, all of which had been conducted in the US, demonstrating that research on the topic is limited. The review found mostly negative views, including the belief that patients misuse pain medicines and demonstrate drug-seeking behaviours. Racial bias, widely recognised as a negative influence on the care of patients with SCD, was not mentioned in any of the studies. Staff education regarding SCD is required to ensure patients receive the care they need when they present to the ED. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise there are occasional instances of problematic behaviour towards colleagues in nursing teams • To learn ways of investigating potential problematic behaviour through exploring the beliefs, values and attitudes of individuals and the team • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Behaviour towards colleagues within the nursing team that undermines teamwork and conflicts with standards and policies can be described as problematic. It is important that nurse managers understand and investigate potential problematic behaviour towards colleagues, particularly in today’s healthcare environment where team cohesion and morale are constantly under threat. In this article, the author highlights the challenges for nurse managers and describes the sensitive and respectful exploratory process they need to undertake. Nurses’ behaviours are underpinned by beliefs, values and attitudes so investigating potential problematic behaviour warrants an exploration of these aspects with individual nurses and with the nursing team. Therefore, the author also suggests a way for nurse managers to conduct a collective exploration of the team’s values. [ABSTRACT FROM AUTHOR]

Aim: Social workers are at the front line of helping individuals experiencing alcohol usage, due to their professional duties, ideology and values that underpin it. In Lithuania, where social work still continues to develop in both practice and education, it is crucial to supplement with relevant information to strengthen social work's response to issues with alcohol usage. Therefore, the aim of this study was to explore social workers' attitudes towards individuals with alcohol usage problems. Methods: In total, 149 Lithuanian social workers completed a web survey that gathered information about education, work experience and workplace, and filled in the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ) to measure their attitude towards individuals with alcohol usage problems. Results: The social workers showed a positive attitude towards individuals with alcohol usage problems (mean 35.81 [SD 4.8]). Attitude domain analysis revealed Role Legitimacy (91.3% above the midpoint) to reflect the most positive attitudes and Work Satisfaction (24.2% above the midpoint) to reflect the least positive attitudes. Those with master's degrees scored higher on the total SAAPPQ (t = −2.44, p = 0.016) and its subscales Work Satisfaction (t = −2.52, p = 0.013) and Therapeutic Commitment (t = −2.21, p = 0.029). Having 6–13 years of work experience (mean SAAPPQ = 37.02 [SD 5.11]) was associated with a more positive attitude compared to those with less than 5 years of experience (mean SAAPPQ = 34.08 [SD 3.87]). Conclusion: Although social workers understand their professional responsibility to work with individuals with alcohol usage problems, their dedication to work, motivation and task-specific self-esteem are low. The results also support education, as those with master's degrees showed more positive attitudes. This study further encourages support for social workers just beginning their career, who might report lower attitudes towards individuals with alcohol usage problems. [ABSTRACT FROM AUTHOR]

Background: The goals for staff in Supported Housing for people with psychiatric disabilities include helping to develop the residents' independence and self-confidence in activities. However, staff have expressed frustration about providing this type of support when motivating residents to engage in meaningful activities and also about the difficulty in finding suitable levels of independence within a housing setting with limitations. Objective: The aim is to explore the views and experiences of housing staff in Supported Housing on how they can stimulate and support engagement in activities for people with psychiatric disabilities. Methods: Twenty-six members of staff from 20 supported housing units in 10 municipalities in Sweden were interviewed in five focus groups. A semi-structured interview guide was used, and the transcribed material was analyzed using qualitative content analysis. Results: Three main categories emerged from the analysis: Multi-faceted factors influencing the staff's provision of activity support, Staff's approach for supporting activities, and Staff's struggles to develop their work. Obstacles to participating in activities in the community were identified. Many contrasting factors were found, such as spontaneous or structured activities and individual or group activities, which affected the staff's ability to motivate to activity. Conclusion: A broad approach encompassing in-house training including a focus on values, recruitment policies, staff supervision and interventions focusing on both residents and staff are ways to support staff in motivating residents toward being more active within Supported Housing. [ABSTRACT FROM AUTHOR]

BackgroundThe goals for staff in Supported Housing for people with psychiatric disabilities include helping to develop the residents’ independence and self-confidence in activities. However, staff have expressed frustration about providing this type of support when motivating residents to engage in meaningful activities and also about the difficulty in finding suitable levels of independence within a housing setting with limitations.ObjectiveThe aim is to explore the views and experiences of housing staff in Supported Housing on how they can stimulate and support engagement in activities for people with psychiatric disabilities.MethodsTwenty-six members of staff from 20 supported housing units in 10 municipalities in Sweden were interviewed in five focus groups. A semi-structured interview guide was used, and the transcribed material was analyzed using qualitative content analysis.ResultsThree main categories emerged from the analysis: Multi-faceted factors influencing the staff’s provision of activity support, Staff’s approach for supporting activities, and Staff’s struggles to develop their work. Obstacles to participating in activities in the community were identified. Many contrasting factors were found, such as spontaneous or structured activities and individual or group activities, which affected the staff’s ability to motivate to activity.ConclusionA broad approach encompassing in-house training including a focus on values, recruitment policies, staff supervision and interventions focusing on both residents and staff are ways to support staff in motivating residents toward being more active within Supported Housing.

Why you should read this article: • To increase your knowledge of the McCloskey/Mueller Satisfaction Scale, used to measure job satisfaction • To find out about the job satisfaction of migrant nurses working in critical care in Saudi Arabia • To consider strategies for enhancing nurses' job satisfaction and increasing nurse retention Background: Nurses' job satisfaction is a crucial component of a safe and efficient healthcare environment. Aim: To understand the level of job satisfaction among migrant nurses working in intensive and critical care in Saudi Arabia. Method: This study used a quantitative descriptive design. A total of 421 migrant nurses working in intensive and critical care units in two teaching hospitals in Saudi Arabia completed a questionnaire based on the McCloskey/Mueller Satisfaction Scale. Findings: Participating migrant nurses had moderate levels of job satisfaction overall, except for salary, holiday allowance and maternity leave, which attracted low satisfaction scores, and nursing peers, which attracted a high satisfaction score. There were no statistically significant differences in job satisfaction scores according to demographic variables except marital status, with a significantly higher job satisfaction among married respondents. Conclusion: Promoting job satisfaction among nurses could improve the efficiency and quality of nursing care. There is a range of strategies that can be used to enhance nurses' job satisfaction, including improving working conditions and promoting career development. [ABSTRACT FROM AUTHOR]

Jails are often the first point of assessment after arrest. This structural position provides an early opportunity to document and treat opioid use disorder (OUD). This paper describes the findings of the Building Bridges Planning Initiative, a project which prepared jail staff and their community treatment partners for the implementation and/or expansion of the use of medications for opioid use disorder (MOUDs) in 16 different jurisdictions across the U.S. From August 2019 through April 2020, 123 staff participants from 16 different counties in the U.S. completed surveys at baseline and again at one-year follow-up for staff still engaged in the project documenting changes in knowledge about, and the perceived helpfulness of, six different MOUDs. Participants were predominantly female (61%), averaged 49 years of age (SD = 11), and worked in jail (60%). Bivariate and multivariate results suggest that respondents' perceived knowledge of/helpfulness of all MOUDs increased from baseline to follow-up, though findings for naltrexone-based MOUDs were mixed, with only depot naltrexone demonstrating significant increases in perceived helpfulness. Findings presented here suggest that over the course of the intervention, familiarity with and attitudes about MOUDs improved among individuals working within treatment centers and individuals working within correctional facilities. [ABSTRACT FROM AUTHOR]

Introduction Smoke-free environments have already been successfully introduced in hospitals world-wide. But despite convincing evidence of their success, many countries still struggle to make the necessary changes. Not only is the smoking prevalence higher amongst people with mental health problems and staff working in psychiatric units, but employees in psychiatry often resist the implementation of smoke-free policies. This study explores staff attitudes towards smoke-free environments in psychiatric hospitals in Germany and tries to identify barriers and opportunities for implementation. Methods This cross-sectional online survey was carried out at eight psychiatric units of the state-owned healthcare company Vivantes Netzwerk für Gesundheit GmbH in Berlin, Germany, in 2019. A total of 448 members of staff were surveyed on their views towards creating a smoke-free environment in their workplace. Results Psychiatric staff present contradictory attitudes towards implementing smoke-free regulations. On the one hand, a majority recognizes the need for smoke-free environments as they promote physical well-being of staff and patients. On the other hand, a majority opposes comprehensive restrictions like a complete smoking ban. Smokers are more likely than non-smokers to resist restrictive measures and show a tendency to only support those measures which they deem unlikely to affect their own smoking habits. Conclusions The contradictory attitudes towards implementing smoke-free regulations present an entry point to elicit behavior change and a shift in attitudes, for example in staff training on smoke-free environments. Staff who smoke, in particular, should be motivated to reflect on the contradiction that is presented by their private smoking behavior and their role as healthcare professionals.

The study aimed to explore and describe the experiences of inmates living with HIV/AIDS regarding ARV adherence in correctional services in Limpopo Province. A qualitative, exploratory, descriptive and contextual approach with a constructive paradigm was employed to gain insight into the experiences of inmates living with HIV and AIDS. Non-contact telephone interviews through transparent windows were conducted with the inmates living with HIV/AIDS (n=20) from May 2021 until September 2021 in the correctional service facilities in Limpopo Province. Telephone interviews were audio-recorded and transcribed verbatim from Tshivenda, Sotho, and Tsonga into English. Data were analyzed using eight steps according to Tech's method of qualitative analysis to determine themes and subthemes. The results indicate the burden of taking multiple medication regimens, fear of stigma and break of confidentiality, shortage of nursing staff and high workload, professional nurses 'insufficient' adherence counseling and health-related information and education, inmates transitioning between correctional and police station facilities, insufficient provision of meals and meals unrelated to treatment times, and inconsistent criteria for provision of a special diet as factors contributing to medication adherence for detained inmates living with HIV/AIDS in the correctional service environment. The study concluded that optimal adherence to ARV treatment for inmates living with HIV/AIDS during incarceration is crucial to achieving viral suppression and improving medication outcomes for inmates in correctional service facilities. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand why there is less nursing research in the Middle East than in other countries • To explore an innovative approach to overcome the lack of research knowledge • To appreciate how increasing research capacity can benefit nurses and evidence-based practice Background: The main barrier to engaging nurses in research is the lack of research knowledge and skills. Aim: To explore the influence of research workshops on the research orientation of nurses in a large referral hospital in Qatar. Discussion: This article describes a cross-sectional study involving 564 nurses working in 14 health facilities who attended research workshops in Qatar. The authors collected data using the Edmonton Research Orientation Survey (EROS) as well as questions considering support and barriers to research. Descriptive statistics were used to summarise and determine the sample characteristics and distribution of participants. The participants who attended the workshop were found to have a higher orientation towards the EROS sub-scales of evidence-based practice, valuing of research, involvement in research, being at the leading edge of the profession and support for research, compared to those who did not attend the workshop. There was no statistical difference between the groups in the research barrier sub-scale. Conclusion: Despite significant improvements in their responses to the EROS research orientation sub-scales after attending the workshop, the nurses still reported many barriers to being actively engaged in research. Implications for practice: Healthcare organisations should assist with integrating evidence-based practice into healthcare. There is a need for research education for clinical nurses to bring evidence into clinical practice to improve the quality of patient outcomes. Increasing the research capacity of nurses will lead to their emancipation in addressing the flaws in clinical practice and motivate them to use evidence in patient care. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To familiarise yourself with factors that can affect employees' attitudes towards their role • To recognise the link between improved productivity in healthcare services and ensuring patients' health and well-being • To learn how organisational justice can be linked to improved productivity in emergency nurses Background: Human resource management and employees' performance are fundamental to the success of healthcare organisations. Therefore, it is important to consider the factors that may affect employees' performance. Aim: To determine the relationship between perceived organisational justice, positive organisational behaviour (POB) and the productivity of emergency nurses. Method: This was a descriptive-analytical study that involved distributing questionnaires to emergency nurses working in hospitals affiliated with Mazandaran University of Medical Sciences in Iran. The researchers used proportionate stratified sampling to calculate the sample size. Three questionnaires were used to collect data on organisational justice, POB and productivity. The data were analysed using the Pearson correlation coefficient and multiple regression tests. Results: The questionnaires were distributed to 284 emergency nurses and completed by 234 of them. The results demonstrated a significant relationship between the productivity of the emergency nurses and the variables of perceived organisational justice and POB. Conclusion: Higher levels of perceived organisational justice and POB in the ED setting are likely to lead to increased productivity among emergency nurses, and as a result the quality of patient care is likely to improve. Therefore, healthcare organisations should pay particular attention to the application of organisational justice, with the aim of promoting POB among nurses and increasing their productivity. [ABSTRACT FROM AUTHOR]

Recovery orientation (RO) is directed at living a worthwhile life despite being impaired by the constraints of mental illness. Although being quite common in general psychiatry in Switzerland, the dual mission of forensic psychiatry—safeguarding and therapy—challenges the idea of establishing RO as a work philosophy in this context. This explorative study qualitatively investigates baseline expectations and professional perspectives of forensic staff members concerning the idea of establishing RO in Swiss forensic psychiatric wards. Thereby, three central themes were worked out, namely “challenges associated with recovery,” “expected barriers,” and “possible recovery-oriented interventions.” From a general point of view, the staff members were uncertain whether RO interventions could be introduced at all, and if so, to what extent. This, on the one hand, had to do with structural obstacles such as security requirements; however, personal obstacles in the form of different, sometimes contradictory attitudesand ideals and fearful anticipations—such as the loss of authority and power— also played a central role. As forensic psychiatric wards are non-existent in Latin-speaking Switzerland, the study does only refer to the German-speaking language region. [ABSTRACT FROM AUTHOR]

Background: This research aimed to investigate the views and experiences of specialist mental health professionals working with adults with intellectual disabilities and mental health problems in Singapore in order to gain insight into the functioning of the local specialist intellectual disability mental health service and how it may be improved.Methods: Eight staff members from specialist service were interviewed. The transcriptions of the interviews were analysed using thematic analysis.Results: Analysis revealed four themes (1) Identifying their roles; (2) Ensuring continuity of care; (3) Disempowerment of service users and (4) Improving clinical practice.Conclusions: Participants identified the challenges they faced working with this population. They highlighted the importance of building therapeutic relationships during the treatment process and discussed the stigma that people with intellectual disabilities face in the community. Recommendations and implications are discussed in relation to service provision, improving staff knowledge and recruiting more staff to work in this field. [ABSTRACT FROM AUTHOR]

Aim : To develop and measure the psychometric properties of the Gambling and Gambling Problem Perception Questionnaire (GGPPQ); a scale to evaluate professionals' attitudes towards people with problem gambling in the Japanese context. Data collection : We held 12 workshops in Japan targeted at mental health professionals who consult people with gambling problems. Participants completed the survey before the workshop. Some were also asked to complete the survey after the workshop to measure workshop influence. Setting : Public and private healthcare facilities in all 47 prefectures of Japan. Participants : Medical doctors, nurses, social workers, clinical psychologists, and other professionals working in the aforementioned facilities (n = 653, response rate = 98.5%). Measurements : licence; knowledge about gambling and gambling problems (questionnaire); self-rating of knowledge and general confidence for helping problem gamblers; years of practice; frequency of working with clients; experience in attending workshops; overall satisfaction with the workshop. Results : A five-factor structure extracted by exploratory factor analysis showed a good fit by confirmatory factor analysis (CFI =.973, TLI =.967, RMSEA =.060, AIC = 28913.6, BIC = 29110.8). The GGPPQ showed good internal consistency and good concurrent validity with participants' self-rating of their knowledge, general confidence, frequency of working with clients who have gambling problems, and experience in attending workshops. The workshop had a positive influence on participants' attitudes. Japan's unique gambling industry and lack of training opportunities on problem gambling were assumed to have influenced the psychometric properties of the measurement tool. Conclusion : The GGPPQ is a valid tool to measure the attitudes of healthcare professionals towards people with gambling problems, as well as workshop effectiveness in Japan. [ABSTRACT FROM AUTHOR]

Recovery orientation (RO) is directed at living a worthwhile life despite being impaired by the constraints of mental illness. Although being quite common in general psychiatry in Switzerland, the dual mission of forensic psychiatry—safeguarding and therapy—challenges the idea of establishing RO as a work philosophy in this context. This explorative study qualitatively investigates baseline expectations and professional perspectives of forensic staff members concerning the idea of establishing RO in Swiss forensic psychiatric wards. Thereby, three central themes were worked out, namely “challenges associated with recovery,” “expected barriers,” and “possible recovery-oriented interventions.” From a general point of view, the staff members were uncertain whether RO interventions could be introduced at all, and if so, to what extent. This, on the one hand, had to do with structural obstacles such as security requirements; however, personal obstacles in the form of different, sometimes contradictory attitudesand ideals and fearful anticipations—such as the loss of authority and power—also played a central role. As forensic psychiatric wards are non-existent in Latin-speaking Switzerland, the study does only refer to the German-speaking language region.

INTRODUCTION Smoke-free environments have already been successfully introduced in hospitals world-wide. But despite convincing evidence of their success, many countries still struggle to make the necessary changes. Not only is the smoking prevalence higher amongst people with mental health problems and staff working in psychiatric units, but employees in psychiatry often resist the implementation of smoke-free policies. This study explores staff attitudes towards smoke-free environments in psychiatric hospitals in Germany and tries to identify barriers and opportunities for implementation. METHODS This cross-sectional online survey was carried out at eight psychiatric units of the state-owned healthcare company Vivantes Netzwerk für Gesundheit GmbH in Berlin, Germany, in 2019. A total of 448 members of staff were surveyed on their views towards creating a smoke-free environment in their workplace. RESULTS Psychiatric staff present contradictory attitudes towards implementing smoke-free regulations. On the one hand, a majority recognizes the need for smoke-free environments as they promote physical well-being of staff and patients. On the other hand, a majority opposes comprehensive restrictions like a complete smoking ban. Smokers are more likely than non-smokers to resist restrictive measures and show a tendency to only support those measures which they deem unlikely to affect their own smoking habits. CONCLUSIONS The contradictory attitudes towards implementing smoke-free regulations present an entry point to elicit behavior change and a shift in attitudes, for example in staff training on smoke-free environments. Staff who smoke, in particular, should be motivated to reflect on the contradiction that is presented by their private smoking behavior and their role as healthcare professionals. [ABSTRACT FROM AUTHOR]

Abstract Background High comorbidity exists between mental illness and substance use disorders (SUD). Patients in psychiatry living with problematic alcohol or drug consumption can experience a sense of exclusion, where seeking help for SUD can be perceived as stigmatizing. The aim of this study is to illuminate staff experiences of encountering patients with SUD within the psychiatric outpatient context. Methods The study was exploratory, with a qualitative design. Interviews with outpatient psychiatry managers and focus groups with clinical staff focused on the experience of encountering patients with SUD. Data were evaluated using content analysis inspired by phenomenological-hermeneutic methodology. Results Three themes were identified and each illuminated by two sub-themes. Bridging the organizational gap included sub-themes of having an established collaboration and facing difficulties in the collaboration; Having beliefs about the patient you encounter included sub-themes of working with patients who are exposed to prejudicial thoughts and expressing prejudicial thoughts about the patient. Striving to achieve a therapeutic alliance included sub-themes of having a feeling of developing together and supporting the patient towards recovery. Conclusion A life-world perspective, used to interpret results, indicated that caring for patients with SUD in psychiatry was perceived as difficult, where collaboration between psychiatry and addiction care was often experienced as problematic. Based on these findings, we believe that the current gap between the psychiatry and addiction care could be reduced to some extent by offering patients digital treatment for SUD. In this way, patients could remain under the care of their regular psychiatric clinic without having to physically visit SUD services. Thus, a virtual bridge could be established to bring psychiatry and addiction care closer to each other for the patients’ benefit.

Why you should read this article: • To enhance your knowledge and understanding of intercultural communication principles and challenges • To reflect on intercultural communication in your workplace and on how you may be able to help enhance it • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Globalisation and migration trends are reflected in emergency departments (EDs), which increasingly care for patients and employ staff from diverse cultural and/or ethnic backgrounds. EDs are busy, pressured and unpredictable environments where effective communication with patients and families is challenging at the best of times. This is compounded by language and cultural barriers experienced by patients and families whose background differs from the prevailing culture. Cultural differences and language comprehension may also be a challenge for overseas nurses recruited to the ED, who may need support from colleagues and organisations. ED nurses therefore need to be competent in intercultural communication. This involves combining optimal interpersonal skills with cultural awareness, knowledge and sensitivity. [ABSTRACT FROM AUTHOR]

We evaluated current knowledge and attitudes about type 2 diabetes among female students pursuing nursing degrees at one university in Saudi Arabia in 2018–19. The majority of the 87 respondents were aware of risk factors for type 2 diabetes, such as obesity (95 percent) and age (93 percent). Most participants were also aware that diabetes can cause complications such as blindness (88 percent), kidney disease (77 percent), and heart disease (67 percent). However, only about half believed that type 2 diabetes is a very serious disease (47 percent), and many believed that people with diabetes who do not use insulin have mild disease (61 percent) and do not need to worry about long‐term complications (36 percent). Addressing these misperceptions, perhaps with education that combines the cognitive and affective domains, will prepare these rising professionals to provide better patient care in the coming years as Saudi Arabia seeks to reduce its epidemiological and economic burden from diabetes. Key Takeaways: Saudi nursing students are knowledgeable about diabetes complications yet may not consider diabetes to be a serious disease. Nurses who do not perceive diabetes to be a serious condition may be underprepared for clinical practice even if they are knowledgeable about the disease. Health education that connects the cognitive and affective domains may close gaps between knowledge and perceptions. [ABSTRACT FROM AUTHOR]

Abstract Background Little is known about staff’s attitudes in Irish acute hospital settings towards people living with dementia and their perceived dementia knowledge. The aim of this study was to understand the general level of dementia knowledge and attitudes towards dementia in different types of hospital staff, as well as to explore the potential influence of previous dementia training and experience (having a family member with dementia) and the potential moderating effects of personal characteristics. This data was required to plan and deliver general and targeted educational interventions to raise awareness of dementia throughout the acute services. Methods A cross-sectional survey was carried out among a diverse range of hospital staff (n = 1795) in three urban acute general hospitals in Ireland, including doctors, nurses, healthcare attendants, allied professionals, and general support staff. Participants’ perceived dementia knowledge and attitudes were assessed as well as their previous dementia training and experience. To measure participant’s attitude towards dementia, the validated Approaches to Dementia Questionnaire (ADQ) was used. Results Hospital staff demonstrated positive attitudes towards people living with dementia, and believed they had a fair to moderate understanding of dementia. Both ‘having previous dementia training’ and ‘having a relative living with dementia’ predicted attitude towards dementia and perceived dementia knowledge. Interestingly, certain personal staff characteristics did impact dementia training in predicting attitude towards dementia and perceived dementia knowledge. Conclusion This study provides a baseline of data regarding the attitudes towards dementia and perceived dementia knowledge for hospital staff in Irish acute hospitals. The results can inform educational initiatives that target different hospital staff, in order to increase awareness and knowledge to improve quality of dementia care in Irish hospitals.

Background: Generic mental health staff often have contact with people with intellectual disabilities when they access mainstream mental health services. To date, there has not been any research conducted in non-western countries to explore their views. This paper investigates the views and experiences of mainstream mental health professionals regarding the mental health services for people with intellectual disabilities in Singapore. Methods: Eight staff members from generic mental health services were interviewed. Thematic analysis was used to identify main themes. Findings: The main themes are related to their work experiences, perceptions of people with intellectual disabilities, ideal staff characteristics and service recommendations. Conclusions: Participants identified a lack of experience and knowledge when working with this population. They highlighted the challenges they face promoting choice and autonomy for people with intellectual disabilities. The discussion includes recommendations for improving staff knowledge through training opportunities, consideration of non-pharmacological approaches and early collaboration with caregivers during the treatment process. [ABSTRACT FROM AUTHOR]

Improving access to buprenorphine treatment is necessary to address the national opioid use disorder (OUD) crisis. This study investigates attitudes about buprenorphine prescribing among staff at a primary care clinic and compares attitudes before and after implementation of an office-based opioid treatment (OBOT) program. Providers and staff in an academic primary care clinic were surveyed prior to and one year following implementation of an OBOT program. Descriptive statistics, Pearson's Chi-2 tests and logistic regression models were used to compare staff and provider attitudes about use of buprenorphine for OUD and to compare attitudes before and after OBOT implementation. At baseline, 20% of staff indicated strong belief that buprenorphine is an effective treatment for OUD and 16% indicated strong belief that primary care providers should prescribe it. Staff appeared less likely than providers to believe strongly that buprenorphine is effective (OR 0.24, 95% CI= 0.08-.78, p = 0.02; aOR 0.28, 95% CI=.08-1.0, p = 0.05 adjusted for age, race and gender). Following implementation of an OBOT program, the percentage of staff who believed strongly in the effectiveness of buprenorphine for OUD increased from 20% to 40% (p = 0.31), and the percentage who believed that primary care providers (PCPs) should prescribe it increased from 16% to 30% (p = 0.52). Staff in a primary care clinic were less likely than providers to believe in the effectiveness of buprenorphine treatment or that PCPs should prescribe it for OUD. That their beliefs substantially changed after implementation of an OBOT program suggests that direct experience impacts attitudes. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic prompted an unprecedented level of change in service delivery across the NHS and nurses needed to adapt their practice quickly. However, to date, there has been little recognition of the challenges encountered during the pandemic by learning disability nurses. This article outlines a listening exercise that was undertaken to gather insights into the experiences and contributions of learning disability nurses during the first wave of the pandemic. Nine reflective group discussions were held via video conferencing with 26 learning disability nurses. Themes were extracted from these discussions. The findings revealed negative and positive effects of the pandemic on learning disability nursing practice. They show that learning disability nurses have responded to the pandemic with increased collaboration, creativity and commitment in an effort to maintain the health and well-being of service users. The insights gained from these reflective discussions enabled an understanding of how organisations and learning disability nurses managed the transformation of services during the first wave. [ABSTRACT FROM AUTHOR]

Abstract Background While involvement in the legal system offers an opportunity to educate, screen, and treat high-risk youth, research shows that staff attitudes toward these practices can serve as barriers to implementation. The current study investigates the degree to which JJ staff endorse HIV prevention, testing, and treatment linkage practices with youth under community supervision and examines differences between individuals who supervise youth (e.g., juvenile probation officer) and those working in non-supervisory roles (e.g., case manager, assessment specialist). Methods Juvenile justice staff consenting to participation in JJ-TRIALS completed an initial staff survey (N = 501). Survey items measured perceived importance of HIV/STI prevention (4 items); perceived importance of HIV/STI testing (7 items); and perceived importance of HIV/STI treatment linkage (8 items). Results Confirmatory Factor Analysis (CFA) was computed (SAS CALIS procedure) for each of the three domains. Findings suggest that while staff recognize that youth are at risk for HIV/STIs and require provision of HIV/STI prevention and treatment linkage, attitudes concerning the importance of procuring or providing testing services for youth is substantially lower. Furthermore, analytic models comparing staff with and without supervision responsibilities (computed using SAS PROC MIXED) indicated that attitudes differed by site and staff responsible for supervision rated HIV treatment linkage practices as less important compared to non-supervising staff. Conclusions Establishing partnerships with health agencies equipped with resources and skillsets to provide HIV/STI testing and related services may be an effective model to promote greater awareness and use of best practices among JJ staff and more effectively address the unmet needs of this high-risk population of youth.

Many determinants leading to the use of different coercive measures in psychiatry have been widely studied and it seems that staff attitudes play a crucial role when it comes to the decision-making process about using coercion. However, research results about staff attitudes and their role in the use of coercive measures are inconsistent. This might be due to a focus on self-report studies asking for explicit answers, which involves the risk of bias. This study aimed to expand research on this topic by examining the impact of explicit and implicit staff attitudes on the use of coercive measures in clinical practice. In addition, the influence of gender, profession (nurses, psychiatrists), and years of professional experience as well as their influence on staff attitudes were examined. An adaption of the implicit association measure, the Go/No-Go Association Task (GNAT), with the target category coercion and distracter stimuli describing work load, as well as the explicit questionnaire Staff Attitudes to Coercion Scale (SACS) was completed by staff (N = 149) on 13 acute psychiatric units in 6 hospitals. Data on coercive measures as well as the total number of treated cases for each unit was collected. Results showed that there was no association between staff's implicit and explicit attitudes toward coercion, and neither measure was correlated with the local frequency of coercive measures. ANOVAs showed a significant difference of the GNAT result for the factor gender (F = 9.32, p = 0.003), demonstrating a higher tendency to justify coercion among female staff members (M = −0.23, SD = ±0.35) compared to their male colleagues (M = −0.41, SD = ±0.31). For the SACS, a significant difference was found for the factor profession (F = 7.58, p = 0.007), with nurses (M = 2.79, SD = ±1.40) showing a more positive attitude to the use of coercion than psychiatrists (M = 2.15, SD = ±1.11). No significant associations were found regarding the extent of professional experience. Results indicate a complex interaction between implicit and explicit decision-making processes dependent on specific contexts. We propose future research to include primers for more context-related outcomes. Furthermore, differences in gender suggest a need to direct attention toward occupational safety and possible feelings of anxiety in the workplace, especially for female staff members.

Many determinants leading to the use of different coercive measures in psychiatry have been widely studied and it seems that staff attitudes play a crucial role when it comes to the decision-making process about using coercion. However, research results about staff attitudes and their role in the use of coercive measures are inconsistent. This might be due to a focus on self-report studies asking for explicit answers, which involves the risk of bias. This study aimed to expand research on this topic by examining the impact of explicit and implicit staff attitudes on the use of coercive measures in clinical practice. In addition, the influence of gender, profession (nurses, psychiatrists), and years of professional experience as well as their influence on staff attitudes were examined. An adaption of the implicit association measure, the Go/No-Go Association Task (GNAT) , with the target category coercion and distracter stimuli describing work load , as well as the explicit questionnaire Staff Attitudes to Coercion Scale (SACS) was completed by staff (N = 149) on 13 acute psychiatric units in 6 hospitals. Data on coercive measures as well as the total number of treated cases for each unit was collected. Results showed that there was no association between staff's implicit and explicit attitudes toward coercion, and neither measure was correlated with the local frequency of coercive measures. ANOVAs showed a significant difference of the GNAT result for the factor gender (F = 9.32, p = 0.003), demonstrating a higher tendency to justify coercion among female staff members (M = −0.23, SD = ±0.35) compared to their male colleagues (M = −0.41, SD = ±0.31). For the SACS, a significant difference was found for the factor profession (F = 7.58, p = 0.007), with nurses (M = 2.79, SD = ±1.40) showing a more positive attitude to the use of coercion than psychiatrists (M = 2.15, SD = ±1.11). No significant associations were found regarding the extent of professional experience. Results indicate a complex interaction between implicit and explicit decision-making processes dependent on specific contexts. We propose future research to include primers for more context-related outcomes. Furthermore, differences in gender suggest a need to direct attention toward occupational safety and possible feelings of anxiety in the workplace, especially for female staff members. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the barriers and facilitators to research engagement for healthcare staff • To learn about the factors that can predict staff members' interest in engaging with research • To consider how staff interest in research engagement could be increased in your area of practice Research in learning disability teams is crucial to ensure effective and high-quality care. This article details a service evaluation that aimed to assess the relationship between staff interest and staff involvement in research. It also aimed to investigate whether staff interest can be predicted by three other factors that affect engagement in research – support, confidence and time. A ten-item survey about research attitudes was distributed to 154 staff members in five adult learning disability teams based in the community in one NHS trust, and 80 of these staff members responded. An exploratory groupwise t-test found that staff interest in conducting research is significantly related to staff involvement in research, with those involved reporting more interest. Regression modelling found that confidence was the sole predictor of interest in research; therefore, future studies could examine the role of staff confidence in developing interest in research. Further studies are required to understand how to increase research activity in learning disability services. [ABSTRACT FROM AUTHOR]

Background: High comorbidity exists between mental illness and substance use disorders (SUD). Patients in psychiatry living with problematic alcohol or drug consumption can experience a sense of exclusion, where seeking help for SUD can be perceived as stigmatizing. The aim of this study is to illuminate staff experiences of encountering patients with SUD within the psychiatric outpatient context. Methods: The study was exploratory, with a qualitative design. Interviews with outpatient psychiatry managers and focus groups with clinical staff focused on the experience of encountering patients with SUD. Data were evaluated using content analysis inspired by phenomenological-hermeneutic methodology. Results: Three themes were identified and each illuminated by two sub-themes. Bridging the organizational gap included sub-themes of having an established collaboration and facing difficulties in the collaboration; Having beliefs about the patient you encounter included sub-themes of working with patients who are exposed to prejudicial thoughts and expressing prejudicial thoughts about the patient. Striving to achieve a therapeutic alliance included sub-themes of having a feeling of developing together and supporting the patient towards recovery. Conclusion: A life-world perspective, used to interpret results, indicated that caring for patients with SUD in psychiatry was perceived as difficult, where collaboration between psychiatry and addiction care was often experienced as problematic. Based on these findings, we believe that the current gap between the psychiatry and addiction care could be reduced to some extent by offering patients digital treatment for SUD. In this way, patients could remain under the care of their regular psychiatric clinic without having to physically visit SUD services. Thus, a virtual bridge could be established to bring psychiatry and addiction care closer to each other for the patients' benefit. [ABSTRACT FROM AUTHOR]

One of the resources of the manager in the organization is Human Resources/manpower. Today, developments especially in the field of technology, such human resources work and processes have been accomplished in computer environment, as well as many processes. In the study, it was aimed to investigate the attitudes of personal towards electronic human resources management practices and situation of organizational trust, to look at the relationship of organizational trust environment with electronic human resources applications, to search whether employees' attitudes towards electronic human resources practices and organizational trust change according to demographic characteristics or not. In order to reach the objectives of the study, the necessary literature review was performed and then a structured questionnaire was applied to the administrative staff at Siirt University and the necessary tables were created and analyzed. It is understood that electronic human resources applications are actively used, adopted and welcomed by the personnel of the institution. [ABSTRACT FROM AUTHOR]

Background: Infection is one of the major threats to Healthcare Workers (HCW) worldwide. It exposes HCW to more than 20 kinds of blood-borne pathogen infections, especially the most severe cases, namely Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV). The impact of infection about HCWs' health, clinical burden, national economic burden, and humanistic burden suggests the importance of further investigation and discussion on this topic. Aims: This paper aimed to discuss literature on infection control knowledge and attitudes among HCWs and potential factors contributing to infection control. Method: For this narrative review Proquest, Medline, and Up To Date have been utilized to search articles about infection control knowledge and attitudes among healthcare workers and potential factors contributing to infection control. The search was narrowed to article between 2000 and 2018. A total of 400 materials were initially identified to be potentially relevant for the review. A total of 28 articles were included, and they were found to match the inclusion criteria. Results: Results from the reviewed studies showed that there was a high-level knowledge in terms of precautionary measures and compliance with needle safety precautions while staff attitude achieved above average. Weak positive correlation was found between staff attitude and precautionary measures, while moderate positive correlation was found between precautionary measures and compliance with needle safety precautions. Only precautionary measures were found to significantly influence compliance with needle safety precautions, in which higher precautionary measures, resulted in higher compliance with needle safety precautions. [ABSTRACT FROM AUTHOR]

Background: Infection is one of the major threats to Healthcare Workers (HCW) worldwide. It exposes HCW to more than 20 kinds of blood-borne pathogen infections, especially the most severe cases, namely Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV). The impact of infection about HCWs’ health, clinical burden, national economic burden, and humanistic burden suggests the importance of further investigation and discussion on this topic. Aims: This paper aimed to discuss literature on infection control knowledge and attitudes among HCWs and potential factors contributing to infection control. Method: For this narrative review Proquest, Medline, and Up To Date have been utilized to search articles about infection control knowledge and attitudes among healthcare workers and potential factors contributing to infection control. The search was narrowed to article between 2000 and 2018. A total of 400 materials were initially identified to be potentially relevant for the review. A total of 28 articles were included, and they were found to match the inclusion criteria. Results: Results from the reviewed studies showed that there was a high-level knowledge in terms of precautionary measures and compliance with needle safety precautions while staff attitude achieved above average. Weak positive correlation was found between staff attitude and precautionary measures, while moderate positive correlation was found between precautionary measures and compliance with needle safety precautions. Only precautionary measures were found to significantly influence compliance with needle safety precautions, in which higher precautionary measures, resulted in higher compliance with needle safety precautions.

Background: Therapeutic untruths (TU) are used in dementia services to de‐escalate distressing situations. The present authors explored the use of TU by care staff supporting people with an intellectual disability who displayed behaviours that challenged. Method: Data were collected from 126 staff (female = 72.2%; mean age = 41.9 years, SD = 10.7) via an online survey in relation to three areas: responses to three scenarios, reported use of different forms of TU and ratings of perceived effectiveness of, and level of comfort using, each type. Results: 96% of participants reported using TU themselves and observing their colleagues doing likewise. Models that included perceived effectiveness of, and level of staff comfort with using, different TU were significant, although only perceived effectiveness significantly independently contributed to the model. Conclusion: The use of TU was common, with levels consistent with those found in dementia services. The limitations and implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

In May 2019 a scandal about the care of people with learning disabilities emerged when the BBC broadcast secret footage of abuse perpetrated at Whorlton Hall, a specialist unit for vulnerable adults. This was another case in a list of abuse in care settings for people with learning disabilities, including systematic abuse uncovered at Ely Hospital in 1967 and Winterbourne View in 2011. This article reflects on the parallels that can be drawn between the cases at Ely Hospital, Winterbourne View and Whorlton Hall, suggests explanations for these recurrent patterns of abuse and makes recommendations for how to address them. [ABSTRACT FROM AUTHOR]

Background: Health care professionals have poor recognition of cognitive impairment among older patients and often have difficulties in providing care for people with dementia in acute hospitals. There are also reported high levels of stigma and negative staff attitudes towards people with dementia. Methodology: A one-time survey of staff working on acute medical and orthopaedic wards of five District Health Boards in New Zealand using the 'Approaches to Dementia Questionnaire'; a 19-item Questionnaire that aims to capture two attitudinal domains (Hope and Person-Centredness), towards people with dementia. A total of 563 questionnaires were distributed. Data were analysed using R. Results: Three hundred and four (53.99%) respondents completed the survey. Ninety-four of the respondents (31.1%) were aged 51 years or older, and nearly all (88.4%) were women. One hundred and sixty-four of the respondents (53.9%) were registered nurses, 10 were student nurses (3.3%), 24 (7.9%) were healthcare assistants, 70 (23.0%) were allied health professionals, 27 (8.9%) were doctors and 9 (3%) were pharmacists. The mean total score of 72.7 reflected positive attitudes overall on the part of the respondents. Allied health professionals, student nurses and pharmacists had high scores on both scales whilst healthcare assistants scored lowest on both scales. Conclusion: Overall, the Approaches to Dementia Questionnaire is a useful measure, but it can be difficult to differentiate between genuine attitudinal differences and confounding influences such as level of knowledge and education amongst such a diverse group of participants. Differences between staff may be considered as a reflection of the high level of direct care that is expected of some staff and not of others. Further, the Approaches to Dementia Questionnaire may not be the most appropriate measure to accurately understand attitudes to dementia care in acute environments; and that it more usefully reveals knowledge about dementia rather than attitudes related to real-time practice. [ABSTRACT FROM AUTHOR]

The assessment and management of pain in acute hospitals has been shown to be suboptimal in literature dating back to the 1950s. Inadequate pain management is thought to be partly due to knowledge gaps and suboptimal attitudes among healthcare professionals regarding pain assessment and management. The literature focuses on measuring and comparing knowledge scores, but it is necessary to understand where the knowledge gaps are and how to fill them. This article presents the findings of an evaluation project conducted across the acute sector of a district general teaching hospital. The project aimed to improve knowledge and attitudes, among nurses, regarding pain assessment and management with a targeted educational intervention. [ABSTRACT FROM AUTHOR]

Background: An appropriate level of knowledge, a positive attitude and awareness of learning needs are essential to provide high-quality care to people living with dementia. Aim: To explore the knowledge, attitudes and perceived learning needs of formal carers of residents living with dementia in one long-term care facility. Method: Questionnaires were sent to nurses and nursing assistants working in one long-term care facility in Malta. A total of 207 completed responses were received from these formal carers. The questionnaire comprised scales: the Alzheimer's Disease Knowledge Scale, the Dementia Attitude Scale and the Dementia Learning Needs Assessment tool. Results: Formal carers' knowledge about dementia was satisfactory. Increased knowledge was associated with being a nurse and working on a specialist dementia unit. Overall, formal carers' attitudes towards people with dementia were positive. Nurses identified managing behaviour that challenges as the most important learning need, while for nursing assistants it was how to assist family caregivers in coping with Alzheimer's disease. Nurses and nursing assistants considered learning about the use of technology to be the least important learning need. Being a nurse and working in a specialist dementia unit were predictors of better knowledge. Working in specialist dementia units was also a predictor of positive attitudes towards people with dementia. Conclusion: Policymakers should be aware that continued investment in specialist dementia units should be an intermediate and long-term goal because of the projected increase in the number of people living with dementia and the need to ensure these individuals receive optimum care. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To understand the experiences of non-biological lesbian mothers when accessing healthcare for their children • To recognise the various forms of discrimination that non-biological lesbian mothers can experience • To increase awareness of the language and attitudes encountered by non-biological lesbian mothers in healthcare settings Background: Lesbian, gay, bisexual and trans (LGBT) parents may have negative experiences when accessing healthcare for their children as a result of homophobia, transphobia or other forms of prejudice. Patients and their families have reported receiving inappropriate comments from healthcare professionals about sexual orientation, despite policy and government recommendations advising healthcare professionals to provide care that demonstrates respect, dignity and compassion. Aim: The aim of this pilot study was to understand the experience of non-biological lesbian mothers accessing healthcare for their children and the types of attitudes and language they encountered. The pilot was also carried out to determine that the style of questioning allowed differentiation between sexuality and gender. Method: This narrative enquiry pilot study used interviews conducted with three non-biological lesbian mothers aged 36-45 years. Two of the participants were a married couple with adopted children; the other had undergone in vitro fertilisation (IVF) with her partner. Of the three participants, two were the authors of this study. The data were coded using thematic analysis. Findings: The participants' interviews revealed mixed experiences with healthcare professionals' attitudes. Four common themes emerged: attitudes and managing healthcare experiences; acknowledgement of sexual orientation; professional standards; and family constellation. Conclusion: The study found that non-biological lesbian mothers experience positive and negative interactions with healthcare professionals but feel disenfranchised because of their non-biological status. A reason for the negative interactions could be a lack of training for healthcare professionals about the challenges that lesbian mothers face when accessing healthcare for their children. [ABSTRACT FROM AUTHOR]