How to Evaluate Online Education for General Practitioners: Development of a Tailored Questionnaire for Heart Failure Education

Physician-oriented online education could be a pathway to improve care for patients with heart failure, however, it is difficult to measure the impact of such education. Self-efficacy is a potential outcome measure. In this article, we develop a methodology for analyzing an educational intervention for general practitioners (GPs) using self-efficacy as a concept. This study was partly conducted within the setting of an observational study, IMPACT-B, where we developed online education for GPs. We designed and refined a 24-item questionnaire using item analysis, and exploratory and confirmatory factor analysis. Ninety-one GPs completed the questionnaire before and after the online education. Follow-up data after 6 months was available for 13 GPs. Item analysis revealed a high degree of internal consistency (coefficient alpha 0.95) and validity. Each additional year of experience was associated with an average baseline self-efficacy score of 0.50 points (95% CI [0.21-0.80]), and each additional patient in HF follow-up with an average score of 2.0 points (95% CI [0.48-3.5]). Items that differentiated most between GPs with high and low self-efficacy were the treatment of congestion as well as titrating medication and MRA in heart failure with reduced ejection fraction. Factor analysis reduced the number of questions to 14, mapping to three factors (diagnosis, treatment, and follow-up), and improved the model fit as measured by the goodness-of-fit indicator comparative-fit-index (from 0.83 to 0.91). We demonstrated a method to assess the impact of online education on general practitioners. This led to a questionnaire that was reliable, valid, and convenient to use in an implementation context.

Exploring the Lived Experiences of Individuals With Spinal Cord Injury During the COVID-19 Pandemic

The global spread of severe acute respiratory syndrome coronavirus 2019 (COVID-19) has affected over 100 countries and has led to the tragic loss of life, overwhelmed health care systems and severely impacted the global economy. Specifically, individuals living with spinal cord injury (SCI) are particularly vulnerable during the COVID-19 pandemic as they often face adverse impacts on their health, emotional well-being, community participation, and life expectancy. The objective of this study was to investigate the lived experience of individuals with SCI during the COVID-19 pandemic in Ontario, Canada. An exploratory design with a qualitative descriptive approach was used to address the study objective. Nine semi-structured interviews were conducted with individuals with traumatic and non-traumatic SCI (37-69 years, C3-L5, AIS A-D, and 5-42 years post-injury). Using reflexive thematic analysis, the following themes were created: (1) Caregiver exposure to COVID-19; (2) Staying physically active in quarantine; (3) Living in social isolation; (4) Difficulty obtaining necessary medical supplies; (5) Access to health services and virtual care during COVID-19; and (6) Fighting COVID-19 misinformation. This is one of the first studies to explore the impact of COVID-19 on individuals living with SCI in Ontario. This study contributes to a greater understanding of the challenges faced by individuals living with SCI and provides insight into how to better support and respond to the specific and unique needs of individuals with SCI and their families during a national emergency or pandemic.

An exploration of the relationship between voices, dissociation, and post-traumatic stress disorder symptoms

OBJECTIVES

Extensive research has shown voice hearing to be associated with symptoms of Post-Traumatic Stress Disorder (PTSD) and dissociation. However, most studies have adopted a quantitative design, using cross-sectional data sampling methods, precluding temporal relationships between variables from being defined.

DESIGN

Using a qualitative design, this study sought to identify potential symptom relationships by addressing the research question: what is the nature of the temporal relationship between voices, dissociation and PTSD symptoms?

METHODS

Seven voice hearers (aged 27 to 68 years) participated in a semi-structured interview exploring voice hearing, PTSD symptoms, and dissociation. The interviews were analysed using Interpretative Phenomenological Analysis.

RESULTS

One superordinate theme was identified in the data. Voices were observed to occur in dynamic interrelationship with PTSD symptoms and dissociation, and were frequently experienced before and after PTSD symptoms and dissociative episodes.

CONCLUSIONS

Implications for theoretical understandings of voice hearing and future research are discussed.

Verbal violence and missed nursing care: A phenomenological study

AIM

To define the missed care experiences of nurses exposed to verbal violence from patients.

BACKGROUND

Verbal violence takes the first place among the types of violence that nurses face in healthcare settings. This can cause negative emotional and physical responses in nurses and issues in patient and nurse interaction. As a result, it may lead to missed nursing care, defined as skipped, postponed or incomplete care during the patient's care.

METHODS

This is a phenomenological study. The study sample included 16 nurses working in inpatient clinics who reported experiencing verbal violence at least once in Turkey. The study was conducted between January and February 2022 with institutional permission and ethics committee approval (09/12/2021-2021/357). A semi-structured interview method was used to collect data. The information gathered from the interviews underwent thematic analysis using an inductive approach. The 'Consolidated Criteria for Reporting Qualitative Research (COREQ)' was used to report this qualitative study based on a comprehensive protocol.

RESULTS

The types of verbal violence most frequently faced by nurses were determined as swearing, insulting, shouting and threats. Study findings were classified into three main themes: (i) response to verbal violence, (ii) missed nursing care experiences and (iii) suggestions to cope with verbal violence. The most felt emotions in the face of verbal violence were feeling sad, unsafe and worthless. Nurses common behaviours, in response to verbal abuse were ignoring, getting used to, and wishing to get away. The examples of missed care included using non-therapeutic communication, postponing care or withdrawing from care.

CONCLUSION

Verbal violence caused negative emotional and behavioural responses in nurses, which, in turn, negatively affected the nurse-patient interaction. These findings mean that verbal violence may pave the way for missed nursing care.

IMPLICATIONS FOR NURSING POLICY

According to these findings, an uninterrupted nursing care process needs to focus on preventive measures against verbal violence and increase the administrative and legal support offered to nurses.

'Why doesn't anyone ask me'? Patients' experiences of receiving, performing and practices of oral care in an acute Orthopaedic Department

AIMS AND OBJECTIVES

Oral care is an integrated part of everyday life. Within nursing, barriers related to providing oral care often lead to unmet caring needs. Poor oral care is associated with a risk of respiratory and cardiovascular complications during hospitalisation. Knowledge on patients' perspectives of maintaining or receiving oral care during admissions are limited. Following the Fundamentals of Care (FOC) framework, this study uses a person-centred approach to explore patients' perceptions and experiences of receiving or performing oral care, including the nursing staff's clinical practices.

METHODOLOGICAL DESIGN AND JUSTIFICATION

A focussed ethnographic approach was used to explore patients' perspectives and clinical practices during acute admissions in an Orthopaedic Department.

ETHICS ISSUES AND APPROVAL

The local Data Protection Agency and the Ethics Committee approved the study.

RESEARCH METHODS, RESULTS AND CONCLUSIONS

Data were collected in an Orthopaedic ward at a Copenhagen University hospital, Hvidovre, and consisted of 14 days of field observations of clinical practices and 15 patient interviews. Data were analysed inductively using qualitative content analysis. Two themes were identified. The first, 'The purpose of oral care is defined by the eye of the beholder', describes the social implications for the patients and how patients reject the assumption of oral care being a transgressive act. The second, 'The unspoken need', focus on the lack of dialogue, including the limited provision of oral care and how the nursing staff assesses patients' ability to perform oral care (in)dependently without including the patients.

CONCLUSION

Oral care is related to the patient's psychological and physical well-being and affects social appearance. When oral care is provided respectfully, patients do not experience oral care as a transgressive act. Nursing staff's self-assessments of the patients' (in)dependency to perform oral care risk leading to incorrect care. Developing and implementing interventions applicable to the clinical practice is needed.

Good life in old age: Qualitative interviews about ageing with older adults with mild intellectual disability, prior to an educational intervention

Background: Knowledge about ageing from the perspective of people with intellectual disability is extremely scarce, which means a lack of evidence-based interventions for healthy ageing adjusted to their needs. Aim: To investigate how people with intellectual disability experience ageing, prior to an educational intervention. Methods: Twenty-six persons with mild intellectual disability, age 42-74 (mean 61.3) were interviewed and the text was analyzed qualitatively. Results: The main findings are reflected in the themes Live for today - tomorrow you are old and Need of support to enable a meaningful ageing. The participants avoided thinking about ageing, which they associated with retirement, loneliness and social isolation, increased need for help in everyday life, worsening health and death. Meaningful ageing meant continuance of leisure activities and working as long as possible. Conclusions: Interventions to prepare people with mild intellectual disability for healthy ageing must take into account these people's loneliness.

"I don't know if you have searched through the scriptures to find a reference on HIV/AIDS. I mean there isn't going to be one, right?": HIV stigma solutions from dialogues between faith leaders and health care workers

In South African communities, both faith leaders and health care workers play a vital role in supporting the health of community members and people living with HIV in particular. This study describes HIV stigma when faith leaders and health care workers engaged in discourse. The study used a descriptive qualitative inquiry design. Data were gathered between 2015 and 2016 in the areas of Masiphumelele and Gugulethu in Cape Town, South Africa. Three themes emerged: (1) participants identified influences that can increase HIV stigma; (2) participants shared the challenges that they face to reduce HIV stigma; and (3) participants suggested solutions to reduce HIV stigma. Themes discussed include ground-level problems and practical solutions to address HIV stigma in faith communities. Collaboration between faith leaders and health care workers are vital resources in the fight against HIV stigma. Future research and interventions should aim to promote organised collaboration between faith communities and health care structures.

Strengthening the role of the executive nurse director: A qualitative interview study

AIM

To explore the challenges and opportunities facing executive nurse directors in the UK and identify factors to strengthen their role and support more effective nurse leadership.

DESIGN

A qualitative descriptive study using reflexive thematic analysis.

METHODS

Semi-structured, telephone interviews were carried out with 15 nurse directors and 9 nominated colleagues.

RESULTS

Participants described a uniquely complex role with a broader scope than any other executive board member. Seven themes were identified: preparation for the role, length of time in role, role expectations, managing complexity, status, being political and influencing. Strengthening factors included successful working relationships with other board colleagues, development of political skills and personal status, coaching and mentoring, working within a supportive team culture and having strong professional networks.

CONCLUSION

Executive nurse leaders are key to the transmission of nursing values and the delivery of safety and quality in healthcare settings. To strengthen this role, the limiting factors and the recommended shared learning identified here should be recognized and addressed at an individual, organizational and professional level.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Given the pressure on all health systems to retain nurses, the role of executive nurse leaders needs to be seen as an important source of professional leadership and their value in actioning health policy into practice recognized.

IMPACT

New insights have been provided into the executive nurse director role across the UK. Findings have demonstrated challenges and opportunities to strengthen the executive nurse director role. These include recognition of the need for support, preparation, networking and more realistic expectations of this unique nursing role.

REPORTING METHOD

The study adhered to the Consolidated Criteria for Reporting Qualitative Research.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

'Everything that's said comes from me': New fathers' experiences of individual conversations with the child health nurse

AIM

Swedish Child Health Services provide regular health surveillance of children 0-5 years and support to parents, with the aim to contribute to equitable child healthcare and to promote physical, emotional, and social health for children. Individual conversations with the child health nurse, including screening for postnatal depression, have been recommended and well implemented for mothers, whereas routines for a visit specifically for the nonbirthing parent vary and are not well studied. The aim of this study was therefore to explore how nonbirthing parents experienced individual conversations with their child health nurse, held 3 months after the birth of their child.

DESIGN

Qualitative interview study.

METHODS

Semistructured interviews were conducted with 16 fathers who had participated in individual conversations with a nurse at their child health centre, 3 months post-partum. Data were analysed with qualitative content analysis. The study adhered to the COREQ checklist for qualitative studies.

RESULTS

The findings are presented in three categories: 'Being invited into a supportive context', 'Talking about what was important' and 'Taking it home', each of them including three subcategories. The individual conversations, without the mother present, made the fathers feel important and allowed for a different type of content, tailored to their own needs. The conversations were validating and led to changes in daily routines with their child for some fathers.

Experiences of dialogue in advance care planning educational programs

BACKGROUND

Advance care planning (ACP) is a process in which adults engage in an ongoing dialogue about future medical treatment and care. Though ACP is recommended to improve the quality of end-of-life care, the details of the dialogue experience in ACP are unknown.

OBJECTIVE

To explore participants' experiences of dialogue in an ACP educational program that encouraged them to discuss the value of a way of life.

RESEARCH DESIGN

This qualitative descriptive study used the focus group interview method. Data were analyzed using qualitative content analysis.

PARTICIPANTS AND RESEARCH CONTEXT

A dialogue-based ACP educational program was conducted in four regions in Japan for local citizens to discuss the value of their way of life. A total of 66 individuals (mean age = 55.5 ± 17.2 years; 50 women and 16 men) participated in focus group interviews.

ETHICAL CONSIDERATIONS

This study was approved by the Ethical Review Committee of Tokyo Women's Medical University (no. 4723) and Kyoto University (no. R2099).

FINDINGS

Five main themes were extracted: discussing one's thoughts with others in a considerate manner, reflecting on one's way of life through others, feeling a sense of connection with others through storytelling, realizing the difficulties of talking about "what if" topics, and turning one's eyes toward the future through the dialogue. These themes were interrelated and illustrated the complexity of the experience of discussing values.

CONCLUSIONS

The results suggest that dialogue in ACP is useful in clarifying values. They also indicated the need for dealing with the ethical challenges of discussing value and the importance of caring for the interlocutor to have a safe dialogue. In the ACP process, safety in dialogue may improve readiness in ACP, and health practitioners who support ACP need to address the ethical challenges entailing dialogue about values.

Through a relational lens: reflections about foster care experience in Italian emancipated foster youth

The study aimed to investigate relational outcomes of Italian emancipated foster youth across open-ended reflections about their perceptions of their relationships with the biological and foster family, with partner and peers. A total of 26 Italian emancipated foster youth (19-25 years old) recruited by social services completed a single in-depth interview. A qualitative thematic analysis was selected for this study. The results revealed two major themes of foster care experience that emerged often simultaneously from the participants' narration: (1) Positive Relational Outcomes including "Feeling supported," "Sense of belonging," "Good memories," "Relationship with family of choice," and "Staying in touch"; and (2) Negative Relational Outcomes referring "Devaluation," "Refuse," "Bad memories," and "Isolation." Foster care experience leads to complex relational perceptions in emerging adulthood according to different relational outcomes and ways of processing foster care experience. Professionals could work on relational outcomes and memories, especially during a critical transition like emerging adulthood, to support youth in making sense of their past experiences.

Experiences of Sex Workers in Chicago during COVID-19: A Qualitative Study

COVID-19 exacerbated health disparities, financial insecurity, and occupational safety for many within marginalized populations. This study, which took place between 2019 and 2022, aimed to explore the way in which sex workers (n = 36) in Chicago were impacted by COVID-19. We analyzed the transcripts of 36 individual interviews with a diverse group of sex workers using thematic analysis. Five general themes emerged regarding the detrimental impact of COVID-19 on sex workers: (1) the impact of COVID-19 on physical health; (2) the economic impact of COVID-19; (3) the impact of COVID-19 on safety; (4) the impact of COVID-19 on mental health; and (5) adaptive strategies for working during COVID-19. Participants reported that their physical and mental health, economic stability, and safety worsened due to COVID-19 and that adaptive strategies did not serve to improve working conditions. Findings highlight the ways in which sex workers are particularly vulnerable during a public health crisis, such as COVID-19. In response to these findings, targeted resources, an increased access to funding, community-empowered interventions and policy changes are needed to protect the health and safety of sex workers in Chicago.

Do you Hear what I Hear? A Qualitative Study Examining Psychological Associations Underlying Evaluations of Everyday Sounds in Patients with Chronic Tinnitus

Tinnitus is a multifactorial phenomenon and psychological, audiological, or medical factors can facilitate its onset or maintenance. A growing body of research investigates individuals' perceptions, associations, and experiences of living with tinnitus. This body of research examines tinnitus as a condition rather than a symptom. We examine a sample of chronic tinnitus patients in terms of associations that are induced by neutral sounds. In particular, we investigate how patients with chronic tinnitus ascribe meaning to those neutral sounds. The present study uses Mayring's content analysis to explore the content of psychological associations underlying valence ratings of everyday neutral sounds. Nine tinnitus patients completed a hearing exercise, during which they listened to seven neutral sounds, following which we examined their sound-induced associations using semi-structured interviews. Three groups of factors influenced patients' associations and valence ratings of neutral sounds: affect, episodic memory, and 'other'. The former two factors further comprised two subcategories. In line with previous psychoaudiological research designs, our findings suggest that neutral, everyday auditory stimuli evoke strong affective reactions-possibly through serving as retrieval cues for episodic memories. Based on these findings, we discuss our results in the context of previous psychoaudiological findings and propose further research concerning psychological associations that may specifically underlie the tinnitus sound.

Taking command of continuity-An interview study with agency nurses

AIM

The aim of the study was to describe continuity from the perspective of working as an agency nurse (AN).

DESIGN

Qualitative design was applied using individual semi-structured interviews.

METHOD

Individual interviews with fifteen registered nurses working at agency companies were conducted in 2020. The interviews were analyzed with thematic analysis. The study followed the guidelines addressed in the COREQ (Consolidated Criteria for Reporting Qualitative Research) framework.

RESULTS

Thematic analysis yielded one theme - standing strong and taking command - and four categories: being competent and experienced, being prepared and at ease, ensuring an unbroken chain of care, and belonging on my own terms. The categories illustrated the engagement, professionalism, and natural leadership showed by the ANs to uphold quality and continuity.

Understanding children's voices about enablers of obesity from a causal attribution's stance: a vignette study

OBJECTIVE

Childhood obesity is a public health challenge with health, economic and psychosocial consequences. The design of interventions addressing childhood obesity seldom considers children's perspectives on the topic. Weiner's causal attribution framework was used to explore children's perspectives on enablers of obesity.

METHODS AND MEASURES

Children (N = 277) responded to a vignette with an open-ended question. Data were analyzed using content analysis.

RESULTS

Children perceived internal, unstable and controllable causes (e.g. dietary intake, self-regulation and emotionality) as the main enablers (76.53%) of obesity, while some (11.91%) highlighted external, unstable and controllable causes (e.g. parent food restrictions). A focus on children with healthy body weight showed that they mentioned more internal, stable and controllable causes for obesity than children with unhealthy body weight/obesity did. The latter mentioned more external, unstable and controllable causes than their counterparts.

CONCLUSIONS

Understanding children's causal attributions for obesity is expected to deepen our knowledge of obesity enablers and help design interventions matching children's perspectives.

Risk and protective factors for a salutogenic sense of health in adolescents with Moyamoya disease

PURPOSE

To identify the risk and protective factors affecting a salutogenic sense of health in adolescents with Moyamoya disease based on Antonovsky's salutogenesis theory.

METHODS

This study used a qualitative descriptive design. We interviewed adolescents diagnosed with Moyamoya disease and their parents and experts with experience in treating them from 4 July 2019 to 10 October 2019. Data analysis was performed according to the process of deductive content analysis based on Antonovsky's salutogenesis theory.

RESULTS

This study identified risk and protective factors affecting a salutogenic sense of health in adolescents with Moyamoya disease. Risk factors were closely related to problems with friends, parent relationships and academic work. Protective factors were identified as emotional support through interpersonal relationships, positive attitudes to the disease situation, ability to understand and predict patterns of symptoms, increasing strength to resolve the state of tension and developing available resources.

CONCLUSION

The factors affecting a salutogenic sense of health in adolescents were identified reflecting on the characteristics of the developmental stage of adolescents and the symptoms and situations that are unique to adolescents. It is important for adolescents with Moyamoya disease to recognize available resources and use them appropriately to successfully manage the state of tension caused by stress.

Practical advice for refugees aspiring to become registered nurses in Australia

AIMS

This paper describes practical advice for refugees aspiring to become Registered Nurses (RNs) in Australia.

DESIGN

Qualitative description using a naturalistic inquiry framework.

METHODS

Between February 2018 and September 2019, the lead author conducted semi-structured interviews with employed RNs that are former refugees that speak English. Interviews were 45-90 min in duration and digitally recorded. Participants provided voluntary informed consent and were sent questions beforehand. All transcription data were thematically analysed for key themes until no further themes were identified. This paper covers practical advice provided by the participants at the conclusion of their interviews.

RESULTS

Twelve participants provided practical advice. Six themes were identified: (1) Find your purpose and set goals; (2) Work hard and never give up; (3) Seek support; (4) Capitalize on opportunities; (5) Be optimistic; (6) Give back. The last theme, give back, was salient across all interviews and was an inherent motivator for some participants once their RN status was achieved.

CONCLUSION

Each participant set the goal of becoming a fully registered nurse and made it a life goal that provided meaning for them. Despite their experiences, the participants provided practical advice that could guide younger people aspiring to become successfully qualified RNs.

IMPACT

The findings in this study are unique as they are derived from people with experiences as refugees who, despite their adversity, became RNs. The practical advice provides a framework not only for younger people from refugee backgrounds seeking to achieve their professional goals, but others looking to succeed in other workforce sectors. The practical advice for success will be useful in informing nursing authorities, tertiary institutions and private and public health organizations to develop effective approaches to guide the next generation of would-be RNs set to contribute to nursing practice in Australia. There were no patient or public contributions as the focus was the personal and professional lives of nurses with refugee backgrounds.

Familial colonoscopic screening: how do French general practitioners deal with patients and their high-risk relatives. A qualitative study

Background

Screening of colorectal cancer (CRC) can reduce incidence and mortality. First-degree relatives (FDRs) of patients with CRC or advanced adenoma before the age of 65 (index patients) are at increased risk of CRC; however, the guidelines for screening of FDRs by colonoscopy are poorly followed.

Objectives

The present study, conducted in the context of the COLOR3 interventional study project, aimed to explore the positioning of general practitioners (GPs) in familial CRC screening in France.

Methods

From February 2020 to April 2021, 35 semi-structured interviews with GPs of index patients and/or their FDRs were conducted by telephone. The full-data transcribed corpus was subjected to horizontal thematic analysis.

Results

Knowledge and compliance with the guidelines vary greatly between GPs. Although initiating the diagnostic process, GPs do not consider themselves as actors in the flow of information concerning familial risk. Their accompaniment of index patients in this role varies. GPs should overcome barriers to implementing colonoscopic screening for FDRs. They underline the importance of exploring family history, but they lack the time and doubt the reliability of the information given by FDRs.

Conclusion

Challenges include circumventing gaps in knowledge, adherence to guidelines and improving family history updates. The GPs interviewed suggested personalised guidelines in specialists' reports to initiate information campaigns raising awareness of familial risk, and to enhance coordination between organised screening and familial screening.

From Expressing Human Milk to Breastfeeding-An Essential Element in the Journey to Motherhood of Mothers of Prematurely Born Infants

BACKGROUND

Lactation and breastfeeding present an extraordinary challenge for mothers of prematurely born infants.

PURPOSE

To explore the significance of and the circumstances that affect lactation for mothers of premature infants.

METHODS

A qualitative exploratory study based on single, in-depth, semistructured interviews with 16 purposefully sampled mothers of premature infants admitted to the neonatal intensive care unit (NICU). Data were analyzed using content analysis. The study was reported according to Standards for Reporting Qualitative Research.

FINDINGS

The overall theme was "From expressing human milk to breastfeeding-an essential element in the journey to motherhood." The theme emerged from 3 categories: the birth preparation time has been interrupted; expressing human milk is essential for lactation; and the motherhood journey encompasses breastfeeding. The analysis also revealed that the categories were impacted by initiating, performing, and maintaining lactation and further influenced by inhibitors and promoters.

IMPLICATIONS FOR PRACTICE

The promoters for performing milk expression and breastfeeding should be stimulated and the inhibitors should be eliminated. The achievement of "zero separation" and mother-infant couplet care in the NICU would be beneficial. In order for mothers to maintain successful lactation, it is essential that they receive supportive around-the-clock access to health professionals with expertise in lactation and breastfeeding until exclusive breastfeeding is well established.

IMPLICATIONS FOR RESEARCH

The study highlights the need to investigate mother-infant as one entity rather than separately as mother and infant.

Creative adolescent experiences of education and mental health during COVID-19: A qualitative study

This qualitative study investigated creative adolescent perceptions of their educational and mental health experiences during the coronavirus disease 2019 (COVID-19) pandemic. Participants were 25 English-speaking adolescents from the Midwest in the United States. They were identified as creative by their teachers according to known creative profiles. Participants attended an all-day creative career workshop in the Spring 2021 semester. The five focus groups guided by semi-structured interviews conducted for this study occurred during the workshop. This study was phenomenological in nature with constructivist and transformative paradigms, and transcripts were analyzed using reflexive thematic analysis by the first, second, and third authors. Creative adolescents' education during the pandemic was marked by classroom changes based on COVID-19 policies, experiences of disconnection, disengagement, and disappointment, as well as feelings of empathy and appreciation for their educators. Creative adolescents experienced mental health challenges related to adjustment issues, powerlessness and hopelessness, and isolation. Implications of results are discussed.

Adaptive Challenges, Adaptive Work, and Adaptive Leadership Among Women Living With HIV in the Southern United States: Findings From a Qualitative Study

ABSTRACT

Women living with HIV have a higher burden of non-AIDS comorbidities and prevalence of chronic conditions. The Adaptive Leadership Framework for Chronic Illness clarifies living with complex health challenges by delineating the technical work of health care providers as well as the adaptive work and leadership behaviors of patients and their providers. We conducted a descriptive, qualitative study of women residing in the Southern United States who were participating in the Women's Interagency HIV Study in North Carolina. Twenty-two participants (mean age = 52.2 years; 90.9% self-identifying as Black or African American) completed semi-structured qualitative interviews. We identified adaptive challenges (e.g., affective and disclosure challenges) and adaptive work and leadership behaviors. Women learned skills to care for their health and support their families and to work with their providers to manage their care. Findings support the importance of identifying leadership behaviors for the purpose of developing person-centered interventions.

Reflections of psychomotor skill development in preclinical simulation: A qualitative analysis

INTRODUCTION

Reflection on competency helps students become more proficient in performing skills, with the ultimate goal of better retention of knowledge and skill. Competency progression involves a complex interplay of factors, and not having the insight of such multiple perspectives of the same experience, we will not be able to understand students as learners fully and consequently may rely on assumption and may not be able to provide the necessary interventions for growth and progress towards competency. This study aims to investigate students' insight of their own progression during psychomotor skill development.

MATERIALS AND METHODS

Data were obtained from scanned reflective dialogue log document portfolios from the preclinical fixed dental prosthodontics section, which is part of a comprehensive dental care course during the second year. Data were coded using NVivo software version 12 plus (QSR International Pty Ltd, Vic, Australia), and subsequent thematic analyses identified emerging themes.

RESULTS

Three themes emerged and these were (a) challenges to overcome, (b) feed-back and self-appraisal, and (c) progress and growth. The qualitative data generated did not reveal considerable variation in the students' reflections, and the three themes seem to interrelate.

CONCLUSIONS

The main challenge was the concept of the single path of insertion and the perception that it was a source of frustration during this course. Self-appraisal identified time management issues and the transformation from preconceived or learned concepts. As the semester progressed, students reflected progress and growth.

Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability

AIM

To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC).

DESIGN

A qualitative descriptive design.

METHODS

Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute-care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis.

RESULTS

A preponderant theme emerged-the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.

How breastfeeding behavior develops in women with gestational diabetes mellitus: A qualitative study based on health belief model in China

BACKGROUND

Gestational diabetes mellitus (GDM) is a condition in which women develop hyperglycemia during pregnancy, and is associated with long-term health burden on both mother and their offspring, such as future type 2 diabetes mellitus (T2DM). Although breastfeeding was expected to mitigate metabolic sequelae for both mothers and their newborns, the prevalence of breastfeeding in GDM mothers are sub-optimal worldwide.

OBJECTIVE

To explore the experience of disease among mothers with GDM and how they develop feeding behaviors.

METHODS

This study was conducted in three branches of an integrated tertiary hospital in the central area of China. Mothers who were diagnosed with GDM, had no other complications, and gave birth before no more than 6 months were approached based on a purposive sampling. GDM mothers' experience of the disease and breastfeeding were collected via in-depth interviews. A theory-driven thematic analysis based on Health Belief Model (HBM) was applied for data analysis. Inductive reasoning was used to identify emerging themes which were not included in HBM.

RESULTS

16 GDM mothers were included in the current study, with nine using breastfeeding, six mixed feeding and one artificial feeding, respectively. Nine themes were identified, including: 1) GDM diagnosis and severity; 2) information searching and GDM knowledge;3) GDM management; 4) perceived susceptibility of future diabetes;5) perceived severity of future diabetes;6) perceived benefits of breastfeeding;7) perceived barriers of breastfeeding;8) decision making process of feeding and social support. Generally, mothers with GDM lack reliable sources of information, considered the disease as a minor and transient illness during pregnancy, and failed to realize the long-term risk of GDM and the protective effect of breastfeeding to themselves and their babies. They rarely considered GDM in their feeding decision. Instead, the formation of feeding behaviors depends on the balance between the benefits and barriers of breastfeeding as well as the level of social support.

CONCLUSION

To promote breastfeeding, a multi-facet intervention targeted on healthcare providers (HCPs), GDM mothers and their networks was important to help GDM mothers better and correctly understand the disease and breastfeeding, and increase their capacity of breastfeeding.

Retrospective experiences of individuals two decades after anterior cruciate ligament injury - a process of re-orientation towards acceptance

PURPOSE

Individual perspectives of long-term consequences decades after anterior cruciate ligament (ACL) injury are unexplored. We addressed experiences and the impact on life of former athletes >20 years post-ACL injury.

METHODS

Individual interviews, analysed using Grounded Theory, were conducted with 18 persons injured mainly during soccer 20-29 years ago.

RESULTS

A theoretical model was developed with the core category Re-orientation towards acceptance, overarching three categories illustrating the long-term process post-injury. Initially the persons felt like disaster had struck; their main recall was strong pain followed by reduced physical ability and fear of movement and re-injury. In the aftermaths of injury, no participant reached the pre-injury level of physical activity. Over the years, they struggled with difficult decisions, such as whether to partake or refrain from different physical activities, often ending-up being less physically active and thereby gaining body weight. Fear of pain and re-injury was however perceived mainly as psychological rather than resulting from physical limitations. Despite negative consequences and adjustments over the years, participants still found their present life situation manageable or even satisfying.

CONCLUSION

ACL injury rehabilitation should support coping strategies e.g., also related to fear of re-injury and desirable physical activity levels, also with increasing age.IMPLICATIONS FOR REHABILITATIONMore than 20 years after the ACL injury, the individuals despite re-orientation towards acceptance and a settlement with their life situation, still had fear of both pain and re-injury of the knee, with concerns about physical activity and gaining of body weight.Patients with ACL injury may need better individual guidance and health advice on how to remain physically active, to find suitable exercises and to maintain a healthy body weight.Education related to pain, treatment choices, physical activity, injury mechanisms in participatory discussions with the patient about the ACL injury may be beneficial early in the rehabilitation process to avoid catastrophizing and avoidance behaviour.ACL injury rehabilitation needs to address coping strategies incorporating the psychological aspects of suffering an ACL injury, including fear of movement/secondary injury, in order to support return-to-sport and/or re-orientation over time.

Milestones in the journey: The story of refugees becoming registered nurses in Australia

AIMS

To explore the experiences of refugees who became registered nurses after arriving to Australia.

DESIGN

Qualitative description using a naturalistic inquiry framework.

METHODS

Between February 2018 and September 2019, the lead author conducted semi-structured interviews with employed registered nurses (RNs) that are former refugees and English-speaking. Interviews were 45-90 min' duration and digitally recorded. Participants provided voluntary informed consent and were sent questions beforehand. Data were collected and coded into themes. Rigor was achieved with multiple transcript readings by the research team to confirm common themes.

RESULTS

Twelve participants discussed their story. Three major themes were identified: (1) Milestone of being a refugee; (2) Milestone of resettling in Australia; (3) Milestone of becoming a RN.

CONCLUSION

Each participant's story started at a place of disadvantage. They progressed successfully through the three milestones; despite living with traumatic experiences, they learned new skills, developed English literacy, became a RN and juggled the demands of life. This paper highlights the poorly understood pockets of the current Australian RN workforce.

IMPACT STATEMENT

The nuanced stories of RNs with refugee backgrounds in this study move beyond trauma and struggle and demonstrate the important journey this particular group of health professionals undertake. Increasing the contextual knowledge of the complex lives of former refugees turned nursing professionals will raise public awareness of the diversity of life experiences of RNs working in Australia.

Patients' Experience of Attending a Binge Eating Group Program - Qualitative Evaluation of a Pilot Study

We developed a group program for patients with binge eating disorders (BED), comprising cognitive therapy, affect consciousness, and therapeutic writing. We wished to investigate how therapeutic writing and affect consciousness were experienced by the patients when integrated in a cognitive behavioral therapy (CBT) program. To our knowledge, such an intervention has not been tried in patients with BED. Aim: To explore patients’ experience of attending a binge eating group program comprising therapeutic writing, affect consciousness, and CBT. Research question: How do patients evaluate their experience of attending an integrative binge eating group program? Method: A qualitative design using an evaluative focus group interview with participants (four women and two men) who had completed the pilot program. Results: Three themes emerged: Enhanced self-awareness about the meaning of feelings; A more generous attitude towards oneself; and On the path to a better grip on the eating difficulties. Discussion: We interpreted the three themes in light of transition processes. The program was described as an essential part of the healing process and seems valuable for enabling new approaches leading to therapeutic changes when suffering from BED.

The multidisciplinary team perspectives on agitation management in critical care: A qualitative study

BACKGROUND

People who are experiencing a period of critical illness frequently experience severe agitation. The presence of agitation can pose risks to the patient, family, and clinical team.

AIMS AND OBJECTIVES

To capture the views and opinions of critical care multidisciplinary teams concerning the approaches in the management of agitation, and to understand and identify the perceived risks and benefits of current management strategies.

DESIGN

A descriptive qualitative design.

METHODS

Data were gathered using semi-structured interviews with multidisciplinary teams from adult critical care units from one region in the United Kingdom.

FINDINGS

A total of 19 participants participated between February to September 2017. There were two group interviews (GIs) (n = 12, GI 1 n = 8, GI 2 n = 4) and seven one-to-one interviews, across four hospital organisations with one participant working via an agency. The mean length (± SD) of each interview, one to one or group, was 58.86 minutes (5.81 minutes). Three major themes were generated about the complex clinical decision-making required to manage an agitated patient. These themes represented: the burden of care, continuity of clinical decision-making, and uncertainty and indecision experienced by participants.

CONCLUSION

Participants described caring for an agitated patient as challenging and stressful. Staff sought clarification on what level of restrictive practice is allowed. Feelings of anxiety and stress generated by the decisions made may have an impact on staff, particularly those who are more inexperienced, which in the longer term could lead to fatigue or moral distress.

RELEVANCE TO CLINICAL PRACTICE

The study has emphasised the challenges faced by multidisciplinary teams and how decision-making may impact on individuals within the team.

Experiences of the mothers of infants hospitalized in the neonatal intensive care unit (NICU)

BACKGROUND

The mother-newborn relationship is more important in neonates hospitalized in the NICU than in healthy neonates. This study was conducted to explore the experiences of the mothers of infants hospitalized in the NICU.

MATERIALS AND METHODS

This qualitative study was done in 2016 by adopting a conventional content analysis approach. Thirty-five mothers in the NICUs, Imam Hossein Hospital and Fatemieh Hospital were selected. Their experiences were assessed using in-depth individual semi-structured interviews. Sampling was purposive and was continued until reaching data saturation.

RESULTS

Two hundred and nine primary codes were extracted. After removing duplicates and overlaps, 95 primary codes were categorized in 8 subcategories, 2 accessory categories and 1 main category based on their appropriateness, agreement, and similarity. The accessory categories of "mothers' worries" and "mothers' hopes" were merged into a more general, abstract category named "dual feelings about the baby".

CONCLUSIONS

The nurses' awareness of the mothers' experiences can help design interventions to promote the quality of care for mothers and infants in the critical period of the NICU admission.

Children's rights as law in Sweden-every health-care encounter needs to meet the child's needs

Background

In 2020, the United Nations Convention on the Rights of the Child (UNCRC) became law in Sweden. This puts extra demands on Swedish health care for children in need. This study aimed to investigate children's experiences and paediatric nurses' experiences of caring in accordance with the UNCRC.

Methods

Interviews were conducted in 2019 with 10 children and 13 nurses at a paediatric clinic in western Sweden. Child and nurse data were analysed separately with qualitative content analysis. The results are presented as a synthesis of the combined analysis of both data sets.

Results

Children did not always meet health‐care professionals with the necessary competence to care for them, and they were not always cared for in a child‐friendly environment. Even though nurses in paediatric care had the competence necessary to meet children's rights in health care, organizational issues made it challenging. Providing health care in accordance with the UNCRC principles required time and competence. Sufficient time to help children participate in their care and ensure that they feel secure was considered necessary—regardless of the health‐care context.

Conclusion

Health‐care encounters without the necessary time or competence can affect children and future encounters negatively. Instruments to safeguard children's rights in health care need to be developed and implemented, such as a documentation system to make children's rights visible and/or UNCRC certification. Implementation of UNCRC principles in all health‐care situations for children as standardized care requires competence, involvement, strong leadership and economic support. Children's voices in research can assist in guiding care.

Expressions of Gratitude and Positive Emotion among Hemodialysis Patients: Qualitative Findings

Objectives

The current qualitative inquiry solicited hemodialysis (HD) patients to identify events or incidences that have gone well in their day-to-day life, things they consider to be blessings, and to further reflect on the contributors of such events.

Methods

Hemodialysis patients kept an electronic journal using investigator-purchased tablet computers.

Results

Multiple themes emerged for which HD patients expressed gratitude: 1) life itself, 2) positive or improving health 3) family interactions and social support, 4) clinic resources, favorable treatment therapy, and staff, and 5) other small events.

Conclusions

Clinicians are urged to explore the psychological assets that HD patients possess with a focus on how these might be further cultivated and whether their amplification leads to improved quality of life.

Registered nurse's experiences of continence care for older people: A qualitative descriptive study

AIM

This study aimed to illuminate nurses' experience of continence care for older people receiving home care, either in their own home or in an assisted living facility.

BACKGROUND

Registered Nurses (RNs) have a major role to play in identifying and establishing appropriate actions regarding continence care for older people. However, the crucial nursing care pathway for continence care is commonly described as poor.

METHODS

Interviews were conducted with 11 RNs providing home care, and the transcribed texts were analysed using inductive content analysis.

RESULT

The impressions of RNs were categorised according to four themes: perceptions of continence care, an open approach to continence care, the need for personalised aid fittings and the importance of teamwork in continence care. Key findings were the importance of teamwork; the need for nurses to embrace leadership at the point of care and be more visible in terms of the provision of direct care; substantiation that evidence-based interventions, such as scheduled toileting and prompted voiding, should constitute the norm in continence care within the context of home care; and the need for nurses to support the right of older persons to receive an assessment of their continence problems, deemed to be the minimum standard of quality care.

CONCLUSION

The provision of continence care that is based on key nursing standards, such as evidence-based and person-centred care, as well as individualised continence care that is based on evidenced-based guidelines, would ensure an improvement in the continence care that is presently on offer to older people.

IMPLICATIONS FOR PRACTICE

Nurses need to embrace leadership at the point of care and to be more visible with the provision of direct care in order to improve continence care for older people receiving home care.

Traumatic Brain Injury in Adolescence and the Family Resilience Process: A Case Study

Introduction

The aim of this study was to better understand the family resilience process following a severe traumatic brain injury during adolescence.

Case Presentation

Inspired by the humanistic model of nursing care as a disciplinary perspective, this study used a qualitative and inductive case study design.

Management and Outcome

The data analysis yielded six themes as well as four subthemes that illustrate this family’s resilience process. The most important factors that emerged are (a) family characteristics (i.e., a fighter personality, cultural and spiritual beliefs, presence of hope, keeping a sense of humor), (b) support of family members, (c) support of friends, (d) practicing sports and leisure activities, (e) back-to-school support, and (f) feeling helpful to the adolescent.

Discussion

This study provides interesting avenues with regard to the implementation of strategies to foster the resilience process in families during particularly difficult situations in their lives, such as a traumatic brain injury during adolescence.

Barriers for involvement of private doctors in RNTCP - Qualitative study from Kerala, India

Introduction:

Engaging the private sector effectively has been considered as the single most important intervention required for Revised National TB Control Program (RNTCP) to achieve the overall goal of universal access and early detection. This study attempts to identify the barriers and facilitators in the involvement of private practioners in signed schemes of RNTCP.

Materials and Methods:

Six focus group discussions - four among private sector doctors and two among RNTCP TB key workers and 10 key informant interviews were conducted. Themes were divided into private sector involvement in RNTCP, barriers for private sector involvement, facilitators for private sector involvement and suggestions for better PPP.

Results:

General feel was that private sector involvement in RNTCP was increasing. Public sector at ground level has not really understood the need to engage the private sector. Lack of capacity for public sector staff to understand and deal with private sector, power relations and not taking hospital managements to trust emerged as important barriers for engagement while private sector doctors expressed concerns over patient confidentiality and patient choices, apprehension of losing patients, inability of program to keep commitments and timely payments, poor recognition to private sector, bureaucratic hurdles and cumbersome formalities. Building locally customised partnership schemes, behaviour change for PPP, building managerial capacity of Public sector to deal with private sector, presence of an interphase agency and quality control through a participatory body were important suggestions for improvement of PPP.

Conclusion:

Strategies have to be formulated to customise partnership for private sector doctors using the flexibilities of the program. Strengthening PPP will be possible in presence of strong administrative will and the understanding that personal relationships are the best key to Public Private Partnerships.

Correspondence between primary and secondary care about patients with cancer: A qualitative mixed-methods analysis

Cancer care is complex and involves many different healthcare providers, especially during diagnosis and initial treatment, and it has been reported that both general practitioners and oncology specialists experience difficulties with interdisciplinary communication. The aim of this qualitative study was to explore information sharing between primary and secondary care for patients with lung, breast or colorectal cancer. A qualitative content analysis of 50 medical files (419 documents) was performed, which identified 70 correspondence‐related items. Six main topics were identified in most referral letters from primary to secondary care, but it was particularly notable that highly relevant information regarding the past medical history was often mixed with less relevant information. To lesser extents, the same held true for the medication list and presenting history. In the letters from specialists, nine topics were identified in most letters. Although information about actual treatment was always present, only limited detail, if any, was given about the intent of the treatment (curative or palliative) or the treatment alternatives. Interviews with nine healthcare providers confirmed these issues. These findings indicate that neither the initial referral nor the specialist correspondence is tailored to the needs of the recipient.

To change or not to change - That is the question: A qualitative study of lifestyle changes following acute myocardial infarction

Objective The purpose of this study was to investigate key factors related to lifestyle changes following acute myocardial infarction (AMI) by eliciting survivors' subjective needs for, attitudes towards and experiences with behaviour changes in their everyday life to improve future interventions promoting lifestyle changes. Methods Semi-structured interviews were conducted with 21 individuals who had recently experienced an AMI. The interviews were audio-recorded and transcribed verbatim. The data were analysed using qualitative content analysis. Results The data analysis revealed that lifestyle changes following AMI are influenced by a combination of individual (physical and psychological) and social factors that can be grouped into facilitators and barriers. The interviews indicated the need for more personalised information regarding the causes and risk factors of illness, the benefits of lifestyle changes and the importance of including significant others in lifestyle advice and education and of individualising support. Discussion Lifestyle change is a continuous process that is not completed within a few months after a cardiac event. Considering the identified themes when developing interventions to promote lifestyle changes following AMI may enhance the effectiveness and sustainability of such interventions.

Exploring Positive Survivorship Experiences of Indigenous Australian Cancer Patients

Amongst Indigenous Australians, "cancer" has negative connotations that detrimentally impact upon access to cancer care services. Barriers to accessing cancer services amongst Indigenous Australians are widely reported. In contrast, factors that facilitate this cohort to successfully navigate cancer care services ("enablers") are scarcely reported in the literature. Through qualitative interviews, this article examines factors that assist Indigenous Australians to have positive cancer experiences. Semi-structured interviews were conducted with twelve adult Indigenous oncology patients recruited from a tertiary hospital in Queensland, Australia during 2012-2014. Data generated from the interviews were independently reviewed by two researchers via inductive thematic analytical processes. Discussions followed by consensus on the major categories allowed conclusions to be drawn on potential enablers. Two major categories of enablers were identified by the researchers: resilience and communication. Individual's intrinsic strength, their coping strategies, and receipt of support improved participant's resilience and consequently supported a positive experience. Communication methods and an effective patient-provider relationship facilitated positive experiences for participants. Despite potential barriers to access of care for Indigenous cancer patients, participants in the study demonstrated that it was still possible to focus on the positive aspects of their cancer experiences. Many participants explained how cancer changed their outlook on life, often for the better, with many feeling empowered as they progressed through their cancer diagnosis and treatment processes.

What makes parents act and react? Parental views and considerations relating to 'child health' during infancy

Lifestyle factors and behaviours are adopted very early in life and tend to persist throughout life. Considering that the parents are the primary gatekeepers for their child's health, there is a need to gain more knowledge and deeper understanding about what causes parents to act and react in order for early preventive efforts to have any effect. The aim was to explore the parental views and considerations concerning 'child health' among parents with infants 8-10 months old. The sample was strategic and 16 parents (aged 23-41) were recruited from three child health centres in Sweden. Open-ended interviews were conducted and a qualitative, manifest content analysis approach was utilized. The parents described the subject 'child health' as a large, multifaceted concept. Three categories emerged during data analysis: developing a sixth sense, being affected by perceptions and believing health and ill health as a continuum. The parents perceived food and feeding issues as one of the most worrying aspects and a significant indicator of 'child health'. In order to meet the parents on their turf, the 'healthy health message' conveyed needs to take the parental perspective into consideration rather than attempting to educate the parents from predetermined assumption, belief and values.

The lived experience of behaviours of concern: A qualitative study of men with traumatic brain injury

BACKGROUND AND AIMS

Behaviours of Concern (BoC) are a debilitating consequence of Traumatic Brain Injury (TBI). Whilst perspectives of clinicians, carers and family members on BoC have been previously explored, few qualitative studies have included individuals with TBI. The aim of this study was to explore the lived experience of BoC in individuals with TBI, their close others and clinicians.

METHOD

Eleven males with TBI and BoC were recruited and 25 semi-structured qualitative interviews were conducted (9 individuals with TBI, 9 close others, 7 clinicians). A six-phase thematic analysis approach was utilised.

RESULTS

Frequent and persistent BoC were reported and the key themes identified included the brain injury, control, environment, mood, identity, social relationships, and meaningful participation. Whilst the brain injury contributed to BoC in all cases, the way the other themes manifested and interacted was variable.

CONCLUSIONS

This study enriches our understanding of factors associated with BoC. Themes emerging from this study will inform interventions designed to reduce BoC and ultimately maximise quality of life for individuals with TBI and their families.

Stakeholders' Perspectives on Strategies for the Recruitment and Retention of Primary Health Care Employees in Qatar: A Qualitative Approach

This study explores the recruitment and retention conditions influencing primary health care (PHC) human resources for health (HRH) in Qatar and suggests strategies for their improvement. A qualitative design employing semistructured key informant interviews with PHC stakeholders in Qatar was utilized. Key interviewees were originally recognized, and snowball sampling was used to identify additional interviewees until reaching saturation point. Interview scripts were transcribed and then analyzed thematically using the Nvivo software package. Thematic analysis precipitated a number of themes. Under recruitment, the centrality of enhancing collaboration with academic institutions, enhancing extrinsic benefits, and strengthening human resources recruitment and management practices. Dedicated support needs to be provided to expatriate HRH especially in regard to housing services, children schooling, and streamlining administrative processes for relocation. Findings revealed that job security, continuous professional development, objective performance appraisal systems, enhanced job transparency, and remuneration are key retention concerns. The study provides a number of recommendations for the proper recruitment and retention of HRH. Health planners and decision makers must take these recommendations into consideration to ensure the presence of a competent and sustainable HRH in the PHC sector in the future.

A Student-Centered Mental Health Virtual Community Needs and Features: A Focus Group Study

Mental health is a pervasive challenge in the population and especially for university/college students on campuses across North America. Anxiety, stress and depression are on the rise and a scalable, economically sound innovation is essential to address these mental health challenges. The research team has conducted 8 focus groups in April to May 2016 in order to elicit perspectives of students at York University about their online activities and the development of an online mindfulness based Mental Health Virtual Community. This paper explains the main results of the qualitative analysis pertaining to the challenges and benefits of an online mindfulness based Mental Health Virtual Community.

Young people with psychiatric disabilities and their views of day centres

Young people with psychiatric disabilities may require support in structuring their everyday life. To learn more about the relevance of day centres in this respect, this study aimed to examine the experiences of young people with psychiatric disabilities. A particular focus was on the perceptions of meaningful occupation when visiting day centres, their reasons for not choosing this option when given it and what they desired instead. A qualitative design based on individual interviews was used. Twelve women and eight men between 18 and 35 years, with a need for organized daily occupations, participated as informants. Qualitative content analysis revealed three categories: 'Being in a context', 'Balancing between developing and stagnating', and 'Longing for something more'. The findings indicated that the occupations were inherently age neutral, as were the possibilities for socializing. There was a desire for more activities in the community and more support for engaging in occupations that other young people did. A major issue in the accomplishment of this was the need to earn money, and the lack of opportunities for doing that in the day centre context was a considerable drawback. The findings highlight the importance of identifying young people's views when designing day centres.

Qualitative Descriptive Methods in Health Science Research

OBJECTIVE

The purpose of this methodology paper is to describe an approach to qualitative design known as qualitative descriptive that is well suited to junior health sciences researchers because it can be used with a variety of theoretical approaches, sampling techniques, and data collection strategies.

BACKGROUND

It is often difficult for junior qualitative researchers to pull together the tools and resources they need to embark on a high-quality qualitative research study and to manage the volumes of data they collect during qualitative studies. This paper seeks to pull together much needed resources and provide an overview of methods.

METHODS

A step-by-step guide to planning a qualitative descriptive study and analyzing the data is provided, utilizing exemplars from the authors' research.

RESULTS

This paper presents steps to conducting a qualitative descriptive study under the following headings: describing the qualitative descriptive approach, designing a qualitative descriptive study, steps to data analysis, and ensuring rigor of findings.

CONCLUSIONS

The qualitative descriptive approach results in a summary in everyday, factual language that facilitates understanding of a selected phenomenon across disciplines of health science researchers.

Registered nurses views of caring in coronary care--a deductive and inductive content analysis

AIMS AND OBJECTIVES

To extend nurses' descriptions of how they understood caring, as reflected in the findings of an earlier study (i.e. the hierarchical outcome space) and to gain additional understandings and perspectives of nurses' views of caring in relation to a coronary care patient case.

BACKGROUND

Scientific literature from the 1970s-1990s contains descriptions of caring in nursing. In contrast, the contemporary literature on this topic--particularly in the context of coronary care--is very sparse, and the few studies that do contain descriptions rarely do so from the perspective of nurses.

DESIGN

Qualitative descriptive study.

METHODS

Twenty-one nurses were interviewed using the stimulated recall interview technique. The data were analysed using deductive and inductive qualitative content analysis.

RESULTS

The results of the iterative and integrated content analysis showed that the data mainly reproduced the content of the hierarchical outcome space describing how nurses could understand caring; however, in the outcome space, the relationship broke up (i.e. flipped). The nurses' views of caring could now also be understood as: person-centredness 'lurking' in the shadows; limited 'potential' for safeguarding patients' best interests; counselling as virtually the 'only' nursing intervention; and caring preceded by the 'almighty' context. Their views offered alternative and, at times, contrasting perspectives of caring, thereby adding to our understanding of it.

CONCLUSION

Caring was described as operating somewhere between the nurses caring values and the contextual conditions in which caring occurred. This challenged their ability to sustain caring in accordance with their values and the patients' preferences.

RELEVANCE TO CLINICAL PRACTICE

To ensure that the essentials of caring are met at all times, nurses need to plan and deliver caring in a systematic way. The use of systematic structures in caring, as the nursing process, can help nurses to work in a person-centred way, while sustaining their professional values.

Using a nursing theory or a model in nursing PhD dissertations: a qualitative study from Turkey

PURPOSE

The aim of this study was to reveal experiences of nursing students and their advisors using theories and models in their PhD dissertations.

METHODS

The study adopted a descriptive qualitative approach. This study was performed with 10 PhD candidates and their five advisors from nursing faculty.

RESULTS

The results of the study were categorized into four. These are reasons for using a theory/model in a PhD dissertation, reasons for preferring a given model, causes of difficulties in using models in PhD dissertations, and facilitating factors of using theories and models in PhD of dissertations.

CONCLUSIONS

It was also reported to contribute to the methodology of research and professional development of the students and advisors.

Occupational performance and strategies for managing daily life among the elderly with heart failure

AIM

The aim of this study was to describe experiences of limitations in occupational performance and strategies for managing daily activities among the elderly with chronic heart failure (CHF).

METHODS

Ten participants from primary healthcare with a confirmed diagnosis of CHF were interviewed. The interviews were analysed using qualitative content analysis.

RESULTS

The first theme, "Redefining an active life, aware of one's impaired body", was based on four sub-themes: realizing one's limited activity ability; striving to preserve an active life; focusing on meaningful activities; and changing vs. not changing habits and roles. The second theme, "Planning activities and balancing the degree of effort", was based on three sub-themes: limiting, organizing, and rationalizing activities; adjusting activities to today's ability; and using technology and adapting the environment.

CONCLUSIONS

Elderly people with CHF are struggling with an ongoing process of occupational adaptation due to periodical physical decline and fluctuating day-to-day ability. This highlights a need for information on strategies from a holistic perspective and client-centred occupational therapy interventions.

Participation in physical and social activities among home-dwelling persons with dementia - experiences of next of kin

Introduction

To be next of kin to a home-dwelling person with dementia is known to be a heavy burden, especially early in the process. Studies have revealed a need for information and support during the disease process. Likewise, there is support for the positive impacts of physical and social activities for wellbeing in home-dwelling people with dementia. It is important to obtain experiences from next of kin whose spouses or parents participate in such physical and social activities.

Aim

The aim of this study was to elucidate the experiences of next of kin to home-dwelling persons in an early stage of dementia who had an opportunity to participate in organized physical and social activities.

Method

The study has a qualitative design. Focus group interviews were conducted with ten next of kin to home-dwelling dementia sufferers, who participated in physical and social activities in an activity center. The interview texts were analyzed using qualitative content analysis.

Findings

In the analysis, two categories emerged: “a break in the everyday” and “being attended and cared about.” Two sub-categories identified in each of the two main categories were: “need of relief ” and “meaningful activities;” and “being confirmed” and “sharing experiences and getting advice and help,” respectively. These categories were interpreted in an overall theme: “contentment with adapted activities and group meetings provided with a person-centered approach.”

Conclusion

Adapted physical and social activities led by highly qualified personnel can provide needed relief and support to the next of kin, and meaningful activities to the dementia sufferers. However, it is crucial that the personnel provide person-centered care and are able to meet the needs of the dementia sufferers and their next of kin, to help to give them a new everyday life.