Exploring Internal Conflicts and Collaboration of a Hospital Home Healthcare Team: A Grounded Theory Approach

An aging society is on the rise, leading to a variety of caregiving issues. The Taiwanese government has been implementing a home healthcare integration plan since 2015, aimed at integrating and forming interdisciplinary care teams with medical institutions. This study explores the internal conflict factors among hospital home healthcare team members at a district teaching hospital in Taichung, Taiwan, and it seeks a better collaboration model between them. Semi-structured in-depth interviews were conducted with seven hospital home healthcare team members. Data analysis was based on grounded theory, with research quality relying on the triangulation and consistency analysis methods. The results show that "work overload", "resource overuse", "inconsistent assessment", "limited resources", "communication cost", and "lack of incentives" are the major conflicts among the team. This study proposed the following collaboration model, including "identifying the internal stakeholders of a home healthcare team" and "the key stakeholders as referral coordinators", "patient-centered resource allocation", and "teamwork orientation". The study recommends that within a teamwork-oriented home healthcare team, its members should proactively demonstrate their role responsibilities and actively provide support to one another. Only through patient-centered resource allocation and mutual respect can the goal of seamless home healthcare be achieved. The content of the research and samples were approved by the hospital ethics committee (REC108-18).

Specific interests as a social boundary and bridge: A qualitative interview study with autistic individuals

LAY ABSTRACT

Growing evidence shows that specific interests can help autistic individuals cope with difficulties in social communication and interaction. However, it is unclear which specific characteristics of these interests make them suitable for this coping role. Therefore, this study explored how specific interests can help autistic individuals navigate social communication and interaction. We conducted semi-structured interviews with nine autistic individuals to inquire about their perspectives on the meanings and functions of their specific interest in their (social) life. We found that specific interests served two important social functions. First, the interests provided a way to disconnect from the challenging outside world, through a shift in the attentional focus of participants. Second, the interests served as a "social compass," providing structure and meaning to social situations and helping the participants feel more connected to others. Based on these findings, we propose a conceptual model suggesting that specific interests create the experience of a "protective boundary" between oneself and others, which helps autistic individuals feel safe during social interactions. Namely, engaging in specific interests not only creates a space where autistic individuals can retreat when they feel overwhelmed, but also provides a framework with delineations in time and space, as well as explicit rules for social interactions, which make them more predictable and regulated. The study suggests that incorporating specific interests into therapy can help improve social communication and interaction for autistic individuals while still prioritizing their personal well-being.

Research on the Influencing Factors of Sustainable Supply Chain Development of Agri-Food Products Based on Cross-Border Live-Streaming E-Commerce in China

The organization and coordination of cross-border e-commerce platforms in agricultural product trading are continuously increasing, and the involvement of digital platforms has driven the integration and development of cross-border agricultural product supply chains with live-streaming e-commerce, effectively facilitating the comprehensive development of producers, sellers, and professional service providers within the ecosystem. However, despite the growing importance of this integration model in the market, there are still numerous unresolved issues from a supply chain perspective, and existing research provides relatively limited guidance on the effective operation of this integrated supply chain model. To address this gap in theoretical research, this study first delves into the essence and fundamental characteristics of sustainable cross-border agricultural product supply chains in the context of live streaming. Secondly, employing grounded theory as the primary research method and combining platform theory and ecosystem theory, an influencing factor system and an impact model for the development of sustainable cross-border agricultural product supply chains in the context of live streaming are constructed to gain a more comprehensive understanding of the complexity of this integrated supply chain model. Finally, from the perspectives of government agencies and practitioners, development pathways for sustainable cross-border agricultural product supply chains in the context of live-streaming e-commerce are proposed, aiming to enhance existing research and provide decision-making support for relevant stakeholders in formulating development strategies. The findings of this study contribute to expanding the research perspective on the ecosystem of live-streaming e-commerce and sustainable cross-border agricultural product supply chains, providing theoretical support for the establishment and operation of sustainable cross-border agricultural product supply chains in the context of live streaming. Additionally, it offers important references for promoting the sustainable development of live-streaming e-commerce and cross-border agricultural product supply chains, facilitating industry upgrading, global agricultural trade, and achieving mutually beneficial outcomes.

Health advocacy role performance of nurses in underserved populations: A grounded theory study

AIM

Nurses' health advocacy (HA) role requires them to speak up for patients, clients, and communities in relation to healthcare. Various studies report the importance of the HA role of the nurse in healthcare. However, nurses' performance in this role is not clear yet. The present study aims to identify and explain how nurses perform their HA role in underserved populations.

DESIGN

Qualitative grounded theory by Strauss and Corbin.

METHODS

Data were gathered from three regional hospitals in Ghana with 24 registered nurses and midwives as participants through purposive and theoretical sampling techniques. Face-to-face in-depth semi-structured interviews were conducted from August 2019 to February 2020. The data were analysed using Strauss and Corbin's method and Nvivo software. The reporting follows Consolidated Criteria for Reporting Qualitative Research guidelines.

FINDINGS

The HA role performance theory emerged from data with role enquiry, role dimension, role context, role influence, role reforms and role performance as building blocks. Data analysis showed that the main concerns of the nurses during their daily practice were mediating, speaking up, and negotiating. Among others, the intervening conditions were clientele influence and interpersonal barriers, whereas the outcome was a balance between role reforms and role performance.

CONCLUSION

Although some nurses proactively initiated biopsychosocial assessment and performed the HA role, most of them relied on clients' requests to perform the role. Stakeholders should prioritise critical thinking during training and intensify mentoring programmes in the clinical areas.

RELEVANCE FOR CLINICAL PRACTICE

The present study explains the process by which nurses perform their roles as health advocates in their daily activities as nurses. The findings can be used to teach and guide clinical practice for the HA role in nursing and other health care fields. There was no patient or public contribution.

Ambiguous loss in organ donor families: A constructivist grounded theory

AIMS AND OBJECTIVES

Explore families' experiences when being approached for organ donation authorisation after brainstem death.

BACKGROUND

The complexities of potential organ donor families' experiences include challenges related to emotional distress, coping with the loss and the organ donation decision-making process, and support needed. A lack of conceptual clarity was found concerning families' experiences when being approached for organ donation authorisation, which guided the study.

DESIGN

Constructivist grounded theory.

METHODS

Seventy-one participants, including healthcare professionals and families, were recruited from two large hospitals in Chile between 2017 and 2019. Field notes, documents (n = 80), interviews (n = 27) and focus groups (n = 14) were collected and analysed following Charmaz's constructivist grounded theory principles and practices until theoretical saturation was reached. The study is reported using the COREQ checklist.

RESULTS

A third type of ambiguous loss of bereaved families' experience was developed as a fourfold process: (1) impending loss, (2) confirming loss, (3) ambiguous loss and organ donation decision-making and (4) organ donation as a third type of ambiguous loss. This grounded theory expands the concepts of ambiguous loss by Boss, dying by Glaser and Strauss and grief by Brinkmann, enabling explanation of families' experiences.

CONCLUSION

Families of potential organ donors develop a highly complex grieving process, which may play a significant role in the organ donation decision-making process. Ambiguity is embedded in how donor families reframe the existence of the donor through the act of giving life.

RELEVANCE TO CLINICAL PRACTICE

The findings shed light on families' experiences on the organ donation process after brainstem death. The study can be used in nursing practice, education and to inform policy nationally and globally, mainly due to the current focus on quantitative measures and legislative changes fostering individual decision-making.

PATIENT OR PUBLIC CONTRIBUTION

Families contributed through their first-hand experiences of the organ donation process.

Young men and anxiety: Resisting, reckoning and responding

Anxiety is the most prevalent mental disorder experienced by young men, and when untreated, is predictive of co-morbid mental health challenges and suicide. Despite the rising prevalence, there is a conspicuous absence of qualitative research to distil and theorise young men's anxiety. Twenty-five young Australian men (15-25 years), who had been diagnosed with an anxiety disorder or self-reported anxiety symptoms, took part in individual semi-structured interviews. Interviews were transcribed verbatim and analysed using a constructivist grounded theory approach. A three-process grounded theory (Resisting-Reckoning-Responding; Triple R Anxiety Model) depicted young men's experiences of anxiety, gilded and guided by their masculine socialisation. Initially, young men noticed somatic symptoms (i.e., headaches, nausea and myalgia) but did not connect these symptoms to anxiety. Avoiding anxiety (e.g., denying, distracting) proved unhelpful in the longer term and as symptoms diffused, a subsequent process of reckoning anxiety (i.e., meaning making) ensued. As young men gained insight to the life limiting bounds of their anxiety, some were prompted towards actions of acceptance, seeking help proactively and employing strength-based adaptive coping strategies. This theoretical conceptualisation of young men's anxiety has the capacity to enhance identification and treatment efforts, improving young men's mental health outcomes across the lifespan.

Missed Opportunities to Ease Suffering: An Explanatory Model of Occupational Therapy Utilization in End-of-Life Care

Background: With disease progression, a terminally ill person may experience loss of physical and cognitive skills required to perform everyday activities. Such functional loss can erode autonomy and cause existential suffering. Supported engagement in everyday activities may help terminally ill people stay involved in living and cope with dying. Occupational therapy enables people to engage in valued activities at the end of life, yet remains under-utilized. Objectives: To address the perceived under-utilization of end-of-life care occupational therapy, the authors investigated how utilization of occupational therapy in end-of-life care is determined from the perspective of decision-makers and occupational therapists and then developed a model of the process. Methods: Using a grounded theory method, authors conducted two semi-structured interviews with 20 decision-makers and 21 occupational therapists. Theoretical sampling followed by paradigm analysis, yielded a data-grounded model. Results: The authors developed The Model of Occupational Therapy Utilization in End-of-Life Care. Service utilization was primarily contingent upon the decision-makers' awareness of occupational therapy's role in end-of-life care and further influenced by place of care cost constraints and participants' ability to adjust focus of the occupational therapy to accommodate the patient's dying process. Conclusion: Limited awareness of occupational therapy's role in end-of-life care warrants research on whether modification of model constructs may increase awareness and utilization. Education is indicated to teach providers about suffering due to functional loss and how to adjust focus of occupational therapy to sustain occupational participation through decline, across different care settings, and along a range between rehabilitation-focused to participation-focused outcomes.

An Emergent Theory Depicting Patients' Fortitude Through the Healing and Recovering Process of Depression

BACKGROUND

Depression is a common mental disorder. Literature has explored patients' perspectives of the recovering process of depression. However, there is a lack of research to explore both patients' and caregivers' perspectives of the healing process and develop a theory to support patients with depression.

AIMS

The purpose of this study is to develop a substantive theory that depicts patients with depression toward healing and recovering.

METHODS

This study used a grounded theory approach and collected data between 2019 and 2020 in a medical center in Taiwan. A theoretical sampling was performed after interviewing 29 participants, including 20 patients who had recovered from depression and nine caregivers; data saturation was achieved. Data analysis was conducted with open, axial, and selective coding and used NVivo Version 11 to aid the process of coding.

RESULTS

A substantive theory was developed and the core category was "Patients' fortitude through the healing and recovering process of depression." Other main categories interrelated in this core category were reframing negative thinking and cultivating positive thinking, rebuilding a positive self-worth by embracing self-compassion, and learning to cope with everyday stress.

CONCLUSIONS

This theory could help health care professionals to work therapeutically with patients and commend their fortitude while experiencing depression and engaging them with the care they planned together; and find some joy in life. Educators and researchers could use this theory to advance nursing care.

A new theory to promote self-management of symptom clusters and healthcare quality in patients with decompensated cirrhosis

Patients with decompensated cirrhosis, a symptomatic phase of cirrhosis, commonly experience multiple symptoms concurrently, referred to as symptom clusters. Effective self-management of symptoms is known to improve outcomes in various chronic diseases. However, a theory for self-management of symptom clusters in decompensated cirrhosis is lacking. In this study, we applied grounded theory research methodology to construct a new theory of self-management of symptom clusters in these patients. This qualitative study prospectively enrolled 20 patients with decompensated cirrhosis within 1 week after hospital admission. Data related to patients' experiences, needs, perspectives, and abilities related to their symptoms were collected via a semi-structured, in-depth interview and analyzed with Nvivo version 20 software. Grounded theory methodology with 3 coding steps (open, axial, and selective coding) was applied to generate a theory of self-management of symptom clusters. From the step-by-step coding process, 2 core categories or major themes were identified: patients' experiences with symptoms and coping with symptoms. The first major theme included symptom clustering, multidimensionality, recurrence, and specificity, while the second consisted of endogenous motivation, endogenous resistance, and external support needs. A new theory of self-management of symptom clusters was then constructed and delineated to enhance self-management among patients with decompensated cirrhosis. Using patient experience data, we developed a new theory of self-management of symptom clusters in patients with decompensated cirrhosis. Use of this theory has the potential to promote patient self-management and guide healthcare providers in planning optimal treatments and implementing timely interventions, ultimately improving in patient outcomes.

Combining differentiating and integrating over time to sustain multiple institutional logics: a case study of a higher education institution

To understand how organizations adopt varying configurations of differentiating (i.e., compartmentalizing logics into different subunits or roles) and integrating (i.e., combining logics to highlight synergies) over time to navigate logic contestations and extract logic complementarities for organizational innovation, we conduct a 15-year in-depth longitudinal case study of a higher education institution to examine how it devised innovative hybrid practices to manage and support college student development. By employing the grounded theory method, we develop a four-stage process model of the varying configurations of differentiating and integrating that expounds on how two contested logics are sustained and exploited over time. We assert that selective bridging-the instrumental use of one logic enables some practices of one logic to be selectively integrated with the other, while irreconcilable practices remain differentiated to play their respective roles, is vital in allowing organizations to leverage respective advantages in combining differentiating and integrating over time. Further, we show that combining integrating and differentiating features simultaneously transforms contested logics into compatible and complementary, offering a novel way for logic hybridization. These findings advance the understanding of how organizations can differentiate and integrate contested logics over time through a dynamic and paradoxical view, thus being manageable and manipulated for organizational innovation.

Hard-Headed Decisions: Intrapersonal Factors Underlying Concussion Reporting in University Athletes

Most of the research investigating sports concussion (SC) disclosure has been conducted using questionnaires with a pre-determined set of questions. Hence, significant gaps remain in our understanding of which factors weight in the decision-making process underlying SC disclosure and how they contribute to it. This present study aims to fill some of these gaps using qualitative methods to identify intrapersonal determinants of SC disclosure and describe their influence on an athlete's decision-making process. Our results are based on in-depth, semistructured interviews (range, 56-79 min; total = 587 min) with 9 university athletes (5 females, 4 males) from three team sports (soccer, rugby, and cheerleading). Using constant comparative analysis guided by Straussian grounded theory, we identified 13 concepts, across three major intrapersonal categories (i.e., attitudes and behaviors; concussion knowledge; and subjective evaluation of the concussion), contributing to SC disclosure, including novel determinants such as prioritization of athletic versus intellectual activities and maturity level. Our results suggest that a comparison between experiential knowledge and severity of the injury plays a major role in determining an athlete's disclosure behaviors. Athletes with a history of concussion seem to adopt a non-disclosure default strategy and are inclined to disclose their concussion symptoms only if they judge their current concussion to be worse than their previous most severe injury. Other concepts identified appear to contribute to the decisional process by modulating the adoption of this non-disclosure default strategy. Our work highlights the benefits and necessity of using qualitative methods to study the decision-making process underlying concussion disclosure.

Analysis of the factors influencing the effectiveness of local government's purchase of older adults care services - a grounded theory study based on typical cases

Background

Population aging is a basic national condition in China at present and for a long time to come, forcing the country to accelerate the pace of building its public older adults care system. The government's purchase of older adults care services has become an effective way to make up for the lack of the family's older adults care function, to which the Chinese government attaches particular importance. The article selects 11 typical cases from the excellent case base released by the Chinese Ministry of Civil Affairs officials in 2022 to study the influencing factors of the effect of local government purchase of older adults care service supply.

Methods

NVivo data analysis tools have significant advantages in retrieving, analyzing and coding data more efficiently and accurately, which helps to construct theoretical propositions and formulate hypotheses to be tested in qualitative research. The study intends to adopt the grounded theory approach to analyze the text with the help of NVivo12 software, to condense the practice mechanism of local governments' purchasing of older adults care services and to construct a relational model.

Results

Taking "the supply effect of local government purchasing older adults services" as the main logic line, the article summarizes the four main influencing factors of the supply effect of government purchasing older adults services: the real demand of the society, the government's power and responsibility system, the government's governance ability, and the society's acceptance ability.

Conclusion

The sense of gain, happiness and security of the older adults group is the starting point and landing point of the older adults service policy formulation and implementation. Policy guidance and decision-making have an important impact on the quality of the supply of older adults care services and the development of the older adults care services industry. Clarifying the direction of policy guidance, reflecting the comprehensive efficiency of government governance and utilizing the professional advantages of social forces, is the key to improving the effectiveness of the government's purchase of older adults care services.

'Hold the course(s)!' - a qualitative interview study of the impact of pandemic-triggered contact restrictions on online instruction in community-based family medicine teaching

The COVID-19 pandemic has been identified as a catalyst for the digitalization of medical education. Less is known about the specific impact of the pandemic on decentralized, community-based education, such as in General Practitioner practices. The aim of this study is to understand the impact of the digital transformation process, triggered by the COVID-19 pandemic. As, family medicine courses involve both university-based and community-based teaching, this study focuses the mode and quality of instruction and instructors in family medicine teaching. A qualitative interview study was conducted. The participants (N = 12) of a multi-perspective Quality Circle in family medicine teaching were interviewed twice: first, in 2019, about digitalization in family medicine teaching in Tübingen, Germany, not yet aware of the global changes and local transformation that would take place shortly thereafter. Second, in a follow-up interview in 2020 about the transition process and digitalization following the impact of contact restrictions during the pandemic. Grounded Theory was used as a qualitative research approach to analyze the complex processes surrounding this transformation. By analyzing the interviews with various stakeholders of community and university-based teaching, a model for the digital transformation process of family medicine teaching at the University of Tübingen in response to an external stimulus (the pandemic) was developed. It involves six chronological steps: "The calm before the storm," "The storm hits," "All hands on deck," "Adrift," "Reset course," and "The silver lining." This model seeks to understand the process of digital transformation and its impact on the teaching institution (medical faculty of the University of Tübingen, Institute for General Practice and Interprofessional Health Care) and instructors from an integrated perspective and thereby critically revisits prior concepts and opinions on the digitalization of medical teaching. Insights gained are presented as key messages.

Meanings and Experiences of Prisoners and Family Members Affected by the COVID-19 Pandemic in a Brazilian Prison Unit: A Grounded Theory Analysis

Worldwide, the COVID-19 pandemic represented a health emergency for prisons. This study sought to understand the meanings and experiences through the narratives of prisoners and family members affected by the COVID-19 pandemic in the context of a maximum-security state penitentiary complex in southern Brazil. For this purpose, a qualitative study was developed based on the methodological framework of constructivist grounded theory. Data were collected between February and August 2022 through individual in-depth interviews and field notes. The sample consisted of 41 participants: 28 male prisoners, and 13 family members. Guided by the Charmaz method of grounded theory analysis, the study afforded the core category "Feeling trapped in prison during the COVID-19 pandemic" with three interrelated phases: "Triggering", "Escalating", and "Readjustment". The "Triggering" phase refers to COVID-19-related elements or events that triggered certain reactions, processes, or changes in prison. During the "Escalating" phase, participants became overwhelmed by the suffering caused by incarceration and the pandemic crisis. The "Readjustment" phase involved adapting, reorienting, or reformulating previous approaches or strategies for dealing with a specific situation. Prisons faced complex challenges during the pandemic and were forced to prioritize protecting public health. However, the measures adopted must be carefully evaluated, ensuring their needs and that they are based on scientific evidence. The punitive approach can undermine inmate trust in prison authorities, making it difficult to report symptoms and adhere to preventive measures.

A qualitative exploration of parental perspectives on quality of care for children with serious illnesses

Introduction

Being responsive to end-users is essential to good care. Limited in-depth exploration of parental perspectives on care received by children over the course of serious illness has hindered the development of process measures to evaluate quality of care. Our objective was to identify the key process indicators prioritized by parents in the care of seriously ill young children and develop a framework to guide assessment of quality of care.

Methods

This qualitative study followed Charmaz's Constructivist Grounded Theory. In-depth semi-structured interviews were conducted with parents of young children with serious illness in Singapore. Participants were sampled across various healthcare settings, children's ages, and illness categories. Theoretical sampling and constant comparative analysis were used to generate initial, focused, and theoretical codes, which informed construction of a conceptual framework.

Results

31 parents participated from July 2021 to February 2022. Initial and focused coding generated 64 quality of care indicators describing key care practices, interactions, and procedures. Indicators were categorized under four themes: (1) efficient healthcare structures and standards, (2) professional qualities of healthcare workers, 3. supporting parent-caregivers, and 4. collaborative and holistic care. Theoretical coding led to the development of the "PaRental perspectives on qualIty of care for Children with sErious iLlnESSes (PRICELESS)" framework which summarizes elements contributing to the parental perception of quality of care.

Discussion

The identified process indicators will facilitate the development of standardised parent-reported measures for assessing service quality and benchmarking among providers. The framework provides overall guidance for conceiving quality improvement initiatives.

"I Should at Least Have the Feeling That It […] Really Comes from Within": Professional Nursing Views on Assisted Suicide

Background

Due to a decision by the German Federal Constitutional Court of February 26, 2020, it is currently possible in Germany to avail of assisted suicide. The ruling has given rise to a controversial debate within the professional community as well as in society in general. Within this debate, little attention has been given to the role of nursing staff in assisted suicide. However, international studies show that nurses play an important role in assisted suicide.

Objective

The aim of this study is to assess the views and attitudes of nurses from different care settings in Germany toward assisted suicide.

Design

A qualitative research design was chosen to capture the subjective experience of nursing staff on suicide assistance. This was analyzed using the grounded theory method.

Methods

With the help of a semi-structured, narrative-generating interview guide, in which five case vignettes are integrated, 20 interviews were conducted with nursing professionals from different care settings throughout Germany.

Results

The analyzed phenomenon shows that nursing professionals need to understand the desire to die for themselves. The individual life situation of the respective patient is decisive. The action strategy based on being able to tolerate the wish to die determines how intensively they want to be involved before, during, and after assisted suicide. For nurses, however, it is undisputed that it is their professional role to accompany the patient in their "existence" and thus also in the context of assisted suicide.

Conclusion

In view of the future development of assisted suicide in Germany, it seems necessary to prepare nursing professionals for activities related to assisted suicide by means of a curricular offer. In addition, nursing professionals should be supported in forming their own attitude to the issue.

Empowerment through participation in community-based participatory research-effects of a physical activity promotion project among socially disadvantaged women

Introduction

Community-based participatory research (CBPR) approaches are associated with a range of positive impacts on empowerment. However, only a few studies have investigated the influence of different modes of target group participation on empowerment. The present study examined the empowerment processes and outcomes of women in difficult life situations through their participation as co-researchers in the form of Photovoice in "Stark durch Bewegung" (English: "Strong through Movement"), a CBPR project for physical activity (PA) promotion. The extent to which women's participation as co-researchers leads to empowerment was compared with other forms of participation.

Methods

The Photovoice approach consisted of three components: (1) photo task, (2) focus group interviews, and (3) exhibition of photos. It was then extended through participant observation. A total of 18 women took part in Photovoice. They took photos, were involved in four focus groups, helped in the analysis of data, and supported their exhibition. Two additional short focus group interviews in which four more women participated were conducted at the end of the project. The interview guideline was based on the SHOWeD questions proposed within the framework of Photovoice and enriched with various other questions (e.g., self-efficacy, social contacts, and community involvement). The data were analyzed based on a grounded theory approach.

Results

"Stark durch Bewegung" contributed to women's empowerment in several ways. By participating in the project's PA programs, the women reported numerous empowerment effects, such as improved self-efficacy, perceived competencies like swimming and language skills, and social networks. By participating as co-researchers, they perceived empowering processes on organizational and community levels that are comparable with other forms of participation (e.g., participation in a cooperative planning group) but also differ from them at relevant points (e.g., encouraging them to reflect on their own PA behaviors). The willingness to get involved in Photovoice was estimated to be significantly higher than in other possible forms of participation.

Conclusion

Our findings support the notion that health promotion interventions with marginalized groups can contribute to their empowerment on multiple levels when participants become equal partners in the CBPR project. Involving women as co-researchers has advantages over other forms of participation in terms of their empowerment.

Exploring and modeling the reading-writing connection in EFL integrated writing

Reading-to-write tasks have increasingly been used in high-stakes language tests worldwide; however, the nature of the reading-writing connection is not well understood. This study utilized a mixed-methods approach to ground descriptions of EFL cognitive processes and identify process interaction patterns to determine how reading and writing were connected. Grounded theory analysis of fourteen EFL learners' writing think-aloud protocols showed that students engaged in an interactive composing process involving source reading, comprehension monitoring, planning, language monitoring, narration monitoring, and continuity evaluation. We also conducted a confirmatory factor model study on 486 EFL learners' responses to a self-developed writing questionnaire, which covered five factors, including reading monitoring, narration monitoring, ideational planning, continuity evaluation, and skill integration. The findings showed that reading monitoring was the only factor that had a direct and significant impact on skill integration, a composite factor covering discourse synthesizing and source using processes. Based on the discussion of the theoretical, empirical, and pedagogical implications of the current findings, we called for more studies to explore the use of three pillar skills-reading, writing, and language use-to support EFL integrated writing. We also suggested that test designers include explicit rating descriptor(s) for source using to evaluate reading comprehension, and instructors enhance reading instruction to improve task performance.

Sexual Wellbeing according to Transgender Individuals

Objective

Sexual wellbeing is an important aspect of quality-of-life. In transgender individuals who seek gender affirming treatment, various aspects of sexuality have been assessed. However, not much is known on how transgender individuals themselves perceive sexual wellbeing. This study aims to explore the perception of sexual wellbeing in transgender-individuals (an emic-perspective).

Methods

To explore sexual wellbeing from an emic perspective, qualitative interviews with transgender individuals were conducted, recorded and transcribed verbatim. Inductive coding and thematic analysis were used to assess topics and themes pertaining to sexual wellbeing.

Results

Based on interviews wih15 participants (19-74 years) with diverse self-identified genders, four main themes, relating to sexual wellbeing were derived: (1) given description of sexual wellbeing, (2) conditions for sexual wellbeing, (3) factors affecting sexual wellbeing, and (4) experienced sexual wellbeing.

Conclusion

Positive experiences, feeling comfortable with body/self, intimacy, acceptation and communication with partner appeared helpful to overcome hurdles and experience sexual wellbeing.

Translating Discovery Science. Fostering relationships: Service provider perspectives on community building among veteran families

Objective

We sought to identify the social process through which communal support can be established among veteran couples and families.

Background

On the basis of the social organization theory of action and change, a sense of community is crucial for military veterans' well-being and may serve as a resource for intervention.

Method

We interviewed service providers (n = 8) and corroborated their perspectives by triangulating evaluations from veteran family participants (n = 143). Data were analyzed using grounded theory techniques.

Results

Providers suggested promoting a sense of community in prevention and intervention programming by (a) establishing a safe and empowering space, (b) bridging existing gaps within family and community systems, and (c) encouraging interpersonal healing by promoting connection and facilitating the sharing of common experiences. Providers also described challenges to facilitating the program, including logistics, time, and funding constraints.

Conclusion

According to our results, fostering community among veterans and their family members may be achieved by applying an integrative approach that goes beyond siloed individual, couple, and group therapy orchestrated by practitioners.

Implications

We recommend multicomponent interventions that create synergy between different levels and forms of social support. Providers recommended being intentional about the program structure to focus on community strengths and shared connection.

An explanation on the process of production to the utilization of patient education media in chronic diseases in Iran: Protocol for a grounded theory study

BACKGROUND

Chronic diseases are always considered one of the most critical challenges of the health system in any country. Patient education on self-care is one of the basic strategies in controlling the disease process and minimizing complications in patients with chronic diseases. It seems that in the process of patient education, from the preparation of materials to their delivery to the final user, many problems prevent the proper and practical education. The study aims to explain the process of production to the utilization of patient education media in chronic diseases in Iran.

MATERIALS AND METHODS

This study employs a grounded theory (GT) methodology and the data will be analyzed by Strauss and Corbin method. Participants in this study include groups involved in the field of patient education, including policymakers, managers at all management levels, clinical, educational, and public health service providers (physicians, nurses, medical librarians, medical, and nursing professors, NGOs in the field of patient education, physiotherapists, nutritionists, and psychologists) as well as service receivers such as patients, their family, and caregivers whom will be all selected through theoretical as well as snowball sampling method. The interview method will be semi-structured and will not be ceased until the data is saturated.

CONCLUSIONS

It is anticipated that in this study, the pros and cons of the process of production to utilization of patient education media will be identified and appropriate solutions to improve this process will be provided.

Bystander Behavior and Sexual Harassment: The Case of the Fashion Industry

This study examines the role of bystander behavior in cases of sexual harassment within the cultural economy's fashion industry. Using grounded theory to explore 34 sexual harassment narratives posted on Instagram, this analysis revealed that while some bystander victim-alliance behavior occurred in the forms of verbal objections and a strong physical presence to thwart perpetrators, bystander facilitation of perpetrator abuse was much more common. Types of facilitation included active bystander complicity, bystander inaction, and what is termed automatic industry bystander deference, whereby seemingly widespread acceptance of certain norms in the business prevented intervention. Implications for victim counseling, bystander intervention training, and public policy reforms are discussed.

A Qualitative Study of How Hospice Workers Cope With Their Level of Exposure to Death

OBJECTIVE

To identify whether hospice workers hold unique and theoretically-informative perspectives about death, especially as they relate to terror management processes.

METHOD

Twelve hospice workers from two hospices in Tucson, Arizona, United States, participated in semi-structured interviews. Interview and analytic practices were guided by Grounded Theory (Glaser & Strauss, 1967).

RESULTS

Three categories were identified in relation to death attitudes: effects of chronic confrontation with death; reasons for working in hospice; and perceptions of death in others.

CONCLUSIONS

Two theoretically informative trends appeared. First, hospice workers largely manage death anxiety as identified by existing literature with the notable exception that hospice workers overall seem to integrate death and dying into their worldviews as a meaningful category, as opposed to avoiding thinking about death. Second, even among those regularly exposed to death, there seems to be a range across participants on a continuum from avoiding to confronting the topic of death.

Pushing Through: How Older Adult Caregivers Manage Wound Care

Older adults are taking on caregiving roles and are performing complex care procedures, such as wound care, in the home setting yet there is a dearth of knowledge about how older adult caregivers manage the performance of wound care on a day-to-day basis. The theoretical framework developed in this research describes this process of managing the caregiving role. Interviews with 18 caregivers aged 65 years and older who were performing wound care in the home for a care recipient yielded a theoretical framework from their narratives using a qualitative grounded theory analysis. The resultant theoretical framework, Pushing Through, consisted of five phases: (a) accepting the role, (b) lacking confidence, (c) creating a system, (d) trusting in self, and (e) owning the outcomes. An understanding of the older adult caregiver's process creates opportunities for healthcare professionals to develop and implement evidence-based interventions.

Rebuilding and Guiding the Self With Spirituality: A Grounded Theory of Experiences of Adolescents and Young Adults With Cancer

PURPOSE

To clarify the experiences of spirituality among adolescents and young adults (AYAs) with cancer following diagnosis.

PARTICIPANTS & SETTING

Participants were recruited at a clinic and on an oncology unit in Turkey. A combination of purposive sampling and theoretical sampling strategy was used to identify 14 participants.

METHODOLOGIC APPROACH

A grounded theory design was used for this study. Semistructured interviews were conducted with each participant between October 2021 and January 2022. The data were analyzed using open, axial, and selective coding.

FINDINGS

All the participants were Muslim, were aged 15-39 years, spoke Turkish, and had undergone treatment for any type of cancer. The core category was identified as rebuilding and guiding the self with spirituality. AYAs connected more closely with their sense of spirituality after being diagnosed with cancer.

IMPLICATIONS FOR NURSING

This study demonstrated the importance of providing a supportive healing environment to address the spiritual dimension of the cancer experience for AYAs. Individualized interventions ensuring an appropriate level of spiritual care based on clinical standards are essential to meet the needs of patients and ensure positive long-term health outcomes.

Research on Employee Voice Intention: Conceptualization, Scale Development, and Validation Among Enterprises in China

Purpose

Expressing opinions and ideas in the workplace is an important aspect of organizational development and employee well-being. However, employee voice intention, which refers to an employee's willingness to share their opinions or ideas, is an area that has received limited attention in research. Therefore, the aim of this study was to develop and validate a reliable measurement tool for employee voice intention.

Methods

The study followed a three-stage process. First, in-depth interviews were conducted with managers and employees from Chinese companies, resulting in 38 qualitative data points. Second, the employee voice intention scale was developed and validated through two surveys. Exploratory factor analysis (N=264) and confirmatory factor analysis (N=260) were performed, respectively. Third, the predictive validity of the scale was assessed by collecting 366 valid responses across three rounds of questionnaires, using voice efficacy and employee voice behavior as correlational calibration criteria.

Results

The study employed grounded theory methodology to analyze the qualitative data collected, resulting in the development of a robust conceptual framework of employee voice intention. This framework is composed of two dimensions: perceived desirability and perceived feasibility, which together capture the key factors that influence whether an employee will express their opinions or ideas within an organizational context. A corresponding measurement scale was developed, consisting of nine measurement items that underwent rigorous testing to ensure their reliability and validity. Furthermore, the results of the empirical study showed that employee voice intention mediated the positive effect of voice efficacy on voice behavior, supporting the scale's predictive validity.

Conclusion

This study provides valuable insights into the dimensions of employee voice intention and contributes significantly to the existing literature on this topic by introducing a reliable and valid measurement tool. Furthermore, it advances our understanding of the underlying dimensions associated with this construct.

Dyadic process and dynamics of caregiving and receiving in suicide recovery among Filipino college-aged students and their families

With the increasing incidence of suicidality among the youth, identifying effective care and support that family members provide is essential. Despite numerous studies on the link between suicide mitigation and caregiving, the dyadic process and dynamics of family members supporting youth at risk have been scarcely explored. This study utilizes grounded theory to explore the actions, interactions, and processes involved in caregiving and receiving between five pairs of Filipino family caregivers and college-aged care receivers who recovered from suicidality. The study gave rise to a seven-phase model that characterizes the dynamic dyadic interactions between the family caregiver and the youth care receiver. This is summarized in the acronym C² A² R² E, which means calling-on, contemplating, accepting, allowing, responding, reciprocating, and empowering. This model highlights the processes and dynamics of care within families, which may be useful in paving the way for families and mental health professionals to foster more effective support in mitigating suicidality among youth at risk.

Development of an Evidence-Based Conceptual Model of the Health Care Sector Under Digital Transformation: Integrative Review

BACKGROUND

Digital transformation is currently one of the most influential developments. It is fundamentally changing consumers' expectations and behaviors, challenging traditional firms, and disrupting numerous markets. Recent discussions in the health care sector tend to assess the influence of technological implications but neglect other factors needed for a holistic view on the digital transformation. This calls for a reevaluation of the current state of digital transformation in health care. Consequently, there is a need for a holistic view on the complex interdependencies of digital transformation in the health care sector.

OBJECTIVE

This study aimed to examine the effects of digital transformation on the health care sector. This is accomplished by providing a conceptual model of the health care sector under digital transformation.

METHODS

First, the most essential stakeholders in the health care sector were identified by a scoping review and grounded theory approach. Second, the effects on these stakeholders were assessed. PubMed, Web of Science, and Dimensions were searched for relevant studies. On the basis of an integrative review and grounded theory methodology, the relevant academic literature was systematized and quantitatively and qualitatively analyzed to evaluate the impact on the value creation of, and the relationships among, the stakeholders. Third, the findings were synthesized into a conceptual model of the health care sector under digital transformation.

RESULTS

A total of 2505 records were identified from the database search; of these, 140 (5.59%) were included and analyzed. The results revealed that providers of medical treatments, patients, governing institutions, and payers are the most essential stakeholders in the health care sector. As for the individual stakeholders, patients are experiencing a technology-enabled growth of influence in the sector. Providers are becoming increasingly dependent on intermediaries for essential parts of the value creation and patient interaction. Payers are expected to try to increase their influence on intermediaries to exploit the enormous amounts of data while seeing their business models be challenged by emerging technologies. Governing institutions regulating the health care sector are increasingly facing challenges from new entrants in the sector. Intermediaries increasingly interconnect all these stakeholders, which in turn drives new ways of value creation. These collaborative efforts have led to the establishment of a virtually integrated health care ecosystem.

CONCLUSIONS

The conceptual model provides a novel and evidence-based perspective on the interrelations among actors in the health care sector, indicating that individual stakeholders need to recognize their role in the system. The model can be the basis of further evaluations of strategic actions of actors and their effects on other actors or the health care ecosystem itself.

Understanding the process of people with hypersensitivity pneumonitis implementing continuous antigen avoidance and their affecting situations: A grounded theory study

AIMS AND OBJECTIVES

To explore the process by which people with hypersensitivity pneumonitis implement continuous antigen avoidance, alongside the situations that influence this process.

BACKGROUND

Antigen avoidance is the primary treatment for people with hypersensitivity pneumonitis. However, the best method to support antigen avoidance has not yet been established.

DESIGN

The present qualitative study used a constructivist grounded theory approach.

METHODS

The participants were inpatients or outpatients with hypersensitivity pneumonitis diagnosed at a Japanese urban university hospital. In parallel with semi-structured interviews and a medical record survey from 2016 to 2021, we conducted coding, categorising, writing memos, theoretical sampling and continuous comparisons of experiences from finding physical abnormalities to implementing antigen avoidance. The COREQ checklist was followed for reporting.

RESULTS

Interpreting the experiences leading to the implementation of continuous antigen avoidance by 28 participants provided a process consisting of a core category: trying to maintain one's desired life under uncertain situations, and four phases: (1) searching for a convincing cause of the illness, (2) gradually understanding the disease, (3) realising the need for behaviour change and (4) seeking a good balance between behaviour change and one's desired life. The situations that influenced the process were also revealed.

CONCLUSIONS

Being convinced of the cause of one's illness and realising its severity led to the participants' realisation of the need for a behavioural change to avoid antigens. The uncertainty of the cause of illness and measures taken, a lack of clear advice from healthcare providers and one's desired life influenced participants' implementation of continuous antigen avoidance.

RELEVANCE TO CLINICAL PRACTICE

This study provides important insights regarding how healthcare providers should better understand and support people with hypersensitivity pneumonitis in avoiding antigens.

Becoming Experts in Their Own Treatment: Child and Caregiver Engagement With Burn Scar Treatments

Children who experience a severe burn injury not only require acute medical care but may also need ongoing rehabilitation. To mitigate the potential long-term consequences of scarring and the impact of scarring on their everyday lives, children may be expected to use a variety of time-consuming and multi-component non-invasive scar treatments (such as pressure garments and silicone gels). These treatments may pose unique challenges for children and their caregivers. With limited research previously addressing how Australian children navigate the use of scar treatments at home, this study aimed to develop a grounded theory of children and their caregivers' engagement with non-invasive burn scar treatments. Using a constructivist grounded theory approach, interviews were completed with 20 caregivers and 7 children, and a theory of children and their caregivers becoming experts in the use of non-invasive burn scar treatments was developed. Through persistence and flexibility, they continued to develop expertise. Engaging with scar treatments was an evolving process over time for children with burns and their caregivers. Theoretical categories identified included 'making it work', 'finding the balance' and 'seeking reassurance' and highlighted the remarkable strengths and adaptability of children and their caregivers. Through trial and error, children and their caregivers developed their own unique strategies for engaging with scar treatments. These insightful results may inform the development of interventions to support children and their caregivers' day-to-day engagement with non-invasive burn scar treatments and guide health professionals recommending these treatments.

Pathways, Contexts, and Voices of Shame and Compassion: A Grounded Theory of the Evolution of Perinatal Suicidality

There is an urgent need to generate deeper understandings of how suicidality manifests and evolves during pregnancy and the following year. Several perinatal studies have examined the incidence of suicidal thoughts and behaviours and associated social and obstetric risk factors; however, there is very limited research offering insights into women's experiences of suicidality at this time in their lives. This study aimed to generate a theory to explain how suicidality evolves in the perinatal period. A grounded theory design was used with data generated using anonymous online surveys (119 participants) and in-depth interviews (20 participants) with women who received pregnancy care in the past 5 years in Australia. The developed theory holds shame as a core concept. Origins and contexts of shame reflect current epidemiological understandings of risk for perinatal suicide, including experiences of gender-based violence, adverse childhood experiences, and a history of mental health difficulties. When women feel that they are defective, are unworthy of love and belonging, and do not possess what it takes to be a good mother, they can conclude that their family is better off without them. Pathways beyond shame were facilitated by compassionate and rehumanising care from family, friends, and care providers. Findings demonstrate that perinatal suicidality is a complex multidimensional phenomenon, influenced by socio-cultural expectations of motherhood and interpersonal, systemic, and intergenerational experiences of trauma. Increasing the prominence of perinatal suicide prevention within health professional education and practice, and addressing systemic barriers to compassionate health care are critical first steps to addressing perinatal suicide.

Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005-2022: A Systematic Review

Qualitative research on malaria in pregnancy (MiP) is incipient, therefore its contextual, experiential and symbolic associated factors are unknown. This study systematizes the qualitative research on MiP, describes knowledge, perceptions and behaviors about MiP, and compiles individual, socioeconomic, cultural and health system determinants of MiP through a meta-synthesis in 10 databases. A total of 48 studies were included with 2600 pregnant women, 1300 healthcare workers, and 2200 relatives or community members. Extensive knowledge was demonstrated on ITN and case management, but it was lacking on SP-IPTp, risks and consequences of MiP. Attitudes were negative towards ANC and MiP prevention. There were high trustfulness scores and preference for traditional medicine and distrust in the safety of drugs. The main determinants of the Health System were rationing, copayments, delay in payment to clinics, high out-of-pocket expenses, shortage, low workforce and work overload, shortcomings in care quality, low knowledges of healthcare workers on MiP and negative attitude in care. The socioeconomic and cultural determinants were poverty and low educational level of pregnant women, distance to the hospital, patriarchal-sexist gender roles, and predominance of local conceptions on maternal-fetal-neonatal health. The meta-synthesis demonstrates the difficulty to detect MiP determinants and the importance of performed qualitative research before implementing MiP strategies to understand the multidimensionality of the disease.

Self-awareness as the key to successful adherence to antiretroviral therapy among people living with HIV in Indonesia: A grounded theory study

Background

Adherence to antiretroviral therapy (ART) continues to pose a significant challenge for people living with HIV (PLWH). Non-adherence to ART can have far-reaching implications for patient well-being, particularly in increasing the risk of opportunistic infections when medication is not taken as prescribed.

Objective

This study aimed to develop a theoretical model that explains how PLWH in Indonesia adhere to their ART regimen and the strategies they follow to maintain adherence.

Methods

The study used a grounded theory approach. Data were collected through face-to-face in-depth interviews with 21 PLWH who had been taking ART for six months or more at a non-governmental organization (NGO) in Jakarta, Indonesia, between July 2019 and November 2019. Theoretical sampling was used, and the data analysis method of Corbin and Strauss was utilized, including open coding, axis coding, and selective coding.

Results

Three stages were identified as a process of adherence to the ART regimen: 1) initiating ART, 2) missing the connection, and 3) taking control. Self-awareness was identified as the central core theme describing the ART adherence process.

Conclusion

Having adequate self-awareness to take ART regularly is crucial to improving adherence to ART. Moreover, social support from one's spouse and family members can help patients maintain adherence. Therefore, self-awareness and support systems should be included as components in nursing interventions when starting ART therapy. In addition, nurses can help identify potential support persons and provide information related to ART therapy.

Person-specific evidence has the ability to mobilize relational capacity: A four-step grounded theory developed in people with long-term health conditions

Person-specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self-determination method with people with various long-term health conditions. It explains the mechanisms of mobilizing relational capacity by including person-specific evidence in shared decision-making. Person-specific self-insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self-management challenges. This step paved the way for sharing these insights and challenges in a relationship with a supportive health professional, who could then rely on person-specific evidence instead of assumptions or a narrow disease perspective for shared decision-making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person-specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self-insights in daily life with other people, decreasing loneliness they experienced in self-management. Relational capacity, the core of the theory, is mobilized in both people with long-term health conditions and healthcare professionals. Further research on person-specific evidence and relational capacity in healthcare is recommended.

Empowering Cancer Survivors in Managing Their Own Health: A Paradoxical Dynamic Process of Taking and Letting Go of Control

In cancer care, gaps in support to help patients manage and live with the side-effects from cancer treatments have increased the emphasis on empowering patients to be more active and involved in managing their own health. However, empowerment in relation to promoting self-management behaviors is not well understood. Using the social constructivist grounded theory approach, our goal was to develop a theoretical understanding of this phenomenon in relation to the self-management behaviors of post-treatment cancer patients. Twenty-two post-treatment cancer patients participated in a semi-structured focused interview to co-construct with us how empowerment is defined, described, and experienced in relation to their capacity to self-manage. Through this co-construction, we defined empowerment as a process of personal growth, a display of fortitude and strength when participants confronted the impact of their illness that emerged in two dynamic and paradoxical ways: 1) establishing control over the impact of the illness as a means to maintain normalcy and to circumvent change over an eroding and changing sense of self and 2) relinquishing control over aspects of the illness deemed irrepressible and acknowledging and accepting change. When successful at establishing and/or relinquishing control, participants no longer viewed cancer as a threat, but re-interpreted their illness as also having a beneficial "empowering" experience and more capable of managing. Findings will guide the development of self-management interventions that use empowerment as a core construct.

"It's Stable but Not Stable": A Conceptual Framework of Subjective Housing Stability Definition Among Individuals with Co-occurring Mental Health and Substance Use Disorders

Objective: Despite increasing efforts to improve housing stability, research has largely defined housing stability in a narrow sense and heavily relied on objective measures, such as housing types and housing duration. The present study constructed a conceptual framework for a subjective housing stability definition from the perspectives of individuals with co-occurring mental health and substance use disorders and their behavioral health service providers. Methods: Following the principles of grounded theory, we collected and analyzed qualitative data through semistructured interviews with 24 individuals with serious mental illness and substance use problems and three focus groups with 22 behavioral health service providers. Results: We developed a conceptual framework with two domains of subjective housing stability: functional stability and experiential stability. The functional stability domain includes four theoretical concepts: meeting basic needs, housing quality, housing affordability, and housing permanence. The experiential stability domain includes four theoretical concepts: autonomy and independence, connectedness, safety, and supportiveness. Conclusions: The conceptual framework can inform future research, practices, and policies to move beyond focusing on merely providing housing to consider the diverse and underlying needs in improving housing stability and well-being among those experiencing or at risk of housing instability.

Exploring patients' perspectives of gestational diabetes mellitus screening and counselling in Ontario: A grounded theory study

INTRODUCTION

Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes. Approaches to screening for GDM continue to evolve, introducing potential variability of care. This study explored the impact of these variations on GDM counselling and screening from the perspectives of pregnant individuals.

METHODS

Following a Corbin and Strauss approach to qualitative, grounded theory we recruited 28 individuals from three cities in Ontario, Canada who had a singleton pregnancy under the care of either a midwife, family physician or obstetrician. Convenience and purposive sampling techniques were used. Semi-structured telephone interviews were conducted and transcribed verbatim between March and December 2020. Transcripts were analysed inductively resulting in codes, categories and themes.

RESULTS

Three themes were derived from the data about GDM screening and counselling: 'informing oneself', 'deciding' and 'screening'. All participants, regardless of geographical region, or antenatal care provider, moved through these three steps during the GDM counselling and screening process. Differences in counselling approaches between pregnancy care providers were noted throughout the 'informing' and 'deciding' stages of care. Factors influencing these differences included communication, healthcare autonomy and patient motivation to engage with health services. No differences were noted within care provider groups across the three geographic regions. Participant experiences of GDM screening were influenced by logistical challenges and personal preferences towards testing.

CONCLUSION

Informing oneself about GDM may be a crucial step for facilitating decision-making and screening uptake, with an emphasis on information provision to facilitate patient autonomy and motivation.

PATIENT OR PUBLIC CONTRIBUTION

Participants of our study included patients and service users. Participants were actively involved in the study design due to the qualitative, patient-centred nature of the research methods employed. Analysis of results was structured according to the emergent themes of the data which were grounded in patient perspectives and experiences.

A grounded theory study on Swedish 10 to 16-year-olds' perceptions of pain in conjunction with orthodontically indicated tooth extraction

OBJECTIVE

Children frequently experience pain and/or discomfort during dental treatment. Still, pain research in dentistry has mainly been performed on adults using quantitative methods while research on the child's perspective is scarce. This study aims to explore and describe children's experiences and/or thoughts regarding pain in conjunction with tooth extraction.

MATERIAL AND METHODS

Interviews were carried out with twelve Swedish 10-16-year-olds who had recently undergone tooth extractions due to orthodontic reasons. Interviews were transcribed verbatim and analysed according to grounded theory.

RESULTS

A core category was identified and named 'handling the unavoidable unknown'. The informants recalled experiences of pain and discomfort during extractions. However, instead of focussing on pain, they described an urge for more information about the procedure and what to expect in terms of pain and/or discomfort, during and/or after treatment. They stated that the levels of pain/discomfort were manageable, while the lack of information negatively affected their coping abilities, causing feelings of unease.

CONCLUSIONS

To improve patients' ability to deal with pain in conjunction with dental extraction, the dental team should ensure better and individually tailored information about the treatment. Thus, the use of psychological techniques is a cornerstone in pain management and must be reflected in clinical guidelines.

'I'm having jelly because you've been bad!': A grounded theory study of mealtimes with siblings in Australian families

Obesity prevention interventions have been designed to promote responsive feeding in early childhood. However, existing interventions primarily target first-time mothers without considering the complexities of feeding multiple children within a family unit. By applying principles of Constructivist Grounded Theory (CGT), this study aimed to explore how mealtimes are enacted in families with more than one child. A mixed-methods study was conducted with parent-sibling triads (n = 18 families) in South East Queensland, Australia. Data included direct mealtime observations, semistructured interviews, field notes, and memos. Data were analysed using open and focused coding, during which constant comparative analysis was applied. The sample comprised of two-parent families with children ranging in age from 12 to 70 months (median sibling age difference = 24 months). A conceptual model was developed to map sibling-related processes integral to the enactment of mealtimes in families. Notably, this model captured feeding practices used by siblings, such as pressure to eat and overt restriction, that previously had only been described in parents. It also documented feeding practices used by parents that may occur only in the presence of a sibling, such as leveraging sibling competitiveness and rewarding a child to vicariously condition their sibling's behaviour. The conceptual model demonstrates complexities in feeding that give shape to the overall family food environment. Findings from this study can inform the design of early feeding interventions that support parents to remain responsive, particularly when their perceptions and expectations of siblings differ.

Information and counselling needs of patients with major low anterior resection syndrome: A qualitative study

AIMS AND OBJECTIVES

The aim was to explore the information and counselling needs of rectal cancer survivors confronted with major low anterior resection syndrome.

BACKGROUND

Rectal cancer survivors are often confronted with bowel problems after surgery. This is called low anterior resection syndrome. Patients are unsure what to expect after treatment and healthcare professionals often underestimate the impact of low anterior resection syndrome on patients' lives.

DESIGN

A qualitative study with a grounded theory approach was conducted.

METHODS

Patients were recruited between 2017 and 2019 in three hospitals, and a call was distributed in two patients' organisations. Semi-structured interviews with patients confronted with major low anterior resection syndrome were performed. An iterative process between data collection and data analysis was used. Data analysis was done using the constant comparative method, and investigators' triangulation was applied. Qualitative data were reported following COREQ guidelines. The study was registered at Clinicaltrials.gov NCT04896879.

RESULTS

A total of 28 patients were interviewed until theoretical data saturation. Before surgery patients' need for information varied according to their individual coping mechanisms. Some patients required information before surgery, while others considered this too overwhelming. When confronted with LARS, patients desired that healthcare professionals recognised its impact and clarified its expected evolution. A proactive counselling with an easy accessible and approachable healthcare professional was beneficial.

CONCLUSION

Patients expressed several needs regarding the information before rectal cancer surgery and counselling of low anterior resection syndrome after surgery.

RELEVANCE TO CLINICAL PRACTICE

Better knowledge and understanding of major low anterior resection syndrome and its challenges by healthcare professionals are crucial. Especially the impact on quality of life is significant for patients and underestimated by healthcare professionals. Information before surgery and counselling when confronted with major low anterior resection syndrome should be optimised and tailored to patients' needs.

Towards best practice during COVID-19: A responsive and relational program with remote schools to enhance the wellbeing of Aboriginal and Torres Strait Islander students

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020-2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures; (un)availability of other services; community uncertainty and anxiety; school staff capability and wellbeing; and risk of educational slippage. SUN strategies were: enhancing teachers' capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff; greater school-community engagement; student belonging and engagement; a voice for advocacy; and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools' capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally.

Parents' and Health Care Professionals' Perspectives on Prevention and Prediction of Food Allergies in Children: Protocol for a Qualitative Study

BACKGROUND

Food allergy in children is increasing in prevalence in the western world and appears to become an important health problem. Parents of children at risk of food allergy live with the fear of allergic reaction, especially when the children are very young. The paradigm shift in allergy prevention in the last decade-away from allergen avoidance toward a tolerance induction approach-challenges both parents and health care professionals, as they have to deal with changing information and new evidence that often contradicts previous assumptions. Yet, research on health information-seeking behavior and needs of parents on primary prevention of food allergy in children as well as on prediction and prevention strategies of German health care professionals is lacking.

OBJECTIVE

The aim of the study is to explore and understand parents' and health care professionals' perspectives on the prediction and prevention of food allergies. We are particularly interested in information needs, information seeking, and health care usage and place a special focus on families' experiences when their child is at risk or diagnosed with food allergies. Furthermore, food allergy prediction and prevention strategies of health care professionals will be explored.

METHODS

This study is part of the NAMIBIO (food allergy biomarker) app consortium, which aims to identify early predictors for the development of food allergy in children and develop apps to guide health care professionals and parents of children with a high risk of food allergy toward prevention and timely tolerance induction. The study uses a qualitative approach with topic-guided interviews and focus groups with parents of children (0-3 years) and health care professionals. Data collection will continue until theoretical saturation is reached. The qualitative content analysis will be used according to Kuckartz to identify overarching themes toward information needs and seeking behavior as well as usage of health care and health care professionals' predictive and preventive strategies. In addition, a constructivist grounded theory approach will be used to explore and understand parents' experiences, interactions, and social processes in families in daily life.

RESULTS

Recruitment and data collection started in February 2022 and is still ongoing.

CONCLUSIONS

The qualitative study will provide insight into parents' information-seeking behavior and needs regarding the prevention of food allergy in children, parents' use of pediatric primary care, and health care professionals strategies for the prediction and prevention of food allergies in children. We assume that our results will highlight the challenges associated with the paradigm shift in allergy prevention for both parents and health care professionals. The results will be used to make practical recommendations from the user's perspective and inform the development of the NAMIBIO apps.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41436.

The Relationship between Teachers and Pupils with Down Syndrome: A Qualitative Study in Primary Schools

Down syndrome (DS), due the presence of an intellectual disability and a precarious health condition, involves important challenges for developing skills at school. The study explores the relational dynamics between teachers and students with DS and how the latter influence the processes of socialization and learning at school. The study involved 15 (n = 15) special education teachers (M _age = 40.4; SD = 9.3) from primary schools in Italy who were or had previously been in charge of a pupil with DS. The teachers were interviewed through a semi-structured interview, built ad hoc. The data were analyzed through the grounded theory method supported by ATLAS.ti software. Data analysis produced 20 (n = 20) categories grouped into 6 (n = 6) macro-categories: (1) psychophysical characteristics; (2) learnings; (3) relational aspects; (4) collaborations; (5) extracurricular activities; and (6) teacher training. The research shows that students with DS have good relationships with their peers; however, there are still some important critical issues, including poor training of teachers on certain topics and on the application of collaborative and relationship support strategies, the limited collaboration between support teachers and curricular teachers, and the absence of support from ad hoc professional figures.

What makes people feel loved? An exploratory study on core elements of love across family, romantic, and friend relationships

With research long focusing on distinct characteristics of different love types, little is known about love as a general feeling across relationship contexts. To explore the core elements of love as perceived by laypeople and whether these elements weigh differently in different relationships, grounded theory was used to analyze open-ended responses from 468 individuals about their feeling loved in family, romantic, and friend relationships. Results indicated that the feeling of love is an interpersonal process in which one receives positive responsiveness from the other and experiences an authentic connection with the other, consistently across conditions and time (i.e., in a sense of stability); three core elements were shared across family, romantic, and friend relationships. Chi-square independence tests revealed differentiated weights for love elements in three relationships, which corresponded to the prototypical love definition in family, romantic, and friend relationships. Findings suggested an integrated theoretical conceptualization of love as a shared feeling and asset across relationships, which provided important insights on love conceptualization, assessment, and study design, as well as implications for the treatment of dysfunctional relationships, best practices in daily interpersonal interactions, and improvement in intervention and therapy.

"Attempting to protect self and patient:" A grounded theory study of error recovery by intensive care nurses

AIM

The aim of this study was to explore the process of error recovery (ER) by nurses in intensive care unit (ICU).

DESIGN

This qualitative study was conducted in 2018-2020 using the grounded theory methodology.

METHODS

Participants were 20 staff nurses, head nurses and nursing managers recruited from the ICUs. Sampling was started purposively and continued theoretically. Data were collected using semi-structured interviews and were analysed using the approach proposed by Corbin and Strauss.

RESULTS

The findings indicated that nurses' primary concern was for the patient and their own personal/professional identity. Five strategies were found including evaluating situation, identifying error, analysing error and situation, determining the agent for error correction, and reducing error effects. Contextual factors were also highlighted as being important in the error recovery. Attempting to protect self and patient" was the core category of the study. Nurses' concern about protecting patient life and their own personal/professional identity make them use unprofessional approaches for ER.

Characterizing the trophy hunting debate on Twitter

Social media is an arena of debate for contentious political and social topics. One conservation topic debated online is the acceptability of trophy hunting, a debate that has implications for national and international policy. We used a mixed-methods approach (grounded theory and quantitative clustering) to identify themes in the trophy hunting debate on Twitter. We examined commonly co-occurring categories that describe people's stances on trophy hunting. We identified 12 categories and 4 preliminary archetypes opposing trophy hunting-activism, scientific, condemning, and objecting-whose opposition derived from different moral reasoning. Few tweets (22) in our sample of 500 supported trophy hunting, whereas 350 opposed it. The debate was hostile; 7% of tweets in our sample were categorized as abusive. Online debates can be unproductive, and our findings may be important for stakeholders wishing to effectively engage in the trophy hunting debate on Twitter. More generally, we contend that because social media is increasingly influential, it is important to formally contextualize public responses to contentious conservation topics in order to aid communication of conservation evidence and to integrate diverse public perspectives in conservation practice.

Using a mixed methods grounded theory methodology to explain neonatal nurses' professional quality of life

BACKGROUND

Nurse researchers are constantly seeking novel methods of maintaining philosophical congruence while advancing their knowledge of the human condition using paradigmatically diverse means.

AIM

To provide an overview of the research philosophies underpinning the mixed methods grounded theory (MM-GT) methodology, illustrate its optimal use and introduce a quality-appraisal tool being developed with reference to extant literature.

DISCUSSION

The utility of MM-GT has been effectively demonstrated in the nursing and health literature. Yet, there are examples of how it has been under-used and sub-optimally applied. This article includes a two-phase MM-GT study protocol guided by a pragmatic research philosophy and best practice recommendations that aims to explain neonatal nurses' professional quality of life.

CONCLUSION

Optimal use of MM-GT's five essential components - purposive sampling, constant comparative methods with iterative coding and analysis, theoretical saturation, memoing and theory development - combine to produce high-quality, defensible research outputs and new nursing theory.

IMPLICATIONS FOR PRACTICE

Research outputs, such as publication and presentation, expounding the multifactorial influences affecting neonatal nurses' professional quality of life will not only benefit the neonatal nursing community but also contribute to the corpus of nursing and midwifery research and enhance the health, well-being and retention of nurses and midwives more broadly.

Factors and Mechanism Influencing Client Experience of Residential Integrated Health and Social Care for Older People: A Qualitative Model in Chinese Institutional Settings

BACKGROUND

An emerging service delivery model of integrating health and social care for older people has been actively promoted by the Chinese government since 2016, but the client experience and influencing mechanism still remain unclear.

METHODS

this study adopts a qualitative methodology to delve deeper into the factors and mechanism shaping the client experience of residential integrated health and social care for older people in the Chinese context, so as to understand the experiences of older residents during the whole process of receiving integrated care services, and on this basis, put forward suggestions for the improvement of a high-quality aged care service system. We coded and analyzed the in-depth interview data of twenty older adults and six staff members from June 2019 to February 2020, recruited from six institutions in Changsha, one of the ninety pilot cities for integrated health and social care in China.

RESULTS

the findings showed that the client experience of older adults is mainly affected by factors in three dimensions (scene construction, individual minds, and interaction and communication), which are comprised of six sub-categories (social foundation, institutional functions, perception and emotion, cognition and understanding, intimacy and trust, and participation). Based on the factors and mechanism (consisting of six influencing paths), we constructed a model of the client experience of integrated health and social care for older people in the Chinese population.

CONCLUSIONS

the factors and mechanism influencing the client experience of integrated health and social care for older people are complex and multifaceted. Attention should be paid to the direct effects of perception and emotion, institutional functions, intimacy and trust in the client experience, and the indirect effects of social foundation and participation on the client experience.

Older adults' subjective experiences of the COVID-19 outbreak and lockdown in Italy: A qualitative study

OBJECTIVE

To evaluate the subjective experience of the COVID-19 outbreak in healthy older adults and develop a model of the older population's psychological adaptation to the COVID-19 pandemic.

METHODS

A qualitative grounded theory approach was taken to the study design and analysis, using semi-structured interviews to collect data from 19 community-active Italian older people by telephone during the first wave of COVID-19 (May 2020).

RESULTS

The theory emerging from the study conceptualized the COVID-19 subjective experience in older people as an adjustment process to the disruption of habits, social contacts, and routines that prompted a meaning-making process to face this adverse experience. Three emergent categories included 'loss, uncertainty, and distress' as the psychological impact of the pandemic emergency, 'making sense of COVID-19' as a subjective sense-making process of the pandemic, and 'living with the pandemic' as agency and self-management within the pandemic experience. The resulting narratives encompassed themes, i.e. risk perception, representation of the self, connection with past-time memories, and compliance with safety measures.

CONCLUSION

The results have implications for designing effective messages to promote hope, social responsibility, and commitment in aging during the COVID-19 pandemic and for health workers who wish to support the psychological health of older adults.

Where Are All the Men? A Qualitative Review of the Barriers, Facilitators, and Recommendations to Older Male Participation in Health Promotion Interventions

OBJECTIVE

Older men have lower participation rates than females in health promotion interventions. We conducted a qualitative review of 20 years of existing research across a variety of academic search databases to outline the barriers, facilitators, and recommendations for this imbalance.

DATA SOURCE

A systematic search was conducted across Google Scholar, PubMed, MEDLINE, CINAHL, Academic Search Premier, Psychology and Behavioral Sciences Collection, and Web of Science from dates January 1, 2000 - December 31, 2020.

STUDY INCLUSION AND EXCLUSION CRITERIA

Abstracts were screened based on: original research, English language, recruitment or participation, health promotion or health program, and male gender.

DATA EXTRACTION

Of 1194 initial search results, 383 article abstracts were thoroughly screened for inclusion and 26 articles met inclusion criteria.

SYNTHESIS

Included studies were coded and analyzed using Grounded Theory.

RESULTS

Barriers included masculine gender roles as well as program scope, environment, and gender of the instructors and other participants. Facilitators included creating social groups of older males that participate in a variety of activities together, including hobbies and health promotion, over a long period of time.

CONCLUSION

Health promotion interventions should involve men in all aspects of program planning and implementation, take into account men's existing relationships and interests to create gender-sensitive programming, and clearly delineate the benefits to participation.