Thematic analysis of qualitative research data: Is it as easy as it sounds?

The Financial Toxicity Experience of Patients with Colorectal Cancer During Chemotherapy: A Qualitative Study

BACKGROUND

This study aimed to explore the experience of financial toxicity in patients with colorectal cancer during chemotherapy and to inform the development of targeted interventions.

METHODS

A descriptive qualitative research method was used to conduct semi-structured interviews with a purposive sample of 15 patients with colorectal cancer undergoing chemotherapy who attended the Department of Medical Oncology of the First Affiliated Hospital of Anhui Medical University from March to June 2024, and the data were organized and analyzed using the Nvivo 11.0 qualitative data analysis software and the thematic analysis method.

RESULTS

Four themes were extracted: patients with chemotherapy-stage colorectal cancer bear direct and indirect multifaceted economic pressures, are affected by multidimensional risk factors, which cause multiple adverse outcomes, and cope with financial toxicity in various ways.

CONCLUSIONS

The experience of financial toxicity in colorectal cancer patients undergoing chemotherapy is presented in a multidimensional format, with multiple causes influencing their financial toxicity. In the future, healthcare professionals should identify patients at high risk for financial toxicity, provide financial toxicity interventions and support, and mitigate their exposure to financial toxicity.

Scaling up medications for opioid use disorder in Kentucky: Qualitative perspectives of treatment organizations

Background

Underutilization of medications for opioid use disorder (MOUD), which reflects the limited number of patients initiating treatment and being retained in treatment, remains a persistent barrier to addressing the opioid epidemic. Using an adapted PRISM (Practical, Robust Implementation and Sustainability Model) framework, this study describes multi-level barriers and facilitators to expanding MOUD as part of the HEALing (Helping to End Addiction Long-term®) Communities Study in Kentucky (HCS-KY).

Methods

Cross-sectional small group and individual semi-structured interviews were conducted with 60 employees representing 30 MOUD agencies in eight Kentucky counties from December 2022 to June 2023. A deductive-dominant approach to interviewing, with all interviews recorded and transcribed. Using a codebook informed by the adapted PRISM framework, a directed consensus-based approach to coding and thematic analysis was used.

Results

Although some agencies had a fairly static number of patients, most described recent experiences with modestgrowth in MOUD census and the ability to provide same day/next day MOUD. Multi-level factors, includingorganizational, patient-level, and community characteristics and perspectives, were perceived to impact MOUDcensus. Organizational characteristics impacting growth included the physical space of the clinic and staffing. Organizational policies in some agencies constrained treatment retention, while other agencies implementedinnovations to better meet patients' needs. Patients often encountered numerous challenges to treatmentinitiation and retention, including limited access to transportation, technology, safe and stable housing, and childcare. These patient-level barriers often reflected community characteristics, while community stigma alsoimpeded MOUD growth.

Conclusions

These qualitative data revealed that some degree of growth in MOUD has occurred, but multi-level barriers are impeding further increases in treatment initiation and retention. Some barriers likely require policy changes related to financing and regulation, while other barriers require community-level efforts to decrease stigma and greater community investment in infrastructure, such as transportation and housing.

Trial registration

ClinicalTrials.gov, NCT04111939. Registered 30 September 2019.

Understanding Needs for Chronic Musculoskeletal Pain Management in a Northern Dene and Métis Community: A Community Based Needs Assessment

Background

Chronic musculoskeletal (MSK) pain disproportionately affects Indigenous Peoples, and rural/remote communities face significant barriers in accessing care. La Loche, a Dene/Métis community in northern Saskatchewan, has limited access to specialized chronic pain management services and specialized health providers.

Aims

The aim of this needs assessment was to gain insight into the community's priorities, strengths, and concerns regarding chronic MSK pain management. Community engagement and relationship building were essential to ensure that cultural protocols were respected and community worldviews were accurately represented.

Methods

A community-directed needs assessment was conducted in collaboration with local health care providers and community members. To ensure appropriate representation of community-led priorities, reflexive thematic analysis was utilized and rooted within interpretive description and informed by community-based participatory research and Two-Eyed Seeing. Open discussions were conducted in person, over the phone, or via Zoom in a semistructured format. Thirteen individuals were interviewed (eight community members, five health care professionals).

Results

Interviews conducted with community members and health care providers were analyzed separately. Both yielded the same four major overarching themes: (1) impact of pain on daily living, (2) barriers limiting access to care and the understanding of pain between health care provider and patient, (3) systemic oppression and negative experiences with health care, and (4) strength-based solutions.

Conclusions

Five recommendations were developed to promote culturally safe and patient-centered environments for chronic MSK pain communication and future care delivery: (1) person-centered and community-directed care, (2) clinic model and staffing requirements, (3) practitioner education and awareness, (4) community education and awareness, and (5) community resources.

Living through their first pandemic: Mississippi young adults reveal COVID-19 concerns and challenges

Objective: The study aimed to understand the perceptions, knowledge, information sources, and coping skills pertaining to COVID-19 among two groups of African American young adults. Participants: African American ages 18-29 years enrolled in Historically Black Colleges and Universities and non-college enrolled young adults in Mississippi were the participants. Methods: Focus groups were conducted from February through May 2021. The qualitative data were analyzed using thematic analysis. Results: Findings suggest the college students faced anxiety and stress from the loss of loved ones and the college experience. Non-college enrolled young adults dealt with maintaining employment, pros and cons of taking the vaccine to continue work, and handling the frequent flow of information. Conclusion: The study highlights the importance of ensuring that reliable and trustworthy health promotion and health crisis prevention information, resources, and coping tools are available in the environments in which young adults live, learn, and work.

Meaning-oriented thematic analysis grounded in reflective lifeworld research-A holistic approach for caring science research

BACKGROUND AND AIM

The aim of the present article is to describe meaning-oriented thematic analysis grounded in reflective lifeworld research and to illustrate how the thematic analysis can be integrated in the research process. The article is a methodological paper, including ontological and epistemological assumptions for lifeworld theory. Research based on lifeworld theory is directed towards lived experiences and meanings in everyday life. Research that is founded on the epistemology of the lifeworld can present existential issues important for caring and qualitative research can in particular contribute to existential knowledge needed to understand the world of the patient.

DESIGN

Theoretical paper.

RESULTS

Starting with a phenomenon of relevance for caring science, the article argues for lifeworld interviews as a data collection method that can contribute to depth and meaning, and then presents a description of how structures of meaning can be outlined through a meaning-oriented thematic analysis. The research of lived experiences in caring science demands an approach that includes a reflective attitude during the methodological considerations. This article highlights the importance of ontological and epistemological considerations when conducting a meaning-oriented thematic analysis.

CONCLUSION

The article places meaning-oriented thematic analysis in a wider research process, considering all aspects from collection of data to the creation of meaning-oriented themes.

COVID-19 and local community resilience in the Westfjords of Iceland

Remote Arctic communities have often been depicted as being particularly vulnerable to the challenges of disasters, with their location and lack of infrastructure exacerbating risk. This study explores the characteristics of local resilience in the Arctic using the case study of the communities of the north-western Westfjords. A total of 42 semi-structured interviews were carried out with various community members, seeking to uncover the features of inbuilt resilience that contribute to successes and vulnerabilities. These were transcribed, coded, and categorised in relation to an integrated framework for assessing community resilience in disaster management, which groups topics via the themes of environmental, social, governance, economic, and infrastructure. All themes played a role in the success of local coping strategies, with easy access to the natural environment central to physical and mental well-being. Despite this, vulnerabilities of the community were evident, including insufficient local healthcare workers during a severe COVID-19 outbreak in a care home, the absence of a local quarantine hotel, and insufficient information in foreign languages for non-natives of Iceland. The general trend of following rules and expert advice was demonstrative of strong social capital, with locals trusting those in charge, nationally and locally, to manage the pandemic.

Environmental risk assessment in the EU regulation of medicines for human use: an analysis of stakeholder perspectives on its current and future role

An environmental risk assessment (ERA) is mandatory for all applications for marketing authorisation of medicines in the European Union (EU). We investigated stakeholder perspectives on the role of the ERA in EU regulation of medicines for human use. We discuss the current position of the ERA and the current conduct and assessment of the ERA, such as the required expertise, data, and studies, its applicability to generic drugs, and its use in regulatory decision-making. We also discuss future perspectives, including extension of the ERA to cover antimicrobial resistance, improved risk mitigation, impact on 'over-the-counter' (OTC) status, and incorporation into reimbursement considerations.

A pilot randomized clinical trial of a smartphone-based application to support at-home PSA screening and culturally tailored prostate cancer education for African American men: A study protocol

BACKGROUND

Prostate cancer is the most diagnosed cancer in Black/African American men (AA) and the second‑leading cause of cancer-related deaths. A prostate-specific antigen (PSA) blood test is an early detection screening tool for prostate cancer, but uptake of PSA screening remains low among AA men. Greater PSA screening rates among AA men, coupled with earlier treatment, may reduce disparities in prostate cancer outcomes, including mortality. The current pilot study will test the first-of-its-kind mobile health (mHealth) app to improve prostate cancer knowledge and increase PSA screening uptake among AA men using home-based screening methods.

METHODS

AA men aged 55 to 69 and are not up to date with PSA screening will be randomly assigned 1:1 to receive a prostate cancer screening app: Prevention Taskforce App (Taskforce App; control condition) or the Prostate Cancer Genius App (Genius App; intervention condition), which was developed specifically for AA men.

RESULTS

We will evaluate the preliminary efficacy of the apps via post-intervention group differences on the validated 18-item Prostate Cancer Knowledge Scale (primary outcome). We will also explore post-intervention group differences in perceived engagement, accessibility, and acceptability between the apps. Finally, we will derive preliminary estimates of PSA screening rates between study conditions and identify mechanisms of screening adherence.

DISCUSSION

mHealth apps offer promise to improve prostate cancer knowledge and screening rates among AA men. Demonstrating the preliminary efficacy of the Genius App will support future fully-powered mHealth interventions to address health disparities.

Who Should Be Legitimate Living Donors? The Case of Bangladesh

In 1999, the Bangladesh government introduced the Human Organ Transplantation Act allowing organ transplants from both brain-dead and living-related donors. This Act approved organ donation within family networks, which included immediate family members such as parents, adult children, siblings, uncles, aunts, and spouses. Subsequently, in January 2018, the government amended the 1999 Act to include certain distant relatives, such as grandparents, grandchildren, and first cousins, in the donor lists, addressing the scarcity of donors. Nobody, without these relatives, is legally permitted to donate organs for transplantation in Bangladesh. The focus of this study was to investigate who should donate organs for transplantation in Bangladesh. The ethnographic fieldwork revealed that potential donors are not always available to immediate family members, and even when they are, they might be medically unsuitable for transplants. These considerations influenced the government in the revision of the Act. Secondly, the findings of the study suggest maintaining the current family-based regulations for living organ donation in Bangladesh. Furthermore, the study highlighted a potential consequence: amending the regulation to permit donations to unrelated recipients could significantly amplify the issue of organ selling and buying. While Islam advises Muslims to be compassionate towards all humankind, it also encourages Muslims to prioritize saving the lives of family members. This religious belief limits Muslims from donating organs to family members.

Gaining Insight into Operative Performance: Analysis of an Automated 360-Degree Feedback Tool Among Perioperative Staff

Background

Surgery has seen limited adoption of 360-degree feedback tools, and no current tools evaluate intraoperative performance from a technical, nontechnical, or teaching skill perspective. We sought to evaluate the overall findings and perceived value of a novel 360-degree feedback tool for surgeons from their operating room colleagues.

Methods

The 'intraoperative 360' (i360) combined 3 previously validated scales of surgeon performance. The electronic medical record at a single academic medical center was queried for perioperative staff involvement in recent cases for a cohort of surgeons. Staff with frequent surgeon case involvement were emailed a link to an anonymous i360 survey. Aggregated survey responses were provided to surgeons and surgical leadership. We performed semi-structured interviews with 10 surgeons and 5 surgical leaders. Combined inductive and deductive coding was used to determine their perceptions regarding the utility of and barriers to the i360.

Results

Over 2-years, a total of 960 surveys were completed for 88 surgeons. The composite rating of technical skills was 4.87/5 (SD: 0.36); nontechnical skills, 4.65/5 (SD: 0.55); and teaching skills, 2.92/3 (SD: 0.24). There was no difference in mean scores based on gender, age, or years of tenure. Six themes emerged from the interviews: initial reactions, utility, additional needs, other feedback mechanisms, reciprocal feedback, and logistical challenges.

Conclusions

A 360-degree feedback tool is feasible, and feedback is perceived as valuable and actionable for surgeons and surgeon leaders. The intraoperative focus provided surgeons with specific feedback on how to improve within the operating room to promote efficiency, teamwork, and patient safety.

The perspectives of neurologists on positron emission tomography utility in multiple sclerosis: A qualitative study

BACKGROUND

Magnetic resonance imaging (MRI) is the gold standard for imaging disease activity in multiple sclerosis (MS) patients. However, recent studies indicate that positron emission tomography (PET) may provide added value in visualizing MS disease in the future.

OBJECTIVE

This study aims to investigate the barriers to implementing PET for MS patients and its potential added value in the context of MS.

METHODS

11 semi-structured in-depth interviews with neurologists specialized in MS were conducted. The neurologists were selectively recruited from six medical centers in Belgium and the Netherlands. Inductive thematic analysis was used to analyze the data.

RESULTS

The interviews revealed several hurdles that play a role in using PET for MS, including financial and scientific considerations. Potential clinical applications of PET were also identified, such as understanding unexplained symptoms, making a more accurate prognosis, evaluating the nature and seriousness of a lesion, and assessing disease activity. In addition, research applications were highlighted, including unraveling the pathophysiology of MS and developing new treatment options for MS.

CONCLUSION

Using PET is advancing our understanding of MS and can accelerate the development of novel therapies to combat its progression. However, its integration into routine clinical practice for MS remains a future prospect, contingent upon further technological advancements and supportive healthcare frameworks.

Readiness of primary healthcare and community markets for joint delivery of cardiovascular disease prevention services in Kenya: an observational feasibility study of Health Kiosks in Markets (HEKIMA)

OBJECTIVES

The increasing burden of cardiovascular diseases (CVDs) in Kenya threatens its healthcare system. There is a need for innovative models that improve equitable access to CVD prevention services. Community markets are social establishments with untapped potential to promote public health. This is a multiphased feasibility study that explores the potential of Health Kiosks in Markets (HEKIMA) to improve access to CVD prevention services. In this formative phase, the aim was to assess the readiness of primary healthcare centres (HCs) and community markets to jointly deliver CVD prevention services.

DESIGN

Mixed methods using concept mapping and readiness surveys. Concept mapping with 35 stakeholders from different sectors (health and non-health) to identify feasible priorities for HEKIMA. The readiness questionnaire contained 193 items which were based on the guidance of the WHO Handbook for Monitoring the Building Blocks of Health Systems and adapted to suit the context of a single HC.

SETTING

Vihiga County is located in western Kenya and has a population of 590 013. A total of 18 HCs and 19 markets were assessed, with 10 HCs and 15 markets included in the evaluation.

RESULTS

91 statements were generated from concept mapping and distilled into 8 clusters, namely equipment and supplies, access and referral, communication, manpower, networks and linkages, practice, service delivery and health promotion. Agreed actions for HEKIMA were provision of efficient quality services, health promotion and partnerships sensitive to the local context. HCs and markets had established governance systems and basic infrastructure. The majority of the HCs lacked essential CVD medications. No HC-market interface existed but there was willingness for a partnership.

CONCLUSION

There was strong consensus that an HC-market interface via community health worker manned kiosks could have a positive impact on health systems, markets and CVD prevention in vulnerable communities. However, significant infrastructural, technical and resource gaps were observed that need to be addressed.

Health service provider views on measuring patient involvement in healthcare: an interview study with researchers, clinicians, service managers, and policymakers

BACKGROUND

There are several strategies used to assess involvement in their healthcare across service providers. However, there is no consensus on the most appropriate measurement tool to use when evaluating patient involvement initiatives. This qualitative study aimed to explore the perspectives of stakeholders from micro, meso, and macro levels within the Danish healthcare system on measuring patient involvement in their healthcare.

METHODS

This descriptive, explorative study employed semi-structured interviews with open-ended questions to elicit participants' views and experiences of patient involvement and measurement tools. A purposeful sample of participants was identified, to include decision makers, researchers, and health professionals (n = 20) with experiences of measuring patient involvement in healthcare at micro, meso, and macro levels across Danish organizations. Data underwent reflexive thematic analysis.

RESULTS

Three main themes were identified: 1) Determining the purpose of patient involvement practices and measurement alignment; 2) Reflecting on the qualities, fit, and usefulness of measures; 3) Recognizing conflicting stakeholder paradigms. Despite the interest in and positive attitudes toward patient involvement innovations, views on the meaning and value of evaluating involvement varied; in part, this was attributable to challenges in selecting criteria, methods, and measures for evaluation.

CONCLUSION

The findings indicate the need to integrate the perspectives of all key stakeholders in designing the evaluation of patient involvement initiatives. The application of a multiple stakeholder approach and co-production of a multidimensional evaluation may provide some common ground for selecting evaluation criteria and measurement tools in the healthcare setting.

TRIAL REGISTRATION

Danish Data Protection Agency (1-16-02-400-21) 15 October 2021.

Not all cost conversations are the same: An exploration of potential value in cost conversations during Atrial fibrillation treatment decision making

OBJECTIVES

To explore the cost conversations taking place when patients with atrial fibrillation and their clinicians decide on whether and how to use anticoagulation to prevent strokes.

METHODS

Secondary qualitative thematic analysis of conversations from 476 clinical encounters in three sites of a multicenter randomized trial comparing usual care with and without a shared decision-making tool.

RESULTS

We identified three themes with subthemes: (1) What was discussed: conversation content (2) How content was transmitted: communication patterns and (3) Implicit conversation drivers. Due to each patient's unique circumstances, bi-directional conversations focused on relationship- and solution-based content enabled better cost burden discovery. Conversation drivers included affordability, comorbidities, preferences, and uncertainty about future costs.

CONCLUSIONS

Cost conversations were often initiated by clinicians, and if they did not invite a response, patients passively received information without understanding or weighing cost burden. When clinicians discussed cost information using relational or solution-focused content and bi-directional communication patients were more likely to engage in discussion including their unique situation.

PRACTICE IMPLICATIONS

Solution-focused cost conversations can reduce financial treatment burden, but require estimates of out-of-pocket costs, insurance coverage, and long-term financial effects of various options. Conversation tools and information on financial resources are valuable to patients and clinicians.

A retrospective feedback analysis of objective structured clinical examination performance of undergraduate medical students

Introduction

Feedback is an essential component of medical education, enhancing the quality of students' knowledge and skills. However, providing effective feedback, particularly in clinical skills assessments like Objective Structured Clinical Examinations [OSCEs], often poses challenges. This study aimed to evaluate the content of OSCE feedback given to undergraduate medical students over five years.

Methods

A retrospective analysis of 1034 anonymised medical students' OSCE performance was conducted, focusing on written feedback. The written feedback data were randomly selected from OSCE sessions, collected from university assessment records and anonymised for ethical considerations. R software was used to identify the most frequently repeated words in the examiners' feedback text, and word cloud charts were created to visualise the responses.

Results

Word clouds generated from the top 200 most frequently used terms provided visual insights into common descriptive words in feedback comments. The most frequently repeated word over five years was "good," indicative of potentially non-specific feedback.

Discussion

The high frequency of non-specific terms like "good" suggests a need for more specific, constructive feedback. However, such generic terms can offer some positive reinforcement, more than they may be needed to foster significant improvement. As previously proposed in the literature, adopting structured feedback forms may facilitate the delivery of more specific, actionable feedback.

Conclusion

This study emphasises the importance of providing specific, actionable feedback in medical education to facilitate meaningful student development. As medical education continues to evolve, refining feedback processes is crucial for effectively guiding students' growth and skill enhancement. Using structured feedback forms can be a beneficial strategy for improving feedback quality.

Exploration of the barriers and facilitators influencing use of telehealth for orthotic/prosthetic services in the United States of America: An orthotist/prosthetists perspective

Innovative models of healthcare, such as telehealth, are required to meet the growing demand for orthotic/prosthetic (O&P) services. While O&P users report being very satisfied with telehealth, many clinical facilities have reverted to in-person modes of care as COVID-19 restrictions have eased. As such, there is a disconnect between benefits of telehealth to O&P users, and the clinical services being delivered in-person. The aim of this study was to explore the orthotist/prosthetist's perspective of the barriers and facilitators influencing use of telehealth in the United States of America (USA). O&P practitioners were recruited from across the USA. In-depth, semi-structured interviews were used to document practitioner demographics, the services being provided using telehealth, and practitioners' perspective of the barriers and facilitators influencing use of telehealth. Data describing participant demographics and services were summarised. Interviews were transcribed verbatim and analysed using thematic analysis. 30 practitioners from across the USA participated. Telehealth was used to deliver a range of O&P services including: initial evaluations, routine follow-ups, and delivery of a device in rare circumstances. Barriers to using telehealth included: poor phone/internet connection and lack of access to technology. Facilitators to using telehealth included: a patient-focussed attitude, and recognition of the benefit of telehealth. Telehealth is being used across the entire spectrum of O&P care. Once the significant barriers were resolved, like access to reliable internet/phone reception, telehealth was feasible. An outstanding telehealth experience was facilitated by practitioners who focused on the benefits that telehealth can provide (not the limitations), as well as giving O&P users agency over the choice to use telehealth. There are opportunities to improve access to safe and effective O&P telehealth services by adopting a right-touch approach to practitioner regulation, and advocating for reimbursement that supports better systems and procedures within clinical facilities.

The MINT Program: A Mixed-Method Approach to Identifying Nature-Based Resources to Promote Adolescent Parent Social and Psychological Well-Being

BACKGROUND

Adolescent parents are at an increased risk for loneliness and mental health challenges compared to childless peers. Nature-based interventions are shown to promote social connectedness.

AIM

To identify elements of a nature-based intervention to reduce loneliness and foster nature connection among pregnant and parenting adolescents.

DESIGN

Sequential exploratory mixed methods.

METHODS

In 2020 and 2021, we piloted the 8-week MINT program at a school for pregnant and parenting teens. Our qualitative approach (n = 17) included online and in-person group meetings with nature-based educational content, discussion, park excursions, mindfulness activities, journaling and nature photography. Subsequently, we recruited 131 young mothers at a children's hospital for a cross-sectional survey based on qualitative school findings.

RESULTS

Qualitative results from the school-based intervention showed a preference for meditative and contemplative activities and for spending time in nature with extended family. Participants typically accessed nature close to home. Our clinic-based teen parent survey illustrated that participants' access to nature were most limited by lack of time (25% of responses), company (18%) and energy (28%). While participants showed a close nature connection (mean NR-6 score = 3.9 (SD = 0.84)), they also showed moderate levels of loneliness (mean UCLA Loneliness score = 4.78 (SD = 1.60)). Walking, hiking and/or running were the most preferred nature activity.

CONCLUSION

These findings provide key details to define nature-based activities to address loneliness and psychological well-being among teen mothers.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nature-based health interventions can address loneliness and nature disconnection by building community resilience, improving provider and patient well-being and motivating environmental stewardship.

IMPACT

We identify key features of a nature-based intervention for adolescent mothers. These findings support teen mothers in the US and abroad and may serve as a foundation for using nature-based solutions for vulnerable mothers and for adolescents facing loneliness and mental health challenges.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Cannabis Use and Cannabis Use Disorders in South Africa: A Narrative Review

Cannabis significantly contributes to the substance use and abuse statistics in South Africa (SA), rendering it a dangerous drug into which research on the contextual motivations and long and short term effects must be conducted. The aim of this review was to determine the availability of cannabis use and CUD research in SA, identify the central issues and themes explored over the past 2 years (2020–2022), and outline literary inconsistencies and shortcomings in cannabis use and CUD-related research in SA. The 16 articles used in this study were sourced from five databases. Reflexive Thematic Analysis (RTA) was then used to analyse the findings of the study. The study revealed, literature has a thematic focus on one or more of the following: cannabis use and psychophysiological health, determinants of cannabis use and CUD, polysubstance use, legalisation of cannabis in SA, and the effects of cannabis use and CUD.

Perspectives of pharmacy staff on provision of self-care and minor ailment education in primary schools: a qualitative study

BACKGROUND

Pharmacy professionals, given their health expertise, can play a role in enhancing health education within their communities and among patients. The potential of the pharmacy workforce to enhance health education among primary school children is underexplored.

AIM

This study aimed to investigate the perspectives of pharmacy staff on the provision of education regarding self-care and treatment of minor ailments to primary school-aged children and to identify roles that pharmacists could play in this regard.

METHOD

Qualitative semi-structured interviews were conducted online with frontline pharmacy staff in the UK who had patient facing roles with primary school-aged children and parents. Interviews were audio-recorded and transcribed verbatim. Thematic data analysis was applied to the transcripts.

RESULTS

A total of 17 participants were recruited. Participants included 12 pharmacists, two pharmacy technicians and three pharmacy dispensers. All participants worked within community, hospital or primary care facilities. Five themes emerged from the data analysis: sources of health knowledge accessed by children and parents; a perceived lack of knowledge regarding self-care and treatments for minor ailments among children and parents; a perceived positive impact of education on self-care; barriers to health education; and the potential role of pharmacy staff in self-care education in schools.

CONCLUSION

Pharmacy staff recognise the value of integrating health education into primary school curricula. A collaborative approach with educational institutions could bridge the gap in knowledge regarding self-care and treatment of minor ailments, and could empower children and reduce unnecessary use of healthcare resources.

Stimulating implementation of clinical practice guidelines in hospital care from a central guideline organization perspective: A systematic review

BACKGROUND

The uptake of guidelines in care is inconsistent. This review focuses on guideline implementation strategies used by guideline organizations (governmental agencies, scientific/professional societies and other umbrella organizations), experienced implementation barriers and facilitators and impact of their implementation efforts.

METHODS

We searched PUBMED, EMBASE and CINAHL and conducted snowballing. Eligibility criteria included guidelines focused on hospital care and OECD countries. Study quality was assessed using the Mixed Methods Appraisal Tool. We used framework analysis, narrative synthesis and summary statistics.

RESULTS

Twenty-six articles were included. Sixty-two implementation strategies were reported, used in different combinations and ranged between 1 and 16 strategies per initiative. Most frequently reported strategies were educational session(s) and implementation supporting materials. The most commonly reported barrier and facilitator were respectively insufficient healthcare professionals' time and resources; and guideline's credibility, evidence base and relevance. Eighty-five percent of initiatives that measured impact achieved improvements in adoption, knowledge, behavior and/or clinical outcomes. No clear optimal approach for improving guideline uptake and impact was found. However, we found indications that employing multiple active implementation strategies and involving external organizations and hospital staff were associated with improvements.

CONCLUSION

Guideline organizations employ diverse implementation strategies and encounter multiple barriers and facilitators. Our study uncovered potential effective implementation practices. However, further research is needed on effective tailoring of implementation approaches to increase uptake and impact of guidelines.

Reviewing the Risk of Ketene Formation in Dabbing and Vaping Tetrahydrocannabinol-O-Acetate

Introduction: In the wake of continued consumer demand despite increasing regulatory scrutiny, there is a need to develop systematic methods for identifying the harm profile of new psychoactive substances derived from hemp. Tetrahydrocannabinol-O (THC-O)-acetate, colloquially known as THCO, is the acetate ester of the principal psychoactive compound in cannabis. The heating of THCO can create ketene gas, which is harmful to the lungs. Materials and Methods: The research team used a multidisciplinary, iterative process to develop a survey to incorporate consumers' perspectives of semisynthetic cannabinoids. The survey was then distributed across the social media platform Reddit to learn about delivery device preferences and associated use styles when consuming THCO. Results: Most participants (74.9%) vaped THCO and one-quarter of participants (24.3%) dabbed THCO and tended to report higher temperatures for dabbing than vaping THCO. A small portion (12.0%) of participants reported concerns regarding ketene risk. Conclusion: As there are multiple variables associated with the formation of ketene, and consumer responses indicate temperatures use that might enable ketene formation, more research is needed to understand the risk profile of hemp-derived substances like THCO. Further studies are needed to understand the how various routes of administration and delivery devices used with THCO may exacerbate the risk of ketene formation and other potential harms.

Exploring Symptom Management Experiences Among College Students With Type 1 Diabetes Mellitus Using a Theoretical Framework: A Qualitative Study

PURPOSE

The purpose of this study was to explore symptom management experiences among college students with type 1 diabetes mellitus (T1DM). Limited qualitative data using a theoretical framework exist that explore the self-care behavior processes for symptom management.

METHODS

A qualitative approach was used for this study. The middle-range theory of self care of chronic illness served as a framework for data collection and analysis procedures. Data collection included distributing a survey to collect participants' demographic and sociodemographic data and utilizing a semi-structured interview guide to conduct one-on-one interviews with 31 participants. Interviews occurred via Zoom (n = 28) and in person (n = 3). Interview transcripts were uploaded in NVivo for data management. The research team created a codebook using theoretical constructs to assist with thematic analysis. Data are representative of a sample whose characteristics include undergraduate students ages 18 to 23 living with T1DM for 2 years or more who attended large, public, 4-year universities located in the southeastern United States.

RESULTS

Three main themes were created using theoretical constructs: symptom detection experiences, symptom interpretation experiences, and symptom response experiences. Two subthemes were identified for each theme. Participants engaged in symptom management for blood glucose regulation through detecting changes in their blood glucose physiologically and via technology. Additionally, symptom interpretation involved analyzing blood glucose trends and determining common causes of blood glucose changes. Symptom response included immediately addressing hypoglycemia but delayed responses addressing hyperglycemia.

CONCLUSIONS

Challenges were present responding to hypoglycemia; therefore, additional research is warranted to improve symptom response skills.

The implementation of telemedicine in wound care: a qualitative study of nurses' and patients' experiences

BACKGROUND

The increasing use of telemedicine (TM) represents a major shift for health workers and patients alike. Thus, there is a need for more knowledge on how these interventions work and are implemented. We conducted a qualitative process-evaluation alongside a larger randomized controlled trial designed to evaluate a telemedicine follow-up intervention for patients with a leg- or foot-ulcer, who either have or do not have diabetes. Accordingly, the aim of this study was to explore how both health care professionals and patients experienced the implementation of TM follow-up in primary care.

METHODS

The intervention comprised an interactive TM platform facilitating guidance and counselling regarding wound care between nurses in primary care and nurses in specialist health care in Norway. Nurses and patients from seven clusters in the intervention arm were included in the study. We conducted 26 individual interviews (14 patients and 12 nurses) in primary care between December 2021 and March 2022. Thematic analyses were conducted.

RESULTS

The analyses revealed the following themes: (1) enhancing professional self-efficacy for wound care, (2) a need to redesign the approach to implementing TM technology and (3) challenging to facilitate behavioral changes in relation to preventive care. As to patients' experiences with taking part in the intervention, we found the following three themes: (1) experience with TM promotes a feeling of security over time, (2) patients' preferences and individual needs on user participation in TM are not met, and (3) experiencing limited focus on prevention of re-ulceration.

CONCLUSIONS

TM presents both opportunities and challenges. Future implementation should focus on providing nurses with improved technological equipment and work on how to facilitate the use of TM in regular practice in order to fully capitalize on this new technology. Future TM interventions need to tailor the level of information and integrate a more systematic approach for working with preventive strategies.

CLINICAL TRIAL REGISTRATION

NCT01710774. Registration Date 2012-10-17.

"Balancing work and movement": barriers and enablers for being physically active at Indian workplaces - findings from SMART STEP trial

BACKGROUND

Non-communicable diseases are rising rapidly in low- and middle-income countries, leading to increased morbidity and mortality. Reducing sedentary behavior (SB) and increasing physical activity (PA) offer numerous health benefits. Workplaces provide an ideal setting for promoting SB/PA interventions; however, understanding the barriers and enablers is crucial for optimizing these interventions in workplace environments.

METHODS

Nested within a cluster randomised controlled trial (the SMART-STEP trial), the present study employed in-depth interviews with 16 office workers who have completed 24 weeks of two distinct (technology assisted and traditional) workplace SB/PA interventions. Using a deductive analysis, semi-structured interviews were administered to explore the barriers and enablers to the SB/PA interventions at individual, interpersonal and organisational level using the socio-ecological model.

RESULTS

Several individual (poor goal setting, perceived health benefits & workload, attitude, intervention engagement), interpersonal (lack of peer support) and organisational (task prioritisation, lack of organisational norm and material or social reward) barriers were identified. Indian women engaged in desk-based office jobs often find themselves burdened with intense home and childcare responsibilities, often without sufficient support from their spouses. A primary concern among Indian office workers is the poor awareness and absence of cultural norms regarding the health risks associated with SB.

CONCLUSIONS

Raising awareness among workplace stakeholders-including office workers, peers, and the organization-is crucial before designing and implementing SB/PA interventions in Indian workspaces. Personalized interventions for Indian female office workers engaged in desk-bound work are warranted.

Redesign of a virtual reality basic life support module for medical training - a feasibility study

BACKGROUND

Healthcare providers, including medical students, should maintain their basic life support (BLS) skills and be able to perform BLS in case of cardiac arrest. Research shows that the use of virtual reality (VR) has advantages such as improved accessibility, practice with lifelike situations, and real-time feedback during individual training sessions. A VR BLS module incorporating these advantages, called Virtual Life Support, has been developed especially for the medical domain. Virtual Life Support was collaboratively developed by software developers and stakeholders within the field of medical education. For this study, we explored whether the first version of this module capitalised on the advantages of VR and aimed to develop an understanding of barriers to feasibility of use.

METHODS

This study was conducted to assess the feasibility of employing Virtual Life Support for medical training and pinpoint potential obstacles. Four groups of stakeholders were included through purposive sampling: physicians, BLS instructors, educational experts, and medical students. Participants performed BLS on a BLS mannequin while using Virtual Life Support and were interviewed directly afterwards using semi-structured questions. The data was coded and analysed using thematic analysis.

RESULTS

Thematic saturation was reached after seventeen interviews were conducted. The codes were categorised into four themes: introduction, content, applicability, and acceptability/tolerability. Sixteen barriers for the use of Virtual Life Support were found and subsequently categorised into must-have (restraining function, i.e. necessary to address) and nice to have features (non-essential elements to consider addressing).

CONCLUSION

The study offers valuable insights into redesigning Virtual Life Support for Basic Life Support training, specifically tailored for medical students and healthcare providers, using a primarily qualitative approach. The findings suggest that the benefits of virtual reality, such as enhanced realism and immersive learning, can be effectively integrated into a single training module. Further development and validation of VR BLS modules, such as the one evaluated in this study, have the potential to revolutionise BLS training. This could significantly improve both the quality of skills and the accessibility of training, ultimately enhancing preparedness for real-life emergency scenarios.

Urban novel ecosystems as affective landscapes

Intertwined within a patchwork of different types of land use and land cover, novel ecosystems are urban ecosystems that have no historical analogues and contain novel species assemblages. Some researchers and practitioners in the field of conservation and restoration regard urban novel ecosystems unworthy of concern, while other groups call for their preservation due to the rate of biodiversity loss in cities and limited access to nature among some social groups. However, very little is known about how people perceive novel ecosystems (such as informal green spaces, post-industrial or derelict land sites awaiting redevelopment, brownfield sites, vacant lots, interstitial or gap spaces) which are often characterised by assemblages of wild, spontaneous, and overgrown vegetation, but also remanent or derelict urban infrastructure in cities. This paper addresses this gap by firstly asking how people percieve assemblages of wild-looking vegetation and urban infrastructure often found in novel ecosystems and how our affective and aesthetic responses to these ecosystems affects our attitudes towards wildness in cities. To begin to unpack this question, we obtain data from a series of exploratory workshops held in four cities in the global north where we asked people 'what is urban nature?' Our findings suggest that value judgements that people ascribe to novel ecosystems are often deeply polarised, but they are influenced by different ecological and urban conditions that people encounter within them. However, some negative perceptions about novel ecosystems may be mediated by situational cues; these situational cues could have important implications for rewilding and restoration programmes that aim to reconnect urban communities with nature through socio-ecological stewardship. To conclude, areas for further research that could improve our understanding of the social values of novel ecosystems in cities and the influence that these ecosystems may have on affective encounters with urban nature are proposed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11625-024-01539-w.

'I've got no PPE to protect my mind': understanding the needs and experiences of first responders exposed to trauma in the workplace

ABSTRACTBackground: First responders (FRs) are at high risk of being exposed to traumatic events in their occupational roles. Responding to critical incidents often involves exposure to life-threatening circumstances, dealing with fatalities and encountering highly stressful situations that may trigger traumatic responses. These experiences can lead to poor physical and mental health (MH) outcomes including post-traumatic stress disorder, co-morbid conditions such as depression, anxiety, substance abuse, insomnia, and suicidality. Little research has explored the perspectives and experiences of FRs in dealing with occupational trauma(s) and how best to meet their health needs.Objective: This study aimed to explore FRs' experiences of exposure to occupational trauma and its impact on their mental wellbeing. The wider objective was to investigate how FRs can be supported to access appropriate and relevant help, addressing barriers like stigma.Method: A qualitative research design using in-depth semi-structured interviews with FRs (n = 54) was adopted. Interviews were audio-recorded, transcribed and analysed using an inductive thematic approach.Results: Themes developed were: (1) the pervasive, cumulative and salient impact of occupational trauma on MH (micro-traumas, nightmares, flashbacks and reliving experiences); (2) the demands of the job exacerbating the adverse effects of trauma (self and others); (3) insufficient support and unhelpful ways of coping following exposure to trauma (lack of psychological safety); (4) stigma and fear of judgement as barriers to MH help-seeking; and (5) need for specific, accessible and credible trauma-focused interventions and workplace support.Conclusions: The implications of these findings are discussed at the individual, service provider and organisational level, emphasising the importance of implementing a strengths-based, non-pathologising and de-stigmatising approach to trauma in the workplace as experienced by FRs. Emphasis is placed on the importance of overcoming barriers to accessing MH support and improving access to evidence-based, trauma-focused psychological interventions and workplace support.

A qualitative study of negative sociocultural experiences of accessing primary health care services among Africans from refugee backgrounds in Australia: implications for organisational health literacy

BACKGROUND

Primary health care is the first point of contact for patients from refugee backgrounds in the Australian health system. Sociocultural factors, including beliefs and value systems, are salient determinants of health literacy and access to primary health care services. Although African refugees in Australia have diverse sociocultural backgrounds, little is known about the influence of sociocultural factors on their experiences of accessing primary health care services. Guided by the theoretical framework of access to health care, this study examined from the perspective of African refugees how culturally and religiously conditioned, constructed and bound health beliefs, knowledge and practices influence their experiences of access to, acceptance and use of primary health care services and information in Australia.

METHODS

This exploratory, qualitative study involved 19 African refugees from nine countries living in New South Wales, Australia. Semi-structured interviews were conducted and recorded using Zoom software. The interviews were transcribed verbatim and analysed using a bottom-up thematic analytical approach for theme generation.

RESULTS

Four main themes were identified. The themes included: participants' experiences of services as inaccessible and monocultural and providing information in a culturally unsafe and insensitive manner; the impact of the clinical care environment; meeting expectations and needs; and overcoming access challenges and reclaiming power and autonomy through familiar means. The findings generally support four dimensions in the access to health care framework, including approachability, acceptability, availability and accommodation and appropriateness.

CONCLUSION

African refugees experience significant social and cultural challenges in accessing primary health care services. These challenges could be due to a lack of literacy on the part of health services and their providers in servicing the needs of African refugees. This is an important finding that needs to be addressed by the Australian health care system and services. Enhancing organisational health literacy through evidence-informed strategies in primary health systems and services can help reduce disparities in health access and outcomes that may be exacerbated by cultural, linguistic and religious differences.

Understanding facilitators and barriers to oxygen therapy for patients with interstitial lung disease

BACKGROUND

Interstitial lung disease (ILD) is comprised of a heterogeneous group of pulmonary diseases. Oxygen therapy is used in patients with advanced lung disease; however, there are challenges associated with initiation of oxygen therapy specific to individuals with ILD. The key objectives of this study were to create a common understanding of the facilitators and barriers to oxygen therapy for patients with ILD, and healthcare professionals (HCP) caring for patients with ILD.

METHODS

This qualitative study included 1 hour semistructured focus groups/interviews. An iterative and concurrent process was used for data collection and analysis to allow for supplementary development of themes and concepts generated. Data analysis used a three-phase approach: coding, categorising and development of themes.

RESULTS

A total of 20 patients and/or caregivers and 31 HCP took part in 34 focus groups/interviews held over 3 months (November 2022-January 2023). Facilitators to oxygen therapy were identified including support from HCP and support groups, the perseverance and self-advocacy of patients, a straightforward administrative process and vendors/private industry that expedite access to oxygen therapy. There were also several barriers to accessing oxygen therapy for patients with ILD. The themes identified include rural disparity, testing requirements and qualifying for funding and the need for ILD-specific evidence base for oxygen therapy.

CONCLUSION

Further research is needed to facilitate development of specific exertional oxygen criteria for patients with ILD, to create supports for oxygen use and monitoring and to enable providers to tailor therapy to patients. Oxygen therapy education for ILD should address the benefits and risks of oxygen therapy.

Dehumanizing air travel: a scoping review on accessibility and inclusion of people with disabilities in international airports

Introduction

Worldwide, one in six individuals live with a disability. Many people continue to experience disabling situations, particularly when travelling. Travel can be an important part of the lives of many people, including people with disabilities. Barriers to accessing air travel can lead to a reluctance to travel for these potential passengers. As early as the flight planning stage, options to facilitate accessibility are limited. At airports, passengers must travel long distances in areas where navigation is complex, and accessibility limited. Furthermore, few aircraft are accessible. The travel experience can have adverse effects on the health of people with disabilities. Practices are sometimes not inclusive, not always available, and may not address the full spectrum of possible needs. The objective of this study is to provide a state of art on accessibility features available to people with disabilities in the busiest international airports.

Methods

A scoping review of practices in airport accessibility was done. A search strategy was deployed in 4 databases (Avery index to architectural periodicals, Medline, CINAHL, and Web of science). The official websites of the 35 busiest airports were exhaustively consulted. All information regarding accessibility measures and inclusive services were extracted.

Results

31 scientific articles, out of 3,640 screened, and all extracted data from airports' website were considered for synthesis. While efforts are made in major airports, there is a great inconsistency in accessibility features. Both facilitators and challenges are encountered by people with disabilities at every stage of air travel. These stages include journey planning; getting to and from the airport, obtain human assistance, navigate in the premises, check in, security screening, using facilities, boarding and disembarking, customs and immigration procedures, and luggage management.

Discussion

Services need to be extensively planned, placing a significant burden on passengers. The disability-centric perspective disregard passengers' unique needs and capabilities, leading to a sense of dehumanization. The complexity of airport organizations, shared responsibilities, limited communication, training challenges can deter accessibility initiatives and create discomfort during travel. This study is the first step of a broader project supported by Canadian Accessibility Standards, focusing on enhancing inclusive accessibility in Canadian airports.

Needs and capabilities for improving poultry production and health management in Indonesia

In Indonesia, the development of the poultry industry is facing numerous challenges. Major constraints include high disease burdens, large fluctuations in farm input and output prices, and inadequate biosecurity. Timely and reliable information about animal production and health can help stakeholders at all levels of the value chain make appropriate management decisions to optimize their profitability and productivity while reducing risks to public health. This study aimed to describe the challenges in the Indonesian poultry industry, assess stakeholders' needs and capabilities in terms of generating and using poultry information for making production and health management decisions, and identify levers for improvement. Interviews were conducted with a diversity of key informants and value chain actors in five Indonesian provinces. Thematic analysis was applied with an interpretivist approach to gain an in-depth understanding of the lived experiences of various stakeholders and their opinions as to what might constitute appropriate solutions. Our findings indicate that market and political instability, ineffective management of poultry data, and limited inter-sectoral collaboration are limiting the development of the sector. Increased intersectoral cooperation is needed to implement standards for data collection and sharing across the industry, provide education and practical training on the use of information technologies for farm management, and accelerate research and innovation. Our study can contribute to the development of data-driven tools to support evidence-based decision-making at all levels of the poultry system.

The Impact of Climate Change on Road Traffic Crashes in Ghana

Despite the substantial injuries and fatalities from Road Traffic Crashes (RTCs), evidence of climate change's impact on RTCs in Ghana is lacking. This study assessed the impact of climate change on RTCs in Ghana by combining quantitative (Mann-Kendall trend tests, Continuous Wavelet Transform analysis, causal inference analysis) and qualitative (15 key stakeholder interviews) methods. The quantitative analysis employed monthly rainfall and temperature data (1991-2021) alongside RTC data (1998-2021) across 10 regions. While rainfall trends varied regionally, the wet season (April through mid-October) showed a strong link to crash severity for all regions across Ghana. Wavelet analysis showed higher crash severity in the wet season within every 2-8 months period in a particular annual year during the study period. Causal inference analysis revealed rainfall's stronger influence (3.59%) on fatal crashes during the wet season compared to temperature (0.04%). Key stakeholder interviews highlighted perceived changes in temperature and intense rainfall patterns affecting RTCs, especially during rainy seasons suggesting an association between increased rainfall and crash severity. These findings emphasize the multifaceted role of climate change on road safety and the need to address weather-specific risks.

"Psychiatric emergency consultations of minors: a qualitative study of professionals' experiences"

BACKGROUND

Psychiatric emergency assessment of minors can be a complex process, especially for professional staff who are not specifically trained in handling child and adolescent emergency patients. As minors cannot usually express their feelings and experiences as well as adults, it is difficult to form an accurate picture of their condition and to determine what kind of emergency care is needed, for instance whether or not a psychiatric emergency admission is necessary. We lack insight in what professionals at emergency departments need to adequately assess these minors and their families. The aim of this study was to explore staff members' experiences with assessing minors and explore recommendations for improving their ability to provide appropriate support.

METHODS

Guided by a topic list with open-ended questions, we conducted 11 semi-structured interviews with staff working at psychiatric emergency services. Thematic analysis enabled us to identify five main themes: (1) young age and the crucial role of parents; (2) professionals' feelings, especially uncertainty; (3) psychiatric emergency admissions and the alternatives to them; (4) regional differences in organization and tasks; and (5) options for improving care.

RESULTS

The staff interviewed all agreed that it was often complicated and time consuming to take full responsibility when assessing minors with serious and urgent psychiatric problems. Most found it difficult to determine which behaviors were and were not age-appropriate, and how to handle systemic problems during the assessment. When assessing minors and their families in crisis, this led to uncertainty. Professionals were especially insecure when assessing children under age 12 and their families, feeling they lacked the appropriate knowledge and routine.

CONCLUSION

Customized expertise development and improved regional embedding of the psychiatric emergency service in the child and adolescent services will reduce professionals' uncertainty and improve psychiatric emergency care for minors.

Impact of Collaborative Testing on Academic Performance in Pharmacy Education

OBJECTIVE

To determine the impact of 2-stage collaborative testing (CT) on academic performance of pharmacy students and to characterize pharmacy student perceptions of CT.

METHODS

Two-stage CT was piloted in a 2-course patient assessment sequence within a Doctor of Pharmacy program. Students were randomly allocated into 2 groups and further divided into teams of 4 to 5 students. Student teams alternated taking section examinations in a traditional 1-stage (individual) and 2-stage CT (individual then team) format to establish an experimental design. Near the end of each semester, students individually took a post-test to facilitate assessment of CT on academic performance. A 12-item, anonymous survey instrument assessed student perceptions of 2-stage CT. The group differences in academic performance and survey responses were analyzed statistically.

RESULTS

There were 128 students enrolled in the course sequence, 123 of whom met the inclusion criteria for assessment of academic performance and 100 of whom completed the survey (response rate = 83%). Generally, students performed better on post-test items initially assessed through 2-stage CT (retention marker) and on post-test items that were answered incorrectly under 2-stage CT conditions (learning marker). Approximately 9 in 10 survey respondents preferred 2-stage CT over traditional 1-stage individual testing, with an equivalent proportion reporting it helped them learn from their mistakes and retain what they learned. There was high-level agreement among respondents that 2-stage CT improved their ability to work as a team and think critically.

CONCLUSION

The implementation of 2-stage CT in a patient assessment course sequence was associated with improved learning and retention and was well-received by students.

Contextual Barriers to Implementing Open-Source Electronic Health Record Systems for Low- and Lower-Middle-Income Countries: Scoping Review

BACKGROUND

Low- and lower-middle-income countries account for a higher percentage of global epidemics and chronic diseases. In most low- and lower-middle-income countries, there is limited access to health care. The implementation of open-source electronic health records (EHRs) can be understood as a powerful enabler for low- and lower-middle-income countries because it can transform the way health care technology is delivered. Open-source EHRs can enhance health care delivery in low- and lower-middle-income countries by improving the collection, management, and analysis of health data needed to inform health care delivery, policy, and planning. While open-source EHR systems are cost-effective and adaptable, they have not proliferated rapidly in low- and lower-middle-income countries. Implementation barriers slow adoption, with existing research focusing predominantly on technical issues preventing successful implementation.

OBJECTIVE

This interdisciplinary scoping review aims to provide an overview of contextual barriers affecting the adaptation and implementation of open-source EHR systems in low- and lower-middle-income countries and to identify areas for future research.

METHODS

We conducted a scoping literature review following a systematic methodological framework. A total of 7 databases were selected from 3 disciplines: medicine and health sciences, computing, and social sciences. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were used to assess the quality of relevant studies. Data were collated and summarized, and results were reported qualitatively, adopting a narrative synthesis approach.

RESULTS

This review included 13 studies that examined open-source EHRs' adaptation and implementation in low- and lower-middle-income countries from 3 interrelated perspectives: socioenvironmental, technological, and organizational barriers. The studies identified key issues such as limited funding, sustainability, organizational and management challenges, infrastructure, data privacy and protection, and ownership. Data protection, confidentiality, ownership, and ethics emerged as important issues, often overshadowed by technical processes.

CONCLUSIONS

While open-source EHRs have the potential to enhance health care delivery in low- and lower-middle-income-country settings, implementation is fraught with difficulty. This scoping review shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. The role of local implementing organizations in addressing implementation barriers in low- and lower-middle-income countries remains unclear. A holistic understanding of implementers' experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline.

Investigating the perceptions and experiences of Canadian dentists on dental regulatory bodies' communications and guidelines during the COVID-19 pandemic

OBJECTIVE

Dental regulatory bodies aim to ensure the health and safety of dentists, dental staff patients and the public. An important responsibility during a pandemic is to communicate risk and guidelines for patient care. Limited data exist on the perceptions and experiences of dentists navigating new guidelines for mitigating risk in dental care during the pandemic. The objective of this study was to use a qualitative approach to explore how dentists in Canada experienced and perceived their regulatory bodies' communication about COVID-19 risks and guidelines during the pandemic.

METHODS

Participants were Canadian dentists (N = 644) recruited through the email roster of nine provincial dental associations or regulatory bodies. This qualitative analysis was nested within a prospective longitudinal cohort study in which data were collected using online questionnaires at regular intervals from August 2020 to November 2021. To address the objective reported in this paper, a conventional qualitative content analysis method was applied to responses to three open-ended questions included in the final questionnaire.

RESULTS

Participants encountered challenges and frustrations amid the COVID-19 pandemic, grappling with diverse regulations and communications from dental bodies. While some bodies offered helpful guidance, many participants felt the need for improved communication on guidelines. Dentists urged for expedited, clearer and more frequent updates, expressing difficulty in navigating overwhelming information. Negative views emerged on the vague and unclear communication of COVID-19 guidelines, contributing to confusion and frustration among participants.

CONCLUSION

As COVID-19 persists and in planning for future pandemics, these experiential findings will help guide regulatory bodies in providing clear, timely and practical guidelines to protect the health and safety of dentists, dental staff, patients and the public.

Perceptions of the use of terms of endearment among older adults in an assisted living facility

BACKGROUND

'Elderspeak' has been defined as a form of communication overaccommodation used with older adults that typically involves inappropriate simplified speech. One aspect of elderspeak is the use of terms of endearment such as 'honey', sweetie' and 'dear'. There is disagreement regarding the use of terms of endearment with older adults, with differing views on whether it is beneficial or harmful.

AIM

To explore the perceptions of older adults residing in an assisted living facility on the use of terms of endearment by healthcare staff.

METHOD

This qualitative study used a descriptive phenomenological design. Semi-structured interviews were undertaken with 15 older adults regarding their perceptions of the use of terms of endearment. The data were analysed to identify themes.

FINDINGS

Two themes emerged from the interview data: 'it's a matter of opinion' and 'context matters'. Not all older adults viewed terms of endearment negatively; some liked them, others were neutral and some viewed them as childish or disrespectful.

CONCLUSION

Perceptions regarding the use of terms of endearment appear to differ among older adults. Therefore, the use of such terms should be individualised based on the preferences of the older adult.

Professional Pharmacy Fraternities as a Mechanism for Co-Curricular Learning: A Qualitative Analysis of Two Organizations

OBJECTIVE

Professional pharmacy fraternal organizations are among the most common student organizations in schools and colleges of pharmacy, present on 98% of campuses. However, sparse literature explores the educational value these organizations offer. The purpose of this review is to explore the alignment of national requirements of two major pharmacy fraternities with co-curricular learning objectives.

METHODS

All four fraternal pharmacy organizations recognized by the Professional Fraternal Association were invited to collaborate on this project. Ultimately, two fraternities participated by gathering national office requirements for reports and activities for collegiate chapters. Qualitative review of fraternity requirements was conducted via manifest content analysis by two independent reviewers, and items were coded to the relevant co-curricular domain(s) from the Accreditation Council for Pharmacy Education Standards 2016; disagreements were resolved by a third author.

RESULTS

A total of 50 fraternity requirements were identified and mapped to one or more co-curricular domains, for a total of 63 codings. All six co-curricular domains were coded at least once. The most common codings were professionalism and leadership. Significant overlap existed in requirements that encompassed professionalism plus cultural sensitivity, professionalism plus self-awareness, and self-awareness plus leadership. Some activities benefited the school or community, while others solely contributed to individual member professional development.

CONCLUSION

Professional pharmacy fraternities provide ample co-curricular learning opportunities among the breadth of affective domains. The mission and vision of these organizations foster affective domain skill development in both school- and community-facing events as well as dedicated individual professional development.

Cycle safe or cycle cool? Adolescents' views on bicycle helmet use and injury prevention campaigns in Belgium

OBJECTIVES

Although cycling is a healthy, ecological and practical way of transportation, it is not without risk. The effect of bicycle helmets to prevent head injuries on crashing has been extensively investigated. Nonetheless, the overall use of helmets by adolescents remains low. While various interventions to increase helmet use have been adopted, adolescents' perspectives on these interventions have not been extensively explored. In our study, we aim to understand the facilitators and barriers to bicycle helmet use by adolescents and their perspectives on injury prevention campaigns.

METHODS

A qualitative methodology was selected. A convenience sample of three schools in Belgium was selected for participation. 12 focus groups were conducted with a total of 84 adolescents aged 12-17 years in the second, third or fourth year of secondary school.

RESULTS

Four key themes regarding adolescents' views on safe cycling practices emerged from the analysis: external motivation, internal motivation, factors specific to the helmet and the cycling environment. The main barriers to bicycle helmet use identified by adolescents were peer pressure, appearance and discomfort. The perceived risks of cycling without a helmet among adolescents were low. Mandatory bicycle helmet laws and non-legislative programmes were considered to be an effective strategy by the study participants. Parental strategies, including strict parental rules and parental helmet use, further contributed to wear a bicycle helmet.

CONCLUSION

The results of this qualitative study add to the literature by expanding the understanding of motivation for bicycle helmet use and should be considered when designing interventions to promote bicycle helmet use.

The Pathway to Developing a Competency-based Tool for Entry-level Nursing Simulation: A Delphi Study

BACKGROUND

Simulation-based learning experiences allow undergraduate nursing students to develop competence and confidence through deliberate practice with immediate feedback on the learner's performance through debriefing. With the transition to competency-based nursing education, nursing faculty need more guidance in implementing competency-based evaluations in the simulation setting.

PURPOSE

This Delphi study aims to inform the future development of a competency-based tool - SimComp - based on the American Association of Colleges of Nursing (AACN) Essentials.

METHODS

A Delphi framework was used to recruit expert nursing faculty to complete the surveys via an online platform. Data analysis occurred through open-ended questions and quantitative methods to ensure that the responses from expert panelists were used to form the results.

RESULTS

After four rounds of this Delphi study, a consensus was achieved on 111 appropriate items for assessing competence in the simulation-based learning environment.

CONCLUSION

While further research is warranted, this study provides insight for nursing institutions considering implementing or increasing the use of simulation within their program for competency-based evaluations.

Cultivating Competency in Cardiac Sonography: Aligning Entrustable Professional Activities With Industry Expectations

BACKGROUND & AIM

Echocardiography education involves the teaching and assessment of multiple competencies to ensure work-ready graduates. To connect these competency standards to professional practice, it is important that the industry expectation around specific entrustable professional activities (EPAs) is determined. In Australia, echocardiography examinations are eligible for Medicare reimbursement when performed by sonographers listed on the Australian Sonographers Accreditation Registry (ASAR), either as an Accredited Medical Sonographer or as an Accredited Student Sonographer. A key criterion for acceptance onto the registry is the completion of, or active enrolment in, an accredited cardiac sonography course. Eligible courses apply for accreditation and are assessed by ASAR against their Standards for Accreditation of Sonographer Courses. This study sought to investigate the existing cardiac EPAs and provide insights into the industry's expectations for graduate cardiac sonographers in Australia.

METHODS

Using an anonymous online survey tool, an invitation to participate was circulated via professional sonography groups and social media platforms. Accredited Medical Sonographers, Accredited Student Sonographers or interested stakeholders (academic, employer, medical specialist) working in Australia or New Zealand were invited to complete the survey. Survey questions were structured around the existing EPAs and knowledge items described in published sonography competency documents. Participants were asked if each individual EPA should be considered appropriate at the threshold of graduation, or at a higher level following a period of working in the profession.

RESULTS

There were 211 cardiac sonographers who completed the survey. The majority of respondents (148 of 211, 72.2%) indicated that the current EPAs should be updated. At 80% agreement, the following EPAs were considered essential for the graduate: left ventricular structure and function, right ventricular structure and function, atrial size, valvular disease, systemic hypertension, cardiomyopathies, diseases of the aorta, coronary artery disease, pulmonic hypertension, and basic congenital heart disease. This list is more extensive than the current ASAR-endorsed EPAs, and the findings in this research will guide the revision of current ASAR-endorsed EPAs for graduate-level cardiac sonography.

CONCLUSIONS

The results of this study show Accredited Medical Sonographers completing a cardiac sonography course in Australia should be entrusted to perform a wide range of examinations however, greater alignment between educational providers, ASAR and industry is still required.

An implementation evaluation of the Breaking Down human rights barriers to HIV services initiative in Ukraine

INTRODUCTION

Globally, stark inequities exist in access to HIV treatment and prevention. The eastern European and central Asian region is experiencing the sharpest rise in new HIV acquisition and deaths in the world, with low rates of treatment and prevention services, especially for key and vulnerable populations who face a range of human rights-related barriers to HIV prevention and treatment.

METHODS

An implementation learning evaluation approach was used to examine the implementation of the Breaking Down Barriers initiative targeting key and vulnerable populations in Ukraine. Between September 2022 and April 2023, researchers conducted 23 key informant interviews with individuals from the Ukrainian government, implementing organizations and human rights experts. Using a concurrent triangulation design, researchers and key informants, in a process of co-creation, sought to describe programme accomplishments, challenges and innovations in implementation, between 2021 and 2023, including periods before and after Russia's February 2022 full-scale invasion.

RESULTS

Eight rights-based interventions related to HIV were identified in Global Fund programme documents and key informant interviews as making up the core of the Breaking Down Barriers initiative in Ukraine. These included programmes seeking to: eliminate stigma and discrimination; ensure the non-discriminatory provision of medical care; promote rights-based law enforcement practices; expand legal literacy ("know your rights"); increase access to justice; improve laws, regulations and policies; reduce gender discrimination, harmful gender norms and violence against women and girls; and mobilize communities for advocacy. These programmes received US$5.9 million in funding. Key informants reported that significant progress had been made addressing human rights barriers and scaling up interventions, both before and after Russia's invasion. Programme implementors adopted innovative approaches, including using paralegals, hotlines and other community-led interventions, to ensure that key and vulnerable populations, including displaced individuals, were able to access prevention and care.

CONCLUSIONS

An implementation learning evaluation approach examining programmes addressing human rights barriers to HIV services, designed as a process of co-creation between researchers, programme implementors, government officials and human rights experts, can provide a robust assessment of programme outputs, outcomes and evidence of impact, despite a challenging operational environment.

Staff and students' perceptions about using telehealth technology in a medical university: A qualitative study

INTRODUCTION

The use of telehealth technology is a way to promote the health status of the community. The purpose of this study was to investigate staff and students' perceptions about using telehealth technology in a medical university.

METHODS

This was a qualitative study completed in 2020. The research participants were 26 university staff and students who took part in semi-structured interviews. To analyze the data, the thematic analysis method was used.

RESULTS

The findings of the present study included five themes, 20 subthemes and 58 categories. The main themes were the current status of providing healthcare services at the university, and the strengths, weaknesses, opportunities and threats of using telehealth technology for the university staff and students.

CONCLUSION

According to the results, there are many opportunities for using telehealth technology in the medical university. The experiences of other institutes can be used to implement the technology successfully.

Implementation barriers and facilitators for referral from the hospital to community-based lifestyle interventions from the perspective of lifestyle professionals: A qualitative study

PURPOSE

A lifestyle front office (LFO) in the hospital is a not yet existing, novel concept that can refer patients under treatment in the hospital to community-based lifestyle interventions (CBLI). The aim of this study was to identify implementation barriers and facilitators regarding the implementation of an LFO in the hospital from the perspective of CBLI-professionals and to develop evidence-based implementation strategies to reduce these identified barriers.

METHODS

We conducted semi-structured interviews until data saturation, with 23 lifestyle professionals working in the community. A semi-structured topic guide was used, inquiring about (1) community-based lifestyle interventions; (2) their views about referral from the LFO; and (3) their preferences, needs and recommendations for collaboration with the LFO in the hospital. The online interviews lasted on average 46 minutes, were audio-recorded and transcribed verbatim. A thematic content analysis was conducted. Found barriers and facilitators regarding the LFO where mapped using the consolidated framework for implementation research (CFIR) whereafter evidence based strategies were developed using the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC).

RESULTS

Barriers and facilitators were divided into two main themes: 1) barriers and facilitators related to the referral from LFO to CBLI (i.e. financial, cultural, geographical, quality) and 2) barriers and facilitators related to the collaboration between LFO and CBLI (i.e. referral, communication platform and partnership). Thirty-seven implementation strategies concerning 15 barriers were developed and clustered into six overarching strategies: identify referral options, determine qualifications lifestyle professionals, develop support tools, build networks, facilitate learning collaboratives, and optimize workflow.

CONCLUSIONS

In this study, barriers and facilitators for the development of the LFO were found and matching implementation strategies were developed. Practical improvements, like identifying specific referral options or develop support tools, can be implemented immediately. The implementation of other strategies, like connecting care pathways in basic services, primary, secondary and tertiary care, will take more time and effort to come to full potential. Future research should evaluate all implemented strategies.

Proactive review for people with diabetes in hospital: a cluster randomised feasibility trial with process evaluation, protocol V3.1

BACKGROUND

Diabetes inpatient specialist services vary across the country, with limited evidence to guide service delivery. Currently, referrals to diabetes inpatient specialists are usually 'reactive' after diabetes-related events have taken place, which are associated with an increased risk of morbidity/mortality and increased length of hospital stay. We propose that a proactive diabetes review model of care, delivered by diabetes inpatient specialist nurses, may contribute to the prevention of such diabetes-related events and result in a reduction in the risk of harm.

METHOD

We will conduct a cluster randomised feasibility study with process evaluation. The proactive diabetes review model (PDRM) is a complex intervention that focuses on the prevention of potentially modifiable diabetes-related harms. All eligible patients will receive a comprehensive, structured diabetes review that aims to identify and prevent potentially modifiable diabetes-related harms through utilising a standardised review structure. Reviews are undertaken by a diabetes inpatient specialist nurse within one working day of admission. This differs from usual care where patients are often only seen after diabetes-related harms have taken place. The trial duration will be approximately 32 weeks, with intervention delivery throughout. There will be an initial 8-week run-in phase, followed by a 24-week data collection phase. Eight wards will be equally randomised to either PDRM or usual care. Adult patients with a known diagnosis of diabetes admitted to an included ward will be eligible. Data collection will be limited to that typically collected as part of usual care. Data collected will include descriptive data at both the ward and patient level and glucose measures, such as frequency and results of capillary glucose testing, ketonaemia and hypoglycaemic events. The analysis aims to determine the fidelity and acceptability of the intervention and the feasibility of a future definitive trial. Whilst this study is primarily about trial feasibility, the findings of the process evaluation may lead to changes to both trial processes and modifications to the intervention. A qualitative process evaluation will be conducted in parallel to the trial. A minimum of 22 patients, nurses, doctors, and managers will be recruited with methods including direct non-participant observation and semi-structured interviews. The feasibility of a future definitive trial will be assessed by evaluating recruitment and randomisation processes, staffing resources and quality of available data.

DISCUSSION

The aim of this cluster randomised feasibility trial with a process evaluation is to explore the feasibility of a definitive trial and identify appropriate outcome measures. If a trial is feasible and the effectiveness of PDRM can be evaluated, this could inform the future development of inpatient diabetes services nationally.

TRIAL REGISTRATION

UK Clinical Research Network, 51,167. ISRCTN, ISRCTN70402110. Registered on 21 February 2022.

A mixed-methods descriptive study on the role of continuous quality improvement in rural surgical and obstetrical stability: Considering enablers, challenges and impact

INTRODUCTION

The Rural Surgical Obstetrical Networks (RSON) initiative in BC was developed to stabilize and grow low volume rural surgical and obstetrical services. One of the wrap-around supportive interventions was funding for Continuous Quality Improvement (CQI) initiatives, done through a local provider-driven lens. This paper reviews mixed-methods findings on providers' experiences with CQI and the implications for service stability.

BACKGROUND

Small, rural hospitals face barriers in implementing quality improvement initiatives due primarily to lack of resource capacity and the need to prioritize clinical care when allocating limited health human resources. Given this, funding and resources for CQI were key enablers of the RSON initiative and seen as an essential part of a response to assuaging concerns of specialists at higher volume sites regarding quality in lower volume settings.

METHODS

Data were derived from two datasets: in-depth, qualitative interviews with rural health care providers and administrators over the course of the RSON initiative and through a survey administered at RSON sites in 2023.

FINDINGS

Qualitative findings revealed participants' perceptions of the value of CQI (including developing expanded skillsets and improved team function and culture), enablers (the organizational infrastructure for CQI projects), challenges in implementation (complications in protecting/prioritizing CQI time and difficulty with staff engagement) and the importance of local leadership. Survey findings showed high ratings for elements of team function that relate directly to CQI (team process and relationships).

CONCLUSION

Attention to effective mechanisms of CQI through a rural lens is essential to ensure that initiatives meet the contextual realities of low-volume sites. Instituting pathways for locally-driven quality improvement initiatives enhances team function at rural hospitals through creating opportunities for trust building and goal setting, improving communication and increasing individual and team-wide motivation to improve patient care.

Perceptions of Hearing Health Care: A Qualitative Analysis of Satisfied and Dissatisfied Online Reviews

PURPOSE

The aim of this study was to examine the hearing health care experience of satisfied and dissatisfied consumers as reported on Google reviews.

METHOD

Using qualitative thematic analysis, open-text responses from Google regarding hearing health care clinics across 40 U.S. cities were examined. During the original search, 13,168 reviews were identified. Purposive sampling led to a total of 8,420 five-star reviews and 321 one-star reviews. The sample consisted of 500 five-star (satisfied) and 234 one-star (dissatisfied) reviews, describing experiences with audiology clinics, excluding reviews related to ear, nose, and throat services; other medical specialties; and those not relevant to hearing health care.

RESULTS

Satisfied and dissatisfied consumer reviews yielded nuanced dimensions of the hearing health care consumer experience, which were grouped into distinct domains, themes, and subthemes. Six and seven domains were identified from the satisfied and dissatisfied reviews, encompassing 23 and 26 themes, respectively. The overall experience domain revealed emotions ranging from contentment and gratitude to dissatisfaction and waning loyalty. The clinical outcomes domain highlights the pivotal contribution of well-being and hearing outcomes to the consumer experience, while the standard of care domain underscores shared expectations for punctuality, person-centered care, and efficient communication. Facility quality, professional competence, and inclusive care were also highlighted across positive and negative reviews.

CONCLUSIONS

Findings indicate dimensions of satisfied and dissatisfied hearing health care consumer experiences, identifying areas for potential service refinement. These consumer experiences inform person-centric service delivery in hearing health care.

Living Organ Donation for Transplantation in Bangladesh: Reality and Problems

The stipulation of living organ transplantation policy and practice in Bangladesh is family-oriented, with relatives being the only people legally eligible to donate organs. There have been very few transplantations of bone marrows, liver lobes, and kidneys from related-living donors in Bangladesh. The major question addressed in this study is why Bangladesh is not getting adequate organs for transplantation. In this study, I examin the stipulations of the policy and practice of living organ donation through the lens of 32 key stakeholders including physicians and nurses, a health administrator, organ donors and recipients, and their family members, as they can shed light on the realities and problems of organ donation for transplantation in Bangladesh. My ethnography reveals that the family members are always encouraged to donate organs for transplantation, and saving the lives of relatives through organ donation is seen as a moral obligation. Many view saving the life of a relative by donating one's organs as equivalent to saving one's own life. An assessment of the dynamics of biomedicine, religion, and culture leads to the conclusion that the family-oriented organ donation policy and practice have been widely endorsed and accepted in Bangladesh, and Islamic ethical principles and collective family ethos undergird that policy and practice. However, the unavailability of medical resources, lack of post-operative coverage for organ donors, religious misconceptions and unawareness of the general public, and the absence of posthumously donated vital organs for transplantation are perceived to be the most common barriers to a successful living donor-recipient pair organ transplantation. By overcoming these obstacles, Bangladesh can develop a successful living donor-recipient pair organ transplantation program that will ensure improved healthcare outcomes, promote altruism and solidarity among Bangladeshi families, and protect the poor from having their organs sold to wealthy patients.

Barriers and Facilitators Impacting Disease and Symptom Management Among College Students With Type 1 Diabetes: A Qualitative Study

PURPOSE

This study aimed to explore barriers and facilitators impacting disease and symptom management among college students living with Type 1 Diabetes (T1D).

DESIGN

A qualitative, phenomenological approach using semi-structured, one-on-one interviews.

SETTING

Interviews conducted on Zoom (n = 28) and in-person (n = 3).

PARTICIPANTS

Purposive sample of 31 college students living with T1D for at least 2 years who attended large, 4-year public universities in the Southeastern United States.

METHOD

This study was theoretically informed using the Middle-Range Theory of Self-Care of Chronic Illness Integration of Symptoms to develop interview questions. Interviews were transcribed verbatim and uploaded in NVivo. Data were analyzed thematically using a codebook developed by the research team using the theory as a framework. Trustworthiness was established using an audit trail, memos, and negative case analysis.

RESULTS

Four themes described barriers: diabetes burnout, challenges adjusting to a college lifestyle, difficulty receiving medical supplies, and insurance limitations. Five themes explained facilitators: years of experience managing T1D, tangible support with medical supplies, informational support for disease management, and emotional/technological support for disease and symptom management.

CONCLUSION

Barriers and facilitators in this study should be addressed in future T1D interventions for college students. Findings can also guide healthcare professionals, health promotion practitioners, family, friends, and significant others on how to better support college students as they manage T1D.

Emergency department Nurses' narratives of burnout: Changing roles and boundaries

PURPOSE

Emergency department nurses work in rapidly changing environments, which can contribute to occupational stress. Emergency department nurses utilise diverse strategies to mediate the impact of stress on their daily lives. There is a paucity of qualitative research which explores emergency department nurses' experiences and perspectives of burnout. This study aimed to explore emergency department nurses' experiences of burnout. Further, the study considered how emergency nurses conceptualised burnout and the strategies they used to manage the professional and personal effects of burnout.

PROCEDURES

The COREQ research guidelines were used throughout the study from the design stage through to dissemination. Narrative inquiry was used as the underpinning theoretical framework. The researcher met individually with eight emergency department nurses from NSW hospitals to undertake a face-to-face semi-structured interview. An inductive approach was used to establish major themes within the narrative.

FINDINGS

Two major themes were established: experiencing conflicting emotions and trying to establish a personal sense of control. Emergency nurses felt passionate about their professional roles, yet encountered difficulties due to management structures, time constraints and a sense of underappreciation. The misalignment between their expectations and the reality of emergency department nursing, resulted in experiences of burnout such as dissatisfaction and frustrations at work. Consequently, these nurses adopted diverse strategies within both their professional and personal domains.

PRINCIPAL CONCLUSIONS

The conclusions of this study are transferable to a variety of acute health services. Health service management have a role to promote a positive workplace culture for nurses, which advocates for home life balance. This will support nurses to construct clear boundaries between professional identity and their personal lives.