Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness

Experiences of Wheelchair Users With Spinal Cord Injury With Self-Tracking and Commercial Self-Tracking Technology ("In Our World, Calories Are Very Important"): Qualitative Interview Study

BACKGROUND

Commercial wearable and mobile wellness apps and devices have become increasingly affordable and ubiquitous. One of their aims is to assist the individual wearing them in adopting a healthier lifestyle through tracking and visualizing their data. Some of these devices and apps have a wheelchair mode that indicates that they are designed for different types of bodies (eg, wheelchair users with spinal cord injury [SCI]). However, research focuses mainly on designing and developing new condition-specific self-tracking technology, whereas the experiences of wheelchair users with SCI using self-tracking technology remain underexplored.

OBJECTIVE

The objectives of this study were to (1) provide a comprehensive overview of the literature in the field of self-tracking technology and wheelchair users (as a basis for the study), (2) present the self-tracking needs of wheelchair users with SCI, and (3) present their experiences and use of commercial self-tracking technology.

METHODS

We conducted semistructured interviews with wheelchair users with SCI to understand their experiences with self-tracking and self-tracking technologies, their self-tracking needs, and how they changed before and after the injury. The interviews were thematically analyzed using an inductive approach.

RESULTS

Our findings comprised three themes: (1) being a wheelchair user with SCI, (2) reasons for self-tracking, and (3) experiences with self-tracking technologies and tools. The last theme comprised 3 subthemes: self-tracking technology use, trust in self-tracking technology, and calorie tracking.

CONCLUSIONS

In the Discussion section, we present how our findings relate to the literature and discuss the lack of trust in commercial self-tracking technologies regarding calorie tracking, as well as the role of wheelchair users with SCI in the design of commercial self-tracking technology.

Community health systems and priority setting for elderly healthcare services in rural Tanzania: Experience from Nzega and Igunga districts

INTRODUCTION

In the 1990s, Tanzania adopted health sector reforms with the aim of engaging the local communities in priority setting and decision-making for effective and efficient use of resources. Community engagement aims to enhance community voice and efficiently allocate available resources according to the citizen's demands to achieve the targeted health outcomes. The Community Health Systems (CHS) aim to strengthen Primary Health Care (PHC) services by empowering all community actors close to and serving community members. This study explored the role of the CHS during priority setting process in improving health services for the elderly in rural Tanzania.

METHODS

An exploratory case study design was employed to collect data using Key Informants Interviews (KIIs) in Nzega and Igunga districts. Purposeful sampling was used to select participants from the two districts. Twenty-four (12 from each district) interviews were conducted with community representative members of the Health Facility Governing Committee (HFGC), social welfare, Council Health Management Team (CHMT), District medical officers, Medical Officers in-charge (MOI), planning officers and health system information focal person. All audio recorded interviews were transcribed verbatim. The transcribed interviews were translated from Kiswahili to English. The data were analyzed using the content analysis approach. The transcribed data, field notes, and documents were reviewed and read to identify broad areas in which to form initial codes and codes. Similar codes with related concepts were grouped to form initial categories and categories.

RESULTS

The findings of this study demonstrated the importance of CHS in strengthening community participation in identifying the elderly who are in need in the community and been involved in elderly matters during priority setting of the elderly health services through the health facility governing committee. This means that there was community participation in elderly matters especially to help the elderly reach health facilities and during priority setting, positive and negative perceptions among community members about the elderly agenda during priority setting. In addition, the findings show that there is poor awareness among community members including family members who perceive that the government is responsible for providing health services to the elderly and not the community or family members.

CONCLUSION

The findings of this study indicate the importance of community during the priority setting process which plays a great role in identifying the elderly who are in need and the most needed health services for the elderly in their communities. Therefore, the Local government authority should fully involve CHWs in collaboration with all community actors to address elderly matters in rural areas and improve elderly healthcare services. The community members have to be educated and raise awareness about elderly health matters through different platforms such as during world elderly day, village meetings and at the health facility level.

Pediatric Nurses' Experiences in Refugee Children Care: A Qualitative Research

OBJECTIVE

Communication is one of the main foundations for providing nursing care. Due to intercountry mobility, nurses encounter communication barriers with patients and their families, such as language and sociocultural differences.

METHODS

This study was conducted to investigate the experiences of pediatric nurses in caring for refugee children. The phenomenological study was conducted between November 2023 and February 2024 with 16 pediatric nurses working in the inpatient wards of Istanbul Prof. Dr. Cemil Tascioglu City Hospital Pediatrics Clinic who agreed to participate in the study. Data were collected through face-to-face interviews and voice recordings. After the interviews were transcribed, the MAXQDA 2022 program was used for coding, creating themes, and analyzing the relationship between codes and sub-codes.

RESULTS

The nurses revealed themes of the care process, difficulties related to the patient, communication methods, risks in patient safety, feelings experienced about the ineffective communication, and suggestions. The main codes obtained from the themes were loss of time, difficulties in communication and training, difficulties arising from cultural practices, using body language, wrong practices regarding patient safety, sadness and fatigue experienced when there is no communication, and the need for learning Turkish.

CONCLUSIONS

The pediatric nurses had problems with communication and felt sadness about caring for refugee children. The problem of loss of time in giving care due to language and sociocultural differences, and the suggestion of learning Turkish as the solution come to the fore. It is necessary to carry out comprehensive research on this subject.

Leader perspectives on the "experience-complexity gap": Recommendations to fortify the nursing workforce

BACKGROUND

Reported workforce shifts, characterized as the "experience-complexity gap," threaten nurses' ability to deliver safe, high-quality care. Addressing this threat requires a robust understanding of the current state, which leaders in practice settings are well-positioned to elucidate.

PURPOSE

Describe practice leaders' perceptions of (a) new-to-practice nurses' (NTPNs) ability to practice competently, (b) the current composition of nursing teams, and (c) the impact of team composition on quality and safety, experienced nurses, and leaders.

METHODS

A web-based survey was administered to practice leaders across the country. Responses were analyzed using descriptive statistics and conventional content analysis.

DISCUSSION

Approximately 45% of respondents believe NTPNs practice competently. Specific skills gaps, measures to support NTPNs, the strain placed on experienced nurses to maintain the standard of care, generational conflict, and perceived risks to quality and safety are described.

CONCLUSION

These findings should inform academic and practice leaders' partnered efforts to implement competency-based education.

Assessing Older Adults Who Have Experienced Homelessness: Findings from an Exploratory Study

We report results of a workforce initiative to increase functional screenings for older adults with lived experiences of homelessness. Thirty-four healthcare practitioners screened 253 patients ages 50 years + using a battery of screening tools aligned with the 4 Ms. Using secondary analyses, we describe practitioners' participation in the workforce initiative, patients' functional scores, and a qualitative analysis of "what matters" to patients. Many practitioners did not complete all screenings. Among patient respondents, 6% reported moderate to severe ADL impairment; 24% scored positive cognitive impairment; 32% reported being unable to walk 250 feet; 46% reported moderate to severe pain. Resilience strategies developed during homelessness "matter." Few participants reported impaired ADL performance, which may reflect levels of independence needed to survive homelessness or to maintain services while homelessness. Findings suggest a need for additional workforce training to increase functional screenings for older adults in this population.

'I would have blamed myself, but coming back, I can see that it wasn't me': A qualitative, descriptive phenomenological analysis of doctors' reflective processes in recovery from burnout and mental crisis

Elimination of burnout and work-related mental illness in hospital doctors, at least in the short term, is unrealistic. Supporting doctors' recovery continues to be important. Despite this, the aftermath of work-related mental illness and burnout, is not well understood. Using a descriptive phenomenological method, we describe the experience of coming to terms with mental crisis perceived to be caused or exacerbated by work stress for six senior consultant hospital doctors. Findings show that, in the aftermath of crisis, doctors engaged in two types of reflection: 'situational sense-making' to make sense of their experiences and 'transformative self-reflection', reflection in a deeper way on the experience, themselves and their lives. Transformative self-reflection led to change and in some cases growth. Not all doctors engaged in transformative self-reflection, and the process of recovery was complicated by contextual factors and when support from employers was perceived as absent, poor or acrimonious.

Experiences of F@ce - a team-based, person-centred intervention supported by information and communication technology for rehabilitation after a stroke

PURPOSE

The study aimed to explore the experiences of participation in F@ce, a team-based, person-centred intervention program supported by information and communication technology, among persons with stroke, their significant others, and the team members.

METHODS

The clients (n = 10) and their significant others (n = 6) were interviewed individually once and the rehabilitation team members (n = 6) were interviewed once in focus groups at the end of the intervention. The transcribed interviews were analysed using content analysis.

RESULTS

The findings indicate that the F@ce intervention program was perceived as relevant, effective, and satisfying by clients, significant others, and rehabilitation team members, helping to reduce restrictions on participation in daily activities and to improve recovery during post-stroke rehabilitation. Five themes are presented: setting activity-based goals, enabling daily activities and motivation through SMS reminders: integrating F@ce into daily life, managing digital technology, collaboration and communication with the team, and involvement of significant others.

CONCLUSIONS

The study highlights the strengths of this intervention program, noting that it is evidence-based and activity-based, tailored in a person-centred manner to align with clients' needs, priorities, and preferences in daily life.

Virtual patient simulation in an interactive educational module on intimate partner violence: nursing students' experiences-a mixed-methods study

Background

Multiple studies have shown that healthcare professionals often feel uncertain about when to inquire about intimate partner violence (IPV), the appropriate methods for doing so, and how to respond to the answers. Virtual patient (VP) cases are an interactive educational tool that can be effective for learning and training clinical reasoning skills. However, there is a lack of research on the use of VP in psychiatry education. This study aimed to investigate nursing students' experiences of using a VP as part of an educational module, integrated into their foundational training on IPV during their nursing education.

Methods

The study employed a mixed-methods approach, incorporating both quantitative and qualitative data. Participants (N = 62) completed an interactive educational module on IPV, in three consecutive parts: (a) a web-based education on IPV, (b) training with a VP, and (c) a seminar for follow-up discussions.

Results

The VP platform was considered user-friendly and easy to navigate, although some participants found the instructions challenging. Participants perceived the VP as beneficial for learning about IPV and for practicing interactive patient dialogues. They appreciated the rich set of questions and the feedback provided, both by the experts in the field of IVP and by the VP itself. However, some participants noted that interacting with a VP on a screen was less emotional compared to real human interactions.

Conclusion

The interactive educational module, integrated into the regular nursing program, was positively received by the students. Overall, the VP was considered beneficial for learning about IPV, easy to navigate, and provided a valuable opportunity for practice.

PregNut survey: knowledge, attitude, and practices of midwives regarding plant-based diets during pregnancy

BACKGROUND

Plant-based diets (PBD) are gaining global popularity, yet there is limited research on the experiences of pregnant women adhering to these diets. This study employed the knowledge, attitudes, and practices (KAP) framework to assess midwives' readiness in managing the growing plant-based trend in Aotearoa New Zealand (NZ).

METHODS

A cross-sectional, online-administered survey was developed in collaboration with midwifery academics, and was presented in three sections: knowledge, attitudes, and practices towards nutrition in general, towards PBD during pregnancy, and practice information. Questions included Likert-style, free text responses, and check boxes. Currently practising lead maternity carer midwives in NZ were invited to participate, primarily via an email newsletter disseminated by the New Zealand College of Midwives. Descriptive statistics, chi-square tests, and content analysis were used to interpret data.

RESULTS

The study received 133 valid responses from a total of 1246 registered midwives in NZ, reflecting a demographic profile similar to the current midwifery workforce. Although respondents demonstrated foundational knowledge of plant-based nutrition, midwives reported feeling significantly less prepared to advise clients following PBD, compared with omnivorous diets (96% vs. 72%, Χ2 (1, n = 133) = 29.03, p <.001)). While attitudes towards PBD appeared positive, midwives reported higher expectations of knowledge from plant-based clients, compared with omnivore-based clients. Midwives' practices towards their PBD clients varied considerably, with some inconsistencies attributable to reported barriers including lack of time or feeling unqualified. Respondents' personal dietary patterns were correlated with preparedness, knowledge of emerging concepts, and the belief that PBD are better for mothers and infant development.

CONCLUSION

This study, conducted within NZ innovative midwifery care system, reveals discrepancies between midwives reported levels of preparedness to manage clients following PBD compared with omnivorous diets, despite a strong foundation of general and plant-based nutrition knowledge. The reported desire to expand midwives understanding of PBD nutrition and improve practices reiterates the importance of access to current research, evidence-based practice protocols, and support avenues to enhance midwives' preparedness in advising the growing number of individuals following PBD.

The spiritual needs of surgical patients in Iranian hospital settings: a qualitative study

BACKGROUND AND AIM

Surgical patients seek spiritual support because they feel threatened by their physical integrity and sense of self. Delivering spiritual care to surgical patients requires recognizing their spiritual needs. These needs can take on various forms in different cultures and religions. Thus, the present study aimed to investigate the spiritual needs of surgical patients in Iranian hospital setting.

METHOD

This qualitative content analysis study research was conducted on 16 surgical hospitalized patients in Shiraz, Iran. The data was collected through in-depth and semi-structured interviews. The qualitative content analysis method of Graneheim and Lundman was used for analyzing the data, and Guba and Lincoln criteria were used to ensure the trustworthiness of the research data.

RESULTS

The findings of this study were presented in the form of four key categories: "Divine Resilience," which highlights the need for a divine relationship to achieve spiritual strength; "Supportive Bonds in the Healing Process," emphasizing the importance of interpersonal connections and support networks; "Peaceful Environment," reflecting the necessity of a tranquil and supportive setting; and "Transcendence Beyond Difficulties," which underscores the patients' quest for meaning and purpose amidst their challenges.

CONCLUSION

Surgical patients experience interconnected spiritual needs, including divine resilience, supportive interpersonal relationships, a peaceful environment, and transcendence beyond difficulties. Addressing these needs by healthcare authorities and policymakers is essential for providing holistic surgical care and enhancing patients' overall well-being.

Speech-Language Pathologists' Perspectives on Language Assessment in Bilingual Children

PURPOSE

This study used a semistructured open interview approach to gather information from school-based speech-language pathologists (SLPs) regarding their assessment practices for bilingual children with suspected language disorders.

METHOD

Phone interviews were conducted with 25 school-based SLPs across the United States. The interviews explored assessment topics related to tool selection and rationale and the integration of assessment data to determine diagnosis and treatment eligibility.

RESULTS

The results of this study suggest that SLPs use a combination of norm-referenced and informal assessments when evaluating bilingual children. Informal measures, such as parent/teacher interviews and language sampling, were relied upon for diagnostic decisions, contrasting with the emphasis on norm-referenced testing observed in previous research. District policies and guidelines influenced norm-referenced assessments. Informal tools were used to capture natural language use, provide a comprehensive view of bilingual abilities, and gather detailed case histories.

CONCLUSIONS

School-based SLPs integrate norm-referenced and informal measures in their bilingual assessment practices, with a notable reliance on informal assessments for diagnostic decision making. This approach contrasts with the reliance on norm-referenced measures typically observed in monolingual assessment practices, reflecting SLPs' potential recognition of limitations and biases in norm-referenced tests when used with bilingual children. The findings suggest that SLPs are aware of and use culturally sensitive diagnostic practices.

Designing and validating a patient education model for cardiovascular patients: protocol for a multilevel mixed-method study

INTRODUCTION

Patient education is an integral component of advanced nursing care. However, current educational practice approaches exhibit numerous deficiencies and have not yielded favourable outcomes. The models used for educating patients with cardiovascular conditions lack specificity for these patients, and each addresses only a particular aspect of patient education. Consequently, this study aims to describe the process of designing and validating a patient education model for the cardiovascular community.

METHODS AND ANALYSIS

This study will employ a multilevel mixed design, encompassing 'evidence analysis and context explanation' and 'validity testing'. The linking phase, namely, model design, will connect the two phases by building a preliminary model based on findings from the first phase. The evidence analysis and context explanation phase will involve three key steps. First, a scoping review will identify existing patient education processes and frameworks through a comprehensive literature search that includes qualitative and quantitative studies, review articles, mixed-methods research and developmental studies. This review aims to map existing evidence and provide an overview of current constructs in patient education, such as models, theories, frameworks, protocols and methods. Second, stakeholder experience elucidation will use conventional content analysis to explore stakeholders' experiences, including nurses, patient education managers, physicians, patients and their families regarding current patient education practices. Third, situational analysis will evaluate human resources by assessing the performance of nurses and physicians in delivering patient education while also analysing non-human resources by examining the physical space and materials for patient education, evaluating current educational content and assessing educational outcomes. In the linking phase (model design), data collected during Phase One will be integrated to create an initial construct derived from the scoping review. This construct will be refined through content analysis and clarified using situational analysis data. The third phase (model validation) will focus on internal and external validation. For internal validation, a Delphi study will achieve expert consensus on the proposed model, involving specialists engaged in patient education who will evaluate its elements. For external validation, the model will undergo pilot testing in clinical settings to assess its utility by measuring outcomes for cardiac patients, such as self-care, quality of life, patient education satisfaction and treatment adherence. After the validation process, the final patient education model will be reviewed and finalised based on insights gained during both study phases.

ETHICS AND DISSEMINATION

This study has been approved by the Regional Ethics Committee at Tabriz University of Medical Sciences (IR.TBZMED.REC.1402.670). Dissemination will be achieved by publishing findings and depositing data in a publicly accessible repository to ensure transparency and facilitate future research.

Exploring patients' understanding of behavioral risk factors for non-communicable diseases: a study on diabetes and hypertension in Bushbuckridge, South Africa

BACKGROUND

Non-communicable diseases (NCDs) account for 41 million annual deaths worldwide, or 74% of all deaths. Notably, 86% of the 17 million premature deaths attributed to NCDs occur in low- and middle-income countries. Despite the burden of these diseases, many patients lack sufficient knowledge of behavioral risk factors that contribute to NCDs. The study aimed to explore the knowledge of patients diagnosed with diabetes and hypertension about behavioral risk factors contributing to non-communicable diseases.

METHOD

The study employed a qualitative, explorative, and descriptive design. Data was collected through semi-structured interviews, and participants were selected purposively. The data analysis followed Tesch's open thematic approach, applied at various levels and based on patient-provided text data, with the thematic analysis, the researcher was able to organize and interpret the data presented in the themes systematically.

RESULTS

Four major themes emerged regarding the understanding of behavioral risk factors for non-communicable diseases among patients diagnosed with diabetes and hypertension. These include unhealthy eating habits and poor lifestyle choices, mental health issues and stress, challenges patients face in adhering to medications, and optimal management of their conditions, cultural practices, and beliefs.

CONCLUSION

The study shed some insights into the knowledge of patients diagnosed with diabetes and hypertension about behavioral risk factors contributing to NCD. They indicated that witchcraft, cultural beliefs, and inadequate health education could have resulted in NCDs, which influenced them to consult traditional healers before coming to the health facility. The observations of participants underscore the urgent need for targeted interventions to improve the knowledge of patients regarding behavioral risk factors for NCDs.

Adolescents' perceptions of being physically active in the presence of lowback pain - an interview study

OBJECTIVE

The aim of this study was to explore the knowledge adolescents with low back pain (LBP) need and already claim to have about being in motion despite pain, and how they search to increase this knowledge.

METHODS

Face-to-face semi-structured, in-depth interviews based on an interview guide were conducted with 15 adolescents with LBP recruited from a senior secondary school in Gothenburg, Sweden and analyzed using qualitative content analysis.

RESULTS

An overarching theme "Stuck in ambivalence" emerged, comprising three categories: "Existing knowledge is insufficient," "Searching for trustworthy information" and "Making sense of the new information" based on six sub-categories that together illustrate the participants' thoughts and beliefs about being physically active despite LBP. Their lives were negatively affected by not fully understanding the cause of their pain or what they can do to alleviate it. They wanted information tailored to their specific needs and searched for support and guidance to feel safe and gain confidence in the ability of their body to move and exercise.

CONCLUSION

The participants were aware of the benefits of remaining physically active despite LBP but were unsure how to apply this knowledge. Healthcare professionals should support adolescents with LBP by means of person-centered guidance about how they can turn information about pain and activity into health-promoting knowledge. It is of the utmost importance to apply a person-centered approach when providing evidence-based information.

Labour ward midwives' experiences of remote video calls with women during early labour

BACKGROUND

The shortage of midwives makes it difficult to meet healthcare needs in early labour, a phase when professional support and personal evaluation are crucial. Digitalisation has transformed healthcare, offering new communication and support methods. Although still uncommon, the use of a virtual waiting room with video calls by midwives during early labour could provide vital support for pregnant women and their partners. This study aimed to describe labour ward midwives' experiences of remote video calls with women during early labour.

METHODS

A qualitative descriptive study with seven semi-structured interviews followed by a qualitative content analysis was conducted.

RESULTS

The findings revealed that remote video calls enabled the midwives to work flexibly with chosen working hours and become involved in a challenging new e-function. They interacted with the women and their partners and experienced that they created a supportive relationship and simultaneously gained an overview of the situation. They felt secure in their professional role when providing the necessary care and had confidence in their competence.

CONCLUSION

The potential benefits of integrating remote video calls into midwives' tasks during early labour care include flexible working hours and fostering supportive relationships with women and their partners at home.

When the Home Becomes the Setting for Hospital Treatment: A Qualitative Study of Relatives' Experiences

AIM

The aim of the study is to explore the experiences of adult relatives who cohabit with patients receiving hospital-at-home (HaH) care. The healthcare system is increasingly adopting HaH as a response to hospital overcrowding and the growing need for personalised, home-based care. While HaH has been shown to benefit patients, there is limited understanding of the impact on cohabiting relatives, who often assume a caregiving role without adequate preparation or support.

DESIGN

A qualitative inductive approach.

METHOD

Semi-structured interviews were carried out with 10 cohabiting relatives of HaH patients from North Zealand and Denmark. Data collection took place over two periods between March 2023 and February- April 2024. Data were analysed using inductive qualitative content analysis to identify key themes in the relatives' experiences.

RESULTS

Relatives reported mixed feelings about HaH. While they appreciated the ability to be close to their loved ones and maintain a more normal daily routine, some felt overwhelmed by the caregiving responsibilities imposed upon them. The lack of involvement in treatment decisions, sometimes inadequate communication from healthcare professionals, and the pressure to manage both practical and emotional aspects of care were among the concerns. However, despite these challenges, relatives strongly preferred HaH over conventional hospital admissions due to the reduced disruption to their daily lives and the perceived improvement in their loved ones' well-being.

CONCLUSIONS

Although HaH presents additional burdens and concerns for relatives, they prefer this model of care over traditional hospitalisations. However, it is crucial that relatives are actively involved in the decision-making process and provided with adequate support to manage the caregiving responsibilities effectively. This involvement can help ensure a more positive experience for both relatives and patients, contributing to the overall success of HaH.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study emphasises the vital role of relatives in HaH care, highlighting their preference for HaH despite the additional burden. Healthcare professionals must involve relatives in decision-making and provide adequate support to manage caregiving responsibilities. A more individualised approach can enhance the caregiving experience, reduce stress and improve patient outcomes.

IMPACT

This study fills a gap in understanding relatives' experiences in HaH care, stressing the need for better communication and support. By involving relatives more effectively, healthcare professionals can improve the success of HaH and reduce strain on healthcare systems.

REPORTING METHOD

This study adhered to the COREQ criteria.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Community perceptions about factors influencing access to care after sexual violence in North Kivu, Democratic Republic of the Congo: a qualitative study

BACKGROUND

Sexual violence is widespread in the eastern parts of the Democratic Republic of the Congo, including in the North Kivu province. Moreover, in this region survivors of sexual violence often have limited access to care and encounter a variety of barriers when seeking care and support. The aim of this study was to explore community perceptions about access to care, barriers, enablers and possible actions to improve access to care for survivors of sexual violence in North Kivu. A deeper understanding of community perceptions about access to care can guide ongoing efforts to overcome barriers and increase access to care for survivors of sexual violence.

METHODS

The study utilised a qualitative design, based on focus group discussions with male and female adult community members in the study area. Previous experience of sexual violence was not a requirement. The transcripts from the discussions were analysed using manifest and latent qualitative content analysis.

RESULTS

A total of 18 focus group discussions were carried out. The analysis resulted in three main themes; Knowledge and misconceptions around medical consequences crucial for care seeking, Community and family attitudes playing a dual role in care seeking behaviours and Care seeking dependent on optimised healthcare facilities and sensitive staff.

CONCLUSIONS

Lack of correct knowledge, harmful attitudes from community and healthcare staff, and poorly adapted healthcare services constitute barriers to accessing care. Improved awareness raising around sexual violence is needed to address both lack of knowledge and misconceptions. Efforts should be made to build upon the community support models and actively work to improve community attitudes towards survivors of sexual violence. In addition, there is a need for better adapted healthcare services with improved proximity, access for different groups of survivors and respectful and well-trained healthcare staff.

No longer alone

BACKGROUND AND PURPOSE

Absence from work due to illness is common in many western countries and has many negative consequences for both the individual and society. Since 2020 Swedish healthcare regions are required to provide resources to coordinate the rehabilitation process, a complex system involving medical as well as work-related parties, where both the physician and the rehabilitation coordinator play a central role. The aim of this study was to describe how primary care physicians experience the role of and the collaboration with a rehabilitation coordinator.

MATERIALS AND METHODS

We used a qualitative design doing semi-structured interviews with primary care physicians (n= 9) in the Skåne healthcare region. The interviews were recorded, transcribed and analyzed using qualitative content analysis.

RESULTS

One main category "An external and internal connecting point that has improved the sick-listing and rehabilitation process", and four subcategories: "Provides relief for the individual physician"; "Offers practical support at the clinic"; "Gives increased sense of security for the patients" and "Sufficiently trained, with potential to take further responsibility", were determined.

CONCLUSIONS

The study shows that primary care physicians experienced benefits from a close collaboration with a rehabilitation coordinator, feeling less lonely. The rehabilitation coordinator is often regarded as having a central role in insurance medicine related tasks, but an even more active role is desired.

The therapeutic alliance during remotely delivered therapy: A Delphi study with health professionals

OBJECTIVES

Delivering psychological therapy via videoconferencing and telephone is now commonplace across mental health services, but many therapists remain concerned about the impact on the therapeutic alliance. This study aimed to establish consensus amongst psychological therapists regarding the factors involved in establishing and maintaining the therapeutic alliance during remote therapy interventions.

METHODS

Psychological therapists from a range of professional backgrounds were invited to complete a three-Round Delphi survey online. Round 1 generated qualitative data which was used to develop a list of statements relating to key factors in establishing and maintaining alliance in therapy delivered over the telephone or videoconferencing. Participants were invited to rate their level of agreement with these statements in Rounds 2 and 3.

RESULTS

Of the 149 participants who completed Round 1, 93 completed Round 2, and 71 participants completed all three Rounds. Following Round 3, a high level of agreement (above 80%) was obtained in relation to 31/63 statements reflecting communication style, contracting, quality and value, environment, emotional differences, effort, and technological aspects of engaging clients in this way. Participants reported similar views for therapies delivered via telephone and videoconferencing.

DISCUSSION

Clinicians who have had to navigate the rapid rise in online delivery of therapy have valuable insights which warrant sharing amongst communities of practicing therapists and those in training. Identifying factors which therapists agree are important in developing alliances with patients remotely also guides researchers in identifying factors that warrant further investigation through empirical studies.

Collecting real-time infant feeding and support experience: co-participatory pilot study of mobile health methodology

BACKGROUND

Breastfeeding rates in the UK have remained stubbornly low despite long-term intervention efforts. Social support is a key, theoretically grounded intervention method, yet social support has been inconsistently related to improved breastfeeding. Understanding of the dynamics between infant feeding and social support is currently limited by retrospective collection of quantitative data, which prohibits causal inferences, and by unrepresentative sampling of mothers. In this paper, we present a case-study presenting the development of a data collection methodology designed to address these challenges.

METHODS

In April-May 2022 we co-produced and piloted a mobile health (mHealth) data collection methodology linked to a pre-existing pregnancy and parenting app in the UK (Baby Buddy), prioritising real-time daily data collection about women's postnatal experiences. To explore the potential of mHealth in-app surveys, here we report the iterative design process and the results from a mixed-method (explorative data analysis of usage data and content analysis of interview data) four-week pilot.

RESULTS

Participants (n = 14) appreciated the feature's simplicity and its easy integration into their daily routines, particularly valuing the reflective aspect akin to journaling. As a result, participants used the feature regularly and looked forward to doing so. We find no evidence that key sociodemographic metrics were associated with women's enjoyment or engagement. Based on participant feedback, important next steps are to design in-feature feedback and tracking systems to help maintain motivation.

CONCLUSIONS

Reflecting on future opportunities, this case-study underscores that mHealth in-app surveys may be an effective way to collect prospective real-time data on complex infant feeding behaviours and experiences during the postnatal period, with important implications for public health and social science research.

Holistic framing for improving care provision for older people with chronic diseases in Jordan: a phenomenological study

There is a sharp increase in the number of older people globally. Thus, it is important to adopt strategies to improve the care provided for older people, especially due to the increased prevalence of chronic conditions. However, very little evidence is available on what should be done, especially from the perspective of healthcare professionals responsible for providing care for older people in nursing homes. Thus, this study aimed to explore the opinions of healthcare professionals including nurses and physicians in nursing homes on adopting holistic framing for improving care provision for older people with chronic conditions in Jordan. The study employed a descriptive phenomenological design using semi-structured interviews with 13 nurses and two physicians in Amman governorate in Jordan during the period from June to September 2024. Inductive content analysis was used to analyze data. The findings revealed three overarching themes including: (1) offering dedicated courses and postgraduate programs; (2) improving facilities and resources; and (3) raising awareness and enhancing collaborations. The findings provide a holistic framing for improving healthcare provision for older people with chronic diseases in Jordan.

"I can't endure it" vs. "I can handle it" - experiencing work fatigue risk for nurses: a qualitative study

BACKGROUND

Work fatigue has become a significant challenge for nursing staff, yet there is a paucity of qualitative research that explores their lived experiences in this context. This study aims to examine clinical nurses' experiences with work fatigue risk and to identify the hindering and facilitating factors contributing to this issue.

METHODS

In this study with descriptive phenomenological method, semi-structured interviews with 25 nurses conducted in the meeting room of a hospital from June to August 2024. Colaizzi's seven-step analysis method was used for data analysis.

RESULTS

Three main themes with twelve subthemes were identified. The primary themes included: (1) phases of work fatigue risk experience, (2) hindering factors of work fatigue risk management, and (3) facilitating factors of work fatigue risk management. Nurses faced a combination of facilitators and inhibitors in managing work fatigue. While some nurses demonstrated a positive attitude towards their work, others showed a strong intention to leave the profession.

CONCLUSIONS

Our findings offer a nuanced understanding of the dynamic stages of nurses' work fatigue experience, highlighting both hindering and facilitating factors that influence the management of work fatigue risk. Nurses encounter multiple challenges in managing work fatigue effectively, underscoring the need for comprehensive strategies. These strategies should address structural barriers while fostering individual resilience, ultimately promoting a healthier and more sustainable work environment.

Qualitative Analysis of the Lived Experiences of Nurses on Forensic Teams

Forensic nurses (FNs) can work in various settings such as children's advocacy centers, hospitals, clinics, and emergency departments. Pediatric FNs focus on caring for vulnerable children in crisis and must respond empathetically to victims using trauma-informed care principles. They also support the families of child victims, who often experience shock and disbelief. Pediatric FNs and multidisciplinary teams (MDTs) handle complex family dynamics in child maltreatment cases, requiring robust skills to care for both patients and themselves to combat secondary trauma. Forensic professionals assess child abuse allegations, formulate safety plans, and make key recommendations. Understanding how they develop resilience is crucial, as better resilience is linked to retention in the field, which needs skilled professionals. In our qualitative study, we explored how FNs develop resilience during their careers. We interviewed a sample of eight experienced FNs from two different programs involved in the care of victims, including maltreated children and adolescents in the southeast United States to understand how they mitigate burnout, compassion fatigue, and secondary trauma. Our aim was to identify factors contributing to resilience in child abuse nursing, which can inform best practices to reduce these challenges among child abuse professionals.

Exploring patients' opportunities for participation in meetings with a contact nurse, prior to cancer treatment - An interview study

PURPOSE

In Swedish cancer care, Contact Nurses (CNs), have a role to enhance the patients' opportunities for participation through improved communication and information. The aim of this study was to explore how patients describe their opportunities for participation during the first encounter with the CN, prior to starting the cancer treatment.

METHODS

Semi-structured interviews with 14 patients with cancer, planned for curative treatment, were performed. Purposeful sampling, based on estimated high or low activation level measured with PAM-13®, as well as gender and age, were used. The interviews were analysed, using a qualitative inductive approach.

RESULTS

The overarching theme "Dealing with an entirely new life situation" encompass three categories; "Establish relationships", "Gaining understanding of the illness" and "Taking part in treatment planning". The relationships with the CNs as well as the understanding of what was being planned, was considered important. Having the opportunity to communicate essential matters and the adaption of the information, was also found to be of great importance. The perceived possibilities to participate in the planning of treatment and care varied, with some patients describing the plan to be predetermined, while others had a more accommodating experience.

CONCLUSION

The result highlights the importance for CNs of establishing relationships with their patients. It also points out the importance of the patients understanding of their situation. These insights emphasize the need for CNs to prioritize empathic communication, the need to adapt information to the patient's preunderstanding and to actively involve patients in their care planning, enhancing overall patient satisfaction and outcomes.

Barriers and Motivators for Women in Surgical Training: A Qualitative Study From Malaysia

BACKGROUND

Women are significantly underrepresented in surgical specialties, particularly in Southeast Asia. The factors influencing this gender disparity remain poorly understood. This study aims to explore the motivations, challenges, and barriers faced by female medical doctors in pursuing surgical careers in Malaysia.

METHODS

An exploratory qualitative study was conducted between May 2016 and November 2017, using semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs) with male and female senior surgeons, medical officers, and surgical trainees. A coding tree was constructed and refined after initial rounds of data analysis. Thematic content analysis was performed using the NVivo 11 Pro (Windows) qualitative data analysis software.

RESULTS

Ten IDIs and five FGDs (N = 34 participants) revealed three key themes: (A) influences on trainees' career choices, (B) challenges encountered during surgical training, and (C) trainee empowerment. Participants highlighted the demanding nature of surgical training, the lack of flexibility in work schedules, and the male-dominated work environment as significant barriers for women. Despite these challenges, supportive family structures and strong mentorship were found to be critical for the retention of women in surgery.

CONCLUSION

Institutional support, mentorship opportunities, and culture change are essential for improving the representation and retention of female surgeons in Malaysia. Tailored policies that acknowledge the unique challenges faced by women in surgery could foster a more inclusive and supportive environment.

Secondary Traumatic Stress and Coping Experiences in Psychiatric Nurses Caring for Trauma Victims: A Phenomenological Study

AIM

In this study, it was aimed to evaluate the secondary traumatic stress and coping experiences of psychiatric nurses who care for people who have experienced psychological trauma with a phenomenological approach.

MATERIALS AND METHODS

In this study, semi-structured in-depth interviews were conducted with 18 psychiatric nurses residing in Turkey using the phenomenological research method. The criterion sampling method was used to reach the sample group. Interviews continued until data saturation was achieved, and all interviews were audio-recorded and then transcribed. The data were analysed using thematic analysis. The study was conducted and reported using the COREQ checklist.

FINDINGS

In the analysis of the data, three themes (difficulties in caring for people who have experienced trauma, the effects of caring for people who have experienced trauma on the individual and coping, reflections of secondary trauma on the profession) and seven sub-themes (mental, physical, social, psychosocial difficulties and coping, quality of care, professional and organisational aspects) were identified.

CONCLUSION

As a result of the study, it was determined that secondary traumatic stress was observed in psychiatric nurses caring for individuals who experienced psychological trauma. It was determined that caring for people who have experienced psychological trauma can negatively affect nurses psychosocially, and individuals have difficulty coping. In line with the results of the study, it is thought that necessary intervention programs should be created for nurses experiencing secondary traumatic stress.

Experiences of mothers caring for children with rare diseases in Turkey

Rare diseases (RDs), important for children and families, have been poorly studied in Turkey. This study aimed to describe the experiences and needs of mothers whose children have RDs from the perspectives of their mothers. In-depth interviews were held with the mothers of 16 children followed up in the Pediatric Nutrition and Metabolism Outpatient Clinic of a University Hospital. The data were analyzed using thematic analysis procedures. The experiences of mothers caring for children with RDs were categorized into three main themes: (1) challenges with treatment, (2) burden of care, and (3) expectations. This study demonstrated that mothers of children with RDs experienced many common challenges in caregiving.

Chronic kidney disease and the alternative labels used by GPs in Australia: a qualitative interview study

BACKGROUND

Guidelines for terminology defining chronic kidney disease (CKD) have been in use for 20 years. Age is not currently considered in the guideline definition of CKD. In previous studies, GPs have been reluctant to give older patients the label of CKD.

AIM

To determine what language GPs are using to describe or label CKD with their older patients, and to explore the reasons for their use of alternative language.

DESIGN & SETTING

This was a descriptive qualitative interview study of Australian GPs.

METHOD

Twenty-seven GPs were recruited via email and interviewed regarding their management of CKD. GPs were asked what language and terminology they used when discussing a diagnosis of CKD with their older patients.

RESULTS

'Labelling of CKD', the language that GPs use when talking about CKD with their patients, emerged as a major theme from the initial GP interviews. Sub-themes emerged, including types of alternative labels and rationale for alternative labels. GPs used descriptions of 'reduced kidney function' to explain CKD to their patients, either in parallel with the diagnosis of CKD or instead of it. GPs had concerns about the words 'chronic' and 'disease', and used different terminology to explain these words to patients when diagnosing them with CKD.

CONCLUSION

GPs use alternative descriptions to explain mild decrease in kidney function with older patients. Alternative labels that denote level of risk to older patients, without creating unnecessary concern about normal age-related kidney function, need to be explored.

Balancing intimacy, family life and cancer - A qualitative study on the impact of parental cancer on the couple relationship in couples with dependent children

PURPOSE

In-depth exploration of how the couple relationship is affected by parental cancer in couples with dependent children.

METHODS

Semi-structured interviews were carried out with a convenience sample of 17 parents with cancer who were in a couple relationship and had children aged 18 years or younger. Data were analysed using qualitative content analysis.

RESULTS

The content analysis resulted in three categories representing areas in the couple relationship that had changed following the cancer diagnosis: Altered communication; Adapting to new roles; and A change in sex life, intimacy and fertility. The results illustrate a significant increase in the need for constructive communication when couples face a range of emotionally-charged topics that were made difficult to talk about due to the children being present. The results also showed that the experience of cancer had forced couples to adapt to new roles in their relationship, and in the family, in order to manage the complex practical issues of simultaneously being parents and dealing with cancer. Lastly, both physical and psychological aspects of cancer had affected the couples' sex life, intimacy and fertility including decreased sexual engagement and changed conditions impacting family planning.

CONCLUSIONS

Results highlight the specific areas that are challenging for couples facing cancer who are parents of dependent children. Couples may need support to cope with these challenges due to the complexity of parenthood when managing cancer as a couple.

A place of encounter: Health and social care workers' perspectives on public gathering spaces for people using drugs

Background: The use of drugs is an escalating concern, with significant implications for the health and daily functionality for individuals. It has proven challenging to provide accessible health and social services. In the context of addressing substance use issues in urban areas, public gathering places for individuals who use drugs play a multifaceted role, serving as sites of belonging, support and potential illicit activity. This qualitative study explores the experiences of healthcare and social workers regarding a public gathering place, referred to as "the Bench", in a medium-sized Norwegian city. Methods: A qualitative research design consisting of semi-structured focus group interviews and individual interviews with 13 participants representing various support agencies. Results: The analysis resulted in four thematic areas: (1) belonging and a gateway to support and services; (2) balancing user autonomy at the Bench and systems support; (3) the role of a centralised location; and (4) the preventive role of support workers at the Bench. Conclusion: While the Bench fosters a sense of community and provides access to vital services, concerns about illicit activities persist due to its visibility. Nevertheless, its central location facilitates outreach efforts and ensures easy access to support services. The study underscores the preventive role of healthcare and social workers in stabilising the environment and mitigating conflicts. Furthermore, it highlights the importance of central locations for public gathering places, emphasising the proximity to low-threshold services. The Bench represents a crucial venue for establishing relationships and providing assistance to individuals who use drugs, contributing to harm reduction efforts in the community.

"I Worry About My Kids' Safety When They Visit": Mothers' Perceptions of Father/Child Post-Separation Contact in the Context of IPV

After separation because of intimate partner violence, fathers' contact with children can be problematic. This mixed methods secondary analysis focused on 280 Canadian separated/divorced mothers who were 48.4% White, 45.1% Indigenous, and 6.5% Visible Minority. Of 176 fathers, 105 (59.7%) had regular visits and, 71 (40.3%) visited sporadically; 104 had no contact. Comments from half the mothers (54.3%) with regular father-child visits indicated worry, and 41.9% of all mothers perceived their children as sad/upset and another 14.5% as angry/acting out in response to visitation. Recommendations to address mothers' and children's issues with respect to problematic father-child contact are provided.

Our clock is truly ticking-a qualitative study on patients' experiences of tumor treating fields

Background

TTFields is recommended internationally for the treatment of glioblastoma. In Sweden, TTFields requires a possibly challenging collaboration between the patient, next-of-kin, healthcare, and the private company providing the device, both from an ethical and practical perspective. Little is known about glioblastoma patients' own experiences of TTFields treatment.

Methods

Semi-structured individual interviews were conducted with 31 patients with glioblastoma who had been offered TTFields by the healthcare. These were analyzed by qualitative content analysis.

Results

Participants described there being multiple actors around them as TTFields users; (1) device prescription from physicians, sometimes providing insufficient information, (2) practical assistance from next-of-kin, necessary to access treatment, (3) home visits from the private company staff for device control, where close bonds between patients and TTFields staff occurred. TTFields treatment created hope and a feeling of control in an otherwise hopeless situation, sometimes evoking worries at the time of planned treatment stop. Some refrained from TTFields or discontinued early due to fear or experience of negative effects on quality of life. Others described finding practical and mental solutions for coping with the treatment in everyday life.

Conclusions

Our study identified a need for better support and information from healthcare providers for TTFields. A solution is necessary for assistance with TTFields for those without support from next-of-kin. The study raises the question of possible advantages of healthcare handling the technical support of the device instead of a private company, thereby avoiding a true or perceived influence on the patient's decision to continue or stop treatment.

Traumatised Nurses' Desired Support Needs for Continued Recovery After the COVID-19 Pandemic: A Qualitative Descriptive Study Utilising Photovoice

AIMS

The aims of this study were to describe the experiences of nurses in the aftermath of the COVID-19 pandemic and to explore nurses' current desired support needs.

DESIGN

This study used a qualitative descriptive design.

METHODS

This study was conducted in the Southeastern United States at an academic health system encompassing acute care hospitals and outpatient speciality clinics. Thirteen nurses were interviewed in August and September of 2023 in five small groups of two or three nurses. Photovoice was used for data collection and each nurse submitted two photographs. Data were analysed utilising conventional content analysis, with transcripts and photograph analysis occurring concurrently.

RESULTS

Three themes were identified: (1) organisational turmoil, (2) personal traumatisation and transitions and (3) striving for revival and renewal. A conceptual model illustrating the three themes and their relationships was developed to depict study findings.

CONCLUSION

Nurses were impacted by organisational factors, such as staffing issues and lack of support, and personally through psychological trauma that has remained challenging. Nurses found revival and renewal in their personal lives, but still desire continued improvement in organisational factors to enhance their well-being in ways not currently being addressed to allow for full recovery. Findings from this study are pertinent for healthcare organisations and leaders to develop organisational changes and mental health solutions to support nurse well-being.

IMPLICATIONS FOR THE PROFESSION

The prioritisation of nurse well-being is critical for the nursing profession and healthcare organisations. Organisational improvements and the implementation of support resources are urgently needed to aid in nurse recovery, nurse retention and to ensure patients receive quality care.

IMPACT

This study identified nurses' struggles 3 years after the beginning of the COVID-19 pandemic, highlighting the ongoing need to provide resources and interventions that support nurse well-being. Our findings offer nurses' descriptions of their experiences and support needs for organisations and healthcare leaders to consider in the future.

REPORTING METHOD

Standards for Reporting Qualitative Research (SRQR) Checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Exploring the Patients' Perspective on Digital Tools for Psychosocial Assessment in Dentistry

BACKGROUND

Psychosocial screening is a valuable part of the assessment of patients with orofacial pain, as psychosocial factors will affect prognosis and treatment outcomes. Paper-based questionnaires are predominately used to assess the degree of psychosocial comorbidity; however, digital alternatives for screening questionnaires may be more cost-effective and resource-saving if patients are receptive to using them.

OBJECTIVE

To evaluate how patients perceive digital psychosocial screening in dentistry.

METHOD

Using a qualitative approach, individual semi-structured interviews were conducted with a purposive sample of adult patients with orofacial pain (n = 16) recruited from specialist dental clinics in Umeå and Gävle, Sweden. The interviews were transcribed verbatim and then analysed using Qualitative Content Analysis. Before the interviews, patients first completed the paper-based questionnaires and then the digital version.

RESULTS

The analysis of patients' experiences resulted in an overarching theme: Patients appreciate a holistic approach, thus valuing psychosocial screening, and they particularly favour screening in a digital format. From this theme, two categories emerged: Perceptions about health shape patients' expectations of dental care, and with deeper understanding of the value of psychosocial assessment, patients appreciate a holistic approach that includes psychosocial factors. Digital screening is perceived by patients as a reliable, meaningful and environmentally sustainable method.

CONCLUSIONS

In general, the patients appreciated a holistic approach in dentistry and understood the value of psychosocial screening as part of this. From the patients' perspective, digital psychosocial screening was both acceptable and beneficial. The findings support the introduction of digital psychosocial screening into daily dental practice.

"I'm still the person I am. Not the body it has become." An active but challenging life with cervical dystonia

BACKGROUND

Improvement of activity and participation for the disabled and chronically ill is an important aim of rehabilitation. Cervical dystonia is a neurological movement disorder characterized by involuntary contractions of the neck muscles. Until now, research has identified factors contributing to disability rather than factors which may make it easier to be active and participate in the community.

OBJECTIVE

Explore and describe perceived experiences of activity and participation in daily life as experienced by persons with cervical dystonia.

METHODS

Sixteen informants participated in this semi-structured interview study. Inductive qualitative content analysis was performed to understand and interpret experiences shared by the informants.

RESULTS

Results from the analysis generated two themes "An active life" and "A challenging life" and six sub-themes: Using helpful coping strategies, Accepting a new life situation, Adhering to BT treatment, Facing the negative impact of stress, Experiencing a negative self-image and Suffering from pain and fatigue.

CONCLUSIONS

Our results support the importance of actions using a rehabilitation approach that consider both motor and non-motor symptoms. Future studies should compare the effects of physiotherapy taking into account wishes and challenges in patients' everyday life versus traditional physiotherapy addressing mostly the motor disorder.

The effect of interprofessional education on the surgical team members' self-efficacy perception of interprofessional communication in the healthcare system

AIM

The current study aimed to assess the effect of interprofessional education on participants' self-efficacy perception of interprofessional communication at different levels of a healthcare system (relationships in the interpersonal, interprofessional, and administration levels).

DESIGN

This is a sequential explanatory mixed-method study.

METHOD

Learners include surgical residents, surgical technology nurses, and anesthesia nurses (n = 130) who participated in the intervention and control groups. The quasi-experimental study was conducted in the first step. The educational strategy was interprofessional education and the main teaching method was case-based learning. The self-efficacy perception of the participants was assessed by a 26-item questionnaire before and 1 month after the intervention. The descriptive tests (mean, SD, percentage), student t-tests, and ANOVA were analyzed. The participants' experiences were explored through semi-structured interviews. Qualitative content was analyzed by Lundman and Graneheim's approach.

RESULTS

The results showed that the scores of the learners in the intervention group (4.05 ± 0.31) improved significantly compared to the control group (3.35 ± 0.37) (p = 0.0001). In the present study, the experiences of the participants were categorized into a theme "explicit and implicit confrontations with perceived distrust in the system" which includes two categories "failure to internalize professionalism among team members" and "dominance of a paternalistic culture within the health care system".

CONCLUSION

The results showed the positive impact of interprofessional education interventions on participants' self-efficacy perception of interprofessional communication. The results showed that interprofessional education, with the participation of different professionals and managers at different levels of a healthcare system, improved the participants' perception of self-efficacy regarding interprofessional communication. The results showed the improvement in the participants' communication with team members and managers required to solve the perceived explicit and implicit confrontations in the surgical departments.

IMPLICATIONS FOR THE PROFESSION

The implementation of an interprofessional education strategy focused on interprofessional professionalism and collaboration principles in clinical activities, formal and informal education in the surgical department is recommended.

Nurses' Perceptions of Their Professional Autonomy in Nonpharmacologic Pain Management: A Qualitative Study

PURPOSE

The aim was to examine nurses' experiences and opinions regarding using their professional autonomy in nonpharmacologic pain management.

DESIGN

A qualitative descriptive approach was used in the study.

METHODS

The study was conducted in the acute care services of a public hospital between December 10, 2022, and March 2023. It was completed with 29 nurses using the purposive sampling method. Data were collected using an ``Interview Guide'' consisting of semi-structured open-ended questions and analyzed using the content analysis method.

RESULTS

Four main categories emerged. (1) Individual qualities behind independent actions, (2) physician influence in professional autonomy, (3) establishing a positive therapeutic relationship in professional autonomy, and (4) recognizing barriers to professional autonomy. Nurses perceive that they enhance their professional autonomy in nonpharmacologic pain management by making independent decisions and selecting the nonpharmacologic intervention that will optimally benefit the patient. This is achieved by making the most beneficial nonpharmacologic application for the patient, having professional competencies, and realizing physician-nurse collaboration.

CONCLUSIONS

Nurses can improve their professional autonomy in nonpharmacologic pain management by gaining knowledge, skills, expertise, and leadership skills, participating in joint decision-making processes with physicians, and considering patient preferences and needs. Discussions regarding complete professional autonomy among nurses were limited by the patients' conditions, physicians' opinions, and management's decisions. Nurse managers can use their experience to offer additional details on care, protocols and practices.

CLINICAL IMPLICATIONS

Nurse managers can support nurses in their units and use their expertise to develop care, practices, and processes. At the organizational level, they can create a working environment in which nurses can better participate in multiprofessional working groups. Supportive management can have a significant positive impact on nurses' professional autonomy. It creates a work culture in the organization where there is an opportunity for shared decision-making and development of daily work without hierarchy and where employees feel trusted and valued.

Perioperative Staff's Experiences of Premedication for Children

PURPOSE

Providing perioperative care for children who express anxiety or react with negative anxiety-associated consequences can be a challenge. The use of premedication is established as an important intervention for young children before surgery, yet research into care providers' experiences of premedication is limited. The aim of this study was to explore perioperative staff's experiences of premedication for preschool-age children.

DESIGN

A descriptive inductive qualitative study was performed based on focus group discussions.

METHODS

A purposive sample of a team from the operating department with experience in anesthetizing and caring for children in the perioperative period was interviewed in small focus groups: five preoperative and postoperative care nurses, five nurse anesthetists, and five anesthesiologists. The transcribed text was categorized using qualitative content analysis.

FINDINGS

The content analysis revealed three themes: a matter of time, do not wake the sleeping bear, and on responsive tiptoes.

CONCLUSIONS

Care providers must adapt their work to the child's emotional state of mind and needs, allowing time for the child to trust and accept the premedication and for the premedication to reach its peak effect. Premedication provides light sleep preoperatively, which requires careful treatment of the child to avoid emotional reactions, and the postoperative path is most peaceful when the premedication supports a long duration of sedation. Our findings highlight the need for safety precautions and a permissive and flexible organization with the goal of achieving a smooth and safe journey for the child in the perioperative path.

Journey of touching death, nursing undergraduates' experiences in the simulated death graded exposure Programme: A qualitative descriptive study in China

BACKGROUND

Nursing undergraduates receive inadequate training in death and end-of-life care within the education system, resulting in feelings of unpreparedness and inadequacy when confronted with their first death event in clinical practice, as well as a low willingness to engage in end-of-life care.

OBJECTIVE

To explore the cognitive and emotional experiences of nursing undergraduate students participating in the simulated death graded exposure programme, and to evaluate the educational significance of the programme.

DESIGN

A qualitative descriptive study design.

SETTING

A comprehensive university in Jiangsu Province, China.

PARTICIPANTS

In October 2023, twenty-eight (age range, 19-21 years; 21 [75 %] female;) first-year nursing undergraduates were recruited to participate in the simulated death graded exposure programme.

METHODS

The research team developed and implemented a systematic simulated death graded exposure programme, consisting of four parts: end-of-life farewell role-playing, simulated funeral experience, post-simulation recovery and death reflection. Semi-structured interviews were conducted after the experience, and the interview data were analysed using content analysis.

RESULTS

The nursing students' experiences in the simulated death graded exposure programme could be divided into three phases through a longitudinal process: approaching death (dying), immersing in the world of death (death), and initiating the transformation of life's meaning (rebirth). In the first phase, participants felt integrated into the simulated roles, experienced the complex emotions of approaching death, and ultimately accepted the declaration of death. In the second phase, participants experienced a highly realistic simulation of death, guiding physical symptoms and emotional reactions. Additionally, their awareness of death began to awaken and disperse, leading to profound reflections on death. In the third phase, participants engaged in a process of self-examination which culminated in a self-proclaimed healing process from the experience of the simulated death. Through deep reflection, they were reacquainted with their values and professional mission.

CONCLUSIONS

The simulated death graded exposure programme enhances nursing students' psychological preparedness and emotional adjustment helping to prepare them for experiencing death in a clinical context, and deepens their understanding of life and death. This programme provides a practical example of nursing professionals' training and education in end-of-life care.

Advanced practice nursing students' experiences with room of horror simulation to promote patient safety: A qualitative study

BACKGROUND

In considering the level of responsibility held by advanced practice nurses, ensuring patient safety must be a central component of advanced practice nursing education. Several healthcare education programmes have integrated Room of Horror simulations, which emphasise patient safety, as a learning activity. However, scant research has examined the effectiveness of Room of Horror as a method in advanced practice nursing education, especially studies that employ qualitative methodologies to explore student perspectives on this simulation.

AIM

The study aimed to explore the experiences of advanced practice nursing students using a Room of Horror simulation focused on promoting patient safety as an educational approach within their master's degree programme.

DESIGN

The study employed a descriptive qualitative design.

SETTINGS

This research was conducted at a Norwegian university college that offers two master's programmes in advanced practice nursing. Students participated in the Room of Horror simulation to prepare for their upcoming clinical practice placement.

PARTICIPANTS

Eleven advanced practice nursing students participated in the study.

METHODS

Data were collected through individual, dyadic and triadic interviews and analysed using systematic text condensation.

RESULTS

Two main categories of student experience were identified: (1) an engaging and memorable simulation that included competitive elements, and (2) enhanced awareness of competencies and responsibilities.

CONCLUSIONS

As an educational approach, Room of Horror simulations show promise for enhancing awareness, competencies and an emphasis on patient safety among advanced practice nursing students. The simulations also have the potential to deepen the students' understanding of their roles and responsibilities in advancing patient safety as future advanced practice nurses.

Vulnerable older people's views on proactive care planning: a qualitative interview study in primary care

BACKGROUND

Patients in old age often have complex care needs owing to multimorbidity and polypharmacy. This qualitative study is part of a larger ongoing Swedish intervention trial Secure And Focused primary care for older pEople (SAFE), including shorter care agreements based on person-centred patient goals.

AIM

To explore, in a primary care setting, the views of older and vulnerable patients on a more systematic, proactive approach to care planning, including establishing and documenting care agreements based on person-centred goals.

DESIGN & SETTING

Individual semi-structured interviews with patients (n = 25) aged >75 years from 12 intervention primary healthcare centres in two counties in Sweden.

METHOD

Interviews were conducted between June and October 2023. They were digitally recorded and transcribed verbatim. Latent qualitative content analysis was used.

RESULTS

The following three categories, with 10 sub-categories, were found: I would like to live in the present, so why plan ahead? Let me decide versus they know best; and Care agreements usually went unnoticed. The latent theme - The ambivalence of care planning in the fourth age - was created to give a deeper meaning to the content of the categories.

CONCLUSION

This study emphasises that older, vulnerable persons have varying attitudes towards participation in proactive care planning. This ambivalence may originate from the individual's desire to have their autonomy respected and express future care preferences on the one hand, and to avoid or postpone end-of-life conversations and care planning on the other hand. Patients also expressed a desire to be more actively involved in care planning. Although care agreements have the potential to increase patient involvement in proactive care planning, they often went unnoticed. The conversation itself was essential.

Explanation of factors affecting food choice among Iranian young adults (18 to 24 years old): a qualitative study

BACKGROUND

The young adult period, encompassing the ages of 18 to 24, is characterized by a rapid increase in weight, particularly among individuals born in recent decades, during which environments have become saturated with inexpensive, palatable, and processed foods. While physiological, environmental, and social factors significantly impact health conditions, decisions such as food selection, also play a critical role over time. Understanding food choices is crucial for developing effective health promotion efforts aimed at addressing the root causes of disease and mortality. The aim of this study is to explain the factors affecting the food choices of Iranian youth.

METHODS

The study population comprised young individuals from Mashhad, and interviews continued until data saturation was reached to capture exhaustive insights on the phenomenon. This qualitative study employed semi-structured in-person interviews for data collection, alongside content analysis using an inductive approach based on the methodologies developed by Granheim and Lundman. Data analysis followed a systematic procedure involving transcription, re-reading, categorization of meaning units, coding, and theme extraction, leading to the identification of new concepts. Data were analyzed using MAXQDA 2020 software.

RESULTS

The results indicated that factors influencing young people's food choices were categorized into three overarching themes: Self-concepts: Personal reflections on food behaviors, Abundance of inventory and manifestation of food quality, and the module of the surrounding social environment. The first theme encompasses categories reflecting various influences on individual-centric food choices. The second theme highlights characteristics of the food itself. Lastly, the third theme focuses on the social and environmental impacts of food selection.

CONCLUSION

This research explains the multifaceted factors affecting the food choices of young individuals, emphasizing the roles of individual characteristics, social environments, and dietary potential. It underscores the need for targeted interventions that address the diverse influences on dietary behaviors to promote healthier eating among youth.

Nurses' Perceptions of Pain Management Facilitators for Cancer Patients: A Qualitative Study

PURPOSE

Pain is a common symptom in cancer patients. It negatively impacts their emotional well-being, cognitive function, and daily communication, thereby reducing their overall quality of life. To enhance the quality of life of patients and their families, healthcare providers need to understand the factors that facilitate effective pain management. This study aimed to explore nurses' perceptions of the factors that facilitate pain management in cancer patients.

METHODS

The current research constitutes a qualitative conventional content analysis study conducted from January 2023 to June 2023. The study participants comprised head nurses, clinical nurses and clinical supervisior, totaling 27 individuals selected through purposive sampling. Data collection involved individual, in-depth, and semi-structured interviews. Subsequently, data analysis was performed utilizing the approach outlined by Graneheim and Lundman (2004), leading to the identification of participants' perspectives.

RESULTS

According to the nurses' perspective, two main categories of factors emerged that facilitate pain management. These categories are emotional support, which includes subcategories of family support and peer support, and organizational support, which includes subcategories of experienced nurses, accessible facilities, and financial support for patients.

CONCLUSIONS

The study findings highlight the importance of identifying factors that facilitate pain management in cancer patients to enhance their quality of life. These facilitators involve factors related to patients and their families, factors related to healthcare service providers, and various components of the health system. Therefore, strengthening the facilitators associated with each of these factors is critical in pain management and addressing any deficiencies in the health care system.

"Aha, so that's how it's done!" - parents' voices on an early language and literacy intervention

The early intervention Språkstart Halland targets children aged 0-3 years. During home visits at 6 and 11 months, library staff deliver gift-packs containing books, toys, songs, and rhymes to promote early language stimulation. Parents are encouraged to engage in 'talk, play, sing, read' activities to support language development. The aim of the present study was to examine parents' experiences of the 6- and 11-month visits and develop an understanding of their general impressions and thoughts regarding the perceived impact of the visits. Parents (n = 15) were interviewed in four focus groups and two one-on-one interviews. Data was analysed using qualitative content analysis. The findings show that the intervention changed the parents' mindset and increased their knowledge regarding early language stimulation. Tools and strategies benefitting the parent-child interaction were gained. A positive experience and personal guidance created motivation for the parents to carry out the language stimulating activities after the visit. Social gains were described. The findings imply usefulness of the intervention in supporting children's language and literacy development.

Why vital signs observations are delayed and interrupted on acute hospital wards: A multisite observational study

BACKGROUND

Vital signs monitoring is key to identifying deteriorating hospital patients. However, adherence to monitoring protocols is limited, with observations frequently missed or delayed. Previous studies of interruptions and delays to vital signs observations have been descriptive, with none attempting to conceptualise the types of tasks that are prioritised over vital signs observations.

OBJECTIVE

This paper aims to explore how nursing teams perform vital sign observations on acute hospital wards and conceptualises which types of work delay or interrupt them.

DESIGN

Non-participant observational study.

SETTING(S)

Four hospitals in the south of England.

METHODS

Eligible adult wards (surgical and medical) within each hospital were randomly sampled for inclusion. Four sets of two-hour daytime observation sessions were undertaken on each ward. Two observers recorded structured and unstructured observations (open comments, field notes) on a tablet with adapted QI Tool software. We collected data over 128 h, including 715 sets of vital signs observations and 1127 interruptions. We undertook a qualitative content analysis of interruptions and delays to planned vital signs observations using both structured and unstructured observations.

RESULTS

We identified eight reasons why vital signs were delayed or interrupted: fixed routines, staff availability, bundled care, proximity-related activities, collaborative care, patient inaccessible or unavailable, requests for or responses to time-critical activities, or limited context available. We propose a new concept of 'temporal status.' Flexible care (vital signs observations, 'bundled care' and 'proximity-related care') has a low temporal status so is delayed in favour of higher temporal status activities (fixed routines and time-critical care).

CONCLUSIONS

Our findings could explain why vital signs taken early in the morning and evening are least likely to be postponed, as there may be fewer competing tasks with a higher temporal status at these times. Our work also challenges binary conceptualisations of interruptions as 'beneficial' or 'detrimental', recognising the complexity of nursing care decisions on a moment-by-moment basis. Our new framework suggests the lower temporal status of vital signs observations (and other flexible care) means they are delayed by higher temporal status tasks during daytime shifts in acute hospitals, regardless of their clinical priority.

REGISTRATION

10863045, ISRCTN (6/8/2019).

Immersive Virtual Reality Experience of Patients with Cancer During Intravenous Antiblastic Therapy: A Qualitative Study

OBJECTIVES

To explore the experiences patients with cancer using immersive virtual reality (iVR) during antineoplastic infusion therapy.

METHODS

A qualitative descriptive study was nested in a randomized controlled three-arm trial. Semistructured individual interviews were conducted in person at the end of the 30-minute iVR experience, which included 310 scenarios, depicting beaches, animals, submarine environments, and mountains, available in 4K to 8K 360° sphere video. The interviews were audio-recorded and transcribed verbatim. The transcripts were analyzed using content analysis.

RESULTS

Twenty-four patients participated. Content analysis generated three main categories (cognitive and emotional benefits of iVR, customizable intervention with beautiful images, and negative aspects of iVR), and seven subcategories (enrichment of knowledge and experiences, positive emotions, cognitive engagement, variety of scenarios, quality and beauty of the videos, discomfort with the equipment, negative feelings toward the iVR devices).

CONCLUSIONS

The patients' experience with iVR was positive and enhanced their experience of receiving antineoplastic infusion therapy, with minimal cybersickness.

IMPLICATIONS FOR NURSING PRACTICE

iVR is an innovative intervention that can be implemented in nursing practice to enhance the humanization of care and foster a patient-centered approach in patients undergoing antineoplastic infusion therapy.

A study of professional practices, attitudes and barriers to blended tube feeding in Australia and New Zealand

AIMS

This study investigates the utilisation of blended tube feeding by health professionals in Australia and New Zealand, assessing factors influencing its implementation following the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding consensus statement.

METHODS

A cross-sectional survey was conducted targeting health professionals across Australia and New Zealand. The survey comprised 35-questions including multiple choice, Likert scales and open-ended responses, to gain insights into blended tube feeding practices and perspectives. The effect of the health professional factors on outcomes was explored in pairs with a series of Chi-squared tests. Odds ratios (ORs) were calculated using standard univariate logistic regression. An exploratory content analysis was used to code the open-ended text responses to the survey questions which were then categorised and further synthesised into overarching themes.

RESULTS

Out of 89 health professionals who completed the survey, the majority were dietitians, 63% reported managing fewer than five patients using blended tube feeding within their services. Parental request was the leading reason for adoption. Notable barriers included clinician time constraints, resource limitations and a lack of formal guidelines. Some health professionals considered the primary risk associated with blended tube feeding to be poor growth and/or weight loss. Professional development was pivotal in increasing confidence and advocating for blended tube feeding, with significant correlations observed between blended tube feeding training and clinical practice.

CONCLUSIONS

This study emphasises the essential role of education, resource availability and institutional policy in promoting blended tube feeding practices for health professionals. Findings suggest that focusing on professional development and standardised resources could significantly enhance knowledge, confidence and competence of health professionals in blended tube feeding application. The outcomes point towards the need for a coordinated approach to support evidence-based blended tube feeding practices, aligning with the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding resources and recommendations.

Clinician and researcher responses to the term pain catastrophizing and whether new terminology is needed: Content analysis of international, cross-sectional, qualitative survey data

Pain catastrophizing is understood as a negative cognitive and emotional response to pain. Researchers, clinicians, advocates, and patients have reported stigmatizing effects of the term on patients when used clinically and in the media. This report describes the results of an international, observational, cross-sectional study investigation of clinician and researcher (professionals) perspectives on the term pain catastrophizing and whether new terminology is needed or desired. Open-ended electronic surveys were distributed to researchers and clinicians by collaborators, stakeholders, and through social media. Professionals reported on their familiarity with the term, its meaning and impacts, and their use of the term with patients. 1397 surveys from professionals in 46 countries (48.5% from the U.S.) were received. The sample was almost two-thirds female (61.3%), with a mean age of 56.67 (SD=4.04) years, and comprised of 78.6% clinicians (63.6%, pain specialists; n=698) and 20.3% researchers. The majority were familiar with the term (82.2%; n=1148). Among the 1098 clinicians, 33.6% had used the term in communication with patients. A content analysis of professionals' responses to open-ended questions is presented. Coded responses were synthesized into five content categories or themes: (1) pain catastrophizing is an exaggerated response to pain; (2) pain catastrophizing is an unhelpful response to pain; (3) the term pain catastrophizing is stigmatizing; (4) the term pain catastrophizing is clinically useful; (5) patients' perception of the term varies. Results highlight the continual controversy surrounding the term pain catastrophizing and the need for additional research and education to incorporate patient-centered approaches into clinical and public communications. Perspective: We present a content analysis of international clinician and researcher perspectives on the term pain catastrophizing. This investigation provides the largest depiction to date of the controversy surrounding pain catastrophizing and may guide future efforts to decrease stigma in patients with chronic pain and improve patient-clinician communication.

Physical activity targeting patients admitted to a psychiatric hospital- a mixed method feasibility study

BACKGROUND

Physical activity (PA) shows positive effects on mental illness. PA and the use of municipal rehabilitation after discharge from psychiatric hospitalisation are inconsistent. The aim of this study was to evaluate the feasibility and acceptability of an intervention consisting of structured PA during hospitalisation and the use of a personalised physical activity plan and referral for municipal rehabilitation after discharge.

METHODS

A mixed-method design was used to explore the feasibility and acceptability of the intervention. Changes in health-related quality of life and physical function were measured using a six-minute walk test, a 30-second sit-to-stand test, handgrip strength, and patient reported outcomes (SF-36 and the Patient Specific Functional Scale [PSFS]). Qualitative results were further explored through semi-structured telephone interviews with twelve participants three weeks after discharge.

RESULTS

Twenty-six participants completed the intervention (median age: 46 years old; female: 57.7%). Improvements were seen in the PSFS. For SF-36, overall improvements were observed in the subscales physical function, well-being, and social function. Participants adhered to 61.5% of the scheduled physical activity sessions, 88% received a personalised physical activity plan, and 57% received municipal rehabilitation. The clinical provider played an important role in terms of motivation, structure, and knowledge about physical activity.

CONCLUSION

Physical activity during hospitalisation, a personalised physical activity plan, and municipal rehabilitation was feasible for persons with mental illness. Positive changes were observed in the following self-reported outcomes: Quality of life, physical function, and social function, and participants reported moderate to good acceptance of the intervention.

Speech and communication classification of children with cerebral palsy: Novice rater agreement and clinical utility

PURPOSE

To examine novice inter-rater agreement and clinical utility perspectives for speech and communication classification of children with cerebral palsy (CP).

METHOD

Twenty-one clinicians (speech-language pathologists [SLPs] n = 11; physiotherapists [PTs] n = 5; occupational therapists [OTs] n = 5) novice to the Viking Speech Scale (VSS), Functional Communication Classification System (FCCS), and Communication Function Classification System (CFCS) rated eight unfamiliar children with CP (8-16 years) following classification orientation. Inter-rater agreement was examined between (a) novices, (b) novice SLPs vs. PTs and OTs, and (c) novice vs. expert (kappa statistics). Utility perceptions were scored regarding classification terminology, ease of use, assistive decision-making resources, and construct validity and were analysed using Kruskal-Wallis H-tests.

RESULT

Rating agreement between novices was substantial (VSS, k = 0.72, 95% CI [0.53-0.92]) to moderate (FCCS, k = 0.44, 95% CI [0.23-0.65]; CFCS, k = 0.45, 95% CI [0.18-0.71]), and almost perfect between novice and expert ratings (VSS, kw = 0.89, 95% CI [0.86-0.92]; FCCS, kw = 0.89, 95% CI [0.86-0.92]; CFCS, kw = 0.86, 95% CI [0.82-0.91]). Statistically significant differences, presented highest to lowest, were found for clinical utility: terminology (VSS, FCCS, CFCS; p = 0.02), assistive decision-making resources (FCCS, VSS, CFCS; p = 0.009), and construct validity (FCCS, CFCS, VSS; p < 0.001).

CONCLUSION

Novice raters achieved substantial agreement for speech classification, supporting utilisation in clinical, research, and CP register activities. Orientation to communication classification constructs, content, and instructions is recommended for novice raters.