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

Rating of overall childbirth experience: A qualitative study of a quantitative measurement

INTRODUCTION

Overall childbirth experience scores are used both in research and in clinical settings. Since it is still not fully understood what assessment of childbirth experience on a single-item numeric rating scale or visual analog scale represents, the aim of this study was to explore women's reasoning and thoughts when rating overall childbirth experience numerically.

MATERIAL AND METHODS

A qualitative interview study of 26 women was conducted using a think-aloud technique at a university referral hospital in Sweden. A manifest qualitative content analysis was performed to generate categories and sub-categories representing how women decided which single value should represent their experience of giving birth.

RESULTS

Two main categories emerged from the analysis. The first, Strategies for choosing a number, reflects variations in how the women approached the rating scale itself and includes five sub-categories, each relating to a different strategy: (1) Comparison, (2) Start from the maximum value, (3) Start from the middle, (4) Weigh certain experiences more heavily, and (5) A means to an end. The second category, Specific factors considered in the rating, includes four sub-categories, representing groups of factors contributing to the final childbirth experience score: (1) The time period, (2) Events linked to strong emotions, (3) Perceived support, and (4) Previous expectations. What the women included in their overall childbirth experience was hence translated into a number, using strategies from the first category and factors from the second category.

CONCLUSIONS

The considerable variations in how women approach the rating scale, and what they include in the assessment of overall childbirth experience, suggest that not only the childbirth experience itself but also the reasoning when evaluating it, is multifaceted. A standardized phrasing of the question and a clear purpose for the evaluation is warranted to strengthen the validity of the measurement. When used clinically for identifying women in need of support after childbirth, the rating should be followed by a conversation about the experience of giving birth, independent of the value chosen.

Symptom Documentation in Unstructured Palliative Care Notes of Children and Adolescents With Cancer

CONTEXT

Children and adolescents with cancer experiencing complex symptoms can benefit from subspeciality palliative care. However, standardized methods of symptom documentation by pediatric palliative care teams are lacking. Understanding current approaches to symptom documentation will inform next steps to optimize symptom support.

OBJECTIVE

To explore the documentation of symptom prevalence and characteristics in unstructured clinical notes by pediatric palliative care clinicians caring for children and adolescents with cancer.

METHODS

We reviewed unstructured clinical notes documented by the pediatric palliative care team for 115 children and adolescents with cancer. Symptom-related data were abstracted and evaluated using content analysis based on the Memorial Symptom Assessment Scale 10-18 instrument items. We also evaluated documentation of severity and distress for six commonly experienced symptoms in pediatric cancer: difficulty sleeping; feelings of sadness; lack of energy; nausea/vomiting; pain; and worry.

RESULTS

We identified 1420 symptoms in 662 clinical notes for 106 patients. We identified a median of 5 individual symptoms (IQR = 3-8.5) per patient. Pain was the most frequently documented symptom (n = 79 patients, 74.5%). We identified at least one of the six commonly experienced symptoms in 88 patients (83%). Documentation of the associated severity and distress of these symptoms was inconsistent.

CONCLUSION

Palliative care clinicians routinely documented the co-occurrence of multiple complex symptoms experienced by children and adolescents with cancer. Unstructured progress notes captured evidence of symptom impact on daily life. Clinicians may benefit from a systematic approach to document symptoms in the clinical record which supports symptom identification and communication across clinical teams.

Care managers' experiences of interprofessional collaborative practice with physicians in community-based integrated care: a qualitative study

Objective

Under Japan's Long-term Care Insurance system, care managers (CMs) are expected to function as coordinators in the community-based integrated care system. However, few studies have focused on inter-professional collaboration between medical and non-medical professionals. The aim of this study was to identify CMs' perspectives on enablers and barriers to successful collaboration between care managers and physicians within the community.

Patient/Materials and Methods

We targeted care managers with ample experience working as CMs in the community and recruited 12 CMs using snowball sampling. Online interviews were conducted from January to May 2023 using an open-ended questionnaire concerning participants' experiences of collaborating with physicians and integrating medical services into care management. Qualitative data were analyzed through inductive manual coding using a qualitative content analysis approach.

Results

Four main themes were identified as enablers and barriers to successful CM-physician collaboration in the community: medical knowledge, professional attitudes, communication skills, and the professional culture of medicine. Equipping CMs with practical medical knowledge is essential for effective communication. Professional attitudes among CMs are imperative to fostering collaborative relationships. Effective communication skills are another critical factor, emphasizing the need for clarity, specificity, and utilization of nurses as key mediators in physician-care manager dialogue. Recognizing and navigating the professional culture of medicine is essential to overcome barriers stemming from differences in norms, beliefs, and practices between CMs and medical professionals.

Conclusion

This study underscores the significance of interprofessional education focusing on cultural differences and the development of systematic learning approaches to enhance CMs' medical knowledge of CMs. Furthermore, the findings highlight the need for clarity in defining CMs' roles within healthcare teams and addressing physicians' misperceptions regarding their contributions and responsibilities.

Users' Experience of Treatment and Coercion in an Inpatient Medium-Stay Psychiatric Rehabilitation Unit: A Mixed Methods Study

INTRODUCTION

Coercion influences mental health services users' experience of care and can hinder their recovery process, so it is essential to understand how it is perceived in rehabilitation settings oriented towards recovery.

AIM

To describe and measure users' experience of coercion and explore their perception of the treatment received in an inpatient medium-stay psychiatric rehabilitation unit (IMSPRU).

METHOD

This study, in which 75 service users participated, used a mixed methods approach. Twenty participants were administered a semistructured interview and completed quantitative measures for coercion and 55 additional service users completed the quantitative measurements only. The perception of coercion was measured using the Coercion Experience Scale.

RESULTS

The content analysis of qualitative data resulted in two main themes: treatment received and experience of coercion in the IMSPRU. The participants made a distinction between good treatment and mistreatment or unfair treatment. Experience of coercion in the IMSPRU included the feeling of freedom or lack thereof in the unit, forms of formal and informal coercion, and the positive or negative impact of rules on the unit. The quantitative data revealed a low perception of formal coercion among the users.

DISCUSSION

Individuals had different views of what it meant to be treated well, but all agreed on the importance of communication and the need to feel respected. Informal coercion was the most frequent type of coercion identified, but users were often unaware of its existence.

IMPLICATIONS FOR PRACTICE

Knowledge of how IMSPRU users experience the treatment received from nursing staff and how they perceive coercive situations will help to lay the foundations of a system of care oriented towards good treatment and noncoercive practices.

The Quality of Fundamental Care as Perceived by Nurses and Patients in a Hospital Setting: A Descriptive Comparative Study

AIM

To describe and compare nurses' perceptions of the quality of fundamental care and related factors before and after a clinical development project, and to describe patients' perceptions of the quality of fundamental care.

DESIGN

A descriptive, comparative study design.

METHODS

Data were collected online from nurses in 2015 and 2021 with a structured questionnaire exploring fundamental care through 12 areas at the beginning and the end of a clinical developmental project. Patient experiences were collected with a paper-based questionnaire in 2021. A STROBE checklist was used as the reporting guideline.

RESULTS

The nurses assessed the overall quality of fundamental care as high at both data collection timepoints. However, the quality deteriorated in general and in specific areas, including skin condition and cleansing, elimination, nutrition and blood circulation, during the follow-up period according to the nurses' experiences. A correlation was found between the areas of the quality of fundamental care. The registered nurses and the nurse managers expressed that not all areas of fundamental care were part of their work. The patients' experiences were mostly good. A small number of patients expressed a need to deal with issues related to their wellness of mind during their care.

CONCLUSIONS

The quality of fundamental care was perceived as high by nurses and patients, but the quality deteriorated during the follow-up period. It may be that the Covid-19 pandemic and a general shortage of nurses in the hospital contributed to nurses having to decide how to prioritise their tasks between fundamental and specialised care. It is therefore recommended to further develop fundamental care in the hospital.

RELEVANCE TO CLINICAL PRACTICE

Nursing roles and practices need to be reviewed and developed further to better support nurses in their work to provide high-quality fundamental care. A systematic evaluation of the quality of fundamental care is recommended.

PATIENT OR PUBLIC CONTRIBUTION

Patients responded to the research questionnaire.

The content analysis used in nursing research and the possibility of including artificial intelligence support: A methodological review

BACKGROUND

This article explores how AI supports nurses by employing content analysis for scientific nursing research.

METHODS

A narrative literature review was conducted.

RESULTS

The article summarizes the knowledge known about content analysis and outlines qualitative and quantitative content analysis concepts and simplifies the issues related to the coding process. It explains how to identify and assess quality during content analysis and gives examples of topics that can be investigated using it, especially in the field of nursing.

CONCLUSIONS

Knowledge of AI capabilities is needed to make positive use of it. These capabilities change very quickly and require constant knowledge updates. Legal and ethical regulations concerning the use of technology are still lacking, so AI outputs still require human verification of them.

[Meanings attributed to caring for an older person in the family]

The scope of this study was to understand, together with elderly family caregivers, the significance attributed to caring for an elderly person in the family. The qualitative approach involved a semi-structured interview with three guiding questions for elderly family caregivers. The participants of the research sample were older family members who care for their relatives over 60 years of age, who are sick and/or dependent, selected for convenience, according to the eligibility criteria. Of the 51 participants, 23 were chosen to compose the qualitative study sample. The two categories suggested in the categorical thematic content analysis were also confirmed through factor analysis. The first dimension, "aspects related to care", referred to the chronicity of the health of the older adult being cared for. In the second dimension, "aspects related to the caregiver's quality of life", the category referring to the condition of the elderly caregiver predominated. Therefore, these two categories identified shed light on the significance attributed to the process of caring for a sick elderly family member, including the importance of the elderly caregiver's role as an essential agent in the relationship between him/her and the elderly person being cared for, as well as in the caring process.

Till death do us Part: experiences of migrant live-in care workers facing the death of their care recipients - a study from Israel

Background

As ageing in place becomes more widespread, the burdens on relatives of older people at advanced stages of illness, particularly those reaching life's end, become greater, requiring a level of support and responsibility that often exceeds the families' abilities. A common solution is employing live-in care workers, frequently migrant workers.

Objectives

This study explores how live-in migrant care workers experience and cope with their care recipients' end-of-life and death phases.

Methods

This study is based on an ethnographic study that included 37 interviews with live-in migrant care workers employed in the homes of older adults in Israel.

Results

We identified four themes: (1) Loneliness and fear due to the need to make decisions; (2) Devotion; (3) Trauma, loss and disenfranchised grief; and (4) The impact of the national immigration policy. The first two themes related to the care workers' pre-death experiences, the third their post-death experiences and the last extraneous factors affecting end-of-life care.

Discussion

Live-in care workers, often the last to accompany their care recipients in their final moments, develop a sense of devotion and responsibility, often leading to feelings of fear and loneliness. Their lower occupational status and sociocultural foreignness affect them in the pre-death and post-death phases. The local immigration policy also influences their motivation to work with palliative patients.

Conclusion

Applying a feminist critical social care perspective, we recommend policy and social attitude changes regarding live-in migrant care workers' role in end-of-life care.

Men's experiences of decision-making in life-prolonging treatments of metastatic castration-resistant prostate cancer - wishing for a process adapted to personal preferences: a prospective interview study

BACKGROUND

In the fast-expanding field of life-prolonging-treatment of metastatic, castration-resistant prostate cancer, treatment decision-making is very complex - both for patients and healthcare professionals since there is no "one size that fits all" in choosing treatment in this phase. Little research has been conducted about men's experiences of treatment decision-making in this advanced, incurable, phase. Hence, this study aimed to describe men's experiences of decision-making in life-prolonging treatments of metastatic castration-resistant prostate cancer.

METHODS

Seventeen men were recruited from four oncology clinics in Sweden and interviewed at baseline. Qualitative interviews (n = 31) were conducted over two years, the timepoints for subsequent interviews (10 men were interviewed twice or more) adhered to when each man switched or terminated life-prolonging treatment. Data was analysed with qualitative content analysis.

RESULTS

Initially, the men were adamant about proceeding with treatment. As their illness continued to progress, they gradually turned their focus more towards their well-being. They wished for continuity regarding treating physicians and constantly being assigned new physicians compromised the quality of care and complicated decision-making. In their decision-making, the men adapted their own approach to the approach taken by their physician, even if it was not an approach they had originally preferred. They wished for their role preferences to be respected. Most men had made treatment decisions collaboratively with their physician, but some described having taken on a more, or less, driving role in decision-making than they really wished for. Navigating healthcare was perceived as difficult and for some it thus felt necessary to pursue and coordinate their own care by e.g. using personal connections or contacting clinics ahead of referral. A part of treatment decision-making was forming a basis for a decision, in which the need for personalized information (quality, quantity and timing) came forth as important.

CONCLUSIONS

When diagnosed with metastatic castration-resistant prostate cancer, men's preferences for their decision-making role, and perspectives on the treatment outcome need to be continuously addressed throughout their disease course. Improved continuity of care and a more personalised care approach should meet these patients' wishes and needs in this phase.

TRIAL REGISTRATION

Clinical trial number: Not applicable.

Content analysis of barriers to delivering maternity care to women with physical disabilities: A qualitative study

BACKGROUND

Women with physical disabilities face many barriers in accessing safe, respectful and acceptable health care. This study was designed and conducted with the aim of identifying the barriers of delivering maternity care to women with physical disabilities.

METHODS

This study was conducted with a qualitative research method of guided content analysis, and it explained the barriers to prenatal care in women with physical disabilities in Kermanshah province. In this study, a targeted sampling method with maximum diversity was used, and in order to collect data, face-to-face semi-structured interviews were used with open questions and, if necessary, follow-up and probing questions. A total of 24 people (12 pregnant women with physical disabilities and 12 antenatal care providers) participated in this study, and the data collection period lasted 10 to 12 months. In this study, the comparative analysis method was used, and Guba and Lincoln criteria were used for the accuracy and strength of the data.

RESULTS

Barriers to providing care for pregnant women with disabilities in two themes, barriers related to stakeholders, including classes of society-related barriers, barriers related to healthcare providers, family-related barriers, barriers related to companions and barriers related to women with physical disabilities, and barriers related to support organizations, including classes: the lack of a systematic support system, the lack of a systematic care program and poor accessibility were categorized.

CONCLUSIONS

The findings of the present study showed that there are many obstacles in the field of providing care to women with disabilities, and knowing these factors will make the program managers and policy makers in the field of health and rehabilitation, with a closer look at the existing capacities of the country, to provide these cares to women with physical disabilities and their families should take more effective steps and adopt and implement the necessary mechanism in the field of policy making and planning in order to reach a better situation.

The Need for Organisational Structure and Leadership Support: A Qualitative Study on Nurse Mentors' Perspectives on the Prerequisites for Effective Mentoring

BACKGROUND

Research consistently underscores the importance of mentoring and a supportive work environment for nurse retention and well-being. Previous research on nurse mentoring has primarily focused on mentees' perspectives. Research is scarce on the prerequisites for mentoring from the perspective of mentors-experienced registered nurses who guide and support their new colleagues, mentees.

AIM

To explore nurse mentors' perspectives on the prerequisites for mentoring, following their participation in a mentoring intervention.

DESIGN

Qualitative study design with an inductive approach using focus group interviews as a data collection method.

METHODS

A total of 19 experienced registered nurses, appointed as mentors, were interviewed in four focus groups and one individual interview, in May and June 2022, following the conclusion of the intervention period. Focus groups consisted of three to six participants. The transcribed interview data were analysed using qualitative content analysis.

RESULTS

The main theme identified in the results was that mentors needed organisational structure and leaders' support to facilitate the mentoring process. Participants underscored the necessity of a comprehensive support system that spans the entire mentoring process, as described in three themes: creating foundations for mentoring; navigating mentoring challenges in everyday work routines; and post-mentoring reflection and learning.

CONCLUSIONS

This study underscores the importance of integrating mentoring into daily healthcare routines by addressing barriers and facilitators, such as organisational structure and support from first line leaders. Key results highlight the need for pre- and post-mentoring phases to create a sustainable, continuous learning process. Further research should focus on developing sustainable frameworks for implementing mentoring.

IMPLICATIONS FOR THE PROFESSION

Policies should explicitly support the dual role of experienced registered nurses as both caregivers and mentors, acknowledging the demands on their time and responsibilities. Policymakers should integrate mentoring frameworks into nursing roles. This could play a critical role in stabilising the work environment.

IMPACT

What problem did the study address? Mentoring plays a critical role in helping newly qualified nurses transition into their professional roles, contributing to their retention and overall well-being. Although there is limited research on mentoring from the perspective of mentors. What were the main findings? Mentors needed organisational structure and leaders' support to facilitate the mentoring process. We identified that mentoring structures should include clear responsibilities, pre-mentoring preparation and post-mentoring reflections to ensure full implementation of the mentoring process. Where and on whom will the research have an impact? The findings of this study can support organisations in creating sustainable mentoring structures for registered nurses, in which both mentors and mentees collaborate within a community of practice. The mentoring findings can also be applicable to other contexts and professions.

REPORTING METHOD

Reporting of this study was guided by the Standards for Reporting Qualitative Research (SRQR).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A Scale to Assess Competence in Preventing Emerging Infectious Diseases Among Long-Term Care Workers

AIM

To develop an instrument for assessing competence in emerging infectious disease prevention among health and care workers in long-term care institutions and evaluate its psychometric properties.

DESIGN

A cross-sectional, descriptive design utilising both qualitative and quantitative methods was employed.

METHODS

Based on scale development guidelines, the scale was developed in two phases, namely the scale development phase and scale testing phase, with the staff of long-term care institutions as the study population and their workplaces as the sampling unit.

RESULTS

The scale comprises 27 items across three dimensions: 14 items pertaining to professional role performance, 7 items addressing workplace resources, and 6 items focusing on soft skills in communication and collaboration. Content analysis was conducted via a focus group discussion; content validity analysis was carried out via expert reviews; item analysis was performed via a pilot study; and construct validity and reliability were ensured via factor analysis and internal consistency testing, respectively. The total variance explained by the three factors of the 27-item scale was 64.8%, demonstrating acceptable validity and reliability with a Cronbach's α value of 0.97.

CONCLUSION

This scale demonstrates excellent reliability and validity, making it suitable for clinical practice and research. In practice, this instrument could also assist managers in adjusting policies to adapt to dynamic situations and enhance the quality of care in long-term care institutions. Nonetheless, further research is warranted to refine the scale and enhance its generalisability.

IMPACT

The scale is a psychometrically robust tool tailored for the evaluation of competence in emerging infectious disease prevention in long-term care institutions. It assesses the role performance, workplace resources, and soft skills of health and care workers in these institutions, which are crucial for guiding educational interventions and shaping policies to enhance disease prevention, ultimately improving care quality.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Improving the psychomotor performance of student nurses using remote clinical skills practice: a mixed-methods study

INTRODUCTION

Innovative approaches are essential in nursing education to ensure the continuity of skill acquisition, particularly in situations where traditional face-to-face teaching methods are not feasible.

OBJECTIVE

This study aimed to evaluate the effectiveness of remote learning in enabling student nurses to acquire psychomotor skills, with a focus on 'blood pressure measurement'-a noninvasive procedure that can be practiced safely at home.

METHODS

Using an experimental design with group randomization and a mixed-method approach, 44 first-year nursing students participated, with 22 in the experimental group and 22 in the control group. After a theoretical course on blood pressure measurement, the control group followed a licensed video program, while the experimental group practiced with a simulated patient under an educator's guidance in an remote environment. The research was conducted between March 2021 and October 2021, encompassing all phases of the study. These phases included preliminary information, remote training, and feedback sessions in March 2021, the first assessment in April 2021, and the second assessment in October 2021. The 'Descriptive Characteristics Form,' 'Blood Pressure Measurement Skill Checklist,' and 'We Practice Remote Clinical Skills Together Online Comments Form' were used for data collection. Descriptive statistics (means, standard deviations, frequencies, percentages) and the Mann-Whitney U test were applied for quantitative data analysis, while qualitative data were analyzed inductively based on student opinions from both groups.

RESULTS

The first performance assessment showed no significant difference between the control and experimental groups' mean scores (p = 0.440). However, the second assessment revealed a significant difference favoring the experimental group (p = 0.001). The qualitative data were categorised into three main themes: emotions, learning and confidence, with a total of 34 codes. Emotions accounted for 50% of the codes, including happiness, stress, comfort and anxiety. Learning accounted for 41% and included awareness, interaction-communication, skill acquisition and information retention. Finally, self-confidence, represented by skill practice in the laboratory, accounted for 9% of the codes.

CONCLUSION

This study demonstrates that educator-guided remote skill training can positively impact students' psychomotor skill acquisition. It highlights the potential for effectively teaching specific nursing skills in remote environments when guided by an educator.

Identifying key drivers affecting the future of virtual reality in medical education

BACKGROUND

Policymakers must have a forward-looking mindset. Future studies are valuable tools for monitoring upcoming developments and identifying the driving forces that shape the future. This research aimed to identify the drivers or key influencing factors in the future of virtual reality in medical education.

MATERIALS AND METHOD

This study was conducted in 2021-2023 in three phases: conducting literature review, interviewing with experts, and categorizing these results within the STEEPV (Social, Technological, Economic, Environmental, Political, and Values) framework.

RESULTS

Content analysis of the literature review resulted in 273 codes and seven categories. Interviews with 15 experts were analyzed, which led to 220 codes and 30 sub-categories. Ultimately, the results of the two aforementioned stages were categorized within the STEEPV framework, including six, seven, six, two, four, and five drivers in the categories of social, technological, economic, environmental, political, and values drivers, respectively.

CONCLUSION

To successfully introduce virtual reality in universities, it is essential to create a supportive environment, adjust policies, and establish ethical guidelines. This will require initial investments, cost-reduction strategies, and collaboration with knowledge-based companies. In addition, it is vital to leverage existing technology, provide training, and enhance digital literacy to ensure effective utilization. The future of virtual reality in medical education will be influenced by technological advancements, economic factors, environmental concerns, political frameworks, and value-driven approaches.

Ambulance Commanders' Reluctance to Enter Road Tunnels in Simulated Incidents and the Effects of a Tunnel-Specific e-Learning Course on Decision-Making: Web-Based Randomized Controlled Trial

BACKGROUND

The optimal response to a major incident in a road tunnel involves efficient decision-making among the responding emergency services (fire and rescue services, police, and ambulances). The infrequent occurrence of road tunnel incidents may entail unfamiliarity with the tunnel environment and lead to uncertain and inefficient decision-making among emergency services commanders. Ambulance commanders have requested tunnel-specific learning materials to improve their preparedness.

OBJECTIVE

We aimed to assess decision-making among ambulance commanders in simulated road tunnel incidents after they had participated in a tunnel-specific e-learning course designed to support timely and correct decisions in this context.

METHODS

We conducted a web-based intervention study involving 20 participants from emergency medical services in Sweden who were randomly allocated to a test or control group. The control group (n=10, 50%) received a lecture on general incident management, while the intervention group (n=10, 50%) completed an e-learning course consisting of 5 modules focused on tunnel structure, safety, and collaboration in response. The participants took part in 2 simulation-based assessments for ambulance commander decision-making in major road tunnel incidents 1 month and 6 months after their allocated study intervention. In each simulation, the participants decided on the best course of action at 15 independent decision points, designed as multiple-choice questions. The primary outcome was the correct response to the question regarding how to appropriately enter the road tunnel. The secondary outcome measurements were correct or incorrect responses and the time taken to decide for each of the 15 decisions. Limited in-depth follow-up interviews were conducted with participants (n=5, 25%), and collected data were analyzed using qualitative content analysis.

RESULTS

All 20 participants completed the first simulation, and 16 (80%) completed the second. The main finding was that none (0/20, 0%) of the participants correctly answered the question on entering the tunnel system in the 1-month assessment. There were no significant differences between the groups (P=.59; 2-sample test of proportions) in the second assessment. The e-learning course was not associated with more correct answers at the first assessment, including accounting for participant factors (mean difference between groups: -0.58 points, 95% CI -1.88 to 0.73; P=.36). The e-learning course was also not associated with a shorter time to completion compared to the nonintervention group in either assessment. Interviews identified 3 categories linked to the main outcome: information (lack of), risk (limited knowledge and equipment), and mitigation (access to maps and aide-mémoire).

CONCLUSIONS

Participation in a tunnel-specific e-learning course did not result in a measurable change in ambulance commanders' decision-making behavior during simulated road tunnel incidents. The observed hesitation to enter the road tunnel system may have several plausible causes, such as the lack of actionable intelligence and tunnel-specific plans. This novel approach to assessing commander decision-making may be transferable to other educational settings.

Post-COVID-19 Syndrome as Described by Patients: A Qualitative Study

Background/Objectives: Growing interest in post-viral conditions following COVID-19 infection has led researchers and clinicians to develop several definitions of post-COVID-19 syndrome. This study aimed to understand the meaning given to post-COVID-19 syndrome by individuals who survived the first wave of the pandemic two years after its onset. Methods: A descriptive qualitative study was performed according to the Standards for Reporting Qualitative Research guidelines. An inductive and content analysis were adopted on narratives collected via the interview of patients who had been infected with SARS-CoV-2 during the first pandemic wave in the Friuli Venezia Giulia Region (Italy). Results: This study included 230 patients, of whom 158 experienced post-COVID-19 syndrome, and 46 (29.1%) reported suffering from this condition 24 months after the infection. On average, patients experienced three symptoms, with most of them experiencing at least one. Seventy-five patients reported being familiar with the definition of the post-COVID-19 syndrome, mainly through media and the internet (28.9% and 28.2%, respectively). The post-COVID-19 syndrome was described as characterized by two themes: (a) the experience of interrelated physical and psychological symptoms and (b) the experience of fighting like warriors for a long time. Conclusions: The post-COVID-19 syndrome is highly prevalent but poorly understood. Patients rely on low-quality information rather than that offered by clinicians. The post-COVID-19 syndrome appears to be a complex syndrome encompassing physical and mental symptoms, as well as those disabling the person with an unclear trajectory. There is a need to focus on the long-term consequences of COVID-19, incorporating insights from individuals' lived experiences.

Factors influencing the resilience of clinical education in general medicine in Iran: a qualitative content analysis study

BACKGROUND

Clinical education is one of the key components of medical education and directly affects the efficiency, professional skills, and quality of future services graduates provide. Additionally, resilience plays an essential role in facing crises and forming medical students' professional identity. Strengthening resilience can accelerate this process. Therefore, this study was conducted to comprehensively understand the dimensions and factors affecting resilience in the clinical education of general medicine, based on the experiences of stakeholders, including professors and students present in clinical environments.

METHODOLOGY

This qualitative study was conducted based on purposive sampling among ten faculty members and six medical students. The data collection process was conducted from September 2023 to April 2024 through semi-structured interviews. Interviews were transcribed, and data analysis was accomplished according to the steps proposed by Graneheim and Lundman (2004).

RESULTS

Data analysis revealed three themes that reflected the factors influencing resilience in clinical education: Facilitators of resilient clinical education, Barriers of resilient clinical education, and Prerequisite factors of resilient clinical education.

CONCLUSION

According to the results, in order to create a resilient clinical education system, it is necessary to pay attention to factors such as the use of residents in teaching, cooperative learning, effective interaction, strong knowledge base, infrastructure development, and spreading the culture of learning from experiences. In the meantime, obstacles such as the loss of trust between community members and doctors, heavy workload, non-scientific management and treatment-oriented clinical training centers can prevent the realization of this goal. On the other hand, supporting faculty members with training programs and job promotion as well as paying attention to individual resilience are considered as facilitating factors in this direction.

Exploring nursing assistants' competencies in pressure injury prevention and management in nursing homes: a qualitative study using the iceberg model

BACKGROUND

As the global population ages rapidly, pressure injuries (PI) in nursing homes have become a serious health concern. Nursing assistants play an important role in pressure injury prevention and management (PIPM).

OBJECTIVE

This study aimed to explore the PIPM competencies required by nursing assistants within nursing homes based on the Iceberg Model.

METHODS

We employed a qualitative descriptive study and collected data through a focus group with 12 nursing assistants and semi-structured interviews with 11 key stakeholders in China. Deductive content analysis was utilized based on the Iceberg Model.

RESULTS

Five main categories of nursing assistants' PIPM competencies were identified: theoretical knowledge, comprehensive skills, self-concept, traits, and motives. Theoretical knowledge included PI basic and professional theoretical knowledge, emphasizing the importance of understanding PI mechanisms, risk factors, and prevention strategies. Comprehensive skills encompassed practical skills (e.g., repositioning techniques, wound care), communication skills, collaboration skills, and observation skills. Self-concept involves professional identity, ethical awareness, and a sense of responsibility. Traits included carefulness and love, and empathy and patience. Motives were driven by professional development opportunities and supportive institutional policies.

CONCLUSION

The application of the Iceberg Model enhanced the understanding of competencies required for effective PIPM. The findings can guide the development of targeted training programs and assessment tools for nursing assistants in long-term care facilities. Future research should explore the long-term impacts of well-trained nursing assistants on patient outcomes and expand the PIPM competencies scope required by nursing assistants.

CLINICAL TRIAL NUMBER

Not applicable.

A Qualitative Analysis of Multilevel Barriers and Facilitators to Breastfeeding for Mothers Receiving Medication for Opioid Use Disorder

BACKGROUND

As national rates of opioid use disorder (OUD) continue to persist, the resulting impact on the affected mother-infant dyad is immense. While there is concrete evidence in support of breastfeeding in women receiving medication for OUD, gaps in widespread support for breastfeeding in this population remain, leading to continued breastfeeding disparities.

PURPOSE

Explore the multilevel barriers and facilitators to breastfeeding for mothers receiving medication for OUD.

METHODS

Semi-structured interviews were completed with a total of 29 participants (N = 14 mothers, N = 3 family members, and N = 12 providers). We used three levels of the socio-ecological model, including the individual, microsystem, and macrosystem, to guide our multiple case study analysis. Qualitative, latent content analysis was used to focus on identifying and understanding barriers and facilitators to breastfeeding across these various levels.

RESULTS

Participants across groups identified barriers to breastfeeding at all three socio-ecological model levels, while facilitators were only identified at the individual and microsystem levels. Across the different levels of the socio-ecological model, six subthemes emerged: (1) breastfeeding knowledge and readiness; (2) infant factors; (3) support; (4) daily routines; (5) organizational environment; and (6) policies.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Application of the socio-ecological model to identify barriers and facilitators to breastfeeding may inform approaches that are sustainable and more likely to improve rates of breastfeeding over time for mothers receiving medication for OUDs.

Calf Morbidity and Mortality: Critical Challenges for Smallholder Dairy Farmers in Northern Ethiopia

Calf morbidity and mortality pose significant economic challenges for smallholder dairy farms in Ethiopia, resulting in direct losses from calf deaths, replacement costs, treatment expenses, and reduced lifetime productivity. This study aimed to comprehensively investigate the magnitude and epidemiological characteristics of calf morbidity and mortality in Northern Ethiopia. A cross-sectional study with mixed approaches was carried out from December 2019 to September 2020. A total of 183 questionnaire survey, four focus group discussion (FGD), and 17 key informant interviews (KII) were included in the study. Furthermore, participatory epidemiological appraisals were incorporated to triangulate and strengthen survey evidences. Analysis of survey results revealed that 69.4% of the farmers have experienced calf morbidity, while 63.9% of them have encountered calf mortality. Similarly, results of proportional piling indicated that calf morbidity and mortality were estimated to occur in 75.5% and 55.9% of the farms, respectively. Moreover, all KIIs had encountered calf morbidity, while 88.2% of them had faced calf mortality. Ninety percent of KIIs, 66.2% of the participants of community-based epidemiology, and 27.87% of questionnaire survey respondents suggested that calf morbidity and mortality occur in less than one-week-aged calves. Regarding the potential risk factors, source of water, frequency of barn disinfection, breed types, health status of dams, using separate calf housing, amount of colostrum provided to calves, and cleaning frequency of barns had statistically significant association with the occurrence of calf morbidity and mortality (p < 0.05). Additionally, results of participatory appraisal, FGDs and KIIs showed that calf diarrhea, nutritional disorder, pneumonia, and navel ill were the leading causes of calf morbidity and mortality. Furthermore, observation assessment showed that most dairy farms were surrounded by dense human settlements, livestock markets, and municipal slaughtering houses. Hence, the farms had critical space limitation (for animals to exercise) as well as poor drainage systems and hygienic practices. Our assessment also showed that lack of veterinary services, shortage of water supply, and poor artificial insemination services were the major challenges of dairying in the area. In conclusion, the present study revealed that calf morbidity and mortality were critical challenges for dairying in Northern Ethiopia. Furthermore, the study highlighted the epidemiological characteristics and potential risk factors associated with calf morbidity and mortality, awareness gaps in calf management, as well as key bottlenecks in dairy farming. These findings underscore the need for a comprehensive study, continuous capacity building initiatives, improved infrastructure, and services to mitigate calf losses.

"It Just Rips My Heart Out": Child Custody Dispositions After Women Leave Abusive Partners

Family court child custody dispositions for women who have left violent partners can result in complications and difficulties. This secondary analysis of data from 2005 to 2009 describes the child custody dispositions of 369 Canadian women survivors of intimate partner violence (IPV) (48.5% Indigenous, 44.7% White, and 6.4% Visible Minority). Of these, the most common court disposition was mothers receiving sole custody (38.9%), then those who did not use formal custody (34.5%), joint custody (13.3%), fathers receiving sole custody (4.4%), and family court still in progress (8.8%). Mothers' perspectives about these dispositions were qualitatively analyzed. Implications for researchers and practitioners are presented.

Cross-Sectoral Collaboration Between Mental Health Hospitals and Municipalities: A Scoping Review

INTRODUCTION

Cross-sectoral collaboration between mental health hospitals and municipalities addresses the multifaceted needs of individuals with mental health conditions. Recovery-oriented care emphasizes personal empowerment, holistic support, and integrated services. However, barriers to collaboration hinder effective service delivery. This scoping review explores how recovery-oriented approaches are integrated within collaborative practices and identifies key barriers and facilitators to cross-sectoral collaboration.

METHODS

This review followed Arksey and O'Malley's framework, with systematic searches conducted in PubMed, CINAHL, PsycINFO, and Web of Science. Studies published between 2012 and 2024 were included if they focused on cross-sectoral collaboration within a recovery-oriented framework. Data from 30 peer-reviewed articles were synthesized to identify themes related to barriers, facilitators, and best practices.

RESULTS

Barriers to collaboration included fragmented communication systems, cultural and professional differences, and power imbalances across sectors. Structural challenges, such as discrepancies in legislative and funding mechanisms, hindered integration. Successful models, such as Individual Placement and Support (IPS) and Open Dialogue, demonstrated the potential of structured frameworks in overcoming barriers. User involvement emerged as a pivotal facilitator of meaningful collaboration but remains underutilized in practice.

DISCUSSION

Recovery-oriented care necessitates overcoming systemic and cultural barriers to develop integrated, person-centered approaches. Despite promising practices, gaps in understanding long-term outcomes and user perspectives persist, highlighting the need for further research.

CONCLUSION

Effective collaboration between mental health hospitals and municipalities is fundamental to delivering recovery-oriented care. Future research should explore standardized metrics, enhance user involvement, and assess the scalability of successful models to strengthen integration.

Collaboration between local authorities and civil society organisations for improving health: a scoping review

OBJECTIVES

Cross-sector collaboration has been encouraged to improve population health. Both local authorities and civil society organisations impact population health, but less is known about how the actual process of collaboration is done. This scoping review aims to explore how local authorities and civil society organisations collaborate with the ambition to improve population health.

DESIGN

This scoping review was informed by the guidance of the Joanna Briggs Institute, and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

DATA SOURCES

Medline, Web of Science, CINAHL and Sociological Abstracts were searched from inception to September 2022.

ELIGIBILITY CRITERIA

We included peer-reviewed empirical studies that describe the initiation, execution or sustainment of collaboration for health between local authorities and civil society organisations.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data, which was summarised and analysed using inductive content analysis.

RESULTS

In the 79 included articles, collaborations between local authorities and civil society organisations entailed many different aspects, from exchanging knowledge, allocating resources, providing different types of support or human resources, training, forming different working groups, agreements and working plans to gathering data for needs analysis or evaluation. Few articles described how the collaboration had been initiated or sustained. Initiation was done through advocacy, needs assessments, making a request, creating a workgroup and conducting a pilot study. Sustainment efforts were continuous meetings, documents and tools, funding, and different plans and work structures. There were often additional actors involved in the collaborations. Information about study design was often not described in a clear and comparative manner.

CONCLUSIONS

There is a need for more research on the details of initiating, executing and sustaining collaborations for health between local authorities and civil society organisations. Knowledge from this scoping review can be used to inform the planning of future collaborations between local authorities and civil society organisations.

Nursing and medical students' views on their knowledge related to the Sustainable Development Goals - a mixed methods study at three Swedish universities

BACKGROUND

The challenges that the world faces to ensure good life for future generations are vast and complex. The United Nations Sustainable Development Goals (SDGs) aim to meet these challenges. A growing number of higher education institutions have integrated them within their curricula, but there are indications that health professional education has been lagging behind. Therefore, it is important to better understand the views of students in health professional education on the level and depth of their education on sustainable development.

METHODS

This sequential exploratory mixed methods study was based on survey responses from N = 294 nursing (N = 137) and medical (N = 157) students of first and last semesters from three Swedish universities. From the full group of survey responders, 21 students participated in 5 focus group discussions (FGDs) and 9 individual interviews. The survey findings were summarized through descriptive statistics and the interviews and FGDs were analyzed by qualitative content analysis.

RESULTS

The survey findings showed that most students (63%) perceived that they had not learned enough about the SDGs and Agenda 2030 during their education, or for the purposes of their future career. Most of the students (63%) also thought that Agenda 2030 and the SDGs should be a greater part of their education. The qualitative data gave a more in-depth understanding of the quantitative findings, forming two themes: The first theme revealed that the SDGs may be more relevant for health care practice than what the students initially thought, but that the education they had received was in most places superficial, or not tied to the SDGs. The second theme detailed what and how students wished to learn more about. Here, they called for a more in-depth understanding of how to promote equality, equity, inclusion and psychosocial aspects in health care. They also hoped for more knowledge about how to ensure a sustainable working life for themselves.

CONCLUSIONS

Nursing and medical students at three Swedish universities experience that they lack the knowledge necessary to face sustainability challenges they encounter in working life and give some suggestions about how this may be improved in future education.

Content analysis of succession planning in nursing management: a qualitative study

AIM

The identification and development of managerial talents for nursing manager succession in the future should be a concern for organisations, as the concept of succession planning has not been seriously addressed in nursing. This study aimed to explore managers' perceptions of the concept of succession planning in nursing management.

DESIGN

This qualitative study used a conventional content analysis approach.

METHODS

Participants included 15 nursing managers, who were purposively selected based on predetermined inclusion and exclusion criteria. After obtaining ethical approval, data were collected through semistructured interviews. MAXQDA software was used for data management, and data analysis was performed using the seven-stage method by Graneheim and Lundman. The credibility and dependability of the data were assessed using Guba and Lincoln's criteria.

RESULTS

The main categories identified in this study were barriers to succession planning, facilitators, succession planning requirements, contextualisation, succession planning cycle, the dynamism of the successor organisation and consequences of lack of succession planning. Based on the findings of this study, it is recommended that organisations plan and adopt policies to develop qualified personnel management in nursing organisations and appoint these individuals to critical managerial positions.

Health Care Professionals' Perspectives on Using eHealth Tools in Advanced Home Care: Qualitative Interview Study

BACKGROUND

The rising demand for advanced home care services, driven by an aging population and the preference for aging in place, presents both challenges and opportunities. While advanced home care can improve cost-effectiveness and patient outcomes, gaps remain in understanding how eHealth technologies can optimize these services. eHealth tools have the potential to offer personalized, coordinated care that increases patient engagement. However, research exploring health care professionals' (HCPs) perspectives on the use of eHealth tools in advanced home care and their impact on the HCP-patient relationship is limited.

OBJECTIVE

This study aims to explore HCPs' perspectives on using eHealth tools in advanced home care and these tools' impact on HCP-patient relationships.

METHODS

In total, 20 HCPs from 9 clinics specializing in advanced home care were interviewed using semistructured interviews. The discussions focused on their experiences with 2 eHealth tools: a mobile documentation tool and a mobile preconsultation form. The data were analyzed using content analysis to identify recurring themes.

RESULTS

The data analysis identified one main theme: optimizing health care with eHealth; that is, enhancing care delivery and overcoming challenges for future health care. Two subthemes emerged: (1) enhancing care delivery, collaboration, and overcoming adoption barriers and (2) streamlining implementation and advancing eHealth tools for future health care delivery. Five categories were also identified: (1) positive experiences and benefits, (2) interactions between HCPs and patients, (3) challenges and difficulties with eHealth tools, (4) integration into the daily workflow, and (5) future directions. Most HCPs expressed positive experiences with the mobile documentation tool, highlighting improved efficiency, documentation quality, and patient safety. While all found the mobile preconsultation form beneficial, patient-related factors limited its utility. Regarding HCP-patient relationships, interactions with patients remained unchanged with the implementation of both tools. HCPs successfully maintained their interpersonal skills and patient-centered approach while integrating eHealth tools into their practice. The tools allowed more focused, in-depth discussions, enhancing patient engagement without affecting relationships. Difficulties with the tools originated from tool-related issues, organizational challenges, or patient-related complexities, occasionally affecting the time available for direct patient interaction.

CONCLUSIONS

The study underscores the importance of eHealth tools in enhancing advanced home care while maintaining the HCP-patient relationship. While eHealth tools modify care delivery techniques, they do not impact the core dynamics of the relationships between HCPs and patients. While most of the HCPs in the study had a positive attitude toward using the eHealth tools, understanding the challenges they encounter is crucial for improving user acceptance and success in implementation. Future development should focus on features that not only improve efficiency but also actively enhance HCP-patient relationships, such as facilitating more meaningful interactions and supporting personalized care in the advanced home care setting.

Nurses' lived experiences of self-control in emergency settings: a qualitative study

BACKGROUND

Given nurses' vital role in emergencies, it is essential to understand their perceptions and strategies for self-control. This study examines nurses' experiences and insights regarding self-control during high-pressure scenarios. The findings could inform the development of effective stress management strategies and enhance nursing training programs, ultimately improving patients' overall quality of care.

METHODS

This study utilized a qualitative, descriptive design with a content analysis approach. Data was collected through semi-structured interviews with 24 nurses in various wards of five university-affiliated hospitals, including [specific wards, e.g., emergency, intensive care, internal, etc.]. The nurses were selected using a purposive sampling technique, and the data were analyzed through qualitative content analysis.

FINDINGS

Nurses' lived experiences and understanding of self-control in emergencies revealed three main categories, each comprising several sub-categories: Managing Emotional Intelligence in Crisis Situations (Emotion Regulation in Critical Situations, Using Resources and Experiences for Emotion Management, and Control of Individual Emotions), Adherence to Principles in Crisis Situations (Compliance with Ethical Standards, Ethical Decision-Making, Patient-Centered Focus, and Effective Communication), and Self-Control in Managing Stress and Fatigue (Fatigue Management and Interpersonal Interaction and Collaboration).

CONCLUSION

This study highlights the importance of self-control for nurses working in high-stress environments. It emphasizes that enhancing emotional intelligence, adhering to professional standards, and effectively managing stress are crucial for overcoming workplace challenges. These factors not only foster resilience but also support self-control, which is essential for maintaining composure and making informed decisions during emergencies. The findings advocate for creating supportive work environments and implementing evidence-based policies to improve nurses' self-control skills, ultimately leading to better patient outcomes. These insights can guide enhancements in nursing education and overall care quality.

Barriers and facilitators of complications risk perception among rural patients with type 2 diabetes mellitus: a qualitative content analysis

BACKGROUND

Diabetes and its complications have emerged as a significant health threat to rural residents. Accurately perceiving the risk of complications may play a crucial role in modifying health behaviors and preventing complications' occurrence. We aimed to explore the barriers to and facilitators of risk perception of complications in rural patients with type 2 diabetes mellitus, and to provide new perspectives and ideas for the development of relevant interventions in the future.

METHODS

This study adopted the qualitative content analysis method. Semi-structured interviews were conducted with 14 rural diabetic patients selected by purposive sampling from July to September 2023, and the interview data were systematically analyzed.

RESULTS

Data analysis identified 9 sub-themes falling into the 2 macro-themes: (a) facilitators of complications risk perception (Increased disease knowledge, Low sense of disease control, Risk experiences, Negative mindset); (b) barriers to complications risk perception (Lack of awareness of diabetes or its complications, Information barriers, Optimistic bias, Overconfidence, Disease generalization).

CONCLUSIONS

This study explored the barriers and facilitators of complication risk perception among rural patients with type 2 diabetes mellitus, offering new insights into risk perception research, and aiding primary medical staff to develop targeted intervention measures to ensure that rural diabetes patients can accurately and objectively perceive risk.

Patient-centered outcomes on preparing for and undergoing gender-affirming phalloplasty: a qualitative, descriptive study

OBJECTIVE

Despite increasing incidence of genital gender-affirming surgery (GGAS), there is no systematic method of evaluating patient perspectives. The objective of this study is to elucidate transgender and non-binary patient perspectives on gender-affirming phalloplasty/metoidioplasty via structured focus groups and determine convergent themes as the first step towards the development of a GGAS patient-reported outcome measure.

DESIGN

We conducted a systematic qualitative study using a thematic content analysis of four focus groups from April 2021 to April 2022 comprising 8 patients undergoing phalloplasty/metoidioplasty and 10 patients post-phalloplasty/metoidioplasty. Focus groups were hosted virtually and recorded and transcribed. Discussions were guided by participant input and focused on goals, experiences, outcomes, satisfaction, and quality of life.

SETTING

This volunteer but purposive sample of patients was recruited directly in clinic, via email, and via social media at NYU Langone Health (primary site), Callen-Lorde Community Health Center (New York, New York, USA) and the San Francisco Community Health Center.

PARTICIPANTS

We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. PRIMARY AND SECONDARY OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Transcripts were uploaded into ATLAS.ti, a qualitative data analysis software that facilitates coding for thematic content analysis. We performed deductive and inductive coding to identify the themes that were clustered into overarching domains.

RESULTS

The mean duration of focus groups was 81.5 min. Seven themes and 19 subthemes were constructed. The major themes were (1) goals, expectations, and priorities before/after surgery; (2) sexual function; (3) urinary function; (4) peer support; (5) decision-making; (6) mental health and quality of life; and (7) gender dysphoria. Of the major themes, those determined before the study included themes 1-3 and 6-7. Limitations include small sample size and bias in patient selection.

CONCLUSIONS

We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. Mental health, quality of life, functional, and aesthetic outcomes are all critical to patients. Phalloplasty/metoidioplasty impact numerous aspects of patients' lives. Experiential components of the surgical process, mental health, and quality of life are important metrics to consider in addition to functional and aesthetic outcomes.

Leadership with a Learning-Oriented Relationship Supports Nursing Staff in a Changed Approach Towards Health

Managers in psychiatric outpatient care may play a crucial role in motivating staff to adopt new approaches, often navigating challenges such as organisational resistance and the complexities of the care environment. This study describes managers' experiences motivating staff to adopt a new approach by implementing a lifestyle program for individuals with mental illness in an outpatient psychiatric setting. Interviews with seven managers revealed an overarching theme of a "learning-oriented relationship," emphasising the importance of mutual engagement and staff development. The findings highlight that building relationships and prioritising staff development enhance engagement and facilitate meaningful change. A learning-focused leadership style-marked by inspiration, support, and trust-emerged as a key driver of sustainable change and the adoption of health-promoting practices. This leadership approach may not only aid the implementation of new initiatives but also foster a workplace culture grounded in collaboration, growth, and shared purpose. The study also underscores the importance of training managers in frameworks like Self-Determination Theory, focusing on inspirational motivation and personalised support. Embodying genuine care managers can create an empowering environment that enables staff to embrace and sustain new practices. Future research should explore perspectives to refine strategies for implementation in complex healthcare settings.

Palliative nurses' experiences of alleviating suffering and preserving dignity

BackgroundMost patients in need of palliative care remain in their homes, thus great focus should be placed on the creation of functional palliative homecare. Suffering through an often multifaceted illness and contemplating one's death can contribute to the loss of one's sense of dignity, and the preservation of patient dignity is a major challenge for health professionals worldwide.AimThe aim of the study was to explore and describe nurses' experiences of caring qualities alleviating suffering and preserving the dignity of patients in need of palliative homecare.Research designA qualitative exploratory study. In-depth semi-structured interviews as data collection method, and the qualitative content analysis of Graneheim and Lundman for data analysis. The theoretical perspective was based on Eriksson's caritative caring theory.Participants and research contextA total of nine nurses with extensive work experience from a palliative homecare context participated in the study.Ethical considerationsThe study was conducted in accordance with the criteria set forth by the Finnish National Board on Research Integrity TENK. Research permission was granted and participants gave their written informed consent to participate in the study.FindingsOne main theme and three subthemes were found. The main theme was: Being there for the other alleviates suffering while shaping and reshaping dignity preservation in a process. The three subthemes were: (1) Being a sensitive and compassionate witness who becomes responsible, (2) Having compliance, courage, and perception in a deep presence, (3) Being calm and patient while having time for conducting skilled practical knowledge.ConclusionsCertain caring qualities are important in the dignity-preserving care of people in need of palliative homecare, and person-centeredness plays a central role in alleviating suffering. Deep and trusting caring relationships and nurses' ability to customize the care being provided are significant in alleviating patient suffering and preserving dignity.

Healthcare Professionals' Perceptions of Pre-, Peri-, and Postoperative Virtual Reality Immersion in Elderly Patients

Background/Objectives: There is a lack of research examining healthcare professionals' perspectives regarding the potential of non-pharmacological solutions such as immersive virtual reality (VR). The aim of this study was to investigate opportunities and challenges related to the application of immersive virtual reality (VR) technology in patients aged 65 and older undergoing surgery with regional anesthesia and sedation. Method: A qualitative, multicenter study was conducted in the spring of 2024, involving semi-structured interviews with 17 healthcare professionals. Result: A qualitative content analysis of the interviews identified the main theme "Healthcare professionals' openness to opportunities for this technology for elderly patients", with the subthemes and themes "elderly patients", which included the participants' attitudes towards elderly patients; "virtual reality", which concerned opportunities, barriers, and risks; and "sustainable healthcare", which comprised the participants' thoughts about its impact on sustainable development. Conclusions: The participants suggested potential areas of use for VR during the perioperative period but also identified limitations and risks. They suggested VR was likely to have a positive impact on sustainable healthcare, as well as economic advantages. For its successful implementation, the equipment must be safe. There also needs to be a clear division of responsibilities for it to be functional and suitable for its users. Strategies such as nudging can be used to facilitate its implementation.

Preferences for Mobile Apps That Aim to Modify Alcohol Use: Thematic Content Analysis of User Reviews

Background

Nearly one-third of adults in the United States will meet criteria for alcohol use disorder in their lifetime, yet fewer than 10% of individuals who meet for alcohol use disorder criteria will receive treatment for it. Mobile health (mHealth) applications (apps) have been suggested as a potential mechanism for closing this treatment gap, yet there is a wide variety of quality and integrity within these apps, leading to potential harms to users.

objectives

The aim of this paper is to systematically record and qualitatively examine user reviews or mHealth apps to identify features in the existing apps that may impact usefulness and adoption of them.

Methods

The researchers used Apple App and Google Play stores to identify mHealth apps that were focused on modifying alcohol use and treating common comorbidities. Apps that were free without in-app purchases and provided multiple features for users were included. User reviews from the apps were downloaded and coded using content analysis.

Results

A total of 425 unique apps were found in our search. Of these, the majority of apps (n=301) were excluded from the present analyses for not focusing on reducing alcohol-related concerns (eg, many apps were for purchasing alcohol). Eight apps were identified and had user reviews downloaded. The apps examined in this study were VetChange, SMART, DrinkCoach, SayingWhen, AlcoStat, Celebrate Recovery, TryDry, and Construction Industry Helpline. A total of 370 reviews were downloaded and 1353 phrases were coded from those reviews into a total of 11 codes. The 5 most common themes identified were praise (498 counts coded; 36.831%), tools (150 counts coded; 11.062%), suggestions for improvement (118 counts coded; 8.756%), criticism (105 counts coded; 7.768%), and tracking (104 counts coded; 7.724%).

Conclusions

The current findings suggest that alcohol mobile app users broadly found the apps helpful in reducing their drinking or meeting their drinking goals. Users were able to identify features that they liked or found helpful in the apps, as well as provide concrete feedback about features that they would like included or improved. Specifically, flexible and expansive tracking features and comprehensive whole health tools were cited as valuable and desired. App developers and those looking to expand access to and uptake of alcohol reduction apps may find these user reviews helpful in guiding their app development.

A framework to identify opportunities to address socioscientific issues in the elementary school curricula: A case study from England, Italy, and Portugal

Scientific literacy is crucial to address important and complex societal problems, both current and future. Teaching using a socioscientific issues (SSI) approach is a potential strategy to develop students' scientific literacy, although teachers have reported concerns about its implementation, such as the inability to add additional distinct requirements to already demanding curricula. To facilitate this task, we describe the development of a valid and reliable instrument for curricula analysis, called "Framework for Identifying Opportunities to implement an SSI approach in science school curricula" (FIOSSI), and use it to identify opportunities to implement the SSI approach in the elementary school science curriculum of three European countries (England, Italy and Portugal). The framework categorizes SSI opportunities into three areas: 1) awareness of the issue; 2) socioscientific reasoning; and 3) socioscientific identity. Our analyses of the three countries' elementary curricula reveal that the current versions have significant opportunities to explore awareness of SSI (especially relating to environmental and human health issues), promote the development of socioscientific reasoning, and foster socioscientific identity. FIOSSI can be a useful tool for education research and practice, and our results can help inform future research and guide educational policies.

"It Is No Solution to Sit and Keep Quiet": Experiences of Communicative Function in People With Parkinson's Disease Following Participation in a Group Intervention for Speech and Communication

PURPOSE

This study aimed to explore and describe subjective experiences and feelings related to speech and communicative function for a group of individuals with Parkinson's disease (PD) and whether these changed after participation in HiCommunication, an intensive group intervention program focusing on speech and communication for individuals with PD.

METHOD

Seven individuals who had completed the 10-week program participated in individual semistructured interviews that were transcribed and analyzed with content analysis.

RESULTS

Eight subthemes grouped into three main themes emerged during the analysis, including communication challenges, insights from treatment, and practical considerations.

CONCLUSION

The overarching theme, speech and communication training as a tool to respond to communication difficulties, describes that a group speech and communication treatment program, HiCommunication, may help individuals with PD form and implement strategies to maneuver negative emotional stress related to communication and decrease the risk of social isolation.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28556273.

Influencing factors of self-advocacy in stroke patients from multiple perspectives: a qualitative study

BACKGROUND

Self-advocacy can help stroke patients actively participate in disease management and maximize health benefits, which is a central issue in chronic disease management. The aim of the study was to explore the influencing factors of self-advocacy in stroke patients from multiple perspectives.

METHODS

A descriptive qualitative interview study was performed. Semi-structured in-depth interviews were conducted with 19 stroke patients, 6 caregivers, and 8 medical staff from two hospitals in Henan province between October 2023 to February 2024. This study analyzed interview data using a Social Ecological Model (SEM) and content analysis strategies.

RESULTS

Factors associated with stroke patients' self-advocacy were categorized using the social ecological model: (1) individual factors: influence of individual cognitive and psychological factors (weak sense of autonomy, insufficient disease cognition, severity of the disease, self-perceived burden, concerns about deteriorating doctor-patient relationship). (2) interpersonal factors: influence of family, peers and medical staff (insufficient family support, lack of peer support, authority of medical staff dominates). (3) community factors: influence of socio-environmental factors (shortage of medical staff, incomplete rehabilitation equipment, limited channels for information). (4) policy-economic factors: influence of existing policy (insufficient support from medical insurance, long-term financial burden).

CONCLUSION

This study's application of a social ecological model helped to illuminate the complex and multilevel factors that may influence self-advocacy in stroke patients. Stroke patients' self-advocacy was influenced by the patients themselves, interpersonal relationships, community factors, and policy-economic factors. These findings can be used to guide the development of a multi-pronged intervention strategy to increase the level of self-advocacy for stroke patients in the self-management process.

Youth receiving protection and advocacy services in the COVID-19 pandemic: Impacts and service recommendations from the perspectives of youth and their supporters

BACKGROUND

There has been limited research examining the perspectives of children and youth receiving protective services during the COVID-19 pandemic, despite reported challenges of unmet support needs due to reduced services.

OBJECTIVE

The purpose of this study was to elicit experiences in navigating the COVID-19 pandemic from the perspective of youth receiving child/youth protection and advocacy services, and that of their supporters/advocates. Participants were invited to reflect on their experiences in the pandemic and offer recommendations for better supporting youth during a pandemic.

PARTICIPANTS AND SETTING

Using a convenience sampling approach, 32 participants were recruited for study participation. They comprised youth receiving child/youth protection and advocacy services (n = 10), peer mentors (e.g., young adults who had received and aged out of youth protective services) (n = 2), informal adult supporters/advocates such as foster parents (n = 4), and professional service providers/advocates serving youth who were receiving youth protection services (n = 16).

METHODS

Semi-structured qualitative interviews were inductively analyzed based on line-by-line coding, code categorization, identification of themes, and mapping of themes.

RESULTS

Support provided by child/youth protection and advocacy services were decreased or modified during the pandemic. Participants conveyed pandemic-related challenges both for youth and service providers, yet resilience among youth. Impacts on youth comprised mental health struggle, uncertainty and feeling alone, increased personal responsibility, personal coping strategies, and heightened recognition of system gaps. Recommendations for future pandemic planning and recovery are offered.

CONCLUSIONS

Critical struggles of youth in receipt of mandated protective and advocacy services, and their supporters resulted from service modifications in the pandemic. Results inform services, and call for action in advancing proactive pandemic/disaster planning in the child and youth care sector.

Mandatory research projects during medical specialist training in Australia and New Zealand: a survey of trainees' experiences and reports

OBJECTIVE

To determine how many specialist trainees are required to conduct research projects, how they conduct these studies, and their views on the value of these activities; to assess the design and reporting quality of their research reports.

STUDY DESIGN

Online, anonymous survey.

SETTING, PARTICIPANTS

Current and recent trainees (past five years) at Australian and New Zealand specialist colleges, recruited through eleven colleges and snowballing; survey was available 31 March - 31 December 2021.

MAIN OUTCOME MEASURES

Whether trainees were required to conduct research as part of specialty training; how they conducted their projects; the skills mix of the project team and access to relevant expertise and supervision; trainee views on mandatory research during specialty training; research engagement after training. Respondents were invited to submit project reports for reporting and methodological quality evaluation.

RESULTS

A total of 371 people commenced the survey; 361 respondents provided answers about mandatory research projects during specialist training, including 311 (86%) who had been required to complete projects. Seventy-six of 177 people who had completed projects (43%) provided information about 92 projects and submitted 34 project reports for evaluation. Thirty-eight projects (41%) investigated questions developed by the trainees alone; in 48 cases (52%) trainees had planned their projects with little outside input; of the 69 study protocols developed (75% of projects), 60 were developed by the trainees. The median proportion of time devoted to the research project exceeded 50% for trainees in ten of twelve colleges. Respondents typically worked in non-collaborative teams, restricted to members of their own specialty, and additional expertise was limited to statisticians, allied health professionals, and nurses. Eighty-seven of 174 participants who had completed projects (50%) felt that doing so was very or moderately important for their clinical careers; 36 of 67 respondents (54%) supported the requirement for scholarly projects during specialty training; 33 of 61 respondents (54%) had participated in research after completing training, and 44 (72%) had considered doing so. Twenty-five of 34 available reports had been published; in 27 assessable reports, methods and results reporting was generally poor, and the risk of bias moderate to high in all but three. Participants criticised using their own time for projects and their potentially low quality results.

CONCLUSION

For trainees who undertake specialty training, the time commitment and poor quality research associated with mandatory research projects were frequently concerns. Medical colleges should focus on research training tailored to individual career aspirations and training needs.

Ethical challenges in conducting research in low and middle income setting during public health emergencies: a qualitative evidence of a COVID-19 pandemic: the experience of Iran

BACKGROUND

Every minute during an epidemic is important and research in such conditions is for the benefit of the society. Considering that identifying experiences is a way to prevent repeated mistakes and prepare people to face crisis situations, this study aimed to explain participants' experiences of ethical challenges encountered in conducting research related to Covid-19 in Iran.

METHOD

This qualitative study was carried out using conventional content analysis for 2 years from March 2020 to March 2022 in Tehran, Iran. A number of 30 people were selected in a purposeful method and information was obtained through semi-structured interviews. The participants in the study were people with positions including members of institutional and national research ethics committees, researchers, clinicians, university hospitals managers during the COVID-19 pandemic. The method of data analysis in this study was conventional content analysis using the Graneheim and Lundman method.

RESULTS

Participants' experiences on ethical challenges were explained through three themes: "substantive ethical values principles", "the Research Environment", "Research Governance and Management".

CONCLUSION

This study examines ethical challenges in COVID-19 research across three domains: values, environment, and research governance. The results suggest the need to develop crisis-specific ethical frameworks, strengthen research ethics infrastructure and training, and establish more transparent standards and oversight systems. These findings could be useful in refining ethical policies and managing future crises.

Experiences of Surgical Nurses in Patient Care During Earthquake 2023 in Turkey: A Disaster Management Study

This study aims to qualitative examine the patient care experiences and roles of surgical nurses affected by the major earthquake that occurred in Kahramanmaraş on February 6, 2023, in the city of Osmaniye. Using a qualitative descriptive design, face-to-face individual interviews were conducted with 12 surgical nurses. The interviews were recorded, transcribed verbatim, and thematically analyzed. The study complies with the Standards for Reporting Qualitative Research (SRQR) guidelines. The main findings of the study encompass the themes of care of traumatized patients, challenges in work life, and work life and organization. Nurses play a crucial role in disaster relief planning, intervention, and recovery processes, and there is a need for further examination of their experiences to shape and improve future practices in disaster management and patient care.

Non-communicable diseases challenges and opportunities in Iran: a qualitative study

Policymakers should focus on reducing risk factors and ensuring equitable access to preventive and therapeutic care for NCDs. This study aimed to identify health promotion challenges and opportunities for NCDs in Iran. This qualitative study involved semistructured interviews with 14 participants, including policymakers and experts in obesity, diabetes, hypertension, and cardiovascular disease management in Iran. Interviews were conducted via Skype, recorded, and transcribed. A deductive approach was applied to extract codes using MAXQDA 10 through open coding. Qualitative analysis identified five main categories and 14 subcategories of challenges and opportunities for addressing NCDs in Iran, aligned with the Ottawa Charter for Health Promotion; policy levers for NCD prevention, including legislation and economic growth creating health-promoting environments, focusing on strengthening physical and social infrastructure community and Individual empowerment for health, focusing on social capital development, public participation, improving the quality of education, and promoting health literacy and transforming Healthcare for better health, organizing health systems and eliminating conflicting interests. The critical important of policies, environmental determinants, community involvement, and healthcare frameworks was highlighted. A holistic approach is essential for the effective prevention and management of NCDs.

Experience of physiotherapeutic care in pregnancy-related pelvic girdle pain: A qualitative study from a primary care perspective

INTRODUCTION

Although pregnancy-related pelvic girdle pain (PPGP) is a common cause of pain, there seem to be deficiencies in healthcare, regarding both knowledge and awareness of the condition. There is clearly a need for more research in the field of PPGP.

OBJECTIVE

The aim was to highlight how people affected by PPGP experience physiotherapeutic care in the primary care setting in Sweden.

METHODS

This qualitative interview study applied an inductive approach. The participants were selected through strategic sampling in primary healthcare units and via snowball sampling. Sixteen individual interviews were analyzed via qualitative content analysis according to Graneheim and Lundman.

RESULTS

The analysis identified one overarching theme: Reflection on the participants' experiences cracks the façade, exposing a great need for healthcare. This theme is based on the participants' descriptions of initially feeling satisfied with the care they received for PPGP. However, when given the opportunity to reflect on their experiences, the participants clearly expressed wishes for improvements in physiotherapists' competence and interventions. The participants also emphasized a great desire to improve society's understanding of female-coded diagnoses.

CONCLUSIONS

The results highlight the participants' ambivalent experience of healthcare for PPGP. Paying attention to the diagnosis and taking it seriously should be emphasized. One way to improve healthcare for PPGP would be to improve physiotherapists' competence regarding PPGP.

Preventive breast health care, an embarrassing subject for women with intellectual disability

BackgroundWomen with intellectual disability run an increased risk of dying of breast cancer compared to the general population. There is a clear connection between late detection and low participation in the mammogram screening program. This study aimed to explore the views and experiences of breast health care in women with intellectual disability.MethodSemi-structured interviews were performed individually and in small groups among 11 women with intellectual disability in Sweden.ResultsBreast cancer screening is not adapted to women with intellectual disability. Insufficient support and disrespectful treatment can cause ignorance, fear and anxiety. Familiarity with processes and personal networks are examples of improvement in participation.ConclusionPreventive breast health care is a sensitive topic for many women with intellectual disability that needs to be addressed. Preventive breast health care needs to be more inclusive and better adapted. Personal networks must not determine the possibility of preventive care.

The adaptation of clinical practice guideline recommendations regarding family-centered collaborative care of people living with schizophrenia, major depressive disorder, and bipolar mood disorder in the Iranian context: using the resource toolkit for guideline adaptation

INTRODUCTION

Chronic mental diseases are enduring and recurring, and need constant care and a collaborative approach for management. Based on clinical guidelines, family interventions can improve the quality of care for individuals with chronic mental diseases.

OBJECTIVE

Specifically, the study examined family involvement in the care of people suffering from schizophrenia, major depressive disorder, and bipolar mood disorder by adapting international clinical guidelines.

METHODS

The resource toolkit for guideline adaptation was selected as the adaptation process. Seven databases were searched for international clinical guidelines. Independent reviewers utilized the Appraisal of guidelines for research and evaluation II tools to assess guidelines that met the inclusion and quality criteria. The recommendations from the guidelines were combined with those from the systematic review and qualitative research, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and COnsolidated criteria for REporting Qualitative research checklists. Rephrased recommendations with redundant or overlapping content were excluded from the Iranian context due to the cultural, religious and belief changes of the people, as well as the lack of necessary facilities. Translations of the selected recommendations were made into Persian, along with modified recommendations.

RESULTS

A total of 573 recommendations from 17 books, 10 national documents, 16 guidelines, 27 articles, and 31 English and Persian theses were identified. After the initial review (referred to as RAND/UCLA Appropriateness Method 1), 467 recommendations received an appropriate score, 106 had an uncertain score, and none of them received an inappropriate score. After merging the recommendations, they received 433 good grades and 98 uncertain grades. After the face-to-face meeting of the research team, 7 were merged due to similarity, and 91 recommendations were made in a hybrid panel of experts (RAND/UCLA Appropriateness Method 2). Finally, 524 recommendations were identified that applied to the psychiatric medical centers in Iran. The examined and revised recommendations suggest healthcare professional interventions for family involvement in the care of patients with schizophrenia, major depressive disorder, and bipolar mood disorder referred to medical centers in Iran. The adapted recommendations emphasize the need for family-centered collaborative care ( interventions which satisfy the needs of patients with chronic mental diseases and their caregivers, considering their preferences and capabilities.

The role of society and family in adolescents' disaster resilience: A qualitative study

BACKGROUND

Resilience is a person's ability to adapt to life problems and crises and is influenced by many factors. Due to the increase in the number and severity of disasters, disaster preparedness policies should be developed at different levels and among multiple groups. More attention should be given to vulnerable groups. The aim of the present study is exploring the role of society and family in adolescents' disaster resilience.

METHODS

The present study was conducted using a qualitative method with content analysis approach. The participants were 28 high school teachers in Bam city, who were selected based on the purpose, to be the least 10 years of age at the time of the Bam earthquake, willingness and ability to provide experiences, active participation in this study and filling the written consent form. Sampling was continued until data saturation. The data were collected via in-depth and semi-structured interviews and analyzed with the steps suggested by Granheim and lundman method.

RESULTS

The data analysis revealed 452 open codes, 192 conceptual codes after integration, 14 subcategories, and 4 categories of factors affecting resilience against disasters. The categories included resilience strengthening and restraining factors in the family and society.

CONCLUSION

The results of the present study revealed the importance of family and society function in adolescent resilience, which can be used to help crisis management practitioners and decision makers plan community preparedness and improving Support Systems especially in schools, before disasters or Situational and predictable crisis.

Resilient living program for patients with advanced cancer and their caregivers

OBJECTIVES

Patients with advanced cancer and their caregivers experience a substantial amount of anxiety and distress. The purpose of this study was to assess the feasibility, acceptability, and preliminary effects of an 8-week, remotely delivered Resilient Living Program (RLP) for adult patients with advanced cancer and their caregivers.

METHODS

Eligible patients included adults (≥18 years) with advanced cancer. Their caregiver had the option to participate. The RLP components included online modules, a print journal, and 4 video-telehealth-delivered sessions. Content focused on techniques for managing stress and building resilience (mindful presence, uplifting emotions, reframing experiences through practicing principles of gratitude, compassion, acceptance, meaning, and forgiveness). Feasibility and acceptability were assessed quantitatively and with semi-structured interviews conducted with a subset of participants. Effectiveness measures (anxiety, stress, quality of life [QOL], sleep, resiliency, and fatigue) were administered at baseline, week 5, week 9, and week 12.

RESULTS

Of the eligible patients, 33/72 (46%) were enrolled. In all, 15 caregivers enrolled. Thirty participants (21 patients/9 caregivers) completed at least 3 video-telehealth sessions (63% adherence). For patients, there were statistically significant improvements in anxiety and fatigue at week 12 (p = 0.05). Other effectiveness measures (stress, QOL, sleep, resiliency) showed positive trends. Eleven participants were interviewed and qualitative analysis revealed 4 themes: Easy to Use, Learning Key Principles, Practice is Essential, and Examples of Benefits.

SIGNIFICANCE OF RESULTS

Participation in the RLP was feasible and acceptable for patients with advanced cancer and their caregivers. Participants tended to indicate that the practices were easy to integrate into their everyday lives, engendered their ability to focus on the positive, and would recommend the RLP to other individuals living with advanced cancer. Preliminary effectiveness data suggest the program may positively impact anxiety, stress, QOL, sleep, resiliency, and fatigue. A larger randomized clinical trial is warranted to confirm these preliminary findings.

Exploring the causes of workplace bullying among nurses in pediatric intensive care units: a qualitative study

INTRODUCTION

Workplace bullying (WB) is a significant occupational hazard for nurses, especially in high-stress environments such as pediatric intensive care units (PICUs). WB adversely affects nurses' physical and mental health, patient safety, and overall quality of care. This study aimed to explore the causes of WB among nurses working in PICUs.

METHODS

This qualitative study used a conventional content analysis approach. Eleven nurses from the PICUs of the Children's Medical Center Hospital, affiliated with Tehran University of Medical Sciences, participated in the study. Participants were selected through purposive sampling. Data were collected through semi-structured face-to-face interviews, continuing until data saturation was achieved. The data were analyzed using Graneheim and Lundman's five-step approach. Lincoln and Guba's four criteria-credibility, confirmability, dependability, and transferability-were used to ensure the study's rigor.

RESULTS

The analysis of the data revealed two main categories: [1] the "Imposing and Stereotypical Atmosphere," which encompasses sub- categories such as power imbalances, work-related challenges, immature behaviors among staff, and passive reactions of nursing managers; and [2] the "Victim's Achilles' Heel," which emphasizes weaknesses in clinical and communication skills as contributing factors to WB.

CONCLUSION

The study identifies organizational and personal factors as causes of WB in PICUs. Nursing leaders can implement targeted interventions aimed at improving workplace culture, monitoring interpersonal relationships, enhancing communication skills, and promoting the clinical skills of staff. These strategies can reduce WB and create a healthier work environment for nurses.

Development of an eHealth Intervention in Pediatric Home Infusion Therapy: Interview Study of Needs and Preferences of Parents and Health Care Professionals

Background

With the provision of home infusion therapy in children with acute or long-term illness on the rise, eHealth technologies have the potential to bridge the transition between hospital and home. However, eHealth interventions intended to support parents in managing home infusion therapy are sparse. Gaining insight into the needs and experiences of parents and health care professionals is crucial to developing feasible and sustainable eHealth interventions that target their needs. This study describes the first phase of a research study designed to develop and evaluate an eHealth intervention to support home infusion therapy.

Objective

This study aimed to identify the experiences and needs of parents and health care professionals during home infusion therapy and their preferences for digital features in a future eHealth intervention.

Methods

A qualitative study was conducted at 3 pediatric departments at a university hospital in Denmark. We individually interviewed 17 parents of 14 children who had received home infusion therapy with a portable pump. In addition, 5 focus groups were conducted with 15 health care professionals. We conducted a qualitative content analysis of the data, which we collected from February to July 2020.

Results

We identified 6 subthemes that we merged into 3 main themes: increasing safe self-management at home; adapting information and responsibility to individual changing needs; and requesting digital features to ensure skill level, safety, and quality of care. The analysis showed that parents and health care professionals had corresponding needs and preferences, for example, a need for a high sense of safety and easier ways to communicate during home infusion therapy. Both groups emphasized the need for digital features to improve problem-solving and communication as a supplement to existing care to promote a safe environment, self-management, and quality of care. A vital issue was that an eHealth intervention should be aligned with the workflow of health care professionals and comply with regulations regarding confidentiality in communication and data sharing.

Conclusions

Our study highlights the needs that parents and health care professionals have for increased safety and easier access to communication when receiving and providing home infusion therapy. The findings will be used to help develop an eHealth intervention supporting home infusion therapy tailored to individual needs.

Needs of novice midwives in the management of obstetric emergencies: a qualitative study

BACKGROUND

Maintaining the health of mothers and neonates depends on the provision of high-quality, timely emergency care by competent health professionals. Obstetric emergencies are among the most challenging moments in a midwife's professional career, especially for novice midwives. Therefore, it is crucial to address the specific needs of novice midwives to ensure they are equipped to effectively and promptly manage such emergencies. The present study was conducted to explore the needs of midwives in the management of obstetric emergencies.

METHODS

In this qualitative study, a conventional content analysis approach was employed. The study included a total of 26 participants, comprising 13 novice midwives, 8 experienced midwives, and 5 supervisor midwives. Participants were selected using purposive sampling method with the aim of achieving maximum diversity within the sample. Data collection was performed through in-depth and semi-structured individual interviews, and the process continued until data saturation was reached. Data analysis was conducted simultaneously with data collection, leading to the extraction of the main categories.

RESULTS

Two main categories were extracted from 26 interviews: (1) Promotion of professional empowerment in the management of obstetric emergencies with five categories, including familiarity with the clinical environment, promotion of professional competence, promotion of professional wisdom, promotion of professional care, and promotion of inter-professional competence; and (2) Promotion of organizational support that involves the two categories of creating a support platform for the healthcare team and strengthening organizational resources.

CONCLUSION

The results of the present study indicated that professional development of individuals and organizational support were the primary needs of novice midwives in managing obstetric emergencies. Based on the findings of this study, it is recommended to develop and implement training-support programs focused on the professional development of midwives in emergency management.