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

The end-of-treatment process in medically assisted reproduction: a qualitative study of healthcare professionals' views

In the medically assisted reproduction (MAR) pathway, one of the most complex phases is the end of the treatment. Unlike other medical contexts, there is no biological endpoint in the MAR setting. This absence makes the decision to end MAR treatment extremely challenging for both patients and healthcare professionals. Accordingly, our research aimed to examine the process related to the end of MAR treatment, as devised by healthcare professionals. Our sample included physicians, biologists, and psychologists aged ≥18 years with specialised training in assisted reproduction. Data were collected through four focus groups (in February-May 2023), focusing on the topic of the end of treatment (EoT) and its definition. Data were collected and analysed according to the principles of Grounded Theory. The findings shed light on the attributes and components related to the end of the treatment process. The central category "the end of treatment" consists of a definition of what is considered the end of treatment and the associated decision-making process. In the phase leading up to the EoT, the process is influenced by contextual and proximal factors, which interact and influence each other. To cope with and manage the EoT, healthcare providers adopt spontaneous strategies that lead to positive or negative outcomes. End-of-treatment management is a key facet of clinical practice. This contribution increased knowledge about EoT and highlighted healthcare professionals' perspectives, which should be considered for the implementation of best practice points and respect for patients' rights to the highest attainable standard of mental and physical health.

Student experiences and perspectives on decolonising global health education: a qualitative study across five Nordic countries

BACKGROUND

Decolonisation has become a global health priority, addressing inequities rooted in colonial histories that continue to shape power dynamics and knowledge systems. Nordic global health programmes bring together students and faculty from diverse backgrounds in a region defined by inclusive ideals but shaped by underexamined colonial legacies. This context offers a valuable setting to examine how decolonial perspectives are integrated or overlooked in global health education.

OBJECTIVE

To explore students' perspectives on decolonisation in global health education, focusing on their understanding, experiences, and views on potential pedagogical change.

METHODS

A qualitative study involving 72 students from Nordic countries and other world regions, enrolled in global health programmes at 11 academic institutions across five Nordic countries. Fourteen focus group discussions were conducted, and the data were analysed using qualitative content analysis principles.

RESULTS

Students shared nuanced understandings of systemic power imbalances in global health practice and education and expressed the need for structural changes. They identified gaps in curricula and pedagogy, including limited integration of decolonial perspectives and inequities in knowledge production. Students called for more inclusive and culturally relevant curricula that reflect diverse contexts. They emphasised student agency in shaping education while acknowledging barriers such as institutional biases and inconsistent faculty engagement.

CONCLUSIONS

Decolonising Nordic global health education is a long-term process requiring sustained institutional commitment. Student-informed strategies include embedding reflexivity into curricula, engaging with Nordic colonial histories, and designing reciprocal international learning arrangements. While context-specific, these findings may inform broader efforts to decolonise global health educational practices.

Primary healthcare nurses' experiences of symptoms and treatment needs of patients with RLS-associated symptoms at telephone nursing - an abductive analysis based on the Four Habits communication model

BACKGROUND

Restless legs syndrome (RLS) is a common, neurological disease. Primary healthcare (PHC) nurses are often the patient's first contact, but studies regarding their experience assessing RLS-associated symptoms and treatment needs in telephone nursing (TN) are lacking.

PURPOSE

To describe how PHC nurses experience symptoms and treatment needs of patients with RLS-associated symptoms during TN.

METHODS

A descriptive abductive design, including semi-structured interviews with 18 PHC nurses from six Swedish regions. Data was deductively analyzed using the Four Habits communication model. Facilitators and barriers were inductively identified.

RESULTS

Invest in the beginning included the use of professional competence, interpretation of influencing factors at the start of the conversation and initial understanding of the patient's RLS symptoms. Elicit the patient's perspective involved originate from the patient's perception of the symptoms and comprehending the symptoms' impact on the patient's life situation. Relate to the patient's situation and the importance of trust in the patient meeting described demonstrating empathy. Invest in the end involved triaging patients with RLS-associated symptoms, providing self-care advice to patients with RLS-associated symptoms and achieving consensus at the end of the conversation.

CONCLUSION

Using the Four Habits communication model could enrich communication regarding RLS-associated symptoms and treatment needs during TN.

The development and preliminary evaluation of a financial navigation program among patients with breast cancer in China

Objective

This study aims to develop a financial navigation program among patients with breast cancer in China and assess its feasibility, acceptability, and preliminary effects on cost-related health literacy and financial toxicity (FT).

Methods

The Medical Research Council (MRC) framework were adopted to guide the development of the financial navigation program, providing a structured approach to complex intervention development and evaluation. It consisted of three phases: evidence identification via a scoping review, intervention content modeling through qualitative study analysis, and outcome mapping based on social stress theory. The feasibility, acceptability and primary effectiveness were examined in a single-center, assessor-blinded pilot randomized controlled trial with 26 recruited patients.

Results

The financial navigation program consists of needs assessment, cost-related health education, resource/service referral and personalized counseling. The consent rate and a 1-month attrition rate for the feasibility study of the intervention were 55.9% and 7.7%, respectively. Most (91.7%) participants were satisfied with the program and perceived benefits. The intervention significantly improved cost-related health literacy, although no statistically significant between-group difference in FT was observed.

Conclusions

The MRC framework serves as a useful scientific basis for developing financial navigation program with a culturally sensitive approach. The financial navigation program was feasible, acceptable, effective in improving cost-related health literacy and has the potential to enhance FT among patients with breast cancer in China.

Trial registration

ClinicalTrials.gov Identifier NCT06355440.

Patients experience of trauma adapted yoga as a health promoting activity in forensic psychiatric care

PURPOSE

Although the effects of yoga on psychiatric symptoms in psychiatric care are gaining increasing recognition, research within forensic psychiatric care, particularly on subjective experiences, remains limited. To address this gap, the present study aims to describe patients' experience of trauma-adapted yoga (TAY) as a health-promoting activity in forensic psychiatric care.

METHODS

Twelve individual semi-structured interviews with patients in forensic psychiatric care were conducted, and data were analysed using inductive content analysis.

FINDINGS

The patients' experience of TAY as a health-promoting activity was captured in an overarching theme, "To feel that one is connected to mind, body, and soul in a way that can promote a sense of well-being in an uncertain existence". This overarching theme contained four themes: Strengthening the body, finding a calm place within oneself, something to do solely for oneself but together with others, and prerequisites for doing yoga.

CONCLUSION

The findings emphasize that TAY has the potential to be a valuable health-promoting activity for patients in forensic psychiatric care by facilitating their resources to manage stressors in everyday life. Therefore, it should be offered as a complement to other treatments to promote patients' health and well-being in forensic psychiatric care.

Women's experiences with continuous care during labor by maternity care assistants in The Netherlands: a qualitative study

Despite evidence on effectivity and WHO recommendations, continuous care during labor is not yet available for all women. Options such as doula support are being considered, but face barriers in accessibility. To explore other implementation options, the Continuous Care Trial looked at the provision of continuous care by maternity care assistants. Maternity care assistants are well-established care providers within Dutch maternity care, routinely involved in the final stages of labor and postpartum. This qualitative study is an addition to the Continuous Care Trial and explores women's experiences with continuous care during labor by maternity care assistants in the Netherlands. Fourteen interviews were conducted, audio-recorded and transcribed verbatim for manifest content analysis, following the methodology of Graneheim and Lundman. The explored experiences were analyzed for evident similarities and differences. Findings were described in three themes: 'Women's experiences with continuous care,' 'Continuous care of maternity care assistants' and 'Perspectives on implementation.' Noted facilitators include positive effects of continuous care, a larger role of the partner, and recognition of the professional background of the maternity care assistant. Barriers include difficulty to decide when and what kind support to ask for and lack of knowledge on the effectivity of continuous support.

Experiences of insomnia among older people living in nursing homes A qualitative study

PURPOSE

The study aimed to explore older people's experiences of insomnia in nursing homes.

METHOD

This qualitative study used an inductive approach with semi-structured interviews involving 19 older people (aged 67-101 years) from nine nursing homes in southwestern Sweden. The older people were purposively selected based on insomnia criteria according to the International Classification of Diseases (ICD-10, G47.0) and cognitive competence according to the Standardized Mini-Mental State Examination (S-MMSE). The interviews were analysed using qualitative content analysis.

RESULTS

Two categories were identified: Valuing good sleep and Disruptive influence on sleep, with the subcategories of internal and external disturbances. Older people expressed that sleep was crucial to their well-being, and poor sleep quality negatively influenced their mood and physical health. They experienced internal disturbances, such as anxiety and physical discomfort, as causing sleep disturbances, but also external aspects that included environmental disturbances, reduced activity levels, loneliness, and worry about which nursing staff was on duty.

CONCLUSION

This study highlights the critical role of sleep in maintaining energy, coping with daily life, and ensuring overall well-being for older people in nursing homes.

Collective wellbeing sacrifices versus superior ego - perspectives on adherence to COVID-19 recommendations in Stockholm, Sweden

During the COVID-19 pandemic, Sweden adopted a recommendation-based approach rather than strict lockdowns. This approach relies on public willingness to adhere to guidelines and motivations for prosocial behaviour. This study aimed to explore the motivations behind adherence or non-adherence to COVID-19 recommendations in Sweden. Semi-structured interviews were conducted in 2022 with 20 participants aged 26 to 63, all residing and working in Stockholm. The interviews were conducted via online platforms, Teams and Zoom, transcribed and analysed using content analysis. The analysis yielded two overarching themes that motivated adherence or non-adherence, Sacrificing comfort for collective wellbeing and A sense of being superior and able to handle national recommendations in your own way derived from six categories: (i) Social pressure and the desire to appear prosocial, (ii) Embracing a new reality as a means to return to normalcy, (iii) The absence of punitive measures for non-adherence, (iv) Creating safe environments and circumventing the system, (v) Negotiating which recommendations to follow and (vi) Diminished adherence over time. Adherence to public health recommendations was driven by social pressure and a desire to protect loved ones, often requiring personal sacrifices and behavioural adjustments. Conversely, non-adherence stemmed from a sense of autonomy, mental well-being preservation and tiredness, highlighting the challenges of sustaining compliance over time.

Simulation as a foundation for experiential learning among ambulance nursing students: A qualitative observation study

Simulation-based education is commonly used in undergraduate training but has gained increased utilization in postgraduate education. Ambulance nursing programs struggle to provide suitable simulations, as ambulance care can involve any possible situation. Simulation-based education in ambulance nursing programs commonly includes basic assessment and treatment of various conditions. However, there seems to be a lack of knowledge regarding students' experience of simulating pediatric emergency care in an ambulance care setting. Thus, the aim of this study was to explore specialist nursing students' experiences of simulating pediatric emergency care in an ambulance care setting. A qualitative design was deployed, utilizing field notes, individual and group interviews to capture the students' experiences. The results show that students immerse themselves in the simulations when the environment and facilitators support this. The simulation can elicit both emotional and physical responses among the students. Students gain insights into their knowledge deficit regarding certain topics, such as pediatric emergency care, as well as the rules and regulations governing what they are allowed to do for a child's safety and well-being. During simulation, students understand the importance of using adequate communication and recognize that there might be several aspects influencing this. Finally, the students gain insight into their emotional and behavioral responses when encountering patients and relatives in situations that conflict with their own views. In conclusion, simulation-based education can be a useful pedagogical tool if barriers to immersion are reduced. It can provide students with insights into their emotional and behavioral responses when encountering unexpected events. If properly discussed in debriefing sessions, these matters lead to increased learning that students can carry with them into their future careers. However, more research is needed on the feasibility of this kind of simulation in the ambulance nurse education setting.

Evaluating the impact of an educational intervention with cognitive rehearsal training on preparing pre-registration nursing students to respond to workplace incivility

BACKGROUND

Workplace incivility can cause distress to nursing students and adversely affect team cohesiveness which can then negatively affect the quality of patient care. Preparing students to foster healthy work environments and deal with acts of incivility that threaten teamwork and patient safety becomes increasingly important as nursing students progress through their academic careers.

OBJECTIVES

This study aimed to assess the impact of structured education based on cognitive rehearsal response training on pre-registration nursing students' self-efficacy perceptions in dealing with workplace incivility.

DESIGN

A single-group pre - and post - intervention study design.

SETTINGS & PARTICIPANTS

A consecutive sample of 91 third-year pre-registration Bachelor of Nursing students across three campuses of a single university participated in the study between August and October 2022.

METHODS

A concurrent nested mixed method design comprising a structured educational intervention and a 'before and after' survey (open-ended and closed-ended questions) was conducted to evaluate the efficacy of the intervention on nursing students' perceived self-efficacy in handling workplace incivility. The quantitative component was supplemented by qualitative insights from free-text comments on the quality and effectiveness of, and satisfaction with the educational intervention.

RESULTS

Participants reported an increase in perceived self-efficacy of 4.8 (SD = 4.5) points, 95 % CI [3.8, 5.8], during the post-intervention phase compared to the pre-intervention stage. This difference was statistically significant, t (90) = 10.2, p < .001, and large, d = 0.84. Additionally, the overall effectiveness of the educational intervention was rated highly, with a mean score of 8.51 and SD of 1.71. Qualitative content analysis revealed five categories: knowledge is power, the cue card method, simple and clear, role-playing realism, and the road to improvement and change. Qualitative content analysis revealed five categories: knowledge is power, the cue card method, simple and clear explanation, role-playing realism, and the road to improvement and change.

CONCLUSION

Cognitive rehearsal response training significantly enhanced nursing students' perceived self-efficacy in handling workplace incivility. Larger-scale randomised controlled trials are warranted in order to validate these findings and support broader scale implementation.

To Talk or not to Talk About Existential Questions - An Interview Study With Elderly Persons and Patients With Fatal Disease

Background: Existential experiences often come to the fore in the case of a severe and/or life-threatening disease and in old age. This can evoke a variety of thoughts and emotions. The existential dimension is a concept that encompasses spiritual, religious and secular perspectives. Objective: The aim of this study was to gain a deeper understanding of how patients describe the existential dimension of life and whether and in what way the existential questions are raised in conversations and other forms of support within care. Methods: A qualitative design, with in-depth semi-structured interviews with patients admitted to an out-clinic oncology department at one hospital and participants living in a nursing home. The interviews were analysed using qualitative content analysis. Results: A total of 15 persons were interviewed. The respondents varied in age from 44 to 96. Two main themes emerged: What are existential questions? and Talk about existential questions. The existential questions refer to life as a whole and death as an end of life. It was summarized into three subcategories: The experience of the life, Existing within context and Spirituality and religion. About half of the participants thought it was important to talk about existential questions. They wanted to choose who to talk to, when and about what. Support was received from loved ones, professionals and experiences beyond conversations. Conclusions: The study provide new knowledge of how patients and elderly experience the existential dimension. The respondents emphasized a desire to be selective with whom they shared these questions and thoughts.

Usability and desirability of a hearing health chatbot: an explorative study

OBJECTIVE

This study explored the usability and desirability of an AI-driven chatbot designed to support adults with hearing loss.

DESIGN

A mixed-methods exploratory study was conducted, incorporating mobile analytics, in-app feedback, and qualitative interviews. A prototype AI-driven chatbot was developed using GPT Creator and integrated into a simple app interface. Participants used the chatbot over a 2-week period, with their interactions and feedback recorded for analysis.

STUDY SAMPLE

Ten adults with hearing loss (mean age: 58.6 years, SD = 8.7) participated in the study.

RESULTS

Participant individual chatbot usage ranged from one to eight interactions. Key areas of inquiry included hearing aid functionality, tinnitus management, and audiologist-related concerns. The chatbot was perceived as user-friendly and useful for basic support, but experienced users desired more personalised responses. Suggested improvements included conversation memory, better handling of multiple questions, and enhanced voice-to-text functionality.

CONCLUSIONS

This study provides preliminary evidence that AI-driven chatbots may offer valuable support for adults with hearing loss. While usability and desirability were generally favourable, enhancements in personalisation and accessibility are needed to improve engagement and long-term adoption. Future iterations should incorporate user-centred refinements to maximise the chatbot's effectiveness in hearing health management.

Nurses' Perceptions of Caring at Work: Qualitative Findings

OBJECTIVE

The study objective was to identify qualitative themes of nurse perceptions of self, coworker, and leadership caring.

BACKGROUND

Although caring is an important and valuable component of nursing practice and a healthy nurse work environment, nurse perceptions of behaviors that exemplify caring in the work environment have not been extensively studied.

METHODS

Qualitative content analysis conducted with data retrieved from responses to open-ended questions from the Watson Caritas Self-rating Score, Watson Caritas Co-Workers Score, and Watson Caritas Leader Score.

RESULTS

Five primary themes were identified: 1) what matters most in a caring work environment; 2) what harms the caring work environment; 3) togetherness as a team; 4) pandemic impact on the caring work environment; and 5) distress emerging from unmet expectations.

CONCLUSIONS

Nurses reported positive and negative exemplars of caring that can be used to provide lessons for leaders to emulate caring behaviors and promote healthy, caring work environments.

Conceptual Analysis of Professional Conscience Among Healthcare Workers in Iran: A Hybrid Analysis

BACKGROUND

Professional conscience among healthcare workers is a contextual concept, which depends on various factors. Studies have revealed different meanings, definitions and characteristics for professional conscience. This study was conducted to clarify the concept of professional conscience and identify its characteristics among healthcare workers.

METHODS

This is a hybrid conceptual analysis, which was conducted in three phases of theoretical, fieldwork and final analysis. In theoretical phase, 22 articles were analysed using a combination of key words 'professional conscience', 'professional conscience in health', 'professional conscience in health workers' and 'health workers' from valid databases. In fieldwork phase, semi-structured in-depth interviews were conducted with 15 healthcare workers. In final analysis phase, results of two previous phases were integrated, and a comprehensive definition was presented for the concept of professional conscience.

FINDINGS

The six main themes extracted in the theoretical phase included: 'Evidence-based care', 'ethics reflection in care', 'correct and timely performance', 'professional commitment', 'response to the inner voice' and 'internal personal evaluation'. In fieldwork phase, the seven main themes extracted included: 'nursing as an inner and sacred value', 'human care', 'self-sacrifice', 'timely response', 'god's supervision in care', 'covenant between oneself and god' and 'being one's own judge'. In final phase, final definition of the concept was presented with combination of results of two previous phases.

CONCLUSIONS

The findings showed that professional conscience among healthcare workers is a dynamic and multidimensional concept, which consists of dimensions of comprehensive care, sense of commitment and responsibility, divine supervision on performance and self-evaluation.

Integrating physiotherapy into primary health care in Italy: qualitative focus group study examining perspectives of involved professionals

INTRODUCTION

The Community Physiotherapist model is an on-call service within the primary care setting, consisting of four consultations for people with chronic functional limitations. It was designed, developed and introduced as a project for the first time in Italy in 2021 and it has been shown to be effective and safe.

PURPOSE

Given the novelty of the model, this focus group study aims to explore the perspectives of involved physiotherapists, general practitioners and medical specialists on the perceived efficiency and quality of the service. A qualitative design was used with two balanced multidisciplinary focus groups of 12 participants. The Focus groups were audio recorded and transcribed verbatim. Data were analyzed using thematic analysis.

RESULTS

Five themes emerged from the analysis, related to the speed of both referral and intervention, tailored interventions and perceived quality: Efficiency, Perceived quality, Project implementation, Training, and Project dissemination.

CONCLUSION

The study findings showed that the model was appreciated by the professionals involved, although some aspect about communication between professionals and with patients/caregivers, as well as some organizational aspects, needed improvement. Further research should address the perspectives of the patients/caregivers involved.

Perspectives of healthcare professionals on cross-sectoral collaboration between mental health centers and municipalities: A qualitative study

AIMS

This paper aims to explore the intricacies of cross-sectoral collaboration in mental health care, focusing on the perspectives of health professionals across various disciplines. It seeks to understand how collaboration can enhance service delivery and patient outcomes while identifying existing challenges.

BACKGROUND

The evolving healthcare landscape emphasizes the importance of integrating services across sectors, particularly in mental health care, to improve continuity and efficiency of care.

DESIGN

The study utilizes qualitative methods to investigate health professionals' experiences with cross-sectoral collaboration in mental health services.

METHODS

Purposive sampling was used to select 21 health professionals for focus group discussions held at a mental health center in Region Zealand, Denmark. Data was collected through these discussions, and content analysis was performed to extract key themes. The data collection took place in 2022.

RESULTS/FINDINGS

Health professionals recognized the potential benefits of cross-sectoral collaboration, such as enhanced service delivery and improved patient outcomes. However, significant barriers were identified, including bureaucratic obstacles, communication gaps, and insufficient organizational support.

CONCLUSION

Cross-sectoral collaboration in mental health care offers significant advantages, but challenges must be addressed to fully realize its potential. Efforts should focus on policy reforms, organizational support, and fostering interdisciplinary communication to improve care delivery.

Experiences on Role Transition Among Nurse Prescribers

AIM

The aim was to describe the experiences of nurse prescribers on role transition during nurse prescriber education and working in a new role.

BACKGROUND

Nurse prescribing has increased globally, bringing a new importance for nursing. Transition into a new nursing role can be motivating, satisfying, and empowering. However, it can also be stressful and complex. It is important to know how the role transition from a nurse to a nurse prescriber could already be facilitated during studies and the first working years in a new role. As little work has been conducted on this topic, there is a gap in this research area.

METHODS

This phenomenological study was implemented with 14 Finnish nurse prescribers using semi-structured individual interviews. The data were analyzed with inductive content analysis.

FINDINGS

Altogether, this study identified four main categories for experiences on role transition. These main categories are in role transition during nurse prescribing education (1) learning decision-making; (2) meaningfulness of studies during education and at the beginning of nurse prescriber role at work; (3) development of expertise; and (4) significant change in work.

DISCUSSION

The meaningfulness of the learning and learning decision-making are important in role transition during nurse prescribing education. There is a significant development of expertise and change in work procedures during the transition from a nurse to a nurse prescriber.

CONCLUSIONS AND IMPLICATIONS FOR NURSING

Nurse prescriber education has a key role in the transition experience from registered nurse to nurse prescriber. It is also possible that healthcare units do not utilize nurse prescribers effectively.

B-phosphatidylethanol testing to identify hazardous alcohol use in primary health care-a game changer and a challenge for general practitioners: a qualitative study

BACKGROUND AND AIMS

Alcohol use disorder (AUD) and hazardous alcohol use are common but underdiagnosed in primary health care (PHC). This study aimed to explore general practitioners' (GPs') experiences and perceptions of using B-Phosphatidylethanol (PEth), a specific quantitative biomarker for alcohol use, in their clinical work with patient consultations and treatment follow-up in Swedish PHC.

DESIGN, PARTICIPANTS, AND SETTING

Individual interviews were conducted with GPs and resident GPs (n 20) in Swedish PHC and analysed using qualitative content analysis.

FINDINGS

The overarching theme PEth testing in primary health care-a game changer and a challenge illustrated that PEth testing has improved the prerequisites for the GP-patient interaction while making it more complex. Four categories underpinned this theme: Comprehending the context, describing the challenges in the GP-patient interaction when hazardous alcohol use or AUD was suspected; Getting the pieces in place, illustrating the struggle of integrating PEth testing into clinical practice and how it diminished the role of alcohol history taking; The challenges and facilitators of the conversation, comprising both the difficulties in informing about PEth testing and the positive impact on the interaction, and Considerations based on the PEth test results, emphasising the consequences of elevated PEth test results and their influence on physicians' motivation to using PEth.

CONCLUSIONS

PEth is an important tool in the identification of hazardous alcohol use. Emerging ethical dilemmas regarding patient information on PEth testing and management of medical and medico-legal obligations when test results indicate high alcohol use need to be addressed in future guidelines for clinical management of PEth.

The Experiences of Nurses as First Responders to Disaster: A Qualitative Study

This study aimed to explore the experiences of nurses who were the first to respond to the disaster, using a descriptive qualitative design. The sample consisted of 22 nurses who were nurses in the earthquake-affected provinces of Turkey or who were on assignment in the region after the disaster. Data were collected through individual in-depth interviews and analyzed using content analysis. The findings are categorized into four main themes: the assignment process, practical challenges, psychosocial challenges, and positive experiences. Under the assignment process, sub-themes of voluntary and non-voluntary assignment are identified. Practical challenges include ineffective crisis management, communication and coordination issues, lack of medical materials and equipment, difficulty working in tents, triage challenges, lack of personal hygiene, and nurses' lack of knowledge and skills. Psychosocial challenges encompass emotional burden, feelings of inadequacy, safety concerns, and the challenges of post-disaster recovery. Finally, positive experiences are reflected in the sub-themes of professional satisfaction and team support. The findings emphasize the need for disaster preparedness in health systems to enhance nurses' response capabilities and recommend that policymakers develop effective disaster management strategies.

'Balancing Challenges and Personal Resources': A Qualitative Study of Women's Experiences of Arm Impairment After Axillary Surgery for Breast Cancer

AIM

To explore how women previously treated for breast cancer experience living with arm impairment after axillary surgery.

DESIGN

Descriptive qualitative study. The inductive starting point for the analysis was followed by a deductive approach as the categories were related to the components of the sense of coherence framework.

METHODS

Twenty-eight relapse-free Swedish-speaking females participated in six focus group discussions conducted between September and December 2022. All participants had undergone sentinel lymph node biopsy with or without completion axillary dissection 4 years earlier. Data were analysed using qualitative content analysis.

RESULTS

Three categories and an overall theme were identified. The categories 'Sense-making', 'Daily life' and 'Driving force' reflect actions to understand and prevent arm symptoms, adaptations made in daily life and the empowering resources adopted to meet challenges. The overall theme, 'Balancing challenges and personal resources', comprised a process that began at diagnosis and remained ongoing for some participants. Most participants considered their new life situations manageable. However, those with more pronounced arm impairment reported that they did not always receive adequate aid, and that their daily lives were negatively affected.

CONCLUSION

Returning to everyday life after axillary surgery for breast cancer is associated with varying degrees of challenges. Individuals with persistent arm impairment find returning to normal life more challenging. Therefore, further improvements in person-centred care are of utmost importance.

PATIENT AND PUBLIC CONTRIBUTION

Members of the Swedish Breast Cancer Association were involved in the creation of the interview guide.

IMPACT

This study emphasises the requirement for providing further individualised support to those living with more severe arm impairment after axillary surgery.

REPORTING METHOD

This study was reported in accordance with the Standards for Reporting Qualitative Research.

Background and design of the Physical Frailty and Symptom Monitoring and Management Behaviors in Heart Failure (PRISM-HF) study: A mixed methods study

Background

Many adults with heart failure (HF) are physically frail and have worse outcomes. While the biological profile of physical frailty in HF has been examined, the behavioral profile remains unstudied. Physical frailty may impact self-care behaviors, particularly symptom monitoring and management (SMM), which in turn results in adverse outcomes. This paper describes the background and design of a study that addresses this knowledge gap, entitled "Physical Frailty and Symptom Monitoring and Management Behaviors in Heart Failure" (PRISM-HF).

Study design and methods

PRISM-HF is a sequential mixed methods study where in Phase 1, we collect quantitative data from a sex-balanced sample of 120 adults with HF, and in Phase 2, we collect qualitative data from ∼32-40 adults from this sample, aiming to: (1) quantify associations among physical frailty, SMM behaviors, and outcomes; (2) describe the experience of SMM behaviors for physically frail and non-physically frail adults with HF; and (3) identify the SMM behavioral needs of physically frail and non-physically frail adults with HF. At baseline, we measure symptoms, SMM behaviors, and physical frailty and collect clinical events at 6-months. We will use generalized linear modeling and survival analysis in Aim 1, directed content analysis in Aim 2, and triangulation analyses using an informational matrix in Aim 3.

Conclusions

This innovative study will investigate the behavioral underpinnings of physical frailty in HF, incorporate the patient's perspective of SMM behaviors in the context of physical frailty, and identify possible explanations for the effect of physical frailty on outcomes.

"It's hard to talk to a computer, I get it": An exploratory analysis of clinician connection-building communication practices in rural telepalliative care encounters

Context/Objectives

Establishing human connection is critical during serious illness conversations, however the sensory and relational environment of telehealth may require innovative communication practices for clinicians, patients, and families to do so effectively. We sought to explore if and how recommended in-person best practices for establishing human connection are adapted to the telehealth palliative care (telePC) setting, to enable discovery and description of practice innovations in this new care environment.

Methods

We analyzed data from the Northern New England Palliative Care TeleConsult Research Study - a formative mixed-methods pilot study at two academic medical centers in rural US states with patients with serious illness (2019-2020). We used a qualitative descriptive approach paired with directed content analysis to analyze video-recorded telePC consultations.

Results

Nine video-recorded telePC consultations were analyzed including 9 patients and 6 palliative care clinicians. Patient-participants had a mean age of 68 years, 56 % were women, and 38 % did not complete high school. Mean consultation duration was 52 min (standard deviation 10, range 40-70 min). Our qualitative analysis of visits resulted in three key themes describing clinician communication: 1) Practices for fostering human connection; 2) Practices for overcoming technical problems/difficulties; and 3) Practices for engaging in multi-participant tele-conversations.

Conclusion

Our study findings help to provide proof-of-concept evidence that clinicians can use recommended in-person connection-building communication practices in telePC. As palliative care clinicians naturally adapt to telehealth environments, more empirical research is needed to understand which innovative approaches most effectively foster human connection.

Innovation

TelePC represents an expanding, yet understudied, mode of palliative care delivery. This study is among the first to describe how the telePC context is catalyzing naturally-occurring communication innovations.

Identifying Trends in the Most Cited Nursing Articles: Research Topics, Author Gender Representation and Characteristics Correlated With Citation Counts

AIM

To assess the top 1000 cited nursing articles in terms of their impact, conceptual and social characteristics.

DESIGN

Bibliometric literature review design.

METHODS

A bibliometric analysis on the 1000 most cited nursing articles in English, focusing on assessing their impact and prevalent terms, keywords, co-occurrence networks and topic trends. Non-parametric statistical tests were used.

DATA SOURCES

Web of Science Core Collection (accessed 14 February 2024).

RESULTS

The 1000 most cited articles were exported from 201,310 eligible articles. The most cited articles received a total of 319,643 citations. The Journal of Advanced Nursing and the International Journal of Nursing Studies were the most cited journals. Literature reviews accounted for 21% of the most cited articles, compared to only 7% of all eligible articles. Most first authors were female, 63%. The data showed an increase in female first authorship among the most cited articles over time. This may reflect a shift towards greater gender equity in nursing research. Shorter article titles and fewer article pages were associated with more citations.

CONCLUSION

Methodological and conceptual articles received the most citations, likely due to their broad applicability (e.g., across disciplines) and enduring relevance. There was a statistically significant correlation between article brevity and citation count, but the relationship should be viewed with caution given the small effect size.

IMPLICATIONS FOR THE PROFESSION

Bibliometrics is important for evidence-based practice because it helps nurses evaluate journals, articles and research topics. Since citation counts do not always indicate research quality, nurses and nursing students would benefit from training in bibliometrics to enhance their critical thinking in this area.

IMPACT

Top-cited nursing articles indicate influential research topics and methods. They also influence authors' academic career opportunities, allowing assessment of research equity in terms of dominant countries and author gender representation.

REPORTING METHOD

The Preferred Reporting Items for Bibliometric Analysis (PRIBA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Collaborative coding in inductive content analysis: Why, when, and how to do it

Inductive content analysis (ICA) is a useful method for analyzing qualitative data in genetic counseling research. It is particularly relevant when the goal is to examine and improve practices or develop recommendations. Although ICA can be undertaken by a single analyst, ideally there is involvement of multiple analysts (or co-coders). Co-coding can bring many benefits to qualitative analysis that sits within a constructivist paradigm, including developing a representation of the data that is not only understandable to more than one individual but also richer and more nuanced. It also provides an opportunity for mentoring more junior researchers and can be an efficient way to analyze large datasets. However, co-coding requires important planning and consideration, and there is currently a paucity of clear guidance. In this paper, we provide an outline of the small body of existing literature on this topic and propose six flexible step-by-step components of our approach to co-coding in ICA, based on our own work. We have utilized it to analyze reporting practices and perspectives for diagnostic genomic sequencing, informed consent for genetic testing, data sharing and storage, and genomic newborn screening, among other topics. To illustrate these components, we present some example vignettes to show how these procedures can be applied in different scenarios and with different analysts.

Barriers to hand hygiene practice among healthcare workers in health centres of Kirkos and Akaki Kality sub-cities, Addis Ababa, Ethiopia: a qualitative study

Background

Hand hygiene is an easy step to reduce healthcare-acquired infections, and improve patient safety. Major progress in facility accessibility was made during the coronavirus disease 2019 (COVID-19) pandemic, and this led to greater adherence to hand hygiene practices. However, handwashing practices have now returned to the pre-COVID-19 era. Most of the studies that have investigated hand hygiene adherence are quantitative. As such, this study aimed to explore barriers to hand hygiene practice in the health centres of Kirkos and Akaki Kality sub-cities in Addis Ababa, Ethiopia.

Methods

Twenty-four healthcare professionals employed at the aforementioned health centres were interviewed using the key informant interview method. Data were analysed using a qualitative content analysis technique.

Results

Based on the findings, there were three main categories of barriers to hand hygiene practice: barriers related to individuals (including three sub-categories: lack of knowledge and skill, improper attitude, and poor attention and negligence of healthcare workers); leadership barriers (including two sub-categories: lack of dedicated staff and low attention of leaders); and institutional barriers (including three sub-categories: inappropriate infrastructure and lack of resources, shortage of water, and high work load and staff turnover).

Conclusion

There were several reasons why hand hygiene guidance was not followed. Hand hygiene barriers can be minimized by displaying colour-coded notice boards, making washing facilities easily accessible, monitoring the availability of soap, offering training, and providing accurate evidence about the need to enhance hand hygiene.

Unethical conduct as a multifaceted phenomenon in psychiatric care: Nurse leaders' perspectives

Background: Mental healthcare can be considered a unique practice due to its ethical characteristics, and an awareness of ethics is crucial when working in a mental health setting. Several ethical challenges exist, and professionals may not always recognize the ethical aspects of psychiatric care. Research on psychiatric care from nurse leaders' perspective is scarce but important, because nurse leaders can impact and cultivate workplace culture. Aim: To explore the phenomenon of unethical conduct in a psychiatric inpatient context from nurse leaders' perspectives. Research design: Qualitative exploratory design. In-depth semi-structured interviews. Participants and research context: Eight nurse leaders from two different healthcare organizations in Finland. Leadership experience ranged between 2 and 30 years. Ethical considerations: Research ethics permission was received from a Research Ethics Board where the researchers are domiciled. Guidelines on good scientific practice as delineated by the Finnish Advisory Board on Research Integrity TENK were followed. Findings: Six main categories were generated: Unethical conduct and violations against patients, Unethical conduct and violations against staff, Unethical conduct and violations by staff against other staff, Unethical conduct and violations against leaders, Reasons underlying unethical conduct, and Consequences of unethical conduct and the positive development of psychiatric care. Conclusions: Unethical conduct was seen to be a multifaceted phenomenon, and patients and staff alike can experience and engage in unethical conduct. Unethical conduct against patients was linked to power imbalance (nature of involuntary care, staff attitudes) and a focus on rules based in historical precedent (paternalistic, routine-focused, not patient-centered). Unethical conduct against staff was linked to the nature of involuntary care and patient ill-health. Unethical conduct by staff against other staff was linked to a lack of understanding for others' work, interpersonal chemistry, (length of) work experience, and staff character. Unethical conduct against leaders was linked to leaders being perceived as the organization.

Co-Producing and Evaluating a Culturally Inclusive Dementia Education Initiative: A Multimethod Study Protocol

INTRODUCTION

Limited dementia awareness among culturally and linguistically diverse communities can exacerbate stigma and hinder support for carers and people at risk of or living with dementia. Co-producing a culturally inclusive dementia education intervention with representative stakeholders can address these knowledge and service gaps. This paper details the protocol for designing and evaluating a co-produced multilingual dementia education intervention named Dementia Friends Unite. This project aims to improve dementia knowledge, attitudes and supportive practices in a multicultural context.

METHOD

This project will be conducted in South Western Sydney, Australia, where Arabic, Cantonese, English, Greek, Mandarin and Vietnamese are the most common languages spoken. A multi-stakeholder collaboration involving representatives from each of these communities was formed to co-produce the multilingual dementia education intervention. Two studies are planned to explore the co-production process and evaluate the intervention's impact, guided by implementation science frameworks. Study 1 will examine stakeholder and researcher experiences in co-production through minuted meetings and responses to the patient and public engagement evaluation tool. Data will be descriptively analysed to identify the barriers and facilitators to co-production. Study 2 involves evaluating the initiative's impact according to the RE-AIM framework. Outcome measures include intervention reach and effectiveness in changing participants' knowledge, attitudes and supportive practices through questionnaires (pre-, post- and follow-up) and interviews; adoption and implementation characteristics through focus groups with stakeholders and facilitators; and maintenance through a cost-benefit analysis.

CONCLUSION

This project will employ a comprehensive approach to address unmet needs and research gaps in co-produced dementia education and its implementation in multicultural contexts. It can serve as a blueprint for others seeking to engage culturally diverse populations in community-based health education and research.

PATIENT OR PUBLIC CONTRIBUTION

A multi-stakeholder collaboration involving representatives from local government and care services, as well as people with living and caring experiences of dementia, from each of the targeted communities, was formed to co-produce this initiative. Their involvement spans study design, conduct, interpretation of findings and dissemination.

Patient experiences of narcolepsy and idiopathic hypersomnia in the Nordics: a patient journey map

Central disorders of hypersomnolence (CDH) are chronic diseases that significantly impact the lives of affected individuals. We aimed to explore the perspectives of individuals with narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH), and the challenges they encounter in their daily lives and within the healthcare systems in the Nordics. Interviews with patients (N = 41) and healthcare professionals (n = 14) and a patient survey (n = 70) were conducted in 2022 in Denmark, Sweden, Finland, and Norway to develop a patient journey map that visualises the patient with CDH journey and provides insights into the difficulties faced by these individuals. The patient journey mapping approach was chosen to focus on the processes and experiences of patients, highlighting the challenges they confront. Our findings revealed that the process of receiving a CDH diagnosis, as well as subsequent misdiagnoses and treatment, can be protracted and burdensome. CDH diagnoses remain poorly understood by neurologists, general practitioners, and the public, resulting in adverse consequences, with patients reporting a mean (standard deviation [SD]) time from symptom onset to diagnosis of 8.4 (5.11) years and a mean (SD) of 5.5 (4.17) productive hours lost/day. The available non-pharmaceutical support for patients with CDH, encompassing medical, psychological, educational, and professional assistance, was insufficient. The generalisability of the findings to one specific diagnosis is limited due to the collective analysis of the CDH. These findings are invaluable for identifying disruptions in the patient with CDH journeys and for designing improved pathways for those with NT1, NT2, and IH in the future.

They paid attention to the whole of me in some way, both physically, mentally, and everything in between: a qualitative study of patients' experiences of interdisciplinary rehabilitation (PREVSAM) in primary care for musculoskeletal disorders

PURPOSE

To explore and describe patients' experiences and perceptions of rehabilitation according to the rehabilitation model 'Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal pain' (PREVSAM).

METHOD

A qualitative study was conducted, with individual semi-structured interviews analysed using qualitative content analysis. Fifteen patients from three primary care rehabilitation clinics in Sweden who had undergone rehabilitation based on the PREVSAM model participated.

RESULTS

Four categories were identified from the participants' experiences: Gratitude for the holistic view, Challenging but clarifying to create a health plan, Different needs for addressing work-related factors, and Difficulties and negative experiences. From these categories, an overarching theme was conceptualised: Grateful for being seen for who I am and given the care I need.

CONCLUSION

Participants were generally positive towards the PREVSAM model. The addition of occupational therapy and psychological treatment to physiotherapy was seen by many, albeit not all, as enriching the rehabilitation. Collaboration with the workplace was mainly considered 'good in theory'. The wide variation in the need for support underscore the importance of person-centredness.

Need for Human Interaction and Acknowledging Communication-An Interview Study With Patients With Aphasia Following Stroke

AIM

To explore stroke patients' experiences of the communicative practice during their hospitalisation and describe strategies and supporting communication techniques applied by patients and nursing staff from the patient's perspective.

DESIGN

A qualitative descriptive study was undertaken.

METHODS

A qualitative approach was chosen; through a purposeful sample strategy, 13 semi-structed interviews with 12 patients who had aphasia following stroke, and one patient had dysarthria. The interviews were video-recorded and partially transcribed. Data were analysed according to Graneheim and Lundman's content analysis. Interview data were collected in 2022.

RESULTS

The analysis generated one overarching theme; Being acknowledged as an equal human being as it appeared to be a pervasive and underlying trait across the four categories; Waking up to a new communicative reality, A task-oriented communicative agenda, Misunderstandings as a communicative dead end and Establishing a communication-friendly environment: peace, patience and supporting techniques, describing the immediate and descriptive level. The patients did not seem to encounter a systematic approach to communication. They perceived the health care staff's communication as primarily task and purpose-oriented, lacking deeper conversations, which seemed to leave several with unmet emotional and psychological needs. Emotional, relational and existential aspects seemed interwoven in communication.

CONCLUSION

These findings contribute by illuminating an important patient perspective and ultimately, raising the point that from the perspective of patients the nursing staff's communication was primarily task and purpose oriented, and they lacked deeper conversations. Hence also raises the point that the use of supportive communication strategies alone will allow nursing staff to meet the existential needs of patients with aphasia. Supported communication needs to address compassionate and acknowledging aspects of communication. No Patient or Public Contribution in this paper.

It Has To Be My Way-Reducing Sedentary Time in the Transition to Retirement

BACKGROUND

Sedentary behavior is highly prevalent in older adults transitioning to retirement. Sedentary time is all of the time spent in sedentary behavior, and prolonged sedentary time is associated with an increased risk of noncommunicable diseases. The aim of this study was to explore perceptions among older adults transitioning from working life to retirement regarding self-management strategies for reducing sedentary time and adhering to the reduced sedentary time.

METHODS

Twenty-eight older adults, age 60-75 years, participated in one of four focus group interviews. Qualitative content analysis was used to analyze the data.

RESULTS

The analysis resulted in the theme "It has to be my way," and the three categories "Activities scattered with joyfulness," "Support for changes in everyday life," and "Health affects willingness and ability, and is affected by adherence."

CONCLUSIONS

Interpreted from the perspective of self-determination theory, self-management strategies for reducing sedentary time should be adaptable as every individual is unique, indicating a need for autonomy. Sedentary time was said to be reduced by activities that evoked joyfulness, and joyfulness was considered to increase adherence. Support for changes to one's everyday life was considered necessary. The support that was mentioned primarily involved targeting cognitive determinants such as self-efficacy and attitudes. This new knowledge can be included when designing self-management interventions; however, more research is needed in order to evaluate whether self-management strategies targeting autonomous motivation and affective determinants, such as affective judgment and cognitive determinants, can reduce sedentary time in those who are in the transition to retirement.

Physical Activity on Prescription "Not a Quick Fix": School Nurses' Experiences of Promoting and Tailoring Physical Activity to Children in Swedish Compulsory School

This study aimed to explore school nurses' experience of using physical activity on prescription with children in Swedish compulsory school. Semistructured interviews were conducted with 24 school nurses who had the educational qualification to prescribe physical activity. The analysis resulted in one overarching theme, "A delicate process of tailoring physical activity on prescription to a child's social context," and two categories: "Promoting joyful physical activity through individualization and support" and "Dealing with dilemmas and challenges," with related subcategories. The results demonstrate the importance of tailoring prescribed physical activity to each individual child, their living conditions, and the school context. In addition, they highlight the nurses' working conditions and collaborations as important prerequisites when initiating physical activity on prescription. In conclusion, the results suggest that school nurses perceive physical activity on prescription as a useful tool in the school context, but it needs to be tailored to each individual child.

Domains of Discharge Readiness for Patients After Abdominal Surgery: A Qualitative Exploratory Study

AIM

To explore the domains of discharge readiness among patients following abdominal surgery.

DESIGN

A qualitative exploratory study.

METHODS

Data were collected through semi-structured interviews involving patients, caregivers, and healthcare providers (clinical nurses and surgeons) engaged in abdominal surgical care. A total of 19 participants contributed to the study through four focus group discussions and four individual interviews. Data were analysed using content analysis. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

RESULTS

Five key dimensions of discharge readiness were identified: physical readiness, knowledge/information readiness, psychological readiness, social readiness, and spiritual readiness. Each domain includes specific factors that influence a patient's preparedness to transition safely and effectively from hospital to home.

PATIENT CONTRIBUTION

Patients and caregivers provided valuable insights into the core domains of discharge readiness through their active participation in this study.

The benefits of caregiver singing and receptive music in dementia care: a qualitative study of professional caregivers' experiences

BACKGROUND

For persons with dementia, receptive music may reduce negative expressions and increase positive ones. Caregiver singing (CS) is an intervention aimed at facilitating care situations and involves caregivers singing for or together with persons with dementia during care activities. In the literature, CS is commonly addressed as a music activity rather than a care intervention. The aim was to describe caregivers' experiences of the reactions of persons with dementia when using CS and receptive music in dementia care.

METHOD

The data comprised three focus group interviews with 12 professional caregivers in dementia care, analysed using qualitative content analysis.

RESULTS

the analysis resulted in two themes: "CS increases interaction and builds companionship" and "Receptive music soothes, awakens memories and reflects the person's self".

CONCLUSION

Both CS and receptive music was shown to have positive influences, and while the results were sometimes intertwined, CS was shown to better facilitate problematic care situations.

Assessment Teams Experience of Barriers and Challenges When Assessing Loneliness and Depression Among Home-Dwelling Elderly: A Qualitative Study

BACKGROUND

Loneliness and depression in the elderly population are a worldwide challenge. Elderly people receiving home care are very vulnerable, as they often suffer from comorbidity and various other challenges.

AIM

The study aim was to explore how care assessment teams experience assessing loneliness and symptoms of depression among home care recipients aged 65 years and older in planned home visits.

METHOD

This study has a qualitative design. Data were collected during two phases. First, data from documents were collected in seven municipalities on 168 home care decisions made by assessment units during 1 month. Second, 10 caseworkers and 10 case managers from different care assessment teams in 20 municipalities located in four different regions in Norway were individually interviewed. Both data sources were analysed using qualitative content analysis.

RESULTS

Analysis of the documents revealed that only three of the 168 home care decisions described support for mental health. The analysis of the interviews resulted in three themes: (i) 'Physical health has higher priority than mental health in home care', (ii) 'Being diagnosed is essential to receive support from home care', (iii) 'Major differences in mental health support between municipalities'.

CONCLUSION

Caseworkers in care assessment teams find that many home-dwelling elderly are struggling with loneliness and depression, but barriers on both organisational and administrative levels prevent them from providing appropriate interventions. Mental health is thus not systematically recorded in assessments, which may lead to loneliness and depression being overlooked. There are significant differences between municipalities regarding service offerings and follow-up procedures for loneliness and depression, and both caseworkers and municipal leadership must ensure a system that provides comprehensive patient care.

Feasibility of implementing a codesigned patient reported outcome measures (PROMs) collection system for older adults in acute and sub-acute hospital settings

PURPOSE

To test the feasibility of a co-designed PROMs collection system for hospitalised older adults.

METHODS

A mixed-methods feasibility study was conducted sequentially across one acute and one sub-acute ward, over a 12-week period. Patients aged ≥ 60 years who discharged from hospital were eligible. The EQ-5D-5L with added items on fatigue and cognition was administered on discharge and at 3-6 months post-discharge. Administration was by either a research assistant or volunteer using a variety of modes (tablet computer, phone, SMS). Feasibility was evaluated using a feasibility framework to capture demand, implementation, practicality, and acceptability. Descriptive statistics were applied. Interviews were conducted with volunteers and analysed using deductive content analysis.

RESULTS

Completion rates indicated high demand (discharge = 84%, n = 110/131; follow-up = 81%, n = 90/110). At discharge, most completed PROMs on the tablet (57%) and 9% were administered by a volunteer. Most required assistance using the tablet (67%) and the average time to administer PROMs was longest for the tablet (17.9 min, SD = 3.3), followed by phone (8.8 min, SD = 4.4) and SMS (1.3 min, SD = 0.5). Fewer participants reported acceptability with using the tablet (61%) compared to SMS (100%). At follow-up, most completed PROMs on the phone (82%) and the average time to administer PROMs was less than discharge (4.9 vs. 13.4 min). Volunteers reported administering PROMs to unwell patients was challenging.

CONCLUSION

A co-designed PROMs collection system demonstrated feasibility in hospitalised older adults with phone and SMS having greatest acceptability. Administration of PROMs by volunteers was not feasible.

TRIAL REGISTRATION

ACTRN12623000576628. Registered 25 May 2023.

Success factors in clinical teaching: An integrated pedagogical approach

INTRODUCTION

Clinical learning has an important role in health care education. However, challenging working environments with increasing staff turnover, sick leave and high work pace create tensions between teaching and clinical activities. After participation in a faculty development program, a teacher team implemented new activities, the supervisors were grouped in pairs for support; a workshop was created for sharing experiences; and a video about feedback was produced.

OBJECTIVES

To explore and describe supervisors' perceptions of workplace-based interventions to develop quality in supervision in a clinical learning environment, we posed the research question: How did physiotherapy supervisors perceive the interventions during their supervision?

METHODS

A qualitative study was conducted. Data was collected using focus group interviews with clinical physiotherapist supervisors (n = 12) and analyzed with inductive qualitative content analysis.

RESULTS

One overarching latent theme was identified: an integrated and structured pedagogical approach was key to manage clinical learning. Three categories were identified: The teacher team contributed to structure and a sense of coherence, increased opportunity for collegial collaboration, and clarification of tasks and roles decreased experience of stress.

CONCLUSION

The teacher team and the learning activities implemented contributed to an integrated pedagogical approach where collegial collaboration was beneficial for both new and experienced supervisors. Through the testing of new approaches, the clinical supervisors reported that their educational work was made more visible and attractive and that the well-functioning organization made a difference.

Barriers to active transport modes in Tehran, Iran: a qualitative study from the citizens' perspective

BACKGROUND

A physical inactivity epidemic has been described as one of the greatest public health challenges. It accounts for 6% of deaths and is the fourth most common risk factor for mortality worldwide. Active transport (i.e. cycling and walking) has been identified as a key strategy for combating physical inactivity. Our aim was to explore the barriers to and perceptions of active transport modes in Tehran from the perspective of citizens.

METHODS

This qualitative study was conducted using a phenomenological approach, from April to November 2024. Twenty-five individual interviews and four focus group discussions were conducted with 18 residents of Tehran. Interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis in MAXQDA 18 software.

RESULTS

Participants mentioned walking in their daily lives, but never using a bicycle. Although cycling is not a widely used mode of transport among Tehran residents, it has been reported to be a clean and environmentally friendly mode of transport and an effective vehicle for reducing traffic congestion and air pollution. Walking was also considered a convenient mode of transport that could help save money. Three main themes were identified as barriers to active transport modes: (1) individual-level factors (e.g., lack of skills and confidence); (2) social and cultural-level factors (e.g., incompatibility of women's cycling with cultural conditions); and (3) environmental-level factors (e.g., poor infrastructure).

CONCLUSION

Our study found that there are multiple barriers to cycling and walking as active modes of transport at individual, social and cultural, and environmental levels. Thus, programs or policies promoting active transport modes are effective when they target a multi-component approach.

Why they come, why they stay and why they leave: a survey to understand the drivers of recruitment, retention, and attrition of allied health clinicians in an Australian metropolitan health network

BACKGROUND

While allied health plays a central role in healthcare, workforce challenges are straining the sector. Challenges are shaped by population changes, emerging models of care, and educational limitations, and were exacerbated by COVID-19. This study aimed to identify drivers of recruitment and retention for allied health clinicians in an Australian metropolitan setting. Identifying and addressing these factors is essential to the design and implementation of tailored, evidence-informed workforce strategy and policy.

METHODS

This cross-sectional, online survey explored workplace attraction, job seeking behaviours, and workplace perceptions. 29 Likert-scale statements informed by the existing literature examined factors influencing allied health retention. Allied health employees from a single Australian metropolitan health network were invited to participate. Descriptive statistics, logistic regression, and deductive content analysis were undertaken.

RESULTS

42.6% (n = 593) of those invited participated in the survey, with 45.7% (n = 271) of participants having been with the organisation for six or more years. 35% (n = 197) of respondents to a question about intention to leave agreed that they aimed to leave their current role within six months. Variables associated with intention to leave were not feeling a sense of satisfaction with their role (odds ratio [OR] 1.51, 95% CI 1.22-1.85), not being recognised and rewarded by the team manager (OR 1.37, 95% CI 1.12-1.67), not working in the preferred clinical area (OR 1.56; 95% CI 1.25-1.95), and feeling burned out by the job (OR 1.44; 95% CI 1.16-1.78). Qualitative findings support the centrality of aspects of the job (job characteristics), the organisational context (rewards offered; climate; organisational support) and person-context interface (peer/group relations; work-life conflict) to attraction, retention, and attrition in roles.

CONCLUSION

This study identifies factors affecting recruitment, retention, and attrition of allied health professionals in a metropolitan setting. Findings are impacted by the personal and professional effects of the COVID-19 pandemic response. Results provide a baseline upon which the impact of interventions can be measured, while informing the prioritisation and design of tailored workforce strategies. Further, findings may inform local policy responses to improve the allied health workforce and ensure excellent care for the community.

Pandemic Recipes-Nutritional Values of Recipes in Legacy Media

BACKGROUND/OBJECTIVES

Legacy media are those that existed prior to the advent of the internet. Legacy media have a focus on the needs of specific readership populations. Because of this focus, they remain a trusted source of information for many people. During the COVID-19 pandemic, these media addressed readers' needs for recipes for home food preparation.

METHODS

To evaluate the accuracy of the recipe descriptions and to compare these to their estimated nutritional value, we examined 182 recipes extracted from 942 food- and nutrition-related articles in a sample of magazines collected from January to December 2020. Because herbs and spices enhance the palatability of foods, are associated with healthier diet patterns, and provide phytochemicals which may have health benefits, we also examined the inclusion of these in the recipes when comparing their nutritional value.

RESULTS

Nutrient comparisons across these groups showed that recipes identified as healthy were the highest in vitamin C, fiber, and potassium and the lowest in cholesterol (p < 0.01). Cocktails were about half the calories per serving as all other recipes, and they were substantially lower in all the nutrients evaluated (p < 0.01) except for sugars (p = NS). An increase in seasonings was associated with higher levels of vitamin A, vitamin C, calcium, potassium, iron, and fiber (p < 0.001). Recipes with added seasonings were also lower in sugar (p < 0.05).

CONCLUSIONS

Overall, these results support the hypothesis that recipes in legacy media identified as healthy, as well as those that contained more herbs and spices, were more likely to correspond to healthy diet guidelines.

Exposure to distressing situations among registered nurses during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

The COVID-19 pandemic exacerbated distressing situations among healthcare professionals, due to resource limitations and complex patient care challenges.

RESEARCH OBJECTIVES

The research aims to explore the frequency of RNs' exposure to distressing situations across various care settings during the pandemic and assess the association between this exposure and: (1) stress of conscience, (2) intentions to leave the profession, (3) job satisfaction, and (4) self-rated health in the late phase of the pandemic. In addition, the aim was to describe other common situations they encountered during the pandemic.

RESEARCH DESIGN

A cross-sectional multi-method study was conducted with participants recruited from a national cohort of Registered Nurses (RNs) between October 2021 and January 2022. In total, 3,958 individuals met the eligibility criteria, with 2,237 participants (56.5%) responding to the survey. Among these respondents, 1,881 answered questions about distressing situations, and 239 shared open-ended responses about their experiences.

RESULTS

The results showed that during the peak of the COVID-19 pandemic, between 24% and 70% of RNs encountered distressing situations on a weekly basis or more often. Over 70% reported difficulties in communication due to personal protective equipment. Additionally, just over 40% of RNs reported working in situations lacking clear guidelines and facing prioritization challenges. RNs exposed to these distressing situations were frequently nearly twice as likely to experience stress of conscience (44% vs. 21%, [OR] = 2.87) and showed a stronger intention to leave the profession (25% vs. 14%, [OR] = 1.98). Moreover, they reported lower job satisfaction (85% vs. 92%, [OR] = 0.50) and poorer self-rated health (34% vs. 50%, [OR] = 0.52) compared to their counterparts with less exposure. In addition, RNs experienced a lack of support, understaffing, and working beyond their expertise, leading to emotional and physical exhaustion. They felt inadequate due to overwhelming workloads and limited recovery time.

CONCLUSION

The COVID-19 pandemic has significantly impacted RNs, underscoring the need for strong organizational support and leadership. Nurses require guidance from leaders and institutions to manage distress and ethical challenges effectively. Future strategies should prioritize adequate staffing, skill development, teamwork, mental health resources, and transparent communication to support nurses' wellbeing and recovery, ensuring the delivery of high-quality care.

Manual therapists in Sweden during the COVID-19 pandemic -they remained in business, but how was their work environment and practice impacted?

BACKGROUND

The Swedish governmental strategy during the COVID-19-pandemic was to impose voluntary recommendations to limit viral spread, but to keep health care and important societal functions running. The objective of this study was to describe the work environment and practice of manual therapists, who were challenged by this strategy, in Sweden during a year of the pandemic.

METHODS

The cohort study Corona And Manual Professions (CAMP) was studying chiropractors and naprapaths, registered in the public register of licensed manual therapists in Sweden, during the pandemic. Mixed methods were used to answer the research aims. Surveys were distributed in November 2020, during the second wave, and in February, May and November of 2021. The quantitative data were presented descriptively, with the development over time illustrated in graphs. The qualitative data from the free-text answers were analyzed using content analysis.

RESULTS

In total, 816 manual therapists (47% of the invited sample) were included in the study, of which between 275 and 662 participants answered the free-text questions. At baseline, most (60-65%) rated their knowledge of viral infections and their spread, of vulnerable patient groups, and of protective gear as fairly good or good. Most (68-70%) were able to follow the official recommendations, but decreased numbers of patients and changes in clinic routines were reported. There was a positive trend in caring adequately for patients and having access to protective gear. Manual therapists reported that they were unable to care for vulnerable patient groups, had to adhere to routines perceived as onerous, and found care to be less personalized.

CONCLUSION

At the time of the outbreak of the COVID-19 pandemic, manual therapists in Sweden encountered challenges regarding knowledge about pandemics and availability of protective equipment. Sweden's official recommendations were possible to implement by the manual therapists, but had adverse impacts on clinic activities and patient care. Despite this, over 50% were able to deliver adequate care for their patients.

The challenges of prenatal care services during the COVID-19 pandemic: qualitative evidence of primary health care providers' perspective in Iran

BACKGROUND

The COVID-19 pandemic affected almost all healthcare services, including prenatal care. Providing care to pregnant women during the pandemic was affected by general policies related to the control of COVID-19 and thus faced many challenges. Exploring the challenges of prenatal care during the pandemic can be helpful for effective planning and interventions to reduce the fundamental challenges. The present study aimed to explore the midwives' perception of care challenges during the COVID-19 pandemic.

METHODS

This qualitative research was conducted using conventional content analysis in 13 health centers of Hamadan, Iran, between July and September 2023. A semi-structured interview was conducted with 13 midwives who had experience providing prenatal care services to pregnant mothers during the COVID-19 pandemic and were selected using the purposive sampling method. Granheim and Lundman's 5-step content analysis approach was used for data analysis.

RESULTS

Three themes describing challenges to prenatal care during the COVID-19 pandemic emerged, including the unfamiliarity and unpreparedness of the health system in facing COVID-19, disruption in the quantity and quality of services, and socio-economic and systemic challenges.

CONCLUSION

PNC providers have experienced various challenges during the current COVID-19 pandemic. The results of the present study can be used to reduce the problems and challenges of providing prenatal care services in future pandemics. Effective interventions such as strong and managed organizational support, maintaining and sustaining the midwifery staffing, empowering PNC providers, supplying personal protective equipment, adopting strategies to improve mental health, and considering special measures and various incentives for midwives are necessary to overcome similar crises in the future.

"It is today that counts, and today everything is fine": coping strategies utilized by parents of children treated for cancer who seek psychological support - a qualitative study

BACKGROUND

Childhood cancer treatment completion is a period of vulnerability for parents and is associated with depression, anxiety, restrictions on daily life, and negative socioeconomic consequences. Understanding what helpful and unhelpful coping strategies parents utilize to manage cancer-related distress and concerns may inform the development of tailored psychological support. However, coping strategies used by parents who seek psychological support related to their child's cancer are not well described. To address this gap, we conducted an embedded semi-structured interview study with parents enrolled into the feasibility study ENGAGE. The overall aim of ENGAGE was to examine the acceptability and feasibility of an internet-administered, guided, low intensity cognitive behavioral therapy based self-help intervention, EJDeR. Study aims were to: (1) describe coping strategies used by parents who seek psychological support after end of treatment to cope with cancer-related distress and concerns and (2) consider these coping strategies to inform ongoing adaptations to the EJDeR intervention, taking potential gender differences in coping and subsequent support needs into consideration.

METHOD

Seventy-three semi-structured interviews were conducted. Data was coded using inductive manifest content analysis and subsequently triangulated with a secondary theory-driven data analysis guided by the control-based model of coping.

RESULTS

Parents used three primary control coping strategies: utilizing tools and techniques, striving for a healthy and balanced lifestyle, and seeking support. Parents used three secondary control coping strategies: accepting and refocusing, adapting to the situation with help from others, and distracting temporarily. Parents used one disengagement-focused coping strategy: avoiding and distancing.

CONCLUSIONS

Parents adopted both primary and secondary control coping strategies as well as disengagement-focused coping strategies in accordance with the control-based model of coping. Findings supported the choice of low intensity cognitive behavioral therapy techniques used in the EJDeR intervention to target behavioral and experiential avoidance (i.e., disengagement-focused coping). A need to emphasize the importance of seeking social support in future EJDeR adaptations was identified. Understanding coping strategies used by parents of children off treatment who seek psychological support may inform the development of other psychological interventions for the population.

TRIAL REGISTRATION

ISRCTN57233429 ( https://doi.org/10.1186/ISRCTN57233429 ; registration date 19/04/2018).

In their own words: older persons' experiences of participating in co-creation

BACKGROUND

Co-creation methods ensure that interventions are tailored to the target group by incorporating their unique insights and preferences, strengthen innovation, and facilitate implementation. Although co-creation research is becoming more common, most research exploring co-creation focuses on the researchers' perspectives rather than the experiences of the target population. By exploring these experiences, researchers can better understand the preferences for, and facilitators/barriers to, engagement and participation to inform future co-creation studies. This study aimed to explore older persons' experiences and insights into participating in co-creation of an intervention to prevent falls.

METHODS

Qualitative interviews were conducted with 13 community-dwelling older persons (aged 66-83 years) after their participation in a co-creation study developing an intervention for fall prevention. Data were analyzed using qualitative content analysis.

RESULTS

Three themes emerged from the analysis: Diversity of co-creators enriches understanding and creativity, Interactive activities promote learning, and Supportive environments enhance collaboration. These themes describe how participating in workshops with others deepened and broadened participants' knowledge and understanding of the subject and enabled them to contribute their experiences and perspectives. Discussing and testing exercises gave participants new insights into their physical abilities and the importance of exercise and a better understanding of the concept of motor-cognitive exercises and their role in everyday life. A respectful atmosphere where everyone shared responsibility for creating a supportive environment so all participants could express their thoughts was perceived as important by the participants.

CONCLUSIONS

The results underscore the potential for co-creation to enhance participants' knowledge and understanding of the topic, as well as their own capacity. For researchers, it is important to consider how to foster an inclusive and supportive environment, thereby boosting participation, engagement and collaboration.

Lived experiences of maternal near misses: a qualitative study in the Kilimanjaro Region, Tanzania

BACKGROUND

In recent years, Tanzania has significantly reduced maternal mortality rates; however, pregnant women in Tanzania still face severe health risks and complications. The rate of maternal near misses is nearly 60% higher in Tanzania compared to other low-income countries. Women who survive severe complications during pregnancy or childbirth may experience long-lasting adverse effects, such as poor physical health, impaired sexual function, psychological distress, and a decreased quality of life. Therefore, our research aimed to understand the lived experiences of Tanzanian women who survived severe maternal complications within their cultural and social context.

METHOD

By using the Sub-Saharan Africa criteria for near misses, twelve (12) women who survived severe maternal complications were recruited between August and September 2022. The study utilized a descriptive qualitative design with an inductive approach to explore women's lived experiences of a maternal near miss. The participants were purposively sampled and interviewed face-to-face in the hospital or their homes six weeks after discharge from the hospital. Recorded interviews were transcribed and analysed using Graneheim and Lundman's content analysis.

RESULTS

The analysis revealed four themes and eight subthemes. The themes were living with severe maternal complications, impact on social life, perception of obstetric care services and person-centred care. The informants described pain experiences, weakness, fear, financial difficulties, neglect, long waiting times, and a lack of information. However, they also mentioned a need for increased awareness of danger signs, care satisfaction, and the importance of close relatives' social support.

CONCLUSION

Maternal near misses have a great impact on women's physical, financial, and mental well-being. Women also experience long service waiting times, communication barriers, and neglect. Good healthcare, person-centred care, patient education, and psychological support can improve women's lived experiences.

Taking action, return-to-work strategies used by Iranian cancer survivors: a qualitative study

OBJECTIVES

The transition back to work after cancer is a significant milestone for many survivors, affecting their financial stability, psychological well-being and overall quality of life. Return-to-work (RTW) process is often complicated by lingering physical and cognitive impairments, changes in self-identity and workplace dynamics. Understanding how cancer survivors navigate this process is crucial for the development of effective support systems. This study aimed to explore strategies employed by cancer survivors in managing the RTW process.

DESIGN

This study employed a qualitative content analysis approach to explore RTW strategies used by cancer survivors.

SETTING

The study was conducted at a referral cancer centre and the workplaces of cancer survivors located in East Azerbaijan, Iran.

PARTICIPANTS

A total of 22 cancer survivors were selected using purposive sampling. These participants had completed primary cancer treatment and had rich and diverse RTW-related experiences. Data were collected through semi-structured, face-to-face interviews and then analysed using the inductive content analysis approach described by Graneheim and Lundman (2004).

RESULTS

'Active Strategies for Returning to Work' constituted the main theme and consisted of three categories, including assessing the situation, self-accommodation and impressing the workplace.

CONCLUSIONS

Cancer survivors actively engaged in RTW. They evaluate their situations before returning to work, seek to accommodate themselves to their circumstances and impress their workplaces to gain the necessary support. Healthcare providers, employers and families, as the most influential parties in the RTW process of cancer survivors, should recognise survivors' positive strategies and provide informational, financial, emotional and occupational support.

Health care professionals' perspectives and experiences of low-risk outpatient and inpatient labour induction: A qualitative interview study within the Swedish OPTION trial

PROBLEM

Labour induction rates are rising globally, with 25 % of all births induced today. Research on professionals' perspectives is limited. Few qualitative studies have been conducted, and none in the Nordic countries.

BACKGROUND

Some countries offer low-risk outpatient induction, allowing women without monitoring needs to await contractions at home.

AIM

To describe Swedish health care professionals' perspectives and experiences of low-risk outpatient and inpatient induction.

METHODS

A qualitative interview study was conducted at five hospitals participating in the randomised controlled OutPatient InducTION (OPTION) trial (EU CT No.: 2023-507,164-39-00). Focus group discussions or individual interviews were held with 20 health care professionals (midwives, obstetricians and auxiliary nurses) and analysed using qualitative content analysis.

FINDINGS

Four generic categories were identified: The woman is more central; The birth companion has a natural role; Strategies are needed to maintain safe care; and Health care resources are used more effectively. Professionals viewed low-risk outpatient induction as a beneficial option for many women. They highlighted advantages for women, companions, health care professionals and their work environment, and resource allocation, but emphasised the importance of ensuring safe care.

DISCUSSION

Professionals' experiences support previous research on women's experiences of outpatient labour induction. The structured implementation of the OPTION trial, including guidelines, training and communication strategies, facilitated integration.

CONCLUSION

While underscoring the need for robust safety protocols, according to our findings professionals find that low-risk outpatient induction can improve care, by offering benefits for women, their companions, and the health care system, and contributing to an improved work environment.

Examining the hesitations of pregnant women towards COVID-19 vaccines during the pandemic: A mixed methods approach

BACKGROUND

Various reasons stemming from direct vaccine concerns, individual factors, and sociocultural and environmental factors contribute to vaccine hesitancy among pregnant women regarding COVID-19 vaccines.

AIMS

The study described and compare pregnant women's perspectives on COVID-19 vaccination during the pandemic and to identify barriers and facilitators.

FINDINGS

A mixed-methods research design was adopted to integrate quantitative and qualitative descriptive methods. At a state hospital in the western region of Turkey, 249 pregnant women attending the maternity clinic from March to August 2022 were surveyed using questionnaires, and in-depth individual interviews were conducted with 17 of them. The interview topics were based on the participants' perceptions and attitudes toward COVID-19 vaccines. A mixed-methods research design was adopted, using quantitative purposive sampling to describe and compare their COVID-19 vaccination status and qualitative purposive sampling to identify their hesitations regarding COVID-19 vaccines, analyzed through content analysis. Reporting followed the GRAMMS guidelines.

DISCUSSION

Sixty-six percent of pregnant women had not received the COVID-19 vaccine. Those with advanced age, lower education levels, and lower income exhibited higher levels of vaccine hesitancy. The hesitations of pregnant women toward COVID-19 vaccines revealed three main themes: direct vaccine-related hesitation, hesitation arising from individual factors, and hesitation stemming from socio-cultural and environmental factors.

CONCLUSION

Vaccine hesitancy, which emerged during the COVID-19 pandemic, was a significant cause for concern. This hesitancy was explained by three main themes: vaccine hesitancy arising from the vaccine itself, vaccine hesitancy due to individual factors, and vaccine hesitancy stemming from socio-cultural and environmental factors. Additionally, sub-themes such as perceptions related to the management of the vaccination program, personal and infant-related risk-benefit assessments, the influence of anti-vaccine activists on social media, and political factors were also identified as playing a significant role in vaccine hesitancy.

Challenges and needs in the management of non-alcoholic fatty liver disease from the perspective of gastroenterology and hepatology specialists: a qualitative study

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, and it poses a significant threat to public health. There is insufficient documented evidence about the problems and needs of patients and physicians in managing NAFLD. This study aimed to explore the challenges and needs in managing NAFLD from the perspective of gastroenterology and hepatology (GH) specialists.

METHODS

This qualitative study was conducted from January to September 2023. Fifteen Iranian GH specialists selected by purposive sampling. Data were collected through semi-structured interviews. The interviews were analyzed inductively using the Elo and Kyngas content analysis approach. The criteria proposed by Guba and Lincoln were used to ensure the study's validity.

RESULTS

The identified challenges were divided into thirteen main categories (34 subcategories and 117 primary codes), and the identified needs were divided into eight main categories (21 subcategories and 97 primary codes). The main categories of the challenges were chronic nature and time-consuming differential diagnosis, complex treatment process, defects in the patient management process, shortcomings of the healthcare system, the effect of unhealthy eating and cultural and social factors on the diet, incorrect attitude of patients, lack of knowledge and awareness of patients, lack of comprehensive treatment plans based on patients' conditions, defect in knowledge and awareness of physicians, inadequate cooperation of patients, defects in the process of recording and monitoring information and providing feedback, insufficient policies and plans in the prevention of NAFLD, and economic problems. The main categories of needs included developing a comprehensive treatment plan, updating physicians' knowledge and creating standard treatment protocols, changing attitudes and empowering patients, informing and educating patients, establishing multi-specialty clinics for NAFLD treatment, establishing peer support groups and facilitating communication, utilizing digital technology to track patient information and monitor their progress, and supportive, educational, prevention, and management policies in the treatment of NAFLD.

CONCLUSIONS

This study showed that managing NAFLD involves physical, psychological, nutritional, sports, economic, and social aspects and requires multidisciplinary clinical approaches, digital technologies, and supportive and educational policies. These findings have important implications that can help patients, physicians, and policymakers design better lifestyle prescriptions to manage NAFLD.