Fear of Movement: Past, Present, and Future for Rehabilitation and Health

Experiences of Exercise-Related Worry Among Chinese Childhood Cancer Survivors and Their Carers: A Qualitative Study

BACKGROUND

The low levels of physical activity in childhood cancer survivors have increasingly garnered attention from nursing scholars. Exercise-related worry is a prominent barrier, yet the understanding of such experiences among childhood cancer survivors and their primary caregivers remains scarce.

OBJECTIVE

The aim of this study was to further understand the factors contributing to exercise-related worry from the perspective of childhood cancer survivors and their primary caregivers.

METHODS

In this qualitative study, we conducted face-to-face semistructured interviews with childhood cancer survivors (n = 20) and carers (n = 20) in 2 hospitals in China. The interviews were analyzed according to thematic analysis.

RESULTS

Two main themes and 8 subthemes emerged: (1) internal factors: changes in the perception of physical activity (threat perception from the disease, active avoidance of stressful events, lack of safety due to past experiences), and (2) external factors: weak support system (limited peer support, family strength, feeling abandoned by the tumor team, reintegration into school, external environmental constraints). In summary, exercise-related worry is from internal factors and can be influenced by external factors.

CONCLUSION

There are various factors contributing to the concerns of exercise in childhood cancer survivors, which may be a key factor for their significantly lower levels of physical activity compared to guideline recommendations.

IMPLICATIONS FOR PRACTICE

The findings of this study call for healthcare professionals to provide additional assistance for childhood cancer survivors with exercise-related worry and establish personalized mechanisms for supporting physical activity in pediatric cancer survivors within the Chinese healthcare system.

A behavioural driving model of adherence to home-based cardiac rehabilitation exercise among patients with chronic heart failure: A mixed-methods study

AIMS AND OBJECTIVES

To develop and validate a behavioural driving model for adherence to home-based cardiac rehabilitation exercise in patients with chronic heart failure, and to explain the potential driving mechanism of social support on exercise adherence.

BACKGROUND

Despite the benefits of home-based cardiac rehabilitation exercise, adherence among patients with chronic heart failure remains suboptimal. Several factors contributing to adherence have been confirmed; however, the specific pathway mechanisms by which these factors impact exercise adherence have not been thoroughly explored.

DESIGN

An exploratory sequential mixed-methods study was conducted in this study.

METHODS

A total of 226 patients with chronic heart failure were recruited using convenience sampling. Quantitative data were collected using a series of self-report questionnaires. Hierarchical regression analysis was performed to verify multiple pathways. Subsequently, 12 patients with chronic heart failure were drawn from the quantitative stage. The interview data were thematically analysed. This study followed the Good Reporting of a Mixed Methods Study (GRAMMS) guidelines (Appendix S1).

RESULTS

Perceived social support had a direct positive predictive effect on exercise adherence. Importantly, exercise self-efficacy and exercise fear played a chain-mediating role between perceived social support and exercise adherence. As a result of the qualitative phase, scale, tightness and homogeneity of social support networks emerged as potential drivers of the effectiveness of social support on exercise adherence.

CONCLUSIONS

This study reveals a potential pathway mechanism for social support to improve adherence to home-based cardiac rehabilitation exercises. Social support network plays a crucial role in the effect of social support on exercise adherence.

RELEVANCE TO CLINICAL PRACTICE

To enhance exercise adherence in home-based cardiac rehabilitation for patients with chronic heart failure, establishing a social support network is recommended. This strategy has the potential to promote exercise self-efficacy and alleviate exercise fear.

PATIENT OR PUBLIC CONTRIBUTION

None.

'Powering through': A qualitative descriptive study of nurses working while in pain

AIMS AND OBJECTIVES

To describe the experience of nurses working while in pain and the potential impact on work performance. Pain is described more broadly and inclusive of musculoskeletal injuries, psychological and emotional pain.

BACKGROUND

Nurse have been recognised as developing pain and injuries; however, the experience of nurses working while in pain and its impact is not well-described.

DESIGN

A qualitative descriptive analysis of interviews from an explanatory mixed methods study.

METHODS

Twenty direct care nurses who experienced pain in the past week participated in the semi-structured interviews. Transcripts were analysed using content analysis. Guidelines for reporting following the COREQ checklist.

RESULTS

Categories identified: (1) pain provocation, quality of pain, refers, severity, and time (PQRST); (2) Avoiding pain at work; (3) Hiding pain's impact; (4) Tools at Work; (5) Pain recovery at home; (6) Career consequences; and (7) 'Supernurse' culture; (8) Stigma and its impact on pain management; and (9) Dream work environment.

CONCLUSIONS

Pain was described as part of nursing and impacted nurses' career plans and performance. Nurses described minimising the direct impact on their patient care but admitted that there was an impact on teamwork and thinking which have been linked to negative patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

Clinical practice was an aggravating factor for all nurses in the study and impacted their performance and career trajectory. Workplace tools to decrease nurse injury and pain exist; however, tools were not used often due to lack of resources and training. The culture of nursing that accepts pain as part of the job needs to be addressed.