Using Reflexive Thinking to Establish Rigor in Qualitative Research

Education professionals' perceptions on perinatal mental health education in Australian and New Zealand medical and pharmacy curricula

INTRODUCTION

Primary healthcare workers, including doctors and pharmacists, are well-positioned to detect and support women experiencing mental health disorders in the perinatal period. However, research exploring their education and training to fulfil these roles is limited. This study aimed to examine the perspectives of medical and pharmacy educational program representatives on perinatal mental health education in medical and pharmacy curricula at Australian and New Zealand universities.

METHODS

A web-based search (e.g., Australian Health Practitioner Regulation Agency) was used to identify potentially relevant medical and pharmacy educational program representatives. Eligible participants were invited to participate in audio-recorded semi-structured interviews which were transcribed verbatim. Data regarding perinatal mental health content within each program were extracted and tabulated for comparisons. Thematic analysis of participants' perspectives on perinatal mental health education was conducted.

RESULTS

Fifty medical and pharmacy educational program representatives were invited to participate (December 2022-March 2023), of which 13 participated representing 14 programs. The extent and content of perinatal mental health education varied considerably across programs. Thematic analysis resulted in four themes: How much perinatal mental health content is enough?; Reflections on perinatal mental health related content; Perinatal mental health education in and beyond the classroom; Challenges associated with delivering perinatal mental health content.

CONCLUSIONS

Participants acknowledged the importance of perinatal mental health content for medical and pharmacy students; however, limited time and lack of opportunities for students to complete placements were key challenges to curricular integration.

Patient Perspectives on a Patient-Facing Tool for Lung Cancer Screening

BACKGROUND

Individuals with high risk for lung cancer may benefit from lung cancer screening, but there are associated risks as well as benefits. Shared decision-making (SDM) tools with personalized information may provide key support for patients. Understanding patient perspectives on educational tools to facilitate SDM for lung cancer screening may support tool development.

AIM

This study aimed to explore patient perspectives related to a SDM tool for lung cancer screening using a qualitative approach.

METHODS

We elicited patient perspectives by showing a provider-facing SDM tool. Focus group interviews that ranged in duration from 1.5 to 2 h were conducted with 23 individuals with high risk for lung cancer. Data were interpreted inductively using thematic analysis to identify patients' thoughts on and desires for a patient-facing SDM tool.

RESULTS

The findings highlight that patients would like to have educational information related to lung cancer screening. We identified several key themes to be considered in the future development of patient-facing tools: barriers to acceptance, preference against screening and seeking empowerment. One further theme illustrated effects of patient-provider relationship as a limitation to meeting lung cancer screening information needs. Participants also noted several suggestions for the design of technology decision aids.

CONCLUSION

These findings suggest that patients desire additional information on lung cancer screening in advance of clinical visits. However, there are several issues that must be considered in the design and development of technology to meet the information needs of patients for lung cancer screening decisions.

PATIENT OR PUBLIC CONTRIBUTION

Patients, service users, caregivers or members of the public were not involved in the study design, conduct, analysis or interpretation of the data. However, clinical experts in health communication provided detailed feedback on the study protocol, including the focus group approach. The study findings contribute to a better understanding of patient expectations for lung cancer screening decisions and may inform future development of tools for SDM.

[Registered nurses' experience of necessary performed and missed nursing care: a qualitative study]

Registered nurses' experience of necessary performed and missed nursing care: a qualitative study Abstract: Background: Providing high quality care based on their caring attitude is essential for nurses. Missed Care can cause feelings of guilt and dissatisfaction among them. Studies on their experiential transition between fully performed and missed care are lacking. They may contribute to a more comprehensive understanding of influencing factors and the impact on nurses' experience. Aim: The aim was to explore how nurses at a centre hospital in German-speaking Switzerland describe performance of nursing interventions in terms of the different expressions between performed and missed care. Methods: Between September 2020 and March 2021 the first author conducted eleven qualitative guide-based individual interviews with registered nurses which were analysed using Mayring's qualitative content analysis and knowledge maps. Results: The analysis resulted in five main categories: Optimal care, satisfaction in mediocrity, a huge lack, patients' reactions and influencing factors. Nurses described, in addition to personal experience and expertise, different coping strategies to prevent missed care and maintain patients' and their own satisfaction. Conclusions: In addition to interventions that can prevent missed care, nurses' experience of performed care should be explored further. This can deepen the understanding of its relationship with professional caring attitudes as well as with patient-related and professional satisfaction.

Understanding the factors related to how East and Southeast Asian immigrant youth and families access mental health and substance use services: A scoping review

The objective of the review is to identify factors related to how East and Southeast Asian immigrant youth aged 12-24 and their families access mental health and substance use (MHSU) services. To address how East and Southeast Asian youth and their families access mental health and substance use services, a scoping review was conducted to identify studies in these databases: PubMed, MEDLINE (Ovid), EMBASE (Ovid), PsychINFO, CINAHL, and Sociology Collection. Qualitative content analysis was used to deductively identify themes and was guided by Bronfenbrenner's Ecological Systems Theory, the process-person-context-time (PPCT) model, and the five dimensions of care accessibility (approachability, acceptability, availability and accommodation, appropriateness, affordability). Seventy-three studies met the inclusion criteria. The dimensions of healthcare accessibility shaped the following themes: 1) Acceptability; 2) Appropriateness; 3) Approachability; 4) Availability and Accommodation. Bronfenbrenner's Ecological Systems Theory and the PPCT model informed the development of the following themes: 1) Immediate Environment/Proximal Processes (Familial Factors, Relationships with Peers; 2) Context (School-Based Services/Community Resources, Discrimination, Prevention, Virtual Care); 3) Person (Engagement in Services/Treatment/Research, Self-management); 4) Time (Immigration Status). The study suggests that there is a growing body of research (21 studies) focused on identifying acceptability factors, including Asian cultural values and the model minority stereotype impacting how East and Southeast Asian immigrant youth access MHSU services. This review also highlighted familial factors (16 studies), including family conflict, lack of MHSU literacy, reliance on family as support, and family-based interventions, as factors affecting how East and Southeast Asian immigrant youth access MHSU care. However, the study also highlighted a dearth of research examining how East and Southeast Asian youth with diverse identities access MHSU services. This review emphasizes the factors related to the access to MHSU services by East and Southeast Asian immigrant youth and families while providing insights that will improve cultural safety.

Positioning the surgical patient - roles, responsibilities and challenges. A qualitative study

AIMS

The aim was to explore how representatives from the different professions in the surgical team experience roles, responsibilities and challenges in positioning the surgical patient.

BACKGROUND

Appropriate patient positioning on the operating table during surgery is vital for optimal anatomical exposure, access to essential equipment, patient comfort and to minimize the risk of injuries. Patient positioning has been described as a shared responsibility of the entire surgical team. The research on roles and responsibilities in patient positioning during surgery is sparse.

DESIGN

The study had a qualitative design, including 16 individual, semi-structured interviews, conducted in November and December 2023.

METHODS

Participants included surgeons (n = 4), anaesthetists (n = 4), operating room nurses (n = 4) and nurse anaesthetists (n = 4) in a hospital in Southeastern Norway. The data were analysed using Braun and Clarke's six-step Reflexive Thematic Analysis.

RESULTS

Three main themes with subthemes were identified, namely (1) A teamwork approach, with subthemes (a) facilitating surgery and (b) health professionals' roles and responsibilities. (2) A patient safety issue, with subthemes (a) risk patients and (b) procedural challenges. (3) Absence of a systematic approach, with subthemes (a) various approach to second time-out and (b) documentation and feedback issues.

CONCLUSION

Appropriate and safe positioning during surgery is a common responsibility of all members of the surgical team. Despite the common assumption that surgeons hold the primary responsibility, the operating room nurses seemed to hold the hands-on responsibility. Different health professionals emphasized different risk patients, risk procedures and perceived challenges. This suggests a connection between the specific focus of distinct professional domains, their tasks and expertise within the surgical context.

IMPACT

There is a lack of clear guidelines outlining roles and the distribution of responsibility in patient positioning, which may be a safety concern. A need for reviewing responsibilities and defining roles is identified. Systematic follow-up of documentation of post-operative observation and documentation of skin status and the "second time-out" procedure is crucial to establish measures rooted in guidelines supported by both professional and administrative management. This dual commitment may ensure a comprehensive strategy for systematic follow-up, fostering a culture of continuous improvement.

PATIENT CONTRIBUTION

Not applicable.

Bringing rigor in contextual objectivity: lessons from applying feminist lens in scoping the evidence on girlhood studies in Indonesia

This perspective paper contemplates the nuances of engaging with literature ethically in conducting a scoping review based on the researchers' project on girlhood studies in Indonesia. We assert that the ethical perspective extends beyond conventional primary data collection from human participants, further emphasizing the essence of a feminist methodology in this scholarly investigation. We discuss the interplay between the role of rigor and the dynamics of power relations in research, shedding light on reconciling between the pursuit of facts and acknowledgment of biases in knowledge production. This reflection offers insights into the methodological process and the researcher's role, contributing to the broader discourse on how research can effectively address issues of gender equity and social inclusion. Through this paper, we underscore the necessity of an intentional approach in unifying the domains of science and advocacy because only then can we truly catalyze transformative change. In doing so, we seek to foster a more comprehensive, objective, and empathetic understanding of the researched: in this case, the experiences of girls and young women -and, by extension, marginalized individuals in Indonesia and beyond.

Neonatal intensive care nurses' accounts of care for mothers/families with substance-exposed pregnancies: A critical discourse analysis

AIMS

To explore the effects of power dynamics and hospital organizational structure upon neonatal intensive care nurses' experiences caring for infants and families from a substance-exposed pregnancy (SEP).

DESIGN

This secondary data analysis further investigated the results of a primary study after the original analysis suggested differences in work environments may impact relationship-building opportunities between nurses and mothers/families. Critical discourse analysis served as both the theoretical lens and analytic technique.

METHOD

Nine (9) nurses from the southeast region of the United States (U.S.) were interviewed in 2019. Fifty-one (51) stories of caregiving experiences were analysed with a focus on narratives related to organizational structure and care delivery.

RESULTS

Study findings revealed nurses experienced challenges providing high-quality, family-centered care for patients in the neonatal intensive care unit (NICU) affected by substances during pregnancy. Nurses described the central challenge of workload, exacerbated by power imbalances and structural constraints within the hospital's organizational structure. Findings suggest workload issues may endorse stigma by inhibiting opportunities to build relationships. Nurses report manageable workloads can support healthcare teams and recipients of care.

CONCLUSION

The study suggests power imbalances between nurses, families and adjacent healthcare professionals can inhibit the delivery of high-quality care. Supporting healthcare teams and recipients of care while centering the role of organizational structure is critical. Questions emerged about workload demands impacting the potential production of stigma in clinical environments.

IMPACT

This study examines the intersection of nurses' care experiences and hospital organizational structure. It identifies how the unique needs of caring for infants and families from a SEP increase the complexity of power imbalances and organizational constraints to further increase workload demands. Findings have implications for global healthcare organization leaders who build and maintain the structural integrity of clinical environments and nurse leaders who advocate and guide clinical teams to provide high-quality care in stressful healthcare environments.

REPORTING METHOD

EQUATOR guidelines were followed, using the COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

NICU nurses were interviewed about their care-provision experiences. Interviews were analysed in the primary study and the current analysis of secondary data.

Exergaming (physically active video gaming) for mental health service users in a community mental health care setting: an ethnographic observational feasibility study

BACKGROUND

People with severe and enduring mental illness experience health inequalities with premature mortality; lifestyle behaviours are known to be contributing factors with low levels of physical activity reported. Facilitating physical activity to help maintain or improve health for those who are disadvantaged is essential. Exergaming (gaming involving physical movement) is increasingly used to improve physical activity across the lifespan and for those with a range clinical conditions; this might offer a way to increase physical activity for those with severe mental illness. The aim of this study was to explore engagement of mental health service users with exergaming to increase physical activity in a community mental health care setting.

METHODS

An ethnographic observational feasibility study was undertaken through participant observation and semi-structured interviews. A gaming console was made available for 2 days per week for 12 months in a community mental health setting. A reflexive thematic analysis was performed on the data.

RESULTS

Twenty one mental health service users engaged with the intervention, with two thirds exergaming more than once. One participant completed the semi-structured interview. Key themes identified from the observational field notes were: support (peer and staff support); opportunity and accessibility; self-monitoring; and perceived benefits. Related themes that emerged from interview data were: benefits; motivators; barriers; and delivery of the intervention. Integrating these findings, we highlight social support; fun, enjoyment and confidence building; motivation and self-monitoring; and, accessibility and delivery in community mental health care context are key domains of interest for mental health care providers.

CONCLUSIONS

We provide evidence that exergaming engages people with SMI with physical activity. The value, acceptability and feasibility of open access exergaming in a community mental health service context is supported. Facilitating exergaming has the potential to increase physical activity for mental health service users leading to possible additional health benefits.

Impact of cancer diagnosis and treatment: a qualitative analysis of strains, resources and coping strategies among elderly patients in a rural setting in Ghana

BACKGROUND

Rurality is fraught with numerous difficulties including a lack of advanced health facilities to provide health services, and an absence of specialist cancer services, and qualified personnel, among others. These factors exacerbate the challenges of elderly patients diagnosed with cancer and further pose limitations to activities/instrumental activities of daily living. Yet, there is limited scholarship on the strains that affect elderly patients diagnosed with cancer and the resources that helps them to overcome them. This study explores the strains, resources, and coping strategies of elderly patients diagnosed with cancer and undergoing treatment in rural Ghana.

METHODS

An exploratory, descriptive qualitative design was adopted. Purposive sampling was used to recruit 20 individuals to participate in in-depth interviews. The collected data was analysed inductively using Collaizi's framework. QSR NVivo-12 was used in managing the data.

RESULTS

The results were grouped into two main categories, namely: strains and resources. Within the category of strains, three main themes with their corresponding sub-themes emerged: cancer-related strains (systemic side effects from treatment, altered physical appearance and body image, and experience of pain), elderly strains (altered functional ability, limited social interactions and participation, psycho-emotional reactions, limited/restricted economic participation, and financial strains), and health system strains (negative attitude and insensitive communication, delay in diagnosis, lack of geriatric oncology care, lack of community-based specialist cancer centre and long travel distance to access care, and limited availability of essential cancer medicines and other radiations services). Four types of resources were available to cancer patients: personal resources, family resources, community resources, and healthcare systems resources.

CONCLUSION

In conclusion, elderly patients diagnosed with cancer experience physical, economic, psychological, and emotional strains that threaten their health and well-being. However, they are able to leverage family, community, and health system-related resources to navigate through the strains. There is, therefore, a need to expand advanced health facilities with geriatric oncology units and specialists to improve access to cancer care in rural areas. The government needs to assist elderly persons with costs associated with their diagnosis and treatment through the expansion of the National Health Insurance Scheme to include this as part of the benefits package.

Nonurgent Pediatric Interhospital Transfers: A Narrative Enquiry of Nurses' Experiences in Australia

INTRODUCTION

This study aimed to explore nonurgent pediatric interhospital transfers through the lens of nurses' experiences and perceptions when undertaking these transfers.

METHODS

Using a narrative inquiry approach, data were collected via semistructured interviews with registered nurses (N = 7) who had experience undertaking patient transfers between nonurgent low-acuity and urgent high-acuity hospital settings.

RESULTS

Findings established the following 8 themes: ensuring transfer preparation for risk mitigation, practicing confident advocacy, being accountable for risk mitigation of the deteriorating patient during transfer, maintaining standardized procedure, using training and mentorship to support confidence, maintaining interhospital and intrahospital relationships, recognizing the significance of transfer on families, and acknowledging the burden of transfer and delay.

DISCUSSION

By exploring the stories and experiences of emergency nurses who undertake pediatric interhospital transfers, a deep investigation of the risks and challenges has been described, an area often underrepresented in the literature. Findings from this study highlight important learnings for pediatric interhospital transfer that add value to the wider body of evidence.

Staff experiences, perceptions of care, and communication in the intensive care unit during the COVID-19 pandemic in Australia

BACKGROUND

In 2020, during the first wave of the COVID-19 pandemic in Australia, hospital intensive care units (ICUs) revised patient care practices, curtailed visiting, and augmented the use of personal protective equipment to protect patients, staff, and the community from viral transmission.

AIM

The aim was to explore ICU staff experiences and perceptions of care and communication with patients during the COVID-19 pandemic to understand how alternative ways of working have influenced work processes, relationships, and staff morale.

METHODS

This was a qualitative exploratory design study using audio-recorded and transcribed interviews with 20 ICU staff members. Data were analysed using thematic analysis.

FINDINGS

Four major themes were derived from the data: (i) Communication and connection, (ii) Psychological casualties, (iii) Caring for our patients, and (iv) Overcoming challenges. Patient care was affected by diminished numbers of critical care qualified staff, limited staff entry to isolation rooms, and needing to use alternative techniques for some practices. The importance of effective communication from the organisation and between clinicians, families, and staff members was emphasised. personal protective equipment hindered communication between patients and staff and inhibited nonverbal and verbal cues conveying empathy in therapeutic interactions. Communication with families by phone or videoconference was less satisfying than in-person encounters. Some staff members suffered psychological distress, especially those working with COVID-19 patients requiring extracorporeal membrane oxygenation. Moral injury occurred when staff members were required to deny family access to patients. Workload intensified with increased patient admissions, additional infection control requirements, and the need to communicate with families using alternative methods.

CONCLUSION

The results of this study reflect the difficulties in communication during the early stages of the COVID-19 pandemic. Communication between staff members and families may be improved using a more structured approach. Staff reported experiencing psychological stress when separating families and patients or working in isolation rooms for prolonged periods. A flexible, compassionate response to family presence in the ICU is essential to maintain patient- and family-centred care.

The blacksmith approach: a strategy for teaching and learning in the medical anatomy course (a qualitative study)

BACKGROUND

Anatomy is a symbolic, essential core topic and one of the fundamental pillars of medical and paramedical knowledge. Nevertheless, few exploratory data analyses have focused on how students approach learning anatomy. This study examined how students perceive their learning experience during anatomy lessons and how to make a model which promotes their meaningful learning and professional identity.

METHODS

Using purposive sampling with maximum variation, we conducted a qualitative content analysis at the Shiraz University of Medical Sciences in Iran (2020 to 2021). Twenty-four medical students and twelve faculty members of Iran's medical science universities were enrolled in the study. The data were collected through semi-structured interviews and analyzed according to the theme.

RESULTS

A conceptual model emerged from the data analysis with the main theme called the blacksmith approach, which included Three sub-themes: (1) making a new forge (adequate preparation and mindful beginning), (2) heating the students' hearts (considering supporting systems that learners need) and (3) using Sledgehammer's approach (teaching anatomy by using more active methods and engaging all neuroanatomical regions) and (Using fun for enjoyable learning). All the concepts were related to each other.

CONCLUSION

Medical students experience a challenging fundamental evolution into professional doctors. Educational systems focus primarily on teaching and learning, while students' transition can be facilitated by a three-step model called the Blacksmith Approach. It best serves as an educational framework for any pivotal, preclinical course capable of helping students acquire new roles and tackle challenges. Further research should be conducted to confirm how hard work leads to satisfying results with the opportunity to create enjoyable learning.

Towards defining quality in home care for persons living with dementia

INTRODUCTION

Accelerating rates of dementia worldwide coupled with older adults living longer in the community calls for greater focus on quality home care support services. Few frameworks for quality dementia home care exist though prior findings have found elements considered to be important for "good" home care for people living with dementia. This study aimed to identify core components of a quality home care experience for people with dementia and their caregivers.

METHODS

As part of a larger research study, in-depth interviews were conducted with persons living with dementia and caregivers (n = 25) to explore hospital-to-home care transitions. The design used for this study was a qualitative description. We used deductive-inductive thematic analysis, which was informed by previous work in this area. Open codes were mapped to pre-determined themes, and for codes not accommodated by an a piori framework, new themes were developed.

FINDINGS

Our findings resulted in 4 overarching themes. Two themes were identified deductively (Availability and Acceptability of Home Care Services) and two inductively (Adaptability and Affordability of Home Care Services). Findings highlight the roles of family-care provider partnerships and responsive support in receiving quality home care, and the cost associated with unmet needs.

INTERPRETATION

With an aging population, an increase in home care client acuity, and post-COVID-19 concerns over long-term care, more attention is needed to improve the quality of home care. The demand for these services will continue to increase particularly for those living with dementia and their families. The findings of availability, acceptability, adaptability, and affordability as core to quality care can help lay the groundwork for a home care framework for persons living with dementia and their caregivers. Future research could benefit from comparative analyses to evaluate the applicability of the findings to non-dementia home care service users and caregivers.

Addressing the Syndemics of HIV, Mental Health, and COVID-19 Using the Health and Human Rights Framework among Youth Living with HIV, in Uganda: an Interpretive Phenomenological Study

Stigma and discrimination negatively impact the prevention, treatment, and care of HIV. The COVID-19 pandemic increased this complexity and created a cluster of synergistic health contexts, wherein the physiological aspects of HIV and the social and environmental conditions increased the vulnerability in health outcomes for youth living with HIV (YPLHIV) in Kampala, Uganda. We used interpretive phenomenological analysis (IPA) and the syndemics framework to understand the lived experiences of YPLHIV. From December 2020 to May 2021, six qualitative focus groups were held with 31 youth living with HIV to understand the lived experiences of YPLHIV. The guided questions used were audio-recorded, transcribed verbatim, and coded for thematic analysis. Findings highlight the complexity of intersecting stigma of HIV and COVID-19 that have worsened antiretroviral treatment adherence and mental health issues due to lack of access to critical needs such as fears of food insecurity, health-related worries, the fear of perishing due to COVID-19, and human rights concerns related to gender and sexual identity. The study recommends addressing human rights-related concerns in addition to health-related concerns to comprehensively mitigate the syndemics of HIV and COVID-19 for YPLHIV in Uganda.

Parents' perceptions of their children's physical activity during the COVID-19 pandemic

Background

COVID-19 has drastically changed the everyday lives of children, including limiting interactions with peers, loss of regularly organized activities, and closure of schools and recreational facilities. While COVID-19 protocols are in place to reduce viral transmission, they have affected children’s access to physical activity opportunities. The purpose of this study was to understand how COVID-19 has affected children’s engagement in physical activity and to identify strategies that can support children’s return to physical activity programming in public places.

Methods

Parents of past participants in the Grade 5 ACT-i-Pass Program in London, Ontario, Canada were invited to participate in a semi-structured interview online (in November and December 2020) via Microsoft Teams. The script was comprised of questions about their child’s physical activity levels (before, current, and anticipated following COVID-19), lifestyle changes due to COVID-19, and what service providers can do to assist children’s return to public programming. Interviews were transcribed in Microsoft Teams, reviewed by a member of the research team, and analyzed in NVivo 12 using thematic analysis.

Results

Twenty-seven parents participated in an interview. Four themes and two subthemes were identified during analysis: (1) modifications to everyday life (a. activity options available and b. altered social environment), (2) safety in public spaces, (3) accessibility of activities, and (4) utilizing outdoor spaces.

Conclusions

COVID-19 protocols have decreased children’s physical activity levels due to the loss of their regular activities, recreational spaces, and peer support. Implementing facility and activity-specific health protocols, providing outdoor activity options, and offering a variety of activity types, times, and locations are three strategies recommended by parents to help facilitate their children’s return to public recreational places. Due to the negative consequences of physical inactivity on children’s health and well-being, service providers need to implement programming and safety protocols that support children’s engagement in physical activity throughout the remainder of, and the years following, the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13829-y.

Exploring the perspectives of key stakeholders on the design and delivery of a cognitive rehabilitation intervention for people post-stroke

Purpose

Stroke is a leading cause of death and disability worldwide. Despite the prevalence and associated burden of post-stroke cognitive impairment, there is uncertainty regarding optimum interventions to improve cognitive function in people post-stroke. The aim of this study is to explore the perspectives of key stakeholders on the design and development of a multidisciplinary intervention to rehabilitate cognitive deficits in people post-stroke.

Materials and methods

Audio-recorded, semi-structured interviews were employed with people post-stroke, caregivers, healthcare professionals and academics. All transcribed interviews were exported to NVivo software and analysed using reflexive thematic analysis.

Results

Thirty interviews were conducted across stakeholder groups including people post-stroke (n = 10), caregivers (n = 5), healthcare professionals (n = 14) and academics (n = 1). Four themes relevant to the design and development of the intervention were identified (i) engagement in the intervention must be meaningful, (ii) the point of readiness to engage, (iii) a familiar but flexible setting is key (iv) pragmatics of intervention delivery.

Conclusions

These findings present new perspectives across stakeholder groups on the design and delivery of an intervention to rehabilitate cognitive deficits in people post-stroke. Taken together with existing quantitative evidence, these findings will inform the development of a feasibility trial, examining patient and process outcomes, to rehabilitate cognitive deficits post-stroke.

Nursing students' risk perceptions related to medication administration error: A qualitative study

AIM

The purpose of this study was to explore and describe pre-licensure nursing students' perceptions of risk for medication administration errors in fourth-year baccalaureate student nurses from three campuses at a large central Pennsylvania university.

BACKGROUND

Medication administration errors continue to be a significant safety concern in healthcare settings. Pre-licensure nursing education is a critical time period during which to have an impact on future medication administration practices. Perception of risk influences decision making and behavior, including nursing clinical decision making.

DESIGN

This descriptive, exploratory study involved a qualitative design.

METHODS

A thematic analysis of the qualitative data resulting from 60 individual, in-depth semi-structured interviews was conducted.

RESULTS

The participants offered rich, detailed narratives which revealed the following themes: (1) the nature of risk perceptions, (2) more opportunities to learn, (3) experiences with medication administration error, and (4) intrinsic characteristics influence errors.

CONCLUSIONS

The findings provide a broad description of the nature of student nurse risk perceptions for future medication administration errors. Recommendations for nursing education practice and pedagogy include additional clinical experiences, modified pharmacology curricula and instruction, and expanded simulations involving medication administration error.

Coping strategies and perceived barriers of women hospitality workplace employees to sexual harassment in Bahir Dar city, Ethiopia: a grounded theory approach

Background

Coping depicts how people detect, appraise, deal with, and learn from stressful encounters. Applying preferred coping strategies in various situations makes the issue a persistent agenda in hospitality workplaces, where women are unduly victims of sexual harassment. Thus, this study aimed to develop a context specific and data-driven coping strategy framework and barriers to coping strategy mechanisms for sexual harassment victimisation against women working in hospitality workplaces.

Methods

A qualitative, grounded theory approach was used. Data were collected from female employees, managers, cashiers, and customers. Semi-structured focus-group discussions and in-depth interview guides were employed. A constant comparative approach was used to describe the meanings and summarise the data. Data were coded, categorised, and networks were visualised using the ATLAS ti version 8.4.24 software package.

Results

In this study, six focus group discussions, ten in-depth interviews, and thirteen key informant interviews were conducted. The provided context specific coping strategic framework consists of four strictly interconnected dimensions with corresponding barriers practised by female hospitality employees. These were normalisation, engagement, help-seeking, and detachment. The normalisation dimension encompasses silence, acceptance, denial, refusal, grief, and tolerance. Confrontation, negotiation, retaliation/threatening, and discrimination of the perpetrators were included in the engagement dimension. Elements such as discussing with friends, complaining with supervisors, consulting professionals, and accusing perpetrators were in the help-seeking dimension. Lastly, job-hopping, job withdrawal, work withdrawal, and distancing were in the detachment dimension. Some barriers deterred all dimensions, some factors facilitated normalisation, and some adverse outcomes ended the engagement dimension.

Conclusion

Our study demonstrated that the coping capacities of sexual harassment among female hospitality employees have been apparent, providing space for stakeholders to intervene. Our new coping strategy framework can serve as a valuable guide for designing context-specific interventions. These interventions could help women and stakeholders prevent sexual harassment, decrease barriers, and alleviate these effects.

Pflegefachpersonen denken über eine Definition von "durchgeführter und versäumter Pflege" nach

Nurses reflect upon a definition of "performed and missed nursing care" - A qualitative study Abstract. Background: It is known that necessary nursing interventions are repeatedly omitted respectively only carried out partially or at a time that is not appropriate. In the literature, this is referred to as "missed nursing care". In the German-speaking region, there is no critically reflected definition of what is meant by "performed and missed nursing care", using qualitative methods. Therefore, we developed one in a three-phase study. Aim: The aim of phase 2, which is the focus of this article, was to critically reflect on the literature-based definition developed in phase 1 with nurses working in acute care hospitals in German-speaking Switzerland in order to specify it in phase 3. Methods: We conducted two focus group interviews with a total of 17 participants. We provided the participants with the preliminary definition and asked them for their reflections. We analysed the interviews content-analytically with the knowledge mapping technique as well as according to Mayring. Results: The participating nurses described that the contents of the definition were relevant and comprehensible for them. However, they also noticed differences from their understanding and gave indications for refining the definition, especially in relation to terms that include a time-related aspect. Conclusions: By involving nurses in the development of the definition, there is now a practical description of "performed and missed nursing care" that can be useful for quality assurance and development of care.

Optimizing Myanmar's community-delivered malaria volunteer model: a qualitative study of stakeholders' perspectives

BACKGROUND

In parallel with the change of malaria policy from control to elimination and declines in the malaria burden in Greater Mekong Sub-region, the motivation and social role of malaria volunteers has declined. To address this public health problem, in Myanmar, the role and responsibilities of malaria volunteers have been transformed into integrated community malaria volunteers (ICMV), that includes the integration of activities for five additional diseases (dengue, lymphatic filariasis, tuberculosis, HIV/AIDS and leprosy) into their current activities. However, this transformation was not evidence-based and did not consider inputs of different stakeholders. Therefore, qualitative stakeholder consultations were performed to optimize future malaria volunteer models in Myanmar.

METHODS

Semi-structured interviews were conducted with key health stakeholders from the Myanmar Ministry of Health and Sports (MoHS) and malaria implementing partners to obtain their perspectives on community-delivered malaria models. A qualitative descriptive approach was used to explore the experiences of the stakeholders in policymaking and programme implementation. Interview topic guides were used during the interviews and inductive thematic data analysis was performed.

RESULTS

While ICMVs successfully provided malaria services in the community, the stakeholders considered the ICMV model as not optimal and suggested that many aspects needed to be improved including better training, supervision, support, and basic health staff's recognition for ICMVs. Stakeholders believe that the upgraded ICMV model could contribute significantly to achieving malaria elimination and universal health care in Myanmar.

DISCUSSION AND CONCLUSION

In the context of high community demand for non-malaria treatment services from volunteers, the integrated volunteer service package must be developed carefully in order to make it effective in malaria elimination programme and to contribute in Myanmar's pathway to universal health coverage (UHC), but without harming the community. An evidenced-based, community-delivered and preferred model, that is also accepted by the MoHS, is yet to be developed to effectively contribute to achieving malaria elimination and UHC goals in Myanmar by 2030.

Meals beyond the bedside: An ethnographic exploration of staffs' perspectives and experiences of communal dining in subacute care

Communal dining offers multiple benefits for hospital patients, yet dining rooms may be underutilized in practice. This study aimed to understand and explore staffs' perspectives and experiences of communal dining in subacute care, and the impacts on staff mealtime practice. Using qualitative, ethnographic methodology, 94 hours of fieldwork were conducted across two subacute care wards. Participants were staff involved in nutrition care or present on the ward at mealtimes. Ninety-one semistructured and ethnographic interviews were conducted with 59 staff, and 54 episodes of observation captured more than 190 staff. Interviews and field notes were thematically analyzed using an inductive approach. Three themes were identified: (i) benefits to patients; (ii) logistical and practical challenges; and (iii) supportive cultural factors. While staff recognized how communal dining benefited patients, logistical and practical challenges impacted their ability to facilitate it in practice. Healthcare organizations seeking to embed communal dining into the mealtime routine should recognize that clear delineation of staff roles and responsibilities, and cultural change involving normalization, setting expectations, and collective advocacy may be needed to optimize benefits for patients.

Misconceptions and Unmet Need for Modern Contraception among Cambodian Females: A Mix Methods Study

(1) Background: Women using unreliable traditional contraception need to be included in the proportion of women having an ‘unmet need for modern contraception’ instead of the current classification which presumes they have a ‘met need’. (2) Methods: Mix methods research design comprising initial quantitative analyses utilizing data from the nationally representative 2014 Cambodian Demographic and Health Survey (CDHS) for 4823 Cambodian, sexually active females aged 15–29 years. Then a qualitative phase explored knowledge about the menstrual cycle and misconceptions about modern contraception with 30 females aged 15–29 years in urban Cambodia using semi-structured interviews, transcribed verbatim with quality checks. Purposive and snowball sampling strategies were used until data saturation was reached. Inductive thematic data analysis was conducted; (3) Results: Unmet need for modern contraception increased to 25.4% when traditional contraception users were included. The qualitative themes show women have a lack of information about the menstrual cycle and misconceptions about modern contraception which contributed to increased use of traditional contraception; (4) Conclusion: Major drivers of increased unmet need for modern contraception include lack of literacy, misconceptions and low autonomy to choose modern contraception. Cambodia needs to endorse a policy shift to implement targeted, countrywide sexual and reproductive health literacy and family planning services.

Self-care while undertaking qualitative nursing research

BACKGROUND

Nursing research is usually carried out by registered nurses with some experience of practice. However, nurses may find that the role of the nurse researcher is very different from that of the practising clinical nurse and has its own challenges.

AIM

To explore the differences between the two roles and offer some guidance to nurses carrying out qualitative research, particularly research into sensitive topics.

DISCUSSION

Nurses need to be aware of various issues that could affect their ability to carry out nursing research and be emotionally traumatic.

CONCLUSION

There is a general need for greater awareness about the potential risks of carrying out qualitative research into sensitive topics.

IMPLICATIONS FOR PRACTICE

Nurse researchers must consider self-care when planning a research project, assessing their role, personality, background, personal experiences and stress triggers, and ensuring peer and supervisory support, reflection and a healthy lifestyle.

Sustaining, Forming, and Letting Go of Friendships for Young People with Inflammatory Bowel Disease (IBD): A Qualitative Interview-Based Study

Inflammatory bowel disease (IBD) is an incurable, chronic, gastrointestinal condition that can constrain young people's social relationships. Few studies have specifically explored friendships of people with IBD. This qualitative, participatory study used interviews, photographs, and friendship maps to explore friendships and friendship networks of young people with IBD. An online Young Person's Advisory Group was actively engaged throughout the study. Thirty-one young people participated (n = 16 males, n = 15 female; n = 24 Crohn's disease, n = 6 ulcerative colitis, n = 1 IBD-unclassified; the mean age at study was 18.7 years; range 14-25 years). Findings present a metatheme “The importance and meaning of friendships” and three interwoven subthemes of “Sustaining friendships,” “Forming new friendships,” and “Letting go of friendships.” Friendship was important to the young people with IBD, providing support, but associated with challenges such as disclosure. Such challenges could be mitigated by clearer conversations with clinicians about friendships and more extensive conversations about friendships and long-term conditions in education settings.

["One always has to be watchful": Categorisation of patient-related complexity of nursing care in acute care hospitals]

"One always has to be watchful": Categorisation of patient-related complexity of nursing care in acute care hospitals Abstract. Background: The increase of chronic illnesses and multimorbidity as well as more challenging treatment methods have caused higher acuity and complexity of nursing care situations. Aim: The aim of this study was to explore and establish categories which describe different levels of patient-related complexity of nursing care in order to broaden the understanding of demands on nursing care due to patient situations. Methods: Using a collective case study design, we asked registered nurses and clinical nurse specialists to assess the complexity of twelve nursing care situations through a questionnaire before interviewing them about their deliberations on how they rated the situation. In this sub-study, we performed a qualitative secondary analysis of these data and looked for categories of comparable degrees of complexity. Results: We found five categories of complexity, ranging from "slightly complex" to "highly complex". "Slightly complex" situations demanded a nurse's attention on routine interventions, while "highly complex" situations demanded their constant attention on poorly assessable and poorly controllable conditions with uncertain outcomes. Conclusions: The five categories of complexity describe characteristics of the different levels of complexity in nursing care situations. They can support nursing managers with allocating nursing staff to patients according to their needs and provide a framework for discussing complex nursing care situations in basic and continuing education.

Validation of the instrument "Complexity of Nursing Care"-A mixed-methods study

Aims

This study aimed to psychometrically test the instrument "Complexity of Nursing Care" and to broaden the understanding of the instrument's psychometrics and applicability.

Design

Embedded mixed-methods design.

Methods

We performed a cross-sectional study assessing all stationary patients of five Swiss hospitals daily for up to 5 days with the instrument "Complexity of Nursing Care" over a 1-month period in 2015. The scale's psychometrics were analysed using partial least square structural equation modelling. In the qualitative study section, we completed 12 case studies and analysed them case-wise and across cases. Quantitative and qualitative results were synthesized in tables.

Results

Structural equation modelling confirmed a reflective-formative second-order model of the instrument with good psychometric properties leading to a formula for the calculation of a complexity score. Qualitative results evolved descriptions of low and high extent of complexity. Narrative considerations of two raters deepened the understanding of the inter-rater reliability.

Barriers and facilitators involved in standardised care plan individualisation process in acute hospitalisation wards: A grounded theory approach

OBJECTIVE

To identify and classify the barriers and facilitators of the individualisation process of the standardised care plan in hospitalisation wards.

BACKGROUND

The administration of individualised care is one of the features of the nursing process. Care plans are the structured record of the diagnosis, planning and evaluation stages of the nursing process. Although the creation of standardised care plan has made recording easier, it is still necessary to record the individualisation of the care. It is important to study the elements that influence the individualisation process from the nurses' perspective.

DESIGN

Qualitative study with the grounded theory approach developed by Strauss and Corbin.

METHODS

Thirty-nine nurses from three hospitals participated by way of theoretical sampling. In-depth interviews were conducted, as well as participant observation, document analysis and focus group discussion. The analysis consisted of open, axial and selective coding until data saturation was reached. EQUATOR guidelines for qualitative research (COREQ) were applied.

RESULTS

For both barriers and facilitators, three thematic categories emerged related to organisational, professional and individual aspects. The identified barriers included routines acquired in the wards, the tradition of narrative records, lack of knowledge and limited interest in individualisation. The identified facilitators included holding clinical care sessions, use of standardised care plan and an interface terminology, the nurse's expertise and willingness to individualise.

CONCLUSION

The individualisation process of the standardised care plan involves multiple barriers and facilitators, which influence its degree of accuracy.

RELEVANCE TO CLINICAL PRACTICE

Implementing strategies at an organisational level, professional level and individual level to improve the way the process is carried out would encourage individualising the standardised care plan in a manner that is consistent with the needs of the patient and family; it would improve the quality of care and patient satisfaction.

A qualitative study of refugee families' experiences of the escape and travel from Syria to Sweden

Objective

Research shows that, depending on the route of travel during the escape, the journey presents the refugees with different health risks. Traumatic events during flight may have long-lasting physical and psychological effects on the refugee children. Therefore, it is important to illuminate the experiences that refugee families arriving in Sweden have endured during their flight. A qualitative study was conducted through interviews with fifteen recently arrived Syrian refugee families.

Results

The parents described different reasons as to why they as families had to escape the war. Some families had lost jobs and loved ones in the war and did not want their children to die as well. They mentioned that the journeys varied between 10 and 40 days and were usually filled with struggles and threats. The escape to Sweden was expressed as an emotionally trying journey. Many parents talked about the fear and terror the children felt. Traumatic events during the escape, such as separation from family, death of family members, sexual violence, kidnapping or extortion may have long-lasting physical and psychological effects on the refugee children and their families. Therefore, health care workers meeting and caring for these families after arrival must pay close attention to that.