A Guide to Field Notes for Qualitative Research: Context and Conversation

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.

'A Necessary Idea Given Our Current Climate': A Qualitative Study of Stakeholder Perspectives and Actions Required to Increase the Proportion of Plant to Animal Protein in Hospital Patient Menus

INTRODUCTION

Replacing dietary animal protein with plant protein reduces greenhouse gas emissions and improves human health. Hospital foodservices can support change, but require buy-in and collaboration between people across the system.

METHODS

A qualitative descriptive study aimed to explore hospital patient menu content expert perspectives regarding increasing the proportion of plant to animal protein in hospital patient menus and outline actions required to do this. Semi-structured interviews were completed with hospital or foodservice contractor employees and data were analysed using a general inductive approach.

RESULTS

Twenty-five of the 35 content experts interviewed supported increasing the proportion of plant to animal protein foods. All voiced concerns, including patients not eating meals, jeopardising protein intake and increasing malnutrition rates, and the prohibitive cost of plant-based protein foods. Participants described steps to change patient menus, including a cyclical design process. This entailed consultation with stakeholders, setting a target, choosing a strategy, developing a menu and recipes, finding food product, planning the system and operations, and checking it works. Most felt the best ways to increase the proportion of plant to animal protein were to swap ingredients in familiar recipes or replace entire menu items (n = 21), add plant-based options to the menu (n = 25), and move the position of plant-based meals on the menu (n = 22).

CONCLUSION

This study conceptualised a process for increasing the proportion of plant to animal protein in hospital patient menus for use by hospitals or policymakers. Future studies should test these suggested menu changes, assessing impacts on greenhouse gas emissions, plate waste, malnutrition indicators, cost and patient satisfaction.

Experiences of resettled Iraqi and Syrian refugee young people and families with a mental health triage and assessment service

The Refugee Access Service (RAS) is a triage, assessment and referral service established in Melbourne, Australia to ensure timely and appropriate mental health support for young refugees. This qualitative study sought to explore the experiences of young people aged 12-25 years, and their families, newly arrived from Iraq and Syria, who had contact with the RAS, for the purposes of further programme development. Semi-structured interviews were conducted with participants, either individually or in family groups. Thematic analysis was used to identify themes. Four key themes were identified. These were that mental health help-seeking of newly arrived young people and families is influenced by cultural norms; that trauma, grief and loss influence mental health service needs; that settlement challenges influence mental health service needs; and that the cultural responsiveness of mental health care is important to young people and families. Results highlight ways in which this service, and similar models, can improve to better meet the needs of young refugees and their families. Services should be developed in partnership with the wider operating environment. This will improve providers' understanding of communities they serve. It will also promote pathways between, and collaboration with, different types of services.

Stimulating ambulance specialist nurse students' ethical reflections by high-fidelity simulation

Introduction: Ethical competence in professional practice can be considered essential among nurses and nurses in ambulance care encounter ethical dilemmas frequently. To enhance ethical competence among students in the ambulance specialist nursing program, high-fidelity simulation scenarios including ethical dilemmas were introduced as a learning activity. Research aim: The research aim was to investigate the usefulness of high-fidelity simulation in ambulance specialist nurse education to teach ethical reasoning when caring for children. Research design: This study was conducted as a qualitative interview study, complemented with observations and using field notes and qualitative interviews for data collection. Data was analysed using deductive qualitative content analysis based on a care ethical model. Participants and research context: Participants (n = 35) were recruited from an ambulance nurse educational program at a Swedish university. Data was collected after the students took part in two high-fidelity simulations involving children in an ambulance care setting. Ethical considerations: The study has been vetted and approved by the ethical council at the University of Borås, Sweden. The study follows the Helsinki Declaration's advice on ethical principles. Results: The results showed that most of the students expressed some form of ethical reasoning during the simulation sessions, which were elaborated and reflected upon during the debriefing part of the sessions. The simulation design seemed to have a great impact on the outcome of the student's ethical reasoning, where increased immersion led to deeper emotional engagement among the students which increased awareness of their personal preconceptions. Conclusions: This study aimed to investigate whether high-fidelity simulations could be useful to stimulate ethical reflections and contribute to increased ethical competence among students. In conclusion, a well-designed high-fidelity simulation can be useful as an educational tool to learn and enhance ethical competence among specialist ambulance nursing students.

Knowledge-Behavior Relationships and Technology Adoption Among Patients With Diabetes: A Mixed-Methods Analysis of Smart Foot Care Technology

BACKGROUND

Although recent systematic reviews indicate low adherence to foot care practices among patients with type 2 diabetes compared to other self-management behaviors, smart healthcare technologies offer potential solutions for improving foot care management. The smart diabetic foot screening system represents an innovative approach to diabetic foot care. However, the factors influencing its adoption, particularly the relationship between knowledge, behavior, and technology acceptance, remain poorly understood.

METHODS

A mixed-methods design was employed, integrating quantitative and qualitative data. Quantitative data were collected from 80 patients with type 2 diabetes using validated instruments: the foot care knowledge questionnaire, diabetic foot self-management behavior scale, and the unified theory of acceptance and use of technology questionnaire. Pearson correlation and regression analyses examined relationships between knowledge, behavior, and technology adoption intention. In-depth, semistructured interviews with 20 participants explored adoption factors. Thematic analysis was conducted on qualitative data.

RESULTS

Despite high levels of foot care knowledge (86.2% correct response rate), actual self-management behaviors remained suboptimal, with a modest correlation between knowledge and behavior (r = 0.31 and p < 0.01). Regression analysis identified attitude and facilitating conditions as significant predictors of smart system adoption intention, explaining 57% of the variance. Qualitative analysis revealed three main themes: technology acceptance perceptions, implementation support system, and self-management patterns, highlighting the complex interplay between knowledge, attitudes, and behavioral factors.

CONCLUSIONS

This study reveals that despite improved knowledge levels compared to previous decades, the knowledge-behavior gap in diabetic foot care persists. The findings suggest that successful implementations of smart healthcare technologies require addressing both attitudinal factors and facilitating conditions, rather than focusing solely on knowledge enhancement. These insights contribute to understanding technology adoption in chronic disease self-management and inform the development of more effective implementation strategies.

Knowledge and skills transfer perspectives of diagnostic radiographers and students in clinical practice

INTRODUCTION

The effective transfer of knowledge and skills between diagnostic radiographers and students in the clinical practice is crucial for professional development and patient care. However, information on the factors influencing this transfer is limited in the diagnostic radiography profession. The objective was to determine the contributors affecting knowledge and skills transfer between diagnostic radiographers and students in clinical practice.

METHODS

A qualitative, descriptive research design was used. Semi-structured interviews were conducted with 15 participants, including seven qualified radiographers, five student radiographers and three newly graduated radiographers. The qualitative data were analysed using reflexive thematic analysis, from which three focus areas and eight themes were identified.

RESULTS

Focus areas for knowledge and skills transfer were enablers, barriers and possible solutions. The themes under the focus area enablers included a safe and conducive working environment, personal attributes and preferred methods for learning. The themes identified as barriers to knowledge and skills transfer were communication and supervision challenges, personal and interpersonal factors, workplace pressures and adaptation challenges. Participants emphasised student placement strategies and professional development and engagement as possible solutions to overcome barriers experienced.

CONCLUSION

Knowledge and skills transfer is an integral part of clinical practice. This study provided a platform for participants to voice their perspectives on the factors influencing knowledge and skills transfer the clinical environment. The proposed solutions offer practical recommendations to enhance knowledge and skills transfer, supporting improved learning outcomes and professional development.

IMPLICATIONS FOR PRACTICE

The authors recommend in-service training sessions to promote knowledge transfer, regular professional development seminars, encouraging collaborative practice, fostering a supportive social environment, and introducing structured student orientation sessions for clinical practice as solutions to address knowledge and skills transfer barriers.

Secondary Qualitative Analysis of the Effect of Work-Related Stress on Women Who Experienced Miscarriage During the COVID-19 Pandemic

OBJECTIVE

To explore the effect of work-related stress on women who experienced miscarriage during the COVID-19 pandemic.

DESIGN

Secondary qualitative analysis using a qualitative descriptive approach.

SETTING

Participants completed interviews virtually or face to face in North Carolina in 2022.

PARTICIPANTS

Thirteen women who experienced miscarriage from March 30, 2020, to February 24, 2021, during recommended and mandated stay-at-home orders, and discussed work-related stress.

METHODS

We used qualitative data from a primary study. We analyzed semistructured interviews using inductive content analysis with first- and second-cycle coding. After finalizing the themes, we applied the theory of transactional stress and coping deductively as an interpretive lens to contextualize the findings.

RESULTS

Four themes emerged: Difficulties Maintaining Work-Life Balance, Inadequate Workplace Accommodations, Varying Levels of Workplace Social Support, and Compounded Pressures of Miscarriage and Pandemic-Related Stress. Struggles with work-life balance, inadequate work accommodations, and limited workplace social support led to additional emotional distress and impaired work performance, and they prompted changes in employment status.

CONCLUSION

Our findings underscore the need for comprehensive workplace policies and interventions that support women's unique needs after miscarriage, particularly during crises. Practical recommendations include flexible work schedules, paid leave, and mental health resources.

Addressing Issues of Inclusive Workplace Culture for Women Orthopaedic Surgeons in Academia: A Qualitative Investigation

BACKGROUND

The scarcity of women in academic orthopaedics has persisted for decades despite general interest in promoting diversity. Therefore, we aimed to understand what aspects of workplace culture enhance or detract from building an inclusive workplace for women surgeons in academic orthopaedics.

METHODS

Women orthopaedic surgeons in the United States with a range of training backgrounds, races/ethnicities, academic institutions, subspecialties, and geographic locations were recruited using purposive sampling techniques until thematic saturation was achieved. All women currently hold or previously held an academic position in orthopaedics. Forty-minute virtual semistructured interviews were conducted from December 2023 to April 2024. Data were analyzed using grounded theory methodology to develop a conceptual model of inclusive culture.

RESULTS

Of the 35 women approached for participation, 26 (74%) participated. Eighty-one percent were currently in academia, and 19% had left academia; 12% identified as Asian, and 23% identified as Underrepresented in Medicine (URiM). Our model of inclusive workplace culture is built on 2 interrelated pillars: "supportive structures" and "social inclusion." The first pillar, supportive structures, is primarily under the direction of department leaders and includes themes of intentional career development, valuing diverse contributions, transparent policies, and building department cohesiveness. The second pillar, social inclusion, relies on all members of an organization. Themes within social inclusion are respect for women, male allyship, women supporting women, and true integration of women surgeons.

CONCLUSIONS

With intentional effort, orthopaedic departments can create the structures of support necessary to foster women's career success, as well as the social inclusion to encourage their longevity in academia.

Empowering Frontline Nurses as Implementation Science Leaders: The EQUIP Model for Evidence-Based Practice Integration and Quality Improvement

BACKGROUND

Sustaining evidence-based practice (EBP) in nursing faces systemic and workforce barriers. Implementation science (IS) offers structured approaches to support EBP integration. Under Saudi Arabia's Vision 2030, scalable nurse-led models are critical to bridging the research-to-practice gap.

AIM

To evaluate the Evidence-Based Quality Improvement Project (EQUIP), a nurse-led model grounded in IS, by assessing its implementation through frontline implementation lead (IL) nurses.

METHODS

A mixed-methods formative evaluation was conducted across multiple healthcare facilities. Two IL nurse-led quality improvement (QI) projects were used as illustrative examples. Data sources included QI documentation, clinical metrics, and researcher field notes.

RESULTS

EQUIP enabled IL nurses to apply EBP in routine care and proved adaptable across diverse settings. However, inconsistent engagement and competing workload demands were the most influential barriers, underscoring the need for structured support.

CONCLUSION

EQUIP presents a scalable IS-based initiative to embed EBP in nursing. Institutional support is essential for sustained implementation.

Exploring the pattern of mental health support-seeking behaviour and related barriers among women experiencing intimate partner violence in urban slums of Bangladesh: perspectives from multiple level stakeholders

Intimate partner violence (IPV) is a recognised global public health concern, substantially impacting women's well-being. While there is growing research on how IPV victim-survivors seek mental health support in the Global North, it remains understudied in the Global South, particularly for those residing in slums in low-income countries like Bangladesh. Through interviews and group discussions with different stakeholders, this study explored the mental healthcare-seeking behaviour of victim-survivors of IPV residing in urban slums, barriers to service utilisation, and recommendations to strengthen care pathways. Stakeholders perceived IPV as normalised in slums, indicating sociocultural norms and interpersonal causes as significant contributors to mental health issues and events of IPV. Seeking healthcare and moral support for IPV from local dispensaries and informal sources was common; however, IPV victim-survivors had no knowledge about mental-health-related services. Low mental health literacy and lack of financial support prevented them from seeking the necessary care. Social stigma regarding accessing mental healthcare, coupled with the absence of professional service providers and community-based services, represent critical systemic challenges. Recommendations included promoting community-level awareness of IPV and mental health issues, increasing mental healthcare services, training health workers, and fostering positive masculinities in community-based interventions. Stakeholders emphasised the need to adopt culturally relevant interventions for tackling IPV and improving mental healthcare pathways, especially for the low-income population of Bangladesh.

"I can't unsee him lying in my kitchen": Understanding the trauma of family members who witness a loved one's cardiac arrest

Background

While there is a growing body of research in the field of post-cardiac arrest outcomes and survivorship, the lived experience of close family members who witness the arrest itself and who may have performed CPR, has not been specifically explored.

Methods

We employed qualitative interpretive descriptive methodology using key informant interviews for data collection. Participants were recruited internationally, and interviews were conducted virtually following a semi-structured format. Thematic data analysis was conducted using a constant comparative approach.

Results

Interviews were conducted with 33 family members who were present at the time of their loved ones cardiac arrest. Across the participant stories, we identified the core concept of 'base trauma' that centres around what family member witnesses initially experience at the time of the arrest itself. We postulate that this core theme influences six significant patterns of experience including: 1) feelings of responsibility, 2) fear of recurrence without them, 3) the impact of reliving the event, 4) the inability to escape triggers, 5) the delayed realization of their own trauma, and lastly 6) dealing with psychologic disconnect.

Conclusions

There is increasing research evidence that family members of cardiac arrest survivors have their own challenges as part of the recovery journey. We introduce novel concept of the compounded impact of the initial base trauma those that witness and respond to a loved ones cardiac arrest have. The nuanced experiences of this group point to the need to normalize their experience as a 'trauma' and suggest that support pathways need to recognize this.

The lived experience of exemplary physical therapist students in clinical education: a phenomenological study

BACKGROUND

Physical therapy educators strive to achieve excellence in education and develop clinicians who are prepared to meet the health needs of society. Previous research has focused on describing the traits, beliefs, and experiences of exemplary educators and clinicians to inform didactic and clinical curricula and serve as a model for expert practice. However, no studies have explored the experiences and perspectives of exemplary students.

PURPOSE

The aim of this phenomenological study was to describe the traits, beliefs, and experiences of exemplary physical therapist (PT) students in clinical education.

METHODS

A phenomenological design was utilized to gather data through semi-structured interviews with 26 students from the United States who met the criteria for exemplary and were completing their terminal clinical experience or were within six months of graduation. Data were analyzed using constant comparison and methodological rigor was maintained using an inquiry audit, peer debriefing, member checking, and pilot interviewing.

RESULTS

A Desire to Serve emerged as an overarching theme. The essence of being exemplary was further elucidated through the following themes: (1) Being adaptable (2) Being reflective (3) Embracing challenges and seeking opportunities (4) Valuing a collaborative relationship with their CI (5) Importance of self-care, and (6) Coming into my own as a PT.

CONCLUSION

Given the emphasis on excellence in physical therapy education, these results can provide insights for defining the necessary qualities for achieving excellence in both classroom and clinical environments. Additionally, these findings can assist educators in fostering excellence-driven attributes among entry-level students.

Strabismic Adults' Expectations of Psychosocial Support From Healthcare Professionals-A Qualitative Descriptive Study

Background and Aims

Strabismus, an eye misalignment, impacts the functional and psychosocial health-related quality of life in adult patients. Corrective surgery generally improves adults' health-related quality of life. Previous research reports that strabismic adults with a psychosocial influence of the condition may benefit from preoperative psychosocial support, although what such support should consist of is unclear. Therefore, this study aimed to describe strabismic adults' expectations of psychosocial support from healthcare professionals.

Methods

The study has a qualitative descriptive design. It included 12 semi-structured interviews with purposefully recruited patients who had experienced the psychosocial influences of strabismus. The data were analyzed by inductive content analysis.

Results

Strabismic adult patients described their expectations for psychosocial support, consisting of education about strabismus, genuine encounters with strabismus experts, accessible support, and available peer support. The participants explained that strabismus specialists should provide tailored education for patients, the public, and other healthcare professionals. They shared that strabismus professionals should ask about patients' psychosocial well-being-that by intently listening, openly discussing, and validating patients' experiences, they could support their well-being. Psychological care provided by nurses and psychologists should be easily accessible, supportive, and timely for children and adolescents. Participants also expected professionals to guide them to available peer support.

Conclusion

Strabismic adult patients dealing with the condition's psychosocial burden expect psychosocial support from strabismus experts. This study's results can be used to improve psychosocial care in clinical strabismus services.

Getting Everyone on Board to Break the Cycle of Bacterial Vaginosis (BV) Recurrence: A Qualitative Study of Partner Treatment for BV

INTRODUCTION

Bacterial vaginosis (BV) is a common condition that affects the sexual wellbeing of women and other people with a vagina. Recurrence following individual treatment is frequent and exerts a cumulative burden over time. Researchers at the Melbourne Sexual Health Center have recently completed the first successful trial of male partner treatment (MPT) for BV, demonstrating the superior effectiveness of concurrent MPT in reducing recurrence.

METHOD

Using a case study design, semi-structured interviews with trial participants explored the views and experiences of nine men who had received MPT and nine women whose partners had received MPT. Action and emotion coding were employed to create an explanatory model of experiences of BV recurrence and MPT.

RESULTS

Three key themes within this model related to the cycle of recurrent BV: the physical, psychological, and relationship impacts of BV ("experiencing BV"); the importance of healthcare providers exploring different options and understanding individual context ("seeking care"); and the frustration, cost, and inconvenience of individual treatment ("dealing with it alone"). This cycle was broken by "Getting everyone on board" with MPT. This involved women, men, and healthcare professionals understanding BV and MPT, overcoming barriers to access, and open communication between partners. These factors, in combination, resulted in couples "dealing with BV together", undertaking a week of inconvenience to share the responsibility of preventing recurrence.

CONCLUSION

These findings suggest that the widescale adoption of MPT for BV will require multilevel approaches to address gaps in the awareness of BV with sensitivity to the relational, social, and structural context of delivering care.

The Impact of Telepresence Robots on Family Caregivers and Residents in Long-Term Care

Telepresence robots can enhance social connection and support person-centered care in long-term care (LTC) homes. This study evaluates their impact in facilitating virtual visits between family caregivers and older residents in Canadian LTC homes. Telepresence robots were placed in residents' rooms, allowing virtual visits at mutual convenience. A total of 18 residents and 17 family caregivers participated. Quantitative assessments included the Zarit Burden Interview, the De Jong Gierveld Loneliness Scale, and the Quality of Life in Alzheimer's Disease scale, while qualitative data were collected through interviews, field notes, and observations. Repeated ANOVA showed that using telepresence robots significantly reduced caregiver burden (p = 0.008), improved residents' quality of life (p = 0.028), and decreased resident loneliness (p = 0.038). Older caregivers experienced the greatest burden reduction, with scores dropping from a mean of 25.0 at baseline to 16.1 at two months. Qualitative findings provided further context, revealing that residents felt more connected, close, and engaged, while families found the robots facilitated continuity of care, complemented in-person visits, reduced stress and guilt, and provided reassurance. These findings suggest that telepresence robots can enhance the well-being of both residents and caregivers in LTC homes, though future research should explore their long-term impact and technological limitations.

Development of patient reported outcome measures assessing tumor pain intensity and tumor pain interference for individuals with neurofibromatosis type 1 and plexiform neurofibromas: qualitative findings

BACKGROUND

Pain is a common symptom in individuals with neurofibromatosis type 1 (NF1) that often is associated with plexiform neurofibroma (pNF) tumors. To date, no patient-reported outcome measures have been validated specifically to assess pNF-related pain intensity or pain interference in this population. Such measures are sorely needed since pain is being considered as an outcome in clinical trials targeting reduction of pNF. The study aims were to: (1) obtain qualitative information from individuals with NF1 and pNFs about their pain and its measurement and (2) modify existing scales to assess pNF-related pain intensity and pain interference for NF1 clinical trials.

METHODS

For this multi-site, qualitative study, 56 individuals (26 children, 6-16 years; 30 adults, 18-68 years) with NF1 and pNF participated in a focus group and/or individual interview about pain intensity and pain interference (concept elicitation) and also provided feedback about existing pain measures (Numeric Rating Scale-11 and Pain Interference Index) assessing these domains (cognitive debriefing). Four additional waves of cognitive debriefing interviews further refined the measures. Qualitative concept elicitation data from transcripts were coded, analyzed using NVivo software, and thematic analysis was conducted using both deductive and inductive techniques. Additional themes and systematic problems and suggestions regarding the measures were gleaned from reviewing the field notes and interview transcriptions generated by the cognitive debriefing sessions.

RESULTS

Concept elicitation themes included descriptions of two types of pNF-related pain (chronic and episodic), variability of pain over time, varying ability to recall pain, lack of knowledge of pNFs, and the ways pain interferes with daily activities. Cognitive debriefing themes included information on how to rate pNF-related pain intensity apart from other pain; problems and suggestions regarding the measures included difficulty comprehending some items and preferences for alternative wording and formatting. Based on these qualitative results, the measures' instructions, items, and formatting were modified to create the PAin INtensity Scale for plexiform neurofibromas (PAINS-pNF) and the Pain Interference Index for plexiform neurofibromas (PII-pNF) for administration on a mobile app or web-based platform.

CONCLUSIONS

The PAINS-pNF and PII-pNF are promising self-report measures developed using patient engagement to evaluate tumor pain intensity and pain interference in NF1 clinical trials. The second phase of the study to provide reliability, validity, and normative data for individuals with NF1 and pNFs ages 8 years and older is underway.

Perceived barriers and facilitators to managing psychological distress in COPD: The perspectives of patients and carers - a qualitative study using the theoretical domains framework (TDF)

Psychological distress is highly prevalent in people with chronic obstructive pulmonary disease (COPD), however, remains under-recognised and under-treated. A qualitative study using semi-structured interviews was undertaken to explore lived experiences of psychological distress of people with COPD and their informal carers, as well as barriers and facilitators to uptake of mental health treatments. Participants were recruited via purposive sampling from respiratory clinics at two Australian tertiary hospitals. Thirteen people with COPD and comorbid mental illnesses and two informal carers participated. Interview transcripts were analysed using the Theoretical Domains Framework (TDF). Barriers to patients' acceptance of structured management for psychological distress in COPD included: limited understanding of overlapping symptoms, high burden of care from physical issues, stigma, and healthcare that did not align with individual preferences. Increased psychoeducation, supported self-management, and individualised care were possible facilitators. Multidisciplinary care integrating mental health services within primary care and pulmonary rehabilitation settings are required to overcome current challenges and improve patient outcomes.

Cancer-related financial toxicity among Latinas with breast cancer in a rural area of the United States: a qualitative study

BACKGROUND

Financial toxicity, or the adverse impact of cancer diagnoses on survivors' financial well-being, is an increasing global concern. In the United States, it is disproportionately high among racial/ethnic minorities. Latina breast cancer patients encounter greater financial burdens than their non-Latina White counterparts, which can lead to discontinuation of medical treatment, poor quality of life, or early mortality. In particular, cancer patients in rural regions are at a greater risk for financial toxicity due to a lack of resources and structural barriers. Despite its magnitude, financial toxicity among Latina breast cancer patients who reside in rural areas is understudied. This study aims to fill this gap by exploring financial toxicity from the perspectives of Latina breast cancer patients, family members, and healthcare professionals.

METHODS

This qualitative, cross-sectional study aimed to address this gap in the literature through in-depth interviews with 47 participants, including Latina breast cancer patients (n = 21), their family members/caregivers (n = 14), and healthcare professionals (n = 12), all from a rural agricultural region, with a focus on contributing factors and impacts of financial toxicity. Qualitative data were analyzed using a thematic analysis approach. Demographic data were analyzed using descriptive statistics.

RESULTS

The main themes relating to contributions to changes in patient financial situations included (1) employment disruption (e.g., reduced working hours and quitting the job) post breast cancer diagnosis, and (2) medical-related (out-of-pocket costs, co-payment) and non-medical related financial costs (transportation, childcare). The impacts of financial toxicity were multi-faceted. Patients struggled to meet basic needs (e.g., food, paying bills) and experienced psychological distress. Coordinating patient support care (e.g., transportation, caretaking) to accommodate their financial needs negatively impacted their families' work schedules and routines. It also affected family relationships, leading to family conflicts, including marital conflict, as well as patients' continuum of cancer care.

CONCLUSIONS

Financial toxicity encountered by rural Latina breast cancer patients is complex, and its adverse effects are multifaceted. Culturally appropriate interventions targeting patients and families to address their personal, psychological, and familial issues related to financial toxicity are needed.

Health providers' perspectives on effects of the COVID-19 pandemic and anti-epidemic measures on maternal health services in Nairobi, Kenya: a qualitative study

BACKGROUND

The first case of COVID-19 in Kenya was confirmed in March 2020; the Kenyan government swiftly introduced measures to curb transmission, some of which negatively impacted maternal health services. Most research on the effects of COVID-19 on maternal health is from the perspectives of pregnant women and mothers. Our study explores health providers' perspectives on the effect of COVID-19 on maternal health services in Nairobi, Kenya.

METHODS

From February to May 2023, we conducted key informant interviews with 39 health providers in Nairobi County, Kenya. Study participants included medical doctors/officers, clinical officers, nurses, and community health assistants. Thematic inductive and deductive analysis were used to analyze the data; coding was done using NVIVO.

RESULTS

The interviewed health providers confirmed that COVID-19 prevention and infection control measures had negatively affected maternal health services. The measures led to the temporary closure of health facilities because there was a shortage of health providers due to their deployment in isolation centers and quarantine, and some contracted COVID-19, restricted access to maternal health services, and delayed service delivery due to social distancing. Health providers stated that they faced numerous challenges, including fear of and contracting COVID-19, being overworked as they were short-staffed, limited resources, stigma from the community as they were considered infectious, and psychological distress. In addition, health providers said that the Kenyan government addressed some challenges by providing personal protective equipment, prioritizing health providers for vaccination, facilitating their movement, and providing temporary tax relief.

CONCLUSION

Our findings highlight the negative effect of COVID-19 on maternal health services in Kenya. Future pandemic preparedness should entail proper planning, staffing, training, psychosocial support, and staff motivation through the provision of risk allowance and health insurance. In addition, funds should be set aside for purchasing medical supplies, equipment, and vaccines, building isolation centres, and other contingencies.

Factors Influencing Information Distortion in Electronic Nursing Records: Qualitative Study

BACKGROUND

Information distortion in nursing records poses significant risks to patient safety and impedes the enhancement of care quality. The introduction of information technologies, such as decision support systems and predictive models, expands the possibilities for using health data but also complicates the landscape of information distortion. Only by identifying influencing factors about information distortion can care quality and patient safety be ensured.

OBJECTIVE

This study aims to explore the factors influencing information distortion in electronic nursing records (ENRs) within the context of China's health care system and provide appropriate recommendations to address these distortions.

METHODS

This qualitative study used semistructured interviews conducted with 14 nurses from a Class-A tertiary hospital. Participants were primarily asked about their experiences with and observations of information distortion in clinical practice, as well as potential influencing factors and corresponding countermeasures. Data were analyzed using inductive content analysis, which involved initial preparation, line-by-line coding, the creation of categories, and abstraction.

RESULTS

The analysis identified 4 categories and 10 subcategories: (1) nurse-related factors-skills, awareness, and work habits; (2) patient-related factors-willingness and ability; (3) operational factors-work characteristics and system deficiencies; and (4) organizational factors-management system, organizational climate, and team collaboration.

CONCLUSIONS

Although some factors influencing information distortion in ENRs are similar to those observed in paper-based records, others are unique to the digital age. As health care continues to embrace digitalization, it is crucial to develop and implement strategies to mitigate information distortion. Regular training and education programs, robust systems and mechanisms, and optimized human resources and organizational practices are strongly recommended.

Family perspectives and experiences on implementing telehealth in pediatric palliative care: a qualitative approach

Telehealth is seen as a promising avenue to improve accessibility and quality of pediatric palliative care (PPC) yet engaging users with digital tools (DT) over the long term poses a challenge. Aligning telehealth initiatives with the actual needs and expectations of families is crucial for sustainable care models. To explore family perspectives and experiences with telehealth in PPC, focusing on their needs, perspectives, concerns, and hopes to refine digital care models. This research employed a qualitative methodology, gathering data through a combination of semi-structured interviews and focus group discussions with primary caregivers (PCGs) of PPC patients. PCGs of children utilizing telehealth services in PPC contexts. Interviews with seven individuals and a focus group of eight revealed three main themes: the experience of engaging with a PPC service that utilizes telehealth, the transformative potential of telehealth within PPC, and the barriers and facilitators influencing its adoption. A key finding was the collective desire among PCGs for telehealth solutions that support a patient and family-centered, holistic care model that integrates various health services without compromising the humanized essence of care.

CONCLUSIONS

Families are generally positive about integration of telehealth into PPC, emphasizing the need for telehealth models that maintain the core values of humanized care. Success depends on engaging end-users throughout development, implementing user-friendly technology that fits into family life, and focusing on customization for patients.

WHAT IS KNOWN

• Telehealth has emerged as an innovative response to meet the increasing demand for highly specialized care in PPC. • Digital health solutions often face increasing abandonment rates over time.

WHAT IS NEW

• Families caring for children with palliative needs are receptive to telehealth, identifying essential features for its long-term success. • They value the preservation of personal attention in care, emphasizing the importance of maintaining human connection alongside digital innovations.

Examining the impact of the COVID-19 pandemic among staff and consumers at Florida centers for independent living

BACKGROUND

People with disabilities (PWD) face health disparities due to barriers that limit their access to essential healthcare services. During the COVID-19 pandemic, health disparities among PWD increased as stay-at-home mandates and other safety measures interrupted access to healthcare and social services. Community-based and consumer-driven Centers for Independent Living (CILs) attempt to reduce disparities faced by PWD by providing information and referrals, peer counseling, and advocacy.

OBJECTIVE

Despite funding to utilize public health workers to respond to the COVID-19 pandemic and prepare for future crises, the literature currently lacks examinations of the impact of the COVID-19 pandemic on CIL consumers and staff.

METHODS

This qualitative study employed a directed content analysis to evaluate 6 consumer focus groups (N = 35) and 4 staff focus groups (N = 14).

RESULTS

Through data analysis, staff themes included Resource Gaps, COVID-19 Concerns, Impact on Independence, Impact on Health, Work Demand Changes, and Work/Life Balance. Among consumers, themes of CIL Service Experiences, CIL Benefits, COVID-19 Concerns of Using CILs, COVID-19 Barriers to Using CILs, Impact on Independence, Impact on Health, Resource Gaps, and Recommendations for CILs were present.

CONCLUSIONS

This study demonstrates the diverse experiences among PWD during the COVID-19 pandemic. However, there are similarities in the impact of environmental factors on the severity of disability experienced by consumers and staff. This study highlights the benefits of independent community living resource centers and the need to better understand the experiences of PWD to prepare for future pandemics.

Implementation of Goal-Oriented Care in Belgium: Experiences From 25 Primary Care Organisations

Introduction

Goal oriented care (GOC) and its readiness for implementation has been described in scientific literature, but research on GOC implementation in primary care organisations is limited. This study aims to capture the experiences of primary care organisations in implementing GOC in their context.

Method

A qualitative study, with data triangulation, was conducted. Primary care organisations that experimented with the implementation of GOC in their context were followed. Data were analysed using inductive thematic analysis.

Results

Seven themes supporting GOC implementation were identified. Project leaders from the primary care organisations experienced that related concepts can serve as a foundation for initiating the implementation of GOC. The implementation process is an iterative and reflective process, with resistance viewed as an integral part of the process, offering opportunities for reflection. Collaborating with partners, especially the active participation of patients, was seen as a facilitator. Furthermore, having a clear vision for GOC is necessary. Projects invested in adapting tools and processes to align with GOC and provided relevant training.

Discussion and conclusion

The findings led to recommendations that can guide the implementation of future GOC projects. Effective implementation extends beyond the development and adaptation of tools; it requires translating theoretical concepts into practical application and creating a shared vision on GOC.

Incorporating Best-Worst Scaling (BWS) Questions into Focus Groups to Improve Understanding of Patient Preferences and Refine BWS Attributes

BACKGROUND AND OBJECTIVE

Best-worst scaling (BWS) is a stated preference elicitation method used for prioritizing attributes of healthcare interventions. Best-worst scaling attribute development is commonly based on literature review, qualitative work, and methodological/clinical expert input. There is limited research incorporating BWS in focus groups as part of the attribute development process. We sought to explore how incorporating BWS questions using the list of potential attributes in focus groups could be used to improve understanding of patient preferences and refine the list of potential BWS attributes as part of the attribute development process.

METHODS

We administered BWS questions on healthcare priorities for inflammatory bowel disease in five focus groups with Canadian patients with inflammatory bowel disease to (1) understand the "what," "how," and "why" of participant choices and (2) note how participants understand the attributes and the language they use to refine the list of potential BWS attributes. A list of 20 potential attributes was used to generate the BWS questions. We coded most/least important choices ("what") and used a thematic analysis to derive subthemes indicating "how" and "why" participants made their choices. We coded how participants understood the attributes/BWS questions and language used when discussing the attributes.

RESULTS

Across the 36 participants, the most frequently chosen most/least important attributes were summarized. Three subthemes explaining the "how" and "why" of participant choices were identified: perceived gain; influence of individual experiences; current health state and personal circumstances. Participants identified challenges understanding specific attributes and BWS questions, and provided suggestions for modifications to attribute language/descriptions. Administering BWS questions in focus groups provided: (1) insight into the assumptions participants made when completing the BWS questions; (2) clarity in language and attribute descriptions, and challenges participants had when completing the BWS questions that can be used to refine the list of potential attributes as part of the attribute development process; and (3) understanding of which attributes were most/least important and why to identify potential attributes to remove during the next steps of the attribute development process.

CONCLUSIONS

Best-worst scaling questions conducted within focus groups can stimulate discussions around relative importance and prioritization of attributes. Through open dialogue, this method can unveil unforeseen responses or identify areas that are unclear and enable a transparent approach to refine the list of potential attributes as part of the attribute development process.

Mirrors for Pacific Islander Children: Teaching Resilience Through Culturally Adapted Bibliotherapy

Pacific Islander youth face disproportionately high rates of suicide and mental health challenges, yet culturally appropriate interventions remain scarce. This study investigated whether culturally adapted bibliotherapy could effectively promote resilience in American Samoan children by incorporating culturally relevant stories and coping strategies. Through collaboration with on-island Samoan cultural brokers, we developed and implemented culturally adapted stories and lessons designed to resonate with the experiences of children in American Samoa. The study employed a mixed-methods approach with 34 American Samoan children aged 5-13 years, using observations, adapted card sorts, and forced-choice procedures to measure responses to the intervention. The results demonstrated that participants showed strong identification with the culturally adapted stories and characters, actively engaged with the embedded coping strategies, and reported increased confidence in applying resilience techniques. These findings suggest that culturally adapted bibliotherapy holds promise as an effective method for promoting resilience in Pacific Islander children while highlighting the importance of cultural authenticity in mental health interventions.

Shared medication coordination in a social psychiatric residence: adaptation to meet local requirements

BACKGROUND

Shared medication coordination (MedCo) is vital yet difficult to manage for residents living with severe mental disorders in residential care, where multidisciplinary teams provide support. A successful Shared MedCo model in one residence included three core components: "shared decision-making," "patient involvement" and "MedCo". This model was effective but transfer to other residential settings needed implementation adaptation. The aim of this study was to meet local MedCo requirements by achieving a good fit between a Shared MedCo intervention core components and a social psychiatric residential context.

METHODS

The methodology was guided by a complex intervention adaptation framework involving co-creation with stakeholders to gather iterative feedback. The intervention was adapted through a systematic four-phase process and tested through shared consultations. Ten residents took part in the test, and the intervention's feasibility and acceptability were assessed.

FINDINGS

The adaptation process ensured a good fit between the intervention's core components and the new context. Stakeholder input provided crucial content and contextual insights, while planned adaptations laid the foundation for modulating the individual residence Shared MedCo model. Iterative adaptations during the test phase refined the intervention, leading to near-routine performance by the tenth consultation. Residents gained a stronger voice in their healthcare, and all ten had their medication coordinated and optimised. The intervention was found feasible and acceptable.

CONCLUSION

For effective implementation, complex multidisciplinary Shared MedCo interventions require contextual adaptation and active stakeholder involvement. The shared MedCo intervention offers a guideline for achieving a good fit between the intervention core components and diverse residential contexts, ensuring successful medication coordination for residents living with severe mental disorders.

Designing qualitative research with value in the clinical and epidemiological context: what, why and how

Clinical and epidemiological research is indispensable for improvements in evidence-based healthcare and health outcomes, but it also leaves important gaps in our understanding of health and illness. Qualitative research has been increasingly recognized as a key to addressing some of these gaps, using both exploratory (to gain a more complete and in-depth understanding of problems) and explanatory (to explain quantitative results) approaches. By finding out 'what's going on' and bringing people's stories to light, qualitative research is widely advocated as crucial in enhancing patient-centered research and healthcare. To date, most clinicians, clinical researchers and epidemiologists are relatively unfamiliar with and untrained in qualitative research-a type of research that, compared with quantitative research, requires different research skills and uses a different jargon, type of reasoning, and methods. This article aims to equip them with the basic knowledge necessary to appraise and design qualitative research. Specifically, we provide a comprehensive overview of (i) what qualitative research is, including various examples of qualitative research questions and explanations of the contrasting properties of quantitative and qualitative research; (ii) what constitutes the added value of qualitative research in the clinical and epidemiological context, illustrated using numerous research studies conducted within nephrology; and (iii) practical guidelines for designing qualitative research within this context, including a self-developed checklist containing essential information to include in qualitative research protocols. In doing so, we hope to enrich clinical and epidemiological research with complementary qualitative evidence-amongst others, invaluable insights into patients' lived experiences and perceptions-and thereby greatly enhance patient-centered research and evidence-based healthcare.

Exploring intensive care unit nurses' acceptance of clinical decision support systems and use of volumetric pump data: A qualitative description study

BACKGROUND

Intensive care units are well positioned for the rapid development of data-driven clinical decision support systems. However, clinical decision support systems using volumetric pump data are uncommon. This may be explained by the complexity of this data source as well as our limited understanding of the acceptability of clinical decision support systems and volumetric pump data use from nurses' perspectives.

AIM

To describe intensive care unit nurses' perceptions regarding (1) the acceptability of developing and implementing novel intensive care technologies (i.e. clinical decision support systems) and (2) the acceptability of using infusion pump data to inquire about intensive care practices and improve the quality of care.

STUDY DESIGN

A qualitative description study was performed. Semi-structured interviews were conducted between January and March 2024 and involved 10 intensive care nurses from the province of Quebec (Canada).

RESULTS

Nurses generally perceived the development and implementation of novel technologies, and the use of pump data, as acceptable. However, the discrepancy between the delays in care computerization and the rapid development of novel technologies with advanced algorithmic capabilities, coupled with nurses' doubts and limited comprehension of data-driven clinical decision support systems, influenced their perspectives. Nurses' appraisal that infusion logs can enhance clinical practices and that logs should align with their documentation motivated their perception that it is acceptable to use this data source.

CONCLUSIONS

Overall, novel technologies as well as volumetric pump data use were perceived as acceptable. Leveraging novel data processing and computation techniques could lead to the development of more dynamic clinical decision support systems that utilize infusion logs, further improving care delivery.

RELEVANCE TO CLINICAL PRACTICE

For clinical decision support systems to be useful for intensive care nurses, alarms must be seamlessly integrated into their workflows. Involving nurses in the technological development process may help ensure the usability of these technologies.

Guiding novice nurses through resuscitations in the intensive care units: A qualitative descriptive study

BACKGROUND

Resuscitation in the ICU represents a critical juncture where both junior and experienced nurses are expected to respond effectively. As junior nurses may lack the clinical expertise to contribute optimally in a resuscitation, senior nurses may then be required to guide them while managing the intricacies of a resuscitation. Understanding such clinical teaching experiences is essential to strengthening the intra-professional nursing response to resuscitations.

AIM

The aim of this study was to explore junior and senior nurses' experience of guiding and being guided during resuscitations in the ICUs.

STUDY DESIGN

A qualitative descriptive study was conducted in four ICUs of a tertiary hospital. Ten ICU nurses who have experience with guiding junior nurses or being guided during resuscitations were recruited and interviewed using semi-structured interviews. Interviews were transcribed verbatim and thematically analysed.

RESULTS

Three main themes emerged from the data. First, "Under siege from all sides" highlights the limitations and challenges faced by junior nurses, as observed by senior nurses. Particularly, competency gaps in executing resuscitative procedures resulted in them being under-performing team members during resuscitations. Second, "Acts of guiding" depicted how senior nurses guided junior nurses through passive observation or active participation, with either approach facilitating the junior nurse into the functional roles of a resuscitation. Lastly, "Shouldering guiding responsibilities" espoused the moral quagmire that senior nurses experience when they must manage the complexity of a resuscitation while simultaneously guiding the junior nurse.

CONCLUSIONS

This study provides insights on the intra-professional experiences of nurses guiding and being guided during ICU resuscitations. Findings illuminate the need for leadership and clinical teaching capability building among senior nurses to create opportunistic learning during resuscitations for junior nurses.

RELEVANCE TO CLINICAL PRACTICE

More support is required for junior and senior nurses as they mount an attempt to revive the patient during resuscitations.

"Families are a resource, not the enemy": Canadian family caregivers' experiences of COVID-19 pandemic visitor restrictions

Canadian long-term care homes implemented strict visitor restrictions at the onset of the COVID-19 pandemic to control the spread of the virus among residents. These restrictions extended to family caregivers, a significant provider of in-person physical and social care, preventing them from entering long-term care homes. The purpose of the current study was to explore the experiences and observations of family caregivers during the prolonged visitor restrictions. Fifteen semi-structured, one-on-one interviews were conducted with family caregivers of persons living in long-term care and analysed using a codebook thematic approach. Four themes were identified: a) pandemic policies dismissed family relationships; b) prolonged separation traumatised families; c) family caregivers were resourceful in fulfilling their roles; and d) family caregivers are calling for collaborative change. Our findings reflect how long-term care policies and standards that lacked a family-centred lens resulted in barriers to care and led to serious concerns about the quality of life of residents and serious distress among family caregivers.

How Do University Students Navigate Distress? An Examination of Determinants, Coping Strategies, and Support Systems Through the Lens of Self-Determination Theory

Entrance to university is marked by significant changes and challenges that can impact mental health and well-being. This study investigated the determinants of psychological distress, coping strategies used, and the availability of support systems among university students in a non-Western country through the lenses of self-determination theory. The thematic analysis of 16 in-depth interviews revealed several academic, socio-demographic, and situational factors crucial in facilitating or impeding university students' sense of self-determination and, consequently, their psychological distress. The study uncovered students' relative preference for avoidance coping mechanisms, the limited presence of perceived formal support systems in higher education institutions, and a clear reliance of students on informal sources of support to buffer the effects of distress. Moreover, it was evident that students perceived their higher education settings as leaning toward being controlling rather than autonomy-supportive. Implications for promoting well-being among university students are discussed.

Physician Perspectives on the Potential Benefits and Risks of Applying Artificial Intelligence in Psychiatric Medicine: Qualitative Study

BACKGROUND

As artificial intelligence (AI) tools are integrated more widely in psychiatric medicine, it is important to consider the impact these tools will have on clinical practice.

OBJECTIVE

This study aimed to characterize physician perspectives on the potential impact AI tools will have in psychiatric medicine.

METHODS

We interviewed 42 physicians (21 psychiatrists and 21 family medicine practitioners). These interviews used detailed clinical case scenarios involving the use of AI technologies in the evaluation, diagnosis, and treatment of psychiatric conditions. Interviews were transcribed and subsequently analyzed using qualitative analysis methods.

RESULTS

Physicians highlighted multiple potential benefits of AI tools, including potential support for optimizing pharmaceutical efficacy, reducing administrative burden, aiding shared decision-making, and increasing access to health services, and were optimistic about the long-term impact of these technologies. This optimism was tempered by concerns about potential near-term risks to both patients and themselves including misguiding clinical judgment, increasing clinical burden, introducing patient harms, and creating legal liability.

CONCLUSIONS

Our results highlight the importance of considering specialist perspectives when deploying AI tools in psychiatric medicine.

Implementation strategies to support recovery support workers serving criminal legal involved people who use drugs

INTRODUCTION

Recovery support workers (RSWs) who provide social support interventions for people who use drugs (PWUD) often face challenges that can jeopardize the well-being, efficacy and sustainability of this essential workforce. To date, little has been reported on the types of implementation strategies used to support RSWs. We describe and evaluate a multifaceted implementation strategy package to support Reducing Opioid Mortality in Illinois (ROMI), a paired peer recovery coach and case manager (PRC-CM) intervention for PWUD with recent criminal-legal involvement in urban and rural settings.

METHODS

ROMI utilized a remote, hub and spoke-administered multifaceted implementation strategy package to support PRCs-CMs to deliver evidence-based services to PWUD with criminal-legal involvement. The core strategies included: (a) comprehensive training; (b) individual clinical supervision; (c) group consultation; and (d) centralized technical assistance. We evaluated the implementation strategy package using a mixed-methods design including qualitative interviews with the intervention staff to explore their experiences with each strategy component, as well as a quantitative coding of topics discussed during supervision and group consultation meetings to estimate prioritization of issues and balance of topics between strategy type.

RESULTS

Between January 2019 and January 2024, the study interviewed 8 PRC-CMs and quantitatively coded 568 sessions (79 group consultations and 489 individual supervisory) for discussion themes. The hub-and-spoke model allowed for centralized access to highly skilled supervisory staff as well as knowledge sharing across geographically remote teams. The therapeutic space to process feelings and emotional support provided during individual supervision was noted to be an essential resource by PRC-CMs. Group consultation facilitated camaraderie, mutual support and continual learning through dynamic and responsive trainings. Frustrations around resource limitations and systemic barriers facing their clients remained a dominant concern for PRCs-CMs, and was incompletely addressed by the technical assistance strategy.

CONCLUSION

Understanding the practical components and individual strengths of the implementation strategies required to support the implementers of complex interventions such as social support and navigation for PWUD with criminal-legal involvement elucidates the organizational and professional capacities that may be required for real world implementation.

TRIAL REGISTRATION

NCT04925427.

Factors Influencing Guardians' Health-Seeking Decisions for Children With Burkitt Lymphoma in Northern and Central Malawi

BACKGROUND

The survival of children with Burkitt lymphoma (BL) in sub-Saharan Africa is disproportionately low compared to high-income countries. In Malawi, many of these children are diagnosed in advanced stages. Early and accurate diagnosis is critical to survival of children with BL. This qualitative study evaluates factors influencing health-seeking decisions of guardians of children with BL in Northern and Central Malawi.

METHODS

We conducted in-depth interviews of guardians of children (<18 years) diagnosed with BL and admitted to the Pediatric Oncology Unit at Kamuzu Central Hospital, in Lilongwe, Malawi, from February to April 2023. Participants were identified using purposive sampling. Data were analyzed using thematic content analysis.

RESULTS

Twenty guardians participated in the interviews. The median age of the respondents was 41 years, and 65% were females. Four main themes emerged as factors influencing health-seeking behaviors as guardians of children with BL navigated the Malawi health system. These included personal, economic, access to healthcare, and social factors. Financial status consistently emerged as a crucial determinant in the health-seeking behaviors of guardians, but thematic analysis also revealed knowledge and awareness, geographical accessibility, and symptom interpretation as key factors shaping health-seeking behaviors for guardians of children with BL. Symptom interpretation was influenced by the limited knowledge of the disease, and the lack of general awareness about childhood cancer.

CONCLUSION

We identified financial and non-monetary barriers affecting health-seeking behavior among guardians of children with BL in Malawi. Targeted initiatives to alleviate the economic burden of cancer on affected families and increased awareness campaigns in the community are critical to improving BL outcomes in Malawi and other low-resourced settings.

A Qualitative, Patient-led Exploration of Vaccination Communication Preferences Among a Diverse Sample of Pregnant, Postpartum, Breastfeeding Canadians

BACKGROUND

Vaccination during pregnancy is recommended to protect pregnant individuals and their fetus from vaccine-preventable diseases and to protect infants during the vulnerable postnatal period. However, vaccine uptake in pregnancy remains low. This study explores how pregnant, postpartum and breastfeeding individuals living in Canada prefer to communicate about vaccination during pregnancy.

METHODS

We used peer-to-peer, patient-oriented research to conduct an exploratory qualitative descriptive study using focus groups and semistructured in-depth interviews to enquire about vaccination in pregnancy communication preferences, including preferred provider and communication timing. We coded deductively using direct content analysis and inductively while remaining sensitive to themes arising during the interviews.

RESULTS

Fourteen individuals from diverse cultural backgrounds living in Canada who self-identified as women and either as being pregnant, recently postpartum, or breastfeeding participated. Most preferred a participatory approach to vaccine communications combined with clear guidance. A trusted relationship with their provider mattered more than the healthcare provider's profession. Participants wanted to discuss vaccines early and often to allow them time to find answers and discuss with their partners before making decisions. Participants also shared the importance of mutual respect, maintaining their autonomy and not feeling forced or coerced.

CONCLUSIONS

Pregnant individuals want to play an active role in decision-making regarding vaccination during pregnancy. Their preference is to have open communication with familiar, trusted providers where they can express their questions and receive a clear recommendation which takes into consideration their unique circumstances so they can evaluate their options before making a decision.

Using a rapid ethnographic assessment to explore vaccine hesitancy on a public university campus in the Upper Midwest

Objective: This exploratory study examined campus attitudes toward vaccines to guide subsequent development of context-relevant interventions for increasing vaccine acceptance and uptake. Participants: We gathered ethnographic data on a convenience sample of campus community members (students, faculty, staff) at a public university over six weeks in spring 2022. Methods: Student researchers conducted a rapid ethnographic assessment across campus locations. Weekly team debriefs enabled ongoing, iterative refinement of instruments and supplemented observational fieldnotes. Data analysis was inductive and oriented toward practical recommendations for intervention development. Results: Four themes, and attendant recommendations, emerged: 1) social identities and social roles influence health-related beliefs, including vaccination; 2) vaccine knowledge influences vaccination behaviors; 3) language surrounding vaccines (sometimes) matters; 4) vaccines aren't considered part of general health and wellness and can't be forced. Conclusions: Findings highlight the need to address individual, social, and institutional contexts when designing campus-based behavioral interventions for vaccine uptake.

"Everything That Is Here, I Have Lived": A Triangulated Analysis of an Intimate Partner Violence Assessment Tool in Curitiba, Brazil

Using a mixed-methods triangulation approach we piloted the Composite Abuse Scale-Brazilian version (CAS-Brazil) at the House of the Brazilian Woman of Curitiba among 62 survivors of intimate partner violence and four professionals serving survivors to assess its feasibility for use. Quantitative data were tabulated using descriptive statistics while qualitative data were recorded, coded, and thematically analyzed. Four qualitative domains emerged: (a) conceptual understanding; (b) item definitions; (c) women's experiences; and (d) professionals' perspectives. Comprehension of the CAS-Brazil appeared high across participants from diverse backgrounds. Professionals viewed it as highly feasible for use in Brazilian cross-sectoral services to support survivor decision-making.

Using the knife to build the trust? The role of trust in the decision-making process of aesthetic surgeons and women patients/clients

Trust is a fundamental element in decision-making processes. In medicine, trust also helps to build relationships between patients/clients and doctors (aesthetic surgeons) and will influence a woman's decision to undergo aesthetic/cosmetic surgery. Patients/clients, as well as aesthetic surgeons, use different ways to build trust. Our analyses are based on fifteen qualitative interviews with aesthetic surgeons, fifteen qualitative interviews with women who have undergone or are planning to undergo aesthetic surgery procedure(s) and non-participatory observations at the clinic of aesthetic surgery in the Czech Republic. Based on our analysis, three levels of trust were identified: macro level: trust in medicine as a social institution; meso level: a priori trust to the aesthetic surgeon; and micro level: trust in aesthetic surgeon and/or other medical staff in the process of medical aesthetic encounters. These results call for further studies outside of primary care and a deeper understanding of how these 'voluntary' medical specialties work and influence patients/clients and their 'treatment'.

Implementation strategies: lessons learned during an e-learning intervention to improve dietary behaviors and feeding practices in early childhood education and care

BACKGROUND

Early Childhood Education and Care (ECEC) centers play an important role in fostering healthy dietary habits. The Nutrition Now project focusing on improving dietary habits during the first 1000 days of life. Central to the project is the implementation of an e-learning resource aimed at promoting feeding practices among staff and healthy dietary behaviours for children aged 0-3 years in ECEC. Implementing new interventions often presents challenges. This study explores ECEC staff views and experiences with selected strategies for implementing an e-learning resource in ECEC centers in a municipality in Southern Norway.

METHODS

The study is a part of the Nutrition Now study, a hybrid type 1 non-randomized controlled trial. The implementation process followed the Dynamic Integrated Evaluation Model (DIEM). Implementation strategies were selected from the Expert Recommendations for Implementing Change (ERIC) project and included identify and prepare champions, conduct educational meetings, distribute educational materials, create a learning collaborative, and remind clinicians. ECEC teachers from participating ECEC centers in the intervention municipality were recruited as champions. Brief (5-7 min minutes), semi-structured phone interviews, covering key points, were conducted with the champions 8 times, evenly distributed over six months. The interviews were analysed using qualitative thematic analysis.

RESULTS

In total, 29 of the invited ECEC centers (53%) participated, and 260 brief interviews (88%) were conducted with champions (n = 37). An evaluation of the feedback from the champions suggests that the five selected implementation strategies were acceptable. Five main themes were developed by qualitative analysis: 1) Being a champion resembles what I already do. 2) Educational meetings are fine but take time. I prefer when peers share experiences. 3) Newsletters were helpful and reminded me, but I do not always have enough time to read. 4) Evaluations have increased my awareness, and we do them informally and formally. 5) The regular phone calls reminded me I could receive support and express my opinion.

CONCLUSION

This study's findings suggest that several implementation strategies are acceptable for stakeholders in an ECEC e-learning healthy eating intervention. However, time constraints among champions may hinder deep engagement. These results provide valuable insights into how the selected implementation strategies may function in practice and how they are perceived and experienced by the ECECs staff.

TRIAL REGISTRATION

Trial registration on June 6, 2022: ISRCTN10694967 .

Changing practices, procedures, and perceptions: A multi-year person-centered planning initiative in group homes for residents with intellectual and developmental disabilities

Person-centered planning has been shown to benefit people with disabilities and their quality of life. However, we have little knowledge of how person-centered planning can benefit staff and administration within a group home organization, as well as the extent to which it results in changes to organizational practices and procedures, as well as perceptions of people with disabilities. In this qualitative study, we explored the perspectives of organizational employees, an affiliating behavioral consultant, and residents with intellectual and developmental disabilities, taking into consideration key insights from person-centered planning consultant-coaches, to understand the effects of a person-centered planning initiative on the group home organization. Accompanying our findings are five stories that poetically describe each of the participating residents and their experiences with organizational employees throughout the implementation of the initiative. Implications for research and practice are discussed.

Interpretation of immediately released health information: Informing patient medical education in breast oncology

BACKGROUND

The Cures Act mandated immediately released health information. In this study, we investigated patient comprehension of mammography reports and the utility of online resources to aid report interpretation.

METHODS

Patients who received a normal mammogram from February to April 2022 were invited to complete semi-structured interviews paired with health literacy questionnaires to assess patient's report comprehension before and after internet search.

RESULTS

Thirteen selected patients via purposeful sampling completed interviews. Most patients described their initial understanding of the mammography report as "good" and improved to between "good" and "very good" after an internet search. Patients suggested "a little column on the side" for medical terminology, "an extra prompt" for making an appointment, or a recommendation for "good sites" to improve mammography reports.

CONCLUSION

Patients varied in their ability to independently interpret medical reports and seek additional resources. While online resources marginally improved patient understanding, actionable and clear resources are needed.

Transition to Practice: Perceptions of Newly Graduated Nurses in Relation to the Participation of Nurse Managers in a Transition Program

Throughout existing transition programs for new nurses, few appear to include the participation of nurse managers in its activities. This qualitative study explores the perceptions of newly graduated nurses ( N = 7) toward the participation of their nurse manager in a transition program through dedicated group discussion periods. Four interconnected themes emerged from the interviews. Our findings support the inclusion of this participation in transition programs by nurse leaders to improve the transition experience of new nurses.

Canadian cannabis researcher perspectives on the conduct and sponsorship of scientific research by the for-profit cannabis industry

There has been considerable financial investment by the for-profit cannabis industry to conduct research on cannabis in Canada. Similar to peer industry counterparts such as the pharmaceutical, alcohol, tobacco, and food industries, there is evidence that for-profit cannabis companies are financially sponsoring research programs and researchers as well as non-financially, such as donating products. However, a large body of research has established that researchers' financial relationships with industries may influence research agendas, outcomes, lead to conflicts of interest, and bias the evidence base. Within a complex, emerging context of legalization, there is limited information on how cannabis researchers negotiate their relationships with the for-profit cannabis industry in Canada. Following a qualitative phenomenological methodology informed by moral experience for bioethics research, we conducted 38 semi-structured interviews with academic researchers, peer researchers, and clinicians with relevant perspectives about Canadian cannabis companies' research activities. We used a codebook approach to thematic analysis which generated three central themes: Navigating Systemic Barriers to Conduct Research; Impressions and Influences; and Guiding Principles for an Ethical Research Process. Our findings suggest that Canadian cannabis researchers tend to be morally ambivalent about cannabis industry sponsorship of research: they are motivated to conduct high quality research and generate evidence for population health benefit, yet they have concerns over the potential for research agenda bias created by these relationships which could be harmful to population health. Participants spoke how they relied heavily on personal values and individual strategies (transparency, value alignment, arms-length association, independence) to determine how they manage cannabis industry relationships. Our findings highlight how the issue of industry-academic relationships is a structural problem, thus individual-level solutions without attention to the relationship itself will only deepen ethical worries about industry-sponsored research.

"The Whole Culture of Nursing Needs to Change": A Descriptive Phenomenology of Nurses Being Bullied

Workplace bullying impacts at least half of the nurses worldwide. Despite the link to increased nurse turnover, few intervention studies have addressed bullying in the workplace. Since most studies report cross-sectional designs that provide little insight into the complexities of this phenomenon, the purpose of this descriptive phenomenology was to describe the lived experiences of nurses as they were actively being bullied in the workplace. Semi-structured interviews were conducted through Skype until data adequacy was realized with 12 participant interviews. Giorgi's six-step method was used to analyze the data in Atlas.ti. A central theme, "The whole culture of nursing needs to change" described an organizational culture where managers were unable to identify or unwilling to respond to workplace bullying. The four themes identified from the data included "going to work can be really hard," "not good for patient care," "learning to live with bullying," and "changing the culture." Leaders of organizations should implement comprehensive anti-bullying programs to assess bullying in their workplace and to provide bullied nurses with reporting options. Nurse managers need to prevent workplace bullying by intervening when aware of bullying and cultivating a culture of mutual respect.

How does organisational culture facilitate uptake of home dialysis? An ethnographic study of kidney centres in England

OBJECTIVE

The proportion of people having home dialysis for kidney disease varies considerably by treating centre, socioeconomic deprivation levels in the area and to some extent ethnicity. This study aimed to gain in-depth insights into cultural and organisational factors contributing to this variation in uptake.

DESIGN

This is the first ethnographic study of kidney centre culture to focus on home dialysis uptake. The NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) framework was used to map factors that influence the use of home dialysis.

SETTING

We conducted focused ethnographic fieldwork in four kidney centres in England, with average or high rates of home dialysis use, selected to represent geographic, ethnic and socioeconomic diversity.

PARTICIPANTS

Observations of patient consultations, team meetings, patient education and training sessions (n=34); and interviews with staff, patients and carers (n=72).

RESULTS

We identified three themes that can support the decision to pursue home dialysis: (a) Encouraging patient voice and individualised support. Kidney care teams engaged with people's psychosocial needs and cultural contexts, and valued peer support as part of patient education; (b) Ensuring access to home dialysis. Transparency about all treatment options, minimisation of eligibility assumptions and awareness of inequities of access; (c) Achieving sustained change based on benefits for patients. This included organisational cultures which adopted quality improvement approaches and worked with wider stakeholders to shape future policy and practice.

CONCLUSIONS

Willingness to pursue dialysis at home relied on patients' and carers' ability to place their confidence in their kidney care teams rather than how services were organised. Our study of kidney centre culture has identified approaches to patient empowerment, access to treatment and readiness for improvement and change that could be incorporated into a service delivery intervention.

ADAPTing to participant distress: A protocol for applied improvisation in healthcare

INTRODUCTION

Applied improvisation (improv) is an emerging innovative approach to clinical education and requires the cultivation of a highly engaged learning environment. With highly interactive and engaging forms of learning, it is critical to address participant distress and psychological safety in an improv learning environment in order to prevent damage to the learning capacities of individual participants as well as the group as a whole. However, little is available to guide applied improv practitioners to navigate the socially complex dynamics of participant distress during an improv session. The purpose of this project was to develop a distress protocol, tailored for improvisation-based interprofessional clinical communication training curricula, aiming to characterise, anticipate, prevent and address participant distress during sessions.

METHODS

Using an interpretive descriptive approach, we analysed qualitative data including previously collected interview data and primary field notes taken during improv simulations in order to develop the Addressing Distress in Applied Improvisation Participants Tool (ADAPT).

RESULTS

Analysis revealed two key distress manifestations (resistant distress and reactive distress) as well as three distress profiles (primary distress, secondary distal distress and secondary proximal distress) that may occur during an improv session. The ADAPT guides facilitators through four phases of attending to participant distress during applied improvisation sessions. These four phases include Redirecting the Spotlight, Responding to Distress, Reintegrating the Group and Reflecting on the Distress.

DISCUSSION

The ADAPT is the first of its kind as a general guide for addressing participant distress and can be customised and tailored to other applied improv curricula and experiential learning activities. Future inquiry should evaluate the utility and effectiveness of the ADAPT for responding to in situ participant distress in applied improv or other similar active learning environments.

Individualized participatory care planning for individuals with intellectual and developmental disabilities: a qualitative descriptive study

BACKGROUND

Goal setting for persons within health and social care environments can be a challenging task; although health and social care settings aim to address a person's care needs, the literature tends to focus on health. Person-centred care should encompass the goals/needs/wants of the person, whether these goals focus on career, relationship, and/or health domains. To understand how a person-centred participatory goal setting process is carried out in a care environment, we used an integrated knowledge translation approach.

METHODS

We conducted 11 semi-structured interviews with community-care staff to understand a person-centred planning process, including key components and impacts.

RESULTS

The interviews provide a thorough understanding of an implemented approach to person-centred plans, including its creation, implementation, and benefits (for the person-supported, family, friends, and staff). Person-centred plans provide a map with which to plan activities based on a persons' goals, interests, and capacities, and have positive impacts for the person-supported, family, friends, and staff.

CONCLUSIONS

Our study highlights how a community-care organization can facilitate person-centred services through person-centred plans and has implications for wider uptake of person-centred plans in community-care organizations.

"We don't look too much into the communication disability": clinicians' views and experiences on the effect of communication disability on falls in hospital patients with stroke

PURPOSE

Difficulty with communicating basic needs and attracting the attention of health professionals may contribute to falls for patients with communication disability after stroke. The aim of this study was to explore the views of hospital-based health professionals on: (a) the effect of communication disability on falls in patients with stroke; (b) falls prevention strategies for patients with communication disability following stroke; and (c) the roles of speech pathologists in the assessment, management, and prevention of falls in this population.

MATERIALS AND METHODS

Online focus groups were conducted and analysed using content thematic analysis.

RESULTS

In total, 11 health professionals participated in four focus groups. Clinicians viewed that: (a) the effects of falls in patients with communication disability are far-reaching; (b) communication disability complicates falls risk assessment and falls management; (c) current falls prevention strategies do not meet the needs of patients with communication disability; and (d) strong relationships have a central role in decreasing falls in this population.

CONCLUSIONS

Health professionals articulate concerning gaps in falls prevention strategies for patients with communication disability. Further research should investigate strategies enabling falls prevention and management to be more inclusive of patients with communication disability following stroke and consider ways in which speech pathologists could contribute to this field.

There is 'no cure for caregiving': the experience of women caring for husbands living with Parkinson's disease

BACKGROUND

Parkinson's disease is a progressive neurodegenerative disorder. The majority of the nearly 9 million people living with Parkinson's disease are men. As such, caregiving is often assumed by wives as the disease progresses. However, there is little research about the lived experience of wives as they transition to caregivers.

OBJECTIVE

To describe the lived experience of wife caregivers of male spouses living at home with Parkinson's disease.

METHODS

A descriptive phenomenological study. Semi-structured interviews were recorded and transcribed for analysis in Atlas.ti using Colaizzi's method.

RESULTS

Thirteen women, aged 50 to 83 years, were interviewed. Five themes emerged from the analysis, (1) caregiver who? (2) taking it day by day, (3) not sure what to do next, (4) just too much, and (5) caring is your soul's growth, to support the central theme "there is no cure for caregiving."

CONCLUSION

Transitioning from wife to caregiver was a gradual but difficult process. Although the wife caregivers wanted to be part of the health care team, they remained outsiders. Clinicians need to recognize the wives as care coordinators linking medical management with home care. Policy makers need to develop reimbursement models that provide wife caregivers with support groups, education programs, and telemental health services.

Nurse leaders' recommendations for implementing LGBTQ+ inclusive practices in health systems: A qualitative descriptive study

Background

Discrimination against lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) individuals in healthcare settings remains a priority issue. Nurse leaders, who oversee the largest healthcare workforce, are critical in implementing inclusive practices to address LGBTQ+ discrimination, yet implementing LGBTQ+ inclusive practices and effective strategies is inconsistent. This qualitative descriptive study explored nurse leaders' perceptions of LGBTQ+ inclusive practices across the United States to inform recommended strategies within health systems.

Methods

Twenty-one nurse leaders (e.g., chief nurse executives) from diverse healthcare settings (e.g., children's hospitals and public health centers) in 12 states across the United States participated in semi-structured interviews from October to December 2023. Interview transcripts were analyzed using content analysis to (1) describe nurse leaders' definitions of LGBTQ+ inclusive practices and (2) identify effective strategies for their implementation.

Results

Nurse leaders defined LGBTQ+ inclusive practices to include delivering culturally responsive and competent care, fostering safe and affirming environments, integrating inclusivity into daily interactions and organizational culture, and supporting the needs of both LGBTQ+ staff and patients. Key implementation strategies included fostering a flexible organizational culture through open communication; a diverse workforce; and inclusive mission statements, policies, and strategic plans. Supportive infrastructure involved effective LGBTQ+ training and adapting electronic health record systems to include information on sexual orientation and gender identity. Active and interdisciplinary engagement from staff and leadership, as well as systematic data collection on patient and staff experiences, were essential for driving inclusivity. The advocacy highlighted included legislative support, discourse within the nursing profession, and the incorporation of LGBTQ+ inclusion into healthcare regulations and accreditation standards. Additionally, multisectoral partnerships with LGBTQ+ health experts and external organizations, along with multilevel evaluations, were recommended to develop tailored interventions and promote LGBTQ+ inclusive practices.

Conclusion

Implementing LGBTQ+ inclusive practices in healthcare is a multifaceted effort influenced by strategies at various levels. Promoting a supportive organizational culture, establishing comprehensive support structures, encouraging active engagement, and fostering community partnerships can address the needs of LGBTQ+ individuals more effectively. Future implementation efforts should tailor strategies to accommodate variability across healthcare settings and regions, ensuring that practices are both adaptable and sustainable.