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Several institutional aspects within the U.S. public school system impede the delivery of adapted physical education (APE) services to disabled children, including a lack of understanding and prioritization of these services by the special education team and a lack of qualified APE professionals to deliver these services. Thus, we conducted a qualitative inquiry grounded in a critical-ableism perspective to explore special education gatekeepers' experiences and perspectives of APE. Gatekeepers included parents, physical educators, and school administrators. Using a reflexive thematic analysis, we developed four interrelated themes: (a) disregard, negative, and charity mindsets toward disability; (b) systemic challenges in valuing and prioritizing APE; (c) presence as inclusion: (un)intentional marginalization in physical education; and (d) physical education for my child was a nightmare. These findings illustrate the complexities around the provision of physical education and APE to disabled children. [ABSTRACT FROM AUTHOR]

This study sought to understand the lived experiences of wheelchair basketball athletes from low- and middle-income countries of recent or current armed conflict and the meaning that they ascribed to their participation. Wheelchair basketball athletes (N = 108) from eight national teams participated in semistructured focus-group interviews. Study data were analyzed thematically using an interpretive descriptive approach. Three themes were developed: "I can do anything I want; not only basketball," self-concept changes through sport participation; "Now they see me as a respectable person," societal belonging through sport; and "I have motivated other disabled people," influence on nonparticipating disabled persons. The findings indicated that participation in wheelchair sports may help disabled persons see themselves as capable individuals on the court and in aspects of daily living, perhaps even peer role models for other disabled persons in their communities and countries. [ABSTRACT FROM AUTHOR]

This study explored the classification experiences and views of Para Alpine skiers with visual impairment. Data from 11 interviews were analyzed using reflexive thematic analysis to generate three themes: Suitability—The skiers questioned the suitability of the visual measurements, testing environment, and the information they received regarding classification; Exclusivity—Skiers felt certain aspects of the system remain exclusive due to the restrictions of sport classes and lack of the athlete voice; and (Dis)trust—Skiers felt distrust in those implementing the system and in other athletes due to intentional misrepresentation. Speculation surrounding this resulted in the skiers' feeling doubt in their own classification. While there is not a "one size fits all" approach to classification, understanding skiers' experiences can be a vital first step and will help to guide future research into the evolution of this sport's classification. [ABSTRACT FROM AUTHOR]

In this paper, we analyze the subjective inclusion experiences of visually impaired (VI) adult tennis players from an ableism-critical perspective. The primary focus of this research is the inclusive potential of blind tennis from the perspective of VI individuals. Episodic interviews were conducted to capture subjective perspectives. A qualitative text analysis revealed that the interviewees were confronted with multiple ability assumptions by sighted people in their everyday lives. Deficit notions on the performance of VI people included sports, work, and general activities. Participation in blind tennis helped the interviewees build a "competent identity" and acquire various skills useful for their everyday lives as participation in blind tennis was a pathway for competence in sports. Further research is needed to identify exclusion experiences from the perspective of disabled people to recognize the potential of different sports in reducing barriers to participation. [ABSTRACT FROM AUTHOR]

Context: Rehabilitation after an anterior cruciate ligament injury is recommended to be started soon after the injury. When surgery is required, research supports the delivery of physiotherapy before anterior cruciate ligament reconstruction (prehabilitation) to optimize recovery and positive outcomes. Individuals attending prehabilitation have never been questioned regarding their adherence to prehabilitation, perception of utility in meeting needs, upcoming events, or anticipated recovery goals. Design: Mixed methods cross-sectional study: Methods: 25 individuals before anterior cruciate ligament reconstruction (43% of eligible individuals from 12 clinics during the delivery period) were surveyed on their mindset and recovery expectancies. Semistructured interviews conducted in 9 of 25 participants assessed their lived experience of prehabilitation. Results: Participants reported that preventing a reinjury (96% of responses) and feeling confident during daily activities about their knee (92%) were the higher rating expectations at this stage of their treatment course. Three themes were developed from the interviews and analyses. (1) Participants reported that prehabilitation was a period full of challenges with memories of the injury and uncertainties. (2) They viewed prehabilitation as a step to move forward by finding support and self-motivating. (3) They believed that prehabilitation would have positive impacts on the treatment outcomes. Participants were confident that prehabilitation would accelerate the recovery of muscle volume (88%) and strength (84%). Conclusion: Participants had positive experiences of prehabilitation, aligning with the findings on functional outcomes in the existing literature on prehabilitation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the ways in which in-service physical education teachers construct their self-efficacy beliefs toward teaching students with disabilities in general physical education classes. Using a qualitative descriptive approach situated within self-efficacy theory, data were collected via semistructured audio-recorded interviews with 16 in-service physical educators. Three interrelated themes were constructed: (a) The more I do it, the better I feel: the importance of professional experiences; (b) I've learned from others: the influence of colleagues; and (c) Being in the general educational setting is a challenge: the impact of contextual factors. Findings supported the influence of the four sources of self-efficacy (i.e., mastery experience, vicarious experience, social persuasion, and affective and physiological state), in addition to potential contextual factors (i.e., class sizes and availability of hands-on support), impacting participants' self-efficacy to teach students with disabilities in general physical education classes. [ABSTRACT FROM AUTHOR]

Although the Paralympic Games have been around for over 60 years, women remain underrepresented in almost all aspects of the Paralympic Movement. It has been suggested that a way to increase women's involvement is through the implementation of mixed-gender events. On paper, this approach makes sense. However, when it comes to the implementation of mixed-gender opportunities for women, it is less clear how effective these events are in increasing participation by women in Para sport. Through document analysis and interviews with athletes and organizers of mixed-gender Paralympic sport, we explore the various strategies that four mixed-gender sports have used to address the issue of gender parity. Using critical feminist theories, we illustrate how larger social, political, and cultural ideas about gender influence women's experiences within these events and discuss the potential of using mixed-gender initiatives to address gender parity within the Paralympic Movement. [ABSTRACT FROM AUTHOR]

Technology in libraries has played an essential role in serving today's communities. This study provides an overview of the integrated library systems/software (ILSs) used in libraries in South Sulawesi, Indonesia. It aims to highlight the strengths and possibilities of ILSs and briefly explain their advantages and disadvantages along with the cost of implementation. The data was gathered from questionnaires sent via an online survey and from direct interviews with certain academic libraries over the period of 2019 to 2020. Fifty-three of 67 libraries that fulfilled the study have implemented an ILS. To deeply understand the application, a direct interview with some libraries was conducted to learn the advantages and disadvantages. The result of the study showed that the most used ILSs are SLiMS and INLISlite and other programs like Apollo, Athenium Light, Simpus, Spektra, Jibas, KOHA, and Openlibrary. The budget spent is an average of300 USD. While the ILSs have helped these libraries improve services, IT expertise and adequate resources are needed, especially when the systems present problems. An easy-to-use system that costs less will potentially be used in this area of research. This study will be particularly helpful for any library in Indonesia. These findings may also be generalized to libraries in other countries facing economic and technological similarities. [ABSTRACT FROM AUTHOR]

Objective: To rate athletes' functional ability and return to sport (RTS) success at the end of their individual, formal, medically prescribed rehabilitation after anterior anterior cruciate ligament (ACL) reconstruction. Methods: In our prospective multicenter cohort study, 88 (42 females) adults aged 18-35 years after acute unilateral ACL rupture and subsequent hamstring grafting were included. All patients were prospectively monitored during their rehabilitation and RTS process until the end of their formal rehabilitation and RTS release. As outcome measures, functional hop and jump tests (front hop, balance hops, and drop jump screening test) and self-report outcomes (Knee Injury and Osteoarthritis Outcome Score, ACL-RTS after injury) were assessed. Literature-based cut-off values were selected to rate each performance as fulfilled or not. Results: At 7.5 months (SD 2.3 months) after surgery, the percentage of participants meeting the functional thresholds ranged from 4% (Knee Injury and Osteoarthritis Outcome Score SPORT) and over 44% (ACL-RTS after injury sum score) to 59% (Knee Injury and Osteoarthritis Outcome Score activities of all daily living) in the self-report and from 29% (Balance side hop) to 69% (normalized knee separation distance) in performance testing. Only 4% fulfilled all the cut-offs, while 45% returned to the same type and level of sport. Participants who successfully returned to their previous sport (type and level) were more likely to be "over-cut-off-performers." Conclusions: The low share of the athletes who fulfilled the functional RTS criteria highlights the importance of continuing the rehabilitation measures after the formal completion to assess the need for and success of, inter alia, secondary-preventive therapies. [ABSTRACT FROM AUTHOR]

Organizational culture in sports affects well-being, performance, and overall success. Although team culture has been explored within able-bodied teams, little is known about culture development within parasport. Using a descriptive case study approach, our study examined the culture development and experiences of an elite parasport team. Two semistructured individual telephone interviews were conducted with nine participants (athletes and staff), and one athlete-participant completed one interview. An inductive thematic analysis revealed two themes: approach to culture development and team culture components. Culture development was linked with facilitative leadership and important resources. This supported the team to create their shared values and mechanisms, including a behavioral framework, other artifacts (e.g., shared language and team motto), and a relaxed environment. These helped to maintain their agreed culture and benefited their well-being, progress, and team cohesion. Our results offer a starting point regarding research into the culture of elite parasport and have practical implications for managers, coaches, and psychologists. [ABSTRACT FROM AUTHOR]

Most people with intellectual disabilities have comorbid health conditions, which will impact optimization of sporting performance. Classification is used in Paralympic events to ensure that those with similar levels of functional ability compete fairly against each other. An evidence-based approach needs to be developed for athletes with intellectual disabilities to be classified in relation to their overall functional capacity into competition groups of similar ability. This research builds on previous work using the taxonomy of The International Classification of Functioning, Disability and Health (ICF) to group athletes with intellectual disabilities into comparable competition groups as an approach to Paralympic classification. Three groups of athletes—Virtus, Special Olympics, and Down syndrome—are compared using the ICF questionnaire indicating functional health status in relation to sporting performance. The questionnaire was found to discriminate between athletes with Down syndrome and other athletes, and an approach to using a cutoff score to develop competition classes is explored. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify contextual factors that negatively affect activity and participation among powerchair football (PF) players. Thirty-seven semistructured interviews were conducted with PF players (Mage = 27.9 ± 8.2 years) in France (n = 18) and the United States (n = 19). Participants reported acute back and neck pain as the primary morbidities resulting from PF participation, with sustained atypical posture in the sport chair as the primary cause. Competition-related physical and mental stress were also identified as participation outcomes. Accompanying the many benefits of PF, participants recognized negative impacts of discomfort, physical fatigue, and mental fatigue. Interventions such as seating modifications, thermotherapy to combat pain, napping to combat acute physical stress, and mental preparation to manage state anxiety were all identified as prospective interventions. [ABSTRACT FROM AUTHOR]

Children with autism engage in active play in different ways than children who are neurotypical, but their active play behaviors are not well understood. Research with twins and triplets with autism offers a unique opportunity to gain a clear picture of the play behaviors of children with autism because twins and triplets share many similarities (age, access to toys, etc.). Through semistructured interviews, this descriptive phenomenological study aimed to describe the active play behaviors of 19 twins and triplets with autism from the perspective of their parents (N = 9). The interviews revealed two main themes: (a) parents' descriptions of active play and (b) parents' descriptions of social play. The results reveal the diverse active and social play behaviors of twins and triplets with autism; parents described their children's play behavior when engaging in sensory, indoor, outdoor, and organized play. These results suggest that children with autism may be meeting the definition of active play in nontraditional ways. [ABSTRACT FROM AUTHOR]

School sports programs intentionally created for students with and without disabilities may increase social participation of students with intellectual disabilities (IDs). Special Olympics Unified Sports is one program where students with and without ID participate on one team. Guided by a critical realist paradigm, this study explored the perceptions of students with and without ID and coaches of in-school Unified Sports. Interviews were conducted with 21 youths (12 with ID) and 14 coaches. Thematic analysis resulted in four developed themes (identified is outdated language): Inclusion—Is it a "we" or a "they?"Roles and Responsibilities, Educational Context for Inclusion, and Buy-In. Findings suggest students with and without ID and coaches value the inclusive nature of Unified Sports. Future research should explore training for coaches on inclusive practices (e.g., language), and optimal methods for consistent training (e.g., use of training manuals) to foster the philosophy of inclusion within school sports. [ABSTRACT FROM AUTHOR]

Identifying factors that influence physical activity (PA) among individuals with Down syndrome is essential for PA promotion. Insight can be gained from guardians and health professionals. The purpose of this study was to explore the perspectives of guardians and health professionals on facilitators and barriers of PA in individuals with Down syndrome. Interviews were conducted with 11 guardians (five mothers, four fathers, and two legal guardians) and 11 professionals (four PA specialists, three physical therapists, and four occupational therapists). Grounded theory was applied. Barriers and facilitators fit the levels of the ecological model of health behavior: (a) intrapersonal (perceived rewards), (b) interpersonal (interaction), (c) community (availability of programs), (d) organizational (school systems), and (e) policy (education). Guardians and professionals agreed on the importance of enjoyment, interaction, and programs to promote PA. Differences between groups were identified at the organizational and policy levels. PA in persons with Down syndrome is influenced by interactions between individual and environmental factors. [ABSTRACT FROM AUTHOR]

This study aimed to examine physical activity (PA) levels and mental health status (i.e., anxiety and depression) among parents of children with autism spectrum disorder (ASD). Secondary data analysis was conducted using the 2018 National Health Interview Survey. We identified 139 parents of children with ASD and 4,470 parents of children with no disability. Their PA levels, anxiety, and depression were analyzed. Compared with parents of children with no disability, parents of children with ASD were significantly less likely to meet the PA guideline for Americans and had lower odds of vigorous PA (aOR = 0.702), strengthening PA (aOR = 0.885), and light to moderate PA (aOR = 0.994). Parents of children with ASD reported significantly higher odds of anxiety (aOR = 1.559) and depression (aOR = 1.885). This study revealed lower PA levels and higher risks of anxiety and depression in parents of children with ASD. [ABSTRACT FROM AUTHOR]

Purpose: Telerehabilitation is emerging as a means for delivering stroke rehabilitation to address unmet lower extremity rehabilitation needs. However, there is currently limited and low-quality evidence supporting the use telerehabilitation interventions for lower extremity recovery after stroke. Thus, we developed an exercise-based telerehabilitation program (TRAIL) for safe and effective promotion of lower extremity function after stroke. This study reports on the qualitative findings from the feasibility study of the TRAIL program. Methods: An interpretive description methodology and inductive thematic analysis approach were undertaken. One-on-one semi-structured interviews were conducted on a subset of participants who completed the TRAIL feasibility study. Participants were recruited via email and enrolled into the study based on pre-determined purposeful sampling strategies. Results: Ten participants (6 men, 4 women) completed a semi-structured interview. Two main themes emerged: (i) TRAIL ingredients for success and (ii) telerehabilitation is a viable option for stroke rehabilitation. Conclusion: Exercise-based telerehabilitation appears to be well-received by men and women post-stroke when social support, professional guidance, and program resources are offered. TRAIL may also prolong the continuum of care that individuals receive once they are discharged back into the community, and contribute to improvements in mobility, lower extremity strength and balance. IMPLICATIONS FOR REHABILITATION: Exercise-based telerehabilitation for individuals with stroke can be delivered safely when clinicians are trained, and social support and program resources are available. Exercise-based telerehabilitation may be viable and accessible for men and women with stroke to extend the opportunity for rehabilitation services within the first year post-event. Synchronously delivered telerehabilitation programs using user-friendly videoconference software is recommended for optimal participant satisfaction. [ABSTRACT FROM AUTHOR]

Objectives: Assess the acceptability of and self-reported behavioral change from participation in a sexual assault prevention intervention on a U.S. university campus. Participants: Thirty-one undergraduate students who identified as women and opted-in to participating in both the intervention and research. Methods: In-depth interviews and written reflections were collected. Analysis was thematic with three investigators coding and reaching consensus. Results: The EAAA program was well-liked by most participants, with positive behavior changes reported. Five key themes reflecting strengths of EAAA were identified, including improved verbal communication, reduced sexual assault myths, empowerment, recognizing and responding to danger cues, and learning about healthy sexuality. Three key themes reflecting challenges were identified, including time commitment, use of outdated program materials, and a single gender focus. Conclusions: EAAA translates well, with a few adaptations, to a residential campus environment in the U.S. Research is needed to assess program effectiveness in reducing sexual assault. [ABSTRACT FROM AUTHOR]

Objective: To explore young adult's experiences of how starting university influenced their physical activity, diet, sleep, and mental well-being, and barriers and enablers to health behavior change. Participants: University students aged 18–25 years. Methods: Three focus groups were conducted in November 2019. Inductive thematic approach was utilized to identify themes. Results: Students (female: n = 13, male: n = 2, other gender identity: n = 1, 21.2 (1.6) years) reported mental well-being, physical activity levels, diet quality and sleep health were negatively affected. Stress, study demands, university timetabling, not prioritizing physical activity, cost and availability of healthy foods, and difficulty falling asleep were key barriers. Health behavior change interventions aiming to support mental well-being need to include both information and support features. Conclusions: There is a significant opportunity to improve the transition to university for young adults. Findings highlight areas to target in future interventions to improve physical activity, diet, and sleep of university students. [ABSTRACT FROM AUTHOR]

Objective: This mixed methods study examined student and parent experiences with anxiety and preferences for campus-based programming to address anxiety. Participants: College students (n = 156) completed a survey, and 20 students participated in focus groups. Parents of college students (n = 85) completed a survey, and 12 parents completed a phone interview. Methods: Students and parents completed surveys about trait worry, mental health literacy, and preferences for proposed programming. Descriptive statistics were calculated. Students participated in focus groups, and parents completed interviews regarding their experiences and preferences. Thematic analysis was conducted with the coded focus group and interview transcripts. Results: Quantitative and qualitative findings revealed specific program preferences (eg scheduling). Qualitative findings highlighted mismatches between student and parent perspectives and opportunities for parental skill building. Conclusions: Students and their parents are open to and eager for campus programming that provides education, skills, and support for college students with anxiety. [ABSTRACT FROM AUTHOR]

Objective: This paper discusses the influence of family and cultural backgrounds on South Asian student survivors' understandings of dating relationships and help-seeking after experiencing dating violence. Methods: Six South Asian undergraduate women dating violence survivors participated in two thé talks (similar to semi structured interviews) and a photo-elicitation activity to share their experiences of dating violence and how they make meaning of these experiences. Findings: Through analysis guided by the tenets of Bhattacharya's Par/Des(i) framework, this paper highlights two key findings: 1) the powerful role of cultural values in students' conceptualizations of healthy and unhealthy relationships; and 2) the effect of familial and intergenerational experiences on students' help-seeking behaviors. Conclusion: Findings highlight the need to incorporate considerations of family and culture in efforts to address and prevent dating violence in higher education. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine how college students perceive and manage stress and anxiety in the university setting and explain their perceptions of the effects of MBAT, NCT, and MO on stress, anxiety, and general student functioning. Participants: 58 undergraduate college students participated in post-test interviews following their engagement in either mindfulness-based art therapy (MBAT), a neutral clay task (NCT) or mindfulness only (MO) interventions using a 5-week online format. Methods: Magnitude coding was used to describe participant's perspectives. Results: Many themes emerged including habitual creative practice, prioritizing time for the self, enjoyable/relaxing activity, learning new techniques, understanding of processing and developing self-insight. Themes in the NCT group were more surface level observations, whereas MBAT, and to a lesser extent, MO groups contained an element of deeper understanding and processing. Conclusions: These findings offer support for implementing online and accessible mental health strategies as a gateway to traditional therapies in college settings. [ABSTRACT FROM AUTHOR]

Many children who require hospitalization in the pediatric intensive care unit (ICU) are unable to or have difficulty communicating through speech, whether because of preexisting or acute conditions. Children who are unable to be heard and understood using only speech benefit from aided augmentative and alternative communication (AAC), including in hospital settings. This qualitative interview study sought to understand the perspectives of nurses on care and support for children who use or would benefit from aided AAC in the pediatric ICU. Participants were six nurses who worked in pediatric intensive care at a tertiary care unit of a children's hospital in the United States. Three main themes were identified related to nurses' views about supporting children's communication: (a) Caring for the Whole Child, (b) Needing Support from Others and Moving between Roles, and (c) Working with Available Resources and Demands. Nurses emphasized the importance of a holistic approach to care, the impact of others' support and knowledge, and a desire for building greater capacity for promoting children's access to effective communication. Findings offer insight that could improve patient-centered care for children with complex communication needs and support for nurses themselves, particularly within the broader context of ICU liberation. [ABSTRACT FROM AUTHOR]

Background: Person-centred care is based on ethical principles, and it is regarded as high-quality care. Care of older persons should embrace person-centredness. During the pandemic, older persons were highlighted as a vulnerable group at risk of developing serious illness and/or suffering death from COVID-19. Several pandemic-related measures were introduced in residential care facilities (RCFs) to reduce this risk, which influenced the possibilities to lead and provide a person-centred care. Aim: This study's aim was to explore ethical challenges in relation to person-centredness during the COVID-19 pandemic, from the perspective of leaders in RCFs. Research design: The study had a qualitative descriptive design. Participants and research context: Semi-structured interviews were conducted with 26 leaders working in RCFs in Sweden. Data were analysed using conventional content analysis. Ethical considerations: The study was approved by the Swedish Ethical Review Authority. The participants received oral and written information about the study and gave written consent. The study was conducted in accordance with the Declaration of Helsinki. Findings: The overarching ethical challenge was Having to disregard the individual needs of the person in order to protect the group and society. This included (a) Protecting the group versus promoting the older person's autonomy; (b) Being forced to lead care based on uncertainty instead of evidence; (c) Striving to provide dignified care but lacking opportunities; and (d) Going far beyond ordinary duty and endangering one's own and the staff's health. Discussion: The ethical challenges meant being torn between the person's individual needs and protecting the group and society, with clashing ethical principles as a consequence. Conclusions: The leaders faced ethical situations resulting in undignified and compromised person-centred care, which has implications for stakeholders and management who need to address the work conditions in RCFs. [ABSTRACT FROM AUTHOR]

Background: Moral distress is a far-reaching problem for nurses in different settings as it threatens their health. Aim: This study examined which situations lead to moral distress in home-care nursing, how and with which consequences home-care nurses experience moral distress, and how they cope with morally stressful situations and the resulting moral distress. Research design: A qualitative interview study with reflexive thematic analysis was used. Participants and research context: We conducted semi-structured interviews with 20 home-care nurses in Germany. Ethical considerations: The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. Findings: Twenty (14 female and 6 male) home-care nurses were interviewed between April and August 2023 at their chosen location. The situations leading to moral distress were inadequate care of the person in need of care, not being able to protect one's health, extended responsibility for the entire care arrangement, work–privacy conflicts, and conflicts between the understanding of care or professional ethics and the performance and billing system. The nurses experienced moral distress as they worked alone and provided care in the patient's territory. Short- and long-term strains with destructive cognitions, negative emotions, physical symptoms, and health consequences were reported. They faced challenges in coping with moral distress on institutional and individual levels. Conclusions: In cases of tension between the service and billing system and the understanding of these nurses' care services, moral distress is unavoidable. Alternative forms of organization and billing modalities, such as payment by time and the expansion and refinancing of service, should be implemented. The latter relates to systematic case and ethics meetings. Further, a transfer of medical activities, such as the prescription of wound material to registered nurses, could prevent morally stressful situations and improve patients' quality of care. [ABSTRACT FROM AUTHOR]

Background: Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL's experience. Research aim: The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. Research design: A qualitative descriptive design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. Participant and research context: Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. Ethical considerations: This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. Findings: UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. Conclusions: The UBCCNL's experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed. [ABSTRACT FROM AUTHOR]

Background: Moral distress has negative effects on physical and mental health. However, there is little information about nurses' coping strategies reducing moral distress. Aim: The purpose of this study was to investigate the coping strategies of intensive care unit nurses reducing moral distress in Iran. Study design: This is a qualitative study with a content analysis approach. Participants and research context: The research sample consisted of nurses working in intensive care units of teaching hospitals affiliated to Tehran University of Medical Sciences. Samples were selected among eligible nurses by purposive sampling. Data were obtained through 17 in-depth, individual, and semi-structured interviews with 17 nurses. Graneheim and Lundman's (2004) 6-step content analysis method was used to analyze the data. Data management was also performed by MAXQDA software version 20. The COREQ checklist was used to report the study. Ethical considerations: This project was approved by the Ethics Committee of Tehran University of Medical Sciences. All ethical guidelines in research were followed. Finding: The data analysis resulted in the formation of two main categories of desirable coping strategies (with two subcategories of compensation and rejuvenation) and less desirable coping strategies (with three subclasses of indifference over time, escape and concealment). Discussion: The intensive care unit nurses in dealing with ethical problems first try to solve the problem through discussion, but when they fail to resolve it peacefully, they resort to several coping strategies. Factors, such as increasing experience, lack of support from hospital managers and officials, poor communication between colleagues, the need to maintain hierarchy, fear of reprimand, and a sense of powerlessness, changed the nurses' preferred strategies. It is important for managers to provide a blame/punishment-free atmosphere for expression of ethical experiences; a supportive atmosphere in which staff can engage in ethical discussions without fear of punishment. They should also provide opportunities for rest, rejuvenation, and adequate training for their employees. [ABSTRACT FROM AUTHOR]

Background: Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding end-of-life care and its consequential impacts. Research objectives: To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design: A qualitative descriptive approach was employed. Participants and research context: Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations: We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings: The moral distress-inducing factors and nurses' perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions: End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. [ABSTRACT FROM AUTHOR]

Background: Moral distress is a well-recognized term for emotional, cognitive, and physical reactions of professionals, when facing conflicts between perceived obligations and institutional constraints. Though studied across medical roles, limited research exists among physiotherapists. Research Question: What factors contribute to Moral distress among physiotherapists and how do they cope? Objectives: To develop and test a multifaceted model of Moral distress and gain an in-depth understanding of the phenomena. Research Design: A 2017–2022 mixed-methods study: (1) Survey of 407 physiotherapists quantitatively testing a literature-based model analyzing relationships between Moral distress, Moral sensitivity, Locus of control, Self-efficacy, Ethical climate perceptions and demographics, analyzed by descriptive and inferential statistics, multiple comparisons and structural equation modelling (SPSS26, SAS, AMOS); (2) Semi-structured interviews with 21 physiotherapists examining Moral distress experiences using meticulous phenomenological analysis. Participants and Context: Israeli physiotherapists from various occupational settings recruited via professional networks. Ethical Considerations: The Haifa University Ethics Committee authorized the study. Informed consent was obtained for the anonymous survey and before interviews regarding recording, and quote use. Findings: Quantitative results showed moderately high average Moral distress, significantly higher among women and paediatric physiotherapists, positively correlating with Moral sensitivity. Qualitative findings revealed intense emotions around Moral distress experiences, inner conflicts between care ideals and constraints, and coping strategies like reflective skills. Senior therapists, despite higher self-efficacy and moral sensitivity, still reported persistent high distress. Discussion: Moral distress has complex links with moral sensitivity, self-efficacy, perceived professional autonomy and organizational support. A renewed framework emerged explaining relations between moral distress and personal, professional and organizational factors. Conclusions: Multidimensional insights help identify Moral distress causes and coping strategies among physiotherapists, advancing theory. Conclusions can shape ethics training programs and competencies. [ABSTRACT FROM AUTHOR]

Background: Ethical principles behind prioritization in healthcare are continuously relevant. However, applying ethical principles during times of increased need, such as during the COVID-19 pandemic, is challenging. Also, little is known about nursing home nurses' prioritizations in their work to achieve well-being and health for nursing home residents. Aim: The aim of this study was to explore nursing home nurses' priority-setting for older nursing home residents in Sweden during the COVID-19 pandemic. Research design, participants, and research context: We conducted a qualitative interview study. Data were collected through in-depth interviews (retrospective self-reports) between February and May 2021 with 21 nursing home nurses. To help respondents to recall their memories, we used the critical incident technique (CIT). We analyzed data within the theoretical framework and the methodological orientation of content analysis. Ethical considerations: Written and verbal consent was obtained before the interviews, and information was given to participants informing them that participation was entirely voluntary. The Swedish Ethical Review Agency gave an advisory opinion stating that there were no ethical objections to the research project (Dnr. 2020-05649). Findings: We identified an overarching theme—nursing home nurses struggling on multiple fronts, "just do it"—and seven categories: striving for survival and caring about a dignified death; responding sensitively to relatives' expectations; ranking the urgency of needed care; responding to input from different actors; combating the spread of infection in unconventional ways; taking the lead and doing what is required; and following the ideals of person-centered nursing. Conclusions: Nurses' priority-setting for older nursing homes residents during the COVID-19 pandemic meant strain and struggle. In some cases, nurses had taken responsibility for priorities falling outside their statutory powers. Different demands and interests affected nurses' priorities. Nursing home nurses need organizational and managerial support to prioritize. [ABSTRACT FROM AUTHOR]

Background: Healthcare worker retention and burnout are confounding issues. Trust among workers and their employer, that is, organization, is an important yet underexplored concept in research. Research aim: The aim of this qualitative study is to explore organizational actions and systems that promote or denigrate trust among registered nurses and patient care aides (aides). Research design: The study uses the Model of Psychological Contract as a theoretical framework. Focus groups were conducted to explore the concept of organizational trust and the consequences of broken trust. Participants: Registered nurses (RNs) (n=6) and aides (n=6) participated in the study. Six focus groups (three RN and three aide) were conducted, with two participants per group. Focus groups were conducted online. Ethical considerations: The study's methods were reviewed by the University of Pittsburgh Institutional Review Board. Findings: Among RNs and aides, a sense of trust and feeling valued were important to their sense of relationship with their employers. Trust was breached when resources were scarce, employees did not feel validated and listened to, and problems were not addressed. RNs and aides described feeling devalued when compensation practices were unjust or inequitable, they had limited autonomy, and the employer created an organizational climate where business needs superceded human caring. Consequences of trust breach included burnout, dejection, and feelings of non-belonging. Discussion: Tangible organizational resources (compensation and staffing) and intangible resources (value, respect, autonomy) are important to RNs and aides alike. Inability to provide these resources diminishes trust and even causes a sense of betrayal. Conclusion: Future research can explore the concepts of organizational justice and interventions to restore lost trust and improve healthcare worker well-being. This is one of only a few identified studies to explore organizational factors and well-being among aides and more research among this healthcare worker population is warranted. [ABSTRACT FROM AUTHOR]

Background: Encounters of moral distress have long-term consequences on healthcare workers' physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research Objective: The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic medical center. Participants & Research Context: Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Research Design: Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine's National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethical Considerations: Ethics approval was obtained from the university and medical center institutional review boards. Findings: Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Conclusion: Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being. [ABSTRACT FROM AUTHOR]

Background: In recent years, patient advocacy has emerged as a prominent concept within healthcare. How nursing students decide what is best for their patients is not well understood. Objective: The objective is to examine nursing students' views on doing what is best for patients during their clinical experiences and how they seek to establish patient interests when providing care. Research questions guiding the interview were as follows: (1) What are nursing students' perceptions of patient interests? (2) What factors influence nursing students' perceptions of advocating for patient's interests? Research design: Qualitative descriptive research using thematic analysis. Participants and research context: Data was collected through individual online interviews with nine nursing students with clinical experience. Ethical considerations: The study was approved by the University Research Ethics Committee. Participants provided digital informed consent. Results: The students asserted that they are able to understand the patients' interests by placing emphasis on the patients' needs. They believe that it is crucial to adopt a collaborative strategy for the provision of care to meet these requirements. In addition, some of them expressed concern over the most effective methods of advocating for the interests of patients. Three themes were identified. (1) Focussing on patient needs first, (2) taking a collective approach, and (3) learning how to advocate. Conclusions: Students understand and value the ethical commitments associated with advocating for the patient's best interest by considering factors such as prioritising the patient's needs, adopting a strategy that involves everyone, and acquiring the ability to undertake the advocacy role. Additionally, nursing education strategies in clinical contexts require additional study to inspire students to do what is in their patient's best interests. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe practicum experiences as perceived by nurse leader preceptors of graduate students in a nursing administration practicum. BACKGROUND: Practicum experiences in graduate nursing administration programs provide students with exposure to the real-life experiences of nurse leaders, bridging the gap between academic knowledge gained and the application of that information to the workplace. The literature lacks best practices for graduate nursing administration practicum experiences. METHODS: Eight nurse leaders were interviewed using a semistructured format. Data were transcribed and subjected to selective thematic analysis. RESULTS: Five themes were identified: professional and personal growth, transition of education into practice, academic partner engagement and support, time, and contributions to the organization. CONCLUSION: Leadership practicum experiences provide a real-world perspective and are an essential part of growing future nurse leaders. This study yielded invaluable insight from nurse leader preceptors, recommendations for structuring graduate nursing administration practicums, and implications for sustaining resilient academic-practice partnerships. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to explore the lived experiences of presenteeism among Taiwanese nursing staffs. BACKGROUND: Presenteeism is a subjective and multifaceted experience, but nurses have rarely been invited to provide their own views of presenteeism. METHODS: A qualitative study based on content analysis was conducted. Fifteen participants were recruited. Data were collected through face-to-face interviews and analyzed using the constant comparative method. RESULTS: Four key categories and their subcategories were identified: 1) burden of being forced to attend work; 2) physical or mental discomfort; 3) predisposing factors; and 4) binding duty. CONCLUSION: This preliminary study provides guidance for administrators to establish a healthy workplace and maintain quality patient care. Managers should understand the predisposing factors that lead to absenteeism, such as insufficient staffing, and propose effective measures. This study contributes to the development of research and measurement tools, adds preliminary data, and explores nursing staff presenteeism. [ABSTRACT FROM AUTHOR]

Aims: People with a learning disability are at increased risk of becoming homeless, but little is known about how learning disability is viewed by people accessing homeless services. This study aimed to obtain the views of people experiencing homelessness about learning disability, in the context of a project that was exploring how to increase identification of learning disability. Methods: A qualitative approach was used, and 19 adults were interviewed who were receiving support from homeless services in the North-East of England. Information from the interviews was analysed using thematic analysis. Results: Four themes were identified relating to understanding of learning disability, the role of identification, day-to-day challenges, and experiences of services. Conclusion: There is a need to: promote better understanding of learning disability; for early identification processes that involve the person in a meaningful way; and the provision of support that is non-stigmatising, practical and which addresses health concerns. [ABSTRACT FROM AUTHOR]

Background: Knowledge about ageing from the perspective of people with intellectual disability is extremely scarce, which means a lack of evidence-based interventions for healthy ageing adjusted to their needs. Aim: To investigate how people with intellectual disability experience ageing, prior to an educational intervention. Methods: Twenty-six persons with mild intellectual disability, age 42-74 (mean 61.3) were interviewed and the text was analyzed qualitatively. Results: The main findings are reflected in the themes Live for today – tomorrow you are old and Need of support to enable a meaningful ageing. The participants avoided thinking about ageing, which they associated with retirement, loneliness and social isolation, increased need for help in everyday life, worsening health and death. Meaningful ageing meant continuance of leisure activities and working as long as possible. Conclusions: Interventions to prepare people with mild intellectual disability for healthy ageing must take into account these people's loneliness. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, many people with intellectual disabilities living in care facilities could not receive visitors. Health authorities suggested the use of digital social contact as an alternative for in-person visits. We examined how people with intellectual disabilities living in care facilities experienced the use of digital social contact with their informal social network throughout 2020. Residents, their relatives, volunteer visitors, direct support staff, and care facility managers (N = 283) completed an online questionnaire, of whom 35 participated in an interview. Video calling and in-person visits were among the most common forms of staying in touch. Experiences with digital social contact depended on residents' abilities and support needs, and on preconditions, such as staff availability. The first phases of the pandemic led to experiences of possibilities and benefits of using digital social contact as complementary to in-person contact for people with different levels of intellectual disability, also after the pandemic. [ABSTRACT FROM AUTHOR]

In this study, it was aimed to examine the adaptation processes of individuals with intellectual disabilities and their mothers to COVID-19 restrictions. The research was designed in qualitative research method and focus group interview technique was used. The mothers of individuals with intellectual disabilities constitute the participant group of the study. A semi-structured interview form consisting of eight questions prepared by the researchers was used as a data collection tool. Data were collected through two focus group interviews via Zoom link. The data obtained were analyzed by content analysis method. As a result of the research, four themes were reached: "Life Before the Pandemic", "Encountering the Pandemic", "Effects of the Pandemic", and "Facilitation in the Adaptation Process to the Pandemic". As a result, although COVID-19 restrictions led to the regression of some skills of individuals with intellectual disabilities, it created an opportunity for them to develop new interests. In addition, although there were supports that facilitated the pandemic process, it was determined that mothers needed even more psychological support during this period. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the transition of employees with intellectual disabilities to inclusive work environments from sheltered workplaces. The study was conducted in a sheltered workplace in Turkey for people with intellectual disabilities. Data was collected from 71 participants in interviews. Interviews were conducted with employees (n = 28), families of employees (n = 24), company human resource managers (n = 8), sheltered workshop foremen (n = 7), and special education teachers (n = 4). The study group asked about the future of the sheltered workplace and participants' views on transition to inclusive work environments. The answers of the participants were analysed using thematic analysis. Findings showed that many participants had positive views about transition along with concerns about accidents and security problems that may occur in inclusive environments. It was observed that negative attitudes and views were related with lack of knowledge about inclusive work environment conditions. [ABSTRACT FROM AUTHOR]

The current study aims to identify Jordanian mothers' perspectives on their intellectually disabled daughters receiving hysterectomies. A qualitative methodology was employed; for the study sample, twelve mothers were chosen using a snowballing technique. Semi-structured interviews were carried out, and thematic analysis was utilized. Two main themes arose from the data analysis process: the reasons why mothers made the decision for their daughters to have hysterectomies – which included fears about unwanted pregnancy and keeping family honor – despite this conflicting with their religious and cultural values, and their concerns about their daughters having hysterectomies. Based on these findings, some implications and suggestions for future research were provided. [ABSTRACT FROM AUTHOR]

Our study aims to describe the status of workplace violence against medical students during clinical practice, which consists of its prevalence, types, perpetrators, students' responses and influences on them, reasons for workplace violence and to determine some relevant factors of this issue through both quantitative questionnaire and qualitative interview. A descriptive cross-sectional study with mixed methods was conducted on 320 students from the second-year to the sixth-year classes at Hanoi Medical University from August 2022 to February 2023. The questionnaire was based on the WHO questionnaire survey 'Workplace violence in the health sector – country case studies research instruments – Geneva 2003'. 10 students from quantitative research who completed the questionnaire, experienced at least one type of workplace violence and consented to continue taking part in the research were chosen for in-depth interviews. The prevalence of students witnessing and/or experiencing workplace violence was 35.6% and 19.4% of the sample population had experienced at least one kind of workplace violence. Medical staff were the most common perpetrators. 86.8% of students who were exposed to workplace violence did not report the incidents for a variety of reasons. The major reasons leading to workplace violence related to patients, patients' relatives and students, among which the first-ranked ones were the patients' education level and their unsatisfied expectations. Some relevant factors to workplace violence against medical students were determined by quantitative analysis such as students' grade (OR = 3.09) and region (OR = 3.31) and were explored additionally by qualitative interview such as the student management of the instructors, students' personality, attitude and appearance as well as hospital environment. Based on the research findings, establishing prevention methods, which require action from both individuals (students, medical staff) and organizations (universities, hospitals) is recommended. [ABSTRACT FROM AUTHOR]

Aim: To explore the healthcare experiences and needs of older adults living with HIV in Sweden. Design: A phenomenological study using qualitative thematic analysis. Methods: Data were gathered through semistructured qualitative interviews and analysed using thematic analysis. A purposive sample of individuals ageing and living with HIV was recruited for this study. Results: A total of 22 participants aged 65 years and older, with a mean age of 75 years, participated in the study. Living with HIV meant a need to rely on consistent healthcare and treatment over the course of one's lifetime. The experiences of older adults were described under four themes: relying on access to health care, desiring involvement and shared decision‐making, the importance of trust and confidentiality and experiences of stigma in healthcare visits. Conclusion: Living and ageing with HIV involved recurring exposure and vulnerability in healthcare encounters, and experiences of being exposed to HIV‐related stigma, especially outside HIV clinics. Continuity and being seen as a person in healthcare encounters were important. Enhancing HIV knowledge alongside fostering supportive attitudes and approaches of healthcare professionals is critical for ensuring high‐quality and nondiscriminating health care. Implications for the Profession and/or Patient Care: Meeting the needs of older adults living with HIV requires a person‐centred approach, including active involvement and shared decision‐making between patients and healthcare providers. Impact: This study describes the healthcare experiences and needs of older adults, aged 65 years and older, living with HIV, a population that is not typically investigated in qualitative research. Living and ageing with HIV means a vulnerability where the attitudes of professionals and the active involvement of the patient become significant for quality care. The findings can help with the implementation of policies and practices for the care of older adults living with HIV. Reporting Method: The Consolidated Criteria for Reporting Qualitative Studies (COREQ) was used. Patient and Public Contribution: Patient representatives were involved in discussions on data collection and the development of the interview guide. [ABSTRACT FROM AUTHOR]

Aims: To explore the care experiences of informal carers of people with chronic conditions in hospitals and identify areas for improvement in the context of comprehensive care delivery. Design: A explanatory sequential mixed‐method study. Methods: This study was conducted, involving a survey with 182 carers and interviews with 31 carers of individuals who attended an Australian hospital. Descriptive analysis of quantitative data was performed using RStudio, while thematic analysis of qualitative data was conducted using NVivo. Results: The findings revealed seven overarching components of care that influenced carers' hospital experiences and their perceptions of care quality. Areas requiring improvement were identified within these categories. Conclusion: This review identifies common perspectives of informal carers of people with chronic conditions in hospital settings and highlights important areas that require attention to improve carers' hospital care experiences. Carers should be welcomed, involved, informed and supported during hospital attendance to foster the most positive care experiences. Implications: Healthcare professionals should involve carers in assessment, shared decision‐making and the care process and recognise and address carers' needs. Impact: The findings revealed the carer's hospital experiences in the context of comprehensive care delivery and identified areas requiring improvement. Reporting Method: The CROSS and the COREQ guidelines were followed. Patient or Public Contribution: The study protocol was presented to stakeholders from two hospitals in Australia, a Patient and Carer Advisory Board (attached to the parent project: evaluating Quality of Care (eQC)) and the Australian Commission on Safety and Quality in Health Care, and discussions were held to assess the relevance and significance of this study to clinical practice and health policy. [ABSTRACT FROM AUTHOR]

Aim: To assess a commercially available electronic whiteboard's usability and acceptability in isolation rooms, focusing on improving nurse–patient communication and supporting data input. Design: A cross‐sectional study with quantitative and qualitative mixed methods. Methods: We evaluated the usability and acceptability of electronic whiteboards among nurses using scenarios in a virtual isolation room environment. Results: Nurses recognised the electronic whiteboard as a valuable tool for communication and error reductions in record‐keeping but noted a learning curve for less tech‐savvy users. Positive correlations were found between perceived usefulness, ease of use and adoption intent. Despite challenges, electronic whiteboards show promise for enhancing patient care, requiring comprehensive training and management systems. Time allocation in patient wards and nurse–patient interactions are crucial considerations. Conclusion: Electronic whiteboards have usability and acceptability as a tool to improve nurse–patient communication. However, considering technical issues and staff resistance, a management system and user training are necessary. Implications for the Profession and/or Patient Care: Nurses perceive electronic whiteboards as user‐friendly and as facilitating data input. Reporting Method: TREND (Nonrandomised evaluations of behavioural and public health interventions). Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To explore registered nurses' beliefs regarding pain assessment in people living with dementia. Design: A descriptive exploratory qualitative study informed by the Theory of Planned Behaviour. Methods: Online semi‐structured in‐depth interviews were conducted from January to April 2023 with a purposive sample of 15 registered nurses caring for people with dementia. Following transcription, data were analysed using direct content analysis. Findings: Registered nurses believe pain assessment improves the well‐being of people with dementia and informs and evaluates practice. However, there is a possibility of misdiagnosing pain as agitation or behavioural problems, leading to inaccurate pain management. Interpersonal factors, such as registered nurses' knowledge and experience, beliefs and motivation to improve care provision, were the primary facilitators of pain assessment. Physical and behavioural dimensions of the pain of the dementia syndrome were the most reported barriers to pain assessment. Registered nurses reported that multidisciplinary team members expect them to do pain assessments. Most did not experience disapproval when performing pain assessments. Conclusion: Registered nurses hold beliefs about pain assessment benefits, consequences, enablers, barriers, approvals and disapprovals regarding dementia. The findings could inform interventions to enhance pain assessment practices. Implications for the Profession and/or Patient Care: Policymakers should provide education opportunities for registered nurses to improve their knowledge, skills and beliefs about pain assessment in dementia. Future research should develop and implement multidisciplinary, multifaceted pain assessment protocols to enhance the accuracy of pain assessment practices. Impact: Pain is underassessed in dementia, and this could stem from registered nurses' beliefs about pain assessment in dementia. The findings could inform interventions to enhance pain assessment beliefs and practices. Reporting Method: This study adhered to the COREQ criteria. Patient or Public Contribution: Registered nurses caring for people living with dementia participated as interview respondents. [ABSTRACT FROM AUTHOR]

Aim and Objectives: To provide an in‐depth insight into the barriers, facilitators and needs of district nurses and nurse assistants on using patient outcomes in district nursing care. Background: As healthcare demands grow, particularly in district nursing, there is a significant need to understand how to systematically measure and improve patient outcomes in this setting. Further investigation is needed to identify the barriers and facilitators for effective implementation. Design: A multi‐method qualitative study. Methods: Open‐ended questions of a survey study (N = 132) were supplemented with in‐depth online focus group interviews involving district nurses and nurse assistants (N = 26) in the Netherlands. Data were analysed using thematic analysis. Results: Different barriers, facilitators and needs were identified and compiled into 16 preconditions for using outcomes in district nursing care. These preconditions were summarised into six overarching themes: follow the steps of a learning healthcare system; provide patient‐centred care; promote the professional's autonomy, attitude, knowledge and skills; enhance shared responsibility and collaborations within and outside organisational boundaries; prioritise and invest in the use of outcomes; and boost the unity and appreciation for district nursing care. Conclusions: The preconditions identified in this study are crucial for nurses, care providers, policymakers and payers in implementing the use of patient outcomes in district nursing practice. Further exploration of appropriate strategies is necessary for a successful implementation. Relevance to clinical practice: This study represents a significant step towards implementing the use of patient outcomes in district nursing care. While most research has focused on hospitals and general practitioner settings, this study focuses on the needs for district nursing care. By identifying 16 key preconditions across themes such as patient‐centred care, professional autonomy and unity, the findings offer valuable guidance for integrating a learning healthcare system that prioritises the measurement and continuous improvement of patient outcomes in district nursing. Reporting Method: Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Patient of Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: Based on the two‐factor model of caregiving appraisals, this study aims to (1) investigate the relationships between competence in dementia care and job satisfaction (work attitudes in positive aspect) and turnover intention (work attitudes in negative aspect) among formal caregivers in nursing homes, and (2) examine the mediating roles of positive aspects of caregiving (caregiving appraisals in positive aspect) and caregiving burden (caregiving appraisals in negative aspect) in the above associations. Design: A cross‐sectional design was used. Structural equation modelling was employed to test the proposed model. STROBE checklist guides the reporting of this study. Methods: Using the multistage cluster sampling method, 407 formal caregivers were selected from 43 nursing homes across 7 districts/counties in China. Results: The proposed model shows a good model fit. Competence in dementia care shows significant positive associations with increased job satisfaction and decreased turnover intention among formal caregivers in nursing homes. Caregiving burden and positive aspects of caregiving mediate the relationships between competence in dementia care and both job satisfaction and turnover intention. Furthermore, the relationship between positive aspects of caregiving and job satisfaction is stronger than that with turnover intention, but the relationship between caregiving burden and turnover intention is not stronger than that with job satisfaction. Conclusions: The results demonstrate that the two‐factor model of caregiving appraisals effectively elucidates the associations and underlying mechanisms between competence in dementia care and formal caregivers' work attitudes. Specifically, two crucial conclusions are drawn: (1) competence in dementia care is associated with higher levels of job satisfaction and lower levels of turnover intention among formal caregivers in nursing homes; (2) caregiving burden and positive aspects of caregiving serve as parallel mediators in these associations. Implications for the Profession and/or Patient Care: Policymakers and nursing homes managers should implement a series of measures aimed at formal caregivers in nursing home. Specifically, allocating more resources to enhance the competence in dementia care of formal caregivers is crucial, given its significant association with elevated job satisfaction and reduced turnover intention. Besides, positive and negative caregiving appraisals emerge as proximal factors influencing work attitudes of formal caregivers. Therefore, intervention projects focused on formal caregivers in nursing home should target enhancing positive experiences and alleviating caregiving burden. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Objectives: To explore the postoperative kinesophobia of patients after percutaneous coronary intervention (PCI) and its related factors. Background: Percutaneous coronary intervention is an effective method to treat coronary heart disease (CHD), and cardiac rehabilitation is an important auxiliary method after PCI. However, the compliance of patients with cardiac rehabilitation after PCI is not good, among which kinesophobia is an important influencing factor. Design: A descriptive cross‐sectional design was implemented, and the high‐quality reporting of the study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology Statement. Methods: In total, 351 inpatients who underwent PCI in three tertiary grade‐A hospitals in China were selected by convenient sampling method. We use one‐way ANOVA and multiple linear regression analysis to determine the relevant related factors. Results: The kinesophobia of patients after PCI was negatively correlated with chronic illness resource utilization and sense of personal mastery, and positively correlated with illness perception. Education level, clinical classification of CHD, exercise habits, chronic illness resource utilization, illness perception and sense of personal mastery entered the regression equation, which could explain 78.1% of the total variation. Conclusion: The level of kinesiophobia of patients after PCI is high. Education level, clinical classification of CHD, exercise habits, chronic illness resource utilization, illness perception and sense of personal mastery are the related factors of kinesiophobia of patients after PCI. Relevance to Clinical Practice: By reducing the level of exercise fear of patients after PCI, patients are more likely to accept and adhere to the cardiac rehabilitation plan, thus improving their prognosis and improving their quality of life. Patient or Public Contribution: The patient underwent PCI in the research hospital. Researchers screen them according to the inclusion criteria and invite them to participate in this study. If they meet the requirements, participants will answer the research questionnaire face to face after signing the informed consent form. [ABSTRACT FROM AUTHOR]

Introduction: Understanding patients' experiences is important when developing interventions for people living with persistent pain. Interviews and focus groups are frequently used to capture beliefs, views, and perspectives. These methods often require a commitment to a predetermined date and time that may present a barrier to participation. An asynchronous online discussion forum, specifically designed for research purposes, provides an alternative and potentially more accessible method for participation. In this article we discuss a bespoke online discussion forum, the Q-PROMPPT blog, as a case example. Methods: We describe how we developed the Q-PROMPPT blog, with patient and public involvement, and its use as an innovative method for qualitative data collection in the context of developing an intervention for patients prescribed opioids for persistent pain. Drawing on our experiences we discuss the following areas: planning and design, participant recruitment and registration, and participant experience and engagement. Results: We identify and address key concerns for each area of the Q-PROMPPT blog: planning and design: choosing software, assigning roles, designing the interface to promote usability; recruitment of participants: recruiting eligible participants, participant anonymity; participant experience and engagement: mitigating risk of harm, facilitating discussions, planning for forum close. Conclusion: Based on our lessons learnt, we outline recommendations for using a bespoke online discussion forum as a qualitative method to inform intervention development for people living with persistent pain. These include collaboration with information communication technology teams, co-design with patient and public partners, minimising risk of imposter participants and developing trust and online community identity. [ABSTRACT FROM AUTHOR]