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Aim: To explore how nurses working in general practice experienced remote and technology-mediated working during the COVID-19 pandemic. Design: Exploratory qualitative study with nursing team members working in general practices in England and national nurse leaders. Methods: Data were collected between April and August 2022. Forty participants took part in either semi-structured interviews or focus groups. Data were analysed using Framework Analysis informed by the PERCS (Planning and Evaluating Remote Consultation Services) Framework. University of York ethics approval [HSRGC/2021/458/I] and Health Research Authority approval were obtained [IRAS:30353. Protocol number: R23982. Ref 21/HRA/5132. CPMS: 51834]. The study was funded by The General Nursing Council for England and Wales Trust. Results: Participants continued to deliver a significant proportion of patient care inperson. However, remote and technology-mediated care could meet patients' needs and broaden access in some circumstances. When remote and technology-mediated working were used this was often part of a blended model which was expected to continue. This could support some workforce issues, but also increase workload. Participants did not always have access to remote technology and were not involved in decision-making about what was used and how this was implemented. They rarely used video consultations, which were not seen to add value in comparison to telephone consultations. Some participants expressed concern that care had become more transactional than therapeutic and there were potential safety risks. Conclusion: The study explored how nurses working in general practice during the COVID-19 pandemic engaged with remote and technology-mediated working. It identifies specific issues of access to technology, workload, hybrid working, disruption to therapeutic relationships, safety risks and lack of involvement in decision-making. Changes were implemented quickly with little strategic input from nurses. There is now an opportunity to reflect and build on what has been learned in relation to remote and technology-mediated working to ensure the future development of safe and effective nursing care in general practice. Impact: The paper contributes to understanding of remote and technology-mediated working by nurses working in general practice during the COVID-19 pandemic and indicates to employers and policy makers how this can be supported moving forward. Reporting method: Standards for Reporting Qualitative Research (O'Brien et al., 2014). Patient or public contribution: This was a workforce study so there was no patient or public contribution. Implications for the profession and patient care: The paper highlights specific issues which have implications for the development of remote, technology-mediated and blended working for nurses in general practice, care quality and patient safety. These require full attention to ensure the future development of safe and effective nursing care in general practice moving forward. [ABSTRACT FROM AUTHOR]

Background: Vaccination is the most important public health practice for preventing infectious diseases and maintaining health. However, some parents are hesitant to vaccinate their children. Design: This study was designed as an instrument development study. Methods: This study aimed to develop a scale to measure the attitudes of parents with children aged 0–5 years towards vaccination and to evaluate the validity and reliability of this scale. The data were collected from 691 participants between November 2020 and January 2021. During the development of the scale, experts provided feedback on its technical, content and language dimensions. The data were analysed using exploratory and confirmatory factor analyses for conceptual validity and Cronbach's α and item‐level test–retest analyses for reliability. Results: The developed scale is a reliable and valid tool for measuring attitudes towards vaccination among parents (Cronbach's α = 0.97, variance explained by these 28‐item two factors = 62.47%). Conclusion: This scale can be used as a guide in measuring the attitudes of parents towards vaccination and determining the direction of primary health‐care services based on the results of the measurement. Summary statement: What is already known about this topic? Vaccination plays an important role in health practice.Parents' attitudes towards vaccination affect their children's vaccination status.Increasing vaccination rates in children will contribute to the reduction of infectious diseases and mortality. What this paper adds? A new valid and reliable measurement tool for determining vaccine hesitancy has been developed.The validity and reliability of the scale of attitudes towards vaccination among parents of children aged 0–5 years were tested.The tool could be used to determine the attitudes of parents of children aged 0–5 years towards vaccination. The implications of this paper The scale may help in determining factors affecting parents' attitudes on vaccination.The scale can generate data to guide nursing practices to increase vaccination rates.The scale can be used to influence nursing practices to increase vaccination rates and promote vaccine awareness, trust and acceptance. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present a mixed methods study of child criminal exploitation (CCE), particularly in the form of "county lines", in three local authorities in southeast England. The data is analysed using a framework constructed from two relevant contextual and relational theories to understand experiences of CCE and the safeguarding responses undertaken to protect young people from harm. Design/methodology/approach: Data were drawn from a survey (n = 118); interviews (n = 5) and focus groups (n = 15) with professionals; interviews with parents (n = 4); and from secondary analysis of eight interviews with young people affected by criminal exploitation. The analytic framework was applied to the data to answer two research questions: what is the role and significance of young people's interactions with peers, parents and professionals in their CCE trajectories; and how do professionals understand and address risks within contexts in which young people are exposed to CCE? The mixed methods data collected by the authors were coded and analysed using this framework. Findings: Although professionals were aware of contexts and relational power dynamics, the situated and temporal nature of CCE remained overlooked within safeguarding systems. Professionals required more space, time and support to fully and flexibly engage with young people and their families to increase safety. Originality/value: There is limited research available that critically examines safeguarding responses to CCE in diverse geographic and cultural contexts. This paper contributes a critical account of how professionals might create connections and opportunities for change with young people, identifying structural constraints within practice systems alongside emerging examples of effective practice. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Despite extensive evidence on the value of patient decision support interventions ( DESIs), there is no consensus on optimal DESI formats. Assessing clinicians' perceptions about DESI formats can help facilitate their adoption. The aim of this study was to assess clinicians' perceptions of DESIs formats and potential use in practice. Methods Semi-structured qualitative interviews were conducted with doctors from diverse practice areas (internal medicine, OB/ GYN, surgery, medical oncology, emergency medicine) and elicited perceptions toward patient DESIs formats (digital vs. paper) and timing of administration. Questions also elicited beliefs underlying attitudes, perceived social norms and self-efficacy for using DESIs and the feasibility of doing so. Data analysis was conducted using a thematic analysis approach. Results Participants identified strengths of both more comprehensive digital and shorter paper-based tools and thought they could complement each other. Participants consistently expressed the advantages of using DESIs outside the consultation to supplement clinical discussions about cancer decisions given the amount of information to discuss during these emotion-laden conversations. Participants felt that patients with older age and lower socio-economic status were more likely to use a paper-based compared with a digital DESI. Participants also noted challenges related to reliable resources such as computers and Internet in the practice setting, which would be necessary for implementing the digital DESIs on site. Conclusions Clinicians' perceptions and opinions about value of DESIs can vary widely across doctor, patient and clinic characteristics. A one-size-fits-all approach to implementation might not be feasible, suggesting that flexible approaches to providing decision support for patients are needed to drive broader adoption. [ABSTRACT FROM AUTHOR]

For over 70 years, studies have reported lower rates of completed suicide in Muslim-majority countries and individuals who identify as Muslim. To this point, the mechanisms underlying the relationship between Islam and lower risk of suicide remain understudied. In an effort to advance our understanding, we convened a bilingual international interdisciplinary panel of experts for a discussion of the current state and future directions of the field. In this paper, we present an exploratory qualitative analysis of the core themes that emerged from the group interviews. We also derive a general theoretical model of the association between Islam and suicide risk. [ABSTRACT FROM AUTHOR]

Objective: It is widely understood that a key means of improving health systems and patient outcomes is through research – accessing, understanding, generating and applying research evidence-based practice. To promote more targeted and strategic research in Allied Health practice, this study sought to establish the principles, areas and priorities for clinical research as perceived by Allied Health leaders in the South Australian public health system. Methods: The study used a mixed-methods design (full, sequential and equal model). Participants were recruited from the South Australian Department of Health and Wellbeing employment lists for Allied Health senior leaders. Consenting participants attended face-to-face focus groups; after an overview presentation, they discussed the principles for Allied Health research, followed by areas and priorities for research. Summaries of the responses were themed descriptively and circulated electronically so participants could confirm the research areas and ascribe priority ratings, clinical populations and services. Results: A total of 28 people attended the stakeholder forum (5 online); 20 responded to the second-round electronic summary. Nine principles of research action were agreed. Fourteen research areas were identified and prioritised. There was a relatively consistent prioritisation of measuring Allied Health value, Allied Health workforce, hospital avoidance and closing the gap for Aboriginal and Torres Strait Islander peoples health outcomes – whether the individuals were thinking about their own service or the state as a whole. Conclusions: Allied Health leadership identified key principles and priorities for research to improve service delivery and patient outcomes. These priorities should generate further discussion and interest for novice and experienced researchers and leaders and can be used to inform granting and project plans. What is known about the topic? Allied Health are well equipped to engage in research but have limited capacity. What does this paper add? We have identified key priorities and principles to inform Allied Health research activity. What are the implications for practitioners? Practitioners, funders and other stakeholders can develop these identified principles and priorities to direct research time and resources for the most impact on health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Current strategies to address shortages of rural doctors focus on developing a pipeline for rural generalist practice. Limited research has explored how doctors' professional journey engenders the skills required to practice rurally. Objective: This paper analyses how rural general practitioners' clinical pathway informs their scope of practice and future retention. Design: Qualitative thematic analysis using semi‐structured telephone interviews. Twenty‐one general practitioners appointed in their local health district of Murrumbidgee and Southern New South Wales, Australia, within the past 10 years. Participants comprised 10 Australian medical graduates (AMG) and 11 international medical graduates (IMG). Findings: AMGs and IMGs contrasted how their pathway into rural practice, and capacity to work rurally, informed their scope of practice. Australian medical graduates' familiarity with rural areas was consolidated through congruous experiences, including at rural clinical schools. Paradoxically, the fluency of their training limited the amount of unsupervised experience and confidence AMGs gained. Together with a focus on work‐life balance, this limited many to providing mainstream general practice, precluding extending their scope of practice. International medical graduates described disseminated experiences, often unsupervised in high‐volume contexts. However, a lack of professional opportunities prevented them from extending their scope of practice. Discussion: IMG and AMG motivation and pathway for working rurally differ. Respective cohorts have concerns regarding requisite skills and knowledge for rural practice, which incorporates opportunity and recognition. Entry points for training should be variable to allow consideration of life stage, prior skill development and extension of scope of practice. Conclusion: Doctors' scope of practice is informed by their pathways into rural practice. Australian medical graduates may not gain adequate competence during expedited training programs to confidently undertake extended clinical activities. International medical graduates, however lacked the opportunities and support, to utilise their expertise in rural practice. Complementarily utilising the expertise and commitment of both AMGs and IMGs may synergistically address workforce shortages. [ABSTRACT FROM AUTHOR]

The holistic needs of Queer and Trans Latine students have been habitually excluded from prominent discussion in US higher education. This paper positions itself as an urgent addition to the literature on Hispanic Serving Institutions (HSI) and emerging HSI (eHSI) institutional identity to consider the needs of Queer and Trans Latine students directly. I conducted a total of four semi-structured interviews that were methodologically integrated with the testimonio framework. In these interviews, participants engaged in a journey toward healing from the injustices they (may) have faced at their eHSI while also deeply ingraining students in the process of what an equitable HSI institutional and organizational identity could be for Queer and Trans Latine students. The data were analyzed through an intersectionality and LatCrit theoretical framework. Findings showcase (1) the impact of department-level support of Queer and Trans identity as profoundly influential in students' Queer and Trans identity development and navigational capital and (2) the impact that low levels of visibility of Queer and Trans Latine persons on campus have on how Queer and Trans Latine students navigate campus services and faculty support. I conclude with a discussion on how Queer and Trans Latine student experiences should be explored to develop campus resources further and supports for a historically resilient population. [ABSTRACT FROM AUTHOR]

Migration to South Africa is motivated by the pursuit of employment, safety, and improved living conditions. However, immigrants encounter significant challenges, such as restricted access to essential services, which were exacerbated by the COVID-19 pandemic. This paper investigates the impact of the COVID-19 pandemic on Malawian immigrants in South Africa, addressing the lack of attention given to this immigrant population by highlighting their vulnerabilities. Using a qualitative exploratory and descriptive approach, in-depth interviews were conducted with 24 Malawi immigrants who were over 18 years old and had established residency in South Africa before the onset of the COVID-19 pandemic. Five key stakeholders were also interviewed for additional perspectives and to ensure triangulation and improve data reliability. The interviews were transcribed verbatim and analyzed using thematic analysis strategies and coding with Nvivo12 software. The study highlighted the exacerbated struggles of Malawian immigrants in South Africa amid the COVID-19 pandemic, uncovering systemic discrimination in healthcare, marked by longer wait times and reluctance from health workers to treat undocumented immigrants. The study also revealed a dire security situation, with immigrants living in high-crime areas and feeling particularly targeted due to their foreign status, a situation worsened by the pandemic's economic effects. Additionally, the economic downturn induced by COVID-19 significantly impacted employment opportunities, with many immigrants facing prolonged unemployment and job losses, especially in sectors where they traditionally found work. The detailed accounts of participants highlight not only the multifaceted challenges imposed by the pandemic but also the critical need for inclusive policies and support systems that ensure healthcare access, safety, and economic resilience for immigrants, particularly during global health emergencies. Future research should focus on effective interventions for socioeconomic integration and well-being, particularly for immigrants from other African countries. [ABSTRACT FROM AUTHOR]

Background: Haptic feedback has been shown to be an effective facilitator of the learning of scientific concepts in a series of studies. However, little is known about the underlying salient learning mechanisms, which are activated when learning from haptic feedback. Objectives: We investigate the learning mechanism in a higher chemistry education setting, in which the students learned about the abstract concept of potential energy in a quantum chemical context. Methods: In this work, we present a mixed‐methods problem‐solving prior to instruction (PS‐I) study with chemistry bachelor students. In an interactive quantum chemistry learning environment, the students explored the energetic profiles of nucleophilic substitution reactions and the corresponding activation barriers experienced as repulsion and attraction. We measured cognitive and affective mechanisms which have been shown to be activated in PS‐I designs, such as knowledge gap awareness, state curiosity, and positive affect as well as the learning outcome quantitatively and the learning trajectories qualitatively. Results and Conclusions: Planned contrasts revealed a small hindering effect of the haptic feedback on the learning outcome. Thematic analysis of the qualitative data lets us attribute this effect to the lack of scaffolding of the haptic feedback and the spontaneous atomic movements in the simulation, which may be interpreted as a visual representation of force in itself. This work highlights the importance of accurate mappings of the haptic feedback unto the target domain and further delivers insight into the prior conceptions of chemistry undergraduate students. Lay Description: What is already known about this topic: Haptic feedback can facilitate learning by grounding abstract concepts in sensory experiences.While previous studies have reported positive affective results, the cognitive results are ambiguous.Moreover, it was frequently reported that the learning of potential energy in a (quantum) chemical context is particularly difficult due to (i) the lack of grounding opportunities and (ii) the diverse previous conceptions. What this paper adds: A learning environment to interact with molecular systems in real‐time is proposed.The concept of activation energy is grounded in sensory experience of pushing and being pulled.The mixed‐methods design allows to explore cognitive and affective variables as well as the specific prior conceptions activated by the environment. Implications for practice and/or policy: We found a small negative effect of the haptic feedback on the learning outcome, potentially due to insufficient introduction of it to the students.The spontaneous movement of the atoms was identified as a more suitable external representation of the force.Future studies should investigate, if explicit introduction of the embodied metaphor can reverse this effect. [ABSTRACT FROM AUTHOR]

The main aim of this paper is to explore and discuss the interesting juxtaposition of patient involvement within a standardised Enhanced Recovery After Surgery care programme (ERAS). We address our aim by examining the work and strategies of nursing staff caring for patients during postoperative recovery from surgery, exploring how these two potentially competing priorities might effectively co‐exist within a hospital ward. This was a qualitative exploratory study, with data generated through 42 semi‐structured interviews with patients and nurses who had taken part in an ERAS programme in one of three hospital wards in the United Kingdom, adopting a reflexive thematic approach to data analysis. We shine a light on the work undertaken by patients and nurses during the navigation of postoperative recovery, identifying strategies of collaboration and negotiation during this journey. Furthermore, we also identify and consider patients engaged in peer‐peer support during postoperative recovery. This paper adds to the existing literature and current ways of thinking in relation to the quest for standardised, clinically effective care balanced with the aspirations for individualised, patient‐centred care. This paper also helps inform thinking about the use of care pathways in relation to service delivery, considering how best to initiate and deploy best practice aimed at safe and effective postoperative recovery. [ABSTRACT FROM AUTHOR]

Background: Empirical studies suggest that gratitude positively influence the quality of life of palliative patients and relatives. However, the literature is marked by a lack of conceptual clarity about what gratitude is and whether it can bring about individual and social benefits. Aim: This paper explores how palliative care patients and relatives understand gratitude, how discursive representations of gratitude may affect their positions, perceptions and relations, and how to conceptualise gratitude in the palliative context. Design: We examine 33 gratitude letters written by patients and relatives and 25 semi-structured interviews conducted as part of a pilot gratitude intervention study. We use a qualitative approach, thematic analysis, within a conceptual framework of discourse analysis. Settings/participants: Data were collected from 23 patients and 13 relatives recruited through three hospital palliative care services in French-speaking Switzerland. Results: Participants articulate gratitude in five ways: (1) appreciating others; (2) love; (3) need to reciprocate; (4) appreciating the little things; (5) solace amid serious illness. While some of these representations are sources of positive emotions and outlook, wellbeing and hope, others may confirm self-perceptions of powerlessness and burden. These results support a tridimensional conceptualisation of gratitude in palliative care as source of individual benefits, valuing closest relationships and moral obligation. Conclusion: Our study suggests that gratitude is a key to a good (end of) life, whilst highlighting potential negative effects. It could help healthcare professionals to better understand what gratitude means to patients and relatives, which may facilitate awareness and fostering of gratitude in palliative care. [ABSTRACT FROM AUTHOR]

Background: Virtual care quickly became of crucial importance to health systems around the world during the COVID-19 pandemic. Despite the potential of virtual care to enhance access for some communities, the scale and pace at which services were virtualized did not leave many organizations with sufficient time and resources to ensure optimal and equitable delivery of care for everyone. The objective of this paper is to outline the experiences of health care organizations rapidly implementing virtual care during the first wave of the COVID-19 pandemic and examine whether and how health equity was considered. Methods: We used an exploratory, multiple case study approach involving four health and social service organizations providing virtual care services to structurally marginalized communities in the province of Ontario, Canada. We conducted semi-structured qualitative interviews with providers, managers, and patients to understand the challenges experienced by organizations and the strategies put in place to support health equity during the rapid virtualization of care. Thirty-eight interviews were thematically analyzed using rapid analytic techniques. Results: Organizations experienced challenges related to infrastructure availability, digital health literacy, culturally appropriate approaches, capacity for health equity, and virtual care suitability. Strategies to support health equity included the provision of blended models of care, creation of volunteer and staff support teams, participation in community engagement and outreach, and securement of infrastructure for clients. We put our findings into the context of an existing framework conceptualizing access to health care and expand on what this means for equitable access to virtual care for structurally marginalized communities. Conclusion: This paper highlights the need to pay greater attention to the role of health equity in virtual care delivery and situate that conversation around existing inequitable structures in the health care system that are perpetuated when delivering care virtually. An equitable and sustainable approach to virtual care delivery will require applying an intersectionality lens on the strategies and solutions needed to address existing inequities in the system. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to explore and describe the translation and cultural adaptation of the Fundamentals of Care framework to a Swedish context, and highlight the need for a translated version. Design: An exploratory, descriptive approach was adopted. Methods: A structured forward‐backward translation process and cultural adaptation were used, considering situation and recipient as recommended for such process. Data such as literature and documents were collected during 2019–2021. The authors took systematic steps in collaboration with a strategic sample of experts: professional language service providers, clinicians, educators and a linguist. Results: The framework was mainly translated verbatim. A few fundamental care elements were adjusted to the Swedish language, context and clinical practice. Also, this work clarified the relational elements to be coherently seen as nursing actions. Addressing the need for a translated version was illustrated in activities in research, education and clinical practice. Conclusion: This paper highlights the importance of translating the Fundamentals of Care framework into a country's native language to gain acceptance and application there. Sharing the framework's translated version impacts nursing science, generating a consistent language in the development and conducting of research for the comparison and transferability or generalizability of findings. Together with a cultural adaptation, the translated framework can support and guide researchers, educators and nursing leaders in articulating fundamental nursing care for enacting change. By disseminating the first Swedish version of the framework we encourage a global discussion and sharing of examples of translation and cultural adaptation by others. Impact The framework's English version has limitations in various context. This paper shows a systematic translation and cultural adaptation process of the framework. We proclaim that this is necessary for nursing leaders and nurses to be able to apply it in guiding nursing practice and leading change. [ABSTRACT FROM AUTHOR]

Some media have suggested that many youths who have previously completed a gender transition are "detransitioning". Their experience is often framed around the idea of regrets but rare are the articles that provide a nuanced examination of their journey. This article presents the perspectives of youths who have detransitioned or discontinued a transition regarding their experiences and feelings on their journey from transition to detransition. Semi‐structured interviews were conducted with 20 youths between the age of 16 and 25 years who were recruited on social media and who transitioned and detransitioned or discontinued their transition. Data were analysed according to thematic analysis. Regrets and feelings of satisfaction can both coexist. The processes of transition and discontinuation or detransition appear to be non‐linear and participants do not necessarily return to a cisgender identity. Ambiguous loss theory is applied to frame youth experiences and feelings and to suggest way forward for intervention. Highlights: This paper examines the experiences and feelings of youth on their journey from transition to detransition.Their journey is experienced as non‐linear, and often comprised mixed feelings and experiences about transition and detransition steps.Ambiguous loss theory allows a nuanced understanding of feelings and experiences of their journey from transition to detransition. [ABSTRACT FROM AUTHOR]

Aims: To explore the nuances of theory utilization in qualitative methodologies, discuss the different relationships that applied qualitative methodologies have with theory and use the foundational underpinnings of interpretive description to challenge strongly entrenched ideas of theory that have extended into applied qualitative nursing research. Design: Methodology discussion paper. Data sources: Narrative literature review and personal observations. Conclusion: Many qualitative research traditions have viewed the use of an explicit theoretical framework as an integral grounding for qualitative research studies. Much of the discussion of theory in extant qualitative methodological literature focuses on its use in the context of traditional methodologies such as ethnography, phenomenology and grounded theory, with less attention on methodological approaches developed for applied and practice disciplines such as nursing. Uncritical adoption of ideas about theory based on traditional qualitative methodological conventions can result in findings with little utility for application to the practice context. Impact: Nursing researchers should think critically about how theory is used in research endeavours geared towards applied practice and ensure that their methodological choices are in alignment with their philosophical and disciplinary epistemological positionings. [ABSTRACT FROM AUTHOR]

Crisis intervention services for people experiencing psychological distress and suicidal ideation are frequently described by the people accessing them as failing to meet their needs. This paper reports a prominent finding from a realist evaluation of Taranaki Retreat—a charitable, non‐clinical organisation in New Zealand, which offers free respite for people experiencing acute distress. Using qualitative methods, the study aimed to move beyond vague notions regarding the helpfulness of respite, to a deeper understanding of the contextual factors and mechanisms which generate outcomes for such an intervention. Participant observation, focus groups with staff, semi‐structured interviews with service users, and analysis of service users' case notes were conducted over a six‐month period in 2018. The most prominent finding from the study related to 'genuine care'—care which is interpreted by the recipient as being motivated by a genuine desire to help. We present this finding as to the central mechanism in a wider programme theory developed through the realist evaluation study. We also present five key features of the care participants were offered at Taranaki Retreat which contributed to their common interpretation regarding the motivations behind this care. Upon considering the centrality of this mechanism we conclude that, in designing crisis interventions, greater consideration should be given to how the intervention can demonstrate genuine care. Having highlighted the ways in which the structure of charitable organisations appears conducive for interpretations of genuine care, we further conclude that the provision of comprehensive crisis intervention by charitable organisations should be further explored and supported. [ABSTRACT FROM AUTHOR]

Abstract: Background Evidence-based practice is embedded in all aspects of nursing and care. Understanding research evidence and being able to identify the strengths, weaknesses and limitations of published primary research is an essential skill of the evidence-based practitioner. However, it can be daunting and seem overly complex. Aim: To provide a single framework that researchers can use when reading, understanding and critically assessing published research. Discussion: To make sense of published research papers, it is helpful to understand some key concepts and how they relate to either quantitative or qualitative designs. Internal and external validity, reliability and trustworthiness are discussed. An illustration of how to apply these concepts in a practical way using a standardised framework to systematically assess a paper is provided. Conclusion: The ability to understand and evaluate research builds strong evidence-based practitioners, who are essential to nursing practice. Implications for practice: This framework should help readers to identify the strengths, potential weaknesses and limitations of a paper to judge its quality and potential usefulness. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present an analysis of a "county lines" safeguarding partnership in a large city region of England. A critical analysis of current literature and practice responses to "county lines" is followed by the presentation of an analytical framework that draws on three contextual and social theories of (child) harm. This framework is applied to the partnership work to ask: are the interconnected conditions of criminal exploitation of children via "county lines" understood?; do interventions target the contexts of harm?; and is social and institutional harm acknowledged and addressed? Design/methodology/approach: The analytical framework is applied to a data set collected by the author throughout a two-year study of the "county lines" partnership. Qualitative data collected by the author and quantitative data published by the partnership are coded and thematically analysed in NVivo against the analytic framework. Findings: Critical tensions are surfaced in the praxis of multi-agency, child welfare responses to "county lines" affected young people. Generalising these findings to the child welfare sector at large, it is proposed that the contextual dynamics of child harm via "county lines" must be understood in a broader sense, including how multi-agency child welfare practices contribute to the harm experienced by young people. Originality/value: There are limited peer-reviewed analyses of child welfare responses to "county lines". This paper contributes to that limited scholarship, extending the analysis by adopting a critical analytic framework to a regional county lines partnership at the juncture of future national, child welfare responses to "county lines". [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Trauma among psychiatric nurses and other healthcare workers is related to workplace violence, but other risk factors may also contribute, including those occurring before, during or after workplace violence. What does this paper add to existing knowledge?: Most previously identified PTSD risk factors were not tested or supported in research with psychiatric nurses, although there is promising evidence for risk factors including severe or injurious assault, cumulative exposure, burnout, and other worker characteristics.We identify directions for research needed to improve knowledge, including collecting data before nurses experience workplace violence, defining workplace risk factors consistently and conducting and reporting qualitative analysis. What are the implications for practice?: Provide training in risk assessment and violence prevention to psychiatric nurses.Offer mental health support to those exposed to violence, especially with cumulative exposure. Introduction: Psychiatric nurses are at risk of workplace violence and post‐traumatic stress disorder (PTSD). There is limited understanding of pre‐trauma and post‐trauma risk factors. Aim: Our aim was to review factors associated with workplace PTSD in psychiatric nurses. Method: We searched quantitative and qualitative studies from 1980 to 2019 in 23 databases plus abstracts for studies on psychiatric hospital nursing staff, potentially traumatic workplace events, workplace factors and PTSD. Following duplicate abstract (n = 10,064) and full‐text (n = 199) screening, data were extracted in duplicate from 19 studies. Using best‐fit framework synthesis, we identified workplace violence, pre‐trauma and post‐trauma risk factors. Results: Six variables yielded evidence in at least two empirical studies scoring at least 6/8 on a quality measure, or one such study plus more than one other study ("promising": severe/injurious assault, cumulative exposure, burnout, poor mental health, low compassion satisfaction, neuroticism). Four were supported by at least one better quality study or at least two others ("suggestive": gender, poor training, any physical aggression exposure, compassion fatigue). Discussion: Pre‐trauma measures, consistent definitions of workplace exposures and thorough reporting of quantitative results are needed to improve research. Implications for Practice: Violence prevention and mental health care for exposed nurses appear the most promising targets for PTSD prevention. Therefore, it is particularly important to understand workplace violence and mental health among nurses working in psychiatric hospitals. [ABSTRACT FROM AUTHOR]

Families of persons with acquired brain injuries need to be supported from the early phase of hospitalization. To date, no known early family intervention is available for this population. Using the Medical Research Council Framework, we developed a new intervention based on the Calgary Assessment and Intervention Models that includes the family preferences, clinician's expertise, and the contextual resources. This paper aims to describe the complete development process including a scoping review, an assessment of families and clinicians' needs, an evaluation of the contextual resources, and an adaptation of the theoretical framework. Using a systemic perspective, we tailored the new intervention to involve the stakeholder's preferences. The result is an early family intervention named SAFIR©, led by a clinical nurse specialist, including five core components and structured around three phases and a follow-up. The next steps will be focused on assessment of the clinical feasibility of this new intervention. [ABSTRACT FROM AUTHOR]

Background: Several studies have suggested that practitioners hold speech and language therapy (SLT) practice as tacit and consequently it is difficult for the therapist to describe. The current study uses a range of knowledge elicitation (KE) approaches, a technique not used before in SLT, as a way of accessing this tacit knowledge. There is currently no agreed framework that establishes key factors underpinning practice for preschool children with speech and language disorders. This paper attempts to address that gap. Aims: To develop a framework of SLTs' practice when working with preschool children with developmental speech and language disorders (DS&LD). Methods & Procedures: A mixed‐methods approach was adopted for this study. Data were collected iteratively, from 245 SLTs with experience of working with preschool children with DS&LD across sites in England, by means of focus groups and national events. There were three stages of data collection: local sites, specific‐interest groups and two national events. KE techniques were used to gather data, with initial data being collected in local site focus groups. Findings from groups were taken to subsequent larger groups where a combination of concept mapping, teach‐back and sorting exercises generated a more detailed description of practice, using discussion of consensus and disagreement to stimulate further exploration and definition and provide validatory evidence. Outcomes & Results: This paper provides a high‐level framework of therapy for preschool children with DS&LD that makes practice explicit in this area. The framework proposes that therapists' aims for this group of children fall into three categories: addressing children's areas of impairment and skills; achieving functionally meaningful skills and carryover; and supporting adults to provide a supportive communication environment. The exact configuration is shaped by the child's context and needs. Conclusions & Implications: The framework highlights themes that are well researched in the literature (e.g., speech) and others that have been little studied (e.g., adult understanding), indicating a disconnect between research evidence and practice. The research also highlights the complex nature of interventions for preschool children with DS&LD and the importance therapists attribute to tailoring therapy to individual needs. The framework provides a scaffold upon which SLTs can focus their clinical practice and encourages the profession to understand and explore better the gaps between research evidence and clinical practice for preschool children with DS&LD. [ABSTRACT FROM AUTHOR]

Aim: Globally, the rapid increase of hypertension is particularly prevalent in low‐ and middle‐income countries. Hypertension is the most significant modifiable risk factor for stroke and ischaemic heart disease, the leading cause of mortality in Vietnam. The aim of this study was to gain insight into the provision of hypertension care in Vietnam by exploring provider perceptions. Methods: A sequential exploratory mixed‐method design was selected to allow for the initial qualitative interview findings to be incorporated into the development of the hypertension education workshop. Data were collected through semistructured interviews of 15 Vietnamese clinicians involved in the care of patients with hypertension. Results: Anxiety related to diagnosis of hypertension and specifically fear of having a stroke was mentioned by half of the participants. Several themes also emerged regarding barriers to implementing lifestyle modification to improve patient hypertension outcomes. There were contradictory opinions on the nurse's role in providing patient education across clinical settings. A lack of systematic structure and evidence‐based teaching resources was also noted. Conclusions: Gaining the provider's perspective increases understanding of the regional culture and context of hypertension care. The increased understanding can be used to improve provider education and enhance hypertension population outcomes. SUMMARY STATEMENT: What is already known about this topic? There is an increasing global prevalence of hypertension, the leading modifiable risk factor for cardiovascular morbidity and mortality.Lifestyle modifications are first‐line treatment to attaining hypertension goals and improving patient outcomes.Strengthening nursing intellectual capital by building nurse skills and knowledge can maximize their contribution and enhance population health. The implications of this paper: Awareness of patient culture strengthens patient education and enhances uptake of lifestyle modifications.Nurses, when appropriately equipped and supported, are ideally situated to significantly improve hypertension outcomes.Appropriately educating nurses and clarifying role expectations would develop nursing intellectual capital and add value to the health‐care system in Vietnam. [ABSTRACT FROM AUTHOR]

The need to establish universal standards to protect children led to the development of the United Nations Convention on the Rights of the Child (UNCRC). I drew on literature exploring the UNCRC and children's rights to provision, protection, and participation. This paper aimed to ascertain challenges of enforcing children's rights to provision, protection, and participation in rural and urban Ghana drawing on the experiences and perceptions of 60 government officials, NGO representatives, and parents. Semistructured interviews were conducted with parents (10), stakeholders (10), focus groups (30); and participant observation techniques (10) were utilised to gather the required data and purposively sampled across rural and urban areas in Ghana. Interviews were recorded, and transcribed utilising a framework approach as the qualitative data analysis method. Acceptance of childhood as understood in the UNCRC is different from traditional child-rearing patterns in rural and urban Ghana. IMPLICATIONS Social workers' knowledge about dealing with dilemmas posed by rights to provision, protection, and participation for children may be enhanced. Social workers can improve their knowledge of factors that challenge the enforcement of children's rights for children engaged in child labour and the possible tension between children and parental rights in their everyday social work practice. Social workers can introduce culturally sensitive parenting programs and develop their own contribution towards monitoring and implementing the rights to provision, protection, and participation for children. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There is body of knowledge available about the harms associated with restrictive interventions used in behaviour management, service users' perceptions of the use of restraints, and staff competence in behaviour management. The staff perspective has been studied in terms of staff exposure, responses to and prevention of aggression, staff‐related factors associated with service user aggression, and staff attitudes and perceptions towards violence.The definitions of competence in behaviour management provided in training interventions are fragmented and based on unilateral measurements.Training interventions with the purpose of enhancing staff competence in behaviour management are organized regularly, yet there is a lack of clarity on how effective these interventions are. Inadequate conceptual understanding of behaviour management can weaken the effectiveness of these interventions. What this paper adds to existing knowledge?: Our study produced new knowledge by providing a preliminary conceptual framework that can be used to comprehensively describe and assess competence in managing challenging behaviour and to cover safely the whole care process. Humane care and ethical sensitivity should be the premises of interaction with people in distress. We also pointed out the needs for conceptual clarification of the concepts of confidence, support and restraint.We provide important new insight into the leadership and cultural issues of behaviour management that is relevant for patients, staff members and healthcare organizations. We found that staff members do not consider service user safety and workplace safety as opposing issues.Further, we provide new perspectives for prevention, the risk assessment process and effective communication in the context of behaviour management. What are the implications for practice?: A comprehensive understanding of the competences related to behaviour management will foster universal definitions for "support" and "restraint," which can then be used to ensure that the best practices are used for behaviour management.Organizational culture and participative leadership on behaviour management should be developed with a special focus on safety issues, common understanding of comprehensive competence, risk assessment and prevention, views regarding the use of restraints, and teamwork. Introduction: Previous research concerning staff views of behaviour management has not considered instructors' views. The definitions of competence in behaviour management are fragmented, which can undermine the effectiveness of training interventions. Aim/Question: This study aimed to describe Finnish and British Management of Actual or Potential Aggression instructors' perceptions of safety and behaviour management‐related competences and create a conceptual framework for comprehensive competence. Method: An explorative‐descriptive qualitative approach with purposive sampling (N = 22), semi‐structured interviews and abductive content analysis. Results: Conceptual framework of comprehensive competence in managing challenging behaviour includes five categories—knowledge, skills, attitude, confidence and ethical sensitivity—and 21 subcategories. Competent staff and supportive leadership ensured safety, while inconsistent risk management culture, the health and behaviour of service users, and inadequate staff orientation endangered safety. Discussion: The study produced new knowledge of safety issues and competences from the perspective of the instructors who deliver behaviour management training. Implications for practice: Competence to manage challenging behaviour should be developed based on our conceptual framework to provide an effective and safe training. Prevention, the risk assessment process, alternative communication, and the definitions of "confidence," "support" and "restraint" should all be sufficiently addressed in future training. [ABSTRACT FROM AUTHOR]

To promote social justice and equity, global health research should meaningfully engage communities throughout projects: from setting agendas onwards. But communities, especially those that are considered disadvantaged or marginalised, rarely have a say in the priorities of the research projects that aim to help them. So far, there remains limited ethical guidance and resources on how to share power with communities in health research priority-setting. This paper presents an "ethical toolkit" for academic researchers and their community partners to use to design priority-setting processes that meaningfully include the communities impacted by their projects. An empirical reflective equilibrium approach was employed to develop the toolkit. Conceptual work articulated ethical considerations related to sharing power in g0l0o0bal health research priority-setting, developed guidance on how to address them, and created an initial version of the toolkit. Empirical work (51 in-depth interviews, 1 focus group, 2 case studies in India and the Philippines) conducted in 2018 and 2019 then tested those findings against information from global health research practice. The final ethical toolkit is a reflective project planning aid. It consists of 4 worksheets (Worksheet 1- Selecting Partners; Worksheet 2- Deciding to Partner; Worksheet 3- Deciding to Engage with the Wider Community; Worksheet 4- Designing Priority-setting) and a Companion Document detailing how to use them. Reflecting on and discussing the questions in Worksheets 1 to 4 before priority-setting will help deliver priority-setting processes that share power with communities and projects with research topics and questions that more accurately reflect their healthcare and system needs. [ABSTRACT FROM AUTHOR]

Virtual reality is widely recognized as offering the potential for fully immersive environments. This paper introduces a framework that guides the creation and analysis of immersive environments that are pedagogically structured to support situated and experiential education. The "situated experiential education environment" framework described in this paper is used to examine the impact that a virtual environment can have on the user experience of participants in a virtual space. The analysis of a virtual environment implemented to support learner exploration of issues of tourism development and the related impacts, suggest that this type of experience is capable of providing participants with a holistic experience of real‐world environments that are otherwise too expensive, impractical, or unethical for large groups of people to visit in person. The pedagogical value of such experiences is enabled through immersion in a reality‐based environment, engagement with complex and ambiguous situations and information, and interaction with the space, other students, and teachers. The results demonstrate that complex immersive learning environments are readily achievable but that high levels of interactivity remain a challenge. Lay Description: What is already known about this topic: Virtual reality (VR) technology is developing rapidly with interest from practitioners and researchers increasing concurrently.Although VR headsets are extensively researched in a gaming context, there is insufficient research examining the user‐experience of VR headsets in the context of education.What this paper adds: Users reported a multitude of positive features of the VR headsets in the context of experiential learning that is situated in a meaningful context, such as a Pacific island when learning about sustainable development.In particular, a strong sense of immersion was reported by users of the VR headsets.Additionally, the complexity of the material studied, an important feature of situated experiential learning, was also reported to high.Implications for practice and/or policy: VR headsets provide significant opportunities to foster situated experiential learning in a virtual environmentParticularly the immersive experience and the complexity of the material studied were reported to be effective with the VR headsets. However, the interaction with other learners and teachers could not be examined in depth, although interaction is also an important feature of situated experiential learning [ABSTRACT FROM AUTHOR]

This exploratory experimental study investigates the impact of motivational strategies based on the Attention, Relevance, Confidence, Satisfaction, and Volition (ARCS‐V) model on online learners' academic performance, motivation, volition, and course interest. The research was conducted over an 11‐week semester with 122 undergraduate online learners within two groups. One group received a traditional e‐course, while the other group was offered the course with extra motivational strategies derived from the ARCS‐V model. The results revealed that the group who used motivational strategies showed significantly higher gains in motivation, academic performance, and course interest scores. However, there were no significant differences between the groups regarding the volition. Furthermore, the motivation and interest variables were measured with Attention, Relevance, Confidence, and Satisfaction subscales of the ARCS‐V model. In terms of interest variable, there was only a statistically significant difference on the Attention subscale. Regarding motivation variable, the results also showed a statistically significant difference on the attention, confidence, and satisfaction subsections of the ARCS‐V model. The findings of the present study offer insights into ARCSV model‐based research by examining the effects of the model as a valid and reliable framework for online learning environments. The implications and directions for future research are then discussed. Practitioner Notes/ Lay Description: What is already known about this topic: Learning motivation is the most vital factor that influencing effective and efficient learning process.The attention, relevance, confidence, and satisfactionARCS model of motivational design has been used myriad times to design motivational instructions in a wide range of educational settings (from traditional to computer‐assisted instruction and distance education).Few studies address the online learners" motivation through the attention, relevance, confidence, satisfaction, and volition (ARCS‐V) ‐based motivational strategies. What this paper adds to this: A quasi‐experimental study was conducted in online learning environment to research the effects of the ARCS‐V ‐based motivational strategies.The impact of the ARCS‐V ‐based motivational strategies on online learners" academic performance, motivation, volition, and course interest was investigated.The results showed that the ARCS‐V ‐based motivational strategies had positive effects on online learners' regarding to academic performance, motivation, volition, and course interest. The implications of study findings for practitioners: This research provided evidences for effects of the ARCS‐V motivational strategies on online learners.Online learners who took the ARCS‐V ‐based motivational messages had positive effects regarding to academic performance, motivation, volition, and course interest. [ABSTRACT FROM AUTHOR]

Assistive technologies (ATs) are being 'mainstreamed' within dementia care, where they are promoted as enabling people with dementia to age in place alongside delivering greater efficiencies in care. AT provision focuses upon standardised solutions, with little known about how ATs are used by people with dementia and their carers within everyday practice. This paper explores how people with dementia and carers use technologies in order to manage care. Findings are reported from qualitative semi-structured interviews with 13 people with dementia and 26 family carers. Readily available household technologies were used in conjunction with and instead of AT to address diverse needs, replicating AT functions when doing so. Successful technology use was characterised by 'bricolage' or the non-conventional use of tools or methods to address local needs. Carers drove AT use by engaging creatively with both assistive and everyday technologies, however, carers were not routinely supported in their creative engagements with technology by statutory health or social care services, making bricolage a potentially frustrating and wasteful process. Bricolage provides a useful framework to understand how technologies are used in the everyday practice of dementia care, and how technology use can be supported within care. Rather than implementing standardised AT solutions, AT services and AT design in future should focus on how technologies can support more personalised, adaptive forms of care. [ABSTRACT FROM AUTHOR]

Background Healthcare systems are faced with changing community health profiles and ageing populations. Together with economic considerations, these factors have influenced the increase in provision of care in primary rather than other healthcare settings. Many nurses are electing to move from acute care to meet demands for a skilled primary healthcare workforce. However, little is reported about these nurses' experiences of transition. Aim To describe how role theory provides a theoretical framework to inform the design of a mixed-methods study exploring the transition of acute care nurses to roles in primary health care. Discussion The paper explores the relevance of role theory and its components as a validated framework for informing the design of the quantitative and qualitative components of the study. The methodology consisted of a national survey of recently transitioned nurses, with questions that explored experiences of nurses in relation to role exit, role entry, role enactment, role ambiguity, role stress, role strain and rites of passage. The qualitative component of the study incorporated semi-structured interviews with selected participants to further explore aspects of the transition. Conclusion There are few published reports on the value of theoretical frameworks in the design of nursing research. This paper describes one example of the value of selecting an appropriate theoretical framework for a national study of experiences of transition. Implications for practice Nurses transitioning between clinical settings experience a range of personal and professional challenges. Role theory provides a valuable framework which is applicable to qualitative and quantitative research into these experiences. [ABSTRACT FROM AUTHOR]

The minimally invasive autopsy (MIA), an innovative approach for obtaining post-mortem samples of key organs, is increasingly being recognized as a robust methodology for cause of death (CoD) investigation, albeit so far limited to pilot studies and research projects. A better understanding of the real causes of death in middle- and low-income countries, where underlying causes of death are seldom determined, would allow improved health planning, more targeted prioritization of available resources and the implementation of coherent public health policies. This paper discusses lessons learnt from the implementation of a Feasibility and Acceptability (F&A) study evaluating the MIA approach in five countries: Gabon, Kenya, Mali, Mozambique and Pakistan. This article reports the methodological choices made to document sociocultural and religious norms around death, to examine community and relatives' attitudes and perceptions towards MIA, and to identify factors motivating the MIA's acceptance and refusal. We used ethnography, grounded theory and framework method approaches. In-depth and semi-structured interviews and focus group discussions with key informants, including next of kin of deceased individuals and healthcare providers, were conducted. Participant observation and direct observation of procedures and ceremonies around death were organized in all study sites. In Mozambique, MIA procedures were observed and case studies conducted. The implementation of this F&A protocol has provided critical lessons that could facilitate the future implementation of post-mortem procedures for CoD investigation. These include the need for early community engagement, staff training and preparedness, flexibility to adapt the protocol, gathering qualitative data from diverse sources, and triangulation of the data. We have applied a rigorous, effective and culturally sensitive methodological approach to assess the F&A of MIA in resource-constrained settings. We strongly recommend that such an approach is applied in settings where MIAs or similar post-mortem sensitive procedures are to be introduced. [ABSTRACT FROM AUTHOR]

Purpose: The telehealthcare sector has been expanding steadily in the UK. However, confusing, complex and unwieldy designs of telehealthcare devices are at best, less effective than they could be, at worst, they are potentially dangerous to the users. Method: This study investigated the factors within the new product development process that hindered satisfactory product design outcomes, through working collaboratively with a leading provider based in the UK. Results: This study identified that there are too many costly late-stage design changes; a critical and persistent problem area ripe for improvement. The findings from analyzing 30 recent devices, interviewing key stakeholders and observing on-going projects further revealed that one major cause of the issue was poor practice in defining and communicating the product design criteria and requirements. Conclusions: Addressing the characteristics of the telehealthcare industry, such as multiple design commissioners and frequent deployment of design subcontracts, this paper argues that undertaking a robust process of creating the product design brief is the key to improving the outcomes of telehealthcare device design, particularly for the small and medium-sized enterprises dominating the sector. Implications for rehabilitation: Product design criteria and requirements are frequently ill-defined and ineffectively communicated to the designers within the processes of developing new telehealthcare devices. The absence of a (robust) process of creating the design brief is the root cause of the identified issues in defining and communicating the design task. Deploying a formal process of creating the product design brief is particularly important for the telehealthcare sector. [ABSTRACT FROM AUTHOR]

BACKGROUND: The theory of Structural Cognitive Modifiability and Mediated Learning Experience of Reuven Feuerstein states that individuals with brain impairment, because of congenital or acquired origin, may substantially and structurally improve their cognitive functioning, by a systematic intervention based on a specific, criteria-based type of interaction ("mediated learning"). Three application systems are based on it: a dynamic-interactive assessment of learning capacity and processes of learning, the LPAD (Learning Propensity Assessment Device); a cognitive intervention program called "Instrumental Enrichment Program", which trains cognitive, metacognitive and executive functions; and a program, which is oriented atworking in context, Shaping Modifying Environments. These programs have been applied in widely different target groups: from children and young adults with learning and developmental disabilities, at risk of school failure, or having failed at school, because of socio-economic disadvantage or congenital neurological impairment; disadvantaged youngsters and adults in vocational training, to elderly people at the beginning of a dementia process. Experience with cognitive rehabilitation of children and adults with acquired brain damage, has been relatively recent, first in the Feuerstein Institute's Brain Injury Unit in Jerusalem, later in other centers in different parts of the world; therefore scientific data are scarce. OBJECTIVES: The purpose of this paper is to examine how the Feuerstein-approach fits into the goals and proposed approaches of cognitive rehabilitation, and to explore its relevance for assessment and intervention in individuals with congenital or acquired brain damage. METHODS: The methodology of the Feuerstein approach consists of four pillars: dynamic assessment, cognitive activation, mediated learning and shaping a modifying environment. The criteria of mediated learning experience are explained with specific reference to people with acquired brain injury. The procedure of learning propensity assessment device uses visuospatial and verbal tasks known from neuropsychological assessment (such as Rey's complex figure drawing), as well as a in a pre-test - brief intervention - post-test format. Cognitive activation is done in various ways: a paper-and-pencil relatively content-free program called "instrumental enrichment", with transfer of learned principles into daily life situations, followed by metacognitive feedback. Four case histories of acquired brain damage are analyzed: a 19 year old man with extensive postastrocytoma frontotemporal brain lesions; a 19 year old man with bilateral frontal and right temporal and parieto-occipital parenchymatous destruction after a traumatic brain injury; a 24 year old man with hemispherectomy for intractable epilepsy because of Sturge-Weber syndrome; and a 30-year old man with left porencephalic cyst after cerebral hemorrhage. RESULTS: Structural cognitive improvement could be demonstrated in positive change scores in visuo-spatial memory, associative and verbal memory, abstract thinking, and organizing tasks, even more than 10 years post-TBI. In some cases a rise in IQ has been documented. Improvement in daily life functioning and academic skills (re)learning has also been seen. CONCLUSIONS: Though impossible to claim scientific evidence, the case histories nevertheless suggest the importance of interactive assessment in designing intervention programs which have sufficient intensity, frequency, duration and consistency of mediation; furthermore, an essential ingredient is the ecological approach which requires working with the patient and the whole network around; a firm "belief system" or that modifiability is possible even with severe brain damage and many years after the injury; a cognitive, metacognitive and executive approach, and a quality of interaction according to criteria of mediated learning. They suggest that Feuerstein approach may offer interesting perspectives to cognitive rehabilitation. More extensive research is needed to provide a broader scientific evidence base. [ABSTRACT FROM AUTHOR]

People with intellectual and developmental disabilities must often advocate for themselves in many facets of life, including sexuality. Because of this, sexual self-advocacy is an important concept to develop and apply to policy and practice. This paper provides a conceptualization of sexual self-advocacy, a view of sexuality formulated by adults with intellectual and developmental disabilities that is closely tied to the values of the Self-Advocacy Movement. In describing the study process, this paper also puts forth the Participatory Action Research method, Nominal Group Technique, as an accessible method for gaining insight from adults with intellectual and developmental disabilities. The choice of Nominal Group Technique as a research method was motivated by several factors. Nominal Group Technique served to counterbalance many of the potential research difficulties when working with people with intellectual and developmental disabilities, including the need for understandable, inclusive, and participatory ways to access data from people with intellectual and developmental disabilities, and addressed the topic of sexual self-advocacy that is important to people with intellectual and developmental disabilities. [ABSTRACT FROM AUTHOR]

Aim To provide an overview of the relevance and strengths of using the literary folkloristic methodology to explore the ways in which people with persistent pain relate to and make sense of their experiences through narrative accounts. Background Storytelling is a conversation with a purpose. The reciprocal bond between researcher and storyteller enables the examination of the meaning of experiences. Life narratives, in the context of wider traditional and communal folklore, can be analysed to discover how people make sense of their circumstances. Data sources This paper draws from the experience of the author, who has previously used this narrative approach. It is a reflection of how the approach may be used to understand those experiencing persistent pain without a consensual diagnosis. Review methods Using an integrative method, peer-reviewed research and discussion papers published between January 1990 and December 2014 and listed in the CINAHL, Science Direct, PsycINFO and Google Scholar databases were reviewed. In addition, texts that addressed research methodologies such as literary folkloristic methodology and Marxist literary theory were used. Discussion The unique role that nurses play in managing pain is couched in the historical and cultural context of nursing. Literary folkloristic methodology offers an opportunity to gain a better understanding and appreciation of how the experience of pain is constructed and to connect with sufferers. Conclusion Literary folkloristic methodology reveals that those with persistent pain are often rendered powerless to live their lives. Increasing awareness of how this experience is constructed and maintained also allows an understanding of societal influences on nursing practice. Implications for practice/research Nurse researchers try to understand experiences in light of specific situations. Literary folkloristic methodology can enable them to understand the inter-relationship between people in persistent pain and how they construct their experiences. [ABSTRACT FROM AUTHOR]

Australian Social Work (ASW) seeks to publish high quality, original research and receives a steady stream of manuscripts reporting quantitative methods. However, there has been considerable variation in standard and style. Consistent with international efforts to ensure quality and integrity in reporting quantitative research, this paper offers guidance and suggestions for the reporting of intervention research, observational studies, and the quantitative components of evaluation and mixed-method studies. They address the overall structure of articles and considerations for the abstract, introduction, method, results and the discussion sections, including presentation of statistical analyses and findings. The paper can assist authors and reviewers by clarifying expectations and contribute to ongoing efforts to enhance the quality of research reporting. [ABSTRACT FROM AUTHOR]

In developed countries, residential aged care facilities ( RACFs) are increasingly becoming the place of care and site of death for older people with complex chronic illnesses. Consequently, it is becoming ever more relevant for these facilities to provide appropriate complex, as well as end-of-life care for this growing group of people. Evidence-based guidelines for providing a 'palliative approach' were developed and introduced in Australia in 2004, with the emphasis on improving symptom control earlier in the disease trajectory. The aim of the study reported here was to explore the extent to which a palliative approach was being used in the organisation and provision of care for older people with complex needs living in mixed-level (a combination of low- and high-level care) RACFs. This paper primarily reports on the qualitative findings. Two residential aged care organisations, one in rural New South Wales and the other in Sydney, Australia, participated. Data were collected over a 9-month period from May until December 2008. Residents, family members and aged care staff were interviewed. Thematic analysis of participant interviews shows that while the various elements of a palliative approach are incorporated into the care of high-level care residents, the discourse itself is not used. In this paper, we argue for a new conceptualisation of care for people in mixed-level care facilities: a community-of-care, in which a palliative approach is one of several components of the care provided. The findings illuminate aged care staff experiences of providing care to high-level care residents. They also provide valuable insights into high-level care residents' perceptions of their health, care provided and the way in which they foresee their care being provided in future. These findings will be important for informing clinical practice, research and policy in these settings. [ABSTRACT FROM AUTHOR]

We critically examine the three papers on terrorism and jihad in Indonesia contained in this issue. First, we argue that thorough discussion and definition of key terms (including religious violence and jihad) would have led to a much stronger framework for understanding the voices of the activists and their supporters. Second, the authors could have engaged more systematically with the international literature on intergroup relations and conflict to discuss how psychological and social processes of radicalization are similar or different in the Indonesian context. Third, we highlight methodological and ethical shortcomings in the three papers that call into question a number of the conclusions drawn by the authors. We outline future research questions and provide suggestions to strengthen this important line of research. [ABSTRACT FROM AUTHOR]

This study builds on and contributes to research on student teachers’ reflection during internships in teacher education. In order to gain insight into the research question ‘What characterizes four Norwegian third-grade students’ expressed collective and individual reflections during their internships’, the student teachers in question were followed during their internships for two periods of two weeks each. In this paper, video-observation from guidance sessions and the student teachers’ individual logs were used to collect data. In the analyses it appeared that that the content in the collective reflections during guiding sessions mostly concerned the concrete ‘how’ and ‘who’ of teaching. This result corresponds to former research on student teachers’ reflection. In the analyses of their individual logs, however, we found that that the student teachers not only reflected at a concrete level, but also at a more abstract level as their reflections contained contemplations regarding ‘why’ they sought to teach according to the expressed concerns in the collective reflections. The overall theoretical framework of the study is socio-cultural theory, and in particular the notion of ‘reflective mediation’ was useful both in the analyses of the data and in the further interpretation of the findings. As the findings partially contradict previous congruent research that argues for student teachers’ tenuous reflections, the paper concludes that this important aspect of student teachers’ development should be further scrutinized and discussed in a more nuanced manner than it has been until now. [ABSTRACT FROM PUBLISHER]

This paper describes the factor analysis testing and construct validation of the Japanese version of the Caffrey Cultural Competence Health Services (J-CCCHS). The inventory, composed of 28 items, was translated using language and subject matter experts. Psychometric testing (exploratory factor, alpha reliability, and confirmatory factor analyses) was undertaken with nurses (N = 7494, 92% female, mean age 32.6 years) from 19 hospitals across Japan. Principal components extraction with varimax rotation yielded a 5-factor solution (62.31% variance explained) that was labeled: knowledge, comfort-proximal, comfort-distal, awareness, and awareness of national policy. Cronbach α for the subscales ranged from 0.756 to 0.892. In confirmatory factor analysis using the robust maximum likelihood estimator, the chi-square test was as follows: χ2(340) = 14604.44, P < .001. After correlated errors were introduced, there was evidence of improved model fit (χ2(335) = 8681.61, P < .05) but the other indices showed improvement (RMSEA = .058 [90% CI, 0.057-0.059], TLI = .891, CFI = .903, and SRMR = .059). The discriminating power of the J-CCCHS was indicated by statistically mean differences in J-CCCHS subscale scores between predefined groups. Taking into consideration that this is the first foray into construct validation for this instrument, and that fit was improved when a subsequent data driven model was tested, and it has the ability to distinguish between known groups that are expected to differ in cultural competence, the instrument can be of value to clinicians and educators alike. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: Strong health systems are said to be paramount to achieving effective and equitable health care. The World Health Organization has been advocating for using system-wide approaches such as 'systems thinking' to guide intervention design and evaluation. In this paper we report the system-wide effects of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality. Methods: We conducted a qualitative study in three target districts. We used a systems thinking conceptual framework to guide the analysis focusing on intended and unintended consequences of the intervention. NVivo version 10 was used for data analysis. Results: The addressed community responded positively to the BHOMA intervention. The indications were that in the short term there was increased demand for services but the health worker capacity was not severely affected. This means that the prediction that service demand would increase with implementation of BHOMA was correct and the workload also increased, but the help of clinic lay supporters meant that some of the work of clinicians was transferred to these lay workers. However, from a systems perspective, unintended consequences also occurred during the implementation of the BHOMA. Conclusions: We applied an innovative approach to evaluate a complex intervention in low-income settings, exploring empirically how systems thinking can be applied in the context of health system strengthening. Although the intervention had some positive outcomes by employing system-wide approaches, we also noted unintended consequences. [ABSTRACT FROM AUTHOR]

Aim To discuss the implications of drawing on core nursing knowledge as theoretical scaffolding for qualitative nursing enquiry. Background Although nurse scholars have been using qualitative methods for decades, much of their methodological direction derives from conventional approaches developed for answering questions in the social sciences. The quality of available knowledge to inform practice can be enhanced through the selection of study design options informed by an appreciation for the nature of nursing knowledge. Design Discussion paper. Data sources Drawing on the body of extant literature dealing with nursing's theoretical and qualitative research traditions, we consider contextual factors that have shaped the application of qualitative research approaches in nursing, including prior attempts to align method with the structure and form of disciplinary knowledge. On this basis, we critically reflect on design considerations that would follow logically from core features associated with a nursing epistemology. Implications for nursing The substantive knowledge used by nurses to inform their practice includes both aspects developed at the level of the general and also that which pertains to application in the unique context of the particular. It must be contextually relevant to a fluid and dynamic healthcare environment and adaptable to distinctive patient conditions. Finally, it must align with nursing's moral mandate and action imperative. Conclusion Qualitative research design components informed by nursing's disciplinary epistemology will help ensure a logical line of reasoning in our enquiries that remains true to the nature and structure of practice knowledge. [ABSTRACT FROM AUTHOR]

Research mentorship has long been considered a preeminent research capacity building (RCB) approach. However, existing mentorship models designed to improve the research skills (i.e., research methods and grant writing) of faculty scholars at United States minority serving institutions (i.e., historically Black colleges and universities, Hispanic serving institutions, and American Indian tribal colleges and universities) may be insufficient for building such capacities. This paper proposes an emerging conceptual framework for a new Peer-to-Peer Mentor Research Team Model (PPMRTM) designed to enhance the research skills of faculty scholars (herein referred to as fellows) and help to build the needed critical mass of researchers of color in the field of disability, health, independent living, and rehabilitation. A combination of Lippitt's planned change theory and critical mass theory provided a useful framework to contextualize and support the design of this model. A set of recommended approaches that can be considered by federal research organizations (i.e., National Institute on Disability, Independent Living, and Rehabilitation Research, and National Institutes of Health), minority serving institutions, and researchers for assessment of the model and advancing the current state of science on minority serving institution RCB are presented. [ABSTRACT FROM AUTHOR]

This article presents emerging findings from the first year of a two-year study, which employed ethnographic methods to explore the culture of interprofessional collaboration (IPC) and family member involvement in eight North American intensive care units (ICUs). The study utilized a comparative ethnographic approach - gathering observation, interview and documentary data relating to the behaviors and attitudes of healthcare providers and family members across several sites. In total, 504 hours of ICU-based observational data were gathered over a 12-month period in four ICUs based in two US cities. In addition, 56 semi-structured interviews were undertaken with a range of ICU staff (e.g. nurses, doctors and pharmacists) and family members. Documentary data (e.g. clinical guidelines and unit policies) were also collected to help develop an insight into how the different sites engaged organizationally with IPC and family member involvement. Directed content analysis enabled the identification and categorization of major themes within the data. An interprofessional conceptual framework was utilized to help frame the coding for the analysis. The preliminary findings presented in this paper illuminate a number of issues related to the nature of IPC and family member involvement within an ICU context. These findings are discussed in relation to the wider interprofessional and health services literature. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to report on primary research which investigated the first-hand experience of producing and implementing accessible information (AI). Design/methodology/approach -- In total, 18 participants were recruited for a qualitative scoping exercise from four distinct sampling groups: adults with learning disabilities; specialist learning disability service staff; mainstream NHS and local authority staff; and speech and language therapists. Each participant took part in a semi-structured focus group or interview which explored their range of skills, knowledge and attitudes relating to AI. Findings -- Framework approach to thematic analysis led to three main classifications: ideology of AI, AI practice and the outcomes of delivering AI. First-hand experience varied across the stakeholders, highlighting differences in the operationalisation of national policies and legislation. Originality/value -- The data supported the notion of AI as a multifaceted process; although the practice of delivering accessible resources appeared less advanced than accessible resource production. [ABSTRACT FROM AUTHOR]

Approaches to self-management traditionally focus upon individual capacity to make behavioural change. In this paper, we use Bourdieu's concepts of habitus and capital to demonstrate the impact of structural inequalities upon chronic illness self-management through exploring findings from 28 semi-structured interviews conducted with people from a lower socioeconomic region of Adelaide, South Australia who have type 2 diabetes. The data suggests that access to capital is a significant barrier to type 2 diabetes self-management. While many participants described having sufficient cultural capital to access and assess health information, they often lacked economic capital and social capital in the form of support networks who promote health. Participants were often involved in social networks in which activities which are contrary to self-management have symbolic value. As a consequence, they entered relationships with health professionals at a disadvantage. We conclude that structural barriers to self-management arising from habitus resulting in the performance of health behaviours rooted in cultural and class background and limited access to capital in the form of economic resources, social networks, health knowledge and prestige may have a negative impact on capacity for type 2 diabetes self-management. [ABSTRACT FROM AUTHOR]

Aims This paper describes the perceptions of nurse managers about their dual role in nursing units as cost centres. Background The tertiary hospital in the Limpopo province is the first institution to appoint nurse managers with a dual role in cost centres. The development of a conceptual framework for a context-specific programme for Cost Centre Managers is the first of its nature in South Africa. Method A qualitative, exploratory, descriptive design was followed. The target population included nurse managers ( n = 35) formally appointed as cost centre managers with a dual role of delivering quality care and cost management. A focus group and individual interviews were conducted until data saturation occurred. Results Personal and professional distress, an empowering potential of being a cost centre manager, and the need for decentralized cost centre management were indicated as barriers for nurse managers that led to a framework for a context-specific training programme. Conclusion There is a need for a context-specific training programme for cost centre managers in a hospital with cost centres. Implications for nursing management The training of cost centre managers for their dual role in cost centres could enhance cost effectiveness, quality care and staff satisfaction. [ABSTRACT FROM AUTHOR]

Literature indicates a knowledge gap in the preparedness of teachers to deliver sexuality and human immunodeficiency virus (HIV) prevention education to learners with intellectual disabilities in Africa. This paper reports on teachers' opinions on sexuality of Nigerian learners with intellectual disabilities and awareness of their risk of HIV infection. The study utilized key informant interviews with 12 teachers to explore their views on the sexuality and risk of HIV exposure of learners with intellectual disabilities in special schools across Oyo State, Nigeria. Interview scripts were analyzed using interpretative phenomenological analysis. Teachers considered learners with intellectual disabilities as 'hypersexual' and incapable of intimate relationships. Learners with intellectual disabilities were reported to be at risk of exposure to HIV infection due to sexual abuse, transactional sex and lack of sexuality and HIV education. Teachers expressed confidence to deliver sexuality and HIV education but lacked skills to communicate relevant information to learners with intellectual disabilities in accessible formats. Teachers' negative attitudes, misconception and lack of skills to deliver sexuality education to learners with intellectual disabilities have to be addressed through training. Further studies are needed to provide baseline information for developing a tailored sexuality and HIV education for Nigerian learners with different types of disabilities. [ABSTRACT FROM AUTHOR]

This paper, made from an explicitly academic-practitioner stance, aims to highlight some of the problematic ways in which academic writing on trans people, and on the clinicians working in trans healthcare, has been presented in recent years. We argue that much work theorizes trans people and clinicians whilst failing to recognise the full and complex humanity of the people concerned. Also, such work frequently universalises a small number of accounts as if they were representative of ‘the trans person’ or ‘the medical/psy profession' as a whole. We call upon future writers and researchers to pay more attention to the multiplicity and diversity of accounts, and to consider the potential damage of perpetuating certain accounts as fixed or universal. [ABSTRACT FROM PUBLISHER]

Objectives: In theory, greater interaction between researchers and practitioners should result in increased potential for implementation. However, we know little about whether this is the case, or what mechanisms might operate to make it happen. This paper reports findings from a study that is identifying and tracking implementation mechanisms, processes, influences and impacts in real time, over time in the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). Methods: This is a longitudinal, realist evaluation case study. The development of the conceptual framework and initial hypotheses involved literature reviewing and stakeholder consultation. Primary data were collected through interviews, observations and documents within three CLAHRCs, and analysed thematically against the framework and hypotheses. Results: The first round of data collection shows that the mechanisms of collaborative action, relationship building, engagement, motivation, knowledge exchange and learning are important to the processes and outcomes of CLAHRCs' activity, including their capacity for implementation. These mechanisms operated in different contexts such as competing agendas, availability of resources and the CLAHRCs' brand. Contexts and mechanisms result in different impact, including the CLAHRCs' approach to implementation, quality of collaboration, commitment and ownership, and degree of sharing and managing knowledge. Conclusion: Emerging features of a middle range theory of implementation within collaboration include alignment in organizational structures and cognitive processes, history of partnerships, responsiveness and resilience in rapidly changing contexts. CLARHCs' potential to mobilize knowledge may be further realized by how they develop insights into their function as collaborative entities. [ABSTRACT FROM AUTHOR]