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Quality early care and education (ECE) presents an unparalleled opportunity to avert disadvantage and promote children's development. Mealtimes are essential daily routines, yet are often overlooked in research on ECE quality. This paper crystallises a composite case study of ECE mealtimes in highly disadvantaged communities by combining Departing Radically in Academic Writing (DRAW) methodology with parent surveys, scorings of educator‐child interactions (inCLASS), and field notes. Poverty is perpetuated in these centres: children do not have enough food, and educator‐dictated feeding practices restrict children's opportunities to exercise their agency and learn. Systemic policy action is needed to address poverty in ECE. [ABSTRACT FROM AUTHOR]

The "Talking with Voices" (TwV) approach is a novel, formulation-driven approach to helping people who hear distressing voices. It is based on an understanding of voice-hearing as a relational phenomenon, often linked to trauma. Therapy involves facilitation of dialogical engagement between hearers and their voices. There are as yet few empirical studies of the approach. The current study explored experiences of the TwV approach from the perspectives of voice-hearers and also of their voices. Ten qualitative interviews were subjected to Interpretative Phenomenological Analysis. Both hearers and their voices felt that the TwV approach can be a powerful enabler of positive change, and that it provides a valuable means of working through past trauma. Establishing a safe base – with time to build trust in the process – was considered key, as were the personal qualities of the facilitator, including openness, courage and a non-judgemental approach. Participants also saw flexibility as important, including the ability to try things out within the work. It was also important that the ideas behind the approach made sense to the participant. Perceived barriers included the medicalised nature of current services and the lack of availability of the TwV approach. The findings provide support for the acceptability and value of dialogical approaches to helping people who hear voices. In particular, they suggest that participating in TwV can help people develop an understanding of, and a more peaceful relationship with, their voices. The study is novel in eliciting perspectives from the voices themselves, and this yielded valuable insights. [ABSTRACT FROM AUTHOR]

Black women social workers (BWSWs) represent essential workforce members who are burdened by ongoing COVID-19 circumstances. Strategies to deal with highly stressful situations on the job, such as those experienced in 2020, were absent from the research literature leaving intervention strategies to support highly stressed BWSWs unknown. This study aimed to uncover the various ways BWSWs experienced their organizations as they performed work duties. Atlas.ti. 9 was used to analyze verbatim transcripts from 17 semi-structured qualitative interviews given by BWSWs across the United States in February 2021. Hermeneutic phenomenology was implemented to interpret interview data. The convenience sample was drawn from professional organizations where BWSWs claimed membership and volunteered to be electronically interviewed for 2 hours generating themes such as stress perceptions, institutional barriers to efficient work productivity and recommendations for workplace support. BWSWs reported high stress work environments in the past year. Some believed that their health and mental health declined because of the inability to find work-home life balance. Findings suggest BWSWs persevere regardless of high levels of stress and being unsupported in the workplace in order to maintain a livelihood. BWSWs play a crucial role in the lives of vulnerable populations, but need to attend to ways to be healthier given the polarization associated with racism, classism, and sexism experienced. Thematically, the data revealed stressful situations in the workplace and how organizations have failed to implement strategies in order to improve social worker health. Suggestions for workplace supports were also identified. [ABSTRACT FROM AUTHOR]

Background and Objectives Past research about family involvement in long-term care (LTC) homes mainly focuses on family members' involvement with their own relative, interactions with staff, and collective activities such as Family Councils. Our research provides novel insights into family member's involvement in the care of residents who are not their relatives, an area that has not previously been explored. Research Design and Methods This critical ethnographic study examined ways that family members negotiate and navigate their roles within LTC homes. Data collection and analysis took place at 3 LTC homes in British Columbia, Canada, between 2014 and 2018. Data were collected through participant observation and semistructured interviews. Eleven family member participants shared experiences of caring for residents who were not their relatives. Results The umbrella theme was "filling in," which takes place in a care environment that is understaffed and underresourced. The subthemes reflect the various ways that families are "filling in": responding to resident's needs, supporting staff to respond to resident needs, and filling in for residents' families. Discussion and Implications Caring for residents who are not their relatives is facet of family involvement in LTC homes that has not been previously explored. Many family members have expertise in providing person-centered care and they extend this expertise to residents who are not their relatives. Policies and legislation are needed to formalize family involvement in caring for nonrelative residents as it is a component of quality of care for all residents. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be able to demonstrate the multiple impacts of research educational initiatives to the organisation funding them • To appreciate why changes in culture are needed in the health professions to support an evidence-base to better serve our populations • To understand how to build research capacity and show the benefit of investing in training opportunities Background: There is increasing emphasis in the UK on developing a nurse, midwife and allied health professional (NMAHP) workforce that conducts research. Training for clinical academic careers is provided by the National Institute for Health and Care Research (NIHR). However, the low number of successful applicants suggested there were barriers to achieving this. The Centre for Nursing and Midwifery Led Research (CNMR) launched a fellowship programme in 2016 to backfill two days a week of NMAHPs' time for up to a year, to give them time to make competitive applications to the NIHR. Aim: To report a study evaluating the CNMR fellowship programme. Discussion: The making Visible the ImpaCT Of Research (VICTOR) tool (Cooke et al 2019) was developed to describe the organisational impact of research. The 2016-17 CNMR fellows completed VICTOR and their responses were analysed using a framework approach. The analysis found the main benefits of participating in the programme were protected time for research, opportunities to develop collaborations, increasing intra- and inter-professional awareness of NMAHPs' research, peer-reviewed publications, and conference presentations. Challenges included a lack of support from line managers, limited value placed on NMAHPs' research and failure to backfill posts. Conclusion: There were some challenges with the fellowship programme, but all recipients found it to be a positive experience and undertook significant scholarly activity. Implications for practice: A contractual agreement must be established to foster committed partnerships between higher education institutions (HEIs) and the NHS. HEIs and the NHS should conduct frank discussions of the challenges encountered in fellowship programmes. Positive initiatives and outcomes in tertiary education and clinical settings should be shared to improve fellows' experiences and enhance partnerships between HEIs and the NHS. Job descriptions should include time allocation to review fellowship candidates' applications regardless of outcome. The showcasing of research successes and the benefits of NMAHP research must evolve to secure organisational 'buy in', which is the precursor to widening access to clinical academic pathways. [ABSTRACT FROM AUTHOR]

The concept of schizophrenia has been contested since its inception. Over the last decades, criticism of the concept has become increasingly mainstream and calls for its abandonment have intensified. Nevertheless, the concept remains widely used and retains taken-for-granted status within much mental health research and practice. The combination of its contested status and continued use raises questions about how it is used and with what implications for people who receive the diagnosis. This study explores how 'schizophrenia' is spoken about by mental health professionals who use the diagnosis in day-to-day practice. Eight interviews with professionals across professions were analysed using Foucauldian Discourse Analysis. Two striking and consistent themes were identified. The first is a discrepancy between the way participants talked about 'schizophrenia' to the interviewer, and the way they described talking about it in clinical encounters. The second is the potentially entrapping impact of the wider discourses participants drew on in talk about clinical encounters. The study concludes with reflections on how those working in the mental health field can break out of this discursive entrapment, and help the people they work with do the same. [ABSTRACT FROM AUTHOR]

Introduction: A qualitative exploration into the views, opinions and decision-making of paramedics involved in undertaking pre-hospital 12-lead electrocardiograms (PHECGs) for stroke patients was undertaken, in order to gain a deeper understanding of the clinical and occupational context that the paramedics work within, the acceptability of the paramedics in using PHECGs for stroke patients and the consequences and influences of their decision-making. Methods: Data were collected via semi-structured interviews and analysed using the framework method, with the underpinning theoretical framework of cognitive continuum theory. A purposive sample of 14 paramedics was recruited and interviewed. Results: Five themes were generated from the analysis of the interviews: (1) ‘time is brain’: minimising delays and rapid transport to definitive care; (2) barriers and facilitators to undertaking PHECGs for stroke patients; (3) recognising and gaining cues; (4) maintaining patient dignity, self-protection and fully informed consent; and (5) education, experience and engagement with evidence. Conclusion: The study showed mixed views on the usefulness of PHECGs, but all participants agreed that PHECGs should not cause additional delays. Paramedic decision-making on recording PHECGs relies on intuitive and quasi-rational cognitive modes, and requires a number of clinical, logistical and ethical considerations. The findings suggest careful consideration is needed of the benefits and potential drawbacks of incorporating PHECGs into pre-hospital stroke care. [ABSTRACT FROM AUTHOR]

To ensure care continuity during the COVID-19 pandemic, telehealth has been widely implemented in human immunodeficiency virus (HIV) care. However, participation in and benefits from telehealth were unequal. This study aims to assess the willingness of people living with HIV (PWH) and HIV care providers to use telehealth and perceptions of the future role of telehealth. In-depth interviews with 18 PWH and 10 HIV care providers from South Carolina assessed their willingness to use telehealth, their perspectives on the future of telehealth in HIV care, and recommendations to improve telehealth. Interviews were analyzed using thematic analysis. Most PWH were female (61%), Black/African American (67%), and non-Hispanic (78%). Most PWH (61%) and all providers had used telehealth for HIV care. Most PWH and all providers reported being willing to use or (re-)consider telehealth HIV care services in the future. Providers suggested that telehealth is most suitable for routine HIV care encounters and for established, clinically stable, generally healthy PWH. Attitudes toward telehealth were heterogeneous, with most interviewees valuing telehealth similarly or superior to in-person care, yet >20% perceiving it less valuable. Recommendations to improve telehealth included multilevel strategies to address challenges across four domains: technology, the virtual nature of telehealth, administrative processes, and the sociodemographic profile of PWH. Telehealth in HIV care is here to stay; however, it may not yet be suitable for all PWH and all care encounters. Decision processes related to telehealth versus in-person care need to involve providers and PWH. Existing telehealth options require multilevel adjustments addressing persistent challenges. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to describe the experiences and barriers to care for women with autistic spectrum condition (ASC) under the care of the Brighton and Hove Specialist Perinatal Mental Health Service (BHSPMHS) and provide recommendations to improve the service. Design/methodology/approach: Patients with an ASC diagnosis or suspected diagnosis and awaiting assessment under the care of BHSPMHS were offered to take part in the study. Five patients were interviewed to explore their experiences. Findings: Participants had a mix of positive and negative experiences of services. Positives included the continuous support and allowing flexibility around appointments. Dialectical behavioural therapy groups running online instead of in-person was highlighted as a universal negative as well as delays in diagnosing ASC. Practical implications: Those likely to meet the criteria for ASC but are awaiting formal diagnosis should be treated with appropriate adjustments to service provision as those who have received a diagnosis. Recommendations for service improvements include the provision of smaller, in-person therapy groups. Adjustments to treatments may include flexibility around appointment times and location. Originality/value: There is little research into the experiences of people with ASC under the care of perinatal mental health teams. As specialist perinatal services expand, it is important to understand the experiences of women with ASC being cared for by these services, to ensure they are accessible and inclusive. The results of this study will be used to guide service development and act as a model for other services, with the intention of improving care for this patient group. [ABSTRACT FROM AUTHOR]

Objectives: To capture patients' perspectives on migraine‐related cognitive symptoms during pre‐headache, headache, post‐headache, and interictal periods. Background: Migraine‐related cognitive symptoms are reported by people with migraine both during and between attacks. Associated with disability, they are increasingly viewed as a priority target for treatment. The Migraine Clinical Outcome Assessment System (MiCOAS) project is focused on developing a patient‐centered core set of outcome measures for the evaluation of migraine treatments. The project focuses on incorporating the experience of people living with migraine and the outcomes most meaningful to them. This includes an examination of the presence and functional impact of migraine‐related cognitive symptoms and their perceived impact on quality of life and disability. Methods: Forty individuals with self‐reported medically diagnosed migraine were recruited via iterative purposeful sampling for semi‐structured qualitative interviews conducted using audio‐only web conferencing. Thematic content analysis was performed to identify key concepts around migraine‐related cognitive symptoms. Recruitment continued until concept saturation was achieved. Results: Participants described symptoms consistent with migraine‐related deficits in language/speech, sustained attention, executive function, and memory that manifest during pre‐headache (36/40 [90%] reported ≥1 cognitive feature), headache (35/40 [88%] reported ≥1 cognitive feature), post‐headache (27/40 [68%] reported ≥1 cognitive feature), and interictal periods (13/40 [33%] reported ≥1 cognitive feature). Among participants reporting cognitive symptoms during pre‐headache, 32/40 (81%) endorsed 2–5 cognitive symptoms. Findings were similar during the headache phase. Participants reported language/speech problems consistent with, for example, impairments in receptive language, expressive language, and articulation. Issues with sustained attention included fogginess, confusion/disorientation, and trouble with concentration/focus. Deficits in executive function included difficulty processing information and reduced capacity for planning and decision‐making. Memory issues were reported across all phases of the migraine attack. Conclusions: This patient‐level qualitative study suggests that cognitive symptoms are common for persons with migraine, particularly in the pre‐headache and headache phases. These findings highlight the importance of assessing and ameliorating these cognitive problems. [ABSTRACT FROM AUTHOR]

Although the value of family caregivers' involvement with relatives in long-term care (LTC) is well recognized, tensions remain regarding their role. Such tensions were exacerbated during the COVID-19 pandemic as strict public health measures restricted family access to LTC homes. Using interpretive description, we examined the impact of visitation restrictions on family caregivers' experiences caring for a relative in LTC between March 2020 and June 2021. In-depth interviews were conducted with 14 family caregivers (five spouses and nine adult daughters) and two key themes were identified. The first theme, "seeking to maintain relational continuity," illustrates how caregivers sought to sustain connections with residents prior to and during the pandemic. The second theme, "disrupted relational continuity," highlights the impact of severed relational connections on caregivers' sense of self and ongoing feelings of loss and anger. Findings call for a trauma-informed approach that recognizes the pervasiveness of trauma for family caregivers and the avoidance of re-traumatization. [ABSTRACT FROM AUTHOR]

Background: Family‐centered care (FCC) has been successfully incorporated into daily practice in many neonatal intensive care units (NICUs) worldwide. However, the implementation of FCC in lower‐resourced settings, such as Thailand, can be challenging and needs to be further explored. Aims: To identify parents' and interdisciplinary professionals' perceptions of FCC and to describe the opportunities to improve FCC in a Thai NICU. Design: An exploratory qualitative approach was used. Methods: The data were collected through face‐to‐face, semi‐structured, individual interviews based on an interview guide. This study was conducted before the outbreak of coronavirus disease 2019 (February 2020) in a hospital in southern Thailand. Inductive thematic analysis was used to analyse interview data. Results: Participants were parents (n = 9) and interdisciplinary professionals (n = 8). The results revealed four key themes: (a) Recognizing and responding to individual families' different readiness and their rights and values, (b) working in a parent‐interdisciplinary partnership to provide care, (c) lacking resources and motivation and (d) understanding of care requirements and providing help/sympathy. Conclusions: The interdisciplinary professionals accepted that FCC is necessary for clinical practice, but there are some challenges in the Thai NICUs context because of the system of health care delivery. The findings highlighted that interdisciplinary professionals often viewed parents' involvement as an obstacle to providing neonatal care. Relevance to clinical practice: Further research is recommended to investigate how FCC is operationalized by interdisciplinary professionals and how hospital administrators can be supported to implement the FCC approach into clinical practice in Thai NICUs. [ABSTRACT FROM AUTHOR]

This study responds to calls for more in‐depth and qualitative studies, the return to a focus on external factors, and the inclusion of business strategy and industrial relations in human resource management (HRM) research, as well as more research in the retail sector in the Chinese context. We examine the coevolution of the business strategy and HR strategy of Walmart (China) in the last two decades and identify tensions in the context of intensifying competition in the Chinese retail market. We highlight the interactive effect of business and HR strategies through a historical lens. Our study reveals a shift from the original employee‐oriented win–win strategy through rent sharing between the firm and the employees to a win–lose strategy through the introduction of more cost conscious HR policies and practices. Findings of our study challenge the conventional wisdom that firms adopt either the cost or quality strategy and, along with it, the suggestion of matching the quality strategy with employee‐oriented HR policies and practices, and cost leadership with a transactional approach to HRM. We argue a cost and quality business strategy may be adopted, which requires the support of employee‐oriented, rather than cost‐oriented, HR policies and practices. [ABSTRACT FROM AUTHOR]

Since the onset of the COVID-19 pandemic, community-dwelling people living with dementia and their family caregivers have experienced many challenges. The unanticipated consequences of public health measures have impacted these families in a myriad of ways. In this interpretive policy analysis, which used a longitudinal, qualitative methodology, we purposively recruited 12 families in British Columbia, Canada, to explore the impacts of pandemic public health measures over time. Semi-structured interviews were conducted every 3 months and participants completed diary entries. Twenty-eight interviews and 34 diary entries were thematically analyzed. The findings explore ways that families adopted and adapted to public health measures, loss of supports, both formal and informal, and the subsequent consequences for their mental and physical well-being. Within the ongoing context of the pandemic, as well as potential future wide-spread emergencies, it is imperative that programs and supports are restarted and maintained to avoid further harm to these families. [ABSTRACT FROM AUTHOR]

Postnatal post‐traumatic stress disorder (PTSD) affects 3%–4% of women who give birth. It is underdiagnosed and undertreated. Thus far, no studies have investigated doctors' perceptions of PTSD in postnatal women. We investigated whether GPs and psychiatrists perceive PTSD symptoms after birth to indicate pathology and what diagnosis and management they would offer. Semi‐structured interviews were conducted with six GPs and seven psychiatrists using a fictional vignette featuring a woman experiencing PTSD following a traumatic birth. A framework analysis approach was used. Despite half the GPs recognizing trauma‐related features in the vignette their most common diagnosis was postnatal depression whereas six of the seven psychiatrists identified PTSD. Management plans reflected this. Both GPs and psychiatrists lacked trust in timeliness of referrals to psychological services. Both suggested referral to specialist perinatal mental health teams. Results suggest women are unlikely to get a PTSD diagnosis during initial GP consultations, however the woman‐centred care proposed by GPs means that a trauma‐focussed diagnosis later in the care pathway was not ruled out. Further research is needed to confirm these findings, which suggest that an evidence base around best management for women with postnatal PTSD is sorely needed, especially to inform GP training. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to consider how a South East project approached systems change to improve unsupported temporary accommodation (UTA) and the changes made for people experiencing multiple disadvantage ("multiple and complex needs"). This paper also covers some matters that are hard to change or uncertain, such as housing shortages and financial constraints. The paper focuses on a case study of the East Sussex Temporary Accommodation Action Group (TAAG) – a multi-agency action group. Design/methodology/approach: A qualitative case study involving a thematic analysis of seven semi-structured interviews, with a review of published literature and internal documentation. Findings: This example of setting up a TAAG shows us the value of having a dedicated forum to look at a part of the system that requires changing and to identify what works well. Creating a collaborative and democratic space with a common purpose brings different stakeholders and perspectives together and opens discussions to new ways of working. Equalising partners creates an opportunity to create change from the bottom-up within a system traditionally governed by statutory bodies. This study found that the TAAG has facilitated learning around trauma-informed practice and nurtured more sustainable changes towards a Standards Charter and women-only safe UTA. Originality/value: This is one of the first qualitative case studies of a local systems change approach to improving UTA for people experiencing multiple disadvantage in East Sussex. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study explored nursing students' views of using virtual reality in healthcare. Background: The popularity and use of virtual reality in healthcare delivery and education is on the rise. Yet, the views of future nurses regarding this technology remain underexplored. Design: This is a qualitative descriptive study guided by a naturalistic inquiry and reported using the Standards for Reporting Qualitative Research checklist. Methods: Nursing students (n = 26) were recruited using convenience and snowball sampling. They were first exposed to a virtual reality intervention aimed to enhance men's awareness of testicular diseases. This was attempted to familiarise participants with the technology and initiate conversations around its use in healthcare. Participants were then interviewed face‐to‐face, either individually or within focus groups. Data were analysed using thematic analysis. Results: Four themes were identified: (i) positive experiences of virtual reality; (ii) challenges to using virtual reality; (iii) settings where virtual reality can be implemented; and (iv) blue‐sky and future applications of virtual reality. Participants described this technology as novel, enjoyable, immersive, memorable and inclusive. They questioned, however, the suitability of virtual reality for older adults, reported minor technical difficulties and stressed the importance of prior preparation in the use of the technology. Virtual reality was recommended for use in outpatient healthcare settings, schools and the community. Participants suggested using virtual reality in health promotion, disease prevention and management, and to promote nurses' empathy towards patients. Conclusions: Findings highlight the potential role of virtual reality in assisting nurses in promoting health and managing disease. Future research is needed to establish the long‐term effect of virtual reality interventions among more diverse participants. Relevance to clinical practice: Virtual reality can be implemented in outpatient, educational and community settings in order to promote health, prevent disease, enhance disease and self‐management, and increase nurses' empathy towards patients. [ABSTRACT FROM AUTHOR]

The Royal College of Physicians and Surgeons of Canada (RCPSC) recently redesigned the Canadian neurosurgery residency training curriculum by implementing a competency-based model of training known as Competence by Design (CBD) centered around the assessment of Entrustable Professional Activities (EPAs). This sequential explanatory mixed-methods study evaluated potential benefits and pitfalls of CBD in Canadian neurosurgery residency education. Two four-month interval surveys were distributed to all Canadian neurosurgery residents participating in CBD. The surveys assessed important educational components: CBD knowledge of key stakeholders, potential system barriers, and educational/psychological impacts on residents. Paired t-tests were done to assess changes over time. Based on longitudinal survey responses, semi-structured interviews were conducted to investigate in-depth residents' experience with CBD in neurosurgery. The qualitative analysis followed an explanatory approach, and a thematic analysis was performed. Surveys had 82% average response rate (n = 25). Over time, most residents self-reported that they retrospectively understood concepts around CBD intentions (p = 0.02). Perceived benefits included faculty evaluations with more feedback that was clearer and more objective (53% and 51%). Pitfalls included the amount of time needed to navigate through EPAs (90%) and residents forgetting to initiate EPA forms (71%). There was no significant change over time. During interviews, five key themes were found. Potential solutions identified by residents to enhance their experience included learning analytics data availability, mobile app refinement, and dedicated time to integrate EPAs in the workflow. This study was the first to assess resident-perceived benefits and pitfalls of the neurosurgery CBD training program in an educational framework context. In general, residents believed that theoretical principles behind CBD were valuable, but that technological ability and having enough time to request EPA assessments were significant barriers to success. Long-term studies are required to determine the definitive outcomes of CBD on residents' performance and ultimately, on patient care. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) pandemic is an ongoing global health crisis that has had a range of impacts on people living with migraine. Methods: Qualitative interviews performed as part of the Migraine Clinical Outcome Assessment System project, a multi‐stage Food and Drug Administration–grant funded program to develop a patient‐centered core set of outcome measures for use in migraine clinical trials, offered an opportunity to explore the experience of living with migraine during the pandemic as well as to examine whether migraine treatment priorities, symptoms, and associated disability changed due to the pandemic. Semi‐structured interviews were conducted in the United States between the summer and fall of 2020 with 40 individuals with self‐reported, medically diagnosed migraine who self‐reported that they had not tested positive for or been diagnosed with COVID‐19. Results: Seventy percent (n = 28) of the sample reported ≥1 pandemic‐related impact on their life with migraine. Fourteen participants reported both positive and negative impacts, twelve reported negative impacts only, and two reported positive impacts only. Among those reporting ≥1 pandemic‐related impact, nine participants (32%) reported more frequent and five (17%) reported less frequent migraine attacks. Other negative impacts included interrupted medical care (n = 9; 32%), and greater stress (n = 13; 46%). The most frequent positive impact reported was greater access to health care (n = 8; 29%). Ictal and interictal symptoms were not noted to change due to the pandemic, but some respondents reported less disability due to increased flexibility of schedules and reduced expectations. Treatment priorities did not change due to the pandemic. Conclusion: The global COVID‐19 pandemic has resulted in both negative and positive impacts for people living with migraine. Lessons to be considered when moving into a post‐pandemic world include benefits of and satisfaction with telehealth and the benefits and importance of healthy lifestyle habits and flexibility such as improved sleep, reduced stress, and fewer social expectations. [ABSTRACT FROM AUTHOR]

Background Errors in reasoning are a common cause of diagnostic error. However, it is difficult to improve performance partly because providers receive little feedback on diagnostic performance. Examining means of providing consistent feedback and enabling continuous improvement may provide novel insights for diagnostic performance. Methods We developed a model for improving diagnostic performance through feedback using a six-step qualitative research process, including a review of existing models from within and outside of medicine, a survey, semistructured interviews with individuals working in and outside of medicine, the development of the new model, an interdisciplinary consensus meeting, and a refinement of the model. Results We applied theory and knowledge from other fields to help us conceptualise learning and comparison and translate that knowledge into an applied diagnostic context. This helped us develop a model, the Diagnosis Learning Cycle, which illustrates the need for clinicians to be given feedback about both their confidence and reasoning in a diagnosis and to be able to seamlessly compare diagnostic hypotheses and outcomes. This information would be stored in a repository to allow accessibility. Such a process would standardise diagnostic feedback and help providers learn from their practice and improve diagnostic performance. This model adds to existing models in diagnosis by including a detailed picture of diagnostic reasoning and the elements required to improve outcomes and calibration. Conclusion A consistent, standard programme of feedback that includes representations of clinicians' confidence and reasoning is a common element in non-medical fields that could be applied to medicine. Adapting this approach to diagnosis in healthcare is a promising next step. This information must be stored reliably and accessed consistently. The next steps include testing the Diagnosis Learning Cycle in clinical settings. [ABSTRACT FROM AUTHOR]

Background and Objectives Much of the literature examining the staffing–care quality link in long-term care (LTC) homes focuses on staffing ratios; that is, how many staff are on shift. Far less attention is devoted to exploring the impact of staff members' workplace relationships, or who is on shift. As part of our work exploring workplace incivility and bullying among residential care aides (RCAs), we examined how RCAs' workplace relationships are shaped by peer incivility and bullying and the impact on care delivery. Research Design and Methods Using critical ethnography, we conducted 100 hr of participant observation and 33 semistructured interviews with RCAs, licensed practical nurses, support staff, and management in 2 nonprofit LTC homes in British Columbia, Canada. Results Three key themes illustrate the power relations underpinning RCAs' encounters with incivility and bullying that, in turn, shaped care delivery. Requesting Help highlights how exposure to incivility and bullying made RCAs reluctant to seek help from their coworkers. Receiving Help focuses on how power relations and notions of worthiness and reciprocity impacted RCAs' receipt of help from coworkers. Resisting Help/ing outlines how workplace relationships imbued with power relations led some RCAs to refuse assistance from their coworkers, led longer-tenured RCAs to resist helping newer RCAs, and dictated the extent to which RCAs provided care to residents for whom another RCA was responsible. Discussion and Implications Findings highlight "who" is on shift warrants as much attention as "how many" are on shift, offering additional insight into the staffing-care quality link. [ABSTRACT FROM AUTHOR]

Background: People with inflammatory rheumatological conditions (IRCs), are at increased risk of comorbidities such as cardiovascular disease, osteoporosis, anxiety and depression. The INCLUDE pilot trial evaluated a nurse-delivered review of people with IRCs which sought to identify and initiate management of comorbid conditions. Aim: A nested qualitative study was undertaken to examine the acceptability of the INCLUDE review. Methods: A qualitative interview-based design in UK primary care settings. A purposive sample of 20 patients who attended an INCLUDE review, were interviewed. Inductive thematic analysis was undertaken. Themes were agreed through multidisciplinary team discussion and mapped onto constructs of the Theoretical Framework of Acceptability (TFA). Results: Six themes mapped onto six of the seven TFA constructs. Patients reported the review to be effective by identifying and initiating management of previously unrecognised comorbid conditions. Some participants reported barriers to following recommendations, such as lifestyle modifications or taking more medication. Conclusion: A nurse-delivered review to identify comorbidities is acceptable to patients with IRCs. The TFA provided a novel analytical lens. [ABSTRACT FROM AUTHOR]

Objective: Nonacademic qualities such as time management, study skills, stress, and motivation have been linked to academic performance. The purpose of this study was to gain an understanding of this relationship to enable early remediation in a chiropractic training program. Methods: Questionnaire data were collected at the beginning of the academic year, end of semester 1, and end of semester 2. Questions were related to participants' time management, study skills, stress, and motivation. These were compared to summative assessment results. Semistructured interviews were conducted at the end of semester 1 and end of semester 2. Results: Amount of time spent studying did not correlate significantly with assessment results. At the beginning of the year, 85.7% of students participated in extracurricular activities. This reduced throughout the year; students who stopped activities were significantly more successful in assessments. When stress at the beginning of the year was compared to end of semester 1, there was a significant increase (p = .012), with further significant increases from semester 1 to the end of semester 2 (p= .001). Students were very motivated at the beginning of the year, and this was maintained to the end of semester 1 (p = .257). However, at the end of semester 2, students became significantly less motivated (p = .007). End-of-year motivation correlated with poor student outcomes (p = .056). Conclusion: Time management, study skills, stress, and motivation influenced academic performance in this sample of students. This study supports the notion that student assistance is needed. Additional research into student assistance would be beneficial. [ABSTRACT FROM AUTHOR]

Background: Failure of clinicians to recognise and respond to patient clinical deterioration is associated with increased hospital mortality. Emergency response teams are implemented throughout hospitals to support direct‐care clinicians in managing patient deterioration, but patient clinical deterioration is often not identified or acted upon by clinicians in ward settings. To date, no studies have used an integrative theoretical framework in multiple sites to examine why clinicians' delay identification and action on patients' clinical deterioration. Aim: To identify barriers and facilitators that influence clinicians' absent or delayed response to patient clinical deterioration using the Theoretical Domains Framework. Methods: The Theoretical Domains Framework guided: (a) semi‐structured interviews with clinicians, health consumers and family members undertaken at two sites; (b) deductive analyses of inductive themes to identify barriers and facilitators to optimal care. This study complied with the COREQ research guidelines. Findings: Seven themes identified: (a) information transfer; (b) ownership of patient care; (c) confidence to respond; (d) knowledge and skills; (e) culture; (f) emotion; and (g) environmental context and resources. Discussion: The Theoretical Domains Framework identified traditional social and professional hierarchies and limitations due to environmental contexts and resources as contributors to diminished interprofessional recognition and impediments to the development of effective relationships between professional groups. Communication processes were impacted by these restraints and further confounded by inadequate policy development and limited access to regular effective team‐based training. As a result, patient safety was compromised, and clinicians frustrated. Conclusions: These results inform the development, implementation and evaluation of a behaviour change intervention and increase knowledge about barriers and facilitators to timely response to patient clinical deterioration. Relevance to clinical practice: Results contribute to understanding of why clinicians delay responding to patient clinical deterioration and suggest key recommendations to identify and challenge traditional hierarchies and practices that prevent interdisciplinary collaboration and decision‐making. [ABSTRACT FROM AUTHOR]

Background: Consistent assignment (CA) is the practice within long‐term care (LTC) by which care staff work with the same residents almost every shift for an indefinite period of time. CA is considered by many to be essential to person‐centred care. Objectives: This paper explores how staff assignment practices impact the caregiving experience from the perspectives of resident care aides (RCAs), residents and family members and, by doing so, describe the nuanced conditions under which CA may or may not be beneficial to all, and why. Methods: Data are drawn from 40 in‐depth interviews conducted as part of a larger institutional ethnography exploring the social organisation of care in three purposively selected LTC homes in Western Canada. Data analysis was based on the principles of constant comparison. Results: RCAs, residents and family members described the primary benefit of CA as being able to 'get to know' each other well and form meaningful relationships. However, the RCAs also indicated that CA can contribute to feelings of isolation, which has negative effects on worker comfort and satisfaction, care team dynamics and communication, and resident care. Conclusions: Management initiatives are needed to ensure that the implementation of CA does not result in the unintended consequences of decreasing RCAs' experience of teamwork, decreasing RCAs' exchange of individualised resident care information, or negatively impacting RCAs' ability and desire to care for each other as well as the residents. Implications for practice: The staffing practice of consistent assignment in long‐term care homes provides increased opportunities for the development of stronger staff‐resident and staff‐family member relationships. Findings from this study enable us to offer several, evidenced‐based recommendations for ensuring the successful implementation of consistent assignment, such that it may be beneficial to all. [ABSTRACT FROM AUTHOR]

The Chinese finance industry has experienced significant expansion both within the state sector and into the private sector. Professional consultancy firms have also emerged as a result of the rising interest in the outsourcing of accounting and management services. However, the study of women's careers in the accountancy profession in contemporary China remains largely an uncharted territory. Drawing on data from 69 interviews with auditors in five firms, this article investigates the nature of work of external auditors in China and how women auditors view their work-life choices and constraints. We explore the likely differences between male and female auditors in their career aspirations and the extent to which these self-perceived differences are informed by social conventions of gender role, organizational practices, and personal preferences. The study has strong implications for human resource management in professional service firms in China, with particular reference to job design, work organization, career support, and work-life balance initiatives. The study contributes to the debate on gender, employment, and career development in the accountancy profession in different parts of the world. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: The importance of modern contraceptive methods in averting unwanted pregnancies has been acknowledged in Malawi. Currently, the country has registered the highest rates of unsafe abortions, unmet needs for contraception and a low contraceptive prevalence rate. Understanding why these rates exist is important. However, women's views and experiences regarding uptake of family planning methods in Malawi have not been explored. Methods: A grounded theory methodology was used. Data were gathered through in-depth interviews with women (n = 18), men (n = 10), healthcare workers (n = 10) and non-participant observations of family planning clinic consultations (n = 10). Data were analysed using constant comparative technique. Methods of open, axial and selective coding enabled subsequent conceptualisations until theoretical saturation occurred. Results: The core category 'disenabling environment prevents women's family planning needs from being met' provides an understanding of women's, men's and healthcare workers' experiences of contraceptive use and non-use. The disenabling environment contributed to shaping women's family planning experiences. This was supported by three main categories: navigating the processes, disempowerment of women and learning by chance. Conclusion: Findings from this study illuminate contextual issues into how women, men and healthcare workers experience family planning use and non-use in Malawi. A multifaceted strategy is required to support a woman's family planning needs. At community level, awareness and education of family planning methods is required to actively inform all people in society so that they support a woman's family planning needs. At national level, laws that would empower women with decision-making ought to be developed and enforced. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Children's risk-taking is increasingly acknowledged as an important part of early childhood education. Previous research has predominantly focussed on children's engagement with, and educators' perspectives on, children's risk-taking in outdoor physical play. However, little attention has been paid to how educators conceptualise children's risk-taking more broadly. Our study addresses this research gap. A three-site case study, the research gathered data from educators in high quality early childhood services through observations and interviews. Findings show that educators predominantly framed children's risk-taking as taking place in physical and outdoor play. However, with minimal provocation, educators extended their conceptualisations of risk to encompass a broader range of children's experiences. Data suggests that participation in the research provoked many participants to think more broadly about children's risk-taking. [ABSTRACT FROM AUTHOR]

Some theories (e.g. Jackson's Paradigm Shifting Hypothesis) and many personal accounts suggest that some psychotic crises, whilst distressing, can also be transformative, leading to growth and valued outcomes. However, little is known about the extent to which this idea informs mainstream mental health care. Clinical psychologists are influential advocates of psychosocial approaches more broadly: This study explored their use of transformative models. Twelve U.K. clinical psychologists were interviewed: Transcripts informed a grounded theory. No participants saw psychosis as a purely biological problem where the content of experiences is irrelevant. Two held a "biopsychosocial" model, viewing psychosis as an illness with psychosocial elements. Most either held a continuum view (i.e., schizotypy), in which psychosis proneness was also associated with positive attributes such as creativity or sensitivity, or a "fully psychological" view, seeing experiences as meaningful and/or as adaptive responses to events. Many believed that psychosis can be transformative in a broad sense, that is, lead to "post‐traumatic growth." Some went further, believing that it can be a purposeful (e.g., an attempt, albeit painful and sometimes unsuccessful, to solve problems) or even a spiritual phenomenon. Participants' perspectives influenced their therapeutic approach: Those who saw experiences as purposeful were more likely to facilitate direct engagement with them and to support clients to explore potentially transformative aspects. However, this represented an extension of conventional approaches rather than being qualitatively different. More research is needed to clarify how widespread this approach is, to explore its utility, and to establish for whom and when it may be appropriate. [ABSTRACT FROM AUTHOR]

Background and Objectives Current nursing home policy emphasizes the need for collaborative, team-based care planning in which families and/or residents are actively involved. Resident care conferences are common where care providers, families, and/or residents discuss and coordinate resident care needs and evaluate care goals. This study critically examines the process, structure, and content of care conferences to expand our understanding of how resident care is negotiated among care providers and families in this context. Research Design and Methods This study was part of a larger critical ethnography examining the negotiation of care work among care providers, families, and residents in three purposively selected nursing homes in British Columbia, Canada. Thirty-seven care conferences were observed. Field notes and interview data were thematically analyzed with a focus on what was said, who said what and to whom, whose voice was privileged, and how power manifested between care providers, families, and/or residents. Results As illustrated by three key themes, Exclusion by Process—Following Script, Exclusion by Content—Scripted Reports, and Exclusion through Devalued Knowledge, families were overtly and covertly excluded from contributing to the care conferences. As such, families' presence did not guarantee open communication or active solicitation of their perspectives. Discussion and Implications The use of predetermined agendas and processes, clinically generic reporting, and technical jargon reproduced the structural inequality between care providers and families making collaboration difficult to effectively negotiate. For care conferences to meaningfully contribute to person-centered care, it is imperative that mutual exchange be promoted and families empowered to participate as equals. [ABSTRACT FROM AUTHOR]

The Vendée Globe is a solo round-the-world sailing race without stopovers or assistance, a physically demanding challenge for which appropriate nutrition should maintain energy balance and ensure optimum performance. This is an account of prerace nutritional preparation with a professional and experienced female racer and assessment of daily nutritional intake (NI) during the race using a multimethod approach. A daily energy intake (EI) of 15.1 MJ/day was recommended for the race and negotiated down by the racer to 12.7 MJ/day, with carbohydrate and fluid intake goals of 480 g/day and 3,020 ml/day, respectively. Throughout the 99-day voyage, daily NI was recorded using electronic food diaries and inventories piloted during training races. NI was assessed and a postrace interview and questionnaire were used to evaluate the intervention. Fat mass (FM) and fat-free mass (FFM) were assessed pre- (37 days) and postrace (11 days) using dual-energy X-ray absorptiometry, and body mass was measured before the racer stepped on the yacht and immediately postrace. Mean EI was 9.2 MJ/day (2.4-14.3 MJ/day), representing a negative energy balance of 3.5 MJ/day under the negotiated EI goal, evidenced by a 7.9-kg loss of body mass (FM -7.5 kg, FFM -0.4 kg) during the voyage, with consequent underconsumption of carbohydrate by ~130 g/day. According to the postrace yacht food inventory, self-reported EI was underreported by 7%. This intervention demonstrates the practicality of the NI approach and assessment, but the racer's nutrition strategy can be further improved to facilitate meeting more optimal NI goals for performance and health. It also shows that evaluation of NI is possible in this environment over prolonged periods, which can provide important information for optimizing nutritional strategies for ocean racing. [ABSTRACT FROM AUTHOR]

This study investigates changes and continuity in the performance appraisal and reward systems of four Chinese IT firms after they were acquired by US-owned multinational corporations. Drawing on different perspectives, it examines changes in the appraisal and reward systems of the acquired units and the extent to which they may be influenced by the interplay of business strategy, organizational structure, resource-based power of the acquiring and acquired partners, management competence, labor market factors, and the cultural norms of China. The study reveals that the guiding principle of performance management and reward policy of the acquired firms have experienced changes. However, the structure of compensation remains largely unchanged. There is a high level of resistance from the Chinese managers to adopt more sophisticated performance appraisal techniques and to widen the wage band to differentiate employees' performance. The foreign acquirers have taken a cautious and pragmatic approach to implement changes. As a result, the relatively slow speed of change and limited substantive changes in the performance and reward practices make it impossible to achieve a full strategic alignment of human resource practices at the corporate-level post-acquisition. © 2011 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This paper presents a case study of how GfK NOP is moving one of the UK's major market measurement studies online. In this case study we share our learning and illustrate, with empirical data, the limits and possibilities that panel-based research offers in this most demanding arena for online research. Our conclusion is that, in this instance, it is inappropriate to replace the traditional face-to-face methodology with a wholly online solution, but that, instead, a multi-modal approach that combines face-to-face with online interviewing is the way forward. [ABSTRACT FROM AUTHOR]

Objective: Avoidant/restrictive food intake disorder (ARFID), pica, and rumination disorder (RD) were added to the revised DSM‐5 Feeding and Eating Disorders chapter in 2013. We developed a structured interview—the Pica, ARFID, and Rumination Disorder Interview (PARDI)—to assess the presence and severity of these diagnoses for evaluation and treatment planning in clinical and research settings. Here, we describe the development of the PARDI and provide a preliminary report on feasibility, acceptability, reliability, and validity in relation to ARFID. Method: We created an initial item pool from existing measures of similar constructs and clinical experience. The PARDI includes items assessing the level of endorsement and overall severity of common ARFID features organized into profiles (i.e., sensory sensitivity, lack of interest in eating, and fear of aversive consequences) and algorithms for diagnosing ARFID, pica, and RD. We collected initial psychometric data from participants (10–22 years) with ARFID (n = 39), clinically significant avoidant/restrictive eating (n = 8), and healthy controls (n = 10). Results: On average, the PARDI took 39 min to complete and was acceptable to participants. All subscales achieved internal consistency greater ≥0.77, and inter‐rater reliability for the ARFID diagnosis was moderate (κ = 0.75). Individuals with ARFID scored significantly higher than healthy controls on ARFID severity and ARFID profiles. Discussion: The PARDI appears acceptable to respondents and preliminary evidence of reliability and validity has been demonstrated in an initial sample. Larger‐scale validation studies are currently underway. The PARDI is freely available to clinicians and researchers. [ABSTRACT FROM AUTHOR]

Plan sponsors of Medicare Part D must provide beneficiaries who receive a comprehensive medication review (CMR) with a written summary using the Medicare Part D Medication Therapy Management Standardized Format (SF). The SF is a means to advance consistency in the CMR program by providing a template of expected content. However, barriers remain with beneficiary use and integration into existing electronic health records. The current study assessed Medicare beneficiary, caregiver, and case manager perceptions of the SF through five focus group interviews with a total of 23 participants. Qualitative analysis found that beneficiaries and case managers preferred a consolidated SF document to share and update their entire health care team. Beneficiaries suggested adding information to the SF on dosage, timing, drug interactions, cost, and less expensive alternatives. Identifying elements of the SF that are perceived as useful to beneficiaries will allow for a more streamlined SF that may enhance interoperability among the health care team. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. Background: While there are evidence‐based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. Design: Critical incident technique. Methods: Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south‐east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. Results: Three themes emerged from 23 reflective accounts of fall events: "direct observation is confounded by multiple observers" and "knowing the person has cognitive impairment is not enough," and "want to rely on the guideline but unsure how to enact it." While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. Conclusions: Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice: To reduce falls, nurses can involve the family to support "knowing the patient" to enable prediction of impulsive actions; shift the focus of in‐service from lectures to specific case presentations, with collaborative analysis on person‐focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Oncology Nursing Journal is the property of Pappin Communications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: This article aims to examine RCAs' own experiences of personhood in dementia care settings. Background: Conceptually, person-centred care entails fostering the personhood of residents and the residential care aides (RCAs) who provide much of their hands-on care. To date, however, staff personhood has been overlooked in the empirical literature. Design: The study was part of a larger focused ethnographic project exploring how the organisational care environment impedes or facilitates the provision of quality dementia care. Methods: Semi-structured interviews with 23 RCAs and more than 230 hours of participant observation were conducted in two nursing homes with specialised dementia units in British Columbia, Canada. Results: Two overarching themes, "personhood undermined--management-staff relations" and "personhood undermined--workplace policies and practices" emerged, illustrating how, despite exposure to features believed beneficial to their working environment (e.g., favourable staffing ratios, relatively good remuneration), RCAs encountered repeated affronts to their personhood. The first theme encompasses the importance of being known (i.e., as persons and of their job demands) and valued (i.e., appreciated for their work in non-monetary terms). The second highlights the salience of work-life balance, full-staffing coverage and supportive human resource practices. Conclusions: RCAs' experiences reveal how the ongoing search for cost-efficiencies, cost-containment and cost-accountability overshadows their individuality, indicating a key disconnect between conceptual ideals and workplace realities. Implications for practice: Organisations are encouraged to consider creating person-centred management and workplace practices that provide tangible evidence that RCAs, and their work, matter. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: This pilot trial will inform the design and methods of a future full‐scale randomized controlled trial (RCT) and examine the feasibility, acceptability and fidelity of the Increasing Physical activity in Older People with chronic Pain (iPOPP) intervention, a healthcare assistant (HCA)‐supported intervention to promote walking in older adults with chronic musculoskeletal pain in a primary care setting. Methods and analysis: The iPOPP study is an individually randomized, multicentre, three‐parallel‐arm pilot RCT. A total of 150 participants aged ≥65 years with chronic pain in one or more index sites will be recruited and randomized using random permuted blocks, stratified by general practice, to: (i) usual care plus written information; (ii) pedometer plus usual care and written information; or (iii) the iPOPP intervention. A theoretically informed mixed‐methods approach will be employed using semi‐structured interviews, audio recordings of the HCA consultations, self‐reported questionnaires, case report forms and objective physical activity data collection (accelerometry). Follow‐up will be conducted 12 weeks post‐randomization. Collection of the quantitative data and statistical analysis will be performed blinded to treatment allocation, and analysis will be exploratory to inform the design and methods of a future RCT. Analysis of the HCA consultation recordings will focus on the use of a checklist to determine the fidelity of the iPOPP intervention delivery, and the interview data will be analysed using a constant comparison approach in order to generate conceptual themes focused around the acceptability and feasibility of the trial, and then mapped to the Theoretical Domains Framework to understand barriers and facilitators to behaviour change. A triangulation protocol will be used to integrate quantitative and qualitative data and findings. [ABSTRACT FROM AUTHOR]

The current study aimed to describe the eff ect of an educational program on RNinitiated eff orts to involve family caregivers in delirium care. A descriptive qualitative study was performed. A purposive sample of 12 RNs who participated in a one group, pre-post evaluation of a delirium educational program, and a nominated sample of six family caregivers of patients who had been cared for by RNs in the program participated in individual, in-depth interviews. The qualitative fi ndings indicated that the inclusion of a delirium brochure in ward orientation on admission, with reinforcement during shift changes, and RN-initiated engagement with family caregivers promoted family caregiver involvement in delirium prevention. Further studies in South Korea are needed to determine which family- centered nursing care interventions are culturally appropriate and most eff ective for RNs and family caregivers in delirium care. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the effect of an educational programme on registered nurses' knowledge and attitude in delirium care for hospitalised older adults with and without dementia, and to examine the strengths and weaknesses of the programme from the participants' perspectives. Background Providing care for patients with delirium or delirium superimposed on dementia often poses particular challenges such as distinguishing between delirium and dementia for nurses. Design A descriptive qualitative study was used. Methods A delirium educational programme based on adult learning principles was provided to the participants. A purposive sample of 12 registered nurses who participated in the educational programme undertook individual interviews. Content analysis was conducted to identify unique and common themes indicative of registered nurse perceptions. Results Registered nurses reported improved knowledge and attitude towards the delirium care of hospitalised older adults with dementia and at risk of delirium. Active learning in the programme facilitated the participants' learning processes. This active learning included deep learning, collaborative learning and application of new concepts to practice. Most participants felt that they had inadequate management support to apply their new knowledge in practice, and this included staff resource and policies and protocols. Conclusion The qualitative findings indicated that the delirium education had benefited the participants by improving their knowledge and attitude towards the delirium care of hospitalised older adults with dementia and at risk of delirium. This study provided an understanding of the strengths and limitations of the educational programme delivered to registered nurses in South Korea. Relevance to clinical practice Registered nurses in South Korea should need not only appropriate education, but also adequate resources, policies and guidelines as well as support from managers and from all other healthcare professionals. [ABSTRACT FROM AUTHOR]

Background People with intellectual disabilities, if convicted of offences, may be sentenced to prison, but little is known about their life when they are released. Method This study followed up men with intellectual disabilities who were leaving prisons in England. Results The men were hard to contact, but 38 men were interviewed, on average 10 weeks after leaving prison. The men were living in a variety of situations and often were very under-occupied, with limited social networks. A total of 70% were above the clinical cut-off for anxiety, and 59.5% were above the clinical cut-off for depression. The men were receiving little support in the community, and many had been reinterviewed by police. Conclusions Community teams need to provide better support to this very vulnerable group. [ABSTRACT FROM AUTHOR]

Background The population is ageing in South Korea, increasing the incidence of dementia and delirium. Despite this, registered nurses in South Korea tend to have poor understanding and limited involvement in the assessment of delirium. Aim To evaluate the effect of an educational programme on acute care nurses' knowledge, attitudes and the potential for family caregiver involvement in care for older adults with cognitive impairment. Methods A mixed-methods study that included a single group, pre-post design and individual interviews was used. Forty registered nurses were recruited from four medical wards of one regional general hospital in South Korea. A 3-month educational programme on care for older adults with cognitive impairment tailored to the specific learning needs of nurses and guided by adult learning principles was provided to participants. A purposive sample of 12 registered nurses who participated in the quantitative component, and a nominated sample of six family caregivers whose older family members were cared for by participating nurses, joined individual interviews. Results The educational programme had a positive impact on nurses' knowledge of cognitive impairment and attitudes towards older adults. The qualitative data indicated that the educational programme improved nurses' knowledge of cognitive impairment and their attitudes towards older adults with cognitive impairment. It also increased nurses' initial efforts to involve family caregivers in cognitive impairment care. Conclusion Educational programmes are an effective means of improving nurses' knowledge and attitudes, but more research is required to explore the impact of such a programme on practice change and patient health-related outcomes including incidence of delirium, length of hospital stay and hospital-acquired complications. [ABSTRACT FROM AUTHOR]

Guidelines are ubiquitous but inconsistently used in UK mental health services. Clinical psychologists are often influential in guideline development and implementation, but opinion within the profession is divided. This study utilized grounded theory methodology to examine clinical psychologists' beliefs about and use of NICE guidelines. Eleven clinical psychologists working in the NHS were interviewed. The overall emerging theme was; NICE guidelines are considered to have benefits but to be fraught with dangers. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, due to the pressures and dominant discourses within services they tended to practice in ways that prevent these skills from being recognized. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. To our knowledge, the theoretical framework presented in this paper is the first that attempts to explain why NICE guidelines are not consistently utilized in UK mental health services. The current need for services to demonstrate 'NICE compliance' may be leading to a perverse incentive for clinical psychologists in particular to do one thing but say another and for specialist skills to be obscured. If borne out by future studies, this represents a threat to continued quality improvement and also to the profession. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Guidelines have many benefits, but the current pressure for services to be 'NICE compliant' may be having unintended negative as well as positive effects., Lack of implementation may be partly the result of active choice by clinicians concerned to use the full range of professional skills and to offer flexibility and choice to service users., The current context is creating a perverse incentive for clinicians to say one thing but do another. This is problematic for services and a potential threat to the profession of clinical psychology. [ABSTRACT FROM AUTHOR]

Background: Medical schools are challenged to incorporate more prevention-based education into curricula, offering an opportunity to revisit approaches to nutrition education. The objective of this study was to explore United States (US) medical students' understanding of childhood obesity, specifically barriers to childhood obesity prevention and treatment and students' perceived educational deficits. Methods: The research team conducted phone interviews with 78 3rd- and 4th-year medical students, representing 25 different medical schools across the US. Using a semi-structured interview guide, researchers asked students to describe the etiology of childhood obesity and reflect on where they acquired knowledge of the etiology and what additional resources they would need to treat obese children. Using a phenomenological approach to analysis, researchers identified five dominant emergent themes. Results: Student-perceived barriers to childhood obesity prevention and treatment in clinical care included student-centered (e.g., lack of knowledge), patient-centered (e.g., lack of access), and healthcare system-centered barriers (e.g., limited time). Students requested more applicable nutrition information and counseling skills relevant to preventing and treating childhood obesity; however, they tended to identify others (e.g., parents, schools), rather than themselves, when asked to describe how childhood obesity should be prevented or treated. Discussion: To provide students with an understanding of their role in preventing and treating childhood obesity, US medical schools need to provide students with childhood obesity-specific and general nutrition education. To build their self-efficacy in nutrition counseling, schools can use a combination of observation and practice led by skilled physicians and other healthcare providers. Increasing students' self-efficacy through training may help them overcome perceived barriers to childhood obesity prevention and treatment. [ABSTRACT FROM AUTHOR]

Aims: In the UK, people tend to have poor knowledge of government guidelines for alcohol use, and lack the motivation and skills required to use them to monitor their drinking. The study aim was to determine whether using glasses marked with such guidelines would improve knowledge and attitudes, increase frequency of counting units and lower alcohol intake. Methods: A total of 450 adults in the UK participated in an intervention vs control study with 1-month follow-up. The intervention group was encouraged to use glasses supplied by the researchers that indicated the unit content of drinks of different strengths and volumes, and stated the intake guidelines. Data were collected online. A further more in-depth interview with 13 intervention group participants enquired into their experiences of using the glasses. Results: Analyses adjusted for baseline variables showed that the intervention improved the following: knowledge of unit-based guidelines, ability to estimate the unit content of drinks, attitudes toward the guidelines and frequency of counting unit intake. However, there was no significant difference in alcohol consumption between the groups at follow-up. Interviews suggested that the glasses encouraged people to think about their drinking and to discuss alcohol with other people. The design of the glasses was not appealing to all, and their initial impact did not always persist. Conclusion: Use of unit-marked glasses led to changes in people’s reported use of unit-based guidelines to monitor their drinking but, in the short term, no change in consumption. Qualitative data suggested that the glasses could have an impact at the individual level (on knowledge and attitudes) and at a broader level (by prompting discussion of alcohol use). [ABSTRACT FROM AUTHOR]

There are significant controversies regarding rising antipsychotic prescription trends in children and adolescents. Many pharmacoepidemiology trend studies have been published, and interpretations of these data are helpful in explaining what is happening in prescribing practices, but not why these patterns exist. There is a lack of qualitative data in this area, and the experience of prescribing antipsychotics to children and adolescents has not been adequately researched. We conducted a qualitative study using an interpretive phenomenological analysis of physicians’ experiences of antipsychotic prescribing to children and adolescents. Prescribers participated in individual interviews and a focus group. We used a staged approach for data analysis of transcriptions. In all, 11 physicians including psychiatrists and general practitioners participated in our study. We identified themes related to context, role and identity, and decision-making and filtering. Struggles with health system gaps were significant leading to the use of antipsychotics as substitutes for other treatments. Physicians prescribed antipsychotics to youth for a range of indications and had significant concerns regarding adverse effects. Our results provide knowledge regarding the prescribers’ experience of antipsychotics for children and adolescents. Important gaps exist within the health system that are creating opportunities for the initiation and continued use of these agents. [ABSTRACT FROM AUTHOR]

Purpose – Stigma towards people with mental health problems is a significant problem and appears trenchant despite recent anti-stigma campaigns. Attitudes develop in young children, and may be stronger and less malleable in adolescence. Early intervention may be important for mental health education and stigma prevention. Theory, evidence and practical considerations all suggest that teachers’ involvement is key. By exploring communication about mental health between teachers and young children, it will be possible to elaborate how stigma develops and may be ameliorated. The purpose of this paper is to explore teachers’ accounts of this communication and the factors that influence it. Design/methodology/approach – Semi-structured interviews with 15 primary school teachers were transcribed and analysed using a grounded theory approach. Findings – Discussions about mental health were largely absent from the classroom, due to teachers’ anxiety. Teachers felt the need to protect children from exposure to people with mental health problems and even from information about the topic, believed they lacked the necessary expertise, worried that such discussions were outside their remit and were anxious about parents’ reactions. Originality/value – This was the first study to interview teachers on this topic and suggests that a significant opportunity to address fear and stigma is being missed. Teachers’ silence may reinforce that mental health problems are taboo, and prevent children from developing knowledge and a language to talk about mental health. The inclusion of teachers in early mental health education and could promote better understanding and more inclusive attitudes, especially if supported by educational policy and curriculum. [ABSTRACT FROM AUTHOR]

Background: Clergy are often important sources of guidance for patients and family members making medical decisions at the end-of-life (EOL). Previous research revealed spiritual support by religious communities led to more aggressive care at the EOL, particularly among minority patients. Understanding this phenomenon is important to help address disparities in EOL care. Objective: The study objective was to explore and describe clergy perspectives regarding 'good' versus 'poor' death within the participant's spiritual tradition. Methods: This was a qualitative, descriptive study. Community clergy from various spiritual backgrounds, geographical locations within the United States, and races/ethnicities were recruited. Participants included 35 clergy who participated in one-on-one interviews ( N = 14) and two focus groups ( N = 21). Semistructured interviews explored clergy viewpoints on factors related to a 'good death.' Principles of grounded theory were used to identify a final set of themes and subthemes. Results: A good death was characterized by wholeness and certainty and emphasized being in relationship with God. Conversely, a 'poor death' was characterized by separation, doubt, and isolation. Clergy identified four primary determinants of good versus poor death: dignity, preparedness, physical suffering, and community. Participants expressed appreciation for contextual factors that affect the death experience; some described a 'middle death,' or one that integrates both positive and negative elements. Location of death was not viewed as a significant contributing factor. Conclusions: Understanding clergy perspectives regarding quality of death can provide important insights to help improve EOL care, particularly for patients highly engaged with faith communities. These findings can inform initiatives to foster productive relationships between clergy, clinicians, and congregants and reduce health disparities. [ABSTRACT FROM AUTHOR]