Trans people perceptions of care received from healthcare professionals - A phenomenological study.

Introduction: Trans people have unique health needs and turn to the public health system to meet them. Offering them a more inclusive assistance requires health professionals to know these needs and work on cultural competence. Understanding trans people perceptions of service received will improve therapeutic relationships and the assistance provided to them. Objective: To understand trans patients experiences with health care and their perception of care rendered by the Andalusian Public Health System. Design: A qualitative phenomenological study according to Ricoeur's hermeneutic approach. Methodology: 18 in-depth interviews were conducted between January and April 2022 with trans adult users of the Andalusian Public Health System. These interviews were audio recorded, transcribed and analyzed following the steps proposed by Tan. The Consolidated Criteria for Reporting Qualitative Research was used for writing the study report. Results: Three themes were generated from trans patients experiences in the Andalusian Public Health System related to the assistance provided to them: 1) Positive and negative feelings during their pass through the public health system, 2) The importance of being able to receive the care they need, and 3) Having the chosen identity in official documents in order to utterly complete their transition. Conclusion: Care rendered by healthcare professionals to trans people was received as positive in mostly cases. However, trans people think these professionals need more training in order to avoid some behaviors they perceive as discriminatory and which they believe tends to pathologize gender identity. They also require more information about the treatments in particular they are about to receive and they demand to end drug shortages. Administrative procedures to change identity are also problematic. So the healthcare system must undergo some modifications in order to become more inclusive.

Muslim and Christian Women's Perceptions of the Influence of Spirituality and Religious Beliefs on Motherhood and Child-Rearing: A Phenomenological Study.

(1) Background: Spirituality is a factor that plays a role in decisions related to health and illness. When a woman becomes a mother, she undergoes physical, psychological, and social changes for which healthcare professionals must provide the necessary care. However, women may feel misunderstood and stigmatized when they carry out their religious practices and express their spirituality related to motherhood. The aim of this study was to describe the experiences of women with Muslim and Christian religious ideologies on the influence of spirituality and religious beliefs in motherhood and child-rearing. (2) Methods: A descriptive phenomenological qualitative study with two groups of women of Islamic and Christian ideology, respectively. Three focus groups and in-depth interviews were conducted, recorded, transcribed, and analyzed with ATLAS.ti 7.0. An inductive analysis was carried out according to the Moustakas model. (3) Results: Three themes were identified: religious and cultural aspects that determine child-rearing, the influence of spirituality and family on the mother's role, and the support received from healthcare personnel. (4) Conclusions: Spirituality and religious beliefs are manifested during motherhood and child-rearing in the form of infant feeding, the need for their protection, or the need for support from mothers. Healthcare personnel must be able to offer culturally competent and spiritually respectful care. Patients should not be judged based on their spirituality.

Young Women's Attitudes and Concerns Regarding Pornography and Their Sexual Experiences: A Qualitative Approach.

This study explores female university students' attitudes toward and concerns about pornography, based on their experience watching it and on sexual encounters with men. It used a qualitative descriptive design. Individual semi-structured interviews were conducted with 22 participants between March and April 2020. Thematic data analysis was performed using COREQ reporting guidelines. Three themes emerged from the data: (1) the sexual learning process, (2) the role of pornography in women's sexuality, and (3) sexual experiences. Participants reported how they learned about sexuality and how pornography influenced sexual experiences. Self-esteem issues and societal norms regarding hair removal and difficulty saying "no" to unwanted or humiliating sexual practices were found. The young women were not comfortable with women's representations in mainstream pornography. They blamed pornography for negative sexual experiences and claimed it influenced them and young men. Participants usually assumed submissive roles during sex and permitted aggressive sexual behaviors. The study reveals valuable information on how young women learn about sex and their difficulty in refusing unwanted sexual activities and even aggressive practices. Sexual education programs should include assertiveness training to improve sexual health, consent, and well-being.

Experiences of poverty amongst low-income older adults living in a high-income country: A qualitative study.

AIM: To understand the experience of low-income older adults living in poverty in a high-income country. DESIGN: A qualitative study based on Gadamer's hermeneutic phenomenology. METHODS: A convenience sample of twenty-seven low-income older adults were interviewed in-depth between September 2021 and January 2022. Fleming's method for conducting phenomenological qualitative studies was followed and ATLAS.ti software was used for data analysis. RESULTS: Three main themes were extracted from the analysis: (i) 'living in the shadow of poverty', (ii) 'unprotected by the 'social shield' of the welfare state' (iii) 'the struggle to attain good health'. CONCLUSION: Living in poverty affects all spheres of life. Older adults living in poverty feel excluded from social support policies and laws. This has a negative impact on the older adults' mental health and can lead to social isolation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nursing interventions to promote health amongst older adults living in poverty should include an assessment of the patient's social determinants and a focus on increasing social participation. Older people living in poverty experience difficulties accessing formal social support so nurses should implement patient navigation interventions that aim to help them overcome the complexities of the system. Nursing interventions to improve mental health amongst older adults living in poverty are much needed. IMPACT: Living in poverty increases older adults' vulnerability. Older adults living in poverty suffer from mental health issues as they live under constant pressure to meet their basic needs and lack formal social support. These findings are important for nurses, who play a pivotal role in the design, implementation and evaluation of policies and interventions that promote health equity. REPORTING METHOD: The study has been conducted following the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: There has been no public or patient involvement in the design or development of the study.

Lived experiences and opinions of women of sub-Saharan origin on female genital mutilation: A phenomenological study.

AIMS AND OBJECTIVES: This study aimed to describe and understand the lived experiences and opinions of sub-Saharan women living in Spain in relation to female genital mutilation. BACKGROUND: Female genital mutilation is a bloody procedure with serious consequences for the health of women and girls. Understanding mutilated women's lived experiences plays a crucial role in the management of health consequences and could help healthcare professionals to provide assistance to these women. DESIGN: A descriptive phenomenological study was carried out. The COREQ checklist was followed as guidance to write the manuscript. METHODS: A total of 12 in-depth interviews were conducted. Interviews were recorded, transcribed and analysed using ATLAS.ti 9.0. RESULTS: Two themes with four subthemes were identified from the data analysis: 1) 'The traumatic experience of female circumcision' with the subthemes 'Female mutilation is a physical and psychological torture procedure' and 'recognising and coping with negative emotions'; 2) 'The fight for the eradication of female genital mutilation' which contains the subthemes 'the need for a real sociocultural change at the origin' and '"I want to be the last": Personal development leads to sociocultural change'. CONCLUSIONS: Female genital mutilation was experienced by women as a very aggressive and traumatic event. It causes considerable negative emotions that last over time. Although there is a tendency to reject the practice, in women's countries of origin, there is social pressure for girls to be mutilated. RELEVANCE TO CLINICAL PRACTICE: Caring for women who have suffered from female genital mutilation requires awareness of the traumatic experience they underwent when they were girls. Healthcare professionals play a crucial role in eradicating female genital mutilation. Apart from education, preventive measures may include specific recommendations when girls are travelling to the country of origin and participatory action research.

Nursing students in Saharan refugee camps: Expectations and options of professional future from a qualitative perspective.

AIM: The aim of this study was to explore and understand the perceptions of the expectations of the professional future of nursing students who study in Saharan refugee camps. BACKGROUND: Part of the Saharan population live in refugee camps with a precarious healthcare system, which depends on nursing professionals who are trained in the only nursing school in the world that exists inside a refugee camp. DESIGN: An interpretive qualitative research methodology using Gadamer's philosophical hermeneutics. METHODS: A qualitative study with nursing students (n = 14) of different years from the nursing school in a Saharan refugee camp (Algeria) in 2021. Focus groups recorded in audio for subsequent transcription and analysis by two researchers through Fleming´s stages. RESULTS: Three themes were identified as important aspects of the personal and professional expectations perceived by this population group: (1) studying nursing as a moral obligation; (2) Culture as a determinant for dropping out of school; and (3) aspirations for a professional future in the Saharan refugee camps. The participants highlighted the role of social and cultural aspects to complete their studies and develop a professional career. CONCLUSIONS: These Saharan nursing students can study a nursing speciality or work in healthcare. However, they struggle to choose between the moral obligation of doing so and the social and cultural factors that lead some of them to abandon their studies. TWEETABLE ABSTRACT: The possibility of studying for a career and the professional future of Saharan nursing studies are conditioned by the environment, culture and the socio-economic situation. Their work is especially important in the refugee camps where they live.

A Qualitative View of Homecare Support Workers on Unmet Health Needs of People with Dependency.

BACKGROUND: Longevity and population growth generate an increase in the number of people with dependency, who require homecare assistance to meet their health needs. Homecare support workers provide this care in Spain, and they may have unique insights into the unmet health needs of those receiving homecare assistance. The aim of this study was to determine the unmet health needs of people with dependency based on the perspective of homecare support workers. METHODS: Qualitative exploratory-descriptive study. Through convenience sampling, homecare support workers from a Spanish province were selected, following inclusion and exclusion criteria. Four focus groups, transcription and thematic analyses were performed using Atlas.ti. Coding triangulation was carried out, applying criteria for scientific rigour. RESULTS: The six themes obtained were classified into the material, psychoemotional, socioeconomical and psychosocial needs of people with dependency from the point of view of homecare support workers, along with the contributions of improvements and the need of these professionals for continuous training. CONCLUSIONS: People with dependency need complex technical assistance, materials, psychological attention due to their situation, and more effective assessments of their health and disability status. Homecare support workers perceive themselves to be essential in these assessments. They ask for psychological assistance, due to the emotional burden of their work, and believe this help would contribute to improving the quality of their service. Homecare support workers perceive that they are capable of performing their job, although they believe that some delegated activities are beyond their levels of competency.

Economic Problems and Loneliness as Factors Related to Subjective Unmet Health Needs in People with Chronic Diseases and Dependency.

Background: The continuous increase of people with chronic diseases is one of the greatest challenges for healthcare systems worldwide. Population growth and life expectancy means that an increasing number of people with chronic diseases and dependency need some kind of assistance to meet their needs. Determining these subjective unmet needs helps to understand the situation of these people. The aim of this study was to explore the perceptions of chronic patients over 65 years of age from the day-care center toward subjective health needs that are not being met by the socio-health system. Methods: Qualitative exploratory-descriptive study. Through convenience sampling, we selected people with chronic diseases and dependency who used day-care centers and met the inclusion criteria. Focus groups were performed. The data were transcribed and a thematic analysis was carried out using Atlas.ti software. Results: The topics resulting from the analysis were classified into dissatisfaction of biological/physiological needs, psychological needs, social needs, and other issues that arose in both groups of participants which referred to the types of needs previously indicated. The issues related to social and psycho-social needs stood out. Conclusions: People with chronic diseases and dependency have their physiological needs covered with the help they receive, but their situation of dependency generates additional costs that worsen their economic situation. However, their greatest need is due to the loneliness they feel and the feeling they have of "being a burden" on their families.

Updates in Hypertension Studies According to the Main Clinical Trials: A Review of the Past 45 Years about Pharmaceutical Intervention Effects.

BACKGROUND: High blood pressure remains one of the most important risk factors for cardiovascular disease. Although there is no consensus, all the clinical practice guidelines agree on the need to reduce blood pressure levels to minimize the risks. There are many clinical trials conducted to try to find the best pharmacotherapy to achieve this goal. The aim was to compare the main international randomized clinical trials on hypertension in people older than 50 years. METHODS: Literature qualitative review of randomized clinical trials selected from PubMed and UpToDate in people older than 50 years, from 1985 until 2020. The clinical trials conducted during this period show variability in the drugs used, the inclusion criteria for blood pressure figures, and the consideration or not of other vascular risk factors (smoking, obesity, lipid disorders, diabetes, and physical inactivity). RESULTS: Of the 8334 articles found, 19 of them fulfilled the inclusion and exclusion criteria that involved 202,638 people. The main findings of each investigation were grouped as follows: incidence of non-cardiovascular death, death of cardiovascular origin, coronary heart disease, cerebrovascular disease, renal failure, and hypertensive retinopathy. In all patients, blood pressure figures were reduced, although this did not always lead to statistically significant differences in morbidity and/or mortality risk reduction. Twelve of them found risk reduction as an effect of reduced blood pressure. CONCLUSIONS: Randomized clinical trials conducted on hypertension in people older than 50 years of age show variability in the inclusion criteria. Variability in the antihypertensive drugs used was observed in this population. Blood pressure figures were reduced in all cases, although without statistically significant differences in morbidity and/or mortality risk reduction.

Should We Be Trained to Train? Nursing Students' and Newly Qualified Nurses' Perception on Good Lecturers and Good Clinical Preceptors.

Background: The reform of the Spanish higher education studies from the Bologna Declaration did not entail the necessary changes in the teaching methodologies used. The clinical preceptor emerged as the main guiding professional in the practical training of nursing students. The aim of this qualitative study was to understand fourth-year nursing students' and newly qualified nurses' (NQNs) perception on their lecturers' and clinical preceptors' effectiveness. Methods: Exploratory, descriptive qualitative study was carried out at a Spanish University. By convenience sampling and according to defined inclusion and exclusion criteria, twelve newly qualified nurses and twelve fourth-year students of the Degree in Nursing were included in order to contrast the results. A thematic analysis of data was carried out, to later be coded by two researchers. Results: Two main themes were identified: the good lecturer and the good clinical preceptor, with several subthemes in each. These included the characteristics that both should have, both in teaching, nursing and interpersonal-relation skills. Conclusions: The need of preceptorship training programs has been highlighted in our context. Educators all over the world should be properly qualified in order to train and educate competent nurses for the future.

Newly Qualified Nurses' Perception of Their Competency Achievement on Leaving University: A Qualitative Study.

Background: After implementing the Tuning Educational Structures in Europe Project, numerous efforts have been made to define, establish, and evaluate nursing competences. The European Federation of Nurses Association played a key role in enacting the nursing competences included in Directive 2013/55/EU. Nevertheless, assessing competences remains elusive, and there is little research into nurses' perceptions of the competency training provided by their universities. The purpose of the study was to explore the perceptions and experiences of newly qualified nurses about the competences they acquired during their university education. Methods: A qualitative research study was developed in a Spanish university. Twelve semi-structured interviews with newly qualified nurses were conducted, and two focus groups made up of twelve students were carried out in order to triangulate the results. Participants were recruited through email contact. Interviews focused on clinical training, theoretical content, and the reality of healthcare. Data was analyzed thematically. Results: Two main themes emerged: (1) improving theoretical content and (2) rethinking practical lessons and clinical training. A lack of knowledge about mental health, pharmacology, or critical care has been found; in addition, it was highlighted, among others, the need to improve communication skills in difficult and conflictive situations. Conclusions: Considering the participants' perception of deficiency in some aspects of most of the competences established by the European Federation of Nurses Association, further research has been suggested to include other stakeholders' views.

Is It Possible to Become a Nurse in a Refugee Camp?

The history of the Western Sahara has been marked by several events that have contributed to the protracted refugee situation in which the Sahrawi people have found themselves since 1975: the Spanish colonization and the subsequent decolonization process, the armed struggles between the indigenous population and the states of Morocco and Mauritania to occupy Western Saharan territory, assassinations and repression of the Sahrawi population, and the economic interests of external agents with regards to mineral resources. Twenty-five years ago, in the hostile environment of the Sahrawi refugee camps, a nursing school was founded. Essentially depending on foreign aid, this school has been responsible for training nursing professionals to meet the healthcare needs of the population. The aim of this paper is to provide an approach to the origin and evolution of nursing education for the Sahrawi refugee camps. The Sahrawi are the only refugee camps in the world to host such nursing schools.

Assessment of Nursing Care and Teaching: A Qualitative Approach.

BACKGROUND: The reform of the Spanish higher education to adapt to the European Higher Education Area involves, among other issues, the students' participation in the curriculum assessment. The aim is to understand the insights of both nursing professionals and current undergraduate students of nursing on the connection between the knowledge acquired throughout the degree and the professional healthcare practice. METHODS: An exploratory, descriptive qualitative study was carried out at a Spanish University. By convenience sampling, twelve nursing professionals and twelve 4th-year students of the Degree in Nursing were included. In two phases, twelve semi-structured interviews and two focus groups were conducted in order to triangulate data. A thematic analysis of data was carried out, later to be coded by two researchers. RESULTS: Two main themes were identified: Evidence-based nursing vs. experience-based nursing, and a theory-practice gap. The topics that were specifically highlighted were the coexistence between professionals who work according to evidence and those whose work is based on experience, and the lack of connection between the training received during the degree and actual healthcare practice. CONCLUSION: Nursing care work varies in terms of the implementation of evidence-based care. Nursing training is perceived as being affected by a theory-practice gap. To achieve the linking between nursing theory and practice, a great effort on stakeholders would be needed.

Is it possible to become a midwife in a refugee camp?

The historical backdrop of Western Sahara has meant that, for the last 43 years, part of its indigenous population has survived in refugee camps located in the Algerian desert. International aid from abroad has become the main source of sustenance for all people living in this hostile environment. Since the beginning of this type of settlement, the Sahrawi Arab Democratic Republic has been concerned with creating the necessary infrastructures to meet the health needs of the people living in these conditions. As a result, the Ahmed Abdel-Fatah School of Nursing was created in the Sahrawi refugee camps, which began to train midwives to care for women during the stages of pregnancy, childbirth and postpartum in 2002. The aim of this paper is to provide an approach to the origin and evolution of midwifery education for the Sahrawi refugee camps, in the only school of nursing that exists worldwide in a refugee camp.

Quality Assurance in Nursing Education: A Qualitative Study Involving Students and Newly Graduated Nurses.

Background: Assuring quality training for future nursing professionals is essential to preserving population health and socio-economic development. Quality assurance in the European Higher Education Area places students in a leading role to transform and improve higher education programs. Therefore, an innovative way of reviewing strengths and weaknesses of the nursing education program of a Spanish university has been developed. Objectives: The aim of this paper was to explore the perceptions and opinions of nursing students and newly-qualified nurses regarding the contents of the nursing curriculum in order to improve its quality. Methods: Descriptive and exploratory qualitative research was carried out involving 12 newly-qualified nurses and 12 student nurses. Semi-structured interviews and focus groups were performed. Results: Based on the thematic analysis, two themes emerged: improving clinical practices and reviewing the theoretical curriculum. Conclusions: Among the improvements suggested by the participants, the most relevant ones were establishing a clear structure of learning contents in the practicum, and redistributing the European Credit Transfer and Accumulation System ECTS credits in various courses of the study program. However, additional evidence is needed prior to proceeding with any changes.

Association of cardiovascular emerging risk factors with acute coronary syndrome and stroke: A case-control study.

In this study, we estimated the risk of acute coronary syndrome and stroke associated with several emerging cardiovascular risk factors. This was a case-control study, where an age - and sex-matched acute coronary syndrome group and stroke group were compared with controls. Demographic and clinical data were collected through patient interviews, and blood samples were taken for analysis. In the bivariate analysis, all cardiovascular risk factors analyzed showed as predictors of acute coronary syndrome and stroke, except total cholesterol and smoking. In the multivariate logistic regression model for acute coronary syndrome, hypertension and body mass index, N-terminal section brain natriuretic peptide and pregnancy-associated plasma protein-A were independent predictors. For stroke, the predictors were hypertension, diabetes mellitus, body mass index, and N-terminal section brain natriuretic peptide. Controlling for age, sex, and classical cardiovascular risk factors, N-terminal section brain natriuretic peptide and pregnancy-associated plasma protein-A were independent emerging cardiovascular risk factors for acute coronary syndrome, but pregnancy-associated plasma protein-A was not for stroke. High levels of cardiovascular risk factors in individuals with no episodes of cardiovascular disease requires the implementation of prevention programs, given that at least half of them are modifiable.