How health seeking behavior develops in patients with type 2 diabetes: a qualitative study based on health belief model in China.

Background: Type 2 diabetes(T2DM) is a global health problem which is accompanied with multi-systemic complications, and associated with long-term health burden and economic burden. Effective health seeking behavior (HSB) refers to reasonably utilize health resources, effectively prevent and treat diseases, and maintain health. Effective health seeking behavior (HSB) is vital to mitigate the risk of T2DM complications. However, health seeking behavior for T2DM patients remains sub-optimal worldwide. Objective: The study aimed to explore the internal logic of how health seeking behavior of T2DM patients develops and the influencing factors of health seeking behavior. With a view to provide a reference basis for improving the health seeking behavior situation of T2DM patients. Methods: This study was conducted at an integrated tertiary hospital in China. People who were diagnosed with T2DM, capable of expressing clearly and had no mental illness, were approached based on a purposive sampling. The experience of T2DM and health seeking behavior were collected via in-depth interviews. A theory-driven thematic analysis based on Health Belief Model (HBM) was applied for data analysis. Inductive reasoning was used to identify emerging themes which were not included in HBM. Results: 26 patients with T2DM were included in the current study. Seven themes were identified, including: (1) T2DM diagnosis and severity; (2) T2DM treatment and management; (3) Perceived susceptibility of diabetes progression; (4) Perceived severity of diabetes progression; (5) Perceived benefits of health seeking behavior; (6) Perceived barriers of health seeking behavior; (7) Perception of behavioral cues. Generally, patients with T2DM lacked reliable sources of information, considered T2DM to be slow-progressing and without posing an immediate threat to life. Consequently, they did not fully grasp the long-term risks associated with T2DM or the protective effects of health seeking behavior. Conclusion: This study highlighted the challenges in health seeking behavior for patients with T2DM. It suggested that future interventions and strategies should involve multi-faceted approaches, targeting healthcare providers (HCPs), patients with T2DM, and their support networks. This comprehensive strategy can help patients better understand their condition and the importance of effective health seeking behavior. Ultimately, enhancing their capacity for adopting appropriate health-seeking practices.

Responsible coordination of municipal health and care services for individuals with serious mental illness: a participatory qualitative study with service users and professionals.

BACKGROUND: Care coordination is crucial to ensure the health of individuals with serious mental illness. The aim of this study was to describe and analyze an inclusive innovation process for coordinating municipal health and care services for individuals with serious mental illness. METHODS: We conducted café dialogues with professionals and service users with serious mental illness. The café dialogues engaged participants in conversation and knowledge exchange about care coordination, adressing topics of efficiency, challenges, and improvement. We used a responsible innovation framework to analyze the innovation process. RESULTS: Responsible coordination requires promoting service users' health and ensuring communication and mutual awareness between professionals. Individual-level factors supporting responsible coordination included service users knowing their assigned professionals, personalized healthcare services, and access to meaningful activities. Provider-level factors included effective coordination routines, communication, information exchange, and professional familiarity. Results reflect professionals' and service users' perspectives on efficient care coordination, existing challenges, and measures to improve care coordination. CONCLUSION: Café dialogues are an inclusive, participatory method that can produce insights into the responsible coordination of municipal health and care services for individuals with serious mental illness. The responsible innovation framework is helpful in identifying care coordination challenges and measures for responsible coordination.

A qualitative inquiry to explore management of distal radius fracture by certified hand therapists.

BACKGROUND: Distal radius fractures (DRF) are extremely common in middle-aged and elderly. Certified Hand Therapists (CHT) are experts in managing hand injuries including DRF. PURPOSE: Using qualitative methodology, this study examined practice patterns among CHT and understand prevalent common patterns in managing DRF. STUDY DESIGN: Descriptive qualitative study. METHODS: This study utilized a qualitative descriptive method with an inductive approach to discern the practices of CHT in managing DRF. A purposive sample of practicing CHT was assembled. A semi-structured interview guide facilitated qualitative interviews using open-ended questions to assess practices of CHT in the domains of assessment, interventions, and appropriateness for discharge. Two student physical therapists transcribed the interviews, which were verified by a third rater for accuracy. Thematic content analysis guided the coding and analyses of the interview data. A two-phase coding process was conducted using Nvivo software. Two study authors developed initial codebook and completed subsequent analysis of transcripts. RESULTS: Of the 12 participants, five were PT and seven were OT with an average experience of 14.1 years as a CHT. Practice patterns across domains were largely consistent among CHT. All CHTs reported inquiring about severity of displacement of DRF, orthopedic management, comorbidities, and medical history as well as examining wrist/hand range of motion (ROM), grip strength (GS), and wrist functions (n = 12). A large majority administered outcome measures and performed sensory and integumentary assessment. Patient education regarding injury and exercises was the key element for interventions. Adequate gains in GS, wrist functions, wrist ROM, and ability to use wrist/hand for functional tasks were the key benchmarks for discharge from care. DISCUSSION: Most practice behaviors were common among CHTs while managing DRF. Some variations exist depending whether their primary discipline is PT or OT. The results highlight knowledge-to-action gap, where most CHTs do not integrate fall-risk management in DRF. CONCLUSIONS: This study identified common practice patterns among CHTs in managing DRF while also identifying opportunity to improve practice by integrating assessment of balance and fall-risk.

How to Evaluate Online Education for General Practitioners: Development of a Tailored Questionnaire for Heart Failure Education.

Physician-oriented online education could be a pathway to improve care for patients with heart failure, however, it is difficult to measure the impact of such education. Self-efficacy is a potential outcome measure. In this article, we develop a methodology for analyzing an educational intervention for general practitioners (GPs) using self-efficacy as a concept. This study was partly conducted within the setting of an observational study, IMPACT-B, where we developed online education for GPs. We designed and refined a 24-item questionnaire using item analysis, and exploratory and confirmatory factor analysis. Ninety-one GPs completed the questionnaire before and after the online education. Follow-up data after 6 months was available for 13 GPs. Item analysis revealed a high degree of internal consistency (coefficient alpha 0.95) and validity. Each additional year of experience was associated with an average baseline self-efficacy score of 0.50 points (95% CI [0.21-0.80]), and each additional patient in HF follow-up with an average score of 2.0 points (95% CI [0.48-3.5]). Items that differentiated most between GPs with high and low self-efficacy were the treatment of congestion as well as titrating medication and MRA in heart failure with reduced ejection fraction. Factor analysis reduced the number of questions to 14, mapping to three factors (diagnosis, treatment, and follow-up), and improved the model fit as measured by the goodness-of-fit indicator comparative-fit-index (from 0.83 to 0.91). We demonstrated a method to assess the impact of online education on general practitioners. This led to a questionnaire that was reliable, valid, and convenient to use in an implementation context.

Optimizing the Maastricht Work-Related Support intervention in clinical patient care: the value of integrating action research into intervention mapping.

BACKGROUND: Healthcare professionals (HCPs) are increasingly recommended to play an important role in supporting people with chronic disease in work participation. An intervention for HCPs to provide work-related support to their patients in clinical care was developed with intervention mapping (Maastricht Work-Related Support; Maastricht WRS). Action research proposes 'combining research and practice', which allows us to incorporate experiences of HCPs while implementing and to realize intervention's full potential. Therefore, the aim of this study is to explore, by integrating action research into an intervention mapping approach, how experiences of HCPs with early implementation can be used to optimize the Maastricht WRS in clinical care. METHODS: Semi-structured interviews were held with nine HCPs (response rate 82%), involved in care for people with inflammatory arthritis, knee problems or inflammatory bowel disease. Some of them were not yet trained in the Maastricht WRS while others had received the training and were providing the Maastricht WRS. RESULTS: All participants regarded WRS an important part of clinical care. Untrained HCPs indicated a lack of knowledge and skills in providing the Maastricht WRS, and a need for tools. Trained HCPs were satisfied with the training and tools, but stressed that practical limitations hindered providing the Maastricht WRS. Action research showed that the intervention meets the needs of HCPs, but need some optimizations: (1) organizing 'intervision' for HCPs, (2) inform and activate patients to discuss work with their HCP, (3) update initial tools and (4) including patients' work status in the electronic patient system. CONCLUSIONS: Action research integrated into intervention mapping proved to improve the Maastricht WRS intervention. By involving HCPs, the intervention could be optimized to provide to support people with chronic diseases in clinical care in healthy and sustainable work participation.

Perceptions and Experiences of Parents of Burn-Injured Children during Hospital Stay: A Need for Integrated Care.

Pediatric burn injuries are a critical medical condition that triggers a series of ongoing multifactorial stressors that affect both children and their families. To inform healthcare research and clinical practice, this study aimed to understand and describe the perceptions and experiences of the parents of burn-injured children during hospital stay. Forty-six parents (thirty-eight mothers) of forty-six children (eighteen girls) with a mean age of 2.28 years (SD = 1.52) answered ten open-ended questions. This qualitative study was conducted in a referral hospital in the northern region of Portugal. Qualitative data were analyzed using an inductive content analysis. Five key themes emerged from the data analysis: diving into the crisis of the child burn injury, being together and in good hands, becoming aware of an uncertain future, enhancing supportive care and environment, and finding ways to guide parents. Qualitative findings underlined the pressing need for integrated care within this context. Parents were significantly burdened and distressed during the inpatient phase. These parents should be included in the integrated care plan starting from admission. Understanding and addressing parents' healthcare needs and psychosocial adjustment difficulties is paramount to the development of future intervention programs and the delivery of suitable integrated healthcare.

Experiences of an Online Palliative Rehabilitation Programme for Spousal Caregivers of People With Amyotrophic Lateral Sclerosis and Cognitive and/or Behavioural Impairments: A Qualitative Interpretive Study.

Purpose: The purpose of this study was to understand how spousal caregivers of people with amyotrophic lateral sclerosis and cognitive and/or behavioural impairments felt about the EMBRACE intervention. Materials and methods: A qualitative interpretive study, using individual semi-structured interviews pre- and post-participation in a palliative rehabilitation blended learning programme, was applied. In total, 13 spousal caregivers were interviewed pre-intervention and 10 of them post-intervention. Results: Three overarching themes were identified: Striving to Obtain Control in Everyday Life, Peer support Across the Illness Trajectory and The Complexity of Relations. Information provided in targeted videos and sharing experiences with peers in virtual group meetings were beneficial to comprehend, manage and find meaning in everyday challenges related to being a caregiver. Conclusion: The EMBRACE intervention helped spousal caregivers cope with everyday needs and challenges related to being a caregiver. EMBRACE was found to support and strengthen the participants in gaining more control in everyday life, creating a sense of coherence. Through targeted videos and discussions with peers, the participants felt prepared for the illness trajectory of their relative. Peer support promoted resilient functioning and reduced their feelings of loneliness. Clinical trial registration: This study was registered on clinicaltrials.gov under the name: A Complex Intervention Study on a Palliative Rehabilitation Blended Learning Programme to Support Relatives and Health Care Providers of People with ALS and Cognitive Impairments in Coping with Challenges. ID no. NCT04638608. URL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT04638608&cntry=&state=&city=&dist=.

In situ simulation training strengthened bachelor of nursing students' experienced learning and development process- a qualitative study.

BACKGROUND: In advanced clinical learning labs on campus, high-fidelity simulation has become an essential educational approach in the Bachelor of Nursing Education programme. However, simulation while in clinical placement, in situ, is rarely used in Bachelor of Nursing Education. The aim of the present study was to explore how in situ simulation training at a surgical hospital ward, according to Bachelor of Nursing students, influenced their learning and development process. METHODS: A qualitative descriptive study was conducted. Data were collected through individual interviews with a sample of 21 s-year Bachelor of Nursing students who completed 40 in situ simulations during their eight-week clinical placement at a Norwegian University Hospital. Data were analysed using inductive content analysis. RESULTS: The data analysis generated six subcategories constituting two descriptive categories: building professional confidence and internalising nursing knowledge. Although the students found in situ simulation stressful and uncomfortable for being assessed by student peers, the teacher and preceptor, the process of managing clinical situations in simulation helped build professional confidence. What the students had learned in the simulation was directly transferable to real clinical situations because they were in the hospital setting. The simulation sessions enabled them to connect theoretical knowledge and clinical skills. They could test their skills in a safe environment, performing procedures that made them aware of how their knowledge could be used in real life. CONCLUSION: According to the Bachelor of Nursing students' own experiences, in situ simulation supported the students' learning process, connected theory and practice and contributed to developing confidence in the performance of clinical skills. Including simulation in clinical practice could prove to be an effective way of teaching and learning clinical skills in nursing regarding resources and learning outcomes.

Adaptation, Translation, and Validation of a Patient-Reported Experience Measure for Children and Young People for the Canadian Context.

BACKGROUND: Patient-reported experience measures (PREMs) evaluate children's and young people's (CYP) perceptions of care. An important PREM developed with and for children was created in London, UK. Given the absence of similar North American instruments, we aimed to adapt, translate, and linguistically validate this instrument for use in a Canadian pediatric outpatient setting. METHODS: A qualitative design was used, involving CYP and their parents/caregivers. Phase 1 entailed the English survey adaptation using think-aloud testing, revision, and cognitive testing. Phase 2 involved translation into French, revision and back-translation, and cognitive testing. Phase 3 encompassed a cross-validation of the English and French versions of the adapted instrument. RESULTS: Fifty-five children in 3 age groups (8-11y, 12-13y, 14-16y) participated in creating the Canadian PREM. In Phases 1 and 2, 41 children participated in reviewing and updating specific questions in the instrument, resulting in adjustments and revisions based on their feedback. In Phase 3, 14 bilingual children linguistically validated the PREM instrument. CONCLUSIONS: This study reports the development of the first Canadian PREM specifically tailored to children. By incorporating the perspectives and preferences of CYP in clinical practice, this approach has the potential to amplify the delivery of patient-centered care for this vulnerable population and ensure that the needs and voices of CYP are acknowledged. LEVEL OF EVIDENCE: V, Therapeutic.

Perceived barriers of family-centred care in neonatal intensive care units: A qualitative study.

BACKGROUND: Family-centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana. AIM: To describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers. STUDY DESIGN: The study employed a descriptive qualitative design. The researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist. RESULTS: Perceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes. CONCLUSION: The findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice. RELEVANCE TO CLINICAL PRACTICE: Health facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes.

Exploring the Lived Experiences of Individuals With Spinal Cord Injury During the COVID-19 Pandemic.

The global spread of severe acute respiratory syndrome coronavirus 2019 (COVID-19) has affected over 100 countries and has led to the tragic loss of life, overwhelmed health care systems and severely impacted the global economy. Specifically, individuals living with spinal cord injury (SCI) are particularly vulnerable during the COVID-19 pandemic as they often face adverse impacts on their health, emotional well-being, community participation, and life expectancy. The objective of this study was to investigate the lived experience of individuals with SCI during the COVID-19 pandemic in Ontario, Canada. An exploratory design with a qualitative descriptive approach was used to address the study objective. Nine semi-structured interviews were conducted with individuals with traumatic and non-traumatic SCI (37-69 years, C3-L5, AIS A-D, and 5-42 years post-injury). Using reflexive thematic analysis, the following themes were created: (1) Caregiver exposure to COVID-19; (2) Staying physically active in quarantine; (3) Living in social isolation; (4) Difficulty obtaining necessary medical supplies; (5) Access to health services and virtual care during COVID-19; and (6) Fighting COVID-19 misinformation. This is one of the first studies to explore the impact of COVID-19 on individuals living with SCI in Ontario. This study contributes to a greater understanding of the challenges faced by individuals living with SCI and provides insight into how to better support and respond to the specific and unique needs of individuals with SCI and their families during a national emergency or pandemic.

Diversion of medications to treat opioid use disorder: Qualitative findings from formerly incarcerated adults in Massachusetts.

BACKGROUND: Carceral officials often cite diversion of medication for opioid use disorder (MOUD) (e.g., buprenorphine) as a reason for not offering MOUD treatment in jails and prisons with little understanding of patient perspectives. We aimed to understand patient perceptions of medication diversion from jail-based MOUD programs and the factors that contribute to and reduce diversion. METHODS: We conducted thematic analyses of semi-structured interviews held in 2021-22 with 38 adults who received MOUD treatment and were released from eight Massachusetts jails that had implemented a MOUD program on or after September 2019. RESULTS: Consistent with prior reports from carceral staff, patients perceived MOUD diversion to happen less frequently than expected, which they attributed to dosing protocols that have effectively reduced it. Patients reported that MOUD availability reduced the contraband buprenorphine market, although other contraband substances have entered jails (fentanyl, oxycodone, K2). Patients perceived Subutex to have greater misuse potential and added diversion risks. Patients valued graduated consequences and other efforts to reduce MOUD diversion and contraband for making jails safer and for enabling patients to receive treatment. Nearly all participants reported having heard about, witnessed, or been involved in actual or attempted diversion, with variation in reports by jail. Patients suggested that dispensing MOUD to all who need it immediately upon intake would be the most effective way to reduce MOUD diversion and contraband. CONCLUSION: Formerly incarcerated patients perceived MOUD diversion within jail medication programs as occurring less often than expected and that it can be reduced with appropriate protocols. To help limit medication diversion, patients recommended provision of MOUD upon intake to all individuals with opioid use disorder who need it. Findings have implications for MOUD program adaptation, successful routinization, and diffusion in carceral settings.

Good life in old age: Qualitative interviews about ageing with older adults with mild intellectual disability, prior to an educational intervention.

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

Exploring key determinants of health among individuals with serious mental Illness: qualitative insights from a first episode psychosis cohort, 20 years postdiagnosis.

BACKGROUND: Individuals with serious mental illness (SMI) are more likely to experience functional decline, low well-being, comorbidities, shorter lifespan, and diminished quality of life than the general population. This qualitative study explores determinants of health that individuals with SMI perceive as important to their health, well-being, and ability to live a meaningful life. METHOD: We conducted interviews with 13 individuals with early detected first episode psychosis as part of a 20-year follow-up study of a larger cohort. Interview data were analyzed using qualitative content analysis. RESULTS: Analysis identified two themes comprising eight categories representing determinants of health. The first theme reflected management of mental and physical health. Categories in this theme were: access to mental healthcare adapted to individual needs, strategies during deterioration, use of psychotropic medication, maintenance of physical health and lifestyle. The second theme reflected social health determinants in coping with mental illness and comprised three categories: family and friends, engaging in meaningful hobbies and activities, and the influence of employment on mental health. CONCLUSIONS: Individuals with SMI outlined mental, physical, and social determinants of health that were important for their health, well-being, and ability to live a meaningful life. In future clinical practice, coordinated care addressing the complexity of health determinants will be important.

"I don't know if you have searched through the scriptures to find a reference on HIV/AIDS. I mean there isn't going to be one, right?": HIV stigma solutions from dialogues between faith leaders and health care workers.

In South African communities, both faith leaders and health care workers play a vital role in supporting the health of community members and people living with HIV in particular. This study describes HIV stigma when faith leaders and health care workers engaged in discourse. The study used a descriptive qualitative inquiry design. Data were gathered between 2015 and 2016 in the areas of Masiphumelele and Gugulethu in Cape Town, South Africa. Three themes emerged: (1) participants identified influences that can increase HIV stigma; (2) participants shared the challenges that they face to reduce HIV stigma; and (3) participants suggested solutions to reduce HIV stigma. Themes discussed include ground-level problems and practical solutions to address HIV stigma in faith communities. Collaboration between faith leaders and health care workers are vital resources in the fight against HIV stigma. Future research and interventions should aim to promote organised collaboration between faith communities and health care structures.

An exploration of the relationship between voices, dissociation, and post-traumatic stress disorder symptoms.

OBJECTIVES: Extensive research has shown voice hearing to be associated with symptoms of Post-Traumatic Stress Disorder (PTSD) and dissociation. However, most studies have adopted a quantitative design, using cross-sectional data sampling methods, precluding temporal relationships between variables from being defined. DESIGN: Using a qualitative design, this study sought to identify potential symptom relationships by addressing the research question: what is the nature of the temporal relationship between voices, dissociation and PTSD symptoms? METHODS: Seven voice hearers (aged 27 to 68 years) participated in a semi-structured interview exploring voice hearing, PTSD symptoms, and dissociation. The interviews were analysed using Interpretative Phenomenological Analysis. RESULTS: One superordinate theme was identified in the data. Voices were observed to occur in dynamic interrelationship with PTSD symptoms and dissociation, and were frequently experienced before and after PTSD symptoms and dissociative episodes. CONCLUSIONS: Implications for theoretical understandings of voice hearing and future research are discussed.

Through a relational lens: reflections about foster care experience in Italian emancipated foster youth.

The study aimed to investigate relational outcomes of Italian emancipated foster youth across open-ended reflections about their perceptions of their relationships with the biological and foster family, with partner and peers. A total of 26 Italian emancipated foster youth (19-25 years old) recruited by social services completed a single in-depth interview. A qualitative thematic analysis was selected for this study. The results revealed two major themes of foster care experience that emerged often simultaneously from the participants' narration: (1) Positive Relational Outcomes including "Feeling supported," "Sense of belonging," "Good memories," "Relationship with family of choice," and "Staying in touch"; and (2) Negative Relational Outcomes referring "Devaluation," "Refuse," "Bad memories," and "Isolation." Foster care experience leads to complex relational perceptions in emerging adulthood according to different relational outcomes and ways of processing foster care experience. Professionals could work on relational outcomes and memories, especially during a critical transition like emerging adulthood, to support youth in making sense of their past experiences.

Verbal violence and missed nursing care: A phenomenological study.

AIM: To define the missed care experiences of nurses exposed to verbal violence from patients. BACKGROUND: Verbal violence takes the first place among the types of violence that nurses face in healthcare settings. This can cause negative emotional and physical responses in nurses and issues in patient and nurse interaction. As a result, it may lead to missed nursing care, defined as skipped, postponed or incomplete care during the patient's care. METHODS: This is a phenomenological study. The study sample included 16 nurses working in inpatient clinics who reported experiencing verbal violence at least once in Turkey. The study was conducted between January and February 2022 with institutional permission and ethics committee approval (09/12/2021-2021/357). A semi-structured interview method was used to collect data. The information gathered from the interviews underwent thematic analysis using an inductive approach. The 'Consolidated Criteria for Reporting Qualitative Research (COREQ)' was used to report this qualitative study based on a comprehensive protocol. RESULTS: The types of verbal violence most frequently faced by nurses were determined as swearing, insulting, shouting and threats. Study findings were classified into three main themes: (i) response to verbal violence, (ii) missed nursing care experiences and (iii) suggestions to cope with verbal violence. The most felt emotions in the face of verbal violence were feeling sad, unsafe and worthless. Nurses common behaviours, in response to verbal abuse were ignoring, getting used to, and wishing to get away. The examples of missed care included using non-therapeutic communication, postponing care or withdrawing from care. CONCLUSION: Verbal violence caused negative emotional and behavioural responses in nurses, which, in turn, negatively affected the nurse-patient interaction. These findings mean that verbal violence may pave the way for missed nursing care. IMPLICATIONS FOR NURSING POLICY: According to these findings, an uninterrupted nursing care process needs to focus on preventive measures against verbal violence and increase the administrative and legal support offered to nurses.

Experiences of dialogue in advance care planning educational programs.

BACKGROUND: Advance care planning (ACP) is a process in which adults engage in an ongoing dialogue about future medical treatment and care. Though ACP is recommended to improve the quality of end-of-life care, the details of the dialogue experience in ACP are unknown. OBJECTIVE: To explore participants' experiences of dialogue in an ACP educational program that encouraged them to discuss the value of a way of life. RESEARCH DESIGN: This qualitative descriptive study used the focus group interview method. Data were analyzed using qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT: A dialogue-based ACP educational program was conducted in four regions in Japan for local citizens to discuss the value of their way of life. A total of 66 individuals (mean age = 55.5 ± 17.2 years; 50 women and 16 men) participated in focus group interviews. ETHICAL CONSIDERATIONS: This study was approved by the Ethical Review Committee of Tokyo Women's Medical University (no. 4723) and Kyoto University (no. R2099). FINDINGS: Five main themes were extracted: discussing one's thoughts with others in a considerate manner, reflecting on one's way of life through others, feeling a sense of connection with others through storytelling, realizing the difficulties of talking about "what if" topics, and turning one's eyes toward the future through the dialogue. These themes were interrelated and illustrated the complexity of the experience of discussing values. CONCLUSIONS: The results suggest that dialogue in ACP is useful in clarifying values. They also indicated the need for dealing with the ethical challenges of discussing value and the importance of caring for the interlocutor to have a safe dialogue. In the ACP process, safety in dialogue may improve readiness in ACP, and health practitioners who support ACP need to address the ethical challenges entailing dialogue about values.

Personalizing precision medicine: Patients with AML perceptions about treatment decisions.

BACKGROUND: This study aims to explore patients' with acute myeloid leukemia perceptions about precision medicine and their preferences for involvement in this new area of shared decision-making. METHODS: Individual semi-structured interviews were conducted in Finland, Italy and Germany (n = 16). The study population included patients aged 24-79 years. Interviews were analyzed with thematic content analysis. RESULTS: Patient's perceived lack of knowledge as a barrier for their involvement in decision-making. Treatment decisions were often made rapidly based on the patient's intuition and trust for the physician rather than on information, in situations that decrease the patient's decision capacity. The patients emphasized that they are in a desperate situation that makes them willing to accept treatment with low probabilities of being cured. CONCLUSIONS: The study raised important issues regarding patients' understanding of precision medicine and challenges concerning how to involve patients in medical decision-making. Although technical advances were viewed positively, the role of the physician as an expert and person-of-trust cannot be replaced. PRACTICE IMPLICATIONS: Regardless of patients' preferences for involvement in decision-making, information plays a crucial role for patients' perceived involvement in their care. The concepts related to precision medicine are complex and will imply challenges to patient education.