Coping among South Asian individuals living with chronic illnesses: A latent profile analysis.

Individuals' coping differs based on sociocultural determinants and the nature of illness. This study developed a coping typology for South Asians with chronic illnesses and differentiated the coping profiles based on sociocultural determinants. Individuals (n = 384) with chronic illness were recruited. The Brief COPE scale was used for data collection and latent profile analysis for typology development. The class differences were examined in terms of age, gender, socioeconomic status, education, type of family, smoking, primary decision maker in the family, type of community, number of years living with chronic illness and type of health care services used. Latent profile analysis supported four class model: Avoider-Emotion (n = 34, 9%), Problem-Emotion (n = 128, 33.9%), Problem-Avoider (n = 55, 14.6%) and Emotion-Avoider (n = 161, 42.6%) copers. Comparison of classes across chronic illness showed that individuals with chronic respiratory disorders were Emotion-Avoider and Avoider-Emotion copers, those with cardiac problems were Problem-Emotional and Problem-Avoiders copers, those with renal problems were Emotional-Avoiders and Problem-Emotions copers, and individuals with mental health issues were mainly Problem-Emotional and Emotion-Avoider copers. These class differences were statistically different (χ2 = 134, df = 18, p < .001). The findings can be useful for developing coping programmes for South Asian populations in low- and middle-income countries and South Asian immigrants.

Sex based differences in depression, anxiety, and quality of life and predictors of quality of life among South Asian individuals with chronic obstructive pulmonary disease: A Bayesian analysis.

BACKGROUND: COPD can affect both men and women leading to deteriorating impact on general well-being, personal, and family life and decreased quality of life. Anxiety, depression, and self-care behaviours can affect the quality of life of individuals with COPD. There is a dearth of sex-based comparative analyses of anxiety, depression, quality of life, and predictors of quality of life among South Asian individuals with COPD. PURPOSE: To identify the sex-based differences in depression, anxiety, and quality of life and the predictors of quality of life among South Asian individuals with COPD. METHODS: A cross-sectional survey of 294 men and 114 women with COPD was conducted in Khyber Pakhtunkhwa, Pakistan. Hospital Anxiety and Depression scale, World Health Organization Quality of Life-brief version, Self-Care of Chronic Obstructive Pulmonary Disease Inventory, the Self-Care Self-Efficacy in COPD Scale were used for data collection. Bayesian independent sample t-test was used to compare mean differences in depression, anxiety, and quality of life among men and women. Two regression models were examined to determine if age, years of living with COPD, anxiety, depression, self-care self-efficacy, self-care monitoring, management, and maintenance were predictors of quality of life among men and women. FINDINGS: Bayesian analysis showed anecdotal evidence that women had higher levels of depression, but lower levels of anxiety compared to men. Anecdotal evidence indicated that the physical quality of life of men was better than women, but strong evidence that their social relationship and environmental quality of life was better than women. Years of living with COPD, anxiety, depression, self-care self-efficacy, self-care management, self-care monitoring, and self-care maintenance were stronger predictors of women's quality of life. Anxiety and depression only predicted men's psychological quality of life, but predicted women's psychological, social relationships, and environmental quality of life. CONCLUSIONS: The findings contribute to literature highlighting sex-based differences in anxiety, depression, and quality of life among South Asian men and women with COPD. Men generally reported higher levels of quality of life than women across all domains. Women's social relationships and environmental quality of life were greatly impacted by anxiety and depression. Quality of life interventions for women should be targeted at improving their social relationships and environmental satisfaction and addressing anxiety and depression.

Perceived Therapeutic Self-Care Ability of Patients in Surgical Units: A Multisite Survey.

Assessing patients' therapeutic self-care ability allows nurses to initialize care and implement interventions to enhance their self-care abilities. However, sociocultural beliefs and determinants can affect patients' self-care practices. This study determined perceived therapeutic self-care ability of patients in surgical units in Pakistan. A survey was conducted using a purposive sample 511 patients admitted to surgical units for at least 24 hours. Data were collected using the Urdu version of Therapeutic Self-Care Measure. The mean self-care ability score was 20.05 ± 4.3. Patients felt more prepared to take their medications, but less prepared to respond to any unforeseeable physical changes. Significant difference was found between self-care ability of male (20.68 ± 4.15) and female (19.18 ± 4.27) (p < .001) patients. A weak negative correlation was found between patient age and self-care ability (r = -0.15, p = .001). Self-care ability assessment should be included in routine discharge planning, and nurses should provide more tailored self-care discharge education to surgical patients.

Organizational support and Nurse-Physician collaboration during SARS-CoV-2 pandemic: A qualitative study.

Health care professionals experienced multiple uncertainties during the pandemic. Exploring health care professionals' views about collaboration and organizational support can offer insights into organizational processes and issues during the pandemic. This research explored the perspectives of nurses and physicians about organizational support and nurse-physician collaboration during the SARS-CoV-2 pandemic. Using a qualitative descriptive design, interviews were conducted with nurses and physicians working in hospital settings. The interviews lasted for 24-61 min. Reflexive thematic analysis was used for data analysis. Nurses and physicians were disappointed with the organizational support, but they were satisfied with nurse-physician collaboration. The theme "Management Abusing Authority and Blaming the Victimized Workforce" included organizational nepotism, unethical managerial actions, and neglecting frontline workforce. Nurses and physicians supported each other in tackling the intensive and complex demands of the pandemic. The theme "Demonstrating Professional Humility and Overcoming Patient Care Issues at Hand" entailed subthemes - negotiating conflicts and prioritizing patient care, practicing kindness, and jointly managing conflicts with patients' families. Nurses and physicians reported frustrations with limited organizational support and abusive practices of managers. Still, they prioritized patient care needs and family-related conflicts over interprofessional tensions.

Nurse educators' experiences of fostering undergraduate students' ability to manage stress and demanding situations: A phenomenological inquiry.

AIM: To understand the lived experience of nurse educators when mitigating nursing students' stress and fostering their ability to manage demanding situations. BACKGROUND: Supporting and advocating for nursing students during their stressful and challenging times is one of the core competencies of nurse educators. Much of the research has focused on understanding nursing students' views and experiences of managing their stress. No research could be found to have explored the role and contribution of nurse educators in managing student well-being and supporting them during demanding situations. DESIGN: A hermeneutic phenomenology was conducted in Pakistan. The COREQ guidelines were followed for reporting. METHODS: Semi-structured interviews were conducted from February to May 2021 with a purposive sample of 13 nurse educators with atleast a bachelor's degree in nursing or a three-year diploma with one-year specialization and at least three months of teaching experience in educational or clinical settings. Data were analyzed using Ricoeur's interpretation theory. The three steps included: (a) explanation, (b) naïve understanding and (c) in-depth understanding. RESULTS: Six themes captured educators' experience: Sharing personal experiences, developing a trustworthy relationship, creating a stress-sharing culture, demonstrating stress management, encouraging to speak up and confront and prompting management to address student issues. Policymakers and management should collaborate with educators to strengthen existing mechanisms and revisit the policies directed toward supporting students in managing their clinical and academic stress. CONCLUSIONS: Nurse educators should continue to play their part by creating a stress-sharing culture, sharing personal experiences and enhancing student stress management abilities by teaching through demonstration and building their courage to speak up for their issues. Nursing institutions should develop policies to expand nurse educators' role in supporting student stress management. Institutions also need to collaborate with educators to establish mechanisms and resources to mitigate student stress.

Social suffering in individuals with chronic obstructive pulmonary disease: a secondary analysis of interpretative phenomenological study.

Individuals with chronic obstructive pulmonary disease experience suffering that affects their families and community relationships. However, no studies provide an explicit account of social suffering among these individuals. This secondary analysis was conducted to understand the lived experiences of social suffering in individuals with chronic obstructive pulmonary disease. The theory of social suffering guided the analysis of an interpretative phenomenological study. Thirteen individuals were recruited using purposive sampling. Data were analyzed using reflexive thematic analysis. Three themes were generated: a) prevailing hopelessness and burden, b) progressing relational adversities, and c) struggling with co-dependency. Social suffering is a complex entity experienced by the patients and the family caregivers. For enhanced caregiving, health professionals could prepare patients to tackle the suffering through collective actions.

Convective Heat Transfer Analysis for Aluminum Oxide (Al2O3)- and Ferro (Fe3O4)-Based Nano-Fluid over a Curved Stretching Sheet.

In this work, the combined effects of velocity slip and convective heat boundary conditions on a hybrid nano-fluid over a nonlinear curved stretching surface were considered. Two kinds of fluids, namely, hybrid nano-fluid and aluminum oxide (Al2O3)- and iron oxide (Fe3O4)-based nano-fluid, were also taken into account. We transformed the governing model into a nonlinear system of ordinary differential equations (ODEs). For this we used the similarity transformation method. The solution of the transformed ODE system was computed via a higher-order numerical approximation scheme known as the shooting method with the Runge-Kutta method of order four (RK-4). It is noticed that the fluid velocity was reduced for the magnetic parameter, curvature parameter, and slip parameters, while the temperature declined with higher values of the magnetic parameter, Prandtl number, and convective heat transfer. Furthermore, the physical quantities of engineering interest, i.e., the behavior of the skin fraction and the Nusselt number, are presented. These behaviors are also illustrated graphically along with the numerical values in a comparison with previous work in numerical tabular form.

Mindful Self-Care Practice of Nurses in Acute Care: A Multisite Cross-Sectional Survey.

Consistent mindful self-care practices mitigate professional burnout and improve resilience to enable nurses provide safe and effective patient care. This study determined the levels and the influencing factors of mindful self-care of nurses in acute care settings. Data were collected from a convenience sample of 258 nurses from seven acute care hospitals using the 36-item Mindful Self-Care Scale. Data were analyzed using descriptive and correlation analyses. Nurses' mindful self-care scores were low, and female nurses had higher levels of mindful self-care than male nurses. Statistically significant negative correlations were found between nurses' mindful self-care levels and their age and clinical experience. Nurses' engagement in mindful self-care is low which may negatively affect their interactions with and care of patients and their families. Therefore, a need exists to develop and evaluate more clinical-based personal and organizational strategies to enhance the mindful self-care practices of nurses.

Self-care experiences of Pakistani patients with COPD and the role of family in self-care: A phenomenological inquiry.

Self-care enables patients in improving quality of life and reducing hospital admissions. Research explored the experiences of patients about breathlessness, sleep problems and complication management in chronic obstructive pulmonary disease (COPD). However, the self-care experiences and the role of the family in self-care are underexplored. This study aimed to understand the self-care experiences of patients with COPD and explore the role of the family in self-care. An interpretive phenomenological inquiry was used, and 13 patients were interviewed in 2019 from two hospitals in Pakistan. The inclusion criteria were patients above 30 years of age at any stage of COPD, who received a confirmed diagnosis of COPD and were receiving the treatment, and engaged in self-care at their homes or communities. The interviews lasted for 35-60 min. Ricoeur's interpretation theory was used for data analysis comprising steps explanation, naive understanding and in-depth understanding. Self-care emerged as a complex individual and familial endeavour affected by personal, social and economic factors. Poverty was one of the core determinants of self-care. Patients emphasised the spiritual, cultural and traditional approaches to self-care. Future research is warranted to develop better understanding of spiritual and cultural self-care and how these dimensions of self-care affect patients' self-care behaviours.

Lived Experiences of Male Nurse Educators: An Interpretive Phenomenological Inquiry.

BACKGROUND: Male nurses experience stereotypes and obstacles that affect their career progression in clinical and leadership roles. The experiences of male students and nurses in educational and clinical settings are documented, but no research explored the experiences of nurse educators. PURPOSE: To explore and develop a deeper understanding of the lived experiences of male nurse educators. METHODS: An interpretive phenomenological inquiry was used. Semi-structured interviews were conducted with 12 male educators in Khyber Pakhtunkhwa. Ricoeur's interpretation theory was used for data analysis. FINDINGS: The themes included "searching for respect and autonomy: from discrimination to recognition", "keeping up the pace: proving worth as nurse educators", "building relationship with the opposite gender: overcoming cultural constraints", "withstanding unfair female nursing and non-nursing management", "appreciating support from democratic management" and "envisioning a non-gendered nursing profession". CONCLUSION: Male educators surmounted various challenges while searching for respect and recognition and felt content with their professional growth. The greatest challenge was discriminative institutional and the government policies. The educators recognized that female dominance in nursing can be a hurdle, but they indicated that gender discrimination can be ended with collaborative efforts at personal, institutional, and governmental levels. Nursing regulatory bodies and institutions should develop policies that are conducive to recruitment of male and female educators. Separate sub-divisions could be established to provide support to and advocate for the rights of male nurses in clinical, educational, and leadership positions.

Using legitimation criteria to establish rigour in sequential mixed-methods research.

BACKGROUND: Despite the extensive use of mixed methods across health sciences, there has been a limited discussion about the methodological rigour and quality in mixed methods research (MMR). Although the empirical and methodological literature about mixed methods is increasing, there are few practical examples of the implementation of rigour criteria. AIM: To discuss and illustrate the application of 'legitimation criteria' to the design and conduct of a sequential exploratory MMR study of nurse educators' challenges when teaching undergraduate students. DISCUSSION: The legitimation criteria can establish philosophical and methodological validity and rigour in MMR. MMR is complex and daunting, so maintaining rigour is crucial in ensuring the conclusions drawn are plausible and researchers, practitioners and policymakers use them to guide research and practice. CONCLUSION: The legitimation criteria are specific to MMR and are useful in improving the conduct and execution of studies. They enable researchers to maintain quality throughout their studies, from the development of a research question to the generation of conclusions. IMPLICATIONS FOR PRACTICE: This illustration of the legitimation criteria for the design and conduct of MMR will guide researchers in establishing rigour and lessen the threats to their studies' validity.

Data integration using the building technique in mixed-methods instrument development: Methodological discussion.

AIMS: To discuss and illustrate how meaningful integration can be achieved in instrument development design. DESIGN: Discussion paper. DATA SOURCES: A mixed-methods study about challenges of nurse educators in Pakistan. The building technique was implemented when the findings of the qualitative phase were integrated to develop an instrument to determine educators' challenges while teaching nursing students in academic and clinical settings. IMPLICATIONS FOR NURSING: Nurses are required to use cultural- and population-specific instruments for data collection. The six-step building approach can enable nurses to develop such instruments using rigorous and robust mixed-methods design. CONCLUSION: Building and merging techniques are used in instrument development design during and after the completion of the study, respectively. However, building technique is essential for using the qualitative findings to develop the instrument. The proposed building approach starts with a robust qualitative data analysis and is strengthened with the selection of key themes and subthemes, linking them to the participants' quotes and then the conversion of the quotes into meaningful and pertinent items. Using the proposed building integration technique can enable researchers to meaningfully and efficiently use qualitative findings for developing instruments using mixed-methods designs. IMPACT: Mixed methods are valuable for the development of data collection instruments that are tailored to the study context and relevant for the study participants. There is limited guidance about how meaningful integration can be achieved when developing research instruments using mixed methods. We proposed a practical building technique that allows researchers to meaningfully use qualitative findings from one phase to develop an instrument for the subsequent phase. The proposed approach is useful for researchers aiming to develop data collection instruments using mixed methods.

Nurse educators' perceived organizational factors affecting their psychological empowerment: An exploratory qualitative study.

BACKGROUND: Organizational culture affects nurse educators' psychological empowerment. Limited research exists on the organizational culture and psychological empowerment in nursing educational environments and about the type of organizational factors affecting nurse educators' psychological empowerment. AIM: To explore nurse educators' perceived organizational factors that affect their psychological empowerment. METHODS: A qualitative descriptive exploratory study was drawn from a larger sequential exploratory-mixed-methods study. Semi-structured interviews were conducted with 12 educators with both clinical and educational experience. The data were analyzed using thematic analysis. RESULTS: We generated three themes: poor organizational structure, dynamics of educators-academic administrators' relations, and educational tools and physical environment. The educators perceived factors were poor organizational structure, lack of collaboration across institutions and regulatory bodies, condescending attitudes of administrators and educators toward novice educators, limited teaching aids and scholarly resources, poorly defined roles, and underdeveloped and inconsistent curricula. CONCLUSIONS: The identified organizational factors should be addressed to enhance educators' psychological empowerment so that they can effectively teach students. Emphasis should be placed on developing collaboration among educators, academic administrators, and regulatory bodies to address these factors. Further quantitative research is warranted to assess the degree and strength of association of these factors with psychological empowerment.

Perceived challenges of nurse educators while teaching undergraduate nursing students in Pakistan: An exploratory mixed-methods study.

BACKGROUND: Nurse educators are required to equip students with adequate theoretical and practical knowledge to provide effective nursing care. Limited studies have explored educators' challenges while teaching students. Existing studies are limited because of small sample, overreliance on qualitative approaches, and unreliable instruments that have not been tested. OBJECTIVES: To explore nurse educators' perspectives about their clinical and academic teaching, to develop a questionnaire to determine educators' challenges, and to develop a comprehensive understanding of educators' challenges. DESIGN: A sequential exploratory mixed-methods study. SETTINGS: Twelve nursing institutions in five cities of Pakistan. PARTICIPANTS: A purposive sample of 12 educators for interviews and 112 for the survey. METHODS: Semi-structured interviews and survey for data collection and expert consultations for questionnaire development. Thematic analysis for qualitative analysis, descriptive analysis for quantitative, and joint display tables for mixed methods. RESULTS: Educators experience workload and time constraints and struggle to effectively teach students due to inadequate student-educator ratio; underdeveloped curriculum; inadequate resources; inadequate clinical teaching settings for skills, simulation labs; inadequate professional development opportunities; lack of autonomous decision making; lack of educational, management, and research support from the regulatory bodies; and lack of educational research. CONCLUSIONS: Nurse educators' issues and challenges are persistent and require support from regulatory bodies and educational authorities. There is a need to develop policies to improve teaching and learning conditions for educators, provide them with the opportunities to enhance their own learning, and opportunities to collaborate with other educators in order to better prepare student nurses.

A Mixed Methods Review of Male Nursing Students' Challenges during Nursing Education and Strategies to Tackle these Challenges.

BACKGROUND: Calls to action have been placed for recruitment of more men to address nursing shortage and to achieve a better balance and diversity in workforce. Studies also indicated patients' demand for male nurses. Despite this, male nursing students experience challenges during their education resulting in their attrition. No reviews have explored this research area. This review explored the challenges of male nursing students during their education and identified strategies used to tackle these challenges. METHODS: Literature was searched within three databases using indexed search phrases and 1 mixed-methods, six quantitative, and 36 qualitative studies (n = 43), published from December 1990 to May 2018, were reviewed. The qualitative and quantitative data were separately extracted and analyzed using thematic synthesis and narrative summaries, and then compared using joint displays. FINDINGS: "Call me a nurse" and "Male nurses understand us better: Need more men in nursing" were the prominent themes. An array of educational and clinical challenges was identified. Students used appraisal-focused, problem-focused, and social support strategies to tackle these challenges. CONCLUSION: Considering the identified challenges, the lack of support and efforts from educators and institutions, we reiterate calls to action for strategic policies to help male nursing students adapt to educational and clinical learning environments and to increase their recruitment and retention in nursing.