Psychological Challenges Research Articles

Coping strategies of the sandwich generation in the care process: a qualitative study

ObjectiveThe sandwich generation refers to individuals who are simultaneously responsible for caring for their aging parents and their own children. Research shows that the number of sandwich generation caregivers is increasing, and they face significant physical, psychological, social, and economic challenges. Therefore, it is crucial for these caregivers to develop effective coping strategies. This study aimed to identify the coping mechanisms used by sandwich generation caregivers.MethodsIn 2022, during the COVID-19 pandemic, we conducted a qualitative study involving semi-structured interviews with 18 sandwich generation caregivers in Tehran, Iran, who were responsible for both elderly parents and their own children. These interviews were conducted either in person or by telephone. Subsequently, the collected data were analyzed using the inductive content analysis method within the MAXQDA software (2018 version).ResultsData analysis revealed three categories of coping strategies: “distancing from the situation”, “self-soothing” (including sub categories of spiritual matters, establishing relationships, emotional outlet, and engaging in favorite activities), and “diversifying responses to needs” (including transferring responsibility to the family members, prioritizing needs for responsiveness, utilizing available community services, mediating to reduce conflict, and remote monitoring of the older adult).ConclusionSandwich generation caregivers use various coping strategies, each with different outcomes. This study found that self-care and using social resources can greatly reduce caregiving burdens. Therefore, providing these caregivers with training in problem-solving and self-care skills is recommended to better prepare them for their responsibilities.

The Effects of Symptom Distress and Depression on Quality of Life in Patients With Terminal Cancer: The Mediating Role of Meaning in Life and Spiritual Well-being.

Terminal cancer patients experience worsening physical symptoms, psychological challenges, and spiritual difficulties. Improving the quality of life (QOL) and reconstructing the meaning of life (MIL) for these patients ensure a dignified end-of-life experience. Spiritual well-being is necessary to promote effective end-of-life coping strategies. This study aimed to construct and verify the suitability of a model that explains the impact of physical and psychological factors on the QOL of patients with terminal cancer using MIL and spiritual well-being as mediating factors. The participants were patients with terminal cancer 25 years or older hospitalized in 40 nationally designated hospices. A total of 172 patients were included in the final analysis. Data analysis was performed using structural equation modeling. In the effect analysis of the final model, the variables affecting QOL were depression (β = -.62, P < .001), symptom distress (β = -.33, P = .001), and spiritual well-being (β = .36, P = .002), and a significant indirect effect of MIL was found in the depression-MIL-spiritual well-being and depression-MIL-QOL paths. Spiritual interventions that help people find their MIL can serve as an important component of optimal hospice and palliative care for patients with terminal cancer. In clinical practice, interventions that increase the MIL and spiritual well-being of patients with terminal cancer are needed. Additionally, the practice will see other benefits including enhanced patient care, psychological support, effective treatment planning, family caregiver support, and further research advancement.

Assessing the efficacy of artificial intelligence to provide peri‐operative information for patients with a stoma

AbstractBackgroundStomas present significant lifestyle and psychological challenges for patients, requiring comprehensive education and support. Current educational methods have limitations in offering relevant information to the patient, highlighting a potential role for artificial intelligence (AI). This study examined the utility of AI in enhancing stoma therapy management following colorectal surgery.Material and MethodsWe compared the efficacy of four prominent large language models (LLM)—OpenAI's ChatGPT‐3.5 and ChatGPT‐4.0, Google's Gemini, and Bing's CoPilot—against a series of metrics to evaluate their suitability as supplementary clinical tools. Through qualitative and quantitative analyses, including readability scores (Flesch–Kincaid, Flesch‐Reading Ease, and Coleman‐Liau index) and reliability assessments (Likert scale, DISCERN score and QAMAI tool), the study aimed to assess the appropriateness of LLM‐generated advice for patients managing stomas.ResultsThere are varying degrees of readability and reliability across the evaluated models, with CoPilot and ChatGPT‐4 demonstrating superior performance in several key metrics such as readability and comprehensiveness. However, the study underscores the infant stage of LLM technology in clinical applications. All responses required high school to college level education to comprehend comfortably. While the LLMs addressed users' questions directly, the absence of incorporating patient‐specific factors such as past medical history generated broad and generic responses rather than offering tailored advice.ConclusionThe complexity of individual patient conditions can challenge AI systems. The use of LLMs in clinical settings holds promise for improving patient education and stoma management support, but requires careful consideration of the models' capabilities and the context of their use.

The Patient-Physiotherapist Tango: a Personalized Approach to ACL Recovery - a Qualitative Interview Study.

Person-centered care is a concept in healthcare that aims to promote the patient's health and adapt resources and interventions based on the patient's needs and wishes. Knowledge on what person-centered physiotherapy is for patients who rehabilitate after an anterior cruciate ligament (ACL) reconstruction, and how patients experience it within the context of sports injury rehabilitation, is lacking. The aim of this study was to explore how patients who were in a late rehabilitation stage (8-12 months) after ACL reconstruction experienced their rehabilitation from a person-centered perspective. Qualitative interview study. Fourteen patients (57% females), aged 18-57, treated with ACL reconstruction, were interviewed with semi-structured interviews 8-12 months after ACL reconstruction. Interviews were recorded, transcribed and analyzed with qualitative content analysis. One theme: all lights on me; be seen and heard, a cornerstone for patients, supported by three main categories: 1) rehabilitation: a roller coaster of physical and psychological challenges; 2) patient involvement; 3) the physiotherapist - stronger together; emerged from the collected data. Patients in a late rehabilitation stage (8-12 months) after ACL reconstruction experienced that the rehabilitation process was person-centered when they felt to be the focus and were allowed to participate via open and constructive communication with the physiotherapists.

Accessing the Lived Experiences of Children with Illness in Sweden for Health Care Research

Background: Children are a relatively marginalized group when doing research in the context of illness, young children particularly so. This even though children can and should contribute their point of view in providing evidence-based care. This article contributes the experiences of Nurse Researchers in gathering research data in Sweden on the lived experiences of children undergoing needle-related medical procedures, living with home mechanical ventilation or undergoing treatment for cancer. Methods: Nine published articles from four unique Swedish PhD dissertations in Caring Science formed the basis for the present paper where various open and critical qualitative approaches for gathering data were used. Results: Accessing and interpreting the lived experiences of ill children in healthcare research presents methodological, ethical, and cultural challenges. As with health care contexts in other countries, capturing the ill child’s experiences in Sweden requires several different methods. Health researchers in Sweden must navigate a complex landscape of communication barriers, emotional and psychological challenges, and structural issues within the healthcare system to effectively access and understand the lived experiences of children. Conclusions: This paper adds to the knowledge base of research with a focus on gathering the experiences of children with illness within a Swedish health care context. These insights underscore the importance for all researchers of using child-friendly, inclusive methods to understand children’s lived experiences thus ensuring their voices are heard and respected in health research. Children’s and families’ inability to speak the native language of a country cannot be a hinder for inclusion, but rather be encouraged.

COVID-19 Related Stressors, Cognitive Reappraisal, and Students’ Engagement in Online Learning: A Mediation Model

The effects of COVID-19 remained significant on the social and academic well-being of university students. This raised various mental and psychological challenges for the students, which had the potential to deteriorate their academic engagement and performance in online learning environments. The emotion regulation theory hypothesizes that various cognitive skills may assist people in coping with such types of social and psychological challenges. Cognitive reappraisal is a strategy used at the individual level to regularize thought processes in stressful situations. This study aimed to investigate the influence of cognitive reappraisal “as a mediator” on the relationships between COVID-19 related stressors and university students’ engagement in an online learning environment. Three hundred and one students selected from eight public sector universities in Pakistan participated in a survey. Three instruments, including the COVID-19 Related Stressors, Cognitive Reappraisal Questionnaire, and Student Engagement Dimensions, were used to collect data. Mediation analysis confirmed the application of emotion regulation theory in the context of relationships between COVID-19 related stressors and students’ engagement in online learning environments. The study has significant implications for promoting students’ well-being in online setups during stressful situations.

Facilitating and limiting factors in the implementation of Revie ⊕ among registered nurses: A multimethod study

PurposePeople with advanced cancer face long-term physical, psychological, and existential challenges. Revie ⊕ is a life review intervention based on building the strengths and resources of this patients. A randomized clinical trial evaluated the effectiveness of the intervention on self-esteem, well-being, personal development, life satisfaction and perceived interaction with registered nurses. In addition, the research team analysed the process of implementation with registered nurses, which was the subject of the present study. The aim of our study was to describe the facilitating or limiting factors in the implementation of Revie ⊕ with registered nurses in oncology units. MethodThis study used a multimethod cross-sectional research design and was conducted in the context of a randomized controlled trial. The selected sample included 57 registered nurses. Organizational readiness for change, satisfaction, and compassion fatigue were measured for the quantitative component, and two focus groups were conducted for the qualitative component. ResultsOrganizational readiness for change reveals favourable results conducive to the implementation of Revie ⊕. The professional quality of life measures highlighted high compassion satisfaction and a low risk of burnout and exposure to secondary traumatic stress. Participants with additional postgraduate training felt more strongly that the intervention was evidence-based, considered clinical experience, and respected patient preferences. The analysis of the qualitative data allowed for the extraction of 7 themes and 21 subthemes. ConclusionsThis study highlighted facilitating and limiting factors in the implementation process of Revie ⊕, good professional quality of life of registered nurses, and supportive preparation for change.

A tutor training framework for radiographers: Basic concepts to effectively train future generations of professionals

IntroductionClinical practice is crucial for the professional development of radiographers. To effectively benefit from their training, students need guidance from well-trained and competent tutors. However, the literature lacks evidence of training programs specifically designed for radiographer tutors. This study aims to suggest a novel framework able to identify the key elements of a successful tutor training curriculum for radiographers. MethodsThrough a literature review on the topic of tutor training in the healthcare sector, a novel tutor training framework specifically for radiographers was developed. This model is structured into two main components: knowledge development and skill acquisition. The framework emphasizes four key topics: understanding the essence of tutoring; conducting briefing, debriefing, and providing feedback; addressing students' psychosocial challenges; conducting simulations and role plays. It concludes with a skill test. ResultsThe proposed curriculum highlights the importance of tutors understanding their roles and responsibilities, as well as the significance of providing feedback and conducting briefing activities. Noteworthy additions to this pioneering model include an in-depth examination of the psychosocial challenges faced by students during their training and the introduction of role-playing activities. These activities help tutors develop empathy and better understand the students' perspectives and needs, therefore optimizing the tutoring experience. ConclusionThis framework outlines the fundamental principles that tutors should incorporate into their daily tutoring activities to maximize student learning and engagement. Emphasis is placed on understanding the psychological challenges faced by students, which can help tutors tailor their teaching to better meet students' needs. Implication for practiceThe proposed framework wills to promote significant improvement in the clinical practice of future professionals through the optimization of tutors' competencies.

An overview of the psychological complexities in sports performance

Our special issue comprises a diverse collection of ten research and review articles, each offering unique insights into the psychological dimensions of athletic performance. From studies examining the role of resilience in overcoming extreme score shifts to explorations of the mental toll caused by external crises like the COVID-19 pandemic and geopolitical conflict, these papers provide a broad spectrum of perspectives. The issue digs into critical topics such as the influence of crowd dynamics, athlete-coach relationships, and the psychological challenges of breaking long-standing records, all while highlighting innovative methodologies like ecological approaches and creative non-fiction. Together, these ten papers underscore the complexity of the psychological factors that impact athletes’ success and well-being, offering both theoretical advances and practical applications for the sporting world.

Bisexual Identity Concealment for Marital Harmony: Cultural and Religious Pressures in Malaysia

This study investigates the concealment of bisexual identity among married men in Malaysia, a country where homosexuality is both stigmatized and criminalized under Syariah law. The problem lies in the immense cultural, religious, and legal pressures that compel these men to hide their sexual orientation, leading to significant emotional and psychological challenges. The primary objective of this research is to explore how these men manage their bisexual identities while maintaining marital harmony within a conservative, heteronormative society. Using a qualitative phenomenological approach, in-depth interviews were conducted with 15 self-identified bisexual men married to heterosexual women. The data were analyzed through thematic analysis. The findings reveal that societal expectations, fear of divorce, and family reputation are key factors influencing their decision to hide their sexual orientation. Participants reported high levels of anxiety, guilt, and isolation due to the dual pressure of performing heteronormativity in public while concealing their true selves in private. This study contributes to understanding the challenges faced by bisexual men in mixed-orientation marriages in Malaysia, particularly the psychological toll of maintaining secrecy. The implications underscore the need for culturally sensitive mental health services and policy reforms to provide adequate support for bisexual individuals. Such interventions are critical to reducing stigma and promoting emotional well-being in conservative societies.

The Relationship Between Spirituality and Depression Levels in the Elderly at Graha Senior Resident Karya Kasih, Medan

Elderly individuals frequently experience declines in biological, psychological, social, and spiritual functioning, particularly those residing in orphanages who encounter considerable psychological challenges such as depression. The objective of this study is to investigate the relationship between spirituality and depression levels within the elderly population at Graha Residen Senior Karya Kasih, Kota Medan. This research employed a correlational design utilizing a cross-sectional approach. The sampling technique used was purposive sampling, with participants selected based on the criteria of being 60 or older and possessing practical communication abilities. A total of 41 respondents participated in the study. The instruments employed included the Daily Spirituality Experience Scale (DSES) and the Geriatric Depression Scale (GDS). The study found that 40 participants (97.6%) reported positive spiritual experiences, while nearly half (20 individuals or 48.8%) showed symptoms of depression. Statistical analysis revealed a significant negative relationship between spirituality and depression in older adults, with a Spearman rank p-value of 0.007 and a correlation coefficient of -0.415. In conclusion, higher spirituality is linked to lower depression levels, although depressive symptoms can still be present. The researcher recommends enhancing spirituality and suggests reminiscence therapy as a possible intervention for depression in older adults.

The Perspective of Young Maghrebi People With a Migratory Background and Their Social Agents on Substance Use During the Migration Process: A Qualitative Study.

People with a migratory background often face traumatic experiences increasing the risk of mental health problems and substance use. It is important to gain a greater understanding of the perspectives of substance use among North African young people with a migratory background and social agents. A qualitative phenomenological study was conducted. Purposive sampling methods were used to recruit 14 male participants and 9 social agents. Data were collected through semi-structured interviews and focus groups, and processed by thematic analysis. Four themes were identified: beginning of cross-border consumption that worsens at the reception centers; different ways of obtaining and accessing substances; reasons leading to substance use; and mental health care needs during the migration process. The implementation of individual-centered and culturally adapted psychosocial support programs can significantly contribute to mitigating psychological challenges, preventing substance use, and promoting greater well-being among people with a migratory background.

Perceived unmet needs and impact on quality of life of patients living with advanced bladder cancer and their caregivers: results of a social media listening study conducted in five European countries

BackgroundAdvanced bladder cancer (aBC) is a significant health concern in Europe and has a poor prognosis. Patients with aBC face numerous unmet needs and challenges that significantly impact their quality of life (QoL). This study aims to analyze social media data from five European countries to address gaps in our understanding of the unmet needs, challenges, and impact on QoL in European patients with aBC and their caregivers.MethodsThis retrospective, real-world study includes public social media posts geolocated in France, Italy, Germany, Spain, and the UK, posted between October 2017 and January 2022. To enhance the filtering process, natural language processing methods and specific algorithms were used to remove irrelevant content and retain posts from patients and caregivers. QoL impacts were identified using a deep-learning algorithm, followed by qualitative analysis. Unmet needs were analyzed via annotation of messages and the saturation method.ResultsA total of 1670 posts from 1396 users (699 posts from 546 patients and 971 posts from 850 caregivers) discussing aBC in 91 publicly available online sources were identified. Half of patients were male (n = 272, 49.8%) while more caregivers were female (n = 474, 55.8%), with an average age of 58.2 and 35.2 years, respectively. Patients and caregivers expressed an impact on QoL, wherein 40.0% (558/1396) of users mentioned at least an impact on one aspect of QoL. Among those, 56.8% (317/558) and 48.6% (271/558) of users expressed physical and psychological challenges, respectively. Most unmet needs identified belonged to two main categories: transversal, i.e., arising throughout the patient’s care pathway (307/1092 [28.1%]), and disease specific (295/1092 [27.0%]). Main challenges included worsening of the disease (n = 141, 12.9%), psychological impact (n = 112, 10.3%), and need to share experiences and seek support (n = 94, 8.6%).ConclusionsThis social media listening study demonstrated the profound emotional and physical burden on patients with aBC and their caregivers, and a genuine need for support and an outlet to discuss their challenges, particularly in terms of managing the illness. These results underscore the importance of enhancing education for both patients and caregivers and the necessity for more effective systemic cancer therapies and better palliative care alternatives.

Efektivitas Model Konseling Kelompok Cognitive-Behavior untuk Permasalahan Diri Peserta Didik: A Systematic Literature Review (SLR)

Cognitive-Behavior Therapy (CBT) in dealing with students' psychological problems. The background to this research shows that there are psychological challenges faced by students, such as anxiety and depression, which can hinder their development. The aim of this study was to evaluate the effectiveness of CBT in a group context and understand the factors that influence its success. The method used is Systematic Literature Review (SLR), by collecting data from various academic sources to analyze findings related to CBT group counseling. The results showed that CBT group counseling significantly reduced anxiety and depression, and improved students' social skills. Peer support and a supportive school environment were shown to be important factors in the success of the intervention. The conclusions of this study confirm that the integration of therapeutic approaches with social support can produce positive changes in students' mental health, as well as provide a basis for the development of counseling programs in schools.

Stress-Easing Effect of Diacyl Glyceryl Ethers on Anxiety-Related Behavior in Mice

Stress and anxiety are significant psychological challenges in modern society, which have led to a rapidly growing market for functional foods, including those reported to relieve stress, as alternatives to psychoactive drugs. Among these, diacyl glyceryl ethers (DAGE) derived from deep-sea shark liver oil have gained attention for their strong antioxidant properties and potential mental health benefits. Building on preliminary evidence suggesting DAGE’s efficacy in enhancing stress resilience and modulating biochemical pathways associated with reduced oxidative stress, the present study aimed to examine their effects on stress responses in two specific mouse strains. Each mouse was fed either a DAGE-infused diet or a control diet for three weeks. Their stress responses were evaluated using three behavioral tests: the elevated plus maze, open-field, and forced swimming tests. The DAGE-fed mice displayed lower stress responses than the control mice in the initial trial of each test. Specifically, DAGE-fed mice demonstrated increased time spent in the open arms in the elevated plus maze and more time spent in the center of the open field, suggesting reduced anxiety. Additionally, in the forced swimming test, DAGE-treated mice displayed reduced immobility times, indicating potential antidepressant effects on the mice. These findings suggest the potential of DAGE to bolster stress resilience in mice, emphasizing their promise for further studies in human stress management.

Facing Illness Together: Understanding the Role of the Couple in Palliative Care.

Serious illness is rarely experienced by patients in isolation. Many patients present to palliative care (PC) accompanied by their intimate partner. The intimate partnership is a critical axis around which many patients' experiences of serious illness revolve. However, there is a lack of literature and training on how PC clinicians can effectively support couples as a unit. Many existing PC communication strategies can be expanded to the dyadic unit, offering more holistic support for patients, partners, and the entity of their relationship. This paper integrates concepts from couples therapy, psychology, and PC communication to provide insights into the emotional, psychological, interpersonal, and practical challenges couples face during serious illness, as well as opportunities for growth and resilience. Key strategies for PC clinicians include helping couples navigate shifts in relational identity, share the "emotional housework," and transform conflict into connection. Concrete techniques are illustrated throughout this manuscript, employing clinical micro-vignettes to demonstrate their practical application in PC practice. Recognizing the couple as a unified entity empowers clinicians to foster open communication, helping couples maintain connection and evolve intimacy throughout the illness journey. By applying relational concepts and acknowledging the couple's shared experience, PC clinicians can enhance the quality of life for both patients and their partners. Conceptualizing the couple as a distinct entity within PC practice can deepen clinician-patient communication and improve therapeutic effectiveness.

Every Life Matters: Empowering Care Leavers on Their Path to Independence

ABSTRACTFollowing the transition into society, adolescents' rehabilitation and social integration are the main concerns for child care institutions (CCIs). By recognizing the challenges adolescents face, it is possible to facilitate their rehabilitation and integration into society. This study aims to identify the issues and obstacles impeding care leavers' rehabilitation and integration process, as perceived by caregivers. The researcher employs social constructivism as a theoretical framework and qualitative description method as the research design. The study involved eight participants, selected through purposive sampling, and semi‐structured interviews were used to collect data. The study's findings elucidate the risk and protective factors associated with the issues faced by care leavers, including caregiving environment and support, social and community support, educational challenges, psychological and emotional challenges, social isolation and discrimination, among others. Based on the findings, the researcher has developed a Holistic Care Integration and Transition (HCIT) framework for practitioners and policymakers.

Correlation among anxiety and depression, fear of disease progression, and social support in coronary heart disease

BACKGROUND The mental well-being of individuals with coronary heart disease (CHD) during the intensive care unit (ICU) transition period is a multifaceted and significant concern. In this phase, the individuals might encounter psychological challenges like anxiety and depression, which can impede their recuperation and potentially have lasting effects on their health. AIM To investigate the correlation among psychological factors in CHD patients in the ICU transition period. METHODS A questionnaire survey was conducted with 119 patients admitted to the ICU after coronary artery bypass grafting between March and December 2023. Variations in Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD), Fear of Progression Questionnaire-Short Form (Fop-Q-SF), and Social Support Rating Scale (SSRS) were collected and analyzed among diverse populations. We used Pearson’s correlation analysis to examine the correlation. Multiple linear regression analysis was used to explore whether these indicators influenced depression and anxiety in the patients. RESULTS The total scores for anxiety, depression, fear of disease progression, and social support were (7.50 ± 1.41) points, (8.38 ± 1.62) points, (35.19 ± 8.14) points, and (36.34 ± 7.08) points, respectively (P &lt; 0.05). Multivariate regression analysis showed that both the level of disease progression and social support affected the level of postoperative depression and anxiety in patients. CONCLUSION The anxiety and depression levels were positively related to each dimension of phobia disease progression and negatively related to each dimension of social support among patients with CHD.

A Review of Psychological and Moral Challenges Faced by Medical Staff in High-Stress Environments

Healthcare professionals often operate in high-stress environments that expose them to significant psychological and moral challenges. This review examines the prevalent stressors impacting medical staff, including burnout, anxiety, depression, and moral distress, as well as the coping mechanisms and institutional supports that mitigate these pressures. In exploring psychological factors, such as emotional exhaustion, and moral challenges, like ethical dilemmas and moral injury, this article highlights the compounded toll on staff well-being and patient care quality. Evidence suggests that these pressures negatively impact healthcare outcomes, leading to increased errors, higher turnover rates, and diminished staff retention. The review further discusses strategies to support healthcare workers, including peer support, institutional programs, ethics training, and resilience-building initiatives, emphasizing the need for systemic changes to foster a sustainable, compassionate healthcare environment. Addressing these challenges is essential to ensuring high-quality patient care and a resilient healthcare workforce.

Challenges Faced by Women in Learning English Language: Aprisma Study

This study reviews the scientific research concentrating on the challenges of women learning English. We followed the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) framework. Based on the secondary data from an axiological perspective, we explore educational barriers, psychological challenges, cultural values, social position, gender identity, and related issues. We discuss the challenges into two axiological categories: social economics and education. The study indicates that limited access to resources and cultural norms discourage women's education, and economic restrictions further complicate acquiring English. We suggest tailored interventions to help women overcome the challenges of effective English learning.