Comfortable Talking Research Articles

Fundamentals of end-of-life communication as part of advance care planning for older people: An interview study with nursing staff

This exploratory interview study investigated nursing staff members’ perspectives on the fundamentals of end-of-life communication with older people as part of advance care planning in home care, nursing home, and hospital settings. Separate semi-structured interviews were conducted with 17 nursing staff members about their experiences, opinions, and preferences before, during, and after end-of-life conversations. Overall themes clustering the fundamentals include preconditions such as feeling comfortable talking about the end of life and creating space for open communication. Fundamentals related to the actual conversation–such as using senses and applying associative communication techniques (e.g., using understandable language), following conversation phases, and being aware of interprofessional collaboration–were also considered important. This study emphasizes the importance of moving along with the older person as well as connecting, adapting, and letting go of control over the conversation's outcome. Many fundamentals can be traced back to the basics of nursing and the humanity of conversation.

Mental Health Arts Festival as a tool for mental health promotion

Abstract Background of the problem 1 in 4 people experience mental health problems each year, and that number is only growing. Stigma and discrimination of mental health are widespread and affect the quality of life at the individual and societal level. The WHO identifies mental health arts festivals as an effective way to reduce stigma and improve mental health. Description of the problem We are not comfortable talking about mental health difficulties and the care we need. Consequently, individuals often withhold personal experiences to shield themselves from potential bias and harsh judgement. Methodology The Mental Health Arts Festival (MHAF) Bonds https://www.rysiaifest.lt/, https://www.facebook.com/Rysiaifest) seeks to contribute to the human rights based mental health knowledge creation across the partner organisations, involved communities and audiences, as well as contribute to local creation of artworks on the topic of mental health in open, accessible, safe space where every voice matters. The biannual MHAF brings together recognised artists, arts institutions, scientists, policy makers and communities of people with mental health issues (over 80 events, attracting about 4,500 spectators) for group exhibition, films, contemporary dance and live performances, literary readings, open microphones, followed by discussions and workshops. Qualitative study methodology is applied to assess the potential impacts of the MHAF. Lessons • Visual identity that seeks to challenge existing stigmatising views. • The festival has become the production or premier place of new artworks on the topics of mental health, spanning addiction, war-related trauma, transgenerational trauma, neurodiversity. Key messages • Mental health arts festivals promote mental health literacy and reduce negative attitudes towards health-seeking behaviour. • Art festivals should be an integral part of national programs to address stigma and promote mental health and well-being.

Exploring Factors Influencing College Females' Perceptions of Menstruation: A Study on Awareness and Cultural Influences

This study surveyed 225 respondents on their attitudes towards menstruation, revealing predominantly negative feelings. A significant majority (84.9%) expressed disagreement with feeling proud during menstruation, while none agreed or felt happy about having their period. Most respondents (66.7%) also did not feel excited about menstruating. Similarly, a large portion of respondents (82.2%) were not eager to experience their first period, and 65.8% reported not being happy when they found out about menstruation. Although many respondents disagreed with feeling different during their period, nearly 58.7% agreed that menstruation makes them uncomfortable. When asked if it was acceptable to miss college due to menstrual cramps, 45.3% strongly agreed, indicating that many find menstruation physically challenging. The majority (75.1%) also disagreed with feeling scared, suggesting awareness and understanding of the menstrual process. Respondents were generally open to discussing menstruation, with 72% feeling comfortable talking to friends. However, 62.2% expressed feeling nervous when the word “period” is mentioned. Social stigma remains an issue, as 60.9% disagreed with fearing boys finding out about their period, but a smaller group (24.9%) expressed fear. Finally, 86.2% disagreed that girls should worry during their period. Overall, this survey highlights the widespread discomfort, negative associations, and stigma surrounding menstruation, with respondents showing minimal positive feelings or eagerness towards their periods.

Mind4Health: decolonizing gatekeeper trainings using a culturally relevant text message intervention.

When a person dies by suicide, it takes a reverberating emotional, physical, and economic toll on families and communities. The widespread use of social media among youth and adolescents, disclosures of emotional distress, suicidal ideation, intent to self-harm, and other mental health crises posted on these platforms have increased. One solution to address the need for responsive suicide prevention and mental health services is to implement a culturally-tailored gatekeeper training. The Northwest Portland Area Indian Health Board (NPAIHB) developed Mind4Health, an online gatekeeper training (90 min) and text message intervention for caring adults of American Indian/Alaska Native (AI/AN) youth. The Mind4Health intervention was a multi-phase, single-arm, pre-and post-test study of users enrolled in the intervention that is available via text message (SMS) or via a 90 min online, self-paced training. We produced four datasets in this study: Mobile Commons, pre-survey data, post-survey data, and Healthy Native Youth website's Google Analytics. The analysis included data cleaning, basic frequency counts, percentages, and descriptive statistics. Qualitative data were analyzed using thematic content analysis methods and hand-coding techniques with two independent coders. From 2022 to 2024, 280 people enrolled in the Mind4Health SMS training, and 250 completed the 8-week intervention. Many messages in the sequence were multi-part text messages and over 21,500 messages were sent out during the timeframe. Of the 280 subscribers, 52 participated in the pre-survey. Pre-survey data show that 94% of participants were female, and nearly one-fourth lived in Washington state, 92% of participants in the pre-survey were very to moderately comfortable talking with youth about mental health (n = 48). Most participants interact with youth in grades K-12. Post-survey data demonstrate changes in knowledge, beliefs, comfort talking about mental health, and self-efficacy among participants. Mind4Health improved participant's skills to have mental health conversations with youth and refer youth to resources in their community.

Exploring Experiences of People With Knee Osteoarthritis Who Received a Physiotherapist-Delivered Dietary Weight Loss and Exercise Intervention: A Mixed Methods Study.

Explore the experiences of people with knee osteoarthritis (OA) who received a very low energy diet (VLED) and exercise program from a physiotherapist. Mixed methods study involving questionnaires (n = 42) and semistructured interviews (n = 22) with randomized control trial participants with knee OA who had received a 6-month physiotherapist-delivered VLED weight loss and exercise intervention. Questionnaires measured participant satisfaction and perceptions about physiotherapist's skills/knowledge in delivery of the dietary intervention (measured on 5-7 point Likert scales). Interviews explored participant's experiences and were analyzed based on the principles of reflexive thematic analysis. Questionnaire response: 90%. Participants were satisfied with the program (95%), confident their physiotherapist had the required skills (84%) and knowledge (79%) to deliver the dietary intervention, felt comfortable talking to the physiotherapist about weight (74%), and would recommend others see a physiotherapist for the intervention they undertook (71%). The following four themes were developed from the interviews: (1) one-stop-shop of exercise and diet; (2) physiotherapist-delivered weight loss works (unsure initially; successfully lost weight); (3) physiotherapists knowledge and skills (exercise is forte; most thought physiotherapists had the necessary weight loss skills/knowledge, but some disagreed); and (4) physiotherapists have a role in weight loss (physiotherapists are intelligent, credible, and trustworthy; specific training in weight loss necessary). This study provides, to our knowledge, the first documented perspectives from people with OA who have received a physiotherapist-delivered weight loss intervention. Findings suggest physiotherapists may have a role in delivering a protocolized dietary intervention for some people with knee OA with overweight and obesity.

The impact of surgical complications on obstetricians’ and gynecologists’ well-being and coping mechanisms as second victims

Obstetrics and gynecology surgery is becoming increasingly complex because of an aging population with increasing rates of medical comorbidities and obesity. Complications are therefore common, and not only impact the patient but can also cause distress to the obstetrics and gynecology surgeon as a "second victim." This study aimed to describe and quantify the range of effects of complications on obstetrics and gynecology surgeons, and assess sociodemographic, clinician, and practice factors associated with such impact. A cross-sectional survey was developed on the basis of interviews with obstetrics and gynecology surgeons and a review of the literature. The survey assessed obstetrics and gynecology surgeons' demographic, clinical, and practice characteristics; estimated the number of complications per year and the impact of complications on distress, physical and mental health, sleep, and relationships; and explored strategies that obstetrics and gynecology surgeons used to cope with complications. Univariate logistic regression analyses were used to determine the association between obstetrics and gynecology surgeons' characteristics and complication consequences. Overall, of 727 survey respondents, 431 (61%) were female, 384 (55%) were aged ≥50 years, almost half had worked as obstetrics and gynecology surgeons for ≥15 years (329 [45%]), and 527 (73%) reported completing <10 surgical procedures per week. Most (568 [78%]) reported <3 surgical complications per year, and most (472 [66%]) thought this was similar or less frequent compared with their colleagues. Complications caused most stress when they resulted in poor patient outcomes (653 [90%]), had severe patient consequences (630 [87%]), or were a result of surgeon error (627 [86%]). Complications impacted most obstetrics and gynecology surgeons' well-being and sleep. A greater proportion of those aged <50 years reported that their mental well-being (32 [10%]; P=.002) and sleep (130 [42%]; P=.03) were affected when a complication occurred. Female participants were also more likely to report that their physical health (14 [3%]; P≤.001), mental health (39 [9%]; P=.01), and sleep (183 [43%]; P≤.001) were affected. Current trainees (11 [10%]) and surgeons with <15 years of experience (25 [9%]) were more likely to experience mental well-being consequences compared with surgeons with ≥15 years of experience (12 [4%]; P=.01). Female participants reported less willingness to interact with colleagues when complications occurred (323 [75%]; P=.006), and surgeons with <15 years of training were less likely to report comfort in talking (221 [74%]; P=.03) and interacting with others (212 [74%]; P=.02). The vast majority of obstetrics and gynecology surgeons experience a major impact on their health and well-being when one of their patients develops a complication. The degree and type of impact reported are similar to those observed in other surgical specialties. Future studies are needed to test interventions that alleviate the substantial impact and to follow obstetrics and gynecology surgeons longitudinally to understand the duration of the impact of complications.

Personil Sekolah yang Memberi Kenyamanan untuk “Curhat”

Mental health problems in students require good support from all school personnel. However, not all students who have problems are comfortable talking to others about their problems. The purpose of this study is to describe school personnel who can make students feel comfortable to tell their story. Through this research, it is hoped that data can be obtained to serve as a basis for utilizing school personnel in providing guidance and counseling services. The study used a quantitative approach of descriptive survey type. The research sample was taken from 179 vocational school students in Yogyakarta City randomly. Data collection was conducted using an open-ended questionnaire to obtain who the school personnel were most comfortable talking to. Data analysis was done by calculating the percentage of the results of filling out the questionnaire. The results showed that the majority of students felt comfortable talking to friends, with teachers coming second and other school staff. The results of this study emphasize the chances of success of guidance and counseling services by utilizing peers, such as group-based services and peer facilitator services

Understanding the selection of support partners in a behavioral weight loss program

Objective Engaging a support partner during behavioral weight loss (BWL) programs can improve outcomes. However, little information is available about those selected as support partners. The study aimed to (1) characterize support partners and qualities of the relationship, (2) assess differences in relationship dynamics across relationship types, and (3) assess differences in supportive relationships by participant gender. Methods and Measures Upon entering a 24-month BWL program, participants (N = 323) nominated a support person from their existing social networks. Participants completed self-report measures at baseline, including the Working Alliance Inventory and study-specific measures assessing characteristics of the support person and comfort in communicating with them. Results Spouse/partners were chosen by 43.3% of all participants. Among married participants, 80.9% of men and 53.8% of women chose their spouse/partner. Working alliance was lower when the support partner was a spouse/partner versus a friend (p < 0.05, r = −0.19). Comfort talking about exercise with a support partner was higher than talking about eating or weight (p < 0.001, η2 p = 0.05). Conclusion A variety of friends and family can be selected as support partners during BWL. Programs should attend to the unique needs of men versus women when identifying sources of support.

Sexuality education for school-aged children and adolescents: A concept analysis.

Sexuality education is essential for children and adolescents to make better choices regarding their sexual well-being. Parents, teachers, and healthcare providers are not always comfortable talking to school-age children about sex, making sexuality education a concept of interest to be explored. The purpose of this paper is to explain the concept of sexuality education in school-aged children and adolescents. This paper uses Walker and Avant's concept analysis to help clarify its meaning. The sexuality education concept is explored in this article in the views of educating school systems K-12 with three types of sexuality education (abstinence-only, abstinence-plus, and comprehensive sexuality education). Literature from 1990 to 2023 was retrieved using PubMed, Google Scholar, and CINAHL. A model case is used to demonstrate the importance of sexuality education. A borderline case and a related case are proposed to explain other uses of the concept. Defining attributes, antecedents, consequences, and empirical referents are explored. Antecedents of sexuality education are grouped into three categories: resources, political environment, and social beliefs. A conceptual understanding of sexuality education can foster nurses' confidence in talking to their patients about this topic and encourage nurses to advocate for comprehensive sexuality education nationwide.

A Virtual Interprofessional Death Café to Increase Comfort With End-Of-Life Conversations

The Death Café model has been adopted in lay and professional communities world-wide to foster agenda-free discussion about death. To address the discomfort discussing death common among healthcare trainees and professionals, the authors coordinated a virtual, interprofessional Death Café within an academic medical community. Students and faculty affiliated with Schools of Nursing, Medicine, and Public Health at a United States academic center were invited by email to participate in a virtual Death Café. Participants were asked to complete an anonymous postevent survey about their level of comfort discussing death. Forty-six of 69 Death Café attendees completed the survey. About 77.8% agreed that this event positively impacted their perspective on end-of-life discussion and 80% reported feeling more comfortable talking about death and dying after the event. These preliminary findings suggest this virtual Death Café model provides a feasible, acceptable platform to increase comfort discussing death among healthcare trainees and professionals.

The association between gynecologic healthcare providers’ sexual health and their comfort discussing their patients’ sexual function

ObjectiveStigma surrounding discussions of sexuality can prevent patients from discussing sexual health issues with their healthcare providers. Clinicians may also experience similar stigma, compounding the problem if also reticent to assess their patients’ sexual health. We explored the association of healthcare providers’ personal sexual experience and health with their comfort with and frequency of optimizing their patients’ sexual function and satisfaction. MethodsWe conducted an anonymous online survey of gynecologic care providers and their comfort with and frequency of addressing their patients’ sexual function. Covariates examined via bivariate analysis included: socio-demographics, training level, prior sexual experiences and education, history of sexual trauma, and current sexual problems and satisfaction. ResultsMost respondents (N = 189) identified as sexually active (82.5 %), heterosexual (90.5 %), female (85.7 %) medical trainees (63.5 %). A quarter (23.8 %) reported currently having at least 1 sexual problem and 27.0 % reported a history of sexual trauma. Notably, 91.0 % of respondents had never been asked about their own sexual health by a healthcare provider. Less than half (43.9 %) reported frequently bringing up sexual health issues with their patients, while about half (50.8 %) reported being comfortable optimizing patients’ sexual function, which was significantly correlated (p < 0.05) with practicing at the attending level, being comfortable talking about their own sexuality, the absence of sexual problems, reported sexual satisfaction, and prior education in a greater number of sexual healthcare topics. ConclusionVariation in how gynecologic healthcare providers manage their patients’ sexual function may be linked to their own sexual experiences and well-being.

Acupuncture knowledge, attitudes, beliefs and health service needs after traumatic brain injury: a cross-sectional survey.

Acupuncture is a promising treatment for common symptoms after traumatic brain injury (TBI). Our objectives were to explore knowledge, attitudes and beliefs about acupuncture, identify health service needs and assess the perceived feasibility of weekly acupuncture visits among individuals with TBI. We surveyed adults 18 years of age and older with TBI who received care at the University of Washington. Respondents were asked to complete 143 questions regarding acupuncture knowledge, attitudes and beliefs, injury-related symptoms and comorbidities, and to describe their interest in weekly acupuncture. Respondents (n = 136) reported a high degree of knowledge about acupuncture as a component of Traditional Chinese Medicine, needle use and safety, but were less knowledgeable regarding that the fact that most conditions require multiple acupuncture treatments to achieve optimal therapeutic benefit. Respondents were comfortable talking with healthcare providers about acupuncture (63.4%), open to acupuncture concurrent with conventional treatments (80.6%) and identified lack of insurance coverage as a barrier (50.8%). Beliefs varied, but respondents were generally receptive to using acupuncture as therapy. Unsurprisingly, respondents with a history of acupuncture (n = 60) had more acupuncture knowledge than those without such a history (n = 66) and were more likely to pursue acupuncture without insurance (60%), for serious health conditions (63.3%) or alongside conventional medical therapy (85.0%). Half of all respondents expressed interest in participating in weekly acupuncture for up to 12 months and would expect almost a 50% improvement in symptoms by participating. Adults with TBI were receptive and interested in participating in weekly acupuncture to address health concerns. These results provide support for exploring the integration of acupuncture into the care of individuals with TBI.

Are Ontario Midwives Prepared to Respond to Their Clients’ Sexual Concerns? A Survey of Attitudes, Perceived Training, Knowledge, and Comfort

Objective: Sexual health and well-being are vital components of overall health, quality of life, and relationship satisfaction and stability. Midwives have the potential to play an important role in addressing their clients’ sexual health concerns and promoting their sexual health. The goal of this study was to assess the attitudes, perceptions of training, knowledge, and comfort of midwives registered in Ontario with respect to addressing their clients’ sexual concerns. Methods: We used a cross-sectional online survey (45 mins) of registered midwives in Ontario. An email containing information about the study and a link to the survey was sent to all midwives registered in Ontario in 2016 and members of the Association of Ontario Midwives (AOM) as part of the weekly “Midwife Memo” from the AOM, and was posted on a Canadian midwifery Facebook group. Participants were asked about their training and practice, attitudes toward their role in addressing their clients’ sexual concerns, perception of quality of sexual health training, and sexual knowledge and comfort. Results: Of the 740 midwives registered in Ontario at the time of the study, 100 submitted responses yielding a response rate of 14%. Results indicated that participants felt strongly that midwives have an important role to play in addressing their clients’ sexual concerns and most participants reported that they would feel very or extremely comfortable addressing each of the 10 sexual health topics. Participants who rated themselves as more knowledgeable and comfortable addressing sexual topics had more positive attitudes toward doing so. However, the results also suggested that some midwives currently are not adequately prepared to take on this role. Many participants perceived gaps in how knowledgeable they would feel in addressing the sexual health topics. The topics that participants were most likely to feel knowledgeable about were postpartum issues, changes in sexuality over the lifespan, sexual health, sexual practices, and biological aspects of sexuality, whereas participants felt least knowledgeable about sex and disability, sexual problems/concerns/dysfunction, and experiences of sexual violence. Moreover, participants felt significantly less knowledgeable than comfortable talking about sexual issues. Conclusion: These results suggest that midwives would benefit from training that provides them with information about sexual topics, translating this knowledge into practice, and strategies on how to be proactive on these topics in a way that is acceptable to their clients. Such training is likely to also increase midwives’ comfort discussing sexual issues. Peer-reviewed article.

Black Pregnant and Postpartum Peoples' Perspectives on Mental Health and Substance Use Disorders.

Introduction: Mental health and substance use disorders in pregnant and postpartum people (PPP) are common, and most will not receive adequate treatment. In addition, Black PPP experience higher rates of mental health conditions and are less likely to receive treatment compared with White PPP. Yet, our understanding of the experience of Black PPP with respect to these conditions is limited. The goal of this study was to better understand these experiences with respect to mental health, substance use, and barriers to treatment. Methods: Semi-structured interviews were completed with 68 Black PPP who were pregnant or had been pregnant in the last 24 months to gain an understanding of mental health and substance use screening and treatment during the peripartum and postpartum period. Interview data were analyzed with qualitative software, using a qualitative content analysis method, informed by grounded theory. Results: Four main themes were identified: (1) personal beliefs and views about mental health and substance use, (2) family and community beliefs about mental health and substance use, (3) personal experience with mental health and substance use, and (4) comfort in talking to others about mental health and substance use. Subthemes evolved within each of the four themes. Black PPP indicated that maternal mental health and substance use disorders are common in the Black community, but negative stigma related to these conditions often prevents PPP from talking about these conditions or seeking support or treatment despite believing that support and treatment can be beneficial. Conclusions: Clinical practice initiatives within this population can focus on advanced training for providers to more clearly understand personal experiences and related stigma related to mental health and substance use disorders, with the goal of supporting Black PPP mental health needs.

Open communication between patients and relatives about illness & death in advanced cancer—results of the eQuiPe Study

ObjectiveTo assess the degree of openness of communication about illness and death between patients with advanced cancer and their relatives during the last three months of the patient’s life, and its association with relatives’ characteristics and bereavement distress.MethodsWe used data from bereaved relatives of patients with advanced cancer from the prospective, longitudinal, multicenter, observational eQuipe study. Univariate and multivariable linear regression analyses were used to assess the association between the degree of openness of communication (measured using the validated Caregivers’ Communication with patients about Illness and Death scale), the a priori defined characteristics of the relatives, and the degree of bereavement distress (measured using the Impact of Event Scale).ResultsA total of 160 bereaved relatives were included in the analysis. The average degree of open communication about illness and death between patients with advanced cancer and their relatives was 3.86 on a scale of 1 to 5 (SE=0.08). A higher degree of open communication was associated with a lower degree of bereavement distress (p=0.003). No associations were found between the degree of open communication and the relatives’ age (p=0.745), gender (p=0.196), level of education (p>0.773), (religious) worldview (p=0.435), type of relationship with the patient (p>0.548), or level of emotional functioning before the patient’s death (p=0.075).ConclusionsOpen communication about illness and death between patients and relatives seems to be important, as it is associated with a lower degree of bereavement distress. Healthcare professionals can play an important role in encouraging the dialogue. However, it is important to keep in mind that some people not feel comfortable talking about illness and death.

The Role of Single Fathers in the Moral Development of Children Aged 5-6 Years

This study aims to explore the role of single fathers in the moral development of children aged 5-6 years in Nguwok Village, where morality is considered a crucial aspect of human development and life. The research method employed is qualitative with a descriptive approach. The subjects of this study are two single fathers with children aged 5-6 years residing in Nguwok Village, Modo District, Lamongan Regency. Data collection techniques include interviews, observations, and documentation, with data analysis following the Milles and Huberman model. The findings from this research indicate that single fathers play a significant role in nurturing their children, including bathing, feeding, and assisting with homework. The second role involves providing education, particularly in moral values, the third is acting as a mentor, which includes accompanying and disciplining the children, and the last role is that of a friend, ensuring the child feels comfortable talking or sharing stories with their father. According to the research results, the moral development of children raised by single fathers shows a balanced development between capability and incapability. The aspects of moral development examined include speaking politely, practicing religious worship, expressing gratitude when receiving something, maintaining personal and environmental cleanliness, and apologizing when making mistakes.

Let’s Talk About Sex! Perspectives from People with Intellectual and Developmental Disabilities and Caregivers in Residential Institutions in Greenland

This study explores how attitudes toward talking about sex and sexual matters influence practices regarding sexuality, sexual rights, and sexual abuse in residential institutions for people with disabilities in Greenland. 16 residents aged 17–62 and 29 managers and staff from 8 residential institutions have been interviewed about the ways sexual needs and rights are treated and discussed as well as how sexual harassment and violations are prevented or handled. The results of the study show that there are great variations between the residential institutions regarding meeting residents’ sexual needs, talking about sex, sex education, and knowledge of rules and policies in the area. While some managers and staff are quite comfortable talking to residents and each other about sex, boundaries, and the body, others find it extremely difficult and some even reject the thought of sex as a relevant topic for the residents. Regardless of the level of openness about sexual matters in the residential institutions, staff and managers express a need for more sex education with a focus on how they can best help, guide, and protect residents, but guidance about sex is much more available for residents when staff feel comfortable talking about sex. Sexual violations and illegal sexual contact might take place in residential institutions regardless of the local practices regarding sex and sex education. However, openness about sexual matters might help detect overstepped sexual boundaries and stop sexual harassment and violations earlier.

Pediatric Resident and Program Director Views on Climate Change and Health Curricula: A Multi-Institution Study.

The American Academy of Pediatrics emphasized in a 2007 policy statement the importance of educating trainees on the impacts of climate change on children's health, yet few studies have evaluated trainee knowledge and attitudes about climate change-related health effects in children. This multi-institution study assessed pediatric resident and program director (1) knowledge/attitudes on climate change and health, (2) perspectives on the importance of incorporating climate and health content into pediatric graduate medical education, and (3) preferred topics/activities to include in climate and health curricula. This mixed-methods study employed an anonymous cross-sectional survey of pediatric residents and residency program directors from Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN)-affiliated programs. Multivariable regression models and factor analyses were used to examine associations among resident demographics and resident knowledge, attitudes, and interest in a climate change curriculum. A conventional content analysis was conducted for the open-ended responses. Eighteen programs participated in the study with all program directors (100% response rate) and 663 residents (average response rate per program, 53%; overall response rate, 42%) completing respective surveys. Of the program directors, only 3 (17%) felt very or moderately knowledgeable about the association between climate change and health impacts. The majority of residents (n=423, 64%) agreed/strongly agreed that physicians should discuss global warming/climate change and its health effects with patients/families, while only 138 residents (21%) agreed/strongly agreed that they were comfortable talking with patients and families about these issues. Most residents (n=498, 76%) and program directors (n=15, 83%) agreed/strongly agreed that a climate change curriculum should be incorporated into their pediatrics training program. Pediatric residents and program directors support curricula that prepare future pediatricians to address the impact of climate change on children's health; however, few programs currently offer specific training, despite identified needs.

İntörn Hemşirelerin Kanser Hastalarına Bakım Verirken Ölüm Kavramına İlişkin Yaşadığı Deneyimler ve Tutumları: Tanımlayıcı ve Kesitsel Bir Çalışma

Aim: This study was conducted using a descriptive and cross-sectional method to determine the attitudes and experiences of intern nursing students toward the concept of death while providing care for individuals with cancer. Methods: The sample of the study consists of 94 intern nurse students. The data were collected through face-to-face interviews using the data form including questions about sociodemographic characteristics and the concept of death, and the Frommelt Attitude Towards Care of the Dying Instrument. Descriptive statistics, Mann Whitney U and Kruskal-Wallis tests were used in the analysis of the data. Results: Of the students 91.5% encountered the concept of death outside the clinical environment, while 70.2% encountered in the clinical setting, and 58.5% provided care for five or more dying patients. Of the students 67.1% had difficulties in the interviewing and data collection process, and 22.3% had difficulties in all nursing practices. 47.3% said they experienced helplessness, and 19.7% said they experienced grief. In the current study, it was found that the mean FATCOD score was 73.00 ± 8.70. There was a difference in the scale scores in terms of the students' status of feeling comfortable talking to a cancer patient about the concept of death (p&amp;lt;0.05). Conclusions: Intern nursing students have experienced helplessness. Students need strategies focusing on all stages of the nursing process in both theoretical and clinical practice.

CLINICIAN EXPRESSIONS OF CONDOLENCE AFTER THE DEATH OF A PATIENT: AN INTERNATIONAL SURVEY

Abstract There is little literature about expressions of condolence from providers to family members of those that have died, and no known literature reported during the COVID-19 pandemic. This study utilized an investigator-developed survey of healthcare clinicians about contacting families of patients who have died. It conducted via email and online from October to December 2021. Of 131 respondents, 67% were female, from 23 states, Canada, and UK. Half (49%) had &amp;gt;15 years experience, and most (85%) were attending physicians. The majority (99%) reported that a patient had died in their care within last year, while 18% reported lost &amp;gt;10 patients per month. Methods of condolences were phone calls, and personal letters. Most (67%) reported no change in contacting families, while 23% increased. When asked if they would be interested in education on expressing condolences, 47% responded “yes.” Barriers to condolences were time (64%), unsure of what to say (20%), afraid family will be upset (19%), medical/legal reasons (10%), no training (8%), and no personal relationship (7%). Most, (85%) reported that most calls “went well or better than expected.” Females (vs. male) reported often/always sending letters (45% vs 20%, p=0.13), and often/always calling by phone significantly more (71% vs 63%, p=0.04). Younger (&amp;lt; 40) clinicians (vs. older) reported being very/moderately comfortable talking to families (72% vs 78%, p=0.79), phone calls (64% vs 69%, p=0.68) and personal letters (27% vs 42%, p=0.91). Nearly half of respondents requested training. This is a practice that should be further studied for clinician and family experience purposes.