Concept Of Care Research Articles

The intercultural caring-coping patterns of disaster-displaced families in temporary shelters

This integrative research review sought to explore the concepts of caring and coping in the context of the disaster-displacement phenomenon. It intended to describe and characterize the process of human flourishing amidst crisis through the caring and coping experiences of people living temporarily in emergency shelters after having been forcefully displaced following a devastating disaster event. This review adopted the 11-step method introduced by Tawfik and his colleagues in 2019. Three databases were utilized which included CINAHL, PubMed, and ProQuest. Papers needed to be published in English, with full-text availability for their inclusion. A total of 16 references met the inclusion criteria for the final review. To construct a logical and coherent integration of the important points, four categories of themes were developed: i) disaster impacts on daily life patterns and cultural lifeways; ii) caring patterns during disaster displacement; iii) coping patterns during disaster displacement; and iv) cultural learnings for disaster-based practitioners. It was noted that despite the challenges of crises, disaster victims often recover naturally and return to their previous levels of functioning. Resilient caring-coping mechanisms enable people to flourish in adversity, with culture and traditions playing a vital role in shaping their adjustment and adaptation to current circumstances.

Bijdrage van welzijnsorganisaties in het faciliteren van geïntegreerde zorg: 3 praktijkvoorbeelden

Contribution of regionally organised public centres for social welfare to the facilitation of integrated care: 3 practical examples Three key insights of the last few decades related to health and health care are the health care concepts of quintuple aim, positive health and the importance of experiential knowledge. All of these insights argue for integrated care in which also experiential knowledge is integrated, along with wellness and health care at and between all levels. Developing integrated care is difficult. Welfare organizations are regional associations of municipalities in Flanders (Belgium) by which local governments jointly implement social and welfare policies that meet the welfare needs of the region. How welfare organizations can help make integrated care a reality, is illustrated in this publication through 3 examples: a transmural care pathway for addiction, a case manager between physicians and municipal social services, and improving sleep health knowledge in the Kempen region (Flanders). These examples were all selected for the International Conference on Integrated Care 2023 as good practices of integrated care.

The BrEasT cancer afTER-CARE (BETTER-CARE) programme to improve breast cancer follow-up: design and feasibility study results of a cluster-randomised complex intervention trial.

The risk of breast cancer patients for long-term side effects of therapy such as neurotoxicity and cardiotoxicity as well as late effects regarding comorbidities varies from individual to individual. Personalised follow-up care concepts that are tailored to individual needs and the risk of recurrences, side effects and late effects are lacking in routine care in Germany. We describe the methodology of BETTER-CARE, a parallel-arm cluster-randomised controlled trial conducted at 15 intervention and 15 control centres, aiming to recruit 1140 patients, and the results of the pilot phase. The needs- and risk-adapted complex intervention, based on existing development frameworks, includes a multidisciplinary network and digital platforms for symptom and need documentation and just-in-time adaptive interventions. The control group comprises usual care according to clinical guidelines. The primary outcome is health-related quality of life (EORTC QLQ-C30 global health), and secondary outcomes include treatment adherence. The 2-month pilot phase comprising 16 patients in one intervention and one control pilot centre demonstrated the feasibility of the BETTER-CARE approach. BETTER-CARE is a feasible intervention and study concept, investigating individualised needs- and risk-adapted breast cancer follow-up care in Germany. If successful, the approach could be implemented in German routine care. German Clinical Trial Register DRKS00028840. Registered on April 2022.

Evaluate the Differential Effectiveness of the Case Management and Primary Nursing Models in the Implementation of Discharge Planning.

This study aims to compare the effectiveness of the case management model and the primary nursing care model by focusing on hospital stay length, readmission, follow-up resource utilisation and survival. To improve patient continuity of care, a discharge planning team has been established at the hospital to implement the service concept of long-term medical care. The team works with a multidisciplinary medical team to provide case management, which ensures high-quality patient care. Retrospective case-control study. This study collected data from the medical record information system database and the Ministry of Health and Welfare's care service management information system to explore medical and follow-up care utilisation of patients discharged between 2017 and 2018. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, with the checklist used to ensure transparent and complete reporting of the methodology and results. To ensure comparability between the case management model group and the primary nursing model group, propensity score matching was used. After matching, 660 individuals from the case management model group and 2876 individuals from the primary nursing model group were selected for further analysis. In this study, patients were primarily involved in the research as participants, providing data through their medical records for analysis. However, no direct involvement from the public or patients was used in the planning or design stages of the research. The study found that factors such as activities of daily living (ADL) score ≤ 60 points, catheterisation, poor chronic disease control and inadequate primary caregiver capacity can lead to longer hospitalisations. Males and patients with catheters have a higher risk of readmission within 30 days, and men, those aged ≥ 75 years, those with ADL score ≤ 60, catheterisation, pressure sores or unclean wounds, financial problems, insufficient primary caregiver capacity and those readmitted within 14 days after discharge had significantly increased mortality after discharge. Although the case management model group had higher hospitalisation days, they had lower readmission rates and higher survival rates than the primary nursing model group. Early consultation with the case manager for discharge planning can help patients to continue to receive care and utilise relevant resources after returning home. Identifying and addressing patient-specific factors can significantly improve patient outcomes by reducing hospitalizations and readmissions, and lowering mortality rates. The case management model is more effective than the primary nursing care model in reducing readmission rates and increasing survival rates. Early consultation with case managers for discharge planning is crucial to ensuring patient care continuity and resource utilization.

Combining quality improvement and critical care training: Evaluating an ICU CPR training programme quality improvement initiative at the National Hospital in Tanzania

BackgroundThe United Republic of Tanzania has had a 41.4% mortality rate in the intensive care unit. In Tanzania, the Ministry of Health and Social Welfare has implemented quality improvement (QI),...

Narrative Coherence and Relational Agency: Unraveling Transitions Into and Out of Alberta Correctional Facilities for People Living With HIV.

Incarcerated populations in Canada face significant health and social challenges during transitions into and out of correctional facilities. These transitions around facilities pose disproportionate barriers to care for people living with HIV. Further research is crucial to comprehend these challenges and reimagine care concepts for people who experience structural marginalization. In this article, experiences of transitions into and out of Alberta correctional facilities for people living with HIV are explored using narrative inquiry. Conducted in a Western Canadian city from 2021 to 2022, the inquiry revolved around two men living with HIV and a history of incarceration. Through co-creating field texts and narrative accounts, their unique experiences of transitions were explored through a collaborative process of analysis. Narrative threads from Bruce and Kyle showcased a lack of narrative coherence and the presence of tensions in their lives, while also emphasizing relational agency. The findings provide avenues for health, social, and justice practitioners who support and care for individuals living with HIV and a history of incarceration to think differently about transitions. By highlighting the importance of attending to the unique identities of individuals and relationships from a position of relational agency, the study advances our understanding of transitions. Recommendations for practice and policy include (a) fostering relational agency among practitioners; (b) challenging conventional views of transitions around correctional settings; (c) incorporating peer-based programming into support services; and (d) reconsidering health, justice, and social systems to better support communities disproportionately affected by high rates of incarceration and HIV.

Gender and healthcare leadership: Addressing critical knowledge gaps by explicitly considering the gendered concept of care.

This scoping review of gender and healthcare leadership synthesized the barriers and facilitators at multiple levels employing a framework that integrates a specific focus on the concept of care. The 71 sources identified focus predominantly on barriers to women's leadership at the individual and team level and, to a lesser extent, at the organizational and system level. Facilitators tend to be presented as recommended actions than evaluated interventions. Healthcare leadership tends to ignore the gendered context of care elevating leaders who are least likely to provide such care. Where personal caregiving circumstances are considered, they are individualized, reflecting the literature in general. More critical analysis is needed to focus on women's experiences and how their gender can predetermine their success in achieving and being in leadership positions. Healthcare leadership researchers are encouraged to include gender and care-focused analyses and interventions to address the under-representation of women in healthcare leadership.

Family-Centered Care from the Point of View of Undergraduate Nursing Students Studying in Selected Public Universities: A Cross-Sectional Study

Background: The concept of family-centered care (FCC) is central to the care model and is an essential core principle of pediatric nursing. Objectives: This study aimed to assess undergraduate nursing students' perceptions of FCC in selected government universities and examine differences in nursing students' perceptions of FCC based on gender and academic level. Methods: A cross-sectional design was used, involving 124 eligible students. Data were collected using a validated Family-Centered Care Questionnaire (FCCQ), which had a Cronbach’s alpha score of 0.90. Statistical package for social sciences (SPSS) version 25 was employed for data analysis, specifically for calculating means, standard deviations (SDs), frequencies, percentages, and conducting independent t-tests. Results: The overall mean score of perceptions was 3.35 ± 0.76. The "Family is the constant" dimension had the highest score (3.45 ± 0.91), while the "Developmental needs" dimension had the lowest score (3.26 ± 0.95). There was a significant difference in perceptions of FCC between male and female students (t = -5.291, P < 0.001) and between third- and fourth-year students (t = 7.345, P < 0.001). Conclusions: It can be concluded that undergraduate nursing students had modest perceptions of FCC, and there was a significant difference in these perceptions based on gender and academic level. This study provides valuable insight into FCC, which can inform policy design and interventions in nursing education in Jordan. An educational program is recommended to improve undergraduate nursing students' perceptions of FCC.

Evolution of fundamental nursing concepts

Eminently essential to nursing and nursing science, the four concepts of person, environment, health and care enable us to give meaning to the discipline, situate it, link it to theories, question it and help it evolve. Enunciated in 1984 by Jacqueline Fawcett, these initial concepts are evolving in line with health and social issues.

Development and feasibility of a sex- and gender-sensitive primary care intervention for patients with chronic non-cancer pain receiving long-term opioid therapy (GESCO): a study protocol

BackgroundChronic non-cancer pain (CNCP) is a common condition worldwide. The disease burden is influenced not only by pain itself, but also by psychiatric co-morbidities, which aggravate symptoms, generally negatively influence therapies, and may thereby lead to frustration, resignation, or withdrawal. A growing body of evidence suggests that sex and gender aspects influence CNCP management as the experience of pain, the emotions associated with it, and the expression of pain may differ between women and men. In addition, doctor-patient communication is known to be influenced by gender stereotypes. Despite there being evidence on such differences, current guidelines do not consider sex- and gender-sensitive approaches. In order to examine how to adequately address the diversity of the experience and processing of pain in patients of differing sex and gender, the GESCO study aims at developing and pilot testing a sex- and gender-sensitive intervention for patients with CNCP receiving long-term opioid therapy (LTOT) in primary care.MethodsThe development process is designed in accordance with the first two phases of the UK Medical Research Council. Phase I will iteratively explore, develop, and pilot the intervention’s modules using literature searches, interviews, and workshops involving stakeholders and experts. Phase II will pilot-test the novel intervention in a sample of 40 patients with CNCP under LTOT from ten general practices using an effectiveness-implementation hybrid design including a mixed-methods process evaluation focusing on implementation strategy criteria and a single-arm, pre-post comparison to determine preliminary effects in preparation for a larger effectiveness trial. The intervention will combine in-person educational sessions for general practitioners and tools to be used in patient care.DiscussionThe intervention aims to improve CNCP management in primary care by empowering practitioners to reflect on their attitudes towards pain and stereotypes. Besides sex and gender aspects, awareness of other factors that might affect the care process, such as age, social conditions, or culture, is also promoted. The intention is to develop a comprehensive care concept for CNCP that considers aspects relevant for sex- and gender-sensitive care which are transferrable to other health care fields as well.Trial registrationGerman Clinical Trial Register DRKS00029980.

Disruptive Encounters. Concepts of Care and Contamination out of Control. An Introduction

Introduction to the guest edited section.

“The stay here is, of course, not appropriate for an old person”: the perspective of healthcare providers on older patients in the emergency department

BackgroundIn aging societies, emergency departments (ED) face an increasing number of older, geriatric patients. Research shows that older emergency patients have a greater burden of comorbidities and a higher risk of adverse events. It has been questioned whether contemporary ED structures can meet the specific needs and characteristics of older patients. Little is known about how professional health care providers perceive and experience ED care for older patients. This study aimed to get insight into the perspective of healthcare providers working with older ED patients and to explore the challenges they experience in their daily work.MethodsThe study used a qualitative research design with a social-constructivist perspective and a Grounded Theory based methodology. Data were collected through qualitative interviews with N = 25 healthcare providers from different urban EDs in Berlin, Germany, and adjacent healthcare institutions. Following the Ground Theory approach, categories and central themes were identified, analyzed, and interpreted to gain a comprehensive understanding of the healthcare provider perspective.ResultsThe interviews revealed a significant and increasing relevance of geriatric ED patients for healthcare providers. However, there was no shared definition of ‘the geriatric patient’. Most interviewees found ED structures to be inadequate for older patients. They described specific challenges, such as information gathering and safety risks in the ED, as well as an increased use of resources (both time and personnel) when caring for older patients. In addition, specific problems in the collaboration with other professions and institutions were addressed, namely nursing homes, hospital wards, consultations, and the hospital social service.ConclusionHealthcare providers experience a structural mismatch between contemporary EDs and the specific needs of geriatric patients. They are aware of the vulnerabilities of geriatric patients and try to compensate for inherent structural shortcomings. Such structures and limited resources often cause practical, organizational, and ethical problems. There is a great need to develop, implement, and evaluate systematic approaches and care concepts that address the specifics of ED care for geriatric patients.

Postoperative nursing in robot‐assisted urologic surgery: Are there any platform‐based differences?

AbstractMany robotic platforms are currently available for urologic surgery, each with its technical characteristics. It can be hypothesised that these characteristics might affect postoperative nursing, as they affect several aspects of surgery. They could, therefore, impact the surgical outcomes and wound characteristics, involving aspects of postoperative care such as mobilization, nutrition and length of stay. Although data are available on surgical technique aspects and intraoperative nursing, studies have yet to offer insights and considerations about the potential effect of having different robotic platforms on postoperative nursing care. We aimed to verify whether the technical features of the available robots could impact postoperative nursing. We conducted an integrative review on PubMed, CINAHL and Scopus, using Medical Subject Headings (MeSH) and free‐text terms; wildcards and boolean operators were also used. Studies of any design were included. Fifteen papers were retrieved; the key themes emerging from the literature regard trocar setup, technical characteristics of the robots (e.g. single or multiple ports), pneumoperitoneum and Trendelenburg degree. According to the literature, none of these characteristics produce differences in postoperative nursing. The fundamental concepts of postoperative care in surgical inpatients stay the same no matter the robotic platform used. Having competing platforms able to ensure reduced complications without impacting postoperative nursing allows health care facilities to adopt the newest technologies without the need for differentiated nursing protocols. This is an advantage in times of global nursing shortage as it avoids the need for additional platform‐based nursing training.

Patient and healthcare provider perspectives on a digital first general practice: mixed-method study

Abstract Background General practitioners (GPs) are facing an increased workload as a result of an aging population and a growing prevalence of chronic diseases. Utilizing eHealth may help to enhance healthcare accessibility and reduce costs. A digital platform was developed that integrates eHealth into the organizational aspects of general practices. This study aims to provide insight into the experiences of patients and healthcare professionals with this new, digital way of working. Methods A mixed-method study was conducted in three Dutch general practices working with the digital platform. The digital platform focuses on digital communication and remote healthcare delivery in primary care. Primary outcomes included acceptability, the implementation process, suggestions for improvement, and facilitators and barriers for future implementation. Patient perspectives were identified through online questionnaires and focus groups, and healthcare professionals’ experiences were explored through in-depth interviews. Results Five focus groups and ten in-depth interviews were held. The questionnaires were completed by 616 patients. Patient acceptability of the care concept was high (M = 3.9, SD = 1.0; on a scale from 1-5) and they were satisfied with received care (M = 30.1, SD = 3.4; on a scale from 8-32). Regarding the perceived quality of consults, patients were positive about the longer duration of physical consults (i.e., 20 instead of 10 minutes). Some participants indicated a less personal doctor-patient relationship, because care was provided by various GPs. Conclusions Overall, patients and healthcare professionals were positive about the digital platform. The study gives insights into how to improve the care concept, e.g., how to enhance the doctor-patient relationship. Key messages • Digital first general practices that integrate eHealth into the practice’s organizational aspects of are considered acceptable by patients and healthcare professionals. • Digital first general practices can help to improve healthcare accessibility for both patients and healthcare professionals.

Physical activity promotion in Aged care: a participatory approach

Abstract Introduction Aged care facilities (ACF) constitute an increasingly important, yet challenging setting for health promotion - given it is a highly sedentary pseudo-total institution characterized by structured daily routines within a paradigm of care for residents perceived as fragile and vulnerable. A participatory approach with residents, significant others, staff, and management might be a promising pathway to address intrapersonal, sociocultural, organizational, environmental, and political determinants of physical activity in this specific context. We will present processes and results from a research project, funded by the German Ministry of Health (2019-2023), on physical activity promotion in ACFs. Methods Our co-creation approach involved residents, significant others, staff, and management from seven nursing homes in Southern Germany. Methods included 800hrs on-site observations, semi-structured interviews (n = 31), Photovoice (n = 27 participants, n = 169 photos), as well as future workshops (n = 14) for intervention co-development (n = 14) and co-evaluation workshops (n = 7). Data analysis used reflexive thematic analysis with MaxQDA20. Results Implemented interventions (n = 57) addressed individual, social, environmental, and organizational factors. Activity promotion was integrated into care concepts and mission statements, staff work descriptions, as well as informal internal routines. Of the interventions implemented, 33% were rated as more successful, 43% as successful, and 19% as less successful than anticipated. Conclusions Participation can initiate structural and cultural change towards physical activity. However, the analyses also emphasized the critical role of staff training, along with the involvement of significant others and external service providers, as essential components for achieving sustainable change. Key messages • Participatory approaches integrate physical activity into aged care, fostering cultural shifts for resident well-being. • Success requires staff training, engaging residents’ support networks, balancing empowerment with protection.

6.Y.1. Defining, measuring, and reducing low-value care in Europe - proposing a new definition and framework

Abstract The EU Expert Group on Health Systems Performance Assessment (HSPA) selected value-based healthcare, with a focus on low-value care, as the work topic for 2023-2024. Against the backdrop of increasing healthcare expenditures and the overall aim to deliver high quality and efficient healthcare, efforts to reduce waste and inefficiencies have long been emerging in health systems worldwide. Value-based healthcare shifts the focus towards improving patient outcomes; the concept of low-value care in particular aims to identify health services that provide little or no health benefits but expose patients to potential harm. The COVID-19 pandemic clearly demonstrated that value-based healthcare is a prerequisite for high-performing health systems and the need to steer resource allocation to those services that maintain or improve health. The reduction in certain elective services observed during the pandemic (e.g. tonsillectomies) indicates that there may be areas for potential dis-investment and reallocation of resources to higher-value care. The pandemic has thereby emphasized the need for identifying and systematizing measurable efforts directed at reducing low-value care. Tackling low-value care can contribute to alleviating health workforce constraints by ensuring that efforts are focused where they are most beneficial, and not on unnecessary services. Engaging and educating the health workforce about low-value care and how to reduce it is a key measure in this direction. What is more, there is increasing awareness about the health sector’s considerable environmental footprint. Reducing low-value care would contribute to less greenhouse gas emissions, energy consumption and air pollution from the delivery of health services. Despite intensified efforts to address waste and inefficiencies in healthcare in the last decade, the ability of health systems in Europe to identify and reduce low-value care varies. Through the Expert Group’s work, a new comprehensive definition was proposed and a framework to distinguish different types of low-value care was developed as a basis for identifying and tackling low-value care in EU Member States. Indicators to measure low-value care as well as measures to reduce it were collected. This workshop aims to present the findings of the Expert Group´s work on low-value care and to discuss them with conference participants to both raise awareness and identify priority elements for future activities. After a brief introduction on the definition, framework, obstacles and solutions, the panelists will share their views and experiences, followed by a facilitated discussion with the audience. Key messages • A comprehensive definition of low-value care and an accompanying framework for categorizing and identifying low-value care is proposed. • Country experiences with indicators to measure low-value care and strategies to reduce it, as well as related methodological obstacles, offer substantial opportunities for cross-country learning.

Quality indicators of long-term care for older people in OECD countries; a rapid scoping review

Abstract Background The COVID-19 pandemic has exposed the vulnerability of older people living in long-term care facilities (LTCF), highlighting the urgent need for research on the quality of care for this group of the population. There is no universal definition for quality of care in LTCF, and yet, multiple tools and indicators have been developed to measure it. In this rapid scoping review, we aim to provide a comprehensive overview of the current knowledge on quality of care concepts and indicators for older people in LTCF in OECD countries. Methods This review follows the World Health Organization (WHO) guide for rapid reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) extension for scoping reviews, including protocol registration (https://doi.org/10.17605/OSF.IO/34B2S). The electronic bibliographic databases MEDLINE (PubMed), EMBASE, and CINAHL were searched in September 2023 for studies published between 2013 and 2023 for quality indicators in LTCF. Experts in quality of care in LTCF were contacted and consulted to retrieve sources of grey literature. Information on the definition or framework of quality of care, quality of care dimensions, measurement instruments, context and purpose of the measurement will be extracted. Results Of the 8,516 identified records, 6,449 were screened by title and abstract after removing duplicates. A total of 469 publications will be screened in full-text. Experts recommended 40 websites to be screened for quality indicators. The PRISMA flowchart diagram will be provided to describe the selection process. Conclusions This review aims to improve the quality of care for older people living in LTCF. Our results will identify which concepts and dimensions of care are currently being measured in OECD countries, whether they are backed by any definition and scientific framework of quality of care for older residents of LTCF, and whether there is consideration of closing gaps in quality measurement. Key messages • Quality of care is an understudied field in the context of long-term care facilities for older people. • In order to further improve quality in long-term care for older people, it is necessary to systematically review the current state of knowledge on quality concepts and indicators.

Best supportive care for patients with primary progressive multiple sclerosis (PPMS) in Germany prior to ocrelizumab treatment: Final results from the RETRO PPMS study.

Best supportive care (BSC) measures are an essential component for the management of primary progressive multiple sclerosis (PPMS). RETRO PPMS (ML39631) is the first study to systematically analyze the therapeutic journey and standard of BSC of patients with PPMS in Germany. This multicenter, non-interventional study retrospectively analyzed patient charts. Methods: Data were recorded up until the first infusion of ocrelizumab (July 2018 to October 2021). Medical history, disease status, disease activity and treatments were assessed from 12 months before PPMS diagnosis until study start. Acute interventions, BSC parameters and rehabilitation measures from the past 27 months were assessed. The core analysis population (N = 462) had a mean age (range) of 57.4 (27-85) years and mean disease duration of 13.7 (0.3-55.2) years. The most frequently reported symptoms were muscle spasticity, bladder disorder, ataxia, gait disturbance and fatigue. The most commonly used treatment was physical/occupational therapy (66.5% of patients); 47.2% received off-label treatment with corticosteroids/disease-modifying therapies. BSC measures for many symptoms were strikingly rare - especially for fatigue and cognitive impairment. This analysis uncovers severe BSC deficits for many debilitating PPMS symptoms. There is still a large unmet need for innovative multidisciplinary care concepts and improvements in neurological primary and secondary care.

Volunteers and their heritage – a heritage from within

ABSTRACT This article furthers research on heritage volunteering by focusing on the relationship between the volunteers and the heritage they produce and perform. It explores how volunteers engage with specific aspects of the past. Through an ethnographic study of contemporary heritage volunteers in Norway, we found a deeply personal connection between volunteers and their heritage. To better grasp the heritage produced by volunteers, we propose a conceptual framework for this heritage, reflecting that it derives from a characteristic personal engagement. We argue that volunteers’ heritage is a ‘heritage from within’, closely connected to the volunteers’ personal history and bodies. Accordingly, we frame and discuss volunteer heritage production as ‘care’ to emphasise the emotional and ethical commitment that affects how volunteers preserve and produce heritage. This concept of care is inspired by heritage and STS scholars who approach heritage as a ‘matter of care’ and care as an ethically and politically charged practice.

Collaborative Online International Learning With Prelicensure Nursing Students: Teaching Family-Centered Care Through a Global Perspective.

A Collaborative Online International Learning (COIL) experience was designed for prelicensure nursing students taking a pediatric course in the United States and in Brazil, to teach family-centered care to develop inclusive, global nursing practices. The purpose of this study is to describe prelicensure nursing student learning of family-centered care concepts facilitated by COIL. For data collection, six focus groups with 37 students were conducted across both universities. Data were analyzed using inductive qualitative analysis by each country separately and as a global team. Major themes included understanding the needs of families of children with chronic conditions as impacted by health systems, assigning meanings to family care of children with chronic conditions, applying concepts of family-centered care and self-reflection. Results suggest COIL is a feasible way for prelicensure nursing students to learn family-centered nursing care by operationalizing concepts, from real experiences and increasing cultural awareness.