My research journey began while caring for critically ill patients and questioning what happens after they leave the intensive care unit (ICU). This curiosity evolved into a systematic program of research on post-intensive care syndrome and evidence-based recovery interventions that has influenced how nurses approach the transition from critical illness survival to meaningful recovery. The goal of my research has been to eliminate delirium, oversedation, and immobilization in intensive care and to maximize the quality of survivorship for patients and family members after critical illness. I have led investigations into implementation of the ABCDEF bundle (assess, prevent, and manage pain; both spontaneous awakening and spontaneous breathing trials; choice of analgesia and sedation; delirium: assess, prevent, and manage; early mobility; family engagement and empowerment), demonstrating how organizational factors like workload burden, unit leadership, and interprofessional coordination influence implementation adherence and patient outcomes. My work in telemedicine-enhanced follow-up care of patients with post-intensive care syndrome addresses the cognitive, physical, and psychological impairments that affect more than half of ICU survivors. Work implementing ICU diary and peer support programs has shown how evidence-based interventions can support patients and family members when barriers to implementation are systematically addressed. My efforts embody interdisciplinary collaboration, integrating nursing science with implementation science, health services research, and clinical psychology. My journey illustrates how bedside observations, when coupled with rigorous inquiry, collaborative partnerships, and intentionality to let patient and family voices reshape thinking, can drive meaningful contributions that improve outcomes for patients and families beyond survival.

Qualitative analysis of long-term clozapine adherence in schizophrenia: An exploratory study.

SWAP IT is a school-based nutrition programme that promotes healthier lunchbox choices for children in Australia. As part of the programme scale-up, ensuring that implementation responds to the social and cultural determinants that shape food and nutrition practices for Aboriginal and Torres Strait Islander communities is important for equitable impact. To inform the cultural adaptation of SWAP IT, this study aimed to explore the experiences and perspectives of Aboriginal school staff regarding the implementation of SWAP IT in schools with high Aboriginal and/or Torres Strait Islander enrolments. An exploratory qualitative study was conducted within the Hunter New England (HNE) region of NSW Australia-a large and geographically diverse area (132 000 km2) and one of 15 Local Health Districts in NSW. The study was led by an Aboriginal Program Manager from the Population Health Unit of HNE Local Health District, with further cultural oversight provided by programme governance groups. Grounded in Indigenous methodology, data were collected using yarning (an Aboriginal communication method and data collection tool) through individual and group yarns with 11 staff from seven SWAP IT schools. Data were analysed using Thematic Analysis and group yarns to inductively identify and refine key themes. Eight themes were identified. Four themes captured participants' direct experiences and perspectives of SWAP IT, including positive perceptions of its value (1A), and opportunities to strengthen cultural responsiveness in programme processes (1B), resources and content (1C) and distribution methods (1D). A second set of four themes reflected broader contextual considerations that emerged through the yarns and were seen to influence implementation, including preferences for culturally responsive materials and methods (2A), food access and insecurity as a significant challenge (2B), potential barriers to family engagement (2C) and sustainability concerns (2D). Incorporating surface level adaptations (e.g., Aboriginal artwork) and deep-level adaptations (e.g., cultural food practices) will enhance the programme's cultural responsivity for equitable delivery. Additional implementation strategies that account for the broader considerations may maximise impact for Aboriginal children and communities. Co-designing and piloting an adapted programme with Aboriginal communities is a critical next step. SO WHAT?: These findings highlight opportunities to strengthen cultural responsivity in programme design and delivery to better support Aboriginal and Torres Strait Islander communities.

Continuum of Crisis Care.

Implementing a Family Engagement in Research Program.

To identify and synthesise existing evidence on family-centred care for Lesbian, Gay, Bisexual, Transgender, Queer and other diverse identities (LGBTQ+) people in acute hospital settings, including hospital-based palliative care, oncology, general in-patient and intensive care. A scoping review guided by the JBI methodology. Nine databases and grey literature sources were searched. Inclusion criteria focused on LGBTQ+ adults and family-related care experiences in hospital-based acute settings. After screening, qualitative, quantitative, and narrative data were extracted. Thematic analysis synthesised findings, with quantitative data narratively integrated. Searches were conducted across nine databases and grey literature up to April 2025. Five studies met inclusion criteria: three qualitative, one quantitative, and one reflective narrative. Four themes emerged: (1) invisibility and disclosure dilemmas, (2) exclusion of chosen families from visiting and decision-making, (3) barriers to inclusive communication and provider competence, and (4) enabling conditions for affirming care. Challenges occurred at interpersonal (e.g., provider assumptions, discomfort) and structural (e.g., lack of inclusive protocols, failure to recognise legal surrogates) levels. In the two studies reporting gender identity, transgender participants described heightened misrecognition and exclusion. LGBTQ+ individuals and their chosen families face relational and structural barriers in acute hospital care. Inclusive interventions, protocols, and training are urgently needed to ensure affirming care. Acute and intensive care providers should promote inclusive family engagement by using patient-preferred terminology, recognising chosen families, and advocating for inclusive policies and staff training. This scoping review adhered to PRISMA-ScR guidelines. No Patient or Public Contribution. Registered with the Open Science Framework: 10.17605/OSF.IO/FSU8D (23/02/2025).

ABSTRACT Family engagement is essential to student success, yet schools continue to struggle to include family voices in consequential decisions. This conceptual, reflective practice article applies Ecological Systems Theory and Empowerment Theory to examine how school social workers can prioritize family perspectives to promote equity and improve student outcomes. The article identifies structural and attitudinal barriers that suppress family participation and offers practice-ready strategies for building family capacity, establishing two-way communication, and advocating for policy reform. These strategies align with the NASW Nine Competencies and are linked to measurable improvements in attendance, academic achievement, and family-school partnerships. The arguments are grounded in practitioner experience and theoretical analysis rather than empirical outcome research, highlighting the need for future studies examining equity-centered family engagement frameworks in school social work practice. The integrated theoretical framework and reflective vignettes constitute a contribution to practice-based scholarship. When school social workers center family voice, they transform engagement from a compliance requirement into the equity-driven, relational practice that social work values demand.

ABSTRACT Schools are vital environments for cultivating lifelong health behaviors. This study evaluated the outcomes associated with a 15-week comprehensive after-school health program, Healthy Kids+, on students’ health-related knowledge, attitudes, and self-efficacy in five public elementary schools. Using a quasi-experimental pre-post design, 228 students aged 8–11 years (grades 3–6) participated in a multi-component program that integrated nutrition, physical activity, social-emotional learning, and family engagement. Data was collected using the validated After-School Student Questionnaire (ASSQ). Descriptive statistics, paired samples t-tests, and repeated-measures ANOVA evaluated pre-/post-differences. Program participation was associated with significant improvements in health knowledge (ΔM = +17.8, p < .001, d = 1.62), attitudes (ΔM = +.66, p < .001, d = 1.54), and self-efficacy (ΔM = +.72, p < .001, d = 1.53). Interaction effects among gender, grade level, and socioeconomic status were not significant, indicating that the program had an equitable impact across all student subgroups. Hierarchical linear regression confirmed that baseline attitudes (β = 0.36, p < .001) and student age (β = 0.12, p = .008) were both significant predictors of post-test attitude scores, with the model accounting for 44% of the variance (R2 = .44, p < .001). Findings support the short-term potential of multi-component programs in enhancing elementary students’ health-related cognition and motivation. The results underscore the importance of intensive educator capacity-building and family engagement to maintain high program fidelity and achieve consistent outcomes across diverse school settings.

Complete breastfeeding cessation is an important maternal-child health transition and is distinct from complementary feeding, which the World Health Organization defines as providing foods in addition to milk when milk alone is no longer adequate (generally from 6 to 23 months). Evidence on how mothers decide to stop breastfeeding and which practices they use remains limited in LMICs. This study described breastfeeding cessation timing, decision-making, practices, and support-seeking among mothers in Tehran, Iran, using a Social Ecological Model to organize influences at individual, interpersonal, healthcare/organizational, and broader contextual levels. We conducted a cross-sectional online survey from March to August 2021 among mothers of healthy singleton children aged 6 months to <4 years, recruited from 28 public health centers in Tehran. The final analytic sample included 420 mothers. Data were collected using a 42-item questionnaire with structured items and optional open-text questions; open-text responses were provided by 98-380 mothers, depending on the item. Quantitative data were summarized descriptively, and associations were examined using bivariate tests. Open-text responses were analyzed using thematic content analysis to contextualize the survey findings. Findings were organized using the Social Ecological Model across individual, interpersonal, healthcare/organizational, and broader contextual levels. Most mothers were aged 25-34 years (69.3%), reported average financial status (79.8%), and held a university degree (45.5%); children were primarily aged 42-48 months. Breastfeeding cessation was mainly mother-initiated (86.4%), and 56.2% reported complete cessation between 18 and 24 months. Traditional practices to discourage breastfeeding were common, including applying bitter or adhesive substances (41.2%) and using medicinal products without prescription (32.9%). Only 34.8% consulted healthcare providers during cessation, most often for emotional reassurance. Family advice influenced some decisions (22.3%). Mothers reported mixed experiences after cessation, including relief as well as guilt and breast discomfort, while many reported child behavioral challenges (e.g., irritability and clinginess) alongside perceived increases in independence. In this Tehran sample, breastfeeding cessation was largely mother-initiated but frequently involved traditional practices and limited professional support. Findings suggest a need for clear, culturally sensitive guidance and counseling on breastfeeding cessation within routine maternal-child health services, including family engagement and practical support for gradual cessation. Not applicable, as this study did not involve a health care intervention.

This evidence implementation project aimed to enhance communication practices in dementia care by assessing staff adherence to evidence-based criteria, identifying barriers and facilitators to best practices, and evaluating the effectiveness of tailored training strategies. Using the JBI Model of Evidence-Based Health care and its seven-phase implementation framework, a baseline audit was conducted in three community dementia daycare centers in Yilan County, Taiwan. Thirty staff members and 80 dementia care records were evaluated against six JBI-derived best practice criteria. Following a gap analysis, a multimodal dementia communication training program was implemented using the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tools. A follow-up audit was conducted 8 months later, involving 15 staff members and 40 records. Baseline concordance with best practices was low, with two criteria scoring 0%. Post-implementation, compliance markedly improved: four criteria exceeded 80%, and two (structured staff training and multimodal approaches) reached 100%. Staff demonstrated enhanced ability to identify communication difficulties, utilize validated tools such as the Holden Communication Scale and Mini-Mental State Examination, and document care communication plans. Embedding structured training, validated assessment tools, and family engagement strategies substantially improved staff competence and adherence to evidence-based dementia communication standards. This project underscores the effectiveness of structured evidence implementation and ongoing audit-feedback mechanisms in promoting sustainable, person-centered dementia care. http://links.lww.com/IJEBH/A644.

ABSTRACT Families are central to psychiatric rehabilitation, providing emotional, practical, and advocacy support that enables recovery for individuals with serious mental illness. Despite growing endorsement of family-centered care, the literature remains dispersed across diagnoses, service models, and disciplines, and there is limited synthesis of how families are engaged across psychiatric rehabilitation over time. This scoping review synthesizes 83 studies published between 2005–2025 on family roles in rehabilitation. Evidence shows that when families are actively involved, through psychoeducation, therapy, and peer-led programs, outcomes improve such as symptom reduction, relapse prevention, and functional gains. Caregivers often demonstrate resilience but face significant stress, stigma, and systemic barriers. Cultural norms and policy frameworks strongly influence family engagement; while some regions integrate families into care, others lag. Not all patients desire family involvement, highlighting the need for flexible, person-centered approaches. Key implications include expanding family-inclusive programs, training providers, and addressing confidentiality and resource gaps. A shift toward family-centered psychiatric rehabilitation is evident; however, systematic implementation remains uneven.

To explore perspectives of older patients, family members, and healthcare professionals regarding patient and family engagement in medication management across transitions of care. A qualitative study utilising semi-structured interviews with patients aged ≥ 65, family members and healthcare professionals. Participants were recruited from four hospital sites from a major public hospital system which services a large socioeconomically diverse population of metropolitan Melbourne. Interviews were analysed using inductive content analysis. In total, 67 patients, 66 family members, and 69 healthcare professionals participated in the study (n = 202). The three themes generated were: challenges in supporting patients and families in communication, factors influencing patient and family ability to communicate, and approaches to enhanced engagement. There is a need for strategies which empower and encourage patients and family members to engage in medication management, which, despite complex barriers, could be achieved through enhanced communication. Proposed strategies present possibilities for older patients and families to engage in medication management across transitions of care, providing opportunities to reduce medication errors and adverse events with the potential to improve patient outcomes. This research uncovers the complexities relating to older patient and family engagement and decision-making, and generates strategies to improve communication in medication management. Conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research. This study sought insights from older patients who were admitted to hospital and family members, with experience in managing medications across transitions of care. Two consumers with lived experience as caregivers for older patients and involved in medication management were invited to contribute to manuscript preparation and provided detailed feedback, which was implemented in the final manuscript. Australian New Zealand Clinical Trials Registry (ANZCTR) on 24 July 2024: ACTRN12624000901505.

Diabetic foot ulcers (DFU) represent a major global burden, requiring more effective prevention strategies. Digital solutions have been proposed to improve DFU early-detection and reduce DFU burden, but user-centered solutions for low-and-middle income countries (LMIC) are lacking. The aim of this paper is to describe the process and lessons learned from the co-creation of (1) an intervention based on a mobile health (mHealth) app for early detection of pre-ulcerative lesions and prevention of DFU in people living with diabetes, and (2) the strategy to pilot test the intervention in rural and urban settings in Peru. We conducted a co-creation process between December 2024 and April 2025. Four workshops were held in Lima (urban) and four in Piura (semi-rural), involving 54 people living with diabetes, their caregivers, and healthcare professionals (HCPs). In workshop #1, patient journey mapping was used to identify barriers and facilitators to DFU care. Workshops #2 and #3 focused on the co-development of a mHealth app, while workshop #4 gathered participant feedback on study procedures for the upcoming pilot study. A total of 23 people with diabetes, 21 HCPs, and 10 caregivers participated in the workshops. Patient journeys revealed barriers to DFU management, including health system fragmentation, limited clinician training, and insufficient education for people with diabetes and caregivers. In workshops #2 and #3 a beta version of the mHealth app was tested by the participants who proposed recommendations on how to improve it and other features to be added. Study procedures for the coming pilot study of the developed intervention were tested with role play. Participants recommended community-based recruitment of participants for the pilot study, manuals and videos to train users, family engagement, WhatsApp reminders, a helpline, interim feedback calls, and graphical results in multiple formats. Participant engagement was sustained throughout the study, with participants contributing from barrier identification through to intervention and procedure design. This work describes the usage of a structured co-creation processes to develop a digital health tool for DFU prevention and detection. The co-creation process was conducted with the aim to develop an intervention that is contextually relevant, acceptable, and more likely to be implemented successfully in the Peruvian context. The processes described here offer a practical model for developing DFU-prevention interventions in similar resource-constrained environments. The upcoming pilot study will be essential to evaluate usability, adherence, and early signals of impact, ultimately guiding future scale-up.

Childhood obesity disproportionately affects children with intellectual and developmental disabilities, in part due to additional risks, including food selectivity, metabolic differences, and systemic inequities. Given the critical role of nutrition in obesity prevention, this systematic review examines the effectiveness of nutrition-based interventions targeting intellectual and developmental disabilities across socio-ecological levels. This review followed PRISMA guidelines (PROSPERO ID # CRD42023493651). A search of four electronic databases (PubMed MEDLINE, PsycINFO, CINAHL, Embase) identified articles evaluating nutrition-based obesity prevention interventions for children with intellectual and developmental disabilities. Inclusion criteria encompassed interventions implemented at household, school, community, or policy levels, with outcomes measuring diet-related behaviors and obesity. Outcomes included diet-related behaviors and obesity indicators. Two independent reviewers screened articles, extracted data, and assessed quality. Articles were assessed for methodological quality and intervention effectiveness. Of 3531 initial citations, 10 articles met inclusion criteria. Most interventions were school-based and incorporated nutrition education, behavioral strategies, and environmental modifications. Of these, 80% targeted school-level interventions, with some extending to community and policy levels. Results showed improved diet-related behaviors, especially increased fruit and vegetable intake, though statistically significant reductions in obesity measures were not observed, likely due to small sample sizes and methodological limitations such as lack of control groups. Nutrition-based interventions show promise in improving dietary behaviors among children with intellectual and developmental disabilities, but evidence on obesity reduction remains inconclusive. Future research should adopt rigorous study designs and incorporate family and community engagement to enhance intervention efficacy and sustainability.

Type 2 Diabetes prevalence is rapidly increasing in low- and middle-income countries (LMICs), where constrained health budgets and inequitable resource distribution limit access to quality care. Primary healthcare is central to addressing these challenges; however, the implementation of evidence-based diabetes care remains inconsistent. This scoping review mapped implementation strategies for integrating diabetes care into primary healthcare settings in LMICs and identified associated barriers and facilitators influencing implementation. This review focuses on type 2 diabetes, given its predominance and relevance to primary healthcare delivery in LMICs, and followed the Joanna Briggs Institute methodology for scoping reviews and was reported in accordance with PRISMA-ScR guidelines. The search strategy was peer-reviewed using the PRESS checklist. Eight electronic databases were searched for studies published between January 1996 and November 2024. Eligible studies were conducted in LMICs, as defined by the World Bank, and described the implementation, adaptation, or evaluation of evidence-based Type 2 diabetes care in primary healthcare settings. Two reviewers independently screened titles, abstracts, and full texts. Implementation strategies were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy, while reported barriers and facilitators were coded using the Consolidated Framework for Implementation Research (CFIR). Ninety-two articles describing 85 studies across 27 LMICs were included. Implementation strategies most frequently clustered within Engage Consumers, Change Infrastructure, and Use Evaluative and Iterative Strategies, whereas Adapt and Tailor to Context and Utilise Financial Strategies were less often explicitly reported. Forty-three studies reported clinical outcomes only, 11 reported implementation outcomes only, and 31 reported both. Studies more frequently reported improvements in clinical and/or implementation outcomes that combined multiple strategies, particularly provider training and decision support alongside patient or family engagement and pragmatic system redesign. Co-occurrence analyses indicated that Train and Educate Stakeholders was frequently paired with Engage Consumers, supported by supervision, feedback mechanisms, and infrastructure strengthening. CFIR mapping suggested that workflow integration, leadership engagement, regular supervision, and reliable medicine and diagnostic supplies were commonly associated with improved adoption and fidelity, while connectivity challenges, stock-outs, and high workload disrupted implementation and limited scale-up. Reporting of adoption, fidelity, and acceptability remained uneven, and financial strategies were poorly described despite their relevance to sustainability. In LMIC primary healthcare settings, diabetes care implementation most commonly emphasises provider training, infrastructure strengthening, and interactive support strategies, while explicit attention to contextual adaptation and financial mechanisms is less frequently reported. Implementation outcomes were reported to be influenced by leadership engagement, digital tools, and community involvement, alongside persistent constraints related to workforce capacity, supply chains, and feedback systems. Future implementation efforts should more explicitly address contextual fit, system integration, and sustainability when designing and scaling diabetes care interventions in primary healthcare.

Mechanical ventilation is lifesaving yet harmful when paired with deep sedation and immobility. The ABCDEF, or intensive care unit liberation bundle (assessment and treatment of pain, spontaneous awakening and breathing trials, judicious choice of analgesia/sedation, delirium prevention/management, early mobility, and family engagement) mitigates these risks, improving survival, reducing delirium and coma, shortening time receiving ventilation, and promoting recovery. This article synthesizes evidence for the awake-and-walking intensive care unit, in which wakefulness and mobility are the default. We define the role of the advanced practice registered nurse in reliable implementation of this model: embedding bundle elements into workflows, aligning sedation and mobility targets, coordinating interprofessional teams, and driving culture change through measurement and feedback. A case example illustrates a patient's trajectory under high versus low adherence. We close with pragmatic strategies to overcome workflow fragmentation, staffing variability, and safety concerns, mapping barriers to solutions such as protocol standardization, nurse-respiratory therapist coleadership, daily goal alignment, and data transparency.

ABSTRACT Most research on children’s media focuses on audiovisual formats, but little is known about how children and families engage with audio-only media, such as podcasts. This gap is important to address given the rise in podcast popularity and its potential as an accessible, screen-free learning tool for families. Podcasts are easily scalable and can serve as a low-cost, high-quality resource for families with limited means. To explore how families use podcasts, we conducted a virtual, mixed-methods study with 110 caregivers and children aged 4 to 8 living in low-income households. We investigated how families listened to and engaged with publicly available children’s podcasts over a 6-week period, and how podcast design features promoted engagement. Findings from caregiver surveys and in-depth interviews reveal that families easily integrated podcasts into their routines, creating opportunities for shared listening in screen-free contexts. Additionally, findings indicate that certain podcast design features, such as interactive prompts, relatable characters, and serial narratives, helped sustain children’s interest and fostered co-listening and joint media engagement. This engagement included conversations and playful, podcast-related activities that can enhance learning. This study suggests that with intentional design, podcasts have the potential to be a powerful and accessible tool for family engagement.

ABSTRACT Paraguay’s National System for the Evaluation of Educational Process (SNEPE) conducted census-based Grade-3 mathematics tests in 2015 and 2018, revealing a sharp overall drop in scores. We used these open datasets (n = 182,016) to investigate the source of this decline. We estimated two-level random-intercept models with standardised predictors, first separately for each cohort and then pooled across years with a random slope for year. In both cohorts, teacher attendance—a proxy for opportunity to learn—and socio-economic status (SES) were the strongest predictors of students’ performance, while teacher attendance was the strongest predictor of schools’ performance. By 2018, additional factors—digital connectivity, a safe climate, and engaged leadership—had become salient. Schools that improved teacher attendance and teacher–parent relations experienced a noticeably smaller decline in scores, yet the SES gradient steepened and the between-school variance rose, signalling emerging equity risks. Policy options centre on attendance monitoring, purposeful family engagement, and violence-prevention measures.

Adolescent pregnancy is associated with heightened nutritional vulnerabilities due to the concurrent demands of adolescent growth and fetal development. Despite the critical importance of adequate dietary intake during this period, dietary practices among pregnant adolescents in rural Ghanaian settings are poorly understood. This study assessed dietary practices, nutritional knowledge, and socio-economic and cultural influencing factors among pregnant adolescents in North Dayi District, Volta Region, Ghana. A qualitative study design was employed, using in-depth interviews with eleven (11) pregnant adolescents aged 16-19 years. Participants were recruited via a combination of purposive and snowball sampling from rural communities in North Dayi District. Data were collected using a semi-structured interview guide and analysed using Braun and Clarke's six-phase thematic analysis framework. The Health Belief Model (HBM) provided the theoretical framework for interpreting how adolescents' perceptions of susceptibility, barriers, benefits, and self-efficacy shaped their dietary behaviours. Three overarching themes emerged: (1) dietary habits centred on starchy staples (banku, kenkey, rice, fufu) with reportedly limited dietary diversity and irregular meal patterns; (2) severely limited nutritional knowledge, with most participants unable to define a balanced diet or identify pregnancy-appropriate foods despite attending antenatal care (ANC); and (3) multiple intersecting barriers to adequate nutrition, including financial constraints, cultural food taboos, limited household decision-making autonomy, and reportedly inadequate dietary counselling at ANC. Food cravings frequently went unmet due to financial limitations, and ANC services reportedly focused predominantly on hygiene and medication rather than dietary guidance. Pregnant adolescents in North Dayi District face significant dietary challenges stemming from poverty, knowledge gaps, cultural food restrictions, and perceived inadequate health system support. Current ANC nutrition education approaches appear insufficiently tailored to the needs of this population. Comprehensive, multi-level interventions may be needed, including food assistance programmes, adolescent-friendly nutrition education, enhanced health worker training, family engagement strategies, and policy reforms addressing adolescent-specific nutritional needs.

Mental health needs in Arab schools are increasingly recognized, yet little research has examined culturally grounded interventions that integrate art therapy and family involvement. Therefore, this qualitative multi-perspective study explored how art therapy, alongside family engagement, supports students with mental health disorders in Arab schools. Semi-structured interviews were conducted with 25 participants, 15 art therapists and 10 mothers, and data were analyzed using constructivist grounded theory. Findings indicate that art therapy provides a culturally responsive, nonverbal space for emotional expression, regulation, and meaning-making and that family involvement enhances acceptance of support, reduces stigma, and strengthens continuity between school and home. Importantly, the study reveals how mothers and art therapists actively navigate cultural norms, stigma, and institutional limitations through adaptive.