Objective: to analyze Brazilian publications on health actions aimed at LGBTQIAP+ women. Methods: an integrative review was conducted using the Virtual Health Library and Scientific Electronic Library Online databases, considering the period between 2004 and 2024, in Portuguese, freely available, and addressing the role of nursing in meeting the needs of LGBTQIAP+ women. The articles were subjected to inductive thematic content analysis, with exhaustive reading, data extraction, coding, and grouping into thematic categories. Results: 49 articles were selected. Fourteen themes were developed, highlighting: barriers in health services, such as prejudice, unprepared professionals, difficulties in accessing prevention technologies, and the impacts of violence and discrimination on mental and physical health; gaps in nursing training; and inclusive care initiatives and public policies aimed at equity. Conclusion: healthcare for LGBTQIAP+ women requires structural transformations in academic curricula, ongoing professional training, and public policies that ensure equity and humanization in care.

This study investigates how individual aesthetic expressions are negotiated, repositioned, and reconstituted within a collective visual structure through an arts-based research (ABR) framework, focusing on collaborative learning in visual arts education. Conducted in the Spring semester of the 2024–2025 academic year, the study involved seven senior undergraduate students in a visual arts education program at a state university who collaboratively produced a large-scale acrylic painting. Each participant contributed personal imagery shaped by cultural memory and emotional experience to a shared composition conceptualized through the metaphor of a “stage.” Rather than framing collaboration as a purely harmonious process, the study conceptualizes the stage as a pedagogical and representational space in which aesthetic experience emerges through negotiation, tension, and shared authorship. Data were collected through systematic observations, process documentation, and semi-structured interviews, and analyzed using inductive thematic content analysis. Findings indicate that participants initially experienced uncertainty and tension regarding creative autonomy, intervention, and compositional balance. However, these tensions functioned productively, fostering empathy, reflective thinking, and collective aesthetic coherence. The study demonstrates that collaborative artistic production operates simultaneously as an aesthetic, pedagogical, and epistemic space in which individual creativity is not diminished but reconfigured through collective engagement. By foregrounding collective aesthetic agency and the performative dimension of collaboration, this research extends arts-based research beyond individual-centered models and offers a nuanced understanding of how aesthetic experience is restructured within shared creative practices. The findings contribute to pedagogical strategies in visual arts education that emphasize negotiation, reflexivity, and collective meaning-making.

Abstract Background Feedback on faculty teaching is essential for faculty development and education quality. Often in surgical training programs, this feedback is provided through resident evaluations of faculty. The content and quality of faculty teaching evaluations being used are, however, unknown as no standardized tool exists. The aim of this study was to identify the characteristics and evaluation domains of faculty teaching evaluation tools used in surgical residency programs. Methods Using convenience sampling, blank faculty teaching evaluation forms completed by residents were collected from university-based surgery residency programs across multiple U.S. geographic regions, including large public and private academic medical centers. A document analysis was performed using a mixed-methods approach to conduct a quantitative analysis to characterize the tools’ design features using descriptive statistics and perform a qualitative analysis of all question items using inductive content analysis to determine the evaluation domains. Results Fourteen faculty teaching evaluation forms from thirteen U.S. surgery departments met the sampling criteria and were included in the final analysis. Quantitative analysis showed that the mean number of questions per evaluation was 14.7 (median 13; range 4–23), composed of rating questions (median 10.5; range 0–20), free text comments (median 3; range 1–12), and checklist questions (median 0.5; range 0–2). The analysis also identified five styles of response anchors to each question including sequential, agreement, frequency, binary, and open-ended, and three performance levels for assessed faculty traits or behaviors including below expected performance, at expected performance, and above expected performance. Qualitative analysis of 206 question items revealed four major evaluation domains including teaching effectiveness (53.8% of codes), professionalism (25.5%), clinical performance (11.6%), and overall performance (9.1%) from the faculty teaching evaluation tools. Conclusions Surgical faculty teaching evaluations vary widely in design and frequently conflate teaching with professionalism and clinical performance. This domain mixing poses challenges for score interpretation and threatens construct validity if evaluations are used to assess teaching effectiveness exclusively. The findings suggest a consensus-based approach to defining core teaching domains and evidence-informed design principles, while allowing flexibility for local implementation. This study demonstrates the value of document analysis for critically examining assessment tools and provides empirical groundwork to inform future faculty evaluation efforts in surgical education.

Stitching wisdom: Midwifery students' and educators' experiences with perineal repair trainers.

Palliative Care Needs in Pediatric Hematologic Oncology: Parent-Child Perspectives Across Stages.

Factors influencing nursing students' motivation to work with older adults after graduation: a mixed-methods study.

Clinical ethics are becoming increasingly important in the twenty-first century. Value-laden cases and moral dilemmas in healthcare have led to the creation of clinical ethics support structures. The last decades have shown their implementation in hospitals around the globe. Recent literature investigates their value, function, and integration. Many conclude that they do valuable work yet remain inadequately integrated, lack institutionalization, and struggle with resource shortages. To gain an understanding of this development and pave the way for future implementation and research, a scoping review was chosen to determine which macro-level factors currently influence the heterogeneous approaches. This review used the scientific research databases Medline and CINAHL in April 2025. It included studies, opinion papers, and book chapters in English and German offering explanations, analysis, discussion, and examples of macro-level clinical ethics support structures' adoption and implementation influences. An inductive qualitative content analysis was conducted to extract the desired information. The resulting categories were formatted into an overview frame. The literature search yielded 400 publications, full-text analysis and snowball search resulted in 47 eligible for analysis. Eight main factors with respective subcategories were identified. These vary in their degree of binding authority, ranging from clearly defined regulations, such as national laws, to more ambiguous influences, such as public opinion and advocacy. Further insights reveal that the effectiveness of these factors cannot yet be determined, and their influence may vary based on the values and political context of the country where a support structure is implemented.

Usability assessment for cave automatic virtual environment-based immersive education system on novice nurses and nursing students: A mixed methods study.

Personality and Perception: A Qualitative Investigation of Factors That Shape Mentorship Satisfaction Among Hand Surgery Fellows.

Hospital-based nurse leaders manage complex operational, staffing, and organizational demands that influence well-being and job satisfaction. Hybrid work models, adopted widely during the COVID-19 pandemic, may offer needed flexibility, though little is known about their impact on nurse leaders. To explore nurse leaders' experiences with hybrid work schedules and examine perceived effects on job satisfaction, work-life balance, communication, and unit-level performance outcomes. A qualitative descriptive study was conducted with seven nurse leaders at a Level 1 safety-net hospital. Individual interviews were recorded and transcribed, followed by inductive content analysis. A five-item job satisfaction survey was administered, and unit-level nurse-sensitive indicators were reviewed for performance trends. Three themes emerged: 1) leadership style unchanged, with hybrid work enhancing focus and reducing distractions; 2) the need for rules of hybrid engagement to support communication, visibility, and collaboration; and 3) improved work-life balance, with participants emphasizing that removing hybrid options could affect retention. Job satisfaction was high, and performance indicators showed mixed trends without evidence of decline attributable to hybrid work. Hybrid scheduling supported flexibility, productivity, and satisfaction among nurse leaders without compromising unit-level performance. Clear expectations and communication can optimize hybrid leadership models and contribute to leadership sustainability.

Night shifts in intensive care units (ICUs) are associated with significant physical and cognitive fatigue among nurses, which may affect staff well-being and patient safety. Although short naps have been shown to reduce fatigue, their implementation in ICUs remains limited and poorly understood. This study explored ICU nurses' and nurse managers' perceptions of planned napping. A qualitative descriptive design was used, involving nine focus group interviews (n = 20) across three Finnish ICUs. Data were analysed using inductive content analysis. Participants described severe fatigue during night shifts and acknowledged the benefits of planned napping, including improved alertness, reduced errors, and enhanced well-being. Informal napping was common, but formal structures were lacking. Barriers included unclear policies, cultural resistance, and logistical challenges; whereas facilitators involved organisational culture, environment, scheduling, and managerial support. Emphasis was placed on fairness, flexibility, and clear protocols. Planned napping was perceived as a valuable strategy for managing fatigue, but successful implementation requires institutional support and context-sensitive planning. This study provides practical insights into implementing planned napping in high-acuity environments and supports the development of structured, evidence-informed protocols to promote staff well-being, patient safety and sustainable nursing practices.

ABSTRACT This study employed a qualitative case study design to examine how teacher and peer relationships shape the school adaptation of three-year-old children in a multicultural classroom. The study group included 17 children (11 girls, six boys), eight parents, and one teacher. The classroom’s multicultural nature stemmed not only from diverse family backgrounds (eight mothers were Russian) but also from cultural differences among children and the teacher. Data were collected through observations and interviews. Observations focused on teacher-child, peer, and teacher-parent interactions during adaptation. The primary researcher (PR) interviewed the teacher and parents to explore how cultural elements affected adaptation. Data were analyzed using inductive content analysis. Results show that effective classroom management significantly influences children’s adaptation and shapes teacher-child relationship quality. Classroom interactions reflected cultural dynamics, showing that children from varied backgrounds and those with similar traits tended to build supportive connections during adaptation.

The National Institute for Health and Care Research (NIHR) has 20 Biomedical Research Centres (BRCs) and 28 Clinical Research Facilities (CRFs) that work with NHS organisations and universities to translate cutting-edge research into new interventions. As mandated by NIHR, all BRCs/CRFs have an Equality, Diversity and Inclusion (EDI) strategy which details how they will implement EDI through their practices, research and organisational systems. This UK-based study aimed to conduct a pilot qualitative analysis of EDI strategies to compare all 20 NIHR BRCs/CRFs, identify common priorities and improve inclusion across research infrastructures. The analysis was presented at the first in-person seminar for NIHR EDI professionals (Birmingham, October 2024). Qualitative content analysis of publicly available EDI strategy documents. 48 research infrastructures (20 BRCs and 28 CRFs). EDI strategies were collated into NVivo and Microsoft Excel where inductive coding and content analysis was executed for objectives, action plans and success measures. Both quantitative and qualitative content analyses were conducted to analyse the prevalence of categories and similarities or differences between them. Logic models were developed to map the process of implementing EDI for each main category generated. The most common main category across objectives was 'Cultural change in workplaces' for BRCs and 'Leadership, governance and policy' for CRFs. For action plans, codes for 'Collaborations and Networks' and 'Research development and delivery' were most prevalent for BRCs-for CRFs, it was 'Workforce culture change' and 'Research development and delivery'. Success measures for both BRCs and CRFs most often related to 'Summary reports, feedback, audits and monitoring'. Differences between BRCs and CRFs reflected their organisational roles and strategic maturity, with BRCs tending to have more comprehensive, measurable strategies. This study provides the first systematic analysis of EDI strategies across all NIHR BRCs and CRFs, offering a comprehensive mapping of how EDI priorities are articulated and operationalised across objectives, action plans and success measures. While both infrastructures align with NIHR's inclusion goals, BRCs generally showed more strategic maturity than CRFs. As the analysis was based solely on publicly available strategy documents, it could not determine the extent to which any strategy had been implemented in practice. Future research is needed to examine implementation and impact. The contribution of this work lies in demonstrating systematically and for the first time the ways in which EDI commitments are framed across NIHR infrastructures and their varying levels of depth and maturity. Our findings support the development of more measurable EDI frameworks and highlight opportunities to strengthen inclusion across NIHR-funded research infrastructures.

ABSTRACT Objectives Africans who migrate to the US are initially leaner than US-born Black Americans of the same age. However, over time, they become affected by obesity, possibly due to exposure to the obesogenic food environment and sedentary lifestyle in the US. We aimed to understand barriers and facilitators to healthy diet and physical activity among African immigrants in the US. Methods Using qualitative methods, we conducted eight focus groups remotely with 31 African immigrants (BMI ≥ 27 kg/m2) living in the US. We recruited African immigrants born in Ghana, Nigeria, Kenya, Uganda, Botswana, Ethiopia, South Africa, Sudan, and Zimbabwe. Participants completed a 5-minute screening survey to assess their eligibility. In focus groups, participants were queried about barriers and facilitators to the consumption of vegetable, lean proteins, and less sugary beverage consumption, physical activity. Data were recorded and fully transcribed. We analyzed the data using inductive qualitative content analysis, achieving inter-rater reliability of 81.8%. Results We identified 11 barriers to a healthy diet, including differences in the taste of fruits and vegetables in the US compared to their home African countries, difficulty finding traditional African fruits and vegetables in the US, and not being accustomed to consuming raw vegetables. We identified 5 healthy diet facilitators, including making smoothies to obtain fruit servings and buying in bulk. We identified 4 barriers to physical activity, including a lack of time and paying for gym memberships. We also identified 5 physical activity facilitators, including weight gain and having friends and family with whom to exercise. Conclusions African immigrants share similar barriers and facilitators to healthy diet and physical activity as others but also have unique barriers and facilitators that need to be addressed in tailored lifestyle interventions. Incorporating these in future lifestyle interventions may enhance relevance, engagement, and more sustainable behavior change.

Purpose This study aims to examine how the evolving European Union (EU) sustainability regulatory landscape, shaped by the Corporate Sustainability Reporting Directive (CSRD) and recent developments such as the Stop the Clock Directive and the Omnibus I Package, and embodying differing political, economic and institutional interpretations of sustainability, may influence the future configuration of the sustainability assurance market for both mandatory and voluntary adopters. Design/methodology/approach The paper adopts a scenario analysis approach, supported by an inductive content analysis of legislative texts related to CSRD transposition and the Omnibus I Package. Key variables, including the scope of authorised providers, the role of incumbent auditors, professional qualifications and training requirements, guide the construction of alternative scenarios. Findings For mandatory adopters, the analysis outlines three possible trajectories for the sustainability assurance market: (1) a monopoly of statutory auditors, (2) competitive coexistence between statutory auditors and independent assurance service providers and (3) thematic specialisation between financial and sustainability auditors. For voluntary adopters, the analysis adds (4), a fragmented and largely optional assurance market shaped by the Omnibus I framework. Practical implications The scenarios identify actionable regulatory levers that policymakers and oversight bodies can use to mitigate fragmentation risks and safeguard assurance quality under both mandatory and voluntary regimes. Social implications By clarifying how regulatory recalibration may affect sustainability assurance practices, the study informs stakeholders who rely on sustainability reports for accountability and decision-making. Originality/value This study presents a novel approach by employing scenario analysis to link the diversity of CSRD implementation with potential assurance market outcomes. By connecting expected divergence in CSRD transposition to broad political and sustainability dynamics within the EU, the study demonstrates how competing policy directions and differing emphases on the economic, social and environmental pillars shape the emerging assurance market.

ABSTRACT Objective Misophonia involves intense affective and physiological reactions to everyday sounds, yet the accompanying negative cognitive processes are understudied. The objective of this study was to qualitatively characterize cognitions that occur during and after misophoniasounds. Method We used inductive content analysis to analyse the open ended responses from 60 treatment-seeking adults using the Duke Misophonia Interview. Results During exposure, participants reported: (1) self-critical/self-devaluing thoughts related to one’s reactions to misophonicsounds, (2) externalizing appraisals of others as rude orinconsiderate, (3) intrusive aggressive thoughts, and (4)escape-focused cognitions. After exposure, they described: (1) regret and guilt about their reactions, (2) social worries about how other sperceived them, and (3) intrusive or repetitive memories of prior sound experiences. Conclusion These themes highlight how cognition play a central role in misophonia in the moment and afterwards, with post-misophonic-event processes extending distress beyond exposure to the sound itself. Clinical implications from these themes include screening for these thought patterns, targeting maladaptive self-appraisals, addressing regret and rumination, and channelling escape-related cognitions towards functional coping strategies. Future work should utilizereal-time assessment and more diverse samples to test how these cognitive processes maintain misophonia and to inform tailoredinterventions.

Purpose This study explores factors influencing pelvic floor muscle exercise (PFME) intention and engagement among men post-radical prostatectomy (RP), and examines facilitators and barriers to PFME engagement and proposes strategies to enhance engagement. Materials and methods A qualitative descriptive study guided by the Reasoned Action Approach (RAA) model was conducted. Twenty-eight men were purposively sampled based on their PFME intention and engagement levels. Semi-structured phone interviews were transcribed and analyzed using deductive and inductive content analysis. Themes were developed from the interview analyses to reflect participants’ perceptions of determinants influencing PFME engagement and their transition from intention to sustained engagement. Results Findings identified experiential and instrumental attitudes, injunctive norm, as well as patient autonomy, capacity, and perceived urinary incontinence as key determinants influencing PFME intention and engagement. Patient barriers included monotony, inadequate knowledge, limited healthcare support, and physical challenges. Self-regulatory skills, family encouragement, and positive healthcare interactions promoted patient engagement. Patients also mentioned that self-management strategies and eHealth resources were effective in overcoming challenges. Conclusions The study underscores the importance of tailored interventions targeting psychosocial determinants and self-regulatory skills to enhance PFME engagement. These insights inform rehabilitation strategies to improve UI management and quality of life for men post-RP.

Medical education combines theoretical and practical components; it is often considered an apprenticeship. While medical schools strive to provide a comprehensive foundation, the transition to internship introduces a new set of challenges and opportunities. This study assessed the transition from the interns' perspective to inform the development of targeted interventions and mentorship programs. A cross-sectional study design was used to survey ninety-eight (98) medical interns educated in the tertiary institutions in Rivers State, using a semi-structured self-administered questionnaire, built on Google Forms. Data was collected through the interns’ WhatsApp group after obtaining ethical approval (PUMS/REC/2024/005). Quantitative data were analysed using IBM SPSS version 27 and was presented in the form of frequencies and percentages (%). Qualitative responses were analysed using inductive and deductive content and thematic analysis. Most respondents were within the age group 25 to 29 years, 59 (60.2%), 50 (51.0%) were females, and 9 (9.2%) were married. The study found that 87 (88.8%) had a good preparedness level for hospital practice, 43 (43.9%) had orientation before commencement of internship, and wished for more training before the internship. Emotional challenges were reported by 53 (54.1%) of interns, psychological challenges by 29 (29.6%), and only 13 (13.3%) found it easy/very easy to manage emotional well-being. The study revealed good preparedness for hospital practice among interns; gaps remain in pre-internship orientation, emotional readiness, and psychological support. Most interns received no emotional support. Advice, mentorship, and emotional encouragement were the most appreciated forms of support among those who received any.

To study the factors that influence physicians' and patients' use of, and willingness to use, economic information in clinical decision-making, and examine physicians' views on whether clinical practice guidelines can support its use. Semistructured focus group discussions with an inductive content analysis. Finnish health centre general practitioners (GPs) and adult patient representatives, five groups of each. 22 GPs and 15 patient representatives. In the GP groups, five factors involved in using economic information in clinical decisions were raised: the issue of who pays, knowledge about cost information, the cost-benefit ratio of treatments, care planning and health economic understanding. Concerning the inclusion of economic information in clinical guidelines, GPs raised themes including the content and means of presentation of economic information, and advantages and challenges related to the integration of economic information into clinical guidelines. In the patient groups, the identified themes related to seeing the costs of treatments, the organisation of healthcare services, inclusion of cost information in clinical guidelines, patient information and support, and cost containment in healthcare. The study suggests that GPs and patients are willing to use economic information in clinical decision making. It also implies a need for easily accessible and understandable economic information, and that clinical guidelines may be a good way to support this. In addition, the study highlights the need for education on the economic aspects of healthcare for physicians.

Home gardens are promoted as a strategy for climate change adaptation in SSA. Here, we determined the lived experiences, the perceived knowledge gain and practice change, and the suggested strategies for maintenance, spread and scaling among beneficiaries, implementers and stakeholders of a home gardening intervention in rural Kenya. For this explanatory qualitative study, we conducted two focus group discussions (FGDs) with stakeholders (n = 5) and implementers (n = 8), and 30 in-depth interviews (IDIs) with male (n = 5) and female (n = 25) beneficiaries living in Siaya county, from September to November 2023. We used purposive sampling and employed semi-structured interview guides. The data were translated into English, transcribed verbatim, and analyzed using inductive content analysis; we mapped the findings along the proposed impact pathways. The participants articulated good understanding of the trainings and valued them as an occasion for knowledge exchange. The adoption of tailored garden structures, organic gardening, and food preservation created feelings of fulfillment, women empowerment, and family peace. Experienced challenges included water scarcity, ineffective pesticides, and long distances between the beneficiary households. Perceived benefits were increased income, cost savings, and increased dietary diversity. For maintenance, spread and scale, the participants suggested agri-business, local partnerships, and the integration of home gardens into the county's political agenda. This project seems to have followed its planned pathways to improved child nutritional status. The organic gardening approach offers solutions in low-resource settings but creates challenges for maintenance, spread and scale of home gardens in Siaya county, Kenya.