Decsions about prenatal screening for trisomies are complex for some women. Mobile decision aids (mDAs) can help them make informed decisions based on their values and preferences. To assess pregnant women's intention to use an mDA for prenatal screening of trisomies 21, 18, and 13. This mixed-methods study in Quebec recruited a purposeful sample of women aged 18 or over, at least 16 weeks pregnant or who had given birth in the past year after a low-risk pregnancy. After they completed a paper-based decision aid, we assessed their intention, and its psychosocial determinants, to use a mobile version. Quantitative data underwent descriptive, bivariate, and multivariate analyses; qualitative data were thematically analyzed. 67 pregnant women participated, mostly French-speaking (89.6 %), aged 25-34 (59.7 %). Mean intention to use the mDA was 4.92 (SD: 2.03). Beliefs about consequences (β:1.21; p < 0.0001) and social influence (β:0.17; p = 0.03) were significant predictors of intention, explaining 77.5 % of variance, and 63 % of women evaluated the proposed mDA positively. Beliefs about consequences and social influence were the main pyschosocial factors associated with pregnant women's intention to use an mDA for prenatal screening. Healthcare providers could increase uptake by adopting strategies that underline the social acceptability and benefits of mDAs.

Insights from an interprofessional education course- a mixed methods study among novice healthcare professionals.

Night shift work is known to disrupt circadian rhythms, leading to significant physical and mental health challenges, including fatigue, sleep deprivation, and long-term health risks. For nurses working the night shift, these factors compromise both their own well-being and patient safety. Addressing these challenges is critical to improving outcomes for both staff and patients. This study aimed to explore nurses' perspectives on night shift work, identify fatigue countermeasures, and elicit nurses' recommendations for improving working conditions. This mixed-methods study was conducted in two phases. In Phase One, night shift nurses at 12 hospitals within a northeastern U.S. health care system were surveyed to assess their night shift experiences. Phase Two employed focus groups at six of those hospitals to gain insight into night shift nurses' perspectives on the challenges they face and suggestions for improvement. Descriptive statistics were used to analyze the survey data. Thematic analysis of focus group transcripts was conducted to identify themes. The survey results identified gaps in night shift support, including limited access to in-person education and hot, nourishing food. Recognition of night shift nurses' unique needs was the overarching theme from the focus groups. Seven additional themes further described those needs and indicated areas for improvement: safety at night--from feeling safe to being terrified; drowsy driving; need for a break; "we're tired"--napping; nourishment at night; self-care; and night work is undervalued. The results support findings from prior research and underscore the persistent challenges night shift nurses face. While these challenges are well documented, changes to address them have been limited. Health care organizations must move beyond acknowledging the issues to implementing evidence-based interventions and structured programs. Addressing the concerns of night shift nurses is imperative and necessary to safeguard nurses' health and well-being; reduce turnover; and ensure safer, high-quality patient care.

Physical and mental health impact of perimenopause, menopause and post menopause in a diverse global population (MARIE Project- Global Chapter WP 2a): cross-sectional quantitative data from a mixed-methods study.

Clinical alarm management is a critical patient safety challenge in intensive care units (ICUs). The high frequency of non-actionable alarms paradoxically undermines safety by contributing to alarm fatigue, increased cognitive load and delayed responses among nurses. To systematically synthesise and appraise qualitative evidence on ICU nurses' experiences, perceptions and coping behaviours regarding clinical alarms. A systematic review of qualitative evidence using meta-aggregation was conducted. A comprehensive search of eight databases (PubMed, Web of Science, Embase, CINAHL, CNKI, Wanfang, VIP and CBM) was undertaken from inception to December 2024. Included qualitative and mixed method studies were critically appraised using the Joanna Briggs Institute's Critical Appraisal Checklist. Data were synthesised using the meta-aggregation approach, and the confidence in the synthesised findings was assessed using the ConQual approach. Fourteen studies were included in the synthesis. The meta-aggregation produced four synthesised findings: (1) The Perceptual Paradox: Alarms as an Essential Safety Mechanism and a Clinical Burden; (2) Nurses' Alarm Response as an Evolving Practice of Situated Clinical judgement; (3) A Multi-level System of Nurses' Alarm Response: Individual, Contextual and organisational Factors; and (4) ICU Nurses' Expectations for Clinical Alarms: Intelligent Support, Practical Training and Sustained Autonomy. Effective alarm management is fundamentally a socio-technical challenge, rooted in a core perceptual paradox. Nurses navigate this paradox through situated clinical judgement, a process shaped by a multi-level system in which unit safety culture is pivotal. Therefore, sustainable solutions must integrate technological optimisation to reduce cognitive load, cultivate positive unit safety cultures and augment clinical expertise-thereby repositioning nurses from passive alarm responders into empowered clinical decision makers. The synthesised evidence suggests that interventions should prioritise competency-based, situational training to bridge the recognition-intervention gap, foster a non-punitive unit alarm safety culture to mitigate responder isolation and adopt a human-centred design paradigm for future technologies to reduce cognitive load and support, rather than replace, clinical expertise.

To explore concerns and coping experiences regarding sexual well-being in inflammatory bowel disease and examine the relationship between these concerns and affected individuals' background factors. Explanatory sequential mixed methods study. Recruitment flyers (n = 1347) were distributed to individuals attending inflammatory bowel disease outpatient clinics in seven facilities. Participants completed a questionnaire assessing demographics, concerns and coping experiences related to their sexual well-being. Those who provided consent participated in semi-structured online interviews. Quantitative data were analysed descriptively, and qualitative data were analysed using content analysis. A total of 551 participants completed the questionnaire, and 21 participated in the interviews. Among them, 251 (45.6%) reported experiences of concerns related to romantic relationships and marriage, sexual life, pregnancy, childbirth and childcare. The nature of these concerns varied by background factors: unmarried individuals more often reported relationship concerns; those with surgical or perianal history more often reported sexual concerns; and women, married individuals and individuals with Crohn's disease more often reported pregnancy-related concerns. Coping experiences were categorized as (1) active barrier management, (2) partner and professional support, (3) passive or resignation coping and (4) cognitive reframing. Sexual well-being is significantly affected among individuals with inflammatory bowel disease. Many participants reported understanding and support from significant others or relied on personal coping strategies; however, others reported an absence of coping experiences. Sharing these findings with individuals with inflammatory bowel disease and healthcare professionals may enhance awareness and promote support strategies to improve these individuals' sexual well-being. Concerns about sexual well-being are influenced by both clinical and psychosocial factors, including treatment history, life stage and partner relationships. Healthcare professionals should provide individualised and comprehensive care that incorporates the partners and families of individuals with inflammatory bowel disease to better address sexual well-being. This study presents the first large-scale mixed methods evidence on how individuals with inflammatory bowel disease experience sexual well-being, providing direct implications for improving quality of life. By illustrating both adaptive and absent coping strategies, the findings contribute essential insight to inform patient-centred clinical practice and psychosocial care. The Good Reporting of a Mixed-Methods Study (GRAMMS) guidelines were followed. No patient or public contribution.

Research and innovation are essential for advancing clinical practice and safeguarding patient safety in healthcare. This review aims to assess the research capacity of Advanced Practice Nurses in Australian healthcare settings. By identifying the barriers and enablers to, the findings aim to inspire research engagement of paediatric nurses. A rapid review methodology was used to systematically identify, appraise and synthesise data relevant to Advanced Practice Nurses' research capacity. A comprehensive search of Ovid Medline and Cumulative Index to Nursing and Allied Health Literature databases was conducted, covering publications from 1 July 2010 to May 2024. Additional reference checks and grey literature searches were undertaken to identify relevant studies. Data extraction and quality appraisal were conducted independently and checked by the research team. The Mixed Methods Appraisal Tool was used for quality assessment and a descriptive narrative synthesis approach integrated findings across qualitative, quantitative, and mixed methods studies. Eight studies met the inclusion criteria. Findings revealed that while Advanced Practice Nurses value research and evidence-based practice, barriers-such as time constraints, limited resources, and lack of organisational support-restricted their engagement. Leadership support and structured mentorship were identified as critical enablers of research capacity. This review highlights the need for targeted strategies to enhance Advanced Practice Nurses' research capacity within Australian healthcare. Addressing identified barriers and fostering a supportive environment can empower Advanced Practice Nurses to better utilise their roles, contributing to improved patient care and healthcare innovation. This research addresses the limited understanding of research capacity among Advanced Practice Nurses identifying challenges and opportunities for engagement. It is particularly relevant for healthcare organisations, policymakers, and educational institutions seeking to strengthen research capacity among APN roles. Findings will inform evidence-based practice, patient outcomes, and research culture in Australian healthcare services. International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42024539163.

Shifting pharmacist medication counselling from directive monologue to collaborative dialogue using the CONNECT-6 framework: A mixed-methods pre-post interventional validation study.

Because critical illness, sedation, and ICU treatment commonly disrupt attention, memory, and executive function, early cognitive rehabilitation during the ICU stay may preserve or restore these capacities, reduce the delirium burden, and support engagement and recovery. Our primary aim was to identify and describe cognitive rehabilitation interventions delivered during the ICU stay and describe the healthcare professionals providing them. Secondarily, we summarized patient-important outcomes associated with these interventions and appraised study quality to inform future research. We performed a systematic integrative review with searches in Medline, EMBASE, CINAHL, and CENTRAL. Eligible studies included adult ICU patients receiving or healthcare professionals delivering early cognitive rehabilitation initiated in the ICU. Data synthesis followed PRISMA guidelines, and risk of bias was assessed using RoB2 and ROBINS-I and narratively described. We included 27 studies: 10 randomized clinical trials, six cross-sectional studies, five cohort studies, three qualitative studies, three non-randomized trials, and one mixed-methods study. Four categories of interventions were identified: (1) orientation and multisensory stimulation, (2) activities of daily living (ADL)-focused functional occupational therapy, (3) early mobilization and physical rehabilitation, and (4) technology-based sensory and affective stimulation (music or virtual reality). Interventions were provided by nurses, physiotherapists, occupational therapists, research staff, and family members. Multi-component programs combining cognitive and physical elements indicated possible benefits for selected cognitive measures. Effects estimates on delirium and ADL were inconsistent and, in several studies, were based on secondary or exploratory outcomes analyses. Outcomes related to ventilator-free days, health-related quality of life, and survival were also inconsistent, with substantial heterogeneity in outcome definitions, measurement tools, and assessment time points. Multi-component cognitive rehabilitation appeared clinically applicable, but effects on patient-important outcomes were uncertain. High-quality research is needed to assess whether interventions targeting the improvement of cognitive function benefit ICU patients. This systematic review presents and update of published work on cognitive rehabilitation performed during ICU care and then also with assessments after critical illness in ICU survivors. The findings support the idea that this field need more robust clinical research to assess these different interventions in the ICU and their possible benefit and cost.

Deficient palliative care coverage and nursing training in Ecuador warrant examining self-efficacy to inform education strategies and strengthen equitable services. To examine Ecuadorian nurses' self-efficacy in Palliative Care. A sequential explanatory mixed-methods study was conducted. Convenience samples of nurses completed the Self-Efficacy in Palliative Care Questionnaire and participated in online semi-structured interviews. Descriptive statistics were used for quantitative data. A side-by-side joint display supported integration. 497 nurses completed the questionnaire (90.4% female; 11.47 years of experience). Teamwork scored highest, while communication scored lowest. Eighteen nurses were interviewed (88.8% female; 11.5 years of experience). Participants reported communication difficulties related to emotions, prognosis, denial, collusion of silence and paediatric cases. They expressed strong confidence in pain management but more difficulty with agitation and dyspnoea. Spiritual care was mainly understood as facilitating access to religious figures. Although teamwork was perceived positively, tensions with physicians and an excessive focus on physical aspects were noted. Quantitative and qualitative findings aligned overall, with dissonances regarding psychological and social communication. Strengthening communication and comprehensive patient management competencies, as well as addressing interdisciplinary tensions, is necessary to improve and consolidate Palliative Care in Ecuador. This study adhered to EQUATOR guidelines and used COREQ for qualitative reporting. No patient or public contribution.

A significant gap exists in medical support for organ transplant patients during out-of-hours(OOH). General large language models (LLMs), affected by AI hallucinations, are unsuitable for complex post-transplant care. We built the first post-transplant AI agent based on LLMs to address these issues. We constructed a specialized "post-transplant AI agent" (namedDoctor Xiao Yi) and conducted a mixed-methods study comparing it to a hospital-wide general AI agent (namedNan Xiao Yi). Data included 20,176 real-world logs (June-December 2025) and a cross-sectional survey of 152 transplant patients. We examined patterns of use over time, the types of questions raised, and the factors influencing patient behavior. Unlike Nan Xiao Yi, Doctor Xiao Yi remained active during OOH, with a peak at 4:00 AM (P < 0.001). The general agent handled admin tasks like appointments, while the specialist agent provided clinical support such as diet, symptoms, and medication. Survey found 60.5% of OOH use by transplant patients due to reluctance to disturb human doctors. Furthermore, 63.8% of transplant patients were satisfied with the specialist agent's responses, and 48% reported they would decide on further hospital treatment based on AI suggestions. The specialist AI agent effectively fills the gap in medical and psychological services during OOH for transplant recipients. Based on the "dual-source knowledge base + GraphRAG+ multi-agent framework" architecture, our specialist AI agent offers safe, reliable post-transplant care.

This convergent mixed-methods study explores how Theater of the Oppressed (TO) fosters critical consciousness among gay, bisexual, queer, and transgender men (n = 16) in Singapore. Grounded in Freirean praxis, the study assessed pre- and post-intervention changes across four domains: perceived inequality, egalitarianism, critical motivation, and support networks. Quantitative findings showed a significant improvement in support networks and positive shifts in motivation. Qualitative insights revealed how TO's embodied and dialogic methods promoted reflection, solidarity, and agency. Furthermore, this study operationalizes support networks as a distinct, measurable component of critical consciousness within a TO framework. Findings highlight the potential of arts-based, relational interventions to advance psychosocial resilience and collective empowerment among marginalized queer communities in non-Western contexts.

Texas student pharmacists' approaches to community pharmacy drug diversion: A mixed-methods study using criminal justice models.

There is a recognised desire to teach amongst GP trainees yet limited formal opportunities to do this. There are known benefits of near-peer teaching to both teacher and learner, but minimal research investigating the role of GP trainees as teachers in a clinical setting. This study aims to evaluate the views of GP trainees participating in a teaching scheme piloted at the University of Manchester. This mixed-methods study was conducted over a three-year period. In years one and three, evaluation was undertaken using questionnaires comprising Likert scale items and free-text responses (n = 11). In the second year, qualitative data was collected via a focus group with GP trainees following their teaching experiences (n = 8). Subsequently, a thematic analysis was conducted. GP trainees reported benefits including improved clinical skills, job satisfaction and development of leadership skills. There was a noted impact on their teaching skills, as GP trainees demonstrated their ability to be adaptable to learners' needs and develop interactive, structured teaching sessions. The main challenges identified were organisation and time management, balancing responsibilities and adapting to student needs. Trainees unanimously felt the scheme allowed them to meet their portfolio requirements, develop their teaching skills and made them more likely to consider pursuing medical education as part of their future careers. All participants expressed a desire to continue with teaching and reported improved job satisfaction. Participation in a near-peer teaching scheme can have significant positive impacts on GP trainees' personal and professional development. Despite some challenges, trainees reported numerous benefits from undertaking the scheme. Formal teaching opportunities for GP trainees could contribute to the development of a skilled and motivated future workforce of clinician-educators in general practice.

This scoping review aimed to map the characteristics of outcomes arising from Community Health Development and Capacity Building in Community Health (CHD/CCH) conducted by public health-related nursing professionals and to identify the types of evidence that inform public health research and practice. Following Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, we systematically searched PubMed, CINAHL, Web of Science Core Collection, and the Cochrane Library. Eligibility was based on the Population-Concept-Context framework: (a) community-dwelling individuals and communities, (b) CHD/CCH activities involving collaborative engagement with residents and stakeholders, and (c) nursing professionals engaged in public health practice. Quantitative, qualitative, mixed-methods studies, and gray literature were included without restrictions on language or publication year. Outcomes were synthesized according to follow-up period (short, mid, long term) and ecological level (micro, meso, macro). Thirty studies published between 1990 and 2024 were included. Of them, 14 used qualitative designs, 13 mixed methods, and 3 quantitative methodologies. Short-term evaluations primarily reported individual and organizational changes, whereas mid- and long-term studies demonstrated more complex, multilevel outcomes such as policy development, strengthened community networks, and enhancements to health and social service systems. Across ecological levels, 14 domains of community capacity were identified. Public health-related nursing practice contributes to multilayered community capacity building through CHD/CCH. However, gaps remain in quantitative evaluation and standardized outcome measures, underscoring the need for methodological advancement to reinforce the evidence base for community development in public health nursing.

Evaluating the treatment of patients with paroxysmal nocturnal hemoglobinuria in Brazil: disparities in access and treatment persistence.

Academic buoyancy in EFL learning: A mixed-methods study among Chinese private university students.

Self-affirmation interventions can protect individuals from perceived threats and enhance well-being. However, previous studies highlight the need to adapt these interventions to specific populations, particularly non-WEIRD ones, to achieve effective results. To our knowledge, this is the first study to use a mixed-methods participatory approach to develop self-affirmation techniques tailored to the threats Syrian forced migrants face during acculturation in European host societies. In the first qualitative study, 30 in-depth interviews explored threats encountered during acculturation, their negative effects and spontaneous self-affirmation mechanisms used to preserve well-being and self-image. A second experimental study assessed the effectiveness of tailored self-affirmation interventions. Three hundred and thirteen participants reported their acculturation orientations, read a threat-inducing text and were then assigned to one of three self-affirmation conditions (host-domain, heritage-domain or individual) or a control condition. We then measured hedonic well-being, self-esteem and a challenged sense of belonging. Contrast analysis showed that combined self-affirmation interventions enhanced hedonic well-being compared to control, particularly when aligned with individuals' acculturation orientations. Our studies contribute to the literature by developing culturally grounded interventions for a specific underrepresented population using mixed methods. Future research should test their effectiveness with similar forced migrant populations and continue adapting interventions to fit diverse cultural contexts and interindividual differences.

Autistic children and their parents during war - A mixed-methods study.

Reiki and Therapeutic Touch are complementary therapies sometimes used in palliative and end-of-life care. To examine the available evidence regarding the effects of Reiki and Therapeutic Touch, compared to usual care, in palliative and end-of-life care. Systematic review registered in PROSPERO (CRD420251059364; May 23, 2025). MEDLINE, Web of Science, and Scopus were searched for English-language studies published between 2013 and 2024. Eligible studies included patients receiving palliative care who underwent Reiki and/or Therapeutic Touch compared with usual care. Any primary study design was eligible. Risk of bias was assessed and findings synthesized narratively. Nine studies involving 415 participants were included: five mixed-methods studies, three randomized controlled trials, and one qualitative cross-sectional study conducted in North America (n = 6) and Europe (n = 3). Cancer was the predominant diagnosis. Risk of bias raised some concerns in randomized trials and was moderate to high in qualitative and non-randomized designs. Some studies reported improvements in symptoms (pain, anxiety, depression, fatigue, and stress), and in quality-of-life domains (sleep, relaxation, energy, hope, and emotional well-being). Qualitative findings described perceived relaxation, comfort, and emotional support. Reporting of harms was limited; only one study monitored adverse events and reported one serious event considered potentially related to the intervention. Evidence regarding Reiki and Therapeutic Touch in palliative and end-of-life care remains limited and heterogeneous. The very low certainty of evidence precludes firm conclusions regarding their effectiveness. Further well-designed studies are needed to clarify their potential role in palliative care.