Medical and care errors are common in health care, posing serious risks to patient safety, with over 10% of patients being harmed annually. Despite efforts to reduce errors, underreporting persists, as nurses report only about 20% of incidents. Understanding the factors that influence nurses' intention to report errors is essential for developing effective strategies to improve reporting and patient safety. This systematic review aimed to identify factors associated with nurses' intention to report medical and care errors. A comprehensive search was conducted in 3 databases (PubMed, CINAHL, and PsycINFO) and Google Scholar using a combination of MeSH and synonymous terms related to medication errors, medical errors, care errors, intention to report, and nurses. Twenty-seven articles were included in the analysis. The review revealed that interpersonal characteristics such as attitude, subjective norms, and perceived behavioral control were found to have a significant relationship with nurses' intention to report medical errors. In addition, organizational environmental factors like patient safety culture and climate, nonpunitive responses to errors, open communication, teamwork, management support, task-oriented culture, organizational learning, reporting awareness, leadership behavior, and psychological safety positively influence error-reporting intentions. Furthermore, some demographic characteristics, including nurses' age, level of education, years of experience, and prior exposure to medication errors positively impacted reporting behaviors. This review results highlight the multifaceted nature of factors influencing nurses' intention to report medical errors. Understanding the complex interplay of attitude, subjective norms, perceived behavioral control, and other contextual factors is crucial to promote a reporting culture that enhances patient safety.

This study aims to analyze the interpersonal communication of senior baristas in the training process of novice baristas at Nest Coffee & Donuts Jogja. The research employs a descriptive qualitative approach, with data collected through in-depth interviews, direct observation, and documentation. The informants consist of senior baristas and novice baristas who are directly involved in the training activities. The findings indicate that open, supportive, and two-way interpersonal communication plays a crucial role in enhancing the effectiveness of the training process. Senior baristas function not only as technical instructors but also as mentors who foster trust, comfort, and learning motivation among novice baristas. Although communication barriers such as differences in experience levels and work pressure are present, adaptive and empathetic communication strategies are able to minimize these obstacles. Effective interpersonal communication has a positive impact on improving technical competence, self-confidence, and the ability of novice baristas to adapt to the work culture at Nest Coffee & Donuts Jogja.

Opening the door to what matters most in advanced childhood cancer.

This study analyzes the communication strategies of PR agencies that act as consultants in supporting the needs of clients in the technology industry. This research uses a descriptive qualitative approach through in-depth interviews with KlikPR managers and direct observation. The findings show that KlikPR's communication strategy follows three communication objectives, namely to secure understanding, to establish acceptance, and to motivate action. KlikPR prioritizes open communication, regular coordination, and participatory work practices to strengthen relationships with clients. This strategy is based on the theory of organizational communication flow through the aspect of downward communication, which serves to convey strategic directions and context, while upward communication facilitates the exchange of ideas, reporting, and evaluation. With an integrated and transparent communication approach, KlikPR is able to maintain client trust and build long-term partnerships.

Black pediatric patients in the United States experience disproportionate harm from systemic racism in health care. Black LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender Queer, Intersex, Asexual, with the "+" representing additional sexual orientations and gender identities) parents and caregivers, as primary navigators of care for their children, may also encounter homophobia, transphobia, and heteronormative bias. These intersecting biases can shape clinical interactions and influence pediatric care quality yet remain underexamined in health equity research. This study assessed how the intersecting identities of Black LGBTQIA+ caregivers influence their interactions with pediatric clinicians and affect the health care their children receive. This qualitative study recruited 14 Black LGBTQIA+ parents or caregivers of pediatric patients from 10 families through purposive and snowball sampling. Semistructured interviews were conducted via videoconference in 2023. Data analysis was conducted using a 3-round inductive and deductive thematic coding process to identify barriers to inclusive care and caregiver-informed strategies to advance equity in pediatric settings. Six themes were identified. Three themes reflect the unique experiences of Black LGBTQIA+ caregivers in pediatric medicine: (1) lack of awareness or experience with same-sex families, (2) proactive caregiver advocacy, and (3) caregiver-perceived impact of clinician representation. The remaining 3 themes offered actionable recommendations for pediatric clinicians: (4) expansion of clinician understanding of caregiver roles, (5) adaptive communication practices, and (6) inclusive caregiver support. The intersecting identities of Black LGBTQIA+ caregivers shape pediatric care through systemic barriers and opportunities for better clinician engagement. Inclusive, culturally responsive practices that strengthen family relationships, foster open communication, and recognize all caregivers' roles can build trust, improve outcomes, and advance equity in pediatric care.

Objective To identify barriers to psychological safety in long-term care insurance facilities through a qualitative descriptive analysis of verbatim transcripts obtained from facility directors.Methods Directors of long-term care insurance facilities in the Kinki region of Japan were recruited using snowball sampling. Semi-structured interviews were conducted between August and September 2023. Verbatim transcripts were analyzed qualitatively and inductively to generate codes representing statements that impede psychological safety. Codes were iteratively grouped to increase abstraction, forming subcategories and higher-order categories. Findings were further organized according to three antecedent domains: individual, structural/system, and interpersonal factors, to examine how these barriers manifest within facilities.Results A total of 11 directors participated (9 male; age distribution: 40s, n=5; 50s, n=5). Mean age was 50.0 years (SD=6.44), and mean tenure in the current role was 10.4 years (SD=5.12). Three categories of individual factors were identified: "Position of new employees and junior employees," "Trait of being overly conscious of others and defensive of oneself," and "Difficult work performance among employees suspected of having psychological issues." Three structural/system categories were identified: "Limited understanding and capability regarding managerial duties," "Difficulties in managing, supporting, and training staff," and "Burden due to staff shortages and challenges in appropriate staffing." Five interpersonal categories were identified: "Self-centered and dismissive behavior toward others," "Self-righteous and pressure-generating behavior from superiors," "Intolerance and low flexibility associated with excessive righteousness," "Misunderstandings and concerns arising from insufficient ethical knowledge and rumors," and "Emotionally complex relationships that are difficult to reconcile." Interpersonal factors were prominent and interacted with individual factors. The findings suggested that the lack of effective organizational and workplace structures and systems to address these issues hinders psychological safety in long-term care facilities.Conclusion Individual, interpersonal, and structural/system factors directly and indirectly inhibit open work-related communication among employees in long-term care insurance facilities. Persistent staffing shortages in Japan further exacerbate these barriers. Enhancing psychological safety requires targeted interventions addressing structural/system factors, particularly leadership practices within management.

ABSTRACT Little is known about the ongoing pedagogical strategies adopted by tutors and their impact on coaches’ professional development, which limits the ability to support tutor development and the quality of tutoring provisions. Considering the Portuguese sports context, this article explored, from the student-coaches’ (SCs) perspective, the most valued pedagogical strategies employed by their tutors, and examined its potential impact on fostering their professional development. Eight SCs participated in this study. Data was gathered through individual written reflective logs and focus-group interviews and examined via thematic analysis. Highlighted pedagogical strategies associated with feeling seen included collaborative training session planning and delivery, and active involvement in competition, while feeling heard involved open communication, assignment of meaningful tasks and using the SC’s inputs to support athletes and inform decision-making. Such pedagogical strategies contributed to enhancing SCs’ self-confidence, accountability, content-related coaching skills, and professional identity. Key findings provide a foundation for developing tutoring guidelines.

ABSTRACT Online sports betting has become a profitable segment of the global gambling industry, with young men identified as the demographic most likely to engage in online sports betting and at risk of gambling problems. Despite its prominence, limited qualitative research has explored young men’s experiences with online sports betting, and even less has examined parents’ perspectives, who may influence their child’s betting. We interviewed 16 young men (aged 18–24) and 11 parents to investigate attitudes toward sports betting, factors influencing engagement, parental strategies for addressing betting, and suggestions for support and reform. Thematic analysis revealed mixed attitudes. Parents largely emphasized the risks, while young men acknowledged the appeal and potential harms. Key influences on engagement included peer dynamics, marketing, and the accessibility of betting apps. The role of family gambling history was complex, having protective and risk-enhancing effects. Open communication with children and highlighting the risks of betting were common parental strategies. Participants recommended reforms to advertising, spending limits, and targeted educational content. Integrating perspectives from young men and parents of young men, this study highlights the multiple factors shaping young men’s sports betting behaviors and underscores the need for targeted, evidence-based support for young men and their families.

Partial-encryption-decryption-based secure state estimation of singularly perturbed complex networks: A Paillier encryption approach.

Complex extremity wounds, if not addressed properly, are a leading cause of major limb amputation. Chronic wounds in salvaged extremities contribute to long-term morbidity in the extremity. Orthoplastic surgery treats limb-threatening conditions through the combined application of orthopaedic and plastic surgical principles, applied to clinical problems simultaneously. Key components include early stakeholder evaluation of the limb and patient and open collaborative communication between orthopaedic and plastic surgeons. Meticulous débridement at the time of presentation and careful selection of fixation informed by the overall reconstructive plan should be executed when the patient presents to the emergency department. Implementation of Orthoplastic protocols results in quicker time to skeletal stabilization and soft tissue coverage, reduced risk of infection, improved functional outcomes, and less cost for care. This review presents a protocol-driven guide for establishing an Orthoplastic program and optimizing limb salvage outcomes across diverse practice settings.

ABSTRACT Palestinian adolescents in Israel face endemic community violence within a context of systemic structural discrimination and political marginalization. Their subjective experiences and coping mechanisms, however, remain underexplored in qualitative research. This study used a developmentally-appropriate methodology to explore how Palestinian adolescents experience community violence and the coping strategies they employ, framed through Cicchetti and Lynch’s Ecological/Transactional Model. Qualitative and child-friendly methods, including drawing, photo elicitation activity, and selecting online photos, were used to interview 39 Palestinian adolescents (22 girls, 17 boys) aged 11–15. Interviews were conducted in person or via Zoom based on the participants’ preferences. Inductive thematic analysis guided the research. The analysis revealed that community violence inflicted profound psychological and physical impacts, including living in a state of pervasive insecurity and anxiety, a sense of confinement, and disturbances in sleep and concentration. A central theme was grappling with unanswered questions about the violence, exacerbated by a lack of dialogue from adults and institutions. Coping strategies were primarily disengagement-oriented (avoidance of spaces and news) and engagement-oriented (seeking peer support and shared dialogue online). The findings illustrate a transactional process where macrosystemic structural violence and institutional neglect necessitate microsystemic coping. Accordingly, interventions must be multi-systemic, targeting the root causes by demanding institutional accountability, co-designing community safety initiatives, equipping parents to foster open communication, and formally integrating adolescents’ peer support networks into public health and school-based programs.

Teamwork and communication are essential to ensuring the provision of high-quality, safe, evidence-based nursing care. Open and effective communication among members of a team is recognized to facilitate implementation of evidence-based practices (EBPs) and communication is an essential element of teamwork; however, how these factors relate to one another during implementation is unknown. This study was designed to fill this gap by concurrently exploring nurses' perceptions of teamwork and communication within the context of the implementation of EBPs. The purpose of this study was to test the relationships between the positionality of nurses within communication networks for practice change and their perceptions of teamwork. This exploratory, descriptive, cross-sectional survey study collected perceptions of teamwork, using the Nursing Teamwork Survey, and communication network data, using a sociometric survey. Teamwork scores, centrality and coreness of participants across two intensive care units (ICUs) were calculated. Data were analyzed across the whole network and subnetworks. Relationships between centrality measures and teamwork scores were analyzed using univariate regression models; coreness and teamwork perceptions were compared using t-tests. The assortativity coefficient was calculated to determine homophily. Data were collected between January to March 2019. Across the two ICUs, 145 nurses reported overall high perceptions of teamwork (mean = 4.04). Few significant relationships were seen between communication centrality metrics or coreness and teamwork subscale measures within the whole network nor subnetworks. The assortativity coefficients suggest that those who are closely connected in these communication networks do not have similar perceptions of teamwork. The hypothesis that members central to the communication network would hold higher perceptions of teamwork was not supported in this analysis. Although teamwork and communication are each established factors known to influence the implementation process of EBPs, this study did not reveal a clear relationship between nurses' positionality in communication networks and perceptions of teamwork during implementation. This finding was surprising; however, possible explanations for these findings offer insight into how to approach future research to understand team boundaries, team composition, and determining appropriate and meaningful measurements of teamwork during the implementation process.

Raising concerns is essential to patient safety and professionalism in healthcare. Dental students and trainees, however, may encounter unique challenges in voicing concerns within clinical training environments. This study explores self-reported confidence and perceived barriers in raising concerns among dental students and trainees across the Gulf Cooperation Council (GCC) region. A cross-sectional, multicenter survey was distributed to dental students at five dental institutions across Qatar, the United Arab Emirates, and the Kingdom of Saudi Arabia. An online questionnaire assessed respondents' confidence in raising concerns, preferred reporting pathways, and perceived barriers. Descriptive statistics, including confidence intervals, were calculated for each item and the combined dataset. Analysis of variance (ANOVA) assessed variation by gender, year of study, and institution type. A total of 363 respondents participated in the study. Approximately one-third of the respondents (31.4%, n = 114) reported having previously encountered situations requiring the raising of a concern, while 40.5% (n = 147) reported no such experience and 28.0% (n = 102) were unsure. Students reported greater confidence in raising patient safety concerns (e.g., infection control) than interpersonal issues (e.g., staff conduct). Confidence in reporting patient safety concerns was similarly high for clinical supervisors and peers, whereas for interpersonal concerns, students appeared more comfortable discussing issues with peers. Confidence varied significantly by gender, year of study, and institutional type (p < 0.05). The three most common barriers were "not wanting to cause trouble," "fear of conflict with staff or colleagues," and "concern about being perceived negatively." Respondents emphasized the need for confidential, approachable support systems and greater institutional clarity and responsiveness. While the importance of raising concerns is widely recognized, students' confidence is influenced by individual and systemic factors. Establishing structured mentorship, transparent reporting processes, and psychological safety within dental education is critical for empowering students and promoting a culture of open communication. A regional, collaborative approach is required to create sustainable systems that support students in raising concerns confidently and responsibly. However, these findings are based on a non-probability sample and are specific to the GCC region, which may limit their generalizability to other contexts.

BackgroundNear‐miss reporting intention is essential for patient safety; however, reporting rates among nurses remain low. Nurses’ silence behavior—the intentional withholding of work‐related concerns—is a key barrier to reporting. While authentic leadership is known to promote nurses’ voice behavior, research examining the relationships between authentic leadership, nurses’ silence behavior, and near‐miss reporting intention remains limited. Therefore, this study aimed to examine the abovementioned relationships and to test the mediating role of nurses’ silence behavior.MethodsA predictive correlation design was used. Data were collected from 171 nurses at three general and tertiary hospitals in South Korea between August 20 and September 15, 2022. The mediating effect of silence behavior on the relationship between authentic leadership and near‐miss reporting intention was tested using the PROCESS macro (Model 4).ResultsAuthentic leadership was negatively associated with nurses’ silence behavior (B = −0.27, p < 0.001), and silence behavior was negatively associated with near‐miss reporting intention (B = −0.65, p = 0.008). Authentic leadership did not have a significant direct effect on near‐miss reporting intention (B = 0.36, p = 0.142) but had a significant indirect effect through the mediator (B = 0.18, 95% CI = 0.03–0.37).ConclusionAuthentic leadership is indirectly linked to higher near‐miss reporting intentions through lower individual silence behavior among nurses. To enhance reporting intentions, it is necessary to mitigate situational constraints associated with silence and foster an environment conducive to open communication.Implications for Nursing ManagementNurse managers should consistently practice authentic leadership to dismantle rigid hierarchical atmospheres and cultivate an open communication climate. This targeted strategy may help reduce nurses’ silence behavior and encourage active participation in patient safety–strengthening behaviors, thereby creating a secure healthcare setting.

Depression is one of the most prevalent mental health problems in adolescence. Due to the covert nature of depressive symptoms, parents play an important role in recognizing distress and seeking intervention for their child. However, research often reports discrepancies between parent and adolescent reports of depressive symptoms, and integrating and interpreting these discrepancies remains a challenge. The present study used a trifactor model to isolate sources of variance stemming from shared and unique perspectives in a sample of 583 parent-adolescent dyads (59% male; Mage= 14.22, SD = 1.81). Consensus between parents and adolescents was characterized by feelings of sadness, whereas unique views of adolescent depressive symptoms highlighted somatic symptoms (e.g., overtiredness), with adolescents generally reporting more symptoms. Adolescents' attachment security and family affective responsiveness were associated with lower depressive symptoms reported by adolescents, whereas parents' reports of problem-solving skills were associated with lower depressive symptoms reported by parents. These findings emphasize the importance of considering the degree of parent-adolescent agreement regarding adolescent mental health and educating parents to raise awareness of their adolescents' mental health, which could facilitate early detection and intervention. Furthermore, prevention and intervention efforts should target promoting family functioning through open and affective communication.

Vehicular Ad Hoc Networks (VANETs) are essential for intelligent transportation systems; however, their dynamic topology and open wireless communication environment expose them to impersonation, Sybil, replay, and message modification attacks. Existing authentication schemes mainly rely on centralized authorities and conventional cryptographic mechanisms, which lack dynamic trust evaluation and fail to ensure secure authentication during Roadside Unit (RSU) handover and cluster mobility. To address these challenges, this paper proposes a blockchain-enabled trust-aware authentication framework for secure VANET communication. The framework integrates a Joint Probability and Error Unit-based Deep Learning Neural Network (JPEU-DLNN) for dynamic trust assessment and Log-based Edwards Curve Cryptography (LECC) for lightweight key generation. In addition, Gini Indexed Farthest First Clustering (GIFFC) ensures stable cluster formation, while the Directional Gannet Optimization Algorithm (DGOA) supports optimal routing. Blockchain technology provides decentralized and immutable credential storage, eliminating single-point failure and certificate forgery. Simulation results show that the proposed framework achieves 95.62% authentication accuracy and 96.94% packet delivery ratio, with reduced end-to-end delay and improved network lifetime compared to existing blockchain-based authentication schemes. Security evaluation confirms strong resistance against active and passive attacks. These results demonstrate the practical applicability of the framework for secure and reliable VANET deployments.

ABSTRACT The COVID-19 pandemic forced sport coaches globally to embrace new coaching formats, where utilising digital technologies was considered a ‘needs must’ method in the absence of face-to-face coaching. These circumstances contributed towards the rise of online/remote approaches where coaching practice is delivered virtually via web-based platforms either synchronously or asynchronously, overcoming logistical, geographical, and financial boundaries. In endurance sports such as running, online/remote coaching existed prior to the pandemic, yet there remains limited understanding of what coaches do within a virtual environment. To address this lacuna, the aim of this research is to explore the experiences, practices, and development of online running coaches. Data were collected via online semi-structured interviews with eight running coaches (five male, three female) who provide online coaching delivery. Following a phronetic iterative approach to data analysis, three themes were constructed: (1) Limited value and instrumental intentions: Becoming a qualified online running coach; (2) Striving to build rapport: Perspectives towards effective running coaching in an online space; and (3) Prescribing training plans, data monitoring, and video feedback: Understanding the everyday practices of online running coaches. The findings reveal that formal coach education is perceived to lack value to online running coaches, with it being suggested that the online coaching space requires further regulation by national governing bodies. Online running coaches outlined the importance of open communication and acknowledged that although building rapport virtually can be problematic, online delivery enables an individualised and bespoke coaching approach. Finally, online running coaches’ everyday practices centred on prescribing training programmes while balancing tensions between objective performance data and the subjective perspectives of their athletes. This research advances our understanding of the online coaching environment and lends weight to the recommendation that increased professional learning and development opportunities for coaches who provide online delivery are needed.

ABSTRACT This study utilized relational dialectics theory to examine the discursive (re)constructions of family for Christian feminists who have renegotiated their conservative evangelical religious identities in the age of Trumpism. Participants’ talk manifested discursive struggles between two competing discourses about family: the discourse of obliged relationship endurance (DORE) and the discourse of deliberate relationship cultivation (DDRC). The DORE views family as permanently bound by biological or legal ties, requiring unconditional, enduring commitment. In contrast, the DDRC emphasizes the voluntary nature of family relationships, individual needs, and open communication. This study sheds light on how (formerly conservative Christian) feminists make sense of new family dynamics, offering insights into evolving definitions of family and the complexities of navigating family relationships amid sociopolitical divisions.

ObjectiveThis qualitative exploratory study aimed to deepen the understanding of selective disclosure among adolescents and young adults (AYAs) living with chronic conditions, particularly in the context of intimate relationships. The project created a space for AYAs to reflect on and share their lived experiences of managing chronic illness and disclosing it to potential partners.MethodsThe study used a participatory design that combined elements of Youth Participatory Action Research (YPAR) with citizen science. Four YPAR partners, young people with lived experience of chronic illness, were actively involved in all stages of the research process, including topic selection, recruitment, development of questions, data collection, analysis, and dissemination. Additionally, 44 AYAs participated as respondents to a longitudinal qualitative survey consisting of 35 open-ended questions that focused on intimacy, challenges, coping mechanisms, and support systems. NVivo 14 was used to code and analyze responses thematically.ResultsOf the 44 AYAs contacted, 27 answered all survey questions. The sample had a high representation of young women with diabetes and LGBTQ + individuals with ADHD and other chronic conditions. Levels of self-acceptance, feelings of empowerment, and previous experiences of disclosure shaped participants' willingness to disclose their health conditions in intimate situations. Supportive social and relational environments, including open-minded partners and trusted peer networks, encouraged disclosure. In contrast, experiences of stigma, fear of rejection, and concerns about being misunderstood or reduced to their diagnosis acted as barriers. Additionally, the presence of visible medication use or physical symptoms contributed to a sense of vulnerability, further complicating the decision to disclose.ConclusionThe study sheds light on the nuanced relationship between chronic conditions, self-identity, and intimacy among AYAs. It highlights the importance of creating supportive environments and promoting open communication in both clinical and social settings. By integrating YPAR partners throughout the research process, the study highlights the value of participatory methods in capturing diverse youth perspectives and promoting more empathetic approaches to addressing intimacy related challenges in healthcare contexts.MESH termsChronic Disease / psychology*; Qualitative Research; Truth Disclosure*; Young Adult.

How I Do It: "Family Meetings" as a Structured Practice for Psychological Safety and Bidirectional Communication in Surgical Residency.