Exploring the factors affecting ICU nurse retention during and post-COVID-19: A qualitative descriptive interview study.

Barriers and facilitators to adherence with home-based exercise in persistent spinal pain - A nested qualitative study.

Infant readmissions within the first 28 days of life have risen significantly over the past decade. Postnatal care is often described as under-resourced, with many women reporting a lack of sufficient support after birth. To explore parents' experiences in the lead-up to infant readmission within the first four weeks of life. Twenty-eight parents of 18 infants unexpectedly admitted to a large urban paediatric referral hospital in England within four weeks of birth were interviewed face to face. Data were analysed using thematic analysis. Parents valued being united in their role as protectors. Mothers struggling with breastfeeding often felt intense responsibility, being their baby's sole source of nutrition. When concerns arose, some parents were unsure who to contact. Seeking advice from family sometimes delayed professional help. Others felt dismissed by health professionals offering false reassurance. Many were comforted upon arriving at the hospital and receiving a diagnosis, which validated their concerns and reinforced their protective instincts. This study highlights parents' need to be together post-birth, their decision-making when their baby became unwell, and their interactions with health professionals during readmission. Services should support shared caregiving early on by improving partner access to postnatal wards and enhancing community support for families returning home. The care pathway for unwell infants is often unclear and should be made more accessible to avoid unnecessary emergency visits. Health professionals must prioritise women's emotional wellbeing, especially during breastfeeding challenges, and respond seriously to parental concerns with clear escalation routes.

Water knowledge, understanding the current and future availability and needs of water, has been critical in negotiating international water disputes. Drawing from expert interviews, this article examines how Artificial Intelligence (AI) tools influence knowledge production and exchange in water diplomacy. The findings suggest that technical strides from AI technologies can enhance data and information objectivity and social learning, potentially benefiting water negotiations and consensus building. However, without addressing political and human challenges, AI tools canexacerbate the risk of eroding trust and spreading dis- and mis-information about politically sensitive water issues. The malicious use of AI poses a serious risk, as negotiators may face increased pressure from public opinion, potentially undermining cooperative progress and escalating tensions over water.

When the system fails: a qualitative interview study of foster parents’ perceptions of placement breakdown in Sweden

Patients with advanced heart failure or lung failure often experience significant changes in psychosocial needs, which may affect their quality of life, emotional wellbeing, and daily functioning. Although nurses are well-positioned to address these needs, there is limited understanding of their perspective on these conversations. Therefore, this study aimed to explore how nurses approach and experience addressing changes in psychosocial needs of patients with advanced heart failure (NYHA stage III or IV) or lung failure (GOLD 3 or 4). A qualitative study consisting of semi-structured interviews with hospital and home care nurses. Data were collected from February to April 2025. Based on a case presented by participating nurses and on the Spider Web model for Positive Health, we inquired about perceptions, approaches and challenges to discussing psychosocial needs with patients. Interviews were recorded, transcribed, and analyzed inductively following the principles of thematic analysis. We interviewed six hospital and six home care nurses (total n = 12). Nurses generally experienced conversations about psychosocial needs as meaningful and part of their professional role. They used an intuitive and organic style, attuning to the needs and boundaries of patients. In practice, their approach was challenged by competing priorities and a lack of time, especially in hospital settings. Nurses found conversations about psychosocial needs easier when they had a click and trusting relationship with patients. Some were hesitant to address sensitive topics such as sexuality and financial concerns due to discomfort, perceiving it as a lower priority, or as outside their responsibility. We identified a discrepancy between nurses' perceived importance of discussing psychosocial issues, and the extent and thoroughness with which they do this in practice. Approaches were shaped by nurses' professional intuition and attunement to patients' needs and boundaries. Topics that nurses considered sensitive, such as sexuality and financial concerns, emerged as challenging.

Experienced nurses' perceptions of essential nursing care in the emergency department - A focus group study.

Diversity of model output is a crucial yet underexplored factor in co-creative AI systems, as meaningful choices aid user decision-making, especially early in a task where precise specifications are unknown. This is particularly relevant in domains where sustained user engagement relies on maintaining variation over multiple generative tasks, such as recipe generation. This paper investigates the relationship between algorithmically assessed and user-perceived diversity through a three-part study of Ten Thousand Spices (10kS), a multi-agent generative system that produces health-oriented recipes tailored to user profiles. The study includes: a computational simulation using an entropy-based measure to algorithmically assess semantic diversity, a quantitative user survey of perceived diversity with 100 participants, and a qualitative interview study with 12 users. The results show that, while algorithmic diversity correlates with perceived diversity, it overlooks thematic and cultural factors identified through the follow-up interviews. Participants gave higher ratings to variation that was not only generally different but specifically meaningful given the context. The findings highlight the limitations of current diversity metrics and suggest the need for hybrid approaches that align computational variety with user experience. We conclude by discussing implications for the design of personalized co-creative systems aimed at supporting creativity and engagement.

The aim is to explore co-design facilitators' perspectives and experiences of using co-design to improve intrapartum care in four sub-Saharan African settings. The inquiry focuses particularly on how they fostered engagement, built trust and mitigated unintended consequences during the co-design process. Qualitative interview study with reflexive thematic analysis. Sixteen public and private not-for-profit hospital-based maternity units in Benin, Malawi, Tanzania and Uganda (four per country). A total population sample of 10 co-design facilitators involved in a hospital-based co-design project implemented in maternity units in Benin, Malawi, Tanzania and Uganda were interviewed. Semistructured interviews were conducted between December 2022 and January 2023. Co-design facilitators viewed co-design as a collaborative process to develop contextually relevant solutions. Our findings elucidate their role in facilitating consensus-building and fostering stakeholder ownership amidst significant power divides. They described approaches co-design facilitators take to maintain ongoing stakeholder engagement and manage misaligned expectations in a trusting and collaborative environment, while being mindful of existing tensions and power imbalances. They also highlighted key challenges faced, including navigating norms, power imbalances and unintended consequences. This study underscores the importance of power-sharing, fostering ownership and engaging end users equitably and continuously in co-design efforts, while also being aware of how to address its potential unintended consequences. Further research is needed to understand co-design facilitators' impact on co-design and how to address unintended consequences for stakeholders during and after co-design activities in intrapartum interventions in low-resource settings.

Simple frailty assessments, such as the clinical frailty scale (CFS), are prognostic for worse outcomes in older adults with cancer and could support treatment decision-making. This interview study aims to explore clinicians' experiences of using simple frailty assessments in oncology, including the impacts on patient care and barriers and facilitators to successful implementation. Semi-structured individual interviews were conducted with clinicians at three UK sites that had implemented CFS screening in lung cancer clinics as part of a national pilot, to explore how frailty assessments are applied and are impacting care. Purposive sampling targeted a range of professionals involved in assessing frailty and making treatment decisions. Recordings were transcribed verbatim and analysed thematically. Ten clinicians participated, and four main themes were identified. 'Assessing fitness and frailty' explores the central role of performance status (PS), as well as its limitations, and what frailty assessments add. 'Scoring and interpreting CFS' describes the ease and relative yield of CFS use, particularly for patients with 'borderline' PS scores (e.g., PS 1-2 or 2-3), and the importance of contextual interpretation. 'Role of frailty and impacts of assessment' highlights how frailty assessments can enhance patient-centered care and support, and clinical and shared decision-making, with potential for streamlined care and system-level benefits. 'Barriers and facilitators to implementation' are described, including time, culture, guidance, and training, with recommendations provided. Assessing frailty has wide-ranging potential benefits for patients, oncology teams, and the wider system, but barriers must be overcome. Specific recommendations are provided to support the routine implementation of frailty assessments, which is a key step towards the benefits of frailty-informed care being realised at scale.

BackgroundHealth care apps are widely used to support weight loss and lifestyle modification. Many of these apps offer tailored feedback on dietary intake and nutritional behavior. However, most lack personalized features that promote physical activity (PA), which is important for weight management, metabolic health, and chronic disease prevention. To develop future personalized PA promotion functions, it is essential to understand users’ perceptions of PA.ObjectiveThis study aimed to explore health care app users’ perception of PA, including perceived motivators and barriers.MethodsA qualitative study was conducted using focus group interviews with health care app users. Participants were recruited regardless of age, sex, or body mass index. A thematic analysis was conducted using a combination of inductive and deductive approaches. Question 1 (“How do you perceive the importance of physical activity?”) was analyzed inductively, whereas questions 2 (“What are the motivating factors for engaging in physical activity?”) and 3 (“What are the barriers to engaging in physical activity?”) were analyzed deductively based on the social ecological model.ResultsEleven participants were interviewed and were unfamiliar with the term “physical activity” but recognized the importance of movement and reducing sedentary behavior. The identified motivators included improvements in mood; changes in physical appearance; support from family; alignment with personal routines and conditions (eg, goal setting, feedback, reminders, and praise); and tailoring to physical condition, daily schedules, and weather. The reported barriers included time restrictions due to work, fatigue, weather, remote work, and social pressure in workplace settings.ConclusionsThis study provides user-informed insights that can inform the design of personalized approaches better aligned with daily routines, competing demands, and situational barriers. Future work should evaluate how incorporating such user perspectives into personalized support strategies affects engagement and PA.

ABSTRACT Objective This study explores the role of General Practitioners (GPs) in managing patients’ medication information in Norwegian municipalities, focusing on their responsibilities and interactions with other healthcare professionals. It also examines how GPs’ roles are perceived by nurses and physicians in municipal healthcare to identify areas to improve medication information sharing. Methods A qualitative approach was employed, involving semi-structured interviews with GPs (n = 2), a medical doctor (n = 1), and nurses (n = 5) in a Norwegian municipality implementing the Shared Medication List (SML). Data were analyzed using reflexive thematic analysis. Findings The analysis revealed three main themes: (1) Lack of information sharing infrastructure, highlighting fragmented digital systems hindering accurate medication management. (2) Division of labour and responsibility, with GPs often acting as intermediaries between healthcare professions. (3) Expectations of the SML, with professionals anticipating improved information sharing but expressing concern about changing responsibility for updating the medication list. Concerns were also raised about maintaining GPs’ primary role in ensuring medication accuracy and preventing errors. Conclusion GPs currently play a critical intermediary role in medication information management within a fragmented digital infrastructure. While the SML is expected to improve information sharing, unresolved issues related to responsibility and workflow remain key concerns prior to implementation.

To explore physical and mental health professionals' hopes and concerns around integrating their services in a colocated children's hospital. One-off semi-structured interviews were conducted with 31 participants (16 mental health and 15 physical health professionals). Participants were purposively sampled to ensure representation across each trust and professional background. Participants included allied health professionals, nurses, team managers, paediatricians, psychiatrists and psychologists. Staff described integration as both promising and ambiguous. While many welcomed the potential for improved collaboration and holistic care, others expressed uncertainty about what integration would entail. Six key themes were identified: (a) siloed and patchy beginnings, (b) one whole child, (c) day-to-day of colocation, (d) the integrated worker, (e) patients not in the same boat and (f) extending integration. This novel analysis offers insights around the practical and emotional processes involved in integrating care systems. Staff valued the potential for holistic, child-centred care, improved collaboration and shared learning but expressed concerns around ambiguity, shifting professional identities and the practicalities of colocating services. These tensions underscore the need for clearer communication, relationship-building and support structures during service redesign. Our findings also support integrating wider community and social care systems and call for future research involving young people's perspectives to ensure meaningful, inclusive integration.

BackgroundInstructional documents are crucial for safely operating medical devices. However, few studies have explicitly considered designing instructions for health care professionals (HCPs). Psychological research suggests that advanced learners with prior expertise in a domain are better able to generalize their existing knowledge to new areas compared to those with little prior expertise, resulting in different informational needs.ObjectiveWe aimed to understand how HCPs learn from and use their existing expertise when interacting with instructions for use to familiarize themselves with a novel medical device. This would allow us to explore how instructional documents could be designed to better accommodate HCPs’ needs as experienced learners with prior knowledge in the domain.MethodsWe conducted our studies centered around a novel liver support system, the HepatiCan and its current instructions for use. We conducted 3 user studies, first using semistructured interviews and think-aloud protocols to understand HCPs’ expectations for the process of setting up the HepatiCan and how training for the use of medical devices typically takes place. We followed this up with an observational study to understand HCPs’ actual experience in practice and corresponding instructional design needs.ResultsOur results showed that HCPs’ prior expertise allowed them to prioritize key areas for attention, but also led them to make assumptions and potentially skim and miss important information. Visual representations and communication were preferred, as well as designs that supported memorization, as this was an essential function of using instruction manuals.ConclusionsDevelopers must be aware of what is considered “common” and potentially ignored knowledge within a specific domain in order to clearly emphasize important, safety-relevant information. We also recommend developers focus on using images with attached appendices where possible. This allows advanced users to process information more efficiently without compromising the needs of less familiar users for greater instructional details.

BackgroundIt is considered advantageous to adopt an interdisciplinary approach when creating serious games in the sphere of health practice. However, different fields have reported that interdisciplinary work is challenging. Yet, the literature is scarce regarding how participants within health research have experienced collaborative research. In 2019 and 2020, total 3 teams collaborated to produce a serious game for children undergoing radiotherapy.ObjectiveThe aim of this study was to describe the experiences of collaborating within and between teams, during their participation in the development of a serious game about radiotherapy for children.MethodsA qualitative design was used for gathering data through in depth interviews and a reflective thematic analysis was made. The collaboration included 15 people, 14 of them were asked to participate and 13 accepted. The teams included a game design team, a research team, and an expert team. The latter consisted of a play therapist, a pediatric nurse, and radiation oncology nurses.ResultsIn total, 1 main theme and 4 subthemes were formulated. The main theme was a learning experience during the participatory process. The subthemes were: (1) new insights were established due to the collaboration, (2) discovering the mechanisms behind the design elements provided understanding of the game’s complexity, (3) collaboration within teams and between teams needs time and takes time, and (4) confidence that the project was going to make a difference created engagement.ConclusionsIn conclusion, knowledge expansion arose on several levels during the time the participants were part of the project. Having time and building trust in team constellations are significant factors in achieving a productive, favorable and beneficial experience for participants. Furthermore, confidence in the usefulness of the end product could be a contributory factor for participants continuing to work and the understanding of the complexity of the evolving process. Based on the findings of the team members’ individual experiences, we recommend other medical research teams to consider the following implications for practice before starting interdisciplinary design research: (1) establish who can bridge the fields and act to establish mutual understanding; (2) make time for frequent meetings to update on progress; and (3) be responsive, because when everybody feels connected to what needs to be done and feel safe it gets easier to work together.

ABSTRACT This qualitative interpretive interview study examines how war, displacement, and the destruction of educational infrastructure have reshaped gifted education, intellectual leadership, and the conditions for talent development in Gaza. Eleven senior and mid-career academics and education-sector actors from diverse institutions and disciplines were interviewed virtually to examine their interpretations of educational collapse under siege. Guided by five analytic domains (institutional destruction; psychological impact; knowledge survival; academic identity; and education as moral resilience), data were analyzed using reflexive thematic analysis. Findings indicate that participants interpret the devastation of schools and universities as the annihilation of Gaza’s educational and knowledge infrastructure, resulting in the erosion of institutional memory, rupture of research continuity, and loss of developmental affordances necessary for activating giftedness. Gifted students are perceived by participants as a “lost generation,” with talent rendered structurally non-activatable amid displacement, trauma, and disrupted learning trajectories. Importantly, giftedness is not described as disappearing, but as being re-expressed through continuity-oriented practices, including ethical leadership, knowledge preservation, digital archiving, tent-based instruction, low-bandwidth supervision, and international scholarly collaboration. These practices are framed by participants as moral and intellectual acts aimed at sustaining educational continuity and collective hope rather than as substitutes for formal talent development. The study introduces the concept of non-activatable giftedness to theorize how gifted potential persists yet remains constrained when educational capital is systematically destroyed. By extending the actiotope model to conditions of war and displacement, the findings clarify the boundary conditions of giftedness theory and highlight the ethical stakes of preserving educational capital for gifted learners under extreme structural deprivation.

Objectives. During their studies, software engineering students develop various skills that are crucial for their professional careers. Surprisingly, there is limited research on how these graduates perceive these skills in the workplace. This paper details a study that specifically examines the experiences of graduates from Software Engineering and Mobile Solutions programs that were implemented as project-based curricula. The study sheds light on how they have utilized their skills and identified any gaps in their capabilities. Participants. Project-based curriculum graduates (N = 10) who had a few years of work experience after their graduation. Complementary data was collected from three participants who graduated earlier from the traditional curriculum. Study Method. This is a qualitative interview study on graduates’ perceptions of the working life competences they gained during their studies. Data includes graduate interviews that were recorded and transcribed verbatim, complemented by field notes. Transcriptions were analyzed using content analysis with both descriptive a priori codes and data-driven coding. Findings. Graduates of the project-based curriculum felt that the skills they acquired during their studies were adequate for their professional work. However, they often noted that communication presented some challenges. They specifically mentioned gaps in communication skills with different audiences, such as customers. Other gaps mentioned included written communication, code maintenance, and test automation. Several interviewees expressed a view that their reluctance to ask questions had hindered their integration into the work community. Conclusions. Project-based education facilitates competence acquisition during studies: Graduates have reported acquiring vital professional non-technical competences such as teamwork, communication, and project management. Moreover, they indicated that they had gained proficient technical skills throughout their academic pursuits. The results of this study could be used to develop curricula and design a survey to collect current perceptions, identify gaps, and generate improvement ideas from a larger number of graduates.

BackgroundTechnology is changing the way the world communicates and how we learn, remember, and transform information. The ascendancy of the internet has dramatically altered the landscape of health information access and seeking behaviors. This transformation is embodied by the concept of digital health literacy (DHL) and the need for interventions that improve DHL.ObjectiveThis study aims to explore readiness for DHL transformation and intervention preferences from the perspectives of patients with cancer, caregivers, and health care professionals.MethodsWe conducted semistructured telephone and on-site interviews with 19 patients with cancer, 6 caregivers, and 10 oncology health care professionals. Purposive sampling was used to recruit the participants. We followed the 7 stages of the Framework Method analysis: transcription, familiarization with the interview, coding, developing a working analytical framework, applying the analytical framework, charting the data into the framework matrix, and interpreting the data. This was used to investigate participants’ beliefs about technology adoption, their preferences for DHL training, and the facilitating conditions for adopting such training. We used a hybrid deductive-inductive approach to data analysis, starting with a priori themes and allowing emergent themes to develop as the analysis progressed. The Unified Theory of Acceptance and Use of Technology informed our data generation and analysis.ResultsThe following 6 themes emerged from the analysis: introducing technology-driven solutions, simplifying technology training materials, providing user-friendly training materials, patient-centered care, partnership, and addressing cultural and linguistic barriers. We found that patients with cancer and caregivers were self-sufficient and motivated to use new technology to improve their DHL; however, health care professionals were concerned about the reliability of online information. By mapping interview themes to the Unified Theory of Acceptance and Use of Technology, we identified specific recommendations for the creation of a DHL intervention: content should be concise, easy to understand, and web-based; content should include training on how to identify reliable cancer information; patients would like to be involved in content creation in addition to medical and government stakeholders; and content should be accessible in multiple languages.ConclusionsPatients with cancer and their caregivers were motivated to use modern technology to improve cancer DHL, despite the quality issues raised by health care professionals. The participants’ preferences regarding DHL training align with the innovative microlearning pedagogy. Microlearning could leverage technology to deliver tailored DHL training for patients with cancer. Collaboration with multiple medical and nonmedical stakeholders could facilitate the delivery of cancer DHL training. Future work should focus on designing and assessing the feasibility of implementing a microlearning-based DHL training program that involves end users and diverse stakeholders.

The rising demand for services and scarcity of hospital workers call for innovations to decrease workload and support occupational well-being. Recent technological advancements have enabled the implementation of autonomous mobile robots as service robots for use in service delivery. We studied perceptions of service robots through retrospective data and a technology acceptance-based survey of 64 hospital workers (Study 1) and how service robots co-constructed the occupational well-being with 16 experienced hospital workers through a survey and qualitative interviews (Study 2) at hospitals in Denmark and South Korea. Results indicated equivalence in use of service robots across the two hospitals, high work engagement, and experiences of predictability and flow, which enabled hospital workers to prioritize work tasks and focus throughout the day. We found that service robots are complex human-robot interaction technologies that carry demands and resources, including casting anthropomorphism and playful work design as important job resources in digitalized workplaces.

Objectives: Limited research has examined spousal and adult-child differences with dementia caregiver burden. To address this gap, objectives of this scoping review were to: (1) synthesize differences in caregiver burden between spouse and adult-child dementia caregivers, and (2) determine whether a relationship status group consistently experienced more caregiver burden. Methods: A literature search was conducted in October 2024, using PubMed, Ovid, and Scopus databases. Articles written in English published between January 1991 and June 2024 were included if they: (1) examined impacts of caregiving for an individual with any form of dementia; (2) reported kinship distribution and/or stratified results by relationship status; and (3) examined caregiver burden as a separate variable. Studies were excluded if they: (1) described a condition without a dementia diagnosis; (2) included caregivers not stratified by kinship; or (3) examined a caregiver tool like a physical assistive device as a moderator. Results: A total of 15 studies met review criteria and were divided into quantitative (N = 14) and qualitative interview (N = 1) studies. Six found adult-children caregivers experienced more caregiver burden than spousal caregivers. Four studies found spouses experienced more burden. One study showed live-in adult-children reported the most burden, followed by spouses, and then non-live-in adult-children. Three studies found no difference. Lastly, one qualitative interview study documented profound differences by caregiver type. Conclusion: Results of this scoping review were mixed as to which group consistently felt more total burden. Future longitudinal investigations should further examine these associations, especially given an increasingly aging world.