Relationship Factors Research Articles

Factors associated with the attraction and retention of family and community medicine and nursing residents in rural settings: a qualitative study

BackgroundThe current shortage of primary care doctors and nurses is causing difficulties in replacement, and this shortage is expected to increase. This situation is more pronounced in rural environments than in urban ones. Family and community care specialty training is a key component of both the transition to clinical practice and the retention of new professionals. The aim of this study is to explore the attitudes and perceptions of internal medicine residents and internal nurse residents trained in a rural teaching unit on factors associated with recruitment and retention, including the role of the specialty training programme.MethodsA qualitative study was conducted. Purposive sampling was used, and thirteen residents from the central Catalonia teaching unit who were in their final year of training participated in semistructured interviews. The data were collected during 2022 and were subsequently analysed with thematic analysis. The study is reported using the COREQ checklist.ResultsSix themes emerged from data related to perceptions and attitudes about the factors associated with recruitment and retention: training programme, characteristics of the family and community specialty, concept of rural life, family and relational factors, economic and resource factors, and recruitment and job opportunities.ConclusionsFamily and community medicine and nursing residents trained in rural settings expressed satisfaction with the specialty programme and most features of primary care, but they experienced a wide range of uncertainties in deciding on their professional future in terms of living in rural areas, family support, financial support and recruitment. This study identifies individual and structural factors that could be of great use to retain doctors and nurses in rural areas.

Design of a Protocol for Detecting Victims of Aporophobia—Violence against the Poor

Aporophobia or aversion to the poor is a discriminatory phenomenon that causes a serious problem to the person with consequences related to damage, injury and physical and/or psychological sequelae. This paper describes the creation of the first aporophobia risk assessment tool, developed through a bibliometric review and expert opinion. This article presents the results obtained in the first phase of the design of this instrument for the detection of victimisation suffered by people in extreme poverty or at risk of poverty due to discrimination or aversion. Initially, a bibliometric review was carried out to identify the risk factors present in aporophobic situations and victimisations related to discrimination or rejection of people living in poverty. For the development of this aporophobic victimisation detection tool, the methodology of structured judgment by means of a panel of experts was used. After identifying the risk factors present in aporophobic victimisation, the panel of experts was formed with the participation of 26 academic professionals and those who work with these people in situations of social exclusion. Using expert methodology and the Delphi technique, they identified the most appropriate variables for inclusion in the detection instrument currently being designed, distinguishing between individual, social and relational factors and, finally, the most influential environmental factors for being victims of aporophobia. The results of the panel of experts highlight some of the following variables, for example, substance use and/or possible undiagnosed mental illness related to individual dimensions, in the case of variables related to one’s social level, among others, a lack of community ties and/or social participation and, finally, among the variables within a context called victim opportunity, the routine of staying overnight on the street or in enclosed spaces at street level by homeless people is highlighted. The experts who made up the panel highlighted the usefulness of this type of instrument for the professionals who attend to these people with different resources; the first version of this instrument is a protocol that evaluates all possible areas of the people of interest in order to detect these invisible situations.

Hand-blink reflex modulation: The role of primary emotions and attachment dimensions.

The hand-blink reflex (HBR) is a subcortical response elicited by the electrical stimulation of the median nerve. HBR magnitude is enhanced when the stimulated hand is close to the face and is modulated by high-level structures according to the perceived threat magnitude. Psychological factors may contribute to threat evaluation and possibly to HBR amplitude modulation. In this study, we assessed distinctively emotional and relational aspects of personality and evaluated their associations with the HBR response, or lack thereof, in healthy subjects. Seventy-one volunteers filled the Experiences in Close Relationships Scale, the Affective Neuroscience Personality Scales, and the State-Trait Anxiety Inventory Form Y questionnaires and underwent HBR recording. We found that the HBR could be evoked only in 50.7% of all subjects (responders). Non-responders subjects showed higher scores in the avoidance dimension (p = .005), and lower scores in the care dimension (p = .008), compared with responders. In responders, regression analysis showed a negative association of HBR amplitude (difference in near vs. far responses) with anger dimension and a positive association with state anxiety (R2 = 0.239). A positive association also emerged with HBR latency and fear dimension (R2 = 0.419). We conclude that primary emotional and relational factors may play an important role in the modulation of brainstem circuits mediating the HBR response. Our results may also contribute to the question about the absence of the HBR in about half of the subjects since high-level cognitive processes seem to play an important role in the differentiation between responder and non-responder.

Intimate Partner Violence in Transgender and Nonbinary Relationships: Actor-Partner Associations with Relationship Satisfaction, Dyadic Coping, and Partner Support.

Purpose: Transgender and nonbinary (TNB) adults experience disproportionate levels of intimate partner violence (IPV) compared with cisgender populations. Most research with TNB samples has focused on individual and demographic risk factors associated with IPV. Scarce research with TNB samples has evaluated how relational factors correlate with IPV victimization, which would be more consistent with dyadic models of IPV. The current study assessed associations between relational factors and psychological and physical victimization among TNB adults and their significant others. Methods: The sample included 112 dyads (total N = 224; mean [M] relationship length = 8.2 years; M age = 35) comprising a TNB adult and their significant other. Given our dyadic sample, we used actor-partner interdependence models to assess actor (i.e., intrapersonal) and partner (i.e., cross-partner) associations between relational factors (e.g., relationship satisfaction, dyadic coping, and partner social support) and IPV victimization among TNB individuals and their partners. Results: We identified numerous actor-partner effects across dyadic coping subscales and measures of partner support on TNB adult reports of IPV victimization. Actor effects were also significant for relationship satisfaction on both TNB and their partner's reports of IPV victimization. Conclusion: Results provide some of the first evidence of relational factors in association with IPV victimization among TNB adults and their intimate partners. These findings have clinical implications for identifying TNB individuals at risk for IPV in their relationships.

How school policies, strategies, and relational factors contribute to teacher victimization and school safety.

In this study, we examined how school policies and strategies (i.e., positive discipline, hardening strategies, and positive behavioral strategies) affect teacher relational factors and teacher reports of victimization and safety. Specifically, we examined the mediational roles of teacher support of student learning, maltreatment of students by teachers, and teachers' differential treatment of students in schools. Using a sample of 6643 pre-K-12th-grade teachers, path analysis results revealed that positive behavior strategies, hardening strategies, and positive discipline were indirectly associated with teacher victimization and sense of safety. Additionally, teachers' perceptions of other teachers maltreating students had the greatest contributions to their sense of safety and victimization by students. Positive discipline was directly and indirectly associated with teacher victimization and safety. Implications and directions for future studies are discussed.

The Norwegian version of the Copenhagen Psychosocial Questionnaire (COPSOQ III): Initial validation study using a national sample of registered nurses.

Employers are legally obligated to ensure the safety and health of employees, including the organizational and psychosocial working environment. The Copenhagen Psychosocial Questionnaire (COPSOQ III) covers multiple dimensions of the work environment. COPSOQ III has three parts: a) work environment b) conflicts and offensive behaviours and c) health and welfare. We translated all three parts into Norwegian and evaluated the statistical properties of the 28 work environment dimensions in part a), using a sample of registered nurses. The original English version was translated into Norwegian and back translated into English; the two versions were compared, and adjustments made. In total, 86 of 99 items from the translated version were included in a survey to which 8804 registered nurses responded. Item response theory models designed for ordinal manifest variables were used to evaluate construct validity and identify potential redundant items. A standard confirmatory factor analysis was performed to verify the latent dimensionality established in the original version, and a more exploratory factor analysis without restrictions is included to determine dependency between items and to identify separable dimensions. The measure of sampling adequacy shows that the data are well suited for factor analyses. The latent dimensionality in the original version is confirmed in the Norwegian translated version and the scale reliability is high for all dimensions except 'Demands for Hiding Emotions'. In this homogenous sample, eight of the 28 dimensions are found not to be separate dimensions as items covering these dimensions loaded onto the same factor. Moreover, little information is provided at the low and high ends of exposure for some dimensions in this sample. Of the 86 items included, 14 are found to be potential candidates for removal to obtain a shorter Norwegian version. The established Norwegian translation of COPSOQ III can be used in further research about working environment factors and health and wellbeing in Norway. The extended use of the instrument internationally enables comparative studies, which can increase the knowledge and understanding of similarities and differences between labour markets in different countries. This first validation study shows that the Norwegian version has strong statistical properties like the original, and can be used to assess work environment factors, including relational and emotional risk factors and resources available at the workplace.

Factors that enhance and limit youth empowerment, according to social educators

PurposeThis study aims to identify the contextual and relational factors that enhance and limit the empowerment of young people from the perspective of social education professionals.Design/methodology/approachBronfenbrenner's bioecological model made it possible to locate the narratives of the educators in the territory. These narratives include field diaries, i.e. hybrid narratives that include visual, written and spoken materials, and focus groups with 11 educators from different fields of action and related to youth empowerment projects.FindingsAccording to these educators, the most important factors for empowering young people are their immediate environment, and the issues that affect them most. For these factors to be empowering, young people need to be accompanied, with support based on connectedness, horizontality and the creation of safe spaces and learning experiences. Both the microsystem and the mesosystem form the immediate reality for their action. Aware of this, educators do the work of connecting with the exosystem.Practical implicationsIt is evident why communities are spaces with opportunities for youth empowerment, and the authors observe the need for more transversal and less welfare-based social and youth policies that generate empowerment instead of dependency.Social implicationsThis methodology evidenced the environmental structures of educators and the dissimilar levels to explore and understand the work of educators and the complex interrelationships, which play an important role in empowerment processes.Originality/valueThis research presents a new perspective that allows traditional qualitative reflection to be embedded in the bioecological model. All of this sheds light on relational ecosystems with young people and proposes youth policies, in this case, oriented towards empowerment.

Students’ Voices: A Qualitative Study on Contextual, Motivational, and Self-Regulatory Factors Underpinning Language Achievement

A lack of qualitative studies examining adolescent students’ voices regarding the contextual, relational, and self-regulatory factors that drive their language achievement has been observed. Therefore, the present study aimed to address this issue. Sixteen face-to-face semi-structured interviews were conducted with secondary school students in Greece to document and analyse their perceptions of the factors that influence language achievement. The study was guided by social-cognitive theory and models of self-regulated learning. Computer-assisted thematic analysis was performed using abductive open coding followed by refinement of codes. Three overarching global themes were identified in line with theoretical expectations, namely personal factors (motivation and self-regulatory strategies), relational factors (teachers’ practices, parental achievement expectations, peer influences), and structural factors (the educational system). Afterwards, an abductive thematic network analysis was conducted to explore and theorise about potential relationships between the emergent themes in the data. It was found that parental expectations for higher performance and the teachers’ behaviours were associated with students’ language achievement. Task-related characteristics and peers influenced students’ regulation of effort in learning. The students believed that they were not objectively graded and frequent summative assessments created test anxiety. The findings are discussed in light of existing empirical evidence and in terms of educational implications.

Clinical decision-making by fourth-year pharmacy students: Towards an understanding of their uncertainty

IntroductionClinical decision-making is a critical process underpinning much of a pharmacist's daily activities. While it is known that pharmacists hesitate to make decisions, it remains unclear whether pharmacy students experience similar hesitancy. The objective of this study was to better understand the phenomenon of decision-making in pharmacy students. MethodsThis study was designed from a social constructivist paradigm using qualitative case study methodology. The purpose was to investigate issues related to hesitancy in clinical decision-making by fourth-year pharmacy students. Data were collected through observation of students engaging in simulations, post-simulation interviews, and written reflections. Data analysis included multiple stages of coding, followed by pattern identification and discovery of interrelationships. ResultsThe primary themes relating to issues in pharmacy student clinical decision-making were relational factors, teaching and learning, degree of certainty, and personal characteristics. Relational factors include elements of relationships with patients and physicians as well as a sense of autonomy. The theme of teaching and learning included the sub-themes of formal education and learning in the real world. Degree of certainty included patient complexity, weighing risks and benefits, comfort in ambiguity, and a lack of information. Finally, personal characteristics associated with decision-making include personal experiences, leadership skills, and confidence. ConclusionsPharmacy education needs to focus on ensuring preceptors can help model comfort in ambiguity, that assessments include the reality of practice, and ensuring ample practice of decision-making in a simulated environment.

Let's talk about Sex!: AI and relational factors in the adoption of a chatbot conveying sexual and reproductive health information

This study addresses the adoption intention of ANA Chatbot, developed as part of the "Chup! Jom Sembang Seks" (translated as "Wait a minute! Let's Talk about Sex") campaign in Malaysia. ANA Chatbot provides youths with comprehensive sexual and reproductive health (SRH) information, empowering them in this vital aspect of their lives. Despite the emerging interest in chatbots conveying SRH information, research on the factors affecting the technology's adoption remains scarce. This paper proposes an adoption model straddling AI attributes (perceived intelligence and anthropomorphism), relational elements (perceived risk and trust), and the UTAUT's factors (performance expectancy, effort expectancy, social influence, and facilitating conditions). We empirically analyzed the model using Partial Least Squares Structural Equation Modelling based on 243 valid responses from participants engaging with ANA Chatbot. The results indicate that perceived intelligence positively relates to anthropomorphism, functional elements (performance expectancy and effort expectancy), trust, and SRH chatbot adoption intention. Anthropomorphism enhances performance expectancy but does not affect effort expectancy, trust, and SRH chatbot adoption intention. Performance expectancy, effort expectancy, facilitating conditions, and social influence are antecedents to ANA Chatbot adoption intention, thus affirming the UTAUT model. Contrary to predictions, perceived risk and trust do not influence the intention to adopt ANA Chatbot. Overall, this study contributes theoretical knowledge concerning AI-centric technology adoption models with a unique and novel focus on an SRH chatbot while providing pragmatic recommendations for promoting SRH chatbot adoption intention.

The impact of alcohol minimum unit pricing on people with experience of homelessness: Qualitative study.

Alcohol Minimum Unit Pricing (MUP) was introduced in Scotland in May 2018. Existing evidence suggests MUP can reduce alcohol consumption in the general population, but there is little research about its impact on vulnerable groups. This qualitative study explored experiences of MUP among people with experience of homelessness. We conducted qualitative semi-structured interviews with a purposive sample of 46 people with current or recent experience of homelessness who were current drinkers when MUP was introduced. Participants (30 men and 16 women) were aged 21 to 73 years. Interviews focused on views and experiences of MUP. Data were analysed using thematic analysis. People with experience of homelessness were aware of MUP but it was accorded low priority in their hierarchy of concerns. Reported impacts varied. Some participants reduced their drinking, or moved away from drinking strong white cider, in line with policy intentions. Others were unaffected because the cost of their preferred drink (usually wine, vodka or beer) did not change substantially. A minority reported increased involvement in begging. Wider personal, relational and social factors also played an important role in responses to MUP. This is the first qualitative study to provide a detailed exploration of the impact of MUP among people with experience of homelessness. Our findings suggest that MUP worked as intended for some people with experience of homelessness, while a minority reported negative consequences. Our findings are of international significance to policymakers, emphasising the need to consider the impact of population level health policies on marginalised groups and the wider contextual factors that affect responses to policies within these groups. It is important to invest further in secure housing and appropriate support services and to implement and evaluate harm reduction initiatives such as managed alcohol programmes.

The effects of app-related factors on app stickiness: The role of cognitive and emotional app relationship quality

Prior research tends to examine the effect of a narrow set of app-related factors on the construct of app relationship quality holistically. However, it is well-established that app relationship quality consists of cognitive and emotional aspects. To address these two issues, our study takes a more nuanced approach by examining a comprehensive set of app-related factors, including functional, offerings, experiential and relational factors, and their differential impacts on two distinct components of app relationship quality, namely cognitive app relationship quality (CARQ) and emotional app relationship quality (EARQ). It also examines the differential impact of CARQ and EARQ on app stickiness, which has long been considered as a managerial challenge. A ‘modular design approach’ was used to collect the data from an online UK consumer panel. 605 responses were analyzed using AMOS 24. The results indicated that functional and offering factors produced greater effects on CARQ than on EARQ. In contrast, experiential and relational factors were found to have stronger effects on EARQ than on CARQ. Further, CARQ was found to have a stronger effect on app stickiness compared to EARQ. The current study offers a detailed understanding of the factors that contribute to each component of app relationship quality and empirically demonstrates the differential effects of the cognitive and emotional aspects on app sickness. Such results are expected to help e-retailers to develop a strong digital presence, build future readiness for their brands, and design app-focused strategies using a consumer-centric approach.

Advancing school dropout early warning systems: the IAFREE relational model for identifying at-risk students.

There is a global effort to address the school dropout phenomenon. The urgency to act on it comes from the harmful evidence that school dropout has on societal and individual levels. Early Warning Systems (EWS) for school dropout at-risk student identification have been developed to anticipate and help schools have a better chance of acting on it. However, several studies point to a doubt that Correct EWS may come too late because they use only publicly available and general student and school information. We hypothesize that having a tool to assess more subjective and inter-relational factors would help anticipate where and when to act to prevent school dropout. This study aimed to develop a multidimensional measure for assessing relational factors for predicting school dropout (SD) risk in the Brazilian context. We performed several procedures, including (a) the specialized literature review, (b) the item development of the Relational Factors for the Risk of School Dropout Scale (IAFREE in Portuguese), (c) the content validity analysis, (d) a pilot study, and (e) the administration of the IAFREE to a large Brazilian sample of high school and middle school students (N = 15,924). After the theoretical steps, we found content validity for five relational dimensions for SD (Student-School, Student-School Professionals, Student-Family, Student-Community, and Student-Student) that include 12 facets of risk factors. At the empirical stage, confirmatory analysis corroborated the proposed theoretical model with 12 first-order risk factors and 5 s-order dimensions (36 items). Further, through the Item Response Theory analysis, we assessed the individual item parameters of the items, providing a brief measure without losing psychometric quality (IAFREE-12). We discuss how this model may fill gaps in Correct EWS models and how to advance it. The IAFREE is a good measure for scholars investigating the risk of SD. These results are important for implementing an early warning system for SD that looks into the complexity of the school dropout phenomenon.

Towards a Deeper Understanding of the Graduate Student and Faculty-Advisor Relationship

The relationship between graduate students and faculty members is a topic of great interest in higher education. While there is a wealth of theoretical and empirical research on the subject, discussions overlook the social dynamics that shape these relationships. This article seeks to fill this gap by presenting a conceptual framework that considers crucial components, including interpretations, reciprocal roles and responsibilities, relational factors, and effects, in analysing graduate student-faculty advisor relationships. By exploring these elements, the article offers a comprehensive framework that accounts for the nuances and limitations of these relationships and provides recommendations for best practices.

Exploring Patients’ Feeling of Being Coerced During Psychiatric Hospital Admission: A Qualitative Study

Various coercive measures can be used to legally compel a person suffering from psychiatric disorder to undergo treatment. However, evidence suggests that patients’ feeling of being coerced is not determined solely by their being submitted to formal coercion. This study aimed to explore voluntary and involuntary patients’ experience of coercion during psychiatric hospitalisation and to identify which factors, from their perspective, most affected it. We chose a qualitative design inspired by a hermeneutic-phenomenological approach. Participants were purposively selected from six psychiatric hospitals in Switzerland. Maximum variation sampling was used to ensure the inclusion of patients with different levels of perceived coercion and different admission statuses. In-depth, semi-structured interviews were co-conducted by a research psychologist and a service-user researcher. The transcribed data underwent thematic analysis. All twelve interviewed patients described the hospitalisation as an experience of loss of control over their life due to either external or internal pressures. During the process, perceptions of these pressures varied and sometimes overlapped, leading some patients to describe their admission as a form of simultaneous protection and violation. The balance between these two contradictory feelings was affected by a variety of contextual and relational factors, as well as by the meaningfulness of the experience and the patient’s subsequent satisfaction with it. Increasing policy-makers’ and clinicians’ awareness about the main factors influencing patients’ experience of loss of control is of paramount importance in order to develop skills and strategies able to address them, reinforcing patients’ empowerment, reducing their feeling of coercion and improving their well-being.

Primary Socialization Theory and American Indian Adolescents’ Intentions to Use Substances

Objective Intentions to use substances are a robust risk factor for future substance use. Primary Socialization Theory (PST), with its focus on relational factors, is well-suited to provide insight into American Indian adolescents’ intentions to use substances given the importance of relationships in American Indian communities. The goal of the present study was to examine the role of PST-related factors (i.e., parental monitoring, peer pressure, attitudes toward school) on likelihood of intending to use substances (i.e., alcohol, cigarettes, cannabis, other drugs) among American Indian adolescents. Methods American Indian participants (N = 8,950, 50.7% females) were recruited as a part of the Our Youth, Our Future survey, an ongoing surveillance of substance use among 7th–12th graders attending school on or near reservations. Results Parental monitoring was found to be associated with decreased likelihood of intending to use alcohol (aOR = 0.97, 95%CI [0.96, 0.99]), cigarettes (aOR = 0.96, 95%CI [0.94, 0.98]), cannabis (aOR = 0.95, 95%CI [0.94, 0.96]), and other drugs (aOR = 0.94, 95%CI [0.92, 0.96]). Peer pressure was associated with increased likelihood of intending to use alcohol (aOR = 1.68, 95%CI [1.59, 1.78]), cigarettes (aOR = 1.73, 95%CI [1.60, 1.86]), cannabis (aOR = 1.81, 95%CI [1.71, 1.92]), and other drugs (aOR = 1.40, 95%CI [1.26, 1.56]). More positive attitudes toward school were associated with decreased likelihood of intending to use alcohol (aOR = 0.93, 95%CI [0.91, 0.94]), cigarettes (aOR = 0.92, 95%CI [0.90, 0.94]), cannabis (aOR = 0.90, 95%CI [0.88, 0.91]), and other drugs (aOR = 0.96, 95%CI [0.93, 0.99]). Conclusions Results support incorporating social relationships into interventions aiming to prevent substance use initiation, including promoting positive parental monitoring, peer interactions, and school attitudes.

Drivers of sustainability: technological and relational factors influencing young consumers’ green buying intentions and green actual consumption behavior

Purpose This study aims to explore the factors that influence young green actual consumption behavior (GACB) by examining the relational and technological aspects that are dependent on technology and youth green buying intention (GBI). Additionally, this study endeavors to examine the moderating effect of adolescent green organizational citizenship behavior (OCB) on the association between young consumer GBI and young GACB. Design/methodology/approach The data for this study was collected from a sample of 282 university students located in the southern region of China. A time lag approach was used in this study, with data being gathered during two separate intervals spaced apart by duration of two months. Findings The findings of this study demonstrate that both technological and relational factors play a significant role in predicting young consumer GBI, which in turn predicts young GACB. Additionally, the results indicate that GBI is a crucial facilitator in the investigation. Furthermore, the results reveal that young green OCB serves as a significant moderator, enhancing the association between young consumer GBI and young consumer GACB. Originality/value The present study provides a novel perspective on the examination of how technology and relational factors impact young consumers, offering a deeper understanding of their intentions and actual consumption behavior. The findings of this study offer both theoretical and practical implications for academics, policymakers, senior managers and practitioners, providing valuable insights into the field.

Improving Efficiency and Effectiveness of Psychopharmacology Practice: What Must Be Done and What Shouldn't Be Done

As the science and the data underlying psychopharmacology treatments has become roughly equal to the science underlying medical illness, the level of quality care to achieve psychopharmacology clinical competence in practice has become more difficult for clinicians. This article aims to fill the gap in teaching psychopharmacology and raise the quality level by describing the core tasks for prescribing quality clinical psychopharmacology. We describe reasons why the quality is low, the most common clinical practices that are not being done, and most importantly, delineate the necessary elements for initial and ongoing follow-up visits. The goal is an integrated approach incorporating objective, subjective, and relational factors in psychopharmacology practice. [ Psychiatr Ann . 2023;53(7):294–297.]

Antenatal predictors of postnatal maternal attachment and competence after assisted conception-a prospective cohort study in South India.

The aim of this study is to examine the influence of antenatal factors suchas anxiety, depression, perceived stress, marital satisfaction, maternal antenatal attachment, and social support on postnatal maternal attachment and competence in women whoreceived assisted reproductive treatment. A prospective longitudinal cohort design was adopted with two groups-50 women who received assisted reproductive treatment and 50 women who had natural conception. Both the groups were assessed using self-report measures over three time points: T1, 7th month of pregnancy; T2, 2weeks postpartum; and T3, 3months postpartum.Afinal sample of44 women who had assisted conception and 47 women who had natural conception completed assessments across all three time points. Descriptive, bivariate analyses, and stepwise multiple linear regression analyseswerecarried out.In the assisted conception group, maternal antenatal attachment, depression, and marital satisfaction significantly predicted postnatal maternal-infant attachment. Perceived social support, depression, and duration of marriage significantly predicted postnatal maternal competence. In the naturally conceived group, maternal antenatal attachment and social support significantly predicted postnatal maternal-infant attachment;perceived stresssignificantly predicted postnatal maternal competence. Antenatal depressive symptoms and relational factors significantly influenced postnatal maternal attachment and competence highlighting the need for screening and targeted psychological interventions during pregnancy.

Understanding the co-construction of safety in the paediatric intensive care unit: A meta-ethnography of parents' experiences.

Children experiencing critical illness or injury may require admission to a paediatric intensive care unit (PICU) to receive life-sustaining or life-saving treatment. Studies have explored the experience of parents with a child in PICU but tend to focus on subgroups of children or specific healthcare systems. Therefore, we aimed to undertake a meta-ethnography to draw together the published research. A systematic search strategy was developed to identify qualitative studies, which had explored the experiences of parents with a critically ill child treated in a PICU. A meta-ethnography was undertaken following the structured steps of identifying the topic; undertaking a systematic search; reading the research; determining how the studies relate and translate into each other; and synthesising and expressing the results. We identified 2989 articles from our search and after a systematic series of exclusions, 15 papers remaining for inclusion. We explored the original parent voices (first order) and the interpretation of the study authors (second order) to identify three third-order concepts (our interpretation of the findings), which related to technical, relational and temporal factors. These factors influenced parents' experiences, providing both barriers and facilitators to how parents and caregivers experienced the time their child was in the PICU. The dynamic and co-constructed nature of safety provided an analytical overarching frame of reference. This synthesis demonstrates novel ways in which parents and caregivers can contribute to the vital role of ensuring a co-created safe healthcare environment for their child when receiving life-saving care within the PICU.