Care Relationships Research Articles

Racial and ethnic disparities in the medical home for children born premature in the National Survey of Children's Health.

Children born premature are more likely to be from minoritized racial and ethnic groups and face chronic health and developmental problems. The medical home aims to comprehensively address health and social needs of all families. This study evaluates racial and ethnic disparities in the prevalence of a medical home amongst children born premature with comparison to children born full-term. A 2017-2018 National Survey of Children's Health dataset was used to calculate the medical home performance measure and subcomponents for children aged 0-17 born premature (n=5,633) or full-term (n=45,819). Chi square and logistic regression assessed magnitude and significance of variations by race and ethnicity and prematurity status. Prematurity prevalence differed by race and ethnicity (12.0% non-Hispanic Black [NHB], 12.8% Hispanic, 11.1% Multiracial/Other, 11.0% non-Hispanic White [NHW]). Minoritized children born premature had lower adjusted odds of receiving care in a medical home compared to NHW peers (e.g., NHB aOR 0.54 [95% CI: 0.38-0.76] and Hispanic aOR 0.56 [95% CI: 0.40-0.79]). Differences were greater in magnitude among children born premature compared to full-term peers (e.g., NHB premature aOR 0.54 [95% CI: 0.38-0.76] vs NHB full-term aOR 0.67 [95% CI: 0.58-0.78]), with similar results for "personal doctor/nurse" and "usual sick care." Racial and ethnic disparities exist in the medical home among children born premature, some more pronounced than full-term peers. To deliver equitable care for all children, efforts are needed to expand access to and improve the medical home, including reliable routine and sick care and stronger family-provider relationships.

Mentoring and its Significance in the Formation of Translators' Self-Efficacy Perceptions

Self-efficacy is defined as the confidence in one's talents and capacity to carry out the tasks assigned to them as well as to address and resolve the issues in their personal and professional lives. On the other hand, the word ‘mentor’ is assumed to have roots in Greek mythology. The term "mentoring" refers to a caring, sharing, and supportive relationship in which one person invests time, knowledge, and effort into promoting the development of another person's skills, abilities, and knowledge. In this study, the role of mentoring in the formation of translator candidates' self-efficacy perception is examined. This study employs a qualitative research methodology to ascertain the translator candidates' opinions on the mentoring practice in the development of their perception of self-efficacy in their workplaces. In the findings, translator candidates state that practical training is important for them to gain self-efficacy in the field of profession. The results indicate that participants’ professional experience is insufficient, they see themselves inadequate in the fields of application and they need mentor help in terms of methods to be used, self-confidence and guidance. They emphasize the value of mentoring in terms of obtaining personal and professional experience and share favourable views on this practice. The results show that the translation candidates' self-efficacy perspective is poor, but the mentoring practice may be helpful in gaining professional experience and developing a self-efficacy perception.

“What is my experience of what I am in relation to people who I have shared my life with for the last 34 years?”: exploring care relationships at the end of life in two life-sharing communities for people with a learning disability

Old age is still an under-researched stage in the lives of people with a learning disability. Providing support to people towards the end of their lives can be challenging for services and involves complex ethical decision-making processes. This study explores the experiences of social care staff in two life-sharing communities where adults with a learning disability and staff live together. Four main themes were identified, highlighting different dimensions of care. These included an emphasis on relational care, responsive care and collaborative care, and an acknowledgement of barriers to care and caring that allowed people to live and die within the communities.

Distributed agency: Care, human needs, and distributive struggles in Portugal

Austerity policies in Portugal unleashed a violent crisis of well-being and social reproduction which intensified the ‘triple burden’ placed upon women, making them the primary ‘shock absorbers’ of the crisis. This article addresses the critical role of working-class women’s various forms of paid and unpaid care work in responding to the material and immaterial needs of impoverished individuals and working-class households. It is shown that women’s care-based responses and distributive struggles sought to minimise the risks that the agency of those they cared for could be compromised in the present and the future. Expanding feminist approaches and broader contributions decentring agency from the ends of individual choice and freedom, the article argues that agency is a distributed capacity and potentiality produced by, and productive of, embedded interdependent caring practices, relationships and investments across space and time to define, fulfil and negotiate the inescapable existence of fundamental needs.

Multi-Level Ethical Considerations of Artificial Intelligence Health Monitoring for People Living with Parkinson’s Disease

Artificial intelligence (AI) has garnered tremendous attention in health care, and many hope that AI can enhance our health system’s ability to care for people with chronic and degenerative conditions, including Parkinson’s Disease (PD). This paper reports the themes and lessons derived from a qualitative study with people living with PD, family caregivers, and health care providers regarding the ethical dimensions of using AI to monitor, assess, and predict PD symptoms and progression. Thematic analysis identified ethical concerns at four intersecting levels: personal, interpersonal, professional/institutional, and societal levels. Reflecting on potential benefits of predictive algorithms that can continuously collect and process longitudinal data, participants expressed a desire for more timely, ongoing, and accurate information that could enhance management of day-to-day fluctuations and facilitate clinical and personal care as their disease progresses. Nonetheless, they voiced concerns about intersecting ethical questions around evolving illness identities, familial and professional care relationships, privacy, and data ownership/governance. The multi-layer analysis provides a helpful way to understand the ethics of using AI in monitoring and managing PD and other chronic/degenerative conditions.

Character Building Strategy In Early Children

Character building in early childhood requires a strategy. Without the right strategy, character building will be difficult to realize. This descriptive qualitative research with literature study examines the strategy of character building in early childhood. The data analysis technique uses analysis content by sorting out data according to the objectives and research problems. This paper produces the following things. First, the character development strategy in early childhood can be done in two ways, namely: (1) integration in daily activities, can be done by example, spontaneous activities, reprimand, environmental conditioning, and routine activities; (2) integration in programmed activities, which is carried out after the teacher first makes a plan for the values ​​that will be integrated in certain activities. Second, other strategies to develop character education include: applying learning methods that involve the active participation of students; create a conducive learning environment; provide explicit, systematic, and continuous character education; using teaching methods that take into account the uniqueness of each child; build supportive and caring relationships in the classroom and throughout the school; build positive behavior models; create opportunities for students to be active and meaningful, including in classroom and school life; and others

Clinical Action Research and Its Radically Reflexive Way: Dialogical Encounters to Face Current Organizational Needs

The paper presents a clinical and radically reflexive approach to action research, capable of nurturing caring relationships and renewed organizational wealth. These outcomes are achieved by creating space for research-oriented, in-the-moment, constitutive, and collective reflexivity. The paper discusses a framework for understanding a clinical and radically reflexive approach to action research. Second, the radically reflexive perspective is illustrated via a case study. Finally, the specific conditions and limits of such an approach are discussed. The radically reflexive perspective we present hopes to return researchers and participants to the center as authors of renewed organizational landscapes, thanks to their collective agency and their capacity to resist the taken-for-granted cultural and social structures whose “sickness” often has a toxic and unconscious impact on people lives. The paper, therefore, contributes to an understanding of radical reflexivity in action research and its implications for productive dialogue between other clinical, dialogical, and reflexive action-research approaches.

Food laborers as stewards of island biocultural diversity: reclaiming local knowledge, food sovereignty, and decolonization

Creating nutritious and ecologically regenerative food cultures depends on the local knowledge of food system laborers. Food producers in small island developing states center socioecological interdependence in their livelihoods and, as such, conserve biocultural diversity. Amid burgeoning health, economic, and climate crises brought on by colonialism, reclaiming food sovereignty requires a critical and embodied scientific approach, one that considers what traditional ecological knowledge is and who creates and sustains it. This study positions laborers as the primary sources of knowledge in island food systems; discusses declines in nutrition and agrobiodiversity as consequences of food labor loss; and proposes laborers' stewardship as essential to regenerating self-determination. Using critical quasi-ethnographic methods, this report synthesized primary data from narrative interviews in Guam (Guåhan, n = 13) and Puerto Rico (Borikén, n = 30), two former colonies of Spain and current territories of the United States, as specific examples of place-based knowledge production, interwoven into critical discussion of broader literature in this space. Our findings show that local food laborers combine intergenerational, ecosystem-specific knowledge with robust human value systems, negotiating across competing economic, cultural, and ecological needs to sustain livelihoods and regenerate biodiversity. As well-connected nodes in family and community networks, laborers serve as the scaffolding on which compassionate and relational care can thrive. Trade policies and the market dominance of transnational food corporations have severely reduced local food production in favor of food import dependence in islands, aggravating labor shortages and augmenting food insecurity. Through waves of out-migration and cash remittance, social care relationships have become monetized, reinforcing mass-produced food consumption and dietary diversity loss as islanders, both at home and in the diaspora, transition to an industrialized diet. The loss of local labor similarly poses threats to agrobiodiversity, with export-oriented agribusiness simplifying landscapes to streamline extraction. This study demonstrates that to reclaim food systems in Guam, Puerto Rico, and similar island settings, laborers must be valued as stewards of cultural and agrobiodiversity and can be integral to efforts that preserve cultures, agroecosystems, and health.

The telephone nursing dialogue process: an integrative review

BackgroundTelephone nursing involves triage, advice, and care management provided by a nurse over the telephone. The telephone nursing dialogue process has been used clinically in telephone nursing in Sweden for several years to structure the communication and ensure a safe assessment and advice. Studies are needed to determine whether there is sufficient scientific evidence to support the method.AimTo describe the scientific basis of the phases of the telephone nursing dialogue process.DesignThis was an integrative review.MethodsThe literature searches were performed in August 2023, in the PubMed, CINAHL, Cochrane Database of Systematic Reviews and SwePUB databases. Sixty-two articles were included. Data was sorted deductively according to the five phases of the telephone nursing dialogue process and categorized inductively to form subcategories describing the content of each phase.ResultAll five phases in the telephone nursing dialogue process were supported by a range of articles (n = 32–50): Opening (n = 32), Listening (n = 45), Analysing (n = 50), Motivating (n = 48), and Ending (n = 35). During the opening of the call, the nurse presents herself, welcomes the caller and establishes a caring relationship. In the listening phase, the nurse invites the caller to tell their story, listens actively and confirms understanding. During the analyzing phase, the nurse gathers, assesses, and verifies information. In the motivating phase, the nurse reaches a final assessment, informs the caller, gives advice and creates a mutual agreement and understanding while supporting the caller. Ultimately, the nurse ends the call after checking for mutual agreement and understanding, giving safety-net advice, deciding on whether to keep monitoring the caller and rounding off the call.ConclusionThe phases of the telephone nursing dialogue process as described in the scientific literature are well aligned with the theoretical descriptions of the telephone nursing dialogue process.

Interpersonal relationships in the nursing care of people with type 2 diabetes / Relação interpessoal no cuidado de enfermagem a pessoas com diabetes tipo 2

Objective: to analyze the effectiveness of the interpersonal relationship in nursing care and its relationship with general self- care and foot care in people with type 2 diabetes. Method: this cross-sectional, analytical study was conducted at a University Hospital with 150 people with type 2 diabetes who answered the Interpersonal Relationship in Nursing Care Questionnaire, a questionnaire on self-care activities with diabetes, and a questionnaire to assess adherence to feet self-care. Results: the results showed that the effectiveness of the interpersonal relationship in care ranged from moderate to high. The questionnaire scores were significant with nephropathy comorbidities, cerebrovascular accident, diet adherence, and receiving foot care guidance. Conclusion: interpersonal relationships in effective care can strengthen bonding, trust, and verbalization of feelings, improving diabetes education and adherence to self-care behaviors.

God, Owner, Master

Abstract Scholars ascribe the label “god” to many of the beings found in the world’s religions. However, the definitions of “god” commonly offered do not fit most of those entities. This article argues for a clarification of scientific/analytical language which specifies which supernatural beings are “gods” and which are something else. A likely category for most of the world’s putative “gods” is “owner-master,” a concept highly developed in Amazonian cultures and religions but present around the world, particularly in hunting and herding societies. Accordingly, the article explores “gods” in various religions that are not at all god-like by any familiar standard, presents the ontology of owner-master as a relationship of care and encompassment, and considers how employing the term “owner-master” instead of “god” in many if not most cases more accurately represents local beliefs, avoids the imposition of foreign/Christian assumptions, and contributes to an understanding of the history of the god-concept.

“I just try my best to make them happy”: the role of intra-familial relationships of care in the integration of reunited refugee families

Migration through managed routes such as spousal and work visas has been conceptualized as being a pragmatic choice driven by the needs of families rather than individuals. In contrast, studies of refugee integration post-migration have tended to analyse integration processes through the perspective of the individual rather than through a family lens. Drawing from data collection using a social connections mapping tool methodology with recently reunited refugee families supported by a third sector integration service in the UK, in this paper the author makes a valuable contribution to addressing this theoretical gap. The author explores the ambivalent ways in which family relationships, and the care that flows between family members, influence emotional, and practical aspects of refugees' integration. Empirically the inclusion of accounts from people occupying different positions within their families, including from children, adds depth to our understanding of integration from a refugee perspective. Conceptually, the paper argues that a focus on familial relationships of care re-positions refugees not as passive recipients of care, but active and agentive subjects who offer care to others. The paper ends with a call for integration to be understood in a family way that fully encompasses the opportunities and limitations offered by familial care.

Home care nurses lived experiences of caring relationships with older adults: A phenomenological study.

This paper describes registered nurses' lived experiences of caring relationships in the context of homecare provision for older adults living in Denmark. With the growing ageing population throughout Europe, more older adults will require complex care solutions within already overburdened care systems. This development places demands on the competencies and organisation of homecare nurses, as they become key players in healthcare systems. Fostering caring relationships in homecare is a rewarding and valuable process that enhances the holistic and humanising aspects of caring for older adults. For a caring relationship to be truly caring, we must understand not only the subjective experience of such a relationship but also how it is experienced in relation to and shared with others. This study aimed to describe the essential meaning of the phenomenon of caring relationships in homecare for older adults based on the lived experiences of homecare nurses. Registered nurses working in homecare for older adults were interviewed, and a phenomenological analysis was conducted according to the methodological principles of the reflective lifeworld research approach. The essential meaning of the phenomenon is described as creating an existential and embodied space in which each patient's world is the foundation of caring. The constituents are as follows: caring for the whole person, a sense of 'at-homeness' through trusting 'the other', experiencing continuity as caring and prioritising the time to care. Caring competence in homecare for older adults relies on a nurse's ability to intertwine physical and existential care needs and articulate them in their daily work. A focus on the phenomenon of caring relationships brings value to and adds an extra layer to the discussion on caring competence.

Weight Stigma Associated With Mental Health Concerns Among College Students

Weight stigma is widespread and exists across numerous domains including health care, educational institutions, workplaces, mass media, and interpersonal relationships. Weight stigma experienced during the college years may be particularly consequential because the college years are a period of increased vulnerability for the development of mental health concerns. The purpose of the present study was to examine how experiences of weight stigma relate to mental health concerns, including symptoms of eating disorders, anxiety, and depression, among college students. Prevalence of interpersonal and anticipated weight stigma was examined among 2,707 students participating in the 2018-2019 and 2019-2020 Healthy Minds Study and tested for differences in prevalence across student characteristics. Logistic regression was used to explore relationships between measures of weight stigma and student mental health. Analyses were conducted in 2021-2023. Interpersonal and anticipated weight stigma were reported by 12.3% and 15.3% of students, respectively. Experiences of interpersonal and anticipated weight stigma were generally lowest among cisgender male students, heterosexual students, those with the fewest financial concerns, and those who did not perceive themselves to be "overweight." Both interpersonal and anticipated weight stigma were associated with elevated odds of high weight concerns, past-month binge eating, past-month purging, high eating disorder risk, moderate/severe anxiety symptoms, and moderate/severe depressive symptoms. Findings implicate interpersonal and anticipated weight stigma as potential risk factors for a range of mental health concerns. Weight stigma is an under-recognized and under-funded public health problem.

Role of spiritual experiences in shaping the quality of intergenerational relationships - exploring views of older adults in South India

ABSTRACT Objectives To investigate how the older adults in India use spiritual thoughts and practices in their everyday lives to shape intergenerational care relationships and cope with challenges in such relationships. Methods Twenty-five qualitative interviews were conducted with older adults aged 55 to 85 years from two South Indian states from the diverse socio-economic backgrounds. Interview transcripts were analyzed using thematic analysis principles. Results The analysis shows that the spirituality of older adults shapes the quality of relationships with their kin. Participation in daily spiritual exercises such as prayer, chanting, self-reflection, and text reading help older adults develop personal resources such as a sense of peace, patience, acceptance, and forgiveness. This personal transformation helps older adults gain a stronger understanding of their kin and reduces pressure on the quality of intergenerational relationships in the family. They see spirituality as a vehicle, providing a structure for knowledge exchange, joint participation in religious events, and spiritual discussions with family members and others in the community. These experiences strengthen older persons’ emotional bonds with their families and help them develop larger social networks. Conclusion Spiritually inspired resources seem to help older adults to transform their disadvantaged position into a more rewarding and productive state.

An Investigation of Barriers and Enablers for Genetics in Speech-Language Pathology Explored Through a Case Study of Childhood Apraxia of Speech.

Advancements in genetic testing and analysis have allowed improved identification of the genetic basis of childhood apraxia of speech, a rare speech presentation. This study aimed to understand speech-language pathologists' (SLPs') consideration of incorporation of genetics in clinical practice using a theory-informed qualitative approach. Semistructured interviews were conducted with 12 pediatric SLPs using a behavior change theory (Theoretical Domains Framework [TDF]) within a case study describing a child with complex co-occurring features, including childhood apraxia of speech. Interviews focused on three stages of the patient journey (prereferral, referral, and postreferral). Interviews were analyzed to identify barriers and enablers to considering incorporation of genetics in current clinical practice. Barriers and enablers were grouped and mapped onto a contextually relevant TDF-coded analysis framework. Barriers were identified across several TDF domains, through all stages of the patient journey. Lack of confidence, relevance, and level of experience were most common prereferral, and connection to and awareness of genetics services and contextual factors were barriers in the referral stage. Perception of professional role, knowledge, and beliefs about effects on families were barriers postreferral. Associated enablers were also identified, including seeing value in genetic diagnosis, support from other health care professionals, supervision, and relationships with genetics services. Results of this qualitative study highlight barriers and enablers to incorporating genetics into speech-language pathology clinical practice. These findings will assist in the development of theory-informed implementation strategies to support SLPs into the future. https://doi.org/10.23641/asha.24112800.

Interventions co-designed by healthcare providers and clients for improving therapeutic relationships in maternal and child healthcare: a pilot study using human centered design in rural Tanzania

BackgroundResearch shows that poor provider–client interactions in maternity and child health (MCH) continue to affect health outcomes, service uptake, continuity of care, and trust in formal healthcare systems.ObjectiveThe study’s objective was to jointly create a prototype intervention package for enhancing nurse-client relationships using human centered design (HCD) approach.MethodsA five-step HCD methodology was used: (1) Community-driven discovery through qualitative descriptive research methods using 9 focus groups with nurses and clients and 12 key informant interviews with MCH administrators; (2) consultative ideation and co-creation meetings with 10 nurses, 10 clients, and 10 administrators to co-design a rough prototype model; (3) rough prototype validation through qualitative insight gathering using 6 FGDs with nurses and clients; (4) refinement and adaptation meetings with 14 nurses, 14 clients and 12 administrators; and (5) documentation and sharing of lessons learnt.ResultsAccording to the community-driven research, poor service, a lack of concern, poor communication, a bad attitude, and unhappiness at work are the nurse factors that affect the relationships between nurses and their patients. Non-compliance with procedures, unfavorable attitudes, poor communication, low education, poverty, and faith in conventional healers were among the client-related factors. Inadequate funding, bad management techniques, improper policy execution, and a lack of an independent institution for handling complaints are the health system factors that affect nurse-client relationships. In response, three ideation and co-creating meetings resulted in 24 interventions. Seven (7) of these were rated as more acceptable and feasible in the local context and formed a rough prototype. During validation, there were some disagreements on the feasibility of curriculum and resource-related interventions. Refinement meetings resulted in a final prototype including four interventions: (i) promotion of patient-centred care; (ii) awards and recognition for nurses; (iii) strengthening complaints mechanisms and (iv) disciplinary measures for abusive nurses and clients. The lessons learnt have been shared through publications and institutional research meetings.ConclusionsHCD approach provides a novel entry point for providers and clients to examine the problems and design interventions for strengthening their therapeutic relationships in MCH care. Researchers, practitioners, and policy developers are welcome to consider the emerging prototype as it was deemed acceptable and potentially feasible in rural African contexts.

Effects and safety of virtual reality-based mindfulness in patients with psychosis: a randomized controlled pilot study

Virtual reality (VR) technology can be a supporting tool to enhance mindfulness. Recently, many research using VR-based mindfulness (VBM) has been carried out in various psychiatric disorders but not in psychosis. We investigated safety and effects of virtual reality-based mindfulness (VBM) in patients with psychosis as a pilot study. Sixty-four patients were randomly assigned to VBM or to VR control. For VBM, education and meditation videos were provided. For VR control, 3-dimensional natural scenes were shown. Both programs consisted of 8 weekly sessions, each lasting about 30 min. Pre- and post-assessments were performed using the experiences questionnaire (EQ), psychotic symptom rating scales-delusion (PSYRATS-D), PSYRATS-auditory hallucinations (AH), motivation and pleasure scale-self rating (MAP-SR) and etc. The safety questionnaire was also surveyed after 1st and 8th session. Physiological measures such as skin conductance level (SCL), heart rate (HR) and RR interval, were collected during the VR interventions. Limited individuals participated in the safety questionnaire and physiological measures. All the results were presented in mean and standard deviation. We did not observe significant results in group x time interaction and main effects of group and time in the decentering and clinical scales. However, within group comparison showed that patients randomized to VBM showed increased decentering (p = 0.029) and decreased amount (p = 0.032) and duration of preoccupation (p = 0.016) in the PSYRATS-D. For the feelings and motivations about close caring relationships of the MAP-SR, we observed a significant group x time interaction (p = 0.027). The frequency of VR sickness was high but its severity was mild. There were significant differences only in HR over time in the VBM group (p = 0.01). These results suggest that VBM was not more effective in reducing decentering and psychiatric symptoms than VR control but its adversity was modest.

Mifepristone implementation in primary care: Clinician and staff insights from a pilot learning collaborative

ObjectivesThe ExPAND Mifepristone (ExPAND) learning collaborative aims to support primary care providers in overcoming logistical barriers to mifepristone provision. This qualitative study describes clinician and staff perspectives on the impact of ExPAND in two federally qualified health center networks (FQHCs). Study designResearchers conducted semi-structured qualitative interview with a purposive sample of clinicians, staff, and leadership from two Illinois FQHCs. We analyzed transcripts in batches using modified grounded theory to identify themes regarding the reception of ExPAND and barriers to and facilitators of mifepristone implementation. ResultsParticipants (n = 13) expressed strong support for providing mifepristone for miscarriage management at their clinics. Most also personally supported mifepristone for abortion care. Many participants felt that ExPAND reflected their clinics’ values, as it strengthens the primary care relationship, emphasizes patient-centered care, and addresses disparities in access. Barriers to implementation included fear that providing abortion care would jeopardize FQHC funding and logistical hurdles due to the coronavirus disease pandemic. ConclusionsParticipants felt that mifepristone provision in primary care was an important service, and that ExPAND helped achieve that goal. Future clinics participating in ExPAND would benefit from education about how FQHCs can provide mifepristone for abortion care while complying with federal funding restrictions. ImplicationsLearning collaboratives like ExPAND can prepare primary care clinics to provide mifepristone. Participants describe a clear benefit of mifepristone integration to their patients, and they report mifepristone integration aligns with clinic values.

Navigating the Impacts of Dementia: The Experience of Male Spousal Carers.

This article investigates the experience of male spousal carers for women living with dementia. While cultural discourses on care are highly gendered, social scientific research often addresses care relationships in gender-neutral terms. Setting out to address this matter, this qualitative research study incorporated semi-structured joint interviews with 10 couples in which a male spouse cared for a woman with dementia. The aim was to explore how couples negotiate relationships and care following a diagnosis of dementia. The focus of this paper is on the perspectives expressed in these joint interviews by the male carers. A thematic analysis was undertaken to establish the key content of the men's accounts. Three principal themes were identified: making sense of the condition; treating dementia as a problem to be solved; and engaging with professionals and support. The gendered basis of experience for male carers is explored within these themes, demonstrating how societal norms of masculinity intersect with caring roles. The paper concludes that a nuanced research approach to dementia care must continue to be developed, accounting for how gender shapes personal responses to the navigation of care relationships. Practitioners and policymakers must also consider how gendered experience shapes the identities and strategies of male carers.