Responsibility For Care Research Articles

Rural dyadic collaboration in heart failure

Abstract Background Dyads (patient/care partner) living with heart failure have shared responsibility for patient care. While theoretical and empirical literature regarding heart failure dyadic care is evolving rapidly, sociocultural contexts are unique and affect relationship dynamics. Yet, dynamics and underlying structures of rural dyadic collaboration in heart failure remains unknown. Purpose The purpose of this secondary analysis was to describe the dynamics and underlying structures of dyadic collaboration in heart failure among rural dyads. Methods A semi-structured interview was used to evaluate the acceptability and usefulness of a 12-week problem-solving intervention in addressing dyadic heart failure-related issues and the development of effective management strategies in week 5. Initially, in the qualitative analysis, an adjusted matrix analysis for each rural dyad was used to identify these dyadic issues and strategies. Subsequently, dynamics and underlying structures of collaboration occurring within these dyads in addressing these issues and strategies were analyzed and thematic codes generated. Finally, a multiple correspondence analysis of dyadic collaboration was performed within these thematic codes and a Benzécri equation used to normalize results, helping to determine the underlying structure and variance explained by the model on a Cartesian graph. Results Twenty-eight living in the rural southeastern U.S. were included. Patients were mostly Caucasian (73.3%), female (60%), married (70%), and college-educated (43%), with an average age of 67.7 years. Care partners were primarily women (n = 50%), Caucasian (82.1%), married (89.3%), and high school-educated (46.4%), with an average age of 64.5 years. Using inductive coding, four codes emerged regarding dyadic relational and collaborative aspects between dyads: role awareness, requesting or receiving help, and improving dyadic communication. XLStat was used for a multiple correspondence analysis (Fig. 1), with checking and then normalizing results using the Benzécri equation on R (Fig.2). There were two gender-determined patterns within dyads. In dyads in which the patient was female and the care partner male, communication improved, requests for assistance were verbalized, and there was an improvement in collaborative orientation. However, partners were unaware of their collaborative role. In contrast, when the care partner was a woman and the patient a man, communication and requests for help were implied, and there was no improvement in collaborative orientation. In this situation, partners had full role awareness. Conclusion(s) These findings suggest gender constitutes a key element in communication, verbalization of needs, and collaborative orientation within rural dyads living with heart failure. The importance of gender roles may be useful in designing future dyadic interventions for rural individuals with heart failure and their informal care partners.

The association between overprotective parenting, parental perceptions of child vulnerability and growth and development of children with congenital heart disease

Abstract Background Congenital Heart Disease (CHD) is the most prevalent childhood birth defect, leading to health concerns in growth and development post-surgery. Parents mostly shoulder the responsibility for post-hospitalization care. The chronic nature of caring for a child with CHD induces significant stress, fostering perceptions of the child as highly vulnerable and resulting in overprotective behaviors. These behaviors could restrict the child's developmental opportunities, affecting overall growth and development. Purpose The purpose was to investigate the association between parental perceptions of child vulnerability, overprotective parenting, and growth and development of children with CHD. Methods The study employed a cross-sectional, comparative design. The total sample included 186 [93 CHD and 93 healthy controls] parents and their child aged 1-5 years. Data on parenting practices were gathered using the Child Vulnerability Scale and Parental Protection Scale. Child development was examined using the Ages and Stages Questionnaire-3. Growth and other clinical variables were gathered from the medical records. Data were analyzed using descriptive statistics, correlational and mediation analyses. Results CHD parents exhibited higher overprotective parenting (p=0.008) and perceived their child as more vulnerable (p<0.001) than healthy controls. In CHD, parental perception of child vulnerability was associated with worse gross motor (p=0.010) and problem-solving development (p=0.011), while among the controls, overprotective parenting was negatively associated with height (p=0.027) and weight (p=0.003). The path analyses revealed direct effects but no mediating or moderating effects of perceived child vulnerability and overprotectiveness on growth and development of the child with CHD. Higher parental perceptions of child vulnerability were associated with lower height (b1= -0.253, 95% CI: -0.397 to -0.087) and weight (a2= -0.098, 95% CI: -0.195 to 0.003). The higher the parental stress, the greater the perceptions of child vulnerability were (d1= 0.108, 95% CI: 0.058 to 0.160) and the worse communication skills of the child (cʹ2= -0.250, 95% CI: -0.422 to 0.091). Higher education level of the parents was associated with less perceptions of child vulnerability (d1= -1.562, 95% CI: -2.753 to -0.623), better fine motor development (c2=6.948, 95% CI: 4.137 to 9.552) and less overprotective parenting (f1=-1.874, 95% CI: -3.186 to -0.499). Higher perceptions of child vulnerability were associated with lower personal-social development (b1= -0.378, 95% CI: -0.803 to 0.046). Top of Form. Conclusion Healthcare providers should consider the diverse parental and child factors identified to initiate interventions aimed at parenting practices, realistic perceptions of their child’s condition, and reducing parental stress to optimize growth and development in children with CHD.

Summarising Quantitative Outcomes in Parental Mental Illness Research.

A quarter of all children grow up in a family where a parent experiences a mental illness (FaPMI). Research activity in this area is growing rapidly and it is now critical to better understand the extant knowledge in the field. This scoping review of quantitative FaPMI literature parallels a qualitative literature review and a series of Delphi studies with key stakeholders (e.g. lived experience and clinicians), that is part of a larger program of research to achieve consensus regarding the direction of FaPMI research; including making recommendations about outcomes and measures. The programme of research aims to promote and facilitate greater comparison and learning across studies and settings. Initially this scoping review summarises the quality and focus (e.g. country and sampling) of 50 quantitative studies from 2000 to 2023 and then classifies studies according to outcomes for parents, children and families. Six to eleven years were the most common child sample group and girls were slightly underrepresented (49/51) and parents were 88% mothers. Analogous parent and child outcomes were; mental illness/psychopathology, wellbeing, mental health literacy, trauma and stressful experiences, coping, help seeking/service need, within family relationships and supports, outside family relationships and supports. Additional outcomes for parents were; parenting skills, parent competence and parenting stress and for children in relation to their; cognitive functioning and caregiving. The family related outcomes were the within and outside family relationships and supports. Since 2000 there have been 136 different survey instruments employed with approximately 80% used in only one study. This suggests that the broader goals of the program of research are warranted as there is a need for less heterogeneity in measures used. Suggested areas for future research include a sampling focus on fathers, economic evaluations of programs, parent mental health literacy, trauma, genetics and integrating well-being concepts into research designs. Child research should focus on mental health literacy, the level and impact of caring responsibilities, assessing past trauma and the roles of close family and external supports.

Overeducation in the EU: Gender and regional dimension

The paper investigates factors associated with the overeducation risk in the EU, with a specific focus on gender and regional variables. The study tests Frank's theory of differential overqualification, which suggests that women are more likely to be overeducated than men, especially in small local labour markets. Although women's overeducation rates usually exceed those of men, the study's results show limited validity of Frank's model due to a nuanced relationship by which gender is linked to overeducation. They suggest that gender differentiates the overeducation risk in combination with care responsibilities, whilst easier access to childcare facilities is associated with a lower risk of overeducation among women in households with young children. Moreover, migrant women are found to be more at risk of overeducation, compared to both migrant men and non-migrants. Contrary to Frank's theory, the degree of urbanisation is found irrelevant for overeducation. Furthermore, the study shows the evidence of growing incidence of overeducation in the EU in 2011–2018.

Quality of Life of the Family Caregivers of Children with the Cerebral Palsy and its Determinants: A Study from India

abstract Introduction: The responsibility of caring for a child with cerebral palsy (CP) at home can be challenging to the caregiver’s and children’s quality of life (QoL). This study was designed to assess the QoL and its determinants amongst family caregivers of children with CP. Materials and Methods: A study was conducted in a Tertiary Care Hospital in Yavatmal, Maharashtra, from March to May 2021, involving 126 participants selected through systematic random sampling. QoL was assessed using the World Health Organization QoL Brief Version scale. The data were analyzed using the statistical software, Epi Info Version 7.2. Results: The mean ± standard deviation of the overall QoL of family caregivers of CP children was 66.7 ± 1.44. The study found a significant association of QoL with the age of the caregiver, residence, education, socio-economic class, total number of children, health insurance and accessibility of services. Conclusion: More than half of the study participants exhibited low overall, physical, social and environmental QoL, influenced by various determinants.

Caregivers and Clinic Providers View Soft Casts for Pediatric Hand Burns as Acceptable and Feasible: A Mixed Methods Survey.

Soft casts have been introduced as an efficacious strategy to manage hand burns that simplifies wound care for families. We hypothesized that the outpatient use of soft casts in pediatric hand burns would be viewed as acceptable by patient caregivers and providers, logistically feasible, and result in satisfactory clinical outcomes. A review was performed of pediatric clinic patients managed with soft casts since implementation (9/2022 - 9/2023). Patient caregivers and providers were surveyed. The primary outcome was acceptability of soft casts as a management strategy (questions targeted care burden, overall satisfaction, comfort, pragmatism, and healing concerns). Secondary outcome was feasibility (effect on clinic workflow, efficiency). Survey responses were collected from 70% of caregivers and 95% of providers. Responses overwhelmingly favored soft cast acceptability. Among providers, 84% agreed that "the soft cast method simplified the hand burn care experience in our clinic" and 100% indicated "the soft cast was easy for parents to manage at home" (Likert range 7-10, mode 10). Thirty-three English-speaking patients with partial and full thickness hand burns were managed with soft casts. A mean of 1.8 reapplications (mode 1, range 1-5) were required with median healing time of 13 days. No infections were attributed to the use of soft casting, and only one patient ultimately required grafting. Overall, the introduction of soft casts as a management strategy for pediatric hand burns was acceptable and feasible. The clinical outcomes assessed suggest soft casts are associated with good wound healing with minimal wound care responsibilities for patient and family.

Tingkat Kepuasan Pasien Terhadap Pelayanan Kefarmasian di Apotek Parviz Kota Palangka Raya

Pharmaceutical services involve direct and responsible care for patients related to pharmaceutical preparations, aiming to achieve definite results that enhance patients' quality of life. One indicator of healthcare quality is measuring user satisfaction. Apotek Parviz provides pharmaceutical services to the surrounding community, offering dual healthcare services—doctor diagnosis and pharmaceutical care—thus improving the health and quality of life for residents of Palangka Raya City. This study aims to determine patient satisfaction levels with pharmaceutical services at Apotek Parviz in Palangka Raya City, based on five dimensions: tangibility, reliability, responsiveness, assurance, and empathy. This descriptive study used a questionnaire with a sample size of 86 respondents selected through accidental sampling. The research results showed that the satisfaction percentages for each dimension were: 87.43% for tangibility, 81.16% for reliability, 83.25% for responsiveness, 84.49% for assurance, and 83.25% for empathy. The overall average satisfaction across the five dimensions, according to the Likert scale, was 84.18%, indicating that patients are very satisfied with the pharmaceutical services at Apotek Parviz in Palangka Raya City.

InCHARGE: Co-creating, implementing and evaluating interventions to utilize nurses' competence and achieve person-centred fundamental care-A research protocol describing an action research approach.

This research protocol presents an action research project with the aim to demonstrate the value of person-centred fundamental care to nurses and nurse managers in surgical care units to encourage a far-reaching change in this direction. The objectives are to describe this process and to evaluate the effects on missed nursing care and person-centred fundamental care. In a novel collaboration between nursing science and medical humanities the action research design will be used to interact with nursing staff and leaders in three surgical care units and design interventions with the purpose to affect the direction of nursing. Initially, the care units will be presented with interactive workshops including evidence-based education on person-centered fundamental care, person-centredness, nurse role responsibility and leadership. This will be followed by cocreation of interventions to stimulate person-centered fundamental care. The Fundamentals of Care framework will be used as the overarching theoretical framework. Data on missed nursing care, person-centred climate and person-centered fundamental care will be collected repeatedly from patient- and nursing stakeholders through interviews and validated questionnaires. Additionally, data from written reflections following clinical observations and focus group interviews will be included. The duration of the study will be approximately five years from ethical approval. It has been previously reported that the current working environments of registered nurses are forcing them to ration their caring responsibilities, leading to a lack of fulfillment of patients' fundamental care needs, with possible severe consequences for patients. The action research design helps researchers gain an understanding of the contextual factors important for forthcoming interventions, enabling reflective processes and cocreation of interventions with stakeholders. This may lead to feasible interventions and strengthen nursing leadership in the involved units.

Patient satisfaction and value based purchasing in hospitals, Odisha, India.

To examine how a general inpatient satisfaction survey functions as a hospital performance measure. We conducted a mixed-methods pilot study of the Hospital Consumer Assessment of Health Providers and Systems survey in Odisha, India. We divided the study into three steps: cognitive testing of the survey, item testing with exploratory factor analysis and content validity indexing. Cognitive testing involved 50 participants discussing their interpretation of survey items. The survey was then administered to 507 inpatients across five public hospitals in Odisha, followed by exploratory factor analysis. Finally, we interviewed 15 individuals to evaluate the content validity of the survey items. Cognitive testing revealed that six out of 18 survey questions were not consistently understood within the Odisha inpatient setting, highlighting issues around responsibilities for care. Exploratory factor analysis identified a six-factor structure explaining 66.7% of the variance. Regression models showed that interpersonal care from doctors and nurses had the strongest association with overall satisfaction. An assessment of differential item functioning revealed that patients with a socially marginalized caste reported higher disrespectful care, though this did not translate into differences in reported satisfaction. Content validity indexing suggested that discordance between experiences of disrespectful care and satisfaction ratings might be due to low patient expectations. Using satisfaction ratings without nuanced approaches in value-based purchasing programmes may mask poor-quality interpersonal services, particularly for historically marginalized patients. Surveys should be designed to accurately capture true levels of dissatisfaction, ensuring that patient concerns are not hidden.

Informal carers of people with dementia

Social work is constantly evolving and theoretically enriched to meet people's needs in new social situations. Informal carers must balance care with other demands while facing a range of obstacles. Despite research on what informal carers require, a specific typology of their needs has yet to be formulated. The research question considered is "What are the (groups of) needs of individuals who provide informal care for people with dementia?". As part of the research project Long-term Care for People with Dementia in Social Work Theory and Practice, we interviewed a non-random convenience sample of 20 relatives acting as informal carers of people with dementia. The results are presented as a typology of needs on the micro level (personal health—emotional health, physical health), mezzo level (care tasks—support from formal care, planning—information, counselling) and macro level (legislation, system changes). Most obstacles and needs identified were on the micro and mezzo levels. More than on the system (macro level), informal carers see the responsibility and burden of care as lying on the individual (micro level) and institutions and the community (mezzo level).

Nurses' knowledge of medical device-related pressure injuries and risk factors: A descriptive study at a large medical centre from Palestine.

Nurses' knowledge of pressure injuries causes and risk factors helps to prevent their occurrences and protect the patient. To assess the level of knowledge of medical device-related pressure injuries and to identify risk factors that affect the knowledge. A cross-sectional design was used in this study considering a convenience sample from critical care nurses. The nurses were invited to complete the Medical Device-Related Pressure Injuries Knowledge Questionnaire. About 71 nurses participated in the study. The mean score of MDRPI_KQ was 23.28 ± 4.14 out of 36. Mann-Whitney Test did not show statistically significant relationships between the MDRPI_KQ mean score and related variables (p > 0.05). The regression results indicated that the three predictors explained 46.4% of the variance (R2 = 0.215, F(3, 6.114) = 3.75, p = 0.001). It was found that the Frequency of encountering a patient with MDRPIs significantly predicted MDRPI_KQ score, job position, and assuming the care responsibility for MDRPIs in the department. Poor knowledge of pressure injuries can negatively affect patient care so training programs and policies should be developed based on the level of knowledge and practices of the staff to be more effective.

Psychometric Analysis of the Spanish-Language Version of the Instrument for the Evaluation of Handovers in Critically Ill Patients in Urgent and Emergency Care Settings.

Background/Objectives: Patient handover is the process by which the responsibility for care is transferred from one health care professional to another. Given the lack of validated scales to assess the handover of critically ill patients, our aim was to evaluate the reliability and validity of the Instrumento de Evaluación de la Transferencia de Enfermos Críticos (IETEC) (English: Instrument for the Evaluation of Handovers in Critically Ill Patients). Methods: Psychometric analysis of the reliability and validity (construct, convergent, and discriminant) of the IETEC. This single-center study included professionals (nurses, physicians, and emergency medical technicians) involved in the care of the critically ill in urgent care and emergency situations. Results: We evaluated 147 handovers of critically ill patients. The KR-20 score was 0.87, indicting good internal consistency. Of the 147 handovers, 117 (79.6%) were classified as unsafe and 30 (20.4%) as safe. The model fit showed an acceptable construct validity (24 items and four factors: Identification, Communication, Quality, and Family). The Communication domain had the strongest correlation with the total scale (r = 0.876) while Family had the weakest (r = 0.706). The Communication and Family domains were closely correlated (r = 0.599). The IETEC reliably differentiated between safe and unsafe handovers, with a mean (SD) score of 26.3 (1.2) versus 19.0 (4.8), respectively. No significant differences (p = 0.521) in mean IETEC scores were observed between the physicians and nurses. Conclusions: These results show that the IETEC presents adequate psychometric properties and is, therefore, a valid, reliable tool to evaluate handovers in critically ill patients in urgent care and emergency settings.

Tanggung Jawab Pemerintah Daerah Terhadap Anak Terlantar

Introduction: Legal issues in this study include, What is the form of responsibility of local governments towards abandoned children and the legal consequences that arise if local governments do not carry out responsibilities towards abandoned children.Purposes of the Research: This paper aims to describe the legal consequences if local governments do not carry out their responsibilities towards abandoned children.Methods of the Research: The type of research used is normative research, where research is carried out by collecting legal materials obtained from literature studies. The problem approach used is a statutory approach and a conceptual approach. Legal materials are analyzed qualitatively to achieve clarity on the issues to be discussed.Results of the Research: The results of this study show that Legal consequences arising if the local government does not carry out its responsibilities towards abandoned children based on Perma No. 2/2019 Article 3 that local governments can be sued on the grounds of committing illegal acts because negligence towards the responsibility of caring for abandoned children has been regulated in laws and regulations, besides that it is also contrary to the principles of good governance

Barriers to conservative kidney management for Japanese healthcare professionals involved in the treatment of end-stage renal disease.

Conservative kidney management (CKM) is a treatment alternative for patients with end-stage kidney disease (ESKD). Despite the increasing population of elderly dialysis patients in Japan, CKM is not as readily available compared with that in North America and Europe. Therefore, it is important to clarify the barriers to CKM in Japan. We interviewed 11 experts to explore their beliefs and issues regarding CKM. Based on the interviews, we categorized the CKM barriers into eight categories and created a 24-item questionnaire. A questionnaire survey was conducted among 112 medical professionals involved in ESKD management. To investigate the types of barriers, we conducted an exploratory factor analysis using the questionnaire results. Responses were obtained from 53 (47.3%) of 112 subjects (18 doctors, 29 nurses, 6 clinical engineers), with 94.3% considering CKM as a treatment option for ESKD. Factor analysis categorized the questions into the following: (1) Lack of palliative care experience, (2) Ethics and responsibility, (3) Patient's problem, (4) Dialog with patients and families, and (5) Lack of support system. Regarding barriers to CKM, "lack of experience in palliative care" and "lack of support system" scored the highest, and "ethics and responsibility" scored the lowest. Barriers to CKM may be classified into five factors, with "lack of experience in palliative care" and "lack of support system" being the important barriers to overcome. Additionally, most healthcare professionals consider CKM as the fourth option for renal replacement therapy.

Factors Militating Against Family Caregivers on Cancer Patients Health in Selected Teaching Hospitals in Ogbomoso Area, Oyo State, Nigeria

Introduction: Cancer is gradually becoming a chronic disease, which brings important needs and difficulties to both patients and caregivers. Objective: The study examines factors militating against family caregivers on cancer patients health in selected teaching hospitals in Ogbomoso area, Oyo State, Nigeria. Materials and Methods: Both questionnaire and interviewed techniques were used for data collection from 120 respondents chosen through stratified sampling techniques. In analyzing the data, logit regression model was employed in addition to conventional descriptive statistics such as tables, frequency distribution and percentages. Results: The result of regression model has coefficient of five (5) variables that were statistically significant at 1%, and 5% probability levels. The results revealed that variables with positive signs indicate that the chances of factors militating against family caregivers on cancer patients health increase with education (2.15), social support (2.76), communication, (2.67), and financial support (4.92) whereas, variables with negative sign indicates that the chances of factor militating against family caregivers on cancer patients health decreases with socio-cultural beliefs (-2.64). Conclusion: It identified that factors militating against family caregivers on cancer patients health strongly influenced by gender, age, education, marital status and religion. Hence, recommendation was made that regular systemic assessment of effects of caregiving and shared care responsibility among family members to provide a respite for a particular caregiver.

The Hidden Epidemic: Burnout and Mental Health Amongst Medical Students

In the noble pursuit of healing others,medical students often find themselvesgrappling with their own silent battles:burnout and mental health issues. Despitethe aura of prestige surrounding themedical profession, the harsh reality is thatthose training to become doctors facetremendous pressure, leading to alarmingrates of burnout and mental healthchallenges. In the UK, this issue has beengaining significant attention, shedding lighton the need for systemic changes to supportthe well-being of future physicians.The Burnout Epidemic:According to a recent study published in theBritish Medical Journal (BMJ), burnoutamongst medical students in the UK isalarmingly high; with nearly two-thirdsexperiencing symptoms at some pointduring their training. Burnout,characterised by emotional exhaustion,depersonalisation, and reduced personalaccomplishment, not only affects themental health of medical students but alsocompromises patient care and contributesto high dropout rates within the professionThe Perils of Perfectionism:One contributing factor to the prevalence ofburnout among medical students is theculture of perfectionism ingrained inmedical education. From the rigorousacademic demands to the relentless pursuitof clinical excellence, students often findthemselves striving for unattainablestandards, leading to chronic stress andpsychological strain.Research conducted by the Royal Collegeof Psychiatrists indicates that the fear offailure and the pressure to excelacademically contribute significantly to themental health challenges faced by medicalstudents. The stigma surrounding mentalhealth within the medical communityfurther exacerbates the problem, leadingmany students to suffer in silence ratherthan seeking the support they desperatelyneed.The Impact on Mental Health:Beyond burnout, mental health issues suchas anxiety, depression, and suicidal ideationare prevalent among medical students. Asurvey conducted by the Medical SchoolsCouncil revealed that nearly one in fivemedical students in the UK experiencedepression or anxiety severe enough torequire treatment.The demanding nature of medical training,coupled with long hours, sleep deprivation,and exposure to distressing clinicalscenarios, takes a toll on the psychologicalwell-being of students. Without adequatesupport systems in place, many studentsfind themselves overwhelmed, strugglingto cope with the demands of their studieswhile battling their inner demons Addressing the Crisis:Recognising the urgent need to addressburnout and mental health issues amongmedical students, universities andhealthcare institutions are beginning toimplement proactive measures to supportstudent well-being. From mental healthcounseling services to peer supportnetworks and wellness initiatives, effortsare underway to create a more nurturingand supportive learning environment forfuture physicians.Additionally, initiatives such as the#MentalMovement within the medicalcommunity are working to reduce thestigma surrounding mental health andencourage open conversations about thechallenges faced by medical students andprofessionals alike. By fostering a culture ofcompassion and understanding, theseinitiatives aim to break down barriers toseeking help and promote a healthierapproach to medical education and practice.The prevalence of burnout and mentalhealth issues among medical students in theUK is a pressing concern that demandsimmediate attention. As future guardians ofpublic health, it is imperative that weprioritize the well-being of those entrustedwith the responsibility of caring for others.By addressing the root causes of burnout,challenging the culture of perfectionism,and fostering a supportive learningenvironment, we can create a brighter andhealthier future for medical students andthe patients they serve.Now we want YOUR opinions on this.burnout and mental health are subjectswhich are hard to talk about as medicalstudent so we would love to hear about yourthoughts and opinions. If you have 5 minutesto fill in the google form below it would begreatly appreciated.

A life of piety: aging and dying in a rural Sinhala Buddhist village

ABSTRACT This paper explores the relationship between aging, care, and death in a rural village in Sri Lanka from an anthropological perspective. It examines how the Buddhist concept of merit acts as a link between these elements. Through a 14-month ethnographic study, I observed how elders, and their younger caregivers engage in a reciprocal exchange of care and merit. Elders in the village engage in various pious activities to accumulate merit, which in turn leads to the care they receive from others as a meritorious deed. The responsibility of caring for the elderly primarily falls on women, who seek to accumulate more merit to alleviate their suffering. Both elders and caregivers believe that accumulating merit reduces suffering, leads to a good death, and ensures a good rebirth. These beliefs are reinforced and evaluated by Buddhist clergy in funeral sermons. This article illustrates how Buddhist ideas of accumulating merit give rise to an emerging ‘economy of merit,’ wherein elders are cared for by their families and communities. This finding has significant implications for understanding and addressing the challenges of an aging population in Sri Lanka.

Paid Leave Mandates and Care for Older Parents.

Family caregivers play a critical role in the American long-term care system. However, care responsibilities are known to potentially conflict with paid work, as about half of family caregivers are employed. The federal Family and Medical Leave Act passed by the US Congress in 1993 provides a nonuniversal, unpaid work benefit. In response, several states and localities have adopted the Paid Family Leave policy (PFL) and Paid Sick Leave policy (PSL) over the last two decades. Our objective is to examine the effect of these policies on the probability of personal care provision to older parents. This study used longitudinal data from the Health and Retirement Study (1998-2020). Difference-in-differences regression models were estimated to examine associations between state- and local-level PFL and PSL mandates and personal care provision to older parents. We analyzed heterogeneous effects by the type of paid leave exposure (provision of job protection with PFL and availability of both PSL and PFL [with or without job protection] concurrently). We also examined results for different population subgroups. PSL implementation was associated with a four- to five-percentage point increase in the probability of personal care provision. These effects were mainly attributable to respondents in states/periods when PSL and PFL were concurrently offered. The strongest effects were found among adult children who were employed at baseline, women, younger, unpartnered, and college educated. PFL implementation by itself was not associated with care provision to parents except when the policy also offered job protection. Paid leave policies have heterogeneous impacts on personal care provision, potentially owing to differences in program features, variation in caregiving needs, and respondent characteristics. Overall, the results indicate that offering paid sick leave and paid family leave, when combined with job protection, could support potential family caregivers.

Caregivers' experiences in helping individuals with severe and enduring mental health challenges integrate into the community: A qualitative descriptive study in Singapore.

Individuals with severe and enduring mental health challenges continued to consume mental health services for an average of 13 years as they needed multiple acute psychiatric admissions due to the challenges they experienced in their everyday activities. As caregivers of individuals with severe and enduring mental health challenges, they often bear the brunt of caregiving through their assistance with activities of daily living (ADL), providing emotional support and ensuring medication compliance for their loved ones. When caring for their loved ones, caregivers often reported psychological stress, social isolation and emotional exhaustion due to stressors such as uncertainty of the future, the lack of support from professional services and the isolation from their own social network and support mechanism. Insights from this study revealed that caregivers for individuals with severe and enduring mental health challenges went through a lonely and exhausting journey fraught with psychological, physical, social and financial challenges, echoing the caregiving needs and the prevalence of the caregiver burden. Insights shared by the caregivers demonstrated the need for a centralised point of contact to navigate Singapore's fragmented mental healthcare sector. Peer-support groups should be further promoted because they offer the benefits of information exchange, mutual support and a sense of empowerment and hopefulness, which may help ease the caregiver burden. Life skills training, such as teaching how to communicate empathetically with family members, resolve conflicts using open communication, maintain a structured daily routine and solve pragmatic problems in daily life, is more critical for individuals with severe and enduring mental health challenges. This will help them learn how to manage their well-being, live independently, and stabilise their conditions. Lastly, public awareness campaigns should honour caregivers by highlighting their strength, resilience, and dedication. The state can provide financial assistance in the form of tax relief for their income per annum or caregiver allowance to alleviate the financial stress that caregivers are facing. Introduction The progressive deinstitutionalisation of mental healthcare has increasingly shifted care responsibilities from healthcare professionals to family caregivers for individuals with severe mental illness. Caregivers must balance many obligations, which often compromise their overall health and well-being, while helping their loved ones integrate into the community. Aim To identify and understand caregivers' needs and challenges as they help individuals with severe and enduring mental health challenges integrate into the community. Methods This study used a descriptive qualitative approach to explore the experiences and challenges of caregivers for individuals with severe and enduring mental health challenges when integrating back into the community. A semi-structured guide was used during the video-conferencing interviews conducted between December 2021 and November 2022. This study was reported according to the 32-item Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Findings Fourteen caregivers were individually interviewed by the primary author. Most caregivers were female, with an average of 15 years of experience caring for their loved ones. Using Braun and Clark's six-phase thematic framework, we inductively generate the themes and subthemes from the data. The two themes were (i) challenges (whose subthemes included personal challenges in caregiving, the lack of awareness, and stigma and employment) and (ii) support (whose subthemes included the importance of socialisation for individuals with mental health conditions, existing avenues of support and potential areas for support). Discussion Our findings informed the contemporary needs of caregivers caring for individuals with severe and enduring mental health challenges integrating into the community. Like the global challenges for people with mental health issues, psychosocial support and other supplementary support are still common themes in mental health settings. The findings further specifically highlighted the importance of accessible points of contact as resources and employment-enabling and sustaining initiatives to help manage caregivers' emotional and system challenges, which addresses the gaps identified in the findings. Caregivers' peer-support groups, life skills training and public mental health awareness are also necessitated by the caregivers' voices. Implications for Practice Priority areas include having a centralised point of contact within the community for caregivers. Government or not-for-profit organisations can take the lead by initiating employment-enabling initiatives for individuals with severe and enduring mental health challenges and their caregivers.

Assessing Nursing Students' Knowledge of Sleeve Gastrectomy Effects

This descriptive study assesses the knowledge of gastric sleeve procedures among 55 fourth-year nursing students at the College of Nursing in 2024. Recognizing the crucial role of nurses in managing obesity through surgical interventions, this research aims to identify educational gaps within the nursing curriculum. The students were evaluated using a structured questionnaire focused on their understanding of the procedure's link to obesity factors. Results indicated that the majority of students had a satisfactory knowledge level, with significant mean scores; however, about 25% of the responses—mainly those detailing surgical specifics—showed insufficient knowledge. These findings highlight the need for enhanced educational focus on bariatric surgery in nursing programs to better prepare students for clinical responsibilities in patient care and surgical support. Highlights: Knowledge Level: Majority of students showed good understanding of gastric sleeve procedures. Knowledge Gaps: About 25% lacked detailed surgical knowledge. Educational Implications: Results suggest the need for enhanced bariatric surgery content in nursing curricula. Keywords: Gastrectomy, Obesity, Nursing Education, Bariatric, Knowledge