Agents of prevention: A qualitative exploration of Black fathers' strategies to safeguard youth from violence.

To explore the lived experiences of perimenopause/menopause among Ghanaian women. Qualitative study using in-depth, semi-structured interviews. Community and hospital based settings across Ghana, where women's lives are largely shaped by informal trade, caregiving, and gendered work roles. Perimenopausal, menopausal, and post-menopausal women aged between 18 and 99 years that provided informed consent. A qualitative methodology was used based on a topics guide that was developed following an evidence synthesis, patient-public involvement and expert opinions. Interviews explored experiences linked to symptoms, healthcare access, coping strategies, work-life balance, and societal perceptions. Data were analysed using Braun and Clarke's six-phase reflexive thematic analysis to identify key patterns and meanings. Experiences and perceptions of menopause, including symptom burden, coping mechanisms, and barriers to care. Six interconnected themes were identified. Menopause intensified occupational and economic strain, with symptoms disrupting income generation and caregiving. Psychological burden and emotional disruption were widespread, often concealed due to stigma. Physical and somatic symptoms significantly impaired daily functioning. Barriers to healthcare included limited awareness, fragmented services, and low prioritisation of menopause. Women adopted coping and resilience strategies, such as herbal remedies and social withdrawal. Outlook, migration, and intergenerational lessons shaped planning for future generations. Menopause in Ghana is a neglected occupational and sociocultural health issue. Integrating menopause care into chronic disease and mental health services, improving access, and enhancing workplace protections are critical.

• We survey 19 Utah water and wastewater organizations on their power resilience. • Most have backup power and some have renewable energy. • The most prevalent renewables are photovoltaic solar, cogeneration, and hydropower. • However, ee find more cases of failed renewables than successful ones. • Feasibility studies seem to miss operation of renewable energy. Drinking water and wastewater services are vulnerable to power disruptions because they rely on the electric grid. Power outages can lead to water outages, creating cascading failures that compromise sanitation, firefighting, healthcare, and daily routines. However, there are few studies of water and wastewater power resilience at the state level. In this study we investigate the extent of backup power and renewable energy integration as well as the motivations and barriers around their power resilience. We collect our data through semi-structured interviews with staff at 19 urban and rural water and wastewater facilities throughout the state of Utah, USA. We find that all facilities experience power outages, 89% have backup power, and 69% are satisfied with their backup power. We also find that 19% of facilities have functioning renewable energy technologies while 30% have inoperable renewables. The high rate of failed renewables corresponds to circumstances after installation that feasibility studies did not consider, including monitoring, compatibility, permitting, and inconsistent generation. In addition, 96% of organizations have explored renewables, 7% plan to install more renewables, and 30% plan to procure more backup power. The primary motivations for power resilience are providing uninterrupted service and saving money. The primary barriers are financial and operational difficulties associated with the technologies. We recommend that water and wastewater facilities ensure continuity of service through backup generators, water storage, and other alternatives; more carefully select renewables, with particular attention to their operability after installation; and commit to raising funds—the most-cited barrier—for power resilience projects.

The therapeutic use of self, first articulated by Peplau in the 1950s, remains fundamental to mental health nursing practice, yet continues to be interpreted in diverse ways. This paper reports findings of a qualitative descriptive study, situated within a constructivist paradigm, exploring how experienced Australian mental health nurses understand and apply the therapeutic use of self in contemporary recovery-oriented contexts. Eleven mental health nurses participated in semi-structured interviews, with data analysed using reflexive thematic analysis. Three interrelated themes were developed: 'Diverse conceptualisations of the therapeutic use of self'; 'The prominence of self-disclosure'; and 'The nurse as a therapeutic instrument'. Participants described the therapeutic use of self as an intentional and reflective use of the professional self to foster connection, presence and trust. While the value of self-awareness and relational authenticity was acknowledged, self-disclosure emerged as a significant, ethically bounded strategy within a broader reflective orientation. By recognising the diverse conceptualisations of the therapeutic use of self, this study offers a more integrative formulation of the practice as relational, contextual and also experiential, with the prominence of self-disclosure reflecting evolving socio-cultural and recovery-oriented frameworks. Such recognition strengthens shared professional language, education and critical reflection in mental health nursing practice.

Understanding oncology nurses' experiences with virtual care and interprofessional collaboration in Canada: A mixed-method study.

Achieving long-term behavioural change in chronic disease management, particularly in chronic obstructive pulmonary disease (COPD), remains a significant challenge. Although maintenance programmes have been developed to extend the benefits of pulmonary rehabilitation, patient adherence is often comperomised by persistent symptoms, low motivation, and fragmented care. Research highlights the importance of therapeutic alliance, social support, and personalised follow-up to encourage long-term healthy behaviour. Care managers (CMs) may help facilitate these key elements by providing individualised support and coordination. The aim of this study is to identify key elements that support the sustainable implementation of the CM role in chronic care pathways, by exploring the shared experiences of COPD patients and CM involved in an 18-month remote follow-up post-rehabilitation programme. A qualitative descriptive study was conducted using semi-structured interviews with COPD patients and care managers who participated in the INSPIR'ACTION national experiment. This programme included an initial pulmonary rehabilitation phase followed by an 18-month remote follow-up. Interviews focused on the follow-up phase and were analysed using inductive thematic analysis. Data saturation was reached with a final sample of 9 patients and 7 CMs. Patients described CMs as supportive professionals who helped sustain motivation, adherence to healthy behaviours, and continuity of care. The relationship was perceived as trustful and personalised, even in a remote format. CMs expressed pride in their role but also reported organisational challenges, including lack of recognition and insufficient time allocation. Both groups emphasised the importance of relational continuity and individualised support. Patients and care managers described the CM as a key supportive figure offering personalised follow-up perceived as helping promote therapeutic engagement and behavioural change. Relational continuity throughout the remote follow-up was seen as fostering a trusting relationship that shaped participants' experience of the programme. By highlighting organisational elements that could influence implementation, our study may help inform future strategies to enhance the sustainable integration of care management in COPD care pathway. COPD patients and CMs involved in the INSPIR'ACTION programme shared their experiences through interviews, helping to identify key factors for improving care manager support and long-term follow-up. Their input directly informed the study's findings and recommendations.

How does emotional control affect men's long-term risk of ischemic heart disease and stroke? Analysis of linked registry data.

Bipolar disorder (BD) is a recurrent psychiatric disorder with episodes of mania and depression. The severe and recurrent symptoms of BD can considerably influence patients' significant others and alter their lives and thereby, influence family functioning (FF). This study aimed at exploring the influential factors on the FF of patients with BD. This qualitative study was undertaken in 2021-2022 with the conventional content analysis method, adhering to the COREQ checklist. Data were collected through semi-structured interviews with 22 family members of BD patients and three healthcare providers, all purposefully selected from a psychiatric hospital in Hamadan, Iran. Data analysis was performed through Graneheim and Lundman's conventional content analysis. Participants' experiences of the influential factors on their FF came into 20 categories and six main themes, namely family interaction, struggle for adaptation, role challenges, sexual behaviour challenges, financial problems and cultural backgrounds and conflicts. Different personal, financial and sociocultural factors influence the sociocultural, financial, relational, sexual and role-related aspects of FF among the families of patients with BD. Given the critical role of FF in the prevention, early diagnosis and effective treatment and rehabilitation of patients with BD, healthcare authorities and providers need to carefully consider these influential factors when planning care. This study offers valuable insight into the role of influential factors on the FF of patients with BD. The findings equip mental health nurses with a deeper understanding of these factors, enabling them to provide better support to relatives. Psychiatric nurses can adopt a participatory care approach that actively involves family members and provides stronger support for family caregivers.

Making shared care work: A national qualitative case study on collaborative practice in pediatric oncology

Pressure on emergency departments is increasing, perpetuating the phenomenon known as ramping or ambulance ramping, where patients are forced to wait on stretchers in corridors until they are allocated a suitable treatment space. This once temporary response to emergency department crowding has now become the norm for many emergency departments. The ramping environment impacts the patient experience well beyond the undesirability of extended waiting times. Nevertheless, there remains little research regarding how patients experience the ramping environment and what might make their wait more comfortable. Semi-structured interviews were performed with patients who had waited at least an hour on the ramp at two Australian emergency departments. An inductive thematic analysis was undertaken to explore the patient experience while ramped and aspects of the built environment and care that participants perceived could better support their health and waiting experience. Twenty-six patients participated in the study. Four major themes and 13 subthemes were developed from the data. Participants described psychological distress, physical discomfort, an unsuitable built environment, and challenges to maintain physical health. They suggested modifications to the built environment and care received that may ameliorate some of their concerns. Ramping can create additional stresses to the patient experience. Making changes to the physical aspects of the built environment may be challenging in the short term; however, other aspects of the ramp were identified that could be considered to maximise patient-centred care.

Living kidney donor program patients’ perceptions of genetic testing: A qualitative study

Implementation factors influencing utilisation of Seniors Exercise Parks: A community stakeholder qualitative study

A contextual perspective on mental health is critical in developing a comprehensive understanding of wellbeing in line with the precepts of Geopsychiatry. A review of the literature indicates a limited understanding of how people deal with the global climate crisis using a geo-psychiatry perspective. The experience of awakening to the climate crisis has been described using the term “eco-anxiety”. A lack of in-depth exploration of this subjective experience has meant a fragmented theory. To contribute to our understanding of eco-anxiety, the current study explores qualitative aspects of this experience, looking at the reports of eco-anxiety experienced by people who self-reported attending a group psycho-ecological intervention for facing the climate crisis. Using a constructivist grounded theory approach, critical realist ontology and moderate social constructionist epistemology, semi-structured interviews were conducted with 13 adults who self-identified as experiencing “eco-anxiety” and had attended an ecopsychology support group. Two core categories of theory emerged: “the psychosocial processes of eco-anxiety” and “the psychosocial processes of regeneratively sustained eco-anxiety”. The results are explored through figures that analogise the seasons, demonstrating the participants' reported process of psychosocial adaptation: the growth and expansion of the self in the face of eco-anxiety, reflecting the integration of experiences. This metaphor does not suggest a linear process. Participants described moving bidirectionally. Despite the challenges, group participants report that the process of awareness can lead to a more connected way of life and ultimately the development of psychosocial resilience, which is essential for navigating sustained mutual care in the face of global environmental instability.

Indonesian immigrant nurses' stress, distress, and coping: A qualitative study.

Professional Identity Formation (PIF) is a dynamic process by which students and trainees integrate the professional values, expectations, and community norms of the medical community into their personal identity. PIF is often understood as occurring through socialization into a Community of Practice (CoP). Despite the growing use of social media by medical trainees, little is known about how PIF unfolds in virtual environments and the extent to which social media use can influence the career development of trainees. In this study, we explored how participation in a social media community ("#NeuroTwitter") influenced PIF and career development among neurology trainees. Informed by CoP theory, we developed a semistructured interview guide. We used purposive criterion sampling and snowball sampling to identify and recruit neurology trainee "superusers" on X, the social media platform formerly known as Twitter. Eligible participants were invited to complete a one-on-one virtual semistructured interview between August and November 2024. We used inductive thematic analysis to identify key themes and interpreted these through the lens of PIF. We interviewed 18 X superusers (13 residents, 3 fellows, and 2 first-year attendings) from 17 institutions in the United States. We identified 4 key themes of how the #NeuroTwitter community influenced the trainees' PIF: (1) Access to Neurology, (2) #NeuroTwitter as a CoP, (3) Translation of #NeuroTwitter involvement into "in real-life" achievements, and (4) Challenges in navigating the digital environment. Many neurology trainees shared how the #NeuroTwitter Community was equitable, nonhierarchal, and generous and described how involvement accelerated professional opportunities. However, accruing these benefits required navigating the platform and tensions between their professional self, digital self, and "real" self. #NeuroTwitter functioned as a CoP which fostered a sense of belonging and accelerated PIF among deliberate superusers. However, participants also described identity friction and platform concerns. Although PIF that happens in virtual communities is important, it should be viewed as complementary-rather than a replacement-to PIF occurring in real-life.

To identify priority domains that influence healthcare provider sedation practices and to describe key sedation protocol elements reported by participants that serve as facilitators and barriers to sedation practice change. We conducted qualitative individual semi-structured interviews with critical care healthcare providers, including physicians/nurse practitioners, nurses, pharmacists, respiratory therapists, and physiotherapists, to understand sedation practices and define key factors that limit the opportunity for optimization of ICU sedation practices. We analyzed responses with deductive content analysis using the Theoretical Domains Framework (TDF) to identify priority domains related to sedation practices and describe constructs within the priority domains. We conducted 29 semi-structured interviews virtually from April 29 to December 10, 2024, consisting of 12 physicians/nurse practitioners, 5 respiratory therapists, 8 nurses, 3 pharmacists, and 1 physiotherapist. We identified seven priority TDF domains across healthcare provider groups including: Beliefs about consequences, Beliefs about capabilities, Reinforcement, Memory, attention, and decision processes, Environmental context and resources, Social influence, and Social/professional roles. Participants reported sedation use for multiple purposes including patient and staff safety, unit culture, and to address environmental and organizational challenges (e.g., patient care efficiency). Participants reported several recommendations for optimizing sedation delivery including available nursing-driven sedation protocols for specific patient populations (e.g., alcohol withdrawal) and specific sedation weaning recommendations. Critical care healthcare providers identified several domains relevant to sedation practices, underpinned by patient and staff safety, key patient-specific factors, and socioenvironmental factors. In understanding priority domains and underlying factors that influence sedation practice, implementation strategies using protocol-driven sedation as a tool to improve guideline adherence should be designed targeting the identified priority domains and underlying driving factors. Protocol-driven sedation strategies are more likely to succeed when interventions intentionally address the priority domains and driving factors that influence adherence to clinical practice guidelines during implementation processes.

The study explored healthcare workers' experiences using the AfyaPro Connected Care app and identified key enablers and barriers to its adoption for diabetes and hypertension care in Ghana. The study applied the Technology Acceptance Model (TAM) to examine how perceptions of usefulness and ease of use of the app influence adoption and to address the gap in evidence on mHealth uptake by frontline providers in low- and middle-income country (LMIC) health systems. A qualitative study was conducted with 20 healthcare workers from two healthcare facilities. Semi-structured interviews, guided by the TAM, explored perceptions of the app's usefulness, ease of use, and behavioral intention. The framework was appropriate for examining individual and contextual drivers of technology adoption in resource-constrained healthcare settings. Interviews were transcribed verbatim and analysed thematically. Participants reported positive experiences with the app, noting reduced administrative burden, workflow integration, stronger patient-provider interaction and improved continuity of follow-up. The app enhanced access to specialist care, supported self-monitoring of blood pressure and glucose, and boosted confidence through its intuitive design and structured training. However, challenges persisted, including unstable power and internet connectivity, increased data entry workload, limited patient access and digital literacy, and restricted roles for junior staff. Participants recommended clearer roles, regular supervision, refresher training, and decision-support tools to improve sustainability and equitable adoption. This study adopts a user-centered and context-sensitive approach based on provider experiences. It shows how mHealth tools can be fitted into Ghana's healthcare system, where challenges like limited infrastructure and digital literacy affect use. Innovation is seen as adapting tools and systems through digital literacy training, decision-support in provider workflows, and blended care models, helping to build a fairer and more sustainable health system. Healthcare workers found the mHealth app feasible and acceptable. The findings highlight the potential of digital tools to improve chronic disease care in resource-limited settings. The study demonstrates how contextual factors in LMIC settings reshape key TAM constructs, with clear implications for mHealth policy, scale-up strategies, and refinement of technology adoption theory.

Due to an ongoing culture change, relocations from regular nursing homes to innovative living arrangements are increasing. This affects not only residents but also their family caregivers. The perspective of family caregivers regarding the relocation processes that occur within the context of culture change is understudied. Therefore, this study examines the experiences of family caregivers concerning the relocation of their relatives from a regular nursing home to an innovative living arrangement. A qualitative study, using semi-structured interviews, was performed in the Netherlands. Three nursing homes offering 24-h care that were planning a relocation from a regular nursing home to an innovative living arrangement were selected. Twenty-two family caregivers were included in the study. Interviews took place 2 weeks to a month after the relocation day. Four themes were constructed from the data: (1) Family caregivers took on an active role throughout the relocation process; (2) Family caregivers were concerned about the emotional impact of relocating on their relative; (3) Lack of communication with family caregivers during the relocation process; and (4) The challenges of implementing the culture change. This study emphasizes the need to provide practical support when preparing for the move. Emotional support, information provision and optimal communication are important to support family caregivers. Furthermore, family caregivers appear to be hesitant regarding the intended culture change. Therefore, it is important to create a sense of innovation readiness in both staff and family caregivers by informing and involving them.

During rehabilitation following anterior cruciate ligament (ACL) reconstruction, increased attention is given to addressing psychological factors, such as fear. Fear can hinder the rehabilitation process and return to sport after rehabilitation. This study aimed to explore sports physiotherapists' experiences and needs in assessing and managing fear-related barriers in patients undergoing rehabilitation following ACL reconstruction. A qualitative study. Semi-structured interviews were performed among sports physiotherapists experienced in treating athletes during ACL rehabilitation following ACL reconstruction. Inclusion continued until data saturation. Inductive thematic analysis was used. Relevant phrases from each interview were iteratively coded and clustered into categories and themes. Fourteen sports physiotherapists were interviewed. Three themes emerged: (I) fear is normal during rehabilitation, (II) handling fear, and (III) psychosocial education. The impact of fear-related barriers during ACL rehabilitation varied and was linked to causes including personal stressors or confidence. Participants used tailored assessment and management strategies based on personal or athlete-specific factors alongside clinical guidelines. Collaboration with other professionals, such as (sport) psychologists, was sometimes limited by logistical and financial barriers or stigma. Sports physiotherapists expressed a need for additional education in the psychosocial domain. Sports physiotherapists recognise fear as a normal part of rehabilitation, but face challenges in managing excessive fear. Strategies to address and handle fear are highly individualised, based on experience and athlete-specific needs. Further research should focus on developing training programmes for physiotherapists that address both psychological and physical aspects of rehabilitation, updating ACL guidelines accordingly, and facilitating interdisciplinary collaboration.

Caring at the crossroads: Exploring end-of-life challenges for advanced heart failure patients in saudi emergency departments.