Sequential Mixed Methods Study Research Articles

The Influence of the Sherman STEM Teacher Scholars Program on Persistence in Science, Technology, Engineering, and Mathematics: A Mixed-Methods Study

This sequential explanatory mixed-methods study investigated the differences in persistence between students from the Sherman STEM Teacher Scholars Program (STEP), a STEM teacher scholarship and career preparation program, and STEM majors not in the program. Quantitative results indicated that STEP participants had higher levels of academic integration, women scored higher on persistence factors than men, and White students had a higher degree commitment than students of color. Qualitative findings indicated that STEP provided a family atmosphere and connected their coursework to their career aspirations. Women of color felt stereotyped by White classmates in STEM courses, which impacted their degree of commitment, and students of color in STEP relied on the program as a counterspace to racially insensitive STEM classrooms.

Improvements in Transitional Care Among Medicaid-Insured Patients With Serious Mental Illness.

The Thrive program is an evidenced-based care model for Medicaid-insured adults in the hospital-to-home transition. A substantial portion of Thrive participants live with serious mental illness (SMI), yet Thrive's efficacy has not been tested among these patients. To compare 30-day postdischarge outcomes between Thrive participants with and without SMI and explore Thrive's appropriateness and acceptability among participants with SMI. We conducted a sequential explanatory mixed-methods study of 252 (62 with SMI) Thrive participants discharged from an academic medical center from February 2021 to August 2023. Interviews of participants with SMI were analyzed using rapid qualitative analysis. Participants with and without SMI experienced similar rates of 30-day readmissions, emergency room visits, and postdischarge follow-up visits, with these differences being nonsignificant. Participants with SMI were highly satisfied with Thrive's care coordination and attention to social needs, yet participants suggested stronger connections to behavioral health care. Participants with and without SMI benefit equitably from Thrive.

Educational needs for virtual reality-based simulation training in the nursing care of adult respiratory patients: an explanatory sequential mixed-methods study.

We aimed to ascertain the current state of and needs for virtual reality (VR)-based simulation training in the care of adult respiratory patients. Learning to care for patients with infectious respiratory disease is crucial in nurses' practical education. Thus, studies on the state of VR-based simulation-training are required. We used an explanatory sequential mixed-methods design. The sample included 122 new nurses at two advanced general hospitals and five educators at a nursing college. The educational needs of virtual reality-based simulation education were measured by the tool developed in this study. Research data were collected from August 31 to September 26, 2022. Quantitative data were subjected to a descriptive analysis, while qualitative data were subjected to content analysis. The new nurses in this study had a mean age of 24.51 years and total clinical experience of 11.18 months; 82.8% of the participants had experience in adult respiratory patient care, and 94.3% were aware of the need for this training. In the qualitative data analysis of six new nurses, all participants had experience with simulation training and were aware of its need. Moreover, all participants wanted repeated VR-based simulation training using real clinical cases. Regarding the qualitative data analysis of five nursing college educators, most of them had experience providing and receiving simulation training, and they were aware of its need in caring for respiratory patients. They reported the need for VR learning spaces that reflect the clinical environment, alongside sufficient duration and frequency of learning. Our findings could help develop simulation training programs for nursing students to assist adult respiratory patients. We provide a basis for developing VR-based simulation training for respiratory care by studying the current state of and demand for nurses' VR-based simulation training. The results can contribute to improving the quality of nursing for adult respiratory patients.

Schoolwork With Purpose: A Mixed Methods Study on Youths’ Perspective on What Makes Learning Meaningful

Making school meaningful is a widely accepted goal in education, yet what is considered meaningful, meaningful to whom, and why, leaves room for interrogation. This sequential explanatory mixed methods study aims to understand: (1) The extent to which students experience meaningful education at EL Education schools compared to comparison schools, and (2) How adolescents describe meaningful schoolwork. Survey responses were gathered from 258 students at nine middle schools (five EL Education, four comparison). Participants self-identified as 49% male, 47% female, 2% gender non-binary, 41% Black, 40% Latina/o, 33% White, 16% Multiracial, 1% Asian, and 31% low-income. Controlling for demographic characteristics, EL Education students reported statistically significantly more meaningful school experiences than comparison school students. Subsample analyses showed substantially greater meaningfulness at EL Education than comparison schools for Black ( n = 107; p < .01) and Latina/o students ( n = 40; p < .001). Interviews from 32 students and grounded theory analysis revealed that meaningful schoolwork focuses on: (a) Learning about and addressing “real-world problems” (e.g., racism, environmentalism, sociopolitical development), (b) Engaging content that was personally relevant, hands-on, and socially interactive, and (c) Future-oriented academic or social skills. Findings point to promising practices at EL Education schools and implications are discussed.

How does family resilience develop among stroke survivors and their caregivers? A mixed-method study using a chain mediating model

BackgroundWalsh's family resilience theory indicated that families could foster resilient outcomes among their members when they are facing changes or crises. However, little is known about family resilience among Chinese stroke survivors and their caregivers. ObjectivesTo explore the direct and indirect relationships between the family resilience of stroke survivors, perceived social support, self-perceived burden, self-efficacy, and the burden on their principal caregivers, and to examine the journey of adapting to family resilience among stroke survivors. DesignAn explanatory sequential mixed-method study. MethodsA quantitative assessment of perceived social support, self-perceived burden, self-efficacy, and family resilience was conducted among a cohort of stroke survivors. For a deeper understanding of the family resilience formation process, semi-structured, in-depth interviews were undertaken with a purposefully selected subset of participants, consisting of 15 stroke survivors and their principal caregivers who met the study criteria. Data analysis encompassed descriptive statistics, mediation models, and content analysis to integrate and interpret both quantitative and qualitative data. ResultsIn a comprehensive hospital in Guangdong Province, China, 379 participants—229 men (60.4%) and 150 women (39.6%)—completed a cross-sectional questionnaire survey. The quantitative phase revealed significant statistical differences (p < 0.05) in total family resilience scores among stroke survivors related to various factors, such as age, marital status, educational level, occupational status, average monthly income per capita, first-time onset, and types of stroke. Self-perceived burden and self-efficacy partially mediate the relationship between perceived social support and family resilience, contributing to a sequential chain-mediated effect. During the qualitative phase, in-depth interviews revealed a progressive trajectory from the initial shock of diagnosis through the ongoing presence of stress and challenges to the ultimate development of family resilience and an adaptive perspective toward the future. ConclusionsExploring the factors influencing family resilience in stroke survivors could assist healthcare professionals developing interventions to enhance family resilience and lessen the burden on principal caregivers from individual, family, and social perspectives.

Why becoming a positive deviant for malaria prevention and control: a sequential explanatory mixed methods study in Bugesera district, Rwanda

BackgroundMalaria continues to be a significant global health challenge, particularly in sub-Saharan African regions. Effective prevention and control strategies are crucial in mitigating its impact. Therefore, assessing the use of malaria preventive measures, treatment-seeking behaviours, and understanding the motivating factors behind positive behaviours/practices and barriers to using malaria preventive and control measures is essential for designing successful intervention programs.MethodsUsing a sequential explanatory mixed methods design, a descriptive cross-sectional study was conducted among 382 heads of households in the Mareba sector, Bugesera district, Rwanda. A qualitative study followed with 30 in-depth interviews among the top performers and other community members to explore the motivations and barriers to performing positive behaviours. Descriptive statistics for quantitative data and thematic analysis for qualitative data were used.ResultsThis study revealed that among those who own insecticide-treated nets, 234(89.3%) reported that they slept under the bed net the night preceding the survey; 256(67%) had fever cases in the last 24 months preceding the survey; and 214(87%) reported seeking care within 24 h. While almost all 243(98.8%) of participants who had fever case reported that they have taken all medicines as prescribed, however, a large number 263(68.8%) and 148(38.7%) still think that there are people in the community who do not take all malaria medications as prescribed and there are people who share malaria medications in the community, respectively. 82(65.1%) of those who never had a fever case believe that they have been using malaria preventive measures correctly and consistently. This study found that knowledge about malaria, family support, and community mobilization are the top motivating factors to practice positive behaviours while, lack of bet nets, poverty, and lack of time were reported as main barriers.ConclusionInterventions that target key motivating factors for adopting positive behaviours in malaria prevention and control should be prioritized. This, in turn, will reduce the disease burden on affected populations. Efforts to overcome barriers in malaria prevention and control should also be participatory. Community involvement should be at the centre of these interventions.

Parental Preferences and Shared Decision-Making for the Management of Febrile Young Infants.

To inform shared decision-making by identifying parental preferences for the management of their febrile young infant. This was a sequential explanatory mixed-methods study using a cross-sectional questionnaire (May 2020-May 2022) followed by qualitative focus groups (September-December 2022) with parents of infants aged ≤60 days evaluated for fever at a tertiary pediatric hospital. Parental expectations, stressors, and desired level of decisional involvement were assessed using multiple-choice and 6-point-Likert scales. Questionnaire results informed the qualitative naturalistic inquiry into parents' decision-making experiences and preferences regarding the need for lumbar puncture (LP) and hospitalization. Among 432 parents (64.9% response), few anticipated the need for LP (10.2%) or hospitalization (20.8%), and these were selected as the most stressful aspects of management. No parent identified lack of decisional involvement as the most important stressor, although nearly all (97.5%) wanted to be involved in management decisions. Six focus groups with a subset of 17 parents revealed 4 main themes: (1) varying preferences for decisional involvement depending on the strength of the medical recommendation; (2) importance of involving parents in their infant's medical care; (3) need for tailored information; and (4) importance of supportive relationships. Parents reported feeling involved in discussions about their infant's care but that decisions regarding LP and hospitalization were usually made by the medical team. Parents of febrile young infants identified LP and hospitalization as the most unexpected and stressful aspects of care. Understanding individual family expectations and tailoring information based on the strength of medical recommendation is necessary to guide shared decision-making.

Shaping Student Relationships: The Role of Personality in Early Childhood Pre-Service Teachers.

The purpose of this explanatory sequential mixed-methods study is to explain teacher-student relationships in preschool classrooms in terms of the child's temperament and the pre-service preschool teachers' personalities. The study was conducted using a sequential exploratory mixed-methods design. Since both quantitative and qualitative data were obtained, sampling was carried out in two stages: quantitative random stratified sampling, and qualitative purposive sampling. Quantitative data were obtained from 126 pre-service teachers. The qualitative study group consisted of 18 pre-service teachers. Quantitative data were collected using the Student-Teacher Relationship Scale-Short Form, the Short Temperament Scale for Children (STSC), and the Five Factor Personality Inventory (FPI). Qualitative data were obtained from interviews with 18 teachers. The findings revealed that the student-teacher relationship can be explained by adult and child characteristics. In addition, pre-service teachers' perceptions of the student-teacher relationship are explained by adult characteristics much more than pre-service teachers' perceptions.

Mentorship of Junior Surgical Faculty Across Academic Programs in Surgery

Because mentorship is critical for professional development and career advancement, it is essential to examine the status of mentorship and identify challenges that junior surgical faculty (assistant and associate professors) face obtaining effective mentorship. To evaluate the mentorship experience for junior surgical faculty and highlight areas for improvement. This qualitative study was an explanatory sequential mixed-methods study including an anonymous survey on mentorship followed by semistructured interviews to expand on survey findings. Junior surgical faculty from 18 US academic surgery programs were included in the anonymous survey and interviews. Survey responses between "formal" (assigned by the department) vs "informal" (sought out by the faculty) mentors and male vs female junior faculty were compared using χ2 tests. Interview responses were analyzed for themes until thematic saturation was achieved. Survey responses were collected from November 2022 to August 2023, and interviews conducted from July to December 2023. Mentorship from formal and/or informal mentors. Survey gauged the availability and satisfaction with formal and informal mentorship; interviews assessed broad themes regarding mentorship. Of 825 survey recipients, 333 (40.4%) responded; 155 (51.7%) were male and 134 (44.6%) female. Nearly all respondents (319 [95.8%]) agreed or strongly agreed that mentorship is important to their surgical career, especially for professional networking (309 respondents [92.8%]), career advancement (301 [90.4%]), and research (294 [88.3%]). However, only 58 respondents (18.3%) had a formal mentor. More female than male faculty had informal mentors (123 [91.8%] vs 123 [79.4%]; P = .003). Overall satisfaction was higher with informal mentorship than formal mentorship (221 [85.0%] vs 40 [69.0%]; P = .01). Most male and female faculty reported no preferences in gender or race and ethnicity for their mentors. When asked if they had good mentor options if they wanted to change mentors, 141 (47.8%) responded no. From the interviews (n = 20), 6 themes were identified, including absence of mentorship infrastructure, preferred mentor characteristics, and optimizing mentorship. Academic junior surgical faculty agree mentorship is vital to their careers. However, this study found that few had formal mentors and almost half need more satisfactory options if they want to change mentors. Academic surgical programs should adopt a framework for facilitating mentorship and optimize mentor-mentee relationships through alignment of mentor-mentee goals and needs.

Improving Athletic Trainers' Knowledge of Clinical Documentation Through Novel Educational Interventions: A Randomized Controlled Trial.

Athletic trainers (ATs) have reported the need for more educational resources about clinical documentation. To investigate the effectiveness of passive and active educational interventions to improve practicing ATs' clinical documentation knowledge. Randomized controlled trial, sequential explanatory mixed methods study. Online module(s), knowledge assessment, and interviews. We emailed 18 981 practicing ATs across employment settings, of which 524 ATs were enrolled into a group (personalized learning pathway [PLP = 178], passive reading list [PAS = 176], control [CON = 170]) then took the knowledge assessment. A total of 364 ATs did not complete the intervention or postknowledge assessment; therefore, complete responses from 160 ATs (PLP = 39, PAS = 44, CON = 77; age = 36.6 ± 11.2 years, years certified = 13.9 ± 10.7) were analyzed. Knowledge assessment (34 items) and interview guides (12-13 items) were developed, validated, and piloted with ATs before study commencement. We summed correct responses (1 point each, 34 points maximum) and calculated percentages and preknowledge and postknowledge mean change scores. Differences among groups (PLP, PAS, CON) and time (preintervention, postintervention) were calculated using a 3 × 2 repeated-measures analysis of variance (P ≤ .05) with post hoc Tukey HSD. Semistructured interviews were conducted (PLP = 15, PAS = 14), recorded, transcribed, and analyzed following the consensual qualitative research tradition. No differences in the preknowledge assessment were observed between groups. We observed a group × time interaction (F2,157 = 15.30, P < .001; partial η2 = 0.16). The PLP group exhibited greater mean change (M = 3.0 ± 2.7) than the PAS (M = 1.7 ± 3.0, P = .049) and CON (M = 0.4 ± 2.2, P < .001) groups. Descriptively, ATs scored lowest on the legal (61.3% ± 2.1%), value of the AT (63.7% ± 4.3%), and health information technology (65.3% ± 3.7%) items. Whereas ATs described being confident in their documentation knowledge, they also identified key content (eg, legal considerations, strategies) which they deemed valuable. The educational interventions improved ATs' knowledge of clinical documentation and provided valuable resources for their clinical practice; however, targeted continuing education is needed to address knowledge gaps.

Patients’ experiences with ‘sludge’ (administrative burden) in the cancer screening process and its relationship with screening completion, experience and health system distrust

Objective‘Sludge’ refers to administrative burdens or frictions that preclude people from getting what they want or need (eg, duplicative forms, complicated instructions, long waiting times). This mixed methods study evaluated...

31 Barriers to Physical Activity in Pregnant Women: An Explanatory Sequential Mixed Method Study

31 Barriers to Physical Activity in Pregnant Women: An Explanatory Sequential Mixed Method Study

Healthcare Professionals' Perspectives on the Use of Standing Frames for Children Diagnosed With Cerebral Palsy: An Explanatory Mixed Methods Study.

Standing frames are commonly used by healthcare professionals in their practice with children with cerebral palsy (CP) who do not have an independent standing function. A better understanding of healthcare professionals' attitudes and experiences with standing frames may impact practice and rehabilitation. Therefore, this study aimed to investigate the standing frame practice among healthcare professionals and expand their attitude and experience with the use of standing frames for children with CP. This is an explanatory sequential mixed methods study. A cross-sectional survey was conducted, providing quantitative data on 210 healthcare professionals' use of standing frames. The quantitative data were descriptively analysed. Subsequently, the results from the survey were followed up with five focus group interviews of healthcare professionals (n = 14). The qualitative data were analysed using thematic analysis, enabling integration between the quantitative and qualitative data. When quantitative and qualitative data are integrated, expansion between the two datasets occurred. The quantitative dataset emphasised the use of GMFCS levels as a guideline for recommending standing frames, whereas the qualitative data showed that the healthcare professionals' recommendations were based on individual needs. Furthermore, the healthcare professionals expanded the quantitative data, showing that the healthcare professionals' considerations regarding age and dosage were based on clinical experience, and saw the standing frame as having many benefits. The healthcare professionals had a child-centred approach, where the child's need for using a standing frame was assessed based on the functional level, stage of development, cognitive level and clinical assessment. All of these considerations showed that the use of standing frames for children with CP was individualised, thereby making it difficult to make unified descriptions.

Perceived discrimination and mental health among female migrant domestic workers in Hong Kong: A sequential explanatory mixed-methods study.

Female migrant domestic workers (MDW), often unemployed in their home country, are household workers that migrate abroad for better wages. Although poor employment conditions have shown detrimental effects on MDWs health, the mental health effect of perceived discrimination remains understudied among MDWs. This mixed-methods study seeks to (a) assess the association between perceived discrimination and mental health among female MDWs and (b) explore in-depth the common ways MDWs experience discrimination. A cross-sectional self-administered survey (n = 1965) was conducted among Filipino and Indonesian MDWs from August 2020 to August 2021 in Hong Kong. A multivariable logistic regression model, controlling for background characteristics, assessed associations between perceived discrimination with anxiety and depression. Qualitative semistructured interviews were then conducted (n = 20) to provide in-depth information about perceived discrimination. Thematic analysis was used to identify the contexts and types of discrimination experienced. Among survey respondents, 60.4% reported ever experiencing discrimination, and 10.5% reported often/always feeling discriminated against. Of MDWs, 18.1% and 31.5% were classified with anxiety and depression, respectively. MDWs reporting higher frequency of discrimination were at increased risk of anxiety (ORadj: 2.30-6.60) and depression (ORadj: 2.06-5.91). In-depth interviews revealed that perceived discrimination inside the workplace (from overwork, lack of autonomy, and employer-imposed restrictions) and outside the workplace (from MDW policies) had strong effects on MDWs' mental health. Increased availability to mental health services should be considered. To improve MDW mental health, policymakers may also regulate maximum weekly working hours and ensure minimum standards for living environments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Perceived Discrimination and Mental Health Among Female Migrant Domestic Workers in Hong Kong: A Sequential Explanatory Mixed-Methods Study

Supplemental Material for Perceived Discrimination and Mental Health Among Female Migrant Domestic Workers in Hong Kong: A Sequential Explanatory Mixed-Methods Study

Knowledge, confidence and clinical reasoning of dental students for diagnosing pediatric periodontal diseases

ObjectiveGiven the importance of diagnosing periodontal diseases in pediatric patients, the objective of this study was to examine knowledge, confidence, and clinical reasoning of third- and fourth-year dental students regarding periodontal diagnosis and treatment planning in pediatric patients. MethodsAn explanatory sequential mixed-method study was conducted in two phases. In the first phase, the survey questions were administered online to the third-and fourth-year dental students. Surveys tested for knowledge, confidence and clinical decision-making using questions and case-studies. Answers from periodontists and the pediatric dentists were used as the gold standard. For the next phase, individual interviews were recorded, transcribed, and coded followed by verbal analysis to assess their clinical reasoning for the specific diagnosis and treatment planning. ResultsWhile there was no overall difference in the knowledge and the confidence level between the students, they differed from the experts for some questions in confidence levels. As measured using the Script Concordance Test (SCT), no significant differences were observed between the participants in their clinical reasoning. The verbal analysis of the interview data showed that the students used three different patterns for searching through the problem space. Most of the students used the forward pattern of search and reported low confidence in diagnosing and treating pediatric periodontal diseases. ConclusionDue to low self-reported confidence in diagnosing periodontal disease in pediatric patients. Providing education solutions will improve the confidence of undergraduate dental students in diagnosing and treating periodontal disease.

A model proposal explaining the influence of smartphone addiction related factors on high school students’ academic success

AbstractAn exploratory sequential mixed-method study is designed to develop and test a comprehensive model explaining the relationships between factors associated with smartphone addiction and high school students’ academic achievement. Involving two main phases of qualitative and quantitative, focus group discussions with high school students and interviews with teachers were conducted in the first phase, both to decide on the factors and to reveal the relationships between the factors in the model. According to the qualitative results, the most important factors were found as social media usage, cyberloafing, academic procrastination, external and internal academic locus of control. Then, a hypothesis model involving these factors was developed to explain high school students' academic achievement. Obtained from 410 high school students, quantitative data are collected online by the use of some scales measuring the factors included in the model. Using the path analysis method, the hypothesis model was tested, and it was observed that the model fit the data well. As a result, the factors that most influence academic achievement were found as duration of social media usage, external academic locus of control, smartphone addiction, internal academic locus of control, academic procrastination, and cyberloafing respectively. The uniqueness of the presented model in this research is believed to lie in its holistic perspective on the relationships between smartphone addiction and related factors, and their effects on academic achievement. Looking from a big picture, this model is expected to provide a roadmap for practitioners and decision-makers in terms of how to improve students’ academic achievement.

Validation of a quantitative instrument measuring critical success factors and acceptance of Casemix system implementation in the total hospital information system in Malaysia

ObjectivesThis study aims to address the significant knowledge gap in the literature on the implementation of Casemix system in total hospital information systems (THIS). The research focuses on validating a...

Building Public Health Workforce Capacity: Longer-Term Effectiveness of a Capacity Building Intervention to Improve Community-Based Public Health Prevention Work

Objective: There is an urgent need to build capacity among existing and incoming public health workers to enhance community-based work focused on prevention and health promotion. Public Health Essentials (PHE), a cohort-based facilitated asynchronous online capacity building intervention, was designed to build public health workers’ strategic skills and professional confidence. Earlier research reported on the short-term learning outcomes of the intervention; here we report on results from a longer-term outcomes evaluation, including skill retention, skill application, and possible indicators of workforce retention and community health improvement.Methods: A sequential mixed-methods research study was used to assess and explore longer-term outcomes among a sample of PHE graduates working in community public health roles.Results: Some 46% of eligible PHE graduates (n=70) completed a skills survey at three timepoints: Pre-PHE, post-PHE, and 3-to-6 months post-PHE completion. Longitudinal analysis of responses showed statistically significant skill gains over baseline (Beginner → Proficient, p<0.005), despite a slight drop in self-perceived ability in the 3-6 months post-PHE completion. Qualitative interviews with respondents and focus groups with their supervisors suggest PHE completion benefits participants’ everyday work by developing strategic skills, and grounding their work in shared public health language, paradigms, and values. Broader reported benefits include the ability to apply new skills to community public health prevention projects and expressed motivation to continue to work in public health.Conclusions: Successful completion of PHE provides learners with durable skills applicable to public health work and may spur interest in continuing to work in the field of public health. The importance of developing and retaining a competent community-focused public health workforce cannot be overstated. Comprehensive facilitated, online asynchronous capacity building programs may be an effective tool.

The influence of care home registration type and size on senior care leader’s confidence to provide palliative and end-of-life care: an explanatory sequential mixed methods study

BackgroundCare home staff are key providers of palliative and end-of-life care. Yet, little is known about how care home characteristics can influence care leader’s confidence in their ability to provide optimal palliative and end-of-life care.AimTo understand the influence of care home registration type (nursing, residential or dual registered) and size on senior care leader’s confidence to provide palliative and end-of-life care.DesignAn explanatory sequential mixed methods study comprising an online cross-sectional survey (including the Palliative Care Self-Efficacy Scale) and qualitative individual interviews. Analysis of survey data used a multivariate logistic regression and qualitative interview data used Framework Analysis. A ‘Following the Thread’ method was undertaken for data integration.Setting/participantsUK care home senior care leaders, purposively sampled by registration type, size and geographical location.ResultsThe online survey (N = 107) results indicated that nursing home senior care leaders had higher confidence scores on the Palliative Care Self-Efficacy Scale than residential care home leaders (aOR: 3.85, 95% CI 1.20-12.31, p = 0.02). Care home size did not show effect when adjusting for registration type (medium - aOR 1.71, 95% CI 0.59–4.97, p = 0.33; large – aOR 0.65, 95% CI 0.18–2.30, p = 0.5). Interviews (n = 27) identified three themes that promote confidence, (1) ‘feelings of preparedness’ stemming from staff expertise and experience and care home infrastructure, (2) ‘partnership working’ with external services as a valued member of the multidisciplinary team, and (3) a shared language developed from end-of-life care guidance.ConclusionCare home senior care leader’s confidence is influenced by care home characteristics, particularly availability of on-site registered nurses and the infrastructure of large care homes. All care home leaders benefit from training, working with external, multidisciplinary teams and use of guidance. However, mechanisms to achieve this differed by care home type and size. Further exploration is needed on successful integration of palliative care services and interventions to enhance confidence in residential care homes.