Sequential Mixed Methods Study Research Articles

Barriers to and Facilitators of Pediatric Vaccination Reporting in Four US States, 2023.

In a 2023 sequential explanatory mixed-methods study in four US states, we identified barriers and facilitators experienced by Vaccines for Children (VFC) program providers in reporting vaccination data to state immunization information systems (IISs). We found the following: VFC providers value accurate, robust, and widely used IISs. IIS reporting is easier with but does not require an electronic health record. Negative interactions with IISs and VFC officials and limited practice capacity are barriers to reporting. The COVID-19 pandemic highlighted the need for a nationwide vaccination database. (Am J Public Health. 2024;114(6):569-574. https://doi.org/10.2105/AJPH.2024.307638).

Oncology's Silent Caregivers: A Mixed-Methods Exploration of the Experiences, Outcomes, and Unmet Needs of Caregiving Youth of a Parent With Cancer.

Cancer affects the whole family system causing reorganization of functioning and responsibilities where children may take on a caregiving role. In the United States, an estimated 204 000 to 475 000 caregiving youth provide multifaceted, extended care in oncology. This results in both positive and negative outcomes for youth-spanning multiple domains of health. The aim of this study was to explore the caregiving experiences, outcomes, and unmet needs of caregiving youth (aged 12-24 years) in oncology. An explanatory sequential mixed-methods study design was used. Fifty-two adults who lived with a parent with cancer as a child were recruited via social media and asked to complete an online survey. A subsample of 18 individuals reporting high to very high amounts of caregiving were subsequently interviewed. The mean reported caregiving youth age was 16.13 (±4.86) years. They provided care approximately 22.43 h/wk for approximately 3.04 years. Most (71.2%) reported high to very high amounts of caregiving activity. The highest reported categories of unmet needs were information, family, feelings, friends, and time out/recreation. Qualitative findings included 4 themes: stepping into the role, family communication, dealing with feelings, and a new separateness. Identified needs included a desire for more information to aid in uncertainty, better communication within the family, needing someone to help them process their feelings, and peer-to-peer support. It is important for nurses and researchers to be aware of and acknowledge the needs of families dealing with cancer and aid in the development and implementation of tailored interventions to support caregiving youth.

U.S. Men’s Sheds: Promoting Meaning, Purpose, and Connection

ABSTRACT The purpose of this study was to explore U.S. Men’s Sheds, learn how they operate, who attends them, and how participants perceived sheds. It is the first study exploring Men’s Sheds in the U.S. An explanatory sequential mixed methods study was conducted, and paper-based surveys were sent to sheds registered with the U.S. Men’s Sheds Association. Shed chairpersons encouraged members to complete surveys (N = 76), and results showed that most members were male, older adults, in good health, and joined to make new friends or learn new skills. Four in-depth interviews were also conducted and revealed men participated to give back to their community but at times disagreed on the best way to do so. Some members were focused on sharing their religious beliefs with others whereas others were interested in rebuilding structures in the community. U.S. Men’s Sheds provide members with benefits by providing a sense of continued purpose and engagement. Overall, participants joined because they wanted something worthwhile to do with their time, especially retired men. Future researchers should conduct other interviews with Men’s Sheds members in the U.S. to provide additional insight into shed operations and the activities they are involved in.

The environmental awareness of nurses as environmentally sustainable health care leaders: a mixed method analysis

BackgroundPeople worldwide are concerned with the possibility of climate change, microplastics, air pollution, and extreme weather affecting human health. Countries are implementing measures to reduce environmental impacts. Nurses play a vital role, primarily through Green Teams, in the process of promoting sustainable practices and minimizing the environmental footprint of health care facilities. Despite existing knowledge on this topic, assessing nurses’ environmental awareness and behavior, including the barriers they face, is crucial with regard to improving sustainable health care practices.AimTo analyze the environmental awareness and behavior of nurses, especially nurse leaders, as members of the Green Team and to identify areas for improvement with regard to the creation of a sustainable environment.MethodsA sequential mixed-method study was conducted to investigate Spanish nurses. The study utilized an online survey and interviews, including participant observation. An online survey was administered to collect quantitative data regarding environmental awareness and behavior. Qualitative interviews were conducted with environmental nurses in specific regions, with a focus on Andalusia, Spain.ResultsMost of the surveyed nurses (N = 314) exhibited moderate environmental awareness (70.4%), but their environmental behavior and activities in the workplace were limited (52.23% of participants rarely performed relevant actions, and 35.03% indicated that doing so was difficult). Nurses who exhibited higher levels of environmental awareness were more likely to engage in sustainable behaviors such as waste reduction, energy conservation, and environmentally conscious purchasing decisions (p < 0.05). Additionally, the adjusted model indicated that nurses’ environmental behavior and activities in the workplace depend on the frequency of their environmental behaviors outside work as well as their sustainable knowledge (p < 0.01). The results of the qualitative study (N = 10) highlighted certain limitations in their daily practices related to environmental sustainability, including a lack of time, a lack of bins and the pandemic. Additionally, sustainable environmental behavior on the part of nursing leadership and the Green Team must be improved.ConclusionsThis study revealed that most nurses have adequate knowledge, attitudes, and behaviors related to environmental sustainability both inside and outside the workplace. Limitations were associated with their knowledge and behaviors outside of work. This study also highlighted the barriers and difficulties that nurses face in their attempts to engage in adequate environmental behaviors in the workplace. Based on these findings, interventions led by nurses and the Green Team should be developed to promote sustainable behaviors among nurses and address the barriers and limitations identified in this research.Graphical

Climate change and health: The case of mapping droughts and migration pattern in Iran (2011-2016).

Migration and mobility of population have been reported as a common reaction to drought. There is historical evidence to suggest the health effects of droughts and human migration linkage in Iran. This study aimed to map the drought and migration patterns in Iran in 2011 and 2016 and explore their possible health impacts. This sequential explanatory mixed-method study was done in two stages of spatial analysis and qualitative study. Data mapping was conducted through the equal interval classification and using drought, migration, and agriculture occupation data based on provincial divisions in Iran in 2011 and 2016. This qualitative study was conducted using the content analysis approach. The in-migration rate was higher in 2011 rather than 2016. Migration to cities was much higher than migration to villages in both years. The frequency of male migrants was higher than females in all provinces in 2011 and 2016. Physical and mental diseases as well as economic, sociocultural, education, and environment effects on health were extracted from the qualitative data. A holistic picture of droughts and migration issues in Iran and their health consequences were achieved by the present research. Further research is needed to explore the determinants of health impacts of climate change in vulnerable groups. Public health problems can be prevented by adaptive and preventive policy-making and planning. This can improve the coping capacity of the population facing droughts and enforced migration.

Treatment fatigue among adult patients with chronic heart failure in a tertiary care hospital in Ethiopia: a mixed-methods study

Background/Aims Patients with heart failure must adhere to strict treatment regimens, including pharmacological treatments, medical appointments and lifestyle modifications. This study aimed to assess the extent of treatment regimen fatigue among patients with heart failure in Ethiopia and identify factors that may exacerbate this. The authors also aimed to gather insights from patients and health professionals about how to ameliorate the impact of treatment regimen fatigue. Methods An explanatory sequential mixed-methods study was conducted at a specialist cardiac clinic in Ethiopia from 1 August to 30 September 2021. In the quantitative stage, the Treatment Regimen Fatigue Scale was delivered via interview to 325 patients with heart failure to collect data on their level of treatment regimen fatigue and analyse this against their demographic, clinical and treatment-related characteristics. The influences of factors on treatment regimen fatigue were tested using the Mann–Whitney U, Kruskal–Wallis and Chi square tests, as appropriate. In the qualitative stage, interviews were conducted with 14 patients with heart failure and 10 specialist health professionals to identify possible interventions to reduce treatment regimen fatigue. Interviews were recorded, transcribed and subject to content analysis to identify themes. Results In the quantitative phase, participants' mean level of treatment regimen fatigue was −48.38±13.1, indicating low levels of fatigue. Several factors had a significant impact on level of treatment regimen fatigue, including living alone (U=7819.5; Z=−3.01; P=0.003); poor knowledge of heart failure (U=4379.0; Z=−4.24; P&lt;0.001); lack of family support (U=6152.5; Z=−4.09; P&lt;0.01); presence of two or more comorbidities (U=11273.5; Z=−2.28; P=0.023); adverse drug effects (U=6990.0; Z=−2.78; P=0.006); poor availability of medications (U=10215.0; Z=−3.43; P=0.001); and reliance on health insurance to obtain medication (X2=7.18; P=0.028). Qualitative results indicated that improving patients' self-care, making changes to the structure of the cardiac clinic (eg more regular follow up with the same clinician) and improving the general healthcare system could reduce treatment regimen fatigue. Conclusions Patients with heart failure seem to experience low levels of treatment regimen fatigue, but this can be influenced by a variety of demographic, clinical and treatment-related factors. Interventions on a local and systemic level could reduce the risk of treatment regimen fatigue, but there is no one-size-fits-all solution.

Physical activity and mental health in individuals with multimorbidity during COVID-19: an explanatory sequential mixed-method study

ObjectiveTo understand the physical activity and mental health of individuals living with long-term conditions during the COVID-19 pandemic.DesignA sequential explanatory mixed-methods study with two phases: phase 1: quantitative survey and...

Clinical Decision Support for Surgery: A Mixed Methods Study on Design and Implementation Perspectives From Urologists

ObjectivesTo assess urologist attitudes toward clinical decision support embedded into the electronic health record and define design needs to facilitate implementation and impact. With recent advances in big data and artificial intelligence, enthusiasm for personalized, data-driven tools to improve surgical decision-making has grown, but the impact of current tools remains limited. MethodsA sequential explanatory mixed methods study from 2019-2020 was performed. First, survey responses from the 2019 American Urological Association annual census evaluated attitudes toward an automatic clinical decision support tool that would display risk/benefit data. This was followed by the purposeful sampling of 25 urologists and qualitative interviews assessing perspectives on clinical decision support impact and design needs. Bivariable, multivariable, and coding-based thematic analysis were applied and integrated. ResultsAmong a weighted sample of 12,366 practicing urologists, the majority agreed clinical decision support would help decision-making (70.9%, 95% CI 68.7–73.2%), aid patient counseling (78.5%, 95% CI 76.5–80.5%), save time (58.1%, 95% CI 55.7–60.5%), and improve patient outcomes (42.9%, 95% CI 40.5–45.4%). More years in practice was negatively associated with agreement (p<0.001). Urologists described how clinical decision support could bolster evidence-based care, personalized medicine, resource utilization, and patient experience. They also identified multiple implementation barriers and provided suggestions on form, functionality, and visual design to improve usefulness and ease of use. ConclusionsUrologists have favorable attitudes toward the potential for clinical decision support in the electronic health record. Smart design will be critical to ensure effective implementation and impact.

COVID-19 Vaccine Hesitancy Among Healthcare Workers: A Phenomenological Study of Skepticism.

Despite the prioritizing the healthcare workers (HCWs) for COVID-19 in a systematized manner the phenomenon of vaccine hesitancy was observed in them. HCWs are presumed to be pre-emptive in up-taking the vaccine due to their closest association and having reasonable background information. Hence, we intended to explore and investigate the phenomenology of skepticism and hesitancy toward the COVID-19 vaccine among HCWs. A sequential explanatory mixed methods study design incorporating a baseline cross-sectional survey followed by qualitative and semiquantitative text-mining approach was adopted in a tertiary care center in Madhya Pradesh, India. Six hundred seventy-nine HCWs for quantitative data and 30 HCWs for qualitative interviews were surveyed. After determining the quantum and baseline traits of hesitant HCWs, 30 participants were purposively selected for in-depth qualitative analysis based on grounded theory using a framework approach and consolidated from the psychological and philosophical plane of skepticism. This was complementedby a semiquantitative text-mining approach using mono/bigram analysis and network plotting. Approximately one-fifth of participants (18%,122 out of 679) were initially, and one-tenth of initially hesitant (10 out of 122) were terminally hesitant. Hesitant and non-hesitant participants were similar except for comorbidity status.Five themes emerged namely individual, vaccine-related, social, system, and contextual after thematic consolidation. Words/phrases indicating individualistic desire to knowing more, internal conflicts, and conjecture were mined further. The network plot showed diversified expressionsof participants. There seems to be a requirement to prime HCWs by offering objective information beforehand and removing diffidence using a systematic approach addressing the psychology and prevalent partisan belief in similar circumstances in the future.

Secondary School Teachers’ Conceptions of Teaching Science Practical Work through Inquiry-Based Instruction

Contemporary science teaching pedagogy in Namibia places a strong emphasis on fostering inquiry-based instruction and practical work in secondary school science education. In recent years, there has been a growing recognition of the need to move beyond traditional, rote-based methods towards more learner-centred approaches that encourage active inquiry and critical thinking. Teachers are encouraged to design lessons that promote inquiry, where learners actively investigate scientific phenomena, ask questions, and develop solutions through hands-on experimentation. Science practical work, which involves conducting experiments and investigations, is considered a cornerstone of this approach as it provides learners with opportunities to apply theoretical knowledge, develop laboratory skills, and gain a profounder understanding of scientific concepts. This sequential explanatory mixed methods study explored Namibian secondary school teachers’ conceptions of teaching science practical work through inquiry-based instruction to provide a comprehensive understanding of teachers’ perspectives and practices. Findings from this study revealed that many teachers held traditional views of science practical work, emphasizing cookbook-style experiments and memorisation. These teachers often faced challenges in implementing inquiry-based instruction due to a lack of training and resources to facilitate science practical work. However, a subset of teachers who embraced inquiry-based methods reported increased learner engagement, critical thinking, and in-depth understanding of scientific concepts. Additionally, the findings underscored the importance of aligning teacher conceptions with contemporary pedagogical approaches for effective secondary science education in Namibia. The study thus, highlighted the need for professional development and support to help more teachers transition to inquiry-based instruction and improve science education in Namibian secondary schools.

Motivations for Entrustable Professional Activity Assessment: Gaps Between Curriculum Theory and Resident Reality

Background Previous research demonstrates mixed reactions from residents toward competency-based medical education (CBME), and entrustable professional activities (EPAs) specifically. However, understanding what motivates residents to obtain EPAs may be vital to the longevity of CBME, given the emphasis on assessment for learning under this paradigm. Objective This study explored resident perspectives across 3 domains: motivation for obtaining EPAs, perceived importance of EPAs, and overall thoughts on CBME curriculum. Methods This was a sequential exploratory mixed-methods study involving 2 phases of data collection. Phase 1 was semi-structured interviews with residents enrolled in CBME at one Canadian institution from November 2019 to July 2020. Analyses included thematic and manifest content analysis. Phase 2 was an electronic close-ended survey to capture residents’ primary motivation for requesting EPAs and importance of EPAs for learning. Survey data were analyzed descriptively. Results Of 120 eligible residents, 25 (21%) and 107 (89%) participated in the interview and survey, respectively. Program requirement was the dominant motivation for obtaining EPAs. There was variability in perceived importance of EPAs on learning. Increased resident workload, gaming the system to maximize EPA scores, and lack of shared ownership from preceptors were cited as critiques of the curriculum. Survey responses corroborated interview findings. Conclusions Although many residents recognize the value of EPAs, the majority are not intrinsically motivated to seek out assessment under the current CBME framework.

IJCM_43A: Status of sexual and reproductive health services among youths from a rural area of Madhya Pradesh: A mixed-method approach

Background: Warranting adequate sexual and reproductive health (SRH) among the youth population in India is challenging. While the Government has undertaken several measures to improve SRH services, gaps exist in terms of availability of these services at the health centre. Objective: To assess utilization of SRH services and explore the associated factors among youth population in rural area of Central India. Methodology: An explanatory sequential mixed method study was conducted which included collection and analysis of quantitative data pertaining to the utilization of SRH services from 236 youth (aged 15-24 years) selected through multistage cluster sampling. This was followed by 29 in-depth interviews conducted among the various stakeholders. Quantitative data was entered using MS Excel and analyzed using R v-4.1.0. The notes and audio recordings from the interviews were transcribed manually and thematic analysis was done. Results: Out of 236 youths, only 90 (38.1%) had ever availed SRH services, of whom 85.5% had visited the SRH clinic in the past 12 months. The most common reason to visit a government health facility was cited as a pregnancy test while in the case of private health facility the reasons were STD treatment, pregnancy tests, and abortions. Except the request for contraceptive services and adequate response to questions by clients, the services provided by the facilities were reported to be inadequate. Further exploration summarized the barriers and facilitators of the health care services under the themes of training, logistics, ARSH clinic, adolescent health days, and community awareness. Conclusion: Among the various influences of SRH, the healthcare system is a fundamental aspect; which seems to address inadequately the varied needs of the rural youth. Future efforts must focus on community awareness and involvement of all stakeholders to uplift SRH services, so as to have positive impact on their sexual health.

Language teachers’ identity tensions and professional practice in intercultural teaching

Language teachers’ experiences of identity tensions present valuable opportunities for researchers to understand the complex role of professional identity in shaping language teachers’ instructional practice. This exploratory sequential mixed-method study reports on identity tensions as experienced by teachers of Chinese as an additional language (CAL), and its role in mediating their instructional practice in intercultural teaching. First, seven types of professional and sociocultural identities related to intercultural teaching were generated based on interview responses and observation field notes from 10 CAL teachers. One hundred and three CAL teachers were then surveyed to identify the roles of these identities in mediating their approaches to intercultural teaching. An exploratory factor analysis of the survey data suggested that cultural learner identity, cultural bridge identity, and bearer of Chinese culture identity were significant predictors of fact-oriented or holistic development-oriented approaches to intercultural teaching. Furthermore, it was found that the tension and synergy among different identity components coexisted in mediating the participants’ efforts in intercultural teaching. The findings underscore the importance of adopting identity-oriented perspectives and approaches, and paying more attention to teacher identity tensions in supporting language teachers’ professional practice and development.

Method Study to Compare a CAAHEP Accredited Advanced Cardiac Sonography Program With Two Pilot Advanced Sonography Programs

Objective: The aim was to review the value of advanced sonography programs and to quantitatively evaluate the educational outcomes of two pilot advanced sonography programs (e.g., vascular and perinatal) with a well-established Commission on Accreditation of Allied Health Education Programs (CAAHEP) accredited Advanced Cardiac Sonography Program. Materials and Methods: The first phase of this sequential mixed-method study was to conduct a document analysis and extracting themes from published literature to highlight the content, benefits, and development of advanced sonography programs. The second phase was to implement a one-group pre-test post-test design to address the population, intervention, control, and outcomes (PICO) question: Among a sample of 12 participants (P), what are the effects of advanced programs (I) in cardiac, vascular, and perinatal sonography (C) on students’ composite knowledge, across 12 course levels and one clinical internship (O)? Results: The document analysis identified four latent themes: (1) the benefits of sonographer certification; (2) the need for sonographers to continuously develop their knowledge and skills; (3) the need to develop sonographers in diverse specialties of medicine; and (4) the need to develop new credentials for advanced practice sonographers. The effects of the three advanced sonography programs on the composite knowledge of the graduates were impressive, indicated by Hedges’ g = 2.02 (moderate) to 2.71 (large) effect size. Triangulation of data revealed that the four latent themes were consistent with the evaluation of the content and outcomes of the advanced cardiac, perinatal, and vascular sonography programs. Conclusion: Consistency between theory and practice and similar educational outcomes were achieved when comparing a well-established Advanced Cardiac Sonography Program with two pilot programs in advanced perinatal sonography and advanced vascular sonography. As this is the first comparison of this type, distinct conclusions that apply to all allied health programs cannot be drawn. The data collection in this study is a set of outcome measures that fits into a larger picture of academic success for these programs.

The effect of a midwifery continuity of care program on clinical competence of midwifery students and delivery outcomes: a mixed-methods protocol

BackgroundThe midwifery continuity of care model is one of the care models that have not been evaluated well in some countries including Iran. We aimed to assess the effect of a program based on this model on the clinical competence of midwifery students and delivery outcomes in Ahvaz, Iran.MethodsThis sequential embedded mixed-methods study will include a quantitative and a qualitative phase. In the first stage, based on the Iranian midwifery curriculum and review of seminal midwifery texts, a questionnaire will be developed to assess midwifery students’ clinical competence. Then, in the second stage, the quantitative phase (randomized clinical trial) will be conducted to see the effect of continuity of care provided by students on maternal and neonatal outcomes. In the third stage, a qualitative study (conventional content analysis) will be carried out to investigate the students’ and mothers’ perception of continuity of care. Finally, the results of the quantitative and qualitative phases will be integrated.DiscussionAccording to the nature of the study, the findings of this research can be effectively used in providing conventional midwifery services in public centers and in midwifery education.Trial registrationThis study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (IR.AJUMS.REC.1401.460). Also, the study protocol was registered in the Iranian Registry for Randomized Controlled Trials (IRCT20221227056938N1).

Effectiveness of Contextualized Marungko Approach-Based Supplementary Reading Material

Acquiring solid reading skills is significant in education as it is the cornerstone for academic success and lifelong learning. This sequential explanatory mixed-methods study investigates the effectiveness of a contextualized Marungko approach-based supplementary reading material in improving the reading performance of Grade 1 pupils. In the pre-experimental phase the Early Grade Reading Assessment (EGRA) tool was utilized to measure the reading skills of the twenty four (24) Grade 1 pupils in terms of identifying letter sounds, identifying initial sounds, reading familiar words, reading invented words, and reading oral passages before and after the implementation of the contextualized Marungko approach-based supplementary reading material. Findings revealed a significant improvement in the early reading skills of Grade 1 pupils after using the supplementary reading material. This indicated that the reading material effectively enhanced the Grade 1 pupils’ reading performance. The responses of the five (5) participants in the qualitative phase, which were examined following Braun and Clark (2013) analysis, yielded two (2) themes. It is recommended that educational institutions and policymakers should consider incorporating the Marungko Approach into their reading instruction programs to enhance alphabet knowledge, phonemic awareness, word recognition, decoding, and oral reading fluency.

Development and validation of the clinical judgment capability questionnaire in nurses: A sequential exploratory mixed method study

BackgroundClinical judgment is one of the most important competencies required for safe care, decision-making, and diagnosis in nursing profession. Therefore, it is necessary to examine clinical judgment in nursing care. Existing a standard questionnaire based on cultural and social conditions can accurately evaluate clinical judgment in nurses. ObjectiveThe present study aimed to develop and validate clinical judgment capability questionnaire in nurses. DesignThe current research was a sequential exploratory mixed method study. SettingThe teaching hospitals affiliated to Jahrom University of Medical Sciences in the South of Iran in 2023. ParticipantsTwelve clinical nurses were included in the qualitative part and 181 nurses in the quantitative part. MethodsThe study was conducted in two parts: one qualitative and one quantitative. In the qualitative part, the concept of clinical judgment was explored using qualitative content analysis. Then, the initial pool of items was generated to develop a questionnaire. In the quantitative part, psychometric properties of the questionnaire were evaluated including face, content, and structure validity and reliability (internal consistency and stability). ResultsAfter examining the psychometric properties, 22 items were developed for the final questionnaire. The results of factor analysis led to the extraction of four factors, including noticing, interpreting, responding, and reflecting. The internal consistency of the questionnaire was confirmed with a Cronbach's alpha coefficient of 0.95 and its stability with an intraclass correlation coefficient of 0.84. ConclusionThe developed 22-item questionnaire is a valid and reliable tool for assessment of clinical judgment capability in nurses.

Figure it out on your own: a mixed-method study on pelvic health survivorship care after gynecologic cancer treatments.

Pelvic health issues after treatment for gynecological cancer are common. Due to challenges in accessing physiotherapy services, exploring virtual pelvic healthcare is essential. This study aims to understand needs, preferences, barriers, and facilitators for a virtual pelvic healthcare program for gynecological cancer survivors. A multi-center, sequential mixed-methods study was conducted. An anonymous online survey (N=50) gathered quantitative data on pelvic health knowledge, opportunities, and motivation. Focus groups (N=14) explored patient experiences and consensus on pelvic health interventions and virtual delivery. Quantitative data used descriptive statistics, and focus group analyses employed inductive thematic analysis. Findings were mapped to the capability, opportunity, and motivation (COM-B) behavior change model. Participants reported lacking knowledge about pelvic health interventions and capability related to the use of vaginal dilators and continence care. Barriers to opportunity included lack of healthcare provider-initiated pelvic health discussions, limited time in clinic with healthcare providers, finding reliable information, and cost of physical therapy pelvic health services. Virtual delivery was seen favorably and may help to address motivational barriers related to embarrassment and frustration with care. Awareness of pelvic healthcare is lacking among people treated for gynecological cancer. Virtual delivery of pelvic health interventions is perceived as a solution to enhance access while minimizing travel, cost, embarrassment, and exposure risks. A better understanding of the pelvic health needs of individuals following gynecological cancer treatments enables the development of tailored virtual pelvic health rehabilitation interventions which may improve access to pelvic health survivorship care.

Pharmacy Students’ Perception of the Content and Delivery of Drug Information Training: A Mixed-Methods Study

ObjectiveTo explore the pharmacy students’ perception of the content and pedagogical strategies used for the delivery of drug information (DI) training. MethodsAn explanatory sequential mixed-methods study was conducted among BSc Pharmacy and PharmD students at the College of Pharmacy, Qatar University. The first phase consisted of a quantitative cross-sectional survey using a 34-item pretested questionnaire. The Donabedian framework guided the development of the questionnaire. This was followed by a phenomenological qualitative phase that was conducted based on the result of the first phase. Descriptive statistics and thematic content analysis were used for data analyses. ResultsThe completion and usable rates were 88.7% (102 of 115) and 91.2% (93 of 102) respectively. The online resources used for the delivery of DI and the progressive structuring from year 1 to 4 were reported to be adequate by a majority of the respondents (93.55%). Ninety percent of the students opined that the use of simulation-based assessments improved their integration of the theoretical and practical aspects, and their preparedness to apply the DI concepts in practice. However, 20% of the participants reported inconsistency of the DI curricular content with some practices encountered during their experiential learning exposures. The themes identified from the focus group discussion included the perceived value and skills acquired from the DI content, availability and currency of DI resources, students’ preparedness, curricular structuring of DI content, and reflection on and recommendations to improve DI coverage and delivery. ConclusionThe curricular structuring of the DI content across varieties of relevant undergraduate pharmacy courses from the lower to higher professional years and its focus on the progressive development of DI-related competencies appeared to have enhanced the students’ perception of the relevance, appropriateness, and utility of the content, resources, and pedagogical strategies used for the delivery of DI education at the undergraduate level.

Inductive process of moral distress development in viewpoints from surgical nurses: a mixed-method study

BackgroundMoral distress is a multifactorial and complex phenomenon influenced by various individual, cultural, and systemic factors. This study aimed to investigate the frequency and intensity of nurses’ moral distress, explore their experiences, and develop the conceptual model of risk factors of moral distress in surgical units and operating rooms.MethodThis is a sequential mixed-method study conducted at four teaching hospitals affiliated with the Qom University of Medical Sciences. In the first step, the moral distress of nurses in surgical units and operating rooms was investigated by a survey. The participants included nurses who worked in the operating room and surgical units. (n = 180). The data was collected by a Moral Distress Scale-Revised (MDS-R) questionnaire. In the second step, the experiences of nurses regarding risk factors of moral distress were explored using semi-structured interviews and analyzed using the conventional content analysis by Graneheim and Lundman’s approach.ResultsOne hundred eighty nurses participated in this study. The mean total moral distress scores ranged from 12 to 221, with a mean (SD) of 116.8 (42.73). The causes of moral distress cited with the highest frequency and intensity related to the ‘role of healthcare providers’. The experiences of the participants in the theme ‘Inductive process of moral distress development’ were categorized into three categories: ‘Melting into the faulty system’, ‘Power and the system as distress promotors’, and ‘Perceived unpleasant consequences’.ConclusionThe results indicated that the frequency of moral distress in operating rooms and surgical units was at a moderate level and the distress intensity of nurses was at a moderately high level. The results indicated that in the investigated system, the “inductive moral process of distress development” was continuously understood by the participants. This process was influenced by systemic and individual factors. Weak assertiveness, conservative compromise, and desensitization to unprofessionalism as individual factors were effective in causing distress. Risk factors at the systemic level led nurses to melt into the faulty system and created adverse outcomes at the individual level. The lack of systemic support and the stabilization of mobbing by powerful system members had a negative impact on the individual factors of distress development. Also, these factors directly cause negative consequences.