Search Results (390)

Objectives: To theorize the work-related dimension involved in the process of reconciling work and personal roles among nurses working in Intensive Care Units. Methods: Constructivist grounded theory was employed to conceptualize the phenomenon of interest from the perspectives of nurses, their families, and administrative staff. Data were derived from 202 h of non-participant observation in two high-complexity hospitals in Chile (one public and one private), 57 institutional documents, and 51 in-depth interviews. Data analysis followed the constant comparative method and multilevel coding. To ensure methodological rigor, the study adhered to the 13 criteria for constructivist grounded theory research proposed by Charmaz and Thornberg and was approved by a scientific ethics committee. Results: Work-related roles are defined as the set of behaviors associated with the professional context, which are shaped by nine sources of interaction: (1) Job content; (2) Workload and pace; (3) Work schedule; (4) Control; (5) Environment and equipment; (6) Organizational culture; (7) Interpersonal relationships; (8) Function within the organization; and (9) Career development. Conclusions: The study presents the theorization process of the work-related dimension involved in the reconciliation of work and personal roles among nurses in Intensive Care Units. Work-related roles are essential to understanding this reconciliation process. The findings provide evidence for the existence of nine sources of interaction, which are influenced by institutional strategic planning and, in turn, by national and international public policies. Full article

Introduction: Tuberculosis (TB) predominantly affects older adults in Japan, and prolonged hospitalization remains a challenge. This study evaluated both clinical and social factors influencing hospitalization duration. Methods: We retrospectively analyzed 203 patients with smear-positive pulmonary TB admitted to NHO Wakayama Hospital (2017–2022). Stepwise multiple regression was used to identify factors associated with hospitalization duration. Results: Key factors included time to smear negativity, duration from isolation release to discharge, independence in daily life, and discharge destination. Prolonged stays were often due to social issues, such as difficulties in arranging transfers to long-term care homes or family acceptance. Conclusions: While Japan is developing new discharge criteria based on clinical indicators, our findings highlight the significant impact of non-clinical, social factors on hospitalization duration. Addressing these factors is essential for effective discharge planning. Full article

Diverse realities challenge the management capacity of public and private systems to ensure equitable quality and efficient access to resources, in line with the 2030 Agenda and the Sustainable Development Goals, which aim to close gaps in essential services and ensure quality of life. The reality in Spain, and more specifically in the Principality of Asturias, is that most resources are concentrated in urban areas rather than rural ones, partly due to the region’s geography. Background/Objectives: This study aimed to explore the perspectives of various stakeholders on the early childhood care system in the Principality of Asturias (Spain), with the purpose of analyzing the mechanisms and determinants involved in its functioning and identifying opportunities for improvement. Methods: A qualitative study was conducted using the theoretical framework of the National Institute on Minority Health and Health Disparities (NIMHD) as a conceptual basis. Semi-structured interviews were carried out with 24 participants selected based on their relationship with early childhood care systems, encompassing different levels of responsibility and operational roles. Data were analyzed using a phenomenological approach, employing inductive and deductive coding to identify recurring patterns and code co-occurrences within ATLAS.ti software. Conclusions: This study reveals major barriers to equitable early childhood intervention (ECI) in rural areas, such as geographic isolation, lack of specialists, long waiting times, and poor transport. Six key themes emerged, including the need for standardized system management, better family support, and digital tools like centralized electronic health records. Rural areas are directly limited regarding their access to services, highlighting the need for fair territorial planning and a holistic, inclusive care model. Improving coordination, accessibility, and technology is vital. Full article

This study investigated how county- and state-level socioeconomic factors influence racial differences in placement stability outcomes for children in foster care. Using a sample drawn from the Adoption and Foster Care Analysis and Reporting System (AFCARS) covering 2012–2020, we employed linear mixed modeling (LMMs) to nest individual- and case-level data within counties and states. Our analysis focused on Black and White children, examining how variables such as poverty, unemployment, public welfare expenditures, residential mobility, and family structure affect the number of placement moves experienced by children. The findings indicated that Black children experience higher rates of placement instability compared to White children, although the gap narrows over time. Key factors associated with improved stability included county-administered child welfare systems and higher rates of multigenerational households and owner-occupied housing, particularly benefiting Black children. In contrast, higher levels of Supplemental Nutrition Assistance Program (SNAP) participation and increased residential mobility were linked to greater instability. The implementation of program improvement plans (PIPs) during the third round of the Child and Family Services Reviews (CFSR-3) produced mixed outcomes, with PIPs contributing to a reduction in the racial gap primarily by increasing placement moves for White children. These findings underscore the importance of analyzing data by race and incorporating broader socioeconomic contexts into child welfare improvement strategies, while also emphasizing the need for localized, context-sensitive approaches to improve placement stability. Full article

With increasing life expectancy, the number of older people living with comorbid diabetes and frailty is increasing. The development of frailty accelerates diabetes-related adverse outcomes. Frailty is a multidimensional syndrome with physical, mental and social aspects which is associated with increased risk of hypoglycaemia, dementia and hospitalisation. Therefore, regular screening for all aspects of frailty should be an integrated part of the care plans of older people with diabetes. In addition, every effort should be made for prevention, which includes adequate nutrition combined with regular resistance exercise training. In already frail older people with diabetes, metabolic targets should be relaxed and hypoglycaemic agents should be of low hypoglycaemic risk potential. Furthermore, the metabolic phenotype of frailty should be considered when choosing hypoglycaemic agents and determining targets. With increasing severity of frailty, proactive chronological plans of de-escalation, palliation and end-of-life care should be considered. These plans should be undertaken in a shared decision-making manner which involves patients and their families. This ensures that patients’ views, wishes and preferences are in the heart of these plans. Full article

Pediatric palliative care (PPC) aims to enhance the quality of life of children with life-limiting conditions and their families through individualized, interdisciplinary support. Among this population, children with neurological diseases represent a substantial and growing group, often facing prolonged disease courses, cognitive impairment, and high prognostic uncertainty. Effective communication is central to PPC; however, it remains deeply influenced by cultural, religious, and spiritual frameworks that shape family perceptions of illness, suffering, and decision-making. This narrative review explores communication strategies in PPC, with a specific focus on children with neurological conditions, highlighting conceptual foundations, cross-cultural variations, and emerging best practices. Key findings highlight the importance of culturally humble approaches, family-centered communication models, and structured tools, such as co-designed advance care planning and dignity therapy, to enhance communication. Additionally, the review highlights the presence of ethical and interdisciplinary challenges, particularly in neonatal and neurology settings, where misaligned team messaging and institutional hesitancy may compromise trust and timely referral to palliative care. Future research, policy, and clinical education priorities should advocate for models that are inclusive, ethically grounded, and tailored to the unique trajectories of neurologically ill children. Integrating cultural competence, team alignment, and family voices is essential for delivering equitable and compassionate PPC across diverse care settings. Full article

If God cares and is present, can God use pain and suffering in my life? Absolutely. Does this mean that God planned, ordained, or designed the pain (or cancer) to be instrumental in my life for some sort of higher spiritual purpose? If so, why? Why does God allow cancer to invade and interrupt one’s life? There are no theologically sound or definitive answers to these questions. Although asking such questions is basic to our humanity, as we will observe in various passages of Scripture, the answers will always remain elusive. Instead of seeking to answer the question “why?”, I will suggest two areas for theological and pastoral reflection with respect to those facing cancer: humility and hope. Enduring cancer, from diagnosis through treatment, requires humility in mind and body before our Creator and before our caregivers. Cancer also provides an opportunity for Christians to embed themselves in the hope of resurrection and new creation. Resurrection hope is also not reduced to hope beyond death but hope that is manifested now through embodied resurrection “signs” and actions of human sacrificial love, both received and practiced by the patient undergoing illness and by the patient’s caregivers, family, and friends. Full article

Background: Family caregivers are a vital yet often under-recognized part of the healthcare system. They provide essential emotional, physical, and logistical support to individuals with illness, disability, or frailty, and their contributions improve continuity of care and reduce system strain. However, many healthcare and social service providers are not equipped to meaningfully engage caregivers as partners. In Alberta, stakeholders validated the Caregiver-Centered Care Competency Framework and identified the need for a three-tiered education model—Foundational, Advanced, and Champion—to help providers recognize, include, and support family caregivers across care settings. This paper focuses on the development and early evaluation of the Advanced Caregiver-Centered Care Education modules, designed to enhance the knowledge and skills of providers with more experience working with family caregivers. The modules emphasize how partnering with caregivers benefits not only the person receiving care but also improves provider effectiveness and supports better system outcomes. Methods: The modules were co-designed with a 154-member interdisciplinary team and grounded in the competency framework. Evaluation used the first three levels of the Kirkpatrick–Barr health workforce education model. We analyzed pre- and post-surveys from the first 50 learners in each module using paired t-tests and examined qualitative feedback and SMART goals through inductive content analysis. Results: Learners reported a high level of satisfaction with the education delivery and the knowledge and skill acquisition. Statistically significant improvements were observed in 53 of 54 pre-post items. SMART goals reflected intended practice changes across all six competency domains, indicating learners saw value in engaging caregivers as partners. Conclusions: The Advanced Caregiver-Centered Care education improved providers’ confidence, knowledge, and skills to work in partnership with family caregivers. Future research will explore whether these improvements translate into real-world practice changes and better caregiver experiences in care planning, communication, and navigation. Full article

Background/Objectives: End-of-life care is a vital part of nursing education that has been overlooked until recent years. Advance care planning should be incorporated into the prelicensure nursing curriculum to build student nurses’ confidence in aiding patients and families with their preferred future care plans. Advance care planning tools, such as the Advance Health Care Directive (AHCD) and Five Wishes, provide experiential learning opportunities that bridge theoretical knowledge with real-world patient advocacy. In this study, students were asked to complete either the AHCD or Five Wishes document as though planning for their own end-of-life care, encouraging personal reflection and professional insight. Embedding these assignments into nursing education strengthens students’ confidence in facilitating end-of-life discussions. This study applied Kolb’s experiential learning theory, including concrete experience, reflective observation, abstract conceptualization, and active experimentation, to explore student nurses’ perspectives on the Advance Health Care Directive and Five Wishes assignments, as well as their understanding of end-of-life care. Methods: This study used an exploratory–descriptive qualitative design featuring one open-ended question to collect students’ views on the assignments. Results: The final sample comprised 67 prelicensure student nurses from Bachelor of Science and Entry-Level Master’s programs. The Advance Health Care Directive and/or Five Wishes assignment enhanced students’ understanding of end-of-life decision-making. Conclusions: It is essential to complete the assignment and immerse oneself in an end-of-life situation to grasp patients’ perspectives and concerns regarding when to engage in difficult conversations with their patients. Full article

Background: Family involvement in promoting patient safety is a strategy that is increasingly recognized. Nurses have a major role to play here. This study aims to know the family care process developed by nurses and explore the logistic process identified as support for the development of family care in ensuring patient safety in the hospital. Methods: An interpretative qualitative study was conducted through semi-structured interviews with 10 nurses selected by convenience. Content analysis was performed using Atlas.ti 9.1.7 software and Bardin’s methodology. Results: Two large families were identified according to the nature of the strategies mentioned by the participant/s: assistance process and logistic process, 5 categories and 23 subcategories. Care process categories: initial assessment, planning, and implementation. Categories of the logistic process: material and human resources and organization. Conclusions: To implement patient and family-centered care to ensure patient safety, it is necessary to adjust the care and logistic process. At the care level, the importance of the nursing process in the organization of care is evident. At the logistical level, organizational initiatives are needed to stimulate and support this philosophy of care and to intervene at the level of human and material resources. Full article

Background/Objectives: Family self-care (FSC) is increasingly recognized as a vital aspect of caregiving in pediatric chronic conditions. However, its development in families of children with intellectual disabilities (IDs) remains underexplored. This study aimed to examine how families construct and sustain FSC, and to identify factors that shape its development across four domains: physical, cognitive, psychosocial, and behavioral. Methods: A qualitative study was conducted using an abductive approach, combining inductive thematic analysis with a deductively applied theoretical framework. Semi-structured interviews were carried out with nine families of children with ID in southern Portugal. The children ranged in age from 4 to 15 years, and the parents were aged between 29 and 53 years. The data was analyzed using Bardin’s content analysis, supported by NVivo software, and organized according to the FSC framework. This study followed COREQ guidelines. Results: The families described a range of self-care strategies, including environmental adaptations, experiential learning, emotional regulation, and long-term planning. These practices were shaped by contextual factors such as access to healthcare, relationships with professionals, emotional support networks, and socioeconomic conditions. Four emergent conclusions illustrate how structural and relational dynamics influence FSC in daily caregiving. Conclusions: FSC is a dynamic, multidimensional process shaped by lived experience, family interactions, and systemic support. The findings support inclusive, family-centered care models and inform clinical practice, training, and policy in pediatric IDs. Full article

Objective: This study seeks to analyze the incidence of breastfeeding self-efficacy in postpartum woman who are undergoing prenatal care at the Family Health Strategy Units in the city of Tubarão, Santa Catarina (SC), Southern Brazil, from August to December 2022. Methods: An observational epidemiological study with a cross-sectional design was carried out with puerperal women—either primiparous or multiparous—who were followed in the municipal public network, along with their live-born children delivered at the maternity hospital of Hospital Nossa Senhora da Conceição in Tubarão, SC. Participants agreed to participate in the study. For data collection, an instrument developed by researchers and a validated instrument entitled Breastfeeding Self-Efficacy Scale-Short Form were used to assess the self-efficacy of breastfeeding. Results: The mean score of the Breastfeeding Self-Efficacy Scale (BSES) was 61.75 points (±6.39), indicating high self-efficacy. There was an association between the mean of the general score and/or the domains of the BSES with maternal characteristics. Women with higher education had greater technical mastery (p = 0.010), and those with previous breastfeeding experience and those who breastfed their children during the first hour of life had a higher average in the overall score and in the domains of the scale. In addition, those who planned the pregnancy (p = 0.024) and those who did not receive assistance from the milk bank (p = 0.047) had greater technical domain. Conclusions: In the present study, there was a predominance of high breastfeeding self-efficacy. It was verified that the personal and clinical aspects interfered in the self-efficacy of breastfeeding. Full article

Background: Patients with Down syndrome (DS) commonly experience psychological and mental problems. Studying the quality of life (QoL) of children with DS is important because it increases knowledge related to understanding the challenges that this group may face. This study aims to examine the QoL of children with DS from a parental perspective in terms of physical, emotional, social, and school domains, depending on several factors, and identify demographic characteristics of their parents that may affect their QoL. Methods: This online survey study was conducted in Saudi Arabia between November 2024 and March 2025. The inclusion criteria targeted parents of children with confirmed DS diagnoses aged between 8 and 18 years. Results: The findings of this study showed that children with DS aged between 0 and 2 years had significantly lower QoL scores (10.18 ± 3.83) compared to other age groups (p = 0.02). In addition, gender differences were significant in the emotional (p = 0.03), social (p = 0.01), and school (p = 0.01) domains, with females scoring lower QoL scores in all areas compared to males. Moreover, educational level showed significant results across all domains, particularly for children with no education, who had the lowest QoL scores in the physical domain (22.34 ± 7.53, p = 0.004), emotional domain (10.41 ± 3.79, p = 0.003), social domain (11.22 ± 4.06, p = 0.001), and school domain (8.75 ± 5.09, p = 0.001). The findings of this study showed that children with DS who are in primary school (odds ratio (OR) = 5.90, 95% confidence interval (CI): 1.85–18.78, p = 0.003) and middle school (OR = 5.27, 95% CI: 1.44–19.31, p = 0.012) had significantly higher odds of better QoL compared to children with no formal education. Additionally, children cared for by their fathers had significantly lower odds compared to those cared for by their mothers (OR = 0.07, 95% CI: 0.01–0.90, p = 0.041). None of the demographic characteristics of caregivers reached a statistical significance level to have influence on caregivers QoL (p > 0.05). Conclusions: The findings of this study demonstrated a low level of QoL, affecting the emotional, social, and school domains, especially among female children with DS aged between 0 and 2 years with no formal education and cared for by their fathers. Governments should develop a comprehensive plan to care for these children and families in order to enhance their rights and quality of life, thereby placing emphasis on those who exhibit parameters related to a lower QoL. Full article

Background/Objectives: Using healthcare vouchers mitigates the financial burdens of low-income individuals, therefore enhancing mothers’ satisfaction and encouraging service utilization. In Yemen, reducing financial barriers results in marked improvement in reproductive health services utilization for mothers and their newborns. Such financial strain can be addressed through reproductive health vouchers, which reduce out-of-pocket expenses of family planning, pregnancy, birth, postnatal care and neonatal care. This study compares the Safe Motherhood and Family Planning Voucher Program in the Lahj governorate to the non-voucher program in the Abyan governorate in terms of enhancement of reproductive healthcare accessibility and use. Methods: This facility-based, quantitative, comparative, cross-sectional study was conducted in the Lahj governorate, which supports the Safe Motherhood and Family Planning Voucher Program, and the Abyan governorate, which does not. Results: The voucher-supported program has greatly improved mothers’ satisfaction, access, and use of all reproductive health services by covering transportation, covering lodging during hospitalization, and providing free reproductive treatments. Compared to Abyan mothers, Lahj governorate mothers more frequently used rental vehicles (paid for by the voucher program) and free reproductive health services (p-value < 0.001). Lahj governorate mothers (who used the vouchers) used family planning, prenatal care, facility-based delivery, home delivery by competent birth staff, cesarean section, postnatal care, and neonatal care more frequently than Abyan governorate mothers. A health institution which supported the Safe Motherhood and Family Planning Voucher Program (SMHFPVP) provided prenatal care (98.5%), competent birth services (99.0%), and modern contraceptive use (92.3%)—oral contraceptive pills, implants, injectables, contraceptive patches, vaginal rings, and intrauterine devices—for mothers who were interviewed and attended the targeted HFs in the Lahj governorate, compared with (77.6%), (80.3%), and (67.8%), respectively, for mothers in Abyan governorate who were not supported by the SMHFPVP. This study demonstrates substantially higher satisfaction levels among voucher-using mothers in the Lahj governorate compared to those in the Abyan governorate, across all satisfaction domains and overall satisfaction scores. Conclusions: This study found that women without access to maternal health vouchers experienced worse prenatal, natal, and postnatal care and were less satisfied with healthcare services compared with women who used vouchers. Full article

Background: It is generally well-known that narration of care is critically important to high-quality nursing care. Narration of care is loosely defined as a nurse’s ability to describe to patients and families the clinical purpose behind nursing practice, what is hoped to be achieved, and the “why” (or clinical rationale) behind nursing activities. Despite the importance of narration of care, there is little practical guidance given to nurses about how to narrate care—what makes for effective or ineffective narration of care. Objective: Our aim was to develop a framework for teaching nurses and patient care assistants (PCAs) on how to effectively narrate care. In this article, we provide a practical framework for teaching nurses and PCAs how to narrate care. We describe the process of developing the framework as part of quality improvement efforts and implementing a course for eight hospitals based on the framework. Methods: Consistent with a Plan-Do-Study Act (PDSA) quality improvement approach, we developed the framework by first conducting a data and literature review, then convening a taskforce, discussing with patients on our existing committees, and finally formulating a framework. We then drafted supplementary cases and course material and implemented a course to teach nurses and PCAs how to narrate care. Results: The narration of care framework (NOC) that we developed and implemented consisted of the following five principles, which can be called RECAP as an acronym: 1. The “R” in RECAP stands for removing uncertainty. 2. The “E” in RECAP stands for explaining the environment. 3. The “C” in RECAP stands for being calm and sincere. 4. The “A” in RECAP stands for assume nothing. 5. The “P” in RECAP stands for personal connection. As for the course developed based on the RECAP principles, there was a total of 276 course offerings conducted by 30 facilitators, and 7341 nurses and PCAs completed the course. The evaluations reflected that 99% of learners believed their learning was improved by the course. Discussion: There are several multifaceted benefits to NOC: nurses’ and PCAs’ capability to narrate care well shows empathy and compassion to patients; it strengthens patient understanding and education that can lead to improved patient outcomes; and it helps allay patients’ uncertainties and anxieties. In essence, narrating care in an effective manner cultivates a strong nurse–patient therapeutic relationship. Yet, in the absence of any practical guidance, nurses and PCAs are left to develop narration skills on their own, learning by trial and error, and, in doing so, perhaps failing to meet patients’ needs and failing to fully derive the many benefits that the NOC is designed to achieve. Our hope is that, if hospital systems adopt our work, nurses and PCAs can comfortably and confidently enter the profession knowing the purpose or narrating care, its many benefits, and how to practically conduct sufficient narration, and what would constitute insufficient narration. Hospitals, in turn, can specify and clearly articulate their expectations for nurses and PCAs narrating with patients—what would make for a strong, compassionate process and what would be inadequate. For more experienced nurses, they can use the RECAP framework to reflect on their own practices and perhaps strengthen or refreshen existing skills. Conclusions: NOC is acknowledged, somewhat implicitly, as being critical to nursing and PCA practice, yet practical instruction and specified principles are lacking. We aimed to fill this gap by developing, implementing, and teaching a practical framework, armed with many tools nurses can use. Full article