Facilitating and hindering factors of community nurses'emergency and critical care treatment abilities:A qualitative study

BACKGROUND This study adopts a descriptive phenomenological approach to investigate the facilitators and barriers of community nurses'abilities in managing critical and emergency conditions.With the transition of healthcare systems to the community,the evolution of nursing practices,and the attention from policies and practices,community nurses play a crucial role in the management of critical and emergency conditions.However,there is still a lack of comprehensive understanding regarding the factors that promote or hinder their capabilities in this area.AIM To understand the facilitators and barriers of community nurses in managing critical and emergency conditions,exploring the fundamental reasons and driving forces influencing their treatment capabilities.METHODS This study utilized the destination sampling method between May 2023 and July 2023.It employed a descriptive phenomenological approach within qualitative research methodologies.Through objective sampling,17 community nurses from 7 communities in Changning District,Shanghai,were selected as the study subjects.Semi-structured interviews were conducted to gather data,which were subsequently organized and analyzed using Colaizzi's seven-step analysis method,leading to the extraction of final themes.RESULTS The barrier factors identified from the interviews encompassed three topics:resource allocation,professional factors,and personal literacy.The facilitators comprised three themes:professionalism,management attention,and training and continuing education.We identified that the root causes of the barriers included the lack of practical treatment experience among community nurses,insufficient awareness of self-directed learning,and limited knowledge and technical proficiency.The professional quality of community nurses and management attention serve as motivation for them to enhance their treatment abilities.CONCLUSION To enhance the capability of community nurses in treating acute and critical patients,it is recommended to bolster training specifically tailored to acute and critical care,raise awareness of first aid practices,and elevate knowledge and skill levels.

A qualitative study on nurses'reactions to inpatient suicide in a general hospital

Aims:To explore the impact of inpatient suicides on nurses working in front-line,the patterns of regulation and their needs for support.Methods:Data were collected through purposive sampling by conducting semi-structured and individual in-depth interviews in a tertiary referral hospital in China.Colaizzi's sevenstep phenomenological method was simultaneously used by two interviewers.Results:Reactions to inpatient suicides revealed three central themes:(1)inpatients were highly likely to commit suicide,(2)inpatient suicide was difficult to prevent,and(3)nurses lacked the necessary suicide prevention skills.Psychological responses mainly included shock and panic,self-accusation or guilt,sense of fear,and frustration.The impacts on practice were stress,excessive vigilance,and burnout.Avoidance and sharing of feelings played key roles in the regulation patterns of nurses.Conclusions:Nurses who experienced inpatient suicide became stressed.Effective interventions must be implemented to improve the coping mechanisms of nurses against the negative consequences of inpatient suicide.The findings of this study will allow administrators to gain insight into the impacts of inpatient suicides on nurses in general hospitals.Such information can be used to develop effective strategies and provide individual support and ongoing education.Consequently,nurses will acquire suicide prevention skills and help patients achieve swift recovery.

Exploring Barriers to Implementation of Smoking Policies: A Qualitative Study on Health Professionals from Three County-Level Hospitals

Objective This study was to identify factors limiting the implementation of smoking policies in county-level hospitals. Methods We conducted qualitative interviews （17 focus groups discussions and 6 one-to-one in depth interviews） involving 103 health professionals from three target county-level hospitals. A combination of purposive and convenience sampling was used to recruit subjects and gain a broad range of perspectives on issues emerging from ongoing data-analysis until data saturation occurred. The transcripts were analyzed for themes and key points. Results The main themes that emerged suggested that both smokers and non-smokers viewed smoking very negatively. However, it was clear that, underlying this acceptance of the health risks of smoking, there was a wide range of beliefs. Most of the health professionals pointed out that, as smoking was legal, addictive, and influenced by social norms, currently it was almost unrealistic to expect all smokers to give up smoking or not to smoke in the hospitals. Furthermore, they were concerned about the potentially detrimental effects of providing counseling advice to all smokers on the interpersonal relationship among colleagues or between doctors and patients. In addition, low level of employee participation influenced the sustainable implementation of smoking policies. Conclusions Simply being aware of the health risks about smoking did not necessarily result in successful implementation of the smoking policies. Application of comprehensive intervention strategies such as implementing smoking policies in public places at the county level, creating supportive environments, promoting community participation, and conducting health education, may be more effective.

Perceptions of nurses in Japan toward their patients' expectations of care: A qualitative study

Objectives: This study aimed to investigate ideal nurse involvement based on the expectations of patients.Data on conflicts between nurses and patients were obtained.The patient situation involved standard nursing treatment,rather than acute phase or palliative care.Methods: Questionnaires were distributed among senior nurses attending a series of trainings in 2012 and 2013.The nurses were requested to return their completed questionnaires within two weeks.We ensured the effectiveness of the interview process to obtain accurate answers.The sample comprised 240 head nurses and assistant head nurses who were asked to respond anonymously to 57 questions about non-acute (stable) psychiatric or physical nurse-patient scenarios.Qualitative data analysis was conducted using these responses.Results: We received 41 completed responses (response rate =17.1%).The expectations of patients and their families were reflected in five categories,namely,inference,empathic understanding,listening attitude,individual treatment,and reliable skills and explanations.Inference was independently categorized as a particularly strong characteristic of Japanese patients' expectations.Conclusions: Nursing care in situations where conflicts or misunderstandings may arise can be improved by encouraging nurses to be attentive to the moods,feelings,and expectations of patients and their families.The findings from this study can improve the quality of Japanese nursing care with regard to sensing (inferring) and reacting to the expectations of patients.

Parents' experience of caring for children with type 1 diabetes in China's Mainland: A qualitative study

BACKGROUND Parents of children with type 1 diabetes mellitus(T1DM)are under heavy caregiving stress,and parental caregivers'experience can affect the health outcomes of children with T1DM.AIM To describe the true inner feelings of parents caring for children with T1DM.METHODS Descriptive research methods were used to classify and summarize parents'experience when adapting to the role of caregivers for children with T1DM.The data was sorted and analyzed using content analysis.Themes of parents'experience caring for children with T1DM were refined,and their feelings were deeply investigated.RESULTS A total of 4 themes and 12 subthemes were identified:(1)Desire for information(disease-related information,home care information,and channels of information acquisition);(2)Skill guidance needs(insulin injection techniques,skills required for symptom management,and skills for parent-child communication);(3)Seeking emotional support(family support,peer support from other parents of children with T1DM,and professional support);and(4)Lack of social support(needs for financial support and needs for social security).Exploring the true experience of parents caring for children with T1DM is of great significance for helping them adapt to their role as caregivers.Nurses should provide professional guidance in terms of information,skills,emotion,and social support to parental caregivers.

Struggling to live a new normal life among Chinese women after losing an only child:A qualitative study

Objectives:Losing an only child is a life-altering event that destroys Chinese women’s lives and health in several dimensions.However,there is no unified theory exists to guide nursing practice.This study aimed to discover the substantive theory of how Chinese women live with the loss of their only child.Methods:This qualitative study used the grounded theory method.Purposive sampling,snowball sampling,and theoretical sampling were used to recruit participants.Saturated data from the in-depth interview,observation,and field notes with 13 Chinese women who have lost an only child in Southwest China were analyzed using the constant comparative method concurrently supplemented by the ATLAS.ti program,memo writing,and diagramming.Findings:Struggling to live a new normal life among Chinese women after losing an only child emerged as the substantive theory.It consists of three phases:living in agony,coming to terms,being alive in a new way.Receiving support motivated them to deal with such a loss.However,it brought them back to the previous phase(s)whenever they encountered adverse triggering situations.Therefore,they moved back and forth between these phases.The findings also illustrated that this process was profoundly affected by Chinese culture and personal beliefs.Conclusions:This substantive theory may guide nursing practice based on understanding the living process by working through the three phases.It would help develop a professional care plan recognizing individual diversity and incorporating socio-cultural and religious knowledge to effectively support women to deal with the loss of an only child.

Progressive exhaustion:A qualitative study on the experiences of Iranian family caregivers regarding patients undergoing hemodialysis

Objective:The aim of this study was to explore the burden of care for patients undergoing hemodialysis from the experiences of family caregivers.Methods:In this qualitative study,a content analysis approach was used for data collection and analysis.Participants were 16 family caregivers selected through purposive sampling from four medical education centers affiliated with Ahvaz Jundishapur University of Medical Sciences,Iran.Semi-structured interviews were held to collect data.Results:Four categories were developed as follows:‘care challenges’,‘psychological vulnerabilities’,‘the chronic nature of care’and“care in the shade”.The categories led to the development of the main theme of‘progressive exhaustion’experienced by the family caregivers during the provision of care to patients undergoing hemodialysis.Conclusion:Family caregivers have a significant role in the process of patient care,and this role leads them to progressive exhaustion;therefore,the overall health of the caregivers should be taken into account and more attention should be paid to their quality of life,social welfare,and satisfaction level.

Resilience in new nurses:a qualitative study

Objectives:To explore the resilience experience of new nurses and how new nurses develop and apply resilience strategies to cope with the difficulties during the transition period.Methods:A descriptive qualitative research method was on data acquired using data semi-structured interviews with 12 new nurses aged 20-26 years whose working time was more than 12 months but less than 24 months.Results:Analysis of the data could determine participants adopting resilience strategies to withstand difficulties and challenges in transition period.This period consisted of three main phases:"self-protection,""undertaking challenges,"and"planning future."The first-line nurse managers'feedback and flexible shift scheduling paid a vital part in promoting the resilience development of new nurses.Conclusions:Recognizing the importance of understanding and developing the resilience of new nurses in the transition period could greatly reduce the turnover rate and alleviate the shortage of nurses in global nursing workforce.

Why pregnant women delay to initiate and utilize free antenatal care r service:a qualitative study in the Southern District of Mzimba,Malawi

Aim:The study aimed to explore factors related to the initiation and utilization of focused antenatal care(FANC)in the Southern District of Mzimba,Malawi.Methods:This study used an exploratory qualitative design.Total of 22 in-depth interviews with pregnant women and community midwife assistants were conducted from December 2015 to January 2016 in Mzimba.Thematic analysis approach was adopted to identify the facilitator and harriers of the FANC initiation and utilization.Results:Facilitator of FANC initiation and utilization included seeking pregnancy confirmation,medical treatment for an existing health problem and the support by community health extension workers.Barriers included the additional cost to free FANC service,lack of essential equipment,unfriendly adolescent reproductive health service,and HIV stigma.Conclusion:Early initiation of FANC relies on both woman’s awareness and community support.Promoting the use of FANC should focus on creating an enabling environment,e.g.,increasing investment of essential medical equipment,reducing additional costs of FANC services,eliminating the discrimination against adolescent pregnancy and people living with HIV,and strengthening health personnel’s training.

Patient tracking in earthquake emergency response in Iran： A qualitative study

BACKGROUND: After a disaster, all victims have to be rapidly and accurately identified for locating, tracking and regulating them. The purpose of this study was to summarize people's experiences that how the patients were tracked in past earthquake disasters in Iran.METHODS: A qualitative study was carried out in 2015. This was an interview-based qualitative study using content analysis. The interviewed people included physicians, nurses, emergency medical technicians, disaster managers, Red Crescent Society' first responders and managers. Participants were identified using a snow ball sampling method. Interviews were audiotaped, transcribed, coded, and entered into MAXQDA(version 10) for coding and content analysis.RESULTS: Three main themes and seven categories including content(recoding data), function(identification of victims, identification of the deceased, informing the patients' relatives, patients' evacuation and transfer, and statistical reporting), technology(the state of using technology) were identifi ed that showed the patient tracking status in past earthquakes in Iran.CONCLUSION: Participants believed that to identify and register the data related to patients or the dead, no consistent action plan was available. So developing a consistent patient tracking system could overcome this issue and improve patient safety.

A qualitative study of the psychological processes in patients with post-herpetic neuralgia

Objective:To understand the psychological process of patients with post-herpetic neuralgia(PHN)and provide references for the psychological management of PHN.Methods:The objective sampling method was used to conduct semi-structural in-depth interviews on 10 PHN patients,and Colaizzi’s phenomenological analysis method was used for data analysis.Results:According to the different pain durations of PHN patients,the patients were divided into three stages and five themes were extracted:the need for strong pain relief,the helpless tolerance of pain,the self-feeling burden,the need for health education,and the positive response to pain.Conclusions:PHN has complex psychological activities,so it is necessary to pay attention to the psychological process of patients and take effective psychological measures to intervene negative psychology so that patients can actively cope with the pain.

Assessment of community health needs of Chongqing residents: a qualitative study

Objective: The aim of this preliminary qualitative study was to gain insight into community health needs in order to develop health program for community in Chongqing. Methods: Totally 40 participants were assigned into 6 focus group discussions. All groups were led by local language speakers, and their talking was recorded after gaining informed consent. Transcribed data were coded and subjected to thematic analysis. Results: The main obtained themes were that community health problems were chronic noncommunicable disease, main health service needs included regularly free check-up and health education, and perceived health risk factors were unhealthy lifestyle and behavior as well as environment problems. Conclusion: Our community health needs assessment (CHNA) with FGDs indicate that residents realize the importance of prevention of disease. Our study identifies that primarily community health promotion is one of the priorities of community health service needs, including reorienting health service, health education, guiding behavior or lifestyle, and creating healthy environments. The findings of this study can provide guidance to the development of more effective and pertinent health program in this community.

Hikikomori, a Phenomenon of Social Withdrawal and Isolation in Young Adults Marked by an Anomic Response to Coping Difficulties: A Qualitative Study Exploring Individual Experiences from First- and Second-Person Perspectives

Hikikomori is a recent phenomenon among young adults in which they isolate themselves from social contacts and responsibility for more than 6 months. This problem has assumed epidemic proportions in Japan and has been widely discussed across disciplines. Previous studies have associated hikikomori with a maladaptation to structural change, an emergent mental problem that needs new diagnosis, or an under-diagnosed schizophrenic disorder. Most previous work has adopted a clinical perspective, and there have been no qualitative studies exploring the individual feelings of people suffering from the syndrome. We adopted a qualitative method using a grounded theory approach. Data collection and analysis took place between September 2006 and August 2008. Theoretical sampling included eight informants from snowball sampling and an online observation consisting of 160 online participants. Analysis focused on informants’ first- and second-person experiences of hikikomori. Data analysis revealed one overriding theme: coping difficulties consisting of the two categories stasis and expression. As a result of conflicting demands and reduced autonomy, respondents experienced stasis, which prevented them from moving forward;“hiding” or “avoiding” heightened the expression of their behaviors. This is the first study to explore the in-depth experience of individuals suffering from hikikomori syndrome in a non-clinical setting. We argue that hikikomoriis not a result of asocial behavior, but rather an anomic response to a situation that informants felt powerless to change and from which they could see no way out. We also observed that feelings of hopelessness and relationship fatigue might be overcome by introducing a relaxed social environment that people can control during rehabilitation.

Explaining the dimensions of specific competence in training specialist nurses in multiple sclerosis:a qualitative study

Background:The complexity of multiple sclerosis(MS)due to psychological,emotional,physical,family,and social dimensions complicates the care of these patients.MS patients need hospitalizations and long-term care to treat and control the progression of the disease.Therefore,the competence of caring for MS patients is one of the important issues in clinical nursing.Objective:To explain the dimensions of competence in caring for MS patients.Methods:This study is a qualitative descriptive study using conventional content analysis method.Field notes and semi-structured face-to-face interviews were conducted on 12 specialist nurses of MS and 3 MS patients from the neurology ward.Participants were selected through purposeful sampling.Data analysis was performed using the approach of Zhang and Wildemuth by continuous comparison simultaneously with data collections.Results:Data analysis led to the extraction of 2 categories with 5 subcategories.The first category is“unlearned care competence,”with the subcategories as psychological-emotional resilience,psychological skills,and excellent communication skills.The second category is“specialized technical competence,”with the subcategories as up-to-date pathological knowledge and expertise in clinical procedures.Conclusions:Identifying the competencies of nurses of MS patients is important for educating nurses to provide qualified care and improve MS patient satisfaction.Nursing managers can empower nurses in non-technical areas such as in-service psychology courses and improve professionalism in caring for MS patients by promoting communication and specific clinical skills.

Experiences of Chinese nurses studying for master’s degree in the UK: a qualitative study

Objective:To explore experiences of Chinese nurses who study for Master of Science in Professional Practice(health care)in the United Kingdom.Methods:A qualitative approach was applied,consisting of semi-structured telephone interviews(n=8).The Colaizzi seven-step framework analysis method was used to extract themes.Results:The themes that emerged are as follows:(1)gains from studying overseas,(2)difficulties during studying,and(3)impacts of learning experience on work.The gains for nurses studying overseas include the improvement of scientific research capabilities,reconstruction of critical thinking,and development of reflection ability.Difficulties while studying mainly include language barrier,strict assessment,and boring life.Conclusions:The education of nursing postgraduate attaches impor tance to the cultivation of thinking.Nurses are very interested in nursing research including qualitative and quantitative methods.Nurses encountered language barriers in their study and life even though they knew a cer tain level of English.

A Qualitative Study on the Negative Emotions of Mothers during Chemotherapy of Their Children with Malignant Brain Tumors

Objective: To explore the negative emotions of mothers during chemotherapy of their children with malignant brain tumors. Methods: The phenomenological method for qualitative studies was adopted;convenience sampling was used to conduct semi-structured interviews to the mothers of 9 children with malignant brain tumors who received chemotherapy from June 2019 to December 2019;the Colaizzi 7-step analytical method was implemented to collate and analyze the original data. Results: The results were summarized into six subjects: stressed, exhausted because of trying to control everything in home care, prone to excessive care, financially burdened, desperate for knowledge of patient care, and desperate for psychosocial support. Conclusions: Understanding the real experiences and inner feelings of mothers during chemotherapy of their children with malignant brain tumors is helpful for medical staff to learn about the psychological distress and needs of mothers of children with malignant brain tumors, so as to give them psychological support and even social support, and help the mothers and the families of children with malignant brain tumors get through a special period.

A Qualitative Study for Measuring Warehouse Performance Using Triangulation Approach

This research aims to validate a structural equation modeling （SEM） model for measuring warehouse performance using data from an international company in Australia （company G）. Moreover, a methodological triangulation method was also adopted to test whether different methodological approaches produce convergent findings about warehouse performance measurement （WPM）. These three different methods are the SEM model, the multiple case research study, and validation of the SEM model using data from 80 companies in Thailand and a company in Australia. With the results from the triangulation method, it is obvious that the SEM model can be used to measure the performance of warehouses in Thailand and Australia. Since the SEM model consists only of significant indicators, it is more appropriate than company G＇s scorecard. Furthermore, the SEM model can overcome the limitations of traditional models by allowing companies to compare their performance over time.

What Contributes to Satisfaction with Care for Family Caregivers of Terminal Cancer Patients Admitted to General Wards? A Qualitative Study

Satisfaction with care is an important indicator for family caregivers of patients with terminal cancer and is linked to the quality of life. Despite this, few studies have examined the aspects of satisfaction with care of family caregivers of inpatients with cancer in general wards. This qualitative study aimed to elucidate the elements of satisfaction with the care that inpatients with terminal cancer in general wards and their family caregivers receive from medical staff, as perceived by the family caregivers. Semi-structured interviews were conducted with 10 family caregivers of inpatients with terminal cancer. Participants were asked about the care received until then from medical staff, the features of satisfactory care, and the aspects of care they felt were unsatisfactory or could become satisfactory with improvement. The data were analyzed with the content analysis method and the six categories were extracted. For family caregivers of inpatients with terminal cancer in general wards, along with the care identified as important in palliative care, the methods of alleviating symptoms and explaining the patient’s condition were also important. The results highlight the importance of determining a patient-oriented approach and explanations together with each patient and family caregiver, based on an understanding of the long treatment process.

Why Do Pregnant Women Choose a Planned Caesarean Section in Burkina Faso? A Qualitative Study

Despite the complications related to the caesarean section, some couples choose it by desirability. This study aimed to understand the reasons for maternal requests for a planned caesarean section in Burkina Faso, in the absence of obstetric indications. A qualitative descriptive study was conducted in March 2019, consisting of twelve semi-structured interviews with women requesting caesarean section at Tingandogo Teaching Hospital in Burkina Faso. The operative reports were also examined. Thematic analysis based on Braun and Clarke approach was performed with QDA Miner software. Twelve patients were involved in the study. The mean age was 33 years. The majority had a higher level of education. Half were employees. The mean stay duration was 72 hours, with an estimated cost of CFA 300.000 (457,347 EUR). The choice of a planned caesarean was motivated by fear of birth (tokophobia), the positive feeling associated to the surgical technology, the doctor-patient relationship and the confidence in the quality of healthcare services such as reception and hygiene. Maternal reasons for requesting a planned caesarean section in Burkina Faso are multifactorial. Information, education and communication and shared decision-making strategies concerning the different modes of delivery and complications at the end of pregnancy, may contribute to reducing this problem.

Experiences of Women Receiving Multifraction High Dose-Rate Brachytherapy for Cervical Cancer: A Prospective Qualitative Study

Objective: The aim of this study was to establish cervical cancer patients’ expectations and experiences during high dose-rate (HDR) intracavitary brachytherapy procedure, as part of a process to develop guidelines for quality patient-centered care. Methodology: A prospective, qualitative study with a descriptive phenomenological approach was used. Purposive sampling was carried out to recruit 31 women undergoing HDR brachytherapy for cervical cancer from June to August 2020 at the National Institute of Oncology in Rabat. Semi-structured, one-to-one interviews guided by a theme list were conducted by a female radiation oncologist in Arabic before, during and after treatment. The following aspects were discussed: expectations, experiences in the waiting room, in the treatment room, and suggestions for improvement. Data was transcribed, translated and thematic analysis performed. Results: Most of the patients felt unprepared and did not have a clear understanding of brachytherapy. Brachytherapy was a difficult experience causing fear and anxiety throughout treatment. Most women dreaded the procedure, before receiving the first treatment and even after having had one. Pain was a major problem for the participants. Some women compared this pain to childbirth, a process they preferred to brachytherapy. Patients agreed that the preventative medication received was not efficient to relieve the pain. Despite these negative experiences, patients were left with a positive outlook. Dialogue with the healthcare professionals, support from their family and fellow patients, envisaged outcomes and desires to heal were used to cope, whilst faith and spirituality gave them strength to endure the procedure. Conclusion: Women undergoing uterovaginal brachytherapy for cervical cancer experience pain and emotional distress. Providing patients with adequate information, more sensitive support during the procedure and debriefing afterwards could lessen feelings of fear and anxiety. Our findings advocate for the revision of pain management protocols. Further studies should be carried out to define patient-centered recommendations and provide quality care to this group of women.