Charting the Course of the Nursing Professional Identity: A Qualitative Descriptive Study on the Identity of Nurses Working in Care for Older Adults.

AIMS: To explore and describe the meaning of nurses working in care for older adults give to the nursing professional identity. DESIGN: A qualitative approach was taken. METHODS: Semi-structured interviews were conducted with 50 bachelor and vocational-educated nurses working in care for older adults. Interviews were conducted between December 2019 and May 2020. Data were analysed and interpreted through inductive content analysis. RESULTS: Five themes embody the meaning of the nursing professional identity of nurses who work in care for older adults. The five themes are: born to care: a lifelong motivation to nursing; nursing through the noise: dedication in a demanding profession; the silent backbone: caught in the crossfire of interdisciplinary teams; learning under pressure: the demand for expanded nursing expertise and against the current: the barriers to advocacy in nursing. CONCLUSION: The professional nursing identity of nurses working in care for older adults is multi-faceted. A personal dedication to patient care, where patients 'human' aspect is heavily valued, commits nurses to their profession and underscores their dedication to upholding the quality standard in nursing practice. IMPLICATIONS FOR THE PROFESSION: The older adults' nursing identity highlights that nursing deserves acknowledgement as a professional occupation. Nurses should speak to the public about their professional roles to improve the public view of older adult nursing. IMPACT: A clear understanding of the older adult nursing professional identity clarifies specific roles, experiences and expectations. This can help attract and retain nurses whose views of older adult nursing align with the nursing professional identity. This could help resolve nurse turnover and reduce shortages in older adult care. REPORTING METHOD: We adhered to Consolidated Criteria For Reporting Qualitative Research guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Critical care nurses' experiences on environmental sustainability: A qualitative content analysis.

BACKGROUND: Intensive care units (ICUs) are the primary producers of greenhouse gas emissions within hospitals, due to the use of several invasive materials. Nurses represent a large portion of the healthcare workforce and can be pivotal in promoting sustainability practices. Several international reports have suggested that nursing can help achieve the sustainable development objectives set by the United Nations. AIMS: The purpose is to explore behaviour related to environmental sustainability in intensive care nurses. STUDY DESIGN: A qualitative content analysis comprised of in-depth interviews involving 27 ICU nurses, who were each asked the same open-ended question. The transcripts collected were then analyzed and organized by a team of independently-working researchers. The analysis of the extrapolated concepts was carried out following the Neem M. (2022) method. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship, Rome, July 2024. FINDINGS: The main recurring themes are as follows: (1) concepts of environmental sustainability in ICUs, (2) critical issues related to sustainable intervention in the ICUs (3) proactive environmental sustainability attitudes in ICUs. Time to know, define criticality, and improve is the conceptualization of sustainable behaviors experienced by ICU nurses. CONCLUSIONS: Taking the time to know and define the critical issues for implementing sustainable behaviours in the ICU, turned out to be the key to enforce the mindset of green nursing thinking. IMPLICATIONS TO CLINICAL PRACTICE: Sustainability behaviours need to be proposed and verified by ICU managers by creating sustainability teams and promoting a good working environment, founding the progression to green ICUs by focusing on health impact education and mindfulness.

An Environmental Scan of Canadian Kidney Transplant Programs for the Management of Patients With Graft Failure: A Research Letter.

Background: Kidney transplant recipients with graft failure (KTR-GF) and those with a failing graft are an increasingly prevalent group of patients. Their clinical management is complex, and outcomes are worse than transplant naïve patients on dialysis. In 2023, the Kidney Disease: Improving Global Outcomes (KDIGO) organization reported findings from a controversies conference and identified several clinical practice priorities for KTR-GF. Objective: As an exercise in needs assessment, we aimed to collate and summarize current practices in adult Canadian kidney transplant programs around these KDIGO-identified clinical practice priorities. Design: Environmental scan followed by content analysis. Setting: Canadian adult kidney transplant programs. Measurements: We categorized the themes of our content analysis around 7 clinical practice priorities: (1) determining prognosis and kidney failure trajectory; (2) immunosuppression management; (3) management of medical complications; (4) preparing for return to dialysis; (5) evaluation and listing for re-transplantation; (6) management of psychological effects; and (7) transition to supportive care. Methods: We solicited documents that identified each program's current care practices for KTR-GF or patients with a failing graft, including policies, procedures, pathways, and protocols. A content analysis of documents and informal correspondence (email or telephone conversations) was done to extract information surrounding the 7 practice priorities. Results: Of the 18 programs contacted, 12 transplant programs participated in this study and a document from a provincial organization (where 2 non-responding programs are located) was procured and included in this analysis. Overall, practice gaps and discrepancies were noted. Many participants highlighted the lack of evidence or consensus to guide the management of KTR-GF as the key reason. Immunosuppression management was the most frequently addressed priority. Six programs and the provincial document recommended a nuanced approach to immunosuppressant management based on clinical factors and re-transplant candidacy. Two programs used the Kidney Failure Risk Equation and eGFR to determine referral trajectories and prepare patients for return to dialysis. Exact processes outlining medical management during the transition were not found except for nephrectomy indications and in 1 program that has a specific transition clinic for KTR-GF. All programs have a formal or informal policy that KTR-GF should be assessed for re-transplantation. Referrals for psychological support and transition to supportive care were made on a case-by-case basis. Limitations: Our environmental scan was at risk of non-response bias and restricted to transplant programs. Kidney clinics and dialysis units may have relevant policies and procedures that were not examined. Conclusion: The findings from our environmental scan suggest gaps in care and potential areas for quality improvement, including a lack of multidisciplinary care, structured dialysis preparation and psychological support. There is also a need to prioritize research that generates evidence to guide the management of KTR-GF and contributes to the aim of developing clinical practice guidelines.

Contexte: Les receveurs d'une greffe rénale avec perte du greffon (RGR-PG) et ceux dont le greffon est défaillant constituent un groupe de patients de plus en plus répandu. La prise en charge clinique de ces patients est complexe et les résultats sont moins bons que ceux des patients dialysés naïfs de transplantation. En 2023, l'organisme KDIGO (Kidney Disease: Improving Global Outcomes) a présenté les résultats d'une conférence portant sur les controverses et a identifié plusieurs priorités de pratique clinique pour les RGR-PG. Objectif: Dans le cadre d'un exercice d'évaluation des besoins, nous avons voulu rassembler et résumer les pratiques actuelles dans les programs canadiens de transplantation rénale chez les adultes en lien avec les priorités de pratique clinique identifiées par le KDIGO. Conception: Analyze contextuelle suivie d'une analyze du contenu. Cadre: Les programs canadiens de transplantation rénale chez l'adulte. Mesures: Nous avons classé les thèmes de l'analyze de contenu autour de sept priorités de pratique clinique: 1) la détermination du pronostic et de la trajectoire de l'insuffisance rénale; 2) la gestion du traitement immunosuppresseur; 3) la prise en charge des complications médicales; 4) la préparation au retour à la dialyze; 5) l'évaluation et l'inscription pour la retransplantation; 6) la gestion des effets psychologiques; et 7) la transition vers les soins de soutien. Méthodologie: Nous avons sollicité les documents (politiques, procédures, parcours, protocoles) des programs de transplantation qui décrivent les pratiques de soins actuelles pour les RGR-PG ou les patients avec un greffon défaillant. Une analyze du contenu de ces documents et de la correspondance informelle (courriels ou conversations téléphoniques) a été effectuée pour en extraire les données sur les sept priorités de pratique. Résultats: Des 18 programmes de transplantation contactés, 12 ont participé à l'étude et un seul document provenant d'une organisation provinciale (où se trouvent deux programmes n'ayant pas participé) a été obtenu et inclus dans l'analyse. Dans l'ensemble, on a observé plusieurs lacunes et divergences dans la pratique. La principale raison donnée par plusieurs participants étant le manque de données ou de consensus pour guider la prise en charge des RGR-PG. La gestion du traitement immunosuppresseur était la priorité la plus fréquemment abordée. Le document provincial et six programmes recommandaient une approche nuancée, fondée sur les facteurs cliniques et la candidature à la retransplantation, pour la gestion du traitement immunosuppresseur. Deux programmes utilisaient l'équation KFRE (Kidney Failure Risk Equation) et le DFGe pour aiguiller les patients et les préparer à retourner en dialyse. Nous n'avons pas trouvé de processus précis décrivant spécifiquement la prise en charge médicale pendant la transition, mis à part dans les indications de néphrectomie et un programme ayant une clinique de transition spécifique aux RGR-PG. Tous les programmes disposent d'une politique formelle ou informelle indiquant que les RGR-PG doivent être évalués pour la retransplantation. Les aiguillages vers du soutien psychologique et la transition vers les soins de soutien sont traités au cas par cas. Limites: L'analyse contextuelle présentait un risque de biais de non-réponse et elle a été limitée aux programmes de transplantation. Les cliniques de soins rénaux et les unités de dialyse pourraient disposer de politiques et de procédures pertinentes qui n'ont pas été examinées. Conclusion: Les résultats de l'analyse contextuelle suggèrent qu'il existe des lacunes dans les soins et de possibles domaines d'amélioration de la qualité. On a notamment observé un manque de soins multidisciplinaires, de préparation structurée à la dialyse et de soutien psychologique. Il est également nécessaire de prioriser la recherche produisant des données probantes afin de guider la prise en charge des RGR-PG et l'élaboration de lignes directrices de pratique clinique.

'Balancing Challenges and Personal Resources': A Qualitative Study of Women's Experiences of Arm Impairment After Axillary Surgery for Breast Cancer.

AIM: To explore how women previously treated for breast cancer experience living with arm impairment after axillary surgery. DESIGN: Descriptive qualitative study. The inductive starting point for the analysis was followed by a deductive approach as the categories were related to the components of the sense of coherence framework. METHODS: Twenty-eight relapse-free Swedish-speaking females participated in six focus group discussions conducted between September and December 2022. All participants had undergone sentinel lymph node biopsy with or without completion axillary dissection 4 years earlier. Data were analysed using qualitative content analysis. RESULTS: Three categories and an overall theme were identified. The categories 'Sense-making', 'Daily life' and 'Driving force' reflect actions to understand and prevent arm symptoms, adaptations made in daily life and the empowering resources adopted to meet challenges. The overall theme, 'Balancing challenges and personal resources', comprised a process that began at diagnosis and remained ongoing for some participants. Most participants considered their new life situations manageable. However, those with more pronounced arm impairment reported that they did not always receive adequate aid, and that their daily lives were negatively affected. CONCLUSION: Returning to everyday life after axillary surgery for breast cancer is associated with varying degrees of challenges. Individuals with persistent arm impairment find returning to normal life more challenging. Therefore, further improvements in person-centred care are of utmost importance. PATIENT AND PUBLIC CONTRIBUTION: Members of the Swedish Breast Cancer Association were involved in the creation of the interview guide. IMPACT: This study emphasises the requirement for providing further individualised support to those living with more severe arm impairment after axillary surgery. REPORTING METHOD: This study was reported in accordance with the Standards for Reporting Qualitative Research.

Negotiating pricing and payment terms for insurance covered mHealth apps: a qualitative content analysis and taxonomy development based on a German experience.

BACKGROUND: Germany was the first country worldwide to offer mobile digital health applications (mHealth apps, "DiGA") on prescription with full cost coverage by statutory health insurances. Especially statutory health insurances criticize the current pricing and payment regulations in Germany due to "free and non-transparent" pricing in the first year and lack of cost use evidence. The study consists of two parts: The first part evaluates interests of digital health application providers and statutory health insurances in Germany to identify overlaps and divergences of interests. The second part includes the development of a comprehensive pricing and payment taxonomy for reimbursable mHealth apps in general. METHODS: Both parts of the study used the input from 16 expert interviews with representatives of digital health application providers and statutory health insurances in Germany. In part one the authors conducted a qualitative content analysis and in part two they followed the taxonomy development process according to Nickerson et al. (2013). RESULTS: A value based care model is expected to bring the greatest benefit for patients while statutory health insurances welcome the idea of usage based pricing. The final pricing and payment taxonomy consists of four design and negotiation steps (price finding, payment prerequisites, payment modalities, composition of negotiation board). CONCLUSIONS: As healthcare resources are scarce and thus need to be optimally allocated, it is important to implement pricing and payment terms for reimbursable mHealth apps that result in the greatest benefit for patients. To the best of the authors' knowledge, there has been no structured study yet that examines alternative pricing strategies for reimbursable mHealth apps.The developed pricing and payment taxonomy for reimbursable mHealth apps serves as planning and decision basis for developers, health policy makers and payers internationally.

The meaning of obstetric violence experiences: A qualitative content analysis of the Break the Silence Campaign.

BACKGROUND: Obstetric violence involves the mistreatment, disrespect, and abuse of birthing people and the problem has been recognized in healthcare systems worldwide. Obstetric violence is a gendered, sex-specific form of violence against women that is a public health problem and a violation of human rights. There are an unknowable number of online posts and social media messages that describe obstetric violence experiences. There are no known studies about self-published experiences of obstetric violence in the US maternity care system. OBJECTIVE: To understand the meaning of obstetric violence experiences in the US maternity care system from a naturally occurring, purposive sample. DESIGN: A secondary analysis of the textual data from the original Break the Silence social media campaign using qualitative content analysis. The theory of social justice in nursing provided a theoretical framework. A healthcare systems approach was used for a wide-angle view of the multidirectional structure, processes, and outcome of obstetric violence. SETTING: The study setting is the public Facebook page where the Break the Silence social media campaign can be seen. Break the Silence was an online activism response to the problem of obstetric violence in the US maternity care system with signboard messages posted from 31 known US states. The setting is bounded by the digital page where the campaign is published. PARTICIPANTS: There were 139 participants, and 11 of them posted more than one signboard message. Most participants were birthing people (n = 125) followed by doulas (n = 10). METHODS: Krippendorff's methodology for qualitative content analysis was applied to 156 signboard messages posted on Break the Silence from 2014 to 2016. Qualitative content analysis was supported by Atlas.ti 23. RESULTS: Four themes illustrated the meaning of obstetric violence in US maternity care: 1) pregnancy and birth as a battle with healthcare providers and the healthcare system, 2) sacrifice of the maternal body normalized and assumed as a gender stereotype, 3) disrupted rites of passage from childbirth, and 4) abuse of fiduciary power by healthcare providers. CONCLUSIONS: This study demonstrated thematic meanings for the experience of obstetric violence in US maternity care with a healthcare systems approach that included structural and organizational considerations to increase understanding. Categories and forms of obstetric violence from the existing literature were expanded and strengthened by findings from this study. Themes were validated in principle with consistency in findings across the international evidence base on obstetric violence. TWEETABLE ABSTRACT: The meaning of #obstetricviolence experiences is interpersonal and structural with thematic consistency across international studies.

Network Analysis to Visualize Qualitative Results: Example From a Qualitative Content Analysis of The National Child Abuse Hotline.

Data visualization, such as figures created through network analysis, may be one way to present more complete information from qualitative analysis. Segments of qualitatively coded data can be treated as objects in network analysis, thus creating visual representations of the code frequency (i.e., nodes) and the co-occurrence (i.e., edges). By sharing an example of network analysis applied to qualitative data, and then comparing our process with other applications, our goal is to help other researchers reflect on how this approach may support their interpretation and visualization of qualitative data. A total of 265 de-identified transcripts between help-seekers and National Child Abuse Hotline crisis counselors were included in the network analysis. Post-conversation surveys, including help-seekers' perceptions of the conversations, were also included in the analysis. Qualitative content analysis was conducted, which was quantified as the presence or absence of each code within a transcript. Then, we divided the dataset based on help-seekers' perceptions. Individuals who responded that they "Yes/Maybe" felt more hopeful after the conversation were in the "hopeful" dataset, while those who answered "No" were in the "unhopeful" dataset. This information was imported to UCINET to create co-occurrence matrices. Gephi was used to visualize the network. Overall, code co-occurrence networks in hopeful conversations were denser. Furthermore, the average degree was higher in these hopeful conversations, suggesting more codes were consistently present. Codes in hopeful conversations included information, counselor support, and problem-solving. Conversely, non-hopeful conversations focused on information. Overall, network analysis revealed patterns that were not evident through traditional qualitative analysis.

Conceptualising wellbeing among health-care workers during the Covid-19 pandemic.

Since 2020 health workers everywhere have been challenged by the ongoing ramifications of the Covid-19 pandemic. This virus impacted all aspects of life but health-related workplaces particularly, were transformed virtually overnight. Demands were heightened and customary supports came under pressure presenting a huge crisis for health systems. The goal of this study was to explore how this catastrophic pandemic event impacted the wellbeing of healthcare professionals (HCPs) working through this time. Interviews with 57 HCPs from multiple countries and specialty areas were explored utilising inductive content analysis (ICA). Resulting data were then categorised into themes and deductively analysed utilising a method informed by Capability Theory. These were secondary data as the interviews were part of a larger set collected primarily for the purpose of a documentary being made about this experience. This study found that illbeing experiences were prevalent among HCPs. However, significant sources of wellbeing were also evident, and were instrumental in maintaining HCP resilience. Wellbeing was enhanced when HCPs experienced a small number of key capabilities that enabled a broad range of functionings. The capabilities were for (a) participation in positive relationships, (b) a sense of identity, purpose, meaning and value in relation to one's work and (c) ability to provide an appropriate level of medical treatment, care and other role related support. These capabilities were central to HCP wellbeing irrespective of the individual's location and specialty area, however the ability to realise these capabilities in desired functionings was differentially impacted by each individual's unique circumstances.

Qualitative analysis of Portuguese-language YouTube videos about autism spectrum disorders.

BACKGROUND: In the digital age, social media platforms such as YouTube have become significant channels for disseminating health information, including content related to autism spectrum disorder (ASD). The quality and reliability of this information, especially when produced by healthcare professionals, are crucial for public health education and promotion. This study aims the content of Portuguese-language videos about the treatment of ASD on YouTube, produced by healthcare providers from 2019 to 2023, assessing their quality and alignment with evidence-based practices. METHODS: A qualitative exploratory descriptive approach was used, with content analysis based on Bardin's method. A total of 41 videos were selected using keywords related to ASD. Transcriptions were analyzed for discussions on treatment approaches, best practices, and professional recommendations according to DSM-V and ICD-10 guidelines. The quality of information was assessed using the DISCERN questionnaire. RESULTS: The analysis revealed significant variability in the quality of the information. Videos were categorized into four quality groups based on DISCERN scores: good (n = 6), moderate (n = 11), poor (n = 20), and very poor (n = 4). Good quality videos had the highest engagement metrics and overall quality scores. Common themes identified included defining and understanding ASD, ABA interventions and strategies, family and social impact, skills development, and challenges and solutions. CONCLUSION: While some videos provided accurate, evidence-based information, a substantial portion did not meet minimum quality criteria. This highlights the need for improved mechanisms to ensure the dissemination of reliable health information on social media platforms.

Parents' perspectives on conversations about prognosis and an assessment of prognostic information available online: A mixed-methods study.

BACKGROUND: Conversations about prognosis for genetic neurodevelopmental conditions are becoming more frequent; however, there is a lack of evidence and guidance on how to approach these conversations and frame the information being provided. OBJECTIVE: (1) To understand how parents perceive prognostic conversations with healthcare professionals and their preferences for these conversations, (2) To investigate the framing of prognostic information found online. METHODS: This was a mixed-methods study, comprising of (1) a thematic analysis of interviews with parents and (2) a quantification of prognostic information available on the internet that portrayed a negative message. The strategy to classify the framing of prognostic information was defined iteratively, informed by the information found online. RESULTS: We interviewed 32 parents from across Australia. Parents had a child with a genetic neurodevelopmental condition, such as Fragile X syndrome (28 %), 22q11.2 deletion syndrome (16 %) or Angelman syndrome (16 %). Parents reported their preference to discuss their child's potential strengths as well as challenges regarding prognosis. They reported that conversations about prognosis often focused on the child's possible deficits and that online information they encountered was similarly framed negatively. Our analysis of online information confirmed parents accounts: 95.3 % was coded as negative, while only 4.7 % was positive/neutral. CONCLUSIONS: Our data provide evidence of an over-emphasis of deficit-framed prognostic information about genetic neurodevelopmental conditions. The initial exposure to negative information may adversely affect parents' psychological well-being and expectations, which future research could address. Health professionals could consider strengths-based framing of prognostic information gained from current and emerging technologies when returning results to families. Findings from this study can help to inform health communication practices as well as online content development.

Bridging the knowledge gap: educational needs of Iranian women for virtual breast cancer prevention: a qualitative study.

BACKGROUND: Breast cancer prevention is a globally significant and cost-effective public health priority, particularly in low- and middle-income countries. Empowering women through improved health literacy is a key strategy for reducing the disease burden. However, effective educational programs must be tailored to the specific cultural context and needs of the target community. This study explored the educational needs of Iranian women for a virtual breast cancer prevention program. METHODS: A descriptive qualitative design was used from January to July 2022. Purposive sampling with maximum variation was utilized to recruit a sample of 28 participants. Data collection was conducted through semi-structured interviews. Following the method outlined by Graneheim and Lundman, qualitative content analysis was employed to analyze the interview data. MAXQDA 2020 software was used for data analysis. Components of trustworthiness, including credibility, dependability, confirmability, and transferability, were considered. RESULTS: Our findings identified three primary categories: "developing women's scientific, practical, and attitudinal capabilities"; "features of program content"; and "principles of electronic content design". These results offer valuable insights into the educational needs of Iranian women for virtual breast cancer prevention programs. CONCLUSIONS: To design an effective virtual program, it is crucial to address all three domains: cognitive, emotional, and psychomotor. Program content should be organized and presented using methods that sensitize women to the importance of breast cancer prevention and motivate them to participate. Furthermore, the program's design should be grounded in evidence-based practices and principles of electronic content design, ensuring cultural sensitivity to the needs of Iranian women.

Locating the potential development of spatial ability in the Swedish national curriculum.

There exists a plethora of studies that have related pupils' spatial ability to their academic achievement and problem-solving skills, especially in science, technology, engineering, and mathematics (STEM) subjects. However, little is known about how spatial ability could be presented in a national curriculum. To increase the awareness and intention to develop pupils' spatial ability within the national curriculum, the compulsory curriculum document from the Swedish National Agency for Education which details all subject syllabi is examined and analysed using a content analysis method. The results show that two major dimensions could be used to locate the potential spatial ability development within the curriculum. The first is a visual dimension, which manifests as three different visual components: graphical, pictorial, and manufactured. The second is an epistemic dimension, which describes how pupils' different types of spatial knowledge can be nurtured, and inductively described as conceptual, procedural, and spatial citizenship knowledge. A three-by-three matrix framework is created based on the above dimensions and components. Policymakers and educators in Sweden, as well as in other countries, may draw insights from the framework created by this study and adapt it to educational practice, particularly in the realm of developing students' spatial ability through curriculum design and classroom instruction.

"This Incident Happened When There Were 10 People in the House?" Exploring a Framework to Categorize Defense Attorneys' Plausibility Questioning in CSA Trials.

While researchers find that attorneys in CSA trials dedicate substantial time to questioning children about the plausibility of their reports, we know of no study to date that has assessed the types of plausibility issues attorneys raise, the relative frequency of different types, or if attorneys vary their plausibility questioning depending on case characteristics. In the current study we explored these questions. Guided by the story model of jury decision-making, we proposed defense attorneys would raise plausibility issues by 1) highlighting jurors' misconceptions about CSA dynamics; 2) highlighting confusing or implausible statements made by the child; and 3) offering alternative explanations for events. We conducted a content analysis of the cross-examinations of 134 children aged 5-17 testifying about alleged CSA. We found that attorneys raised all three proposed types of plausibility questioning, and they varied their plausibility questioning somewhat by age, severity, child-defendant relationship, and the number of victims in the case. Attorneys' preferred strategy was to highlight jurors' misconceptions about CSA. Prosecutors should address jurors' misconceptions preemptively in direct examinations of children or through expert testimony. Beyond implications for courtroom practices, our plausibility framework may apply to plausibility concerns raised in other crime types, something researchers should explore.

Leadership in federally qualified health centers: examining recruitment and retention in rural Oklahoma.

PURPOSE: Healthcare workforce shortages, particularly in rural areas, present a global challenge. The purpose of this study is to explore the leadership dynamics within federally qualified health centers (FQHC) in rural Oklahoma, focusing on recruitment, retention, job satisfaction and development practices. DESIGN/METHODOLOGY/APPROACH: Eighteen managers with five or more years of tenure from Oklahoma FQHCs were interviewed. Leadership's role in influencing job satisfaction, recruitment, retention and development practices was analyzed using a multilevel ecological framework through qualitative content analysis with NVivo. FINDINGS: The analysis includes ten key themes including the critical role of leadership in addressing recruitment and retention challenges, the importance of aligning organizational culture, rural culture, access challenges, trainings and values with workforce development initiatives, and the impact of leadership practices on job satisfaction. ORIGINALITY/VALUE: This study uniquely examines leadership strategies in rural FQHCs, integrating ecological considerations for cultural, logistical and community-specific factors. It emphasizes the pivotal role leadership plays in shaping workforce development. As rural healthcare evolves, refining these approaches is crucial for addressing workforce challenges, improving healthcare access and ensuring that rural FQHCs remain sustainable, driving positive outcomes for healthcare professionals and communities.

Donor human milk practice in Indonesia: a media content analysis.

Introduction: Donor human milk (DHM) is recommended as the second-best alternative form of supplementation when a mother is unable to breastfeed directly. However, little is known about the experience of mothers and families in the communities regarding accessing and donating expressed breastmilk in Indonesia. This study aimed to identify the experience related to donor human milk in the society in Indonesia. Method: A search was conducted through six main online news portals. The keywords used included "donor human milk," "expressed breastmilk," and "wet nursing" in the Indonesian language, Bahasa Indonesia. A total of 107 articles were found, but only 20 articles were included for analysis using a qualitative media content analysis approach. Results: In the study, the following five themes were identified: (1) the whys and wherefores of donor human milk, (2) national and religious-based regulations, (3) recommendations from authorized organizations, healthcare professionals, and Islamic scholars, (4) the negative impact from the lack of national regulations, and (5) contradictory feelings among mothers. Conclusion: With the lack of detailed information on how to access or donate expressed human milk and the absence of a human milk bank in place, informal human milk sharing is inevitably occurring in the community. This has also raised concerns among authorized organizations, healthcare professionals, and Islamic scholars. Consequently, mothers, both donors and recipients, experienced negative impacts, which included contradictory feelings. Engaging with Islamic scholars and healthcare professionals to develop clear guidelines and regulations to enable mothers' and families' access and/or make contributions to DHM in a safe and accountable way is critical to prevent further problems from occurring in Indonesian society.

Not all norm information is the same: Effects of normative content in the media on young people's perceptions of e-cigarette and tobacco use norms.

Norm information in media can predict individuals' norm perceptions and, ultimately, their behavior. Little research has examined how descriptive norm information manifests in media and impacts beliefs in the real world. Previously, using automated content analysis, we measured and examined longitudinal trends in two types of descriptive norm information, individual use depictions and population norms, pertaining to tobacco and e-cigarette use across six media sources from 2014-2017. Here, we assess how this norm information affected norm perceptions over time by pairing these data with a rolling cross-sectional survey of young people's beliefs and intentions related to these behaviors. We found that individual use depictions predicted some norm perceptions, although the direction of effects varied depending on the source, behavior, and type of perceptions considered. Population norm content did not affect perceptions. These findings highlight that real-world media norm information has real-world effects, and moderators of these effects should be studied.

Factors associated with self-management in older adults with multiple chronic conditions: a qualitative study.

Background and purpose: Recognizing the importance of self-management in older adults with multiple chronic conditions (MCCs) is crucial for their quality of life. This qualitative study explored the factors linked to self-management among older adults with MCCs. Materials and methods: The present study was conducted in three stages: an integrated review, qualitative interviews, and Delphi. The search used electronic databases including Web of Science, PubMed, Scopus, Magiran, SID, and Iranmedex. The results of 33 studies that met the inclusion criteria were analyzed using conventional content analysis. A data matrix was formed; and purposeful sampling was conducted among older adults with MCCs, family caregivers, and specialists. The data were collected through semi-structured interviews. Data analysis of 29 interviews was conducted simultaneously with data collection using oriented qualitative content analysis and the Elo and Kyngäs approach. Three rounds of Delphi were conducted via email correspondence with a group of 30 experts to develop and validate the proposed variables. Results: The factors that influence self-management can be categorized into various categories. Biological factors, cognitive factors, co-morbidities, socio-economic factors, health-related behaviors, mental health, interactions with healthcare teams, Family relationships, medical facility resources, employee empowerment, health policy development, and cultural influences. Conclusion: Self-management in older Iranian adults with MCCs is a complex and multidimensional phenomenon. By identifying the relevant factors, it is possible to design operational plans that promote self-management among the older adult population and are tailored to fit the specific needs of Iranian society.

Crisis and Emergency Risk Communication and Emotional Appeals in COVID-19 Public Health Messaging: Quantitative Content Analysis.

BACKGROUND: Although COVID-19 is no longer a global health emergency, it remains pervasive in Singapore, a city-state situated in Southeast Asia, with periodic waves of infection. In addition to disease management, strong communication strategies are critical in the government's response to the pandemic to keep the public updated and equip them in protecting themselves. OBJECTIVE: Grounded in the crisis and emergency risk communication (CERC) framework and emotional appeals, this study aimed to analyze public health communication strategies in Singapore during the COVID-19 pandemic. METHODS: Quantitative content analysis was conducted on 696 Facebook (Meta Platforms Inc) posts and 83 website articles published by Singapore-based public health institutions between January 2020 and September 2022. RESULTS: The results showed that increasing communication on message themes, such as inquisitive messaging and clarification, can enhance communication strategies. The use of emotional appeals also varies with time and should be carefully used as they are context-specific. CONCLUSIONS: Theoretically, this study contributes to advancements in the CERC framework and concepts of emotional appeals by exploring the applications and changes of CERC message types and emotional appeals at different phases. The findings can provide practical guidance for authorities and communication practitioners in developing effective communication strategies.

The Role of Health Belief Model Constructs and Content Creator Characteristics in Social Media Engagement: Insights from COVID-19 Vaccine Tweets.

INTRODUCTION: The Health Belief Model (HBM) has been widely studied, but it is unclear how social media post creators use HBM constructs to influence the public's awareness of health topics, particularly for COVID-19 preventative health behaviors. Moreover, there is limited knowledge about how content creators enhance user engagement with COVID-19 vaccine tweets. METHODS: A content analysis of COVID-19 vaccine tweets (n = 362) examined how HBM constructs were used in social media posts and their relationship to content creator characteristics (e.g., race, education level) and user engagement behaviors (e.g., number of favorites). FINDINGS: Content creators' tweets about COVID-19-related topics generally centered on two HBM constructs-benefits and barriers-while fewer tweets emphasized perceived susceptibility or self-efficacy; tweets containing these constructs were retweeted less often. Findings revealed that tweets from politicians, health experts, and white and Asian sources emphasized the perceived benefits of the COVID-19 vaccine. Individual tweets, especially from Black individuals and celebrities, generated more user engagement. CONCLUSIONS: Understanding the factors that contribute to social media user engagement with health-related content is important for designing more focused and impactful health communication campaigns and promoting healthier habits and perspectives. Thus, by demonstrating the possible relevance of the HBM to digital communication strategies or health campaigns, our study provides useful guidance for health promoters and policymakers who use social media to raise public health awareness.

Reconciliation in palliative care: A concept analysis.

OBJECTIVES: The aim was to gain a deeper understanding of the meaning of reconciliation as a concept in palliative care. Terminal illnesses affect almost all aspects of life and being close to death may lead to a need for reconciliation. The end of life is stressful on an existential level for both patients and relatives. It can therefore be of relevance for palliative care nurses to understand the meaning of reconciliation. METHODS: This study used a design for a literature study in accordance with a hybrid model. A deductive qualitative content analysis of autobiographies about being seriously ill and in a palliative stage in life was used to test the meaning of reconciliation. Ethical aspects concerning the use of autobiographies and the ethical principles of the Helsinki Declaration were considered. The theoretical perspective was the caritative theory of caring. RESULTS: The result showed that for patients in palliative care, reconciliation can be described as a strive for acceptance, to live in a truthful way, to forgive and be forgiven. People wish to create meaning in their existence and reconcile as a whole in body, spirit, and soul. By striving to unite suffering, life, and death as well as a peaceful relationship with relatives, people can achieve reconciliation at the end of life. Reconciliation is something ongoing and can be a force in what has been, what is, and what will be. SIGNIFICANCE OF RESULTS: We conclude that reconciliation is a concept of importance when caring for patients in end-of-life care. However, reconciliation can be expressed in different ways without necessarily using the concept itself. A broader and deeper understanding of the concept facilitates conversations about the meaning of reconciliation in palliative care and can enable patients who strive to achieve reconciliation to be more easily identified and supported.