So Why Do They Not Engage? Grounded Theory Research to Understand and Explain Why Medical Students Disengage from Undergraduate Psychiatry Education in India.

Background: For almost 60 years, Indian psychiatry literature has called for all medical students to learn psychiatry so that millions of mentally unwell people across India might receive appropriate treatment. Yet for almost 60 years, medical students have disengaged from psychiatry education, resulting in limited learning. The literature has repeatedly cited the solution as one that involves longer exposure on posting and more exam questions, with little impact. This research sought to understand why medical students disengage from psychiatry education so that meaningful change might occur. Methods: The research utilized constructivist grounded theory, initially in one medical college in Mumbai, followed by a quantitative survey to test the findings with a wider group of interns across 10 states of India. An iterative process of data gathering and analysis was undertaken using the constant comparison method and theoretical integration. Results: Findings identified that 98% of interns believe all MBBS (doctors) should "know" psychiatry, with "know" meaning practical skills-how to assess and treat people with mental illness. The majority of students attend psychiatry to learn those skills, but on finding faculty too overworked to teach, they disengage, saying: "there's nothing in it for me." The findings indicate that more exam questions would not increase engagement. Conclusion: Medical students want to learn skills to help those in mental distress. Faculty do not have time and, arguably, the training to teach them. To address the nation's mental health needs, the government needs to prioritize teaching of psychiatry skills by releasing and enabling psychiatry faculty, alongside the certification of psychiatry skills.

Exploring operating room staff engagement in the planning and design of the built environment in Australia: Development of a constructivist grounded theory.

AIM: This study aimed to explore Australian health professionals' perceptions and experiences regarding built environment planning for operating rooms. METHODS: We conducted semi-structured interviews and a focus group using exploratory qualitative methods, involving 16 participants: anaesthetists, surgeons, nurses, theatre technicians and designers of operating rooms. FINDINGS: Four core concerns of participants were analysed: Engagement, Respect & Collaboration; Foreseeing & Responding to Safety Concerns; Enhancing Design Planning to Minimise Internal & External Consequences; and Ambiguous Application of Standards in Operating Room Design Planning. CONCLUSION: Health professionals highlighted safety impacts related to patients and staff due to the built environment and emphasised the need for improved engagement, respect and collaboration in design processes. Consideration needs to be given to the lived experiences of health professionals in design planning to address safety concerns effectively. Hierarchies and cultural factors were identified as barriers to inclusive design processes.

Explaining the Family-Centred Care of Young People With Depressive Disorders and Suicidal Ideations: A Grounded Theory Study.

AIM: This study aimed to develop a theory to guide family members caring for young people with depressive disorders and suicidal ideations. DESIGN: Strauss and Corbin's Grounded Theory. METHODS: Theoretical sampling was used to recruit primary family caregivers (aged 22-60) of young people experiencing depressive disorders and suicidal ideations from hospitals and psychiatric clinics in Taiwan. Data were collected using interviews (n = 23) in 2023. Data were analysed using Corbin & Strauss' analytical framework, including open, axial and selective coding until theoretical saturation was reached. RESULTS: A paradigm model was used to link the 13 categories and develop a substantive theory to help guide family members in the care of their young persons with depressive disorders and suicidal ideations. The core category that emerged was 'Struggling to contain the young person's life by adjusting, assisting, and protecting them from diving into depression'. Other key categories interconnected with this core category were-creating a nurturing environment, adjusting to changes, protecting the young person's safety and assisting with their medical treatment. CONCLUSION: Family caregivers could use this theory as a guide to enhance the care of young persons experiencing depressive disorders and suicidal ideations and accompany them alongside the healing process. IMPLICATIONS FOR THE PROFESSION: Nursing professionals could provide psychoeducation to family caregivers on how to hold the young person gently and acquire compassion for the young persons' lived experience, thoughts and emotions, by creating a nurturing environment, adjusting to changes, protecting their safety and assisting with their medical treatment. IMPACT: This theory provides valuable guidance for future intervention research aimed at improving family caregivers' ability to care for young persons with depressive disorders and suicidal ideations. REPORTING METHOD: The COREQ guidelines were utilised. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Information behaviours of people with type 2 diabetes in Kuwait: a grounded theory study.

BACKGROUND: Relative to country-specific epidemiological trends, Kuwait experiences a far greater burden of type 2 diabetes among its population. Information behaviours form a significant component of self-care management for patients diagnosed with type 2 diabetes, however this remains an understudied aspect of disease management. This study aims to investigate the information behaviours of patients with type 2 diabetes in Kuwait, and characterise the methods employed to manage their disease. METHODS: This qualitative study employed a grounded theory method. Semi-structured interviews were conducted with twenty-seven participants over three phases of data collection in primary, secondary and tertiary healthcare settings across Kuwait. These were complemented by in-depth interviews to detail the information behaviours of these participants. The interviews were translated where appropriate, transcripts, and analysed through qualitative coding to synthesise the information behaviour patterns. RESULTS: The findings demonstrated that living with type 2 diabetes involved a range of developmental and transformative stages, including changes to the patients' emotional state, reconstruction of their lifestyle and identity, and changes in the ways they find and use information. Living with the chronic condition was viewed as a dynamic and transitional process, where patients' information behaviours continually changed throughout the process across various identifiable stages. This dynamic pattern was reflected most prominently across the participants' behavioural needs, sources and information-seeking patterns. CONCLUSION: Patients with type 2 diabetes continuously adapted their information behaviours to optimise the self-management of their condition across a relatively predictable pattern. Greater understanding of these behaviours across a wider population would improve the provision of clinical care for patients with diabetes.

Exploring perceptions and expectations of COPD patients: A grounded theory approach for personalized therapeutic interventions.

Objectives: This study aimed to investigate the dynamic patterns of perception and expectations among COPD patients. Methods: Conducted at the Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, in Milan, Italy, the research involved 28 participants (16 males; mean age 72.8 ± 9.9) in face-to-face interviews. Utilizing a Grounded Theory approach, complemented by clinical data, recorded, and transcribed interviews underwent enhancement through the integration of two pictorial tools. Results: The central theme that emerged was a profound sense of responsibility toward their condition, perceived as a significant threat to life. Key symptoms, such as shortness of breath, coupled with negative expectations about their condition, contributed to depressive mood and avoidance behaviors. A notable proportion (N = 17; 60.71%) of participants struggled to envision a positive future, expressing a pervasive sense of hopelessness, which significantly influenced their health behaviors and adherence to medical recommendations. Conversely, individuals who felt supported and optimistic about treatment efficacy exhibited more positive expectations and adopted proactive coping strategies. Discussion: Recognizing the dynamic nature of patients' perceptions and negative illness expectations is essential to create personalized therapeutic interventions and meet the specific needs of COPD patients, ultimately improving the overall effectiveness of their care journey.

Barriers for bariatric surgery in provincial New Zealand: a qualitative analysis.

BACKGROUND: Bariatric surgery is the most effective treatment for people with obesity. It has been shown that there's is a complex psychosocial overlay in the pathophysiology and treatment, which requires specific consideration when delivering care. There is a significant drop out rate for patients accepted on to bariatric programmes in New Zealand, resulting in failure to progress to surgical intervention. METHODS: We conducted individual, semi-structured interviews with patients who were accepted onto the bariatric surgery programme but did not complete the programme, or receive an operation between 2015 and 2020. Grounded theory methodology was used to create an exploratory framework to identify and describe the themes encountered. An iterative process of thematic analysis and comparison between participants experiences was used to consolidate the shared key barriers. This study aims to explore patients experiences of a bariatric surgery programme to understand barriers and enablers to complete a bariatric programme and receive an operation. Adding to previous qualitative work investigating patients experience of bariatric surgery programmes in New Zealand. RESULTS: Five themes of barriers that patients face to receiving bariatric surgery were identified. These were preoperative weight loss requirement, experiencing the social stigma of obesity, communication, socioeconomic and geographic barriers, and community support. These five themes often co-exist in patients experiences and combine, to cause patients to disengage with the bariatric service. CONCLUSION: Many factors contribute to eligible patients not receiving bariatric surgery once accepted onto the programme. Specified weight loss goals was the most significant barrier. Community support and online resources were significant enablers. This study should inform changes to bariatric programmes in New Zealand.

Exploring the journey of supporters in bereavement support groups: Experiences, sense-making, and social connections.

This study aimed to explore facilitators' experiences in bereavement support groups as they relate to their experiences of personal loss. Semi-structured interviews were conducted with nine facilitators who had experienced such grief, and data were analyzed qualitatively using a modified grounded theory approach (M-GTA). The analysis revealed two categories and nine subcategories: (i) 'Experiences in group activities,' encompassing positive and negative experiences during activities, and (ii) 'Structuring of Meaning,' the process of deciphering for oneself in relation to one's experience of loss and life. These two categories interacted with each other, and it was important for facilitators to find meaning in their activities, loss experiences, and lives for the stable continuation of bereavement support group activities. These findings underscore the importance of facilitators following and supporting the sense-making process.

Spinal cord injury due to road traffic accident in the pre-hospital phase: a grounded theory study in an Iranian context.

Introduction: Spinal cord injury is a devastating outcome for individuals and a major public health problem that leads to sensory, motor, and autonomic dysfunction and permanent disabilities. Thus, it is necessary to identify the causes of disability and injury both in the accident phase and in the post-accident phase. This study aimed to develop a theory based on which this complex environment can be discovered. Methods: This research was a grounded theory study with the constant comparative analysis recommended by Corbin and Strauss in 2015. Participants in this study included 24 Participants were selected from Rofideh Rehabilitation Hospital and Shahid Jalaeipour Spinal Cord Injury Center of Tehran city in 2020. A semi-structured interview with an interview guide was used for data collection. Purposeful sampling method was performed within 10 months until data saturation. Lincoln and Guba's criteria were used to assess the scientific accuracy and validity of the study. Findings: The results of interviews showed that "uncertainty" was identified as the most important concern of the injured people, and "trying to save the injured" was identified as the most important concern of the witnesses and families of the injured people. The main categories included "emotional interaction," "overwhelming anxiety," "the scene shock," "misunderstanding of the delay," "inadequate emergency service," and "insufficient understanding of the injury." Conclusion: In a traffic accident, uncertainty about the situation is the main concern of everyone at the crash scene, from pre-hospital emergency personnel, traffic police, and law enforcement officer to the patient's companions and other witnesses. Further research is needed to shed more light on this issue.

"Do they think I'm good enough?": General practitioners' experiences when treating doctor-patients.

BACKGROUND: When doctors seek medical care, there is evidence that the treating doctor can struggle to provide optimal treatment. Guidelines state that doctor-patients should be treated like any other patient, but this is challenging for the treating doctor. This study set out to explore both the positive experiences general practitioners (GPs) have when caring for doctor-patients, and the challenges they confront. It sought to identify whether GPs believe they treat doctor-patients differently to other patients and if so, in what ways, for what reasons, and how this impacts their provision of care. The study also aimed to develop a model that makes sense of GPs' experiences when caring for a patient who is also a medical doctor. METHOD: Qualitative in-depth interviews with 26 GPs were carried out, with analysis of de-identified transcripts using pragmatic grounded theory. Evolving understandings were used to develop a model to make sense of GPs' experiences caring for their doctor-patients. RESULTS: The core aspects of GPs' experiences of treating fellow doctors centred around concepts of respect and collegiality. These play a central role in mediating how a treating doctor experiences a consultation with a doctor-patient, influencing the quality of care provided. GPs shared that the use of medical language (and assumptions about the doctor-patient's knowledge/behaviours), testing, the exploration of sensitive issues, and the degree of shared decision-making were areas where their treatment might vary when treating a doctor-patient. Treating doctors often experience anxiety about errors and the likely scrutiny from the medical, and wider community. The decision to treat the doctor-patient differently was driven by a desire to maintain a sense of collegiality, to not offend, to meet their doctor-patient's expectations, and to appear competent. CONCLUSION: The professional socialisation of doctors, with its emphasis on collegiality and respect, plays a significant role in the dynamics of the therapeutic relationship when a doctor treats a doctor-patient. Current guidelines make little reference to these dynamics with the over-simplified 'keep it normal' recommendations. Treating doctors need evidence-informed training to navigate these challenges and ensure they can effectively deliver quality care to their doctor-patients.

Theoretical sensitivity and reflexivity in grounded theory.

BACKGROUND: Grounded theory (GT) has become one of the foremost tools in qualitative nursing research. There are different approaches to GT but a feature common to all of them is theoretical sensitivity, which facilitates GT's iterative process. However, differences between the approaches in how to apply theoretical sensitivity and how much influence existing knowledge should play have contributed to tribalism. AIM: To critically evaluate the role of theoretical sensitivity and reflexivity in GT and the involvement they can have, as well as explore what steps researchers can take to improve their insight. DISCUSSION: Theoretical sensitivity enables researchers to steer their studies to answer their research questions, gain insight into their study's findings and develop theory grounded in the data. However, reflection is required for researchers to understand their effect on the theories that emerge, prevent them from applying preconceived ideas and allow for the unfettered emergence of theory. CONCLUSION: Researchers who do not demonstrate insight into their own philosophical positions and influences risk being accused of bias; this may result in the perceived value of their theoretical outcomes being reduced. Applying a reflexive process may mitigate this, enabling them to understand and refine their methodological processes and produce high-quality GT research. IMPLICATIONS FOR PRACTICE: All researchers should consider using reflexivity when conducting research. Understanding influences and positionality in qualitative methodologies allows for transparency and improves the rigour of their outcomes.

"Maintaining symbiosis in conflict": the quality of life of disabled elderly individuals in Chinese elderly care institutions - a grounded theory study.

BACKGROUND AND OBJECTIVES: Exploring the quality of life of disabled elderly individuals in eldercare facilities holds significant importance in the improvement of service quality, the allocation of eldercare resources, and the enhancement of the well-being of the elderly. This study, grounded in the subjective perspective of disabled elderly individuals, aims to investigate their quality of life within eldercare institutions. RESEARCH DESIGN AND METHODS: A grounded theory approach was employed, involving semi-structured interviews with 35 participants. RESULTS: Data analysis revealed that the quality of life of disabled elderly individuals in Chinese elderly care institutions is characterized by "maintaining symbiosis in conflict" and encompasses four dimensions: complex adaptation process, complexities in social interactions, physical pain and the lonely soul. DISCUSSION AND IMPLICATIONS: Spending late years in elderly care institutions poses a trial and challenge for disabled elderly individuals, especially within a cultural environment that traditionally revolves around the "family" unit. In these institutions, disabled elderly individuals not only endure physical pain but also grapple with feelings of loneliness. They maintain the facade of family dignity by concealing true emotions, ensuring the harmonious and stable operation of the elderly care institution.Enhancing the quality of life for disabled elderly individuals requires not only an improvement in the service capabilities of elderly care institution staff but also collaborative efforts from policymakers and family members.

The process of challenge formation in Iranian nursing education: A grounded theory study with model presentation.

BACKGROUND: Nursing education faces many challenges that must be identified and removed to improve nursing education and promote the quality of nursing care. Identifying the challenges of nursing education helps to solve or correct the weaknesses and achieve educational goals, which ultimately help to train skilled professionals capable of providing higher quality care to patients. The present study was conducted with the aim of explaining the experiences of nursing tutors in regard to the process of challenge formation in nursing education in Iran. MATERIALS AND METHODS: This is a qualitative study with a grounded theory approach that was conducted in two stages. In the first stage, which took about 9 months, 18 experienced nursing tutors with managerial positions were selected by purposeful sampling from universities across the country. Data were collected through semi-structured interviews, field notes, observation, and memos. Data analysis was done by Corbin and Strauss method through MAXQDA software version 10. In the next step, using the method of Walker and Avant (2011), concepts and statements were gathered within a whole and a model was presented. RESULTS: Twelve male university tutors and six female tutors participated in this study. The mean age of the participants was 45.38 ± 2.1 years, and their mean work experience was 18.66 ± 3.8 years. The findings showed that the challenges of nursing education could be categorized into three categories (defective educational cycle, efforts to restore the educational structure, and learning is a member of educational family), and 12 subcategories. After analyzing the data, trying to provide a need-based education was determined to be the central theme of this study. The components of model developed in this study were presented in the three axes of improving the tutor's teaching skills, managing the situation and educational facilities, and facilitating student's participation in the education process and decision-making. CONCLUSION: Identifying barriers and facilitators of need-based education in health policy making can enable nurses to build a better future for their nursing position. To provide need-based education, it is necessary to create a suitable ground and platform for proper education. Such platform and ground are a necessity of educational, therapeutic, and community environments. To achieve this goal, it is recommended to improve the professional capabilities of tutors and support educational organizations.

Unraveling Childhood Obesity: A Grounded Theory Approach to Psychological, Social, Parental, and Biological Factors.

Childhood obesity is a major medical and public health issue of global interest, which is influenced by a diverse array of factors and carries significant medical and psychosocial implications. Despite the extensive studies that have been conducted to explore the specific issue, the impact of several factors that influence, generate, worsen, and make chronic the phenomenon needs further exploration. This study aimed to construct a grounded theory that includes and connects the psychological, social, parental, and biological factors affecting childhood obesity. Key psychological factors include mental health issues such as depression and emotional eating, while social factors encompass socioeconomic status and cultural influences. Parental factors involve parenting styles and feeding practices, and biological factors relate to genetic predispositions and prenatal conditions. These factors interact in complex ways, highlighting the multifactorial nature of childhood obesity. The study employed a qualitative grounded theory approach, using research articles to achieve a thorough understanding. Qualitative analysis of the articles was conducted using Atlas.ti 24.0 software. Twenty-five research articles were required to reach theoretical saturation. The analysis resulted in 336 codes that were grouped into seven broad categories and twenty-four different subcategories. Through the construction of the theoretical framework, it was recognized that obesity in minors is a complex and multifactorial issue and that the network of causes and influencing factors covers a broad spectrum ranging from the individual to the family, and subsequently to society at large, which interact with each other.

A qualitative exploration of changes and mechanisms of changes in a psychoeducational intervention for family dementia caregivers.

BACKGROUND: 'Learning to feel better… and help better' is a psychoeducational intervention that aims to empower family caregivers of people with dementia by helping them cope better with the daily stress of dementia caregiving. The intervention has been adapted to a Swiss context and evaluated with a mixed-method design, yielding promising results in caregivers, such as a reduced subjective burden and improved self-efficacy. Qualitative findings have provided insight into potentially relevant intermediate changes that must be further explored to better understand how the intervention precipitates the achieved changes. We aim to qualitatively explore such changes, related mechanisms and key intervention components in the context of this intervention. METHODS: A constructivist grounded theory approach was used to achieve this aim. Changes, related mechanisms and key intervention components were identified by exploring the following: 1) longitudinal qualitative data, collected from 13 family caregivers via interviews performed before, during and after the intervention (39 interviews total) and 2) cross-sectional post-intervention interview data collected from 22 family caregivers (22 interviews). RESULTS: Experiencing calmness was the most important change for caregivers in the context of this intervention. The calmness model, developed based on the qualitative analysis, illustrates the intermediate changes that contributed to calmness, such as being able to cope with daily life and experiencing positive interactions with the family member with dementia. Related key intervention components were the coping strategy 'reframing', employed in diverse ways by the caregivers to reduce daily stress, and the didactic method 'active skills' training', which involved active participation by the caregivers and the guidance of a professional group leader. One important factor hampering changes in caregivers was having difficulties accepting the caregiver role or accepting the losses due to dementia. CONCLUSION: The calmness model offers valuable insight into how this intervention can benefit family caregivers and aid in developing interventions targeting similar mechanisms and changes. TRIAL REGISTRATION: ISRCTN13512408 (registration date 17.05.2021, retrospectively registered).

Resilience for working in Ontario home and community care: registered practical nurses need the support of themselves, family and clients, and employers.

BACKGROUND: The context of practice is often not explicit in the discourse around the personal and professional resilience of nurses. The unique factors related to providing nursing care in home and community care may provide novel insight into the resilience of this health workforce. Therefore, this research addressed how nurses build and maintain resilience working in the home and community care sector. METHOD: A qualitative study was conducted between November 2022 to August 2023 using 36 in-depth interviews (29 registered practical nurses [RPNs], five supervisors of RPNs, two family/care partners (FCPs) of clients receiving home and community care services). Analysis was consistent with a grounded theory approach including coding and comparative methods. RESULTS: The factors of personal and professional resilience were not distinct but rather mixed together in the experience of nurses having resilience working in the home and community care sector. The process of building and maintaining resilience as home and community care nurses was informed by three categories: (1) The conditions of working in HCC; (2) The rapport RPNs held with FCPs; and (3) The nurses' ability for supporting the 'self'. Multiple components to inform these categories were identified and illustrated by the words of the nurse participants. CONCLUSION: The process of building and maintaining resilience by RPNs working in the home and community care sector was guided by the day-to-day experiences of providing care for clients and the conditions of being a mobile health care provider. However, nurses may sense when they need to support their 'self' and must be empowered to request and receive support to do so.

Forming our grief rhythm: The relational window of tolerance for bereaved parents.

The shared loss of a child can present challenges to couple relationships as both partners attempt to cope with their own grief and their partner's grief. In this longitudinal qualitative study, five bereaved parent couples participated in 13 total interviews, revealing coregulatory interactions surrounding their shared loss. Using thematic coding and grounded theory analysis, their reflections were organized into three interrelated process themes: regulating self, regulating other, and forming our grief rhythm. This article explores the complexity of the last theme "forming our grief rhythm" in-depth, and a new theoretical orientation, the relational window of tolerance, is introduced to examine how couples coregulate both fragile and stable states within their shared grief. The reflections of bereaved parents indicated that prolonged "dual fragile states" and prolonged "imbalanced states" may hinder relationship quality. In order to regain relationship stability, couples learned to trade off supporting one another and/or to resonate with one another in their shared pain. Implications for future research and clinical practice are discussed, focusing especially on how to integrate individual and relational needs into grief therapy frameworks.

Experiences of Generation Z Nurses Adapting to Work in a Tertiary Hospital: A Grounded Theory Study.

AIM: To investigate the adaptation process of Generation Z nurses at a tertiary hospital in Korea. DESIGN: This qualitative study using grounded theory. METHODS: The participants were 17 Generation Z nurses who were working at tertiary hospitals in Korea. Data were collected through in-depth interviews from September 2022 to July 2023. FINDINGS: Eight categories and 19 concepts were extracted. The core category was 'accepting deficient myself as a nurse in a vertical culture', which consisted of three phases: chaos, endeavouring to adapt and accepting myself. In the adaptation process at the tertiary hospital, most of the participants felt embarrassed by tasks. The most of them tended to stay away from stressors and endeavour to improve their competence. The participants who had familiarity and a sense of belonging and achievement tended to acknowledge themselves. CONCLUSIONS: This study provides help in suggesting the importance of a horizontal organisational culture to Generation Z nurses. Also, the support of senior nurses is needed to encourage Generation Z nurses to accept deficient themselves. IMPLICATIONS FOR THE PROFESSION: Generation Z nurses tended to feel confused by the vertical culture, uncertainty of work and daunting tasks; excessive criticism and rebuke seems to make Generation Z nurses feel a sense of shame. The family-centred culture of nursing organisations could cause conflicts for Generation Z nurses who tend to separate their personal lives from work. IMPACT: Generation Z nurses had no difficulty acquiring knowledge because they had the skills to search for the necessary information, but they experienced difficulty applying this knowledge in practice and becoming familiar with their role as a nurse. REPORT METHODS: We adhered to relevant EQUATOR guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC INVOLVEMENT AND ENGAGEMENT: No patient or public involvement.

Risk management during times of health uncertainty in Spain: A qualitative analysis of ethical challenges.

The study examines the reflections of various experts in risk management when asked about uncertainty generated by a health threat and the response to such a threat: what criteria should guide action when potential harm is anticipated, but not known with certainty? The objective of the research is to obtain a holistic perspective of ethical conflicts in risk management, based on experts' accounts within the Spanish territory. A qualitative study was conducted through semi-structured interviews with 27 experts from various fields related to health risk management and its ethical implications, following the grounded theory method. The method includes theory generation through an inductive approach, based on the identified categories. The 27 narratives obtained revealed a variety of fundamental issues grouped into 8 subcategories and subsequently grouped into three main categories. The first category focuses on human vulnerability in health matters. The second category explores the agents and instruments for decision-making that arise from uncertain or traumatic social events. The third category refers to the need for common ethical paradigms for all humanity that implement justice over universal values. A main theory was suggested on the concept of responsibility in a global common good. There is an urgent need to assume this integrative responsibility as an inherent strategy in decision-making. To achieve this, the involved actors must acquire specific humanistic training, conceptualizing fundamental ethical principles, and emphasizing skills more related to humanistic virtues than technical knowledge.

A Grounded Theory Approach to Understanding Men Confronting Infertility.

Purpose: This study aims to delve into the process of men confronting infertility. Design: This research employed the Straussian grounded theory approach. Methods: The study encompassed interviews with 16 participants from a private fertility center in Isfahan, Iran, between March 2023 and March 2024. The interviews were semistructured. Data analysis was carried out concurrently using constant comparative methods and standard grounded theory techniques. the participants' main concerns were identified, culminating in developing a substantive theory centered around a core category. Findings: The primary category for men struggling with infertility was "forced concealment." This was exhibited through the suppression of emotions, maintaining secrecy about infertility, hiding treatment, and attributing infertility to their wives to counteract threats to their masculinity. Factors such as partners, family, societal surroundings, care providers, and beliefs influenced the adopting of the "forced concealment" strategy. Conclusions: The "forced concealment" theory offers insights into the experiences of men struggling with infertility. The study highlights the necessity of formulating culturally sensitive strategies that enable healthcare providers, nurses, and health system managers to effectively fulfill their roles and address the challenges and needs of couples confronting male infertility. This can be realized through a comprehensive approach that integrates nursing skills and competencies.