Medical consultants' experience of collective leadership in complexity: a qualitative interview study.

PURPOSE: The aim of this study was to explore and understand the leadership experiences of medical consultants prior to a major hospital move. Health and care is becoming increasingly complex and there is no greater challenge than the move to a new hospital. Effective leadership has been identified as being essential for successful transition. However, there is very little evidence of how medical consultants experience effective leadership. DESIGN/METHODOLOGY/APPROACH: A qualitative methodology was utilized with one-to-one semi-structured interviews conducted with ten medical consultants. These were transcribed verbatim and analyzed using inductive thematic analysis. The research complied with the consolidated criteria for reporting qualitative research (COREQ). FINDINGS: Four themes were found to influence medical consultants' experience of leadership: collaboration, patient centredness, governance and knowledge mobilization. Various factors were identified that negatively influenced their leadership effectiveness. The findings suggest that there are a number of factors that influence complexity leadership effectiveness. Addressing these areas may enhance leadership effectiveness and the experience of leadership in medical consultants. RESEARCH LIMITATIONS/IMPLICATIONS: This study provides a rich exploration of medical consultants' experience of collective leadership prior to a transition to a new hospital and provides new understandings of the way collective leadership is experienced in the lead up to a major transition and makes recommendations for future leadership research and practice. PRACTICAL IMPLICATIONS: The findings suggest that there are a number of factors that influence complexity leadership effectiveness. Addressing these areas may enhance leadership effectiveness and the experience of leadership in medical consultants. SOCIAL IMPLICATIONS: Clinical leadership is associated with better outcomes for patients therefore any interventions that enhance leadership capability will improve outcomes for patients and therefore benefit society. ORIGINALITY/VALUE: This is the first research to explore medical consultants' experience of collective leadership prior to a transition to a new hospital.

A Qualitative Analysis of Urbanization and Menstrual Health Among Young Women.

This qualitative study, grounded in theory, employed inductive coding for analysis, focusing on menstrual health among urban women aged 10-25. The research aims to explore the menstrual health status, practices, and beliefs of participants. The research delves into the impact of recent government initiatives on menstrual health and assesses the role of urbanization in shaping evolving menstrual health practices among young girls. Employing in-depth qualitative methods such as interviews and focus group discussions, the study seeks a comprehensive understanding of participants' experiences and perceptions related to menstrual health. The dynamics of women's menstrual experiences are significantly influenced by urbanization, heightened exposure to social media, evolving lifestyles, and government initiatives like the distribution of menstrual products in schools and the enhancement of water, sanitation, and hygiene (WASH) facilities in government institutions. Positive shifts have been observed, including reduced restrictions on menstruating individuals, enhanced access to affordable hygiene products, and improved disposal facilitated by municipal garbage collection services. However, notable gaps persist in basic knowledge about menstruation, hygienic practices, effective interpersonal communication with schoolteachers or community health care workers, and compliance with government programs promoting weekly iron-folic acid supplementation and biannual Albendazole intake, calling for substantial improvement.

Colorectal cancer survivors' adjustment to permanent colostomy in Switzerland: A qualitative analysis.

Colostomized colorectal cancer survivors present physical, psychological, and social difficulties after treatment, which complicate their return to normal life. Nevertheless, we lack insight into their lived transition experience after treatment in Switzerland. We led nine semi-structured interviews with participants who had a colostomy for a mean of 16.4 years. The participants' mean age was 73.1 years. Through an inductive thematic analysis, we highlighted several adaptation difficulties. Their body image was poor, and they behaved differently than before the surgery. For fear of being rejected, they concealed their colostomy. However, they felt isolated and often wished for more support. They may be in a vicious circle where their difficulties are maintained. We advocate that supporting survivors psychologically beyond the end of their treatment is essential to facilitate adjustment and overcome cancer.

Older Adults and Their Families' Online Reviews of Urban Nursing Homes in China.

BACKGROUND AND OBJECTIVES: Social media has made online care facility reviews popular. By analyzing online reviews of nursing homes (NHs), managers and designers can acquire insight into the perceptions of the older adults and their families. This study aims to help improve the care and environment of NHs. RESEARCH DESIGN AND METHODS: This study employed a mixed-methods approach to analyze online NH reviews. An inductive thematic analysis was utilized to identify and develop themes, followed by a detailed content analysis using Jieba, a Python-based program. Also, a regression analysis was conducted between the sentiment level of each subtheme and the final star ratings. RESULTS: Online reviews of NHs could be classified into 6 main themes, 18 subthemes, and 53 initial themes. Among the main themes, "service quality" received the most reviews, followed by "physical space environment." Of the 53 initial themes, "attitude and caring" received the most feedback, followed by "general impression of the space environment," and "meals and nutrition." Regression analysis using 18 subthemes revealed that, except for the "facility scale," all 17 subthemes were significantly connected with the final star rating. "Personal and property security" had the highest regression coefficients, followed by "service attitude" and "space." DISCUSSION AND IMPLICATIONS: Online reviews provide a valuable supplement to conventional NH quality assessment criteria, enhancing person-centered care delivery. Based on the findings, recommendations for NH management and design are proposed to improve care quality, environment, and satisfaction for older adults and families.

Delineating family needs in the transition from hospital to home for children with medical complexity: part 2, a phenomenological study.

BACKGROUND: A systematic literature review on the transition from hospital-to-home (H2H) of families with a child with medical complexity (CMC), resulted in nine overarching themes. These demonstrated common needs and experiences despite the widely differing CMC diagnoses and family characteristics. However, none of the reported studies was conducted in the Netherlands, which hampers the creation of a tailored H2H care pathway, deemed essential for our recently established Transitional Care Unit in the Netherlands: the 'Jeroen Pit Huis'. Therefore, the aim of this study was to gain a deeper understanding of the needs and experiences of Dutch CMC parents on H2H transition and integrate these insights with the literature review into an evidence-based H2H care pathway for CMC and their families. METHODS: A descriptive phenomenological approach was applied. Heterogeneous purposeful sampling methods were used to recruit participants according to the following criteria: parents of CMC from various regions in the Netherlands, who spoke Dutch fluently and who had been discharged home from a tertiary hospital within the previous five years. Semi-structured, open-ended interviews were conducted via video call by two researchers, who transcribed the audio recordings verbatim. Thematic analysis methods were used to identify emerging themes from the individual transcripts, involving a third and fourth researcher to reach consensus. RESULTS: Between March and August 2021, 14 mothers and 7 fathers participated in 14 interviews. They elaborated on the H2H transition of 14 CMC with a wide range of underlying diseases: 7 male, 7 female, aged 6 months to 10 years. Eight overarching themes, consistent with the results of the systematic review, represent CMC parental needs and experiences during the H2H process in the Netherlands: (1) autonomy, (2) division of tasks and roles, (3) family emotions, (4) impact on family life, (5) communication, (6) coordination of care, (7) support system and (8) adaptation. CONCLUSIONS: The H2H needs and experiences reported by the CMC families in this study align with the results of our systematic review. The H2H transition process is not linear but continuous, and should extend beyond the specific medical needs of the CMC to holistic care for the family as a whole. The overarching care needs and experiences, expressed by all CMC families, regardless of underlying symptoms and diagnoses, inform the H2H care pathway and its future evaluation. Our studies highlight the necessity to focus on the family needs rather than on the specific illness of the child, as well as the value of our interdisciplinary care team partnering with parents in the 'Jeroen Pit Huis' towards a safe and sustainable transition home.

Experiences and Perceptions of Post-Stroke Fatigue Among Stroke Survivors in Saudi Arabia: A Qualitative Interview Study.

Purpose: Post-stroke fatigue (PSF) is a debilitating condition that negatively impacts the quality of life of stroke survivors. The rehabilitation of stroke survivors is important for their quality of life, and rehabilitation programs that cater to the needs of these patients are required. However, there is very little published information on their needs, especially in the Middle East. Therefore, this study aimed to explore stroke survivors' perceptions and experiences of PSF and its causes, its impact on their daily life, their coping strategies, and support from physicians and caregivers in the context of Saudi Arabia. Patients and Methods: This qualitative interview study was conducted with eight post-stroke survivors from two tertiary stroke centers in Saudi Arabia. Results: The responses in the interviews showed high heterogeneity. From the responses, five main themes and several subthemes were generated: (1) description of PSF as both a physical and psychological experience; (2) perceived causes of PSF (physical causes, psychological causes, and stroke-related causes); (3) impact of PSF on daily life (activities of daily living and social interactions); (4) coping strategies for PSF (pacing, self-motivation, and social participation); and (5) perspectives about support from caregivers and healthcare practitioners (lack of support, provision of information about PSF and its management, physiotherapy interventions, encouragement, and overprotectiveness). Conclusion: Stroke survivors have variable physical and psychological experiences of PSF and variable perceptions of its causes and impact. High heterogeneity was also noted in the perception of support provided by healthcare providers and families or caregivers-ranging from lack of support to overprotection. Similarly, patients' perceptions of the role of physiotherapy and their attitude towards physiotherapy were also variable. Despite this, the findings do highlight the need for more individualized understanding of PSF and the development of treatment strategies that consider biological, psychological, and social factors.

Transgender Healthcare and Medical Education: An Inductive Thematic Analysis of Digital Discourse.

Introduction Transgender and gender-diverse (TGD) patients face significant healthcare disparities informed by discrimination, social stigma, and socioeconomic inequality. This is further exacerbated by a paucity of transgender health content in medical education, contributing to a large proportion of providers being ill-equipped to manage TGD patients' health concerns. Method This paper uses the framework approach for an inductive thematic analysis of online discussion forums concerning transgender health and medical education. Online text from anonymous participants was chosen for their authentic accounts of healthcare experiences and to ensure responses are less restrained in discussing sensitive topics. Results Three major themes were identified from the data: desire for more knowledgeable providers, negative healthcare experiences and attitudes, and recommendations for transgender health education. Three subcategories emerged from the latter theme that further illuminated participant recommendations for inclusive healthcare. Conclusions As a result of the unique healthcare concerns faced by TGD patients, providing materials to educate students and providers is crucial to meet the needs of the TGD patient population. Participant reports align with previous literature in recommending curricular reforms in medical school, promoting career options for TGD-identifying people in healthcare, and cultivating a more inclusive clinical culture.

Academic publisher guidelines on AI usage: A ChatGPT supported thematic analysis.

Background: As Artificial Intelligence (AI) technologies such as Generative AI (GenAI) have become more common in academic settings, it is necessary to examine how these tools interact with issues of authorship, academic integrity, and research methodologies. The current landscape lacks cohesive policies and guidelines for regulating AI's role in academic research which has prompted discussions among publishers, authors, and institutions. Methods: This study employs inductive thematic analysis to explore publisher policies regarding AI-assisted authorship and academic work. Our methods involved a two-fold analysis using both AI-assisted and traditional unassisted techniques to examine the available policies from leading academic publishers and other publishing or academic entities. The framework was designed to offer multiple perspectives, harnessing the strengths of AI for pattern recognition while leveraging human expertise for nuanced interpretation. The results of these two analyses are combined to form the final themes. Results: Our findings indicate six overall themes, three of which were independently identified in both the AI-assisted and unassisted, manual analysis using common software tools. A broad consensus appears among publishers that human authorship remains paramount and that the use of GenAI tools is permissible but must be disclosed. However, GenAI tools are increasingly acknowledged for their supportive roles, including text generation and data analysis. The study also discusses the inherent limitations and biases of AI-assisted analysis, necessitating rigorous scrutiny by authors, reviewers, and editors. Conclusions: There is a growing recognition of AI's role as a valuable auxiliary tool in academic research, but one that comes with caveats pertaining to integrity, accountability, and interpretive limitations. This study used a novel analysis supported by GenAI tools to identify themes emerging in the policy landscape, underscoring the need for an informed, flexible approach to policy formulation that can adapt to the rapidly evolving landscape of AI technologies.

A thematic analysis of smokers' and non-smokers' accounts of E-cigarettes.

This study explored smokers' and non-smokers' accounts of E-cigarettes. A total of 51 UK-based participants, 20 men and 31 women, responded to open-ended questions online. Inductive thematic analysis identified that the factors that influence E-cigarette behaviour and opinion in adult smokers and non-smokers are related to social context, informative sources, practical aspects and health implications. Participants presented varying accounts of E-cigarettes, suggesting that individual narratives regarding E-cigarettes are multi-faceted. This is important information for health professionals and policy makers tasked with advising on E-cigarette use.

Emotional reactions of trained overdose responders who use opioids following intervention in an overdose event.

Background: Our aim was to explore emotional reactions to intervening in an overdose event from the perspective of individuals who use opioids (peer responders). In addition, we were interested in the impact this experience may have on peer responders' feelings about helping in an overdose situation in the future. Methods: For this qualitative sub-study of a randomized controlled trial (RCT), data from 61 interviews were analyzed thematically using an inductive approach. Results: Peer responders had diverse emotional reactions to the overdose event. These ranged from a sense of pride and other positive feelings associated with their ability to help to ambivalence about being involved in situations perceived as challenging and burdensome. There were few reports of the overdose event as an exclusively negative experience. Many peer responders perceived it as their duty to use naloxone again if required. However, some had ambivalent feelings toward this responsibility, which may be related to negative experiences with previous intervention efforts. Conclusions: The capacity of people who use opioids to help reduce the harms associated with opioid overdose is experienced as empowering by some. Nonetheless, engaging peer responders in strategies to reduce opioid-related mortality should be coupled with appropriate resources to process their experiences and emotional responses.

Thinking aloud on the road: Thematic differences in the experiences of drivers, cyclists, and motorcyclists.

This study takes a qualitative approach to exploring the experiences (and differences therein) of individuals using either their car, bicycle, or motorcycle to navigate a ∼10.5 km urban route in a provincial UK city, with the aim of contributing to our understanding of the needs and requirements of different road users. Forty-six individuals provided concurrent verbal reports, using the 'think aloud' method, whilst using their vehicle to navigate the test route, the transcripts of which were subjected to a theory-agnostic, inductive, thematic analysis. A number of group differences were observed, revealing (among other factors) the importance of road surface quality to cyclists, the focus on vigilant observation in motorcyclists, and the heightened emotionality experienced by both two-wheeled groups, particularly those on bicycles. This affective component has, as yet, been under-explored in the academic domain and under-utilised in road transport policy and strategy; this is discussed, with attention drawn to the cyclists' greater tendency to make negatively valenced value judgements. Results are also discussed in terms of the potential to improve road users' experiences, foster inter-group empathy and understanding, and encourage a shift in mobility towards more sustainable modes.

Autism research is 'all about the blokes and the kids': Autistic women breaking the silence on menopause.

OBJECTIVES: The menopause is a major transition marked by considerable challenges to health and well-being. Its impact on autistic women has been almost largely ignored but is of significant concern, given the poorer physical and mental health, emotion regulation and coping skills, and the common social isolation of this group. We aimed to explore awareness and perception of the menopause; menopausal experiences and their impact across each individual's life; ways that menopause with autism might differ from a non-autistic menopause; and what optimal support might look like. DESIGN: A qualitative interview study. METHODS: Comprehensive interviews were conducted with 17 autistic participants (16 of whom identified as cisgender women). Inductive thematic analysis was used, guided by IPA principles and literature. RESULTS: Four major themes were identified: (1) covering the long journey of our participants to recognizing autism in adulthood; (2) menopausal awareness and perceptions; (3) symptoms and their impact; and (4) ways that a neurodiverse menopause might differ from the norm. Menopausal experiences varied greatly and some participants experienced marked deterioration in daily function and coping skills, mental health, and social engagement. Menopausal awareness was often low, so too was confidence in help from health care professionals. CONCLUSIONS: These findings implicate the potential for menopause to severely compromise health and well-being of autistic people and indicate an area of underserved support needs.

Am I Really Bipolar? Personal Accounts of the Experience of Being Diagnosed With Bipolar II Disorder.

Bipolar disorder (BD) is a complex and chronic mental illness with highs and lows beyond the ordinary, which induces a significant risk of suicide. The aim of this study was to explore the experience of being diagnosed with BD and the impact that receiving a correct diagnosis had had on life situations and relationships with others. Semi-structured qualitative interviews were conducted with seven people diagnosed with BD. The results showed that the primary treatment all participants had received or were currently receiving was pharmacotherapy, typically without any psychological component. A major concern that arose was delayed diagnosis, leading to inadequate treatment, and lack of knowledge among professionals about non-typical forms of BD. Moreover, the experiences of others' reactions were multifold, though generally surprisingly positive. Generally, the participants had learned to recognize, understand and tackle early symptoms of both hypomanic and depressive episodes to avoid developing a full-blown acute episode. This study highlights the crucial importance of a collaborative relationship between the clinician and the patient.

Using frame analysis to re-analyse the results of inductive thematic analysis: A methodological discussion of investigating meanings and learning contexts in baccalaureate nurse education.

AIMS: Recovery of the antecedents and assumptions of Goffman's frame analysis to illustrate learning contexts in baccalaureate nursing programs. DESIGN: A discussion paper on the secondary analysis of focus group data. DATA SOURCES: Focus group data collected in a multi-site study conducted in 2017 to understand the challenges of transitioning to practice in Lebanon. The discussion is illustrated with empirical data, but the article is a conceptual paper not a research report. IMPLICATIONS FOR NURSING: Transition to practice research requires studies of interaction in university schools of nursing to examine the meanings embedded in classroom instruction. METHODS: Clarification and use of Goffman's concepts of primary frame, mainframe (storyline), keying, and re-keying to describe how differences in learning contexts make the transition to practice difficult. CONCLUSION: Baccalaureate nursing education consists in re-keying the knowledge students bring with them to university into an idealized conception of nursing practice. This storyline dominates classroom learning and is re-keyed into the pragmatic approach to nursing practice that dominates learning contexts in clinical units. Students respond to discrepancies between the meanings embedded in classroom and clinical unit learning contexts by striving to apply the classroom storyline or delaying their commitment to a nursing career. IMPACT: The discussion explains how secondary analysis can overcome some of the limitations of inducive thematic analysis. It promotes frame analysis as an intuitive, conceptually sound method for identifying dominant meanings in baccalaureate nursing education. Qualitative researchers who have used inductive thematic analysis can use frame analysis to complement their previous analyses with a structural sociological perspective. We suggest dimensions to help investigators interpret learning contexts. Frame analysis of classroom interaction will bring new insights to transition to practice research.

A Quantitative and Qualitative Study of Notes Left by Youth Who Died by Suicide in Quebec from 1895 to 1985.

The study of suicide notes and the evolution of their content could contribute to a better understanding of reasons conducive to suicide mortality and offer further prevention strategies. From 1895 to 1985, 706 coroner's inquests of individuals who died by suicide and were 20 years old or younger were found in the province of Quebec. Quantitative analysis compared those who left notes (n = 47) to those who did not leave notes (n = 659). Furthermore, notes were subjected to inductive thematic analysis. Sociodemographic characteristics of the deceased individuals did not change over time. Qualitative analysis revealed four superordinate themes: (1) last wishes, (2) to those I leave behind, (3) about me and how and why I did it, and (4) self-positioning in the world. Only the last theme evolved over the time period considered. Suicide notes shed light on the psychological state of the majority of young note leavers and suggest the persistent feelings of distress and entrapment before the suicide, which may be important factors for caregivers and family members to monitor.

Queering Poetics: The Impact of Poetry on LGBT+ Identity in Singaporean Adolescents.

This qualitative study explores identity formation in LGBT+ Singaporean adolescents, and how reading, writing, and listening to poetry shapes Singaporean adolescents' social identities as queer people. Analyzing in-depth interviews with nine LGBT+ Singaporean adolescents, four themes were found: (1) LGBT+ Singaporean adolescents interested in poetry believe that reading, writing, and/or listening to poetry has been an integral part of constructing their queer identities; (2) the poems that have impacted LGBT+ Singaporean adolescents' queer identities the most have been informed by queer sociocultural values; (3) poetry provides validation to LGBT+ Singaporean adolescents that their identities are real and that others before them have experienced the same challenges they are going through; and (4) poetry serves as a third space for LGBT+ Singaporean adolescents to safely construct their growing queer identities. Implications for teachers, counselors, and adult supporters of queer Singaporean adolescents are discussed, and recommendations for future research are provided.

Development of an interprofessional competency framework for collaborative practice in Japan.

Rapid aging of the population necessitates improved collaboration among healthcare professionals. Unfortunately, interprofessional collaboration has yet to be implemented effectively in Japan. Therefore, we aimed to develop an interprofessional competency framework for Japanese healthcare professionals. The project was conducted as a four-step process, starting with initial categorization of potential competency domains,, followed by guiding principle and prototype development, feedback on the prototype, and final consensus. First, authors (JH and MO) collected opinions about competency in interprofessional collaboration at two academic meetings of the Japan Association for Interprofessional Education (JAIPE) and then analyzed the data thematically. Second, a project team consisting of JAIPE and University representatives extracted the domains and statements as prototype 1. Third, seven representatives from professional organizations joined the project team and developed prototype 2. We then called for feedback on the revised prototype 2 at both an open symposium and via public comments. Following revision of prototype 2, a new project team including 20 university, professional organization and health practitioner representatives finally discussed prototype 3, developed the final draft and reached a consensus. In analysis after collecting the data, we extracted 11 themes. We developed four key principles which applied to six domains as prototype 1-3. Finally, our competency framework included two core domains of "Patient-/client-/family-/community-centered" and "Interprofessional communication", and four peripheral domains of "Role contribution", "Facilitation of relationships", "Reflection" and "Understanding of others". We developed an interprofessional competency framework in Japan which consists of two core and four peripheral domains. The interprofessional competency framework is likely to affect the understanding of "high-context" and "relationalism" in Japanese healthcare. We hope that our interprofessional competency framework will encourage the systematic implementation of interprofessional education and collaboration in Japan.

Perceptions of Group-Based Walks and Strategies to Inform the Development of an Intervention in Retirement Villages: Perspectives of Residents and Village Managers.

The aim of the current study was to explore perceptions of group-based walking and gather suggestions to inform the development of a group-based walking intervention among older adults in retirement villages. Twenty-four physically inactive residents (16 female, 8 male; age range: 69-88) and four managers from four retirement villages were interviewed. Inductive thematic analysis revealed six broad themes: lack of motivation, values versus constraints, fears and confidence, need for structure, creating a sense of belonging, and the physical environment as a double-edged sword. Proposed intervention strategies included using trained walk leaders, using small groups, planning for flexibility, setting attainable goals, creating a routine, creating opportunities for sharing experiences, and planning a variety of walks. Group-based walking programs may be used to promote physical activity but careful planning of such programs is needed to make them appealing and feasible to a diverse group of residents.

Development of an interprofessional competency framework in Japan.

This article presents a project that aimed to identify a set of competencies (domains and statements) to prepare Japanese students and healthcare practitioners for collaborative practice. The Japan Association for Interprofessional Education (JAIPE) has started a government-funded project to formulate its interprofessional competency framework, in cooperation with professional organisations (e.g. Japan Society for Medical Education) in healthcare and social sciences. This three-year project is underway as part of the Initiative to Build up the Core Healthcare Personnel programme of Mie University. This project consists of five stages: literature review, data collection, prototype development, consensus formation, and finalisation. Our efforts will culminate in Japan's first interprofessional competency framework, with consensus from relevant academic societies and other stakeholders. We hope that the involvement of stakeholder participation will improve the usability of the final interprofessional competency framework.

Perceptions of Determinants of Successful Aging Among Older U.S. Veterans: Results from the National Health and Resilience in Veterans Study.

OBJECTIVE: To conduct a qualitative study of older American veterans' subjective perceptions of factors that contribute to successful physical, emotional, and cognitive aging. METHODS: A nationally representative sample of 2,025 veterans aged 60 or older (range: 60-96; 96.9% male, 39.4% combat veterans) participated in the National Health and Resilience in Veterans Study. Using qualitative analysis software, the authors coded responses to three open-ended questions, inductively developed categories, aggregated similar categories into factors, and grouped factors into broader themes. RESULTS: A total of 53, 56, and 61 categories of responses was identified in response to questions about successful physical, cognitive, and emotional aging, respectively, with 10 aggregate factors linking these categories. The most prominent theme overall was "What you do," which received 2,295, 2,210, and 1,247 mentions for each of these domains of successful aging, with health behaviors the most common factor for both successful physical and cognitive aging and social engagement the most common for successful emotional aging. The theme "Who you are" was the second-most common factor (discerned from 376, 247, and 943 total mentions, respectively), with the factors that comprise this theme-personality and explanatory style, moral compass, and emotional dispositions-more commonly endorsed for successful emotional aging. External factors such as healthcare were least commonly endorsed across all domains. CONCLUSION: Older U.S. Veterans emphasize health behaviors, social engagement, and dispositional characteristics as key determinants of successful aging. Prevention and treatment initiatives that target these potentially modifiable factors may help promote successful aging in this growing segment of the population.