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Objective: Telenursing e-learning courses have been shown to enhance nurses' skills and knowledge; however, the subjective learning experience is unclear. In this study, we identified meta-inferences to quantitatively and qualitatively understand this experience, as well as the types of knowledge gained through an e-learning course and how they are linked to each other, in order to enhance nurses' confidence in their understanding of telenursing. Methods: We employed a single-arm intervention with a mixed-methods convergent parallel design. We converged participants' self-reported pre- and post-course confidence scores with their reflections on the learning experience, which were reported qualitatively as improved or unimproved. A total of 143 Japanese nurses with a mean of 20 years of nursing experience participated in this study. Results: Among the participants, 72.7% demonstrated improved confidence in their understanding of telenursing after completing the e-learning course. The baseline confidence score was originally higher in the group that reported unimproved confidence (p < .001). Although there was no statistical difference in the usability and practicality scores between the two groups, the qualitative learning experience in these aspects differed in terms of the depth of knowledge of telenursing obtained. Conclusions: Nurses' quantitative confidence in their understanding of telenursing after course completion was incongruent with their qualitative perspectives of the learning experience. Nursing educators, healthcare policymakers, and other stakeholders should consider that learners' overconfidence in their understanding of telenursing and comprehension of e-learning materials may result in their failure to develop key telenursing competencies, skills, and knowledge.
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Background: The policies and mission statements of nursing homes support the implementation of person-centred dementia care. The Dementia Policy Questionnaire assesses the content of person-centred dementia care in policies. To date, it is unknown whether these policies exist exclusively in dementia care units and whether the policies are consistent with the mission statements of nursing homes. Objective: We aimed to (1) investigate nursing home care unit types regarding the existence of policies measured by the Dementia Policy Questionnaire, (2) explore whether these policies are addressed in the mission statements of the nursing homes, and (3) integrate both results. Design: This is a convergent mixed methods study performed with a quantitative and qualitative dataset that was collected in the BeStaDem survey (2020). Setting: The BeStaDem survey included licensed nursing homes in Germany. Participants: A total of 134 nursing home administrators provided informed consent to participate in the BeStaDem survey. Methods: For quantitative data, we performed Fisher's exact test to identify differences in the Dementia Policy Questionnaire item distribution of several types of care units (aim 1). To support the results of Fisher's exact test, we additionally applied logistic regression analysis. For qualitative data, we analyzed the mission statements deductively with the qualitative content analysis method (aim 2). For integration, we used a convergent triangulation approach (aim 3). Results: The quantitative data collected from 134 German nursing homes show significant associations among person-centred dementia care policies, such as behavior assessment, and nursing homes with dementia care units. Regarding the qualitative data, of the 60 mission statements in total, eight mission statements of nursing homes with dementia care units exclusively address aspects such as dementia-specific interventions. The convergent triangulation approach shows that the answers given by the nursing homes in the quantitative survey are not always consistent with what they address in their mission statements. Conclusions: Nursing homes with dementia care units provide more person-centred dementia care policies than other care unit types do but mostly do not address these aspects in their mission statements. The implementation of person-centredness benefits from the existence of policies and mission statements if nursing homes clearly address what is meant by person-centred dementia care in their nursing home.
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Daily carrying of heavy loads of domestic water, especially during pregnancy and postpartum, bears a threat to maternal health in low-income countries. Using an extended health action process approach (HAPA), we examined women's reasons for and psychosocial determinants of safe water-carrying during pregnancy and postpartum. In a mixed-methods study, trained local interviewers conducted 1001 quantitative interviews with women of reproductive age (n = 921 analyzed) and 21 qualitative interviews with women of reproductive age, in-laws, and spouses in rural Nepal. We analyzed the quantitative data with generalized estimating equations to model the HAPA-based psychosocial determinants of avoiding water-carrying during pregnancy and postpartum. Subjective perspectives were investigated with thematic analysis. Outcome expectancies (B = 0.24), self-efficacy (B = 0.20), and injunctive norms (B = 0.23) were significantly associated with the intention to avoid water-carrying. Self-efficacy (B = 0.36) and instrumental support (B = 0.05) are related to behavior (all p < 0.05). Women explained water-carrying during pregnancy by a lack of family support, a shift of health decision-making power to in-laws, and low behavioral control. Overall, the necessity of water, family decision-making structures, and low support make it difficult for women to discontinue water-carrying. Additionally to infrastructural improvements, behavioral interventions may increase women's self-efficacy for safe water-carrying (e.g. reducing weight) and social support.