The association between patient safety culture and adverse events - a scoping review.

BACKGROUND: Adverse events (AEs) affect 10% of in-hospital patients, causing increased costs, injuries, disability and mortality. Patient safety culture (PSC) is an indicator of quality in healthcare services and is thus perceived as a proxy for the quality of care. Previous studies show variation in the association between PSC scores and AE rates. The main objective of this scoping review is to summarise the evidence on the association between PSC scores and AE rates in healthcare services. In addition, map the characteristics and the applied research methodology in the included studies, and study the strengths and limitations of the evidence. METHODS: We applied a scoping review methodology to answer the broad research questions of this study, following the PRISMA-ScR checklist. A systematic search in seven databases was conducted in January 2022. The records were screened independently against eligibility criteria using Rayyan software, and the extracted data were collated in a charting form. Descriptive representations and tables display the systematic mapping of the literature. RESULTS: We included 34 out of 1,743 screened articles. The mapping demonstrated a statistical association in 76% of the studies, where increased PSC scores were associated with reduced AE rates. Most of the studies had a multicentre design and were conducted in-hospital in high-income countries. The methodological approaches to measuring the association varied, including missing reports on the tools` validation and participants, different medical specialties, and work unit level of measurements. In addition, the review identified a lack of eligible studies for meta-analysis and synthesis and demonstrated a need for an in-depth understanding of the association, including context complexity. CONCLUSIONS: We found that the vast majority of studies report reduced AE rates when PSC scores increase. This review demonstrates a lack of studies from primary care and low- and- middle-income countries. There is a discrepancy in utilised concepts and methodology, hence there is a need for a broader understanding of the concepts and the contextual factors, and more uniform methodology. Longitudinal prospective studies with higher quality can enhance efforts to improve patient safety.

Fighting the waves; Covid-19 family life interference in a neurodevelopmental disorder-caregiver population.

INTRODUCTION: The current COVID-19 pandemic interferes with family lives across the world, particularly families of children with neurodevelopmental disorders (NDDs) are at a greater risk for being negatively impacted by the pandemic. Together with representatives from this caregiver population the aim was to explore the interference associated with normal family life caused by the COVID-19 pandemic. METHOD: This is a descriptive study using a cross-sectional design. Following a strategic network sampling strategy, a user-developed national survey was completed by a larger sample (N = 1,186) of parents and informal caregivers of children with NDDs. The survey utilized a combination of both closed and open-ended questions, and a logistic regression analysis was carried out to assess the association between family characteristics, characteristics of the child, and COVID-19 related family life interference. Before carrying out the regression an inductive content analysis of the open-ended question on `How has the isolation affected the family´ was carried out to construct the outcome variable. RESULTS: The initial analysis indicated that the COVID-19 pandemic induced a shift in everyday family life and a lack of guidance and support related to managing the challenges they were facing. Caregivers who reported that COVID-19 had significantly interfered with their family life, were more likely to report having anxious children, and to have experienced an increased number of conflicts at home. The logistic regression showed that both anxious children and increased conflicts considerably increased the risk for reporting family life interference compared to those that reported no increased conflicts or anxious children. DISCUSSION: Considering how the COVID-19 related increased conflicts at home and anxious children threaten the family life of the NDD caregiver population, as an external source of family stress, which might lead to negative impact on their mental and physical well-being, the need for further research in collaboration with user representatives is apparent. Our study suggests that more information should be provided to healthcare providers, social professionals, peers, people with NDDs, and caregivers of people with NDDs about the potential threats that a stressful life event such as the current pandemic can pose to their mental and physical health and their family life.

Internationally educated nurses and resilience: A systematic literature review.

AIM: To synthesize knowledge extracted from the literature about protecting factors and challenges to resilience, among migrant nurses, and specifically how knowledge synthesized through the process of the literature review is relevant to nursing and health policy. BACKGROUND: How nurses, in general, face challenges is well documented and is often linked to the concept of resilience; however, there seems to be a lack of systematic knowledge synthesis focusing on the resilience of internationally educated nurses following migration. METHOD: The review was guided by the PRISMA guidelines, and a systematic search of peer-reviewed qualitative and mixed-method articles reporting empirical research was performed in the MEDLINE, CINAHL, PsycINFO and Academic Search Ultimate databases. Methodological rigour was assessed by the Joanna Briggs' checklist, and a structured theme-based ecological framework, inspired by Ungar's model of resilience, was chosen. RESULTS: Following critical appraisal, 37 studies were included that identified both challenges and individual, contextual and structural protective factors in host countries and are linked to resilience. DISCUSSION: Resilience of internationally educated nurses depends on a combination of individual and contextual protective factors, with the major emphasis being placed on individual protective factors. It is crucial to consider resilience in ensuring that internationally educated nurses' experience is appreciated, as this is necessary if nurses are to deliver the best possible health service while integrating into their host country. IMPLICATION FOR NURSING AND HEALTH POLICY: Authorities, managers in clinical practice and education, trade unions and nurses in general should be aware of the coping strategies, the strengths and supportive factors that can promote resilience and be aware of the challenges that undermine resilience and negatively impact internationally educated nurses' practice and social interactions.

Nurses' job involvement and association with continuing current position-A descriptive comparative study.

AIMS AND OBJECTIVES: The aim of the study is to examine nurses' job involvement and intentions to continue in their current position. BACKGROUND: Globally, the supply of nurses fails to meet the labour markets' high demand. Compared to specialist health service, the community health service has the greatest challenge when it comes to nursing shortage. There is a lack of studies comparing nurses working in different parts of the healthcare system in research focusing on nurses' intentions to continue in their current position. Similarly, there has been relatively little research on nurses' job involvement, even less how it is associated with retaining the nurses, despite indications that job involvement may be the key to job-related motivated behaviour. DESIGN: A descriptive comparative study with a cross-sectional design. METHODS: The study comprises 297 nurses from the community health service and specialist health service, respectively. The relationships between nurses' intention to continue and participant characteristics were examined using binary logistic regression. Reporting followed the STROBE guidelines. RESULTS: Nurses in the community health service are older, have more children under the age of 18 and hold more permanent positions than nurses in the specialist health service. Job involvement is the only variable associated with nurses' intention to continue in their current position regardless of whether the nurse works in the community health service or specialist health service. CONCLUSIONS: The results indicate that the community health service has the same possibilities as the specialist health service to retain nurses in their current jobs. RELEVANCE TO CLINICAL PRACTICE: The results indicate that nursing leaders/employers with a goal to retaining nurses are recommended to focus on improving the nurses' job involvement.

The association between hope, marital status, depression and persistent pain in men and women following cardiac surgery.

BACKGROUND: Cardiac surgery is a major life event, and outcomes after surgery are associated with men's and women's ability to self-manage and cope with their cardiac condition in everyday life. Hope is suggested to impact cardiac health by having a positive effect on how adults cope with and adapt to illness and recommended lifestyle changes. METHODS: We did a secondary analysis of 416 individuals (23% women) undergoing elective coronary artery bypass graft and/or valve surgery between March 2012 and September 2013 enrolled in randomized controlled trial. Hope was assessed using The Herth Hope Index (HHI) at three, six and 12 months following cardiac surgery. Linear mixed model analyses were performed to explore associations after cardiac surgery between hope, marital status, depression, persistent pain, and surgical procedure. RESULTS: For the total sample, no statistically significant difference between global hope scores from 3 to 12 months was observed (ranging from 38.3 ± 5.1 at 3 months to 38.7 ± 5.1 at 12 months), and no differences between men and women were observed at any time points. However, 3 out of 12 individual items on the HHI were associated with significantly lower scores in women: #1) I have a positive outlook toward life, #3) I feel all alone, and #6) I feel scared about my future. Over the study period, diminished hope was associated with older age, lower education, depression prior to surgery, and persistent pain at all measurement points. Isolated valve surgery was positively associated with hope. While neither sex nor marital status, as main effects, demonstrated significant associations with hope, women who were divorced/widowed/single were significantly more likely to have lower hope scores over the study period. CONCLUSION: Addressing pain and depression, and promoting hope, particularly for women living alone may be important targets for interventions to improve outcomes following cardiac surgery. TRIAL REGISTRATION: Clinical Trials gov Identifier: NCT01976403 . Date of registration: November 28, 2011.

Self-Management of Cardiac Pain in Women: A Meta-Summary of the Qualitative Literature.

Symptom recognition and self-management is instrumental in reducing the number of deaths related to coronary artery disease (CAD) in women. The purpose of this study was to synthesize qualitative research evidence on the self-management of cardiac pain and associated symptoms in women. Seven databases were systematically searched, and the concepts of the Individual and Family Self-Management Theory were used as the framework for data extraction and analysis. Search strategies yielded 22,402 citations, from which 35 qualitative studies were included in a final meta-summary, comprising data from 769 participants, including 437 (57%) women. The available literature focused cardiac pain self-management from a binary sex and gender perspective. Ethnicity was indicated in 19 (54%) studies. Results support individualized intervention strategies that promote goal setting and action planning, management of physical and emotional responses, and social facilitation provided through social support.

Impact of marital status and comorbid disorders on health-related quality of life after cardiac surgery.

PURPOSE: To explore associations between HRQL, marital status, and comorbid disorders in men and women following cardiac surgery. METHOD: A secondary analysis was completed using data from a randomized controlled trial in which 416 individuals (23% women) scheduled for elective coronary artery bypass graft and/or valve surgery were recruited between March 2012 and September 2013. HRQL was assessed using the Health State Descriptive System (15D) preoperatively, then at 2 weeks, and at 3, 6, and 12 months following cardiac surgery. Linear mixed model analyses were performed to explore associations between HRQL, social support, and comorbid disorders. RESULTS: The overall 15D scores for the total sample improved significantly from 2 weeks to 3 months post surgery, with only a gradual change observed from 3 to 12 months. Thirty percent (n = 92) of the total sample reported a lower 15D total score at 12 months compared to preoperative status, of whom 78% (n = 71) had a negative minimum important differences (MID), indicating a worse HRQL status. When adjusted for age and marital status, women had statistically significant lower 15D total scores compared to men at 3, 6, and 12 months post surgery. Compared to pre-surgery, improvement was demonstrated in 4 out of 15 dimensions of HRQL for women, and in 6 out of 15 dimensions for men at 12 months post surgery. Both men and women associated back/neck problems, depression, and persistent pain intensity with lower HRQL; for women, not living with a partner/spouse was associated with lower HRQL up to 12 months. CONCLUSION: Women experienced decreased HRQL and a slower first-year recovery following cardiac surgery compared to men. This study demonstrates a need for follow-up and support to help women manage their symptoms and improve their function within the first year after cardiac surgery. This was particularly pronounced for those women living alone.

Pain experiences of men and women after cardiac surgery.

AIMS AND OBJECTIVES: To compare the prevalence and severity of pain in men and women during the first year following cardiac surgery and to examine the predictors of persistent postoperative pain 12 months post surgery. BACKGROUND: Persistent pain has been documented after cardiac surgery, with limited evidence for differences between men and women. DESIGN: Prospective cohort study of patients in a randomised controlled trial (N = 416, 23% women) following cardiac surgery. METHODS: Secondary data analysis of data collected prior to surgery, across postoperative days 1-4, at two weeks, and at one, three, six and 12 months post surgery. The main outcome was worst pain intensity (Brief Pain Inventory-Short Form). RESULTS: Twenty-nine percent (97/339) of patients reported persistent postoperative pain at rest at 12 months that was worse in intensity and interference for women than for men. For both sexes, a more severe co-morbidity profile, lower education and postoperative pain at rest at one month post surgery were associated with an increased probability for persistent postoperative pain at 12 months. Women with more concerns about communicating pain and a lower intake of analgesics in the hospital had an increased probability of pain at 12 months. CONCLUSION: Sex differences in pain are present up to one year following cardiac surgery. Strategies for sex-targeted pain education and management pre- and post-surgery may lead to better pain outcomes. RELEVANCE TO CLINICAL PRACTICE: These results suggest that informing patients (particularly women) about the benefits of analgesic use following cardiac surgery may result in less pain over the first year post discharge.

Nurse-Led Telephone Follow-Up Intervention for Titrating and Tapering Opioids in Chronic Pain Patients - A Feasibility Study.

Background and Purpose: Opioids in chronic non-cancer pain are debated, but remain a part of the pain treatment for selected patients. Research is scarce on the relieving and adverse effects of opioids, and how to deliver opioid treatment in this patient group. This study's purpose was to assess the feasibility of a nurse-led telephone follow-up intervention for titrating or tapering opioids, including a pilot study of the intervention outcomes. Patients and Methods: The feasibility assessment and process evaluation were performed according to the UK Medical Research Council (MRC) framework for evaluating complex interventions. A pilot study of the intervention outcomes was also performed. With a retrospective, descriptive, and longitudinal approach, we analyzed reports from 32 patients who titrated or tapered opioids. Information on demography, sleep satisfaction, health status, pain intensity/bothersomeness, opioid doses, and side effects was derived from the Oslo Pain Registry. Descriptive statistics, t-tests, and chi-square tests were used to analyze registry data. Results: The study findings indicate that the intervention is feasible. Areas of impact were lack of a sound theory basis, unclear allocation criteria, and inconsistent and non-validated measurement tools. Mechanisms of change were interprofessional collaboration, nurses' knowledge and competencies, predictability, and availability. Statistical analyses showed no between-groups differences in demographical-, clinical-, and pain characteristics, except those who titrated opioids were significantly older than patients tapering opioids (P=0.010). All patients reported poor health and side effects at baseline. Those who tapered opioids had a significant reduction in opioid use (P=0.004). Titrating opioids was associated with a significant increase in side effects (P=0.038). Conclusion: Considering the limitations and the strengths of the intervention, the present study indicates that the nurse-led telephone follow-up program is a feasible intervention. With the right adjustments and improvements, the intervention is eligible for a larger efficacy study.

Re-traumatization of torture survivors during treatment in somatic healthcare services: A mapping review and appraisal of literature presenting clinical guidelines and recommendations to prevent re-traumatization.

RATIONALE: The number of torture survivors is on the rise, posing issues for their care in healthcare settings. Even healthcare experts with training in refugee care are unaware of the health difficulties faced by torture survivors. Any medical evaluation or treatment has the potential to re-traumatize torture survivors, thereby reactivating trauma symptoms without applicable guidelines to prevent re-traumatization. OBJECTIVE: Our objective was to identify, characterize, evaluate, and organize current, available evidence presenting existing recommendations and suggestions to prevent re-traumatization during the treatment of torture survivors' physical diseases in healthcare services. METHODS: A comprehensive search of electronic databases was conducted. Gray literature coverage was obtained by searching for publications from relevant associations and healthcare organizations focusing on torture survivors. Clinical practice guidelines (CPGs) and research focusing on somatic healthcare services for adult torture survivors, regardless of study design, were eligible for review. Studies that concentrated on psychiatric departments were excluded. To conduct an overview of the available research and describe the scope and distribution of evidence, a mapping review methodology was used. RESULTS: Forty out of 13,111 initial citations met our criteria. There were two guidelines, and text and opinion statements predominated. Two authors independently assessed the risk of bias in each primary research study using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for the research design. CONCLUSIONS: This mapping review identifies triggers that may re-traumatize torture survivors during treatment and makes recommendations for prevention. Only a few studies have considered torture survivors' perspectives on treatment and re-traumatization. According to the findings of the mapping review, healthcare providers should consider survivors' biopsychosocial situations, demonstrate cultural sensitivity, and change theirpersonal attitudes . They must also identify tortured patients and determine when professional interpreters should be used.

Torture survivors' experiences of receiving surgical treatment indicating re- traumatization.

Due to the invasive nature of surgical procedures and the involvement of medical personnel, torture survivors may experience re-traumatization during surgical treatment. This study aimed to explore torture survivors' experiences of re-traumatization during surgical treatment as well as the process by which trauma-related emotions and responses are evoked during surgical treatment for torture survivors. Eight men, aged 45 to 72, from four different countries, who have lived in Norway for 6-40 years, were recruited. We assessed torture and surgical care experiences through in-depth interviews, and the data were analyzed using thematic analysis, resulting in five themes: (1) Interactions with healthcare providers, (2) Reactions during treatment, (3) Triggers causing re-experiences, (4) Avoidance, and (5) Suggestions to healthcare providers. In this study, survivors reported challenges receiving surgical treatment, indicating re-traumatization and difficulty returning to daily life following treatment. Participants reported little collaboration in care-related decision-making processes, lack of recognition of torture by healthcare providers involved in surgical care and experiencing healthcare professionals' attitudes as a source of perplexity, frustration, and despair. Exacerbation of torture memories throughout treatment and re-experiencing of trauma symptoms aggravated these difficulties. Our findings suggest that surgical treatment can remind torture survivors of the traumatic aspects of torture, eliciting strong reactions and feelings like those experienced during torture.

Mental health and well-being of unpaid caregivers: a cross-sectional survey protocol.

INTRODUCTION: Unpaid caregiving, care provided by family/friends, is a public health issue of increasing importance. COVID-19 worsened the mental health conditions of unpaid caregivers, increasing substance/drug use and early development of chronic disease. The impact of the intersections of race and ethnicity, sex, age and gender along with unpaid care work and caregivers' health and well-being is unknown. The aim of this study is to describe the inequities of caregiver well-being across the intersections of race and ethnicity, sex, age and gender using a cross-sectional survey design. METHODS AND ANALYSIS: We are collaborating with unpaid caregivers and community organisations to recruit a non-probability sample of unpaid caregivers over 18 years of age (n=525). Recruitment will focus on a target sample of 305 South Asian, Chinese and Black people living in Canada, who represent 60% of the Canadian racial and ethnic populations. The following surveys will be combined into one survey: Participant Demographic Form, Caregiver Well-Being Index, interRAI Self-report of Carer Needs and the GENESIS (GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond-Premature Acute Coronary Syndrome) PRAXY Questionnaire. Sample characteristics will be summarised using descriptive statistics. The scores from the Caregiver Well-Being Index will be dichotomised into fair/poor and good/excellent. A two-stage analytical strategy will be undertaken using logistic regression to model fair/poor well-being and good/excellent well-being according to the following axes of difference set a priori: sex, race and ethnicity, gender identity, age, gender relations, gender roles and institutionalised gender. The first stage of analysis will model the main effects of each factor and in the second stage of analysis, interaction terms will be added to each model. ETHICS AND DISSEMINATION: The University of Toronto's Health Sciences Research Ethics Board granted approval on 9 August 2022 (protocol number: 42609). Knowledge will be disseminated in pamphlets/infographics/email listservs/newsletters and journal articles, conference presentation and public forums, social media and through the study website. TRIAL REGISTRATION NUMBER: This is registered in the Open Sciences Framework with a Registration DOI as follows: https://doi.org/10.17605/OSF.IO/PB9TD.

Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics.

Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.

Validating the Five-Item World Health Organization Well-Being Index.

Purpose: Research on the psychological well-being of caregivers of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) suggests that the well-being of parents and caregivers has been negatively affected by the COVID-19 pandemic. Although the psychological well-being of caregivers is a major concern, few validated well-being measures exist for caregivers of children diagnosed with ADHD. Therefore, a valid self-report scale is needed to assess well-being during the pandemic. The brief Five-Item World Health Organization Well-Being Index (WHO-5) has previously been used in studies on caregivers. However, its validity in this population remains unknown. This study aimed to evaluate the reliability and construct validity of the WHO-5 with caregivers of children with ADHD. Methods: A cross-sectional anonymous online survey was conducted in Norway. The study recruited caregivers from a community sample during the COVID-19 pandemic. This was carried out to investigate the construct validity by exploring the relationship between well-being, quality of life, social support, self-reported psychological distress, and perceived stress. Results: The findings of unidimensionality and high internal consistency, together with the results from the hypothesis testing, demonstrate the reliability and construct validity of the Norwegian version of the WHO-5 in this population. Conclusions: This study provides the first empirical evidence of the validity and reliability of the WHO-5 from a sample of Norwegian caregivers of children diagnosed with ADHD, with excellent reliability and construct validity. The scale can be used to systematize the measurement of well-being in caregivers because of its brevity and good psychometric properties, making it a valuable resource in research settings and assisting healthcare professionals in their crucial work of caring for caregivers.

Patient engagement partnerships in clinical trials (PEP-CT): protocol for the systematic development and testing of patient partner and investigator decision aids.

INTRODUCTION: Building capacity to improve sex/gender knowledge and strengthen patient engagement in clinical trials requires training and support. The overall goal of this 2-year project is to refine, translate and evaluate two web-based open-access patient and investigator decision aids aimed to improve patient engagement partnerships in clinical trials. METHODS AND ANALYSIS: Two decision aids were designed in Phase 1 of this programme of research and this protocol describes a subsequent sequential phased approach to refine/translate (Phase 2A) and conduct alpha/usability (Phase 2B) and beta/field (Phase 3) testing. Decision aid development is guided by the International Patient Decision Aid Standards, User-Centred Design, Ottawa Decision-Support Framework and the Ottawa Model of Research Use. We have integrated patient-oriented research methods by engaging patient partners across all phases of our programme of research. Decision aids will first be refined and then translated to French (Phase 2A). Eight iterative cycles of semistructured interviews with 40 participants (20 patient partners and 20 investigators) will be conducted to determine usability (Phase 2B). A pragmatic pre/post pilot study design will then be implemented for field/beta testing using another purposive sample of 80 English-speaking and French-speaking participants (40 patients and 40 investigators). The samples are purposive to ensure an equal representation of English-speaking and French-speaking participants and an equal representation of men and women. Since sex and/or gender differences in utilisation and effectiveness of decision aids have not been previously reported, Phase 3 outcomes will be reported for the total sample and separately for men and women. ETHICS AND DISSEMINATION: Ethics approval has been granted from the University of Toronto (41109, 28 September 2021). Informed consent will be obtained from participants. Dissemination will include co-authored publications, conference presentations, educational national public forums, fact sheets/newsletters, social media sharing and videos/webinars.

"Her Heart Matters"-Making Visible the Cardiac Pain Experiences of Women with Physical Disabilities and Heart Disease: A Qualitative Study.

BACKGROUND: Women with physical disabilities are faced with challenges in many aspects of life-education, work, income, relationships, as well as their general health. These women are at a greater risk of developing heart disease. This study aimed to explore the cardiac pain experiences of women with physical disabilities and heart disease within a Canadian healthcare context. METHODS: In this qualitative study, 8 women with physical disabilities and heart disease from across Canada were interviewed. They were asked about their pre-, peri-, and post-diagnostic experiences in the Canadian healthcare system. Transcripts of the interviews were analyzed using a hermeneutic phenomenological approach inspired by Ricoeur. RESULTS: Two main themes were uncovered in the analysis of the transcripts, as follows: (i) the diagnostic journey; and (ii) life with cardiac symptoms and a disability. The women indicated that they had experienced difficulties in utilizing the Canadian healthcare system prior to receiving a cardiac diagnosis, including long waitlists, expensive and unreliable transport, issues with accessibility, and dealing with providers' attitudinal barriers regarding disability. Receiving a diagnosis was challenging due to poor relationships with healthcare providers; however, having a same-sex provider seemed essential to receiving adequate care. Self-managing a disability and heart disease had significant physical and psychological impact, which was lightened by financial and social supports, modified lifestyle choices, and self-advocacy. CONCLUSIONS: Women with physical disabilities are often forgotten in discussions encompassing equity and inclusion. The participants' experiences offer insight into what changes are needed within the Canadian healthcare system in order to improve outcomes for these women.

CONTEXTE: Les femmes qui présentent une incapacité physique doivent composer avec des défis dans de nombreux aspects de leur vie, notamment en ce qui touche l'éducation, le travail, le revenu, les relations et la santé en général. Le risque de cardiopathie est plus important dans leur cas. Cette étude visait à examiner comment la douleur cardiaque est vécue par les femmes présentant une incapacité physique et une cardiopathie dans le contexte des soins de santé au Canada. MÉTHODOLOGIE: Dans le cadre de cette étude qualitative, huit femmes présentant une incapacité physique et une cardiopathie ont participé à des entrevues menées à l'échelle du Canada. Elles ont été interrogées sur leurs expériences au sein du système de santé canadien au cours des périodes précédant, entourant et suivant le diagnostic. Les transcriptions des entrevues ont été analysées en fonction d'une approche phénoménologique herméneutique inspirée par Ricœur. RÉSULTATS: Deux grands thèmes ressortent de l'analyse des transcriptions, à savoir : (i) le parcours diagnostique; (ii) la vie avec des symptômes cardiaques et une incapacité physique. Les femmes interrogées ont indiqué qu'elles avaient éprouvé des difficultés dans leur parcours au sein du système de santé canadien avant de recevoir un diagnostic en cardiologie, évoquant à cet égard les longues listes d'attente, les services de transport coûteux et peu fiables, les problèmes d'accessibilité et les obstacles liés à l'attitude des fournisseurs de soins vis-à-vis de l'incapacité physique. Le fait de recevoir un diagnostic a été éprouvant en raison de rapports difficiles avec les fournisseurs de soins de santé; cependant, le fait d'avoir un fournisseur de soins de sexe féminin semblait être une condition essentielle à une prestation de soins adéquate. L'autoprise en charge d'une incapacité physique et d'une cardiopathie a eu des répercussions physiques et psychologiques importantes qui ont pu être allégées par le soutien financier et social, des modifications des habitudes de vie et l'autonomie sociale. CONCLUSIONS: Les femmes qui présentent une incapacité physique sont souvent laissées pour compte dans les discussions portant sur l'équité et l'inclusion. Le vécu des participantes donne un aperçu des changements qui doivent être apportés au sein du système de santé canadien afin d'améliorer les résultats chez ces femmes.

Uncovering re-traumatization experiences of torture survivors in somatic health care: A qualitative systematic review.

Little research has focused on torture survivors' re-traumatization experiences in health and hospital units that treat somatic diseases, though any medical procedure can re-traumatize survivors. This study's purpose was to summarize qualitative research evidence on torture survivors' somatic healthcare experiences and to identify "triggers" or "reminders" that can lead to re-traumatization. The study's search strategies identified 6,326 citations and eight studies, comprising data from 290 participants, exploring encounters with healthcare providers from torture survivors' perspectives, which were included in the present research. Dallam's Healthcare Retraumatization Model was used as a framework for data extraction and analysis. Five main themes were elicited from the findings: (1) invisibility, silence, and mistrust; (2) healthcare providers' attitudes and a lack of perceived quality in healthcare; (3) disempowerment; (4) avoidance; and (5) satisfaction and gratitude. An analysis of the study's findings revealed that torture survivors do not receive adequate healthcare and may experience challenges during treatment that can result in re-traumatization. The findings of this literature review provide a basis for understanding the difficulties that survivors experience in receiving somatic healthcare, as well as an explanation of the re-traumatization process.

Enhancing students learning experiences in nursing programmes: An integrated review.

Nursing as a profession is both fragmented and complex. The education setting is demanding, and prepared students are more clinically and academically robust. Therefore, nursing programmes should implement high-quality teaching based on the best available scientific evidence to improve learning quality and students' experience. This study aimed to identify the teaching tools used to enhance students' perceived experiences in undergraduate nursing programmes. Nine databases were systematically searched to identify quantitative and qualitative studies regarding the teaching tools utilised across nursing education programmes. Results were summarised following a systematic integrated review framework. The searches identified 15,886 citations, and after title/abstract/full-text screening, 66 primary research studies were included comprising data from 4,411 participants with a mean sample size of 66 (range 6-447). Educators utilising a student-centred wrapping approach exploiting knowledge building and self-development were found to improve students' experiences; however, consensus on success factors was lacking. The findings indicate that educators' knowledge and pedagogical skills used in a flexible way, tailored and sensible to students and the learning context, enhance student experiences. Nursing educators should identify learning situations that make students vulnerable and pay particular attention to the students' learning experiences. We identified several tools accommodating the students' experience.

Development and evaluation of guidelines for prevention of retraumatisation in torture survivors during surgical care: protocol for a multistage qualitative study.

INTRODUCTION: Healthcare professionals working in somatic departments are not trained to recognise signs of torture or provide appropriate healthcare to torture survivors, which may result in retraumatisation during surgical treatment. METHODS AND ANALYSIS: This protocol outlines a four-stage qualitative-method strategy for the development and evaluation of guidelines for prevention of retraumatisation of torture survivors during surgical care. The systematic search for literature review in stages 1 and 2 was conducted in August 2019 and March 2021, respectively, using nine databases. The search strategies employed in stage 1, without imposing any date limits, resulted in the inclusion of eight studies that addressed inadequate healthcare strategies associated with retraumatisation. The clinical guidelines review in stage 2 will include publications from 2000 onwards, which will be appraised using the Appraisal of Guidelines Research and Evaluation Version II instrument. Following multi-institutional recruitment in Norway, stage 3 will explore survivors' experiences of receiving surgical treatment using indepth interviews (n=8-12), which will be audio-recorded, transcribed verbatim and analysed using the interpretative phenomenological analysis approach. In stage 4a, based on the findings from stages 1, 2 and 3, a set of clinical guidelines for preventing retraumatisation during surgical treatment will be developed. Next, the feasibility and acceptability of the guidelines will be assessed in stage 4b in three interdisciplinary focus group interviews (n=5 per group) and text condensation analyses. ETHICS AND DISSEMINATION: The Regional (South-East C) Committee for Medical and Health Research Ethics approved the study in May 2021 (#227624). In stages 3 and 4, an informational letter and an informed consent form will be distributed to the participants to sign before the interview. The study results will be disseminated through publications, conference presentations, and national and local public forums to healthcare professionals, service managers, policymakers and refugee-supporting agencies.

Students' top 10 priorities of research uncertainties on students' sleep: a pragmatic James Lind Alliance approach.

OBJECTIVES: Inspired by the James Lind Alliance (JLA) user involvement approach, the aim of the present study was to identify the top 10 uncertainties for sleep research raised by students in higher education, and to discuss our experiences with adapting the JLA method to a student population. DESIGN: The study design is a pragmatic JLA approach, including a priority setting partnership within the field of sleep, collection of sleep-related research uncertainties as reported by students in higher education, sorting of the uncertainties and a final identification of the top 10 uncertainties through collaborative work between researchers, students, stakeholders and experts in the field. Uncertainties were collected using a one-question online survey: 'as a student, which question(s) do you consider to be important with regards to sleep?'. A variety of approaches were applied to promote the survey to the students, including social media, radio, the university website, stands in university cafeterias and a sleep stunt. NVivo V.12 was used to code and sort the questions. SETTING: A higher education institution in Norway. PARTICIPANTS: 555 students. RESULTS: The data collection provided 608 uncertainties, and the following prioritised top 10: (1) screen time, (2) stress, (3) educational achievements, (4) social relations, (5) mental health, (6) physical activity, (7) indoor environment, (8) substance abuse, (9) shift work and (10) sleep quality. Despite successful data collection, we found sleep to be a broad topic, and defining specific questions throughout the sorting and verification process proved difficult. CONCLUSIONS: We identified the prioritised top 10 research uncertainties as reported by students in higher education, ranking screen time first. However, the process was time and resource consuming. The research uncertainties addressed by the students showed great diversity, characterised by heterogeneity and a lack of specificity, making verification of the uncertainties challenging.