"I Am Forever Changed": A Phenomenological Study of the Existential Experiences of Parents of Children and Young People With Complex Care Needs.

AIM: To explore the existential lived experiences of parents of children and young people with complex care needs. DESIGN: An explorative qualitative design. METHODS: We conducted 16 in-depth interviews with parents of children and young people with complex care needs across Norway from February to May 2022. Data collection and analysis were guided by the theoretical framework of van Manen's phenomenology of practice approach. RESULTS: Four distinct but interwoven themes reflecting the comprehensive and holistic nature of parents' existential lived experiences emerged: lived body: "I am forever changed"; lived space: Seeking sanctuary; lived time: "Time doesn't seem to exist"; and lived self-other: Parents' changing relationships. CONCLUSIONS: Parents' ongoing efforts to manage fluctuations in their daily lives profoundly affect the existential aspects of their well-being, suggesting that respectful and attentive nurse-parent relationships can nurture existential growth. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: There is a crucial need for a genuine nursing presence characterised by an attitude of open sensitivity and attentive listening to parents' existential experiences. Nurses should embrace the opportunity to engage in respectful and attentive dialogues with parents. Acknowledging that the insights emerging from these conversations can improve integrated and personalised nursing services worldwide. IMPACT: Parents of children and young people with complex care needs often experience suboptimal healthcare. Additionally, access to quality healthcare services, particularly in rural areas, is limited, creating inefficiencies and coordination challenges. This study provides nurses, other health care professionals, researchers, and decision-makers with valuable perspectives on supporting parents' existential needs which may significantly impact their overall well-being and coping abilities, contributing to a more compassionate approach to family care. REPORTING METHOD: Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: Parents of children and young people with complex care needs provided valuable feedback on the findings and implications of this work.

Experiences of people with unexplained hearing concerns seeking hearing healthcare in the United States.

OBJECTIVE: Up to 10% of adults seeking hearing healthcare for significant hearing concerns have diagnostic test results that indicate normal hearing. Knowledge of the interactions between patients with unexplained hearing concerns and hearing healthcare providers is minimal. In this study, we explored what themes emerged when individuals with unexplained hearing concerns discuss their experiences seeking hearing healthcare. DESIGN: We employed a prospective, cross-sectional qualitative design with semi-structured interviews. STUDY SAMPLE: Fifteen adults who had sought professional hearing evaluations in the United States due to hearing concerns but had audiological testing that indicated hearing within normal limits, and no other medical explanation for their hearing concerns participated in the study. Saturation of themes was reached by Interview #2, suggesting sufficient sampling. RESULTS: Thematic analysis revealed 3 themes from the interviews: (1) dismissive healthcare providers, (2) misalignment of patient concerns and assessment protocols, and (3) doctor shopping. CONCLUSION: These findings highlight the need for improved care for patients with unexplained hearing concerns. Clinicians could help improve care provision for patients with unexplained hearing concerns, despite a lack of professional guidance on diagnostic tests or treatment recommendations, by soliciting, listening to, and trusting patient experiences as they seek support for their hearing concerns.

"Sink or swim": mothers' experiences of extremely preterm infants after 15 years from birth.

OBJECTIVES: To evaluate the experience of parenting a preterm infant from birth to adolescence and to raise awareness of the complexity of premature birth and the child's subsequent developmental journey for the entire family. STUDY DESIGN: A phenomenological, qualitative approach using semi-structured interviews with open-ended questions was adopted to obtain retrospective, in-depth narratives. Seven mothers of adolescents born preterm with extremely low birth weight (ELBW) and admitted to a neonatal intensive care unit (NICU) participated in the study. Interviews were conducted by a trained researcher in qualitative methods, and independent coders performed data analysis. RESULTS: Three phases and eight core themes, chronologically organized, emerged from the thematic analysis: starting from preterm birth (panic, fear and uncertainty; hope and a positive attitude to the future; altered parental role), transitioning to life after hospitalization (fatigue and worry about an uncertain future; need of support), and extending into adolescence (adolescents' fragility; overprotection; post-traumatic personal growth). CONCLUSIONS: The birth of a preterm baby has significant repercussions for the entire family, not only in the period immediately following birth but also for many years afterwards, as the traumatic event is retraced with memories that remain both painful and vivid. These findings should be acknowledged by professionals working in the NICU to foster the development of targeted interventions that help parents build resilience, including from a personal growth perspective.

Effects of adverse childhood experiences on observed parenting and children's behavior problems among Jewish and Arab Muslim families in Israel.

Research points to the substantial impact of parents' exposure to adverse childhood experiences (ACEs) on parents and their children. However, most studies have been conducted in North America, and research on ACEs effects on observed parenting or on intergenerational transmission of ACE effects is limited. We therefore studied families from diverse ethnocultural backgrounds in Israel and examined whether mothers' ACEs hampered maternal sensitivity and the quality of the home environment and whether mothers' psychological distress mediated these links. We also explored whether mothers' ACEs predicted children's behavior problems indirectly through maternal psychological distress and whether maternal sensitivity and the home environment attenuated this mediating path. Participants were 232 mothers (Mchild age = 18.40 months, SD = 1.76; 63.36% non-ultra-Orthodox Jewish, 17.24% ultra-Orthodox Jewish, 19.40% Arab Muslim). Results showed mothers' ACEs were directly associated with decreased maternal sensitivity. Mothers' ACEs were indirectly associated with more behavior problems in children through mothers' higher psychological distress, and maternal sensitivity moderated this indirect link; it was significant only for mothers who showed lower sensitivity. Findings emphasize the significant role ACEs play in early mother-child relationships. The importance of including ACE assessment in research and practice with families of infants and toddlers is discussed.

Prevalence of psychotic-like experiences and their association with depression symptoms among patients entering adolescent psychiatric care.

BACKGROUND: Psychotic-like experiences (PLEs) are common in clinical adolescent samples and form a continuum based on their frequency and intensity. PLEs can have harmful effects on both behaviour and affect. METHODS: Prevalence and subjective distress due to PLEs were assessed with the Prodromal Questionnaire-Brief (PQ-B) and depressive symptoms with the Beck Depression Inventory (BDI-21A) among adolescents (N = 399; 71.7% female, mean age 14.9 years, range 13-18) entering specialized adolescent psychiatric services. Various PQ-B Distress scale cut-off points were tested for their ability to detect high and low BDI scores using the superiority index, the effect size for mean difference, and spline regressions. RESULTS: The mean number of endorsed PLEs assessed with the PQ-B was 3.27 (SD 3.64; males: M 1.75; SD 2.78; females: M 3.89; SD 3.78), while mean PQ-B Distress scores were 20.33 (SD 18.03; males: M 11.84; SD 13.90; females: M 23.74; SD 18.40). The most common PLE within both genders were experiences of paranoia and suspiciousness, with a prevalence of 59.9%. BDI scores and PQ-B distress scores were strongly associated (r = 0.534, p<.001). Superiority indices, effect sizes, and spline regressions indicated that a low PQ-B Distress cut-off of 2 or 3 was most informative both when using BDI as a continuous variable and when dichotomized as mild depression (≥10) or major depressive disorder (≥16). CONCLUSION: PLEs are common among adolescent entering psychiatric care. Even a relatively small amount of distress due to PLEs indicates clinical levels of depressive symptoms.

[The Experiences of Healthy Adults Participating in Advance Care Planning].

BACKGROUND: After enactment of the Patient Right to Autonomy Act in Taiwan, most of the individuals participating in advance care planning (ACP) and signing advance decisions (AD) have been healthy adults. This demographic is inadequately covered in the literature, in which related studies focus primarily on individuals with major illnesses. PURPOSE: This study was implemented to understand the experiences of healthy adults participating in ACP. METHODS: A qualitative approach was taken and participants were recruited from ACP outpatient clinics in three hospitals in northern, central, and southern Taiwan. All of the participants were healthy adults who had completed the ACP process, did not have a major illness, had no psychiatric diagnoses, and could express themselves clearly. Data were collected via semi-structured interviews and analyzed using content analysis. RESULTS: A total of 15 participants were interviewed, generating three major themes: "Establishing the foundations of ACP", "Preserving dignity in end-of-life care", and "Key elements for successful ACP". Their motivation to engage in ACP and sign the AD form was influenced by past experiences and a desire to maintain dignity and physical autonomy through the aging process. Their decision-making processes were influenced by family opinions, sociocultural factors, and systemic dynamics. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: During the ACP and AD signing process, the consulting team not only helps healthy adults successfully provide informed consent but also, by fostering a supportive communication environment, ensures medical preferences and expectations are accurately reflected, thus promoting mutual care, support, and understanding among all parties.

Adult refugees' perspectives on the impact of trauma and post-migration hardships on learning.

Background: Research shows that adult refugees' well-being and future in the reception country heavily depend on successfully learning the host language. However, we know little about how adult learners from refugee backgrounds experience the impact of trauma and adversity on their learning.Objective: The current study aims to investigate the perspectives of adult refugee learners on whether and how trauma and other adversity affect their learning.Methods: We conducted in-depth interviews with 22 adult refugees (10 women) attending the Norwegian Introduction Programme (NIP). The participants came from six Middle Eastern, Central Asian, and African countries. Two questionnaires were included, one about past stressful life events (SLESQ-Revised), and one about mental health symptoms and current psychological distress following potentially traumatic experiences (PCL-5).Results: Participants held varying beliefs about trauma's impact on learning: that it had a constant impact, that it was situational, or that it had no impact. Other aspects they brought up as having an essential effect on learning and school attendance include psychological burdens from past and present school experiences, and post-migration hardships such as loneliness, depression, ongoing violence, and negative social control. Post-migration trauma and hardships exacerbated the burden of previous trauma and were frequently associated with a greater negative influence on learning.Conclusion: This study adds new insights from adult refugee learners themselves into how post-migration hardships as well as trauma can impact their learning, and the importance of recognising their struggles. A safe space is required for refugees to open up about their difficulties in life and with learning. This knowledge can be used to enhance teaching practices, foster better teacher-student relationships, and inform policy-making decisions, ultimately benefiting both individuals and society.

Adult refugee learners' own perspectives on the impact of trauma on learning varied from constant to situational to no impact at all.Other factors identified as impacting learning and school attendance included, amongst others, psychological burdens from past and present school experiences, ongoing violence, forced family separation, and negative social control.Post-migration trauma and hardships were frequently associated with a greater negative influence on learning than the burden of previous trauma.

A quarantine paradox: understanding Gender-Based Violence (GBV) in post-COVID-19 era: insights from Golden Valley mining community, Zimbabwe.

The COVID-19 pandemic has brought unprecedented challenges globally, with a notable surge in gender-based violence (GBV) incidents. This descriptive, exploratory study conducted in the Golden Valley mining community in Kadoma, Mashonaland West Province, Zimbabwe, delves into the challenges faced by GBV survivors during and after the pandemic, alongside community perceptions of GBV in the post-COVID-19 era. Guided by Bronfenbrenner's Social-Ecological Model which offers insights into the various levels of influence on GBV behavior and experiences,aiding in the development of contextually relevant prevention strategies. The study used qualitative methods such as interviews and focus group discussions, there were 24 study participant classified by random and convenient sampling techniques including traditional and community leaders, gbv surviours medical personnel and male and female, community members. The research followed the COREQ guidelines to transparently document the research process and findings. The research sheds light on the multifaceted nature of GBV exacerbated by societal norms and economic instability in a low-income, masculine-dominated work culture experience in the COVID-19 period. Findings underscore the urgent need for comprehensive prevention programs, effective legislation, and community engagement to address GBV in post-pandemic communities. The research provides valuable lessons for enhancing GBV prevention efforts globally, emphasizing the significance of survivor voices and addressing root causes of GBV.

Experiences and Perspectives of Transgender Individuals Accessing Gender-Affirming Care in Manitoba, Canada.

As the number of trans people seeking gender-affirming care (GAC) continues to increase globally, it is increasingly important to understand the experiences of this patient population to improve healthcare delivery and ensure identified needs are being met. This qualitative descriptive study describes the experiences and perspectives of trans people (age 18-34) accessing GAC in Manitoba, Canada based on data obtained from semi-structured focus groups and individual interviews (N = 10). Three major themes were identified to capture key elements of seeking GAC: (1) the transition decision, (2) the transition process, and (3) barriers to receiving desired care. In each major theme, subthemes were described. In addition to providing insight into critical aspects of this journey, this study also highlights the importance of including a diverse variety of perspectives when considering the design of healthcare services for the trans community.

Experiences of clinical nurses with medication interruption: A systematic review and qualitative meta-synthesis.

BACKGROUND: Managing medication interruptions is considered one of the biggest dilemmas for nurses in clinical settings. To improve medication safety, it was imperative to conduct a systematic review to get a deeper understanding of nurses' experiences with medication interruptions. AIMS: A systematic review and qualitative meta-synthesis aimed to explore clinical nurses' experiences of interruption during medication in hospitals. METHODS: Systematic searches were conducted in PubMed, CINAHL, Ovid Medline, Embase, Web of Science, and The Cochrane Library from inception to January 2024. The search strategy included four groups of keywords: (1) qualitative research, (2) nurses, (3) medication interruption, and (4) experience. Critical Appraisal Skills Programme was used to assess the quality of the studies. Meta-ethnography was utilized to synthesize the findings of the included studies. RESULTS: Nine articles published between 2012 and 2023 were included; the number of participants varied from 5 to 40, aged 20-68 years, and the majority were female. Four synthesized findings were identified as follows: (1) an inevitable part of the routine, (2) a decision-making process, (3) working in a minefield, and (4) coping with interruption. LINKING EVIDENCE TO ACTION: Nurses embraced interruptions as an inherent component of clinical care. Previous experience and nursing culture, encompassing personal and professional aspects, significantly influence nurses' attitudes toward medication interruptions. It is crucial to incorporate the distinctive work experiences of nurses into techniques aimed at efficiently handling interruptions in future research. The registration number in PROSPERO is CRD42023470276.

Individual and relational factors related to disclosure of epilepsy in the workplace.

BACKGROUND: The decision to disclose epilepsy in the workplace is complex, as it entails both advantages and disadvantages. In this study, we aimed to identify the factors associated with disclosure of epilepsy in the workplace based on the disclosure decision-making model for patients who required underwent comprehensive assessment in the Epilepsy Monitoring Unit (EMU). METHODS: This retrospective study included 193 patients with epilepsy (112 men, aged 18-66 years) who underwent comprehensive assessment, including long-term video-EEG monitoring, neuroimaging studies, and neuropsychological and psychosocial assessment in the Tohoku University Hospital EMU. Data were obtained from the medical records and self-reported questionnaires at our EMU. The outcome variable was disclosure of epilepsy. Predictive variables were selected based on the disclosure decision-making model: individual factors (i.e., age, sex, age at onset of epilepsy, seizure frequency, generalized tonic-clonic seizures or focal to bilateral tonic-clonic seizures in the last 2 years, experiences of viewing own seizure, and felt stigma), and relational factors (i.e., experiences of discrimination, enacted stigma, and social support). Data were analyzed using a logistic regression analysis model. RESULTS: Our results indicated that 43.5% of patients disclosed epilepsy to their employer. The factors that associated with disclosure of epilepsy were experiences of discrimination (odds ratio [OR], 7.78; 95% confidence interval [CI], 2.84-21.34, p < 0.01), experiences of viewing own seizure (OR, 3.51; 95% CI, 1.27-9.72, p < 0.05), and level of enacted stigma (OR, 0.69; 95% CI, 0.48-0.99, p < 0.05). CONCLUSION: This study indicated that the decision to disclose epilepsy was associated with both individual factors, such as experience of viewing own seizures, and relational factors, such as experience of discrimination and enacted stigma.

Association between adverse childhood experiences and obesity, and sex differences: A systematic review and meta-analysis.

BACKGROUND: Obesity is one of the most common health problems worldwide. Although studies have reported associations between adverse childhood experiences (ACEs) and obesity, specific subtype associations and sex differences are unclear. OBJECTIVE: To systematically evaluate the association between ACEs and adult obesity risk and sex differences. METHODS: Five databases, PubMed, Web of Science, Cochrane Library, Embase, and PsycINFO, were searched with a June 10, 2024 deadline. Included studies investigated the association between at least one ACE and obesity. Two researchers independently assessed the risk of bias using the Newcastle-Ottawa Scale (NOS) and its adaptations and extracted relevant characteristics and outcomes. Statistical analyses were performed using STATA 17.0, including random effects models, heterogeneity tests, sensitivity analyses, publication bias assessments, Meta-regression analyses, and subgroup analyses. Dose-response analyses revealed potential trends between different levels of abuse and risk of obesity. RESULTS: The meta-analysis included 46 studies and showed a notable increased risk of obesity in adults experiencing ACEs (OR: 1.48, 95% CI: 1.38-1.59). Subgroup analyses showed significantly increased risk in Europe and North America, with significant increases observed in both developed and developing countries. Prospective, retrospective, and cross-sectional studies showed strong associations. Different types of ACEs (physical, sexual, psychological, and non-physical, psychological, or sexual abuse) were linked to a higher obesity risk. Sex difference analyses showed that females faced a greater risk when experiencing physical (OR: 1.606), sexual (OR: 1.581), and non-physical, psychological, or sexual (OR: 1.319) abuse; males exhibited increased risk only with non-physical, psychological, or sexual abuse (OR: 1.240). Dose-response analyses indicated that a higher number of ACEs was associated with an increased risk of obesity in adults. CONCLUSIONS: ACEs significantly increase the risk of adult obesity, with consistent findings across geographic regions, levels of economic development, and types of study design. Sex difference analysis indicates that females are particularly affected. Future research should prioritize including studies from underrepresented geographic areas to enhance understanding of the global impact of ACEs on obesity risk. Additionally, strengthening child protection and intervention efforts is crucial to mitigate the adverse effects of ACEs on adult health.

Hospital Experiences of Carers in Relation to the Comprehensive Care Standard: A Mixed Method Study.

AIMS: To explore the care experiences of informal carers of people with chronic conditions in hospitals and identify areas for improvement in the context of comprehensive care delivery. DESIGN: A explanatory sequential mixed-method study. METHODS: This study was conducted, involving a survey with 182 carers and interviews with 31 carers of individuals who attended an Australian hospital. Descriptive analysis of quantitative data was performed using RStudio, while thematic analysis of qualitative data was conducted using NVivo. RESULTS: The findings revealed seven overarching components of care that influenced carers' hospital experiences and their perceptions of care quality. Areas requiring improvement were identified within these categories. CONCLUSION: This review identifies common perspectives of informal carers of people with chronic conditions in hospital settings and highlights important areas that require attention to improve carers' hospital care experiences. Carers should be welcomed, involved, informed and supported during hospital attendance to foster the most positive care experiences. IMPLICATIONS: Healthcare professionals should involve carers in assessment, shared decision-making and the care process and recognise and address carers' needs. IMPACT: The findings revealed the carer's hospital experiences in the context of comprehensive care delivery and identified areas requiring improvement. REPORTING METHOD: The CROSS and the COREQ guidelines were followed. PATIENT OR PUBLIC CONTRIBUTION: The study protocol was presented to stakeholders from two hospitals in Australia, a Patient and Carer Advisory Board (attached to the parent project: evaluating Quality of Care (eQC)) and the Australian Commission on Safety and Quality in Health Care, and discussions were held to assess the relevance and significance of this study to clinical practice and health policy.

Effects of childhood adversities on alexithymia features vary between sexes. Results of a prospective population study.

Introduction: Adverse childhood experiences (ACEs) associate with various mental disorders, including personality features. Our understanding of how ACEs influence alexithymia features in the general population is limited. In a prospective population setting, we studied whether ACEs associate with alexithymia, and the role of sex and emotional symptoms in this association.Methods: In a Finnish population-based prospective study, 3,142 individuals aged between 30 and 64 years completed eleven ACE questions and the Toronto Alexithymia Scale in 2000 and 2011, and the Hopkins Symptoms Checklist in 2011. The effect of ACEs on alexithymia and its subdomains - difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT) in 2000 and 2011 - was analysed using repeated measures ANOVA.Results: The number of ACEs and their main component, childhood social disadvantage, associated positively with total alexithymia scores and its subdomains DIF and DDF, and negatively with EOT. After controlling for the effect of depression and anxiety, the strength of these associations was reduced, but the effect of social disadvantage on DIF and EOT remained significant in females. Childhood family conflicts associated positively with DIF in males and negatively with EOT in females. Additionally, maternal mental problems associated positively with DIF and DDF in females.Discussion: In the general population, ACEs, particularly social disadvantage, are associated with adult alexithymia features. Alexithymia features, detectable from youth, may predispose individuals to emotional disturbances caused by childhood adversities. The effect of family conflicts and maternal mental problems on alexithymia features varies between sexes.

Childhood social disadvantage, a main component of adverse childhood experiences, is associated with increased difficulties in identifying and describing feelings in both sexes, and with decreased externally oriented thinking in females.Childhood family conflicts are associated with increased difficulties in identifying feelings in males, but decreased difficulties in describing feelings and decreased externally oriented thinking in females.Maternal mental problems during childhood are associated with increased difficulties in identifying and describing feelings in females.

Adverse childhood experiences and profiles of healthy orthorexia versus orthorexia nervosa: towards an explanatory model of orthorexia as a multidimensional eating style.

BACKGROUND: Orthorexia is a complex phenomenon comprising distinct dimensions, including orthorexia nervosa (ON) and healthy orthorexia (HO). However, little is known about the factors influencing these dimensions, their disparities, and the psychological factors underlying orthorexia behaviours. OBJECTIVES: This study aims to explore ON versus HO dimensions and the predictive role of adverse childhood experiences (ACEs) in a nationally representative sample of Polish individuals. In addition, we aim to investigate the mediating roles of alexithymia, embodiment, and experiential avoidance levels in this association. METHODS: A representative sample of Polish adults (n = 3557) participated in this study. Dimensions of orthorexia (HO, ON) were assessed using the Teruel Orthorexia Scale, while ACEs were evaluated using the Adverse Childhood Experiences Questionnaire. Levels of alexithymia were measured using the Toronto Alexithymia Scale, experiential avoidance through the Acceptance and Action Questionnaire, and embodiment intensity via the Experience of Embodiment Scale. RESULTS: Cluster analysis identified two distinctive orthorexia profiles in the whole sample, i.e., HO (n = 469) and ON (n = 1217), alongside three intermediate HO/ON profiles (n = 1871). The number of ACEs predicted ON tendencies as opposed to HO behaviours in participants. The mediating role of alexithymia, experiential avoidance, and embodiment in the association between ACEs and ON was also observed. CONCLUSIONS: Our study suggests that orthorexia is a multidimensional eating style shaped by socio-cultural factors. Adverse childhood experiences may be related to ON behaviours by mediating psychological factors such as experiential avoidance, alexithymia, and embodiment. Effective education and collaborative support are necessary for addressing ON tendencies.

Unlocking the forest: An ethnographic evaluation of Forest Schools on developmental outcomes for 3-year-olds unaccustomed to woodland spaces.

Background and purpose: Early years experiences shape a child's physical, cognitive and emotional development. Spending time in greenspaces offers benefits for children's development, but access and use can be limited in urban settings. There is increasing interest in the health and developmental benefits of Forest Schools for primary-aged children, but little is known about the benefits for pre-school children. This study aims to identify these and explore the processes and activities associated with a Forest School intervention for early years children that may influence outcomes. Methods: This paper reports on an ethnographic approach involving 65 hours of observations with two cohorts of 10 3-year-olds attending 11 weekly Forest School sessions in an urban setting. The children attending had little or no previous experience of natural spaces. 14 in-depth interviews were conducted with parents, and nursery and Forest School staff. The data were analysed using thematic analysis, and outcomes were identified using the Early Years Foundation Stage Statutory Framework. Results: Despite logistical challenges, the intervention benefitted age-specific health and development outcomes, particularly personal, socio- and emotional development, verbal communication, and mathematics. Unexpected benefits were observed among nursery staff and parents attending Forest School. Conclusion: Forest Schools are a promising and feasible method to improve nature connectedness and development in children aged 3 years and support school readiness. The maintenance and protection of urban woodland spaces are paramount to facilitate this.

Early years experiences affect children's physical, cognitive and emotional development. Spending time in green spaces offers benefits for children's development, but access and use can be limited in urban settings. Forest schools have become increasingly popular for nurseries and kindergartens. The benefits of Forest Schools for primary-aged children have been explored, but little is known about the benefits for pre-school children. A Forest School programme in an urban area of Bradford was evaluated to understand children's experiences and benefits. Dr Chavez observed 20 3-year-olds attending 11 weekly Forest School sessions. Observations totalled 65 hours. Dr Chavez also interviewed 14 parents, and nursery and Forest School staff. Dr Chavez and Dr Dharni used the Early Years Foundation Stage Statutory Framework and looked for patterns in the interview data to understand the benefits children had gained. The results showed that Forest School for this age group had benefits for age-specific health and development outcomes, particularly personal, socio- and emotional development, verbal communication, and mathematics. Forest School is a promising and feasible method to improve connection to nature and development in children aged 3 years, and help prepare them for school. Forest School can support very young children to enjoy and be safe in natural environments. It can help children cope with change from being mainly at home with family and carers, to being at school and in their neighbourhood.

Sex-specific association between schizophrenia polygenic risk and subclinical schizophrenia-related traits.

BACKGROUND: According to the dimensional view of psychiatric disorders, psychosis is expressed as a continuum in the general population. However, the investigation of the putative genetic aetiological continuity between its clinical and subclinical phenotypes has yielded mixed results. We aimed to replicate previous findings regarding the association of polygenic risk for schizophrenia with subclinical traits (i.e., schizotypy traits and psychotic-like experiences), and to examine the role of sex in this association in a large nonclinical sample. METHODS: The Multidimensional Schizotypy Scale and the Community Assessment of Psychic Experiences were assessed in 919 nonclinical participants. Polygenic Risk Scores for schizophrenia (SZ-PRSs) were computed using the PRS-CS method based on the latest genome-wide association study of schizophrenia. Summary statistics derived from the total GWAS sample and stratified by sex were used. Linear regression analyses tested the associations of the SZ-PRSs with the psychometric variables, both in the total sample and by sex. RESULTS: No associations were found between the SZ-PRSs and the positive, negative or disorganized dimensions of schizotypy in the total sample. Likewise, no associations were found with psychotic-like experiences. However, the sex-stratified analyses revealed a male-specific association with positive schizotypy. Similar results were obtained with the PRSs derived from the sex-stratified summary statistics. DISCUSSION: Our results are consistent with the lack of clear evidence of an association between SZ common genetic risk and its subclinical phenotypes. Nevertheless, the male-specific association found suggests that this PRS might explain better the male phenotype, as reported in previous studies. Future studies should put a focus on the role of sex in this association to unravel its sex specificities.

Clinical learning of nursing students during the COVID-19 pandemic in Limpopo province, South Africa.

BACKGROUND:  The Nursing Education Programme was affected during the coronavirus disease 2019 (COVID-19) pandemic, resulting in nursing students being unable to participate in the clinical experiential learning required by the South African Nursing Council. OBJECTIVES:  The study seeks to explore and describe nursing students' experiences of clinical experiential learning during the COVID-19 pandemic. METHOD:  A qualitative, explorative and descriptive, research design was used in the study. A non-probability purposive sampling method was used, and 55 nursing students participated in the study. Data were collected through six focus group discussions, consisting of 8-12 nursing students in each group. Data were analysed following Tesch's open coding method. RESULTS:  Three themes emerged from the study's findings: The impact of COVID-19 on the clinical experiential learning of nursing students, the effects of COVID-19 on the mental well-being of nursing students, and nursing students' experiences of support during the COVID-19 pandemic. Notably, 11 sub-themes emerged. CONCLUSION:  The findings of this study reveal that the COVID-19 pandemic severely disrupted the Nursing Education Programme, highlighting the challenges of inadequate clinical hours, restricted clinical access and the significant psychological impact on students.Contribution: This study adds to the literature on students' experiences during clinical experiential learning in South Africa during the COVID-19 pandemic.

Towards validating invalidated knowledge: a discourse analysis of firsthand accounts of hearing voices.

BACKGROUND: As Foucault historically traced, dialogs about madness were silenced with the emergence of biomedical psychiatry. The silence entailed the epistemic violence of invalidating persons who hear voices as knowers, arguably leaving them without validating sensemaking languages for firsthand experiences. This article analyzes five Norwegian firsthand accounts of hearing voices, and how they differed from the predominating biomedical psychiatry discourse, in search of validating languages and knowledge that may facilitate making sense of voice-hearing for persons who hear voices. METHODS: The text material consisted of four sets of blogs authored by four young women and a short interview with a man, all of whom had firsthand experiences of voice-hearing in a Norwegian context. Ian Parker's version of Foucauldian discourse analysis was used to analyze the material. RESULTS: Six discourses were identified: biomedical psychiatry-discourse, discourse of reason, psychodynamic discourse, discourse of personal characteristics, spiritual discourse and discourse of personal relationships between hearer and voices. Within the discourses of biomedical psychiatry and reason, voice-hearing was rendered as hallucinations, unreason, and as a problem to be solved, preferably by professionals, thus silencing the person who hears voices. In contrast, within the discourses of psychodynamics, personal characteristics, spirituality, and personal relationships between hearer and voices, voice-hearing has diverse meanings, and they grant voice hearers greater freedom concerning voice-hearing. The psychodynamic discourse nonetheless aligns with the discourses of reason and biomedical psychiatry in allowing professionals the prerogative of determining the meaning of voice-hearing. The remaining three discourses appear to facilitate more space for voice-hearers to narrate and engage with their voice-hearing at their discretion, with little to no professional impingement. CONCLUSIONS: Discursive complexity notwithstanding, I consider that particularly the discourses of personal characteristics, spirituality, and personal relationships facilitate languages that may enable a person to narrate their own experiences and actions at their own discretion, without needing an expert commentator on the side. To have such languages available is argued to entail clear strides towards more empowered positions in one's life.

Lived experiences of adults' non-compliance with psychiatric medication for depression.

Background: Non-compliance with psychiatric medication among patients diagnosed with depression ranges from 28% to 52% exacerbating illness and reducing treatment effectiveness. There is a paucity of research on medication non-compliance and its causes in South Africa and globally, and an urgent need to develop appropriate interventions. Aim: This study aimed to explore and describe the experiences of adults living with depression who are non-compliant with their psychiatric medication and formulate recommendations to facilitate their medication compliance. Setting: The study was conducted in a psychiatric ward at a public hospital in Gauteng, South Africa. Methods: The study employed a qualitative, exploratory, descriptive and contextual research design. Ten adults' lived experiences were explored using in-depth individual interviews, and Tech's coding method was used to analyse data. Results: Two themes emerged from the data: adults living with major depression offered several reasons for non-compliance, and adults living with major depression experienced non-compliance, which created a setback to their recovery. Conclusion: Non-compliance with medication is a common challenge among adults receiving mental health care and treatment. Ensuring compliance to medication is crucial for improving the prognosis of psychiatric conditions. Therefore, it is essential for healthcare practitioners in the field of psychiatry to have a comprehensive understanding of medication compliance and to effectively address any challenges that may arise in this area. Contribution: This paper contributes to the research field and adds knowledge to clinical nursing practice by exploring adults' experiences with non-compliance to psychiatric medications while living with depression in the South African context.