[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.

Adolescents' Adverse Childhood Experiences, Poor Mental Health, and Substance Use During the COVID-19 Pandemic.

PURPOSE: Adverse childhood experiences (ACEs) increase the risk for poor mental health (MH) and substance use. We describe relationships between adolescents' ACEs, substance use, and poor MH occurring during the COVID-19 pandemic. METHODS: We conducted a secondary analysis of data among U.S. high school students aged <18 years, who participated in the nationally representative Adolescent Behaviors and Experiences Survey. Data were collected from January to June 2021. Bivariate and multivariable analyses assessed associations between individual ACEs (physical, emotional abuse by parent or caregiver, parent or caregiver job loss, food insecurity, sexual violence, physical dating violence, or cyber bullying) and cumulative ACEs (0, 1-2, 3, 4+) experienced during the pandemic and substance use; stratified analyses assessed effects of poor MH on associations between ACEs and substance use. RESULTS: Use of all substances was higher among adolescents with ACEs, particularly those who experienced both ACEs and poor MH during the COVID-19 pandemic. Prevalence of substance use was especially high among adolescents exposed to any sexual violence or physical dating violence. Compared to adolescents without ACEs, a higher percentage of adolescents with 4+ ACEs reported current use of alcohol (adjusted prevalence ratio [aPR], 5.32) or marijuana (aPR, 5.86), misuse of prescription pain medications (aPR, 8.82), binge drinking (aPR, 7.70), and increased alcohol (aPR, 6.54) or drug (aPR, 7.09) use during the pandemic. DISCUSSION: The individual and combined impact of ACEs and MH on adolescent substance use reinforce the need for trauma-informed care and primary prevention of ACEs to prevent and mitigate poor MH and substance use among adolescents.

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.

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.

"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.

Types and timing of trauma exposure across the life course and maternal hypertension.

BACKGROUND: Exposure to trauma across the life course may be associated with cardio-metabolic dysfunction during pregnancy; however, previous research has been inconsistent, particularly in highly exposed populations. OBJECTIVES: To estimate associations between types and timing (first occurrence) of trauma exposure and hypertension experienced during pregnancy in a safety-net hospital in Atlanta, Georgia, 2011-2022. METHODS: Participants completed a 14-item trauma screener. We linked that information to data from the medical record on hypertension (including chronic hypertension, gestational hypertension or preeclampsia). We fit logistic regression models and used the estimates to calculate risk ratios for each trauma type and each critical window (0-9 years, 10-19 and 20+). We fit unadjusted models and adjusted for age, parity and education. RESULTS: We included 704 individuals with a delivery within 12 months following screening. The majority (94%, 661) reported at least one traumatic event, most commonly witnessing violence (79.4%). Overall, 18% experienced gestational hypertension, 10.8% chronic hypertension and 11.9% preeclampsia. Among individuals who reported trauma, 31.5% screened positive for probable posttraumatic stress disorder and 30.9% for probable depression, compared to 0 and 2.3% among those without reported trauma. No trauma type (violence, witnessing violence, non-interpersonal or sexual assault) was associated with increased hypertensive risk, regardless of timing. CONCLUSIONS: In this sample with a high trauma and hypertension burden, trauma was not associated with an elevated risk of hypertension during pregnancy, despite a high burden of PTSD and depressive symptoms among people with trauma exposure.

Feelings, thoughts and experiences of fathers in the early postpartum period: a phenomenological study.

AIMS/BACKGROUND: Transition to parenthood is a complex and challenging situation not only for mothers but also for fathers. In this process, fathers' feelings, thoughts and experiences are very important. This study aims to understand fathers' feelings, thoughts and experiences in the early postpartum period. DESIGN/METHODS: The descriptive phenomenological design was used in this study. Data were collected from 13 fathers through in-depth interviews. The content analysis method was used in data analysis. RESULTS: The following three themes were identified regarding the experiences of fathers in the early postpartum period: 'need for support', 'difficulties of being a father' and 'recommendations'. The fathers had more needs and inadequate support in their transition to the fatherhood role. CONCLUSION: All these results suggest that they faced many challenges in the early postpartum period. Sleep deprivation, being tired, having a restricted social life and increased responsibilities, and experiencing postpartum psychological fluctuations were some of these difficulties. In order to overcome these difficulties, they needed financial and moral support. The fathers who participated in the present study stated that they did not receive enough training and support from healthcare professionals. Healthcare professionals should keep in mind that not only of mothers and babies but also of fathers have needs to be met.

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.

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.

Determinants of Poor Health among Workers in Criminal Justice, Community and Social Services, and Healthcare: Adverse Childhood Experiences, Workplace Trauma Exposure, and Gender Differences.

Adverse childhood experiences and workplace trauma exposure are associated with poor health. However, their differential impacts by gender are difficult to assess in studies of organizations with gender imbalances (e.g., law enforcement officers are more likely men whereas social workers are more likely women). Using a community-based participatory research framework, this study examines trauma exposure, mental and physical health, and substance use in an occupationally diverse sample (n = 391). Trauma exposure was high and associated with poor health. Even though women experienced more adversity, they were often more resilient than men. Implications for trauma-informed workplaces are discussed.

Fatigue Management in Advanced Prostate Cancer: Real-World Insights From Qualitative Interviews With Patients.

BACKGROUND: Patients with advanced prostate cancer (PC) commonly experience fatigue related to the disease itself and its treatment, which affects their quality of life. There are limited real-world data available on patients' experiences of fatigue while receiving PC treatment and its management. PATIENTS AND METHODS: This was a cross-sectional, noninterventional qualitative study involving individual concept-elicitation interviews with patients in the United States. Patients with advanced PC aged ≥18 years who had experienced fatigue and were on androgen-deprivation therapy in combination with second-generation androgen receptor pathway inhibitors were interviewed and their experiences quantified. RESULTS: Of the 143 patients screened, 13 qualified and 11 completed the interview. Most patients used the term "fatigue" (n = 8) to describe their experiences of tiredness, exhaustion, lack of energy, and weakness. Most patients (n = 8) did not receive any form of educational support from their healthcare providers (HCPs), but some expressed an interest in receiving this support (pamphlets, n = 4; discussion with HCPs, n = 4; online resources, n = 3). Most patients (n = 9) self-discovered fatigue-management strategies over the course of their disease and treatment. Patients found that rigorous exercise (n = 5), regular naps (n = 2), increased rest (n = 3), and a healthy diet (n = 3) were the most effective approaches for managing their fatigue. CONCLUSION: Tools are needed to support HCPs with counseling patients with PC for effective management of disease- and treatment-related fatigue.

Lived experiences of medical students of online learning: lessons for adopting virtual learning in medical education.

BACKGROUND: The COVID 19 lockdown created a shift in medical education from the traditional physical classroom to online learning. OBJECTIVES: To explore the lived experiences of students in various years of medical education attending a medical college in Chennai, India. METHODS: In this qualitative exploration of lived experiences we conducted 4 focus group discussions among students of the four years in the medical college with the help of a checklist. We recorded the interviews, transcribed them and performed a thematic content analysis. RESULTS: There was a gendered impact of the lockdown on the online learning experiences with women students finding it challenging to attend classes balancing their gender roles of performing household chores. Online learning offered some advantages in the form of increased participation and engagement due to the partial anonymity. The greatest disadvantage of online learning was lack of clinical learning experience. The students resorted to fabricating case studies for discussion, which some students found useful and some commented that it can never replace real life clinical discussions. A generational gap between adoption of technology between the senior professors and the students hampered the online learning. Online assessments were challenging, and many students resorted to cheating in these exams. CONCLUSIONS: Though online learning offers several advantages, it has serious limitations in offering the clinical learning experience. While planning adoption of online learning into routine medical education adequate time must be set aside for real life clinical exposure in addition to the online lectures and demonstrations for conceptual understanding.

"I was also trying to protect myself and save my life," experiences of people living with severe mental illness and their caregivers regarding COVID-19 response in Uganda.

Introduction: People with severe mental illness (SMI) are highly vulnerable and more affected by epidemics than the general population. They encounter limited access to care, miss out on infection prevention measures and are more prone to relapses. Objectives: This study explored the experiences of individuals with SMI and their caregivers in Uganda during the COVID-19 pandemic. Its focus was on the impact of COVID-19 and its response measures on their mental health. Methods: The study was conducted at three sites; a national referral mental hospital, a regional referral hospital and a district hospital. Participants included persons with SMI, their caregivers and mental health professionals. Data collection involved in-depth interviews, key informant interviews and focus group discussions. Phenomenological thematic analysis was employed. Results: The key themes identified encompassed challenges in accessing mental health services, disrupted routine care, the impact of lockdown measures and discrimination. Conclusion: The findings highlight the unique challenges faced by individuals with SMI and their caregivers during the COVID-19 pandemic in Uganda. There is need for interventions focusing on continued access to care, improving information dissemination and addressing the psychological impact of containment measures on people with SMI.

Changes in harm avoidance and incompleteness across group CBT for OCD and their relationship with symptom change.

BACKGROUND: Obsessive-compulsive disorder (OCD) symptoms are hypothesized to be driven by two core motivations: harm avoidance and incompleteness. While cognitive-behavioural therapy (CBT) is an effective treatment for OCD, many posit that OCD presentations characterized by high incompleteness may be harder to treat. The relationship between the core motivations and treatment outcomes remains to be further explored. AIMS: To investigate if harm avoidance and incompleteness decrease across group CBT and to examine the relationship between treatment outcomes and both baseline and changes in harm avoidance and incompleteness throughout treatment. METHOD: A naturalistic sample of 65 adult out-patients with OCD completed self-report questionnaires measuring OCD symptom severity and the core motivations before, during, and after 12 weeks of group CBT for OCD. RESULTS: Harm avoidance and incompleteness scores significantly decreased from pre- to post-treatment. Pre-treatment harm avoidance and incompleteness levels did not predict post-treatment symptom severity, but changes in the core motivations throughout treatment were significant predictors of treatment outcome. Specifically, reductions in harm avoidance across treatment and reductions in incompleteness early in treatment, were associated with better treatment outcomes. CONCLUSIONS: Participants who completed group CBT for OCD experienced modest reductions in the core motivations thought to maintain OCD symptoms and these changes predicted better outcomes. However, pre-treatment levels of harm avoidance and incompleteness do not appear to moderate treatment outcome.

Social isolation and poor mental health in young people: testing genetic and environmental influences in a longitudinal cohort study.

We assessed genetic and environmental influences on social isolation across childhood and the overlap between social isolation and mental health symptoms including depression symptoms, conduct problems, and psychotic-like experiences from adolescence to young adulthood. Participants included 2,232 children from the Environmental Risk Longitudinal Twin Study. Social isolation was measured at ages 5, 7, 10, 12, and 18. A Cholesky decomposition was specified to estimate the genetic and environmental influences on social isolation across ages 5, 7, 10, and 12. An independent pathway model was used to assess additive genetic (A), shared environmental (C), and non-shared environmental (E) influences on the overlap between social isolation and mental health problems from age 12 to 18. Genetic and non-shared environmental influences accounted for half of the variance in childhood social isolation. Genetic influences contributed to the continuity of social isolation across childhood, while non-shared environmental influences were age-specific. The longitudinal overlap between social isolation and mental health symptoms was largely explained by genetic influences for depression symptoms (r = 0.15-0.24: 82-84% A, 11-12% C, and 5-6% E) and psychotic-like experiences (r = 0.13-0.15: 81-91% A, 0-8% C, and 9-11% E) but not conduct problems (r = 0.13-0.16; 0-42% A, 42-81% C, 16-24% E). Our findings emphasise that rather than a risk factor or an outcome, social isolation is aetiologically intertwined with the experience of poor mental health. An integrative assessment of social isolation could be a helpful indicator of underlying mental health symptoms in young people.

Lifetime trauma, mental well-being, alcohol and help-seeking; the phenomenological experience of veterans residing in Northern Ireland.

BACKGROUND: Veteran residents in Northern Ireland (NI) are an under-researched population. Little is known about their experiences of trauma and mental health management. The overall mental well-being of veterans living in NI may be poorer than other veteran populations, due to the challenges presented by the unique landscape. Understanding their experiences is crucial for providing appropriate, targeted support. METHOD: Six male veterans, who had received a mental health diagnosis, living in NI and all aged > 40 years participated. Semi-structured interviews, using open-ended questions, were conducted over the telephone. Interpretative phenomenological analysis was used to explore their experiences. RESULTS: Two experiential themes were identified each containing three experiential statements. Statements for 'an extreme lack of' included: lack of mental health literacy/awareness; lack of expectations of official support; lack of a sense of perceived appreciation. Statements for 'an extreme abundance of' included: exacerbated exposure to a range of extreme environments; high levels of ruled-based living; high levels of engaging with informal/local level support. CONCLUSIONS: Several experiential statements aligned with existing literature, including having poor mental health literacy and problem recognition, and heavily utilising social support versus formal help-seeking. Some novel findings included bouncing between extreme positive and negative environments which could be as detrimental to mental health as experiencing conflict trauma. Heavy alcohol use was just another rule soldiers followed. Positive help-seeking experiences failed to improve poor opinions of support organisations. Finally, poor self-perceptions connected to military status are pertinent in NI, which seems to fuel self-marginalisation and distrust. A combination of factors likely contributes to many veterans living in NI having poorer mental well-being. Novel findings would benefit from further exploration as understanding how NI veterans interpret their experiences is key to providing adequate healthcare.

Nurses' experiences with ad-hoc patient education in an Austrian acute care setting - A qualitative multicentric study.

OBJECTIVE: This paper aims to explore nurses' experiences with ad-hoc patient education (AHPE) in an acute inpatient setting. METHODS: We conducted nine focus groups with 34 nurses. Data was analysed using thematic analysis and the social-ecological model (SEM). FINDINGS: We identified two main themes. 1) characteristics of AHPE: the complexity, contents, and timing of AHPE, as well as features of successful AHPE. The central phenomenon was the subconscious and incidental nature of AHPE. This negatively impacts charting and recognition of patient education as a core nursing responsibility. 2) requirements for successful AHPE, using the SEM: a) interpersonal level: nurses' own expertise, personality traits, and attitude; b) intrapersonal level: relationship building, communication at eye-level, and recognising patients' receptivity and education needs; c) institutional level: environmental factors (time, space, and clear responsibilities within care teams) and the charting system; d) social level: recognition and appreciation for the value of patient education. CONCLUSION: AHPE often occurs subconciously and unreflected. Patient education can positively impact patient outcomes; however, this requires a complex interaction of factors on multiple systemic levels. PRACTICE IMPLICATIONS: Awareness raising for AHPE, its value for patients and society, and its proper charting is needed on multiple levels to ensure patient safety and the peace of mind of care teams.

Effects of maternal contact and positive human contact during lactation on pork quality: Positive human contact to piglets during lactation improves pork loin muscle pH.

Enhancing stress resilience through the early life period in pigs could potentially improve pork quality. It was hypothesised that pigs receiving maternal contact or positive human contact during lactation would have improved carcass and pork quality. Seventy-nine mixed-sex pigs were selected from a 2 × 2 factorial randomised block design for treatments maternal contact (MC+) / reduced maternal contact (MC-); and positive human contact (HC+) / control (HC-). Modified farrowing crates were utilised to reduce maternal contact (MC-). Litters in the HC+ treatment received five minutes of daily positive human interaction (stroking). Treatments ceased at 22 days of age (weaning) and pigs were slaughtered after 21 weeks of age. The m. longissimus thoracis et lumborum pH was higher in HC+ than HC- pigs (P < 0.05) during chilling, from 90 min post slaughter. No HC effects (P > 0.05) were observed for cortisol or haptoglobin concentration, hot carcass weight, P2 backfat, carcass scratches, colour, drip loss, cook loss and shear force. MC+ tended (P < 0.086) to increase carcass weight, P2 and carcass scratch score compared to MC-, but no further impacts were observed. The impact of positive human contact during early life was observed 20+ weeks after treatment with reduced pH decline, potentially indicating a reduction in pre-slaughter stress, however there were no further impacts on pork quality. There is evidence that maternal contact is important for lifetime growth performance of pigs but the impacts on stress resilience are less apparent.

Sharing midwifery philosophy through a positive learning environment prepares students for a future providing midwifery continuity of care: A mixed method study.

BACKGROUND: Global and national frameworks for midwifery education recognise and prioritise the provision of midwifery continuity of care. Previous studies report that learning is enhanced when students have professional experience placements within these models, however there remains wide variation in midwifery students' access to placements within these models in Australia. AIM: To evaluate Bachelor of Midwifery students' experiences in midwifery continuity of care models within two local health districts in New South Wales, Australia. METHOD: A mixed methods design was used: qualitative data collected through interviews, and quantitative data collected via an online survey using the Midwifery Student Evaluation of Practice (MidSTEP) tool. Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken. RESULTS: Sixteen students responded, four students were interviewed, and 12 students completed the survey. The MidSTEP mean scores for all sub-scales rated above 3.0/4.0. Participants rated 'work across the full scope of midwifery practice' and five out of eight subscales of Philosophy of Midwifery Practice at 100 %. 'Experiences prepare me to be a change agent for maternity service reform' rated the lowest (67 %). Three qualitative themes emerged: care versus carer model; learning experience; and future career as a caseload midwife. CONCLUSION: A mixed method approach using a validated tool to measure student experiences, contributes to the evidence that students value professional experience placements within midwifery continuity of care models. Currently this is not an option for all midwifery students and as midwifery continuity of care models expand, these findings will inform further implementation of student professional experience placement within these models.