'Humility, Concern, Respect': A Qualitative Study Exploring Parent Perspectives on a Pediatrician's Role in Addressing Racism.

OBJECTIVE: To explore racially minoritized families' perceptions on how, and if, physicians should address children's racial identity and concepts of racism within clinical settings. STUDY DESIGN: Parents of racially minoritized children, ages 5 through 18, were interviewed to explore experiences with racial identity formation, discrimination, and the extent to which they wanted pediatricians to address these topics. Children were included at the discretion of their parents. Interviews were transcribed, coded, and analyzed through a critical race theory lens based in constructivist grounded theory. RESULTS: Parents encouraged their children to embrace their racial identities but also wanted to shield them from negative experiences of racism to preserve identity safety. Parents felt pediatricians should address racial issues in a manner specific to their child's situation. Thoughtful inclusion of race-related questions, whether in discussion or on questionnaires, is essential to prevent tension in a therapeutic relationship. There was no consensus on the use of preclinical screening. Instead, families highlighted the importance of embracing humility, trust, and respect. CONCLUSIONS: Participant families have preferences for approaches to address the effects of racism on their children's health. Pediatricians should understand the importance of identity safety and approach their discussions with cultural humility, which includes self-reflection, empathy, active listening, and flexible negotiation. Above all, pediatricians need to create a safe environment for appropriate discussion of these issues.

Proactive health behavior in middle-aged and older adult females with urinary incontinence: A grounded theory study.

AIM: To develop a conceptual framework for proactive health behavior among middle-aged and older adult females with urinary incontinence. DESIGN: Qualitative grounded theory study. BACKGROUND: There is a growing body of research emphasizing the pivotal significance of proactive health behavior. Proactive health behavior can empower patients to actively manage their illnesses and facilitate disease recovery. Clearly defining patients' relevant beliefs and assumptions regarding proactive health behavior can effectively promote their adoption. However, there is currently a lack of relevant research in this area. METHODS: We conducted in-depth interviews with middle-aged and older adult females with urinary incontinence (n = 17) and nursing caregivers (n = 9). We used theoretical sampling, whlie conducting continuous comparative analysisi and data collection. RESULTS: The study has yielded a substantive theory to facilitate healthcare professionals' comprehension of proactive health behavior in middle-aged and older adult females with urinary incontinence. The foundation for middle-aged and older adult females to adopt proactive health behavior is having a certain level of health literacy regarding their conditions. Patients' internal motivation to engage in proactive health behavior includes a sense of health responsibility and health demands. Additionally, external support received by patients can also facilitate their adoption of proactive health behavior. The proactive health behavior practices of middle-aged and older adult females mainly include proactive medical care behavior and establishing a healthy lifestyle. CONCLUSIONS: The conceptual framework established in this study offers theoretical support for middle-aged and older adult females with urinary incontinence to adopt proactive health behavior. It provides a basis for future exploration of proactive health behavior among this demographic and informs the development of more effective health interventions and support measures tailored to their needs. IMPACT: The study specifically elucidates the mechanisms and manifestations of proactive health behavior adopted by middle-aged and older adult females with urinary incontinence, laying the foundation for clarifying the level of proactive health among patients and implementing corresponding intervention measures. Additionally, it can also serve as a reference for related research on other diseases.

Suffering and adjustment: a grounded theory of the process of coping with financial toxicity among young women with breast cancer.

PURPOSE: To explore the process of coping with financial toxicity among young women with breast cancer and formulate a grounded theory that serves as a foundation for creating intervention strategies aimed at supporting cancer survivors. METHODS: A qualitative study using the Corbin and Strauss variant of grounded theory. A series of in-depth interviews were carried out with young women with breast cancer (n = 29) using the theoretical sampling method. We analyzed data by coding core categories in the patients' coping processes and developing theory around these categories. Data collection and analysis were performed simultaneously. RESULTS: A substantial theory of the process of coping with financial toxicity among young female breast cancer survivors was constructed. Two core concepts, suffering and adjustment, were identified. Young women with breast cancer suffered from financial toxicity, which was related to risk factors, coping resources, and unmet needs. To overcome financial toxicity, young women with breast cancer adjusted by reshaping consumption concept, re-dividing of family functions, re-planning of occupation career, and rebuilding life confidence. CONCLUSION: This qualitative study constructed a theory delineating the coping strategies employed by young women with breast cancer in response to financial toxicity, offering profound insights into the intricacies of cancer-related financial toxicity. Identifying risk factors, enhancing coping resources, and meeting unmet needs would be helpful to patients' adjustment to financial stress.

A model for older adults' coping with the death of their child: a grounded theory study.

BACKGROUND: Losing a child at an old age while also facing health problems and physical limitations can have significant negative impacts on parents' lives such as anxiety, depression, and impairment in social functions. The process of coping with the death of a child is particularly unknown among older adults. Therefore, this study aimed to explore how older adults cope with the death of their child. METHOD: This qualitative study was conducted in 2020-2021, using Corbin and Strauss (2015) approach to the grounded theory method. The sampling began purposefully and continued theoretically until theoretical saturation was achieved. Semi-structured interviews were conducted to collect data from Iranian older adults who had experienced the death of their child. To ensure data trustworthiness, the Guba and Lincoln (1985) criteria were utilized. A qualitative data analysis software, MAXQDA2020, was used to manage the data. FINDINGS: The results of this study were obtained from 27 participants. The main concern of older adults was the fear of their lives collapsing following the death of their child. Participants utilized three main strategies to address their concerns: attempting to rebuild themselves, connecting to a higher power, and searching for positivity amidst grief. The central category that emerged from the analysis was "improving physical, mental, and spiritual capacities," resulting in personal growth and improved social relationships. CONCLUSIONS: Through the use of the three aforementioned strategies, older adults were able to overcome their primary concern of the fear of their lives collapsing following the death of their child. Further development of the theory is suggested in order to design a model that can facilitate older adults' coping with this difficult life event.

Value-related attitudes towards mental health problems and help-seeking barriers: a sequential mixed-methods design investigating participants with reported depressive episodes in rural Northern Germany with and without treatment experience.

BACKGROUND: Seeking help for severe depressive symptoms remains a major obstacle for particular groups within the general population. Value-related attitudes might contribute to this treatment gap, particularly in rural regions with a low density of psychiatric-psychotherapeutic services. We aimed to investigate narratives of socialization, value systems, and barriers of help-seeking to better understand social milieus at increased risk for underuse of psychiatric-psychotherapeutic services in a rural area in East Germany. This could complement the explanatory power of classical socio-demographic determinants and provide guidance for possible interventions. METHOD: Based on results of an analysis of a population-based German cohort study (SHIP-TREND-1), 20 individual semi-structured interviews were conducted with participants who met criteria for having been moderately or severely depressed at least once in their life. Qualitative analyses of interview data were guided by grounded theory methodology. RESULTS: Participants with severe symptoms of depression were more frequent among non-responders of this study. We identified key aspects that influence help-seeking for mental health problems and seem to be characteristic for rural regions: family doctors serve as initial contact points for mental health problems and are considered as alternatives for mental health professionals; norms of traditional masculinity such as being more rational than emotional, needing to endure hardships, embodying strength, and being independent were frequently mentioned as inhibiting help-seeking by middle-aged men; anticipated adverse side-effects of therapy such as worsening of symptoms; a frequently expressed desire for less pathologically perceived treatment options. CONCLUSIONS: Our results suggest that barriers regarding help-seeking in rural regions are multifaceted and seem to be influenced by traditional norms of masculinity. We believe it is critical to strengthen existing and already utilized services such as family doctors and to implement and evaluate tailored interventions targeting the needs of the rural milieu.

More than the sum of its parts-A constructivist grounded-theory study on specialist palliative care during crises like the COVID pandemic.

BACKGROUND: The COVID pandemic is an example of a crisis challenging healthcare systems worldwide. The impact of the pandemic on providing high-quality palliative care calls for a deeper understanding of specialist services during crises. This is essential in preparation for further crises. AIM: To develop a conceptual understanding of the impact of the pandemic on specialist palliative care as an example for arising future crises. DESIGN: Qualitative interview study across Germany, following a constructivist grounded theory methodology. SETTING/PARTICIPANTS: Eleven semi-structured interviews with experts with overarching knowledge of structures and processes in specialist palliative care between 05-07/2020 and between 02-06/2021, 23 semi-structured interviews with healthcare professionals working in a specialist palliative care setting. RESULTS: The complex system of palliative care provision during crises has properties that cannot be understood as separated parts of the care process. The pandemic led to unique structural and processual challenges characterized by interconnectedness, uncertainty, dynamic, underlying dilemmas, and unclear long-term goal. In response to the pandemic, teams experienced different phases, which enhanced adaption, innovation, and progress within complex care situations. Creative strategy approaches and dynamic responsiveness facilitated innovative development and could lead to long-lasting improvement within services. Availability of information, transparent communication, comprehensible instructions, participation in decision-making, and search for solutions contributed to teams' proactive development throughout the pandemic. CONCLUSION: Addressing the complex problems in specialist palliative care caused by crises requires system thinking and a learning mindset. This can facilitate teams to overcome the crisis and move forward rather than bounce back to normal.

"Collateral beauty." Experiences and needs of professionals caring for parents continuing pregnancy after a life-limiting prenatal diagnosis: A grounded theory study.

BACKGROUND: Caring for parents continuing pregnancy after learning about a severe life-limiting condition in their unborn is challenging. Most existing studies focus on affected families, whereas research on the subjective experience of care professionals is scarce. AIM: We aimed to (1) explore experiences and needs of involved care professionals, (2) obtain information about existing care structures, and (3) identify requirements for a structured perinatal palliative care program. DESIGN: Grounded Theory study using theoretical sampling. Data was collected by semi-structured interviews and analyzed following the principles of grounded theory coding and situational analysis. SETTING: A total of 18 professionals from 12 different services in Munich and surroundings participated in the study: 8 physicians, 3 midwives, 2 nurses, 1 each pregnancy counselor, grief counselor, chaplain, clinical psychologist, and undertaker. RESULTS: Several organizations provide support for affected parents, but inter-institutional communication is scarce. Due to the lack of a dedicated perinatal palliative care program, professionals make immense and partly unpaid efforts to support concerned parents. Providers experience "collateral beauty" in their work despite all the suffering and grief. This includes the development of a humble attitude and feelings of gratitude toward life, the feeling of having a meaningful task and professional as well as personal growth. Requirements for a structured perinatal palliative care program include: fostering peer support, ensuring regular supervision, and enhancing interdisciplinary exchange. CONCLUSIONS: Perinatal palliative care demands a high level of personal engagement but is experienced as highly rewarding by care professionals.

How palliative care professionals develop coping competence through their career: A grounded theory.

BACKGROUND: Palliative care professionals face emotional challenges when caring for patients with serious advanced diseases. Coping skills are essential for working in palliative care. Several types of coping strategies are mentioned in the literature as protective. However, little is known about how coping skills are developed throughout a professional career. AIM: To develop an explanatory model of coping for palliative care professionals throughout their professional career. DESIGN: A grounded theory study. Two researchers conducted constant comparative analysis of interviews. SETTING/PARTICIPANTS: Palliative care nurses and physicians across nine services from Spain and Portugal (n = 21). Theoretical sampling included professionals who had not continued working in palliative care. RESULTS: Professionals develop their coping mechanisms in an iterative five-stage process. Although these are successive stages, each one can be revisited later. First: commencing with a very positive outlook and emotion, characterized by contention. Second: recognizing one's own vulnerability and experiencing the need to disconnect. Third: proactively managing emotions with the support of workmates. Fourth: cultivating an integrative approach to care and understanding one's own limitations. Fifth: grounding care on inner balance and a transcendent perspective. This is a transformative process in which clinical cases, teamwork, and selfcare are key factors. Through this process, the sensations of feeling overwhelmed sometimes can be reversed because the professional has come to understand how to care for themselves. CONCLUSIONS: The explicative model presents a pathway for personal and professional growth, by accumulating strategies that modulate emotional responses and encourage an ongoing passion for work.

Women's decision process when actively choosing to 'go flat' after breast cancer: a constructivist grounded theory study.

OBJECTIVE: This study aims to describe a conceptual model that could illuminate the decision process women go through when choosing to go flat on one or both sides due to breast cancer. METHODS: A qualitative design, with constructivist grounded theory was used. Eighteen women were individually interviewed, digitally or by telephone, until saturation was reached. Data were analysed using a constant comparative iterative method in accordance with grounded theory. By examining the text data to identify the decision process for going flat and rejecting reconstructive surgery open coding was obtained. As the study proceeded patterns were explored and categories developed into a core category. RESULTS: The overall decision process for women choosing to go flat on one or both sides emerged in three phases: Phase 1, where the women are forced to "Face the cancer", Phase 2 comprising "Reflections on health and motivation" and Phase 3, described as "Hobson's choice". The fundament of the decision process was found in the core category "Establishing and safeguarding the chosen self". CONCLUSIONS: The decision process involved in actively going flat and rejecting reconstructive surgery is founded in the individual woman's motivations, such as view of femininity and apprehensions about the offered reconstructive surgery.

Children's behavioural and emotional reactions towards living with congenital heart disease in Saudi Arabia: A grounded theory study.

BACKGROUND: A high incidence of children with congenital heart disease (CHD) was found in Saudi Arabia (SA). International literature reports that children with CHD exhibit behavioural and emotional issues due to experiencing hospitalisation and clinical treatments combined with a dearth of qualitative understanding of the experiences of younger children with CHD. Therefore, the aim was to explore the behaviour and emotions of 4-10-year-olds with CHD in SA through children's accounts of their own experiences and parental proxy reports of children's behaviour and emotions. METHODS: Charmaz's constructivist grounded theory (GT) approach was used. Twenty single semi-structured interviews of 10 child/parent dyads were undertaken at a hospital clinic in SA. Children's interviews were combined with an arts-based approach using drawings, pictures and faces of emotions (emojis). Constant comparison analysis was undertaken. Consolidated Criteria for Reporting Qualitative Research guidelines was followed in reporting this study. FINDINGS: A substantive GT: children's behavioural and emotional reactions towards stressors related to living with CHD was developed and provides new insights into children's and parents' perceptions of the children's behavioural and emotional reactions to living with CHD in SA. The theory proposes that children's reactions to living with CHD relate to medical treatment stressors, sociocultural stressors and physical change stressors. Several further factors influenced children's responses to these stressors. CONCLUSION: Children and parents in SA contributed to a new understanding of the relationship between CHD and children's behavioural and emotional reactions. In addition, findings support the need for early assessment of behaviour and emotions among children with CHD and the application of preventative and supportive measures for the children and their families in SA. PATIENT OR PUBLIC CONTRIBUTION: Before the research commenced, the developmental appropriateness of the proposed arts-based data collection tools was tested with three healthy children aged 6-9 years old; the tools were then revised accordingly before the interviews were undertaken.

"Just pee in the diaper" - a constructivist grounded theory study of moral distress enabling neglect in nursing homes.

BACKGROUND: A growing body of evidence shows that many nursing home residents' basic care needs are neglected, and residents do not receive qualitatively good care. This neglect challenges nursing staff´s professional and personal ideals and standards for care and may contribute to moral distress. The aim of this study was to investigate how nursing staff manage being a part of a neglectful work culture, based on the research question: "How do nursing home staff manage their moral distress related to neglectful care practices?" METHODS: A qualitative design was chosen, guided by Charmaz´s constructivist grounded theory. The study was based on 10 individual interviews and five focus group discussions (30 participants in total) with nursing home staff working in 17 different nursing homes in Norway. RESULTS: Nursing staff strive to manage their moral distress related to neglectful care practices in different ways: by favouring efficiency and tolerating neglect they adapt to and accept these care practices. By disengaging emotionally and retreating physically from care they avoid confronting morally distressing situations. These approaches may temporarily mitigate the moral distress of nursing staff, whilst also creating a staff-centred and self-protecting work culture enabling neglect in nursing homes. CONCLUSIONS: Our findings represent a shift from a resident-centred to a staff-centred work culture, whereby the nursing staff use self-protecting strategies to make their workday manageable and liveable. This strongly indicates a compromise in the quality of care that enables the continuation of neglectful care practices in Norwegian nursing homes. Finding ways of breaking a downward spiralling quality of care are thus a major concern following our findings.

Perpetuating ability to live life as usual: a grounded theory study of persons living with age-related macular degeneration.

BACKGROUND: Age-Related Macular Degeneration (AMD) is an eye disease associated with age that causes progressive and irreversible loss of central vision, while the peripheral visual ability remains. The occurrence of and especially late AMD is estimated to increase extensively to 2040 among persons aged ≥ 65 in Scandinavia, due to an increasing aging population. OBJECTIVES: The present study explored what it means to live with AMD through the eyes of those living with the condition. METHODS: This is an explorative interview study. People who were ≥ 65 years old, living in their own homes, and diagnosed with advanced dry AMD in one or both eyes, causing a visual acuity of no more than 0.3 or worse in the best eye, were invited to participate in the study. The method chosen was the constructivist grounded theory, where reality is seen as fundamentally social and processual and a way of accessing the participants' experiences, thoughts, and feelings. RESULTS: In total, 12 interviews were conducted. Living with dry AMD confronted different problems and challenges. The substantive theory, Perpetuating ability to live life as usual, is characterised by a desire to continue life as usual, which requires an acceptance of the disease's progress, self-acceptance of the new me, and an acceptance that the new life needs to be lived a little more carefully. Moreover, the participants used three strategies to resolve their main concern by maintaining an everyday life 1) Navigating the new normal, 2) Trusting own ability, and 3) Interdepending. CONCLUSION: Maintaining an everyday life is the primary concern among people with AMD. In supporting self-care, gaining information about the subjective experience to support their everyday living is of the utmost importance. This grounded theory captures valuable knowledge of how the older adults resolved their main concern "you got to keep on" despite their affected vision by "facing the fact" live life as usual since since life goes on. Our study also gives rise both to implications for research and practice in order to strengthen older people with AMD facing their future challenges. TRIAL REGISTRATION: The Swedish Ethical Review Authority (EPN 2021/02877).

'Getting addicted to it and losing a lot of money it's just like a hole.' A grounded theory model of how social determinants shape adolescents' choices to not gamble.

BACKGROUND: Gambling abstinence when underage lowers the risk of harmful gambling in later life. However, little research has examined why many young people refrain from gambling, even though this knowledge can inform protective strategies and lower risk factors to reduce underage gambling and subsequent harm. This study draws on the lived experience of adolescent non-gamblers to explore how social determinants while growing up have shaped their reasons and choices to not gamble. METHODS: Fourteen Australian non-gamblers, aged 12-17 years, participated in an in-depth individual interview (4 girls, 3 boys) or online community (4 girls, 3 boys). Questions in each condition differed, but both explored participants' gambling-related experiences while growing up, including exposure, attitudes and behaviours of parents and peers, advertising, simulated gambling and motivations for not gambling. The analysis used adaptive grounded theory methods. RESULTS: The grounded theory model identifies several reasons for not gambling, including not being interested, being below the legal gambling age, discouragement from parent and peers, concern about gambling addiction and harm, not wanting to risk money on a low chance of winning, and moral objections. These reasons were underpinned by several social determinants, including individual, parental, peer and environmental factors that can interact to deter young people from underage gambling. Key protective factors were parental role modelling and guidance, friendship groups who avoided gambling, critical thinking, rational gambling beliefs, financial literacy and having other hobbies and interests. CONCLUSIONS: Choices to not gamble emanated from multiple layers of influence, implying that multi-layered interventions, aligned with a public health response, are needed to deter underage gambling. At the environmental level, better age-gating for monetary and simulated gambling, countering cultural pressures, and less exposure to promotional gambling messages, may assist young people to resist these influences. Interventions that support parents to provide appropriate role modelling and guidance for their children are also important. Youth education could include cautionary tales from people with lived experience of gambling harm, and education to increase young people's financial literacy, ability to recognise marketing tactics, awareness of the risks and harms of gambling, and how to resist peer and other normalising gambling influences.

'Doing culture' in contemporary south-eastern Australia: how Indigenous people are creating and maintaining strong cultural identities for improved health and wellbeing.

BACKGROUND: Indigenous people in Australia experience far poorer health than non-Indigenous Australians. A growing body of research suggests that Indigenous people who are strong in their cultural identity experience better health than those who are not. Yet little is known about how Indigenous people create and maintain strong cultural identities in the contemporary context. This paper explores how Indigenous people in south-eastern Australia create and maintain strong cultural identities to support their health and wellbeing. METHODS: Data were collected from 44 Indigenous people living in the south-eastern Australian state of Victoria via yarning. Yarning is a cultural mode of conversation that privileges Indigenous ways of knowing, doing and being. Yarning participants were selected for their prominence within Victorian Indigenous health services and/or their prominence within the Victorian Indigenous community services sector more broadly. Due to the restrictions of COVID-19, yarns were conducted individually online via Zoom. Data were analysed employing constructivist grounded theory, which was the overarching qualitative research methodology. RESULTS: All yarning participants considered maintaining a strong cultural identity as vital to maintaining their health and wellbeing. They did this via four main ways: knowing one's Mob and knowing one's Country; connecting with one's own Mob and with one's own Country; connecting with Community and Country more broadly; and connecting with the more creative and/or expressive elements of Culture. Importantly, these practices are listed in order of priority. Indigenous people who either do not know their Mob or Country, or for whom the connections with their own Mob and their own Country are weak, may therefore be most vulnerable. This includes Stolen Generations survivors, their descendants, and others impacted by historical and contemporary child removal practices. CONCLUSIONS: The yarns reveal some of the myriad practical ways that Indigenous people maintain a strong cultural identity in contemporary south-eastern Australia. While programs designed to foster connections to Community, Country and/or Culture may benefit all Indigenous participants, those most disconnected from their Ancestral roots may benefit most. Further research is required to determine how best to support Indigenous Victorians whose connections to their own Mob and their own Country are unable to be (re)built.

Resilience for working in Ontario home and community care: registered practical nurses need the support of themselves, family and clients, and employers.

BACKGROUND: The context of practice is often not explicit in the discourse around the personal and professional resilience of nurses. The unique factors related to providing nursing care in home and community care may provide novel insight into the resilience of this health workforce. Therefore, this research addressed how nurses build and maintain resilience working in the home and community care sector. METHOD: A qualitative study was conducted between November 2022 to August 2023 using 36 in-depth interviews (29 registered practical nurses [RPNs], five supervisors of RPNs, two family/care partners (FCPs) of clients receiving home and community care services). Analysis was consistent with a grounded theory approach including coding and comparative methods. RESULTS: The factors of personal and professional resilience were not distinct but rather mixed together in the experience of nurses having resilience working in the home and community care sector. The process of building and maintaining resilience as home and community care nurses was informed by three categories: (1) The conditions of working in HCC; (2) The rapport RPNs held with FCPs; and (3) The nurses' ability for supporting the 'self'. Multiple components to inform these categories were identified and illustrated by the words of the nurse participants. CONCLUSION: The process of building and maintaining resilience by RPNs working in the home and community care sector was guided by the day-to-day experiences of providing care for clients and the conditions of being a mobile health care provider. However, nurses may sense when they need to support their 'self' and must be empowered to request and receive support to do so.

Exploring the decision-making process of female genital cosmetic procedures in Iranian women and constructing and validating a results-based logic model for a healthy public policy: a study protocol.

BACKGROUND: Female genital cosmetic procedures have grown rapidly in most parts of the world. Professional organizations have issued warnings about the complications and long-term consequences of these practices. To be able to adopt the right health policies, it is necessary to know why women decide to perform these procedures. Therefore, the present study will be aim to discover the decision-making process involved in performing female genital cosmetic procedures for Iranian women and construct and validate a results-based logic model for healthy public policy. METHODS: The present study was conducted in three phases. In the initial phase, a qualitative study will be conducted with the Corbin and Strauss ground theory approach. The participants in the study will be healthy women who desire or have undergone female genital cosmetic procedures without medical indications. In this phase, purposive and theoretical sampling will guide recruitment and data collection. The data will be collected via semi-structured interviews, field notes and observations of individual interactions. The data will be analysed using the approach of Corbin and Strauss (2015). MAXQDA 2007 software was used for managing the process of data analysis. In the second phase, the development of a results-based logic model for a healthy public policy is performed based on the findings of the first phase of the study, interviews with key informants and a review of the results of the literature in this field. Finally, validation of the designed program will be performed by the nominal group technique with the presence of a group of experts in the third phase. DISCUSSION: The findings of this study, by identifying women's main concerns related to the studied phenomenon, the existing context, participants' reactions and the consequences of the adopted reactions, can be very important in designing a program that fits Iran's cultural characteristics. In this research, a program using a logical model will be presented that is suitable for policymakers, planners and healthcare service providers to be implemented in the social-cultural context of the study.

Female genital cosmetic procedures refer to a group of cosmetic procedures that change the structure and healthy appearance of the female external genitalia to improve sexual performance or body image. The desire to perform these techniques has become popular in most parts of the world. However, scientific societies have warned about the efficiency, effectiveness and side effects of these techniques. According to these points, the present study aims to discover the decision-making process of performing FGCPs for Iranian women and to construct and validate a program for healthy public policy. This study will be performed in three stages. First, a qualitative study and interviews with healthy women who desire or have undergone female genital cosmetic procedures will be performed. In the following, based on the findings of the first stage, interviews with key informants and a review of literature, a program will be presented to reduce or prevent these procedures, and then this program will be validated. Using the designed program, healthcare practitioners will be able to provide women with more effective advice and guidance to make correct and informed decisions. In addition, this program will enable planners and policymakers to take steps to reduce the demand for these actions and make informed decisions by women by changing and adjusting the conditions and context.

Family caregivers' preferences for support when caring for a family member with cancer in late palliative phase who wish to die at home - a grounded theory study.

BACKGROUND: Family caregivers are essential in end-of-life care for cancer patients who wish to die at home. The knowledge is still limited regarding family caregivers needs and preferences for support and whether the preferences change during the patient's illness trajectory. Therefore, the aim was to explore family caregivers' preferences for support from home care services over time when caring for a family member with cancer at the end of life who wished to die at home. METHODS: A qualitative method was applied according to Grounded Theory. Data was collected longitudinally over the illness trajectory by means of repeated individual interviews (n = 22) with adult family caregivers (n = 11). Sampling, data collection and data analysis were undertaken simultaneously in line with the constant comparative method. RESULTS: The findings are captured in the core category "hold out in duty and love". The categories "having control and readiness for action" and "being involved in care" describe the family caregivers' preferences for being prepared and able to handle procedures, medical treatment and care, and to be involved by the healthcare personnel in the patient's care and decision making. The categories "being seen and confirmed" and "having a respite" describe family caregivers' preferences for support according to their own needs to be able to persevere in the situation. CONCLUSION: Despite deterioration in the patient's illness and the increasing responsibility family caregiver struggle to hold out and focus on being in the present. Over time together with deterioration in the patient's illness and changes in the situation, they expressed a need for more intense and extensive support from the home care services. To meet the family caregivers' preferences for support a systematic implementation of a person-centred care model and multicomponent psycho- educational interventions performed by nurses can be proposed. Moreover, we suggest developing a tool based on the conceptual model generated in this study to identify and map family caregivers' needs and preferences for support. Such a tool can facilitate communication and ensure person-centred interventions.

Risk management during times of health uncertainty in Spain: A qualitative analysis of ethical challenges.

The study examines the reflections of various experts in risk management when asked about uncertainty generated by a health threat and the response to such a threat: what criteria should guide action when potential harm is anticipated, but not known with certainty? The objective of the research is to obtain a holistic perspective of ethical conflicts in risk management, based on experts' accounts within the Spanish territory. A qualitative study was conducted through semi-structured interviews with 27 experts from various fields related to health risk management and its ethical implications, following the grounded theory method. The method includes theory generation through an inductive approach, based on the identified categories. The 27 narratives obtained revealed a variety of fundamental issues grouped into 8 subcategories and subsequently grouped into three main categories. The first category focuses on human vulnerability in health matters. The second category explores the agents and instruments for decision-making that arise from uncertain or traumatic social events. The third category refers to the need for common ethical paradigms for all humanity that implement justice over universal values. A main theory was suggested on the concept of responsibility in a global common good. There is an urgent need to assume this integrative responsibility as an inherent strategy in decision-making. To achieve this, the involved actors must acquire specific humanistic training, conceptualizing fundamental ethical principles, and emphasizing skills more related to humanistic virtues than technical knowledge.

"Perinatal loss, a devastating cyclone": A situation-specific nursing theory.

PURPOSE: The aim of this paper is to develop a preliminary theory that explores in depth into understanding the experiences of women who have suffered a spontaneous perinatal loss during any trimester of their pregnancy regarding their emotional response to this loss. DESIGN: A grounded theory approach was used, and 25 in-depth interviews were conducted with Spanish women who suffered a spontaneous perinatal loss. METHODS: Theoretical sampling and constant comparative analysis were used to reach theoretical saturation. EQUATOR guidelines were followed, using the COREQ checklist. RESULTS: The "Perinatal loss, a devastating cyclone," a situation-specific nursing theory, explains the process that a woman experiences when she loses her baby at any stage of pregnancy, drawing an analogy with tropical cyclones as natural disasters that destroy everything in their path. This situation-specific theory includes three dimensions, explaining the phases identified in the perinatal loss process (phase prior to impact [before the perinatal loss], impact phase [diagnostic moment], emergency phase [hospital care], relief or honeymoon phase [return home], disillusionment or stock-taking phase [after the first postloss days at home], reconstruction and recovery phase [grief construction process] and consequences [with an eye to the future]). Three intervention areas were described around the perinatal loss process: "rescue area" (partner, grandparents, and siblings of the deceased baby), "relief area" (healthcare professionals), and "base camp" (society). CONCLUSION: The situation-specific nursing theory "Perinatal loss, a devastating cyclone" is the final product of a grounded theory study that provided an in-depth analysis of women's experiences when they suffer a spontaneous perinatal loss at any point in their pregnancy. CLINICAL RELEVANCE: The situation-specific theory "Perinatal loss, a devastating cyclone" with the seven identified phases and the three areas of intervention could be used as a framework for healthcare professionals in their clinical practice as a guide to support women in this disfranchised grief.

Bereaved Family Caregivers Perception of Trust in Palliative Care Doctors by Patients with Terminal Cancer.

Trust is a key factor in achieving a good death. However, few studies have focused on factors that help patients with terminal cancer establish trusting relationships with their palliative care doctors. This exploratory qualitative study, conducted in Japan, was designed to identify factors related to terminal cancer patients' trust in their doctors. Semi-structured interviews were conducted with 18 caregivers and grounded theory was the research approach chosen to guide this study. The data revealed seven factors related to the trust to palliative care doctors, including caring attitude, symptom management, courteous and specific explanations, long-term involvement in the patient's care, being faced with inevitable death, good impression of the institution, and referral by a trusted doctor. These factors were categorized into three main themes: [1] palliative care doctors, [2] patients with terminal cancer, and [3] professional reputation. There is potential for improving end-of-life experiences through understanding and implementing interventions to ensure trust identified by these caregivers.