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Introduction: During the COVID-19 pandemic lockdowns in 2020, midwives in Aotearoa New Zealand were classified as essential workers and continued providing maternity services in hospitals, birth centres and the community. Midwives adapted their practice, using virtual care and navigating the restrictions imposed on birthing women/people and their whānau. This paper reports on midwives’ experiences of providing care during the pandemic. Aim: To identify the impacts of the pandemic on midwives providing antenatal, labour and birth, and postnatal care to birthing women/people and their whānau during the 2020 Level 4 and Level 3 restrictions. Method: In-depth exploratory interviews and Braun and Clarke’s (2019) process of reflexive thematic analysis were used to explore impacts on the practice and personal lives of midwives. Findings: Fifteen midwives described their work-related challenges: significantly increased workloads, inconsistent messaging regarding practice guidance between health authorities and others, and limited access to personal protective equipment. Reflections about wider professional interests included these midwives’ immense pride in their profession and their increased agility in the use of new technologies. But these positive elements were juxtaposed against a perceived lack of recognition and financial support for their increased workloads, leaving midwives feeling marginalised and invisible. Midwives’ personal lives were significantly challenged by the stress and fear of facing COVID-19 itself, the juggle of managing their work and whānau lives, and their sense of conflict from feeling unable to practise in ways that aligned with their philosophies of inclusion and family-centredness. Conclusion: Despite challenges, these midwives were committed to whānau in their care and demonstrated resilience, adaptability and resourcefulness in meeting their needs. Health planners should recognise that, as a primary health service, a significant amount of midwifery care is provided in the community setting and future pandemic planning should ensure smooth provision of resources to community-based midwives. Streamlining of information from trusted sources, together with consistency across the country, will assist midwives to respond to health directives confidently.

Despite regular exposure to patient deaths, little research has explored how psycho-oncologists experience and cope with these events. This study examined the unique challenges faced by psycho-oncologists in Germany, aiming to contribute to the broader understanding of professional grief and its impact on healthcare professionals’ mental health and well-being. We conducted 25 semi-structured interviews with psycho-oncologists. The interviews were audiorecorded, transcribed, and analyzed using content analysis. Participants experienced an average of two patient deaths per month. The findings revealed both positive and negative effects of patient deaths on their personal and professional lives. While many participants managed professional grief successfully, most expressed unmet needs for education and information on coping strategies. Peer support was identified as particularly valuable for managing the emotional toll. Overall, patient deaths had significant, varying impacts on psycho-oncologists, highlighting the need for healthcare institutions to implement targeted support and educational interventions to address professional grief and enhance their well-being.

Digital tools are progressively reshaping the daily work of health care professionals (HCPs) in hospitals. While this transformation holds substantial promise, it leads to frustrating experiences, raising concerns about negative impacts on clinicians' well-being. The goal of this study was to comprehensively explore the lived experiences of HCPs navigating digital tools throughout their daily routines. Qualitative in-depth interviews with 52 HCPs representing 24 medical specialties across 14 hospitals in Switzerland were performed. Inductive thematic analysis revealed 4 main themes: digital tool use, workflow and processes, HCPs' experience of care delivery, and digital transformation and management of change. Within these themes, 6 intriguing paradoxes emerged, and we hypothesized that these paradoxes might partly explain the persistence of the challenges facing hospital digitalization: the promise of efficiency and the reality of inefficiency, the shift from face to face to interface, juggling frustration and dedication, the illusion of information access and trust, the complexity and intersection of workflows and care paths, and the opportunities and challenges of shadow IT. Our study highlights the central importance of acknowledging and considering the experiences of HCPs to support the transformation of health care technology and to avoid or mitigate any potential negative experiences that might arise from digitalization. The viewpoints of HCPs add relevant insights into long-standing informatics problems in health care and may suggest new strategies to follow when tackling future challenges.

Abstract Background The incidence of colorectal carcinoma (CRC) in patients ≤50 (early-onset-CRC, EOCRC) years is increasing. Given their different phase of life, younger individuals may face specific challenges in terms of body image, professional life, and psychosocial support. However, tailored programs for EOCRC patients are lacking in Germany. JUMP-START, a prospective study at the National Center for Tumor Diseases (NCT) Heidelberg in collaboration with the AIO (Arbeitsgemeinschaft internistische Onkologie) and the foundation for young adults with cancer in Germany aims to identify the specific needs of EOCRC patients and improve multiprofessional care. Materials and Methods Semi-structured interviews were conducted until content saturation, based on an interview guide focused on challenges related to diagnosis, utilization of support programs, and unmet needs. The interview guide was developed in an expert and patient panelist discussion. Qualitative analysis was performed with MAXQDA, using a content structuring qualitative content analysis according to Kuckartz. Results Forty-three EOCRC patients were screened, and 14 participants were interviewed at NCT Heidelberg between October 2023 and January 2024. Three main themes emerged: (1) The impact of CRC diagnosis at an early age on psychological and physical health, daily routine, and future perspectives, (2) Experiences with care service access and utility, and (3) Expectations for a multiprofessional care at a dedicated EOCRC center. Conclusions EOCRC patients highlighted various age-group-specific challenges related to diagnosis and treatment. Tailored multiprofessional programs may optimize care for EOCRC patients. Graphical Abstract Graphical Abstract

BackgroundThe use of artificial intelligence (AI) in psychiatry holds promise for diagnosis, therapy, and the categorization of mental disorders. At the same time, it raises significant theoretical and ethical concerns. The debate appears polarized, with proponents and critics seemingly irreconcilably opposed. On the one hand, AI is heralded as a transformative force poised to revolutionize psychiatric research and practice. On the other hand, it is depicted as a harbinger of dehumanization. To better understand this dichotomy, it is essential to identify and critically examine the underlying arguments. To what extent does the use of AI challenge the theoretical assumptions of psychiatric diagnostics? What implications does it have for patient care, and how does it influence the professional self-concept of psychiatrists?MethodsTo explore these questions, we conducted 15 semi-structured interviews with experts from psychiatry, computer science, and philosophy. The findings were analyzed using a structuring qualitative content analysis.ResultsThe analysis focuses on the significance of AI for psychiatric diagnosis and care, as well as on its implications for the identity of psychiatry. We identified different lines of argument suggesting that expert views on AI in psychiatry hinge on the types of data considered relevant and on whether core human capacities in diagnosis and treatment are viewed as replicable by AI.ConclusionsThe results provide a mapping of diverse perspectives, offering a basis for more detailed analysis of theoretical and ethical issues of AI in psychiatry, as well as for the adaptation of psychiatric education.

Introduction Healthcare professionals’ perspectives are often overlooked in the evaluation of digital weight loss interventions. Thus, we examined how healthcare professionals perceive patient success in a one-year web-based weight management program, the Healthy Weight Coaching, aiming to identify key success factors and common challenges within the coaching process. Methods Thematic analysis was conducted on ten semi-structured interviews with healthcare professionals from the Healthy Weight Coaching. Interviewees included individuals of both sexes, with an average age of 41 years, ranging from 10 months to 5 years of coaching experience, and treating 90 to 500 patients. Results Three main themes emerged from the analysis: (1) Positive progress during the Healthy Weight Coaching, (2) Factors facilitating success, and (3) Barriers hindering progress. The coaches noted significant positive changes among patients, including increased self-compassion, reduced weight-related stress, and a shift toward holistic well-being. Improvements in eating habits, physical activity, and vegetable consumption were observed, along with reductions in binge eating behaviors. Personal factors such as internal motivation and engagement with the program were crucial for success. Additionally, aspects of the Healthy Weight Coaching program, such as its individualized and supportive environment, flexible coaching approach, and the pivotal role of coaches, were seen as facilitators of success. Patients valued being treated equally and acceptingly and fostering trust and collaboration. However, challenges such as burdensome life situations, limited resources, and inadequate support posed significant barriers to progress. Unrealistic goals and societal pressures were also observed to hinder successful weight management efforts. Conclusion A comprehensive, individualized approach addressing resource limitations and societal norms can enhance long-term success in weight management programs like the Healthy Weight Coaching, ultimately promoting overall well-being.

Aim. To bring insights into how healthcare managers and staffing assistants work to achieve sustainable working hours within a participatory scheduling system. Background. Hospital nurses and assistant nurses often work on rotating shifts, which affects their opportunities for sleep, recovery, and work-life balance. In Sweden, a participatory scheduling approach is commonly used, where working hours are planned in collaboration between employees, managers, and staffing assistants. Influence over working hours is related to positive outcomes among shift workers. However, it also places responsibility on the employee to schedule working hours that promote health and patient safety, i.e., sustainable working hours. Accordingly, the organisation has responsibilities to support the employee in this regard. Methods. Semistructured individual interviews were conducted with 11 managers and 9 staffing assistants from four Swedish regions and analysed using thematic analysis. Results. Several key factors for achieving sustainable working hours within the context of participatory scheduling were described: distribution and clarity of responsibilities, allocating time for scheduling, establishing shared responsibility, considering fairness, fostering an individual relationship with the employee, managing dissatisfaction, providing support, clarifying guidelines for sustainable scheduling, managing inconsistencies between employee requests and sustainable working hours, and considering recovery opportunities and the competence mix on shifts. Additionally, contextual factors, such as staffing levels, working procedures, working time arrangements for night work, and technological support, were highlighted as important. Conclusion. Achieving sustainable working hours within participatory scheduling involves considering the interactions between factors at the levels of the organisation, the individual, and the technological systems. Implication for Nursing Management. Nurse managers and staffing assistants must work closely with their employees during participatory scheduling to ensure sustainable working hours. Key goals in this regard include establishing a shared responsibility, clarifying responsibilities and guidelines for sustainable scheduling, and allocating time for the scheduling process.

Background Genetic diagnosis is often understood as a single event within the care pathway of rare disease patients. Legal, policy and ethical scholarship focusing on rare diseases and genetic information discusses questions of how to best deal with the process of genetic diagnosis and the communication of genetic information within a given health system. We co-created a research design with rare disease patients and their families in Austria to explore in-depth the experiences of genetic diagnosis for people affected by rare diseases. Our objective was to trace the whole pathway of genetic testing and understand how rare disease patients experience genetic diagnosis as part of their care pathway in the healthcare system. Results Data was collected through in-depth semi-structured qualitative interviews with 14 patients with a suspected or diagnosed rare disease or their parents, focusing on their perception of the pathway of genetic diagnosis in Austria. This pathway included the initial triggering of genetic diagnosis, the process of testing and its immediate (communication of results, counselling) and long-term, wider aftermath. Patients missed a clear link to already established forms of care such as their primary care/treating physicians. They also advocate for an integrated and interdisciplinary care pathway. Conclusions Our study underscores the importance of a continuous care and communication pathway spanning from the initial genetic diagnosis process to post-test phases. It further shows the importance of exploring patients’ perspectives through qualitative research methods to understand the intricate workings of public health policies and tools. Integrating genetic diagnosis into a broader care trajectory is crucial for a holistic approach to care for rare disease patients who often rely on regular interactions with the healthcare system. Achieving this holistic approach requires collaboration between experts in specific rare disease areas, primary care physicians, and support networks.

Background Nursing homes are under strong pressure to provide good care to the residents. In Norway, municipalities have applied the ‘Joy-of-Life-Nursing-Home’ strategy to increase a health-promoting perception that focuses on the older persons` resources. Implementations represent introducing changes to the healthcare personnel; however, changing one’s working approaches, routines and working culture may be demanding. On this background, we explored how the ‘Joy-of-Life-Nursing-Home’ strategy is perceived by the employees in retrospective, over a period after the implementation and which challenges the employees experience with this implementation. Method We used a qualitative approach and interviewed 14 healthcare personnel working in nursing homes in one Norwegian municipality, which had implemented the ‘Joy-of-Life-Nursing-Home’ strategy. The analysis was conducted following Kvale’s approach to qualitative content analysis. Results The main categories were: (a) the characteristics of care activities before implementations of ‘Joy-of-Life-Nursing-Home’, (b) how ‘Joy-of-Life-Nursing-Home’ influenced the care activities, and (c) challenges with the implementation of ‘Joy-of-Life-Nursing-Home’. Some of the informants spoke well about the implementation concerning the care quality stating “ to see the joy in the eyes of the resident then I feel we have succeeded”. For informants who experienced resistance toward the implementation, they felt it was too much to document, it was too complicated, and the requirements were too many. Conclusions Quality of care seems to have increased after the implementation, as perceived by the informants. Nevertheless, the fact that the informants seemed to be divided into two different groups related to their main perspective of the implementation is concerning. One group has positive experiences with the implementations process and the benefits of it, while the other group focuses on lack of benefits and problems with the implementation process. To understand what facilitates and hinders the implementation, research on contextual factors like work environment and leadership is recommended.

Long-term use of antidepressants frequently extends beyond clinical guidelines, with limited structured support for deprescribing in primary care. Little is known about the factors that influence general practitioners (GPs) in Germany regarding deprescribing of antidepressants. To identify barriers and facilitators that influence GPs in Germany regarding antidepressant deprescribing. To provide points of departure for developing a targeted intervention to address these challenges. We conducted semi-structured interviews with 20 GPs in Bavaria and purposively sampled for diversity in gender and professional experience. The interview topic guide was informed by the Capability-Opportunity-Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Interviews were transcribed verbatim. Thematic analysis was conducted using a structured coding approach. Key barriers to deprescribing included time constraints, limited practical tools, and inadequate collaboration with specialists, as well as uncertainty about when to deprescribe. Social and psychological factors, such as patient fears, were also significant. Facilitators included strong GP-patient communication, the use of digital tools, pharmacist support, and positive attitudes towards deprescribing. Antidepressant deprescribing in German primary care is shaped by systemic, social, and behavioural factors. Addressing time constraints, enhancing interdisciplinary collaboration, and integrating decision-support tools into clinical practice could facilitate deprescribing. These insights inform targeted interventions to promote safe and evidence-based antidepressant use. Further research is recommended to develop an intervention suitable for real-world usage.