Successful return to work in anaesthesia after maternity leave: a qualitative study.

Seeking formal help can significantly improve the outcomes of perinatal depression (PND). However, currently, women with PND are not consistently seeking formal help. Research indicated that spouses played a crucial role in helping women recognize PND and encouraging them to seek formal help. This study aimed to explore the factors that prevent spouses from supporting women with PND in seeking formal help, based on the Knowledge-Attitude-Practice (KAP) theory. This is a qualitative study, utilizing semi-structured interviews to explore the factors that influence spouses to support women with PND to seek formal help. The interviews were conducted at a tertiary hospital in Shanghai, China from September 2023 to October 2023. Purposive sampling was used, and the sample size was determined by data saturation. Data analysis was conducted using Colaizzi's seven-step method. Twelve spouses had a mean age of 34.92 years (SD 5.81); n = 7 (58.33%) were new fathers. The influencing factors identified in this study can be explained by KAP theory, ultimately three major themes and six sub-themes emerged: (1) individual knowledge factors: lack of proper recognition of PND, (2) individual attitude factors: negative attitude toward PND screening and treatment and (3) service provider factors: imbalance between supply and demand for perinatal mental health services. Spouses who lacked supportive behavior were influenced by individual factors, including knowledge factors and attitude factors, as well as service provider factors. These identified factors can guide future research and the development of interventions to improve perinatal mental health services and encourage family support in seeking formal help.

Objectives Despite the emphasis on early marriage in different cultures, the age at marriage has increased in most countries. Many studies have investigated various factors that prevent marriage; however, psychological factors have been neglected. This study aims to identify the psychological factors that postpone Iranian women’s decision to marry. Methods This is a qualitative study using the conventional content analysis method. The participants were 14 single women aged 25-41 years in Tehran, Iran in 2023 who were selected using a purposive method until reaching data saturation in semi-structured interviews. Finally, the data was analyzed in MAXQDA 2020 software. Results The analysis of the interviews led to the extraction of 35 first-order sub-themes, 13 second-order sub-themes, and three main themes: (1) idealistic cognitive beliefs (ideal personality characteristics, ideal relational characteristics, ideal socio-economic characteristics, and ideal family characteristics), (2) negative cognitive attitudes (negative attitudes towards the marriage outcome, negative attitudes towards the marriage, negative attitudes towards childbearing, and prioritizing work over marriage), and (3) individualistic personality traits (perfectionism, intimacy avoidance, emotional orientation, self-centeredness, and negative self-identity perception). Conclusion Based on the findings, in addition to considering external factors and requirements, Iranian women need to have a positive attitude towards marriage, real expectations and beliefs, and lower individualistic personality traits to have the intention to marry and maintain a desirable marital relationship.

BackgroundDespite the gender parity existing in medical schools for over three decades, women remain underrepresented in academic medical centers, particularly in senior ranks and in leadership roles. This has consequences for patient care, education, research, and workplace culture within healthcare organizations. This study was undertaken to explore the perspectives of faculty members at a single department of medicine on the impact of the existing gender gap on organizational effectiveness and workplace culture, and to identify systems-based strategies to mitigate the gap.MethodsThe study took place at a large university department of medicine in Toronto, Canada, with six affiliated hospitals. In this qualitative study, semi-structured individual interviews were conducted between May and September 2016 with full-time faculty members who held clinical and university-based appointments. Transcripts of the interviews were analyzed using thematic analysis. Three authors independently reviewed the transcripts to determine a preliminary list of codes and establish a coding framework. A modified audit consensus coding approach was applied; a single analyst reviewed all the transcripts and a second analyst audited 20% of the transcripts in each round of coding. Following each round, inter-rater reliability was determined, discrepancies were resolved through discussion, and modifications were made as needed to the coding framework. The analysis revealed faculty members’ perceptions of the gender gap, potential contributing factors, organizational impacts, and possible solutions to bridge the gap.ResultsOf the 43 full-time faculty members who participated in the survey (29 of whom self-identified as female), most participants were aware of the existing gender gap within academic medicine. Participants described social exclusion, reinforced stereotypes, and unprofessional behaviors as consequences of the gap on organizational effectiveness and culture. They suggested improvements in (1) the processes for recruitment, hiring, and promotion; (2) inclusiveness of the work environment; (3) structures for mentorship; and (4) ongoing monitoring of the gap.ConclusionThe existing gender gap in academic medicine may have negative consequences for organizational effectiveness and workplace culture but many systems-based strategies to mitigate the gap exist. Although these solutions warrant rigorous evaluation, they are feasible to institute within most healthcare organizations immediately.

ntroduction: Almost 90% of nurses are affected by incivility in their workplace, which has negative outcomes for nurses, the organisation, and patients. Workplace culture is a key determinant of incivility because it shapes how employees perceive, feel, act, and relate to one another within the organisation.Research objective: To explore nurses’ perceptions of encouraging and sustaining a workplace culture that addresses nurse-to-nurse incivility.Materials and methods: A descriptive qualitative design was used to describe nurse-to-nurse incivility. Eight nurses working in a female medical ward in an academic hospital were interviewed individually and face-to-face. These nurses were selected through purposive and snowball sampling. Nurses voluntarily signed a consent form based on the information provided by the researcher. The data was analysed using content analysis.Findings: Interview results showed that a respectful workplace culture to address nurse-to-nurse incivility could be achieved through team interventions such as team building, weekly/monthly meetings to discuss staff problems; training interventions such as orientation on appropriate behaviour at work, teaching staff about coping mechanisms, in-service training; and managerial interventions such as swift managerial action against workplace incivility, support to victims and perpetrators by Employee Wellness unit, and decisive resolution of incivility fair and just manner. Conclusion: It was evident that a disrespectful workplace culture caused by nurse-to-nurse incivility is still prevalent in the designated academic hospital, with negative consequences for nurses, patients, and the organisation. Hospital management and nurse managers should implement the recommendations to create a respectful workplace culture.

Background: Students in the southeastern United States were affected by Hurricane Michael in 2018. The storm's devastation led to communication and education issues that transformed students' paths to completing their nursing degree program. Climate change will cause increased natural disasters, and educators must be prepared. Method: This qualitative study used a descriptive phenomenological design. A purposive sample of 10 graduate nursing students were recruited and interviewed. The data gathering ended when data saturation was achieved. Results: Five themes were generated: Devastation and no communication, survival mode, emotional impact, before and after, and forever changed. The rich data documented the resiliency of the students as they described events during and after the hurricane in relation to their personal and educational experiences. Conclusion: Universities and students need to be prepared for natural disasters; understanding graduate nursing students' prior experiences can benefit educators.

IntroductionPregnancy and childbirth are crucial events in women's lives that can be done well with the support of people around them, especially their husbands. However, a number of factors can reduce or increase the supportive role of spouses during this period. The aim of the present study was to explore the barriers and facilitators of Iranian men's involvement in perinatal care.Materials and methodsThis was a qualitative phenomenological study that sampling of respondents (pregnant women or the women who have recently given birth (one week to six months after childbirth), spouses, policy makers and midwifery service providers) was done through purposive sampling. The inclusion criteria included: being Iranian, the ability to understand and transfer the concepts into Persian, and employment in a midwifery center for at least one year (for service providers). Data were collected through in-depth interviews until the data saturation. The collected data were analyzed by conventional content analysis based on Graneheim and Lundman method steps. MAXQDA version 10 software was used to manage the data and Guba and Lincoln criteria were also used to ensure the trustworthiness of findings.ResultsMen's involvement in perinatal care was found to be influenced by certain incentives, particular constraints and some gender authoritarian attitudes. There were 5, 4, and 3 subcategories in incentives, constraints, and gender attitudes respectively.ConclusionThe results revealed that men face a dual mechanism in participating in perinatal care, in which some of these factors can facilitate their participation and others can reduce it.

Taste disorders are one of the most common side effects of treatment in oncology patients and often occur after allogeneic haematopoietic cell transplantation (allo-HCT). Dysgeusia does not receive close medical attention, and information about this disorder is largely based on the clinician's own experience. However, taste disorders can have an impact on the quality of life and nutritional status of survivors of allo-HCT. The number of performed annual transplantations is growing, as the number of older long-term survivors increases, but only few research studies examine survivors of allo-HCT with taste disorders. We conducted a qualitative descriptive study to explore experiences of dysgeusia in patients undergoing allo-HCT and to examine what strategies they used to mitigate it. Using purposeful sampling, survivors of allo-HCT were recruited. Audiotape interviews were conducted until data saturation was achieved. Each interview was transcribed verbatim, and content analyses were performed to extract significant themes and subthemes. Three major themes embracing various aspects of allo-HCT survivors' experiences were identified: (1) the shape of taste; (2) everything is irritating and it is arduous to eat; (3) finding new strategies to overcome the problems. Together, they highlight the experiences of survivors showing how the taste disorders can affect the physical, psychological and social dimensions of a person. A cumulative burden is the result of dysgeusia and its clinical course reinforced also by related symptoms. Healthcare professionals must focus their attention on the management of these symptoms and offer interventions to safeguard the patient's social, physical and psychological well-being.

Background: Today empowerment of women by health literacy has become a necessity. Researchers have shown that women are active seekers of health information and seeking behaviors are driven by various motivational factors. Paying attention to women's motivations for seeking health information could facilitate evidence-based policy making in promotion of public health literacy. As health information seeking develops within personal-social interactions and also the health system context, it seems that a qualitative paradigm is appropriate for studies in this field. Objectives: The aim of this study was to explore Iranian women's motivations for seeking heath information. Patients and Methods: In this qualitative content analysis study, data collection was conducted considering the inclusion criteria, through purposive sampling and by semi-structured interviews with 17 women, using documentation and field notes, until data saturation. Qualitative data analysis was done constantly and simultaneous with data collection. Results: Five central themes emerged to explain the women's motivation for health information seeking including: a) dealing with fear and uncertainly b) understanding the nature of disease and diagnostic/therapeutic procedures c) performing parental duties d) promoting a healthy life style e) receiving safer health care. Conclusions: It seemed that respecting client's concerns, providing comprehensive health information, as well as risk management and promoting safer health care is necessary.

Introduction: To manage the psychological consequences of providing services in the COVID-19 intensive care units (ICUs), it is necessary to identify the experience of nurses from the organizational climate. The current study was conducted to explain the nurses’ experience of the organizational climate of the COVID-19 ICUs. Methods:This qualitative study was conducted in three teaching hospitals affiliated to Isfahan University of Medical Sciences. 17 individual and semi-structured interviews with 12 nurses working in three selected COVID-19 centers were included in the data analysis. The participants were selected by purposive sampling and interviewed in one or more sessions at a suitable time and place. Interviews lasted for 45 to 90 minutes and continued with conventional content analysis until data saturation. Data analysis was done using conventional content analysis of Graham and Leideman model. Guba and Lincoln criteria (including validity, transferability, consistency, and reliability) were used to ensure reliability and accuracy. Results: The results of data analysis were classified into 82 primary concept codes and 10 sub-categories in the form of 3 categories: "positive climate of attachment and professional commitment", "emotional resonance in the work environment" and "supportive environment of the organization". Conclusion: This study led to the identification of nurses’ experiences of the organizational climate during the COVID-19 which provides appropriate information to nursing managers to create a favorable organizational climate and increase the quality of work-life of nurses.

What factors influence the decision-making process of fathers regarding multifetal pregnancy reduction or maintaining a triplet pregnancy, and how do these decisions impact their psychological well-being? For fathers, the emotional impact of multifetal pregnancy reduction or caring for triplets is extensive and requires careful consideration. Multifetal pregnancy reduction is a medical procedure with the purpose to reduce the number of fetuses to improve chances of a healthy outcome for both the remaining fetus(es) and the mother, either for medical reasons or social considerations. Aspects of the decision whether to perform multifetal pregnancy reduction have been rarely investigated, and the impact on fathers is unknown. Qualitative study with semi-structured interviews between October 2021 and February 2023. Fathers either after multifetal pregnancy reduction from triplet to twin or singleton pregnancy or ongoing triplet pregnancies 1-6 years after the decision were included. The interview schedule was designed to explore key aspects related to (i) the decision-making process whether to perform multifetal pregnancy reduction and (ii) the emotional aspects and psychological impact of the decision. Thematic analysis was used to identify patterns and trends in the father's data. The process involved familiarization with the data, defining and naming themes, and producing a final report. This study was a collaboration between a regional secondary hospital (OLVG) and a tertiary care hospital (Amsterdam University Medical Center, Amsterdam UMC), both situated in Amsterdam, The Netherlands. Data saturation was achieved after 12 interviews. Five main themes were identified: (i) initial responses and emotional complexity, (ii) experiencing disparities in counselling quality and post-decision care, (iii) personal influences on the decision journey, (iv) navigating parenthood: choices, challenges, and emotional adaptation, and (v) shared wisdom and lessons. For fathers, the decision whether to maintain or reduce a triplet pregnancy is complex, in which medical, psychological but mainly social factors play an important role. In terms of psychological consequences after the decision, this study found that fathers after multifetal pregnancy reduction often struggled with difficult emotions towards the decision; some expressed feelings of doubt or regret and were still processing these emotions. Several fathers after an ongoing triplet had experienced a period of severe stress in the first years after the pregnancy, with major consequences for their mental health. Help in emotional processing was not offered to any of the fathers after the decision or birth. While our study focuses on the multifetal pregnancy reduction process in the Amsterdam region, we recognize the importance of further investigation into how this process may vary across different regions in The Netherlands and internationally. We acknowledge the potential of selection bias, as fathers with more positive experiences might have been more willing to participate. Caution is needed in interpreting the role of the mother in the recruitment process. Additionally, the time span of 1-6 years between the decision and the interviews may have influenced emotional processing and introduced potential reporting bias. The emotional impact of multifetal pregnancy reduction or caring for triplets is significant, emphasizing the need for awareness among caregivers regarding the emotional challenges faced by fathers. A guided trajectory might optimize the decision-making and primarily facilitate the provision of appropriate care thereafter to optimize outcomes around decisions with potential traumatic implications. This study received no funding. The authors have no conflicts of interest to declare. N/A.

Background: Medical errors are particularly significant in the operating room due to their potential to critically affect patient care. For students, one of the key challenges is learning how to identify and report these errors during treatment and understanding their potential consequences. Accordingly, this study aimed to explore the challenges faced by the operating room interns in reporting medical errors. Methods: This qualitative study was conducted using a content analysis approach from March to June 2024 in the operating theaters of teaching hospitals affiliated with Hamadan University of Medical Sciences in Hamadan, Iran. Data were collected through semistructured interviews with ten operating room interns, selected via purposive sampling. Data were analyzed using conventional content analysis, following the methodology outlined by Graneheim and Lundman. Results: Two main themes emerged from the analysis, including personal challenges and organizational barriers. These themes were further divided into five categories, including perceptions of errors, emotional hurdles, structural limitations, educational challenges, and workplace culture. Conclusion: Addressing both personal and organizational challenges in error reporting is essential for improving patient safety outcomes. Fostering a culture of open communication and enhancing educational frameworks can empower operating room interns to actively participate in error reporting, thereby improving the overall quality of patient care.

Introduction: Following the outbreak of COVID-19, people started to exercise quarantine. With all the psychological, economic, and social implications of the quarantine at home, an interesting topic has been the differences in the way different individuals have encountered these implications. Methods: In the study, a psychodynamic approach was followed to investigate this topic using a qualitative methodology based on the content analysis. The data was collected through a total of 10 semi-structured interviews with individuals who have exercised a 3-month quarantine. Samples were taken via purposive sampling in Tehran, with the sampling process started in 2020 and continued until data saturation was achieved. Simultaneously with data collection, data analysis was performed via qualitative content analysis. Results: Based on the analysis results, five principal classes were extracted, which represented the experiences and feelings about and the type of encountering the then-new conditions. These included the fear and anxiety, different approaches to the outbreak of the disease, improvement of the health level, taking attitude toward the patients, and growth under pressure. Conclusion: Considering the emergence of negative psychological feelings, the research tends to provide psychologists and other practitioners in the field of the psychology with valuable information that can be used for prevention and treatment purposes.

This chapter provides a historical overview of professional identity within the context of social work, what we mean by professional identity, how we measure it and how we teach it to students. Through exploring definitions of professional social work identity and findings from empirical research involving social workers and students, we identify challenges for educators, based on competing social work discourses and multiple identities of practitioner, researcher and educator. Findings from empirical research, conducted by the author in Northern Ireland, highlight the learning activities that student social workers found most useful in terms of developing readiness for practice competence and professional social work identity (Cleak et al., 2016; Roulston et al., 2018). This research offers insights into the differing perspectives of students based on the placement setting and stage of training, as well as the perceived usefulness of specific learning activities. This chapter concludes with some evidence-informed advice to curriculum developers.

Background: Molecular biomarker testing has become a cornerstone of precision oncology, guiding targeted therapy and improving diagnostic accuracy. However, its integration into routine cancer care, particularly in low- and middle-income countries, remains suboptimal due to multifactorial challenges. Objective: To explore the experiences, attitudes, and perceived barriers faced by oncology clinicians in implementing molecular biomarker testing in routine cancer care in Lahore, Pakistan. Methods: A qualitative descriptive study was conducted over eight months in Lahore, utilizing purposive sampling to recruit 23 oncology clinicians from public and private tertiary care hospitals. Semi-structured, in-depth interviews were audio-recorded, transcribed, and analyzed using Braun and Clarke’s thematic analysis framework. Data saturation was achieved and NVivo software supported systematic coding. Results: Five major themes emerged: clinical relevance and awareness, operational and logistical challenges, educational and training gaps, ethical and emotional dilemmas, and systemic and policy-driven barriers. Clinicians reported variability in biomarker knowledge, difficulties in interpreting results, infrastructure limitations, and lack of standardized protocols. Emotional strain in discussing ambiguous or unactionable results, and disparities in patient access due to financial constraints, were also prominent. Participants emphasized the need for clearer guidelines, institutional support, and continued medical education. Conclusion: The study highlights the complex landscape surrounding biomarker testing adoption in oncology practice within a resource-limited setting. Addressing the identified barriers through systemic reform, clinician support, and targeted education can enhance the practical uptake of precision diagnostics, ultimately improving cancer care delivery in similar contexts.

AB0808 A SYSTEMATIC REVIEW ON SYNDEMICS IN RHEUMATIC AND MUSCULOESKELETAL DISEASES (RMDs)