IntroductionShort breaks are essential to enable unpaid carers to have a life alongside caregiving. However, there is limited understanding of how carers' break needs evolve over time. This scoping review aimed to identify models of dementia caregiving to explore how short break needs may change across the caregiving career.MethodsThe review followed the best practice guidelines by and Arksey and O'Malley and Levac et al. A search was conducted across four databases in 2023 and rerun in 2025: Applied Social Sciences Index and s, CINAHL, MEDLINE, and APA PsycINFO.ResultsEleven models were identified, outlining various stages of caregiving. These models focused specifically on spousal carers or predominantly included spouses. They demonstrate that caregiving is a dynamic process, marked by increasing demands on carers' time and shifting relational dynamics. The models suggest that short break needs may change in response to certain circumstances, with a shift in emphasis from relational well-being in the early stages to rest and recuperation in later stages.DiscussionThe findings highlight the importance of regular practitioner engagement to monitor and discuss changing break needs, and the need for accessible community and social opportunities that support a mutual respite experience for both the carer and the person with dementia. Key knowledge gaps are identified, including the potential role of short breaks in supporting the person with dementia during the transition to residential care, and in helping carers adjust to this new phase of caregiving. Future research could also examine the best ways to capture and monitor short break needs over time, including during Carers' Assessments and other short break conversations.

ObjectiveTo evaluate the impact of establishing standardized community-based venous catheter maintenance nursing clinics, leveraging the training resources and expertise of tertiary general hospitals and following specialized nursing protocols.MethodsThis retrospective before–after study examined the implementation of a standardized peripherally inserted central catheter (PICC) maintenance model across 45 community clinics in Shanghai. The intervention included structured training, supervision, and quality control led by a tertiary hospital vascular access nursing team. Clinical outcomes before (n = 831) and after (n = 984) the intervention were compared using statistical analysis.ResultsAfter implementation, the incidence of PICC-related complications decreased significantly (from 7.82% to 0.71%, P < 0.001), missed maintenance appointments were reduced (from 2.78 to 0.88, P < 0.001), and patient satisfaction improved (from 69.33 ± 7.02 to 88.30 ± 6.92, P < 0.001). Moreover, patients experienced decreased travel time, transportation costs, and work absences.ConclusionThe standardized community-based PICC maintenance model significantly improved care quality, reduced complication rates, and enhanced patient experience. It offers a scalable framework for expanding specialist nursing services within primary care settings.

IntroductionImplementing evidence-based interventions for tobacco use disorder (TUD) in community mental health agencies is critical, given the low adoption rates of these interventions and the high rates of TUD among patients, contributing to the high morbidity and shortened lifespan of this population. Implementation efforts require enhancing organizational preparedness to integrate these evidence-based interventions.PurposeWhen the Addressing Tobacco Through Organizational Change (ATTOC) model was evaluated in a cluster-randomized trial (with 13 clinics, 610 clients, and 222 staff) and compared with an education-only intervention, ATTOC proved to be better at having more TUD treatment, policies, and staff skills. This paper presents a secondary analysis focusing only on the ATTOC sites, examining whether clinic-level preparedness is associated with increased implementation activities and estimating the combined direct and indirect impact on patient referrals to evidence-based TUD interventions.MethodsSeven sites applied the ATTOC model over 9 months, with the ATTOC Environmental Scan (ES) conducted at baseline and 3, 6, and 9 months to assess the following: (1) the environment inside and outside the building, (2) staff training and personal tobacco use, (3) clinical TUD services and documentation, and (4) tobacco policies. Summary statistics are provided, and generalized linear mixed model analyses for repeated measures were used to assess time trends and relationships among composite preparedness, activities, and number of referrals.ResultsOver the 9-month period, significant improvements were observed in ES composite preparedness (p < 0.001) and individual ES areas (p < 0.001 for each). Eight out of 11 ATTOC Dashboard items showed significant changes, including increased number of patients treated (p = 0.002); tobacco discussions (p = 0.022); provision of educational brochures (p = 0.034); referrals to a Nicotine Anonymous group (p < 0.001), an in-house wellness or tobacco group (p < 0.001), and state quitline (p = 0.012); and documentation in treatment plans (p = 0.008). Both composite preparedness (p = 0.006) and composite activities (p < 0.001) were significantly associated with the number of composite referrals.ConclusionSignificant TUD intervention uptake was found over time through the ATTOC model organizational change intervention and tracking tools.

[This corrects the article DOI: 10.3389/frhs.2025.1650709.].

The application of lean thinking in healthcare has gained momentum in recent years, yet its implementation continues to face persistent challenges. Among these, staff resistance and conceptual misalignment between industrial principles and clinical environments remain significant barriers. This study argues that these issues stem not from the failure of lean theory itself, but from a flawed translation of lean tools, particularly Value Stream Mapping (VSM), from manufacturing to healthcare. To address this, we propose a systematic translation model that redefines key VSM elements (e.g., customer, inventory, takt time) in a way that aligns with the operational realities of outpatient care. The model is empirically validated through two case studies conducted in Saudi Arabia: an ophthalmology clinic and a dental clinic. By applying translated VSM tools, both clinics achieved substantial reductions in and patient waiting time, without compromising value-added care. The findings support the efficacy of contextualized lean implementation and provide healthcare managers with a practical framework for operational improvement. This study contributes to bridging the gap between lean theory and its real-world application in clinical settings.

IntroductionCOVID-19 vaccines are crucial for preventing severe illness from the virus. Despite their effectiveness; vaccine hesitancy, unequal access, and economic disparities hinder vaccination programs across Africa, posing significant challenges in Ethiopia.MethodThis scoping review followed the methodological guidelines outlined in the Joanna Briggs Institute Reviewer's and employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR) checklist and explanation to ensure transparency. To analyze the data, we developed tailored search strategies for key databases [HINARI, PubMed, Cochrane, African Journals Online (AJOL), and Science Direct] and gray literature sources. These strategies combined controlled vocabulary and relevant keywords. A descriptive thematic analysis was then employed to identify and categorize the various findings within the included studies. The results are presented in a narrative format, summarizing the key themes and providing a clear and comprehensive overview of the current evidence base.Results and recommendationsA review of 34 Ethiopian studies revealed significant COVID-19 vaccine hesitancy, with rates exceeding 50% in over 40% of the studies. The lowest hesitancy was found in adults from Addis Ababa (19.1%), while the highest rates were seen among healthcare workers in Oromia (69.7%) and pregnant women in Southwest Ethiopia (68.8%). Factors contributing to vaccine hesitancy in Ethiopia include being female, having only primary education, residing in rural areas, younger age, limited knowledge about the vaccine, reduced trust in authorities, and misperceptions about the risk of the virus. To address this challenge effectively, policymakers should prioritize interventions that build public trust, enhance awareness of the vaccine's benefits, and counter misinformation.

PurposeThis article examines how generative artificial intelligence (AI) can simulate, analyze, and enhance mental health care journeys for individuals from diverse backgrounds, supporting improved access, personalization, and outcomes.Design/methodology/approachAn AI-generated case study of Marcus Johnson, a 24-year-old Black software developer in Atlanta, models the interplay of personal, cultural, and systemic factors affecting mental health care access. The analysis integrates Andersen's Behavioral Model, Penchansky and Thomas's Dimensions of Access, and Measurement Based Care (MBC) to systematically identify barriers, facilitators, and opportunities for data-driven intervention and tailored care.FindingsThe case study demonstrates that generative AI simulations, especially when combined with MBC, can replicate real-world complexities, inform clinical decision-making, and personalize interventions through ongoing assessment, symptom monitoring, and collaborative planning. Telehealth, flexible scheduling, and cultural competence are highlighted as critical for bridging access gaps and improving outcomes.Originality/valueThis work is among the first to synthesize leading access-to-care models, MBC, and generative AI to simulate and improve mental health care pathways. The approach offers a novel framework for educators, clinicians, and system designers to address the full spectrum of access challenges and clinical needs in contemporary populations.Practical implicationsGenerative AI, anchored in evidence-based frameworks, enables mental health professionals and trainees to test and refine care strategies in a risk-free environment, promoting more equitable, responsive, and effective mental health systems for all.

This report details a bench to bedside translation of behavioral and social science research into a clinical program as a result of a collaboration between two United States Defense Health Agency Centers of Excellence for warfighter traumatic brain injury (TBI) and brain health. Identifying a gap in health-related quality of life (HRQOL) measures, our team instigated a 7-year multisite effort to validate and develop generic and caregiver specific HRQOL domains for family members of warfighters and civilians with a TBI using state-of-the-science measurement development standards; the Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) measurement system. The TBI-CareQOL was integrated into the Defense and Veterans Brain Injury Center-Traumatic Brain Injury Center of Excellence 15-Year Longitudinal TBI Study designed to address four elements in a Congressional mandate (NDAA FY2007 Sec721 Public Law 109-364). Based on findings from the 15-Year Longitudinal TBI study and larger body of related literature demonstrating the bidirectional associations between warfighter neurobehavioral outcomes and family distress, relevant TBI-CareQOL measures were integrated into the Family Wellness Program (FWP) for intimate partner (IP) beneficiaries of warfighters with TBI in treatment for chronic neurobehavioral symptoms across the Defense Intrepid Network for Traumatic Brain Injury and Brain Health (DIN). The FWP screens IPs for clinically elevated HRQOL symptoms with clinical follow up offered in alignment with operations at each DIN treatment center and military base. In July 2024, the FWP was launched at the National Intrepid Center of Excellence at Walter Reed National Military Medical Center, and is currently expanding across the DIN.

IntroductionClinical decision support (CDS) tools have the potential to enhance treatment outcomes in chronic pain care, yet their successful implementation depends on the readiness of both providers and clinical staff. The purpose of this study was to assess the readiness for a CDS tool and identify implementation strategies.MethodsA mixed methods approach combined Organizational Readiness for Implementing Change (ORIC) surveys (n = 24 providers; n = 31 clinical staff) and semi-structured interviews (n = 7 providers; n = 3 clinical staff). Quantitative data were analyzed using descriptive statistics and inferential tests, while qualitative data were coded using a rapid qualitative analysis approach.ResultsBoth the ORIC surveys and semi-structured interviews revealed high perceived organizational readiness for implementation across clinics and roles. There was variation in change efficacy, commitment to change, and overall readiness by clinics (p > 0.05) and between roles (p < 0.01), with providers demonstrating statistically significant lower ORIC scores than clinical staff. The qualitative results added nuance, with participants identifying patient and provider level barriers to implementation (e.g., technological literacy, low relative priority). However, these barriers were perceived as surmountable with implementation strategies (e.g., technological support, training and materials for providers and staff).DiscussionThe study highlights the benefits of a mixed methods approach to assessing the readiness. Variation in ORIC scores can help target support resources to clinics and roles with lower perceived readiness. Interviews provide an essential opportunity to identify local barriers and acceptable implementation strategies to build stakeholder support. Combined, these approaches allow for a holistic approach to inform tailored implementation support.

Rules, policies, and technologies are increasingly introduced in healthcare to reduce complexity and iatrogenic harm. One example is the implementation of Electronic Medication Management Systems (EMMS) to minimise medication errors. However, in hospitals where nurses primarily administer medications, research shows that nurses often adopt "workarounds" to overcome barriers in medication administration. This study explored how nurses experienced and perceived the use of workarounds in their daily medication administration practices. Understanding these feelings is crucial, as they are linked to both patient safety and staff retention. This ethnographic study was conducted in six wards in two Australian hospitals across 91 shifts, 46 interviews, seven focus groups, and member-checking sessions with nurses and EMMS stakeholders (N = 113 participants). Data analysis used a general inductive approach. Nurses described positive, negative, ambivalent, and conflicting feelings about using workarounds. Some denied the use or tolerance of workarounds, despite them being routinely observed. Most reported a tension between the perceived necessity of workarounds, reluctance to deviate from policy, and the desire to be a good nurse. Workarounds were seen both as the trademark of an expert, mindful nurse and as deviations from the rules, unsafe for both patients and nurses. This study demonstrates challenges to patient safety associated with the tension between the necessity of workarounds and the desire to adhere to policy. This can create stress and anxiety among nurses. They experience a tension at the intersection of the necessity of workarounds to deliver care, to be a good nurse, and the desire to adhere to policy. The associated stress and anxiety can lead to burnout, professional disengagement, and attrition. The study proposes solutions to manage challenges associated with workarounds. Workarounds are an inevitable aspect of healthcare delivery in response to standardisation. Negative perceptions of workarounds may inadvertently contribute to the very harm that standardisation seeks to prevent. A more open dialogue about their use is essential. Recognising their inevitability and equipping nurses to manage them constructively is key to reducing stress, preventing burnout, and enhancing patient safety.