Simulation-based learning is widely used to prepare nursing students for therapeutic communication, but transfer is often treated as if students acquire decontextualized skills in the laboratory and then apply them in clinical practice. This qualitative descriptive study explored how undergraduate nursing students experienced the transition from communicating with simulated patients to communicating with real patients during early clinical practice. Fifteen third-year Bachelor of Science in Nursing students in the United Arab Emirates who had completed the required Adult Health Nursing I simulation component and an initial medical-surgical clinical rotation participated in three face-to-face focus groups. Data were analyzed inductively using reflexive thematic analysis. The overarching interpretation was that students moved from prepared encounters in simulation to situated responsiveness in clinical practice. Three themes explained this shift: encountering unplanned patient agency, becoming accountable for one’s response, and communicating within institutional opacity. Simulation supported foundational communication practices but did not fully reproduce the emotional, relational, cultural, and organizational conditions of real patient communication. Findings suggest that simulation-to-practice transfer should be supported through progressively complex patient portrayals, explicit orientation to communication boundaries and workflows, and structured post-clinical reflection.
Older adults’ physical activity engagement in institutional long-term care is insufficient, despite the importance of physical activity for their health, functioning, and wellbeing. The purpose of this study was to improve the promotion of the physical activity of older adults in institutional long-term care by co-developing, implementing, and evaluating changes to care practices and the care environment in collaboration with staff members, older adults, and their family members. A participatory action research study was conducted in one unit with 18 staff members, 17 older adults, and 6 family members. Qualitative data were collected throughout the research process using interviews, focus groups, observations, workshops, and meetings, and analyzed with thematic analysis. Quantitative data collection was used to measure changes in older adult and staff outcomes before and after implementation of changes in activity promotion, and analyzed with statistical methods. Qualitative and quantitative findings were integrated in the results section. Three themes were developed, including (i) there is a need for a paradigm shift to improve physical activity promotion, (ii) change requires collaboration and time, and (iii) produced change can be beneficial in many ways and for different actors. Opportunities exist that are not currently used to promote older adults’ physical activity. Implementing physical activity in different parts of daily life and employing the environment could facilitate the sustainability of physical activity promotion. The role of nursing professionals is important in the implementation. Engaging staff members in co-development facilitates context-fitting change and care culture change, producing benefits also for themselves.
This study aimed to explore polio survivors’ childhood experiences of corrective surgery and rehabilitation in post-war Finland during the 1950s and 1960s. Oral history research was used with a descriptive qualitative approach. Between September 29, 2018 and June 30, 2019, 40 participants were interviewed, while one wrote about their experiences (N = 41). The data were analyzed using reflexive thematic analysis, which produced the overarching theme ‘The Ongoing Process of Recovery: Body, Mind, and Self, ‘describing recovery as a holistic process shaped by bodily changes, emotional responses, and social experiences. Three related themes further elaborated children’s treatment trajectories: ‘Surgical Treatments as Healing and Traumatizing Experiences,’ ‘The Multidimensional Nature of Rehabilitation,’ and ‘The Child’s Emotional Coping and Agency in the Hospital Environment.’ The findings emphasize that corrective surgery and rehabilitation were not experienced solely as clinical interventions but as life-shaping events influencing children’s sense of safety, control, and self. This study highlights the need to consider the long-term psychosocial impact of childhood hospitalization and supports child-centered, family-centered, and trauma-informed approaches in pediatric care.
Primary care nurses (PCNs) in Canada were instrumental in caring for COVID-positive patients during the pandemic, yet their contributions received little attention in the pandemic preparedness plans published before the pandemic. Therefore, the purpose of this study was to explore PCNs’ experiences caring for COVID-positive patients and the roles they fulfilled in supporting this patient population. Using a pragmatic, qualitative descriptive design, we conducted semi-structured interviews with 76 PCNs from four Canadian provinces (British Columbia, Ontario, Nova Scotia, Newfoundland and Labrador). Participants were asked to describe their actual and potential roles during different stages of the COVID-19 pandemic, as well as facilitators and challenges they encountered. We applied a thematic analysis approach to the data and analyzed codes related to treating and managing COVID-positive patients. We identified four roles performed by PCNs caring for COVID-positive patients: (1) conducting patient outreach and monitoring initiatives; (2) adapting infection prevention and control protocols; (3) administering medications to treat COVID-19; and (4) supporting patients with post-COVID-19 condition/long COVID. Roles and specific activities varied by nurse designation, consistent with their scope of practice. These findings can be used to inform the development of future pandemic preparedness plans for primary care providers.
Frontline clinicians are key to implementing Serious Illness Conversations (SICs), yet little qualitative research has examined how they experience its implementation in practice. This qualitatively driven mixed-method study explored clinicians’ experiences with SIC Program implementation across diverse practice settings in British Columbia, Canada, guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Implementation barriers and facilitators were identified through semi-structured interviews and survey data that included open- and closed-ended questions. Clinicians valued the SIC Guide’s credibility, reporting greater confidence and improved patient engagement during conversations when using the guide. Implementation of SICs was supported by leadership endorsement, peer networks, and integration into electronic health records, but constrained by documentation gaps, role confusion and limited mentorship following training. Rural clinicians highlighted strong relational continuity with fewer system supports, while urban clinicians reported the opposite. Nurses were prominent drivers of success, strengthening implementation fidelity and enhancing interprofessional collaboration. Findings affirm the utility of PARIHS but extend it by 1) positioning equity and cultural safety as essential contextual factors, 2) illustrating the overlap within domains of the PARIHS framework and 3) emphasizing the role of champions as facilitators to implementation.
The aim of this pilot study was to explore the feasibility, safety, acceptability, and perceived effects of an immersive, multi-platform distraction (virtual reality/smartphone) intervention on pain and anxiety of children undergoing cancer treatment to improve and refine the intervention. Qualitative data were collected through parent journals and semi-structured, in-person child–parent interviews and analyzed using content analysis to evaluate intervention feasibility and perceived effects on child anxiety and pain management. These data were analyzed through content analysis to evaluate feasibility of the intervention and its perceived effects on the child’s anxiety and pain management. Children’s and parents’ satisfaction were evaluated through surveys. Five children aged from 6 to 17 years hospitalized for cancer treatments and their parents, were recruited (n=10, 5 children, 5 parents). No negative side effects or major logistic issues were reported. Child experiences and parent observations are summarized across three categories: “Effects of the Game Experience,” “Logistical Issues,” and “Engagement and Motivation.” Children and their parents were satisfied with the intervention and mentioned that it had a positive effect on anxiety, pain management, social isolation and children’s mood. Results show the potential of a customized avatar in a multiplatform virtual environment for anxiety and pain management of children hospitalized for cancer treatments. Further research is needed with a larger sample size to have a better understanding of the effects of this intervention with this population of patients.
The aim of this study was to identify how Peer Support Workers (PSWs) understand their scope of practice, to provide greater clarity for PSWs working in addiction care with interprofessional teams. We conducted semi-structured interviews with PSWs and analysed the results using qualitative description. We interviewed 17 PSWs from a variety of backgrounds. We identified five descriptive themes that illustrate how PSWs delineated their scope of practice: building relationships with clients, therapeutic engagement with clients, system navigation, providing supplies to clients, and professional development. PSWs had a clear sense of their scope of practice and how they could be most effective, despite a lack of recognition of this scope in their workplaces. By creating a preliminary description for a PSW scope of practice, we hope that PSWs and nurses can work together to support the PSW professional role, enhancing patient outcomes.
The Basque Country is one of Europe’s many stateless nations and home to the Basque Indigenous population. As members of an Indigenous and ethnic minority culture, Basque women and gender non-normative individuals risk suboptimal healthcare services and outcomes because of gender bias and discrimination. This study explores their experiences with healthcare services and identifies the ways in which gender bias and discrimination serve as a barrier to cultural safety in the Basque Country. We used critical ethnography and triangulated data from 37 semi-structured interviews, health clinic observations, 4 focus groups, and document analysis. Thematic analysis was used to identify overarching themes from transcripts and field notes. Participants reported numerous instances of discrimination that hinder the implementation of cultural safety. We found that gender bias and discrimination are central to the healthcare experiences of Basque women and gender non-normative individuals. These issues manifest in various ways, including knowledge transmission gap regarding women’s health, discrimination based on sexual and/or gender identity, and obstetric and gynecologic violence. Meanwhile, patient autonomy during healthcare encounters is a key facilitator. Training in self-reflection, bias awareness, and gender-affirming can reduce discrimination. Findings also highlight clinical knowledge gaps and the need to integrate cultural safety into nursing education and practice.
Expressions of a wish to die among patients with advanced illness represent a complex and ethically challenging phenomenon within palliative care. Nurses working in advanced healthcare in patients’ homes are often at the forefront of responding to such expressions in a setting characterized by close relationships and prolonged engagement. The aim of this study was to examine nurses’ experiences of caring for end-of-life patients who express a wish to die. A qualitative descriptive design was adopted. Semi-structured interviews were conducted with nine registered nurses working in advanced healthcare in patients’ homes in Sweden. Data were analysed using qualitative content analysis, combining an initial deductive phase informed by the Six S model of person-centred palliative care with a subsequent inductive analysis. One overarching theme was identified: Alleviating suffering by engaging with the patient’s lifeworld . Nurses interpreted expressions of a wish to die primarily as communicative acts reflecting multidimensional suffering, including physical pain, anxiety, existential distress, and loss of meaning. Four generic categories described how nurses responded through symptom relief, support for meaning-making, collaboration with relatives and the interdisciplinary team, and preservation of patient autonomy. Rather than indicating a stable desire to end life, nurses understood patients’ expressions of a wish to die as manifestations of suffering that could be alleviated through person-centred, relational, and symptom-focused care. The findings highlight the central role of nurses in palliative home care and contribute nursing-specific knowledge to the international literature on end-of-life care.
Nursing is rooted in social justice principles, yet achieving health equity remains challenging, particularly given the unclear perceptions of social justice among newly graduated registered nurses (NGRNs). High turnover rates in this group further threaten progress toward equity goals. This study explored how NGRNs understand, cocreate, process, and respond to social justice in practice using a constructivist grounded theory approach. Analysis of 28 NGRNs’ narratives from virtual interviews led to the development of a theoretical framework encompassing four co-constructed processes of Best Care for All, No Matter What ; Importance of Making the Human Connection; Novice Emancipators; and a Supportive Organizational Environment and a fluid process. Based on these findings, a situation-specific theory titled the NGRN Evolving Identity of Social Justice was proposed. The study highlights the need to foster social justice identity during NGRNs’ transition to practice. Implications include integrating social justice into nursing curricula, onboarding programs, leadership strategies, and policy initiatives to promote person-centered care and health equity. Supporting NGRNs as advocates for social justice may strengthen retention, improve patient outcomes, and position nursing at the forefront of systemic change toward equity.
Much is known about what relatives do in residential long-term care, yet the question of who they are as persons within this context remains unasked. Research frames relatives through functional categories, addressing their contributions but not their self-understanding, which is accessible only through their own accounts. This qualitative study examined how relatives of care-dependent persons in Swiss residential long-term care understand themselves as persons within the institutional context. Guided by McCormack and McCance’s Person-Centred Practice Framework, we conducted interviews with seven relatives across three care facilities and analysed the data using Reflexive Thematic Analysis. Four themes position “being relative” as an ontological condition rather than a functional role: Being irreducibly relational : identity constituted through biographical relationships, not institutional categories; Being attentively co-bearing : felt responsibility for the entire care situation, including nursing staff; Being deeply anchored : the institution as constitutive of who relatives are, marked by simultaneous belonging and strangeness; and Being persistently unsettled : a self kept in motion by displaced identities, guilt, and moral impossibilities. These dimensions coexist as features of a condition for which person-centred care may need a vocabulary that recognises relatives’ personhood rather than their function.
Qualitative research continues to grapple with the challenge of moving beyond rich description toward explanatory insight. While Classic grounded theory is explicitly designed to generate theory through conceptualisation, researchers frequently struggle to sustain conceptual-level analysis in practice, resulting in descriptive or thematic outputs. This paper addresses this methodological problem by making explicit the analytic work required to move from description to explanation. Drawing on classic GT, it identifies common points of descriptive drift, demonstrates how descriptive codes can be reformulated into conceptual codes, and introduces the Conceptual Lift Practice Loop as a practice-oriented articulation of this analytic work within the constant comparative method. In doing so, the paper clarifies how conceptualisation is enacted in practice without reducing it to procedural technique. This contributes to strengthening methodological rigour in grounded theory research. The paper has particular relevance for nursing, where grounded theory is widely used to examine complex clinical, organisational, and workforce processes, and where explanatory insight is critical for informing practice beyond local contexts.
Tuberculosis (TB) treatment adherence remains a major public health challenge, particularly where illness is experienced within family and social contexts. This study examined how TB patients and family members described treatment adherence in an urban Indonesian primary healthcare setting, with attention to relational and cultural dimensions. A qualitative exploratory descriptive study was conducted at across primary health facility in Kupang, East Nusa Tenggara, Indonesia, using individual semi-structured interviews with six TB patients and five family members. Data were analysed using reflexive thematic analysis. Adherence appeared as a temporally unfolding process shaped by emotional adjustment, household obligation, and faith. Six themes were constructed: psychological disruption at diagnosis; fragile illness acceptance and early non-adherence; stigma as a social identity threat; cultural explanatory models; family as behavioural infrastructure; and spirituality as therapeutic reinforcement. Where prior literature has treated family support, stigma, and cultural belief as separate variables, this study shows how these forces interact across the treatment trajectory, reframing TB adherence as a relational process that households actively produce. Programmes engaging families as active participants, addressing stigma at the household level, and communicating within patients’ cultural frameworks may better support adherence in collectivist settings.
Brain death, as the irreversible cessation of brain function, provides the possibility of organ donation, yet the consent rate among families in Iran remains low. Transplant coordinators, mostly nurses, play a crucial role in communication, emotional support, and trust-building, while facing significant psychological and professional challenges. The aim of this descriptive qualitative study was to describe transplant coordinators’ experiences and needs in the consent process, with the goal of enhancing performance and ultimately increasing organ donation rates. A purposive sample of 20 transplant coordinator nurses was selected to capture a diverse range of experiences relevant to the study aims, and participants took part in semi-structured interviews. Using inductive content analysis, six main themes were developed to reflect nurses’ experiences in obtaining informed consent for organ donation: professional duality in balancing emotional sensitivity with procedural responsibilities; managing emotional and moral complexities; communication challenges with patients’ families; work-related and psychological pressures during the consent process; the influence of individual values and cultural beliefs; and the need for psychological and organizational support. The findings show that obtaining consent for organ donation is a complex, multi-layered experience beyond simple communication skills, involving moral responsibility, emotional conflicts, cultural beliefs, and severe psychological pressures. Coordinating nurses face professional duality, communication challenges, and a lack of support. The findings highlight the need for supportive, educational, and policy programs to improve care quality and the success of organ donation.
Relatives are constitutive to residential long-term care, yet are often conceptualised through a functional lens that focuses on tasks or burden. This qualitative multiperspective study explores the ontological condition of "being relative" beyond these functional categories. Analysing 30 "Integrated Encounter Analyses" from two Swiss facilities, which synthesised participant observations and interviews, we identified eight constitutive dimensions organised into Situational, Relational, and Spatial-Temporal meta-dimensions. Findings reveal "being relative" not as a static role but as a dynamic movement across continua - oscillating between alienation and resonance, and institutional subjection and strategic agency. We conclude that "being relative" is a distinct existential condition characterised by permanent liminality - dwelling in the in-between rather than transitioning through it. The institutional context fundamentally shapes this existential condition: agency manifests not as resistance against but as quiet negotiation within constraints. Institutions must therefore validate the existence of this threshold and support relatives' navigational competencies rather than forcing binary categorisations of visitors or partners.
Effects of pervasive exposure to trauma result in a costly public health crisis. Trauma-informed care (TIC) is a well-known and established health care approach for supporting individuals who experience trauma. Despite increasing recognition of its importance, TIC remains poorly integrated into nursing education, with reasons that are not yet well understood. This interpretive descriptive study explored nurse educators’ perspectives on the facilitators and barriers for embedding TIC into nursing curricula in Ontario, Canada. Twenty eight participants were purposively sampled from an online survey of 145 respondents for semistructured interviews. Reflexive thematic analysis guided the generation of key facilitators and barriers. Facilitators included: passionate educators, innovative teaching strategies, supportive leadership, and collaborative teaching models. The barriers to TIC integration in undergraduate nursing programs included: the invisibility of TIC in curricula; a lack of faculty training and confidence; overloaded, siloed program structures; challenges with authentic assessment; and inconsistent role modelling in clinical settings. Embedding TIC into undergraduate nursing education requires intentional curricular mapping, institutional support, faculty development, and alignment with clinical practice and experiential learning. Effective integration of TIC in undergraduate nursing curricula is needed to equip nurses to address the growing global burden of trauma and support a resilient nursing workforce.
An important part of a qualitative project is the proposal preparation required for ethics review and funding application, yet proposals are relatively undeveloped at the beginning of a qualitative study. Here we describe a new method, Conceptual Scaffold Analysis, for applying a relevant, mature lay concept (from the literature) as a focus within a research proposal. This method enables analyzing and integrating a concept into your proposed methods, expedites inquiry, provides an organizing framework, and reconstructs understanding. We present a selection of mature concepts pertinent to nursing that may be used for Conceptual Scaffold Analysis. As a complete method, Conceptual Scaffold Analysis may serve as the qualitative (QUAL) component in a mixed method project, enhancing the qual method for the sequential component, thereby enabling advanced theory development. We present an example of Conceptual Scaffold Analysis on a topic critical to nursing and public health: the importance of mothers' trust in vaccinating their infants and children with developmental disabilities. Analysis of trust is used to organize the main QUAL component, contributing to a mixed methods design, as a scaffold for the analysis of the qual supplemental research study to follow. Thus, the concept analytic structure, developed from the scaffold analysis, expedites and enriches the subsequent qualitative component, strengthening an inductive mixed-method qualitative process.
An important part of a qualitative project is the proposal preparation required for ethics review and funding application, yet proposals are relatively undeveloped at the beginning of a qualitative study. Here we describe a new method, Conceptual Scaffold Analysis, for applying a relevant, mature lay concept (from the literature) as a focus within a research proposal. This method enables analyzing and integrating a concept into your proposed methods, expedites inquiry, provides an organizing framework, and reconstructs understanding. We present a selection of mature concepts pertinent to nursing that may be used for Conceptual Scaffold Analysis. As a complete method, Conceptual Scaffold Analysis may serve as the qualitative (QUAL) component in a mixed method project, enhancing the qual method for the sequential component, thereby enabling advanced theory development. We present an example of Conceptual Scaffold Analysis on a topic critical to nursing and public health: the importance of mothers’ trust in vaccinating their infants and children with developmental disabilities. Analysis of trust is used to organize the main QUAL component, contributing to a mixed methods design, as a scaffold for the analysis of the qual supplemental research study to follow. Thus, the concept analytic structure, developed from the scaffold analysis, expedites and enriches the subsequent qualitative component, strengthening an inductive mixed-method qualitative process.
Our study aimed to identify and classify proactive health management patterns among rural older adults with multimorbidity using a user persona approach. We conducted a descriptive qualitative study with user persona methodology in a rural area of South China from February to May 2025, where 33 rural adults aged ≥60 years with ≥2 chronic conditions were recruited via purposive sampling. We used semi-structured interviews to explore key dimensions of proactive health management, including health cognition, resource use, and information acquisition; we coded and analyzed interview data using NVivo 12 to extract behavioral characteristics and construct persona categories. Our analysis of the interview data from 33 participants identified 5 typical user personas: tradition-oriented self-management, low perceived risk management, family-delegated management, resource-constrained striving, and actively learning management. The findings indicate that rural older adults with multimorbidity exhibit diverse proactive health management patterns shaped by cultural beliefs, family dynamics, and resource constraints. Recognizing this heterogeneity is essential for moving beyond uniform health promotion approaches and supporting more responsive chronic disease management.
Palliative care nursing practice supports individuals and their caregivers through the end-of-life by emphasizing a person-centered approach. However, in practice, nurses must navigate ongoing tensions between organizational norms, professional responsibilities, and the diverse values and wishes of patients, raising questions about how care can remain responsive within complex and constraining contexts. Despite recognition of these challenges, the mechanisms through which palliative care nursing practice sustains meaningful living at the end-of-life remain insufficiently understood. This study examined the mechanisms through which palliative care nursing enables patients to live a meaningful life until death. Using an interpretive descriptive design informed by Sen's capability approach, the study combined three qualitative methods: co-construction of practice narratives with three home-based palliative care nurses, reflexive writing of a personal narrative by the main researcher, and analytical questioning. The analysis identified four interrelated mechanisms that characterize palliative care nursing practice: navigating between patients' valued lives and norms; recognizing patients as simultaneously capable and vulnerable; reflexively engaging with one's own practice; and being creatively present through sensitive and slow actions tailored to each situation. Together, these mechanisms depict a reflexive, relational, and context-sensitive nursing practice oriented toward expanding patients' real possibilities for living a meaningful life until death.
