Resilience in family caregivers of people with dementia: a qualitative descriptive study Abstract: Background: Family caregivers of people with dementia often take on extensive caregiving responsibilities, frequently at the expense of their own needs and health. A deeper understanding of their resilience is important to derive practice-relevant implications for nursing care. Aim: The aim of this study was to gain insight into the experiences of family caregivers of people with dementia and to derive implications for nursing practice. Methods: Sixteen semi-structured interviews were conducted with family caregivers and analysed using reflexive thematic analysis according to Braun and Clarke. Results: Four themes were identified: (a) finding outlets for positive emotional relief, (b) coming to terms with the disease and developing acceptance, (c) drawing strength from one's social environment, and (d) being able to apply the emergency brake. Resilience was reflected particularly in the gradual assumption of the caregiving role, the development of stable support networks, and strategies such as humour and taking time out. Reluctance to seek professional help sometimes limited access to supportive resources. Conclusions: The findings point to practice-relevant implications for nursing in emotional support, information provision, resource activation, and raising awareness of personal burden limits. The KoRes model provides a useful framework for interpreting the findings.

Zusammenfassung: Hintergrund: Angehörige von Menschen mit Demenz übernehmen häufig umfassende Betreuungsaufgaben und vernachlässigen dabei eigene Bedürfnisse und ihre Gesundheit. Ein vertieftes Verständnis ihrer Resilienz ist wichtig, um pflegepraktische Unterstützungsansätze abzuleiten. Ziel: Ziel der Studie war es, Einblicke in die Erfahrungen betreuender Angehöriger von Menschen mit Demenz zu gewinnen und Implikationen für die Pflegepraxis abzuleiten. Methoden: Es wurden 16 leitfadengestützte Interviews mit betreuenden Angehörigen geführt und mittels reflexiver thematischer Analyse nach Braun und Clarke ausgewertet. Ergebnisse: Es zeigten sich vier Themen: (a) Ventile für positive emotionale Freiräume finden, (b) sich mit der Krankheit auseinandersetzen und Akzeptanz entwickeln, (c) Kraft aus dem Umfeld schöpfen und (d) die Notbremse ziehen können. Resilienz zeigte sich besonders in der schrittweisen Übernahme der Betreuungsrolle, im Aufbau tragfähiger Netzwerke sowie in Strategien wie Humor und Auszeiten. Eine zurückhaltende Inanspruchnahme professioneller Hilfe erschwerte teilweise den Zugang zu entlastenden Ressourcen. Schlussfolgerungen: Die Ergebnisse weisen auf pflegepraktisch relevante Ansatzpunkte in der emotionalen Begleitung, Informationsvermittlung, Ressourcenaktivierung und Sensibilisierung für Belastungsgrenzen hin. Das KoRes-Modell bietet einen geeigneten Rahmen zur Einordnung der Befunde.

Designing effective conversational agents for healthcare requires methods grounded in expert interaction that scale to deployable agents. We present a structured, large language model-driven approach that transforms authentic expert-user dialogues into modular, patient-centered agents. Our three-step pipeline (elicitation, structure extraction, modular implementation) yields interpretable interaction phases implemented with the lightweight agent framework. In a case study on hearing-loss support for young adults, a communication-vulnerable and underserved group, the resulting agents foster purposeful engagement and surface well-being information aligned with WHOQOL domains. Compared with a fat-prompt baseline, the structured agents produced shorter, more focused exchanges and broader coverage of well-being topics. We position this method within context-aware and personalized healthcare systems and argue it offers a reproducible path toward adaptive, transparent, and trustworthy conversational agents.

Aim: The study explored nurses' perceptions of team resilience in coping with continuous changes and in developing nursing practices. Additionally, it sought to identify what nurses need to strengthen their team's resilience in adapting to change and how clinical nurse specialists can support these efforts. Background: Persistent changes in healthcare require nursing teams to continuously adapt and develop their practices. However, development and implementation processes are often challenging, stressful, or unsuccessful. This can lead to change fatigue and, when combined with daily workload pressures, high job turnover. Currently, individual resilience is regarded as a key factor in coping with workplace stressors and burdens. Yet, growing critical perspectives emphasise the importance of team resilience, which differs from individual resilience. Despite practice development being mainly a team effort, nursing team resilience remains underexplored in the literature. Study design and methods: This qualitative descriptive study involved 29 registered nurses from two nursing teams at a Swiss paraplegic rehabilitation clinic. Data were collected through eight semi-structured group discussions, and the analysis was conducted using structured qualitative content analysis. Results: The nurses identified four key areas as crucial factors for team resilience in managing change: 1. A lack of knowledge about team resilience and interest in integrating the concept as fundamental resource. 2. Psychological safety within the nurse team and the desire to enhance interprofessional psychological safety, recognised as key factor in team resilience. 3. Readiness to learn. 4. Anticipated burdens. Furthermore, they expressed a need for support from clinical nurse specialists to strengthen team resilience. Conclusion: Team resilience was identified as an unrecognised and neglected concept, yet it was acknowledged as being significant both intra-and interprofessionally for coping with challenges; weak team resilience was considered disadvantageous. Clinical nurse specialists should play a key role in supporting team resilience. Recommendations for research and practice: Team resilience should be promoted among nurses across all education levels and fostered within nursing teams. Models for interprofessional collaboration and implementation could enhance team resilience factors that are essential for managing change. Additionally, the perspectives of other professionals on collaboration with nursing teams should be explored further. What is already known? center dot Nursing teams must continuously adapt their practices due to persistent changes in healthcare. This process is often challenging and stressful, increasing daily workloads and potentially leading to change fatigue and job turnover. center dot The level of resilience in individuals, teams and organisations becomes evident when challenges and stresses arise. Currently, individual resilience is regarded as a key factor in coping with workplace challenges and burdens. center dot Hospital nursing relies on a strong team-based approach, and nurses face numerous challenges, including those arising from ongoing change. What this study contributes: center dot This study highlights the importance of team resilience. A knowledge gap regarding this concept was identified and addressing it could enhance teams' ability to cope with change. center dot Nurses recognised team resilience as an essential resource for managing persistent change and fostering future development. Consequently, they expressed a desire to gain knowledge about team resilience and to strengthen key factors such as psychological safety in interprofessional collaboration, readiness to learn, and the anticipation of burdens associated with change. center dot Integrating and strengthening team resilience in change implementation may facilitate more successful and sustainable development. center dot Clinical nurse specialists should play a key role in enhancing team resilience.

Abstract Introduction The stay of a critically ill child in a pediatric intensive care unit (PICU) is a significant experience for the family. Thus far, little is known regarding the impact of this stay on parents and their healthy children for whom no continuous aftercare services are offered. This study aimed to capture the post-stay experience and needs of parents after this traumatic event so that they could return to family and everyday life. Methods This qualitative descriptive study was conducted in collaboration with four pediatric intensive care units in Switzerland. It included parents whose children had fully recovered after a stay and who did not require continuous medical follow-up. All children were hospitalized in the PICU for at least 48 h. Data were collected through narrative pairs (n = 6) and individual interviews (n = 8). Interviews were audio recorded, transcribed, coded inductively according to Saldaña, and analyzed. Results The results showed three related phases that influence each other to restore normality in daily life: Trust and inclusion in the treatment process during the stay (1), processing after the stay (2), and returning to everyday life (3). Conclusion Follow-up meetings should be available to all parents whose children have been hospitalized in the PICU. In particular, it should also be available to parents whose children have fully recovered and no longer have any medical disabilities.

BACKGROUND:The loss of hearing and thus communication affects the well-being of millions of people worldwide. Digital tools for coping with everyday life are becoming increasingly important and can have a positive impact on health literacy, especially among young adults. This raises the question of which issues such apps should specifically address in order to meet the needs of young adults with hearing loss or deafness. METHODS:The aim was to identify the health issues of young adults (aged 18-28 years) with hearing loss or deafness in order to derive specific recommendations for a conversational agent (chatbot). A multiple embedded case study design consisting of chat interviews (n = 8) and an online-based expert survey (n = 14) was used. RESULTS:The central phenomenon focuses on "The sense of belonging and feeling well in spite of hearing loss", which is influenced by two main categories: a. the ability to be oneself despite one's vulnerability; b. the desire to be strong despite one's vulnerability. Important health issues include depression, drug use, diet, exercise, isolation due to COVID measures and HIV prophylaxis. CONCLUSION:Written information must be provided in simple and accessible language supported by images and symbols. Conversation agents developed to support people with hearing impairment should be easy to install and self-explanatory to use.

Objective Connected health services will change the scope of health professionals’ roles. It is unclear how parents of a child with inflammatory bowel disease perceive the role of health professionals in relation to these services and what their experiences and needs are. The purpose of this study is to highlight parents’ experiences with this role. Furthermore, it aims to outline the fundamental needs that parents have regarding this role, in order to promote audience-specific access to these services and derive overarching action measures. Methods Fourteen parents of children with inflammatory bowel disease from seven different clinics in Switzerland were recruited. Between August 2022 and February 2023, these parents were interviewed in semi-structured interviews. The interviews were analyzed using a structured qualitative content analysis. Results Five main categories were identified, with few parents having prior experience with the role of health professionals in this area. Parents saw health professionals in the role of gatekeepers, transferers of knowledge and in a supporting function for these services. From the parents’ perspective, health professionals should recognize the limitations of these services and use them as a complement to standard treatment. Conclusion The role of health professionals in relation to connected health services needs to be adapted from the parents’ perspective. To meet the needs of parents, health professionals must have access to these services. In addition to health professionals’ personal engagement with these services, institutional and policy changes, as well as research on role development from the perspective of other stakeholders are needed.

Digital health interventions (DHIs) are increasingly used to address the health of migrants and ethnic minorities, some of whom have reduced access to health services and worse health outcomes than majority populations. This study aims to give an overview of digital health interventions developed for ethnic or cultural minority and migrant populations, the health problems they address, their effectiveness at the individual level and the degree of participation of target populations during development. We used the methodological approach of the scoping review outlined by Tricco. We found a total of 2248 studies, of which 57 were included, mostly using mobile health technologies, followed by websites, informational videos, text messages and telehealth. Most interventions focused on illness self-management, mental health and wellbeing, followed by pregnancy and overall lifestyle habits. About half did not involve the target population in development and only a minority involved them consistently. The studies we found indicate that the increased involvement of the target population in the development of digital health tools leads to a greater acceptance of their use.

Introduction: Due to globalization and the resulting diversity intercultural communication is increasingly coming to the fore. In addition, long-term care is mainly staffed with caregivers who have a migration background, which makes successful intercultural communication all the more important. Therefore, the aim of the present study was to define recommendations by interviewing relatives which can be used to promote intercultural communication in long-term care with regard to relationship building.Method: A qualitative explorative content analysis, which follows the content-structuring method with an inductive approach. The semi-structured guided individual interviews were conducted with relatives (n =14) of residents from two retirement centers in Switzerland.Results: Four categories were defined: "Perceive communication as a need", "Consider the desire for recognition of relatives", "Promote readiness of caregivers", and "Know opportunities and challenges in intercultural communication".Conclusion: Intercultural communication means being aware of the significance of culture and one's own origins in order to recognize the peculiarities of the counterpart and to interact sensitively with them. Relatives want to be actively involved when nurses reach their limits in communication and interaction. Relatives want safe care that is based on empathy. When nurses show concern towards others in a person-centered way and are aware of where they come from, this can promote trust and contribute significantly to supporting communication and interaction between cultures.

This report focuses on the collaboration between care and pastoral care, which can contribute significantly to the promotion of caring communities. The proverbs of Aotearoa (New Zealand) illustrate the aspect of diversity in togetherness and show how care and pastoral care can meet in practice-based work.

OBJECTIVE:The aim of this study is to identify the sources of illness-related emotional distress from the perspective of individuals living with mild to severe chronic obstructive pulmonary disease (COPD).METHODS:A qualitative study design with purposive sampling was applied at a Swiss University Hospital. Eleven interviews were conducted with individuals who suffered from COPD. To analyze data, framework analysis was used, guided by the recently presented model of illness-related emotional distress.RESULTS:Six main sources for COPD-related emotional distress were identified: physical symptoms, treatment, restricted mobility, restricted social participation, unpredictability of disease course and COPD as stigmatizing disease. Additionally, life events, multimorbidity and living situation were found to be sources of non-COPD-related distress. Negative emotions ranged from anger, sadness, and frustration to desperation giving rise to the desire to die. Although most patients experience emotional distress regardless of the severity of COPD, the sources of distress appear to have an individual manifestation.DISCUSSION:There is a need for a careful assessment of emotional distress among patients with COPD at all stages of the disease to provide patient-tailored interventions.

Background: There is an increase in hearing and visual impairments worldwide. Those affected have a reduced ability to participate in social contacts, mobility, and access to information. Until now, there have been no recommendations for Advanced Practice Nurses (APNs) in Switzerland to support this group of people in the autonomous organization of everyday life in their own homes. Objective: The aim of the study was to understand how people integrate their dual hearing and visual impairments into everyday life to derive recommendations for APNs to support individuals to manage their daily lives. Methods: Following the constructivist approach of grounded theory, guided interviews and a ques-tionnaire survey with hearing and visually impaired persons (n = 46) over 70 years of age on independent daily living were conducted (concurrent embedded strategy). In addition, demographic data on age, gen-der, living situation, and use of assistive devices were analyzed. Findings: Based on the results, a communication-based dynamic resilience model (CoRes) was devel-oped. This article represents the third phase of the three-stage-model. Integration of altered hearing depends on resources and risk factors. Conclusions: Advanced practice nurses can use recommendations from this research to actively help individuals and their families build resilience.

Accessible SummaryWhat is known on the subject? Treatment and mental health care in familiar environments are beneficial for older people experiencing mental health issues. But there are not enough qualified and specialized nurses who can meet the complex needs of nursing home residents experiencing mental health issues. The University Hospital of Psychiatry Zurich, Switzerland, established an outreach interprofessional mental health service to foster the care for residents experiencing mental health issues in nursing homes. Based on existing studies, little can be said about whether nurses in nursing homes find these types of services helpful. What does this paper add to existing knowledge? Nurses in nursing homes caring for residents experiencing mental health issues felt relieved by having inclusive support from the interprofessional mental health service. Nurses appreciated the mental health team and felt accompanied and more confident in their daily work. Results showed that nurses wanted to be included in the care and treatment processes and to work as partners on an equal footing with the mental health team. What are the implications for practice? Outreach interprofessional mental health services for nursing homes should take into account nurses' views and professional experience, and value and respect their role as nurses. Outreach interprofessional mental health services for nursing homes should offer further training in psychiatric nursing, include an accessible contact person in the team, and develop clear processes and responsibilities. AbstractIntroductionOutreach interprofessional mental health services for nursing homes can increase the quality of care for residents experiencing mental health issues but research on how nurses in nursing homes experience such a service is lacking worldwide.AimTo describe how nurses experience the involvement of an outreach interprofessional mental health team in the care for older people experiencing mental health issues in nursing homes and to identify barriers to and facilitators of interprofessional collaboration.MethodQualitative descriptive analysis based on 13 semi‐structured interviews. Framework analysis and complex adaptive systems theory were applied.ResultsOne core theme with two main categories: Nurses experienced relief from burden through inclusive support provided by the mental health team. Main categories were feeling accompanied and confident as a nurse and partnership‐based collaboration.DiscussionResults showed for the first time that nurses felt supported by the mental health team and were encouraged to find new ways of coping with challenging situations.Implications for PracticeTo empower nurses, mental health teams should take into account nurses' perceptions in the treatment process, value and respect their role as nurses, transfer knowledge in both formal and informal settings, establish a steady and reliable contact person, and define processes and responsibilities.

The COVID-19 pandemic significantly affected global healthcare access and exacerbated pre-pandemic structural barriers. Literature on disabled people’s experiences accessing healthcare is limited, with even less framing healthcare access as a human rights issue. This study documents and critically analyses Deaf people’s healthcare access experiences in Aotearoa New Zealand during the COVID-19 pandemic. Eleven self-identified Deaf individuals participated in semi-structured videoconferencing interviews. Discourse analysis was applied to participant narratives with discourses juxtaposed against a human rights analysis. Barriers influencing healthcare access included: (1) the inability of healthcare providers to communicate appropriately, including a rigid adherence to face mask use; (2) cultural insensitivity and limited awareness of Deaf people’s unique needs; and (3) the impact of ableist assumptions and healthcare delaying care. Barriers to healthcare access represent consecutive breaches of rights guaranteed under the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Such breaches delay appropriate healthcare access and risk creating future compounding effects. Action is required to address identified breaches: (1) The CRPD should also underpin all health policy and practice development, inclusive of pandemic and disaster management responsiveness. (2) Health professionals and support staff should be trained, and demonstrate competency, in Deaf cultural awareness and sensitivity.

ZusammenfassungDieser Beitrag geht der Frage nach, welche Heilsversprechen unter angehenden Gesundheitsfachpersonen bezüglich digitaler Medien vorherrschen und wodurch sie bedingt sind. Er stützt sich auf Daten einer Erhebung unter Bachelor-Studierenden einer Gesundheitshochschule in der Schweiz. Die Resultate zeigen, dass 59 % der Befragten die Vorteile digitaler Medien mit der Erbringung von Gesundheitsleistungen assoziieren und 41 % ihre Vorteile auf Seite der PatientInnen sehen. Aus der statistischen Analyse geht hervor, dass die Studierenden gehobener Herkunft und die Studierenden früher akademisierter Studienrichtungen die Vorteile digitaler Medien wesentlich häufiger mit der Dienstleistungserbringung als mit den PatientInnen verbinden. Dies scheint nicht nur anzuzeigen, dass in Gesundheitsberufen ein Zusammenhang zwischen den vorherrschenden sozialen Kräften und der Assoziation digitaler Medien mit der Dienstleistungserbringung besteht. Es dürfte auch darauf hinweisen, dass die „Digitalisierung“ im Gesundheitssektor die herkunftsbedingte kulturelle Spaltung in Gesundheitsberufen befördert.

INTRODUCTION:Combined hearing and vision impairment, which can negatively affect the performance of activities of daily living, is particularly prevalent in those over 70 years of age. Existing studies show that this dual sensory impairment has implications for safety in the home environment. Insights into how individuals integrate hearing and vision changes into their daily lives are needed for planning care-related interventions.METHODS:A qualitative method was used supplemented with quantitative methods ("Concurrent Embedded Strategy"). Based on the grounded theory approach, we conducted guided interviews with hearing- and vision-impaired individuals aged 70 years and over (n=46) as well as a questionnaire survey on how they cope with their daily lives.RESULTS:As part of their processing, individuals with hearing and visual impairments go through three stages that are closely linked to "being able to communicate." A partial result of the KoRes model is presented. This article focuses on the first two stages of this model: "diagnosis" and "reflection".CONCLUSION:People with dual sensory impairment behave reactively on the first two of a total of three stages with regard to the processing of their impairments. They need a supportive environment to be able to clarify these changes in hearing and vision and come to grips with the underlying causes.