Background The COVID-19 pandemic profoundly altered daily life and interrupted key milestones during the transition to adulthood for youth with special healthcare needs (YSHCN). In this patient-oriented study, we investigated the impact of the COVID-19 pandemic on Canadian YSHCN during their transition to adulthood.Methods We used a sequential, exploratory mixed methods design. In Phase 1 (Interpretive Description), we conducted semi-structured interviews with 21 YSHCN or their caregiver proxies. Rapid qualitative analysis identified key themes that informed Phase 2, a cross-sectional online survey completed by 516 YSHCN or their proxies. Survey results were summarized using descriptive statistics, and heterogeneity in experiences was examined using chi-square and multivariable logistic regression analyses. Mixed methods findings were integrated using joint displays.Results YSHCN described positive and negative experiences across the domains of healthcare, autonomy, relationships, vocation and lifestyle. Virtual modalities enhanced accessibility for some but deepened exclusion for others, particularly youth requiring hands-on or specialized support. Participants described strengthened family connections and accelerated pathways to autonomy as positive experiences, whereas disrupted access to healthcare, delayed milestones and increased social isolation were common negative experiences. In the survey, family support and positive coping strategies emerged as protective influences, whereas lack of in-person services, distressing news and social distancing were identified as key negative factors. Youth with mental or developmental healthcare needs were more likely to experience positive impacts of virtual services, whereas younger youth and those with mental healthcare needs were more likely to be negatively impacted by the lack of in-person services.Conclusions The pandemic had mixed impacts on YSHCN, highlighting the need for flexible health, education and community services that accommodate diverse needs. Findings underscore the importance of building inclusive, resilient systems and policies that preserve accessibility gains and meaningfully engage youth and caregivers in post-pandemic recovery and future crisis planning.

INTRODUCTION:The transition from paediatric to adult health care (i.e., 'health care transition') poses many challenges for youth with medical complexity (YMC) and their families. YMC need specific approaches to supporting transition, tailored to individual youth and family contexts. In this study, we examine the contextual factors influencing families' transition experiences and describe their recommendations for improving the experience. METHODS:We conducted a qualitative explanatory case study in Ontario, Canada. We completed 21 interviews with 17 participants (11 mothers, 2 fathers, 2 YMC, 2 siblings) from 11 families of YMC. Six YMC (55%) were under 18 years of age (pre-transfer) and five (45%) were aged 18 years and older (post-transfer). Analytic approaches included reflexive thematic analysis and directed content analysis. FINDINGS:Participants described how the interplay of personal and environmental factors impacted their transition experiences. Recommendations for health care providers focused on providing instrumental and psychological support, advocacy and care continuity. Families expressed a need for better access to information and support from primary care providers. System-level recommendations included streamlining transition processes, improving adult health care services and expanding community supports. A socioecological model is presented to guide health care providers and decision makers in assessing and tackling the challenges faced by YMC and their families during transition. CONCLUSION:Findings highlight the complexity and scope of issues surrounding the transition to adult care for YMC in Ontario, with evidence of major gaps in services across multiple sectors and settings. Ongoing efforts are needed to move evidence into practice and advocate for more equitable and responsive care for YMC during the transition and beyond. PATIENT OR PUBLIC CONTRIBUTION:The research team included two parent co-researchers with lived experience, who contributed to protocol refinement, funding acquisition, recruitment, findings interpretation and ongoing knowledge translation efforts.

•Families prioritize health, safety, participation and autonomy for the YMC’s future.•Families fear their YMC’s health will suffer due to lack of trained adult providers.•The culture of the adult system leaves families feeling unsafe and unwelcome.•Caregivers weather the effects of prolonged, intense caregiving/unpredictability.•Families adapt to transition through survival, sacrifice, persistence and reframing.

BackgroundPoorly supported transitions from pediatric to adult healthcare can lead to negative health outcomes for youth and their families. To better understand the current landscape of healthcare transition care across Canada, the Canadian Health Hub in Transition (the "Transition Hub", established in 2019) identified a need to: (1) describe programs and services supporting the transition from pediatric to adult healthcare across Canada; and (2) identify strengths, barriers, and gaps affecting the provision of transition services.MethodsOur project included two iterative steps: a national survey followed by a qualitative descriptive study. Service providers were recruited from the Transition Hub and invited to complete the survey and participate in the qualitative study. The survey was used to collect program information (e.g., setting, clinical population, program components), and semi-structured interviews were used to explore providers' perspectives on strengths, barriers, and gaps in transition services. Qualitative data were analyzed using the Framework Method.ResultsFifty-one surveys were completed, describing 48 programs (22 pediatric, 19 bridging, and 7 adult) across 9 provinces. Almost half of the surveyed programs were in Ontario (44%) and most programs were based in hospital (65%) and outpatient settings (73%). There was wide variation in the ages served, with most programs focused on specific diagnostic groups. Qualitative findings from 23 interviews with service providers were organized into five topics: (1) measuring transition success; (2) program strengths; (3) barriers and gaps; (4) strategies for improvement; and (5) drivers for change.ConclusionsWhile national transition guidelines exist in Canada, there is wide variation in the way young people and their families are supported. A national strategy, backed by local leadership, is essential for instigating system change toward sustainable and universally accessible support for healthcare transition in Canada.

Civilian nurses have gradually become the main body of military nurses. Our study aimed to understand their occupational happiness and its influencing factors.This descriptive study was conducted with 319 civilian nurses working in 15 military hospitals in China. Based on literature review, expert consultation and combined with the characteristics of civilian positions, this study developed a questionnaire on occupational happiness of civilian nurses in military hospitals. The questionnaire includes 7 dimensions as follows: work emotion, salary, work environment, professional identity, work output, interpersonal relationship, well‑being. The demographic questionnaire and occupational well-being questionnaire of civilian nurses in military hospitals were analysed by t-test, analysis of variance and Pearson correlation analysis.The occupational happiness score (3.83 ± 0.56, upper limit score: 5) was at the upper middle level. There were significant differences in occupational well-being by gender (t = -2.668, p = 0.008), age (F = 5.085, p = 0.007) and the type of city where the hospital was located (F = 15.959, p < 0.0001). The happiness score of females (3.94 ± 0.60) was higher than that of males (3.47 ± 0.54). Nurses who were over 41 years old had the highest occupational happiness. Compared with nurses younger than 30 years old, the p value was 0.004. The occupational happiness of nurses in hospitals in a "prefecture-level city" (p < 0.0001) and a "sub-provincial city" (p < 0.0001) was significantly higher than that of nurses in hospitals in a "municipality directly under the central government". Correlation analysis showed that the higher the nurses' satisfaction with professional identity, work output, work environment, salary, and interpersonal relationships, the higher their occupational happiness.Occupational happiness of civilian nurses in Chinese military hospitals was above the medium level. Gender, age, and the type of city where the hospital was located had a very significant impact on the level of occupational happiness. In addition, "professional identity", "work output", "work environment", "salary", and "interpersonal relationships" were significantly correlated with the occupational happiness of civilian nurses. They can be improved with some future lines of research.

Patient and family engagement has become a widely accepted approach in health care research. We recognize that research conducted in partnership with people with relevant lived experience can substantially improve the quality of that research and lead to meaningful outcomes. Despite the benefits of patient-researcher collaboration, research teams sometimes face challenges in answering the questions of how patient and family research partners should be compensated, due to the limited guidance and lack of infrastructure for acknowledging partner contributions. In this paper, we present some of the resources that might help teams to navigate conversations about compensation with their patient and family partners and report how existing resources can be leveraged to compensate patient and family partners fairly and appropriately. We also present some of our first-hand experiences with patient and family compensation and offer suggestions for research leaders, agencies, and organizations so that the health care stakeholders can collectively move toward more equitable recognition of patient and family partners in research.

BACKGROUND:Technological advances have led to more youth with medical complexity (YMC) who are living into adulthood and being transferred from pediatric to adult care. The transition to adult care is a complex and challenging process, partly due to differences in how pediatric and adult systems deliver health care. YMC and their families need support from their health care providers to ease this transition. To identify how to better support transitioning YMC, a needs assessment was conducted to examine the current state of transitional support for youth and families cared for by a pediatric Complex Care Program.AIMS:The aims of this needs assessment were to understand the transition practices of pediatric Complex Care Programs, explore transition-related needs of YMC and their families, and identify priorities for future quality improvement.METHODS:This project involved three components: a literature review, a benchmarking survey of pediatric Complex Care Programs in Ontario, and key informant interviews.FINDINGS:The benchmarking survey identified transition planning and transfer of care as areas of strength in the Complex Care Program, while transition readiness and transfer completion provided opportunities for improvement. Stakeholder collaboration, an early start, and knowledgeable providers facilitated a successful transition. Barriers included lack of time, poor access to adult services and resources, higher medical complexity, and inadequate support for adult health care providers.CONCLUSIONS:Recommendations for improving transitional care for YMC are provided, along with resources, tools, and considerations for implementation.

Background: Advancing inclusivity in graduate nurs-ing education is paramount for preparing diverse nursing leaders to mobilize change within health care and educa-tional systems. This scoping review examined inclusivity in graduate nursing education. Method: CINAHL, Medline, and ERIC databases were searched for studies published in English since 2011. Key journals and reference lists of included studies were hand searched. Included studies focused on inclusivity in the context of graduate nursing education. Results: Data from 31 included studies are pre-sented. Most of the studies (n = 22) aimed to cultivate in-clusivity among students, primarily through cultural com-petence training. A few studies enacted inclusivity through program-level strategies (n = 4) or explored the lived ex-periences of diverse students (n = 5). Conclusion: Future research and education initiatives should advance a more holistic, intersectional approach to cultivating inclusivity, as well as emphasize enacting inclusivity through strate-gies to transform the learning environment. [J Nurs Educ. 2022;61(12):679-692.]

Abstract Background For youth with medical complexity and their families, the transition to adulthood is a stressful and disruptive period that is further complicated by the transfer from relatively integrated and familiar pediatric services to more fragmented and unfamiliar adult services. Previous studies report that families feel abandoned, overwhelmed, and unsupported during transition. In order to provide better support to families, we need to understand how families currently manage transition, what supports they need most, and how key factors influence their experiences. The aim of this study is to understand how families of youth with medical complexity adapt to the youth’s transition to adulthood and transfer to adult health care, social, and education services, and to explain how contextual factors interact to influence this process. Methods Informed by the Life Course Health Development framework, this study will use a qualitative explanatory case study design. The sample will include 10–15 families (1–3 participants per family) of youth with medical complexity (aged 16–30 years) who have lived experience with the youth’s transition to adulthood and transfer to adult services. Data sources will include semi-structured interviews and resources participants identified as supporting the youth’s transition. Reflexive thematic analysis will be used to analyze interview data; directed content analysis will be used for documentary evidence. Discussion While previous studies report that families experience significant challenges and emotional toll during transition, it is not known how they adapt to these challenges. Through this study, we will identify what is currently working for families, what they continue to struggle with, and what their most urgent needs are in relation to transition. The anticipated findings will inform both practice solutions and policy changes to address the needs of these families during transition. This study will contribute to the evidence base needed to develop novel solutions and advance policies that will meaningfully support successful transitions for families of youth with medical complexity.

Thematic analysis is a widely cited method for analyzing qualitative data. As a team of graduate students, we sought to explore methods of data analysis that were grounded in qualitative philosophies and aligned with our orientation as applied health researchers. We identified reflexive thematic analysis, developed by Braun and Clarke, as an interpretive method firmly situated within a qualitative paradigm that would also have broad applicability within a range of qualitative health research designs. In this approach to analysis, the subjectivity of the researcher is recognized and viewed not as problematic but instead valued as integral to the analysis process. We therefore elected to explore reflexive thematic analysis, advance and apply our analytic skills in applied qualitative health research, and provide direction and technique for researchers interested in this method of analysis. In this paper, we describe how a multidisciplinary graduate student group of applied health researchers utilized Braun and Clarke's approach to reflexive thematic analysis. Specifically, we explore and describe our team's process of data analysis used to analyze focus group data from a study exploring postnatal care referral behavior by traditional birth attendants in Nigeria. This paper illustrates our experience in applying the six phases of reflexive thematic analysis as described by Braun and Clarke: (1) familiarizing oneself with the data, (2) generating codes, (3) constructing themes, (4) reviewing potential themes, (5) defining and naming themes, and (6) producing the report. We highlight our experiences through each phase, outline strategies to support analytic quality, and share practical activities to guide the use of reflexive thematic analysis within an applied health research context and when working within research teams.

Background Military nurses should possess the competency to provide quality care in both clinical and military nursing contexts. This study aimed to identify the competencies of military nurses in general hospitals. Methods A qualitative study was carried out using a qualitative content analysis. We purposefully sampled and interviewed 21 nurses in general hospitals in China. Results The data analysis revealed 40 competencies, which were categorised into four main categories according to the Onion Model. These categories were motive (mission commitment), traits (perseverance, flexibility, etc.), self-identity of dual roles (obedience, empathy, etc.), as well as knowledge, skills and abilities (clinical and military nursing knowledge and skills, basic nursing ability, professional development ability, leadership and management ability). Conclusions Existing knowledge of competencies of military nurses in general hospitals is limited. A detailed exploration of this topic can provide guidance for recruitment, competency assessment, and competency building.

As youth with medical complexity transition to adult services, their extensive support networks are disrupted, leaving them vulnerable to care gaps. Within the setting of a pediatric complex care clinic in Ontario, Canada, the authors conducted a needs assessment guided by transitions theory to better understand the movement to adult services for youth and their families. The authors here describe the application of transitions theory and critique the theory’s usefulness for understanding the transition to adult services for youth and their families.

AbstractYouth with medical complexity (YMC) are a small subset of youth who have a combination of severe functional limitations and extensive health service use. As these youth become adults, they are required to transition to adult health, education, and social services. The transition to adult services is especially difficult for YMC due to the sheer number of services that they access. Service disruptions can have profound impacts on YMC and their families, potentially leading to an unsuccessful transition to adulthood. This meta-ethnography aims to synthesize qualitative literature exploring how YMC and their families experience the transition to adulthood and transfer to adult services. An in-depth understanding of youth and family experiences can inform interventions and policies to optimize supports and services to address the needs of this population at risk for unsuccessful transition to adulthood. Using Noblit and Hare’s approach to meta-ethnography, a comprehensive search of Medline, CINAHL, Embase, PsycINFO, Social Sciences Index, and Sociological Abstracts databases, supplemented by hand searching, was conducted to identify relevant studies. Included studies focused on the transition to adulthood or transfer to adult services for YMC, contained a qualitative research component, and had direct quotes from youth or family participants. Studies were critically appraised, and data were analyzed using meta-ethnographic methods of reciprocal translation and line of argument synthesis. Conceptual data from ten studies were synthesized into six overarching constructs: (1) the nature and process of transition, (2) changing relationships, (3) goals and expectations, (4) actions related to transition, (5) making sense of transition, and (6) contextual factors impacting transition. A conceptual model was developed that explains that youth and families experience dynamic interactions between their goals, actions, and relationships, which are bounded and influenced by the nature, process, and context of transition. Despite the tremendous barriers faced during transition, YMC and their families often demonstrate incredible resilience, perseverance, and resourcefulness in the pursuit of their goals. Implications for how the conceptual model can inform practice, policy, and research are shared. These implications include the need to address emotional needs of youth and families, support families in realizing their visions for the future, promote collaboration among stakeholders, and develop policies to incentivize and support providers in implementing current transition guidelines.

AIM(S):To identify competencies of military nurse managers and develop a unifying framework of military nurse managers' competencies. BACKGROUND:Military nurse managers shoulder multiple responsibilities because of duality roles, and they should possess competencies that enable them to manage human and material resources during peacetime and wartime. Therefore, nursing management within military context is demanding, such that a comprehensive understanding of their competencies is needed for effective military nursing management. Although relevant studies have focused on different military branches and different levels of managers, there is no standard evaluation framework. EVALUATION:A scoping review of studies focusing on competencies of military nurse managers from seven databases was carried out. KEY ISSUES:Nine studies were included in this review, and a framework consisting of six domains of military nurse managers' competencies was identified: clinical expertise, role model, leadership competencies, human competencies, financial competencies and deployment competencies. CONCLUSION:Existing knowledge of competencies of military nurse managers is limited, and a comprehensive understanding of this topic can provide direction for future work. IMPLICATIONS FOR NURSING MANAGEMENT:Military nurse managers play substantial roles within the military nursing context. A unifying framework can facilitate personnel recruitment and competency measurement, as well as training protocol development.

BACKGROUND:Organ transplantation is an important method to save the lives of patients suffering from organ failure. However, the low rate of organ donation is a common problem worldwide. Many potential organ donors in the intensive care unit (ICU) are not properly identified, which is one reason for the low donation rate. ICU nurses play a key role in organ donation but may be uncertain regarding some issues. In this study, an analysis of the reasons why ICU nurses in western China are reluctant to encourage patients and their families to donate organs is performed, providing a reference for promoting ICU nurse participation in organ donation work.METHODS:From August to November of 2017, using a purposive sampling method, we conducted semi-structured, in-depth interviews using a phenomenological research method with 18 ICU nurses who were working in 4 large hospitals with organ transplant accreditation in Chongqing City, China, and analyzed the data with phenomenology.RESULTS:Reasons for the reluctance of ICU nurses in encouraging patients to donate organs were categorized into the following 4 themes: limitation of the nurses' professional role, influence of the family's negative emotions, lack of training regarding organ donation in medical institutions, and impact of a conservative social attitude.CONCLUSION:Chinese medical and health institutions need to attach importance to the duties and roles of ICU nurses in organ donation work, the creation of a good death culture, the implementation of training for organ donation specialist nurses, and the strengthening of advocacy efforts for organ donation so that ICU nurses' reluctance in engaging in organ donation coordination in China can be mitigated and the nurses can better participate in promoting organ donation to potential donors.

Background Realizing patient partnership in research requires a shift from patient participation in ancillary roles to engagement as contributing members of research teams. While engaging patient partners is often discussed, impact is rarely measured. Objective Our primary aim was to conduct a scoping review of the impact of patient partnership on research outcomes. The secondary aim was to describe barriers and facilitators to realizing effective partnerships. Search Strategy A comprehensive bibliographic search was undertaken in EBSCO CINAHL, and Embase, MEDLINE and PsycINFO via Ovid. Reference lists of included articles were hand-searched. Inclusion Criteria Included studies were: (a) related to health care; (b) involved patients or proxies in the research process; and (c) reported results related to impact/evaluation of patient partnership on research outcomes. Data Extraction and Synthesis Data were extracted from 14 studies meeting inclusion criteria using a narrative synthesis approach. Main Results Patient partners were involved in a range of research activities. Results highlight critical barriers and facilitators for researchers seeking to undertake patient partnerships to be aware of, such as power imbalances between patient partners and researchers, as well as valuing of patient partner roles. Discussion Addressing power dynamics in patient partner-researcher relationships and mitigating risks to patient partners through inclusive recruitment and training strategies may contribute towards effective engagement. Further guidance is needed to address evaluation strategies for patient partnerships across the continuum of patient partner involvement in research. Conclusions Research teams can employ preparation strategies outlined in this review to support patient partnerships in their work.

BACKGROUND Organ donation education as an important approach to improve support for donating, but it is inconsistent and unstructured. Therefore, the development of donation-related curriculum is essential, especially for medical undergraduates. This study aimed to define the fundamental contents for organ donation curriculum that could be useful for international organ donor agencies and educational institutions. MATERIAL AND METHODS The basic framework of the organ donation curriculum was constructed under the guidance of the theory of planned behavior in China. Then, Delphi method was used to modify and improve the contents by conducting 2 rounds of consultation with 22 Chinese experts from 6 professional fields. The surveys winnowed the list and assessed the accuracy and importance of each item. RESULTS Response rates for the Delphi were 100.00% for the first round and 95.45% for the second round. A 3-layer curriculum system was developed based on 3 dimensions of the theory of planned behavior. The primary-layer items including the overview, cultural concepts, ethical issues, laws and regulations, medical knowledge, and psychological care in organ donation, elicited at least 85% of the experts to agree or strongly agree that the items were basic and core content for organ donation education. All of the 17 second-layer and 46 third-layer items also had 80% or more expert agreement. CONCLUSIONS This study identified the contents of an organ donation curriculum for medical undergraduates in China, which would be useful for researchers and instructors in medical education. Determining the fundamental content of a donation-related curriculum is an indispensable step for implementation of organ donation education and promotion of organ donation.

Within the context of evidence-informed decision making, health care professionals are critical consumers of research evidence. Clinician scientists, including nurse researchers, play a central role in producing this research evidence to inform and improve health practice, education, and policy. Health research is commonly conducted within one of three different paradigms: quantitative, qualitative or mixed methods. Each research approach is underpinned with unique philosophic assumptions, methods, and rhetoric. The evidence produced within each paradigm is necessary to provide health care decision-makers with information about the complex, and intrinsically diverse, human experiences of health and illness. Qualitative health research has been defined as a discipline, which has its roots in qualitative research and yet is unique in its focus, methods, and rules. The focus of qualitative health research is to describe, explore, and explain the health-illness continuum and issues specific to health services or policy contexts. Research designs unique to conducting qualitative health research include qualitative description, interpretive description, focused ethnography, and case study. Each qualitative health research design helps to logically and pragmatically determine the appropriate methods to use to: 1) define a purposeful sample; 2) identify appropriate strategies for data collection; 3) rigorously apply analytic techniques to the gathered data; and 4) present valid findings. In health, qualitative studies are often an integral component of program evaluations to identify and describe contextual factors related to individuals, teams, organizations or social structures that inhibit or facilitate the successful adoption, implementation and delivery of an intervention or program. Findings from qualitative studies can also inform the development of theoretically and contextually relevant assessment tools that can be used in practice.

BACKGROUND:Global promotion of organ transplantation is contingent upon continuous improvement of the donation rate. Organ donation education is an important measure for changing public awareness and promoting organ donation. Therefore, it is important and urgent to conduct a systematic study of the organ donation courses offered in China and around the world. The aim of this study was to learn the views and needs of Chinese medical students and provide a reference for international peers.METHODS:Semistructured, in-depth interviews and purposive sampling were used in this study. A total of 18 university students majoring in medicine and nursing were selected according to the principle of data saturation and interviewed. The data were sorted and analyzed with phenomenology.RESULTS:These interviewees generally agreed that an organ donation course should be offered. They were in urgent need of knowledge regarding organ donation procedures and relevant policies and eager for a practical and experience-based teaching method design. The Chinese medical students surveyed also believed that the course should also be available to clinical practitioners, nonmedical students, and the public.CONCLUSION:Medical students' demand for an organ donation course should be considered. To fully stimulate their interest in learning and to provide support and a guarantee for continuous improvement of transplant operations promotion and donation rate worldwide, specific organ donation courses and flexible training should be created.

Background Use of synchronous digital health technologies for care delivery to children with special health care needs (having a chronic physical, behavioral, developmental, or emotional condition in combination with high resource use) and their families at home has shown promise for improving outcomes and increasing access to care for this medically fragile and resource-intensive population. However, a comprehensive description of the various models of synchronous home digital health interventions does not exist, nor has the impact of such interventions been summarized to date. Objective We aim to describe the various models of synchronous home digital health that have been used in pediatric populations with special health care needs, their outcomes, and implementation barriers. Methods A systematic scoping review of the literature was conducted, guided by the Arksey and O’Malley Scoping Review Framework. MEDLINE, CINAHL, and EMBASE databases were searched from inception to June 2018, and the reference lists of the included systematic reviews and high-impact journals were hand-searched. Results A total of 38 articles were included in this review. Interventional articles are described as feasibility studies, studies that aim to provide direct care to children with special health care needs, and studies that aim to support family members to deliver care to children with special health care needs. End-user involvement in the design and implementation of studies is evaluated using a human-centered design framework, and factors affecting the implementation of digital health programs are discussed in relation to technological, human, and systems factors. Conclusions The use of digital health to care for children with special health care needs presents an opportunity to leverage the capacity of technology to connect patients and their families to much-needed care from expert health care providers while avoiding the expenses and potential harms of the hospital-based care system. Strategies to scale and spread pilot studies, such as involving end users in the co-design techniques, are needed to optimize digital health programs for children with special health care needs.