BACKGROUND: In the scientific literature on Malaria in Pregnancy (MiP), no studies have been conducted on lifestyles based on critical theory. The objective of this study was to analyse the lifestyles or singular processes of social determination of health in MiP in northwestern Colombia.
METHODS: Mixed QUAN-QUAL convergent triangulation study. In the quantitative component, a psychometric evaluation and a cross-sectional design were conducted in 400 pregnant women to whom the Pender-Walker lifestyle scale and a survey on MiP prevention were applied. In the qualitative study, a critical ethnography was conducted with 46 pregnant women in whom their narratives and practices regarding lifestyles at home and healthcare were described.
RESULTS: The frequency of MiP was 9%, and a higher occurrence of the disease was identified in those who did not control stagnant water (29%), did not use insecticide-treated net (16%) and went to the hospital (14%) or the microscopist (20%) when they had fever. This coincides with the presence of unhealthy lifestyles, little knowledge about malaria, and a low perception of the risk of getting sick, as well as meanings and experiences about MiP, maternity, and pregnancy that show a high clinical, cultural, and socioeconomic burden for the women studied.
CONCLUSIONS: This epidemiological profile and the approach to lifestyles based on the postulates of critical theory in health evidence that pregnant women exposed to malaria suffer serious social, cultural and health injustices that are not possible to impact with the current health model of malaria control in Colombia guided by aetiopathogenic, biomedical, positivist and utilitarian theories.

UNASSIGNED: Social prescribing involves connecting individuals to community groups and activities, often to support their mental health and well-being. It has received increasing support in recent years across the NHS. There is a strong evidence base for the benefits of different types of community activities, including exercise groups, arts groups and nature interventions, on mental health outcomes, however, less is known about how these groups impact mental health and well-being. This study explores through what individual-level mechanisms (the \'how\') these groups support psychosocial well-being.
UNASSIGNED: An ethnographic study was conducted over 12-months to explore key shared, individual-level mechanisms across 4 social prescribing community groups: football, singing, gardening and reading. This study focused mostly on those with severe mental illness, whereas previously most social prescribing studies have focused on mild to moderate mental health problems. To frame the findings, a \'multi-level theoretical framework of mechanisms of action\' of leisure activities was used.
UNASSIGNED: Key shared psychological mechanisms were: increased self-confidence and self-esteem, increased purpose/meaning, increased sense of achievement, experience of pleasure; social mechanisms included: increased social support, formation of friendships and reduced loneliness, enhanced sense of community and belonging; behavioural mechanisms were: increased independence and openness to experience, reduction in addictive behaviours and building healthier habits, increased work-seeking behaviour, and provision of structure & routine.
UNASSIGNED: It is hoped that the findings of this study can help referring professionals increase their understanding of exactly how such groups support individuals\' mental health, thus enhancing referring practices.
This study uses ethnographic methods, wherein the lead researcher spent over a year participating in 4 different community groups, using interviews, conversations and observation to explore the mental health impact of such groups on individuals\' lives. The participants had moderate to severe mental health conditions, and the groups consisted of a reading, gardening, singing and football group. The study explored \'mechanisms\' underlying the mental health benefits of these groups. Key shared psychological mechanisms were: increased self-confidence and self-esteem, increased purpose/meaning, increased sense of achievement, experience of pleasure; social mechanisms included: increased social support, formation of friendships and reduced loneliness, enhanced sense of community and belonging; behavioural mechanisms were: increased independence and openness to experience, reduction in addictive behaviours and building healthier habits, increased work-seeking behaviour, and provision of structure & routine. It is hoped that the findings of this study can help referring professionals (e.g. GPs, social workers, link workers) increase their understanding of exactly how such groups support individuals’ mental health, thus improving referring skills.

UNASSIGNED: People with learning disabilities are living longer. Despite government policy to encourage people to lead supported lives in their community, family carers often maintain support due to dissatisfaction with services. This can lead to people moving from the family home in a crisis.
UNASSIGNED: (1) Find out what is known about health needs and resources for older people with learning disabilities (aged ≥ 40 years); (2) identify exemplars of good services for older people with learning disabilities; (3) explore service exemplars through ethnographic case studies; (4) evaluate support for older people with learning disabilities and their families through co-producing and testing future planning tools and (5) co-produce recommendations and resources.
UNASSIGNED: Work package 1 rapid scoping reviews - three reviews focused on the health and social care needs of older people with learning disabilities and \'behaviours that challenge others\', and family carers, and the co-ordination of support for this group. Work package 2 scoping and mapping exemplars of good practice - analysis of published service standards to assess excellence criteria, by mapping services, interviews (n = 30), survey (n = 9) and informal discussion with commissioners. Work package 3 ethnography of case studies of exemplar provision; independent supported living (n = 4); residential/nursing home (n = 2); day activities (n = 1), Shared Lives (n = 2). Fieldwork (20 days per model), interviews (n = 77) with older people with learning disabilities, family carers, support staff and commissioners. Work package 4 - co-producing and testing resources for older people with learning disabilities and their families involved interviews and focus groups with 36 people with learning disabilities, parents, and siblings, and experience-based co-design with 11 participants. Eight families evaluated the resources. Work package 5 - three stakeholder workshops co-produced service recommendations.
UNASSIGNED: The reviews confirmed an inadequate evidence base concerning the experiences and support of family carers and older people with learning disabilities and \'behaviours that challenge others\'. Criteria of excellence were produced, and a shortlist of 15 services was identified for consideration in work package 3. The ethnographic work found that environmental, organisational and social factors were important, including supporting independence and choice about who people live with, matching staff to people, consistent relationships and adapting to ageing. Practices of institutionalisation were observed. In work package 4, we found that families were worried about the future and unsupported to explore options. \'Planning Ahead\' cards and a booklet to record discussions were produced, and the evaluation was positively rated. Finally, formative discussion informed recommendations. Outputs include training packages, a carers\' forum, a film, a podcast and academic papers.
UNASSIGNED: There is little focus on older people with learning disabilities and family carers. Services vary in their approach to planning for older-age support. Families are unsupported to plan, leaving people without choice. \'Behaviours that challenge others\' was found to be unhelpful terminology. Recommendations: A new strategy is recommended for older people with learning disabilities and family carers that encompasses commissioning practices, professional input and peer learning, proactive support in ageing well and excellent service design.
UNASSIGNED: The COVID-19 pandemic created recruitment challenges. Reliance on providers for recruitment resulted in a lack of diversity in work package 3. Families\' plans, and therefore change, may be frustrated by insufficient service resources.
UNASSIGNED: Given the lack of focus in this area, there is a range of future work to consider: experiences of older people with learning disabilities from diverse ethnic backgrounds; supporting people to age and die \'in place\'; best practice regarding designing/commissioning services, including housing; the role of social workers; access to nature; accessing mainstream support; and evaluation of the \'Planning Ahead\' cards.
UNASSIGNED: This trial is registered as ISRCTN74264887.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129491) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 16. See the NIHR Funding and Awards website for further award information.
People with learning disabilities are living longer, but most live with their families, who are also getting older. This is because there are not enough suitable places for people with learning disabilities to live, and family carers worry that the person will not get the right support and have a good life. Our research aimed to improve support for people with learning disabilities and their family carers to plan ahead for a good life. We focused on people who are labelled with ‘behaviours that challenge others’. We read what has been written about this area. We looked for and found examples of excellent support for older people with learning disabilities. Researchers and people with learning disabilities and family carers spent time hanging out with people where they live or spend their days to see what support they get. Then we had three meetings with everyone involved and discussed our research findings with people with learning disabilities, family carers, and professionals. We found that people can be supported to live good lives as they grow older. This can be living alone or with people they choose, and it means having staff they like and who like them and being supported to be active. However, we found that ageing of people with learning disabilities is often ignored, and some people were not living good lives. We also found that the label of ‘behaviours that challenge others’ is unhelpful. We worked with people with learning disabilities and family carers to make a set of cards with pictures and questions to help people plan ahead for a good life. We produced resources and made recommendations to create a new plan for older people with learning disabilities to support people to lead good lives. This is very important because there is a lack of attention to and support for people with learning disabilities as they age.

OBJECTIVE: To address knowledge gaps by (i) developing a theoretical understanding of escalation and (ii) identifying escalation success factors.
METHODS: Non-participant observations were used to examine deteriorating patient escalation events.
METHODS: Escalation event data were collected by a researcher who shadowed clinical staff, between February 16th 2021 and March 17th 2022 from two National Health Service Trusts. Events were analysed using Framework Analysis. Escalation tasks were mapped using a Hierarchical Task Analysis diagram and data presented as percentages, frequency and 95% CI.
RESULTS: A total of 38 observation sessions were conducted, totaling 105 h, during which 151 escalation events were captured. Half of these were not early warning score-initiated and resulted from bleeding, infection, or chest pain. Four communication phenotypes were observed in the escalation events. The most common was Outcome Focused Escalation, where the referrer expected specific outcomes like blood cultures or antibiotic prescriptions. Informative Escalations were often used when a triggering patient\'s condition was of low clinical concern and ranked as the second most frequent escalation communication type. General Concern Escalations occurred when the referrer did not have predetermined expectations. Spontaneous Interaction Escalations were the least frequently observed, occurring opportunistically in communal workspaces.
CONCLUSIONS: Half of the events were non-triggering escalations and understanding these can inform the design of systems to support staff better to undertake them. Escalation is not homogenous and differing escalation communication phenotypes exist. Informative Escalations represent an organizational requirement to report triggering warning scores and a targeted reduction of these may be organizationally advantageous. Increasing the frequency of Spontaneous Escalations, through hospital designs, may also be beneficial.
UNASSIGNED: Our work highlights that a significant proportion of escalation workload occurs without a triggering early warning score and there is scope to better support these with designed systems. Further examination of reducing Informative and increasing Spontaneous Escalations is also warranted.
UNASSIGNED: Extensive PPIE was completed throughout the lifecycle of this study. PPIE members validated the research questions and overarching aims of the overall study. PPIE members contributed to the design of the study reviewed documents and the final data generated.

OBJECTIVE: The focus of this paper is to provide a detailed ethnographic exploration of rural nurses\' experiences of their resuscitation preparedness and the subsequent post-resuscitation period.
METHODS: An ethnographic study across two small rural hospital sites in New South Wales, Australia.
METHODS: Fieldwork was undertaken between December 2020 and March 2022 and included over 240 h of nonparticipant observation, journalling and interviews. Data were analysed using reflexive thematic analysis.
RESULTS: The first key theme-\'Sense of Preparedness\'-included three subthemes: \'Gaining experience\', \'Issues with training and education\' and \'Lack of warning\'. The second key theme \'Aftermath\' comprised two subthemes: \'Getting on with it\' and \'Making sense of the resus\'.
CONCLUSIONS: This study has highlighted the intricate relationship between resuscitative preparedness and the post-resuscitation period in shaping rural nurse\'s experiences and their well-being. Rural nurses are asking for an authentic and contextually relevant training experience that mirrors the unique rural challenges they experience. In the absence of frequent resuscitation presentations, the post-resuscitation period should be viewed as a crucible moment that can be leveraged as a valuable learning opportunity enhancing rural nurses\' sense of preparedness and the provision of quality resuscitation care.
CONCLUSIONS: Having a greater level of insight into the challenges that rural nurses experience in the pre- and post-resuscitation period is critical. This insight opens the door for fortifying policies and work processes that will better support rural nurses in the resuscitation environment.
UNASSIGNED: Reporting complied with COREQ criteria for qualitative research.
UNASSIGNED: This study explored the experiences of rural nurses. No patient data were collected.

BACKGROUND: Digitally assisted health care services and technologies are gaining popularity. They assist patients in managing their conditions, thereby reducing the burden on health care staff. Digital health care enables individuals to receive care that is more tailored to their needs and preferences. When implemented properly, it can promote equity by considering each person\'s opportunities and limitations in the context of health care needs, preferences, values, and capabilities.
OBJECTIVE: This study aims to understand the needs, values, and preferences of individuals with chronic obstructive pulmonary disease (COPD) who are provided with a 24/7 digital health care service. Furthermore, we aim to understand the dynamics of the communities to which they belong and how these communities intersect. This will provide us with the essential knowledge to establish new methods of providing education, including the development of educational activities for health professionals to engage, train, and empower people living with COPD.
METHODS: The study included 7 informants diagnosed with COPD who received 24/7 digital health care service support from a regional project in Region Zealand, Denmark. The informants were visited 4 times during 2 months, including a \"Hello\" visit, a day with a semistructured interview, and 2 days with field observations. The informants participated in a semistructured interview, following participant observation and an ethnographic approach. The interview content was analyzed using an inductive methodology to categorize the empirical data.
RESULTS: Using the inductive approach, we identified 3 main categories related to the informants\' needs, values, and preferences: (1) Health, (2) Value Creation, and (3) Resources. These 3 main categories were based on 9 subcategories: (1) health and barriers, (2) self-monitoring, (3) medication, (4) behavior, (5) motivation, (6) hobbies, (7) social networks, (8) health professionals, and (9) technology. These findings revealed that the informants placed value on maintaining their daily activities and preserving their sense of identity before the onset of COPD. Furthermore, they expressed a desire not to be defined by their COPD, as conversations about COPD often shifted away from the topic.
CONCLUSIONS: Digital health solutions and the health care professionals who offer them should prioritize the individuals they serve, considering their needs, values, and preferences rather than solely focusing on the medical condition. This approach ensures the highest level of daily living and empowerment for those living with long-term health conditions. The communities surrounding individuals must engage in constant interaction and collaboration. They should work together to incorporate people\'s needs, values, and preferences into future digital health services, thereby promoting empowerment and self-management. New educational programs aimed at developing the digital health service competencies of registered nurses should facilitate collaboration between the 2 communities. This collaboration is essential for supporting patients with long-term health conditions in their daily activities.

BACKGROUND: The high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICUs), an understanding of staff interactions with the patient monitoring system and alarm management practices is essential.
OBJECTIVE: This study investigated the interaction of nurses and physicians with the patient monitoring system, their perceptions of alarm management, and smart alarm management solutions.
METHODS: This explorative qualitative study with an ethnographic, multimethods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semistructured interviews with ICU staff members, and the results of a participatory task were analyzed. The data analysis followed an inductive, grounded theory approach.
RESULTS: Nurses and physicians reported interacting with the continuous vital sign monitoring system for most of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated that alarms were addressed through ad hoc reactions, a practice they viewed as problematic. Staff members\' perceptions of intelligent alarm management varied, but they highlighted the importance of understandable and traceable suggestions to increase trust and cognitive ease.
CONCLUSIONS: Staff members\' interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision-making. Alarm management standards and workflows have been shown to be deficient. Our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows, and real-world data at the core.

BACKGROUND: Existing qualitative research on early-stage Parkinson\'s disease draws on patients\' reported disease experience, aiming to capture the symptoms and impacts most relevant to patients living with the disease. As a complement to this research, the present study investigated the patient experience of early-stage Parkinson\'s disease from a holistic, ethnographic perspective. We explored the attitudes, beliefs, and social structures that shape how people understand and adapt to life with early-stage Parkinson\'s disease.
METHODS: Researchers interviewed 30 people with early-stage Parkinson\'s disease, 10 relatives, and 10 neurologists and movement disorder specialists in the USA and Germany. Many of these interviews took place in-person, allowing researchers to spend time in participants\' homes and witness their daily lives. A multidisciplinary team of social scientists, clinical researchers, and patient organization representatives led the mixed-methods study design and analysis. In-depth ethnographic interviews yielded qualitative insights, with a quantitative survey following to assess their prevalence in a larger sample of 150 patients.
RESULTS: In addition to developing a patient life experience pathway of early-stage Parkinson\'s disease, we identified five key thematic findings that provide insight into how the clinical features of the disease become meaningful to patients on the context of their daily lives, family relations, and subjective well-being: (1) People with early-stage Parkinson\'s disease start coming to terms with their disease before receiving a medical diagnosis; (2) Acceptance is not a finalized achievement, but a cyclical process; (3) People with early-stage Parkinson\'s disease \"live in the moment\" to make the future more manageable; (4) Slowing disease progression is an important goal driving the actions of people with early-stage Parkinson\'s; and (5) People with early-stage Parkinson\'s disease value information that is grounded in lived experience and relevant to their stage of disease progression.
CONCLUSIONS: This holistic, ethnographic approach to patient life experience provided five key thematic findings that complement insights from qualitative and quantitative datasets on early-stage Parkinson\'s disease. An enhanced understanding of how early-stage Parkinson\'s symptoms impact patients\' health-related quality of life and their broader social lives can help us better understand how patients make decisions about their usage of healthcare services and therapies.
This study aimed to understand the experience of people living with early-stage Parkinson’s. In addition to looking at how symptoms impact people’s daily lives, this research examined how people think about and give meaning to early-stage Parkinson’s. The first step was to conduct interviews with people with early-stage Parkinson’s, their relatives, and doctors. These interviews covered topics such as how people with early-stage Parkinson’s are eventually diagnosed, where they go for information, and how they approach the future. In the second step recordings and transcripts of the interviews were analyzed in detail. The ideas and themes that emerged from analysis were used to create a picture of how people experience early-stage Parkinson’s as part of their broader lives. Researchers identified five key insights: (1) people often begin to come to terms with Parkinson’s before being diagnosed; (2) accepting Parkinson’s is an ongoing process; (3) people with early-stage Parkinson’s value living in the moment; (4) people with early-stage Parkinson’s see slowing the worsening of the disease as an important goal; and (5) learning from the first-hand experience of others can be more valuable than scientific information. Ultimately, this research shows that understanding how early-stage Parkinson’s fits into people’s everyday lives can help researchers, doctors, and patient organizations provide more effective support and care.

BACKGROUND: Supporting ageing in place, quality of life and activity engagement are public health priorities for people living with dementia, but little is known about the needs and experiences of community-dwelling people with rarer forms of dementia with lesser known symptoms. Posterior cortical atrophy (PCA) is a rare form of dementia usually caused by Alzheimer\'s disease but which is characterised by diminished visual processing (rather than a dominant memory problem), which poses challenges for maintaining independence and accessing appropriate support.
METHODS: This study used a comparative qualitative design and focussed ethnographic methods to explore experiential differences in activity engagement for 10 people with the most common, memory-led presentation of Alzheimer\'s disease and 10 people with posterior cortical atrophy within their everyday home environments.
RESULTS: While the data collection revealed much rich variation in individual and contextual factors, some tentative high-level differences in the experiences of everyday activities could be drawn out, seemingly attributable to the different diagnoses\' differing dominant symptoms. These included people with posterior cortical atrophy being less likely to use environmental cues to initiate activities, and more likely to withhold from asking for support because of preserved insight into the impact of this on carers. This lack of initiation of activities could be misinterpreted as apathy. People with posterior cortical atrophy also were discouraged from engaging in activities by disorientation within the home, and difficulties localising, identifying and manipulating objects. People with the more common, memory-led presentation of Alzheimer\'s disease exhibited more memory-based difficulties with engaging with activities such as forgetting planned activities, where to locate the items required for an activity and the steps involved. Despite these distinct symptom-led challenges, all participants and their family members demonstrated resourcefulness and resilience in making creative adaptations to support continued engagement in everyday activities, supporting the widely reported management strategies of people with dementia of the Alzheimer\'s type more generally.
CONCLUSIONS: These findings offer helpful insights into some the differing impacts dementia related visual and memory impairments can have on everyday activity engagement, which will be helpful for others navigating these challenges and the health and social care practitioners working with people affected by these conditions. The findings also highlight the vast individual variation in the multitude of individual and contextual factors involved in everyday activity engagement, and suggest important areas for future work utilising methods which are similarly high in ecological validity and accessibility as the home-based focussed ethnographic methods utilised here.

OBJECTIVE: The literature highlights the importance of an interprofessional approach in palliative care to improve the quality of care, favoring an effective use of resources. Members of the interprofessional team include all professionals involved in patient care; in some contexts, the advanced practice nurse (APN) has a clearly defined role. This study aimed to define the possible role of the APN within the interprofessional palliative care team in our context.
METHODS: A focused ethnographic approach was taken involving participant observation and semistructured interviews.
CONCLUSIONS: From the participant observations, interaction of the participants, discussion content, and styles of meeting management were described. From the thematic analysis of the interviews, 15 themes emerged, grouped into four macro-themes: interprofessional collaboration, the interprofessional meeting, nurse\'s role, and developments.
CONCLUSIONS: The study has identified current nursing practice within the interprofessional palliative care team and areas where interprofessional collaboration can be improved. These are both organizational (role definition and team meeting management) and professional (development of nursing culture, expanded nursing role, and introduction of the APN within the team). Nurses must develop advanced skills to ensure more effective care for patients and caregivers. The introduction of an APN could be appropriate to address this need.