BACKGROUND: Caring for a person with dementia can be a challenging experience, often associated with chronic stress and a heavy burden on family caregivers. Dementia also impacts the relationship between the caregiver and the person with dementia. The quality of this relationship is, in turn, an important factor influencing the well-being of both dyad members. The psychoeducational intervention \"Learning to feel better . . . and help better\" has shown positive results regarding family caregivers\' subjective burden, psychological distress, and self-efficacy. However, relationship quality has not been addressed in the context of this intervention.
METHODS: A longitudinal constructivist grounded theory approach was used to explore relationship quality as perceived by caregivers, possible changes and intervention components facilitating or preventing such changes. Three qualitative, semi-structured interviews (before, during and after the intervention) were performed with 13 family caregivers from three different intervention groups. The resulting 39 interviews were analysed regarding individual caregiver trajectories, per time point for all caregivers and regarding specific caregiver subgroups.
RESULTS: A model focusing on sustaining relationship quality in dementia was developed. It shows strategies that family caregivers develop and apply to facilitate positive interactions and feelings of connectedness with their family members with dementia. It also indicates that mastering such strategies requires reflective skills based on specific knowledge of dementia and coping strategies, which can be enhanced through active skills training, in which caregivers are guided to work on their individual stressful situations. Factors hampering change included difficulties in accepting dementia-related changes.
CONCLUSIONS: Findings suggest that psychoeducation, with active skills training based on caregivers\' current daily life situations, providing systematic procedures to handle daily challenges and specific knowledge about the impact of the disease, could support them in developing and applying supportive strategies to sustain or improve their relationship to their family member with dementia.

UNASSIGNED: Globally, many children with physical disabilities (CwPDs) are excluded from their education and social life, mainly due to stigma and its effects. However, information on disability stigma is scarce in low-and middle-income countries like Ethiopia. The purpose of this study, therefore, was to explore the lived experience of stigma from the perspective of CwPDs and their caregivers in northwest Ethiopia.
UNASSIGNED: The study incorporated a constructivist grounded theory approach. Data were gathered through observations, in-depth interviews, and key informant interviews. Inductive and iterative grounded theory techniques were used to code and categorize data through constant comparison.
UNASSIGNED: The study showed that CwPDs are bullied and talked about, subject to pity, socially excluded, and held in contempt at home, in their neighborhood, and at school. They live in fear and uncertainty and struggle with stigma. These factors affect their emotions, social relationships, and educational activities.
UNASSIGNED: This study makes theoretical and practical contributions to understanding and addressing disability stigma and can help to introduce inclusive education policy, school practice, and disability advocacy. The study results highlight the need for disability awareness-raising programs, interventions for empowerment, and informing disability policy and practice.
The study sheds light on stigma experiences encountered by children with physical disabilities (CwPDs) in low income settings and adds new insights from the Ethiopian context to advance the rehabilitation professions.Stigma is dynamic and contextual, and presents the most significant barrier to inclusion and participation in education for CwPDs.Rehabilitation intervention is needed to address stigmatized circumstances and enable better inclusion of CwPDs.The study shows the need for rehabilitation interventions that inform disability awareness and help to shift the focus from charity-based and medical models to approaches-based in the social model.The findings of the study revealed the importance of advocacy to raise disability awareness among all stakeholders using the lived experiences and stories of CwPDs.

OBJECTIVE: To explore older inpatients and their caregivers\' care experience and how this relates to the gerontology care practice.
BACKGROUND: Research interest in the conceptualization of safe care for older inpatients was growing, and these studies were predominantly reported from a single or healthcare perspective. There is a shortage of literature on how patients and their caregivers conceptualise safe care.
METHODS: Constructivist grounded theory.
METHODS: Stage 1 included semi-structured interviews with inpatients. Stage 2 included semi-structured interviews with caregivers and six field notes. Purposive and theoretical sampling were used to recruit 61 participants across six healthcare institutions. Data analysis included initial coding, focused coding, and theoretical coding using constant comparative, field notes and memo writing.
RESULTS: The substantive theory to emerge from the data was A balance of unsafe care incidents and interactive cooperative care. This core concept was informed by four categories: unsafe care incidents, interactive cooperative care, person-centred care, contextual conditions, and one care outcome. The relationships between these categories constituted a balance in which patient-centred care was the core, unsafe care incidents were the barriers, interactive cooperative care was the facilitator, and the result of the balance was the care outcome. The balance constituted a safe care ecosystem under the interaction of contextual conditions.
CONCLUSIONS: Interactive cooperative care is vital in enabling care stakeholders to reduce unsafe care incidents, which facilitates them in achieving safe care and further constructing a healthy care ecosystem.
CONCLUSIONS: This theory identifies barriers and facilitators encountered by care stakeholders to cope with everyday problems and guides them in developing personalised care plans to ensure patient safety.

BACKGROUND: Several studies have explored the mechanisms of intergenerational transmission of child maltreatment (ITCM), which also involves care-experienced parents; however, what is less explored is their direct experience, especially regarding resilience processes.
OBJECTIVE: Developing the theoretical framework of ITCM through an exploration of the perspectives of those who appear to have interrupted it.
METHODS: A sample of 27 Italian parents - with experience in foster and/or residential care - who have broken the ITCM, completed an in-depth interview between May 2021 and February 2023.
METHODS: A Constructivist Grounded Theory (Charmaz, 2014) approach was adopted in carrying out the interviews, which focused on daily experiences of parenting (Morgan, 2011) and on factors perceived as supporting ITCM interruption. Data were analyzed using open, focused and theoretical coding; the analysis itself was discussed with a consultive board of care-experienced parents.
RESULTS: The study highlighted important aspects that, from parents\' perspectives, play a role in breaking ITCM: for instance, how their parenting experience is a challenging process of constructing what they term \'zero family\'. Furthermore, starting a family from scratch requires coming to terms with the past, re-imagining oneself as a parent, and managing the complexity of everyday life despite such tensions.
CONCLUSIONS: The results throw light on how the transition to parenthood itself is perceived as a significant developmental opportunity for the interruption of ITCM. However, many problems persist, foregrounding the relevance of discussing possible supports to strengthen parenting agency and skills. Such a discussion should therefore be increasingly informed by ecological approaches and parents\' perspectives (also on everyday practices and life contexts), thus avoiding the risk of pathologizing responses.

BACKGROUND: The current crisis of emergency department overcrowding demands novel approaches. Despite a growing body of patient flow literature, there is little understanding of the work of emergency nurses. This study explored how emergency nurses perform patient flow management.
METHODS: Constructivist grounded theory and situational analysis methodologies were used to examine the work of emergency nurses. Twenty-nine focus groups and interviews of 27 participants and 64 hours of participant observation across four emergency departments were conducted between August 2022 and February 2023. Data were analyzed using coding, constant comparative analysis, and memo-writing to identify emergent themes and develop a substantive theory.
RESULTS: Patient flow management is the work of balancing department resources and patient care to promote collective patient safety. Patient safety arises when care is ethical, efficient, and appropriately weighs care timeliness and comprehensiveness. Emergency nurses use numerous patient flow management strategies that can be organized into five tasks: information gathering, continuous triage, resource management, throughput management, and care oversight.
CONCLUSIONS: Patient flow management is complex, cognitively demanding work. The central contribution of this paper is a theoretical model that reflects emergency nurses\'conceptualizations, discourse, and priorities. This model lays the foundation for knowledge sharing, training, and practice improvement.

BACKGROUND: A growing body of evidence shows that many nursing home residents\' basic care needs are neglected, and residents do not receive qualitatively good care. This neglect challenges nursing staff´s professional and personal ideals and standards for care and may contribute to moral distress. The aim of this study was to investigate how nursing staff manage being a part of a neglectful work culture, based on the research question: \"How do nursing home staff manage their moral distress related to neglectful care practices?\"
METHODS: A qualitative design was chosen, guided by Charmaz´s constructivist grounded theory. The study was based on 10 individual interviews and five focus group discussions (30 participants in total) with nursing home staff working in 17 different nursing homes in Norway.
RESULTS: Nursing staff strive to manage their moral distress related to neglectful care practices in different ways: by favouring efficiency and tolerating neglect they adapt to and accept these care practices. By disengaging emotionally and retreating physically from care they avoid confronting morally distressing situations. These approaches may temporarily mitigate the moral distress of nursing staff, whilst also creating a staff-centred and self-protecting work culture enabling neglect in nursing homes.
CONCLUSIONS: Our findings represent a shift from a resident-centred to a staff-centred work culture, whereby the nursing staff use self-protecting strategies to make their workday manageable and liveable. This strongly indicates a compromise in the quality of care that enables the continuation of neglectful care practices in Norwegian nursing homes. Finding ways of breaking a downward spiralling quality of care are thus a major concern following our findings.

BACKGROUND: Some studies suggest that female patients have more concerns about receiving intimate care from male than female nurses. Thus, providing intimate care to female patients is a challenging experience for male nurses. The purpose of this study was to explore Chinese male nurses\' experiences and process of providing intimate clinical care to female patients.
METHODS: A constructivist grounded theory approach was used to develop a theoretical understanding of male nurses\' experiences. This study included participants from 3 hospitals in different locations in China. Twenty-five male nurses were recruited using purposive and theoretical sampling. Semi-structured interviews were conducted. Data analysis was completed using initial coding, focused coding, theoretical coding and memo writing to produce core concepts and categories, and theory development.
RESULTS: Chinese male nurses\' experiences of providing intimate care to female patients can be constructed as a three-stage process: (1) anticipation of the level of embarrassment, (2) deciding on the process: do it or not do it and (3) protecting both parties and dealing with embarrassment. Additionally, seven themes and associated categories were identified to represent the important factors in the process of male nurses providing intimate care to female patients in China.
CONCLUSIONS: Chinese traditional culture may affect the embarrassment in Chinese male nurses providing intimate care to female patients. The embarrassing situation can be divided into three different stages, and male nurses have different main concerns in each stage. Hospital nursing administrators should consider the experiences and needs of male nurses in providing intimate care and provide them with psychological support, education and training.

The purpose of this study was to explore the experiences of perioperative nurses in Sweden (ie, operating theater nurses) associated with caring for a donor patient during organ procurement procedures. We sought to determine the nurses\' main concerns and how they dealt with them. Using constructivist grounded theory methodology, our participant sample included 10 nurses, one of whom self-identified as male. The average age of the participants was 51.8 years (range = 38 to 63 years). After interviewing the participants and coding their responses, we developed the core category of optimum organ procurement. The generated grounded theory comprises four main categories: brace oneself, facilitate, procurement, and completion. Commitment is the force that binds the perioperative nurse to a course of action. This theory may help guide a team-based approach to prepare nurses to care for donor patients with dignity and respect during procurement procedures.

BACKGROUND: Clinical nurses are susceptible to compassion fatigue when exposed to various types of traumatic events in patients for extended periods of time. However, the developmental process, staging, and psychological responses distinct to each stage of compassion fatigue in nurses are not fully clarified. This study aimed to explore the processes of compassion fatigue and the psychological experiences specific to each phase of compassion fatigue among clinical nurses.
METHODS: Charmaz\'s Constructivist Grounded Theory methodology was used in this qualitative research. Semi-structured interviews were conducted with 13 clinical nurses with varying degrees of compassion fatigue from December 2020 to January 2021. Interview data were analyzed using grounded theory processes.
RESULTS: The data were categorized into five separate categories and 22 sub-categories. This study found that the process of compassion fatigue is dynamic and cumulative, which was classified into five phases: compassion experience period, compassion decrement period, compassion discomfort period, compassion distress period, and compassion fatigue period.
CONCLUSIONS: Clinical nurses who experience compassion fatigue may go through five stages that are stage-specific and predictable. The findings can shed light on local and global applications to better understand the problem of nurses\' compassion fatigue. The interventions for addressing compassion fatigue in clinical nurses should be stage-specific, targeted, and individualized.

The importance of enjoyable, memorable cellar door experiences is well-established in the literature. The winescape, which incorporates views, building design, and ambience is recognised as a central motivation for wine tourism and the most repeated content in word-of-mouth communication, a valuable marketing tool. Recent research has prioritised human interaction, which develops a connection as the most important component of the cellar door experience (d\'Ament, Nayeem, & Saliba, 2022). The current study expands previous research methodologies, adopting memory work and cellar door surveys in a mixed methods approach to explore the cellar door schema and its influence on cellar door expectations, assessments, purchases, and future positive word-of-mouth communication. A constructivist grounded theory approach was adopted to analyse participant memories. A Bayesian network was produced from 136 cellar door surveys to determine the influence of cellar door schema on purchases and intention to engage in word-of-mouth communication. The results supported recent findings that the human element is the most remembered and valued; it fosters a connection, strengthens brand attachment and creates enduring customers. The winescape, while important for grounding the memory, is less prominent in recollections. Additionally, the results demonstrate the importance of word-of-mouth as a contributor to cellar door schemas. Recommendations are made for cellar door managers and staff who strive to create memorable cellar door experiences for their customers.