To describe parents\' past and present experiences of their newborn infant\'s therapeutic hypothermia (TH) treatment after perinatal asphyxia 10-13 years after the event.
Newborn infants are treated with TH following perinatal asphyxia to improve neurodevelopmental outcomes.
A qualitative descriptive design using focus groups (FGs).
Twenty one parents to 15 newborn infants treated with TH between 2007 and 2009 participated in five FGs. The FGs were transcribed verbatim and analysed using framework approach. The SRQR checklist was followed for study reporting.
Two main categories were identified: hardships and reliefs during TH treatment and struggles of everyday life. Both categories include three subcategories, the first: (1) concern and gratitude for the unrecognized treatment, (2) insufficiency of information and proposed participation and (3) NICU nurses instilled security and hope. The second with subcategories: (1) unprocessed experiences of the TH treatment, (2) later challenges at school and (3) existential and psychological challenges in everyday life.
TH of their newborns affected the parents psychologically not only during the treatment, but lasted months and years later. Information and communication with health care professionals and school management were inefficient and inadequate. The parents\' concerns could be prevented by an improved identification and understanding of the problems and the needs of the infants and their families before discharge.
Through more personalized and efficient preparation and communication by the nursing staff before discharge, many of the parents\' worries and problems could be reduced. Check-up of parents\' needs of psychosocial support before and after discharge and offering counselling should become routine. Also, nurses at Well-Baby Clinics and in school health care should receive knowledge about TH treatment and the challenges the children and the parents experience.
Participation of parents was limited to the data provided through interviews.

OBJECTIVE: To further develop Earnshaw and Chaudoir\'s HIV stigma framework by describing the experiences of HIV-related stigma among people living with viral suppression in a context where HIV is well controlled and to investigate how these experiences correspond to the stigma mechanisms of the framework.
METHODS: Qualitative study using interviews and a framework approach to analysis.
METHODS: People living with virally suppressed HIV in Sweden were recruited through an outpatient clinic and interviewed about their experiences of social aspects of living with HIV. The interviews were audio recorded, transcribed and analysed using a framework approach.
RESULTS: Fifteen participants (eight women and seven men, aged 30-64 years) were interviewed from March to September 2017. They described stigma around HIV as a barrier in many situations. Anticipated and enacted stigma were found to be more complex than is described in the existing literature. Being labelled as a person with HIV was found to be an important and persistent part of the stigma experience. Disclosure was found to be context-related and a result of a process of negotiating and weighing the relevance of disclosing HIV, perceiving HIV as a private matter and feeling a responsibility to disclose one\'s HIV status to others. An important reason for nondisclosure was to avoid being labelled with HIV, which would then become their most defining feature.
CONCLUSIONS: The HIV stigma framework could benefit from revision for people living with virally suppressed HIV.
CONCLUSIONS: The present findings, which indicate the role of health professionals in relation to disclosure and labelling, may guide nurses and other healthcare personnel in providing counselling and support for people who live with virally suppressed HIV and experience stigma.

OBJECTIVE: To explore parental experiences of therapeutic hypothermia (TH) in their newborn infant suffering from hypoxic ischaemic encephalopathy following perinatal asphyxia.
BACKGROUND: Since more than a decade, newborn infants are treated with TH following perinatal asphyxia to reduce mortality and disabilities and to improve neurological outcome. The infants\' body temperature is lowered to 33.5°C for 72 hr, and the infant is usually cared for in an open incubator. The parents are not able to hold their infant skin to skin, which risks causing emotional reactions in parents and a loss of normal parent-infant bonding.
METHODS: A qualitative descriptive design using semi-structured interviews.
METHODS: Up to 7 months after the event, interviews were conducted with 14 parents of seven infants who had received TH in a neonatal intensive care unit (NICU) in Sweden. The interviews were transcribed and analysed using framework approach. Findings were reported following the Standard for Reporting Qualitative Research (SRQR) checklist.
RESULTS: From the interviews, an overall theme was found: Transition through a life-altering time, and three categories: (a) trepidation about prognosis, (b) transitioning into parenthood supported by the caring philosophy of family-centred care (FCC) and (c) rewarming as a milestone.
CONCLUSIONS: Parental experiences of TH are based on the immediate emotions and stress of uncertainty of the infant\'s prognosis. The values of FCC in the NICU append a natural transitioning into parenthood by parental involvement in nursing care and decisions. The rewarming of the infant is seen as a restart to more or less normal circumstances from the critical period of delivery and TH.
CONCLUSIONS: The management of NICUs should update the awareness of and deepen knowledge about FCC. The emphasis ought to be on adequate information about TH and the values of FCC to parents in the NICU context.

Little research has investigated in-depth how physicians perceive their role in smoking cessation care. This qualitative study sought to understand physicians\' perceptions of responsibility for smoking cessation.
Data were collected through individual semi-structured interviews and focus group interviews between June and November 2017 in The Netherlands. We interviewed 5 addiction specialists, 5 anesthesiologist, 4 cardiologists, 8 GPs, 5 internists, 5 neurologists, 2 pediatricians, 6 pulmonologists, 7 surgeons, and 8 youth healthcare physicians (N = 55). Data analysis followed the framework approach.
The analysis showed that three actors were perceived as responsible for smoking cessation: physicians, patients, and the government. Participants perceived physicians as responsible for facilitating smoking cessation -albeit to different extents-, patients as carrying the ultimate responsibility for quitting smoking, and the government as responsible for creating a society in which smoking uptake is more difficult and quitting smoking easier. Perceptions of smoking itself were found to be important for how participants viewed responsibility for smoking cessation. It remained unclear for many participants which healthcare provider is responsible for smoking cessation care.
The organization of smoking cessation care within health systems should be a focus of intervention, to better define physician roles and perceptions of responsibility. In addition, it seems important to target perceptions of smoking itself on the level of physicians and -as suggested by comments by several participants- the government.

METHODS: Qualitative and interpretive description.
BACKGROUND: Orthoses are often the first-choice treatment for thumb carpometacarpal osteoarthritis (CMCOA). It is unknown to what extent the orthoses are used in the way intended by health professionals and why patients continue using the orthoses despite minimal pain reduction.
OBJECTIVE: The purpose of this study is to investigate user perspectives and experiences with 2 types of CMCOA orthoses.
METHODS: Semistructured interviews were conducted with 16 individuals with CMCOA who used the Push-Ortho-Thumb-Brace-CMC (Nea International BV, Netherlands) and a custom-made orthosis. The data were analyzed using the phenomenological and the framework approach.
RESULTS: Four men and 12 women participated (mean age, 57 years; half of whom were employed). Five central phenomena were identified, explaining the essence of the relation between user and orthosis: the orthosis as stabilizer, tool, healer, preventer, and nuisance. Users mentioned better appearance and the ability to do a variety of activities as advantages of the Push-Ortho-Thumb-Brace-CMC and better support and the ability to do strenuous activities as advantages of the custom-made orthosis. The central phenomena were related to the users\' understanding of the disease process and the working mechanism of the orthoses and affected the patterns of usage and orthosis preference.
CONCLUSIONS: It is recommended that the provider recognizes user perspectives and discusses the disease process of CMCOA along with the working mechanism of the orthosis to support therapy adherence.
CONCLUSIONS: There is a wide variety in usage patterns of the CMCOA orthoses, which are influenced by different user perspectives.

To explore approaches to the assessment of mental capacity within acute hospital and intermediate care settings in England.
Two focus group interviews were conducted with multidisciplinary staff (n = 13) within a large hospital trust. Data were analysed using a Framework approach.
Three main themes were identified: (i) the assessment process; (ii) staff experience of assessment; (iii) assessing capacity for patients with communication difficulties. Staff identified the main patient groups, patient decisions and professionals involved in capacity assessment. They described using both formal and informal approaches to assess capacity and specific methods to identify and support the needs of patients with communication difficulties during the assessment process. Most staff reported finding capacity assessment challenging, due to time pressures, a perceived lack of knowledge or skills and encountering practice that is not consistent with legal requirements. Staff stated a need for initiatives to facilitate and improve practice.
These findings provide confirmatory evidence that mental capacity assessment is complex and challenging and that staff would benefit from additional support and resources to aid their practice. It provides new evidence about the methods used by staff to assess capacity, particularly for patients with communication difficulties. Implications for Rehabilitation This study contributes to our understanding of how staff assess capacity in hospital and intermediate care settings. Mental capacity assessment is a complex activity and many staff reported finding it challenging. Patients with communication difficulties need additional support during capacity assessments but may not always receive this. Current practice needs to be improved and staff need support and resources to achieve this.

OBJECTIVE: To investigate the perspectives of general practitioners (GPs) on the practice of soliciting additional concerns (ACs) and the acceptability and utility of two brief interventions (prompts) designed to aid the solicitation.
METHODS: Eighteen GPs participating in a feasibility randomised controlled trial were interviewed. Interviews were semi-structured and audio-recorded. Data were analysed using a Framework Approach.
RESULTS: Participants perceived eliciting ACs as important for: reducing the need for multiple visits, identifying serious illness early, and increasing patient and GP satisfaction. GPs found the prompts easy to use and some continued their use after the study had ended to aid time management. Others noted similarities between the intervention and their usual practice. Nevertheless, soliciting ACs in every consultation was not unanimously supported.
CONCLUSIONS: The prompts were acceptable to GPs within a trial context, but there was disagreement as to whether ACs should be solicited routinely. Some GPs considered the intervention to aid their prioritisation efficiency within consultations.
CONCLUSIONS: Some GPs will find prompts which encourage ACs to be solicited early in the consultation enable them to better organise priorities and manage time-limited consultations more effectively.