Search Results (162)

Background: Effective communication with relatives is an essential component of family-centered intensive care. This study evaluated preferences for receiving information in intensive care units (ICUs) and examined factors associated with communication expectations and perceived adequacy of information. Methods: In this cross-sectional survey, 401 participants completed a 25-item questionnaire developed from the literature, reviewed by experts, and pilot-tested. Communication preferences and perceptions were analyzed according to age, sex, education, marital status, geographic region, employment status, healthcare background, degree of kinship, duration of ICU stay, and previous ICU experience. Multivariable logistic regression was performed to identify factors independently associated with considering telephone-based communication sufficient. Results: Most participants (89.8%) preferred face-to-face communication. Overall, 62.8% considered telephone-based information insufficient, and face-to-face communication was more frequently perceived as promoting trust and understanding. Communication preferences varied according to demographic, educational, regional, and experiential characteristics. Women placed greater importance on direct interpersonal communication, whereas men favored more practical information delivery. Participants with higher educational attainment reported greater expectations regarding the structure and content of information. In multivariable analysis, male sex (OR = 2.63, 95% CI: 1.40–4.93; p = 0.003), residence outside the city where the hospital was located (OR = 2.86, 95% CI: 1.49–5.46; equivalent to OR = 0.35 for residence within the hospital city; p = 0.002), and having a relative hospitalized in the ICU for 21–31 days (OR = 3.74, 95% CI: 1.42–9.86; p = 0.008) were independently associated with considering telephone-based communication sufficient. Conclusions: Face-to-face communication was the preferred method of information delivery for most relatives. Communication preferences and the perceived adequacy of telephone-based information varied according to demographic, regional, and clinical characteristics. These findings support adopting individualized communication strategies rather than a uniform approach when communicating with relatives of intensive care patients. Full article

Academic setbacks are common in college, yet instructor responses to poor performance vary widely and may shape students’ motivation, emotional reactions, and perceptions of faculty support. Prior work suggests that supportive communication matters, but less is known about which types of messages students prefer after academic failure or whether faculty accurately anticipate these preferences. The present research examined how college students and instructors evaluate different instructor responses to a disappointing exam grade and assessed alignment between student preferences and faculty perceptions. Using a mixed-methods design, college instructors and undergraduate students responded to parallel vignette scenarios involving a poor exam outcome and rated brief instructor comments representing three response types: solution-focused, emotional validation, and interpersonal affirmation. Participants also provided open-ended responses describing what they would say to a student or want to hear from an instructor. Across two studies, students rated affirmation as most effective, validation as moderately helpful, and solution-focused responses as least effective, despite perceiving solution-focused comments as most common in actual classrooms. Faculty in our sample rated validation and affirmation as more effective than solution-focused responses but primarily generated strategy-focused advice in their own responses. Faculty correctly anticipated students’ preference for encouragement but rarely offered such messages. These findings point to a gap between what faculty believe students value and what they typically communicate following academic setbacks, suggesting that incorporating brief affirming and emotionally responsive messages may strengthen student–teacher relationships by signaling care, understanding, and support in moments of academic difficulty. Full article

The complexity of authentic assessment within Deep Learning frameworks often hinders teacher adoption. This study analyses the diffusion process of such an innovation at SMP Taruna Bakti Bandung using an Explanatory Sequential Mixed Methods design. Through Social Network Analysis (SNA) of the entire teacher population and in-depth interviews, this study maps communication patterns and the roles of key actors. SNA results reveal a network structure with moderate density and subject-based clustering patterns. Qualitative findings confirm that adoption success relies heavily on opinion leaders acting as “pedagogical translators” to simplify the technical complexities of assessment. Through collaborative strategies, innovation barriers are reduced by enhancing aspects of trialability and observability. The study concludes that the adoption of authentic assessment requires synergy between formal institutional support and technical validation fostered within interpersonal trust networks, rather than relying solely on managerial instruction. Full article

Introduction: Patients are increasingly aware of ways to manage their own health—especially regarding chronic diseases—along with the fundamental factors that should be present in well-organized and patient-oriented healthcare organizations. Due to the fact that the image of healthcare organizations depends on patients’ opinions, healthcare organizations are continuously improving and transforming their processes to increase patient satisfaction. This study aimed to analyze the relationship between patients’ opinions about the public hospitals in which they were treated and selected factors, including socio-demographic characteristics, previous hospital experiences, sources of information, and satisfaction with hospitalization in Poland. Methods: A cross-sectional survey was conducted among patients hospitalized in eight public hospitals in Wrocław. A self-developed questionnaire included two sections: (I) opinions about the hospital (11 items) and (II) expectations and satisfaction (12 items). Questionnaires were distributed in person. Data were analyzed using descriptive and inferential statistics, including correlation and chi-square tests. Results: Hospital image was shaped mainly by interpersonal factors, particularly staff kindness (82.9%), access to specialists (75.4%), and a sense of safety (54.4%). Women were more likely than men to seek information about hospitals before admission (47.6% vs. 39.3%; p = 0.021). A positive correlation was found between patient expectations and satisfaction with hospitalization (ρ = 0.425; p < 0.001). Media exposure played a minor role in shaping hospital image (22.1%), while personal recommendations and previous experience were the dominant sources of influence. Conclusions: Patients’ assessments of hospital image are determined primarily by relational and communication factors rather than infrastructural or technical aspects. Sociodemographic characteristics, such as gender and previous contact with the institution, may moderate these perceptions. The findings highlight the need to strengthen patient-centered care models, improve communication competencies among health professionals, and develop transparent institutional communication strategies. Full article

Living with Loss, an eight-session community-based bereavement program, supports individuals who have lost a loved one to cancer within the past two years. This pilot study sought to document people’s experiences across program delivery and compare levels of hope and coping before and after program completion. Participants (N = 11) completed self-report e-questionnaires (Hope Herth Index and Brief Cope Scale) before and after program completion. Semi-structured individual interviews were conducted before program attendance, at the midpoint and after program completion. Levels of hope and coping were compared using paired-sample t-tests. Digitally recorded interview data were transcribed verbatim and thematically analyzed. Total hope scores significantly increased at program completion. There were no significant pre-post changes in coping subscales. Qualitative data revealed three themes: (1) tangible and intangible program contributions to bereavement processes (i.e., developing coping strategies, perspective changes), (2) an enhanced sense of community post-attendance (i.e., mutual understandings, group-related growth), and (3) distinct preferences for in-person vs. virtual delivery (i.e., depth of interpersonal connections, anticipated instrumental issues including parking restrictions). Preliminary findings suggest that Living with Loss is relevant and beneficial for bereaved participants. Documenting experiences across program delivery serves to further inform program adjustments to better meet participants’ needs and preferences. Full article

Background/Objectives: Growing concern about narcissistic traits in younger generations and their effects on empathy, communication, and mental health underscores the need for focused research on medical students as future healthcare professionals. Medical training carries a substantial psychological burden that can compromise students’ well-being, professional development, and the future quality of patient care. Personality traits, including grandiose and vulnerable narcissistic dimensions, may shape susceptibility to such psychological distress. Therefore, this study aimed to examine narcissistic traits and their associations with psychological distress among Croatian medical students across study years and trait levels. Methods: In this cross-sectional study, 413 medical students from the University of Split completed self-administered questionnaires during mandatory classes. Narcissistic traits were assessed using the Pathological Narcissism Inventory (PNI) and psychological distress was measured with the Brief Symptom Inventory (BSI). High pathological narcissistic traits were operationally defined as scores within the highest quartile. Statistical analyses included correlation, comparative, and regression analyses. Results: Overall, pathological narcissistic traits were expressed at low to moderate levels and did not differ across academic years. High narcissistic traits were identified in 35% of students, with 15% exhibiting elevated levels of both grandiose and vulnerable dimensions, suggesting an overlap between the two dimensions. Gender differences emerged across both narcissistic dimensions, with women scoring higher on vulnerable and men scoring higher on grandiose narcissism. One-quarter of students met the criteria for clinically significant psychological distress, which was more prevalent in the earlier years of study. High levels of pathological narcissistic traits, particularly vulnerable traits, were significantly associated with clinically significant distress and elevated symptoms across nearly all BSI domains, most notably interpersonal sensitivity and paranoid ideation. Despite this burden, only a minority of distressed students reported seeking psychological help. Conclusions: Elevated pathological narcissistic traits are significantly associated with psychological distress in medical students. The high prevalence of distress, combined with low help-seeking rates, underscores the need for early identification strategies and structured mental health support within medical education. Addressing personality-related vulnerability factors may improve student well-being, enhance professional development, and, ultimately, elevate the quality of healthcare delivery. Full article

Firearm homicide is a leading cause of death among children and young men in the U.S. (ages 1–19), with young Black males in urban environments facing rates 18-to-24-fold higher than their non-Hispanic White peers in 2023. A key precursor to firearm violence victimization is weapon-carrying behavior (WCB), defined as carrying, concealing, or displaying firearms or other weapons in community or social contexts that elevate risk for injury, interpersonal threats, or law enforcement contact. Several structural, behavioral, and trauma-based risk factors fuel weapon-carrying. Yet these WCBs are rarely studied in tandem, leaving a critical gap in our understanding of these high-risk behaviors for youth. This cross-sectional study leveraged baseline data from a convenience sample of 226 violence-exposed urban young Black males, ages 15–24 (M_age = 18.3 years; SD = 3.1) enrolled in a trauma-informed digital firearm violence prevention pilot study. Eligibility required prior personal or witnessed experience of youth violence; reported prevalence therefore characterizes a high-risk subgroup rather than urban young Black males as a whole. Past-30-day weapon-carrying frequency was measured across five YRBS-aligned categories (0, 1, 2 to 3, 4 to 5, and 6+ days) and modeled as a categorical index under negative binomial regression. Associations with peer and community violence exposure, substance use, sociodemographic, and socioeconomic factors were estimated as incidence rate ratios (IRRs) with 95% CI. Past-30-day weapon carrying was reported by 42.5% of participants, with carrying frequency ranging from 1 day to 6 or more days. Participants reported high levels of direct victimization (64.8%), witnessing community violence (76.4%), and use of nonprescribed medications, including in instances preceding violence. In the fully adjusted model, indicators of violence exposure were the most consistent correlates of carrying. Direct victimization (IRR = 1.15, p < 0.05), general exposure to violence or aggression (IRR = 7.82, p < 0.01), and physical fighting (IRR = 1.11, p < 0.05) remained independently significant. Conversely, associations with substance use, dating aggression, and employment were attenuated, suggesting shared ecological vulnerability rather than independent causal pathways. Findings underscore the central role of chronic violence exposure and support the need for trauma-informed, multilevel prevention strategies in clinical and community settings. Full article

Background/Objectives: Sustaining a stable and competent workforce in neonatal intensive care units (NICUs) is critical for ensuring high-quality care for vulnerable neonates. However, workforce-related challenges such as job dissatisfaction and turnover remain significant concerns in high-acuity settings. Guided by the ecological model, this study aimed to examine resilience, communication competence, and the nursing work environment as multilevel factors associated with nursing workforce sustainability, with job satisfaction serving as a proxy indicator related to workforce retention and sustainability. Methods: A descriptive cross-sectional survey was conducted among 145 NICU nurses from three tertiary and three general hospitals in South Korea. Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson’s correlation coefficients, and multiple regression analyses using SPSS version 29.0. Results: Job satisfaction was positively associated with resilience (r = 0.67, p < 0.001), communication competence (r = 0.52, p < 0.001), and the nursing work environment (r = 0.57, p < 0.001). Multiple regression analysis indicated that resilience (β = 0.43, p < 0.001), nursing work environment (β = 0.30, p < 0.001), communication competence (β = 0.15, p = 0.040), and employment in a tertiary hospital (β = 0.12, p = 0.038) were significant factors associated with job satisfaction, explaining 55.1% of the variance (adjusted R²) in job satisfaction (F = 30.42, p < 0.001). Conclusions: Job satisfaction, used as a proximal indicator related to workforce sustainability, was associated with multilevel factors across intrapersonal, interpersonal, and organizational domains. Although resilience showed the strongest association, communication competence and the nursing work environment also showed meaningful associations with job satisfaction. These findings highlight the need for integrated, multilevel strategies to support nursing workforce sustainability and sustained nursing practice in NICU settings. Full article

Background: The negative impact of adverse childhood experiences (ACEs) on child development is documented. The parent–child relationship protects against ACEs and improves healthy child development, playing a crucial role in preventing and mitigating ACEs by strengthening parental resilience. However, there is a gap in the literature on our understanding of parental resilience’s impact on the parent–child relationship within the social–ecological model (SEM) (i.e., intra- and interpersonal, community, and societal levels). Objective: This study explores parents’ perspectives on parental resilience as a protective factor for preventing and mitigating ACEs at every level of the SEM. Method: This study uses a thematic analysis approach for qualitative research. In-depth individual interviews (n = 21) were conducted with members of a parent support group (PSG) (85% female) based in a community-based organization serving families. Demographic information and ACE scores were collected for each participant to describe the sample. Results: Key findings highlighted parents’ perspectives on improved resilience through self-regulation and social support following participation in PSGs, conceptualized as an inter-level construct within the SEM mechanism due to its influence on parents’ well-being, traversing SEM levels. Under Theme 1: The Many Faces of Parental Resilience, Theme 3: The Power of Close Relationships, Theme 4: Community Resources as a Buffer, and Theme 7: Change Through a Policy Lens: “Anything that protects them,” parents expressed a strong desire for ACE prevention and mitigation strategies and called for systemic policy change to combat ACEs. Conclusions: Parental resilience perceptions are valuable and hold promise to inform the future institutionalization of a multi-level parent resilience-focused framework, which will aid in ACE prevention and mitigation. Full article

The transformation of the hospitality industry has increased the demand for managerial profiles capable of integrating technical, strategic, and socio-emotional competencies. However, a persistent gap remains between the competencies required by the labor market and those developed through formal education. This study aims to identify and validate the core competencies of hotel management and to translate them into a structured training proposal. A two-round Delphi study was conducted with senior hotel management experts (n = 42 in round 1; n = 32 in round 2), using a competency matrix derived from prior research. Quantitative analysis included frequency distributions, weighted scores, and consensus indicators. The results show a high level of consensus stability (3.1% disagreement), leading to a final matrix of 43 competencies organized into four dimensions: operational, interpersonal, cultural-communicative, and strategic. Interpersonal and leadership competencies emerged as the most prominent, highlighting their structural role in effective managerial performance. Based on these findings, a progressive training framework is proposed, structured around three domains (operations, leadership, and strategy) and supported by a metacognitive pathway that integrates planning, monitoring, and evaluation processes. This study contributes to the professionalization of hotel management by providing an empirically grounded competency model and a coherent framework for aligning educational programs with industry demands. Full article

Background: Despite the availability of safe vaccines, Ethiopia’s human papillomavirus (HPV) vaccine uptake remains suboptimal, particularly among out-of-school girls (OOSGs). This study examines the effect of multi-channel demand generation messages in two districts to determine which interventions most effectively improve uptake. Methods: A convergent mixed-methods design was employed across four districts in the Somali and South Ethiopia regions, with Jigjiga and Derashe serving as intervention sites and Gode and Kolango Zuria as controls. For the quantitative component, 950 sample households were recruited using cluster sampling. The qualitative inquiry involved 27 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) within the intervention sites. Results: A total of 950 caregivers and 1134 girls completed the survey. Awareness was significantly higher among caregivers (AOR: 4.42; 95% CI: (3.06, 6.39)) and girls (AOR: 7.63; 95% CI: (3.49, 16.67)) in intervention sites, as well as among in-school girls (AOR: 13.46; 95% CI: (4.09, 41.90)). The mean vaccination coverage reached 71%, with significantly higher rates in intervention sites (AOR: 4.07; 95% CI: (2.29, 7.23)) and among in-school girls (AOR: 47.16; 95% CI: (20.23, 109.9)). Interpersonal communication—via teachers, peers, community health workers and vehicle-mounted promotion—was more effective in influencing awareness, attitude and uptake. Barriers for OOSGs included limited access to vaccination sites, low campaign awareness, misconceptions and gender-related issues. Conclusions: Appropriate demand generation strategies effectively enhance HPV awareness and vaccine uptake, yet a significant equity gap remains, as only one-third of OOSGs received the vaccine compared with 85% of in-school girls. Targeted interventions are recommended for OOSGs focused on both access to service and context-specific demand creation to address this disparity. Full article

Veterinary practice involves frequent interactions with pet owners that may be conflictual, emotionally charged, and ethically complex. These relational demands may contribute to burnout and related distress, but the evidence remains scattered across outcomes and study designs. This scoping review mapped the literature on how veterinarian–client communication and relational experiences are associated with burnout among veterinarians. Five databases were searched, and 17 studies met the inclusion criteria. Most were quantitative, with qualitative and mixed-methods studies also identified. Overall, the findings showed that repeated relational friction with clients, emotionally demanding end-of-life conversations, financial conflicts, and blurred boundaries around availability can contribute to burnout risk. The review also identified mechanisms linking these experiences to distress, particularly emotional reactivity and the effort required to regulate emotions during difficult interactions. Protective factors included supportive teams, autonomy, structured communication training, and interventions such as Acceptance and Commitment Training. These findings suggest that burnout in veterinary practice is shaped not only by workload, but also by the relational demands of client-facing care. Prevention efforts should therefore combine individual support with team-based and organizational strategies that strengthen communication practices and reduce avoidable interpersonal strain. Full article

Background/Objectives: Nonpharmaceutical interventions such as social distancing and face mask use were central to controlling infectious disease transmission during the early phases of the COVID-19 pandemic, particularly when vaccines and treatments were limited or unevenly available. Although public health strategies emphasized individual compliance, adherence varied widely. Empirical evidence remains limited regarding how individuals integrate influences across individual, interpersonal, and community levels when assessing their ability and readiness to socially distance. This study examined how residents evaluated, prioritized, and experienced multi-level factors shaping perceived ability and readiness to practice social distancing during the early phase of the COVID-19 epidemic. Methods: We conducted a cross-sectional online survey of adults (≥18 years) residing in St. Louis City and St. Louis County, Missouri, between April and July 2020. Participants selected and ranked individual/interpersonal and community-level factors influencing social distancing and provided open-ended explanations of their choices. Quantitative data were analyzed descriptively to assess selection frequency and ranking priority. Qualitative responses were analyzed using iterative thematic coding to examine how participants interpreted and combined these factors. Results: The analytic sample included 1692 respondents. At the individual/interpersonal level, family and friends’ distancing behavior (58.9%), desire for in-person interaction (52.4%), and personal risk of COVID-19 (48.9%) were frequently selected, while personal risk, caring for others, and ability to work from home were most often ranked as the highest priority. At the community level, others’ distancing in public spaces (66.2%), availability of COVID-19 testing (58.9%), and businesses’ ability to ensure distancing and sanitation (57.2%) were most frequently selected, with epidemic severity, testing availability, and treatment availability ranked as most influential. Qualitative findings indicated that respondents experienced these influences as interconnected, integrating personal and relational risk, local epidemic conditions, healthcare access, visible community norms, and employer policies. Conclusions: Perceived ability and readiness to practice social distancing emerge from interdependent social and structural conditions rather than isolated individual motivations. Public health responses to emerging infectious diseases may be more effective when individual-level guidance is complemented by accessible testing and treatment, supportive workplace policies, and community environments that visibly reinforce protective behaviors. Full article

Background: In multicultural healthcare systems such as the Italian one, migrant children may experience dental care as particularly stressful because linguistic and cultural barriers can limit communication, emotional expression, and understanding of the clinical setting. Aim: Understanding the emotional experience of migrant children during dental visits is essential for improving clinical management in pediatric dentistry and orthodontics within multicultural contexts. Because linguistic barriers often limit verbal communication, this study aimed to explore children’s mental representations, emotional states, and perceptions of the dental environment through drawing and to evaluate the clinical implications for communication and therapeutic collaboration. Methods: This qualitative study was conducted in Italy between 2016 and 2025 and analyzed 50 drawings produced by 50 foreign-born migrant children aged 6–13 years, recruited through an educational cooperative in Piacenza. Most participants originated from developing countries and had limited proficiency in Italian, frequently showing a marked “experience gap” in drawing ability that interfered with normative developmental stages described by Lowenfeld. The analysis focused on spatial organization, line quality, color use, posture, interpersonal distance, and representation of the clinical environment, integrating graphic competence assessment with emotional interpretation. Results: Younger children commonly depicted rigid lines, essential settings, and oversized dental unit lamps, whereas older children increasingly represented threatening or disproportionate instruments, aggressive dentists, and omission of the patient figure. Around age 10, drawings became more detailed and colorful, although symbols of closure, such as locked doors, persisted. In adolescents, representations polarized between rich, coherent scenes and extremely essential drawings dominated by fear, rigidity, minimal environments, and symbols of constraint. The findings suggest that drawing may represent a valuable non-verbal clinical and communicative resource for exploring migrant children’s emotional experience of dental care and for identifying signs of anxiety and vulnerability that may not emerge through verbal interaction alone. Conclusions: These findings support the value of a culturally sensitive dental approach integrating drawing, visual aids, multilingual educational materials, and play-based strategies to reduce communication barriers and improve cooperation in migrant children receiving pediatric dental and orthodontic care. Full article

Background: Informal caregivers experience elevated psychological distress but face substantial challenges in accessing mental health support. Prior research has focused primarily on individual or interpersonal determinants, with less attention to how organizational, community, and policy contexts shape access and contribute to inequities in service availability. Methods: Fifty-one stakeholders, including 17 informal caregivers, 23 community health workers (CHWs), and 11 mental health professionals, completed a demographic survey and 60–90-min semi-structured interviews in English or Spanish. Data were analyzed using thematic analysis, combining deductive coding guided by the Socioecological Model with inductive identification of emergent themes. Results: Participants identified both barriers and supports influencing access to caregiver mental health support across socioecological levels. Individual-level barriers included limited mental health literacy, stigma, competing responsibilities, and language or technology challenges. Interpersonal barriers reflected family minimization of distress and limited encouragement for help-seeking. Organizational barriers involved program instability, restrictive eligibility criteria, long wait times, limited cultural responsiveness, and workplace constraints, while community-level influences included stigma and scarce affordable services. Policy-level barriers reflected immigration-related exclusions and the absence of caregiver-specific mental health coverage. Identified supports, such as CHW navigation and culturally responsive services, were often constrained by structural and organizational limitations. Conclusions: Caregivers face intersecting, multilevel barriers that constrain access to mental health support, while available supports are frequently insufficient to overcome structural constraints. Findings highlight the need for coordinated public health and systems-level strategies that address organizational and policy conditions shaping equitable access to caregiver mental health care. Full article