Search Results (7,376)

Background: Evidence-based practice (EBP) is a cornerstone of high-quality and safe nursing care. However, undergraduate nursing students often experience cognitive, methodological, and contextual barriers to learning and applying EBP. Active teaching strategies, such as the flipped classroom, may support the development of EBP competencies, yet qualitative evidence exploring students’ learning experiences remains limited. Objectives: To explore nursing students’ perceptions and experiences of learning evidence-based practice through a flipped classroom model. Methods: A qualitative descriptive study was conducted at the Faculty of Nursing of the University of Murcia (Spain). Purposeful maximum variation sampling was used to recruit undergraduate nursing students from the second and fourth academic years who had completed an EBP course delivered using a flipped classroom approach supported by an online learning platform. Twenty semi-structured interviews were conducted via videoconference. Data were transcribed verbatim and analyzed using reflexive thematic analysis with independent coding by two researchers and consensus procedures. Ethical approval and confidentiality were ensured. Results: Three main themes were identified: (1) transformation of the meaning of EBP learning and professional role, (2) cognitive and metacognitive processes in EBP learning, and (3) the learning experience as a catalyst for deep learning. Students described a shift from initial fear and perceived difficulty toward recognizing the practical value of EBP, accompanied by increased critical thinking, autonomous learning, and a growing evidence-informed professional identity. The flipped classroom model facilitated engagement and understanding, while the transfer of learning to clinical practice was influenced by contextual facilitators and barriers. Conclusions: Learning EBP through a flipped classroom was experienced as a transformative process that fostered critical thinking, self-regulated learning, and the construction of an evidence-oriented professional identity among nursing students. Strengthening information literacy skills and improving alignment between academic and clinical environments may enhance the sustainable application of EBP in clinical practice. Full article

The COVID-19 pandemic intensified communication challenges for community college leaders navigating prolonged uncertainty and organizational disruption. This qualitative study examines how community college administrators described and interpreted their communication practices during the pandemic. Guided by the Elaboration Likelihood Model (ELM), this study explores how leaders made sense of message design, audience responsiveness, and trust under conditions of information overload and emotional strain. Semi-structured interviews were conducted with twelve administrators from community colleges across the United States, including presidents, vice presidents, and senior-level directors. Data were analyzed using reflexive thematic analysis. Five themes emerged: communication breakdowns between employee groups; tailored messaging for specific constituencies; preferences for in-person and interactive communication; trust-building through transparency; and reliance on collaborative communication structures. Participants described communication as an ongoing relational and organizational practice rather than a one-time transmission of information. Administrators reported adapting strategies by combining repetition, audience-specific framing, interactive formats, and structural supports to manage uncertainty and sustain institutional trust. Findings are not intended to be generalizable but provide contextually grounded insight into leadership communication during an extended crisis. This study contributes to scholarship on higher education leadership and crisis communication by illustrating how persuasion, sensemaking, and relational cues intersected in administrators’ communication practices. Full article

Research on how patients and family carers experience their relationships with physicians and healthcare staff is limited, particularly regarding the gap between ideal expectations and actual care. This study explored patients’ and carers’ perceptions of the ideal care relationship, their lived experiences, and factors shaping discrepancies between expectations and reality. A total of 143 individual, face-to-face semi-structured interviews (mean age = 56.7 ± 13.2; 61.4% women) were conducted with 57 cancer patients and 86 family carers in outpatient oncology clinics in Southern Italy. Participants were recruited through purposive sampling and interviewed separately, with carers recruited as an independent group. Transcripts were analysed using Thematic Analysis of Elementary Contexts (TAEC), a mixed-methods approach combining qualitative and quantitative techniques. Methodological rigor and trustworthiness were ensured in line with COREQ reporting guidelines. Four thematic clusters emerged: “Variability in the experience,” “The ideal care relationship,” “Waiting times and delays in care,” and “The luck of being cared for by a good physician.” Oncology care experiences emerge as inherently ambivalent: supportive in interactions with clinicians, yet tension-laden due to systemic and organizational constraints. These findings suggest that strengthening patient- and family-centered care requires both relational improvements and organizational interventions aimed at reducing waiting times, enhancing care integration across fragmented pathways, and improving continuity of care. Full article

This study investigates Chinese students’ perspectives on leveraging Generative Artificial Intelligence (GenAI) to enhance reading and writing abilities in preparation for the language learning and examination. 76 students enrolled in an online virtual learning environment (VLE) and participated in forum discussions prompted by questions relating to AI use and different study practices. Analysis identified 33 detailed forum posts written by and between students that specifically engaged in discussions concerning the use of AI to support English as an Additional Language (EAL) fluency, academic reading/writing skills, and IELTS-related skills development. This article presents an analysis of these contributions using thematic analysis. An inductive approach enabled the identification of key themes relating to students’ perceptions. Findings indicated that students appreciated AI’s capacity for personalised language learning, reading and writing practice while expressing reservations about overreliance on digital tools. The concept of Artificially Intelligent Mediated Counterbalance (AIMC) is proposed to capture students’ reported strategies for integrating AI tools with traditional study methods to maintain authentic language development. The article concludes by discussing the implications of AIMC for educators and policymakers seeking to support the responsible integration of AI into language education. Full article

Voluntary placement agreements are a less understood avenue through which children and families receive child welfare services. This article describes a qualitative exploratory study of participants who oversee and engage with children and families utilizing voluntary placement services in two states (n = 12). Thematic analysis of interviews revealed voluntary placements are used as a strategy for strengths-based engagement with families, including creative problem-solving, to help obtain resources for youth with emotional and behavioral health needs. Participants also described challenges managing ambiguity regarding the use of voluntary placements and acknowledged limitations and varied outcomes of voluntary placement. Youth in voluntary placements are often overlooked in broader child welfare and foster care practice and policy discussions. Stronger accountability and guidance on voluntary placements are needed to ensure children and families are provided adequate supports to reduce the need for out-of-home placements when possible. Full article

Background: Globally, rates of children with physical and mental health problems are increasing. Health issues in early childhood often persist into adulthood, highlighting the need to ensure children are supported to flourish from the start of life. Objectives: This protocol describes methods used to test the acceptability and feasibility of a novel digital Flourishing Intervention (designed to empower parents and promote child wellbeing), comprising a Flourishing Check (a newly developed online questionnaire) and a Pathway Tool (an online directory of high-quality, evidence-based programmes and resources). Methods: Using a randomised feasibility trial, participants (N = 600 parents of children aged 0–5 years) will complete the Flourishing Check. The intervention group (n = 400) will access the Flourishing Check and Pathway Tool, whereas a waitlist control group (n = 200) will access the Flourishing Check only. Results: The primary aim is to assess the acceptability and feasibility of the intervention through a mixed-methods design incorporating quantitative data from pre- and post-intervention questionnaires and qualitative data from focus groups. This will be assessed using a traffic light system, which will inform if and how to proceed to a future effectiveness trial. Secondary aims are to assess changes in parent and child outcomes. Primary outcomes will be assessed using descriptive statistics and thematic analysis. Secondary outcomes will be analysed using mixed-effects regression models. Conclusions: We anticipate that the Flourishing Intervention will be feasible and acceptable to parents. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12626000187347). Full article

Background: Telehealth has expanded access to care for people with chronic diseases, but little is known about how patients in Jordan become activated, motivated, and ready to use these services, particularly during early adoption. Aim: To explore how patients with chronic diseases in Jordan describe their initial activation, readiness, and experiences with telehealth services. Methods: This exploratory qualitative study used interviews with 14 purposively selected adults with chronic diseases from three hospitals in Jordan. Data was analyzed using Braun and Clarke’s six-step thematic analysis. Results: Four interrelated themes emerged. First, patients valued telehealth for preserving independence and ensuring continuity of care, particularly by reducing reliance on family members for transportation to health facilities. Second, readiness was shaped by geography, mobility, and finances. Although telehealth reduced transport costs and lost wages, patients still had to pay for devices and internet access, creating an economic paradox for poorer patients. Third, participation was supported by families but hindered by low digital literacy, platform changes, and unstable internet connectivity. Fourth, trust in telehealth was conditional and depended on patients’ perceptions of convenience and responsiveness. Conclusions: Readiness to use telehealth was relational, structural, experiential, and conditional rather than purely individual. Patients with chronic diseases in Jordan need hybrid care models that engage families and leverage affordable digital technologies to support sustained telehealth use for disease management. Full article

Estimates suggest that approximately 400 million dogs are kept as pets worldwide. Despite their popularity, around 10% to 30% are surrendered to rescue shelters each year. Shelter workers play a pivotal role in the success of dog adoptions and provide ongoing support to help owners keep these dogs in their homes. However, research that captures their perspectives and experiences regarding the dog adoption process remains limited. Royal Society for the Prevention of Cruelty to Animals Queensland shelter teams participated in six focus group discussions to share their perspectives and experiences of the dog adoption process in their shelters. Reflexive thematic analysis of the gathered data generated three themes: 1. “Doing great adoptions” starts with an inclusive, well-resourced application process and a skilled team. 2. Finding the right fit involves navigating the duality of carer and advocate through honest, informative interactions with the whole family. 3. Successful outcomes involve supporting and educating the public to care for and keep their dog. This grounded understanding of the challenges facing shelters in their work could provide valuable feedback to help shelter leaders and staff develop policies and practices that support positive adoption outcomes, tailor programmes to local needs, and reduce return rates. Full article

The project aimed to explore the psychosocial impact on parents of receiving a false-positive outcome following a positive newborn bloodspot screening (NBS) result for SCID for their child. A mixed-methods design was employed using semi-structured interviews and standardised health-related questionnaires (EQ-5D-5L, ITQOL-47, and GAD-7). The participants were recruited from six National Health Service hospital trusts in England involved in the NHS England In-Service Evaluation of Screening for SCID. A total of 22 interviews were conducted with 28 parents. Health-related questionnaire data were collected from 26 of these parents. The interviews were analysed using a reflexive deductive approach to thematic analysis. For the health-related questionnaire data, a comparison of group means against population norms was undertaken using t-tests with unequal variances. The findings from the interviews showed that receiving a false-positive outcome following a positive NBS SCID result could cause parents to have an enhanced view of their child’s vulnerability in the short term. However, negative sequelae were largely mitigated as parents viewed their child’s exposure to ‘normal’ infections as evidence of a functional immune system. The health-related questionnaire data showed that the parents had significantly worse health than the population norm (as indicated by EQ-VAS: p = 0.0296); however, all the other measures were non-significant. More research is needed to explore the potential longer-term psychosocial impact of a false-positive screening result for SCID on parents beyond their child’s first year of life. Full article

The integration of sustainability into strategic management (SSM) has drawn increased academic interest, yet the literature is conceptually fragmented and lacks a cohesive framework that systematically describes the integration of SSM. This study seeks to fill this gap and uncover the essential strategic dimensions, driving forces, and influencing variables that shape the integration of SSM and planning. This study conducts a systematic literature review (SLR) of peer-reviewed articles indexed in the Web of Science and Scopus databases. Through the application of established search parameters and content analysis methodologies, 30 relevant studies are identified and examined. Under a management theory lens, this study synthesizes the literature using a systematic search method and thematic classification approach. The results show that the interaction between internal capabilities and external pressures leads to the formation of sustainable integration. Stakeholder participation, operational integration, governance and leadership commitment, strategy alignment, and sustainability performance evaluation are important factors. The findings also point to important enabling and limiting variables, including the lack of defined measures, regulatory uncertainties, and resource constraints. This study proposes a structured conceptual framework that connects organizational integration mechanisms, strategic drivers, and sustainable results based on these discoveries. This work contributes to the literature on sustainability-oriented strategic management by offering a theory-driven synthesis and highlighting important boundary conditions. It also provides practical implications for practitioners and researchers alike. Full article

Uncertainty is a central feature of sport and has been extensively examined in sport science, primarily from performance-oriented perspectives such as anticipation, decision-making, and motor control. However, less attention has been given to how athletes subjectively perceive and experience uncertainty and how these interpretations shape their responses. The present study addresses this gap by exploring athletes’ lived experiences of uncertainty in sport. Using a qualitative design, semi-structured interviews were conducted with former youth athletes from various sports. Data were analyzed using thematic analysis, generating 15 themes organized across key dimensions of uncertainty, including unpredictability, lack of information, internal versus external sources, and the appraisal of uncertainty as a threat or a challenge. Findings indicate that uncertainty is experienced as a multifaceted and subjective phenomenon shaped by perceived control, prior experience, and situational context. Athletes differed in how they interpreted uncertainty, with some perceiving it as threatening and others as an opportunity for growth, which in turn influenced emotional responses and coping strategies. Key coping mechanisms included communication, information seeking, social support, and focusing on controllable aspects of performance. These findings extend existing sport science literature by integrating experiential and interpretative dimensions of uncertainty with established performance-based approaches. Furthermore, the results suggest conceptual links with the construct of intolerance of uncertainty (IU), highlighting the potential value of examining individual differences in how athletes appraise and manage uncertainty. The study provides an exploratory foundation for future research integrating IU within sport contexts and underscores the importance of addressing both subjective and performance-related aspects of uncertainty in sport psychology. Full article

Background/Objective: In Spain, 99% of births occur in hospital settings, and planned home birth is neither funded nor regulated by the Public Health System. Despite growing interest in this birth option, qualitative evidence exploring the experiences of women who opt for a planned home birth after a previous hospital birth remains scarce, particularly in contexts where this practice is not integrated into the healthcare system. This study aimed to explore the perceptions and experiences of Spanish women who opted for a planned home birth following a previous hospital birth, focusing on the reasons that motivated this decision and the care received during the process. Methods: A qualitative descriptive design was employed. Semi-structured interviews were conducted between July and December 2025 with 19 women who had experienced a planned home birth in Spain after a previous hospital birth. Data were analysed using inductive thematic analysis following Braun and Clarke’s approach. The study adhered to the Standards for Reporting Qualitative Research (SRQR). Results: Three main themes emerged: (1) motives related to choosing a planned home birth, including negative hospital experiences characterised by loss of autonomy, medicalisation of birth without consent, and fragmented care; (2) seeking a physiological and humanised birth, reflecting women’s desire for empowerment, control, and a transformative experience, alongside barriers such as lack of professional support and financial burden; and (3) the need to increase visibility and establish regulation, highlighting demands for professional training, dissemination strategies, and integration of planned home birth into the Public Health System to ensure equitable access. Conclusions: Women who opted for a planned home birth after a hospital experience reported highly positive and empowering outcomes. However, the absence of regulation, professional support, and public funding creates significant inequalities. Integrating planned home birth into the Public Health System, educating healthcare professionals, and developing strategies to increase the visibility of planned home births are essential to guarantee women’s right to choose where they give birth. Full article

Artificial intelligence (AI) systems and tools are increasingly reshaping educational practices. This study examines perspectives shared in student-focused online communities on AI’s impact on education, comparing those of computer science (CS) and business students through an analysis of Reddit posts. Using natural language processing (NLP), sentiment analysis, and Latent Dirichlet Allocation (LDA) topic modeling, we analyzed 1108 posts collected from six subreddits. Results reveal distinct thematic focuses: CS students emphasize technical aspects, including programming efficiency, coding assistance, and concerns about job displacement, while business students focus on decision-making enhancement, financial analysis applications, and operational efficiency. Sentiment analysis indicates that the Business/Finance-oriented corpus is slightly more positive than the CS-oriented corpus (51.9% vs. 50.1% positive). The CS-oriented corpus also contains a higher proportion of negative posts (36.0% vs. 33.2%). These differences reflect discipline-specific epistemological frameworks shaping AI perception. The findings provide educators with guidelines for developing tailored AI integration strategies that address discipline-specific concerns and opportunities. This study contributes to understanding how academic background influences perceptions of AI in education, offering insights for curriculum design and policy development. Full article

This article examines how algorithmic classification systems participate in the production of meta-identities, understood as operational classificatory constructs that mediate the visibility, circulation, and interpretation of digital content and its authors. The study employs a mixed-methods design combining controlled analytical simulation with qualitative interpretive analysis, systematic thematic coding, and comparative statistical procedures. Empirical data are derived from the analysis of 150 audiovisual works produced in formative workshops and interpreted by four types of agents: authors, peers, specialized human analysts, and two Large Language Model-based AI systems (ChatGPT and Gemini). Interpretations were analyzed across micro, meso, and macro levels, using a consolidated system of thematic categories with hierarchical weighting and normalization procedures to ensure inter-agent comparability. The results demonstrate a systematic and structural divergence between human and algorithmic classifications. While human agents preserve semantic plurality and contextual anchoring, AI systems tend to reorganize thematic hierarchies through semantic aggregation and stabilization, thereby privileging broad, reusable categories. This process produces recurring, opaque classificatory patterns that serve as infrastructural references for subsequent algorithmic decisions. The article contributes methodologically by offering a replicable framework for comparing human and algorithmic regimes of meaning production in digital environments. Full article

Health and spa tourism is a rapidly growing sector that merges traditional healing with modern innovations to meet increasingly diverse client needs. Understanding professionals’ perspectives is crucial for developing sustainable strategies that enhance service quality, organizational performance, and long-term business viability. Drawing on qualitative narrative analysis and thematic network analysis, this study explores the key factors that spa tourism professionals in Băile Felix—the largest spa resort in Romania—associate with business success, competitive differentiation, and sustainable development. Data were collected through semi-structured interviews with 41 entrepreneurs and managers who provided detailed narratives on their strategic goals and market positioning. Rather than measuring customer psychological constructs directly, this study captures professionals’ expert attributions regarding service quality, staff professionalism, infrastructure investment, and economic objectives, and interprets these as managerial perceptions grounded in operational experience. Five research propositions guided the interpretive analysis: (P1) professionals narratively associate service quality and treatment diversity with perceived business performance and guest retention signals; (P2) staff professionalism and attitude are attributed as the primary drivers of competitive differentiation; (P3) infrastructure investment and innovation are framed as prerequisites for sustaining market positioning; (P4) the identified themes form a structurally interconnected network with key bridging nodes; and (P5) professional narratives reveal tensions between short-term economic objectives and longer-term commitments to service quality and sustainability. Thematic network analysis identified four central constructs—service quality and treatment diversity, staff professionalism and attitude, innovation and infrastructure investment, and economic and development objectives—and mapped 16 interconnected sub-themes, with modularity analysis (Q = 0.42) confirming a moderately cohesive structure. Sustainable innovation was operationalized across environmental efficiency, social value, and economic resilience dimensions, and found to be embedded systemically across multiple thematic clusters rather than treated as an isolated practice. The originality of this study lies in integrating narrative and thematic network analysis to reveal how these constructs co-evolve within a sustainability-oriented system, offering a novel methodological lens for spa tourism research in post-transitional Central and Eastern European contexts. Findings provide actionable insights for spa managers, policymakers, and investors seeking to balance modernization with tradition in resource-constrained destinations. Full article