This study aims to describe the experiences of women with gynaecological cancer regarding family-oriented care (FOC) and how they rated their health-related quality of life (HRQoL) using a 15D instrument (15D©).
A cross-sectional mixed-method study.
The data were collected by electronic surveys of two Finnish cancer associations from gynaecological cancer patients (n = 53). The qualitative data were analysed using thematic analysis. The HRQoL answers were analysed statistically using IBM SPSS Statistics (Version 27).
The results emphasized that FOC is not yet part of the care process. Furthermore, comprehensive encounters are lacking, and the experience of being a woman is forgotten during the care process. The results of the HRQoL analysis suggest that distress and the discomfort and symptoms of cancer patients are perceived as significant factors affecting their quality of life during different phases of treatment. Family status also has an impact on perceived quality of life, whereby those living alone gave worse ratings for the depression and vitality dimensions.
In part, the quantitative and qualitative data supported each other, but the descriptions provided a more comprehensive view of issues that affect women in a more multidimensional way, such as sexual health issues. More research on the effectiveness of FOC is needed to develop the capacity for effective healthcare.
This study was able to identify important areas for improvement in clinical practice from the perspective of patients and their families.
This study was prepared and reported according to the STROBE checklist.
No patient or public contribution.
To (a) seek examples of nursing caring success stories and (b) identify the common contributors to these successes. By focusing on the successes of nursing care rather than critically examining failures, this research seeks to provide examples of proven and feasible approaches and processes for improving care.
This study used a narrative inquiry design.
Data were collected through group interviews. Four interviews were conducted with a total of 20 nurse participants working in inpatient settings in South Australian hospitals. A thematic analysis approach was used to analyse the data.
Two dominant themes concerning the contributors to caring success were identified. These contributors were (1) the provision of holistic care and (2) the influence of the caring community, which includes family members and other patients. The findings also indicated that the definition of caring success according to nurses is not aligned with organisational performance indicators but is more closely represented by caring values.
Success, according to nurses, is not exclusively defined by patient outcomes but includes the approach to, and process of, care delivery.
Nurses value the caring process while working in an environment that primarily values clinical and systems-level outcomes. Nurses want patients and their families, allied health professionals and hospital executives to be involved and invested in the process of care.
This study addressed a gap in the current literature to identify commonalities in nursing success stories, the contributors informing these successes and how these contributors can facilitate improved patient care. Understanding nursing definitions of caring success provides an opportunity to expand upon current accepted industry definitions and perspectives such as key performance indicators.
Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
No direct patient or public contribution.
To explore the effectiveness of interventions to enhance patient participation in shared decision-making in wound care and tissue viability.
Caring for people living with a wound is complex due to interaction between wound healing, symptoms, psychological wellbeing and treatment effectiveness. To respond to this complexity, there has been recent emphasis on the importance of delivering patient centred wound care and shared decision-making to personalise health care. However, little is known about the effectiveness of existing interventions to support shared decision-making in wound care.
Systematic review of interventional studies to enhance shared decision-making in wound care or tissue viability. This was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020.
Interventional primary research studies published in English up to January 2023 were included. Screening, data extraction and quality appraisal were undertaken independently by two authors.
Medline, EMBASE, Cochrane Central Register of Controlled Trails (trials database), CINAHL, British Nursing Index (BNI), WorldCat (thesis database), Scopus and registries of ongoing studies (ISRCTN registry and clinicaltrials.gov).
1063 abstracts were screened, and eight full-text studies included. Findings indicate, interventions to support shared decision-making are positively received. Goal or need setting components may assist knowledge transfer between patient and clinician, and could lower short term decisional conflict. However, generally findings within this study had very low certainty due to the inconsistencies in outcomes reported, and the variation and complexity of single and multiple interventions used.
Future research on shared decision-making interventions in wound care should include the involvement of stakeholders and programme theory to underpin the interventions developed to consider the complexity of interventions.
Patients setting out their needs or goals and exploring patient questions are important and should be considered in clinical care.
The review protocol was prospectively registered (PROSPERO database: CRD42023389820).
Not applicable as this is a systematic review.
The aim of this study was to explore home care nurses' experience of enablers and barriers for planned home death in municipal health care.
A focused ethnography.
This qualitative study collected data from 20 semi-structured interviews of home care nurses and 8.5 h of participant observations. Data was analyzed using thematic analysis.
The findings in our study show that home care nurses consider supportive cultures, a commitment to safety and continuity when facilitating planned home deaths and family rotations to be enablers for planned home deaths. Barriers to planned home deaths involve a lack of palliative experience affecting confidence, shortages of nurses and medical supplies and night shift challenges.
This study underscores the need for supportive organizational cultures, ongoing education and improved communication and staffing policies to enhance the quality of care and the experiences of patients and home care nurses, especially in the context of planned home deaths.
The study adds knowledge to the evidence base of the practice of facilitating planned home deaths. The findings of the study could offer valuable insights for shaping future policies or devising effective implementation strategies.
Adherence to the COREQ guidelines for reporting qualitative research was maintained.
No patient or public contribution.
Identified enablers and barriers provide a new perspective, contributing to a comprehensive understanding of planning home deaths. The study emphasizes supportive cultures, safety commitment and family rotations as crucial for planned home deaths, guiding healthcare professionals to adopt best practices and enhance palliative care quality.
To achieve an in-depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self-care.
The study employed a qualitative explorative design utilizing a phenomenological-hermeneutic inspired approach, involving field observations and individual semistructured interviews.
Data were collected during 2020–2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research.
Three key themes emerged: ‘Diabetes when life is noisy’, ‘Sacrifices and compromises in life’ and ‘The double silence’. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self-care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long-term complications as a serious medical condition demanding careful attention and treatment.
Self-managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways.
The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support.
To explore predictors of spiritual well-being behaviors among heart failure patients based on Wilson and Cleary's conceptual model of health-related quality of life and to clarify the interrelationships among these variables.
A descriptive and correlational study design was used.
This study included 202 heart failure patients treated between October 2020 and July 2021. Data were collected using the Symptom Status Questionnaire-Heart Failure, Perception of Health Scale, and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale. Descriptive analysis, correlation, and structural equation modeling were performed.
Characteristic factors positively affected spiritual well-being both directly (β = 0.19, p = 0.007) and indirectly (β = 0.19; CI (0.106; 0.311)). The direct relationship between health perception and spiritual well-being was significant (β = 0.83, p < 0.05). Symptom status acted as an essential mediator between model variables and spiritual well-being (β = −0.28; CI (−0.449; −0.133)). Comorbidity and symptom status also influence spiritual well-being through health perceptions. These variables explain 77% of the variance in spiritual well-being.
The modified structural equation modeling based on Wilson and Cleary's conceptual model fits well in predicting spiritual well-being in patients with heart failure. Spiritual well-being was reported to be poor, and changes in spiritual well-being were predicted by age, educational level, marital status, comorbidity, symptom status, and health perception. The results can be applied to patients with heart failure and may serve as a guide for assessment and interventions for improving spiritual well-being.
This study mainly concludes that symptom status and perceived health status affect spiritual well-being in heart failure patients. Symptom relief and improvement in perceived health status interventions may help enhance spiritual well-being in this population. Future studies are needed to investigate the different predictor's effects on spiritual well-being and examine whether symptom management and health status-enhancing interventions result in improved spiritual well-being in the heart failure population.
This study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.
No patient or public contribution.
To examine the impact of implementing nurse-led consultations compared to physician-led consultations on the frequency of follow-up contacts within 14 days following an acute infectious consultation.
Monocentric, prospective cohort study.
The study was conducted in a multidisciplinary, capitation-based general practice in Belgium. Through analysis of patient files, the number of follow-up contacts within 14 days after an infection consultation was investigated to determine any difference between physician-led or nurse-led consultations. Secondary outcomes included pharmacological interventions and the prescribing behaviour of medical leave certificates.
A total of 352 consultations were analysed, of which 174 conducted by physicians and 178 by nurses. No significant difference was found in the number of follow-up contacts. However, the probability of a pharmacological intervention by a physician was revealed to be significantly higher. The presence or absence of such pharmacological intervention did not significantly influence the number of follow-up contacts.
This study demonstrates that nurses can be safely and efficiently utilized in acute infection care within a general practice setting. Although these results are promising, more extensive research is needed which incorporates the experiences of patients and healthcare providers. Furthermore, it is advisable to consider the experience and education of the nurses and incorporate them into the analyses.
This study addressed the high workload on general practitioners by researching a task shift in the acute infectious, primary health care. The results demonstrate the feasibility of this task shift, which may have an impact on primary health care professionals (whose workload may be reorganized), as well as on patients for whom primary care may become more accessible.
This study includes direct patient data from people who presented themselves with acute infectious complaints in a primary healthcare practice.
This study was conducted to examine the possible aetiology of nocturia in patients with long-term COVID-19.
Physical and neuropsychiatric symptoms, an increase in overactive bladder symptoms, especially from urinary system complaints, has been reported in patients with COVID-19, 10–14 weeks after the illness.
A descriptive design.
The study consisted of 70 patients who had experienced COVID-19, had nocturia, and were followed in the State Hospital between April and July 2022. Data were collected using a patient information form, the ‘TANGO’ nocturia screening tool, and the Visual Analog Scale. This study was created in accordance with the STROBE Statement Checklist.
When the nocturia effects of long-term COVID-19 were examined it was determined that the urinary tract was the ‘priority’ aetiological condition. It was observed that there was a significant difference between the aetiological factor groups in terms of the mean age of the patients and the number of nocturia (p < .05). According to post-hoc analysis, the mean age of patients with a dominant cardio-metabolic factor was found to be significantly younger (p < .05). In addition, when comparing the number of nocturia according to the aetiological factors of the patients, it was observed that the number of nocturia was significantly frequent in the patients with a dominant sleep factor (p < .05).
It was found that the urinary tract aetiological factor was dominant in patients with long-term COVID-19 and nocturia, patients with a dominant cardiovascular aetiological factor were younger, and that the number of nocturia was higher in patients with a dominant sleep factor.
Identification of the early signs and symptoms and underlying causes of nocturia in individuals with post-COVID-19 syndrome will enable nurses and health professionals to guide the early identification of different underlying problems, as well as the implementation of approaches to treat and eliminate nocturia.
The patients contributed to the study by agreeing to participate in the evaluation of nocturia complaints after COVID-19 infection.
To explore challenges in everyday life for people with long-term cognitive effects of COVID-19 and whether a rehabilitation programme contributed to the remedy thereof.
Healthcare systems around the world need knowledge about acute COVID-19 treatment, long-term effects exerting an impact on peoples' everyday lives, and how to remedy these.
This is a qualitative study with a phenomenological approach.
Twelve people with long-term cognitive effects of COVID-19 participated in a multidisciplinary rehabilitation programme. Individual semi-structured interviews were made. Data were analysed thematically.
Three themes and eight sub-themes emerged with respect to everyday life challenges and experiences of the rehabilitation programme. The themes were (1) Personal insight and knowledge, (2) Changed daily routines at home and (3) Coping with working life.
Participants experienced long-term effects of COVID-19 as cognitive challenges, fatigue and headaches, which affected their everyday lives, that is inability to overcome daily tasks at home and at work, maintaining family roles and relations with relatives. The rehabilitation programme contributed to a vocabulary and insights related to the long-term effects of COVID-19 and the experience of being a different person. The programme contributed to changes in daily routines, organising breaks in everyday life and explaining challenges to family/relatives and the way in which they affected daily routines and their role in the family. In addition, the programme supported several of the participants in finding the right workload and working hours.
We recommend multidisciplinary rehabilitation programmes inspired by cognitive remediation of long-term COVID-19 cognitive effects. Municipalities and organisations could collaborate in the development and completion of such programmes, possibly comprising both virtual and physical elements. This could facilitate access and reduce costs.
Patients contributed to the conduct of the study by participating in the data collection via interviews.
Data collection and processing of data are approved by the Region of Southern Denmark (journal number: 20/46585).
University students are generally quite active in social life. It is thought that their fear of contagion/being contagious will affect their depression, anxiety and stress levels due to the removal of restrictions and the increase in individual responsibilities. This study aims to determine the effect of fear of contagion/being contagious on depression, anxiety and stress levels of university students during the COVID-19 pandemic.
This study, descriptive and cross-sectional. Quantitative data were collected using the Demographic Information Form, the Fear of Contagion/Transmission Scale and the Depression-Anxiety-Stress Scale. The sample included 3500 participants. Descriptive statistics were used for the presentation of the results. The STROBE checklist for cross-sectional studies was used in this study.
This study revealed that the depression, anxiety and stress levels of university students were above normal, and these results were mostly associated with females, those with a chronic disease and high fear of contagion/being contagious.
The findings of this study may be useful for precautionary plans to support the psychological health of university students after the COVID-19 pandemic and in the fight against possible new pandemics. Considering the findings of our study, educational programs should be planned for youth in general and university students in particular to deal with depression, anxiety, stress and fears.
The depression, anxiety and stress levels of university students were above normal. As the fear of contamination and contagion increases, the level of depression, anxiety and stress increases. Those with chronic diseases have high levels of depression, anxiety and stress.
Research data were collected through an online questionnaire. Data collection tools were prepared on Google Forms, and then, links were shared with student groups over social media. Students shared the link on their social platforms, allowing it to reach wider audiences.
To explore the lived experience of advanced preparation nurses (APNs) who are mothers (APN-mothers) as they seek care in the Emergency Department for a child with a chronic disease.
Qualitative, Narrative Inquiry.
Narrative Inquiry was used to examine critical self-reflections of four (n = 4) APN-mothers. Directed by a question guide, participants engaged in the Narrative Reflective Process through metaphoric and artistic means.
Participants identified salient challenges associated with their experiences. Narrative threads that emerged include feelings around being discovered, unfair expectations by healthcare providers, feelings of guilt and the tension from competing roles: APN and mother.
APN-mothers represent a unique population with enhanced knowledge, skills and judgement; however, they indicate that there is insufficient communication and interprofessional collaboration between parents and Emergency Department staff. Further research is needed to foster and improve therapeutic relationships between APN-mothers and healthcare providers.
Findings can inform the development of family centred care guidelines for healthcare professional parents and their children.
This study explores the experiences of an understudied population. This research will impact APN-mothers, healthcare professionals in the Emergency Department as well as nursing students and researchers.
EQUATOR guidelines and SRQR reporting method used.
APN-mothers, caregivers and support persons of children with chronic disease enacted investigator-participant roles and were involved in each step of the study process. In addition, some patients (participants' children with chronic diseases) were included in data collected.
To explore the practice of mobilisation of conscious and mechanically ventilated patients and the interaction between patients, nurses and physiotherapists.
Long-term consequences of critical illness can be reduced by mobilisation starting in Intensive Care Units, but implementation in clinical practice is presently sparse.
A qualitative study with a phenomenological-hermeneutic approach.
Participant observations in three Intensive Care Units involved twelve conscious mechanically ventilated patients, thirty-one nurses and four physiotherapists. Additionally seven semi-structured patient interviews, respectively at the ward and after discharge and two focus group interviews with healthcare professionals were conducted. The data analysis was inspired by Ricoeur's interpretation theory. The study adhered to the COREQ checklist.
Healthcare professionals performed a balance of support and guidance to promote mobilisation practice. The complexity of ICU mobilisation required a flexible mobility plan. Furthermore, interaction with feedback and humour was found to be ‘a leverage’ for patient's motivation to partake in mobilisation.
The practice of mobilisation found patients striving to cope and healthcare professionals promoting a ‘balanced standing by’ and negotiating the flexible mobility plan to support mobilisation.
The study revealed a need to clarify interprofessional communication to align expectations towards mobilisation of conscious and mechanically ventilated patients.
The study demonstrated the important role of healthcare professionals to perform a stepwise and ‘balanced standing by’ in adequately supporting and challenging the mobilisation of mechanically ventilated patients. Furthermore, a synergy can arise when nurses and physiotherapists use supplementary feedback and humour, and cooperate based on a flexible situation-specific mobility plan in intensive care.
Commentary on: Verhoeven JE, Han LKM, Lever-van Milligen BA, et al. Antidepressants or running therapy: comparing effects on mental and physical health in patients with depression and anxiety disorders. J Affect Disord 2023;329:19–29. doi: 10.1016/j.jad.2023.02.064.
Supervised outdoor running at vigorous intensity leads to antidepressant and physical health benefits in outpatients with major depression or anxiety disorders. More pragmatic exercise trials for mental health outpatients with heterogeneous symptomatology are needed.
Exercise is associated with antidepressant effects in clinical settings but relevant research in pragmatic (real-life) settings is scarce.
Participants were physically inactive adult outpatients with a current major depression or an anxiety disorder and were treated with...
To explore hospital managers' perceptions of the Rapid Response Team.
An explorative qualitative study using semi-structured individual interviews.
In September 2019, a qualitative interview study including nineteen hospital managers at three managerial levels in acute care hospitals was conducted. Interview transcripts were analysed with an inductive content analysis approach, involving researcher triangulation in data collection and analysis processes.
One theme, ‘A resource with untapped potential, enhancing patient safety, high-quality nursing, and organisational cohesion’ was identified and underpinned by six categories and 30 sub-categories.
The Rapid Response Team has an influence on the organization that goes beyond the team's original purpose. It strengthens the organization's dynamic cohesion by providing clinical support to nurses and facilitating learning, communication and collaboration across the hospital. Managers lack engagement in the team, including local key data to guide future quality improvement processes.
For organizations, nursing, and patients to benefit from the team to its full potential, managerial engagement seems crucial.
This study addressed possible challenges to using the Rapid Response Team optimally and found that hospital managers perceived this complex healthcare intervention as beneficial to patient safety and nursing quality, but lacked factual insight into the team's deliverances. The research impacts patient safety pointing at the need to re-organize managerial involvement in the function and development of the Rapid Response Team and System.
We have adhered to the COREQ checklist when reporting this study.
“No Patient or Public Contribution”
To explore registered nurses' perspectives on challenges and facilitators to implementing a telephone-based self-management support (SMS) intervention (Proactive Health Support) as an everyday healthcare practice, during the early stages of implementation.
Data were collected using a qualitative research design involving focus-group interviews and participant observations.
We conducted participant observation following nine nurses and four focus group interviews with 14 nurses. Data were analysed using thematic analyses.
Proactive Health Support was implemented in units organized independently of the existing organizational units within healthcare services. This independent organization, along with the intervention's generic (non-disease specific) design, empowered nurses to become autonomous practitioners capable of prioritizing the operationalization of SMS as an everyday healthcare practice. However, unlearning already embedded medical practices and establishing new nursing roles necessary to accommodate the intervention in practice was experienced a challenge. Education and supervision were identified as valuable tools for successful implementation.
Our study highlights the significance of organizational context and autonomy in successful SMS implementation. Balancing external factors like organizational context, priority and time is vital, but navigating the internal shift in professional practice is equally crucial. Role transition processes can constitute challenges demanding accommodation.
From a nursing perspective, this study highlights that practising SMS requires substantial training and education. Generic SMS interventions can introduce higher levels of contingency due to their versatile nature. Thus, equipping nurses with competencies that enable them to navigate this unpredictability flexibly is crucial.
Policymakers and administrators should allocate resources and support implementation processes in ways that accommodate both internal and external conditions to facilitate nurses in delivering effective SMS.
This study adheres to the SRQR guideline.
No patient or public contribution.
The aim of this was to psychometrically adapt and evaluate the Tilburg Frailty Indicator to assess frailty among older people living in Slovenia's community and nursing home settings.
A cross-cultural adaptation and validation of instruments throughout the cross-sectional study.
Older people living in the community and nursing homes throughout Slovenia were recruited between March and August 2021. Among 831 participants were 330 people living in nursing homes and 501 people living in the community, and all were older than 65 years.
All items were translated into the Slovene language, and a slight cultural adjustment was made to improve the clarity of the meaning of all items. The average scale validity index of the scale was rated as good, which indicates satisfactory content validity. Cronbach's α was acceptable for the total items and subitems.
The Slovenian questionnaire version demonstrated adequate internal consistency, reliability, and construct and criterion validity. The questionnaire is suitable for investigating frailty in nursing homes, community dwelling and other settings where older people live.
The Slovenian questionnaire version can be used to measure and evaluate frailty among older adults. We have found that careful translation and adaptation processes have maintained the instrument's strong reliability and validity for use in a new cultural context. The instrument can foster international collaboration to identify and manage frailty among older people in nursing homes and community-dwelling homes.
The Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting cross-sectional studies was used.
No patient or public involvement in the design or conduct of the study. Head nurses from nursing homes and community nurses helped recruit older adults. Older adults only contributed to the data collection and were collected from nursing homes and community dwelling.
The commitment of nurses to their profession and workplace is closely linked to the delivery of high-quality patient care. Existing literature highlights the positive impact of commitment on care quality and patient outcomes. Conversely, a lack of commitment can lead to nurse burnout and disengagement. However, it remains unclear whether and how cultural beliefs and practices influence newly graduated nurses' commitment to the nursing profession and their workplace.
To explore the cultural beliefs and practices influencing newly graduated nurses' commitment to the profession and commitment to their workplace during their first year of employment.
A focused ethnographic study.
Data consisted of field notes from 94 h of participant observations and 10 semi-structured interviews with newly graduated nurses working in acute care settings in Denmark. Data were analysed using ethnographic content analysis. Data were collected between March and June 2022.
The findings reveal a major theme, termed ‘A State of Transience among Newly Graduated Nurses’, consisting of two themes: ‘Newly Graduated Nurses’ Pursuit of Professional Development and Supportive Work Environments' and ‘A Lack of Formal Agreements or Conditions to Meet Expectations for Professional Development.’
Hospitals and nurse managers need to support newly graduated nurses in their first employment after registration by providing a range of clinical experiences through job rotation opportunities within the same organization, deliver on promises for onboarding support and foster a culture of trust. These strategies will help maintain the motivation, commitment and ability of newly graduated nurses to deliver high-quality patient care, thereby reducing the likelihood of turnover.
A trusting and supportive work environment is fostered by providing diverse clinical experiences and consistent support for newly graduated nurses. To address potential high turnover associated with job rotation, hospitals need to rethink how retention is defined and measured, moving beyond hospital unit-level models and measures.
This study reports to the SRQR guidelines.
No patient or public contribution.
To explore how patients with Inflammatory bowel disease experienced encounters with healthcare professionals in two gastrointestinal outpatient clinics to demonstrate what matters in the communication between patients and healthcare professionals.
This fieldwork study is part of a larger study developing an application for patients with inflammatory bowel disease in a framework inspired by Participatory Design. Participatory design consists of three phases and this study focused on the first phase, needs assessment. A phenomenological hermeneutic approach and qualitative methods were applied to obtain an understanding of patients' needs.
Three weeks of participant observations and three focus groups with 14 subjects were conducted at two university hospitals in Denmark. Field notes and interview transcripts were analysed using condensation of meaning and interpreted based on interactional nursing practice theory. The reporting method adhered to the EQUATOR guideline: COREQ.
Four themes emerged: Easy and dependable access to healthcare professionals. Predictability of follow-up appointments. Importance of privacy during patient exams and Quality of time spent with healthcare professionals.
Easy, dependable access, privacy, presence and predictability of follow-up appointments were important to patients with Inflammatory Bowel Disease.
In communication with patients with inflammatory bowel disease, healthcare professionals must be aware of privacy and the importance of predictable follow-up agreements. They must be aware that presence and easy, reliable access positively affect patients' self-care skills.
This study is part of a larger project based on Participatory design involving patients and healthcare professionals in the development of technology to support communication.