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Aims and objectives: To evaluate acceptability, efficiency, and quality of a new digital care management system in a residential aged care home (RACH). Background: Improving care quality and efficiency in RACH, while simultaneously upgrading data management, is a priority for communities and governments. Design: Participatory action research with mixed methods data collection was employed to evaluate a digital care management system implemented at a 169‐bed RACH. This paper reports qualitative findings of the 2‐year evaluation. Methods: Qualitative data were collected using focus groups with residents, visitors, nurses, managers, care workers, and consultants; resident/visitor and staff hallway interviews and responses to open‐ended questions in online staff surveys. Data were analysed thematically under the four predetermined study objectives. Reporting adhered to COREQ guidelines. Results: 325 data captures from 88 participants, over seven data sources were coded. Findings indicate that the system was acceptable to both residents and staff due to perceptions of time‐saving and improved quality of care. Increased efficiency was perceived through timeliness as well as reduced time spent retrieving and documenting information. Quality of care was improved through care scheduling individualised to resident needs, with reminders to avoid missed care. Relatives were reassured and activities were scheduled to loved one's preferences. The co‐design implementation process was successful through commitment to quality from leadership teams and prioritising the focus on the holistic needs of the residents. Conclusion: A strong emphasis on co‐design with care staff in developing and implementing the digital care system contributed to a system that supported nursing and care work, facilitated reporting and documentation, and improved resident care and well‐being including identification of missed care. Relevance to Clinical Practice: Nurses, carers, administrators, and advocates can support the co‐design creation of information systems that suit the workflow of an organisation and keep the focus on individualised models of care provision. [ABSTRACT FROM AUTHOR]

Aim: To explore patients' and healthcare professionals' (HCPs) experiences of oral care during hospitalisation to identify needs and challenges. Background: Daily oral care is important to patients' health and well‐being, to prevent diseases in the oral cavity, systemic infections and increased morbidity, which subsequently can lead to prolonged hospitalisation and, at worst, increased mortality. Despite this knowledge, oral care is a neglected part of nursing practice. Studies do not clearly identify barriers regarding oral care, as the existing knowledge is inadequate. Design: A qualitative study exploring participants' experiences to gain new in‐depth knowledge of oral care among hospitalised patients. Methods: A phenomenological‐hermeneutic approach was applied. Participant observations were conducted on five hospital wards, combined with individual semi‐structured interviews with 16 patients and 15 HCP. Data analysis was based on Ricoeur's theory of narrative and interpretation. Results: Four themes describing the challenges regarding oral care emerged: Oral care as a gut feeling; oral care fades into the background; even self‐reliant patients need help with oral care; and the mouth reflects the life lived. Conclusions: The identified challenges show there is a need for improvement in the health professional approach to oral care in nursing practice. Focus on increasing HCPs' knowledge, skills and competences can increase their nursing agency and support patients' self‐care capacity. Impact: Investigation of oral care during hospitalisation revealed four main challenges concerning both patients' and HCPs' lack of knowledge and awareness of oral care. Thus, patients and HCPs should be included in developing solutions to improve oral care in nursing practice. Reporting methods: The COREQ criteria for reporting qualitative research were adhered to. Patient contribution: A patient representative was involved in the discussion of the proposal, conduct and results of the study. [ABSTRACT FROM AUTHOR]

Aim To identify and discuss the competencies required by learning disability nurses to work effectively with people with an offending background in low, medium, high secure and community settings. Background Research into the competencies required by nurses working with individuals with an offending background, particularly those with a learning disability, is limited. There is some uncertainty as to whether there should be differentiation according to specific setting. Design A qualitative study addressing the perceptions of nurses on the knowledge, skills and competencies required to effectively work with people with learning disabilities and an offending background in different settings. Methods Seven focus groups were conducted across the four settings to inform the construction of the semi-structured interview schedule. Thirty-nine interviews were subsequently undertaken with nurses across settings to develop a fuller understanding of the competencies and ascertain if these were influenced by the specific setting where the nurses worked. Data were collected over 1-year in 2010 and analysed using a structured thematic analysis supported by the software package MAXqda. Findings The thematic analysis produced four over-arching competencies: knowledge assimilation and application; team working; communication skills; and decision-making. A further competency around personal attributes constitutes the basis of a future paper. Conclusion The first three competencies combine well to inform the work of nurses and appear transferable across settings, but the fourth appears more complicated, specifically in terms of the role of risk in supporting or detracting from decision-making capacity. [ABSTRACT FROM AUTHOR]

Aim This paper is a report of a qualitative study conducted as part of a randomized controlled trial comparing a lay-facilitated angina management programme with usual care. Its aim was to explore participants' beliefs, experiences, and attitudes to the care they had received during the trial, particularly those who had received the angina management intervention. Background Angina affects over 50 million people worldwide. Over half of these people have symptoms that restrict their daily life and would benefit from knowing how to manage their condition. Design A nested qualitative study within a randomized controlled trial of lay-facilitated angina management. Method We conducted four participant focus groups during 2008; three were with people randomized to the intervention and one with those randomized to control. We recruited a total of 14 participants to the focus groups, 10 intervention, and 4 control. Findings Although recruitment to the focus groups was relatively low by comparison to conventional standards, each generated lively discussions and a rich data set. Data analysis demonstrated both similarities and differences between control and intervention groups. Similarities included low levels of prior knowledge about angina, whereas differences included a perception among intervention participants that lifestyle changes were more easily facilitated with the help and support of a lay-worker. Conclusion Lay facilitation with the Angina Plan is perceived by the participants to be beneficial in supporting self-management. However, clinical expertise is still required to meet the more complex information and care needs of people with stable angina. [ABSTRACT FROM AUTHOR]

Aim: To understand the postpartum care received by birthing people with disabilities and their newborns, from their own perspectives. Design: A qualitative study with semi‐structured interviews. Methods: Between July 2019 and February 2020, in‐person and virtual interviews were conducted with 31 people with physical, sensory, and intellectual/developmental disabilities in Ontario, Canada, about the formal inpatient and outpatient services and supports they used in the first few months after they gave birth. Thematic analysis was used identify common themes. Results: We identified three overall themes concerning participants' postpartum care experiences and the different types of formal services received in and out of hospital: (1) lack of adequate care, (2) lack of provider awareness of disability and disability accommodations, and (3) fear of judgement, discrimination, and intrusive surveillance. The identified themes were applicable across disability groups. However, most comments on disability accommodations came from participants with physical or sensory disabilities, while participants with intellectual/developmental disabilities most commonly reported concerns about lack of adequate care and fear of judgement, discrimination, and intrusive surveillance. Conclusion: Findings indicate that postpartum care often fails people with disabilities. This could contribute to negative health consequences for them and their newborns. Impact: Birthing people with disabilities need multidisciplinary, proactive, and strengths‐based postpartum care to mitigate risk for health complications. Further, disability‐related training and guidelines for health and social service providers is required. Reporting method: Consolidated criteria for reporting qualitative research (COREQ). Patient or Public contribution: Our research team included two peer researchers with physical disabilities who served as co‐interviewers and participated in data analysis, contributing their lived experience of disability and interactions with the health care system. All stages of the study were also informed by feedback from the study's Advisory Committee, which comprised women with disabilities (many of whom are parents), disability organization staff, clinicians, and policy representatives. [ABSTRACT FROM AUTHOR]

Background: Nurses working in intensive care units make autonomous decisions to manage high‐risk vasoactive medications in critically ill patients. Noradrenaline (norepinephrine) is a vasoactive medication commonly administered to patients in intensive care units. The influence of unit culture and environment on nurse‐decision‐making on noradrenaline (norepinephrine) management is unknown. Aims: The study aimed to investigate nurses' perceptions of the impact of interpersonal interactions, socialisation, and the intensive care environment on decision‐making when managing noradrenaline (norepinephrine). Materials & Methods: An exploratory qualitative study applied thematic analysis to focus group data. A purposive sample of nineteen nurses participated in four focus groups at two intensive care units in Melbourne, Australia, from March to June 2021. The COREQ checklist was used to guide study development and no patients or members of the public were involved in focus groups. Results: Three themes were generated from the researcher's interaction with data, Nursing and Medications; Culture and Decision‐making; and a Safe Practice Environment. Nurses reported decision‐making challenges associated with learning to manage noradrenaline (norepinephrine) early in their intensive care career and discussed feelings of isolation due to staffing resources, and the configuration of the intensive care environment. Nurses developed titration and weaning strategies to support decision‐making in the absence of evidence‐based algorithms. Discussion: Empathetic patient allocation early in nurses' intensive care careers facilitated a safer learning environment, and reduced isolation inherent in single room intensive care units. Nurses developed and used titration and weaning strategies, often learnt from other clinicians to manage practice uncertainty. Conclusions: Management of noradrenaline (norepinephrine) is core business for intensive care nurses worldwide. Development of titration and weaning strategies by nurses indicated unmet need for guidelines to support decision‐making. Identifying contextual elements that impact nurse management of high‐risk medications can guide development of environments, resources and policies that support nurse decision‐making, and reduce nurse anxiety and disempowerment. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to understand how people living with Parkinson's and healthcare professionals perceived their care management and interactions with health services were affected during the COVID‐19 pandemic. Background: During the COVID‐19 pandemic, many governments introduced restrictions and services that support Parkinson's care management had to cease or be delivered remotely. These changes may have had an impact on the well‐being of people living with Parkinson's. Methods: A qualitative exploratory UK study was carried out. Semi‐structured individual interviews with people living with Parkinson's and health professionals were recorded, transcribed verbatim and analysed using Braun´s and Clarke´s thematic analysis. Eleven patients and 10 health professionals were recruited between April and September 2020. The study was reported using the COREQ. Results: Two main themes were identified. In the first theme, many patients and professionals reported that the COVID‐19 pandemic made some people living with Parkinson's feel isolated and vulnerable due to disruptions to their social networks and usual activities related to Parkinson's disease care. However, other patients remained connected with their networks. In the second theme, patients and most professionals mentioned that some clinical practices were cancelled, delayed or transformed to remote consultation. Conclusion: The COVID‐19 restrictions had an impact on how people living with Parkinson's managed their care and in their interactions with healthcare services. Health professionals should assess the risk of vulnerability, social isolation, physical inactivity and confidence with remote consultations in people living with Parkinson's. This might inform a rethinking of existing clinical interactions with people living with Parkinson's towards a flexible, sustainable, person‐centred care model. Relevance to clinical practice: This study has shown that Parkinson's care management and interactions with healthcare services should provide personalised and flexible support. To meet this challenge, the design of the organisation of health services should include greater involvement of patients and person‐centred care models. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study aimed to explore inpatient healthcare delivery experiences of Māori (New Zealand's Indigenous people) patients and their whānau (extended family network) at a large tertiary hospital in New Zealand to (a) determine why Māori are less satisfied with the relational and psychosocial aspects of fundamental care delivery compared to other ethnic groups; (b) identify what aspects of care delivery are most important to them; and (c) contribute to the refinement of the Fundamentals of Care framework to have a deeper application of Indigenous concepts that support health and well‐being. Background: Bi‐annual Fundamentals of Care audits at the study site have shown that Māori are more dissatisfied with aspects of fundamental care delivery than other ethnic groups. Design: Retrospective analysis of narrative feedback from survey data using an exploratory descriptive qualitative approach. Methods: Three hundred and fifty‐four questionnaires containing narrative patient experience feedback were collected from the study site's patient experience survey reporting system. Content analysis was used to analyse the data in relation to the Fundamentals of Care framework and Māori concepts of health and well‐being. The research complies with the SRQR guidelines for reporting qualitative research. Results: Four themes were identified: being treated with kindness and respect; communication and partnership; family is the fundamental support structure; and inclusion of culture in the delivery of care. Conclusion: The current iteration of the Fundamentals of Care framework does not reflect in depth how indigenous groups view health and healthcare delivery. The inclusion of an Indigenous paradigm in the framework could improve healthcare delivery experiences of Indigenous peoples. Relevance to clinical practice: Research around the application and relevance of the Fundamentals of Care framework to Indigenous groups provides an opportunity to refine the framework to improve health equity, and healthcare delivery for Indigenous people. [ABSTRACT FROM AUTHOR]

Aims: To, firstly, explore student and academic nurse perceptions of classroom content about the assessment and identification of pressure injuries across skin tone diversity and, secondly, to describe the impact of classroom content on student nurse understanding of pressure injury in people with dark skin tones. Design: Qualitative case study employing focus groups and semi‐structured interviews. Methods: Five higher education institutions in the United Kingdom were purposively chosen. At each of the five‐case sites, one focus group with student nurses and one semi‐structured interview with a nurse academic were conducted between May 2018 and April 2019. The participants' narratives were transcribed verbatim and analysed via thematic analysis. Results: Classroom learning was predominately framed through a white lens with white normativity being strongly reinforced through teaching and learning activities. This reinforcement of white normativity was evidenced through two main themes: (i) dominance of whiteness in the teaching and learning of pressure injuries in undergraduate nurse education and (ii) the impact and implications for student nurses of whiteness as the norm in pressure injury teaching. Conclusion: Nurses responsible for the design and delivery of teaching and learning experiences for nursing students need to ensure meaningful teaching and learning experiences. This learning should assist future nurses to interrogate their complicity in a system of white dominance. Impact: Nurse education delivered today influences and shapes nurses of the future. Nurses are the cornerstone of healthcare and play a significant role in the delivery of equitable healthcare. Nurse academics have a duty of care to inform and highlight health inequities in nursing and ultimately to enhance equity in care. [ABSTRACT FROM AUTHOR]

Aim: To explore chronic disease education, self‐management and health literacy abilities from First Nations Australian adults with chronic disease through the integration of qualitative and quantitative findings. Background: Chronic disease management requires good health literacy abilities to manage long‐term health needs. First Nations people have a higher burden of chronic disease although little is known regarding chronic disease health literacy of First Nations people. Design: A concurrent embedded mixed methods study reported using the Consolidated Criteria for Reporting Qualitative Research guidelines. Methods: Data were collected from First Nations people with one or more chronic diseases living in remote Australia between February–November 2017. Quantitative data (n = 200) were collected using the Health Literacy Questionnaire along with demographic and health data. Qualitative data (n = 20) were collected via face‐to‐face interviews to examine chronic disease education and self‐management experiences. Data were analysed separately then integrated to develop meta‐inferences. Results: Poor communication from healthcare providers coupled with low health literacy abilities is a major barrier to both active and successful management of chronic disease. Communicating in medical jargon resulted in individuals being placed in a power differential causing lack of trust and relationship breakdowns with healthcare providers affecting active chronic disease self‐management. The perception of inevitability and ambivalence towards chronic disease and the notion of futility towards self‐management were concurred with the low level of active engagement in health care. Conclusions: Yarning is an important strategy used by First Nations people for communication. For nurses, understanding and developing skills in yarning will facilitate cultural safety, communication and understanding about chronic disease self‐management in contexts where health literacy abilities are challenged. Relevance to Clinical Practice: Using yarning, and plain language visual aids, and teach‐back will readdress the power differential experienced by First Nations people and may also improve understanding of chronic disease self‐management. [ABSTRACT FROM AUTHOR]

Aims: Stroke is affecting an increasing number of young and middle‐aged adults. Given the substantial diversion from anticipated life trajectories that younger stroke survivors experience as a result of their stroke deficits, their health‐related quality of life (HRQOL) is likely to be negatively impacted during the immediate post‐acute recovery period. The aim of this study was to generate a comprehensive understanding of the influences on HRQOL and acute recovery during the first three months following stroke for younger adults using a socio‐ecological perspective. Design: Longitudinal, convergent mixed methods design. Methods: HRQOL survey data, assessed using the Patient Generated Index (N = 31), and qualitative interview data about survivors' recovery experiences (N = 20) were collected. Simple linear regression and effect size results were integrated with themes and sub‐themes identified from conventional content analysis using joint data displays. Results: Depression and fatigue negatively affected recovery at the individual level. At the family and societal level, family functioning, social support including being married, having insurance, working, adequate income and being unemployed post‐stroke all positively impacted recovery. Qualitative findings revealed determination, coping, and accessing healthcare to positively affect recovery though a meta‐inference could not be drawn as no quantitative data addressed these concepts. Conclusion: A variety of factors intersecting across socio‐ecological levels were perceived by young stroke survivors to influence acute recovery experiences and outcomes. Impact: This study identified individual‐, family‐ and societal‐level factors in younger adults' environments that may affect the acute stroke recovery experience. Findings underscore the need for research and clinical approaches that consider environmental factors at multiple levels of influence when supporting stroke recovery for younger adults. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To understand hospice palliative care nurses' (HPCNs) perceptions towards spiritual care and their competence to provide spiritual care. Background: Previous research has shown that many nurses lack a clear understanding of the concept of spirituality and feel inadequately prepared to assess patients' spiritual needs. Studies on competence in spiritual care are mostly descriptive, and the evidence for improving it is limited. Design: A mixed‐methods research design was used. Methods: Quantitative data were collected from 282 nurses in forty hospice palliative care (HPC) institutions in South Korea and analysed using descriptive statistics, independent t‐test, one‐way ANOVA with Bonferroni test and multiple regression. Qualitative data collection involved two stages: first, an open‐ended question posed to 282 nurses, and second, focus group interviews conducted with six HPC experts. Both qualitative data sets were analysed separately using content analysis. This study followed the GRAMMS guidelines. Results: Of the six dimensions of spiritual care competence (SCC), the mean scores were highest in 'attitude towards the patient's spirituality' and 'communication', whereas the 'assessment and implementation of spiritual care' and 'professionalisation and improving the quality of spiritual care' had the lowest mean scores. Through content analysis, 4 themes regarding the meaning of spiritual care, 3 themes regarding requirements for spiritual care and 2 themes regarding preparedness for spiritual care were revealed. They perceived the needs of the understanding of spiritual care based on the attributes of spirituality, the education in systematic assessments and implementation for spiritual care with standardised terminology, and the opportunity to reflect on nurses' own spirituality. Conclusions: Practical SCC training for HPCNs and the subsequent development of clinical practice guidelines are of vital importance. Relevance to clinical practice: The results of this study provide a useful resource to develop educational programmes for strengthening the SCC of nurses and the entire HPC team. [ABSTRACT FROM AUTHOR]

Aims and objectives: The current study surveyed nurse practice patterns for performing swallowing screens in an academic cardiac intensive care unit (ICU). It aimed to index: training and levels of confidence in conducting dysphagia screens; screening methods employed; timing and frequency of implement; and subsequent plan of care in identified high‐risk patients. Background: Swallowing impairment (dysphagia) is common following cardiac surgery and associated with significant morbidity and mortality. Early and accurate detection of dysphagia is therefore critical to afford implementation of interventions to optimise patient care. Currently, no validated instruments or guidelines exist for nursing screening of dysphagia in this setting. Methods: An anonymous and voluntary 10‐item mixed‐methods online survey was conducted using Qualtrics software. Nonprobability purposive sampling was utilised to recruit nurses working in an academic 24‐bed cardiac ICU. Thematic analysis using operationally defined coding, SRQR checklist and descriptive statistics were employed. Results: Sixty‐nine nurses completed the survey during a 1‐month period, representing an 84% response rate. Formal training in performing swallowing screens was reported in 18.6% of nurses. In rank order, reported level of confidence was the following: "moderately" (49%); "somewhat" (35%); "not" (13%); and "very" (3%). The majority of nurses performed screens within 1 hr (40.6%) or between 1–4 hr (43.8%) of extubation. Fifteen different methods were utilised to screen swallowing function by nurses who reported a total of 31 different clinical signs indicative of dysphagia. Conclusions: Survey data of practicing nurses in an academic cardiac ICU revealed limited formal training in swallowing screening methodology, a high degree of variability in screening methods employed and low levels of agreement for dysphagia signs. Relevance to clinical practice: Data highlight a knowledge gap and need for the development of formal education and validated rapid nursing dysphagia screening tools for standardised implementation in the cardiac surgery ICU setting. [ABSTRACT FROM AUTHOR]

Aims and objectives: To understand the social construction of frontline nurse leadership and how power operates at this level. Background: It is argued that frontline nurse leaders are central to the negotiation of care. Evidence suggests they feel ill‐equipped to lead and lack confidence in their ability to do so. Disempowerment has been proposed as a barrier to effective ward leadership. There is a lack of studies about daily frontline leadership practice. Design: Single instrumental case study with embedded cases. Methods: A purposive sample of one acute National Health Service Trust, with a convenience sample of embedded cases, was selected. Multiple methods of data collection were used including semi‐structured interviews, nonparticipant observations, field notes and documentary evidence. Thematic analysis using constant comparison and categorisation of data within, between and across cases was used to generate a theory of ward leadership in its organisational context. COREQ Checklist compliant. Results: These findings suggest the frontline nurse leaders' power is a dynamic and situation‐dependent phenomenon that shapes and is shaped by ongoing interactions between stakeholders in the NHS. In these interactions, power ebbs and flows. These leaders, like all actors involved, were paradoxically both powerful and powerless at the same time. Conclusion: This study offers a new contribution to the discussion about the power of ward leaders and problematises the theoretical assumptions that perpetuate calls for increased power. Relevance to practice: In their efforts to resolve the spontaneous dilemmas that arise in practice, frontline nurse leaders would benefit from regularly participating in communities of reflexive practice. [ABSTRACT FROM AUTHOR]

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Aim: To explore Registered Nurses' attitudes and behaviour towards patients' use of complementary therapies. Background: Despite high rates of use of complementary therapies by the general population, little is known of how nurses respond to patients' use of these therapies. Design: A two-phase sequential exploratory mixed methods design. Methods: Nineteen Registered Nurses working in Australia participated in a semi-structured interview in 2015-2016 and emerging themes informed the development of a quantitative survey instrument administered online nationwide in 2016. Findings: Emerging key themes "Promoting safe care"; "Seeking complementary therapies knowledge";" Supporting holistic health care"; and "Integrating complementary therapies in practice" were reflected in survey results. Survey responses (N = 614) revealed >90% agreement that complementary therapies align with a holistic view of health and that patients have the right to use them. Most nurses (77.5%) discussed complementary therapies with patients and 91.8% believed nurses should have some understanding of the area. One-third did not recommend complementary therapies and there was a lack of overall consensus as to whether these therapies should be integrated into nursing practice. Nurses with training in complementary therapies held more positive views than those without. Conclusion: Nurses were generally supportive of patients' interest in complementary therapies, although their primary concern was safety of the patient. Despite broad acceptance that nurses should have a basic understanding of complementary therapies, there was a lack of consensus about recommendation, integration into nursing practice and referral. Further research should explore how nurses can maintain safe, patient-centred care in the evolving pluralistic healthcare system. [ABSTRACT FROM AUTHOR]

Aims and objectives: To obtain an understanding of how Hospital in the Home (HITH) nurses recognise and respond to clinical deterioration in patients receiving care at home or in their usual place of residence. Background: Recognising and responding to clinical deterioration is an international safety priority and a key nursing responsibility. Despite an increase in care delivery in home environments, how HITH nurses recognise and respond to clinical deterioration is not yet fully understood. Design: A prospective, descriptive exploratory design was used. A survey containing questions related to participant characteristics and 10 patient scenarios was used to collect data from 47 nurses employed in the HITH units of three major health services in Melbourne, Australia. The 10 scenarios reflected typical HITH patients and included medical history and clinical assessment findings (respiratory rate, oxygen saturation, heart rate, blood pressure, temperature, conscious state and pain score). Results: The three major findings from this study were that: (i) nurse and patient characteristics influenced HITH nurses’ assessment decisions; (ii) the cues used by HITH nurses to recognise clinical deterioration varied according to the clinical context; and (iii) although HITH nurses work in an autonomous role, they engage in collaborative practice when responding to clinical deterioration. Conclusion: Hospital in the Home nurses play a fundamental role in patient assessment, and the context in which they recognise and respond to deterioration is markedly different to that of hospital nurses. Relevance to clinical practice: The assessment, measurement and interpretation of clinical data are a nursing responsibility that is crucial to early recognition and response to clinical deterioration. The capacity of HITH services to care for increasing numbers of patients in their home environment, and to promptly recognise and respond to clinical deterioration should it occur, is fundamental to safety within the healthcare system. Hospital in the Home nurses are integral to a sustainable healthcare system that is responsive to dynamic changes in public health policies, and meets the healthcare needs of the community. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore registered nurses’ perceptions of safe practice in care for patients with an extended length of stay in the emergency department. Background: Extended length of stay and overcrowding in emergency departments are described internationally as one of the most comprehensive challenges of modern emergency care. An emergency department is not designed, equipped or staffed to provide care for prolonged periods of time. This context, combined with a high workload, poses a risk to patient safety, with additional medical errors and an increased number of adverse events. From this perspective, it is important to extend our knowledge and to describe registered nurses’ experiences of safe practice. Design: A qualitative, inductive and descriptive study. Methods: Qualitative interview study carried out in five emergency departments. Data were analysed using a qualitative content analysis with a latent approach. Results: Patient safety meets obstacles in the clinical environment involving experiencing deficiencies regarding patient safety in the clinical setting and the impact of working procedures and routines. Moreover, nurses are challenged in their professional responsibilities involving balancing essential nursing care and actual workload; it is common to experience emotional reactions based on feelings of loss of control. Conclusions: From the nurses’ perspective, a prolonged stay in the emergency department may lead to negative consequences for both patient safety and care as well as registered nurses’ psychosocial experiences. An extended length of stay significantly reduces the level of nursing and caring that registered nurses can perform in the emergency department. Relevance to clinical practice: This study indicates that emergency departments should review their procedures to avoid both deviations from normal practice and moral stress among registered nurses. This can contribute to an increased understanding and insight about the challenge of patient safety in an emergency department setting. [ABSTRACT FROM AUTHOR]

Aims To raise awareness of critical care nurses' cognitive bias in decision-making, its relationship with leadership styles and its impact on care delivery. Background The relationship between critical care nurses' decision-making and leadership styles in hospitals has been widely studied, but the influence of cognitive bias on decision-making and leadership styles in critical care environments remains poorly understood, particularly in Jordan. Design Two-phase mixed methods sequential explanatory design and grounded theory. Setting: critical care unit, Prince Hamza Hospital, Jordan. Participant sampling: convenience sampling Phase 1 (quantitative, n = 96), purposive sampling Phase 2 (qualitative, n = 20). Methods Pilot tested quantitative survey of 96 critical care nurses in 2012. Qualitative in-depth interviews, informed by quantitative results, with 20 critical care nurses in 2013. Descriptive and simple linear regression quantitative data analyses. Thematic (constant comparative) qualitative data analysis. Results Quantitative - correlations found between rationality and cognitive bias, rationality and task-oriented leadership styles, cognitive bias and democratic communication styles and cognitive bias and task-oriented leadership styles. Qualitative - 'being competent', 'organizational structures', 'feeling self-confident' and 'being supported' in the work environment identified as key factors influencing critical care nurses' cognitive bias in decision-making and leadership styles. Two-way impact (strengthening and weakening) of cognitive bias in decision-making and leadership styles on critical care nurses' practice performance. Conclusion There is a need to heighten critical care nurses' consciousness of cognitive bias in decision-making and leadership styles and its impact and to develop organization-level strategies to increase non-biased decision-making. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to explore how nurses and care-assistants (nursing staff) working in six Flemish nursing homes experience and describe their involvement in grief care. Background Although grief in older people is widely described in literature, less is known about how nursing staff in nursing homes offer and perceive grief care. Design A qualitative research design with elements of constructivist grounded theory was used. Methods Loosely structured face-to-face interviews were done with fourteen nurses and care-assistants. Data were collected from October 2013-March 2014. Interview transcripts were analysed using the Qualitative Analysis Guide of Leuven ( QUAGOL) method with support of NVivo 10. Findings Grief care in nursing homes is characterized by a complex tension between two care dimensions: (1) being involved while keeping an appropriate distance; and (2) being while doing. Nursing staff described key enablers and influencing factors for grief care at the level of both the individual and the organizational context. Conclusion Findings suggest an established personal sensitivity for grief care considered from the nursing staff points of view. Nevertheless, a common denominator was the necessity to further develop a supportive and multidisciplinary grief care policy ingrained in the existing care culture. Suggested components of this grief care policy are: (a) centring attention on non-death-related loss and the cumulative nature of loss in residents; (b) building capacity by means of reflective practices; and (c) the importance of self-care strategies for nursing staff. Furthermore, the findings from this study point towards a need for education and training. [ABSTRACT FROM AUTHOR]

Aim To explore how practising mindfulness affects people's experiences of living with a long-term condition. Background Increasing evidence suggest that mindfulness meditation-based interventions benefit people with long-term conditions, particularly in terms of psychological well-being. Most evidence, however, relates to short-term outcomes and limited information exists about how people use mindfulness in the longer term and how this affects their experience of living with their condition. Design A qualitative study using constructivist-informed grounded theory. Methods Using interviews, diaries and focus groups, data were collected between 2011 - 2012 from participants and/or trainers of Breathworks' mindfulness intervention. Phased recruitment enabled theoretical sampling, with data analysed concurrently using Charmaz's two-stage coding strategy. Findings The final sample comprised 41 adults with diverse physical and/or mental health conditions. Participants reported predominantly positive experiences, almost all identifying significant changes in thinking and behaviour. A core process of 'Starting where I am' was formulated, highlighting how people became more aware and accepting of their condition and thus able to self-care more effectively. The process was encapsulated in five themes: Getting a new perspective; Feeling equipped to cope; Doing life differently; Seeing a change; and Finding mindfulness difficult. Strong resonances were identified between participants' experiences and the process of transition through which people come to terms with challenging life events. Conclusion Mindfulness can be conceptualized as a facilitator of transition, enabling people to adapt to living with a long-term condition. Transition is associated with improved, self-directed self-management, which is significant to both people with long-term conditions and healthcare providers. [ABSTRACT FROM AUTHOR]

Aim. To establish, implement and evaluate the impact of a quality care-metric developed to measure public health nursing practice. Background. Measurement of care practices plays an integral role in quality improvement and promotes positive change in healthcare delivery. Quality caremetrics has been identified as a means of effectively measuring public health nursing practice. Public health nurses in Ireland are 'all-purpose' generalist community-based nurses caring for people across the lifespan, in defined geographical areas, employed by the Health Service Executive. In the public health nurse's child and maternal health role, the 'primary visit' (postnatal visit) has been identified as the most important contact a public health nurse has with a mother and her new baby. Design. Mixed methods using a sequential multiphase design. Methods. This study involves three phases. The first phase will include focus group and individual interviews with key healthcare professionals and new mothers, using purposively chosen sampling. Thematic analysis of data will identify key components for the development of a quality care-metric. Phase two will be a RAND appropriateness survey with a panel of experts, to develop and validate the quality care-metric. The third phase will involve implementation and evaluation of the quality care-metric. Descriptive and inferential statistics will be completed using SPSS version 21. Funding for this research study was approved in December 2013. Conclusion. This study will evaluate the impact of introducing a quality caremetric into public health nursing practice. Results will illuminate the quality of public health nursing practice in relation to the primary visit. [ABSTRACT FROM AUTHOR]

Aim. To report a multi-phase modified Delphi study conducted with carers and professionals to identify the priority areas for inclusion in an alert screening tool for carers providing support to someone dying at home. Background. Internationally, there is a growing emphasis on increasing choice for patients who wish to die at home which relies heavily on care provided by the unpaid family carers. Family carers can have high levels of unmet needs comprising their psychological and physical health and their ability to provide effective care and support. Development of an alert tool to identify carers' needs in everyday practice required identification and consensus of the priority areas of need for inclusion. Design. Multi-phase modified Delphi study and instrument development. Method. Qualitative and quantitative data collection took place between 2011-2013 with 111 carers and 93 professionals to identify carers' needs and gain consensus on the priority areas for inclusion in the alert tool. An expert panel stage and final evidence review post-Delphi were used. Results. The Delphi panels had high levels of agreement and consensus. Ten areas of carer need across two themes of 'the current caring situation' and 'the carer's own health and well-being' were prioritized for inclusion in the alert tool. An optional end-of-life planning question was included following the final stages. Conclusions. The results provide evidence of carers' needs to be assessed, areas for consideration in the education of those who support carers and someone dying at home and targeting of services, while demonstrating the usefulness and adaptability of the Delphi method. [ABSTRACT FROM AUTHOR]

Aims To describe the lived experiences of aggression and violence among patients with schizophrenia and their victimized biological parent as the major caregiver being aggressed by their child (parent-adult-child dyads), and to gain an understanding of the precipitating factors influencing violence. Background Child-to-parent violence, particularly in the mentally ill adult child, is arguably the most stressful and under-researched issue of family violence. Violence in patients with mental illness is most frequently targeted at family members, and most often takes place at home. Both patients and their parents' experiences of violence are relatively unexplored. Design Qualitative study design. Methods Data were collected using individual in-depth interviews between August 2010-August 2011 in Taiwan. Purposive sample of 14 hospitalized patients with schizophrenia who had aggression and violence in the past year directed towards their biological parent of either gender. Findings Five main themes were identified: violence occurring beyond control in a particular situation translated into parent and patient's possible endangerment, the repetitive nature of violence, distress, ineffective communication, and management of violence and help-seeking. Repetitive violent episodes and tension made both the parent and patient feel uncontrollable. Parents had a perceived fear of adverse consequences such as being punished by receiving more retribution and they also had concerns related to their parental responsibility. Conclusions Health professionals should be aware of the complexity of phenomena and the interplay of factors inducing violence. A comprehensive dyadic parent-child intervention is suggested for violence prevention. [ABSTRACT FROM AUTHOR]

Aim To explore how families with children at home managed 4-12 months after an adult family member was discharged from the hospital to home following bone marrow or blood cell transplantation. Background Studies of these families have been limited in number. The Family Management Style Framework offers a conceptual framework relevant to families with children who have an adult member who has undergone a bone marrow or blood cell transplant. Design This was a descriptive, qualitative, one-point-in-time study. Method Content analysis in relation to the three conceptual components of the Family Management Style Framework was employed; inductive thematic analysis determined the emergent conceptual dimensions present in the data. The sample was composed of 29 participants: 15 transplant recipients and 14 significant others who met the study criteria in 2008 and 2009. Each patient and his or her significant other were interviewed; the audio-recorded interviews were analysed after transcription. Findings The three conceptual components of the Family Management Style Framework: (1) definition of the situation; (2) management behaviours; and (3) perceived consequences , were validated as relevant for this sample across all participants. New conceptual dimensions were also present, inclusive of recovery view, support base, financial picture, management domains, perceived consequences to the whole family, and perceived consequences to the dyad relationships. Conclusion There are several overarching findings in this study, notably that recovery at home is a family experience. Implications for nursing practice include the need for effective transitional care for the patient and family. [ABSTRACT FROM AUTHOR]

Aim To report a study that investigated the career development, aspirations, and choices of undergraduate students and graduates of nursing double degree programmes. Background Over one-third of Australian undergraduate nursing students study by double degree mode. Their career destinations will have an impact on the availability of graduates in a time of nursing shortages, but little is known about why nursing students choose double degrees or take up a career in nursing vs. the other specialization. Design A qualitative study using two longitudinal methods. Methods The study was conducted in 2008-2009 with 68 participants from an Australian regional university offering double degrees in nursing. A time series method involved interviews with 12 first year students followed by focus group interviews with 22 final year students. A longitudinal method involved repeated interviews with 34 graduates. Interview transcripts were analysed thematically. Results Enrolment in a double degree was influenced by advice from significant others; previous experiences of health care; and the anticipated rewards associated with a choice of two careers. Career development and decisions of undergraduates were influenced by intrinsic and extrinsic rewards distinctive to each area of specialization and marketing and job availability. For graduates, the impact of workplace experiences such as prior practicums and past and present workplace support were foremost. Conclusion This study provides previously unknown information about double degree nursing students' and graduates' career development and career choices over time. A socio-ecological framework adapted to nursing enabled a broad understanding of the many environments and contexts that confirm or discourage a nursing career. [ABSTRACT FROM AUTHOR]

hutchings h., rapport f., wright s., doel m. & jones a. (2012) Obtaining consensus about patient-centred professionalism in community nursing: nominal group work activity with professionals and the public. Journal of Advanced Nursing 68(11), 2429-2442. Abstract Aim. To report on the development of a ranked thematic list encompassing the positive and challenging exemplars of patient-centred professionalism in community nursing. Background. There has been little research exploring what 'patient-centred professionalism' means to those working within the healthcare settings. Consensus methods, such as those developed through Nominal Group Work, can help establish the extent of agreement on a particular issue whilst overcoming some of the problems associated with group decision-making. Design. Mixed methods studying through consultation workshops. Method. The study took place in South-west Wales, UK between October 2009-September 2010. Thirty-four participants consisting of community nurses (9), newly qualifying nurses (13), nursing stakeholders (6) and members of the public (6) took part in the study. An adapted Nominal Group Work approach was used in five individual consultation workshops: two with community nurses, one with newly qualifying nurses, one with stakeholders and one with members of the public followed by a mixed-group Forum event. Results. Each of the five workshops resulted in the production of approximately ten positive and ten challenging exemplars of patient-centred professionalism. The thematization of these exemplars allowed the development of eight broad themes. The Forum event then provided a mechanism for ranking the importance of these themes. The patient, community nurse as a person and nursing ethos were ranked as the most important themes by study participants. Conclusions. The adapted Nominal Group Work approach was a useful method to allow the development of a ranked thematic list that illustrated the important positive and challenging exemplars of patient-centred professionalism in community nursing. [ABSTRACT FROM AUTHOR]