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Aims: The aim of this study was to explore the reasons for and experiences of patients who make an unplanned return visit to the emergency department. Design: This study forms the qualitative phase of a larger explanatory sequential mixed methods study and is informed by interpretive description. The paper was prepared using the consolidated criteria for reporting qualitative research. Methods: Semi‐structured patient interviews were conducted over a 3‐month period (July–September 2021). Data were analysed using reflexive thematic analysis. Results: Interviews from 13 participants generated findings related to experiences at and following their initial visit that contributed to their decision to return to the emergency department. Four themes were developed: (1) Patients experience barriers to feeling heard and having their concerns addressed; (2) Patients have little choice but to place their trust in clinicians; (3) Patients unexpectedly experience persistent symptoms which cannot be managed at home; and (4) Patients develop a sense of urgency about having their condition treated. Conclusion: A negative experience at the initial ED visit may have dual conflicting impacts. It can contribute to patients' perceived need for a return visit because they are ill‐equipped to manage their condition at home, and it can also contribute to their initial reluctance to return to the ED when symptoms persist. Nurses and other clinicians working in ED need to actively build patient's experiential trust through clear communication, timely consultation and shared decision‐making at discharge, which in turn can increase patient's confidence and capability to self‐manage their condition. This study adds to the current body of literature about return visits by highlighting that a more positive experience of ED may assist patients to make better‐informed decisions about when and how to seek treatment and minimize unnecessary and unplanned return visits. Whilst not an intended topic for exploration in this study, the COVID‐19 pandemic influenced patients' experiences at both initial and return ED visits and limited their ability to access primary healthcare options. These experiences contributed to patients' decisions to make a return visit. [ABSTRACT FROM AUTHOR]

Aim: To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention. Design: A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions. Methods: We implemented a tailored ward‐based intervention to redesign nursing handover practice with co‐constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre‐implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio‐recorded handover events (n = 233). Post‐intervention we conducted interviews and focus groups (n = 79) and observed and/or audio‐recorded handover events (n = 129) to qualitatively evaluate impact. Results: Our translational approach resulted in substantial changes post‐intervention. Nurses conducted more shift‐to‐shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information. Conclusion: Contextualised training combined with changes to ward‐level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward‐level leadership, collaboration and mentoring. The speed and degree of change post‐intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists. Relevance to Clinical Practice: Nurses are more likely to conduct efficient group handovers and informative, patient‐centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward‐level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change. Reporting Method: We adhered to the COREQ guidelines. Patient or Public Contribution: We interviewed patients on study wards pre and post intervention. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore the experiences of secondary care nurse prescribers to establish how prescribing is employed and what its benefits and disadvantages are perceived to be. Background. Nurse prescribing has developed rapidly since it inception almost 20 years ago and there is a significant body of research evaluating its implementation in primary care. Recent expansion of non-medical prescribing rights has prompted nurses in secondary care establishments to become prescribers. Evaluation of nurse prescribing in this new environment is required, if practice is to be informed and advanced. The lack of such evaluations in the published literature was the impetus for this study. Design. A cross-sectional qualitative study. Methods. A convenience sample of nurse prescribers was interviewed using a single broad question to prompt elaboration. Transcribed interviews were analysed using Colaizzi's procedural steps. Results. Three main themes emerged from the analysis: motivations behind becoming a nurse prescriber; benefits and limitations of prescribing education and continuing professional development and prescribing in practice. Conclusion. Nurses felt nurse prescribing offers clear benefits in relation to patient care. Where nurses were not prescribing, finance arrangements between different NHS trusts appear to be a significant barrier to its successful implementation of prescribing in practice. Nurse prescribing is strongly believed to be the domain of the experienced nurse. There is a clear need for ongoing evaluation of all aspects of nurse prescribing. Relevance to clinical practice. This paper makes key recommendations on the future development and delivery of programmes of education for nurse prescribers and for the delivery of safe and effective prescribing in practice. [ABSTRACT FROM AUTHOR]

Aim. To understand the uniqueness of the experience of testing HIV positive from the perspective of pregnant women. Background. As more people learn of their HIV diagnosis through routine screening processes, it is timely to reflect on the impact of receiving an unexpected positive result. Design. A prospective qualitative study. Methods. This paper draws on the case studies of four women who were participating in a larger prospective qualitative study of reproductive decision-making, pregnancy and childbirth following HIV diagnosis. Multiple interviews were conducted following diagnosis during pregnancy, and, after the birth of their babies. Thematic data analysis was undertaken. Results. Drawing on Becker's theory of disruption, we document the 'sudden disjuncture' of their antenatal diagnosis and the embodied emotional struggle the women engaged in to create continuity in their lives. A diagnosis of HIV disrupted the women's biographies in terms of their health, relationships and social identity. As pregnant women, the threat of HIV was experienced most significantly in relation to their unborn child. However, their narratives also revealed how a diagnosis of HIV in the context of pregnancy, whilst traumatic, provided a focus for regaining continuity in their lives, as the baby became a metaphor for hope and orientation toward the future. Conclusions. As HIV testing becomes more 'routine', the findings of this study serve to remind health professionals that a positive diagnosis continues to constitute a major trauma to individuals and families. Relevance to clinical practice. We propose that appropriately educated nursing and midwifery staff could facilitate the 'meaning making' process that is required for newly diagnosed HIV positive persons to find a subjective sense of well-being in their lives. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study exploring the lived experiences and emotional responses of female patients learning to perform clean intermittent self-catheterisation (CISC). Background. There is general consensus that CISC should be considered in preference to in-dwelling catheterisation wherever feasible. Published literature has tended to focus on quality of life issues and technical and physical aspects. There has been less investigation into patients' initial perceptions of CISC and into their subsequent experiences of learning the technique. Design. This qualitative study used a phenomenological research design. Method. A series of semi-structured, in-depth interviews were held with a purposive sample of adult female patients performing CISC aged 34-64 years. Interviews were tape recorded and transcribed verbatim. Data were analysed using the 'Framework' method. Results. This study identified six recurrent themes: grief and loss, lack of knowledge (regarding female anatomy, bladder dysfunction and catheters), negative associations and stigma, psychological aversion and embarrassment, nursing approaches and coping mechanisms. Conclusion. Loss of normal bladder function may represent a devastating event and trigger emotional responses associated with grief and loss. Patients may experience a range of reactions whilst learning CISC, including embarrassment and aversion, which may not dissipate over time. However, psychological distress is not inevitable and varies enormously between individuals. The nursing approach is vital, as individualised, empathic care is recognised and valued. Relevance to clinical practice. This study adds to an emerging body of knowledge providing an enhanced understanding of the lived experiences of patients learning CISC. Nurses need to be alert to a range of potential emotional responses. This will facilitate the adoption of individualised teaching and learning strategies, designed to optimise the patient's assimilation of CISC into their lifestyle, promoting physical health, psychological wellbeing and independent living. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study that explores and describes the meaning of the phenomenon of health-promoting self-care as experienced by people living with rheumatic diseases. Background. People with rheumatic diseases estimate health status as low and health belief and health status influence self-care behaviours. Several self-care behaviours are used in the efforts to mitigate the diseases. Method. The study had a descriptive phenomenological approach based on a reflective life-world perspective. Data were gathered in 2007 by unstructured open-ended interviews with 12 individuals living with rheumatic diseases. Findings. The meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care takes place against a background of continual hope and belief to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three inter-related constituents elucidated their experiences: dialogue, power struggle and choice. Self-care was experienced as dialogues with the body and with the immediate environment. In order to respond to signals from the body, power struggles were required to be entered into when fighting the diseases. Choices were required to be made and things that were beneficial for the body were prioritized. Conclusion. In this study, the meaning of health-promoting self-care as experienced by people living with rheumatic diseases was that self-care was a way of life. This meant to be ready to understand and respond to signals from the body. Self-care required dialogues, power struggles and choices. [ABSTRACT FROM AUTHOR]

Aim. To explore the life experiences of those living with glaucoma and describe their strategies to deal with the consequences of this disorder. Background. Glaucoma, the second most common cause of worldwide blindness, often imposes limitations on the daily functions of its victims, thus resulting in a decline in their quality of life and high costs in healthcare. Methods. A hermeneutical phenomenological research approach was adopted. Fourteen people with glaucoma were selected for in-depth interviews, and another ten were interviewed in two focus groups. Participants were recruited from a specialized eye hospital in Shanghai. The data were collected from July to September 2009. An interpretive analysis of the data was performed. Findings. The core theme was identified while interpreting the data on the patients' life experiences as 'learning to living with glaucoma' by one of our participants. The meaning of this is demonstrated in four interwoven themes: (1) seeking support; (2) coping with everyday tasks; (3) living with future uncertainties; and (4) adapting to the declined quality of life. Conclusion. This paper provides an insight into the living experiences of the patients with glaucoma using 1-on-1 and focus-group interviews, suggesting that the latter can also offer a means of phenomenological inquiry. We found that those with glaucoma can experience uncertainty surrounding treatment, illness prognosis and family members' risk status. In addition, the Chinese culture can influence the patients' strategies of maintaining a healthy lifestyle. In helping those with glaucoma considerations should be taken towards the feelings of future uncertainty that may develop. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an exploration of the experiences of patients with end-stage kidney disease who were having haemodialysis. Background. The losses and lifestyle disruptions caused by end-stage kidney disease are a fundamental source of suffering for people. The hope of a transplant is an important factor in people's ability to cope with end-stage kidney disease and dialysis. Method. A Heideggerian phenomenological methodology was used. A purposive sample was selected of 16 patients with end-stage kidney disease having hospital-based haemodialysis therapy in the Republic of Ireland. Qualitative interviews were conducted in 2006-2007. Data were analysed using qualitative interpretive analysis. Findings. The overarching pattern identified was 'Waiting for a kidney transplant'. This pattern consisted of three themes: living in hope, uncertainty and being on hold. Participants described their experiences of living in hope while they waited for a kidney transplant. However, as the waiting time continued indefinitely, participants became uncertain, and this meant that they were unable to contemplate opportunities in the future. Moreover, the restrictions of haemodialysis therapy prevented them from performing many of the activities they had taken for granted in the past. Consequently, they described their experiences of being on hold while they waited for a kidney transplant. Conclusion. Nurses should engage in open and honest discussions with patients in relation to kidney transplantation so that they are able to recognize and address their concerns about kidney transplantation. [ABSTRACT FROM AUTHOR]

This paper presents findings from a small piece of interpretive research into the lived experience of trained nurses who fulfilled the role of workplace mentors for Foundation degree students. The interprofessional landscape of workplace learning is also examined. The participants were all employed in acute care settings in a large UK National Health Service hospital and provided mentorship to Healthcare Assistants studying the adult pathway of a Foundation degree in Health and Social Care; in preparation for the role of the Assistant Practitioner. A purposive sample of eight workplace mentors (who had supported at least one Foundation degree student) were interviewed using a semi-structured questionnaire. All interviews were audio recorded and subsequently transcribed. A hermeneutic phenomenological approach was used to uncover the lived experience of workplace mentors and 10 major themes were generated from the data. The findings suggest that the mentorship of work-based learners presents mentors with a range of challenges that are quite different from pre-registration students given the situatedness of the learner in their clinical team. While the mentorship of work-based learners in busy clinical environments is challenging, the relationship between mentor and mentee appears to have greater equality due to the situatedness of the student in the clinical team. As a result workplace mentors seem to benefit from a relationship lacking in the hierarchical features that characterise traditional mentoring. Awareness of the unique experience of work-based learners and mentors needs to be raised, particularly where students are seeking to complete their Foundation degree to emerge as Assistant Practitioners. Trained nurses undertaking the role of workplace mentor in support of Foundation degree students, do so to provide coaching that (in a developmental relationship), places them in the vanguard of an emerging professional group; the Assistant Practitioner. [ABSTRACT FROM AUTHOR]

hughes c., knibb w. & allan h. (2010) Laparoscopic surgery for endometrial cancer: a phenomenological study. Journal of Advanced Nursing 66(11), 2500-2509. Aim. This paper is a report of a study of women's perspectives on the experience of laparoscopic surgery for endometrial cancer. Background. Laparoscopic surgery is increasingly used to treat early endometrial cancer. It is associated with low levels of morbidity and is considered safe as cancer surgery, but research on quality of life and women's experiences is limited. Method. Heideggerian hermeneutic phenomenology was used to explore the experiences of 14 women who had undergone the procedure in two English cancer centres between February 2008 and July 2009. In-depth interviews were taped, transcribed and analysed using Colaizzi's framework. Findings. A phenomenological description was produced from five identified themes: having cancer, transfer of responsibility to the surgeon, information and support, independence, and normality. The experience of laparoscopic surgery was overshadowed by the presence of cancer. Fear and lack of knowledge played an important role in entrusting the surgeon with the responsibility for decision-making. Individual, unmet information needs focused on the practicalities of treatment and being in an unfamiliar situation and environment. Loss of control and vulnerability were associated with illness and surgery, but early postoperative mobility and reduced pain, facilitated rapid return to independence and maintained a sense of normality. Conclusion. Healthcare professionals should deliver care in early endometrial cancer in a way that recognizes the significance of the cancer diagnosis, the role of the surgeon in decision-making and the need for practical information. Women with endometrial cancer should have access to treatments that reduce dependency and maintain normality. [ABSTRACT FROM AUTHOR]

nicholson j., slade p. & fletcher j. (2010) Termination of pregnancy services: experiences of gynaecological nurses. Journal of Advanced Nursing 66(10), 2245–2256. Aim. This paper is a report of a study to identify the experience of gynaecological nurses involved with termination of pregnancy. Background. Staff involved with termination of pregnancy have been found to experience both positive and negative views. Varying processes and experiences for staff have been identified, from termination of pregnancy work being emotionally draining and stressful to there being a process of care that evolves with greater experience. Methods. A purposive sample of seven gynaecological nurses currently working in a termination of pregnancy service was recruited. Data were collected between October 2007 and January 2008 using interviews and standardized questionnaires. Transcripts of the interviews were analysed using Interpretive Phenomenological Analysis. Results. Eight superordinate themes emerged from the analysis: (1) Unconditional acceptance and understanding of termination of pregnancy, (2) Strategies for managing the demands and challenges, (3) What we do for patients and job satisfaction, (4) Challenges to unconditional acceptance, (5) Juggling the contrasting needs and demands of patients, (6) The most demanding aspects of the role, (7) The significance of personal experience and (8) The service context. Some of the experiences were interpreted as ways in which nurses justified their role. The themes were understood in terms of a balance between strains, coping and contextual influences. Conclusion. Providing a recognized supportive supervisory environment might allow for the acknowledgement of the unique challenges staff in termination of pregnancy services face, and might enhance a sense of validation within the organization and hence staff wellbeing. [ABSTRACT FROM AUTHOR]

kwong e.w.-y., pang s.m.-c., choi p.-p. & wong t.k.-s. (2010) Influenza vaccine preference and uptake among older people in nine countries. Journal of Advanced Nursing 66(10), 2297–2308. Aim. This paper is a report of a study delineating factors that influence older people’s preferences and uptake of the influenza vaccine in nine countries. Background. Vaccination uptake for the aging population in many countries still remains below the World Health Organization recommended rate. Older people who perceive higher susceptibility to and severity of influenza, and more benefits from vaccination and action cues prompting vaccination, tend to accept the vaccine, but those with more perceived barriers to vaccination are less likely to accept it. Method. A total of 208 older people from China, Indonesia, Turkey, Korea, Greece, Canada, the United Kingdom, Brazil and Nigeria were recruited to 14 vaccinated and 12 unvaccinated focus groups. They shared their experiences of influenza, and influenza vaccination, and promotion of influenza vaccination in focus groups. The data were collected in 2007. Findings. We identified five themes and generated a hypothetical framework for in-depth understanding of vaccination behaviour among older people. Participants’ vaccine preferences were determined by their behavioural beliefs in vaccination, which were based on their probability calculation of susceptibility to and severity of influenza and vaccine effectiveness, and their utility calculation of vaccine, healthcare and social costs. Action cues prompting vaccination and vaccine access further affected the vaccine uptake of participants with vaccine preferences. Vaccination coverage was likely to be higher in the countries where normative beliefs in favour of vaccination had formed. Conclusion. The hypothetical framework can be used to guide healthcare providers in developing strategies to foster normative beliefs of older people in vaccination, provide effective action cues and promote vaccine access. [ABSTRACT FROM AUTHOR]

Aim s : To describe medical‐surgical nurses' reflections on their experiences with patient deterioration. Background: An extensive body of knowledge exists regarding optimal responses to acute patient deterioration within a hospital environment. Much less attention has focused on the profound psychological and emotional impact these experiences of unexpected deterioration can have on nurses who provided the supportive or rescue care. A triggering event, such as patient deterioration, or direct questioning about these experiences, can lead nurses to reflect further on the situation. Engaging in reflection is believed to enhance learning and improve clinical judgement when future complex situations arise. Findings related to nurses' reflective practice when recalling previous situations with deteriorating patients are limited. This gap in the literature provided the basis for the current project. Design: A qualitative descriptive design. Methods: Twenty medical‐surgical nurses were interviewed in 2018. The nurses were recruited through purposive sampling. Semi‐structured telephone interviews explored nurses' experiences of a patient deterioration. Conventional content analysis with iterative coding and categorising and theme development was used for data analysis. Findings: Three themes emerged as participants reflected on their experiences. The themes were, Enduring frustration and regret, Feeling deeply responsible for and to the patient and Making sense of what happened. Conclusions: Medical‐surgical nurses who care for acutely deteriorating patients can experience lasting emotional, psychological and physical concerns that often go unrecognised and untreated. Furthermore, nurses with this background commonly reported their perceived increased risk for workplace distress. Relevance to Clinical Practice: Findings from this study are important for nurses, healthcare administrators and leaders, and patients. Participating in a rescue attempt often has a negative impact on nurses' perception of workplace stress and on persistent concerns about nurses' mental and physical health. The findings can be useful in informing additional studies about the phenomenon. Findings also can inform the exploration of workplace design. Organisations should assess for factors influencing workplace stress, develop strategies to mitigate the presence of workplace stress and foster nurses' well‐being so they can respond to future scenarios of patient deterioration, while maintaining their physical and mental health. Patient or Public Contribution: This study did not include any patient or public input. [ABSTRACT FROM AUTHOR]

Aim: To explore factors influencing newly graduated nurses' delivery of direct care in acute care hospital settings. Design: Qualitative study using focused ethnography. Methods: During the period from March to June 2022, a total of ten newly graduated nurses were purposively sampled, and data were collected through 96 h of participant observation as well as ten semi‐structured interviews. This research took place in a large hospital located in Denmark. Data were analysed using LeCompte and Schensul's ethnographic content analysis. Results: Three main structures were developed from the data: 'Contrasting Intentions and Actions for care delivery', 'Organizational Constraints Block Interpersonal Aspects of Nursing Care' and 'Newly Graduated Nurses' Suppressed Need for Support Constitutes Delay in Care Actions'. Conclusion: Newly graduated nurses were committed to delivering high‐quality care but were aware they sometimes provided compromised care. The paradox between a commitment to care and compromised care delivery was borne out of tensions between newly graduated nurses' professional beliefs and nursing values, a desire to integrate patients' needs and preferences, and organizational constraints on everyday practices where newly graduated nurses often worked alone without the support of a more experienced nurse. Critical reflection on cultural, social and political forces that influence direct care delivery might support newly graduated nurses to deliver direct patient care more intentionally. Relevance to Clinical Practice: Establishment of onboarding programs and other support activities for newly graduated nurses to cope with contrasting intentions and actions that must address organizational constraints is essential. These development programs should include how critical reflection competency is supported to address value inconsistencies and emotional distress to ensure high‐quality patient care. Reporting Method: The reporting adhered to the COREQ guidelines. Patient or Public Contribution: 'No Patient or Public Contribution'. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of female registered nurses (RNs), who encounter workplace gender discrimination in nursing. Design: This study used a qualitative exploratory design informed by feminist perspectives and was underpinned by social constructionism. Methods: Women who were RNs (N = 10) and employed in New South Wales (NSW) were purposively selected to convey their experiences of workplace gender discrimination. Data were collected through semi‐structured interviews, between April and July 2020. Analysis was guided by the work of Anderson and Jack (Women's words; 1991) who recommend three ways of listening. Interviews were transcribed verbatim and Braun and Clarke's (Qualitative Research in Psychology, 3, 77–101; 2006) six‐step guide was used to develop themes. Results: Thematic analysis revealed five overarching themes: It's a man's world; Gender stereotypes; Being a woman and nurse; Reluctance to call out gender discrimination and The status quo. Findings from this study highlighted that participants believed men's career progression in nursing were favoured over women. Conclusion: Findings from this research highlight that socially constructed gendered norms continue to form the basis of inequality for women in the workplace. Fostering and sustaining workplace cultures that support family and work life balance, and that do not discriminate against women, is fundamental to ensuring equality for women. Impact: There is limited qualitative research into women's experiences of workplace gender discrimination in nursing. This research highlights the need for workplace strategies to be implemented to ensure women are better supported and equally represented in leadership positions and advanced practice roles in nursing. All nurses should be given equal consideration based on experience and qualifications. Career development and progression opportunities should be fair, equitable and transparent with clearly documented criteria. [ABSTRACT FROM AUTHOR]

Aims: Explore the self‐care experiences of patients with multiple chronic conditions (MCCs) and caregivers' contributions to patient self‐care during COVID‐19 pandemic. Design: A descriptive qualitative design was used. The COREQ checklist was used for study reporting. Methods: Individual semi‐structured interviews were used to collect data from patients with MCCs and caregivers selected from the dataset of an ongoing longitudinal study. Data analysis was performed through deductive thematic analysis. The middle‐range theory of self‐care of chronic illness, which entails the three dimensions of self‐care maintenance, monitoring and management, was used as a theoretical framework to guide data collection and analysis. Results: A total of 16 patients and 25 caregivers were interviewed from May to June 2020. The participants were mainly women, with a mean age for patients of 76.25 years and caregivers of 45.76 years; the caregivers were mainly the patients' children (72%). During the pandemic, some patients reported remaining unchanged in their self‐care maintenance, monitoring and management behaviours, others intensified their behaviours, and others decreased them. Caregivers played an important role in protecting patients from the risk of contagion COVID‐19 and in ensuring patients' self‐care of chronic diseases through direct and indirect interventions. Conclusions: Critical events can modify the self‐care experiences of chronically ill patients and caregivers' contributions, leading to maintenance, increase or decrease of self‐care and contributions to self‐care behaviours. Impact: Patients with MCCs and their caregivers can react in different ways in their performances of self‐care and contribution to patients' self‐care behaviours when ordinary daily life is disrupted; therefore, nurses should assess such performances during critical events to identify the individuals at risk of reduced self‐care and promote the most suitable healthcare services (e.g. eHealth) to implement individualised interventions. [ABSTRACT FROM AUTHOR]

Aims: To increase the quality and safety of patient care, many hospitals have mandated that nursing clinical handover occur at the patient's bedside. This study aims to improve the patient‐centredness of nursing handover by addressing the communication challenges of bedside handover and the organizational and cultural practices that shape handover. Design: Qualitative linguistic ethnographic design combining discourse analysis of actual handover interactions and interviews and focus groups before and after a tailored intervention. Methods: Pre‐intervention we conducted interviews with nursing, medical and allied health staff (n = 14) and focus groups with nurses and students (n = 13) in one hospital's Rehabilitation ward. We recorded handovers (n = 16) and multidisciplinary team huddles (n = 3). An intervention of communication training and recommendations for organizational and cultural change was delivered to staff and championed by ward management. After the intervention we interviewed nurses and recorded and analyzed handovers. Data were collected from February to August 2020. Ward management collected hospital‐acquired complication data. Results: Notable changes post‐intervention included a shift to involve patients in bedside handovers, improved ward‐level communication and culture, and an associated decrease in reported hospital‐acquired complications. Conclusions: Effective change in handover practices is achieved through communication training combined with redesign of local practices inhibiting patient‐centred handovers. Strong leadership to champion change, ongoing mentoring and reinforcement of new practices, and collaboration with nurses throughout the change process were critical to success. Impact: Ineffective communication during handover jeopardizes patient safety and limits patient involvement. Our targeted, locally designed communication intervention significantly improved handover practices and patient involvement through the use of informational and interactional protocols, and redesigned handover tools and meetings. Our approach promoted a ward culture that prioritizes patient‐centred care and patient safety. This innovative intervention resulted in an associated decrease in hospital‐acquired complications. The intervention has been rolled out to a further five wards across two hospitals. [ABSTRACT FROM AUTHOR]

Aims and objectives To obtain an understanding of how health professionals support the kidney transplant patient to take their medications as prescribed long term. Background Kidney transplantation requires stringent adherence to complex medication regimens to prevent graft rejection and to maintain general well-being. Medication nonadherence is common in kidney transplantation, emerging in the first few months post-transplantation, leading to poor patient outcomes. Design Exploratory qualitative design. Methods Five focus groups were conducted with a total of seven renal nurse transplant coordinators, two renal transplant nurse unit managers, seven nephrologists, seven pharmacists, four social workers, and one consumer representative representing all five hospitals offering adult kidney transplantation in Victoria, Australia in 2014. The views of two general practitioners who were unable to attend the focus groups were incorporated into the data set. All data underwent thematic analysis. Results Analysis revealed that adherence was a collective responsibility involving the whole of the transplant team and the patient via education blitz in hospital, identifying and managing nonadherence, promotion of self-advocacy, and the partnership between the patient and health professional. Patients were directed how to take their complex medications to be self-empowered, yet the partnership between the patient and health professional limited the patient's voice. Conclusion Although medication adherence was a collective responsibility, communication was often one-way chiefly as a result of staffing and time constraints, hindering effective partnerships necessary for medication adherence. Expert skills in communication and adherence counselling are necessary to identify barriers affecting medication adherence. Patients need to be systematically screened, prepared and supported long-term within an accommodating healthcare system for the reality of caring for their transplanted kidney. Relevance to clinical practice Kidney transplant recipients require systematic preparation and quality long-term follow-up to adhere to their prescribed medications. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore postoperative pain management experiences among school-aged children. Background Ineffective postoperative pain management among children has been commonly reported. School-aged children are able to evaluate how their pain is managed and what their preferred strategies are. Most studies in pain management have adopted quantitative methods and have overlooked children's pain management experiences. Design This is a qualitative study using face-to-face interviews. Methods Data were collected from 15 school-aged children admitted to a tertiary hospital in Singapore by in-depth interviews conducted between November 2010 and January 2011. Data were analysed by thematic analysis. Results Five themes were identified: children's self-directed actions to relieve their postoperative pain (e.g. using cognitive-behavioural methods of distraction and imagery, physical method of positioning, sleeping and drinking, seeking other people's help by informing parents and crying and using pain medications); children's perceptions of actions parents take for their postoperative pain relief (assessing pain, administering pain medications, using various cognitive-behavioural, physical methods and emotional support strategies, assisting in activities and alerting health professionals); children's perception of actions nurses take for their postoperative pain relief (administering medication, using cognitive-behavioural methods, emotional support strategies and helping with activities of daily living) and suggestions for parents (using distraction and presence) and nurses (administering medications, distraction and positioning) for their postoperative pain relief improvement. Conclusions This study contributed to the existing knowledge about children's postoperative pain management based on their own experiences. Children, their parents and nurses used various strategies, including pain medication and non-pharmacological methods, especially distraction, for children's postoperative pain relief. Relevance to clinical practice This study provides evidence for health care professionals to consider using more pain relief strategies when caring for children postoperatively and provide guidance for children to practice these strategies. [ABSTRACT FROM AUTHOR]

Aim. To explore the perceptions and work experiences of internationally recruited neonatal nurses. Background. Neonatal nursing and health care are global issues facing developing and developed countries. In the UK, the recruitment of international nurses to address the labour shortage is not a new phenomenon. Methods. A purposeful sample was drawn from internationally recruited neonatal nurses, working at two teaching hospitals in London. Husserl's phenomenological approach underpins this study. Thirteen nurses, (all female) participated in the study and semi-structured face-to-face interviews were conducted to capture the unique perceptions and experiences of neonatal nurses at two hospital sites. A qualitative approach was adopted and this study used Colaizzi's analytical framework to analyse the data. Results. The analysis of the data resulted in four themes namely the support mechanisms, unfamiliarity with family centred care, feelings of being treated like a child and coping strategies. Conclusion. It can be concluded that in recruiting internationally recruited neonatal nurses to work in the NHS, there is a need to support them, encourage them to become familiar with family centred care and they should be treated as qualified nurses. Therefore, there is a need to consider these findings in any recruitment process involving neonatal nurses. Relevance to clinical practice. Internationally recruited neonatal nurses play an important role in caring for neonates in the NHS in the UK however meeting their needs have not always been addressed in the health care setting. [ABSTRACT FROM AUTHOR]

Aim. The purpose of this study was to explore the meaning of resilience, or adaptation in the face of adversity, to people living with chronic pain. Background. Little research on the usefulness of resilience, strength-based approach to health care has been undertaken to date in the area of pain yet this approach has recently been proposed as a new model for chronic pain management. However, the meaning of resilience to people with chronic pain remains unknown. Design. An interpretive qualitative design using in-depth interviews and phenomenological type analysis was undertaken. Methods. Purposive sampling and in-depth interviewing were undertaken to develop a rich description of the experience. Results. The findings from this study revealed that while living with chronic pain is generally a negative experience, the participants also told positive stories around the following themes: (i) Recognising individual strength; (ii) Looking for the positives in life; (iii) Accepting the pain; and (iv) Learning to accept help. Conclusion. Chronic pain influences all aspects of life. Resilient individuals with chronic pain recognise the value of remaining positive, accepting help and learning to live with the pain. Relevance to clinical practice. It is important for health professionals to recognise the role of supporting positive attributes in people living with chronic pain as a way of enhancing resilience. [ABSTRACT FROM AUTHOR]

Aim and objectives. This study aims to illuminate factors that facilitate and hinder the manageability of living with amyotrophic lateral sclerosis in patients and next of kin. Fourteen patients and 13 next of kin were interviewed. Background. The whole family becomes affected when a person gets the disease. Therefore, it is important to identify strategies for managing the life situation among both patients and their next of kin. Design. A qualitative descriptive study. Method. This study based on individual interviews was performed in spring 2007. The interviews were subjected to qualitative content analysis. Results. The results indicate constant fluctuation between opportunities and limitations in individual ability - of patients and family members - to manage the life situation. Both patients and next of kin devised strategies to manage their situations through acceptance, living in the present and perceiving real presence and support from family, friends and authorities. Dysfunctional relationships with family members, friends, or authorities reduced the manageability of the situation. Furthermore, patients experienced difficulties managing their situations when forced into passivity and increased dependence. Next of kin experienced decreased ability to manage because of burden, lack of own time and feelings of being controlled. Conclusion. The fluctuations in manageability and the similarities and differences between the pairs, indicate the importance of support, both for the individual and the family. Relevance to clinical practice. Fluctuations in manageability and similarities and differences between approaches to managing the situation suggest a need for input from caregivers, for the whole family. Family members need support and time for their own needs and also the opportunity to increase their awareness and understanding of the needs of other family members. This study may give health personnel insight into how to help families devise strategies to manage a complex life situation. [ABSTRACT FROM AUTHOR]

Aims. This article is a report of a study done to identify how renal nurses experience information about renal care and the information practices that they used to support everyday practice. Background. What counts as nursing knowledge remains a contested area in the discipline yet little research has been undertaken. Information practice encompasses a range of activities such as seeking, evaluation and sharing of information. The ability to make informed judgement is dependent on nurses being able to identify relevant sources of information that inform their practice and those sources of information may enable the identification of what knowledge is important to nursing practice. Method. The study was philosophically framed from a practice perspective and informed by Habermas and Schatzki; it employed qualitative research techniques. Using purposive sampling six registered nurses working in two regional renal units were interviewed during 2009 and data was thematically analysed. Findings. The information practices of renal nurses involved mapping an information landscape in which they drew on information obtained from epistemic, social and corporeal sources. They also used coupling, a process of drawing together information from a range of sources, to enable them to practice. Conclusion. Exploring how nurses engage with information, and the role the information plays in situating and enacting epistemic, social and corporeal knowledge into everyday nursing practice is instructive because it indicates that nurses must engage with all three modalities in order to perform effectively, efficiently and holistically in the context of patient care. [ABSTRACT FROM AUTHOR]