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A large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as “compelling” and “overwhelming”, there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence, which concluded there is insufficient good quality evidence available to fully inform practice. In this paper we explore this apparent contradiction. After summarising the evidence review that informed the National Institute for Health and Care Excellence guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey. Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing, it may not provide operational solutions. We conclude by posing a series of questions about design and methods for future researchers who intend to further explore this complex relationship between nurse staffing levels and outcomes. These questions are intended to reflect on the potential added value of new research given what is already known, and to encourage those conducting research to take opportunities to produce research that fills gaps in the existing knowledge for practice. By doing this we hope that future studies can better quantify both the benefits and costs of changes in nurse staffing levels and, therefore, serve as a more useful tool for those delivering services. [ABSTRACT FROM AUTHOR]

Abstract: Background: Paper based simulated patients are widely used to analyse nurses’ clinical judgements. However, developments in the physical simulation of clinical environments offer exciting, but relatively underexploited, opportunities for exploring nurses’ judgements. Critical event risk assessment is an element of acute care practice which lends itself well to simulation and in which more clinical experience is often assumed to lead to better quality judgements. Objectives: To model nurses’ judgements of critical event risk using physical and paper simulation and to examine whether improving fidelity via physical clinical simulation impacts on the apparent benefits of clinical experience on nurses’ judgement performance. Design: A comparative clinical judgement analysis. Setting: A university in Northern England. Methods: Sixty-three nursing students and 34 experienced nurses made dichotomous risk assessment judgements (“at risk” or “not at risk”) in response to 25 paper and physical simulated scenarios. These were randomly generated from a dataset of real patient case records. Clinical outcomes (the judgement criteria) for a ‘correct’ judgement were derived from the same case records. Logistic regression models were constructed to derive statistics for each nurse representing various measures of judgement performance: achievement (r a ), consistency (R s ) and clinical information use (G). These statistics were known as Lens Model statistics (from the psychological theory of Brunswik''s Lens Model of judgement). Performance measures for novice and experienced nurses were compared. Results: No significant differences in judgemental achievement (r a ) between experienced nurses and students were observed in either paper or high fidelity clinical simulations. Similarly, there were no significant differences in the nurses’ abilities to correctly match the ways they synthesised clinical information with the optimum synthesis required by the task (policy matching) (G). When faced with “paper patients” experienced nurses exercised more cognitive control/consistency (R s ) than students (P =0.04). However, this heightened control in experienced nurses was absent when those same nurses made judgements in the higher fidelity clinical simulation environment. Conclusion: Clinical experience made no difference to nurses’ judgement achievement (accuracy) in either the lower fidelity paper scenarios or the higher fidelity setting of the clinical simulation unit. The significant impact of clinical experience on judgement consistency was negated by the increases in fidelity offered through clinical simulation. [Copyright &y& Elsevier]

This classic methods paper () considers the assessment of agreement between measures, an often overlooked aspect of assessing measurements taken for use in research and practice and (re) introduces the ubiquitous ‘Bland Altman’ procedures for assessing agreement. The importance of these procedures is high and they address issues that are not always considered in research which uses measurement scales or describes the characteristics of scales developed for use in clinical practice. Many widely used approaches for reliability assessment can fail to consider the agreement between measures at all and can give an entirely misleading impression of an instrument's suitability for use in research or practice. [Copyright &y& Elsevier]

Objectives: To establish the most effective securing devices and techniques for preventing nasogastric tube displacement or inadvertent extubation, mucosa and skin lesions, discomfort, and complications (ab ingestis pneumonia, reduced caloric intake, mortality) in adult patients. Design: Systematic review of published and unpublished reports in any language, identified by searching 5 electronic databases, websites, reference lists, and existing systematic reviews and papers identified by experts in the field. Eligibility criteria for selecting studies: Systematic reviews, randomised controlled trials, and comparative studies that compared ≥2 techniques or devices to secure nasogastric tubes in patients 18 years old or older. Results: Five studies (of which two were randomised controlled trials) were included. Four studies reported on bridle versus the tape technique (unbridled). The studies' population was comprised of mostly Intensive Care Unit patients. Four studies measured unintentional dislodgement or removal and found a statistically significant advantage in favour of the bridle. Three studies measured time until failure: two studies compared the bridle versus tape technique whereas the other compared different types of tape. One study did not find any significant difference between the two groups of patients whereas the second demonstrated a significantly longer time until failure in the bridled patients. Three studies comparing bridled and unbridled patients measured adverse events such as external nasal ulceration, epistaxis and sinusitis, and there was no agreement between their results. One study measured caloric intake and found that bridled patients received a higher percentage of their caloric goal than unbridled patients. Only one study analysed the cost-effectiveness of the bridle versus the tape technique and found a cost saving by implementing routine bridling of nasoenteric feeding tubes. Discomfort was not measured in the included studies. Conclusions: Despite the large number of patients receiving this intervention, there is insufficient evidence to suggest one securing technique or device over another. Data are lacking on the beneficial effects of the various methods or systems. There is little or no statistically significant evidence regarding bridling of nasogastric tubes but more research is needed. There is a need for more well-designed studies conducted in various clinical settings. [ABSTRACT FROM AUTHOR]

Background Communication errors have a negative impact on patient safety. It is therefore essential that healthcare professionals have the skills and confidence to speak up assertively when patient safety is at risk. Although the facilitators to and barriers of assertive communication have been the subject of previous reviews, evidence regarding the effectiveness of interventions designed to enhance assertive communication is lacking. Thus, this paper reports the findings from a systematic review of the effectiveness of assertiveness communication training programs for healthcare professionals and students. Objective The objective of this review is to identify, appraise and synthesise the best available quantitative evidence in relation to the effectiveness of assertiveness communication training programs for healthcare professionals and students on levels of assertiveness, communication competence and impact on clinicians’ behaviours and patient safety. Data sources The databases included: CINAHL, Cochrane library, EMBASE, Informit health collection, MEDLINE, ProQuest nursing and allied health, PsycINFO, Scopus and Web of Science. The search for unpublished studies included: MedNar, ProQuest Dissertations & Theses A&I. Studies published in English from 2001 until 2016 inclusive were considered. Study eligibility criteria The review included original quantitative research that evaluated (a) any type of independent assertiveness communication training program; and (b) programs with assertiveness training included as a core component of team skills or communication training for healthcare professionals and students, regardless of healthcare setting and level of qualification of participants. Study appraisal and synthesis methods Studies selected based on eligibility criteria were assessed for methodological quality and the data were extracted by two independent researchers using the Joanna Briggs Institute critical appraisal and data extraction tools. Results Eleven papers were critically appraised using the Joanna Briggs Institute critical appraisal checklists. Eight papers from the USA, Australia, Ireland, and Taiwan were included in the review. Conclusions Interventions to improve assertive communication were reported to be effective to some degree with all targeted groups except experienced anaesthesiologists. Face-to-face and multimethod programs, support from leaders, teamwork skills training and communication techniques adapted from the aviation industry were identified as appropriate approaches for optimising the effectiveness of assertiveness communication training programs. Behavioural change as the result of assertiveness interventions was evaluated by observer-based rating scales during simulation, whilst self-perceived knowledge and attitudes were evaluated using validated scales. Future research should consider evaluation of sustained effect on behaviour change and patient safety. [ABSTRACT FROM AUTHOR]

Background The role and scope of nursing practice has evolved in response to the dynamic needs of individuals, communities, and healthcare services. Health services are now focused on maintaining people in their communities, and keeping them out of hospital where possible. Community based nurse-led clinics are ideally placed to work towards this goal. The initial impetus for these services was to increase patient access to care, to provide a cost-effective and high quality streamlined service. Objectives This systematic review aimed to identify the impact of nurse-led clinics in relation to patient outcomes, patient satisfaction, impact on patient access to services, and cost effectiveness. Methods A review of community based nurse-led clinic research in Medline, CINAHL and Embase was undertaken using MeSH terms: Nurse-managed centres, Practice, Patterns, Nurse, Ambulatory Care, keywords: nurse-led clinic, nurse led clinic, community and phrases primary health care and primary care. Papers were appraised using the Joanna Briggs Appraisal criteria. Results The final review comprised 15 studies with 3965 participants. Most studies explored patient satisfaction which was largely positive towards nurse-led clinics. Patient outcomes reported were typically from self-report, although some papers addressed objective clinical measures; again positive. Access was reported as being increased. Cost-effectiveness was the least reported impact measure with mixed results. Conclusions Nurse-led clinics have largely shown positive impact on patient outcomes, patient satisfaction, access to care and mixed results on cost-effectiveness. Future research evaluating NLCs needs to adopt a standardised structure to provide rigorous evaluations that can rationalise further efforts to set up community based nurse-led clinical services. [ABSTRACT FROM AUTHOR]

Background Improving the quality of healthcare remains central to UK and international policy, practice and research. In 2003, The Institute of Medicine's ‘ Health Professions Education: A Bridge to Quality ’, advocated quality improvement as a core competency for all healthcare professionals. As a result, developing capacity and capability of those applying improvement methodologies in the pre-registration population has risen, yet, little is known about the teaching approaches employed for this purpose. Objectives To describe and analyse educational approaches used to teach quality improvement to pre-registration healthcare professionals and identify enabling and impeding factors. Design Integrative review. Data sources CINAHL, PsychINFO, MEDLINE, ERIC, ASSIA, SCOPUS and Google Scholar were accessed for papers published between 2000 and 2016. Review methods Publications where quality improvement education was delivered to pre-registration healthcare professionals were eligible. One author independently screened papers, extracted data using a modified version of the Reporting of Primary Studies in Education Guideline and evaluated methodological quality using the Weight of Evidence Framework. The Kirkpatrick Education Evaluation Model was used to explore the impact of teaching approaches. Enabling and impeding factors were thematically analysed. A narrative synthesis of findings is presented. Results Ten papers were included, representing nursing, pharmacy and medicine from UK, Norway and USA. Studies comprised four quantitative, four mixed method, one qualitative and one cluster randomised trial, all allocated medium Weight of Evidence. Teaching approaches included experiential learning cited in all studies, didactics in seven, group work in four, seminars in three, self-directed learning in three and simulation in one. Most studies measured Level 1 of the Kirkpatrick Model (reaction), all but one measured Level 2 (skills, knowledge or attitudes), none measured Level 3 (behaviour) and one measured Level 4 (patient outcomes). Enabling and impeding themes included: Teaching Approaches, Clinical/Faculty support, Information Provision, Curriculum Balance and Data. Conclusions Evaluating quality improvement education is complex. Experiential learning combined with didactics is the favoured approach; however, attributing causality to educational intervention proves difficult in light of poor methodological rigour, lack of validated tools and complex clinical settings. Clarity regarding which quality improvement competencies are priority for this population would be useful to streamline future educational development and evaluation. Stronger collaboration between educators and clinicians is recommended to explore the multiple components and contextual factors associated with quality improvement education in practice. Ethnographic enquiry may be a logical next step to advance knowledge within the field. [ABSTRACT FROM AUTHOR]

This paper discusses how a research team negotiated the challenges of language differences in a qualitative study that involved two languages. The lead researcher shared the participants’ language and culture, and the interviews were conducted using the Arabic language as a source language, which was then translated and disseminated in the English language (target language). The challenges in relation to translation in cross-cultural research were highlighted from a perspective of establishing meaning as a vital issue in qualitative research. The paper draws on insights gained from a study undertaken among Arabic-speaking participants involving the use of in-depth semi-structured interviews. The study was undertaken using a purposive sample of 15 participants with Type 2 Diabetes Mellitus and co-existing depression and explored their perception of self-care management behaviours. Data analysis was performed in two phases. The first phase entailed translation and transcription of the data, and the second phase entailed thematic analysis of the data to develop categories and themes. In this paper there is discussion on the translation process and its inherent challenges. As translation is an interpretive process and not merely a direct message transfer from a source language to a target language, translators need to systematically and accurately capture the full meaning of the spoken language. This discussion paper highlights difficulties in the translation process, specifically in managing data in relation to metaphors, medical terminology and connotation of the text, and importantly, preserving the meaning between the original and translated data. Recommendations for future qualitative studies involving interviews with non-English speaking participants are outlined, which may assist researchers maintain the integrity of the data throughout the translation process. [ABSTRACT FROM AUTHOR]

Objectives The aim of this systematic literature review is to investigate older residents’ thoughts on, experiences of and engagement in sexual behavior and aged sexuality within institutionalized elderly care. Design Systematic literature review. Data sources We conducted an extensive search of the electronic databases Cinahl, Medline, Pubmed, Embase, Web of Science and Invert for papers published between January 1980 and October 2014 when the searches were closed. Additional papers were identified through forward and backward citation chasing. Review methods Data from relevant studies were extracted by means of a data extraction form. Relevant data were isolated, summarized, compared, related and categorized according to theme. Quality assessment of the included studies focused on their adequacy of reporting the study's research aim, sampling, collection, and analysis procedures, ethical considerations and results. Results Twenty-five appropriate studies were identified. These studies varied in research design (using surveys, vignettes, focus groups, interviews, or observation), objectives, quality of reporting, and sample characteristics (i.e. male and/or female long-term care residents with and/or without dementia). Yet, they all point to the relevance of sex and sexuality in old age and emphasize the highly individual character of both sexual interest and expression. Older residents who wish to sexually express themselves, might do this in a wide variety of ways, including, but not limited to, daydreaming, dressing-up, looking for emotional and intellectual intimacy, stroking, caressing, kissing, and engaging in sexual intercourse. Overall, residents appear to have a rather positive attitude toward aged sexuality as such. When it comes to specific sexual behaviors or homosexuality, however, attitudes tend to be more negative. The perceived appropriateness of the displayed behavior is a predominant factor in determining older people's reactions to the sexual behavior of co-residents, rather than the potential emotional discomfort brought on by witnessing this behavior. Conclusions Relatively little work has been published on older residents’ perspectives regarding aged sexuality in institutionalized elderly care. If, however, we wish to devote ourselves to individualized or person-centered nursing care, we will have to gain more insight into the patient's perspective and take notice of the needs, expectations, attitudes, experiences and behaviors of residents with regard to (aged) sexuality. Hence more research is needed that depicts the issue of aged sexuality in institutionalized elderly care from a patient's and thus resident oriented perspective. [ABSTRACT FROM AUTHOR]

Background Psychometric concepts have undergone a transformation in health fields, as articulated in a consensus report by an international panel of health measurement experts: COSMIN, the COnsensus-based Standards for the selection of health Measurement INstruments. Objectives The aims of this paper are to describe emerging ideas relating to the development and testing of new measures in health fields, to present a revised measurement taxonomy that builds upon COSMIN, and to explore the extent to which the new measurement concepts have played a role in psychometric assessments in nursing. Design A descriptive analysis of a sample of psychometric papers published in three major nursing journals was undertaken. Methods A new measurement taxonomy is presented and explained. A sample of 105 studies, representing a consecutive sample of psychometric studies published in the International Journal of Nursing Studies, Nursing Research , and Research in Nursing & Health between 2010 and 2014 was reviewed to ascertain the extent to which psychometric assessments in nursing map onto the new taxonomy. Results Most nursing studies reviewed adhered to traditional concepts of psychometric assessment, which focus on reliability and validity. The studies in the sample rarely involved assessments of longitudinal measurement aspects, namely the reliability and validity of change scores (responsiveness). Conclusions Many constructs of interest to nurse researchers are amenable to change—and these constructs are frequently the target of nursing interventions designed to foster change. Future psychometric work by nurse researchers would benefit from assessments of the psychometric adequacy of change scores. [ABSTRACT FROM AUTHOR]

Objectives: To investigate paediatric nurses’ postoperative pain management practices with the aim of identifying the factors associated with undermanaged paediatric postoperative pain. Design: Systematic search and review. Data sources: PsychInfo, CINAHL, PubMed, EMBASE and hand searching. Review methods: English peer-reviewed quantitative, qualitative, or mixed methods research articles published between 1990 and 2012 exploring registered nurses’ paediatric postoperative pain management practices were included. Articles with a primary focus on nurses’ pain management practices in the neonatal or paediatric intensive care units, recovery room, and/or focused on children with cognitive impairment were excluded. The search terms used were: postoperative pain; nurs*; paediatrics; pediatrics; children; pain assessment; non-pharm*; analges*. Titles and abstracts were used for initial screening. Two researchers conducted data extraction and assessment of rigour for each paper. Results: From the initial 248 citations, 27 studies were included. Most studies were descriptive and examined relationships between personal factors and nurses’ pain management practices. Observational data from four papers added insights beyond that provided in self-report studies. Two articles used experimental designs with vignettes. Data were categorised into four topics: pain assessment; pharmacological practices; nonpharmacological practices; and factors affecting practices. Despite improvements in analgesic administration over the past 20 years, practices remain suboptimal. Children’s behaviour appears to influence nurses’ pain assessment more than validated measures. A significant proportion of children did not have pain scores recorded in the first 24-h postoperatively. Children receive more analgesia when ordered around the clock compared to as required. However, around the clock analgesia prescription did not guarantee administration. Nurses reported using several non-pharmacological strategies routinely but some are not evidence based. Conclusions: The results of this review indicate nurses’ assessment and management of children’s pain is not consistent with published guidelines. Results of studies exploring nurse and child related factors are inconclusive. Research needs to examine the impact of organisational factors on nurses’ pain care practices. Intervention studies are needed to determine the most effective strategies to support and improve nurses’ pain care for children. [ABSTRACT FROM AUTHOR]

Background: Pressure ulcers are considered to be an adverse outcome of care that should never occur in clinical practice. The formation of a pressure ulcer is also perceived to be an indicator of poor quality nursing care. Therefore, pressure ulcer prevention is a priority for nurses, healthcare professionals and healthcare organisations throughout the world. A key factor in pressure ulcer prevention and management is individual nurse decision making. Objectives: To synthesise the literature on the judgement and decision making of nurses in relation to the assessment, prevention, grading and management of pressure ulcers in all care settings (hospital and community). Design: A systematic search of published literature relating to judgement and decision making in nurses, with a focus on the prevention and management of pressure ulcers. Methods: A search of electronic databases from 1992 to present, together with hand searching of the reference lists of retrieved publications, to identify published papers that reported results of studies evaluating the decision making of nurses in relation to the prevention and management of pressure ulcers. Abstracts were independently reviewed by two authors and full text of potentially relevant articles retrieved. Each paper included in this systematic review was evaluated using recognised appraisal criteria relevant to the specific study design. Included papers provided empirical data on key aspects of nurses' pressure ulcer related judgements and decision making. Data were synthesised into themes using narrative analysis. Results: Sixteen studies and one systematic review were included in the review, focusing on pressure ulcer risk assessment, pressure ulcer prevention, grading of pressure ulcers and treatment decisions. The results indicated that assessment tools were not routinely used to identify pressure ulcer risk, and that nurses rely on their own knowledge and experience rather than research evidence to decide what skin care to deliver. Conclusions: Emphasising pressure ulcer risk assessment and pressure ulcer grading in clinical practice is unlikely to deliver improved outcomes. Further research into nurses' pressure ulcer related judgements and decision making is needed and clinicians must focus on the consistent delivery of high quality care to prevent and mange pressure ulcers to all patients in clinical practice. [ABSTRACT FROM AUTHOR]

In recent years several authors have documented common problems in the use of statistics in nursing research, including failure to consider the effects of multiple testing, inattention to clinical significance, and under-reporting of effect sizes and confidence intervals. More subtle forms of multiple testing are not as widely recognized, and abuse of researcher degrees of freedom has received little attention in the nursing research literature. These and other unsound practices in applying and interpreting statistics are problematic in themselves, and they arguably reflect an insufficiently clear understanding of statistical inference as a method for dealing with randomness among many researchers. The goal of this educational paper is to improve the understanding and practice of inferential statistics among nursing researchers. An accessible explanation of hypothesis testing is provided, including discussion of the crucial concept of repeated sampling. Several pervasive mistakes and misconceptions in statistical inference are examined in detail, including misinterpretation of "non-significant" p -values as evidence for the null hypothesis, failure to account for forms of multiple testing that arise in model selection, abuse of researcher degrees of freedom, and hypothesis testing for baseline differences between arms in randomized trials. Recommendations for better statistical practice are offered. For the foreseeable future classical methods of statistical inference based on the idea of repeated sampling will be the primary tools for quantifying randomness in nursing research. The hypothesis testing framework, despite its limitations, can be helpful in ruling out chance as an explanation for observed effects. Nursing researchers who use quantitative methods, as well as journal reviewers and editors, should understand this framework well. Those involved in educating nursing researchers and those who teach statistics would do well to ask what changes need to be made to raise the level of statistical practice in nursing research. [ABSTRACT FROM AUTHOR]

Numerous reviews of nursing handover have been undertaken, but none have focused on the patient's role. To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. Systematic mixed- methods review. Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. Segregated synthesis of research of patients' perceptions revealed two contrasting categories; patient-centred handover and nurse-centred handover. Segregated synthesis of research of nurses' perceptions included three categories: viewing the patient as an information resource; dealing with confidential and sensitive information; and enabling patient participation. The segregated synthesis of QI projects included two categories: nurse barriers to enacting patient participation in bedside handover; and involving patients in beside handover. Once segregated findings were configured, we discovered that the patient's role in bedside handover involves contributing clinical information related to their care or progress, which may influence patient safety. Barriers related to nurses' discomfort encouraging patient participation and worries for sharing confidential and sensitive information. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and increasing the interpersonal approach during handover. Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses to achieve this and prepare patients to do this. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects. [ABSTRACT FROM AUTHOR]

Exploratory factor analysis (hereafter, factor analysis) is a complex statistical method that is integral to many fields of research. Using factor analysis requires researchers to make several decisions, each of which affects the solutions generated. In this paper, we focus on five major decisions that are made in conducting factor analysis: (i) establishing how large the sample needs to be, (ii) choosing between factor analysis and principal components analysis, (iii) determining the number of factors to retain, (iv) selecting a method of data extraction, and (v) deciding upon the methods of factor rotation. The purpose of this paper is threefold: (i) to review the literature with respect to these five decisions, (ii) to assess current practices in nursing research, and (iii) to offer recommendations for future use. The literature reviews illustrate that factor analysis remains a dynamic field of study, with recent research having practical implications for those who use this statistical method. The assessment was conducted on 54 factor analysis (and principal components analysis) solutions presented in the results sections of 28 papers published in the 2012 volumes of the 10 highest ranked nursing journals, based on their 5-year impact factors. The main findings from the assessment were that researchers commonly used (a) participants-toitems ratios for determining sample sizes (used for 43% of solutions), (b) principal components analysis (61%) rather than factor analysis (39%), (c) the eigenvalues greater than one rule and scree tests to decide upon the numbers of factors/components to retain (61% and 46%, respectively), (d) principal components analysis and unweighted least squares as methods of data extraction (61% and 19%, respectively), and (e) the Varimax method of rotation (44%). In general, well-established, but out-dated, heuristics and practices informed decision making with respect to the performance of factor analysis in nursing studies. Based on the findings from factor analysis research, it seems likely that the use of such methods may have had a material, adverse effect on the solutions generated. We offer recommendations for future practice with respect to each of the five decisions discussed in this paper. [ABSTRACT FROM AUTHOR]

Background: Family carers provide strong support for many older adults, often enabling older adults to remain at home. Little is known about the care recipients' perspectives of the role and contributions of family carers, particularly when hospital admissions occur as part of end of life care. Aim: This paper explores the meanings of family caring for care recipients by drawing on older adults' perspectives about the impact of hospital admission on established family caring relationships. Design: Exploratory semi-structured qualitative interviews. Key findings reported in this paper emerged from within the inductive research design. Setting: Interviews were conducted in older adults' place of residence in northwest England between June 2009 and July 2010. Participants: Participants were 27 older adults living with heart failure (n = 13) or lung cancer (n = 14), aged 69-89 years (mean 79 4.3 years) and considered by their health professionals to be in their last year of life. In 12 of the interviews, a family carer was also present and made contributions. Findings: For community-dwelling older adults, family carers are conceptualised as 'conductors'; making strong contributions to maintaining the rhythm of good care throughout the illness trajectory. Following older adults' hospital admission, family carers find themselves in the role of 'second fiddle', their ability to work with the individual and to make or influence decisions vastly reduced. Despite this, carers continue to invest considerable effort in maintaining continuity in the carer relationship to maximise the individual's wellbeing by identifying needs, filling gaps in provision and advocating on patients' behalf. Family carers act flexibly to provide continuity, support and take responsibility for older adults' wellbeing across settings. Conclusions: Nurses and family carers working together, and greater appreciation of the contribution and role of family carers by health professionals may contribute to improving the quality and continuity of care for older adults. [ABSTRACT FROM AUTHOR]

For decades various pressure ulcer risk assessment scales (PURAS) have been developed and implemented into nursing practice despite uncertainty whether use of these tools helps to prevent pressure ulcers. According to current methodological standards, randomised controlled trials (RCTs) are required to conclusively determine the clinical efficacy and safety of this risk assessment strategy. In these trials, PURAS-aided risk assessment has to be compared to nurses' clinical judgment alone in terms of its impact on pressure ulcer incidence and adverse outcomes. However, RCTs evaluating diagnostic procedures are prone to specific risks of bias and threats to the statistical power which may challenge their validity and feasibility. This discussion paper critically reflects on the rigour and feasibility of experimental research needed to substantiate the clinical efficacy of PURAS-aided risk assessment. Based on reflections of the methodological literature, a critical appraisal of available trials on this subject and an analysis of a protocol developed for a methodologically robust cluster-RCT, this paper arrives at the following conclusions: First, available trials do not provide reliable estimates of the impact of PURAS-aided risk assessment on pressure ulcer incidence compared to nurses' clinical judgement alone due to serious risks of bias and insufficient sample size. Second, it seems infeasible to assess this impact by means of rigorous experimental studies since sample size would become extremely high if likely threats to validity and power are properly taken into account. Third, means of evidence linkages seem to currently be the most promising approaches for evaluating the clinical efficacy and safety of PURAS-aided risk assessment. With this kind of secondary research, the downstream effect of use of PURAS on pressure ulcer incidence could be modelled by combining best available evidence for single parts of this pathway. However, to yield reliable modelling results, more robust experimental research evaluating specific parts of the pressure ulcer risk assessment-prevention pathway is needed. [ABSTRACT FROM AUTHOR]

Background: Knowledge translation is attracting different professional, educational and institutional strategies mainly focused on how new knowledge should be tailored and transferred at bedside. Less attention is dedicated to the antecedent of knowledge translation, which is the availability of the knowledge itself. Knowledge diffusion is a process by which an innovation is communicated through certain channels among members of a social system over time. Publishing in peer review journals is recognised as the main method for knowledge diffusion: nevertheless publication efficiency has received little attention to date. Objectives: Describing publication efficiency via nursing journals as the time occurring between data collection and manuscript publication was the main aim of the study. The secondary aim was to discover the differences, if any, in publication efficiency within manuscripts reporting results from different study designs. Design: A retrospective study design was adopted in 2010. Methods: The 2009 Impact Factor List of Nursing Journals published by the ISI web of Knowledge in 2010 was obtained. The first top ten IF Nursing Journals available as a full text and for which the overall ISI 5-Year Impact Factor was also available, was eligible. The articles published on paper by the selected journals, from 1st January to 31st December 2009, were then included. Commentaries, editorials and book reviews were excluded. For each article included, the following were evaluated: (a) the time occurring between each step of publication, from data collection to article submission, acceptance and publication online and on paper; and (b) the differences in the publication efficiency within articles reporting different study designs. Results: 1152 articles were included. From the end of data collection to manuscript publication online/on paper it takes an average of 981 days [CI95% 929-1032] (2.5-3 years). Meta-analysis and systematic reviews have demonstrated the fastest process, requiring an average 1.3 years and 1.9 years respectively. Case-control, cohort and quasiexperimental studies have required more time to enjoy publication in nursing journals, 4 years, 3.5 years and 3.2 years respectively. Conclusions: The production time of an article from its data collection involves significant processes and skills. However, the time may also be lengthened by factors not related to the processes of research, such as the time available to researchers. The scientific world needs to reflect on publication efficiency because lateness can potentially have a negative impact on patients and on further research. In the future, the same emphasis given to the evaluation of knowledge translation effectiveness should be given also to the complex process of knowledge diffusion, discovering facilitators and barriers. [ABSTRACT FROM AUTHOR]

Background: As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems. Objectives: To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey. Design and settings: We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe. Participants: Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field. Methods: The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context. Results: The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation. Conclusions: The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across health systems and language translation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Nurses guide and support learning of students and new graduates in the workplace. A plethora of literature exists about learners needs in the workplace however nursing leadership teams also need to support experienced nurses who facilitate others’ learning. Aim: This study sought to develop a tool for Registered Nurses’ to report on the support they receive when they facilitate the learning of others. Scale development: An extensive literature review identified 28 papers about support RNs need to facilitate learning. Five re-occuring themes pertaining to workload, communication, acknowledgement, teamwork and preparation for role emerged from analysis of these papers. These were verified independently through focus groups. A 30-item instrument was generated based on the themes; further RN focus groups were conducted to ensure clarity of items. Testing of instrument: Data were collected from RNs working in medical and surgical areas across three acute care hospitals (ranging from 300 to 750 beds). A total of 372 registered nurses responded. Principle component analysis identified 5 distinct sub scales represented by 17 items with good reliability: workload 0.953; communication 0.847; acknowledgement 0.858; teamwork 0.852; preparation 0.942. Conclusion: This newly developed tool measures Registered Nurses perceptions of support they receive to fulfil their role in supporting the learning of others. The data generated from use of this tool can inform nursing leadership about the effectiveness of existing infrastructure and resources to support RNs. [Copyright &y& Elsevier]

Abstract: Background: Many critical appraisal tools (CATs) exist for which there is little or no information on development of the CAT, evaluation of validity, or testing reliability. The proposed CAT was developed based on a number of other CATs, general research methods theory, and reporting guidelines but requires further study to determine its effectiveness. Objectives: To establish a scoring system and to evaluate the construct validity of the proposed critical appraisal tool before undertaking reliability testing. Methods: Data obtained from this exploratory study along with information on the design of the proposed CAT were combined to evaluate construct validity using the Standards for educational and psychological testing which consist of five types of evidence: test content, response process, internal structure, relations to other variables, and consequences of testing. To obtain data for internal structure and relations to other variables, the proposed CAT was analysed against five alternative CATs. A random sample of 10 papers from six different research designs across the range of health related research were selected, giving a total sample size of 60 papers. Results: In all research designs, the proposed CAT had significant (p <0.05, two-tailed) weak to moderate positive correlations (Kendall''s τ 0.33–0.55) with the alternative CATs, except in the Preamble category. There were significant moderate to strong positive correlations in the quasi-experimental (τ 0.70–1.00), descriptive/exploratory/observational (τ 0.72–1.00), qualitative (τ 0.74–0.81), and systematic review (τ 0.62–0.82) designs and to a lesser extent in the true experimental (τ 0.68–0.70) design. There were no significant correlations in the single system research designs. Conclusions: Based on the results obtained, the theory on which the proposed CAT was designed, and the objective of the proposed CAT there was enough evidence to show that inferences made from scores obtained from the proposed CAT should be sound. [Copyright &y& Elsevier]

Abstract: A new form of literature review has emerged, Mixed Studies Review (MSR). These reviews include qualitative, quantitative and mixed methods studies. In the present paper, we examine MSRs in health sciences, and provide guidance on processes that should be included and reported. However, there are no valid and usable criteria for concomitantly appraising the methodological quality of the qualitative, quantitative and mixed methods studies. Objective: To propose criteria for concomitantly appraising the methodological quality of qualitative, quantitative and mixed methods studies or study components. Design: A three-step critical review was conducted. Data sources: 2322 references were identified in MEDLINE, and their titles and abstracts were screened; 149 potentially relevant references were selected and the full-text papers were examined; 59 MSRs were retained and scrutinized using a deductive–inductive qualitative thematic data analysis. This revealed three types of MSR: convenience, reproducible, and systematic. Review methods: Guided by a proposal, we conducted a qualitative thematic data analysis of the quality appraisal procedures used in the 17 systematic MSRs (SMSRs). Results: Of 17 SMSRs, 12 showed clear quality appraisal procedures with explicit criteria but no SMSR used valid checklists to concomitantly appraise qualitative, quantitative and mixed methods studies. In two SMSRs, criteria were developed following a specific procedure. Checklists usually contained more criteria than needed. In four SMSRs, a reliability assessment was described or mentioned. While criteria for quality appraisal were usually based on descriptors that require specific methodological expertise (e.g., appropriateness), no SMSR described the fit between reviewers’ expertise and appraised studies. Quality appraisal usually resulted in studies being ranked by methodological quality. Conclusion: A scoring system is proposed for concomitantly appraising the methodological quality of qualitative, quantitative and mixed methods studies for SMSRs. This scoring system may also be used to appraise the methodological quality of qualitative, quantitative and mixed methods components of mixed methods research. [Copyright &y& Elsevier]

Abstract: Background: Evidence-based practice has become an imperative for efficient, effective and safe practice. Furthermore, evidences emerging from published research are considered as valid knowledge sources to guiding practice. Objectives: The aim of this paper is to review all research articles published in the top 10 general nursing journals for the years 2000–2006 to identify the methodologies used, the types of evidence these studies produced and the issues upon which they endeavored. Design: Quantitative content analysis was implemented to study all published research papers of the top 10 general nursing journals for the years 2000–2006. Methods: The top 10 general nursing journals were included in the study. The abstracts of all research articles were analysed with regards the methodologies of enquiry, the types of evidence produced and the issues of study they endeavored upon. Percentages were developed as to enable conclusions to be drawn. Results: The results for the category methodologies used were 7% experimental, 6% quasi-experimental, 39% non-experimental, 2% ethnographical studies, 7% phenomenological, 4% grounded theory, 1% action research, 1% case study, 15% unspecified, 5.5% other, 0.5% meta-synthesis, 2% meta-analysis, 5% literature reviews and 3% secondary analysis. For the category types of evidence were 4% hypothesis/theory testing, 11% evaluative, 5% comparative, 2% correlational, 46% descriptive, 5% interpretative and 27% exploratory. For the category issues of study were 45% practice/clinical, 8% educational, 11% professional, 3% spiritual/ethical/metaphysical, 26% health promotion and 7% managerial/policy. Conclusions: Published studies can provide adequate evidences for practice if nursing journals conceptualise evidence emerging from non-experimental and qualitative studies as relevant types of evidences for practice and develop appropriate mechanisms for assessing their validity. Also, nursing journals need to increase and encourage the publication of studies that implement RCT methodology, systematic reviews, meta-synthesis and meta-analysis methodologies. Finally, nursing journals need to encourage more high quality research evidence that derive from interpretative, theory testing and evaluative types of studies that are practice relevant. [Copyright &y& Elsevier]

Background The predicted demographic changes internationally have implications for the nature of care that older people receive and place of care as they age. Healthcare policy now promotes the implementation of end-of-life care interventions to improve care delivery within different settings. The Gold Standards Framework in Care Homes (GSFCH) programme is one end-of-life care initiative recommended by the English Department of Health. Only a small number of care homes that start the programme complete it, which raises questions about the implementation process. Aim To identify the type, role, impact and cost of facilitation when implementing the GSFCH programme into nursing care home practice. Design A mixed-methods study. Setting Nursing care homes in south-east England. Participants Staff from 38 nursing care homes undertaking the GSFCH programme. Staff in 24 nursing care homes received high facilitation. Of those, 12 also received action learning. The remaining 14 nursing care homes received usual local facilitation of the GSFCH programme. Methods Study data were collected from staff employed within nursing care homes (home managers and GSFCH coordinators) and external facilitators associated with the homes. Data collection included interviews, surveys and facilitator activity logs. Following separate quantitative (descriptive statistics) and qualitative (template) data analysis the data sets were integrated by ‘following a thread’. This paper reports study data in relation to facilitation. Results Three facilitation approaches were provided to nursing home staff when implementing the GSFCH programme: ‘fitting it in’ facilitation; ‘as requested’ facilitation; and ‘being present’ facilitation. ‘Being present’ facilitation most effectively enabled the completion of the programme, through to accreditation. However, it was not sufficient to just be present. Without mastery and commitment, from all participants, including the external facilitator, learning and initiation of change failed to occur. Implementation of the programme required an external facilitator who could mediate multi-layered learning at an individual, organisational and appreciative system level. The cost savings in the study outweighed the cost of providing a ‘being present’ approach to facilitation. Conclusions Different types of facilitation are offered to support the implementation of end-of-life care initiatives. However, in this study ‘being present’ facilitation, when supported by multi-layered learning, was the only approach that initiated the change required. [ABSTRACT FROM AUTHOR]

Background Ever-growing demands on care systems have increased reliance on healthcare support workers. In the UK, their training has been variable, but organisation-wide failures in care have prompted questions about how this crucial section of the workforce should be developed. Their training, support and assessment has become a policy priority. Objectives This paper examines: healthcare support workers’ access to training, support and assessment; perceived gaps in training provision; and barriers and facilitators to implementation of relevant policies in acute care. Design and settings We undertook a qualitative study of staff caring for older inpatients at ward, divisional or organisational-level in three acute National Health Service hospitals in England in 2014. Participants 58 staff working with older people (30 healthcare support workers and 24 staff managing or working alongside them) and 4 healthcare support worker training leads. Methods One-to-one semi-structured interviews included: views and experiences of training and support; translation of training into practice; training, support and assessment policies and difficulties of implementing them. Transcripts were analysed to identify themes. Results Induction training was valued, but did not fully prepare healthcare support workers for the realities of the ward. Implementation of hospital policies concerning supervision and formal assessment of competencies varied between and within hospitals, and was subject to availability of appropriate staff and competing demands on staff time. Gaps identified in training provision included: caring for people with cognitive impairment; managing the emotions of patients, families and themselves; and having difficult conversations. Access to ongoing training was affected by: lack of time; infrequent provision; attitudes of ward managers to additional support workforce training, and their need to balance this against patients’ and other staff members’ needs; and the use of e-learning as a default mode of training delivery. Conclusions With the current and unprecedented policy focus on training, support and assessment of healthcare support workers, our study suggests improved training would be welcomed by them and their managers. Provision of training, support and assessment could be improved by organisational policy that promotes and protects healthcare support worker training; formalising the provision and availability of on-ward support; and training and IT support provided on a drop-in basis. Challenges in implementation are likely to be faced in all international settings where there is increased reliance on a support workforce. While recent policies in the UK offers scope to overcome some of these challenges there is a risk that some will be exacerbated. [ABSTRACT FROM AUTHOR]

Background De-escalation techniques are recommended to manage violence and aggression in mental health settings yet restrictive practices continue to be frequently used. Barriers and enablers to the implementation and effectiveness of de-escalation techniques in practice are not well understood. Objectives To obtain staff descriptions of de-escalation techniques currently used in mental health settings and explore factors perceived to influence their implementation and effectiveness. Design Qualitative, semi-structured interviews and Framework Analysis. Settings Five in-patient wards including three male psychiatric intensive care units, one female acute ward and one male acute ward in three UK Mental Health NHS Trusts. Participants 20 ward-based clinical staff. Methods Individual semi-structured interviews were digitally recorded, transcribed verbatim and analysed using a qualitative data analysis software package. Results Participants described 14 techniques used in response to escalated aggression applied on a continuum between support and control. Techniques along the support-control continuum could be classified in three groups: ‘support’ ( e.g. problem-solving, distraction, reassurance) ‘non-physical control’ ( e.g. reprimands, deterrents, instruction) and ‘physical control’ ( e.g. physical restraint and seclusion). Charting the reasoning staff provided for technique selection against the described behavioural outcome enabled a preliminary understanding of staff, patient and environmental influences on de-escalation success or failure. Importantly, the more coercive ‘non-physical control’ techniques are currently conceptualised by staff as a feature of de-escalation techniques, yet, there was evidence of a link between these and increased aggression/use of restrictive practices. Risk was not a consistent factor in decisions to adopt more controlling techniques. Moral judgements regarding the function of the aggression; trial-and-error; ingrained local custom (especially around instruction to low stimulus areas); knowledge of the patient; time-efficiency and staff anxiety had a key role in escalating intervention. Conclusion This paper provides a new model for understanding staff intervention in response to escalated aggression, a continuum between support and control. It further provides a preliminary explanatory framework for understanding the relationship between patient behaviour, staff response and environmental influences on de-escalation success and failure. This framework reveals potentially important behaviour change targets for interventions seeking to reduce violence and use of restrictive practices through enhanced de-escalation techniques. [ABSTRACT FROM AUTHOR]

Background The increasing prevalence of diabetes is well-documented along with the findings that some ethnic minorities have a higher prevalence than non-minority individuals. Along with possible biological differences between ethnicities, access to economic, social, cultural and symbolic capital may impact on the success of managing type-2 diabetes. Objectives To examine how people from ethnic minorities in Western countries describe their experiences of managing type-2 diabetes mellitus. Data sources PubMed and Ovid Medline databases. Eligibility criteria Studies between 1946 and July 2016 were included if they were qualitative in design and presented findings in relation to adults from ethnic minorities and their descriptions of self-managing type-2 diabetes mellitus. Study appraisal and synthesis The CASP evaluation for qualitative studies was used for quality appraisal and synthesis involved thematic analysis and evaluation of evidence using GRADE-CERQual approach. Findings Twenty-seven papers were included in the review. The primary studies were all conducted in middle-high income western countries with people from diverse ethnicities, although the majority were Black American. There was high confidence in the evidence that a sense of powerlessness, issues of treatment accessibility and acceptability, and the culturally defined roles within families impacted on how some participants managed their diabetes. There was moderate confidence in the evidence in relation to the cultural significance of food and for the cultural effect of stigma. Conclusion The potential for a sense of powerlessness to manage diabetes, the acceptability and accessibility of treatment, the significance of food, the impact of cultural roles and stigma needs to be pivotal to diabetes education for people from ethnic minorities in Western countries. [ABSTRACT FROM AUTHOR]

Background The quality of care delivered to people with dementia in hospital settings is of international concern. People with dementia occupy up to one quarter of acute hospital beds, however, staff working in hospitals report lack of knowledge and skills in caring for this group. There is limited evidence about the most effective approaches to training hospital staff on dementia. Objective The purpose of this literature review was to examine published evidence on the most effective approaches to dementia training and education for hospital staff. Design and review methods The review was conducted using critical synthesis and included qualitative, quantitative and mixed/multi- methods studies. Kirkpatrick’s four level model for the evaluation of training interventions was adopted to structure the review. Data sources The following databases were searched: MEDLINE, PsycINFO, CINAHL, AMED, British Education Index, Education Abstracts, ERIC (EbscoHost), The Cochrane Library-Cochrane reviews, Economic evaluations, CENTRAL (Wiley), HMIC (Ovid), ASSIA, IBSS (Proquest), Conference Proceedings Citation Indexes (Web of Science), using a combination of keyword for the following themes: Dementia/Alzheimer’s, training/education, staff knowledge and patient outcomes. Results A total of 20 papers were included in the review, the majority of which were low or medium quality, impacting on generalisability. The 16 different training programmes evaluated in the studies varied in terms of duration and mode of delivery, although most employed face-to-face didactic techniques. Studies predominantly reported on reactions to training and knowledge, only one study evaluated outcomes across all of the levels of the Kirkpatrick model. Key features of training that appeared to be more acceptable and effective were identified related to training content, delivery methods, practicalities, duration and support for implementation. Conclusions The review methodology enabled inclusion of a broad range of studies and permitted common features of successful programmes to be identified. Such features may be used in the design of future dementia training programmes, to increase their potential for effectiveness. Further research on the features of effective dementia training for hospital staff is required. [ABSTRACT FROM AUTHOR]

Background Although nursing has been an academic discipline for decades, the infrastructure for nursing research in many countries is still fragile and struggling. Postdoctoral nurses have difficulties developing sustaining careers in nursing research due to lack of career opportunities. Considerable research has been conducted on leadership and mentoring in various areas of nursing. We aimed to systematically review the literature investigating leadership programs and mentoring for postdoctoral nurse researchers, as well as the influence of leadership and mentoring on research productivity, research career development, leadership knowledge and skills, the nurses’ health and well-being, staff relationships, work culture and collaboration, salaries and postdoctoral nurses’ experiences. Methods A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted. The electronic databases PubMed, CINAHL and EMBASE were searched without time limits for eligible studies up to January 2016. Reference lists of included articles were also searched manually and authors were contacted to inquire about other relevant papers. Two authors independently assessed eligibility of studies for inclusion. Titles and abstracts were matched with the inclusion criteria: studies investigating leadership and mentoring programs for postdoctoral nurses and leadership and mentoring influencing research productivity, and career development; and leadership knowledge and skills and other outcomes. The quality of the studies was appraised using the Centre for Evidence-Based Medicine for surveys, the Critical Appraisal Skill Program Qualitative Appraisal Checklist for qualitative studies, and a critical appraisal list for mixed methods studies. Any disagreements were resolved by consensus. Data were extracted by two reviewers. Findings We screened 1775 titles and abstracts, resulting in 15 studies, which included quantitative, descriptive, qualitative and mixed methods designs and involved 3855 postdoctoral nurses. Two studies presenting mentoring programs for postdoctoral nurses were identified. Other studies investigated the influence of mentoring on various outcomes. The findings showed a positive influence of mentoring on research productivity, including increase in publications and grant writing and research career development, improved leadership skills and knowledge. Furthermore, mentoring positively influenced nurses’ health and well-being, staff relationships, work culture and collaboration. Postdoctoral nurses’ experience of mentoring, mentorship, leadership and peer-support is essential in supporting ongoing research activity. Conclusion Although there is a lack of studies with robust designs investigating leadership and mentoring programs, our results document some evidence of mentoring’s influence on research productivity, career development and other outcomes of postdoctoral nurses. [ABSTRACT FROM AUTHOR]

Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context. To understand the development of patient-centred care in the context of acute hospital settings over the past decade. A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic. One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care. Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions. Patient-centred care in acute care settings – we have arrived! Is it sustainable? [ABSTRACT FROM AUTHOR]

Developing and evaluating health interventions for the benefit of patients is notoriously difficult. This also applies to the discipline of nursing, owing to the complexity of nursing interventions. Following significant revision, the updated guidance of the Medical Research Council (MRC) adopts a pluralistic view to intervention development and evaluation, including a theory-based perspective. This perspective promotes the use of program theory, aiming to understand how and under what circumstances interventions lead to change. In this discussion paper, we reflect the recommended use of program theory in the context of evaluation studies addressing complex nursing interventions. First, we review the literature by investigating the question whether and how evaluation studies targeting complex interventions used theory and to what extent program theories may contribute to enhance the theoretical foundations of intervention studies in nursing. Second, we illustrate the nature of theory-based evaluation and program theories. Third, we argue how this may impact theory building in nursing in general. We finish by discussing which resources, skills and competencies are necessary to fulfill the demanding task of undertaking theory-based evaluations. We caution against an oversimplified interpretation of the updated MRC guidance regarding the theory-based perspective, e.g. by using simple linear logic models, rather than articulating program theories. Instead, we encourage researchers to embrace the corresponding methodology, i.e. theory-based evaluation. With the prevailing perspective of knowledge production in crisis, we might be on the verge of a paradigm shift in health intervention research. Viewed through this lens, the updated MRC guidance could lead to a renewed understanding of what constitutes useful knowledge in nursing. This may facilitate knowledge production and, thereby, contribute to improve nursing practice for the benefit of the patient. The latest iteration of the MRC Framework for developing and evaluating complex healthcare interventions could lead to a renewed understanding of what constitutes useful knowledge for nursing. [ABSTRACT FROM AUTHOR]

Aims This two phase study aimed to explore health care professionals’ teaching and prescribing practice related to intermittent catheterisation and to identify their perceptions about the possible implementation of a mixed (single and multi-use) package for intermittent catheterization. Introduction Single-use intermittent catheters are the norm in the UK although multi-use is common in some other countries. A recent Cochrane review found no difference in complications, including urinary tract infection rates, between those using single or multi-use catheters. A flexible option of both multi-use and single use intermittent catheters could provide users with more flexible choices in self-care. However, understanding health care professionals’ perspectives is one of the keys to developing a multi-use intervention. Design A qualitative research framework using in-depth interviews to inform an on line survey. Method In-depth interviews were conducted with health care professionals based in the UK who prescribe catheters, teach intermittent catheterisation or manage an intermittent catheterisation service. The interviewees were selected to represent a range of clinical areas, experience and professions − continence advisors, urology, multiple sclerosis (MS) and spinal cord injury specialist nurses, and General Practitioners. Following framework analysis the themes and factors identified were used to develop an on-line survey which was disseminated through health care professional networks whose members saw patients who use intermittent catheters. Results Nineteen health care professionals participated in the telephone interviews; 206 completed the survey. A wide range of professionals in terms of experience and specialty afforded rich information regarding the contextual issues around the teaching and prescribing of intermittent catheters. The primary finding was that health care professionals were concerned about ‘minimising health risk’ and maximising ‘normalcy’ for those using intermittent self-catheterisation. Health care professionals who worked in the acute setting or had no experience of re-use were most resistant to the re-use of catheters. Professionals requested evidence that a multi-use package would not increase the risk of developing a urinary tract infection or increase the burden of use to a patient before a mixed package would be considered. Conclusions For multi-use to be acceptable, evidence based guidelines must be available for healthcare professionals and cleaning methods must be acceptable and safe for intermittent catheter users. Further evidence may be required to establish that a mixed catheter package is equivalent to single use only, particularly for outcomes such as urinary tract infection, urethral injury and quality of life. Relevance to clinical practice This paper highlights that if multi-use catheters are to be successfully introduced into clinical practice, the ease of use, safety and effectiveness of the cleaning technique will need to be convincingly demonstrated by a range of well-defined users. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to explore Indigenous people’s experiences and perceptions of hospitalisation and acute care. Methods Systematic procedures were used for the literature search covering the period from 2000 to 2016. Final search was conducted in early September 2016. Quality of the selected studies was assessed using the Critical Appraisal Skills Program. Data extraction was conducted using the data extraction tool from the Joanna Briggs Institute. A thematic approach to synthesis was taken. Statements were assembled to produce aggregated data of the findings, which were then categorised based on similarity of meaning, and the categories were used to produce comprehensive synthesised findings. Data sources The literature search was conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature, Google scholar, Medline, Psychology and Behavioural Sciences, and PsycINFO. Manual searches of the International Journal of Indigenous Health, Menzies website and references of reviewed papers were also conducted. Inclusion criteria were qualitative articles, published in English from across the world, in peer-reviewed journals, that investigated acute health care experiences of Indigenous people. Review methods A metasynthesis of qualitative research studies was conducted following Joanna Briggs Institute guidelines. Findings A total of 21 primary studies met the inclusion criteria. Three themes emerged from the metasynthesis: Strangers in a strange land ; Encountering dysfunctional interactions ; and Suffering stereotyping and assumptions . These themes emphasised the importance of meaningful relationships for Indigenous people and highlighted their cultural marginalisation in hospital settings. Conclusion The findings indicate that healthcare experiences of Indigenous patients and their relatives in acute settings can fall well short of their expectations and needs. It behoves healthcare professionals to firstly be aware of such discrepancies, and secondly to implement strategies that enable inclusive and individualised care. [ABSTRACT FROM AUTHOR]

Background Nurse managers play an important role in implementing patient safety practices in hospitals. However, the influence of their professional background on their clinical leadership behaviour remains unclear. Research has demonstrated that concepts of Bourdieu (dispositions of habitus, capital and field) help to describe this influence. It revealed various configurations of dispositions of the habitus in which a caring disposition plays a crucial role. Objectives We explore how the caring disposition of nurse middle managers’ habitus influences their clinical leadership behaviour in patient safety practices. Design Our paper reports the findings of a Bourdieusian, multi-site, ethnographic case study. Settings Two Dutch and two American acute care, mid-sized, non-profit hospitals. Participants A total of 16 nurse middle managers of adult care units. Methods Observations were made over 560 h of shadowing nurse middle managers, semi-structured interviews and member check meetings with the participants. Results We observed three distinct configurations of dispositions of the habitus which influenced the clinical leadership of nurse middle managers in patient safety practices; they all include a caring disposition: (1) a configuration with a dominant caring disposition that was helpful (via solving urgent matters) and hindering (via ad hoc and reactive actions, leading to quick fixes and ‘compensatory modes’); (2) a configuration with an interaction of caring and collegial dispositions that led to an absence of clinical involvement and discouraged patient safety practices; and (3) a configuration with a dominant scientific disposition showing an investigative, non-judging, analytic stance, a focus on evidence-based practice that curbs the ad hoc repertoire of the caring disposition. Conclusions The dispositions of the nurse middle managers’ habitus influenced their clinical leadership in patient safety practices. A dominance of the caring disposition, which meant ‘always’ answering calls for help and reactive and ad hoc reactions, did not support the clinical leadership role of nurse middle managers. By perceiving the team of staff nurses as pseudo-patients, patient safety practice was jeopardized because of erosion of the clinical disposition. The nurse middle managers’ clinical leadership was enhanced by leadership behaviour based on the clinical and scientific dispositions that was manifested through an investigative, non-judging, analytic stance, a focus on evidence-based practice and a curbed caring disposition. [ABSTRACT FROM AUTHOR]

To identify the patient classification systems used to classify nursing intensity in the assessment of nursing staffing resources currently used in home health care, with a special emphasis on validity, reliability and staff allocation. Scoping review of internationally published and grey literature, based on a methodological framework by Arksey and O'Malley. Searches of the electronic databases Cinahl, Medline, Embase and SweMed, the websites Google and Google Scholar and hand searches of reference lists occurred. Eligibility criteria included (A) a focus on patient classification systems measuring nursing intensity and workload in home health care and (B) published in English between January 2007 and March 2019. In level one testing two team members screened titles and abstracts, in level two testing two team members determined which papers should undergo a full text review. Data were extracted using structured extraction by one team member and verified by two other members. Thirteen peer-reviewed articles and grey literature documents were identified, from Canada, Ireland, the UK, the USA, Scotland, Turkey and the Netherlands. Four patient classification systems had been tested for both validity and reliability. Validity was tested through face validity, predictive validity, concurrent validity or content validity index. Reliability was tested through stability, internal consistency, observer agreement or inter rater reliability. One patient classification system had been tested only for reliability, through interrater reliability and observer agreement. Two patient classification systems had been evaluated through summative evaluation; one qualitatively through focus group interviews and one through semi-structured interviews. Only one patient classification system had been validity and reliability tested and evaluated. Overall, the patient classification systems in the included papers (13) were considered to have benefits and to be appropriate for the measurement of patients' needs, workload and allocation of staff, although specific information was not always given. Little has been published on validity or reliability tested patient classification systems linked to staffing allocation in home health care in the past decade. Limited research was seen where a patient classification system was considered to be fully operational in home health care. [ABSTRACT FROM AUTHOR]

Background Ability to elicit individuals’ perceptions of complex behavioral processes can be challenging, as it hinges not only upon the skill of the researcher, but also upon assumptions of a shared language and individuals’ ability to recall, analyze, and effectively communicate events. In a case-based qualitative-descriptive study about teens’ experiences of asthma self-management, we found that variations in terminology and descriptions of events, symptoms, and responses made it difficult to understand teens’ experiences of asthma. In particular, teens’ conceptualization of their asthma symptoms and self-management responses differed from situation to situation, from other teens in the study, from the interviewer, and from prior reports in the literature. These differences across many levels made it difficult to identify patterns in individual processes of self-management, and among teens in general.. Objectives To address these challenges, we developed a card sorting activity to facilitate in-depth exploration of teens’ experiences of asthma. Design Case-based qualitative description. Setting: Teen-parent dyads (N=28) were recruited from the community, Emergency Department, Pediatric Pulmonary Department, and prior study subjects of a major medical center. Methods Teens first identified and then sequenced their own unique sets of asthma symptoms and self-management responses. Teens then developed contextually grounded narratives using the card sort they had created as a visual aid. Results This technique not only allowed us to bridge teen-interviewer communication barriers and develop shared terminology, but also resulted in a visible sequence of asthma symptoms and self-management responses. Conclusions The card sort technique facilitated researcher-teen discussion and enabled comparison of self-management patterns across teens in our study. This technique is potentially useful for other areas of research exploring behavioral processes with complex and individual-specific experiences, in particular those involving sequences of events and self-management responses. This paper delineates the development, utility, and potential applications of the symptom-response card sorting technique for research and clinical practice. [ABSTRACT FROM AUTHOR]

Background The English National Health Service Institute for Innovation and Improvement designed a series of programmes called The Productive Series. These are innovations designed to help healthcare staff reduce inefficiency and improve quality, and have been implemented in healthcare organisations in at least 14 different countries. This paper examines an implementation of the first module of the Productive Community Services programme called ‘The Well Organised Working Environment’. Objective The quantitative component aims to identify the quantitative outcomes and impact of the implementation of the Well Organised Working Environment module. The qualitative component aims to describe the contexts, mechanisms and outcomes evident during the implementation, and to consider the implication of these findings for healthcare staff, commissioners and implementation teams. Design Mixed methods explanatory sequential design. Settings Community Healthcare Organisation in East Anglia, England. Participants For the quantitative data, participants were 73 staff members that completed End of Module Assessments. Data from 25 services that carried out an inventory of stock items stored were also analysed. For the qualitative element, participants were 45 staff members working in the organisation during the implementation, and four members of the Productive Community Services Implementation Team. Methods Staff completed assessments at the end of the module implementation, and the value of items stored by clinical services was recorded. After the programme concluded, semi-structured interviews with staff and a focus group with members of the Productive Community Services implementation team were analysed using Framework Analysis employing the principles of Realist Evaluation. Results 62.5% respondents ( n = 45) to the module assessment reported an improvement in their working environment, 37.5% ( n = 27) reported that their working environment stayed the same or deteriorated. The reduction of the value of items stored by services ranged from £4 to £5039 across different services. Results of the qualitative analysis suggests explanations for why the programme worked in some contexts and not others, for instance due to varying levels of management support, and varying levels of resources allocated to carrying out or sustaining the improvement work. Conclusions Quantitative analysis of data generated during healthcare improvement initiatives can give an impression of the benefits realised, but additional qualitative analysis also provides opportunity for learning to improve future implementations. Targets set by commissioners for innovation should focus on sustaining improvement rather demonstrating one-off benefits, and implementation teams should not let their preconceptions of what will and what will not work prevent them from trying interventions that may benefit staff. [ABSTRACT FROM AUTHOR]

Background and objectives Interdisciplinary geriatric consultation teams are implemented in the acute hospital setting in several high-income countries to provide comprehensive geriatric assessment for the increasing numbers of older patients with a geriatric profile hospitalized on non-geriatric units. Given the inconclusive evidence on this care model's effectiveness to improve patient outcomes, health care policy and practice oriented recommendations to redesign the structure and process of care provided by interdisciplinary geriatric consultation teams are needed. A scoping review was conducted to explore the structure and processes of interdisciplinary geriatric consultation teams in an international context. As nurses are considered key members of these teams, their roles and responsibilities were specifically explored. Design The revised scoping methodology framework of Arksey and O’Malley was applied. Data sources An electronic database search in Ovid MEDLINE, CINAHL and EMBASE and a hand search were performed for the identification of descriptive and experimental studies published in English, French or Dutch until April 2014. Review methods Thematic reporting with descriptive statistics was performed and study findings were validated through interdisciplinary expert meetings. Results Forty-six papers reporting on 25 distinct interdisciplinary geriatric consultation teams in eight countries across three continents were included. Eight of the 12 teams (67%) reporting on their composition, stated that nurses and physicians were the main core members with head counts varying from 1 to 4 members per profession. In 80% of these teams nurses were required to have completed training in geriatrics. Advanced practice nurses were integrated in eleven out of fourteen interdisciplinary geriatric consultation teams from the USA. Only 32% of teams used formal screening to identify patients most likely to benefit from their intervention, using heterogeneous screening methods, and scarcely providing information on the responsibilities of nurses. Nurses were involved in the medical, functional, psychological and social assessment of patients in 68% of teams, either in a leading role or in collaboration with other professions. Responsibilities of interdisciplinary geriatric consultation teams’ nurses regarding in-hospital follow-up or transitional care at hospital discharge were infrequently specified (16% of teams). Conclusions This scoping review identified that the structure and processes of care provided to geriatric patients by interdisciplinary geriatric consultation teams are highly heterogeneous. Despite nurses being key team members, only limited information on their specific roles and responsibilities was identified. More research in this area is required in order to inform health care policy and to formulate practice oriented recommendations to redesign the interdisciplinary geriatric consultation team care model aiming to improve its effectiveness. [ABSTRACT FROM AUTHOR]

Background Understanding how to mitigate language barriers is becoming increasingly important for health care providers around the world. Language barriers adversely affect patients in their access to health services; comprehension and adherence; quality of care; and patient and provider satisfaction. In 2003, the United States (US) government made a major change in national policy guidance that significantly affected limited English proficient patients’ ability to access language services. Objective The objectives of this paper are to describe the state of the language barriers literature inside and outside the US since 2003 and to compare the research that was conducted before and after a national policy change occurred in the US. We hypothesize that language barrier research would increase inside and outside the US but that the increase in research would be larger inside the US in response to this national policy change. Methods We reviewed the research literature on language barriers in health care and conducted a cross sectional analysis by tabulating frequencies for geographic location, language group, methodology, research focus and specialty and compared the literature before and after 2003. Results Our sample included 136 studies prior to 2003 and 426 studies from 2003 to 2010. In the 2003–2010 time period there was a new interest in studying the providers’ perspective instead of or in addition to the patients’ perspective. The methods remained similar between periods with greater than 60% of studies being descriptive and 12% being interventions. Conclusions There was an increase in research on language barriers inside and outside the US and we believe this was larger due to the change in the national policy. We suggest that researchers worldwide should move away from simply documenting the existence of language barriers and should begin to focus their research on documenting how language concordant care influences patient outcomes, providing evidence for interventions that mitigate language barriers, and evaluating the cost effectiveness of providing language concordant care to patients with language barriers. We think this is possible if funding agencies around the world begin to request proposals for these types of research studies. Together, we can begin document meaningful ways to provide high quality health care to patients with language barriers. [ABSTRACT FROM AUTHOR]

Background The recognition, assessment and management of pain in hospital settings is suboptimal, and is a particular challenge in patients with dementia. The existing process guiding pain assessment and management in clinical settings is based on the assumption that nurses follow a sequential linear approach to decision making. In this paper we re-evaluate this theoretical assumption drawing on findings from a study of pain recognition, assessment and management in patients with dementia. Aim To provide a revised conceptual model of pain recognition, assessment and management based on sense-making theories of decision making. Methods The research we refer to is an exploratory ethnographic study using nested case sites. Patients with dementia ( n = 31) were the unit of data collection, nested in 11 wards (vascular, continuing care, stroke rehabilitation, orthopaedic, acute medicine, care of the elderly, elective and emergency surgery), located in four NHS hospital organizations in the UK. Data consisted of observations of patients at bedside (170 h in total); observations of the context of care; audits of patient hospital records; documentary analysis of artefacts; semi-structured interviews ( n = 56) and informal open conversations with staff and carers (family members). Findings Existing conceptualizations of pain recognition, assessment and management do not fully explain how the decision process occurs in clinical practice. Our research indicates that pain recognition, assessment and management is not an individual cognitive activity; rather it is carried out by groups of individuals over time and within a specific organizational culture or climate, which influences both health care professional and patient behaviour. Conclusions We propose a revised theoretical model of decision making related to pain assessment and management for patients with dementia based on theories of sense-making, which is reflective of the reality of clinical decision making in acute hospital wards. The revised model recognizes the salience of individual cognition as well as acknowledging that decisions are constructed through social interaction and organizational context. The model will be used in further research to develop decision support interventions to assist with the assessment and management of patients with dementia in acute hospital settings. [ABSTRACT FROM AUTHOR]

Background Studies estimate that approximately one-third of episodes of delirium are preventable and that delirium prevention and management are often suboptimal in practice. While there is no doubt that prevention is desirable, the evidence of the benefits of early intervention and treatment for older hospitalised patients with dementia is unclear. Aim To determine the effects of DemDel, a comprehensive delirium management programme, in inpatient acute care elders with cognitive impairment. Design and methods This paper reports the quantitative part of a mixed methods study, comparing an intervention with treatment as usual using validated outcome measures. After training, ward nurses and physicians administered the intervention based on the DemDel algorithm that focused on delirium prevention, including an intensive systematic screening schedule for cognitive impairment and delirium, as well as comprehensive delirium management. The delirium management regimen included timely administration of pro re nata medication. Settings The study was conducted within four medical wards of an acute care university hospital in urban Switzerland. Participants A total of 268 patients with cognitive impairment participated in the pre/post comparison study. The intervention and treatment as usual groups consisted of 138 and 130 patients, respectively. Results Eighty-seven (32.5%) out of 268 patients developed delirium, of whom 51 (58.6%) were of mixed, 10 (11.5%) hyperactive and 26 (29.9%) hypoactive delirium subtypes. Delirium appeared within the first five days after admission in 81.6% of cases. The 44 (31.9%) patients with delirium in the intervention group with systematic delirium management had less severe episodes of delirium and required medication for management than the 43 (33.1%) delirious patients in the control group. Intervention compliance was good on three of the four units. Conclusions The DemDel programme was effective with regard to improvement of outcomes associated with delirium in patients with cognitive impairment. The intervention was feasible and possible to be embedded within routine practice on four busy general medical wards. [ABSTRACT FROM AUTHOR]

The last few years have witnessed a growing concern with the well-being of healthcare professionals internationally because of increasing recognition of its impact on patient outcomes and staff retention. The COVID-19 pandemic, which has placed additional and substantial pressure on frontline healthcare professionals, gives added urgency to the topic. While numerous, and successful, interventions have been developed to address compromised well-being among healthcare professionals, they have not always been able to support the needs of frontline staff, specifically those working in high-pressure environments. This paper presents findings of an evaluative research study of an intervention, named the Resilience and Well-being Training Programme, developed and implemented within an Acute Assessment Unit in a hospital in the UK. The 8 week-long programme followed a combined approach (both person-directed and work-directed), with mindfulness training as well as lectures and discussions to deepen participants' understanding of organisational life. The training, delivered from January to July 2018, involved a total of 72 healthcare professionals from a wide range of levels (UK bands 2–8), trained in three cohorts. The research followed a pre-post design to explore participants' experiences of working on the Unit, the programme and its impact on themselves and their working life. The study was conducted in a large NHS district general hospital in South London, UK. Participants included healthcare assistants and nurses who had completed their preceptorship, worked in the hospital's acute assessment unit, and had undertaken the resilience and well-being training programme. The study employed mixed methods (online questionnaire, face-to-face focus groups/interviews) to collect data. Findings showed participants' positive experience with the programme, however it had limited positive impacts on aspects of compromised well-being at the personal level and a statistically significant enhancement of the quality of relationships and communication on the Unit, with medium effect size (Cohen's D). The programme had a positive impact on the culture of the Unit. Results highlight the demand for and value of programmes designed in ways that enable this group of professionals to take part, because these professionals are often not able to participate in such programmes. A strong commitment from the leadership to enable staff attendance in time-protected programmes is one approach that works well in the short-term. However, this may be challenging to accomplish and raises issues of sustainability. [ABSTRACT FROM AUTHOR]

Background: On arrival to the emergency department many older persons are accompanied by family/carers. Yet the role of family/carers in the emergency department is unclear. We know very little about how emergency department nurses balance care practices to accommodate family/carers while specifically meeting the needs of cognitively impaired older persons experiencing pain. Objectives: The aim of this paper was to understand emergency nurses' perceptions of the role of family/carers in caring for the older cognitively impaired person experiencing pain. Design: Emergency nurses were invited to participate in focus group interviews. A semi-structured interview tool was developed from the literature and comprised open-ended questions and three Likert scale items which assisted to focus nurses' thoughts on their perceived role of family/carers in the emergency department. Settings: The study was undertaken across four emergency departments in Sydney, Australia and included two district hospitals and two tertiary referral hospitals. Participants: Emergency nurses were invited to participate in one face to face, focus group interview. Purposive sampling was used and inclusion criteria included at least one year emergency department experience. Methods: Interview data were analysed and organised thematically. Two expert qualitative researchers independently reviewed transcripts and emerging coding and interpretation. Results: Eighty nurses participated in 16 focus group interviews across four hospitals. Participating nurses included 67 (84%) females and 13 (16%) males with 8.6 years (mean; SD ±8.64) experience in the emergency department. Three key themes relating to family/ carers emerged from the analysis. The themes included (i) the role of families and carers in building a clinical picture; (ii) family and carers as a hidden workforce; and (iii) family and carer roles in pain management decision making. Conclusions: The study has provided insight into the role of family/carers as perceived by emergency nurses. There were many benefits in partnering with family/carers when information gathering on the older cognitively impaired person in pain. Family/carers are sensitive to health behaviour changes of older cognitively impaired people, which can assist nurses to optimise pain management. [ABSTRACT FROM AUTHOR]

Treatment preferences reflect individuals' choice of therapy and influence their adherence to treatment and achievement of outcomes. The two-stage partially randomized clinical or preference trial (two-stage PRCT) is an appropriate design for examining the contribution of treatment preferences. It involves a two-stage process for assigning participants to treatments, which is useful to dismantle the effects of the treatments from those of treatment preferences. In this paper, we explain the role of treatment preferences in intervention evaluation research, describe the protocol for implementing the two-stage PRCT, and discuss issues in its application. The issues are encountered in the selection of treatments, assignment of participants and assessment of treatment preferences. Lastly, we propose ways to address the issues. [ABSTRACT FROM AUTHOR]

Objectives: To review the current literature on educational interventions used in peritoneal dialysis (PD). Educational interventions have become increasingly relevant because they play a key role in helping individuals to actively participate in their therapy and to manage their chronic condition. The paper will focus on two areas: (a) educational interventions for individuals living with PD and (b) educational interventions for PD nurses. Design: A narrative review of primary research. Data sources: Electronic searches of the MEDLINE, CINAHL, EMBASE, ERIC and Cochrane Library (2006–2013) databases were undertaken using terms such as peritoneal dialysis, insertive training, curriculum, nursing education, train the trainer, coach the coach, tutor the tutor, and patient education were used. All studies were reviewed by two researchers. Review methods: Titles and abstracts of 555 studies were screened and read. Full text articles retrieved were further screened against the inclusion and exclusion criteria. Relevant data on the educational interventions for people receiving PD and nurse training programs were extracted and synthesized narratively. Results: Eighteen articles met the inclusion criteria. Most of them focused on educational intervention programs for people undergoing PD. Findings on the link between the PD trainer’s background and peritonitis rates among individuals undergoing PD are inconsistent. PD learners should be taught self-management skills as well as technical skills. They might also benefit from receiving decision-making aids. Older people, people with co-morbidities and people with low educational status need more time to acquire self-care skills and are more likely to develop peritonitis. Home visits have the potential to improve learning outcomes. Re-training needs should be assessed and fulfilled as appropriate. Case and disease management programs have been shown to have positive outcomes for individuals receiving PD. Conclusions: Educational interventions for PD remain an under-researched area, despite the potential they have to make this type of therapy more successful. Further research on education and training for people receiving PD and for PD nurses is needed. In the meantime, educational interventions used for other chronic conditions could provide guidance. [ABSTRACT FROM AUTHOR]

Background: Death and dying are inevitable life encounters, but a nurse’s first experience with patient death may pose considerable cognitive, emotional and clinical challenges. This paper reports the findings of the second phase of a study; the first has been reported elsewhere. This phase explored the earliest memorable patient death experiences of New Zealand registered nurses. Method: A purposeful, self-selected sub-sample of a larger study of New Zealand registered nurses, took part in individual face-to-face semi-structured interviews. Interpretative phenomenological analysis was utilised to seek to understand participants’ experiences. Thematic analysis was undertaken to identify emerging themes, with participants’ own words used as theme headings, where their phrases provided succinct or powerful descriptors. Results: A diverse participant group of twenty, currently practising, New Zealand registered nurses provided rich and detailed descriptions of their earliest memorable experience with patient death. Participants from a variety of training backgrounds described patient deaths, which occurred in a range of settings – some only a few months prior, others – more than thirty years ago. Seven emergent themes, and features of more positive, or negative experiences were identified: Event Significance; Emotional Challenges; Sharing the Experience; Learning; Feeling Unprepared, Responses to Death and Finding Benefits. Conclusion: For participants in this study, there was considerable evidence that their earliest memorable patient death was a significant event. Furthermore, although most participants’ experiences were characterised by emphatic or poignant description, there was most often a balance of challenges and rewards. [ABSTRACT FROM AUTHOR]

Background: The Clinical Learning Environment, Supervision and Nurse Teacher scale is a reliable and valid instrument to evaluate the quality of the clinical learning process in international nursing education contexts. Objectives: This paper reports the development and psychometric testing of the Spanish version of the Clinical Learning Environment, Supervision and Nurse Teacher scale. Design: Cross-sectional validation study of the scale. Setting: 10 public and private hospitals in the Alicante area, and the Faculty of Health Sciences (University of Alicante, Spain). Participants: 370 student nurses on clinical placement (January 2011--March 2012). Methods: The Clinical Learning Environment, Supervision and Nurse Teacher scale was translated using the modified direct translation method. Statistical analyses were performed using PASW Statistics 18 and AMOS 18.0.0 software. A multivariate analysis was conducted in order to assess construct validity. Cronbach's alpha coefficient was used to evaluate instrument reliability. Results: An exploratory factorial analysis identified the five dimensions from the original version, and explained 66.4% of the variance. Confirmatory factor analysis supported the factor structure of the Spanish version of the instrument. Cronbach's alpha coefficient for the scale was .95, ranging from .80 to .97 for the subscales. Conclusion: This version of the Clinical Learning Environment, Supervision and Nurse Teacher scale instrument showed acceptable psychometric properties for use as an assessment scale in Spanish-speaking countries. [ABSTRACT FROM AUTHOR]