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Aims: To explore how parents experienced their child with delirium and how parents viewed our delirium management bundle. Design: We conducted a qualitative exploratory descriptive study using semi‐structured individual or dyad interviews. Methods: Twelve semi‐structured interviews with 16 parents of 12 critically ill children diagnosed with delirium in a paediatric intensive care unit were conducted from October 2022 to January 2023 and analysed through a reflexive thematic analysis. Findings: We generated five themes: (1) knowing that something is very wrong, (2) observing manifest changes in the child, (3) experiencing fear of long‐term consequences, (4) adding insight to the bundle, and (5) family engagement. Conclusion: The parents in our study were able to observe subtle and manifest changes in their child with delirium. This caused fear of lasting impact. The parents regarded most of the interventions in the delirium management bundle as relevant but needed individualization in the application. The parents requested more information regarding delirium and a higher level of parent engagement in the care of their child during delirium. Impact: This paper contributes to understanding how parents might experience delirium in their critically ill child, how our delirium management bundle was received by the parents, and their suggestions for improvement. Our study deals with critically ill children with delirium, their parents, and staff working to prevent and manage paediatric delirium (PD) in the paediatric intensive care unit. Reporting Method: The consolidated criteria for reporting qualitative research guidelines were used to ensure the transparency of our reporting. Patient or Public Contribution: No patient or public contribution to the research design. What does this Paper Contribute to the Wider Global Community?: ‐ It increases awareness of the parent's perspective on PD in critically ill children.‐ It shows how PD might affect parents, causing negative emotions such as distress, frustration, and fear of permanent damage.‐ It shows that the parents in our study, in addition to the care bundle, requested more information on delirium and more involvement in the care of their delirious child. [ABSTRACT FROM AUTHOR]

Aim: To explore the prospective acceptability of an implementation leadership training programme prototype for nurse managers in China to implement evidence‐based practices, from the perspectives of potential programme participants and deliverers. Design: A qualitative descriptive study was conducted in Spring 2022 at three tertiary hospitals in Hunan, China. Methods: We conducted individual semi‐structured interviews with unit‐level nurse managers (n = 14), including 12 potential participants, and two potential deliverers that have been involved in developing the programme prototype. Interview questions and thematic analysis were guided by the Theoretical Framework of Acceptability. Results: After reviewing the programme content, potential participants and deliverers reported that unit nurse managers would benefit from engaging in the programme, acknowledging that the programme fit with professional nursing values for implementing research evidence. They expressed positive views about being involved in producing academic papers through the training process, and interactive multi‐modal training activities such as group work, experience‐sharing and coaching. Seven participants were not very confident about being fully engaged in the training, as they could not navigate the English research literature. Both participants and deliverers highlighted factors that would influence their participation, including time constraints, the impact of the COVID‐19 pandemic, and support from senior organizational leadership. Conclusions: The training programme prototype was perceived to be useful and acceptable. The multimodal training activities were considered a strength and managers expressed an interest in writing academic papers about their implementation processes. Support from senior hospital leaders and programme deliverers was identified as critical to the training programme's success. Impact: The study helps understand nurse managers' perceptions and concerns of participating in an implementation leadership training programme and could inform the development and refinement of similar programmes in various nursing contexts globally. [ABSTRACT FROM AUTHOR]

Aim: To obtain a deeper understanding of peoples' experiences of cancer treatments with immune checkpoint inhibitors (ICIs). Background: ICIs are transforming survival outcomes for many with certain advanced cancers. Given the possibility of unique immune‐related adverse events (irAEs), understanding treatment experiences is crucial to identify support needs and provide safe and effective person‐centred care. Design: A systematic review of qualitative research and thematic synthesis. To report this review, the Preferred Reporting Items for Systematic Analysis and Meta Analysis (PRISMA) checklist and Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidance have been used. Data Sources: MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science databases were searched in January 2022 for eligible studies published in English from database inception. Review Methods: Two reviewers independently screened records, identified papers for inclusion and appraised methodological quality using the Critical Appraisal Skills Programme checklist. Themes were developed using thematic synthesis. Results: Eighteen papers were included and three analytical themes developed: immune checkpoint inhibitor treatment decision‐making; the experience and impact of immune checkpoint inhibitor treatments; and appraising and responding to irAEs. Conclusion: The synthesis renders visible individuals' unmet information, psychological and practical support needs. It identifies shortcomings in immune checkpoint inhibitor treatment decision‐making processes and highlights the need for healthcare professionals to recognise and sensitively handle individuals' treatment expectations. Individuals' understandings of and responses to irAEs are also illustrated, and attention drawn to patients' concerns about healthcare professionals' checkpoint inhibitor and irAEs knowledge. Implications for Patient Care: To sensitively manage treatment expectations and uncertainties, and optimise health outcomes, there are distinct points in treatment trajectories where care and support might require adapting and enhancing. Impact: This review addresses people's experiences of immune checkpoint inhibitor treatments. The core findings reveal unmet information, psychological and practical support needs. Insights derived from this review will enhance individuals' experiences and outcomes and healthcare professionals' practice. Patient or Public Contribution: No patient or public involvement. [ABSTRACT FROM AUTHOR]

Accessible Summary: What Is Known about the Subject?: One in five mothers and birthing parents are affected by postpartum depression (PPD), yet only a small proportion of those with PPD receive treatment.Given cost and accessibility barriers to treatment, brief therapies (e.g. 1 day) could help address PPD on a large scale, though understanding participants' unique experiences with this novel treatment will help guide its refinement and use. What this Paper Adds to Existing Knowledge?: This paper describes the experiences, perspectives and satisfaction of participants who attended a 1‐day workshop for PPD.Participants appreciate being taught practical techniques and the receipt of social support from facilitators and other attendees in the group setting, while some recommended further 'booster sessions' to enhance effectiveness. What Are the Implications for Practice?: One‐day CBT‐based workshops may be an effective, low‐intensity treatment option that provides helpful skills and builds social networks for individuals with PPD.Additional post‐workshop booster sessions may enhance participant satisfaction with this new treatment by providing a reinforcement of their learning and an opportunity to re‐connect with other birthing parents. Introduction: Postpartum depression (PPD) affects up to one in five mothers and birthing parents. Understanding their perceptions of therapeutic interventions is key to their effectiveness and scalability. Aim: The aim of the study was to understand participants' experiences attending an in‐person or online 1‐day cognitive behavioural therapy (CBT)‐based workshop for PPD and compare their experiences participating in either modality. Method: This descriptive qualitative study was embedded in two separate randomized controlled trials evaluating the effectiveness of 1‐day CBT‐based workshops for PPD delivered in‐person or online. Responses were provided by 94 in‐person and 95 online participants about their experiences. Content analysis was used to code and categorize the data. Results: Participants appreciated learning skills to improve PPD symptoms and joining a community of individuals with shared experiences. Integrating practical coping techniques after the workshop was reported to be most useful, though some wanted additional post‐workshop support. Online participants identified additional barriers to workshop engagement. Discussion: Participants who attended either workshop found them to be valuable and effective. Participants valued psychoeducation, social connections and applying practical CBT techniques. Implications for Practice: One‐day CBT‐based workshops may be an accessible treatment option for individuals with PPD, providing new skills and social support, though some prefer to receive additional post‐workshop support. [ABSTRACT FROM AUTHOR]

Aims: To explore the nature of interactions that enable older inpatients with cognitive impairments to engage with hospital staff on falls prevention. Design: Ethnographic study. Methods: Ethnographic observations on orthopaedic and older person wards in English hospitals (251.25 h) and semi‐structured qualitative interviews with 50 staff, 28 patients and three carers. Findings were analysed using a framework approach. Results: Interactions were often informal and personalised. Staff qualities that supported engagement in falls prevention included the ability to empathise and negotiate, taking patient perspectives into account. Although registered nurses had limited time for this, families/carers and other staff, including engagement workers, did so and passed information to nurses. Conclusions: Some older inpatients with cognitive impairments engaged with staff on falls prevention. Engagement enabled them to express their needs and collaborate, to an extent, on falls prevention activities. To support this, we recommend wider adoption in hospitals of engagement workers and developing the relational skills that underpin engagement in training programmes for patient‐facing staff. Implications for Profession and Patient Care: Interactions that support cognitively impaired inpatients to engage in falls prevention can involve not only nurses, but also families/carers and non‐nursing staff, with potential to reduce pressures on busy nurses and improve patient safety. Reporting Method: The paper adheres to EQUATOR guidelines, Standards for Reporting Qualitative Research. Patient or Public Contribution: Patient/public contributors were involved in study design, evaluation and data analysis. They co‐authored this manuscript. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to develop a model to help parents cope with decisional conflict. Background: Parents of children with congenital heart defect experience decisional conflict when they are uncertain about treatment decisions for their child, which may lead to delay in seeking care or distress over the decision made. Design: Correlational design with model building and data triangulation was used. Methods: Data were collected through surveys and interviews with a consecutive sample of 221 parent respondents from June to December 2018. Structural equation modelling and qualitative data analysis were used. Results: Lower decisional conflict was seen in parents with higher income, more nurse support and physician risk communication. Time delay for surgery was correlated with the child's age, social service coverage, and social support. Decisional conflict mediated the influence of income, nurse support and physician risk communication on satisfaction with decision. Based on model fit parameters, the emerging model is a good and parsimonious model of decisional conflict. The overall theme, 'Deciding for Surgery: What Matters Most', described the processes parents went through in making treatment decisions. Conclusion: Nurses may help parents feel more certain, less conflicted, and more satisfied with their decision by addressing factors including knowledge gaps, personal values, available support, and resource access. Summary statement: What is already known about this topic? Decisional conflict occurs when parents are uncertain of the best action for their child because treatment options entail risks for undesirable outcomes, value compromise, unclear prognosis, or anticipated regret over the decision.Professional support, information, and communication are vital to parents' decision‐making process.Child, parent, and support factors may influence parent treatment decisions in varied paediatric conditions. What this paper adds? Child's age at the time of decision‐making had an effect on the delay in surgery. However, assisting parents to weigh their options and focus on personal values allowed them to make their treatment decision.Low income, costly health services, and bureaucratic processes impeded the timely availment of surgery. Healthcare reforms that provide a system of government funding, streamlined health structure, and social insurance may be looked into.Family support weighed in on the parents' decision to delay surgery for fear of blame or guilt. Providing relevant information enabled parents to make a choice and stand by their decision regardless of the outcome. The implications of this paper: Modelling provides a framework to identify which factors are more important and how they interact to affect decision‐making. It may be used as an approach to find solutions to clinical problems for groups with different diagnoses.Though nursing support, information, and communication are essential, a more holistic family nursing care approach may be considered to assist parents to make appropriate treatment decisions for their child.Familiarity with the healthcare system may equip nurses to aid parents in processing available healthcare funding and dealing with financial uncertainty affecting decisions for their child's treatment. [ABSTRACT FROM AUTHOR]

Aim: To explore undergraduate nursing and midwifery student perspectives of using digital patient systems on clinical placements. Design: This was an interpretative qualitative design study. Methods: Undergraduate nursing and midwifery students in a large Australian metropolitan university were invited to participate in two focus groups from April to June 2019. Twenty (20) students participated and data on their perspective of using digital systems on placement were collected. Thematic analysis using NVivo 12 software was undertaken. Findings: Students identified benefits and challenges when moving between paper records and digital systems. Whilst paper reporting was more efficient for some processes, the students recognised the advantages of digital technology, such as enabling greater confidentiality and consolidation of patient data in one place. However, they also reported difficulty with student access and the size of the portal digital workstation at the bedside. Generally, the lack of preparation and access was considered frustrating and mitigated some of the benefits described when using digital systems. Conclusions: Nursing and midwifery students prefer to be prepared for both paper and digital record keeping. Whilst students identify the benefits of digital platforms, not having direct access mitigates the benefits of these systems. Students identified the use of simulation and interactive modules prior to commencement of clinical practice to enable them to feel more confident with using the systems in patient care. Impact: Health care students require direct access to digital health platforms whilst on clinical placement to facilitate their learning. Higher Education Institutions (HEIs) are in a unique position to work with health care providers to better prepare health care professionals, including nurses and midwives, to work with digital health care systems. Further research is needed to develop the educational preparation for nurses, midwives, and other health care professionals to work with digital systems in practice. [ABSTRACT FROM AUTHOR]

Background: Utilization of video calls on hospital wards to facilitate involvement of and communication with family members is still limited. A deeper understanding of the needs and expectations of family members regarding video calls on hospital wards is necessary, to identify potential barriers and facilitate video calls in practice. Aim: The aim of this study was to explore the views, expectations and needs of a patient's family members regarding the use of video calls between family members, patients and healthcare professionals, during the patient's hospital admission. Methods: A qualitative study was carried out. Semi‐structured interviews with family members of patients admitted to two hospitals were conducted between February and May 2022. Family members of patients admitted to the surgical, internal medicine and gynaecological wards were recruited. Results: Twelve family members of patients participated. Family members stated that they perceive video calls as a supplemental option and prefer live visits during hospital admission. They expected video calls to initiate additional moments of contact with healthcare professionals, e.g. to join in medical rounds. When deploying video calls, family members mentioned that adequate instruction and technical support by nurses should be available. Conclusion: Family members considered video calls valuable when visiting is not possible or to participate in medical rounds or other contacts with healthcare professionals outside of visiting hours. Implications: Family members need to be supported in options and use of video calls on hospital wards. Additional knowledge about actual participation in care through video calls is needed as well as the effect on patient, family and healthcare professional outcomes. Impact: Using video calls on hospital wards can provide family members with flexible alternatives for contact and promote family involvement. Reporting Method: COREQ guidelines. Patient or Public Contribution: Family members of patients admitted to hospital have contributed by sharing their perspectives in interviews. What does this paper contribute to the wider global clinical community?: Family members perceive additional value from the use of video calls on hospital wards.For family, use of video calls needs to be facilitated with clear instruction materials and support. Trial and Protocol Registration: Amsterdam UMC Medical Ethics Review Committee (ref number W21_508 # 21.560). [ABSTRACT FROM AUTHOR]

Aim: To identify attitudes towards HIV/STI screening guidelines and explore the acceptability of assessing sexual positioning practices among Black sexual minority men (SMM). Background: Risks for HIV/STIs vary by sexual positioning practices. However, clinicians and Black SMM do not always discuss sexuality with each other. Therefore, HIV/STI screening and testing remain suboptimal. Design: Qualitative study using focus groups. Methods: Data were obtained from 12 focus groups and one in‐depth interview conducted in Baltimore, MD among HIV‐negative Black SMM between October 2019 and May 2020 (N = 39). Groups were stratified into three age categories: 18–24, 25–34 and 35+. Participants were given the "5 P's" from the CDC's 2015 Sexual History Screening Guidelines and asked to discuss attitudes towards existing questions regarding sexual positioning practices. Themes were identified using an electronic pile sorting approach. Results: Most identified as homosexual/gay/same gender‐loving (68%), were employed (69%) and single (66%). Additionally, 34% had ever been diagnosed with an STI, of whom 38% had a history of repeated STI acquisition in their lifetime. Participants across age groups said clinicians should use the words "top" and "bottom" to demonstrate cultural familiarity and build trust. Some said that screening for sexual positioning was unnecessary and intrusive; others said that questions should be justified. Younger men wanted clinicians to ask questions in ways that make them feel cared for. Discussion: Guidelines should include language for clinicians to use culturally specific language and better ways to prepare Black SMM patients for screening. Impact to Nursing Practice: Some Black SMM will not discuss sexual positioning practices without clinicians' demonstration of cultural understanding and respect. Screening should incorporate culturally responsive language, justification and convey care. Reporting Method: Consolidated criteria for reporting qualitative research (COREQ). No Patient or Public Contribution: There was no patient or public involvement in the design or drafting of this discursive paper. [ABSTRACT FROM AUTHOR]

Aim: To identify barriers and facilitators impacting the implementation of a comprehensive transfer program aimed at parents of adolescents with chronic illness in clinical practice. Design: A real‐time, qualitative process evaluation. Methods: Individual interviews were conducted with 10 nurses and seven physicians from paediatric and adult outpatient clinics: Nephrology, hepatology, neurology, and rheumatology. Data were analysed through the lens of normalization process theory. Results: Themes were framed within the theory's four components. (1) Coherence: Healthcare professionals' views on their core tasks and on the parents' role influenced their perception of the program. (2) Cognitive participation: A named key worker, autonomy, and collaboration impacted healthcare professionals' involvement in the program. (3) Collective action: Department prioritization and understanding of the program's aim were key factors in its successful delivery. (4) Reflective monitoring: Participants experienced that the program helped parents during transfer but questioned if the program was needed by all families. Conclusion: We identified three barriers: Healthcare professionals' lack of understanding of the parental role during transfer, top‐down decisions among nurses, and physicians' uncertainty about their role in joint consultations. Facilitators: Healthcare professionals' understanding of the program's purpose and expected effect, the nurses' significant role as named keyworkers, and good collaboration across paediatric and adult departments. Implications for the Profession and/or Patient Care: Implementation strategies should be developed before implementing a transfer program in clinical practice. Impact: Implementing a parental transfer program in clinical practice can be challenging. Therefore, for successful implementation, it is crucial to identify barriers and facilitators.Barriers and facilitators exist at the personal, professional, and organizational levels, and it is important to understand them.The results of this qualitative study could support the implementation of transfer programs in other settings. Reporting Method: Consolidated criteria for reporting qualitative studies (COREQ). Patient or Public Contribution: No patient or public contribution. What does this paper contribute to the wider global clinical community?: Nurses' and physicians' experiences of ownership of the transfer program is essential for successful implementation.Clinics should appoint a named keyworker, preferably a nurse, as the driving force during the implementation of a transfer program.Nurses and physicians should receive training about the purpose, justification, and expected effect of a transfer program before implementation. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: At the outset of the COVID‐19 pandemic, little was known about ways of delivering registered nurse practice within CMHTs under restrictions associated with a global pandemic.Emerging research focused on broad healthcare staff wellbeing during the pandemic. Qualitative research explored the overall response of COVID‐19 on people with existing health needs or remote working more specifically.Over the past 2 years studies have emerged detailing experiences but no studies have used qualitative research to understand community mental health nurses and service users experience of services. What the paper adds to existing knowledge?: This co‐produced qualitative study is the first to explore the changes to CMHT care from the experience of service users and nurses later in the COVID‐19 pandemic.The study questions whether recovery‐based approaches are possible in a hybrid way of working.The findings identify challenges for nurses' well‐being and work–life boundaries when working from home.The study adds to historical professional narratives of mental health nursing. What are the implications for practice: While hybrid approaches developed in response to COVID‐19 restrictions may offer more choice these approaches need further co‐produced evaluation on the impact of recovery‐focused care and therapeutic relationships.Mental health nurses need to review how future hybrid working continues to impact nurses' mental health and emotional safety.Nurses and service users need to raise awareness within society and policy on the impact that COVID‐19 had on people with existing mental health conditions. Introduction: Community Mental Health Team responses to COVID‐19 included fundamental service delivery adaptations. Aim/Question: Our co‐produced study sought to understand which service delivery changes experienced by service users and registered nurses were helpful or unhelpful to caregiving and receiving. Method: Qualitative semi‐structured interviews were undertaken with 10 service users and 13 registered nurses from 3 NHS England sites. Co‐produced throughout, people with lived experience of mental health services and nurses wishing to improve their research experience undertook interviews following training. Data were analysed thematically. Findings: Care radically changed from in‐person to large phone or video contact. This reportedly altered therapeutic relationship building and raised questions about whether recovery‐focused care was possible. Hybrid working was viewed as helpful but raised challenges for nurse wellbeing. Discussion: Changes to care delivery challenged the fundamentals of recovery‐focused interventions and therapeutic relationships. Service users and nurses well‐being consequently suffered. The impact of the pandemic on people with existing mental health conditions was poorly acknowledged in the media. Implications for Practice: Recovery‐focused interventions and relationship building need evaluating in the light of ongoing hybrid working. Teams need to consider the well‐being of nurses engaged in complex service‐user interactions from home. [ABSTRACT FROM AUTHOR]

Aims: To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit. Design: Experience‐based co‐design. Methods: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis. Results: Twenty‐three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient–provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow‐up care. Conclusion: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes. Implications for the Profession and/or Patient Care and Impact: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life. Reporting Method: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting. Patient or Public Contribution: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience‐based co‐design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co‐design events, to support symptom management for people with multimorbidity. [ABSTRACT FROM AUTHOR]

What Is Known about the Subject?: Immigrant, refugee and asylum seeker populations worldwide are at high risk of mental health issuesNational mental health policies call for recognising Australian society's multicultural characteristics to ensure adequate mental health services to CALD communitiesSeveral barriers exist for people from CALD communities in Victoria to access and utilise mental health servicesImproving mental health professionals' knowledge of mental health service provision and cultural responsiveness can enhance CALD community access to services. What Does this Paper Add to Existing Knowledge?: We analysed the perspectives of people from CALD communities in Victoria regarding their needs and experiences with mental health services. Participants reported diverse perceptions and understanding of mental health issues and servicesVarious challenges were identified regarding health service utilisation for the CALD community in Victoria, including language barriers, stigma towards mental health issues, mental health illiteracy, distrust and lack of familiarity with mainstream mental health services. These challenges were acknowledged by community members even after a long residence in AustraliaThe data generated on the beliefs about mental health issues and consequent help‐seeking behaviours highlight the importance of culturally sensitive targeted prevention and early intervention strategies and ongoing commitment to building mental health literacy in the wider community What Are the Implications for Practice?: The information from the study can be adapted for quality improvement and culturally responsive practicesThe strategies for effective service delivery drawn by this paper can be a comprehensive resource tool for mental health professionals, organisations and policymakersThe findings imply that CALD mental health service users and their families will likely benefit from improved service assessment and quality of mental health care and equity when MHNs undertake cultural competence training and bring that into their practice. Introduction: Victoria is one of the most multicultural states in Australia. Many CALD communities in Victoria may have encountered complicated migration journeys and complex life stressors during their initial settlement, leading to adverse mental health concerns. This diversity necessitates public policy settings to ensure equity and access in health services planning and delivery. While the MH policies and services take cultural diversity into account, there needs to be more implementation of those components of MH policies that relate to the particular needs of various CALD communities in Victoria. Even though mental health services prevent and address mental health issues, many barriers can impair CALD community access and utilisation of mental health services. Furthermore, the recent Royal Commission inquiry into the Victorian Mental Health system drives a renewed policy imperative to ensure meaningful engagement and cultural safety of all people accessing and utilising mental health services (Department of Health, 2023). Aim: This study focused on the perspectives of people from CALD communities in Victoria regarding their mental health service needs, understandings of and experiences with mental health services to prepare an education package for mental health nurses as part of a larger multi‐method research project. Method: A qualitative descriptive design was used to collect and analyse the perspectives of 21 participants in Victoria, using telephone interviews, followed by thematic analysis. Results: The themes and sub‐themes identified were: Settling issues; Perceptions of understanding of mental health issues (help‐seeking attitudes toward mental health issues; the need for CALD community education); perceived barriers to accessing and utilising mental health services in Victoria (socio‐cultural and language barriers; stigma, labelling and discrimination; knowledge and experience of accessing health facilities); experience with mental health services and professionals. Discussion: Community participation, mental health professional education and robust research regarding the mental health needs of CALD people are some of the recommended strategies to improve access and utilisation of mental health services in Victoria. Implications for practice: The current study can contribute to the existing knowledge, understanding, practice and quality improvement as it vividly portrays the issues of various CALD communities in Victoria. The findings of this study imply that CALD MH service users and their families are likely to benefit in terms of improved service assessment and quality of MH care and equity when MHNs undertake CC training and bring that into their practice. [ABSTRACT FROM AUTHOR]

Aim: To identify culturally related stressors that influence self‐care in Chinese older adults with multiple chronic conditions. Background: Effective self‐care can improve health outcomes for chronic conditions, but implementing self‐care is challenging. Individuals with multiple chronic conditions face even more self‐care complexity than those with single chronic conditions, generating additional stressors. Although stressors have been found to negatively influence self‐care in multiple chronic conditions, the role of culture in generating stressors has been neglected. Design: This paper reports on the qualitative component of a larger mixed‐methods study. Two free‐response items in a survey were used to identify culturally related stressors that influence self‐care. This report adhered to the SRQR guideline checklist. Methods: Data were collected between January and April 2022. One hundred and thirty‐eight free text responses asking participants to identify stressors that influenced their self‐care effectiveness were analysed sequentially using deductive content analysis and thematic analysis. Results: Findings from deductive content analysis largely confirmed published work in Western literature on stressors complicating self‐care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. Conclusion: Chinese older adults with multiple chronic conditions identified a wide range of stressors that impacted their day‐to‐day self‐care. This study provided valuable insights into culturally related stressors in older adults with multiple chronic conditions. Findings deepened our knowledge of cultural influences on the success of self‐care in older adults with multiple chronic conditions, suggesting the potential for reaching populations across different cultures and regions. Implications for the profession and/or patient care: Stressors that might influence self‐care ability are important for nurses to assess in people with multiple chronic conditions. The design of self‐care interventions should take a culturally tailored intergenerational family‐centred approach to help mitigate the impact of stressors and ultimately improve patient outcomes. Impact: What problem did the study address?Stressors documented in older adults with MCCs have all been generated from research with Western populations. China is now home to the largest population of older people in the world. Understanding the influence of culturally relevant stressors on self‐care in Chinese older adults with MCCs is lacking.What were the main findings?Findings from deductive content analysis largely confirmed published work in Western literature on stressors that complicated self‐care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors in older adults with MCCs in China: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems.Where and on whom will the research have an impact?The research will have an impact on guiding nurses' assessment of culturally relevant stressors' impact on self‐care for older adults with MCCs. In addition, findings could inform research and policy development to aim at mitigating the impact of culturally based stressors on self‐care. Reporting Method: This study adhered to the Standards for Reporting Qualitative Research (SRQR) guideline checklist. Patient or Public Contribution: During the member‐checking process, the validation of findings for accuracy was carried out by 10 participants, who also found resonance between these findings and their own experiences. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Mental health nursing staff may experience psychological stress and burnout. Exercise provision for mental health staff may improve staff physical and mental wellbeing and mitigate against psychological burnout.Existing research suggests the provision of exercise equipment for mental health nursing staff may improve staff attitudes towards physical activity and staff confidence in motivating physical activity amongst patient groups they care for, although more research is needed, and research investigating the attitudes of mental health staff towards such initiatives is warranted. What this paper adds to existing knowledge?: Access to fitness facilities in the workplace for mental health staff was endorsed.Logistical and practical concerns (i.e. shower access, time) were noted as barriers to implementation of fitness facilities in the workplace for staff use.Mental health staff expressed desire to have access to varied gym equipment at work What are the implications for practice?: The introduction of fitness facilities in the workplace environment for staff use was actively endorsed by mental health professionals, suggesting such initiatives may be warranted in mental health settings. However, barriers to successful implementation were noted and are worth considering in preparation for trialling provision of exercise equipment for staff use. Introduction: Exercise equipment for mental health staff may improve staff wellbeing, mitigate against stress and improve staff attitudes towards physical activity. This said, there is a lack of researching investigating the attitudes of mental health staff towards the provision of fitness facilities in the workplace. Aim: The study investigated staff attitudes towards being offered exercise bikes in the workplace. Method: Three focus groups and one individual interview were conducted with 12 healthcare professionals. Data were subject to a thematic analysis. Results: Three themes were identified. (1) 'This sounds like a good idea', which reflected positive views in the provision of exercise in the workplace for staff use. (2) 'I'm not sure it would work because ...', which reflected implementation concerns including not having access to shower facilities and time constraints. (3) 'Balancing choice', which reflected participant's desire to have access to varied gym equipment. Discussion: The introduction of fitness facilities in the workplace for staff use was endorsed. However, implementation barriers were noted. Implications for Practice: This research provides justification for the exploration of the feasibility and benefits of providing exercise equipment for mental health staff in the workplace but presents implementation barriers that are worth considering before trialling provision of exercise equipment. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Coercive measures represent an ethical conflict because they limit the person's freedom, compromising their personal autonomy, self‐determination and fundamental rights.The reduction of the use of coercive measures implies not only regulations and mental health systems, but also cultural aspects, such as societal beliefs, attitudes, and values.There is evidence about the professionals' views on coercion in acute mental health care units and community settings, but they remain unexplored in inpatient rehabilitation units. What the paper adds to existing knowledge?: The knowledge about coercion varied from not knowing at all the meaning of the word, to a proper description of the phenomenon.Coercive measures are considered a necessary evil or normalized in mental health care and considered implicit to daily practice. What are the implications for practice?: The perceptions and attitudes towards coercion might be influenced by the knowledge about the phenomenon. Training of mental health nursing staff in non‐coercive practice could help professionals to detect, be conscious towards, and question coercive measures, thus orienting them to the effective implementation of interventions or programmes with evidenced effectiveness to reduce them. Introduction: Creating a therapeutic and safe milieu with the minimum coercive measures requires knowing professionals' perceptions and attitudes towards coercion, but they remain unexplored in medium and long‐stay inpatient psychiatric rehabilitation units. Aim: To explore the knowledge, perception and experience of coercion among nursing staff at a rehabilitation medium‐stay mental health unit (MSMHU) in Eastern Spain. Method: Qualitative phenomenological study including 28 face‐to‐face, semi‐structured interviews based on a script. Data were analysed using content analysis. Results: Two main themes were found: (1) therapeutic relationship and treatment in the MSMHU, which included three subthemes: qualities of the professionals for building the therapeutic relationship; perceptions about the persons admitted to the MSMHU; views of the therapeutic relationship and treatment in the MSMHU; (2) Coercion at the MSMHU, comprising five subthemes: professional knowledge; general aspects; emotional impact of coercion; opinions; alternatives. Discussion: Coercive measures are often normalized in mental health care and considered implicit to daily practice. A proportion of participants who did not know what coercion is. Implications for Practice: Knowledge about coercion might influence attitudes towards coercion. Mental health nursing staff could benefit from formal training in non‐coercive practice, facilitating the operative implementation of effective interventions or programmes. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of women who have had ovarian hyperstimulation syndrome, and healthcare professionals who care for them. Background: Ovarian hyperstimulation syndrome is a side effect of fertility treatment. Little research exists internationally that explores the experiences of women who have had this condition, or the healthcare professionals who manage it. Design: Qualitative study using semi‐structured interviews. Methods: Eighteen interviews with women who had experienced ovarian hyperstimulation syndrome (n = 10) and healthcare professionals (n = 8) in six UK fertility centres. Framework analysis was used. This paper is reported following COREQ guidelines. Results: Women described a range of symptoms and severity, sometimes experiencing worrying physical health problems such as abdominal swelling and shortness of breath. The combination of the symptoms, and their management, on delaying future fertility treatment could cause emotional distress. Healthcare professionals at different centres described variation in practice, which generally involved 'active monitoring' until symptoms became severe, when women would be hospitalised. Women expressed feeling 'left in limbo' while waiting for symptoms to improve or worsen, and described a lack of control during this waiting period. Healthcare professionals felt they provided adequate information about ovarian hyperstimulation syndrome and its management. This, however, did not align with women's perceptions that information, including potential delays to their fertility treatment, was missing. There was similar mismatch between women's and healthcare professionals' views of decision‐making about fertility treatment following ovarian hyperstimulation syndrome, including women's concerns about having to make rushed, unplanned decisions about their fertility treatment when they did not feel adequately informed to do so. Conclusion: Ovarian hyperstimulation syndrome and its management can have a significant physical and emotional impact on women, and influence their fertility treatment. Improvements could be made to the information women receive about this condition, its management and its implications for wider fertility treatment. Implications for the profession and/or patient care: Nurses have the skills and knowledge to support women through the physical and emotional stresses of fertility treatment. Therefore, they are well placed to provide specialist information and support for OHSS and ensure women are fully informed about all aspects of the condition, including how its management might delay fertility treatment. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether a novel decision support tool would effectively minimize physical restraint use in critically ill adult patients. Design A nonequivalent quasi‐experimental design combined with a descriptive qualitative approach was used. Methods: A Restraint Decision Tree was developed based on a qualitative study that explored the barriers to employ the Restraint Decision Wheel. During the quasi‐experimental study, patients admitted to the unit between October 2017 and March 2018 were enrolled as the control group receiving the Restraint Decision Wheel (n = 528), whereas patients between April 2018 and September 2018 were enrolled as the intervention group receiving the Restraint Decision Tree (n = 564). The physical restraint rate, accidental catheter removal rate and nurses' satisfaction were compared. Results: The Restraint Decision Tree significantly decreased physical restraint use. No significant difference in the rate of accidental catheter removal was found. Nurses reported increased satisfaction with the restraint decision‐making. Conclusions: The Restraint Decision Tree could minimize physical restraint use. Physicians' involvement in the restraint decision‐making and nurses' competence in delirium assessment may be essential for successful implementation of the Restraint Decision Tree. Summary statement: What is already known about this topic? Physical restraint is a common practice in the intensive care unit.Minimizing physical restraint use does not increase the risk of catheter self‐removal.Nurses equipped with clinical decision‐making skills could promote the appropriateness of restraint application. What this paper adds? The Restraint Decision Tree could help nurses make appropriate restraint decisions for critically ill adult patients, thus decreasing the use of physical restraint.Multidisciplinary decision‐making improves nurses' satisfaction with the restraint decision process. The implications of this paper: This study suggests that the Restraint Decision Tree can be implemented in the intensive care unit as an effective decision‐making tool to decrease physical restraint use while maintaining patient safety.A strong culture of multidisciplinary collaboration and delirium screening is called for prior to utilizing the Restraint Decision Tree. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The impacts of racism on health are well documented and are greater for mental than for general health.Mental health professionals are well positioned to help dismantle racism and structural barriers compromising optimal patient care. What the paper adds to existing knowledge: We describe a systematic and orderly way to identify factors that contribute to entrenching racism as the status quo or that help to uproot it.By incorporating a racial equity lens, we can better understand daily racism and inform the optimal antiracist actions most relevant to an inpatient psychiatric setting. What are the implications for practice?: Our two‐domain/six‐theme model may serve as a rubric for individuals to engage in structured self‐reflection, for organizations in auditing or programmatic evaluation, or as scaffolding for difficult but frequently elided conversations.The unique strengths of a mental health environment can be harnessed toward the elimination of racism and racist practices in clinical care and in the workplace Introduction: It is well documented that racism plays a role in health care access and outcomes. However, discussions about racism in the inpatient psychiatric workplace are generally avoided. To address this gap, we incorporated a racial equity perspective into a qualitative study to better understand daily racism, its impact on patients and staff, and to inform optimal antiracist actions most relevant to inpatient psychiatric settings. Aim/Question: We sought to identify factors that may contribute to or deter from racism to inform interventions to sustain a psychologically supportive environment for patients and staff. Methods: We conducted semistructured interviews using a purposive sample of 22 individuals in an acute child psychiatric inpatient service. We analysed transcripts using thematic analysis guided by a constructivist grounded theory conceptual framework. Results: We identified two countervailing processes: (1) Entrenching—factors that sustain or increase racism: Predisposing, Precipitating, and Perpetuating and (2) Uprooting—factors that rectify or reduce racism: Preventing, Punctuating, and Prohibiting. We organized each of the elements into a '6P' model along a temporal sequence around sentinel racist events. For each of the six components we describe: Contributing Factors, Emotional Reactions, and Behavioural Responses as reported by participants. Implications for Practice: Identifying factors that entrench or uproot racism can inform specific steps to improve the care of all children and families on an inpatient child psychiatry unit. The two‐domain/six‐theme model we developed can serve as a rubric for individuals or milieu‐based inpatient settings serving patients of any age to engage in structured self‐reflection, auditing, program evaluation, or as scaffolding for difficult but frequently elided conversations. [ABSTRACT FROM AUTHOR]

Aims: To explore the experiences of health professionals and families concerning supporting low‐birth weight (LBW) infants along the continuum of care (CoC) in Ghana with the goal to unveil new strategies to improve the quality of neonatal care. Design: A constructivist grounded theory. Method: Simultaneous data collection and analysis among health professionals alongside families with LBW infants from September 2020 to April 2021. The study used constructivist grounded theory strategies for data collection and analysis. Results: The analysis of 25 interviews resulted in a theoretical model describing 10 themes along the CoC for LBW infants, categorized into health and family systems drivers. In this paper, we focus on the latter. Early bonding and family involvement were empowering. Mothers needed assistance in balancing hope and confidence which enabled them to render special care to their LBW infants. Providing mothers with financial and domestic support as well as creating awareness on newborn health in communities were important. Conclusion: To achieve family involvement, a coordinated CoC must entail key players and be culturally inclusive. It must be applied at all levels in the CoC process in a non‐linear faction. This can help LBW infants to thrive and to reach their full developmental potential. Impact The theoretical model developed shows the importance of family involvement through family systems care for a comprehensive response in addressing needs of health professionals and families with LBW infants and bridging the fragmentations in the neonatal CoC in Ghana. Context‐tailored research on family systems care in the neonatal period is necessary to achieve a quality CoC for LBW infants and their families. Patient or Public Contribution: Caregivers and providers participated by granting in‐depth interviews. Care providers further contributed through their feedback on preliminary findings. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: In the initial months of the pandemic, there was no significant increase in demand for mental health servicesDuring the pandemic, there was an increase in people reporting an increase in suicidal thoughts.Understanding of the experience of seeking help for self‐harm during lockdown is lacking, in terms of availability and accessibility of support services What the paper adds to existing knowledge?: People who self‐harm found that their support structures were significantly impacted by lockdownLockdown presented relational difficulties for people who self‐harm What are the implications for practice?: Learning about the experience of receiving support from mental health liaison services during lockdown from a first‐hand perspective is essential to improving the provision of these services in the future.In times of national crisis, services should be prepared to support clients via alternative means including telephone and online.Public facing messages about service availability should be carefully expressed to minimize misunderstandings. Introduction: National lockdown caused disruption to health services and third‐sector organizations offering support to people who self‐harm. Early reports suggested self‐harm‐related hospital attendances declined. Lack of knowledge related to the availability and accessibility of support provisions for people who self‐harm warrants exploration into how they experienced help‐seeking during lockdown. Aims: This study aimed to explore the experiences of people who self‐harm and perspectives on help‐seeking. Method: We conducted a qualitative study based on telephone and email interviews with 14 people who self‐harm in England. Results: Participants identified challenges to coping with life in lockdown, emphasizing the role of self‐harm. Help‐seeking was impeded by feeling like a burden and potential for spreading the virus. People who self‐harm exercised self‐reliance in response to "stay home" messaging, but some may have struggled without formal support. Online support served an important role in continuity of care during lockdown but could widen inequalities from limited resources and access. Implications for practice: Helping mental health liaison nurses to understand the experiences of people who self‐harm during lockdown is critical to providing continuing support to this population. Services should consider how and when they communicate changes to their provisions to the public, and the impact this will have on those in need of support. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed to describe and understand the lived experiences and opinions of sub‐Saharan women living in Spain in relation to female genital mutilation. Background: Female genital mutilation is a bloody procedure with serious consequences for the health of women and girls. Understanding mutilated women's lived experiences plays a crucial role in the management of health consequences and could help healthcare professionals to provide assistance to these women. Design: A descriptive phenomenological study was carried out. The COREQ checklist was followed as guidance to write the manuscript. Methods: A total of 12 in‐depth interviews were conducted. Interviews were recorded, transcribed and analysed using ATLAS.ti 9.0. Results: Two themes with four subthemes were identified from the data analysis: 1) 'The traumatic experience of female circumcision' with the subthemes 'Female mutilation is a physical and psychological torture procedure' and 'recognising and coping with negative emotions'; 2) 'The fight for the eradication of female genital mutilation' which contains the subthemes 'the need for a real sociocultural change at the origin' and '"I want to be the last": Personal development leads to sociocultural change'. Conclusions: Female genital mutilation was experienced by women as a very aggressive and traumatic event. It causes considerable negative emotions that last over time. Although there is a tendency to reject the practice, in women's countries of origin, there is social pressure for girls to be mutilated. Relevance to clinical practice: Caring for women who have suffered from female genital mutilation requires awareness of the traumatic experience they underwent when they were girls. Healthcare professionals play a crucial role in eradicating female genital mutilation. Apart from education, preventive measures may include specific recommendations when girls are travelling to the country of origin and participatory action research. [ABSTRACT FROM AUTHOR]

Aim: To explore the benefits and challenges of a recently introduced Registered Undergraduate Student of Nursing workforce from the perspective of Nurses and Registered Undergraduate Students of Nursing, in a major metropolitan hospital in Australia in 2020. Design: A qualitative descriptive study was undertaken using individual interviews and focus groups. Methods: Purposively selected employed Registered Undergraduate Students of Nursing and nurses who worked with them were interviewed, using a semi‐structured format. Recordings were transcribed and coded using NVivo software. Reflexive thematic analysis using an inductive approach was undertaken. Results: Four major themes were revealed: (i) Navigating the programme, (ii) Belonging and integration; (iii) Patient care; and (iv) Continuing Development. Initial challenges were common, often related to clarifying the scope of practice for the new role. Ongoing issues were associated with gaps in understanding the role and lack of integration into the team. Mostly, nurses and Registered Undergraduate Students of Nursing built positive, professional relationships. Nurses valued the Registered Undergraduate Student of Nursing knowledge and skill level, reporting improved workload and work experiences when the Registered Undergraduate Student of Nursing was on shift. Nurses believed that the Registered Undergraduate Students of Nursing enhanced patient care. Registered Undergraduate Students of Nursing described positive, therapeutic relationships with patients. Registered Undergraduate Student of Nursing employment provided opportunities for new learning, leading to increased efficiency and confidence on clinical placement. Conclusions: This employment model benefited the Registered Undergraduate Students of Nursing and nurses who worked with them. In the absence of adequate training and support, challenges remained unresolved and negatively impacted the experience for nurses. In addition to university‐level education and clinical placement, the employment model can create a third space for student learning via on‐the‐job training. The study supports the ongoing employment of student nurses through the Registered Undergraduate Student of Nursing model. Implications for the Profession and/or Patient Care: Impact: This study contributes to the very small body of literature investigating Registered Undergraduate Student of Nursing workforces in Australian hospitals. It is the first to explore the experiences of both nurses and students working together in a major metropolitan setting and also the first in the context of the COVID‐19 pandemic.This study reflected a mostly positive experience for Registered Undergraduate Student of Nursing and the nurses who worked with them and highlighted the importance of adequate oversight and support in the implementation and maintenance of a Registered Undergraduate Student of Nursing workforce.Employed Registered Undergraduate Students of Nursing reported improved confidence, skills, and felt like they started clinical placement at an advantage, ready to step up and learn the Registered Nurse scope of practice.In addition to university‐level education and clinical placement, this employment model creates a third space for learning via on‐the‐job training. Reporting Method: COREQ guidelines were followed in the reporting of this study. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: This study aims to describe the experiences of women with gynaecological cancer regarding family‐oriented care (FOC) and how they rated their health‐related quality of life (HRQoL) using a 15D instrument (15D©). Design: A cross‐sectional mixed‐method study. Methods: The data were collected by electronic surveys of two Finnish cancer associations from gynaecological cancer patients (n = 53). The qualitative data were analysed using thematic analysis. The HRQoL answers were analysed statistically using IBM SPSS Statistics (Version 27). Results: The results emphasized that FOC is not yet part of the care process. Furthermore, comprehensive encounters are lacking, and the experience of being a woman is forgotten during the care process. The results of the HRQoL analysis suggest that distress and the discomfort and symptoms of cancer patients are perceived as significant factors affecting their quality of life during different phases of treatment. Family status also has an impact on perceived quality of life, whereby those living alone gave worse ratings for the depression and vitality dimensions. Conclusion: In part, the quantitative and qualitative data supported each other, but the descriptions provided a more comprehensive view of issues that affect women in a more multidimensional way, such as sexual health issues. More research on the effectiveness of FOC is needed to develop the capacity for effective healthcare. Implications for the Profession and/or Patient Care: This study was able to identify important areas for improvement in clinical practice from the perspective of patients and their families. Reporting Method: This study was prepared and reported according to the STROBE checklist. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: While there exists an ample body of research in international contexts focused on the characterization and quantification of infertility psychological distress, the level of scholarly scrutiny directed towards this phenomenon within the context of China remains scant. Aims and Objectives: To investigate the formation and developmental processes of psychological distress associated with infertility and infertility treatment among women within the Chinese cultural context and to construct a theoretical framework that elucidates this phenomenon. Design: Qualitative approach with grounded theory methodology. Methods: This study was conducted within the reproductive medicine department of a tertiary‐level hospital located in central China from May to August 2023. Twenty‐seven women who experienced infertility and underwent assisted reproductive treatment (ART) were interviewed. The interview sessions spanned durations ranging from 20 min to 1 h and 35 min. Data analysis included open coding, axial coding and selective coding. The study is reported using the COREQ checklist. Results: The infertility psychological distress experienced by women undergoing ART is a socially constructed phenomenon influenced by a dynamic interplay of forces that construct and conciliate it. The formation and progression of infertility psychological distress are rooted in the process of self‐construction. A Middle‐Ranged Theory titled 'self‐reconstruction under the dome of infertility and infertility treatment' (SUDIT theory) was developed to explain this phenomenon. Within this framework, infertility psychological distress manifests across three distinct phases under the gambling of the constructive force and conciliative force: (1) distress of disrupting the former self; (2) distress linked to the struggling present self; and (3) the renewed‐self harmonized with distress. Conclusions: It is imperative for healthcare professionals and policymakers to acknowledge the socially constructed nature of infertility psychological distress, and proactively implement measures aimed at ameliorating it. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To explore and analyse the adaptation process of patients and their families at the point of lung cancer diagnosis. Methods: Totally 23 operable lung cancer patients were included in this study. Colaizzi's method of phenomenology was employed for data analysis. Results: This study found two different aspects of family adaptation at the diagnosis of lung cancer. For family resilience, three themes emerged: (1) Positive family belief systems (giving meaning to a cancer diagnosis and maintaining a positive/optimistic attitude), (2) Flexible family organizational patterns (maintaining the stability of family structure and function, adjusting the relationship between patients and family members and receiving external support and help) and (3) Good communication and problem‐solving strategies (open communication on an equal basis, positive and open expression of emotions and collaborative problem‐solving). For family vulnerability, three themes were as follows: (1) Negative family belief systems (negative attitudes and concealment and self‐isolation due to stigma), (2) Rigid family organizational patterns (adaptation lost, conflicts between family support and patients' willingness and pressure upon social support) and (3) Unhealthy communication and problem‐solving (poor communication, emotional asymmetry of family members and tendency to solve problems alone). Conclusion: The study highlights the existence of the family resilience and family vulnerability at the point of lung cancer diagnosis and provides patient's perspective for understanding family resilience in specific cultural contexts. Patient Contribution: The data were collected through face‐to‐face interviews. Trail registration number: ChiCTR2300074801. [ABSTRACT FROM AUTHOR]

Aim: To explore relatives' needs in terms of bereavement care during euthanasia processes, how healthcare providers respond to these needs, and the degree of commonality between relatives' and healthcare providers' reports. Design: A phenomenological design was employed, utilising reflexive thematic analysis to examine interviews conducted with relatives (N = 19) and healthcare providers (N = 47). Results: Relatives' needs throughout euthanasia processes are presented in five main themes and several subthemes, with similar findings between both sets of participants. Although relatives infrequently communicated their needs explicitly to healthcare providers, they appreciated it when staff proactively met their needs. Healthcare providers aimed to assist with the relatives' grief process by tending to their specific needs. However, aftercare was not consistently offered, but relatives did not have high expectations for professional follow‐up care. Conclusion: Our research offers important directions for healthcare professionals, empowering them to provide needs‐based bereavement care during euthanasia processes. Moreover, it emphasises the importance of recognising the unique needs of relatives and proactively addressing them in the period before the loss to positively contribute to relatives' grief process. Implications for the profession and/or patient care: Insights into relatives' needs in the context of euthanasia. Good practices on how healthcare providers can attend to relatives' needs before, during and after the loss Impact: Current literature and guidelines on needs‐based bereavement care in the context of euthanasia and, more generally, assisted dying, are limited. These findings provide concrete directions for practice in supporting (nearly) bereaved relatives in the context of euthanasia, potentially mitigating adverse health outcomes. Reporting method: Standards for Reporting Qualitative Research (SRQR checklist). Patient or Public contribution: Relatives of deceased cancer patients were involved in the conduct of the study. [ABSTRACT FROM AUTHOR]

Aims: Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care. The purpose of this mixed‐methods study was to determine if simulation accurately captures elderspeak communication by nursing staff in hospital dementia care. Design: A 3‐part mixed‐methods design in which (1) three dementia care simulations were designed and validated by a panel of experts, (2) communication by nursing staff completing each simulation was quantitatively compared to communication during actual patient care, and (3) views on the realism were explored using within‐ and across‐case coding. Methods: Three simulations using different modalities (manikin, role‐play, and standardised patient) were designed and validated with eight experts using the Lynn Method. Ten nursing staff were audio‐recorded and their communication was coded for elderspeak communication. Results for each simulation were compared using Wilcoxon signed‐rank test to recordings taken during actual dementia care encounters. Debriefings were coded for realism and results were converged. Results: The average time using elderspeak during naturalistic care was 29.9% (SD = 20.9%) which did not differ from the average amount of elderspeak used across the three simulations modalities which ranged from 29.1% to 30.4%. Qualitative results suggested a lack of realism with the manikin condition and the nursing staff indicated preference for the simulation with the standardised patient. Conclusions: Communication elicited in the dementia care simulations was congruent to communication produced in actual dementia care but preference was for the standardised patient. Implications for Patient Care: Elderspeak communication can be accurately produced in the simulated environment which indicates that simulation is a valid method for person‐centred communication training in nursing staff. Impact: Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care.Elderspeak communication captured in the simulated environment was congruent to communication nursing staff use during actual patient care to hospitalised persons living with dementia.This study empirically identifies that communication is elicited in similar patterns by nursing staff in the simulated environment compared to the naturalistic care environment which demonstrates that simulation can be used as a valid tool for education and research on person‐centred communication. Reporting Methods: STROBE. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To describe a grading system that can be used to evaluate core competency of clinical nurse specialists (CNSs) at different levels. Background: Evaluate core competence of CNSs at different levels reflects the quality of nursing and the development of the nursing profession. Design: This research employed the Delphi method. Methods: The STROBE checklist for observational cross‐sectional studies was followed to report this research study. This study consisted of two main phases: a literature review and semistructured interviews. Individual semistructured interviews were conducted with 11 healthcare experts and two patients. Two rounds of questionnaire surveys were administered to 21 nursing experts using the Delphi method. The CNSs were classified as primary, intermediate or advanced based on their years of work, professional titles and educational qualifications. Results: The graded competency evaluation system consisted of five first‐level indicators (clinical practice, consulting guidance and teaching, scientific research innovation, management and discipline development, and ethical decision‐making), 15 second level indicators, and 40 third‐level indicators. The authority coefficients (Cr) of the experts were.865 and.901. The Kendall's concordance coefficients of the three‐level indicators were.417,.289 and.316 for primary CNSs;.384,.294 and.337 for intermediate CNSs; and.489,.289 and.239 for advanced CNSs. Conclusion: The graded use evaluation system in clinical practice initially involves a comprehensive evaluation of the core abilities of CNSs. This is a tool for cultivating and grading the abilities of specialised nurses that can promote a practical upwards spiral. Relevance to Clinical Practice: The evaluation system can promote the scientific management and continuous improvement of CNSs in clinical nursing and can serve as a practical and objective reference for the effective management and development of CNSs. Patient or Public Contribution: Patients participated in the data collection process, during which they shared their health‐seeking experience with our research team. [ABSTRACT FROM AUTHOR]

Aims: To explore adult inpatients' perceptions, understanding and preferences regarding the term 'malnutrition' and to identify the terms that adult inpatients report are used by themselves and health workers to describe malnutrition. Design: This qualitative study was conducted using data collected for a separate qualitative study that investigated factors that influence the dietary intake of long‐stay, acute adult inpatients. Methods: Semi‐structured interviews were conducted with a purposive sample of current inpatients. Data were analysed using inductive content analysis. Results: Nineteen interviews were included (mean age 64 years (standard deviation ±17), 10 female (53%), 12 malnourished (63%)). Four categories were identified. 'Variation in patients' recognition of malnutrition' represents the differing abilities of patients to understand and identify with the term 'malnutrition'. 'Recognising individuals' needs and preferences' highlights patients' varying beliefs regarding whether 'malnutrition' is or is not an appropriate term and participants' suggestion that health workers should tailor the term used to each patient. 'Inconsistencies in health workers' and patients' practice regarding malnutrition terminology' encapsulates the multiple terms that were used to describe malnutrition by health workers and patients. 'Importance of malnutrition education' summarises patients' views that health workers should provide patient education on malnutrition prevention, management and complications. Conclusion: Findings highlight variations in patients' perceptions and understanding of the term 'malnutrition' and differences in the terms used by patients and health workers to describe malnutrition. Implications for the Profession and/or Patient Care: The terminology used by health workers to describe malnutrition risk or malnutrition to their patients can influence patients' recognition of their nutritional status and thus the multidisciplinary management of the condition. To ensure that patients receive information about their malnutrition risk or diagnosis in a way that meets their needs, health workers' practices must be revised. To do this, it is imperative to conduct further collaborative research with patients and health workers to identify optimum terms for 'malnutrition' and how health workers should communicate this to patients. Impact: There is a disparity in patients' perceptions, understanding and preferences for the term 'malnutrition' and there are inconsistencies in how health workers communicate malnutrition to patients.To support patients' recognition and understanding of their nutritional status, it is imperative for health workers to consider how they discuss malnutrition with patients. Reporting Method: Adheres to the Consolidated Criteria for Reporting Qualitative Research (Tong et al., 2007). Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aim: To characterise experiences with telehealth for Medications for Opioid Use Disorder (MOUD) services among patients, prescribers, nurses and substance use counsellors to inform future best practices. Design: We engaged a qualitative descriptive study design. Methods: Semi‐structured interviews were conducted with prescribers (nurse practitioners and physicians, n = 20), nurses and substance use counsellors (n = 7), and patients (n = 20) between June and September 2021. Interviews were verbatim transcribed. Thematic analysis was conducted using a qualitative descriptive method. Results: Among both providers and patients, four themes were identified: (1) Difficulties with telehealth connection (2) Flexibility in follow‐up and retention, (3) Policy changes that enabled expanded care, (4) Path forward with telehealth. Two additional findings emerged from provider interviews: (1) Expansion of nurse‐managed office‐based opioid treatment, and (2) Novel methods to engage patients. Conclusions: Patients and providers continued to view telehealth as an acceptable means for delivery and management of MOUD, particularly when utilised in a hybrid manner between in‐person visits. Nurse‐managed care for this service was evident as nurses extended the breadth of services offered and utilised novel methods such as text messages and management of 'call‐in' lines to engage patients. Implications for the profession and/or patient care: Use of telehealth for MOUD should be incorporated into practice settings to reach patients in a flexible manner. Nurses in particular can use this medium to extend office‐based opioid treatment by conducting assessments and expanding capacity for other wrap‐around services. Impact: We identify recommendations for best practices in the use of telehealth for opioid use disorder management and highlight the value of nurse‐managed care. Reporting method: The consolidated criteria for reporting qualitative research. Patient or Public Contribution: Patients with opioid use disorder and prescribers with experience using telehealth were interviewed for this study. [ABSTRACT FROM AUTHOR]

Background: The survival rate among patients with breast cancer is high. It is well described that after primary treatment patients may experience symptoms and concerns but the needs and resources during the first year to manage everyday life are not well described. Aim: To describe experiences of symptom distress, needs and support during the first year after primary treatment for breast cancer from the perspectives of patients and healthcare professionals. Design: Qualitative descriptive. Methods: Data collection through individual interviews with patients (n = 17) and a focus group interview with healthcare professionals (n = 7). Data was analysed using thematic analysis and resulted in three themes. Results: The first theme, 'Struggling with symptoms and changes in everyday life' shows how symptoms and concerns interfered with the everyday life of patients and in some situations even impeded them. Patients try to adapt to their new situation by creating new routines and managing symptoms through self‐care. The second theme, 'Adaption in a period of uncertainty' describes thoughts about cancer recurrence and doubts about continuing with the endocrine therapy if symptoms prolong. In the third theme, 'Support and need for individualized follow‐up care' healthcare professionals described that they provide support by being available and by giving both verbal and written information. Patients expressed that the information could be too general and voiced a need for more individually tailored support. Conclusion: During the first year after primary treatment, patients with breast cancer describe how they try to manage by themselves, but express both unmet needs and a wish for extended and more individually tailored support. The healthcare professionals recognised that patients lack a structured plan for the first year and the need for continued support. This stresses a need for development of care models with special consideration towards individualised support after breast cancer treatment. No Patient or Public Contribution: There was no patient or public involvement in the design or conduct of the study. The interview study was not considered to benefit from involving patients or healthcare professionals when designing the interview guides as they were developed through literature and previous research of patients treated for breast cancer. [ABSTRACT FROM AUTHOR]

Aim: To describe patients' experiences of the quality of counselling to develop new digital counselling solutions for patients with cerebrovascular disease. Design: A descriptive, qualitative approach. Methods: Semi‐structured in‐person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and treated as inpatients at a single university hospital in Finland between September 2021 and February 2022. Data were analysed using deductive and inductive content analysis. Results: The identified facilitators, barriers and possible solutions for the development of new digital counselling solutions were deductively categorized into five main categories: (1) background factors, (2) resources, (3) implementation, (4) sufficiency, and (5) effects and 12 generic categories. Patients with cerebrovascular diseases worry about symptoms affecting their ability to receive information and valued a supportive atmosphere. Staff should have more time for counselling and use motivational digital counselling solutions in plain language, moderate length and with multimedia content. Patients desired reminders, easy search functions and possibilities for two‐way communication. Conclusion: New digital counselling solutions could be beneficial in supporting the patients' knowledge, emotions and adherence. For the success of such solutions, patients' special needs concerning different levels of cognitive impairment need to be considered. Impact: The results of this study may benefit healthcare organizations in the development of digital counselling solutions that meet the patients' needs. Reporting Method: We have adhered to relevant EQUATOR guidelines with the COREQ reporting method. Patient or Public Contribution: Patients were involved as the study population. [ABSTRACT FROM AUTHOR]

Objective: A systematic review and meta‐analysis was performed to identify the factors related to cancer death anxiety based on available evidence. Design: This systematic review and meta‐analysis followed the PRISMA 2020 guidelines. Methods: Seven databases were searched to identify studies on the relationships of cancer death anxiety with demographic characteristics, disease factors and psychosocial factors from inception to May 2023. The Agency for Medical Research and Quality (AHRQ) scale was used to evaluate the quality of the included studies. After two researchers independently completed the literature search, data extraction and quality evaluation, meta‐analysis was conducted by using RevMan5.3 and Stata 17.0 software. Results: In total, 52 studies were included in this review. The results revealed that there were positive correlations of death anxiety with female sex, the symptom burden, anxiety levels, depression levels, fear of recurrence, attachment avoidance, psychological distress, resignation and confrontation coping. Death anxiety was negatively correlated with age, education level, ability to perform daily activities, self‐esteem, spiritual well‐being, sense of meaning in life, resilience, quality of life, social support and religious beliefs. Conclusions: Our results can inform the design of interventions to address death anxiety and improve the overall quality of life of cancer patients. Healthcare professionals should promptly identify and focus on death anxiety in high‐risk populations of cancer patients. Relevance to Clinical Practice: Cancer patients commonly experience death anxiety, and this anxiety has a nonnegligible impact on patients' mental health and overall quality of life. This study can inform the development of interventions by clinical healthcare professionals. No Patient or Public Contribution: This was a meta‐analysis based on data from previous studies. [ABSTRACT FROM AUTHOR]

Aim: To gather and understand the experience of hospital mealtimes from the perspectives of those receiving and delivering mealtime care (older inpatients, caregivers and staff) using photovoice methods to identify touchpoints and themes to inform the co‐design of new mealtime interventions. Methods: This study was undertaken on acute care wards within a single metropolitan hospital in Brisbane, Australia in 2019. Photovoice methods involved a researcher accompanying 21 participants (10 older patients, 5 caregivers, 4 nurses and 2 food service officers) during a mealtime and documenting meaningful elements using photographs and field notes. Photo‐elicitation interviews were then undertaken with participants to gain insight into their experience. Data were analysed using inductive thematic analysis, involving a multidisciplinary research team including a consumer. Results: Themes were identified across the three touchpoints: (1) preparing for the meal (the juggle, the anticipation), (2) delivering/receiving the meal (the rush, the clutter and the wait) and (3) experiencing the meal (the ideal, pulled away and acceptance). Despite a shared understanding of the importance of meals and shared vision of 'the ideal' mealtime, generally this was a time of tension, missed cares and dissatisfaction for staff, patients and caregivers. There was stark contrast in some aspects of mealtime experience, with simultaneous experiences of 'the rush' (staff) and 'the wait' (patients and caregivers). There was an overwhelming sense of acceptance and lack of control over change from all. Conclusions: This study identified themes during hospital mealtimes which have largely gone unaddressed in the design of mealtime interventions to date. This research may provide a framework to inform the future co‐design of mealtime interventions involving patients, caregivers and multidisciplinary staff, centred around these key touchpoints. Practice Implications: Mealtimes are experienced differently by patients, caregivers, nurses and food service officers across three key touchpoints: preparing for, delivering/receiving and experiencing the meal. Improving mealtime experiences therefore necessitates a collaborative approach, with co‐designed mealtime improvement programs that include specific interventions focusing each touchpoint. Our data suggest that improvements could focus on reducing clutter, clarifying mealtime roles and workflows and supporting caregiver involvement. Impact: What problem did the study address?: Mealtimes are the central mechanism to meet patients' nutritional needs in hospital; however, research consistently shows that many patients do not eat enough to meet their nutritional requirements and that they often do not receive the mealtime assistance they require.Interventions to improve hospital mealtimes have, at best, shown only modest improvements in nutritional intake and mealtime care practices. Gaining deeper insight into the mealtime experience from multiple perspectives may identify new opportunities for improvement. What were the main findings?: Patients, caregivers and staff have shared ideals of comfort, autonomy and conviviality at mealtimes, but challenges of complex teamwork and re‐prioritisation of mealtimes in the face of prevailing power hierarchies make it difficult to achieve this ideal.There are three discrete touchpoints (preparing for, delivering/receiving and experiencing the meal) that require different approaches to improvement.Our data suggests a need to focus improvement on reducing clutter, clarifying mealtime roles and workflows and supporting caregivers. Where and on whom will the research have an impact?: The research provides a framework for multidisciplinary teams to begin co‐designing improvements to mealtime care to benefit patients, caregivers and staff, while also providing a method for researchers to understand other complex care situations in hospital. Reporting Method: This manuscript is written in adherence with the Standards for Reporting Qualitative Research. Patient or Public Contribution: Patients and caregivers were involved in the conception and design of the study through their membership of the hospital mealtime reference group. A consumer researcher (GP) was involved in the team to advise on study conduct (i.e. recruitment methods and information), data analysis (i.e. coding transcripts), data interpretation (i.e. review and refinement of themes) and manuscript writing (i.e. review and approval of final manuscript). [ABSTRACT FROM AUTHOR]

Aim: To achieve an in‐depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self‐care. Design: The study employed a qualitative explorative design utilizing a phenomenological‐hermeneutic inspired approach, involving field observations and individual semistructured interviews. Methods: Data were collected during 2020–2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research. Results: Three key themes emerged: 'Diabetes when life is noisy', 'Sacrifices and compromises in life' and 'The double silence'. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self‐care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long‐term complications as a serious medical condition demanding careful attention and treatment. Conclusion: Self‐managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways. Implications for patient care: The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to provide insight from maternal survivors of intimate partner violence (IPV) describing their experiences with their ex-partners' firearm ownership, access, storage and behaviours in the context of co-parenting and separation. Design: We conducted a qualitative descriptive study informed by the IPV and Coparenting Model. Methods: The analytic sample consists of self-identified maternal survivors (n= 14) who completed semi-structured qualitative interviews between January and May 2023 describing experiences of post-separation abuse. Participants were recruited through social media and domestic violence advocacy and legal aid organizations. In the interview guide, participants were asked one item about firearm exposure: Have you or your children had any experiences with guns and your ex-partner that made you or your children feel scared? Interviews were audio-recorded and transcribed. Interview transcripts were managed and coded in ATLAS.ti using a codebook. Codes were applied using descriptive content analysis, discrepancies reconciled and themes related to firearm exposure in the context of post-separation abuse identified. Results: Six themes emerged related to firearm experiences and post-separation abuse: (1) gun ownership (2) gun access; (3) unsafe storage; (4) direct and symbolic threats; (5) involving the children; (6) survivors' protective actions. Conclusion: This manuscript provides context on how abusive ex-partners' firearm ownership, access and threats cause terror and pervasive fear for mothers and children following separation. Analysis of qualitative data provides important insights into opportunities to address firearm injury prevention. Impact: Findings add to the contextual understanding of how survivors of IPV experience non-fatal firearm abuse. Existing quantitative data may not capture the full extent of fear caused by perpetrators' gun ownership access and symbolic threats. Data from this study can help inform firearm injury prevention efforts. [ABSTRACT FROM AUTHOR]

Introduction: Though the evidence of the role of the arts in mental health is growing, no systematic review has focused on the impact of art groups in non‐clinical settings in the process of recovery following the CHIME framework. Aim: The aim of this study was to examine the effects of engaging in community‐based art groups in mental health recovery. Method: A search in five electronic databases for relevant research using quantitative, qualitative or mixed methods published between 2000 and 2019 identified nine eligible studies. Results: While there was great methodological heterogeneity, most studies were qualitative, used visual arts, facilitated by artists and assessed by mental health nurses, and took place in community locations or artistic venues. Quantitative outcomes, though few, provided evidence of increased well‐being, and qualitative outcomes corresponded mostly with the recovery process of Connectedness. Additional outcomes related to the settings were a sense of safety and to the intervention: self‐expression, development of skills and achievements, and the impact of final exhibitions and peer leadership. Discussion: Studies should aim at prospective designs following mixed methods approaches, with larger and gender‐sensitive samples, control groups and follow‐up assessments, and evaluate cost‐effectiveness. Implications for practice: Community‐based art groups which increase well‐being and promote connectedness should be key in recovery‐action planning. [ABSTRACT FROM AUTHOR]

Aim: To explore registered nurses' thinking strategies during the drug administration process in nursing homes. Design: An exploratory qualitative design. Methods: Eight registered nurses, one male and seven female, in five nursing home wards in Mid‐Norway were observed during 15 drug dispensing rounds (175 drug dispensing episodes). Think Aloud sessions with follow‐up individual interviews were conducted. The Think Aloud data were analysed using deductive qualitative content analysis based on Marsha Fonteyn's description of 17 thinking strategies. Interview data were used to clarify missing information and validate the content of Think Aloud data. Results: The registered nurses used all 17 thinking strategies described by Fonteyn, including several variants of each strategy. The three most frequent were 'providing explanations', 'setting priorities' and 'drawing conclusions'. In addition, we found two novel thinking strategies that did not fit into Fonteyn's template, which were labelled 'controlling' and 'interacting'. Among all strategies, 'controlling' was by far the most used, serving as a means for the registered nurses to stay on track and navigate through various interruptions, while also minimising errors during drug dispensing. Conclusion: The study highlights the diverse thinking strategies employed by registered nurses in nursing homes during medication administration. The findings emphasise the multifaceted nature of medication administration and underscore the importance of skilled personnel in ensuring medication safety. Recognising the significance of these findings is crucial for maintaining patient well‐being and upholding medication safety standards in healthcare settings. Relevance to Clinical Practice: Understanding the thinking strategies employed by registered nurses can inform training programmes and enhance the clinical judgements of health care professionals involved in medication administration, ultimately leading to improved patient outcomes and reduced medication errors in practice. Patient or Public Contribution: Patients were involved in this study as recipients of drugs which the nurses distributed during the observations. The patients were involved as a third party and consent to the observations was either given by the patients themselves or relatives in cases where the patient was not competent to consent. No personal information was collected about the patients. Reporting Method: The reporting of this study adhered to the COREQ checklist. [ABSTRACT FROM AUTHOR]

Aim: To explain the process taken by Chinese family care partners of older adults in the Greater Toronto Area, Canada, to access health and social services in their communities. The research question was: What mechanisms and structures impact the agency of Chinese family care partners of older adults, in the process of assisting them to access health and social services? Design: This qualitative study was informed by critical realism. Methods: Chinese family care partners of older adults in the Greater Toronto Area, Canada, were interviewed from August 2020 to June 2021. Transcripts underwent thematic analysis. Findings: Twenty-eight Chinese family care partners expressed a firm commitment to maintain caregiving conditions and to judiciously access health and social services. Their commitment was made up of three parts: (a) legislative and cultural norms of family, work, and society; (b) their perseverance to fill gaps with limited social and financial resources; (c) the quality of their relationship to, and illness trajectory of the older adults. The social structures created tension in how Chinese family care partners made decisions, negotiated resources, and ultimately monitored and coordinated timely access with older adults. Conclusion: Participants' commitment and perseverance were conceptualized as "grit," central to their agency to conform to legislative and cultural norms. Moreover, findings support grit's power to motivate and sustain family caregiving, in order for older adults to age in place as long as possible with finite resources. Implications for the profession: This study highlights the importance of cultural awareness education for nurses, enabling continuity of care at a systems level and for a more resilient healthcare system. Impact: Family care partners' grit may be crucial for nurses to harness when together, they face limited access to culturally appropriate health and social services in a system grounded in values of equity and inclusion, as in Canada. Reporting method: When writing this manuscript, we adhered to relevant EQUATOR guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ). Patient or public involvement and engagement: No patient or public involvement. [ABSTRACT FROM AUTHOR]

Aim: The study's main objective was to use a fuzzy set qualitative comparative analysis to identify the configuration of recipes that predict nurses' safety compliance behaviour. Design: A cross-sectional design. Methods: A survey was used where questionnaires were collected from 285 nurses across four primary healthcare hospitals within the Ashanti Region, Ghana. The data collection happened between June 1 to August 2, 2022. A fuzzy set qualitative comparative analysis was used to identify the recipes of psychological factors that determine nurses' safety compliance behaviour. Results: Results from the study suggest that the necessary configurations that explained nurses' safety compliance behaviour came from the presence of subjective norm, attitude, perceived behavioural control, perceived organizational support and negation of intention. The result highlights the need for safety protocols to be conscious of the interplay between nurses' assessment of self, social clues and perception of management care and support since such psychological factors must be considered concurrently to achieve the optimal safety compliance behaviour among nurses. Conclusion: A health and safety protocol that fails to recognize the importance of psychological antecedents on subordinates' safety compliance behaviour could limit the safety policy's usefulness in bringing the appropriate behavioural change in nurses. Impact: To date, no study has combined the antecedents of theory planned behaviour with perceived organizational support and cue to action to assess how they collectively predict nurses' safety compliance behaviour. Findings from the study suggest that nurses in primary health facilities inform their safety compliance behaviour by assessing self-capabilities, social signals from superiors and colleagues and perception of management support. Hospital administrators and nursing managers in sub-Saharan Africa may rely on these psychological forces to persuade nurses to develop positive safety compliance behaviour at the health facility. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aims: To describe the health literacy (HL) levels of hospitalised patients and their relationship with nursing diagnoses (NDs), nursing interventions and nursing measures for clinical risks. Design: Retrospective study. Methods: The study was conducted from December 2020 to December 2021 in an Italian university hospital. From 146 wards, 1067 electronic nursing records were randomly selected. The Single‐Item Literacy Screener was used to measure HL. Measures for clinical risks were systematically assessed by nurses using Conley Index score, the Blaylock Risk Assessment Screening Score, Braden score, and the Barthel Index. A univariable linear regression model was used to assess the associations of HL with NDs. Results: Patients with low HL reported a higher number of NDs, interventions and higher clinical risks. HL can be considered a predictor of complexity of care. Conclusions: The inclusion of standardised terms in nursing records can describe the complexity of care and facilitate the predictive ability on hospital outcomes. Implications for the profession and/or patient care: HL evaluation during the first 24 h. From hospital admission could help to intercept patients at risk of higher complexity of care. These results can guide the development of interventions to minimise needs after discharge. Patient or Public Contribution: No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection. [ABSTRACT FROM AUTHOR]

Aims: The aims of the study were to explore the experiences of women with gestational diabetes mellitus (GDM) and their partners and examine the factors influencing partner involvement in GDM management, seeking to inform a targeted couple‐based intervention. Design: A descriptive qualitative study. Methods: We conducted semi‐structured interviews with 14 women with GDM and their partners. Participants were recruited through convenience sampling from a tertiary hospital in Xi'an, China. Data were analysed using thematic analysis. Results: Three themes and 12 subthemes were identified. Theme I: Women's expectations of their partner's involvement in GDM management—practical support and emotional support. Theme II: Partner involvement in GDM management—constructive involvement, unhelpful involvement with good intentions and insufficient involvement. Theme III: Factors that influence partner involvement in GDM—knowledge of GDM, GDM risk perception, health consciousness, attitudes towards the treatment plan, couple communication regarding GDM management, family roles and appraisal of GDM management responsibility. Conclusion: Women desired practical and emotional support from partners. The types of partner involvement in GDM management varied. Some partners provided constructive support, while some partners' involvement was limited, non‐existent or actively unhelpful. By combining these results with the factors influencing partner involvement, our findings may help healthcare professionals develop strategies to involve partners in GDM care and enhance women's ability to manage GDM. Implications for the Profession and Patient Care: Partner involvement in GDM care may help them understand and better attend to women's needs, thus improving their experience and potential outcomes. This study highlights novel factors that need to be considered in developing couple‐based interventions for this population. Reporting Method: The reporting follows the COREQ checklist. Patient or Public Contribution: Some patients were involved in data interpretation. There is no public contribution. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to explore factors that influence family caregiver readiness to adopt health smart home technology for their care‐dependent older adult family member. Health smart homes are designed to remotely monitor the health and wellness of community‐dwelling older adults supporting independent living for as long as possible. Accordingly, if the health smart home is deployed into the home of a care‐depended older adult, it can potentially support family caregivers by facilitating workforce participation and give piece of mind to the family caregiver who may not live close to the older adult. However, wider adoption of health smart home technologies into the homes of community‐older adults is low, and little is known about the factors that influence the readiness of family caregivers to adopt smart home technologies for their care‐dependent older adults. Design: A qualitative Descriptive study design was utilized. Methods: Qualitative data were collected between 2019 and 2020 via semi‐structured interviews. Thematic analysis of interviews was completed, and data were organized into themes. Results: Study findings show that caregiver readiness (N = 10) to adopt smart home technology to monitor older adult family members were influenced by five primary themes including a 'big brother effect', 'framing for acceptance', 'data privacy', 'burden' and 'cost.' Conclusion: Family caregivers were open to adopting smart home technology to support the independent living of their older adult family members. However, the readiness of family caregivers was inextricably linked to the older adults' readiness for smart home adoption. The family caregiver's primary concern was on how they could frame the idea of the smart home to overcome what they viewed as hesitancy to adopt in the older adult. The findings suggest that family caregivers endeavour to balance the hesitancy in their older adult family members with the potential benefits of smart home technology. Impact: Family caregivers could benefit if their care‐dependent older adults adopt smart home technology. Recognizing the role of caregivers and their perspectives on using smart home technologies with their care‐dependents is critical to the meaningful design, use and adoption. [ABSTRACT FROM AUTHOR]

Aim: To describe experiences of work‐related stress, stress reactions and coping strategies among registered nurses (RNs) in the ambulance service (AS). Design: A descriptive and qualitative design. Methods: Participants were recruited from eight different ambulance stations from different geographical locations in central Sweden. Data were collected from 14 RNs during the period from January 2022 to May 2022 using a semi‐structured interview guide. Qualitative content analysis was used to analyse data using an abductive approach. Results: Three categories describe the RNs' experiences; (1) Situations that cause work‐related stress, (2) Reactions and feelings that occur and (3) Management of work‐related stress. These three main categories included a total of 12 subcategories. Work‐related stress was experienced when participants were a part of traumatic events or experienced insufficient cooperation or a disturbing event in the work environment. The different causes lead to different kinds of reactions with feelings of frustration, fear and loneliness being prominent. To manage the work‐related stress, RNs used different kinds of strategies and support from colleagues or lack thereof seemed to have a major impact. Conclusions: Findings revealed the importance of having competent colleagues in the AS. Working with a competent colleague can reduce experiences of stress and prevent feelings of loneliness. It is important for the AS to provide stress‐reduction support, to promote cooperation and to maintain and develop RNs' professional competence to ensure quality care and patient safety in the AS. [ABSTRACT FROM AUTHOR]

Aim: To investigate how NGNs perceived and applied an intervention for preventing stress‐related ill health embedded in a transition‐to‐practice programme when entering their professional life. Design: A qualitative exploratory descriptive design was selected for this study to gain insights and perspectives on the adoption and utilization of the intervention. Methods: In this qualitative methodology process evaluation, semi‐structured and audio‐recorded interviews were conducted with a sample of 49 nurses. Data were collected between December 2016 and July 2017, and were sorted in NVivo 12 Plus, followed by thematic analysis. Results: The analysis resulted in three change processes stimulated by the intervention: (a) Building acceptance of being new; (b) Gaining insight into professional development and health and (c) Practical steps for skills development, healthy habits and better‐organized work. In addition to the three themes, barriers that hindered the progression of the processes were also described. Each process influenced the development of the others by stimulating a deeper understanding, motivation to change and courage to act. Several barriers were identified, including the use of cognitively demanding intervention tools, fatigue, high work demands, inconvenient work hours and a hostile social climate on the ward. Conclusion: This process evaluation showed that newly graduated nurses used knowledge from the intervention and adopted new behaviours largely in accordance with how the intervention was intended to work. Impact: When entering a new profession, it is crucial to receive a well‐thought‐out, structured and targeted introduction to the new professional role, tasks and work group. Nurses stated that the intervention increased their understanding of the role as new nurses and their insight into how to develop skills that promoted better functioning and recovery. The intervention also stimulated the development of new health behaviour and some new learning strategies. [ABSTRACT FROM AUTHOR]

Aim: To explore which factors, influencing dietary behaviour change support among patients by Dutch community nurses (CNs; nurses), are key focal points in training programmes. Background: Nurses have an important role in counselling patients towards healthier dietary behaviour to prevent or delay long‐term complications from chronic lifestyle‐related diseases. Most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential. Design: A qualitative descriptive study. Methods: Data were collected in the Netherlands in 2018–2019 via semi‐structured face‐to‐face interviews with 18 nurses. Interview guide themes were informed by the COM‐B model, using validated descriptions in Dutch. Data were recorded, transcribed and analysed using inductive thematic analysis. Results: Factors that affected dietary behaviour change support were linked to (1) the nurse (role identity, dietary knowledge and competences such as methodical approach, behaviour change techniques and communication techniques), (2) nurse–patient encounter (building a relationship with a patient, supporting patient autonomy and tailoring the approach) and (3) cooperation and organizational context. Conclusion: It is of utmost importance to pay attention to nurses' role identity regarding dietary behaviour change support, as this underlies professional behaviour. This should be accompanied by improving competences on dietary behaviour change support. Focus on competences regarding the application of behaviour change technique is crucial. Furthermore, having a relationship of trust with a patient was important for discussing sensitive topics such as diet. Impact: The promotion of a healthy diet provides opportunities to contribute to patient autonomy and self‐management. Well‐fitted training offers for (senior) nurses will lead to improved professional practice of nurses, leading to healthier dietary behaviour of patients. Patient or Public Contribution: A nurse provided feedback on the interview guide. [ABSTRACT FROM AUTHOR]

Aims: To explore how emerging adult‐aged women self‐manage their sexual and reproductive health and to generate a grounded theory of these self‐management processes. Design: Grounded theory methods using a constructivist approach. Methods: Between September 2019 and September 2020, 18‑ to 25‐years‐old women (n = 13) were recruited from a 4‐year university, a 2‐year community college, and neighbourhoods surrounding the institutions of higher education. Individual interviews were transcribed verbatim and qualitatively analysed using a constant comparative method and inductive coding. Results: The theory purports that core processes of sexual and reproductive health self‐management used by the women in this study included both passive and (re)active processes. These processes expanded upon and/or maintained the women's accessible sexual and reproductive health knowledge, behaviour and beliefs, defined as the sexual and reproductive health repertoire. The processes appeared to be cyclical and were often initiated by a catalysing event or catalyst and resulted in conversations with confidantes, or trusted individuals. A catalyst was either resolved or normalized by expanding or maintaining the sexual and reproductive health repertoire. Conclusion: The resulting theory, EMeRGE Theory, offers insight into the complex and cyclical processes emerging adult‐aged women use to simultaneously develop and adapt their foundational sexual and reproductive health knowledge, behaviours and beliefs. Implications for the Profession and/or Patient Care: This explication of emerging adult‐aged women's sexual and reproductive health self‐management processes can be used by nurses and nurse researchers to better address this population's unique health needs. Impact: The EMeRGE Theory provides valuable guidance for future exploratory and intervention research aimed at improving the health and well‐being of emerging adult‐aged women. Reporting Method: The authors adhered to the Consolidated Criteria for Reporting Qualitative studies (COREQ) in preparation of this publication. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim and Objective: The purpose of this study was to generate a conceptual definition and theory of grief for nurses working on the frontlines during the COVID‐19 pandemic using grounded theory methodology. Background: The COVID‐19 pandemic has had a negative impact on nurses working on the frontlines. The increasing flow of diagnosed COVID‐19 cases, diverse unknowns and demands in the treatment of patients with COVID‐19, and depression related to countless deaths can trigger grief experiences. Design: A mixed methods approach, including the qualitative method of grounded theory and a quantitative 30‐question survey, was used in this study. Methods: Eight focus group sessions were conducted with registered nurses working on the frontlines during the pandemic. Sessions were audio recorded and analysed using constant comparative data analysis. Following the interviews, a survey including demographics and self‐report inventories was completed by participants. The COREQ checklist was used to assess study quality. Results: Major concepts that emerged include 'facing a new reality', 'frustrations', 'stress' and 'coping'. Core concepts were combined into a conceptual definition of grief and a grounded theory of the experience of nurses working on the frontlines during the pandemic. Cross comparisons of qualitative and quantitative findings were made and compared with the literature. Conclusions: This study provides a better understanding of the grief experience of nurses working on the frontlines during the COVID‐19 pandemic. It is necessary to recognise professional grief and develop intervention strategies that lead to grief reconciliation. Relevance to Clinical Practice: Findings provide useful insights for healthcare administrators to provide support and develop interventions to reduce frustrations and stress of frontline registered nurses. Patient or Public Contribution: This study design involved registered nurses participating in focus group sessions. Participants detailed their experience working on the frontlines of the COVID‐19 pandemic with patients, family and hospital administration. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to develop the Risk Perception Scale of Disease Aggravation for older patients with non‐communicable diseases and evaluate its psychometric properties. Design: Instrument development and cross‐sectional validation study were conducted. Methods: This study contained four phases. In phase I, a systematic literature review was conducted to identify the conception of disease aggravation and risk perception. In phase II, a draft scale was formulated from face‐to‐face semi‐structured in‐depth interviews by Colaizzi's seven‐step qualitative analysis method and group discussions among the researchers. In phase III, domains and items of the scale were revised in accordance with the suggestions from Delphi consultation and patient feedback. In phase IV, psychometric properties were evaluated. Findings: Exploratory and confirmatory factor analyses determined four structural factors. Convergent and discriminant validities were acceptable because the average variance extracted coefficients ranged from.622 to.725, and the square roots of the average variance extracted coefficients for the four domains were larger than those of bivariate correlations between domains. The scale also exhibited excellent internal consistency and test–retest reliability (Cronbach's alpha coefficient =.973, intraclass correlation coefficient =.840). Conclusions: Risk Perception Scale of Disease Aggravation is a new instrument that measures the risk perception of disease aggravation for older patients with non‐communicable diseases, including possible reason, serious outcome, behaviour control and affection experience. The scale contains 40 items that are scored on a 5‐point Likert scale, and it has acceptable validity and reliability. Impact: The scale is applied to identify different levels of risk perception of disease aggravation for older patients with non‐communicable diseases. Clinical nurses can provide targeted interventions to improve older patients' risk perception of disease aggravation based on levels of risk perception during hospitalization and the period before discharge. Patient or Public Contribution: Experts provided suggestions for revising the scale dimensions and items. Older patients participated in the scale revision process to improve the wording of the scale. [ABSTRACT FROM AUTHOR]