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Accessible Summary: What is known on the subject?: Advanced clinical practitioners (ACPs) are, typically, non‐medical healthcare professionals, who possess advanced clinical skills, a master's level qualification and evidence of leadership, management and research abilities.Most ACPs are nurses and new ACP roles are increasingly being established around the world.The views of senior staff towards new mental health nursing roles in organizations are likely to influence their introduction and sustainabilityResearch on mental health nursing ACP roles is sparse. What the paper adds to existing knowledge?: The paper uniquely provides specific information as to factors perceived by senior staff as affecting the implementation of ACP roles in mental health services.A wide range of mental health services were perceived as potentially benefiting from ACPs.Establishing role clarity for MHN ACPs is perceived as being as essential to successful introduction of the role, as has been found for other specialities. What are the implications for practice?: Participants identified a need for early engagement with service users and professions about new ACP roles and for processes that can evaluate ACP roles once they established.Some mental health nurses may require long‐term developmental pathways to help prepare them to take on a master's level course and then the ACP role. Introduction: Advanced clinical practice (ACP) roles are increasingly being developed internationally. Identifying factors perceived as affecting the development of ACP can support effective implementation. Aim: To understand the views of senior health service staff as to factors influencing the development of ACP roles in mental health services. Method: Focus group and semi‐structured interviews. Participants were directors of nursing (n = 10) and other senior staff from roles important to workforce development (n = 10). Results: Content analysis suggested seven categories: understanding the role and national guidelines, attitudes to the role, learning from implementing other roles, understanding prerequisites for development, challenges, opportunities and future support/actions. Prerequisites for success would include early engagement with stakeholders. Medical attitudes towards ACP roles were perceived as generally more positive than previously. Discussion: The study provides unique information regarding perspectives of senior staff regarding the implementation of ACP roles in mental health services. A wide range of mental health services were perceived as potentially benefiting from ACPs, with the importance of role clarity being highlighted and long‐term developmental pathways for staff. Implications for practice: Successful Implementation of ACP roles may require clear role definition, early engagement with stakeholders and processes to evaluate role outcomes. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There is body of knowledge available about the harms associated with restrictive interventions used in behaviour management, service users' perceptions of the use of restraints, and staff competence in behaviour management. The staff perspective has been studied in terms of staff exposure, responses to and prevention of aggression, staff‐related factors associated with service user aggression, and staff attitudes and perceptions towards violence.The definitions of competence in behaviour management provided in training interventions are fragmented and based on unilateral measurements.Training interventions with the purpose of enhancing staff competence in behaviour management are organized regularly, yet there is a lack of clarity on how effective these interventions are. Inadequate conceptual understanding of behaviour management can weaken the effectiveness of these interventions. What this paper adds to existing knowledge?: Our study produced new knowledge by providing a preliminary conceptual framework that can be used to comprehensively describe and assess competence in managing challenging behaviour and to cover safely the whole care process. Humane care and ethical sensitivity should be the premises of interaction with people in distress. We also pointed out the needs for conceptual clarification of the concepts of confidence, support and restraint.We provide important new insight into the leadership and cultural issues of behaviour management that is relevant for patients, staff members and healthcare organizations. We found that staff members do not consider service user safety and workplace safety as opposing issues.Further, we provide new perspectives for prevention, the risk assessment process and effective communication in the context of behaviour management. What are the implications for practice?: A comprehensive understanding of the competences related to behaviour management will foster universal definitions for "support" and "restraint," which can then be used to ensure that the best practices are used for behaviour management.Organizational culture and participative leadership on behaviour management should be developed with a special focus on safety issues, common understanding of comprehensive competence, risk assessment and prevention, views regarding the use of restraints, and teamwork. Introduction: Previous research concerning staff views of behaviour management has not considered instructors' views. The definitions of competence in behaviour management are fragmented, which can undermine the effectiveness of training interventions. Aim/Question: This study aimed to describe Finnish and British Management of Actual or Potential Aggression instructors' perceptions of safety and behaviour management‐related competences and create a conceptual framework for comprehensive competence. Method: An explorative‐descriptive qualitative approach with purposive sampling (N = 22), semi‐structured interviews and abductive content analysis. Results: Conceptual framework of comprehensive competence in managing challenging behaviour includes five categories—knowledge, skills, attitude, confidence and ethical sensitivity—and 21 subcategories. Competent staff and supportive leadership ensured safety, while inconsistent risk management culture, the health and behaviour of service users, and inadequate staff orientation endangered safety. Discussion: The study produced new knowledge of safety issues and competences from the perspective of the instructors who deliver behaviour management training. Implications for practice: Competence to manage challenging behaviour should be developed based on our conceptual framework to provide an effective and safe training. Prevention, the risk assessment process, alternative communication, and the definitions of "confidence," "support" and "restraint" should all be sufficiently addressed in future training. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Mental health nurses provide care within an environment that is often threatening.The environment is often threatening because: (a) patients' needs are complex and highly emotional, (b) nurses often do not have the time and resources they would wish for and (c) caring for patients can be emotionally exhausting and distressing.Compassionate care involves providing a welcoming environment, promoting bidirectional compassion, providing training in compassion and creating supportive organizations.To date, there is no study evaluating compassion interventions for the high‐threat profession of mental health nursing and no study qualitatively evaluating compassion training and implementation. What the paper adds to existing knowledge?: This study looked at what happens if compassion training delivered by the originator of Gilbert's model of compassion is given to mental health nurses.Nurses were interviewed 1 year later to see how relevant and useful the training was, and whether they had been able to use it in their daily work.Consistent with previous studies, the study found a reduction in professionals' self‐criticism and an increase in self‐compassion, which in this study extended to increased compassion and reduced criticism of colleagues and patients; and professionals applying the training directly to reduce patient self‐criticism. What are the implications for practice?: Nurses felt that more training and supervision was needed to build the confidence to use the training regularly at work.They felt it had been difficult to use the training because of the threatening environment in which they worked.Nurses recommended that the whole organization would need the training to make it part of their everyday work. Introduction: Compassionate care involves providing a welcoming environment, promoting bidirectional compassion, providing training in compassion and creating supportive organizations. To date, there has not been a study evaluating compassion interventions for the high‐threat profession of mental health nursing. Neither has there been a study providing an in‐depth qualitative evaluation of training and implementation. The current study aims to address these gaps in the literature. Aim: The aims were to evaluate Compassionate Mind Training‐CMT for mental health nurses and to assess implementation. Method: Focus groups were conducted (N = 28) 1 year later to evaluate CMT and implementation. Results: Content analysis revealed four training themes: (a) Useful framework; (b) Thought‐provoking and exciting; (c) Appreciation of person‐centred approach; and (d) Need for ongoing training and supervision. Three implementation themes emerged: (a) Applied approach with patients and staff themselves; (b) Environmental challenges to implementation; and (c) Attitudinal challenges to implementation. Discussion: Consistent with previous studies, professionals experienced reduced self‐criticism and an increased self‐compassion, which extended to increased compassion and reduced criticism of colleagues and patients; and professionals applying training directly to reduce patient self‐criticism. Implications: For successful implementation, formal adoption of compassion approaches is needed with strategic integration at all levels. [ABSTRACT FROM AUTHOR]

Aim: Globally, the rapid increase of hypertension is particularly prevalent in low‐ and middle‐income countries. Hypertension is the most significant modifiable risk factor for stroke and ischaemic heart disease, the leading cause of mortality in Vietnam. The aim of this study was to gain insight into the provision of hypertension care in Vietnam by exploring provider perceptions. Methods: A sequential exploratory mixed‐method design was selected to allow for the initial qualitative interview findings to be incorporated into the development of the hypertension education workshop. Data were collected through semistructured interviews of 15 Vietnamese clinicians involved in the care of patients with hypertension. Results: Anxiety related to diagnosis of hypertension and specifically fear of having a stroke was mentioned by half of the participants. Several themes also emerged regarding barriers to implementing lifestyle modification to improve patient hypertension outcomes. There were contradictory opinions on the nurse's role in providing patient education across clinical settings. A lack of systematic structure and evidence‐based teaching resources was also noted. Conclusions: Gaining the provider's perspective increases understanding of the regional culture and context of hypertension care. The increased understanding can be used to improve provider education and enhance hypertension population outcomes. SUMMARY STATEMENT: What is already known about this topic? There is an increasing global prevalence of hypertension, the leading modifiable risk factor for cardiovascular morbidity and mortality.Lifestyle modifications are first‐line treatment to attaining hypertension goals and improving patient outcomes.Strengthening nursing intellectual capital by building nurse skills and knowledge can maximize their contribution and enhance population health. The implications of this paper: Awareness of patient culture strengthens patient education and enhances uptake of lifestyle modifications.Nurses, when appropriately equipped and supported, are ideally situated to significantly improve hypertension outcomes.Appropriately educating nurses and clarifying role expectations would develop nursing intellectual capital and add value to the health‐care system in Vietnam. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Mental health service users ( MHSUs) may experience disruptions in their education. However, education has been shown to have a positive influence on their recovery, potentially offering them broader employment opportunities., The literature suggests that providing support for MHSUs in their educational efforts may be beneficial and is wished for by the service users themselves. However, there is a lack of mental health professionals' views on the topic in the setting of a community mental health centre., What does this paper add to the existing knowledge? In the perception of mental health professionals, the predominance of disease in the life of MHSUs and their marginalization may form barriers to their success in education., Professionals can support MHSUs in their educational efforts by strengthening the MHSUs' internal resources and creating a supportive environment with professional expertise available. A service user-centred education might further help MHSUs to achieve their educational goals., Our findings confirm previous knowledge of a recovery-oriented approach to supporting MHSUs' education. This study explored the topic from the professionals' perspective in the context of community mental health centres, which is a fresh view in the research literature., What are the implications for practice? The findings suggest which types of support professionals perceive to be required for MHSUs to advance their studies. Knowledge of adequate forms of support can be applied in the mental health nursing practice to develop support measures for service users to advance in their studies., All levels of the community mental health centres should be aware of and adopt a recovery-oriented approach. MHSUs and professionals need to have a shared opinion on the definition of recovery orientation. This requires mutual discussion and the more active involvement of MHSUs in the design of their own rehabilitation process., Abstract Introduction Studies show the importance of providing support for mental health service users' ( MHSUs') education. However, none of these studies explored this support in the community mental health centre setting. The range of MHSUs' educational activities identified in this study varied from participation in courses at the mental health centres to independent studies at different levels of education outside the centres. Aim (1) How do mental health professionals perceive the challenges that may limit service users' potential when they apply for, and complete, their education? (2) How do the professionals describe the methods of rehabilitation aimed at supporting the service users in achieving their educational goals? Method The data were collected from 14 mental health professionals using focus group interviews. Inductive content analysis was then performed. Results Professionals perceive that the predominance of disease and marginalization may be barriers to MHSUs' success in education. Strengthening the MHSUs' internal resources, creating a supportive environment with professional expertise available and service user-centred education appeared to support the MHSUs' educational achievements. Our findings confirm previous knowledge of a recovery-oriented approach to support MHSUs' education. However, professionals' views on this topic in the context of community mental health centres have not been investigated previously. Discussion Professionals perceive that a recovery-oriented approach to rehabilitation may support MHSUs in their educational efforts. Implications for practice A recovery-oriented approach should be adopted by all levels of the community mental health centres. MHSUs and professionals need to have a shared opinion on the definition of recovery orientation. This requires mutual discussion and a more active involvement of MHSUs in the design of their own rehabilitation process. [ABSTRACT FROM AUTHOR]

Aim: To explore young adults' experiences of living with type 1 diabetes in the transition to adulthood, including experiences of the transfer from paediatric to adult care. Design: A qualitative approach was used. Method: Ten young adults, six women and four men, aged 19–29 years, participated. Participants were recruited at their regular diabetes clinic from spring 2021 to spring 2022. Semi‐structured interviews were transcribed and analysed using qualitative content analysis. Findings: Dreaming of being nurtured towards self‐reliance was the overarching theme. Personal experiences of the transition to adulthood, including the transfer from paediatric to adult care, were described in terms of struggling to find balance in daily life, dealing with feelings of being different, being gradually supported to achieve independence, and wishing to be approached as a unique person in healthcare. Conclusion: In healthcare, it is important to emphasize not only diabetes‐related factors but also emotional and psychosocial aspects of life connected to the transition to adulthood, including the transfer to adult care. The young adults wished to be seen as unique persons in healthcare during their emerging adulthood and should therefore be supported to achieve self‐reliance through personal preparations for new challenges and for the consequences of transitioning to adulthood. Specialist nurses can provide appropriate knowledge and leadership. Implications for the Profession: These findings can guide nurse specialists in support for emerging adults to achieve self‐reliance and indicate the importance of person‐centred care when experiencing transition and transfer. Reporting Method: The study adhered to EQUATOR guidelines, and the COREQ checklist for qualitative studies was used as the reporting method. [ABSTRACT FROM AUTHOR]

Aims: To explore the experiences of healthcare personnel when they face resistiveness to care in people living with dementia in nursing homes. Design: The study has a qualitative explorative design. Methods: Three focus group interviews were conducted in June 2019. A total of 16 nurses and other healthcare personnel employed in three different nursing homes participated. A semi‐structured interview guide was used during the focus group interviews. Data were transcribed verbatim and analysed using an inductive qualitative content analysis. Results: The analysis generated one overarching category—'Tension when facing resistiveness to care', which describes the discomfort healthcare personnel experienced when confronted with resistiveness to care in people with dementia—and two other categories: 'Attitude change' and 'Changing behaviour', which describes their strategies to reduce and/or manage the discomfort. Four subcategories—'Changing the mindset', Conceptual shift', Stepping back' and 'Not giving up'—described the actions taken by healthcare personnel to manage or reduce their cognitive dissonance. Conclusion: The strategies used to manage or reduce cognitive dissonance provide a new understanding of how healthcare personnel choose to approach resistiveness to care in people living with dementia. Impact: This study addresses cognitive dissonance, a discomfort experienced by healthcare personnel when facing resistiveness to care from people living with dementia. To reduce their dissonance, the participants employed several strategies, including coercive measures, when providing care. The theory of cognitive dissonance may help explain why healthcare personnel sometimes choose to employ coercive measures while providing care. [ABSTRACT FROM AUTHOR]

Rhoades DR, Al-Oballi Kridli S, Penprase B. International Journal of Nursing Practice 2011; 17: 562-570 Understanding overweight adolescents' beliefs using the theory of planned behaviour This qualitative inquiry examined adolescents' experiences surrounding their beliefs towards being overweight. The purpose of this qualitative study was to understand behavioural, normative and control beliefs of overweight adolescents regarding losing weight, exercising and eating healthy. Purposive sampling was used to obtain 10 overweight adolescents between the ages of 13 and 19. The theory of planned behaviour was used as a theoretical framework for this study. An interview guide based on the Theory of Planned was used to conduct individual semistructured interviews. Content analysis showed that overweight adolescents exhibited positive attitudes in dealing with their weight status and valued their family's support and guidance in helping control their weight. Although friends were important to facilitate regular exercise, families, particularly mothers, were crucial in addressing healthy eating habits. Understanding the subtleties and complexities of living with childhood overweight might assist health professionals in creating more effective and developmentally sensitive interventions. [ABSTRACT FROM AUTHOR]

Forsberg A, Lindgren E, Engström Å. International Journal of Nursing Practice 2011; : 110-116 People who have been cared for in intensive care units (ICUs) are transferred between different levels of care and hospitals. The aim with this study was to describe peoples' experiences of being cared for in an ICU and transferred to a ward. An inductive, descriptive qualitative study was performed with qualitative individual interviews with 10 participants. The interviews were transcribed verbatim and subjected to qualitative thematic content analysis which resulted in one theme; searching for the known in the unknown, and five categories. The findings showed the importance of being prepared for the transfer and knowing what was going to happen. Some participants felt secure in the ICU and excluded on the ward, others appreciated leaving the stressful environment in the ICU for a more peaceful ward. Feelings of anxiety and exposure were experienced during the transfer and it was helpful if staff involved were known to the participants. Better information and patients' involvement concerning the transfer from ICUs to general wards are suggested as means of improving nursing care. Further studies are needed to improve continuity of care for critically ill people. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe healthcare professionals' perceptions of advance care planning (ACP) in palliative care unit in hospital ward or outpatient clinic. Background: Clinical guidelines recommend timely ACP as a central component of patient‐centred palliative care. However, the ACP concept and terminology have been judged to be confusing, and practices are not established. Professionals' views are needed for ACP adoption and usage. Design: Qualitative descriptive design. Methods: The study used purposive sampling. The data were collected through focus group interviews with registered nurses and practical nurses and individual or couple interviews with physicians and social workers. The data (n = 33) were analysed by inductive content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Three main categories emerged: Information content of ACP, coordination of care activities through ACP, and support for patients' and family members' coping. The information content of ACP included assessment of need for patient care, preparing for changes in patient's state of health and proactive medication. Coordination of care activities through ACP contained ACP care planning, cooperation and work practices between healthcare professionals. Support for patients' and family members' coping included communication between patient, family members and professionals and promoting patient self‐care. Conclusions: ACP is a useful and proactive tool for integrating patient‐centred information, care and services as well as support for patients' and family members' coping. Palliative care activities can be coordinated through ACP in a multidisciplinary manner. ACP is significant and relevant for both professionals' work and patient care throughout the service system. Relevance to clinical practice: Results highlight the importance of proactive, concrete and holistic ACP. ACP should be up to date to reflect patient's current wishes. Raising professional awareness and implementing ACP into work processes are essential. Results can be utilised in planning and implementing interprofessional in‐service training. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the experience of parenting for younger stroke survivors (aged 18 to 64 years at the time of the stroke). Background: Stroke among younger adults increased 43% between 2000 and 2010. The social, emotional and physical functioning of younger adults affects multiple aspects of their lives including parenting. There is limited research on the experience of parenting after stroke. Design: This is a qualitative descriptive study. Methods: We conducted individual semi‐structured interviews with 10 younger adults who were actively parenting children under the age of 18 years at the time of stroke. Conventional content analysis was used to analyse the data. We report the methods and results using the COREQ checklist. Results: Impairments from stroke disrupted participants' identity, relationships and roles as a parent. The degree to which parenting abilities and behaviours were affected by stroke was contingent upon the type and severity of impairments as well as the children's age. Participants also observed emotional and behavioural changes in their children in response to their stroke. Support from family, friends, healthcare providers and children's school/day care was crucial to participants throughout their stroke recovery. Two major themes emerged: (a) finding a new normal; and (b) support for parenting post‐stroke. Conclusions: Findings enable a deeper understanding of the distinct parenting challenges younger stroke survivors face and can inform future research on this population. Relevance for clinical practice: Study findings highlight the need for continual and tailored follow‐up by nurses and other allied healthcare professionals to decrease the difficulty stroke survivors experience when trying to resume their role as parents. [ABSTRACT FROM AUTHOR]

Aim: To describe and explain nurses' protocol‐based care decision‐making. Background: Protocol‐based care is a strategy to reduce variability in clinical practice. There are no studies looking at protocol‐based care decision‐making. Understand this process is key to successful implementation. Method: A multiple embedded case study was carried out. Nurses' protocol‐based care decision‐making was studied in three inpatient wards (medical, surgical and medical‐surgical) of a university hospital in northern Spain. Data collection was performed between 2015 and 2016 including documentary analysis, non‐participant observations, participant observations and interviews. Analysis of quantitative data involved descriptive statistics and qualitative data was submitted to Burnard's method of content analysis (1996). The data integration comprised the integration of the data set of each case separately and the integration of the findings resulting from the comparison of the cases. The following the thread method of data integration was used for this purpose. The SRQR guideline was used for reporting. Results: The multiple embedded case study revealed protocol‐based care decision‐making as a linear and variable process that depends on the context and consists of multiple interrelated elements, among which the risk perception is foremost. Conclusion: This study has allowed progress in protocol‐based care decision‐making characterisation. This knowledge is crucial to support the design of educational and management strategies aimed at implementing protocol‐based care. Relevance to clinical practice: Strategies to promote protocol‐based care should address the contexts of practice and the ability of professionals' to accurately assess the degree of risk of clinical activity. Hence, it will promote quality of care, patient safety and efficiency in healthcare cost. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify general competence areas for graduating registered nurses and podiatrists providing chronic wound care. Background: The provision of care for chronic wounds involves a team of multiple professionals, and registered nurses and podiatrists play an important role. However, previous studies have found that registered nurses have limited competence in wound care. In addition, there are no standardised international competence areas for the provision of chronic wound care by registered nurses and podiatrists. Design: A qualitative design was used in this study. Methods: The data were collected using six focus‐group interviews with the following professionals: (a) registered nurses; (b) authorised wound care nurses; (c) nurse educators; (d) physicians; (e) podiatrists; and (f) podiatry educators (N = 23). The data were analysed using inductive and deductive content analysis. COREQ guidelines were followed, See Appendix S1. Results: The competence areas for registered nurses and podiatrists providing care for chronic wounds include knowledge, skills and performance in anatomy and physiology; aetiology, care and prevention of chronic wounds; and wound management and assessment. The competence areas also include a set of attitudes and values relating to chronic wound care and patients with chronic wounds. Conclusions: In nursing and podiatry education and in working life, teaching should focus on these areas of competence in chronic wound care. This would standardise and integrate education on wound care, especially that of chronic wounds. Relevance to clinical practice: Wound care is an important part of clinical practice in nursing and podiatry. It is suggested that registered nurses and podiatrists need general competence in chronic wound care to carry out evidence‐based, safe, high‐quality and cost‐effective care. These results could be used to define registered nurses' and podiatrists' competence areas and roles in evidence‐based wound care as independent healthcare professionals. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore patients and carers' experience and perceptions of different modalities of long‐term enteral feeding. Background: With an ageing population in Singapore, there is a concomitant increase in number of patients with dysphagia and hence increase in prevalence of enteral feeding. It is essential to understand experiences of patients and home carers with long‐term home enteral feeding and perceptions of different modalities to better provide support. Design: A qualitative descriptive approach fulfilling the COREQ checklist criteria (See File S1). Nine patients who were receiving long‐term enteral feeding and nine carers were recruited over the period of August to December 2017. One‐to‐one interviews were conducted and audio‐recorded. An inductive content analysis approach, with open coding, creation of categories and abstraction of data, was adopted. Results: Three themes were generated: (a) factors influencing choice of mode of enteral feeding; respondents narrated factors such as need to "conceal" illness, need to be independent and previous bad experience with alternative modality (b) identified informational, emotional and physical needs. Respondents reported the need for support in terms of information on the different modalities, and training on how to self‐care or provide care and (c) individual perception and attitude towards life with enteral feeding. Most respondents portrayed a positive outlook to life, despite that they could no longer participate in communal eating. Conclusion and Relevance to clinical practice: Understanding patients and carers' experience and perceptions will inform the development of strategies to empower future patients and carers in choice of modality for enteral feeding. Patients with percutaneous endoscopic gastrostomy (PEG) found it easier to integrate enteral tube feeding into daily lives. Carers played a pivotal role in choice of modality, as well as in care of patients on enteral feeding. [ABSTRACT FROM AUTHOR]

Aims and objectives To understand the challenges faced by patients with heart failure. Background Heart failure is a clinical syndrome that is increasing across the globe. People affected with it encounter various problems that reduce their quality of life and well-being. Therefore, identifying the challenges faced by patients with heart failure is necessary for health care and treatment plans. Design This study was performed using the qualitative research approach and content analysis method. Methods Data were collected using semistructured interviews and notes in the field of 21 Iranian participants, namely 12 patients with heart failure, three cardiologists, three nurses and three members of patient family. The data were analysed using Lundman and Graneheim qualitative content analysis. Results The results of this study were revealed in the form of a theme: 'sliding context of health' in which the following three categories 'perceived threat of health and life', 'the struggle between doubt and certainty' and 'in the downward slope of quality of life' reflect the experiences of patients faced with heart failure. Conclusions The findings of this study showed that it is necessary to identify the challenges of facing heart failure, in order to support and educate patients with heart failure. Patients do not take care of themselves based on the fact that these challenges affect them psychologically and physically, and as such, the new situations are often misunderstood, thereby resulting in frequent recurrence of symptoms, mandatory hospitalisations and reduced quality of life. Relevance to clinical practice Nurses, as the first line of health care, play an important role in identifying problems and supporting patients with heart failure. By acquiring knowledge and listening to the complaints of patients, interventions can be developed to improve their situation. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the views of student nurses' and stakeholders of what is important for student nurses to know about cancer treatment and care. Background Worldwide, the number of people living with cancer is increasing because the population is ageing and effective cancer treatments are prolonging survival. All nurses need knowledge, skills, confidence and competence to support people living with cancer. Education is an important tool in preparing a nursing workforce that can support people affected by cancer. Design A descriptive, explorative qualitative design. Methods Semi-structured interviews with 12 student nurses and seven stakeholders were conducted in 2014 (a subgroup of participants in a mixed-methods study investigating an innovation in undergraduate cancer education and reported elsewhere). The interviews were audio-taped, transcribed and analysed using content analysis. Results Two key findings emerged: the benefits of learning from people affected by cancer and knowledge deficits. Students valued the opportunity to meet people affected by cancer away from a clinical environment. It gave them the opportunity to gain skills and confidence, in providing information and psycho-educational support, in a safe and facilitated context. Students and stakeholders reported blended learning (lectures and engaging with both cancer clinicians and people affected by cancer) important for developing confidence and competence in cancer care. However, at the end of their education students identified knowledge deficits in relation to cancer screening, common cancers, treatment side effects and supporting people who have been given 'bad news'. Conclusions Collaborative working with people affected by cancer and educationalists has allowed the patient and carer experience to be placed at the centre of the undergraduate cancer education. Relevance to clinical practice This research reveals the potential importance of the coproduction of undergraduate nurse cancer education, if nurses are to understand and improve the experience of people living with cancer and beyond. [ABSTRACT FROM AUTHOR]

Aims and objectives To provide an insight into the views of healthcare professionals on the presence of family members during brainstem death testing. Background Brainstem death presents families with a paradoxical death that can be difficult to define. International research suggests families should be given the choice to be present at brainstem death testing, yet it appears few units offer families the choice to be present and little attention has been paid to developing practice to enable effective facilitation of choice. Design A qualitative, exploratory design was adopted to understand the perceptions of healthcare professionals. Individual semi-structured interviews were audio-taped and carried out over two months. Methods A purposive sample of 10 nurses and 10 doctors from two tertiary intensive care units in the United Kingdom was interviewed, and transcripts were analysed using content analysis to identify emergent categories and themes. Results Healthcare professionals indicated different perceptions of death in the context of catastrophic brainstem injury. The majority of participants favoured offering families the choice to be present while acknowledging the influence of organisational culture. Identified benefits included acceptance, closure and better understanding. Suggested challenges involved the assumption of trauma or disruption and sense of obligation for families to accept if choice was offered. Key issues involved improving knowledge and communication skills to individually tailor support for families involved. Conclusions If families are to be offered the choice of witnessing brainstem death testing, considering that needs and conventions will differ according to global cultural backgrounds, then key needs must be met to ensure that effective care and support is provided to families and clinicians. Relevance to clinical practice A proactive approach to facilitating family choice to be present at testing requires the development of guidelines that accommodate cultural and professional variations to provide excellence in end-of-life care. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the differing perspectives of patients and providers and their assessment of supportive care needs in breast cancer patients receiving oral chemotherapy. Background The patient-provider concordance in patients' needs assessment is critical to the effective management of cancer. Self-administered oral chemotherapy greatly shifts responsibilities for side-effect monitoring, symptom management and dose adjustments from the provider to the patient. Home-based care plans will be central to the effective management of these patients. Design A descriptive qualitative design was used. Methods A purposive sample of nine breast cancer patients, four oncologists and four oncology nurses were recruited in Shanghai, China. Semi-structured and in-depth interviews were conducted to collect data. A qualitative content analysis aimed at finding manifest and latent meanings of data was applied to analyse the information. Results Four themes of needs emerged from the interviews with patients and providers: information/knowledge, communication, social support and symptom management, but patients and providers only agreed on the assessment of symptom and side-effects management needs. Patients want more positive encouraging information from providers, but providers think patients need more information of efficacy and safety. Patients appreciate support from other peer patients with similar experiences, but providers think the support from families and friends are readily available to them. Patients discussed their spiritual needs, while oncologists see the need to improve patient adherence to medication. Conclusion Breast cancer patients differed from their providers in assessment of healthcare needs. Further investigation of the relationships between patient-provider discordance and patient outcomes may guide interventions to improve care for cancer patients receiving oral chemotherapy. Relevance to clinical practice Oncology nurses should develop a holistic home-based care plan by exploring and integrating the discordance of needs assessment of both patients and health providers. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate healthcare staff's views and experiences of caring for older hospitalised adults (aged 60+) with osteoporosis focusing on moving and handling. Specific objectives were to explore the composition of manual handling risk assessments and interventions in osteoporosis. Background Osteoporosis is a skeletal disease that reduces bone density and causes increased fracture risk. Incidence rises with age and osteoporotic fractures cause increased morbidity and mortality. It is a major global health problem. In the UK older hospitalised adults are normally screened for falls risk but not necessarily for osteoporosis. As presentation of osteoporosis is normally silent until fractures are evident, it is frequently undiagnosed. Healthcare staff's knowledge of osteoporosis is often suboptimal and specific manual handling implications are under-researched. Design An exploratory qualitative content analysis research design informed by critical realism. Methods The purposive sample comprised 26 nursing and allied health professionals. Semi-structured interviews addressed topics including knowledge of osteoporosis, implications for acute care, moving and handling and clinical guidelines. Qualitative content data analysis was used. Results Awareness of osteoporosis prevalence in older populations varies and implications for nursing are indistinct to nonspecialists. In-hospital fractures potentially linked to suboptimal moving and handling seemed rare, but prospective studies are needed. Categories of 'Understanding moving and handling as routine care or as a healthcare intervention', with further categories 'healthcare practitioners' capacities and capabilities for dealing with people with osteoporosis' and 'the structural and organisational context for moving and handling' are reported alongside safety, frailty and dependency dimensions. Conclusions This study informs moving and handling in higher risk groups such as osteoporosis. Clinical knowledge/expertise is required when adapting generic manual handling guidelines to specific patients/contexts. Patients' experiences of moving and handling have received limited attention. Relevance to clinical practice Increased focus on musculoskeletal conditions and moving and handling implications is required. [ABSTRACT FROM AUTHOR]

The aim of this study was to elicit patient safety experts' views of patient participation in promoting patient safety. Data were collected between September and December in 2014 via an electronic semi-structured questionnaire and interviews with Finnish patient safety experts ( n = 21), then analysed using inductive content analysis. Patient safety experts regarded patients as having a crucial role in promoting patient safety. They generally deemed the level of patient safety as 'acceptable' in their organizations, but reported that patient participation in their own safety varied, and did not always meet national standards. Management of patient safety incidents differed between organizations. Experts also suggested that patient safety training should be increased in both basic and continuing education programmes for healthcare professionals. Patient participation in patient safety is still lacking in clinical practice and systematic actions are needed to create a safety culture in which patients are seen as equal partners in the promotion of high-quality and safe care. [ABSTRACT FROM AUTHOR]

Aims and objectives In this study, the aim was to understand health care personnel's expectations and experiences of participating in an intervention aimed at the implementation of three assessment scales for fall injuries, malnutrition and pressure ulcers, and the performance of preventive measures in these areas over the period of 18 months. Background Fall injuries, malnutrition and pressure ulcers among older people are challenging issues for caregivers at different levels in the health care system. Design A descriptive design with a qualitative approach was used to follow health care personnel before, during and after implementation of a care prevention intervention. Methods Twelve health care personnel with different professions at the hospital, primary care and municipal care levels participated in a preventive care introduction. Seminars were held at four occasions, with assignments to be completed between seminars. Lectures and group discussions were performed, and three risk assessment scales were introduced. The participants were interviewed before, during and after the introduction. Manifest and latent content analysis were used. Results The main results are presented in the theme 'Patient needs are visualised through a gradually developed shared understanding' and in five categories. The work approach of performing three risk assessments simultaneously was perceived as positive and central to ensuring quality of care; it was not, however, perceived as unproblematic. Conclusion The participants as well as health care team members showed a positive attitude towards and described the advantages of being given opportunities for shared understanding to improve patient safety and to provide structure for the provision of good care. Relevance to clinical practice The managerial approach of listening to and acting on issues stressed by health care personnel is important to ensure ongoing and future improvement initiatives. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine carers' views on patient self-care in chronic heart failure (CHF). Background. Self-care, a key strategy in the long-term management of CHF, can be complex and difficult to master. Carers play a key role in supporting patients in self-care, yet their views on it are rarely sought. Design. A qualitative approach was adopted with a purposeful sample of carers of patients with CHF residing in Australia. Methods. Carers who identified themselves as providing informal care to a person diagnosed with chronic heart failure were interviewed about their views on patient self-care. Data were collected by face-to-face interviews with a semi-structured interview guide. Qualitative content analysis of the interviews was undertaken by two nurses and one psychologist. Results. Four key themes were identified pertaining to CHF patient self-care: hindrance to engagement; roles and relationships; social support and community engagement and competency. Most carers viewed patients' fatigue and inactivity, mood and coping, and memory loss as major challenges to engagement in self-care. They viewed emotional support and encouragement, independence and organised routines as important aspects of their relationship with the patient and as facilitators of self-care, but also required for themselves support from their families, communities and healthcare professionals. They also viewed patient and carer experience and knowledge as being essential to successful self-care. Conclusion. Carers viewed self-care as an important issue for patients with CHF and indicated that they could play an enhanced role with the provision of better support and knowledge from their families, communities and health care professionals. Relevance to clinical practice. Carers are closely involved in supporting patients in CHF self-care, even though their views are rarely considered in the organisation and delivery of heart failure management programmes. Therefore, their important contribution should be acknowledged and supported in contemporary heart failure health services. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore women's perspectives on deciding to undergo hysterectomy for benign conditions based on physicians' recommendations and the women's own judgement. Background Hysterectomy is the second most common surgical procedure worldwide. Although most hysterectomies are elective, physicians may recommend treatment that involves a loss of sexuality or ovary removal, creating a difficult choice for women. Design Qualitative, in-depth interview Methods A purposive sample of 17 women was recruited. The women had decided to undergo hysterectomy after the diagnosis of uterine fibroids. All these women had already decided not to have more children. Data were collected by in-depth interviewing, and content analysis was used to analyse the data. Results Our study revealed five themes: release from stress, inescapable fate, positive support, hoping for peace of mind and sense of trust. Conclusions The participants felt that mental and physical health were the most important considerations, noting that when women no longer want children, a uterus is useless. The women believed that they retained their womanhood, even without a uterus, and were satisfied with the outcomes of their hysterectomy decisions. Relevance to clinical practice Our findings might serve as educational and counselling reference materials for healthcare providers, ensuring that women receive appropriate care quality and have their needs met. Healthcare providers can then maximise women's empowerment, deepen their awareness of body image and their concept of self-care and help them to clearly perceive their own concerns and needs so that they can make suitable decisions. [ABSTRACT FROM AUTHOR]

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

Aim. To explore the experiences of patients with coronary heart disease in China. Background. The morbidity and mortality rates of people with coronary heart disease have been growing rapidly in the past decades in China, yet little is known about the experiences of Chinese patients with the disease. Design. A qualitative descriptive study. Methods. Face-to-face semi-structured interviews were employed in this study. Using a purposive sample, 11 participants who had been diagnosed with coronary heart disease for at least one month were recruited. A content analysis was used to identify themes. Results. Three themes were identified from the data: experiencing a life-threatening illness, strategies for adapting to living with coronary heart disease and help-seeking behaviour. Conclusion. Chinese patients with coronary heart disease experienced the disease as a life-threatening illness related to chest pain. Chinese culture, values and beliefs influenced their adaptation strategies and help-seeking behaviour. Their misconceptions about coronary heart disease and the information needs for lifestyle changes were evident in this study. This study highlights the need for health education to support coronary heart disease patients in China. Relevance to clinical practice. The findings provide useful information for Chinese health professionals to develop interventions for Chinese patients with coronary heart disease. [ABSTRACT FROM AUTHOR]

Aims and objectives. To establish adolescents' beliefs regarding the need for structured diabetes education and their views on how such a programme should be organised and what topics need to be addressed. Background. Structured diabetes education programmes have become common place in diabetes care in recent years. Despite the use of these programmes in adult patients, to date, there exists no tried or tested programme for adolescents. Prior to the development of programmes for this age group, there is a need to establish their views on programme content, delivery mechanisms and how best to introduce structured education in this population. Design. An exploratory qualitative study. Methods. Five focus group interviews were undertaken across three acute Hospital Trusts in Northern Ireland. A total of 21 adolescents between 13-19 years were interviewed. Data were analysed by means of a thematic content analysis framework. Results. All participants expressed a need for a structured education programme specifically tailored to their needs. The complexity of existing diabetes regimens brought with it feelings of frustration and guilt for the majority of adolescents. Many felt isolated and alone. Dietary management and insulin adjustment were seen as very complex. Conclusion. Participants favoured a structured diabetes education programme that was short in duration, practical in nature, positive in outlook and relevant to daily life. Relevance to clinical practice. Programmes should address the specific needs of adolescents, be delivered in a practical manner and be realistic for everyday use. [ABSTRACT FROM AUTHOR]

baker j. (2011) Multi-disciplinary perceptions of patient group directions as a replacement for the pro re nata prescribing of antipsychotic medications in acute mental health settings. Journal of Advanced Nursing 67(9), 2191-2199. Abstract Background. Patient group directions have been used in the NHS for 10 years. Despite high levels of reported use, few studies have examined staff perceptions or evaluated them in practice. In mental health services, pro re nata prescriptions continue to contribute to high doses and polypharmacy of antipsychotics. Replacing pro re nata with patient group directions might improve the quality and safety of care associated with this practice. Aims. This study aimed to explore the acceptability of patient group directions in acute mental health services. Method. Qualitative methods were used. Data were analysed using thematic content analysis. Twenty-six members of the multi-disciplinary team (doctors, nurses and pharmacists) participated in either focus groups or individual interviews in 2009. Results. A broad range of benefits were suggested, including improved safety and access to treatments, and the professional development of nurses. However, concerns also emerged about the need for a culture shift in thinking, and the danger of multiple systems for the supply of medicines. Conclusion. Despite the widespread use of patient group directions in clinical settings in the last 10 years, limited research has examined their development and potential. Patient group directions can potentially give a rigorous means of supplying or administering medicines. However, their development requires careful consideration. [ABSTRACT FROM AUTHOR]

sitvast j.e., abma t.a. & widdershoven g.a.m. (2011) Living with severe mental illness: perception of sickness. Journal of Advanced Nursing 67(9), 2170-2179. Abstract Aim. This article is a report of a study on how participation in photo groups influenced the perception of the impact of sickness on daily life. Background. Living with severe mental illness can have a strong impact on daily life and the experience of self. In combination with self-stigmatization, this can lead to a sense of being no more than a patient. Method. A mixed-methods design was used to measure the perception of sickness impact. Consumers of psychiatric services participated in photography groups that aimed at integration of illness and developing new goals in life. These groups were conducted by nurses and data were collected between the years 2005 and 2009. The Sickness Impact Profile (SIP) questionnaires were completed by the respondents before and after intervention. The SIP was used to differentiate between respondents who perceived less impact of illness on their daily lives after following a photogroup and those who did not perceive so or remained the same. A sample of these three groups was used to complement the quantitative findings with in-depth interviews with consumers and mentor nurses. Results. Findings indicated absence of important changes in the sickness impact scores except in the domain of mobility. Consumers did, however, show signs of progress in terms of increasing openness, understanding of their feelings and situation and abilities to cope with them. Conclusion. Participating in photo groups can help patients get along with their life and make it more bearable. No signs of demoralization and self-stigmatization were found. [ABSTRACT FROM AUTHOR]

The article examines a study on the stress experienced by a primary family caregiver of a living-related liver transplant patient after the operation. Such study revealed that the stress of primary caregivers is relevant to the gap between expectations and primary care-giving experiences. The study identified various factors that cause caregiver stress including unstable sentiment on liver transplantation, distance from the healthcare professional, and concern on the protector role function.

Farahani MA, Sahragard R, Carroll JK, Mohammadi E. International Journal of Nursing Practice 2011; : 322-328 Growing evidence in a variety of health-care settings supports the need to strengthen nurse-physician communication and interprofessional collaboration to optimize patient-health outcomes. The objective of this study is to explore communication barriers from the perspective of nurses themselves, as well as physicians, patients and families in a hospital-based cardiac care setting. Qualitative analysis of individual interviews with 35 participants was taken in two hospitals in Tehran, Iran. Interview questions asked about experiences with patient education and communication barriers among physicians, nurses and patients. The three major themes identified were: (i) lack of collegiality and communication between nurses and physicians; (ii) problematic communication between the health-care team, patients and their families; and (iii) cultural challenges. Findings from this study support the need for health-care organizations to be more collaborative and inclusive of nursing professionals. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore dignity in care from patients' perspectives in Taiwan. Dignity is a core element of nursing care. In nurses' clinical practice, maintaining the dignity of patients is an important issue because a lack of dignity in care can affect the health and recovery of patients. In Western countries, patient dignity has been well researched, but only one study has examined this topic in an Asian country. Descriptive qualitative methods were used in this study. Interviews were conducted with 40 patients purposively sampled at a teaching hospital in eastern Taiwan from May-August 2009. Audiotaped interviews were transcribed verbatim, and data in transcripts were coded and analysed by content analysis. The major findings revealed that many hospitalised patients were satisfied with the maintenance of their dignity. Six themes that contribute to the preservation of their dignity were identified: sense of control and autonomy, being respected as a person, avoidance of body exposure, caring from the nursing staff, confidentiality of disease information and prompt response to needs. The findings can help nurses better understand dignity in care because it is described from the patient viewpoint. By identifying the most important factors from patients' perspectives that contribute to dignity, nursing interventions in clinical practice can be further developed and improved. [ABSTRACT FROM AUTHOR]