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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 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 on the subject?: We know that there are similar rates of borderline personality disorder (BPD) diagnosed in both men and women; however, some research suggests that BPD is diagnosed later and less frequently in men. Some research suggests that males diagnosed with BPD present differently to women, but not much is known about how this influences the care men receive in inpatient mental health hospitals. What the paper adds to existing knowledge?: This paper is the first to specifically ask inpatient staff about men diagnosed with BPD, and to hear about their perceptions and experiences.It identified that some staff do not feel as knowledgeable in identifying and treating BPD in men compared to women. Some staff talked about how emotional difficulties like BPD are often not the first thought when men present with distress compared to women. Staff also talked about needing a safe, open and transparent working culture to be able to ask questions and to be questioned on their own assumptions, biases or lack of training. What are the implications for practice?: This paper suggests that inpatient staff may hold some assumptions about men and their emotions, such as assuming that they are less likely to struggle with emotional difficulties like BPD. Staff anxieties about risk management may influence how they perceive and care for men in inpatient wards. The findings suggest that male‐specific training in identifying and treating BPD should be provided for staff on inpatient wards, to improve knowledge and confidence. Introduction: Research highlights discrepancies in recognition of borderline personality disorder (BPD) in men, despite similar rates of prevalence across genders. Aim: To investigate inpatient mental health professionals' experiences of delivering treatment for males with a diagnosis of BPD. Method: Six mental health professionals working within adult acute inpatient wards completed a semi‐structured interview. All participants were members of the nursing team. Thematic analysis was used to analyse the data. Results: Five themes were identified: Gender Differences, Stereotyping, Facilitators to Care Delivery, Barriers to Care Delivery and Ways to Improve Care. Participants talked of a lack of awareness and understanding of BPD in males impacting both diagnosis and treatment in an acute inpatient setting. Discussion: There may be factors ranging from gender stereotypes, limited knowledge and understanding of gender differences in presentations, and personal/organisational cultures influencing the formulation and treatment of males with a diagnosis of BPD in inpatient settings. Implications for Practice: The findings suggest that gender stereotypes such as masculine norms may influence how male patients' emotional difficulties are understood and managed, and that additional training in male‐specific issues to improve knowledge and care provision. This research will support inpatient staff, service leads and clinical educators to identify ways to adapt care provision for men. [ABSTRACT FROM AUTHOR]

Aim: Studies of the effects of COVID‐19, especially post‐acute COVID‐19 syndrome, on psychological health in non‐severe cases are limited. We aimed to evaluate the prevalence and associated risk factors of psychological symptoms, and quality‐of‐life in three groups of outpatients, hospitalized and intensive care patients. Methods: A total 276 patients, previously confirmed with SARS‐CoV‐2 infection, attending the COVID‐19 follow‐up outpatient clinic from December 2020 to July 2021 were interviewed face‐to‐face. In this cross‐sectional, retrospective study, all participants were asked our self‐designed demographic and screening questions to assess their psychological symptoms and administered the WHQOOL‐BREF survey to evaluate quality of life. Results: In screening questions, major depressive disorder symptoms were detected at a rate of 20.3%, generalized anxiety disorder symptoms at a rate of 16.7%, panic attack symptoms at a rate of 10.9%, post‐traumatic stress disorder symptoms at a rate of 28.6% and obsessive‐compulsive disorder symptoms at a rate of 18.1%. The outpatient group with COVID‐19 infection had a higher risk of developing psychological symptoms and decreased quality of life. Conclusion: COVID‐19 infection was found to have a considerable psychological impact on those treated as outpatients despite the less severe course of their illness. Summary statement: What is already known about this topic? Post‐intensive care syndrome affects physical, cognitive and psychological health.It is associated with symptoms such as generalized weakness, memory disturbances, cognitive function impairment, depression, anxiety and post‐traumatic stress disorder.Some physical and psychological symptoms persist for over 12 weeks in some patients and have been classified as 'Post‐acute COVID‐19 Condition or Syndrome' (PCS). What this paper adds? At the post‐acute‐COVID‐19 period, a considerable number of outpatients with COVID‐19 infection were at higher risk for psychological distress symptoms than those who had been treated in the hospital or intensive care unit.Depression, anxiety, panic disorder and PTSD symptoms were found to be higher in outpatients and those with these symptoms were also shown to have a lower quality of life.Our findings highlight the significant psychological impact of COVID‐19 on patients, even after their reported recovery from the acute manifestations of this disease. The implications of this paper: Ongoing psychological symptoms in the post‐COVID period are not associated with the severity of the disease in the acute phase.It is important that healthcare professionals are equally concerned not only with physical condition of post‐COVID‐19 patients but also with their psychological state and the patient's psychology‐related quality of life. [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: To explore how nurses working in general practice experienced remote and technology-mediated working during the COVID-19 pandemic. Design: Exploratory qualitative study with nursing team members working in general practices in England and national nurse leaders. Methods: Data were collected between April and August 2022. Forty participants took part in either semi-structured interviews or focus groups. Data were analysed using Framework Analysis informed by the PERCS (Planning and Evaluating Remote Consultation Services) Framework. University of York ethics approval [HSRGC/2021/458/I] and Health Research Authority approval were obtained [IRAS:30353. Protocol number: R23982. Ref 21/HRA/5132. CPMS: 51834]. The study was funded by The General Nursing Council for England and Wales Trust. Results: Participants continued to deliver a significant proportion of patient care inperson. However, remote and technology-mediated care could meet patients' needs and broaden access in some circumstances. When remote and technology-mediated working were used this was often part of a blended model which was expected to continue. This could support some workforce issues, but also increase workload. Participants did not always have access to remote technology and were not involved in decision-making about what was used and how this was implemented. They rarely used video consultations, which were not seen to add value in comparison to telephone consultations. Some participants expressed concern that care had become more transactional than therapeutic and there were potential safety risks. Conclusion: The study explored how nurses working in general practice during the COVID-19 pandemic engaged with remote and technology-mediated working. It identifies specific issues of access to technology, workload, hybrid working, disruption to therapeutic relationships, safety risks and lack of involvement in decision-making. Changes were implemented quickly with little strategic input from nurses. There is now an opportunity to reflect and build on what has been learned in relation to remote and technology-mediated working to ensure the future development of safe and effective nursing care in general practice. Impact: The paper contributes to understanding of remote and technology-mediated working by nurses working in general practice during the COVID-19 pandemic and indicates to employers and policy makers how this can be supported moving forward. Reporting method: Standards for Reporting Qualitative Research (O'Brien et al., 2014). Patient or public contribution: This was a workforce study so there was no patient or public contribution. Implications for the profession and patient care: The paper highlights specific issues which have implications for the development of remote, technology-mediated and blended working for nurses in general practice, care quality and patient safety. These require full attention to ensure the future development of safe and effective nursing care in general practice moving forward. [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]

Aim: This study aimed to investigate the impact of bronchial asthma‐related factors on the emotional well‐being of adolescents with bronchial asthma and their primary caregivers. Background: Bronchial asthma is a common chronic disease in childhood and adolescence that can have a psychological impact on both patients and their primary caregivers. Methods: The study used a cross‐sectional design and included 150 patient–caregiver dyads diagnosed with bronchial asthma, aged between 12 and 16 years and collected between 2018 and 2020. It assessed the emotional adjustment of both patients and caregivers and recorded variables related to the disease. Qualitative and quantitative analyses were conducted to perform statistical analyses. Results: Caregivers had higher anxiety and depression scores than patients. Good adherence to treatment was necessary for the emotional adjustment of the dyad. Controlled asthma, good adherence to treatment and a reduction in medical treatment were the primary predictors of emotional adjustment. Conclusions: The study highlights the importance of assessing anxiety and depression levels in both patients and caregivers because the presence of these symptoms can lead to the misuse of medication, inadequate inhalation techniques, the omission of medication and reduced confidence in controlling asthma symptoms. Summary statement: What is already known about this topic? Certain variables related to asthma, such as its degree of control, severity, duration of diagnosis and adherence, have been linked to adjustment to the disease by the adolescent–caregiver dyad. What this paper adds? Caregivers had higher anxiety and depression scores than patients.Good adherence to treatment was necessary for the emotional adjustment of the dyad.Controlled asthma, good adherence to treatment and a reduction in medical treatment were the primary predictors of emotional adjustment. The implications of this paper: The study evaluated the variables in combination to identify risk and healthier profiles in the dyad's emotional adjustment and identified variables related to the disease most associated with emotional adjustment to the disease in the dyad.Identifying the risk and health profiles in emotional adjustment in both the adolescent and his or her caregiver may be used to mitigate future consequences related to poor adjustment to asthma.Knowledge of these variables allows health professionals to design psychoeducational programmes to ensure better adaptation to the disease. [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]

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 highlight the value of utilizing the Listening Guide methodology for nursing research and provide an exemplar applying this methodology to explore a novel concept in an underrepresented group—inner strength in persons newly diagnosed with mild cognitive impairment along with their care partners. Design: Methodology discussion paper. Methods: The exemplar study used the Listening Guide methods for data elicitation and analysis. Methods included adaptations for the study population and novice qualitative researchers. Results: The Listening Guide methodology with adaptations enabled the research team to centre the voices of persons living with mild cognitive impairment, highlight an abstract phenomenon and attend to the influences of the sociopolitical context. Further, this methodology helped address common challenges emerging qualitative researchers encounter, including understanding methods of application, engaging reflexively and immersing in the data. Conclusion: The Listening Guide is a voice‐centred qualitative methodology that is well suited to foreground the experiences of groups underrepresented in research and explore emerging phenomena. Implications for Nursing: Nurses are central to striving for health equity. The Listening Guide methodology offers a valuable and accessible research tool to understand the experiences and needs of underrepresented groups and shape healthcare in response. Impact: The Listening Guide methodology can be broadly applied to research with persons with mild cognitive impairment, and other underrepresented groups, to explore other phenomena beyond inner strength and move the science forward in representing the perspectives of groups underrepresented by research. Patient or Public Contribution: Persons living with cognitive impairment and their care partners participated in study conceptualization, interview guide development, methods development and dissemination plans. [ABSTRACT FROM AUTHOR]

Aim: To describe the application of selected creative and participatory research methods in nursing science. Design: Research methodology paper. Methods: Researcher‐initiated role play, stimulated recall interviews, the Storycrafting method, painting and drawing. Altogether, 11 children (5–7 years old) and 12 parents participated in the research. Results: Each small group (n = 3) acted differently during the data collection. Not every child wanted to play, draw or tell stories, but they all expressed their views through some method. Although the same themes emerged from children's narratives, they could not have been verified by just one method. Conclusions: Using creative and participatory methods and the principles of studies of child perspectives are applicable ways of conducting research in nursing science. Children must be treated as individuals during the research process, and they must have opportunities to use several communication methods to express their views. Implications for the profession and patient care: Understanding different ways to interact with children and hear children's views will help nurses to encounter children. Impact: In this article, we present a valid way of conducting research with children. By following our protocol, nursing research from a child perspective can be implemented. Reporting Method: Consolidated criteria for reporting qualitative research (COREQ). Patient Contribution: The child participants were involved in choosing physical places for data collection and the usage and order of the selected methods. Both the children and the adult participants took part in interpreting the research data. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Major depressive disorder is the most prevalent of all mental illnesses.10%–20% of patients with depression and 1% of the population overall have treatment‐resistant depression (TRD).DBS is an emerging investigational treatment for TRD with documented clinical efficacy and safety.The framework of the recovery model includes both clinical and personal recovery. Personal recovery is a self‐process in which hope, empowerment and optimism are embraced to overcome the impact of mental illness on one's sense of self.Although clinical and functional outcomes of DBS for TRD have been well documented in the previous studies, personal recovery as an outcome has been explored only in a handful of studies. What this paper adds to existing knowledge?: This is the first qualitative study exploring personal recovery from DBS treatment specific to the target of subcallosal cingulate cortex in patients with TRD. Since the existing literature on personal recovery in DBS studies is limited, the contribution of this paper is crucial to this field.For individuals who responded to deep brain stimulation clinically, neither participants nor family believed it cured their depression, but rather there was a significant decrease in the severity of symptoms of depression. A holistic‐oriented framework (that includes personal recovery) is significant for those individuals with TRD undergoing DBS. Personal and clinical recovery are two different constructs, and individuals may experience one or the other or both.The experience of participants who responded to deep brain stimulation recognized that the recovery from depression is a process of reconstructing self. This process involved a period of adjustment that evoked a deeper self‐awareness, re‐engagement with daily living and newfound gratitude in living. Individuals transitioned from an emotionally driven life to one where future goals were considered. Supportive relationships were instrumental in this process. What are the implications for practice?: A deep brain stimulation intervention for treatment‐resistant depression offered individuals an opportunity for personal recovery where a reconstruction of self occurred.Personal recovery can be considered as an outcome in conjunction with clinical and functional outcomes in future DBS trials for TRD. The relevance of personal recovery in the prevention of relapses needs further investigation.To advocate for care and services that facilitate the process of recovery from depression, it is important to understand the personal dimensions and experience of recovery that may influence the process.To develop recovery‐oriented interventions to help patients and families in recovery post‐deep brain stimulation, further understanding of support and negotiating relationships during this life‐altering experience is needed. Introduction: Multiple trials of antidepressant treatments in patients with depression pose a major challenge to the mental health system. Deep brain stimulation (DBS) is an emerging and promising investigational treatment to reduce depressive symptoms in individuals with treatment‐resistant depression (TRD). The clinical and functional outcomes of DBS for TRD have been well documented in previous studies; however, studies of personal recovery as an outcome of DBS specific to the target of subcallosal cingulate cortex in patients with TRD are limited. Aim: To explore the processes of personal recovery in patients with treatment‐resistant depression following subcallosal cingulate‐deep brain stimulation. Method: Participants were 18 patients with TRD who participated in the subcallosal cingulate (SCC)‐DBS trial and 11 family members. They also participated in add‐on individual cognitive behavioural therapy during the trial. A qualitative constructivist grounded theory approach was used to conceptualize the personal recovery process of patients and families. Results: While every participant and their families' journey were unique following the deep brain stimulation intervention, a theoretical model of Balancing to Establish a Reconstructed Self emerged from the data. The themes underlying the model were (1) Balancing to Establish a Reconstructed Self: A Whole‐Body Experience, (2) The Liminal Space in‐between: Balancing with Cautious Optimism, (3) Hope: Transitioning from Emotion‐Focussed Living to Goal‐Oriented Planning and (4) Support: Negotiating Relationships. Discussion: This is the first study examining recovery from patients' perspectives as an outcome of SCC‐DBS intervention for TRD. The study shows that personal recovery is a gradual and continual process of reconstruction of the self, developing through supportive relationships. Clinical and personal recovery are two distinct constructs, and individuals may experience one or the other or both. Most patients who do respond clinically experience improvement in terms of having optimism and hope. Some patients, however, respond with significant symptom reduction but are not able to achieve personal recovery to experience joy or hope for improved quality of living. Implications for Practice: Strategies for personal recovery for both patients and family need to be considered during and post deep brain stimulation intervention. Nurses working with these patients and families may benefit from education, training and support to assess and engage in conversations about their recovery process. [ABSTRACT FROM AUTHOR]

Aim: This study's aim is to develop and psychometrically assess the Sickness Presenteeism Scale‐Nurse. Background: Evaluation of the effects of sickness presenteeism on nurses' performance and productivity is important for healthcare quality. Design: This was an instrument development and validation study. Methods: Scale items were created based on literature review and qualitative research. Data were collected from 619 nurses between October and December 2021. The factor structure of the scale was determined by explanatory and confirmatory factor analysis performed with different sample groups. Convergent and discriminant validity were investigated, and reliability was evaluated with Cronbach's α values, adjusted item‐total correlation, composite‐reliability and split‐half reliability. Results: Explanatory factor analysis showed that Sickness Presenteeism Scale‐Nurse consisted of four sub‐dimensions and 21 items and explained 57.9% of the total variance. This factor structure was confirmed by confirmatory factor analysis. The convergent and discriminant validity was confirmed. The total Cronbach's α value of the scale was calculated as 0.928, with Cronbach's α values of the sub‐dimensions calculated as 0.815–0.903; composite reliability values were calculated as 0.804–0.903. Conclusions: The Sickness Presenteeism Scale‐Nurse is a valid and reliable measurement instrument that can be used to evaluate the effect of nurses' sickness presenteeism behaviour on job performance. Summary statement: What is already known about this topic? Presenteeism can reduce work performance and productivity.Nursing is one of the occupations where presenteeism is commonly reported, but there is no scale to measure the effect of presenteeism on nurses' work performanceWhat this paper adds? In this study, the Sickness Presenteeism Scale‐Nurse, an instrument that can be used to evaluate the effects of sickness presenteeism on nurses' work performance, was developed.The Sickness Presenteeism Scale‐Nurse consists of four dimensions: general performance, patient safety, relationships within the team and emotion.This study provides evidence of the validity and reliability of the Sickness Presenteeism Scale‐Nurse.The implications of this paper: Effects of presenteeism on the performance and productivity of nurses can be evaluated by using Sickness Presenteeism Scale‐Nurse to provide information to guide policy makers in determining interventions to promote work performance and productivity. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) has adversely affected intensive care nurses; for instance, they have fought against an unknown disease, and their workload has increased. In addition, the COVID‐19 pandemic has led intensive care nurses to work in new settings and with new teams. Objective: The aim of this study was to explore and describe the caregiving experiences of nurses who were working in a new COVID‐19 intensive care unit in Turkey and providing care for patients infected with SARS‐CoV‐2. Method: In this descriptive qualitative study, semi‐structured interviews were held from 22 July to 31 August 2020 and were recorded and analysed based on thematic analysis. The researchers followed the COREQ checklist in reporting the study. Findings: From interviews held with 11 nurses, four main themes (uncertainty and challenges in the 'danger zone', emotional and psychosocial changes, professional effects of the pandemic and being ready for a future pandemic) were derived from 11 sub‐themes. Conclusions: The new setting and the ever‐changing team make caring for the COVID‐19 patient even more difficult. A good organization, an experienced permanent team, a known setting and good working conditions are essential to be prepared for possible pandemics in the future. Summary statement: What is already known about this topic? Pandemics are emergencies that can lead the health system to collapse.Patient care quality is associated with nurses' knowledge and experience.The COVID‐19 pandemic has led intensive care nurses to work in new settings and with new teams. What this paper adds? Nurses described challenges such as the fear, stress and stigma they experienced in the ICU during the first wave of the pandemic, which negatively affected patient care.The new setting and the ever‐changing team make caring for the COVID‐19 patient even more difficult. The implications of this paper: A good organization and an experienced permanent team should be established in order to ensure patient safety and high‐quality care in ICU settings for COVID‐19 patients.Working conditions of nurses should be improved without changing their setting during the pandemic. [ABSTRACT FROM AUTHOR]

Accessible summary: What Is Known on the Subject?: Service user involvement in mental health nursing education is beneficial in terms of attitudinal change to reduce stigma, clinical skill development and enhancing understandings of recovery‐oriented practice.Service users as experts by experience have not been embedded within pre‐registration nursing programs. Consequently, they remain limited in number, ad hoc and frequently tokenistic.Nurse academics responsible for the design and delivery of pre‐registration mental health nursing curricula have a potentially important role in facilitating expert by experience involvement in mental health nursing education. What this Paper Adds to Existing Knowledge: Nurse academics teaching mental health nursing have generally favourable views about the importance of expert by experience involvement.Nurse academics experience significant barriers in supporting the implementation of academic positions for experts by experience, particularly in obtaining funding.The experts by experience could contribute to mental health nursing education does not appear to be clearly understood by nurse academics. What Are the Implications for Practice?: Mental health services aspire to adopt a recovery‐oriented approach to practice. Involving experts by experience in mental health nursing education can facilitate increased understanding and appreciation of recovery‐oriented practice.Nurse academics could play an important role in supporting the implementation of experts by experience positions in nursing academia. To do so, they require an understanding of the benefits of EBE involvement in academia and the barriers that can be encountered when attempting to facilitate the implementation of such positions.Experts by experience contribute unique expertise, essential to the development of quality mental health services. Conveying this expertise through the educating the future nursing workforce in mental health is essential. Introduction: Involving service users in mental health nursing education is ad hoc and minimal, despite growing evidence of its benefits. Insights and experiences of nurse academics teaching mental health to pre‐registration students have been underrepresented in the research to date. Aim: To seek insights and experiences of nurse academics involved in designing and delivering pre‐registration mental health nursing education in Australian universities regarding involving service users in mental health nursing education. Methods: A descriptive qualitative study involving 19 nurse academics from 13 Australian universities, involved in pre‐registration mental health nursing education. Data were analysed thematically. Results: Participants reported minimal service user involvement. Most sought an increase and identified barriers. Data analysis resulted in five identified themes: (1) value‐rich, (2) resource‐poor, (3) imperfect processes, (4) 'part, but not all' and (5) unrecognised worth. Conclusions: Increasing meaningful involvement of service‐users in mental health nursing education requires support and investment from multiple stakeholders. Nurse academics are crucial stakeholders in understanding the unique expertise service users bring. Implications for Practice: Service users being central to all aspects of mental health services requires their active participation in the education of health professionals. Nurse academics have an important role in realising this goal. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Quitlines are known to be effective in helping people quit smoking, including those with mental health conditions. It is particularly important to address smoking in this population as the prevalence of smoking ranges from 40% to 75%. However, professionals working in quitlines often face barriers due to their limited training and resources to effectively support these smokers quit, especially if they are not mental health professionals. Therefore, training programmes should be developed to enhance their knowledge and skills in providing smoking cessation support to this vulnerable population. What the paper adds to existing knowledge?: The '061 QUIT‐MENTAL study' evaluated the efficacy of a proactive telephone‐based intervention for smoking cessation among smokers with severe mental health disorders. Conducted through a quitline service in Catalonia, Spain, the study focused on training non‐mental health specialized nurses and other health professionals to provide evidence‐based interventions for promoting smoking cessation among individuals with mental health disorders. The objective of this study is to assess the changes in nurses' knowledge and readiness to treat smokers with mental health conditions, while also capturing their insights and perceptions regarding the facilitators and barriers to providing smoking cessation interventions. The training and insights of the nurses were integral to conducting this research and providing valuable information for the future sustainability of such interventions. This is particularly important as quitlines hold the potential to offer cessation support to these patients at the community level. What are the implications for practice?: While the training programme was successful in improving non‐mental health specialized nurses' knowledge and motivation skills to help patients with mental health disorders quit smoking, they encountered obstacles in delivering this intervention over the phone. These difficulties were mainly due to challenges in reaching participants and delivering the intervention as detailed in the protocol. The study highlights the need of reducing barriers for providers in attending to these patients, particularly if they are non‐mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco‐related diseases among this population. Introduction: The viewpoint of those who implement a programme for the first time is crucial for understanding its impact and ensuring its long‐term viability. The 061 QUIT‐MENTAL study was a pragmatic randomized controlled trial evaluating a proactive telephone‐based intervention addressed to mental health patients conducted by non‐psychiatric specialized nurses. Aim: We assessed nurses' knowledge of smoking cessation interventions addressed to this population before and after receiving training and their insights after delivering the intervention. Method: Mixed methods study: (1) Pre‐post evaluation to assess self‐reported knowledge, self‐efficacy and opinions about smoking cessation. (2) In‐depth interviews with key nurses to ascertain their perceptions regarding the impact of the training received in delivering the study intervention. Results: The training enhanced nurses' knowledge of psychological and pharmacological resources to aid these patients, as well as their ability to increase their motivation to quit. However, nurses reported difficulties in delivering population‐based interventions to individuals with mental health disorders. These challenges primarily arose from participants being hard to reach, exhibiting low motivation to quit, struggling to comprehend instructions or follow recommendations, and nurses feeling unsure about their capacity to assist individuals with mental illnesses in quitting, despite the training they received. Discussion: Despite the training and protocol designed to facilitate the delivery of the intervention, nurses faced difficulties in providing population‐based interventions to individuals with mental health disorders. Implications for Practice: Future quitline programmes aimed at the population with mental health disorders should strive to reduce barriers for providers in attending to these patients, particularly if they are non‐mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco‐related diseases among this population. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Adult psychiatric services typically focus on the mental health needs of the client but they do not support his or her parenting role.Many authors highlight the importance of a non‐judgmental approach when providing support and care to clients with mental illness who are parents.Assessments frequently focus on the negative aspects while the strengths of these families were often overlooked.There is a lack of scientific literature exploring nurses' experiences when caring for parents with mental illness and their families. What this paper adds to existing knowledge: Trust is the basis that helps clients to be open to receiving care and answering parenting‐related questions. Therefore, without adequate professional‐client trust, some care and interventions addressed to parents with mental illness could be poorly received by the client.Tronto's phases of care facilitated the collection of data and exploration of mental health nurses' experiences of care. What are the implications for practice: Mental health nurses should be aware of the potential needs of these families, as described in the scientific literature, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique.Mental health nurses must take the person's environment into account (family, social and political aspects and different forms of stigma) since all these factors may influence how parents with mental illness receive and provide care. Introduction: Many authors highlight the importance of a non‐judgmental approach when providing care to parents with mental illness. However, assessments frequently focus on the negative aspects while the strengths of such families were often overlooked. Aim: To explore the lived experiences of mental health nurses who care for clients who are parents. Method: We conducted a qualitative phenomenological study. The main data collection technique was in‐depth interviews. Data were analysed according to Colaizzi model, subsequently, the main categories that arised were compared and related to the five phases of Tronto's care. Results: The main categories identified from the analysis of the interviews were: (1) individualized care, (2) continuity of care, (3) psychoeducation and counselling, (4) trust and (5) context of the client. Discussion: Trust is the basis that helps parents with mental illness to be open to receiving care and answering parenting‐related questions. Without trust, some interventions could be poorly received by the client. Implications for Practice: Mental health nurses should be aware of the potential needs of these families, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique. [ABSTRACT FROM AUTHOR]

Accessible Summary: What Is Known on the Subject?: Dual diagnosis is one of the leading causes of disability globally.Consumers with dual diagnosis have complex needs and are at risk of relapse of their psychiatric symptoms.Mental health nurses require essential skills, including empathy, to manage consumers with dual diagnosis.No studies have explored mental health nurses' empathy towards consumers with dual diagnosis. What Does the Paper Add to Existing Knowledge?: Developing empathy towards consumers with dual diagnosis is complex.Mental health nurses' unemotional empathy experiences with consumers with dual diagnosis are related to their lack of ability to connect to their consumers' choices and feelings.Negative attitudes towards consumers with dual diagnosis contributed to nurses' poor empathy experiences.The unemotional responses of mental health nurses can be caused by factors such as novelty, insufficient information, and neutral evaluation of a consumer's situation. What Are the Implications for Practice?: The study results benefit researchers, teachers, clinicians, and administrators when designing, developing, and delivering empathy training packages for mental health nurses.Improving the empathy of mental health nurses towards consumers with dual diagnosis should be a top priority for healthcare leaders and educators.A core curriculum containing holistic awareness of the biopsychosocial components of dual diagnosis makes it easier for mental health nurses to understand and develop empathy towards consumers with dual diagnosis.Future studies must address the relationship between attitude, stress, burnout, compassion fatigue and empathy among mental health nurses in relation to consumers with dual diagnosis. Introduction: There is a lack of evidence regarding mental health nurses' empathy towards consumers with dual diagnosis. Aims: This qualitative study aimed to describe mental health nurses' empathy towards consumers with dual diagnosis in Australian mental health settings. Method: Through purposeful sampling, interviews were conducted with 17 mental health nurses who have experience in caring for consumers with dual diagnosis. Thematic analysis, as an inductive approach was used, to generate codes and themes from participant data. To report on this qualitative study, we adhered to the ENTREQ guidelines. Results: Four themes emerged: challenges to develop empathy with consumers, lack of conducive attitude of nurses towards consumers, appraising consumers' emotions accurately and holistically responding to the appraised emotions. The findings indicated that developing empathy towards consumers with dual diagnosis is a complex task. Discussion: Mental health nurses may struggle to empathize with consumers when encountering confrontational situations. Interventional studies are required to address the relationship between mental health nurses' attitudes, stress, burnout, compassion fatigue and empathy in relation to consumers with dual diagnosis. Implications for Practice: Understanding why mental health nurses emotional experiences differ about a similar challenging situation experienced by their consumers is vital. Further research on strategies to address empathy issues among mental health nurses could enhance nursing practice and consumer care. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject: Treatment groups in Mental Health Service is cost‐effective, increases patients´ self‐understanding and stimulate changeResearch shows that people with mental illness have different barriers to attend group sessions which often originates from a lack of trust in other people, but it is known that the possibility to build gradual trust among the participants encourages attendance. What the paper adds to existing knowledge: This study is based on the experience from outpatients and illuminates how discovery groups from the Tidal Model can be used as introductory sessions to build gradual trust among people with mental illness before engaging in a person‐centred group intervention.The study fills a research gap in methods to create a safe and trusting environment in treatment groups for people with mental illness working with recovery‐oriented person‐centred interventions. What are the implications for practice: This study emphasizes the importance of meeting concerns about social interactions in persons with mental illness when joining treatment groups. It presents a recovery‐oriented method which meets this requirement and is easy to implement in practice. Introduction: Recovery‐oriented interventions delivered individually or in groups are more and more common within mental health nursing. However, persons with mental illness may be cautious about engaging in groups. Therefore, it is important to provide a trusting basis in the group to allow for the best opportunities to promote engagement, attendance and impact of treatment. Aim: The aim was to explore how discovery group sessions were experienced as introductory sessions from the perspectives of participants and facilitators before engaging in a person‐centred group intervention. Method: A qualitative interview study was conducted, involving four group facilitators and 16 participants with mental illness from five completed groups. Data were analysed with Ricoeur's theory of interpretation. Results: The findings showed that the two discovery group sessions were experienced as useful and meaningful to all and created a safe atmosphere and a trusted relationship among group participants and facilitators. Discussion: Feeling safe and sharing experiences and emotions contribute to the relational climate in a group. Implication for practice: Addressing concerns about social interactions in persons with mental illness is important in group treatment. This study proved that engaging patients in designing or adapting interventions for mental health services is important to improve quality. [ABSTRACT FROM AUTHOR]

Aims: To describe nurse managers' perceptions of interventions to support nurses as second victims of patient safety incidents and to describe the management of interventions and ways to improve them. Design: A qualitative study using interviews. Methods: A purposive sample of nurse managers (n = 16) recruited from three hospital districts in Finland was interviewed in 2021. The data were analysed using elements of inductive and deductive content analysis. Results: The study identified three main categories: (1) Management of second victim support, which contained three sub‐categories related to the nurse manager's role, support received by the nurse manager and challenges of support management; (2) interventions to support second victims included existing interventions and operating models; and (3) improving second victim support, based on the sub‐categories developing practices and developing an open and non‐blaming patient safety culture. Conclusion: Nurse managers play a crucial role in supporting nurses as second victims of patient safety incidents and coordinating additional support. Operating models for managing interventions could facilitate nurse managers' work and ensure adequate support for second victims. The support could be improved by increasing the awareness of the second victim phenomenon. Implications for the Profession and Patient Care: Mitigating the harmful effects of patient safety incidents can improve nurses' well‐being, reduce burden and attrition risks and positively impact patient safety. Impact: Increasing awareness of the second victim phenomenon and coherent operation models would provide equal support for the nurses and facilitate nurse managers' work. Reporting Method: COREQ checklist was used. What does this paper contribute to the wider global clinical community? Nurse managers' role is significant in supporting the second victims and coordinating additional support.Awareness of the second victim phenomenon and coherent operating models can secure adequate support for the nurses and facilitate nurse managers' work. [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]

Accessible Summary: What is known on the subject: Self‐harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self‐harm. Most fatal and non‐fatal suicidal behaviours in inpatient settings are a result of ligature use.There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self‐harm by ligature. What the paper adds to existing knowledge: Key issues related to self‐harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self‐harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self‐harm by ligature.Working with self‐harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self‐harm by ligature, and unsupported after responding to a ligature incident. What are the implications for practice: Training about self‐harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self‐harm, and acknowledgement of the emotional impact on staff.Support for staff members who respond to ligature incidents should be available for all staff members who respond to self‐harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. Introduction: Self‐harm by ligature is a common form of self‐harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self‐harm. Aim: We explored the experiences of clinical staff who work with patients who self‐harm by ligature. Method: A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. Results: 275 staff members participated. Challenges most frequently reported about working with self‐harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. Discussion: Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self‐harmed by ligature. Implications for Practice: There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self‐harm by ligature. [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]

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]

Aims: This study aimed to delineate the relationships between actors and contextual factors associated with the development of the advanced practice role in Catalonia. Methods: A complementary data analysis was conducted based on the social network analysis (SNA) method. The primary study design was qualitative, descriptive and explanatory. Participants from diverse perspectives of practice, organization and external environment were engaged to participate in semi‐structured focus groups. Data collection was conducted between March and May 2016 in Catalonia, Spain. Participants were asked to report on various dimensions of the role development context: understanding of the role, felt needs, perceived outcomes, barriers and facilitators. Results: Primary data analysis performed for 44 participants identified 71 related contextual factors associated with role development. Complementary network analysis revealed multiple relationships and agreements among participants and context‐related themes. Professional roles and disciplines clustered around topics show consensus and the significance of topics. Conclusion: Understanding the level of interactions and consensus among participants and contextual factors will ultimately allow better insight into how complex contexts influence the development of advanced practice nursing in healthcare organizations. Significant, consensual contextual factors should be used to influence further development and implementation of new roles that affect patient care and outcomes. Summary statement: What is already known about this topic? Comprehensive understanding of context at various levels should generate greater knowledge about what affects advanced practice role development locally and globally.What this paper adds? Findings could help organizations to make sense of the full dimension of context and to predict or act on development of advanced practice nursing roles.The implications of this paper: Significant, consensual contextual factors should be used to influence further development and implementation of new roles that affect patient care and outcomes. [ABSTRACT FROM AUTHOR]

Aims: To investigate factors that influence the willingness of inactive nurses to return to nursing in a crisis situation and to identify aspects that need to be considered with regard to a possible deployment. Design: A deductive and inductive qualitative content analysis of semi-structured focus group interviews. Methods: Semi-structured focus group interviews with inactive or marginally employed nurses, nurses who have been inactive for some time and nursing home managers in October and November 2021. The participating inactive nurses had declared their willingness for a deployment during the COVID-19 pandemic or not. Data were analysed using qualitative content analysis. Results: Communication was seen as essential by the participants for an informed decision for or against a temporary return to nursing and to potential or actual deployments. To make them feel safe, inactive nurses need to know what to expect and what is expected of them, for example, regarding required training and responsibilities. Considering their current employment status, some flexibility in terms of deployment conditions is needed. A remaining attachment to care can trigger a sense of duty. Knowledge of (regular) working conditions in nursing can lead to both a desire to support former colleagues and a refusal to be exposed to these conditions again. Conclusion: Past working experiences and the current employment situation play a major role in the willingness of inactive nurses to return to nursing in a crisis situation. Unbureaucratic arrangements must be provided for those who are willing to return. Summary Statement: • What already is known - In crisis situations, not every inactive nurse is willing or able to return to nursing and therefore, the 'silent reserve' may not be as large as suspected. • What this paper adds - Inactive nurses need to know what to expect and what is expected of them for their decision regarding a return to active patient care during a crisis situation. • Implications for practice/policy -- Inactive nurses need to be informed and should be offered free training and refresher courses to ensure patient safety. Impact: This research shows that the group of inactive nurses are not a silent workforce which can be activated anytime. Those who are able and willing to return to direct patient care in crisis situations need the best possible support -- during and between crises. Reporting Method: This study adhered to COREQ guidelines. No Patient or Public Contribution: The involvement of patients or members of the public did not apply for the study, as the aim was to gain insight into the motivations and attitudes of the group of inactive nurses. [ABSTRACT FROM AUTHOR]

Aims: To codesign a cancer personalised activity and lifestyle tool (CAN‐PAL) based on an existing tool. To help cancer care workers support people affected by cancer to plan and integrate physical activity into lifestyles. Design: Mixed‐methods codesign study. Methods: Phase 1: Focus groups with people affected by cancer (n = 10) or interviews (n = 2) to discuss suitable physical activities and adaptation of the existing tool. Data were recorded, transcribed and analysed thematically. Themes informed the design of the prototype CAN‐PAL and user guide. Phase 2: Healthcare professionals considered the potential use of the CAN‐PAL prototype and completed an online survey including the system usability scale and free text responses. Results: Phase 1: Identified suitable physical activities and four themes were identified including: Capability, benefits, barriers and resources which informed the prototype CAN‐PAL and user guide. Phase 2: The user survey was completed by 12 healthcare professionals. Median (range) system usability scale was 80 (50–95) (best score 100), scores >68 indicate good or better usability. Themes from the free text comments included strengths, amendments, considerations and limitations. Results were used to finalise CAN‐PAL and the user guide. Conclusion: The codesigned CAN‐PAL tool had good usability. Further work is needed to evaluate the impact of CAN‐PAL on activity levels and behaviour in people affected by cancer. Relevance to Clinical Practice: People affected by cancer need support to undertake physical activity. The purpose of CAN‐PAL is to assist cancer care workers to support people affected by cancer to plan and integrate physical activity into lifestyles. Patient or Public Contribution: Public partners considered the findings from Phase 1 and 2 and informed the design of the prototype, final CAN‐PAL and user guide and coauthored the paper. Reporting Method: The study adhered to relevant EQUATOR guidelines; the study was reported according to the COREQ checklist. [ABSTRACT FROM AUTHOR]

Aim: To explore the satisfaction and experiences of women and staff with the BSOTS in an Australian hospital. Design: Cross‐sectional descriptive survey. Methods: Surveys were distributed to women and staff between February and May 2022. Survey questions reflected satisfaction with triage and provision of care under the BSOTS system (for women) and confidence in using the BSOTS system and its impact on triage‐related care (for staff). Survey data were summarized using descriptive statistics, and qualitative responses were analysed using content analysis. Results: There were 50 women and 40 staff (midwives and doctors) survey respondents. Most women were satisfied with triage wait times, the verbal information they received and the time it took for them to receive care. Nearly all midwife participants indicated they had high knowledge and confidence in using the BSOTS. Most staff indicated that the BSOTS supported the accurate assessment of women and had benefits for women, staff and the hospital. Conclusion: The findings showed that women and staff were satisfied with receiving and providing care in a maternity triage setting under the BSOTS system. Implications for the Profession and/or Patient Care: Implementing standardized maternity triage approaches such as the BSOTS in health settings delivering care to pregnant women is recommended for improving flow of care and perceptions of care quality by women. Impact: Quality of maternity triage processes is likely to impact the satisfaction of women attending services and the staff providing care. The BSOTS was shown to improve maternity triage processes and was associated with satisfaction of women and staff. Maternity settings can benefit from implementing triage approaches such as the BSOTS as it standardizes and justifies the care provided to women. This is likely to result in satisfaction of women and staff engaged in maternity triage and improve the birth outcomes of women and babies. Reporting Method: The reporting of this paper has followed SQUIRE guidelines. Patient or Public Contribution: Women engaged with maternity services were participants in the study but did not contribute to the design, conduct or publication of the study. [ABSTRACT FROM AUTHOR]

Aim: To identify structural barriers to the uptake and practice of anti‐racism in nursing education, specifically in the Canadian context. Design: A deconstructive, critical, qualitative inquiry informed by critical race theory, critical whiteness, feminism and post‐colonialism. Methods: This study employed an anonymous online open‐ended questionnaire and online focus groups with Canadian nurse educators from April to June 2021. The data were analysed through a contextualist thematic analysis that accounts for data as essential experience and also a product of discourse. Results: Structural barriers identified are organized into themes of: the academic environment; position and power; racism; program delivery; and Whiteness. Pervasive silence, especially white silence, can be interpreted in related contexts of precarity, self‐interest and institutional violence. Overarching processes of precarity and resistance exert power over the environment of nursing education which act to destabilize, disrupt and discourage anti‐racist efforts and education. Conclusion: The sustainability of anti‐racism should be a primary focus. This entails attending to structures in nursing and higher education that make nursing education precarious work, especially for educators racialized as Other in the white supremacist racial binary of White: non‐White. Explicit and ongoing attention to conditions that silence is necessary for any progress to be made. Strategies of applying anti‐racism need to be as complex as the barriers. Implications: Many schools of nursing are engaged in attempts to include anti‐racism as learning and environment. The structural barriers that interfere with effective integration of anti‐racism as a lens for nursing education must be named and addressed so educators and schools can be successful. The implication of trying to incorporate anti‐racism without addressing the barriers is a very superficial or pocketed application of anti‐racism, and a continuation of the status quo that reproduces Whiteness and excludes and harms people racialized otherwise. Impact: The study addressed both strategies and barriers to anti‐racism in nursing education. This article addressed structural barriers in anti‐racism in Canadian nursing education. The main findings are that processes of precarity specific to nursing education in institutions of higher learning, and resistance through Whiteness, decision‐making hierarchy and regulatory structures interfere with the application of anti‐racism. This research impacts nurse educators in all nursing schools and leaders in higher education. It also impacts all current and future nursing students as the recipients of the education we provide. Reporting Method: The paper adheres to COREQ checklist. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: We aimed to investigate the perspective of primary care nurses on their role with patients who have chronic cardiovascular disease and to identify cultural elements shared by nurses caring for people with chronic cardiovascular disease. In primary care, the role of the nurse is essential to promote self‐efficacy in cardiovascular self‐care. Individuals with chronic cardiovascular disease need to integrate the disease into their life, together with the health recommendations for management and follow‐up. Methods: A qualitative, focused ethnographic study was conducted. Purposeful sampling was used to include nurses who were working in primary care during the study. Data collection took place between 20 January and 20 May 2014 and consisted of semi‐structured interviews. A thematic analysis was applied using the data. Results: Eleven participants were included. Cardiovascular care forces nurses to reflect on their identity and role in primary care. The relationship between the nurse and people with chronic cardiovascular disease is a complex process, which may cause nurses to feel a sense of failure and monotony in their work. Conclusions: Our findings may help to understand the role of the nurse and the care provided in patients with chronic cardiovascular disease. Summary statement: What is already known about this topic? Primary care nursing is necessary for the improvement of cardiovascular risk factors.Chronic cardiovascular patients need training in self‐care.The organizational culture confers different forms of care to patients. What this paper adds? The vision of the socio‐cultural role of the family and community nurse is shown regarding cardiovascular prevention.Information is provided on the differentiating approach to chronic cardiovascular patients in primary care.Our study reflects the influence of routine care in nursing consultations, and what it entails to provide improved nursing care in cardiovascular patients. The implications of this paper: These findings can be used to understand the need to change the focus of nursing care in cardiovascular prevention.The implementation of a follow‐up protocol for the care of cardiovascular patients can improve patients' self‐care and reduce monotony in the nursing consultation.Further training and research is necessary regarding comprehensive chronic cardiovascular care within primary care services. [ABSTRACT FROM AUTHOR]

Aim: To examine the relationships between self‐efficacy, uncertainty and anxiety among nursing graduates waiting for a mandatory nursing licensing test that was postponed due to the COVID‐19 pandemic. Methods: A total of 352 graduates of nursing education programs participated in this mixed‐methods study. The data were collected using an online questionnaire in June 2020. Results: The participants demonstrated high uncertainty and anxiety and low self‐efficacy towards the ability to succeed in the licensing exam. Graduates, who started working, reported lower uncertainty. Self‐efficacy, uncertainty, gender and family status contributed significantly to the explanation of 24% of the variance of the anxiety. The qualitative analysis revealed three themes: (a) emotional distress, cognitive challenge and social implications, (b) consequences for significant others and (c) strengthening of professional values and norms. Conclusions: A significant crisis like a pandemic is accompanied by acute cognitive burden and stressful emotional experiences and creates an unconventional situation that requires unusual solutions. Granting a temporary permit for employment as a nurse following the postponement of a licensing test contributed to the ability of nursing graduates to cope with the situation. Policies to deal with similar situations in the future emergencies should be developed and implemented. Summary statement: What is already known about this topic? The COVID‐19 pandemic changed all the rules when the licensing examination was postponed at relatively short notice.The graduates found themselves without a work permit and also outside the education system.Many graduates reported economic challenges and feelings of uncertainty and fear of the future. What this paper adds? The participants demonstrated high levels of uncertainty and anxiety, with low self‐efficacy.Self‐efficacy, uncertainty, gender and family status contributed significantly to the explanation of the anxietyQualitative analysis supported these findings through examples that paint the whole picture in vivid colours. The implications of this paper: The study emphasizes the importance of providing emotional support and information to the students in times of crisis, while communicating policy decisions.Granting a temporary permit for employment as a registered nurse following the postponement of the licensing test contributed to the ability of nursing graduates to contend with the situation.There is a need to formulate policies to deal with similar situations in the future. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore and understand the barriers perceived by Italian nurses to adopting self‐monitoring for managing oral anticoagulation in real‐life settings. Background: Barriers to self‐monitoring implementation for managing oral anticoagulation have been poorly described. Design: The study had a qualitative descriptive and exploratory design with a hybrid approach. Methods: A literature review was conducted to identify a priori barriers (deductive approach), while a small and semi‐structured focus group discussion was performed to explore the contextual barriers experienced by Italian nurses (inductive approach). A classic content analysis technique was adopted. Data were collected in 2019. Findings Two main categories were identified. Organizational barriers referred to the lack of inter‐professional collaboration and health‐care system strategies to provide clinical pathways for self‐monitoring. Individual barriers encompassed professional characteristics (e.g. university background, professional knowledge, continuum education and accountability/responsibility) and patient characteristics (e.g. patient health literacy and knowledge, engagement/empowerment and educational programmes). Finally, unwarranted clinical variation in oral anticoagulation management arose as a barrier determined by organizational and individual elements. Conclusions: The results of this study pointed out an urgent public health issue in addressing barriers influencing self‐monitoring practice and in sustaining care models that might enhance the quality improvement of self‐monitoring for managing oral anticoagulation. Summary statement: What is already known about this topic? Anticoagulation therapy is one of the leading chronic treatments worldwide to prevent stroke in atrial fibrillation patients.Self‐monitoring is a valuable option to further improve the quality of anticoagulation surveillance and patient medication adherence compared to standard care models.Thus far, the barriers underpinning self‐monitoring implementation experienced by Italian nurses are mainly unexplored.What does this paper add? This study is the first Italian description regarding the main barriers perceived by Italian nurses to adopting SM in patients treated using oral anticoagulation therapy.Organizational barriers refer to the lack of inter‐professional collaboration and health‐care system strategies to provide clinical pathways for self‐monitoring.Individual barriers encompass professional characteristics and patient characteristics, and unwarranted clinical variation arose as a barrier determined by both organizational and individual barriers.The implications of this paper Description of the main barriers perceived by Italian nurses to adopt self‐monitoring of oral anticoagulation is required to prioritize policies and system‐level interventions.Health institutions, patient associations and scientific societies should develop policies that enhance the continuum of professional education of nurses regarding self‐monitoring for oral anticoagulation.Integrated care models where nurses have a leadership role in providing self‐monitoring practice are required to implement self‐monitoring widely. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this project was to examine the role of cultural differences in shaping the management of diabetes among Ethiopian immigrants living in Israel. Methods: A qualitative, in‐depth study involved semistructured interviews with 16 Ethiopian immigrants with diabetes living in Israel. The interviews were audio‐recorded, transcribed and translated into Hebrew, if necessary. The authors each identified themes in the responses and then through discussion came to a consensus about the most significant ones and how to categorize them. Results: A main theme was revealed structuring the participants' perception of diabetes: an oscillation between a familiar narrative, associated with traditional life in Ethiopia, and a foreign one. Five additional subthemes were also identified as an oscillation about the causes of disease, between collectivism and individualism, between accessible food and a balanced diet, between relying on bodily sensations and prescribed treatment and between culturally oriented and translated knowledge. Conclusion: The participants understood that they could be adversely affected both by the changes in lifestyle following their move and by adhering to the traditional norms. They agreed that professional liaisons and peers who have successfully managed their diabetes could help provide a bridge between the narratives. Summary statement: What is already known about this topic? Diabetes is a worldwide epidemic where immigrant populations are more likely to suffer from it.Language and cultural barriers pose a challenge to immigrants when accessing healthcare.Among immigrants, diabetes‐related distress is often accompanied by distress due to the challenges of immigration and acculturation.What this paper adds? Among Ethiopian immigrants, there exists a division between two main narratives about their illness and the way it is treated: the familiar and the foreign.Ethiopian communities play an important role in the treatment of an individual's illness, for better or worse.Translation alone is not sufficient to make language accessible; it must be combined with a medically‐culturally tailored approach.The implications of this paper: An understanding of the oscillations between narratives that Ethiopian immigrants experience is important for promoting person‐centred care for this population.During individual and group training, nurses should include Ethiopian immigrants who have successfully managed their diabetes.Nurse managers should ensure that their clinic has professional liaisons not only for translation but also for the provision of culture‐based health care. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Traditionally, treatment for eating disorders (EDs) has been provided on an inpatient or outpatient basis, but more recently other levels of treatment provision to include, day care (DC) and community outreach programmes, have been developed.There is limited research exploring the experience of patients who have transitioned from inpatient ED treatment to a remote DC treatment. This lack of knowledge can impact mental health nurses' understanding of what that experience is like for patients and hence may influence the efficacy of collaboration and inclusion between patients and nurses. What this paper adds to existing knowledge?: This research addresses this dearth of knowledge and adds to our understanding of patients' experiences of attending a remote DC programme following a period of inpatient treatment for an ED.This is an important study for nurses and other mental health professionals working with people in ED treatment, as it highlights the specific challenges and anxieties of transitioning from inpatient to a remote DC programme and the individualized supports advisable during this process. What are the implications for practice?: This research provides a basis on which nurses can understand and address the challenges experienced by patients after transitioning to a less intensive supportive ED programme.The understanding of these experiences will enhance the therapeutic alliance between the nurse and patient, which will in turn support the patient in increasing agency as they progress through their recovery.This research provides a foundation on which to develop specific supports that need to be in place to help patients manage the anxieties they experience as they transition to a less intense and remote treatment.Findings from these lived experiences can be used to support the development of similar DC programmes for EDs in other settings. Introduction: Day care (DC) treatment for people with an eating disorder (ED) provides for an easier transition from hospital to home, along with a treatment milieu where patients can maintain occupational and social functioning and allow for the transfer of newly acquired skills to everyday life. Aim: To explore patients' experiences of attending a remote day programme following intense inpatient treatment in an adult ED service. Method: A qualitative descriptive methodology informed the study. In‐depth semi‐structured interviews were conducted with 10 consenting patients. A thematic analysis framework was used to guide the process of data analysis. Results: Three themes reflected participants' experiences: 'Moving On: Preparing for Change', 'Navigating a New Support System' and 'Increasing Agency'. Discussion: An underlying issue for participants was an ongoing but changing experience of anxiety. While anticipatory anxiety is evident in preparing for discharge, this is replaced with a real‐time anxiety as they endeavour to negotiate an effective support network. Implications for Practice: The findings from this study provide a basis on which mental health nurses can develop timely and effective treatment and support systems with patients who are transitioning from a high support inpatient ED programme to a less intensive ED remote DC programme. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is Known on the Subject?: Staff working with other people's mental health are in more danger of experiencing high stress at work.These members of staff are more likely to have mental health problems themselves.Previous research has suggested that training these members of staff to deal with their daily stress and become mentally tougher can protect them. What this Paper Adds to Existing Knowledge?: The findings showed that higher levels of perceived stress and reduced quality of life in mental health workers were related to lower levels of mental toughness.This research provides a detailed understanding of the current issues experienced in a range of different mental health settings, which may contribute to stress and quality of life.The research highlights the importance of protecting staff mental wellbeing, controlling and reducing levels of stress and suggests that one route to doing this is improving mental toughness. What are the Implications for Practice?: These findings suggest a need to increase the awareness of and further protect the mental health of staff working in the mentioned settings.Staff working in mental health settings should be provided with information about how to enhance mental toughness and how to reduce stress.This will lead to a better quality of life for mental health staff and in turn improve the quality of care provided. Introduction: Clinicians working in mental health services are at increased risk of stress at work. Previous work suggests that mental toughness is a protective mechanism for stress in other professions. This has not yet been examined in mental health workers. Aim/Question: To examine whether mental toughness predicts perceived stress and quality of life in mental health workers, to develop an understanding of the factors contributing to and techniques used to deal with stress in this population. Method: Sixty‐two workers completed measures of mental toughness, perceived stress, quality of life and answered questions regarding their personal experience of stress at work. Results: Mental toughness was a predictor of stress (F(7, 54) = 10.58, p <.001) and quality of life (F(6, 55) = 7.58, p <.001, F(7, 54) = 7.15, p <.001 and F(7, 54) = 6.81, p <.001, for compassion satisfaction, burnout and secondary traumatic stress, respectively), with particular roles for the interpersonal confidence and control of life components. Qualitative analysis revealed sources of stress for health workers and a variety of stress management techniques to cope with workplace stress. The findings suggested that mental toughness develops in some but not all health workers due to the demands of their role. Discussion: The findings provide an insight into stress, quality of life and protective factors for stress in mental health workers and suggest that future research should consider mental toughness training in mental health workers. Implications for Practice: There is a need to increase the awareness of factors contributing to stress in mental health workers, such as a lack of resources and staff, and to promote organizational change to improve their professional quality of life. Future research should also explore the potential of mental toughness training in this population. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Physical restraint is widely used in the elderly at home, and cognitive impairment is an important risk factor. Family caregivers of people with dementia are the main decision makers and implementers of physical restraint at home.Most people with dementia in China receive home care, and family caregivers face enormous care and moral pressures influenced by Confucian culture.Current research on physical restraints focuses on quantitative analysis of its prevalence and reasons within the institutions. There is little research on how family caregivers perceive physical restraints in home care context, especially under Chinese culture. What the paper adds to existing knowledge?: Many family caregivers face approach – avoidance conflict and moral dilemmas when making decisions to restrain, and they make difficult choices in these dilemmas.In China, family caregivers are influenced by many unique factors, including traditional Confucian culture, family affection, and rural home environment.Inadequate laws and policies provide the ground for abuse of physical restraints, and family caregivers rarely consider legal and policy restrictions when using physical restraints. What are the implications for practice?: With limited medical resources, nurse‐led dementia management is the hope to reduce physical restraints in home.Mental health nurses need to assess for the appropriateness of physical restraints associated with psychiatric symptoms in people with dementia.At both organizational and community levels, improving effective communication and relationships between professionals and family caregivers are important to address. Improvements in this context require education and time for staff to develop skills and experience which is necessary to provide family caregivers with ongoing information and psychological support within their communities.Considering Confucian culture will be of value for mental health nurses working in other countries where there are Chinese communities to better understand perceptions of family caregivers. Introduction: The use of physical restraints is a common practice in home care. Family caregivers face care‐related and moral pressures due to the influence of Confucian culture in China. The use of physical restraints in the Chinese cultural environment may differ from the use of such restraints in other cultures. Scientific Rationale: Current research on physical restraints focuses on quantitative analysis of its prevalence and reasons within the institutions. However, there is little research on how family caregivers perceive physical restraints in home care context, especially under Chinese culture. Aim: To explore the perceptions of family caregivers on physical restraints in people diagnosed with dementia receiving home care. Method: A descriptive, qualitative study of Chinese family caregivers of people diagnosed with dementia in home care. Framework method analysis was adopted using the multilevel socio‐ecological model. Results: Beliefs about benefit lead to a dilemma for family caregivers. Cherishing family's affection encourages caregivers to reduce physical restraints, but lack of help from family members, professionals and the community forces them to restrain their loved ones. Discussion: Future research should explore the complex issue of culturally specific physical restraints decisions. Implications for Practice: Mental health nurses must receive education regarding the negative outcomes of the use of physical restraints for family members of people diagnosed with dementia. A more liberal approach to mental health and relevant legislation, which is an emerging global phenomenon that is currently in an early phase of development in China, grants human rights to people diagnosed with dementia. Effective communication and relationships between professionals and family caregivers can contribute to the establishment of a dementia‐friendly community in China. [ABSTRACT FROM AUTHOR]

Background: Older people in the nursing home environment are much less mobile and capable of taking care of themselves as they age, and most of them face the plight of loneliness, which seriously affects the quality of life of older people in their later years. Aims: A systematic review and synthesis of older people's experiences of loneliness in nursing homes. Design: Following ENTREQ, do a systematic evaluation and synthesis of qualitative investigations. Methods: A search of PubMed, Cochrane Library, Web of Science, Embase, the Chinese biomedical literature service system, the China National Knowledge Infrastructure, the Wanfang Database and the Wipu Database for qualitative studies of older people's experiences of loneliness in nursing homes was conducted with a search time frame of March 2023. Evaluation of the quality of the literature using the Joanna Briggs Institute's Australian Centre for Evidence‐Based Health Care Quality Assessment Criteria for Qualitative Research, And the data were synthesised using Thomas and Harden's method of thematic and content analysis. Results: A total of 13 papers were included, and 36 research findings were distilled and integrated into three themes: causes of loneliness; feelings of loneliness; coping with loneliness; and seven sub‐themes: aging and loss; environmental transformation; loneliness is a pain; loneliness is a choice; participation; strengthening social ties; and diverting attention. Conclusions: Older people in nursing homes face varying degrees of loneliness, which is a subjective feeling influenced by the interplay between personal awareness and the external environment, so future care interventions should be developed in a comprehensive manner, taking into account the characteristics of the older people themselves and their external environment. No Patient or Public Contribution: This study is a meta‐synthesis and does not require relevant contributions from patients or the public. [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]

Background: The first wave of the COVID‐19 pandemic caused a shortage of health care staff, forcing the hiring of senior nursing students. Aims: To describe the psychosocial impact and coping strategies used by nursing students during the first outbreak of the COVID‐19 pandemic and to understand the coping strategies they employed. Method: A qualitative exploratory study was conducted, based on Sandelowski's proposal. Purposive sampling was carried out to recruit 18 students hired during the pandemic. The students were interviewed between 18 March and 15 June 2020. Semi‐structured interviews were conducted using a digital platform. An inductive thematic analysis was performed. Findings The students lived alone and isolated during their contract to protect their cohabitants from possible contagion. The impact of working during the pandemic leads to experiences of stress, insomnia, nightmares and anxiety. Nursing students coped with the emotional burden through mental disconnection and the support of co‐workers and family members. Conclusion: Psychological support and tutoring should be provided by health centres. In addition, in these special circumstances, universities should adapt the training provided. Summary statement: What is already known about this topic? In Spain, as in many other countries, a state of alarm was declared during the first wave of COVID 19. The Ministry of Health established measures to manage the health crisis and contain infections, including the hiring of senior nursing students to work.Working conditions had a high physical and psycho‐emotional impact on health professionals.The lack of prior experience of students in the context of a pandemic and how they enter the workforce could make it difficult to develop adequate coping strategies, enhancing the presence of mental and emotional disorders.What this paper adds? During their work, and in order to avoid contagion, the students lived apart from their families, limited their contacts and were isolated in refuge in rooms or homes. Upon entering the home, they showered, changed clothes and disinfected any surfaces they touched.The students described feeling stressed due to the lack of protective equipment and staff, heavy workloads and lack of knowledge regarding the unit and work protocols. They worried about making mistakes, doing their jobs poorly or being unable to help patients. When they got home, they had episodes of insomnia and anxiety.Faced with this situation, students used mental disconnection or distraction as coping strategies. Others shared their fears and uncertainties with other health care professionals and family members, seeking support and understanding. Other times, they tried to be strong and hide their suffering.The implications of this paper: The incorporation of students as relief for professionals in a situation of extreme need is not exempt from significant psychosocial risks and should include monitoring programs and psychological evaluation.The hospitals should monitor and mentor students to facilitate their adaptation to similar situations in the future.The students required greater support from the administration, including offering them housing where they could live away from family and relatives. [ABSTRACT FROM AUTHOR]

Background: There are controversial results about the effects of cancer and chemotherapy on the perception of distress. Aims: The purpose to the study is to explore the meaning of the distress experienced by patients with cancer and verify whether the cancer diagnosis, stage and receiving chemotherapy influence this experience. Design This is a mixed‐methods study with cancer patients. Methods: Data were collected in 2018 using a phenomenological interview (n = 18) and one suffering inventory (n = 100). Qualitative analysis was performed using the empirical‐comprehensive model and quantitative using statistical tests. The results were triangulated. Results: Distress originated from difficulties faced in health services, diagnosis confirmation, beginning treatment and interruption of life projects. Patients mobilized resources in the spiritual dimension that allowed them to redefine their distress positively. Chemotherapy brought hope back and promoted healing expectations. Higher average scores for distress were found in patients with advanced stage and receiving palliative chemotherapy. Not having begun chemotherapy and having head and neck cancer were associated with higher average scores for distress. Conclusion: Distress was greater among patients who had not yet begun chemotherapy; nearness of death and difficulty talking about feelings caused distress; distress was redefined by mobilization of spiritual resources. Summary statement: What is already known about this topic? There are conflicting results about distress between patients with cancer.The distress of cancer patients has been little reported or treated in cancer care units.There are no mixed‐method studies on distress in chemotherapy patients that have combined a measuring instrument and a phenomenological approach. What this paper adds? Distress among patients with cancer derives from elements that relate to health services, as well as the individual's ability to deal with the situation.Distress is greater among patients who have not begun chemotherapy and those who have head and neck cancer diagnoses.Phenomenological method can complement the use of scales to assess the subjective experience of distress in the context of cancer and chemotherapy. Implications of this paper Distress evaluation must encompass listening and the use of measurement instruments to strengthen the implementation of patient‐centred nursing care.Nurses are in a unique position to identify and approach distress, because they are often at the side of patients throughout the course of treatment.Professional training for reporting of difficult news is required. [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 understand nurses' perceptions and experiences of work role transitions. Background. Globally an uncertain healthcare landscape exists and when changing work roles nurses experience periods of transition when they may not cope well. A greater understanding of work role transitions may help facilitate workforce retention and successful careers. Design. Mixed methods systematic review. Data sources. Six data bases were searched for peer reviewed primary empirical research, published in English language between January 1990 and December 2014, supplemented by hand and citation searching. Review methods. Evidence for Policy and Practice Information and Co-ordinating Centre methods for systematic reviews principles were followed. Analysis and synthesis of the qualitative and quantitative papers was conducted separately using thematic analysis. A third synthesis combined the narrative findings and a narrative synthesis of results is presented. Results. Twenty-six papers were included. Across nurses' work role transitions two pathways were found: Novice and Experienced. 'Novice' comprises pre-registration and newly qualified nurses. 'Experienced' comprises, Enrolled/Licensed Practical Nurse to Registered Nurse, experienced to specialist nurse and clinical role changes. Each pathway results in different emphasizes of two themes; 'Striving for a new professional self' includes emotional upheaval and identity while 'Know how' includes competence and boundaries. Novice nurses are more susceptible to the extremes of emotional upheaval while experienced nurses' competence eases aspects of transitions while boundary issues pervade. Conclusion. Informed work and educational environments are required for all groups of nurses. Using existing models of transition can facilitate successful individual transitions and develop the workplace. [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?: Having a mental illness may undermine men's self‐image as a father while having children may facilitate their recovery.Many fathers who experience mental health issues experience stigma and are reluctant to seek support in their parental role.Most studies in this field focus on fathers from Western countries. What does the paper add to existing knowledge?: Similar to Western fathers, Chinese fathers reported both negative parenting (parenting disengagement, harsh parenting and inconsistent discipline) and positive father–child interactions when ill.Unlike their Western counterparts, Chinese fathers relied on extended family support in their parenting role, though this support was problematic at times. What are the implications for practice?: This research helps mental health nurses understand the experiences of Chinese fathers with mental illness.Findings suggest that specific cultural adaptions to family‐focused interventions are needed for the Chinese context including considering extended family members (e.g. grandparents). Introduction: Parenting roles are important for those with a mental illness. While research on mothers is well established there is scant focus on fathers with mental illness, especially in non‐Anglophone countries. Aim: To better understand the parenting and family experiences of fathers, who have a mental illness, from the People's Republic of China. Method: Qualitative semi‐structured interviews were conducted with nine Chinese fathers with mental illness, using Interpretative Phenomenological Analysis. Results: Seven superordinate themes were identified: (i) mental illness undermines idealized images of fatherhood; (ii) parenting in the context of mental illness; (iii) concerns about the negative impact of their illness on children; (iv) children as a burden and a source of hope; (v) stigma; (vi) relying on family support; and (vii) unmet professional and peer support needs. Discussion: Chinese fathers held a gendered image of fatherhood, and experienced self‐stigma for not living up to their ideal sense of fatherhood, which resulted in a reluctance to seek support. This study adds to the existing literature by focusing on Chinese fathers. Although many of their experiences are similar to fathers from Western countries, some differences were found, notably around a reliance on extended family support. Implications for practice: Nurses and other mental health professionals need to adopt a family‐focused, culturally informed approach to supporting Chinese fathers with mental illness and their families. [ABSTRACT FROM AUTHOR]

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]

Aims: The aim was to describe the experiences of nurses in broaching the issue of overweight and obesity at maternity and child health clinics. Background: The mother's obesity and excessive weight gain during pregnancy and rapid weight gain in early childhood increase the risk of obesity of the newborn baby both in childhood and throughout life. Attention must be paid to the prevention of weight gain in families already during pregnancy and before school age. Methods: Informants were nurses working at maternity and child health clinics (N = 28). The qualitative data were collected by a focus group interview in spring 2016 and analysed using inductive content analysis. Findings The nurses interviewed considered it their duty to broach the issue and felt that they have sufficient courage to bring up overweight. They sometimes found it frustrating to talk about overweight and obesity, because families do not commit themselves to making lifestyle changes, and changes happen slowly. Nurses found the lasting relationship with families helpful for bringing up overweight. Conclusion: Nurses need more broaching skills, more training, supervising and tools for bringing up overweight and obesity with client families. The continuity of care in primary health care supports bringing up overweight. Summary statement: What is already known about this topic? Overweight means the risk of obesity, and obesity is defined as excessive fat accumulation in the body.Early recognition of the risk factors for overweight and addressing them play a key role, because treating obesity and reaching lasting results is difficult.Nurses working at maternity and child health clinics play an important role in preventing overweight and obesity in pregnant families and families with children and in broaching the issue, because almost all families use maternity and child health clinics' services. Whatthis paper adds? Nurses consider broaching the issue of overweight and obesity as their duty and an integral part of their work.Nurses recognize the feelings of frustration and negative emotions sometimes associated with taking up the issue of overweight and obesity, but they have difficulties to support families in this kind of situations.Nurses found the lasting relationship with families helpful for bringing up overweight. The implications of this paper: When in practice both nurses and clients recognize bringing up overweight and obesity, nurses need more training and support how to motivate families for the necessary change, identify family‐specific ways and utilize the family's own resources in spite of their own frustration.More attention has to be paid in nursing education on how to bring up overweight or some other emotional issues with clients. Nurses need more broaching skills, more training, supervising and more tools for bringing up overweight and obesity.We need more scientific knowledge about how negative emotions steer the operation of nurses and how they affect the willingness of families to make lifestyle changes. [ABSTRACT FROM AUTHOR]