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Aim: To clarify the concept of oral frailty to provide a clear and standardized conceptual basis for further research in older people. Design: Rodgers and Knafl's evolutionary concept analysis approach. Methods: The narrative analysis detailedly extracted and synthesized the attributes of oral frailty, as well as its antecedents, consequences and related terms under the guidance of Rodgers' evolutionary method. Data Sources: Multiple databases including Pubmed, CINAHL and Cochrane were searched using selected search terms 'oral frail*', 'oral health' and 'aged' respectively. Articles written between 2013 and 2023 were included, and grey literature was excluded. Results: A total of 32 articles were included for further analysis and synthesis. The attributes of oral frailty were hypofunction, predisposing in nature, non‐specific and multidimensional. Antecedents of prefrailty were classified into four categories, namely, sociodemographic characteristics, comorbidity, physical function and psychosocial factors. Consequences of oral frailty include three themes: increased risk of adverse outcomes, poor nutritional status and possibility of social withdrawal. Related terms that had shared attributes with oral frailty were oral health, functional dentition, oral hypofunction and deterioration of oral function. Conclusions: Oral frailty is an age‐related phenomenon reflected in decreased oral function. The findings of this concept analysis are conducive to understanding and clarifying the oral frailty, which can help clinicians or other healthcare providers to consider how to distinguish oral frailty in older adults and further promote the development of this field. Impact: Oral frailty is increasingly recognized as an age‐related phenomenon reflected in decreased oral function. As it is newly proposed, no consensus has been reached regarding the theoretical and operational concept of it. Through clarifying the concept, this paper will guide future healthcare research on oral frailty regarding the influencing factors, mechanisms and interventions, thus raising the awareness with regard to oral health among older adults. What does this paper contribute to the wider global clinical community?: In the context of older adults, oral frailty is a concept that requires further research to guide future theoretical development, and the influencing factors, mechanisms and interventions need to be further studied.Raise awareness with regard to oral health among older people and more attention will be paid to the early identification and intervention of oral frailty, so as to further improve the quality of life of older adults. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions This qualitative systematic review aimed to consolidate existing evidence on the self‐management experience of older patients with multimorbidity worldwide.Nine databases were searched, for papers published from database inception to April 2023. The systematic review was conducted according to the systematic review method of qualitative evidence by the Joanna Briggs Institute (JBI).Seven studies were included. Finally, four themes and 12 subthemes were formed: (1) physical level: reduced physical function and lack of coordinated care; (2) psychological level: mental state of anxiety and positive attitude towards life; (3) social level: technical support, support from family, support from healthcare workers and support from others; and (4) practical level: economic burden, lifestyle changes, self‐care in daily life and compliance was much lower than expected.To improve self‐management in older people with multimorbidity, nurses should provide more guidance to patients to improve their self‐management skills, and clinicians should recommend effective self‐management behaviours. [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?: People diagnosed with serious mental illness have a high risk of diabetes and are more likely to develop type 2 diabetes at ages below 60 years.Effective diabetes self‐care behaviours among people diagnosed with serious mental illness can improve glycaemic control and reduce vascular complications.Few studies have investigated diabetes self‐care behaviours and their associations with health literacy and self‐efficacy in people diagnosed with serious mental illness. What the paper adds to existing knowledge?: Diabetes self‐care behaviours in people diagnosed with serious mental illness were suboptimal; the least frequently performed self‐care activities were self‐monitoring of blood glucose.Factors associated with diabetes self‐care behaviours are gender, age, communicative and critical health literacy and self‐efficacy.Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid serious mental illness and type 2 diabetes. What are the implications of practice?: Mental health nurses should assess diabetes‐specific health literacy of people diagnosed with serious mental illness to ensure that they possess the knowledge and skills related to diabetes self‐care.When treating young people and those with newly diagnosed type 2 diabetes, nurses should incorporate strategies to minimise their perceptions of diabetes‐related distress and increase their confidence in managing comorbid diabetes. Introduction: People diagnosed with serious mental illness (SMI) experience greater challenges in managing their type 2 diabetes mellitus (T2DM) than do those diagnosed with T2DM alone. Aim: This study investigated diabetes self‐care activities and the factors associated with these activities in people diagnosed with SMI in a hospital setting. Methods: A cross‐sectional correlational study was conducted among 126 people diagnosed with comorbid SMI and T2DM in Taipei, Taiwan, between October 2020 and April 2021. Data were collected using self‐report questionnaires and a chart review. Three‐step hierarchical multiple regression analysis was used to identify factors associated with diabetes self‐care behaviours. Results: Diabetes self‐care behaviours in people diagnosed with SMI were suboptimal overall. Hierarchical multiple regression analyses revealed that age (β = 0.18, p =.037) and self‐efficacy (β = 0.27, p =.004) significantly associated with diabetes self‐care behaviours. Discussion: Self‐efficacy is the strongest predictor of self‐care behaviours among people diagnosed with comorbid SMI and T2DM. Implications for Practice: Mental health professionals should focus on enhancing confidence in managing comorbid diabetes in people diagnosed with comorbid SMI, especially young people and those with newly diagnosed T2DM. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences and emotions of individuals with depression and physical comorbidity within the context of psychoeducational group interventions led by primary care nurses in Catalunya (Spain). Method: A psychoeducational group intervention was conducted in the first semester of 2019 with 13 primary care teams (rural/urban) and 95 participants with depression and physical comorbidity. The qualitative research and phenomenological perspective were based on 13 field diaries and 7 semi‐structured interviews carried out with the observer nurses. The interviews were recorded and transcribed. Codes were identified by segmenting the text into citations/verbatim accounts and emerging categories/subcategories by regrouping the codes. The results were triangulated among the researchers to identify and compare similarities and differences. Results: Four major themes were found: (a) gender differences; (b) coping strategies and changes observed during the intervention; (c) functions of the group as a therapeutic element; and (d) the nurses' perceptions of the group experience. Gender differences were identified in relation to experiences and emotions. Conclusions: As some patients acquired skills/behaviours during the intervention that helped them initiate changes and the nurses were satisfied with the intervention, it is important to include this information when planning effective interventions for patients with this profile. Summary statement: What is already known about this topic? There are gender differences in the prevalence of depression. What this paper adds? This study describes the experiences and emotions of women with depression and physical comorbidity within the context of psychoeducational group intervention. The implications of this paper: The study provides information about the experiences and emotions of women with depression. It will be important to include this qualitative information when planning effective interventions directed at patients with this profile. [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]

Background: Poor medication adherence is a concern among patients with hypertension. However, few studies have assessed the effect of health literacy on medication adherence among refugee patients. Aim: The aim was to examine the effect of health literacy and associated factors in explaining medication adherence among Syrian refugee patients with hypertension. Methods: A cross‐sectional study was used, recruiting 150 Syrian refugees with hypertension in February 2020. The Hill‐Bone scale and the Health Literacy Questionnaire were used to collect data, which were analysed using descriptive and inferential statistics. Results: Participants had low levels of medication adherence and had low mean scores in eight of nine subscales of the health literacy scale, except in the appraisal of health information subscale. Factors including patient's age, marital status, the number of medications and co‐morbid diseases were significantly associated with medication adherence. Age, understanding written health information and ability to engage with healthcare providers were predictive of medication adherence. Conclusion: To increase medication adherence among refugee patients with hypertension, nurses need to improve patients' health literacy and understanding of health information about their disease. Summary statement: What is already known about this topic? Refugees report a higher prevalence of chronic diseases than non‐refugees due to a lack of available medications and limited access to health‐care services.Adherence to antihypertensive drugs is the cornerstone for accomplishing hypertension control.Health literacy is closely associated with better adherence to medications. What this paper adds? Syrian refugees diagnosed with hypertension showed low medication adherence.Age and level of understanding of health information were found to be factors that explained the level of medication adherence.Medication adherence was associated with the number of prescribed medications, the presence of other medical problems and marital status. The implications of this paper: To enhance medication adherence, healthcare providers, including nurses, should educate their patients about their diseases and medical regimes to enhance their health and health literacy.Further research is required to explain other personal factors, including patients' beliefs about their health and medications.Nurses, nurse managers and other healthcare professionals should develop and implement programs that address the individual needs of refugees to increase patients' levels of health literacy and medication adherence. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Depression is a leading cause of disability worldwide that negatively impacts quality of life. Talk therapy such as cognitive behavioural therapy is an effective treatment for depression. The Internet is an important tool for mental healthcare delivery. Internet‐delivered or online talk therapy interventions are associated with lower costs and improved accessibility.Current reviews do not address the effectiveness of Internet‐delivered cognitive behavioural therapy (iCBT) on quality of life (QoL). What the paper adds to existing knowledge: Interventions for iCBT have better QoL improvements for individuals with greater depressive symptom severity, females, young adults and individuals with complex comorbid disorders. Support from a healthcare provider for iCBT interventions have better outcomes than self‐guided therapy interventions. Tailoring the iCBT intervention to the specialized needs of the population is beneficial. What are the implications for practice: There is potential to address treatment gaps for managing the care of individuals with depression. Utilizing iCBT promotes the integration of accessible mental healthcare in clinical settings.Healthcare providers can have a more comprehensive approach to delivering iCBT by considering adaptations relevant to the clinical population being treated. Introduction: Major depressive disorder (MDD) is a leading cause of disability resulting from social, psychological and biological factors affecting quality of life (QoL). Cognitive behavioural therapy (CBT) is an effective psychotherapy for MDD. Internet‐delivered CBT (iCBT) is associated with lower costs and improved accessibility. Aim: We aimed to examine the effectiveness of iCBT on QoL in adults with depression. Method: PubMed, Embase and PsycINFO were searched between 2010 and 2022. Inclusion criteria were experimental designs, adults ≥18 years old, depression diagnosis or valid self‐report measure, iCBT intervention; and QoL outcome. Exclusion criteria were studies without depression analysis and intellectual disabilities or psychosis. Results: Seventeen articles were included, with a negative correlation between depression severity and QoL. Sex, age and physical comorbidity positively influenced effectiveness. Depressive severity, dysfunctional attitude and negative thinking were predictors and moderators of QoL. Clinician support can impact social interactions and sense of belonging. Discussion: Internet‐delivered cognitive behavioural therapy is effective for improving QoL in adults with MDD. Severe depression, females, younger age and comorbid disorders were associated with greater QoL improvements. Implications for Practice: The findings suggest iCBT could address depression treatment gaps related to improving QoL. Utilizing iCBT potentially improves the care continuum for individuals with complex disorders. [ABSTRACT FROM AUTHOR]

What is known on the subject: Supported housing approaches that include case management and increased opportunities for independence and personal autonomy for people who are living with severe and persistent mental illness (SPMI) have been found to help reduce hospitalizations and use of the emergency department.What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. What the paper adds to existing knowledge: This study uncovered that individuals experiencing SPMI who lived in supported housing used more primary health care and specialist physician services, in the year following transition to this housing arrangement. What are the implications for practice: The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual residents, including increasing access to both primary health care and specialist services.This is important for nursing practice, as the findings of the study show that supported housing arrangements for people experiencing SPMI may assist in better supporting their complex health care needs. Introduction: Supported housing for people who are living with severe and persistent mental illness (SPMI) has been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services. Aim/Question: The aim of this study was to compare the use of health services use of individuals with SPMI, before and after transition to the new supported housing program. Method: Using health care administrative databases, a pre‐post cohort study was conducted examining the health system use of residents who transitioned from custodial to supported housing arrangements between 2017 and 2019. Results: Individuals with SPMI used more primary health care and specialist physician services after transition to the supported housing model. Discussion: The results suggest that a supported housing model may be associated with increased usage of outpatient person‐centred health services in people experiencing SPMI. Implications for Practice: The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual. This is important for nursing practice, as the findings of the study show that supported housing arrangements may assist in better supporting complex health care needs of individuals. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Individuals experiencing mental illness make up a significant portion of the world's population.Individuals with mental illness experience higher rates of morbidity and die on average at least a decade earlier than individuals without mental health disorders. What this paper adds to existing knowledge?: Issues of stigma, diagnostic overshadowing, premature closure, inadequate workup, fear and lack of training negatively impact the care of individuals with mental illness.Issues impacting the care of individuals experiencing mental illness cross geographic and care setting boundaries. What are the implications for practice?: Partnerships between physical and mental health practitioners are needed to thoroughly assess and accurately diagnose symptoms experienced by individuals with mental illness.Educational interventions can help prepare practitioners to care for individuals with mental illness.Nurses can better advocate for effective patient care by learning about the phenomenon of diagnostic overshadowing and calling attention to its occurrence. Introduction: Individuals with mental illness experience significantly higher overall rates of morbidity and mortality than counterparts without mental illness. Misdiagnosis of symptoms emanating from physical illnesses as psychiatric in nature presents one important cause. Aim: This integrative review explores research on healthcare professionals' misattribution of physical health symptoms to patients' comorbid psychiatric issues and seeks to identify unifying themes, shared causes, and possible strategies for addressing the issue. Method: This review uses Whittemore and Knafl's 2005 integrative review methodology coupled with vetted quality appraisal tools. Results: Following a systematic search of allied health, medical, psychological, sociological and general literature, 24 publications employing qualitative, quantitative, mixed and synthesis research methodologies were selected. Each study was appraised according to design, and relevant data were extracted. Discussion: Themes of stigmatization, diagnostic overshadowing, incomplete medical examination, insufficient training, and fears experienced by providers and patients emerged. Implications for Practice: Increased partnering between physical and mental health practitioners, continuing education, and improving patient–provider communication are key to providing equitable care. Nurses play primary roles in empathizing with patients, advocating for appropriate care and educating others on the dangers of misattributing physical symptoms to psychiatric cause. [ABSTRACT FROM AUTHOR]

Background: Multiple chronic conditions (MCCs) are highly prevalent in primary care. Coping is an important psychological factor that influences patients' ability to adapt physically and mentally to MCCs. Testing a reliable and valid psychometric inventory is necessary to identify coping strategies before developing coping‐oriented interventions. Purpose The purpose of this study is to examine the psychometric properties of the Chinese version of the Brief Coping Orientation to Problems Experienced (Brief COPE‐CN) inventory in patients with MCCs. Method: This study adopted a cross‐sectional design. A convenience sample of 290 Chinese patients with MCCs was recruited from a tertiary hospital in East China. The Brief COPE‐CN, sociodemographic characteristics and clinical data were collected using a self‐reported questionnaire from November 2017 to May 2018. Factor analysis and reliability analysis were performed. Results: The mean age of the participants was 58.5 years (range from 23 to 95 years), and approximately half of the participants were female (49.3%). Most participants had two chronic conditions (82.1%) and reported having had MCCs for more than 2 years. The explanatory factor analysis (EFA) identified five factors in the Brief COPE‐CN that explained 58.4% of the total variance. The Cronbach's α coefficients ranged from.65 to.85 for the five subscales. Conclusions: The psychometric properties of the Brief COPE‐CN were acceptable for use with Chinese patients with MCCs. With further evaluation, this instrument may help health‐care professionals understand patients' coping and develop coping‐based interventions to promote coping in this population. Summary statement: What is already known about this topic? There is a growing predominance of chronic diseases in China, with many Chinese patients living with multiple chronic conditions (MCCs) that can adversely impact physical and psychological health.Coping‐oriented interventions that address and enhance patients' coping strategies are beneficial in terms of improving their health.There is no valid and reliable Chinese tool to measure coping strategies among patients with MCCs. What this paper adds? This study reports a five‐factor structure of the Chinese version of the Brief Coping Orientation to Problems Experienced (Brief COPE‐CN) established by explanatory factor analysis.The five‐factor structure of the Brief COPE‐CN has good internal consistency. The implications of this paper: The five‐factor Brief COPE‐CN has the potential to measure coping strategies effectively in Chinese patients with MCCs.With further evaluation, this instrument may be a useful tool for developing specific interventions to promote coping in Chinese patients with MCCs. [ABSTRACT FROM AUTHOR]

Aim: We aimed to identify the risk factors for delayed discharge in a day surgery centre in west China. Background: Delayed discharge affected by various factors is a key indicator for healthcare quality of day surgery. However, few studies have focused on this issue in developing countries where the day surgery started much later. Design A retrospective case–control design. Method: A random sample of 169 delayed discharge cases and 514 normal discharge cases was randomly selected from 38,021 day surgery cases from May 2011 to May 2019 in a tertiary teaching hospital in west China. Socio‐demographic and clinical characteristics of patients were collected through the hospital electronic database and a chart review. A multivariate logistic regression was conducted to identify the risk factors for delayed discharge. Results: The urban employee basic medical insurance, comorbidity, general anaesthesia, pain, fever, bleeding and metabolic disorder were identified as the risk factors for delayed discharge. Living in the city where the hospital located was a protective factor for delayed discharge. Conclusion: Post‐operative complications including fever, pain, bleeding and metabolic disorder were the most important risk factors for delayed discharge. The pre‐operative prevention, careful monitoring and rapid reactions to post‐operative complications may reduce delayed discharge. Summary statement: What is already known about this topic? Day surgery is conducted worldwide due to its time‐saving, cost‐effectiveness and low risk for post‐operative infection.Delayed discharge is considered as one of the most important indicators for healthcare quality of a day surgery centre.Most of the identified risk factors for delayed discharge are from the developed countries' experience of day surgery and remain controversial. What this paper adds? The insurance reimbursement rate influenced patients' willingness for discharge.Living in the same city where the hospital is located was a protective factor for delayed discharge.Post‐operative metabolic disorder was a risk factor for delayed discharge. The implications of this paper: Reducing the insurance reimbursement rate of patients who meet discharge criteria but ask for longer hospital stays may be helpful to reduce delayed discharge.Careful monitoring and rapid response to post‐operative complications may be simple but useful measures to reduce the risk of delayed discharge. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Intellectual disability (ID) involves problems with general mental abilities and affects intellectual functioning and adaptive functioning.People diagnosed with ID present higher levels of functional disability, which means they usually have difficulty or the inability to independently perform basic activities of daily living.Little to no attention has been paid to the issues of the mental health of people diagnosed with ID. Specifically, healthcare workers' experiences of caring for patients with IDPD have been neglected. What does the paper add to existing knowledge?: The findings increase our understanding and partially address the knowledge gap regarding the situations and circumstances faced by healthcare workers in caring for patients diagnosed with intellectual disability co‐occurrent with psychiatric disorders (IDPD).In cases of insufficient staffing, healthcare workers may be forced to ignore the individualized needs of patients so as to facilitate management.Healthcare workers may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. They adapt by adjusting their expectations of their patients. What are the implications for practice?: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in‐service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them.The government department responsible for the management of ID patient care institutions should be able to regularly monitor the overall staffing and quality of care in these institutions. Introduction: When intellectual disability co‐occurs diagnosed with psychiatric disorders (IDPD), the impact of the burden of illness on the affected individuals, their caregivers, their family and friends, and the services that provide for them is particularly high. The issues of the mental health of people diagnosed with ID have received little, if any, attention. One specific area of neglect is healthcare workers' experiences of caring for patients diagnosed with IDPD. Aim: The aim of this study was to understand healthcare workers' experiences of caring for patients diagnosed with IDPD. Methods: A qualitative descriptive research approach and semi‐structured interviews were used in this study. We interviewed 15 participants who had experience in caring for patients diagnosed with a dual diagnosis of IDPD. Findings: Four themes were found, as follows: (1) Negative impacts of insufficient staffing on the quality of care, (2) Constantly worrying about harmful incidents, (3) Discovering effective ways to provide individual patient care and (4) Adjusting expectations and attitudes towards patients. Participants' experiences revealed that they perceived the importance and effectiveness of providing individualized care for IDPD patients. However, when staffing is insufficient, they may be forced to ignore the individualized needs of patients so as to facilitate management. They may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. In addition, they adapt by adjusting their expectations of the patients. Discussion: The findings from this research help to fill the knowledge gap in our understanding of healthcare workers' experiences of and their perspectives on caring for patients diagnosed with IDPD. Implications for Practice: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in‐service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department overseeing the management of institutions providing ID patient care should be empowered to conduct regular monitoring of the overall staffing and quality of care in such institutions. [ABSTRACT FROM AUTHOR]

Purpose During the survival period of breast cancer patients, an understanding of and ability to implement health knowledge may be important for survivors' physical and mental quality of life (QOL). This study aims to investigate the health literacy and predictors of QOL for survivors of breast cancer. Method: A cross‐sectional design was used, and convenience sampling was performed. Eighty‐six survivors with breast cancer were recruited from a general hospital in northern Taiwan from February to August 2017. Taiwan's health literacy scale and SF‐12 questionnaire were used for data collection. Results: The average health literacy score was 3.28. Education level and breast cancer stage were significant factors for the health literacy of survivors with breast cancer. Age, body mass index and health literacy were predictors of physical health‐related QOL. Health literacy also was a predictor of mental health‐related QOL. Conclusion: The results provide the factors associated health literacy as well as health‐related QOL. Nurses should understand the health literacy among survivors with breast cancer and improve health literacy to optimize their quality of life. SUMMARY STATEMENT: What is already known about this topic? Individuals with lower health literacy generally had fewer communications with medical personnel regarding their own risk of disease.Individuals with higher health literacy tend to have better social‐related QOL. What this paper adds? Survivors with early‐stage breast cancer tended to be younger (aged 60 years or less) had normal body mass index, continued working, had no other illnesses and better physical health.Survivors with normal body mass index who had not received chemotherapy had better mental health.Health literacy was the main predictor and accounted for 20% of the variance in physical health and for 18.8% of the variance in mental health. Implications of this paper: Nurses should understand the importance of health literacy, which is a key factor to improve QOL for survivors with breast cancer.Nurses should develop individualized care plans for survivors based on different levels of health literacy to improve the efficiency of the nurse–patient dialogue. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate illness perceptions and their predictors among Chinese patients with type 2 diabetes. Methods: A descriptive, correlational, and exploratory design was used. The Chinese version of the Revised Illness Perception Questionnaire was modified and used to collect data between September 2016 and February 2017. Results: On average, patients recognized fewer than five of the 14 common symptoms of type 2 diabetes. Of the six causal factors, "dietary behaviours" had the highest mean score, while "psychological factors" had the lowest score. Most patients lacked understanding of type 2 diabetes mellitus. They perceived it as a chronic and stable illness, without negative affective response, and controllable by themselves and through treatment. Gender, age, marital status, educational level, family income, employment status, diabetes duration, diabetes‐related complications, comorbid conditions, number of hospital admissions, and the level of haemoglobin A1c were predictors of illness perceptions. Conclusions: The findings of the present study suggest that the illness perceptions of Chinese patients with type 2 diabetes should be improved. This evidence may enrich the theoretical understanding of illness perceptions and be used to develop interventions for enhancing illness perceptions in such patients. SUMMARY STATEMENT: What is already known about this topic? Diabetes has become a global epidemic and poses a major risk in terms of morbidity and mortality.Illness perceptions significantly influence the lifestyle and behavioural choices of individuals; this concept has been employed as part of an effective mechanism to improve behavioural change and health outcomes.Few studies have examined illness perceptions among Chinese patients with type 2 diabetes mellitus. What this paper adds? Of the 14 common symptoms of type 2 diabetes, Chinese patients with type 2 diabetes recognized fewer than five, on average.The patients lacked understanding of their illness, frequently believing that smoking was not related to their illness.Socio‐demographic factors (including gender, age, marital status, educational level, family income, and employment status) and clinical factors (including diabetes duration, diabetes‐related complications, comorbid conditions, number of hospital admissions, and level of haemoglobin A1c) are predictors of illness perceptions among Chinese patients with type 2 diabetes mellitus. The implications of this paper: The findings provide evidence regarding illness perceptions among Chinese diabetic patients, which adds to the international understanding of diabetes care.The findings help health care professionals to understand, recognize, and address illness perceptions and their predictors among patients with diabetes. [ABSTRACT FROM AUTHOR]

Aim: The awareness for the need for end‐of‐life care has increased among noncancer patients. However, studies on the topic have rarely targeted the needs of noncancer patients who want to die at home. This study assessed the end‐of‐life care needs of noncancer patients who were receiving care and wanted to die at home. Methods: A cross‐sectional study design was used and involved 200 participants who were diagnosed as noncancer patients and receiving home care nursing. Data were collected on demographics, disease, Palliative Performance Scale (PPS) scores, and end‐of‐life care needs, in April and May, 2016. Results: Among the six areas of care, "supporting fundamental needs" of patients required the most care, followed by "coordination among family or relatives." Multivariate analysis revealed that the duration of home care nursing held a significant association with end‐of‐life care needs. Conclusion: By reflecting on the comprehensive care needs of patients with chronic illnesses and including them in the care process, it will be possible to provide better quality palliative care to patients at home in the end‐of‐life stages. SUMMARY STATEMENT: What is already known about this topic? Noncancer patients at the end‐of‐life stage have complex needs and problems that are difficult to solve, compared with cancer patients.Noncancer patients need to receive effective symptom management or sufficient support for satisfactory care.End‐of‐life care is still mainly focused on cancer patients and attention to noncancer patients is lacking. What this paper adds? Among the six areas of care, "supporting fundamental needs" of patients required the most care, followed by "coordination among family or relatives."Duration of home care nursing and an income level were significantly associated with higher end‐of‐life care needs. The implications of this paper: Home care nurses must clearly assess the care needs of noncancer patients at the end‐of‐life stage and subsequently provide comprehensive patient‐centered care based on this assessment.It is important to adjust the care direction between patient, family, and medical staff from early on for patients who want to die at home.The results highlight needs for the development of interventions that focus on the duration of home care nursing of patients. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Patients with Korsakoff's syndrome suffer from a broad range of comorbid somatic and/or psychiatric conditions.The various health problems in patients with Korsakoff's syndrome limit their ability to perform daily activities and also negatively affect their social functioning. What the paper adds to existing knowledge?: Patients with Korsakoff's syndrome have complex somatic and psychiatric comorbid conditions co‐occurring with behavioural and functional problems. They are compounded by patients' poor self‐awareness regarding their health status and functioning. What are the implications for practice?: This review demonstrates that patients with Korsakoff's syndrome should receive integrated care.Integrated care for patients with Korsakoff's syndrome should be based on accurate multidimensional and multidisciplinary diagnostics in which nurses and nurse assistants have a prominent role due to their central position in the care process patients with Korsakoff's syndrome. Introduction: The literature shows that Korsakoff's syndrome is associated with a wide range of severe comorbid somatic and psychiatric health problems that lead to care needs in several domains of functioning. Aim: To provide a comprehensive overview of Korsakoff patients' health conditions and related care needs. Method: Following the PRISMA guidelines, we searched MEDLINE, PsycInfo, Cochrane Library and CINAHL up to January 2019. After applying our inclusion criteria, two reviewers independently selected the studies, extracted the data and assessed methodological quality. Results: Twelve articles were included. The commonest somatic comorbid conditions were liver disease, cardiovascular disease, COPD and diabetes mellitus. The commonest psychiatric comorbid conditions were mood disorder, personality disorder and psychotic disorder. Anxiety, aggressive/agitated behaviour, depressive symptoms and care needs in social functioning and (instrumental) activities of daily living were also very commonly reported. Discussion: In patients with Korsakoff's syndrome, somatic and psychiatric comorbid conditions co‐occur with behavioural and functional problems. They are compounded by patients' poor self‐awareness regarding their health status and functioning. Adequate responses to their care needs require high‐quality integrated care. Implications for practice: Patients with Korsakoff's syndrome should receive integrated care based on accurate multidimensional and multidisciplinary diagnostics in which nurses have a prominent role. [ABSTRACT FROM AUTHOR]

Accessible summary In the Western world, many people who have mental health problems experience poor physical health. Research suggests that those with mental illness often have difficulties in accessing health care services, reporting that when they do, their physical health needs are often overlooked., Nurses are expected to deliver safe and effective care that meets the needs of service users. In order to help mental health nurses address physical health care needs, changes to nurse education, supported by government policy, have been made in the United Kingdom. Despite these changes, mental health nurses still feel less confident and prepared to address physical health needs of service users. However, this same problem is also reported by nurses throughout Europe and in other Western countries, who have undergone different training and education programmes., This paper discusses important factors affecting the mental health nurses' ability to deliver physical care and how they impact on confidence and competence., The paper concludes by highlighting the role of the mental health nurse being key in addressing the physical health needs of those in their care, and how this will only be realized when education and practice provide sufficient opportunity for them to develop and maintain their knowledge and skills., Abstract In the Western world, there is increasing concern regarding the ability of health care professionals to meet the physical health care needs of those diagnosed with mental illness. This discussion paper seeks to explore some of the issues facing mental health nurses in delivering care to those who have both mental and physical illness. Criticism of the National Health Service for failing to meet the physical health needs of people with serious mental illness has generated a number of political strategies aimed at addressing inequalities between mental and physical health care, a consequence being a change in pre-registration nurse education. It is envisaged that such changes will enable all nurses to deliver safe, effective care to service users, with adult and mental health nurses being more adept at meeting both the mental and physical health needs of those in their care. The impact of three key areas identified within the literature will be considered: the impact of co-existing physical and mental illness; the role of mental health nurses and perceptions of service users re physical health care; and education, training and learning from others in the Western world. In conclusion, the complexities of delivering such care will be addressed. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments., Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services., Little is known about mental health nurses' perspectives about how to address these problems., What this paper adds to existing knowledge? Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive., The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation., Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular., What are the implications for practice? Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity., Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments., Abstract Introduction Mental health service users with medical co-morbidity frequently experience difficulties accessing appropriate treatment in medical hospitals, and often there is poor collaboration within and between services. Little is known about mental health nurses' perspectives on how to address these problems. Aim To explore mental health nurses' perspectives of the experience of service users with medical co-morbidity in tertiary medical services, and to identify how to improve care planning and coordination for service users transitioning between tertiary medical and primary care services. Method Embedded within an experience-based co-design study, focus group discussions were conducted with 17 emergency department nurses and other clinicians, in Melbourne, Australia. Results Three main themes were abstracted from the data: feeling confused and frustrated, enhancing service users' transition and experience and involving families and caregivers. Participants perceived the service user experience to be characterized by fear, confusion and a sense of not being listened to. They highlighted that service users' transition and experience could be enhanced by facilitating transitions and improving coordination and continuity of care. They also emphasized the need to increase family and caregiver participation. Conclusion Our findings contribute to knowledge about improving the way service users are treated in emergency departments and improving care planning and coordination; in particular, facilitating transitions, improving coordination and continuity of care and increasing family and caregiver participation. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Nurses play an important role in monitoring and supporting patients and their relatives at the end of life., To date, there is a lack of recent empirical research on the experiences of psychiatric nurses in providing palliative care to psychiatric patients who suffer from life-threatening physical co-morbidity., The limited literature available indicates that palliative care for psychiatric patients needs to be improved., What this paper adds to existing knowledge? This explorative study is unique in offering an insight into current palliative care practice for psychiatric patients and showed that one in three nurses working in Dutch mental health facilities is involved in palliative care provision., Important elements of palliative care, i.e.: care domains, multidisciplinary approach, early recognition and family care are recognized by nurses. Moreover, in palliative care for psychiatric patients there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders., Patient characteristics and little attention for palliative care within mental health facilities were found to hamper timely and adequate palliative care provision by nurses., What are the implications for research and practice? Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of this vulnerable patient group., Since mental health care is increasingly provided ambulatory, the development of palliative care for psychiatric patients outside mental health facilities should be closely monitored., Abstract Introduction Recent empirical research on palliative care for psychiatric patients is lacking. Aim The aim of this study was to explore nurses' experiences with and identify barriers to providing palliative care to psychiatric patients in Dutch mental health facilities. Methods Mixed-methods; 137 nurses working in Dutch mental health facilities completed a survey. Nine participated in in-depth interviews. Results Thirty-six percent of nurses had experience with providing palliative care to psychiatric patients with physical co-morbidity in the past 2 years. Of all patients, 63% received physical care before death, 46% psychosocial care and 33% spiritual care. In 91% of all cases, care was provided by multidisciplinary teams. Patient characteristics and little attention to palliative care were barriers for timely and adequate palliative care. Discussion In palliative care for psychiatric patients, there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Yet there are barriers to adequate palliative care provision. Implications for practice Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of psychiatric patients. Since mental health care is increasingly provided ambulatory, palliative care for psychiatric patients outside mental health facilities should be closely monitored. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Physical health problems, especially cardiovascular disease and metabolic disorders are far more common in people with severe mental illness ( SMI) than the general population., While there are a considerable number of studies that have examined the physical health and health behaviours of people with SMI in Western countries, there have been few studies that have done this in Asia., What this paper adds to existing knowledge? Unhealthy body mass index ( BMI) values were observed in 44% of Thai service users diagnosed with schizophrenia despite desirable levels of exercise and relatively good diets being reported by the majority of participants., Being prescribed two or more antipsychotics was significantly associated with greater body weight and a higher BMI than in people prescribed only one antipsychotic., What are the implications for practice? Mental health professionals in Asia should be particularly aware of the additional risks of obesity that seem to be associated with antipsychotic polypharmacy when they are promoting the physical health of people with schizophrenia., Abstract Introduction People with schizophrenia have worse physical health than the general population, and studies in developed countries demonstrate that their health behaviours are often undesirable. However, as no similar studies have been conducted in Asian countries with emerging healthcare systems, the physical health promotion challenges in these settings is unknown. Aim To identify and explore relationships between cardiometabolic health risks, lifestyle and treatment characteristics in people with schizophrenia in Thailand. Method This cross-sectional study reports the baseline findings from a physical health check programme using the Thai version of the Health Improvement Profile. Results Despite desirable levels of exercise and relatively good diets being reported by most of the 105 service users, unhealthy body mass index values were observed in 44% of participants. A BMI>23 kg/m² and central obesity was found to be most likely in women. Being prescribed antipsychotic polypharmacy was significantly associated with a higher BMI than in people prescribed monotherapy. Implications for Practice Mental health professionals in Asia should be aware of the additional risks of obesity that are associated with antipsychotic polypharmacy and may benefit from additional training in order that they may advocate for service users within medication reviews to minimize the potential iatrogenic effects of treatment. [ABSTRACT FROM AUTHOR]

Background Developed countries face increasing challenges to providing health care services for ageing populations, and new models of care and workforce practices are needed to address these challenges (Arbon et al. 2008). Although nurse practitioner (NP) roles are diverse (Carryer et al. 2007, Gardner et al. 2010), the potential role for aged care NPs working in primary care is relatively new (Arbon et al. 2008). Aims This study aimed to describe the implementation and challenges for the development of an aged care NP role within general practice. This paper reports on part of a larger study on the role of aged care NPs in primary health care, dementia and mental health services. Methods A mixed methods design was used to analyse the work of the NPs and challenges to the development of their role in general practice. The study followed two NPs in a general practice over the period from January 2012 to February 2014, with one experienced NP mentoring and transitioning responsibility to a newly endorsed NP. Both NPs worked part-time at the practice and were funded by the project. The NPs developed a business case for sustaining the NP role beyond the project funds during this time. Two researchers conducted repeated, semi-structured interviews with the NPs on their progress and challenges on implementation over the study period. Interviews were audiotaped and transcribed, and analysed using thematic analysis. Clients' episodes of NP care within general practice were de-identified and specific clinical (diagnosis, purpose of visit, actions taken) and demographic (age and sex) details extracted by the NP and entered into an SPSS database (IBM, Armonk, NY, USA) for descriptive and content analysis. The purpose of the visit and the actions taken by the NPs were used to analyse the work undertaken by the NPs. The patient/client-related work of the NPs was classified as direct care (activities performed for and in the presence of the patient/family, including explanations given to the patient/family/caregiver about these activities) and indirect care (activities performed away from the patient but on a specific patient's behalf, including coordination of care, collaboration with other health care professionals and documentation) (Gardner et al. 2010). Ethics approval was granted by the Tasmania Social Sciences Human Research Ethics Committee. Results The NPs saw 168 clients ranging from 29-99 years of age, the majority presenting with multimorbid conditions. Table 1 provides a summary of the demographic and clinical details of the clients consulting with the NPs. In the older (age ≥ 65 years) client group (n = 109), 19 clients (17%) were diagnosed with dementia and 7 (6%) with mild cognitive impairment. Seventy-three clients (67%) presented with multimorbidity - two or more multimorbid conditions as defined by the Cumulative Illness Rating Scale domains (Britt et al. 2008). Twenty-two (85%) of the clients with dementia/mild cognitive impairment had multimorbidity. One NP implemented a targeted weight loss programme, which engaged 43 clients (aged 29-79 years) during the last three months of the data collection period. Nurse practioners provided direct and indirect care. Direct patient care involved cognitive assessments, patient assessment and reviews, ordering and/or reviewing tests and medications, and liaising with family members. Indirect care comprised documentation and letters, and referrals to/coordinating care with other health professionals. The NPs' referrals included geriatricians, GPs, allied health professionals (e.g. physiotherapists, dieticians), social services (e.g. home care), and dementia support programmes. It takes time to develop collaborative practice between general practitioners (GPs) and NPs, with better understanding of respective roles and experience of working together being significant factors that improve collaboration (Schade-waldt et al. 2013). The implementation of the aged care NP role in the general practice required negotiation with practice managers, GPs and practice nurses. It was important 'to get a meeting with the practice managers so that we can start planning up a model ... we've got two years' (NP). The NPs reported several challenges to developing their role, including time to establish rapport and trust with the GPs and other staff in the general practice, regular access to consulting rooms and limitations arising from the part-time nature of the role (e.g. not being able to follow up in a timely manner). Initially, the NPs conducted many off-site and telephone consultations. Most of these encounters took place in clients' homes and in residential aged care facilities. The majority (74%) of these clients (median age = 85 years) presented with multimorbidity, particularly combinations in two or more of the cardiac, vascular, psychological, respiratory and muscu-loskeletal domains (Britt et al. 2008). The NPs perceived the acknowledgement by GPs that NPs, through their expertise and knowledge, were able to provide a consultative service to people in residential aged care facilities and the community: ... most of [the GP's] patients were in this particular nursing home and because he was the one going [to see them in the home, he said], "here's my nursing home patients, here's some in the community. Off you go, get started." (NP) In 2013, the general practice expanded and made more consulting rooms available to the NPs. One NP now has regular consulting rooms in the practice and is able to exercise professional autonomy, which is central to the NP role (Carryer et al. 2007). This resulted from the development of a successful business case for an aged/primary care NP role in general practice, which included NPs undertaking independent client assessments and reviews, and the implementation of specific programmes such as healthy ageing and weight loss. As one of the NPs remarked, configuring the NP role in this way involved 'aged care straddling into primary care'. Conclusions and relevance to clinical practice The implementation of an aged care NP role in general practice was achieved to some extent through building partnerships, particularly in specialised aged care assessment, and in creating a primary care role focussing on healthy ageing lifestyle programmes and disease management. The hybrid aged/primary care NP role offers opportunities for coordination between aged care and general practice, given an ageing population and the increasing burden of chronic conditions. A sustainable, professionally supported, combination aged care NP role can add value to general practice with the provision of cost-effective, holistic primary care but must augmented by independent practice opportunities for the NP. [ABSTRACT FROM AUTHOR]