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This study explores the experiences of nurses that provide 'complex', generalist healthcare in hospital settings. Complex care is described as care for patients experiencing acute issues additional to multimorbidity, ageing or psychosocial complexity. Nurses are the largest professional group of frontline healthcare workers and patients experiencing chronic conditions are overrepresented in acute care settings. Research exploring nurses' experiences of hospital‐based complex care is limited, however. This study aims to add to what is known currently. Four 'complex care' nurses undertook in‐depth semistructured interviews and their narratives were analysed using the conceptual framework of complex adaptive phenomenology. Two overarching themes constituting the 'essence' of complex care nursing were identified: Contextual factors and attribute/value‐based elements. Creating meaningful patient outcomes and feeling part of a team were experienced as fulfilling, whereas time constraints, institutional settings and systemic barriers to comprehensive caregiving diminished the experience of providing complex care. Overall, work meaning presented as a dynamic phenomenon, shaped by personal and professional values, local settings and systemic factors. It is recommended that more expansive research be undertaken to explore the experience of complex care for nurses. Such knowledge can contribute to initiatives that draw a skilled, effective and engaged hospital‐based complex care nursing workforce. [ABSTRACT FROM AUTHOR]

Rationale: Healthcare research exploring the lived experiences of health care professionals from different disciplines, such as nursing, medicine, and allied health, has repeatedly highlighted many methodological challenges, especially in understanding the individual human experience within complex systems. In response, complexity theory and phenomenological approaches emerged and evolved in ways that potentially offered researchers frameworks to inform an understanding of the individual human experience. However, while these two theoretical approaches inform a method of inquiry, there is a gap in understanding the phenomenon of 'being' and how this is embodied within complex systems such as the healthcare system. The Aims and Objectives: The aim of this paper is to present an integrated theoretical framework, namely complex adaptive phenomenology (CAP). CAP aims to address this inquiry gap by offering a structured conceptual framework wherein complexity theory and phenomenology are complementary but multi‐dimensional. The key objective of CAP was to synthesize and integrate two methods of inquiry that examine the relational aspects of 'being', that is the gestalt of perception, action, and context, The authors argue that CAP is well‐suited to complex research contexts such as healthcare. The framework focuses on the reciprocal, co‐constructive relationships extant between perception, meaning, context, and action that shape experiences of 'being' within complex systems. Complexity theory's connectionist orientation explains the relationships that are formative of the experience of being, while phenomenology explores the manifestations of these formative relationships by attending to the notion of 'being' itself. Conclusion: The authors propose that an integrated framework, of phenomenology and complexity theory, can provide a platform for deeper understandings of the experiences of health professionals and contribute to healthcare scholarship. [ABSTRACT FROM AUTHOR]

Increasingly, complexity science concepts are informing health care design and practice. The present paper describes the implementation of early complexity science principles in a Complex Care Program with the aim of strengthening the provision of integrated care. Grounded in cybernetic network theory, Stafford Beer's Viable Systems Model [1] provided the guiding principles for the program's redesign. The Viable Systems Model with its broadly applicable principles [1], is now the conceptual model of information management in the program. Beer's framework has enabled a relatively small number of clinicians to coordinate care for a large cohort of patients with significant clinical complexity, and a multitude of providers, in the community setting. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners have been well-established in many parts of the world and valued as a senior role in healthcare systems. This paper offers an appraisal of a palliative care nurse practitioner model of care project and augments an understanding of being a nurse practitioner (NP) in the Australian context. Aims: To enhance outcomes for people regardless of care setting; and to enhance professional relationships between hospital and community services. A secondary objective was to facilitate a seamless transition from one service to another. Methods: The setting was a home-based palliative care service and a tertiary acute hospital, between which the role was employed. This paper describes the role from the NP's perspective, using the NP's log of work and personal reflections. Results: Despite describing many challenges, an NP shared model of care has benefits not just for smoothing the client's journey through settings of care, but also for increased opportunities for clinicians to work together. Conclusions: There are opportunities for further research, including models of role implementation, the skills required by the clinician, and acceptance and respect of the NP role. [ABSTRACT FROM AUTHOR]

Objective: This study compared the prevalence of homelessness in consecutive patients presenting to a metropolitan hospital ED measured via a prospective housing screen with the prevalence of homelessness determined via retrospective audit of hospital data. Factors that altered the odds of patients being homeless and service outcomes that differed were examined for screened patients. Methods: All patients presenting to the ED during a 7 day period in 2017 were invited to complete a housing screen. A retrospective audit of all ED presentations during the same period also occurred. Demographic (e.g. age, gender), clinical (e.g. reason for presentation, ED presentation history) and arrival mode (e.g. time, how arrived) predictors of homeless status were examined alongside care outcomes (e.g. ED length of stay, admission and 28 day re‐presentation). Results: Of 1208 presenting patients, 504 were prospectively screened and 7.9% were homeless. This compared with 0.8% of ED presentations coded as homeless in the Victorian Emergency Minimum Dataset and 2.3% of the 704 non‐screened patients identified as homeless using Victorian Emergency Minimum Dataset Usual Accommodation alongside primary diagnosis and registration address. Within the screened sample, homeless patients were more likely to be male, arrive by emergency ambulance/with police, have a psychosocial diagnosis, and be frequent presenters. Re‐presentation within 28 days occurred for 43% of homeless and 15% of not‐homeless patients. Conclusions: Hospital ED administrative data substantially under‐recognises the prevalence of homelessness in presenting patients. Standardised use of brief housing screens could improve identification of and provision of support to this often highly vulnerable population. [ABSTRACT FROM AUTHOR]