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Background: Intensive care nurses frequently encounter ethical issues with potentially severe consequences for nurses, patients, and next of kin. Therefore, ethical issues in intensive care units (ICU) should be recognized and managed., Research Objectives: To analyze ethical issues reported by intensive care nurses and how reported issues were managed within the organization using register data from the HaiPro critical incident reporting system (CIRS), and to explore the suitability of this system for reporting and managing ethical issues., Research Design: This was a retrospective descriptive register study. CIRS reports on ethical issues in adult ICUs ( n = 12) in one hospital district in Finland over 25 months (2019-2021) were analyzed through inductive content analysis and descriptive quantification. The CIRS's suitability for reporting and managing ethical issues was evaluated through a strengths, weaknesses, opportunities, and threats (SWOT) analysis., Ethical Considerations: The study was approved by the University Ethics Committee, and permission to conduct the research was granted before data collection within the organization., Results: CIRS reports on ethical issues ( n = 35) made by nurses were found in seven of the 12 ICUs. The CIRS managers of these units managed these reports. The ethical issues described by the nurses were divided into four main categories: nature, situational information, consequences, and contributing factors. Management of reported ethical issues was divided into three main categories: preventive actions proposed by nurses, proposals for actions by CIRS managers, and actions taken by CIRS managers., Conclusions: Systematic register data broadly describe ethical issues and their management, indicating that the CIRS could be suitable for reporting and managing ethical issues, thereby enabling the monitoring and development of ethical quality at the unit and organizational levels., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Ethics is a fundamental component of nursing education to increase students' moral competence and moral reasoning abilities. However, the core ethics content that should be included in undergraduate education has not been established to date at the international level., Aim: To identify the core contents required in formal undergraduate education to ensure morally competent nurses., Research Design: An international workshop-research study design in 2023 reported here according to the COnsolidated criteria for REporting Qualitative research., Participants and Research Context: Five countries in the context of Promoting a Morally Competent Nurse project participated. In each country, two workshops took place, one with nurse professionals and one with patients' representatives for a total of 58 individuals (32 and 26, respectively). After being translated into English language, data were categorized deductively. The Dublin Learning Outcomes Descriptors and the blueprint methodology were applied., Ethical Considerations: The research protocol was ethically approved in every country where the study was performed., Results: A total of 59 core content elements emerged, with 'ethics of individualized/tailored/patient-centred care' ( n = 8) and 'empathy' ( n = 6) as the most suggested. Nearly half ( n = 26) of the core content items suggested were reported only once (e.g. 'priority setting') while overall several referred to 'communication skills' ( n = 17). A diverse richness across countries emerged, with some suggesting a few items, and others providing several. Similarly, professionals and patients in most countries agreed that some contents of individualized care, empathy and responsibility should be taught in nursing education, but several core contents were mentioned by only one group of participants and in one country., Conclusion: The lack of convergence on core content to be taught suggests that different views are still present. Merging these perspectives may stimulate a reciprocal understanding between professionals and patients, as well as across countries, and support the identification of commonalities and differences to further harmonize undergraduate education in the field., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Nurses' well-being at work (WAW) is important for overall health care outcomes. Nurses often navigate complex roles, contending with time constraints, ethical challenges and societal undervaluation, underscoring the necessity of addressing their WAW., Methods: The aim of this systematic review was to analyse the interventions that potentially improve nurses' WAW in care settings for older people. The ultimate goal is to provide an understanding of this field and advance the development of WAW interventions. We performed a systematic review which was registered in PROSPERO and conducted according to PRISMA guideline. We conducted a comprehensive literature search across five scientific databases and one platform in February 2023., Results: Out of 5975 records, we included 21 full-text articles in the review. Interventions were typically complex and focused on (a) nurses' health, (b) nursing care, (c) care facilities and (d) management. Interventions resulted in a range of outcomes on the (a) physical, (b) psychosocial and (c) environmental dimensions of WAW, with most interventions leading to positive outcomes, albeit with instances of negative and neutral results., Conclusions: Interventions focusing on nurses' health or care facilities can be promising to improve WAW of nurses working in care settings for older people. Interventions aimed at improving the WAW have focused on various aspects. Despite the mainly positive outcomes, some interventions can also compromise nurses' WAW., Implications for Practice: Strategies and interventions aimed at improving nurses' WAW are needed in practice as nurses' WAW is crucial in recruiting to and retaining nurses in care settings for older people. Promoting WAW also contributes to the quality of care for older people and the provision of ethically high-quality health services., Trial Registration: The review protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42023399478)., (© 2024 The Author(s). International Journal of Older People Nursing published by John Wiley & Sons Ltd.)

Aims: This study describes nurse leaders' experiences of nursing leadership in Finland towards Magnet hospital culture., Design: This is a qualitative descriptive study., Methods: The data from nurse leaders (n = 9) were collected in face-to-face or online interviews in June and August 2023 in Finland and analysed using an inductive content analysis approach., Results: Excellent nursing leadership consists of possibilities for impact, the determination of responsibilities, strong leadership in the organisation, interpersonal leadership, the empowerment of nurses' excellence and nursing leadership development. In addition, excellent nursing leadership creates the basis for development structures and nurses' participation in a Magnet culture framework., Conclusion: Excellent nursing leadership requires ability and opportunities for impact, clear responsibilities and strong interpersonal competencies so that nurses are empowered to strive for excellence. Strong nursing leadership is needed to enable functioning structures that produce efficient processes that can be used to maintain and develop the quality of nursing work in the direction of Magnet culture., Implications for the Profession: Nurse leaders' status and power must be recognised and legislated as equally as those of other professional leaders in social and health care., Impact: This study addresses nurse leaders' remarkable role in nursing development towards Magnet hospital culture. At the same time, it discusses their uncertain position in the decision-making process of the organisation., Reporting Method: COREQ guidelines were used in reporting., Patient or Public Contribution: None., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background : Individualizing care is the essence of nursing, and its benefits have been extensively proven in older people. The changes arisen during the COVID-19 pandemic may have affected it. The aim of this study is to analyze the changes produced in the perceptions about the individualization of care, quality of life, and care environment of elderly people living in long-term care centers before and after the pandemic. Methods : A prospective cross-sectional observational study was carried out. For data collection, the Individualized Care Scale-patient, the EuroQol-5D scale, and a reduced version of the Sheffield Care Environment Assessment Matrix test were used, and a statistical analysis was performed. Results : A total of 177 people participated in the study, with 87 pre-COVID-19 and 90 post-COVID-19, 62.7% of whom were women. The average age was 83.3 years. General activities of the individualized care obtained medians of 4, 2.5, and 3 (out of 5) in clinical situation, personal life situation, and decisional control dimensions, respectively, and no substantial change was observed pre- and post-pandemic. Nevertheless, 10 out of 17 items related with the maintenance of individuality in the last shift were higher rated after COVID-19. They are mainly related to the feelings and needs of care, daily life activities, and the expression of opinions. The median of all items was 3 despite the improvement observed after the pandemic. Residents scored an average of 6.47 points (out of 10) in the life quality self-evaluation and were satisfied with the care environment (94%). Patients with higher life quality and adherence to their environment perceived better care. Conclusions : Although slight improvements were observed in the individualized care after the pandemic, the obtained results revealed that there is still room for improvement. Particularly, it is necessary to develop strategies aimed at motivating the family participation or providing individual spaces in the residences.

Ethics is a foundational competency in healthcare inherent in everyday nursing practice. Therefore, the promotion of qualified nurses' and nursing students' moral competence is essential to ensure ethically high-quality and sustainable healthcare. The aim of this integrative literature review is to identify the factors contributing to the promotion of qualified nurses' and nursing students' moral competence. The review has been registered in PROSPERO (CRD42023386947) and reported according to the PRISMA guideline. Focusing on qualified nurses' and nursing students' moral competence, a literature search was undertaken in January 2023 in six scientific databases: CINAHL, Cochrane Library, PsycINFO, PubMed Medline, Scopus and Web of Science. Empirical studies written in English without time limitation were eligible for inclusion. A total of 29 full texts were retrieved and included out of 5233 citations. Quality appraisal was employed using Joanna Briggs Institute checklists and the Mixed Method Appraisal Tool. Data were analysed using inductive content analysis. Research about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence is limited and mainly explored using descriptive research designs. The contributing factors were identified as comprising two main categories: (1) human factors, consisting of four categories: individual, social, managerial and professional factors, and ten sub-categories; and (2) structural factors, consisting of four categories: educational, environmental, organisational and societal factors, and eight sub-categories. This review provides knowledge about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence for the use of researchers, nurse educators, managers, organisations and policymakers. More research about the contributing factors is needed using complex intervention, implementation and multiple methods designs to ensure ethically sustainable healthcare., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: To describe how nurses' moral competence can be supported from the perspective of nurses, nurse managers, researchers, educators, and nursing students., Background: Moral competence is the capacity or ability of nurses to recognise one's own emotions of what is right or wrong, to reflect on these emotions, to make decisions, and to act in ways that bring the highest level of benefit to patients. Moral competence is part of professional competence. However, little is known about how nurses' moral competence can be supported., Methods: A qualitative descriptive study design was applied. Stratified purposive sampling was employed and focus group discussions were conducted in Belgium, Cyprus, Finland, Greece, Ireland, and Italy in 2023. A total of 38 informants (5-8 per focus group) who were registered nurses or nursing students participated. The data were analysed using both deductive and inductive content analysis. The COnsolidated criteria for REporting Qualitative research were adhered to., Results: Seven themes were developed following analysis, which suggested that support for nurses' moral competence can be located at individual-relational, organisational, and societal levels. Several approaches and/or tools were also identified to support moral competence., Conclusion: Nurses' moral competence could benefit from continuous support from colleagues, those in leadership positions, organisations and society. Practical tools and approaches can also successfully support nurses' moral competence., Implications for Nursing and Health Policy: Support for nurses' moral competence forms a continuum from the beginning of nursing studies throughout nursing careers. Thus, educational interventions and training programmes are needed both at basic and continuous ethics education. There is also a need for investments in and development of strategies and regulations on ethics management in health systems, national- and international-level ethics indicators for health policy-making, and implementation of existing practices, interventions, and procedures in nursing practice., (© 2024 The Author(s). International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

Background: Moral courage is defined as the courage to act in ethical conflicts based on individual or professional values despite the personal risks involved. Nurses justify their decisions to act morally courageously as part of their ethical decision-making. Objective: To describe registered nurses' justifications for acting morally courageously, or not, in ethical conflicts where they needed moral courage. Research design: A narrative inquiry with a holistic content approach was used. Individual, in-depth interviews were conducted in January-February 2023. The data were analysed using holistic content analysis. Participants and research context: Fourteen registered nurses with experience in situations where they needed moral courage participated. The nurses came from the somatic, palliative, mental health, and substance abuse care fields in Finland. Ethical considerations: Good scientific practice was followed. Ethical approval was obtained before data collection from the university's ethics committee. Findings: The nurses needed moral courage in ethical conflicts with patients present and between professionals. Individual responsibility, professional ethics, and emotions were identified as bases of nurses' justifications for morally courageous acts. The justifications for acting morally courageously, or not, had individual, contextual, and organisational perspectives. Morally courageous acts included starting a discussion about the conflict with other professionals and reporting the situation in writing within one's organisation. Discussion and conclusions: The identified bases and perspectives of justifications illustrate the complexity of nurses' decision-making in ethical conflicts, either leading to morally courageous acts or not. These results can inform nursing practice and research in developing processes to strengthen nurses' moral courage and examining relationships between moral courage and other concepts, such as moral resilience., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Problem: Despite advances in diabetes technology, many adolescents with type 1 diabetes (T1D) cannot achieve target metabolic control. Resilience is associated with better outcomes in diabetes care. The aim of this review is to synthesize studies on resilience in adolescents with T1D, particularly how the concept of resilience has been explored., Methods: This integrative review was carried out according to Whittemore and Knafl's framework. A systematic search was conducted in the CINAHL, PubMed/Medline and PsycInfo databases. Eligibility criteria included studies on resilience in adolescents with T1D, aged 13 to 18 years, that were published in English in peer-reviewed scientific journals. The Mixed Methods Appraisal Tool was used to assess study quality., Results: The review included twenty-four studies. Resilience was defined as the ability or capacity, or the process, to maintain physical and psychological well-being despite exposure to significant stressors or distress events. Diabetes resilience was defined as achieving positive psychosocial and health outcomes despite the challenges of living with T1D. Studies were quantitative (n = 21), qualitative (n = 1) and mixed methods (n = 2). Six resilience instruments were found. The DSTAR-Teen was the most used and the only instrument for adolescents with T1D., Conclusions: This review highlighted the need for an explicit definition of the concept of resilience because previous studies used different definitions or lacked a definition. In the future, a more precise concept analysis of resilience in adolescents with T1D is warranted., Implications: The DSTAR-Teen is a promising resilience measure with good psychometric properties for further studies in adolescents with T1D., Competing Interests: Declaration of competing interest No conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Older people's autonomy is an ethical and legal principle in everyday residential care, but there is a lack of clarity about the roles and responsibilities of the key professional stakeholder groups involved., Research Objectives: This study aimed to identify and define the roles and responsibilities of the key professional stakeholder groups involved in promoting older people's autonomy in residential care settings., Research Design: We used a Delphi method with two iterative rounds of online group discussions and collected data from experts in older people's care in Finland in summer 2020. The data were analyzed using deductive-inductive content analysis methods., Ethical Considerations: According to Finnish legislation, this type of research did not need approval from a research ethics committee. Informed consent from the participants was obtained and they were informed about the voluntary nature and confidentiality of the study and their right to withdraw at any time., Results: Key professional stakeholders had different roles and responsibilities, but their shared, integrated goal was to achieve older people's autonomy in residential care settings. Their combined roles and responsibilities covered all aspects of promoting older people's autonomy, from care and service planning and daily decision-making to service structures that included ethical competencies and monitoring. Multipronged, variable, coordinated strategies were required to identify, assess, and promote autonomy at different levels of care., Conclusion: Key professional stakeholders need to work together to provide an unbroken chain of care that provides older people with autonomy in residential care settings. In future, more knowledge is needed about how to create structures to achieve the shared goal of older people's autonomy in these settings., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Each year, more than 1.5 million people in Europe have a stroke, and many experience disabilities leading to activity and participation restrictions. Home-based rehabilitation is the recommended approach for stroke rehabilitation, in line with the international shift to integrated care. Despite this, rehabilitation often focuses on the person's physical functions, not the whole life situation and opportunities to live an active life. Given that rehabilitation today is often provided in the person's home, there is a need to develop new models that consider the rehabilitation process as situated in the everyday living environment of persons with stroke. This project is grounded in experiences from our ongoing research, where we study the importance of the home environment for health and participation among persons with stroke, rehabilitated at home. This research has shown unmet needs, which lead to suboptimal rehabilitation outcomes. There is a need for studies on how to use environmental resources to optimize stroke rehabilitation in the home setting., Objective: The overarching objective of the project is to develop a new practice model for rehabilitation where the needs of the person are the starting point and where the environment is considered., Methods: The project will be conducted in partnership with persons with stroke, significant others, health care professionals, and care managers. Results from a literature review will form the base for interviews with the stakeholders, followed by co-designing workshops aiming to create a new practice model. Focus groups will be held to refine the outcome of the workshops to a practice model., Results: This 4-year project commenced in January 2023 and will continue until December 2026. The results of the literature review are, as of April 2024, currently being analyzed. The ethics application for the interviews and co-design phase was approved in October 2023 and data collection is ongoing during spring 2024. We aim to develop a practice model with stakeholders and refine it together with care managers and decision makers. The outcome is a new practice model and implementation plan, which will be achieved in autumn 2026., Conclusions: The project contributes with a prominent missing puzzle to optimize the rehabilitation process by adding a strong focus on user engagement combined with integrating different aspects of the environment. The goal is to improve quality of life and increase reintegration in society for the large group of people living with the aftermath of a stroke. By co-designing with multiple stakeholders, we expect the model to be feasible and sustainable. The knowledge from the project will also contribute to an increased awareness of the importance of the physical environment for sustainable health care. The findings will lay the foundation for future upscaling initiatives., International Registered Report Identifier (irrid): DERR1-10.2196/56996., (©Marie Elf, Lizette Norin, Louise Meijering, Hélène Pessah-Rasmussen, Riitta Suhonen, Magnus Zingmark, Maya Kylén. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 23.07.2024.)

Background: Ensuring morally competent nurses depends on many factors, such as environmental, social, political, and cultural. However, several inadequacies in nursing education have been documented, and no common framework has been established for how nursing ethics should be taught in undergraduate education., Research Questions: What are the different approaches across nursing programmes established in teaching ethics? What are the main similarities and differences across programmes facilitating a common understanding in developing a curriculum capable of preparing a morally competent nurse?, Research Design: International comparative education study in five steps: (1) formulating the initial question; (2) defining the units of comparison; (3) determining the variables of comparison; (4) describing the findings; (5) interpreting the findings. The comparative variables were identified, extracted, and populated in a piloted grid., Participants: Six universities were purposefully selected by the Promoting a Morally Competent Nurse project partners for their nursing education curricula as delivered in 2022-2023., Ethical Considerations: No ethical approval was required, given no human participants and public data regarding nursing curricula., Findings: Variability emerged in the terminologies used in naming the courses, the numbers of credits and hours devoted to teaching ethics, when the courses are delivered (since the initial semesters of nursing education or concentrated in the final years), and their main modes of delivery (a single or separate module or integrated across the curriculum). Contents have some similarities, whereas the teaching methods varied and included (or not) explicit connections with clinical practice. Attendance is mandatory in all courses. The assessment methods used varied from knowledge-based to more competence-based approaches involving multidimensional strategies., Conclusions: This comparative study explored similarities and differences across nursing programmes in six different European countries. The reviewed ethics curricula lack significant clarity, and they offer important areas to consider for future development. Issues emerged regarding terminologies, learning workloads, when to deliver, how to deliver, the main contents, and the teaching and assessment methods that merit further discussion., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: To describe the development of the Actualisation of Evidence-Based Nursing instrument targeted at nurses working in clinical practice (ActEBN-nurses), meant for evaluating the actualisation of individual and organisational-level support structures for evidence-based nursing within social and healthcare organisations, and to test its validity and reliability., Design: Cross-sectional survey., Methods: The FinYHKÄ model was used as the theoretical background of the instrument development and supplemented with the JBI Model of Evidence-Based Healthcare, previous literature and items from a previous instrument, the Evidence-Based Practice Process Assessment Scale, with permission of the copyright holders. After two rounds of expert panel and piloting, a national survey was conducted with the instrument in 2021. The target group consisted of nurses working in clinical practice. Psychometric testing included internal consistency (Omega, item analysis) confirmatory factor analysis and t-test for comparison of two groups' differences (sensitivity)., Results: A new instrument, ActEBN-nurses was developed, comprising two parts: Individual-level (32 items, 5-point Likert-scale) and Organisational-level support structures for evidence-based nursing (37 items, 5-point Likert-scale). In total, 1289 nurses participated in the survey. The ActEBN-nurses proved to have good internal consistency in both parts (Omega ω .931 and .966), structural validity and sensitivity based on the two educational levels within the sample. The structure of both parts was slightly modified, based on the CFA modification indices, considering the impact of the reverse worded items in part Individual and redundant items within both parts., Conclusion: The ActEBN-nurses has promising psychometrics, and it can be used for evaluating individual and organisational-level support structures for evidence-based nursing within social and healthcare organisations., Implications for the Profession And/or Patient Care: Evaluation of the support structures within social and healthcare organisations is needed to recognise shortcomings in current structures and advance evidence-based nursing across different contexts., Reporting Method: The authors state that they have adhered to relevant EQUATOR guidelines: STROBE statement for cross-sectional studies., Patient or Public Contribution: No patient or public contribution., (© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Foot health services for people with rheumatoid arthritis (RA) are an important part of their comprehensive care. However, little is known about the perceptions of people with RA have about foot health services. This study aimed to explore how people with RA perceive foot health services., Methods: A descriptive cross-sectional survey design was applied. The electronic survey data were collected in April 2023 from people with RA through a national patients' association (N = 2400, response rate 24%, n = 565). The statistical data were analysed using descriptive statistics and textual data with thematic analysis., Results: Most of the respondents (n = 322, 59%) had used foot health services provided by chiropodist or podiatrist. Those who had used services were mostly satisfied but considered patient education about foot health insufficient. One third reported no visits to foot health services at all because of personal and health service system-related factors., Conclusions: Those people with RA who have access to foot health services value and appreciate the services. However, many people with RA do not use foot health services because they perceive availability of such services limited and thus unequal and hard to access. There is a need to develop foot health services for people with RA so that they are easy to access, correspond to their foot health needs and have seamless care paths at different levels of the health care system., (© 2024 The Authors. Journal of Foot and Ankle Research published by John Wiley & Sons Australia, Ltd on behalf of Australian Podiatry Association and The Royal College of Podiatry.)

Background: Based on previous evidence person-centred care (PCC) as a quality indicator is important in long-term care (LTC) settings for older people. Effective ways to increase nurses' person-centred care competence are missing., Aim: To evaluate the effectiveness of a continuing education (CE) intervention named 'Person First-Please' (PFP) for improving nurses' PPC competence and its connection to PPC climate., Methods: Quasi-experimental cluster design with intervention and control groups was carried out in LTC settings for older people. The intervention group (n = 77) received a 10-week CE intervention, with control group (n = 123) working as usual. The primary outcome was professional nurses' PCC competence. Secondary outcome was the PCC climate as perceived by nurses and, residents with their next of kin. Measurements were conducted pre-/post-intervention and after 6 weeks using the validated, Person-centred Care Competence scale and the Person-centred Care Climate questionnaire, staff and patient versions. Data was analysed with descriptive and inferential statistics., Results: PCC competence was significantly increased in the intervention group and remained after 6 weeks of follow-up. PCC climate increased in the intervention group in total score and also in all sub-scales, across residents with their next of kin. The control group did not show any significant change. Comparisons of PCC competence and PCC climate in time between intervention and control groups confirmed that changes seen between groups were statistically significant in intervention group., Limitations: Measurements were self-assessments, which may have been affected by bias, especially in context of competence assessment., Conclusion: The intervention was effective in increasing professional nurses' PCC competence and on person-centred care climate in long-term care settings for older people., (© 2023 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Background: Doctor of Philosophy (PhD)-prepared nurses are expected to exercise leadership in their various roles. Therefore, European nurse scholars developed a cross-national web-based Nursing Leadership and Mentoring Educational (Nurse-Lead) program., Purpose: To evaluate changes in leadership practices, professional and research competencies as well as career development of PhD-prepared nurses and doctoral nursing students after participation in the Nurse-Lead program., Methods: A pre-post-test evaluation was conducted. Surveys addressed leadership, professional and research competencies, and career development. Quantitative data were analyzed with descriptive statistics and paired sample t-tests. Content analysis was used for qualitative data., Discussion: The 30 participants showed significant improvements in all leadership practices, professional competencies, and most research competencies. Participants reported increased confidence in decision-making, taking on new responsibilities, and becoming more visible within research teams., Conclusion: Web-based, international leadership and mentoring programs are promising tools for the leadership and professional development of PhD-prepared nurses and doctoral nursing students., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: To integrate research literature regarding careers, career development and factors influencing the career development of doctorally prepared nurses., Design: An integrative review., Data Sources: Medline, CINAHL and Embase were searched in June 2022 without time restrictions., Methods: Peer-reviewed empirical publications written in English with different types of study designs were included. Two researchers independently applied eligibility criteria, selected studies and conducted quality appraisals using Joanna Briggs checklists. Data were extracted and analysed using a convergent integrated approach with thematic analysis. Themes were established within three categories based on the research questions: career, career development and factors influencing career development., Results: Twenty-two studies were included. Nine themes were identified. One theme regarding careers describes that doctorally prepared nurses need to prioritize work within different positions. The two themes focusing on career development described the need to determine career goals after the doctorate and further develop competencies. Six themes described factors influencing career development: 'Intrinsic motivation to improve health care and nursing education', 'Available support sources', 'Professional development programmes', 'Work-life balance', 'Organizational infrastructures for career advancement' and 'Competition and hostile treatment among colleagues'., Conclusion: Limited knowledge of the careers and career development of doctorally prepared nurses was found. Doctorally prepared nurses need to balance work with various part-time positions. Careers and career development could be supported by the development of structures for career advancement as well as supportive working environments., Impact: Doctorally prepared nurses with strong careers are important to health care and nursing as they generate and implement new knowledge into clinical practice and thereby support the improvement of (nursing) care and patient outcomes. This study provides considerations towards strengthening the careers of doctorally prepared nurses., Reporting Method: PRISMA., Patient or Public Contribution: No Patient or Public Contribution., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Professional care workers face ethical issues in long-term care settings (LTCS) for older adults. They need to be independent and responsible, despite limited resources, a shortage of skilled professionals, global and societal changes, and the negative reputation of LTCS work., Research Aim: Our aim was to describe the care workers' lived experiences of ethical issues. The findings can be used to gain new perspectives and to guide decision-making to improve the quality of care, occupational well-being and nursing education., Research Design: Focus group interviews were analyzed using a hermeneutic-phenomenological method. The analysis comprised three steps: naïve reading, structural analysis, and comprehensive understanding., Participants and Research Context: We randomly sampled LTCS service providers in Finland and 53 care workers with different educational backgrounds from seven organizations participated in focus group interviews in 2021., Ethical Considerations: This was a sensitive study, which was connected to the participants' individual views of the world, professional ethics and social and health care legislation. The participants' provided informed consent and their anonymity was guaranteed., Findings: Care workers spoke about their lived experiences of ethical issues in an emotional way, using practical examples. They talked about how they were experts at caring and advocating for residents, balanced the responsibilities of their different roles, and defended their work to the wider society. The care workers said that ethical aspects of their work were too difficult to solve on their own. There were elements of their working environment and practices that caused unnecessary strain and they needed the commitment of managers, organizations, and society to solve ethical issues in LTCS., Conclusions: Ethical issues were related to the well-being of both residents and care workers and reflected both internal and external pressures. Some issues could not be resolved by individuals and needed input from managers, organizations, and society., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Foot health and lower extremity function are important in older people with rheumatoid arthritis (RA), as they maintain and promote these individuals' independent living and functional health. RA is a long-term inflammatory health condition that alters foot structure and function. Relatively little is known about the association between foot health and lower extremity function in older people with RA. Therefore, the aim of the study was to analyse the levels of foot health and lower extremity function in older people with RA and to explore the associations between these factors., Methods: A cross-sectional survey design study was conducted. The data were collected online in April 2023 from a national association of patients with rheumatic conditions in Finland using two instruments: the Self-administered Foot Health Assessment Instrument (S-FHAI) and the Lower Extremity Function Scale (LEFS). The data were analysed using descriptive and inferential statistics., Results: Older people with RA (n = 270) reported many foot health problems, the most common of which were foot pain, dry skin, and oedema. Lower extremity function in older people with RA was at the mild-to-moderate functional limitation level and respondents reported major difficulties running or hopping, squatting, carrying out their usual hobbies, performing strenuous activities outside their homes or putting on shoes/socks. Poor levels of foot health were correlated with decreased lower extremity function., Conclusion: Foot health is associated with lower extremity function in older people with RA. Therefore, it is essential that older people with RA be provided with systematic foot health assessments, care and rehabilitation to promote their lower extremity health and improve their functional health. Multiprofessional collaboration and seamless care chains at different levels of health care could benefit older people with RA looking to maintain their functional ability and - above all - promote their active ageing., (© 2024 S. Karger AG, Basel.)

Background: Patient stress is often overlooked in the care of patients with neurological problems. Nursing theorists have previously heralded stress assessment through conceptual clarification, while clinical nurses in the health care system hold an ideal position for implementation of assessment and coordination of support. Integrated with a hospital assessment and support scheme, recognition of stress as a target of systematic assessment can lead to improved clinical outcomes., Objective: The aim of the study was to describe and compare patient-reported outcome measures suitable for assessment of the stress response as symptoms in neurological patients., Design: This study is an integrative review and concept development of patient stress based on qualitative and quantitative analysis of available self-reporting instruments., Methods: Instruments were retreived with a systematic search from PubMed, CINAHL, PsychINFO and Web of Science reference databases on August 2, 2021. Search terms associated with the concept of stress symptoms were used. Instrument inclusion was done with the guidance of authoritative symptom inventories, with partial confirmation by a second author to mitigate bias. In the analysis, the instruments included in the review were quantitatively described and compared. Insights from the instrument composition led to clarification of our concept of stress response to further refine the list of instruments suitable for self-assessment of the stress status. This study was not registered., Results: Based on the inclusion criteria, 23 patient-reported outcome measures extending over a variety of stress concepts were included. The similarity of items among the instruments implied a symptom cluster delineated by 59 common symptom subclasses that were grouped together in a re-classification of instrument items. A comparative quantitative analysis prompted us to distinguish the concept of stress response from antecedent, consequent, and related concepts as a manifestation of mental, somatic, and behavioral domains. Ten instruments with items covering the three domains, each with unique qualities regarding number of items, measured spread, and letter count were described., Conclusions: Within an organizational framework, effective allotment among types of support can be founded on the patient's stress status and the stressors. The stress status manifests itself as a set of measurable symptoms. Optimal instruments for use in systematic clinical assessment of neurological patients' stress status should satisfy the suggested specification of the stress response with a minimal number of items and concise wording. Finding and including the relevant instruments for analysis were the main limitation of the study., Tweetable Abstract: Stress of neurological patients needs to be assessed and addressed. We ranked 10 suitable instruments that can be useful in the assessment., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)

Aim: To explore the factors that affect the quality of interactions between nursing personnel and the informal caregivers of people with memory disorders., Design: Systematic review and metasummary of qualitative empirical research., Methods: The literature search targeted studies concerning the professional care interactions between nursing personnel and the informal caregivers of people with progressive memory disorders. The search in PubMed, CINAHL, PsycINFO and Scopus covered records from the earliest possible date up to December 2020. The data were summarised using a qualitative metasummary method. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was used to validate the reporting process., Results: Ten articles were included. As presented in 33 statements, the factors affecting the quality of interactions were related to (1) expectations, (2) memory disorders, (3) interaction strategies, (4) time and place of interactions and (5) organisational aspects. Meeting the individual interactional needs of informal caregivers is recommended. The results provide guidance for improving the quality of interactions between nursing personnel and informal caregivers., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Aim(s): The aim of this research study is to collaboratively generate insights in the current institutional long-term care environment for activity and mobility of older adults, and of solutions that could be used to increase the activity and improve the mobility of the older adults., Design: This research constitutes a qualitative study with a critical approach., Methods: Data were collected using photo-elicitation in four long-term care units in Finland during the spring of 2022. Older adults participated in individual data collection sessions which combined photographing and discussion. Staff members individually took photographs and later participated in a group discussion based on the photographs. Reflexive thematic analysis was used to analyse all data together., Results: Ten older adults and 12 staff members participated in the research study. Four themes were identified: (1) facilities should be designed and equipped for their users, (2) moving in the institutional environment, (3) passivity as a norm, and (4) nurses should act differently and have the resources to do so., Conclusion: To increase the activity and improve the mobility of older adults, improvements are needed in terms of the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources., Implications for the Profession And/or Patient Care: Increased attention to the support of activity and mobility could benefit older adults in institutional long-term care. Physical activity promotion should be incorporated as an integral part of nursing practice., Patient or Public Contribution: Directors of units were consulted when planning the study. Older adults and nurses contributed to the data collection and interpretation of data., Impact: (ADDRESSING): What problem did the study address? ○Older adults have recurrently been reported as living inactive lives in institutional long-term care. ○There is evidence of the relationship between the environment and the activity and mobility of older adults, but there seems to be a research-practice gap in terms of implementing activity- and mobility-promoting environments. ○Older adults and staff members are important in developing practice and change-oriented knowledge that can be used to increase the activity and improve the mobility of older adults in institutional long-term care. What were the main findings? ○Various environmental improvements are recommended to increase the activity and improve the mobility of older adults in institutional long-term care settings. ○Improvements for the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources for activity support would benefit older adults' activity and mobility. Where and on whom will the research have an impact? ○Increasing the activity of older adults requires better activity promotion and mobility support by nurses in institutional care. Sufficient education and resources should be organized for activity promotion, in addition to a care and organizational culture that values activity. ○Environmental aspects to promote activity and mobility need to be considered already at the planning, building and renovating phases of facilities. ○Policymakers and care organizers should consider evidence of the harms and benefits of different institutional living environments when making decisions on organizing care., Reporting Method: The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ)., (© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: In line with the impetus traceable among the nursing staff, studies regarding the perception of Unfinished Care among students have increased in recent years as also recommended by some policy documents in the consideration that, as future members of the staff, they are expected to raise concerns about failures in the standards of care. However, no discussion of their methodological requirements has been provided to date. The aim of this study is to debate Unfinished Care explorations among nursing students and developing recommendations., Methods: A Rapid Review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, followed by a scientific discussion based on empirical evidence that emerged from the review combined with expert knowledge. Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were searched up to May 2022., Results: In the last five years, seven studies have been conducted by researchers affiliated at the university level, involving from 18 to 737 undergraduate students across Europe. By critically analysing their key aspects, there are derived some recommendations in conducting investigations in this field as, (a) the hidden meaning of Unfinished Care investigations among students by also deciding which concept is mostly appropriate to investigate; (b) the need of establishing alliances with the clinical settings in order to involve them in such explorations; (c) more complex research methods capable of exploring this issue among students by promoting learning outcomes and not only a simple data collection; and (e) the influences of these explorations on students' wellbeing, as well as on ethical implications and that regarding the relationship between the healthcare services and the universities., Conclusion: Policymakers consider students to be key informants of the quality of nursing care issues witnessed during their clinical placements. The related emerging line of research is intriguing because of the underlying methodological, ethical and system complexities that need to be addressed according to some considerations., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Aim: to explore experiences of being mentored and the contribution of the mentoring to leadership and professional development of doctorally prepared nurses and doctoral nursing students participating in the Nurse-Lead programme., Background: Mentoring is considered important for career development of academic nurses. Doctorally prepared nurses need a wide range of professional competences to develop sustainable careers. Therefore, they may benefit from a larger network of mentors, outside their own organization, to support their professional development. Therefore, a web-based leadership and mentoring programme was developed - the Nurse Lead programme., Design: A descriptive study with semi-structured focus groups., Method: Three focus groups were conducted during an on-site programme meeting in 2019 with twenty-one doctorally prepared nurses and doctoral nursing students. The interview guide included questions about mentoring relationships and meaning of mentoring for leadership and professional development. The interviews were thematically analysed., Results: Five themes were identified: "Preferred characteristics of mentors", "Developing trusting relationships", "Engagement of the mentors", "Becoming a proficient researcher and team leader" and "Becoming an empowered and confident professional"., Conclusion: Mentoring supported the leadership and professional development of doctorally prepared nurses and doctoral nursing students. Participants were engaged in rewarding mentoring trajectories. The results indicate that a similar approach could be followed when developing mentoring programmes in the future., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Ethical competence is a key area of professional expertise in physiotherapy. It is needed for successful interaction and rehabilitation - most physiotherapists encounter ethical situations weekly, but the ability to recognize and meet these situations varies., Objective: This study describes physiotherapists' ethical competence in situations in which they experience they have succeeded to act ethically competently. The study also seeks to verify an existing conceptual frame, developed through a concept analysis of ethical competence., Method: All together 164 physiotherapists responded to open-ended questions by writing short narratives of an ethically challenging situation. The narratives which were analyzed using deductive-inductive content analysis to discover meaningful underlying categories under the existing analysis frame's themes., Results: Responses were related to advocating and supporting patients, identifying barriers in own knowledge and implementing physiotherapy according to the patient's needs, even if the treatment wasn't in line with the actual goals or organization's guidelines. Ethical awareness as an attribute of ethical competence was emphasized in physiotherapists' responses., Conclusion: This study provided new knowledge about ethically challenging situations that physiotherapists encounter and their abilities to work within these. As all the attributes of ethical competence were present in the situations described, it can be stated that the analysis frame at this point is adequate. Further testing of the frame should be done to gain data-driven trustworthiness and credibility.

Background: Whistleblowing is recognised as part of solving wrongdoing. It requires individual reasoning as it is a potentially complicated process with a risk of possible negative consequences for oneself. Knowledge on how individuals reason for whistleblowing in healthcare context is lacking., Aim: This study aimed to create a theoretical construct to describe individual reasoning for whistleblowing., Methods: The methodology was grounded theory, with 244 nurses as informants. The data consisted of nurses' written narratives in response to a wrongdoing situation presented in a video vignette. To ensure the heterogeneity of the population and variation in nurses' professional expertise, experiences and geographical locations in health care to capture the multidimensionality of the responses, nurses were invited to participate, and data were collected electronically from the membership register of the Finnish Nurses' Association on a national level. Constant comparison was used to analyse the open data., Results: The core category of the theoretical construct, 'The formation of morally courageous intervening', was discovered, reflecting individual's values and beliefs. It forms mentally as an integration of cognition and emotion for recognising one's own strengths and limits to act to do the right thing despite the risk of negative consequences for oneself. The core category consists of three dimensions of reasoning: (1) Reasoning Actors, (2) Reasoning Justifications and (3) Reasoning Activities, their categories and three patterns of reasoning connecting the dimensions and their categories with each other: (I) Individual Reasoning, (II) Collaborative Reasoning and (III) Collective Reasoning., Discussion and Conclusion: The theoretical construct indicate that reasoning is a multidimensional phenomenon. In future, a theoretical construct could be further developed. In health care, managers could use the theoretical construct to support employees in their whistleblowing., (© 2022 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Background: Person-centred care requires that nurses are competent in this approach to care. There may be an association between person-centred care competence and person-centred care climate, but it has not been demonstrated in the literature. This is the justification for the survey study to gain staff's perceptions of such a relationship., Objectives: The aim of this study was to analyse the levels and associations between person-centred care competence and the person-centred care climate as assessed by professional nurses in long-term care settings for older people., Methods: A descriptive cross-sectional survey design with cluster sampling was used to recruit professional nurses of different levels from six long-term care institutions for older people. Data were collected using the Patient-centred Care Competency scale (PCC) and the Person-centred Climate Questionnaire staff version (PCQ-S) in September 2021 and analysed with descriptive and inferential statistics., Results: The mean score on the PCC was rated at a good level of 3.80 (SD 0.45), and the PCQ-S was rated at a good level of 3.87 (SD 0.53). The correlation between PCC and PCQ-S total scores (r = .37, p < .001) indicated that person-centred care competence and person-centred care climate were associated. No associations were detected between nurses' educational levels and PCC (p = .19) or PCQ-S (p = .13) or in terms of age or work experience., Conclusions: The results provide insights into competence and climate levels of person-centred care and preliminary evidence of an association between nurses' assessed competence in person-centred care and the perceived person-centred care climate in long-term care. Nurses' individual characteristics did not appear to affect the level of person-centred care competence or climate. In the future professional nurses of different levels could benefit from effective continuing education in person-centred care. This study design serving for the future intervention study registered to the ClinicalTrials.goc NCT04833153., (© 2023 John Wiley & Sons Ltd.)

Objective: The aim of this scoping review is to describe the literature reporting on ethical challenges faced by nurses during the COVID-19 pandemic, including the contextual characteristics of ethical challenges, and the strategies to address these challenges., Introduction: The COVID-19 pandemic presented many ethical challenges to nurses, ranging from allocating scarce resources, to balancing a duty of care with self-preservation, and implementing visitation restrictions. Internationally, there has been a range of reported issues, but few studies have described strategies to overcome these challenges., Inclusion Criteria: Studies that report on ethical challenges faced by nurses while caring for patients during the COVID-19 pandemic will be included. Studies that report on strategies to address these challenges will also be considered for inclusion., Methods: This scoping review will be conducted in accordance with the methods outlined by JBI and reported using PRISMA-ScR guidance. The following databases will be searched for eligible studies from November 2019 to present day: PubMed, CINAHL, Ovid, PsycINFO, the Cochrane Library, and Scopus. No language restrictions will be applied. Studies will be reviewed for inclusion by 2 independent reviewers and a data extraction form developed specifically for this review will be used to extract data relevant to the review questions. Results will be analyzed and presented according to the concepts of interest, using tables, figures, images, and supporting narrative synthesis., Competing Interests: The other authors declare no conflicts of interest., (Copyright © 2023 JBI.)

Perovskite solar cells represent an emerging and highly promising renewable energy technology. However, the most efficient perovskite solar cells critically depend on the use of lead. This represents a possible environmental concern potentially limiting the technologies' commercialization. Here, we demonstrate a facile recycling process for PbI 2 , the most common lead-based precursor in perovskite absorber material. The process uses only hot water to effectively extract lead from synthetic precursor mixes, plastic- and glass-based perovskites (92.6 - 100% efficiency after two extractions). When the hot extractant is cooled, crystalline PbI 2 in high purity (> 95.9%) precipitated with a high yield: from glass-based perovskites, the first cycle of extraction / precipitation was sufficient to recover 94.4 ± 5.6% of Pb, whereas a second cycle yielded another 10.0 ± 5.2% Pb, making the recovery quantitative. The solid extraction residue remaining is consequently deprived of metals and may thus be disposed as non-hazardous waste. Therefore, exploiting the highly temperature-dependent solubility of PbI 2 in water provides a straightforward, easy to implement way to efficiently extract lead from PSC at the end-of-life and deposit the extraction residues in a cost-effective manner, mitigating the potential risk of lead leaching at the perovskites' end-of-life., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Markus Lenz reports financial support was provided by European Commission., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Aims and Objectives: The aim of this study was to discover the nature of the adverse events in Finnish long-term professional homecare reported by professionals, and to identify the circumstances in which adverse events occur and their consequences., Background: Adverse events are incidents causing unintended and unnecessary harm to older people at home. Safety is a basic human right and a fundamental prerequisite for independent living among older people at home. Few studies have focused on both long-term professional homecare environment and the safety of older people., Design: The research was a descriptive registry-based study., Methods: This study consisted of adverse events (N = 61248) in Finnish public long-term professional homecare (2009-2019). Data were described using frequencies and percentages. STROBE statement checklist was chosen for reporting the study process., Results: By profession, practical nurses and registered nurses reported the most of adverse events (89.8%). These were either critical incidents (78.3%) or near misses (20.0%) and concerned medicine, injuries and accidents, information flow or management. Consequences for older people were usually rated from no-harm to moderate harm. For long-term professional homecare, image harm, extra financial costs, no-harm and prolonged care for older people were among the consequences. Personnel frequently observed the older people afterwards and informed older people of adverse events, yet some of actions were unknown., Conclusions: Many harmful adverse events are considered harmless for older people. Sometimes this can lead to unmet care needs or missed care. The degree of harm needs to be assessed in terms of physical, mental and social health with the HaiPro reporting system for homecare., Relevance to Clinical Practice: An understanding and a comprehensive view of the situation and holistic assessment of care needs includes safety and safety risks to increase safety and feeling of safety for older people at home., (© 2022 John Wiley & Sons Ltd.)

Introduction: Meeting spiritual needs is an important part of the quality of nursing for older people living with dementia. The spirituality-supportive caring and living environment has rarely been studied, even though the environment plays an important role in supporting the well-being of older people with dementia., Aim: To further understanding about the spirituality-supportive elements of a caring and living environment from the perspective of older people with dementia and their family members., Design, Setting and Participants: We adapted hermeneutic phenomenology as a philosophical background and methodological approach in this study. After receiving the approval of the researcher's University Ethics Committee, a purposive sample of ten older people with dementia and their nine family members, in home care and long-term care settings in Southern Finland were recruited for interviews., Methods: An interview-based study was conducted using photography to collect the data. The in-depth interviews were conducted in dyads between September 2017 and March 2020 and transcribed verbatim. Thematic analysis was used to interpret the data., Results: Spirituality was seen as a continuum within human life, manifested through the environment even if older people with dementia were unable to express themselves. The spirituality experiences of the participants within the caring and living environment were summarized into three themes: "Where do I belong?", "What remains of me in the world?" and "Where am I going?" The older people, their family members and other people involved in their care provided a caring and living environment that supported spirituality with opportunities to seek answers to these questions through to the meaning of their life., Discussion and Conclusions: This hermeneutic phenomenological study provides a new insight into the environment that supports the spirituality of older people with dementia. The elements of caring and living environment can remind older people with dementia of what supports their own way of thinking about spirituality and brings meaning to their life. Therefore, spirituality is worth of considering when planning a caring and living environment that supports what is important to the personhood of older people with dementia., Tweetable Abstract: Spirituality is worth of considering when planning a caring and living environment that supports what is important to the personhood of older people with dementia., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The management and analysis of work ability risks is important to support well-being at work and requires multidimensional competence. Competence evaluation in Occupational Health Care professionals' (OHCP) practice is essential for their professional development and promotion of quality of care., Objective: To describe OHCPs' self-reported competence level to manage and analyze work ability risks., Methods: A descriptive, cross-sectional study design was applied. The data were collected electronically from May to June 2018 using the Comp-WARMA instrument (scale 1 = poor - 4 = excellent) from Occupational Health Care professionals working in Finnish private medical centers (n = 169, response rate of 10%). The data were analyzed statistically., Results: The levels of knowledge and skills of OHCP in work ability risk management and analysis were mainly at good level (3.22 on average), but some deficient were still identified. The knowledge and skills of the work ability risk management and analysis were associated with the number of customer organizations they worked with, their attendance of supplementary training regarding work ability risk management and analysis, their amount of work experience, their type of employment, age, and gender., Conclusion: OHCP self-reported competence levels in work ability risk management and analysis was at good level. There is a need for development in all areas of work ability risk management and analysis. OHCP could benefit from in-service education on work ability risk management and analysis. Further validation of the Comp-WARMA instrument in larger sample is needed.

Background: Supporting spirituality is an essential aspect of the holistic nursing care of older people living with dementia. Spirituality is defined as a search for answers to questions about the meaning and purpose of life and the individual's relationship with the sacred or transcendent. This relationship may or may not involve an affiliation with a specific religion., Objective: To understand how older people living with dementia and their family members experience spirituality and its support in nursing care., Design: A qualitative study informed by the principles of Ricoeurian hermeneutic phenomenology., Settings: We conducted the study in home care and long-term care settings in Southern Finland., Participants: We collected data between 2017-2020 from a purposive sample of 10 older people living with dementia and their 9 family members (n = 19)., Methods: We used interviews to collect data and adapted and used Ricoeur's theory of interpretation as a method for analysis., Results: The findings of this study show that older people living with dementia need spiritual support in nursing care based on their personal understanding of spirituality. The four elements of this spirituality that emerged were: religion, meaningful relationships, nature, and art. The participants addressed some challenges to spiritual support in the nursing care of older people living with dementia including: the competence and abilities of nursing, time available, presence and experience., Conclusions: Older people living with dementia and their family members consider spiritual support an important aspect of nursing care. To support the spirituality of these older people, the elements of spirituality need to be understood as these are central to each person's spiritual position. Additionally, spiritual support requires understanding knowledge, experience, time and presence, to manage all four elements with individuals., (© 2022 The Authors. International Journal of Older People Nursing published by John Wiley & Sons Ltd.)

Background: Being active in old age is vital for health and well-being. Inactivity decreases functional ability, mobility, and increases care dependence and risk of falling. Worryingly, older individuals in long-term care settings spend most of their waking day sitting or lying down. The environment should be of special interest considering active life in long-term care. This review aimed to synthesize evidence and provide a comprehensive understanding of the environmental aspects related to the physical activity of older individuals in long-term care settings., Methods: A mixed-method systematic review, registered in PROSPERO (CRD42021251899; May 30th, 2021) was conducted using four international scientific databases (CINAHL, PubMed, Cochrane, PsychInfo). The searches were conducted from the earliest possible date till Dec 31st, 2020. All empirical peer-reviewed studies published in the English language in scientific journals were included if they had investigated environmental aspects (physical, social, and/or symbolic) in relation to the physical activity of older individuals in long-term care facilities providing full-time care. Critical appraisal was conducted using Joanna Briggs Institute's Critical Appraisal tools, and the Mixed Method Appraisal Tool. Abductive thematic analysis and a conceptual map were used to synthesize the evidence., Results: Altogether 838 original articles were assessed for eligibility, resulting in 30 included studies. No studies were excluded based on quality. The mean age of residents was over 75 when reported. Their cognitive and physical functioning varied. The most frequent setting was nursing home. Three themes and corresponding descriptive themes were formulated, including 1) Physical environment: accessible and safe living environment, activating physical environment, 2) Social environment: supportive professionals, the role of other people, adequate activities to socialize and be active, and 3) Symbolic environment: policy at multiple levels, values of organizations and professionals. Different environmental aspects within and between the dimensions of the physical, social, and symbolic environment were related to each other., Conclusions: A comprehensive synthesis of current evidence was provided and may be used for the assessment and development of long-term care settings. However, some aspects may have been missed because they have been addressed with terminology not identified with the word environment or similar concepts. As increasing activity may require actions in multiple dimensions, experimental research should be conducted to develop and test the effects of widescale modifications to existing environments from the needs of residents and fitting for each context. The evidence should be used for the design of new facilities., Tweetable Abstract: New mixed methods systematic review develops a concept map of environmental aspects influencing the physical activity of older individuals in long-term care., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aim: To test the effectiveness of a new ethics educational e-learning intervention, Ethics Quarter, in supporting nurse managers' ethical activity profile., Background: Health care organisations need evidence-based ethics interventions to support nurse managers' ethical activity profile., Methods: A parallel-group, individually randomized controlled trial was conducted in 2020. Finnish nurse managers nationwide [members of the Union of Health and Social Care Professionals in Finland (Tehy) trade union] were randomly allocated to intervention (n = 169) or control group (n = 172). The intervention group participated in the Ethics Quarter comprising twelve 15-min evidence-based educational 'quarters' spread over 6 weeks. The control group had standard organisational ethics structures. The primary and secondary outcomes were ethical activity profile and ethics knowledge, respectively. The Consolidated Standards of Reporting Trials (CONSORT) statement for study design and reporting was adopted., Results: Ethical activity profile showed statistically significant differences in mean changes between the groups from baseline to 10 weeks: all five dimensions were statistically significantly higher in the intervention group compared with the control group (p = <.0001)., Conclusion: The Ethics Quarter was effective in increasing nurse managers' ethical activity profile., Implications for Nursing Management: Applying this ethics educational e-learning intervention would benefit nursing management education and health care organisations., Trial Registration: clinicaltrials.gov: NCT04234503., (© 2021 The Authors. Journal of Nursing Management published by John Wiley & Sons Ltd.)

Background: Moral courage means courage to act according to individual's own ethical values and principles despite the risk of negative consequences for them. Research about the moral courage of whistle-blowers in health care is scarce, although whistleblowing involves a significant risk for the whistle-blower., Objective: To analyse the moral courage of potential whistle-blowers and its association with their background variables in health care., Research Design: Was a descriptive-correlational study using a questionnaire, containing Nurses Moral Courage Scale © , a video vignette of the wrongdoing situation with an open question about the vignette, and several background variables. Data were analysed statistically and inductive content analysis was used for the narratives., Participants and Research Context: Nurses as healthcare professionals (including registered nurses, public health nurses, midwives, and nurse paramedics) were recruited from the membership register of the Nurses' Association via email in 2019. A total of 454 nurses responded. The research context was simulated using a vignette., Ethical Considerations: Good scientific inquiry guidelines were followed. Permission to use the Nurses' Moral Courage Scale © was obtained from the copyright holder. The ethical approval and permission to conduct the study were obtained from the participating university and the Nurses' Association., Findings: The mean value of potential whistle-blowers' moral courage on a Visual Analogue Scale (0-10) was 8.55 and the mean score was 4.34 on a 5-point Likert scale. Potential whistle-blowers' moral courage was associated with their socio-demographics, education, work, personality and social responsibility related background variables., Discussion and Conclusion: In health care, potential whistle-blowers seem to be quite morally courageous actors. The results offer opportunities for developing interventions, practices and education to support and encourage healthcare professionals in their whistleblowing. Research is needed for developing a theoretical construction to eventually increase whistleblowing and decrease and prevent wrongdoing.

Background: Rasch analysis is widely used in the life sciences. Rasch analysis is a mathematical and probabilistic model based on the assumption that the probability of passing a single item is governed by a person's ability and the difficulty of the item. However, its use in nursing science remains unclear., Aim: To (i) describe the use of Rasch analysis in nursing research and (ii) determine the quality of reporting in nursing studies using Rasch models., Methods: A methodological scoping review of literature was conducted. The systematic electronic literature search was initially conducted on 1 February 2020 and updated on 16 April 2021 from PubMed/Medline and CINAHL databases. The search was limited to covering the timeframe from the earliest literature available until 31 December 2020. The search terms used were Rasch, IRT, item response theory, and nursing. The search was limited to the English language and title/abstract level. The analysis included quantification and content analysis., Results: In total, 388 hits were identified. Following a two-phase retrieval process, 88 articles were included in the final analysis. Rasch analysis was used to test the psychometric properties of the newly developed instrument, and validate or test a short version of the existing instrument. The reporting of Rasch analysis demonstrated large variability in quality. Rating scale functioning, internal scale validity using goodness-of-fit statistics, and unidimensionality were the most frequently reported outcomes., Conclusion: The use of Rasch analysis in nursing science was found to be unsystematic. Rasch analysis could provide new possibilities for investigating measurement properties. However, robust, comprehensive, and precise reporting of the methodological choices and results of Rasch analysis is needed. Furthermore, the use of Rasch analysis in nursing science is encouraged., What Is Already Known: WHAT THIS PAPER ADDS., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Neglecting to provide older people with the care they need in residential care settings leads to human suffering and increased service needs. Research is lacking on neglect in older people's residential care and one way to assess the key issues is to study complaints. The aim of this study was to analyse official complaints related to allegations of neglect in residential care settings caring for older people in Finland. The data covered 317 complaints that were recorded in the national database in 2018 and 2019. The analysis of the complaints yielded 2,922 observations of neglect in older people's care in residential care settings. Based on our results, most of the complaints were made by family members when the patients were alive and their motivation was to improve the care their relative received, as well as the care of others, in the residential care home. The complaints focused on neglecting clinical care, including restricting older people's movements, not providing daily activities and not paying sufficient attention to their hygiene and secretions. Other complaints included issues relating to nutrition, medication, communication and issues that compromised their privacy, respect and dignity. Nearly three of four complaints identified staffing issues in relation to neglect and most of the complaints concerned private, rather than public, residential care homes. Although the complaints only concerned a small proportion of the annual care provided, more attention should be paid to care practices that prevent neglect in residential care and to multi-level monitoring for dignified care., (© 2021 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.)

Moral distress (MD) has received considerable attention in the nursing literature over the past few decades. It has been found that high levels of MD can negatively impact nurses, patients, and their family and reduce the quality of patient care. This study aimed to investigate the potentially effective interventions to alleviate MD in critical care nurses. In this systematic review, a broad search of the literature was conducted in the international databases including PubMed/MEDLINE, Web of Science, and Scopus, as well as Google Scholar search engine using keywords such as moral distress, intensive care unit, ICU, nurses, and critical care nurses from 1984, when the concept of MD was first introduced in the nursing literature, up to 29 October 2020. Studies focusing on the interventions for managing MD in critical care nurse were evaluated. The quality of eligible papers was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A total of 8 studies fulfilled the eligibility criteria. Three studies had RCT design and five studies had quasi-experimental design. All studies were conducted in the United States or Iran. Educational workshop, moral empowerment program, social work intervention, nursing ethics huddles, and multifaceted resiliency bundle intervention were effective interventions for managing of MD among critical care nurses. There is limited but promising research evidence evaluating the efficacy of educational interventions for managing of MD among critical care nurses. Although some positive results have been reported, there is limited generalizable evidence due to the variability of interventions. These findings highlight the need for further studies to validate the efficacy of these interventions or develop more potent and efficient interventions for reducing MD in critical care nurses.

Background: Mobility is important for health and well-being; however, older individuals in institutional care settings are relatively sedentary. The environment has an increased influence on mobility in older age due to changes in individual functioning; thus, environmental mobility support solutions for this population are needed., Objectives: The aim of this systematic review was to identify elements of the environment that have been used in the content and delivery of interventions to promote mobility and to assess the effects of these interventions on mobility outcomes., Design: A systematic literature search was conducted using CINAHL and MEDLINE from the earliest date through 30 September 2020 for randomised controlled trials, quasi-experimental and pre-post design studies. Inclusion and critical appraisal of articles were conducted by two independent researchers. Data were extracted and synthesised., Setting and Participants: Studies were included if they had employed some element of the environment in the content and/or delivery of the intervention and had assessed mobility-related outcomes of older individuals in institutional long-term care settings providing full-time care., Measures: Studies were included if they reported data on mobility-related outcomes including aspects of physical activity, physical function, life space and functional autonomy., Results: Eight studies were included. Physical, social and symbolic elements of the environment were utilised in the interventions. Positive effects on mobility outcomes were reported in exercise interventions utilising environmental elements mostly as supportive components., Conclusions and Implications: Empirical evidence about effective mobility interventions employing elements of the environment as main intervention components is lacking. A serious dilemma exists about the need for older individuals' independence and mobile/active late life and the lack of support for such initiatives in long-term care. Given the emphasised relationship of the environment and mobility with age due to changes in functioning, environmental solutions require further examination., (© 2021 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Background: Individualising the provided care is mandatory in nursing and is essential in clinical practice. Therefore, there is a need to develop accurate instruments to evaluate the quality of care. Moreover, there is no validated instrument to assess nurses' views of individualised care in Spanish-speaking countries., Aim: To assess the construct validity and internal consistency of the Spanish version of the Individualised Care Scale-Nurse., Methods: A cross-sectional study including 108 nursing professionals (40.84 ± 9.51 years old, 86.1% female) was used to validate the Spanish Individualised Care Scale-Nurse version. A forward-back translation method with an expert panel and a cross-sectional study was used for transcultural adaptation and psychometric validation purposes. Psychometric properties of feasibility, reliability and validity were assessed. Construct validity was examined through a confirmatory factor analysis and fit indices of the overall model were computed. Internal consistency was explored through McDonald's omega and Cronbach's alpha coefficients among other correlation measures., Results: The back-translation concluded both Spanish and English Individualised Care Scale-Nurse versions to be equivalent. The original structure of the Individualised Care Scale-Nurse was verified in the Spanish version through the confirmatory factor analysis (factor loadings >0.3; acceptable fit indices: SRMR ≈ 0.08, CFI ≈ 0.9, RMSEA ≈ 0.09 after posteriori modifications). McDonald's omega exceeded 0.7 for both subscales and complete scales revealing an adequate internal consistency., Conclusions: The Spanish version of the Individualised Care Scale-Nurse has exhibited good properties of homogeneity and construct validity for its use in practice and research in health care systems., (© 2021 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Background: Nurse managers (NMs) expect support to carry out their ethical activities in a complex health care environment. In this study, the Ethics Quarter (EQ) is suggested as a new educational ethics e-learning intervention for nurse managers. The aim of this study was to evaluate the usability, feasibility and fidelity of the EQ. The goal was to create a new way to support NMs' ethical activity profile (developing one's own ethics knowledge, influencing ethical issues, conducting or implementing ethics research, identifying and solving ethical problems) for the use of healthcare organizations., Methods: The EQ was developed under guidance of the criteria for complex interventions in health care (CReDECI2) guideline. A cross-sectional survey was conducted within the intervention group after a randomized controlled trial (the main study is registered in ClinicalTrials.gov with the identifier: 04234503). The participants were NM members of the Union of Health and Social Care Professionals in Finland (n = 95)., Results: A system usability scale (SUS) assessed the overall usability of EQ as good (a mean SUS score of 85.40 out of 100). Positive feedback about the EQ's feasibility was reported in structured and open questions (a good, necessary and practical research knowledge-based e-learning intervention for all nurse managers) and recommendations for further development (intervention contents could be even more challenging and interactive) were highlighted. Fidelity, measured with Google Analytics, reported shorter time used by NMs on the EQ education than estimated., Conclusions: The findings support the high usability, feasibility and average fidelity of the EQ intervention and its potential while also providing evidence for the development of future ethics education. Health care organizations would benefit from adopting the EQ to support the ethical activities and ethical activity profile of NMs. Additionally, this study provides an example of ethics intervention development and evaluation in nursing research., (© 2022. The Author(s).)

Background: Caring for patients with wounds requires diverse competences from nursing professionals. However, wound care education in undergraduate nursing education is often fragmented and lacks consistent learning goals and content., Objectives: To create learning goals and content for wound care education in Bachelor's level nursing education in Finland and to assess the consensus relating to these learning goals and content among wound care experts., Design: A consensus-building approach using the Delphi technique., Settings: A Delphi panel of wound care experts built on an online platform., Participants: The participants of the Delphi panel were registered nurses, authorised wound care nurses, nurse educators and physicians., Methods: Learning goals and content for wound care education which had been formulated on the basis of previous focus-group interviews were presented to the Delphi panel. The data were collected in 2021 with two online Delphi rounds: 51 panellists participated in the first round and 36 in the second round. The data were analysed using statistical and qualitative analysis., Results: Learning goals and content were divided into four competence areas: 1) Anatomy and physiology, 2) Care of chronic and acute wounds, 3) Wound management and care of a patient with a wound, 4) Values and attitudes. These competence areas comprised 26 learning goals and 29 pieces of content. The consensus between the panellists was high, at >90% in all competence areas., Conclusions: The basis of registered nurses' wound care competence is built during their undergraduate nursing studies. The results of this study can be used to standardise wound care education by implementing consistent learning goals and content in Bachelor's level nursing education., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Nurses play a crucial role in enabling older people's autonomy in residential care. However, there is a lack of synthesised knowledge about how nurses can support older people., Objective: The aim of this study was to identify and synthesise nursing support for older people's autonomy in residential care., Methods: An integrative review was carried out by searching the CINAHL, Philosopher's index, PubMed, SocINDEX, Scopus and Web of Science databases, supplemented by manual searches. The searches focused on peer-reviewed scientific empirical research papers published in English, without date limitations. The constant comparison method was used for the analysis., Results: The review identified 24 papers, and these showed that older people's autonomy was based on dignity. Nurses protected older people's autonomy in eight different ways. They protected their right to make their own decisions, acted as advocates, respected their wishes, provided opportunities for autonomy, fostered independence, gave information to residents and relatives, provided individualised care practices and protected older people's safety. However, there were also barriers that needed to be overcome., Conclusions: Nurses used multiple, individually tailored activities to support older people's autonomy, but they also had different reasons for supporting or hindering it. Work and leadership structures are needed to ensure that older people's autonomy is driven by ethical practices., Implications for Practice: The results of this review can help nurses who provide residential care for older people to recognise the different nursing activities that can be used to support older people's autonomy and to develop strategies to apply them in different daily care situations. However, further research is needed to determine how these activities can be realised in daily care and how they cover different aspects of older people's lives in residential care., (© 2021 The Authors. International Journal of Older People Nursing published by John Wiley & Sons Ltd.)

Background: In clinical settings where missed nursing care prevails, nursing students' instructions, supervision and the joint reflection on clinical practice with mentors are also affected and nursing students become involved in dealing with missed nursing care., Aim: To explore the experience of missed nursing care in clinical placements, its meaning for nursing students, and actions they considered or took., Methods: Qualitative study based on a content analysis of nursing students' written reports. Nursing students in three universities in Germany with experience of at least one clinical practice placement were invited to participate. Online, they answered three open questions concerning missed nursing care focusing on: (1) experiences of the phenomenon, (2) its meaning and (3) actions that had been considered or taken when dealing with missed nursing care. A content analysis was performed., Results: The recruitment criteria were met by 69 nursing students. Four main themes and 20 sub-themes were identified. The reports covered all forms of missed nursing care. Becoming involved led to intrapersonal conflicts and, feelings of powerlessness but also to learning opportunities. It challenged professional and ethical standards. Students identified a broad spectrum of actions to answer the challenge., Conclusion: Dealing with missed nursing care creates opportunities and challenges for nursing students. To build up a well-trained and sustainable nursing workforce, learning environments for nursing students must reflect the challenges and counteract deficits.

Research ethics is a fundamental part of the entire research. Patients with rheumatoid arthritis are sensitive group of research participants because their long-term health problems cause significant changes in their foot health. In foot health research, data are usually collected through a clinical assessment of the foot or questionnaires. However, there is limited evidence of the reported research ethics of empirical studies on foot health in patients with rheumatoid arthritis. Therefore this review aimed to analyze the reported research ethics of peer-reviewed empirical studies focusing on foot health in patients with rheumatoid arthritis as research participants. This systematic review used the Medline/PubMed, CINAHL, and Embase databases. A total of 1,653 records were identified, and 32 articles were included in the final analysis. Reporting research ethics in studies of patients with rheumatoid arthritis is fragmented, focusing predominantly on ethical approval and informed consent and lacking a broader discussion about research ethics.

Objective: To describe the development and use of a wound care simulation assessing RNs' and graduating student nurses' practical wound care competence and to describe observations of participants' wound care competence., Methods: A descriptive, qualitative design was used. Data were collected in 2019 from 50 healthcare professionals and students using a simulated wound care situation and an imaginary patient case. The simulation was based on a previously developed and tested wound care competence assessment instrument, which included a 14-item checklist that assesses practical wound care competence of chronic wounds. The data were analyzed and described based on the 14 competence areas or as other competencies., Results: Participants showed competence in identification of wound infection, debridement, dressing selection, tissue type identification, and consultation. Participants' shortcomings were related to pain assessment and management, asepsis, offloading, and documentation. Simulation was shown to be a promising tool to assess healthcare professionals' and students' practical wound care competence in a safe and standardized situation., Conclusions: This study provided new information about simulation as a method to assess student nurses' and RNs' wound care competence. The results could be used in wound care education planning and development in both undergraduate nursing education and continuing education for nursing professionals., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The industrialization of perovskite solar cells relies on solving intrinsic-to-material issues. To reach record efficiencies perovskite deposition needs to be finely adjusted by multi-step processes, in a humidity free glove-box environment and by means of hardly scalable techniques often associated with toxic solvents and anti-solvent dripping/bath. Herein, the use of polymeric material is proposed to deposit perovskite layers with easy processability. To the scope, a starch-polymer/perovskite composite is developed to suit slot-die coating technique requirement, allowing the deposition of hybrid halide perovskite material in a single straightforward step without the use of toxic solvents, and in uncontrolled humid environment (RH up to 70 %). The starch-polymer increases the viscosity of the perovskite precursor solutions and delays the perovskite crystallization that results in the formation of perovskite films at mild temperature (60 °C) with good morphology. These innovative inks enables the fabrication of flexible solar cells with p-i-n configuration featured by a power conversion efficiency higher than 3 %. . Overall, this approach can be exploited in the future to massively reduce perovskite manufacturing costs related to keeping the entire fabrication line at high-temperature and under nitrogen or dry conditions., (© 2021 The Authors. ChemPlusChem published by Wiley-VCH GmbH.)