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Aim: This study examined the preliminary effects of a nurse‐led self‐management education and support programme on the self‐management behaviours and quality of life among people with type 2 diabetes in Western Ethiopia. Methods: A pilot randomized controlled trial was conducted between January and August 2021. Participants were recruited in the hospital and randomly assigned to the control arm to continue usual care (n = 38) or the intervention arm to receive usual care and the diabetes self‐management education and support programme (n = 38) in the community. Self‐management behaviours and quality of life were assessed using a 10‐item summary of diabetes self‐care activity (expanded) scale and a 34‐item diabetes quality of life measure, respectively, at baseline and 2 months after follow‐up. Generalized estimating equation models were used to examine the preliminary effects of the programme on the outcomes. Results: Preliminary results indicated that the programme outperformed usual care in self‐management practise, with large effect sizes immediately postintervention and at 2 months after the intervention, and quality of life at 2 months after the intervention. Conclusion: A nurse‐led diabetes self‐management education and support intervention, including the families of people with diabetes, may be an option to boost the self‐management practise and quality of life of patients with diabetes. Summary statement: What is already known about this topic? Family‐supported diabetes self‐management education intervention produced inconclusive effects on self‐management behaviour and quality of life. What this paper adds? A social‐cognitive theory‐guided, culture‐tailored, and community‐based diabetes self‐management education and support programme resulted in a preliminary effect on improving self‐management behaviour and quality of life.A nurse‐led diabetes self‐management education and support programme intervention, including the families of patients, may be an option to boost the self‐management practise and quality of life of people with diabetes. The implications of this paper: Culturally tailored diabetes self‐management education and support programme could be an option to improve self‐management behaviour and enhance quality of life.Community‐based nurse‐delivered diabetes self‐management education and support can improve self‐management behaviours and enhance quality of life in 2 months duration. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to develop a model to help parents cope with decisional conflict. Background: Parents of children with congenital heart defect experience decisional conflict when they are uncertain about treatment decisions for their child, which may lead to delay in seeking care or distress over the decision made. Design: Correlational design with model building and data triangulation was used. Methods: Data were collected through surveys and interviews with a consecutive sample of 221 parent respondents from June to December 2018. Structural equation modelling and qualitative data analysis were used. Results: Lower decisional conflict was seen in parents with higher income, more nurse support and physician risk communication. Time delay for surgery was correlated with the child's age, social service coverage, and social support. Decisional conflict mediated the influence of income, nurse support and physician risk communication on satisfaction with decision. Based on model fit parameters, the emerging model is a good and parsimonious model of decisional conflict. The overall theme, 'Deciding for Surgery: What Matters Most', described the processes parents went through in making treatment decisions. Conclusion: Nurses may help parents feel more certain, less conflicted, and more satisfied with their decision by addressing factors including knowledge gaps, personal values, available support, and resource access. Summary statement: What is already known about this topic? Decisional conflict occurs when parents are uncertain of the best action for their child because treatment options entail risks for undesirable outcomes, value compromise, unclear prognosis, or anticipated regret over the decision.Professional support, information, and communication are vital to parents' decision‐making process.Child, parent, and support factors may influence parent treatment decisions in varied paediatric conditions. What this paper adds? Child's age at the time of decision‐making had an effect on the delay in surgery. However, assisting parents to weigh their options and focus on personal values allowed them to make their treatment decision.Low income, costly health services, and bureaucratic processes impeded the timely availment of surgery. Healthcare reforms that provide a system of government funding, streamlined health structure, and social insurance may be looked into.Family support weighed in on the parents' decision to delay surgery for fear of blame or guilt. Providing relevant information enabled parents to make a choice and stand by their decision regardless of the outcome. The implications of this paper: Modelling provides a framework to identify which factors are more important and how they interact to affect decision‐making. It may be used as an approach to find solutions to clinical problems for groups with different diagnoses.Though nursing support, information, and communication are essential, a more holistic family nursing care approach may be considered to assist parents to make appropriate treatment decisions for their child.Familiarity with the healthcare system may equip nurses to aid parents in processing available healthcare funding and dealing with financial uncertainty affecting decisions for their child's treatment. [ABSTRACT FROM AUTHOR]

Background: Choosing Wisely is an international movement that stimulates conversations about unnecessary care. The campaign created five recommendations including a statement that less wound care is sometimes better. Aims: The study aims to evaluate nurses' and physicians' adherence to the Choosing Wisely recommendations for acute wound care in the Netherlands and the barriers and facilitators to improve this. Design: This is a mixed methods study using a survey and interviews. Methods: The survey was completed by 171 nurses and 71 physicians from November 2017 to February 2018. A total of 17 nurses and 6 physicians were interviewed. Results: Awareness of the five recommendations ranged from 62% to 89% for nurses and 46% to 85% for physicians. However, up to 15% of the nurses and 28% of physicians were aware but did not adhere to the recommendations. Barriers to adhering were a lack of knowledge, the work environment and perceptions of patients' preferences. Repeated attention, cost‐consciousness and an open culture facilitated the implementation. Conclusion: Although most nurses and physicians were aware of the recommendations, not all adhered to them. Increasing awareness is not enough for successful implementation. A tailored approach that removes the barriers is necessary, such as increasing knowledge about wounds and changing the work environment. Summary statement: What is already known on this topic? Less wound care is sometimes better: cleaning wounds with tap water only, not bathing wounds, using simple bandages and not using bandages on wounds healing by primary intention leads to better wound care for lower costs.It is unknown to what extent this is known and practiced by nurses and physicians and what barriers and facilitators they experience in practicing this. What this paper adds? Although the majority of nurses and physicians were aware of the Choosing Wisely recommendations for acute wounds, not all adhered to them.Awareness is not always sufficient for successful implementation, which requires a broader approach that targets the barriers. The implications of this paper Implementation of these recommendations can be improved by increasing knowledge about wounds and wound care, changing the work environment, and verifying the patient's presumed preferences regarding wound care. [ABSTRACT FROM AUTHOR]

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

Aim: The aim of this study was to determine the effects of solution‐focussed education and counselling on problematic internet usage, sleep quality and school achievement. Methods: This randomized controlled trial was conducted between January ‐ December 2016 with 44 adolescents who participated in a solution‐focussed intervention to address their problematic internet usage and poor sleep quality. After the intervention, the teens were followed up for 6 months to measure problematic Internet usage, sleep quality and school achievement using the Internet Addiction Test, Pittsburg Sleep Quality Index, Parent–Child Internet Addiction Scale and the students' end‐of‐term school grades. Data were analysed in Statistical Package for the Social Sciences programme using Chi‐square test, Independent t test, Man–Whitney U test, Friedman test and Spearman correlation analysis. Results: The median Internet Addiction Test and Pittsburg Sleep Quality Index scores of the adolescents in the intervention group were significantly lower than those of the controls (P < 0.05), and there was a positive and moderate association between problematic Internet usage and sleep quality in both groups after the follow‐up (r = 0.537, P = 0.010; r = 0.576 P = 0.005). Conclusion: The education and counselling intervention decreased problematic Internet usage and increased sleep quality. There was also an improvement in school achievement, but the difference was not significant. Summary statement: What is already known about this topic? Problematic internet usage is a common public health problem among adolescents, and it affects their physical, social and academic lives.There are some studies in the literature on the prevalence and treatment of problematic internet usage, but there are few on preventing its occurrence.Strengths‐based approaches in adolescent interventions encourage active learning. What this paper adds? A solution‐focussed approach was used for the first time in adolescents to prevent and manage problematic internet usage and accompanying problems.A programme of solution‐focussed health education and counselling was found to be an effective intervention for preventing problematic internet usage and some accompanying problems in adolescents. The implications of this paper: For the prevention and management of problematic internet usage school nurses should screen young adolescents for Internet addiction symptoms and accompanying problems.Nurses must have the benefit of multiple approaches to systematize health care in fulfilling their school health responsibilities.Health education programmes administered by school nurses to address Internet addiction in students can be based on solution‐focussed approaches. [ABSTRACT FROM AUTHOR]

Purpose: To identify the risk and protective factors affecting a salutogenic sense of health in adolescents with Moyamoya disease based on Antonovsky's salutogenesis theory. Methods: This study used a qualitative descriptive design. We interviewed adolescents diagnosed with Moyamoya disease and their parents and experts with experience in treating them from 4 July 2019 to 10 October 2019. Data analysis was performed according to the process of deductive content analysis based on Antonovsky's salutogenesis theory. Results: This study identified risk and protective factors affecting a salutogenic sense of health in adolescents with Moyamoya disease. Risk factors were closely related to problems with friends, parent relationships and academic work. Protective factors were identified as emotional support through interpersonal relationships, positive attitudes to the disease situation, ability to understand and predict patterns of symptoms, increasing strength to resolve the state of tension and developing available resources. Conclusion: The factors affecting a salutogenic sense of health in adolescents were identified reflecting on the characteristics of the developmental stage of adolescents and the symptoms and situations that are unique to adolescents. It is important for adolescents with Moyamoya disease to recognize available resources and use them appropriately to successfully manage the state of tension caused by stress. Summary statement: What is already known about this topic? Adolescence is an important developmental stage in which individuals experience rapid physical and cognitive changes; these developmental changes can be more stressful for adolescents with Moyamoya disease.Stressful situations increase the frequency and worsen the symptoms of transient cerebral ischaemic attacks, and these negative experiences lead to depression, anxiety, low self‐esteem, negative self‐concept formation and social maladjustment, which persist until adulthood. What this paper adds? The risk factors affecting the salutogenic sense of health in adolescents with Moyamoya disease were related to problems with interpersonal relationships and academic work.The families of adolescents with Moyamoya disease play a pivotal role in increasing their strength to resolve their state of tension.It is important for adolescents with Moyamoya disease to identify and understand the resources available to them and use them appropriately to manage the state of tension. The implications of this paper: This study is meaningful in that the factors affecting the salutogenic sense of health were identified by reflecting on the unique characteristics of the developmental stage of adolescents.The results of this study will guide clinical nurse and researchers in developing interventions to maintain and promote the health of adolescents with Moyamoya disease. [ABSTRACT FROM AUTHOR]

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

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

Purpose This study aimed to develop and test the psychometric properties of a Professional Nursing Support Scale for patients with cancer in mainland China. Methods: The study was conducted in two phases from January 2017 to January 2020. Phase I involved item generation and developing a preliminary version of Professional Nursing Support Scale through literature review, qualitative interviews, content validity evaluation and a pilot study. Phase II involved psychometric properties testing of the Professional Nursing Support Scale in 700 patients with cancer recruited from four public hospitals in Anhui Province, China. Results: A 49‐item Professional Nursing Support Scale was finally developed. Exploratory factor analysis showed a four‐factor structure of the 49‐item Professional Nursing Support Scale, accounting for 56.95% of variance. Cronbach's α ranged from 0.91 to 0.94 for the four subscales. Confirmatory factor analysis further confirmed the best model fit of four‐factor structure of the Professional Nursing Support Scale. The Professional Nursing Support Scale also showed an acceptable concurrent validity with Supportive Care Needs Scale short form 34 (r = 0.75, p < 0.001) and Psychological Distress Thermometer (r = 0.39, p < 0.001). Conclusions: The Professional Nursing Support Scale is a reliable and valid instrument to assess perceived needs of professional nursing support and support acquisition in relation to the care in Chinese patients with cancer. Summary Statement: What is already known about this topic? Nurses generally provide supportive care services and play imperative roles in supporting patients in cancer.Using a valid and reliable instrument to assess supportive care needs for patients with cancer is a critical step for the improvement of clinical practice and research. What this paper adds? Mixed methods were beneficial for developing the new self‐report and culturally appropriate instrument for Chinese patients with cancer.The Professional Nursing Support Scale (PNSS) is a reliable and valid instrument to assess perceived needs of professional nursing support and support acquisition in relation to the needs. The implications of this paper: The PNSS is expected to a reliable needs evaluation tool. [ABSTRACT FROM AUTHOR]

Background: There are controversial results about the effects of cancer and chemotherapy on the perception of distress. Aims: The purpose to the study is to explore the meaning of the distress experienced by patients with cancer and verify whether the cancer diagnosis, stage and receiving chemotherapy influence this experience. Design This is a mixed‐methods study with cancer patients. Methods: Data were collected in 2018 using a phenomenological interview (n = 18) and one suffering inventory (n = 100). Qualitative analysis was performed using the empirical‐comprehensive model and quantitative using statistical tests. The results were triangulated. Results: Distress originated from difficulties faced in health services, diagnosis confirmation, beginning treatment and interruption of life projects. Patients mobilized resources in the spiritual dimension that allowed them to redefine their distress positively. Chemotherapy brought hope back and promoted healing expectations. Higher average scores for distress were found in patients with advanced stage and receiving palliative chemotherapy. Not having begun chemotherapy and having head and neck cancer were associated with higher average scores for distress. Conclusion: Distress was greater among patients who had not yet begun chemotherapy; nearness of death and difficulty talking about feelings caused distress; distress was redefined by mobilization of spiritual resources. Summary statement: What is already known about this topic? There are conflicting results about distress between patients with cancer.The distress of cancer patients has been little reported or treated in cancer care units.There are no mixed‐method studies on distress in chemotherapy patients that have combined a measuring instrument and a phenomenological approach. What this paper adds? Distress among patients with cancer derives from elements that relate to health services, as well as the individual's ability to deal with the situation.Distress is greater among patients who have not begun chemotherapy and those who have head and neck cancer diagnoses.Phenomenological method can complement the use of scales to assess the subjective experience of distress in the context of cancer and chemotherapy. Implications of this paper Distress evaluation must encompass listening and the use of measurement instruments to strengthen the implementation of patient‐centred nursing care.Nurses are in a unique position to identify and approach distress, because they are often at the side of patients throughout the course of treatment.Professional training for reporting of difficult news is required. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a public health problem globally. Understanding the perceived challenges of low‐income older people populations with chronic disease is an obstacle the world is facing today. Aim To explore perceived challenges of self‐management in low‐income older people with hypertension. Methods: Data were collected in three communities from September 2019 to October 2019 by semi‐structured interviews. Interviews were audio‐taped by digital voice recorder and analysed according to Colaizzi's seven steps. Results: Participants demonstrated perceived challenges concerning hypertension self‐management. Six themes were identified: hypertension belief bias, family dysfunction, deep‐rooted habit, elder self‐neglect, medical informatization and supportive health policy. Each theme was identified with several subthemes. Conclusions: Findings implied that most of the low‐income older people lacked self‐management behaviours. Future research is needed to address perceived challenges related to self‐management behaviour for patients with hypertension worldwide. Summary statement: What is already known about this topic? Self‐management of hypertension is a cornerstone for blood pressure control.Most older patients lack self‐management behaviours.Low‐income older people with hypertension are the population most vulnerable to poor self‐management.What this paper adds Low‐income older people are more likely to have biased perceptions of hypertension self‐management, which might be affected by social customs, peer behaviour and personal preference.Older people also tend to ignore their health to meet the needs of family members as a priority.With the development of information technology, more effort should be taken to help low‐income older people acquire medical information via e‐health.The implications of this paper Proper awareness of the importance of self‐management is the priority for hypertension control.Managing physical, psychological and social frailty in older people and reducing elder self‐neglect rates are significant to improve self‐management behaviours.Family plays an important role in self‐management of low‐income older people with hypertension and family empowerment programs are suggested. [ABSTRACT FROM AUTHOR]

Background: Elders' disability severity and caregiver health could predict elders' informal care time, but the mechanism by which the degree of disability in the elderly affects informal care time is unclear. Aim: The aim of this works is to explore the mediating roles of caregiver health and home‐based care quality between disability severity of elders and informal care time in far north‐western low‐income areas in China. Method: From September 2017 to February 2018, three hundred fifty‐two dyads of Kazakh disabled elders and informal caregivers in Xinjiang were interviewed. Structural equation modelling analyses were applied. Results: Significant positive correlations were observed between elders' disability severity and informal care time, caregiver health and informal care time, elders' disability severity and caregiver health. Significant negative correlations were observed between home‐based care quality and informal care time, elders' disability severity and home‐based care quality, caregiver health and home‐based care quality. Elders' disability severity had 71.94% direct effect on informal care time, 28.06% indirect effect on informal care time mediated by home‐based care quality and caregiver health. Conclusion: Caregiver health and home‐based care quality play mediating roles on the path relationship between the elders' disability severity and informal care time. Summary statement: What is already known about this topic? Elders' disability severity and caregiver health are critical factors that affect informal care time.The mechanism by which the degree of disability in the elderly affects informal care time is unclear. What this paper adds? Elders' disability severity is positively associated with caregiver health and negatively associated with home‐based care quality.The better home‐based care quality, the shorter the informal care time.Disabled elders' severity degree had a direct effect on informal care time and indirect effects on informal care time mediated by caregiver health and home‐based care quality. The implications of this paper: Community nurses, doctors and health care teams should provide medical services, nursing skills and knowledge for the dyads of disabled elders and informal caregivers and should provide emotional support for other family members to enable growth of the entire family in the process of long‐term care and to reduce informal care time.The government should attach great importance to the informal care time for disabled elders and propose specific informal care time cost compensation policies based on path relationships that influence informal care time. [ABSTRACT FROM AUTHOR]

Aim: This qualitative study explored de‐implementation of feeding tube auscultation practice in adult patients by critical care nurses. Background: Despite years of evidence suggesting inaccuracy and harm, auscultation (air bolus method) continues to be used by the majority of critical care nurses to verify small‐bore feeding tube placement in adults. Design This descriptive qualitative study used thematic analysis with telephone interview data. Methods: Fourteen critical care nurses from four stratified groups within the United States (by hospital type and auscultation practice) participated in telephone interviews. Results: Two major themes of individual influence and organizational leadership emerged from the data. Categories identified key components required for auscultation de‐implementation. Conclusions: Nurses feel obligated to follow hospital policies and expressed less accountability for their own practice. Organizational leadership involvement is recommended to facilitate de‐implementation of this tradition‐based, low‐value practice and mitigate harm events. Summary statement: What is already known about this topic? Auscultation is not an accurate method to identify feeding tube placement.Many critical care nurses continue to use the auscultation method (a low‐value, tradition‐based practice) to verify feeding tubes.Factors associated with de‐implementation of auscultation method for feeding tube verification are unknown. What this paper adds? Many nurses are aware that auscultation is not evidence based for adult feeding tube verification and are falsely comforted by hearing the whoosh sound (psychological bias).A combination of individual and organizational factors are barriers to de‐implementing auscultation of feeding tubes.Nurses seek guidance from leaders within their organization to facilitate de‐implementation, which is a necessary component of evidence‐based practice. The implications of this paper: A major challenge to de‐implementation of auscultation is the lack of valid bedside methods to assess feeding tube placement. Active involvement by organizational leaders will facilitate decision‐making to recommend a safe substitution for the auscultation method.Nurses expressed eagerness to incorporate evidence into their practice if they have adequate leadership support and the necessary resources to make practice changes.Formal intervention by organizational leaders is needed to promote de‐implementation of auscultation for feeding tubes. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether a novel decision support tool would effectively minimize physical restraint use in critically ill adult patients. Design A nonequivalent quasi‐experimental design combined with a descriptive qualitative approach was used. Methods: A Restraint Decision Tree was developed based on a qualitative study that explored the barriers to employ the Restraint Decision Wheel. During the quasi‐experimental study, patients admitted to the unit between October 2017 and March 2018 were enrolled as the control group receiving the Restraint Decision Wheel (n = 528), whereas patients between April 2018 and September 2018 were enrolled as the intervention group receiving the Restraint Decision Tree (n = 564). The physical restraint rate, accidental catheter removal rate and nurses' satisfaction were compared. Results: The Restraint Decision Tree significantly decreased physical restraint use. No significant difference in the rate of accidental catheter removal was found. Nurses reported increased satisfaction with the restraint decision‐making. Conclusions: The Restraint Decision Tree could minimize physical restraint use. Physicians' involvement in the restraint decision‐making and nurses' competence in delirium assessment may be essential for successful implementation of the Restraint Decision Tree. Summary statement: What is already known about this topic? Physical restraint is a common practice in the intensive care unit.Minimizing physical restraint use does not increase the risk of catheter self‐removal.Nurses equipped with clinical decision‐making skills could promote the appropriateness of restraint application. What this paper adds? The Restraint Decision Tree could help nurses make appropriate restraint decisions for critically ill adult patients, thus decreasing the use of physical restraint.Multidisciplinary decision‐making improves nurses' satisfaction with the restraint decision process. The implications of this paper: This study suggests that the Restraint Decision Tree can be implemented in the intensive care unit as an effective decision‐making tool to decrease physical restraint use while maintaining patient safety.A strong culture of multidisciplinary collaboration and delirium screening is called for prior to utilizing the Restraint Decision Tree. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to describe the experiences of nurses and other health care workers who were infected with coronavirus disease 2019. Methods: An empirical phenomenological approach was used. Sixteen participants were recruited in Wuhan using purposive and snowball sampling. Semistructured, in‐depth interviews were conducted by telephone in February 2020. Interviews were transcribed verbatim and analysed following Colaizzi's method. Results: Two themes emerged: (1) Intense emotional distress since becoming infected. Participants were fearful of spreading the virus to family and overwhelmed by a lack of information, experienced uncertainty and worried about treatment, felt lonely during isolation and reported moral distress about inadequate health care staffing. (2) Coping strategies were needed. They tried their best to address negative psychological reactions using their professional knowledge and gaining support from others and community resources. Conclusions: Preparedness for catastrophic events and providing timely and accurate information are major considerations in government policy development, related to pandemics and adequacy of health care personnel. Mental health resources and support, both short‐ and long‐term should be anticipated for health care providers to alleviate their fear and anxiety. Summary statement: What is already known about this topic? Health care workers, including nurses, are at the frontlines of the COVID‐19 outbreak and at high risk of infection.Experts have called for infection prevention for health care providers.Limited research has reported the experiences of health care workers infected by COVID‐19 using an empirical phenomenological approach. What this paper adds? Upon diagnosis, nurses and other health care workers experienced fear, uncertainty and distress like general patients.Health care workers reported moral distress about inadequate health care staffing issues.Health care workers could cope with their negative psychological reactions using professional knowledge and support from significant others and the community. The implications of this paper: Preparedness for large‐scale pandemics and a system that can provide openness and timely information needs consideration in policy development.Accurate information and good communication are vital to support infected health care workers and enhance their sense of safety and belonging.Long‐term support should be available when these health care workers return to work. [ABSTRACT FROM AUTHOR]

Background: Multiple studies focus on the experiences of visiting students from high resource regions that participated in clinical placements in lower resource countries but less focus on the experiences of the educators accompanying students. Aim: The purpose of this study was to explore the experiences of educators during an international clinical placement of nursing students in a country in West Africa. Methods: We implemented a focussed ethnographic design. We purposively sampled educators who accompanied students on an international clinical placement. Data collection from 2018 to 2019 consisted of in‐depth individual interviews. We utilized Roper and Shapira's (2000, 10.4135/9781483328294.) data analysis process, which includes coding keywords, identifying patterns and theorizing. Findings Three themes emerged from the data: rewards in accompanying students, challenges experienced and the need for mentoring and continuous support. Educators found it rewarding to see growth in students, how students developed as global citizens, how students developed critical thinking and problem‐solving skills and create lifelong friendships. Conclusion: Educators who accompany nursing students to international clinical placement experience valuable learning and challenging issues. Educators must navigate, support and advance student learning when on an international placement. It is crucial to have adequate institutional support from both the home and host country. Summary statement: What is already known about this topic? Multiple research studies focus on the experiences of visiting students from high resource regions that participated in clinical placements in lower resource countries but less focus on the experiences of the educators accompanying students.Multiple rewards exist for educators who accompanying students on an international clinical placement.Nurse educators are expected to mentor students and provide continuous support. What this paper adds? The need for continuous contact between the educators and the home faculty is highlighted.Mentoring topics to 'soften' the impact of the challenges experiences by educators are identified; this includes regular debriefing with senior educators at the home and host university.The importance of working with the host during the predeparture period, as well as report on arrival and have regular meetings during the placement to ensure that both the needs of the visiting student group and the host are met, is highlighted. The implications of this paper: (how findings influence or can be used to change policy/practice/research/education) A well‐developed support system and debriefing sessions are necessary for the accompanying faculty member.Research is needed to develop the content of a mentorship model/framework for junior academics that plan to accompany students on international clinical placements to low and middle‐income countries.Additional research is needed on the value of pairing a junior academic with an experienced mentor to answer questions as they arise related to day‐to‐day challenges and student related questions during the international clinical placements. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the experiences of family caregivers interacting with people with dementia. Background: A majority of people with mild‐to‐moderate dementia live at home with family caregivers. This interaction creates positive experiences and challenges for these caregivers. Design Descriptive phenomenological qualitative inquiry guided this study. Methods: This qualitative study involved semi‐structured interviews with the caregivers of people with mild‐to‐moderate dementia (n = 10). Data were collected from June to September 2018, and then data were thematically analysed. Results: Six categories of themes were identified from the interviews: (1) unexpected things often happen; (2) positive coping strategies; (3) sense of accomplishment because people with dementia actively participate in activities; (4) sense of frustration because of the reluctance of people with dementia to participate in activities; (5) hope for the happiness of people with dementia; and (6) want to have their own life. Conclusions: This study reveals that caregivers could positively interact with people with dementia through creating opportunities and arranging meaningful activities. Future research should focus on family management and training on how to help caregivers interact effectively with people with dementia. SUMMARY STATEMENT: What is already known about this topic? A majority of people with mild‐to‐moderate dementia live at home with family caregivers.Many caregivers suffer from depression, anxiety, fatigue, insomnia, family conflicts and low levels of life satisfaction.How caregivers interact with people with dementia at home remains unclear. What this paper adds? Caregivers experience various feelings, such as a sense of accomplishment and occasionally frustration, when interacting with people with dementia.Caregivers stated that they wanted people with dementia to be happy and live their life. Thus, the caregivers changed their attitude, accepted the situation and organized meaningful activities for people with dementia.Caregivers employed various strategies for handling situations involving people with dementia and shared how they interacted with such individuals. The implications of this paper: Care organizations that can offer certain services for people with dementia should be developed to lessen caregivers' burden.Community nurses should develop caregivers' strengths and enhance their abilities to improve interaction with people with dementia.Future research should focus on family management and training on how to help caregivers interact effectively with people with dementia. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to investigate the effect on health, well‐being and weight loss of a motivational support programme provided for adolescents who were overweight and obese. Methods: This was a randomized controlled trial. Sixty‐four adolescents (39 girls and 25 boys) who were overweight and obese and consulted at our polyclinic from January 2015 to February 2016 comprised the study population. The sociodemographic characteristics, well‐being levels and physical parameters of the adolescents were evaluated. Routine follow‐ups were practiced for both groups. The adolescents in the experimental group had motivational interviews and were sent reminder messages over a 6‐month period, and education programmes were conducted with the parents. Results: After 6 months, the body mass index values had decreased in the experimental group compared with baseline, with no decrease in the controls. Scores for the Paediatric Quality of Life total scale and physical health and psychosocial health subscale points were increased in experimental and control groups, but the quality of life scale points of the experimental group were higher than the control group. In the experimental group, aspartate aminotransferase, alanine aminotransferase, insulin, homeostasis model assessment of insulin resistance (HOMA‐IR) and total cholesterol were decreased. Conclusion: The motivational support programme affected the adolescents' health positively and can be recommended as a routine nursing intervention. SUMMARY STATEMENT: What is already known about this topic? Obesity is increasing in the world and becoming an important public health problem.Childhood obesity can critically affect health outcomes.Effective preventive interventions are greatly needed to decrease the prevalence of childhood obesity. What this paper adds? The motivational support programme that was provided to obese and overweight adolescents decreased their body mass index.The motivational support programme positively affected biochemical values and quality of life in adolescents who were obese and overweight.The present study found that this motivational support programme with parental involvement was an effective strategy in changing obesity‐related outcomes. Implications of this paper: Nurses evaluate adolescents who present to hospitals with other health problems and play an important role in recognizing overweight or obesityNurses could learn to apply this programme to decrease future health problems.Motivational support programmes can be applied to obese children and adolescents admitted to obesity clinics and their use should be more widespread. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to determine the effects of demographic and obstetric variables with body image on sexual dysfunction in pregnant women. Background: Sexual dysfunction is frequent in pregnant women. To what extent body image plays a role is incompletely understood. Methods: In the research, a cross‐sectional and comparative study was conducted. A personal information form, body image scale, and female sexual function index were applied to 472 pregnant women. Descriptive statistics, the Student t‐test, the χ2 test, and logistic regression analysis were employed for evaluating the data. Results: Sexual dysfunction was found in 54.7%. The frequency of sexual dysfunction in the first trimester was lower. In addition, factors like the place of residence of the pregnant women and number of pregnancies were found to be related to sexual dysfunction in pregnant women. Each unit decrease in body image score resulted in women being 0.98 times more likely to experience sexual dysfunction. Conclusion: It was determined that approximately one in two pregnant women experienced sexual dysfunction, and body image, place of residence, trimester of the pregnancy, and number of pregnancies were important factors affecting sexual function. SUMMARY STATEMENT: What is already known about this topic? Many factors cause sexual dysfunction, and one of these factors in women is pregnancy.In addition to the anatomical, physiological, and psychological changes caused by pregnancy, some demographic and obstetric variables can affect sexuality during pregnancy.To what extent body image plays role on sexual dysfunction in pregnancy is incompletely understood. What this paper adds? Approximately one in two pregnant women experienced sexual dysfunction in this study.We determined body image, living place, trimester of the pregnancy, and number of pregnancies were important factors affecting sexual function. The implications of this paper: The integration of findings with prenatal care services can be used to assess risk factors and provide protective services.Sexual dysfunction in pregnancy should be considered in the presentation of prenatal care services.Body image and all other variables should be considered as part of holistic follow up of pregnant women. [ABSTRACT FROM AUTHOR]

Aim: To translate the International Consultation on Incontinence Questionnaire (ICIQ) Long‐Term Catheter Quality of Life (LTCqol) questionnaire (ICIQ‐LTCqol) from English to Arabic and evaluate its psychometric properties. Background: Currently, no tool for Arabic‐speaking patients is available to measure the quality of life in patients using long‐term urinary catheters. Design Translation and psychometric assessment of questionnaire. Methods: The internal consistency and construct validity of the translated Arabic version of the ICIQ‐LTCqol were evaluated in a convenience sample of 141 participants recruited from a hospital in Egypt from April to September 2017. Test‐retest reliability was assessed for a sample of 15 participants who completed this version at two time points. Construct validity was assessed by factor analysis. Results: The translated Arabic version of the ICIQ‐LTCqol showed satisfactory test‐retest reliability and internal consistency, with the Cronbach α =.75. Confirmatory factor analysis confirmed the same two factors ("catheter function" and "lifestyle") structure as found in the English version of the tool supporting the construct validity of the translated questionnaire. Conclusion: This original and significant study allows, for the first time, researchers and clinicians working with Arabic‐speaking patients, the opportunity to evaluate the quality of life in long‐term urinary catheter users. SUMMARY STATEMENT: What is known about this topic: The potential negative impact of using a long‐term indwelling urinary catheter on patients' everyday lives has been well documented.There is no available psychometrically robust self‐report questionnaire that can be used to assess the impact of living with a long‐term catheter among Arabic speakers.To date, the Incontinence Questionnaire (ICIQ) Long‐Term Catheter Quality of Life (LTCqol) questionnaire (ICIQ‐LTCqol) has not been translated into Arabic, and therefore, it has not been used with Arabic‐speaking catheter patients.In Arabic countries, no research has been conducted focusing on the experience of patients with urinary catheters. What this paper adds? The International Consultation on Incontinence Questionnaire (ICIQ) Long‐Term Catheter Quality of Life questionnaire (ICIQ‐LTCqol) Arabic version is a clear, understandable, and short questionnaire.The Arabic version of the ICIQ‐LTCqol has the same factor structure as the English version using confirmatory factor analysis.The Arabic version of the ICIQ‐LTCqol has good internal consistency. Implications of this paper: Clinicians and researchers working with Arabic‐speaking patients, who use long‐term urinary catheters, can utilize this version of the ICIQ‐LTCqol to evaluate their QOL.The Arabic version of the ICIQ‐LTCqol is a robust tool for assessing the impact of living with a long‐term catheter in Arabic countries.Further research is needed on the retest reliability of the ICIQ‐LTCqol in the Arabic‐speaking population.The impact of living with a long‐term catheter has not been investigated in Arabic countries. [ABSTRACT FROM AUTHOR]

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

Aim: The aim of this study is to evaluate incidences of inappropriate initial urinary catheter placements within an older inpatient cohort. Methods: A total of 200 inpatients that received urinary catheterizations within 24 hours of admission were recruited for this observational study. The key demographic and clinical factors were recorded. Adverse outcomes were assessed by examining incidences of catheter‐associated urinary tract infection (CAUTI) during hospitalization, after transfer to skilled nursing facilities, second, duration of hospital stay and by scoring changes on the Katz Index of Independence in Activities of Daily Living. Correlative relationships between demographic data and clinical factors with adverse outcomes were analyzed. Results: Inappropriate initial urinary catheterization in our cohort was approximately 39%. This was associated with elevated Charlson comorbidity index scores and increased dependency, with correlations to medical diagnosis. We also observed that the primary rationale for the procedure (inappropriate catheterization) was for neurogenic bladder (where intermittent catheterization was indicated) and in 'convenience‐of‐care' catheterizations. Inappropriate catheter placement was ultimately associated with an elevated CAUTI at point of discharge, with transfers to skilled nursing facilities and also with an increased duration of hospital stay. Conclusions: Inappropriate catheter placement was prevalence in southwestern China and associated with adverse outcomes. SUMMARY STATEMENT: What is already known about this topic? Urinary catheterization is a common procedure for geriatric in‐patients, yet up to half of such placements are inappropriately performed.Reducing inappropriate urinary catheter use is key to minimizing adverse outcomes such as urinary tract infection and genitourinary trauma.Although guidelines for in‐patient catheterization have been developed, there are no uniform standardized national guidelines in China that could advise physicians on the placement of inpatient urinary catheters.What this paper adds? High incidences of inappropriate initial urinary catheterizations in mainland China have been reported (as represented by a hospital in southwestern China).This study finds that inappropriate catheter placements are associated with catheter‐associated UTIs at the point of discharge, with transfers to skilled nursing facilities, and an increased duration of stay.We also find that inappropriate catheter placements occur when catheterization is indicated for neurogenic bladder (with intermittent catheterization), and for 'convenience‐of‐care' purposes.The implications of this paper: The study identifies situations where older in‐patients have an elevated risk of receiving inappropriate initial urinary catheterization which should receive special attention.The findings of this study highlight the need to develop effective uniform strategies to reduce inappropriate catheterization for older Chinese patients.The factors associated with inappropriate catheterization based on our findings could be useful in establishing the proactive strategies. [ABSTRACT FROM AUTHOR]

1HypothesisDisabled elders' activities of daily living, caregiver burden, caregiver depression, and caregivers' life satisfaction are significantly related to the life satisfaction of elderly people with disability.2HypothesisThere are direct and indirect effects between the life satisfaction of elders, disabled elders' activities of daily living, and family caregivers' factors. This study explored the interrelationships of disabled elders' life satisfaction and activities of daily living, caregivers' factors (burden, depression, and life satisfaction) through a structural equation model. In total, 621 dyads of disabled elders and informal family caregivers completed questionnaires during face ‐ to ‐ face interviews in Xinjiang Uyghur Autonomous Region from September 2013 to January 2014. Activity of daily living exerted a direct effect on life satisfaction of disabled elders and 30.4% indirect effect through caregivers' factors. Caregiver burden had a 60.0% direct effect on life satisfaction of disabled elders and a 40.0% indirect effect through the caregiver depression. Caregiver depression showed 76% direct effect on life satisfaction of disabled elders and 24% indirect effect through caregivers' life satisfaction. Direct relationships between activity of daily living and caregiver burden, caregiver burden and caregiver depression, and caregiver depression and caregivers' life satisfaction were observed. Activity of daily living had a 91.3% indirect effect on caregiver depression mediated by caregiver burden; caregiver burden had a 40.0% indirect effect on caregivers' life satisfaction mediated by caregiver depression. Results provide useful information for nurses and policymakers and shed light on the need to consider caregivers' factors in improving care recipients' life satisfaction. SUMMARY STATEMENT: What is already known about this topic? Disabled elders' life satisfaction is related to factors of the poor state of their own and caregivers' problem e.g. caregiver burden.The mechanism of how the factors affect disabled elders' life satisfaction is unclear. What this paper adds? The study created a causal chain among the disability elders' activity of daily living, caregivers' burden, depression, life satisfaction, and disabled elders' life satisfaction and explored the interrelationship between above factors and disabled elders' life satisfaction.Findings indicated that family caregivers' burden not only affects elders' life satisfaction directly but also brings further problems to affect disabled elders' life satisfaction indirectly. The implications of this paper: Government should pay high attention to the families of elderly people in long ‐ term home care; pension policies should support elders' families including informal family caregivers in poverty ‐ stricken ethnic minority areas.Examples of support include establishing assistance for the disabled elders, care training for family caregivers for free, establishment and improvement of respite care institutions, and psychological counselling. The caregiver's health should be comprehensively considered; formulation and improvement of a specialized disabled elders' family services.Nursing educators should include knowledge of the elderly in home care and ways of coping with care, nursing skills, and time management should be taught to family caregivers. [ABSTRACT FROM AUTHOR]

Aim To explore how and why mobile instant messaging applications are used by Filipino nurses as part of their work. Methods Guided by the uses and gratifications theory, in-depth interviews with 20 staff nurses working in 9 hospitals (ie, 4 private and 5 public hospitals) in the Philippines were conducted in July 2015. Interview data were analysed through a phenomenological perspective to thematic analysis. Results Results show that mobile instant messaging applications such as Facebook Messenger and Viber were mostly used by staff nurses and these were accessed using their own smartphones. Thematic analysis indicates that they were used to meet staff nurses' need for information exchange, socialization, and catharsis. Moreover, user interactions vary depending on members within a chat group. For instance, communication via mobile instant messaging applications are much formal when superiors are included in a chat group. Conclusion In general, the results show that mobile instant messaging applications are routinely used by Filipino staff nurses not only for clinical purposes (ie, information exchange) but also for non-clinical purposes (ie, socialization and catharsis). This paper ends with several practical and theoretical implications including future research directions. [ABSTRACT FROM AUTHOR]

This paper examines the experiences of mothers caring for a child with Down syndrome in the Malaysian ( Sarawak) context. Qualitative interviews were conducted with 26 biological mothers of children with Down syndrome aged 18 years and below. They were accessed through selected child health clinics, community-based rehabilitation centres and schools using purposive sampling within two regions in Sarawak, one of the two Borneo States of Malaysia. Major themes emerging within the context of care demands were children's health, developmental delays, daily needs and behaviour issues. The insights obtained into the care demands experienced by mothers of children with Down syndrome have several implications for practice by care professionals. [ABSTRACT FROM AUTHOR]

This paper reports on a funded project that explored the perceptions and experiences of mentors regarding student nurse support in practice. The study employed a mixed-method approach, using questionnaires and focus groups with mentors from one acute Trust and one community Trust. The findings highlighted the multifaceted nature of student learning in practice, with mentors reporting that clinical skills, adjustment to the placement and integrating into the team were the aspects students needed most support with. Mentors were aware of their roles and responsibilities in supporting students and recognized the importance of their own personal attributes. The participants reported a number of challenges, particularly time, competing demands and paperwork, and suggested that a team approach and support groups could help to overcome these. The support for students provided by peers and health-care assistants was recognized, as was the need to ensure that students are prepared to take responsibility for their learning. [ABSTRACT FROM AUTHOR]

Aim: To develop and psychometrically test the Australian Midwifery Workplace Culture instrument. Background: Workplace culture is critical within midwifery settings. Culture determines not only the well‐being and continued retention of maternity staff and managers but it also affects the quality and ultimate safety of the care they provide to women, infants and families. Several studies have identified cultural problems within maternity services. Relatively few instruments take account of the unique aspects of these workplaces and the relationship between midwives and women. Design Three‐stage instrument development involved item generation (based on the Culture of Care Barometer), expert content validation and a pilot test. Methods: During 2016, 38 midwifery experts reviewed the initial items, and 322 midwives then pilot‐tested the draft instrument. We used exploratory factor analysis to identify key domains and to refine the instrument. Results: The refined instrument contained 22 items in three distinct domains: relationship with managers, empowerment and collegiality. Conclusion: The instrument can contribute to understanding important dimensions of the culture in maternity workplaces and thus to examining problematic attitudes and practices. The instrument requires further development and testing with larger and more diverse samples of midwives and validation in specific midwifery settings and models of care. SUMMARY STATEMENT: What is already known about this topic? Previous research reports problems in the organizational culture in maternity services, increasing the stress on midwives and potentially affecting the care they provide to women and infants.Negative workplace culture may contribute to attrition in maternity workforce.There are few measures that specifically address midwifery workplace culture. What this paper adds? This paper presents a new instrument designed to measure dimensions of midwifery workplace culture, detailing item generation and pilot testing.Analysis identified three domains that demonstrated good psychometric properties: relationship with management; empowerment and autonomy; collegiality and relationship with peers. Implications of this paper: The exploratory factor analysis suggests the utility of this instrument for assessing workplace culture in midwifery settings.The study recommends further testing of this instrument and validation in diverse midwifery workplaces, including large and small hospitals, community services and rural and remote areas. [ABSTRACT FROM AUTHOR]

Background: Thailand has a shortage of community health nurses for supporting the self‐management of type 2 diabetes, which is prevalent and poorly controlled. Aim: This study examined the feasibility and acceptability of a self‐care assistance programme for poorly controlled type 2 diabetes mellitus. The SukapapNet programme consisted of automated interactive voice response calls to patients and automated follow‐up email notifications to their nurses. Design: Single‐arm pre‐post trial. Methods: Six nurses and 35 type 2 diabetes patients were recruited from primary care settings in suburban provinces in Thailand. The study was conducted from June 2017 to November 2017. We assessed patients before and after 12 weeks of the SukapapNet intervention. Results: Mean glycated haemoglobin decreased by 0.9%. Patients reported reduced carbohydrate consumption, increased physical activity, increased medication adherence, improved sleep quality, and more frequent foot care. Patients and nurses both recommended using the intervention, although nurses expressed concerns regarding increased workload. Conclusions: The study programme could improve outcomes in Thai type 2 diabetes patients. Further study of the impact of technology upon nurses' workload is warranted. SUMMARY STATEMENT: What is already known about this topic? Prevalence of type 2 diabetes is increasing in Thailand, and nurses who play an important role in health care at the community level are limited.Mobile health strategies including short message service, automated telephonic monitoring, and internet‐based education have been successfully applied in Thailand with prenatal care, depression, Parkinson disease, cardiac rehabilitation, and diabetes.Although mobile health is a promising way to bridge gaps in managing type 2 diabetes, an effect of automated mobile health with nurse follow‐up has never been investigated in primary care settings. What this paper adds? Automated interactive voice response monitoring of diabetes patients with emailed updates to nurses is acceptable to Thai patients with poorly controlled type 2 diabetes.Mobile health strategies could also improve Thai nurses' ability to help diabetes patients with glycaemic control.To reduce burden for nurses, summaries of patients' responses should be emailed on a less‐than‐daily basis. The implications of this paper: This study contributes to the knowledge of how mobile health strategies could help Thai patients with type 2 diabetes achieve glycaemic control and increase nurses' engagement with these patients.Innovative use of automated interactive voice response with feedback to community health nurses should be further developed in Thailand.Future research should investigate a mobile health benefit to diabetes glycaemic control through a large‐scale randomized controlled trial. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the effect of application of superficial local heat and a home exercise program on pain and function levels to patients with bilateral knee osteoarthritis. Methods: This study was conducted in Turkey between January 2014 and February 2015. The sample group of the study consisted of 62 patients with osteoarthritis; 15 assigned to heat application, 15 to exercise, 15 to exercise after heat application, and 17 for the control group. While the patients in the control group received routine treatment only, the patients in the intervention group were treated with heat application, exercise, or exercise after heat application, suggested for 5 days a week for 4 weeks in addition to routine treatment. Results: In this study, all of the intervention groups had decreases in Visual Analogue Scale Pain and Western Ontario and McMaster Universities Osteoarthritis Index pain, stiffness, and function scores when compared with the control group. It was found that this decrease in Visual Analogue Scale Pain and Western Ontario and McMaster Universities Osteoarthritis Index scores was mostly in the exercise group, but this condition was not statistically significant. Conclusions: As a result, it is recommended that nurses train patients with osteoarthritis on heat application and home exercises and encourage them to apply these practices. SUMMARY STATEMENT: What is already known about this topic? Knee osteoarthritis is a chronic musculoskeletal system disease characterized by pain and physical disabilities that affects joints, typically progresses bilaterally, and impairs quality of life.The most frequent symptoms of knee osteoarthritis are pain, stiffness, limited range of joint motion, motion restriction, joint deformity, and loss of function.The combination of heat application and exercise for knee osteoarthritis has been stated to reduce pain, ensure comfort, and enhance stiffness and physical function. What this paper adds? This study showed that application of heat and a home exercise program reduced pain and enhanced the functional level for patients with osteoarthritis.While Western Ontario and McMaster Universities Osteoarthritis Index stiffness, pain, and disability subgroup scores decreased in all intervention groups (heat application, exercise after heat application, and exercise) post intervention, no change was found in the control group.Pain was significantly lower in all intervention groups post intervention. The implications of this paper: It is important for nurses to use nonpharmacological methods with high evidence levels in patient care.Nurses can train patients with osteoarthritis on application of heat and home exercise, which are easy‐to‐apply, cost‐effective, and efficient methods, and encourage them to do these practices. [ABSTRACT FROM AUTHOR]

Aim: The purposes of this study were to describe the degree of knowledge and explore the factors associated with knowledge of infertility among women of childbearing age with breast cancer. Methods: In this cross‐sectional study, we recruited women of childbearing age with a diagnosis of breast cancer who had completed chemotherapy at a hospital in Taipei from 2015 through 2016. Face‐to‐face interviews were completed with 201 (62%) of 324 eligible women, asking about sociodemographic variables, disease and treatment characteristics, fertility intention, and infertility‐related knowledge. Results: The result showed one in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy. The mean score of infertility knowledge among participants was low, especially for general knowledge. Women with higher levels of education had better knowledge scores. Fertility intention score, especially for the domain of the pregnant risk, was negatively associated with infertility knowledge score. Conclusion: Women with breast cancer lacked knowledge about infertility and underestimated the possibility of infertility. We suggest future patient education on infertility after cancer treatment and about reproductive technology in oncologic practice before treatment begins. SUMMARY STATEMENT: What is known about this topic? Women with cancer diagnosed during the reproductive age are interested in a subsequent pregnancy.Less than half of childbearing‐age women with cancer have a comprehensive discussion about the potential impact of cancer therapy on fertility with the oncology physician.Reproductive‐age women with breast cancer have gaps in their knowledge of fertility planning as breast cancer survivors. What this paper adds? One in 10 women had thought about becoming pregnant after completion of breast cancer chemotherapy.Most women with breast cancer lack sufficient general and cancer‐specific knowledge about infertility.Factors associated with knowledge of infertility are fertility intention and education level. The implications of this paper: Results offer oncological nurses an understanding of fertility needs and infertility‐related knowledge in childbearing‐age women with breast cancer.Clinical nurses should continue to assess fertility willingness and knowledge of infertility in women with cancer both before and after cancer treatments.Comprehensive education about fertility and infertility in Taiwan is suggested. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the effect of a transtheoretical model–based motivational interview method on self‐efficacy, metabolic control, and health behaviour in adults with type 2 diabetes mellitus. Methods: A randomized controlled study design was used. The study was conducted with 50 individuals with type 2 diabetes mellitus, divided into an intervention group and a control group. The researcher held motivational interviews with the patients in the intervention group. Both groups were observed at the beginning of the study and 6 months after the baseline interview. The study data were collected between January 8 and November 18, 2014. Results: Comparing the intervention and the control groups, the differences in the level of self‐efficacy and participants' metabolic values were significant (P < .05). The number of participants in the action stage of the intervention group for nutrition, exercise, and medication use significantly increased compared with the control group (P < .05). Conclusion: The transtheoretical model–based motivational interview method increased the self‐efficacy level of participants with type 2 diabetes mellitus, which helped them improve their metabolic control and health behaviour stages over this 6‐month period. SUMMARY STATEMENT: What is already known about this topic? Type 2 diabetes mellitus is one of the top 10 potentially fatal diseases that are increasing in prevalence worldwide.The level of self‐efficacy is directly associated with health‐promotion behaviours such as proper diet and regular exercise. The self‐belief or self‐efficacy level for a behaviour can increase or decrease the motivation for taking action.The transtheoretical model facilitates the classification of stages a person goes through before engaging in a behaviour. What this paper adds? The transtheoretical model–based motivational interview helps people with type 2 diabetes mellitus control their blood glucose levels; increase their level of self‐efficacy, which is important for behavioural change; and make positive improvements in nutrition, exercise, and medication use.The frequency of conducting transtheoretical model–based motivational interviews should be planned according to the characteristics of individuals. The implications of this paper: The transtheoretical model–based motivational interview method for encouraging positive health behavioural change (nutrition, exercise, and medication use) in adults with type 2 diabetes mellitus who resist behavioural change may be beneficial in promoting behavioural change.Health care providers can easily apply the transtheoretical model–based motivational interview method. [ABSTRACT FROM AUTHOR]

Aim: To explore the process of tradition‐based practice (TBP) de‐implementation by critical care nurses. Background: Ritualistic and routine practices have been described as sacred cows or TBPs. Many clinical practices have insufficient or no evidence and may lead to poor patient outcomes. De‐implementation (termination) of potentially harmful, ineffective, or non cost‐effective TBP is necessary to facilitate evidence‐based practice (EBP) in the clinical setting. Design Descriptive qualitative inquiry guided this study. Methods: Twenty‐two critical care nurses from an acute care hospital in central Florida participated. Individual and focus group interviews were performed March to July 2016 and analysed using thematic analysis. Results: Three themes were identified: (a) uncertainty, (b) desire to know, and (c) preparing for practice change. Nurses were uncertain about the scientific underpinnings of everyday clinical practices and had difficulty differentiating TBP from EBP. De‐implementation processes and strategies appeared to replicate implementation processes. Conclusion: More research is needed to evaluate de‐implementation processes and strategies used for de‐implementation. An emphasis should be placed on ensuring that nurses are knowledgeable about fundamental EBP skills to encourage assessment of clinical practices for supporting research evidence. Awareness and understanding of TBPs will facilitate a more comprehensive approach towards achieving the gold standard of EBP. SUMMARY STATEMENT: What is already known about this topic? Research has been focused on the process of implementing evidence‐based practices but not on how to de‐implement tradition‐based practices that are found to be of little value or harmful to patients.The concept of de‐implementation is relatively new in health care and remains poorly understood.De‐implementation is a complex process and not simply the reverse of implementing evidence‐based practice.What this paper adds? Nurses were uncertain about the scientific underpinnings of everyday clinical practices and had difficulty differentiating tradition‐based from evidence‐based practice.Barriers to de‐implementation of a tradition‐based practice included psychological biases related to loss of the practice and values previously placed on the practice.The implications of this paper: Nurses must question the origin of clinical practices and ensure that they are based on quality research evidence.Nurses should be able to identify a tradition‐based practice and know when it is appropriate to consider de‐implementation.More research is needed to understand de‐implementation processes and strategies used for de‐implementation. [ABSTRACT FROM AUTHOR]

Aims and objectives: This article presents the generation of a model of care encompassing "function" and "affect" based on findings from a 2011 research project aimed at improving care delivery for people with advanced dementia. Objectives were to provide comprehensive and sustainable care, honouring and respecting the person. Background: Dementia is a debilitating, progressive, and terminal disease with a trajectory ranging from approximately 3 to 16 years, yet attention to end‐of‐life care, promoting comfort, alleviating suffering, and maximizing quality of life is frequently overlooked for people living in the advanced stages of the disease. Methods: The research project from which the model was drawn used a three‐phase mixed methods approach at three residential aged care facilities (nursing homes) providing high care in New South Wales, Australia. Thematic analysis was elicited from focus group discussions with staff, family members, and carers of residents. Findings Themes describe distinct dimensions of a model of care: "function" (dedication, designation, and deliberation) and "affect" (the personal outcomes revealed in relaxation, stimulation, and transformation). Conclusion: Reframing nursing practice from task and disease orientation to person centred and relationship focused is essential in meeting the complete needs of people with advanced dementia. This transformational model of care may be useful in adapting to other end‐of‐life care settings. SUMMARY STATEMENT: What is already known about this topic? Worldwide, the number of people aged 60 years and older is projected to nearly triple by 2050, placing a significant burden on health care systems.Sensory stimulation influences emotions and their expression.As residents progress along the dementia trajectory, they have less opportunities for engaging in meaningful activities. What this paper adds? A new model of care that has a positive effect on quality of life for people with advanced dementia.The model addresses functional and affective needs of residents by focusing on their preferences and personal outcomes.An approach for all health professionals in providing person‐centred care. The implications of this paper: Knowing and engaging the residents' personal history and understanding their physical, psychosocial, and spiritual needs are integral in improving the quality of life for people with advanced dementia, their families, and carers.Redesigning residential aged care facility environments to incorporate home comforts offers an opportunity to enhance health professionals' capacity for improved care. [ABSTRACT FROM AUTHOR]

Aim: This study explored health beliefs and behaviours related to sexually transmitted infections (STIs) from the perspective of juvenile offenders with STIs in three urban cities. Methods: Data were collected using observations and in‐depth interviews between July and November, 2014. Under the supervision of probation officers, 24 juvenile offenders with STIs were interviewed. Leininger's four‐step method guided the data analysis. Findings From participants' perspectives, poor hygiene and a promiscuous lifestyle caused the STIs. The diseases were considered an adult disease with distinct symptoms and deformities, no cure, and therefore fatal. STIs were shameful for juveniles because their presence revealed sexually active behaviours. The juveniles' health‐related behaviours included neglecting their STI symptoms because they did not know they were infected, mistaking STIs for other health conditions, choosing to suffer rather than revealing their diagnosis, and keeping their genitals clean. Conclusion: A large gap emerged between juveniles' beliefs and behaviours related to STIs. Policies and education are needed to provide accurate STI information for this population. SUMMARY STATEMENT: What is already known about the topic? Juvenile offenders are at risk for sexually transmitted infections (STIs).Juvenile offenders are likely to engage in inappropriate behaviours to manage their STIs. What this paper adds? Juvenile offenders believed poor hygiene and a promiscuous lifestyle caused STIs, which were viewed as adult, fatal, deformity‐causing, and shameful diseases.STI symptoms were neglected at first or mistaken for other health conditions due to limited knowledge on STI symptom presentation.Juvenile offenders refused health care for STIs to avoid shame and kept their genitals clean as an STI treatment. The implications of this paper: Policies to provide STI screening for juvenile offenders should be developed considering the high prevalence rates of STIs and low awareness of STI symptoms in this population.Use of social media managed by health professionals could increase accessibility to STI management information among juvenile offenders.Nurse‐led clinics that focus on juveniles' sexual health could lower barriers to health care for the juvenile population. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the nutritional status and needs of a person with dementia living in an aged care home, including identification of barriers to, and effective strategies for, the provision of person‐centred care. Background: Nutrition and hydration care are integral to quality of life for adults with dementia, but there is little research on whether staff knowledge around effective care strategies for residents is translated into optimal care. Design Focused ethnographic single‐case design. Methods: The perspectives of the resident, her prime family member, and six care staff were triangulated through interviews, observation, document audit, and medical file review to investigate the resident's nutrition and hydration status and needs (October 2014‐April 2015). Results: During 3 years in care, this resident had lost weight steadily. Staff appeared attentive but did not maintain a systematic record of body mass index. At meals, staff encouraged eating but used ineffective strategies. Food was not served in ways that facilitated active participation. Eating and drinking were structured as tasks to be completed rather than activities to be enjoyed. Conclusion: This instrumental case study identified a task‐oriented, rather than person‐centred, approach to nutrition and hydration care, adversely affecting the resident's nutritional health and capability to participate actively. SUMMARY STATEMENT: What is already known about this topic? Nutrition and hydration care are integral to quality of life for adults with dementia.Data are limited, but studies document that many point‐of‐care staff in aged care homes have limited knowledge of residents' nutrition and hydration needs and that evidence‐based and person‐centred care practices are not being followed in mealtime management.There is little research on whether staff knowledge around nutrition and hydration care strategies for residents is translated into optimal daily care.What this paper adds? It adds to the limited ethnographic research on nutrition care practices for aged care residents with dementia.This focused ethnographic single‐case description provides insight into key systematic barriers to person‐centred care and effective nutritional management that have wider relevance to the nutritional health of all residents.The case study identifies a task‐oriented, rather than person‐centred, approach to nutrition and hydration care, which adversely affects the resident's nutritional health and capability to participate actively.The implications of this paper: There are many opportunities for improved nutrition and hydration care practices in aged care homes, such as documentation of body mass index and facilitation of social engagement.While cachexia inevitably occurs in advanced dementia, it is important that nutritional status should not be further compromised by ineffective or inadequate care practices.The findings may be used as a basis for further research and to tailor education for aged care home staff to enhance nutrition and hydration care practices. [ABSTRACT FROM AUTHOR]