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Aims: To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit. Design: Experience‐based co‐design. Methods: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis. Results: Twenty‐three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient–provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow‐up care. Conclusion: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes. Implications for the Profession and/or Patient Care and Impact: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life. Reporting Method: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting. Patient or Public Contribution: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience‐based co‐design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co‐design events, to support symptom management for people with multimorbidity. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: To explore how emerging adult‐aged women self‐manage their sexual and reproductive health and to generate a grounded theory of these self‐management processes. Design: Grounded theory methods using a constructivist approach. Methods: Between September 2019 and September 2020, 18‑ to 25‐years‐old women (n = 13) were recruited from a 4‐year university, a 2‐year community college, and neighbourhoods surrounding the institutions of higher education. Individual interviews were transcribed verbatim and qualitatively analysed using a constant comparative method and inductive coding. Results: The theory purports that core processes of sexual and reproductive health self‐management used by the women in this study included both passive and (re)active processes. These processes expanded upon and/or maintained the women's accessible sexual and reproductive health knowledge, behaviour and beliefs, defined as the sexual and reproductive health repertoire. The processes appeared to be cyclical and were often initiated by a catalysing event or catalyst and resulted in conversations with confidantes, or trusted individuals. A catalyst was either resolved or normalized by expanding or maintaining the sexual and reproductive health repertoire. Conclusion: The resulting theory, EMeRGE Theory, offers insight into the complex and cyclical processes emerging adult‐aged women use to simultaneously develop and adapt their foundational sexual and reproductive health knowledge, behaviours and beliefs. Implications for the Profession and/or Patient Care: This explication of emerging adult‐aged women's sexual and reproductive health self‐management processes can be used by nurses and nurse researchers to better address this population's unique health needs. Impact: The EMeRGE Theory provides valuable guidance for future exploratory and intervention research aimed at improving the health and well‐being of emerging adult‐aged women. Reporting Method: The authors adhered to the Consolidated Criteria for Reporting Qualitative studies (COREQ) in preparation of this publication. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: We tested key hypotheses derived from the Cultural Determinants of Trauma Recovery Theory (CDTR) with an American sample. Design: A cross‐sectional study using anonymous online surveys. Methods: This study was conducted with 225 American survivors of gender‐based violence (GBV) between August to November 2019. Demographics, distress (depression: PHQ8; PTSD: PCL‐5), mental health service utilization (counselling and medication), sense of coherence (SOC), internal barriers to help‐seeking (shame, frozen and problem management subscales: BHS‐TR Internal) and the GBV healing (GBV‐Heal) were used. Structural equation modelling (SEM) was conducted to test the hypotheses. Results: The final SEM model showed that the relationship between distress and mental health service utilization was not mediated by internal help‐seeking barriers; the relationship between distress and trauma healing was partially mediated by internal help‐seeking barriers; the relationship between internal help‐seeking barriers and trauma healing was partially mediated by SOC; mental health service utilization was not significantly associated with trauma healing. Overall, the relationship between distress and trauma healing was partially mediated by internal help‐seeking barriers and SOC. Conclusions: This study confirmed some hypothetical pathways between distress and trauma healing. Further research with larger and international samples should be necessary to test the overall CDTR and compare groups. Impact: This study can help us focus on psychological interventions that enhance meaning and mitigate internal help‐seeking barriers to promote holistic trauma recovery. Public and public contribution: The sample was gathered from a clinical population registry that alerts patients of potential research opportunities. [ABSTRACT FROM AUTHOR]

Aim: First, to identify which aspects of missed care accurately define the integration of care and context of care dimensions of the Fundamentals of Care Framework. Second, to test the Framework for validity and reliability and lastly, to explore how leadership influences care integration. Design: A non‐experimental research design using self‐audit data collected information about variations in nursing care as exemplars for dimensions of the Framework. Methods: A multi‐variate approach using path analysis was used to apply the consensus scores of 3079 Australian residential care nurses and carers to define the dimensions of the Framework. Results/Findings In the Australian residential care setting, the factors that define both the contexts of care and the integration of care dimensions constructs are now empirically established. The most direct predictor for the integration of care dimension arises from both the leadership and resource allocation variables, while the remaining context of care factors have indirect but significant effects. The integration of psychosocial care in the residential care sector is not influenced by any of the Framework's context‐based factors. Conclusion: The component variables of the Framework show both good reliability and convergent validity. These findings confirm a predictive relationship exists between the elements of the context of care and the different types of nursing activities that form the integration of the care dimension, including organizational leadership. [ABSTRACT FROM AUTHOR]

Aim: Although normative and ethical procedures are extremely critical for health care providers, during this unique time, when the pandemic suddenly increased job requirements and workloads, maintaining a morally appropriate working style became an increasingly difficult challenge for nurses. Few previous studies have examined whether these highly increased job demands influence nurses' resource condition, in turn affecting their deviance and task mastery. Designs: In the current study, we proposed a theoretical model examining whether nurses' job demands (the predictor) will affect task mastery and deviance (the outcomes) by increasing resource depletion. Methods: A multiwave field study of 172 nurses from two comprehensive hospitals was conducted to test the proposed theoretical model from April to August 2020. Descriptive statistics, confirmatory factor analyses, correlation coefficients and linear regressions were used to test the hypotheses. Results: The results suggested that even though job demands may temporarily increase nurses' task mastery and decrease their organizational deviance, they ultimately have a negative influence since resource depletion acts as a side effect that suppresses the two direct effects. Conclusion: The theoretical contributions and practical implications of our findings were discussed. Specifically, we suggested that healthcare institutions should provide abundant support for nurses to supplement their resource reserves to avoid the risk of potential medical malpractice. Impact: Practically, this study tried to emphasize the important role of nurses' resource condition. Especially we aimed to remind managers and leaders cannot just improve nurses' job demand to deal with the public health crises. They also need to focus on their resource condition during pandemics. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim To test a hypothesized model linking new graduate nurses' perceptions of their manager's authentic leadership behaviours to structural empowerment, short-staffing and work-life interference and subsequent burnout, job satisfaction and patient care quality. Background Authentic leadership and structural empowerment have been shown to reduce early career burnout among nurses. Short-staffing and work-life interference are also linked to burnout and may help explain the impact of positive, empowering leadership on burnout, which in turn influences job satisfaction and patient care quality. Design A time-lagged study of Canadian new graduate nurses was conducted. Methods At Time 1, surveys were sent to 3,743 nurses (November 2012-March 2013) and 1,020 were returned (27·3% response rate). At Time 2 (May-July 2014), 406 nurses who responded at Time 1 completed surveys (39·8% response rate). Descriptive analysis was conducted in SPSS. Structural equation modelling in Mplus was used to test the hypothesized model. Results The hypothesized model was supported. Authentic leadership had a significant positive effect on structural empowerment, which in turn decreased both short-staffing and work-life interference. Short-staffing and work-life imbalance subsequently resulted in nurse burnout, lower job satisfaction and lower patient care quality 1 year later. Conclusion The findings suggest that short-staffing and work-life interference are important factors influencing new graduate nurse burnout. Developing nurse managers' authentic leadership behaviours and working with them to create and sustain empowering work environments may help reduce burnout, increase nurse job satisfaction and improve patient care quality. [ABSTRACT FROM AUTHOR]

Aim To explore how practising mindfulness affects people's experiences of living with a long-term condition. Background Increasing evidence suggest that mindfulness meditation-based interventions benefit people with long-term conditions, particularly in terms of psychological well-being. Most evidence, however, relates to short-term outcomes and limited information exists about how people use mindfulness in the longer term and how this affects their experience of living with their condition. Design A qualitative study using constructivist-informed grounded theory. Methods Using interviews, diaries and focus groups, data were collected between 2011 - 2012 from participants and/or trainers of Breathworks' mindfulness intervention. Phased recruitment enabled theoretical sampling, with data analysed concurrently using Charmaz's two-stage coding strategy. Findings The final sample comprised 41 adults with diverse physical and/or mental health conditions. Participants reported predominantly positive experiences, almost all identifying significant changes in thinking and behaviour. A core process of 'Starting where I am' was formulated, highlighting how people became more aware and accepting of their condition and thus able to self-care more effectively. The process was encapsulated in five themes: Getting a new perspective; Feeling equipped to cope; Doing life differently; Seeing a change; and Finding mindfulness difficult. Strong resonances were identified between participants' experiences and the process of transition through which people come to terms with challenging life events. Conclusion Mindfulness can be conceptualized as a facilitator of transition, enabling people to adapt to living with a long-term condition. Transition is associated with improved, self-directed self-management, which is significant to both people with long-term conditions and healthcare providers. [ABSTRACT FROM AUTHOR]

Aims To explore the existence of symptom clusters in advanced chronic kidney disease. Background People with chronic kidney disease commonly report multiple symptoms. However, the complex relationships among these symptoms are still poorly understood. Design Cross-sectional. Methods A total of 436 people with stage 4 and 5 chronic kidney disease were recruited from three tertiary hospitals during 2013-2014. Participants completed the Chronic Kidney Disease-Symptom Burden Index that assesses four symptom dimensions (occurrence, distress, severity and frequency) of 32 symptoms. Exploratory factor analysis was used to identify symptom clusters across each symptom dimension. Core symptoms in each cluster were determined based on stability across dimensions and clinical plausibility. A high cutoff of 0·50 for factor loading was used for all analyses. Results Five symptom clusters were consistently identified across all symptom dimensions: fluid volume symptoms, neuromuscular symptoms, gastrointestinal symptoms, sexual symptoms and psychological symptoms. Overall, clusters ranged from 2-10 symptoms. Several symptoms were also interconnected with multiple clusters. Fatigue cross-loaded on all five clusters, whereas sleep disturbance and restless leg symptoms cross-loaded across three clusters. Conclusions Adopting a symptom cluster approach has the potential to significantly advance symptom assessment and nursing care for people in advanced stages of chronic kidney disease. Routine clinical assessment and management strategies targeted at the cluster level should have synergistic effects in reducing symptoms. Fatigue is a pervasive symptom in advanced chronic kidney disease that is interconnected with global symptom burden, suggesting better management of symptom clusters may also reduce fatigue. [ABSTRACT FROM AUTHOR]

Aims. The aim of this study was to determine nurses' readiness for evidence-based practice at Finnish university hospitals. Background. Although systematic implementation of evidence-based practice is essential to effectively improving patient outcomes and value of care, nurses do not consistently use evidence in practice. Uptake is hampered by lack of nurses' individual and organizational readiness for evidence-based practice. Although nurses' evidence-based practice competencies have been widely studied in countries leading the evidence-based practice movement, less is known about nurses' readiness for evidence-based practice in the non-English-speaking world. Design. A cross-sectional descriptive survey design. Methods. The study was conducted in November-December 2014 in every university hospital in Finland with a convenience sample (n = 943) of practicing nurses. The electronic survey data were collected using the Stevens' Evidence-Based Practice Readiness Inventory, which was translated into Finnish according to standardized guidelines for translation of research instruments. The data were analysed using descriptive and inferential statistics. Results. Nurses reported low to moderate levels of self-efficacy and low levels of evidence-based practice knowledge. A statistically significant, direct correlation was found between nurses' self-efficacy in employing evidence-based practice and their actual evidence-based practice knowledge level. Several statistically significant differences were found between nurses' socio-demographic variables and nurses' self-efficacy in employing evidence-based practice, and actual and perceived evidence-based practice knowledge. Conclusions. Finnish nurses at university hospitals are not ready for evidence-based practice. Although nurses are familiar with the concept of evidence-based practice, they lack the evidence-based practice knowledge and self-efficacy in employing evidence-based practice required for integrating best evidence into clinical care delivery. [ABSTRACT FROM AUTHOR]