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Aims and Objectives: To explore organisation‐wide experiences of person‐centred care and risk assessment practices using existing healthcare organisation documentation. Background: There is increasing emphasis on multidimensional risk assessments during hospital admission. However, little is known about how nurses use multidimensional assessment documentation in clinical practice to address preventable harms and optimise person‐centred care. Design: A qualitative descriptive study reported according to COREQ. Methods: Metropolitan tertiary hospital and rehabilitation hospital servicing a population of 550,000. A sample of 111 participants (12 patients, 4 family members/carers, 94 nurses and 1 allied health professional) from a range of wards/clinical locations. Semi‐structured interviews and focus groups were conducted at two time points. The audio recording was transcribed, and an inductive thematic analysis was used to provide insight from multiple perspectives. Results: Three main themes emerged: (1) 'What works well in practice' included: efficiency in the structure of the documentation; the Introduction, Situation, Background Assessment, Recommendation (ISBAR) framework and prompting for clinical decision‐making were valued by nurses; and direct patient care is always prioritised. (2) 'What does not work well in practice': obtaining the patient's signature on daily care plans; multidisciplinary (MDT) involvement; duplication of paperwork and person‐centred goals are not well‐captured in care plan documentation. (3) 'Experience of care'; satisfaction of person‐centred care; communication in the MDT was important, but sometimes insufficient; patients had variable involvement in their daily care plan; and inadequate integration of care between MDT team which negatively impacted patients. Conclusions: Efficient and streamlined documentation systems should herald feedback from nurses to address their clinical workflow needs and can support, and capture, their decision‐making that enables partnership with patients to improve the individualisation of care provision. Relevance to clinical practice: The integration of effective MDT involvement in clinical documentation was problematic and resulted in unmet supportive care from the patient's perspective. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the documentation of pro re nata (PRN) medication for anxiety and to compare documentation at two hospitals providing similar psychiatric services, one that used paper charts and another that used an electronic health record (EHR). We also assessed congruence between nursing documentation and verbal reports from staff about the PRN administration process. Background: The ability to accurately document patients’ symptoms and the care given is considered a core competency of the nursing profession (Wilkinson, Nursing process and critical thinking, Saddle River, 2007); however, researchers have found poor concordance between nursing notes and verbal reports or observations of events (e.g., Marinis et al., 2010, J Clin Nurs, 19, 1544–1552) and considerable information missing (e.g., Marinis et al., 2010, J Clin Nurs, 19, 1544–1552). Additionally, the administration of PRN medication has consistently been noted to be poorly documented (e.g., Baker et al., 2008, J Clin Nurs, 17, 1122–1131). Design: The project was a mixed‐method, two‐phase study that collected data from two sites. Methods: In phase 1, nursing documentation of PRN medication administrations was reviewed in patient charts; phase 2 included verbal reports from staff about this practice. Results: Nurses using EHR documented more information than those using paper charts, including the reason for PRN administration, who initiated the administration, and effectiveness. There were some differences between written and verbal reports, including whether potential side effects were explained to patients prior to PRN administration. Conclusions: We continue the calls for attention to be paid to improving the quality of nursing documentation. Our results support the shift to using EHR, yet not relying on this method completely to ensure comprehensiveness of documentation. Relevance to clinical practice: Efforts to address the quality of documentation, particularly for PRN administration, are needed. This could be made through training, using structured report templates and by switching to electronic databases. [ABSTRACT FROM AUTHOR]

Aims and objectives: To assess and compare the quality of paper-based and electronic- based health records. The comparison examined three criteria: content, documentation process and structure. Background: Nursing documentation is a significant indicator of the quality of patient care delivery. It can be either paper-based or organised within the system known as the electronic health records. Nursing documentation must be completed at the highest standards, to ensure the safety and quality of healthcare services. However, the evidence is not clear on which one of the two forms of documentation (paper-based versus electronic health records is more qualified. Methods: A retrospective, descriptive, comparative design was used to address the study’s purposes. A convenient number of patients’ records, from two public hospitals, were audited using the Cat-ch-Ing audit instrument. The sample size consisted of 434 records for both paper-based health records and electronic health records from medical and surgical wards. Results: Electronic health records were better than paper-based health records in terms of process and structure. In terms of quantity and quality content, paper-based records were better than electronic health records. The study affirmed the poor quality of nursing documentation and lack of nurses’ knowledge and skills in the nursing process and its application in both paper-based and electronic-based systems. Conclusion: Both forms of documentation revealed drawbacks in terms of content, process and structure. This study provided important information, which can guide policymakers and administrators in identifying effective strategies aimed at enhancing the quality of nursing documentation. Relevance to clinical practice: Policies and actions to ensure quality nursing documentation at the national level should focus on improving nursing knowledge, competencies, practice in nursing process, enhancing the work environment and nursing workload, as well as strengthening the capacity building of nursing practice to improve the quality of nursing care and patients’ outcomes. [ABSTRACT FROM AUTHOR]

Aims: To explore the nature of interactions that enable older inpatients with cognitive impairments to engage with hospital staff on falls prevention. Design: Ethnographic study. Methods: Ethnographic observations on orthopaedic and older person wards in English hospitals (251.25 h) and semi‐structured qualitative interviews with 50 staff, 28 patients and three carers. Findings were analysed using a framework approach. Results: Interactions were often informal and personalised. Staff qualities that supported engagement in falls prevention included the ability to empathise and negotiate, taking patient perspectives into account. Although registered nurses had limited time for this, families/carers and other staff, including engagement workers, did so and passed information to nurses. Conclusions: Some older inpatients with cognitive impairments engaged with staff on falls prevention. Engagement enabled them to express their needs and collaborate, to an extent, on falls prevention activities. To support this, we recommend wider adoption in hospitals of engagement workers and developing the relational skills that underpin engagement in training programmes for patient‐facing staff. Implications for Profession and Patient Care: Interactions that support cognitively impaired inpatients to engage in falls prevention can involve not only nurses, but also families/carers and non‐nursing staff, with potential to reduce pressures on busy nurses and improve patient safety. Reporting Method: The paper adheres to EQUATOR guidelines, Standards for Reporting Qualitative Research. Patient or Public Contribution: Patient/public contributors were involved in study design, evaluation and data analysis. They co‐authored this manuscript. [ABSTRACT FROM AUTHOR]

Aim: To identify culturally related stressors that influence self‐care in Chinese older adults with multiple chronic conditions. Background: Effective self‐care can improve health outcomes for chronic conditions, but implementing self‐care is challenging. Individuals with multiple chronic conditions face even more self‐care complexity than those with single chronic conditions, generating additional stressors. Although stressors have been found to negatively influence self‐care in multiple chronic conditions, the role of culture in generating stressors has been neglected. Design: This paper reports on the qualitative component of a larger mixed‐methods study. Two free‐response items in a survey were used to identify culturally related stressors that influence self‐care. This report adhered to the SRQR guideline checklist. Methods: Data were collected between January and April 2022. One hundred and thirty‐eight free text responses asking participants to identify stressors that influenced their self‐care effectiveness were analysed sequentially using deductive content analysis and thematic analysis. Results: Findings from deductive content analysis largely confirmed published work in Western literature on stressors complicating self‐care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. Conclusion: Chinese older adults with multiple chronic conditions identified a wide range of stressors that impacted their day‐to‐day self‐care. This study provided valuable insights into culturally related stressors in older adults with multiple chronic conditions. Findings deepened our knowledge of cultural influences on the success of self‐care in older adults with multiple chronic conditions, suggesting the potential for reaching populations across different cultures and regions. Implications for the profession and/or patient care: Stressors that might influence self‐care ability are important for nurses to assess in people with multiple chronic conditions. The design of self‐care interventions should take a culturally tailored intergenerational family‐centred approach to help mitigate the impact of stressors and ultimately improve patient outcomes. Impact: What problem did the study address?Stressors documented in older adults with MCCs have all been generated from research with Western populations. China is now home to the largest population of older people in the world. Understanding the influence of culturally relevant stressors on self‐care in Chinese older adults with MCCs is lacking.What were the main findings?Findings from deductive content analysis largely confirmed published work in Western literature on stressors that complicated self‐care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors in older adults with MCCs in China: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems.Where and on whom will the research have an impact?The research will have an impact on guiding nurses' assessment of culturally relevant stressors' impact on self‐care for older adults with MCCs. In addition, findings could inform research and policy development to aim at mitigating the impact of culturally based stressors on self‐care. Reporting Method: This study adhered to the Standards for Reporting Qualitative Research (SRQR) guideline checklist. Patient or Public Contribution: During the member‐checking process, the validation of findings for accuracy was carried out by 10 participants, who also found resonance between these findings and their own experiences. [ABSTRACT FROM AUTHOR]

Background: Vicarious trauma can significantly affect the physical and mental health of nurses, as well as their ability to provide quality of care. However, the concept of vicarious trauma has received limited attention and remains controversial in the nursing context. Objective: The purpose of this study was to clarify and define the concept of vicarious trauma as it pertains to the nursing context. Methods: The Schwartz and Kim's three‐stage hybrid concept analysis method was used to define the concept. In the theoretical phase, PubMed, CINAHL, OVID, Medline, Embase, Web of Science, Scopus, ProQuest, PsycINFO, CNKI database, VIP database and Wanfang database were used using keywords "nurs*"and "vicarious trauma*", resulting in a total of 25 papers. In the fieldwork phase, we conducted participatory observations in three hospitals and semi‐structured in‐depth interviews with 18 clinical nurses from seven cities. In the analysis phase, the results of the previous two phases were integrated to develop a comprehensive concept of vicarious trauma in nursing. Results: Based on the results of the theoretical and field phases, we propose the concept of vicarious trauma in nursing as follows: vicarious trauma is a psychological trauma impacting nurses' cognitive schema which they may experience in clinical settings or on social media, resulting from deeply empathize with the physical or emotional trauma of patients, family, or colleagues, such as patients' physical injuries or death, family's grieving feelings and colleagues' received threats and attacks. Positively, vicarious trauma can transform into vicarious post‐trauma growth through repositioning and connection, nourishing nurses and promoting their personal and professional development. Conclusion: The concept of vicarious trauma in nursing is multidimensional and holistic. This study clarifies the concept of vicarious trauma in nursing using the hybrid concept analysis, providing a framework for future research and practice on vicarious trauma in the nursing field. Patient or Public Contribution: Nurses contributed to the conduct of the study by participating in the data collection via interviews. [ABSTRACT FROM AUTHOR]

Aims: To codesign a cancer personalised activity and lifestyle tool (CAN‐PAL) based on an existing tool. To help cancer care workers support people affected by cancer to plan and integrate physical activity into lifestyles. Design: Mixed‐methods codesign study. Methods: Phase 1: Focus groups with people affected by cancer (n = 10) or interviews (n = 2) to discuss suitable physical activities and adaptation of the existing tool. Data were recorded, transcribed and analysed thematically. Themes informed the design of the prototype CAN‐PAL and user guide. Phase 2: Healthcare professionals considered the potential use of the CAN‐PAL prototype and completed an online survey including the system usability scale and free text responses. Results: Phase 1: Identified suitable physical activities and four themes were identified including: Capability, benefits, barriers and resources which informed the prototype CAN‐PAL and user guide. Phase 2: The user survey was completed by 12 healthcare professionals. Median (range) system usability scale was 80 (50–95) (best score 100), scores >68 indicate good or better usability. Themes from the free text comments included strengths, amendments, considerations and limitations. Results were used to finalise CAN‐PAL and the user guide. Conclusion: The codesigned CAN‐PAL tool had good usability. Further work is needed to evaluate the impact of CAN‐PAL on activity levels and behaviour in people affected by cancer. Relevance to Clinical Practice: People affected by cancer need support to undertake physical activity. The purpose of CAN‐PAL is to assist cancer care workers to support people affected by cancer to plan and integrate physical activity into lifestyles. Patient or Public Contribution: Public partners considered the findings from Phase 1 and 2 and informed the design of the prototype, final CAN‐PAL and user guide and coauthored the paper. Reporting Method: The study adhered to relevant EQUATOR guidelines; the study was reported according to the COREQ checklist. [ABSTRACT FROM AUTHOR]

Objective: To synthesise the evidence relating to the contribution nurses make during respiratory infectious disease pandemics. Background: Pandemics are known for their abrupt and contagious nature, as well as their impact on individuals and society. Nurses are more likely to work closely with patients experiencing illness and disease during pandemics, and studies on the role of the profession have mainly focused on the challenges, barriers and shortfalls in nursing care provision. The nursing role in service delivery and their contribution in improving patient well‐being has received far less attention. Methods: In May 2020, three review registers, grey literature and the following databases were searched: Medline via Ovid, Web of Science, CINAHL via EBSCO and Cochrane Library. The specific focus was on qualitative literature that considered the experiences and perceptions of nurses providing care during several respiratory pandemics. Selected papers were appraised using CASP checklist. ENTREQ checklist was used to inform stages associated with the synthesis of selected papers. Results: From 5553 retrieved citations, the analysis of 24 eligible papers resulted in three key themes: the implications of working during pandemics on nurses' personal and family life, nursing contribution in challenging conditions, and working above and beyond. Considering nurses' role in healthcare system, research on their contribution found to have received little appreciation in peer‐reviewed journals. Conclusions: This review pertains to nurses' work in global context and highlights the huge contribution made by the profession in the context of respiratory pandemics. It confirms that nurses' experiences outweighed economic, social and psychological implications of providing care during the pandemic crisis. Acknowledging nurses' resilience and professional motivations, we also argue that the nurse contribution during pandemics can be enhanced when resources, support and training are provided. Further research on contexts and conditions which mitigate nurses the potential for sustained contribution is needed. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of women who have had ovarian hyperstimulation syndrome, and healthcare professionals who care for them. Background: Ovarian hyperstimulation syndrome is a side effect of fertility treatment. Little research exists internationally that explores the experiences of women who have had this condition, or the healthcare professionals who manage it. Design: Qualitative study using semi‐structured interviews. Methods: Eighteen interviews with women who had experienced ovarian hyperstimulation syndrome (n = 10) and healthcare professionals (n = 8) in six UK fertility centres. Framework analysis was used. This paper is reported following COREQ guidelines. Results: Women described a range of symptoms and severity, sometimes experiencing worrying physical health problems such as abdominal swelling and shortness of breath. The combination of the symptoms, and their management, on delaying future fertility treatment could cause emotional distress. Healthcare professionals at different centres described variation in practice, which generally involved 'active monitoring' until symptoms became severe, when women would be hospitalised. Women expressed feeling 'left in limbo' while waiting for symptoms to improve or worsen, and described a lack of control during this waiting period. Healthcare professionals felt they provided adequate information about ovarian hyperstimulation syndrome and its management. This, however, did not align with women's perceptions that information, including potential delays to their fertility treatment, was missing. There was similar mismatch between women's and healthcare professionals' views of decision‐making about fertility treatment following ovarian hyperstimulation syndrome, including women's concerns about having to make rushed, unplanned decisions about their fertility treatment when they did not feel adequately informed to do so. Conclusion: Ovarian hyperstimulation syndrome and its management can have a significant physical and emotional impact on women, and influence their fertility treatment. Improvements could be made to the information women receive about this condition, its management and its implications for wider fertility treatment. Implications for the profession and/or patient care: Nurses have the skills and knowledge to support women through the physical and emotional stresses of fertility treatment. Therefore, they are well placed to provide specialist information and support for OHSS and ensure women are fully informed about all aspects of the condition, including how its management might delay fertility treatment. [ABSTRACT FROM AUTHOR]

Aims and objectives: This paper investigates the feasibility and the perception of the nurse's role as the palliative care coordinator. Background: Integrated care is a global imperative in all healthcare improvement processes. Due to Andrija Štampar's success in the organisation of public health services, Croatia today has more than hundred years of experience in care integration. The palliative care system has been continuously developing since 2014 as an integrated care model, with nurses as care coordinators. Methods: The study used a mixed methodology based on pragmatic research principles, including an analysis of strategic and policy documents and reports, and thematic analysis of focus group conducted with palliative care coordinators, following COREQ checklist. Results: Although a legal, professional and financial regulation of nurse coordinators has been achieved, a number of implementation challenges remain. These challenges arise as a result of long‐term fragmentation of the health and social care, and can be found in both horizontal and vertical integration of care, that is in the dimensions of functional, clinical, cultural and social integration. Conclusions: Nurses play a central role in care coordination. Coordination and integration promote professionalisation with clear roles and tasks. However, even with the legal, professional and financial implementation of the nurse coordinator model, it has to be further promoted as an equally important job in the healthcare system, with nurses as competent professionals in charge of care coordination. Relevance to clinical practice: Palliative care provides a range of individualised, coordinated services that meet the medical and non‐medical needs of seriously ill patients. Described model of palliative care in Croatia is particularly important because it was developed as an integrated part of health care (and partly social welfare) system, indicating with the nurse's role as palliative care coordinator that coordination is a continuous process that requires a dedicated professional role. [ABSTRACT FROM AUTHOR]

Aims and objectives: To map existing evidence about educational interventions or strategies in nursing and allied healthcare concerning students' and staffs' spiritual care provision. Background: Spiritual care is an important part of whole person care, but healthcare staff lack competence and awareness of spiritual issues in practice. To rectify this, it is important to identify what educational approaches are most helpful in supporting them to provide spiritual care. Design: A scoping review using the PRISMA‐ScR checklist. Method: Searches in the databases CINAHL, MEDLINE, ATLA and ERIC were conducted for papers spanning January 2009–May 2020. Search terms were related to spirituality, spiritual care, education and clinical teaching. Appraisal tools were used. Results: From the 2128 potentially relevant papers, 36 were included. The studies were from 15 different countries and involved nurses, physicians and other health‐related professions, and both quantitative, qualitative and mixed methods were used. The results are presented in three themes: Understanding of spirituality, Strategies in educational settings, and Strategies in practice settings. The review points to great diversity in the content, lengths and setting of the educational interventions or strategies. Conclusions: Courses in spiritual care should be implemented in curricula in both undergraduate and postgraduate education, and several studies suggest it should be mandatory. Courses should also be available for healthcare staff to raise awareness and to encourage the integration of spiritual care into their everyday practice. There is a need for greater consensus about how spirituality and spiritual care are described in healthcare settings. Relevance to clinical practice: Spiritual care must be included both in monodisciplinary and multidisciplinary educational settings. The main result of spiritual care courses is in building awareness of spiritual issues and self‐awareness. To ensure the provision of spiritual care for patients in healthcare practices, continuing and multidisciplinary education is recommended. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop a gendered understanding of sexual and reproductive health for Australian women following traumatic brain injury. Background: The intersection of socialised normative expectations of sexuality and sexual health, and being a woman with a disability, can lead to inequity and a misconception that a woman with a disability is asexual. Design: An equal weighting concurrent mixed methods design. Methods: Twenty women participated in conversational interviews and 49 women completed an online survey. Equal priority was given to both qualitative and quantitative data which were collected concurrently. A separate analysis of data was performed and was later merged. This paper follows the Good Reporting of a Mixed Methods Study guidelines for reporting mixed methods research. Results: Women reported changes in menstruation, reproduction, and sexual activity. Results identified that following traumatic brain injury, routine reproductive, and sexual health screening were neglected. Women revealed a personal reticence to discuss sexual health in a holistic sense and appeared more comfortable discussing reproductive health rather than sex for pleasure. Additionally, they perceived there was a reticence by clinicians to discuss sexual health as part of their rehabilitation. Conclusions: Shifting the focus to be on women's health through periodic comprehensive health assessments is essential to the delivery of holistic health care. These results can inform the provision of sexual health, sexual safety, and sexual assertiveness education and training for women and girls within a rehabilitation framework and would be a way of addressing what women in this study identified as an unmet need. Relevance to Clinical Practice: Reproductive and sexual health are important elements of routine comprehensive health screening for women. Nurses are well positioned to begin discussions regarding sexual agency, sexual, and reproductive health to ensure person‐centred care. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to determine the correlations between the violence experienced by emergency nurses in the work environment, their occupational commitment and their intention to resign. Background: The emergency service, when compared with other hospital departments, is the unit where violence against healthcare workers is most common. Design: A multi‐method design was used. Methods: The research was carried out between 15 January 2020 and 15 May 2021. The sample of the study consisted of 202 emergency service nurses. The first stage of the research was reserved for the validity and reliability study of the Turkish version of the Perceptions of the Prevalence of Aggression Scale (POPAS). Quantitative data were collected using the POPAS, the Three‐Component Model of Commitment Scale. A qualitative method was used to determine in‐depth the causes and effects of the violence the nurses were exposed to and what they thought and felt about the factors affecting their commitment to the occupation and their intention to resign. The Consolidated criteria for Reporting Qualitative Research (COREQ) were used for this paper. Results: The fit index values of the POPAS, which were confirmed with 15 items and four subdimensions, were determined to be acceptable and highly reliable. It was determined that 96.5% of the nurses were exposed to verbal violence. Qualitative interviews with nurses revealed that the violence they were subjected to in the working environment affected the nurses physically, psychologically, socially and caused them to consider leaving their jobs. Conclusions: The increasing incidence of exposure to violent behaviours and verbal violence was found to decrease nurses' emotional commitment to their occupation. Relevance to clinical practice: Nurses' working conditions and work environments should be improved and their workload should be reduced in order to maximise their level of occupational commitment and prevent them from thinking about resigning. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate acceptability, efficiency, and quality of a new digital care management system in a residential aged care home (RACH). Background: Improving care quality and efficiency in RACH, while simultaneously upgrading data management, is a priority for communities and governments. Design: Participatory action research with mixed methods data collection was employed to evaluate a digital care management system implemented at a 169‐bed RACH. This paper reports qualitative findings of the 2‐year evaluation. Methods: Qualitative data were collected using focus groups with residents, visitors, nurses, managers, care workers, and consultants; resident/visitor and staff hallway interviews and responses to open‐ended questions in online staff surveys. Data were analysed thematically under the four predetermined study objectives. Reporting adhered to COREQ guidelines. Results: 325 data captures from 88 participants, over seven data sources were coded. Findings indicate that the system was acceptable to both residents and staff due to perceptions of time‐saving and improved quality of care. Increased efficiency was perceived through timeliness as well as reduced time spent retrieving and documenting information. Quality of care was improved through care scheduling individualised to resident needs, with reminders to avoid missed care. Relatives were reassured and activities were scheduled to loved one's preferences. The co‐design implementation process was successful through commitment to quality from leadership teams and prioritising the focus on the holistic needs of the residents. Conclusion: A strong emphasis on co‐design with care staff in developing and implementing the digital care system contributed to a system that supported nursing and care work, facilitated reporting and documentation, and improved resident care and well‐being including identification of missed care. Relevance to Clinical Practice: Nurses, carers, administrators, and advocates can support the co‐design creation of information systems that suit the workflow of an organisation and keep the focus on individualised models of care provision. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To describe the development of the Patient Centeredness Index (PCI), evaluate its psychometric characteristics and evaluate the relationships between scores on the PCI and an established measure of empathy. Background: Patient centeredness helps patients manage multiple chronic conditions with their providers, nurses and other team members. However, no instrument exists for evaluating patient centeredness within primary care practices treating this population. Design: Multi‐site instrument development and validation. STROBE reporting guidelines were followed. Methods: To identify themes, we consulted literature on patient centeredness and engaged stakeholders who had or were caring for people with multiple chronic conditions (n = 7). We composed and refined items to represent those themes with input from clinicians and researchers. To evaluate reliability and convergent validity, we administered surveys to participants (n = 3622) with chronic conditions recruited from 44 primary care practices for a large‐scale cluster randomised clinical trial of the effects of a practice‐level intervention on patient and practice‐level outcomes. Participants chose to complete the 16‐item survey online, on paper or by phone. Surveys assessed demographics, number of chronic conditions and ratings of provider empathy. We conducted exploratory factor analysis to model the interrelationships among items. Results: A single factor explained 93% of total variance. Factor loadings ranged from 0.55–0.85, and item‐test correlations were ≥.67. Cronbach's alpha was.93. A moderate, linear correlation with ratings of provider's empathy (r =.65) supports convergent validity. Conclusions: The PCI is a new tool for obtaining patient perceptions of the patient centeredness of their primary care practice. The PCI shows acceptable reliability and evidence of convergent validity among patients managing chronic conditions. Relevance to clinical practice: The PCI rapidly identifies patients' perspectives on patient centeredness of their practice, making it ideal for administration in busy primary care settings that aim to efficiently address patient‐identified needs. Trial registration: Clinicaltrials.org Protocol ID: WLPS‐1409‐24372. Title: Integrating Behavioural Health and Primary Care for Comorbid Behavioural and Medical Problems (IBHPC). [ABSTRACT FROM AUTHOR]

Aim: This study aimed to identify, evaluate and summarise current evidence in relation to the factors that influence the conducting of research by nurses in clinical practice. Design: This study used mixed methods systematic review. Data sources: CINAHL, EMBASE, MEDLINE, Scopus and ASSIA, with dates limited from 2015 to 2020, were used to conduct a systematic search of the literature. Review methods: The Joanna Briggs Institute approach was followed, with results reported according to the Preferred Reporting System for Systematic Reviews and Meta‐Analyses. The associated checklist for systematic reviews was also used. A standardised data extraction tool was then used, with quality appraisal guided by the Mixed Methods Appraisal Tool, with a subsequent convergent qualitative synthesis. Results: Sixteen papers were identified for inclusion, nine quantitative, six qualitative and one mixed methods. Four themes were identified: research competence and culture, proactive research mentorship, research resources and making a difference. These were critically discussed in relation to barriers and enablers to the conduct of research by nurses in clinical practice. Commonly cited barriers included a lack of research knowledge, confidence and access to resources, particularly protected time, while enablers such as educational partnerships, identifying research‐motivated clinical nurses and access to research role models were also apparent in the literature. Conclusions: Globally, nurses in clinical practice are clearly motivated to engage in the research process despite apparent barriers that have a significant impact on productivity. Nevertheless, there are also enablers to building research capacity apparent that offer methodological and structural approaches to empower this group to conduct research. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to understand the lived experience of rural mothers caring for a child with a chronic health condition and to understand their perspectives on the support, services and resources they identify as necessary to effectively manage caregiving. Background: Maternal caregivers in rural areas experience difficulty accessing specialist health care for their child and can also experience geographical and social isolation. Understanding the factors that enable these maternal caregivers to overcome the challenges and adversities faced is crucial to help nurses identify and facilitate avenues for support and resources. Design: This study employed a phenomenological design. The study is reported in line with Consolidated criteria for reporting qualitative research guidelines (COREQ). Methods: Semi‐structured interviews were conducted with 17 maternal caregivers in rural New South Wales, Australia, who had at least one child with a chronic health condition aged between 2–18 years. Data were collected from March to June 2018. Thematic analysis was used to develop a thematic framework. This paper reports on one of the major themes identified in this research, specifically maternal resilience. Results: Participants demonstrated maternal resilience by creating meaningful social connections, cultivating networks, developing problem‐solving skills, enhancing their self‐efficacy and finding a sense of purpose through hope and optimism. These strategies provide nurses insight into how some rural women overcome adversities associated with their maternal labour required in caring for a child with a chronic health condition. Conclusion: This study found that participants overcame the challenges related to their caregiving work, emerging as resilient caregivers. Understanding maternal resilience assists nurses to provide the services rural mothers in Australia need to care for their child with a CHC. Relevance to clinical practice: Findings from this study provide insight into the experiences of rural maternal caregivers of children with a chronic health condition and identify the strategies they adopt to overcome caregiver challenges. Understanding these strategies allows nurses to improve care and support for rural mothers using a strength‐based approach to build maternal resilience. [ABSTRACT FROM AUTHOR]

Aim and objective: To explore older people's initial experience of household isolation, social distancing and shielding, and the plans they constructed to support them through the COVID‐19 pandemic. Background: Public health guidance for those aged 70 or older was predominantly to undertake stringent social distancing within their household. Little is known about older people's experience of these measures. This paper explores changes experienced by those over the age of 70 during the first two weeks of household isolation, social distancing and shielding in the UK and the Republic of Ireland, and their early perceptions and plans to support them through the pandemic. Methods: An inductive phenomenological study. University staff posted the study invitation flyer on social media, such as WhatsApp neighbourhood groups, the Nextdoor App and Twitter. Qualitative semi‐structured interviews were undertaken with 19 participants and repeated at 2‐week intervals for 10 weeks; further data collection is still in progress. This paper presents the findings from the baseline interviews, which showed older peoples' early responses. The COREQ (COnsolidated criteria for REporting Qualitative research) checklist was adhered to in the reporting of this study. Results: Three themes emerged from older people's early experiences of social distancing: protective measures; current and future plans; and acceptance of a good life, but still a life to live. Conclusion: People over 70 adapted to household isolation, social distancing and shielding, by using social media and neighbourhood resources. Nurses and other professionals can develop holistic care for older people by listening to their experiences of what works for them, helping them link to local and distant supports. Understanding the holistic life view of older people, including death anxiety, is an important element of care planning; to help older people access the protective resources, they need to reduce the serious risks associated with coronavirus. Relevance to clinical practice: Older people engage with social media, and during the current pandemic and beyond nurses can engage with this medium to communicate with older people. The importance of nurses to understand some older people consider quality of life to be more important than longevity, which may impact on their adherence to health advice. [ABSTRACT FROM AUTHOR]

Aim and objective: We explored the experiences of nurses who cared for coronavirus disease 2019 patients in Iraqi Kurdistan. Background: Nurses play a major role in response to pandemics and epidemics in delivering patient care. The experiences of nurses who provided care have significant short and long‐term consequences for individuals, communities, and the nursing profession. Methods: Descriptive qualitative research approach was adopted in this study. We interviewed 12 nurses (22–50 years) who cared for the coronavirus disease 2019 patients in one of the clinical units of two coronavirus disease 2019 hospitals in Iraqi Kurdistan in 2020. Interviews were conducted via phone calls and were analysed using the thematic analysis method. The Consolidated criteria for reporting qualitative research checklist was applied when constructing this paper. Results: The nurses had to care for a number of situations during the outbreak of coronavirus disease 2019 in Kurdistan. As people in the public did not believe that there was such a virus, nurses often had to deal with this lack of knowledge and aggression from some patients and their family members. Most nurses changed their preventive behaviours since the coronavirus disease 2019 outbreak at hospital or in public. This was mainly to protect not only themselves but their patients, colleagues, family members and friends. They were cautious about the use of a mask at the hospital and in public. Most nurses experienced fear, stress, anxiety and isolation during this period. Conclusions: The patients had some concerns about their health and staying at hospitals, and some of them had aggressive behaviours towards nurses at corona hospitals. The public, close friends and relatives of the nurses had a fear of getting the infection by the virus through the nurses. However, the nurses attempted to protect themselves, colleagues and family members, and provide the best care to coronavirus disease 2019 patients. The nurses had a high obligation towards care giving at hospitals. Relevance to clinical practice: The negative experiences of the nurses regarding the care of coronavirus disease 2019 patients must be considered in clinical settings. Sensitive policy programs must be established to protect nurses from the ostracization and stigmatization of the coronavirus disease 2019 pandemic and to allow them to be able to achieve their professional practices safely. [ABSTRACT FROM AUTHOR]

Aims and objectives: To synthesise and review literature related to instruments that measure psychosocial aspects of fundamental care in acute hospital care settings. Background: Psychosocial aspects of care often receive less priority in terms of care provision in acute care environments. At the same time, if these elements are overlooked, there may be consequences. Despite the availability of many instruments designed to measure specific aspects of care, these concepts are often not studied within the broader context of fundamentals of care, but rather coexist as isolated explorations of specific subelements. Design: A scoping review was conducted, based on Arksey & O'Malley's (2005) methodological framework and following the PRISMA checklist. Methods: Using the five recommended steps—identifying the research question; identifying relevant studies; study selection; charting the data; and summarising and reporting the results—three databases were searched: MEDLINE/PubMed, CINAHL and EMBASE, in February 2019. Results: Following independent screening by two of the authors, 48 papers were included. From these 48 papers, 33 instruments were identified. Only five of these tools thoroughly assessed psychosocial aspects elements of care (dignity, respect, privacy and patients' choice) through dedicated items. Conclusions: This review provides nurses with a synthesis of 33 instruments that assess the psychosocial aspects of care. This provides an important resource to guide measurement of dignity, respect, privacy and patients' choice. The findings also provide guidance to future research in this field. Relevance to clinical practice: This paper reviews and synthesises these instruments to provide a resource to nurses to inform their decisions and practice around measurement and evaluation of these key aspects of care. This provides a useful guide to measure and monitor the improvement of fundamental care delivery in practice and points to strengths and weaknesses of the instruments concerned. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the structures, processes and outcomes involved in an Automated Medication Dispensing system implementation and its impact on patient safety. Background: Increasing digitalisation of medication prescribing, dispensing, administration and stock management has occurred over the past two decades. While automated medication dispensing units aim to provide safe, high‐quality, patient‐centred care, the implementation may result in unintended consequences leading to suboptimal outcomes. Design: This study uses a qualitative approach guided by Donabedian's structure, process and outcome framework. Methods: Twenty‐six registered nurses and pharmacy assistant staff, from clinical areas equipped with automated medication dispensing cabinets, participated in semi‐structured interviews. In‐depth, thematic analysis explored the structures and processes. Together with interview data, content analysis of text data generated by internal risk management and critical incident reporting systems was undertaken to evaluate outcomes. Findings were considered in light of the Interactive Sociotechnical Analysis approach to health information technology. The COREQ checklist was used in preparation of this article. Results: Pharmacy assistants reported better satisfaction with the system at implementation than nurses. Training provided for nurses and their involvement in system implementation was reported as insufficient; however, nurses' use of and satisfaction with the system improved over time. A recursive relationship between the changes imposed by the system and nurses' creative problem solving (workarounds) used to manage these changes, impacted work productivity for nurses and safety for patients. Conclusions: The individualised nature of "workarounds" employed offered both risks and opportunities which require further identification, investigation and management. Relevance to clinical practice: Nurses are the majority of the health workforce. Digitalisation of traditionally paper‐based activities in health care, impacting nursing work, requires similar strategies to any practice change. [ABSTRACT FROM AUTHOR]

Aim: To develop a working definition of the concept of "clinical credibility" in nursing science. Background: In both academic and clinical settings, the phrase "clinical credibility" is used when discussing the education of health professionals. No clear definition for the concept is evident in the academic literature. To date, there has not been a study undertaken to develop a working definition of clinical credibility in nursing science. Methods: This protocol is stage 1 of a registered report. We will use concept mapping to compare and organise views of three stakeholder groups: nursing students (n = 20) from years 2 or 3 of a three‐year Bachelor of Nursing Programme, nurses and other health professionals (n = 20) still practising within a clinical setting, and people who have recently been inpatients in hospital (n = 20). First, participants will take part in separate stakeholder focus groups to generate statements about "What is clinical credibility?". Second, the same participants will complete two tasks: (1) rank the importance of each statement (prioritising) and (2) put the statements that appear to go together into groups (clustering). The data will then be analysed using a specialised software program called Ariadne. A visual "concept map" will be produced showing the importance and relationship of each statement as viewed by the participants. The projected timeline for the study is one year. The paper complies with the SPIRIT 2013 guidelines for study protocols adapted for mixed methods research. Conclusion: The findings of this study will provide a working definition of the concept of "clinical credibility" in nursing science. Relevance to clinical practice: The findings can be used to develop a measure of clinical credibility to predict student satisfaction and patient safety outcomes. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to explore the perceptions, attitudes and beliefs of middle‐aged Australians around their health, lifestyle risks and chronic disease. Background: Health promotion and risk reduction are important to stem the rising prevalence of chronic disease. While there has been much emphasis on supporting these strategies in older Australians, there has been less attention on those in middle age. However, as this group age, their health will inevitably be impacted by lifestyle risk. Design: A qualitative descriptive study using semi‐structured interviews. Reporting was guided by the COREQ checklist. Methods: Thirty‐four participants aged 40–65 years were recruited across South Eastern New South Wales, Australia, using convenience sampling. Semi‐structured interviews were conducted by four registered nurses with qualitative research experience. Verbatim transcripts were analysed using thematic analysis. Results: Sixteen women and 18 men participated in the interviews. Four themes emerged, namely: adopting healthy lifestyles; denial; an impetus for change; and sustaining change. Perceptions about what constituted good health varied, with male participants being more ambivalent about their health. Impetus for change was mostly influenced by family history, awareness of health risks and identification of risks by health professionals. Participants found sustaining change challenging, particularly with regard to smoking cessation and dietary modifications. Conclusions: Understanding the perceptions of health of middle‐aged people is important and enables health professionals to engage in early behavioural change conversations that consider perceived barriers to lifestyle modification. Findings from this study emphasise the importance of discussions about lifestyle risk to reduce the future burden of chronic disease. Relevance to Clinical Practice: These findings illustrate the importance of understanding perceptions of health to guide primary health care nurses to develop person‐centred health promotion and chronic disease prevention strategies in this age group. [ABSTRACT FROM AUTHOR]

Background: Historically, it has been reported that new graduates make limited use of their clinical assessment skills, yet these form the basis for making nursing decisions and selecting all nursing interventions. Aims and objectives: To explore new graduates' preparedness for, and confidence with, clinical assessment and their reliance on electronic monitoring. To identify barriers that hinder, and strategies that enable, clinical assessment. Design: A mixed‐method study comprising a cross‐sectional, quantitative survey and qualitative data, gathered using the World Café method. Methods: Data were collected from volunteers (n = 137) of all new graduates (n = 160) working in adult settings for a New Zealand district health board over a 1‐year period. A paper‐based survey explored use of clinical assessment, using a five‐point Likert scale. Qualitative data comprised written records of group discussions and individual responses to four questions with thematic analysis of results. A STROBE checklist was used. Results: Most (n = 128) new graduates agreed/strongly agreed that clinical assessment was part of their role. Most (n = 119) agreed/strongly agreed that assessing patients by technology alone was inadequate. Thirty‐six did not agree/strongly agree that they were well‐prepared to perform clinical assessment. Forty‐one did not agree/strongly agree that they were confident to perform clinical assessment, particularly those aged ≥30 years. Factors limiting use of clinical assessment were lack of time, knowledge, skill, confidence, reliance on doctors and an unsupportive work environment. Factors that would enhance clinical assessment involved increased supervision by experienced staff, provision of short courses and more in‐service education on clinical assessment. Conclusions: New graduates acknowledged that clinical assessment was part of their role and involved more than electronic monitoring. However, many lacked confidence and preparedness for clinical assessment in their work area, particularly those aged ≥30 years, potentially limiting clinical assessment use. Supportive changes, including short courses to revise clinical assessment skills and supervision of workplace‐specific clinical assessments, could help new graduates more confidently and efficiently assimilate clinical assessment into their practice. Relevance to Clinical Practice: This research identified reasons that caused a cohort of new graduates to make limited use of their clinical assessment skills. It also reports the practical solutions they considered would help them increase their use of clinical assessment and thus support their decision‐making in nursing practice. [ABSTRACT FROM AUTHOR]

Aims: The aims of this paper are to (a) outline the design and implementation of an evidence‐based assertiveness communication workshop for Japanese nursing students; and (b) report on the evaluation of nursing students' satisfaction with the workshop using the Satisfaction with Assertiveness Communication Training Program Survey. Background: A body of research attests to the relationship between assertive communication and patient safety. This paper reports the design and evaluation of an assertiveness communication training programme designed to enhance students' ability to communicate safety in clinical practice. Design: A culturally appropriate and evidence‐based assertiveness communication workshop, informed by Gagne's instructional design principles, was implemented for third‐year nursing students in two Japanese higher educational institutions in December 2017. A descriptive study design was used to evaluate the workshop. Methods: Students' perceptions of the workshop were evaluated using the Satisfaction with Assertiveness Communication Training Program Survey, which includes ten items that are rated using a 5‐point Likert scale from strongly disagree [1] to strongly agree [5]. Data were analysed using descriptive statistics. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were used in the reporting of this study. Results: A total of 111 students from a population of 150 participated in the study giving a response rate of 74%. The overall mean satisfaction score was 4.12 indicating a high level of agreement with each of the survey items. With the exception of two items, the mean scores were above 4.0. "Confidence in using assertiveness communication skills" and "Utilising role‐plays to practice learnt skills" received mean scores of 3.71 and 3.90, respectively. Conclusion: Given the compelling research about the importance of assertive communication in health care, the results from this study support continuing investment in assertiveness communication training programmes for nursing students. Relevance to clinical practice: Assertive communication is an essential communication skill for safe nursing practice. Culturally appropriate assertiveness communication training programmes are of particular relevance in hierarchical healthcare contexts. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study intended to contribute to the improvement of nursing care for both children and their parents and aimed to identify the best and worst experiences of school‐aged children during hospitalisation. Background: Child hospitalisation has traditionally been studied from the parent's perspective, but studies in which the child is the subject are scarce and mainly focus on to the hospitalisation experiences. Design: A cross‐sectional, observational and descriptive exploratory design was used, and STROBE reporting guidelines were followed. Methods: A paper survey was applied by the primary researcher within a 3 months period to 252 children. It presented two open‐ended statements: 'In my opinion the best thing about the hospital is ...' and 'In my opinion the worst thing about the hospital is...'. The study was submitted and approved by the national data protection commission and also by the ethics committees of each of the six institutions where the study was undertaken. Informed consent was also obtained from children and parents. Results: Answers were analysed through content analysis. Five categories were identified for each of the open‐ended statements. Children identified 'people', 'physical environment', 'activities', 'outcomes' and 'food' as best experiences. The worst experiences included: 'feelings', 'activities', 'food', 'environment' and 'outcomes'. Conclusions: The results allowed the identification of the children's most valued aspects of hospitalisation. Relevance to Clinical Practice: The results should be considered by healthcare professionals in order to make the hospitalisation experience more positive from the perspective of the school‐aged children. [ABSTRACT FROM AUTHOR]

Aims: To examine issues around the use of mixed methods research in doctoral research in nursing and healthcare. We raise questions around challenges and appropriateness of this type of research methodology for doctoral students. Background: In recent years, mixed methods research has grown rapidly in health‐related research. As an emerging research methodology, mixed methods research has much to offer doctoral researchers in health care who increasingly are faced with complex research issues. However, despite evolving as a research paradigm, researchers from both qualitative and quantitative perspectives have hotly debated application of mixed methods approaches. The body of supporting knowledge underpinning mixed methods research continues to grow and become refined. Evolving complexities pose new challenges for newly‐enrolled doctoral students. Design: Discussion paper. Method: Using a discursive approach, we raise questions around the challenges and appropriateness of this type of research methodology for doctoral students. Results: Mixed methods research poses a unique range of methodological challenges that need to be carefully considered by research students when choosing their research methodology. These include scope of methodological learning required, additional time for data collection and analysis, need to acquire additional skill sets, approaches to reporting study results, dissemination of findings and specific supervisory support and thesis examination issues. Conclusions: Mixed methods approaches can make important contributions to clinical research. However, their application to doctoral studies is challenging and should only be considered where appropriate to answer the research question. Relevance to clinical practice: Mixed methods research approaches are commonly used in doctoral studies undertaken to understand clinical nursing practice and can make an important contribution to knowledge. However, there is a need for appropriate application of the methodology to ensure strong, appropriate research outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives: The role of professional doctorates is receiving increased attention internationally. As part of building the rigour and scholarship of these programmes, we assessed projects undertaken as part of a doctor of nursing practice (DNP) programme at Johns Hopkins University. Recommendations for programme development in professional doctorates are provided. Background: Past research has described the methodologic limitations and dissemination of DNP projects. However, few studies have provided recommendations for strengthening these projects and alternative strategies for achieving scale in larger student cohorts. Design: A descriptive study reported in accordance with STROBE guidelines. Methods: From 2009–2018, 191 final DNP project reports were obtained from the DNP programme administrator. Essential project characteristics from the papers were extracted, including use of theoretical framework, design, setting, sample and dissemination through publication. To determine whether the results of the projects had been published, the title and student's name were searched in Google Scholar and Google. Results: Of the 191 projects, 83% focused on adults and 61% were conducted in the hospital setting. Sample sizes ranged from 7 to 24,702. Eighty per cent of the projects employed a pretest/post‐test design, including both single and independent groups. The projects spanned six overarching themes, including process improvement, clinician development, patient safety, patient outcome improvement, access to care and workplace environment. Twenty‐one per cent of the project findings were published in scholarly journals. Conclusions: Conducting a critical review of DNP projects has been useful in refining a strategy shifting from incremental to transformative changes in advanced practice. Relevance to clinical practice: Programme evaluation is critical in order to sufficiently prepare nurses in advanced nursing practice to influence healthcare outcomes at the individual or population level. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore South Asians' experience of choosing and prioritising lifestyle changes during their recovery from first myocardial infarction. Background: Coronary heart disease continues to be a leading cause of premature death globally. South Asians' suffer increased risk of coronary heart disease and have poorer outcomes following myocardial infarction compared to other ethnic groups. Lifestyle modification slows atherosclerosis, and models of behaviour change have been proposed to support such changes. However, little is known about the experiences of South Asians' when attempting to modify their lifestyle. Design: Constructivist grounded theory design, using longitudinal, face‐to‐face, semistructured in‐depth interviews. The consolidated criteria for reporting qualitative research checklist were used to report the study. Method: A series of in‐depth interviews with a purposive sample of South Asian patients were conducted at 3 and 16 weeks following hospital discharge. Transcripts were analysed line by line with focused and theoretical coding using the constant comparative method and memo writing. Data collection and analysis occurred simultaneously. Results: Three categories characterised the findings. First, patronage of the family, referring to the role that family played in supporting recovery. Conflict often existed between the needs of the family and the individual with the family needs taking priority resulting in lifestyle modifications being abandoned. Second, conforming to beliefs, which explain how religious and health beliefs influenced decisions. Third, affinity towards one's group which refers to the conflictual nature afforded by social norms. The need for "harmony" was identified as the substantive theory. Decisions about choosing and prioritising lifestyle changes were based on what helped participants to maintain harmony in their life rather than meeting individual health needs. Conclusion: South Asians' choose and prioritise lifestyle changes after first myocardial infarction against a backdrop of competing religious, cultural and family beliefs. Relevance to Clinical Practice: This paper illustrates that South Asians attempt to balance their individual needs with their family goals, cultural priorities and their religious beliefs when attempting to adopt a healthy lifestyle post myocardial infarction. We propose a model of shared priority setting as a means of promoting behaviour change with South Asians. [ABSTRACT FROM AUTHOR]

Aims and objective To draw on the findings of a grounded theory study aimed at exploring how power is exercised in nurse-manager relationships in the hospital setting, this paper examines the empirical and pragmatic adequacy of grounded theory as a methodology to advance the concept of empowerment in the area of nursing leadership and management. Background The evidence on staff nurse empowerment has highlighted the magnitude of individual and organisational outcomes, but has not fully explicated the micro-level processes underlying how power is exercised, shared or created within the nurse-manager relationship. Although grounded theory is a widely adopted nursing research methodology, it remains less used in nursing leadership because of the dominance of quantitative approaches to research. Grounded theory methodology provides the empirical and pragmatic relevance to inform nursing practice and policy. Grounded theory is a relevant qualitative approach to use in leadership research as it provides a fine and detailed analysis of the process underlying complexity and bureaucracy. Design Discursive paper. Method A critical examination of the empirical and pragmatic relevance of grounded theory by (Corbin & Strauss, , ) as a method for analysing and solving problems in nurses' practice is provided. Conclusions This paper provides evidence to support the empirical and pragmatic adequacy of grounded theory methodology. Although the application of the ontological, epistemological and methodological assumptions of grounded theory is challenging, this methodology is useful to address real-life problems in nursing practice by developing theoretical explanations of nurse empowerment, or lack thereof, in the workplace. Relevance to clinical practice Grounded theory represents a relevant methodology to inform nursing leadership research. Grounded theory is anchored in the reality of practice. The strength of grounded theory is to provide results that can be readily applied to clinical practice and policy as they arise from problems that affect practice and that are meaningful to nurses. [ABSTRACT FROM AUTHOR]

Aims and objectives To review the use of mixed-methods research in nursing with a particular focus on the extent to which current practice informs nurse researchers. It also aimed to highlight gaps in current knowledge, understanding and reporting of this type of research. Background Mixed-methods research is becoming increasingly popular among nurses and healthcare professionals. Emergent findings from this type of research are very useful for nurses in practice. The combination of both quantitative and qualitative methods provides a scientific base for practice but also richness from the qualitative enquiry. However, at the same time mixed-methods research is underdeveloped. Methods This study identified mixed-methods research papers and critically evaluated their usefulness for research practice. To support the analysis, we performed a two-stage search using CINAHL to find papers with titles that included the key term 'mixed method'. Conclusion An analysis of studies that used mixed-methods research revealed some inconsistencies in application and reporting. Attempts to use two distinct research methods in these studies often meant that one or both aspects had limitations. Overall methods were applied in a less rigorous way. This has implications for providing somewhat limited direction for novice researchers. There is also potential for application of evidence in healthcare practice that limited validity. Relevance to clinical practice This study highlights current gaps in knowledge, understanding and reporting of mixed-methods research. While these methods are useful to gain insight into clinical problems nurses lack guidance with this type of research. This study revealed that the guidance provided by current mixed-methods research is inconsistent and incomplete and this compounds the lack of available direction. There is an urgent need to develop robust guidelines for using mixed-methods research so that findings may be critically implemented in practice. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper is drawn from a grounded theory study that aimed to investigate processes undertaken by academics when integrating evidence-based practice into undergraduate curricula. This paper focuses on how nurse academics facilitated students to apply evidence-based practice in theory and practice. Background Facilitating undergraduate nursing students to develop skills within an evidence-based practice framework is vital to achieving evidence-based care. Studies on evidence-based practice conducted globally suggests that there is a need to investigate approaches used by nurse academics in facilitating students' understanding and use of evidence-based practice during their nurse education. Methods Employing constructivist grounded theory approach, 23 nurse academics across Australian universities were interviewed and nine observed during their teaching. Some study participants shared their unit guides to enrich analysis. Data analysis was performed by following Charmaz's approach of coding procedures; as a result, four categories were constructed. This paper focuses on the category conceptualised as Envisaging the use of evidence-based practice. Results Findings revealed that most academics-assisted students to use evidence in academic-related activities. Recognising the importance of evidence-based practice in practice, some also expected students to apply evidence-based practice during clinical experiences. However, the level of students' appreciation for evidence-based practice during clinical experiences was unknown to participants and was influenced by practice-related barriers. Acknowledging these challenges, academics were engaged in dialogue with students and suggested the need for academia-practice collaboration in combating the cited barriers. Conclusion Ensuring academics are supported to emphasise clinical application of evidence-based practice requires strategies at school and practice levels. Faculty development, engagement of clinical nurses with evidence-based practice, supportive culture for nurses and students to apply evidence-based practice principles, and collaboration between academia and practice will make facilitation by academics practical and meaningful for students. Relevance to clinical practice Findings from this study point to a number of initiatives for clinical leadership to provide infrastructure and support for academics, practising nurses and undergraduate students to adopt evidence-based practice in practice settings, thereby influencing practice outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine patients' perceptions of being asked about their sexual orientation and gender identity in the healthcare setting. Background Health disparities exist in the lesbian, gay, bisexual and transgender population, but further research is needed to better understand these disparities. To address this issue, experts recommend the routine collection of sexual orientation and gender identity data in health care. Nurses on the front line of patient care play a key role in the collection of these data. However, to enable nurses to conduct such assessments it is important to understand the perspective of the patients on being asked about their sexual orientation and gender identity in a healthcare setting. Design An integrative review was conducted using the methodology proposed by Whittemore and Knafl ( Journal of Advanced Nursing, 2005, 52, 546). Methods Six electronic databases were searched, and two reviewers independently reviewed papers for inclusion. Papers were included if they were empirical studies, peer-reviewed papers or reports, assessing patient perspectives on discussing sexual orientation and gender identity in the healthcare setting. Results Twenty-one relevant studies that met the inclusion criteria were identified. A majority of the studies indicated patients' willingness to respond to, and a perceived importance of, questions about sexual orientation and gender identity. However, fears of homophobia and negative consequences hindered willingness to disclose this information. Conclusions This review indicates that in most cases patients are willing to answer routine questions about their sexual orientation in the healthcare setting and perceive them as important questions to ask. Relevance to clinical practice The findings of this review have implications for nurses looking to incorporate questions about sexual orientation into their routine patient assessment. The findings indicate that care providers need to be mindful of heteronormative assumptions and take steps to ensure they are knowledgeable about lesbian, gay, bisexual and transgender health. [ABSTRACT FROM AUTHOR]

Aims and objectives: To report the views and experiences of fathers following their child's diagnosis of an intellectual and developmental disability (IDD). Background: There is a growing interest in understanding the experiences of fathers of children with IDD given the transformation of the structural change of fathers' roles within the family and wider society. Design: A qualitative design was used to elicit the view and experiences of fathers. Methods: A total of ten Irish fathers participated in face‐to‐face interviews. The data were thematically analysed. The COREQ guidelines for reporting qualitative studies were used in the development of this paper. Results: The key themes that emerged were (a) the confirmation of the child's diagnosis (b) the impact of the diagnosis and (c) father's motivation to participate in disability research. Conclusions: This study informs and develops a further understanding of the international evidence base of fathers receiving a confirmation of a child's diagnosis of an intellectual and developmental disability, the impact of the diagnosis on fathers and their motivation to share their stories to add to the disability research. Health and social care practitioners have important contributions to make in meeting the needs of fathers. There are specific areas to consider in terms of practice, education and research that require further attention and development to ensure fathers' distinct needs regarding their child's diagnosis of IDD are known and responded to effectively. Relevance to clinical practice: This study highlights that when the child's disability is confirmed, fathers experience a diverse range of mixed emotions. Health and social care practitioners including nurses need to be aware of the impact of the diagnosis upon fathers. There is scope to develop the knowledge, skills and confidence of health and social care practitioners regarding the experiences of fathers and how they can further support fathers and their families during the critical time of a disability disclosure. [ABSTRACT FROM AUTHOR]

Aim and objectives: To explore whether nursing student's experiences at Recovery Camp have impacted their current nursing practices. Background: Recently, there has been a move towards more holistic models of nursing care, which seek to break down barriers of stigmatisation and embrace the tenets of self‐determination, to acknowledge people with lived experiences of mental illness and their ability to manage their recovery. In that regard, future health professionals such as nursing students will need to be educated in a manner that recognises the importance of lived experience. In this paper, we propose that Recovery Camp, an alternative clinical placement setting model, enhances clinical practice in multiple domains and is beneficial for both nursing practitioners and people with lived experiences of mental illness, as well as offering an effective nontraditional alternative to conventional clinical placement opportunities. Methods: This study employed a phenomenological research design, involving individual semi‐structured telephone interviews. The Standards for Reporting Qualitative Research (SRQR) checklist was adhered to. Results: Three main themes were identified from the analysis: (a) engagement, (b) understanding mental health and (c) holistic care. "I definitely look at people with mental health conditions in a different light." At Recovery Camp, participants felt that they had greater opportunities for engagement with people with lived experiences, and through this engagement, their preconceptions of mental illness began to change. Conclusions: Recovery Camp may have facilitated the transfer of knowledge that is more person‐centred among nursing students, consequently impacting their current nursing practices. Relevance to clinical practice: Nurses should be equipped with mental health skills regardless of their career trajectory. While Recovery Camp represents a promising approach to facilitate knowledge transfer, further investigation will be required to determine which other factors are instrumental. This approach may have wider implications for nursing education. [ABSTRACT FROM AUTHOR]

Aims and objectives: To elucidate the experiences of people living with diabetes, residing in an urban diabetogenic area. Background: Community‐level social and environmental factors have a role to play in the development of type 2 diabetes mellitus. Socio‐economic deprivation; high obesity rates; high access to fast foods; and multiculturalism contribute to higher rates of diabetes in some geographical areas. However, there is a lack of research examining people's experiences of living with diabetes in diabetogenic areas. The word diabetogenic implies that the phenomenon of interest contributes to the development of diabetes. Design: Qualitative, geographical case study approach. Methods: A convenience sample of 17 people living with diabetes in a diabetogenic, low‐socio‐economic urban area participated in face‐to‐face, semi‐structured interviews. Interviews were audio‐recorded, transcribed and analysed thematically. This paper adheres to the COREQ guidelines. Findings: Four main themes were identified: 1. Diabetes fatalism: Inevitability and inertia; 2. Living with Inequity: Literacy and intersectionality; 3. Impersonal services: Intimidating and overwhelming; and, 4. Education in the community: Access and anecdotes. Conclusions: This study has highlighted the need to develop local solutions for local problems. In this geographical area, solutions need to address generally lower health literacy, how the community would prefer to receive diabetes education and the issue of diabetes fatalism. Relevance to clinical practice: Findings from this study have highlighted a need to re‐examine how diabetes education is delivered in communities that are already experiencing multiple disadvantages. There are research and practice connotations for how fatalism is positioned for people at high risk of developing diabetes. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe individuals' with type 2 diabetes mellitus sense‐making of blood glucose data and other influences impacting self‐management behaviour. Background: Type 2 diabetes mellitus prevalence is increasing globally. Adherence to effective diabetes self‐management regimens is an ongoing healthcare challenge. Examining individuals' sense‐making processes can advance staff knowledge of and improve diabetes self‐management behaviour. Design: A qualitative exploratory design examining how individuals make sense of blood glucose data and symptoms, and the influence on self‐management decisions. Methods: Sixteen one‐on‐one interviews with adults diagnosed with type 2 diabetes mellitus using a semi‐structured interview guide were conducted from March–May 2018. An inductive–deductive thematic analysis of data using the Sensemaking Framework for Chronic Disease Self‐Management was used. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in completing this paper. Results: Three main themes described participants' type 2 diabetes mellitus sense‐making and influences on self‐management decisions: classifying blood glucose data, building mental models and making self‐management decisions. Participants classified glucose levels based on prior personal experiences. Participants learned about diabetes from classes, personal experience, health information technology and their social network. Seven participants expressed a need for periodic refreshing of diabetes knowledge. Conclusion: Individuals use self‐monitored glucose values and/or HbA1C values to evaluate glucose control. When using glucose values, they analyse the context in which the value was obtained through the lens of personal parameters and expectations. Understanding how individuals make sense of glycaemic data and influences on diabetes self‐management behaviour with periodic reassessment of this understanding can guide the healthcare team in optimising collaborative individualised care plans. Relevance to clinical practice: Nurses must assess sense‐making processes in self‐management decisions. Periodic "refresher" diabetes education may be needed for individuals with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study explores nonverbal communication behaviours between general practice nurses and patients during chronic disease consultations. Background: Nonverbal communication is an important aspect of nurse–patient lifestyle risk reduction conversations. Despite the growing role of general practice nurses in lifestyle risk modification when managing chronic disease, few studies have investigated how this communication occurs. Design: Observational study within a concurrent mixed methods project. Methods: Thirty‐six consultations by 14 general practice nurses were video‐recorded between August 2017 and March 2018. Video analysis used the Nonverbal Accommodation Analysis System. The STROBE checklist was used to guide this paper. Results: Joint convergence of nurse–patient behaviours such as laughing, smiling and eye contact was most common (44%; n = 157). Patient–nurse eye contact time decreased significantly across the consultation, while nurse gesturing increased significantly. No significant relationship between consultation length and convergent to divergent behaviour categorisation or nurse–computer use across the consultation was found. Conclusions: The high levels of convergent behaviours are promising for person‐centred care. However, scope exists to enhance nonverbal interactions around lifestyle risk reduction. Supporting nurses with skills and improved environments for lifestyle risk communication has potential to improve therapeutic relationships and patient outcomes. Relevance to clinical practice: These results indicate that nurses support patients through nonverbal interactions during conversations of lifestyle risk reduction. However, there are opportunities to improve this practice for future interventions. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify and map tools measuring behavioural aspects of the nurse–patient relationship. Background: The behaviours nurses employ to develop relationships with patients form a key part of nursing practice. Systematically measuring these behaviours provides an objective means of assessing and evaluating how nurses establish and maintain relationships with patients in a variety of settings. Whilst tools exist to measure these behaviours, little is known about their aims/scope, structure, method of development and contexts of use. Such knowledge is crucial for understanding the nature of the literature, including in which contexts and for which patient groups existing tools are suited. Design: Scoping review informed by Joanna Briggs Institute methodology. Methods: A database search was undertaken using CINAHL, PsycINFO, Pubmed and Embase. Primary research articles, theses and methodological papers that developed, refined and/or administered tools measuring behavioural aspects of the nurse–patient relationship, in any setting and for any patient group, were included. Tools had to measure actual not hypothetical behaviour (e.g., perceptions regarding importance). Data from included studies and tools were mapped. Results are reported in accordance with PRISMA‐ScR guidelines. Results: One hundred and twenty‐seven studies, containing 35 tools, were included. The literature was characterised by substantial variability, stemming from the continued refinement of tools (e.g., reduction to short forms) but also the development of new tools that appeared to duplicate existing work and the inconsistent use of tools across studies. Conclusions: The volume of tools available demonstrates the importance of measuring the nurse–patient relationship. However, the existing duplication and variability create challenges in choosing amongst the tools available and show that, as a concept, the nurse–patient relationship remains poorly understood. Relevance to clinical practice: Research is required to synthesise, and assess the quality of, existing tools, enabling clinicians, leaders/managers, educators and researchers to administer appropriate tools to evaluate the nurse–patient relationship. [ABSTRACT FROM AUTHOR]

Aims and objective: To capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer. Background: Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting. Method: An exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward‐based nurses (n = 64) and nurse unit managers (n = 8). This paper follows the COREQ guidelines for reporting qualitative health research. Results: Qualitative data analysis revealed three themes central to the nurses' experience: (a) lack of clarity (subthemes: procedures and leadership accountability); (b) confidence in the workforce (subthemes: knowledge and skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and (c) complexity (subthemes: complexity as the new norm and suitability of the mental health environment). Conclusion: The themes found in this study can be used to guide and inform healthcare policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer. Relevance to clinical practice: Findings provide a rich data set for the generation of measurement tools and protocols to guide physical health care and evaluate performance. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify the experience of breast cancer survivors regarding cancer‐related fatigue, exercise and exercise adherence. Background: Cancer‐related fatigue is a common symptom among cancer survivors that limits quality of life. Despite exercise being recommended as a viable solution to manage cancer‐related fatigue, relatively few research studies on the experience of cancer‐related fatigue and exercise adherence have been conducted. Design: This was a qualitative study to identify breast cancer survivors' experience of cancer‐related fatigue, exercise and exercise adherence. This paper adhered to the COREQ checklist in reporting. Methods: Four focus group interviews were conducted with 16 breast cancer survivors who had fatigue score of 4 out of 10 (moderate fatigue) or greater. Ethical approval was obtained and participants met for focus group interview discussion. The interview guide included questions on cancer‐related fatigue, barriers and facilitators of exercising, strategies for exercise adherence and suggestions for a supportive programme. Results: Four themes were identified through thematic analysis: (a) The insidious and overpowering nature of cancer‐related fatigue; (b) exercising when experiencing fatigue surrounded by prevailing myths; (c) multiple barriers to exercise; and (d) facilitative factors to continue exercising despite fatigue. Conclusions: Participants' experience of moderate or greater cancer‐related fatigue prevented them from exercising, despite knowing its importance, and limited them to passive activities. Misconceptions that exercise is associated with lymphedema and risk of recurrence, poor psychosocial self‐image and lack of clear knowledge and exercise programmes for cancer survivors further limited adherence to exercise. In contrast, finding comfort and strength through exercising and interacting with other breast cancer survivors were facilitative factors. Relevance to clinical practice: The insights shared by breast cancer survivors experiencing cancer‐related fatigue can contribute to developing an exercise adherence programme as a way to manage and alleviate fatigue and establish healthy survivorship care. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore women's experiences of working shiftwork in nursing whilst caring for children. Background: In nursing, almost 90% of Australia's practising nurses and midwives are women. Much of the research undertaken in the shiftwork area uses men as their sample and uses a quantitative methodology to achieve results. Little work has been undertaken that explores the experience of women working shiftwork whilst raising children. Design: Heideggerian Hermeneutic Phenomenological Design. Methods: Semistructured interviews were conducted with ten women who cared for children about their experience of shiftwork. Each interview was digitally audio‐recorded. The interviews were transcribed verbatim and thematically analysed. The interpretation used first Heideggerian phenomenology as a lens and then second research on women's work and gender roles to resituate the experience in context. Reporting rigour has been demonstrated using the COREQ checklist. Results: Two major themes were derived from the data, Being Guilty and Being Juggler. Each is discussed in this paper. Conclusions: This study adds a qualitative voice to the substantial quantitative shiftwork body of literature. The themes uncovered in this study have thrown light on the nature of work done by women who are nurses, particularly the work related to their home and children. Relevance to Clinical Practice: There are opportunities to increase education around the importance of sleep and shiftwork self‐care in both preservice and new graduate education to assist nurses to ensure that sleep is a priority whilst working shiftwork. [ABSTRACT FROM AUTHOR]

Aim: To explore patients' accounts of screening and being managed for colonisation with the antimicrobial resistant organism, carbapenemase‐producing Enterobacteriaceae (CPE), when in hospital. Background: Antimicrobial resistance (AMR) has been identified as one of the biggest global health challenges of the 21st Century. As the threat from AMR grows, screening to identify patients who are colonised with resistant organisms such as CPE is becoming an increasingly important aspect of nursing practice, in order to reduce risk of transmission of infection within hospitals. There is currently little research evidence on the patient experience of hospital management of CPE colonisation. Methods: Qualitative semi‐structured telephone interviews were undertaken, using a topic guide. Nine patients participated in the study. The data were analysed thematically, and rigour was maintained through peer review. The COREQ checklist was used. Results: Two main themes were identified: "I can't make sense of CPE," illustrating limitations in patients' understandings of CPE; and, "I feel as if they are saying it is my fault," indicating the feelings of responsibility and blame which patients experienced. Conclusions: This paper contributes original evidence to the limited literature on patients' experiences of being colonised with CPE. The findings suggest that support and information provided for patients by healthcare professionals needs to be based on current evidence‐based guidance on the nature of CPE and its implications for patient care, as well as being responsive to patients' emotional needs. Relevance to clinical practice: This study has international relevance for nursing practice. As the global threat of AMR grows, the demands on healthcare providers to manage resistant organisms and their implications for patient care within healthcare settings are increasing. Enabling healthcare professionals to engage sensitively with patients being managed for colonisation with CPE is paramount to providing patient‐centred care. [ABSTRACT FROM AUTHOR]

Background: Nutrition by enteral tube is a complex therapy requiring significant management to ensure safe, timely delivery of nutrients and avoidance of complications. In the home setting, people with enteral tubes and their carers are required to self‐manage the therapy, including the need to cope with problems that arise. Whilst previous studies have conveyed experiences of people with enteral tubes, few have described views on enteral tube problems. Aims and objectives: Drawing on the findings of a previously reported study (Journal of Human Nutrition and Dietetics, 2019), this paper aims to describe in‐depth the experiences of people with enteral tubes and their carers of living with the tube day to day and managing problems that arise. Design: A qualitative descriptive design using semi‐structured in‐depth interviews was employed. Methods: A purposive sample of 19 people with enteral tubes and 15 carers of people with tubes participated. Interviews were recorded and transcribed. Using a thematic analysis approach, codes were defined and applied; themes developed and refined. Five themes with associated subthemes were generated, of which one, "living with the tube," is reported in‐depth. The COREQ checklist was used. Results: Participants described the tube affecting both physical and psychosocial being and revealed it had resulted in significant changes to their daily living, necessitating adaptation to a new way of life. Participants reported spending much time and effort to manage tube problems, at times without support from healthcare practitioners knowledgeable in tube management. Discomfort associated with the tube was commonly described. Conclusions: Living with an enteral tube impacts significantly on daily life requiring adaptations to normal routine. People with tubes and their carers use a range of strategies to manage common complications. Relevance to clinical practice: Knowledge and understanding of how people with enteral tubes live with their tube and manage issues as they arise will enable healthcare practitioners to provide better support. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the quantitative and qualitative literature on the impact of nurse‐led postdischarge telephone follow‐up (TFU) call interventions on patient outcomes. Background: Adverse patient outcomes such as postdischarge problems, premature contact with health systems, inability to self‐manage conditions and hospital readmissions all have an impact on the health and well‐being, and satisfaction of patients as well as a financial impact on healthcare systems. Design: A mixed‐study systematic review. Review methods: A systematic search of CINAHL, Ebsco, PubMed, Quest and Cinch‐Health databases was undertaken using the key terms "nurs*," "nurse‐led," "nurse initiated," "discharge," "hospital," "telephone," "follow‐up" and "telephone follow‐up" to identify relevant original peer‐reviewed studies published between 2010–2016. Ten articles were selected for inclusion. The selected papers were critically appraised. A sequential explanatory approach with a convergent synthesis was used to report findings following PRISMA guidelines. Results: The findings demonstrate that nurse‐led TFU interventions have the potential to improve patient outcomes. The studies suggest patient satisfaction with TFU is one of the strongest positive outcomes from the interventions. However, the results do not support improvement in patient readmission or mortality. Conclusions: Of the 10 studies reviewed, only two were methodologically strong limiting the conclusions that can be drawn from the current research on this topic. Telephone follow‐up interventions improve patient satisfaction and have the potential to meet patient information and communication needs, improve self‐management and follow‐up appointment attendance and reduce postdischarge problems. Further research is required to explore patients' perceptions of the most useful content of TFU calls, the efficacy of TFU calls and nurses' perceptions and experiences of conducting TFU interventions. Relevance to clinical practice: When conducted by a nurse, these interventions have the potential to enhance postdischarge care to patients and meet care needs. Patients perceive TFU as acceptable and are satisfied with this form of postdischarge care. [ABSTRACT FROM AUTHOR]

Aims and objectives: This qualitative study explored the experiences of neonatal nurses with facilitating closeness between parents and babies with congenital abnormalities in the neonatal intensive care unit (NICU). Background: Babies with congenital abnormalities often require admission to the neonatal intensive care unit. Parents may experience emotional distancing from their baby, due to their response to their baby's congenital abnormality, as well as physical separation due to their baby's hospitalisation in the NICU. NICU nurses can help facilitate the development of closeness between babies and parents in the NICU. Method: This qualitative interpretive description study involved face‐to‐face, semi‐structured interviews with twelve neonatal nurses following which the data collected were thematically analysed. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in preparing this paper. Results: Three major themes emerged from the analysis—"Everyone copes differently," "You have to focus on what is the normal thing" and "It's very much an individualised approach." Participants often felt unprepared to care for babies with congenital abnormalities and implemented coping mechanisms to overcome the emotional labour they experienced. Skin‐to‐skin cuddles were considered the most beneficial strategy for parents to develop closeness with their baby. Participants recognised that they sometimes "pushed" parents into engaging with their baby. Participants highlighted the importance of individualised, supportive care for these parents. Conclusions: Neonatal nurses require increased education about congenital abnormalities and individualised care to support them in caring for babies with congenital abnormalities. Relevance to clinical practice: Further research is needed on parental experience of developing closeness with a baby with a congenital abnormality in the NICU. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the impact of implementing an electronic health record system on staff at a Scottish hospice. Background Electronic health records are broadly considered preferable to paper-based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice. Design Naturalistic prospective repeated-measures mixed-methods approach. Methods Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free-text comments and focus group. Participants were all 150 employees of a single hospice in Scotland. Results Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change. Conclusions It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the 'J-curve' theory of organisational change, and as such, it is both predictable and manageable for other organisations. Relevance to clinical practice It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity ('J' curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically. [ABSTRACT FROM AUTHOR]

Aims and objectives To systematically review the literature on the outcomes of educational interventions relevant to nurses with regard to guideline implementation. Background Previous reviews on interventions to implement guidelines have focused on particular clinical problems, but only one included nursing studies. Design A systematic review based on the procedure of the Centre for Reviews and Dissemination. Methods We searched for papers published from 1 January 2008 to 26 February 2015 using the Cochrane, CINAHL and PubMed MEDLINE databases and paper references were searched manually. Quality appraisal was conducted with tools developed by Thomas et al.(Worldviews on Evidence-based Nursing, 1, 2004, 176) and National Heart, Lung, and Blood Institute. Data were analysed with qualitative content analysis and narrative synthesis. Results The data included 13 studies based on a quasi-experimental study design of 13 different educational interventions, described according to their development and realisation, learning content and teaching and learning methods. Seven interventions were supported by simultaneous strategies, 12 studies reported statistically significant outcomes for the interventions on at least one measurement area and six studies reported improvements in the quality of patient care. Interventions with multi-dimensional content, teaching and learning methods produced several good outcomes. Conclusion Guidelines were implemented in a heterogeneous way and the interventions were delivered once and mainly on a local basis. In the future, we need to test these interventions in different nursing contexts, measure the outcomes on patient care and carry out randomised controlled trials on their effectiveness. It is important to standardise interventions, as this will allow them to be replicated and compared. Relevance to clinical practice Educational interventions to implement guidelines could be beneficial in enhancing nurses' evidence-based decision-making and care practice. The combination of teaching and learning methods proved useful, and educational interventions should be supported with simultaneous strategies. There remains a lack of strong evidence on the subject. [ABSTRACT FROM AUTHOR]

Aims and objectives The purpose of this paper is to provide recommendations to strengthen cardiovascular disease research with lesbian, gay and bisexual adults, and highlight implications for practice. Background Lesbian, gay and bisexual individuals face significant discrimination that negatively impacts their health. Health disparities research in lesbian, gay and bisexual adults have focused on mental health, sexually transmitted infections and substance use. Although cardiovascular disease is the leading cause of death and many lesbian, gay and bisexual adults report increased risk factors for cardiovascular disease, there has been limited research in this area. Design This paper is a critical review. Methods A literature search was conducted that compared cardiovascular disease risk and/or prevalence between lesbian, gay and bisexual and heterosexual adults. Results Measures to assess cardiovascular disease risk factors and diagnoses varied widely across the 31 included studies. There was a lack of standardisation in definitions used for alcohol consumption, illicit drug use, mental health and self-rated physical health. Most studies that reported body mass index relied on participant self-report. Few studies included measures of physical activity and diet and those that did lacked standardisation. Only seven studies used laboratory data to establish diagnosis of cardiovascular disease. Conclusions This study is the first comprehensive review on this topic. In cardiovascular disease research with lesbian, gay and bisexual adults, there is a need for: (1) inclusion of stress as a risk factor for cardiovascular disease, (2) standardised measures, (3) objective measures for determining the presence of cardiovascular disease, (4) data from electronic health records to strengthen the study of cardiovascular disease in this population. Relevance to clinical practice Strengthening cardiovascular disease research in lesbian, gay and bisexual adults is an important step in addressing health disparities in this population. Nurses and other healthcare professionals should assess sexual orientation in routine health assessments. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of the Paediatric International Nursing Study was to explore the utility of key performance indicators in developing person-centred practice across a range of services provided to sick children. The objective addressed in this paper was evaluating the use of these indicators to benchmark services internationally. Background This study builds on primary research, which produced indicators that were considered novel both in terms of their positive orientation and use in generating data that privileges the patient voice. This study extends this research through wider testing on an international platform within paediatrics. Design The overall methodological approach was a realistic evaluation used to evaluate the implementation of the key performance indicators, which combined an integrated development and evaluation methodology. Methods The study involved children's wards/hospitals in Australia (six sites across three states) and Europe (seven sites across four countries). Qualitative and quantitative methods were used during the implementation process, however, this paper reports the quantitative data only, which used survey, observations and documentary review. Results The findings demonstrate the quality of care being delivered to children and their families across different international sites. The benchmarking does, however, highlight some differences between paediatric and general hospitals, and between the different key performance indicators across all the sites. Conclusions The findings support the use of the key performance indicators as a novel method to benchmark services internationally. Whilst the data collected across 20 paediatric sites suggest services are more similar than different, benchmarking illuminates variations that encourage a critical dialogue about what works and why. Relevance to clinical practice The transferability of the key performance indicators and measurement framework across different settings has significant implications for practice. The findings offer an approach to benchmarking and celebrating the successes within practice, while learning from partners across the globe in further developing person-centred cultures. [ABSTRACT FROM AUTHOR]