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Aims: Glioma patients are at high risk for postoperative delirium (POD), yet studies focusing on this population in general neurosurgical ward settings are limited. This paper investigates the incidence of POD and related risk factors in glioma patients hospitalized in general wards. Design: Prospective observational study. Methods: This prospective study included 133 adult glioma patients hospitalized in the general neurosurgery ward. In addition to collecting routine perioperative general clinical data, patients' psychological status was assessed preoperatively using the Hospital Anxiety and Depression Scale (HADS). POD was assessed within 3 days postoperatively using the Confusion of Consciousness Assessment method, twice daily. The incidence of POD was calculated, and risk factors were identified using logistic regression analysis. Results: The incidence of POD in glioma patients admitted to the general ward was 31.6% (40/133). Multivariate regression revealed advanced age (age > 50 years), frontal lobe tumour, presence of preoperative anxiety or depression, retention of a luminal drain, postoperative pain, indwelling catheter these six factors were independent risk factors for the development of delirium in patients after surgery. Conclusion: In general ward settings, supratentorial glioma patients exhibit a high risk of POD. Critical risk factors include preoperative psychological conditions, as well as postoperative pain, drainage and catheterization. Rigorous preoperative evaluations, effective pain management strategies and the integration of humanistic care principles are essential in mitigating the risk of POD for glioma patients. Relevance to Clinical Practice: In general ward settings, this study reveals the high occurrence of POD in glioma patients and identifies preoperative psychological states, age, tumour location and several postoperative factors as significant risk factors for POD, which provides a framework for targeted interventions. By integrating these insights into clinical practice, healthcare teams can better identify glioma patients at risk for POD and implement preventive measures, thereby enhancing recovery and overall care quality for glioma patients in general neurosurgical wards. Reporting Method: This study adheres to the STROBE guidelines, ensuring a transparent and comprehensive reporting of the observational research methodology and results. Patient or Public Contribution: Patients involvement was limited to the provision of data through their participation in the study's assessments and the collection of clinical information. The study did not involve a direct patient or public contribution in the design, conduct, analysis, or interpretation of the data, nor in the preparation of the manuscript. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate reasons for inadequate documentation of vital signs in an electronic health record. Background: Monitoring vital signs is crucial to detecting and responding to patient deterioration. The ways in which vital signs are documented in electronic health records have received limited attention in the research literature. A previous study revealed that vital signs in an electronic health record were incomplete and inconsistent. Design: Qualitative study. Methods: Qualitative study. Data were collected by observing (68 hr) and interviewing nurses (n = 11) and doctors (n = 3), and analysed by thematic analysis to examine processes for measuring, documenting and retrieving vital signs in four clinical settings in a 353‐bed hospital. Results: We identified two central reasons for inadequate vital sign documentation. First, there was an absence of firm guidelines for observing patients’ vital signs, resulting in inconsistencies in the ways vital signs were recorded. Second, there was a lack of adequate facilities in the electronic health record for recording vital signs. This led to poor presentation of vital signs in the electronic health record and to staff creating paper “workarounds.” Conclusions: This study demonstrated inadequate routines and poor facilities for vital sign documentation in an electronic health record, and makes an important contribution to knowledge by identifying problems and barriers that may occur. Further, it has demonstrated the need for improved facilities for electronic documentation of vital signs. Relevance to clinical practice: Patient safety may have been compromised because of poor presentation of vital signs. Thus, our results emphasised the need for standardised routines for monitoring patients. In addition, designers should consult the clinical end‐users to optimise facilities for electronic documentation of vital signs. This could have a positive impact on clinical practice and thus improve patient safety. [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]

Aims and objectives: This study aimed to measure the frequency of spiritual needs, identify the factors associated with these needs among Korean and American persons living with an advance chronic illness and compare them from a cross‐cultural perspective. Background: Persons with serious or life‐limiting illnesses often have spiritual needs. Unmet spiritual needs are associated with poor well‐being and threaten psychological health. Little is known about how specific spiritual needs vary across cultures. Design: A quantitative, cross‐sectional, observational cross‐cultural comparison was undertaken. Methods: The study has been prepared in accordance with the STROBE guidelines. Convenience sampling was used to recruit participants from outpatient clinics in South Korea and Southern California (N = 202). Spiritual needs were measured using the Spiritual Interests Related to Illness Tool (SpIRIT); demographic and illness‐related variables were also assessed using paper‐and‐pencil questionnaires. Data were analysed using various parametric statistical tests, including multiple regression analysis. Results: The findings quantify the intensity and types of spiritual needs that persons living with an advanced chronic illness experience. Furthermore, they show how the spiritual needs of religiously diverse samples of South Koreans and Americans differ. The findings also indicate that self‐reported spirituality and religiosity independently explain a substantial amount of the variance in spiritual needs. Conclusions: In both the samples, spiritual needs were reported and associated with spirituality and religiosity. Although all the eight domains of spiritual needs assessed by the SpIRIT were pertinent to the Korean and American samples, they were prioritised differently. Relevance to clinical practice: Screening patients to ascertain how important spirituality or religiosity is to them may help clinicians focus their in‐depth assessments on those who report high levels of spirituality or religiosity because these patients may experience the strongest spiritual needs. The SpIRIT shows promise as a measure of diverse spiritual needs. [ABSTRACT FROM AUTHOR]

Aims and Objectives This paper explores patients' perspectives on infection prevention and control. Background Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front-line clinicians' practices; patients' roles have been less explored. Design Video-reflexive ethnography. Methods Fieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one-on-one reflexive sessions. Findings Viewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency. Conclusion This study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient-provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care. Relevance to clinical practice This study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours, and assist them to support appropriate patient self-care behaviour. [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: 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 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]

Objectives: To investigate the frailty status of inpatients with chronic heart failure (CHF) and analyse its influencing factors, so as to provide evidence for the early identification of high‐risk groups and frailty management. Background: Early identification of frailty can guide the development and implementation of holistic and individualized treatment plans. However, at present, the frailty of patients with CHF has not attracted enough attention. Design: A cross‐sectional study. Methods: From June 2022 to June 2023, a convenience sample of 256 participants were recruited at a hospital in China. Multivariate logistic regression analysis was used to explore the influencing factors of frailty in patients with CHF, and an ROC curve was drawn to determine the cut‐off values for each influencing factor. STROBE checklist guides the reporting of the manuscript. Results: A total of 270 questionnaires were sent out during the survey, and 256 valid questionnaires were ultimately recovered, resulting in an effective recovery rate of 94.8%. The incidence of frailty in hospitalized patients with CHF was 68.75%. Multivariable logistic regression analysis showed that age, self‐care ability, nutritional risk, Kinesiophobia and NT‐proBNP were risk factors for frailty, while albumin and LVEF were protective factors. Conclusion: Multidimensional frailty was prevalent in hospitalized patients with CHF. Medical staff should take measures as early as possible from the aspects of exercise, nutrition, psychology and disease to delay the occurrence and development of frailty and reduce the occurrence of clinical adverse events caused by frailty. Relevance to Clinical Practice: This study emphasizes the importance of the early identification of multidimensional frailty and measures can be taken to delay the occurrence and development of frailty through exercise, nutrition, psychology and disease treatment. Patient or Public Contribution: Patients contributed through sharing their information required for the case report form and filling out questionnaires. [ABSTRACT FROM AUTHOR]

Aims: To determine whether professional self‐perception of nurses in Mongolia improves following an educational intervention and to identify differences in scores among participant subgroups. Design: A prospective observational pre–post design. Methods: Using a convenience sample of 67 nurses in Mongolia in 2019, the Nursing Professional Values Scale‐3 instrument was used pre‐ and post‐intervention. Independent and paired sample t‐tests were conducted. Data were analysed using IBM SPSS 28.0.1.1 and Stata/SE 16.1. This study complied with the STROBE checklist. Results: Of the 67 nurses, 92.0% were female, mean age was 32.15 years (SD 8.96), 70.0% held a bachelor's degree, 58.0% had 5 or more years' nursing experience and 51.0% were members of a professional nursing organization. After participating in the educational training, nurses reported higher overall professional self‐perception as well as across subscales: activism, professionalism and caring. Conclusion: Considering the nursing shortage in lower‐middle‐income countries, it is important to recognise the influence of nurses' professional self‐perception on nursing retention. This study highlights the significant role continuing educational opportunities play in increasing nurses' professional self‐perception. It is imperative to explore ways of improving this perception and focusing on subgroups of nurses to help guide the use of limited resources. Further research is necessary to include nurses in other areas of Mongolia. Implication for the Profession: Accurately assessing nursing professional self‐perception and providing educational opportunities could improve nursing professional self‐perception, nursing satisfaction, patient safety and nursing retention in lower‐middle‐income countries. Impact: What problem did the study address?This study meets the need for current study on the nursing professional self‐perception of nursing from the perspective of nurses in Mongolia. It addresses the dangerous nursing shortage in Mongolia by determining if an educational intervention could improve nursing professional self‐perception and thus improve nursing job satisfaction and retention.What were the main findings?Mongolian nurses in this study scored in the top quartile of the NPVS‐3, indicating a baseline high NPSP.Educational intervention (including translated oral education and written clinical pathways) significantly improved the nurses' professional self‐perception.Nurses were eager for training in other clinical and leadership topics.Where and on whom will the research have an impact? This research can be impactful for nurses, nurse leaders and policy makers in low‐ and lower‐middle‐income countries. Specifically for nurses in Mongolia, with increasing technologies and services such as cardiac catheterization laboratories becoming available, more education in these nursing specialty areas is imperative. Professional Nursing Organizations are poised to foster more educational offerings to their members and to increase membership. Nursing education provided by international volunteer nurses with Non‐Governmental Organizations can improve NPSP in nurses in LMICs. Reporting Method: This study complied with the STROBE checklist. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To understand the factors that contribute to the risk of suicide among lesbian, gay, bisexual, transgender, queer, intersex and asexual (sexual minorities) youth. Background: The increase in the likelihood of suicide has made it an urgent issue in public health, particularly among young people, where it now ranks as the fourth leading cause of death. This issue becomes even more significant when focusing on sexual minorities. Methods: A cross‐sectional study was performed in targeted young individuals (15–29 years). Several variables were assessed, including suicide risk, self‐esteem, presence and severity of depressive symptoms, perceived social support and self‐reported levels of anxiety and depression. Results: Statistically significant disparities were observed in suicide risk, presence of depressive symptoms and self‐reported levels of anxiety and depression, all of which were more pronounced in sexual minority youth compared to heterosexual cisgender individuals. Likewise, statistically significant differences were noted concerning self‐esteem and family support, both of which were lower in sexual minority youth. Conclusion: This study has identified risk factors, such as anxiety, depression and limited social support, as well as protective factors, like higher self‐esteem and self‐concept. Understanding and addressing all these factors are essential in reducing the elevated rates of suicide among sexual minority youth. Consequently, evidence‐based interventions such as Gender and Sexuality Alliances, which empower and create safe spaces for sexual minority youth, possess substantial potential for effectively addressing this issue. Implications for the Profession: Given sexual minorities vulnerability, healthcare pros, especially nurses, must grasp suicide risk factors. They can help by educating, offering care, assessing risk and fighting stigma. This guarantees safety and access to mental health services for at‐risk individuals from sexual minorities. Reporting Method: The reporting follows the STROBE checklist. Patient Contribution: People who were invited to participate voluntarily completed a range of questionnaires. [ABSTRACT FROM AUTHOR]

Aims: To identify the contaminated areas of the hand collection and analyse the distribution characteristics of bacteria in the hand after swab collection. Design: This study used a cross‐sectional design. Methods: A cross‐sectional study sampling 50 pairs of hands (sampling hand and auxiliary hand) of healthcare workers was performed. Ten samples were collected from each participant. The optimal hand hygiene rates and bacterial colony counts of the whole hand and different hand sections without hand hygiene were identified as the primary outcomes. Results: The optimal hand hygiene rates of the sampling hand and auxiliary hand were 88.8% (222/250) and 91.6% (229/250), respectively. The lowest optimal hand hygiene rates for the sampling hand and the auxiliary hand were both on the dorsal side of the finger and the dorsum of the hand (86.0%, 86.0% vs. 90.0%, 86.0%); the optimal hand hygiene rates for both sites of the sampling hand were 86.0% (43/50), and the optimal hand hygiene rates for the auxiliary hand were 90.0% (45/50) and 86.0% (43/50). The bacteria colony counts did not differ between the sampling hands and auxiliary hand. Conclusions: The dorsal side of the finger and dorsum of the hand were the most likely to be contaminated during oropharyngeal swab collection. Therefore, it is essential to pay extra attention to hand hygiene care of these two sites during the collection process to minimize the risk of cross‐contamination. Reporting Method: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study. [ABSTRACT FROM AUTHOR]

Aim: To elucidate the infrared thermal patterns and temperature readings of the surfaces of surgical wounds for detecting delayed wound healing within four days after surgery. Background: The nursing assessment of surgical wounds within the first four days after surgery is commonly based on visual and physical examination. Surgical wounds with delayed healing may be not detected if they do not exhibit signs such as redness or exudate within four days after surgery. Design: This study was conducted using prospective observational design with reference to the STROBE Statement (see Supporting Information Appendix S1) to examine the temperatures of surgical wounds in their natural settings. Methods: Based on convenience sampling, 60 participants admitted to the colorectal surgical ward for enterostoma closure from January–November 2013 were recruited. Results: Although both infected and noninfected surgical wounds exhibited a significant increase in wound temperature from Days 1–4, the infected wounds revealed a statistically significantly lower temperature than the noninfected ones. Within the infrared thermal images, the infected wounds presented with partial warming of the skin surrounding and along the incision, suggesting that delayed healing could be identified. Conclusion: This study demonstrates that delayed wound healing can be detected within the first four days after surgery for early intervention of prevention and treatment before discharge. Relevance to Clinical Practice: This paper provides evidence‐based information for healthcare professionals in assessing surgical wounds for delayed healing within the first four days after surgery. The findings herein enable the early detection of delayed wound healing, based on which early intervention of prevention and treatment may be instituted for affected patients before their discharge. [ABSTRACT FROM AUTHOR]

Aim and objective: To investigate the incidence of intraoperative blanchable erythema and pressure injuries in patients undergoing digestive surgery and to explore potential risk factors. Background: Pressure injuries pose significant economic and healthcare burden to patients and are used as one of the key indicators of nursing in the operation room with high incidence. Design: A retrospective observational study. Methods: Basic information and the results of 3S intraoperative risk assessment scale of pressure injury were obtained from the information system. And the patients with intraoperative blanchable erythema or pressure injuries were followed up for 72 hr by the information system. The clinical data were collected to analyse risk factors for intraoperative blanchable erythema and pressure injuries by univariate analysis and logistic regression analysis. STROBE checklist for cohort studies was applied in the preparation of the paper. Results: Of 5,136 surgical cases, 134 (2.61%) had blanchable erythema, 37 (0.72%) had intraoperative pressure injuries, and 8 (0.16%) had pressure injuries at 72‐hr follow‐up. Preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure were considered independent risk factors for intraoperative pressure injuries. Conclusion: The incidence of pressure injuries in our study was lower than those reported in the previous studies. Accessing preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure was considered to be significant for preventing pressure injuries. Relevance to clinical practice: The findings suggest that preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure are associated with intraoperative pressure injuries in patients undergoing digestive surgery. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify sources of interruptions and distractions to medicine administration rounds in hospitals. Background: Nurses are frequently interrupted during medicine administration. There is no systematic description of nurses' behaviours and interruptions during administration of medicines to patients. Design: Exploratory nonparticipant observational study. Methods: Three hundred and fifty‐one episodes of medicine administration with 32 nurses from three hospitals in Norway were observed using paper‐based observation grids between December 2013 and March 2014. Results: Nurses were frequently interrupted and distracted, mainly by nurses and other healthcare professionals. One‐third of the nurses interrupted their medicine administration: They prioritised helping patients with direct patient care. When the nurses were interrupted, they left the round and re‐entered the procedure. Even so, they managed to refocus and continue to administer the medicines: Interruptions and disturbances made little difference to most behaviours and actions, possibly because nurses double‐checked more frequently. Some differences were seen in behaviours potentially affecting the safety of the medicine administration, such as leaving medicines at the bedside and not helping patients take their medicines. Some interruptions were avoidable, such as those by other nurses and professionals. Conclusions: This study offers insights into nurses' behaviours and actions when they are interrupted and distracted during medicine administration. The findings highlight a conflict for nurses administering medicines. Nurses are forced to prioritise between two important activities: direct patient care and medicine administration. Management and education providers need to recognise that nurse interrupting each other is a potential threat to patient safety. Relevance to clinical practice: Our data indicate that nurses and other healthcare professionals should be warned not to interrupt colleague administering medicines and managers should ensure other staff are available to respond to patients' immediate needs during medicine rounds. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the factors described by nurses and consumer representatives influencing the delivery of the fundamentals of care. Background: An ongoing challenge facing nursing is ensuring the “basics” or fundamentals of care are delivered optimally. The way nurses and patients perceive the delivery of the fundamentals of care had not been explored. Once identified, the factors that promote the delivery of the fundamentals of care may be facilitated. Design: Inductive content analysis of scenario based focus groups. Methods: A qualitative approach was taken using three stages, including direct observation, focus groups and interviews. This paper reports the second stage. Focus groups discussed four patient care scenarios derived from the observational data. Focus groups were conducted separately for registered nurses, nurses in leadership roles and consumer representatives. Content analysis was used. Results: The analysis of the focus group data resulted in three themes: Organisational factors; Individual nurse or patient factors; and Interpersonal factors. Organisational factors include nursing leadership, the context of care delivery and the availability of time. Individual nurse and patient factors include the specific care needs of the patient and the individual nurse and patient characteristics. Interpersonal factors include the nurse–patient relationship; involving the patient in their care, ensuring understanding and respecting choices; communication; and setting care priorities. Conclusions: Seeking the perspective of the people involved in delivering and receiving the fundamentals of care showed a shared understanding of the factors influencing the delivery of the fundamentals of care. The influence of nursing leadership and the quality of the nurse–patient relationship were perceived as important factors. Relevance to clinical practice: Nurses and consumers share a common perspective of the factors influencing the delivery of the fundamentals of care and both value a therapeutic nurse–patient relationship. Clinical nursing leaders must understand the impact of their role in shaping the delivery of the fundamentals of care. [ABSTRACT FROM AUTHOR]

Aim: To examine the level of adherence to best‐practice guidelines of interprofessional teams with acute care nurse practitioners (ACNPs) compared to interprofessional teams without ACNPs. Design: A retrospective observational study was conducted in 2023. Method: A retrospective cohort was created including 280 patients who underwent a coronary artery bypass graft and/or a valve repair and hospitalised in a cardiac surgery unit of a university affiliated hospital in Québec (Canada) between 1 January 2019 to 31 January 2020. The level of adherence to best‐practice guidelines was measured from a composite score in percentage. The composite score was created from a newly developed tool including 99 items across six categories (patient information, pharmacotherapy, laboratory tests, post‐operative assessment, patient and interprofessional teams' characteristics). Multivariate linear and logistic regression models were computed to examine the effect of interprofessional teams with ACNPs on the level of adherence to best‐practice guidelines. Results: Most of the patients of the cohort were male and underwent a coronary artery bypass graft procedure. Patients under the care of interprofessional teams with ACNP were 1.72 times more likely to reach a level of adherence higher than 80% compared to interprofessional teams without ACNPs and were 2.29 times more likely to be within the highest quartile of the scores for the level of adherence to best‐practice guidelines of the cohort. Impact: This study provides empirical data supporting the benefits of ACNP practice for patients, interprofessional teams and healthcare organisations. Relevance for Practice: Our findings identify the important contributions of interprofessional teams that include ACNPs using a validated instrument, as well as their contribution to the delivery of high quality patient care. Reporting Method: This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies guidelines. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims and Objectives: (I) To identify the opinion and practices of nursing professionals regarding the presence of family members during invasive procedures in hospitalised children; (II) to determine the knowledge of nursing professionals about the patient‐and family‐centred care model. Background: Family presence in invasive procedures benefits the patient and their relatives, but varied attitudes exist among healthcare personnel, with some being favourable and others unfavourable toward family presence. Design: Observational, descriptive, cross‐sectional study. Methods: Study population: Nurses from paediatric critical care services, emergency services, hospital wards, day hospitals and outpatient clinics at a Catalan tertiary hospital who participated voluntarily between September 2021 and July 2022. Data collection instrument: A questionnaire prepared by the researchers, based on the literature and reviewed by experts. REDCap link with access to the questionnaire was sent out to potential respondents through the institutional email. Bivariate analysis was performed with the R 4.2 program. The study was approved by the hospital's Clinical Research Committee and participants gave informed consent before responding to the questionnaire. Results: A total of 172 nurses participated, and 155 valid responses were obtained. All respondents consider the family as a key element in paediatric care and report inviting family members to participate in the care given to their child. However, 12.0% of nurses do not invite the family to be present in invasive procedures. Almost all respondents note the need for training to acquire communication skills and improve the management of emotions. Conclusions: The results show a favourable opinion towards the presence of family members and highlight the need to train nurses to develop communication skills. Relevance to clinical practice: The data provided can favour the design of measures to improve and promote the presence of parents during invasive procedures, reinforcing the patient‐and family‐centred care model and improving the quality of care provided. One example is the creation of family care protocols where the inclusion of parents and the roles of each individual involved in the care process appears. [ABSTRACT FROM AUTHOR]

Aim: To examine the level and influencing factors of discharge readiness among patients with oesophageal cancer following oesophagectomy and to explore its association with post‐discharge outcomes (post‐discharge coping difficulty and unplanned readmission). Background: Oesophageal cancer is common and usually treated via oesophagectomy in China. The assessment of patient's discharge readiness gradually attracts attention as patients tend to be discharged more quickly. Design: Prospective observational study. The STROBE statement was followed. Methods: In total, 154 participants with oesophageal cancer after oesophagectomy were recruited in a tertiary cancer centre in Southern China from July 2019 to January 2020. The participants completed a demographic and disease‐related questionnaire, the Quality of Discharge Teaching Scale and Readiness for Hospital Discharge Scale before discharge. Post‐discharge outcomes were investigated on the 21st day (post‐discharge coping difficulty) and 30th day (unplanned readmission) after discharge separately. Multiple linear regressions were used for statistical analysis. Results: The mean scores of discharge readiness and quality of discharge teaching were (154.02 ± 31.58) and (138.20 ± 24.20) respectively. The quality of discharge teaching, self‐care ability, dysphagia and primary caregiver mainly influenced patient's discharge readiness and explained 63.0% of the variance. The low discharge readiness could predict more risk of post‐discharge coping difficulty (r = −0.729, p < 0.01) and unplanned readmission (t = −2.721, p < 0.01). Conclusions: Discharge readiness among patients with oesophageal cancer following oesophagectomy is influenced by various factors, especially the quality of discharge teaching. A high discharge readiness corresponds to good post‐discharge outcomes. Implications for the Profession and Patient Care: Healthcare professionals should improve the discharge readiness by constructing high‐quality discharge teaching, cultivating patients' self‐care ability, mobilizing family participation and alleviating dysphagia to decrease adverse post‐discharge outcomes among patients with oesophageal cancer. Patients or Public Contribution: Patients with oesophageal cancer after oesophagectomy who met the inclusion criteria were recruited. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To measure the reliability of pH testing to confirm ongoing nasogastric tube (NGT) position and to document associated complications. Background: Confirming NGT position is essential, as use of an incorrectly positioned tube can cause harm. Substantial evidence examines initial confirmation of NGT position, yet limited evidence exists considers NGT displacement which is identified via ongoing NGT position tests. In the NHS, pH testing is recommended to confirm ongoing NGT position; however, there may be an association with excess X‐rays and missed enteral nutrition and/or medications. Design: Prospective observational study using STROBE checklist. Methods: Data collected from medical records of 136 patients with NGTs in a London NHS Trust included pH tests, test results and complications related to ongoing pH tests which failed to confirm the tube was positioned in the stomach, that is, X‐rays, and disruptions to enteral nutrition and medication. Cohen's Kappa determined pH test reliability. Results: Of 1381 pH tests conducted to confirm NGT position, five (0.3%) correctly identified an NGT displacement, and one (0.07%) failed to identify displacement before use. The reliability of ongoing pH tests using Cohen's Kappa was minimal (0.29). Ongoing pH tests that failed to confirm a correctly positioned NGT led to 31 (22.8%) patients having X‐rays, 24 (17.6%) missing >10% of prescribed enteral nutrition and 25 (18.4%) missing a critical medication. Conclusion: Ongoing NGT position testing using pH tests did not prevent the use of a displaced tube, and more than one‐fifth of patients required X‐rays to confirm a correctly position NGT, contributing to missed medications and enteral nutrition. Relevance to Clinical Practice: Caution should be used when confirming ongoing NGT position with a pH test. Future guidelines should balance the risk of using a displaced tube with potential delays to nutrition and/or medication. More research is needed to explore alternative methods of ongoing NGT position testing. [ABSTRACT FROM AUTHOR]

Aims: To investigate the level of adoption of evidence‐based family engagement and support during end‐of‐life cancer care and subsequent bereavement and its contextual facilitators and barriers from health professionals' perspectives, and to explore differences between professional groups. Design: Contextual analysis using an online cross‐sectional survey. Methods: This study was conducted in four Swiss hospitals and three home care oncology and palliative care services. Non‐parametric testing was used to investigate the level of adoption and differences between nurses, physicians, occupational‐ and physiotherapists and psychosocial professionals (chaplains, onco‐psychologists and social workers). The STROBE checklist for cross‐sectional studies was followed. Results: The majority of the 111 participating health professionals were nurses. Adoption was statistically significantly higher during end‐of‐life care than bereavement, with nurses and physicians reporting higher levels than the other professional groups. Guidance on end‐of‐life family care was available in about half of the cases, in contrast to a quarter for bereavement care. Self‐perceived knowledge, skills and attitudes were moderate to high, with nurses and physicians reporting higher levels than others, except for general skills in working with families. Organisational structures were experienced as rather supportive, with the psychosocial group appraising the organisational context as significantly less conducive to fully implementing end‐of‐life and bereavement care than others, particularly during the end‐of‐life phase. Conclusion: Evidence‐based family engagement and support were better adopted during end‐of‐life care than bereavement. Overall, nurses and physicians felt better enabled to care for families compared to other professional groups. Patient or Public Contribution: No patient or public contribution. Protocol registration: https://osf.io/j4kfh. Implications for the profession and/or patient care: Implementation and quality improvement efforts should focus particularly on the bereavement phase and be tailored to professional groups. Impact: The findings show that evidence‐based family engagement and support practices during end‐of‐life were rather well adopted in contrast to subsequent bereavement care, with nurses and physicians better enabled than other professionals to provide care. A better understanding of health professionals' contributions and roles in family care is important to build interprofessional capacity for evidence‐based end‐of‐life and bereavement support. Reporting Method: The STROBE checklist for reports of cross‐sectional studies was followed (von Elm et al., 2007). [ABSTRACT FROM AUTHOR]

Aims: To develop a nomogram to provide a screening tool for recognising patients at risk of post‐operative pain undergoing abdominal operations. Background: Risk prediction models for acute post‐operative pain can allow initiating prevention strategies, which are valuable for post‐operative pain management and recovery. Despite the increasing number of studies on risk factors, there were inconsistent findings across different studies. In addition, few studies have comprehensively explored predictors of post‐operative acute pain and built prediction models. Design: A prospective observational study. Methods: A total of 352 patients undergoing abdominal operations from June 2022 to December 2022 participated in this investigation. A nomogram was developed for predicting the probability of acute pain after abdominal surgery according to the results of binary logistic regression. The nomogram's predictive performance was assessed by discrimination and calibration. Internal validation was performed via Bootstrap with 1000 re‐samplings. Results: A total of 139 patients experienced acute post‐operative pain following abdominal surgery, with an incidence of 39.49%. Age <60, marital status (unmarried, divorced, or widowed), consumption of intraoperative remifentanil >2 mg, indwelling of drainage tubes, poor quality sleep, high pain catastrophizing, low pain self‐efficacy, and PCIA not used were predictors of inadequate pain control in patients after abdominal surgery. Using these variables, we developed a nomogram model. All tested indicators showed that the model has reliable discrimination and calibration. Conclusions: This study established an online dynamic predictive model that can offer an individualised risk assessment of acute pain after abdominal surgery. Our model had good differentiation and calibration and was verified internally as a useful tool for risk assessment. Relevance to Clinical Practice: The constructed nomogram model could be a practical tool for predicting the risk of experiencing acute post‐operative pain in patients undergoing abdominal operations, which would be helpful to realise personalised management and prevention strategies for post‐operative pain. Reporting Method: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study. Patient or Public Contribution: Before the surgery, research group members visited the patients who met the inclusion criteria and explained the purpose and scope of the study to them. After informed consent, they completed the questionnaire. The patients' pain scores (VAS) were regularly assessed and documented by the bedside nurse for the first 3 days following surgery. Other information was obtained from medical records. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To describe a grading system that can be used to evaluate core competency of clinical nurse specialists (CNSs) at different levels. Background: Evaluate core competence of CNSs at different levels reflects the quality of nursing and the development of the nursing profession. Design: This research employed the Delphi method. Methods: The STROBE checklist for observational cross‐sectional studies was followed to report this research study. This study consisted of two main phases: a literature review and semistructured interviews. Individual semistructured interviews were conducted with 11 healthcare experts and two patients. Two rounds of questionnaire surveys were administered to 21 nursing experts using the Delphi method. The CNSs were classified as primary, intermediate or advanced based on their years of work, professional titles and educational qualifications. Results: The graded competency evaluation system consisted of five first‐level indicators (clinical practice, consulting guidance and teaching, scientific research innovation, management and discipline development, and ethical decision‐making), 15 second level indicators, and 40 third‐level indicators. The authority coefficients (Cr) of the experts were.865 and.901. The Kendall's concordance coefficients of the three‐level indicators were.417,.289 and.316 for primary CNSs;.384,.294 and.337 for intermediate CNSs; and.489,.289 and.239 for advanced CNSs. Conclusion: The graded use evaluation system in clinical practice initially involves a comprehensive evaluation of the core abilities of CNSs. This is a tool for cultivating and grading the abilities of specialised nurses that can promote a practical upwards spiral. Relevance to Clinical Practice: The evaluation system can promote the scientific management and continuous improvement of CNSs in clinical nursing and can serve as a practical and objective reference for the effective management and development of CNSs. Patient or Public Contribution: Patients participated in the data collection process, during which they shared their health‐seeking experience with our research team. [ABSTRACT FROM AUTHOR]

Background/aim: Efficient discharge for stroke patients is crucial but challenging. The study aimed to develop early predictive models to explore which patient characteristics and variables significantly influence the discharge planning of patients, based on the data available within 24 h of admission. Design: Prospective observational study. Methods: A prospective cohort was conducted at a university hospital with 523 patients hospitalised for stroke. We built and trained six different machine learning (ML) models, followed by testing and tuning those models to find the best‐suited predictor for discharge disposition, dichotomized into home and non‐home. To evaluate the accuracy, reliability and interpretability of the best‐performing models, we identified and analysed the features that had the greatest impact on the predictions. Results: In total, 523 patients met the inclusion criteria, with a mean age of 61 years. Of the patients with stroke, 30.01% had non‐home discharge. Our model predicting non‐home discharge achieved an area under the receiver operating characteristic curve of 0.95 and a precision of 0.776. After threshold was moved, the model had a recall of 0.809. Top 10 variables by importance were National Institutes of Health Stroke Scale (NIHSS) score, family income, Barthel index (BI) score, FRAIL score, fall risk, pressure injury risk, feeding method, depression, age and dysphagia. Conclusion: The ML model identified higher NIHSS, BI, and FRAIL, family income, higher fall risk, pressure injury risk, older age, tube feeding, depression and dysphagia as the top 10 strongest risk predictors in identifying patients who required non‐home discharge to higher levels of care. Modern ML techniques can support timely and appropriate clinical decision‐making. Relevance to Clinical Practice: This study illustrates the characteristics and risk factors of non‐home discharge in patients with stroke, potentially contributing to the improvement of the discharge process. Reporting Method: STROBE guidelines. [ABSTRACT FROM AUTHOR]

Aim: To investigate the feasibility and acceptability of the training process, procedures, measures and recruitment strategies necessary for a future investigation to test the reliability and validity of using positivity resonance measures in health care encounters. Background: Although the measurement of positivity resonance is promising, and non‐participant observation is considered effective, their approaches to studying nurse–patient relationships have not been fully explored. Design: A mixed‐methods observational study. Methods: Video recordings of 30 nurse–patient dyads completing telehealth video visit encounters were edited and coded using behavioural indicators of positivity resonance. A post‐visit survey gathered data on the participants' perceptions of positivity resonance and the study procedures. The research team completed memos and procedural logs to provide narrative data on the study's training, coding, recruitment and operational procedures. The study included 33 persons with cancer and 13 oncology nurses engaging in telehealth video visit encounters at an academic oncology ambulatory care center located in the southeastern United States. Results: Study procedures were found to be feasible and acceptable to participants. An adequate sample of participants (N = 46) were enrolled and retained in the study. Interrater reliability, as evidenced by Cohen's weighted kappa, ranged from.575 to.752 and interclass correlation coefficients >.8 were attainable within a reasonable amount of time and with adequate training. Behavioural indicators of positivity resonance were observed in all telehealth visits and reported by the participants in the perceived positivity resonance survey. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided reporting. Conclusions: Designing research around the concept of positivity resonance is an innovative and feasible approach to exploring how rapport is cultivated within nurse–patient relationships. Relevance to Professional Practice: Measuring positivity resonance may hold promise for exploring patient and nurse outcomes including trust, responsiveness, health‐related behaviours, well‐being, resilience and satisfaction. Reporting Method: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided the reporting of results to ensure that adequate details of the study were provided to ensure an accurate and complete report. Patient or Public Contribution: Planning of the research design and study procedures was done in consultation with nurse clinicians with experience with telehealth and managers responsible within the practice setting where the study was conducted. This ensured the study procedures were ethical, safe, secure and did not create unnecessary burden to the study participants. The study included collecting data from nurse and patient participants about the acceptability of the study procedures. [ABSTRACT FROM AUTHOR]

Aim(s): To demonstrate how interoperable nursing care data can be used by nurses to create a more holistic understanding of the healthcare needs of multiple traumas patients with Impaired Physical Mobility. By proposing and validating linkages for the nursing diagnosis of Impaired Physical Mobility in multiple trauma patients by mapping to the Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC) equivalent terms using free‐text nursing documentation. Design: A descriptive cross‐sectional design, combining quantitative analysis of interoperable data sets and the Kappa's coefficient score with qualitative insights from cross‐mapping methodology and nursing professionals' consensus. Methods: Cross‐mapping methodology was conducted in a Brazilian Level 1 Trauma Center using de‐identified records of adult patients with a confirmed medical diagnosis of multiple traumas and Impaired Physical Mobility (a nursing diagnosis). The hospital nursing free‐text records were mapped to NANDA‐I, NIC, NOC and NNN linkages were identified. The data records were retrieved for admissions from September to October 2020 and involved medical and nursing records. Three expert nurses evaluated the cross‐mapping and linkage results using a 4‐point Likert‐type scale and Kappa's coefficient. Results: The de‐identified records of 44 patients were evaluated and then were mapped to three NOCs related to nurses care planning: (0001) Endurance; (0204) Immobility Consequences: Physiological, and (0208) Mobility and 13 interventions and 32 interrelated activities: (6486) Environmental Management: Safety; (0840) Positioning; (3200) Aspiration Precautions; (1400) Pain Management; (0940) Traction/Immobilization Care; (3540) Pressure Ulcer Prevention; (3584) Skincare: Topical Treatment; (1100) Nutrition Management; (3660) Wound Care; (1804) Self‐Care Assistance: Toileting; (1801) Self‐Care Assistance: Bathing/Hygiene; (4130) Fluid Monitoring; and (4200) Intravenous Therapy. The final version of the constructed NNN Linkages identified 37 NOCs and 41 NICs. Conclusion: These valid NNN linkages for patients with multiple traumas can serve as a valuable resource that enables nurses, who face multiple time constraints, to make informed decisions efficiently. This approach of using evidence‐based linkages like the one developed in this research holds high potential for improving patient's safety and outcomes. No Patient or Public Contribution: In this study, there was no direct involvement of patients, service users, caregivers or public members in the design, conduct, analysis and interpretation of data or preparation of the manuscript. The study focused solely on analysing existing de‐identified medical and nursing records to propose and validate linkages for nursing diagnoses. [ABSTRACT FROM AUTHOR]

Background: While previous research has established that resilience is affected by various factors, these studies have primarily focussed on individual variables associated with resilience, without providing insights into how to influence the rate of change in resilience. Aim: To examine the trajectory of resilience and identify the factors associated with changes in resilience among spousal caregivers of patients with newly diagnosed advanced cancer receiving treatment during the first 6 months. Design: An observational longitudinal study. Methods: A total of 312 spousal caregivers of patients with newly diagnosed advanced cancer were recruited from January 2022 to December 2022 in Yancheng, China. Three data collection points were established, spanning from the first month to 6 months after initial cancer treatment. A latent growth model was employed to depict the resilience trajectory at various time points. A latent growth model with time‐invariant covariates was adopted to determine the factors influencing resilience trajectory. The study adhered to the STROBE checklist for proper reporting. Results: Throughout the follow‐up period, the participants experienced a significant increase in resilience. Gender, family income, the patient's health status, spirituality and belief in familism were significantly associated with the baseline resilience level. Moreover, family income, the patient's health status, spirituality, caregiver burden and belief in familism were significantly associated with the rate of resilience change over time. Conclusions: Spousal caregivers demonstrated a linear increase in resilience during the first 6 months after initial treatment. Meanwhile, changes in resilience were influenced by multiple factors during the early phase of cancer treatment. Thus, more attention should be paid to early identification and implementation of targeted interventions. Relevance to Clinical Practice: Healthcare professionals should understand the change in resilience among spousal caregivers and conduct timely mental health interventions to enhance the resilience of families affected by cancer. Patient or Public Contribution: The Guidance for Reporting Involvement of Patients and the Public‐Short Form reporting checklists were used to improve patient and public involvement. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate whether a low Braden Skin Score (BSS), reflecting an increased risk of pressure injury, could predict the risk of delirium in older patients in the intensive care unit (ICU). Background: Delirium, a common acute encephalopathy syndrome in older ICU patients, is associated with prolonged hospital stay, long‐term cognitive impairment and increased mortality. However, few studies have explored the relationship between BSS and delirium. Design: Multicenter cohort study. Methods: The study included 24,123 older adults from the Medical Information Mart for Intensive Care IV (MIMIC‐IV) database and 1090 older adults from the eICU Collaborative Research Database (eICU‐CRD), all of whom had a record of BSS on admission to the ICU. We used structured query language to extract relevant data from the electronic health records. Delirium, the primary outcome, was primarily diagnosed by the Confusion Assessment Method for the ICU or the Intensive Care Delirium Screening Checklist. Logistic regression models were used to validate the association between BSS and outcome. A STROBE checklist was the reporting guide for this study. Results: The median age within the MIMIC‐IV and eICU‐CRD databases was approximately 77 and 75 years, respectively, with 11,195 (46.4%) and 524 (48.1%) being female. The median BSS at enrollment in both databases was 15 (interquartile range: 13, 17). Multivariate logistic regression showed a negative association between BSS on ICU admission and the prevalence of delirium. Similar patterns were found in the eICU‐CRD database. Conclusions: This study found a significant negative relationship between ICU admission BSS and the prevalence of delirium in older patients. Relevance to Clinical Practice: The BSS, which is simple and accessible, may reflect the health and frailty of older patients. It is recommended that BSS assessment be included as an essential component of delirium management strategies for older patients in the ICU. No Patient or Public Contribution: This is a retrospective cohort study, and no patients or the public were involved in the design and conduct of the study. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the extent to which a checklist designed to support patient safety in hospital Emergency Departments was recognised and used by staff. Background: Patient crowding in UK Emergency Departments makes it difficult for staff to monitor all patients for signs of clinical deterioration. An Emergency Department Safety Checklist was developed at a UK hospital to ensure patients are regularly monitored. It was subsequently implemented in six hospitals and recommended for use across the National Health Service in England. Methods: This was a qualitative study in two UK hospital Emergency Departments. Data collection consisted of sixty‐six hours of nonparticipant observation and interviews with twenty‐six staff. Observations were sampled across different days and times. Interviews sampled a range of staff. Data were analysed thematically. The study was undertaken in accordance with COREQ guidelines. Results: Staff described the Emergency Department Safety Checklist as a useful prompt and reminder for monitoring patients' vital signs and other aspects of care. It was also reported as effective in communicating patient care status to other staff. However, completing the checklist was also described as a task which could be overlooked during busy periods. During implementation, the checklist was promoted to staff in ways that obscured its core function of maintaining patient safety. Conclusions: The Emergency Department Safety Checklist can support staff in maintaining patient safety. However, it was not fully recognised by staff as a core component of everyday clinical practice. Relevance to clinical practice: The Emergency Department Safety Checklist is a response to an overcrowded environment. To realise the potential of the checklist, emergency departments should take the following steps during implementation: (a) focus on the core function of clinical safety, (b) fully integrate the checklist into the existing workflow and (c) employ a departmental team‐based approach to implementation and training. [ABSTRACT FROM AUTHOR]

Aim: To achieve an in‐depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self‐care. Design: The study employed a qualitative explorative design utilizing a phenomenological‐hermeneutic inspired approach, involving field observations and individual semistructured interviews. Methods: Data were collected during 2020–2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research. Results: Three key themes emerged: 'Diabetes when life is noisy', 'Sacrifices and compromises in life' and 'The double silence'. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self‐care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long‐term complications as a serious medical condition demanding careful attention and treatment. Conclusion: Self‐managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways. Implications for patient care: The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support. [ABSTRACT FROM AUTHOR]

Aims and Objective: To evaluate the attitudes of Indian nurses towards the importance of family involvement in nursing care and the association between nurse attitudes and sociodemographic characteristics. Background: Involving the family in the care process is crucial for delivering family‐ and patient‐centred care and ensuring the best possible patient outcomes. Nevertheless, published literature revealed that the nurses may lack clarity regarding the role of family members in the patient's care, which in turn hinders families' participation in care. Design: Cross‐sectional descriptive study. The STROBE checklist was used to report the present study. Methods: A total of 203 Nurses participated in a prospective cross‐sectional study between May 2022 and August 2022. They were recruited through convenience sampling from two tertiary care centres in India. A two‐part questionnaire was used to gather the data; the first section contained questions for gathering sociodemographic information, and the second part contained the standardized FINC‐NA scale. Results: The mean age of the nurses was (28.08 ± 4.722) years, and their median professional experience was 2.5 (1–5.5) years. Nurses' attitude regarding family's importance in patient care was found to be significantly associated (p ≤.05) with education level, marital status, religion and hometown region. Conclusion: In several items Indian nurses have positive attitudes towards family involvement in care but some of the lower scoring items can present opportunities for focused improvement. Continuing development programmes about family‐centered care can constitute important strategies to improve the positive attitudes of nurses towards families in practice. Patient and public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: To compare anaesthesia‐related outcomes between patients monitored by newly recruited nurse anaesthetists and those monitored by newly recruited anaesthesiologists. Design: This was a retrospective study. Methods: We conducted a retrospective study that collected demographic information on newly recruited nurse anaesthetists and anaesthesiologists between 2017 and 2022 and recorded information on patients within 6 months of monitoring. Postoperative pain, emergency agitation, nausea, and vomiting were designated anaesthesia‐related outcomes. Propensity score matching was used to adjust for covariates. The study adhered to the STROBE guidelines. Results: The study's statistical analysis included 4483 patients monitored by 22 newly recruited nurse anaesthetists and 4959 patients monitored by 23 newly recruited anaesthesiologists. Compared with patients monitored by newly trained anaesthesiologists, the patients monitored by nurse anaesthetists were younger (42.07 ± 20.00 vs. 47.39 ± 18.45 years, p < 0.001) and had a lower body mass index (23.56 ± 4.46 vs. 24.19 ± 4.25, p < 0.001). Patients monitored by anaesthesiologists had a greater proportion of women (61.62% vs. 59.25%, p < 0.001), a high proportion of ASA III and ASA IV (17.1% vs. 8.88%, p < 0.001), and a longer mean surgery duration (78.65 ± 59.01 vs. 70.70 ± 60.65 min, p < 0.001). After propensity score matching was used to adjust for covariates, no statistically significant differences were found in the prevalence of postoperative pain, emergency agitation, or postoperative nausea and vomiting between the two groups (p < 0.05). Conclusion: Nurse anaesthetists monitoring alone during anaesthesia maintenance is feasible and safe. The two groups had no significant differences in the incidence of postoperative pain, emergency agitation, or postoperative nausea and vomiting. Relevance to Clinical Practice: The shortage of anaesthesiologists leads to heavy work burden and high incidence of occupational burnout among anaesthesiologists. The study found that it was safe for nurse anaesthetists to perform anaesthetic monitoring alone in the operating room under the supervision of the attending anaesthesiologist and did reduce the burden of anaesthesiologists' work. The results of the current study contribute to the expansion of occupational categories for nurse anaesthetists in countries where anaesthesiologists are in short supply. It provides new ideas for hospital administrators and policy‐makers to formulate medical and nursing service policies. [ABSTRACT FROM AUTHOR]

Background: Medication self‐management (MSM) is defined as a person's ability to cope with medication treatment for a chronic condition, along with the associated physical and psychosocial effects that the medication causes in their daily lives. For many patients, it is important to be able to self‐manage their medication successfully, as they will often be expected to do after discharge. Aim: The aim of this study was to describe the willingness and attitudes of patients with schizophrenia spectrum or bipolar disorders regarding MSM during hospital admission. A secondary aim was to identify various factors associated with patient willingness to participate in MSM and to describe their assumptions concerning needs and necessary conditions, as well as their attitudes towards their medication. Methods: A multicentre, quantitative cross‐sectional observational design was used to study the willingness and attitudes of psychiatric patients regarding MSM during hospitalisation. The study adhered to guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Results: In this study, 84 patients, of which 43 were patients with schizophrenia spectrum disorders and 41 were patients with bipolar disorders, participated. A majority of the patients (81%) were willing to participate in MSM during their hospitalisation. Analysis revealed patients are more willing to MSM if they are younger (r = −.417, p <.001) and a decreasing number of medicines (r = −.373, p =.003). Patients' willingness was positively associated with the extent of support by significant others during and after hospitalisation (Pearson's r =.298, p =.011). Patients were convinced that they would take their medication more correctly if MSM were to be allowed during hospitalisation (65%). Conclusion: Most of the patients were willing to self‐manage their medication during hospitalisation, however, under specific conditions such as being motivated to take their medication correctly and to understand the benefits of their medication. Relevance to Clinical Practice: From a policy point of view, our study provided useful insights into how patients look at MSM to enable the development of future strategies. Since patients are willing to self‐manage their medication during hospitalisation, this may facilitate its implementation. Patient contribution: Patients were recruited for this study. Participation was voluntary, and signed informed consent was obtained from all participants prior to the questionnaire. [ABSTRACT FROM AUTHOR]

Aim: To explore registered nurses' thinking strategies during the drug administration process in nursing homes. Design: An exploratory qualitative design. Methods: Eight registered nurses, one male and seven female, in five nursing home wards in Mid‐Norway were observed during 15 drug dispensing rounds (175 drug dispensing episodes). Think Aloud sessions with follow‐up individual interviews were conducted. The Think Aloud data were analysed using deductive qualitative content analysis based on Marsha Fonteyn's description of 17 thinking strategies. Interview data were used to clarify missing information and validate the content of Think Aloud data. Results: The registered nurses used all 17 thinking strategies described by Fonteyn, including several variants of each strategy. The three most frequent were 'providing explanations', 'setting priorities' and 'drawing conclusions'. In addition, we found two novel thinking strategies that did not fit into Fonteyn's template, which were labelled 'controlling' and 'interacting'. Among all strategies, 'controlling' was by far the most used, serving as a means for the registered nurses to stay on track and navigate through various interruptions, while also minimising errors during drug dispensing. Conclusion: The study highlights the diverse thinking strategies employed by registered nurses in nursing homes during medication administration. The findings emphasise the multifaceted nature of medication administration and underscore the importance of skilled personnel in ensuring medication safety. Recognising the significance of these findings is crucial for maintaining patient well‐being and upholding medication safety standards in healthcare settings. Relevance to Clinical Practice: Understanding the thinking strategies employed by registered nurses can inform training programmes and enhance the clinical judgements of health care professionals involved in medication administration, ultimately leading to improved patient outcomes and reduced medication errors in practice. Patient or Public Contribution: Patients were involved in this study as recipients of drugs which the nurses distributed during the observations. The patients were involved as a third party and consent to the observations was either given by the patients themselves or relatives in cases where the patient was not competent to consent. No personal information was collected about the patients. Reporting Method: The reporting of this study adhered to the COREQ checklist. [ABSTRACT FROM AUTHOR]

Aim: To explore whether sleep deprivation contributes to medication errors in registered nurses (RNs). Background: Sleep deprivation is a potential issue for RNs, particularly those who work shifts. Sleep deprivation has been found to have a negative impact on numerous cognitive processes. Nurses administer several medications to patients a day, potentially while sleep deprived—anecdotal reports suggest that this could result in an increased risk of error occurring. Design: A scoping review was conducted using the Prisma‐ScR extension framework to explore what is known about the effect of RNs' sleep deprivation on medication administration errors. Methods: A search of databases generated 171 results. When inclusion and exclusion criteria were applied, 18 empirical studies were analysed. Studies included retrospective analysis of errors, surveys of perceptions of causes and observational studies. Results: Data indicated that RNs consider fatigue, which may be caused by sleep deprivation, to be a contributing factor to medication errors. The search only identified three observer studies, which provided conflicting results as to whether lack of sleep contributes to the error rate. Of the numerous tools used to measure sleep, the Pittsburgh Sleep Quality Index was the most frequently used. Conclusion: Although RNs anecdotally consider a lack of sleep potentially contributes to medication errors, there is insufficient research to provide robust evidence to confirm this assumption. No Patient or Public Contributions: Patient or public contributions were not required for this scoping review. Relevance to Clinical Practice: Sleep deprivation is a potential issue for nurses, especially those who work shifts. Poor sleep impacts cognitive processes that potentially could increase errors. Nurses should be aware of the impact sleep may have on patient safety. [ABSTRACT FROM AUTHOR]

Background: Malnutrition, sedentary lifestyle, cognitive dysfunction and poor psychological well‐being are often reported in patients on haemodialysis (HD). Aims: We aimed to explore needs, barriers and facilitators—as perceived by patients, their carers, and healthcare professionals (HCPs) for increasing the adherence to the diet, to physical activity and cognition and psychological well‐being. Methods: This is an observational cross‐sectional study following the STROBE statement. This study is part of an ERASMUS+ project, GoodRENal—aiming to develop digital tools as an educational approach to patients on HD. For that, the GoodRENal comprises HD centers located in four Belgium, Greece, Spain and Sweden. Exploratory questionnaires were developed regarding the perceived needs, barriers and facilitators regarding the diet, physical activity, cognition and psychological well‐being from the perspective of patients, their carers and HCPs. Results: In total, 38 patients, 34 carers and 38 HCPs were included. Nutrition: For patients and carers, the main needs to adhere to the diet included learning more about nutrients and minerals. For patients, the main barrier was not being able to eat what they like. Physical activity: As needs it was reported information about type of appropriate physical activity, while fatigue was listed as the main barrier. For Cognitive and emotional state, it was perceived as positive for patients and carers perception but not for HCPs. The HCPs identified as needs working as a team, having access to specialised HCP and being able to talk to patients in private. Conclusions: Patients and their carers listed as needs guidance regarding nutrition and physical activity but were positive with their cognitive and emotional state. The HCPs corroborated these needs and emphasised the importance of teamwork and expert support. [ABSTRACT FROM AUTHOR]

Aim and objective: To investigate how intensive care nurses prepare, initiate, administer, titrate, and wean vasoactive medications. Background: The management of vasoactive medications is core business for intensive care nurses, but little is known on how nurses manage these ubiquitous and potentially harmful medications. Design: A systematic review of the literature with narrative synthesis of data. Methods: The databases CINAHL Complete, Medline Complete and EMBASE were searched from 1965 to January 2019 with keywords under five concept headings and in a variety of configurations. This systematic review was conducted according to the PRISMA guidelines. Studies were assessed for quality and bias, and a modified narrative synthesis was used to analyse data, investigate findings and explore relationships within and between studies. Results: The review identified 13 studies: two observational studies, two pre and post intervention studies, four survey studies, two quasi‐experimental studies, one longitudinal time series, one prospective controlled trial, and one interview incorporating content analysis. Four studies on preparing and initiating vasoactive medications described a lack of standardisation in infusion preparation and inconsistencies in dosing units and patient weights. Five of six studies on vasoactive medication administration examined nurses' use of syringe changeovers to reduce patient haemodynamic compromise and there were three studies on titration and weaning. Conclusion: Further research on nurse management of vasoactive medications is needed to develop an evidence base for specialist education and standardised practices aimed at reducing risk for patient harm. Relevance to clinical practice: Nurses working in intensive care units in many parts of the world are responsible for the management of vasoactive medications. There is great variation in practices that include preparation, initiation, administration, titration and weaning of vasoactive medications, which increases the risk for medication errors and adverse events in a vulnerable population of critically ill patients. [ABSTRACT FROM AUTHOR]

Aim: To uncover the characteristics of nurses' information practice in municipal health care and to address how, when and why various pieces of information are produced, shared and managed. Background: Nursing documentation in the electronic patient record has repeatedly been found unsatisfactory. Little is known about how the information practice of nurses in municipal health care actually is borne out. In order to understand why nursing documentation continues to fail at living up to the expected requirements, a better understanding of nurses' information practice is needed. Design: A qualitative observational field study. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Methods: Empirical data were collected in three Norwegian municipalities through participant observations and individual interviews with 17 registered nurses on regular day shifts. The data were analysed through thematic content analysis. Results: Nurses' information practice in municipal health care can be described as complex. The complexity is reflected in four themes that emerged from the data: (1) web of information sources, (2) knowing the patient and information redundancy, (3) asynchronous information practice and (4) compensatory workarounds. Conclusions: The complex and asynchronous nature of nurses' information practice affected both how and when information was produced, recorded and shared. When available systems lacked functions the nurses wanted, they created compensatory workarounds. Although electronic patient record was an important part of their information practice, nurses in long‐term care often knew their patients well, which meant that a lot of information about the patients was in their heads, and that searching for information in the electronic patient record sometimes seemed redundant. Relevance to clinical practice: This study provides contextual knowledge that might be valuable (a) in the further development of information systems tailored to meet nurses' information needs and (b) when studying patient safety in relation to nurses' information practice. [ABSTRACT FROM AUTHOR]

Aims and Objectives: (i) To estimate the national incidence of unplanned removal of peripherally inserted central catheters (PICCs) in China. (ii) To explore the associated risk factors to provide evidence for the prevention. Design: A multi‐centre prospective cohort study. Methods: A representative sample of 3222 Chinese adult patients with successful PICC insertion was recruited for the PICC Safety Management Research (PATH) using a two‐stage cluster sampling method from December 2020 to June 2022. Sixty hospitals from seven Chinese provinces representing all geographical regions were selected. Demographic information and PICC characteristics were collected using a standard online case report form. Risk factors for the unplanned removal of PICCs were assessed using a cause‐specific hazard model and verified using a sub‐distribution hazard model. STROBE guidelines were followed in reporting this study. Results: Three thousand one hundred and sixty‐six patients were included in the final analysis with a mean age of 59 years and a total of 344,247 catheter days. The incidence of unplanned removal was 10.04%. Female, with thrombosis history, PICC insertion due to infusion failure, valved catheter and double‐lumen catheter were risk factors, whereas longer insertion and exposure length were protective factors in the cause‐specific hazard model. Higher BMI became an independent risk factor in the sub‐distribution hazard model. Conclusions: Unplanned removal of PICCs is a serious clinical challenge in China. Our findings call for prevention strategies targeting the identified risk factors. Relevance to Clinical Practice: Our study characterised the epidemiology of unplanned removal of PICCs among Chinese adult inpatients, highlighting the need for prevention among this population and providing a basis for the formulation of relevant prevention strategies. Patient or Public Contribution: Patients contributed through sharing their information required for the case report form. Healthcare professionals who provide direct care to the patient at each medical centre contributed by completing the online case report form. [ABSTRACT FROM AUTHOR]

Aims: To describe the health literacy (HL) levels of hospitalised patients and their relationship with nursing diagnoses (NDs), nursing interventions and nursing measures for clinical risks. Design: Retrospective study. Methods: The study was conducted from December 2020 to December 2021 in an Italian university hospital. From 146 wards, 1067 electronic nursing records were randomly selected. The Single‐Item Literacy Screener was used to measure HL. Measures for clinical risks were systematically assessed by nurses using Conley Index score, the Blaylock Risk Assessment Screening Score, Braden score, and the Barthel Index. A univariable linear regression model was used to assess the associations of HL with NDs. Results: Patients with low HL reported a higher number of NDs, interventions and higher clinical risks. HL can be considered a predictor of complexity of care. Conclusions: The inclusion of standardised terms in nursing records can describe the complexity of care and facilitate the predictive ability on hospital outcomes. Implications for the profession and/or patient care: HL evaluation during the first 24 h. From hospital admission could help to intercept patients at risk of higher complexity of care. These results can guide the development of interventions to minimise needs after discharge. Patient or Public Contribution: No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to investigate the prevalence of post‐traumatic stress symptoms, and to identify possible predictive factors in Norwegian intensive care unit survivors, 6 months after admission to the intensive care unit with COVID‐19. Background: The SARS CoV‐2 virus causing COVID‐19 has spread worldwide since it was declared a pandemic in March 2020. The most severely ill patients have been treated in the intensive care due to acute respiratory failure and also acute respiratory distress syndrome. It is well documented that these severe conditions can lead to complex and long‐lasting symptoms, such as psychological distress, and was, therefore, investigated for the specific COVID‐19 population. Design: Prospective observational study. Methods: Clinical data and patient reported outcome measures were collected by the Norwegian Intensive Care and Pandemic Registry and by the study group 6 months after admission to an intensive care unit. Results: Among 222 COVID‐19 patients admitted to Norwegian intensive care units between 10 March and 6 July 2020, 175 survived. The study sample consisted of 131 patients who responded to at least one patient reported outcome measure at 6 months following admission. The primary outcome was self‐reported post‐traumatic stress symptoms, using the Impact of Event Scale‐6 (n = 89). Of those, 22.5% reported post‐traumatic stress symptoms 6 months after admission. Female gender, younger age and having a high respiratory rate at admission were statistically significant predictive factors for reporting post‐traumatic stress symptoms. Conclusions: The result is in accordance with previously published research with comparable populations, suggesting that for many COVID‐19 survivors psychological distress is a part of the post‐acute sequelae. Results from the present study should be replicated in larger datasets. Relevance to Clinical Practice: This project provides important insight to post‐acute sequelae after COVID‐19 that patients may experience after critical illness. [ABSTRACT FROM AUTHOR]

Objectives: To determine post‐COVID syndromes in the Indian population, correlating a wide spectrum of post‐COVID manifestations with acute disease severity and associated risk factors. Background: Post‐COVID Syndrome (PCS) is defined as signs and symptoms that develop during or after acute COVID‐19 infection. Design of Study: This is a prospective observational cohort with repetitive measurements. Methods: The study followed RT‐PCR confirmed COVID‐19‐positive survivors discharged from HAHC Hospital, New Delhi, for a period of 12 weeks. The patients were interviewed over the phone at 4 weeks and 12 weeks from the onset of symptoms for evaluation of clinical symptoms and health‐related quality of life parameters. Results: A total of 200 patients completed the study. At the baseline, 50% of the patients were categorised as severe based on their acute infection assessment. At 12 weeks after symptom onset, fatigue (23.5%), hair loss (12.5%) and dyspnea (9%) were the main persistent symptoms. The incidence of hair loss (12.5%), memory loss (4.5%) and brain fog (5%) were found to be increased as compared to the acute infection period. Severity of the acute COVID infection behaved as an independent predictor for the development of PCS, with high odds of experiencing persistent cough (OR = 13.1), memory loss (OR = 5.2) and fatigue (OR = 3.3). Further, 30% of subjects in the severe group experienced statistically significant fatigue at 12 weeks (p <.05). Conclusion: From the results of our study, it can be concluded that there is a huge disease burden of post‐COVID Syndrome (PCS). The PCS comprised multisystem symptoms ranging from serious complaints of dyspnea, memory loss and brain fog to non‐serious complaints of fatigue and hair loss. Severity of the acute COVID infection behaved as an independent predictor for the development of PCS. Our findings strongly recommend vaccination against COVID‐19, for protection from disease severity as well as prevention of PCS. Relevance to Clinical Practice: The findings of our study support the multidisciplinary approach required for the management of PCS with a team comprising of physicians, nurses, physiotherapists and psychiatrists working in close coordination for the rehabilitation of these patients. As nurses are considered the most trusted professionals in the community and the class of health workers associated with rehabilitation, focus should be given to educating them on PCS, which would prove to be an important strategy for efficient monitoring and long‐term management of COVID‐19 survivors. [ABSTRACT FROM AUTHOR]

Background: Research has shown sleep problems, elevated fatigue, and high cases of burnout, as well as signs of post‐traumatic stress and psychological distress among nurses during the COVID‐19 pandemic. Many US hospitals attempted to minimise its impact on staff by providing basic resources, mental health services, and wellness programs. Therefore, it is critical to re‐evaluate these well‐being indices and guide future administrative efforts. Purpose: To determine the long‐term impact of the COVID‐19 pandemic after 18 months on hospital nurses' insomnia, fatigue, burnout, post‐traumatic stress, and psychological distress. Design Cross‐sectional. Methods: Data were collected online mainly through state board and nursing association listservs between July–September 2021 (N = 2488). The survey had psychometrically tested instruments (Insomnia Severity Index, Occupational Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short Post‐Traumatic Stress Disorder, and Patient Health Questionnaire‐4) and sections on demographics, health, and work. The STrengthening the Reporting of Observational studies in Epidemiology checklist was followed for reporting. Results: Nurses had subthreshold insomnia, moderate‐to‐high chronic fatigue, high acute fatigue, and low‐to‐moderate intershift recovery. Regarding burnout, they experienced increased emotional exhaustion and personal accomplishment, and some depersonalisation. Nurses had mild psychological distress but scored high on post‐traumatic stress. Nurses who frequently cared for patients with COVID‐19 in the past months scored significantly worse in all measures than their co‐workers. Factors such as nursing experience, shift length, and frequency of rest breaks were significantly related to all well‐being indices. Conclusion: Nurses' experiences were similar to findings from the early pandemic but with minor improvements in psychological distress. Nurses who frequently provided COVID‐19 patient care, worked ≥12 h per shift, and skipped rest breaks scored worse on almost all well‐being indices. Relevance to clinical practice: Administration can help nurses' recovery by providing psychological support, mental health services, and treatment options for insomnia, as well as re‐structure current work schedules and ensure that rest breaks are taken. [ABSTRACT FROM AUTHOR]

Aims: To identify changes in mental health status among nursing professionals in a Brazilian municipality during the COVID‐19 pandemic. Design: An observational and longitudinal study. Methods: Using the Patient Health Questionnaire‐9, the presence of depressive symptoms was evaluated among 690 nursing professionals in the city of Pelotas, Brazil, at two moments: June/July 2020 and June/July 2021. Results: 13.0% incidence of depressive symptoms was identified; as well as 12.2% remission; 24.1% persistence and 50.7% absence. Among the factors associated with the worst prognoses we can mention female gender, greater workload, feeling of overload, illness of family members or friends due to COVID‐19 and use of psychotropic drugs Conclusions: There was significant mobility in the diagnosis of depression among the professionals studied during the period analysed, with incidence of new cases of significant depression and greater than the number of remissions. In addition to sociodemographic aspects, traumatic experiences and exposure to continuous overload were associated with persistence and incidence of new cases. Implications for the profession and/or patient care: With the advent of the COVID‐19 pandemic, several studies have shown an increase in depressive symptoms among nursing professionals; however, understanding the long‐term effects of this scenario is still a challenge. Impact: What problem did the study address? This study investigates changes in the mental health status of nursing professionals working at different care levels, taking the prevalence of screening for depression as a proxy, during a period of a year during the COVID‐19 pandemic. What were the main findings? Between both data collection moments, 2020 e 2021, there was a significant percentage of professionals with persistent depression, in addition to a significant proportion of incident cases that slightly exceeded the number of remissions and the factors associated with the worst prognoses were sociodemographic aspects such as gender and emotional stressors like illness of family members or close friends due to COVID‐19, in addition to those related to the organisation and support provided by the services, such as workload and feeling of overload. Where and on whom will the research have an impact? This study will impact the nursing professionals and in role of the health services in order to establishing actions that contribute to minimising the deleterious effects of the pandemic on the mental health of their Nursing teams. Reporting method: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study. Patient or public contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aims and objectives: To contribute in‐depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized? Background: Medication administration is a vital process across healthcare settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety. Design: A qualitative observational study design was applied. Methods: Data were collected using partial participant observations. An inductive content analysis was performed. Results: Factors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation and staff's apparent freedom as to how and where to perform medication‐related activities. Interruptions during medication administration are prevalent and can be characterised as passive (e.g., alarm and background noises), active (e.g., discussions) or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes. Conclusions: A process of normalisation has taken place whereby staff put up with second‐rate technological solutions, noise and interruptions when they are performing medication‐related tasks. Before seeking to minimise interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach. Relevance to clinical practice: Staff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence. [ABSTRACT FROM AUTHOR]

Aims/objectives: Through interviews with clinical service providers, we explored stigma's impact on HIV service provision for African Americans during COVID‐19. Background: African Americans experience disproportionate rates of HIV and COVID‐19. We explored COVID‐19's impact on HIV services for African American adults in a Southern city. Design: The study was qualitative and observational. Methods: Key informant interviews were conducted (n = 11) across two healthcare centres and two community‐based organisations and thematically analysed using phenomenological approaches by two coders. Interviews explored pre‐ and post‐COVID‐19 service provision and parallels between COVID‐19 and HIV, particularly as related to stigma. The COREQ checklist was utilised to ensure research quality. Results: According to the providers interviewed, all providers offered HIV prevention/treatment, but PrEP and preventive services diminished greatly early in the COVID‐19 pandemic. Successful transition to telehealth depended on existing telehealth use. Challenges exacerbated by COVID‐19 included food/housing insecurity and physical distancing constraints. Clients' COVID‐19 informational needs shifted from concerns to vaccine requests over time. Interviewees stated HIV and COVID‐19 both carry 'risk taking'; however, HIV risk was more physically intimate than COVID‐19. Notably, some providers used stigmatising language referring to clients with HIV/COVID and omitted person‐centred language. Conclusions: Findings suggest need to address challenges in telehealth to improve client experiences now and for future pandemics. More research is needed to examine intersectional stigmatisation of COVID‐19 and HIV for African Americans to design person‐centred counselling interventions. Relevance to Clinical Practice: Results demonstrate need for provider training to reframe stigma discussions using client centeredness, educating African Americans on HIV and COVID‐19 prevention, and coordination with local organisations to address multiple care needs. Patient/Public Contribution: This research highlights needs of clients based on the views of healthcare providers caring for predominantly African American communities in a Southern city. However, no patients, service users, caregivers or members of the public were directly involved in this study. [ABSTRACT FROM AUTHOR]

Aims and objective: To describe the experiences of nursing students and their mental health as they entered employment during the first wave of the COVID‐19 pandemic (May–June 2020). Background: As other healthcare professionals, nursing students who worked during the first COVID‐19 wave suffered from dysfunctional mental health symptoms. Design: Sequential, mixed‐method, multicentre study. Methods: The study population comprised 92 students in the third and fourth year of the Nursing degree at three Spanish universities, who entered employment during the pandemic. Data were collected between May and June 2020. In the quantitative phase, data were collected using an online questionnaire containing both validated anxiety and stress scales. In the qualitative phase, semi‐structured interviews were conducted with 18 participants. A descriptive analysis of the quantitative data and a reflexive thematic analysis of the qualitative data were carried out, and analyses were combined. COREQ checklist was used for reporting. Results: The combined quantitative and qualitative results were organised into five thematic areas: (1) Interruption of clinical placements, (2) Entering employment on a healthcare assistant contract, (3) Preventing contagion, (4) Adapting to the situation and managing emotions, and (5) Lessons learned. Conclusion: The students had a positive overall experience of entering employment, as they were able to develop their nursing skills. However, they had an emotional impact in form of stress caused by excessive responsibility, academic uncertainty, lack of personal protective equipment and training in its use, and the possibility of spreading disease to their family members. Relevance to Clinical Practice: In the current context, changes must be made in study programmes to instruct nursing students to be able to cope with extreme clinical situations, such as pandemics. The programmes should include a more extensive coverage of epidemics and pandemics and management of emotional aspects such as resilience. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine the effects of registered nurse staffing levels, work environment and education levels on the residents' quality of life and nurses' job dissatisfaction, burnout and turnover intention. Background: Registered nurse staffing status and work environment are suboptimal in nursing homes worldwide. Nursing home care aims to maximise residents' quality of life. However, evidence on the impact of registered nurse staffing levels, work environment and education levels on the residents' quality of life and nurse outcomes in nursing homes is limited. Design: This is a cross‐sectional observational study. Methods: A total of 513 residents and 117 registered nurses from 39 nursing homes in South Korea participated in surveys. The main measures included registered nurses' staffing levels, work environment, education levels, residents' quality of life, registered nurses' job dissatisfaction, burnout and turnover intention. We analysed data using the generalised estimating equations and reported the study using the STROBE checklist. Results: Overall, the residents' quality‐of‐life score was 13.7 ± 2.6 (out of 17). Residents in nursing homes with a higher number of registered nurses or with work environment evaluated as 'mixed' or 'better' (compared with 'poor') had a higher quality of life. Regarding nurse outcomes, 74.4% of the registered nurses were dissatisfied with their current jobs, 12.0% had burnout and 18.8% had a turnover intention. Registered nurses working in 'mixed' or 'better' work environment were less likely to have job dissatisfaction. Registered nurses' education levels did not have a statistically significant effect on the resident and nurse outcomes. Conclusions: Registered nurse staffing levels and work environment should be considered important for improving residents' quality of life and nurses' job satisfaction. Relevance to Clinical Practice: Regulation and policy reforms are needed to increase the registered nurse staffing levels and to create a good work environment in nursing homes. Patient or Public Contribution: Nursing home residents and registered nurses participated in the surveys of this study. Registered nurses facilitated resident recruitment by identifying and introducing the study to residents who were eligible for study participation. Trial Registration: Not applicable. [ABSTRACT FROM AUTHOR]

Aim: To describe positive and negative spiritual responses to providing COVID‐related nursing care among nurses working in hospitals. Background: The COVID pandemic has intensified and publicised the threats to nurse well‐being. Absent from the recommendations for promoting nurse well‐being is recognition of how nurses' spirituality and/or religiosity is affected by the strain of COVID caring or how it may be affecting their well‐being. Design: Cross‐sectional, descriptive observational, mixed methods study. Methods: Data were collected from 523 registered nurses employed in three Southern California hospitals during March–May, 2022 when these hospitals' COVID case counts were <15%. Using Online survey methods, data were obtained using the Religious/Spiritual Struggles Scale–Short Form, Moral Injury Symptom Scale–Healthcare Professionals, Post‐traumatic Growth Inventory and demographic and work‐related items. STROBE guidelines for cross‐sectional observational studies were observed. Results: The mean for religious/spiritual struggles was 1.98 (range of 1–5, comparable to a little bit). Although roughly half of the sample reported the struggles were not experienced/did not apply, 23%–36.5% reported experiencing these struggles at least somewhat. The most frequent struggle was to find ultimate meaning. The mean observed for moral injury was 6.5 (range of 1–10); applying established criteria indicated it was troubling for at least 50%. The mean for post‐traumatic growth was 4 (on a scale of 0–6); using established criteria, 41% experienced PTG. Quantitative findings were illustrated by the qualitative responses that occasionally expressed spiritual tragedy and transformation concurrently. Conclusion: The professional work of nursing impacts nurses in invisible, spiritual ways that can be tragic and/or transformative. Relevance to Clinical Practice: Interventions to address nurses' mental health challenges must include attention to these invisible struggles. Nurses' mental health challenges must be met in part by addressing how they can surmount spiritual tragedy—and allow spiritual transformation. [ABSTRACT FROM AUTHOR]