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Aim(s): Teamwork among healthcare professionals is a key aspect of patient safety that influences the prevalence of missed nursing care. The association between teamwork and missed care in acute care hospitals is now well established in the literature. Therefore, this review aimed to synthesise the existing empirical evidence on the association between teamwork and missed care in the acute care setting. Design: A mixed‐method systematic review study. Methods: The search was carried out in February 2023 in four scientific databases, PubMed, ProQuest, Web of Science and Scopus based on their institutional availability. The search produced 1542 studies. The method of thematic analysis was used in data synthesis. Results: A total of 18 studies were selected that revealed the relationship between teamwork and missed care. The teamwork score was weak to moderate but significantly associated with the overall score of missed care and was found to be a statistically significant predictor of missed care in an acute care setting. Additionally, teamwork represented an important reason for missed care, primarily in the context of poor communication, lack of trust and cooperation in the nursing team and lack of leadership. Conclusion: The review findings contribute to a deeper understanding of the intricate dynamics between teamwork and missed care and provide valuable information to healthcare professionals and institutions looking to optimise teamwork and mitigate instances of missed care in the acute care setting. Implications for the Profession and/or Patient Care: Recognising how teamwork influences the occurrence of missed care, healthcare organisations can strategically implement targeted interventions to enhance collaboration, address communication gaps, foster trust, and provide effective leadership. Impact: This review suggests that improving teamwork seems to be one of the most important strategies focused on mitigating missed care in acute care settings. Reporting Method: The reporting of this review followed the PRISMA 2020 checklist. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To synthesise evidence from the literature on hospital nurses' perceived challenges and opportunities in the care of people with dementia. Background: People with dementia often have longer lengths of hospital stay and poorer health outcomes compared to those without dementia. Nurses play a pivotal role in the care of people with dementia. However, there is a scarcity of systematic reviews that synthesise the challenges and opportunities they perceive. Methods: A mixed‐methods systematic review was conducted with a database search covering Ageline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Embase, Medline, PsycINFO, ProQuest, Scopus and Web of Science in April 2022. In total, 27 articles that met the selection criteria were critically reviewed and included in this systematic review. Data from the selected articles were extracted and synthesised using a convergent segregated approach. Results: Three main themes and eight subthemes were identified. Theme 1 described nurse‐related factors consisting of the lack of capability in dementia care, experiencing multiple sources of stress and opportunities for nurses to improve dementia care. Theme 2 revealed people living with dementia‐related factors including complex care needs and the need to engage family carers in care. Theme 3 explained organisation‐related factors comprising the lack of organisational support for nurses and people with dementia and opportunities for quality dementia care. Conclusion: Hospital nurses experience multidimensional challenges in the care of people with dementia. Opportunities to overcome those challenges include organisational support for nurses to develop dementia care capability, reduce their stress and partner with the family caregivers. Relevance to Clinical Practice: Hospitals will need to build an enabling environment for nurses to develop their capabilities in the care of people with dementia. Further research in empowering nurses and facilitating quality dementia care in acute care hospitals is needed. Reporting Method: The review followed the PRISMA 2020 checklist. Patient or Public Contribution: No. [ABSTRACT FROM AUTHOR]

Aims: To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses. Design: Mixed method explanatory sequential design. Methods: A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena. Results: Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not. Conclusions: Delegation is a two‐way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety. Implications for the profession and/or patient care: Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety. Impact: Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses.Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants.Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff. Reporting method: Complied with the APA Style JARS‐MIXED reporting criteria for mixed method research. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: To explore the implementation of a dementia care pathway in an acute care setting. Background: Dementia care in acute settings is often constrained by contextual factors. We developed an evidence‐based care pathway with intervention bundles, and implemented it on two trauma units, with the aim to empower staff and improve quality care. Design: Process evaluation using quantitative and qualitative methods. Methods: Pre‐implementation, unit staff completed a survey (n = 72) assessing family and dementia care skills and level of evidence‐based dementia care. Post‐implementation, champions (n = 7) completed the same survey, with additional questions on acceptability, appropriateness and feasibility, and participated in a focus group interview. Data were analysed using descriptive statistics and content analysis guided by the Consolidated Framework for Implementation Research (CFIR). Reporting Guideline: Standards for Reporting Qualitative Research Checklist. Results: Pre‐implementation, staff's perceived skills in family and dementia care were moderate overall, with high skills in 'building relationships' and 'sustaining personhood'. Evidence‐based interventions were delivered seldom to frequent, with 'individualized care' scoring lowest and 'assessing cognition' scoring highest. Implementation of the care pathway/intervention bundles was overshadowed by the pandemic, and failed due to major organisational‐ and process‐related barriers. Acceptability scored highest and feasibility lowest, with concerns relating to complexity and compatibility of pathways/bundles when introduced into clinical routines. Conclusions: Our study implies that organisational and process factors are the most influential determinants to the implementation of dementia care in acute settings. Future implementation efforts should draw on the evolving evidence within implementation science and dementia care research to ensure effective integration and improvement process. Relevance to Clinical Practice: Our study provides important learning around improving care for persons with dementia and their families in hospitals. Patient or Public Contribution: A family caregiver was involved in the development of the education and training programme. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to analyse prevalence of pressure injury in intensive care versus non‐intensive care patients. Background: Hospital‐acquired pressure injury is an enduring problem. Intensive care patients are more susceptible due to multiple risk factors. Several studies have indicated that intensive care patients are more likely than general patients to develop pressure injuries. Design: Secondary data analysis. Methods: Eighteen general hospitals with intensive care units were included. The sample included all consenting patients. Logistic regression modelling was used to derive prevalence and effect estimates. STROBE reporting guidelines were followed. Results: The sample comprised 15,678 patients; 611 were in intensive care. The crude prevalence estimate of hospital‐acquired pressure injury was 9.6% in intensive care and 2.1% in non‐intensive care patients. The ≥Stage II hospital‐acquired prevalence estimate in was 8.6% intensive care and 1.2% in non‐intensive care patients. Intensive care patients were at markedly increased risk of hospital‐acquired pressure injury compared with non‐intensive care patients, with risk persisting after adjusting for pressure injury risk score. Risk of ≥ Stage II hospital‐acquired pressure injury was further elevated. Intensive care patients had a higher pressure injury risk level and developed a greater proportion of severe hospital‐acquired pressure injuries than non‐intensive care patients. In intensive care, most hospital‐acquired pressure injuries were found on the sacrum/coccyx and heels. Conclusions: There were significant differences between the hospital‐acquired pressure injury prevalence of intensive care versus non‐intensive care patients, which is consistent with previous studies. Overall, the prevalence of hospital‐acquired pressure injury in intensive care is relatively high, indicating that their prevention should remain a high priority within the intensive care setting. Relevance to Clinical Practice: These results may be used for benchmarking and provide a focus for future education and practice improvement efforts. Patient or Public Contribution: Neither patients nor the public were directly involved in the project. [ABSTRACT FROM AUTHOR]

Background: Falls are common adverse events in acute care hospitals, and about 25–50% of fallers suffer injuries. In acute care, fall rates range from 0.4–9 falls per 1000 patient days, varying among unit types, patient characteristics, and diseases. Several risk factors have been identified, including recent falls, age, reduced mobility, cognitive ability and polypharmacy. Several countries have become an aging society in which an increasing number of older patients need acute care. Therefore, the prevention of falls has become one of the most important aspects of patient safety. Aim and Design: This retrospective study aimed to explore adults' inpatient falls in a Finnish university hospital with several specialties. The objectives were to draw an overall picture of fall rates in Finnish acute care, and to model risk factors for falls including secondary diagnoses. Methods: The study was conducted in a large university hospital in Finland. The data consisted of patients' electronic health records from 2014–2016 and included a total of 114,951 adult patients. Univariable and multivariable binary logistic regression model analysis was used to identify risk factors for falls and multiple imputation was used to missing data. The study reporting followed the STROBE guidelines. Results: A total of 841 falls were recorded, totalling 1.5 falls per 1000 patient days, and the rate of falls with injury was 0.4 per 1000 patient days. The regression model included the following risk factors: increasing old age, prolonged hospital stays, specialty of neurology, mode of arrival (emergency care and hospital transfer), no operation during hospital stays and secondary diagnoses such as dementia, pneumonia and alcohol abuse. Conclusions: In acute care, falls occur most in patients with neurological diagnoses and least in surgical patients. Risk factors for falls include increasing age, emergency arrival, hospital transfer and prolonged hospital stay. Relevance to Clinical Practice: Educational interventions to improve healthcare professionals' competence and preventive interventions to avoid inpatient falls need to be prioritized in medical specialties with high fall rates. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This integrative literature review is to collect what is known about the care of people with dementia when they require a hospital admission for an orthopaedic surgical procedure and to contribute to developing an evidence‐base to support nursing practice when caring for people with dementia in an orthopaedic setting. Background: People with a dementia diagnosis are increasingly common in acute orthopaedic care settings and the admission exposes people with dementia to risks during their hospital stay. In addition, nurses find people with dementia challenging to care for due to the complexity of dual conditions. Little is known specifically about the care requirements for people with dementia in orthopaedic settings. Design: Integrative literature review. Methods: An integrative literature review and qualitative deductive content analysis using McCormack and McCance's theoretical nursing framework (Person‐Centred Nursing Framework) of nine studies were undertaken. The process of the review was guided by PRISMA checklist. Results: The care environment and resistance either in passive form, or through physical intervention, is common in orthopaedic nursing. Planning and delivering care for physical, cognitive and emotional needs is identified as being difficult, resulting in a lack of inclusion for patients, partly due to communication challenges. Finding ways to implement tailored care plans within standard ward routines proves difficult, and the consequence is a less than optimal care experience with adverse effects on patients characterised by an increase in dementia symptoms. Conclusions: Care for people with dementia in an orthopaedic setting is complex. It needs to be further studied so that more evidence and supporting literature can contribute to improved care for this group of patients. Relevance to Clinical Practice: This study describes the complexity of providing fundamental care for people with dual conditions of dementia and orthopaedic injury and suggests opportunities for improvement. [ABSTRACT FROM AUTHOR]

Background: Whilst performing a pressure injury risk assessment is not in itself preventive, risk status identification is critical to inform the judicious implementation of prevention strategies. Risk assessment is mostly undertaken using a structured tool informed by clinical judgement, though there is a perception that use of clinical judgement alone may be sufficient. Objectives: Within acute hospital settings, to identify differences in outcomes (risk status, preventive interventions) following nursing assessment of pressure injury risk when using a structured assessment tool compared to clinical judgement. Design: Systematic review. Data sources: EBSCO CINAHL Complete, EBSCO MEDLINE Complete, Scopus, Web of Science, Ovid EMBASE. Methods: Primary research relevant to the objectives was eligible for inclusion. Databases were searched in February 2021 (limits: date 2010–2020, English language, adults). Two reviewers undertook the review process, with a third as arbitrator. Appraisal was undertaken using Joanna Briggs Institute critical appraisal tools. Included studies are synthesised narratively. Reporting is in accordance with the PRISMA Statement. Results: Five moderate to high‐quality studies were included. Synthesis was limited by heterogeneity. Several risk assessment tools and methods of clinical judgement were used. Three studies reported pressure injury risk status using both assessment approaches, but in only one did nurses undertake both. Risk status, as identified by each method, varied and was sometimes contradictory. Three studies reported some elements of preventive intervention prescription and/or implementation following risk assessment, but comparison between approaches was limited. Conclusions: Some research suggests that risk status varies across different methods of pressure injury risk assessment, but it is unclear what impact this has on preventive intervention use. Risk status was not well linked to preventive interventions. Research is warranted to examine the influence that each approach to risk assessment alone and combined has on identified risk and preventive intervention prescription and implementation. Registration: A protocol was prospectively registered with PROSPERO (CRD42021224747). [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to explore older adults' perspectives about dignity and dignified nursing care during acute hospitalisation in Ghana. Background: Maintaining hospitalised older adults' dignity is an essential component of nursing care and one of the most important determinants of wellbeing. To date, no study has been published on older adults' perspectives of dignified nursing care in the African context. Study design: A qualitative descriptive research design. Methods: Twenty hospitalised older adults were purposively selected from the medical and surgical wards of a teaching hospital in Ghana. Data were gathered through semi‐structured interviews between April and August, 2021, and analysed using reflexive thematic analysis techniques. The SRQR checklist was used to document reporting of the study. Results: The following four themes were identified: Effective nurse–patient communication, Maintaining patients' privacy, Respectful and compassionate care provision and Providing quality and safe care. Dignity was preserved when patients were treated with respect and compassion, provided privacy, and had close family members involved in physical care. Identified barriers to dignity included inadequate information about their health condition, poor communication by the nurses, lack of autonomy, poorly designed healthcare infrastructure and inadequate privacy. Conclusions: Several enablers and barriers to dignified nursing care have been identified that have been discussed in previous studies. The unique factors identified in the Ghanaian context were family members' involvement in physical care influenced by cultural and religious beliefs, environmental barriers to privacy and dignity and inadequate involvement in decision making. Relevance to clinical practice: Nurses must treat older patients with respect, educate them about the health condition, involve them in care decisions, and identify their preferences regarding provision of hygiene needs, particularly in consideration of religious and cultural beliefs, including involvement of family members. Future planning of healthcare infrastructure needs to consider the importance of private cubicles with disability‐accessible ensuite bathrooms for patients' comfort and privacy. [ABSTRACT FROM AUTHOR]

Aims and objectives: Overall, this study aimed to describe nursing care for patients with dementia in acute hospitals, with the objectives of describing the provided nursing care (a), nurses' attitudes and perceptions in caring for patients with dementia (b), and exploring how nurses deal with challenging behaviour (c). Additionally, we determined background variables associated with caring for people with dementia. Background: Due to comorbidities, people with dementia are frequently admitted to acute care hospitals. Here, they are at high risk of complications. Nurses strive for good care but regularly experience insufficient knowledge and skills regarding caring for people with dementia. Design: A cross‐sectional survey study design. Methods: Data were collected in seven Dutch acute hospitals and through social media. In total, 229 hospital nurses completed the questionnaire. We used the Geriatric In‐Hospital Nursing Care Questionnaire and two subscales of Hynninen on managing challenging behaviour. This report followed the STROBE checklist. Results: Nurses express that they often apply general preventive interventions not explicitly related to dementia care. In general, nurses have mixed feelings about the nursing care provided in their department. For challenging behaviour, a variety of approaches, including restrictive measures and medication, is applied. The nurses' attitudes and perceptions are influenced by the type of hospital where the nurses work, the level of education, the number of hours nurses work, and if the nurses completed a course on dementia in the last year. Conclusions: Despite a positive attitude, nurses do not have the specific knowledge and skills needed to provide proper care. Nurses who recently completed a course on dementia had more positive attitudes and perceptions towards caring for patients with dementia. Relevance to clinical practice: The results of this research can be used to improve the quality of nursing care for patients with dementia in acute hospitals. [ABSTRACT FROM AUTHOR]