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Background: The purpose of this study is to examine and evaluate the existing clinical practice guidelines and consensus statements regarding tracheostomy care for non‐mechanically ventilated patients. Methods: A systematic search of databases, and professional organisations was conducted from inception to 19 March 2023. Two appraisers evaluated each guideline using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Text and Opinion Papers. Results: No specific clinical guidelines exist on airway management in non‐mechanically ventilated patients. Of 6318 articles identified, we included 12 clinical practice guidelines, and 9 consensus statements, which were from China, the US, the UK, South Korea, Australia, France and Belgium. The AGREE II scores in six domains are (1) the scope and purpose, 70.30%; (2) stakeholder involvement, 37.61%; (3) rigor of development, 33.97%; (4) clarity of presentation, 68.16%; (5) applicability, 44.23% and (6) editorial independence, 40.06%. The overall quality of evidence was level B. The summarised recommendations for clinical practice encompass the following six areas: airway humidification, management of the trach cuff, management of inner cannula, tracheostoma care, tracheostomy suctioning and management and prevention of common post‐operative complications. Conclusions: The overall quality of the clinical guidelines on non‐ventilated tracheostomy care was moderate, and further improvements are needed in domains of stakeholder involvement, applicability, clarity of presentation and editorial independence. Recommendations on non‐ventilated tracheostomy care are often embedded in the guidelines on ventilated tracheostomy. Specific clinical guidelines are needed to provide a standardised approach to tracheostomy care for non‐ventilated patients. Relevance to clinical practice: Patients with non‐ventilated tracheostomy need specialised airway management. Improving patient outcomes requires standardised protocols, patient involvement, quality evaluation, and interdisciplinary approaches. No patient or public contribution: The study reviewed clinical practice guidelines and consensus statements, therefore patient or public input was not needed. [ABSTRACT FROM AUTHOR]

Aim: To identify the symptoms and quality of life impacts that are important from the perspective of patients with varicose veins and to compare identified themes to items in varicose vein patient‐reported outcome measures (PROMs). Background: Varicose veins are common worldwide and are considered a chronic condition with implications for quality of life. Treatment is predominantly conservative; therefore, understanding patients' experiences of living with varicose veins is important to inform the provision of clinical care. PROMs are often used to collect data about patients' quality of life. Design: Thematic synthesis of qualitative research reported according to ENTREQ guidelines. Methods: Multiple electronic databases, including MEDLINE and CINAHL, were systematically searched to identify qualitative research examining experiences of adults with varicose veins. Thematic synthesis was then conducted on the included studies. Results: Three studies met the inclusion criteria; the quality of the studies was high. The range and intensity of reported symptoms and participant's experiences of living with varicose veins were varied. Five overarching themes were identified: physical, psychological and social impact of varicose veins, adapting to varicose veins and reasons for seeking treatment. The overall key theme to emerge was adaptation, with patients demonstrating how they adapted to the various impacts. Conclusion: This review demonstrates that varicose veins have a wide range of symptoms and may have a significant impact on quality of life; people made significant adaptations to enable them to live their lives as fully as possible. Relevance to Clinical Practice: Healthcare professionals need to be aware of the range of symptoms and their impact on quality of life. The use of PROMs to gather information about quality of life and symptoms is well established globally; however, PROMs currently used may not capture the full extent of the impact on patient's quality of life. [ABSTRACT FROM AUTHOR]

Aim and Objective: To generate content for a new questionnaire, based on the 10 Principles of Dignity in Care. Background: Older people in hospital are vulnerable and at risk of harm, including indignity. The 10 Principles of Dignity in Care, which undergird the United Kingdom's Dignity in Care Campaign, have been used to promote dignified care for older people in hospital. A 2006 recommendation of the campaign was to survey people on their experiences of dignity in care. To undertake such a survey, a questionnaire based on the 10 Principles of Dignity is required. Design: Qualitative methods based on a modified Delphi technique, assessed against the CREDES checklist. Methods: A Delphi panel of experts was convened that included: consumers, carers, clinicians, academics, policy experts and representatives from the National Dignity Council in the UK, Aboriginal people and people from culturally and linguistically diverse backgrounds. Results: Fifty‐seven experts consented to participate, over the three rounds of Delphi panel deliberations (response rate: R1 n = 49, R2 n = 47 and R3 n = 44). The Delphi panellists were asked to rank, rewrite, relocate or remove items and suggest additional items, under each of the 10 Principles of Dignity in Care. The initial list of 93 items, generated from a review of the literature, existing questionnaires and drafted by the authors, was reduced to 87 items in Round 2 and 69 items in Round 3. Conclusions: A panel of experts were able to determine, based on their own judgement, and through consensus, the 69‐items and response categories to be included in the patient and carer versions of the Dignity in Care questionnaire, to progress to a pilot study. [ABSTRACT FROM AUTHOR]

Aim: To identify clinical observable items that can be used to identify dysphagia while observing a typical eating situation. Design: A three‐round e‐Delphi survey. Methods: An expert panel consisting of five nurses, eight speech language therapists and five physicians participated in this three‐round e‐Delphi survey from November 2022 to January 2023. Round 1 presented the results of a literature research conducted in September 2022 and an open question to the participants. The answers were analysed using the content analysis method. In the following rounds, the results were presented back to the participants with a request to rate them for usefulness. Means, standard deviations, ANOVA and Fisher's exact test were used to demonstrate the panel's opinion, level of agreement, demographic characteristics of the participants as well as differences between the professional groups in regard of the rating of the items. Methods and results are reported in accordance with the 'Guidance on Conducting and Reporting Delphi Studies' (CREDES). Results: The content analysis initially generated 36 items suggested by the expert panel. Seven additional items were incorporated from the literature review. In rounds 2 and 3, a 4‐point Likert scale was used to rate each item and to calculate the level of agreement. The predetermined level of agreement exceeded 70% for 23 items. Conclusion: Based on the expert opinions, it is possible for nurses to identify dysphagia in patients with dementia by using the determined 23 items while observing a typical eating situation. Patient or Public Contributions: The expert panel contributed to the creation of this study by participating in the Delphi rounds. Implications for the profession and/or patient care: The 23 items determined in this e‐Delphi study enable nurses to make dietary adjustments or consult other members of the multidisciplinary team based on available evidence, enabling complications to be avoided. Impact: What problem did the study address? This study provides evidence regarding the identification of dysphagia in patients with dementia by nurses. What were the main findings? Twenty‐three items were determined by an expert panel that can be used by nurses to identify dysphagia in patients with dementia while observing a typical eating situation. Where and on whom will the research have an impact? This research will have an impact on patients with dementia and the nurses caring for them. Reporting method: Methods and results are reported in accordance with the 'Guidance on Conducting and Reporting Delphi Studies' (CREDES) (Jünger et al., 2017), which promotes consistency and quality in conducting Delphi studies. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To establish consensus on items to be included in an instrument to measure person‐centred teamwork in a hospital setting. The objective was to identify the items through a methodological literature review. Refine the items and obtain consensus on the items. Background: A definition and related attributes of person‐centred teamwork have been agreed upon. An instrument is needed to measure and monitor person‐centred teamwork in hospital settings. Design: Consensus, electronic Delphi design. Methods: Items were identified through a methodological literature review. These items were included in three electronic Delphi rounds. Using purposive and snowball sampling, 16 international experts on person‐centred care, teamwork and/or instrument development were invited to participate in three electronic Delphi rounds via Google Forms. Descriptive statistics were used to demonstrate their agreement on the relevance and clarity of each item. Items were included if consensus was 0.75. Content analysis was used to analyse written feedback from experts. Results: The response rate was 56% (n = 9/16). Nine experts participated over an 8‐week period to reach consensus on the items to be included in an instrument to measure person‐centred teamwork in hospital settings. The experts' responses and suggestions for rephrasing, removing and adding items were incorporated into each round. Conclusion: A Delphi consensus exercise was completed, and experts reached agreement on 38 items to be included in an instrument that can be used to evaluate person‐centred teamwork in hospital settings. Relevance to clinical practice: We engaged with nine international experts in the academic and clinical field of person‐centeredness, teamwork and/or instrument development. An online platform was used to allow the experts to give input into the study. The experts engaged from their own environment with full autonomy and anonymity. Person‐centred teamwork, aimed at improving practice is now measurable. Person‐centred teams improve outcomes of patients. Person‐centred teamwork was specifically developed to assist low compliance areas in hospitals. [ABSTRACT FROM AUTHOR]

Aim: To reach consensus on the definition and attributes of 'person‐centred handover practices' in emergency departments. Background: Handover practices between emergency care practitioners and healthcare professionals in emergency departments are important and should be conducted meticulously. Person‐centred handover practices may enhance the delivery of person‐centred care in emergency departments. Design: A three‐round online Delphi survey. Methods: Nine experts participated in a three round Delphi survey. The expert panel comprised experts from nine countries. Quantitative data were descriptively analysed, and qualitative data were thematically analysed. A consensus of 80% had to be reached before an attribute and definition could be accepted. Results: Experts reached a consensus of 79% in round one, 95% in round two and 95% in round three. A final set of six attributes were agreed upon and the final concept definition was formulated. Conclusion: Person‐centred handover practices have not been implemented in emergency departments. Yet, person‐centred handover practices may enhance the delivery of person‐centred care, which has multiple benefits for patients and healthcare practitioners. Implications for the profession and/or patient care: Person‐centred care is not generally implemented in emergency departments. Person‐centred handover practices can lead to person‐centred care. Handover practices in emergency departments are a high‐risk activity. Despite numerous calls to standardise and improve handover practices, they remain a problem. Developing a standardised definition could be a first step towards implementing person‐centred handover practices in emergency departments. Reporting method: The study adhered to the relevant EQUATOR reporting guidelines: Guidance on Conducting and Reporting Delphi Studies (CREDES) checklist. Impact (Addressing): Improve handover practices and patient care.Improve person‐centred care in emergency departments. Patient or public contribution: Emergency care practitioners and nurses experienced in handover practices and/or person‐centred care, working in clinical and academic fields, participated in the study by sharing their expert knowledge during each of the Delphi rounds. [ABSTRACT FROM AUTHOR]

Aim: To identify scales that assess parental stress in the paediatric clinical population and to analyse their psychometric properties. Methods: Four electronic databases (PubMed, Web of Science, PsycINFO, and Scopus) and metasearch engines (Google Scholar and Open Grey) were searched with no time period limitations. Methodological quality was assessed using the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) and quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach modified by COSMIN. Finally, recommendations were made for the instruments with the highest quality of evidence. Results: A total of 38 studies reporting on 11 different instruments for assessing parental stress in the paediatric clinical setting were included. Six instruments were 'A' rated (recommended) in the final phase in line with COSMIN guidelines. The Paediatric Inventory for Parents was the instrument that evaluated the highest number of psychometric properties and obtained the highest methodological quality, global assessment, and quality of evidence for the different psychometric properties. Conclusions: This systematic review provides an overview of the measurement properties of the parental stress instruments used in the paediatric clinical setting. The Paediatric Inventory for Parents stands out as being one of the most robust instruments for measuring stress in parents with a hospitalised or sick child. Evidence needs to be generated for all the parental stress scales used in the clinical setting. Impact: Given that the psychometric properties of the existing parental stress scales used in paediatric health care settings have not been systematically assessed, the present review utilised comprehensive methods according to COSMIN. No Patient or Public Contribution: Reporting method: PRISMA statement and COSMIN reporting guidelines for studies on measurement properties of patient‐reported outcome measures. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the relevance of signs and symptoms for the clinical identification of ESI and TI in HD‐CVC, by means of international expert consensus, and to reach a consensus on a definition and clinical management (CM) for these infections. Background: A recent systematic review showed a high heterogeneity in the signs/symptoms used for determining exit site infection (ESI) and tunnel infection (TI) of haemodialysis central venous catheter (HD‐CVC). Design: A modified Delphi ranking process was carried out between November 2020 and March 2021, consisting of four rounds using an online questionnaire with a panel of 26 experts from 12 countries. Methods: Experts responded on the level of relevance for the identification of ESI and TI, based on a list of 22 signs/symptoms obtained from a previous systematic review, using a 4‐point Likert‐type scale. After reaching consensus on the signs/symptoms, they followed the same method to reach consensus on the CM. The STROBE Checklist was used to report this study. Results: A high degree of consensus was reached to identify the presence of ESI based on nine signs/symptoms: presence of pain at the exit site (ES) during interdialysis period, with fever ≥38°C do not suspect other cause, local signs at the ES (inflammation, induration, swelling, hyperemia/erythema ≥2 cm from ES) and obvious abscess or purulent exudate at ES; and of TI. Likewise, 5 cm were agreed upon. Conclusion: This Delphi study provides international expert consensus definitions of ESI and TI in HD‐CVC, laying the groundwork for the validation of an HD‐CVC ES clinical assessment scale for early identification of ESI. Relevance to Clinical Practice: In addition, this study provides a series of attitudes to consensual clinics regarding signs/symptoms of local infections in HD‐CVC, which may be useful as expert opinion in clinical practice guidelines, when there is insufficient scientific evidence. [ABSTRACT FROM AUTHOR]

Aim: To construct key quality indicators for aged care facilities in China. Background: Evaluating the care quality in aged care facilities is problematic. Evaluation of nursing care quality is important for improving nursing and self‐supervision in aged care facilities. However, a few regulations and studies regarding care quality evaluation have been implemented in China. Design and Method: This two‐tier Delphi study aimed to achieve consensus on key quality indicators for aged care facilities in China. The entry pool was determined by literature review and research team discussion, followed by a discussion by a panel of experts to establish the items of the Delphi study. Finally, key care quality indicators were established through a two‐round Delphi study. This study followed the SQUIRE 2.0 guidelines. Results: The initial 16 quality indicators of the entry pool was developed based on a literature review and a group discussion. Sixteen quality indicators were reduced to eight after the expert discussion. After two rounds of expert consultation, the eight quality indicators became nine, which were then evaluated for importance, formula rationality, and operability using Kendall's harmony coefficients (first round: 0.150, 0.143 and 0.169, respectively; second round: 0.209, 0.159 and 0.173, respectively). Conclusions: Key quality indicators provide quantifiable evidence for evaluating the care quality in aged care facilities, but their applicability needs continuous improvement. Relevance to Clinical Practice: Nine key quality indicators were selected from numerous indicators for measuring the care quality in aged care facilities, supporting the evaluation of the care quality and self‐supervision for aged care facilities. Elderly or Public Contribution: No elderly or public contribution. [ABSTRACT FROM AUTHOR]

Aim: A medical emergency team (MET) stand‐down decision is the decision to end a MET response and hand responsibility for the patient back to ward staff for ongoing management. Little research has explored this decision. This study aimed to obtain expert consensus on the essential elements required to make optimal MET call stand‐down decisions and the communication required before MET departure. Design: A Delphi design was utilised. Methods: An expert panel of 10 members were recruited based on their expert knowledge and recent clinical MET responder experience in acute hospital settings. Participants were emailed a consent form and an electronic interactive PDF for each survey. Two rounds were conducted with no attrition between rounds. The CREDES guidance on conducting and reporting Delphi studies was used to report this study. Results: Consensus by an expert panel of 10 MET responders generated essential elements of MET stand‐down decisions. Essential elements comprised of two steps: (1) the stand‐down decision that was influenced by both the patient situation and the ward/organisational context; and (2) the communication required before actioning stand‐down. Communication after the decision required both verbal discussions and written documentation to hand over patient responsibility. Specific patient information, a management plan and an escalation plan were considered essential. Conclusion: The Delphi surveys reached consensus on the actions and communication required to stand down a MET call. Passing responsibility back to ward staff after a MET call requires both patient and ward safety assessments, and a clearly articulated patient plan for ward staff. Observation of MET call stand‐down decision‐making is required to validate the essential elements. Implication for the Profession and Patient/or Patient Care: In specifying the essential elements, this study offers clinical and MET staff a process to support the handing over of clinical responsibility from the MET to the ward staff, and clarification of management plans in order to reduce repeat MET calls and improve patient outcomes. Impact: Minimal research has been focussed on the decision to hand responsibility back to ward staff so the MET may leave the ward with safety plan in place. This study provided expert consensus to optimise MET stand‐down decision‐making and the ultimate decision to end a MET call. Communication of agreed patient treatment and escalation plans is recommended before leaving the ward. This study can be used as a checklist for MET responder staff making these decisions and ward staff responsible for post‐MET call care. The aim being to reduce the likelihood of potentially preventable repeat deterioration in the MET patient population. Reporting Method: The CREDES guidance on conducting and reporting Delphi studies. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the rigour of nurse‐led quality improvement projects involving education, training or continuing professional development, and examine evaluation frameworks contained within. Background: Healthcare organisations invest significantly in quality improvement in the pursuit of cost‐effective, safe, evidence‐based and person‐centred care. Consequently, efforts to examine the success of investment in quality improvement activities are prominent, against a backdrop of rising healthcare expenditure, reforms, consumer expectations and feedback. Design: A qualitative document analysis of quality improvement projects located in a local health district repository was undertaken. Methods: N = 3004 projects were screened against inclusion criteria, with n = 160 projects remaining for analysis. Projects were mapped to an adapted version of the Standards for QUality Improvement Reporting Excellence (SQUIRE), specifically the education extension (SQUIRE‐EDU). Additionally, project evaluation frameworks were positioned within Kirkpatrick's four levels of training evaluation model. The SQUIRE checklist was also applied in line with EQUATOR guidelines. Results: Of n = 60 completed projects assessed against four broad SQUIRE‐EDU categories and relevant criteria, n = 36 were assessed not to have met any categories, n = 14 projects met one category, n = 8 projects met two categories, and n = 2 projects met three categories. None of the completed projects met all four SQUIRE‐EDU categories. There was insufficient documentation relating to evaluation frameworks in n = 133 projects to position within Kirkpatrick's four levels of training evaluation. Conclusions: Scientific rigour should underpin all quality improvement efforts. We recommend that SQUIRE international consensus guidelines (full or abridged) should guide both the design and reporting of all local quality improvement efforts. Relevance to Clinical Practice: To be of value to the expansion of evidence‐based practice, quality improvement platforms should be designed to reflect the structural logic, rigour and reporting recommendations being advocated in consensus reporting guidelines. This may require investment in training and development programs, and identification of governance and support systems. No Patient or Public Contribution, as the study was retrospective in nature and involved a health service repository of quality improvement projects accessible to health service staff only. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to assess methodological quality of all currently available guidelines and consensus statements for IAD using the Appraisal of Guidelines, Research and Evaluation (AGREE) II and the AGREE Recommendation Excellence (AGREE‐REX) instruments. Background: Globally, incontinence‐associated dermatitis (IAD) is a significant health challenge. IAD is a complex healthcare problem that reduces quality of life of patients, increases healthcare costs and prolongs hospital stays. Several guidelines and consensus statements are available for IAD. However, the quality of these guidelines and consensus statements remains unclear. Design: A systematic review of guidelines and consensus statements. Methods: Our study was undertaken using PRISMA guidelines. We searched seven electronic databases. Guidelines and consensus statements had to be published in English, Chinese or German languages. Five independent reviewers assessed the methodological quality of guidelines and consensus statements using the AGREE II and AGREE‐REX instruments. Mean with standard deviation (SD) and median with interquartile range (IQR) were calculated for descriptive analyses. We generated bubble plots to describe the assessment results of each domain of each guideline and consensus statement. Results: We included ten guidelines and consensus statements. The NICE guidelines, obtained the highest scores, fulfilled 86.11%–98.61% of criteria in AGREE II and 76.67%–91.11% for AGREE‐REX. In the domains 'Stakeholder Involvement' (4.39 ± 1.64), 'Rigor of Development' (3.38 ± 1.86), 'Applicability' (3.62 ± 1.64), 'Editorial Independence' (3.91 ± 2.56) and 'Values and Preferences' (2.98 ± 1.41), the remaining guidelines and consensus statements showed deficiencies. Conclusions: Altogether, this study demonstrated that the currently available guidelines and consensus statements for IAD have room for methodological improvement. NICE guidelines on faecal incontinence and urinary incontinence have better quality. Remaining guidelines and consensus statements showed substantial methodological weaknesses, especially the domains of 'Stakeholder Involvement', 'Rigor of Development', 'Applicability', 'Editorial independence' and 'Values and Preferences'. This study was registered on INPLASY. (Registration number: INPLASY202190078). Relevance to Clinical Practice: The currently available guidelines and consensus statements on IAD have room for methodological improvement. [ABSTRACT FROM AUTHOR]

Aims and Objectives: We aimed to describe daily restraint practices and the factors which influence their use, from an outsider's perspective. Background: A reduction in restraint use is recommended in health care. However, somatic acute care hospital settings currently lack effective reduction strategies. Thus far, hospital restraint practice is described in terms of quantitative assessments and the 'insider' view of healthcare professionals. However, as factors such as routine or personal beliefs seem to play a relevant role in restraint use, these approaches might be incomplete and biased. Design: A qualitative observation study design was employed. Methods: Fieldwork with unstructured participant observation was conducted at a department of geriatrics and a department of intensive care in Switzerland between November 2019 and January 2020. Data were recorded as field notes. The analysis was conducted iteratively in two coding cycles using descriptive coding followed by pattern coding. We adhered to the Standards for Reporting Qualitative Research (SRQR). Results: A total of 67 hours of observation were conducted. We found that daily restraint practice can be described in three categories: the context in which restraints are used, the decision‐making process on the use and continued use of restraints, and the avoidance of restraint use. Most processes and decisions seem to take place unconsciously, and their standardisation is weak. Conclusions: The lack of standardisation favours intuitive and unreflective action, which is prompted by what is also known as heuristic decision‐making. To transform daily restraint practice, a technical solution that leads restraint management in line with ethical and legal requirements might be useful. Relevance to clinical practice: The outsider perspective has allowed daily restraint practice to be described independently of existing routines, departmental cultures and personal attitudes. This is important to comprehensively describe restrictive practices, which is a prerequisite for the development of effective restraint reduction strategies. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To establish a set of scientific and practical nursing care quality evaluation indicators for PACU in China. Background: No unified nursing care quality evaluation indicators for post‐anaesthesia care unit (PACU) were found in China. Design: An international literature review, domestic cross‐sectional survey and two‐round e‐Delphi study. Methods: The international literature review and domestic cross‐sectional survey were conducted to identify the potential nursing care quality evaluation indicators for PACU. A total of 38 and 32 indicators were extracted from 24 articles and the cross‐sectional survey respectively. Two rounds of e‐Delphi study were conducted to collect opinions from a panel of 20 independent experts and establish the final version of the nursing care quality evaluation indicators for PACU. A GRRAS checklist was used to guide the reporting of this study. Results: Of 20 experts, 19 completed the first round of e‐Delphi study and 18 completed the second round, with a response rate of 95% and 90% respectively. The experts' authority coefficient in the two rounds of e‐Delphi study was 0.91 and 0.90 respectively. The Kendall W value of the two rounds ranged between 0.108 and 0.385 (p <.01). Four structure indicators, 12 process indicators and seven outcome indicators were included in the nursing care quality evaluation indicators for PACU. Conclusions: With the methods of literature review, cross‐sectional survey and e‐Delphi study, we established a set of scientific and practical nursing care quality evaluation indicators for PACU, to improve the nursing care quality, reduce incidence of complications and ensure patient safety. Relevant to clinical practice: The findings from this study enable nurses and managers in PACU settings to evaluate clinical nursing care quality using a robust framework. [ABSTRACT FROM AUTHOR]

Background: Nursing care can profoundly reduce the risk of emergencies related to cardiac catheterisation. Therefore, identifying nursing‐sensitive quality indicators (NSQIs) to evaluate nursing quality is critical for optimal cardiac catheterisation. However, studies on NSQIs for cardiac catheterisation are scarce. Objectives: This study was conducted to develop a set of NSQIs for cardiac catheterisation. Methods: Literature retrieval and expert group discussions were conducted to identify potential NSQIs and compile an inquiry questionnaire. Then, Delphi surveys were used to collect opinions from experts in the field of cardiac catheterisation. The consistency of the consultation results formed the basis on which we conducted the next rounds of consultation. Based on the importance given to each NSQI by the consulted experts in the previous round, we determined the weight coefficient of each indicator with the analytic hierarchy process. This study was performed according to the SRQR guidelines. Results: We conducted two rounds of expert inquiry. The recovery rates of the first and second questionnaires were 100% and 66.67%, respectively. The average authoritative coefficients were 0.86 and 0.91. The Kendall W values ranged from 0.214~0.361 (p <.001). Consensus was reached on 3 primary indicators, 8 secondary indicators and 20 tertiary indicators. Conclusions: A set of NSQIs for cardiac catheterisation was developed. However, the effects of these NSQIs on the evaluation and continuous improvement of nursing quality in cardiac catheterisation need to be verified in clinical practice. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To identify how patients and carers collaborate to manage nutrition care throughout and beyond head and neck cancer (HNC) treatment as a step towards identifying changes to service delivery that are inclusive of the needs of the patient–carer dyad. Background: Research in the field of dyadic interventions in cancer care is emerging, and there has been little work exploring patient–carer dyad needs in the provision of nutrition care in HNC. Design: A qualitative study design was used. Methods: Narrative interviews were completed with 13 patients and 15 carers over a 12‐month period (prior to treatment commencing, and 2 weeks, 3 months and 12 months post‐treatment completion). Deductive analysis of interview transcripts was performed using directed content analysis guided by the Theory of Dyadic Illness Management (TDIM). COREQ guidelines were used. Results: Seven themes across four TDIM constructs were identified: (1) understanding and adapting to physical challenges impacting nutrition intake, (2) adjusting to emotional impact of changes to eating and drinking, (3) providing practical support, (4) intrapersonal characteristics, (5) interpersonal characteristics, (6) healthcare culture and (7) managing carer burnout. Conclusion: This study highlights the importance of healthcare professionals recognising the patient and carer dyad as a team to enhance engagement in nutrition care and to ensure that their physical and psychological support needs across the cancer continuum are met. Relevance to clinical practice: It is important that healthcare professionals understand information and support needs and preferences within patient–carer dyads prior to HNC treatment commencing and adapt care and interventions based on their changing needs throughout and beyond the treatment period. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the effects of the health failure mode and effect analysis (HFMEA) used in intrahospital transport (IHT) of critically ill patients from emergency department (ED) to the intensive care unit (ICU). Background: Patients who were transported from ED to ICU is highly critical. IHT of these patients is potentially risky, which may associate with adverse events (AEs). The concern of safe IHT can be addressed by performing proactive risk assessments using HFMEA and implementing the findings after the ED of our hospital being reconstructed. Design: A qualitative action research study combined with a quantitative cross‐sectional method. Methods: According to the HFMEA method, the failure modes of IHT were identified and analysed, and the effect of alterations was verified. We built a project team, drawn up a IHT flow chart, defined steps of IHT, classified the failure modes, calculated risk priority number and analysed by the decision tree, then formulated an action plan and verified the effects of the alterations. Incidence of AEs of transport was compared before and after HFMEA.SQUIRE 2.0 checklist was chosen on reporting the study process. Results: The HFMEA outlined a total of 5 major steps and 16 sub‐steps in the IHT process. From this, 64 potential failure modes were identified, with 17 modes having a RPN score higher than 8. Determined by the decision tree, there were 20 priority control failure modes, of which 16 involved 8 IHT alterations. Notable work‐flow alterations included use of a three‐stage hierarchical transport strategy based on patients' condition assisted by the intelligent assessment system. Incidence of AEs was significantly decreased from 19.64% to 7.14% after the implementation of HFMEA (p < 0.05). Conclusion: Application of the HFMEA in optimising IHT process can improve the safety of transportation, which is worthy of promotion. Hierarchical transport scheme can reduce the incidence of AEs in IHT of critical emergency patients, which mainly includes the integration and construction of the transport team, equipment configuration and patient information system based on the classification of patients' condition. Relevance to clinical practice: Nurses play a crucial role in the IHT process. HFMEA can be adopted for proactive risk assessment of critically ill patients' IHT from ED to ICU which involves multiple processes. The IHT hierarchical strategy based on the results of failure mode analysis should be more widely used to further verify its clinical effects. [ABSTRACT FROM AUTHOR]

Aims: To identify and critically appraise the available evidence on the overall quality of professional life of primary care nurses worldwide and its main influencing factors. Background: Quality of professional life of healthcare workers is a keystone that influences the quality of healthcare services provided by healthcare organisations. Nurses have a key role as healthcare services providers given the growing shortage of doctors in primary care. Design: A systematic review design in accordance with the PRISMA statement. Methods: The search was conducted through MEDLINE (PubMed), CINAHL, SCOPUS, Scientific Electronic Library Online (SciELO) and Web of Science databases. The grey literature was reviewed at OpenGrey. The search was limited to human studies published from April 2010–April 2020. No limit of original language publication was applied. Three independent reviewers analysed the methodological quality of the studies. Results: Ten studies were included from five countries. Five studies reported nurses were satisfied with their quality of professional life and the influencing factors identified were Workload, Job autonomy, Demographic variables, Management support, Recognition, Intrinsic motivation, Interpersonal relations, Compassion fatigue, Burnout, Turnover intention, and work was reported as a component of Quality of life. Conclusion: Primary healthcare nurses reported a high level of quality of professional life, but the scarce studies found do not provide solid consistency to assess the overall quality of professional life. Perception of high workload was the most frequently identified factor to negatively influence the quality of professional life of nurses. Relevance to clinical practice: Quality of professional life of primary care nurses is a key issue because of nurses' important relation with patient's care and satisfaction. Healthcare organisations should strive to address primary care nurses' quality of professional life to enhance their well‐being and consequently patients' safety and high‐quality healthcare services. [ABSTRACT FROM AUTHOR]

Background: Workplace violence (WPV) includes verbal abuse, physical violence, bullying or mobbing, assault and sexual harassment. The area has been well researched in the developed and high‐income countries among nurses and healthcare professionals, but in the case of the low and upper‐middle‐income countries, there remains a paucity of comprehensive data on the prevalence of WPV and its contributing factors. Aims: To estimate the prevalence and determinants of WPV among nurses working in the South‐East Asian Region and Western Pacific Regions. Design: Systematic review and Meta‐analysis. Method: A comprehensive search was done to retrieve articles based on a PRISMA compliant protocol registered in PROSPERO: CRD 42020223605. Study selection, quality assessment and data abstraction were independently done by the team members and discrepancies addressed through mutual consensus. Random‐effect meta‐analysis, I2 statistics and subgroup analysis were done. Results: The review included 41 studies conducted among 42,222 nurses from 13 countries. The pooled prevalence of WPV, verbal abuse, physical violence, threatening behaviour, physical assault, sexual harassment and bullying/mobbing were 58% (CI 51%‐64%), 64% (CI 59%‐70%), 23% (CI 14%–34%), 30(CI‐11%–52%), 21% (CI 8%‐38%), 12% (CI 7%‐17%) and 25% (17%‐33%), respectively. The various determinants of WPV included attributes related to the patient, nurses and organisation. Moreover, the impact of WPV included physical, psychological repercussions on nurses and the various measures used to manage it. Conclusion: Nurses encounter a high level of WPV especially verbal abuse in their workplace settings. Nursing councils and professional nursing organisations should put in their effort towards the formulation and implementation of occupational safety legislation in their respective countries through appropriate political lobbying. Relevance to clinical practice. Our review highlights the emerging need to focus on the prevention of WPV among nurses working in lower, middle and upper‐middle‐income countries. Legislation changes and organisational commitment are vital for ensuring effective policies to combat WPV. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore how nurses use standardised care plans as a new recording tool in municipal health care, and to identify their thoughts and opinions. Background: In spite of being an important information source for nurses, care plans have repeatedly been found unsatisfactory. Structuring and coding information through standardised care plans is expected to raise the quality of recorded information, improve overviews, support evidence‐based practice and facilitate data aggregation. Previous research on this topic has mostly focused on the hospital setting. There is a lack of knowledge on how standardised care plans are used as a recording tool in the municipal healthcare setting. Design: An exploratory design with a qualitative approach using three qualitative methods of data collection. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Methods: Empirical data were collected in three Norwegian municipalities through participant observation and individual interviews with 17 registered nurses. In addition, we collected nursing records from 20 electronic patient records. Results: Use of standardised care plans was influenced by the nurses' consideration of their benefits. Partial implementation created an opportunity for nonuse. There was no consensus regarding how much information to include, and the standardised care plans could become both short and generic, and long and comprehensive. The themes "balancing between the old and the new care planning system," "considering the usefulness of standardised care plans as a source of information" and "balancing between overview and detail" reflect these findings. Conclusions: Nurses' use of standardised care plans was influenced by the plans' partial implementation, their views on usefulness and their personal views on the detail required in a care plan. Relevance to Clinical Practice: The structuring of nursing records is a fast‐growing trend in health care. This study gives valuable information for those attempting to implement such structures in municipal health care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. Background: Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. Design: Delphi Method. Method: A three‐round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. Results: High patient acuity or complexity, as well as inadequate bed space on wards, are "very high" risks that occur "often" and "very often," respectively. The pressure to admit patients, delayed medical review and patient boarding are all "high" risks that occur "often." Though only occurring "sometimes," inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a "very high" risk to patient care. Conclusion: The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system‐wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. Relevance to clinical practice: This study provides a description of the challenges that face acute care nursing in the provision of safe and high‐quality care. [ABSTRACT FROM AUTHOR]

Aim and objective: To establish an index system for the evaluation of undergraduate nursing student innovation ability. Background: An index system for evaluation of undergraduate nursing student innovation ability has not been established. Design: A three‐round Delphi survey sought opinions from experts about the index system for evaluation of undergraduate nursing student innovation ability. Methods: A Delphi survey was used for the study of 19 experts from nursing education, clinical nursing and health management. The consistency of consultation results formed the basis for determining the rounds of consultation. With the importance of consulting experts in the last round, we established the judgement matrix using yaahp7.5 software and the analytic hierarchy process and determined the weight coefficient of each index. A modified recommendation for the Conducting and Reporting of Delphi studies (CREDES) was used to guide this study. Results: Nineteen experts from 10 nursing colleges and nine third‐level first‐class hospitals in seven domestic provinces/municipalities were included in this study. The index system was divided into primary, secondary and tertiary levels. Consensus was reached on three primary indicators ('spirit', 'ability' and 'achievement'), nine secondary indicators and 28 tertiary indicators. Conclusions: A unified and hierarchical quality assessment index framework for nursing undergraduate creative ability was established. The framework should be further tested and improved in practice. Relevance to clinical practice: Nursing students are the main force behind clinical nursing in the future. An innovative approach to skill acquisition and application could enhance the student nurse experience. The innovative ability of nursing students is important for identification of education strategies that be implemented to better support those individuals. Furthermore, the construction of the index system is helpful for evaluation of the innovation ability of nursing students that are required to better meet the needs of clinical nursing work in the future. [ABSTRACT FROM AUTHOR]

Aims and objectives To establish validity of a clinical leadership framework for aged care middle managers (The Aged care Clinical Leadership Qualities Framework). Background Middle managers in aged care have responsibility not only for organisational governance also and operational management but also quality service delivery. There is a need to better define clinical leadership abilities in aged care middle managers, in order to optimise their positional authority to lead others to achieve quality outcomes. Design A Delphi method. Methods Sixty-nine experts in aged care were recruited, representing rural, remote and metropolitan community and residential aged care settings. Panellists were asked to rate the proposed framework in terms of the relevance and importance of each leadership quality using four-point Likert scales, and to provide comments. Three rounds of consultation were conducted. The number and corresponding percentage of the relevance and importance rating for each quality was calculated for each consultation round, as well as mean scores. Consensus was determined to be reached when a percentage score reached 70% or greater. Results Twenty-three panellists completed all three rounds of consultation. Following the three rounds of consultation, the acceptability and face validity of the framework was confirmed. Conclusions The study confirmed the framework as useful in identifying leadership requirements for middle managers in Australian aged care settings. The framework is the first validated framework of clinical leadership attributes for middle managers in aged care and offers an initial step forward in clarifying the aged care middle manager role. Relevance to clinical practice The framework provides clarity in the breadth of role expectations for the middle managers and can be used to inform an aged care specific leadership program development, individuals' and organisations' performance and development processes; and policy and guidelines about the types of activities required of middle managers in aged care. [ABSTRACT FROM AUTHOR]