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Aim and objective This paper aims to explore the ways in which neonatal nurses understand the experience of parents who have experienced infertility, conceived a baby via in vitro fertilisation and delivered an extremely premature infant. The chance of a poor long-term outcome for the baby is significant; therefore, parental anguish plays out in the neonatal intensive care. Background Current literature suggests that infertility is a significant issue for ageing women and many couples experience multiple cycles of invitro-fertilisation ( IVF) treatment to achieve a pregnancy. Babies conceived through IVF are more likely to have genetic disorders, and be born prematurely. When the baby is born through IVF and is also born extremely prematurely, it creates a crisis situation for the parents. This paper will focus on the parental anguish of achieving a pregnancy through IVF to see the baby born extremely prematurely (defined as ≤ 24-week gestation). It will examine parental anguish from caregiver perspective of the neonatal nurse who supports the parents through this very difficult time. Design This study used interviews with neonatal nurses, and drew insights from interpretative phenomenology. Methods This research used a combination of a questionnaire and a series of interviews in a qualitative study informed by phenomenology. The analysis of the interview data involved the creation of key themes following extensive coding of thematic statements and the analysis of the emerging themes. Results This paper outlines the neonatal nurses' understanding of parental anguish and overwhelming sadness in parents whose baby was conceived by IVF, and was also born extremely prematurely. The theme of 'seeking parenthood' was synthesised from two sub-themes - 'longing for a baby' and 'the desperation to become parents'. Conclusion This study identified that neonatal nurses bear witness to parental anguish as their hopes of taking home a live baby might not be realised. The time, effort and money required to achieve a pregnancy does not mean that the baby will be spared the outcomes of extreme prematurity and the risk factors associated with IVF. The parents may be left empty handed. Therefore, the word precious becomes a metaphor for the IVF baby as the neonatal team try desperately to give the parents their much longed baby. Relevance to clinical practice Delayed child bearing has an impact on fertility, with maternal age having the most impact on the ability to conceive. Babies conceived through IVF technologies have a higher risk of genetic abnormalities and being born prematurely, and this will impact on the neonatal intensive care availability. Extreme prematurity and IVF can significantly impact on the baby's outcome. Witnessing parental anguish can be a major source of stress for the neonatal nurses. Neonatal nurses need to develop strategies not only to help the parents but also to prevent the parents' overwhelming sadness from affecting their ability to function in the neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

The study reported in this paper aimed at exploring the views of staff and patients of a potential emergency nurse practitioner service in an acute trust in the UK. The role of the nurse in emergency care has changed considerably in recent years, and the evolution of the emergency nurse practitioner role has changed emergency service provision dramatically. The emergency nurse practitioner role is not uniformly defined across emergency care in the UK, and the resulting blurring of the role of emergency nurse practitioners with that of emergency department medical staff is not helpful to hospital staff or patients. A quantitative and qualitative mixed method design was used that enabled exploration of an individual's viewpoint within their own practice or natural surroundings. Self-completed questionnaires were used to determine health professionals' opinions, and semi-structured interviews were employed to explore patients' views. A total of 144 health professionals responded to the questionnaire survey giving a response rate of 28·5%, and 10 patients participated in qualitative interviews. Health professionals and patients alike were generally supportive of an emergency nurse practitioner service, but there were some concerns in relation to the role and functions of the emergency nurse practitioner and associated accountability issues. This paper contributes further data that demonstrate the inter-professional and patient support of the advanced role of the emergency nurse practitioner and highlights potential conflictual issues and barriers to implementation that can and must be resolved successfully through proper consultation prior to the service being introduced. This paper provides important information to health professionals and service providers that should help to facilitate the introduction and maintenance of a successful and effective emergency nurse practitioner service in any trust. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the perceptions of family‐centred care among nurses and the family members of hospitalised children and investigate the facilitators of and barriers to the implementation of family‐centred care in Malawi. Background: In Malawi, approximately 34% of children have long‐term illnesses that require hospitalisation. Family‐centred care ensures that the delivery of healthcare is grounded in partnerships between healthcare providers, patients and their families, which can improve the psychological well‐being of families. However, there is lack a good understanding of how families and nurses perceive this concept, its facilitators and the barriers. Design: This was an exploratory qualitative study. Data were analysed deductively and inductively using the five‐step qualitative content analysis method. Methods: Twenty‐nine nurses and 31 families were recruited. Data were collected through in‐depth, semi‐structured and face‐to‐face individual interviews. The study was reported using the COREQ checklist. Results: Both nurses and families of hospitalised children recognised the importance of nurse–family partnerships in family‐centred care. Four themes emerged as follows: Perceptions of family‐centred care, elements of family‐centred care, facilitators of family‐centred care and barriers to family‐centred care. Specific information to families and the religious beliefs of families were identified as important facilitator and barrier to family‐centred care, respectively. Conclusion: The implementation of family‐centred care is promising in Malawi, as it is positively perceived by nurses and families, and its implementation is consistent with the Institute for Patient and Family‐Centred Care Framework. Relevance to clinical practice: Our findings present the best practices, gaps and challenges in the context of a low‐income country regrading implementation of family‐centred care. Education programmes on family‐centred care are crucial for sustaining the current gains. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the longitudinal experiences using an application named remote home care for remote palliative care among patients with cancer living at home. Background: Introducing welfare technology in home‐based care for patients with cancer in the palliative phase is internationally suggested as a measure to remotely support palliative care needs. However, little is known about the experiences of patients utilising welfare technology applications to receive home‐based care from healthcare professionals in a community care context. Although living with cancer in the palliative phase often presents rapidly changing ailments, emotions and challenges with patients' needs changing accordingly, no studies exploring the longitudinal experiences of patients were found. Design: A qualitative study with a longitudinal, exploratory design. Methods: Data were collected through individual interviews with 11 patients over 16 weeks. The data were analysed using qualitative content analysis. The COREQ checklist guided the reporting of the study. Results: Three themes were identified: (1) potential to facilitate self‐governance of life‐limiting illness in daily life, (2) need for interpersonal relationships and connections, and (3) experiences of increased responsibility and unclear utility of the Remote Home Care. Conclusion: The results showed that remote home care facilitated patients' daily routines, symptom control and improved illness‐management at home. Interpersonal relationships with healthcare professionals were considered pivotal for satisfactory follow‐up. Infrastructural glitches regarding data access, information sharing and lack of continuous adjustments of the application represented major challenges, with the potential to impose a burden on patients with cancer in the palliative phase. Relevance to Clinical Practice: By exploring the experiences of patients in palliative care over time as the disease progresses, this study provides constructive insights for the design and development of welfare technology applications and optimal care strategies. Patient or Public Contribution: The remote home care was developed by interdisciplinary healthcare professionals. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore registered nurses' perceptions of practice change and describe factors that influence the adoption of practice changes. Background: Nurses play a critical role in optimising patient outcomes. Healthcare organisations and nurses must do their part to achieve the Quadruple Aim, which requires nurses to change their practice. Nurses are ideally positioned to improve patient outcomes by changing their practice to align it with research evidence and organisational initiatives; however, this experience of practice change by nurses is grossly under‐studied. Design: A qualitative design, inductive content analysis, was used to understand nurses' perceptions of practice change. Methods: Eleven registered nurses, who worked in one hospital system, participated in one‐on‐one semi‐structured interviews. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) were followed. Findings: The 11 participants described 63 distinct experiences with practice changes. Their experiences with and perceptions of practice change are categorised as (1) There is A History; (2) It's A Lot of Work; (3) It Happens to Nurses; and (4) Doing Right for the Patient. Conclusion: Nurses experience practice change as a central part of the work they do; it occurs frequently and multiple practice changes may co‐occur. Nurses identify strategies, such as thoughtful planning, engaging nurses, and communicating the rationale for and the outcomes of the practice change, to facilitate changing practice. Relevance to Clinical Practice: Involving nurses in practice changes could alleviate some inhibiting factors for adopting new practices. Local hospital and national policies should explore creative and practical ways to balance the competing needs of nurses providing direct care at the bedside and dedicated time to be engaged in practice change initiatives. With the ongoing focus on improving patient care and optimising patient safety, nurses should be viewed as highly valued members of the team when designing and implementing practice changes. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To understand hospice palliative care nurses' (HPCNs) perceptions towards spiritual care and their competence to provide spiritual care. Background: Previous research has shown that many nurses lack a clear understanding of the concept of spirituality and feel inadequately prepared to assess patients' spiritual needs. Studies on competence in spiritual care are mostly descriptive, and the evidence for improving it is limited. Design: A mixed‐methods research design was used. Methods: Quantitative data were collected from 282 nurses in forty hospice palliative care (HPC) institutions in South Korea and analysed using descriptive statistics, independent t‐test, one‐way ANOVA with Bonferroni test and multiple regression. Qualitative data collection involved two stages: first, an open‐ended question posed to 282 nurses, and second, focus group interviews conducted with six HPC experts. Both qualitative data sets were analysed separately using content analysis. This study followed the GRAMMS guidelines. Results: Of the six dimensions of spiritual care competence (SCC), the mean scores were highest in 'attitude towards the patient's spirituality' and 'communication', whereas the 'assessment and implementation of spiritual care' and 'professionalisation and improving the quality of spiritual care' had the lowest mean scores. Through content analysis, 4 themes regarding the meaning of spiritual care, 3 themes regarding requirements for spiritual care and 2 themes regarding preparedness for spiritual care were revealed. They perceived the needs of the understanding of spiritual care based on the attributes of spirituality, the education in systematic assessments and implementation for spiritual care with standardised terminology, and the opportunity to reflect on nurses' own spirituality. Conclusions: Practical SCC training for HPCNs and the subsequent development of clinical practice guidelines are of vital importance. Relevance to clinical practice: The results of this study provide a useful resource to develop educational programmes for strengthening the SCC of nurses and the entire HPC team. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore from a nurse and patient perspective what questionnaire—"Functional assessment of cancer treatment gynecological group neurotoxicity" or "Oxaliplatin‐Associated Neuropathy Questionnaire"—best describes chemotherapy‐induced peripheral neuropathy and its influence on everyday life in a comprehensive and meaningful way, prior to implementation in daily practice. Background: Patients experience chemotherapy‐induced peripheral neuropathy during and after chemotherapy for colorectal cancer with oxaliplatin. This neuropathy is difficult to describe for patients and to identify for nurses. To address the specific needs of patients and improve identification of neuropathy and its influence on everyday life, we wanted to implement a questionnaire in clinical practice. Design: A phenomenological hermeneutic frame of reference was used. Method: Semi‐structured interviews with 15 patients and two focus groups with eight cancer nurses were used for data collection. Data were organised and interpreted by content analytical steps in a hermeneutical process. COREQ checklist was used in reporting of the study. Results: The analysis resulted in two main themes (a) "To dig deeper" with sub‐themes "to identify the line between acceptable and nonacceptable chemotherapy‐induced peripheral neuropathy," and "searching for a precise description." (b). "When everything is interrelated" with sub‐themes "to be aware of different perspectives and understandings" and "recognise potential pitfalls." Conclusion: Involving patients and nurses in choosing between the two questionnaires revealed that neither alone was sufficient to describe the patients' experiences. Instead, it seems essential to implement both questionnaires, using the answers as a basis for a dialogue to address the patients' specific needs. Relevance for clinical practice: Using patients and nurses perspectives in a complementary way may provide a solid foundation before starting an implementation process in clinical practice. However, attention must be paid to potential barriers and facilitators as well as the fact that a successful implementing process requires leadership and information sharing. [ABSTRACT FROM AUTHOR]

Aim: To describe partners' experiences of living with men with a screening‐detected abdominal aortic aneurysm (AAA). Background: Diagnosis of a chronic life‐threatening disease affects the patients' as well as their partners' lives in different aspects. AAA, with rupture as the major consequence, is a life‐threatening disease that can affect the whole family. Screening programmes for AAA have been introduced in several countries to reduce the mortality rate. Although the awareness of having an AAA influences the individuals' quality of life and well‐being, it is still unclear how it affects their partners. Design: Qualitative descriptive design. Methods: Twenty‐one partners of men with AAA were purposely selected to participate in individual semi‐structured interviews between August 2017–February 2018 in Sweden. Data were transcribed and imported into NVivo‐12®. The data were analysed using qualitative content analysis. The study conforms to the COREQ checklist. Results: Three categories were identified: (a) experiencing the unexpected; (b) being reminded of fragility; and (c) balancing a changing relationship. The partners had a positive attitude towards the screening process and were pleased that their husbands were under surveillance. Nevertheless, at the same time, the diagnosis caused worries and questions. The AAA diagnosis was constantly in the minds of the partners, which sometimes affected and limited daily activities. Furthermore, ambivalent feelings towards surgical treatment were described. The partners tried to support their men and encouraged them to achieve a healthy lifestyle. Conclusion: The partners' well‐being and daily lives were impacted by the awareness of the screening‐detected AAA. Different degrees of worry were the most common reaction and were pervasive in all three categories. Relevance for clinical practice: The result highlights the need to review routines or develop new strategies to include the partners in the process of screening and offer supplementary support and information. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore wishes and needs, such as existing and preferred communication processes, of residents and relatives regarding medical and nursing planning at the end of life. Background: Nursing home residents are a relevant target group for advance care planning (ACP) due to their high age and multimorbidity. Their relatives seem to be important partners in terms of communication and their documentation of wishes and needs. Design: A qualitative descriptive design was used. Methods: Thirty‐two guideline‐based interviews with nursing home residents (n = 24) and relatives (n = 8) were conducted in nursing homes in Germany (n = 7). All interviews were analysed by content‐structured content analysis. The COREQ checklist was used to document reporting of the study. Results: Residents particularly express wishes and needs regarding their health, like the desire to maintain or improve one's current state of health and to be active and mobile and also regarding their social situation, for example the well‐being of relatives and beloved ones. A limited group of people was identified with whom residents spoke about issues such as preparedness and self‐determination. These were mainly their relatives. Relatives themselves have a need for more communication. Various communication barriers could be identified. Conclusion: Residents express diverse and partly explicit wishes and needs. Although many of the respondents had already drafted advanced directives, the demand for offers of communication to plan ahead for the end of life remains clear. The results indicate the unconditional participation of relatives and people close to the residents, if they are available. Relevance to clinical practice: Derivations for a target group‐related ACP concept in the study region are identified. Besides the involvement of relatives, nurses could also be involved in the communication and decision‐making process of residents in nursing homes under certain conditions. [ABSTRACT FROM AUTHOR]

Aim: To explore descriptors of difficulty accessing the mouths of intubated and mechanically ventilated adults for oral care, consequences, modifiable antecedents and recommendations for improving care delivery. Background: Nurses report oral access and care delivery difficulty in most mechanically ventilated patients. Design: A prospective qualitative descriptive design. Methods: Data were collected using video and photographic elicitation interviews focused on delivery of oral care. Directed content analysis was used to explore descriptive categories. Reporting used the SRQR guidelines. Setting and participants: A university‐affiliated hospital in Toronto, Canada. Participants included clinicians experienced in accessing the oral space of adults representing nursing, medicine, dentistry and allied health professionals. Findings: We recruited 18 participants; 9 representing critical care and 9 other specialties frequently accessing the mouth, that is dentistry. Descriptors for observed difficulty accessing the oral cavity were "oral crowding with tubes" and "aversive patient responses", which were considered to result in insufficient oral care. Participants perceived aversive patient responses (e.g. biting, turning head side to side, gagging, coughing) as a consequence of forced introduction of instruments inside a crowded mouth. A key finding identified by participants was the observation of substantial procedural pain during oral care interventions. Potentially modifiable antecedents to difficult oral care delivery identified were procedural pain, oral health deterioration (e.g. xerostomia) and lack of interprofessional team problem‐solving. Recommendations to address these antecedents included patient preparation for oral care through verbal and nonverbal cueing, pharmacological and nonpharmacological strategies, and ICU interprofessional education. Conclusions: Oral care in mechanically ventilated adults is complex and painful. Visual research methods offer important advantages for oral care exploration including its ability to reveal less visible aspects of the nurse–patient encounter, thereby enabling novel insights and care. Relevance for clinical practice: Interprofessional education and training in oral health and care interventions tailored to mechanically ventilated patients are recommended. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences of how Chinese adults cope with multiple chronic conditions in everyday life. Background: Having multiple chronic conditions is stressful, requiring people to make physical and mental adaptations. There is little evidence exploring how people cope with multiple chronic conditions, especially in an Asian context. Design: A qualitative descriptive design was employed. The Consolidated criteria for reporting qualitative research (COREQ) was used to report this study. Methods: This study was conducted in a tertiary referral and teaching hospital in Bengbu, Anhui, China, between August and October 2018. A purposive sample of 14 people with multiple chronic conditions, aged between 32 and 75 years, completed a demographic questionnaire and semi‐structured face‐to‐face interviews. The interviews were digitally recorded and transcribed verbatim. Qualitative content analysis guided data analysis. Results: Four distinctive themes comprising subthemes were developed from participants' narratives pertaining to coping with multiple chronic conditions: (a) appraising multiple chronic conditions, (b) addressing multiple chronic conditions management, (c) maintaining psychological well‐being and (d) fulfilling a social role. Illustrative quotations were cited to support each theme. Conclusions: This study underscores that people cope with multiple chronic conditions in everyday life by using a compendium of coping strategies. As one of the influencing factors, culture dominates the ways of coping at different levels among people with multiple chronic conditions. These findings expand the current literature on coping based on an Asian perspective and inform further cross‐culture research on this topic. Relevance to clinical practice: Healthcare professionals should understand peoples' experiences of coping with multiple chronic conditions to provide more holistic and dynamic health care to address their actual needs. Healthcare professionals should be acquainted with how culture impacts individuals' coping and develops culture‐tailored supportive programmes such as family‐based interventions, to promote the health of people with multiple chronic conditions. [ABSTRACT FROM AUTHOR]

Background and aims: Microscopic colitis causes chronic or recurrent nonbloody, watery diarrhoea, which is associated with urgency, faecal incontinence and abdominal pain. The patient's health‐related quality of life is often impaired. In microscopic colitis, health‐related quality of life has been studied using questionnaires originally constructed and validated for patients with inflammatory bowel disease. The aim of this study was to explore the impact of microscopic colitis on everyday life. Methods and results: Inductive, qualitative, semi‐structured interviews were performed with 15 persons suffering from microscopic colitis. Content analysis was used to explore the impact of the condition on everyday life. The study followed the consolidated criteria for reporting qualitative research. The qualitative inductive content analysis generated one theme and five subthemes. The theme was "struggling with an invisible, disabling disease." The five subthemes were as follows: physical experience of bowel function; associated symptoms affecting quality of life; impact of the disease on everyday life; disease‐related worry; and strategies for managing everyday life. Conclusions: The semi‐structured interviews with persons suffering from microscopic colitis provided a wide spectrum of answers to the question of how everyday life is affected. Microscopic colitis can be a disabling life experience, and patients develop different strategies to adapt, cope and regain their previous performance level. Relevance to clinical practice: There are new and interesting findings in our study that everyday life still remains affected even when patients are in remission. These findings have relevance in clinical practice and may create a better understanding of the patient's symptoms and situation. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine how the use of Social Interaction Maps, a tool in the EXCELLence in Cultural Experiential Learning and Leadership Program, can enhance the development of nurses’ intercultural/intraprofessional communication skills. Background: Nurses face communication challenges when interacting with others from similar background as well as those from a culturally and linguistically diverse background. We used the EXCELLence in Cultural Experiential Learning and Leadership Program's Social Interaction Maps tool to foster intercultural/intraprofessional communication skills in nurses. Social Interaction Maps describe verbal and nonverbal communication behaviours that model ways of communicating in a culturally appropriate manner. The maps include four stages of an interaction, namely Approach, Bridging, Communicating and Departing using the acronym ABCD. Design: Qualitative approach was used with a purposeful sample of nurses enrolled in a postgraduate course. Methods: Fifteen participants were recruited. The Social Interaction Map tool was taught to participants in a workshop where they engaged in sociocultural communication activities using scenarios. Participants were asked to apply Social Interaction Maps in their workplaces. Six weeks later, participants completed a semistructured open‐ended questionnaire and participated in a discussion forum on their experience of using Social Interaction Maps. Data were content‐analysed. Results: Four themes identified in the use of the Social Interaction Maps were (i) enhancing self‐awareness of communication skills; (ii) promoting skills in being nonconfrontational during difficult interactions; (iii) highlighting the importance of A (Approach) and B (Bridging) in interaction with others; and (iv) awareness of how others interpret what is said C (Communicating) and discussing to resolve issues before closure D (Departing). Conclusions: Application of the EXCELLence in Cultural Experiential Learning and Leadership Social Interaction Mapping tool was shown to be useful in developing intercultural/intraprofessional communication skills in nurses. Relevance to clinical practice: Professional development programmes that incorporate EXCELLence in Cultural Experiential Learning and Leadership Social Interaction Maps can enhance nurses’ intercultural/intraprofessional communication competencies when engaging with others from culturally and linguistically diverse backgrounds and improve the way nurses communicate with each other. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine potential facilitators and barriers and tailor interventions to optimise future implementation of a patient-assessment framework into emergency nursing practice. Background An evidence-informed patient-assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) improves the quality of patient assessments performed by emergency nurses. Facilitators and barriers must be understood and tailored interventions selected to optimise implementation. Design A mixed-method convergent study design was used. Methods Thirty eight early career emergency nurses from five Australian hospitals participated in an education workshop on the HIRAID assessment framework. Simulated clinical scenarios enabled participants to experience conducting a patient assessment with and without using the framework. All participants completed surveys, interviews and focus groups to identify potential facilitators and barriers. Twenty three participants completed follow-up telephone surveys 4-6 months later. Quantitative and qualitative data were analysed separately using descriptive statistics and inductive content analysis, prior to integration. Implementation interventions were selected using the Behaviour Change Wheel. Results Nine facilitators and nine barriers were identified to potentially effect implementation of the HIRAID assessment framework. Twelve of the 23 participants (52.2%) who completed follow-up surveys reported using the framework in the clinical setting. To optimise future implementation, the education workshop needs refinement, and environmental restructuring, modelling and social support are required. Conclusion A multimodal strategy is needed to promote future successful implementation of the HIRAID assessment framework into emergency nursing practice. Relevance for clinical practice The successful implementation of the HIRAID assessment framework has the potential to improve nursing assessments of patients in emergency and other acute care settings. This study demonstrates how to systematically identify facilitators and barriers to behaviour change and select interventions to optimise implementation of evidence-informed nursing practices. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine activities conducted, challenges encountered and supports used when sustaining nursing practice guideline implementation in multiple healthcare organisations over 3 years. Background Numerous models and frameworks exist to guide the implementation of guidelines, yet very few focus on sustaining improved practice changes. It is not known if one intervention or multiple interventions are required, nor the long-term activities, challenges and supports for sustaining improved practices. Design Qualitative descriptive study. Methods We conducted focus group interviews with steering committee members and individual interviews with leaders and direct care providers at the end of a 3-year guideline implementation study. The National Health Service Sustainability Model was used to guide data collection and analysis. Results The eight sites included three teaching hospitals, a community hospital, a long-term care facility, two community health agencies and a community health centre. Individual interviews were conducted with 36 leaders and 26 direct care providers. Focus group interviews were conducted with steering committee members ( n = 70) at each site. Guideline implementation activities ( n = 45) included developing new outcome monitoring systems, conducting chart audits, communicating progress to internal stakeholders, appointing interprofessional staff to steering committees, developing educational sessions and resources for staff and patients, revising policies and procedures, and developing partnerships with external organisations. Supports included lessons learned from previous and concurrent change initiatives, and commitment, involvement and positive attitudes of staff and leaders. Conclusion Activities identified by the participants addressed all 10 factors in the Sustainability Model in the three areas of process, staff and organisation. The challenges and supports encountered provide insights into the process of guideline implementation and sustainability. Relevance to clinical practice A multilevel action plan for staff, leaders and the organisation is recommended when introducing and sustaining practice changes. [ABSTRACT FROM AUTHOR]

Aims and objectives To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department. Background Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication. Design A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview. Methods Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis. Results Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting medical information. Around 50% believed that long work hours reduced their ability to communicate effectively with patients. In addition, 34% admitted that they rarely or never listen to patients during a consultation. Conclusion The findings reveal that the quality of communication in this Hong Kong emergency department is compromised by specific factors inherent in the linguistic complexity of Hong Kong emergency departments. These factors include the constant translation of medical information, inadequate documentation of medical information and significant professional and cultural pressures. Each of these issues increases the likelihood that healthcare communication will be difficult, incomplete or incorrect. This research provides empirical evidence for, and justifies the development of, an effective framework to enable clinicians to overcome communication challenges. Relevance to clinical practice The findings of this study may shed light on the unique conditions faced by clinicians, particularly in relation to communication, in the complex trilingual healthcare context of an emergency department similar to those in Hong Kong, and provide potential policy solutions for barriers to improve communication in such settings. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop strategies for the identification and assessment of intimate partner violence in a nurse home visitation programme. Background Nurse home visitation programmes have been identified as an intervention for preventing child abuse and neglect. Recently, there is an increased focus on the role these programmes have in addressing intimate partner violence. Given the unique context of the home environment, strategies for assessments are required that maintain the therapeutic alliance and minimise client attrition. Design A qualitative case study. Methods A total of four Nurse-Family Partnership agencies were engaged in this study. Purposeful samples of nurses ( n = 32), pregnant or parenting mothers who had self-disclosed experiences of abuse ( n = 26) and supervisors ( n = 5) participated in this study. A total of 10 focus groups were completed with nurses: 42 interviews with clients and 10 interviews with supervisors. The principles of conventional content analysis guided data analysis. Data were categorised using the practice-problem-needs analysis model for integrating qualitative findings in the development of nursing interventions. Results Multiple opportunities to ask about intimate partner violence are valued. The use of structured screening tools at enrolment does not promote disclosure or in-depth exploration of women's experiences of abuse. Women are more likely to discuss experiences of violence when nurses initiate nonstructured discussions focused on parenting, safety or healthy relationships. Nurses require knowledge and skills to initiate indicator-based assessments when exposure to abuse is suspected as well as strategies for responding to client-initiated disclosures. Conclusion A tailored approach to intimate partner violence assessment in home visiting is required. Relevance to clinical practice Multiple opportunities for exploring women's experiences of violence are required. A clinical pathway outlining a three-pronged approach to identification and assessment was developed. [ABSTRACT FROM AUTHOR]

Aims and objectives The purpose of this study was to determine how patients' symptom experiences of muscle tightness correlate with examiner assessments. To address this question, we (1) obtained the vocabularies used by patients and examiners to describe muscle tightness, (2) correlated patient- reported Visual Analog Scale ratings for locations of muscle tightness on a body diagram and (3) explored the similarities and differences between patient and examiner evaluation of muscle tightness analytically and graphically. Background Symptoms of muscle tightness are common complaints that occur due to musculoskeletal and neuromusculoskeletal injuries. Terms such as muscle tightness are often intermingled with other conditions including muscle tension, muscle spasticity and muscle rigidity. Discrepancies between patients and clinicians understanding of similar symptoms have been reported in the literature. Design A concurrent exploratory mixed methods design was used. Method Fifty-seven participants (six physical therapists, 51 patients) participated. Participants provided semi-structured interviews, ratings through Visual Analog Scale and concurrently provided the words used to describe muscle tightness. Patients also provided the location of muscle tightness on a body diagram. Content analysis and hierarchical linear modelling were used for data analysis. Results The patients' vocabularies contained more sensory and pain experiences when compared to the clinicians' vocabularies. Examiners and patients ratings were variable (standard deviation >20) and contained discrepancies. Stress played a role in the symptom experience of muscle tightness. Examiners tended to focus on patients' chief complaints, while patients reported their symptoms from a whole-body perspective. Conclusions Symptom experiences of muscle tightness can occur with or without pain. Use of complementary therapy and development of an objective tool that accounts for patients' sensory experiences is warranted. Relevance to clinical Practice Findings from this study indicate that in addition to all other available treatments options, nurses must also educate patients about correct posture alignment, breathing exercises and stress management. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the views of student nurses' and stakeholders of what is important for student nurses to know about cancer treatment and care. Background Worldwide, the number of people living with cancer is increasing because the population is ageing and effective cancer treatments are prolonging survival. All nurses need knowledge, skills, confidence and competence to support people living with cancer. Education is an important tool in preparing a nursing workforce that can support people affected by cancer. Design A descriptive, explorative qualitative design. Methods Semi-structured interviews with 12 student nurses and seven stakeholders were conducted in 2014 (a subgroup of participants in a mixed-methods study investigating an innovation in undergraduate cancer education and reported elsewhere). The interviews were audio-taped, transcribed and analysed using content analysis. Results Two key findings emerged: the benefits of learning from people affected by cancer and knowledge deficits. Students valued the opportunity to meet people affected by cancer away from a clinical environment. It gave them the opportunity to gain skills and confidence, in providing information and psycho-educational support, in a safe and facilitated context. Students and stakeholders reported blended learning (lectures and engaging with both cancer clinicians and people affected by cancer) important for developing confidence and competence in cancer care. However, at the end of their education students identified knowledge deficits in relation to cancer screening, common cancers, treatment side effects and supporting people who have been given 'bad news'. Conclusions Collaborative working with people affected by cancer and educationalists has allowed the patient and carer experience to be placed at the centre of the undergraduate cancer education. Relevance to clinical practice This research reveals the potential importance of the coproduction of undergraduate nurse cancer education, if nurses are to understand and improve the experience of people living with cancer and beyond. [ABSTRACT FROM AUTHOR]

Aims and objectives. To understand parents' experiences of managing their child's postoperative pain at home. Background. Recent changes in children's health care services often shift the responsibility of managing children's postoperative pain to parents. Although pain management is important for good postoperative outcomes, it can be a challenging task for families, and children's pain is often under-managed. Design. This qualitative study used semi-structured interviews to explore parents' experiences of managing their child's postoperative pain at home. Methods. Participants were parents of 10 typically developing 5- and 6-year olds, who underwent (adeno)tonsillectomy, and experienced no complications leading to hospitalisation in the postoperative period. One-on-one interviews were conducted with parents within three months of their child's surgery. Interviews were transcribed verbatim and content analysis was used to identify themes in parents' experiences. Results. All children experienced some postoperative pain. Parents' experiences of managing their child's pain were impacted by balancing the pros and cons of administering analgesic medications, managing the emotional and psychological effects of their child's pain, as well as parents' information needs. Conclusions. Most parents' information needs were met yet they still struggled to manage their child's pain. These findings provide insight into some of the barriers that make this process challenging for many families, and what health care centres can do to help support parents manage their child's postoperative pain at home. Relevance to clinical practice. The results of this study may aid in the design of interventions that will support parents when managing their child's postoperative pain at home and thus improve children's experiences. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim was to describe the moods experienced by people waiting for day surgery. Background. Except for anxiety, there is a lack of knowledge about the moods experienced by patients while waiting for day surgery, as well as the impact of mood during the perioperative period. Preoperative anxiety is common and has multiple negative effects. A deeper knowledge of preoperative moods and how they are experienced is needed and may be useful for improving perioperative care. Design. Qualitative descriptive design. Methods. Qualitative semi-structured interviews (n = 20) with adults waiting for day surgery in a Swedish university hospital. Data were analysed with inductive content analysis. Results. The informants described a variety of moods and mood-influencing reasons. The main category that emerged was, 'feeling hope about regaining health as a help to balance mood' regardless of mood. This category was abstracted from the generic categories 'experiencing a harmonious mood' and 'experiencing a shifting mood'. The subcategories were 'feeling calm and at ease despite concerns and fear,' 'experiencing expectation,' 'feeling trust and confidence,' 'shifting between expectancy and anxiety,' 'feeling vulnerable and exposed, and 'feeling uncertainty'. Conclusions. The findings contribute to the knowledge about that regardless of mood, feeling hope about regaining health may help patients to balance their mood during the waiting period. Relevance to clinical practice. The results can have implications with respect to developing and improving preoperative care, such as having clinicians extend offers of individual assistance and information during the waiting period to patients experiencing shifting mood. Instilling hopefulness in patients who are waiting for day surgery by means of clinical staff attitudes and interactions may help patients to develop healthy coping strategies and thereby improve their physical and emotional well-being. [ABSTRACT FROM AUTHOR]

Aims and objectives The purpose of the study was to describe the personal experiences of relatives of Syrian patients in the intensive care unit in one hospital in Turkey. Background The concept of the intensive care unit can be particularly frightening for family members. Current recommendations for training Intensive care unit nurses should support a holistic approach to patient (and family) care, including explanations at a level that families can easily understand and allowing family members to see the patient at regular intervals. Design This qualitative study was conducted between June and August 2014 and included a study sample of 30 Syrian family members related to patients receiving treatment at a state hospital intensive care unit in Turkey. Methods Data were collected by semi-structured interviews. We used percentages to represent descriptive data and conducted qualitative content analysis. Results Following data analysis, six themes arose: (1) communication-related difficulties, (2) difficulties receiving information regarding the patient's condition, (3) difficulties meeting personal needs, (4) difficulties communicating with other family members, (5) difficulties receiving support from other family members, and (6) unmet expectations from nurses and hospital administration. Conclusions Syrian patient's relatives receiving treatment in an intensive care unit in Turkey experienced communication difficulties in terms of receiving information from health care personnel, informing other family members, receiving social support from other family members, and having various unmet expectations from nurses and hospital administration. Relevance to clinical practice The results of this study can be used to develop guidelines and predictions for scenarios that are likely to arise for patients' relatives from foreign countries who arrive to support patients who receive healthcare services in our increasingly global world. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify and describe the triggers of emotional distress among long-term caregivers (more than 1 year postdiagnosis) of people with head and neck cancer. Background Limited research has been conducted on the factors that cause head and neck cancer caregivers to become distressed. Design Qualitative cross-sectional. Methods In-depth semi-structured interviews. Interviews were conducted via telephone. The study setting was the Republic of Ireland. Results Interviews were conducted with 31 long-term caregivers (mean time since diagnosis 5·7 years, SD 2·9 years). Head and neck cancer caregivers experienced significant distress. Six key triggers of emotional distress were identified: understandings and fears of illness, lifestyle restrictions and competing demands, facial disfigurement, financial problems, comorbid health problems and witnessing suffering. Cutting across all of these individual causes of distress was a strong feeling of loss caused by head and neck cancer. Conclusions Some head and neck cancer caregivers became considerably distressed by their caring role. Although distress appears to decline with time for many caregivers, some continue to be distressed for years following the patient's diagnosis. It would be useful for future research to explicitly investigate caregivers' experiences of loss. Relevance to clinical practice Health professionals may be able to reduce distress in this group if they can help caregivers to access resources that can be used to buffer financial problems. Health professionals may also be able to reduce distress if they can work with caregivers to help them to obtain something of personal value or significance from their experience of loss and suffering. [ABSTRACT FROM AUTHOR]

Aims and Objectives The aim of this research was to understand new ways that young rural people with mental health problems could be helped at an early point in their mental health decline. Background Rural nurses represent skilled mental health helping capital in their local communities, yet this important mental health helping resource, or helping capital, is both under-recognised and under-used in providing early mental health help in rural communities. In recent years international momentum has gathered in support of a paradigm change to reform the delivery of youth mental health services so that they align more closely to the developmental and social needs of young people with mental health problems. Design A mixed methods case study design was used to explore the early mental health care needs of young rural people. Methods A cross-sectional survey was conducted and data were analysed with descriptive techniques. In-depth interviews were conducted and the transcribed data were analysed using thematic techniques. Results The results of this study demonstrate that in general rural people are willing to seek mental health care, and that rural nurses are well suited to provide initial care to young people. Conclusions Non-traditional venues such as community, school and justice settings are ideal places where more convenient first conversations about mental health with young people and their families, and rural nurses should be deployed to these settings. Relevance to Clinical Practice Rural nurses are able to contribute important initial engagement interventions that enhance the early mental health care for young people when it is needed. [ABSTRACT FROM AUTHOR]

Aims and objectives In this study, we aimed to understand how nurses manage handovers at shift change and to identify the working strategies they employ to maintain patients' safety. Background Nursing handovers at shift change are potentially hazardous for patients' quality of care. The nurses on the outgoing and incoming shifts need accurate understanding of the patient's current state, under circumstances that are frequently turbulent and time constrained. Design Qualitative study. Method Eighteen nurses working in a central Israeli hospital participated in the study. Data were collected through in-depth semi-structured interviews, conducted over a 10-month period in 2011-2012. The interviews were tape-recorded and transcribed verbatim. Content analysis method was used. Results We revealed three interrelated themes: (1) Adaptation of declared handover goals to goals, which better fit the day-to-day routine of the ward; (2) Contextual turbulent circumstances, and (3) Strategies to optimise care for patients. Nurses on the outgoing shift developed organising strategies, ensuring efficient transmission of all important information; nurses on the incoming shift used cross-checking strategies to verify the accuracy of the received information. Conclusion A nursing handover is both vulnerable and resilient, given its imposed constraints. The handover should be restructured, assuring resilience in patients' care while also limiting the risk for vulnerability. Relevance to clinical practice Handover should be restructured so that it creates opportunities to cross-check the information against as many sources of information as possible. During handover, special time should be devoted to reading written reports and notes, preferably when the outgoing nurses are still on the ward or are accessible via e-mail or telephone. Team discussions should focus on achieving agreement about the order and manner of delivering concise information and facilitating shared understanding and trust among nurses. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore teenagers' views of the future in relation to their choices to continue or terminate pregnancy. Background Despite recent decreases in the numbers of teenage pregnancies, across the world, the teenage pregnancy rate remains high. Consideration of views of the future (future orientation) appears to play an important part in teenage girls' decisions to continue with pregnancy. To date, no study has explored this in teenage pregnant girls at the time they make their decision to continue with or terminate their pregnancy. Design Cross-sectional mixed methods design. Methods Three groups were included: termination of pregnancy ( n = 19), antenatal ( n = 9) and never pregnant ( n = 23). Participants were 13-18 years old. The termination of pregnancy and antenatal groups were interviewed, and the never pregnant group completed postal questionnaires. Results Groups differed in individual aspects of future orientation, that is, education, career and family, and reasons for pregnancy resolution choice. The termination group had more clearly developed and longer-term plans for the future with a focus on career. The never pregnant group shared aspects of their future orientation with both the antenatal and termination of pregnancy groups. The impact of negative discourses about teenage pregnancy from others was identified as a significant issue. Conclusions How pregnant teenage girls view the future has a relationship with their decision to terminate or continue with their pregnancy. Relevance to clinical practice The findings suggest that working with teenage girls to clarify their views of the future may be useful both in preventing future unwanted pregnancy and in supporting teenagers in making pregnancy decisions. Supporting pregnant teenagers in distancing themselves from negative stereotypes of teenage mothers may also be beneficial. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe registered nurses' reflections on discussing sexuality with patients. Background It is known that many diseases and treatments have a negative impact on sexual health. Despite these facts, registered nurses typically do not address sexual issues with patients. Design A descriptive design and a qualitative approach were used. Methods Interviews were conducted in 2010 with 10 registered nurses. The data were analysed using qualitative content analysis. Results The themes 'Doing the right thing and doing good', 'Could've, would've, should've: a nurse's conflicting feelings' and 'I just don't talk about it: sexuality as a nontopic' confirmed the notion that discussing sexuality in nursing care is still challenging and difficult for nurses, but also revealed that nurses who do talk to patients about sexual issues do so based on their strong sense of wanting to help. They felt a responsibility because of their knowledge in the area, but the topic also brought out conflicting feelings such as fear and embarrassment. Lack of time, support and places to talk to patients in private as well as prejudice were contributing factors to their not addressing sexuality. Some nurses also felt that sexuality was someone else's responsibility and a taboo subject. Conclusions Patients' sexuality is still surrounded by silence. But factors exist that can facilitate discussion of sexuality. Nurses have a key role in detecting ill-health. This study suggests that when nurses use their knowledge and go beyond their comfort zone and address sexuality, they can identify patients' sexual problems. Relevance to clinical practice Nurses need to understand how their knowledge can help patients who are experiencing sexual problems; they also need support from the workplace and to have access to routines that reinforce the notion that sexuality is a topic worth discussing. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore issues related to sexual function and relationships, for men and their wives or partners, following diagnosis and treatment for prostate cancer. Background A diagnosis of prostate cancer and subsequent treatment result in a significant number of men experiencing some impairment to their sexual function. There is scant research into the impact of changed sexual function on these men's masculinity, sexuality, intimate relationships and their needs regarding counselling and supportive care. Design Internet-based survey. Methods Focus groups and couple interviews were used to improve validity for questionnaire items designed to provide insight into men's experiences of prostate cancer in areas such as sexual function and relationships. The questionnaire included both closed and open-ended questions and had the option for the wife or partner to complete a section. Results Qualitative research revealed 17 specific categories within three key themes: sexual dysfunction, loss of libido and masculinity. The questionnaire found, unexpectedly, the majority of men said that they had sufficient emotional and psychological support. Wives/partners confirmed cancer had impacted on their partner's feelings of masculinity (71%), compared to 42% of men who felt that this was the case. Predictors of loss of libido, erectile dysfunction and 'feeling less of a man' were developed. Univariate predictors included hormone therapy, regrets about treatment choice, cancer having impacted on masculinity and distress during the last week. Conclusions Men are not able to clearly identify the challenges prostate cancer brings especially changes to their masculinity. Relevance to clinical practice The findings strongly suggest that for men with prostate cancer, nursing assessments of men's sexual health be augmented by information gained from their partners; further, these assessments should be augmented with a careful exploration of these men's psyche guided by the knowledge that masculinity influences perceptions of self (being a man) and help seeking. [ABSTRACT FROM AUTHOR]