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Aims and objectives: To assess the impact of educational interventions on the knowledge and attitude of healthcare professionals (HCPs) regarding sickle cell disease (SCD) pain management in the UK. Background: Variations and inadequate pain management due toHCPs' lack of knowledge and negative attitude is still an ongoing global concern for SCD patients despite availability of effective treatment and evidence‐based guidelines. Several international studies have implemented interventions aimed at improving knowledge, attitude, and pain management. No review on the effectiveness of these interventions was found. Also, no previous intervention done in the UK was found from the thorough search of research databases. However, there are estimated 240,000 genetic carriers with about 12,500–15,000 estimated people living with SCD in the UK. Design: Rapid Evidence Assessment of existing evidence. Methods: A rapid evidence assessment was conducted between March 2021–January 2022 following the PRISMA 2020 guidelines. Included papers must have an educational intervention about SCD or related symptom management where the learners were HCPs. Excluded papers were those not published in English or before 2010. The following databases were searched: CINAHL, MEDLINE, PubMed America and Europe, Scopus, PsycINFO and Web of Science. Data quality was assessed using the Mixed Methods Assessment Tool (MMAT) and analysed using a narrative approach. Results: Ten studies were included in the final review. Overall, they reported improved outcomes in six main themes: knowledge, attitude, perception, adoption, satisfaction and efficiency. Five studies reported statistically significant improvement in at least one outcome, four studies reported positive improvement, and two studies reported no significant improvement in knowledge and attitude. These heterogeneous studies were implemented once, and all designs were prone to bias; this makes it difficult to state how effective interventions are for SCD. Conclusion: Current evidence of positive improvement in HCPs' knowledge and attitude is insufficient for generalisation and recommendation for adoption. However, we believe that implementing validated educational interventions remains essential for effective acute SCD pain management and patient‐centred care. Further research is needed to find a suitable educational intervention that can be replicated. Relevance to clinical practice: Quality SCD education, timely crisis management and reduced patient stigma are crucial in reducing the risk of rapid clinical decompensation to avoid developing life‐threatening complications. Understanding SCD can also support the building of therapeutic relationships between the patient and practitioner. Trial registration: This review was not registered. [ABSTRACT FROM AUTHOR]

Aims: To identify how the nursing process (assessment, planning, intervention and outcome evaluation) has been incorporated into digital health systems (electronic medical records, electronic care plans and clinical decision support systems) to gain an understanding of known benefits and challenges posed to nurses' decision‐making processes. Background: Nursing terminologies, including the International Classification for Nursing Practice (ICNP), and Nursing Minimum Data Set's (NMDS), have been developed to improve standardised language integration of components of nursing care into digital systems. However, there is limited evidence regarding whether the complete nursing process is effectively being incorporated into digital health systems. Methods: An integrative systematic review following PRISMA guidelines. A search strategy was applied to extract articles from included databases: CINAHL, MEDLINE, SCOPUS and Web of Science Core Collection. Articles were limited to English language and published January 2007–March 2022 and assessed using a pre‐determined eligibility criteria. Quality assessment and a narrative synthesis were conducted. Results: A total of 3321 articles were identified, and 27 studies included. There were (n = 10) qualitative, (n = 4) quantitative non‐randomised controlled trials, (n = 3) quantitative descriptive studies and (n = 10) mixed methods. Nurse assessment and planning components were the most comprehensive phases incorporated into digital health systems, and interventions and outcome evaluation were scarcely reported. Conclusions: Inadequate capture of nursing work is a problem unresolved by digital health systems. This omission may be hindering nurse clinical decision‐making for patient care and limiting the visibility of the nursing role in health care interventions and the associated impact on patient outcomes. Relevance to clinical practice: Further research is needed on how digital systems can support nurses to apply the full nursing process and to further evaluate patient outcomes. Digital systems can support health‐service level evaluation through capturing missed nursing care and the consequences on patients utilising nurse‐sensitive‐outcomes; however, this is not yet being realised. [ABSTRACT FROM AUTHOR]

Aims and objectives: To gain an in‐depth understanding of patients' preferences regarding two bed bath methods: soap and water and disposable wet wipes. Background: Bed baths allow hospitalised, bedridden patients to stay clean and fresh. They serve a number of purposes: health promotion, social propriety and pure pleasure. Traditionally, soap and water have been used for personal hygiene, but in recent years soap and water have increasingly been replaced by the use of disposable wet wipes. Design: A qualitative study with a hermeneutical‐phenomenological approach was chosen to explore and understand patients' experiences of bed bath methods. Methods: Semi‐structured, individual, in‐depth interviews with 16 bedridden patients from three wards were conducted. The software program nvivo was used to structure the transcribed interviews and assist in the initial data analysis. The data were analysed and interpreted within a phenomenological‐hermeneutical framework. COREQ guidelines were used in the preparation of this paper (See Supporting information Appendix S1). Results: Four overall themes were identified: "Creating a sense of cleanliness," "Preferences and concerns in different situations," "Cleanliness of hands and face" and "Clinical decision‐making about bed bath method." Conclusions: Overall, patients' bed bath preference was for soap and water, but disposable wet wipes were considered a convenient alternative and preferred in certain circumstances, for example, when a patient had pain or diarrhoea. Shared decision‐making regarding bed bath method is recommended. Hands and face had specific requirements. Relevance to clinical practice: Nursing staff should be aware that bedridden patients have varying preferences, and it is important to incorporate the patients' preferences in the development of standards, health policies and clinical guidelines for bed bath practices. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify the impact of shiftwork on individuals and their lives and to discuss the implications this has for nurses and nursing. Background The context of shiftwork in the early 21st century is changing rapidly, and those involved in or required to work shiftwork are now spread over many different sectors of the community. In the Australian community, 16% of workers regularly work shiftwork. Most nurses undertake shiftwork at some time in their career, and health services could not operate without a shiftworking nursing workforce. Design Narrative literature review. Methods A narrative review of journal articles was conducted. Databases searched were CINAHL, EBSCO Host, JSTOR, Medline/PubMed and Google Scholar. Search terms used were 'shiftwork' and 'shift work'. Limitations included 'English language', 'published between 1980-2013' and 'human'. Results Reviewed for this paper were 118 studies that met the inclusion criteria. Results were categorised using thematic analysis. Themes that emerged were physical and psychosocial health, and sleep. Findings will be explored under these themes. Conclusions Shiftwork research has mainly focussed on the physiological and psychosocial health and sleep effects. Absent from the literature are studies focussing on the personal experience of the shiftworker and how workers mediate the effects of shiftwork and how shiftwork fits into the rest of their lives. Therefore, it is difficult to draw conclusions about how people 'manage' their shiftwork, and further research needs to be undertaken in this area. Relevance to clinical practice Working shifts for nurses is a reality that comes with the profession. While there is a significant body of research on shiftwork, little of this has been specifically applied to nursing, and the implications for individual nurses needing to care for their own health have not been drawn. [ABSTRACT FROM AUTHOR]

Aims and objectives To review current research into the adherence to mental health treatment by adolescents. Background Nonadherence to medication among adolescents has been studied much more extensively than nonadherence to other forms of treatment. Monitoring adherence to all recommended services is essential when assessing the long-term effectiveness of different treatment programmes. Healthcare professionals who treat patients with mental illness must be able to accurately determine which of their patients are adhering to all prescribed treatments. Design This is a systematic narrative literature review of the current literature. Methods Using a narrative synthesis, the data from 15 relevant articles concerning adolescents in inpatient or outpatient mental health care were extracted and synthesised. Results The reviewed papers are discussed in terms of the methods used to study treatment adherence, the working definition of adherence used in each case and the results obtained concerning adherence in adolescents. Thirty-four to sixty-seven per cent of adolescents treated are fully adherent to their medication and exhibit reasonably good follow-through for the recommended treatments. However, rates of noncompliance with medication are quite high, and significant numbers of adolescents choose to discontinue their medication. Conclusions This review synthesises current published data on adherence to mental health treatment among adolescents in order to provide practitioners and researchers with a better understanding of this important area. It is recommended that future investigations should focus on adherence in inpatient care, adherence to nonpharmacological treatments and the identification of factors that influence adherence. Relevance to clinical practice The monitoring and understanding of adherence to recommended services is important. Therefore, these findings can be used by healthcare professionals who treat patients with mental illness to help them assess which of their patients are adhering to the prescribed treatments. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the issues surrounding privacy during death in ICU. Background: While the provision of ICU care is vital, the nature and effect of the potential lack of privacy during death and dying in ICUs have not been extensively explored. Design: A literature search using CINAHL and Pubmed revealed articles related to privacy, death and dying in ICU. Method: Keywords used in the search were “ICU,” “Privacy,” “Death” and “Dying.” A combination of these terms using Boolean operators “or” or “and” revealed a total of 23 citations. Six papers were ultimately deemed suitable for inclusion in the review and were subjected to code analysis with Atlas.ti v8 QDA software. Findings: The analysis of the studies revealed eight themes, and this study presents the three key themes that were found to be recurring and strongly interconnected to the experience of privacy and death in ICU: “Privacy in ICU,” “ICU environment” and “End‐of‐Life Care”. Conclusions: Research has shown that patient and family privacy during the ICU hospitalisation and the provision of the circumstances that lead to an environment of privacy during and after death remains a significant challenge for ICU nurses. Family members have little or no privacy in shared room and cramped waiting rooms, while they wish to be better informed and involved in end‐of‐life decisions. Hence, death and dying for many patients takes place in open and/or shared spaces which is problematic in terms of both the level of privacy and respect that death ought to afford. Relevance to clinical practice: It is best if end‐of‐life care in the ICU is planned and coordinated, where possible. Nurses need to become more self‐reflective and aware in relation to end‐of‐life situations in ICU in order to develop privacy practices that are responsive to family and patient needs. [ABSTRACT FROM AUTHOR]

Aims: To define nurse‐led clinics in primary health care, identify barriers and enablers that influence their successful implementation, and understand what impact they have on patient and population health outcomes. Background: Nurse‐led clinics definitions remain inconsistent. There is limited understanding regarding what enablers and barriers impact successful nurse‐led clinic implementation and their impact on patient health care. Design: Scoping review using narrative synthesis. Methods: PubMed, MEDLINE, Web of Science, Scopus, CINAHL and PsycINFO were searched to identify nurse‐led clinic definitions and models of care between 2000 and 2023. Screening and selection of studies were based on eligibility criteria and methodological quality assessment. Narrative synthesis enabled to communicate the phenomena of interest and follows the PRISMA for Scoping Reviews (PRISMA‐ScR) checklist. Results: Among the 36 identified studies, key principles of what constitutes nurse‐led clinics were articulated providing a robust definition. Nurse‐led clinics are, in most cases, commensurate with standard care, however, they provide more time with patients leading to greater satisfaction. Enablers highlight nurse‐led clinic success is achieved through champions, partners, systems, and clear processes, while barriers encompass key risk points and sustainability considerations. Conclusion: The review highlights several fundamental elements are central to nurse‐led clinic success and are highly recommended when developing interventional nurse‐led strategies. Nurse‐led clinics within primary health care seek to address health care through community driven, health professional and policy supported strategies. Overall, a robust and contemporary definition of nurse‐led care and the clinics in which they operate is provided. Relevance to Clinical Practice: The comprehensive definition, clear mediators of success and the health impact of nurse‐led clinics provide a clear framework to effectively build greater capacity among nursing services within primary health care. This, in addition, highlights the need for good health care policy to ensure sustainability. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this paper is to explore how people live life successfully with Parkinson's disease and what contributed to the level of success. Objectives To examine the level of success as defined by people with Parkinson's disease. To find what contributed to the level of success. Background Self-care support has gained importance for supporting people with their chronic diseases including Parkinson's disease. Although self-care and life adjustments can improve patients' general well-being, it is unclear which approaches best facilitate positive adjustments to illness. Design Semi-structured interviews with participants with Parkinson's disease. Methods Eight participants living with Parkinson's disease for 2-16 years were recruited from a Parkinson's disease voluntary group in the UK. Interviews covered their perceived level of success and the factors which they perceived led to that success. Thematic analysis was used to analyse the data. Results Participants rated a high level of success in living with Parkinson's disease with an average personal rating 75/100 despite facing difficulties. Successful living was perceived to have taken place when people were either (1) able to return to their usual state of health or (2) considered themselves to be stable within a new/readjusted state of health. Aspects which were perceived to support positive psychosocial adjustment included a positive mindset, determination, acceptance of new challenges and family support. Conclusion Maintaining usual life and physical ability is the major concern among the people with Parkinson's disease. It would be helpful for health care professionals to identify what constitutes a 'usual' life for that person and to support them to develop a positive mindset and acceptance of new challenges, drawing on the determination of the person as well as any available family support. Relevance to clinical practice In supporting self-care, it is helpful to gain information about the subjective experience of living with Parkinson's disease including their perceived level of success at the time and what led to that perceived success for that person. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper presents a theory explaining the processes used by informal carers of people with dementia to mange alterations to their, and people with dementias' relationships with and places within their social worlds. Background Informal carers provide the majority of care to people with dementia. A great deal of international informal dementia care research is available, much of which elucidates the content, impacts and consequences of the informal caring role and the coping mechanisms that carers use. However, the socially situated experiences and processes integral to informal caring in dementia have not yet been robustly accounted for. Design A classic grounded theory approach was used as it is designed for research enquiries that aim to generate theory illustrating social patterns of action used to address an identified problem. Methods Thirty interviews were conducted with 31 participants between 2006-2008. The theory was conceptualised from the data using the concurrent methods of theoretical sampling, constant comparative analysis, memo writing and theoretical sensitivity. Results Informal carers' main concern was identified as 'Living on the fringes', which was stimulated by dementia-related stigma and living a different life. The theory of ' Sustaining Place' explains the social pattern of actions employed by informal carers to manage this problem on behalf of themselves and the person with dementia. Conclusions The theory of ' Sustaining Place' identifies an imperative for nurses, other formal carers and society to engage in actions to support and enable social connectedness, social inclusion and citizenship for informal carers and people with dementia. Relevance to clinical practice ' Sustaining Place' facilitates enhanced understanding of the complex and socially situated nature of informal dementia care through its portrayal of informal carers as social agents and can be used to guide nurses to better support those who live with dementia. [ABSTRACT FROM AUTHOR]

Aim. To understand the uniqueness of the experience of testing HIV positive from the perspective of pregnant women. Background. As more people learn of their HIV diagnosis through routine screening processes, it is timely to reflect on the impact of receiving an unexpected positive result. Design. A prospective qualitative study. Methods. This paper draws on the case studies of four women who were participating in a larger prospective qualitative study of reproductive decision-making, pregnancy and childbirth following HIV diagnosis. Multiple interviews were conducted following diagnosis during pregnancy, and, after the birth of their babies. Thematic data analysis was undertaken. Results. Drawing on Becker's theory of disruption, we document the 'sudden disjuncture' of their antenatal diagnosis and the embodied emotional struggle the women engaged in to create continuity in their lives. A diagnosis of HIV disrupted the women's biographies in terms of their health, relationships and social identity. As pregnant women, the threat of HIV was experienced most significantly in relation to their unborn child. However, their narratives also revealed how a diagnosis of HIV in the context of pregnancy, whilst traumatic, provided a focus for regaining continuity in their lives, as the baby became a metaphor for hope and orientation toward the future. Conclusions. As HIV testing becomes more 'routine', the findings of this study serve to remind health professionals that a positive diagnosis continues to constitute a major trauma to individuals and families. Relevance to clinical practice. We propose that appropriately educated nursing and midwifery staff could facilitate the 'meaning making' process that is required for newly diagnosed HIV positive persons to find a subjective sense of well-being in their lives. [ABSTRACT FROM AUTHOR]

Aims and objectives. To document the narratives of nursing staff in a Thai rehabilitation centre where complementary therapies are used and to discuss perceived progress of these complementary therapies on stroke patients. Specific complementary therapies used at this rehabilitation centre include Thai massage and herbal therapies. Background. In Thailand, there is cultural acknowledgement of a range of traditional therapies (including complementary therapies) widely used in Thai health care. For example, meditation enjoys wide acceptance in Thai culture and attracts strong participation from visitors to Thai Buddhist centres because of growing interest in developing a personal health regime for future preventative health problems. Design. Qualitative study using narrative inquiry and discourse analysis framed by poststructural theory. Method. Six nursing staff and six stroke patients were interviewed about their involvement in complementary therapy practice and treatments and their experiences of these therapies in rehabilitation. This paper reports the six nurses' narratives of their involvement with patients and complementary therapies. Results. The overall findings revealed two strong themes: nurses' professional landscape and changes in stroke patients' embodiment. These two themes were interwoven in a main discourse of nurses attending to and enabling holistic care. Conclusion. The contexts of temporality, spatiality and other people influencing the progress of patients' recovery are significant in this study. In particular, the findings illustrate the importance of the nurses' discourse in preparing stroke patients for a state of readiness to heal. Relevance to clinical practice. The nurses' role becomes much more significant in health care as demonstrated through these stories. Their part in establishing a holistic approach through motivating, advising, educating, calming and imparting a sense of family enables a strong connection with mind, body and spirit potentiating recovery for stroke patients. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the nature of collaboration between registered nurses and general practitioners in Australian general practice. Background There is international recognition that collaboration between health professionals can improve care coordination, enhance health outcomes, optimise the work environment and reduce healthcare costs. However, effective collaboration requires a clear understanding of each team member's role. Design A qualitative approach guided by Naturalistic Inquiry was used to elicit and interpret participant narratives. Methods Eight general practitioners and fourteen registered nurses working in general practice were purposefully recruited. Data were collected via individual, semi-structured face-to-face interviews during February to May 2015. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Results Data revealed three overarching themes. This study presents the data for the overarching theme 'Understanding the general practice registered nurse's role'. Many general practitioner participants lacked clarity around the role and scope of practice of the registered nurse. At the same time, nursing participants often articulated their role as an assistant rather than as an independent health professional. This limited collaboration and the nurses' role within the team. Collaboration was enhanced when general practitioners actively sought an understanding of the registered nurses scope of practice. Conclusion Clarifying the nurses' role promotes collaboration and supports nurses to work to the full extent of their practice. This is important in terms of optimising the nurses' role within the team and reinforcing their professional identity. Relevance to clinical practice Identification of key issues around understanding the nurses' role may help inform strategies that improve collaboration and workplace relations. [ABSTRACT FROM AUTHOR]

Aims and objectives: To increase the knowledge on fidelity challenges in intervention studies promoting eating independence in residents with cognitive decline living in nursing homes (NHs). Background: A few studies have documented to date factors affecting fidelity in intervention studies performed in NH settings. Moreover, fidelity issues in intervention studies aimed at promoting eating independence among NH residents with cognitive decline have not been studied to date. Design: A hybrid study design was performed in 2018 and reported here according to the COnsolidated criteria for REporting Qualitative research. Methods: In a clustered multicentre before/after intervention study design, a nested, multicentre qualitative descriptive design was performed. Four researchers with a nursing background, who received appropriate training, implemented the designed intervention. This consisted in intentional rounds in the dining rooms during lunchtime and was based on supportive, prescriptive and informative prompts delivered to residents with cognitive decline aimed at stimulating eating independence. A momentary assessment method was used, based on daily diary filled in by participant researchers after every session of intervention delivery on the following five dimensions of fidelity: (a) adherence, (b) dose (or exposure), (c) intervention quality, (d) participant responsiveness and (e) programme differentiation. A direct content analysis of the narratives reported on the diaries was performed. Results: Factors increasing or hindering intervention fidelity during its implementation emerged at the NH, staff, family caregivers, resident, researchers and at the intervention itself levels. Conclusions: Several factors emerged and all reported potentially both positive and negative influences on fidelity while implementing an intervention aimed at promoting eating independence among NH residents. Fidelity challenges should be considered as dynamic in NH intervention studies, where continuous adjustments of the intervention delivered are required. Relevance to clinical practice: A calm environment, with staff members showing a caring behaviour, and researchers having achieved good familiarity with the NH setting, the residents, their family carers and the staff members, can all increase intervention fidelity. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the emotional experiences of parents who have had premature babies to inform and educate neonatal nurses and health professionals in this field. Background: Parents find the neonatal unit a daunting and unfamiliar place leading to anxiety, uncertainty and fear about the future of their baby. Parents have significant emotional needs in relation to assisting them to cope with their neonatal experience. In line with a family‐centred approach to neonatal education, it is essential to teach health professionals about the emotional impact of neonatal care based on an appreciation of the parent experience. Design: A narrative‐based, interpretive approach was undertaken in line with constructivist learning theory. Methods: Twenty narrative interviews took place, with a total of 23 parents of premature babies. Following core story creation to create coherent stories from the raw transcripts, thematic analysis of the narrative constructs using the principles of Braun and Clarke's, International Journal of Qualitative Studies on Health and Well‐Being, 2014, 9, 1, framework was undertaken. The study methods were compliant with the consolidated criteria for reporting qualitative research (COREQ). Findings: Thematic analysis revealed key themes relating to the following: parents' emotions through the whole neonatal experience, feelings towards the baby, the environment, the staff and the transitions through the different phases of neonatal care. Both negative and positive experiences were reported. Conclusion: Understanding the emotional experience from the parent's perspective, following birth of their premature baby, informs empathic, family‐centred teaching and learning within the neonatal education arena. Relevance to clinical practice: Students and health professionals alike can learn what is important in the delivery of care that addresses the emotional needs of parents and families. Educators can use narratives and key messages from parents, both negative and positive, to teach family‐centred principles to nurses and health professionals as a core component of a narrative curricula and potentially to enhance empathy. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate nurses' experiences of caring for older (65+ years) patients afflicted by delirium in a neurological department. Background: Delirium is a frequent, acute and potentially fatal condition. Patients experience delirium as painful and stressful. The literature shows that nursing care is crucial in the prevention and treatment of delirium. The nurses' approach to the patient with delirium is essential for the quality of care provided to the patient. Design: A qualitative, exploratory design was used to study the nurses' experiences of caring for patients afflicted by delirium. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Methods: A total of fourteen nurses participated in three focus groups. The nurses' narratives were used to elucidate their experiences, perceptions, attitudes and views towards the patient with delirium. The texts were analysed using thematic analysis. Results: The analysis revealed three themes: The relationship with the patient is challenged, expertise is requested, and barriers to cooperation exist. Conclusions: Nurses experienced a relationship with patients with delirium that was influenced by a lack of knowledge about communication with such patients. This resulted in a lack of person‐centred care and knowledge about the patient's habitual condition and life story; hence, nurses did not discover the patient's initial delirium. Inadequate and unstructured documentation did the nursing effort initiated late so the patient's delirium was developing. Uncertainty caused lack of dialogue between nurses, which afflicted the partnership and relation between the patient and the nurse. A fast pace workload affected relationships, knowledge, documentation and collaboration. Thus, the person‐centred approach to the patient was challenged, which made the provision of professional nursing care difficult. Relevance to clinical practice: A continuous focus on patients with delirium, as well as specialised care, based on factual knowledge about delirium is necessary. Hence, communication skills are required to accommodate this group of patients and their need for care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the experiences and needs of relatives being part of the endovascular therapy (EVT) pathway. Background: Ischaemic stroke is the third leading cause of death and the most common cause of acquired disability among adults in the Western world. The most recently approved treatment for major stroke is EVT. Removing the arterial occlusion has proven to be the best predictor of outcome. While patients are treated, relatives are left waiting. Facing the massive shock of their loved ones having a stroke may cause emotional turmoil and leave relatives with various needs. No previous studies have explored experiences and needs of relatives who are part of an EVT pathway. Design: A qualitative design using a phenomenological–hermeneutic approach. Methods: Semi‐structured interviews and participant observations were carried out. Data were collected from April 2016–January 2017. Data were analysed using Ricoeur's theory of interpretation, capturing meaning and ensuring comprehensive understanding. Results: Four themes emerged are as follows: (a) The first phase—shock, chaos and feeling paralysed; (b) the all‐important information—sharing is pivotal; (c) professional loving care—being seen and heard by caring health professionals; and (d) adjusting to new roles. One essential finding that emerged across all themes was relatives' constant need for care, for support and for health professionals to "be there." Conclusion: Relatives need support and care during the entire EVT pathway. They tend to be modest and ignore their own needs. Relatives who experience chaos, fear and worry need to be met by professionals with real presence. Relevance to clinical practice: These findings will be used as a foundation for development of local structures and policies that should provide knowledge and ensure a consistent and proactive approach to meet the needs of the relatives in a timely and efficient manner. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the lived experience of mothers of children who have survived Hodgkin lymphoma, from diagnosis, through treatment and recovery as she has lived it and in her own words and to discuss the self‐reported experiences in the context of the theoretical propositions of Attachment Theory and birth order as it applies to the mother–child dyad with this life experience. Background: While much has been written about childhood cancer survivors and their parents independently, there are unique struggles that a mother and a childhood cancer survivor face as a dyad. Examining the dyadic relationship over time offers a unique perspective to understanding the parenting experience with a child whose fate is uncertain. Design and Method: Narrative Inquiry was utilised to explore the bonds the mother has with her child before he or she is diagnosed with cancer, the relationship during treatment and the subsequent relationship when the child has entered survivorship. Most specifically, the research explored the attachment of the mother to her child as it relates to the Caregiving System. A purposive sample of 13 mothers of children diagnosed with Hodgkin lymphoma representing children from each birth order category (youngest child, middle child, oldest child and only child) was chosen. The interviews were analysed through thematic analysis with final themes identified. Results: Several core themes emerged from the narratives regardless of birth order. The most significant was the "need to protect." Additional themes were "things will never be the same," "unique bond," "shifting priorities" and "lost innocence." Conclusions and relevance to practice: The research shows activation of the Caregiving Behavioral Response System as it relates as a reciprocal to Attachment Theory. [ABSTRACT FROM AUTHOR]

Aims and objectives: To gain a better understanding of fear‐avoidance beliefs towards physical activity and body awareness in people experiencing moderate‐to‐severe rheumatic pain. Background: Rheumatoid arthritis and psoriatic arthritis are long‐term conditions with pain as the prominent symptom. Health‐promoting physical activity is recommended and can have an analgesic effect. High self‐rated pain has previously been reported to be associated with increased fear‐avoidance behaviour in relation to physical activity. Body awareness, which includes attentional focus and awareness of internal body sensations, could be valuable in the nursing care of long‐term diseases. Design: Empirical phenomenological. Methods: An empirical phenomenological psychological method was applied. The interviews took place between autumn 2016–spring 2017 with 11 informants (eight women and three men, age range 44–71 years) who were diagnosed with rheumatoid arthritis (n = 7) or psoriatic arthritis (n = 4), with a disease duration ranging from 3–35 years. The mean visual analogue scale score in the study sample was 60 mm. Results: Three typologies were identified: "My relatively fragile physical status", "I am an active creator" and "Part of something bigger than myself." Conclusions: The current findings indicated that pain anticipation and fear‐avoidance beliefs towards physical activity sometimes affected the behaviour of individuals with long‐term rheumatic pain syndromes. People experiencing moderate‐to‐severe rheumatic pain tended to focus on their fragile physical and emotional state. By adopting a more favourable attitude towards the self, the body could be restored to a state of calm and balance. Relevance to clinical practice: The current findings are relevant for healthcare professionals engaged in health‐promotion clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore service provision for Victorian regional refugee families from the perspective of maternal and child health nurses. Background: Increasingly, more families from a refugee background are resettling in regional Victoria. The refugee journey has significant effect on families. Refugee families with infants and young children can be provided with support by maternal and child health services; however, many families experience barriers to ongoing engagement with this service. Design: This descriptive study used focus group and questionnaire. A purposive sample of 26 maternal and child health nurses was drawn from six municipalities throughout regional Victoria, where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio‐recorded narratives were transcribed, prior to inductive thematic analysis. Methods: This descriptive study used focus group and questionnaire. A purposive sample of 26 Maternal and Child Health nurses was drawn from six municipalities throughout regional Victoria where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio‐recorded narratives were transcribed verbatim, prior to inductive thematic analysis. Results: Participating nurses were experienced nurses, averaging 12 years in the service. Four major themes emerged from thematic analysis: “How to identify women from a refugee background”; “The Maternal and Child Health nurse role when working with families from a refugee background”; “Interpreting issues”; and “Access to other referral agencies.” Nurses worked to develop a relationship with families, attending to a complex mix of issues which were complicated by language barriers. Nurses found their role in supporting refugee families required additional time and more home visits. Conclusions: To provide best practice, maternal and child health nurses need (i) ongoing professional development; (ii) time, flexibility and creativity to build relationships with refugee families and (iii) better access to services that enhance communication, such as interpreting services and translated resources. Relevance to clinical practice: Nurses require ongoing professional development to help them address the multifaceted needs of families of refugee background. With limited resources available in regional areas, accessing further education can be challenging. Distance education models and organisational support could provide nurses with educational opportunities aimed at improving service provision and clinical practice. [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 clarify strengths for promoting the recovery process among older adults with depression in Japan. Background: With the ageing of the global population, care and treatment of older adults with depression has been attracting increased attention around the world. It has become clear that the inner strength is inversely related to depression in older adults and that the use of inner strength is becoming a key concept in the context of caring for older adults with depression. Design: Qualitative descriptive design. Methods: Participant observation and narrative interviews were conducted individually with 12 older adults with depression in care‐based and daily life settings. The data obtained were subjected to thematic analysis using the narrative method to extract themes and subthemes. Results: A total of three themes and 12 subthemes were elucidated. Strengths found to promote the recovery process in older adults with depression were (i) a sense of emotional connection, (ii) dialogue with life and (iii) discovery. Conclusions: Strengths promoting the recovery process from a whole‐person perspective were clarified by conceptualising the experiences of older adults with depression with a strength orientation. A sense of emotional connection constituted a basis for promoting the recovery process. Dialogue with life and discovery were thought to represent the wisdom and spirituality found in the experience of old age and depression. Relevance to clinical practice: While regarding the results of this study as basic knowledge, focusing on subjects’ individual narratives of illness and recovery will open the possibility of a strength‐oriented nursing practice for older adults with depression and lead to the provision of care that promotes recovery. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate how fundamental aspects of nursing care have been defined in the literature from 2010–2016. Background: A 2010 narrative review of nursing texts identified little consensus on what constitutes the fundamental aspects of nursing care. Since then there has been a proliferation of policies, strategic frameworks and research teams dedicated to investigating such care. It is unclear whether this increased activity has led to greater conceptual clarity. Design: Scoping review using the Joanna Briggs Institute methodology. Methods: A search of published and grey literature was undertaken using CINAHL, Scopus, PubMed and ProQuest. Documents providing a definition for fundamental aspects of nursing care were included for review. Definitions were identified and mapped. Results: Forty‐nine documents were included. Two ways of constructing the discourse around fundamental aspects of nursing care were identified: compassionate care (n = 25) and fundamentals of care (n = 24). The literature on compassionate care focused primarily on the moral attributes of nurses and their ability to establish meaningful connections with patients. The literature on fundamentals of care was split between describing such care as a list of nursing activities and describing it as a complex, multidimensional construct. Conclusions: There appears to be a lack of consensus around how fundamental aspects of nursing care are defined. Compassionate care and fundamentals of care have commonalities in terms of emphasising the nurse–patient relationship; however, only the literature on fundamentals of care addresses patients’ physical care needs. Despite their commonalities, it seems the two bodies of work are being developed largely independent of one another. Relevance to clinical practice: This scoping review identified areas of convergence and divergence around fundamental aspects of nursing care. An agreed definition for such care is needed to enable the development of a robust evidence base to underpin the coherent and consistent development of nursing practice. [ABSTRACT FROM AUTHOR]

Aims and objectives: The project aimed to develop a unit‐level quality measurement and improvement programme using evidence‐based fundamentals of care. Background: Feedback from patients, families, whānau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board. Design: A general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whānau Centred Care Standards (PWCCS), focused on fundamental care. Methods: Five phases were used to explore the evidence, and design and test a measurement and improvement framework. Results: Nine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six‐monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n = 24) of units improved their overall result. Conclusion: The PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care. Relevance to clinical practice: Delivering fundamentals of care is described by nurses as getting ?back to basics'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit‐level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore patients’, families’ and health professionals’ experiences of a long‐stay patient in an intensive care unit. Background: The fast‐paced technologically driven intensive care unit environment, designed for a short patient stay, supports the provision of complex physiologically focused care for those with life‐threatening illnesses. Long‐stay patients with pronounced fundamental care needs fall outside predicted patient pathways, and nurses can find caring for these patients challenging. Design and methods: A longitudinal, qualitative, multicase study of six cases from four New Zealand units. Case participants were patients, family members, nurses and other health professionals. Data collection methods included observation, conversations, interviews and document review. Data were analysed using thematic analysis, vignette development and trajectory mapping. Results: Challenges and successes of providing fundamental care for long‐stay ICU patients are attributed to two interlinked factors. First, the biomedical model influences ICU nursing practices, resulting in prioritising tasks and technology for patient survival while simultaneously devaluing relational and comfort work. Fundamental psychosocial needs such as family presence, comfort, relationships and communication may be unmet. Second, the unit environment and culture have a significant impact on long‐stay patients’ ICU experiences and form physical and psychological barriers to families being present and involved. Some nurses negotiated these challenges to provide fundamental, patient‐ and family‐centred care by adopting an approach of knowing the patient and these nurses reported satisfaction when seeing patients’ positive responses. Conclusion: The care environment and culture provide challenges to the provision of patient‐ and family‐centred care for long‐stay patients; however, when nurses prioritise knowing their patient these challenges can be overcome and patient and family distress reduced with the potential to improve patient outcomes. Relevance to clinical practice: Recognition that patients have fundamental care needs irrespective of the setting where they receive care. Intensive care environments and cultures create challenges for nurses when there is such a heavy burden of physiological needs to be met and technological tasks to be undertaken, with a focus on acuity; however, improving provision fundamental care can result in positive patient outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine the effects of nursing interventions for people's nutrition, elimination, mobility and hygiene needs. Background: Patient experience of health care is sensitive to nursing quality. A refocus on fundamental nursing care is undermined by lack of evidence of effectiveness for interventions in core areas such as elimination, nutrition, mobility and hygiene. Design: Systematic review. Methods: We searched for and included experimental studies on interventions by professionally qualified and unregistered nurses that addressed participants' nutrition, elimination, mobility and hygiene needs. We extracted data on scope, quality and results of studies followed by descriptive narrative synthesis of included study outcomes using a novel form of harvest plots. Results: We included 149 studies, 35 nutrition, 56 elimination, 16 mobility, 39 hygiene and three addressing two or more areas simultaneously (67 randomised controlled trials, 32 non‐randomised controlled trials and 50 uncontrolled trials). Studies into interventions on participant self‐management of nutrition (n = 25), oral health (n = 26), catheter care (n = 23) and self‐management of elimination (n = 21) were the most prevalent. Most studies focussed their outcomes on observational or physiological measures, with very few collecting patient‐reported outcomes, such as quality of life, experience or self‐reported symptoms. All but 13 studies were of low quality and at significant risk of bias. The majority of studies did not define primary outcomes, included multiple measures of identical concepts, used inappropriate analyses and did not conform to standard reporting quality criteria. Conclusions: The current evidence for fundamental nursing care interventions is sparse, of poor quality and unfit to provide evidence‐based guidance to practising nurses. Relevance to clinical practice: Researchers in nursing internationally should now undertake a programme of work to produce evidence for clinical practice in the fundamentals of care that is reliable, replicable and robust. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe how nurses communicate with older patients and their relatives in a department of medicine for older people in western Sweden. Background: Communication is an essential tool for nurses when working with older patients and their relatives, but often patients and relatives experience shortcomings in the communication exchanges. They may not receive information or are not treated in a professional way. Good communication can facilitate the development of a positive meeting and improve the patient's health outcome. Design: An ethnographic design informed by the sociocultural perspective was applied. Methods: Forty participatory observations were conducted and analysed during the period October 2015–September 2016. The observations covered 135 hours of nurse–patient–relative interaction. Field notes were taken, and 40 informal field conversations with nurses and 40 with patients and relatives were carried out. Semistructured follow‐up interviews were conducted with five nurses. Results: In the result, it was found that nurses communicate with four different voices: a medical voice described as being incomplete, task‐oriented and with a disease perspective; a nursing voice described as being confirmatory, process‐oriented and with a holistic perspective; a pedagogical voice described as being contextualised, comprehension‐oriented and with a learning perspective; and a power voice described as being distancing and excluding. The voices can be seen as context‐dependent communication approaches. When nurses switch between the voices, this indicates a shift in the orientation or situation. Conclusion: The results indicate that if nurses successfully combine the voices, while limiting the use of the power voice, the communication exchanges can become a more positive experience for all parties involved and a good nurse–patient–relative communication exchange can be achieved. Relevance to clinical practice: Working for improved communication between nurses, patients and relatives is crucial for establishing a positive nurse–patient–relative relationship, which is a basis for improving patient care and healthcare outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the perceived unfairness experienced by student nurses during their undergraduate clinical placements. Background: It is important that student nurses feel supported by practice staff during their clinical placement education experiences. However, it has been reported that learners can feel ignored, unsupported and bullied by others in the clinical environment and this has a detrimental effect on their learning. It is important to understand the student nurse perspective and explore ways in which their feelings of belongingness might be enhanced in the clinical area. Design: A descriptive narrative approach was used to explore the qualitative data generated by the survey and interviews. Limited closed‐question survey data were acquired to explore a selection of quantified survey responses about placements and mentorship. Methods: A survey was conducted with 1,425 student nurses from adult and mental health degree nursing pathways, across nine institutions in the North West of England, UK. Unstructured interviews were undertaken with 22 student nurses from across these nine institutions. The data generated from both methods (free‐text survey responses and interview) were thematically analysed. Results: There were times when student nurses felt that they had been treated unfairly by various members of the healthcare team during their clinical placements. Unfairness was related to being ignored and unsupported or being used as an “extra pair of hands” and having their supernumerary status ignored. Student nurses want to have feelings of belongingness in the clinical area and value enthusiasm for teaching from mentors. Certain positive mentor qualities were identified through the data in this study. These have been used to inform a tiered model of mentorship, to inform future thinking about student nurse education. Conclusion: Student nurses can feel like they are being treated unfairly in the clinical area in numerous ways. Identifying ways in which mentorship practice can be developed to adequately support education is important. This can lead to satisfaction and development on both sides of the student/educator relationship. Relevance to practice: Exploring student nurse perceptions of their learning is important when attempting to enhance educational practice in the clinical setting. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe and explore the experience of healthcare encounters in families living with chronic illness. Background: Living with chronic illness is a family concern and often includes frequent encounters with healthcare professionals. These encounters affect how persons with illness and family members handle everyday life. Disease-related explanations are perceived by healthcare professionals as being of higher importance than the actual experience of illness, even though patients are concerned with issues involving their everyday life. Design: A descriptive design with a qualitative approach. Methods: Narrative family interviews were conducted with twelve families, using a qualitative content analysis. Results: One main category was indicated following analysis, specifically “The impact of an accompanying family member.” Additionally, three subcategories were revealed; “The importance of collaboration,” “Mutual understanding,” “A desire to be confirmed in one’s illness”. Conclusions and relevance to clinical practice: Having a participating family member increased the sense of power in families during encounters with healthcare professionals. This participation constitutes a level of support, making it easier for families to handle everyday life due to illness. Family members are, in most cases, included in discussions and decisions, both before and after encounters, and it should be a natural for healthcare professionals to invite them to the encounter too. This is an offer that may not fit every family, but the person with illness or the family should at least have the opportunity to choose. [ABSTRACT FROM AUTHOR]

Aims and objective: To illuminate what it means to live with a resected rectum due to rectal cancer, after reversal of a temporary loop ileostomy. Background: Today, treatment for rectal cancer is performed with increasing emphasis on sphincter-saving surgery, meaning that an anterior resection often includes construction of a temporary loop ileostomy that is later reversed. The majority of patients will subsequently have disordered bowel function, with symptoms ranging from urgency to faecal incontinence. The symptoms are thought to decrease over time, reaching a plateau 1 year after surgery. There is a lack of knowledge about patients’ lived experience after 1 year. Design: An explorative qualitative study. Methods: In-depth interviews were conducted with ten participants, 12–20 months after surgical closure of a temporary loop ileostomy following rectal cancer surgery. The transcribed interviews were analysed using a phenomenological hermeneutical method. Results: The thematic structural analysis resulted in three themes: living with uncertainty, struggling to live with altered bowel function and a preoccupation with bowel function. In the comprehensive understanding, a deeper overall understanding emerged, illuminating that the meaning of living with a resected rectum could be interpreted as being resilient. Conclusions: The participants’ lived experiences were understood as being resilient in that they struggled with the uncertainty and adversity of living with an unpredictable bowel, which was a constantly preoccupation and affected every aspect of life. The participants had not yet adapted to their situation but were struggling in solitude to get there, with little or no help from healthcare professionals. Relevance to clinical practice: The insight from this study highlights the importance of patients being systematically examined and followed up in regard to functional results and impact of symptoms on everyday life. Treatment, information, advice and counselling should be given to promote adaption to the new situation. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the experiences of patients who have failed to maintain weight loss following the insertion of a laparoscopic adjustable gastric band (LAGB) for the treatment of morbid obesity. Background: Obesity is a global health problem resulting in physical, psychological and economic problems and presenting challenges for health services. Surgical intervention is an increasingly common approach to treatment; however, some patients do not sustain their weight loss following bariatric surgery and little is known about people’s longer-term experiences following LAGB insertion. Design: A narrative-based qualitative interview study. Methods: A purposive sample of ten participants who had undergone LAGB insertion for morbid obesity was recruited. Semistructured interviews were conducted in 2014. Thematic analysis identified codes and emerging themes common to the participants’ experiences. Findings: Three major themes emerged: living with the side effects, regret and lack of support. These reflect the difficulties participants experienced and provide new insights on why weight loss is not sustained after 2 years following surgery. Conclusion: Participants reported that the surgery had a detrimental effect on their lives and some regretted having the band inserted. These findings identify areas of care that need to be addressed if patients undergoing LAGB are to experience its potential benefits and indicate that further research is needed into the long-term effects of gastric band insertion. Patients need to be better informed about the consequences of bariatric surgery if it is to have a lasting impact on their weight reduction. Relevance to clinical practice: Patients require comprehensive information and support before and after LAGB insertion to develop strategies which will help them lose weight and sustain it over the longer term. Clinicians need to be sensitive to patients’ needs when weight loss plateaus or weight is regained and intensify support during these periods. [ABSTRACT FROM AUTHOR]

Aims and objectives To report parent and professional perspectives of step-down care in assisting the transition from hospital to home, within one children's hospice in a constituent country of the United Kingdom. Background In recent years, increasing numbers of children-dependent on long term assisted ventilation have been noted. Meeting the complex physical, emotional and social needs of the child and family is challenging. Many of these children spend extended periods in hospital even when medically stable. Design This was a qualitative study using an inductive, semantic analytic approach within a realist epistemology. Methods Data collection was carried out in 2013. Interviews took place with parents ( n = 5) and focus groups with professionals ( n = 26) who had experience of step-down care. Results Multiple benefits of step-down in the hospice were clear. Both sets of accounts suggested that for children and families life was 'on hold' in hospital. Hospice was considered a home-like environment where the child and family could 'live again'. Parents reflected that, in hospice they were 'living, not existing' while professionals highlighted hospice as nurturing and empowering the whole family, promoting the child's development while safely meeting their clinical needs. Conclusions and relevance to clinical practice The study highlights a number of crucial benefits to the child and family both in the immediate and longer terms. The collective perspectives therefore endorse hospice as a potential viable choice for these children and their families during the always difficult, usually protracted transition from hospital to home. [ABSTRACT FROM AUTHOR]

Aims and objectives To implement and evaluate the effect of using the Person-Centred Situational Leadership Framework to develop person-centred care within nursing homes. Background Many models of nursing leadership have been developed internationally in recent years but do not fit with the emergent complex philosophy of nursing home care. This study develops the Person-Centred Situational Leadership Framework that supports this philosophy. It forms the theoretical basis of the action research study described in this article. Methods This was a complex action research study using the following multiple methods: nonparticipatory observation using the Workplace Culture Critical Analysis Tool ( n = 30); critical and reflective dialogues with participants ( n = 39) at time 1 (beginning of study), time 2 (end of study) and time 3 (6 months after study had ended); narratives from residents at time 1 and time 2 ( n = 8); focus groups with staff at time 2 ( n = 12) and reflective field notes. Different approaches to analyse the data were adopted for the different data sources, and the overall results of the thematic analysis were brought together using cognitive mapping. Results The Person-Centred Situational Leadership Framework captures seven core attributes of the leader that facilitate person-centredness in others: relating to the essence of being; harmonising actions with the vision; balancing concern for compliance with concern for person-centredness; connecting with the other person in the instant; intentionally enthusing the other person to act; listening to the other person with the heart; and unifying through collaboration, appreciation and trust. Conclusions This study led to a theoretical contribution in relation to the Person-Centred Practice Framework. It makes an important key contribution internationally to the gap in knowledge about leadership in residential care facilities for older people. Relevance to clinical practice The findings can be seen to have significant applicability internationally, across other care settings and contexts. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe rural and urban palliative/hospice care nurses' communication strategies while providing spiritual care for patients and families at end of life. Background Nurses aim to provide holistic care consisting of physical, psychological and spiritual components. However, it is well documented that spiritual care is largely missing from nursing care. Internationally, spiritual care is a growing topic of interest, yet many nurses feel unprepared to deliver spiritual care. Design This qualitative study used Braun and Clarke's thematic analysis method. Methods As part of a larger multimethod study, this study shares the narrative descriptions from 10 experienced palliative/hospice care nurses. Individual, face-to-face interviews were conducted and lasted 45-60 minutes. Each interview started with the same lead-in questions, was audio-recorded and was transcribed verbatim. The research team used an inductive analysis approach and met several times reviewing and analysing the detected themes until reaching consensus. Results The primary theme, sentience includes the capacity to act, a willingness to enter into the unknown and the ability to have deep meaningful conversations with patients regardless of the path it may yield. Subthemes include: (i) Willingness to Go There, (ii) Being in 'A' Moment and (iii) Sagacious Insight. Conclusion Nurses are integral in the provision of spiritual care for patients/families across the lifespan and at end of life. Nurses must feel confident and competent before they are willing to enter uncomfortable spaces with patients/families. Nursing curriculum must include purposeful engagement and focused debriefing in spiritual assessment and care. Relevance to clinical practice There is a dire need to prepare undergraduate and graduate students to assess and support a patient's spiritual needs. Addressing spiritual care content as a clinical and educational priority will promote a patient-centred approach for spiritual care and can further shape nursing curricula, policies, guidelines and assessment tools. [ABSTRACT FROM AUTHOR]

Aim and objective The aim of this study was to examine how hospitalised, surgical lung cancer patients experience talking to a former patient, and how the former patient experiences the role as supportive. Background During hospitalisation, patients often create a community in which they can engage with fellow patients. The exchange of experiences with others in a similar situation might increase opportunities for support and complement nursing care, but there is a need for more evidence and understanding on the topic. Design The methodological framework is based on the French philosopher Paul Ricoeur's text interpretation theory. Qualitative interviews were conducted with nine patients, including a peer informant, using a narrative structure. The analysis was conducted on three levels: (i) naïve reading, (ii) structural analysis and (iii) critical interpretation . Results Four themes were developed from the analysis of the interviews: Exchanging emotional thoughts is easier with a peer; Talking to a peer reduces loneliness; Being ambiguous about a relationship with fellow patients; and Being the main person in the conversation with a peer. Sharing stories about having similar symptoms and undergoing similar journeys predominated, and the key feature of the contact between patients was the commonality of their stories. Critical interpretation and conclusion Telling one's story to a former patient, and thereby creating a joint, common story, is the essence of this study. The support received in this process can be empowering because knowledge of the illness experience is shared and increased. This can help create new coping strategies. The contact with a former patient offered a way to confirm one's thoughts and to find a way out of the illness perspective, by seeing how the former patient had recovered. Relevance to clinical practice The nursing field faces challenges in the relational aspect of caring because of ever greater efficient and shortened hospital stays; therefore, the peer support concept is becoming increasingly relevant. Patient peers offer each other their own perspectives, and it is important to raise awareness of the value of this and incorporate it into patient stays in hospital. [ABSTRACT FROM AUTHOR]

Aims and Objectives To explore the concept of role modelling in undergraduate nurse education and its effect on the personal and professional development of student nurses. Background Effective educative strategies are important for student nurses, who have to cope with learning in both clinical and university settings. Given the contemporary issues facing nurse education and practice in the United Kingdom (UK), it is timely and important to undertake pedagogical research into the concept of role modelling as an effective educative method. Design A descriptive narrative approach. Methods Unstructured interviews were conducted with 14 current/recently discontinued students from Adult and Mental Health branches of nursing degree programmes in the north-west region of England, United Kingdom (UK). Data were thematically analysed. Results Students valued exposure to positive role models in clinical and university settings and viewed them as beneficial to their learning. Exposure to negative role models occurred, and this provided students with opportunities to consider the type of nurse they aspired to become. In some cases, students' exposure to perceived poor practice had an adverse effect on their learning and led to negative feelings about nursing work. Clinical staff might be perceived as more relevant role models than those in the university setting although there were still opportunities for academic staff to model professional behaviours. Conclusion The study found that role modelling is an effective way to support learning and led to student satisfaction across both clinical and university settings. The findings support the use of role models in nurse education, and further research about conscious positive modelling of practice is required. Relevance to practice Exploring the use of role models is important when examining ways in which the quality of nurse education might be developed. [ABSTRACT FROM AUTHOR]

Aims and Objectives This study investigated experiences of women with a primary diagnosis of ACS ( NSTEMI and Unstable Angina) in the 6-8 week period following discharge from hospital. The aim was to report the experience of the mediating impact of a newly-diagnosed disease. Background Cardiovascular disease is the main cause of mortality in women. Treatment modalities have improved health outcomes and survival rates, however, quality of life and ongoing morbidity after discharge is not clearly understood from a gender specific perspective. Design A naturalistic case study design guided this study. Methods Thirty women participated ( n = 30); a within-case followed by a cross-case analysis provided meticulous knowledge of each case. Data collection included participant diaries and face to face interviews. Data were analysed using modified analytic induction which allowed the emergence of theoretical insights. The theoretical concepts, liminality and transitioning were used to inform the analysis. Within-methods triangulation captured the depth and breadth of the women's experiences. Results The data provide an insight into women's experiences following ACS and highlight a need for support structures and services after discharge. Many women reported a period of disrupted normality following discharge from hospital. While a number of women had transitioned towards recovery, many remained in a liminal space 'betwixt and between' health and illness. Cardiac rehabilitation was reported as a positive experience for those who were attending. Conclusions The findings provide a platform for a wider discourse on the needs of women with ACS in the immediate period after discharge from hospital. Women may benefit from gender-specific, appropriately timed, and targeted interventions to facilitate recovery and adaptation to living with CHD. Relevance to clinical practice It is essential that secondary prevention services are modelled and tailored to meet the needs of women and evaluated appropriately to ensure positive outcomes. Nursing could have a key role to play in managing and providing this support. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the contribution of clinical nurse specialists in intellectual disability nursing in Ireland. Background While clinical nurse specialists exist since the 1940s, they have only been a reality in Ireland since 2001. While the role of clinical nurse specialist has developed over the years, it still however is often seen as a complex multifaceted role that causes confusion, frustration and controversy. Design A exploratory qualitative approach using focus groups with Irish intellectual disability clinical nurse specialists (n = 31). Methods Five focus group interviews were conducted to gather qualitative data to gain insight into the attitudes, perceptions and opinions of the participants. Data were audio-recorded, transcribed and analysed using Burnard's (Vital Notes for Nurses: Research for Evidence-Based Practice in Healthcare, 2011, Blackwell Publishing, Oxford) framework. Ethical approval was gained from the researcher's university and access granted by the national council for the professional development of nursing/midwifery in Ireland. Results The study highlights that intellectual disability clinical nurse specialists contribute to and support care delivery across a range of areas including client-focused and family-centred care, staff support, organisation support, community support and supporting other agencies. Conclusions Overall, the study shows the importance of intellectual disability clinical nurse specialists and their contribution across a range of services, care environments and the support they offer to clients/families/staff/multidisciplinary team members and outside agencies. Relevance to clinical practice Ireland is in a unique position to develop knowledge regarding specialist care for people with intellectual disability that can be shared and adapted by other healthcare professionals in other countries that do not have specialised intellectual disability nurses. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore women's stories of contracting a sexually transmitted infection from a male partner and elucidate the gendered constructs and violence experienced that made the women vulnerable to these infections. Background Violence against women can result in both physical and psychological consequences and expose women to multiple health risks including sexual health adversity. Design Feminist storytelling approach. Methods Qualitative interviews were conducted with 10 women. All data underwent thematic analysis. Findings Findings from this study revealed the women were vulnerable to contracting sexually transmitted infection/s from their male sexual partners as a result of unequal gender and abusive relationship dynamics. Subsequently, contracting a sexual infection within this context potentially increased their vulnerability in both current and future relationships, through their loss of self-confidence and perceived ability to have a trusting loving heterosexual relationship as women with sexually transmitted infection/s. Conclusion Women in relationships in which they are subordinate to their male partner are at heightened risk of sexual health adversity, including contracting a sexually transmitted infection. Contracting a sexually transmitted infection within the context of an abusive relationship can further increase women's vulnerability to dominant male partners, thus further exposure to sexual risk and adversity. Relevance to clinical practice Nurses working in clinical settings are well placed to conduct opportunistic screening of women's sexual health, including assessment of sexually transmitted infections and the nature of the encounter in which they were contracted. Thorough assessment can potentially identify relationship and personal factors that can increase a woman's risk to both sexual adversity and forms of abuse. Also, if women do divulge that they have suffered abuse, nurses are positioned to provide support and guidance in implementing strategies to minimise risk as well as referring them to specialised services. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore in detail how women perceived their experience of domestic violence and leaving or ending the abuse. This research also examined how service providers identified their professional role in assisting women to end such relationships. Background Domestic violence against women continues to occur internationally. Reliable statistics are difficult to capture because of inconsistent definitions, contradictory methods of acquiring data and unreported incidents. Design A qualitative study, undertaken in two phases, was conducted in Australia. Methods Twelve women who had experienced domestic violence and ended those relationships participated in one semistructured interview (Phase 1). Twenty-five professionals from health, social sciences and law, whose work included assisting women experiencing domestic violence, participated in three focus groups (Phase 2). Thematic analysis guided by a narrative inquiry approach forms the framework for information collection and interpretation of data in this project. Findings The barriers that impede women from disclosing abuse and taking action to end domestic violence are complex and varied between participants. Women did not always acknowledge or realise their relationship was precarious and often denied or minimised the abuse to cope with the domestic violence. Professionals identified that women did not always identify or acknowledge abuse inherent in their relationship although this delayed the provision of appropriate services. Conclusion Whether women disclose abuse or deny violence in their relationship, acceptance by service providers and the offer of support is crucial to assisting women in violent relationships. Relevance to clinical practice It is hoped that the findings may assist health practitioners, including nurses, to provide nonjudgemental support to women experiencing domestic violence whether women acknowledge the abusive relationship or not. [ABSTRACT FROM AUTHOR]

Aims and objectives To research the quality of life of Spanish women with coeliac disease. Background Women with coeliac disease express lower quality of life than men with coeliac disease. Design Explanatory sequential approach using mixed methods and with a gender perspective. Methods The research was carried out between May and July 2015. In its quantitative stage, it aimed to determine the health-related quality of life in a representative sample ( n = 1097) of Spanish adult women with coeliac disease using a specific questionnaire named Coeliac Disease-Quality of Life. In its qualitative phase, it aimed to describe the life experiences of a woman with coeliac disease in a qualitative manner by means of interviews ( n = 19) with a semistructured script. Quantitative data were analysed using spss version 20 and presented in descriptive statistics. Qualitative data were analysed using the directed content analysis. Results The quantitative process gave us the values on the four aspects studied: dysphoria, disease limitations, health problems and inadequate treatment. These aspects allowed us to create a qualitative process, based on which we generated an interview, from which four larger categories emerged. These categories were feelings at diagnosis, limitations in day-to-day life, social perceptions of the disease and personal meanings of coeliac disease. Thus, both phases of our project are totally connected. There was a high level of congruence between quantitative scores and narratives. Conclusion This study shows us the strong points of mixed-methods strategy in health sciences. The mixed-methods strategy gave us a wider view of the experience of women living with coeliac disease. In our case, a strength and not a limitation is having performed the quality of life study in women with coeliac disease using a mixed methodology, approaching the experience of being a woman with coeliac disease in Spain in two different but complementary ways. The quantitative and qualitative data allowed us to interpret the experiences of our participants. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine disease-related stress, coping strategies and the need for information and support in patients with inflammatory bowel disease (ulcerative colitis or Crohn's disease). Background Psychological stress is an important factor in ulcerative colitis and Crohn's disease, and therefore, coping strategies and support needs should be considered in routine clinical practice. Design This is a qualitative study using a descriptive interview-based approach. Method Fifteen patients with ulcerative colitis ( n = 7) or Crohn's disease ( n = 8) were interviewed. The interviews were analysed with content analysis. Results The informants largely focused on disease-related stress (e.g. access to a toilet, symptoms and worries) and relations to other people (various reactions from others and social situations). Behavioural strategies (i.e. taking actions and the need for making plans, prepare and adapt), social strategies (seeking help and information and sharing feelings about the disease with others) and emotional strategies (distraction, positive attitude and acceptance) were adopted to cope with the stress associated with the disease. The need for information and support concerned instrumental support (disease-related information) and emotional support (to talk about disease management). Conclusion Faecal urgency and the fear of losing bowel control are important stressors for patients with inflammatory bowel disease. The patients handle this problem using various coping strategies depending on the type of stressful events. Both instrumental and emotional support were requested which primarily occurred at the time of diagnosis and disease flare-ups. Relevance to clinical practice Patients with ulcerative colitis or Crohn's disease ask for information and psychosocial support that are tailored to their individual needs and at different stages in the disease trajectory to improve everyday life and strengthen self-management strategies. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the content of former intensive care unit patients' memories of delusions. Background Intensive care unit patients often have strange and frightening experiences during the critical stage of illness. Earlier studies have provided small-sample in-depth descriptions of patient experiences in intensive care unit, but large-scale studies are also needed to inform intensive care unit follow-up. Methods The study had a qualitative design using phenomenological hermeneutic analysis inspired by Ricoeur's interpretive theory. Patients were assessed with Confusion Assessment Method of the Intensive Care Unit for delirium in intensive care unit, and after discharge, memories of delusions were described by 114 of 325 patients in face-to-face (after two weeks) and telephone interviews (after two and six months) using the Intensive Care Unit Memory Tool. Results Four themes emerged: the ever-present family, dynamic spaces, surviving challenges and constant motion. Memories of delusions were a vivid mix of fact and fiction, demonstrating dynamic shifts in time, place and motion, but not dependent on the presence of delirium assessed by Confusion Assessment Method of the Intensive Care Unit. Conclusions Analysis based on Ricoeurian phenomenological hermeneutics provided insights into themes in intensive care unit patients' memories of delusions. More studies are needed to understand the meaning of memories of delusions, the commonality of themes and the association between delusions and delirium after an intensive care unit stay. Relevance to clinical practice Understanding patients' memories of delusions is beneficial to nurses caring for patients that are anxious, upset or agitated. It opens a window to the world of the patient who is unable to communicate due to intubation and general weakness. We recommend the provision of nurse-led intensive care unit follow-up enabling patients to describe and discuss their intensive care unit experiences. [ABSTRACT FROM AUTHOR]

Aims and objectives This study aimed to explore patients' experiences of healthcare encounters in severe irritable bowel syndrome. Background Irritable bowel syndrome is a common functional disorder with symptoms such as abdominal pain and disturbed bowel habits, the cause of which is not completely known. Treatments options are limited, and healthcare encounters in irritable bowel syndrome have been described as unsatisfying and frustrating for both patients and professional healthcare providers. Furthermore, the influence of power on healthcare encounters has long been recognised, especially regarding the disadvantaged position of those suffering from functional illness which cannot be identified by commonly used tests or investigations. Methods We interviewed 10 patients during 2014, all attending an outpatient clinic and suffering from severe irritable bowel syndrome. Relying on narrative and feminist theory, we explored how they actively negotiate professional discourse communicated to them in the clinical encounter. Results The patients' experiences of healthcare encounters in irritable bowel syndrome were mostly described as negative, and often induced feelings of confusion and self-doubt. Positive encounters were described as being listened to, believed and taken seriously. Narrators found it especially problematic when healthcare professionals described irritable bowel syndrome as a minor disorder with primarily stress or psychological aetiology and put the responsibility for recovery onto the patient. Patients' actively negotiated such professional discourse by presenting a counternarrative describing their own suffering and strengths, experienced healthcare shortcomings and possible organic aetiology of irritable bowel syndrome. Conclusions Patients suffering from severe irritable bowel syndrome described how they often felt a need to protect their positive identities in the face of trivialisation and disbelief by healthcare professionals. Relevance to clinical practice A deepened understanding of patients' experiences of healthcare encounters in irritable bowel syndrome could enable more helpful and supporting interventions by healthcare professionals. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore how clinical leaders enact aesthetic leadership in clinical nursing workplaces. Background. Clinical leadership is heralded as vital for safe and effective nursing. Different leadership styles have been applied to the clinical nursing workplace over recent years. Many of these styles lack an explicit moral dimension, instead focusing on leader qualities and developing leader competence around team building, quality and safety. Aesthetic leadership, with its explicit moral dimension, could enhance clinical leadership effectiveness and improve nursing workplaces. How aesthetic leadership is enacted in clinical nursing settings requires exploration. Design. A qualitative design, employing conversation-style interviews with experienced registered nurses and written responses gathered from an online descriptive survey. Methods. Narrative data were gathered from interviews with 12 registered nurses and written accounts from 31 nurses who responded to an online survey. Together, transcribed interview data and the written accounts were subject to thematic analysis. Results. Three main themes emerged: Leading by example: 'be seen in the clinical area'; Leading with composure: 'a sense of calm in a hideous shift'; and Leading through nursing values: 'create an environment just by your being'. Conclusions. Aesthetic leadership was shown to enhance clinical leadership activities in the nursing workplace. The capacity for clinical leaders to be self-reflective can positively influence the nursing workplace. It was apparent that clinical leader effectiveness can be enhanced with nursing values underpinning leadership activities and by being a visible, composed role model in the clinical workplace. Relevance to clinical practice. Aesthetic leadership can enhance clinical nursing workplaces with its explicit moral purpose and strong link to nursing values. Clinical leaders who incorporate these attributes with being a visible, composed role model have the capacity to improve the working lives of nurses across a range of clinical settings. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this article was to present and discuss findings on what individuals with dementia do by themselves to maintain or promote their dignity of identity when they live in a nursing home. Background The majority of residents living in Norwegian nursing homes suffer from dementia. Individuals who suffer from dementia are particularly vulnerable, and their dignity of identity is at risk. It is therefore of great importance to explore how we can maintain their dignity of identity. Design The study builds on a phenomenological and hermeneutic design. Methods The article reports three cases or life stories based on participant observation in two different nursing homes and interviews with five residents with dementia living in these nursing homes. Fifteen residents with dementia from these nursing home wards were included in the overall study. Results Individuals with dementia living in nursing homes may use life storytelling or narratives to manage chaos and to find safety in their lives. Storytelling is also used as a way to present and maintain identity. We can see this as a way of maintaining dignity of identity or social dignity. Conclusion Life storytelling can be seen as an important way of preserving dignity for people with dementia. It is of great importance that health care professionals are open to and listen to the life stories people with dementia tell. Relevance to clinical practice As nurses we have an obligation to ensure that dignity is enhanced in care for people with dementia. Knowledge about how residents with dementia use life storytelling as a way to maintain dignity is therefore of great importance to health care workers in nursing homes. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the process of learning to speak up in practice among newly graduated registered nurses. Background Speaking up is an important aspect of communication to ensure patient safety within a healthcare team. However, nurses have reported being hesitant about speaking up or being unable to be heard, despite adopting various safety tools. A power differential could be a factor in their hesitation to speak up. While a large number of new graduates are employed in the lower rungs of the hospital hierarchy to resolve local and global nursing shortages, the process of their learning to speak up remains under-explored. Design The narrative concept of experience is addressed through the three-dimensional space of a narrative inquiry. Methods Eighteen new graduates were recruited. Stories of experiences of speaking up emerged naturally during repeated unstructured interviews and ongoing email conversations with three participants. Results The complex process of learning to speak up is schematically represented. Three interrelated narrative threads were identified: (1) learning to speak up requires more than one-off training and safety tools, (2) mentoring speaking up in the midst of educative and miseducative experiences and (3) making public spaces safe for telling secret stories. Conclusions Speaking up requires ongoing mentoring to see new possibilities for sustaining professional identities in the midst of miseducative experiences under the potential shaping of the Chinese culture and generational differences. Appreciative inquiry might be a new approach that can be used to promote positive cultural changes to encourage newly graduated registered nurses to learn to speak up to ensure patient safety. Relevance to clinical practice Cultivating a safe and open culture of communication and mentoring new graduates to speak up will benefit patient safety now and in the future by helping to retain committed patient advocates who could mentor future generations. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this exploratory research was to understand how men experience their advanced cancer in relation to their perceptions of masculinity. Background There are differences in the way men and women experience illness and health care. There are inequalities in incidence and morbidities of many diseases as well as differences in rates of help-seeking behaviours. Theories on masculinity offer some explanation towards this. Men's experiences of advanced cancer in relation to masculinity are under reported, published literature suggests that there are certain issues or men dealing with advanced disease that justify investigation. Design A Qualitative approach using a Husserlian Phenomenological design was conducted. Sample Eight men (aged 26-68) all with advanced cancer, defined as advanced or metastatic disease for which the patient had exhausted all standard therapeutic options. Methods In-depth interviews were conducted to capture narratives of the experiences of men. Data were analysed using Colaizzi's seven stage framework. Results Themes included thwarted ambition, changing expectations, protection and provision, stoicism and coping, images of illness versus images of masculinity, importance of being a fighter and loss. Conclusion Findings showed that the experiences of these men were complex and should be handled sensitively. Ideas for gender-specific interventions and further research were developed from the findings in relation to current literature. Relevance to clinical practice A better understanding and awareness of this in this context will help nurses to consider more subtle challenges that these patients may be dealing with that in turn could affect how they cope with the burden of cancer. [ABSTRACT FROM AUTHOR]

Aims and objectives To illuminate children's experiences prior to colonoscopy. Background It is well known that children need to be well prepared before undergoing stressful medical procedures, and the goal of such preparations should focus on minimising their level of anxiety. The clinical investigation of children with suspected inflammatory bowel disease involves several steps, with colonoscopy being routinely used to investigate the colon and the lower part of the small intestine. To minimise children's anxiety during various medical procedures, it is important that information about their experiences is obtained directly from the children themselves. Design A qualitative study. Method The study was designed as a qualitative interview study involving 17 children aged 10-17 years undergoing colonoscopy at a children's university hospital in Sweden. Verbatim transcripts were analysed using content analysis. Results The children's experiences prior to colonoscopy were identified as belonging to an overall theme, a private affair, and to four categories: preparing yourself, mastering the situation, reluctantly participating and feeling emotional support. Conclusion This study shows that children's experiences prior to colonoscopy are a private affair and that the preparation needs to be individually adapted for the 'preprocedural' preparation to be comprehended. Relevance to clinical practice The children's experiences ascertained in this study can contribute to a greater understanding of children's needs prior to a colonoscopy and may provide professional care staff with the basis for future nursing assessments. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the application of a Multidimensional Model of Clinical Leadership on the community healthcare leader and on transforming community services. Background Healthcare policy advocates clinical leadership as the vehicle to transform community and healthcare services. Few studies have identified the key components of an effective clinical leadership development model. Design The first two stages of Kirkpatrick's ( Personnel Administrator 28, 1983, 62) Four/Five Levels of Evaluation were used to evaluate the application of the multidimensional model of clinical leadership. Methods Eighty community healthcare leaders were exposed to this multidimensional clinical leadership development model through attendance of a community clinical leadership development programme. Twenty five leaders participated in focus group interviews. Data from the interviews were analysed utilising thematic content analysis. Results Three key themes emerged that influenced the development of best practice principles for clinical leadership development: Personal leadership development, Organisational leadership, The importance of multiprofessional action learning/reflective groups, Conclusions Emergent best practice principles for clinical leadership development include adopting a multidimensional development approach. This approach encompasses: preparing the individual leader in the role and seeking organisational leadership development that promotes the vision and corporate values of the organisation and delivers on service improvement and innovation. Moreover, application of the Multidimensional Model of Clinical Leadership could offer the best platform for embedding the Six C's of Nursing ( Compassion in Practice - Our Culture of Compassionate Care, Department of Health, Crown Copyright, 2012) within the culture of the healthcare organisation: care, compassion, courage, commitment, communication, and competency. This is achieved in part through the application of emotional intelligence to understand self and to develop the personal integrity of the healthcare leader and through supporting a culture of lifelong leadership learning. Relevance to clinical practice Embedding the best practice principles of clinical leadership development within a multidimensional model of clinical leadership provides a promising approach to: equipping the healthcare leader with those transferable leadership skills required to help them embark on a journey of lifelong leadership learning; and producing the healthcare leader who is caring, compassionate and can confidently and effectively transform community services. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe patients' experiences from symptom onset to initial treatment for atrial fibrillation. Background The estimated number of individuals with atrial fibrillation globally in 2010 was 33·5 million. World-wide, each year, new cases of atrial fibrillation approach 5 million, and prevalence will increase 2·5-fold by 2050. As a result, clinicians worldwide will treat a growing number of patients with atrial fibrillation. Early intervention to promote atrial fibrillation self-management is critical to reduce associated complications of stroke and heart failure. Greater understanding of patients' experiences from symptom onset to initial treatment for atrial fibrillation is needed to guide development of interventions to promote early effective self-management. Design A descriptive qualitative design was used. Methods Twenty females and 21 males at an academic medical centre were interviewed using open-ended questions to explore their experiences from symptom onset to initial treatment for atrial fibrillation. Data were analysed using qualitative content analysis. Results Participants' mean age was 64·3 (SD = 10·1) years. Four themes were identified: (1) misinterpreting symptoms; (2) discovering the meaning of atrial fibrillation; (3) facing fears, uncertainty, and moving to acceptance; and (4) receiving validation and reassurance. Participants lacked knowledge of atrial fibrillation and took cues from providers' responses to appraise symptoms and diagnosis. Fear and uncertainty were reduced when providers initiated prompt treatment and took time to explain atrial fibrillation. Patients appreciated receiving clear information about atrial fibrillation, were engaged in learning, and motivated to participate in their care. Conclusions Providers played a critical role in helping patients to develop an accurate understanding of atrial fibrillation, to cope with the new diagnosis, and motivated them to engage in effective self-management. Relevance to clinical practice Insight into participant experiences from symptom onset to initial treatment for atrial fibrillation may inform development of interventions to promote effective atrial fibrillation self-management. [ABSTRACT FROM AUTHOR]