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Aims and objectives: To review relevant literature that addresses the challenges of the biosciences in nurse education. More precisely, the review aims to explore the literature, concerning students’ learning, learning contexts and methodological issues and identify any significant gaps. Background: Knowledge of anatomy, physiology and biochemistry is essential for the understanding of human beings and for full appreciation of the concepts of illness and disease. The current status would seem to be that the required competencies within bioscience subjects are difficult to acquire and students have high rates of failure. Design: Integrative review. Methods: The research was performed on CINAHL, ERIC, Medline and British Nursing Index databases in a period from 2013–2017. Descriptive analytical methods were used for the initial research trawl. Findings: The search strategy resulted in 23 papers. The results of this review shed light on certain deficiencies in the research field looking at the biosciences in nurse education. There is a distinct lack of intervention studies and, thereby, knowledge of how best to support students’ learning in effective ways. Of note is that there are no field study approaches identified in the review sample. Conclusion: Many of the papers are single studies and course evaluations which may be seen as too narrow and inadequate as perspective. Students appear satisfied with the courses in the biosciences, but there seems to be no correlation between satisfaction and achievement. Relevance to clinical practice: Understanding and being able to give coherent rationales for the bioscience content in the nursing curricula are crucial and must be established in relation to its relevance to the dynamic nature of patient care, technological advances and demographic realities. Only on that basis can the primacy of this content be seen as relevant to the aspiring student nurse. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate whether implementing the Modified Early Warning Scoring system impacts nurses' free text notes related to Airway, Breathing, Circulation and Pain in general ward medical and surgical patients. Background: The quality of nursing documentation in patient health records is important to secure patient safety, but faces multiple challenges whether being paper‐based or electronic. Nurses' ability to draw a complete picture of the patient situation is thereby compromised. Structured use of the Modified Early Warning Score, found to reduce unexpected death, might affect nurses' free text documentation of clinical observations. Design: A prospective, pre‐ and postinterventional, nonrandomised study adhering to the EQUATOR guideline TREND. Methods: Data on nurses' free text notes were obtained in 1,497 patient records during one preinterventional (March–June 2009) and two postinterventional study periods (September–December 2010 and March–June 2011) in a Danish university hospital. Data were organised by the Airway, Breathing and Circulation principles and by nurses' working shifts in the 56 hr surrounding the first recording of deviating vital parameters or a Modified Early Warning Score ≥ 2. Preinterventional free text notes were compared with notes from the two postinterventional periods, respectively. Results: In the 8‐hr working shift where deviations in vital parameters were recorded for the first time, nurses' free text notes related to patients' breathing (B) increased significantly, comparing 2009 with 2010 and 2011, respectively. In the 24 hr following initial deviations in vital parameters, a significant increase in free text notes was identified concerning Airway, Breathing and Circulation‐related symptoms or problems. Conclusion: Mandatory use of the Modified Early Warning Score and related implementation activities significantly impacts nursing documentation of free text notes. Relevance to clinical practice: Nurses' practice of communicating observed clinical symptoms by documenting free text notes should be supported through measures to enhance situation awareness. [ABSTRACT FROM AUTHOR]

Aims and objectives: This paper explores the conditions for the possibilities of recovery in a Danish mental healthcare practice, expressed from the perspective of nurses. The results and discussion of the study help to make visible and explore the muddle of conceptualisations of recovery in mental healthcare practice. Background: Few studies examine the possibilities of recovery for inpatients and outpatients in mental health centres from a nursing perspective. Design: A qualitative design using a critical social constructionist frame of understanding, in which the real world is considered as a series of social constructions. Method: A Fairclough‐inspired critical discourse analysis was chosen as the analytical strategy. The analysis is comprised of ten interviews in mental health care and notes, written by nurses, in medical records of ten patients with a mental illness admitted to a mental healthcare centre in 2016–2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to secure accurate and complete reporting of the study (See Appendix S1). Results: From the findings of the textual analysis and the analysis of the discourse practice, it seems clear that the social relations and structures relating to recovery in Danish psychiatry are steered and controlled by discourses that reflect, in general terms, the essence of the core of neoliberal ideology. Conclusion: Recovery is generally articulated from an overall discourse of neoliberalism with its embedded discourses of paternalism, biomedicine, self‐care and holism. All these discourses coexist in nursing practice, but the paternalistic discourse becomes the framework for the conditions for the possibility of how recovery is expressed in practice. Relevance to clinical practice: Nurses need to be supported to seek clarity in the understanding and operationalisation of a recovery‐oriented approach, if the agenda is to be truly adopted and strengthened. [ABSTRACT FROM AUTHOR]

Aim: To explore Danish women's experiences with opting out of cervical cancer screening and the role of the nurse in the women's decision‐making process. Design: A qualitative study using semi‐structured, individual interviews with a phenomenological‐hermeneutic approach. Methods: Interviews were conducted with 13 women with experience in opting out of cervical cancer screening. Women were recruited through a public flyer and interviewed virtually or by phone. The interviews were analysed using the theory of interpretation from Paul Ricoeur and consisted of three levels: naïve reading, structural analysis, and critical discussion and analysis. The present study adheres to the COREQ guidelines. Results: The women experience various personal causes for opting out of cervical cancer screening, such as low accessibility of screening appointments, discomfort during the smear test, fear of being sick, and insufficient information about the relevance of screening to the individual woman. The perceived disadvantages of screening outweighed their perceived advantages. The women's experiences did not include the role of the nurse in the procedures and knowledge sharing related to cervical cancer screening. However, nurses were described as having good communicative and relational qualifications relevant to being involved in cervical cancer screening. Conclusion: It was challenging for the women to weigh the advantages and disadvantages of cervical cancer screening and thus to make an informed decision about participation. They expressed a need for more information on which to base their decision. This places nurses in a much needed, yet unexplored, role of identifying and lowering potential personal barriers that may outweigh the women's perceived benefits of participating in screening. Implication for the profession and/or patient care: Nurses should play a more active role in cervical cancer screening such as improving general knowledge and facilitating two‐way communication about its relevance. Reporting Method: The present study adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

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

Aim: To explore how patients with Inflammatory bowel disease experienced encounters with healthcare professionals in two gastrointestinal outpatient clinics to demonstrate what matters in the communication between patients and healthcare professionals. Design: This fieldwork study is part of a larger study developing an application for patients with inflammatory bowel disease in a framework inspired by Participatory Design. Participatory design consists of three phases and this study focused on the first phase, needs assessment. A phenomenological hermeneutic approach and qualitative methods were applied to obtain an understanding of patients' needs. Methods: Three weeks of participant observations and three focus groups with 14 subjects were conducted at two university hospitals in Denmark. Field notes and interview transcripts were analysed using condensation of meaning and interpreted based on interactional nursing practice theory. The reporting method adhered to the EQUATOR guideline: COREQ. Results: Four themes emerged: Easy and dependable access to healthcare professionals. Predictability of follow‐up appointments. Importance of privacy during patient exams and Quality of time spent with healthcare professionals. Conclusion: Easy, dependable access, privacy, presence and predictability of follow‐up appointments were important to patients with Inflammatory Bowel Disease. Implications for the profession and patient care: In communication with patients with inflammatory bowel disease, healthcare professionals must be aware of privacy and the importance of predictable follow‐up agreements. They must be aware that presence and easy, reliable access positively affect patients' self‐care skills. Patient contribution: This study is part of a larger project based on Participatory design involving patients and healthcare professionals in the development of technology to support communication. [ABSTRACT FROM AUTHOR]

Aim: To explore factors influencing newly graduated nurses' delivery of direct care in acute care hospital settings. Design: Qualitative study using focused ethnography. Methods: During the period from March to June 2022, a total of ten newly graduated nurses were purposively sampled, and data were collected through 96 h of participant observation as well as ten semi‐structured interviews. This research took place in a large hospital located in Denmark. Data were analysed using LeCompte and Schensul's ethnographic content analysis. Results: Three main structures were developed from the data: 'Contrasting Intentions and Actions for care delivery', 'Organizational Constraints Block Interpersonal Aspects of Nursing Care' and 'Newly Graduated Nurses' Suppressed Need for Support Constitutes Delay in Care Actions'. Conclusion: Newly graduated nurses were committed to delivering high‐quality care but were aware they sometimes provided compromised care. The paradox between a commitment to care and compromised care delivery was borne out of tensions between newly graduated nurses' professional beliefs and nursing values, a desire to integrate patients' needs and preferences, and organizational constraints on everyday practices where newly graduated nurses often worked alone without the support of a more experienced nurse. Critical reflection on cultural, social and political forces that influence direct care delivery might support newly graduated nurses to deliver direct patient care more intentionally. Relevance to Clinical Practice: Establishment of onboarding programs and other support activities for newly graduated nurses to cope with contrasting intentions and actions that must address organizational constraints is essential. These development programs should include how critical reflection competency is supported to address value inconsistencies and emotional distress to ensure high‐quality patient care. Reporting Method: The reporting adhered to the COREQ guidelines. Patient or Public Contribution: 'No Patient or Public Contribution'. [ABSTRACT FROM AUTHOR]

Purpose: To explore and describe the enactment of user involvement and combined care in a Danish clinic that aimed at providing integrated diabetes and mental health care. Design: An ethnographic study. Data Sources and Methods: Data consisted of field notes from 96 hours of participant observations and field notes from 32 informal conversations with healthcare providers, users and relatives as well as 12 semistructured interviews with users. Data were analysed using a thematic analysis. This study reports to the SRQR guidelines. Results: Treatment was not combined as intended if only one healthcare provider handled the consultations. Here, the healthcare providers' focus was often on their own area of expertise—either mental health or diabetes. If more than one healthcare provider handled consultations, the consultations were often divided between them, focussing on one condition at the time. Healthcare providers noted, that learning from peer colleagues was a way to increase the possibility for combined care. Furthermore, combined care was highly dependent on the healthcare providers' ability to involve users' illness experiences in their own care planning. Here, a high level of user involvement increased the levels of combined care during consultations. Conclusion: This study set out to explore and describe user involvement and combined care in a specialised diabetes and mental health outpatient clinic. Combined care is complexed and requires that healthcare providers are well‐equipped to manage the complexity of delivering care for people with both conditions. The degree of combined care was linked with the healthcare providers' ability to involve users and their knowledge on the condition outside there are of expertise. Relevance to Clinical Practice: A peer‐learning environment in combination with clinical guidelines and joint display could support healthcare providers in involving users in own care and when delivering care outside their area of expertise. Public contribution: No patient or public contribution. Due to the COVID‐19 pandemic, the original user council withdraw their consent to participate due to health‐related worries and anxiety concerning the pandemic. The user council consisted of three members diagnosed with diabetes and severe mental illness. They were invited to participate in physical meetings, phone or online meetings. Presenting findings from the study to the study participants were also hindered by the second lockdown. This influenced the possibility for data triangulation. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Drawing on ethnographic fieldwork exploring various head and neck cancer treatment pathways of patients with low socio‐economic status being treated with radiation therapy in Denmark, our aim was to explore how and why inequality in this treatment pathway might occur in the encounter between these patients and Danish healthcare. Background: In recent years, inequality in cancer treatment of patients with a low socio‐economic status has been a growing concern worldwide. The majority of patients with head and neck cancer have a relatively low socio‐economic status and are at risk of experiencing inequality in their cancer treatment. Design/Methods: Using a method proposed by Robert Yin, we performed a multiple case study of five treatment pathways of patients with a low socio‐economic status. The case studies consisted of participant observations and interviews with patients, relatives and health professionals. We applied Herbert Blumer's theory of symbolic interaction as a framework for our analysis. Results: We identified three concepts that all blocked joint action because patients and health professionals had different perceptions of what interaction required of them in terms of (1) Understanding information; (2) Assuming responsibility for managing practical tasks; and (3) Coordinating one's own treatment pathway. Conclusions: We identified how different situations challenged the patients' abilities to assume participation in their own treatment pathway. In their encounter with patients, healthcare professionals did not know which situational impediments to joint action patients were facing. Relevance to clinical practice: We argue that being aware of how challenges unfold in the interaction with patients with low socio‐economic status may serve as a starting point for changing practice to reduce inequality in the treatment of these patients. Reporting method: This study is reported using consolidated criteria for reporting Qualitative research (SRQR). We used the theory and method of Robert Yin of performing a multi‐case study and we applied Herbert Blumer's theory of Symbolic interactionism as a framework for understanding data. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim and objectives: To identify determinants for using a new screening tool to identify older patients eligible for targeted nurse‐led intervention, as perceived by healthcare professionals implementing the tool, and to examine how these perceptions changed over time. Design: A cross‐sectoral longitudinal qualitative study based on semi‐structured interviews with healthcare professionals in a Danish hospital and two collaborating municipalities. Methods: In three focus groups, seven single interviews and a workshop, we examined the healthcare professionals' perceptions of and attitudes towards the new screening tool before, during and after the implementation. The Theoretical Domains Framework was used to identify the healthcare professionals' perception of barriers and facilitators, followed by content analysis. The results were further discussed using the COM‐B system as an analytic framework. This qualitative study is reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist. Results: 'Professional role', 'Goals' and 'Environmental context' were the domains most talked about by the healthcare professionals across the three time points. The content analysis identified four determinants for using the new screening tool:Making time for the project, External motivation and management, Expectations and reality, and Professional identity. The healthcare professionals' perception of the determinants changed during the implementation, influencing their behaviour and, consequently, the implementation's sustainability. Conclusion: Perception of barriers and facilitators to the interventions were time‐ and context‐sensitive. Beliefs and motivational factors changed during the project, which points out the importance of following implementation processes systematically to understand the outcome of an intervention. Relevance for clinical practice Perceptions and attitudes towards a new initiative may change over time, emphasising the importance of following barriers and facilitators during the implementation of an intervention and working with an implementation plan that can be adapted along the way. [ABSTRACT FROM AUTHOR]

Aim and Objective: To explore Rapid Response Team nurses' perceptions of what it means being a Rapid Response Team nurse including their perceptions of the collaborative and organisational aspects of the rapid response team (RRT). Background: For more than 20 years, RRT nurses have been on the frontline of critical situations in acute care hospitals. However, a few studies report nurses' perceptions of their role as RRT nurses, including collaboration with general ward nurses and physicians. This knowledge is important to guide development and adjustment of the RRT to benefit both patients' safety and team members' job satisfaction. Design: Qualitative focus group interviews. Methods: A qualitative approach was applied. Throughout 2018 and across three regions and three acute care settings in Denmark, eight focus group interviews were conducted in which 27 RRT nurses participated. Transcribed interviews were analysed using inductive content analysis. Reporting of this study followed the COREQ checklist. Results: One overarching theme 'Balancing responsibilities, rewards, and challenges' was derived, comprising six categories: 'Becoming, developing and fulfilling the RRT nurse role', 'Helping patients as the core function of RRT', 'The RRT‐call at its best', 'The obvious and the subtle RRT tasks', 'Carrying the burden of the RRT', and 'Organisational benefits and barriers for an optimal RRT'. Conclusion: Being a RRT nurse is a complex task. Nurses experience professional satisfaction and find it meaningful helping deteriorating patients. The inadequate resources available to train general ward staff how to manage basic clinical tasks are an added stress to nurses. Relevance to clinical practice: Organisational managers need a better understanding of the necessary staffing requirements to attend patients' needs, train staff and handle the increasing acuity of ward patients. Failure to do so will be detrimental to patient outcomes and compromise RRT nurses' job satisfaction. [ABSTRACT FROM AUTHOR]

Objectives: To understand the care and support needs in ageing with neuromuscular disease from a patient‐user perspective. Background: The term neuromuscular disease covers several chronic hereditary or acquired disease subtypes. In the developed countries, advances in symptoms management, technical advancements and rehabilitation initiatives have resulted in increased life expectancy for some subtypes. Life with neuromuscular disease is thus likely to continue into adulthood and old age. However, knowledge of the care and support needs of patients ageing with neuromuscular disease remains sparse. Design: Adopting a user‐participatory approach embedded in a phenomenological hermeneutic tradition, we conducted two user‐group discussions focusing on care and support needs in people ageing with neuromuscular disease. Twenty‐five users with neuromuscular disease participated in the group discussions. Data were analysed using a three‐stepped analysis method inspired by the French Philosopher Paul Ricoeur. In the analysis process, dialectical movements between a surface interpretation and an in‐depth understanding occur. The COREQ checklist was used to report the study. Results: Two themes were identified; 'Changes in the sheltering relationships of life require preparation' and 'Ageing introduces a dichotomy between circumstantial normalcy and minority groupness'. An understanding of care and support needs in life with neuromuscular disease was reached revealing a need for a lifeworld‐led approach. Conclusion: Persons ageing with neuromuscular disease crave a fusion of disease‐ and age‐led care and support. This fusion may be achieved through the introduction of a lifeworld‐led approach to care and support. Relevance for clinical practice: Unmet care and support needs in people ageing with neuromuscular disease may result in patients experiencing fear and concern about their life situation. Healthcare professionals may play a crucial role in creating coherent lives for these persons if they understand the approach proposed herein to uncover the care and support needs in people ageing with neuromuscular disease. [ABSTRACT FROM AUTHOR]

This article presents results from interviews with twelve persons with mild dementia about how life had changed since they received their diagnosis, exploring their experiences of dementia and how they manage life by using different strategies and techniques. Knowledge about how people with mild dementia experience life is important to explore through their unique perspective, providing clinical practice with knowledge to improve dementia care. Twelve participants were recruited at a Danish school service for people with mild dementia where they receive cognitive stimulation. Semi‐structured interviews were conducted, video recorded, transcribed and analysed by using Max Van Manen's five lifeworld existentials: spatiality, corporeality, temporality, relationality and materiality. SRQR checklist was used. Five themes were identified, illustrating the dilemmas and challenges the participants experience, as all existentials are compromised in some way: living a social and active life regardless of difficulties; trying to look at the bright side of life with dementia; it takes time to adapt but at the same time, time is being lost; it is possible to learn, but it is challenging; to try to remember but keep forgetting. The article concludes that all existentials are negatively influenced by dementia, setting the lifeworld of the participants under pressure. However, they still try to live their lives regardless of the difficulties. The study shows it is possible for people with mild dementia to describe their lived experience of dementia and what strategies and techniques they use to manage life. The experienced dilemmas and challenges in the lifeworld of people with mild dementia are of great relevance to be aware of and address in clinical practice. To support people with dementia to identify relevant strategies and techniques, as expressed in the study, that can support them managing life with dementia. [ABSTRACT FROM AUTHOR]

Aim and objectives: To explore the experiences of caregivers of persons with dementia and dementia coordinators regarding their collaboration in care for a person with dementia and the feasibility of using technology in this collaboration. Background: Caregivers of persons with dementia have a significant risk of developing physical strain and psychological stress due to caregiver burden. Internationally, the use of technology is rapidly evolving in health care. Dementia coordinators employed in municipalities in Denmark support caregivers of persons with dementia, thus helping management of life with dementia. The cooperation between dementia coordinators and caregivers is essential, and the use of technology in everyday life is inevitable. Methods: A qualitative, exploratory, descriptive design was used. Data were derived from five focus group interviews in which 13 caregivers and 14 dementia coordinators participated. The participants' narratives were used to elucidate their experiences and attitudes, and data were analysed using thematic analysis. The study reports according to the COREQ checklist. Results: The analysis revealed three themes: the need for creating a safety net in everyday life, the need for moving together in the right direction and the need for handling technology while preserving relational interaction. Conclusions: Technology might be used as a mediator to help ease some caregiving tasks or the burden of caregiving. However, technology is an area in which the caregivers must rely on their competences and initiatives. Even though the collaboration between caregivers and dementia coordinators was beneficial and supportive, dementia coordinators experienced technology as outside the core elements of their daily work. Relevance to clinical practice: We suggest further discussion regarding who is best suited to support caregivers in making choices regarding which technologies to implement in caring for a person with dementia. If this discussion is not taken seriously, there is a risk of leaving caregivers in a technological quagmire. [ABSTRACT FROM AUTHOR]

Objectives: In the current study, we aimed to explore the experiences and attitudes among healthcare professionals as they transitioned from their familiar disciplines to respiratory medicine, intensive care or other departments during the first wave of the COVID‐19 pandemic. Background: In preparation for the increasing number of patients suspected of having or who would be severely ill from COVID‐19, a major reconstruction of the Danish Healthcare System was initiated. The capacity of the healthcare system to respond to the unprecedented situation was dependent on healthcare professionals' willingness and ability to engage in these new circumstances. For some, this may have resulted in uncertainty, anxiety and fear. Design: The study was a descriptive study using semi‐structured focus group interviews. Healthcare professionals (n = 62) from seven departments were included, and 11 focus group interviews were conducted. The focus group interviews took place during June 2020. Analyses was conducted using thematic analysis. The current study was reported using the consolidated criteria for reporting Qualitative research (COREQ). Results: Healthcare professionals experiences was described by five themes: 1) Voluntary involvement, 2) Changes within the organisation, 3) Risks, 4) Professional identity and 5) Personal investment. Common to all five themes was the feeling of being on a pendulum from a meaningful experience to an experience of mental overload, when situations and decisions no longer seemed to be worthwhile. Conclusions: Healthcare professionals experienced a pendulum between a meaningful experience and one of mental overload during the COVID‐19 pandemic. The swinging was conditioned by the prevailing context and was unavoidable. Relevance to clinical practice. To balance the continuous pendulum swing, leaders must consider involvement, and to be supportive and appreciative in their leader style. This is consistent with a person‐centred leadership that facilitates a well‐adjusted work‐life balance and may help prevent mental overload developing into burnout. [ABSTRACT FROM AUTHOR]

Background: Pregnant women and partners with psychological and/or social challenges are exposed to adverse health outcomes. It is therefore recommended that they receive targeted maternity care services. The relationship between parents and professionals is key to help parents engage with services and experience them as supportive. However, more knowledge is needed on parents' care experiences during encounters with professionals to further understand when and how these are experienced as supportive. Objectives: This study aimed at identifying the key elements of supportive care practices by exploring how parents in vulnerable positions experience their relationship and encounters with the professionals involved in their pregnancy and postnatal care. Design: Ethnographic fieldwork was conducted in a Danish municipality, including 50 semi‐structured interviews with parents and 51 field visits during parent‐professional encounters, including informal interviews and participant observation. Using a purposive recruitment strategy, 26 women and 13 men were recruited, who varied in age, socioeconomic background and vulnerability factors. COREQ reporting guidelines were used. Results: The analysis identified five themes: (a) Having a voice: Feeling listened to, (b) Being met with empathy: Feeling understood, (c) Worthy of attention: Feeling taken seriously, (d) On equal terms: Feeling like a normal family and (e) Moving in the right direction: Feeling reassured. Conclusion: Positive care experiences facilitate engagement with services and professionals as this contribute to parents feeling included, respected and safe. Conversely, negative care experiences leave parents feeling excluded, judged and anxious, potentially reinforcing and adding to existing feelings of anxiety and stigma. This requires that professionals have good communication skills and are able to approach parents in an open and non‐judgmental way. Relevance to clinical practice: Understanding the significance of supportive care practices is paramount for health visitors, midwives and other professionals involved in providing for parents in vulnerable positions during pregnancy and the postnatal period. [ABSTRACT FROM AUTHOR]

Aim: To conduct a construct validity test on a clinical nurse specialist core competency scale. Background: Clinical nurse specialists' competency development dates back to the late 20th century; however, there is scarcity of competency descriptions from outside of North America. Furthermore, little knowledge is available on the previous research‐driven efforts to develop and validate clinical nurse specialist core competencies. Design: A descriptive study, using an online self‐report questionnaire, was conducted from May to September 2019 in three Nordic countries. Methods: An exploratory factor analysis using principal axis factoring and rotation method oblimin with Kaiser normalisation was undertaken to examine factors in the 50‐item scale. Parallel analysis with eigenvalue Monte Carlo simulation and scree plot was used to determine the number of factors to extract. Psychometric properties of the scale were evaluated, and subjective interpretation was used to modify the tool in line with the statistical analysis. The STROBE checklist was used as the reporting guideline for this study. Results: One hundred and eighty‐four responses were obtained (Finland n = 52, Denmark n = 95, Iceland n = 37) with an overall response rate of 45%. The results provided construct validity evidence of the underlying theoretical structures of the four competency spheres of patient, nursing, organisation and scholarship. Cronbach's alpha coefficient for the original overall scale was 0.94, thus indicating adequate reliability of the scale. Conclusions: Based on the analysis and subjective interpretation, we suggest a 47‐item clinical nurse specialist core competency scale. Further study should be conducted to validate the core competency content and construct in other contexts beyond the present study. Relevance to clinical practice: The scale may be used to guide clinical nurse specialist practice and identify areas for professional development, develop graduate‐level programme curricula and inform future competency research. [ABSTRACT FROM AUTHOR]

Aims: To explore the existential significance of living with the risk of being infected with coronavirus in patients with COPD. Background: Distancing measures aim to break the coronavirus transmission chains. Physical separation from social networks and social isolation are correlated with anxiety and depression. People with a chronic obstructive lung disease are particularly vulnerable due to the increased risk of a serious course of illness, so therefore many of them choose self‐isolation to protect themselves from COVID‐19. Design: A qualitative exploratory study using individual semi‐structured interviews. Methods: From June–September 2020, 13 participants were recruited through advertisements on Facebook as a convenience sample for semi‐structured individual interviews. The interviews took place through virtual platforms or in physical meetings. Data were analysed using Ricoeur's phenomenological approach, involving naïve reading, a structural analysis and a critical interpretation strategy. The study has been reported in line with COREQ guidelines. Findings: Living with the threat of being infected with coronavirus has greatly affected everyday life for patients with COPD. The nagging fear of coronavirus as a death threat was a dominant feeling, together with anxiety, loneliness and hope. With self‐isolation, followed concerns of being forgotten and thoughts of the future, balancing between fearing the worst, and hoping the best. Conclusions: Patients with moderate to severe COPD feel compelled to self‐isolate, as they fear dying from COVID‐19. The study revealed a need for proactive contact with health professionals to calm the patients' feelings of deprivation, loneliness, hopelessness and anxiety. Relevance to clinical practice: Information about the patient's perspective may be used to develop targeted interventions aimed at giving adequate information, supporting hope, implementing digital or virtual solutions to keep in contact and avoid the feeling of being alone and forgotten during a pandemic crisis. [ABSTRACT FROM AUTHOR]

Aims: To explore experiences of, and practices related to, mealtime challenges in patients with chronic obstructive pulmonary disease (COPD). Background: Nutritional status is a significant indicator of prognosis and outcome in patients with COPD. Preventing unintended weight loss and helping patients regain weight are important nursing tasks. Dietary supplements have been effective in treating underweight in cases of stable COPD. However, compliance with long‐term interventions is quite low. Improving nutritional intake through knowledge of meal‐related challenges is the key to making further progress in preventing unintended weight loss. Design: This study employed an ethnographic design using the go‐along method. Methods: From September 2018–June 2019, 34 hr of meal‐related observations and informal conversations with purposefully selected patients (n = 15) were completed at a Danish respiratory medicine ward and in patients' homes. We analysed the empirical data using a Ricoeur‐inspired method. Reporting adheres to the COREQ Checklist. Findings: In this study, we identified the absence of professional responsibility as a main challenge. Mealtimes appeared to be relegated to a matter of nutrition, and common practices surrounding mealtimes were no longer observed. Patients became dependent individuals who had to settle for the food available. In addition, physiological challenges often resulted in patients re‐evaluating the benefits of eating, concluding that it was not worth the effort and therefore not eating. Furthermore, patients were hesitant to communicate their needs, which left a number of nonverbalised challenges unattended. Conclusions: Overall, meal‐related challenges pose a risk of unintended weight loss, and the health professionals' work with mealtimes lacks a coordinated, systematic approach. Further research is needed to develop or implement interventions that can accommodate mealtimes. Relevance to clinical practice: This study contributes valuable knowledge that can be used to improve the quality of nursing care and prevent unintended weight loss in patients with COPD. [ABSTRACT FROM AUTHOR]

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

Aims and objectives: To evaluate the process of implementing an oral care intervention in nursing homes in a Danish municipality. Background: Older people with aged natural dentition require preventive and curative oral health care. An intervention based on principles of situated learning was implemented to establish closer cooperation between dental and nursing staff in nursing homes, leading to improved oral hygiene in nursing home residents. Design: An embedded multiple‐case study combined with principles of realist evaluation unfolded in three phases: Formulation of initial programme theory, Testing and Refining the programme theory. The COREQ checklist is followed in reporting. Methods: Observations, six group interviews and 22 face‐to‐face interviews with dentists, dental practitioners, nursing home managers, care professionals and residents were conducted in three nursing homes (n = 41). Results: Three main outcomes of a programme theory were identified, relating to (a) residents, in the form of new oral care routines; (b) interdisciplinary working, in the form of professional pride in performing sufficient oral care; (c) organisational level changes, in the form of increased interdisciplinary knowledge sharing. The overarching supportive mechanisms were the creation of relationships between residents, dental practitioners and care professionals as well as nursing home management taking responsibility for structure, planning and knowledge sharing. Conclusion: The situated learning perspective supported residents and care professionals' competencies in performing sufficient oral care. The shared oral care intervention supports an individual and multidisciplinary assessment of nursing home residents' ability to self‐care concerning oral care. Contextual factors, supportive and restraining mechanisms influence the intervention's success. Relevance to clinical practice: Understanding the complexity within interdisciplinary cooperation in primary nursing and unravelling the necessary properties to enhance nursing home residents' oral health care are areas of improvement for care service in nursing homes. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore hospital nurses' experiences of enablers and barriers to apply the recommendations of a hospital delirium guideline, focusing on identification and nonpharmacological prevention and treatment. Background: Nurses' application of delirium guidelines is important as they have a pivotal role in identifying, preventing and managing delirium. Research is sparse concerning barriers and enablers to nurses´ application of guideline recommendations on nonpharmacological prevention and treatment of delirium. Design: Qualitative design using focus group and individual interviews. Methods: Twenty‐three nurses, nurse supervisors and senior staff nurses from four departments in a Danish 530‐bed university hospital participated in the study. The interview guide was based on the Theoretical Domains Framework. Data were analysed using inductive content analysis. The COREQ checklist was used preparing the manuscript. Results: The analysis identified four main categories concerning barriers and enablers to applying the recommendations of a delirium guideline: factors relating to employing the guideline, the individual nurse, collaboration and the context. Lack of identification of delirium and lack of preventive actions were prominent, with inter‐related barriers such as lack of knowledge, lack of meaningfulness, lack of priority, lack of resources and working conditions, causing frustration and discouragement in the nurses. Conclusions: The study identified a wide range of barriers and enablers experienced by hospital nurses to the application of a delirium guideline, showing the complexity of delirium care and applying guidelines. Relevance to clinical practice: Improving the identification, prevention and treatment for patients with delirium requires a determined and focused effort from all stakeholders, both clinicians, leaders and policymakers. Nurses, nurse leaders and educators must be aware of the barriers and enablers related to knowledge, attitudes and co‐operation. Managers and policymakers must be aware of the organisational factors related to priority and working conditions. [ABSTRACT FROM AUTHOR]

Aim: To develop a grounded theory of the patients' experiences with patient‐controlled admission. Background: Research indicates a potential for involving patients in mental health care, but there is a need to develop and investigate new approaches in health services. Patient‐controlled admission is an option for patients with severe mental disorders to refer themselves for a brief hospital admission when needed and thus avoid the usual admission procedure. Design: Classic grounded theory with generation of a theory based on the constant comparative method for data collection and analysis. Methods: Field observations and interviews with 26 mental health patients. The COREQ checklist was followed. Results: We found that patient‐controlled admission induced safety by providing faster access to help and thus preventing further deterioration of symptoms. Being self‐determined, achieving calmness and receiving care with support and guidance from professionals during admission contributed to the sense of safety. The familiarity with the mental health professionals in their related units supported the patients in managing their situation. On the other hand, feelings of being overlooked by the professionals and experiencing uncertainty could undermine patients' feeling of safety. Conclusions: We demonstrate that safety is a focal point for patients when receiving help and support in mental health care. Patient‐controlled admission can induce a feeling of safety both at the hospital and at home. Patients' self‐determination is strengthened, and brief admissions give them an opportunity to handle what they are currently struggling with. Professionals can support patients in this, but their actions can also reduce patients' feeling of safety. Relevance to clinical practice: Patient involvement can be introduced in psychiatry, and even severely ill patients seem to be able to assess their own condition. Feasibility may, however, be associated with the attitude and behaviour of the professionals in clinical practice. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore everyday life experience of relatives of people with amytrophic lateral sclerosis (ALS) living at home with mechanical ventilation and formal caregivers. Background: ALS is a rapidly progressive disease affecting not only the patient but also close relatives. A burden is placed on relatives affecting their mental and physical health in settings where they provide care. Few studies have examined the everyday life challenges of close relatives with formal caregivers at home and home mechanical ventilation, which often prolongs survival. Design: We undertook a qualitative study with a phenomenological‐hermeneutic approach inspired by Ricoeur. Eleven close relatives were interviewed, and the three‐level analysis method developed by Dreyer and Pedersen was conducted. The Consolidated Criteria for Reporting Qualitative Research checklist was used. Results: Four themes were derived from the data during analysis: Vulnerable relatives fighting to keep track of everything, Formal caregivers—a distressing relief, A prison without personal space and We are in this together until the end. Conclusions: Close relatives of persons with ALS are burdened with everyday life challenges despite having formal caregivers at home, and they feel imprisoned. Despite these challenges and concerns about the end of life of their relative, they stay until the end. Relevance to clinical practice: There is clearly a need to investigate interventions in clinical practice supporting close relatives to prepare them for what to expect during a prolonged disease course. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore patients' experiences of situational awareness in the outpatient encounter when they are informed about the diagnosis of breast cancer or malignant melanoma. Background: Patients enter a stressful situation when receiving a diagnosis of breast cancer or malignant melanoma, and research indicates that needs are most prominent at this time. However, healthcare professionals often fail to address these needs adequately. It is unclear how patients experience situational awareness practised to meet their fundamental needs in the encounter when they are informed about the diagnosis of cancer. Design: This study used a phenomenological hermeneutical approach. Methods: Nine semi‐structured interviews with patients being diagnosed with breast cancer or malignant melanoma were performed. The interpretation theory of Paul Ricoeur guided the analysis. The study is presented in line with the COREQ checklist. Results: The analysis resulted in three themes: 1) "Being accompanied" refers to how patients need information to be targeted to them as individuals. 2) "Being seen" points to HCPs' exploration of the patients' perspectives to get an understanding of their preferences. 3) "Being taken care of" indicates that patients feel supported if situational awareness is practised by the healthcare professionals. Conclusion: Practicing situational awareness in the outpatient encounter is essential to patients' experience of feeling accommodated or rejected. Patients feel rejected when their fundamental needs are not met while experiencing situational awareness seems to accommodate fundamental needs and pre‐empt an inappropriate patient outcome. Relevance to clinical practice: HCPs need to acknowledge the importance of using a structured approach to meeting patients' fundamental needs in a stressful situation. Each patient is different and may experience different needs in encounters where they are receiving the diagnosis of breast cancer or malignant melanoma. Therefore, treatment and care must be tailored to the individual patient based on a caring relationship. [ABSTRACT FROM AUTHOR]

Aim: To explore patients' and healthcare professionals' experiences of using a telehealth solution developed to improve follow‐up after kidney transplantation. Background: Transplantation is the treatment of choice whenever feasible for patients with end‐stage kidney disease. However, it implies lifelong adherence of self‐monitoring, medicine and other restrictions to ensure successful outcomes. Based on user involvement, a telehealth solution was developed to support patients and healthcare professionals post‐transplantation. Design: An explorative qualitative study with a phenomenological‐hermeneutic approach. Methods: The developed app and workflow for follow‐up were tested by patients and healthcare professionals and evaluated with interviews. In total, 16 patients and 20 healthcare professionals participated. Individual interviews were conducted with the patients, four nurses participated in two sets of interviews, and 16 doctors participated in a focus group. Data were analysed with inspiration from Ricoeur's theory of interpretation, on three levels: Naïve reading, structural analysis and critical interpretation and discussion. The COREQ checklist was applied in reporting the study. Results: Three themes emerged: Challenging conditions for training sessions, telehealth improves patient reflection and collaboration, and telehealth gives patients a voice in consultations. In a challenging time, post‐transplantation patients found the app easy to use; it facilitated support and reflection on how to manage. It also supported both patients and healthcare professionals at follow‐up consultations in terms of enhanced preparation, improved dialogue and enabling consultations by phone. Conclusion: The study showed that patients and healthcare professionals found the app and workflow valuable and easy to use. The Patient Data feature in the app has potential as a communication tool. However, adjustments and further investigations are needed to develop the solution. Relevance to clinical practice: The potential of telehealth brings new opportunities to provide treatment and care to newly transplanted patients. Telehealth can support both patients and health professionals by improving dialogue and collaboration. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate attitudes towards family involvement in care among a broad sample of Danish nurses from all sectors and healthcare settings. Background: Evidence suggests that nurses hold both supportive and less supportive attitudes about involvement of family members in the care of patients, and the existing findings are limited to specific healthcare contexts. Design: A cross‐sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology for reporting observational studies. Methods: Using snowball sampling, the Families' Importance in Nursing Care‐Nurses' Attitudes questionnaire was initially administered to a broad, convenience sample of Danish registered nurses through social media: Facebook interest groups and the homepage of the Danish Family Nursing Association. These nurses were encouraged to send the invitation to participate in their network of nursing colleagues. Complete data sets from 1,720 nurses were available for analysis. Results: In general, the nurses considered the family as important in patient care. Nurses who held master's and doctorate degrees scored significantly higher than nurses with a basic nursing education. Nurses who had had experience with illness within their own families tended to score higher on the family as a conversational partner subscale than those without this experience. Nurses with the longest engagement within hospital settings scored significantly lower than those with the longest engagement within primary health care and/or psychiatry. Conclusions: Families are considered important in nursing care. Younger nurses with a basic education, short‐term engagement at a hospital and no experiences with illness within their own families were predictors of less supportive attitudes towards including the family in nursing care. Relevance to clinical practice: Clinical leaders and managers should promote education on the importance of active family involvement in patient care in clinical practice and undergraduate education. More focus on collaboration with families in the hospital setting is needed. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore gains and impacts of job rotation through the experiences of involved nursing personnel responsible for different parts of care during the elective orthopaedic patient's pathway. Background: When patients undergo elective orthopaedic surgery, they encounter nurses from different wards. So far, job rotation has only been described through the experiences of the job rotating nurses. This study includes all involved nursing personnel and bases the job rotation on the pathway of the elective orthopaedic patient. Design: This study has an exploratory‐descriptive and qualitative approach and follows the Consolidated Criteria for Reporting Qualitative Research guidelines. Method: A total of nine focus groups including 16 informants were conducted before, during and after a 5‐month trial period. The data were analysed using thematic analysis. Results: The findings show that existing work structures and work content combined with a lack of a common understanding of the job rotation impacted the expectations of the nursing personnel regarding (in)dependence, individual and collegial involvement and investment, as well as the collegial belongingness expressed through terminologies of "home" and "culture." The personal gains among the job rotating nurses showed increased knowledge, skills and influence. When knowledge was shared and exchanged, the job rotating nurses became "cultural translators" of the care to the elective orthopaedic patient. Conclusions: This study shows personal gains among the job rotating nurses through increased knowledge, skills and influence as well as collegial gains by sharing and exchanging knowledge. When this exchange was utilised, the job rotation was evaluated positively, and contrary, when not utilised the job rotation had a negative impact on the work environment. Relevance to clinical practice: Job rotation among nurses following the care of the patient's pathway can be a way of promoting patient safety and quality through increased knowledge across wards by including every aspect and element of the patient's pathway. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate patients' existential experiences in everyday life prior to a kidney transplantation with a living donor. Background: Kidney transplantation is a well‐established treatment for patients with end‐stage kidney disease. The prevalence of patients living with end‐stage renal disease is increasing. Simultaneously, kidney transplantations with a living donor are increasing. However, patients experience challenging existential aspects concerning kidney transplantation. Design: A qualitative study with a hermeneutic‐phenomenological approach inspired by Ricoeur was chosen. Methods: Fourteen interviews with patients living with end‐stage kidney disease were conducted 7–14 days before a planned kidney transplantation with a living donor. Analysis and interpretation were based on Ricoeur's theory of interpretation. We applied the Criteria for Reporting Qualitative Research (see Appendix S1). Results: Four themes were identified: living with subjective feelings of illness while objectifying the body; living in one's own world while the world outside goes on; feeling grateful while being concerned for the donor; and hoping for the best, while preparing for the worst. Conclusion: Patients' existential challenges are multifaceted. Patients articulate their kidney function in numeric terms, trying to make the invisible visible for themselves and others. Sustaining normality becomes important for patients, and the waiting time from donor evaluation to transplantation triggers excitement, hope and frustration. Relevance to clinical practice: The results increase insights into individuals' existential experiences in their everyday lives. Hereby, the results articulate the need for support from health professionals prior to a kidney transplantation. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of the study was to examine patients' experience of dietary habits and nutritional counselling in the early period during hospitalisation after coronary artery bypass surgery (CABG). Background: Undergoing CABG, patients have two different nutritional needs, extra proteins and calories for the first period after surgery and a heart‐healthy diet when the recovery period is over. These needs can be difficult to manage for the patients. Design: Qualitative study. Methods: Interviews were conducted and analysed within a phenomenological‐hermeneutic frame inspired by the French philosopher Paul Ricoeur. Patients undergoing CABG were interviewed 4–5 days after surgery at Odense University Hospital from March to May, 2017. The study adhered to the COREQ guidelines. Results: In total, 15 patients were interviewed (mean age 65 years, 87% men). After analysing the interviews following themes emerged, "Different needs—the nutritional jungle", "Food and heart—the lacking attention," and "The force of habits—being under the influence from spouses on dietary habits". Conclusion: The interviewed patients had no or only a little knowledge about how to eat after heart surgery. In general, they experienced a lack of attention to nutritional counselling by the nursing staff during hospitalisation. Furthermore, the health behaviour of men seems to be different from women's, and therefore, interventions aiming at optimising men's health might be prioritised. Finally, spouses have a great influence on eating habits, why they should be involved in nutritional counselling. Relevance to clinical practice: This study provides important and relevant knowledge about patients' lacking knowledge about nutrition. When planning nutritional measures, whether it is promoting healing after heart surgery or preventing progression of arteriosclerosis, the study contributes with suggestions as to which factors should be considered in this process—men's health behaviour and spouses' influence on dietary habits in the household. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore nurse–patient interactions in relation to the mobilisation of nonsedated and awake, mechanically ventilated patients in the intensive care unit. Background: Lighter sedation has enabled the early mobilisation of mechanically ventilated patients, but little is known about the nurses' role and interaction with critically ill patients in relation to mobilisation. Design and methods: The study had a qualitative design using an ethnographic approach within the methodology of interpretive description. Data were generated in two intensive care units in Denmark, where a strategy of no sedation was applied. Participant observation was conducted during 58 nurse–patient interactions in relation to mobilisation between nurses (n = 44) and mechanically ventilated patients (n = 25). We conducted interviews with nurses (n = 16) and patients (n = 13) who had been mechanically ventilated for at least 3 days. The data were analysed using inductive, thematic analysis. The report of the study adhered to the COREQ checklist. Finding: We identified three themes: "Diverging perspectives on mobilisation" showed that nurses had a long‐term and treatment‐oriented perspective on mobilisation, while patients had a short‐term perspective and regarded mobilisation as overwhelming in their present situation. "Negotiation about mobilisation" demonstrated how patients actively negotiated the terms of mobilisation with the nurse. "Inducing hope through mobilisation" captured how nurses encouraged mobilisation by integrating aspects of the patient's daily life as a way to instil hope for the future. Conclusions: Exploring the nurse–patient interactions illustrated that mobilisation is more than physical activity. Mobilisation is accomplished through nurse–patient collaborations as a negotiated, complex and meaningful achievement, which is driven by the logic of care, leading to hope for the future. Relevance to clinical practice: The study demonstrated the important role of nurses in achieving mobilisation in collaboration and through negotiation with mechanically ventilated patients in the intensive care unit. [ABSTRACT FROM AUTHOR]

Aims: To gain knowledge about families' experiences while staying in a hospital family house during their child's hospitalisation. Background: When a child is hospitalised with a chronic, serious or life‐threatening disease, the entire family is stressed as normal everyday life is disrupted. In Denmark, accompanying the ill child to the paediatric wards is often possible only for one of the parents. Design: This qualitative study takes a phenomenological–hermeneutical approach, exploring the lived experience of families' everyday life in a hospital family house. Method: The study comprised semi‐structured interviews with 33 family members from 15 families who stayed in a hospital family house. The interviews were made in the summer of 2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline "see Appendix S1." Results: The families experienced the house as a home or a haven where they could stay together as a family. The house provided a quiet and peaceful environment with space for family life and playing. Overall, this gave the families a feeling of togetherness. Conclusion: The families who stayed in the hospital family house experienced the house as a place to breathe freely, that is, as a safe haven. A place with peace and quietness, without "activity efficiency." In the house, the volunteers offered a very caring and supportive environment including all families in the house and embracing everyday activities. Providing accommodation for the whole family at the hospital family house afforded the family a place where they could stay together and maintain everyday life even though everything around them was, at times, chaotic. Relevance to Clinical Practice: Healthcare professionals should use knowledge about the healing environment to help create havens for families to a hospitalised child. Hospitalised children need safe places where no treatment takes place—therefore, family houses should stay treatment free. [ABSTRACT FROM AUTHOR]

Aim: To explore patients' and healthcare professionals' experiences of patients' surgical pathways in a perioperative setting. Background: Elective surgical pathways have improved over the past decades due to fast‐track programmes, but patients desire more personalised and coordinated care and treatment. There is little knowledge of how healthcare professionals' collaboration and communication affect patients' pathways. Design: The overall framework was complex intervention method. A phenomenological‐hermeneutic approach was used for data analyses. COREQ checklist was used as a guideline to secure accurate and complete reporting of the study. Methods: Field observations (120 hr) and semi‐structured interviews (24 patients) were undertaken during 2016–2017. Healthcare professionals involved in the pathways were interviewed: (a) 13 single interviews and (b) 13 focus group interviews (37 healthcare professionals) were conducted. The Consolidated Criteria for Reporting Qualitative Research checklist was used. Results: Patients asked for individualised information adapted to their life and illness experiences. Furthermore, healthcare professionals need access to a quick overview of individual patients and their perioperative pathway in the electronic patient journal (EPJ). Agreements made with patients did not always reach the right receiver, there was poor interpersonal communication and the complex teamwork between many healthcare professionals made pathways incoherent and uncoordinated. Healthcare professionals who had the time to talk about other subjects than the disease with smiles and good humour gave patients a feeling of security. Conclusion: Patients wanted to be treated as individuals, but often they received standard treatment. Healthcare professionals had the intention of treating patients individually, but the EPJ and information provided to patients were not easy to access. Relevance to clinical practice: Visible information about the patient's whole pathway could improve healthcare professionals' care and treatment. In addition, systematic feedback from patients' could make it possible to adjust information, care and treatment to achieve a more coherent pathway. Particular attention needs to be paid to how electronic healthcare systems can underpin relational coordination in pathways. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how the hospital and home care nurses talk about and experience cross‐sectoral collaboration related to the transitional care of frail older patients. Background: Effective communication and collaboration between nurses involved in care transition are crucial for a safe patient handover. Organisational systems to support cross‐sectoral collaboration have been developed but do not always promote the intended dialogue and precise and useful exchange of information. Other factors may also be of importance to an effective and constructive cross‐sectoral nurse collaboration. Design: A qualitative design using thematic analysis. Methods: Data were extracted from 24 focus group interviews conducted with registered nurses from eight hospital wards and six municipalities and a total of 165 hr of observations conducted in three hospital wards and three municipalities. The study was reported according to the COREQ guidelines. Results: The perception of nursing and care differed across sectors. The nurses expressed having shared goals for the patients—however, these goals derived from different values, the perception of nursing and approach to the patients. The lack of knowledge of each other's working conditions created assumptions and preconceptions, which affected communication and collaboration related to planning and executing care transition negatively. Conclusions: The nurses perceived the hospital and home care as" two worlds". The collaboration between the nurses was characterised by insufficient communication and preconceptions rather than concrete knowledge and different cultures and professional identities. It can be questioned whether cross‐sectoral collaboration between nurses should be characterised as interprofessional rather than intraprofessional collaboration as the features of the nurses' collaboration. Relevance to clinical practice: Organisational and political systems should recognise that nurses in different sectors are taking care of various aspects of nursing when planning on policies to support cross‐sectoral collaboration. More possibilities for nurses across sectors to meet should be made available. [ABSTRACT FROM AUTHOR]

Aim and objectives: To explore parents' experiences of donation to their child before kidney transplantation. Background: Transplantation is the treatment of choice for paediatric patients with end‐stage renal disease. Living donor kidney transplantation has shown a higher long‐term transplant survival compared to deceased donor transplantation and entails a more controllable process, with shorter waiting time. Besides complex care and treatment of their child, parents must reflect on the prospects of being a donor for their child. However, little is known about the parent donor and parent caregiver perspective. Design: A qualitative exploratory study taking a phenomenological‐hermeneutic approach. Method: The study was conducted in a Danish university hospital. Interviews were conducted with the parents of seven children, aged between 5–15 years, with end‐stage renal disease in the period before kidney transplantation. Data were analysed with inspiration from Ricoeur's theory of interpretation on three levels: naïve reading, structural analysis and critical interpretation and discussion. Results: The decision about donation was experienced as a matter of course and commitment. There were preferences for a kidney from a living donor, including the hope of being accepted as a donor. Being refused as a donor revealed feelings of powerlessness. However, transformation was performed into having a new role providing care and comfort to the child during the transplant process. Asking family and friends about donation could feel like crossing a line. Conclusion: The prospect of donating to one's child had an impact on the well‐being of the entire family. Parents were in a vulnerable situation and in need of support, regarding both living and deceased donation. Waiting time included hopeful thoughts and reflections on a new caregiver role for the child during transplantation. Relevance to clinical practice: Health professionals' attention, engagement and dialogue are essential in order to gain extensive and varied knowledge about the individual parent's experiences and the well‐being of the entire family to provide care and support before, during and after the donation and transplantation process. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore patients' experiences and perspectives of their challenges and needs regarding their return to everyday life after allogeneic nonmyeloablative haematopoietic stem cell transplantation (NMA‐HSCT). Background: NMA‐HSCT can cure patients with malignant blood diseases, but during the following years, the majority of patients suffer from serious side effects and complications. Hence, it is a major challenge for patients treated with NMA‐HSCT to rehabilitate, maintain physical and psychosocial functioning and return to a life in restored balance. Design: The design was qualitative using the interpretive description methodology, and the theoretical framework symbolic interactionism inspired the interview guide and analysis. Methods: Between April to May 2017, five focus group interviews were conducted with 15 outpatients in a haematological ward in Denmark. The patients were treated with NMA‐HSCT 8–30 months prior to the interviews. The study adheres to the Consolidated Criteria for Reporting Qualitative Research guidelines. Results: The impaired functioning was the overarching theme and seemed to be the trigger entailing rehabilitation needs related to the following main themes: realising decline, adapting to changes, the meaning of motivation and reliance on relations. These findings seemed to affect and influence the patients' struggle for a return to an everyday life like before being diagnosed or just before undergoing NMA‐HSCT. Conclusion: This study adds to our understanding of important elements to consider when developing a targeted rehabilitation programme. Relevance to clinical practice: Based on our findings, the rehabilitation programme should encompass: extensive variation regarding how to address the impaired functioning through individualised approaches, multimodal interventions, interventions through several months with varying intensity, an interdisciplinary team approach supporting motivation and visualisation of every progress by tangible goal setting, communication regarding hope and support, extended supportive care for patients living alone and finally increased adherence through social sessions with relatives and fellow patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To elucidate the lived experience of how patients with alcohol use disorders experience being cared for when admitted to acute medical units. Background: Alcohol use is health damaging and is identified as one of the major avoidable risk factors, and alcohol use disorder is classified among the most harmful, debilitating disease categories. Patients suffering from alcohol use disorders are characterised by complex problems and health pictures spawned by chaotic lifestyles. However, the experience of the hospitalisation from patients' perspective is poorly documented. Design: The present study has a qualitative research design and is anchored in phenomenological and hermeneutical methodology, as described in reflective lifeworld research. Methods: The data set consists of 15 in‐depth interviews with patients suffering from alcohol use disorders admitted to an acute medical unit. A purposive sampling strategy was used, and the interviews were conducted as open dialogues. The study was reported in accordance with the consolidated criteria for reporting qualitative research. Results: Being cared for when hospitalised was experienced as a two‐stage process that changed throughout the hospitalisation from an experience of scheduled care experienced as caring to an experience of scheduled care experienced as non‐caring. Four constituents further described the variable experiences: being in a safe haven, sharing a tacit but mutual goal, being in a chaotic space and being on your own. Conclusions: The study showed that being met in an authentic presence by nurses was a powerful tool that helped ease the hospitalisation. Patients suffering from alcohol use disorders call for an intentional and distinctive attentiveness and authentic presence from the nurses throughout their hospitalisation. Relevance to clinical practice: Our findings highlight that patients suffering from alcohol use disorders call for an intentional and distinct attentiveness from nurses throughout the hospitalisation, where a possible transfer of attention is noticed and responded to in the care provided. [ABSTRACT FROM AUTHOR]

Background and aim: Today, mothers are discharged early after birth, and national monitoring shows an increase in readmission of infants. Readmission of the infant might diminish the possibility of bonding and weaken maternal confidence in taking care of the infant. The aim was to explore how new mothers experience the time from birth to being discharged after readmission with their infants. Design: A phenomenological and hermeneutic study. Data were collected through telephone interviews. The study followed the COREQ requirements and was conducted in the Region of Southern Denmark in a University Hospital setting. Convenience sampling was applied, and eight mothers were included from November 2015–February 2016. Seven were interviewed. Results: The data analysis revealed the following six themes: "Early discharge," "Being at home," "Readmission—shock or relief," "Problems with breastfeeding in early motherhood," "Empowering or disempowering guidance" and "Back home with broken expectations." These six themes were all covered by the overall theme: "Broken expectations of a tranquil beginning of early motherhood." Conclusions: Our study points out that mothers wish for a tranquil beginning with their infants at home. Some already experienced problems at home, while others first were confronted at the check‐up at the outpatient clinic. Yet the common denominator was that the mothers experienced broken expectations regarding early motherhood when facing readmission. Readmission may influence the initial process either positively or negatively, depending on how the mothers experience their challenges and how the healthcare professionals support them. This highlights the importance of the way in which healthcare professionals support new mothers when they are readmitted. The study emphasises the importance of maternal feelings of security and confidence in their maternal role, as they are closely connected to the process of becoming a mother. [ABSTRACT FROM AUTHOR]

Background: Relative involvement is crucial in rehabilitation when patients are incapable of being involved due to cognitive and functional dysfunction. However, studies have shown that this is complex because of differing understandings of the meaning of involvement as well as diverse needs to be involved. Aims and objectives: To explore the experience of the rehabilitation process from the perspectives of relatives of patients with a traumatic brain injury. The aim of the study was, through a theoretical‐empirical analysis, to identify relatives' strategies and practices in the rehabilitation process as evidenced in meetings with providers. Design: A longitudinal study with a qualitative approach, drawing on the theory of Pierre Bourdieu. Methods: Data were generated using participant observation and semi‐structured interviews. Participants were eleven relatives of patients with a severe traumatic brain injury, followed through in‐patient rehabilitation varying from 9–12 weeks. Analysis was undertaken using both an inductive and deductive approach. Findings: Drawing on Bourdieu's concept of strategy, three relative positions were identified, the warrior, the observer and the hesitant. These positions illustrate how different relative positions and their related dispositions influence the strategies used by relatives of patients with a severe traumatic brain injury evidenced in how they act, participate and relate to both the patient and the providers during the course of rehabilitation. Conclusions: Acknowledging the relatives' positions during the rehabilitation process enables better understanding and support of the relatives in the rehabilitation process to meet their (and thus the patients') diverse needs. Relevance to clinical practice: The findings have practical implications in informing how clinicians meet, interact, communicate and involve relatives of adult patients' with traumatic brain injury in decision‐making during rehabilitation. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate an intervention developed to improve patient safety in posthospital medication management carried out by visiting nurses working in a municipality in Denmark. The intervention consisted of three elements: an initial interdisciplinary home visit by nurses, two subsequent scheduled visits and the use of an organising tool. Background: As a consequence of specialised treatment plans and new treatment possibilities, patients with complex care needs can now be discharged from hospital more rapidly—and in greater numbers—than previously. Medication management is identified as the most challenging component of a discharge from the hospital to the home, in which discrepancies have been found in up to 94% of medication lists. Design: A process evaluation inspired by the UK Medical Research Council's guidance. Methods: The process evaluation was conducted for three months in a visiting nurses’ department. Data consisted of visiting nurses’ self‐reports of performance of the intervention and group interviews (n = 4) with visiting nurses (n = 14). Self‐reports were analysed to evaluate implementation performance and elaborated with interview data to illuminate mechanisms of impact and contextual factors. Results: The implementation of the intervention highlighted the importance of the nurse–patient relationship, nursing assessment and logistics, and professional values in posthospital medication management. Complex care needs were a mediator in the high implementation rate, which involved 31 of the 38 patients in the target group. Conclusion: For patients with complex care needs, posthospital medication management may be improved by a reconsideration of the activity‐based funding of home health care, a recognition of the importance of organising work and a critical consideration of standard systems. Relevance to clinical practice: An increase in the number of patients with complex care needs in home health care is an international issue that affects many healthcare systems. This study points at contextual challenges and possible methods for facilitating the future development of posthospital care for these patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify and describe patients’ experiences and care needs throughout the diagnostic phase of an integrated brain cancer pathway. Background: A malignant brain tumour is a devastating diagnosis, which may cause psychical symptoms and cognitive deficits. Studies have shown that the shock of the diagnosis, combined with the multiple symptoms, affects patients’ ability to understand information and express needs of care and support. Unmet needs have been reported within this group of patients; however, the experiences and care needs of patients going through the diagnostic phase of a standardised integrated brain cancer pathway have not previously been explored. Design: A case study design was used to provide detailed information of the complex needs of patients being diagnosed with a malignant brain tumour. Methods: Research interviews and direct participant observation of four patients during hospital admission, brain surgery and discharge were conducted in a Danish university hospital. Systematic text condensation was used to analyse the data material. Results: Four major themes were identified: information needs, balancing hope and reality while trying to perceive the unknown reality of brain cancer, not knowing what to expect and participants’ perceptions of the relationship with the healthcare providers. The analysis revealed that participants were in risk of having unmet information needs and that contextual factors seemed to cause fragmented care that led to feelings of uncertainty and loss of control. Conclusions: Brain tumour patients have complex care needs and experience a particular state of vulnerability during the diagnostic phase. Through personal relationships based on trust with skilled healthcare providers, participants experienced an existential recognition and alleviation of emotional distress. Relevance to clinical practice: Patients receiving a brain tumour diagnosis experience unmet care needs in several areas during their hospital stay. There is a need for interventions from healthcare providers. [ABSTRACT FROM AUTHOR]

Aims and objectives: To provide in‐depth insight into patients' lived experiences of participating in an education and counselling nutritional intervention after curative surgery for oesophageal cancer. Background: Surgery for oesophageal cancer carries a risk of malnutrition. The consequences of nutritional problems may lead to increased morbidity and mortality postoperatively and have consequences for convalescence, rehabilitation and quality of life. Design: Qualitative study based on a phenomenological approach. The theoretical framework was grounded in the philosophy of Merleau‐Ponty. Methods: Qualitative interviews were conducted with 10 patients who participated in an education and counselling nutritional intervention after surgery for oesophageal squamous‐cell carcinoma. Data were analysed according to the principles of Kvale and Brinkmann, and their three levels of interpretation were applied. Findings: The essence of experiencing the education and counselling nutritional intervention can be divided into three themes: embodied disorientation, living with increased attention to bodily functions and re‐embodying eating. Conclusions: Patients were living with increased attention to bodily functions and tried to find a balance between the task of eating and nutritional needs. Despite the embodied perceptions of alterations after oesophageal cancer surgery, the patients developed high levels of bodily awareness and skills in self‐management. This process was characterised by reconnecting to the body and re‐embodying eating. The intervention empowered the patients to regain some control of their own bodies in an effort to regain agency in their own lives. Relevance to clinical practice: There is a need for systematic long‐term follow‐up after surgery for oesophageal cancer regarding nutrition. The findings of this study can inform future supportive nutrition care service development aimed at supporting patients to learn to eat sufficiently after oesophageal resection. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how nurse researchers in clinical positions experience the presence of a nursing research culture in clinical practice. Background: Higher demands in the hospitals for increasing the quality of patient care engender a higher demand for the skills of health professionals and evidence‐based practice. However, the utilisation of nursing research in clinical practice is still limited. Design: Intrinsic single case study design underlined by a constructivist perspective. Methods: Data were produced through a focus group interview with seven nurse researchers employed in clinical practice in two university hospitals in Zealand, Denmark, to capture the intrinsic aspects of the concept of nursing research culture in the context of clinical practice. A thematic analysis was conducted based on Braun and Clarke's theoretical guideline. Results: “Caught between a rock and a hard place” was constructed as the main theme describing how nurse researchers in clinical positions experience the presence of a nursing research culture in clinical practice. The main theme was supported by three subthemes: Minimal academic tradition affects nursing research; Minimal recognition from physicians affects nursing research; and Moving towards a research culture. Conclusions: The nurse researchers in this study did not experience the presence of a nursing research culture in clinical practice, however; they called for more attention on removing barriers against research utilisation, promotion of applied research and interdisciplinary research collaboration, and passionate management support. Relevance to clinical practice: The results of this case study show the pressure which nurse researchers employed in clinical practice are exposed to, and give examples on how to accommodate the further development of a nursing research culture in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Good nutritional care of people following major lower extremity amputation is essential as poor nutritional status can lead to delayed wound healing. Working with patients to identify their perspectives on food, views on nutritional care and the need for dietary counselling enables the development of optimised nutritional care. Aims and objectives: To explore hospital patients′ perspectives on food, dietary counselling and their experiences of nutritional care following lower extremity amputation. Design: A qualitative, explorative study design was employed. Method: An inductive content analysis of semi‐structured interviews with a purposive sample of 17 people over 50 years of age, who had recently undergone major lower extremity amputation, was undertaken. The study was reported according to the consolidated criteria for reporting qualitative research guideline. Findings: Three themes emerged: responsible for own dietary intake, diet based on preferences and experiences with dietary counselling and feeling overwhelmed. The participants expressed motivation to ensure their nutritional needs were met but described feeling emotionally overwhelmed by the experience of amputation. They appeared not to expect nursing staff to focus on nutritional issues as they expressed belief that they themselves were solely responsible for their dietary intake. They described being motivated to receive nutritional counselling but indicated advice should be compatible with their lifestyle and eating habits. Conclusion: Lower extremity amputation can be an overwhelming experience which affects nutritional intake. People appear to consider themselves responsible for their nutritional care and describe not experiencing or expecting nursing staff to engage in this aspect of care. Dietary counselling by nurses who respect and incorporate patient preferences and experiences following amputation has the potential to enhance nutritional care. Relevance to clinical practice: This study illustrates that nurses caring for people who undergo lower extremity amputation need to recognise that nutritional care is an essential component of nursing and should focus on working in partnership with the patient. [ABSTRACT FROM AUTHOR]

Aims and objectives: To gain in-depth knowledge of patients’ experiences of the consultation processes at a multidisciplinary atrial fibrillation outpatient clinic in a university hospital in Denmark. Background: Atrial fibrillation is the most common cardiac arrhythmia associated with morbidity and mortality if not diagnosed and treated as recommended. Patients with newly diagnosed atrial fibrillation preferably should be managed in an outpatient setting which includes medical examination, patient education and decision-making on medical therapy. Design: This is a qualitative study of 14 patients newly diagnosed with atrial fibrillation, ranging from asymptomatic patients, to those with mild to severe symptoms; they were all referred from general practitioners. Methods: Data were generated in 2013-2015 using participant observation during each consultation, followed by individual interviews postconsultation. Results: Patients were referred with limited information on AF and knowledge about the management consultation procedures. The consultations were performed in a professional way by the cardiologist as well as by the nurses with an emphasis on the medical aspects of atrial fibrillation. The understanding that atrial fibrillation is not a fatal disease in itself was very important for patients. At the same time, visiting the clinic was overwhelming, information was difficult to understand, and patients found it difficult to be involved in decision-making. Conclusions: This study indicates that patients were uncertain on what AF was before as well as after their consultation. The communication was concentrated on the medical aspects of atrial fibrillation and visiting the clinic was an overwhelming experience for the patients. They had difficulty understanding what atrial fibrillation was, why they were treated with anticoagulation, and that anticoagulating was a lifelong treatment. Relevance for clinical practice: This study demonstrates some lack of patient centred care and an absence of tailored patient AF-related education. Furthermore, the study highlights the need for and importance of active patient involvement. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the barriers for nutritional care as perceived by nursing staff at an acute orthopaedic ward, aiming to implement evidence-based nutritional care. Background: Previous studies indicate that nurses recognise nutritional care as important, but interventions are often lacking. These studies show that a range of barriers influence the attempt to optimise nutritional care. Before the implementation of evidence-based nutritional care, we examined barriers for nutritional care among the nursing staff. Design: Qualitative study. Methods: Four focus groups with thirteen members of the nursing staff were interviewed between October 2013–June 2014. The interview guide was designed according to the Theoretical Domains Framework. The interviews were analysed using qualitative content analysis. Results: Three main categories emerged: lacking common practice, failing to initiate treatment and struggling with existing resources. The nursing staff was lacking both knowledge and common practice regarding nutritional care. They felt they protected patient autonomy by accepting patient0s reluctance to eat or getting a feeding tube. The lack of nutritional focus from doctors decreased the nursing staffs focus leading to nonoptimal nutritional treatment. Competing priorities, physical setting and limited nutritional supplements were believed to hinder nutritional care. Conclusion: The results suggest that nutritional care is in a transitional state from experience- to evidence-based practice. Barriers for nutritional care are grounded in lack of knowledge among nursing staff and insufficient collaboration between nursing staff and the doctors. There is a need for nutritional education for the nursing staff and better support from the organisation to help nursing staff provide evidence- based nutritional care. Relevance to clinical practice: This study contributes with valuable knowledge before the implementation of evidence-based nutritional care. The study provides an understanding of barriers for nutritional care and presents explanations to why nutritional care has failed to become an integrated part of the daily treatment and care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine how shift work affects intensive care nurses’ lives outside work. Background: Shift work is unavoidable for many nurses. When attempting to minimise negative effects of shift work, it is important to identify areas which affect nurses working shifts. Design: A cross-sectional study. Methods: A questionnaire survey among Danish intensive care nurses concerning experiences with shift work and family life, spare time activities, sleep and health. Results: A total of 114 nurses (88%) participated. Shift work was found to influence the opportunities for spare time activities, and about 25% of both evening- and night-shift groups found that working shifts sometimes led to social isolation. A total of 58% of nurses working evening shifts sometimes to very often experienced having trouble falling asleep when working shifts. Night-shift workers had a higher percentage of physical and mental symptoms when working shifts compared with evening-shift workers, with mood swings and headaches being the most common. The median score for thriving on working shifts was 8 (IQR 5–9) for evening-shift workers and 8 (IQR 7–9) for night-shift workers (scale 0–10 with 10 being the highest level of thriving). Conclusion: Shift workers reported that working shifts had a negative impact on life outside work. Opportunities for participating in spare time activities and difficulties falling asleep after shifts were the main issues for evening-shift workers, whereas physical symptoms such as headaches and mood swings were more dominant among night-shift workers. Despite the negative effects, the participants generally thrived on working shifts. Relevance to clinical practice: By identifying modifiable areas which negatively influence life outside work when working shifts, it will be possible subsequently to plan interventions aimed at decreasing the negative effects. Interventions may include nurses having increased influence on their work schedules and education in sleep hygiene and dietary habits. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe nurses’ perspectives on how an e-message system supports communication between hospital and home care nurses in relation to medication administration. Background: Medication administration is a complex process involving a high risk of error. Unclear communication and lack of updated information about medication have been identified as the leading cause of medication errors during care transitions. E-message systems are progressively being used to improve information exchange across sectors, yet little is known about their usage for exchange of medication information between nurses. Design: A qualitative design using content analysis. Methods: Focus group interviews were conducted with nurses from eight hospital wards and six municipalities (n = 79). Participant observations were conducted in three hospital wards and in three municipalities (165 hr). Results: The e-message system did not provide the information needed by the home care nurses to ensure safe medication administration after discharge due to (1) limitations of the system, (2) hospital nurses’ lack of knowledge about home care nurses’ information needs and (3) hospital nurses’ lack of access to medication information. Due the home care nurses’ perception of responsibility, they bypassed the e-message system to get the information. Conclusions: The home care nurses perceived themselves as the last link in the safety chain. As such, access to adequate information was essential for the nurses to ensure safe medication administration; however, the e-message system did not support exchange of the information needed. Relevance to clinical practice: E-message systems must meet home care nurses’ need for information to ensure that safe medication administration does not depend on the knowledge of the individual nurse. Moreover, other system factors that influence inter-professional collaboration and nurses’ cross-sectoral communication must be addressed. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate experienced symptoms of parastomal bulging in relation to an ileostomy or colostomy. Background Parastomal bulging is a common complication of stoma formation that can affect patients' physical, psychological and social function. Symptom burdens reported by health professionals vary from asymptomatic to high symptom load; however, patients' experiences of symptoms are lacking. Design and method A qualitative design with focus group interviews was chosen for data collection. Twenty patients participated in five semi-structured interviews. Analysis was performed using a phenomenological-hermeneutic approach. Findings The bulge caused different unfamiliar bodily sensations that interacted with patients' everyday lives. Some but not all of these sensations were modifiable. As the bulge and the ostomy changed size and shape, patients had to adjust and readjust stoma care continuously. The physical change called for patients' awareness and posed a threat to patients' control of the ostomy and challenged stoma self-care. The bulge caused a bodily asymmetry that deformed the patients' bodies in a way that exceeded the perceived alteration already caused by the stoma. To cover the physical disfigurement, new clothing solutions, garment wear and creativity were essential in everyday life. Patients gradually adapted to the bulge over time. Easy access to professional help was crucial in order to find the best appliance and garment solution in relation to the bulge. Conclusions Various symptoms related to the parastomal bulge affected patients' everyday lives in different ways and underpinned that an individualised approach is important when addressing patients' problems and complaints. Research into nonsurgical treatments and patient perspectives is limited and highly warranted to improve clinical outcome. Relevance to clinical practice The ever-changing bulge posed a threat to patients′ control of the ostomy and required specific care from the stoma therapist. Needs-based access to counselling, advice and supplementary materials is important. [ABSTRACT FROM AUTHOR]