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Background: Some traditional Chinese medicine (TCM)–based integrated health interventions have been used for depression, but pooled efficacy remains unknown. Aims and Objectives: This study aimed to systematically evaluate the efficacy of TCM‐based integrated health interventions for relieving depression. Design: Systematic review and meta‐analysis. Methods: A comprehensive literature search was conducted on 17 databases from inception up to June 2022. Randomised controlled trials (RCTs) that examined an integrated health intervention based on TCM theory for depression were included. The risk of bias was assessed using the second version of the Cochrane risk‐of‐bias tool for randomised trials, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system. Results: Eighteen RCTs with a total of 1448 depressed participants were included. Health care providers, mainly nurses (14 studies), implemented TCM‐based integrated health interventions. The pooled results showed that TCM‐based integrated health interventions had larger effects on reducing depressive symptoms (15 studies; standardised mean difference = −2.05; 95% CI: −2.74, −1.37; p <.00001) compared with usual care at posttreatment but showed no significant difference contrasted to cognitive behavioural therapy (two studies, p =.31). However, the overall evidence was low. Conclusions: The meta‐analysis results indicated that TCM‐based integrated health interventions were effective in reducing depression. However, the results should be interpreted with caution because of the low quality of the included studies. Future RCTs with rigorous designs should be conducted to provide robust evidence of the efficacy of TCM‐based integrated health interventions in treating depression. Relevance to clinical practice: TCM‐based integrated health interventions might be a potentially effective alternative for depression. Nurses could play an important role in designing and providing TCM‐based integrated nursing interventions for patients with depression. No patient or public contribution: This is a systematic review and meta‐analysis based on data from previous studies. [ABSTRACT FROM AUTHOR]

Aim: To determine the reporting accuracy of pressure injury categorisation by bedside clinicians, compared with nurse experts. Background: Pressure injuries are an enduring complication of hospitalisation. The categorisation of pressure injury affects treatment and management decision‐making and use of resources, and severe hospital‐acquired pressure injury incidence is used to benchmark quality of care. However, it is unclear how accurately pressure injuries are categorised by clinicians in practice. Design: Secondary analysis of hospital pressure injury incident and validation data. Methods: All pressure injuries reported in adults between 2016 and 2019 that were subsequently validated by nurse experts were analysed. Absolute agreement is reported using percentages, with inter‐rater agreement reported using Kappa measure of agreement. The GRRAS reporting guideline was followed. Results: Of 6186 pressure injuries that were analysed, the category was reported correctly in 67.3% (n = 4163), with an overall moderate level of inter‐rater agreement by category (Κ =.567, p <.001). Of those found to be non‐pressure injuries when validated (18.3%, n = 1129), most were reported originally as stage II (41.2%, n = 465) or stage I (30.5%, n = 344), and 13.4% (n = 151) were categorised initially as unstageable. The majority reported initially as stage I, stage II, suspected deep tissue injury or mucosal pressure injury were validated, whereas half of those reported initially as stage III or IV were validated and less than a third of those reported initially as unstageable pressure injuries were validated. Conclusions: This study provides important insight into the accuracy of pressure injury categorisation. Whilst moderate agreement of categorisation was found between reporting clinicians and nurse experts, pressure injury differential diagnosis and categorisation of severe injuries were inadequate. Relevance to Clinical Practice: These results may be used for benchmarking and provide a focal point for future education and practice improvement efforts. Patient or Public Contribution: Neither patients nor the public were directly involved in the project. [ABSTRACT FROM AUTHOR]

Background: Nurses usually provide direct patient care. However, they account for the majority of healthcare workers (HCWs) injured by needles or other sharp objects. Objectives: To assess the prevalence of needle stick injuries (NSI) among nurses worldwide; according to WHO regions, the socioeconomic development index (SDI) of countries, and the developmental status of individual countries, and in the Middle East. Design: Systematic review and meta‐analysis. Methods: We searched PubMed, Scopus, and Web of Science databases. We calculated the pooled NSI prevalence estimates using a random‐effect meta‐analysis with the Comprehensive Meta‐Analysis software. The report of the study was in accordance with the PRISMA 2020 statement. Results: The overall worldwide NSI prevalence pooled from our analysis was 40.97% (95% confidence interval [CI]: 31.29–50.63%, p =.00001). A subgroup analysis of NSI prevalence according to WHO regions revealed the highest prevalence in Southeast Asia (49.9%, 95% CI: [23.4–76.3%]) and the lowest in the United States of America (25.1%, 95% CI: [18.1–32.1%]), respectively. The pooled prevalence in developed and developing countries was 30.5% (95% CI: 27.3–33.8%) and 46.6% (95% CI: 33.7–59.5%), respectively. According to the SDI, NSI prevalence was highest in low‐middle SDI countries (48.9% [95% CI: 30.7–67.2%]). Conclusion: Our results showed a high NSI prevalence among nurses worldwide. Developing countries had a significantly higher NSI prevalence than developed countries, especially low‐middle SDI countries. Relevance to Clinical Practice: This study highlighted the prevalence of NSI risk among nurses practising in clinical settings worldwide. The study findings suggest that continuous training programs should be implemented for nurses to enhance their knowledge, performance and attitude toward NSI prevention in clinical settings. No Patient or Public Contribution: Contributions from patients or the public are irrelevant because the purpose of this study was to examine the global prevalence of NSIs in nurses. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study aimed to identify the associations between longitudinal trajectories of self‐care behaviours and unplanned hospital readmissions in patients with heart failure. Background: Adherence to self‐care behaviours is crucial to prevent hospital readmissions; however, self‐care behaviours remain unsatisfactory among patients with heart failure. Studies of long‐term trajectories of self‐care behaviours and their influence on hospital readmissions are limited in this population. Design: A prospective, longitudinal observational study. Methods: Among 137 participants with heart failure (mean age 67.36 years, 62% men), we analysed the 1‐year follow‐up data to determine the association between 1‐year trajectories of self‐care behaviours and hospital readmissions using Kaplan–Meier analysis and multivariable Cox regression, adjusted for confounding variables. Results: Self‐care behaviour trajectories of heart failure patients were classified as 'high‐stable' (58.4%) or 'low‐sustained' (41.6%). The cumulative rate of readmissions for the low‐sustained class was higher than that of the high‐stable class for all periods. Factors influencing readmissions included anaemia, cognitive function, frailty and self‐care behaviours trajectories. The low‐sustained class had a 2.77 times higher risk of readmissions within 1 year than that in the high‐stable class. Conclusions: Longitudinal self‐care behaviours pattern trajectories of heart failure patients were stratified as high‐stable and low‐sustained. Routine follow‐up assessment of patients' self‐care behavioural patterns, including anaemia and frailty, and cognitive function can minimise unplanned hospital readmissions. Relevance to clinical practice: Identification of trajectory patterns of self‐care behaviours over time and provision of timely and individualised care can reduce readmissions for heart failure patients. Healthcare professionals should recognise the significance of developing tailored strategies incorporating longitudinal self‐care behavioural patterns in heart failure patients. Reporting Method: The study has been reported in accordance with the STROBE checklist (Appendix S1). Patient or Public Contribution: Patients have completed a self‐reported questionnaire after providing informed consent. [ABSTRACT FROM AUTHOR]

Aims: To gain a comprehensive understanding of nurses' infection control practices, antibiotics stewardship attitudes and self‐efficacy when caring for patients with multidrug‐resistant bacterial infections in a hospital setting. Background: Multidrug‐resistant bacteria cause a substantial health burden by complicating infections and prolonging hospital stays. Attitudes and self‐efficacy can inform professional behaviour. Nurses' attitudes and self‐efficacy concerning multidrug‐resistant bacteria, infection prevention and control and antibiotic stewardship are vital in keeping patients safe. Design: A descriptive and convergent mixed‐methods design involving quantitative and qualitative approaches was used. Methods: Two hundred and seventeen nurses working in clinical practice at seven different hospital wards (i.e., general medicine, surgical, haematological and oncology) at a Norwegian university hospital were invited to participate. Data were collected in February and March 2020 via two questionnaires: the Multidrug‐Resistant Bacteria Attitude Questionnaire and the General Perceived Self‐Efficacy Scale (n = 131) and four focus group interviews (n = 22). The data were analysed using descriptive statistics and systematic text condensation. Results: Most nurses showed moderate knowledge, adequate behavioural intentions towards infection prevention and antibiotic stewardship, and high self‐efficacy. However, they reported negative emotions towards their knowledge level and negative emotions towards nursing care. The nurses appeared uncertain about their professional influence and role in antibiotic stewardship practices. Organisational and relational challenges and ambivalent perceptions of nurses' role were potential explanations. Conclusion: Nurses report moderate attitudes and high self‐efficacy when caring for patients with multidrug‐resistant bacterial infections. This study suggests that nurses experience organisational and relational factors in their work environment that challenge their attitudes towards infection prevention and control and antibiotic stewardship practices. Measures that strengthen their knowledge and emotional response underpin correct infection prevention and control behaviour. A role clarification is needed for antibiotic stewardship. No Patient or Public Contribution. Relevance to clinical practice: Measures to increase attitudes towards infection prevention and control, antibiotic stewardship and multidrug resistance is recommended. Measures should be taken to overcome organisational challenges. A clarification of the nurses' role in antibiotic stewardship is needed. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Identify and compare learning needs, levels of self‐efficacy and their association among inpatients and outpatients of a cardiac care unit with coronary heart disease who have undergone percutaneous coronary intervention (PCI) in a Swiss university hospital. Background: After primary PCI, 42% of patients will suffer a recurrent ischemic cardiovascular event. Although adherence to therapeutic regimen contributes to prevent recurrence, patient adherence remains low. To strengthen it, learning needs and self‐efficacy must be considered when developing effective therapeutic patient education (TPE). Methods: Learning needs and self‐efficacy were assessed using the Cardiac Patient Learning Needs Inventory (CPLNI) and the Cardiac Self‐Efficacy Scale among inpatients and outpatients. The STROBE checklist for cross‐sectional studies was used in reporting this study. Results: Ninety‐three patients participated in the study with a participation rate of 73.9%. The CPLNI median total score was significantly higher in inpatients than in outpatients: 4.23 (3.82, 4.64) versus 3.67 (3.33, 4.09), p <.001. In both units, participants declared that the most important need was related to 'anatomy and physiology' of the heart. Despite the high score, the least important need was about 'physical activity' for inpatients and 'miscellaneous information' for outpatients. No statistically significant differences were found among patients from both units regarding their self‐efficacy level. Conclusions: This study shows that after PCI, patients have high learning needs and moderate levels of self‐efficacy that require addressing. Relevance to Clinical Practice: Patient's individual learning needs and self‐efficacy level must be assessed prior/after PCI. A tailored TPE that considers individual learning needs and self‐efficacy is recommended as a preventative measure to reduce recurrent ischemic cardiovascular events. Nurses can play a key role in this process. No Patient or Public Contribution: For feasibility reasons, patients and public were not involved in the design, conduct, reporting or dissemination plans of this research. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate the association between perceived nurse–patient interaction and quality‐of‐life among nursing home residents, adjusted for loneliness, anxiety and depression. Background: Symptoms of anxiety and depression are known to residents of nursing homes along with cognitive impairment, physical inactivity and low quality‐of‐life. Anxiety, depression and loneliness are found detrimental to NH residents' quality‐of‐life. The nurse–patient relationship is important for patient's well‐being, both in terms of illness and symptom management. Design: Cross‐sectional design. Methods: Data were collected in 2017 and 2018 from 188 residents in 27 nursing homes resided in two large urban municipalities in Middle and Western Norway. The inclusion criteria were: (1) local authority's decision of long‐term NH care; (2) residential stay 3 months or longer; (3) informed consent competency recognised by responsible doctor and nurse; (4) capable of being interviewed, and (5) aged 65 years or older. This article is executed in accordance with STROBE statement. Results: Adjusting for age, sex, anxiety, depression and loneliness, perceived nurse–patient interaction was statistically significant to quality‐of‐life. While anxiety and depression showed insignificant estimates, loneliness demonstrated a significant relation with quality‐of‐life. Nurse–patient interaction and loneliness explained together 25% of the variation in quality‐of‐life. Conclusion: This study suggests that loneliness is frequent as well as more detrimental to quality‐of‐life among nursing home residents compared to anxiety and depression. Furthermore, the present results show that the nurse–patient interaction represents an essential health‐promoting resource for Quality‐of‐life in this population. Relevance to clinical practice: Staff nurses need to exercise their awareness of loneliness to meet residents' needs. Nursing educations should provide knowledge about nurse–patient interaction, and students as well as staff nurses in NHs should be trained, for instance by simulation, to use the nurse–patient interaction as a health‐promoting resource. Finally, loneliness represents a bigger challenge than depression and anxiety; accordingly, building nurses that are capable of meeting patients' needs and facilitate care that counteracts loneliness is highly warranted [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to examine the association between physical restraint duration and undesirable outcomes amongst inpatients comorbid with dementia and pneumonia in acute care hospitals. Background: Physical restraints are frequently used in the management of patients, especially amongst patients with dementia. No previous study investigated the potential undesirable effects of physical restraints in patients with dementia. Methods: This was a cohort study using a nationwide discharge abstract database in Japan. Patients aged ≥65 years with dementia hospitalised for pneumonia or aspiration pneumonia between April 1, 2016 and March 31, 2019 were identified. The exposure was physical restraint. The primary outcome was hospital discharge to the community. Secondary outcomes included hospitalisation costs, functional decline, in‐hospital mortality, and institutionalisation for long‐term care. Results: A total of 18,255 inpatients with pneumonia and dementia in 307 hospitals were included in this study. Of them, 21.5% and 23.7% had physical restraint during full and partial days of hospital stays, respectively. Discharge to the community incidence rates was lower in the full‐restraint vs. the no‐restraint group (27 vs. 29 per 1000 person‐days; HR, 1.05 [95% CI, 1.01–1.10]) and the partial‐restraint vs. the no‐restraint group (17 vs. 29 per 1000 person‐days; HR, 1.79 [95% CI, 1.71–1.87]). The risks of functional decline were higher in the full‐restraint vs. the no‐restraint group (27.8% vs. 20.8%; RR, 1.33 [95% CI, 1.22, 1.46]) and the partial‐restraint vs. the no‐restraint group (29.2% vs. 20.8%; RR, 1.40 [95% CI, 1.29, 1.53]). Conclusions: The use of physical restraints was associated with a lower incidence rate of discharge to the community and an increased risk of functional decline at discharge. Further research is needed to judge the benefit–risk balance of physical restraints in acute care settings. Relevance to Clinical Practice: Understanding the risk of physical restraints allows medical staff to improve the process of decision making in everyday practice. No Patient or Public Contribution. Reporting Methods: The reporting of this article conforms to the STROBE statement. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effectiveness of eHealth interventions to reduce stress and promote mental health in healthcare professionals, and to compare the efficacy of different types of programs (guided vs. self‐guided; 'third‐wave' psychotherapies vs. other types). Background: Healthcare workers present high levels of stress, which constitutes a risk factor for developing mental health problems such as depression and anxiety. eHealth interventions have been designed to reduce these professional's stress considering that the characteristics of this delivery method make it a cost‐effective and very appealing alternative because of its fast and easy access. Design: A systematic review of quantitative studies. Methods: A comprehensive database search for quantitative studies was conducted in PubMed, EMBASE and Cochrane (until 1 April 2022). The systematic review was conducted in accordance with the PRISMA and SWiM reporting guidelines. The quality of the studies was assessed using the National Heart, Lung and Blood Institute tools. Results: The abstracts of 6349 articles were assessed and 60 underwent in‐depth review, with 27 fulfilling the inclusion criteria. The interventions were classified according to their format (self‐guided vs. guided) and contents ('third‐wave' psychotherapies vs. others). Twenty‐two interventions emerged, 13 of which produced significant posttreatment reductions in stress levels of health professionals (9 self‐guided, 8 'third wave' psychotherapies). Significant effects in improving depressive symptomatology, anxiety, burnout, resilience and mindfulness, amongst others, were also found. Conclusion: The evidence gathered in this review highlights the heterogeneity of the eHealth interventions that have been studied; self‐guided and 'third‐wave' psychotherapy programs are the most common, often with promising results, although the methodological shortcomings of most studies hinder the extraction of sound conclusions. Protocol registration: PROSPERO CRD42022310199. No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To (1) describe the socio‐demographic and behavioural characteristics of older adults who use wearable devices for physical activity monitoring and (2) explore whether wearable device use increases the possibilities of meeting physical activity guideline recommendations among older adults and older adults with known cardiovascular disease or risk. Background: Finding ways to increase physical activity and reduce cardiovascular disease risk among older adults is a public health priority. Wearable technology has great potential for promoting physical activity among older adults. Design: A secondary analysis of the national data. Methods: A nationally representative sample of older adults aged 65 years and older (mean age = 73.79 years, N = 1484) and a subsample of older adults with known cardiovascular disease or cardiovascular disease risk (mean = 74.32 years, N = 1098) was used in the analysis. All analyses were weighted to account for the complex survey design. This study was reported according to the STROBE checklist. Results: The overall prevalence of wearable device use among older adults and older adults with cardiovascular disease risk was 16% and 14%, respectively. Older adults with higher household incomes, better self‐rated health, and greater exercise enjoyment were more likely to use wearable devices. Compared with non‐users, older adult users were more likely to meet the recommended levels of moderate (55% vs. 31%) and strengthening activity guidelines (46% vs. 25%), but not of the sedentary behaviour guideline (69% vs. 62%). Similar findings were also seen in older adults with known cardiovascular disease or risk. Conclusion: The uptake of wearable devices in older adults, particularly those with known cardiovascular disease or risk is still low. The use of wearable devices is an important facilitator of physical activity. It is critical to provide individualised support for their engagement. Relevance to Clinical Practice: Age‐friendly design and individualised support are recommended to increase older adults' adoption of wearable devices to improve their physical health. Patient or Public Contribution: No patient or public contribution was involved in this study since we used publicly available data. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To map current literature on bedside clinicians' use of point‐of‐care subepidermal moisture devices to identify increased pressure injury risk. Background: Pressure injuries are a substantial healthcare burden. Localised oedema occurs before visible or palpable changes, and therefore is a biomarker of increased pressure injury risk. Novel bedside technologies that detect localised oedema may aid early pressure injury preventative practices. Design: A scoping review. Methods: Arksey and O'Malley's six‐step framework and the PRISMA‐ScR guidelines guided this scoping review. CINAHL Complete, Embase, SCOPUS, Cochrane (wounds) and PubMed databases were searched for primary research and quality improvement projects published in English between 2008–2022. Included studies focused on clinicians' bedside use of subepidermal moisture devices to quantify localised oedema and pressure injury risk. The PAGER framework supported narrative synthesis of the extracted data. Results: Nine studies were selected from 1676 sources. Two point‐of‐care subepidermal moisture devices were identified in clinical use, largely by nurses. Inconsistent use and interpretations revealed significant knowledge gaps in clinical practice. Additionally, no included studies engaged patients or the public in their design. Conclusions: Nurses recognise the value of objective measures in determining the risk of pressure injury and are the primary end‐users of point‐of‐care subepidermal moisture devices. However, standardising procedural instructions and interpretive criteria to guide preventative measures requires further research. Relevance to Clinical Practice: International pressure injury clinical practice guidelines advocate for subepidermal moisture devices as an adjunct to routine clinical skin assessment, although little is known about bedside use. This scoping review reveals low adoption of such devices and the need to develop standardised procedures in their use and interpretation. Registration: Open Science DOI https://doi.org/10.17605/OSF.IO/AB6Y5—7th of March 2022. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is considered as a major health problem for women, and the prevalence is increasing over the world. Research to improve their quality of life is necessary. Purpose: This study was to examine the body image and self‐esteem of breast cancer patients who underwent breast reconstruction in order to determine whether these affect their quality of life. Methods: A cross‐sectional descriptive design was employed. This study was conducted on 140 patients who underwent breast reconstruction following breast cancer surgery at S University Hospital in Gyeonggi‐do, South Korea. Measures were the general characteristics list, body image scale, self‐esteem scale, and the Korean version of the Functional Assessment of Cancer Therapy‐Breast Cancer Version 4 for quality of life. Data were analysed using descriptive statistics, Pearson correlation coefficient, linear regression, and process macro bootstrapping for mediation effect. Data were collected from October 2020 to March 2021. Results: The path regression coefficient was 1.59 (p <.001), and the direct effect of body image on the quality of life was 1.34 (p <.001) considering the effect of self‐esteem, which is a parameter. This confirmed that self‐esteem mediates body image and quality of life. The explanatory power of self‐esteem for quality of life was 54%. Conclusion: This study suggests that body image and self‐esteem are important factors in the quality of life of breast cancer patients who underwent breast reconstruction. Also, the self‐esteem has a mediating effect in the relationship between body image and quality of life. Relevance to clinical practice: In clinical practice, nurses should focus on the body image and self‐esteem of breast cancer patients who have undergone breast reconstruction in order to improve their quality of life. Patient or public contribution: This cross‐sectional descriptive design study was conducted on patients who underwent breast reconstruction following breast cancer surgery at hospital in South Korea. [ABSTRACT FROM AUTHOR]

Background: Medication administration errors (MAEs) cause preventable patient harm and cost billions of dollars from already‐strained healthcare budgets. An emerging factor contributing to these errors is nurse fatigue. Given medication administration is the most frequent clinical task nurses undertake; it is vital to understand how fatigue impacts MAEs. Objective: Examine the evidence on the effect of fatigue on MAEs and near misses by registered nurses working in hospital settings. Method: Arksey and O'Malley's scoping review framework was used to guide this review and PAGER framework for data extraction and analysis. The PRISMA checklist was completed. Four electronic databases were searched: CINAHL, PubMed, Scopus and PsycINFO. Eligibility criteria included primary peer review papers published in English Language with no date/time limiters applied. The search was completed in August 2021 and focussed on articles that included: (a) registered nurses in hospital settings, (b) MAEs, (c) measures of sleep, hours of work, or fatigue. Results: Thirty‐eight studies were included in the review. 82% of the studies identified fatigue to be a contributing factor in MAEs and near misses (NMs). Fatigue is associated with reduced cognitive performance and lack of attention and vigilance. It is associated with poor nursing performance and decreased patient safety. Components of shift work, such as disruption to the circadian rhythm and overtime work, were identified as contributing factors. However, there was marked heterogeneity in strategies for measuring fatigue within the included studies. Relevance to clinical practice: Fatigue is a multidimensional concept that has the capacity to impact nurses' performance when engaged in medication administration. Nurses are susceptible to fatigue due to work characteristics such as nightwork, overtime and the requirement to perform cognitively demanding tasks. The mixed results found within this review indicate that larger scale studies are needed with particular emphasis on the impact of overtime work. Policy around safe working hours need to be re‐evaluated and fatigue management systems put in place to ensure delivery of safe and quality patient care. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Explore families' experiences when being approached for organ donation authorisation after brainstem death. Background: The complexities of potential organ donor families' experiences include challenges related to emotional distress, coping with the loss and the organ donation decision‐making process, and support needed. A lack of conceptual clarity was found concerning families' experiences when being approached for organ donation authorisation, which guided the study. Design: Constructivist grounded theory. Methods: Seventy‐one participants, including healthcare professionals and families, were recruited from two large hospitals in Chile between 2017 and 2019. Field notes, documents (n = 80), interviews (n = 27) and focus groups (n = 14) were collected and analysed following Charmaz's constructivist grounded theory principles and practices until theoretical saturation was reached. The study is reported using the COREQ checklist. Results: A third type of ambiguous loss of bereaved families' experience was developed as a fourfold process: (1) impending loss, (2) confirming loss, (3) ambiguous loss and organ donation decision‐making and (4) organ donation as a third type of ambiguous loss. This grounded theory expands the concepts of ambiguous loss by Boss, dying by Glaser and Strauss and grief by Brinkmann, enabling explanation of families' experiences. Conclusion: Families of potential organ donors develop a highly complex grieving process, which may play a significant role in the organ donation decision‐making process. Ambiguity is embedded in how donor families reframe the existence of the donor through the act of giving life. Relevance to clinical practice: The findings shed light on families' experiences on the organ donation process after brainstem death. The study can be used in nursing practice, education and to inform policy nationally and globally, mainly due to the current focus on quantitative measures and legislative changes fostering individual decision‐making. Patient or Public Contribution: Families contributed through their first‐hand experiences of the organ donation process. [ABSTRACT FROM AUTHOR]

Background: Qualified individualised nursing care should be provided to all communities and ethnic groups with free of ethnocentrism. Aims: To evaluate nurses' individualised care behaviours and ethnocentric attitudes and predict the relationship between their individualised care behaviours and ethnocentric attitudes. Design: A descriptive and exploratory study. Methods: This study was conducted with 250 nurses working in a public and two private hospitals in a city, an area with many refugees. Data were collected using the Ethnocentrism Scale and Individualised Care Behaviours Scale. Structural equation model analysis to test hypothetical model and descriptive statistics were used. Results: Nurses working in the private hospitals had a higher individualised care decision control mean score. Those nurses who enjoyed spending time with people from different cultures had lower mean ethnocentrism scale scores, higher individualised care clinical status, personal life and decision control status subscales mean scores compared to other nurses. Mean scores of the individualised care personal life and decision control status subscales of the nurses who followed the literature on transcultural nursing was higher. A significant relationship between the ethnocentrism levels and individualised care behaviours was identified. Accordingly, the ethnocentric attitudes of the nurses negatively affected their individualised care behaviours, and the model established between the two concepts is statistically appropriate. Conclusions: Nurses who work in private hospitals, receive intercultural nursing education and enjoy spending time with different cultures have higher individualised care behaviours and lower ethnocentrism levels. Ethnocentric attitudes of the nurses negatively affected their individualised care behaviours. Care strategies should be developed that consider the factors that will maximize individualised care practices that minimize ethnocentric behaviours among nurses. Implications for the Profession: Increasing awareness on individualised care behaviours, ethnocentric attitudes and effected factors will contribute to improve of nursing care quality of nurses while giving care to individuals from different cultures. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to measure the impact of a complex quality improvement intervention on the incidence of SSI in patients undergoing elective colorectal surgery. Background: Surgical site infections are a major postoperative complication for patients undergoing colorectal surgery. Prevention of SSIs necessitates a complex intervention requiring many elements to be in place to ensure the successful implementation of prevention measures. Design: This study was a non‐equivalent pre‐test post‐test design where consecutive patients undergoing colorectal surgery were surveyed for surgical site infections for 30 days postoperatively and is reported using the SQUIRE 2.0. Methods: A baseline cohort of patients was retrospectively reviewed in a single centre to ascertain the surgical site infection incidence rate in the first 6 months of 2018 (T0) and prospectively at two 6‐month time periods in 2019 (T1, T2) following the introduction of a complex intervention. There were 311 patients included across three time periods. Results: There was a notable decrease in surgical site infection incidence rates from baseline over the course of the study. Univariate analysis identified Body Mass Index, a wound contamination classification of dirty or contaminated, duration of surgery >75th percentile and a National Healthcare Safety Network risk index score of 3 as factors that significantly increase the probability of developing a surgical site infection. Multivariate analysis identified duration of surgery and body mass index increased the probability of an SSI. The results of the logistical regression model found that there was a significant reduction in the probability of an SSI between T0 and T2. Conclusions: The implementation of a complex intervention led to a reduction in the incidence of surgical site infections and improved implementation of evidence‐based practices as part of a care bundle in relation to the prevention of surgical site infections in patients undergoing elective colorectal surgery. Relevance to Clinical Practice: A multicomponent multidisciplinary complex intervention as part of a quality improvement project can successfully reduce the incidence rates of surgical site infections in patients who require elective colorectal surgery. Normalisation Process Theory provides guidance and support in implementing complex interventions for the prevention of surgical site infection. Patient or Public Contribution: Patients provided post‐discharge information on their wound healing as part of the surveillance component of the intervention. Five patients reviewed and provided feedback on a patient information booklet which was developed from this quality improvement intervention. A multidisciplinary steering group guided all stages of the project. [ABSTRACT FROM AUTHOR]

Aims: This study was conducted to determine the risk perceptions of patients with type 2 diabetes mellitus (T2DM) regarding insulin therapy and diabetes complications. Background: Self‐care behaviour is an important requirement for managing T2DM, and risk perceptions are thought to play a key role in this behavioural process. It is predicted that an accurate risk perception will contribute to diabetes management and the reduction in diabetes‐related complications. Design: This study was conducted as cross‐sectional and a descriptive study. The STROBE checklist was used. Methods: The study was conducted with 330 patients with T2DM who presented to the endocrinology outpatient clinic of the Eskisehir City Hospital between October 2020 and May 2021. A personal information form, the Insulin Treatment Appraisal Scale and the Risk Perception Survey‐Diabetes Mellitus were used to collect data. The SAS 9.4 software package was used for the statistical analysis. Data were evaluated using descriptive statistics, the Mann–Whitney U test, the Kruskal‐Wallis test and the Spearman correlation analysis. Results: It was determined that 62.4% of the patients with T2DM participating in the study were female, the mean age was 56.7 ± 9.1 years, 50.6% were primary school graduates, 31% used oral antidiabetic medications, and 58.7% used insulin together with oral antidiabetic drugs. The mean score of participants on the total Insulin Treatment Appraisal Scale was 75.1 ± 11.5, and the level of negative perceptions towards insulin use was found to be high. The participants' mean score on the total Risk Perception Survey‐Diabetes Mellitus was 3.9 ± 0.8, and it was found that they had high levels of risk perceptions of diabetes complications. There was a moderate, statistically significant negative correlation between the Insulin Treatment Appraisal Scale and the Risk Perception Survey‐Diabetes Mellitus. Conclusion: Patients with perceptions of a lower risk for diabetes complications had more negative attitudes towards insulin therapy. It is recommended to determine the risk perceptions of patients with T2DM and to plan appropriate nursing interventions that can increase their positive perceptions and change their negative perceptions so that they can make healthy behaviour changes. Additionally, it is recommended that patients with T2DM should be supported and the number of studies in this field should be increased. Relevance to clinical practice: The effective management of diabetes requires cooperation between patients with T2DM and health professionals. Nurses should perform a constant evaluation and follow‐up to address patients' knowledge, perception and actual health behaviours and to guide a culturally and gender‐sensitive care plan. For individualised care plans that provide appropriate support and counselling, it is necessary to constantly assess risk factors and barriers to preventive health behaviours and perceptions. No patient or public contribution: Patients with T2DM contributed their data to the study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The study aimed to investigate differences in assessing implicit rationing of nursing care by Czech nurses with respect to the type of unit and type of hospital. Background: Implicit rationing of nursing care may differ across different types of hospitals and hospital units. Design: This study used a multicentre cross‐sectional study design. Methods: The STROBE checklist for observational cross‐sectional studies was followed for reporting of the research study. The sample included 8209 nurses providing direct care to medical and surgical patients in 14 acute care Czech hospitals. The main outcome was implicit rationing of nursing care as measured with a Czech version of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument. Data were collected from September 2019 to October 2020. Results: The most frequently rationed nursing care activity was timely response to patient or family request/need, followed by emotional or psychological support and adequate supervision of delegated tasks. More implicitly rationed nursing care was reported in medical units. Statistical differences were found in rating 25 items and the PIRNCA total score. Nurses from middle‐sized hospitals reported implicitly rationed care more frequently than those from large hospitals. Conclusion: More rationed care was reported by nurses from medical units and nurses from middle‐sized hospitals. Organisational variables (the type of unit and type of hospital) influence the implicit rationing of nursing care in our study. Relevance to Clinical Practice: The findings call for nursing managers to pay attention to organisational variables which may affect the implicit rationing of nursing care. [ABSTRACT FROM AUTHOR]

Aims: To identify the barriers and enablers perceived by hospital‐based clinicians to providing evidence‐based continence care to inpatients. Design: This was a cross‐sectional study of inpatient clinicians using a questionnaire. Methods: Acute care and rehabilitation clinicians from 15 wards that admit patients after stroke at 12 hospitals (NSW = 11, Queensland =1, metropolitan = 4, regional = 8) were invited to complete an online questionnaire. The 58 questions (answered on a 5‐point Likert scale) were aligned to 13 of the 14 domains of the Theoretical Domains Framework. Results were dichotomized into 'strongly agree/agree' and 'unsure/disagree/strongly disagree' and proportions were calculated. Data collection occurred between January 2019 and March 2019. Results: The questionnaire was completed by 291 participants with 88% being nurses. Barriers were found in nine domains including knowledge; skills; memory attention and decision making; emotion; environmental context and resources; behavioural regulation; social professional role; intensions, social influences; and beliefs about capabilities. Enablers were found in seven domains including goals; social influences; knowledge; skills; social, professional role and identity; reinforcement and beliefs about consequences. Conclusion: This multi‐site, multi‐professional study that included predominantly nurses highlights the barriers and enablers to inpatient continence care. Future implementation studies in inpatient continence management should address these identified barriers and enablers to improve effectiveness of implementation of evidence‐based care. Implications for the profession: This study highlights that although there are many barriers to ward nurses providing evidence‐based continence care, there are also several enablers. Both should be addressed to improve practice. Reporting method: We adhered to the Checklist for Reporting Results of Internet E‐Surveys (CHERRIES) (Supplementary File 1). Relevance to clinical practice: Establishing barriers to practice gives a broader understanding of why practice does not occur and establishes areas where researchers and clinicians need to address in order to change behaviour. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to gain comprehensive insight into the quality of life of parental living liver donors after liver donation. Background: Several studies reported good quality of life of living liver donors with the SF‐36 scale. Care demand from the recipient and responsibility of being parent might make a difference in parental donors' personal experienced quality of life after transplantation surgery. Methods: It is a cross‐sectional study. The parental donors' demographics, clinical data and post‐donation complications were obtained. Quality of life was assessed using the Medical Outcomes Study SF‐36 and the Quality of Life Scale of Living Organ Donors‐Common Module. Patient or Public Contribution: The enrolled participants were contacted by electronic questionnaires and telephonic interview. Results: A total of 345 parental donors were included, with recruited period ranging from 3 to 85 months post‐donation. 8.1% of donors had post‐operative complications, mostly classified as Clavien grade II. Donors' general quality of life was higher than the Chinese general norm. Issues related to surgical incision, fatigue, worries about income and personal health, effects on work capability, increased medical expenses and difficult reimbursement and suspected donation decision were the prominent problems among donors. Mother–son relationship (OR = 1.87) and equal or less than 2 years after donation (OR = 3.08) were the influencing factors for poor physical quality of life, while unmarried status (e.g. divorced or widowed) was found negatively associated with mental quality of life (adjusted OR = 3.61). Conclusions: General health among parental donors is good but those female, unmarried and near post‐donation might in low life quality. Incision, fatigue, finance, reimbursement and donation decision are prominent problems. Relevance to Clinical Practice: Post‐donation care of living donors should cover social and financial domain besides physical and mental dimension. Providing follow‐up care and counselling is necessary to ensure their life quality. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim was to identify latent trajectories in physical activity (PA) and their determinants in adults with chronic obstructive pulmonary disease (COPD) based on the socio‐ecological model. Background: PA has been linked to poor long‐term outcomes in patients with COPD. However, few studies have explored their PA trajectories and their predictors. Design: Cohort study. Methods: We used data from a national cohort and included 215 participants. PA was quantified using a short PA questionnaire, and group‐based trajectory modelling was used to explore the PA trajectories. Multinomial logistic regression was conducted to identify the predictors of PA trajectories. Generalised linear mixed models were used to elucidate the associations between predictors and PA during follow‐up. A STROBE checklist was used to guide the reporting of this study. Results: Three PA trajectory patterns were identified among 215 COPD participants with an average age of 60.51 ± 8.87: stable inactive group (66.7%), sharp decline group (25.7%) and stable active group (7.5%). The logistic regression showed that age, sex, income, peak expiratory flow, upper limb capacity, depressive symptoms, the frequency of contact with children were PA predictors. Upper limb capacity weakness and depressive symptoms were found to be associated with a sharp decline in PA during follow‐up. Conclusions: This study revealed three PA trajectories among patients with COPD. In addition to strengthening the physical functions and mental health of patients, support from the family, community and society also play a crucial role in promoting PA of patients with COPD. Relevance to Clinical Practice: It is essential to identify distinct PA trajectories in patients with COPD to develop future interventions that promote PA. No Patient or Public Contribution: A national cohort study was used and no patients or the public were involved in the design and implementation of this study. [ABSTRACT FROM AUTHOR]

Objectives: To determine the relationship between nurse burnout, missed nursing care, and care quality following the COVID‐19 pandemic. Background: Quality of care and missed nursing care can be consequences of nurse burnout. Little is known about how these factors related to nurse burnout following the COVID‐19 pandemic. Design: This study used a cross‐sectional correlational design and was conducted in 12 general hospitals across Thailand from August to October 2022. Methods: 394 nurses providing direct nursing care to patients during the COVID‐19 pandemic completed the survey. The Emotional Exhaustion (EE) subscale of the Maslach Burnout Inventory‐Human Services Survey (MBI‐HSS), MISSCARE survey, and quality of care reported by nurses were used to collect data. Descriptive statistics and logistic regression models were used to analyse the data. Results: Approximately thirty‐six percent of nurses had burnout following the COVID‐19 pandemic. Missed nursing care was higher among nurses with burnout. Most participants reported illness/symptoms such as anxiety, fatigue, a lack of concentration, and sleeping problems. After adjusting for demographic characteristics, every additional unit of emotional exhaustion was associated with 1.61 times higher odds of missed nursing care, 3.37 times higher odds of poor quality of nurse care, and 2.62 times higher odds of poor quality of care for the overall unit. Conclusion: The study findings demonstrate that burnout is associated with missed nursing care and poor quality of care following the COVID‐19 pandemic. Relevance to Clinical Practice: Policymakers, hospital administrators, and nurse managers should invest in strategies to reduce nurse burnout, which can increase patient safety and quality of care. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To determine the prevalence and levels of anxiety and depression symptoms among nursing students during the coronavirus lockdown, and to examine factors associated with higher levels of anxiety and depression on this population. Background: Nursing students deal with diverse stressors during their university lives. Confinement measures during COVID‐19 outbreak may have influenced students' mental health and well‐being. Anxiety and depression are common among nursing students due to different factors. Evidence relating to anxiety and depression in nursing student population during SARS‐CoV‐2 pandemic is limited. Design: A cross‐sectional descriptive co‐relational study during the lockdown due to the coronavirus outbreak in Spain was conducted. Methods: An online questionnaire was developed by using google forms. Sociodemographic characteristics form, and the Spanish version of the Hospital Anxiety and Depression Scale (HADS) were used. Spanish nursing students across the country were enrolled. Data collection was performed between 4 April 2020 and 21 April 2020. A multivariate analysis was performed to determine the association between sociodemographic variables, COVID‐19 and HADS scores. Results: 1319 participants were enrolled. The sample was formed by 87.1% female students with a mean age of 22 years (SD ± 5.677). We found a mean score of 8.47 ± 4.104 on Scale HADS‐Anxiety and 6.80 ± 2.988 on HADS‐Depression. 31.6% students presented abnormal scores of anxiety symptoms, and only 11.4% participants revealed abnormal scores on HADS‐Depression. Conclusions: The reported prevalence of anxiety and depression symptoms on nursing students during the COVID‐19 lockdown is 56.4% and 38.2%, respectively. 43.6% of the sample scored normal anxiety levels, and 61.8% obtained normal depression levels. Higher anxiety and depression levels were statistically associated with being a first‐year student, being a smoker, feeling fear, feeling stress and having any close family member infected. Relevance to clinical practice: These data should be valuable for detection and for further treatment decision of this disorders at the initial stage and could be important to prevent further damages to mental health and promote physical, psychological and well‐being among this population. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine knowledge, attitude, and practice regarding postoperative delirium and the relationships among cardiac surgery nurses in China. Background: Postoperative delirium is a prevalent and devastating complication following cardiac surgery. Nurses play a part in multi‐disciplinary collaboration for preventing and managing postoperative delirium, of whom knowledge, attitude, and practice are essential. Design: A cross‐sectional multi‐centre study. Methods: Nurses from cardiac surgery wards and intensive care units of five tertiary hospitals in Wuhan, Hubei Province, China were enrolled. Data were gathered online using a self‐administered questionnaire. Student's t‐test, or analysis of variance, or non‐parametric tests were performed to compare differences across groups. Bootstrapping mediation analysis was conducted to examine the relationship between knowledge, attitude, and practice. The STROBE checklist was used for the reporting of this study. Results: Of 429 nurses, a moderate level of knowledge and high levels of attitude and practice regarding postoperative delirium were revealed. Nurses with higher education, higher academic title, 5–10 years of practice in nursing and cardiac surgery nursing exhibited increased knowledge. With advanced age, practice in a specialised hospital, and training experience, nurses reported a better degree of practice. Attitude played a full mediating effect in the relationship between knowledge and practice, accounting for 81.82% of the total effects. Conclusions: Knowledge, attitude, and practice regarding postoperative delirium are promising among Chinese cardiac surgery nurses, with knowledge of screening tools and perioperative nonpharmacological interventions and practice of screening in need of enhancement. Attitudes act as an intermediary between knowledge and practice regarding postoperative delirium. Relevance to Clinical Practice: Innovative and stratified in‐service education is warranted to address knowledge enhancement. Meanwhile, organisations are suggested to make efforts to foster nurses' positive attitudes, particularly in creating a favourable culture and developing institutional protocols for postoperative delirium management to improve practice. No Patient or Public Contribution: This study is focused on cardiac surgery nurses' knowledge, attitude, and practice regarding postoperative delirium, and the research questions and design are from clinical nursing practice, literature review, and expert panel review, in which the patient or public is temporarily not involved. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To analyze stress levels, sleep quality, sleepiness and chronotypes on emergency room (ER) professionals before and during the COVID‐19. Background: ER healthcare professionals are exposed to high stress levels, and they often present with poor sleep quality. Design: Observational study conducted into two different phases (before the COVID‐19 and during the first wave of the COVID‐19). Method: Physicians, nurses and nursing assistants working in the ER were included. Stress, sleep quality, daytime sleepiness and chronotypes were assessed by the Stress Factors and Manifestations Scale (SFMS), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Horne and Österberg Morningness‐Eveningness questionnaire, respectively. The first phase of the study was performed between December 2019 and February 2020, and the second between April and June 2020. The STROBE checklist was used to report the present study. Results: In total, 189 ER professionals in the pre‐COVID‐19 phase and 171 (of the initial 189) during COVID‐19 were included. The proportion of workers with a morning circadian rhythm increased during the COVID‐19, and stress levels were significantly higher during COVID‐19 compared to the previous phase (38.34 ± 10.74 vs. 49.97 ± 15.81). ER professionals with poor sleep quality presented higher stress in the pre‐COVID‐19 phase (40.60 ± 10.71 vs. 32.22 ± 8.19) and during COVID‐19 (55.27 ± 15.75 vs. 39.66 ± 9.75). Similarly, workers with excessive sleepiness had higher stress in the pre‐COVID‐19 phase (42.06 ± 10.95 vs. 36.64 ± 10.24) and during COVID‐19 (54.67 ± 18.10 vs. 48.44 ± 14.75). Positive associations were also found between the SFMS and the PSQI, as well as with the ESS in both phases of the study. Conclusions: Emergency room professionals had increased stress levels during the COVID‐19 pandemic. Stress was particularly higher in those with poor sleep quality or with excessive daytime sleepiness. Relevance to Clinical Practice: These results should aim to impulse the implementation of measures to improve the working conditions of ER professionals. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate the oral health literacy (OHL) of nurses and explore the factors affecting their OHL. Background: OHL is important for improving the oral health outcomes. Nurses' OHL may affect the oral health of themselves, families, and patients. Few studies have examined the OHL and its related factors among nurses. Design: A cross‐sectional design following the STROBE guideline. Methods: A total of 449 nurses were recruited from tertiary hospitals in the minority areas of southwest China. The participants completed an online questionnaire, which contained questions related to the OHL, sociodemographic factors, general health, oral health and related behaviours, oral health knowledge, attitudes, and oral health‐related quality of life. OHL was measured using the validated Chinese version of the short‐form Health Literacy of Dentistry (HeLD‐14) scale. Descriptive statistics, the Mann–Whitney U test, Spearman's correlation, and multiple linear regression analysis were used to analyse the data. Results: The median HeLD‐14 score (p25–p75) was 50.0 (44.0–54.0). The regression model for OHL was found to be significant. The factors that influenced OHL included oral health knowledge, oral health attitudes, self‐reported oral health, annual household income, and dental flossing; these factors accounted for 13.9% of the variance in OHL. Conclusions: The nurse' OHL has room for improvement. Nurses' OHL could be improved by enriching their oral health knowledge, promoting their positive oral health attitudes, increasing their household income, and helping them build correct oral health behaviours. Relevance to clinical practice: The findings of the study could be used to make a case for changing nursing curricula. Oral health knowledge curriculum or programmes targeted towards nurses should be developed to improve their OHL. Patient or public contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to describe the prevalence of reproductive concerns among young female patients with colorectal cancer and explore the associated factors. Background: With the trend of longer survival and younger age at diagnosis of colorectal cancer patients, reproductive concerns have become increasingly prevalent among young female colorectal cancer patients. Design: Cross‐sectional design. Methods: The study included 150 young female patients with colorectal cancer who completed cancer treatment at 2 hospitals in Guangzhou, China, between November 2020 and December 2021 completed an investigation comprising A general questionnaire, The Reproductive Concerns After Cancer scale, The Family Adaptation and Cohesion Evaluation Scale II and unmet fertility information needs questionnaire. Multivariable linear regression analysis was performed in order to identify factors that influence reproductive concerns. This study was prepared and is reported according to the STROBE checklist. Results: The mean (SD) score on the Reproductive Concerns After Cancer scale was 54.78 ± 8.97. The highest score was for the children's health subscale (3.84 ±.92) and the lowest was for acceptance (2.24 ±.70). Multiple regression analysis showed that patients with fewer children, female children, lower education level (less than undergraduate degree), earlier disease stage, lower family function and higher unmet need for fertility information had more reproductive concerns, which explained 26.9% of the total variation of the model. Conclusions: The patients with fewer children, female children, low cultural degree (less than bachelor), early clinical patients, poorer family function and higher unmet fertility information needs had higher reproductive concerns. Relevance to clinical practice: These findings can guide the development of interventions to mitigate reproductive concerns, including understand and meet their fertility information needs, improve the level of family function. Patient or public contribution: Survey questionnaires were completed by participants among young female with colorectal cancer in this study. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To understand the nutritional status, observing eating difficulties during mealtimes for people living with dementia in acute care settings. Background: Changed eating behaviours caused by declining cognitive function is common in people living with dementia which can lead to malnutrition. Malnutrition is associated with prolonged hospitalisation and increased mortality. People living with dementia in acute care settings are at high risk of malnutrition. This highlights the importance of better understanding the nutritional intake and eating behaviours of people living with dementia in acute care settings. Design: This study is a cross‐sectional, observational study. Methods: Data of mealtime difficulties and nutritional status of people living with dementia were collected in four geriatric care wards (in acute or sub‐acute hospitals) by using Feeding Difficulty Index and Mini Nutritional Assessment Short‐Form. The STROBE checklist was used throughout this study. Results: The study included 94 people living with dementia. The median age of the participants was 85.86 years old, with a Feeding Difficulty Index of 8.27 and had stayed in hospitals for average 14.46 days, with an average total feeding time of 24.61 min. Only 1.2% of participants were considered to be in normal nutritional status, whereas 72.1% were malnourished. All participants required partial or full assistance during mealtime. Participants with higher scores on the Feeding Difficulty Index have longer total feeding times, compared to those with lower scores. Conclusions: Malnutrition is prevalent in people living with dementia. People living with dementia demonstrate varying mealtime difficulties depending on the level of dependence. Mealtime assistance training programs are warranted and are beneficial for nursing staff and family members to improve their feeding skills and knowledge. No patient or public contribution: This study did not involve patients, service users, caregivers or members of the public. Relevance to clinical practice: The study is relevant to clinical practice by identifying changed eating behaviours or mealtime difficulties in people living with dementia in acute care settings can significantly decrease the risk of malnutrition. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate the factors affecting quality of life in healthcare providers who care for patients with COVID‐19. Background: Healthcare providers caring for COVID‐19 patients during the pandemic suffered a deterioration in their quality of life. Several studies have explored their psychological impact of working with COVID patients, but none have examined the causes of this deterioration. Design: A cross‐sectional study. Methods: In the current study, the authors investigated the factors affecting quality of life in 293 healthcare providers recruited from a medical centre in northern Taiwan who had recently cared for patients with suspected or confirmed COVID‐19 by analysing their responses to an online self‐report questionnaire, using bivariate correlations and structural equation modelling. Reporting of this research adheres to the STROBE guideline. Results: The study identified an important sequence of factors that mediated the effects of perceived success of epidemic prevention policies, family relations problems and education level on quality of life in a sample of healthcare workers caring for COVID‐19 patients. The mediators were use of approach‐oriented coping strategies and current mental health status. Specifically, use of approach‐oriented coping strategies was found to directly cause improved quality of life and indirectly cause improved mental health, whereas use of avoidant coping strategies was found to directly cause worsening of mental health. Poor mental health predicted poor quality of life. Conclusions: Results suggest that implementation of sound epidemic prevention policies that promote adoption of approach‐oriented coping behaviour should lead to a better quality of life in the future for healthcare providers working in challenging circumstances. Relevance to Clinical Practice: Assessment of these policies as well as the providers' family relations are necessary first steps to improving the success of approach‐oriented coping behaviour in this population, which in turn can improve their mental health and quality of life. Patient or Public Contribution: Neither patients nor members of the public were involved in the design or execution of the study. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to compare the effects of massage interventions on sleep quality among patients in the adult critical care unit. Background: Massage interventions have positive effects when applied to manage sleep quality in critical care units. However, research identifying the effect of massage intervention is limited. Design: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Methods: Five databases were searched from their inception to 15 April 2022 (the last search was conducted on 15 November 2022, but it yielded no additional eligible studies). The literature search was conducted using Embase, MEDLINE, the Cochrane Library, CINAHL, PsycINFO and additional sources such as Google Scholar. The Cochrane risk of bias tool for randomised trials (RoB 2.0) was used to assess the risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system assessed the certainty of evidence and recommendations. Results: In total, ten randomised controlled trials comprising 569 participants were used in the systematic review, and eight trials were included in the meta‐analysis. Subgroup analysis revealed significant effects of foot reflexology massage on subjective sleep quality. Massage therapy for a two‐night duration in cardiac care unit patients exhibited a significant effect on subjective sleep quality. The overall GRADE certainty of evidence was low. Conclusion: Massage intervention, particularly foot reflexology massage, with a two‐night duration showed improvement in subjective sleep quality among critically ill patients. Although evidence quality was low, the results suggest that massage interventions provide a non‐invasive, low‐cost and effective way to promote sleep quality in critically ill adult patients. Relevance to clinical practice: Massage interventions can enable nurses to recommend and implement strategies promoting and improving sleep quality among critically ill patients. Study registration: The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.York.ac.uk/Prospero with the registration number # CRD42022332371). Patient or public contribution: No patient or public contribution if such details are not necessary or do not apply to your work and state why. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To develop a conceptual framework that explores the process of building family resilience among Chinese families with children diagnosed with leukaemia. Background: The diagnosis of childhood leukaemia has a devastating effect on the family. Nonetheless, some families were able to positively respond to the crisis. The process through which Chinese families bounce back has received little attention. Design: Grounded theory. Methods: This study used purposive and theoretical sampling to select 16 parents who agreed to participate in semistructured interviews after children were diagnosed with leukaemia. Data collection and analysis occurred simultaneously. Data were analysed through a process of open, axial and selective coding. The COREQ checklist was followed for reporting. Results: A core category of 'finding family resilience in adversity' was generated. The core category was underpinned by a transition process between two fluid stages: (a) Disrupting the family system, informed by subcategories of negative emotional disturbances and challenges of the diagnosis and treatment journey; (b) Cultivating resilience in families, informed by subcategories of increasing positive attitudes; establishing new family routines; activating good support systems; and practising open family communication. Conclusions: The transition process from the disruption of the family system to the cultivation of family resilience is perceived as a complex family dynamic in response to childhood leukaemia. Our findings can form the basis for further research about resilience‐based family interventions that promote family well‐being during the early stages of a childhood leukaemia diagnosis. Relevance to Clinical Practice: It is necessary for healthcare professionals to provide essential support for families to face the challenges of diagnosis and treatment to facilitate the successful transition to family resilience. By understanding the dynamic process of developing family resilience, healthcare professionals are able to focus on these families to provide holistic care that satisfies the specific demands of family members. [ABSTRACT FROM AUTHOR]

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

Aims and Objectives: To explore the trajectories of self‐care behaviours in patients with chronic obstructive pulmonary disease based on the latent class growth model and investigate the predictors of each trajectory based on the capability opportunity motivation and behaviour model. Background: Studies on self‐care behaviours of patients with chronic obstructive pulmonary disease are mainly cross‐sectional surveys. However, little is known about longitudinal trends of self‐care behaviours changes among those population. Design: This was a prospective observational research performed according to STROBE Checklist. Methods: One hundred and nineteen patients with chronic obstructive pulmonary disease were followed up at baseline, 3 and 6 months. Data collection included the scores of self‐care behaviours, specific demographic and clinical characteristics, and scores for the predictors. A latent class growth model was used to explore the self‐care behaviours trajectories. Multiple logistic regression analysis was conducted to identify predictors of self‐care behaviours trajectories. Results: Three trajectories in the self‐care behaviours of patients with chronic obstructive pulmonary disease were found: a persistently negative trajectory, a maintenance trajectory after a slight increase and an active trajectory with a slow upward improvement in self‐care behaviours. Medical insurance and access to medical resources were the predictors of self‐care behaviours. Conclusion: The patients with poor medical resources and medical insurance are at high risk for the poor self‐care behaviours and the negative trajectory. Thus, dynamic and individualised intervention should be continuously provided to ensure patients acquire adequate medical resources to comprehensively improve self‐care behaviours. Relevance to Clinical Practice: People with better self‐care trajectory may be patients who receive more medical resources or have less financial burden, which will help with the early identification of high‐risk patients with a negative self‐care trajectory. Intervention guided by Behaviour Change Wheel Theory should be conducted dynamically for patients for patients with different trajectories. Patient or Public Contribution: Thank the patients and their families for their cooperation in data collecting in this study. [ABSTRACT FROM AUTHOR]

Aim: To explore perceptions of people with Parkinson's disease and family carers about the use and impact of health and social care services, community and voluntary sector resources for the management of Parkinson's disease. Background: Resources from outside the formal health care system and collaborations between different levels and sectors could address the unmet needs of people with Parkinson's disease and their family carers and improve the management of Parkinson's disease in the community setting. Design: A qualitative exploratory study was carried out in Denmark, Norway, Spain and the United Kingdom and was reported using the COREQ. Methods: Individual semi‐structured interviews were conducted with people with Parkinson's disease and family carers between May and August 2020. Interviews were digitally recorded, transcribed verbatim and analysed using thematic analysis. A meta‐ethnographic approach was used to analyse and synthesise cross‐national findings. Results: Forty‐seven people with Parkinson's disease and 39 family carers participated in the four countries. Four themes and eight sub‐themes emerged: (1) Personalised care for needs throughout the Parkinson's disease journey; (2) Accessibility of different types of support systems (including initiatives to support emotional well‐being, physical rehabilitation, information on the healthcare services, voluntary associations and community groups); (3) Multiagency collaborations, a more comprehensive approach; (4) Acknowledgment of people with Parkinson's and family carers own role in Parkinson's disease management. Conclusions: An integrated and person‐and‐community‐centred approach, which includes the participation of the health, social, voluntary and community sectors, is desired by people with Parkinson's disease and their family carers to improve the management of Parkinson's in the community setting. These findings could contribute to the creation of more sustainable care systems at the European level that would better respond to individual and changing needs in people with Parkinson's disease and their family carers, and in other long‐term conditions. Patient or Public Contribution: The Patient and Public Involvement groups contributed to the design of the study, the interview guides and validation of findings. Relevance to Clinical Practice: This study will inform the management of Parkinson's disease at the community level and the use of resources not only directly linked to the health system. Taking into account all the actors that provide care and support to people with Parkinson' disease and family carers facilitates the creation of strategies that better respond to individual needs. Nurses and other health and social care professionals in the community and specialist levels of care should collaborate to develop multisectoral strategies that promote personalised and integrated care throughout the Parkinson's journey. [ABSTRACT FROM AUTHOR]

Objectives: To identify the core components of acute pain management in children, re‐conceptualise the process and update the existing model to inform nursing research and clinical practice. Background: Acute pain in hospitalised children remains suboptimal, despite extensive nursing research and education. Improvements require a patient‐centred approach and a conceptual model which includes the role of parents and partnership. Design: Using Rodgers' Evolutionary method, a concept analysis was conducted to define the core components for effective acute pain management in children. Methods: A scoping review of peer‐reviewed literature from 1990 through 2020 was conducted using the terms "pain management," "pain control," "pain treatment," "multi modal," and "concept*". Abstracts from 85 articles were initially reviewed with 30 articles retained for analysis. Core concepts were identified, defined and synthesised. The PRISMA 2020 checklist was used. Results: A new model was developed from a synthesis of past work which incorporates the role of parents, the complexity of the process and definitions for shared decision‐making. Trust, safety, collaborative communication and genuine partnership were identified as the core components for effective pain management in children, with the triadic relationship of nurses, patients and parents in genuine partnership foundational to the nursing process. Conclusion: The new model for acute pain management in children transforms the nurse's role from gatekeeper to facilitator, shifting the process from nurse driven to patient‐centred. The new collaborative model will promote shared decision‐making for individualised pain assessments, interventions and evaluations. Relevance to clinical practice: Establishing the nurse, child, parent partnership as an essential foundation to pain management has the potential to expand pain assessments, optimise treatment selections, advancing clinical practice, patient outcomes and nursing science. No Patient or Public Contributions were included in this paper as this was a concept analysis pulling from past works. [ABSTRACT FROM AUTHOR]

Aim/Objective: To estimate the prevalence and assess the strength of associations between antenatal depressive symptoms and selected possible predictive factors among women attending antenatal care for the first time at the Child Health Centre. Background: Evidence suggests that antenatal depression is a health problem as prevalent as postpartum depression. Antenatal depressive symptoms may persist into the postpartum period and potentially disturb the attachment between mother and family. Design Cross‐sectional. Methods: A sample of 228 women who participated in the New Families research programme answering a questionnaire at Week 28 of pregnancy were included. The Edinburgh Postnatal Depression Scale was used as outcome measure. Prevalence was estimated, and backward stepwise logistic regression analysis was performed to examine associations with somatic, psychiatric and social factors. STROBE checklist was followed. Results: Prevalence of depressive symptoms in this sample was 17.9%. Women reporting not sleeping enough had significantly higher odds of having depressive symptoms. Pregnant women with high relationship satisfaction were less likely to have depressive symptoms. Neither maternal age, education, previous depression, coming from a non‐Nordic country nor having complications during pregnancy were statistically significantly associated with depressive symptoms. Conclusions: High prevalence of depressive symptoms may also be present in low‐risk populations. Sleep and relationship satisfaction are topics that need to be addressed during pregnancy. Relevance to Clinical Practice: The prevalence of depressive symptoms in this sample of low‐risk pregnant women indicates that health personnel needs to be aware of depressive symptoms among women with no risk indicators. Identifying predictive factors associated with depressive symptoms may help midwives, public health nurses and general practitioners support parents. Our results indicate a potential need for screening for depressive symptoms in pregnancy and underscore the importance of involving partners in antenatal care. Patient/Public Contribution: Parents and health personnel participated in designing the New Family research programme. [ABSTRACT FROM AUTHOR]

Background: Effective pain assessment and management is widely reported as sub optimal due to inadequate knowledge and negative attitudes among nurses. Aim: To determine nurses' attitudes, knowledge and education needs towards acute pain management in acute hospital settings Methods: PRISMA (2021) and guidelines from the University of York, CRD (2009) informed the design and conduct of this review. We included studies with registered nurses involved in direct adult patient care and acute pain management in hospital settings. Seven databases were searched (10 June 2020 and 21 January 2022): Medline (EBSCO), EMBASE (Ovid), CINAHL Complete (EBSCO), PsycINFO (EBSCO), Applied Social Science Index and Abstracts (ASSIA), Web of Science and the WHO Library Global Index Medicus. The review outcomes were nurses' knowledge, attitudes and education needs towards acute pain assessment and management. The CASP Cohort Assessment tool was used to independently conduct a quality assessment of included studies. Data extraction was conducted by paired reviewers working independently of each other. A meta‐analysis of findings relating to nurses' knowledge and attitudes towards acute pain management was undertaken using MedCalc software. Results: Ten articles with 1,478 participants met the inclusion criteria. Five studies addressed the review items of knowledge and attitudes while the remaining studies focused on knowledge alone. No study measured educational needs. This meta‐analysis found that only 45.59% (95% CI: 20.46–71.97) of the 1090 respondents had adequate or above adequate levels of knowledge about acute pain management. The proportion of participants with positive attitudes was 25.76% (95% CI: 11.01–44.12). Discussion: High levels of variability exists across the included studies which reduces their comparability. To improve homogeneity and comparability, adaptation of instruments should be kept to a minimum. Reporting knowledge and attitudes separately may highlight education, both theoretical and clinical as the focus for improving assessment and management of acute pain. [ABSTRACT FROM AUTHOR]

Aim and Objectives: The aim of this study is to determine nurses' ethical positions, whistleblowing intention and its causes, and to analyse the correlation between them, while revealing the personal and professional characteristics causing significant difference. Background: In today's challenging healthcare settings, ethical dilemmas are inherent to nursing practices, leading to situations whereby nurses must consider whistleblowing and reasons such as reporting medical errors or misbehaviors. Design: The study is descriptive, cross‐sectional and correlational. Methods: The data were collected from a convenience sample consisting of 294 nurses between 1 April and 30 June 2019, in four hospitals in two cities. An introductory information form, Ethics Position Questionnaire, Whistleblowing Scale and Causes of Whistleblowing Scale were employed to collect data. The data were analysed with descriptive, correlational, comparative and internal consistency analyses (Guidelines for reporting cross‐sectional studies (Data S1)). Results: It was found that nurses encountered (31.3%) and reported (85.9%) unethical incidents. According to the subscales, they obtained higher scores from idealism (4.37 ± 0.52), supportive whistleblowing (3.75 ± 0.72), and moral and professional values (3.77 ± 0.67). The Ethics Position Questionnaire, as well as the Whistleblowing Scale (r =.302) and the Causes of Whistleblowing Scale (r =.211) had a positive weak correlation (p <.001). Nurses' age, marital status, and professional and institutional experiences all created a significant difference (p <.05). Conclusions: The nurses mostly encountered unethical incidents associated with management. The rates of reporting the unethical incidents were high, and they were found not hesitating to report using whistleblowing, yet intended to keep the incidents within the institution. In addition, idealistic nurses were more likely to whistleblow, and their causes for whistleblowing were mostly associated with moral and professional values. Relevance to Clinical Practice: It is recommended that nurses' ethical position, and whistleblowing intentions and causes should be supported and improved through the corporate culture. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the process of change within the clinical practice of nurses in mental health inpatient units in the context of a participatory process to improve the nurse–patient therapeutic relationship. Design: Participatory Action Research. Methods: Ninety‐six nurses from 18 mental health units participated. Data were collected through focus groups and reflective diaries between March 2018 and January 2020. Data were analysed using inductive content analysis. The COREQ guidelines were used. Results: The research process was carried out through two cycles of four stages each in which the nurses were able to identify the facilitating and limiting elements of their practice in relation to the therapeutic relationship. They then proposed two consensual improvement strategies for all the units, which they called reserved therapeutic space and postincident analysis. Finally, they implemented and evaluated the two strategies for change. Conclusions: This study has shown that, despite the different cultural and structural realities of the participating units, it is possible to implement a collaborative process of change, provided the needs and expectations of both the participants and the organisations are similar. Relevance to Clinical Practice: The results obtained through Participatory Action Research were directly transferred to clinical practice, thus having an impact on individual nurses and patients, as well as on the collective dynamics of the teams and aspects related to the management of the units. No Patient or Public Contribution: Patient or public input is not directly applicable to this study. Patients were recipients of the changes that were occurring in the nurses as part of their daily clinical practice. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This meta‐analysis aimed to investigate the safety and feasibility of preoperative chewing gum in adult patients undergoing elective surgery. Background: Postoperative chewing gum has been shown to be safe and effective for most surgeries, while the safety and efficacy of preoperative chewing gum are still controversial. Design: A meta‐analysis of randomised controlled trials was performed. No Patient or Public Contribution: This was a meta‐analysis involving no people or animals. Methods: The literature search was performed in 9 databases from inception to July 2022. Randomised controlled trials that compared the safety and efficacy of preoperative chewing gum and preoperative chewing no gum in adult patients undergoing elective surgery were included. The study was reported in compliance with PRISMA statement. Trial registration: PROSPERO CRD42022330223. Results: Fourteen trials involving 1433 adult patients who undergo elective surgery were pooled in this meta‐analysis. The results showed that preoperative chewing gum group resulted in no significant difference in gastric pH (p =.13) and gastric fluid volume (p =.25) compared with non‐gum‐chewing group. In comparison with the non‐gum‐chewing group, the gum‐chewing group was associated with shorter preoperative thirst score (p =.02), lower incidence of postoperative nausea (p =.0004), lower incidence of postoperative sore throat, lower incidence of postoperative hoarseness, lower postoperative pain score, shorter first postoperative anal exhaust time (p <.00001), shorter first postoperative defecation time (p <.00001) and shorter hospital days (p =.02). Conclusions: Preoperative chewing gum was associated with lower discomforts and complication rates, without increasing gastric pH and gastric fluid volume. This strategy may be an innovative, feasible and safe choice for elective surgery in adults. Relevance to Clinical Practice: This study's results could be used as an evidence for the implementation of preoperative chewing gum in perioperative care for adult patients undergoing elective surgery. [ABSTRACT FROM AUTHOR]

Aim and Objective: The aim of this study was to explore mothers' and public health nurses' (PHN) experiences with sleep problems in children aged 6 months to 3 years in Norway. Background: Sleep problems in children are common, affecting their health and development, and their mothers' well‐being. It is also the primary reason parents seek help in well‐child clinics (WCC). However, there is limited knowledge regarding the experiences of these mothers and the public health nurses who consult them. Design: Qualitative design. Methods: Four semi‐structured focus group interviews were conducted: two with mothers (n = 14) who had children with sleep problems and two with public health nurses (n = 14) from well‐child clinics. The Framework Method was used for analysing the interviews of mothers. Data from public health nurses were charted onto the analytical framework of maternal data to understand how or whether public health nurses addressed the issues raised by mothers. The study is reported according to the COREQ checklist. Result: The analysis resulted in two main themes: 'therapeutic alliance' (categories 'alliance ruptures' and 'demanding negotiation process') and 'reorganisation of identity' (categories 'unfulfilled expectations' and 'internal tension conflicts'). Conclusion: Young children's sleep problems present challenges to new mothers due to failed expectations, negatively affecting their feelings as mothers and towards their children, and consequently the reorganising of maternal identity. Most mothers experienced unsatisfactory therapeutic alliances while seeking help from public health nurses because advice was considered overly general, contradictory and unsafe for their children. Public health nurses were mostly aware of the parental consequences of children's sleep problems, but many appeared unable to help because of limited time and knowledge. Relevance to Clinical Practice: Public health nurses need to establish a therapeutic alliance and provide evidence‐based knowledge and guidance on sleep problems while also considering women's reorganisation of identity when becoming mothers. Clinical Trial Registration: Open Science Framework: osf‐registrations‐6ag38‐v1 (https://archive.org/details/osf‐registrations‐6ag38‐v1). [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the acceptances and associated influences of organ donation in mainland China. Background: The shortage of organ donors has limited the development of organ transplantation in China. It is important to recognise the target population who has high intention to donate their organs may change the status. Design: We conducted a cross‐sectional, multi‐stage sampling study collected demographic data and individuals' willingness to accept organ donation. Methods: A stepwise linear regression analysis was adopted to evaluate the factors related to the attitudes toward organ donation. Results: We collected 11,031 valid samples for the survey. The willingness to donate organs among Chinese residents averaged 56.93 points. To be specific, males (β = −.03), religious believers (β = −.01) and parents with a different number of children (all: β = −.04) are less willing to donate their organs. Respondents who live in an urban area (β =.03), have higher education level (High school or junior college β =.04, Bachelor degree or above β =.09), feel anxious (mild, moderate β =.02), feel pressured (moderate, severe β =.08), have higher scores of the Short‐Form Health Literacy Instrument (HLS‐SF12) (β =.31), The Self‐Management Scale (SHMS) (β =.16), EuroQol Five Dimensions Questionnaire (EQ‐5D) (β =.04) and EuroQol Visual Analogue Scale (EQ‐VAS) (β =.24), are more positive to donate. Conclusions: This study firstly discusses the public acceptance of organ donation through a nationwide sample around China. In this study, we discovered that Chinese residents' acceptance level of organ donation and that gender, house, anxiety, pressure, social support and health literacy were the main influencing factors on residents' attitudes. Relevance to Clinical Practice: To figure out the Chinese public acceptance and its influencing factors of organ donation can help nurse transplant coordinators to recognise the target population and the obstacles of organ donation. Patient or Public Contribution: At the phase of collecting data, participants were recruited to fill the questionnaires. [ABSTRACT FROM AUTHOR]

Background: Optimising preconception health—that is the health of women and men prior to a potential pregnancy—is increasingly recognised as fundamental to improving maternal and infant health outcomes. To date, limited research has been conducted examining preconception knowledge and studies focusing on preconception health behaviours have targeted certain behaviours, while overlooking others, with limited attention given to the interconception period and differences between multiparous and primiparous/nulliparous women. Aims: To determine predictors of preconception health knowledge among Canadian women and to examine whether parity modified the effect of predictors on preconception knowledge. Materials and Methods: A cross‐sectional study reported according to STROBE was undertaken from May to June 2019 in Canada with 928 women. An online questionnaire was used including the Preconception Health Knowledge Questionnaire, demographic characteristics, current health status, previous pregnancy outcomes and use of preconception care services. Ordinary least squares regression was used to model knowledge scores. Predictors were entered using theoretically driven hierarchical entry. Results: Mean age of women was 34 years and one in five were immigrants. In the final model, household income (b =.17, SE =.07; p =.009), being born outside Canada (b = −.75, SE =.25; p =.003), miscarriage/stillbirth history (b =.47, SE =.21; p =.027) and previous use of preconception care (b =.97, SE =.20, p ⟩.001) were predictive of preconception health knowledge. Effect modification by parity was not statistically significant in the final model (f = 1.22, p =.19). Discussion: Women at higher risk of poor preconception knowledge, and who therefore stand to gain from preconception knowledge interventions may include those who (1) are socially and economically disadvantaged; (2) have not engaged in preconception care previously and (3) were not born in Canada. Ensuring national promotion of and access to preconception care is an important strategy to prevent adverse pregnancy outcomes and optimise maternal and infant health. Conclusion: This study highlights the need for national promotion of and access to preconception health care for all pregnancy‐planning families in order to improve perinatal outcomes. Relevance for clinical practice: When evaluating preconception health efforts, preconception health knowledge must be considered within the context of social determinants of health and individuals' abilities to act on their knowledge. [ABSTRACT FROM AUTHOR]

Aims and Objective: This study examined the difference between rotating and fixed shift schedules on work–family conflict, family–work conflict and work‐related quality of life. Background: There is a lack of evidence regarding the effect of rotating shifts on work–family conflict, family–work conflict and work‐related quality of life among nurses. Design: A cross‐sectional design was used to conduct this study. Methods: Data were collected from 216 nurses using the Work and Family Conflict Scale and Work‐Related Quality of Life. Bivariate correlations and independent samples t‐tests were performed. The results of the current study were reported using the STROBE checklist. Results: Bivariate correlations showed that work‐related family quality of life is negatively associated with work–family and family–work conflicts. The mean differences between the two groups (rotating and fixed shifts) were significant for all three variables: work–family conflicts, family–work conflicts and work‐related quality of life. Conclusions: Rotating shifts are associated with an increased risk of experiencing work–family and family–work conflicts and decreasing their quality of working life, which may adversely affect the quality of care provided. Relevance to the Clinical Practice: The effect of shift types on nurses and how rotating shifts have more severe consequences on nurses should be considered. Nurse managers are encouraged to use the findings of this study to mitigate the risk of any work–family or family–work conflicts and improve nurses' work‐related quality of life. Patient or Public Contribution: The chief nursing officers at the data collection settings facilitated direct contact with potential participants and data collection. [ABSTRACT FROM AUTHOR]

Aim: To synthesise published literature exploring online venous thromboembolism (VTE) prevention education programmes to identify, test and refine a program theory supporting translation of knowledge into practice for registered nurses. Background: Venous thromboembolism is a leading cause of preventable morbidity and mortality in hospitalised patients. Successful implementation of prevention strategies can be impeded by a lack of education and translation of knowledge to practice. Continuing professional development programs using e‐learning platforms are increasingly common, however, there is little published literature exploring effective translation of such education to practice. Design: Realist Review. Methods: Searches were conducted in seven healthcare databases prior to July 2020 and updated in March 2022. Synthesis was informed by the unified theory of acceptance and use of technology (UTAUT) model and followed stages of a realist review outlined by Pawson et al. The results were reported according to the RAMESES publication standards. Results: Eight context‐mechanism‐outcome combinations were identified to explain engagement, completion and adoption of VTE e‐learning into practice. Mechanisms included valuing content as relevant to practice, having confidence in the ability to use the technology and empowerment to enact change based on learning. Contextual factors that may constrain the completion of learning include the support of managers and organisations through time, and the availability of resources. Conclusion: Translation of e‐learning is critical to ensure clinical excellence. This realist review demonstrated the varying mechanisms contributing to engagement, completion and adoption of learning. These illustrate the complex nature of education for professional development. It demonstrates that the UTAUT model is suitable for guiding the design, implementation and adoption of e‐learning programmes. Relevance to clinical practice: This review used a common clinical practice (VTE) to provide a program theory that can guide clinical educators to understand mechanisms which can facilitate engagement with, completion and adoption of e‐learning into practice by nurses. No patient or public contribution: The focus of this realist review was on e‐learning for registered nurses. As such, no patient or public contribution was sought or given in the development, progress and writing of the submitted manuscript. [ABSTRACT FROM AUTHOR]

Background: Tracheostomy dislodgment can lead to catastrophic neurological injury or death. A fresh tracheostomy amplifies the risk of such events, where an immature tract predisposes to false passage. Unfortunately, few resources exist to prepare healthcare professionals to manage this airway emergency. Aim: To create and implement an accidental tracheostomy dislodgement (ATD) bundle to improve knowledge and comfort when responding to ATD. Materials & Methods: A multidisciplinary team with expertise in tracheostomy developed a 3‐part ATD bundle including (1) Tracheostomy Dislodgement Algorithm, (2) Head of Bed Tracheostomy Communication Tool and (3) Emergency Tracheostomy Kit. The team tested the bundle during the COVID‐19 pandemic in a community hospital critical care unit with the engagement of nurses and Respiratory Care Practitioners. Baseline and post‐implementation knowledge and comfort levels were measured using Dorton's Tracheotomy Education Self‐Assessment Questionnaire, and adherence to protocol was assessed. Reporting follows the revised Standards for Quality Improvement Reporting Excellence (SQUIRE). Results: Twenty‐four participants completed pre‐test and post‐test questionnaires. The median knowledge score on the Likert scale increased from 4.0 (IQR = 1.0) pre‐test to 5.0 (IQR = 1.0) post‐test. The median comfort level score increased from 38.0 (IQR = 7.0) pre‐test to 40.0 (IQR = 5.0) post‐test). In patient rooms, adherence was 100% for the Head of Bed Tracheostomy Communication Tool and Emergency Tracheostomy Kit. The adherence rate for using the Dislodgement Algorithm was 55% in ICU and 40% in SCU. Discussion: This study addresses the void of tracheostomy research conducted in local community hospitals. The improvement in knowledge and comfort in managing ATD is reassuring, given the knowledge gap among practitioners demonstrated in prior literature. The ATD bundle assessed in this study represents a streamlined approach for bedside clinicians – definitive management of ATD should adhere to comprehensive multidisciplinary guidelines. Conclusions: ATD bundle implementation increased knowledge and comfort levels with managing ATD. Further studies must assess whether ATD bundles and other standardised approaches to airway emergencies reduce adverse events. Relevance to Clinical Practice: A streamlined intervention bundle employed at the unit level can significantly improve knowledge and comfort in managing ATD, which may reduce morbidity and mortality in critically ill patients with tracheostomy. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To assess the effectiveness of educational interventions and the relative effect of intervention duration on secondary prevention health behaviours in adults with coronary heart disease. Background: Patient education can reduce disease progression and improve outcomes. However, there is a lack of knowledge of its efficacy and the relative impact of education duration on health behaviour change in this population. Design: A systematic review and meta‐analysis. Methods: Seven electronic databases and grey literature were searched from Inception to July 2021. The review followed the PRISMA guidelines. This meta‐analysis was analysed in Comprehensive Meta‐Analysis version 3 software. Outcomes considered were disease knowledge and health behavioural outcomes. Data were pooled together with random‐effects models using the inverse‐variance method. The effect of education duration (<3 vs. ≥3 months) was examined by meta‐regressions. Results: In summary, 73 studies were included with a total of participants (n = 24,985) aged mean of 60.5 ± 5.7 years and mostly male (72.5%). Patient education improved all behaviours including disease knowledge at <6 and 6–12 months follow‐up, the likelihood of quitting smoking at <6, and 6–12 months, medication adherence at <6 and 6–12 months; physical activity and exercise participation at <6 and 6–12 months and healthy dietary behaviours, at <6 and 6–12 months. Furthermore, education programmes with a longer duration (≥3 months) improved disease knowledge and physical activity more than shorter programmes. Conclusion: Patient education for secondary prevention, in various delivery modes and intensities, improves multiple self‐reported health behaviours in patients with coronary heart disease. Relevance to clinical practice: This study assessed the effectiveness of secondary prevention education and demonstrated improvements in all outcomes in this population. Longer duration programmes were more effective in improving disease knowledge and physical activity in the long term. These findings can assist the cardiac programmes' design, particularly in ensuring sufficient intervention duration. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Illuminate meanings of living with [or close to someone with] an enterocutaneous fistula before and after reconstructive surgery. Background: Enterocutaneous fistula is a serious condition affecting the well‐being and social life of both patients and families, sometimes for several years. Design: A longitudinal qualitative design. Methods: Patients and families (n = 14) were followed with dyadic interviews at three occasions, conducted 2017–2020. The interviews were analysed with a phenomenological‐hermeneutic approach. COREQ guidelines were followed. Result Living with an enterocutaneous fistula was explained as life being put on hold, while living in a bubble for an uncertain time. This bubble meant facing an unpredictable and restricted life where the dyads were forced to take control over the situation despite being vulnerable inside, striving to resume normality. The patients dealt with never‐ending symptoms such as leakage from the fistula, pain and fatigue, while the family supported with practical matters and just being close. Dependency on intravenous fluids resulted in social isolation, which caused mode swings and depressiveness. In this situation, healthcare professionals often became a substitute for other interactions, but the lack of understanding about the dyads' situation, affected their trust in the healthcare. Despite all, they still had belief in the future, the patients having higher expectations than the family. Conclusions: Living with an enterocutaneous fistula meant a daily life struggling with many limitations. This implies that the transition was associated with difficulties and the dyads strived to accept their situation. Relevance to Clinical Practice: The findings indicate that these patients must be cared for with a multidisciplinary approach. A person‐centred health plan could impact on the dyads' feeling of control and thereby making them less dependent on healthcare. Every patient should have their own contact nurse and be offered psychological support. No Patient or Public Contribution: Not applicable due to the current method. [ABSTRACT FROM AUTHOR]

Aims and objectives: The study was conducted to describe long‐term perceived health among patients after a percutaneous coronary intervention as well as clarify the associations between perceived health and various factors. Background: Perceived health is an important outcome for coronary heart disease patients who have undergone percutaneous coronary intervention. Poor perceived health predicts low adherence to treatment, morbidity and mortality. Design: An explanatory and descriptive survey with a six‐year follow‐up (STROBE Statement: File S1). Methods: Baseline data (n = 416) were collected in 2013, with follow‐up data collected from the same study group in 2019 (n = 154) at two university hospitals and three central hospitals in Finland. The employed self‐reported questionnaire was based on the EuroQoL visual analogue scale and EuroQol five‐dimensional scale. Data were analysed using descriptive statistics and multivariate methods. Results: Perceived health did not significantly differ four months or six years after percutaneous coronary intervention. The respondents most commonly reported pain and discomfort (62.1%), problems in mobility (50.3%), issues with usual activities (27.5%), and anxiety and depression (24.0%). Managing self‐care (8.5%) was least likely to be an issue for the respondents. A majority of the reported problems were of a mild nature. The consumption of an adequate amount of vegetables, lower systolic blood pressure, regular follow‐up treatment, lack of prior invasive procedures, and younger age predicted better scores for both perceived health and its separate dimensions. Conclusion: Regular follow‐up is important to ensure after percutaneous coronary intervention to identify patients with pain and discomfort, mobility problems, depression and anxiety. Healthcare professionals should pay particular attention to elderly patients, who have undergone severe invasive procedures. Relevance to Clinical Practice: This study confirms the importance of regular follow‐ups for post‐percutaneous coronary intervention patients. Patient or Public Contribution: Patients have completed a self‐reported questionnaire based on informed consent. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to explore the mental health of transplant recipients, especially psychological integration and the donor‐recipient relationship. Background: Psychological integration and the donor‐recipient relationship are unique psychological perception of recipients with transplantation, which have important effects on their mental health and recovery. However, few studies have focused on the feelings and attitudes of cadaveric liver transplant recipients. Design: A qualitative descriptive design was used. Methods: Individual semi‐structured interviews were conducted face‐to‐face with 30 recipients after liver transplantation. Qualitative content analysis was used and data saturation was achieved. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) were used. Results: Three themes and eight subthemes were identified. (1) Psychological integration—acknowledging the transplanted liver was a part of their own body and attaching great importance to the liver; (2) Attitudes towards the donor—gratitude to the donor, being inspired by the dedication of the donor and mourning the donor's misfortune; and (3) Living in the moment—health behaviours of self‐care, emotional regulation and positive attitude about life. Conclusion: The psychological integration of recipients of cadaveric liver transplants is smooth, and the attitudes towards the donor are positive. From the perspective of positive psychology, we observed the important role of post‐traumatic growth of the recipient and positive emotions in promoting the recipient's health behaviours for self‐care, emotion regulation and attitudes towards life. Relevance for Clinical Practice Medical staff should help recipients to deal with these issues about the organ and its donor constructively and guide them to focus on postoperative inner growth and positive emotion. [ABSTRACT FROM AUTHOR]