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Aims: To identify the influence of teamwork, communication skills, and structural empowerment on providing patient‐centered care among nurses in Eswatini. Design: A quantitative, cross‐sectional survey was used. Methods: This survey conducted in Eswatini selected registered nurses working as full‐time nurses with more than 3 months of working experience using convenience sampling. Different measures were adopted and used to collect data among 130 eligible nurses from February to March 2022. Data were analyzed using Statistical Program for Social Sciences version 26.0. Results: A total of 123 nurses responded in the study and the mean age was 31.05 years with a standard deviation of 5.49. The overall response rate was 94.6% in this study. Hierarchical multiple regression analysis revealed that teamwork (β = 0.236, p < 0.05) and communication skills (β = 0.328, p < 0.05) were significant predictors of the provision of patient‐centered care among nurses. Conclusion: Team‐building exercises and management interventions to empower nurses should be established to improve the provision of patient‐centered care among nurses. Nurses should be empowered to provide patient‐centered care in health facilities by encouraging them to provide their input in management procedures and planning programs. Impact: Clinical practice requires nurses to use effective communication skills and work as a team. Nursing care established on teamwork, respect, empathy, and communication skills allows patients to express their concerns and views in health facilities as they feel involved in care. Patient or public contribution: No patient or public contribution in this paper. This study only involved registered nurses as health professionals. Summary Statement: What is already known? : Patient‐centered care gives patients the chance to participate actively in discussions and consultations.Patient‐centered care requires nurses to work as a team, use effective communication skills, and feel empowered during the execution of their work.Nurses who are empowered are less likely to make medical errors, and collaborative nurses provide better patient‐centered care. What does this paper add? : Highlights that teamwork and communication skills influence nurses' ability to provide patient‐centered care.Add to the growing evidence‐based support that there is a need for teamwork and communication education programs for registered nurses in the workplace.Empowering nurses to participate in management processes and program planning will enable them to deliver patient‐centered care in healthcare facilities. Implications for practice/policy : Education programs focusing on teamwork and communication skills should be provided to nurses working in the clinical setting to enhance the quality of patient care and improve collaboration.All hospitals should adopt a tailored intervention designed to enhance the delivery of patient‐centered care to raise the standard of care.It is imperative that nurses prioritize the development of their teamwork, respect, empathy, and communication skills. [ABSTRACT FROM AUTHOR]

A significant proportion of somatic symptoms remain, at present, medically unexplained. These symptoms are common, can affect any part of the body, and can result in a wide range of outcomes—from a minor, transient inconvenience to severe, chronic disability—but medical testing reveals no observable pathology. This paper explores two first‐person accounts of so‐called 'medically unexplained' illness: one that is published in a memoir, and the other produced during a semi‐structured interview. Both texts are revelatory for their expression of shame in the context of encountering disrespect from healthcare professionals. The first section of my paper, clinical encounters, explores disrespect which, I argue, takes three interconnecting forms in these texts: disrespect for pain when it is seen as 'medically unexplained', disrespect for the patient's account of her own pain, and disrespect for the patient herself. The second section elucidates the shame that occurs as an affective and embodied consequence of encountering such disrespect. I claim that patients living with so‐called 'medically unexplained' illnesses suffer a double burden. They endure both somatic and social suffering—not only their symptoms, but also disrespectful, traumatic and shame‐inducing experiences of healthcare systems. I conclude with a reflection on the urgent need for changes in clinical training that could improve the quality of life for these patients, even in the absence of an explanation, treatment or cure for their symptoms. [ABSTRACT FROM AUTHOR]

Rationale: Question Storming offers a method that enables one to hold the condition of uncertainty in reflection without the need for resolution. Global interdependencies and unprecedented access to information, social media and multiple forms of communications challenge our ability to see, understand and influence change effectively and efficiently. The tension and need to cope effectively with massive uncertainties cannot be resolved with current methods leading to a necessity for people to seek new ways to transform their understanding and explore new options for action. Problem‐solving and facilitation of the past are not flexible or rapid enough to meet the current demands of decision making and action taking in the face of massive uncertainties. As a result, people face 'wicked unsolvable' issues in their personal and professional lives. Aims and Objectives: An international group of scholar‐practitioners has adapted and tested an enquiry process. Question Storming—The Power of Questions is based on principles of complex adaptive systems, human systems dynamics, and self‐organization. Method: A three‐step method of inquiry and reflection opens new possibilities. Results and Conclusions: Question Storming has helped people see their wicked issues from new perspectives, understand them in useful ways and generate new options for action. This paper introduces Question Storming—the Power of Questions as a practical method for group inquiry in the presence of individual and group uncertainties/wicked issues. The Container, Difference, Exchange (CDE) model and Pattern Logic are presented to explain the paradigm‐shifting dynamics experienced by participants, both individuals and members of the group. It concludes with emerging questions for future consideration. Question Storming generates a divergent problem space that decreases constraint and increases degrees of freedom to allow practical exploration of new and often surprising options for action. [ABSTRACT FROM AUTHOR]

Screening is a useful tool for identifying potential health issues; however, it can also lead to overtreatment. Consequently, patients are sometimes harmed by unnecessary treatments and there are cost implications. Overtreatment can also occur in other areas of medicine besides screening and sometimes medical interventions are used to improve performance rather than to treat disease. In this paper, a distinction is made between the perspectives of the patient and the government. For patients, autonomy is important, and they can refuse life‐saving treatments, assuming they have decision‐making capacity. They can also choose to be treated to avoid a very small risk or to improve their performance. For a government with limited funds, it is important to focus on outcomes and fund those screening programmes and other medical interventions that can potentially save the most lives or prevent severe disability. Governments also have the power to legislate to enable a level playing field by prohibiting medications that improve performance, but there is no general consensus about this, and regulations can only be applied to specific, well‐defined activities. The problem with overtreatment results from the different interests involved: autonomy is the guiding idea for patients and outcome is the guiding measure for societies. A general solution will not be possible because of these inherent conflicting interests. However, medical research may improve the identification and predictions surrounding any anomalies detected during scans and reduce the problem in practice for specific conditions. [ABSTRACT FROM AUTHOR]

Despite experience‐based expertise being increasingly common in health care, what experiential knowledge consists of remains a topic for debate. Here I propose a philosophical approach to clarify experiential knowledge, drawing on an analogous debate in philosophy of mind, which similarly targets the intuition that experience may generate unique knowledge. I outline the philosophical debate and explicate some relevant ideas for health care, so as to (a) evaluate whether and to what extent this analogous debate is helpful, and (b) supplement existing ideas on experiential knowledge with a philosophical analysis. [ABSTRACT FROM AUTHOR]

Rationale: The restrictions to hospital visiting for carers and relatives during the pandemic were unprecedented. To ensure patients could stay in touch with their relatives and carers new liaison roles were introduced. Aims and Objectives: The aim of this study is to report on the evaluation of a Family Liaison Officer (FLO) role to understand the rationale for introducing the role along with the challenges and benefits of its implementation. Methods: A concurrent mixed methods design was used, triangulating both semi structured interviews and online surveys. Data were collected during 2021 from postholders, patients/relatives and key stakeholders. Results: The family liaison officer role occupies a key brokering role between clinical teams and patients/relatives. All participants agreed the importance of the role particularly in relation to communication. Postholders noted issues around clarity of scope of practice. Patients reported the social benefits of the FLOs particularly in relation to technology. There was also key learning in terms of induction, training and line management of this nonprofessional role. Conclusion: There is limited research that evaluates emerging nonprofessional roles that connect clinical teams and patients/relatives. This evaluation study although limited to one organisation provides important insights to the strategic and operational learning to introducing a family liaison officer role during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Shared decision making (SDM) is the process whereby patients and healthcare professionals work together to achieve a consensus management decision, based on best clinical evidence and patient's preferences. No formal approach to documentation of SDM conversations exists in setting of peri‐operative medicine. Objective: To assess and improve the quality and consistency of documentation regarding SDM conversations in an elective surgical outpatient population and appraise the satisfaction of patients and professionals in SDM. Methods: The study was conducted in a geriatrician led perioperative medicine for older people undergoing surgery service, at an inner‐city teaching hospital serving a tertiary surgical referral population. The quality improvement programme intervention comprised a Choosing Wisely, UK SDM tool, consisting of Benefits, Risks, Alternatives and Doing Nothing (BRAN mnemonic), clinic posters, patient leaflets, and an introductory SDM workshop and education sessions, and observation and standardised feedback of SDM. Clinic letters were reviewed to identify SDM documentation compliance. Participants included clinicians of all grades and disciplines, and consecutive patients attending the clinic. Results: Clinician interviews revealed inconsistent documentation of SDM. We reviewed 203 clinic letters following the initial implementation of SDM documentation tool, only 59% (n = 120) had fully completement BRAN tool. Additional interventions improved clinic SDM documentation compliance to 98%. A prospective observation study conducted revealed patients and clinician satisfaction at 93% and 79%, respectively. Conclusion: The BRAN tool is adaptable to many health decision settings, including discussions related to treatment, investigations, and procedures, which expands its potential to improve patient safety. [ABSTRACT FROM AUTHOR]

Rationale: Radiologic imaging is an essential component in the workup of many patients with neuro‐otologic conditions. However, patients often present for consultation with a neurotologist without the imaging that they have already undergone as part of their workup by a referring clinician. This disconnect causes frustration for clinicians and possible delays in care for patients. Anecdotally, clinicians felt that patients who had contact with clinic coordinators before their appointment were more likely to have their prior imaging available for review at the time of their initial consultation. Aims and Objectives: We aimed to increase the rate at which new patients brought their prior imaging to their initial consultation to at least 80% by improving previsit communication with patients and referring providers. Methods: Key stakeholders identified pain points in the flow of information from patients' outside facility workups. We then used the Plan‐Do‐Study‐Act quality improvement framework to develop, implement and iterate on two interventions intended to improve communication with patients, referring clinics and outside imaging centres. Chart review was used to assess the proportion of patients with imaging available for review at the time of initial consultation and a short satisfaction survey was sent to attending neurotologists in the pre and postintervention periods. Results: Before any interventions, 56.5% of typical new patients who reported having prior imaging had that imaging available for review at the time of their initial consultation. Following our interventions, this percentage increased to 73.5% and then 80.9% of new patients, respectively. Additionally, physicians reported improved satisfaction in several areas and spent less time reviewing imaging outside of clinic visits after our interventions. Conclusions: Improved communication and tracking of image receipt in clinics receiving many referrals saves physicians' time, reduces frustration and cuts down on the overall administrative burden following patients' appointments. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Telerehabilitation was used to ensure continued provision of care during the COVID‐19 pandemic, but there was a lack of guidance on how to use it safely and effectively for people with physical disabilities and movement impairment. In this service evaluation, we aimed to collate information on practitioner and patient experiences, challenges and facilitators, and examples of best practice to inform the development of an online toolkit and training package. Methods: Guided discussions were carried out with 44 practitioners, 7 patients and 2 carers from five health and social care organisations in South West England, and analysed thematically. Results: Practitioners and patients had positive experiences of telerehabilitation and were optimistic about its future use. Recognized benefits for people with physical disabilities included greater flexibility, reduced travel and fatigue, having appointments in a familiar environment and ease of involving family members. Challenges encountered were: technological (usability issues, access to technology and digital skills); difficulties seeing or hearing patients; the lack of 'hands‐on' care; and safety concerns. Facilitators were supported by colleagues or digital champions, and family members or carers who could assist patients during their appointments. Key themes in best practice were: person‐centred and tailored care; clear and open communication and observation and preparation and planning. Practitioners shared tips for remote physical assessments; for example, making use of patient‐reported outcomes, and asking patients to wear bright and contrasting coloured clothing to make it easier to see movement. Conclusion: Telerehabilitation holds promise in health and social care, but it is necessary to share good practice to ensure it is safe, effective and accessible. We collated information and recommendations that informed the content of the Telerehab Toolkit (https://www.plymouth.ac.uk/research/telerehab), a practical resource for practitioners, patients and carers, with a focus on remote assessment and management of physical disabilities and movement impairment. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Education of patients is thought to be key to high‐quality oral anticoagulant (OAC) medication management. Theoretically, improving patients' knowledge should improve their self‐management skills and adherence. The study's objective was to explore the opinions of healthcare providers and patients on the desired content and format of patient education on OACs, in addition to perceived barriers to high‐quality patient education. Methods: We applied qualitative descriptive methods in a focus group study on OAC management. Five focus group discussions were conducted in two health regions in Southwestern Ontario from 2017 to 2018 with 19 patients, 7 caregivers and 16 healthcare providers (physicians, nurses and pharmacists). During the focus groups, participants discussed their experiences with OAC education and made suggestions about the content and format for patient education on OACs. Transcripts were analysed using conventional content analysis. Results: We identified the five themes of patient education on OAC management: content of OAC education (rationale, risk and appropriate drug administration methods), the best times for providing OAC education (time of OACs initiation along with continuing education), preferred education delivery strategies (case management targeted patient information summaries from authoritative sources such as Thrombosis Canada and video education), patient and community pharmacist engagement in OAC education, and perceived barriers to optimal patient education (patients depending too much on their healthcare providers for advice, the limited time patients spend with healthcare providers, gaps in clear communication between providers and the lack of a nationally or provincially coordinated OAC management programme). Conclusion: Our findings suggest that patients, caregivers and healthcare providers support the need for education on OACs, including for patients taking DOACs. Specific important content and proper education format are needed. The optimal combination of content, format, duration, timing and sources for OAC education requires further research. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Type 2 diabetes (T2D) is an archetypical chronic condition of significant prevalence. Yet the concept of cure in the context of T2D reveals an interplay between the medical imagination and clinical realities that can shift the course of a patient's care. There are two domains in which cure is sociologically constructed: the professional domain occupied by clinicians treating people with T2D, and the lay domain occupied by T2D patients. Lay epistemologies of cure tend to be focused on modifying the experience of having T2D, while professional epistemologies tend to focus on modifying the disease through medical treatment. The objective of this study is to explore the role of the concept of cure in the context of type 2 diabetes, a model for chronic disease. Methods: Through surveys and interviews of T2D patients, providers and researchers at an urban academic medical centre, I explore the perspectives and attitudes each group have towards the concept of cure in T2D. Semi‐structured interviews of T2D professionals and patient surveys consisting of free response questions and Likert scale items were thematically analysed for perspectives on cure in T2D. Results: Sixteen T2D patients met inclusion criteria and consented to the survey and ten T2D professionals were interviewed. Cure is conceived of heterogeneously both within and between epistemologies. Patients carry hopes of cure predicated on eliminating the unpleasant experiences of T2D and its treatments, while T2D professionals tend to avoid invoking the concept of cure, at least to patients, on grounds of clinical uncertainty. However, the concept of cure is a significant motivator of treatment in both lay and professional epistemologies. Conclusion: Different viewpoints on cure in T2D present an opportunity for shared meaning and decision making between patients and their providers that can frame the best possible outcome for patient care. [ABSTRACT FROM AUTHOR]

Objective: To describe the perspectives of healthcare professionals regarding the implementation of Shared decision‐making (SDM) in primary healthcare centres (PHCCs) in Saudi Arabia. Methods: Qualitative semi‐structured interviews were conducted with a purposive and snowball sample of healthcare professionals in PHCCs. Interviews have been recorded, transcribed, translated and thematically analysed. Themes were mapped to the COM‐B model. Results: Sixteen healthcare professionals were interviewed. The data analysis identified six themes and 14 sub‐themes. The six themes are patient related factors, health professional related factors, environmental context and resources, patient–physician communication, patient–physician preferences toward SDM and physicians' perceived value and benefits of SDM. Physicians are unlikely to practice SDM in the context of time pressures, shortage of physicians, lack of treatment options, and decision‐making aids. The findings also underscored the importance of building a trustworthy physician‐patient relationship through the use of effective conversation techniques. Conclusions: There are multiple barriers to SDM in primary care. Unless these barriers are addressed, it is unlikely that physicians will effectively or fully engage in SDM with patients. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: Consistent data demonstrates negative psychological effects of caregiving on front‐line health professionals. Evidence that psychological resilience factors can help minimize distress and the potential for low‐cost interventions have created interest in resilience‐based development programmes; yet evidence of perceived value amongst health professionals is lacking. This study explored health professionals' experiences and perceptions of a novel, resilience‐based intervention designed to pro‐actively prepare staff for coping with error; to investigate their perceptions of what resilience meant to them, the relevance of the intervention, and impact of participation on ability to cope with error. Methods: Semi‐structured interviews 4‐6 weeks post intervention with 23 randomly selected participants from seven cohorts (midwives, paediatricians, obstetricians/gynaecologists, paramedics) and trainees (physician associates, mammographers, sonographers). Thematic analysis of interview data. Findings: Participants reported various interpretations of, and a shift in perception regarding what the concept of psychological resilience meant to them and their practice. These included for example, resilience as a positive or negative concept and their awareness and response to a range of personal, organizational and system factors influencing personal resilience. They valued the prophylactic, clinically relevant, interactive and applied nature of the intervention; having developed and applied valuable skills beyond the context of involvement in error, noting that individuals needed to be willing to explore their own coping mechanisms and human fallibility to gain maximum benefit. There was also consensus that whilst proactively developing individual level psychological resilience is important, so too is addressing the organizational and system factors that affect staff resilience which are outside individual staff control. Conclusion: Enhancing resilience appears to be considered useful in supporting staff to prepare for coping with error and the wider emotional burden of clinical work, but such interventions require integration into wider system approaches to reduce the burden of clinical work for health professionals. [ABSTRACT FROM AUTHOR]

Study Rationale: Amyotrophic lateral sclerosis is a progressive neurodegenerative disease which causes impairment of the motor functions in the upper and lower limbs and bulbar muscles with a median survival time is three years from the first appearance of symptoms. There is massive psychological impact on health professionals to persons with amyotrophic lateral sclerosis, hence the work leads to multiple challenges and stressful and demanding situations with high risk of experiencing diminished personal well‐being including burnout, moral distress, and compassion fatigue. Aim: To investigate reflections and perspectives from health professionals working within palliative rehabilitation for elements of importance in relation to job satisfaction. Methods and Materials: The design was qualitative and based on the phenomenological‐hermeneutical methodology by Paul Ricoeur's interpretation theory. Data consisted of two semi‐structured focus group interviews with a total of 12 specialized health professionals: Nurses, Psychologists, Physicians, Occupational Therapists, Physiotherapists, and Social workers, working within a hospital setting of specialized palliative rehabilitation for people with amyotrophic lateral sclerosis and their families. Results: The analysis revealed insight into four themes: fundamental drive, working conditions, value of collegiality and work‐life balance. Fundamental drive was deeply rooted in the professionals' sense of having a meaningful job. Working conditions such as self‐management were important for job satisfaction as were good collegial relations. Finally, a good balance between working life and private life was considered important for job satisfaction. Conclusion: Our study indicates that work within the field of palliative rehabilitation is experienced as enriching and beneficial under the right circumstances and in an appreciatory working environment. We found elements like autonomy, mastery, purpose, collegiality, and work‐life balance to be of great importance. Our findings can help guide managements and health professionals in other palliative rehabilitation contexts to ensure satisfied employees and to optimize the quality of care. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: The aims of this study are as follows: (a) to establish whether a relationship exists between the importance that healthcare professionals attach to ethics in care and their likelihood to report reprehensible conduct committed by colleagues, and (b) to assess whether this relationship is moderated by behavioural control targeted at preventing harm. Method: In this cross‐sectional study, which was based on a convenience sample (n = 155) of nurse practitioners (NPs) and physician assistants (PAs) in the Netherlands, we measured ethics advocacy (EA) as a motivating factor (reflecting the importance that healthcare professionals attach to ethics and care) and "behavioral control targeted at preventing harm" (BCPH) as a facilitating factor. "Reporting reprehensible conduct" (RRC) was measured as a context‐specific indicator of whistleblowing intentions, consisting of two vignettes describing morally questionable behaviour committed by colleagues. Results: The propensity to report reprehensible conduct was a function of the interaction between EA and BCPH. The only group for which EA predicted RRC consisted of individuals with above‐average levels of perceived BCPH. Conclusion: The results suggest that the importance that healthcare professionals attach to ethical aspects in care is not sufficient to ensure that they will report reprehensible conduct. Such importance does not induce reporting behaviour unless the professionals also perceive themselves as having a high level of BCPH. We suggest that these insights could be helpful in training healthcare providers to cope with ethical dilemmas that they are likely to encounter in their work. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: The practice of hospital pharmacists in many developing countries has been changing to include the delivery of direct patient care services, but practice change can be a challenging process. This article explores the perceptions of hospital pharmacists in Kuwait about the enablers and challenges to expanding their scope of practice to include direct patient care. Methods: A phenomenological qualitative approach was employed to conduct focus group interviews to explore pharmacists' perceptions about their professional practice at different hospitals across Kuwait. Data were collected from 110 pharmacists using 11 focus group interviews. The interviews were audio‐recorded, transcribed verbatim, and analysed using framework analysis. Results: The practice of most hospital pharmacists includes limited direct patient care role. However, a growing number of pharmacists have been introducing clinical pharmacy services at hospitals. Three themes about enablers to practice change emerged from data: (a) increasing physicians' acceptance to pharmacists' role in patient care, (b) patients' trust in pharmacists' knowledge about medications, and (c) pharmacists' perceived benefits of providing direct patient care. These benefits includes enhancing patients' safety and adherence to therapy and improving the professional identity of pharmacists. Participants' perceived challenges to practice change include professional, individual, and organizational challenges. Most participants welcomed assuming direct patient care role. They agreed that pharmacists need to receive adequate education and training and to be equipped with a clinical degree to responsibly provide direct patient care services at hospitals. Conclusions: Pharmacists have been increasingly attempting to provide clinical pharmacy services in Kuwait hospitals. This qualitative data revealed breadth of challenges hindering pharmacists' attempts to expand their professional practice to include direct patient care role. It also outlines facets of improvement and enablers to practice change. The collaboration between different stakeholders in the profession is essential to support pharmacists' efforts in achieving the change in the scope of pharmacy practice to improve patient care services. [ABSTRACT FROM AUTHOR]

The aim of this study was to employ knowledge user perspectives to develop recommendations that facilitate implementation of a complex, shared decision‐making (SDM)‐based intervention in an interprofessional setting. This study was part of a larger knowledge translation (KT) study in which interprofessional teams from five freestanding, academically affiliated, rehabilitation hospitals were tasked with implementing a cognitive strategy‐based intervention approach that incorporates SDM known as Cognitive Orientation to daily Occupational Performance (CO‐OP) to treat survivors of stroke. At the end of the 4‐month CO‐OP KT implementation support period, 10 clinicians, two from each site, volunteered as CO‐OP site champions. A semi‐structured focus group was conducted with 10 site champions 3 months following the implementation support period. To meet the study objective, an exploratory qualitative research design was used. The focus group session was audio‐recorded, transcribed verbatim and analyzed through the lens of the integrated promoting action on research implementation in health services (iPARIHS) framework. The focus group participants (n = 8) consisted of occupational therapists, physical therapists, and speech language pathologists. Ten recommendations for CO‐OP implementation were extracted and co‐constructed from the focus group transcript. The recommendations reflected all four iPARHIS constructs: Facilitation, Context, Innovation, and Recipients. Implementation recommendations, from the knowledge user perspective, highlight that context‐specific facilitation is key to integrating a novel, complex intervention into interprofessional practice. Facilitators should lay out a framework for training, communication and implementation that is structured but still provides flexibility for iterative learning and active problem‐solving within the relevant practice context. [ABSTRACT FROM AUTHOR]