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Background and aim: Communication is a key factor in intraprofessional collaboration between hospital nurses and homecare nurses in hospital‐to‐home transitions of older patients with complex care needs. Gaining knowledge of the nature of cross‐sectoral communication is crucial for understanding how nurses collaborate to ensure a seamless patient trajectory. This study explores how cross‐sectoral electronic health records communication influences collaboration between hospital nurses and homecare nurses when discharging older patients with complex care needs. Method: The study is based on qualitative group interviews with six hospital nurses and 14 homecare nurses working at different hospitals and municipalities across Denmark. Data were analysed using reflexive thematic analysis, as described by Braun and Clark. Findings: The themes Collecting pieces for the 'puzzle': Losing the holistic picture of the patient; Working blindfolded: limited provision of and access to critical information; and Bypassing the 'invisible wall': dialogue supports cohesion illustrate the impact of organisational structures within electronic health records have on hospital nurses' and homecare nurses' intraprofessional collaboration across sectors. Challenges with predefined and word‐limited elements in digital communication, and inadequate and limited access to significant medical information were identified. To compensate for the inadequacy of the electronic health records, direct contact and dialogue were emphasised as ways of fostering successful collaboration and overcoming the barriers created by electronic health records. Conclusion: Despite hospital nurses' and homecare nurses' desire to conduct holistic patient assessments, their ability to collaborate was hindered by failures in electronic health record communication resulting from restrictive organisational structures across sectors. Thus, it became necessary for hospital nurses and homecare nurses to bypass the electronic health record system and engage in dialogue to provide holistic care when discharging older patients with complex care needs. However, by hospital nurses and homecare nurses compensating for counter‐productive organisational structures, problems brought about by the electronic health record system paradoxically remain invisible. [ABSTRACT FROM AUTHOR]

Background: Communication is a key tool in the nursing profession. It is known that listeners are sensitive to the speaker's voice and interpret the speaker's intentions primarily from the non‐verbal signal conveyed. Aim: To map and discuss the current state of knowledge and research evidence on professional voice use in health and nursing care. Design and Method: A scoping review adherent to the EQUATOR guidelines PRISMA‐ScR. Data Sources: Searches in the EBSCO, CINAHL, Medline, PubMed, PsychInfo and PsycArticles databases were conducted between 1 and 28 February 2023. Results: According to the data (n = 23), health professionals use voice as a vital aspect of caring communication and caring relationships, and in leadership as well as inter‐professional collaboration, to facilitate information exchange and understanding and promote shared decision‐making. The data showed that there is also a rising tendency to explore vocal demands and problems among health professionals. No studies were found on the use of voice in digital health and nursing care services or by social robots. Most of the reviewed studies were cross‐sectional, rather small, and focused primarily on the perspectives of healthcare professionals. Conclusion: The use of voice should be explored as a vital aspect of caring communication and caring relationships from the patients' perspective, and the effects of voice use on listeners' emotions and actions should be examined in different contexts with modern, voice‐specific data collection methods. Studies focusing on voice use in digital health care and by social robots are also needed. By integrating training programmes, education and technological innovations, health care can leverage the full potential of voice‐based communication to promote a more coordinated and patient‐centred care environment, true inter‐professional collaboration and effective leadership. Impact: Professional voice use is an essential part of all health and nursing care and an impressive method that should be used consciously. Therefore, the meaning and methods of voice use, including speech accommodation, should be systematically introduced into health and nursing care and included in nursing education. [ABSTRACT FROM AUTHOR]

Aim: The aim of this concept analysis is to seek clarity as to what end‐of‐life conversations involve by developing a clear working definition and using model cases to conceptualise the defining attributes of an end‐of‐life conversations with the older person. Design: Walker and Avant's eight step approach to Concept Analysis. Data Sources: Four databases were searched, including PubMed, CINAHL, PsycINFO, and Scopus. A total of 339 publications were identified with 30 papers meeting the inclusion criteria and put forward for the final conceptual analysis. Results: The defining attributes associated with end‐of life conversations included (1) an ongoing process of older person empowerment, (2) discussion's concerning values and preferences concerning end‐of‐life issues, and (3) maintaining an open dialogue between all concerned individuals. Antecedents were associated with the older person is their readiness to talk openly about death and dying. Consequences were identified as having a better understanding of what death and dying may mean to the older person in a more specific manner. Conclusions: End‐of‐life conversations are vital in understanding an individual's values and preferences at the end of life, and yet, the concept of the end‐of‐life conversation has not been well defined in the literature. End‐of‐life conversations with the older person encompass ongoing discussions and maintaining open dialogue around end‐of‐life care while developing strategies to promote individual empowerment in making informed choices. Using a conceptual model, aides in addressing aspects of end‐of‐life conversations and an acknowledgment of the dynamic process of end‐of‐life conversations. [ABSTRACT FROM AUTHOR]

Background: Older people often have multiple health conditions and therefore extended care needs. The transition from the hospital back to their home requires careful planning. The fragmented healthcare system and rapid discharge from the hospital can result in limited involvement of the older patient in the discharge planning process. We aimed to explore how older hospitalised patients experienced the transition from hospital to home and how possibilities and constraints in interactions with relevant parties in the transition affected their everyday lives. Method: An ethnographic participant observation study including interviews was conducted with 10 older hospitalised patients. The theoretical perspective in the study is critical psychology and data were analysed using the condition‐, meaning‐ and reasoning analysis. Results: Three themes were identified: (1) Lost in transition – the person's ability to act is limited, (2) In transition – the relatives become important, (3) At home – the home transforms into a workplace. Conclusion: Lack of involvement becomes a condition for older patients as some struggle to create meaning in their transition, affecting their everyday lives. The patients experienced their relatives as important as they ensured that the HCPs got to know their values and wishes. This knowledge is important for HCPs working closely with older people both at the hospital and at home ensuring active involvement of the older person with respect and acknowledgement of the older person's wishes, needs, resources and vulnerability. [ABSTRACT FROM AUTHOR]

Background: Patient participation is fundamental in nursing care and has yielded benefits for patient outcomes. However, despite their compassionate care approach, nurses do not always incorporate patients' needs and wish into evidence‐based practice, quality improvement or learning activities. Therefore, a shift to continuous quality improvement based on evidence‐based practice is necessary to enhance the quality of care. The patient's opinion is an essential part of this process. To establish a more sustainable learning culture for evidence‐based quality improvement, it is crucial that nurses learn alongside their patients. However, to promote this, nurses require a deeper understanding of patients' care preferences. Objective: To explore patients' needs and wishes towards being involved in care processes that nurses can use in developing an evidence‐based quality improvement learning culture. Methods: A qualitative study was conducted in two hospital departments and one community care team. In total, 18 patients were purposefully selected for individual semi‐structured interviews with an average of 15 min. A framework analysis based on the fundamental of care framework was utilised to analyse the data deductively. In addition, inductive codes were added to patients' experiences beyond the framework. For reporting this study, the SRQR guideline was used. Results: Participants needed a compassionate nurse who established and sustained a trusting relationship. They wanted nurses to be present and actively involved during the care delivery. Shared decision‐making improved when nurses offered fair, clear and tailored information. Mistrust or a disrupted nurse–patient relationship was found to be time‐consuming and challenging to restore. Conclusions: Results confirmed the importance of a durable nurse–patient relationship and showed the consequences of nurses' communication on shared decision‐making. Insights into patients' care preferences are essential to stimulate the development of an evidence‐based quality improvement learning culture within nursing teams and for successful implementation processes. [ABSTRACT FROM AUTHOR]

Background: Previous research found that healthcare professionals had low preparedness for palliative care. Thus, it is necessary to explore healthcare professionals' self‐efficacy. The Swedish Self‐Efficacy in Palliative Care Scale (SEPC‐SE) evaluates readiness in communication, patient management and multidisciplinary teamwork; however, it should be tested on a larger population. Furthermore, the constructs of the SEPC‐SE should be compared to that of the original SEPC. Aim: This study aimed to evaluate the consensus between the construct validity and reliability of the SEPC and the translated and adapted SEPC‐SE. Furthermore, it aimed to describe and compare the self‐efficacy of nurses and physicians in hospitals and explore the associated factors. Methods: The nurses (n = 288) and physicians (n = 104) completed the SEPC‐SE. Factor analysis with Cronbach's alpha evaluated validity and reliability, and an analysis using the Mann‐Whitney U test compared self‐efficacy and multiple linear regression‐associated factors. Results: The SEPC‐SE revealed three factors with high reliability. Education or experience in specialised palliative care was minor, especially for nurses. Self‐efficacy was highest in patient management (nurses, median [md] = 74.57, physicians md = 81.71, p = 0.010) and communication (nurses md = 69.88, physicians md = 77.00, p = 0.141) and lowest in multidisciplinary teamwork (nurses md = 52.44, physicians md = 62.88, p = 0.001). The strongest associations with self‐efficacy were education at work and advanced homecare experiences. In addition, there were significant associations between years in the profession, male sex, physicians and university education. Conclusion: The SEPC‐SE is valid and reliable for measuring self‐efficacy. Nurses had lower self‐efficacy than physicians. Physicians were associated with higher self‐efficacy and had more education and experience in palliative care settings, which may explain their levels of self‐efficacy. [ABSTRACT FROM AUTHOR]

Background: In health policy, much attention has been paid to collaboration between the primary and secondary health care sectors, especially in relation to hospitalisation and discharge. Despite ideal plans for collaboration, the research literature shows that inadequate communication is a well‐known problem that can be a barrier to a safe trajectory for the citizen. Based on the assumption that better knowledge of each other's work will lead to better collaboration, a cross‐sectoral exchange program with nurses was initiated. Aim: The aim was to investigate which barriers to good patient trajectories the involved nurses attributed to cross‐sectoral collaboration and what impact the exchange to the opposite sector had for them. Methods: Twenty‐eight nurses were exchanged: 14 from a cardiology department and 14 from municipal home care. The nurses shadowed a colleague from the opposite sector in their daily work. Subsequently, six focus group interviews were conducted. The transcribed material was analysed based on Ricoeur's interpretation theory. Results: Two main themes, including sub‐themes emerged: (1) Challenging communicative conditions: (a) Inadequate digital communication, (b) Inadequate care plans and discharge reports, (c) Conversation promotes understanding, and (d) Challenging collaboration and communication with the discharge coordinators. (2) Perceived importance of the exchange: (a) Cross‐sectoral relationship, prejudice and gaining respect for each other and (b) Working in two different worlds. Conclusion: Electronic communication is inadequate, and the IT systems do not support sufficient cross‐sectoral communication. The organisational model in the municipal care sector is inflexible in terms of allocations for the current needs of citizens, and professionals feel that their professional judgements are not recognised. The nurses gained insight into each other's work and working conditions and respect for each other's professionalism. The exchange has the potential to both improve the relationship and communication between the sectors for the benefit of a better and more coherent patient course. [ABSTRACT FROM AUTHOR]

Background: Effective self‐management of type 2 diabetes requires adequate health literacy (HL) and a supportive network. Diabetes self‐management education and support programmes play a crucial role in improving these factors. However, limited research exists on how such programmes can support health literacy among migrants and facilitate the dissemination of knowledge within their social networks. Aim: This study aimed to investigate the perspectives of Arabic‐speaking informants with a migrant background in relation to how their type 2 diabetes‐related health literacy was acquired, applied and distributed within social networks through participation in a culturally sensitive diabetes self‐management education and support (DSMES) programme. Methods: Semi‐structured interviews were conducted with 12 informants during the programme and three to 7 months later, from September 2019 to May 2020. Abductive analysis was applied using HL and distributed health literacy (DHL) theory as frameworks. Results: The analysis generated three themes: (1) sources of health information and the development of health literacy; (2) changes towards active self‐management; and (3) distributed health literacy. Prior to programme participation, informants faced challenges in navigating conflicting information from family, friends and social media. After participating in the programme, they reported improvements in HL, particularly in knowledge acquisition. Many became more actively engaged in decision‐making and exhibited improved health behaviours, such as dietary choices. Nonetheless, some informants continued to struggle with choosing appropriate prevention and treatment strategies. Notably, certain informants acted as HL mediators, sharing their newly acquired knowledge within their social networks in Denmark and abroad. Conclusion: Culturally sensitive diabetes self‐management education programmes have the potential to enhance HL among migrants, leading to the distribution of relevant diabetes knowledge within their social networks. Future studies should explore how members of migrants' social networks perceive their supportive role in type 2 diabetes management. Programmes can benefit from emphasising critical HL and exploring how participant‐informants effectively communicate diabetes‐related knowledge within their networks to address misinformation and conflicting information. [ABSTRACT FROM AUTHOR]

Background: Worldwide visitor restrictions forced nurses to separate patients from their relatives. However, the experience of implementing shifting restrictions from the frontline nurses' perspectives in a Danish context has yet to be assessed. Aim: The aim of this descriptive qualitative study was to explore frontline nurses' experiences of managing shifting visitor restrictions in a Danish somatic university hospital during the COVID‐19 pandemic. Methods: An online questionnaire, including open‐ended questions, was developed. Data were analysed using descriptive statistics and content analysis. Findings: 116 nurses from 29 departments participated; they were informed about restrictions primarily by their charge nurses and hospital intranet. Shifting visitor restrictions compelled the nurses to constantly adjust and negotiate their practices. When deciding to suggest deviating from the restrictions, they shared their decision‐making with colleagues. Visitor restrictions left the hospital environment quieter, but they also created a lack of overview and predictability, an emotional burden, and a negative impact on the quality of care. Conclusion: Restricting relatives' access challenged the nurses' professional values, and it seems to have affirmed their appreciation of relatives' role as important partners in contemporary hospital‐based health care. [ABSTRACT FROM AUTHOR]

Aim: Dignity in older persons is a goal of palliative care. This study aimed to perform a process evaluation of the Swedish Dignity Care Intervention (DCI‐SWE) in municipal palliative care in Sweden, focusing on implementation, context, and mechanism of impact. Methods: This study had a process evaluation design. The Knowledge to Action framework supported the implementation of the DCI‐SWE. The intervention was used by community nurses with older persons (n = 18) in home healthcare and nursing homes. Data were collected by focus groups‐ and individual interviews with community nurses (n = 11), health care professionals (n = 5) and managers (n = 5), reflective diaries, and field notes. Results: Grasping the DCI‐SWE was challenging for some community nurses. Enhanced communication training and increased engagement from managers were requested. However, the DCI‐SWE was perceived to enhance professional pride in nursing. In terms of fidelity, dose and reach the project was not fully achieved. Regarding mechanism of impact the DCI‐SWE contributes to address older persons' loneliness and existential life issues, as it put conversations with older persons on community nurses' agenda. Conclusions: The DCI‐SWE provided opportunities to maintain older persons' dignity and quality of life. However, with refinements of design and the DCI‐SWE, the sustainability in the context may increase. [ABSTRACT FROM AUTHOR]

Background: Ambulance care is characterised by disaster medicine, traumatology and care for acute illnesses and accidents. The focus of ambulance care is clearly on medical care, whereas interpersonal interaction between patients and ambulance clinicians appears less prioritised. A patient within ambulance care needs to be listened to, be taken seriously, be treated with empathy and be seen as a unique person. These are fundamental to delivering Person‐centred care. Aim: The purpose is to describe how the care relationship and interaction between patients and ambulance clinicians in prehospital emergency care are described in the literature and how they can be interpreted from a person‐centred perspective. Data Sources and Review Methods: A qualitative meta‐synthesis was used. Data collection was carried out with PubMed, CINAHL Plus and Web of Science in September–October 2022 and in August–September 2023. The first article searching applied a timeline 1990–2022 and the second applied a timeline 2022–2023. A total of 13 studies employing a qualitative approach were evaluated and included in the interpretive analysis. Results: Three themes were identified: A good care relationship, Decision‐making and Hindrances to practising person‐centred care in ambulance care. Trust, good communication and respect for patients' dignity were the most important parts of the good care relationship between patients and ambulance clinicians. Decision‐making regarding the examination of patients, medical treatment and transport to the receiving care unit was one of the tasks that ambulance clinicians do independently but in cooperation with patients and family members. Person‐centred care within ambulance care may be hindered due to environmental factors, attitudes and behaviour of ambulance clinicians and patient‐related factors. Conclusion: Many ambulance clinicians have already adopted Person‐centred care, but several factors can hinder Person‐centred care in interactions with patients. Although the results build on a limited number of studies, they indicate that person‐centred care needs to be further developed and studied for high‐quality ambulance care. [ABSTRACT FROM AUTHOR]

Background: Families are introduced as new partners in interprofessional communication and collaboration during hospitalisation of an adult patient. Their introduction into the healthcare team has consequences for the roles and responsibilities of all healthcare professionals. Role clarification is thus needed to create optimal communication and collaboration with families. Aim: To gain insight into how physicians and nurses view their own roles and each other's roles in communication and collaboration with families in the care of adult patients. Methods: A qualitative interpretive interview design was used. Fourteen semi‐structured interviews, with seven physicians and seven nurses, were conducted. Data were analysed according to the steps of thematic analysis. For the study design and analysis of the results, the guidelines of the consolidated criteria for reporting qualitative studies (COREQ) were followed. The ethical committee of the University Medical Center Groningen approved the study protocol (research number 202100640). Findings: Thematic analysis resulted in three themes, each consisting of two or three code groups. Two themes "building a relationship" and "sharing information" were described as roles that both nurses and physicians share regarding communication and collaboration with families. The role expectations differed between physicians and nurses, but these differences were not discussed with each other. The theme "providing support to family" was regarded a nurse‐specific role by both professions. Conclusion: Physicians and nurses see a role for themselves and each other in communication and collaboration with families. However, the division of roles and expectations thereof are different, overlapping, and unclear. To optimise the role and position of family during hospital care, clarification and division of the roles between physicians and nurses in this partnership is necessary. [ABSTRACT FROM AUTHOR]

Background: Children and youth who experience divorce are found to have increased risk of emotional and behavioural adjustment problems. Different prevention programmes have been developed to help and support children. Previous studies have focused on the child or the group leader's experience with divorce groups, but studies describing parent's experience are missing. The aim of this study was to explore parents' experiences of their child's participation in divorce groups. Methods: An inductive, qualitative and descriptive design was applied with philosophical orientation in naturalistic inquiry based on the outlines of a phenomenological perspective. Two fathers and three mothers from two different counties in Norway participated whereof four of them were interviewed twice. Systematic text condensation was used for the analysis. Results: Three themes emerged from the analysis: encouraging the child, missing communication and challenging situations. Parents described how they encouraged the child to attend divorce groups and hoped they would gain a deeper understanding of their parents' divorce and their own feelings. Missing communication relates to lack of information about the groups from the school, the group leader and from the child. Missing information was found to be a challenge for the parents and made them think that the divorce group was beneficial for the child but maybe not always for the family. Parents described challenging situations due to the divorce, and they struggled to understand their child and their own behaviour. Conclusions: The opportunity for the child to talk to other children in the same situation in divorce groups was positive for the parents. To be beneficial for both children and their parents, structured information and cooperation among the school, the child and both parents are important. The knowledge from this study can support the development and use of intervention programmes in the future. [ABSTRACT FROM AUTHOR]

Aim: To assess the agreement between patients' self‐reported degree‐of‐worry (DOW) and nurses' evaluation of patients' DOW. Design: An observational cohort study with patients and their primary nurses. Methods: Between 22 February and 27 March 2021, data collection among patients and their nurses in an emergency department was carried out. Patients ≥18 years, cognitively intact and Danish or English speaking were eligible to participate. Nurses regardless of seniority and gender were eligible for participation. The single‐item degree‐of‐worry measure, 'how worried are you about the condition you are here today on a scale from 1 to 10, where 1 is minimally worried and 10 is maximum worried' as well as information on gender, age, co‐morbidity, triage level and medical reason for encounter was collected from patients. The corresponding nurses were asked; 'how worried do you think your patient is about the condition he/she is there today on a scale from 1 to 10, where 1 is minimally worried and 10 is maximum worried?' Nurses also supplied data on gender, age, seniority as a Registered Nurse and in the ED. Agreement between patients' self‐reported degree‐of‐worry and nurses' evaluation of patients' degree‐of‐worry was assessed with weighted Cohen's Kappa. Results: A total of 194 patient–nurse pairs were included for analysis. The agreement between patients' DOW and nurses' evaluation of patients' DOW categorised as DOWlow, DOWmiddle and DOWhigh was in total agreement in n = 85 pairs (43.8%) of the ratings, which corresponds to a weighted Cohen's Kappa of 0.19 (0.08–0.30; p < 0.001). Conclusion: Nurses estimate of their patients' DOW was in very poor agreement. This indicates that nurses are not able to assess the patient's DOW to a satisfactory level. This result is troubling as it may have serious consequences for patient care as it indicates that the nurses do not know their patients' perspectives. [ABSTRACT FROM AUTHOR]

Background and Rationale: Comprehensive care and service planning in home care is tailored to older people's individual needs and resources in order to support them living at home. However, little is known about how these individual resources and home‐care‐specific tasks are recognised in older people's care and service plans. Aims: To describe the content of care and service plans in older people's home care with special attention to their individual resources and home‐care‐specific tasks. Design: This was a document‐based cross‐sectional study with mixed‐methods analysis, carried out in Eastern Finland during Spring 2018. Methods: A document analysis using the deductive Finnish Care Classification (FinCC), and an inductively developed framework of older people's care and service plans (n = 71). The data were analysed with descriptive statistical methods. Results: Altogether, 1718 notes were relevant to the FinCC main categories: 707 (41%) focused on older people's needs and 1011 (59%) on nursing interventions. We identified 1104 notes based on the 26 inductively developed main categories: the majority (n = 628, 57%) focused on individual resources and the remainder (n = 476, 43%) on home‐care‐specific tasks. Increasing age resulted in fewer notes on safety and sensory functions. There were fewer notes on resources related to sleeping and wakefulness after longer care and service periods. An increased number of home visits resulted in more documentation on tasks related to pharmaceutical issues, including repeat prescriptions. Discussion Individual resources for older people were documented, to some extent, in their care and service plans. It is necessary to review these alongside home‐care‐specific tasks that support older people's independence and safety at home. Conclusion: Individual resources need to be recognised in order to enable home‐care professionals to provide tailored, high‐quality home care services. Home‐care‐specific tasks should be supported by documentation with updated, sensitive home care classifications. [ABSTRACT FROM AUTHOR]

Background: Breathlessness is a serious and distressing symptom and a common reason why patients require prehospital care by ambulance clinicians. However, little is known about how patients experience this care when they are in a state of breathlessness. Aim: The aim of this study is to describe the lived experiences of being cared for by ambulance clinicians when experiencing breathlessness. Methods: Fourteen lifeworld interviews were conducted with patients who experienced breathlessness and were cared for by ambulance clinicians. The interviews were analysed using a qualitative phenomenological approach. Findings: The essential meaning of being cared for by ambulance clinicians when experiencing breathlessness is described in two ways: existential humanising care, in which the experience is that of being embraced by a genuine presence or existential dehumanising care, in which feeling exposed to an objectifying presence is the main experience. This meaning has four constituents: surrendering to and trusting in the care that will come; being exposed to an objectifying presence is violating; being embraced by a genuine presence is relieving; and knowing is dwelling. Conclusion: The findings reveal that the ability of ambulance clinicians to provide existential humanising and trustful care, which is the foundation of professional judgement, was essential in how patients responded to and handled the overall situation when breathlessness. [ABSTRACT FROM AUTHOR]

Background: Health promotion and disease prevention are of utmost importance for sustainable health care and primary health care. District nurses play a key role in primary health care centres, where they meet people suffering from, and/or having risk factors for, non‐communicable diseases. Aim: The study aim was to describe district nurses' perspectives on their health‐promotive/disease‐preventive work at primary health care centres. Methods: Interviews were conducted with 16 district nurses at primary health care centres in Sweden. An interpretive descriptive approach was employed for the analysis. Findings: The district nurses integrated a focus on health‐promotive and disease‐preventive work into every patient encounter, which manifested through four intertwined themes: finding opportunities and striving for visibility; building relationships; considering patients' life situations; and inviting patients to share responsibility. Our findings show how, through a flexible approach, the district nurses strived for equal health and care for all, and how the care was built on a shared responsibility between the district nurse and patient, where district nurses aimed to empower patients to take action for their own health. Conclusion: The district nurses described health‐promotive endeavours, in line with person‐centred care in prioritising building relationships with patients, starting from their lived experience. They spoke of barriers, at both micro and macro levels, to health‐promotive/disease‐preventive work. These included language barriers, the impact of the media, and the overall organisation of primary health care. The work at primary health care centres should be restructured to clarify the district nurse's role, and to strengthen community outreach, and thereby improve individuals' access to support in lifestyle changes. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore the meaning of a coaching intervention for cancer survivors. Background: Cancer survivors often experience existential concerns and worries after adjuvant treatment. A number of "care transition interventions" have been developed to improve person‐centred care by empowering patients. Several of these interventions include a "care transition coach". A coaching approach to communication used in health care communication have among others shown to assists in establishing confidential relationships between health professionals, increase the patient's well‐being and support the patient's experience of being met and viewed as a whole person. Design: This is a qualitative study using semi‐structured interviews to explore the meaning of a coaching intervention. In analyzing and interpreting the qualitative interviews Ricoeur's theory of interpretation was applied. Method: The intervention consisted of two parts: (1) a two‐day training program in coaching for nurses and (2) a specially developed communication intervention for cancer survivors. Results and discussion: The analysis of the transcribed interview material led to the development of two themes: (1) Support in moving forward in life, and (2) An opportunity to talk about existential thoughts and worries. Our results show how the experience of cancer, even when cured, leaves the survivors with profound existential worries. The cancer survivors described how coaching conversations allowed them to express their current concerns and provided them with an opportunity to discuss wider issues than treatment, symptoms, and after‐effects, which had been the main focus during treatment. Conclusion: The time immediately after the end of adjuvant treatment can be challenging, with many existential concerns and opposing emotions. We found that the follow‐up coaching conversations performed helped the cancer survivors to process many of these difficult thoughts and feelings. [ABSTRACT FROM AUTHOR]

Background: Reflection is essential for students to learn and understand caring, their formation as human and caring beings, and their ability to meet patients in a caring way. Consequently, to facilitate nurse students' development into professionals, learning support is needed where the focus is on understanding caring and becoming caring nurses. Aim and research questions: The exploratory study aim is to gain knowledge of the meaning of reflection in first‐term nursing education, and how reflection grounded in caring theory can deepen the students' understanding of caring and their professional formation of becoming a caring nurse. Method: Data consisted of individual written reflections and were collected from 64 nursing students from Norway, who had completed their instruction in caring theories and participated in four reflection groups where they reflected on caring and becoming a caring nurse. A thematic analysis was used. Findings: The results are based on the three main themes, Reflection provides an understanding of caring by developing a language for caring; Reflection provides an understanding of seeing the person behind the illness; and Reflection contributes to increased self‐understanding and awareness of oneself as a caring nurse. Conclusions: Instruction in caring theories and participation in reflection groups, with reflection grounded in caring theory, has a key function in facilitating students' development of a language for caring in nursing and appropriation of caring theory. The appropriation of caring theory provides a foundation for the nurse students to see themselves within a broader perspective and is important for mutual support in the professional formation of becoming a caring nurse. The expected outcome of such integration is a nursing curriculum that progressively supports the development of nursing students professionally and personally in the formation of becoming a caring nurses. [ABSTRACT FROM AUTHOR]

This methodological article aims to describe three methodological strategies for using drawings as a part of qualitative data collection methods in caring research based on hermeneutics. In some research interview situations, participants may have difficulties to express their experiences and feelings in words. The consequences may be that the descriptions in research reports will become superficial and not authentic, meaning, "telling it as it is". Drawn pictures may facilitate and support reflection related to the deepening of experiences and thoughts, and communicate and express more than words can do. It may also reveal thoughts and feelings the person drawing the picture was not aware of. Three methodological strategies are described: (1) Drawing a picture as an introduction or starting point for an interview, (2) During an ongoing interview, encouraging the participant to draw a picture when further explanation or description is needed for deepening the communication and (3) Drawing something in a pre‐existing picture. The theoretical foundation of Gadamer's hermeneutic philosophy is discussed in relation to what a drawing is representing and presents. The interpretation of the drawn picture depends primarily on the creator of the picture, but at the same time the interpretation and understanding is a movement between the interviewer's and the participant's horizons, and thus is open for preunderstanding and new understanding. In contrast to an ordinary interview between two parties, an interview involving a drawing adds something specific to the conversation as it becomes a "trialogue" and not only a dialog. The drawn picture stands on its own. Using the participant's drawing can, therefore, be understood as an ongoing process with three parties involved: (1) the participant, (2) the researcher and (3) the drawing. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic affects care practices for critically ill patients, with or without a COVID‐19 infection, and may have affected the experience of dying for patients and their relatives in the physical, psychological, social and spiritual domains. Aim: To give insight into aspects of end‐of‐life care practices that might have jeopardised or supported the dignity of the patients and their family members during the first wave of the COVID‐19 pandemic in the Netherlands. Methodology: A qualitative study involving 25 in‐depth interviews with purposively sampled bereaved relatives of patients who died during the COVID‐19 pandemic between March and July 2020 in the Netherlands. We created a dignity‐inspired framework for analysis, and used the models of Chochinov et al. and Van Gennip et al. as sensitising concepts. These focus on illness‐related aspects and the individual, relational and societal/organisational level of dignity. Results: Four themes concerning aspects of end‐of‐life care practices were identified as possibly jeopardising the dignity of patients or relatives: 'Dealing with an unknown illness', 'Being isolated', 'Restricted farewells' and 'Lack of attentiveness and communication'. The analysis showed that 'Meaningful end‐of‐life moments' and 'Compassionate professional support' contributed to the dignity of patients and their relatives. Conclusion: This study illuminates possible aspects of end‐of‐life care practices that jeopardised or supported dignity. Experienced dignity of bereaved relatives was associated with the unfamiliarity of the virus and issues associated with preventive measures. However, most aspects that had an impact on the dignity experiences of relatives were based in human action and relationships. Relatives experienced that preventive measures could be mitigated by health care professionals to make them less devastating. [ABSTRACT FROM AUTHOR]

Despite the negative implications for their own health, spouses continue to support each other and maintain their couplehood for as long as possible, including when one of them develops a severe illness. However, with some exceptions, the experiences of older male spousal caregivers have been largely overlooked, and our knowledge of the relational aspects of spousal dementia care is scarce. To respond to this knowledge gap, this article explores the following research questions: How do older male spousal caregivers of wives with dementia talk about changes in their couplehood? What transitions or phases in the relationship can be identified as the caring process evolves and the wife's health continues to deteriorate? To answer these questions, we analyse in‐depth interviews with eight purposefully selected men aged 67–92 years old from Iceland and Norway. Our findings reveal that the participants felt that they were gradually losing their couplehood in the sense that they lost their shared everyday life routines, intimacy, joint activities, meaningful communication, and dreams and hopes for the future. Four phases of the dementia caring process were identified: the denial phase, the battle phase, the new reality phase and the redefinition phase. We hope that our findings spur more research on relational challenges as experienced by spouses caring for partners with cognitive decline. In conclusion, we argue that interdisciplinary clinical guidelines for a couple‐centred approach in elder care should be developed to urge professional care providers to pay attention to the various changes and challenges that dementia couples undergo to meet not only the health and care needs of dementia patients but also those of their spouses. [ABSTRACT FROM AUTHOR]

Background: Acute hospital settings are generally not considered adequate places for end‐of‐life care, but terminally ill patients will continue to die in acute medical wards in the unforeseeable future. Aim: The aim of this study was to investigate family caregivers' experiences of end‐of‐life care in an acute community hospital in Iceland. Methods: Fifteen in‐depth qualitative semi‐structured interviews were conducted with participants who had been primary caregivers. The transcribed interviews were analysed using thematic content analysis. Findings: Findings indicated that the acute hospital setting is not a suitable environment for end‐of‐life care. Effective communication and management of symptoms characterised by warmth and security give a sense of resilience. Three main themes emerged: (1) Environmental influences on quality of care; (2) Communication in end‐of‐life care; (3) The dying process. Each of the themes encompassed a variety of subthemes. Conclusions: Findings suggest that effective communication is the cornerstone of quality of care in the acute hospital environment and essential for establishing a sense of security. The severity of symptoms can deeply affect family caregivers' well‐being. Acknowledging and appreciating the meaning of respect and dignity at the end‐of‐life from family caregivers' perspective is vital. [ABSTRACT FROM AUTHOR]

Background: Physical activity, a core intervention in cardiac rehabilitation, can reduce vascular erectile dysfunction (ED). ED is a common sensitive problem for men with cardiac diseases, decreasing their quality of life. Cardiac health professionals rarely provide information about ED or its relation to physical activity. Developing health professionals' communicative component of the complex intervention 'Physical Activity to reduce Vascular Erectile Dysfunction' (PAVED) is important. Understanding the receiver needs is essential in designing a complex intervention. Aim: To elucidate men's perspectives on cardiac health professionals' communication about PAVED. Ethical issues: An Institutional Data Protection Agency approved the study. Methods: An interpretive data‐driven thematic analysis was applied to individual, qualitative semi‐structured interviews with 20 Danish men attending cardiac rehabilitation. Results: The men wanted health professionals' communicating about ED, as it was perceived as a major problem diminishing masculinity and tabooed by health professionals. Men wanted help for self‐help, which may be possible with the aid of competent health professionals' communication about how to prevent, reduce and cope with ED ‐ including information about PAVED. The men wanted health professionals' communication about ED in various contexts: general information in groups, sexual counselling for individuals and couples and written material. Study limitations: Recruitment was done from a Danish municipality's cardiac rehabilitation, and the transferability of the results may be limited to similar contexts. Conclusion: Erectile dysfunction was experienced as a major biopsychosocial problem for the men and their partners. The men had a need for health professionals' communication about sexuality, ED and information about PAVED as well as about prevention, reduction and management of ED. The men had a need for professional communication about sexual health. [ABSTRACT FROM AUTHOR]

Background: When a child is afflicted by a life‐threatening disease, it places a huge burden on the family. Aim: To gain a deeper understanding of parents' experiences of psycho‐social support in a group activity for families with children and adolescents suffering from cancer. Method: Data were collected by means of focus group interviews with 10 parents from eight families with children treated for cancer during the period 2011–2017. The interviews were transcribed and analysed in accordance with qualitative content analysis. Results: An overarching theme"Togetherness in loneliness" emerged, highlighting the importance of sharing experiences, based on the main categories: "a clearing house" and "a meeting place". A clearing house was described as a place for sharing experiences on equal terms and a short cut to care contacts. A meeting place was depicted as a temporary home, a place for recuperation, but that sharing also had a cost. Discussion: The results revealed that the parents of children suffering from cancer experienced the group activity for such families as an important support during the treatment period. The group served as an arena for mutual support and exchange of experiences, but it was also an easy way for the participants to access psychosocial support at an early stage of the cancer treatment. There was a risk that the participants would be unable to cope with sharing the anxiety and setbacks experienced by others, something that might be difficult to foresee when joining the group. [ABSTRACT FROM AUTHOR]

Aims: (1) To identify and analyse the conceptual framework and operationalise the concept of communication issues related to medication incidents in hospital to facilitate the development of a future tool for measuring frequencies of the communication issues. (2) To determine how the concept is distinct from related concepts. Design: Concept analysis. Data sources: Twenty‐three articles from seven scientific databases covering the years 2010–2020 and two official documents. Methods: Walker and Avant's concept analysis method was used. That was started by a systematised literature review on 2 November 2020 using specified criteria. Two authors evaluated articles' quality by Joanna Brigg's Institute's criteria. Literature review results were analysed deductive‐inductively; conceptual framework was developed and concept defined presenting case scenarios. EQUATOR's standards were used in study reporting. Results: A conceptual framework and the concept of 'communication related to medication incidents in hospitals' were defined, comprising six main attribute categories: (1) communication dyads involved in communication, (2) patients' or professionals' individual issues, (3) institutional, (4) contextual and process issues, (5) communication concerning medication prescriptions and (6) qualitative characteristics of communication. The categories consisted of 128 quantitatively measurable and 10 qualitative attributes describing communication issues. The concept is distinct from related concepts by collating fragmented communication issues into the same concept. Conclusion: The 128‐item conceptual framework and the concept of communication related to medication incidents in hospitals were defined, as there was not one. The concept assembled parts of previous theories and fragmented information to one entity. The concept needs further condensing and validation to develop a tool for measuring communication issues. Impact on medication safety: The conceptual framework can be used in practice and education as indicative rationale for reflection of current communication issues. The concept contributes to research by providing necessary grounding for tool development for measuring communication factors relating medication incidents. [ABSTRACT FROM AUTHOR]

Background: The number of centenarians in Europe is increasing; many face health impairments. Adult children often play a key role in their care, but there is a lack of research into what it means for these caregiving relatives to be confronted for many years with their parents' end of life (EOL), dying and death as well as their own advancing age. Aim: This study aims to analyse the challenges of caregiving adult children regarding their parents' end of life and the related burdens and barriers they report. Material and Methods: Semi-structured interviews were conducted with 13 caregivers following a theory-based and tested guideline. The computer-aided coding and evaluation followed the structured content analysis approach. Results: The analysis showed three main themes: 'Confronting EOL', 'Communicating about death and dying' and 'Assisting in the terminal phase'. The respondents commented on burdensome demands and concerns about the future. Further, a strong underlying presence of intraand interpersonal conflicts relating to EOL became apparent. Discussion: The results indicate several potential burdens for centenarians' caregiving offspring. They are confronted with a double challenge resulting from the combination of their own advanced age and experiencing the burdens of their parents' very old age. Further, some participants struggled with their own unclear perspective on the future because of the relative but unclear proximity of the parent's death. Multiple conflicts and overlapping conflict dimensions emphasise the potential of the EOL topic to influence the well-being of family caregivers and care recipients. Limitations: The convenience sample used for the study may cause limitations, for example, the fact that persons with a formally lower educational status are not represented. Conclusion: The findings suggest that interventions designed for family-related care situations should include topics like 'Finiteness and grief', 'Communicating about dying and death' and 'Decisions and dispositions at EOL'. [ABSTRACT FROM AUTHOR]

Background: Health communication (HC) is a vast research field focusing on changing health behaviours, and rapidly evolving technology is creating different ways and possibilities to reach target groups and audiences. In the context of home care, a deeper understanding of HC is lacking, specifically for older persons with care needs and their informal caregivers. The aim of this concept analysis is to identify and construct the meaning of HC from the perspective of older persons in need of care in the home environment and their informal caregivers. Materials and methods: This study utilised Rogers' (2000) Evolutionary Concept Analysis Method (EMCA) to create and construct a meaning of the concept of HC. The EMCA was based on a systematic literature review of scientific articles, using CINAHL, Pubmed and Inspec (2000‐2017). A total of 29 articles were retrieved and analysed. Results: The identified attributes of the concept were as follows: resources of the recipient, influence on decisions and advantages of tailored information. HC was described as both contributing to knowledge as well as being overwhelming where habits and resources influenced the use of information. The attributes led to the following descriptive definition of HC: 'Tailored HC, based on needs and resources of the recipient influence care decisions'. The home environment influenced HC by habits and interactions between older persons and their informal caregivers. Conclusions: The home environment influenced HC in terms of social aspects of interactions and habits and between the older person and the informal caregiver. Tailored information with the use of technology contributed to knowledge in care of older persons and their informal caregivers. HC was shown to contribute to improve care for older people in their home environment. [ABSTRACT FROM AUTHOR]

Background: Patient participation is fundamental to nursing care and has beneficial effects on patient outcomes. However, it is not well embedded yet and little is known on how nurses could effectively stimulate patient participation in hospital care. The Tell‐us Card is a communication tool for inviting patients to talk about their preferences and needs, and to increase patient participation in daily care. Objectives: To assess feasibility and early effectiveness of the Tell‐us Card communication tool for enhanced patient participation during hospitalisation. Design and method: A pilot cluster randomised controlled study design was used including four nursing wards. Effectiveness was measured with the Individualized Care Scale (ICS) and the Quality from the Patients' Perspective (QPP) questionnaire. Linear mixed model analysis was used for analysis. Feasibility was assessed with an evaluative questionnaire for patients and nurses and by reviewing the content of Tell‐us Cards using the Fundamentals of Care Framework (FOCF) for analysis. Ethical approval was attained. Results: Data of 265 patients showed a significant increase at one intervention ward on the ICS (effect size 0.61, p = 0.02) and most ICS subscales. No effect was visible on the QPP. The majority of patients regarded the intervention as beneficial; nurses however experienced barriers with incorporating the Tell‐us Card into daily care. Analysis of the Tell‐us Card content showed many elements of the FOCF being mentioned, with most patients indicating psychosocial needs like being involved and informed. Conclusions: This pilot study showed a positive early effect of the Tell‐us Card communication tool on patient participation, although integration in daily nursing care appeared to be complex and an optimal fit has not yet been reached. Patients were positive about the intervention and wrote meaningful issues on the Tell‐us Cards. More research is needed on how to incorporate patient participation effectively in complex hospital care. [ABSTRACT FROM AUTHOR]

Background: With a growing nursing home population suffering from chronic progressive illnesses and evolving patterns of comorbidities, end‐of‐life communication takes on a critical role to enable healthcare professionals to gather information about the resident's wishes for care at the end‐of‐life and organise the care plan accordingly. Aim: To explore nurses' perspective about the process by which end‐of‐life communication impacts on the goal of end‐of‐life care in nursing home residents. Design: A qualitative descriptive research design based on thematic analysis was performed. Fourteen nurses involved in the care of residents during their last week of life were recruited across 13 Italian nursing homes and accounted for 34 semi‐structured interviews. A combined approach of analysis that incorporated a data‐driven inductive approach and a theory‐driven one was adopted. Results: Twelve themes described how end‐of‐life communication may contribute to adjust the care plan in nursing home according to the nurses' perspective. Five antecedents (i.e. life crisis or transitions, patient‐centered environment, arising the question of possible dying, quality of relationships and culture of care) influenced the establishment and quality of communication, and five attributes depicted the characteristics and potential mechanisms of end‐of‐life communication (i.e. healthcare professional‐resident and healthcare professional‐family carers communication, knowledge of family carers' preferences, knowledge of residents' preferences, family carers and residents understanding, and shared decision‐making), while curative‐oriented and palliative‐oriented care goals emerged as consequences. Conclusion: This study provides insight into the nursing perspective of end‐of‐life communication between healthcare professionals and bereaved family carers of nursing home residents. Several factors influenced the occurrence and quality of end‐of‐life communication, which contributed to the transition towards palliative‐oriented care by using and improving knowledge about family cares' and resident's preferences for end‐of‐life care, promoting family carers and residents understanding about prognosis and treatments available, and fostering shared decision‐making. [ABSTRACT FROM AUTHOR]

Background: Children often report both fear and pain in conjunction with clinical care and treatment. Interventions developed in the field have still not been sufficient to prevent and relieve children's fear and pain. More knowledge, from children's own perspectives, is needed about how they deal with their experiences. Aim: To explore child‐identified strategies that children use to manage fear and pain during needle‐related medical procedures in hospital. Methods: Interviews with children, age 4–12 years, with experience of hospital care were analysed qualitatively using content analysis. Results: Children have self‐identified strategies for dealing with fear and pain during hospital care and treatment. The strategies vary depending on examination or treatment and on how the child felt at that particular day. Children describe what they can do themselves, how adults can empower them and support from surroundings as strategies that give them a choice and a voice. Children wished to have influence, decide when and how information should be given, scream out loud or squeeze something hard, to deal with fear and pain. The results also show that children tried to be brave, gain control and think positively. Something nice to look at and opportunities to play with others also contributed. Conclusions: Strategies vary between children and are used differently on different occasions. Healthcare professionals pose a threat to the child's needs and ability to use their strategies due to lack of knowledge of the child's chosen strategies. [ABSTRACT FROM AUTHOR]

Background: Hospital readmissions due to illness among geriatric patients result in human suffering and psychological trauma. Resilience in chronic illness protects geriatric patients from outcomes of trauma leads to psychological and physical well‐being and enables bouncing back to life. While communication has been linked to improved health outcomes, little is known about communication pathways in the context of postdischarge resilience. Aim and objective: To explore the role of communication pathways that acute‐care clinicians used with geriatric patients in postdischarge resilience. Methodological design and justification: Participants were ten geriatric patients who were readmitted several times in the past year. Twenty narrative interviews were conducted, one upon discharge and the other a month thereafter. Data for each phase of interviews were analysed using methods of selection mechanisms and Bricolage. Ethical issues: The ethics committee approved the study. Participants signed an informed‐consent form for participation and publication. Findings: Communication in acute care that enhanced health literacy, perceived control and reflection, contributed to higher comprehensibility and manageability during the hospitalisation and postdischarge meaningfulness postdischarge, contributing resilience. Participants who experienced other forms of communication demonstrated anxiety and helplessness with lingering psychological trauma postdischarge. Conclusions: Acute care may provide clinicians with opportunities to alleviate the suffering of geriatric patients and contribute to their postdischarge resilience. The suggested T.E.R model delineates communication pathways to fuel the trajectory from psychological trauma to postdischarge resilience in practice. [ABSTRACT FROM AUTHOR]

Introduction: With governments worldwide reducing their involvement in the provision of institutional long‐term elder care, community‐based family caregivers (FCs) have become a key element in policies aimed at improving the quality of healthcare systems and maintaining their financial sustainability. This paper uses data from focus groups with FCs providing care to older adults to describe their approaches to and priorities for achieving care quality and sustainability as they work with formal health and social care systems. It describes FCs' views on information and communications technology (ICT) as potential supports for achieving these care quality and sustainability goals. Methods: We held 10 focus groups from May 2017 to August 2018 and recruited 25 FCs through a mix of convenience and snowball sampling strategies. We employed an inductive approach and used qualitative thematic content analysis methods to examine and interpret the resulting data. We used NVIVO 12 software for data analysis. Results: Quality of care – as delivered by both FCs themselves, and formal health and social care systems – was a major preoccupation for our participants. They saw communications quality as a key aspect of the broader concept of care quality. Our data analysis produced a typology of communications quality from the FC perspective. Analysis of our data also revealed ICT development opportunities and available products in key areas. Conclusions: Our findings suggest that the formal care system providers could be more caregiver‐oriented in their communications by engaging FCs in the decision‐making process and allowing them to express their own concerns and goals. The implication of our findings for those seeking to develop policies and ICT products in support of FCs is that these should focus on human relationships and seek to expand facilitative communications. [ABSTRACT FROM AUTHOR]

Background: Parents have responsibilities when their adolescent offspring use alcohol, but little is known about their views on the topic. This knowledge would help healthcare organisations to develop practices to help parents meet their responsibilities. Aim: The aim of this study was to describe parents' perceptions and experiences of their responsibilities and what support they needed to tackle underage drinking. Design and methods: This Finnish study was carried out in 2017. It used a qualitative descriptive method that involved carrying out semi‐structured interviews with 20 parents of adolescents aged 14–15 years. The data were analysed using inductive content analysis. Results: Parents described that it was their responsibility to prevent problems that could have a negative impact on their adolescents' well‐being. When it came to their responsibilities with regard to adolescents using alcohol, parents saw these as guiding and protecting their child, being aware of how parents used alcohol themselves, the way they communicated with adolescents and the rules they set about experimenting with alcohol. Parents said that receiving collaborative support from peers, community and professionals working in health and social care services would be useful. This could help them to prevent adolescents using alcohol, tackle problems that occurred when adolescents drank and enable parents to play a responsible role in their local community. Conclusion: Parents recognised that they had responsibilities to prevent alcohol having a negative impact on adolescents' well‐being. They wanted to ensure that adolescents made sensible and responsible decisions when it came to using alcohol. Parents described that the most important form of support was peer support from other parents. The findings of this study can be used to inform the development of preventive healthcare services and support parents to meet their responsibilities with regard to tackling underage drinking. [ABSTRACT FROM AUTHOR]

Background: Cultural competence is recognised as a leading component in the delivery of high‐quality health care. However, a lack of concept clarity has led to lower quality and less effective healthcare provision for culturally diverse groups. Understanding of cultural competence in a healthcare context will be improved through the exploration of health professionals' perceptions of the matter. Aim: The aim of this study was to explore health professionals' perceptions of cultural competence in a student healthcare context. Methodology: The material consists of texts from interviews with ten health professionals in a student healthcare context. A hermeneutical approach was used, and the method was inspired by content analysis. Findings: One main theme and four subthemes were seen. The main theme was 'Caring ethics as the foundation for enabling cultural competence', and the subthemes were 'Cultural competence as knowledge and acting accordingly with open‐mindedness and respect', 'Cultural competence as being willing to understand and learn through a process', 'cultural competence as responsiveness and adaptability' and 'Cultural competence as humility and discretion'. Conclusion: Ethics can be considered a core component of cultural competence in student healthcare. In further research, a focus should be placed on cultural competence as perceived from other (e.g. students') perspectives. [ABSTRACT FROM AUTHOR]

Background: Minimal sedation has made it possible to communicate and cooperate with intensive care patients and mobilisation can start earlier during their stay in the intensive care unit. Purpose: To investigate the intensive care patient's reaction and interaction to mobilisation. Method: This study used focused ethnography combining observations, interviews and four scores for evaluating awareness, and pain levels were included: Richmond Agitation Sedation Scale Confusion Assessment Method For The Intensive Care Unit, Numeric Rating Scale and Critical Pain Observation Tool. Twelve patients were observed during mobilisation, with subsequent interviews of the involved nurses. Findings: Nurses run the risk of overlooking the patient's reactions, such as pain, discomfort or needs during mobilisation. Nurses use several different ways of communicating to create contact with the patients. Patients with an impaired awareness level become more aware during mobilisation. Conclusions: If the nurse's attention is focused on the technical side of caregiving, there is a risk that she might overlook the patient's reactions and needs. If the nurse is aware of the risk of overlooking the patient's reactions, she may plan the mobilisation to ensure that the patient gets the necessary attention and is included in the process. In that way, the patient might avoid unnecessary discomfort and maintain trust and confidence in the nurse. [ABSTRACT FROM AUTHOR]

Background: The rationale of the study was the predominant understanding that patient involvement in treatment‐related decision‐making is essential and that communication with cancer patients can affect their quality of life, satisfaction with care, and psychosocial and medical outcomes positively. Aim: This study explored how patients with advanced prostate cancer experience the communication with health professionals and their experiences of how and by whom treatment‐related decisions were made. Methods: A phenomenological‐hermeneutic research design was applied, and data were collected using qualitative interviews supplemented with participant observations in a urological outpatient clinic at a regional hospital in Denmark. Thirteen patients participated. Data were analysed using Ricoeur's theory of interpretation. Findings: The patients experienced the course as being routine and that decisions related to treatment were made in advance. Three themes were identified: (1) Fast track diagnosing and treatment, (2) Off course I should have this treatment, and (3) They don't ask about existential issues. Conclusion: The study concluded that patients experienced communication primarily revolved around disease‐ and treatment‐related issues and that it was characterised as efficient and straightforward, but insufficient. The patients experienced that the doctors made treatment‐related decisions without involving them. [ABSTRACT FROM AUTHOR]

Background: People with dementia and their informal caregivers get in touch with the healthcare system predominantly via contacts with primary care providers. Among these, community pharmacists have been denominated as the health professionals most accessible to the public. Communication with and counselling people with dementia and their informal caregivers present particular challenges to pharmacists. Aim: This study aims to research the challenges faced and strategies used by community pharmacists who deal with people living with dementia and their informal caregivers. Methods: Within the context of two workshops with 74 participants, 15 small groups were formed, each of which generated and discussed a small story. Fourteen of those narratives were reported, tape recorded and transcribed. In these 14 narratives, community pharmacists reflected on their experiences with people with dementia or their informal caregivers. The narratives were systematically analysed and interpreted. Findings: Among the main challenges reported by the workshop participants are the difficulty of identifying a person with dementia; the question of what appropriate communication is; the only partially successful networking with doctors, nursing personnel and support institutions; unsuccessful counselling; and the tension between the economic situation and the care for people with dementia and their informal caregivers. In general, strategies for dealing with people with dementia are characterised by uncertainty whereas communication with informal caregivers is well rehearsed and effective. Conclusions: Community pharmacies require possibilities to retreat for counselling as well as the possibility for pharmacists to take time for people with dementia and their informal caregivers in everyday pharmacy life. Reflective spaces for narrations about difficult situations provide relief for staff in community pharmacies. [ABSTRACT FROM AUTHOR]

Background and rationale: SPECAL is a model of care for people with dementia based on a novel conceptualisation of memory and how this changes in dementia. Carers adapt their communication style to prevent distress and promote well‐being for the person with dementia. However, there is limited scientific evidence on the effectiveness of SPECAL. Aim: This study explored mechanisms of SPECAL through a qualitative enquiry with family carers. Method: Semi‐structured interviews were conducted with family carers who had been coached in SPECAL and applied its principles and practices. Thematic analysis was applied. Findings: All participants had found SPECAL helpful in caring for a person with dementia. The core themes of this positive experience were empathy, harmony and resilience. Synthesis of these themes contributes to a proposed model of the mechanisms of SPECAL. Conclusion: In applying SPECAL, carers gained an empathetic insight to the feelings of the person with dementia. This empathy leads to a more harmonious environment, which enhances the carer's resilience. [ABSTRACT FROM AUTHOR]

Aims and objective: To describe telenurses' experiences of monitoring calls in telephone advice nursing to parents of children with gastroenteritis. Background: In previous studies, making monitoring calls is mentioned as a method used by telenurses to assess the need for care. MonitoringTHE terms 'care‐seekers', 'care‐seeker' and 'careseekers' are used inconsistently in the article. Please suggest which one to follow. We suggest Care‐seeker calls in telephone advice nursing have been described as when telenurses call care‐seekers back once or twice after an initial call. Calls from parents of children with gastroenteritis are common, and many of these calls result in telenurses providing self‐care advice. Methods: Nineteen telenurses from two healthcare call centres in Sweden were interviewed. Data were analysed using inductive qualitative content analysis. Results: One main category, four generic categories and eleven sub‐categories emerged. The telenurses described how working with monitoring calls aimed to provide self‐care at home in a patient‐safe way. Their focus on the parents aimed at increasing their feeling of security and focus on the child aimed at ensuring patient safety. Monitoring calls also provided a learning opportunity for parents and telenurses, and the possibility of relieving pressure on healthcare services. The findings indicate that the use of monitoring calls aims to provide a patient‐safe form of telephone advice nursing. Conclusion: This study shows that many parents feel insecure when their child has gastroenteritis, and the use of monitoring calls may be an effective approach to help them feel more secure at home with their sick child. [ABSTRACT FROM AUTHOR]

Background: Telephone nursing is expanding worldwide, but a little is known about nurses' interactions with callers and the factors that affect these interactions. Aim: The purpose of this paper is to describe how telenurses experience caller interactions. Methods: A qualitative study designed through open telephone interviews with call centre nurses (n = 9) in 2017. The data were analysed using inductive content analysis. Ethical guidelines were followed at all stages of the study. Results: Callers both enhanced and hindered interactions. Nurses' professional skills, such as communication skills, nurse‐led control over the call and the nurses' capabilities, enabled positive interactions. Disturbing background sounds, communication problems and service system failures made the telephone interactions challenging. Achieving connection with callers, callers who had supportive family members and a supportive organisational structure were features of successful interactions. Study limitations: As all nine participants were recruited from one call centre, the findings are not directly transferable to another environment. Conclusions: The results reveal that nurse–caller interactions are affected by several issues concerning the callers and the nurses' skills. Communication problems were often present when telenurses were unable to provide the services callers expected due to lacking health and medical care resources. Family members could be considered important participants in telephone communication with nurses, though further research should examine the possible benefits of interacting with family members. Practical implications: Based on the results of this study, telenurses could benefit from training that focuses on the communication skills that are needed for telephone nursing and the tools needed to meet individual callers' needs. Work environments could also better support caller–nurse interactions. Organisations should provide more resources for telephone nursing in order to promote positive interactions. [ABSTRACT FROM AUTHOR]

Introduction: Tom Kitwood's theoretical framework of person‐centred care is extensively and internationally referred to in healthcare services. However, despite the broad use of Kitwood's approach in clinical practice, the research examining experiences with the approach has not been mapped. Aim: To map the available literature on current empirical experiences in clinical practice of Kitwood's approach to person‐centred care for people with dementia, living in institutional settings in primary health care. Methods: A total of 154 studies concerning the experiences of people with dementia and their formal caregivers' use of Kitwood's framework of person‐centred care for residents living in institutional settings in primary health care were compiled from scientific databases. All three authors engaged in a systematic selection process, leading to nineteen articles being included in the review. Results: The results showed an overall tendency towards positive experiences gained from applying person‐centred approaches in clinical practice influenced by Kitwood's theoretical framework. Through the synthesis of data from the selected studies, six categories related to our research aim were identified 'Theoretical evaluation of Tom Kitwood's model of care', 'Models and frameworks', 'Interventions', 'Communication', 'Dementia Care Mapping' and 'Environment'. Conclusion: The present review included nineteen studies published from 1998 to 2016 and consisted mainly of peer‐reviewed scientific articles, followed by dissertations, conference posters and nonpeer‐reviewed articles. All studies were undertaken in Western countries. The vast majority of the studies considered Kitwood's theoretical framework to be beneficial and useful in practice. [ABSTRACT FROM AUTHOR]

Background: To date in Germany, only few studies have been conducted concerning the efficacy of care and case management (CCM) for older people and about using communication technology during monitoring. Aim: With this study, it is intended to gain a better understanding of how CCM in general is perceived by older people (65+) living alone and in particular what they think about the CCM monitoring process used during video conferences. Method: The sampling and work cycle were based on the Grounded Theory. Two different subsamples (each n = 20; total sample: 70% women; age range: 64–92 years) were recruited. Interviews were conducted with the focus on CCM contributions (Subsample I) and monitoring supported by video conferences (Subsample II). All participants had received CCM from external providers (care support centres) in two German federal states. The intervention of CCM ranged between four and twelve months. Participants of Subsample II received additionally moderated video conferences via tablet PCs for and with older people over an intervention period of nine months. Results: Care and case management was experienced as a possibility for receiving individual support and for improving the user's everyday life. Within a short time, video conferences were a familiar communication tool. They enabled particularly people with reduced mobility to get barrier‐free access to case managers, compensated for isolation and enabled participation. Conclusions: According to the view of older CCM users with multimorbidity living alone, CCM offers formative and organisational support in various life‐domains. Combined with video conferences, the exchange of information becomes barrier‐free and instantaneous, and the sense of security in health questions is reinforced. [ABSTRACT FROM AUTHOR]

Nursing shift‐to‐shift handovers are important as they impact the care quality indicators such as safety, patient satisfaction and continuity. However, nurses' handovers have also been criticised and described as unstructured and ineffective. To improve the handovers and involve patients and their loved ones in the process, a person‐centred handover (PCH) model performed at bedside has been developed and tested at Karolinska University Hospital, Sweden. This study reports on the nursing staffs' compliance to a checklist used for the newly introduced PCH model. A total of 43 PCH sessions were observed at two acute care wards, using a structured observation protocol. None of the observed handover sessions included all the 13 PCH checklist subcomponents. The checklist was used in 18 (44%) of the observed handover sessions. A statistically significant higher number of subcomponents were observed when the nurses used the PCH checklist (6.4 vs. 4.5 subcomponents, p < 0.05). The mean time spent on each PCH was 6 minutes. In 56% of the sessions, the patients were observed to actively participate in the handover. Overall, the nursing staffs' compliance to the PCH checklist needs to be improved. The observations suggest that training on communication‐oriented tasks would be beneficial to establish a person‐centred handover process. [ABSTRACT FROM AUTHOR]

Background: A constructive patient–nurse relationship is beneficial in self‐management support approaches. Research indicates eHealth interventions hold a potential for self‐management support for adults with type 2 diabetes. However, eHealth may change the patient–nurse relationship. No studies to date have addressed how eHealth self‐management support interventions with written asynchronous communication can influence the relationship between patients and nurses. Aim: The aim of this study was to explore how an eHealth intervention based on the Guided Self‐Determination program (eGSD) influences the patient‐nurse relationship from the perspective of patients participating and the nurses conducting the intervention. Methods: A qualitative approach with individual semi‐structured interviews was used. Ten patients with type 2 diabetes who completed the eGSD and four nurses who delivered the intervention participated. The data were transcribed verbatim, and qualitative content analysis was used to analyse the text. Results: The findings revealed two themes: 'eGSD facilitates a reciprocal understanding and a flexibility in the relationship' and 'eGSD creates a more fragile relationship', reflecting ambiguous experiences with the eGSD. Conclusion and relevance to clinical practice: The findings indicate that eGSD influences the patient–nurse relationship by facilitating reciprocal understanding and flexibility. Both patients and RNs acknowledged these outcomes as beneficial. Nevertheless, familiar in‐person consultations were expressed as integral for the patient–nurse relationship. As written communication in eHealth is a novelty, it demands new knowledge and expertise that RNs must master. Findings from this study may therefore be acknowledged when developing and implementing eHealth interventions. Education programs in written eHealth communication, as well as guidelines and frameworks on how to professionally and effectively conduct eHealth services while maintaining supportive patient–nurse relationships, should be a priority for institutions that educate healthcare personnel, health institutions and other stakeholders. [ABSTRACT FROM AUTHOR]

Background: Cultural sensitivity is a core concept to establish awareness and knowledge about various ethnicities, cultures, genders and additional diversity characteristics to understand individual's requests and respond appropriately to them. A need for further development of the concept is warranted, especially in the context of paediatric nursing. Aims: The purpose of this paper was to determine the main elements of cultural sensitivity in the context of paediatric nursing in Iran. Methods: The Hybrid method was implemented consisting of three phases: theoretical, fieldwork and final analysis. In the theoretical phase, articles from 2007 to 2017 were reviewed for relevance. In the phase of fieldwork, 25 nurses and nine parents were interviewed to explore the aspects of cultural sensitivity in paediatric nursing. The interviews were transcribed, and content analysis was conducted. In the final phase, an overall analysis of the two previous phases was performed. Results: In the theoretical phase, the following attributes were determined: cultural encounter and awareness, acceptance of cultural diversity and designing programmes in accordance with family culture. The fieldwork phase explored three themes of intercultural encounters, intercultural communication and adapting the care plan with family culture. The final synthesis yielded that sensitivity to family requests and beliefs, effective intercultural communication and integration of family culture with the care plan are the main elements of cultural sensitivity in Iranian paediatric nursing. Conclusion: With a deeper understanding of the term cultural sensitivity, nurses will have a foundation to improve paediatric nursing care and align the care plan with the patient's culture to provide trust, child/parent participation, secure care, effective communication and satisfaction. Since the concepts are the building blocks that underpin theory, the present concepts identified can help to serve as the foundation for the development of a theoretical model. [ABSTRACT FROM AUTHOR]

Background: Being diagnosed with cancer is an existential challenge and involves difficult treatment decisions, including treatment in clinical trials. Therapy for advanced cancer is potentially life‐prolonging and only rarely cures advanced cancer, which often renders these patients in a special situation where dealing with end of life, hope and meaning, become an important part of life. Many existing reviews include both patients with advanced cancer and patients undergoing adjuvant cancer treatment, and there is a lack of reviews with consistent study designs and methods. Aim: To systematically review and thematically synthesise the experiences of patients and relatives when they have to decide whether or not to participate in a clinical oncology trial and to provide knowledge about the decision‐making process. Method: A qualitative systematic literature review was conducted based on methods for thematic synthesis by Thomas and Hardens. Results: Eleven full‐text articles were included in this study. Six descriptive themes appeared and were grouped under two analytical themes: Individualised decisions and Hope and existential matters, which, through discussion, developed into the synthesis of What matters in treatment‐related decisions close to the end of life? This review has shown that existential matters are important in the decision‐making and that addressing these might be of great importance in medical decision‐making, whether it concerns the existential matters of the patients, of their relatives or of the health care professionals. Conclusion: This review points to existential issues as important contributors in making decisions about treatment. It can be beneficial if health care professionals address the role of existential matters in patients' decision‐making in terms of clinical trial participation and involve the relatives more directly to increase individualised decisions. Future research should include the health care professionals' experiences when going in depth with decision‐making, with a focus on the existential matters and uncertainties of the health care professionals. [ABSTRACT FROM AUTHOR]

Background: Being involved in the care of a loved one is a desire of many next of kin. However, according to several studies of the perceptions of nursing home staff, the involvement of next of kin is not an obvious part of care. To be able to involve next of kin in care at nursing homes, the perceptions of what participation means are an important piece of knowledge. The aim of this study was therefore to describe variations in next of kin's perceptions of the meaning of participation in the care of older persons living in nursing homes. Methods: Eighteen next of kin of older persons living in ten nursing homes in Sweden were recruited for interviews. The study design was based on a phenomenographic approach, focusing on the qualitatively different ways in which a person perceives, experiences or conceptualises a phenomenon or certain aspect of reality. Results: Five categories emerged from analysis of the interviews, representing the next of kin's perceptions of the meaning of participation in the care of older persons in nursing homes: be present; communicate; monitor; do practical tasks; and to represent. The next of kin expressed meanings that belonged to more than one category, and the categories were interdependent. Conclusions: Our results indicate that there are several meanings of next of kin's perceptions of participation at nursing homes. Nursing home staff's knowledge of these perceptions is important to enable next of kin to participate according to their own preferences. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether varying the communication style of care assistants, encouraging them to use direct instructions and allowing more time for residents' responses influenced the communicative behaviour of care home residents living with dementia. Design: This study used a multiple systematic case study design. Participants were video‐recorded during morning care routines in three communication conditions: usual communication, direct instructions and pacing (allowing more time for resident responses). Each dyad acted as its own control. Setting: The study took place in a residential care home in the East Midlands, UK. Participants: Three dyads (person with dementia/care worker) Measures: The level of compliance with instructions was measured. Validated measures were used to rate positive communicative behaviour (engagement with care tasks, eye contact and initiation of interaction) and negative communicative behaviour (e.g. shouting and kicking). Results: Care assistants were able to employ direct instructions after brief training. The use of direct instructions was positively correlated with positive communicative behaviour from residents (p < 0.05). The pacing condition was not employed adequately to evaluate effectiveness. Negative communicative behaviour (resistiveness to care) was rare. Conclusion: The use of direct instructions by care assistants holds promise for effective communication with people with dementia and warrants further investigation in larger samples and in varied contexts. [ABSTRACT FROM AUTHOR]

Introduction: This paper describes first‐line department healthcare professionals' experiences of conversations with young adults (16–25 years) who express existential concerns. Existential concerns encompass questions about the meaning of life and the choices people must make, and they are sometimes expressed during the period in which a child is becoming an adult. Sometimes the transition to adulthood can be difficult, and many young adults seek support from people in first‐line departments, such as primary care providers, youth guidance centre personnel and student health service employees in high schools and universities. Conversations in which existential concerns are recognised may be important for preventing mental illness in the future. Aim: The study aimed to describe healthcare professionals' lived experiences of conversations with young adults who express existential concerns. Approach and methods: This qualitative study utilises thematic meaning analysis. Interviews were conducted with healthcare professionals working in first‐line departments, and data were analysed based on the principles of reflective lifeworld research. The study followed ethical codes of conduct and conformed to the ethical guidelines adopted by the Swedish Research Council. Findings: The results are presented in three themes of meaning: searching for innermost thoughts requires being present, uncertainty about the unpredictable and awakening of one's own existential concerns. Conclusions and implications: Healthcare professionals are affected when young adults express their existential concerns, and they need more support to strengthen their ability to stay present and create inviting atmospheres. [ABSTRACT FROM AUTHOR]