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Digital tools are becoming more and more common in healthcare. Their potential to improve treatment, monitoring, and coaching in physiotherapy has been recognized. Yet studies report that the adoption of digital health tools in ambulatory physiotherapy is rather low and that their potential is underexploited. This paper aims to investigate how digital health tools in general, and the mobile health tool physitrackTM (hereafter the app) more particularly, are used in outpatient physiotherapy clinics and also to identify what facilitates or hinders the app's use. The paper is part of a larger study and adopts an ethnographic approach. It is based on observational and interview data collected at two outpatient clinics. We reveal how physiotherapists and patients use the app in physiotherapy and identify 16 interdependent factors, on the macro-, meso-, and micro-level, that either facilitate or hinder its use. We argue that a single factor's facilitating or hindering impact cannot be grasped in isolation but needs to be investigated as one piece of a dynamic interplay. Further qualitative research is required, especially to shed more light on the app's compatibility with physiotherapy practice and use in therapist-patient interactions. [ABSTRACT FROM AUTHOR]

Rising health insurance costs and the cost of living crisis are likely leading to an increase in unpaid health insurance bills in many countries. In Switzerland, a particularly drastic measure to sanction defaulting insurance payers is employed. Since 2012, Swiss cantons – who have to cover most of the bills of defaulting payers - are allowed by federal law to blacklist them and to restrict their access to medical care to emergencies. In our paper, we briefly describe blacklisting in the context of the Swiss healthcare system before we examine the ethical issues involved in light of what is known about its social and health impacts. We found no evidence that blacklisting serves as an effective way of recovering unpaid health insurance contributions or of strengthening solidarity within the health insurance system. Furthermore, the ambiguous definitions of what constitutes an emergency treatment and the incompatibility of the denial of medical care with the obligation to provide professional assistance complicate the implementation of blacklists and expose care providers to enormous pressure. Therefore, we conclude that blacklists and the (partial) denial of medical care not only pose profound ethical problems but are also unsuitable for fulfilling the purpose for which they were introduced. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to investigate management auditing, a thorough examination of an organization and the management in place, through an empirical research to gather data about how management audits are perceived and implemented among Geneva’s (Switzerland) business community. The board of directors is in charge of a corporation’s overall supervision. The internal auditing function works under the aegis of the board to ensure that the directors will properly execute their responsibilities as defined by corporate governance rules. Management auditing could thus be used to improve corporation performance. However, management audits are not commonly used or referred to as a tool to address corporate governance. Findings enable the authors to both explain why management audits are not commonly used or referred to as a tool to address corporate governance and generate related research hypotheses. Design/methodology/approach – In this paper, the authors rely on an ethnographic study aimed at exploring perceptions of management audits in service companies from the Geneva region. This study is based on transcripts from 85 semi-directed interviews, conducted over a three-year period, of professionals with managerial and auditing backgrounds. The economic context during these three years was consistently characterized by the Swiss and international financial crises, ensuring that the findings remain comparable over this time period. Findings – This paper identified three main factors that influence the integration of management audits into corporate practices: the degree of acceptance of the tools and requirements of management audits, the national culture and values embodied in the practice and the degree of corporate governance maturity. This paper presents the findings in the form of hypotheses that can be tested on any adoption of good corporate governance practices – not on management audits alone. Research limitations/implications – Notwithstanding the limitations due to its nature and extent, this study’s main limitation is its lack of validation of the hypotheses. In further research, the authors intend to use a quantitative survey to validate the research hypotheses and make statistical inferences. Originality/value – This paper contributes to the literature because it is, to the authors’ knowledge, the first study to empirically examine the significant link between management audits and corporate governance. The findings could be interesting for an international audience because they indicate possible action points that boards of directors can leverage to carry out management audits. The findings also bridge a gap between the literature on management audits and the expanding role of the internal audit function. This study also examines the way companies – in the Swiss context – understand, perceive and may be ready to apply management audits as a good corporate governance practice. [ABSTRACT FROM AUTHOR]

Aims: To investigate the level of adoption of evidence‐based family engagement and support during end‐of‐life cancer care and subsequent bereavement and its contextual facilitators and barriers from health professionals' perspectives, and to explore differences between professional groups. Design: Contextual analysis using an online cross‐sectional survey. Methods: This study was conducted in four Swiss hospitals and three home care oncology and palliative care services. Non‐parametric testing was used to investigate the level of adoption and differences between nurses, physicians, occupational‐ and physiotherapists and psychosocial professionals (chaplains, onco‐psychologists and social workers). The STROBE checklist for cross‐sectional studies was followed. Results: The majority of the 111 participating health professionals were nurses. Adoption was statistically significantly higher during end‐of‐life care than bereavement, with nurses and physicians reporting higher levels than the other professional groups. Guidance on end‐of‐life family care was available in about half of the cases, in contrast to a quarter for bereavement care. Self‐perceived knowledge, skills and attitudes were moderate to high, with nurses and physicians reporting higher levels than others, except for general skills in working with families. Organisational structures were experienced as rather supportive, with the psychosocial group appraising the organisational context as significantly less conducive to fully implementing end‐of‐life and bereavement care than others, particularly during the end‐of‐life phase. Conclusion: Evidence‐based family engagement and support were better adopted during end‐of‐life care than bereavement. Overall, nurses and physicians felt better enabled to care for families compared to other professional groups. Patient or Public Contribution: No patient or public contribution. Protocol registration: https://osf.io/j4kfh. Implications for the profession and/or patient care: Implementation and quality improvement efforts should focus particularly on the bereavement phase and be tailored to professional groups. Impact: The findings show that evidence‐based family engagement and support practices during end‐of‐life were rather well adopted in contrast to subsequent bereavement care, with nurses and physicians better enabled than other professionals to provide care. A better understanding of health professionals' contributions and roles in family care is important to build interprofessional capacity for evidence‐based end‐of‐life and bereavement support. Reporting Method: The STROBE checklist for reports of cross‐sectional studies was followed (von Elm et al., 2007). [ABSTRACT FROM AUTHOR]

Aims and objectives This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. Background Ambiguities remain about how patients participate in routine measures designed to promote patient safety. Design Systematic review using integrative methods. Methods Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: 'patient', 'healthcare provider', 'task', 'work environment', 'organisation & management'. Results We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives. Conclusions Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures. Relevance to clinical practice Patients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety. [ABSTRACT FROM AUTHOR]

The purpose of this article is to investigate the common facilitators and barriers associated with the implementation of hospital-based health technology assessment (HB-HTA) across diverse hospital settings in seven countries. Through a two-round Delphi study, insights were gathered from a panel of 15 HTA specialists from France, Hungary, Italy, Kazakhstan, Poland, Switzerland, and Ukraine. Experts initially conducted a comprehensive review of the HB-HTA implementation in their respective countries, identifying the barriers and facilitators through descriptive analysis. Subsequently, panel experts ranked these identified barriers and facilitators on a seven-point Likert scale. A median agreement score ≥ 6 and interquartile range (IQR) ≤ 1 was accepted as reaching a consensus. Out of the 12 statements categorized as external and internal barriers and facilitators, the expert panel reached consensus on six statements (two barriers and four facilitators). The external barrier, which achieved consensus, was the lack of the formal recognition of the role of HB-HTA in national or regional legislations. The internal barrier reaching consensus was the limited availability of human resources dedicated to HB-HTA. This qualitative study indicates that HB-HTA still has progress to make before being formally accepted and integrated across most countries, although by building on the facilitating factors we identified there may be an opportunity for the implementation of internationally developed strategies to strengthen HB-HTA practices. [ABSTRACT FROM AUTHOR]

Purpose – Despite an impressive body of international research, there is a lack of empirical evidence describing the ways in which organisational environments influence the practices of corporate communications (CC). A cross-cultural survey in five countries contributes to closing this research gap. The paper aims to discuss this issue. Design/methodology/approach – What makes the research design innovative is that the questionnaire incorporates both practitioners’ perceptions of the cultural context and the relevance of CC practices. The sample comprises 418 practitioners from the most senior positions in CC in the biggest companies in Australia, Austria, Germany, Indonesia, and Switzerland. By choosing a systematic access to the field the authors circumvent shortcomings of “snowball” sampling techniques. Findings – While cultural perceptions and CC priorities vary to a certain degree, there are hardly any significant correlations between the two. Meanwhile, the “nation variable”, and the institutional settings associated with it, are more instructive when explaining differences in CC. Research limitations/implications – A large cross-cultural survey needs to take a “birds eye view” and, as such, is able to identify only general tendencies when describing relations between perceptions of culture and CC practices. Future case studies and qualitative research could explore more subtle ways in which CC is influenced not only by the cultural context, but also – and probably even more – by institutional environments. Originality/value – This is the first cross-cultural survey to systematically describe on the level of primary data, the links between CC practices and perceptions of the organisational environment. Since the results indicate only a limited impact of culture, the authors would recommend the rehabilitation of the “nation variable”. Provided it is understood and differentiated as a representation of specific institutional contexts, the nation variable is likely to prove highly instructive when accounting for the diversity of CC observed around the world. [ABSTRACT FROM AUTHOR]

To ensure high qualification standards in medical institutions, a questionnaire has been developed to evaluate the postgraduate medical education in Switzerland. This article describes the development and longitudinal analysis of a questionnaire using eight scales to assess the quality of postgraduate medical education. The questionnaire has been administered to all residents every year since 2003. In 2020, 8,745 residents returned the questionnaire, resulting in a response rate of 70%. In addition, a survey is conducted annually among the directors of medical institutions. We present results of the directors' survey and the resident evaluation from 2020, as well as longitudinal data over 16 years. The mean values of the eight scales remained stable or increased slightly over the years. The decision-making culture scale is generally rated best by the residents, while the evidence-based medicine scale is rated as the least good. The most important drivers of residents' satisfaction with a training site are the work environment and leadership culture scales. The directors perceive the evaluation to be fair and useful. The questionnaire represents a reliable and useful tool for the quality control in postgraduate medical training. It provides yearly feedback to the directors regarding how the residents perceive their training giving insights for improvments. [ABSTRACT FROM AUTHOR]

Postpartum mothers have to decide whether to leave the workforce for some time and, if so, when to return to paid work. Two kinds of regrets might evolve as a result of women's leave‐related decisions: stay‐at‐home and return‐to‐work regrets. The present research investigates how these forms of regrets are associated with women's affective organizational commitment. We conducted a four‐wave longitudinal study with female participants mostly living in Switzerland (61%) and Germany (37%). The first measurement occasion took place during pregnancy (N = 294), and the subsequent three postnatal measurement points were at 6 (n = 281), 12 (n = 254), and 24 months (n = 230) after childbirth. As expected, higher organizational commitment during pregnancy predicted stronger stay‐at‐home regrets. By contrast, women's prenatal organizational commitment did not turn out to be predictive for lowered return‐to‐work regrets. We further assumed cross‐lagged associations between post‐birth organizational commitment and return‐to‐work regrets. Our results suggest that return‐to‐work regrets are predictive of decreases in affective organizational commitment. Reversed causation, that is, effects from postnatal organizational commitment to return‐to‐work regrets, could not be confirmed. Results are discussed regarding theoretical, methodological, and practical implications. [ABSTRACT FROM AUTHOR]

Nurses exhibit higher rates of presenteeism than other professionals, with consequences for the quality of care and patient safety. However, nurses' perceptions of these issues have been poorly explored. This study investigated the perceptions and experiences of frontline nurses and nurse managers in Switzerland and Portugal about the consequences of presenteeism and strategies to minimize it in different healthcare settings. Our qualitative study design used video focus groups involving 55 participants from both countries. Thematic analysis of their transcribed discussions revealed six themes surrounding the consequences of presenteeism: the personal impact on nurses' health and wellbeing, on their family relationships, and on professional frustration and dissatisfaction; the professional impact on work dynamics; the social impact on the quality of care and patient safety and on society's impressions of the profession. At the individual, collective, and institutional levels, six strategies were evoked to minimize presenteeism: encouraging professionals' self-knowledge; creating a positive work atmosphere; facilitating communication channels; developing a positive organizational culture; implementing preventive/curative institutional interventions; identifying and documenting situations linked to presenteeism. Nurses' perceptions and experiences provided a deeper understanding of their presenteeism and revealed underused pathways toward preventing and minimizing presenteeism via bottom-up approaches. [ABSTRACT FROM AUTHOR]

The International Committee of the Red Cross (ICRC) has undergone a considerable transformation in the recent decades: from being driven by a pre-dominantly Swiss body of employees, it has become an organization dominated by international staff that hail from all over the world. While the leadership is still firmly in Swiss hands, the transformation has put into question to what extent the ICRC has been able to uphold its foundational values and its special relationship with Swiss culture. The strong ties with Swiss values such as neutrality, independence, consensus, reliability, work ethics, and participation used to be perceived as key factors for the organization's continuity and success in delivering humanitarian aid in a politically more and more divided world. Indeed, from a historical perspective, the Swiss rootedness shaping the organizational culture and identity allowed the ICRC to be successful in its endeavors as a neutral humanitarian actor even in times of crises. This paper, through an analysis of interviews with ICRC staff members of different nationalities, seeks to explore to what extent Swiss values are perceived to still matter in the ICRC, its humanitarian work and how Swiss and non-Swiss staff members interpret these values. The research suggests that there are three distinct narratives, namely, an internationalist, a traditionalist, and a pragmatist. While the internationalist narrative perceives the ICRC's internationalization as a positive development for the organization as a whole, the traditionalist is concerned about detrimental effects on the organizational culture as well as on the credibility of the humanitarian work in the field. The pragmatist narrative recognizes the benefits of strong Swiss values in the ICRC, yet highlights that current developments call for internationalization. The study extends our understanding of the importance of core organizational values and principles in a process of internationalization in order to stay a credible and successful humanitarian actor. [ABSTRACT FROM AUTHOR]

Today's dynamic and highly volatile environment underlines the relevance of cor- porate entrepreneurship in all types of organizations to respond to current and forthcoming forces in a sustainable way. While extant research has identified several factors that impact corporate entrepreneurship, our understanding of how corporate entrepreneurship is impacted by strategic human resource management (SHRM) is underdeveloped. Drawing upon a dataset from 185 HR managers in Eastern Switzerland, Liechtenstein, and Western Austria, this study replicates the study of Wei et al. (2008) and examines the role of organizational culture in the SHRM adoption and implementation process and transfers their research design into the context of corporate entrepreneurship. The results indicate that SHRM impacts the implementation of organizational culture and that different HRM systems affect the implementation of different types of organizational culture. [ABSTRACT FROM AUTHOR]

Good coordination of healthcare services is vital for ensuring health cost efficiency and high-quality care for patients. It is especially important in the context of palliative care as services are often highly fragmented due to a combination of diverse professional groups, organizations, and approaches to care. However, the coordination of services in this field is often evaluated as insufficient. Little is known about the challenges to coordination in this sector in Switzerland. The present study addresses this gap in research by investigating the challenges to coordination at the interface of palliative care services in Switzerland. Interviews (n = 24) with 38 healthcare practitioners working in palliative care in four cantons (Basel-City, Lucerne, Ticino, and Vaud) form the basis for this investigation. The selected cantons not only represent French, Italian, and German language regions of Switzerland but also represent diverse rural, urban, and historical contexts. Expert interviews are analyzed using structural content analysis. Three clusters of challenges to coordination were identified in the data: (1) organizational challenges to coordination, which relate to explicit forms of coordination; (2) relational challenges to coordination; and (3) structural challenges to coordination, which relate to implicit forms of coordination. The study reveals a need for better financial support for coordination in palliative care and a stronger focus on interprofessional coordination in educating professionals in palliative care. Future research on how to further foster good team coordination practices between primary and specialized palliative services merits further investigation. Since these findings are indicative of areas for improvement for coordination at the interface of Swiss palliative care services, they are of particular interest for healthcare practitioners, policymakers, and researchers involved in the evolution of coordinative practice. [ABSTRACT FROM AUTHOR]

The purpose of this qualitative study is (a) to explore and compare the beliefs and values of the stakeholders working in different national dual career environments, and (b) to enhance the understanding of the relationship between athletes' dual career trajectories and the respective environments. Twelve semi-structured interviews with key informants involved in dual career from Switzerland, Denmark, and Poland were used to discussing benefits, obstacles and best practices of their national dual career settings. Interviews were content analysed in a deductive-inductive way using (Schein, E. H. (2010). Organizational culture and leadership (4th ed.). San Francisco, CA: John Wiley & Sons) cultural framework. Besides the differences in support for elite athletes in higher education across the national contexts, the key informants expressed divergent values and attitudes, which were due to their opinions on how dual careers should be organised. These values were found to be linked to the ideologies of the welfare regimes in the given country. Since dual career practices and programmes are based on different underlying basic assumptions in the three contexts studied, divergent dual career trajectories are proposed to athletes as the typical way to combine elite sport and education. Based on the results of our cross-cultural comparison, we assert that culture is not only an influential but also a constituting factor in the development of dual career environments. Thus, we propose a culturally sensitive approach towards the dual career of athletes and invite professionals (e.g. coaches, career advisors, and educational programme leaders) to critically reflect on their contextualised values about how to support dual career athletes. [ABSTRACT FROM AUTHOR]

Background: In Switzerland as in many countries, steady trend is observed in nursing homes to promote writing of advanced directives (ADs). Implementation of ADs reflects the rise in public concern for the persons' right to self-determination and informed decision. The issue of end-of-life conditions is particularly acute in situations with dementia. This article investigates how ADs interventions in nursing homes strive simultaneously to behave in line with the principles of care ethics and with the intention to respond to legally binding instructions. Healthcare to dying residents with dementia in nursing homes is interpreted in light of the Regulation theory. Methods: Nursing home palliative care reference nurses were contacted through questionnaire. One hundred twenty-one addresses were reached, 69 responses were collected, giving a response rate of 57%. In order to deepen the understanding, 10 semi-directive interviews were conducted in 10 different nursing facilities with 12 palliative nurses. Results: Presently, Swiss nursing homes are lacking a model of AD suitable to people with dementia. The study sheds light on dissimilarities in the purpose assigned to ADs' procedure in the different facilities. Discrepancies in end-of-life care practices reveal more the influence of structural and organisational devices specific to each setting than conflicting views on end-of-life care principles. We analyse the interpretation of the Law and its implementation in the participating NHs as compromises that could be accounted for as a form of social regulation. Conclusion: Dementia accentuates the uncertainty inherent to end-of-life trajectories. The implementation of standardised procedures aimed at collecting the wishes of the person deprived of his or her discernment is source of dissonances with regard to the multiple interests involved in these care situations. In this context, the drafting of ADs during end-of-life care in NH correspond to new normative constraints requiring new collective regulation actions. [ABSTRACT FROM AUTHOR]

Background: An in-hospital death is a profound experience for those left behind and has been associated with family members' psychological morbidity. Supporting bereaved family members is an essential part of end-of-life care and includes attentive presence, information-giving, and emotional and practical support. The actual adoption of hospital-based bereavement care, however, remains little understood. Aim: To investigate hospital-based bereavement care provision and associated barriers. Design: Cross-sectional survey using an online questionnaire. Setting/participants: Health professionals (n = 196) from two University-affiliated acute and psychiatric hospitals in Switzerland. Results: The most frequent bereavement services (⩾40%) were viewing the deceased, giving information on available support, and making referrals; the most often named barriers were lack of time and organizational support. Acute care health professionals faced statistically significant more structural barriers (55.1% vs 21.4% lack of time, 47.8% vs 25.9% lack of organizational support) and felt insufficiently trained (38.4% vs 20.7%) compared to mental health professionals (p ⩽ 0.05). Nurses provided more immediate services compared to physicians, such as viewing the deceased (71.3% vs 49.0%) and sending sympathy cards (37.4% vs 16.3%) (p ⩽ 0.01). In contrast, physicians screened more often for complex bereavement disorders (10.2% vs 2.6%) and appraised bereavement care as beyond their role (26.5% vs 7.8%) (p ⩽ 0.05). Conclusion: The study indicates that many barriers to bereavement care exist in hospitals. More research is required to better understand enabling and limiting factors to bereavement care provision. A guideline-driven approach to hospital-based bereavement care that defines best practice and required organizational support seems necessary to ensure needs-based bereavement care. [ABSTRACT FROM AUTHOR]

Speaking up is an important communication strategy to prevent patient harm. The aim of this study was to examine speak up‐related behaviour and climate for the first time in psychiatric hospitals. A cross‐sectional survey was conducted among healthcare workers (HCWs) in six psychiatric hospitals with nine sites in Switzerland. Measures assessed speak up‐related behaviour with 11 items organized in three scales (the frequency of perceived safety concerns, the frequency of withholding voice, and the frequency of speaking up). Speak up‐related climate was assessed by 11 items organized in 3 subscales (psychological safety for speaking up, encouraging environment for speaking up, and resignation). Statistical analyses included descriptive statistics, reliability, correlations and multiple regression analysis, confirmatory factor analysis, and analysis of variance for comparing mean scores between professional groups. A total of 817 questionnaires were completed (response rate: 23%). In different items, 45%–65% of HCWs reported perceived safety concerns at least once during the past four weeks. Withholding voice was reported by 13–25% of HCWs, and speaking up was reported by 53%–72% of HCWs. Systematic differences in scores were found between professional groups (nurses, doctors, psychologists) and hierarchical groups (lower vs higher status). The vignette showed that hierarchical level and perceived risk of harm for the patient were significant predictors for the self‐reported likelihood to speak up. Situations triggering safety concerns occur frequently in psychiatric hospitals. Speaking up and voicing concerns should be further promoted as an important safety measure. [ABSTRACT FROM AUTHOR]

Aims: This study investigates nurse managers' perception of organisational safety culture and team efficacy in managing patient and visitor aggression , and determines the predictors of team efficacy. Background: Patient and visitor aggression is a serious hazard in healthcare. A positive organisational safety culture regarding patient and visitor aggression enhances the safety and staff efficacy in managing patient and visitor aggression. Methods: A cross‐sectional online survey including nurse managers in psychiatric and general hospitals (n = 446) was conducted in Switzerland, Austria and Germany (November 2016–February 2017). Data were analysed descriptively and through binary logistic regression. Results: The key results are as follows: "Working in a mental health setting" was 3.5 times more likely, "consideration of the physical environment" was four times more likely and a "shared organisational attitude" was twice as likely to predict high team efficacy. In comparison to psychiatric hospitals, general hospital managers perceived organisational safety cultures to be less positive. Conclusions: A positive organisational safety culture leads to the perception that teams are more effective at managing patient and visitor aggression. Implications for Nursing Management: Consideration of the physical environment and a positive shared organisational attitude regarding patient and visitor aggression are crucial for high team efficacy. General hospitals could benefit from approaches utilized in psychiatry to enhance staff efficacy in managing patient and visitor aggression. [ABSTRACT FROM AUTHOR]

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The authors believe there is a need for novel ways of enhancing professional judgment and discretion in the contemporary healthcare environment. The objective is to provide a framework to guide a discursive analysis of an ongoing clinical scenario by a small group of healthcare professionals (4-12) to achieve consensual understanding in the decision-making necessary to resolve specific healthcare inadequacies and promote organisational learning. REPVAD is an acronym for the framework's five decision-making dimensions of reasoning, evidence, procedures, values, attitudes and defences. The design is set out in terms of well-defined definitions of the dimensions, a rationale for using REPVAD, and explications of dimensions one at a time. Furthermore, the REPVAD process of application to a scenario is set out, and a didactic scenario is given to show how REPVAD works together with a sample case. A discussion is fleshed out in four real life student cases, and a conclusion indicates strengths and weaknesses and the possibility of further development and transferability. In terms of findings, the model has been tried, tested and refined over a number of years in the development of advanced practitioners at university healthcare faculties in two European countries. Consent was obtained from the four participating students. [ABSTRACT FROM AUTHOR]

Aim(s) To explore nurse managers' behaviours, attitudes, perceived social norms, and behavioural control in the prevention and management of patient and visitor aggression in general hospitals. Background Patient and visitor aggression in general hospitals is a global problem that incurs substantial human suffering and organizational cost. Managers are key persons for creating low-aggression environments, yet their role and behaviours in reducing patient and visitor aggression remains unexplored. Design A qualitative descriptive study underpinned by the Reasoned Action Approach. Method(s) Between October 2015-January 2016, we conducted five focus groups and 13 individual interviews with nurse leaders in Switzerland. The semi-structured interviews and focus groups were recorded, transcribed, and analysed in a qualitative content analysis. Findings We identified three main themes: (i) Background factors: 'Patient and visitor aggression is perceived through different lenses'; (ii) Determinants and intention: 'Good intentions competing with harsh organizational reality'; (iii) Behaviours: 'Preventing and managing aggressive behaviour and relentlessly striving to create low-aggression work environments'. Conclusion(s) Addressing patient and visitor aggression is difficult for nurse managers due to a lack of effective communication, organizational feedback loops, protocols, and procedures that connect the situational and organizational management of aggressive incidents. Furthermore, tackling aggression at an organizational level is a major challenge for nurse managers due to scant financial resources and lack of interest. Treating patient and visitor aggression as a business case may increase organizational awareness and interest. Furthermore, clear communication of expectations, needs and resources could optimize support provision for staff. [ABSTRACT FROM AUTHOR]