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Background: Choosing Wisely is an international movement that stimulates conversations about unnecessary care. The campaign created five recommendations including a statement that less wound care is sometimes better. Aims: The study aims to evaluate nurses' and physicians' adherence to the Choosing Wisely recommendations for acute wound care in the Netherlands and the barriers and facilitators to improve this. Design: This is a mixed methods study using a survey and interviews. Methods: The survey was completed by 171 nurses and 71 physicians from November 2017 to February 2018. A total of 17 nurses and 6 physicians were interviewed. Results: Awareness of the five recommendations ranged from 62% to 89% for nurses and 46% to 85% for physicians. However, up to 15% of the nurses and 28% of physicians were aware but did not adhere to the recommendations. Barriers to adhering were a lack of knowledge, the work environment and perceptions of patients' preferences. Repeated attention, cost‐consciousness and an open culture facilitated the implementation. Conclusion: Although most nurses and physicians were aware of the recommendations, not all adhered to them. Increasing awareness is not enough for successful implementation. A tailored approach that removes the barriers is necessary, such as increasing knowledge about wounds and changing the work environment. Summary statement: What is already known on this topic? Less wound care is sometimes better: cleaning wounds with tap water only, not bathing wounds, using simple bandages and not using bandages on wounds healing by primary intention leads to better wound care for lower costs.It is unknown to what extent this is known and practiced by nurses and physicians and what barriers and facilitators they experience in practicing this. What this paper adds? Although the majority of nurses and physicians were aware of the Choosing Wisely recommendations for acute wounds, not all adhered to them.Awareness is not always sufficient for successful implementation, which requires a broader approach that targets the barriers. The implications of this paper Implementation of these recommendations can be improved by increasing knowledge about wounds and wound care, changing the work environment, and verifying the patient's presumed preferences regarding wound care. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to delineate the relationships between actors and contextual factors associated with the development of the advanced practice role in Catalonia. Methods: A complementary data analysis was conducted based on the social network analysis (SNA) method. The primary study design was qualitative, descriptive and explanatory. Participants from diverse perspectives of practice, organization and external environment were engaged to participate in semi‐structured focus groups. Data collection was conducted between March and May 2016 in Catalonia, Spain. Participants were asked to report on various dimensions of the role development context: understanding of the role, felt needs, perceived outcomes, barriers and facilitators. Results: Primary data analysis performed for 44 participants identified 71 related contextual factors associated with role development. Complementary network analysis revealed multiple relationships and agreements among participants and context‐related themes. Professional roles and disciplines clustered around topics show consensus and the significance of topics. Conclusion: Understanding the level of interactions and consensus among participants and contextual factors will ultimately allow better insight into how complex contexts influence the development of advanced practice nursing in healthcare organizations. Significant, consensual contextual factors should be used to influence further development and implementation of new roles that affect patient care and outcomes. Summary statement: What is already known about this topic? Comprehensive understanding of context at various levels should generate greater knowledge about what affects advanced practice role development locally and globally.What this paper adds? Findings could help organizations to make sense of the full dimension of context and to predict or act on development of advanced practice nursing roles.The implications of this paper: Significant, consensual contextual factors should be used to influence further development and implementation of new roles that affect patient care and outcomes. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this project was to examine the role of cultural differences in shaping the management of diabetes among Ethiopian immigrants living in Israel. Methods: A qualitative, in‐depth study involved semistructured interviews with 16 Ethiopian immigrants with diabetes living in Israel. The interviews were audio‐recorded, transcribed and translated into Hebrew, if necessary. The authors each identified themes in the responses and then through discussion came to a consensus about the most significant ones and how to categorize them. Results: A main theme was revealed structuring the participants' perception of diabetes: an oscillation between a familiar narrative, associated with traditional life in Ethiopia, and a foreign one. Five additional subthemes were also identified as an oscillation about the causes of disease, between collectivism and individualism, between accessible food and a balanced diet, between relying on bodily sensations and prescribed treatment and between culturally oriented and translated knowledge. Conclusion: The participants understood that they could be adversely affected both by the changes in lifestyle following their move and by adhering to the traditional norms. They agreed that professional liaisons and peers who have successfully managed their diabetes could help provide a bridge between the narratives. Summary statement: What is already known about this topic? Diabetes is a worldwide epidemic where immigrant populations are more likely to suffer from it.Language and cultural barriers pose a challenge to immigrants when accessing healthcare.Among immigrants, diabetes‐related distress is often accompanied by distress due to the challenges of immigration and acculturation.What this paper adds? Among Ethiopian immigrants, there exists a division between two main narratives about their illness and the way it is treated: the familiar and the foreign.Ethiopian communities play an important role in the treatment of an individual's illness, for better or worse.Translation alone is not sufficient to make language accessible; it must be combined with a medically‐culturally tailored approach.The implications of this paper: An understanding of the oscillations between narratives that Ethiopian immigrants experience is important for promoting person‐centred care for this population.During individual and group training, nurses should include Ethiopian immigrants who have successfully managed their diabetes.Nurse managers should ensure that their clinic has professional liaisons not only for translation but also for the provision of culture‐based health care. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to explore the reasons for and experiences of patients who make an unplanned return visit to the emergency department. Design: This study forms the qualitative phase of a larger explanatory sequential mixed methods study and is informed by interpretive description. The paper was prepared using the consolidated criteria for reporting qualitative research. Methods: Semi‐structured patient interviews were conducted over a 3‐month period (July–September 2021). Data were analysed using reflexive thematic analysis. Results: Interviews from 13 participants generated findings related to experiences at and following their initial visit that contributed to their decision to return to the emergency department. Four themes were developed: (1) Patients experience barriers to feeling heard and having their concerns addressed; (2) Patients have little choice but to place their trust in clinicians; (3) Patients unexpectedly experience persistent symptoms which cannot be managed at home; and (4) Patients develop a sense of urgency about having their condition treated. Conclusion: A negative experience at the initial ED visit may have dual conflicting impacts. It can contribute to patients' perceived need for a return visit because they are ill‐equipped to manage their condition at home, and it can also contribute to their initial reluctance to return to the ED when symptoms persist. Nurses and other clinicians working in ED need to actively build patient's experiential trust through clear communication, timely consultation and shared decision‐making at discharge, which in turn can increase patient's confidence and capability to self‐manage their condition. This study adds to the current body of literature about return visits by highlighting that a more positive experience of ED may assist patients to make better‐informed decisions about when and how to seek treatment and minimize unnecessary and unplanned return visits. Whilst not an intended topic for exploration in this study, the COVID‐19 pandemic influenced patients' experiences at both initial and return ED visits and limited their ability to access primary healthcare options. These experiences contributed to patients' decisions to make a return visit. [ABSTRACT FROM AUTHOR]

Aim: The aim of this research was to provide an in‐depth study about the life experiences of patients with inflammatory bowel diseases. Methods: The phenomenological (hermeneutic) method was used to analyse data. The data were collected between March 25 and July 1, 2019. A homogeneous group of 25 patients were included as participants by purposeful sampling methods. Interviews were conducted in the hospital patient‐education room. Results: The results of this study emphasize the importance of understanding the fears, worries, difficulties and life experiences of patients with inflammatory bowel diseases. Three main themes were identified: a flare phase of the disease, a remission period and coping behaviours. Study findings included the experiences of social isolation; inability to perform daily activities of living and to work; stress in the flare phase of the disease; concerns about the future in the remission phase and physical and spiritual strategies used for coping. Conclusion: Coping with the physical symptoms and emotional difficulties of inflammatory bowel diseases can prevent patients from living a normal life. The results of this article highlight the importance of understanding the fear, anxiety, difficulties and life experiences of these patients. Summary statement: What is already known about the topic? Some research on inflammatory bowel disease exists, but patient experiences differ.IBD patients may not be able to maintain a normal life due to the effects of the disease. What does this paper add? It enables nurses to know and understand the life experiences of IBD patients. The implications of this paper: Knowing and understanding the experiences of IBD patients, nurses can provide personalized care and support tailored to each patient's needs and concerns [ABSTRACT FROM AUTHOR]

Background: Multiple studies focus on the experiences of visiting students from high resource regions that participated in clinical placements in lower resource countries but less focus on the experiences of the educators accompanying students. Aim: The purpose of this study was to explore the experiences of educators during an international clinical placement of nursing students in a country in West Africa. Methods: We implemented a focussed ethnographic design. We purposively sampled educators who accompanied students on an international clinical placement. Data collection from 2018 to 2019 consisted of in‐depth individual interviews. We utilized Roper and Shapira's (2000, 10.4135/9781483328294.) data analysis process, which includes coding keywords, identifying patterns and theorizing. Findings Three themes emerged from the data: rewards in accompanying students, challenges experienced and the need for mentoring and continuous support. Educators found it rewarding to see growth in students, how students developed as global citizens, how students developed critical thinking and problem‐solving skills and create lifelong friendships. Conclusion: Educators who accompany nursing students to international clinical placement experience valuable learning and challenging issues. Educators must navigate, support and advance student learning when on an international placement. It is crucial to have adequate institutional support from both the home and host country. Summary statement: What is already known about this topic? Multiple research studies focus on the experiences of visiting students from high resource regions that participated in clinical placements in lower resource countries but less focus on the experiences of the educators accompanying students.Multiple rewards exist for educators who accompanying students on an international clinical placement.Nurse educators are expected to mentor students and provide continuous support. What this paper adds? The need for continuous contact between the educators and the home faculty is highlighted.Mentoring topics to 'soften' the impact of the challenges experiences by educators are identified; this includes regular debriefing with senior educators at the home and host university.The importance of working with the host during the predeparture period, as well as report on arrival and have regular meetings during the placement to ensure that both the needs of the visiting student group and the host are met, is highlighted. The implications of this paper: (how findings influence or can be used to change policy/practice/research/education) A well‐developed support system and debriefing sessions are necessary for the accompanying faculty member.Research is needed to develop the content of a mentorship model/framework for junior academics that plan to accompany students on international clinical placements to low and middle‐income countries.Additional research is needed on the value of pairing a junior academic with an experienced mentor to answer questions as they arise related to day‐to‐day challenges and student related questions during the international clinical placements. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate acceptability, efficiency, and quality of a new digital care management system in a residential aged care home (RACH). Background: Improving care quality and efficiency in RACH, while simultaneously upgrading data management, is a priority for communities and governments. Design: Participatory action research with mixed methods data collection was employed to evaluate a digital care management system implemented at a 169‐bed RACH. This paper reports qualitative findings of the 2‐year evaluation. Methods: Qualitative data were collected using focus groups with residents, visitors, nurses, managers, care workers, and consultants; resident/visitor and staff hallway interviews and responses to open‐ended questions in online staff surveys. Data were analysed thematically under the four predetermined study objectives. Reporting adhered to COREQ guidelines. Results: 325 data captures from 88 participants, over seven data sources were coded. Findings indicate that the system was acceptable to both residents and staff due to perceptions of time‐saving and improved quality of care. Increased efficiency was perceived through timeliness as well as reduced time spent retrieving and documenting information. Quality of care was improved through care scheduling individualised to resident needs, with reminders to avoid missed care. Relatives were reassured and activities were scheduled to loved one's preferences. The co‐design implementation process was successful through commitment to quality from leadership teams and prioritising the focus on the holistic needs of the residents. Conclusion: A strong emphasis on co‐design with care staff in developing and implementing the digital care system contributed to a system that supported nursing and care work, facilitated reporting and documentation, and improved resident care and well‐being including identification of missed care. Relevance to Clinical Practice: Nurses, carers, administrators, and advocates can support the co‐design creation of information systems that suit the workflow of an organisation and keep the focus on individualised models of care provision. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Research indicates many clients using mental health services have trauma histories. Consequently, mental health professionals must be aware of the impact of trauma and of how they can avoid retraumatizing service‐users. Care delivered with this awareness is known as trauma‐informed care (TIC).There is little research on attitudes towards TIC. To date, only one study explored these attitudes among MHNs exclusively. Additionally, a richer understanding of TIC attitudes using methods like in‐depth interviews is needed. It is unclear whether knowledge of TIC results in more favourable attitudes. What this paper adds to existing knowledge?: MHNs in this study had little knowledge of TIC but expressed overall favourable TIC attitudes. Traumatic histories were not appreciated as causes of challenging behaviour. On rehabilitation wards, clients come to be perceived as family members and this makes it harder for MHNs to not take challenging behaviour of clients personally. MHNs face work‐related traumas which interfere with their ability to provide TIC. What are the implications for practice?: Findings of this study can be used to guide plans to implement TIC in psychiatric hospitals. Policymakers are called to appreciate that ensuring MHN well‐being on the workplace will facilitate their delivery of TIC. TIC training initiatives for MHNs must stress the importance of acknowledging traumatic histories as causes of challenging behaviour and of maintaining professional boundaries with long‐term clients. This would benefit service‐users by ensuring MHNs are more trauma‐informed. More research on attitudes towards TIC among MHNs is needed. Introduction: Quantitative studies exploring trauma‐informed care (TIC) attitudes have not used samples made up exclusively of mental health nurses (MHNs). Qualitative methods were sparingly used. Aim: To examine nurses' TIC attitudes at a psychiatric hospital. Method: A mixed‐method design was used. One hundred and thirty‐six MHNs completed the Attitudes Related to Trauma‐Informed Care scale. Data were analysed using inferential statistics. A focus group interview among ten MHNs ensued. Thematic analysis was used. Results: MHNs demonstrated favourable TIC attitudes. Ambivalent attitudes for the subscale "Causes" were identified. MHNs employed for less than 5 years at the hospital and those in acute settings displayed more favourable attitudes on some subscales. Three themes "Awareness," "Unhealthy boundaries" and "Inhibition" emerged from qualitative analysis. Discussion: Challenges uncovered in the provision of TIC include the unacknowledged impact of trauma on challenging behaviour among MHNS, the influence of blurred professional boundaries with long‐term clients on the cycle of perpetuated trauma identified by previous research and MHNs work‐related traumas. Implications for practice: Identified challenges to TIC integration among MHNs can facilitate the implementation of TIC in hospitals. TIC educational packages for MHNs should acknowledge traumatic histories in the aetiology of challenging behaviour and stress the importance of maintaining professional boundaries with clients. [ABSTRACT FROM AUTHOR]