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Accessible Summary: What is known on the subject: Most health professionals working in psychiatric care will experience adverse events (AE) such as service user suicide or violence, during their careerNorway lacks measures to capture potential iatrogenic injuries, such as risk assessment measures, to evaluate patient records for AEs in both inpatient and outpatient psychiatric clinics in hospitals What the paper adds to existing knowledge: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translationWe have incorporated the understanding of health professionals and service users; to bring together the lifeworld of the patient with the professional definition of AEs, triggers and risk areas of AEs in a psychiatric context. The service users' experiences resulted in modifications to the tool. What are the implications for nurses: Applying the 'Global Trigger Tool—Psychiatry' in Norway and Sweden can help mental health nurses to prevent iatrogenic harm and reduce the occurrence of AEs through the identification of potential triggers.Implementing 'Global Trigger Tool—Psychiatry' might help mental health nurses to improve patient safety in Norway and Sweden. Introduction: There is little consensus on cross‐cultural and cross‐national adaptation of research instruments. Aim/Question: To translate and validate a Swedish research tool (GTT‐P) to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals in the process. Method: The GTT‐P, designed to identify events in patient records that were triggers for adverse events, was translated to Norwegian using a cross‐cultural adaptation approach. This involved two focus groups with clinical staff, one of which involved service users, and a joint discussion at a Dialogue Conference to generate consensus on the definition of the triggers of potential adverse events identifiable in patient records. Results: We highlight both the differences and commonalities in defining the nature of risks, the adverse events and the triggers of such events. The Dialogue Conference resulted in three modifications of the tool, based on service users' experiences. Service user involvement and co‐production was essential for both the translation and adaptation of the research instrument. Discussion: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translation. This approach enables a more nuanced understanding of potential risks within a psychiatric context as it engages differences in the care delivery. Applying the GTT‐P in hospital‐based psychiatric care might help to identify processes that need to be changed in order to promote patient safety and a safer work environment for mental health nurses. Implications for practice: When translating and validating the GTT‐P from Swedish to Norwegian, we have considered the knowledge and experiences of both service users and health professionals. The application of the GTT‐P can promote greater patient safety in hospital settings. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Nurses' observation of patients in seclusion is essential to ensure patient safety.Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy.Direct observation and video monitoring are widely used in observing patients in seclusion.Coercive practices may cause distress to patient‐staff relations. What the paper adds to existing knowledge?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients.Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness.Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized.Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion.Pixellating the video camera would give a sense of privacy and dignity. What are the implications for practice?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs.A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision.Viewing panels (small window on the seclusion door) are important in establishing two‐way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients.Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness.More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations.Patient education is paramount. Providing prior information to patients using a co‐produced information leaflet might reduce their anxiety and make them feel safe in the room.When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. Introduction: A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim: The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method: A retrospective phenomenological approach, using semi‐structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results: Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion: The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice: Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion. [ABSTRACT FROM AUTHOR]

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: To assess the effectiveness of an unsupervised home‐based pulmonary rehabilitation with self‐management program in patients with chronic obstructive pulmonary disease (COPD). Background: A few recent studies have shown that unsupervised home‐based pulmonary rehabilitation can improve the clinical outcome of patients with COPD. More studies are needed to prove its benefits. Design: This study used a quasi‐experimental design. Methods: Seventy‐two admitted COPD patients were assigned to experimental group or control group through purposeful sampling. Data were collected from March 2016 to November 2017 in the Thoracic Intensive Care Unit of a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self‐Efficacy Scale and the Clinical COPD Questionnaire were measured before education and at the first, second and third months after discharge. Results: The Medical Research Council dyspnea scale and COPD Self‐Efficacy Scale results in the experimental group were significantly improved compared with the control group in the third month after discharge. The Clinical COPD Questionnaire score continued to improve in both groups in the third month after discharge, and there was no difference between the two groups. Conclusion: A short‐term unsupervised home‐based pulmonary rehabilitation with self‐ management program had significant benefits for patients with COPD. The long‐term effects need to be confirmed. Summary statement: What is already known about this topic? The literature emphasizes the importance of alternative supervision of home‐based pulmonary rehabilitation rather than center‐based pulmonary rehabilitation for patients who find this inconvenient to access.Few studies have shown that unsupervised home‐based pulmonary rehabilitation can improve the clinical outcome of patients with chronic obstructive pulmonary disease (COPD). What this paper adds? This study demonstrates that a short‐term unsupervised home‐based pulmonary rehabilitation with self‐management program can improve dyspnea during physical activity, self‐care efficacy in certain activities and quality of life after discharge in patients with COPD. The implications of this paper: The findings of this study can be used as the basis for providing a short‐term unsupervised home‐based pulmonary rehabilitation with self‐management program for patients with COPD after discharge.We recommend that patients with COPD undergo unsupervised home‐based pulmonary rehabilitation with self‐management for 3 months after discharge, especially if regular hospital visits for this are not convenient.The effect of longer‐term unsupervised home‐based pulmonary rehabilitation can be further studied in the future. [ABSTRACT FROM AUTHOR]

Aim: To identify culturally related stressors that influence self‐care in Chinese older adults with multiple chronic conditions. Background: Effective self‐care can improve health outcomes for chronic conditions, but implementing self‐care is challenging. Individuals with multiple chronic conditions face even more self‐care complexity than those with single chronic conditions, generating additional stressors. Although stressors have been found to negatively influence self‐care in multiple chronic conditions, the role of culture in generating stressors has been neglected. Design: This paper reports on the qualitative component of a larger mixed‐methods study. Two free‐response items in a survey were used to identify culturally related stressors that influence self‐care. This report adhered to the SRQR guideline checklist. Methods: Data were collected between January and April 2022. One hundred and thirty‐eight free text responses asking participants to identify stressors that influenced their self‐care effectiveness were analysed sequentially using deductive content analysis and thematic analysis. Results: Findings from deductive content analysis largely confirmed published work in Western literature on stressors complicating self‐care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. Conclusion: Chinese older adults with multiple chronic conditions identified a wide range of stressors that impacted their day‐to‐day self‐care. This study provided valuable insights into culturally related stressors in older adults with multiple chronic conditions. Findings deepened our knowledge of cultural influences on the success of self‐care in older adults with multiple chronic conditions, suggesting the potential for reaching populations across different cultures and regions. Implications for the profession and/or patient care: Stressors that might influence self‐care ability are important for nurses to assess in people with multiple chronic conditions. The design of self‐care interventions should take a culturally tailored intergenerational family‐centred approach to help mitigate the impact of stressors and ultimately improve patient outcomes. Impact: What problem did the study address?Stressors documented in older adults with MCCs have all been generated from research with Western populations. China is now home to the largest population of older people in the world. Understanding the influence of culturally relevant stressors on self‐care in Chinese older adults with MCCs is lacking.What were the main findings?Findings from deductive content analysis largely confirmed published work in Western literature on stressors that complicated self‐care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors in older adults with MCCs in China: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems.Where and on whom will the research have an impact?The research will have an impact on guiding nurses' assessment of culturally relevant stressors' impact on self‐care for older adults with MCCs. In addition, findings could inform research and policy development to aim at mitigating the impact of culturally based stressors on self‐care. Reporting Method: This study adhered to the Standards for Reporting Qualitative Research (SRQR) guideline checklist. Patient or Public Contribution: During the member‐checking process, the validation of findings for accuracy was carried out by 10 participants, who also found resonance between these findings and their own experiences. [ABSTRACT FROM AUTHOR]

Aims: To codesign a cancer personalised activity and lifestyle tool (CAN‐PAL) based on an existing tool. To help cancer care workers support people affected by cancer to plan and integrate physical activity into lifestyles. Design: Mixed‐methods codesign study. Methods: Phase 1: Focus groups with people affected by cancer (n = 10) or interviews (n = 2) to discuss suitable physical activities and adaptation of the existing tool. Data were recorded, transcribed and analysed thematically. Themes informed the design of the prototype CAN‐PAL and user guide. Phase 2: Healthcare professionals considered the potential use of the CAN‐PAL prototype and completed an online survey including the system usability scale and free text responses. Results: Phase 1: Identified suitable physical activities and four themes were identified including: Capability, benefits, barriers and resources which informed the prototype CAN‐PAL and user guide. Phase 2: The user survey was completed by 12 healthcare professionals. Median (range) system usability scale was 80 (50–95) (best score 100), scores >68 indicate good or better usability. Themes from the free text comments included strengths, amendments, considerations and limitations. Results were used to finalise CAN‐PAL and the user guide. Conclusion: The codesigned CAN‐PAL tool had good usability. Further work is needed to evaluate the impact of CAN‐PAL on activity levels and behaviour in people affected by cancer. Relevance to Clinical Practice: People affected by cancer need support to undertake physical activity. The purpose of CAN‐PAL is to assist cancer care workers to support people affected by cancer to plan and integrate physical activity into lifestyles. Patient or Public Contribution: Public partners considered the findings from Phase 1 and 2 and informed the design of the prototype, final CAN‐PAL and user guide and coauthored the paper. Reporting Method: The study adhered to relevant EQUATOR guidelines; the study was reported according to the COREQ checklist. [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]

Aims: We aimed to investigate the perspective of primary care nurses on their role with patients who have chronic cardiovascular disease and to identify cultural elements shared by nurses caring for people with chronic cardiovascular disease. In primary care, the role of the nurse is essential to promote self‐efficacy in cardiovascular self‐care. Individuals with chronic cardiovascular disease need to integrate the disease into their life, together with the health recommendations for management and follow‐up. Methods: A qualitative, focused ethnographic study was conducted. Purposeful sampling was used to include nurses who were working in primary care during the study. Data collection took place between 20 January and 20 May 2014 and consisted of semi‐structured interviews. A thematic analysis was applied using the data. Results: Eleven participants were included. Cardiovascular care forces nurses to reflect on their identity and role in primary care. The relationship between the nurse and people with chronic cardiovascular disease is a complex process, which may cause nurses to feel a sense of failure and monotony in their work. Conclusions: Our findings may help to understand the role of the nurse and the care provided in patients with chronic cardiovascular disease. Summary statement: What is already known about this topic? Primary care nursing is necessary for the improvement of cardiovascular risk factors.Chronic cardiovascular patients need training in self‐care.The organizational culture confers different forms of care to patients. What this paper adds? The vision of the socio‐cultural role of the family and community nurse is shown regarding cardiovascular prevention.Information is provided on the differentiating approach to chronic cardiovascular patients in primary care.Our study reflects the influence of routine care in nursing consultations, and what it entails to provide improved nursing care in cardiovascular patients. The implications of this paper: These findings can be used to understand the need to change the focus of nursing care in cardiovascular prevention.The implementation of a follow‐up protocol for the care of cardiovascular patients can improve patients' self‐care and reduce monotony in the nursing consultation.Further training and research is necessary regarding comprehensive chronic cardiovascular care within primary care services. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: It is known that people with a diagnosis of borderline personality disorder often experience crises in their mental wellbeing.There is little evidence about the approaches of mental health nurses in community‐based crisis teams when working with people with a diagnosis of BPD. What the paper adds to the existing knowledge?: This paper highlights that limited resources, work‐patterns and issues of stigma present challenges to delivering recovery‐oriented care.The paper highlights that nurses typically try to navigate the challenges to continue to provide individualized care, though their self‐assessment is that this is with mixed success. What are the implications for practice?: The findings suggest that support is needed to develop brief interventions specific to teams working with people with a diagnosis of BPD who are at a point of crisis. Introduction: People with a diagnosis of borderline personality disorder (BPD) are often in contact with mental health services at a point of crisis, and in the UK, this includes Crisis Resolution Home Treatment teams (CRHTT). There is a drive for services to be recovery orientated; however, there is little evidence about the degree to which community services achieve this for people with a diagnosis of BPD when in crisis. Research Aim: To understand the perceptions held by CRHTT clinicians about their provision of recovery‐orientated acute care, for people with a diagnosis of BPD. Method: From a purposive sample of a single CRHTT, seven registered mental health nurses were interviewed and Braun and Clarke's thematic analysis framework was used to interpret the data. Results: Five themes emerged: person‐centred care; the timing is wrong; inconsistent staffing; the risks are too great; and BPD as a label. Discussion: The results demonstrate tensions between a drive to deliver person‐centred care and a range of challenges that inhibit this, with the possibility of reframing a recovery approach as "recovery‐ready". Implications for Practice: A whole‐system approach is required to enable a consistent recovery‐oriented approach, but research is also needed for brief interventions specific to this context. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Physical restraint is widely used in the elderly at home, and cognitive impairment is an important risk factor. Family caregivers of people with dementia are the main decision makers and implementers of physical restraint at home.Most people with dementia in China receive home care, and family caregivers face enormous care and moral pressures influenced by Confucian culture.Current research on physical restraints focuses on quantitative analysis of its prevalence and reasons within the institutions. There is little research on how family caregivers perceive physical restraints in home care context, especially under Chinese culture. What the paper adds to existing knowledge?: Many family caregivers face approach – avoidance conflict and moral dilemmas when making decisions to restrain, and they make difficult choices in these dilemmas.In China, family caregivers are influenced by many unique factors, including traditional Confucian culture, family affection, and rural home environment.Inadequate laws and policies provide the ground for abuse of physical restraints, and family caregivers rarely consider legal and policy restrictions when using physical restraints. What are the implications for practice?: With limited medical resources, nurse‐led dementia management is the hope to reduce physical restraints in home.Mental health nurses need to assess for the appropriateness of physical restraints associated with psychiatric symptoms in people with dementia.At both organizational and community levels, improving effective communication and relationships between professionals and family caregivers are important to address. Improvements in this context require education and time for staff to develop skills and experience which is necessary to provide family caregivers with ongoing information and psychological support within their communities.Considering Confucian culture will be of value for mental health nurses working in other countries where there are Chinese communities to better understand perceptions of family caregivers. Introduction: The use of physical restraints is a common practice in home care. Family caregivers face care‐related and moral pressures due to the influence of Confucian culture in China. The use of physical restraints in the Chinese cultural environment may differ from the use of such restraints in other cultures. Scientific Rationale: Current research on physical restraints focuses on quantitative analysis of its prevalence and reasons within the institutions. However, there is little research on how family caregivers perceive physical restraints in home care context, especially under Chinese culture. Aim: To explore the perceptions of family caregivers on physical restraints in people diagnosed with dementia receiving home care. Method: A descriptive, qualitative study of Chinese family caregivers of people diagnosed with dementia in home care. Framework method analysis was adopted using the multilevel socio‐ecological model. Results: Beliefs about benefit lead to a dilemma for family caregivers. Cherishing family's affection encourages caregivers to reduce physical restraints, but lack of help from family members, professionals and the community forces them to restrain their loved ones. Discussion: Future research should explore the complex issue of culturally specific physical restraints decisions. Implications for Practice: Mental health nurses must receive education regarding the negative outcomes of the use of physical restraints for family members of people diagnosed with dementia. A more liberal approach to mental health and relevant legislation, which is an emerging global phenomenon that is currently in an early phase of development in China, grants human rights to people diagnosed with dementia. Effective communication and relationships between professionals and family caregivers can contribute to the establishment of a dementia‐friendly community in China. [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]

Accessible Summary: What is known on the subject?: Anti‐, peri‐ and post‐natal depression negatively affect the relationship between mothers and their children.At least half of cases of anti‐, peri‐ and post‐natal depression were missed and underdiagnosed by healthcare professionals (HCPs) including doctors, nurses and midwives.Previous qualitative studies considered women's experiences relating to anti‐, peri‐ and post‐natal depression separately from studies looking at the views of HCPs.There is a lack of research in Middle Eastern countries, despite the high prevalence of anti‐, peri‐ and post‐natal depression. What does this paper add to existing knowledge?: This is the first qualitative study investigating the experiences of both HCPs and service users regarding anti‐, peri‐ and post‐natal depression from the Middle East perspective, particularly in Oman.This study revealed that anti‐, peri‐ and post‐natal depression has been neglected in primary healthcare systems in Oman.The study explored many barriers and facilitators which have been identified by both HCPs and patients in identifying and managing anti‐, peri‐ and post‐natal depression in the primary healthcare system. What are the implications for practice?: Nurses, midwives and doctors should develop an empathic screening procedure that allows for the discussion of mental health concerns and help‐seeking behaviours with their patients.Training nurses and midwives in motivational interviewing, routinely screening mothers with any depressive symptoms, as well as providing public education programmes to increase mental health awareness, resources and access to a variety of mental healthcare alternatives, could be successful in recognizing and managing anti‐, peri‐ and post‐natal depression. Introduction: Anti‐, peri‐ and post‐natal depression is known to affect the relationship between infants and their mothers adversely. Previous studies have identified barriers and facilitators, reported by women and HCPs, related to the identification and management of anti‐, peri‐ and post‐natal depression. However, these studies considered the experiences of women separately from those of the healthcare professionals, even though their experiences of anti‐, peri‐ and post‐natal depression are interconnected. Additionally, there is a lack of research among people living in the Middle East, including Oman, which has one of the highest rates of anti‐, peri‐ and post‐natal depression globally. Aim: This study aimed to explore the views and experiences of HCPs and service users relating to anti‐, peri‐ and post‐natal depression from the Middle East perspective. Method: A qualitative descriptive study using semi‐structured interviews was conducted. This study took place at the Family Medicine and Community Clinic at the University Hospital and three selected primary healthcare centres in Muscat, between May 2020 and February 2021. Purposive sampling was used: 15 HCPs with 2–20 years of clinical experience in anti‐, peri‐ and post‐natal primary care and 13 pregnant patients plus 2 post‐birth patients were interviewed. Audio‐recordings were transcribed verbatim, and the anonymized transcripts were then entered into the qualitative data management software, NVIVO 12. Results: A thematic approach was used to analyse the data. Four themes were identified in the data, namely: (1) making sense of anti‐, peri‐ and post‐natal depression; (2) how to deal with anti‐, peri‐ and post‐natal depression; (3) barriers to addressing anti‐, peri‐ and post‐natal depression in primary anti‐, peri‐ and post‐natal care settings and (4) bridging the gap: facilitators in detecting and managing anti‐, peri‐ and post‐natal depression. Conclusions: Improving the identification and management of anti‐, peri‐ and post‐natal depression in primary healthcare systems will require a whole‐system approach with interventions at the patient, practice and comprehensive primary care team levels. Implications for Practice: The findings suggest implications for improving the identification and management of anti‐, peri‐ and post‐natal depression including an increased emphasis on mental health by enhancing the routine screening of mothers during the anti‐, peri‐ and post‐natal period, clearer referral systems, improving resources, providing training with regard to mental health and improving communication skills. [ABSTRACT FROM AUTHOR]

Background: The first wave of the COVID‐19 pandemic caused a shortage of health care staff, forcing the hiring of senior nursing students. Aims: To describe the psychosocial impact and coping strategies used by nursing students during the first outbreak of the COVID‐19 pandemic and to understand the coping strategies they employed. Method: A qualitative exploratory study was conducted, based on Sandelowski's proposal. Purposive sampling was carried out to recruit 18 students hired during the pandemic. The students were interviewed between 18 March and 15 June 2020. Semi‐structured interviews were conducted using a digital platform. An inductive thematic analysis was performed. Findings The students lived alone and isolated during their contract to protect their cohabitants from possible contagion. The impact of working during the pandemic leads to experiences of stress, insomnia, nightmares and anxiety. Nursing students coped with the emotional burden through mental disconnection and the support of co‐workers and family members. Conclusion: Psychological support and tutoring should be provided by health centres. In addition, in these special circumstances, universities should adapt the training provided. Summary statement: What is already known about this topic? In Spain, as in many other countries, a state of alarm was declared during the first wave of COVID 19. The Ministry of Health established measures to manage the health crisis and contain infections, including the hiring of senior nursing students to work.Working conditions had a high physical and psycho‐emotional impact on health professionals.The lack of prior experience of students in the context of a pandemic and how they enter the workforce could make it difficult to develop adequate coping strategies, enhancing the presence of mental and emotional disorders.What this paper adds? During their work, and in order to avoid contagion, the students lived apart from their families, limited their contacts and were isolated in refuge in rooms or homes. Upon entering the home, they showered, changed clothes and disinfected any surfaces they touched.The students described feeling stressed due to the lack of protective equipment and staff, heavy workloads and lack of knowledge regarding the unit and work protocols. They worried about making mistakes, doing their jobs poorly or being unable to help patients. When they got home, they had episodes of insomnia and anxiety.Faced with this situation, students used mental disconnection or distraction as coping strategies. Others shared their fears and uncertainties with other health care professionals and family members, seeking support and understanding. Other times, they tried to be strong and hide their suffering.The implications of this paper: The incorporation of students as relief for professionals in a situation of extreme need is not exempt from significant psychosocial risks and should include monitoring programs and psychological evaluation.The hospitals should monitor and mentor students to facilitate their adaptation to similar situations in the future.The students required greater support from the administration, including offering them housing where they could live away from family and relatives. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Nurses' experience challenges of managing risk, boundaries and emotional responses when working with people who self‐harm.Adolescent self‐harm is a growing problem, with rates increasing in the UK.Existing research has failed to differentiate and specifically explore nurses' experiences of working with adolescents who self‐harm. What the paper adds to existing knowledge?: This paper provides an understanding of the impact of working with adolescents who self‐harm in the community on nurses, and highlights recommendations to improve staff and patient experiences and care.Community CAMHS nurses experience personal and professional conflicts when working with adolescents who self‐harm. They experience interpersonal conflicts balancing the needs of adolescents with the needs of the systems around them, and intrapersonal conflicts regarding experiencing mixed emotions, and balancing the care they want to provide with service pressures.Community CAMHS nurses experience feelings of self‐doubt and shame due to their emotional responses, self‐care behaviours, personal and professional boundaries. They use their feelings of pride, honour and enjoyment to manage these experiences. What are the implications for practice?: Nurses working in CAMHS should be provided with more opportunities for reflective practice and self‐care, to enable reflection and learning regarding the emotional impacts and working with systems. Managerial investment is required to facilitate this.Nurses working with adolescents who self‐harm in CAMHS could benefit from training regarding understanding and managing self‐harm (such as dialectical behavioural therapy), and effectively working with families and people who support these adolescents (such as attachment‐based family therapy). Introduction: Nurses often work in the community with adolescents who self‐harm. There is a lack of qualitative research exploring nurses' experiences of working with adolescents who self‐harm. Aim: This study aimed to gain an understanding of community nurses' experiences of working with adolescents who self‐harm. Method: Ten semi‐structured interviews were conducted with registered nurses working in Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom (UK). Results: Data were analysed using interpretative phenomenological analysis (IPA). Two superordinate themes were identified, each consisting of two subordinate themes: personal and professional conflicts, describing interpersonal and intrapersonal conflicts the nurses experienced working with adolescents who self‐harm and the systems around them, and personal and professional development, outlining processes of management of conflicts and development. Discussion: Nurses feel conflicted about working with adolescents who self‐harm within the context of working with systems surrounding the adolescent. They report positive experiences, which they use to reframe their experiences and feelings of shame as a result of their emotional responses, self‐care behaviours and personal and professional boundaries. Implications for Practice: Nurses working with adolescents who self‐harm would benefit from training, reflective practice and self‐care. CAMHS managers should encourage and invest in these areas. [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]

Accessible Summary: What is known on the subject?: The impacts of racism on health are well documented and are greater for mental than for general health.Mental health professionals are well positioned to help dismantle racism and structural barriers compromising optimal patient care. What the paper adds to existing knowledge: We describe a systematic and orderly way to identify factors that contribute to entrenching racism as the status quo or that help to uproot it.By incorporating a racial equity lens, we can better understand daily racism and inform the optimal antiracist actions most relevant to an inpatient psychiatric setting. What are the implications for practice?: Our two‐domain/six‐theme model may serve as a rubric for individuals to engage in structured self‐reflection, for organizations in auditing or programmatic evaluation, or as scaffolding for difficult but frequently elided conversations.The unique strengths of a mental health environment can be harnessed toward the elimination of racism and racist practices in clinical care and in the workplace Introduction: It is well documented that racism plays a role in health care access and outcomes. However, discussions about racism in the inpatient psychiatric workplace are generally avoided. To address this gap, we incorporated a racial equity perspective into a qualitative study to better understand daily racism, its impact on patients and staff, and to inform optimal antiracist actions most relevant to inpatient psychiatric settings. Aim/Question: We sought to identify factors that may contribute to or deter from racism to inform interventions to sustain a psychologically supportive environment for patients and staff. Methods: We conducted semistructured interviews using a purposive sample of 22 individuals in an acute child psychiatric inpatient service. We analysed transcripts using thematic analysis guided by a constructivist grounded theory conceptual framework. Results: We identified two countervailing processes: (1) Entrenching—factors that sustain or increase racism: Predisposing, Precipitating, and Perpetuating and (2) Uprooting—factors that rectify or reduce racism: Preventing, Punctuating, and Prohibiting. We organized each of the elements into a '6P' model along a temporal sequence around sentinel racist events. For each of the six components we describe: Contributing Factors, Emotional Reactions, and Behavioural Responses as reported by participants. Implications for Practice: Identifying factors that entrench or uproot racism can inform specific steps to improve the care of all children and families on an inpatient child psychiatry unit. The two‐domain/six‐theme model we developed can serve as a rubric for individuals or milieu‐based inpatient settings serving patients of any age to engage in structured self‐reflection, auditing, program evaluation, or as scaffolding for difficult but frequently elided conversations. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Medicinal plants are a part of everyday life.Medicinal plants have many effects on the lives of individuals diagnosed with mental illness. What the paper adds to existing knowledge?: Since there is no qualitative study in which individuals diagnosed with mental illness provided a detailed explanation of their views about the use of medicinal plants, this study will fill a gap in the literature and guide mental health nurses.This study provides information for mental health nurses about how individuals diagnosed with mental illness evaluate medicinal plants, what it means to them and the effects of medicinal plants.It provides ideas about the use of medicinal plants as a tool to protect and improve mental health.In addition, since the majority of the studies on mental illnesses and medicinal plants are quantitative studies, it was thought that this study was different from the seminal studies in the literature and could offer new ideas for future studies. What are the implications for practice?: The results of this study show mental health nurses that the positive aspects of medicinal plants can be used to maintain and improve the mental health of individuals diagnosed with mental illness.Mental health nurses should evaluate the treatment and maintenance process in detail, considering that medicinal plants may interact with drug treatment or the risks of using medicinal plants in terms of adverse effects.Moreover, mental health nurses should fight against the negative aspects of medicinal plants.Mental health nurses and individuals diagnosed with mental illness should be made aware of the use of medicinal plants. Aim: There was no qualitative study found in which individuals diagnosed with mental illness explained their views in detail about the use of medicinal plants. It is therefore thought that this study will fill this gap in the literature and guide mental health nurses in the field. The research was carried out to determine the use of medicinal plants by individuals diagnosed with mental illness. Method: This research was a qualitative study conducted using the case study design. Ten individuals diagnosed with mental illness for at least 10 years, determined by the purposeful sampling method were interviewed. The data were collected between March and April 2022 with information form and semi‐structured interview form and analysed with the content analysis method. Findings: Four of the participants had depression, four had anxiety and two had mood disorders. Themes were determined to be a source of healing (ointment for the soul, body tonic and organic and nature's miracles) and cultural accumulation (faith and inheritance, counselling helpline). Conclusion: Participants described medicinal plants as a source of healing, stating that medicinal plants are good for bodily and mental health and provide purification. Individuals stated that the information about medicinal plants represents cultural accumulation as an inheritance, they applied them as a counselling helpline in case of illness. Implications for Practice: The positive effects of medicinal plant use can be supported by mental health nurses. Considering that medicinal plants may interact with the drug treatment, the use of medicinal plants should be evaluated in detail by mental health nurses. [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]

Accessible Summary: What is known on the subject?: Little is known about how PTSD and dementia in Veterans is identified by health care providers. What the paper adds to existing knowledge?: Healthcare providers identify those behavioural symptoms experienced by older people living with dementia that represent an unmet need associated with PTSD secondary to military service. Once healthcare providers recognize the presence of symptoms relevant to PTSD, they modify their care approach to include focused/tailored non‐pharmacological care interventions that address environmental and situational variables that reflect military action. What are the implications for practice?: Specialized education and training is needed to improve the identification of PTSD when existent with other co‐occurring neurocognitive conditions such as delirium, dementia and depression. Introduction: Co‐occurring PTSD and dementia in Veterans can be difficult to distinguish from dementia‐related responsive behaviours, which may result in inappropriate care management. Improved identification of PTSD and dementia is necessary to inform more appropriate and effective care for Veterans. Aim/Question: The purpose of this study was to understand how Canadian healthcare providers have learned to identify the co‐occurrence of PTSD symptoms in Veterans with dementia. Methods: Eight semi‐structured interviews employing the Critical Incident Technique were conducted with key informant healthcare providers who treat Veterans from across Canada. Framework analysis was used to code, sort and develop themes. Results: Observed differences in Veterans with PTSD and dementia cued healthcare providers to seek our more information, leading to a new understanding of past trauma underlying the symptoms they observed. Healthcare providers then altered their usual care approaches to utilize trust‐based and validation‐oriented strategies resulting in more effective care management. Discussion: Improvement in the identification of co‐occurring PTSD and dementia in Veterans requires specialized education and training for healthcare providers. Implications for Practice: Recognizing the complex needs of older Veterans with co‐occurring PTSD and dementia is necessary for healthcare providers to implement more effective care for this population. Relevance Statement: This paper provides mental health nurses with new understanding of co‐occurring PTSD and dementia in Veterans. With an ageing Veteran population in Canada, mental health nurses need to be knowledgeable about the care for Veteran specific mental health needs. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether a novel decision support tool would effectively minimize physical restraint use in critically ill adult patients. Design A nonequivalent quasi‐experimental design combined with a descriptive qualitative approach was used. Methods: A Restraint Decision Tree was developed based on a qualitative study that explored the barriers to employ the Restraint Decision Wheel. During the quasi‐experimental study, patients admitted to the unit between October 2017 and March 2018 were enrolled as the control group receiving the Restraint Decision Wheel (n = 528), whereas patients between April 2018 and September 2018 were enrolled as the intervention group receiving the Restraint Decision Tree (n = 564). The physical restraint rate, accidental catheter removal rate and nurses' satisfaction were compared. Results: The Restraint Decision Tree significantly decreased physical restraint use. No significant difference in the rate of accidental catheter removal was found. Nurses reported increased satisfaction with the restraint decision‐making. Conclusions: The Restraint Decision Tree could minimize physical restraint use. Physicians' involvement in the restraint decision‐making and nurses' competence in delirium assessment may be essential for successful implementation of the Restraint Decision Tree. Summary statement: What is already known about this topic? Physical restraint is a common practice in the intensive care unit.Minimizing physical restraint use does not increase the risk of catheter self‐removal.Nurses equipped with clinical decision‐making skills could promote the appropriateness of restraint application. What this paper adds? The Restraint Decision Tree could help nurses make appropriate restraint decisions for critically ill adult patients, thus decreasing the use of physical restraint.Multidisciplinary decision‐making improves nurses' satisfaction with the restraint decision process. The implications of this paper: This study suggests that the Restraint Decision Tree can be implemented in the intensive care unit as an effective decision‐making tool to decrease physical restraint use while maintaining patient safety.A strong culture of multidisciplinary collaboration and delirium screening is called for prior to utilizing the Restraint Decision Tree. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to describe the experiences of nurses and other health care workers who were infected with coronavirus disease 2019. Methods: An empirical phenomenological approach was used. Sixteen participants were recruited in Wuhan using purposive and snowball sampling. Semistructured, in‐depth interviews were conducted by telephone in February 2020. Interviews were transcribed verbatim and analysed following Colaizzi's method. Results: Two themes emerged: (1) Intense emotional distress since becoming infected. Participants were fearful of spreading the virus to family and overwhelmed by a lack of information, experienced uncertainty and worried about treatment, felt lonely during isolation and reported moral distress about inadequate health care staffing. (2) Coping strategies were needed. They tried their best to address negative psychological reactions using their professional knowledge and gaining support from others and community resources. Conclusions: Preparedness for catastrophic events and providing timely and accurate information are major considerations in government policy development, related to pandemics and adequacy of health care personnel. Mental health resources and support, both short‐ and long‐term should be anticipated for health care providers to alleviate their fear and anxiety. Summary statement: What is already known about this topic? Health care workers, including nurses, are at the frontlines of the COVID‐19 outbreak and at high risk of infection.Experts have called for infection prevention for health care providers.Limited research has reported the experiences of health care workers infected by COVID‐19 using an empirical phenomenological approach. What this paper adds? Upon diagnosis, nurses and other health care workers experienced fear, uncertainty and distress like general patients.Health care workers reported moral distress about inadequate health care staffing issues.Health care workers could cope with their negative psychological reactions using professional knowledge and support from significant others and the community. The implications of this paper: Preparedness for large‐scale pandemics and a system that can provide openness and timely information needs consideration in policy development.Accurate information and good communication are vital to support infected health care workers and enhance their sense of safety and belonging.Long‐term support should be available when these health care workers return to work. [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: This study aims to report on the everyday concern of the 'potential for misinterpretation', which was the basic social problem revealed in a grounded theory study exploring male nurse practice in inpatient rehabilitation in Australia. Background: Male nurses account for approximately 10% of nursing workforce across western countries and they practice in a range of clinical areas; however, how they practice in inpatient rehabilitation remains unexplored. Methods: Constructivist grounded theory was used in this study and was conducted in two phases: (i) involved semi‐structured interviews with 11 male nurses from October 2013 to June 2014 and (ii) observation of practice of 12 male nurses and semi‐structured interviews with male nurses and 15 patients from February to April 2015. Results: Nurse participants encountered the intersection of two pervasive patient ideologies about male nurses. Patients perceived nursing to be women's work and that male nurses are sexual threats. These two intersecting ideologies created a concern for male nurses working in inpatient rehabilitation and that concern was labelled 'potential for misinterpretation'. Conclusion: Gender stereotypes impacted on the ability of male nurses to practise nursing in inpatient rehabilitation. Male nurses were mindful on a daily basis that misinterpretation could, and did, happen in inpatient rehabilitation. Summary statement: What is already known about this topic? Male nurses work in a range of specialties.Male nurses across many specialties commonly find the provision of nursing care requiring touch to be problematic.Nursing practice in inpatient rehabilitation is reported from a gender neutral or female perspective. What this paper adds? Male nurses encountered the intersection of two pervasive patient ideologies 'nursing is perceived as women's work' and that 'male nurses are perceived as sexual threats'.These two intersecting ideologies lead to the 'potential for misinterpretation' for male nurses.Men were mindful that misinterpretation could happen at any time which influenced their ability to practise nursing. The implications of this paper: The 'potential for misinterpretation' is useful for nurses and others to understand a main concern male nurses encounter in inpatient rehabilitation.Research can inform nurse education providers about gaps in nursing curricula with regards to male nurse practice.Rehabilitation service providers can use this research to support and inform male nurse workforce development. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The delivery of mental health recovery orientated acre is a requirement of mental health professionals and an acknowledged desired outcome for individuals presenting with mental health issues.Hope has been recognized as one of 5 key processes of mental health recovery, and critically as the key catalyst of recovery.Mental health nurses are required to be competent in cultivating service user hope. What the paper adds to existing knowledge?: Novel exploration of how people described and made sense of the lived experience of hope in mental health recovery.Participants described hope as intrinsic to life in the context of its ability to cultivate desire and provide energy for life and living.Participants with experience of attempts to end life had a very clear concept of hope as missing at these times.Participants described the concept of hope as present but hidden to explain their survival through tortuous circumstances.The themes generated contribute to a greater understanding of the dynamic role and process of hope in mental health recovery. What are the implications for mental health nursing practice?: Mental health practitioners need to be competent in understanding and cultivating hope as part of a person‐centred approach, embedded in a therapeutic relationship.All stakeholders including service users, mental health nurses and educators need a more accessible reified dialogue of "hope" that harnesses its therapeutic potential. Introduction: Mental health services have embraced the philosophy and practice of recovery. Research has confirmed hope as a micro‐process of recovery. The lived experience of hope has received scant attention. This is required to improve understanding and optimize its therapeutic potential. Aim: To explore how individuals describe and make sense of their experience of hope in mental health recovery. Method: A qualitative interpretative phenomenological analysis (IPA) approach was used. The sample was accessed via email networks. Data were generated through semi‐structured interviews and analysed using an IPA framework. Results: Three superordinate themes emerged: "Without it we would wither up and die"—Hope as intrinsic to life; "I will be ok"—Having a sense of possibility and "Making it happen"—Moving forward. Individuals referenced hope by its absence when attempts were made to end life, and as present but hidden in tortuous circumstances. Discussion: Individuals were more familiar with the concept of hopelessness, had a ready‐to‐hand vocabulary of "having no hope" and used this by default to inform what hope meant. Implications for Practice: It is important that all stakeholders appreciate the context specific interpretation of hope and cultivate dialogue and understanding to harness its therapeutic potential. [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?: Several studies explore and describe the role of family dynamics in dementia care.However, few focus specifically on the diversity of family relationships that influence family caregivers' experiences of providing care to a relative with dementia.The role of family caregivers engaging in unpaid care of relatives with dementia is becoming more and more critical as the numbers of people living with dementia increase across the globe.Family caregivers are a diverse group of people as there are different categories of kinship relations and thus cannot be viewed as a single collective.They are linked intricately to their family and social support systems, however, they often experience limited family support, and tensions between family members can be a major source of stress.Hence, health professionals need to deepen their understanding of family relationships to enable them to provide effective advocacy and clinical support to family caregivers. What the paper adds to existing knowledge?: This study is unique in that it focuses on a range of family relationships in which a person with dementia finds themselves. It highlights that this network of complex connections influences the caregiving process.The study demonstrates the important role that siblings can play in sharing the caregiving load. However, this sharing is rarely balanced or fair and there is always someone in the family who carries the heaviest load.Communication between family members is frequently a challenge, with family members experiencing denial or an inability to understand the challenges encountered by the family caregiver.Most studies focus on the relationship between the family caregiver and the relative with dementia alone, rather than the family network of the family caregiver and how it influences the caregiving process.This study is unique as it focuses on family dynamics and the family network, particularly the range of family relationships in which family caregivers and their relative with dementia find themselves.Other studies tend to focus on a specific kinship category and the family network, such as an adult child, caring for their parent, but this study presents a wide variety of kinship categories to demonstrate the diversity of family caregiving contexts.The family caregivers in this study all highlighted the need or desire for effective support from the family network.Challenges of communication between family members and the caregiver were also evident and were framed within the existing family dynamic of each family. What are the implications for mental health nursing?: The findings suggest the need for communication (training and therapeutic) interventions between family caregivers and other family members (secondary caregivers). Mental health nurses are often well positioned to offer the family caregiver the option to undertake such an intervention.The findings emphasize the diversity of family caregiving situations and argue that mental health nurses can assess the nature of the care situations and work with families on how best to address the needs of the relative with dementia and the main caregiver.However, tensions frequently exist between family members, some of which existed prior to the relative acquiring dementia and other tensions as a consequence of the relative acquiring dementia. Mental health nurses could assist as a mediator between family members in order to assist families to become more cohesive. Introduction: This article explores the diverse nature of family caregivers, focusing on the different categories of kinship relations. Family caregivers are linked intricately to their families, but often experience limited family support, causing stress and tension between family members. Aim: The article aims to explore the family relationships of family members caring for relatives with dementia in order to provide an insight into the role of such relationships on the caregiver relative with dementia dyad. Method: A phenomenological, exploratory‐descriptive design was used. Eight participants took part and data were obtained using collages and semi‐structured interviews. Results: A range of family relationship patterns was highlighted including sibling involvement in the caregiving process; spousal involvement in supporting a caregiver of a parent; and spousal involvement in caring for their spouse. Discussion: The family caregivers highlighted the need or desire for effective support from the family network. Challenges of communication between family members and the caregiver were also evident and were framed within the existing family dynamic of each family. Implications for Practice: Mental health nurses need to deepen their understanding of family relationships to enable them to provide effective advocacy and clinical support to family caregivers and assist families to become more cohesive. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Intellectual disability (ID) involves problems with general mental abilities and affects intellectual functioning and adaptive functioning.People diagnosed with ID present higher levels of functional disability, which means they usually have difficulty or the inability to independently perform basic activities of daily living.Little to no attention has been paid to the issues of the mental health of people diagnosed with ID. Specifically, healthcare workers' experiences of caring for patients with IDPD have been neglected. What does the paper add to existing knowledge?: The findings increase our understanding and partially address the knowledge gap regarding the situations and circumstances faced by healthcare workers in caring for patients diagnosed with intellectual disability co‐occurrent with psychiatric disorders (IDPD).In cases of insufficient staffing, healthcare workers may be forced to ignore the individualized needs of patients so as to facilitate management.Healthcare workers may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. They adapt by adjusting their expectations of their patients. What are the implications for practice?: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in‐service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them.The government department responsible for the management of ID patient care institutions should be able to regularly monitor the overall staffing and quality of care in these institutions. Introduction: When intellectual disability co‐occurs diagnosed with psychiatric disorders (IDPD), the impact of the burden of illness on the affected individuals, their caregivers, their family and friends, and the services that provide for them is particularly high. The issues of the mental health of people diagnosed with ID have received little, if any, attention. One specific area of neglect is healthcare workers' experiences of caring for patients diagnosed with IDPD. Aim: The aim of this study was to understand healthcare workers' experiences of caring for patients diagnosed with IDPD. Methods: A qualitative descriptive research approach and semi‐structured interviews were used in this study. We interviewed 15 participants who had experience in caring for patients diagnosed with a dual diagnosis of IDPD. Findings: Four themes were found, as follows: (1) Negative impacts of insufficient staffing on the quality of care, (2) Constantly worrying about harmful incidents, (3) Discovering effective ways to provide individual patient care and (4) Adjusting expectations and attitudes towards patients. Participants' experiences revealed that they perceived the importance and effectiveness of providing individualized care for IDPD patients. However, when staffing is insufficient, they may be forced to ignore the individualized needs of patients so as to facilitate management. They may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. In addition, they adapt by adjusting their expectations of the patients. Discussion: The findings from this research help to fill the knowledge gap in our understanding of healthcare workers' experiences of and their perspectives on caring for patients diagnosed with IDPD. Implications for Practice: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in‐service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department overseeing the management of institutions providing ID patient care should be empowered to conduct regular monitoring of the overall staffing and quality of care in such institutions. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Advanced clinical practitioners (ACPs) are, typically, non‐medical healthcare professionals, who possess advanced clinical skills, a master's level qualification and evidence of leadership, management and research abilities.Most ACPs are nurses and new ACP roles are increasingly being established around the world.The views of senior staff towards new mental health nursing roles in organizations are likely to influence their introduction and sustainabilityResearch on mental health nursing ACP roles is sparse. What the paper adds to existing knowledge?: The paper uniquely provides specific information as to factors perceived by senior staff as affecting the implementation of ACP roles in mental health services.A wide range of mental health services were perceived as potentially benefiting from ACPs.Establishing role clarity for MHN ACPs is perceived as being as essential to successful introduction of the role, as has been found for other specialities. What are the implications for practice?: Participants identified a need for early engagement with service users and professions about new ACP roles and for processes that can evaluate ACP roles once they established.Some mental health nurses may require long‐term developmental pathways to help prepare them to take on a master's level course and then the ACP role. Introduction: Advanced clinical practice (ACP) roles are increasingly being developed internationally. Identifying factors perceived as affecting the development of ACP can support effective implementation. Aim: To understand the views of senior health service staff as to factors influencing the development of ACP roles in mental health services. Method: Focus group and semi‐structured interviews. Participants were directors of nursing (n = 10) and other senior staff from roles important to workforce development (n = 10). Results: Content analysis suggested seven categories: understanding the role and national guidelines, attitudes to the role, learning from implementing other roles, understanding prerequisites for development, challenges, opportunities and future support/actions. Prerequisites for success would include early engagement with stakeholders. Medical attitudes towards ACP roles were perceived as generally more positive than previously. Discussion: The study provides unique information regarding perspectives of senior staff regarding the implementation of ACP roles in mental health services. A wide range of mental health services were perceived as potentially benefiting from ACPs, with the importance of role clarity being highlighted and long‐term developmental pathways for staff. Implications for practice: Successful Implementation of ACP roles may require clear role definition, early engagement with stakeholders and processes to evaluate role outcomes. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to understand the lived experience of rural mothers caring for a child with a chronic health condition and to understand their perspectives on the support, services and resources they identify as necessary to effectively manage caregiving. Background: Maternal caregivers in rural areas experience difficulty accessing specialist health care for their child and can also experience geographical and social isolation. Understanding the factors that enable these maternal caregivers to overcome the challenges and adversities faced is crucial to help nurses identify and facilitate avenues for support and resources. Design: This study employed a phenomenological design. The study is reported in line with Consolidated criteria for reporting qualitative research guidelines (COREQ). Methods: Semi‐structured interviews were conducted with 17 maternal caregivers in rural New South Wales, Australia, who had at least one child with a chronic health condition aged between 2–18 years. Data were collected from March to June 2018. Thematic analysis was used to develop a thematic framework. This paper reports on one of the major themes identified in this research, specifically maternal resilience. Results: Participants demonstrated maternal resilience by creating meaningful social connections, cultivating networks, developing problem‐solving skills, enhancing their self‐efficacy and finding a sense of purpose through hope and optimism. These strategies provide nurses insight into how some rural women overcome adversities associated with their maternal labour required in caring for a child with a chronic health condition. Conclusion: This study found that participants overcame the challenges related to their caregiving work, emerging as resilient caregivers. Understanding maternal resilience assists nurses to provide the services rural mothers in Australia need to care for their child with a CHC. Relevance to clinical practice: Findings from this study provide insight into the experiences of rural maternal caregivers of children with a chronic health condition and identify the strategies they adopt to overcome caregiver challenges. Understanding these strategies allows nurses to improve care and support for rural mothers using a strength‐based approach to build maternal resilience. [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]

Aim: Globally, the rapid increase of hypertension is particularly prevalent in low‐ and middle‐income countries. Hypertension is the most significant modifiable risk factor for stroke and ischaemic heart disease, the leading cause of mortality in Vietnam. The aim of this study was to gain insight into the provision of hypertension care in Vietnam by exploring provider perceptions. Methods: A sequential exploratory mixed‐method design was selected to allow for the initial qualitative interview findings to be incorporated into the development of the hypertension education workshop. Data were collected through semistructured interviews of 15 Vietnamese clinicians involved in the care of patients with hypertension. Results: Anxiety related to diagnosis of hypertension and specifically fear of having a stroke was mentioned by half of the participants. Several themes also emerged regarding barriers to implementing lifestyle modification to improve patient hypertension outcomes. There were contradictory opinions on the nurse's role in providing patient education across clinical settings. A lack of systematic structure and evidence‐based teaching resources was also noted. Conclusions: Gaining the provider's perspective increases understanding of the regional culture and context of hypertension care. The increased understanding can be used to improve provider education and enhance hypertension population outcomes. SUMMARY STATEMENT: What is already known about this topic? There is an increasing global prevalence of hypertension, the leading modifiable risk factor for cardiovascular morbidity and mortality.Lifestyle modifications are first‐line treatment to attaining hypertension goals and improving patient outcomes.Strengthening nursing intellectual capital by building nurse skills and knowledge can maximize their contribution and enhance population health. The implications of this paper: Awareness of patient culture strengthens patient education and enhances uptake of lifestyle modifications.Nurses, when appropriately equipped and supported, are ideally situated to significantly improve hypertension outcomes.Appropriately educating nurses and clarifying role expectations would develop nursing intellectual capital and add value to the health‐care system in Vietnam. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: Alcohol addiction is manifested by periods of abstinence and relapse in which the individual returns to previous problematic alcohol use. This may lead to unstable and stressful routines for the family and for women who live with a spouse diagnosed with an AUD.AUD may mentally and physically affect women living with a spouse diagnosed with AUD with respect to relapse. However, most studies have focused on the influence of AUD in general, and the way they cope with it; few have dealt with the experience of relapse as a distinctive stage. What the paper adds to existing knowledge: Women's experiences of their spouses' relapses are embedded within their broader life experience in the shadow of alcohol addiction.The pattern of transitions from closeness to distance in the ways women think, feel and actively respond to their spouses' relapses shows similarities with the ways in which individuals cope with repeated trauma. This helps relate these women's experiences of their spouses' repeated relapses to the potential complex trauma these women experience and leads to a better understanding of the internal emotional dynamics of these women's behavioural patterns. What are the implications for practice: These women need a therapeutic solution that can help them cope with longstanding emotional burdens.Therapists should be sensitive to the complexity of their experience. When relevant, therapy should be based on therapeutic strategies from trauma practice, along with Alcohol Behavioural Couples Therapy that can reinforce the couple's mutual efforts to achieve sobriety or reduce AUD severity Introduction: Alcohol use disorder (AUD) is manifested by periods of remission and relapse which can serve as a source of continuous stressors on the individuals and family. Women living with a spouse diagnosed with AUD can be mentally and physically affected by this behaviour. Most studies have focused on the general influence of AUD on these women and their attempts to cope with AUD; there are scant data on the influences of relapse as a distinctive stage. Aim: To better understand how women whose spouses are diagnosed with AUD experience their relapses. Method: A qualitative‐naturalistic approach was implemented. Semi‐structured, in‐depth interviews were conducted with 12 women whose spouses were diagnosed with AUD. Results: Content analysis revealed three main categories representing the transitions from: a) ignorance to realization, b) emotional opposition to acceptance and c) activity to inactivity. Each category reflects one cognitive, emotional or behavioural dimension of this experience. The overarching theme emerged as shifts from closeness to distance in the way these women think, feel and actively respond to their spouse's relapses and addiction. Discussion: The shift from closeness to distance as manifested by the three transitions is argued to reflect the ways these women experience and cope with the chronic nature of AUD. It is suggested that this experience parallels the phenomenology of symptoms of complex trauma. Implications for practice: Nurses should be alert to the potential accumulative stressors experienced by these women and implement intervention strategies developed in the trauma field in addition to Alcohol Behavioural Couples Therapy. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There is body of knowledge available about the harms associated with restrictive interventions used in behaviour management, service users' perceptions of the use of restraints, and staff competence in behaviour management. The staff perspective has been studied in terms of staff exposure, responses to and prevention of aggression, staff‐related factors associated with service user aggression, and staff attitudes and perceptions towards violence.The definitions of competence in behaviour management provided in training interventions are fragmented and based on unilateral measurements.Training interventions with the purpose of enhancing staff competence in behaviour management are organized regularly, yet there is a lack of clarity on how effective these interventions are. Inadequate conceptual understanding of behaviour management can weaken the effectiveness of these interventions. What this paper adds to existing knowledge?: Our study produced new knowledge by providing a preliminary conceptual framework that can be used to comprehensively describe and assess competence in managing challenging behaviour and to cover safely the whole care process. Humane care and ethical sensitivity should be the premises of interaction with people in distress. We also pointed out the needs for conceptual clarification of the concepts of confidence, support and restraint.We provide important new insight into the leadership and cultural issues of behaviour management that is relevant for patients, staff members and healthcare organizations. We found that staff members do not consider service user safety and workplace safety as opposing issues.Further, we provide new perspectives for prevention, the risk assessment process and effective communication in the context of behaviour management. What are the implications for practice?: A comprehensive understanding of the competences related to behaviour management will foster universal definitions for "support" and "restraint," which can then be used to ensure that the best practices are used for behaviour management.Organizational culture and participative leadership on behaviour management should be developed with a special focus on safety issues, common understanding of comprehensive competence, risk assessment and prevention, views regarding the use of restraints, and teamwork. Introduction: Previous research concerning staff views of behaviour management has not considered instructors' views. The definitions of competence in behaviour management are fragmented, which can undermine the effectiveness of training interventions. Aim/Question: This study aimed to describe Finnish and British Management of Actual or Potential Aggression instructors' perceptions of safety and behaviour management‐related competences and create a conceptual framework for comprehensive competence. Method: An explorative‐descriptive qualitative approach with purposive sampling (N = 22), semi‐structured interviews and abductive content analysis. Results: Conceptual framework of comprehensive competence in managing challenging behaviour includes five categories—knowledge, skills, attitude, confidence and ethical sensitivity—and 21 subcategories. Competent staff and supportive leadership ensured safety, while inconsistent risk management culture, the health and behaviour of service users, and inadequate staff orientation endangered safety. Discussion: The study produced new knowledge of safety issues and competences from the perspective of the instructors who deliver behaviour management training. Implications for practice: Competence to manage challenging behaviour should be developed based on our conceptual framework to provide an effective and safe training. Prevention, the risk assessment process, alternative communication, and the definitions of "confidence," "support" and "restraint" should all be sufficiently addressed in future training. [ABSTRACT FROM AUTHOR]