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Aims and Objectives: To explore the phenomenon of workarounds in clinical practice through the nurses' perspective and identify which factors according to their experience contribute to activities carried forth non-compliantly to procedures, protocols and rules defined by an Institution., Background: A workaround in clinical practice is a non-compliance and a violation of an organisation's defined procedures, regulations or rules that may prevent adverse events. Its increasing recurrence in the workplace calls for a deeper analysis of the phenomenon., Design: A phenomenological descriptive design, following Colaizzi's analysis., Methods: In-depth interviews were conducted with 16 nurses about their experience of workarounds. The interviews were digitally audio-recorded and transcribed verbatim. Two researchers conducted data analysis independently and followed three phases: extracting significant statements, creating formulated meanings and aggregating them into themes. The process employed NVivo 12 software. COREQ checklist was used for reporting., Results: Data analysis identified 17 sub-themes falling into the four macro-themes: (i) living the profession in saved times; (ii) Perceiving contingencies as a guide to action; (iii) sense of personal responsibility; and (iv) emotional aspects., Conclusions: From a nurses' perspective, a workaround is often triggered by the need to overcome problems interfering with efficient and timely patient care in everyday clinical practice. This will of undertaking responsibilities favouring gained efficiency is closely linked to their confidence acquired over years of experience in the field., Relevance to Clinical Practice: The results of this study can help clinical leadership to acknowledge workaround, understand the underlying triggers and work towards reconciling official procedures with real-world situations. They can help nurses working in clinical practice to reflect and understand how to reconcile the needs related to the demands of organisations with the need to live their profession, which is more patient-oriented., (© 2021 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Aims and Objectives: To understand the experiences and support needs of informal caregivers of patients with chronic obstructive pulmonary diseases chronic obstructive pulmonary disease who return home following an acute exacerbation., Background: The presence of an informal caregiver is important to provide practical and emotional support after an episode of acute exacerbation of chronic obstructive pulmonary disease. However, caregiving in such circumstances can be challenging and stressful., Design: Phenomenology., Methods: This is a phenomenological study based on semi-structured interviews with sixteen primary caregivers of chronic obstructive pulmonary disease patients. Interview data were analysed using Colaizzi's descriptive analysis framework, to identify significant themes and sub-themes. Data were collected between April-December 2017 in a Teaching Hospital in Italy. The study was designed and reported following the COREQ guidelines and checklist., Results: Analysis elicited five themes embracing various aspects of the caregivers' lived experiences: (a) a home disrupted, (b) living with constant vigilance and anxiety, (c) feeling the need to escape (d) self-justifications for caregiving role/duty, and (e) feeling abandoned by professionals., Conclusions: Our results show that carers experience a range of difficulties when caring for their relative at home with chronic obstructive pulmonary disease. Some of these are linked to the physical disruption of their home but many are linked to feelings of inability to cope and the psycho-social impact of the caring role. The study also shows how participants felt unsupported by professionals. Focused support for carers is required to enable them to meet these challenges., Relevance to Clinical Practice: Healthcare professionals should be trained to provide technical and psychological support to caregivers especially during the phases of disease that may involve episodes of exacerbation. Home care and continuity of care can work if there is excellent communication and collaboration between healthcare professionals and caregivers. Developing appropriate support for family caregivers is essential to address the problems they can face., (© 2020 John Wiley & Sons Ltd.)

Aim: The aim of this study was to explore and understand the interprofessional collaboration preparation processes implemented by clinical tutors and students, in various professions, involved in interprofessional education experiences., Design: A constructivist grounded theory approach. The study was carried out between 2015-#2017., Method: Semi-structured interviews were conducted with a total of ten undergraduate students and the seven clinical tutors who supervised them from three undergraduate courses in a university of applied sciences and arts in Switzerland. Students were sampled during their clinical placement. Data were analysed and coded using constant comparative analysis with the support of Nvivo 10 software., Results: A substantive theory "Practicing contextual models of interprofessional care" was generated. It explains how the whole process takes place, the tutor-student interactions, and how together they gradually build models of interprofessional care, linked to their clinical context and to the patients/families who are part of it., Conclusion: The process describes a journey to comprehensively explain the roles played by the two main actors (student and tutor) who build a relationship of interaction., Impact: This theory provides an understanding of the complex process set up by students and how they are prepared for collaboration with other professionals. Its importance is mainly expressed in the educational field because it reveals a different vision from the one present so far and enables a thorough reflection from the pedagogical point of view. Teachers will be able to observe and approach the students' training curricula from a different point of view by evaluating any changes to favour it and rethink the organizational and training models of current programs., (© 2020 John Wiley & Sons Ltd.)

Aims and Objectives: To conduct a systematic review and meta-synthesis of findings from qualitative research about sexuality and intimate relationship among patients with dermatological diseases., Background: Over the last few decades, there has been an increase in clinical research investigating aspects related to sex and sexuality in patients living with dermatological diseases. In fact, studies recognise a negative impact on various aspects of intimacy, such as sexual function, self-esteem and romantic relationships. The body of qualitative literature about sexuality in the context of dermatological diseases is emerging but consists mainly of small studies that would benefit from aggregation, synthesis and interpretation to highlight and summarise the overarching dimensions to this clinical issue., Design: A systematic review and meta-synthesis of qualitative studies., Methods: BioMed Central, Cochrane Library, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, ERIC, Scopus, and Web of Science were searched between June-November 2017 with no publication date limits. Screening and selection of studies was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). After retrieval, the qualitative data were subject to meta-synthesis to identify overarching themes., Results: Ten qualitative studies were found. We identified four themes: (a) Embarrassment and shame; (b) Impaired sense of attractiveness and sexual avoidance; (c) Relationship issues; and (d) Lack of professional support. The patients in these studies adopted negative coping styles, such as avoidance and hiding their bodies., Conclusion: When assessing and evaluating patient care in dermatology, it is important that sexuality and the impact the disease could have on relationships is included., Relevance to Clinical Practice: An important part of nursing care is ensuring that patients are helped to develop positive coping strategies rather than negative ones. Patients with dermatological conditions also need advice and treatment to address any physically related sexual problems. Nurses need to be the initiators of these sensitive conversations to put patients at ease and work together to implement positive measures to reduce the sexuality-related issues patients face., (© 2020 John Wiley & Sons Ltd.)

Aims and Objectives: To explore the experience of patients affected by chronic obstructive pulmonary disease following hospitalisation due to an acute exacerbation event., Background: Chronic obstructive pulmonary disease is a progressively debilitating disease, often with very burdensome symptoms such as acute and chronic breathlessness and fatigue. Acute exacerbation often creates a life-threatening event. Exacerbation can also have substantial psychological effects including anxiety and depression although this aspect is less well researched-especially amongst people with chronic obstructive pulmonary disease recovering from an acute event and facing a return home., Design: A descriptive phenomenological study., Methods: In-depth interviews were conducted with 12 chronic obstructive pulmonary disease patients recently recovering from an acute exacerbation of their chronic obstructive pulmonary disease. Data were analysed using Colaizzi's phenomenological framework., Results: Four themes were identified from the data: a sense of loss and frustration, hopelessness, uncertainty about the future and fear of becoming a burden. Participants expressed quite negative views including a loss of hope, uncertainty about their future care and the burden they may become on their families. They appeared stressed and anxious as a result of the acute event they had experienced., Conclusions: This study shows that an acute episode of illness can generate a sense of hopelessness and uncertainty about their future care in people with chronic obstructive pulmonary disease. This occurs as they recover physically and think about the future, often in quite negative terms., Relevance to Clinical Practice: For healthcare professionals, it is important to take into account the potential feelings of loss, hopelessness and uncertainty that people can experience following an acute exacerbation of their chronic obstructive pulmonary disease and ensure that psychological care is available as physical recovery takes place. Such care to include good discharge planning, giving patients time to express concerns and referral to counselling services if appropriate., (© 2017 John Wiley & Sons Ltd.)