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Aim: To assess the perception of the nursing profession in Armenia from the perspective of multiple stakeholders, including nurses and the general public. Background: Nurses' role perception is a complex phenomenon defined by multiple stakeholders. Methods: The assessment used a convergent parallel mixed‐methods design, with a dominant qualitative status. We conducted the qualitative phase through focus group discussions and in‐depth interviews with 235 people and collected quantitative data in a cross‐sectional telephone survey with 389 participants. Results: The nursing profession has been influenced by medical hierarchy and subordination, and none of the participants recognized nursing as an autonomous health care profession. The quantitative survey findings were largely consistent with the qualitative results. Our findings highlighted empathy and compassion as inherent qualities of nurses in Armenia. Conclusion: To change opinions about the nursing profession and highlight nurses' meaningful contribution to the provision of health care services, it is important to develop a national definition of nursing and introduce higher educational opportunities for nurses in Armenia. Implications for nursing management: The paper highlights the importance of quality education for preparing highly competent nurse managers who can become role models in promoting nurses' roles in health care systems and improving the professional and public image of nursing. [ABSTRACT FROM AUTHOR]

Aim. This study aimed to (1) describe the perceived level of role transition from education to practice of new graduate nurses in Oman and (2) explore the barriers to and enablers of a successful transition. Background. The transition from a familiar academic environment to becoming a professional nurse is stressful and challenging. Exploring the transition barriers and enablers is instrumental in designing an effective experience. However, studies exploring the transition experience from academia to practice among new graduate nurses working in Oman are limited. Design. This study used a mixed method research design. Methods. Data were collected from nurses working for no longer than two years. Role transition was assessed using the Casey‐Fink Graduate Nurse Experience Survey. Barriers to and enablers of transition were explored through a focus group interview. Results. The total sample consists of 405 nurses working in 13 public hospitals. The majority (68.89%) of the participants had worked as a nurse for less than 6 months. The average score of the comfort and confidence subscale was 2.96 (SD = 0.38). Findings showed that the amount of workload and unclear role expectations were the most frequent difficulties new graduate nurses were experiencing in their transition from a student to a staff nurse. Findings from focus group interviews revealed a number of barriers and enablers that affected the transition experience of the new graduates. The barriers were fear, insufficient academic preparation, bridging the knowledge‐practice gap, and limited nurse‐physician interactions. The enablers were teamwork, organizational support, and the internship phase. Conclusion. The findings illustrate the need for healthcare organizations to design effective internship programs to ensure a successful transition experience. Providing staff with preceptorship training and enhancing nurse‐physician communication are important strategies for creating a comfortable work environment and ultimately ensuring a successful training experience for new nurses. [ABSTRACT FROM AUTHOR]

Aim. To evaluate the knowledge, attitudes, and practices of Chinese bedside nurses regarding antimicrobial stewardship, as well as to identify factors that influence nurses' engagement in antimicrobial stewardship. Background. Antimicrobial resistance is a pressing global health threat. Antimicrobial stewardship is crucial in combating this issue. Nurses play a key role in implementing antimicrobial stewardship. However, little is known about the involvement of Chinese nurses in antimicrobial stewardship. Methods. An explanatory sequential mixed-methods design was employed. A self-developed questionnaire was administered between March and August 2021 (N = 463), followed by semi-structured interviews with 17 nurses between March and July 2022. Descriptive statistics and qualitative content analysis were used to analyze the data. Results. The study found that nurses scored 75% in knowledge, 82.8% in attitude, and 84.1% in practice domains. There was a moderate correlation between nurses' knowledge, attitudes, and practices. It revealed that knowing local antimicrobial stewardship programmes information and the frequency of receiving antimicrobial stewardship training had a significant impact on nurses' knowledge scores. The willingness to participate in related training influenced nurses' attitude scores. Being a clinical teacher and the frequency of receiving related training influenced nurses' practice scores. The qualitative phase identified three themes: insufficient knowledge of nurses' engagement, diverse attitudes towards engagement, and limited scopes and absence of standards in nurses' participation. Conclusions. Our findings emphasize the importance of enhancing nurses' perception and involvement in antimicrobial stewardship. While nurses exhibit positive attitudes and practices, addressing the existing knowledge gap is crucial. To achieve this, it is necessary to clarify the role and responsibilities of nurses in antimicrobial stewardship, provide regular training and innovative methods, strengthen communication and collaboration, and foster a positive work environment. Additionally, actively promoting the development of guidelines and evaluation criteria will enable nurses to more effectively participate. Implications for Nursing Management. Regular training of nurses in antimicrobial stewardship needs to be enhanced. Nursing managers should strive to create positive, empowering, and supportive work environments, participate in policy formulation and implementation, and provide clear expectations for nurses' engagement in antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Introduction. Diabetes distress is often seen in adolescents with Type 1 diabetes (T1D). Problem Areas in Diabetes (PAID) is the most frequently used scale to assess diabetes distress in clinical settings, but the version for teenagers has not been translated into Danish and validated before now. Objective. This study describes the translation into Danish of the PAID-T scale, which was developed to measure emotional distress in teenagers with diabetes. Materials and Methods. The study was conducted in two phases. First, the PAID-T was translated into Danish based on the guidelines from the International Society for Pharmacoeconomics and Outcome Research and a forwardbackward translation procedure. Second, cognitive interviews were conducted, and the Danish version of the PAID-T was modified to ensure linguistic equivalence with the original scale in English. Results. The Danish version of the PAID-T questionnaire was found to be understandable and relevant for adolescents with T1D. No questions were found to be irrelevant. However, the cognitive interviews showed that the issue of balancing alcohol intake and blood sugar levels was not covered by PAID-T, although this was found relevant in the Danish target group. Conclusion. This study described the translation and linguistic validation of the PAID-T scale into Danish. After modifications based on the feedback from the cognitive interviews, the Danish version was found to be linguistically equivalent to the original English version. [ABSTRACT FROM AUTHOR]

Background. Strong evidence supports the beneficial impact of exercise on cancer patients. However, the provision of exercise programs in Germany is highly heterogeneous. Therefore, the network OnkoAktiv (OA) enables patient consultations and referrals from coordinating regional OA centers (RE) into community-based exercise programs (CBEP). Objective. The aim of this study was to identify barriers and facilitators for the implementation of OA network structures from the perspective of RE and certified CBEP. Methods. This evaluation was executed in a sequential mixed methods design. We conducted 16 qualitative interviews with each leader in RE and the certified CBEP. Then, 89 certified CBEP were invited to a quantitative, cross-sectional survey. Results. We identified 11 facilitators each for RE and certified CBEP, 7 barriers for RE and 5 for certified CBEP. Barriers dealt with, for example, financing OA network structures, a lack of knowledge of exercise trainers, inadequate patient referral, and missing collaborations by healthcare professionals (HCPs). Most of the named facilitators were adequate internal organizational resources, support and reachability of OA staffs, and collaboration with HCPs. Conclusion. Our findings indicate different challenges for the implementation of OA network structures. Future implementation efforts should consider the evaluation of individual barriers and the development of specific solutions. [ABSTRACT FROM AUTHOR]

We developed a pandemic telephone outreach protocol to identify risk for social isolation, health destabilization, medication issues, inadequate services and supports, and caregiver stress among older adults at high risk of destabilization. Screening, conducted between April 1, 2020, and May 8, 2020, was targeted to those who had previously been screened as frail or who were identified as vulnerable by their family physician. This study describes the implementation and results of this risk screening protocol and describes patient, caregiver, and health professional perceptions of this outreach initiative. Mixed methods included satisfaction surveys and interviews completed by patients/caregivers (N = 300 and N = 26, respectively) and health professionals (N = 18 and N = 9, respectively). A medical record audit collected information on patient characteristics and screening outcomes. A total of 335 patients were screened in the early weeks of the pandemic, of whom 23% were identified with at least one risk factor, most commonly related to the potential for health destabilization and medication risk. Follow-up referrals were made most frequently to physicians, a pharmacist, and a social worker. The outreach calls were very well received by patients and caregivers who described feeling cared for and valued at a time when they were socially isolated and lonely. The outreach calls provided access to trusted COVID-19 information and reassurance that health care was still available. The majority of health professionals (>86%) were "very" or "extremely" satisfied with the ease of completing the screening via telephone and value for time spent; for 79% the protocol was "very" or "extremely" feasible to implement. Health professional interviews revealed that patients were unaware they could access care during the pandemic lockdown but were reassured that care was available, potential crises were averted, and they supported future implementation. Risk screening provides a significant opportunity to provide information, support, and mitigate potential risks and is an important and feasible component of pandemic planning in primary care. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to reveal the opinions and experiences of male and female nurses concerning the nursing work environment in hospitals. Background: The quality of the nursing work environment greatly impacts the improvement of the patient, nurse and organizational outcomes. Therefore, a better understanding of the experiences of male and female nurses can contribute to the creation of a more positive work environment. Methods: In this descriptive qualitative study, data were collected with semi‐structured interviews conducted in 2020 with 18 nurses who were recruited via purposive and maximum variation sampling. Data was analysed with content analysis. Results: The content analysis revealed two major themes (the effects of gender on workplace practices and the image of nursing and gendered communication in the nursing work environment) and eight subthemes. Conclusion: This study concluded that male and female nurses experience advantages/disadvantages and similarities/differences in the nursing work environment and that both male and female nurses experience challenges regarding workplace relations and the work environment. Implications for Nursing Management: A better understanding of the problems associated with the different experiences of male and female nurses in the workplace may help nurse managers to create a more positive work environment. [ABSTRACT FROM AUTHOR]

Baby‐led weaning or self‐regulated small chunk feeding by the baby has emerged as an alternative to the traditional method of complementary feeding. Parents and healthcare professionals often differ in the benefits and drawbacks about it. The research aims were to describe the knowledge of health professionals about complementary feeding and baby‐led weaning (BLW) method and the attitudes towards its recommendation, and to explore the knowledge, experiences and attitudes of parents who have used this method to feed their children. A mixed methods research was carried out. A questionnaire was completed by 38 health professionals and 10 interviews were conducted with participating mothers. A total of 52.6% of health professionals recommended initiating complementary feeding at 6 months of age, a guideline followed by the mothers who used BLW. Some 86.8% of the professionals knew the BLW method and 76.3% knew its benefits, but the mothers consulted mainly informal sources of information sources to learn about and implement it. The health professionals stated that it facilitated family transition, enabled the infant to adapt better to flavours and textures, promoted chewing and the development of fine motor skills, improved growth and might also be a protective factor against obesity. The mothers noted that the method was natural, encouraged infant autonomy and promoted healthy eating habits. The health professionals expressed varied opinions concerning the risks entailed in the method. The main conclusions are that the majority of health professionals participating in the study know the BLW method, its benefits; however, they do not recommend it in all cases. Mothers listen to the advice of professionals but continue to rely on other informal sources of information. [ABSTRACT FROM AUTHOR]

Background: 'What matters to me' is a five‐category preference elicitation tool to assist clients and professionals in choosing long‐term care. This study aimed to evaluate the use of and experiences with this tool. Methods: A mixed‐method process evaluation was applied. Participants were 71 clients or relatives, and 12 professionals. They were all involved in decision‐making on long‐term care. Data collection comprised online user activity logs (N = 71), questionnaires (N = 38) and interviews (N = 20). Descriptive statistics was used for quantitative data, and a thematic analysis for qualitative data. Results: Sixty‐nine per cent of participants completed one or more categories in an average time of 6.9 (±0.03) minutes. The tool was rated 6.63 (±0.88) of 7 in the Post‐Study System Usability Questionnaire (PSSUQ). Ninety‐five per cent experienced the tool as useful in practice. Suggestions for improvement included a separate version for relatives and a non‐digital version. Although professionals thought the potentially extended consultation time could be problematic, all participants would recommend the tool to others. Conclusion: 'What matters to me' seems useful to assist clients and professionals with preference elicitation in long‐term care. Evaluation of the impact on consultations between clients and professionals by using 'What matters to me' is needed. [ABSTRACT FROM AUTHOR]

Purpose: To illuminate user experiences of schizophrenia, reasons for receiving antipsychotic medication, and encounters with mental health services. Design and Methods: 24 semistructured qualitative research interviews with schizophrenia patients treated with 3‐monthly paliperidone palmitate across Scandinavia were synthesized in qualitative content analysis. Findings: Participants describe considerable challenges in everyday functioning. Simultaneously, they rate their current mental and physical well‐being high and seem satisfied with their lives. These pathways indicate personal recovery. Practice Implications: The participants emphasize the importance of trustful relations with healthcare professionals, therapeutic conversations, antipsychotic medication in a 3‐monthly formulation, and support from relatives. [ABSTRACT FROM AUTHOR]

Objective: To develop a communication prompt based on dignity therapy to facilitate effective conversations between patients with haematologic neoplasms and their family caregivers and to improve the programme and preliminarily explore the benefits and challenges of family participatory dignity therapy (FPDT). Methods: A mixed‐methods approach was applied to develop and revise the programme. The FPDT was developed and validated using the Delphi survey, and its further improvement was explored with a simple one‐group pre‐ and post‐trial and semi‐structured in‐depth interviews. Results: Most of the FPDT items were endorsed by experts and patient–family dyads. The Content Validity Index was 93.6% in the first round of the Delphi survey and 100% in the second round. The "hope level," "spiritual well‐being" and "general health" scores of pre‐ and post‐testing increased from 33.60 ± 4.30 to 37.70 ± 5.10 (t = 3.99, p =.003); from 30.30 ± 3.65 to 38.80 ± 7.29(t = 4.13, p =.003); and from 41.67 ± 8.78 to 53.33 ± 8.05 (t = 3.50, p =.007) respectively. The qualitative data also indicated that the project was meaningful and well received. Conclusions: We showed that FPDT was a valuable and feasible means of improving communication between patients with haematologic neoplasms and their family caregivers in China by raising the hope level and spiritual well‐being and promoting general health. [ABSTRACT FROM AUTHOR]

Shifting tasks from medical staff to non‐medical staff is a common practice for promoting the efficient use of healthcare resources. The aim of this study was to develop and pilot test a questionnaire that evaluates practice assistants' attitudes towards task shifting and their perceptions of the challenges of task shifting (acronym: ACD questionnaire) and to assess the psychometric properties of the questionnaire. The development and pilot testing of the questionnaire occurred from March 2016 to March 2017 and was based on guided and cognitive interviews with practice assistants. Then, an online survey was conducted throughout Germany from June to August 2017 to determine the questionnaire's psychometric properties. A factorial analysis was conducted via principal component analysis, and reliability was assessed using Cronbach's α. The questionnaire included four themes: "working conditions and job satisfaction", "confidence to execute delegated tasks", "excessive demands associated with executing delegated tasks" and "relevance of task shifting for patient care". A total of 274 practice assistants with an average age of 38.2 years participated in the online survey. Each theme included components that showed good to very good reliability (Cronbach's α 0.64–0.91). The ACD questionnaire provides a way, for the first time, to evaluate delegable tasks, including practice assistants' attitudes towards task shifting and their perceptions of the challenges generated by these tasks. The questionnaire also indicates which components of practice assistants' professional training should be intensified. [ABSTRACT FROM AUTHOR]

Abstract: Rich social relationships contribute to improved well‐being and health outcomes, yet aged care client assessments tend to focus almost exclusively on physical issues. We aim to explore the experiences of aged care staff following their use of social engagement and well‐being instruments as part of routine assessments for home‐care clients. The social engagement (Australian Community Participation Questionnaire, ACPQ) and well‐being (ICEpop CAPability Measure for Older Adults, ICECAP‐O) instruments were embedded into the centralised information system of an Australian aged care provider. Staff administered these instruments during routine client assessments across a 9‐month period involving 289 assessments. Semistructured interviews with 12 staff members were conducted and themes explored using qualitative content analysis. Key factors related to the acceptability of instrument adoption were found. Staff reported the instruments were convenient to use and were valuable in eliciting information for care plan development. Staff found that the instruments complemented their standard assessment procedures and did not disrupt their routine workload. They emphasised that the information gained greatly assisted their discussions with clients, identified social needs, and enhanced client involvement in decisions about desired services. There were also some challenging elements, including staff concerns regarding their ability to deal with emotional responses from clients evoked by the survey questions. ACPQ and ICECAP‐O are useful tools for identifying psychosocial client needs, are feasible for use by large‐scale aged care organisations and provide valuable information to guide decision‐making about services. Future research should identify the long‐term effects on improving social participation and client outcomes. [ABSTRACT FROM AUTHOR]

Aim: Outcomes of an accelerated co‐active coaching intervention for senior clinical nursing leadership development. Background: Co‐active coaching is characterized by a whole person approach, commitment to deep learning and conscious action through supportive compassionate and courageous coach–coachee partnership. The national leadership capabilities framework, “Step into Leadership”, was used for development and evaluation. Methods: 116 senior clinical nurse leaders attended one face‐to‐face induction day and received a total of 3 hours of one‐to‐one telephone coaching and two virtual peer group facilitated sessions. Evaluation used primarily qualitative descriptive methods with iterative review of emerging themes. Results: Capability mapping indicated self‐leadership development as the most frequently cited need. Improvements in self‐confidence, capacity for reflection and bringing whole self into the work were reported to deliver enhancement in team and service performance. Conclusions: Co‐active coaching supported deep analysis by individuals. Focus on self, rather than behaviours provoked reflection on perspectives, mindsets, beliefs and approaches which can lead to more sustainable behaviour and support service change. Implications for Nursing Management: Investment in a co‐active coaching approach offers bespoke support for clinical leaders to develop self‐leadership capability, a precursor to delivering positive impacts on care. [ABSTRACT FROM AUTHOR]

Aims: The aims were (1) to evaluate the modified version of the Intensive Care Unit Information Need Questionnaire for the broader hospital setting, and (2) to describe the differences in respondents' managerial activities and information needs according to the position held by the respondent and the type of hospital unit. Background: Information systems do not support managerial decision‐making sufficiently and information needed in the day‐to‐day operations management in hospital units is unknown. Methods: An existing questionnaire was modified and evaluated. Shift leaders, that is, the nurses and physicians responsible for the day‐to‐day operations management in hospital units were reached using purposive sampling (n = 258). Results: The questionnaire ascertained the importance of information. Cronbach's α ranged from .85–.96 for the subscales. Item – total correlations showed good explanatory power. Managerial activities and information needs differed between respondents in different positions, although all shared about one‐third of important information needs. The response rate was 26% (n = 67). Conclusions: The validity and reliability of the questionnaire were good. Attention should be paid to the positions of shift leaders when developing information systems. Implications for Nursing Management: The questionnaire can be used to determine important information when developing information systems to support day‐to‐day operations management in hospitals. [ABSTRACT FROM AUTHOR]

The purpose was to study users' attitudes towards an electronic medical record ( EMR) closely integrated into the clinicians' cancer care workflow. The EMR, implemented in an ambulatory cancer care centre, was designed as a care pathway information system providing real-time support to the coordination of shared care processes involving all the care personnel. Mixed method pre-post study design was used. The study population consisted of all care personnel. A survey measured the quality attributes of the EMR, the clinical information it produces, the perceived usefulness of the system for supporting clinical data management tasks and the perceived impacts in terms of access and quality of care. The survey shows that users' attitudes towards the EMR (response rate of 71%) measured after the go-live were positive ranging from 3.42 to 3.95 on a 5-point scale. Besides, the content analysis of 33 pre-post interviews revealed five main themes: magnitude of the changes caused by the EMR; its innovative potential; its positive benefits; an ongoing growth in users' expectancies; and the burden associated with the time required to operate the EMR. In sum, the study shows that users can largely apply innovative uses of information technologies that automate their clinical processes. [ABSTRACT FROM AUTHOR]

Disadvantaged childbearing women experience barriers to accessing health and social care services and face greater risk of adverse medical, social and emotional outcomes. Support from doulas (trained lay women) has been identified as a way to improve outcomes; however, in the UK doula support is usually paid-for privately by the individual, limiting access among disadvantaged groups. As part of an independent multi-site evaluation of a volunteer doula service, this study examined women's experiences of one-to-one support from a trained volunteer doula during pregnancy, labour and the post-natal period among women living in five low-income communities in England. A mixed methods multi-site evaluation was conducted with women (total n = 137) who received the service before December 2012, using a combination of questionnaires ( n = 136), and individual or group interviews ( n = 12). Topics explored with women included the timing and nature of support, its impact, the relationship with the doula and negative experiences. Most women valued volunteer support, describing positive impacts for emotional health and well-being, and their relationships with their partners. Such impacts did not depend upon the volunteer's presence during labour and birth. Indeed, only half (75/137; 54.7%) had a doula attend their birth. Many experienced volunteer support as a friendship, distinct from the relationships offered by healthcare professionals and family. This led to potential feelings of loss in these often isolated women when the relationship ended. Volunteer doula support that supplements routine maternity services is potentially beneficial for disadvantaged women in the UK even when it does not involve birth support. However, the distress experienced by some women at the conclusion of their relationship with their volunteer doula may compromise the service's impact. Greater consideration is needed for managing the ending of a one-to-one relationship with a volunteer, particularly given the likelihood of it coinciding with a period of heightened emotional vulnerability. [ABSTRACT FROM AUTHOR]

Purpose: To illuminate whether and how taking care of forensic inpatients is experienced as a burden among staff and managers in general psychiatry. Design and Methods: Qualitative analytical strategies based on interviews and questionnaires. Findings: The interplay between physical environment, bottlenecks, poor information exchange, lack of knowledge and competences, complex psychopathology, and a vague and therefore uncomfortable task of nursing leads to a focus on criminal offenses rather than mental disorders and an increased risk of brutalization and stigmatization in nursing practices. Members of staff identify the care of mentally disordered offenders in general psychiatric units as either “a parking space” or a very difficult or frightening course, where staff members tend to behave like pleasers in order to avoid risks of conflict or physical violence. Either way, it seems hard to provide sufficient mental health care. Practice Implications: Nationwide training and teaching as well as knowledge exchange between specialized forensic psychiatry and general psychiatry are recommended. Further exploration is needed on patient perspectives and on avenues to increase efficiency and decrease bottlenecks throughout the clinical pathways. Furthermore, we need additional knowledge of the impact on general patient populations' resources for treatment and their safety. [ABSTRACT FROM AUTHOR]

This article reports a study exploring what older people believe would enable them to adjust to and gain maximum benefit from wearing a hearing aid. A mixed methods approach was employed during 2006 involving interviews with key stakeholders, a survey across three Scottish health board areas and focus groups. Nine key stakeholders from six national and local organisations were interviewed about the needs of older people being fitted with hearing aids. In total, 240 older people belonging to three different types of hearing impaired older people were surveyed: long-term users of hearing aids, new hearing aid users, and those on a waiting list from urban and rural areas (response rate = 24%). A series of eight follow-up focus groups with 31 audiology patients was held. Health professionals appeared to neglect appropriate provision of information and overly rely on technological interventions. Of 154 older people already fitted with hearing aids, only 52% of hearing aid users reported receiving enough practical help post fitting and only 41% reported receiving enough support. Approximately 40% reported not feeling confident in the use of their aids or their controls. Older people wanted more information than they received both before and after hearing aid fitting. Information provision and attention to the psychosocial aspects of care are key to enabling older people to adjust and optimise hearing aid benefit. [ABSTRACT FROM AUTHOR]

Background. Action-oriented study circles (AOSC) have been found to improve nutrition in 24 nursing homes in Sweden. Little, however, is known about the conceptual use of knowledge (changes in staffs' knowledge and behaviours). Methods. Qualitative and quantitative methods, structured questionnaires for evaluating participants' (working in nursing homes) experiences from study circles (n = 592, 71 AOSC) and for comparisons between AOSC participants (n = 74) and nonparticipants (n = 115). Finally, a focus group interview was conducted with AOSC participants (in total n = 12). Statistical, conventional, and directed content analyses were used. Results. Participants experienced a statistically significant increase in their knowledge about eating and nutrition, when retrospectively comparing before participating and after, as well as in comparison to non-participants, and they felt that the management was engaged in and took care of ideas regarding food and mealtimes to a significantly greater extent than non-participants. The use of AOSC was successful judging from how staff members had changed their attitudes and behaviours toward feeding residents. Conclusions. AOSC facilitates professional development, better system performance, and, as shown in previous studies, better patient outcome. Based on a collaborative learning perspective, AOSC manages to integrate evidence, context, and facilitation in the efforts to achieve knowledge translation in a learning organisation. This study has implications also for other care settings implementing AOSC. [ABSTRACT FROM AUTHOR]