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Nurses are imperative for healthcare systems’ ability to effectively function during pandemics, yet multiple factors may affect their willingness and preparedness to work. The aim of the present cross-sectional survey was to identify factors associated with registered nurses’ (RN) willingness and preparedness to work during the novel coronavirus disease (COVID-19) pandemic. The study was reported following the STROBE guidelines. A total of 358 nurses completed a self-administered online questionnaire. The participants were a part of a COVID-19 task force at a Danish university hospital during spring 2020. The results showed that the majority of RNs felt a professional obligation to engage in clinical work during the pandemic; however, their willingness and preparedness to work were affected by multiple factors, such as being relocated voluntarily, being prepared for the task and feeling safe. This study highlights that these factors are essential for the hospital management and nurse leaders to take responsibility for. [ABSTRACT FROM AUTHOR]

This study aims to explore how a changed COVID-19 work environment influences nurses' clinical decision-making. Data were collected via three focus groups totaling 14 nurses working in COVID-19 pandemic wards at a Danish university hospital. The factors influencing decision-making are described in three themes; navigating in a COVID-19 dominated context, recognizing the importance of collegial fellowship, and the complexities of feeling competent. A strong joint commitment among the nurses to manage critical situations fostered a culture of knowledge-sharing and drawing on colleagues' competencies in clinical decision-making. It is important for nurse leaders to consider multiple factors when preparing nurses not only to work in changing work environments, but also when nurses are asked to work in environments and specialties that deviate from their usual routines. [ABSTRACT FROM AUTHOR]

The maintenance of physical distance, the absence of relatives and the relocation of registered nurses to COVID-19 units presumably affects nursing care at non-COVID-19 units. Using a qualitative design, this study explored registered nurses' experiences of how COVID-19 influenced nursing care in non-COVID-19 units at a Danish university hospital during the first wave of the virus. The study is reported using the COREQ checklist. The analysis offered two findings: (1) the challenge of an increased workload for registered nurses remaining in non-COVID-19 units and (2) the difficulty of navigating the contradictory needs for both closeness to and distance from patients. The study concluded that several factors challenged nursing care in non-COVID-19 units during the COVID-19 pandemic. These may have decreased the amount of contact between patients and registered nurses, which may have contributed to a task-oriented approach to nursing care, leading to missed nursing care. [ABSTRACT FROM AUTHOR]

Aim: This study describes and explores the influences in registered nurses' use of early warning scores to support clinical decisions in a hospital setting. Design: A focussed ethnography allowed for the investigation of registered nurses' clinical practices in two wards in a Danish University Hospital. The study adhered to the 'Standards for Reporting Qualitative Research'. Methods: Participant observation and ethnographic interviews were conducted from March 2019 to August 2019. Ten registered nurses were observed and interviewed, and four physicians were interviewed. Data were analysed using LeCompte and Schensul's ethnographic analysis. Findings: The findings show the registered nurses' ambivalence towards the early warning score as a decision support system. Early warning score monitoring created a space for registered nurses to identify and initiate optimized care. However, when early warning scores contradicted registered nurses' clinical judgments, the latter were given priority in decisions even though elevated scores were not always accounted for in the situation. Moreover, we found unspoken expectations in the collaboration between physicians and registered nurses, which influenced the registered nurses' workloads and decisions regarding early warning scores. Conclusion: Registered nurses' clinical judgment is essential to clinical decisions on the care and safety of patients if used combined with the early warning score. Interprofessional collaboration between registered nurses and physicians about the early warning score is challenged. Future research may address this challenge to explore how it should be operated as a collaboration tool. Impact: The study adds knowledge to the evidence base of registered nurses' use of early warning score and the advantages and challenges associated with the use of these scoring systems. The study may provide valuable knowledge for the future development of policies or implementation strategies. [ABSTRACT FROM AUTHOR]

Background: Nursing documentation is an essential aspect of ethical nursing care. Lack of awareness of ethical dilemmas in nursing documentation may increase the risk of patient harm. Considering this, ethical dilemmas within nursing documentation need to be explored. Aim: To explore ethical dilemmas in nurses' conversations about nursing documentation. Research design, participants and context: The study used a qualitative design. Participants were registered nurses from a Patient Hotel at a Danish University Hospital. Data were collected in three focus groups with a total of 12 participants. Data analysis consisted of qualitative content analysis inspired by Graneheim and Lundman. Ethical consideration: This study was conducted in accordance with the ethical principles of research and regulations in terms of confidentiality, anonymity and provision of informed consent. Findings: Ethical dilemmas were strongly present in nurses' conversations about nursing documentation. These dilemmas were demonstrated in two themes: (1) a dilemma between respecting patients' autonomy and not causing harm, which was visible in nurses' navigation between written documentation and oral tradition, and (2) a dilemma concerning justice and fair distribution of goods, which was visible in nurses' balancing between documenting deviations and proof of nursing practice. Discussion: Ethical dilemmas in nursing documentation regarding respecting patients' autonomy and not causing harm accentuated discussions on professional responsibility and patient participation in clinical decisions. Dilemmas in justice and fair distribution of goods emphasised discussions on trust in relationships versus trust in electronic health records. Conclusion: Actual tendencies in the healthcare system may increase ethical dilemmas in nursing documentation. Sharing otherwise invisible and individual experiences of ethical dilemmas in nursing documentation among nurses, nurse leaders and decision-makers will enable addressing these in reflections and discussions as well as in considering adjustments of conditions for nursing documentation. [ABSTRACT FROM AUTHOR]

Background: Cancer treatment is often given on an outpatient basis. An oncological emergency telephone line has been established to improve access to cancer care and prevent life-threatening side effects. However, healthcare professionals need to make clinical decisions without being able to assess patients face-to-face, which may be problematic. This study explores how healthcare professionals experience clinical decision-making in oncological emergency telephone consultations. Methods: An exploratory qualitative approach applying three focus groups with healthcare professionals from a Danish university hospital were undertaken. Data were analysed using inductive content analysis. Results: An overall theme elucidated how healthcare professionals ended up deciding during each call whether the problem could be solved on the phone or the patient had to come for a face-to-face consultation or to wait and see whether the condition changed. Some decisions were easy to make, while others were moderate or diffi- cult. The decision was influenced by several factors that could be structured into three themes: reliance on one's own knowledge and experience, consideration of different perspectives and the influence of context. Conclusion: This study demonstrated that clinical decisionmaking in oncological emergency telephone consultations includes three types of decisions that are intertwined with intra-personal, inter-professional and contextual factors such as personal knowledge, collaboration and workload. These factors are essential for the timely referral of patients to the right level of service. [ABSTRACT FROM AUTHOR]

Background: Telephone consultations are common in supporting patients and caregivers in managing symptoms from cancer diseases and side effects from cancer treatment. In connection with telephone consultations, it may be a challenge that healthcare professionals have to rely on their auditory sense alone when they assess whether the problem can be solved over the telephone, or whether patients need an examination face to face. Objective: To explore how healthcare professionals identify patients' essential concerns and assess serious conditions in calls to an oncological emergency telephone without face‐to‐face contact. Methods: From a phenomenological‐hermeneutical frame of reference, the analysis of three focus groups with a total of 16 healthcare professionals was guided by content analysis. Ethics: The study follows the ethical guidelines for research. Results: Two themes emerged. To identify patients in serious conditions, healthcare professionals kept focus on: (1) 'Reaching a mutual understanding without the clinical eye'. Before making a decision regarding a face‐to‐face examination, the healthcare providers were as follows: (2) 'Listening to an inner voice – attention on clues and signs'. Limitations: The transferability of the findings is limited to healthcare professionals who perform telephone‐mediated care in a team of nurses and physicians. Conclusion: Staying open for diverse perspectives and integrating nonanalytical as well as analytical illness scripts, healthcare professionals were able to identify patients that needed further examination face to face. [ABSTRACT FROM AUTHOR]

A divergence exists between registered nurses' (RNs') intention to document together with the patient and their actual documentation practice; a practice that also diverges from official intentions of patient participation. This study aimed to explore and describe RNs' reflected experiences on patient participation in nursing documentation. A descriptive qualitative study was conducted based on three focus groups with 14 registered nurses from an acute medical ward. Content analysis and conversational analysis were performed. The reporting adhered to the COREQ checklist. The findings showed that nurses made little mention of patient participation in nursing documentation due to challenges in meeting both the patients' expected needs and nurses' needs. However, patient participation was important for time accurate and summative nursing documentation. This study adds to a critical debate on patient participation and contributes to a practice-based understanding of the challenges that registered nurses experience concerning patient participation in nursing documentation. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore patients' experiences of situational awareness in the outpatient encounter when they are informed about the diagnosis of breast cancer or malignant melanoma. Background: Patients enter a stressful situation when receiving a diagnosis of breast cancer or malignant melanoma, and research indicates that needs are most prominent at this time. However, healthcare professionals often fail to address these needs adequately. It is unclear how patients experience situational awareness practised to meet their fundamental needs in the encounter when they are informed about the diagnosis of cancer. Design: This study used a phenomenological hermeneutical approach. Methods: Nine semi‐structured interviews with patients being diagnosed with breast cancer or malignant melanoma were performed. The interpretation theory of Paul Ricoeur guided the analysis. The study is presented in line with the COREQ checklist. Results: The analysis resulted in three themes: 1) "Being accompanied" refers to how patients need information to be targeted to them as individuals. 2) "Being seen" points to HCPs' exploration of the patients' perspectives to get an understanding of their preferences. 3) "Being taken care of" indicates that patients feel supported if situational awareness is practised by the healthcare professionals. Conclusion: Practicing situational awareness in the outpatient encounter is essential to patients' experience of feeling accommodated or rejected. Patients feel rejected when their fundamental needs are not met while experiencing situational awareness seems to accommodate fundamental needs and pre‐empt an inappropriate patient outcome. Relevance to clinical practice: HCPs need to acknowledge the importance of using a structured approach to meeting patients' fundamental needs in a stressful situation. Each patient is different and may experience different needs in encounters where they are receiving the diagnosis of breast cancer or malignant melanoma. Therefore, treatment and care must be tailored to the individual patient based on a caring relationship. [ABSTRACT FROM AUTHOR]

Background Despite the risk of delayed motor development in infants born preterm, knowledge about interventions in the neonatal intensive care unitt (NICU) and the effects of dosing is sparse. Objective The objectives of this study were to examine the effectiveness of a parent-administered exercise program in the NICU on motor outcome at 3 months corrected age (CA) and the effect of dosing on motor performance. Design This was a randomized clinical trial. Setting The study was conducted at 3 university hospitals in Tromsø, Trondheim, and Oslo, Norway. Participants A total of 153 infants with gestational age  < 32 weeks at birth were randomly assigned to intervention or control groups. Intervention A 3-week parent-administered intervention designed to facilitate movements in preterm infants was performed in the NICU. Parents were asked to administer the intervention 10 minutes twice a day. Measurements Test of Infant Motor Performance (TIMP) was used to assess short-term outcome at 3 months CA. Results No significant difference in the TIMP z-score was found between intervention and control groups at follow-up 3 months CA, but a significant positive relationship was found between total intervention dose and TIMP z-scores. The adjusted odds of having a clinical z-score < 0 at 3 months CA was about 6 times higher for infants with less than median intervention time than for infants with a longer intervention time. Limitations The number of infants born before 28 weeks was small. A spillover effect in favor of the control group was possible. We do not know if the infants received physical therapy after discharge from the hospital. Conclusions There was no difference in motor performance between the intervention group and the control group at 3 months CA. However, an increased intervention dose was positively associated with improved motor outcome. [ABSTRACT FROM AUTHOR]

Background. Early identification of children at high risk of future neurodevelopmental disability is important for the initiation of appropriate therapy. In research settings, the assessment of fidgety movements (FMs) at 3 months supports a general movement assessment (GMA) as a strong predictor for subsequent motor development, but there are few studies from routine clinical settings. Objective. The study objective was to examine the relationship between FMs and neurodevelopmental outcome by the age of 2 years in high-risk infants in a routine hospital clinical setting. Design. This was a prospective study. Methods. A GMA was performed in 87 high-risk infants at 3 months after term age. The infants were clinically assessed for cerebral palsy (CP) at 2 years. Sensitivity, specificity, likelihood ratios, and positive and negative predictive values were computed. The relative risk of motor problems by the age of 2 years, according to the GMA, was estimated. Results. Of the infants with normal FMs, 93% (50/54) had normal development and none was diagnosed with CP, whereas 75% (12/16) with abnormal or sporadic FMs had normal development. In contrast, 53% (9/17) of those without FMs had CP. When the GMA was considered to be a test for CP and absent FMs were considered to be a positive test result, the sensitivity was 90% and the specificity was 90%. The likelihood ratios for positive and negative test results were 8.7 and 0.1, respectively. The negative predictive value was 99%, and the positive predictive value was 53%. The risk of motor problems by the age of 2 years increased linearly with the extent of pathological results on the GMA and was 10 times higher when FMs were absent at 3 months than when FMs were normal. Limitations. The relatively small study sample was a study limitation. Conclusions. When applied in a routine clinical setting, the GMA strongly predicted neurodevelopmental impairments at 2 years in high-risk infants. [ABSTRACT FROM AUTHOR]