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Aim: To explore how people with heart failure develop and change their views of dying and death. Design: A Straussian grounded theory approach. Methods: Purposive and theoretical sampling were used. Data collection and analysis were repeated until reaching data saturation using the constant comparative method. We conducted semi‐structured interviews between January 2019 and July 2020 with 24 people with heart failure from a university and a community hospital in Japan. Results: Initially, participants' views of dying and death were unrelated to their disease. After the first turning point, namely the confirmation of the deterioration and incurability of the disease, their views became related to their own disease, adding to the suffering caused by the exacerbated symptoms. After the second turning point, namely when participants became tormented by the inevitability of death, they added their struggles with physical, psychological, and spiritual pain owing to medical interventions to their views of dying and death. Only a few participants reached the last stage of this process as it was emotionally distressing; some chose not to proceed to the next stage. Conclusion: Participants develop their views of dying and death gradually and in stages while they experience two turning points. Healthcare providers need to address this process while keeping in mind that proceeding this process requires some turning points, and it can be painful. Impact: This study provides a theoretical framework on the development of the views regarding dying and death of people with heart failure; it showed that these people need some turning points and to pass through stages to develop/individualize their views, and that this process is inherently distressing. This theory provides a cornerstone for healthcare professionals to understand the disease‐specific transition in views of dying and psychological readiness, and it may help establish a therapeutic relationship that includes advance care planning. [ABSTRACT FROM AUTHOR]

Aims: To investigate the end‐of‐life (EOL) nursing care practice process in long‐term care (LTC) settings for older adults in Japan. Design: A qualitative study based on grounded theory developed by Corbin and Strauss. Methods: Sampling, interviewing, and analysis were performed cyclically, with results for each stage used as the basis for data collection and next‐stage analysis decisions. Semi‐structured interviews were conducted from March 2015‐March 2019 with 22 nurses from eight LTC settings. Analysis was performed using coding, constant comparison, and emerging categories. Results: The core category, "guiding the rebuilt care community to assist the dying resident" comprised five categories: "assessing the resident's stage," "harmonizing care with the dying process," "rebuilding a care community," "helping community members care for the resident," and "encouraging community members to give meaning." The participants were described as "traditional village elders" who were the integral members of the care community, as well as guides who helped and encouraged the community. Conclusion: Results revealed the holistic process of EOL nursing‐care practice in Japan. Nurses aimed to allow LTC residents to die as social human beings, surrounded by people, and not just responding physical and psychological distress. Such practice requires nursing expertise, healthcare skills, and leadership qualities to build and serve care communities. Nurses must also consider residents' uncertainties and vulnerabilities as well as their cultural backgrounds. Impact: This study showed that the nurses hold unique roles in providing dying people with care from a community. These findings can potentially be applied for developing a universal model for LTC nurses in many aging populations, to modify their EOL care practice, educate new LTC nurses, and collaborate with other healthcare professionals. [ABSTRACT FROM AUTHOR]

Aim This study explores nurse managers' experiences in dealing with patient/family violence toward their staff. Background Studies and guidelines have emphasised the responsibility of nurse managers to manage violence directed at their staff. Although studies on nursing staff have highlighted the ineffectiveness of strategies used by nurse managers, few have explored their perspectives on dealing with violence. Methods This qualitative study adopted a grounded theory approach to explore the experiences of 26 Japanese nurse managers. Results The nurse managers made decisions using internalised ethical values, which included maintaining organisational functioning, keeping staff safe, advocating for the patient/family and avoiding moral transgressions. They resolved internal conflicts among their ethical values by repeating a holistic assessment and simultaneous approach consisting of damage control and dialogue. They facilitated the involved persons' understanding, acceptance and sensemaking of the incident, which contributed to a resolution of the internal conflicts among their ethical values. Conclusions Nurse managers adhere to their ethical values when dealing with patient violence toward nurses. Their ethical decision-making process should be acknowledged as an effective strategy to manage violence. Implications for nursing management Organisational strategies that support and incorporate managers' ethical decision-making are needed to prevent and manage violence toward nurses. [ABSTRACT FROM AUTHOR]