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Ineffective use of the early warning score (EWS) can compromise recognition and response to patients' deteriorating condition. This study explores nurses' and physicians' ideas on initiatives for supporting the effective use of the EWS in a hospital setting. Participatory workshops were conducted, and data were analyzed using content analysis. Ideas generated for integrating new functions into the EWS protocol to facilitate effective use are described. Also recommended was that all users receive training and an update on how to use the EWS score to support acceptance and confidence using the protocol and thereby increase adherence to the EWS. Further research is needed on the efficiency of incorporating nurses' clinical judgment in the EWS protocol within different specialties and the effect on adherence to the tool. [ABSTRACT FROM AUTHOR]

Aim: The aim was to describe and discuss the process of establishing and leading a cross‐institutional partnership to regain focus on and reconceptualize fundamental nursing care in clinical practice, nursing education and research in one region in Denmark. Design: A discursive paper. The case study method is used as an adapted frame for describing and discussing the establishment and strategic decisions of a cross‐institutional partnership. Data sources This discursive paper draws on the authors' experiences with establishing a cross‐institutional partnership and related literature. Implications for nursing: The paper addresses the challenges surrounding fundamental care. Establishing cross‐institutional partnerships can contribute to a reconceptualization of fundamental care and initiate discussions on what nursing care is and requires. The paper provides an example of how a cross‐institutional partnership can be established and describes and discusses the opportunities and challenges in doing so. Conclusion: A key step in the process of establishing a partnership is to actively involve key stakeholders and stimulate their commitment to investing time and resources in the partnership. This requires commitment, clear strategic direction and leadership. Another key step is engaging and informing executive management leaders, and continuously nurture their interest. Impact The paper aims to inform clinicians, educators, nursing leaders, researchers and policy makers on how to organize a formal partnership structured around a strategic research, development and implementation programme where the focal point of the collaboration is improving nursing care by integrating the conceptual FoC framework. No patient or public contribution: Patients, service users, caregivers or members of the public were not involved in this study as it is a discursive paper based on the authors' experiences and relevant literature. [ABSTRACT FROM AUTHOR]

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]

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: Patients and their caregivers are expected to take joint responsibility for reporting symptoms and seeking medical assistance, for example, by calling oncology emergency telephones or other helplines during a cancer trajectory. Research objective: The aim was to explore the meaning of responsibility as it appeared in patients' or caregivers' experiences of calling an oncological emergency telephone. Design, participants and context: Inspired by qualitative description and qualitative content analysis, a secondary analysis of data from interviews with 12 participants calling the oncological emergency telephone at a Danish university hospital was performed. Ethical considerations: The project observes demands for safekeeping data and all regulations concerning research ethics in agreement with the Nordic Nurses Federation and the Danish Health Act. Findings: Two main themes emerged: (1) to act responsibly as a patient or caregiver was to 'be watchful and alert', 'report symptoms the right way' and 'do crosschecking' and (2) to deal with the burden of responsibility was to 'feel safe when dealing with the burden of responsibility' and 'be relieved from the burden of responsibility'. Discussion: Too much responsibility and a potential imbalance between healthcare professionals' expectations and callers' knowledge and capacity to act may place additional burdens on the callers, which may be eased by person-centred care. Conclusion: The meaning of responsibility appeared in the participants' capacity to act, where they observed, assessed and reported symptoms and controlled prescribed treatments as well as shared or handed over the responsibility to the healthcare providers. Thus, the analysis provided essential knowledge for healthcare professionals on how patients and caregivers handle this responsibility when faced with a cancer disease that is treated on an outpatient basis. [ABSTRACT FROM AUTHOR]

Background: Hemoglobin A(1c) (HbA(1c)) has been used in controlled trials for the last 10 years but has never been evaluated in clinical practice as an effective parameter for clinical outcome. We investigated the trend for glycemic control over 11 years in one county of 350,000 citizens., Methods: We studied 226,382 HbA(1c-DCCT-aligned) from 39,455 patients in whom routine monitoring for diabetes was initiated in 1993, 1996, or 2001. The trend in glycemic control was investigated in groups by probit plots, and in individual patients by target plots., Results: From 1993 to 2001, the number of HbA(1c) measurements increased three-fold. The number of new monitoring series increased from 0.22% to 0.27% of the county population, and the number of patients monitored using HbA(1c) as a proxy for diabetes increased from 0.5% to 1.5%. A proportional reduction in high HbA(1c) concentrations of 5% was identified in the 1993 group, compared to 15% in the 1996 group, and 20% in the 2001 group. The percentage of patients with diabetic first HbA(1c) experiencing normalization increased from 8% to 30% for males and from 9% to 24% for females (1993-2001). The percentage of HbA(1c) concentrations that were not normalized decreased from 78% to 53% for males and from 83% to 59% for females (1993-2001). The median HbA(1c) at initiation of monitoring decreased from 8.7% in 1993 to 7.5% in 2001 (p < 10(-5)). The number of normal first HbA(1c) results in monitoring series increased from 7% to 17% for males and from 8% to 22% for females. Up to 10% of subjects developed diabetic concentrations during monitoring., Conclusion: On average, patients with diabetic first HbA(1c) concentrations (> or =6.62%) showed an improvement in glycemic control from 5% in 1993 to 20% in 2001. High concentrations were easiest to reduce. In patients with originally diabetic HbA(1c) levels, 66% on average showed improved glycemic control in the 2001 series compared to 50% in the 1993 series. An average of 6% (1993) vs. 9% (2001) with originally normal HbA(1c) levels showed an upward trend inHbA(1c) levels. Median HbA(1c) at initiation of monitoring decreased from 8.7% in 1993 to 7.5% in 2001 (p < 10(-5)). The incidence of new cases was constant.