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WHAT IS KNOWN ON THE SUBJECT?: Losing a family member due to suicide has been described as a traumatic experience, as suicide-bereaved relatives grapple to accept the particular character of death and the core elements of guilt, self-criticism and stigma it inflicts. There are long-term consequences for those who bereave due to the suicide of their beloved on, a high risk for mental and physical health problems included. Feelings of guilt and self-stigma influence help-seeking behaviour among suicide-bereaved individuals. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Coping mechanisms adopted by suicide-bereaved individuals mediate the impact of suicide on their family, and especially on the quality of relationships among them. Supporting others in need can help alleviate guilt and self-blame for the suicide while it enables the bereaved to fulfil their need to keep a non-traumatizing, or even positive bond with the deceased. WHAT THE IMPLICATIONS FOR PRACTICE ARE?: Nursing interventions to facilitate suicide-bereaved family members' participation in self-help support groups and promote their engagement in supporting others in need are important. Mental health nurses need to facilitate the replacement of dysfunctional coping strategies, such as substance use or self-blame with more adaptive ones focused on the personal needs of the bereaved, in order to help them embrace a non-traumatizing memory of the deceased while being in peace with the social environment. Screening for mental health problems and management of shame, self-stigma and guilt during the grieving period needs to be a priority in nursing interventions.INTRODUCTION: Losing a family member to suicide is a traumatic experience which includes guilt and self-stigma. Yet, there is lack of data synthesis on the survivors' experience.A meta-synthesis of qualitative data on the interpretation of loss in suicide-bereaved family members, their coping strategies and the effects on family.A meta-ethnographic synthesis following a systematic literature search and evaluation of the methodological quality of the selected studies was applied.The narratives of 326 individuals (parents/siblings/children/spouses) reported in sixteen studies were analysed. Trying to achieve a balance between keeping alive a non-traumatizing memory of the deceased, destigmatizing and liberating themselves from self-blame, self-criticism and guilt while being able to transform this experience into support towards others in need, was identified as the essence of the experience of the bereaved.Although suicide within a family is a traumatic experience, spiritual and existential implications among the bereaved have been reported; their coping mechanisms mediate the impact of suicide on family sustainability.Nursing interventions to facilitate adoption of coping strategies centred on keeping a non-traumatizing memory of the deceased among the bereaved and promote their participation in self-help groups and activities to support others in need are important.

COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26 languages via web-based platforms. The findings of this study suggest that detergents, alcohol-based substances, and chlorinated compounds emerged as the most prevalent chemical agents compared to other sanitizers and disinfectants examined. Most frequently reported health issues include skin effects and respiratory effects. The Chi-square test showed a significant association between chlorinated compounds (sodium hypochlorite and per-chlorine) with all possible health effects under investigation (p-value

Objectives This study aimed to record the type and frequency of errors, with an emphasis on omissions, during administration of medicines to inpatients and to investigate associated factors. Methods This was a descriptive observational study. The medication process in 2 medical wards was observed by 2 observers using a structured observation form. χ2 Test, Kruskal-Wallis test, and regression analysis were used to explore associations between factors and errors. Results From the 665 administrations observed, a total of 2371 errors were detected from which 81.2% were omissions and 18.8% were errors of commission. Omissions in the infection prevention guidelines (46.6%) and in the 5 rights of medication safety principles (35.8%) were a predominant finding. In particular, omitting to hand wash before administering a drug (98.4%), omitting to disinfect the site of injection (37.7%), and omitting to confirm the patient’s name (74.4%) were the 3 most frequently observed omissions. Documentation errors (13.1%) and administration method errors (4.5%) were also detected. Regression analysis has shown that the therapeutic class of the drug administered and the number of medicines taken per patient were the 2 factors with a statistical significance that increased the risk of a higher number of errors being detected. Conclusions Errors during drug administration are still common in clinical practice, with omissions being the most common type of error. In particular, omissions in the basic infection and safety regulations seem to be a very common problem. The risk of a higher number of errors being made is increased when a cardiovascular drug is administered and when the number of medicines administered per patient is increased.

Patients with dementia (PwD) are characterized as a vulnerable group as they are unable to communicate their needs, putting them at risk for care omissions. The current study aimed to explore care toward PwD and detect if any aspects of care are omitted. An observation study was conducted in three medical-surgical adult wards of an acute general hospital. Data were collected by an observer, through field notes, and were analyzed with content analysis. A face scale was used to assess PwD's mood. Thirteen PwD were observed for 90 hours. Four thematic areas were identified: (a) Unmet Fundamental Patient Needs, (b) Human Right to Dignity and Respect, (c) Communication Deficiencies, and (d) Implementation of Nursing Interventions. Nurse–patient contact lasted from 5 to 7 minutes and numerous care omissions were noted. The face scale assessment revealed that most PwD looked very sad after nursing care. This study enriches insight for the care of PwD during hospitalization and emphasizes the need for health care workers' education and support. [ Research in Gerontological Nursing, 14 (3), 150–159.]

Introduction Delirium is the most common emergency for older hospitalized patients that demands urgent treatment, otherwise it can lead to more severe health conditions. Nurses play a crucial part in diagnosing delirium and their competencies facilitate the appropriate treatment and management of the condition. Aim This study aims to enhance the understanding of delirium care by exploring both knowledge and attitudes of nurses toward patients in acute care hospital wards and the possible association between these two variables. Method The Nurses Knowledge of Delirium Questionnaire (NKD) and the Attitude Tool of Delirium (ATOD) that were created for the said inquiry, were disseminated to 835 nurses in the four largest Public Hospitals of the Republic. These tools focused particularly on departments with increased frequency of delirium (response rate = 67%). Results Overall nurses have limited knowledge of acute confusion/delirium. The average of correct answers was 42.2%. Only 38% of the participants reported a correct definition of delirium, 41.6 correctly reported the tools to identify delirium and 42.5 answered correctly on the factors leading to delirium development. The results of the attitudes’ questionnaire confirmed that attitudes towards patients with delirium may not be supportive enough. A correlation between the level of nurses’ knowledge and their attitude was also found. The main factors influencing the level of knowledge and attitudes were gender, education, and workplace. Conclusion The findings of this study are useful for the international audience since they can be used to develop and modify educational programmes in order to rectify the knowledge deficits and uninformed attitudes towards patients with delirium. The development of a valid and reliable instrument for the evaluation of attitudes will help to further assess nurses’ attitudes. Furthermore, the results are even more important and useful on a national level since there is no prior data on the subject area, making this study the first of its kind.

Purpose To test whether Virtual Reality (VR) can benefit cancer patients from their interaction with an immersive environment, on their mood and their biophysical parameters, compared to those who will experience a Guided Imagery (GI) intervention. Methods This was a randomized crossover trial with 50 cancer patients on active chemotherapy treatment, who were randomized to one of two treatment sequences VR-GI or GI-VR. Patients were assessed for Mood Changes, using POMS questionnaire, for three symptoms (Nausea, Pain and Feeling Sick), using three questions from FACT-G questionnaire, and Bio-physical parameters (Blood Pressure, Heart Rate, Oxygen Saturation). Linear Mixed Effect Models were used for the statistical analysis. Results Patients experienced a better effect of mood state, for all the sub-scales of mood, after the VR intervention compared to GI, regardless of the sequence (p < 0⋅05). No effectiveness was found for Nausea, Pain and Feeling Sick symptoms. Statistically significant improvements were found on the Bio-physical parameters for the VR intervention (p < 0⋅05). Conclusion VR intervention based on mood induction strategies is a feasible and effective procedure for promoting positive mood in cancer patients during chemotherapy. Ways to integrate such innovative technologies in clinical practice need to be explored by health care professionals. Trial registration number NCT02392728.

Objective To describe the prevalence of polypharmacy and medication administration errors (MAEs) in adult inpatients and explore the association between polypharmacy and MAEs. Polypharmacy and MAEs are common phenomena in hospital settings. Different MAE contributing factors have been suggested by previous studies. Polypharmacy, however, is not always assessed by studies exploring medication error risk factors, and it may deserve further attention. Methods This was a descriptive observational study. The medication administration process in two adult medical wards of a tertiary hospital was recorded by two observers, with parallel review of patients’ medication records. Any deviation from prescriber’s order, manufacturers' administration instructions, or relevant institutional policies were recorded as errors. Chi square and regression analysis were used to explore associations between polypharmacy and MAEs. Results Six hundred sixty-five medication administrations were observed. The mean number of drugs prescribed per patient was 8.7. Most inpatients were prescribed more than 5 drugs (92.6%). Almost half of the inpatients were prescribed more than 9 drugs (45.1%) and some more than 12 drugs (22.6%). In total, 2,371 errors were detected, and the mean number of errors per administration was 3.5. When patients received more than 9 (the odds ratio is 1.57, [95%] CI 1.08-2.27; P = 0.02) or more than 12 (the odds ratio is 1.53, [95%] CI 1.04-2.30; P = 0.04) drugs, the occurrence of a higher number of errors per administration was significantly increased. Conclusion Polypharmacy is common in adult medical wards and can be associated with the occurrence of a higher number of MAEs. Future interventions aiming for the prevention of MAEs should consider addressing polypharmacy by improving prescribing practices and optimizing pharmacotherapy.

Pain is a common symptom for cancer patients. It is a problem for themselves and their relatives. Nurses are confronted with the treatment of cancer pain in their everyday clinical practice. Efficient management requires accurate and appropriate knowledge, positive attitudes, and competent evaluation skills. The aim is to explore the knowledge and attitudes of Cypriot home care nurses in pain management of cancer patients. Regarding methodology, a quantitative descriptive design was used and the data were collected with the Greek version of the McCaffery and Ferrell Nurses’ Knowledge and Attitudes Survey Regarding Pain questionnaire along with a demographic questionnaire. The sample of the study consisted of home care nurses working in non-profit organizations in Cyprus ( n = 31). For the analysis of data, the SPSSv.21. was used and the statistical significance was set to the p = .05. Results revealed of the total of 35 questions only 13 were answered correctly by the 80% of the participants. Limited knowledge was reported mainly on the duration of action, the effect and dosage of Pethidine, the risk of addiction and the use of non-medication interventions. Significant differences were found to the level of knowledge as regards the age and the experience of nurses. In the case study exercise, it was found that false assessment of pain was related to wrong decisions. Nurses’ attitudes seemed to be positive. In conclusion, the study revealed the knowledge deficits and need for continuous education of home care nurses on the assessment and management of pain for patients with cancer. Empowering nurses with better skills to deal with pain, a most distressing symptom of cancer, will result in a better quality of life for patients. However, the integration of pain management within the national cancer strategies is also very important.

Purpose: To evaluate the effectiveness of an educational program for cancer patients who developed pruritus, rash or photosensitivity induced by chemotherapy, epidermal growth factor inhibitor (EGFRI) treatments, or immunotherapy. Method: This study is a pilot randomized controlled study. The patients in the experimental pool were assigned to attend the educational program once weekly, for 4 weeks. For the patients in the control group the usual information was provided to them, as with any cancer patient who initiates treatment. Each participant’s induction day to the program (symptoms initiation) was considered part of week 0. For the Primary endpoint repeated measurements were taken weekly regarding the grade of skin reaction. For the Secondary endpoint the 36-Item Short Form Survey questionnaire (SF-36) (since week 0) and the Dermatology Life Quality Index (DLQI) questionnaire (since week 1) were recorded. Results: The study was conducted between January 2019 and December 2020 and included 40 patients. The grades of skin reactions, showed a statistically significant improvement in the intervention group compared to the control (Walds X2 = 19,25, p = 0.004). The results from the SF-36 questionnaire, showed that patients in the intervention group presented higher functional health and wellbeing status, although the results did not indicate a significant interaction between Group and Time, for all the questionnaire parameters. The effect size difference between control and intervention groups was higher at week 3 (d = 0.44) according to the results of DLQI questionnaire. Conclusions: Further validation of the effectiveness of the educational program over longer periods of time will be required.

Aim:This study aimed to investigate the perceived empowerment and turnoverintention of middle nurse managers before and after the implementation of a majorreform of the health care system in Cyprus, which also includes the transition of pub-lic hospitals towards administrative and financial autonomy.Background:The empowerment of nurse managers is important since previous stud-ies have shown that it is associated with performance at work and may have animpact on their turnover intention.Methods:A repeated cross-sectional study was conducted in March 2019 (firstphase) and was repeated in March 2020 (second phase), after the introduction ofmajor changes. The target population was all nurse managers of the public hospitals.The final sample consisted of 175 (RR 94%) participants in the first phase and178 (RR 95.6%) in the second.Results:Measurements at both time points revealed moderate levels of perceivedempowerment among Cyprus nurse managers. Empowerment score (17.95)appeared slightly lower at the repeat measurement compared to the first empower-ment score (18), but the observed difference was not statistically significant(p=0.184). Among the categories of empowermentopportunitieswas presentingstatistically significant differences between the two phases. At the second phase,mean scores of empowerment were consistently lower among those who statedYEScompared to those who statedNOin relation to (a) the intention to change depart-ment, (b) the intention to change profession and (c) the intention to change organiza-tion/hospital.Conclusions:This study demonstrated lower levels of empowerment among nursemanagers with turnover intentions. It is therefore needed to be investigated furtherReceived: 30 November 2021 Revised: 25 January 2022 Accepted: 23 March 2022DOI: 10.1111/jonm.136061196© 2022 John Wiley & Sons LtdJ Nurs Manag.2022;30:1196–1205.wileyonlinelibrary.com/journal/jonmwhether lower empowerment levels are the main reason for turnover intentions. Italso suggests the need for senior management to create opportunities and todevelop and implement interventions which aim to maintain and further improve theempowerment of the nurse managers and assess their effectiveness in terms of turn-over intention in the organization.Implications for nursing policy:The senior management of the hospitals needs toadopt retention strategies by establishing an empowered positive working environ-ment for nurse managers. Nurse managers need to collaborate with the senior man-agement and seek more access to opportunities, information, support and resourceswhich will enable them to perform their duties with efficiency and be more effective.

UNSTRUCTURED In “Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study”, (JMIR Res Protoc 2021;10(9):e25168,ndoi: 10.2196/25168), one error was noted. The last name of one author, Chatzittofis A, is by mistake written Hatzittofis in the published version. All other information regarding the author were correct.

Background Addressing the enhancement of ill health self-management skills in adults diagnosed with bipolar disorder may be considered an important intervention for health care systems worldwide. Objective This protocol describes the study “Management of my Bipolarity” (MoB), which aims to develop an educational intervention for adults with bipolar disorder and assess its effectiveness. The objectives include (a) a literature review on bipolar disorder educational interventions; (b) a qualitative exploration of the educational needs of people with bipolar disorder; (c) development of an educational intervention based on objectives (a) and (b) (ie, the MoB educational intervention); and (d) exploration of the effectiveness of the intervention regarding participants’ knowledge of their mental health condition and enhancement of their ill health self-management skills. The MoB educational intervention will consist of an in-person and a web-based intervention in the form of a digital platform. Methods The proposed interventional study is a combination of a qualitative and a quantitative design (mixed methods study). A focus group and content analysis will be implemented for the qualitative assessment of the educational needs of adults with bipolar disorder. The intervention will be developed based on the qualitative data of the study and relevant literature. The effectiveness of the acquired knowledge and self-management skills will be assessed according to (a) substance use behavior, (b) health locus of control, (c) impulse control, (d) adherence to pharmacotherapy, (e) relapse prevention, (f) improvement of quality of life, and (g) bipolar disorder knowledge level via structured instruments in the quantitative part of the study using descriptive and inferential statistics (SPSS version 24.0). Results A total of 13 patients with bipolar disorder have been interviewed (8 women, 5 men) to identify educational needs to be covered through the intervention. Moreover, a literature review on bipolar disorder educational interventions has been completed. These data have been incorporated in the design of the MoB in-person intervention and the digital platform. The digital platform is live, and the development of the MoB in-person intervention was completed at the end of 2020. The recruitment of the participants for the intervention (40 patients) and the control group (40 patients) began during the first semester of 2021. Moreover, by tracking the platform for 1.5 years, we have recorded that 2180 users have visited the platform with an average session duration of almost 2 minutes. Mobile and tablet devices are being used by 70% of the visitors. Conclusions Since new parameters regarding educational interventions will be explored, these findings are expected to provide evidence that participation in structured educational interventions offers patients the opportunity to improve adherence to pharmacotherapy and increase their quality of life. Trial Registration ClinicalTrials.gov NCT04643210; https://clinicaltrials.gov/ct2/show/NCT04643210 International Registered Report Identifier (IRRID) DERR1-10.2196/25168

Background From a notion concentrated on the ability to understand health information, health literacy (HL) has become a broad concept, considered a critical determinant of community health. The HLS-EU-measures perceived HL based on a theoretical model of the concept. Methods This study explored the metric properties of the tool in a new European setting among a convenience sample of 300 healthcare users in a state General Hospital, including the construct and known-group validity by social position and health-related behaviours. Results While factor analysis did not reveal the 12 theoretical subscales, there was a meaningful 3-factor structure (52.1% variance): “access to information”, “prevention and health promotion” and “user-provider interaction”. The postulated four cognitive skills (access, understand, appraise, apply) were evident within each domain (healthcare, prevention, health promotion), and vice versa. Overall, HL was problematic in 50.7% of participants with a steep gradient by social position. Alcohol consumption and physical activity were associated with HL, but not being overweight (mean BMI 26.8, SD: 5.2) or smoking (45.6% current or past smokers), which were generally prevalent. Conclusions HLS-EU-Q47 supports at least partly the theoretical construct of HL. The social gradient supports the criterion validity of the tool and highlights an important aspect of health inequality. Key messages HLS-EU-Q47 is a valid measure of perceived health literacy There was a steep gradient in low health literacy by social position

In “Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study” (JMIR Res Protoc 2021;10(9):e25168) one error was noted. One author's name was displayed as: Andreas Hatzittofis It has now been corrected to: Andreas Chatzittofis The correction will appear in the online version of the paper on the JMIR Publications website on September 15, 2021, together with the publication of this correction notice. Because this was made after submission to PubMed, PubMed Central, and other full-text repositories, the corrected article has also been resubmitted to those repositories.

Background The Patient safety movement contributed to the reduction of preventable adverse events associated with health care. Although patient safety issues have received the attention of educators in the health care studies, there is evidence that in nursing education and the associated curricula it is not well-incorporated. This may not allow students to acquire scientific knowledge and develop strong competencies to assure patient safety throughout their professional life. The aım of the study was the exploration of the undergraduate nursing student perspectives regarding knowledge received during their training about patient safety-related issues. Methods A descriptive comparative study was conducted with three and four-year undergraduate nursing students from the Cyprus Republic (n = 243) and Greece (n = 367). All students were surveyed using the Health Professional Education Patient Safety Survey (H-PEPSS) to describe students’ knowledge in the classroom and clinical setting. Results Students’ Knowledge about patient safety was expressed significantly higher (p Conclusıon The findings revealed the gap between theory and practice and the need for collaboration between the two settings. Also, students reported relatively higher knowledge with regards to the technical aspects of patient safety. Still, they were less knowledgable about the sociocultural aspects of the patient, such as working in teams.

Objectives:The clinical assessment of radioiodine-induced sialadenitis is relied on the observer-defined toxicity grading model. However, this model has significant limitations, the major one being the lack of systematic assessment based on objective criteria. The main aim of this study was the development and testing of an assessment tool which could examine the severity of post-irradiation sialadenitis.Methods:The development of the Sialadenitis Assessment Tool proceeded through three phases. The first and second phases included a literature review and the development of the tool which derived from the review, respectively. The third phase involved a pilot testing of the Assessment Tool to a sample of 34 patients undergoing I131therapy. The assessment was carried out by two independent healthcare professionals, pre- and post-radioiodine therapy. The results of the assessment tool were compared with other scales, including the DIRIX and EORTC H&N35.Results:According to the Cohen’s kappa test, the Sialadenitis Assessment Tool is a reliable tool for the assessment of sialadenitis (Cohen’s κ = 1). The concurrent and internal validity tests showed a tendency of association with most variables (p < 0.001) in the DIRIX and EORTC QLQ-HN35 scales.Conclusion:Preliminary evidence show that Sialadenitis Assessment Tool is a valid and reliable tool to assess radioiodine-induced sialadenitis in patients undergoing I131therapy post-thyroidectomy.

Aim To investigate the perceived self-efficacy, structural empowerment and power of middle nurse managers before the implementation of a major reform of public hospitals in Cyprus. Background Nurse managers' self-efficacy is important as it makes a difference in nurses' motivation and the way they feel, think and behave. Empowerment promotes workers' engagement at work, leading to positive performance outcomes. Methods This is a descriptive correlational study with a sample of 175 nurse managers. It was conducted during March-April 2019. Results The results showed that nurse managers perceived relatively high scores of self-efficacy, moderate levels of empowerment and moderate levels of both formal and informal power. Access to resources has been recorded as low. Statistically significant correlations have been found between self-efficacy, age and work experience. Nurse managers with a bachelor's degree had a higher informal power than those with a master's degree. Conclusions The present study provides recommendations for maintaining and enhancing the self-efficacy, empowerment and power of nurse managers in the evolving conditions of health care reforms. Implications for nursing management Nurse managers need to improve their access to empowerment structures and be involved in policy decision-making, future planning, organisation and control, aiming for the improvement of services and care that they provide.

Aim To support the development of appropriate policies and actions in the field of missed nursing care (MNC). Background There has been an ever-growing international debate on MNC, interventions that nurses have identified as necessary for their patients, but which for various reasons they are unable to provide or are forced to delay. Despite MNC's relevance, its translation into policies and actions has not been documented to date. Method A consensus development method was employed involving (a) a nominal group composed of experts in the field, policymakers and the President of the Regional Nursing Professional Boards, and (b) 218 nurses appointed primarily at the managerial levels. Results A total of eight consensus statements were approved and organized in a series of sub-statements designed to (1) render the concept of MNC culturally acceptable in the Italian context, with the agreement that compromised nursing care (CNC) is the best term to be used in this field, as a synonym for MNC; (2) measure CNC as a strategy to increase patient safety; (3) select an appropriate CNC measurement tool; (4) optimize CNC measurement; (5) conduct effective CNC data analysis; (6) design and implement interventions to prevent and/or minimize CNC; (7) assess and disseminate findings on interventions' effectiveness; and (8) provide final remarks on the way to move forward. Conclusions We developed a process to introduce the phenomenon of MNC in the Italian culture and agreed firstly on the term compromised nursing care, which better reflects MNC's meaning according to the context and facilitates an open discussion on the phenomenon both within and outside the profession. The following consensus statements emerged represent a systematic approach, starting from the measurement and finishing with the re-measurement of the occurrence of MNC after having implemented concrete actions. Implications for nursing management The approved consensus statements can guide decision-makers to develop concrete policies and actions that promote the improvement of quality of care and patients' safety by minimizing and/or preventing MNC's occurrence.

Background and PurposeThe prevalence of delirium during hospitalization is high in older patients and there is evidence of staff regarding them as unpopular or a burden. This study aims to develop an instrument examining nurses' attitudes toward patients with delirium.MethodsStages included (a) content identification, (b) content development, (c) content critique, (e) pilot study with a test–retest reliability, (f) field study consisting of psychometric testing of the internal consistency and construct validity.ResultsThe Cronbach's alpha was 0.89 and the stability reliability was acceptable. The factor analysis resulted in three factors explaining a total of 56.5% of the variance. hese factors are “beliefs,” “behavior,” and “emotions,” explaining 37.025%, 12.792%, and 5.652% of variance.ConclusionsThe Attitude Tool of Delirium (ATOD) is a reliable and valid instrument for the assessment of attitudes toward delirium.

Throughout the cancer continuum, patients are faced with the cancer- and treatment-related side effects that can have a negative impact on their overall quality of life. Cancer-related fatigue (CRF) and sleep deficiency are among the symptoms that patients and their caregivers most often experience. An increasing body of literature suggests that a strong correlation between CRF and sleep deficiency exists, indicating that they may be reciprocally related and that they may have similar underlying etiology. This paper aims at bringing together the opinions of leading cancer control (i.e., CRF and sleep) and oncology experts in order to increase the understanding of CRF and sleep deficiency's assessment, associated symptom clustering, symptom burden shared by caregivers, and CRF and sleep deficiency management in the cancer care context.

Caring is a key component of nursing. Exploring patients' perceptions of caring behaviors is essential to providing high-quality health care. This study aimed to investigate the validity, reliability, and internal consistency of the Greek version of the Caring Behaviors Inventory-16. This descriptive cross-sectional study involved hospitalized patients from six major hospitals in Greece who completed the Caring Behaviors Inventory-16 scale. This is a self-completing questionnaire whose answers range from one to six on a Likert-type scale. The overall score ranges from 16 to 96. To study the reliability of the scale, 50 patients completed the scale twice within two weeks, and then the repeatability was tested using the Pearson’s r correlation coefficient and the intraclass correlation coefficient. Construct validity and internal consistency were tested among 180 patients. Construct validity was tested through the principal component analysis. The internal consistency was tested through Cronbach’s alpha index. The statistical analysis was performed through the IBM Statistical Package for the Social Sciences (SPSS) Statistics Version 21.0 (Armonk, NY: IBM Corp.). The level of statistical significance was set at 5%. The study was conducted in the period October-December 2019. According to the results, the average age of patients was 58 years old and 50.6% were men. The mean value of the scale was 79.31 (standard deviation ± 15.75). The principal component analysis showed that the scale is unidimensional highlighting one factor that explains 68.24% of the total variance. Questions loadings ranged from 0.575 to 0.912 on the same factor. This means that all questions measure the same structure and are strongly concentrated in the same construction. Regarding the repeatability test, no statistically significant differences were observed between the two measurements. Pearson's r coefficient was 0.82 while the intraclass correlation coefficient was 0.91 (p

Aim To reflect upon the concrete implications of the COVID-19 outbreak regarding ongoing health service and nursing management research (NMR) and to identify possible research priorities for the current and post-pandemic era. Background Health service research and the nursing management research debate have received little attention to date, despite their relevance in responding to the increased demand of care during the COVID-19 outbreak. Methods A critical analysis on experiences was performed while leading international-funded studies at different degrees of complexity and targets, involving nurse managers, nurses, care processes and health care services in the last year. Results Ongoing research projects have been profoundly affected by the COVID-19 outbreak in their aims, methods, management processes, feasibility and outcomes. Conclusions The COVID-19 outbreak is an unprecedented stress test for the health care sector and for the nursing services. Its onset and persistence have rendered more easily to see what prevails in terms of effectiveness and what fails in our health care services. Implications for nursing management Nurse managers have lived and are still living through this crisis, given their omnipresence in the health care systems. Therefore, setting NMR priorities and working together to imagine and design the post-COVID-19 era is essential.

IntroductionAs the world population ages, glaucoma is becoming an increasingly significant cause of blindness. A key component in the management of glaucoma is the use of prescribed medications and the adherence to treatment. However, there is evidence of low adherence to prescribed medication in chronic diseases, such as glaucoma. This study aims to explore the level of medication adherence, self-efficacy, social support and health literacy among the patients with glaucoma and to determine if there are any correlations between them. The ultimate aim is to use the information to develop an educational programme for patients with glaucoma at a later stage.Methods and analysisThis is a mixed-methods study which includes two stages: a descriptive study (stage 1) and focus group discussions (stage 2). Sample: Patients with glaucoma or ocular hypertension, using at least one kind of drops, from two ophthalmology clinics. Selected measures include: The Glaucoma Treatment Compliance Assessment Tool, The European Health Literacy Survey Questionnaire, The Glaucoma Medication Self-Efficacy Questionnaire and The Multidimensional Scale of Perceived Social Support. Two focus groups will be used for the collection of qualitative data, aiming to enrich the study with the patients’ experiences. The data will be analysed with SPSS, using descriptive and inferential statistics for stage 1 whereas content analysis will be used for the data from the focus group discussions (stage 2).Ethics and disseminationPermission to conduct the study was received from the National Bioethics Committee and the board of management of the two ophthalmology clinics. All participants will be informed fully on the purpose and methods of the study. Consent forms will be signed and at any time participants will have the right to withdraw. Confidentiality and the protection of data will be respected at all times.

Health literacy (HL) and eHealth literacy (eHL) can facilitate carers of people with dementia (PwD) to search, find, assess and apply information related to dementia-specific issues from different resources. There is a lack of research with regard to HL and eHL among carers of PwD. The aim of this study is to identify the levels of HL and eHL among carers of PwD in Greece and Cyprus and to search for the associations with other caring concepts. This study followed a descriptive correlational design. In total, 174 primary informal carers of PwD, mostly women, over 45 years old and with more than 12 years of education and 67 secondary carers (family, friends or neighbours) participated in the study. Primary informal carers completed a face-to-face survey on the level of HL and eHL, internet use, dementia-specific internet use, care-giving self-efficacy, coping strategies, care-giving perceptions and social support. Primary informal carers reported a high level of eHL and HL. Carers with higher HL were more likely to report higher score of eHL, care-giving self-efficacy and lower score of problematic/dysfunctional coping. Higher score of eHeals-Carer "information seeking" was related with higher use of emotion-focused strategies. From this study, a positive message was received with regard to the role of HL and eHL in the everyday caring life. Non-for-profit organisations and healthcare professionals could integrate in their practice assessment tools and develop tailored training courses for carers enhancing low level of HL and eHL.

This chapter discusses the concept of missed care, both from a theoretical point of view and from a practical one, mentioning philosophical and legal distinctions, and in relation to the concept of rationing in nursing care. The central question of this chapter is whether missed nursing care constitutes an unavoidable presumption within the context of rationing discussions. To answer this question, it begins by examining the concept of omission. At first glance, an omission is not equally bad as an action, but this has been contested, and it has important implications in the delivery of health care. Omissions have different meanings in nursing and medical contexts as the scope of practice of these professions is also different. Moreover, nursing care does not have as clear limits as medical care does; this creates difficulties in defining missed nursing care, and coupled with limited resources, that is nursing time combined with low staffing, renders rationing of nursing care inevitable. Therefore, attention is shifted to the question of whether missed nursing care should be seen as an error, and of what kind of error it is. In conclusion, a somewhat idealistic approach of nursing care and its missing elements is adopted, which nevertheless lies in the core of the nursing profession.

RANCARE brought together a large number of researchers, early career investigators, policy makers, academicians, clinical nurses, and PhD students, to talk about and study on an international nursing phenomenon: missed nursing care. As COST actions rely on exchange of ideas, RANCARE made good use of every opportunity that would allow an in-depth study of its objectives. During the life span of RANCARE, a great number of visits, research collaborations, and project submissions for funding took place. Inevitably, these synergies significantly contributed to the success of the action in addition to further expanding the role of nursing as a health science.

The aim was to synthesize the findings of empirical research about the unmet nursing care needs of older people, mainly from their point of view, from all settings, focusing on (1) methodological approaches, (2) relevant concepts and terminology and (3) type, nature and ethical issues raised in the investigations. A scoping review after Arksey and O’Malley. Two electronic databases, MEDLINE/PubMed and CINAHL (from earliest to December 2019) were used. Systematic search protocol was developed using several terms for unmet care needs and missed care. Using a three-step retrieval process, peer-reviewed, empirical studies concerning the unmet care needs of older people in care settings, published in English were included. An inductive content analysis was used to analyse the results of the included studies (n = 53). The most frequently used investigation method was the questionnaire survey seeking the opinions of older people, informal caregivers or healthcare professionals. The unmet care needs identified using the World Health Organization classification were categorized as physical, psychosocial and spiritual, and mostly described individuals’ experiences, though some discussed unmet care needs at an organizational level. The ethical issues raised related to the clinical prioritization of tasks associated with failing to carry out nursing care activities needed. The unmet care needs highlighted in this review are related to poor patient outcomes. The needs of institutionalized older patients remain under-diagnosed and thus, untreated. Negative care outcomes generate a range of serious practical issues for older people in care institutions, which, in turn, raises ethical issues that need to be addressed. Unmet care needs may lead to marginalization, discrimination and inequality in care and service delivery. Further studies are required about patients’ expectations when they are admitted to hospital settings, or training of nurses in terms of understanding the complex needs of older persons.

Missed Nursing Care is widely recognized as affecting patient safety and healthcare outcomes. Theoretical frameworks, antecedents and consequences have been extensively studied while interventions aimed at preventing the Missed Nursing Care remain little investigated to date. Nurse Managers and Nurse Directors play a main role in promoting interventions at the unit, hospital and at the policy levels. However, few evidences are available to date, thus limiting an evidence-based approach. The aim of this study was to emerge interventions used on a daily basis by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care.A qualitative descriptive study design based upon a positive deviance approach was adopted. Twelve Nurse Managers and Nurse Directors were purposefully selected, working at Hospital, Healthcare Trust or Nursing Home levels, in Italy. Participants were interviewed in two focus group sessions. A thematic analysis of the audio-recorded interviews was performed by two researchers.The following interventions have been reported as effective in preventing and/or minimizing the Missed Nursing Care: (a) Expanding the nursing care capacity; (b) Ensuring the standard of care and an early detection of failures; (c) Monitoring the processes of care; (d) Promoting a shared decision-making; (e) Redesigning the layout of the hospital systems; (f) Promoting a culture towards the Missed Nursing Care prevention, and (g) Realigning the nurse management to the care of patients.Several interventions based mainly on process dimension and with preventive intents are daily enacted by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care. Measuring the effect of these interventions through rigorous studies could help in expanding the evidence available to contrast a phenomenon that threatens patient safety.