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BACKGROUND: Patients who are suffering may be commonly encountered in health care. The growing use of telehealth implies that encounters with patients who are suffering may increasingly take place at a distance. "Distant suffering" is a concept coined within sociology to describe the suffering of far-away others. It is conceptualized as a paradox, as distance changes the relation between the witness of suffering and the suffering encountered. Impacts may include a potential detriment to the sufferer and ethical implications for the witness. OBJECTIVE: To explore the concept of distant suffering and any relevance, implications, or important avenues for potential research within the healthcare sciences. DESIGN: Rodgers' evolutionary concept analysis. DATA SOURCES: Databases of Web of Science, Medline, CINAHL and PsycInfo were searched for the terms "distant suffering" or "mediated suffering". REVIEW METHOD: Attributes, surrogate or related terms, antecedents, consequences, and uses of the concept were extracted and synthesized. RESULTS: Thirty articles published within the past ten years were selected for review from the search results. "Distant suffering" was characterized as comprising 1) mediated far-away suffering, 2) a "recognizer" or witness, and 3) a potential role of a moderator. Antecedents include shared understandings and socially-influenced responses. Consequences include responses like empathy, compassion, pity, also indifference, cynicism and compassion fatigue. CONCLUSIONS: Further research to explore distant suffering from healthcare sciences' perspective could uncover valuable insights for those suffering, for healthcare workers, and any who are exposed to it. An improved understanding of how distant suffering is conveyed and moderated could enable targeted reduction of exposure or improve response to distant suffering. Such knowledge could help diminish negative consequences for those suffering, for healthcare workers who are caring at a distance for

INTRODUCTION: During the COVID-19 pandemic, there was a remarkable increase in public volunteering for the care of hospitalized patients. They faced challenges during their voluntary care provision. This study aimed at exploring public volunteers' experiences of the challenges of the voluntary care provision to hospitalized patients with COVID-19. METHODS: A descriptive qualitative study with an inductive content analysis method was conducted, 2022-2023. Eighteen public volunteers providing care to hospitalized patients with COVID-19 were purposefully selected among 10 hospitals, specialized in COVID-19 care in Tehran and Shiraz, Iran. Data were collected over 7 months through in-depth semistructured interviews and concurrently analyzed using conventional content analysis methods. FINDINGS: The challenges of voluntary care provision to hospitalized patients with COVID-19 were illustrated in five main categories, each with two subcategories. The categories included structural challenges, interpersonal conflicts, financial constraints, covert participation and the deteriorating condition of care provision. The subcategories comprised lack of volunteer recruitment bases, ineffective organization of voluntary activities, pervasive distrust, heightened risk of clinical errors, conflicts between volunteer commitments and primary occupation, lack of financial support, lack of family support, isolation by friends, mental trauma and physical exhaustion. CONCLUSION: Public volunteers encounter diverse challenges while providing care to hospitalized patients with COVID-19, which negatively impacts their motivation to serve. By addressing these challenges, we can create a more supportive environment for volunteers and enhance the quality of care provided to patients during public health emergencies. Identifying such challenges can assist healthcare managers and policymakers develop effective strategies to mitigate mounting difficulties and enhance volunteer services, thereby im

Introduction Tele–mental care is ubiquitous worldwide [1]. It is effective and even preferred by patients [2]. Yet, providers have expressed concerns that the technology limits conveying nonverbal cues [3,4] or impedes the therapeutic relationship [3,5]. These key aspects of communication and interpersonal connection in care could be described as types of distances, where spatial distance could prevent patient observation, and psychological distance may prevent effective interpersonal connection. Considering the growing use of tele–mental care and the relevance of these forms of distance for successful tele–mental care encounters, this study was conducted to explore these or other forms of “distance” that arise in providers’ descriptions of tele–mental care encounters., This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

To describe surgical nurses' strategies for enhancing their pain management proficiency. A qualitative design was used to conduct the study. The participants were forty surgical nurses who had at least six years of nursing experience in caring for patients with pain. They responded to open-ended questions based on a review of the policy documents concerning the main elements of the pain management programme to be implemented by surgical nurses. Three key themes emerged from the surgical nurses' suggested strategies: partnering, disrupting, and becoming familiar with pain management competency concerns. Surgical nurses' strategies in acute and chronic pain management nursing units included solving patients' problems and promoting and enhancing pain strategies to address health challenges in organisations. The themes presented in the results include enhancing pain management in nursing competencies. State-of-the-art healthcare technologies are being applied to pain management. Surgical nurses' strategies should improve the quality of nursing care, especially post-surgery recovery time. It is recommended to engage patients, their families, and multidisciplinary care teams in other healthcare fields.

BACKGROUND: Encountering patients who are suffering is common in health care, and particularly when providing mental health care. Telehealth technologies are increasingly used to provide mental health care, yet little is known about the experiences of providers when encountering patients who are suffering within remote care. The present study explored health care providers' lived experiences of encountering patient suffering during telemental health care. METHODS: A qualitative phenomenological approach was used to uncover participants' experiences. In-depth interviews were conducted with a purposive sample of physicians, psychologists, and therapists who used telemental health in varied clinical practices in Sweden. Data were analyzed using descriptive phenomenology. RESULTS: Telehealth care with patients who were suffering was experienced by providers as loose connections, both literally in compromised functioning of the technology and figuratively in a compromised ability connecting emotionally with patients. Providers' lived experiences were explicated into the following aspects: insecurity in digital practice, inaccessibility of the armamentarium, and conviction in the value of telehealth care. Interpersonal connection between patient and provider is necessary. Worry and guilt arose for providers with fears that technology would not work, patient status was deteriorated, or the care needed could not be delivered. Providers overcame barriers in telehealth encounters, and expressed they perceived that patients appreciated the care received, and through it found relief. CONCLUSIONS: This study brings an understanding of experiences in providing telemental care for patients who are suffering. Providers experience challenges in connecting with patients, and in accessing tools needed to enable reaching the goals of the caring encounter. Efforts to ensure functioning of technology, comfort with its use, and accessibility of tools might be some accommodations to suppor

Introduction: Nursing staff have faced various challenges during the global pandemic of COVID-19 such as nursing shortages. The great number of COVID-19 patients requiring hospitalization placed heavy demands on healthcare staff to maintain patient safety and to work according to constantly changing guidelines to prevent the spread of infection. Objective: The objective was to describe nurses’ experiences of caring for patients with suspected or confirmed COVID-19 in the initial phase of the pandemic. Methods: The study has a qualitative design. Semi-structured interviews were conducted with seven nurses in primary care and hospital care during the initial stage of the pandemic. Qualitative content analysis with an inductive approach was used. Results: The nurses expressed that the working routines changed very quickly at the onset of the pandemic. A triage system was implemented to care for patients with symptoms of COVID-19 to prevent transmission between patients. A major change was the constant use of personal protective equipment in patient care. The nurses also experienced a sense of inadequacy regarding the care of the patients and became emotionally affected and exhausted. Conclusion: The nurses experienced that many patients worsened clinically, leading to exhausting and difficult nursing care situations. They also experienced increasing responsibility since new protective equipment and procedures needed to be quickly implemented according to frequently changing recommendations, causing the nurses to feel uncertain about how to maintain patient safety. Support from colleagues was crucial to cope throughout the initial stage of the pandemic.

PURPOSE: This study aimed to describe the core components of an effective pain management education programme (PMEP) for surgical nurses in Thailand. METHODS: A three-round Delphi method was used. A panel of 40 experts advised regarding the essential components of an effective PMEP for surgical nurses. RESULTS: The core components of a PMEP were derived from experts' panel consensus: (i) multidisciplinary collaboration, (ii) acquisition of innovative knowledge and training by healthcare teams, and (iii) consideration of individual differences when delivering pain management services. To enhance their pain management practices, nurses should adopt multimodal pain approaches that involve family roles and engage in active patient listening. CONCLUSIONS: The PMEP designed in this study, which adheres to international nursing training standards, promotes the competency of professional nurses.

Background: Older people abuse includes intentional or unintentional conduct or omission of a specific behavior by a trusted person that causes injury or distress to older people. This study described older peoples' perceptions of abuse in Iranian society. Methods: This qualitative study applied a conventional content analysis method to understand the perceptions of abuse among older Iranian people. Twenty older residents were selected by purposeful sampling. Data were collected through in-depth, semi-structured, and face-to-face interviews. The six-step Graneheim and Lundman content analysis method guided data analysis. MAXQDA software version 10 was used to manage the data. Results: The data analysis led to the identification of three main themes: broken toughness, hidden abuse, and exploitation. The first theme had two sub-themes: domination and disturbed peace and tranquility. Conclusion: Abuse resulted from a combination of causes and factors. Abuse was hidden in many cases and was not limited to physical abuse. The other examples of abuse included disrespect, deprivation of authority, disturbed tranquility, and financial exploitation of older adults.

Persons with advanced dementia disease (ADD), here labelled PADDs, are shown to preserve parts of their self, which hasopened up possibilities for involving them in their own care and establishing strategies for improving their communicationwith the surrounding world. Using the well-known theory of human development proposed by Erik and Joan Erikson, herelabelled EJET, can operate as an efficient structure for formal caregivers to support PADDs in reclaiming their space.However, very few studies have used EJET as a framework in improving formal caregivers’ competence and the quality ofcare. This article aims to demonstrate the feasibility of applying EJET in the care of PADDs through two examples of successfulapplication of this framework in interacting with PADDs in residential care settings. The examples demonstrate the significanceof competent caregivers and the important role of tailoring nursing care plans to specific situations of the PADDs in theirpresent and previous developmental phases.

The study aimed to explore the conditions that accompany conflict of conscience experienced by nurses in intensive care units. A qualitative approach guided the study, which was undertaken between April 2020 and April 2021. A total of 15 registered nurses working in intensive care units were recruited through purposive sampling. Individual semistructured interviews were conducted. The data were analyzed using a qualitative content analysis. The analysis revealed two themes: "conflict of conscience in relation to the structure" and "conflict of conscience based on context." Conflict of conscience in relation to the structure consisted of two categories: conflict of interest and conflict of conscience and law. Conflict of conscience based on context consisted of two categories: care dilemmas and arbitrary behaviors with end-stage patients. A variety of factors were accompanied by a conflict of conscience for nurses in intensive care units. Given that conflict of conscience has negative consequences for the health and quality of nursing care, health care managers need to tailor strategies to reduce the negative consequences considering the findings of the study.

Sirkka-Liisa Ekman, Professor Emeritus of Nursing at Karolinska Institutet, passed away on 3 September 2020 at the age of 77, surrounded by her immediate family. She was a giant in geriatric care and dementia care.

Malin Jordal,1 Henrik Eriksson,2,3 Martin Salzmann-Erikson,1 Monir Mazaheri2,4 1Department of Caring Sciences, University of Gävle, Gävle, Sweden; 2Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden; 3Department of Health Sciences, University West, Trollhättan, Sweden; 4Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, SwedenCorrespondence: Malin JordalDepartment of Caring Sciences, University of Gävle, Gävle, SwedenTel +46 738593373Email malin.jordal@hig.seBackground: Several models for how to support students and provide them with the skills needed to write their degree projects have been proposed. However, few attempts have been made to present a general model for students’ academic work based on reasoning and communication skills rather than memorizing and mimicking their supervisors during their independent degree project.Objective: In the present paper, we propose a well-structured model that assists supervisors in promoting students’ responsibility and autonomy, while at the same time maintaining a high level of support.Presentation: We present a step-by-step protocol based on a partnership model with a contractual style that focuses on students’ academic work with their own texts through a process of alternating between abstract and concrete writing. This protocol, which is called the ESRA (Escorting the Students into Responsibility and Autonomy) model, can be utilized regardless of the content, specific aim and scope of the individual student’s degree project.Discussion and Conclusions: We argue that this model promotes high levels of engagement and assumption of responsibility among students, while also offering a feasible structure for ensuring the steps to empowerment and autonomy. Use of the ESRA model is suitable when a constructive interaction between students and supervisors is desirable as a tool to achieve the learning outcomes of the degree project. Thus, the

Background: Studies reporting inadequate nursing care for patients indicate that nurses are negatively affected in such situations, and research is needed to study nursing care in postoperative situations. Objective: To describe situations of postoperative pain management in a surgical ward in Thailand. Methods: A qualitative approach using the Critical Incident Technique was chosen to investigate situations of postoperative pain management from the perspective of surgical nurses in Thailand. Data were collected through multiple semi-structured interviews with nine nurses over a five-week period. Results: The situations of surgical nurses described three elements that heavily influenced the quality of postoperative pain management: engagement in a trustful nurse-patient relationship, availability of pain medication and nursing care when needed, and imbalance between meeting the patient’s needs and completing routine nursing duties. Conclusion: The results help to expand our understanding of how Thai nurses manage pain in postoperative situations and indicate areas that could be improved in terms of how nurses respond to patients’ pain. Nurses challenge existing guidelines and facilitate development of new nursing guidelines and/or policies in pain management.