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Aims: To describe intensive care unit nurses' experiences of moral distress during the COVID‐19 pandemic, and their recommendations for mitigative interventions. Design: Interpretive description. Methods: Data were collected with a purposeful sample of 40 Canadian intensive care unit nurses between May and September 2021. Nurses completed a demographic questionnaire, the Measure of Moral Distress—Healthcare Professionals survey and in‐depth interviews. Quantitative data were analysed using descriptive statistics. Qualitative data were categorized and synthesized using reflexive thematic analysis and rapid qualitative analysis. Results: Half of the nurses in this sample reported moderate levels of moral distress. In response to moral distress, nurses experienced immediate and long‐term effects across multiple health domains. To cope, nurses discussed varied reactions, including action, avoidance and acquiescence. Nurses provided recommendations for interventions across multiple organizations to mitigate moral distress and negative health outcomes. Conclusion: Nurses reported that moral distress drove negative health outcomes and attrition in response to moral events in practice. To change these conditions of moral distress, nurses require organizational investments in interventions and cultures that prioritize the inclusion of nursing perspectives and voices. Implications for the Profession: Nurses engage in a variety of responses to cope with moral distress. They possess valuable insights into the practice issues central to moral distress that have significant implications for all members of the healthcare teams, patients and systems. It is essential that nurses' voices be included in the development of future interventions central to the responses to moral distress. Reporting Method: This study adheres to COREQ guidelines. Impact: What Problem did the Study Address?: Given the known structural, systemic and environmental factors that contribute to intensive care unit nurses' experiences of moral distress, and ultimately burnout and attrition, it was important to learn about their experiences of moral distress and their recommendations for organizational mitigative interventions. Documentation of these experiences and recommendations took on a greater urgency during the context of a global health emergency, the COVID‐19 pandemic, where such contextual influences on moral distress were less understood. What Were the Main Findings?: Over half of the nurses reported a moderate level of moral distress. Nurses who were considering leaving nursing practice reported higher moral distress scores than those who were not considering leaving. In response to moral distress, nurses experienced a variety of outcomes across several health domains. To cope with moral distress, nurses engaged in patterns of action, avoidance and acquiescence. To change the conditions of moral distress, nurses desire organizational interventions, practices and culture changes situated in the amplification of their voices. Where and on Whom Will the Research Have an Impact on?: These findings will be of interest to: (1) researchers developing and evaluating interventions that address the complex phenomenon of moral distress, (2) leaders and administrators in hospitals, and relevant healthcare and nursing organizations, and (3) nurses interested in leveraging evidence‐informed recommendations to advocate for interventions to address moral distress. What Does this Paper Contribute to the Wider Global Community?: This paper advances the body of scientific work on nurses' experiences of moral distress, capturing this phenomenon within the unique context of a global health emergency.Nurses' levels of moral distress using Measure of Moral Distress—Healthcare Professional survey were reported, serving as a comparator for future studies seeking to measure and evaluate intensive care unit nurses' levels of moral distress.Nurses' recommendations for mitigative interventions for moral distress have been reported, which can help inform future interventional studies. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To evaluate midwives' level of stress and burnout during the COVID‐19 Omicron phase in Italy. Secondary aims were to explore the impact of the pandemic on midwives' personal dimensions and professional activities and potential supporting strategies. Design: A mixed‐methods study was undertaken from July to December 2022. Methods: Data were collected using a national online observational survey. Descriptive and inferential analyses were performed to evaluate stress, burnout and the impact of the pandemic on personal and professional dimensions. A deductive qualitative approach was used to analyse open‐ended responses, that were merged with quantitative data following a convergent mixed‐methods approach. Results: A total of 1944 midwives participated in the survey. The stress summary score mean was 10.34, and 562 midwives (28.91%) experienced burnout. The intention to reduce working hours was reported by 202 midwives (10.39%), with 60.40% (n = 122) of them experiencing burnout. The intention to leave clinical practice within the following 2 years was reported by 239 (12.29%), with 68.20% (n = 163) of them experiencing burnout. All the personal dimensions and professional activities considered were defined by more than half of midwives as being impacted 'Moderately' or 'To a great extent' by pandemic. Stress and burnout frequencies increased when the midwives' perception of the pandemic effects was higher. Potential supporting strategies described by midwives as the most important in increasing their ability to cope with the pandemic were 'Women's awareness of the midwives' role' (n = 1072; 55.14%) and 'Family and friends' emotional support' (n = 746; 38.38%). Conclusion: Our findings suggested strategies to support a positive and safe working environment for midwives during a pandemic emergency, with potential transferability to similar contexts when human resources are lacking. It is recommended that maternity services provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Impact: Studies conducted during the first COVID‐19 pandemic wave showed an increased level of stress, anxiety, burnout, post‐traumatic stress disorder and depression experienced by healthcare professionals; moreover, midwives experienced drastic changes in care pathways and policies with struggles identified when providing high‐quality woman‐centred care following pandemic restrictions. Although it is recommended, there is lack of knowledge about long‐term psychological effects of COVID‐19 for midwives. Our study highlights that during the Omicron wave midwives experienced a high level of stress and burnout with an impact on individual dimensions and professional activities. Their stress and burnout were influenced by several factors, including restrictions in place, lack of organizational acknowledgement, work overload and need for extra childcare cover. Maternity services should provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Recommendations on how to facilitate this are suggested. Reporting Method: During the writing process, we referred to 'The Strengthening the Reporting of Observational Studies Epidemiology Statement', the guidelines for reporting observational studies from the Equator network. Patient or Public Contribution: No patient or public contribution. What does this paper contribute to the wider global clinical community?: Work overload conditions negatively impacted on the quality of maternity services. Improving organizational aspects, reducing working hours, promoting family and friends' emotional support and improving women's awareness of midwife's role were the main strategies reported by midwives. These suggestions for ensuring a positive and safe working environment for midwives during a pandemic emergency could potentially be applied to similar situations where human resources are lacking. [ABSTRACT FROM AUTHOR]

Aim: This article presents the findings of a qualitative study focusing on the experiences of people aged over 70 years in the interpersonal nurse–patient care relationship in hospital settings during and after the COVID‐19 pandemic. The aim was to analyse different aspects of this relationship, including nurses' behaviour and caring attitudes, the person‐centred model of care, patients' involvement in their own care and communication in the hospital context. Design: An exploratory qualitative study was conducted on the basis of an interpretative framework. Methods: Six focus groups were conducted. A total of 34 participants were purposively recruited from three nursing homes in Spain, Italy and Portugal. Specific inclusion criteria were used to select participants. Results: Five main categories were identified. Analysis revealed the importance of empathy and sensitivity in caring relationships, as well as the need for personalized and patient‐centred care. The importance of effective communication and recognition of ageist behaviour by professionals was highlighted. In addition, independent of the pandemic, situational factors in the hospital environment were identified that influence the interpersonal care relationship. Conclusions: The study highlights the need to promote a person‐centred model of care that takes into account the specific preferences and needs of older people. This is achieved by identifying elements of the interpersonal nurse–patient relationship. In addition to highlighting the disparity of opinion regarding an active or passive role in self‐care and decision making, the importance of addressing ageism and improving communication is emphasized. What problem did the study address?: The importance of the patient–nurse relationship in hospital care has been highlighted in previous studies.Critical elements of the patient care experience have been identified as empathy and effective communication.Ageism in healthcare has been recognized as a potential barrier to patient‐centred care. What were the key findings?: The main findings highlight the importance of empathy and personalized care, emphasize the importance of effective communication and address ageist behaviours in the nurse–patient relationship. Where and who will the research impact?: By highlighting the need for person‐centred care and improved communication strategies, particularly in the context of caring for older patients during and after the COVID‐19 pandemic, this research will have an impact on healthcare professionals, policy makers and carers. Reporting Method: The COREQ guideline was used. Patient or public contribution: This study adopted a collaborative approach to ensure that patient perspectives were integrated into the research process. We organized regular focus groups. Patients were actively involved in shaping the research questions, refining the study design and interpreting the emerging findings. Their valuable input helped us to understand the nuances of their experience and to prioritize the aspects that were critical to their well‐being. In addition, their insights guided the development of practical recommendations aimed at improving the interpersonal care relationship between nurses and patients in hospital settings, ensuring that their voices were heard and reflected in the proposed interventions. This patient‐centred approach fostered a sense of empowerment among the participants. It reinforced the notion that their experiences and opinions are integral to shaping healthcare practice. [ABSTRACT FROM AUTHOR]

Aim: This study explores the experiences of interprofessional collaboration of Canadian midwives and obstetricians from midwives' perspective. Design: A concurrent mixed‐methods approach that combined a small validation study and qualitative thematic analysis was used to provide evidence of the nature and importance of collaboration between Registered Midwives (RMs) and obstetricians. Method: Eighteen RMs across Canada completed a demographic survey and the Midwifery‐Obstetrician Collaboration (MOC) scale in 2023. The quantitative analyses were conducted to assess the reliability of the Midwifery‐Obstetrician Collaboration (MOC) and accumulate preliminary evidence to support its validity. Semi‐structured interviews were conducted with 13 participants. After completing the interviews, themes were identified using thematic analysis. Results: The primary themes identified were knowledge of midwifery scope affects collaboration, collaboration is necessary for effective patient care, midwife‐physician collaboration is impacted by power differentials and hierarchies, and proposed methods to improve physician‐midwife collaboration. Although a small sample size did not permit extensive statistical testing, the quantitative results supported the reliability of the MOC scale. In addition, a strong correlation between the MOC and the communication subscale of the Inter‐Professional Collaboration (IPC) scale provided evidence of the MOC's concurrent validity as a measure of collaboration between midwives and physicians. Conclusion: This study provides support for the Midwifery‐Obstetrics Collaboration (MOC) Scale as an assessment tool to evaluate collaboration between midwives and OB/GYNs in obstetrics care. While the 18 RMs recruited for this study provided a fulsome analysis for the qualitative portion, a larger study is necessary to provide more extensive quantitative analysis to validate the MOC scale for continued use among RMs and OBs. Implications: The implications of this study are to foster strong interprofessional relationships between midwives and OBs and to improve the health outcomes of pregnant women and newborns. Reporting Method: The authors adhered to Consolidated criteria for reporting qualitative research (COREQ). [ABSTRACT FROM AUTHOR]

Aim: To explore the views of neonatal intensive care nursing staff on the deliverability of a novel genetic point‐of‐care test detecting a genetic variant associated with antibiotic‐induced ototoxicity. Design: An interpretive, descriptive, qualitative interview study. Methods: Data were collected using semi‐structured interviews undertaken between January and November 2020. Participants were neonatal intensive care nursing staff taking part in the Pharmacogenetics to Avoid Loss of Hearing trial. Results: Thematic analysis resulted in four themes: perceived clinical utility; the golden hour; point‐of‐care device; training and support. Recommendations were made to streamline the protocol and ongoing training and support were considered key to incorporating the test into routine care. Conclusion: Exploring the views of nurses involved in the delivery of the point‐of‐care test was essential in its implementation. By the study endpoint, all participants could see the value of routine clinical introduction of the point‐of care test. Implications for the Profession and/or Patient Care: Nurses are in a key position to support the delivery of point‐of‐care genetic testing into mainstream settings. This study has implications for the successful integration of other genetic point‐of‐care tests in acute healthcare settings. Impact: The study will help to tailor the training and support required for routine deployment of the genetic point‐of‐care test. The study has relevance for nurses involved in the development and delivery of genetic point‐of‐care tests in other acute hospital settings. Reporting Method: This qualitative study adheres to the Standards for Reporting Qualitative Research EQUATOR guidelines and utilizes COREQ and SRQR checklists. Patient or Public Contribution: All staff working on the participating neonatal intensive care units were trained to use the genetic point‐of‐care test. All inpatients on the participating units were eligible to have testing via the point‐of‐care test. The Pharmacogenetics to Avoid Loss of Hearing Patient and Public Involvement and Engagement group provided valuable feedback. Trial and Protocol Registration: Registered within the University of Manchester. Ethics approval reference numbers: IRAS: 253102 REC reference: 19/NW/0400. Also registered with the ISRCTN ref: ISRCTN13704894. [ABSTRACT FROM AUTHOR]

Aim: To investigate the decisional needs in Denmark of people with kidney failure, relatives, and health professionals when planning end‐of‐life care. Design: A qualitative interview study. Methods: Individual semi‐structured interviews were carried out with people with kidney failure, relatives and health professionals from November 2021 to June 2022. Malterud's systematic text condensation was used to analyse transcripts. Results: A total of 13 patients, 10 relatives, and 12 health professionals were interviewed. Overall, four concepts were agreed on: (1) Talking about end of life is difficult, (2) Patients and relatives need more knowledge and information, (3) Health professionals need more tools and training, and (4) Experiencing busyness as a barrier to conversations about end of life. Conclusion: People with kidney failure, relatives, and health professionals shared certain decisional needs while also having some different decisional needs about end‐of‐life care. To meet these various needs, end‐of‐life conversations should be systematic and organized according to the patients' needs and wishes. Impact: Non‐systematic end‐of‐life care decision‐making processes limit patients' involvement. Patients and relatives need more knowledge about end‐of‐life care, and health professionals need more competences and time to discuss decisional needs. A shared decision‐making intervention for people with kidney failure when making end‐of‐life care decisions will be developed. Reporting Method: This empirical qualitative research is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Patient or Public Contribution: Patients, relatives, and health professionals have been involved throughout the research process as part of the research team and advisory board. The patients are people with kidney failure and the relatives are relatives of a person with kidney failure. For this study, the advisory board has particularly contributed to the validation of the invitation letter for participation, the interview guides and the preparation of the manuscript. [ABSTRACT FROM AUTHOR]

Aim: To explore Remote Area Nurses' experiences of the implementation of workplace health and safety policies and risk mitigation strategies in Australian very remote primary health clinics. Design: This qualitative study used online semi‐structured interviews, with participants purposively sampled to maximize variation in work location and service type. Data were analysed using a reflexive thematic analysis approach. Coding was carried out inductively, with NVivo 12 aiding data management. Setting: The interviews were conducted from 24 Februrary 2021 to 06 March 2021 with Remote Area Nurses from very remote primary health clinics in Australia. Participants: Fifteen Remote Area Nurses participated in the study. Results: Thematic analysis revealed varied approaches to workplace safety among the different health services and regions. While the spread of 'never alone' policies in many clinics addressed one of the significant risks faced by Remote Area Nurses, gaps remained even for hazards specifically highlighted in existing work health and safety legislation. Meaningful collaboration with staff and the community, local orientation, preparation for the role and providing quality care were protective factors for staff safety. Understaffing, unsafe infrastructure and inadequate equipment were common concerns among Remote Area Nurses. Conclusion: Health services need to prioritize workplace safety and take a continuous quality improvement approach to its implementation. This will include ensuring safety strategies are appropriate for the local context, improving infrastructure maintenance, and establishing sustainable second responder systems such as a pool of drivers with local knowledge. Implications for the Profession: Poor personal safety contributes to burnout and high turnover of staff. Nurses' insights into the barriers and enablers of current workplace safety strategies will aid policymakers and employers in future improvements. Reporting Method: COREQ reporting guidelines were followed. PIPE Statement: A panel of six Remote Area Nurses collaborated in the development of this project. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to analyse the effects of servant leadership on nurses' emotional failure and compliance with standard precautions and to explore the moderating effect of individual resilience. Design: A cross‐sectional survey. Methods: This descriptive cross‐sectional study was conducted from October 9 to November 1, 2022. The convenience sampling method was used to collect questionnaire data from 924 clinical nurses in a third‐class general hospital in Chongqing, China. Results: The emotional exhaustion and compliance with standard precautions were at the general level. Servant leadership mediated by emotional exhaustion had a significant positive predictive effect on compliance with standard precautions. Personal resilience played a negative moderating role in the relationship between servant leadership and emotional exhaustion. For nurses with low resilience, servant leadership had a greater impact on emotional exhaustion. Conclusion: The current compliance with standard precautions for clinical nurses is not high due to emotional exhaustion. The level of servant leadership can alleviate nurses' emotional exhaustion and improve compliance with standard precautions. Especially for nurses with low personal resilience, the care and support of department leaders are needed. Impact: We found that the compliance with standard precautions is not high, and the link between emotional exhaustion, servant leadership and compliance with standard precautions provides a basis for further patient care. No Patient or Public Contribution: There was no patient or public involvement. Impact Statement: Nurses are the key population for hospital infection prevention and control, and their level of compliance with standard precautions is of great significance for hospital infection prevention and control. However, in practice, nurses' compliance with standard precautions is generally low. Most of the previous studies on nurses' compliance with standard precautions were conducted from the perspective of individual nurses, based on the staff's 'knowledge, belief, and action' to study the current status of compliance with standard precautions and the factors affecting adherence, with less attention paid to the influence of psychological, environmental, and organizational factors. Therefore, the study focuses on the impact of servant leadership and emotional exhaustion on standard precautionary adherence, which is of great significance for good care management at the organizational level. It also explored how the impact of servant leadership on emotional exhaustion varies across levels of resilience, which is important for accurately identifying different types of nursing staff and targeting assistance. [ABSTRACT FROM AUTHOR]

Aim: To describe the childhood experiences of patients with polio from the acute phase of the disease during post‐war Finland in the 1950s and 1960s. Design: Qualitative empirical study based on self‐reported history of nursing rooted in the past, a history of experiences. Methodology: Interview materials were gathered in the form of themes (45) and written interviews (4) (29 September 2018 to 30 June 2019). Data were analysed by reflexive thematic analysis to highlight hidden and latent experiences. This approach generated the study's main theme, themes and subthemes. Results: The main theme, 'shattered childhood', generated from the study results and was then divided into two themes, both of which were influenced in part by the loss of a familiar childhood, the changed environment, the breakdown of the body and the absence of control. Through their childhood memories, polio survivors described their broken childhoods using the following themes: 'betrayal by their bodies' and 'isolation'. In the narratives, the theme 'betrayal by one's own body' was generated by the following subthemes: 'suddenness of the affliction', 'paralysis' and 'being moved to the hospital'. The 'isolation' theme developed from the subthemes 'isolation from the body and surroundings' and 'emotional and social loneliness'. Conclusion: Polio survivors' experiences during the acute stage of the disease were traumatic and demonstrated children's inferior nursing position in Finland in the 1950s and 1960s. Impact: The study increases our understanding of the history of caring for children and families who were affected and disabled by polio and the importance of their experiences in society and healthcare settings. Patient or Public Contribution: The authors collaborated with the Finnish Polio Association to recruit study participants and plan the study. Patients with polio during childhood underwent interviews, and their experiences formulated the data, which were analysed and the basis of the results. Reporting Method: Consolidated criteria for reporting qualitative research (COREQ), a 32‐item checklist for interviews and focus groups, have been used as a reporting and checklist tool. All authors have agreed on the final version and the use of the COREQ criteria, relationship with participants, theoretical framework, setting, data collection and data analysis and report. [ABSTRACT FROM AUTHOR]

Aim: To describe health and social care managers' perceptions of the factors affecting the competence of managers in knowledge management. Design: A qualitative descriptive study. Methods: A semi‐structured interview was conducted with 15 managers from three public health and social care organizations in Finland. Data were collected in the spring of 2022 and analysed using inductive content analysis. Results: Health and social care managers perceived that the competence of managers working in knowledge management is affected by managers' behavioural and attitudinal characteristics, their interactive network competence in knowledge management, the dimensions of their competence in knowledge management, the knowledge management infrastructure with which they work and the organizational learning culture within which they work. Conclusions: The competence of health and social managers in knowledge management is influenced by various factors, including their personal characteristics, management competence and the infrastructure and culture of the organization for which they work. However, their competence is constrained by an absence of clear processes, structures and resources in knowledge management as well as a lack of systematic support and training for managers working in knowledge management. Impact: The study provides valuable information for improving the competence of managers working in knowledge management in health and social care organizations. The competence of managers working in knowledge management is instrumental for successful implementation and sustaining of knowledge management practices and thus, such competence has a positive impact on the overall performance of an organization. Implications: Clarifying the roles and responsibilities of health and social care managers, as well as establishing organizational structures, is essential for effective knowledge management in organizations. Reporting Method: Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist has been used in the reporting. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to present the evidence on the effectiveness of non‐surgical interventions to improve health and well‐being in women living with Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome. Design: Systematic review guided by Preferred Reporting Items for Systematic Reviews checklist. Data Sources: The search was conducted between June and September 2022 across the following databases: CINAHL, EMBASE, Medline, PsycINFO and Cochrane. Trial registries (clinicaltrials. gov, World Health Organization International Clinical Trials Registry Platform (ICTRP), Cochrane Controlled Trials Register‐CCTR), Google scholar, dissertations, conference proceedings and reference lists of included studies were also searched. Corresponding authors, formal and informal MRKH groups were contacted to obtain any significant studies or reviews. Review Methods: Eligible were only English‐language empirical studies of any time period. The review followed narrative synthesis. Results: Twenty‐three studies were identified that fit the inclusion criteria which included 1540 MRKH syndrome affected women. Four studies were on psychological interventions (n = 85) and 19 studies (vaginal dilation therapy n = 897, coital dilation n = 57) focused on non‐surgical vaginal dilation as a measure to vaginal agenesis in MRKH syndrome. Conclusions: Clearly, vaginal dilation is a viable initial treatment option for women with MRKH syndrome. There is limited evidence that 'coital dilation' is an effective method of dilation for vaginal agenesis. The literature, however, supports the need for psychological intervention to improve health and well‐being. Impact: Women with MRKH syndrome who require dilation can receive guidance and support from their healthcare providers, particularly sexual and reproductive health nurses, clinical nurse specialists and gynaecologists. From the point of diagnosis, clinical psychologists should be involved. As much as feasible, family and partner support can be encouraged. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: To explore potential areas of low‐value home‐based nursing care practices, their prevalence and related influencing factors of nurses and nursing assistants working in home‐based nursing care. Design: A quantitative, cross‐sectional design. Methods: An online survey with questions containing scaled frequencies on five‐point Likert scales and open questions on possible related influencing factors of low‐value nursing care. The data collection took place from February to April 2022. Descriptive statistics and linear regression were used to summarize and analyse the results. Results: A nationwide sample of 776 certified nursing assistants, registered nurses and nurse practitioners responded to the survey. The top five most delivered low‐value care practices reported were: (1) 'washing the client with water and soap by default', (2) 'application of zinc cream, powders or pastes when treating intertrigo', (3) 'washing the client from head to toe daily', (4) 're‐use of a urinary catheter bag after removal/disconnection' and (5) 'bladder irrigation to prevent clogging of urinary tract catheter'. The top five related influencing factors reported were: (1) 'a (general) practitioner advices/prescribes it', (2) 'written in the client's care plan', (3) 'client asks for it', (4) 'wanting to offer the client something' and (5) 'it is always done like this in the team'. Higher educational levels and an age above 40 years were associated with a lower provision of low‐value care. Conclusion: According to registered nurses and certified nursing assistants, a number of low‐value nursing practices occurred frequently in home‐based nursing care and they experienced multiple factors that influence the provision of low‐value care such as (lack of) clinical autonomy and handling clients' requests, preferences and demands. The results can be used to serve as a starting point for a multifaceted de‐implementation strategy. Reporting Method: STROBE checklist for cross‐sectional studies. Patient or Public Contribution: No Patient or Public Contribution. Implications for the Profession and/or Patient Care: Nursing care is increasingly shifting towards the home environment.Not all nursing care that is provided is effective or efficient and this type of care can therefore be considered of low‐value.Reducing low‐value care and increasing appropriate care will free up time, improve quality of care, work satisfaction, patient safety and contribute to a more sustainable healthcare system. [ABSTRACT FROM AUTHOR]

Aims: To explore the impact of the coronavirus disease 2019 pandemic on the healthrelated quality of life (HRQoL) of breast cancer survivors. Design: We utilized a qualitative descriptive approach to facilitate interviews among 25 participants, all of whom are survivors of breast cancer and have received treatment in Hong Kong within the preceding 3 years. Methods: Content analysis was performed to understand how patients' HRQoL views and experiences changed during coronavirus disease 2019 pandemic. Results: The results included six themes delineating the impact of the coronavirus disease 2019 pandemic: (i) survivor sensitivities in pandemic times, (ii) coping and conditioning in pandemic times, (iii) transforming work and home dynamics in pandemic times, (iv) cognitive resilience and adaptation to the COVID-19 protective measures, (v) social resilience in pandemic times and (vi) healthcare adaptation and coping in pandemic times. Conclusion: This study provides insights into the experiences and challenges of breast cancer survivors during the coronavirus disease 2019 pandemic. Some survivors had new physical and psychological symptoms, including fear and anxiety, isolation, pain, lymphoedema and burnout, which potentially have long-term impact upon HRQoL. Implications for the profession and/or patient care: This study highlights the unique challenges faced by breast cancer survivors during the coronavirus disease 2019 pandemic, including accessing healthcare services and the impact of social isolation. Healthcare providers should consider the holistic needs of breast cancer survivors in the provision of health care and develop supportive interventions, including telehealth services and online support groups, to address these challenges and improve their HRQoL. Impact: Surgery aimed at treating breast cancer or reducing its risk generally influences the appearance of breast areas and donor sites. The continuing effects of these changes on body image and HRQoL are well-reported, although studies have ineffectively examined the initial experiences of women regarding their postoperative appearance, particularly during the pandemic. Reporting method: The checklist of consolidated criteria for reporting qualitative research (COREQ) was utilized. [ABSTRACT FROM AUTHOR]

Aims: Investigated the experiences of Māori (the Indigenous peoples of Aotearoa, New Zealand) patients and whānau (extended family network) engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. Design: A qualitative Māori-centred research design using a Thought Space Wānanga (learning through in-depth group discussion, deliberation and consideration) approach. Methods: Two wānanga were conducted between May 2022 and June 2022, with 13 Māori patients who had been acutely hospitalized within the past 12 months and their whānau members. The first wānanga utilized storytelling and journey mapping to collect data. The second wānanga refined the initial themes. Wānanga were audiorecorded and then inductively coded and developed into themes. Results: Thirteen patients and whānau attended the first wānanga, while 10 patients and whānau participated in the second wānanga). Four themes were developed: (1) Whakawhanaungatanga (establishing connections and relationships), (2) Whakamana (uplifting the status and esteem of Māori), (3) Whakawhitiwhiti kōrero (the importance of communicating, discussing and deliberating) and (4) Kotahitanga (working together with purpose) all provide insights into the importance of effectively engaging and connecting with Māori patients and whānau when acutely hospitalized. Conclusions: The experiences and priorities of Māori patients and whānau affirm the international literature, suggesting that Indigenous relational concepts are critical to building relationships, connections and trust. Despite existing healthcare models for working with Indigenous peoples, their poor application contributes to sub-optimal healthcare experiences at all points of their healthcare journey. A relational mode of practice focused on engagement and forming connections better meets the needs of Indigenous peoples engaging with inpatient health services. Implications for the profession and/or patient care: Despite the existence of Indigenous models of care, Indigenous peoples consistently report a lack of engagement and connection when accessing inpatient health services. Without establishing relationships, applying models of care is challenging. Impact (Addressing): • What problem did the study address? Internationally, healthcare systems are consistently ill-equipped to deliver culturally safe care for Indigenous and marginalized peoples, evident in ongoing health inequities. Like other reports of Indigenous experiences of health services, Māori express dissatisfaction with care delivery in an acute inpatient setting. This study investigated Māori patients and whānau experiences engaging with acute hospital inpatient services and their priorities for a Māori-centred model of relational care. • What were the main findings? Māori patients and whānau recounted negative experiences with healthcare professionals lacking effective relationships and trust. Satisfaction occurred when engagement with health care professionals resembled Indigenous cultural rituals of encounter that considered their holistic, collective and dynamic worldviews. Previous models of relational care, while helpful, are not Indigenous and so do not address their needs, such as engagement as a mode of practice (how) to achieve this. • Where and on whom will the research have an impact? This research impacts Indigenous peoples' health outcomes, particularly Māori, and nurses and clinicians working and interacting within acute inpatient and other hospital settings. Indigenous research methods support co-constructing knowledge for translation into practical outcomes through transformational practices, policies and theory development. Reporting method: We used the Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER) statement (see File S2—CONSIDER Checklist) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (see File S3—COREQ Checklist). [ABSTRACT FROM AUTHOR]

Aims: To explore how long‐term and late effects of paediatric brain tumours influence the everyday lives of survivors at various ages and their parents. Design: A qualitative interview study using reflexive thematic analysis. Methods: We conducted individual interviews and focus groups with 14 paediatric brain tumour survivors aged 9–52 years and 16 parents, which were audiorecorded and transcribed. We inductively analyzed the data using Braun and Clarke's reflexive thematic analysis. Inductively derived themes were then mapped onto the components of the International Classification of Functioning, Disability and Health framework to examine the survivors' everyday functioning. Results: All survivors experienced ongoing long‐term and late effects but with considerable variations in how these restricted the survivors' functioning and thus their ability to participate in everyday life activities (e.g. social, educational and work activities). All survivors expressed an explicit focus on and use of different strategies to manage their perceived functional limitations and participation restrictions. Many survivors expressed discrepancies between their own goals, expectations and actual abilities post‐cancer; making them very aware of their limitations. In addition, many survivors and parents experienced ongoing concerns about the survivors' future, including the risk of late effects, relapse or other complications. Conclusion: A wide range of long‐term and late effects continue to affect the survivors and their parents' functioning and everyday lives. Their ongoing needs emphasize the importance of comprehensive, life‐long follow‐up care, as recommended. Implications for the Profession and/or Patient Care: The complex challenges across the biopsychosocial realms faced by the survivors supports the call for multidisciplinary survivorship care. Nurses are well positioned to lead such care, as they are trained to provide holistic care and thereby support survivors' functioning and activity participation in everyday life. Reporting Method: We used the COREQ guidelines when reporting the study. Patient or Public Contribution: Two user representatives (one young adult PBT survivor and one mother of a PBT survivor) ensured the relevance and quality of the semi‐structured interview guides prior to the interviews with the survivors and parents. The guides were sent to the user representatives by mail, and they provided their written feedback by mail to the first author. [ABSTRACT FROM AUTHOR]

Aims: To explore how emerging adult‐aged women self‐manage their sexual and reproductive health and to generate a grounded theory of these self‐management processes. Design: Grounded theory methods using a constructivist approach. Methods: Between September 2019 and September 2020, 18‑ to 25‐years‐old women (n = 13) were recruited from a 4‐year university, a 2‐year community college, and neighbourhoods surrounding the institutions of higher education. Individual interviews were transcribed verbatim and qualitatively analysed using a constant comparative method and inductive coding. Results: The theory purports that core processes of sexual and reproductive health self‐management used by the women in this study included both passive and (re)active processes. These processes expanded upon and/or maintained the women's accessible sexual and reproductive health knowledge, behaviour and beliefs, defined as the sexual and reproductive health repertoire. The processes appeared to be cyclical and were often initiated by a catalysing event or catalyst and resulted in conversations with confidantes, or trusted individuals. A catalyst was either resolved or normalized by expanding or maintaining the sexual and reproductive health repertoire. Conclusion: The resulting theory, EMeRGE Theory, offers insight into the complex and cyclical processes emerging adult‐aged women use to simultaneously develop and adapt their foundational sexual and reproductive health knowledge, behaviours and beliefs. Implications for the Profession and/or Patient Care: This explication of emerging adult‐aged women's sexual and reproductive health self‐management processes can be used by nurses and nurse researchers to better address this population's unique health needs. Impact: The EMeRGE Theory provides valuable guidance for future exploratory and intervention research aimed at improving the health and well‐being of emerging adult‐aged women. Reporting Method: The authors adhered to the Consolidated Criteria for Reporting Qualitative studies (COREQ) in preparation of this publication. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: To identify the roles and activities of nurses, including advanced practice nursing (APN), and to determine nursing practice patterns across health facilities in Saudi Arabia. Methods: A descriptive cross‐sectional design was used to collect data from 207 nurses working in the Saudi health sector between November 2021 and March 2022 through an online questionnaire. The Advanced Practice Role Delineation tool was used to measure and delineate nursing practice patterns and activities. Data were analysed using descriptive statistics and analysis of variance. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. Results: Findings showed that participants, regardless of their current role, reported high scores across all domains of practice. The highest average score was obtained for the Clinical Care domain. Except for the leadership domain, findings showed that those reported working as advanced practice nurses had higher average scores across all domains than those working as staff nurses or being in managerial/administrative positions. There were significant differences in the average Clinical Care scores between advanced practice nurses and staff nurses. Conclusion: Advanced practice nursing roles and activities are being practised in Saudi Arabia; however, there is no clear delineation of these roles and activities according to a unified and national‐level APN scope of practice. Impacts: Advanced practice nursing roles are evolving in Saudi Arabia; however, no study has examined the existing patterns of APN activities in Saudi Arabia. This study highlights the practice patterns of advanced practice nurses and adds to the international evidence base on the need for delineating APN activities under a unified scope of practice. The findings of this study are beneficial to practitioners, researchers, and stakeholders as well as the legislative and regulatory bodies. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To discuss nurses' use of networks to address nursing recruitment and retention in London, UK. Design: Qualitative evaluation of the Capital Nurse programme reporting on 30 narrative interviews with executive, clinical and student nurses in 2019. Results: Executive nurses within the Capital Nurse programme recognized the importance of sociomaterial contexts in the health and social care system in London and worked strategically across these contexts to achieve change. Supported through the Capital Nurse programme, executive nurses from health organizations across London initiated collaborative working to improve recruitment and retention. Primarily by designing and delivering sociomaterial products (organizational and educational) to support nurses to build a career in London. Drawing on ideas from actor network theory, in particular sociomaterial contexts, nurses' actions at all levels to develop and sustain networks to address nursing recruitment and retention across the NHS in London are described. Conclusions: Capital Nurse supported collaborative working both within single organizations and across organizations in London. There is evidence of change in how nurses across the capital work together to improve patient care, improve recruitment and retention. Findings may resonate with nurses in other settings who seek to address the problem of recruitment and retention. They show how nurses coming together in networks to effect changes in practice can work successfully. Impact: Nurses' use of networks led to novel models of communication and action to address the problems of recruitment and retention in London. We argue that sociomateriality should be considered outside the clinical practice setting, as part of nurses' professional development and organizational practice, that is how they plan their career, how they address recruitment and retention, how they communicate across organizations about nursing issues. No Patient or Public Contribution: This was an evaluation of a staff development project in London, which sought to elicit nurses' experiences of participation in Capital Nurse. [ABSTRACT FROM AUTHOR]

Background: Continuity of care is viewed as a hallmark of high‐quality care in the primary care context. Measures to evaluate the quality of provider performance are scarce, and it is unclear how the assessments correlate with patients' experiences of care as coherent and interconnected over time, consistent with their preferences and care needs. Aim: To develop and evaluate a patient‐reported experience measure of continuity of care in primary care for patients with complex care needs. Method: The study was conducted in two stages: (1) development of the instrument based on theory and empirical studies and reviewed for content validity (16 patients with complex care needs and 8 experts) and (2) psychometric evaluation regarding factor structure, test–retest reliability, internal consistency reliability, and convergent validity. In all, 324 patients participated in the psychometric evaluation. Results: The Patient Experienced Continuity of care Questionnaire (PECQ) contains 20 items clustered in four dimensions of continuity of care measuring Information (four items), Relation (six items), Management (five items), and Knowledge (five items). Overall, the hypothesized factor structure was indicated. The PECQ also showed satisfactory convergent validity, internal consistency, and stability. Conclusion/Implications: The PECQ is a multidimensional patient experience instrument that can provide information on various dimensions useful for driving quality improvement strategies in the primary care context for patients with complex care needs. Patient or Public Contribution: Patients have participated in the content validation of the items. [ABSTRACT FROM AUTHOR]

Aim: Examining the perspectives of formal and informal caregivers and residents on roles, mutual expectations and needs for improvement in the care for residents with (a risk of) dehydration. Design: Qualitative study. Methods: Semi‐structured interviews with 16 care professionals, three residents and three informal caregivers were conducted between October and November 2021. A thematic analysis was performed on the interviews. Results: Three topic summaries contributed to a comprehensive view on the care for residents with (a risk of) dehydration: role content, mutual expectations and needs for improvement. Many overlapping activities were found among care professionals, informal caregivers and allied care staff. While nursing staff and informal caregivers are essential in observing changes in the health status of residents, and medical staff in diagnosing and treating dehydration, the role of residents remains limited. Conflicting expectations emerged regarding, for example, the level of involvement of the resident and communication. Barriers to multidisciplinary collaboration were highlighted, including little structural involvement of allied care staff, limited insight into each other's expertise and poor communication between formal and informal caregivers. Seven areas for improvement emerged: awareness, resident profile, knowledge and expertise, treatment, monitoring and tools, working conditions and multidisciplinary working. Conclusion: In general, many formal and informal caregivers are involved in the care of residents with (a risk of) dehydration. They depend on each other's observations, information and expertise which requires an interprofessional approach with specific attention to adequate prevention. For this, educational interventions focused on hydration care should be a core element in professional development programs of nursing homes and vocational training of future care professionals. Impact: The care for residents with (a risk of) dehydration has multiple points for improvement. To be able to adequately address dehydration, it is essential for formal and informal caregivers and residents to address these barriers in clinical practice. Reporting Method: In writing this manuscript, the EQUATOR guidelines (reporting method SRQR) have been adhered to. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To describe parents' perspectives on reasonable adjustments in acute healthcare for people with intellectual disability (ID). Background: People with ID are vulnerable in terms of their health needs and marginalized when accessing and utilizing acute healthcare services. Reasonable adjustments are positive measures that can help alleviate health disparities. However, despite significant research advocating their use, evidence of implementation of reasonable adjustments in acute healthcare practice is limited. Design: A qualitative descriptive study. Methods: Qualitative semi‐structured interviews were conducted with six parents of children with ID, who had accessed and used acute healthcare services. The interviews were conducted between January and May 2022, audio‐recordings were transcribed and thematically analysed. Results: Parents described limited or no experiences of reasonable adjustments when accessing or utilizing acute healthcare services for their children. The findings are captured in three themes; describing the reality, understanding the impact and signposting the future. The findings highlight a lack of implementation of reasonable adjustments in acute healthcare which negatively impacts the experience of all stakeholders. Conclusion: There is a pressing need for reasonable adjustments to be implemented at a strategic level across acute healthcare services, so that people with ID and their families can access person‐centred acute healthcare when needed. Impact: The research findings will inform researchers interested in reasonable adjustments and implementation research, and those interested in advocating for the rights of people with ID. Reporting Method: This study adhered to the Equator research reporting checklist: Consolidated criteria for reporting qualitative research: a 32‐item checklist for interviews and focus groups. Patient or Public Contribution: A parent of a child with an ID was part of the research team informing the design, data collection, data analysis and write‐up of this article. [ABSTRACT FROM AUTHOR]

Aims: To explore how nursing home staff perceived their work environment during the COVID‐19 pandemic and how this impacted their well‐being. Design: A qualitative interview study. Methods: Interviews were held with twenty‐two registered nurses and assistant nurses from five nursing homes in the Netherlands between April 2021 and July 2021. The interviews were analysed using qualitative content analysis. The Standards for Reporting Qualitative Research (SRQR) were followed. Results: Five themes emerged from the interviews and indicated that working during the COVID‐19 pandemic impacted perceived well‐being of nursing home staff. Three themes concerned experiences at work: eroding care, additional roles and workplace support. Specifically, the increased workload with additional tasks, the constant stream of new guidelines and constrictive personal protective equipment caused discomfort and anxiety. Two other themes concerned experiences outside of work: work‐life interference and social interactions and status. The nurses reported that when they returned home after work, they were tired and worried about spreading the virus while facing limited social interactions and support. Conclusion: The social distancing measures due to the COVID‐19 pandemic negatively impacted nursing home staff well‐being by increasing demands in the absence of adequate resources. Implications for the Profession and/or Patient Care: The well‐being needs of nurses should receive continued attention to ensure the sustainability of healthcare during future crises. Patient or Public Contribution: The nursing home managers participated in recommending the topics to be covered during interviews. Impact: What problem did the study address? The pressure of stressful working conditions on the well‐being of nurses during the pandemic.What were the main findings? Nurses created strategies to cope with declining well‐being. However, the available resources did not alleviate the increased demands caused by the pandemic.Where and on whom will the research have an impact? This study is important for healthcare organizations to understand how the COVID‐19 pandemic affected nurses so that they may better prepare for future crises. [ABSTRACT FROM AUTHOR]

Introduction: The global nursing workforce is predominantly female, with a large proportion working in the 45–55 age group. Menopause is a transition for all women, and; therefore needs recognition as it can impact work performance and consequently staff turnover. Background: Women will go through the menopause, but not all women are affected. The menopause transition presents a range of signs and symptoms both physical and psychological which can impact the quality of life and individuals' work/life balance. The nursing workforce is predominantly women that will work through the menopause transition. Objectives: The study explored perspectives on digital health interventions as strategies to support menopausal women and to understand the requirements for designing health interventions for support in the workplace. Design: A qualitative explorative design. Settings: Nurses working in a range of clinical settings in England, Finland, Denmark, New Zealand, Australia and USA. Methods: Nurses (n = 48) participated in focus groups from six different countries from February 2020–June 2022 during the pandemic from a range of acute, primary care and education settings. Nurses were invited to participate to share their experiences. Thematic analysis was used. Results: All participants were able to describe the physical symptoms of menopause, with some cultural and possible hemisphere differences; more noticeable was the psychological burden of menopause and fatigue that is not always recognized. Four themes were identified: Managing symptoms in the workplace; Recognition in the workplace; Menopause interventions; and Expectation versus the invisible reality. These themes revealed information that can be translated for implementation into digital health interventions. Conclusions: Managers of nursing female staff in the menopausal age range need greater awareness, and menopause education should involve everyone. Finally, our results demonstrate design attributes suitable for inclusion in digital health strategies that are aligned with likely alleviation of some of the discomforts of menopause. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to investigate why registered nurses seek forensic mental health employment and explore their initial impressions of this setting. Design: Explanatory sequential mixed methods. Methods: Registered nurses employed in a forensic mental health hospital completed an online survey about their reasons for seeking work in forensic mental health and their transition into the setting. To fully explore findings, semi‐structured interviews were conducted with a sub‐group of survey respondents. Descriptive statistics were used to analyse survey data, and thematic analysis was used to analyse the interviews. Results: Sixty‐nine respondents completed the survey, and 11 interviews were conducted. Prior interest in forensic mental health and encouragement from hospital staff were considered important influences in seeking forensic mental health employment. New knowledge, changes in clinical responsibility, exposure to patients' background offences and security processes overwhelmed some participants initially. However, participants reported that the initial challenges of their transition revealed opportunities to develop genuine connections with patients. Conclusion: This study provides a new understanding of the reasons why nurses seek employment in forensic mental health and the challenges and opportunities experienced when first working in this setting. Such professional and personal elements need to be considered by organizations to strengthen recruitment strategies and support future nurses' transition into forensic mental health settings. Impact: This study provides new knowledge about recruiting and supporting nurses' transition into forensic mental health employment. As such, it informs policymakers, clinical services and managers about strategies needed to attract and retain this workforce. Patient or Public contribution: No public or patient involvement. [ABSTRACT FROM AUTHOR]

Aim: To understand how nurses talk about documentation audit in relation to their professional role. Background: Nursing documentation in health services is often audited as an indicator of nursing care and patient outcomes. There are few studies exploring the nurses' perspectives on this common process. Design: Secondary qualitative thematic analysis. Methods: Qualitative focus groups (n = 94 nurses) were conducted in nine diverse clinical areas of an Australian metropolitan health service for a service evaluation focussed on comprehensive care planning in 2020. Secondary qualitative analysis of the large data set using reflexive thematic analysis focussed specifically on the nurse experience of audit, as there was the significant emphasis by participants and was outside the scope of the primary study. Results: Nurses': (1) value quality improvement but need to feel involved in the cycle of change, (2) highlight that 'failed audit' does not equal failed care, (3) describe the tension between audited documentation being just bureaucratic and building constructive nursing workflows, (4) value building rapport (with nurses, patients) but this often contrasted with requirements (organizational, legal and audit) and additionally, (5) describe that the focus on completion of documentation for audit creates unintended and undesirable consequences. Conclusion: Documentation audit, while well‐intended and historically useful, has unintended negative consequences on patients, nurses and workflows. Impact: Accreditation systems rely on care being auditable, but when individual legal, organizational and professional standards are implemented via documentation forms and systems, the nursing burden is impacted at the point of care for patients, and risks both incomplete cares for patients and incomplete documentation. No Patient or Public Contribution: Patients participated in the primary study on comprehensive care assessment by nurses but did not make any comments about documentation audit. [ABSTRACT FROM AUTHOR]

Aims: To explore patient perceptions and understanding of their pressure ulcer risk and how information is communicated between a nurse and patient in the home setting. Design: A pragmatic qualitative research design including community‐dwelling patients, who were deemed at risk of developing a pressure ulcer. Methods: Observation of routine interactions between nurse and patient regarding their pressure ulcer risk and semi‐structured interviews with 15 community patients following the nursing interaction. Results: Four key overarching themes emerged from the data analysis that were related to patient perceptions and understanding of pressure ulcer risk. These included Pressure Ulcer Awareness, Importance of Repositioning, Healthy Eating and Risk Interpretation. Conclusion: Patient perception and understanding of pressure ulcer risk is different from the scientific, professional view. Patient risk perception was based on heuristics and wider personal factors and social influences. Impact: The study provides important new insights into clinical practice in relation to how pressure ulcer advice and information are provided and interpreted in the community setting. Reporting Method: Adhered to the Standards for Reporting Qualitative Research (SRQR) Patient or Public Contribution: A small selection of patients within the NHS Trust in which the research was conducted contributed to the design of the study, in particular some of the interview questions and timing. [ABSTRACT FROM AUTHOR]

Aims: This study explored what informal caregivers of ethnic minority (EM) persons with dementia in the Netherlands perceive as culturally accessible health care and nurses' perceptions of how cultural competence can be improved to facilitate access to health care for EM persons with dementia and their informal caregivers. Design: Qualitative description research with semi‐structured individual interviews and focus group discussions (FGDs). Methods: Semi‐structured interviews with 15 nurses and 6 informal caregivers provided input for two FGDs with nurses about the need to strengthen their cultural competence to improve access to health care for EM persons with dementia and their informal caregivers. Interview data were collected between September 2020 and April 2021 in the Netherlands. Focus group discussion data were collected between June and September 2021 in the Netherlands. Results: Nurses and informal caregivers experienced difficulty building and maintaining a relationship. Contrary to informal caregivers' experiences, nurses felt a shared cultural background with the persons with dementia and informal caregiver is necessary. Although nurses acknowledged the importance of cultural knowledge, cultural skills, in particular, were mentioned as needing improvement. Examples are mapping involved family members and their roles, asking the right questions and letting go of personal judgements. Nurses frequently mentioned stereotypical thinking and seeing 'the other' as different, and collaboration with(in) family proved difficult for informal caregivers and nurses. Conclusion: Strengthening cultural skills will contribute to facilitating better access to cultural appropriate health care for EM persons with dementia and their informal caregivers. Patient or Public Contribution: No patient or public contribution. Impact: This study explores what is perceived as culturally accessible health care and what nurses need to improve their cultural competence. We show that strengthening nurses' cultural competence by addressing which skills should be improved can improve access to health care for EM persons with dementia and their informal caregivers. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to describe how nurses' dialogue compares with that of doctors in the Australian reality television program Emergency and to explain how this dialogue and the use of narration and direct‐to‐camera monologues contribute to the portrayal of nurses. The final aim was to outline how these findings can inform the actions of nurses, nursing organizations and writers and journalists. Design: A descriptive study conducted in 2021 and 2022. Methods: Character network analysis was used to describe the verbal interaction of nurses and doctors and identify major, minor and background characters. Narration and direct‐to‐camera monologues were analysed through frequency counts. Cultivation theory was used to interpret the results. Results: Fifty‐four characters were identified, with 19 of these being nurses. Doctors spoke 87.9% of the dialogue. Most of the dialogue (43%) was monologue by doctors directly to the camera. All major characters were doctors, and only one nurse was a minor character. The mean number of mentions by the narrator of a nurse per episode was 4, and 30 for a doctor. Conclusion: The portrayal of nurses in Emergency is inaccurate and the production methods are used to privilege the role of doctors. This finding comes after decades of research showing inaccurate images of nursing in television. Drawing on recent Australian inquiries and the challenges experienced by mental health and aged care nursing, several approaches for collaborative action to improve these images are suggested. Impact This is the first study of the portrayal of nursing in reality television. These results suggest that much effort is still required even in contemporary reality television to accurately reflect the work and contribution of nurses. It is the shared responsibility of individual nurses, nursing organizations and writers and journalists to accurately portray nurses in the media. No patient or public contribution: This network analysis of a postproduction television program did not allow patient or public involvement in the design or analysis. [ABSTRACT FROM AUTHOR]

Aims: To explore experiences of family caregivers providing support to older persons with delirium superimposed on dementia in acute care hospitals, their role in detection and management of this condition, and support they require. Design: This study has an exploratory‐descriptive design using interpretive description methodology. Methods: Semi‐structured interviews were conducted with nine caregivers from January to April 2020. Interview transcripts underwent thematic analysis. Findings Three themes were identified: (1) family caregivers found delirium superimposed on dementia to be an overwhelming experience, (2) family caregivers can play an important role in the detection and management of delirium superimposed on dementia and (3) family caregivers' experiences were influenced by the nature of their relationship with the health care team. Family caregivers found the experience distressing and felt unprepared to face the condition. Family caregivers also possessed knowledge helpful in detecting acute changes and caring for the older person. Family caregivers' relationships with the health care team varied: some felt supported by the team, while others experienced a power imbalance, characterized by lack of communication and opportunities to participate in care. Conclusions: Family caregivers were distressed to see family members hospitalized with delirium superimposed on dementia. Family caregivers are also ideally positioned to detect the condition and participate in care. However, power imbalances remain, leaving family caregivers feeling disempowered and believing the health care team had more control over the older person's care. Impact Findings highlight the need for strategies to address the distress and disempowerment experienced by family caregivers of hospitalized older persons with delirium superimposed on dementia. By building collaborative relationships, nurses and other health care team members can help family caregivers navigate the complex experience with delirium superimposed on dementia and reduce distress, with the ultimate goal of facilitating family caregivers' ability to care for older persons in the community. No Patient or Public Contribution: While the study participants are members of the public, this population was not involved in the study design and analysis. This method aligns with interpretive description, where researchers are not just a medium through which participants speak, but also interpretive instruments who discern insights not accessible to persons who may be familiar with only a single case. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to develop a sleep problems scale and a coping with sleep problems scale for pregnant women and assess their reliability and validity. Design: An empirical research quantitative design. Review Methods: Self‐reported instruments were developed through (1) item generation, (2) preliminary item evaluation and (3) scale refining and evaluation. Item pools were created via literature review, opinions of experts and women with experience in pregnancy sleep. Content, construct and criterion validities were tested. Reliability was assessed using Cronbach's alpha, split‐half reliability and corrected item‐total correlation. Data Sources: Data were collected between January 23 and July 22, 2020, at a hospital's obstetrics polyclinic. In the pilot and main study, 30 and 368 pregnant women (gestational age: 8–42 weeks) were included, respectively. Results: The content validity index was >0.9 for each scale. Factor analysis showed 24 and 18 items in the two scales, both with four subdimensions. The corrected item‐total correlations were acceptable, and Cronbach's alpha coefficient was 0.883 and 0.799, respectively. Conclusion: Both scales developed in this study are valid and reliable for the Turkish society. Implications for the profession and/or patient care/global clinical community: This study's findings may prevent the lack of validated screening instruments to identify pregnancy‐specific sleep features. Impact We developed two scales to assess sleep problems in pregnant women. These were valid and reliable, can be routinely used by health professionals and may guide nurses and midwives in assessing and managing sleep problems during pregnancy. Reporting Method: The study conforms to the COSMIN checklist. Patient or Public Contribution: Data were collected during face‐to‐face surveys. Ten women contributed to the item pool generation, 30 pregnant women participated in the pilot study, and 368 antenatal service users participated in the main study. [ABSTRACT FROM AUTHOR]

Aim: This qualitative study aimed to explore the experience of being family caregivers of patients treated for oesophageal cancer 2 years after treatment. To better understand the family caregiver's situation, a conceptual model was used in the analysis. The results of the study can guide future interventions to support family caregivers of patients treated for oesophageal cancer. Design: A qualitative descriptive study using semi‐structured telephone interviews. An abductive approach was used in the analysis to reach deeper knowledge about the family caregivers' experiences and to better understand deeper patterns. Methods: A qualitative study was conducted and included 13 family caregivers of patients surgically treated for oesophageal cancer in Sweden in 2018 who participated in a population‐based nationwide cohort study. Individual telephone interviews were held in 2020, 2 years after the patients' surgery. The analysis of the interviews started with an inductive approach using thematic analysis. Thereafter, a deductive approach was used to interpret the findings in relation to the conceptual model, The Cancer Family Caregiving Experience. Results: The most essential/evident stress factors for the family caregivers were distress regarding the patients' nutrition, fear of tumour recurrence and worry about the future. In addition, a transition was experienced, going from a family member to a caregiver, and the many psychosocial aspects of this transition were highlighted during the disease trajectory. Conclusion: Despite, the long‐term survival of the patient, family caregivers were still struggling with psychosocial consequences because of the patient's cancer diagnosis and treatment. Furthermore, there is a need to improve supportive interventions for family caregivers during the whole disease trajectory. Impact The current study includes comprehensive information about the family caregivers' experiences when caring for a patient treated for oesophageal cancer. Family caregivers struggle with the psychosocial consequences of the patient's cancer and worry about tumour recurrence even 2 years after surgery. These findings can be useful in the development of supportive interventions, which may facilitate life for family caregivers. Patient or Public Contribution: The study was discussed and planned together with our research partnership group including patients and family caregivers. In addition, the manuscript was reviewed by some of the members to cross‐check the results and discussed them to avoid misinterpretation. [ABSTRACT FROM AUTHOR]

Aims: To explore community nurses sleep health practices and their perspectives on improving sleep health care provision. Design: An exploratory study utilizing the qualitative description methodology. Methods: Semi‐structured interviews were conducted with community nurses from May 2019 – October 2021. Interviews were audio‐recorded, transcribed, and subjected to an inductive thematic analysis using a constructivist–interpretive paradigm. Results: Twenty‐three Australian community nurses were interviewed. Participants frequently encountered sleep disturbances/disorders in their patients. Data analysis yielded three main themes: (1) Sleep health in the community serviced, (2) sleep health awareness and management, and (3) community nurses' A to Z of improving sleep health. The most common sleep disorder presentations were insomnia and sleep apnea. Although most community sleep apnea cases were appropriately managed, insomnia was often mismanaged. Participants described their sleep health knowledge as deficient, with the majority advocating for increased sleep‐related education tailored to their profession. Other important factors needed for improving sleep health provision were standardized patient treatment/referral pathways, increased interprofessional collaboration, and sufficient time for patient consults. Conclusion: Community nurses service a patient population that requires increased sleep health care. However, they are currently underequipped to do so, leading to suboptimal treatment provision. Providing community nurses with the appropriate resources, such as increased sleep‐related education and standardized treatment frameworks, could enable them to better manage sleep disturbance/disorder presentations, such as insomnia. Impact Little is known about how community nurses care for patients with sleep disturbance/sleep disorders. This study found that contemporary sleep health care was lacking due to knowledge deficits, competing challenges, and a need for standardized care pathways. These findings can inform the development of targeted education/training and standardized guidelines for community nurses providing sleep health care to patients as well as the design of future practice models of care provision. Patient or Public Contribution: Previous research by authors has involved extensive engagement with patients and health professionals, such as community pharmacists, general practitioners, and naturopaths who play a role in sleep health in the primary health care sector. These previous research projects built a significant understanding of the patient and health practitioner experience and have provided the background to the concept and design of this study. [ABSTRACT FROM AUTHOR]

Aim: To explore pre‐nursing students' experiences and identify factors influencing their well‐being as learners during COVID‐19. Design: A qualitative descriptive design was used. Methods: Short answer study data (n = 289) were collected in Fall 2020 as part of a larger IRB‐approved survey‐based study focused on pre‐nursing students. Participants were presented with three short answer questions designed to elicit a description of their experiences as a pre‐nursing student. NVivo and reflexive thematic analysis were used to analyse participant responses. Results: Six themes related to learner well‐being emerged from the data. Learner well‐being was supported by achieving academic goals, experiencing positive feelings about current course content, creating connections with peers and envisioning themselves as nurses in the future. Negative contributors to pre‐nursing student well‐being included managing fears of program rejection and juggling multiple roles and demands. Online learning necessitated by COVID‐19 created opportunities for loneliness and isolation from peers, technological difficulties and additional psychological stress, which also contributed negatively to learner well‐being. Conclusion: These findings illustrate pre‐nursing students' experiences and provide support for the influence of the learning environment and factors within the individual on the well‐being of learners. Impact Students preparing to apply to nursing programs are an understudied population and little is known about their well‐being as learners. Survey‐based open‐ended short answer questions can be utilized to gain rich insight into their experiences. The study themes and sub‐themes can be utilized for discussion and reflection in courses with pre‐nursing students and as a starting point for additional conversations between pre‐nursing students and educators regarding improving the support of well‐being in learners. Additional research and evidence‐based interventions that promote learner well‐being in pre‐nursing students are needed as they prepare for nursing program admission and to support their academic progression. Patient or Public Contribution: Members of the public were not involved in the design or conduct of the study, analysis, or interpretation of the data, or in the preparation of the manuscript because the study focus is on gaining an understanding the experiences of pre‐nursing students and their well‐being. [ABSTRACT FROM AUTHOR]

Background: Whilst increased numbers of people worldwide exercise their human right to seek asylum, the US has greatly reduced the number of asylum seekers able to enter its southern border, resulting in informal encampments. Women and children are uniquely vulnerable to violence and other health risks. Aim: To describe the health and safety concerns of female asylum seekers living in an informal migrant camp, with a particular focus on the risks of violence against women and children. Methods: For this qualitative descriptive study, female asylum seekers were purposively recruited in an informal tent encampment in Matamoros, Mexico (n = 43). Semi‐structured interviews were conducted in January and February 2020. Qualitative data were analysed using thematic analysis. Results: The themes identified were constant vigilance, the effects of constant vigilance, lack of resources, and uncertainty. Women's unrelenting fears about their own safety and that of their children impacted their ability to access the camp's meagre resources and exacerbated negative effects on women and children. Conclusion: Applying established guidelines and best practices for health and safety in humanitarian settings could mitigate threats to women and children. Additionally, camp conditions represent human rights violations. Nurses have an ethical duty to advocate for an end to the US policies creating and maintaining this humanitarian crisis. Impact: As a result of changes to the United States immigration policy, individuals seeking asylum at the Southern border of the US have been largely prevented from entering the US since early 2018. Asylum seekers living in an informal encampment on the border awaiting entry describe a public health, humanitarian and human rights crisis. Women in this already vulnerable group lacked necessities, such as housing, food security, potable water, protection against gender violence and other forms of physical threats to themselves and their children. This created a heightened sense of vigilance and fear, with implications for their mental health and well‐being and that of their children. These findings highlight the need for governmental and international organizations to implement the best health and safety practices for humanitarian settings to ensure equity in relation to the social determinants of health. Nurses have an ethical obligation to be strong human rights advocates. Patient or Public Contributions: One member of the research team has extensive experience as an advocate for recently immigrated women experiencing intimate partner violence. The study procedures were reviewed with advocates providing direct services to migrant women and children. [ABSTRACT FROM AUTHOR]

Aims: To analyse the degree of susceptibility to smoking according to gender in students between 12 and 16 years of age and study the role of factors associated with gender and the extended index of susceptibility to smoking. Design: Cross‐sectional study. Methods: Between November 2019 and March 2020, 12‐ to 16‐year‐old students were recruited from three educational centres in western Spain. Sociodemographic, environmental, social and personal variables were analysed. The value of the extended index of susceptibility to smoking was calculated, and the associations between the students' genders and smoking susceptibility were studied. Multinomial logistic regression was used to study associations between the independent variables and Expanded Susceptibility Index (ESSI) results. The roles of factors in this association were explored through mediation analysis. Results: A total of 364 students participated in the study (53% females). A total of 79.3% of females and 61.4% of males presented a medium‐high level of the extended index of susceptibility. Females reported greater cigarette use (28% vs. 12.3%), hookah (19.9% vs 9.9%) and alcohol consumption (20.7% risk alcohol consumption). They obtained higher scores on the impulsivity scale in the urgency domain and the negative affect scale. Regardless of other factors, females showed more than double the smoking susceptibility (aOR: 2.05, 95% CI: 1.03–4.07, p =.041). Mediation analysis showed that gender had a total effect on the extended susceptibility index β =.023 (95% CI: 0.07–0.38, p =.01). The effect appeared to be mediated only by having smoking friends (0.08; 95% CI: 0.03–0.15, p =.001). Conclusions: The greater susceptibility to smoking found in females may be related to a greater influence of smoking among friends. Impact These results show that smoking friends have a strong influence among adolescent females; therefore, developing preventive programmes with gender approaches aimed at reducing the influence of these environmental factors would be of interest. [ABSTRACT FROM AUTHOR]

Aims: To explore the perceptions of women with lived experience of domestic and family violence on accessing healthcare and to identify how nurses can facilitate and support women experiencing domestic and family violence to receive the care they need. Design: A qualitative single site study. Methods: As part of an evaluation of a nurse‐led domestic and family violence service, a 2‐h focus group was conducted with four women with lived experience of domestic and family violence on 14 December 2021. The Levesque Framework provided a novel approach to identify barriers and facilitators to healthcare access. The focus group guide included eight open‐ended questions. The audio recording was transcribed and analysed using Braun and Clark's thematic analysis process. Results: The Levesque Framework helped highlight individual and structural challenges in accessing healthcare faced by women experiencing domestic and family violence. Dominant themes were first contact, comprehensiveness of services and domestic violence awareness. Conclusion: The growing incidences of domestic and family violence are confounding communities worldwide. Despite the high profile of domestic and family violence in Australia, access to healthcare remains problematic. These preliminary findings suggest that nurses have opportunities to facilitate access in relation to the approachability, acceptability and appropriateness of services. Realizing these opportunities requires education that enables nurses' capacity to provide an effective first contact and facilitate comprehensive care by embodying a no wrong door culture. We intend to explore these concepts in future focus groups. Impact This study explored the factors impacting access to healthcare for women experiencing domestic and family violence. Accessing healthcare when experiencing domestic and family violence in Australia is problematic. Findings suggest that nursing has opportunities to facilitate the approachability, acceptability and appropriateness of services. These findings will be valuable to nurses across all healthcare settings, nursing education providers and health workforce planners. [ABSTRACT FROM AUTHOR]

Aim: First, to identify which aspects of missed care accurately define the integration of care and context of care dimensions of the Fundamentals of Care Framework. Second, to test the Framework for validity and reliability and lastly, to explore how leadership influences care integration. Design: A non‐experimental research design using self‐audit data collected information about variations in nursing care as exemplars for dimensions of the Framework. Methods: A multi‐variate approach using path analysis was used to apply the consensus scores of 3079 Australian residential care nurses and carers to define the dimensions of the Framework. Results/Findings In the Australian residential care setting, the factors that define both the contexts of care and the integration of care dimensions constructs are now empirically established. The most direct predictor for the integration of care dimension arises from both the leadership and resource allocation variables, while the remaining context of care factors have indirect but significant effects. The integration of psychosocial care in the residential care sector is not influenced by any of the Framework's context‐based factors. Conclusion: The component variables of the Framework show both good reliability and convergent validity. These findings confirm a predictive relationship exists between the elements of the context of care and the different types of nursing activities that form the integration of the care dimension, including organizational leadership. [ABSTRACT FROM AUTHOR]

Aim: To understand the factors that affect power in hospital‐based nursing and reveal how the female gender affects an individual's ability to feel empowered. Design: Critical qualitative research design. Method: Semi‐structured interviews were conducted with nurses working in inpatient hospital settings in Utah and New Mexico. Data were collected from February to March 2022. Interviews were analysed using thematic analysis. Results: Sixteen participants were interviewed. Six themes were identified from the data, four of which related to nurses' power at work, and two of which specifically related to how gender affects a nurse's ability to use power and feel empowered. These themes include supportive leaders, positive unit culture, successful advocacy, personal factors, societal gender roles and sexism. Conclusion: Empowered nurses can revolutionize health care. The themes developed in this study will help nurse leaders and nurses alike increase nurses' ability to use their power and feel empowered in the workplace. Impact Nurse leaders should strive to be supportive of their nurses and build a positive work environment while also providing consistent consequences for sexist actions of staff. Nurses should take opportunities to advocate for their patients, be autonomous and build their knowledge base to improve empowerment. As nurse leaders and nurses alike work together to improve health care, nurse experience, patient and clinical outcomes will be improved. Patient or Public Contribution: The nurses interviewed for this study contributed their experiences and insights during data collection. Some also contributed rigour to the data analysis process by participating in member checking. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to develop a predictive model that can identify the suicidal ideation risk group among older adults in rural areas using machine learning methods. Design: This study applied an exploratory, descriptive and cross‐sectional design. Methods: The participants were older adults (N = 650) aged over 65 living in rural areas of South Korea. Self‐report questionnaires were used to collect the demographics, suicidal ideation, depression, socioeconomic information and basic health information from September to October 2020. The collected data were analysed using machine learning methods with R statistical software 4.1.0. Results: The predictive models indicated that depression, pain, age and loneliness were significant factors of suicidal ideation. Good performance was observed based on the area under the receiver operating characteristic curve in the decision tree, random forest and logistic regression. Finally, the evaluation of model performance indicated moderate to high sensitivity and specificity. Conclusion: The predictive models using machine learning methods may be useful to predict the risk of suicidal ideation. Furthermore, depression with pain, age and feelings of loneliness should be included in the initial screening to assess suicide risk among older adults in rural areas. Impact Identifying suicidal risk among older adults is challenging. Thus, employing predictive models that can assess depression, pain, age and loneliness can enable public healthcare providers to detect suicidal risk groups. Particularly, the presented models from this study can facilitate healthcare providers with initiating early interventions to prevent suicide among older adults in clinical and community nursing care settings. Reporting Method: The reporting of this study (Observational, cross‐sectional study) conforms to the STROBE statement. Patient or Public Contribution: No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public. Implication for the Profession and/or Patients Care: Applying this model may help to prevent geriatric suicide because the nursing staff will have a greater awareness regarding the suicide ideation risk of older adults, thereby reducing the possibility of their suicide. [ABSTRACT FROM AUTHOR]

Aims: To identify clusters of risk factors in home health care and determine if the clusters are associated with hospitalizations or emergency department visits. Design: A retrospective cohort study. Methods: This study included 61,454 patients pertaining to 79,079 episodes receiving home health care between 2015 and 2017 from one of the largest home health care organizations in the United States. Potential risk factors were extracted from structured data and unstructured clinical notes analysed by natural language processing. A K‐means cluster analysis was conducted. Kaplan–Meier analysis was conducted to identify the association between clusters and hospitalizations or emergency department visits during home health care. Results: A total of 11.6% of home health episodes resulted in hospitalizations or emergency department visits. Risk factors formed three clusters. Cluster 1 is characterized by a combination of risk factors related to "impaired physical comfort with pain," defined as situations where patients may experience increased pain. Cluster 2 is characterized by "high comorbidity burden" defined as multiple comorbidities or other risks for hospitalization (e.g., prior falls). Cluster 3 is characterized by "impaired cognitive/psychological and skin integrity" including dementia or skin ulcer. Compared to Cluster 1, the risk of hospitalizations or emergency department visits increased by 1.95 times for Cluster 2 and by 2.12 times for Cluster 3 (all p <.001). Conclusion: Risk factors were clustered into three types describing distinct characteristics for hospitalizations or emergency department visits. Different combinations of risk factors affected the likelihood of these negative outcomes. Impact Cluster‐based risk prediction models could be integrated into early warning systems to identify patients at risk for hospitalizations or emergency department visits leading to more timely, patient‐centred care, ultimately preventing these events. Patient or Public Contribution: There was no involvement of patients in developing the research question, determining the outcome measures, or implementing the study. [ABSTRACT FROM AUTHOR]

Aims: To explore and understand lived experiences of end‐of‐life communication among nursing home staff. Design: Interpretive phenomenological study. Methods: In‐person, semi‐structured, in‐depth interviews were conducted from May to August 2021 with 21 nursing home staff members involved in end‐of‐life communication (four managers, four chief nurses, three chief medical officers, three nurses, three psychologists, two occupational therapists, one chief nurse aide and one nurse aide). Data were analysed by van Manen's hermeneutic approach, which uses the lifeworld existentials of spatiality, corporeality, temporality and relationality to guide reflection on the human experience. Data were reported according to the Consolidated Criteria for Reporting Qualitative Research. Results: Thirteen categories were identified and framed within the four existentials. Regarding spatiality, end‐of‐life communication took place in a physical, mental, socio‐cultural and professional competence space. With regard to corporeality, interviewees reported difficulties in managing their own feelings and those of family caregivers. For temporality, interviewees reported delays in end‐of‐life communication due to staffing issues and an increase in urgent and temporary relief admissions to nursing homes. To compensate, they tried to assure that all interactions that did take place were of high quality. Finally, with regard to relationality, interviewees lived end‐of‐life communication through their relationships with family caregivers and colleagues. The supportive role of colleagues was expressed as teamwork, which helped promote reflexivity about how to tailor communication, manage challenging emotions and situations, set aside time for communication, and prepare family caregivers for death. Conclusion: End‐of‐life communication was an all‐encompassing experience for nursing home staff. The supportive role of colleagues was stressed across all existentials, suggesting that teamwork is essential in delivering effective communication at the end‐of‐life. Patient or Public Contribution: There was no patient or public contribution to this study, which addresses the experiences of nursing home staff only. [ABSTRACT FROM AUTHOR]

Aims: To explore nurse–patient interactions during the Covid‐19 pandemic from both nurses' and patients' perspectives. Design: Qualitative study using constructive grounded theory. Methods: A total of 34 patients and 49 nurses from acute and home care settings participated in individual or focus group interviews between December 2020 and May 2021. Data were analysed by a team of researchers using coding, memo‐writing, theoretical sampling and constant comparison and integration. Results: We identified the creation and maintenance of an interactive space as the main social process. This interactive space was shaped by the care context and the course of the pandemic. For nurses, four factors were key, namely protecting oneself and others, navigating communication barriers, adapting nursing actions to the evolving situation, and providing emotional care work. Patients experienced attentive caring relationships with nurses and felt that, for the most part, their individual needs had been met despite the pandemic challenges. Conclusion: Nurses and patients created an interactive space in which they were able to provide and receive the necessary care. Maintaining the interactive space was often challenging, and required an intentional effort by nurses, particularly in acute care settings. The findings illustrate that nurses ensured the provision of necessary care even during a public health crisis, thereby enabling patient access to good quality care. Impact Nurse–patient relationships are important for effective, person‐centred care delivery. Despite the pandemic challenges, nurses managed to uphold their caring imperative and ensure quality care. Findings provide further insights on the importance of nurse–patient interaction in maintaining quality care. They inform models of nursing care delivery and strategies to support quality care during public health crises. [ABSTRACT FROM AUTHOR]

Aim: Guided by the social embeddedness model of thriving at work, this paper explores how nursing organizational culture, work engagement and affective commitment affect nurses' thriving at work. Background: Thriving at work has implications for better employee and organization outcomes. The antecedents of thriving at work among the nursing population needs to be expanded by analysing the cross‐level impact of organizational and individual characteristics. Methods: A cross‐sectional design was used to collect data from 1437 frontline nurses in a tertiary teaching hospital in China between April and May 2020 through an online survey about perceived nursing culture, work engagement, affective commitment and thriving at work. Data were analysed using SPSS, and a structural equation model was established using the PROCESS macro. Results: Our results showed that work engagement and affective commitment mediated the relationship between nurses' perceived nursing culture and their thriving at work. Among nurses, work engagement was positively correlated to affective commitment. Conclusion: Our study confirmed the social embeddedness model of thriving at work by showing that both contextual and dispositional factors can influence nurses' thriving at work. Nurse leaders can foster nursing staff's thriving at work by building an inclusive work environment and by providing adequate resources to staff. Future research is needed to elaborate on employee and organizational outcomes associated with thriving at work. Impact: Nurse leaders should be the advocate for nurses to improve their organizational identification, fostering their thriving at work. Individual nurses can also take an active role in developing work‐related resources to sustain their thriving through self‐adaption processes. Collective thriving in the nursing workforce is needed to overcome adversity and hardship in the ever‐changing and increasingly demanding health care industry and to further contribute to the vitality of the broader social and public environments. Patient or public contribution: No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public. [ABSTRACT FROM AUTHOR]

Aims: To use nurses' descriptions of what would have improved their working lives during the first peak of the COVID‐19 pandemic in the UK. Design: Analysis of free‐text responses from a cross‐sectional survey of the UK nursing and midwifery workforce. Methods: Between 2 and 14 April 2020, 3299 nurses and midwives completed an online survey, as part of the 'Impact of COVID‐19 on Nurses' (ICON) study. 2205 (67%) gave answers to a question asking for the top three things that the government or their employer could do to improve their working lives. Each participants' response was coded using thematic and content analysis. Multiple response analysis quantified the frequency of different issues and themes and examined variation by employer. Results: Most (77%) were employed by the National Health Service (77%) and worked at staff or senior staff nurse levels (55%). 5938 codable responses were generated. Personal protective equipment/staff safety (60.0%), support to workforce (28.6%) and better communication (21.9%) were the most cited themes. Within 'personal protective equipment', responses focussed most on available supply. Only 2.8% stated that nothing further could be done. Patterns were similar in both NHS and non‐NHS settings. Conclusions: The analysis provided valuable insight into key changes required to improve the work lives of nurses during a pandemic. Urgent improvements in provision and quality of personal protective equipment were needed for the safety of both workforce and patients. Impact Failure to meet nurses needs to be safe at work appears to have damaged morale in this vital workforce. We identified key strategies that, if implemented by the Government and employers, could have improved the working lives of the nursing and midwifery workforce during the early stages of the COVID‐19 pandemic and could prevent the pandemic from having a longer‐term negative impact on the retention of this vital workforce. Patient or Public Contribution: No Patient or Public Contribution, due to the COVID‐19 Pandemic, urgency of the work and the target population being health and social care staff. [ABSTRACT FROM AUTHOR]

Aim: To investigate the factors associated with self‐management after hybrid revascularization in patients with lower extremity peripheral artery disease using a structural equation modelling approach. Design: A cross‐sectional study was adopted. Methods: A total of 221 patients who underwent hybrid revascularization for peripheral artery disease of the lower limbs were included from outpatient clinics at a 1200‐bed tertiary care hospital in Korea. Data were collected using a self‐reported questionnaire between December 1, 2019, and August 31, 2020. Structural equation modelling was applied to test the hypothetical model. Results: The item mean score of participants' self‐management was 6.28 (standard deviation, 0.83) out of 8. The structural equation modelling had a good fit index. Autonomy support from healthcare providers was directly associated with self‐management (β = 0.20, p = 0.041). Illness perception directly (β = −0.33, p = 0.031) and indirectly (β = −0.19, p = 0.032) influenced self‐management through competence and relatedness in patients with peripheral artery disease. The construct of autonomy support from healthcare providers, illness perception, competence and relatedness accounted for 49% of the variance in self‐management. The Sobel test confirmed the statistically significant mediating effects of competence (z = −4.52, p < 0.001) and relatedness (z = −2.12, p < 0.001) on the relationship between illness perception and self‐management. Conclusion: Our findings revealed that autonomy support from healthcare providers and patients' illness perception directly influenced patients' self‐management. Additionally, patients' illness perception can indirectly influence self‐management through their perceived competence and relatedness. Impact Healthcare providers' autonomy support to patients may promote self‐care behaviours, leading to greater autonomous motivation. Assessment of patients' illness perception before patient education is vital to designing effective self‐management strategies which can improve patients' perceived competency and meaningful relatedness with healthcare providers. [ABSTRACT FROM AUTHOR]

Aims: To explore the relationship between patient activation (subjective initiative of patients to participate in disease management in self‐health care), social support, self‐efficacy and online health information seeking among older patients with coronary heart disease. Design: A cross‐sectional and survey‐based design. Methods: A total of 451 older patients with coronary heart disease were recruited from July to November 2021 from four communities in Qingdao, China. We collected data using the Patient Activation Measure, Social Support Rating Scale, Self‐Efficacy Scale and Online Health Information Seeking Scale. We performed structural equation modelling to analyse the data. Results: The final model showed good model fit. Patient activation influenced online health information seeking directly (β =.39, p <.05) and indirectly through self‐efficacy (β =.17, p <.05). Social support influenced online health information seeking directly (β =.23, p <.05) and indirectly through self‐efficacy (β =.03, p <.05). Self‐efficacy directly influenced online health information seeking (β =.26, p <.05). Conclusions: We identified the interrelationships of patient activation, social support and self‐efficacy and their influence on the online health information seeking of older patients with coronary heart disease. Our findings provide a theoretical basis for developing and evaluating interventions to enhance online health information seeking for older patients with coronary heart disease. Impact These findings add a better understanding of the relationship between patient activation, social support, self‐efficacy and online health information seeking in older patients with coronary heart disease, and help community health workers to intervene in the early stage of disease diagnosis. [ABSTRACT FROM AUTHOR]

Aims: To investigate the effect of sensory impairment on quality of life in older adults and to assess the role of physical function as a mediator of the effect of the sensory impairment on quality of life. Design: A cross‐sectional study. Methods: Older adults aged ≥65 years (N = 600) were recruited from January 2019 to May 2020. Hearing and visual function were measured with pure‐tone audiometry and Snellen visual acuity tests, respectively. Quality of life (World Health Organization Quality of Life Scale Brief Version), physical function (Multidimensional Functional Assessment Questionnaire) and sociodemographic characteristics were reported by participants using interviewer‐administered questionnaires. Propensity score weighting analysis was conducted based on generalized propensity scores via multinominal logistic regression for age, gender, education, income, and comorbidities. The difference in the quality of life was tested by applying a one‐way analysis of variance. Multiple mediation analysis was conducted to explore the direct, indirect, and total effects of sensory impairment on quality of life through physical function. Results: After propensity score weighting adjustment, when compared with participants with no sensory impairment, participants with dual sensory impairment had the worst quality of life, followed by visual impairment and then hearing impairment. Physical function statistically significantly mediated the effect of hearing impairment, visual impairment and dual sensory impairment on quality of life in older adults. Conclusion: Our findings demonstrated that the negative effect of the sensory impairment on quality of life in older adults was mediated through physical function. Impact The convergence of an increasing ageing population and the prevalence of sensory impairment presents a significant global health burden. This study demonstrated that physical function was a mediator of quality of life in older adults. Designing appropriate physical activity interventions for older adults with sensory impairment could serve to enhance physio‐psychological health and improve quality of life. [ABSTRACT FROM AUTHOR]

Aims: We aim to identify existing empowerment interventions for people living with dementia and to explore which used interventions and projects are considered empowering and why. Design: This was an online survey. Methods: We conducted an online survey between May 2018 and July 2018 amongst professionals interested in dementia care in Europe. Interventions were clustered within the ecological model for health promotion. Reasons from respondents as to why they considered interventions to be empowering were analysed and structured according to a recently developed conceptual framework of empowerment for people living with dementia. Results: Seventy‐three respondents from 23 countries together mentioned 98 interventions or projects, of which 90 were unique. Interventions focused on the (inter)personal (n = 54), organizational (n = 15), communal (n = 6) and societal (n = 15) levels. A broad range of interventions were considered empowering, but no interventions were specifically developed for, nor aimed at, empowerment. Reasons as to why respondents considered these interventions as empowering fitted the framework's domains. Conclusion: This European survey provides insights into interventions considered empowering for people living with dementia. An important step that needs to be taken is to develop and test interventions that specifically aim to promote empowerment for people living with dementia. Impact Empowerment may encourage people with dementia to live the life they choose, and focus on what is possible, instead of what is no longer possible. Many interventions are considered as empowering for people living with dementia, however no interventions could be identified that were specifically developed for or aimed at empowerment. This study shows that for promoting empowerment, it is necessary to develop and test interventions that specifically aim for empowerment, do this in collaboration with relevant stakeholders, and in this way support people living with dementia to live according to their competencies, talents and wishes. [ABSTRACT FROM AUTHOR]

Background: Studies have reported on the important role of the clinical research nurse in clinical studies. Yet, there is no international consensus about the role's competencies and tasks. Furthermore, the literature offers a little description of the career pathway from a ward‐based registered nurse to a clinical research nurse. More knowledge about this specific role could benefit the nursing profession as well as increase the quality of clinical research. Aim: The aim of the study was to explore Swedish registered nurses' experiences transitioning into the clinical research nurse role. Design: The study had a qualitative design. Data were collected via semi‐structured interviews. Inductive qualitative content analysis was employed. Methods: Ten participants (i.e., clinical research nurses) were interviewed in the spring of 2017. A semi‐structured interview guide was used to address the transition into the clinical research nurse role, experience working in a new role, experience of ethical dilemmas and experience of organizational and professional issues related to the role. The interviews were analysed inductively using qualitative content analysis. Results: The registered nurses described experiencing reality shock when they became clinical research nurses; that is, it was a challenging and transforming experience. The main theme, a challenging transition, was developed from the four subthemes highlighting that it defied their previous nursing role. They experienced an unclear professional identity, extended professional mandate, increased professional status and growing ethical consciousness in their new role. Conclusion: The results highlight that registered nurses who became clinical research nurses had needs that were both distinct from and overlapped with those of their former professional role as registered nurses. To avoid reality shocks, the development of clear competence pathways for nurses to become clinical research nurses, including introduction, mentorship and continued support, is necessary. Making their professional title more homogeneous, nationally and internationally, would facilitate role identification and comparisons in research. [ABSTRACT FROM AUTHOR]

Objective: To explore the concept of 'capital' through the study of successive interventions and outcomes (patient and staff) in a quaternity intensive care unit (ICU) across a 5‐year time frame. Design: A longitudinal intrinsic single site, a survey study was designed. The concept of 'capital' was explored through an adopted interpretive approach that involved understanding meanings from different sources, for example, discussions at compassion cafés, follow‐up from staff‐initiated activities, informal responses to organizational imperatives external to the unit (i.e. staff reductions and resource constraints), alongside empirical data about workplace climate and patient incidents. Setting: A single ICU employing approximately 220 registered nurses at a quaternary hospital in Queensland, Australia. Participants: All nurses employed in the ICU at the time of compassion cafes participated in providing feedback to inform successive activities. All nurses in the unit had equal opportunity to complete surveys, participate in subsequent unit‐based sessions, take‐up options; and all nurses had a responsibility to complete incident data. Results: Survey and incident data from 2015 to 2019 identify the complexity of workplace environments. Between 35% and 45% of nurses consistently completed the survey. Activities based on staff requests initially improved incident data but did not impact the work environment; negative perceptions of the work environment at the endpoint (2019) were associated with external factors. Conclusion: Quality care environments are labile; sensitive to both unit activity and external organization directives (namely staff reductions). Quality care can be sustained in adverse situations with increased nurse engagement in patient care dynamics in the short term. Impact This study articulates a previously unidentified concept, 'clinical capital'. Activities facilitating nurse engagement in broad care dynamics gave rise to a more robust climate than just focusing on social and psychological well‐being activities for nurses. Participation in issues of concern about patient care can promote resilience to short term fluctuations. [ABSTRACT FROM AUTHOR]