Search

Background: Evidences have demonstrated the effectiveness of early essential newborn care. However, the implementation of early essential newborn care is suboptimal. The aim is to identify and synthesise the barriers and facilitators impacting the implementation of early essential newborn care in low‐ and middle‐income countries. Data Sources: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, CNKI, Wan Fang Data, SinoMed and Google Scholar. Methods: Two authors independently screened, performed quality assessment using the Mixed Methods Appraisal Tool and extracted data. This review includes papers that reported the barriers and facilitators of implementing early essential newborn care in low‐ and middle‐income countries from the view of healthcare providers. Barriers and facilitators were coded according to the consolidated framework for implementation research in a deductive way and then been inducted into five common themes. This review followed synthesis without meta‐analysis reporting guideline. Results: A total of 28 studies were included. Five inductive common themes influencing implementing early essential newborn care in low‐ and middle‐income countries were system‐level healthcare factors, healthcare providers' knowledge and beliefs, the requirements of mothers or families, adapting to routine practice and the working climate of organisation. Conclusion: The factors were from system level, facility level and individual level and were inducted into five themes. Based on this review, decision‐makers could tailor implementing strategies to narrow the gap between the evidence and implementation. Relevance to Clinical Practice: The study offers guidance for health professionals to identify barriers and facilitators in implementing early essential newborn care and make tailored strategies when implementing early essential newborn care. Patient or Public Contribution: No patient or public contributions. [ABSTRACT FROM AUTHOR]

Aim: This paper explores the invisibility and underrepresentation of Black nurses in formal and informal leadership roles using a Black feminist poststructuralist framework. The paper describes historical and contemporary challenges experienced by Black nurses throughout their nursing education and in practice. It also highlights how social and institutional discourses continue to marginalise and oppress Black nurses as leaders and render them invisible. Background: Diversity among nursing leaders is essential to inform health care delivery, develop inclusive practices and provide culturally sensitive care. Despite this glaring need for diversity within nursing in Canada, there remains a significant underrepresentation of Black nurses in the workforce and as leaders. Design: This is a discursive paper on Black nurses in nursing education and the workforce as well as their location as leaders in health care through a critical analysis using Black feminist poststructuralism. Methods: A review of the literature involved searching electronic databases CINAHL, NovaNet, PubMed and Google Scholar using keywords including: Black; African; Nurses; Leaders; Feminism; Poststructural. Articles were screened by titles and abstracts before accessing full‐text for relevant articles. Results: Black feminist poststructuralism uncovers how power, language, subjectivity and agency are constructed by the historically ingrained social and institutional discourses of everyday life for Black nurses. Experiences of discrimination and oppression were common throughout nursing education and practice for Black nurses, resulting in feelings of marginalisation and isolation. Conclusion: The invisibility of Black nurse leaders is the result of generational oppression and discrimination manifested through discourses. Systemic, institutional and historical discourses perpetuate barriers for Black nurse leaders, resulting in their invisibility or absence in practice. Relevance to Clinical Practice: This paper is designed to generate discussion related to the invisibility of Black nurse leaders by providing an understanding of the historical experiences of Black people, their entry into the nursing profession and the present day challenges they face. This discussion will inform health care practice, policy, and structuring by identifying the barriers to leadership for Black nurses. [ABSTRACT FROM AUTHOR]

Aim: To explore the impact of cultural beliefs of dementia as witchcraft in sub‐Saharan Africa. Background: The population of sub‐Saharan Africa is ageing, which increases the number of those at risk of dementia. Mental health and physical diseases that affect behaviour have often been associated with witchcraft. Accusations of witchcraft leave individuals vulnerable and at risk. Method: A systematic review, which followed the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and completed a PRISMA checklist. CINAHL, PsycINFO, Web of Knowledge, PubMed and Science Direct databases were searched for relevant studies published from their inception to 31 May 2019 by applying appropriate Medical Subject Headings. Data analysis adhered to Thomas and Harding's thematic synthesis. Results: The review identified limited literature on this topic, with only five papers meeting the inclusion and exclusion criteria. Studies explored health provision, and knowledge and beliefs of dementia in Tanzania and South Africa. Three themes emerged as follows: (a) poor knowledge of dementia, including the belief of dementia as witchcraft; (b) challenges of supporting a family member with dementia in the community; and (c) health‐seeking behaviours of and for people with dementia. Conclusion: There remains a need for dementia awareness and education across sub‐Saharan Africa communities, including faith and traditional healers, and healthcare professionals to support pluralistic healthcare provision. Nurses are the best‐placed healthcare professionals to support these initiatives and the development and implementation of low‐resource nonpharmacological interventions to support people with dementia and their families living in the community. Relevance to clinical practice: Nurses working in sub‐Saharan Africa and those caring for patients from sub‐Saharan Africa can only provide person‐centred care and support for a person with dementia and their family if they understand their cultural beliefs, one of which may include witchcraft. [ABSTRACT FROM AUTHOR]

Aims and objectives: To establish an understanding of healthcare professionals' dementia knowledge and attitudes towards dementia care, and family carers' perceptions of dementia care in China. Background: Healthcare professionals and family carers of people with dementia deliver most of the dementia care in China. However, little research on healthcare professionals' dementia knowledge and attitudes towards dementia care, and family carers' dementia care perceptions has been conducted in China. Methods: An integrative review was conducted and reported based on the PRISMA guidelines and Whittemore and Knafl's framework. Eight English databases were searched without date restriction: CINAHL Plus with Full Text, MEDLINE, PubMed, Web of Science, Cochrane Library, Embase, PsycINFO and Scopus; and three Chinese databases: China National Knowledge Infrastructure, Chongqing Weipu and Wanfang, plus a manual search of reference lists. Results: Thirty‐eight primary research papers were included in the review. Three themes were identified from the synthesis: (a) knowledge and competency; (b) attitudes towards dementia care; and (c) carers' burden and unmet needs. Healthcare professionals' dementia knowledge ranged from low to moderate levels and attitudes towards dementia care were generally negative. With low levels of knowledge of dementia and negative attitudes including stigma, family carers were under stress with insufficient support, and they expected more support from community nurses. Conclusions: There is an apparent need for a national policy on healthcare professional education and training to improve dementia care practice in China. Such a policy may improve support services for family carers. Relevance to clinical practice: Nurses, and particularly community nurses, are well‐positioned to support family carers in China. However, healthcare professionals in China are not prepared for this. Therefore, education and training on dementia care should be integrated into medical and nursing undergraduate programmes and provided for healthcare professionals after commencing employment, and strategies to reduce stigma are needed. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate whether implementing the Modified Early Warning Scoring system impacts nurses' free text notes related to Airway, Breathing, Circulation and Pain in general ward medical and surgical patients. Background: The quality of nursing documentation in patient health records is important to secure patient safety, but faces multiple challenges whether being paper‐based or electronic. Nurses' ability to draw a complete picture of the patient situation is thereby compromised. Structured use of the Modified Early Warning Score, found to reduce unexpected death, might affect nurses' free text documentation of clinical observations. Design: A prospective, pre‐ and postinterventional, nonrandomised study adhering to the EQUATOR guideline TREND. Methods: Data on nurses' free text notes were obtained in 1,497 patient records during one preinterventional (March–June 2009) and two postinterventional study periods (September–December 2010 and March–June 2011) in a Danish university hospital. Data were organised by the Airway, Breathing and Circulation principles and by nurses' working shifts in the 56 hr surrounding the first recording of deviating vital parameters or a Modified Early Warning Score ≥ 2. Preinterventional free text notes were compared with notes from the two postinterventional periods, respectively. Results: In the 8‐hr working shift where deviations in vital parameters were recorded for the first time, nurses' free text notes related to patients' breathing (B) increased significantly, comparing 2009 with 2010 and 2011, respectively. In the 24 hr following initial deviations in vital parameters, a significant increase in free text notes was identified concerning Airway, Breathing and Circulation‐related symptoms or problems. Conclusion: Mandatory use of the Modified Early Warning Score and related implementation activities significantly impacts nursing documentation of free text notes. Relevance to clinical practice: Nurses' practice of communicating observed clinical symptoms by documenting free text notes should be supported through measures to enhance situation awareness. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore young adults' knowledge and attitudes of cardiovascular disease and its risk factors. Background: Cardiovascular disease morbidity is rising and mortality is declining among young adults. However, the knowledge of cardiovascular disease by young adults is not well known. Design: A systematic review with meta‐analysis was used. Methods: The databases of CINHAL, MEDLINE Complete, PsycINFO and Psycarticles were searched for all studies published before June 2016. Search terms included cardiovascular disease, young adult, attitude and knowledge. Papers were included if they were published in English and reported quantitative research with a study population between the ages of 18–34 years, with a focus on knowledge and attitudes to cardiovascular disease. Meta‐analyses were conducted to assess the extent of knowledge of risk factors on heart disease. Results: Nine risk factors for cardiovascular disease were identified by the respondents; smoking (synthesised estimate of 55% of respondents identifying as a risk factor, 95% confidence interval of synthesised estimate 45%–65%); obesity (27%, 95% CI, 26%–29%); high blood cholesterol (33%, 95% CI, 12%–54%); high blood pressure (25%, 95% CI, 18%–32%); genetic factors (26%, 95% CI, 23%–29%); physical inactivity (39%, 95% CI, 30%–47%); stress (49%, 95% CI, 48%–51%); advancing age (10%, 95% CI, 8%–12%) and diet (55%, 95% CI, 54%–56%). Conclusion: Young adults demonstrate limited knowledge and poor attitudes regarding cardiovascular disease and its risk factors. The finding of this review demonstrates that there is an urgent need to build knowledge of cardiovascular risk identification in this population group. Relevance to clinical practice: Increasing cardiovascular disease in young adults will put stress in the healthcare system financially and economically. There is a need of awareness of cardiovascular disease in this population group. [ABSTRACT FROM AUTHOR]

Aim and objective: We explored the experiences of nurses who cared for coronavirus disease 2019 patients in Iraqi Kurdistan. Background: Nurses play a major role in response to pandemics and epidemics in delivering patient care. The experiences of nurses who provided care have significant short and long‐term consequences for individuals, communities, and the nursing profession. Methods: Descriptive qualitative research approach was adopted in this study. We interviewed 12 nurses (22–50 years) who cared for the coronavirus disease 2019 patients in one of the clinical units of two coronavirus disease 2019 hospitals in Iraqi Kurdistan in 2020. Interviews were conducted via phone calls and were analysed using the thematic analysis method. The Consolidated criteria for reporting qualitative research checklist was applied when constructing this paper. Results: The nurses had to care for a number of situations during the outbreak of coronavirus disease 2019 in Kurdistan. As people in the public did not believe that there was such a virus, nurses often had to deal with this lack of knowledge and aggression from some patients and their family members. Most nurses changed their preventive behaviours since the coronavirus disease 2019 outbreak at hospital or in public. This was mainly to protect not only themselves but their patients, colleagues, family members and friends. They were cautious about the use of a mask at the hospital and in public. Most nurses experienced fear, stress, anxiety and isolation during this period. Conclusions: The patients had some concerns about their health and staying at hospitals, and some of them had aggressive behaviours towards nurses at corona hospitals. The public, close friends and relatives of the nurses had a fear of getting the infection by the virus through the nurses. However, the nurses attempted to protect themselves, colleagues and family members, and provide the best care to coronavirus disease 2019 patients. The nurses had a high obligation towards care giving at hospitals. Relevance to clinical practice: The negative experiences of the nurses regarding the care of coronavirus disease 2019 patients must be considered in clinical settings. Sensitive policy programs must be established to protect nurses from the ostracization and stigmatization of the coronavirus disease 2019 pandemic and to allow them to be able to achieve their professional practices safely. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to explore the perceptions, attitudes and beliefs of middle‐aged Australians around their health, lifestyle risks and chronic disease. Background: Health promotion and risk reduction are important to stem the rising prevalence of chronic disease. While there has been much emphasis on supporting these strategies in older Australians, there has been less attention on those in middle age. However, as this group age, their health will inevitably be impacted by lifestyle risk. Design: A qualitative descriptive study using semi‐structured interviews. Reporting was guided by the COREQ checklist. Methods: Thirty‐four participants aged 40–65 years were recruited across South Eastern New South Wales, Australia, using convenience sampling. Semi‐structured interviews were conducted by four registered nurses with qualitative research experience. Verbatim transcripts were analysed using thematic analysis. Results: Sixteen women and 18 men participated in the interviews. Four themes emerged, namely: adopting healthy lifestyles; denial; an impetus for change; and sustaining change. Perceptions about what constituted good health varied, with male participants being more ambivalent about their health. Impetus for change was mostly influenced by family history, awareness of health risks and identification of risks by health professionals. Participants found sustaining change challenging, particularly with regard to smoking cessation and dietary modifications. Conclusions: Understanding the perceptions of health of middle‐aged people is important and enables health professionals to engage in early behavioural change conversations that consider perceived barriers to lifestyle modification. Findings from this study emphasise the importance of discussions about lifestyle risk to reduce the future burden of chronic disease. Relevance to Clinical Practice: These findings illustrate the importance of understanding perceptions of health to guide primary health care nurses to develop person‐centred health promotion and chronic disease prevention strategies in this age group. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed to describe and understand the lived experiences and opinions of sub‐Saharan women living in Spain in relation to female genital mutilation. Background: Female genital mutilation is a bloody procedure with serious consequences for the health of women and girls. Understanding mutilated women's lived experiences plays a crucial role in the management of health consequences and could help healthcare professionals to provide assistance to these women. Design: A descriptive phenomenological study was carried out. The COREQ checklist was followed as guidance to write the manuscript. Methods: A total of 12 in‐depth interviews were conducted. Interviews were recorded, transcribed and analysed using ATLAS.ti 9.0. Results: Two themes with four subthemes were identified from the data analysis: 1) 'The traumatic experience of female circumcision' with the subthemes 'Female mutilation is a physical and psychological torture procedure' and 'recognising and coping with negative emotions'; 2) 'The fight for the eradication of female genital mutilation' which contains the subthemes 'the need for a real sociocultural change at the origin' and '"I want to be the last": Personal development leads to sociocultural change'. Conclusions: Female genital mutilation was experienced by women as a very aggressive and traumatic event. It causes considerable negative emotions that last over time. Although there is a tendency to reject the practice, in women's countries of origin, there is social pressure for girls to be mutilated. Relevance to clinical practice: Caring for women who have suffered from female genital mutilation requires awareness of the traumatic experience they underwent when they were girls. Healthcare professionals play a crucial role in eradicating female genital mutilation. Apart from education, preventive measures may include specific recommendations when girls are travelling to the country of origin and participatory action research. [ABSTRACT FROM AUTHOR]

Aims and objectives: To clarify beliefs linked with depression among older adults with depression in Japan. Background: As a result of global population ageing, caring for older adults with depression has become an important issue worldwide. In this paper, the concept of "beliefs" pertains to phenomena that lead to distress about disease and can be alleviated through talk therapy. While previous studies focused on illness beliefs in people with mental illness and depression, no studies have yet focused on such beliefs among older adults with depression. Design: Qualitative, narrative‐research‐based method. Methods: Observation and 1–5 narrative interviews lasting 60–90 min were conducted with each of 19 older adults with depression in a Japanese psychiatric ward. The resulting narratives were thematically analysed to derive relevant themes and subthemes. Reporting of this research adheres to COREQ guidelines. Results: Four themes and twelve subthemes were revealed. Depression‐linked beliefs among older adults with depression were (1) "guilt and regret," (2) "pessimism," (3) "futility of treatment" and (4) "desire to be needed by loved ones and society." Conclusion: Depression‐linked beliefs among older adults with depression constituted spiritual pain reflecting character tendencies, including experiences of loss and developmental challenges related to ageing as well as subjects' natural diligence and consideration for others. Relevance to clinical practice: (1) Helping nurses better understand distress experienced by older adults with depression, who are prone to feel guilt and regret when reflecting on the past and to alleviate distress through dialogue and providing positive affirmation for patients. (2) To understand and assuage distress over experiences of loss in old age. (3) To help older adults with depression form a more relaxed attitude towards life, so that even if they have experienced loss as a result of old age, they can maintain their self‐esteem and existential sense of self‐worth. [ABSTRACT FROM AUTHOR]

Aims: To explore the psychosocial experiences during dietary management among Chinese adults with inflammatory bowel disease. Design: Qualitative phenomenological design. Methods: Eighteen adults diagnosed with inflammatory bowel disease for more than 6 months were recruited using purposive sampling from June to December 2023. Two trained researchers used van Manen's approach to analyse the data. Results: The three themes with multiple subthemes emerged: facing the unknown: at a loss and aggrieved, trying to cope: uncertain and distressed, and growing in adaptation: relieved and transcendent. The first theme included unknown relapses, overlooking diet management and the absence of dietary rules. The second theme showed different coping situations, like complex dietary information and ever‐closing worlds. The third theme explores how participants adapted to disease and their eating patterns. Conclusion: The psychosocial experiences during dietary management are complex. The accumulation of diet‐related experience, acceptance of illness and social support facilitate patients in overcoming negative emotions and adhering to dietary management. Implications for the Profession and Patient Care: Nurses should provide tailored dietary guidance and appropriate psychological interventions to promote healthy eating in patients. Impact: This study may enhance healthcare professionals' understanding, particularly those in China, of the diet‐related experiences among patients. Reporting Method: The Consolidated Criteria for Reporting Qualitative Research checklist. Patient or Public Contribution: Participants contributed by sharing their first hand experiences. [ABSTRACT FROM AUTHOR]

Aim: To obtain an in‐depth understanding of the lived experiences, values, and beliefs of Taiwanese women with breast cancer who withdrew from cancer treatment. Background: Fear of side effects, negative experiences and personal beliefs were identified as reasons for withdrawing from cancer treatments. Body–mind consciousness and body autonomy play a crucial role in cancer treatment decisions. Design: Descriptive phenomenological approach. Methods: We conducted semi‐structured, face‐to‐face and in‐depth interviews with 16 women diagnosed with breast cancer. Participants were purposefully selected from the Cancer Registry database. Employing a phenomenological approach, our aim was to explore the lived experiences of these individuals. Data analysis followed Giorgi's five‐step process. To ensure a comprehensive report the COREQ checklist was applied. Findings: 'The Determination to Preserve Me' is the essence of treatment withdrawal, identified by three themes and seven sub‐themes. 'Raising Body‐Mind Consciousness' was generated using body autonomy and preventing repeated psychological trauma from the participant's view. Their lifestyles, maintaining the family role, and returning to a normal trajectory help develop 'Maintaining Stability for Being a Patient and a Family Carer'. 'Self‐Defending Against the Body Harm' was generated by concerns about maintaining health and preventing harm. Conclusion: Women's behaviours became transformed by suffering. Actions were influenced by physical and psychological distress, misconceptions about treatments, and appearance changes by self‐determination through self‐protection. Relevance to clinical practice: Healthcare professionals should respect women's autonomy and work collaboratively to ensure their decision‐making with accurate information and awareness of the potential risks and benefits of treatment withdrawal need to concern. [ABSTRACT FROM AUTHOR]

Aims and objectives This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. Background Ambiguities remain about how patients participate in routine measures designed to promote patient safety. Design Systematic review using integrative methods. Methods Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: 'patient', 'healthcare provider', 'task', 'work environment', 'organisation & management'. Results We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives. Conclusions Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures. Relevance to clinical practice Patients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety. [ABSTRACT FROM AUTHOR]

Aims and objectives: To understand the factors influencing parental attitudes towards antibiotic prescribing. Background: Overuse of antibiotics and inappropriate prescribing has resulted in rapid development of antimicrobial resistance (AMR) and is a significant global threat to patient safety. In primary care settings, substantial numbers of antibiotics are prescribed for young children, despite viral nature of illness for which antibiotics are ineffective. Parents play a vital role in decision‐making regarding accessing healthcare services and requesting treatment for their children. Design: A systematic review was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) statement (Moher et al., Systematic Reviews, 4, 2015, p. 1). Methods: The CINAHL, MEDLINE, PsycINFO, The Cochrane Library, BRITISH NURSING INDEX, EMBASE and PUBMED databases were searched for primary research published between 2006–2016. All types of primary research were searched and screened against inclusion criteria. The Critical Appraisal Skills Programme tool was used to appraise identified publications. Quantitative data were summarised descriptively, and qualitative data were thematically analysed. Results: A total of 515 publications were initially screened, and 55 full‐text articles were eligibility assessed. Twenty papers met inclusion criteria. Four main themes were identified: the quality of relationships with healthcare providers, dealing with conflicting messages, rationalising antibiotic use and parental practices informed by past experience. Conclusions: Parents wanted reassurance and advice regarding children's illnesses, had poor antibiotic knowledge and were influenced by personal past experiences. More accessible education, including simple information leaflets, is required. Further research on the influence of culture, ethnicity and socio‐economic factors would be beneficial. Relevance to clinical practice: Healthcare professionals must provide adequate time for reassurance and explanations of decision‐making. Easy‐to‐read information regarding appropriate antibiotic usage should be easily accessible for parents. [ABSTRACT FROM AUTHOR]

Aim: To describe a synthesis of the experience related to the spirituality of those living a bereavement journey in primary qualitative studies. Design: A systematic review of qualitative studies. Data Source: A systematic review was carried out in March 2019 and was updated in January 2023. Searching was accomplished by an online database, such as CINAHL, MEDLINE, PsycINFO, MedicLatina, LILACS, SciELO and Academic Search Complete. The search strategy did not consider a timeline as an eligibility criterion. The quality of the studies was assessed, and a thematic synthesis was performed in this review. Methods: A systematic review of qualitative studies was conducted according to Saini and Shlonsky's methodology. Reporting Method: PRISMA checklist. Results: The review included 33 articles. Most of the studies were phenomenological and focused on parents' and family experiences of bereavement. Seven significant categories emerged, which match unmet spiritual needs during the grieving process. Two major categories were identified regarding the role of spirituality in bereavement: Spirituality as a process and spirituality as an outcome. Conclusion: In clinical practice, attention to spirituality and providing spiritual care is critical to guarantee a holistic approach for those experiencing bereavement. Implications: The findings of our study could foster awareness that healthcare professionals should include the spiritual dimension in their clinical practice to provide holistic care to individuals, enhancing the healing process in bereavement. No Patient or Public Contribution: This is a systematic review. [ABSTRACT FROM AUTHOR]

Aim: To generate, test and refine programme theories that emerged from a rapid realist review investigating practising UK Nurses' and Midwives' experiences of effective leadership strategies during the COVID‐19 pandemic. Background: The realist review of literature generated six tentative theories of healthful leadership practices reflecting, working with people's beliefs and values; being facilitative; multiple means of communication and; practical support. The review yielded little insight into the actual impact of the leadership approaches advocated. Methods: A realist study, informed by person‐centredness using mixed‐methods. Online survey (n = 328) and semi‐structured interviews (n = 14) of nurses and midwives across the UK in different career positions/specialities. Quantitative data analysed using descriptive statistics and exploratory factor analysis. Framework analysis for qualitative data using context (C), mechanism (M), outcome (O) configurations of the tentative theories. Results: Three refined theories were identified concerning: Visibility and availability; embodying values and; knowing self. Healthful leadership practices are only achievable within organisational cultures that privilege well‐being. Conclusions: Leaders should intentionally adopt practices that promote well‐being. 'Knowing self' as a leader, coaching and mentoring practice development is important for leadership development. Implications for Clinical Practice: Nurses who feel valued, heard, cared for and safe are more likely to remain in clinical practice. Job satisfaction and being motivated to practice with confidence and competence will impact positively on patient outcomes. Impact: The study addresses the role of leadership in developing healthful workplace cultures. The main findings were six leadership practices that promote healthful cultures. The research will have an impact on strategic and clinical leaders, nurses and midwives. Reporting Method: This study used EQUATOR checklist, RAMASES II as reporting standards for realist evaluations. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims and objectives To discuss Ethiopian food taboos during pregnancy and their relation to maternal nutritional status and pregnancy outcomes. Background Recent waves of migration have seen large groups of Ethiopian refugees moving to countries around the globe. This is of concern as Ethiopian women are at risk of a number of medical and pregnancy complications. Health is further compromised by poor diet and adherence to cultural food beliefs and taboos. In refugee women, many of these factors correspond with significantly higher rates of pregnancy complications and poor birth outcomes. Design This is a discussion paper informed by a literature review. Methods A search of the Scopus, PubMed, Web of Science and Academic Search Premier databases for the keywords Ethiopian, pregnancy, food and taboos was conducted in the research literature published from 1998-2015. This time is contingent with Ethiopian migration trends. Results Ethiopian migrant women are at risk of inadequate nutrition during pregnancy. Risks include cultural factors associated with food taboos as well as issues associated with low socioeconomic status. Consequently, Ethiopian women are more likely to have nutritional deficiencies such as anaemia which have been associated with a range of pregnancy complications. Conclusions There are many serious consequences of poor diet during pregnancy; however, most of these can be avoided by greater awareness about the role of nutrition during pregnancy and by adopting a balanced diet. Relevance to clinical practice There is an urgent unmet need for nutrition education among Ethiopian women. Research indicates that Ethiopian women are receptive to nutritional advice during pregnancy and also that pregnant women are generally motivated to act in the baby's interest. These factors suggest that this high-risk group would be amenable to culturally appropriate nutrition education, which would provide much-needed meaningful support in pregnancy. [ABSTRACT FROM AUTHOR]

An editorial is presented in the Journal of Clinical Nursing, emphasizing the importance of enhancing nurses' awareness of neurodiversity. Topics include appreciating the societal context by shifting perspectives, clarifying the relevance of neurodiversity to nursing, and promoting equality and diversity within the profession, with a focus on addressing the needs of neurodivergent individuals.

Aims. This paper is a report on a study exploring beliefs about health and illness in women with gestational diabetes born in Sweden and Africa living in Sweden. A further aim is to study the influence of beliefs on self-care and care seeking. Background. Extensive global migration leading to multicultural societies implies challenges to health care. Health/illness beliefs are culturally related and determine health-related behaviour, including self-care, which is crucial in management of gestational diabetes. The risk of developing gestational diabetes is increased in migrants, particularly of African origin, when residing in Western countries. No previous studies, except one, have been found comparing health/illness beliefs in women with gestational diabetes of different origin. Design. Exploratory descriptive study. Methods. Semi-structured interviews. Consecutive sample of women diagnosed with gestational diabetes, 13 born in Sweden and 10 born in Africa, from a diabetes clinic in Sweden. Qualitative content analysis of data was applied. Results. Beliefs were mainly related to individual and social factors. Health was described as freedom from disease and being healthy. Swedish women perceived heredity and hormonal changes as causing gestational diabetes, avoided work-related stress, had a healthy lifestyle, worried about the baby's health and development of type 2 diabetes, sought information, used more medications and health care and were on sick-leave more often because of pregnancy-related problems than African women, who did not know the cause of gestational diabetes, had a passive self-care attitude and followed prescriptions, often reported being told by staff that gestational diabetes would disappear after delivery and stated more pregnancy-related problems which they treated with rest or watchful waiting. Conclusions. Health/illness beliefs differed and affected self-care and care seeking. Lower risk awareness in African-born women was related to limited knowledge about the body and gestational diabetes, which was further amplified by healthcare professionals informing them about gestational diabetes being transient. Relevance to clinical practice. Individual beliefs and risk awareness must be elicited, and adequate information must be given to prevent negative health effects of gestational diabetes. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study to investigate the relationships among bone mineral density, demographics, knowledge of osteoporosis, beliefs concerning osteoporosis and preventive behaviours of at-risk females with family histories of osteoporosis. Background. Strong evidence demonstrates that genetics is a significant determinant of peak bone mass, with a heritability of 50–90%. However, few studies have examined the bone mineral density of at-risk females with family histories of osteoporosis, particularly in an Asian population. Design. Telephone survey. Methods. The study population ( n = 2890) was recruited from a radiology department at a national university medical centre in northern Taiwan during 2005–2006. In total, 886 females completed a questionnaire via the telephone; the participation rate was 30·7%. Results. The bone mineral density of at-risk females was close to osteopenia status (T score of −1 to −2·49). Most subjects were aware of osteoporosis-related information; however, few clearly understood osteoporosis. Furthermore, subjects reported difficult implementing strategies to improve bone mineral density. Variation in bone mineral density was correlated with self-rated health ( r = 0·56, p < 0·05), knowledge of osteoporosis ( r = 0·66, p < 0·05) and preventive behaviours ( r = 0·68, p < 0·05). Conclusions. This study is to examine risk factors associated with bone mineral density of females with family histories of osteoporosis. Early identification of risk factors for osteoporosis and development of prevention programmes are required to halt the increasing in the incidence of osteoporosis and improve the bone mineral density of at-risk females. Relevance to clinical practice. Nursing care professionals, who emphasise primary, secondary and tertiary prevention with individuals and families, should develop effective prevention strategies for women with family the history of osteoporosis to protect the health of these vulnerable populations at-risk for osteoporosis. [ABSTRACT FROM AUTHOR]

Aims: To explore the implementation of a dementia care pathway in an acute care setting. Background: Dementia care in acute settings is often constrained by contextual factors. We developed an evidence‐based care pathway with intervention bundles, and implemented it on two trauma units, with the aim to empower staff and improve quality care. Design: Process evaluation using quantitative and qualitative methods. Methods: Pre‐implementation, unit staff completed a survey (n = 72) assessing family and dementia care skills and level of evidence‐based dementia care. Post‐implementation, champions (n = 7) completed the same survey, with additional questions on acceptability, appropriateness and feasibility, and participated in a focus group interview. Data were analysed using descriptive statistics and content analysis guided by the Consolidated Framework for Implementation Research (CFIR). Reporting Guideline: Standards for Reporting Qualitative Research Checklist. Results: Pre‐implementation, staff's perceived skills in family and dementia care were moderate overall, with high skills in 'building relationships' and 'sustaining personhood'. Evidence‐based interventions were delivered seldom to frequent, with 'individualized care' scoring lowest and 'assessing cognition' scoring highest. Implementation of the care pathway/intervention bundles was overshadowed by the pandemic, and failed due to major organisational‐ and process‐related barriers. Acceptability scored highest and feasibility lowest, with concerns relating to complexity and compatibility of pathways/bundles when introduced into clinical routines. Conclusions: Our study implies that organisational and process factors are the most influential determinants to the implementation of dementia care in acute settings. Future implementation efforts should draw on the evolving evidence within implementation science and dementia care research to ensure effective integration and improvement process. Relevance to Clinical Practice: Our study provides important learning around improving care for persons with dementia and their families in hospitals. Patient or Public Contribution: A family caregiver was involved in the development of the education and training programme. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the perceptions of family‐centred care among nurses and the family members of hospitalised children and investigate the facilitators of and barriers to the implementation of family‐centred care in Malawi. Background: In Malawi, approximately 34% of children have long‐term illnesses that require hospitalisation. Family‐centred care ensures that the delivery of healthcare is grounded in partnerships between healthcare providers, patients and their families, which can improve the psychological well‐being of families. However, there is lack a good understanding of how families and nurses perceive this concept, its facilitators and the barriers. Design: This was an exploratory qualitative study. Data were analysed deductively and inductively using the five‐step qualitative content analysis method. Methods: Twenty‐nine nurses and 31 families were recruited. Data were collected through in‐depth, semi‐structured and face‐to‐face individual interviews. The study was reported using the COREQ checklist. Results: Both nurses and families of hospitalised children recognised the importance of nurse–family partnerships in family‐centred care. Four themes emerged as follows: Perceptions of family‐centred care, elements of family‐centred care, facilitators of family‐centred care and barriers to family‐centred care. Specific information to families and the religious beliefs of families were identified as important facilitator and barrier to family‐centred care, respectively. Conclusion: The implementation of family‐centred care is promising in Malawi, as it is positively perceived by nurses and families, and its implementation is consistent with the Institute for Patient and Family‐Centred Care Framework. Relevance to clinical practice: Our findings present the best practices, gaps and challenges in the context of a low‐income country regrading implementation of family‐centred care. Education programmes on family‐centred care are crucial for sustaining the current gains. [ABSTRACT FROM AUTHOR]

Aims: To systematically examine and review relevant qualitative studies exploring the current lifestyle among individuals at high risk of colorectal cancer (CRC), and their awareness of the role of a healthy lifestyle in CRC prevention. Background: The increasing incidence and mortality of CRC have presented a serious threat against the health and life of people. As the major population affected by CRC, the lifestyle of individuals at a high risk of CRC is attracting increasing attention. Design: A qualitative evidence synthesis using the Thomas and Harden method and the PRISMA 2020 checklist provided by the EQUATOR network were used. Data Sources: Literature was retrieved from PubMed, Web of Science, the Cochrane Library, Embase, CINAHL and PsycINFO from the inception to December 2021. Review Methods: Two reviewers independently screened the titles and abstracts and identified the eligible studies. Critical appraisals of each included study were performed. Thematic analysis was used to guide the data synthesis. Results: The data from nine articles were analysed. Three interpretive themes were extracted that formed an overarching synthesis of the experience with healthy lifestyles among high‐risk individuals of CRC. The findings suggested that these individuals with limited awareness of CRC and personal risks lacked sufficient knowledge about the relationship between lifestyle and CRC, and their attitudes and practices towards the role of a healthy lifestyle in CRC prevention were also diversified. Conclusion: Professionals can potentially provide personalised guidance for healthy lifestyles based on knowledge of prevention, the actual background and social support of individuals at high risk of CRC. Impact: Considering that knowledge gaps and health beliefs among these individuals are the premise blocking their adoption of a healthy lifestyle, the findings of this review may make contributions to the design and content of public health policy and prevention programs. No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims and Objectives To explore and describe the link between culture and dementia care with the focus on the influence of the belief in dementia as witchcraft and people with dementia as witches. Background In South Africa, especially in townships and rural areas, dementia is often perceived as connected to witchcraft rather than to disease. Persons labelled as witches-mostly older women-may be bullied, ostracised, beaten, stoned, burned, even killed. Method One strand of findings from a larger international study is presented with in-depth qualitative interviews of one close family member and seven nurses caring for patients with severe dementia in nursing homes in Tshwane in South Africa. A hermeneutic analytic approach was used. Results Two main themes are found, namely 'Belief in witchcraft causing fear of persons with dementia' and 'Need of knowledge and education.' Fear of and violence towards people with dementia are based on the belief that they are witches. Some of the nurses had also held this belief until they started working with patients with dementia. There is a great need for education both among healthcare workers and the populace. Discussion The 'witch' belief prevents seeking professional help. As nursing homes tend to be private and expensive, professional dementia care is virtually unattainable for the poor. Dementia needs a more prominent place in nursing curricula. Nurses as educators need to know the local culture and language to be accepted in the various communities. They need to visit families affected by dementia, give awareness talks in churches, schools and clinics and facilitate support groups for carers of people with dementia in the local language. Conclusion Improved nurses' education in gerontology and geriatric care is needed. Trained specialist nurses may work as mediators and help eradicate the witchcraft beliefs connected to severe dementia. [ABSTRACT FROM AUTHOR]

Aim: To synthesise the evidence regarding older adults' perception of advance care planning in preparation for end‐of‐life care. Background: Advance care planning involves continuous communication of end‐of‐life care goals involving an individual's medical treatment preferences. However, its uptake among older adults remains low. Design: The meta‐synthesis was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative research (ENTREQ) guidelines and thematic synthesis was employed to synthesise the qualitative findings in an inductive manner. Data Source: A search was completed on six electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus), for publications from 1 January 2000 to 4 December 2021. Review Method: The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation and Confidence (GRADE‐CERQual) in the Evidence from Reviews of Qualitative research. Two independent reviewers conducted this process, and disagreements were resolved through discussions. Results: Fourteen studies were analysed. Four major themes and eleven subthemes emerged from the thematic synthesis: (1) psychosocial preparedness, (2) medical preparedness, (3) psychological barriers towards advance care planning and (4) extrinsic barriers towards advance care planning. Discussion These themes consolidated older adults' views of advance care planning and how engagement in this planning affected their end‐of‐life preparedness. Conclusion: This review suggested psychological and extrinsic factors were barriers to the uptake of advance care planning and provided directions for future research to achieve a holistic understanding of the impact of advance care planning on end‐of‐life preparedness. Relevance to Clinical Practice: Healthcare professionals could maintain close communication with older adults and families periodically to evaluate their readiness to discuss advance care planning to improve their preparedness. Healthcare professionals could also provide psychological support during the discussion of clinical decision‐making to enhance readiness and confidence among older adults and their families. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to construct a structural equation model guided by the ecological model to explore the factors influencing health behaviour among hypertensive stroke patients 6 months post‐stroke. Background: Health behaviour is important for recurrence prevention in hypertensive stroke patients. Moreover, previous studies have indicated that health behaviour at the end of the recovery period is of particular concern. The ecological model provides an integrated perspective for explaining the factors influencing health behaviour. Design: A cross‐sectional study guided by the STROBE. Methods: A total of 121 hypertensive stroke patients were included to assess stroke knowledge, health belief, depression, family function, chronic illness resource and health behaviour. A structural equation model was used to explore the health behaviour's factors and pathways. Results: In the final ecological model, sex, education level, depression and chronic illness resource directly affected health behaviour. Stroke knowledge directly affected health behaviour and indirectly affected health behaviour through health belief and chronic illness resource. Family function indirectly affected health behaviour through health belief, depression and chronic illness resource. Health belief affected health behaviour indirectly through depression and chronic illness resource. Conclusions: Hypertensive stroke patients' health behaviour is jointly and interactively influenced by stroke knowledge, health belief, depression, family function and chronic illness resource. In particular, chronic illness resource is an important mediator of health behaviour. Relevance to Clinical Practice: For clinical practitioners, health behaviour of men and patients with low educational levels should be specifically focused on. Additionally, it is necessary to provide stroke knowledge, establish health beliefs, control depression emotion and improve family function. Furthermore, chronic illness resources should be improved particularly due to its important mediating role. Patient or Public Contribution: Participants completed demographic and disease‐related questionnaires during hospitalisation and completed other questionnaires when returning to hospital at 6 months follow‐up. [ABSTRACT FROM AUTHOR]

Background: Avoidable hospitalisation rates for Indian immigrant children with asthma is high in New Zealand and other Western countries. Understanding how children and their carers manage asthma may lead to a reduction in hospitalisation rates. The topic of asthma and Indian immigrant children's perspectives has not been investigated. Most studies on the topic focus on the experiences of family carers and health professionals. Practice cannot be advanced in the child's best interests unless the child's asthma experiences are explored. The following research addressed this gap by upholding Article 12 of the United Nations Convention on the Rights of the Child, thereby giving Indian immigrant children a voice in describing their asthma experiences. Design: Constructivist grounded theory. Methods: Intensive interviews were conducted with ten family carers and nine children (eight to 17 years old). Child‐sensitive data collection techniques such as drawing, and photography were used to facilitate interviewing children younger than 14 years. The COREQ guidelines guided the reporting of this study. Results: The theory, navigating asthma: the immigrant child in a tug‐of‐war, is the resulting grounded theory with the tug‐of‐war being the basic social process. This theory comprises three main categories: being fearful, seeking support and clashing cultures. The data reflected two types of tug‐of‐war: one between two cultures, the native Indian and the host New Zealand culture and another between family carers' and children's preferences. Conclusion: Acculturation and sociocultural factors may significantly influence the asthma experiences of Indian immigrants. Relevance to clinical practice: The theory may assist healthcare practitioners to better comprehend Indian immigrants' asthma experiences within their wider sociocultural context. Our research indicates the need for healthcare practitioners to work in partnership with Indian immigrant families to implement culturally safe asthma management strategies. [ABSTRACT FROM AUTHOR]

Aim and objective: To explore what is known about knowledge, attitudes and beliefs that influence hand hygiene practices in in low‐ and middle‐income Caribbean and Latin American countries. Background: With the emergence of infectious diseases such as the recent COVID‐19 pandemic, handwashing is key to preventing communicable diseases as they disproportionately affect populations in low‐income countries. While hand hygiene is known to be the single most effective method for avoiding the transmission of infection, little is known about the beliefs and practices of individuals in these regions. Methods: Following PRISMA 2020 Checklist, an integrative review of studies published from 2008–2020 was conducted (Preferred Reporting Items for Systematic Reviews and Meta‐analyses). Whittemore and Knafl's method was used to review the literature. Six databases were searched, and the Johns Hopkins Evidence Based Rating Scale was used for study appraisal. Results: The review yielded 18 studies conducted across Latin America. Poor handwashing practices are influenced by various factors including inadequate education and training, cultural beliefs, lack of resources and substandard government regulations. Communicable diseases and other diarrheal illnesses were highly prevalent, especially after a major disease outbreak. Conclusion: Future post‐disaster campaigns aimed at improving hand hygiene and handwashing practices should focus on beliefs and attitudes to affect behaviour change since there was a higher disease susceptibility during those times. Barriers to proper hand hygiene include false attitudes such as, washing hands only after touching bodily fluids/patient contact or not washing hands at all after open defecation. Relevance to clinical practice: Researchers working with populations in Latin America and the Caribbean should partner with local community health workers to improve compliance to recommended hand hygiene practices. [ABSTRACT FROM AUTHOR]

Background: The continued use of a deficit discourse when researching Aboriginal and Torres Strait Islander Peoples of Australia is problematic. Understanding and challenging the researchers position and the power of the words they use is important. It will ensure we do not persist in framing Aboriginal and Torres Strait Islander People as a problem to be solved. Design: Indigenist review of the evidence of Aboriginal young people's health and well‐being. Methods: This review was conducted using an Indigenist approach to identify texts which amplified the voices of Aboriginal young people of Australia and presents a narrative summary of their accounts. This review is reported in line with the PRISMA‐ScR reporting guidelines. Results: Culture and connection are critical components of Aboriginal young people's health and well‐being. Aboriginal young people describe feeling of powerlessness to influence health and well‐being of their community, and they understood the risks they and their communities faced. Young people identified the importance of connection to culture, community and Elders as crucial to their social and emotional well‐being. Conclusion: By harnessing an Indigenous analysis, we were able to reveal a strong counter narrative of strength and resilience within their historical, social, and political contexts through the storied accounts of Aboriginal young people. Relevance to clinical practice: Most of the currently available evidence about Aboriginal health and well‐being is immersed in deficit discourse. Literature reviews being the foundation of research and informing nursing practice, we call for a purposeful shift towards the adoption of an Indigenist strength‐based approach which emphasises the strength and resilience of Aboriginal young people. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to explore older adults' perspectives about dignity and dignified nursing care during acute hospitalisation in Ghana. Background: Maintaining hospitalised older adults' dignity is an essential component of nursing care and one of the most important determinants of wellbeing. To date, no study has been published on older adults' perspectives of dignified nursing care in the African context. Study design: A qualitative descriptive research design. Methods: Twenty hospitalised older adults were purposively selected from the medical and surgical wards of a teaching hospital in Ghana. Data were gathered through semi‐structured interviews between April and August, 2021, and analysed using reflexive thematic analysis techniques. The SRQR checklist was used to document reporting of the study. Results: The following four themes were identified: Effective nurse–patient communication, Maintaining patients' privacy, Respectful and compassionate care provision and Providing quality and safe care. Dignity was preserved when patients were treated with respect and compassion, provided privacy, and had close family members involved in physical care. Identified barriers to dignity included inadequate information about their health condition, poor communication by the nurses, lack of autonomy, poorly designed healthcare infrastructure and inadequate privacy. Conclusions: Several enablers and barriers to dignified nursing care have been identified that have been discussed in previous studies. The unique factors identified in the Ghanaian context were family members' involvement in physical care influenced by cultural and religious beliefs, environmental barriers to privacy and dignity and inadequate involvement in decision making. Relevance to clinical practice: Nurses must treat older patients with respect, educate them about the health condition, involve them in care decisions, and identify their preferences regarding provision of hygiene needs, particularly in consideration of religious and cultural beliefs, including involvement of family members. Future planning of healthcare infrastructure needs to consider the importance of private cubicles with disability‐accessible ensuite bathrooms for patients' comfort and privacy. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine the prevalence and the associated factors of self‐perceived medical errors among Chinese emergency department nurses. Background: The emergency department is a place with a high incidence of medical errors. Studies about the occurrence and related influencing factors of medical errors among emergency nurses in China are very insufficient. Design: A nationwide cross‐sectional study. Methods: A nationwide cross‐sectional study was conducted from July 2018–August 2018. A total of 17,582 emergency department nurses from 31 provinces across China were eventually included in the analysis. Logistic regression is applied to examine the association of the independent variables with the perceived medical errors. The reporting of this study was compliant with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross‐sectional studies. Results: Of 17,582 participating nurses, 4445 (25.28%) reported self‐perceived medical errors in the past 3 months. Nurses who were serving as nurses‐in‐charge; who reported fair or bad physical health; who reported staff shortage; who were exposed to more verbal abuse at work; who experienced effort–reward imbalance; who reported more over‐commitment; or who had depressive symptoms were more likely to report medical errors. Older age and female gender were protective factors. Conclusions: In this study, a quarter of the emergency nurses reported that they had made medical errors in the past 3 months. Self‐perceived medical errors are associated with multiple domains of work‐related factors and personal distress. Feasible measures should be taken to reduce nurses' workload, improve their working environment, monitor and minimise the occurrence of medical errors among emergency department nurses. Relevance to clinical practice: Emergency nurses, who are the most frequently in contact with patients, play an important role in identifying risk factors and preventing medical errors. Identifying risk factors that may lead to medical errors in the medical environment from both internal and external aspects will help nursing practitioners, hospital administrators and policy makers to take timely preventive measures to reduce the occurrence of medical errors and reduce harm to patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify and synthesise the available qualitative evidence on nurses' perceptions and beliefs related to the care of adults living with multimorbidity. Background: The rising prevalence of adults living with multimorbidity has increased demand for health care and challenges nursing care. No review has been conducted to date of the studies of nurses' perceptions and beliefs related to the provision of care to guide policy makers, practitioners and further research to identify and deliver quality care for persons living with multimorbidity. Design: Systematic review of qualitative studies conducted in line with the PRISMA checklist. Methodology: Eight electronic publication databases and sources of grey literature were searched to identify original qualitative studies of the experience of nurses caring for adults with multiple chronic conditions with no restrictions on the date of publication or study context. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were extracted using the Joanna Briggs Institute standardised data extraction tool for qualitative research. Data synthesis was undertaken through meta‐aggregation. Results: Eleven qualitative studies were included in the review. All studies met eight or more of the 10 assessment criteria of the JBI Critical Appraisal Checklist for Qualitative Research. Four synthesised findings were generated from the aggregated findings: (i) the challenge of providing nursing care; (ii) the need to deliver holistic and person‐centred nursing care; (iii) the importance of developing a therapeutic nurse–patient relationship, and (iv) delivering nursing care as part of an interprofessional care team. Conclusions: The complexity of multimorbidity and the predominant single‐disease model of chronic care present challenges for the delivery of nursing care to adults living with multimorbidity. Relevance to clinical practice: The nursing care of persons with multimorbidity needs to incorporate holistic assessment and person‐centred care principles as part of a collaborative and interprofessional team approach. PROSPERO Registration: CRD42020186773. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The study aimed to explore the perspectives of adult children about late‐life living and care arrangements for their ageing immigrant parents living in New Zealand. Background: Older immigrants' well‐being is closely associated with filial relations and is often reliant on families as a main source of social, financial and emotional support. Research among migrant Asian adults has reported mixed findings regarding intergenerational perspectives of filial practices. Design: Qualitative design using focused ethnographic lens. Methods: Semi‐structured individual interviews were undertaken with 45 adult children of older immigrants living in New Zealand to explore their views about filial piety. The CoREQ checklist was used in reporting methods and findings. Results: Two major themes were identified in this study of adult children's view of filial piety and late‐life care for their ageing parents. The first theme, 'holding on—reconfiguring values', referred to a process described by the participants as upholding the core values and cultural familial expectations, looking after their ageing parents, yet modifying the ways in which they provide care. The second major theme 'letting go—reconfigured expectations', described participants' views of aged care for themselves, which meant they no longer held traditional values that needed to be enacted by their children. Conclusions: Adult children from immigrant families were positioned as intermediaries of these shifting values of their own and within younger generations. The adult children's shift of thinking and acceptance of reconfigured expression of filial duties impact care and living arrangements of older people from immigrant and culturally diverse backgrounds, which also influences health and well‐being in later life. Relevance to clinical practice: Healthcare professionals including nurses working in the ageing and aged care sector need to accommodate the changing generational perspectives about filial piety to cater to the unique late‐life care requirements and health needs of older people and their families. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To determine the level of social rejection and well‐being of nurses, whether resilience is a mediator between them and to compare nurses who worked versus did not work on COVID‐19 wards. Background: During the COVID‐19 pandemic health care workers reported psychological distress and social rejection. Methods: An online survey was sent to nursing social media groups in Israel. Respondents completed a Demographic, Social Rejection, Resilience and General Well‐being questionnaire. Results: Two hundred and forty‐seven nurses responded. The majority were female with a mean age of 43.6 years Approximately one‐third were worried about infecting their family members and many agreed that their family fears that the nurse will infect them. Nurses reported their partner, family members, neighbours and the public physically distanced themselves from them. Approximately one quarter reported feeling lonely. Statistically significant differences were found between those who worked versus not work on a COVID‐19 unit on general well‐being, and social rejection. No differences were found in resilience scores. Conclusions: Social rejection was felt by many nurses as shown by an inverse relationship between the closeness of the relationship and the sense of social rejection and a high level of loneliness and depression. A higher level of social rejection and lower well‐being were found among nurses working on COVID‐19 wards as opposed to those who did not. General well‐being was found to be exceptionally low during COVID‐19. Resilience did not mediate the relationship between social rejection and general well‐being. Relevance to clinical practice: Perceived social rejection might be associated with decreased well‐being. The level of resilience is related to the level of well‐being among nurses in general. Nurses not working in COVID‐19 wards have higher levels of well‐being and less social rejection compared with nurses working in these wards. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore what women aged below the national screening age in the UK know and think about cervical cancer and cervical screening. Background: The efficacy of cervical cancer screening is well established. However, cervical screening attendance in the United Kingdom has decreased, with especially low rates at the first screening opportunity at age 25. Research has not yet explored knowledge and beliefs underpinning young women's intention to screen before first screening invitation. Design: Qualitative exploratory study. Methods: Qualitative email interviews were undertaken with 16 participants, using questions derived from the Health Belief Model. Data were analysed using template analysis. The COREQ were followed. Results: Analysis generated three themes; (1) Learning about cervical cancer and cervical screening: sources of information and (missed) opportunities; (2) Young women know screening is important – but they don't always know why; (3) Screening intentions: a cost/benefit analysis of the available information. Conclusions: Young women had varied knowledge and beliefs about cervical cancer and screening which were underpinned by several sources of information available to them. Most women expressed an intention to attend screening when invited; however, some participants were unsure, with low screening‐based knowledge and low perceived susceptibility of cervical cancer identified as key barriers. Social media, familial interactions and interventions within education were highlighted as being suited to interventions aimed at increasing cervical cancer‐ and screening‐based knowledge in young women. Relevance to clinical practice: Findings suggest that women below screening age could be better informed about cervical cancer and screening. Tailored interventions addressing common concerns and misconceptions around screening may be acceptable to young women and could help to promote screening attendance at first invitation. [ABSTRACT FROM AUTHOR]

Aims & Objectives: This study aimed to explore the decision‐making processes undertaken by critical care nurses when considering restraint to manage a patient with psychomotor agitation secondary to hyperactive delirium. Background: Psychomotor agitation is frequently cited as clinical rationale for initiating chemical or physical restraint. Despite the presence of clinical guidance for restraint in critical care, wide variations in nursing and prescribing practice are evident. Nurses are the primary decision makers when initiating restraint, but little is known about this process and influencing factors. Design: A pragmatic qualitative approach was used to explore critical care nurses' decision‐making processes. Methods: A 'think aloud' approach was undertaken. Audio‐visual vignettes featuring simulated patients were used as stimulus to elicit decision‐making processes from thirty critical care nurses and practitioners. The COREQ checklist was followed. Results: Five themes relating to restraint were identified: Intrinsic beliefs and aptitudes; Handover and labelling; Failure to maintain a consistent approach; Restraint might be used to replace vigilance; The tyranny of the now. Conclusions: Restraint was more frequent when staffing ratios were reduced below 1:1 and opportunities for vigilance reduced. Participants described physical and psychological exhaustion when caring for a patient with delirium and how this might lead to restraint to create 'space' for respite. Variations in practice were evident and restraint use appears rooted in custom and culture rather than objective assessment. Relevance to clinical practice: The lack of pre‐emptive management for hyperactive delirium and reduced staffing ratios lead to the decision to restrain to preserve safety in acute agitation. The struggle to manage agitated behaviour is associated with nurse burnout and reduced engagement with therapeutic management methods, suggesting the need for psychological and educational support for clinical staff. Delirium is an important and debilitating form of organ dysfunction which should be collaboratively managed by the multi‐disciplinary team. [ABSTRACT FROM AUTHOR]

Aims and objectives: Examine beliefs about EBP and its level of implementation among nurses working in nursing homes in a bilingual canton of Switzerland and explore associations between these aspects and nurses' sociodemographic and professional characteristics. Background: Although evidence‐based practice (EBP) is recognised as an effective strategy for improving the quality and safety of care, little is known about its use in nursing homes. Nurses' beliefs about EBP and their implementation of it in Switzerland's nursing homes have never been explored. Design: An observational cross‐sectional study. Methods: Beliefs about and implementation of EBP were evaluated using validated French‐ and German‐language versions of the EBP Beliefs Scale and the EBP Implementation Scale, developed by Melnyk and Fineout‐Overholt (Melnyk, Fineout‐Overholt, & Mays, 2008, Worldviews on Evidence‐Based Nursing, 5, 208). The STROBE checklist for cross‐sectional studies was used in reporting this study. Results: The participation rate was 40.6% (N = 194). Most participants stated that they had some knowledge of EBP and held favourable beliefs about it. Nevertheless, 37.1% of participants found the concept complicated and 36.1% found it time‐consuming. Participants were more likely to implement stages in the EBP process linked to direct clinical practice rather than those which required scientific knowledge and skills. Conclusion: Most participants had favourable beliefs about EBP, but the level of implementation of EBP among nurses in their daily clinical practice was sub‐optimal. Relevance to clinical practice: A greater emphasis should be put on fostering the use of EBP among nurses working in nursing homes. This could be achieved via training and the development of individual, institutional and contextual strategies promoting the integration of EBP in clinical settings. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the role of health beliefs in affecting patients' chronic diabetic complication (CDC) screening. Background: Patients' adherence to the guideline‐recommended CDC screening was far from optimal. While many demographic and clinical characteristics were documented to influence patients' adherence, psychological profiles, such as health beliefs, were not well studied before. It is crucial to understand how health beliefs affect patients' CDC screening behaviour and thus to provide implications for future intervention programmes. Design: A cross‐sectional study was conducted. Methods: 785 type 2 diabetes were enrolled from the community health centre in Wuhou District, Chengdu, China. Structured questionnaires were used to collect data regarding the demographic and clinical information, knowledge about CDC, health belief model constructs and CDC screening behaviour. Mediation analysis was performed to explore the mechanisms of health belief model constructs on CDC screening behaviour. The study methods were compliant with the STROBE checklist. Results: Knowledge had a significant indirect effect on CDC screening behaviour through perceived susceptibility, perceived benefits, perceived barriers and self‐efficiency. Cues to action exerted both significant direct and indirect effects on CDC screening behaviour. The indirect effects of cues to action were exerted through perceived susceptibility, perceived barriers and self‐efficiency. Conclusion: Health beliefs played vital roles in mediating the effects of knowledge and cues to action on patients' CDC screening behaviour. Health beliefs should be assessed and modified through creative educational methods. Strategies aimed at increasing cues to action are also expected to facilitate patients' CDC screening behaviour. Relevance to clinical practices: The study contributes to the exploration of how health beliefs affect patients' CDC screening behaviour. The results could be used to inspire future community‐based intervention programmes. [ABSTRACT FROM AUTHOR]

Aims and objectives: To locate and summarise existing literature regarding safer sex practices specific to heterosexual anal intercourse and identify promising health promotion strategies. Background: Much of the literature regarding anal intercourse and safer sex is related to men who have sex with men. However, some studies suggest there are more women than men engaging in unprotected receptive anal intercourse. The risks associated with this sexual practice have been well documented, although many healthcare providers fail to ask about anal intercourse while addressing safer sex in the heterosexual population. Design: The study was based on Arksey and O'Malley's 2005 five‐step methodology. Methods: A search was conducted of MEDLINE; CINAHL; PsycInfo; Cochrane; and PubMed. Databases were searched from 1990–2020. The 72 studies selected were classified according to their main area of focus. A grey literature search was also included. This scientific submission has been assessed for accuracy and completeness using the PRISMA‐ScR guideline criteria (File S1). Results: The literature in this area is heterogeneous in terms of method and topic. Prevalence and incidence (n = 26) in addition to sexually transmitted infection risks (n = 26) related to heterosexual anal intercourse are well understood. However, there is limited information on condom use (n = 6), factors that influence heterosexual anal intercourse (n = 10) and health promotion strategies for this population and practice (n = 4). Two websites that mentioned heterosexual anal intercourse risk reduction activities were included. Conclusions: Although heterosexual anal intercourse appears to be an increasingly common sexual practice, very little is known about health promotion strategies nurses might use for encouraging safer sex in this population. Relevance to clinical practice: Increased awareness of the prevalence and risks of heterosexual anal intercourse could enhance nurses' harm reduction strategies. Screening for sexually transmitted infections may be based on incorrect assumptions about sexual practices or due to stigma linked with anal intercourse. Reducing unprotected heterosexual anal intercourse will reduce sexually transmitted infections and their long‐term sequelae. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how the physical and social environment of acute mental health units influences consumers' perception and experience of safety. Background: Acute mental health units are places in which consumers should feel safe. Not all consumers, however, feel safe in this environment. Little is known about what contributes to consumers' feelings of safety in this setting. Design: The study used a qualitative descriptive design, influenced by naturalistic enquiry. Data were analysed using thematic analysis and are reported according to the COREQ checklist. Methods: Fifteen people who had experienced admission to an acute mental health unit were individually interviewed. Results: Having a supportive environment enhanced consumers' perception and experience of safety. A supportive environment was experienced when consumers had privacy, felt safe from other consumers and had meaningful activities to participate in within the acute mental health unit. In contrast, having their privacy breached by other consumers made participants feel unsafe. Many participants were fearful of other consumers, and felt unsafe and unable to protect themselves. Lack of meaningful activities led to boredom and contributed to consumers feeling unsafe. Conclusions: Personal spaces should address consumers' privacy needs without compromising staff access. Staff presence enhances consumers' feelings of safety, but this need can be heightened when consumers are unable to alert staff when they feel unsafe. Meaningful activities link consumers to their lives outside of the hospital and can enhance recovery. Relevance to clinical practice: Understanding how the acute unit environment is perceived by consumers can assist nurses and managers to promote feelings of safety among consumers. Feeling safe can, in turn, optimise recovery. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to identify features of well‐performing residential aged care services (RACS) as experienced by family carers. Background: Family carers can have an integral role in residential aged care providing social support and are well‐placed to engage with staff and monitor care. Design: A qualitative descriptive design was used. Semi‐structured face‐to‐face and telephone interviews were conducted with family carers of current or past residents of Australian RACS between November 2018 and January 2019. Interview transcripts were analysed thematically. Results: Rather than reporting features of well‐performing RACS, participants shared stories of sub‐standard care, dysfunctional management and poor resident–staff–family interactions. An overarching theme emerged of 'having to be an advocate' for residents' needs, which covered four major categories: organisational accountability (including transparency and individualised care), good communication, connection and trust. Combined, these constitute what carers perceive are the necessary conditions for determining the features of a well‐performing RACS. Conclusion: Family carers need to feel confident and trust RACS staff when they hand over the role of carer for their relative with dementia. Relevance to clinical practice: This study provides insight into the needs and challenges of family carers when they relinquish the care of an older relative with dementia. Strategies to build confidence and trust between RACS and family carers are essential. Aged care nurses can play a pivotal role to support this through the development of open communication and relational connections with residents and their families. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine nursing students' health habits. More specifically, the objectives were to determine whether there were any changes in their health habits during their course of study, and to understand whether the students' perceptions about good health conditions cohered with their health‐related behaviour. Background: The transition from high school to university has an undesirable effect on students' health habits, and nursing students' unhealthy behaviours may prevent them from helping patients improve their poor health habits. Design: A longitudinal design was used. The study followed the recommendations of STROBE (Strengthening the Reporting of Observational studies in Epidemiology). Methods: All students were recruited from a nursing science degree course in an Italian university. The sample consisted of 351 nursing students. Data were collected at the baseline during their entrance into the university (T0) and at the end of their third year of coursework (T3). We developed the Nursing Student Health Habits Scale, which was administered by a trained researcher. The McNemar test and the Wilcoxon signed‐rank test to evaluate the differences in health habits between T0 and T3, and a logistics model to assess the factors influencing students' good health perceptions were used. Results: From T0 to T3, there were decreases in the number of students who requested physician consultations (p =.01) and increases in those who exercised daily (p =.003). There was also a change in the nutrition model (p =.018). In the multivariate model, physician consultations for medical problems and performing physical exercise were factors influencing good health perceptions. Conclusions: Future research is needed to illuminate other aspects of students' health habits. Relevance to clinical practice: Universities are advised to address these problems by reflecting on undergraduate and postgraduate curriculum content concerning health management and disease prevention. [ABSTRACT FROM AUTHOR]

Aims and objectives: To measure hospitalised children's trust in the nurse. Background: Trust is central to the therapeutic relationship between the nurse and the patient. There can be no trusting relationship between the nurse and child if the parents have no trust or block the relationship (Bricher Journal of Clinical Nursing, 8: 452, 1999]). Design: This study was a cross‐sectional, correlational descriptive design using a self‐complete questionnaire to measure children's trust in nurses, to examine the relationship between children's trust and their parents, and the correlations between trust and medication adherence, fear and interactions with the nurse. Methods: A modified version of the Children's Trust in General Nurses Scale designed by Rotenberg et al. (Journal for Specialists in Pediatric Nursing, 20: 298, 2015) was used. This Scale is a short self‐report questionnaire designed to elicit information on children's beliefs in, and attitudes to, trust in nurses. The Strengthening the Reporting of Observational Studies in Epidemiology statement for observational studies was applied (von Elm British Medical Journal, 335: 806, 2007]). Results: The results indicated high levels of trust beliefs in the nurse. The children's and parents' trust beliefs were found to be correlated. Gender did not influence trust beliefs. Younger children had higher levels of trust than older children, particularly in relation to the perceived honesty of the nurse. Trust beliefs in the nurse lessened with previous exposure to the hospital setting. One‐fifth of children reported fear of the nurse. Positive interaction with the nurse was shown to be positively related to adherence to care. Relevance to clinical practice: Children's level of trust in the nurse can be measured. A trusting child is likely to be less fearful and experience clinical procedures as less threatening and is more likely to adhere to treatment. Children's nurses should recognise that trust can change with age and with multiple hospital admissions. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the hand hygiene beliefs and practices of Turkish nursing students and the effectiveness of their handwashing. Background: Handwashing is the most important part of preventing cross‐infection, but there is a considerable amount of evidence that shows that the handwashing technique of nurses and nursing students is not always very effective. Design/Methods: This research was carried out in two stages and is type of descriptive, analytical and observational. The study comprised 563 students from a Faculty of Nursing. Besides evaluating the nursing students' sociodemographic data, we assessed their beliefs and hand hygiene practices using a Hand Hygiene Beliefs Scale (HHBS) and Hand Hygiene Practices Inventory (HHPI) and also used with "Derma LiteCheck" device to assess how effectively they washed their hands. The STROBE checklist was used. Results: The handwashing frequency of the female students was significantly higher. The scores on both the HHBS and the HHPI were significantly higher among the female students compared to the males. The dirtiest areas of the hand were determined as nails (nail beds, beneath the nails), skin between the fingers and fingertips. Conclusions: The results of our study indicate that although student nurses have positive perceptions about hand hygiene and appear to have developed good habits, the effectiveness of their handwashing is poor. Relevance to clinical practice: It is of great importance that UV light and florescent gel are made readily available both at nursing schools and in hospitals and other health institutions since these elements are useful in providing immediate visual feedback for a full assessment of handwashing behaviour. [ABSTRACT FROM AUTHOR]

Aim: To explore HIV‐positive drug users' experiences of taking antiretroviral medications in Taiwan and further develop a conceptual model that can be used to understand their adherence to the long‐term treatment. Background: The global vision of ending AIDS by 2030 cannot be achieved without addressing HIV‐positive drug users' experience of taking antiretroviral treatment. There remains a paucity of qualitative evidence on HIV‐positive drug users' experiences of taking antiretroviral medications globally and in East Asia. Nurses play a key role in supporting HIV‐positive drug users throughout their treatment process. Therefore, it is pivotal to understand HIV‐positive drug users' experiences of managing long‐term anti‐HIV treatment. Design: This qualitative study drew on a constructivist grounded theory approach to achieve the aims. Semi‐structured in‐depth interviews with 22 HIV‐positive drug users were conducted in Taiwan between September 2015 and July 2016. Data were analysed using Charmaz's coding principles. The integration and formation of the model began with focused coding and proceeded through the subsequent analytic process. The reporting of this study was based on the Consolidated Criteria for Reporting Qualitative Research checklist. Results: This study shows that integrating HIV‐positive identity into sense of self laid a solid foundation for the acceptance of self and antiretroviral treatment. Valuing of antiretroviral treatment played a central role in driving their medication‐taking behaviour. While valuing the treatment appeared to drive participants' behavioural change, data revealed that conscious engagement was an important element for their behaviour maintenance. Conclusion: The evidence from this study can extend our knowledge of the mechanisms that influence the change and maintenance of HIV‐positive drug users' adherence to antiretroviral treatment. Relevance to clinical practice: The Identity–Values–Conscious engagement model developed and proposed in this study can serve as a guide for the development of tailored adherence assessment and associated nursing interventions for this population. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the perspectives of patients and health professionals on facilitators and barriers to care in a diabetes clinic in urban South Africa. Background: Although much attention has been given to the science behind diabetes management, a qualitative approach to exploring experiences, facilitators and barriers to care may have considerable value in understanding and improving diabetes care. Design: We conducted a qualitative study in the context of a 3‐year collaboration at a diabetes clinic. The present study formed part of the preparatory phase to the larger project. Methods: Linguistically and culturally matched research assistants collected data over a period of 18 months. Methods included interviews, focus groups, ethnographic observations and informal discussions with 38 patients and health professionals. Data from each participant group were transcribed, translated and analysed using reflexive thematic analysis principles and thereafter triangulated. The Standards for Reporting Qualitative Research checklist was followed. Results: Initial findings suggest that factors can be classified into three overarching themes: relationships, health systems and the interplay between disease and the lifeworld. System resource pressures, the nuances of team interactions and a complex healthcare site may adversely affect care, even at sites where there are elements of good practice. Conclusions: The collective psychosocial experience of patients appears to conflict with the biomedical approach to diabetes management. The all‐consuming nature of the disease, together with contextual and systemic factors, plays a significant role in influencing experiences of care. Relevance to clinical practice: While systemic and contextual influences on experiences of diabetes care may be difficult to modify, our study suggests a need to focus on ways of enhancing relationships within the clinic and seeking to understand the lifeworld of the patient. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine the effect of the knowledge and health beliefs of individuals about colorectal cancer on their screening behaviour. Background: Colorectal cancer ranks third among the most common cancers both worldwide and in Turkey. Colorectal cancer plays an important role in cancer mortality but can be prevented by promoting healthy behaviour and participation in early screening programmes. Design: This descriptive study was completed with 114 women and 121 men. Methods: The study data were collected using the 'Data collection form' and 'Health Belief Model Scale for Protection from Colorectal Cancer'. Potential risk factors were investigated using logistic regression analyses. The AGREE checklist was completed. Results: The colorectal cancer screening tests were known by 23.0% of the subjects and 17% had undergone one of these tests. The score medians obtained from the confidence‐benefit subscale of Health Belief Model Scale for Protection from Colorectal Cancer were found to be significantly higher in those who had undergone colorectal cancer screening. Logistic regression analysis revealed that having knowledge of the relevant tests was associated with undergoing colorectal cancer screening. Conclusions: Having knowledge on colorectal cancer screening tests increases the relevant confidence‐benefit perception regarding the tests and the behaviour of participating in screening programmes. Regular training on colorectal cancer and early diagnosis should therefore be provided by healthcare professionals to both women and men aged 50–70 years to increase the rate of undergoing early screening tests. Relevance to clinical practice: Increasing the rate of early screening is among the responsibilities of health workers working in primary health centres. Therefore, problems that prevent individuals from participating in these programmes need to be identified. In this way, health workers will develop suggestions and initiatives that change the individual's health beliefs and increase motivation. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore nurses' decision‐making regarding intravenous administration set replacement for vascular access device infusions in paediatric and adult clinical settings. Background: Intravenous administration sets are routinely replaced at regular intervals in clinical practice with the goal of preventing catheter‐related bloodstream infection; however, emerging evidence is challenging traditional hang‐time durations. Nurses' perceptions and contextual factors affecting decision‐making for administration set replacement have not been assessed previously. Design: Qualitative study using focus groups with contextualism methodology and inductive analysis. Method: During November–December 2016, eight semi‐structured focus groups were conducted with 38 nurses at two metropolitan hospitals in Queensland, Australia. Interviews were audio‐recorded and transcribed. Two authors independently reviewed transcripts and extracted significant statements using Braun and Clarke's 7‐step method of thematic analysis. The COREQ checklist provided a framework to report the study methods, context, findings, analysis and interpretation. Results: Five key themes emerged from the analysis: (a) infection prevention, (b) physical safety, (c) patient preference, (d) clinical knowledge and beliefs, and (e) workload. Administration set replacement can be a complex task, particularly when patients have multiple infusions and incompatible medications. Nurses drew on perceptions of patient preference, as well as previous experience, knowledge of peer experts and local policies, to aid their decisions. Conclusions: Nurses use clinical reasoning to balance patient safety and preferences with competing workplace demands when undertaking administration set replacement. Nurses rely on previous experience, hospital and medication manufacturer policies, and peer experts to guide their practice. Relevance to clinical practice: Nurses at times deviate from clinical guidelines in the interests of patient acuity, nurses' experience and workload. The findings of this study indicate nurses also balance considerations of patient preference and safety with these competing demands. [ABSTRACT FROM AUTHOR]

Aim and objective: To describe factors associated with father involvement in the neonatal intensive care unit using the Heuristic model of the dynamic of parental behaviour and influence on children over time. Background: Research shows that infants with involved fathers have better cognitive development, fewer crying episodes after caesarean birth, improved breastfeeding exclusivity and duration, and more regular sleep patterns. Preterm infants with involved fathers have improved cognitive development. Design: This cross‐sectional exploratory study used survey methodology to explore factors associated with father involvement in the neonatal intensive care unit. Methods: The STROBE checklist for cross‐sectional studies was used (see Appendix S2). Biological fathers of infants in a 97‐bed neonatal intensive care unit in the southern USA completed a survey which asked about their involvement with their hospitalised infants and factors which affected that involvement. Eighty fathers completed the survey. Results: Age ranged between 20–53 with 43% first‐time fathers. Compared to less involved fathers, fathers who were more involved were younger, married or living with the mother, performed kangaroo care or fathers of multiple gestation. Fathers who had attended the delivery were more likely to bathe their infants than those who had not attended the delivery and fathers who performed kangaroo care felt more confident than those who did not. Compared to fathers who visited less often, fathers who visited more often were younger, had infants with a shorter hospitalisation time and lower acuity, and had fewer children in the family. Conclusions: Fathers are involved with their neonatal intensive care unit infants in many ways. Factors were identified that affect involvement in the neonatal intensive care unit. Relevance to clinical practice: Results can help nurses in neonatal intensive care units worldwide facilitate father–infant interaction, identify fathers at risk for decreased involvement and advocate for institutional policy development for supporting neonatal intensive care unit father involvement. [ABSTRACT FROM AUTHOR]

The author comments on an article by J. Haws and colleagues on a national survey of general practitioners (GP) and nurse attitudes and beliefs toward depression after myocardial infarction (MI). He suggests the significance of the paper to clinicians' views and knowledge about the association between depression and coronary heart disease (CHD). He also agrees with the authors about the increased mortality rates in patients who developed depression following MI presented in the paper.