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This paper describes preliminary research from Japan on developing a new tool for psychiatric nurses, the patient-authored medical record, a "prescription" written in ordinary language by the patient with the assistance of a nurse. The nurse asks the patient how to improve their illness and she types up the patient's story on site in the form of a first-person narrative. The patient checks it for accuracy before taking a copy home. Ten Japanese patients participated in this field-oriented ethnographic study, and the analysis of the qualitative data strongly suggested that the approach had therapeutic effects on each patient. This narrative-based prescription could be used as a tool, specifically by psychiatric nurses, in many cultures, and it is our hope that it contributes to their professional identity.

To identify the key characteristics of practice nurses' communication with people living with Type 2 Diabetes (T2D) where lifestyle activities are discussed.A scoping review of the peer-reviewed literature was conducted. Reflexive thematic analysis was used to identify key themes that emerged. The PRISMA-ScR checklist was followed.25 studies were retained in the final review. Nurses who were committed to engaging in lifestyle discussions created supportive environments and built rapport to enable change conversations. However, this was present in just 20% of the studies. In most studies, (60%) nurses continued to use traditional health education communication styles, had little understanding of behaviour change theories, lacked skills in behaviour change counselling and were reluctant to engage in behaviour change discussions with people with T2D .Nurses require a deeper understanding of behavioural change theories and skills in behavioural counselling.Practice nurses have a unique opportunity to facilitate T2D remission by engaging in evidence-based behaviour change communication. A behaviour change training intervention is needed that recognises the environment of practice nurse consultations. It needs to be pragmatic and fully consider the enablers and barriers to addressing behaviour change in both the nurse and the person with T2D.

Objectives To evaluate the effectiveness of the Blended Communication Skills Training Program for Nurses (CSTN). The program aims to improve nurses’ knowledge about communication skills and structure for interactions with individuals who a have life limiting illness. Methods This was a quasi-experimental study using a pre- and post-test quiz and self-efficacy questionnaire undertaken in Victoria, Australia. Nurses employed across three wards participated. The Blended CSTN comprised two major components: Asynchronous Web-Based Education Program and Experiential Workshop. The program focused on specific communication challenges: Gathering Information, Dealing with Difficult Questions, and Articulating Empathy. The primary outcome was improvement in knowledge of communication skills and structure. Self-efficacy and perceived importance of communication skills were assessed as secondary outcomes. Results Eighteen nurses completed both Web-Based and Workshop components. Statistically significant increases in knowledge regarding communication skills and structure were found, with a large effect size for Gathering Information (r=0.80) and moderate effect for Articulating Empathy (r=0.62), and Responding to Difficult Questions (r=0.532). Self-efficacy significantly increased for all measured communication skills. Conclusions Knowledge improvements and perceived self-efficacy in communication were observed after nurses participated in a blended education program Practice implications A blended CSTN may improve nurse-patient communication in the clinical setting, worthy of further study.

Objective The purpose of this study was to develop and analyze the psychometric properties of an instrument that could analyze the communication of nursing professionals in nurse-patient therapeutic communication. Methods A literature review and a panel of experts were used (N = 10) to develop the questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication. The final version of the questionnaire was composed of 49 items and applied to a convenience sample of 370 nurses. Results The construct validity was assessed by an exploratory factor analysis (EFA) and the reliability using Cronbach’s Alpha. Three dimensions were identified that determine therapeutic communication: professional, contextual and/or situational and patient. The Cronbach’s α total coefficient was 0.90, ranging from 0.71 to 0.81 for the dimensions. Conclusion The questionnaire to analyze the communication of nurses in nurse-patient therapeutic communication represents a valid and reliable questionnaire to measure nurses’ communication with patients in the clinical setting. Implications for practice The use of the questionnaire enables the analysis of elements that interfere with effective communication. This can assist in developing interventions to improve nurses’ therapeutic communication with patients.

Objective To solicit advice from members of the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) on what to include in an update of nurse staffing standards. Design Online, single-question survey with thematic analysis of responses. Setting Electronic survey link sent via e-mail. Participants AWHONN members who shared their e-mail with the association and who responded to the survey (n = 1,813). Measures Participants were asked to answer this single question: “The AWHONN (2010) Guidelines for Professional Registered Nurse Staffing for Perinatal Units are being updated. During their initial development, feedback from nearly 900 AWHONN members was extremely helpful in providing specific details for the nurse staffing guidelines. We’d really like to hear from you again. Please give the writing team your input. What should AWHONN consider when updating the AWHONN nurse staffing guidelines?” Results The e-mail was successfully delivered to 20,463 members; 8,050 opened the e-mail, and 3,050 opened the link to the survey. There were 1,892 responses. After removing duplicate and blank responses, 1,813 responses were available for analysis. They represented all hospital practice settings for maternity and newborn care and included nurses from small-volume and rural hospitals. Primary concerns of respondents centered on two aspects of patient acuity—the increasing complexity of clinical cases and the need to link nurse staffing standards to patient acuity. Other themes included maintaining current nurse-to-patient ratios, needing help with implementation in the context of economic challenges, and changing wording from “guidelines” to “standards” to promote widespread adoption. Conclusion In a single-question survey, AWHONN members offered rich, detailed recommendations that were used in the updating of the AWHONN nurse staffing standards.

Nursing home (NH) residents risk loneliness because of many losses. Nurse–patient interaction includes core aspects contributing to thriving and well-being among long-term NH residents. We performed a cross-sectional observation study of 188 residents 65 years and older from 27 NHs with ≥3 months’ residence. All had informed consent competence recognized by the responsible doctor and nurse and could converse. We asked “Do you sometimes feel lonely?” and used the Nurse–Patient Interaction Scale (NPIS) in face-to-face interviews. We identified associations between nurse–patient interaction and loneliness and investigated the prevalence of loneliness. Eighty-eight (47%) respondents reported loneliness often or sometimes and 100 (53%) rarely or never. Adjusted for sex and age, 10 of the 14 NPIS items were significantly correlated with loneliness. Loneliness is common among cognitively intact NH residents. Nurse–patient interaction associates with residents’ loneliness and might be important in alleviating loneliness. publishedVersion

Background Patient handling policy intends to decrease the risk of musculoskeletal injury for nurses. Many factors influence nurses’ adherence to patient handling policy, including the context in which the activities take place. The aim of this study was to investigate emergency nurses’ beliefs and experiences with patient handling in the emergency department. Methods A phenomenological approach was used to explore the participants’ experience of patient handling in the ED. Focus group interviews were held in a Victorian emergency department. The interviews were audio-recorded, transcribed, and the data were analysed using thematic analysis. Results Five interviews were held with 40 nurse participants. Four themes were identified that described participants beliefs and experiences of patient handling: ‘Putting the patient first’ describes participants prioritisation of patient safety over their own; ‘Patient -related challenges’ describes the patient factors (e.g. language, mobility, size) that make patient handling more difficult; ‘Staff knowledge’ of policy and procedure; and ‘Inadequate resources’ which describes the physical and human resource limitations that made patient handling more difficult. Conclusions Issues with equipment, education and patient handling culture are widespread, and this study reaffirms the importance of considering context in developing interventions to improve practice. Introduction of a Safe Patient Handling Program in the ED, that addresses multiple barriers simultaneously, may improve adherence to policy, and reduce the risk of musculoskeletal injury in emergency nurses.

Background Recently, there has been increased interest in patient satisfaction measures such as Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. In this systematic review, the spine surgery literature is analyzed to evaluate factors predictive of patient satisfaction as measured by these surveys. Methods A thorough literature search was performed in PubMed/MEDLINE, Google Scholar, and Cochrane databases. All English-language articles from database inception to July 2020 were screened for study inclusion according to PRISMA guidelines. Results Twenty-four of the 1899 published studies were included for qualitative analysis. There has been a statistically significant increase in the number of publications across years (P = 0.04). Overall, the studies evaluated the relationship between patient satisfaction and patient demographics (71%), preoperative and intraoperative clinical factors (21%), and postoperative factors (33%). Top positive predictors of patient satisfaction were patient and nursing/medical staff relationship (n = 4; 17%), physician–patient relationship (n = 4; 17%), managerial oversight of received care (n = 3; 13%), same sex/ethnicity between patient and physician (n = 2; 8%), and older age (n = 2; 8%). Top negative predictors of patient satisfaction were high Charlson Comorbidity Index/high disability/worse overall health functioning (n = 7; 29%), increased length of hospital stay (n = 4; 17%), high rating for pain/complications/readmissions (n = 4; 17%), and psychosocial factors (n = 3; 13%). Conclusions There is heterogeneity in terms of different factors, both clinical and nonclinically related, that affect patient satisfaction ratings. More research is warranted to investigate the role of hospital consumer surveys in the spine surgical patient population.

Objective The Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for nursing homes, where staff have faced rapidly evolving circumstances to care for a vulnerable resident population. Our objective was to document the experiences of these front-line health care professionals during the pandemic. Design Electronic survey of long-term care staff. This report summarizes qualitative data from open-ended questions for the subset of respondents working in nursing homes. Setting and Participants A total of 152 nursing home staff from 32 states, including direct-care staff and administrators. Methods From May 11 through June 4, 2020, we used social media and professional networks to disseminate an electronic survey with closed- and open-ended questions to a convenience sample of long-term care staff. Four investigators identified themes from qualitative responses for staff working in nursing homes. Results Respondents described ongoing constraints on testing and continued reliance on crisis standards for extended use and reuse of personal protective equipment. Administrators discussed the burden of tracking and implementing sometimes confusing or contradictory guidance from numerous agencies. Direct-care staff expressed fears of infecting themselves and their families, and expressed sincere empathy and concern for their residents. They described experiencing burnout due to increased workloads, staffing shortages, and the emotional burden of caring for residents facing significant isolation, illness, and death. Respondents cited the presence or lack of organizational communication and teamwork as important factors influencing their ability to work under challenging circumstances. They also described the demoralizing impact of negative media coverage of nursing homes, contrasting this with the heroic public recognition given to hospital staff. Conclusions and Implications Nursing home staff described working under complex and stressful circumstances during the COVID-19 pandemic. These challenges have added significant burden to an already strained and vulnerable workforce and are likely to contribute to increased burnout, turnover, and staff shortages in the long term.

Presence and therapeutic listening are complementary therapies that are incorporated into daily nursing practice. This article presents the nurse's role in facilitating complementary therapies of presence and therapeutic listening, barriers encountered, and the behaviors and techniques to be used. Also discussed is the impact that using presence and therapeutic listening has on patient outcomes. These interventions have the potential to significantly alter patients' perceptions of care and improve patient outcomes. Presence and therapeutic listening are vital to developing a therapeutic nurse-patient relationship. This relationship is what drives positive patient outcomes and increases overall satisfaction and quality of care.

Violence against women is a major public health issue and women with mental illness (WMI) are at a double disadvantage. While nurses play a key role in identifying and responding to abused women, research is limited on this issue from India. This qualitative study was aimed to explore nurses' knowledge, confidence, and learning needs in the identification and responding to disclosure of abuse in women with mental illness. The focus group discussions were conducted among nurses (N = 21) working in psychiatry units at a tertiary care center. An interview guide with semi-structured questions was used to collect the data. Five dominant themes and fifteen sub-themes have emerged from qualitative analysis. The dominant themes include; Awareness of abuse among women with mental illness (AWMI), Experiences of recognizing and responding to abuse, Barriers for routine screening for abuse, Educational preparedness, and learning needs, and Prevention of abuse in women with mental illness. The identified barriers include personal related (personal discomfort, lack of knowledge, etc.), job related (Time consuming, not a nurse's job, lack of time, etc.) and organizational (lack of policies and administrative support, etc.). Most of the participants expressed that they lack confidence in the routine screening of women for abuse due to inadequate training. Therefore, it is critical to include a topic on domestic violence in the nursing curriculum and provide ongoing learning opportunities to the nurses through CNE programs, workshops, and conferences.

Background Postoperative pain is a major concern of patients undergoing surgery. Pain assessment for patients undergoing surgery is a common requirement for surgical nurses and is the most important nursing approach to ensuring patient comfort. Aims The purpose of this study was to identify the reasoning used by nurses when assessing postoperative pain in patients. Methods Phenomenography was the research approach chosen to analyze the nurses’ experiences. This approach is used to acquire qualitative knowledge about the ways individuals experience the world. Results The reasoning used by nurses in postoperative pain assessment was identified from two perspectives: the frames of reference used to interpret a patient's perception of pain and the strategic efforts used to assess the pain. An outcome space for the various categories of reasoning employed by the nurses with regard to postoperative pain assessment was constructed to determine how these categories were logically related. Conclusions These findings have the potential to lead to a diverse range of nursing education modalities related to the adoption of different focuses and actions in postoperative pain assessment.

Nursing research involves much planning and attention to details, yet novice and seasoned nurse researchers often overlook the day-to-day operations required to conduct research studies. Project management is a set of iterative steps that can facilitate the process of conducting nursing research. In this paper we aim to provide an overview of project management and identify ways in which its specific principles and strategies may be applied to facilitate nursing research. Here we give an overview of our current longitudinal study using a Solomon four-group design and illustrate how we applied strategies and tools from the project management literature. In addition, we offer descriptions and illustrations of several other project management tools that could have been used in specific phases of this research project. We encourage nurse educators and researchers to familiarize themselves with the principles of project management and consider using them in future studies.

This study was performed as a quasi-experimental study using a standardized patient simulation program in order to explore the effects of education on the performance and knowledge of undergraduate nursing students with respect to pressure ulcer prevention.The study sample consisted of 38 students who completed the study. After the theoretical education portion, the students first knowledge and performance scores were evaluated with the standardized patient program. Demonstration education with the standardized patient and a second standardized patient practice were then performed. Afterwards, a debriefing session was held under the supervision of the researcher. After three months, the second knowledge and performance score evaluation was performed with the standardized patient. Knowledge and performance scores were compared after theoretical training and three months after simulation training.The mean score of 38 students were 43.68 ± 9.06 and 75.92 ± 16.84 on the pre- and post-tests, respectively. Preliminary points were significantly lower than post-test points (p 0.001). The median performance score was 7.89 (min-max: 0-73.68) in the first simulation and 86.84 (min-max: 63.16-100.00) in the second simulation. There was a statistically significant change between the two performance scores (p 0.001).In this study, it was determined that the level of knowledge and performance persisted in the evaluations after comprehensive training using standardized patient simulations. This study confirmed standardized patient practice as an efficient learning modality for nursing students in the long-term.

Objective Cross-cultural adaptation into Spanish of the Caring Nurse-Patient Interactions (CNPI – 70 items) for assessing nurse-patient relationship competence level. Method Cross-cultural adaptation using translation and back-translation method of the CNPI, and consensus by panel of experts to determine the face and content validity. Results The cross-cultural translation and adjustment procedure was used, and a panel of experts agreed on the final Spanish version of the scale. Conclusions This research study provides a Spanish version of the CNPI, which has appearance and content validity. The internal consistency, criteria validity, and construct validity should be evaluated in future research studies.

As the demographics in the United States continue to change, nurses must deliver care to patients from diverse cultural backgrounds. Cultural humility is a lifelong process of self-reflection which is also defined by that individual. It allows an individual to be open to other people's identities, which is core to the nursing standard of providing holistic care. Embracing and incorporating cultural humility is essential for creating a comprehensive and individualized plan of care. One of the ways to achieve cultural humility in nursing is to train future faculty to become agents of cultural humility. This also helps to create a pipeline of nurses who have respect and empathy for the patients they serve. The aims of this paper include: 1) define cultural humility and its importance to healthcare professionals; 2) explore the intrapersonal, interpersonal, and system levels of cultural humility; 3) provide insight on how to promote cultural humility; 4) reflect on best practices across a variety of healthcare disciplines; and 5) provide suggestions for practice.

A nurse-midwife describes how she had to trust her instincts when she suspected a woman was in danger.

Purpose The aim of this study was to explore the views of chronically-ill pediatric patients on medical errors and disclosure processes. Design and methods Semi-structured, qualitative interviews were conducted with twenty pediatric patients. Participants comprised ten children (8–12 years) and ten adolescents (13–18 years). Multiple methods using qualitative approaches were applied to explore and elicit views on medical errors, disclosure and recommendations for patient safety. For the children, art and play-based methods along with visual aids and vignettes were used to facilitate discussion. Older participants predominantly engaged in discussing the issue of medical errors through an examination of vignettes representing levels of harm. Results Participants revealed a range of perspectives including a strong desire to be told of errors. While they wanted those responsible for the error to be held accountable, they acknowledged that everyone makes mistakes. Children's rights and participation in patient safety as well as the existence of secret errors emerged spontaneously through the data analysis. Conclusions Chronically-ill children want to know about errors, from the person responsible for the error, and consider apologies and genuine remorse to be critical for coping. Children acknowledge that disclosure requires a case-by-case analysis. Practice implications The results have implications for how we view disclosure processes with children and how to engage them in patient safety.

Purpose Youth and young adults (YYA) with chronic illness and/or disability (CID) face numerous challenges in transition from pediatric to adult health care. Established evidence supports interdisciplinary team approaches to preparing youth and families for transition and transfer. The purpose of this national survey was to address a gap in current knowledge specific to pediatric nursing professionals' roles and responsibilities in health care transition planning (HCTP). Methodology A quantitative descriptive study using a survey questionnaire validated by experts in the field investigated respondents' role in HCTP, inclusion of HCTP in job description, levels of HCTP knowledge, and ratings of importance of HCTP elements. A volunteer sample of 1814 respondents was drawn from two professional organizations. Results Over 64% of respondents performed HCTP activities related to complex chronic illness management. Only 18% reported specialized training in HCTP. The highest-ranking items in regard to perceived importance were educating and supporting disease self-management and speaking with families about complex needs. Predictors of perceived importance were role, inclusion of transition planning in a job description, percentage of time in direct care, caring for those aged 14 years and older, and level of knowledge about HCTP. Conclusions The findings highlight key aspects of the pediatric nurse role in HCTP and identify specific elements that can be addressed to support future HCTP role development. Practice implications Pediatric nurses perform a vital role in HCTP for YYA with CID that may be enhanced with the inclusion of HCTP activities in job descriptions and specialized interdisciplinary HCTP training related to this emerging and growing population.

Background Owing to its convenience and easy accessibility, social media is increasingly popular among healthcare professionals and has become a useful tool in the healthcare industry. Doctors’ social media use patterns and online professionalism have been thoroughly studied. Various unprofessional behaviors such as excessive self-disclosure, violations of patient privacy and improper social media posts, were observed. However, studies exploring nurses’ social media use and online professionalism are lacking. Objectives The objective of this study was to understand the social media use and online professionalism of Chinese registered nurses. Design A cross-sectional survey was adopted. Settings Eight nursing conferences and one continuing-education program that took place in Sichuan, China. Participants Convenience sampling was applied to select nurses who had obtained their Chinese nursing certificates, who were aged 18 years and above, and who worked in clinical settings. The final sample consisted of 658 registered nurses. Methods Data were collected through the on-site distribution of an anonymous researcher-designed questionnaire. The questionnaire consisted of 41 items that focused on demographic and professional information, social media use and online professionalism. Medians, averages and percentages were used to describe the social media use patterns and online professionalism of Chinese registered nurses. Results All participants in this study were social media users and 84.5% of them believed that social media had positively influenced their clinical practice. WeChat was the most frequently used form of social media, which was used among 93.5% of the subjects. Common reasons for social media use included receiving messages from work, networking, receiving news and relaxing. Approximately 56% of the participants spent one to three hours on social media daily. Most of the participants had reposted medical knowledge on social media and had subscribed to at least one medical social media account. Additionally, 67.2% of the sample disclosed that they “often” communicate work-related information with colleagues via social media. Roughly 50% of the sample insisted that their facilities had social media guidelines. Registered nurses’ professionalism was also assessed. Around half of the participants had received “friend request” from patients, while 63.5% of the sample acknowledged that there were no patients on their most frequently used social media platforms. About 7.6% of the respondents had “sometimes” posted identifiable patient information, which was much lower than the reported 32.5% rate of witnessing colleagues’ disclosure of identifiable patient information. Fully 50.3% of the participants indicated that they had witnessed improper posts by colleagues.

Purpose To explore the experience of preoperative communication of nurse anesthetists (NAs) in brief meetings with patients in an orthopaedic setting. Design Qualitative research. Methods Three group interviews based on experiences of 18 NAs were conducted. Content data analysis was used. Findings The brief communication was characterized by both difficulties and opportunities. Protecting the patient's integrity, informing worried patients, lack of routines, language difficulties, being present at the meeting, protecting the patient from disturbance, and encouraging the patient to participate were stated as the main challenges in the brief meeting with patients. The NAs also gave some suggestions for improvement. Conclusions The Preoperative meetings need to be developed and structured to improve communication. A way to assess the results of this conversation should be developed. Other recommendations include finding a way to improve patient involvement in this dialogue and development of skills of NAs to enhance the meeting for patients.

Objectives To conceptualize the pathways and assess current evidence for the relationship between caregiver well-being and the quality of the cancer patient's care. Data sources Qualitative, quantitative, and theoretical literature and official reports. Conclusion Caregiver well-being has both direct and indirect effects on the quality of cancer care, including care received from the health care team, from the caregiver themselves, and in relation to patients’ own self-management. Implications for Nursing Practice Supporting caregivers has tangible consequences with regard to the quality of cancer care on multiple levels, with direct implications for patient outcomes. Nurses have a key role in providing psychosocial care to patients and their caregivers, and in supporting system-level change.

Background The ethical values of nursing are crucial to the provision of humane care. Human dignity is a core value that must be preserved in order to deliver such care. No studies to date have compared the perceptions of nurses and/or patients regarding the components of dignified care embedded in actual clinical practice. Purpose To explore the delivery of dignified care by professional nurses. This was an ethnographic qualitative study combining inductive and deductive methods to identify emergent themes. A multicenter study carried out in the internal medicine units of four hospitals in Barcelona (Spain). Convenience sampling was used to recruit nurses from the four units. Setting and sample Multicenter study carried out in the internal medicine units of four hospitals in Barcelona (Spain). Convenience sampling was used to recruit nurses from the four units. Method We conducted 158 hours of participant observation of 27 nurses. Semi-structured individual interviews were undertaken with 20 of these nurses, with data saturation being reached. Data were collected between September 2014 and May 2016 and were analysed using ATLAS.ti 7.2 for Windows. Results Two themes emerged from the analysis: Delivering dignified care and Factors influencing the delivery of dignified care. The nurses regarded human dignity as one of the key values of their profession. However, there was a discrepancy between their perceptions of the care they offered and what they actually did, due mainly to a lack of awareness about their own practice. Respect, confidentiality, privacy and communication were identified as the key elements underpinning dignified care. Institutional policies were seen as the major obstacle to the delivery of humane care, the key issues being frequent shift rotations, a high patient-nurse ratio and excessive paperwork. Conclusions The results of this study underline the importance of delivering dignified care and the need to ensure that nurses' attitudes and behaviours are consistent with this goal. The ethnographic approach, combining participant observation with individual interviews, revealed discrepancies between nurses' perceptions of the care they offered, or should offer, and what they actually did. This suggests a need for professional forums in which nurses can become more aware of their own clinical practice.

Background/Problem Emotional care underpins women's positive experiences during labour andbirth but is under-researched. Applying an attachment theory approach may inform the measurement of emotional aspects of maternity care. Objective To develop and validate a self - report measure for midwives to assess their emotionally attuned intrapartum care. Methods A staged approach to tool development was followed. Item generation was informed by a critical review of the literature and expert review. Following a pilot test, the draft scale was psychometrically assessed. Principal component analysis with varimax rotation was used to establish construct validity. Cronbach’s alpha determined internal reliability. Concurrent validity was tested with the ‘empathic concern’ and the ‘personal distress’ subscales on the Interpersonal Reactivity Index. The study was conducted with midwives (n = 705) who are members of the Australian College of Midwives. Findings The Cronbach’s alpha for the scale was 0.88. Principal component analysis revealed a one- factor solution. Significant but low correlations with Interpersonal Reactivity Index subscales of ‘empathic concern’ (rho = .256, p Conclusion The Emotional Availability and Responsiveness in Intrapartum Care Scale appears to be a valid and reliable measure of emotional aspects of midwives’ caregiving. An Attachment Theory approach validates women’s perspectives and elucidates our understanding of the importance of emotional labour support.

Background Hypertension is a preventable risk factor for cardiovascular disease, the leading cause of death globally. When hypertension is present with tobacco smoking, poor nutrition, physical inactivity or excessive alcohol consumption, risk of cardiovascular disease is increased. Given the prolonged engagement and ongoing relationship with patients, general practice nurses are ideally situated to actively engage with patients about optimal blood pressure control and lifestyle risk reduction. Objectives This study will test the effectiveness of a nurse-led intervention to reduce blood pressure in adults with hypertension and high cardiovascular risk. Design A multi-site, cluster randomised control trial where the general practice is the unit of randomisation. Methods General Practices (n = 20) will be block randomised to the intervention or usual care group. Adults with hypertension and high cardiovascular risk will be identified through an audit of electronic medical records and invited to attend an assessment visit. Eligible consenting patients will be recruited to the study. The intervention involves three face-to-face consultations and two telephone consultations with the nurse to assess lifestyle risk and develop an action plan. An appointment with the general practitioner will optimise pharmacotherapy. The primary outcome is blood pressure, with secondary outcomes of lifestyle risk factors; smoking, nutrition, alcohol and physical activity body mass index and medication adherence. Patients will have outcome measures evaluated at 6 and 12 months. Discussion ImPress is innovative in its proactive approach of identifying those at greatest risk of cardiovascular disease in combination with the emerging role of the general practice nurse to target care towards improved blood pressure control. If successful, findings from this trial could enhance the nursing role, improve health outcomes, inform health policy and provide an evidence base from which to transform blood pressure management in general practice. Trial Registration This trial has been registered with the Australian and New Zealand Clinical Trials Registry as ACTRN12618000169246.

Simulation is used with greater frequency by nursing programs to strengthen the learning process of student nurses. Best practices suggest active learning with the addition of standardized patients engages the student in realistic lifelike scenario. Therefore, the aim of the research study was to have nursing student's self-evaluate classroom learned communication skills through practical application on a standardized mental health patient simulated scenario. Undergraduate nursing students registered for three successive mental health nursing courses during one academic year were recruited. A self-reported pre/post survey measured the nursing student's level of confidence of learned therapeutic communication skills, preparation to engage their skills in clinical experience, and satisfaction with the standardized patient simulated experience. The self-reported online pre/post questionnaire return rate was 72.5% (N-116). The pre/post results suggest the standardized simulated experience enhanced nursing student confidence p.001; the nursing students felt prepared for clinical as noted by the mean score of 7.78 of 10 and overall were satisfied with the simulation process with a mean score of 8.04 of 10. The addition of the standardized patient in a mental health simulated experience promoted an active learning environment that highlighted individualized confidence in therapeutic communication skills through a realistic application process.

Purpose Nursing is theorised to be a component of person-centred care. Communicative constructions of person-centred caring are a topic that needs to be studied in consultations. The study aimed to explore how person-centred caring and non-person- centred caring are verbally constructed in consultations between patients and nurse. Method This study was qualitative using audio-recorded observations from consultations with advanced nurse practitioners in nurse-led chemotherapy clinics from four hospitals in the UK through purposive sampling. Discourse analysis was used to identify communicative patterns in 45 non-participant observations of nurse consultations. Results The dominant discourse was a non-person-centred oriented discourse framed by the biomedical model. It was also possible to identify fragments of an alternative discourse—a person-oriented discourse localising health problems within the patient's personal and sociocultural context. Conclusions The prominent use of a non-person-oriented discourse focusing on the medical/technical aspects of a patient's assessment/evaluation in consultations may make it difficult for patients to raise questions and concerns from their daily lives during consultations. However, fragments of a person-oriented discourse show that it is possible for nurses to allow a person-centred approach to the consultation. The pedagogical implications have to do with raising nurses' awareness of the role of evaluative language in enhancing person-centred communication with patients in clinical interactions.

Background Sedation practice has evolved from deep to lighter or no sedation in mechanically ventilated patients in the intensive care unit (ICU). The care of conscious intubated patients constitutes a change in the nurse-patient interaction. Objective We aimed to compare the perspectives of expert and competent nurses regarding their interaction with non-sedated mechanically ventilated ICU patients. Method The study had a qualitative comparative design applying semi-structured dyadic interviews. We interviewed five pairs of expert and competent ICU nurses with respectively >8 and 2–3 years of ICU experience and performed qualitative content analysis to explore the two perspectives. Findings We identified four main categories illustrating complexities of nurse-patient interaction: Managing frustration, Attempting dialogue, Negotiating reality and Alleviating discomfort. Expert nurses expressed more frustration and ambivalence towards light sedation than competent nurses, who took awake patients for granted. All nurses experienced communication issues, demanding patients, and inability to provide adequate patient comfort. Conclusion Our study added to the knowledge of nurse-patient interaction by describing issues of frustration, ambivalence and insecurity in a contemporary context of minimal sedation. Expert nurses were mere concerned by awake patients than competent nurses. Lighter sedation in ICU requires better staffing and improved communication tools.

Purpose Effective communication in cancer care and treatment is linked to better health outcomes, improved treatment adherence, and improved quality of life for cancer patients. While the characteristics of effective communication have been identified, there is sparse knowledge about the current conditions for providing effective communication especially within the outpatient clinical context, where the majority of cancer patients are currently being treated. This study aimed to explore communication practices between nurses and patients undergoing chemotherapy in an outpatient clinic to gain insight into how patients are supported in this setting. Methods Data were collected through 70 h of participant observations of nurse-patient interactions supplemented with ad hoc interviews with nurses in an oncology outpatient clinic. The methodology and data analysis are guided by interpretive description, thematic analysis and symbolic interactionism. Results Three themes were generated that characterised communication in the outpatient clinic: Treatment-centred communication, efficient communication and spatially-bound communication. While there was good opportunity for patients to learn about treatment and side effects during cancer treatment, psychosocial concerns were rarely addressed. Conclusions The outpatient setting influences the type and quality of communication between nurses and patients. Improvement of communication should include not only verbal and written information, but focus on the importance of nonverbal communication in the oncology outpatient clinic. Furthermore, there is a need to make environmental adjustments that can facilitate the opportunity for patients to express their needs and for nurses to respond to them.

Purpose The aim of this study is to illuminate how nurses working in an intensive care unit perceive their professional duties regarding end-of-life care based on their end-of-life care experience. Design and methods A qualitative research design utilising focus-group interviews was employed. Two focus groups with twelve nurses were recruited, one consisting of nurses with less than five years of clinical experience in intensive care units and the other with more than five years of experience. Findings An analysis of the nurses’ explorations of end-of-life care in an intensive care unit for patients facing impending death revealed three main themes: (1) facing an extreme change in human existence, (2) being in the presence of the patient's transition and (3) being prepared as an intensive care unit nurse. These three themes covered a total of 16 subthemes. Conclusion The findings of this study outline how intensive care unit nurses perceive dying patients and how they manage end-of-life care. It also illustrates how patients and their families can be included in the process, and this should be a component of nurses’ education regarding end-of-life care.

To improve nurses' comfort in helping laboring woman void on a bedpan after initiation of epidural analgesia, to increase the frequency of bedpan use in the labor and birth unit, and to decrease the use of continuous indwelling Foley catheters during the intrapartum period.Quality improvement project.A single large, midwestern U.S. hospital (3,000 births annually), where bedpans are infrequently used after epidural placement.Registered nurses on a labor and birth unit.A 20-minute educational presentation that included current urinary catheter evidence-based practice, preferential use of bedpans, and methods to help women void successfully was taught to all registered nurses in the author's labor unit. Nurses rated on a scale of 0 (not comfortable at all) to 10 (extremely comfortable) their comfort level at helping a woman with a bedpan. Primary data were collected through a convenience sample of anonymous surveys (n = 52) completed by registered nurses regarding their experience with bedpan and catheter use during labor and their comfort level helping women be successful with voiding. This was followed by a retrospective chart audit for women with term, singleton pregnancies who labored with epidural analgesia.Nurses' comfort levels increased from an average of 5.7 to 7.2 (p = .067). Postepidural bedpan use increased from 5.5% (n = 12) to 19% overall (n = 20; p .001), with five women using bedpans exclusively. When assisted with bedpan use, 38% (n = 12) of women were able to void 34 of the 53 times it was offered (64%). Use of continuous indwelling Foley catheters decreased from 61.7% (n = 137) to 54.7% (n = 58), and use of intermittent catheterization increased from 30.6% (n = 68) to 37.7% (n = 40).When assisted by nurses educated in and comfortable with different voiding techniques, women may be able to avoid medically unnecessary use of urinary catheters during labor.

Background Women with breast cancer demand informed shared decision-making. Guidelines support these claims. Objectives To investigate whether an informed shared decision-making intervention for women with ‘ductal carcinoma in situ’ comprising an evidence-based decision aid with nurse-led decision coaching enhances the extent of the mutual shared decision-making behavior of patients and professionals regarding treatment options, and to analyze implementation barriers. Design Cluster randomized controlled trial with accompanying process evaluation. Setting Certified breast care centers in Germany. Participants Women with ductal carcinoma in situ and no previous history of breast cancer facing a primary treatment decision. Methods Sixteen breast centers were randomized to intervention or standard care to recruit 192 patients (partially-blinded). All coaching sessions and physician consultations were videotaped to assess the primary outcome ‘extent of patient involvement in shared decision-making’ using the MAPPIN-Odyad observer instrument (scores 0 to 4). Secondary endpoints included the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), ‘informed choice’, ‘decisional conflict’ and ‘duration of consultations’. Primary intention-to-treat analyses were on cluster level comparing means of cluster values using t-tests. An accompanying process evaluation was conducted comprising 1) analysis of all video recordings with focus on procedures and intervention fidelity and 2) field notes of researchers and feedback from professionals and patients assessed by questionnaires and interviews with focus on barriers and facilitators for implementation at different time points. Results Due to protracted recruitment, the study was terminated after 14 centers had included 64 patients (intervention group 36, control group 28). Patient participation in informed shared decision-making was significantly higher in the intervention group (mean (SD) score 2.29 (0.56) vs. 0.42 (0.51) in the control group; difference 1.88 (95% CI 1.26–2.50, p Conclusions Informed shared decision-making is not yet implemented in German breast care centers. Nurse-led decision coaching grounded on evidence-based patient information enhances informed shared decision-making. Trial registration No. ISRCTN46305518.

Background Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is observed in the beginning of, or first acknowledged during pregnancy. The prevalence of GDM is estimated to be approximately 15% globally and is expected to increase due to growing numbers of overweight and obesity in women in their reproductive age. The nursing management of GDM in terms of lifestyle modifications (exercise, diet and nutrition) and the taking of diabetes medication, if required, and adherence thereto is crucial to prevent maternal and neonatal-perinatal complications. This qualitative study therefore aimed to explore and describe the experiences of women regarding the nursing management they received after being diagnosed with GDM; and the perceptions of nurse-midwives on their nursing management of GDM in Ghana. Setting This study was conducted in the military health institutions in Ghana, which includes one hospital and nine satellite clinics referred to as Medical Reception Stations providing antenatal and postnatal care to both military as well as civilian patients. Research on GDM in Ghana is extremely limited. Design We used a descriptive phenomenological approach to conduct 15 unstructured individual interviews with women that have been diagnosed with GDM (n = 7) and nurse-midwives (n = 8) providing nursing management of GDM during a six months period (December 2014 to May 2015). Audio-recorded data was transcribed, coded and analyzed using an adapted version of Tesch's eight steps for coding. Participants Seven (n = 7) women between 28 and 45 years of age, with 1 to 3 offspring each, participated. Most women (n = 5) did not have a family history of diabetes. The eight (n = 8) nurse-midwives that participated were between 32 and 50 years old with between 2 and 12 years of experience. Findings Participants in this study reported similar issues that could assist in better management of GDM. The majority of participants indicated the need for education on GDM, but both women and nurse-midwives acknowledged that this education is hugely lacking. Participants generally felt that emotional support for women is critical and it was included in the nursing management of GDM. Both groups of participants acknowledged that involving women and their significant others in the nursing management of GDM is important. Cultural and socio-economic issues, such as cultural beliefs that clashed with diabetic diets, lack of financial and social grants and limited nurse-midwifery staff were mentioned by both groups to affect the nursing management of GDM. Key conclusions The results demonstrate that, despite the reported challenges experienced by nurse-midwives and women, it was evident that the aim of nurse-midwives was to manage GDM as optimally as possible for women diagnosed with GDM, while considering the constraints established in the results. The challenges identified, specifically in terms of lack of education and cultural and socio-economic issues that affect the quality of and adherence to the nursing management of GDM, need to be addressed in order to optimize care for women diagnosed with GDM in Ghana. Implications for practice Based on our findings, recommendations are provided that can assist nurse-midwives and other health practitioners to provide comprehensive nursing management to women that have been diagnosed with GDM.

Childbearing women commonly access maternity services via the telephone. A midwife receiving these calls listens to the woman's concerns and then triages women according to their assessment. This may result in the provision of advice and instruction over the telephone or inviting the woman into the health service for further assessment. Midwives are responsible for all care and advice given to women, including via the telephone.The purpose of this study was to explore the experiences and practices of midwives regarding their management of telephone triage.A cross-sectional survey.Purposive non-probabilistic sampling of currently practising midwife members of professional organisations was used to recruit participants. From this, 242 midwives responded and 230 returned valid surveys were used in data analysis.Participant demographics, telephone triage processes, skills, educational preparation, confidence and anxiety levels, and external factors that influence midwives' management of telephone triage were collected via an on-line survey. Descriptive statistics and further analyses were conducted to explore relationships between variables.Eighty-three percent of midwives respond to 2-5 telephone calls per shift, with only 11.7% (n = 24) of midwives reporting that this is included in their workloads. Telephone triage is frequently managed in environments with distractions. Most midwives (84%; n = 177) report receiving no training in this skill. Confidence in performing telephone triage was reported, with higher confidence levels related to midwives' increased years of experience (p 0.05) and age (p 0.01). Anxiety related to managing telephone triage has been experienced by 73% (n = 151) of midwives, with this being greater in midwives with less years of experience. Anxiety is reported less by midwives in rural or remote settings compared to metropolitan or regional (p 0.05) settings in this study. A variety of standards and aids to guide practice, and document calls are utilised in a range of ways.To the authors' knowledge, this is the first study conducted to explore midwives' practises in telephone triage. The findings suggest the need for appropriate environments to conduct telephone calls and the inclusion of telephone triage in midwifery workloads. In addition, consistent education and processes are required to reduce anxiety and support midwives provision of this service to women.

Introduction Studies show that nurse rounding is an effective means to increase patient satisfaction and quality of care and decrease patient-safety events. There is evidence to support that daily leader rounding improves patients' hospital experience as well. Patients' experience increased confidence in their care providers, and leaders are able to address service concerns proactively. Furthermore, recent studies have addressed patient satisfaction in the ED setting as having an impact on patients' perceptions of the health care institution as a whole. Our objective was to demonstrate the effect of hourly nursing rounds and daily leader rounds on the ED patient experience. Methods We used a pre- and postintervention evaluation of Hospital Consumer Assessment of Healthcare Providers and Services (HCAHPS) survey scores. Two groups of stakeholders developed standard work for rounding. The leader group and the bedside nursing care groups used the evidence cited in this article to create their standard processes. Results During the 2-month pilot period, patient experience scores—as measured by 5 survey questions—all improved. Results will continue to be tracked monthly and reported to all stakeholders in real time to help hardwire the process change. Discussion Through collaboration and a participative approach, nurses and leaders used the current evidence from scholarly nursing literature as well as Lewin's theory of change to guide a successful approach to rounding and improving patients' experiences when receiving emergency care.

Background Emotional skills are fundamental for quality service by nursing professionals, providing more personalized attention and a close relationship between the professional and patient. Objectives To compare linear relationship models (linear regressions) and models based on comparative qualitative analysis (QCA) in the analysis of the possible influence of socio-demographic variables (age and sex), working conditions (type of contract and seniority) and academic training (type of degree and specific training) on emotional abilities (emotional intelligence and empathy) in nursing. Design It is a transversal design in a single temporary moment. Participants The sample of this study consisted of 217 direct patient care nursing professionals from 7 public hospitals in Valencia, Spain. Methods The Jefferson Scale for Nursing Empathy was used to measure empathy and the Trait of Meta-Mood Scale 24 to measure emotional intelligence. Two different statistical methodologies were used: traditional regression models and qualitative comparative analysis models of fuzzy sets (fsQCA). Results The results of the regression model suggest that only sex (negatively in the case of perspective taking) and positively (in compassionate care and thinking like the patient) is a predictive variable in the case of empathy, but not in emotional intelligence. Thus, the results of the fsQCA models provide a greater amount of predictive value for both emotional intelligence and empathy, although when varying the variables that best explained the dimensions, the type of contract and age were the main conditions that were sufficient but not necessary. Conclusions Given the differences in linear relationship models and fsQCA, far from prioritizing one technique over another, both are complementary and should be used simultaneously in other studies.

Background Online medical information has transformed the way patients obtain information. Purpose The present study examined patients' informational needs and the patient- Healthcare Provider (HCP) relationship from the perceptions of both patients and HCP. Methods The study was a cross-sectional study; data were collected in Israel from100 HCPs (nurses and physicians) and 184 e-patients. Findings E-patients were comfortable sharing e-information with their HCP and expected them to consider the e-information in treatment decision-making. Physicians thought they provided more information than the patients considered that they received from them, while both nurses and patients were in agreement about their interactions. Patients thought that there was a higher concordance between the e-information and the information they received from the physician/nurse as compared to what physicians and nurses reported. Discussion and Conclusions E-health information does not disrupt the patient-nurse/physician relationship. To promote compliance to treatment, it is important that HCPs consider information presented by patients when preparing the treatment plan.

Fast tracks are widely used in emergency departments to increase patient throughput as annual visits continue to rise in the United States. A modified triage process known as QuickLook, which omits patients' past medical history, is used in some hospitals to further increase throughput. This article discusses the effects of QuickLook on patient placement, reviews the role of past medical history in triage, and discusses the impact of integrating a targeted history question into the QuickLook process of an emergency department in Arizona.

Background Schizophrenia is a chronic mental illness that affects the client, family, and community. Nurses are educated to use the nurse-patient relationship to provide health education and collaborative health decision-making. However, challenges abound for nurses and clients with schizophrenia to effectively utilize the relationship to reach these goals. Problem There is a lack of evidence-based information to assist nurses to meet the challenges of building effective therapeutic relationships with clients for whom schizophrenia hinders health education and decision-making. Purpose To examine current research findings on factors that influence therapeutic relationships in psychiatric treatment settings as an initial effort to provide empirically based guidance for psychiatric nurses who seek to better use the relationship to work with the client toward health-related goals. Method This integrative review of the literature follows Whittemore and Knafl's (2015) method, analyzes 15 studies from multiple databases between the years 2006–2017, and assesses the rigor of each. Findings Numerous methods are used to assess therapeutic relationships. Few studies included nurses. Provider perception of client symptoms can negatively affect provider assessment of quality of relationship; no such association was found on the part of clients. Providers and clients prioritize client needs differently, with providers influenced by treatment setting demands, but provider-training programs can have a beneficial effect on their relationships. Conclusion Nurses and nurse educators can use the findings to guide assessment of how perceptions and priorities influence relationships. Findings also provide the foundation for further study of nurses' perceptions of therapeutic relationship, in progress, to yield more detailed information on what nurses and educators need to strengthen therapeutic relationships.

Objective The objective of this study was to explore midwives’ experiences of being ‘with woman’ in the intrapartum period within the context of an unknown midwife model. Design A descriptive phenomenological design was used with individual in-depth interviews. Transcribed interviews were analysed using thematic analysis that incorporated the data analysis framework offered by Amadeus Giorgi. Setting Hospitals within Western Australia providing intrapartum care to women where the midwife is not usually known to them. Participants Ten midwives were interviewed and recruitment ceased when data saturation was reached. Findings Findings confirm the importance of building a connection to enable partnership with the woman and provide woman-centred care that is inclusive of her partner. Factors influencing midwives’ ability to be ‘with woman’ included the ‘systems’ approach to childbearing as well as common birth interventions prevalent within the public hospital system. Midwives experienced both rewards and challenges associated with being ‘with woman’ in the unknown midwife model, adaptability and self-awareness were features that enhanced the ability to be ‘with woman’ within this model. Key conclusions Findings present new knowledge about being ‘with woman’, a phenomenon so central to the profession of midwifery, yet previously unexplored in the empirical domain. Insights gained reveal the intersection between the phenomenon and the unknown midwife model and highlight characteristics of the midwives that facilitate being ‘with woman’ such as adaptive expertise. Implications for practice Understanding the concept of being ‘with woman’ through the lived experience of midwives provides unique insight into the applied practices of the phenomenon. Characteristics of being ‘with woman’ as well as attributes and strengths demonstrated by the midwives provides important data for education and development of the profession. Explicating the challenges faced by midwives seeking to be ‘with woman’ in the unknown midwife model is useful for health leaders of service delivery and policy development to consider innovative ways to enhance this important practice advised by professional philosophy.

We explored the impact of gender role orientation (masculinity and femininity) on student nurses' caring behaviour and critical thinking.Caring and critical thinking are at the core of professional nursing education. Previous studies revealed inconsistent findings regarding the impact of gender roles on caring behaviour and critical thinking.We employed a quantitative correlational study. Nursing students (N = 449; female = 310, male = 139) who had at least had one month of clinical practice experience were recruited from four universities in Taiwan. Students' ages ranged from 19 to 29 years (Mean age = 21.24 years, SD = 1.28). Data were collected from August 2016 to July 2017, using three questionnaires: Taiwan Critical Thinking Disposition Inventory (CTDI), Caring Assessment Report Evaluation Q-sort Scale (CARE-Q), and Bem Sex Role Inventory (BSRI). Partial least squares structural equation modelling and generalized linear models were conducted to test the research model and hypotheses.Findings indicated that students who reported higher caring and masculinity presented greater critical thinking (ß = .37 and ß = 0.24, respectively; ps.001). Students' gender, age, femininity, or clinical practice experience, however, were not significantly associated with critical thinking (ß = -0.01, ß = 0.09, ß = .10, and ß = 0.01, respectively; ps.05). In addition, students who reported higher masculinity and femininity presented greater caring behaviour (ß = .22 and ß = 0.38, respectively; ps.001). Students' gender, age or clinical practice experience were not significantly associated with caring behaviour (ß = .04, ß = .03, and ß = -0.05, respectively; ps0.05). The findings confirmed a direct influence of caring and masculinity on critical thinking. Masculinity indirectly affected critical thinking via caring behaviour. Caring and masculinity accounted for 34.4% of the variance in critical thinking, and masculinity and femininity accounted for 29.1% of the variance in caring behaviour.Our study confirms the effect of age, gender role, and caring behaviour on critical thinking. We recommend that the cultivation of nursing care behaviour focus on students' gender role orientation. In addition, clinical nurse educators, when working with male students on patient caring, should consider their gender role orientation and support male nursing students' ways of presenting caring behaviours.

Purpose Preparing a future nurse to respond to the complex and sensitive needs of a child and family during the end-of-life requires more than didactic content in a classroom. During clinical experiences, students may care for children diagnosed with a terminal illness however; it is less likely that a student will have a clinical opportunity to care for a child and their family at the end-of-life. Without having an experience, it is challenging to teach students how to care for the dying child and family including how to appreciate the emotions, thoughts, and expectations when faced with a pediatric death (Lindsay, 2010). Design and Methods The instructional model integrates an end-of-life simulation into an undergraduate pediatric nursing course allowing students to practice caring for a child and their family while developing an understanding of the unique needs of a dying pediatric patient. Results Post simulation, students participating in guided reflection, identified several themes impacting their experience with end-of-life care, including symptom management, emotional care and “what to say”. Conclusions The structured simulated experience provided knowledge, skill and awareness to the role of the nurse when providing care at the end-of-life. Practice Implications Nurses' behaviors and responses when caring for a child can have a significant impact on the family's experience and memory of their child's death. Unintended actions may result in the family experiencing negative impressions, causing further distress to the grieving family (Butler, Hall, Willetts, & Copnell, 2015).

Elderspeak communication is typically viewed as patronizing and infantilizing by older adults and can lead to resistive behaviors in persons living with dementia. Little is known about the presence of elderspeak communication in hospitals in the United States. Understanding this phenomenon in the hospital setting is needed in order to improve hospital dementia care.The purpose of the Nurse Talk study was to (1) describe attributes of elderspeak use in hospital dementia care and to (2) determine what characteristics are associated with nursing staff use of elderspeak communication with hospitalized patients with dementia.A cross-sectional observational study design was used to collect and analyze audio-recordings of nursing staff during care for hospitalized patients with dementia.Three hospital units in one Midwestern university hospital in the United States.A convenience sample of 53 staff nurses and nursing assistants that provided direct care to 16 patients with mild or more severe dementia recruited from October 2019 through mid-March 2020.Eighty-eight care encounters were audio-recorded and coded for elderspeak communication using the Iowa Coding of Elderspeak scheme to determine the frequency and characteristics of elderspeak communication. A linear mixed effects model was used to determine what characteristics were associated with elderspeak and the frequency of elderspeak use by nursing staff to hospitalized patients with dementia.Over a quarter (28.7%) of all nursing staff speech directed towards patients with dementia constituted elderspeak and nearly all (96.6%) care encounters included some elderspeak. Particularly common attributes of elderspeak were minimizing words and mitigating expressions, childish terms and phrases, and collective pronoun substitution. A statistically significant interaction was identified between staff role and age (95% CI: -0.02, -0.00, p = .008) in predicting the frequency of elderspeak use, indicating that elderspeak was used more often by older staff nurses, whereas the age of nursing assistants remained constant across elderspeak use. Statically significant effects for delirium and length of stay were also demonstrated. Elderspeak use was 12.5% higher with patients with delirium (95% CI: 0.02, 0.23, p = .025) and increased 1.5% for each additional day the patient with dementia was hospitalized (95% CI: 0.00, 0.03, p = .035).Elderspeak is present and pervasive in the acute care setting. Interventions targeted towards older staff nurses and nursing staff from hospital units that care for patients with delirium and longer lengths of stay are needed.This study identified that nursing staff are frequently using elderspeak (infantilizing speech) with hospitalized patients with dementia. @claireshaw_phd @IowaNursing.

Purpose: Postoperative pain management is an ongoing challenge in surgical care, during which inadequate relief can contribute to postoperative complications, and nurses are key figures in this process. The aim of the present study was to gain knowledge of how nurses provide postoperative pain management for women undergoing major surgery for endometriosis. Design: An ethnographic field study, consisting of semi-structured interviews and participant observations, was conducted in a setting of 2 gynecological units within a large Scandinavian university hospital. Method: The participants were mainly nurses and patients. The overall focus for the field observations and interviews was on how the participants interacted and made care decisions concerning pain. The analysis focused on nurse-patient interaction in postoperative bedside care. A principal theme, pain-related nursing practice emerged, together with the sub-themes nurse-patient interaction, interpretation and assessment of pain and pain management, which represented a circular process, identified in bedside practice. Conclusions: To some extend the postoperative pain management was influenced by unexpressed health beliefs and routine actions, and patient involvement was not prominent. Furthermore, the existing guidelines for pain management did not seem useful to the nurses. Clinical implications: There is a need to develop a new and more practice-oriented postoperative pain management, in ways that also integrate the patient experience.

Professional placement experiences have been considered as an approach to improving nursing attitudes towards mental health nursing and selection of mental health nursing as a career. Mental health nursing placements are now occurring in less traditional settings, however, published research of these placements remains scarce. The aim of this non-experimental comparative study was to investigate the impact of nursing student participation in a non-traditional placement, compared to participation in traditional placement. Particular focus was on the attitudes of nursing students toward mental health nursing and career preferences. Participants of the intervention group attended the non-traditional placement, (n = 23). Participants of the comparison group attended traditional placement settings (n = 27), including placements in inpatient and community mental health. The study utilised The Preplacement Survey. Results showed significant differences in scores of the non-traditional placement Recovery Camp cohort related to reduced anxiety, reduced negative attitudes, and increased preparedness for mental health. These correlated with a comparatively increased desire to pursue a future career in mental health; albeit not a statistically significant increase. Considering mental health care, in any setting, is highly dependent on the training and ability of nurses to deliver effective service, the findings of the current study are important.