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Accessible Summary: What is known on the subject?: Little is known about how PTSD and dementia in Veterans is identified by health care providers. What the paper adds to existing knowledge?: Healthcare providers identify those behavioural symptoms experienced by older people living with dementia that represent an unmet need associated with PTSD secondary to military service. Once healthcare providers recognize the presence of symptoms relevant to PTSD, they modify their care approach to include focused/tailored non‐pharmacological care interventions that address environmental and situational variables that reflect military action. What are the implications for practice?: Specialized education and training is needed to improve the identification of PTSD when existent with other co‐occurring neurocognitive conditions such as delirium, dementia and depression. Introduction: Co‐occurring PTSD and dementia in Veterans can be difficult to distinguish from dementia‐related responsive behaviours, which may result in inappropriate care management. Improved identification of PTSD and dementia is necessary to inform more appropriate and effective care for Veterans. Aim/Question: The purpose of this study was to understand how Canadian healthcare providers have learned to identify the co‐occurrence of PTSD symptoms in Veterans with dementia. Methods: Eight semi‐structured interviews employing the Critical Incident Technique were conducted with key informant healthcare providers who treat Veterans from across Canada. Framework analysis was used to code, sort and develop themes. Results: Observed differences in Veterans with PTSD and dementia cued healthcare providers to seek our more information, leading to a new understanding of past trauma underlying the symptoms they observed. Healthcare providers then altered their usual care approaches to utilize trust‐based and validation‐oriented strategies resulting in more effective care management. Discussion: Improvement in the identification of co‐occurring PTSD and dementia in Veterans requires specialized education and training for healthcare providers. Implications for Practice: Recognizing the complex needs of older Veterans with co‐occurring PTSD and dementia is necessary for healthcare providers to implement more effective care for this population. Relevance Statement: This paper provides mental health nurses with new understanding of co‐occurring PTSD and dementia in Veterans. With an ageing Veteran population in Canada, mental health nurses need to be knowledgeable about the care for Veteran specific mental health needs. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Involuntary treatment orders are increasingly being used around the world to allow the treatment of individuals living with a mental illness deemed incapable of giving consent and who are actively refusing treatment.The use of involuntary treatment orders can impact the nurse–patient therapeutic relationship, which is essential to offer quality care and promote recovery. What the paper adds to existing knowledge?: Nurses and patients do not agree on the possibility to develop a therapeutic relationship, with nurses believing they can build a bond with the patients despite the challenges imposed by the involuntary treatment order, and patients rejecting this possibility.Nurses caring for patients on involuntary treatment orders feel obligated to apply the conditions of this measure, even if it damages the relationship with their patients. This difficult aspect of their work leads them to question their role in relation to the management of involuntary treatment orders. What are the implications for practice?: Nurses need to be aware of the reasons why patients on involuntary treatment orders do not believe in the possibility of building a therapeutic relationship.Nurses need to reflect on and express their concerns about the damaging effects that managing involuntary treatment orders conditions can have on the nurse–patient therapeutic relationship. Introduction: Involuntary treatment orders (ITO) can impact the nurse–patient therapeutic relationship (TR) negatively. Despite the increasing use of ITOs around the world, few studies have explored their influence on the TR from the perspectives of nurses and patients. Aim: To describe the TR in the context of ITOs as reported by nurses and individuals living with a mental illness. Method: Secondary data analysis of qualitative interviews with nurses (n = 9) and patients (n = 6) was performed using content analysis. Results: Participants described the TR as fundamentally embedded in a power imbalance amplified by the ITO, which was discussed through the conflicting roles of nurses, the legal constraints imposed on patients and nurses, the complex relation between the ITO and the TR, and the influence of mental healthcare settings' context. Discussion: Nurses and patients' views were opposed, questioning the authenticity of the relationship. Implications for Practice: Nurses should be aware of the patients' lack of faith in the TR to ensure that they are sensitive to patients' behaviours that may falsely suggest that a relationship is established. Further studies should explore ways to alleviate the burden of the management of ITOs on nurses and allow for a trusting relationship to be build. [ABSTRACT FROM AUTHOR]

mcinnes e., seers k. & tutton l. (2011) Older people's views in relation to risk of falling and need for intervention: a meta-ethnography. Journal of Advanced Nursing 67(12), 2525-2536. Abstract Aim. This paper is a report of a meta-ethnography of qualitative studies of older peoples' views on risk of falling and need for intervention. Background. Falls and falls-related injuries in older people are worldwide problems. A conceptual understanding of older people's views about falls risk and need for intervention is useful for understanding factors likely to impact on acceptance of risk and recommended interventions. Data Sources. Seven electronic databases were searched 1999-2009. Reference lists of included articles were screened for eligible papers. Review Methods. Assessment of quality was carried out. Themes and concepts were extracted using a meta-ethnographic approach to compare similarities and differences across the retrieved studies. A line of argument was developed to produce an explanatory framework of the extracted themes and concepts. Results. Eleven relevant qualitative research articles of reasonable quality were identified. Six key concepts were identified: beyond personal control; rationalizing; salience; life-change and identity; taking control and self-management. A line of argument synthesis describes how older people approach self-appraisal of falls risk and intervention need, and how they cope and adapt to falls risk and intervention need. Conclusion. In response to having an elevated risk status and perceived associations with frailty and impact on an independent life-style, some prefer to adapt to this reality by taking control and implementing self-management strategies. Healthcare professionals should take into account beliefs about risk and negotiate choices for intervention, recognizing that some individuals prefer to drive the decision-making process to preserve identity as a competent and independent person. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: Immigrant women in Canada are at greater risk for post‐partum depression (PPD) than native‐born women.Immigrant women are less likely to have their care needs met as they face multiple barriers to care at both individual and system levels.To date, most PPD research has focused on individual barriers to care, with limited research examining organizational and system level barriers and the uniqueness of immigrant women's post‐partum health experiences. What this paper adds to existing knowledge?: This study provides unique insights into immigrant women's perceptions of what influences their post‐partum mental health and ability to access services for PPD.Factors contributing to immigrant women's PPD included several social determinants of health, particularly a lack of social support and limited knowledge about PPD and available services.Most helpful services acknowledge women's concerns, build trust, enact cultural competence and help with system navigation.Assessment approaches and organizational wait times created barriers to accessing care. What are the implications for practice?: Relationship building by providers is foundational to effective care for immigrant women with PPD.Findings highlight the need for mental health practitioners to improve cultural competence when working with diverse ethno‐cultural communities and for more effective assistance with system navigation, service integration and timely, flexible and accessible services.Findings have implications for the development of healthy public policy to address perinatal mental health issues amongst immigrant women. Introduction: Immigrant women in Canada are at greater risk for post‐partum depression (PPD) than native‐born women yet face multiple barriers to care at individual and system levels. Aim: To explore factors that contribute to PPD and health service accessibility, and the role of health services in supporting immigrant women with PPD. Methods: A qualitative interpretive descriptive design was used. Individual interviews were conducted with 11 immigrant women who had delivered a baby within the previous year and had experienced PPD. Inductive thematic content analysis was conducted. Results: Factors contributing to immigrant women's PPD included several social health determinants. Services were most helpful and accessible when providers acknowledged women's concerns, allowed time to build trust, provided culturally competent care and helped with navigating services. Assessment approaches and organizational wait times created barriers to care. Discussion: Immigrant women with PPD see relationship building by providers as foundational to providing effective support, enhancing coping and facilitating access to services. Improved communication with diverse ethno‐cultural communities and assistance with system navigation, service integration and timely, accessible services are needed. Implications for Practice: Findings can inform health service delivery models and the development of healthy public policy to address perinatal mental health issues amongst immigrant women. [ABSTRACT FROM AUTHOR]

cook c. (2012) Email interviewing: generating data with a vulnerable population. Journal of Advanced Nursing 68(6), 1330-1339. Abstract Aims. This paper describes online recruitment and the email interviewing data collection method with women diagnosed with a viral sexually transmitted infection. The paper highlights the advantages of the method to researchers and participants when conducting research where face-to-face participation may difficult. Background. Online recruitment and in-depth email interviewing have been used by only a small number of nurses internationally. The method enables inclusion of people who might otherwise be excluded from research, for reasons such as geographical distance, incompatible time frames, clinicians''gate-keeping' and participants' desire for anonymity for physical or emotional reasons. Methods. In-depth email interviews were conducted with 26 women in New Zealand, United States of America, Canada and England who had a diagnosis of either human papilloma virus or genital herpes simplex virus. Data were collected during 2007-2008 and analysed using a poststructuralist, feminist thematic analysis. Results. Participant retention was high. Women emphasized satisfaction with the process. Asynchronous interviews allowed for additional reflexivity in the researcher's responses and rich data generation. Conclusion. This method has the potential to enable nurses to include vulnerable and relatively inaccessible participants in 'sensitive' research. In-depth email interviews may generate rich data through a process participants deem to be of personal value. [ABSTRACT FROM AUTHOR]

Accessible summary What Is Known on the Subject? Psychiatric day hospital (DH) treatment has been offered since the 1930s and is appropriate for individuals experiencing intense psychiatric symptoms without requiring 24-hour inpatient care., No empirical research has examined the specific purpose of DH treatment from the perspectives of healthcare providers within these programs., What This Paper Adds To Existing Knowledge? This study was the first to address the question of the purpose and function of DH treatment from the outlook of frontline workers within this setting, and confirmed anecdotal observations that DH treatment provides an alternative to intensive psychiatric care, and also operates as 'bridge' between these intensive services and purely outpatient treatment., Additional information emerged, such as the importance of the name of DH programs avoiding connotations of illness, the benefits and skills that draw patients to these programs, and challenges that staff and patients experience within DH programs (e.g. short length of treatment, barriers to treatment access)., What Are the Implications for Practice? This information can enhance curriculum development within these settings. For example, given the importance of skill building, it is essential to integrate the provision of skill building and coping strategies within these settings., In addition, given that the name of the setting can impact staff (and perhaps service users as well), ensuring that the name of such program highlight wellness and recovery may enable a different type of therapeutic community to develop within these settings., Abstract Introduction Despite the benefits of psychiatric day hospitals ( DH), research has not addressed staff perspectives of these programs' effectiveness and barriers. Aim To elucidate staff perceptions of Adult Mental Health DH programs at two hospitals in Canada, allowing for improved programming, enhanced structure and increased understanding of DH settings within the continuum of care. Method Twenty-five DH staff members completed semi-structured qualitative interviews. Two independent coders applied content analysis to achieve data saturation. Results Four major themes emerged: (1) program purpose and function, (2) what is in a name, (3) perceived patient motivation, and (4) room for improvement. Discussion Findings highlighted the importance of a multidisciplinary team delivering education and skill-focused interventions. Services were cited as 'bridging' different mental health settings. Challenges included barriers to treatment access and inadequate length of treatment. Implications for Practice Understanding the function and purpose of this treatment service may enhance service delivery by enabling programs to integrate identified key ingredients. Providers can also note treatment duration and consider how to best use that time. Finally, language used within a DH setting appears to impact staff delivering services, and may also alter patients' understanding of the services they will receive and purpose of the program. [ABSTRACT FROM AUTHOR]

Aim: To explore clinician-perceived barriers to and facilitators for the provision of actionable processes of care important for patients with persistent or chronic critical illness. Design: Qualitative descriptive interview study. Methods: Secondary analysis of semi-structured telephone interviews (December 2018 – February 2019) with professionally diverse clinicians working with adults experiencing persistent or chronic critical illness in Canadian intensive care units. We used deductive content analysis informed by the Social-Ecological Model. Results: We recruited 31 participants from intensive care units across nine Canadian provinces. Reported intrapersonal level barriers to the provision of actionable processes of care included lack of training, negative emotions and challenges prioritizing these patients. Facilitators included establishment of positive relations and trust with patients and family. Interpersonal barriers included communication difficulties, limited access to physicians and conflict. Facilitators included communication support, time spent with the patient/family and conflict management. Institutional barriers comprised inappropriate care processes, inadequate resources and disruptive environmental conditions. Facilitators were regular team rounds, appropriate staffing and employment of a primary care (nurse and/or physician) model. Communitylevel barriers included inappropriate care location and insufficient transition support. Facilitators were accessed to alternate care sites/teams and to formalized transition support. Public policy-level barriers included inadequacy of formal education programs for the care of these patients; knowledge implementation for patient management was identified as a facilitator. Conclusion: Our results highlighted multilevel barriers and facilitators to the delivery of actionable processes important for quality care for patient/family experiencing persistent or chronic critical illness. Impact: Using the Social-Ecological Model, the results of this study provide intra and interpersonal, institutional, community and policy-level barriers to address and facilitators to harness to improve the care of patients/family experiencing persistent or chronic critical illness. Reporting Method: Consolidated criteria for reporting qualitative studies. [ABSTRACT FROM AUTHOR]

Aim: To explore the priorities of women mothering children in the context of intimate partner violence and to understand what shapes those priorities. Design: A qualitative study using interpretive description, informed by Feminist Intersectionality adhering to the COREQ guidelines. Methods: Thematic analysis was used to analyse the data. Data Sources: Dialogic, semi‐structured interviews were conducted with a community sample of 20 adult Canadian women who were mothering dependent children (under 18 years) in the context of recent intimate partner violence from a current or former partner. Results: Women's main priorities focused on their own and their children's well‐being and creating stability related to housing and finances. Three themes identified: it's all about the kids; my safety...totally disregarded; and I have to take care of him. Multiple external factors (coercive control, structural inequities, assumptions about mothering) shape priorities and the tensions arising from competing priorities women felt compelled to address simultaneously. Conclusion: Priorities of women mothering in the context of intimate partner violence are complex, shaped not only by what they want but by the limited options available to them given constraints such as income, employment, housing and service responses. Coercive control, structural inequities and assumptions about mothering are important factors influencing mothers' priorities and experiences. Better understanding mothers' priorities can support better tailored policies, services and nursing practice. Implications for Nursing: Structural inequities that negatively impact health and well‐being by limiting access to resources and the supports needed to enhance health can be better recognized and addressed through a trauma and violence informed care approach. Impact: This study addressed understanding the priorities of women mothering in the context of intimate partner violence. This research will impact women mothering in the context of intimate partner violence who receive care from nurses and other providers as well as those who provide care. Reporting Method: This study adhered to relevant EQUATOR guidelines (the COREQ checklist). No Patient or Public Contribution: The women who took part in the interviews for this study did not participate in the study design, analysis or manuscript preparation. [ABSTRACT FROM AUTHOR]

Aim: To explain the process taken by Chinese family care partners of older adults in the Greater Toronto Area, Canada, to access health and social services in their communities. The research question was: What mechanisms and structures impact the agency of Chinese family care partners of older adults, in the process of assisting them to access health and social services? Design: This qualitative study was informed by critical realism. Methods: Chinese family care partners of older adults in the Greater Toronto Area, Canada, were interviewed from August 2020 to June 2021. Transcripts underwent thematic analysis. Findings: Twenty-eight Chinese family care partners expressed a firm commitment to maintain caregiving conditions and to judiciously access health and social services. Their commitment was made up of three parts: (a) legislative and cultural norms of family, work, and society; (b) their perseverance to fill gaps with limited social and financial resources; (c) the quality of their relationship to, and illness trajectory of the older adults. The social structures created tension in how Chinese family care partners made decisions, negotiated resources, and ultimately monitored and coordinated timely access with older adults. Conclusion: Participants' commitment and perseverance were conceptualized as "grit," central to their agency to conform to legislative and cultural norms. Moreover, findings support grit's power to motivate and sustain family caregiving, in order for older adults to age in place as long as possible with finite resources. Implications for the profession: This study highlights the importance of cultural awareness education for nurses, enabling continuity of care at a systems level and for a more resilient healthcare system. Impact: Family care partners' grit may be crucial for nurses to harness when together, they face limited access to culturally appropriate health and social services in a system grounded in values of equity and inclusion, as in Canada. Reporting method: When writing this manuscript, we adhered to relevant EQUATOR guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ). Patient or public involvement and engagement: No patient or public involvement. [ABSTRACT FROM AUTHOR]

kwong e.w.-y., pang s.m.-c., choi p.-p. & wong t.k.-s. (2010) Influenza vaccine preference and uptake among older people in nine countries. Journal of Advanced Nursing 66(10), 2297–2308. Aim. This paper is a report of a study delineating factors that influence older people’s preferences and uptake of the influenza vaccine in nine countries. Background. Vaccination uptake for the aging population in many countries still remains below the World Health Organization recommended rate. Older people who perceive higher susceptibility to and severity of influenza, and more benefits from vaccination and action cues prompting vaccination, tend to accept the vaccine, but those with more perceived barriers to vaccination are less likely to accept it. Method. A total of 208 older people from China, Indonesia, Turkey, Korea, Greece, Canada, the United Kingdom, Brazil and Nigeria were recruited to 14 vaccinated and 12 unvaccinated focus groups. They shared their experiences of influenza, and influenza vaccination, and promotion of influenza vaccination in focus groups. The data were collected in 2007. Findings. We identified five themes and generated a hypothetical framework for in-depth understanding of vaccination behaviour among older people. Participants’ vaccine preferences were determined by their behavioural beliefs in vaccination, which were based on their probability calculation of susceptibility to and severity of influenza and vaccine effectiveness, and their utility calculation of vaccine, healthcare and social costs. Action cues prompting vaccination and vaccine access further affected the vaccine uptake of participants with vaccine preferences. Vaccination coverage was likely to be higher in the countries where normative beliefs in favour of vaccination had formed. Conclusion. The hypothetical framework can be used to guide healthcare providers in developing strategies to foster normative beliefs of older people in vaccination, provide effective action cues and promote vaccine access. [ABSTRACT FROM AUTHOR]

Aim: To describe how women perceived relational autonomy for decision‐making during childbirth pain and illuminate influencing factors. Background: Most women report challenging pain during birth. Circumstances can affect their ability to engage in pain management decisions. Design: We used an interpretative description approach to conduct this study. Method: A purposive sample of ten women who reported pain during childbirth participated in semi‐structured interviews. The study was conducted between July 2019 and November 2020 and reported according to the COREQ checklist. Results: Circumstances during childbirth, such as women's expectations and relationships, influenced their efforts to engage in relational autonomy. Care providers dealt with the unpredictability of childbirth and challenges with pain management using decision‐making practices that could disrupt women's expectations, undermine women's trust, demonstrate disrespect for women and rely on inadequate communication. Women who felt dependent on others were less likely to participate in decision‐making. When care providers' perceptions about pain differed from women's reports of pain, participants became distressed because care providers did not acknowledge their subjective pain experiences. Conclusions: Women regarded their relationships and communication with care providers as foundational to relational autonomy in decision‐making about pain management during childbirth. Relevance to clinical practice: Study findings can support care providers' considerations of the complexity of childbirth pain and factors affecting women's relational autonomy in decision‐making about pain. In particular, the findings highlight the importance of women's expectations and care providers' recognition of women's experiences of pain. Patient or public contribution: Women who shared their stories of childbirth pain contributed to the data collected. The chief nursing officers in the data collection setting facilitated the recruitment and data collection. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To illustrate the scope of different types of transitional, community‐based health interventions for formerly incarcerated women, trans and nonbinary people, the eligibility criteria for these interventions, and associated health outcomes. Background: Meeting the health needs of formerly incarcerated people in community, rather than through the criminal justice system, may prevent further experiences of criminalization. Research is needed to understand what community‐based health interventions have been implemented internationally to inform the design of an intervention in Canada. Design: Scoping review using the Joanna Briggs Institute scoping review methodology. Methods: In consultation with a medical research librarian, key databases and journals were searched for English language articles, from any country, with no specified date range. Three authors independently screened titles and abstracts to identify articles for full‐text review. The study adheres to PRISMA‐EQUATOR guidelines. Results: Thirty‐six studies met the present criteria and were reviewed in full text. Method, setting, participants, sample, relevant outcomes and relevant findings were extracted from each study for synthesis. Included studies had varied methods and were published from 1999 to 2020. Thirty‐one studies were based in the United States, one in Puerto Rico and two each in Canada and the United Kingdom. The most common health issue focus was human immunodeficiency virus and/or hepatitis c virus. The most common outcome was uptake of offered services, such as a transitional clinic. Conclusions: Gaps in the research pertain to a lack of attention to clinical outcomes and patient experience, and a lack of consideration of sexual and reproductive health concerns. Women were the minority population in all studies that included both men and women; transgender participants were mentioned in only four of thirty‐six studies. The specific needs of women, trans and nonbinary people must be taken into consideration. Relevance to clinical practice: Nurses must be conscious of the elevated health risks associated with exposure to correctional institutions and the risks associated with the period of transition. Patient or Public Contribution: A member of the research team brings lived experience expertise with respect to the criminal justice system. [ABSTRACT FROM AUTHOR]

Aim: To understand the lived experiences of nurses resuscitating children in community hospital emergency departments. Background: Emergency department nurses exposed to paediatric resuscitations are at a high risk of developing post‐traumatic stress. This may be especially true in community hospital emergency departments, where nurses have less exposure to, knowledge about, and resources for managing these events. Interventions to proactively prevent nurse trauma in these contexts remain largely uninvestigated. To inform such interventions, a detailed understanding of the largely unknown lived experiences of these nurses is necessary. Design and methods: In‐depth, semi‐structured interviews were conducted with four registered nurses that had experienced at least one paediatric resuscitation while working in a community hospital emergency department in Ontario, Canada. Data were analysed using interpretive phenomenological analysis. Reporting follows the COREQ checklist. Results: Analysis revealed three superordinate themes (i.e. 'Conceptualising Paediatric Resuscitations', 'Seeing What I See', and 'Making Sense of What I Saw') and nine corresponding subthemes. Conclusion: This study provides insight into the infrequent, but profound experiences of nurses resuscitating children in community hospital emergency departments. Nurses, who conceptualise these events as unnatural, emotional, and chaotic, are comforted by those who understand their experiences and are distressed by those who cannot see what they see. To reconcile what they have seen, nurses may reflect and ruminate on the event, ultimately restructuring their experiences of themselves, others, and the world to make room for a new reality where the safety of childhood is not certain. Relevance to clinical practice: Our findings contribute to pragmatic recommendations for interventions to proactively prevent nurse distress in these contexts, including psychoeducation, psychological support and in‐situ simulation activities. Nursing leaders should consider staff that have resuscitated children as valuable sources for information on how to improve practice settings. [ABSTRACT FROM AUTHOR]

Aims: To explore nurse practitioners' experiences of medication abortion implementation in Canada and to identify ways to further support the implementation of medication abortion by nurse practitioners in Canada. Design: A qualitative approach informed by feminist theory and integrated knowledge translation. Methods: Qualitative interviews with stakeholders and nurse practitioners between January 2020 and May 2021. Data were analysed using critical feminist theory. Results: Participants included 20 stakeholders, 16 nurse practitioner abortion providers, and seven nurse practitioners who did not provide abortions. We found that nurse practitioners conduct educational, communication and networking activities in the implementation of medication abortion in their communities. Nurse practitioners navigated resistance to abortion care in the health system from employers, colleagues and funders. Participants valued making abortion care more accessible to their patients and indicated that normalizing medication abortion in primary care was important to them. Conclusion: When trained in abortion care and supported by employers, nurse practitioners are leaders of abortion care in their communities and want to provide accessible, inclusive services to their patients. We recommend nursing curricula integrate abortion services in education, and that policymakers and health administrators partner with nurses, physicians, midwives, social workers and pharmacists, for comprehensive provincial/territorial sexual and reproductive health strategies for primary care. Impact The findings from this study may inform future policy, health administration and curriculum decisions related to reproductive health, and raise awareness about the crucial role of nurse practitioners in abortion care and contributions to reproductive health equity. Patient or Public Contribution: This study focused on provider experiences. In‐kind support was provided by Action Canada for Sexual Health & Rights, an organization that provides direct support and resources to the public and is committed to advocating on behalf of patients and the public seeking sexual and reproductive health services. [ABSTRACT FROM AUTHOR]

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Aims and objectives: To understand how acute care nurses make decisions about administering "as‐needed" (PRN) psychotropic medications to hospitalised people with dementia (PWD). Background: Behavioural and psychological symptoms of dementia occur in approximately 75% of PWD admitted to acute care. Despite this, few studies provide insight into the use and prevalence of psychotropic use in acute care. Design: A qualitative descriptive design was used to explore acute care nurses' decision‐making about PRN psychotropic medication administration to PWD. Methods: Semi‐structured interviews were conducted with eight nurses from three acute care medical units in a large tertiary hospital in Western Canada. Conventional content analysis was used to develop three themes that reflect nurses' decision‐making related to administering PRNs to hospitalised PWD. COREQ guidelines were followed. Results: Three themes of legitimising control, making the patient fit and future telling were developed. Legitimising control involved medicating undesirable behaviours to promote the nurses' perceptions of safety. Making the patient fit involved maintaining routine and order. Future telling involved pre‐emptively medicating to prevent undesirable behaviours from escalating. Nurses provided little to no mention of assessing for physical causes contributing to behaviours. PRNs were seen as a reasonable alternative to physical restraints and were frequently used. Additionally, organisational and unit routines greatly influenced nurses' decision‐making. Conclusions: These findings provide an initial understanding of how nurses make decisions to administer PRN medications to hospitalised older people and may inform prescribing practices. There were novel findings about the lack of assessment prior to PRN administration, and the nurses' collective response in decision‐making. More research is needed to better understand the complexities of nurses' decision‐making, to assist in the development of interventions for nursing practice. [ABSTRACT FROM AUTHOR]

brereton l., gardiner c., gott m., ingleton c., barnes s. & carroll c. (2011) The hospital environment for end of life care of older adults and their families: an integrative review. Journal of Advanced Nursing 68(5), 981-993. Abstract Aim. This article is a report of an integrative review to identify key elements of the physical hospital environment for end of life care of older adults and their families as reported by patients, relatives, staff and policy makers. Background. Globally ageing populations and increases in long-term illness mean that more people will need palliative care in the future. Despite policy initiatives to increase end of life care in the community, many older adults prefer, and will require, end of life care in hospital. Providing an appropriate physical environment for older adults requiring end of life care is important given concerns about hospital environments for this group. Data sources. Thirteen databases from 1966 to 2010 were searched including ASSIA, BNI, Cochrane Library, CINAHL, EMBASE, MEDLINE, PsycINFO, Social Science Citation Index, the Science Citation Index, HMIC and the National Research Register. Reference and citation tracking was performed on included publications. Review methods. An integrative review was conducted. Two reviewers independently screened titles and abstracts for inclusion and completed data extraction. Study quality is not reported as this poses methodological difficulties in integrative reviews. Data synthesis involved thematic analysis informed by the findings of included literature. Results. Ten articles were included. Four themes were identified: privacy as needed; proximity (physically and emotionally) to loved ones, home and nature; satisfaction with the physical environment; and deficiencies in physical environment. Conclusion. Little evidence exists about physical hospital environments for end of life care of older adults and their families. More research is required in this field. [ABSTRACT FROM AUTHOR]

Aims: To explore nurses' experience and describe how they manage various contextual factors affecting the nurse‐to‐nurse handoff at change of shift. Design: Qualitative descriptive study. Methods: A convenience sample of 51 nurses from four medical and surgical care units at a university‐affiliated hospital in Montreal, Canada, participated in one of the 19 focus group interviews from November 2017 to January 2018. Data were analysed through a continuous and iterative process of thematic analysis. Results: Analysis of the data generated a core theme of 'sharing accountability for knowing and safeguarding the patient' that is achieved through actions related to nurses' role in the exchange. Specifically, the outgoing nurse takes actions to ensure continuity of care when letting go, and the incoming nurse takes actions to provide seamless care when taking over. In both roles, nurses navigate each handoff juncture by mutually adjusting, ensuring attentiveness, managing judgements, keeping on track, and venting and debriefing. Handoff is also shaped by contextual conditions related to handoff norms and practices, the nursing environment, individual nurse attributes and patient characteristics. Conclusions: This study generated a conceptualization of nurses' roles and experience that details the relationship among the elements and conditions that shape nurse‐to‐nurse handoffs. Impact: Nursing handoff involves the communication of patient information and relational behaviours that support the exchange. Although many factors are known to influence handoffs, little was known about nurses' experience of dealing with these at the point of care. This study contributed a comprehensive conceptualization of nursing handoff that could be useful in identifying areas for quality improvement and guiding future educational efforts. [ABSTRACT FROM AUTHOR]

Aims: To provide insight into the everyday realities facing care aides working in long‐term residential care (LTRC), and how they perceive their role in society. Design: A qualitative ethnographic case study. Methods: Data were collected over. 10 months of fieldwork at one LTRC setting [September 2015 to June 2016] in Western Canada; semi‐structured interviews (70 h) with 31 care aides; and naturalistic observation (170 h). Data were analysed using reflexive thematic analysis. Results: The findings in this work highlight the underpinned ageism of society, the gendered work of body care, and the tension between the need for relational connections – which requires time and economic profit. Four themes were identified, each relating to the lack of training, support, and appreciation care aides felt about their role in LTRC. Conclusion: Care aides remain an unsupported workforce that is essential to the provision of high‐quality care in LTRC. To support the care aide role, suggestions include: (i) regulate and improve care aide training; (ii) strengthen care aides autonomy of their care delivery; and (iii) reduce stigma by increasing awareness of the care aide role. Impact: What problem did the study address? The unsupportive working conditions care aides experience in LTRC and the subsequent poor quality of care often seen delivered in LTRC settings.What were the main findings? Although care aides express strong affection for the residents they care for, they experience insurmountable systemic and institutional barriers preventing them from delivering care.Where and on whom will the research have impact? Care aides, care aide educators, care aide supervisors and managers in LTRC, retirement communities, and home care settings. [ABSTRACT FROM AUTHOR]

Aim: To describe ways in which a hospital context, physically and culturally, influences nurses' abilities to promote and engage with environmentally responsible practice. Design: A focused ethnographic study. Methods: Data were collected during May and August, 2019. Nurses (n = 22) working in the emergency room and three medicine units within a large Western Canadian hospital were invited to participate. Semi‐structured interviews were conducted, and observations were collected. Reporting is in accordance with the consolidated criteria for reporting qualitative research. Results: Three themes were identified: patient care not environmental care, organizational role and operational efficiency. Overall, participants indicated patient care was their primary priority, and due to their workload, they were unable to simultaneously consider the environmental impact of their work. Participants stated they had difficulties practicing in environmentally responsible ways because they felt unsupported by their hospital organization. Regardless, there was a desire for the organization to support environmentally responsible practices. Conclusion: Climate change is a major health concern, and partnership between hospitals and nurses is necessary to ensure environmentally responsible healthcare is delivered. We suggest both a top‐down and bottom‐up approach to help develop hospital contexts that are relevant and environmentally responsible. Impact: Nurses have a professional responsibility to address climate change, yet this study identified that nurses found it challenging to practice in environmentally responsible ways within the hospital context. Challenges they faced are related to their workload, their misaligned nursing priorities and, more importantly, because they felt unsupported by their hospital. Findings are important to both the nursing profession as well as other hospital leaders so that a culture of environmentally responsible healthcare can be developed within hospitals. [ABSTRACT FROM AUTHOR]

Aims: To explore the experiences of strategic leads for nurse education as they sought to respond to the COVID‐19 pandemic. Design: We utilised a qualitative interpretative approach to explore education leaders' experiences of leading during the early months of the pandemic. Methods: Nineteen leaders with significant strategic responsibility for nurse education in Australia, Canada, New Zealand, Singapore and the United Kingdom were identified via purposive sampling and agreed to participate. Interviews were held between May and July 2020. Results: Four overarching themes arose from the analysis: (1) Crisis driven adaptability & flexibility; (2) Responsive, complex and changing communication; (3) Making decisions for student and staff safety; (4) Looking to the future; stronger partnerships. Conclusion: Internationally, while nursing education leaders faced different problems, they shared a common goal amidst the crisis to remain student‐centred. They demonstrated they were able to face major challenges, respond to large scale logistical problems and make decisions under significant and ongoing pressure. Impact: In responding to the pandemic, nurse leaders shared knowledge and offered mutual support. This bodes well for future collaboration. The move to online learning accelerated an existing trend and it seems likely that this will continue. Given the pressures they experienced over an extended period, the sector may wish to consider how it prepares and supports existing and future leaders. [ABSTRACT FROM AUTHOR]

Purpose: To explore patients' and parents' involvement in the formative assessment of undergraduate nursing students' paediatric clinical practice. Methods: We conducted semi‐structured interviews with paediatric patients between 14 to 18 years old and parents who received care from a nursing student while admitted to a paediatric tertiary care hospital in Canada. We analysed the data using qualitative content analysis as well as Lincoln and Guba's criteria for establishing trustworthiness. The Consolidated criteria for reporting qualitative studies (COREQ) checklist was completed for the quality appraisal of this article. Findings: Three categories emerged from the data: 1) how patients and parents are currently involved in the formative assessment of nursing students' paediatric clinical practice; 2) how patients and parents would prefer to be involved in the formative assessment of nursing students' paediatric clinical practice; and 3) the potential benefits and challenges of involving patients and parents in the formative assessment of nursing students' paediatric clinical practice. Conclusion: This study provided an understanding of patients' and parents' past encounters with nursing students and the elements of care that they have assessed as well as those that they would prefer to assess and provide feedback on, while considering the potential benefits and challenges of their involvement. The findings of this study will assist clinical instructors in determining how and when to involve patients and parents in the assessment of nursing students. Academic institutions offering nursing programmes should consider the study findings when improving or changing formative assessment strategies. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describes nurses' moral experiences with Medical Assistance in Dying in the Canadian context. Background: Nurses perform important roles in Medical Assistance in Dying in Canada and do so within a unique context in which Medical Assistance in Dying is provided through healthcare services and where accessibility is an important principle. International literature indicates that participating in Medical Assistance in Dying can be deeply impactful for nurses and requires a high degree of moral sense‐making. Design: A qualitative interview study guided by Interpretive Description using the COREQ checklist. Results: Fifty‐nine nurses from across Canada participated in the study. The decision to participate in Medical Assistance in Dying was influenced by family and community, professional experience and nurses' proximity to the act of Medical Assistance in Dying. Nurses described a range of deep and sometimes conflicting emotional reactions provoked by Medical Assistance in Dying. Nurses used a number of moral waypoints to make sense of their decision including patient choice, control and certainty; an understanding that it was not about the nurse; a commitment to staying with patients through suffering; consideration of moral consistency; issues related to the afterlife; and the peace and gratitude demonstrated by patients and families. Discussion: The depth of nurses' intuitional moral responses and their need to make sense of these responses are consistent with Haidt's theory of moral experience in which individuals use reasoning primarily to explain their moral intuition and in which moral change occurs primarily through compassionate social interaction. Further, work on the moral identity of nursing provides robust explanation of how nurses' moral decisions are contextually and relationally mediated and how they seek to guard patient vulnerability, even at their own emotional cost. Conclusion: Medical Assistance in Dying is impactful for nurses, and for some, it requires intensive and ongoing moral sense‐making. Relevance to clinical practice: There is a need to provide support for nurses' moral deliberation and emotional well‐being in the context of Medical Assistance in Dying care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the day‐to‐day experiences of family caregivers who are caring for children with Osteogenesis Imperfecta (OI). Background: Osteogenesis Imperfecta is a rare genetic condition known to cause bone fragility. Family caregivers of children with OI play an important role in helping these children live well at home. Design: A qualitative descriptive design was used. Methods: A qualitative descriptive study was conducted in accordance with the COREQ guidelines. Adult family caregivers (n = 18) of children with OI were recruited from a university‐affiliated, paediatric orthopaedic hospital in Montreal, Canada. Individual interviews were conducted, transcribed verbatim and inductively thematically analysed. Results: Osteogenesis Imperfecta family caregiving entailed: (a) managing regular day‐to‐day caregiving activities, including morning routines, evening routines and the facilitation of their child's mobilisation; (b) coping with periods that made the caregiving routine more challenging, such as fractures, surgeries and pain; and (c) devising long‐term strategies to support day‐to‐day care, such as managing the environment, accessing medical and school resources, and coordinating care and respite. Conclusions: The day‐to‐day routine of caring for a child with OI may be disrupted by challenging periods and improved by long‐term strategies developed to ease day‐to‐day care. These strategies suggest future directions for clinicians and policymakers to improve health services and caregiver well‐being. Relevance to clinical practice: Clinical, policy and research endeavours need to incorporate new interventions to support the needs of family caregivers. These recommendations may be relevant to other clinicians and policymakers working with families living with rare and chronic physical conditions. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore parents' experiences with paediatric fever to understand their needs for information and support. Background: Paediatric fever is a normal part of childhood, and multiple episodes of fever are a common occurrence between infancy and adulthood. Despite this expectation, paediatric fever often sparks fear and anxiety amongst parents. Existing research has primarily focused on measuring parental deficits, so a more in‐depth exploration is helpful to understand the complexities of caring for a febrile child. Design: Qualitative descriptive study. Methods: Purposive sampling of N = 15 parents from a paediatric emergency department presenting with a febrile child. Semi‐structured interviews were conducted in‐person or via telephone. Thematic analysis was used to understand the data in the light of our research question. Reporting follows the consolidated criteria for reporting qualitative research checklist. Results: We found themes of (a) parental confidence through caregiving tasks, (b) emergent feelings of inadequacy, (i) referrals and limitations of community practice, (c) information needs and (d) information sources. Whereas parents were initially confident accessing information, providing care, making decisions and managing symptoms, new signs/symptoms sparked a change in parents' emotions, coping and behaviour. Parents routinely search for information about paediatric fever and value reliable, accessible resources. Conclusions: Our findings highlight parents' strengths assessing fever and effectively managing symptoms. We are encouraged by the potential for these results to inform the development of empowering resources to help parents make child health decisions during paediatric fever. Relevance to clinical practice: Findings provide an evidence base for researchers, clinicians and policymakers to improve care for paediatric patients and families. Parents want clear, reliable and accessible information about decision points associated with paediatric fever. Resources with an empowerment focus may help parents maintain a sense of control when caring for a febrile child. [ABSTRACT FROM AUTHOR]

Aims and objectives: The purpose of this study was to explore how undergraduate students perceive and make decisions regarding mental health nursing as a career following completion of an inpatient mental health practicum. Background: Among nursing students, mental health is consistently perceived as the least desirable nursing career path. However, evidence to explain why this is the case remains limited, with a lack of research exploring students' experiences of mental health settings and how these experiences influence their perceptions of a mental health nursing career. This knowledge gap limits strategies to support nurses' selection of mental health nursing as a career path, contributing to a global shortage of mental health nurses. Design: This study used a qualitative narrative inquiry design. Methods: In‐depth interviews (N = 15) were conducted with undergraduate nursing students to explore their experiences of mental health practicums. Participants had all completed a 6‐week practicum in inpatient mental health settings in urban hospitals. Reporting follows COREQ guidelines. Results: Nursing students' decisions to not choose a career in mental health nursing were influenced by negative practicum experiences, including the institutional environments of the inpatient mental health settings and witnessing of harmful nursing practices. These factors were identified as barriers to pursuing a career in mental health nursing. However, students expressed desire to continue to work with clients with mental health challenges and aimed to pursue nursing careers that preserve this opportunity in different healthcare settings. Conclusions: These findings expand upon existing literature that frequently positions nursing students as "uninterested" in mental health nursing and offers insights that can contribute to addressing global mental health nursing shortages. Relevance to clinical practice: This study highlights the need for mental health nurses, nursing leaders, and educators to recognise and respond to students' difficult experiences in the inpatient mental health setting during practicums. [ABSTRACT FROM AUTHOR]

Aims and objectives: To compare the communication and practice experiences of migrant nurses in geographically distant, culturally dissimilar countries in Eastern and Western contexts. Background: Considerable research has focused on the experience of acculturation of migrant nurses into geographically diverse locations. However, there remains scant comparative research which considers the ways in which migrant nurses interpret their experience through making "sense" of events encountered in their practice. Design: An exploratory qualitative study was conducted using face‐to‐face interviews with 36 migrant nurses currently practising in New Zealand and 20 migrant nurses practising in the United Arab Emirates. Methods: The same question schedule was used to explore influences on communication and practice in both settings. Thematic analysis and sensemaking theory guided coding and analysis of data. COREQ guidelines informed the reporting of qualitative data. Results: Qualitative analysis resulted in five representative themes, three illustrating similarities across diverse cultures and two that demonstrate the differences migrant nurses require to navigate across contrasting cultural environments successfully. Conclusion: Cultural value‐based differences in both locales caused both systemic and interpersonal sensemaking challenges for migrant nurses that emphasise the importance of orientation and education programmes for internationally qualified nurses. However, cultural conflicts also exist within groups. Orientation programmes should address culturally patterned responses among different groups of internationally qualified nurses. Relevance to clinical practice: Findings demonstrate a need for migrant nurses to be willing to embrace ambiguity in order to acculturate into a collaborative team culture in each of the geographical locations in this study. As registered nurses (RNs) also carry their cultural imprint, orientation interventions targeting the cultural variations of nurses in less standardised orientation programmes may be more beneficial in enhancing acculturation and in turn, staff retention. [ABSTRACT FROM AUTHOR]

Aim: To explore the influence of an acute care setting on competency deployment of new graduate nurses (NGNs) from a competency‐based undergraduate programme. Background: In the last 15 years, nursing education has shifted to competency‐based education (CBE). Few studies have focused on how NGNs from these reformed programmes use the competencies they have developed. To be paradigmatically coherent with the nature of a competence, studies should also examine how context influences nursing practice and competency deployment. Design: A focused ethnography of three acute care units from one academic hospital in Canada. Methods: Purposive and snowball sampling strategies were used to recruit 19 participants: NGNs (n = 4), nurse preceptors (n = 2), clinical nurse specialists (n = 9) and nurse managers (n = 4). Data were collected through individual interviews, focus groups, observation and documentation. Data were analysed according to Roper and Shapira (Ethnography in nursing research. Thousand Oaks, CA: Sage Publications, 2000) ethnographic nursing analysis framework. Results: Organisational and individual factors were identified as influencing NGNs' competency deployment. Organisational factors are orientation, stability, workload and the scientific culture of the unit. Personal factors have been linked to groups of professionals: for NGNs, personality and clinical placements during their initial education; for nurses working with NGNs, to be role models, to promote integration and to denounce bullying; and for other health professionals, to recognise nursing expertise. Conclusion: One way to smooth the transition from academic to clinical settings for NGNs is by offering transition or orientation programmes that will provide them with stability and a reduced workload, allowing them to progressively deploy their competencies. Relevance to clinical practice: Organisational and individual factors influence how new graduate nurses deploy their competencies. Clinical educators and nurse managers can help new nurses by acting on these factors. This study conforms to the COREQ Research Reporting Guidelines for qualitative studies. [ABSTRACT FROM AUTHOR]

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Aims and objectives: To understand how parents experienced miscarriage in an emergency department setting. Objectives were to identify parents' needs, isolate factors that influenced their experience, and provide recommendations to improve care from the perspective of women, their partners, nurses and nurse managers. Background: Miscarriage is the most prevalent complication encountered during pregnancy. It subjects parents to a multitude of emotions and may have significant consequences on mental health. Emergency department visits are frequently the only opportunity for parents to receive formal support during a miscarriage; it is thus crucial to understand the experiences of parents in this setting. Design: The study employed a descriptive, exploratory, qualitative approach with semi‐structured interviews. Methods: The study was founded on the W.K. Kellogg Foundation's Logic Model Development Guide (2004) and Meleis' Transitions Theory (2015). A total of 26 participants were interviewed (17 parents, 7 emergency department nurses and 2 emergency department nurse managers). Consolidated criteria for reporting qualitative research was used to report results. Results: Three categories of needs were identified: physical health, cognitive and emotional. For instance, parents expressed a need to receive more information during their visit to the emergency department (i.e., a cognitive need), whether about the diagnostic test results or how to ensure a better recovery. Parents also reported a desire for professionals to address their emotional concerns. Nurses were aware of the emotional impact of miscarriage but felt that they were not adequately trained in providing optimal care to parents in this situation. Conclusions: Parents who visited the emergency department for miscarriage reported several unfulfilled needs that generated dissatisfaction with care. Emergency department organisational constraints hindered optimal nursing care practices. Relevance to clinical practice: Nurses have an important role to play in improving parents' experience. They can do so by understanding the needs of parents and by being involved in developing new guidelines. [ABSTRACT FROM AUTHOR]

Aims: The objectives of the study were to: (1) examine the relationships between three different qualitative perceptions of safety culture and the Canadian Patient Safety Climate Survey factors; (2) determine whether these perceptions are associated with different hand hygiene practices. Background: Healthcare-associated infections and safety cultures are a worldwide issue. During the A/H1N1 Influenza pandemic, Europe and North America did not have the same responses. Importantly, healthcare professionals' perceptions can influence patient safety through infection prevention practices like hand hygiene. Design: A cross-sectional design was used with data collected in 2015. Methods: The Canadian Patient Safety Culture Survey and hand hygiene observations were gathered from three healthcare centres (two Canadian and one European). Descriptive analyses and ANOVAs were conducted to explore healthcare professionals' safety perceptions and practices. Results: The rates of hand hygiene practices varied widely between the three sites, ranging from 35-77%. One site (Site 3) was found to have the highest scores of management follow-up, feedback about incidents, supervisory leadership for safety, unit learning culture and senior leadership support for safety, and the highest levels of overall patient safety grades for the unit and organization. Conclusion: The quantitative results of this study support the previously described model based on qualitative results: individual culture, blaming culture and collaborative culture. Differences between continents emerged regarding infection prevention practices and the way we qualify infections. The results raise concerns about infection practices and about safety cultures and challenges worldwide. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine activities conducted, challenges encountered and supports used when sustaining nursing practice guideline implementation in multiple healthcare organisations over 3 years. Background Numerous models and frameworks exist to guide the implementation of guidelines, yet very few focus on sustaining improved practice changes. It is not known if one intervention or multiple interventions are required, nor the long-term activities, challenges and supports for sustaining improved practices. Design Qualitative descriptive study. Methods We conducted focus group interviews with steering committee members and individual interviews with leaders and direct care providers at the end of a 3-year guideline implementation study. The National Health Service Sustainability Model was used to guide data collection and analysis. Results The eight sites included three teaching hospitals, a community hospital, a long-term care facility, two community health agencies and a community health centre. Individual interviews were conducted with 36 leaders and 26 direct care providers. Focus group interviews were conducted with steering committee members ( n = 70) at each site. Guideline implementation activities ( n = 45) included developing new outcome monitoring systems, conducting chart audits, communicating progress to internal stakeholders, appointing interprofessional staff to steering committees, developing educational sessions and resources for staff and patients, revising policies and procedures, and developing partnerships with external organisations. Supports included lessons learned from previous and concurrent change initiatives, and commitment, involvement and positive attitudes of staff and leaders. Conclusion Activities identified by the participants addressed all 10 factors in the Sustainability Model in the three areas of process, staff and organisation. The challenges and supports encountered provide insights into the process of guideline implementation and sustainability. Relevance to clinical practice A multilevel action plan for staff, leaders and the organisation is recommended when introducing and sustaining practice changes. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the experiences of eight caregivers who provide care to children with cystic fibrosis in an eight-week cognitive-behavioural counselling programme at a children's hospital in Winnipeg, Canada. Background Youth with cystic fibrosis experience significant behavioural and psychosocial challenges, such as depression, anxiety and poor treatment adherence. Caregivers are critical to the provision of care and treatment to young people living with cystic fibrosis. Caregivers of youth with cystic fibrosis experience psychosocial morbidity. Thus, the development of counselling interventions is required to enhance psychosocial well-being among the caregivers of youth with cystic fibrosis. Design and methods This study was informed by the thematic analytic qualitative research tradition. In-depth, semistructured interviews were conducted with eight caregivers who participated in our programme. The audiotaped interviews were then subject to thematic analysis. Results The counselling sessions were experienced as 'distinctly different' from routine appointments at the hospital and were characterised by a sense of listening and bidirectional communication. In addition to acquiring a sense of trust and accountability through the programme, counselling appeared to enhance caregivers' perception of their time use, leading to greater temporal agency. Conclusion and relevance to clinical practice From this evidence-based cognitive-behavioural counselling programme, insights about the complex psychosocial lives of the cystic fibrosis community are discussed within the context of the literature. Integrating cognitive-behavioural counselling into routine clinical CF care should be considered as a method to enhance caregiving capacity in the CF community and should be championed by nurses. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine patient experiences of hospital-based discharge preparation for referral for follow-up home care services. To identify aspects of discharge preparation that will assist patients with their transition from hospital-based care to home-based follow-up care. Background To improve patients' transitions from hospital-based care to community-based home care, hospitals incorporate home care referral processes into discharge planning. This includes patient preparation for follow-up home care services. While there is evidence to support that such preparation needs to be more patient-centred to be effective, there is little knowledge of patient experiences of preparation that would guide improvements. Design Qualitative descriptive study. Methods The study was carried out at a supra-regional hospital in Eastern Canada. Findings are based on thematic content analysis of 13 semi-structured interviews of patients requiring home care after hospitalisation on a medical or surgical unit. Most interviews were held within one week of discharge. Results Patient experiences were associated with patient attitudes and levels of engagement in preparation. Attitudes and levels of engagement were seen as related to one another. Those who 'didn't really think about it', had low engagement, while those with the attitude 'guide me', looked for partnership. Those who had an attitude of 'this is what I want', had a very high level of engagement. Conclusions Previous experience with home care services influenced patients' level of trust in the health care system, and ultimately shaped their attitudes towards and levels of engagement in preparation. Relevance to clinical practice Patient preparation for follow-up home care can be improved by assessing their knowledge of and previous experiences with home care. Patients recognised as using a proactive approach may be highly vulnerable. [ABSTRACT FROM AUTHOR]

Aim and objectives. To identify the theories and concepts related to building age-friendly rural communities. Background. Global population is rapidly ageing. Creating environments that support active ageing was a catalyst for the World Health Organization to develop Global Age-Friendly Cities guidelines. Although the age-friendly movement has captured the attention of some countries, little is known about the participation of older people in rural settings. Method. An integrative review approach was employed to summarise the research literature on this topic. Using a systematic search strategy, databases including Discover (EBSCO's electronic database system), Web of Science, Scopus, PubMed, CINAHL, PsycINFO, Medline and Google Scholar were searched. Primary, peer-reviewed studies were included if published during 2007-2014 in the English language. Results. Nine studies were eligible for inclusion. The studies were set predominantly in Canada, with the exception of one from Ireland. The findings were summarised and clustered into main topics which included: theoretical perspectives; geographic and demographic characteristics; collaboration and partnerships; sus-tainability and capacity; and finally, future research agendas. Conclusions. Rural communities are changing rapidly and are becoming increasingly diverse environments. Community characteristics can help or hinder age-friendliness. Importantly, the fundamental starting point for age-friendly initiatives is establishing older peoples' perceptions of their own communities. Relevance to clinical practice. It is important for nurses, working in primary health care settings, to understand the needs of older people in the communities in which they practice. This includes the community characteristics that can be enablers and barriers to older people being able to remain and age within their own communities. [ABSTRACT FROM AUTHOR]

Aims and objectives. To determine, from a systematic literature review, the experience of living with heart failure and to propose some practice guidelines and research questions. Background. Chronic heart failure has been one of the fastest growing illnesses in recent decades, with almost 23 million people affected worldwide. This complex syndrome has multiple causes and appears when underlying heart disease is advanced. Currently, heart failure has no cure and leads to a significant deterioration in patients' quality of life. Design. Qualitative meta-synthesis. Methods. A qualitative meta-synthesis was conducted to extract and analyse qualitative research from the Cochrane, PubMed, CINAHL, PsycINFO, Web of Science and Cuiden databases. Snowball sampling and a manual search were performed to identify other relevant studies. Results. Twenty-five qualitative studies were selected. The findings indicate that there are three main themes that describe the phenomenon. The first theme refers to the experiences related to the beginning of the process. The second theme is connected with the effects on the person: physical, emotional, social and spiritual changes. The third theme is linked with how to live with heart failure despite the illness, including the adjustment and coping process and how external resources can help them to manage. Conclusions. Heart failure has a major impact on the entire person, but some areas have not been addressed. By creating new tools to understand and evaluate the impact of this illness and interventions that prevent or improve some situations, we can promote the well-being and the quality of life of this population. Relevance to clinical practice. Nurses must have a personal knowledge of the experiences and needs of the patients. To do this, nurses should create care environments that promote an exchange of experiences and knowledge between the nurse and the patient and family. [ABSTRACT FROM AUTHOR]

Aims and objectives. To understand parents' experiences of managing their child's postoperative pain at home. Background. Recent changes in children's health care services often shift the responsibility of managing children's postoperative pain to parents. Although pain management is important for good postoperative outcomes, it can be a challenging task for families, and children's pain is often under-managed. Design. This qualitative study used semi-structured interviews to explore parents' experiences of managing their child's postoperative pain at home. Methods. Participants were parents of 10 typically developing 5- and 6-year olds, who underwent (adeno)tonsillectomy, and experienced no complications leading to hospitalisation in the postoperative period. One-on-one interviews were conducted with parents within three months of their child's surgery. Interviews were transcribed verbatim and content analysis was used to identify themes in parents' experiences. Results. All children experienced some postoperative pain. Parents' experiences of managing their child's pain were impacted by balancing the pros and cons of administering analgesic medications, managing the emotional and psychological effects of their child's pain, as well as parents' information needs. Conclusions. Most parents' information needs were met yet they still struggled to manage their child's pain. These findings provide insight into some of the barriers that make this process challenging for many families, and what health care centres can do to help support parents manage their child's postoperative pain at home. Relevance to clinical practice. The results of this study may aid in the design of interventions that will support parents when managing their child's postoperative pain at home and thus improve children's experiences. [ABSTRACT FROM AUTHOR]

Aim To explore the concept of sustainability in nursing using social media as a vehicle for discussion on the topic. Background There is a need for an increased awareness among nurses of the issues that are crucial for the healthcare sector to prepare for climate change and contribute to sustainable development. However, topics about sustainability and climate change are not a requirement of nursing curricula in Europe; social media provides an opportunity to raise issues and promote discussion. Design A thematic analysis of a Twitter discussion. Methods A Twitter discussion session hosted by @WeNurses took place on 24 March 2015 over 1 hour. Data were gathered via this online discussion hosted on Twitter, a social media platform. Following the discussion a thematic analysis of the posted Tweets was conducted. Findings One hundred and nineteen people posted nine hundred and ninety six Tweets, a reach of 3,306,368. Tweets broadly followed the questions posted by the team. Several threads related to the sustainable use of healthcare resources and the need to reduce waste was evident. A Word Cloud of the Tweets highlighted prominent words in the discussion: sustainability, nursing/nurses, curriculum, important, waste, practice, resources, student, plastic, health, gloves. Conclusion Social media is an effective way of engaging nurses and students in a discussion on challenging issues. Sustainability appears to be important for nurses, with a particular emphasis on resource use and the importance of sustainability topics in nurse education. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim of this study was to explore the integration of the nurse practitioner role in Canadian nursing homes to enable its full potential to be realised for resident and family care. The objective was to determine nurse practitioners' patterns of work activities. Background Nurse practitioners were introduced in Canadian nursing homes a decade ago on a pilot basis. In recent years, government and nursing home sector interest in the role has grown along with the need for data to inform planning efforts. Design The study used a sequential mixed methods design using a national survey followed by case studies. Methods A national survey of nurse practitioners included demographic items and the EverCare Nurse Practitioner Role and Activity Scale. Following the survey, case studies were conducted in four nursing homes. Data were collected using individual and focus group interviews, document reviews and field notes. Results Twenty-three of a target population of 26 nurse practitioners responded to the survey, two-thirds of whom provided services in nursing homes with one site and the remainder in nursing homes with as many as four sites. On average, nurse practitioners performed activities in communicator, clinician, care manager/coordinator and coach/educator subscales at least three to four times per week and activities in the collaborator subscale once a week. Of the 43 activities, nurse practitioners performed daily, most were in the clinician and communicator subscales. Case study interviews involved 150 participants. Findings complemented those of the survey and identified additional leadership activities. Conclusion Nurse practitioners undertake a range of primary health care and advanced practice activities which they adapt to meet the unique needs of nursing homes. Relevance to clinical practice Knowledge of work patterns enables nursing homes to implement the full range of nurse practitioner roles and activities to enhance resident and family care. [ABSTRACT FROM AUTHOR]

Aim To explore the experiences of nurses providing sexual health care to adolescents with physical and/or developmental disabilities, with attention to the institutional and social discourses that shape these interactions. Background Previous research has shown that nurses demonstrate a lack of attention to the impact of illness or disability on sexual health. However, in their therapeutic relationship with patients and families, nurses are in an ideal position to promote sexual health. Design A critical ethnography study was conducted in an urban paediatric rehabilitative facility. Method Field work occurred over 4 months (2008-2009) and data collection included interviews ( n = 9), key informant discussions, collection of documentary evidence and observation of the institutional setting. Findings Four themes were identified (institutional space, professional interactions, engaging with sexuality, nursing experience), which revealed that nurse-patient interactions about sexual health were affected by a complex network of discourses. These encounters were shaped by practical discourses, such as time and space and by more complex discourses, such as professional relationships, normalization and asexuality. Conclusion Nurses occupy and strive to maintain, the role of a caring agent. However, aspects of the clinical, institutional and broader social environments may undermine their ability to promote sexual health. In nurses' efforts to maintain therapeutic relationships with clients, sexual health is often medicalised to legitimize it as an appropriate topic of discussion with patients and families. Facilities serving youth with disabilities should take steps to address barriers to the delivery of sexual health promotion and several solutions are proposed. [ABSTRACT FROM AUTHOR]

Accessible summary Evidence shows immigrant and refugee women experience difficulties in accessing care and treatment for postpartum depression., Thirty in-depth interviews were carried out to obtain information about the immigrant and refugee women's postpartum depression experiences., Main purpose was to explore how broader background factors influence the ways in which these women seek help to manage postpartum depression., Results show immigrant and refugee women experience many complex gender-related problems. Poverty, immigration status, discrimination, and poor spousal relationships and support can all directly affect a woman's access to healthcare services. Emotional and economic dependence may leave women vulnerable in protecting themselves against postpartum depression., Additional research is needed to further our understanding about immigrant and refugee women's postpartum health, their social support needs, the barriers they experience and their treatment preferences., Abstract The number of migrants arriving in Canada from non- European countries has grown significantly over the past three decades. How best to assist these escalating numbers of immigrant and refugee women to adapt to their new environment and to cope with postpartum depression ( PPD) is a pressing issue for healthcare providers. Evidence has shown that immigrant and refugee women experience difficulties in accessing care and treatment for PPD. This qualitative study was conducted with 30 immigrant and refugee women using in-depth interviews to obtain information about the women's PPD experiences. The primary aim was to explore how cultural, social, political, historical and economic factors intersect with race, gender and class to influence the ways in which immigrant and refugee women seek help to manage PPD. Results reveal that immigrant and refugee women experience many complex gender-related challenges and facilitators in seeking equitable help for PPD treatment and prevention. We will demonstrate that (a) structural barriers and gender roles hinder women's ability to access necessary mental healthcare services and (b) insecure immigration status coupled with emotional and economic dependence may leave women vulnerable and disadvantaged in protecting themselves against PPD. [ABSTRACT FROM AUTHOR]

baumbusch j., dahlke s. & phinney a. (2012) Nursing students' knowledge and beliefs about care of older adults in a shifting context of nursing education. Journal of Advanced Nursing 68(11), 2550-2558. Abstract Aim. To a report a study of improvements in students' knowledge and beliefs about nursing care of older adults following completion of an introductory course with integrated adult/older adult content. Background. Nursing schools are under pressure to provide accelerated programmes to meet growing workforce demands and provide students with the knowledge they require to care for an ageing population. Thus, stand-alone courses in gerontological nursing are being eliminated and integrated with general adult content. The effect of this approach remains poorly understood. Design. A one-group pretest-post-test design was used. Methods. Data were collected between September-December 2010. Students completed the Palmore Facts on Aging Quiz, the Perceptions of Caring for Older People Scale, and open-ended questions about their experiences before and after completing a course with integrated adult/older content. Results. Students' knowledge and beliefs about nursing care of older adults demonstrated an important improvement following completion of the course. Qualitative findings reflected three themes: relating to older people; neglect by the system; having time to learn. Conclusions. Findings from this study suggest that even when integrated with general adult content, students' knowledge and beliefs about older adult care can be positively influenced. Furthermore research is needed to examine long-term integration of students' learning about older adult care. Nursing faculty with expertise in nursing care of older adults must develop resources and supports for their colleagues to build capacity among nurse educators and integrate older adult content throughout nursing programmes to enhance nursing practice with an ageing population. [ABSTRACT FROM AUTHOR]

The article reports a study conducted in Canada and Sweden regarding measuring research utilization in nursing. In the said study, it is said that nursing care providers did not commonly use the term "research utilization." Participants identified various indicators of research utilization which can be used to develop existing or new research utilization measures. Further attention to issues in the areas of clarity, self-report, and aggregation is suggested.