Particularity, Engagement, Actionable Inferences, Reflexivity, and Legitimation tool for rigor in mixed methods implementation research.

BACKGROUND: Implementation science helps generate approaches to expedite the uptake of evidence in practice. Mixed methods are commonly used in implementation research because they allow researchers to integrate distinct qualitative and quantitative methods and data sets to unravel the implementation process and context and design contextual tools for optimizing the implementation. To date, there has been limited discussion on how to ensure rigor in mixed methods implementation research. PURPOSE: To present Particularity, Engagement, Actionable Inferences, Reflexivity, and Legitimation (PEARL) as a practical tool for understanding various components of rigor in mixed methods implementation research. DATA SOURCES: This methodological discussion is based on a nurse-led mixed methods implementation study. The PEARL tool was developed based on an interpretive, critical reflection, and purposive reading of selected literature sources drawn from the researchers' knowledge, experiences of designing and conducting mixed methods implementation research, and published methodological papers about mixed methods, implementation science, and research rigor. CONCLUSION: An exemplar exploratory sequential mixed methods study in nursing is provided to illustrate the application of the PEARL tool. The proposed tool can be a useful and innovative tool for researchers and students intending to use mixed methods in implementation research. The tool offers a straightforward approach to learning the key rigor components of mixed methods implementation research for application in designing and conducting implementation research using mixed methods. CLINICAL RELEVANCE: Rigorous implementation research is critical for effective uptake of innovations and evidence-based knowledge into practice and policymaking. The proposed tool can be used as the means to establish rigor in mixed methods implementation research in nursing and health sciences.

Resistance for Disrupting Inequities and Fostering Social Justice in Nursing: A Discussion.

AIMS: The purpose of this paper is to provide a conceptual overview of resistance and argue for the need to embrace resistance as a part of nurses' professional repertoire for disrupting inequities and fostering social justice in both nursing education and practice. DESIGN: Discursive article. DATA SOURCES: Published peer reviewed literature on 'resistance' and 'professional resistance' in nursing, medicine, social work and other allied health care professions. RESULTS: Enhancing critical consciousness and engaging in intersectional collaboration are promising strategies to embrace resistance for collective action towards disrupting inequities and injustices in nursing education and practice. CONCLUSION: Embracing and legitimising resistance in everyday individual and social interactions in educational and practice settings is instrumental to fostering social justice in nursing. Without resistance, nurses may risk jeopardising enactment of moral and ethical responsibilities and suppressing their professional values of caring and compassion. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses can embrace resistance in practice to counteract social injustice and promote diversity, equity, inclusion and belonging and antiracism in clinical and educational settings. IMPACT: Research demonstrated that perceived and real inequities and injustices are common in nursing in the form of individual and structural racism, sex and gender discrimination, power imbalances and incivility. Nurses' engagement in resistance and increased capacity to resist injustices and incivilities can play an instrumental role in disrupting professional inequities in clinical practice and education. PATIENT AND PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or writing of this discursive article.

Determinants of Sexual Health and Sexual Quality of Life after Cardiovascular Surgeries: An Integrative Review.

BACKGROUND AND AIM: Sexual health and sexual quality of life are key components of psychosocial adjustment after cardiac surgeries and are often linked with improving the general quality of life. Reviews have been conducted to highlight the associations between cardiovascular diseases and sexual dysfunctions, but no review reported determinants of sexual health and sexual quality of life in patients after cardiovascular surgeries. We aimed to comprehensively examine the determinants of sexual health and sexual quality of life among individuals with cardiovascular surgeries. METHODS: Literature was searched within PubMed, CINAHL, Scopus, Web of Science, and OVID databases. In total, 816 records were identified from database searches, 279 records were screened, and 11 empirical studies were included for review. Relevant data were extracted using literature summary tables and synthesised using an inductive approach. RESULTS: The core determinants of sexual health and sexual quality of life were type of surgery and comorbidities, fears and uncertainties regarding sexual activity, sexual health education and counselling, spousal relationship and communication, and demographic factors such as advanced age and literacy levels. Major surgeries performed were coronary artery bypass grafting (CABG) and heart valve surgeries. The data collection tools used to collect data for sexual health and sexual quality of life were the International Erectile Function Questionnaire (IEFQ), International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI), Sexual Knowledge CABG Scale (SKS-CABG), Sexual Quality of Life Questionnaire (SQOL), SKS-Myocardial Infarction Scale (SKS-MI), and Couple Communication Scale (CCS). CONCLUSIONS: Despite their importance, sexual health and quality of life are frequently overlooked during patient rehabilitation after cardiovascular surgeries. The lack of adequate education and counselling from healthcare professionals frequently leads to increased fear and uncertainties among individuals and their partners. Therefore, more person-centred educational and counselling approaches should be developed to address the sexual concerns of individuals and their partners.

Coping among South Asian individuals living with chronic illnesses: A latent profile analysis.

Individuals' coping differs based on sociocultural determinants and the nature of illness. This study developed a coping typology for South Asians with chronic illnesses and differentiated the coping profiles based on sociocultural determinants. Individuals (n = 384) with chronic illness were recruited. The Brief COPE scale was used for data collection and latent profile analysis for typology development. The class differences were examined in terms of age, gender, socioeconomic status, education, type of family, smoking, primary decision maker in the family, type of community, number of years living with chronic illness and type of health care services used. Latent profile analysis supported four class model: Avoider-Emotion (n = 34, 9%), Problem-Emotion (n = 128, 33.9%), Problem-Avoider (n = 55, 14.6%) and Emotion-Avoider (n = 161, 42.6%) copers. Comparison of classes across chronic illness showed that individuals with chronic respiratory disorders were Emotion-Avoider and Avoider-Emotion copers, those with cardiac problems were Problem-Emotional and Problem-Avoiders copers, those with renal problems were Emotional-Avoiders and Problem-Emotions copers, and individuals with mental health issues were mainly Problem-Emotional and Emotion-Avoider copers. These class differences were statistically different (χ2 = 134, df = 18, p < .001). The findings can be useful for developing coping programmes for South Asian populations in low- and middle-income countries and South Asian immigrants.

Survey of Moral Distress and Self-Awareness among Health Care Professionals.

Health care professionals experience moral distress due to challenging ethical decision-making during patient care. Self-awareness can be associated with moral distress. This study determined the levels of and relationship between moral distress and self-awareness of health care professionals. A convenience sample of physicians and nurses was recruited. Data were collected using the Moral Distress and Self-Awareness Scales. In total, 168 physicians and 201 nurses participated with a mean age of 30.54 ± 7.87 and clinical experience of 6.40 ± 6.22 years. Moderate levels of moral distress (127.07 ± 71.90) and high levels of self-awareness (70.20 ± 11.37) were found. A weak positive correlation was found between self-awareness and moral distress (r = 0.21, p < 0.001) and weak negative correlation between moral distress (r = - 0.115, p = 0.03) and age. Nurses were more self-aware, but no differences were observed in moral distress based on sex and clinical settings. A weak correlation between self-awareness and moral distress may suggest that self-awareness can increase intrapersonal tensions, contributing to distress. Further research is needed to support any conclusive relationship between moral distress and self-awareness.

Implementation strategies to promote compassionate nursing care of complex patients: An exploratory sequential mixed methods study.

INTRODUCTION: Individuals with multiple physical and, or, mental health issues and, or, drug-related problems are known as complex patients. These patients are often recipients of poor-quality care. Compassionate nursing care is valuable to promote better care experiences among this patient population. Implementation strategies should be designed to enhance compassionate nursing care delivery. The study aimed to gain understanding of barriers to compassionate care delivery to propose implementation to promote compassionate nursing care of complex patients. DESIGN: An exploratory sequential mixed methods study was conducted. METHODS: Phase 1 was the qualitative component during which 23 individuals with multimorbidities were interviewed for exploring their perceptions of barriers to compassionate nursing care. The barriers were integrated with implementation science frameworks using the building technique during phase 2 to develop a Q-sort survey of implementation strategies for phase 3. Nurses, nurse managers, health care administrators, policymakers, and compassionate care experts responded to the survey by ranking the 21 implementation strategies, out of which five met the Q-factor analysis criteria. RESULTS: Participant-perceived barriers to nurse compassion could be categorized under knowledge, intentions, skills, social influences, behavioral regulation, reinforcement, emotion, and environmental context and resources. The five highest-ranked strategies included facilitation, consultation with stress experts, involvement of patients and families, modeling compassion through shadowing, and utilizing implementation teams. CONCLUSIONS: Enablement and modeling were the integration functions represented by the highest-ranked implementation strategies. Enabling nurses to provide compassionate care through emotional support and mental health counseling, and, modeling compassion and compassionate care through shadowing were recommended and rated as highly relevant by the majority of stakeholders. CLINICAL RELEVANCE: Enhancing nurses compassionate behaviors toward complex patients requires facilitating them in enacting compassion in practice through modeling and support from organizations and nurse managers.

Perception and Challenges of Time Management for Caregivers of People with Heart Failure: A Qualitative Study.

BACKGROUND: Informal caregivers contribute substantially to the self-care of people with heart failure (HF) by helping with concrete and interpersonal tasks. Time perception and management are essential issues among caregivers. However, investigators have not explored this topic in caregivers of people with HF. OBJECTIVES: The aim of this study was to describe the perceptions and challenges of the time management experience among caregivers who support the self-care efforts of their relatives with HF. METHODS: Adult informal caregivers of patients with HF, taking care of the patient for at least 3 months and without cognitive limitations, were recruited from Spain, Italy, and the Netherlands. Data were collected using semistructured interviews. Maryring's qualitative content analysis strategy with both a deductive and an inductive approach was used for analysis. RESULTS: We enrolled 50 participants (20 Italians, 19 Spanish, and 11 Dutch). Caregivers had a mean (SD) age of 62.8 (12.8) years and were mostly female (84%). They dedicated 31.2 (SD, 21.7) hours per week to providing caring activities for their patients. After extracting 33 codes from their qualitative interview data, we summarized them into 8 categories and identified 4 main themes: (1) time for yourself, (2) house management, (3) time for the patient (dedicated to directing care), and (4) time for own socialization. CONCLUSION: Caregivers navigate the complexity of time management by balancing dedicated time for supporting patients with HF and their own personal time.

Decision tree for identifying pertinent integration procedures and joint displays in mixed methods research.

AIMS: To propose a decision tree for identifying appropriate integration procedures and joint displays for  achieving integration in mixed methods studies. DESIGN: A methodological discussion. DATA SOURCES: Methodological literature including mixed methods textbooks, methodological reviews and studies published in the last 10 years (2012-2022). IMPLICATIONS FOR NURSING: Mixed methods are instrumental to study complex nursing care processes and health-human phenomena. Nurse researchers can use this decision tree to choose the most appropriate integration procedures to overcome the integration challenge when designing and conducting mixed methods nursing studies. CONCLUSION: Integration procedures and joint displays are the most widely used methods for tackling the integration challenge in mixed methods research (MMR). The multifaceted and contingent nature of these methods are beneficial for their tailored and adapted use at the data collection, analysis, interpretation and reporting levels. The use of the most pertinent integration procedures and joint displays is critical for ensuring quality in MMR. IMPACT: A growing methodological literature on MMR offers a wide range of integration procedures and techniques. Therefore, choosing appropriate integration procedures and analysis methods can be challenging for nurse researchers interested in conducting mixed methods studies. A decision tree is developed outlining 14 integration procedures and their corresponding mixed methods designs, purposes and joint displays. Examples of mixed methods studies in the discipline of nursing are presented to illustrate the implementation of the integration procedures. The decision tree can serve as a straightforward methodological tool for decision making in MMR. Nurse researchers can effectively use this decision tree for research and teaching purposes. PATIENT OR PUBLIC CONTRIBUTION: No direct patient or public contribution.

Nurses' perceived barriers to the delivery of person-centred care to complex patients: A qualitative study using theoretical domains framework.

AIMS AND OBJECTIVES: To determine nurses' perceived barriers to the delivery of person-centred care to complex patients with multiple chronic conditions in acute care settings. BACKGROUND: Complex patients have multiple physical and mental health problems, and their life is also greatly affected by sociocultural and economic determinants of health. These patients require person-centred care, but nurses often find it challenging to provide effective care to these patients due to their complex health needs. DESIGN: A descriptive qualitative design was used. The COREQ guidelines were followed for reporting. METHODS: Semi-structured interviews were conducted with a purposive sample of 19 nurses in two hospitals. Data were analysed using deductive thematic analysis guided by the Theoretical Domains Framework, which entails 14 domains about factors affecting behaviours. RESULTS: The key barriers were identified under environmental context and resources, social influences, emotions, knowledge and skills domains. Deep-rooted social issues delay patients' health-seeking and nurses' abilities to understand patients' needs and discern appropriate care. Interpersonal hostility influenced nurse-patient-families interactions, and doctor-nurses conflicts affected collaborative efforts towards optimal care. CONCLUSIONS: Nurses' perceived barriers to care were intertwined with the deep-rooted social and cultural beliefs about nurses' image, patients' expectations and families' preference for home remedies over specialised nursing care. These barriers to person-centred care demonstrate an intricate interplay of personal, social and organisational issues and power struggles. Multifaceted implementation strategies targeting environmental context and resources, social influences, emotions, knowledge and skills domains may be beneficial to enable nurses to provide better person-centred care to complex patients. RELEVANCE TO CLINICAL PRACTICE: Designing implementation facilitation teams, organising person-centred care grand rounds, and allocation of stress management resources to address hostility, social-cultural influences, and organisational barriers is essential. Nurses could focus on their self-awareness and collaborative skills to address emotional and interprofessional conflicts.

Behavioural indicators of compassionate nursing care of individuals with complex needs: A naturalistic inquiry.

AIMS AND OBJECTIVES: To explore behavioural indicators of compassionate nursing care from the perspectives of individuals with multimorbidities and complex needs. BACKGROUND: Complex patients are individuals with multimorbidity and/or mental health concerns, andoften with medication and drug-related problems requiring ongoing person-centered care, mental health interventions, and family and community resources. They are frequent consumers of health-care services and it is documented that these patients experience discrimination and substandard care. Compassionate care can improve patient care experiences and health outcomes. However, missing is the guidance on how to provide compassionate care for this population from the perspectives of complex patients. DESIGN: A qualitative descriptive approach was conducted in eastern Canada from December 2020-April 2021. The COREQ guidelines were followed for reporting. METHODS: Data from in-person and virtual semi-structured interviews with 23 individuals having experiences as complex patients were analysed using reflexive thematic analysis. Among them 19 were homeless and lived in a shelter. FINDINGS: Six indicators of compassionate nursing care were generated: sensitivity, awareness, a non-judgmental approach, a positive demeanour, empathic understanding, and altruism. CONCLUSIONS: Individuals perceived that nurses who acknowledge personal biases are better at providing compassionate care by manifesting compassion through their genuine and selfless interest in the complicated health problems and underlying socio-cultural determinants of each patient. Kindness, positivity, and a respectful nursing approach elicit openness and the sharing of heartfelt concerns. RELEVANCE TO CLINICAL PRACTICE: Comprehensive health assessment, dedicated efforts to know the patient as a human being, and listening to the patient's preferences can improve health outcomes among individuals with complex needs. Healthcare administrators can effect the change by supporting nurses to address complex health and social care needs with compassion. PATIENT OR PUBLIC CONTRIBUTION: Patients and healthcare professionals helped in data collection at the community care centre.

Organizational support and Nurse-Physician collaboration during SARS-CoV-2 pandemic: A qualitative study.

Health care professionals experienced multiple uncertainties during the pandemic. Exploring health care professionals' views about collaboration and organizational support can offer insights into organizational processes and issues during the pandemic. This research explored the perspectives of nurses and physicians about organizational support and nurse-physician collaboration during the SARS-CoV-2 pandemic. Using a qualitative descriptive design, interviews were conducted with nurses and physicians working in hospital settings. The interviews lasted for 24-61 min. Reflexive thematic analysis was used for data analysis. Nurses and physicians were disappointed with the organizational support, but they were satisfied with nurse-physician collaboration. The theme "Management Abusing Authority and Blaming the Victimized Workforce" included organizational nepotism, unethical managerial actions, and neglecting frontline workforce. Nurses and physicians supported each other in tackling the intensive and complex demands of the pandemic. The theme "Demonstrating Professional Humility and Overcoming Patient Care Issues at Hand" entailed subthemes - negotiating conflicts and prioritizing patient care, practicing kindness, and jointly managing conflicts with patients' families. Nurses and physicians reported frustrations with limited organizational support and abusive practices of managers. Still, they prioritized patient care needs and family-related conflicts over interprofessional tensions.

Alleviating suffering of individuals with multimorbidity and complex needs: A descriptive qualitative study.

BACKGROUND: Individuals living with multimorbidity and/or mental health issues, low education, socioeconomic status, and polypharmacy are often called complex patients. The complexity of their health and social care needs can make them prone to disease burden and suffering. Therefore, they frequently access health care services to seek guidance for managing their illness and suffering. AIMS: The aim of this research was to describe the approaches used by nurses to alleviate the suffering of individuals with multimorbidity and complex needs in acute care settings. RESEARCH DESIGN: A qualitative descriptive approach. PARTICIPANTS AND RESEARCH CONTEXT: Semi-structured interviews were conducted with 19 nurses working in general, medical-surgical, specialized, and intensive care settings across five hospitals in Pakistan. Reflexive thematic analysis was used for analysis. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the Ethical Committee of Al-Nafees Medical College Islamabad, Pakistan. FINDINGS: Four themes were generated: Deeper Exploration of Patients' Health-Illness Situation and Complexity, Prioritizing Patient Psychosocial and Emotional Needs, Instilling Hope and Encouragement in Patients, and Creating a Comforting Environment to Foster Sharing of felt needs. DISCUSSION: Nurses emphasized the need of deeper inquiry into patients illness situation and complexity to discern the impact of determinants on their well-being and develop care plans that are tailored to address psychosocial, emotional, and physical suffering of this patient population. CONCLUSIONS: Alleviation of patient suffering is integral to compassionate nursing care. Nurses use a multifaceted approach entailing sensitive understanding, recognizing sociocultural and structural determinants impact on patient situation, and individual and interdisciplinary altruistic actions to alleviate patient suffering.

Enhancing nurses' involvement in policy making: A qualitative study of nurse leaders.

BACKGROUND: Nurses can play a valuable role in not only the implementation but development of general and health policies. However, evidence indicates limited involvement of nurses in politics and general health policy making owing to individual, interpersonal, and systematic barriers. INTRODUCTION: Strategies are required to increase nurses' participation and engagement in policymaking. However, no studies explored the perspective of nurse leaders in policy making roles and how to improve nurses' involvement in policy making. PURPOSE: To explore strategies to enhance nurses' involvement in policy making from the perspective of nurse leaders. METHODS: A qualitative descriptive study was conducted. Semistructured interviews were conducted with a purposive sample of 11 nurse leaders with at least one year of experience in policy making. Data were analyzed using a thematic analysis approach. The COREQ guidelines were followed for reporting. FINDINGS: Five themes were generated: strategically revisit and implement educational approaches, becoming transformative leaders, improving social image of nurses, developing triadic partnerships, and empowering nurses through reflective and supportive mechanisms. DISCUSSION: Nurses' involvement in policymaking can be enhanced by implementing grassroots-level educational strategies, managerial-level empowerment efforts, and social mechanisms focused on improving the social image of nursing. CONCLUSIONS: Self and professional role empowerment through education, increasing awareness, and improving the social image of nursing can boost nurses' involvement in policymaking. IMPLICATIONS FOR NURSING POLICY: Nurse leaders, national and global nursing associations, and nursing regulatory bodies should collaborate with associations of nursing colleges to design nurse policymaking competencies framework and contextually tailored strategies to enhance nurses' engagement in policymaking.

Preparedness of Australian and British nurses and midwives about domestic violence and abuse.

BACKGROUND: Domestic violence and abuse (DVA) is a major health problem that affects individuals across the world. Nurses, midwives and healthcare providers need to be confident and competent in identifying and responding to DVA. AIMS: To measure current levels of knowledge, opinions and preparedness towards DVA and how it is managed by registered nurses and midwives residing in Australia and the UK. METHODS: A cross-sectional study design was used. Data were collected using the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) measuring the perceived preparation and knowledge, actual knowledge, opinions and practice issues. Australian data were collected in 2018 and UK data were collected in 2017-2018. Descriptive and inferential statistics were used to analyse the data and differences in knowledge and attitudes of British and Australian nurses. FINDINGS: Nurses and midwives (n = 368; 130 from Australia; 238 from the UK) responded to the survey. Minimal previous DVA training was reported by the participants. Participants had minimal knowledge about DVA, though had a positive attitude towards engaging with women experiencing DVA. DISCUSSION: Most participants felt unprepared to ask relevant questions about DVA and had inadequate knowledge about available resources. Australian participants scored better than British participants; however, the mean difference in all aspects remained statistically insignificant. CONCLUSION: Australian and British nurses and midwives have a positive attitude towards women experiencing DVA; however, the knowledge and skills to support women experiencing DVA are limited. IMPLICATIONS FOR NURSING POLICY: Nursing institutions should develop strategic policies regarding mandatory preparation and training of nurses for domestic violence assessment and management.

Tripartite Analysis: A Data Analysis Technique for Convergent Mixed-Methods Designs.

BACKGROUND: Effective data integration is a daunting task in mixed methods research. Several frameworks for data integration exist, but the choice of and the technique for integration depend upon the research question and design. Innovative integration techniques continuously need to be developed to tackle the integration challenge and provide alternative ways for researchers to generate plausible mixed meta-inferences. OBJECTIVES: The purpose of this study was to describe a new data analysis technique, tripartite analysis (TriPA), and illustrate its use in a convergent mixed-methods study. METHODS: This technique was developed based on a convergent mixed-methods study underpinned by dialectical pluralism aimed to understand Pakistani nursing students' perspectives about compassion and compassionate care and how these perspectives are consistent with the conceptualizations of compassion in nursing literature. RESULTS: TriPA entails analysis and integration using joint displays at three levels: case-by-case integrated analysis, separate and then merged quantitative and qualitative analysis, and comparative and integrated analysis of Levels I and II findings. DISCUSSION: TriPA can enable researchers to develop a more nuanced understanding of a given phenomenon through integration at various levels by identifying linkages within cases and across the whole data set and recognizing relational connections and emerging patterns.

Needs and problems related to sociodemographic factors of informal caregiving of people with heart failure: A mixed methods study in three European countries.

AIMS: To explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics. DESIGN: A qualitative focused mixed methods design was used. METHODS: In total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven-phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed. RESULTS: Three clusters of caregivers were identified: spouses, adult children and non-family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health. CONCLUSIONS: Informal caregiving emerged as a complex process influenced by various sociodemographic factors. Gender, relationship type and economic status are the important factors to be considered planning to develop approaches to address the needs of caregivers serving people with heart failure. IMPACT: A comprehensive understanding of the nature of informal caregiving of individuals with heart failure, the complexity of the real-world sociodemographic and cultural factors is warranted. The use of the EMDA method gave us the possibility of processing large masses of qualitative data through rapid, complex calculations. In detail, AATD allowed us to study in deep the significant fuzziness of what caregivers expressed and to analyse the content of the entire interviews and to produce global knowledge by using multi-dimensional statistical methods to grasp the fundamental sense of the interviews, beyond the simple words. Three clusters were identified in the samples, including spouses, adult children and non-family members. This study demonstrated that some sociodemographic characteristics could lead to everyday needs. Therefore, these demographic characteristics should be considered in developing targeted interventions. The research was conducted in Europe, but the technique shown can be replicated everywhere. The findings not only impact nursing but can be extended to all those stakeholders who concur with a public health educational mission. PATIENT OR PUBLIC CONTRIBUTION: Carers were involved in this study after the discharge of their loved ones or at the time of the outpatient visit. They were involved after they had been observed in their dynamics of involvement in caring of the familiars or friends with heart failure.

Approaches of male nurses for degendering nursing and becoming visible: A metasynthesis.

INTRODUCTION: Patient, nurse and public discrimination against male nurses is well-documented. Male nurses encounter challenges in degendering nursing and becoming more visible nursing professionals. However, little is known about male nurses' decisions and strategies to address issues concerning gender-based discrimination and professional visibility. AIMS: To develop a comprehensive understanding of the approaches of male nurses to degender nursing and become more visible in the profession. METHODS: A metasynthesis using the PRISMA guidelines. A comprehensive literature search was performed PubMed, CINAHL, Web of Science and Scopus databases. The search terms included 'lived experiences', 'male nurses', 'clinical practice', 'male educators' and 'male nurse managers'. In total, 16 qualitative studies published from January 2005 to November 2020 were critically appraised and synthesised. Two authors independently extracted data using summary tables. Data were synthesised using thematic synthesis which entails generation of codes and development of descriptive and analytical themes. RESULTS: Male nurses used intrapersonal, interpersonal and strategic adaptation to degender nursing and becoming visible as a nursing professional. These approaches entailed goal-directed behaviours, relationship-building strategies and positive and negative manipulation of resources. DISCUSSION: The approaches to degender nursing enabled men to prove their worth as competent nursing professionals, lessen the gendered stigmatisation and receive autonomy and respect. CONCLUSIONS: Degendering the gendered stigmatisation of nursing and becoming a visible nursing professional is essential for male nurses to promote diversity in the profession. Male nurses used both negative and positive approaches to gain recognition, respect and autonomy. They continued their struggles to promote the role of men as nurses. RELEVANCE TO CLINICAL PRACTICE: Nursing institutions and regulatory bodies could use the findings to develop conducive environments to degender nursing and increase male nurses' visibility. Future male nurses could use the identified positive approaches and tailor them to meet their needs to become more visible and competent nursing professionals.

Social suffering in individuals with chronic obstructive pulmonary disease: a secondary analysis of interpretative phenomenological study.

Individuals with chronic obstructive pulmonary disease experience suffering that affects their families and community relationships. However, no studies provide an explicit account of social suffering among these individuals. This secondary analysis was conducted to understand the lived experiences of social suffering in individuals with chronic obstructive pulmonary disease. The theory of social suffering guided the analysis of an interpretative phenomenological study. Thirteen individuals were recruited using purposive sampling. Data were analyzed using reflexive thematic analysis. Three themes were generated: a) prevailing hopelessness and burden, b) progressing relational adversities, and c) struggling with co-dependency. Social suffering is a complex entity experienced by the patients and the family caregivers. For enhanced caregiving, health professionals could prepare patients to tackle the suffering through collective actions.

Nurses', midwives' and students' knowledge, attitudes and practices related to domestic violence: A cross-sectional survey.

AIMS: To measure registered nurses', registered midwives', and nursing and midwifery students' current levels of knowledge, attitude and practices related to intimate partner violence. BACKGROUND: Nurses and midwives whether registered or students need to be confident and competent in identifying and responding to intimate partner violence. DESIGN: A cross-sectional survey. METHODS: Data were collected through online surveys using the Physician Readiness to Manage Intimate Partner Violence Survey. Descriptive and inferential statistics were used to analyse the data. RESULTS: Nursing and midwifery students were less knowledgeable and prepared than nurses and midwives. Midwives had more positive attitudes compared with nurses towards women experiencing intimate partner violence. CONCLUSIONS: Heath care institutions and regulatory bodies should provide resources and support to nursing and midwifery professionals. Personal experiences of domestic abuse and professional experience of supporting victims of domestic abuse/intimate partner violence affected practitioner's abilities to identify and manage intimate partner violence. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse and midwifery managers can ensure that clinical and organisational policies and protocols are revisited and updated regularly and that interdisciplinary collaboration is promoted and emphasized for prompt identification and management of intimate partner violence.

Ethical and culturally competent care of transgender patients: A scoping review.

BACKGROUND: Transgender individuals experience discrimination, stigmatization, and unethical and insensitive attitudes in healthcare settings. Therefore, healthcare professionals must be knowledgeable about the ways to deliver ethical and culturally competent care. ETHICAL CONSIDERATIONS: No formal ethical approval was required. AIM: To synthesize the literature and identify gaps about approaches to the provision of ethical and culturally competent care to transgender populations. DESIGN: A Scoping Review. LITERATURE SEARCH: Literature was searched within CINAHL, Science Direct, PubMed, Google Scholar, EMBASE, and Scopus databases using indexed keywords such as "transgender," "gender non-conforming," "ethically sensitive care," and "culturally sensitive care." In total, 30 articles, which included transgender patients and their families and nurses, doctors, and health professionals who provided care to transgender patients, were selected for review. Data were extracted and synthesized using tabular and narrative summaries and thematic synthesis. FINDINGS: Of 30 articles, 23 were discussion papers, 5 research articles, and 1 each case study and an integrative review. This indicates an apparent dearth of literature about ethical and culturally sensitive care of transgender individuals. The review identified that healthcare professionals should educate themselves about sensitive issues, become more self-aware, put transgender individual in charge during care interactions, and adhere to the principles of advocacy, confidentiality, autonomy, respect, and disclosure. CONCLUSIONS: The review identified broad approaches for the provision of ethical and culturally competent care. The identified approaches could be used as the baseline, and further research is warranted to develop and assess organizational and individual-level approaches.