Understanding person-centered care within a complex social context: A qualitative study of Saudi Arabian acute care nursing.

Policy reforms implemented in Saudi Arabia in recent years aim to modernize the culture and infrastructure of healthcare delivery and are expected to integrate person- and patient-centered care principles throughout the national healthcare system. However, in a complex multicultural environment where most nurses are international migrant workers, unique challenges emerge that frame the delivery of care. Better understanding is needed about what nurses perceive to be high-quality, person-centered care in Saudi Arabia and how they manage to enact it in practice. Semi-structured interviews were conducted with 21 nurses working in two tertiary hospitals in Riyadh, the capital city. Participants included Saudi citizens (n = 9) and expatriates (n = 12) who were asked to describe their perceptions of quality nursing care and explain the obstacles that they encounter in providing such care. Nurses reported extensive efforts to achieve individualized, empathetic, developmentally appropriate care. Their descriptions of care aligned with principles of patient-centeredness in care but were not separable from challenges at the patient, organizational, and regional levels, including staffing and supplies shortages, gaps in regional care coordination, inadequate language translation services, variability in cultural beliefs about healthcare communication, and overt discrimination against expatriate workers. Nurses reported creative strategies to achieve professional nursing values while navigating a dynamic landscape of constraints. The findings add to literature suggesting that person-centeredness in care cannot be understood outside the social and organizational conditions that shape it.

Early warning tools and clinician 'agency' for strengthening safety culture: An integrative review.

AIM: Identify and analyse literature investigating nurses' and midwives' use of early warning tools during the care of adult inpatients. DESIGN: An integrative literature review. METHODS: Whittemore and Knafl's (2005) framework guided this integrative review. PubMed, CINAHL, EMCARE and Google Scholar were systematically searched. The authors assessed the methodological quality of 21 papers meeting inclusion criteria and thematically analysed key data. RESULTS: Three main themes were identified, each with further sub-themes. CONCLUSION: Early warning tools operate within various systems and cultural contexts. However, their potential for improved patient safety may be hindered. Protocols influencing tool usage may make nurses and midwives distanced from patients and their expertise. For early warning tools to enhance patient safety, assessing their integration into practice is crucial to maximizing effectiveness. IMPACT: This review emphasizes the importance of integrating human relationships with early warning tools for patient safety. PATIENT OR PUBLIC CONTRIBUTION: This integrative literature review does not include patient or public input. IMPLICATIONS FOR PRACTICE/POLICY: Adapting early warning tools to balance standardization for safety and efficiency and promoting nurses' and midwives' expertise and autonomy is required to optimize delivery of quality care and uphold patient safety. REPORTING METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used.

The Architectural Layout of Long-Term Care Units: Relationships between Support for Residents' Well-Being and for Caregivers' Burnout and Resilience.

With a growing need for long-term care facilities in general, and for specialized dementia units in particular, it is important to ensure that the architectural layouts of such facilities support the well-being of both the residents and the unit caregivers. This study aimed to investigate correlations between the support provided by the architectural layout of long-term care units for enhancing residents' well-being and for decreasing unit caregivers' burnout and increasing their resilience-as layouts may impact each party differently. The Psycho Spatial Evaluation Tool was utilized to assess the support provided by the layouts of seventeen long-term care units (ten regular nursing units and seven specialized dementia units) for the residents' physical and social well-being (five dimensions); a questionnaire was used to measure the unit caregivers' burnout and resilience. When analyzing layouts' support for residents' physical and social well-being, inconsistencies emerged regarding correlations with caregivers' burnout and resilience across the two types of long-term care units. Supporting residents' physical well-being was correlated with increased caregiver resilience in dementia units, and with increased burnout and decreased resilience in regular nursing units. Layouts supporting social well-being showed inconsistent correlations with caregivers' resilience indexes in dementia units, and with burnout and resilience indexes in regular nursing units. The findings underscore the role of the architectural layout of long-term care units in enhancing residents' well-being; the results also highlight the possible unintentional yet negative impact of the layout on the caregivers' burnout and resilience. This study emphasizes the need to identify and rectify design shortcomings as a means of enhancing residents' well-being, while increasing the unit caregivers' resilience and decreasing their burnout. These insights should be addressed when developing strategies and interventions for ensuring optimal care environments for all parties involved.

Factors affecting early career registered nurses' views of building good relationships with patients: A qualitative empirical research study.

AIM: To clarify the factors affecting early career registered nurses' (ECRNs') views on building good nurse-patient relationships. DESIGN: An exploratory qualitative research design was implemented using detailed individual semi-structured interviews. METHODS: Interview data were analysed using a thematic approach based on the systematic text condensation analysis proposed by Malterud. DATA SOURCES: Eleven consenting nurses working in four hospitals. RESULTS: Six characteristics were identified that influenced ECRNs' perceptions of building good nurse-patient relationships: finding clues through reflection, observing patients' reactions, clarifying their role as a nurse, doing their best for the patients, treating each patient as an irreplaceable individual and receiving support. CONCLUSIONS: We discovered that the factors affecting ECRNs' views could be divided into two categories: factors that contribute to ECRNs' views on developing positive relationships with patients, and factors that influence ECRNs' relationships with patients but do not directly lead to positive relationships. It is critical for ECRNs to reflect on their experiences of poor relationship-building and observe patients' reactions. ECRNs seldom recognize that they have developed good relationships with their patients. It is critical to consider organizational environment and support as variables in developing a nurse-patient relationship so that the responsibility does not fall solely on ECRNs. IMPLICATIONS: The results of this study provide clues to help ECRNs overcome difficulties in building relationships with patients. Furthermore, they can be used to develop educational programme for ECRNs. Future studies should use these findings to provide support to ECRNs and help them build relationships with patients.

Exploring older people's experiences of the interpersonal care relationship between nurses and patients during hospitalization in the pandemic period: A qualitative study.

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

Enhancing new graduate nurses and midwives person-centredness through clinical supervision during COVID-19; evaluation of a non-randomized intervention study.

AIM: The aim of the study was to evaluate a person-centred model of clinical supervision to enhance person-centredness. DESIGN: Experimental, quantitative. METHODS: One hundred and three New Graduates were supported to reflect through a person-centred lens (July-December 2020). Evaluation was undertaken at 6 months using: the Manchester Clinical Supervision Scale-26 (effectiveness of supervision) and the Person-centred Practice Inventory (measures attributes of the nurse/midwife, the care environment and person-centred processes). Due to participation difficulties, scores were calculated by attendance rates using descriptive and inferential statistics. RESULTS: Regular attendees scored higher on the supervision's effectiveness; however, this did not reach efficacy. 'Finding time' to attend contributed to low scores. Supervision scored well on its supportive function when attended. Many New Graduates perceived a decline in their care environment. Attendance aside, New Graduates averaged an increased in their person-centred attributes and processes. Greater participation was found in those who scored higher at baseline on their person-centred attributes and processes, and this higher scoring continued at 6 months than those who attended less. CONCLUSION: New Graduates who perceive themselves as person-centred and reflective at baseline are more likely to attend a person-centred clinical supervision and score higher at 6 months than those who attended less often. New Graduates found support within supervision during challenging times. IMPLICATIONS FOR PRACTICE FOR PROFESSIONAL AND/OR PATIENT CARE: For successful implementation of Person-centred Clinical Supervision, New Graduates need support to attend, as attendance supports them to begin seeing value in the process. IMPACT: This intervention kept person-centred practice at the forefront of New Graduates reflection, in a time of extreme change. The research has implications for nursing and midwifery management with the imperative to deliver person-centred care and create the person-centred cultures for staff to feel supported and empowered. REPORTING METHOD: Transparent Evaluation of Non-randomized Designs (TREND). PATIENT OF PUBLIC CONTRIBUTION: No patient or public contribution. CONTRIBUTION TO WIDER COMMUNITY: New Graduates grow their person-centredness over their transitioning year; however, this can be enhanced with regular clinical supervision underpinned by person-centred theory. Clinical supervisors can provide support to New Graduates when the environment is challenged.

Construction of nursing knowledge in commodified contexts: Views and experiences of nurses regarding primary care.

The commodification of health care, particularly primary care, presents challenges to care and knowledge development. The purpose of this study is to examine how nurses perceive and develop their knowledge in a commodified context. A mixed-methods study was conducted that included a closed-question survey and in-depth interviews with nurses in public primary care in Catalonia. There were 104 valid responses to the questionnaire and 10 in-depth interviews. The main findings of the survey were related to workload and limited time for nursing care. Six themes emerged from the in-depth interviews: (1) limited time for nursing, (2) feelings of burnout, (3) awareness of patient and family satisfaction, (4) organizational factors that favor nurses' needs, (5) organizational factors that hinder nurses' needs, and finally (6) public administration requirements. Participants perceive excessive workload and time constraints and feel that this affects their nursing care and their physical and mental health. However, nurses purposefully use knowledge patterns to cope with the problems associated with commodification. Nurses have multidimensional, contextualized, and integrated knowledge that allows them to optimize their care based on the needs of their patients. This research examines many challenges related to nursing practice and the nursing discipline and opens the door for further research that encompasses all areas of nursing.

Surgical wound care preferences and priorities from the perspectives of patients: a qualitative analysis.

OBJECTIVE: To explore patients' priorities and preferences for optimal care of their acute or hard-to-heal surgical wound(s). METHOD: This qualitative study involved semi-structured individual interviews with patients receiving wound care in Queensland, Australia. Convenience and snowball sampling were used to recruit patients from inpatient and outpatient settings between November 2019 and January 2020. Interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Emergent themes were discussed by all investigators to ensure consensus. RESULTS: A total of eight patients were interviewed, five of whom were male (average median age: 70.5 years; interquartile range (IQR): 45-80 years). Four interrelated themes emerged from the data that describe the patients' surgical wound journey: experiencing psychological and psychosocial challenges; taking back control by actively engaging in care; seeking out essential clinician attributes; and collaborating with clinicians to enable an individualised approach to their wound care. CONCLUSION: Findings from this study indicate that patients want to actively collaborate with clinicians who have caring qualities, professional skills and knowledge, and be involved in decision-making to ensure care meets their individual needs.

Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study.

AIMS AND OBJECTIVES: To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units. BACKGROUND: In mental health units, the therapeutic relationship is especially relevant for increasing the effectiveness of nursing interventions. Reflective practice is considered an essential aspect for improving nursing care. DESIGN: Action and observation stages of a participatory action research project. METHODS: Data were collected through reflective diaries designed for the guided description and reflection of practice interactions related to the therapeutic relationship and content analysis was applied. A total of 152 nurses from 18 acute mental health units participated. The COREQ guidelines were used. RESULTS: The results were classified into three categories as follows: (i) Nursing attitude as a core of the therapeutic relationship. For the nurses, the attitudinal component was key in the therapeutic relationship. (ii) Nursing practices that are essential to the therapeutic relationship. Nurses identified practices such as creating a conducive environment, using an appropriate verbal approach, offering help and working together with the patient as essential for establishing a therapeutic relationship in practice. (iii) Contextual factors affecting the therapeutic relationship. The nurses considered the patient's condition, the care dynamics of the unit and its regulations, as well as the structure and environment of the unit, as contextual factors involved the establishment of an adequate therapeutic relationship in daily clinical practice. CONCLUSIONS: This study has provided knowledge of the importance and role of the nurses' attitude in the context of the nurse-patient therapeutic relationship based on the reflections of nurses in mental health units regarding their own practice. RELEVANCE TO CLINICAL PRACTICE: These findings help nurses to increase awareness and develop improvement strategies based on their own knowledge and day-to-day difficulties. Moreover, managers can evaluate strategies that promote motivation and facilitate the involvement of nurses to improve the therapeutic relationship with patients.

The therapeutic relationship at the heart of nursing care: A participatory action research in acute mental health units.

AIMS AND OBJECTIVES: To explore the process of change within the clinical practice of nurses in mental health inpatient units in the context of a participatory process to improve the nurse-patient therapeutic relationship. DESIGN: Participatory Action Research. METHODS: Ninety-six nurses from 18 mental health units participated. Data were collected through focus groups and reflective diaries between March 2018 and January 2020. Data were analysed using inductive content analysis. The COREQ guidelines were used. RESULTS: The research process was carried out through two cycles of four stages each in which the nurses were able to identify the facilitating and limiting elements of their practice in relation to the therapeutic relationship. They then proposed two consensual improvement strategies for all the units, which they called reserved therapeutic space and postincident analysis. Finally, they implemented and evaluated the two strategies for change. CONCLUSIONS: This study has shown that, despite the different cultural and structural realities of the participating units, it is possible to implement a collaborative process of change, provided the needs and expectations of both the participants and the organisations are similar. RELEVANCE TO CLINICAL PRACTICE: The results obtained through Participatory Action Research were directly transferred to clinical practice, thus having an impact on individual nurses and patients, as well as on the collective dynamics of the teams and aspects related to the management of the units. NO PATIENT OR PUBLIC CONTRIBUTION: Patient or public input is not directly applicable to this study. Patients were recipients of the changes that were occurring in the nurses as part of their daily clinical practice.

Reflections on the implementation and evaluation of a system-wide improvement programme based on the fundamentals of care: Lessons learned.

AIM: To demonstrate how implementing a system-wide measurement and improvement programme can make the delivery of the Fundamentals of Care visible in practice. DESIGN: Discussion paper. DATA SOURCES: A retrospective evaluation of the experience of implementing a system-wide peer review programme using the Promoting Action on Research Implementation in Health Services framework. IMPLICATIONS FOR NURSING: Implementing this programme engages nursing leaders at all levels in fundamental care delivery, evaluation and improvement. It positions nursing leaders as accountable for and champions of fundamental care. CONCLUSION: The peer review programme offers a solution to the complex challenge of measuring the fundamentals of care in practice. Successful implementations of this programme at two New Zealand inpatient sites have shown positive results in improved care and patient experience. This makes it worthy of consideration for other health organizations. Nursing leadership has proven to be critical to success. The Promoting Action on Research Implementation in Health Services framework highlights the components that assist with successful implementation and assists in presenting a case for change. IMPACT: This paper addressed the problem of the lack of action and dearth of quality, integrated data, visibility of the patient experience and the contribution of nursing leadership in an inpatient setting. Findings indicate that the peer review programme is translatable, modifiable and sensitive to ethnicity and disability. Using the implementation framework to evaluate the process has provided a guide for future implementations.

Situaciones de violencia por parte de pacientes percibidos por personal de enfermería en un hospital público Corrientes capital 2021 / Situations of violence by patients received by nursing personnel in a public hospital Corrientes capital 2021

Describir las situaciones de violencia por parte de los pacientes percibidas por el personal de enfermería en una institución de salud pública de Corrientes capital durante 2021. Metodología: Estudio observacional, descriptivo, transversal. Muestreo de tipo consecutivo. La población personal de enfermería asistencial de un hospital. Variables: edad, género, instrucción, antigüedad laboral, área de trabajo, turno, identifcación de maltrato físico, verbal y asedio sexual, principal modo de actuar e impacto frente a situaciones de violencia. Recolección de datos mediante cuestionario Google Forms con consentimiento informado anónimo, que fue validado por prueba piloto. Análisis con Microsof Excel y Epidat 4.1. Resultados: Población estudiada 115 trabajadores de enfermería; 69,57% mujeres; rango etario 22-56 años, promedio 35,5 años. Formación: 58,26% enfermeros, 22,61% licenciados en enfermería y 19,13% auxiliares en enfermería. Turno: 37,39% mañana, 30,43% tarde, 17,39% noche y 14,78% rotativo. Área laboral: cuidados intensivos 27,83%, clínica médica 21,74%, clínica quirúrgica 15,65%, emergencias 15,65%, consultorios 10,43%, coronaria 8,70%. De los entrevistados, 89,56% había percibido algún tipo de violencia, de estos 61,17% estaba entre 22 y 38 años. La percepción de violencia mostró que 92,53% eran enfermeros, 88,46% licenciados y 81,81% auxiliares de enfermería. Los tipos de violencia identificados fueron maltrato verbal en el 86,09%, maltrato físico en el 72,17% y asedio sexual en el 24,35%. El principal género afectado por los hechos violentos fue el femenino y el turno de trabajo con mayor identificación de situaciones violentas fue el de la mañana. En cuanto a los modos de proceder para comunicar a la institución las situaciones vividas, el 66,96% lo reportaron a un superior Los hechos de violencia según área de trabajo se reportaron por 80% de los de unidad coronaria, 84,38% de unidad de cuidados intensivos, 88,89% de emergencias, 92% de clínica médica, 94,44% de clínica quirúrgica y 100% de consultorios externos. Conclusión: La violencia hacia enfermería está presente en el hospital y afecta más a las mujeres. La forma más frecuente es la verbal, seguida de la física y del asedio sexual. En general frente a las agresiones optan por no hacer nada[AU]

To describe the situations of violence by patients perceived by the nursing staff in a public health institution in Corrientes capital during 2021. Methodology: Observational, descriptive, cross-sectional study. Consecutive type sampling. Te nursing staff population of a hospital. Variables: age, gender, education, job seniority, work area, shif, identifcation of physical, verbal and sexual abuse, main mode of action and impact in situations of violence. Data collection through Google Forms questionnaire with anonymous informed consent, which was validated by pilot test. Analysis with Microsof Excel and Epidat 4.1.Results: Population studied 115 nursing workers; 69.57% women; age range 22-56 years, average 35.5 years. Training: 58.26% nurses, 22.61% nursing graduates and 19.13% nursing assistants. Shif: 37.39% morning, 30.43% afernoon, 17.39% night and 14.78% rotating. Work area: intensive care 27.83%, medical clinic 21.74%, surgical clinic 15.65%, emergencies 15.65%, doctor's ofces 10.43%, coronary 8.70%. Of those interviewed, 89.56% had perceived some type of violence, of these 61.17% were between 22 and 38 years old. Te perception of violence showed that 92.53% were nurses, 88.46% licensed and 81.81% nursing assistants. Te types of violence identifed were verbal abuse in 86.09%, physical abuse in 72.17% and sexual harassment in 24.35%. Te main gender affected by violent acts was female, and the work shif with the highest identifcation of violent situations was the morning shif. Regarding the ways of proceeding to communicate the situations experienced to the institution, 66.96% reported it to a superior Te acts of violence according to work area were reported by 80% of those in the coronary unit, 84.38% of intensive care unit, 88.89% emergencies, 92% medical clinic, 94.44% surgical clinic and 100% outpatient clinics. Conclusion: Violence towards nursing is present in the hospital and affects women more. Te most frequent form is verbal, followed by physical and sexual harassment. In general, when faced with aggression, they choose to do nothing[AU]

Descrever as situações de violência por pacientes percebidas pela equipe de enfermagem em uma instituição pública de saúde da capital Corrientes durante o ano de 2021. Metodologia: Estudo observacional, descritivo, transversal. Amostragem do tipo consecutivo. A população da equipe de enfermagem de um hospital. Variáveis: idade, sexo, escolaridade, tempo de serviço, área de atuação, turno, identifcação de abuso físico, verbal e sexual, principal forma de atuação e impacto em situações de violência. Coleta de dados por meio de questionário Google Forms com consentimento informado anônimo, que foi validado por teste piloto. Análise com Microsof Excel e Epidat 4.1. Resultados: População estudada 115 trabalhadores de enfermagem; 69,57% mulheres; faixa etária de 22 a 56 anos, média de 35,5 anos. Formação: 58,26% enfermeiros, 22,61% graduados em enfermagem e 19,13% auxiliares de enfermagem. Turno: 37,39% matutino, 30,43% tarde, 17,39% noturno e 14,78% rotativo. Área de atuação: terapia intensiva 27,83%, clínica médica 21,74%, clínica cirúrgica 15,65%, emergências 15,65%, clínicas 10,43%, coronariana 8,70%. Dos entrevistados, 89,56% já perceberam algum tipo de violência, destes 61,17% tinham entre 22 e 38 anos. A percepção da violência mostrou que 92,53% eram enfermeiros, 88,46% licenciados e 81,81% auxiliares de enfermagem. Os tipos de violência identifcados foram abuso verbal em 86,09%, abuso físico em 72,17% e assédio sexual em 24,35%. O principal gênero acometido por atos violentos foi o feminino, e o turno de trabalho com maior identifcação de situações de violência foi o turno da manhã. Em relação às formas de proceder para comunicar as situações vivenciadas à instituição, 66,96% relataram a um superior Os atos de violência por área de trabalho foram relatados por 80% daqueles na unidade coronariana, 84,38% na unidade de terapia intensiva, 88,89% emergências, 92% clínica médica, 94,44% clínica cirúrgica e 100% ambulatório. Conclusão: A violência contra a enfermagem está presente no hospital e atinge mais as mulheres. A forma mais frequente é a verbal, seguida do assédio físico e sexual. Em geral, diante da agressão, optam por não fazer nada[AU]

Reframing nurses' time to enhance interpersonal interactions in dementia care.

Spending time with a person with dementia to develop a rapport is vitally important for nurses who are attempting to deliver high-quality care. However, finding opportunities to spend meaningful time with a person with dementia can be challenging due to the nature of busy clinical environments. Further, spending time with people may be considered a non-essential use of a nurse's time by some colleagues. These factors can result in inadequate outcomes for both the person with dementia and the nurse providing the care. This article outlines a rationale for reframing the time nurses have available to spend with people with dementia. The author explains the concepts of 'ways of being' and 'mentalising' and how these can assist nurses to provide a more authentic presence during their interactions with people with dementia.

'Owning the space'-person-centred practice in a 100% single-room acute-care environment: an ethnographic study.

AIMS AND OBJECTIVES: Exploring the influence of the 100% single-room environment on staff and patient experience of person-centred practice in an acute-care setting. BACKGROUND: Current building guidance for the NHS advocates increasing the single-room inpatient environment. There is little evidence of the impact of this design in adult acute-care settings on the experience and delivery of person-centred care. DESIGN: Ethnography, underpinned by McCormack and McCance's Person-centred Practice Framework. METHODS: Data collection took place between March and June 2018. Staff and patients in a National Health Service hospital in the United Kingdom took part in observations of practice (n = 108 hours); face to face inpatient interviews (n = 9); and participatory reflective staff groups (n = 3). A reflexive journal was kept by the researcher throughout the study. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS: Themes relating to care delivery and interactions were identified. Staff and patients' views converged around visibility and isolation. Patients appreciated the privacy afforded by the single rooms, while staff experienced a psychological shift, being viewed (and viewing themselves) as 'visitors'. There was space for more sympathetic presencing, encouraging patients to speak more openly, to facilitate knowing and authentic engagement. However, time remained an issue resulting in more task-focused care. CONCLUSION: Changes to the physical environment have an impact on the delivery and experience of person-centred practice. While the facilities enhance patient experience, the interweaving of engagement, emotional support and the development of therapeutic relationships remain challenging.

Efeito da escuta terapêutica na ansiedade de pessoas no período pré-operatório imediato / Effect of therapeutic listening on people's anxiety in the immediate preoperative period / Efecto de la escucha terapéutica sobre la ansiedad de las personas en el preoperatorio inmediato

RESUMO Objetivo: avaliar o efeito da escuta terapêutica na ansiedade de pessoas no período pré-operatório imediato. Método: pesquisa quase-experimental e de intervenção realizada com 150 pessoas em um Hospital de Minas Gerais/Brasil, de julho a outubro de 2018. Foi avaliada a ansiedade pela Escala Hospitalar de Ansiedade e Depressão e as medidas fisiológicas. Realizou-se análise estatística descritiva e inferencial e testes Qui-quadrado, Spearman e Wilcoxon. Resultados: das 31 pessoas com ansiedade, 10 tiveram redução da ansiedade e das médias das medidas fisiológicas após a intervenção. Foi verificada relação significativa entre as variáveis sexo, renda familiar mensal, complicações cirúrgicas anteriores e eventos marcantes na vida com a medida de ansiedade. Foi constatada correlação positiva fraca entre ansiedade e frequência respiratória e correlação negativa fraca entre ansiedade e faixa etária. Conclusão: ao identificar pacientes com ansiedade, intervenções como a escuta terapêutica podem ser implementadas para tornar o perioperatório mais saudável.

ABSTRACT Objective: to evaluate the effect of therapeutic listening on people's anxiety in the immediate preoperative period. Method: a quasi-experimental and intervention research study carried out from July to October 2018 with 150 people in a Hospital from Minas Gerais/Brazil. Anxiety was assessed using the Hospital Anxiety and Depression Scale and the physiological measures. Descriptive and inferential statistical analysis and Chi-square, Spearman and Wilcoxon tests were performed. Results: of the 31 people with anxiety, 20 had a reduction in the anxiety levels and in the physiological measures mean values after the intervention. A significant relationship was found between the gender, monthly family income, previous surgical complications and significant life events variables and the anxiety measure. A weak positive correlation was found between anxiety and respiratory rate and a weak negative correlation between anxiety and age group. Conclusion: when identifying patients with anxiety, interventions such as therapeutic listening can be implemented to make the perioperative period healthier.

RESUMEN Objetivo: evaluar el efecto de la escucha terapéutica sobre la ansiedad de las personas en el preoperatorio inmediato. Método: investigación cuasiexperimental y de intervención realizada con 150 personas en un Hospital de Minas Gerais, Brasil, de julio a octubre de 2018. La ansiedad fue evaluada por la Escala Hospitalaria de Ansiedad y Depresión y por medidas fisiológicas. Se realizaron análisis estadísticos descriptivos e inferenciales y pruebas de Chi-cuadrado, Spearman y Wilcoxon. Resultados: de las 31 personas con ansiedad, 20 presentaron reducción de la ansiedad y de las medias de las medidas fisiológicas después de la intervención. Se verificó que había una relación significativa entre la medida de ansiedad y las variables sexo, ingreso familiar mensual, complicaciones quirúrgicas previas y acontecimientos significativos vividos. Se observó una correlación positiva débil entre la ansiedad y la frecuencia respiratoria y una correlación negativa débil entre la ansiedad y la franja etaria. Conclusión: al identificar pacientes con ansiedad, se pueden implementar intervenciones como la escucha terapéutica para que el perioperatorio sea más saludable.

Prevalent practices amongst healthcare professionals in paediatric settings in using medical interpreters for families with limited national language proficiency: A narrative scoping review.

Background: Where language barriers exist, trained medical interpreters provide more accurate and comprehensive communication between clinicians and service users compared to ad hoc interpreters or no interpreter at all. The nature and extent of research evidence about when and how medical interpreters are used by health professionals in paediatric settings to mediate communication with families who do not speak the national language proficiently have not yet been published. Aim: To examine the potential size and scope of available research literature about the prevalent practices of healthcare professionals in using medical interpreters in paediatric settings for families with limited national spoken language proficiency. Methods: We used an established framework for scoping reviews, including suggested modifications by JBI. Precise eligibility criteria were identified, and a comprehensive search strategy was applied. Sources of evidence were confined to primary research that spoke specifically to the research question. The process of study selection and results are presented narratively and in tabular form. Two reviewers independently engaged in the screening process, and two reviewers undertook a full paper review of the included articles, with a third consulted where an additional opinion was required. Results: We included 21 studies published between 2000-2022, most using (quantitative) survey methods. Key results captured in six themes are as follows: medical interpreters tended to be underused by health professionals, especially nurses; time was the greatest impediment to their use, but so too were difficulties with the perceived quality of interpreter services; technology was used for medical interpreting at some study sites with mixed responses; use of unauthorised interpreters was widespread; language barriers impacted on the care provider and family relationship; and cost of interpreter services tended not to be reported as a barrier to their use. Conclusions: Further scholarship is needed to understand the use of medical interpreter services with reference to the complexity of health work, as well as the social context of inequality for many families with limited national language proficiency accessing paediatric healthcare. Recent developments in video technology offer promise in improving interpreter use but require oversight for quality. We have highlighted the need for better training for and regulation of medical interpreters and clinical guidelines on the use of interpreters by healthcare professionals.

NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention.

BACKGROUND: Nursing homes are likely to become increasingly important as end-of-life care facilities. Previous studies indicate that individuals residing in these facilities have a high prevalence of end-of-life symptoms and a significant need for palliative care. The aim of this study was to develop an end-of-life care program for nursing homes in Spain based on previous models yet adapted to the specific context and the needs of staff in nursing homes in the country. METHODS: A descriptive study of a complex intervention procedure was developed. The study consisted of three phases. The first phase was a prospective study assessing self-efficacy in palliative care (using the SEPC scale) and attitudes towards end-of-life care (using the FATCOD-B scale) among nursing home staff before and after the completion of a basic palliative care training program. In the second phase, objectives were selected using the Delphi consensus technique, where nursing home and primary care professionals assessed the relevance, feasibility, and level of attainment of 42 quality standards. In phase 3, interventions were selected for these objectives through two focus group sessions involving nursing home, primary care, and palliative care professionals. RESULTS: As a result of the training, an improvement in self-efficacy and attitudes towards end-of-life care was observed. In phase 2, 14 standards were selected and grouped into 5 objectives: to conduct a comprehensive assessment and develop a personalized care plan adapted to the palliative needs detected; to provide information in a clear and accessible way; to request and record advance care directives; to provide early care with respect to loss and grief; to refer patients to a specialized palliative care unit if appropriate, depending on the complexity of the palliative care required. Based on these objectives, the participants in the focus group sessions designed the 22 interventions that make up the program. CONCLUSIONS: The objectives and interventions of the NUHELP program constitute an end-of-life care program which can be implemented in nursing homes to improve the quality of end-of-life care in these facilities by modifying their clinical practice, organization, and relationship with the health system as well as serving as an example of an effective health intervention program.

The impact of a participatory intervention on the therapeutic relationship in mental health nurses: A multicentre study.

AIMS: To evaluate the effects of an intervention aimed at improving the therapeutic relationship, using the participatory-action research method, in terms of improving the quality of the nurse-patient therapeutic relationship. DESIGN: A single-group pre-post research design. METHODS: Quantitative data were collected between January 2018 and June 2019 using an online form completed by nurses from 18 mental health units (N = 95). Data were collected before and after the intervention, which consisted of the design, implementation and evaluation of strategies to improve the therapeutic relationship through participatory-action research involving nurses. The Working Alliance Inventory-Short, Interpersonal Reactivity Index, Evidence-Based Practice Questionnaire and Practice Environment Scale of the Nursing Work Index were used. The Wilcoxon rank-sum test was used together with the Spearman's correlation coefficient. Two multiple linear regressions models were constructed. RESULTS: Overall, the intervention improved the nurse-patient therapeutic relationship. In addition, the results revealed that, above all, the improvement in evidence-based practice along with a decrease in nurses' personal distress were the factors associated with the improvement of the nurse-patient therapeutic relationship. CONCLUSION: In mental health units, the therapeutic nurse-patient relationship can be improved through participatory interventions that include the implementation of evidence-based practices. IMPACT: This research examined the effects of an intervention aimed at improving the therapeutic relationship among nurses working at mental health units using participatory action research. The results show that the therapeutic relationship can be improved through participatory methods where evidence-based practice is implemented and enhanced among nurses, since a better therapeutic relationship along with reduced staff discomfort are determining factors that influence the quality of the therapeutic relationship. Institutional managers should promote participatory group interventions to enable nurses to develop evidence-based aspects of the therapeutic relationship together with expanding personal aspects and self-knowledge.

Patient experiences of alcohol specialist nurse interventions in a general hospital, and onwards care pathways.

AIMS: To provide insight into patient experiences of a general hospital-based alcohol specialist nurse intervention during alcohol detoxification, experiences of alcohol specialist nurse hospital-based follow-up appointments (Pathway A) as well as the experiences of patients who did not have access to this additional help post detoxification (Pathway B). DESIGN: A longitudinal qualitative study. METHODS: A thematic analysis of semi-structured interviews (2016-2017) with 24 patient participants (N = 12 in each pathway; purposive selection) 1-4 weeks post-detoxification and at 3 and 6 months, to identify patient experiences of these interventions. RESULTS: Participants gave accounts of how 'empathic' and 'straight talking' interactions with alcohol specialist nurses during detoxification helped them to 'open up' and orient towards change. After detoxification follow-up, outpatient appointments in the hospital setting were seen as supporting change in early recovery and engagement with a wider range of services. Those with no access to nurse follow-up described experiencing a 'void' in available help. Participants in both groups described barriers to engagement with community alcohol services, peer groups and access to help for mild-moderate mental health problems. CONCLUSION: Patient accounts indicate alcohol specialist nurse interventions during and after unplanned detoxification in a hospital setting can help orient patients towards change and support early recovery. IMPACT: Providing alcohol specialist nurse interventions in general hospitals offers one route to initiating recovery in alcohol-dependent patients. This has potential to improve the lives of those affected and to reduce related demands on hospital services, but further research is needed.

Suicide care from the nursing perspective: A meta-synthesis of qualitative studies.

AIMS: To explore nurses' experiences of suicide care and to identify and synthesize the most suitable interventions for the care of people with suicidal behaviour from a nursing perspective. DESIGN: Qualitative meta-synthesis. DATA SOURCES: Comprehensive search of five electronic databases for qualitative studies published between January 2015 and June 2019. REVIEW METHODS: The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method. RESULTS: Seventeen articles met the inclusion criteria. The data analysis revealed 13 subcategories from which four main categories emerged: 'Understanding suicidal behaviour as a consequence of suffering', 'Nurses' personal distress in suicide care', 'The presence of the nurse as the axis of suicide care' and, 'Improving nurses' relational competences for a better therapeutic environment'. CONCLUSION: Further training of nurses on the therapeutic relationship, particularly in non-mental health care work settings, and monitoring of the emotional impact on nurses in relation to suicide is required to promote more effective prevention and care. IMPACT: This review provides new insights on how suicide is interpreted, the associated emotions, the way suicide is approached and proposals for improving clinical practice from the point of view of nurses. The results demonstrate that the nurse-patient relationship, ongoing assessment, and the promotion of a sense of security and hope are critical in nursing care for patients who exhibit suicidal behaviour. Consequently, to promote an effective nursing care of suicide, nurses should be provided with further training on the therapeutic relationship. Thus, health institutions do not only provide the time and space to conduct an adequate therapeutic relationship, but also, through their managers, they should supervise and address the emotional impact that is generated in nurses caring for patients who exhibit suicidal behaviour.