Health care professionals' experiences of pain management in the intensive care unit: a qualitative study.

Despite the existence of evidence-based guidelines for the assessment and management of pain in the critical care setting, the prevalence of acute pain remains high. Inadequate pain management is associated with longer duration of mechanical ventilation, reduced capacity for rehabilitation and long-term psychological sequelae. This study aimed to describe the experiences of pain management from healthcare professionals working in intensive care units. Healthcare professionals were recruited from intensive care units in London, UK using a purposive sampling technique. Semi-structured interviews were transcribed verbatim. Transcripts were analysed using an inductive thematic analysis technique. Thirty participants were recruited from eight diverse intensive care units. Five themes were identified. First, there was a lack of consensus in pain assessment in the ICU where nursing staff described more knowledge and confidence of validated pain measures than physicians, and concerns over validity and usability were raised. Second, there was a universal perception of resource availability impacting the quality of pain management including high clinical workload, staff turnover and availability of certain pain management techniques. Third, acknowledgement of the importance of pain management was highest in those with experience of interacting with critical care survivors. Fourth, participants described their own emotional reaction to managing those in pain which influenced their learning. Finally, there was a perception that, due to the complexity of the intensive care unit population, pain was de-prioritised and there were conflicting views as to whether standardised analgosedation algorithms were useful. This study provides evidence to suggest interdisciplinary training, collaboratively designed decision-making tools, prioritisation initiatives and research priorities are areas that could be targeted to improve pain management in critical care.

Counternarratives that illuminate faculty agency: A five-year longitudinal qualitative study of physician educators in academic medicine.

PURPOSE: Physician educators are often expected to direct educational programs and assume roles that conform to field norms for career advancement but that may not afford meaningful work for educators. The purpose of this study was to describe and analyse the perspectives and actions taken by physician educators in response to tension between feeling compelled to direct an educational program and doing educationally meaningful work. METHODS AND MATERIALS: We used data from a longitudinal study and focused on three participants who, over the course of the five-year study, offered significant insights into how physician educators act in ways that run counter to expectations for career advancement. Our narrative analysis entailed organizing data from interview transcripts into time-ordered displays, weaving data into counternarratives that were edited by participants, and using the theory of faculty agency (and its key constructs, strategic perspectives and strategic action) to thread the stories together. RESULTS: In each counternarrative, the participant deliberated their sense of being a physician educator (strategic perspectives) and when expectations became untenable, they did what they needed to do to engage in meaningful work (strategic action) rather than comply with expectations for career advancement in academic medicine. For one participant, faculty agency meant leaving academic medicine; for another, it meant reducing clinical time so that unpaid time could be devoted to education; and for another, it meant opting not do direct a reputable education program. CONCLUSIONS: Faculty agency is a useful theoretical lens for conceptualizing how physician educators navigate their careers in academic medicine. Counternarratives that illuminate faculty agency offer stories that describe alternate career paths and portend a different future for physician educators.

Health promotion roles shaped by professional identity: an ethnographic study in the Netherlands.

How frontline care professionals interpret and fulfill their health promotion roles is of great importance for the health of the vulnerable clients they work with. While the literature on health promotion is limited to describing the roles of healthcare professionals, this study examines the health promotion roles held by various frontline professionals when working with clients with combined psychosocial problems and how this is associated with professional identity. Based on ethnographic data from Dutch frontline professionals in social welfare, general healthcare and mental healthcare, this article shows how various frontline professionals promote health by reframing and customizing health problems and that this is associated with how they identify as pragmatic or holistic professionals.

Academic nurses' transition across an academic career: A qualitative study.

AIM: The aim of this study was to gain a deeper understanding of nurse academics' experiences with the transition from clinical practice to academia and throughout their whole career trajectory. DESIGN: Qualitative study design. METHODS: Three focus group interviews with 17 nurse academics employed at a University in Norway were conducted in May and June 2020. Data were analysed using qualitative content analysis. RESULTS: Nurse academics experienced several diverse career transitions that continued throughout their whole career trajectory, affecting their daily life. Three interconnected themes were identified: 'clinically confident, yet academically uncertain', 'balancing the academic role' and 'lost in academic transition'. CONCLUSION: This study contributes to a deeper understanding of nurse academics' experiences of transitioning into their academic role and identity. Transition was found not as separate occurrences but was described as several ongoing and concurrent processes throughout their whole career trajectory regardless of seniority level or academic experience. These transitions encompass shifts in identity, new responsibilities and increased tasks, yet often occur without adequate support. As a result, nurse academics may lack the essential skills and knowledge of the academic role. IMPACT: This study provides insights into nurse academics' transition from clinical practice to academia and throughout their whole career trajectory. This is not a one-time occurrence but a continuous process that takes place throughout their entire career trajectory. This transition is embedded within a complex environment that requires careful consideration and attention. To address challenges regarding career transitions for nurse academics, universities should provide more training and preparation opportunities for all nurse academics when facing different career transitions. REPORTING METHOD: Consolidated Criteria for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Challenges experienced by cardiac intensive care nurses during first out-of-bed patient mobilization after open-heart surgery: A descriptive phenomenological qualitative study.

AIM: To investigate the potential challenges experienced by cardiac intensive care unit (ICU) nurses in the first out-of-bed patient mobilization after open-heart surgery and propose solutions. DESIGN: A qualitative study design using the descriptive phenomenological approach. METHODS: Individual face-to-face interviews were conducted via a widely used videoconferencing program between 28 July and 22 October 2022, in the tertiary cardiac ICU of a university hospital. Nurses who had at least 1 year of cardiac ICU experience and actively participating in patient care were included. The COREQ criteria and checklist were followed in this investigation and the data were analysed by using the ATLAS.ti 8.0. FINDINGS: Nurses reported that they experience challenges when mobilizing patients, such as patients' fear, reluctance or resistance; nurses having insufficient experience, strength or lack of team members. Despite these challenges, they highlighted some positive outcomes of mobilization, such as feeling happy, reinforced team communication and nurse-patient relationship. The nurses also suggested some facilitators, such as patient motivation and an explanation of the process. CONCLUSION: Nurses experience various patient-related and nurse-related challenges during the first out-of-bed mobilization of the patient after open-heart surgery. It is recommended that healthcare institutions should implement effective strategies to address the staffing shortages and to support nurse motivation to ensure adequate nursing care. IMPACT: This study provides valuable insights into the existing literature by examining the potential challenges and strategies of the first out-of-bed patient mobilization in the cardiac ICU. It shows that patient education and organizational adaptations are effective ways to overcome the challenges. It also suggests that motivating and informing patients before the mobilization can make the process easier. Moreover, it reveals that successful patient mobilization makes nurses happy, improves team communication and strengthens nurse-patient relationship. PATIENT AND PUBLIC INVOLVEMENT AND ENGAGEMENT: No patient or public contribution.

Assessing women's and health professionals' views on developing a midwifery-led mobile health app intervention in pregnancy: A descriptive qualitative study.

AIMS: To explore women's and health professionals' views on the development of a midwifery-led mHealth app intervention in antenatal care and their demands for app functionality. DESIGN: Descriptive qualitative research was utilized. METHODS: In total, 15 pregnant or postpartum women were interviewed via in-depth interviews and 10 health professionals including obstetricians, midwives and obstetric nurses were invited to participate in a focus group discussion (FGD). All interviews and the FGD were analysed using qualitative content analysis. RESULTS: Four key themes emerged from the data, including (1) limitations of current maternity care services; (2) potential benefits for mHealth app-based midwifery care; (3) possible challenges for providing midwifery care through mHealth apps and (4) suggestions and needs for developing a midwifery-led mHealth app. Participants agreed on the potential need of developing a midwifery-led mHealth app in antenatal care to increase access to midwifery care services and to meet women's diverse needs. Participants preferred to develop professional, reliable, full-featured and interactive mobile applications. The main functions of midwifery-led mHealth apps included personalized assessment and health education, self-monitoring and feedback, data sharing and interactive functions. Women mentioned that online communication and consultation with midwives could help them receive continuous support outside facilities. Health professionals expressed it would be of great convenience and timeliness to send personalized messages to women and to inform them of healthy lifestyles during pregnancy. The challenges included a shortage of human resources, medico-legal risks associated with mHealth and data security risks. CONCLUSIONS: This study explores the individual views and functional needs of target users and healthcare providers for developing a midwifery-led mHealth app in antenatal care, which will serve as a reference for future application development. IMPACT: Our study has important and practical implications for guiding the development of future midwifery-led mHealth app interventions. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

A meta-synthesis of the experience of paediatric nurses in communication with children.

AIM: This study aimed to conduct a meta-synthesis to explore the experiences of paediatric nurses in communication with children. METHOD: We conducted a meta-synthesis review, following the outline proposed by Sandelowski, Barrosso & Voils. Our search encompassed six electronic databases, namely PubMed, Scopus, EBSCO (MEDLINE), Web of Science, SAGE, and Wiley. The Primary keywords used were "nurse", "child", "communication", and "qualitative". We included qualitative articles in English within the field of paediatric nursing between 1990 and 2023. Initially, 1980 records were identified which reduced to 1339 references after removing duplicates. Subsequently, we assessed 112 full-text articles for eligibility and 14 relevant studies were ultimately included in our review. Quality appraisal was conducted using the Critical Appraisal Skill Programme checklist with no study being excluded based on quality criteria. Data were synthesized using the qualitative thematic analysis method. RESULTS: The data analysis yielded three themes and seven sub-themes. These themes include swinging between triadic and dyadic communication, applying a hybrid of communication methods, and influential factor in communication. CONCLUSIONS: This study highlighted the significance of establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse-parent-child) in paediatric care. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Additionally, identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments. IMPLICATIONS: Understanding the communication process and the factors that influence it can be instrumental in equipping paediatric nurses with enhanced communication skills in their practice. IMPACT: Establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse-parent-child) in paediatric care is crucial. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments.

Nurses' experiences of moral distress and how it affects daily work in surgical care-a qualitative study.

AIM: To describe nurses' and specialist nurses' experiences of moral distress and how it affects daily work in surgical care. DESIGN: A qualitative descriptive study design was used. METHODS: A qualitative study with 12 interviews with nurses and specialist nurses working in surgical care. All interviews were conducted during October and November 2022 in two hospitals in southeastern Sweden. Data were analysed using conventional qualitative content analysis. FINDINGS: Three categories and seven subcategories generated from the data analysis. The three categories generated from the analysis were Experiences that lead to moral distress, Perceived consequences of moral distress and Strategies in case of moral distress. The results show that a lack of personnel in combination with people with complex surgical needs is the main source of moral distress. Both high demands on nurses as individuals and the teamwork are factors that generate moral distress and can have severe consequences for the safety of patients, individual nurses and future care. CONCLUSIONS: The results show that moral distress is a problem for today's nurses and specialist nurses in surgical care. Action is necessary to prevent nurses from leaving surgical care. Prioritizing tasks is perceived as challenging for the profession, and moral distress can pose a patient safety risk. IMPACT: Surgical care departments should design support structures for nurses, give nurses an authentic voice to express ethical concerns and allow them to practice surgical nursing in a way that does not violate their core professional values. Healthcare organizations should take this seriously and work strategically to make the nursing profession more attractive. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution.

Safety culture in maternity hospital: Perception of nurse-midwives.

AIM: To explore nurse-midwives' perceptions of safety culture in maternity hospitals. DESIGN: A descriptive phenomenological study was conducted using focus groups and reported following the Consolidated Criteria for Reporting Qualitative Research. METHODS: Data were obtained through two online focus group sessions in June 2022 with 13 nurse-midwives from two maternity hospitals in the central region of Portugal. The first focus group comprised 6 nurse-midwives, and the second comprised 7 nurse-midwives. Qualitative data were analysed using content analysis. FINDINGS: Two main themes emerged from the data: (i) barriers to promoting a safety culture; (ii) safety culture promotion strategies. The first theme is supported by four categories: ineffective communication, unproductive management, instability in teams and the problem of errors in care delivery. The second theme is supported by two categories: managers' commitment to safety and the promotion of effective communication. CONCLUSION: The study results show that the safety culture in maternity hospitals is compromised by ineffective communication, team instability, insufficient allocation of nurse-midwives, a prevailing punitive culture and underreporting of adverse events. These highlight the need for managers to commit to providing better working conditions, encourage training with the development of a fairer safety culture and encourage reporting and learning from mistakes. There is also a need to invest in team leaders who allow better conflict management and optimization of communication skills is essential. IMPACT: Disseminating these results will provide relevance to the safety culture problem, allowing greater awareness of nurse-midwives and managers about vulnerable areas, and lead to the implementation of effective changes for safe maternal and neonatal care. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution as the study only concerned service providers, that is, nurse-midwives themselves.

Self-determination in older patients: Experiences from nurse-dominated ambulance services.

AIM: To describe ambulance clinicians' experiences of self-determination in older patients. DESIGN: The study had an inductive and explorative design, guided from a life-world perspective. METHODS: Thirty-two Swedish ambulance clinicians were interviewed in six focus groups in November 2019. The data were analysed with content analysis, developing manifest categories and latent themes. FINDINGS: The ambulance clinicians assessed the older patients' exercise of self-determination by engaging in conversation and by being visually alert, to eventually gain an overall picture of their decision-making capacity. This assessment was used as a platform when informing older patients of their rights, thus promoting their participation in care. Having limited time and narrow guidelines counteracted ambulance clinicians' ambitions to support older patients' general desire to avoid hospitalization, which resulted in an urge to displace their responsibility to external decision-makers. CONCLUSION: Expectations that older patients with impaired decision-making ability will give homogeneous responses mean an increased risk of ageist attitudes with a simplified view of patient autonomy. Such attitudes risk the withholding of information about options that healthcare professionals do not wish older patients to choose. When decision-making is difficult, requests for expanded guidelines may paradoxically risk alienation from the professional nursing role. IMPLICATIONS AND IMPACT: The findings show ambulance clinicians' unwillingness to shoulder their professional responsibility when encountering older patients with impaired decision-making ability. In assuming that all older patients reason in the same way, ambulance clinicians tend to adopt a simplistic and somewhat ageist approach when it comes to patient autonomy. This points to deficiencies in ethical competence, which is why increased ethics support is deemed suitable to promote and develop ethical competence. Such support can increase the ability to act as autonomous professionals in accordance with professional ethical codes. REPORTING METHOD: This study adhered to COREQ guidelines. PATIENT AND PUBLIC CONTRIBUTION: None.

Increasing incidence of endometrial cancer in Aotearoa New Zealand: Health professionals' perspective.

BACKGROUND: The incidence of endometrial cancer is globally increasing. Aotearoa New Zealand is no exception with a 59% increase in cases over that last ten years. AIMS: We report a sub-set of themes which pertain to provider reflections of rising endometrioid-type endometrial cancer incidence in individuals with high weight. MATERIALS AND METHODS: Fifteen semi-structured interviews with healthcare professionals experienced in providing care to women with endometrial cancer were audio-recorded and transcribed. Interviews were analysed using reflexive thematic analysis. RESULTS: Two main themes emerged: (1) concerns for the future; and (2) impact on fertility and treatment options. Healthcare professionals discussed rising incidence in younger people and a need for increased awareness about the association of excess weight as a risk factor for developing the disease. The concern extended to workforce and equipment shortfalls of meeting the needs of individuals with higher weight, which subsequently influenced treatment options, health outcomes and survivorship. CONCLUSIONS: Rising incidence of endometrial cancer in individuals with high weight presents multiple chances for inequitable access and health outcomes over the care continuum for endometrial cancer. Action is required to address incidence, awareness, access to equitable and inclusive treatment, and survivorship.

A qualitative exploration of the use of telehealth for opioid treatment: Implications for nurse-managed care.

AIM: To characterise experiences with telehealth for Medications for Opioid Use Disorder (MOUD) services among patients, prescribers, nurses and substance use counsellors to inform future best practices. DESIGN: We engaged a qualitative descriptive study design. METHODS: Semi-structured interviews were conducted with prescribers (nurse practitioners and physicians, n = 20), nurses and substance use counsellors (n = 7), and patients (n = 20) between June and September 2021. Interviews were verbatim transcribed. Thematic analysis was conducted using a qualitative descriptive method. RESULTS: Among both providers and patients, four themes were identified: (1) Difficulties with telehealth connection (2) Flexibility in follow-up and retention, (3) Policy changes that enabled expanded care, (4) Path forward with telehealth. Two additional findings emerged from provider interviews: (1) Expansion of nurse-managed office-based opioid treatment, and (2) Novel methods to engage patients. CONCLUSIONS: Patients and providers continued to view telehealth as an acceptable means for delivery and management of MOUD, particularly when utilised in a hybrid manner between in-person visits. Nurse-managed care for this service was evident as nurses extended the breadth of services offered and utilised novel methods such as text messages and management of 'call-in' lines to engage patients. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Use of telehealth for MOUD should be incorporated into practice settings to reach patients in a flexible manner. Nurses in particular can use this medium to extend office-based opioid treatment by conducting assessments and expanding capacity for other wrap-around services. IMPACT: We identify recommendations for best practices in the use of telehealth for opioid use disorder management and highlight the value of nurse-managed care. REPORTING METHOD: The consolidated criteria for reporting qualitative research. PATIENT OR PUBLIC CONTRIBUTION: Patients with opioid use disorder and prescribers with experience using telehealth were interviewed for this study.

"I'll fill in the gaps": perspectives of HHAs on promoting aging in place for older adults with low incomes.

Older adults with low incomes experience disproportionate rates of cognitive and functional impairment and an elevated risk of nursing home admission. Home health aides (HHAs) may have insight into how to optimize aging in place for this population, yet little is known about HHAs' perspectives on this topic. We conducted 6 focus groups with 21 English-speaking and 10 Spanish-speaking HHAs in Pennsylvania and New Jersey. Transcripts were analyzed using qualitative thematic analysis, and three themes emerged. First, HHAs described the uniqueness of their role within multidisciplinary care teams. Second, HHAs shared concrete interventions they employ to help their clients improve their function at home. Third, HHAs discussed barriers they face when helping clients age in place. Our findings suggest that HHAs have important insights into improving aging in place for older adults with low incomes and that their perspectives should be incorporated into care planning and intervention delivery.

Expert school nurses' experiences of reopening schools during the COVID-19 pandemic: A qualitative study.

BACKGROUND: There is limited information about expert school nurses' experiences regarding the reopening of schools in the school setting during the COVID-19 pandemic. PURPOSE: This study aimed to explore the views and experiences of reopening schools among expert school nurses during the COVID-19 pandemic. METHODS: We conducted semi-structured interviews with five focus groups of 24 school nurses. A grounded theory methodology was used to analyze emergent concepts, categories, and themes. DISCUSSION: We identified five themes related to the experiences of expert school nurses during the COVID-19 pandemic: unprepared response system, fighting alone, centering the response system, redefining roles, and together against. CONCLUSION: Despite the high workload of school nurses during the COVID-19 pandemic, the expert school nurses led to clarification and expansion of the role of the school nurse role, and highlighted the relationships among school staff who were essential participants of the school health team during the pandemic. PRACTICE IMPLICATIONS: It is imperative to shift the perception that school nurses are health professionals who play key managerial roles with collaboration within and beyond the school.

'We aren't valued for who we are': Australian nurses' and midwives' perceptions of challenges and barriers to safeguarding children.

PURPOSE: Professionals working with children, including nurses and midwives, are foundational to effectively safeguarding children from maltreatment. However, little is known about the full nature and scope of nurses' and midwives' roles in safeguarding children in Australia presenting barriers to effective workforce preparation and support. DESIGN AND METHODS: This study reports an inductive analysis of qualitative responses (n = 51 Round 1, n = 17 Round 2) from a two-round Delphi study. The Delphi study aimed to build consensus on the nature and scope of nursing and midwifery practice in safeguarding children, and this manuscript presents findings of an inductive analysis of qualitative responses beyond the scope of the Delphi study. Participants were Australian nurses and midwives (n = 51, n = 17) from diverse child-focussed settings. RESULTS: Nurses and midwives experienced many factors outside of their control that restricted their capacity to safeguard children. Influences included high workloads, burnout, lack of support, poor collaboration, structural barriers and inaccessible services for children. CONCLUSIONS: Nurses and midwives are advocates for children but experienced many factors preventing them from effectively safeguarding children. Future approaches to reducing child maltreatment must be underpinned by support for frontline professionals to promote workforce capacity and sustainability. PRACTICE IMPLICATIONS: Despite nurses' and midwives' best intentions, their attempts to prevent and respond to child maltreatment were hampered by systemic factors beyond their control. This study highlighted the need to address broader influences on nursing and midwifery practice to reduce the impacts of child maltreatment and support children to thrive.

The perception of healthcare professionals, through their own personal experiences, of the use of music therapy in hospitalised children and adolescents.

BACKGROUND: Music therapy is an emerging and useful methodology for improving patient environments within healthcare fields. However, although it has been shown that music therapy interventions with hospitalised children and adolescents have been used for decades with positive effects, there are currently very few studies that specifically describe the perspectives of healthcare professionals regarding the value of music therapy when applied in these patients. OBJECTIVES: To describe the insights of healthcare professionals regarding music therapy, both on a personal level and in terms of its usefulness in the care of hospitalised children and adolescents. DESIGN: This was a qualitative descriptive-exploratory study with focus groups. PARTICIPANTS: Eighteen healthcare professionals. METHODS: In January 2023, two focus groups, containing nine healthcare professionals each, were created to collect data regarding their experiences concerning the effect of music therapy on hospitalised children and adolescents. Before recording their opinions, all these professionals participated in an interactive music therapy session. The thematic analysis in this work was performed using MAXQDA® software. RESULTS: Two main categories emerged: (a) the effects of music therapy on healthcare professionals, and (b) the benefits of music therapy to patients (children and adolescents). CONCLUSIONS: Music therapy was valued positively by healthcare professionals who described the benefits its use has for hospitalised children and adolescents. They also expressed positive viewpoints regarding the use of music therapy to improve their own self-knowledge and self-care. IMPLICATIONS TO PRACTICE: Healthcare professionals may utilise music therapists to improve patient outcomes and reduce the negative effects of hospitalisation.

"Working in the emergency department is not a job; it's like a war" A narrative inquiry and interpretive phenomenology of the violence experienced by emergency nurses in Turkey.

AIMS: This study aims to reveal the violent experiences of nurses working in the emergency department and the meanings they attribute to them. METHODS: This research was conducted as narrative inquiry and interpretive phenomenology and recruited 15 nurses. Interviews with nurses actively working in the emergency department and who had been exposed to violence by patients or their relatives were conducted with a semi-structured interview form. The consolidated criteria for reporting qualitative research (COREQ) checklist was used. RESULTS: In the study, three themes were determined (1) Unpredictable event, (2) Interminable effects of violence, and (3) Like a bottomless pit. With seven sub-themes. CONCLUSIONS: This study underlined that violence applied to nurses by patients or relatives of patients in the emergency department is an unexpected situation that causes negative emotions. Violence affects all aspects of life and limits communication with the patient. Coping with a violent situation is challenging for nurses, and they demand support from the management.

Alone yet accountable, the unseen buffers: A qualitative study of nurses' experiences working in home care during the COVID-19 pandemic.

BACKGROUND: Norwegian society's resilience during the COVID-19 pandemic resulted in low mortality rates and moderate economic decline. The accessible primary healthcare system played a vital role in this, especially in the care of elderly and chronically ill patients. However, nurses in home care experienced emotional burdens, ethical dilemmas and limited access to protective equipment. These challenges were overshadowed by media coverage of hospital struggles, and municipal home care services were oddly absent from post-pandemic reports. This research therefore aimed to explore and describe how nurses experienced working in home care during the pandemic. METHODS: We designed a qualitative study and conducted semi-structured interviews with nine home care nurses from different municipalities in Southeast Norway. Systematic text condensation inspired by Malterud was employed for data analysis. RESULTS: Nurses' experiences were described through two categories: 'adapting approaches' and 'adapting work practices'. The results showed how nurses often felt alone while simultaneously shouldering a significant responsibility for patients facing a novel and unfamiliar illness. The pandemic necessitated treating patients in their own homes to minimise infection risks, intensifying the nurses' treatment responsibilities. Furthermore, limited access to medical expertise and physical separation from management due to remote work accentuated feelings of isolation and amplified the nurses' responsibility for patient care. Additionally, the nurses encountered frequent changes in work routines, demanding adaptability. CONCLUSION: This study underscores the significant role of home care nurses, who, despite feeling professionally isolated and unsupported, demonstrated impressive adaptability. They served as a crucial buffer in the healthcare system, ensuring vulnerable individuals received essential care. This highlights the importance of a robust primary healthcare system with a skilled nursing workforce that can work autonomously, shoulder responsibility, and make clinical decisions, even when medical expertise is less readily available. It also reminds us that healthcare preparedness depends on collaborative efforts across all sectors.

Navigating healthcare systems: A qualitative study on socially marginalised patients' experiences of hospital transition and support by social nurses.

BACKGROUND: Socially marginalised patients face many challenges related to their health condition and often have several contacts with healthcare and social service workers. The Danish social nursing initiative, whose nurses have experience and knowledge about marginalisation, aims to support socially marginalised patients during hospital admission and through hospital transitions. However, there is limited knowledge about the hospital transitions of patients being supported by a social nurse. OBJECTIVES: The objectives of this study were to explore (1) the perspectives of socially marginalised patients on the transition from hospital to home and (2) how these patients experience the importance of social nursing on patient trajectories after hospital discharge. METHODS: A qualitative study with a phenomenological and hermeneutic approach was performed at a large hospital in southern Denmark. Adult patients who had contact with a social nurse during hospital admission were purposely sampled. Data were collected between January 2023 and March 2023. Initial patient interviews were conducted during hospital admission with a second interview 7-22 days after discharge. Systematic text condensation was used for the analysis, and Nvivo 12 supported data storage and coding. ETHICAL APPROVAL: The study is registered with the Danish Data Protection Agency (22/47509). Informed consent was given by the participants. RESULTS: Sixteen patients participated in the study. The participants experienced major challenges in their transitions from the hospital, which were generally related to their interactions with many different social and healthcare services. While the social nurses supported the patients and helped facilitate care during hospital admission and after discharge, the participants identified transitional care gaps related to multidisciplinary cooperation and standardised care options. CONCLUSIONS: This study identifies challenges related to the hospital transition of socially marginalised patients, which indicates a gap in healthcare services. Future research should focus on improving interprofessional collaboration with socially marginalised patients across healthcare services.

A concept of "cultural competence" among public health nurses in Japan.

OBJECTIVES: To clarify the conceptual structure of "cultural competence (CC)" among Japanese public health nurses (PHNs), to enhance culturally appropriate support. METHODS: A modified grounded theory approach (M-GTA) was used. A total of 11 municipal PHNs participated in this study. Data were collected through semistructured interviews. Interviews were audiotaped and transcribed. A comparative analysis was performed using M-GTA. RESULT: Five categories were identified. Japanese PHNs supported foreign residents while (1) maintaining a sincere attitude with curiosity and humility toward others regarding CC; (2) deepening their realization of issues arising from awareness of one's own and other cultures; (3) developing their knowledge about clients' cultures and the surrounding environments; and (4) mastering the skills of building a relationship with clients while creating supportive systems surrounding them. As they gained more experience in supporting foreign residents, as indicated in the above categories, their cultural competence grew, allowing them to (5) gain experience while encountering individuals without holding stereotypes and prejudice. CONCLUSIONS: The concepts of CC that emerged are based on cultural humility and are cultivated through supportive activities. The concepts identified in this study can serve as educational guidelines for health nurses and other care providers in Japan.