Perspectives and experiences of community-dwelling older adults who experience falling: A qualitative meta-synthesis.

Objectives: This study aimed to systematically review and synthesize the perspectives and experiences of community-dwelling older adults who experience falling, to inform the subsequent development of fall prevention and management interventions, and to provide recommendations for healthcare policy and practice. Methods: The review was a qualitative meta-aggregation study following the JBI qualitative systematic review methodology. Databases searched included Medline (through PubMed), CINAHL, PsycINFO, Embase, and the Web of Science. Peer-reviewed articles published in the English language from January 2010 to May 2023 were retrieved. The JBI Qualitative Assessment and Review Instrument (JBI-QARI) was used to assess the quality of the methodology. The ConQual ranking system was used to establish confidence in the synthesized findings. The protocol was registered with PROSPERO (CRD 42023421789). Results: This review included ten qualitative studies with an overall quality score of 60%-90%. Data extracted from eligible studies resulted in 59 findings, which were then aggregated into seven categories based on the similarity in meaning. Three synthesized findings were generated and rated as moderate for synthesized finding 2 and low for synthesized finding 1 and 3 on the ConQual score. Synthesized finding 1: Older adults experience physical injuries and pain, restricted daily activities, and limitations in social activities, reduction or loss of in independence, and have feelings of fear and helplessness. Synthesized finding 2: After experiencing a fall, older adults reflect on the cause of the fall and recognize and interpret the risk factors. Synthesized finding 3: Older adults' reflections on the causes and impact of falls reveal both positive and negative reactions. They perceive a number of strategies for coping with falls and their consequences, such as using assistive devices, correcting risk factors, seeking medical help, and receiving ongoing physical and psychological attention. Conclusions: Healthcare providers should pay attention to the feelings and experiences of older adults after falling, as well as their reflection on the causes and impacts of falling, and develop tailored plans for intervention. There is also a need for longitudinal studies to examine the longer-term impact of falls on older adults to provide insights into the stability and changes in their reflections, perceptions, attitudes, and preventive behaviors over time.

Understanding the pregnant women's experiences during the COVID-19 pandemic in Macao: A qualitative study.

Objective: To explore and interpret the experiences of pregnant women in Macao during the COVID-19 pandemic. Methods: Recruitment advertisements were published through multiple social platforms in Macao. A purposive snowball sampling method was adopted to select interviewees. Eighteen women who were confirmed as pregnant from January to May 2020 participated in this qualitative study. Data was collected from November to December 2020 using in-depth personal interviews. One-to-one interviews were conducted by telephone to avoid personal contact. Thematic analysis was used to perform the data analysis and identify emergent themes. Results: Five themes emerged from the data analysis: changes in daily life, psychological distress, unique experiences of pregnancy follow-up, trying to pay attention to health information but also feeling overwhelmed, and change in hygiene behaviors due to fear of infection. Six sub-themes were identified: being confined at home but understanding the reasons, financial pressures and timely support from the government, perceived risk of catching the infection, retaining optimism with various help and support, adequate personal protections, and obsessive hygiene behaviors. Conclusion: During a pandemic, there is a risk of greater individual isolation, particularly for vulnerable groups such as women in pregnancy. The humanized attention to and support for the residents from the government buffered the adverse impact on the study participants. Preplanning for such events is needed to focus on psychological distress, financial constraints, and prenatal health services. Alternative service delivery, such as telemedicine, online counseling, and virtual reality (VR) technology, should be applied to offer pregnant women timely support and avoid a crisis.

Achieving culturally competent mental health care: A mixed-methods study drawing on the perspectives of UK nursing students.

PURPOSE: This study aimed to examine the degree of cross-cultural competency among UK mental health student nurses, and the care delivery challenges arising from their internalized cultural assumptions. DESIGN AND METHODS: This study adopted a mixed-methods design. Participants were final-year nursing students in the United Kingdom. FINDINGS: The results revealed participants had a moderate level of cultural awareness and competency but highlighted many challenges to providing cross-cultural care arising from the meanings, enablers, and values they attributed to culturally competent mental health care. PRACTICE IMPLICATIONS: As cultural competency is considered an essential characteristic of effective nursing care, greater attention should be paid to how student nurses assimilate cultural awareness to develop confidence in their day-to-day practice.

Analysis of adversity quotient of nursing students in Macao: A cross-section and correlation study.

OBJECTIVES: To investigate the adversity quotient (AQ) of Macao undergraduate nursing students and analyse its influencing factors. METHODS: A cross-section design was used, and a convenience sample of nursing students (n = 158 valid) was selected from a tertiary institute in Macao. In addition to demographic questions, the Chinese versions of the Adversity Quotient Scale, the Emotional Intelligence (EI) Scale, the Simplified Coping Style Questionnaire and the Parenting Styles Scale were used to assess the students' characteristics. RESULTS: The average AQ score of the students was 116.72 ± 11.39. AQ scores were negatively correlated with coping-negative, and maternal style (excessive interference, excessive protection) (r = -0.332, P < 0.001; r = -0.167, P = 0.036). Coping-negative entered the regression equation (F = 19.154, P < 0.001). The female nursing students had higher scores in ownership dimension of AQ than their male counterparts (31.98 ± 3.26 vs. 29.21 ± 3.08, t = -4.442, P < 0.001). CONCLUSIONS: The average AQ scores of Macao undergraduate nursing students were moderate. The female nursing students are more likely to attribute the cause of adversity to themselves, and specific psychosocial and cultural issues may be at play. There is a necessity for Macao nursing students to improve their ability to overcome setbacks. Special attention should be paid to the cultivation of students' positive coping styles.

Experience of Workplace Violence Toward Nursing Students in Iran: A Qualitative Study.

BACKGROUND AND AIMS: This study explored the dimensions of violence experienced by Iranian nursing students, during their nursing education. Violence toward students has become a major concern in recent years, and strategies are needed to reduce the incidence. METHODS: A qualitative study was conducted. Participants were seven male and nine female third-year undergraduate nursing students. Purposive sampling was used, and qualitative data from semistructured interviews were analyzed using thematic content analysis. RESULTS: From the qualitative data, five categories emerged: instances of violence, causes of violence, emotions after experiencing violence, reactions after violence, and violence prevention strategies. CONCLUSION: To reduce the incidence of violence and provide safer learning environments, nursing students need to be taught preventive measures, but moreover, they need to receive appropriate support from nurses, instructors, and educational managers, Forensic nurses should be active stakeholders in monitoring, supporting, and referring nursing students who experience workplace violence.

Redefining the role of the nurse academic in practice: A pilot study.

Worldwide, health services are interested in supporting the speedy adoption of research findings into practice. To promote the translation of research into practice, a university in the South of England along with a partner NHS Trust piloted a new role - Translation Fellow (TF). This article describes and analyses the experience of implementing this role. It outlines the successes achieved as a result of this partnership between a university and a healthcare organisation as well as describing the challenges involved in establishing such a role. The successes included submitting a joint abstract to a conference; collaboratively developing articles for publication; organizing a visit overseas to compare similar services; co-designing a database to assist in collecting data for service planning and research, and setting up a 'one click access' web space populated with evidence informed material to support the work of the clinical staff. The pilot acted as a proof of concept in which the TF role demonstrated its potential. Additional roles are already being established in other services in the locality and the role merits wider discussion and testing nationally.

A PRISMA-Driven Systematic Review for Determining Cross-Cultural Mental Health Care.

PURPOSE: The study aimed to determine how culture can affect mental healthcare delivery in order to make recommendations for improving care pathways supported by culturally competent care. METHODS: Three international databases were systematically and independently searched by two researchers. FINDINGS: The results were grouped under three themes-quality of cross-cultural mental health care, expectations of people receiving cross-cultural mental health care, and perspectives of healthcare providers on cross-cultural mental health care. CONCLUSIONS: The study indicates how important it is for nurses to understand the complex interplay between culture and mental health and to develop cultural awareness and sensitivity. PRACTICE IMPLICATIONS: The study seeks to identify best practice and make recommendations for enhancing positive attitudes toward the cultural needs of people with mental health problems.

Achieving culturally competent cancer care: A qualitative study drawing on the perspectives of cancer survivors and oncology nurses.

PURPOSE: The aim of this study was to understand how cancer survivors and nurses define and experience cultural care and to make recommendations toward improvements in nursing practice. METHODS: The study used a descriptive qualitative design. Data were collected from 29 cancer survivors and 23 oncology nurses by using in-depth semi-structured interviews. Data were transcribed and themes identified. RESULTS: Three themes emerged from the data; 1) cross-cultural care expectations, 2) reality of cross-cultural care activities, and 3) improving culturally sensitive care. CONCLUSIONS: The data reveals that relationship between the nurse and cancer survivor is critical to an awareness of cultural needs but that nurses need help in raising their own awareness and appreciation of the benefits and impact of culturally competent care. It is only through creating self-awareness amongst nurses, in the context of each survivor and their needs and beliefs, will the standards of practice improve delivering the health outcomes that those in their care deserve.

Closing the gap on nurse retention: A scoping review of implications for undergraduate education.

OBJECTIVES: Newly qualified nurses leave the profession at a higher rate than any other year of experience. Undergraduate education influences nurse retention following qualification. However, it is unclear if the factors associated with intent to leave are included within programmes to aid retention once qualified. A scoping review was conducted to explore the literature within nursing as well as social work undergraduate education to obtain viewpoints from an allied profession with similar retention barriers. DESIGN AND DATA SOURCES: Following PRISMA extension guidelines for scoping review, the research question used to explore the literature was: What is the impact of undergraduate nurse and social work education on retention when newly qualified? Databases searched were BNI, CINAHL complete, Science Direct, PsycINFO, Medline Complete, Academic Search Complete and ERIC. REVIEW METHOD: One author undertook a comprehensive electronic and hand-search of relevant research articles. These were then discussed with two authors for inclusion within the review and data extracted for thematic analysis. RESULTS: Limited through search inclusion and quality of research, ten research papers met the criteria for this review. Main themes found were resilience and commitment, perceived knowledge and confidence, preparation for transition and expectation of supervision. CONCLUSION: The literature presents the need to strengthen resilience-building within undergraduate education in the transition to newly qualified practitioner, support to cope with the emotional and physical impact of professional practice as well as developing confidence in one's skills, guidance for career progression, promotion of authentic leadership in work-place mentors and commitment of both the University and health or social organisation to support staff to be healthy and feel valued.

An iterative approach to enhance the clinical learning experience in Macao nursing education.

OBJECTIVE: The aim of this study was to reduce or eliminate the stressors to enhance nursing students' clinical learning experience through implementation of an iterative approach that developed a personalised response to student stress. METHODS: A prospective cohort research design was applied to collect data from a sample of undergraduate nursing students across the four study years. An iterative approach was employed to improve students' learning experience and the Stressors in Nursing Students Scale-Chinese Version (SINS-CN) was used to measure student stress. Key problems encountered by students were identified, refined and the responding solutions were worked out and implemented among this group of students through their first year to fourth year. RESULTS: The overall SINS-CN mean score (2.17-2.82) of students was declined to a moderate level. CONCLUSIONS: Having implemented iterative approach to address factors that led to stressful environments encountered by the nursing students, the overall stress score and each sub-dimension score decreased significantly. Therefore, it is recommended that this approach could be adopted by other colleagues in the nursing arena around the world.

Virtual health education: Scaling practice to transform student learning: Using virtual reality learning environments in healthcare education to bridge the theory/practice gap and improve patient safety.

The advancements in and affordability of technologies offer increasing opportunities to modernise healthcare education into packages developed to meet the expectations and requirements of the digital generation. Purposefully designed and tested Virtual Reality Learning Environments (VRLE) can offer healthcare students the means to access and revisit learning materials in ways that enhance education and meet a range of needs; including those with specific learning differences and those who have traditionally been disenfranchised. Furthermore, this will make healthcare education much more readily available to those who have been previously marginalised by distance. This paper argues that Virtual Reality (VR) has the unique potential to transform healthcare education and suggests that more providers should consider collaborating with developers and investing in the technology.

Case Studies of Interprofessional Education Initiatives From Five Countries.

BACKGROUND: Although teamwork and interprofessional collaboration are critical to patient safety, nursing, medical, and allied health graduates often feel ill-prepared to confidently communicate and collaborate with other team members. While interprofessional education (IPE) has been advocated as a way of addressing this issue, there are multiple barriers to its systematic and sustained integration in undergraduate healthcare programs. Despite these challenges, examples of effective IPE initiatives have emerged. INNOVATION: This article profiles seven case studies of innovative interprofessional education activities that have been successfully implemented across five countries, for a variety of learners, using different delivery modalities, and with evaluation results attesting to their success. CONCLUSIONS: The case studies demonstrate innovative ideas that have the potential to overcome some of the barriers to IPE through the use of creative and targeted approaches. This article provides a wealth of ideas for the successful design and implementation of IPE initiatives and will be of benefit to educators wishing to expand their repertoire of teaching approaches. CLINICAL RELEVANCE: A body of research attests to the relationship between interprofessional communication, teamwork, and patient outcomes. IPE is imperative for facilitating the development of nursing graduates' communication and teamwork skills; however, innovative approaches are needed to overcome the perceived and actual impediments to its implementation.

Service user engagement in healthcare education as a mechanism for value based recruitment: An evaluation study.

AIM: Within the United Kingdom (UK) there is an increasing focus on Values Based Recruitment (VBR) of staff working in the National Health Service (NHS) in response to public inquiries criticising the lack of person-centred care. All NHS employees are recruited on the basis of a prescribed set of values. This is extended to the recruitment of student healthcare professionals, yet there is little research of how to implement this. Involving Service Users in healthcare educational practice is gaining momentum internationally, yet involvement of service users in VBR of 'would be' healthcare professionals remains at an embryonic phase. Adult nurses represent the largest healthcare workforce in the UK, yet involvement of service users in their recruitment has received scant attention. This paper is an evaluation of the inclusion of service users in a VBR of 640 adult student nurses. BACKGROUND DESIGN: This study used a participatory mixed methods approach, with service users as co-researchers in the study. METHODS: The study consisted of mixed methods design. Quantitative data via an online questionnaire to ascertain candidates' perspectives (n=269 response rate of 42%), and academic/clinical nurses (n=35 response rate 34.65%). Qualitative data were gathered using focus groups and one to one interviews with service users (n=9). Data analysis included descriptive statistics and thematic analysis. FINDINGS: 4 overarching themes were identified; increasing sense of humanness, substantiating care values; impact of involvement; working together and making it work, a work in progress. CONCLUSION: The findings from the study highlight that involving service users in VBR of student healthcare professionals has benefits to candidates, service users and local health services. Appreciating the perceptions of healthcare professionals is fundamental in the UK and internationally to implementing service users' engagement in service enhancement and delivery. Findings from this study identify there may be a dissonance between the policy, the nurses' thoughts and their practice.

Uncovering degrees of workplace bullying: A comparison of baccalaureate nursing students' experiences during clinical placement in Australia and the UK.

Bullying in health workplaces has a negative impact on nurses, their families, multidisciplinary teams, patient care and the profession. This paper compares the experiences of Australian and UK baccalaureate nursing students in relation to bullying and harassment during clinical placement. A secondary analysis was conducted on two primary cross-sectional studies of bullying experiences of Australian and UK nursing students. Data were collected using the Student Experience of Bullying during Clinical Placement (SEBDCP) questionnaire and analysed using descriptive and inferential statistics. The total sample was 833 Australian and 561 UK students. Australian nursing students experienced a higher rate of bullying (50.1%) than UK students (35.5%). Students identified other nurses as the main perpetrators (Aust 53%, UK 68%), although patients were the main source of physical acts of bullying. Few bullied students chose to report the episode/s. The main reason for non-reporting was fear of being victimised. Sadly, some students felt bullying and harassment was 'part of the job'. A culture of bullying in nursing persists internationally. Nursing students are vulnerable and can question their future in the 'caring' profession of nursing after experiencing and/or witnessing bullying during clinical placement. Bullying requires a zero tolerance approach. Education providers must develop clearer policies and implement procedures to protect students - the future nursing workforce.

Reducing avoidable deaths from failure to rescue: a discussion paper.

AIM: This article proposes a radical new approach to the monitoring and governance of services, and the education and training of nurses to meet 'failure to rescue' requirements. BACKGROUND: Healthcare policy in the UK that seeks to ensure safe and effective services for the acutely ill has largely failed, resulting in adult patients dying unnecessarily. Despite grand rhetoric, UK governments have distanced themselves from implementation, resulting in patchy localised developments and creating inconsistent service responses. DESIGN AND DATA SOURCES: This article draws on a review of research and UK policy literature and best international practice to propose a new national framework approach that combines competency development, governance and performance monitoring to address 'failure to rescue' shortcomings. IMPLICATIONS FOR NURSING: Paramount is a nationally agreed and fit-for-purpose competency tool using simulation to assess staff in order to improve recognition of the deteriorating patient. Service improvements should include increased investment in telemedicine; service performance should be communicated through publicly available ratings and overseen by patient panels; and governance will require strengthening through enhanced Care Quality Commission/Monitor input, which should be linked to the maintenance of foundation trust status. CONCLUSION: Health professional bodies, regulators, providers and the Government must work together to strengthen the safety and effectiveness of acute services. This will require investment in staff competency and enhancement of the governance to ensure services consistently meet public expectations and reduce unnecessary deaths.

Patient safety in acute care: are we going around in circles?

This article provides a critical discussion examining why adult patients continue to unnecessarily deteriorate and die despite repeated healthcare policy initiatives. After considering the policy background and reviewing current trends in the data, it proposes some solutions that, if enacted, would, the authors believe, have a direct impact on survival rates. Health professionals working in hospitals are failing to recognise signs of physiological deterioration. As a result, adult patients are dying unnecessarily, estimated to be in the region of 1000 a month. This is despite international healthcare policy requiring practitioners to be appropriately trained to recognise the deteriorating adult patient and to intervene. A literature review centred on health policy for England from 1999 to 2015 was undertaken, with reference to international policy and practice. This article also draws on the authors' combined clinical experience, which is underpinned by relevant research and theory. The implications for nursing could be significant. Change is urgently required otherwise people will continue to die unnecessarily. Health professionals, healthcare organisations and international governments working together can prevent unnecessary deaths from happening within acute hospitals.

The development of the Older Person's Nurse Fellowship: Education concept to delivery.

BACKGROUND: Preparing the nursing workforce to meet the challenges of an ageing population is a priority for many countries. The development of an Older Person's Nurse Fellowship (OPNF) programme for senior clinical nurses is an important innovation. OBJECTIVES: This article describes the philosophical development, delivery and early evaluation of the OPNF. DESIGN: In 2014, Health Education England funded 24 senior clinical nurses to participate in the OPNF. The Fellowship was designed to build clinical leadership and innovation capability and develop a network of nurses to influence local and national strategy for older people's care. The Fellows selected were drawn from mental health (n=4), community/primary care (n=9) and acute care (n=11). The twelve month programme consisted of two Masters-level modules, delivered through study days and e-learning. The first cohort (n=12) commenced the course in November 2014 with a module designed to enhance clinical knowledge and skills. METHODS: Evaluation data were collected from the first cohort using anonymous surveys (n=11) and focus group interviews (n=9). Descriptive statistics are presented for the quantitative data and common themes are described in the qualitative data. RESULTS: The overall satisfaction with the clinical module was high with a median score of 18/20 (range 17-20). Topics such as comprehensive geriatric assessment, frailty, pharmacology and cognitive assessment were regarded as highly relevant and most likely to result in a change to clinical practice. In the focus group interviews students discussed their learning experience in terms of: module specificity, peer-to-peer learning and using the OPNF as leverage for change. CONCLUSIONS: The OPNF is a timely innovation and a positive commitment to developing an academic pathway for senior nurses. It marks an important step in the future development of the older person's nursing workforce.

Promoting positive perceptions and person centred care toward people with mental health problems using co-design with nursing students.

BACKGROUND: People experiencing severe mental health problems often feel excluded from society due to stigmatization and prejudice. They typically experience negativity and lack life opportunities, which can be reinforced by the attitudes of those around them. Health care professionals, especially nurses, have the opportunity to challenge negative perceptions through role-modelling hope and positive expectation, breaking down barriers to participation and challenging discrimination. However, student nurses can enter the profession with attitudes similar to those of wider society and unless addressed can foster life-limiting approaches toward those for whom they are providing care. AIM: This study aimed to design a person-centred education approach in response to an evaluation of the attitudes of nursing students in Turkey toward people with mental health problems. METHOD: A qualitative design adopting descriptive phenomenology. Data were collected from 12 undergraduate nursing students by using in-depth semi-structured interviews. Data were transcribed and themes identified which were used to co-design a person-centred education approach. RESULTS: Three themes emerged from the data; (1) meanings attributed to mental illness, (2) moving from fear to understanding, (3) promoting hope and positive change Students typically demonstrated perceptions/attitudes that could be inhibiting to future practice. CONCLUSIONS: The pedagogy employed in this study moved away from a focus on signs and symptoms of illness to person-centred approaches. More positive perceptions of mental health can be developed through codesigned, person-centred educational approaches.