Allostatic load in children: The cost of empathic concern.

Early-life adversity affects long-term health outcomes but there is considerable interindividual variability in susceptibility to environmental influences. We proposed that positive psychological characteristics that reflect engagement with context, such as being concerned about people or performance on tasks (i.e., empathic concern), could moderate the interindividual variation in sensitivity to the quality of the early environment. We studied 526 children of various Asian nationalities in Singapore (46.6% female, 13.4% below the poverty line) with longitudinal data on perinatal and childhood experiences, maternal report on empathic concern of the child, and a comprehensive set of physiological measures reflecting pediatric allostatic load assessed at 6 y of age. The perinatal and childhood experiences included adversities and positive experiences. We found that cumulative adverse childhood experience was positively associated with allostatic load of children at 6 y of age at higher levels of empathic concern but not significantly associated at lower levels of empathic concern. This finding reveals evidence for the importance of empathic concern as a psychological characteristic that moderates the developmental impact of environmental influences, serving as a source for vulnerability to adversities in children.

Selective attention towards infants in nulliparous women across the menstrual cycle.

Research in women showed that testosterone is associated with decreased selective attention towards infant stimuli, which can be compensated for by oxytocin administration. In theory, caregiving behavior is thought to be mediated by oxytocin. Oxytocin binds to dopaminergic neurons and thus supposedly motivates aspects of caregiving through its influence on dopaminergic transmission. Most previous studies on caregiving behaviors were thereby performed in women under hormonal contraception to avoid hormonal fluctuations. However, recent studies repeatedly demonstrated decisive influences of the hormonal changes across the female menstrual cycle on dopamine-mediated behaviors, suggesting that estradiol acts as dopamine agonist in the follicular phase and progesterone as dopamine antagonist in the luteal phase. In the present study, we investigated selective attention towards infants as one central aspect of caregiving behavior over the natural menstrual cycle and in relation to interindividual differences of estradiol and progesterone. As expected, we found that women with higher estradiol in the follicular phase also showed higher selective attention towards infant faces among adult distractors, whereas the correlation disappeared in the luteal phase. In contrast, progesterone did not correlate with selective attention towards infants. The present findings collectively support the assumption that estradiol may act as dopamine agonist in the follicular phase, thereby supposedly promoting an important aspect of caretaking behavior.

Tanzanian midwives' clinical practices and experiences in caring for women with antepartum hemorrhage: a critical incident technique study.

BACKGROUND: Antepartum hemorrhage (APH) is an obstetric emergency that complicates pregnancy worldwide and continues to lead to hemorrhagic conditions in parts of Tanzania. Midwifery education received by midwives consists theoretical knowledge on the subject but with no or minimal practical skills in the laboratory, which may reduce their practical capacity as graduated midwives. This study therefore aimed to explore midwives' clinical actions and experiences regarding the care of women with APH in Mwanza region. METHOD: Qualitative, inductive approach with critical incident technique was used. Data were analysed using the critical incident technique, and a question guide consisting of eleven open-ended questions was used to collect data from 44 out of 60 midwives who graduated not less than one year. A total of 522 critical incidents, with 199 actions and 323 experiences, were identified and categorized into five main areas. Ethical approval was obtained. RESULTS: Midwives' clinical actions and experiences in caring for women with APH are affected by the knowledge and skills obtained during training at school. They have insufficient theoretical knowledge and practical skills, leading to inadequate identification of the problem and the implementation of care. A need for additional preventive care is described and structural issues, such as co-operation, referral to other instances, access to equipment and relevant treatments need to be improved. CONCLUSION: The actions taken to provide care for women with APH were related to their ability to identify problems, implement care and carry out structural initiatives. However, the midwives' experience was influenced by an attempt to understand the seriousness of the situation and the existence of an organizational challenge. The results can provide knowledge and tools to improve midwives' education and clinical practice and in the long run, prevent complications, improves health and minimize suffering in women with APH.

'I see the high level of interpersonal support during the pandemic as proof that the good in people prevails': the COVID-19 pandemic as a catalyst for building a caring community?

BACKGROUND: The public health approach to end-of-life care has led to initiatives to promote caring communities, involving the community in supporting vulnerable dying people and their families. Our study aimed to explore how the COVID-19 pandemic affected the relevance of a caring community, whether the concept of a caring community took on a different meaning during and because of the pandemic, and how issues of death, dying and bereavement were perceived. METHODS: Qualitative online survey of people interested in the 'Caring Community Cologne' project. Participants in the survey attended the launch event for the Caring Community in Cologne. Direct invitations were sent to professionals and experts in various fields. Information about the event was also disseminated via social media and the city of Cologne's website. Data were collected from June 2020 to August 2020 and analyzed using Braun & Clarke's thematic analysis. RESULTS: N = 63 out of 121 people participated. The median age was 60 years; 65% of the participants were female. Most of them worked in the social sector (53%). Three respondents described positive changes brought about by the pandemic: Greater sense of community and solidarity, more confrontation with one's own finiteness, strengthening of relationships, mindfulness and slowing down of the pace of life. Negative effects mentioned included a deterioration in mental health and well-being, with an increase in anxiety, social isolation but also forced togetherness, which can lead to conflict, and a lack of emotional closeness due to restricted contact. CONCLUSIONS: Our study was conducted at the beginning of the pandemic and shows that the pandemic has raised awareness of the importance and potential benefits of community-based networks and the importance of adopting a public health palliative care approach to advocate for those most in need. The findings also highlight the role of community social capital in promoting engagement, resilience and well-being.

Through the eyes of grandparents: an in-depth exploration of the nexus between grandchild caring and the psychological well-being of older grandparents.

BACKGROUND: Grandchild caring has positive as well as negative impact on the grandparents' psychological well-being and the findings are varied by culture and country. METHODS: Present study was intended to understand the relationship between caring for grandchildren and psychological well-being of grandparents living in skipped (SGH) and multi-generational households (MGH) in Indian demographical context. The present research involved In-depth Interviews (IDI) focusing on grandparents above 60 and grandchildren below 18, where the elder played a crucial role in caregiving. The study area was Malda, a district of West Bengal in India. Purposively 24 IDIs were selected. Psychological well-being was measured using open-ended questions. Thematic and content analyses were adopted to understand the perspective of grandparents. RESULTS: Most of the grandparents from SGH reported depression word frequently, while grandparents from MGH reported happy. In the content analysis, grandparents from SGH expressed tension, mental turmoil, and worry about grandchild's future. On the contrary, grandparents from MGH expressed happy, companionship, and worry about grandchild's future. Further, full time caring, compulsive reason behind grandchild caring, and working status were linked with living in SGH and grandchild caring, which were in turn connected with deteriorate psychological health. However, in MGH, a different scenario was observed, most grandparents were partially and non-compulsively engaged in grandchild caring and had expressed positive mental health. CONCLUSIONS: The Findings provide an intervention implication, particularly in the context of India's ageing population and their well-being by acknowledging the influence of household structure, caring intensity, motive behind grandchild caring, and working status on their psychological health. Understanding the importance of these key factors may help the policy maker and the individual to incorporate the most effective intervention to achieve sustainable development goal 3 and healthy ageing.

How assisted eating becomes a caring practice in institutional settings: Embodied gestures and stages of assisted eating.

Assisted eating is a basic caring practice and the means through which many individuals receive adequate nutrition. Research in this area has noted the challenges of helping others to eat while upholding their independence, though has yet to explicate how this caring practice is achieved in detail and across the lifespan. This paper provides an empirical analysis of assisted eating episodes in two different institutions, detailing the processes through which eating is collaboratively achieved between two persons. Data are video-recorded episodes of infants during preschool lunches and care home meals for adults with dementia, both located in Sweden. Using EMCA's multimodal interaction analysis, three core stages of assisted eating and their underpinning embodied practices were identified: (1) establishing joint attention, (2) offering the food, and (3) transferring food into the mouth. The first stage is particularly crucial in establishing the activity as a collaborative process. The analysis details the interactional practices through which assisted eating becomes a joint accomplishment using a range of multimodal features such as eye gaze, hand gestures, and vocalisations. The paper thus demonstrates how assisted eating becomes a caring practice through the active participation of both caregiver and cared-for person, according to their needs. The analysis has implications not only for professional caring work in institutional settings but also for the detailed analysis of eating as an embodied activity.

"They choke to death in front of your very eyes": nurses' lived experiences and perspectives on end-of-life care during COVID-19.

BACKGROUND: The COVID-19 pandemic led to an intensified fear and threat of dying, combined with dying and grieving in isolation, in turn significantly impacting nursing in end-of-life situations. The study aims (1) to understand the lived experiences of nurses who provided care to end-of-life patients during COVID-19; and (2) to explore whether providing care under such circumstances altered the perspectives of these nurses regarding end-of-life care. METHODS: Applying the phenomenological-interpretive qualitative approach, 34 in-depth semi-structured interviews were conducted between March 2020-May 2021 with nurses from eight hospitals in Israel who were recruited through purposive and snowball sampling. Thematic analysis was applied to identify major themes from the interviews. RESULTS: Five main themes emerged from the analysis, including: (1) a different death; (2) difficulties in caring for the body after death; (3) the need for family at end-of-life; (4) weaker enforcement of advance care directives; and (5) prolonging the dying process. DISCUSSION: During the pandemic, nurses encountered numerous cases of death and dying, while facing ethical and professional issues regarding end-of-life care. They were required to administer more aggressive care than usual and even necessary, leading to their increased moral distress. The nurses' ethical concerns were also triggered by the requirement to wrap the corpse in black garbage-like bags to prevent contagion, which they felt was abusing the dead. The findings also demonstrate how family presence at end-of-life is important for the nursing staff as well as the patient. Finally, end-of-life situations during the pandemic in Israel were managed in an individual and personal manner, rather than as a collective mission, as seen in other countries. CONCLUSIONS: The study offers insights into the nurses' attitudes towards death, dying, and end-of-life care. An emphasis should be placed on the key elements that emerged in this study, to assist nurses in overcoming these difficulties during and after medical crises, to enhance end-of-life care and professionalism and decrease burnout.

Changes in ageing women's sexual subjectivity as seen from a life course perspective: security, caring, and desire.

This article explores the sexual subjectivity of women of post-reproductive age who seek partners on dating apps. The existing literature highlights the sexual subjectivity and agency of older women as contested and not sufficiently investigated. Even less research has been conducted on changes in the sexual subjectivity of women born in the USSR in the 1960s, with the liberalisation of sexual behaviour. The study is based on 45 interviews with women aged 55 years and over, who were born in the USSR and who now live in Israel, Finland and Russia. In the article, we examine sexual subjectivity as presented in the interviews from a life course perspective. We explain theoretically and empirically how changes in sexual subjectivity are expressed in the light of age and socio-cultural context constraints. Three life stories highlight the accumulation of experience and turning points, such as divorce and migration. They illustrate very different pathways in changing sexual subjectivity, yet all contain three Leitmotifs: desire, security and caring. The expression of post-reproductive female desire can be related to the need to feel secure and enjoy mutual care in sexual relationships. We show that these Leitmotifs shape and are shaped by women's identifications as both sexual objects and subjects, and explore how they relate to different sexual cultures and variations in the socio-sexual positioning of women in Israel, Finland, and Russia.

Effect of caring leadership intervention program for first-line nurse managers on their managerial actions and nurse outcomes.

AIM: The aim of the study was to examine the effect of a caring leadership intervention program for first-line nurse managers (FLNM) on their caring knowledge and managerial actions as well as nurses' perceived FLNM caring behaviours and nurse outcomes. DESIGN: A quasi-experimental study design was implemented on two groups; study and control, including 30 FLNM and 150 nurses for each. METHODS: Self-report questionnaires about FLNMs' knowledge of caring behaviours and their managerial actions, nurses perceived line nurse managers' caring behaviours and nurses' outcomes (job satisfaction and work engagement) were utilized to collect study data from 1 July 2022 to 30 December 2022. RESULTS: A statistically significant difference and changes were revealed between the study and control groups in FLNMs' caring knowledge and their managerial actions, and nurses' perceived FLNMs' caring behaviours, nurses' job satisfaction and nurses' work engagement during post-test in comparison to pre-test. Higher total mean scores of post-test in the study group were recorded compared to those of control group regarding FLNMs' caring knowledge and their managerial actions as well as nurses 'perceived FLNMs' caring behaviour, job satisfaction and work engagement. CONCLUSION: The caring leadership intervention program for FLNMs was highly effective in enhancing their caring knowledge and managerial actions as well as nurses' perceived FLNM caring behaviours and nurse outcomes. IMPLICATIONS FOR THE PROFESSION: Caring leadership can help FLNMs to create a healthy environment, resulting in a positive outcome for nurse staff, patients and healthcare organizations. PATIENT AND PUBLIC CONTRIBUTION: No patient and public contribution.

Diversity-On: A Diversity-Sensitive Online Self-Help Program for Family Caregivers-A Protocol for a Mixed Methods Study.

BACKGROUND: Scientific research has consistently emphasised the high levels of stress encountered by family caregivers of individuals living with dementia. However, conventional self-help approaches remain underutilised. The 'Diversity-On' study addresses this issue. The study employs a storytelling approach to develop and evaluate an online self-help program that is participatory and diversity-sensitive, thereby ensuring congruence with diverse identities and lifeworlds. METHODS: The study uses a mixed-methods design, comprising the allocation and implementation of the intervention, the development of stories, a process evaluation (N = 20) and an outcome evaluation (quantitative: N = 130, qualitative: N = 20). The study's primary focus is its comprehensive participatory approach, integrated throughout the research process. The study is dependent on the input of a number of stakeholders, all of whom are committed to advocating for the concerns of patients. DISCUSSION: Given its participatory methodology and intersectional perspective, the 'Diversity-On' study is anticipated to yield a number of significant outcomes. The study has the potential to empower family caregivers of individuals living with dementia who are under high stress, empowering them to take part in self-help groups despite multiple barriers, thus alleviating their burden. Additionally, it has the capacity to promote the well-being of caregiving relatives who are providing care and are experiencing high levels of stress. The study's objective is to maintain home care arrangements for as long as possible, in accordance with the values and preferences of care recipients and their families. The study intends to develop and assess a customised online self-help resource that is suitable for a diverse range of users and that remains accessible beyond the study period. TRIAL REGISTRATION: The project is subsequently registered in ClinicalTrials.gov.

The Caring Life Course Theory: Opening new frontiers in care-A cardiac rehabilitation example.

AIM(S): To operationalize the Caring Life Course Theory (CLCT) as a framework for improving cardiac rehabilitation (CR) engagement and informing ways to address disparities in rural, low socio-economic areas. METHODS: A secondary analysis of data collected from 15 CR programmes to identify CR patterns through the CLCT lens using a mixed-methods approach. All analytical processes were conducted in NVivo, coding qualitative data through thematic analysis based on CLCT constructs. Relationships among these constructs were quantitatively assessed using Jaccard coefficients and hierarchical clustering via dendrogram analysis to identify related clusters. RESULTS: A strong interconnectedness among constructs: 'care from others', 'capability', 'care network' and 'care provision' (coefficient = 1) highlights their entangled crucial role in CR. However, significant conceptual disparities between 'care biography' and 'fundamental care' (coefficient = 0.4) and between 'self-care' and 'care biography' (coefficient = 0.384615) indicate a need for more aligned and personalized care approaches within CR. CONCLUSION: The CLCT provides a comprehensive theoretical and practical framework to address disparities in CR, facilitating a personalized approach to enhance engagement in rural and underserved regions. IMPLICATIONS: Integrating CLCT into CR programme designs could effectively address participation challenges, demonstrating the theory's utility in developing targeted, accessible care interventions/solutions. IMPACT: Explored the challenge of low CR engagement in rural, low socio-economic settings. Uncovered care provision, transitions and individual care biographies' relevance for CR engagement. Demonstrated the potential of CLCT to inform/transform CR services for underserved populations, impacting practices and outcomes. REPORTING METHOD: EQUATOR-MMR-RHS. PATIENT CONTRIBUTION: A consumer co-researcher contributed to all study phases.

Exploring men's struggles with infertility: A qualitative content analysis.

AIM: To investigate the experiences of men struggling with infertility. DESIGN: This is a qualitative study, and the report follows the COREQ checklist. METHODS: A team of nurse researchers conducted this research in Iran to examine the experiences of 11 men with primary infertility. The participants were selected through targeted sampling and underwent in-depth semi-structured interviews. The data collected was analysed using the conventional content analysis method outlined by Krippendorff. To ensure the study's accuracy, it followed the criteria proposed by Lincoln and Guba. RESULTS: The central theme, "the threat to masculinity," was identified upon analysis. It comprises six categories: psychological pressure of confronting reality, frustration, discomfort with others, holding out against ridicule, tolerating unwanted opinions and advice and concealment of infertility and therapy. CONCLUSION: This study brings attention to the challenge to masculinity that men with primary infertility face as their central struggle. It highlights the importance of culturally sensitive care from healthcare professionals, emotional support, counselling services and public awareness to reduce the stigma surrounding male infertility. It can be valuable to evaluate and enhance infertility care in various settings. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: To provide the best possible care for infertile men, it would be beneficial for nurses to pay more attention to sociocultural factors. Fertility care should be respectful of patients' beliefs and backgrounds. IMPACT: WHAT PROBLEM DID THE STUDY ADDRESS?: Infertility care has been the subject of recent research, focusing on the impact of sociocultural factors. Male-factor infertility is often overlooked in clinical care literature. There is a correlation between cultural background and men's acceptance of reproductive healthcare. WHAT WERE THE MAIN FINDINGS?: Male infertility is often avoided in discussions due to its perceived threat to masculinity. Multiple factors, including societal norms, cultural expectations and personal experiences, influence the nature of men's struggles with infertility. Providing emotional support and counselling services is crucial so that men can openly discuss their fertility challenges and seek treatment without feeling ashamed or judged. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Raising public awareness and providing education about male infertility is crucial. Nurses must exhibit cultural sensitivity while caring for men experiencing infertility. Policymakers need to implement strategies to reduce the stigma surrounding male infertility. REPORTING METHOD: The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No public or patient involvement.

How and where does "care" fit within seminal life-course approaches? A narrative review and critical analysis.

AIMS: To map the concepts of the caring life-course theory that are used in life-course approaches from different disciplines; establish whether there is a common recognition of, or language used, to describe care in those life-course approaches; and identify the role and contribution of care to the life-course literature. DESIGN: This discursive paper uses a narrative review process to explore points of convergence and divergence between life-course approaches and the caring life-course theory. METHODS: Categories for analysis were developed deductively and inductively, focusing on the constructs of fundamental care, capacity and capability, care network, care transition, care trajectory and care biography. RESULTS: We identified four disciplinary perspectives: (1) life-course sociology; (2) life-course epidemiology; (3) lifespan developmental psychology; and (4) life-course health development. While six core constructs of the caring life-course theory were described, either explicitly or implicitly, in existing life-course approaches, no single approach fully describes the role and contribution of care across the lifespan. CONCLUSION: Life-course approaches have largely neglected the contribution and role of care in informing the life-course discourse. This review highlights the significance of care beyond traditional healthcare settings and recognizes it as a fundamental human need for well-being and development, which can contribute to existing life-course literature. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: There is a need to understand care as a complex system and embrace a whole-system, life-course approach to enable nurses and other healthcare professionals to provide high-quality, patient-centred care. IMPACT: Incorporating care within a life-course approach provides opportunities to integrate and deliver care centred around the person, their life transitions, trajectories and care networks, including informal carers and healthcare professionals. NO PATIENT OR PUBLIC CONTRIBUTION: Patients or members of the public were not involved in this study as it is a discursive paper based on the relevant literature.

Experience and caring needs of patients with psoriasis: A qualitative meta-synthesis.

BACKGROUND: As a chronic skin disease, psoriasis often affects the physical, psychological and social status of the patient, which in turn impacts on their experience of illness and needs. However, there is no review of qualitative research that integrates and analyses the experiences and needs of these three influences from a holistic perspective. METHODS: This review follows the ENTREQ guidelines. Six English databases (JBI, Cochrane Library, PubMed, PsyINFO, CINAHL and Embase) and three Chinese databases (CNKI, VIP and Wanfang) were searched from January 2012 to October 2022. Literature was included if it was relevant to the experience of illness and caring needs of patients with psoriasis. The JBI-QARI was used to rate the quality of included studies. RESULTS: Eleven studies were included in the meta-synthesis. Four analytical themes were identified for analysis: physical challenges, psychological discomfort, social phenomena and caring needs. CONCLUSIONS: The combined physical, psychological and social effects of psoriasis and the consequent caring needs should be emphasised. Health professionals, including doctors and nurses, should be aware of the multiple changes in patients and their coping strategies, provide information about psoriasis, monitor and follow-up regularly over time and obtain feedback to inform further treatment and care so as to develop high-quality therapeutic interventions to help and guide patients with their coping strategies. RELEVANCE TO CLINICAL PRACTICE: These findings describe the physical, psychological and social experiences of illness and caring needs of patients with psoriasis. Healthcare professionals should be more aware of patients' easily overlooked psychological and social distress, providing prompt attention and recognition of patients' experiences and needs, offering relevant assistance and support and enhancing daily, regular follow-up to help them improve their understanding of and ability to manage their illness. NO PATIENT OR PUBLIC CONTRIBUTION: This is a meta-synthesis without direct patient involvement.

Does a participatory live music practice support nurses to deliver compassionate care to hospitalised patients? A qualitative study.

AIM: To gain more insight into how nurses experience a participatory live music practice in relation to their ability to deliver compassionate care to medically hospitalised patients. DESIGN: Qualitative interpretive design. METHODS: Sixteen nurses participating in a live music practice with patients were interviewed using in-depth interviews with open-ended questions. Audio recordings were transcribed verbatim and subsequently coded. Theory-driven inductive and deductive approaches were applied in thematic data analysis. RESULTS: We identified four themes: (1) Nurses' empathy and compassion; (2) The caring nurse-patient relationship; (3) Person-centred approaches to care and (4) Nurses' subjective wellbeing. By observing patients' reactions to the music, nurses described that they obtained a deeper insight and understanding of patients' emotional wellbeing. These observations led to increased feelings of compassion in patient contact and stimulated informal communication between nurses and patients through a sense of shared humanity. According to nurses, these aspects positively affected collaboration with patients in delivering care and stimulated them to pursue person-centred approaches to care. Participating in the live music practice also positively affected nurses' wellbeing, enhanced relaxation and created an ambiance in which compassion could be expressed. CONCLUSION: A live music practice can positively contribute to the delivery of compassionate care by providing meaningful shared moments that increase feelings of empathy and compassion and strengthen the caring relationship. IMPLICATIONS FOR THE PROFESSION: Offering a live music practice at the ward and bedside offers a unique possibility to enhance engagement in person-centred, compassionate care. IMPACT: While compassion and compassionate care are essential component of nursing, nurses often experience multiple barriers to its provision in daily practice. An innovative way to stimulate compassionate care is through the participation of nurses and patients in a live music practice, providing a meaningful moment shared between them. This stimulates feelings of shared humanity and bonding in the caring relationship. REPORTING METHOD: The COnsolidated criteria for REporting Qualitative research (COREQ). No Patient or Public Contribution.

Patients' and Nurses' experiences of caring in nursing: An integrative literature review across clinical practices.

AIM: To summarise, interpret and synthesize research findings on patients' and nurses' experiences of caring in nursing across clinical practices. BACKGROUND: Caring is a universal element of nursing; however, economic restrictions often negatively impact health services, and time shortages and limited numbers of staff may characterize care encounters. It is unclear how these contextual conditions affect patients' and nurses' experiences of caring. DESIGN AND METHODS: This integrative literature review covers papers published between 2000 and 2022. Four databases-PubMed, PsycINFO (via Ovid), MEDLINE (via Ovid) and CINAHL (via EBSCO)-were systematically searched for eligible papers in May 2022. The included studies were critically appraised. Content analysis was performed to interpret and synthesize the findings. In accordance with the EQUATOR guidelines, the PRISMA 2020 and PRISMA-S checklists were used. An Integrative review methodology guided the process. FINDINGS: In total, 33 studies were included in the review. Three themes captured the experiences of caring in nursing: (1) the complexity of the nursing care context, (2) the professionalism of the nurse, and (3) the trusting patient-nurse relationship. CONCLUSION: The experience of caring in nursing depended on nurses' competence and discretion in the personal encounter framed by the nursing context. The caring relationship was based on reciprocity, but it remains asymmetrical, as the nurse had the power and responsibility to empower the patient. Barriers, such as increased demands for efficiency and resource scarcity, may hinder the experience of caring in nursing. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: By promoting an ongoing discussion of caring in nursing, nurse management can systematically support nurses in reflecting on their practice in diverse and complex clinical contexts. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was made due to the study design.

Linking patient safety, caring behaviours and professional self-efficacy with missed nursing care among Filipino emergency room nurses: A structural equation model study.

AIMS: To investigate the interrelationships of patient safety, caring behaviours, professional self-efficacy and missed nursing care among emergency room nurses. DESIGN: Cross-sectional, correlational study. METHODS: Filipino emergency room nurses (n = 345) participated via convenience sampling from September 2023 to January 2024. Four validated self-report scales were used to collect data and were analysed using Spearman rho, covariance-based structural equation modelling, mediation and path analyses. RESULTS: The emerging model of study variables displayed satisfactory fit indices. Patient safety directly influenced caring behaviours and professional self-efficacy, while negatively influencing missed nursing care. Caring behaviours directly and indirectly affected professional self-efficacy and missed nursing care, respectively. Professional self-efficacy negatively influences missed nursing care. Finally, caring behaviours and professional self-efficacy were significant mediators between the association of patient safety and missed nursing care. CONCLUSION: Caring behaviours and professional self-efficacy of emergency room nurses demonstrated mediating effects that can potentially improve patient safety practices thereby minimizing unfinished or missed nursing care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses and healthcare organizations should commit to consistently maintain a workplace culture that fosters patient safety, caring behaviours and professional self-efficacy to minimize avoidable injuries and omitting nursing care tasks. REPORTING METHOD: STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Acute care nurses' decisions to recognise and respond to patient improvement: A qualitative study.

AIM: To explore and describe acute care nurses' decisions to recognise and respond to improvement in patients' clinical states as they occurred in the real-world clinical environment. DESIGN: A descriptive study. METHODS: Nine medical and eleven surgical nurses in a large Australian metropolitan hospital were individually observed during nurse-patient interactions and followed up in interview to describe their reasoning and clinical judgements behind observed decisions. Verbal description of observations and interviews were recorded and transcribed. Reflexive thematic analysis was used to analyse the data. RESULTS: The three themes constructed from the data were as follows: nurses checking in; nurses reaching judgements about improvements; and nurses deciding on the best person to respond. Acute care nurses made targeted assessment decisions based on predicted safety risks related to improvement in clinical states. Subjective and objective cues were used to assess for and make judgements about patient improvement. Acute care nurses' judgment of patient safety and a desire to promote patient centred care guided their decisions to select the appropriate person to manage improvement. CONCLUSIONS: The outcomes of this research have demonstrated that the proven safety benefits of acute care nurses' decision making in response to deterioration extend to improvement in patients' clinical states. In response to improvement, acute care nurses' decisions protect patients from harm and promote recovery. IMPLICATIONS FOR PATIENT CARE: Early recognition and response to improvement enable acute care nurses to protect patients from risks of unnecessary treatment and promote recovery. IMPACT: This study makes explicit nurses' essential safety role in recognising and responding to improvement in patients' clinical states. Healthcare policy and education must reflect the equal importance of assessment for and management of deterioration and improvement to ensure patients are protected and provided with safe care.

'We had conversations we wouldn't have had otherwise'-Exploring home-dwelling people with dementia and family members' experiences of deliberating on ethical issues in a literature-based intervention.

AIM: To explore home-dwelling people with dementia and family members' perceptions of the feasibility and acceptability of an intervention using dementia-related literature excerpts to facilitate conversations on ethical issues related to living with dementia. BACKGROUND: Ethical issues in dementia care emerge throughout the illness. In the early stages, they may involve decisions about disclosing the illness to the family, shifting roles and responsibilities, and considerations of transitioning to a nursing home. Addressing ethical issues and providing adequate support to home-dwelling people with dementia and their families are often lacking. DESIGN: An exploratory-descriptive qualitative study. METHODS: We conducted eight interviews with 14 home-dwelling persons with dementia and their family caregivers. Six were dyadic interviews, and two were individual interviews with family caregivers. We analysed the interview data using template analysis. We adhered to the COREQ checklist in reporting this study. RESULTS: Using excerpts from dementia-related literature was a feasible and acceptable way of initiating discussions on ethical issues among home-dwelling persons with dementia and family caregivers. However, engaging the families of newly diagnosed individuals was challenging due to emotional distress. The intervention provided peer support, including identifying with others and sharing experiences. Moreover, participating couples found intimacy and relational attunement through shared reflections. CONCLUSION: Based on the findings, it appears that the participants in this study felt that using excerpts from dementia-related literature to deliberate on ethical issues was feasible and acceptable. Deliberating on ethical issues with peers and family caregivers offers valuable social support and opportunities for strengthening relationships. IMPLICATIONS FOR PATIENT CARE: This study makes an important contribution by providing valuable insights into how ethical issues related to living with dementia can be addressed using related literature and suggests how the intervention can be integrated into existing care initiatives for home-dwelling people with dementia and their families. REPORTING METHOD: We have adhered to relevant EQUATOR guidelines with the COREQ reporting method. PATIENT OR PUBLIC CONTRIBUTION: A healthcare professional working as a so-called dementia coordinator (a title used in the Danish context) was involved in the conduct of this study by being responsible for the recruitment of home-dwelling people with dementia and their family members. Moreover, she had joint responsibility for facilitating the intervention along with the first author.

The Effect of Home-Based Telehealth and Postpartum Care Given According to Watson's Theory of Human Caring on the Improvement in the Emotional State of the Mother During the Pandemic Process: A Case Report.

Objective: The purpose of this case report was to evaluate the effect of telehealth and postpartum care provided to a mother with maternal depression according to Watson's Theory of Human Caring during the pandemic on the improvement in the mother's emotional state and to evaluate the applicability of the model. Methods: Edinburgh Postnatal Depression Scale was administered to eight women who responded to the announcement made on social media, and verbal and written permission was obtained from the mother with the highest scale score. A total of six video calls were made with the mother via WhatsApp, twice a week in the first week after postnatal discharge and once a week in the next 4 weeks, in accordance with the form drawn up according to Watson's Theory of Human Caring. Results: In this study, it was observed that home-based telehealth and postpartum care provided using Watson's Theory of Human Caring, which includes a holistic approach, was very useful, and the care provided according to the model provided a positive improvement in the emotional state of the mother with depression. Conclusions: It was concluded that telehealth and postpartum care is useful in home-based care in extraordinary situations/quarantine conditions such as pandemic; care can also be provided in the form of telehealth service according to Watson's Theory of Human Caring to mothers with depression; and care provides positive improvement in the emotional state of mothers.