Agitation in older people is commonly associated with cognitive decline, complex medical diagnoses and polypharmacy. Impaired communication and comprehension within a dementia trajectory adds complexity to assessment and management. Despite high prevalence, agitated behaviours remain challenging to manage in residential aged care settings.
To explore staff perceptions of agitation in residents of aged care facilities, including the influence of dementia, when selecting management strategies to reduce agitated behaviour.
Semi‐structured interviews with 11 aged care staff were conducted at two aged care sites. Transcripts were examined using content analysis to identify common issues and categories. The study complied with COREQ guidelines. (see. Supplementary file)
Participants reported managing resident agitation at least once per shift; most frequently manifesting as wandering, restlessness, or aggression. Management strategies included distraction, providing space, knowing the resident, identifying causative factors, spending individual time, and if necessary medication administration. Agitation management was more challenging for residents with dementia due to impaired communication or comprehension of instruction.
While participants strived to deliver individualised person‐centred care, this was difficult given time and resource constraints. Contemporary management of agitation therefore remains variable in everyday practice, with resident preference used when causative factors were known. Conversely, for residents with impaired communication and/or comprehension, distraction and chemical restraint were commonly used. Nuanced education for assessment and management is recommended to better address this unmet need for some residents.
For optimal care, appropriate allocation of time and resources is necessary to identify causative and contextual factors for individual residents. Recommendations are for additional staff training in communication and attitude, and collaborating with frontline staff to develop a practical guide for management of agitation in aged care. These simple initiatives may help to improve consistency of care delivery and resident outcomes.
To explore the experience of parenting for younger stroke survivors (aged 18 to 64 years at the time of the stroke).
Stroke among younger adults increased 43% between 2000 and 2010. The social, emotional, and physical functioning of younger adults affects multiple aspects of their lives including parenting. There is limited research on the experience of parenting after stroke.
This is a qualitative descriptive study.
We conducted individual semi‐structured interviews with 10 younger adults who were actively parenting children under the age of 18 years at the time of the stroke. Conventional content analysis was used to analyze the data. We report the methods and results using the COREQ checklist.
Impairments from stroke disrupted participants’ identity, relationships, and roles as a parent. The degree to which parenting abilities and behaviors were affected by stroke was contingent upon the type and severity of impairments as well as the children's age. Participants also observed emotional and behavioral changes in their children in response to their stroke. Support from family, friends, healthcare providers, and children's school/daycare was crucial to participants throughout their stroke recovery. Two major themes emerged: 1) finding a new normal and 2) support for parenting post‐stroke.
Findings enable a deeper understanding of the distinct parenting challenges younger stroke survivors face and can inform future research on this population.
Study findings highlight the need for continual and tailored follow‐up by nurses and other allied healthcare professionals to decrease the difficulty stroke survivors experience when trying to resume their role as parents.
The aim was to explore how nurses experience compassionate care for patients with cancer and family caregivers in different phases of the palliative pathway.
Compassion is fundamental to palliative care and viewed as a cornerstone of high‐quality care provision. Healthcare authorities emphasize that patients should have the opportunity to stay at home for as long as possible. There are, however, care deficiencies in the palliative pathway.
This study employed a qualitative design using focus groups and a hermeneutic approach.
Four focus groups with three to seven female nurses in each group were conducted in Mid‐Norway in 2018. Nurses’ ages ranged from 28‐60 years (mean age =45 years), and they were recruited through purposive sampling (N = 21). Compassionate care was chosen as the theoretical framework. Reporting followed the COREQ guidelines.
Three themes expressing compassionate care related to different phases of the pathway were identified: (a) information and dialogue, (b) the creation of a space for dying, and (c) family caregivers’ acceptance of death.
This study showed that it was crucial to create a space for dying, characterized by trust, collaboration, good relationships, empathy, attention, silence, caution, slowness, symptom relief, and the absence of noise and conflict.
The quality of compassion possessed by individual practitioners, as well as the overall design of the healthcare system, must be considered when creating compassionate care for patients and their family caregivers. Nursing educators and health authorities should pay attention to the development of compassion in education and practice. Further research should highlight patients’ and family caregivers’ experiences of compassionate care and determine how healthcare systems can support compassionate care.
What does this paper contribute to the wider global clinical community? It provides insight into nurses’ role in compassionate care in different phases of the palliative pathway. It highlights the importance of early engagement with family caregivers, as a key element of compassionate care. Nurses play a crucial role in creating a space for dying, which is important for patients’ and their family members’ preparation for death.
To identify determinants of family cohesion and adaptability among Chinese registered nurses.
In China, the shortage of registered nurses imposes a higher physical and emotional workload, which will aggravate their work‐family conflicts. Therefore, it is easy for nurses to ignore the importance of family, which is undeniably detrimental to healthy self‐development and providing better care to patients.
ith a cross‐sectional and observational study design (See the STROBE checklist and Supplementary File 1).
The Family Cohesion and Adaptability Scale was administered to registered nurses (N = 825) from 10 hospitals throughout China. Multiple linear regression was used to analyze the related factors for family cohesion and adaptability.
The multiple regression analysis revealed that inharmonious relationship with spouse’s parents, discordant nurse‐patient relationship, parents live in countryside, poor leadership were found to be important risk predictors of family cohesion, and inharmonious relationship with spouse’s parents, discordant nurse‐patient relationship, high education, feel overworked, poor leadership were found to be important risk predictors of family adaptability.
Hospital managers need to pay attention to the risk factors that affect nurses’ family cohesion and adaptability. To achieve this, they should employ targeted measures to enhance these aspects in time, which will help improve nurses’ family life and promote their participation and role in family decision‐making. This will not only help them create a better external environment for their healthy self‐development but also allow them to maintain a better mood and energy to take care of patients.
Family cohesion and adaptability are important for nurses, as they may affect nurses’ healthy self‐development and quality of service provided to patients. Hospital managers should pay attention to the risk factors of nurses’ family cohesion and adaptability, such as poor nurse‐patient relationship, and consider employing corresponding measures to help them.
This study aimed to determine the predictive values of patient‐centred communication (PCC) and patient's characteristics on the body image (BI) perception in postmastectomy patients.
Patient‐centred communication has been touted as a means of addressing BI issues, especially for postmastectomy patients.
This predictive correlational study was conducted on 275 surgically treated breast cancer patients admitted to the Oncology Departments of two hospitals in Tabriz, Iran. These patients were selected using a convenience sampling method. The Body Image after Breast Cancer Questionnaire (BIBCQ) and patient‐centred communication questionnaire (PCCQ) were used for collecting the data. Descriptive and inferential statistics were applied to the data. Reporting was in accordance with the STROBE guideline.
A multivariable model significantly predicted BI perception in participants using surgery type and time elapsed following surgery. Participants’ limitations were significantly affected by surgery type and participants’ perception of the nurses’ PCC skills. Arm concern was significantly affected by surgery type and nurses’ PCC skills.
Patient‐centred skills in nurse–patient communication are critical for resolving BI difficulties such as arm concerns and limitations regarding the disease and its treatment.
Patient‐centred communication skills can be taught nurses in the clinical setting to help alleviate patients’ BI problems.
To assess primary healthcare professionals’ priority for managing diabetic foot disease (DFD) over the progressive course of the condition compared to other aspects of diabetes care.
DFD affects up to 60 million people globally. Evidence suggests that comprehensive preventative footcare may reduce serious complications of DFD, such as amputation.
A cross‐sectional quantitative study reported according to STROBE statement.
General Practitioners (GPs) and Credentialled Diabetes Educators (CDEs) working within Australian primary care were invited to complete an online survey, to obtain information about preventative and early intervention footcare priorities and practices. Ten GPs and 84 CDEs completed the survey.
On diagnosis of type 2 diabetes, haemoglobin A1c (HbA1c) review was identified to be one of the top three priorities of care by 57 (61%) of participants whilst at 20‐year history of diabetes 73 (78%) participants indicated its priority. Foot assessments became a priority for 78% (n = 73) of participants and podiatry referrals a priority for 53% (n = 50) of participants only when a “foot concern” was raised. Referrals to specialist high‐risk foot podiatrists or services were a first priority for 56% (n = 53), when the person had significant amputation risk factors.
Diabetes‐related preventative footcare assessments and management remain a low priority amongst primary healthcare professionals. Preventative care for asymptomatic complications, such as DFD, may be overlooked in favour of monitoring HbA1c or medication management. Limited prioritisation of footcare in primary care is concerning given the risks for amputation associated with DFD.
This study reveals the need for primary healthcare decision makers and clinicians to ensure preventative footcare is a focused priority earlier in the diabetes care continuum. Collaborative and widespread promotion of the importance of proactive rather than reactive footcare practices is required to support prevention of foot ulcers and amputation.
To demonstrate how metaphor method can be employed in health care research, through a rainbow metaphor to conceptualise lived experiences, and represent a sense of verisimilitude, in a phenomenological study of international nurses' experiences of organ procurement procedures.
International operating room nurses are likely to form unique attitudes towards multi‐organ procurement. Phenomenology is used to focus on discovering human experiences and the meanings of certain phenomena. Phenomenological writing can mediate people's reflections and actions, measure people's thoughtfulness and help people to see and show lived experiences from their lifeworlds.
Metaphor was used to interpret meanings of international operating room nurses' experiences in organ procurement surgery. The meanings were identified through a phenomenological approach informed by the work of van Manen.
A metaphor method was used to interpret and understand the lived experiences of eighteen international OR nurses recruited from nine different countries. Thematic data analysis was used to portray their lived experiences in organ procurement procedure.
Using a rainbow as metaphor, a vivid picture was portrayed reflecting international OR nurses' experiences and organ procurement journey in Australia as challenging, with mixed feelings. According to the relationship between certain colours and emotions, four essential themes evolved into the concept of a four‐colour rainbow to signify the meanings of international OR nurses' experiences in organ procurement procedures. The essential themes represented by these four colours were as follows: Orange—“The surreality of experiencing death,” Red—“Personal and professional challenges,” Green—“Becoming stronger” and Purple—“My beliefs, my wishes.”
Interpreting the meanings of their organ procurement experiences using metaphor method provided valuable insights about what personal and professional challenges these nurses faced, how they coped and managed their challenges, what support and care they required from others, and suggestions for future practice.
Operating room nurses in practice needed a range of workplace supports and the rainbow metaphor provides a suitable approach for reflection and understanding of their experiences in organ procurement, with a focus on international, newly graduated and less experienced nurses.
Practice improvement is a likely outcome when nurses have a better understanding of their experiences and the experiences of others in their team and this will assist in identifying their knowledge and professional support needs. The method demonstrates how metaphor can be applied to understand clinical nursing situations.
To explore primary research evidence reporting the reason for undergraduate nursing students' engagement with social media as an extracurricular activity.
The formal integration of social media into nursing education has been discussed extensively in previous research. The influence of social media on nursing students' learning and class engagement has also been explored. However, despite the growing volume of literature examining the formal use of social media by undergraduate nursing students, a broader perspective on how and why nursing students engage with social media as an extracurricular activity has not yet been explored.
An integrative review.
A systematic search was performed to find articles published between 2007–2019 using Ovid MEDLINE, Embase, Ovid Emcare and CINAHL Plus databases and the Google Scholar search engine. The review process is reported according to PRISMA.
Twelve papers met the inclusion criteria, revealing that undergraduate nursing students engaged with social media for many reasons external to their formal curricula. They engaged with social media to keep in touch with others and to entertain themselves, promote learning, find social support, develop a professional nursing identity, share their experiences as nursing students and locate job opportunities.
Undergraduate nursing students engaged with social media for numerous reasons. It supported students in their academic and personal lives by keeping them in touch with people around them. The students used social media to identify with the nursing profession; however, its influence on their professional identity development is yet to be fully explored.
Nursing schools should consider the myriad of reasons students engage with social media in order to optimise their professional development. Understanding how nursing students' professional identity develops via social media may be used to help sustain nursing students and support their transition into practice.
To describe the care provided to patients admitted into a community Nursing‐Led inpatient unit and to identify factors predicting a length of stay exceeding an established threshold.
Few studies have been conducted to describe the care provided in a Nursing‐Led unit. No studies have investigated factors affecting length of stay in these services.
Retrospective cohort study.
Consecutive patients admitted to a community Nursing‐Led unit between 2009–2015 were enrolled. Sociodemographic, medical and nursing care (diagnoses and activities) variables were collected from electronic health records. Descriptive analysis and a backward stepwise logistic regression model were applied. The study followed the STROBE guidelines.
The study enrolled 904 patients (mean age: 77.7 years). The most frequent nursing diagnoses were bathing self‐care deficit and impaired physical mobility. The nursing activities most provided were enteral medication administration and vital signs measurement. Approximately 37% of the patients had a length of stay longer than the established threshold. Nine covariates, including being discharged to home, having an impaired memory nursing diagnosis or being treated for advanced wound care, were found to be independent predictors of prolonged length of stay. Variables related to medical conditions did not affect the length‐of‐stay threshold.
The length of stay in the community Nursing‐Led unit was mainly predicted by conditions related to sociodemographic factors, nursing complexity and functional status. This result confirms that the medical and nursing needs of a community Nursing‐Led unit population substantively differ from those of hospitalised acute patients.
The nursing complexity and related nursing care to be provided may be adopted as a criterion to establish the appropriate length of stay in the community Nursing‐Led unit for each individual patient.
To describe perceptions of managers regarding prerequisites for professional competence development of newly graduated nurses following a 1‐year residency program.
In general, managers are unsatisfied with the professional competence of newly graduated nurses. Therefore, they have been involved in residency programs to support the nurses’ transition from being nursing students to professional nurses. However, perceptions of managers regarding the professional competence development of nurses have been sparingly studied.
Qualitative, descriptive study with a data‐driven inductive approach with content analysis to obtain an understanding of the perceptions of nine managers through interviews. EQUATOR checklist COREQ is used.(see Supplementary file‐1)
Three themes emerged: 1) The nurses´ relationships with their teams and patients, 2) expectations regarding the development of practical skills and leadership skills, and 3) prerequisites for continuing learning by supportive structures and a mutual responsibility between the manager and the nurse. Reflection was perceived by the managers as a cornerstone in the learning and development of professional competence. Learning theory was important, but learning practical clinical skills was essential for the nurses to develop competence and be able to perform their work, including being a leader of the team. Some structures discouraged continued learning in the development of professional competence, indicating a gap between the health care settings and the basic nursing program.
There is a gap between the university and the health care settings in maintaining a structure for continued learning, which requires cooperation. This gap and tension can be a driving force for the learning process of competence development. Relationships with team members and patients are considered fundamental for developing professional competence.
To overcome the gap between the university and the health care settings, the managers can facilitate nurses’ continued learning by creating structures for reflection.
To identify if a Compassionate Mind Model‐based curriculum reduces students’ perceived fears of compassion and improves their professional well‐being.
Enabling compassion is mandatory within nurse education but evidencing it is challenging. Research suggests that application of the Compassionate Mind Model might reduce students’ fears of compassion and also decrease compassion fatigue. This study reports outcomes of a post‐registration curriculum based on that model for training Specialist Community Public Health Nurses (Health Visiting).
A quantitative, prospective evaluation of a 12‐month training course for Health Visiting students. Reporting was guided by the STROBE checklist for observational studies.
Fears of Compassion Scales were applied at course start (time 1), mid‐point (time 2; +6months), and end (time 3; +12months) to evaluate fears of compassion of 26 post‐registration student Health Visitors (81% of course cohort) who provided data at all three points. The Professional Quality of Life tool was administered simultaneously to evaluate compassion satisfaction and burnout/secondary traumatic stress (compassion fatigue).
Between time 1 and time 3 mean Fears of compassion scores decreased by 16.6‐48.5% (Repeated Measures Analysis of Variance); mid‐point scores were intermediary. At time 3, Compassion satisfaction had increased slightly (+4.1%), negatively correlated with Fears of compassion for self (r= ‐0.602; p=0.001;n=26) and Fears of receiving compassion from others (r= ‐0.568; p=0.002;n=26). Burnout score decreased by 18.7%, correlated positively with Fear of compassion for self (r=0.493; p=0.011;n=26) and Fear of receiving compassion from others (r=0.615; p=0.001;n=26). Secondary traumatic stress score decreased by 16.5% but was not correlated with any fear of compassion.
Findings suggest that application of the Compassionate Mind Model might reduce practitioners’ fears of compassion linked to a decrease in risk of compassion fatigue.
The Compassionate Mind Model could provide an effective vehicle to promote compassion and nurse well‐being.
Stroke prevalence is rising internationally. Advanced practice nursing is established across many jurisdictions, however its contribution to stroke services is under researched.
To gain insights into the future scope and role of future advanced nurse practitioners in stroke care from the perspectives of key stakeholders.
A qualitative descriptive approach
Interviews were conducted in 2019 with a purposive sample of 18 participants, comprising stroke nurses, stroke unit managers, stroke survivors and their family carers, recruited in one UK healthcare trust. The research is reported in line with COREQ. Data were analysed in accordance with an inductive content analysis approach.
The abstraction process generated four main themes. These were “The lynchpin of the acute stroke service”, “An expert in stroke care”, “Person and family focussed”, and “Preparation for the role”.
These findings offer new perspectives on the potential scope and role of advanced nurse practitioners in stroke service delivery. Further research should focus on how to address the challenges confronted by advanced nurse practitioners when endeavouring to engage in autonomous clinical decision‐making.
Study findings may advance post registration education curricula, clinical supervision models and research directions.
There is support for the implementation of advanced practice nursing in the hyper acute and acute stroke phases of the care pathway. An interprofessional model of clinical supervision has potential to support the developing advanced nurse practitioner in autonomous clinical decision making.
The purpose of this study was to explore Canadian nurses’ perspectives on climate change, health, nursing practice, and the relationships between these concepts.
Climate change negatively impacts human health. With a mandate to promote health, nurses have a professional and ethical responsibility to address climate change. Little is known about Canadian nurses’ perspectives on climate change or how they perceive of their professional responsibility towards addressing it.
A focused ethnography was conducted in three medicine units and the emergency room at a Canadian hospital. Nurses (n=22) participated in semi‐structured interviews and observations were collected. Data were analysed via thematic analysis. Reporting is in accordance with the COREQ guideline.
Three themes were identified: muddled terminology, climate change and health, and nursing’s relationship to climate change.
Participants had varying levels of knowledge about climate change and its relationship to health or practice. Climate change was a personal concern and nursing’s role in addressing it was not understood.
This study highlighted that practicing nurses did not readily recognize their role in addressing climate change. More work is needed to clarify this role and bring it into the consciousness of every‐day nursing practice. Furthermore, more work is needed to examine how healthcare organizations can better support environmentally responsible nursing practice.
To evaluate the impact of an educational design to develop nursing students’ competence to work systematically with quality improvement in clinical practice.
Competence in how to improve the quality and safety of health care services based on new knowledge is crucial for health care quality. Nursing education should give students opportunities to engage in quality improvement projects to gain this competence.
This project qualitatively evaluated the impact of the course on students’ ability to plan and implement a quality improvement project in their clinical placement.
Data from retrospective focus group interviews and written project reports were analysed by means of qualitative content analysis. Fifty‐five students participated in the study. COREQ reporting guidelines were utilised.
Three themes were derived from the analysis: a) The importance of anchoring the quality improvement project in the clinic; b) Experiencing the steps of a quality improvement project; and c) Challenging student role.
Course design that facilitates student‐run small‐scale quality improvement projects under supervision can enhance nurse students’ competence in quality improvement work, as well as raise the students’ awareness of the responsibility they will undertake as future nurses.
Nursing students work on quality improvement project in clinical placement may enhance their awareness and competence in developing quality and safety of health care services as future nurses.
To explore how healthcare professionals in community‐based dementia teams perceive their role in reaching and supporting family caregivers from minority ethnic backgrounds when caring for a family member suffering from dementia or cognitive impairment.
Despite increased focus on barriers to accessing the dementia healthcare service for family caregivers from minority ethnic backgrounds, the lack of knowledge on how to address these barriers in order to reach and support this group is evident.
The study has a qualitative, explorative design. The principles of consolidated criteria for reporting qualitative research (COREQ) were applied for reporting methods and findings.
Based on data from semi‐structured interviews (n = 9) conducted in two large Norwegian municipalities, a thematic analysis influenced by Braun and Clarke was used. The analytical findings draw on Pierre Bourdieu’s theoretical concepts of field, habitus and capital.
‘The desire for a harmonious interaction’ was identified as an overarching theme. However, while desirable, the analysis shows that healthcare professionals in community‐based dementia teams do not always succeed in reaching and supporting family caregivers from minority ethnic backgrounds. The study reveals that the dementia healthcare service is a complex, normative, and sometimes rigid system that requires a number of distinct attributes to navigate.
The different social structures within the dementia healthcare service can both create and retain barriers that prevent family caregivers from minority ethnic backgrounds from receiving support on their own terms.
A practical implication of allowing critical reflection on the dementia healthcare service is that it provides opportunities for discussion. Healthcare professionals in community‐based dementia teams need to reflect on how normative ideals and ‘taken‐for‐granted’ mindsets can affect their ability to reach and support family caregivers from minority ethnic backgrounds.
The current study surveyed nurse practice patterns for performing swallowing screens in an academic cardiac intensive care unit (ICU). It aimed to index: training and levels of confidence in conducting dysphagia screens; screening methods employed; timing and frequency of implement; and subsequent plan of care in identified high‐risk patients.
Swallowing impairment (dysphagia) is common following cardiac surgery and associated with significant morbidity and mortality. Early and accurate detection of dysphagia is therefore critical to afford implementation of interventions to optimise patient care. Currently, no validated instruments or guidelines exist for nursing screening of dysphagia in this setting.
An anonymous and voluntary 10‐item mixed‐methods online survey was conducted using Qualtrics software. Nonprobability purposive sampling was utilised to recruit nurses working in an academic 24‐bed cardiac ICU. Thematic analysis using operationally defined coding, SRQR checklist and descriptive statistics were employed.
Sixty‐nine nurses completed the survey during a 1‐month period, representing an 84% response rate. Formal training in performing swallowing screens was reported in 18.6% of nurses. In rank order, reported level of confidence was the following: “moderately” (49%); “somewhat” (35%); “not” (13%); and “very” (3%). The majority of nurses performed screens within 1 hr (40.6%) or between 1–4 hr (43.8%) of extubation. Fifteen different methods were utilised to screen swallowing function by nurses who reported a total of 31 different clinical signs indicative of dysphagia.
Survey data of practicing nurses in an academic cardiac ICU revealed limited formal training in swallowing screening methodology, a high degree of variability in screening methods employed and low levels of agreement for dysphagia signs.
Data highlight a knowledge gap and need for the development of formal education and validated rapid nursing dysphagia screening tools for standardised implementation in the cardiac surgery ICU setting.
Using an integrated model of health literacy, we discuss the importance of health literacy among foreign domestic workers in the provision of informal caregiving during outbreaks of communicable diseases. COVID‐19 pandemic is used as an example.
Adequate health literacy in the population is known to be important for the prevention of communicable diseases. Foreign domestic workers, a group of marginalised caregivers in private households, are generally presumed to have limited health literacy because of numerous socio‐cultural disadvantages. To date, there is limited evidence that these informal healthcare providers receive support from community‐based nurses.
A discursive paper.
Foreign domestic workers, with varying levels of health literacy, may be viewed either as a resource to break the chain of infection or as a potential reservoir of communicable diseases in the community. Meanwhile, restrictions imposed in response to diseases transmissions (e.g. stay‐at‐home measures for COVID‐19) may directly exacerbate the social support received by these foreign domestic works and their ability to access health‐related information. There are also concerns about their ability to appraise and evaluate information related to communicable diseases at a time when fake news and misinformation are being disseminated through social media. Language and cultural barriers are important issues that need to be addressed to ensure that foreign domestic workers are in a position to follow public health recommendations.
Nurses hold an important position in empowering foreign domestic workers with adequate health literacy, by engaging groups of foreign domestic workers in the community and their consulates in planning educational programmes and effectively disseminating information. At a time of global pandemic, an assessment of the health literacy levels of foreign domestic workers in places like Hong Kong is urgently required.
To describe and explain nurses’ Protocol‐Based Care decision making.
Protocol‐Based Care is a strategy to reduce variability in clinical practice. There are no studies looking at Protocol‐Based Care decision making. Understand this process is key to successful implementation.
A multiple embedded case study was carried out. Nurses’ Protocol‐Based Care decision making was studied in three inpatient wards (medical, surgical and medical‐surgical) of a university hospital in northern Spain. Data collection was performed between 2015 and 2016 including documentary analysis, non‐participant observations, participant observations and interviews. Analysis of quantitative data involved descriptive statistics and qualitative data was submitted to Burnard's method of content analysis (1996). The data integration comprised the integration of the data set of each case separately and the integration of the findings resulting from the comparison of the cases. The following the thread method of data integration was used for this purpose. The SRQR guideline was used for reporting.
The multiple embedded case study revealed Protocol‐Based Care decision‐making as a linear and variable process that depends on the context and consists of multiple interrelated elements, among which the risk perception is foremost.
This study has allowed progress in Protocol‐Based Care decision‐making characterization. This knowledge is crucial to support the design of educational and management strategies aimed at implementing Protocol‐Based Care.
Strategies to promote Protocol‐Based Care should address the contexts of practice and the ability of professionals’ to accurately assess the degree of risk of clinical activity. Hence, it will promote quality of care, patient safety and efficiency in healthcare cost.
Identify strategies and resources for nurse leaders to use to lead with empathy and prudence to improve quality of care and to ease the psychological toll on nurses caring for patients with COVID‐19.
In a 2020 report, clinicians caring for patients during the COVID‐19 pandemic said their healthcare leaders needed to: ‘hear me, protect me, prepare me, support me, and care for me’. These words provide an action plan for nurse leaders to communicate, educate, and support nurses to practice competently and safely (physically and mentally) in the context of COVID‐19.
Identification and inclusion of relevant international evidence with clinical discussion.
Nurse leaders can mobilise system and individual level strategies and resources to support nurses to manage pandemic‐related issues including: anxiety due to the risk of infection, supporting anxious children, mitigating moral injury; providing safe and quality nursing care for patients with COVID‐19 and end‐of‐life care as needed; supporting relatives who cannot be present with a dying relative, and care for grieving relatives and colleagues. We categorise a selection of evidence‐based, online sources providing current COVID‐19 information, practice updates, and resources to develop personalised self‐care plans to ease anxiety and support renewal and resilience.
Nurse leaders must ensure adequate PPE supply, upskill nurses to provide safe, quality care for patients with COVID‐19, and promote restorative self‐care plans.
Relevance to clinical practice
The strategic actions nurse leaders take today can positively impact nurses’ wellbeing and ability to provide safe and quality care for patients in the context of COVID‐19.