Conectar
To apply the capability approach to understand ICU nurses’ decision-making autonomy.
A qualitative study using Amartya Sen’s capability approach as a conceptual framework.
This study reanalyzed qualitative data from a previous investigation involving semi-structured interviews with 39 experienced Canadian ICU nurses who described their decision-making processes in managing post-cardiac surgery bleeding. The analysis examined how resources (e.g., information, therapeutic and human), conversion factors (personal, social and institutional) and professional agency interact to shape nurses’ decision-making capabilities.
Nurses’ decision-making capabilities encompass: (1) obtaining necessary information, (2) interpreting information to make judgements and (3) making actionable decisions. These capabilities enable nurses to achieve valued outcomes such as clinical effectiveness, patient and family comfort, professional growth and personal fulfilment. However, they are shaped not only by clinical expertise or competency but also by structural and contextual factors, including resource constraints, institutional policies, interprofessional dynamics and hierarchical relationships. These factors influence nurses’ autonomy and real opportunities to translate clinical judgements into action.
The capability approach offers a reflective lens for examining the contextual conditions that shape nurses’ autonomy. By shifting the focus beyond individual competence, it highlights the broader structural and relational influences on nurses’ ability to make and implement clinical decisions.
Understanding decision-making as a capability underscores the importance of creating supportive environments where nurses can apply their expertise. The findings call for context-sensitive strategies in education, policy and practice that valorise nurse agency and respond to the systemic factors influencing decision-making in critical care settings.
What problem did the study address? This study examined the gap between nurses’ clinical expertise and the ability to act on decisions in practice, exploring how contextual factors influence their autonomy in critical care settings. What were the main findings? Decision-making autonomy is shaped by the interaction of individual, organisational and systemic factors—including access to resources, team dynamics and institutional norms—underscoring the need for context-sensitive strategies to support nurses’ decision-making. Where and on whom will the research have an impact? These findings can inform educators, policymakers and healthcare leaders seeking to strengthen decision-making, education and support, especially in complex or resource-constrained environments.
This report adheres to the Standards for Reporting Qualitative Research.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore how practical nurses perceive telehomecare in relation to sustainability.
This study had a qualitative exploratory design.
Ten practical nurses working with telehomecare were interviewed in February–April 2024. The interviews were individual, semi-structured and were analysed through Braun and Clarke's reflexive thematic analysis.
The overarching theme of this study was ‘Telehomecare: A catalyst for a multifaceted transformation towards sustainable practices in homecare nursing’, with three main themes and seven subthemes. The three main themes were ‘Reshaped delivery of care’, ‘Reformed work environment’ and ‘Reallocated resources'. The findings reveal that nurses have multifaceted perspectives on telehomecare in relation to sustainability, recognising both its positive and negative impacts on healthcare organisations, nurses and clients while also acknowledging that more sustainable practices demand significant changes in the healthcare environment.
Telehomecare has significant impacts on multiple dimensions of sustainability within healthcare and notable drawbacks. These findings emphasise the critical need for comprehensive education and training in sustainable digital work practices to enhance healthcare professionals' awareness of environmental impacts. This underscores the importance of transformative leadership that drives organisational change towards sustainable healthcare practices and implements effective sustainability policies.
The findings present some aspects of telehomecare that contribute to a lesser environmental impact from a nursing care perspective, encouraging healthcare leaders to make conscious and effective strategic decisions towards more sustainable healthcare. The findings strengthen nurses, leaders and policymakers' knowledge and awareness of sustainable nursing activities in the digital milieu, highlighting the urgent need for transformation of healthcare practices to decrease the environmental impact.
The study followed the consolidated criteria for reporting qualitative studies (COREQ).
This study did not include patient or public involvement in its design, conduct or reporting.
To explore the experiences of and reasons for midwives leaving practice.
A qualitative approach applying a social constructivism interpretative framework.
Twenty participants were selected for interviews based on reasons for leaving midwifery practice between October 2022 and April 2023. Thematic analysis was used to identify themes, and results were checked for trustworthiness through a third coder, community engagement and member checking with two participants.
One overarching theme with six subthemes characterised the experience of leaving midwifery practice. All participants reported the overarching theme: Caring for myself and my close community became incompatible with the work of midwifery. Five subthemes reflected negative aspects of midwifery work: value incongruence; racism in midwifery; not feeling respected/valued (+compensation); high workload leading to low quality of care; negative practice climate and psychosocial safety climate. The theme of strong professional commitment and identity weighed into their decision to leave. Negative experiences working in birth centres were prominent across themes.
Participants reported leaving the profession of midwifery when they reached an unsustainable balance between the demands of work life and personal life. The decision to leave midwifery was emotional; participants maintained a strong connection to midwifery. The leaving process supports a theoretical premise for midwifery turnover behaviour. The work life of midwives is a complex composite of challenges that are reflective of identified problems with maternity care in the United States.
Midwives are not leaving practice because they want to leave midwifery but because they are unable to meet non-work-related caring demands. Family-friendly policies, such as flexible schedules and leave policies, could help retain the midwifery workforce.
Based on recommendations from representatives of historically marginalised groups within the midwifery community, we offered participants to be interviewed by a midwife of colour.
To explore nurses' experiences with power structures in hospital care and to develop policy recommendations for transforming disempowering structures.
A three-phased critical ethnographic design.
Data were collected in a general teaching hospital in the Netherlands between December 2022 and June 2024 through (1) ethnographic diaries kept by nurses, (2) semi-structured interviews, (3) partial participant observations, (4) one focus group discussion with only nurses and (5) one multistakeholder focus group. Thematic analysis was used to identify themes.
Twenty-eight nurses of thirteen different departments and nine stakeholders participated. Four themes emerged from the analysis: (1) power in cooperation, (2) hierarchical relationships, (3) aggression and (4) insufficient decision-making power in hospital policies. The first theme was experienced as an empowering structural condition, while the last three were identified as disempowering structures.
Job satisfaction and quality of care among nurses are at risk and elicit feelings of burnout because of nurse–doctor hierarchies, aggression and insufficient decision-making power in hospital policies. Therefore, improving interprofessional cooperation and including nurses in decision-making is crucial to structurally empower nurses.
Hospital administrators need to create empowering conditions for nurses by furthering inclusion in policy making and setting department goals, implementing interprofessional education for effective collaboration, increasing nurse representation throughout hospital management layers and ensuring strong support systems. These interventions are important in addressing aggression, hierarchies, nurse turnover and burnout.
COREQ guidelines were used for reporting qualitative studies.
None.
To explore the pathway of care for people post hip fracture and define what is important for person-centred recovery.
Qualitative design using interpretive descriptive methodology, guided by the Health Empowerment theoretical framework.
Semi–structured interviews were conducted from March to October 2021, focussed on the lived experience of recovery post hip fracture. Thirteen participants were interviewed. Five people post hip fracture; four advanced practice nurses and four practice nurses. Data were analysed using thematic analysis.
Fragments of hip fracture care was a major theme describing a disconnected pathway following discharge from hospital, and exposed the gap between recommendations for follow up and implementation. Gaps highlighted the need for a key contact clinician to support care coordination, use of individualised care plans, clinical pathways for practice nurses, and follow up post hip fracture.
A disconnected recovery pathway was found from the lived experience of hip fracture. Findings highlight opportunities to develop integrated person-centred models of care that empower patients to self-manage their recovery. Implementation of an empowered coordinated pathway with a shared care approach integrates consistent care across the whole patient journey.
Identified gaps from a fractured recovery formed key components to support a connected care pathway post hip fracture. Linked by the overarching construct of Health Empowerment, policy and practice development embedding a connected pathway within nurse-led models of care should be considered.
Consolidated Criteria for Reporting Qualitative Research.
No Patient or Public Involvement.
This study explored what was important for recovery post-hip fracture. A fragmented recovery pathway was identified that highlighted key components for improvement. Research supports policy and practice development for nurse-led models of care with an empowered approach post hip fracture.
To explore how classmate ‘ambassadors’ experienced and engaged in social interaction while visiting a hospitalised peer undergoing cancer treatment.
A phenomenological-hermeneutic inspired exploratory study.
Using on-the-go semi-structured interviews and participant observations from January to December 2023 in Denmark, we included 27 school-aged ambassadors aged 6–18 years old; 18 participated in pre- and post-visit interviews, while all 27 took part in observations during 19 visits. Van Manen's phenomenological-hermeneutic approach guided thematic analysis.
Six themes emerged: (1) visiting the hospital, (2) being supportive, (3) aligning expectations, (4) being unsure, (5) safeguarding the relationship and (6) leaving the hospital. Ambassadors were eager to visit, seeking to be good friends by offering social, emotional and physical support. They were mindful of the information shared to prevent the hospitalised children from feeling excluded. Social interactions often involved allowing the hospitalised children to take on decision-making roles, recognising their well-being as a priority.
Ambassadors found hospital visits meaningful as they wanted to make a difference and sought to support their hospitalised peers. Their role was shaped by their understanding of friendship and the disease trajectory. Social interactions were largely conflict-free due to the pre-visit alignment of expectations.
Classmates found visits meaningful and wished to make a difference. Healthcare professionals should facilitate visits to strengthen social connections between the hospitalised child and their surroundings as a part of family-centred care within paediatric oncology.
Problem: Cancer treatment often causes social disruption for children with cancer, making the transition to everyday life more difficult post-treatment.
Classmates were eager to visit hospitalised peers, demonstrating awareness of cancer and a desire to support them.
Facilitating classmate visits may enhance classmates' understanding of cancer and aid hospitalised children's reintegration into everyday life.
The COREQ checklist was used.
Ambassadors contributed to designing the interview guides.
Enhances knowledge of supporting social relationships between hospitalised children and their classmates during cancer treatment. However, the RESPECT study is rooted in the Danish cultural context, where it is common to attend local volunteer activities after school. Although getting diagnosed with a life-threatening illness such as cancer may be difficult to talk about with peers and even a taboo in some countries, we do expect that interventions with structured possibilities for social interactions are an important step towards normalisation of communicating about childhood cancer.
This study aims to examine the experiences and support needs of internationally educated nurses (IENs) who migrated from Türkiye to different countries.
With the impact of globalisation and changes in the healthcare sector, the migration of IENs is on the rise. The global shortage of nurses has prompted high-income countries to increase their recruitment of nurses from low- and middle-income countries.
This descriptive qualitative study included 16 nurses who had migrated to seven different countries: Germany (n = 3), England (n = 3), the USA (n = 3), Canada (n = 2), Sweden (n = 2), Ireland (n = 2) and Switzerland (n = 1). Data were collected between August and November 2024 using Google Meet. The data were analysed using content analysis. The COREQ Checklist was utilised for data analysis and reporting.
Content analysis identified four main themes: (1) challenges encountered, (2) professional and personal development gains, (3) support needs and (4) recommendations for development and adaptation.
This study revealed that IENs face challenges such as professional adjustment, language barriers and cultural differences, while also experiencing gains such as professional skill development and enhanced intercultural nursing competencies.
The findings highlight the critical role of orientation and mentoring programmes that include language training, cultural awareness and psychological support and emphasise the need for more inclusive and sustainable health policies that support the integration of IENs.
The Consolidated Criteria for Reporting Qualitative Studies (COREQ).
No patient or public contribution.
To describe and enhance the understanding of healthcare professionals' perceptions of future leadership in digital healthcare.
A qualitative descriptive study.
The data were collected remotely between February and November 2022 through semi-structured interviews. A total of 26 healthcare professionals were interviewed individually or in focus group interviews at the university hospital and university in Finland. The data were analysed using inductive content analysis.
Results revealed seven main categories that described the professionals' perceptions of future leadership in digital healthcare: building a future-oriented healthcare, strengthening a digitally minded organisational culture, being interactive in a digital environment, leading sustainably in digital healthcare, leading expertise in digital healthcare, leading collaboratively in digital healthcare and using artificial intelligence in leadership in digital healthcare.
Future leadership in digital healthcare will be about leading people in a humane way. Leaders will be at the forefront of digital solutions, sharing their expertise and enabling stakeholders' engagement. Through collaboration, future leaders will be building a future-led digital health system.
Digital healthcare is improving due to the implementation of new digital solutions and the possibility of artificial intelligence. Thus, leaders' competencies in digital healthcare need to be further developed through education and guided by policy to meet the expectations of future professionals, nurses and customers.
No patient or public contribution.
The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used in the reporting.
To explore community nurses' experiences of changes to their roles in palliative and end-of-life care.
An e-survey was followed by focus groups.
Fifty-one community nurses with recent experience of delivering end-of-life care in the United Kingdom completed a survey about changes to their roles. A purposive sample of 35 respondents participated in focus groups exploring these changes in more depth; thematic analysis was used with constant comparison.
As well as two new roles—prescribing and verifying death—many participants talked about a broader expansion of their role, increasing their leadership in making complex end-of-life care decisions with patients and families. Most nurses expressed pride in their new knowledge and skills, and satisfaction with the care they were providing. Yet many also expressed distress that heavy workloads impaired their capacity both to provide good clinical care and to train junior colleagues. The importance of General Practitioner support with complex cases was often highlighted, but accessing such support was sometimes difficult.
While welcoming the opportunity to extend their palliative care roles, many participants indicated experiencing moral distress.
Excessive workloads and patchy medical support threaten the retention of the experienced nurses upon whom community palliative care depends.
Our findings suggest that new and extended palliative care roles are viewed positively by nurses. To be sustainable, these changes require better workload management and consistent medical back-up.
We adhered to relevant EQUATOR guidelines, using the SRQR checklist.
Our Public and Clinician Advisory Group helped shape questions and commented on findings.
To explore the perceptions and experiences of managers in residential aged care settings regarding personal care workers' intention to stay and build a career. Specifically, this study sought to identify enablers and challenges influencing personal care workers' retention and to explore strategies that could improve workforce sustainability.
A qualitative study utilising semi-structured interviews underpinned by the Theory of Planned Behaviour.
The study was conducted in Australia from July 2023 to March 2024. Eleven managers participated in this study. Data were analysed using inductive thematic analysis.
Four themes emerged from the analysis and were conceptualised to illustrate the intricate relationship between recruitment practices, work environment, organisational culture and leadership in influencing personal care workers' intentions to stay in residential aged care. A botanical metaphor was used for each theme. The ‘Diverse Seeds of Varied Potential’ theme highlighted how ad-hoc recruitment processes were a primary driver of workforce instability. Challenging work conditions and differing expectations from personal care workers and management led to ‘Wilting in Adverse Environments’, which also contributed to a broader misalignment between facility culture and values, encapsulated within ‘Mismatched Habitats’. Participants emphasised the need for ‘Building a Greenhouse’, a metaphor for cultivating sustainable leadership and workforce development to address these issues.
This study's findings underscore the critical need for a cohesive approach to workforce development strategies in residential aged care. Transitioning from reactive, ad-hoc recruitment to strategic workforce planning, fostering a supportive organisational culture that aligns with personal care workers' expectations, and prioritising sustainable leadership practices are essential steps. Addressing these interconnected challenges can help build a more stable, committed and skilled workforce, ultimately enhancing the quality and continuity of care for residents.
Strategic workforce planning and sustainable leadership development are essential for building a stable workforce, which directly impacts the quality and continuity of resident care.
This study addressed the critical issue of high turnover among personal care workers in residential aged care facilities, specifically examining managers' perspectives on retention challenges: an underexplored area that is crucial for developing sustainable workforce strategies. The findings revealed that current ad hoc recruitment practices, misalignment between diverse personal care worker profiles and established organisational cultures, have great impact on long-term engagement and retention. These insights are particularly valuable for residential aged care facilities struggling with staffing stability, industry bodies focused on workforce development and educational institutions preparing future aged care workers. Furthermore, the findings can inform policy development aimed at strengthening the aged care workforce, ultimately benefiting the quality of care received by residents.
The Consolidated Criteria for Reporting Qualitative Research (COREQ).
There was no patient or public contribution.
This study explores the lived experiences of critical care nurses who are also mothers, focusing on their challenges with breastfeeding and pumping at work.
Using interpretive phenomenology, grounded in Martin Heidegger's work, semi-structured interviews were conducted with critical care nurses (N = 54) who were also breastfeeding mothers in the United States in 2024. Data were transcribed verbatim and analysed using Patricia Benner's interpretation of the hermeneutic circle in nursing data analysis to identify the essence of lived experiences in breastfeeding as a critical care nurse mother.
Four main themes emerged during the analysis. They are as follows: (1) The Impact of Workplace Environment on Breastfeeding Nurse Mothers and Their Children, (2) The Role of Organisational Support and Resources in Retaining Breastfeeding Nurse Mothers in Critical Care, (3) Team Dynamics and Career Implications of Breastfeeding for Nurse Mothers in Critical Care and (4) Organisational and Systemic Approaches to Supporting Breastfeeding Nurse Mothers in Critical Care.
The findings highlight critical gaps in workplace policies and support systems for breastfeeding nurses. Addressing these inequities through the provision of adequate lactation facilities, flexible pumping schedules and a supportive workplace culture is essential to reducing stress and enabling nurse mothers to continue breastfeeding successfully. This study underscores the need for systemic reforms to support breastfeeding in the nursing profession.
This study did not include patient or public involvement in its design, conduct or reporting.
To explore the lived experience of young people aged 16–24 years diagnosed with melanoma and that of their significant other in England.
Interpretive phenomenological analysis.
Data were collected between August 2023 and January 2024 from one specialist cancer centre in England. Thirteen young people were approached, and 10 took part. Each young person was asked to nominate a significant other. Five nominated a significant other, and five nominated no one. Although interviews were offered face-to-face, virtual was the preferred method. In-depth semi-structured interviews were audio-recorded with the participant's consent. Interview data were transcribed verbatim and analysed.
The core conceptual thread woven throughout the findings was ‘It's like being on a rollercoaster,’ which is representative of the ups and downs of the treatment trajectory, often without the support of age-appropriate specialist care. Four superordinate themes were identified: ‘Is something wrong?’, ‘Suddenly it's serious’, ‘Out on a limb’ and ‘Finding our place’.
Although most young people were treated in a primary treatment centre for adults with cancer, their experience was challenging from route to diagnosis through their treatment and beyond. Few received age-appropriate care to support their physical, emotional, and social wellbeing to help them navigate the experience.
There is limited evidence exploring the experiences of teenagers and young adults living with melanoma or that of their significant other. This enriched understanding supports improvement of the care pathway and service delivery for these young people and their families.
One young person with lived experience was paid as a consultant to be part of the research team. He helped develop the grant application and research questions, data analysis, and writing this paper.
To explore and gain a deeper understanding of how registered nurses in palliative care develop personal and professional approaches in confidential conversations with patients.
A qualitative study using focus groups.
Between March and May 2024, 22 registered nurses working in specialised palliative care in the northern region of Sweden participated in five focus groups. The discussions were recorded, transcribed verbatim and analysed using interpretive description.
Registered nurses pursued meaningful, supportive interactions during confidential conversations. Their reflections revealed vulnerabilities and the importance of continuous self-reflection, fostering growth, resilience and professional development. They sought ways to process emotional challenges, from individual reflection to peer discussions and structured supervision, refining their approaches. Four themes emerged: balancing external demands with inner motivation, recognising personal limitations, managing compassion with professional responsibility and gradually building trust.
Reflection and continuous professional development are essential for navigating confidential conversations in palliative care. These practices help registered nurses balance empathy with boundaries whilst managing emotional and professional challenges. Peer support and shared learning, as well as fostering self-awareness and emotional resilience can enhance care quality and promote sustained professional growth across healthcare settings.
This study highlights the emotional challenges registered nurses face in confidential conversations with patients at the end of life. Reflection and support help them handle these challenges and promote person-centred care by enabling patients to express their inner thoughts and wishes. The findings apply to palliative care and other settings caring for patients at the end of life.
Findings were reported following the Consolidated Criteria for Reporting Qualitative Research guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
To explore how regulatory frameworks, material constraints, and systemic conditions influence nursing practice, focusing on the Nursing and Midwifery Council (UK) Code, emotional labour, gendered expectations, and healthcare technology.
This qualitative study employed a Posthuman Institutional Ethnography (PIE) approach to understand the material and social dynamics that shape nursing practice.
A renal ward in a large acute National Health Service (NHS) hospital in the UK.
The sample consisted of 10 practising nurses, aged from their mid-20s to 50s, with varying lengths of service from 3 to over 30 years, offering diverse perspectives on nursing practice.
Data were collected from October 2018 to April 2019 through documentary analysis, participatory ethnography, multimedia diaries, and semi-structured interviews. Thematic analysis, guided by posthuman and new materialist frameworks, examined how human and non-human actors interact in the production of nurse work.
The Code's emphasis on individual accountability often clashes with systemic barriers such as staffing shortages, outdated healthcare technology, and limited resources, leading to distress and burnout among nurses. Gendered expectations further exacerbate the burden on nurses, contributing to feelings of inadequacy, exhaustion, and emotional strain. Inefficient electronic health records (EHRs) were identified as significant barriers to effective nursing practice.
Addressing systemic barriers is crucial to creating a supportive environment for nurses. Shifting from a model of individual accountability to one of systemic responsibility is vital for enhancing nurse well-being and improving patient care quality. Policy changes must acknowledge systemic factors such as staffing, technology, and resource availability to create a sustainable and effective healthcare system that supports nursing practice.
The study design includes participatory methods where participants create the framing and context of the data included. However, this study did not include patient or public involvement in its design, conduct, or reporting.
To explore mothers' specific discharge preparation needs for preterm infants born before 32 gestational weeks, providing a foundation for developing effective discharge education programmes.
A qualitative descriptive design.
A semi-structured interview was conducted of 16 mothers of preterm infants less than 32 weeks gestation within 1 week post-discharge in March–June 2024. Directed content analysis was conducted using the Integrated Theory of Health Behaviour Change framework to code, categorise, and identify themes within the interview data.
Mothers provided rich, practical, experience-driven feedback regarding discharge preparedness needs. The interview resulted in three emergent themes related to the theory's constructs: maternal needs for knowledge acquisition, multifaceted social support, and adjusting learning strategies. These encompass sub-themes such as observing infant behaviour and health status, basic care knowledge, complex medical care guidance; support from medical staff, family members, fellow parents, community healthcare providers, and Wechat platform tools; learning time arrangement, and preferred learning approaches.
This study explored the discharge preparation needs of mothers with premature infants less than 32 weeks gestation. A nurse-led multidisciplinary team should tailor education programmes, emphasising care knowledge, multifaceted social support, and flexible learning. Future research should assess programme effectiveness on maternal and infant outcomes.
The study's results provided targeted guidance for clinical nursing education, enhancing mothers' readiness for preterm infant discharge and facilitating a smoother NICU-to-home transition.
These findings provide important guidance for nurse-led tailored discharge education and preparation services, thereby promoting improvements in clinical nursing practice and the development of nursing education.
The COREQ checklist was used for reporting.
Four mothers of premature infants (< 32 weeks gestation) provided feedback on the interview guide in the design phase, refining it for the target population, without joining the main study.
To develop a grounded theory that explains how formal care service providers experience caring for and supporting persons with early-onset dementia (EOD).
A grounded theory approach.
Thirty formal care service providers of persons with EOD were recruited from community-based dementia care facilities in northern and central Taiwan from August 2021 and February 2022 using purposive and theoretical sampling. Transcribed face-to-face, semi-structured interview data were analysed with constant comparative analysis. A theoretical framework was constructed from the data to describe the experience of being a formal care service provider for persons with EOD.
The core category of ‘client-as-partner care’ was the theoretical framework that explained the experience of formal care service providers and described how participants met the needs of persons with EOD. Five categories described the components of the process: (1) identifying clients' characteristics; (2) establishing a personal relationship; (3) enhancing self-esteem; (4) maintaining dignity; and (5) the influence of family members and community members. The first four categories were interactive and key to delivering client-as-partner care; the fifth category could alter any key component and reduce or improve the quality of care. Reflections shared by participants offered a window into the outcomes of successful client-as-partner care: quality of life improved for clients and job satisfaction increased for providers.
The client-as-partner care model for persons with EOD required knowledge of the client's unique characteristics, a strong provider-client relationship, offering strategies tailored to the client's abilities and interests, and fostering independence.
Client-as-partner care provides a person-centred approach that enhances support quality for persons with EOD and increases job satisfaction for formal care providers. Successful strategies can inform case management, strengthen support for this population and indirectly improve family caregivers' competencies.
No patient or public contribution.
COREQ (COnsolidated criteria for REporting Qualitative research).
To explore community dwelling adults' lived experiences of participating in death café in Singapore.
A descriptive phenomenological study with Photovoice.
A purposive sample of community dwelling adults who participated in a community-based death café was recruited for this study. Data was collected through online individual semi-structured interviews. The Colaizzi's six-step descriptive phenomenological analysis was conducted for data analysis.
Twenty community dwelling adults who participated in a death café were recruited. Participants' experiences of the death café were expounded in four themes: appeals of attending death cafés, enabling features of death café, engaging in die-logues, and perceived impacts of death café on everyday lives. The participants were attracted to death cafés for various reasons including curiosity and grief. A comfortable environment, accompanied by open dialogues and refreshments, was credited as enablers for death conversations. Through these ‘die-logues’, the participants had a deeper understanding of death and began engaging in advance planning.
Death cafés provide a supportive environment for individuals to engage in death-related conversations that may not easily occur in daily life. By engaging in conversations about mortality within death cafés, participants are encouraged to take proactive steps towards advance planning.
Findings from this study can guide the development of community-based interventions by highlighting the essential components required for a death café tailored to the Asian context.
This study describes the community dwelling adults' lived experiences of participating in a death café. The findings from this study underscore the role of informal conversations about death as a tool to promote population health based palliative care initiatives such as overcoming death taboos and stimulating advance care planning among community dwelling adults.
The Consolidated Criteria for Reporting Qualitative Studies was used.
Community-dwelling adults participated in the interviews.
Managing patients' mental state deterioration in acute hospital settings is a critical challenge, requiring prompt specialised intervention to mitigate adverse outcomes. Current responses vary widely across health systems. Integrating rapid response systems that incorporate mental health expertise offers a promising approach to reduce risks and adverse outcomes.
To evaluate how a response system manages patient mental state deterioration in acute hospital settings, focusing on the mechanisms driving system effectiveness, for whom it works and under what circumstances, using a realist-informed theory-testing approach with field observation.
We conducted non-participant field observations in one trauma and one surgical unit over 4 months to examine the contexts, mechanisms and outcomes shaping a mental state deterioration response system. Observations captured multidisciplinary interactions, escalation processes and decision-making. Structured field notes were thematically coded using a realist framework to refine program theories and identify key factors influencing timely intervention.
Twenty responses were observed, most in the trauma unit. The system worked best when bedside nurses escalated early signs of deterioration, prompting timely intervention. Multidisciplinary collaboration involving nurse unit managers, liaison psychiatry, doctors and allied health professionals activated mechanisms of integrated assessment and coordinated care, enabling both medical and mental health needs to be addressed. Competing medical acuity demands at times reduced system availability. Teleconferencing supported specialist input when in-person attendance was not possible, ensuring person-centred care.
System functioning depended on early risk communication by bedside nurses and proactive multidisciplinary collaboration. Organisational support and staff training are essential to address operational challenges. Findings provide evidence for strengthening response systems to deliver timely, comprehensive interventions that improve physical and mental health outcomes.
DIvERT (De-escalation, Intervention, Early, Response, Team) is a proactive rapid response model of care piloted to improve the management and outcomes of patients experiencing mental state deterioration in acute hospital settings. The model achieves this through structured escalation pathways, proactive interventions and coordinated multidisciplinary collaboration to integrate medical and mental health care. Strengthening organisational support and staff training further reduces reliance on restrictive practices and promotes safer, person-centred care.
What problem did the study address? Acute hospitals face persistent challenges in responding to patient mental state deterioration alongside medical acuity, with existing rapid response systems often insufficiently integrated with mental health expertise. What were the main findings? Field observations of the DIvERT model demonstrated that proactive integration of mental health expertise, supported by organisational investment in training, clear escalation protocols and multidisciplinary collaboration, enabled earlier intervention and more coordinated responses. Where and on whom will the research have an impact? These findings have implications for acute hospital services, informing system-level improvements to rapid response models that support patient safety, reduce adverse events and improve staff wellbeing.
This study adhered to the relevant EQUATOR guidelines. Specifically, reporting followed the RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards II) reporting standards, which provide criteria for transparent and rigorous reporting of realist evaluation methodology.
No patient or public contribution.
To describe the lived decision-making experiences of parents during the first 6 months after their children's new cancer diagnoses.
Descriptive phenomenological study.
This study was conducted from 2022 to 2023 at an academic teaching hospital in Taiwan. Parents of children newly diagnosed with cancer within the previous 6 months were recruited using purposive sampling. Data were collected via in-depth interviews with 18 participants and subsequently analysed using the Giorgi method.
Three major themes emerged: (1) making decisions without choices, with the subthemes of parallel universes and realities and overwhelming information and unanswered questions; (2) deferring decisions to expert judgements, with the subthemes of trust in professionals, working together, and seeing the future; and (c) balancing quality of life and survival, with the subthemes of confronting and suffering, mental preparation and worry, and being a strong supporter and carrying burdens. Hope for their children's survival sustained parents, empowering them to become steadfast sources of strength and support. Through hope, they transitioned from feeling helpless to actively advocating and assuming the primary caregiver role.
After deciding to proceed with their children's cancer treatment, hope for survival becomes the strongest factor motivating parents to navigate, explore, and move forward in an environment filled with uncertainty. Psychological preparation and understanding ease parental anxiety.
The development of clear, structured care plans is recommended to help parents feel supported and transition early from novices to confident guides.
The findings of this study highlight the shift in parents' roles following children's cancer diagnoses from facing unavoidable decision-making to actively striving to balance children's quality of life with treatment outcomes. They provide guidance for the support of parents' engagement with decision-making plans in clinical practice.
Standards for Reporting Qualitative Research.
None.
To characterise nurses' perspectives on factors that influence their ability to provide patient-centered nursing care for autistic patients in a large urban hospital setting.
Qualitative exploratory study.
We conducted semi-structured interviews via Zoom with nurses from a large urban hospital serving primarily adult patients. We analysed interviews using codebook/template analysis. Two researchers coded each interview and resolved discrepancies through discussion.
Twelve nurses (3 males) with 2–20 years of professional experience across research, management, and patient care roles were interviewed. Three primary themes were generated: (1) barriers to patient-centered care, including lack of formal autism education, factors related to the hospital setting, and specific nurse characteristics, such as inflexible adherence to care routines; (2) facilitators of patient-centered care, including experiential autism knowledge, caregiver involvement, and specific nurse characteristics, such as showing respect for all patients; and (3) missed opportunities for patient-centered care, including underuse of behavioural care teams, inadequate time for planning and preparation, and reliance upon restraints and security personnel for behaviour management.
Nurses identified several areas where consistent implementation of existing processes could improve care. A key finding was the need to explore more patient-centered alternatives to the use of restraints and security personnel in response to aggressive or self-injurious behaviour. Overall, our results support the need for competency training to facilitate increased nursing comfort and ability to provide patient-centered care for autistic patients.
This work suggests nurses gain much of their autism-related knowledge through patient care experiences. Despite providing the majority of hands-on care, nurses receive little to no formal training about caring for the growing autistic population.
This work has identified targeted areas to improve education and processes in caring for autistic patients.
No patient or public contribution.
FreshRSS 