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Ayer — Octubre 2nd 2025Tus fuentes RSS

Confidential Conversations in Palliative Care: An Ethnographic Exploration of Trust and Interpersonal Relationship Between Nurse and Patient

ABSTRACT

Aim

To explore aspects of interpersonal relationships in palliative care nursing, focusing on confidential conversations between patients and registered nurses (RN).

Design

A qualitative study employing focused ethnography.

Methods

Data were collected through unstructured participant observations, field notes and interviews with patients and RN in specialist palliative care. Data were analysed using reflective thematic analysis.

Findings

Confidential conversations in palliative care are founded on trust that is fragile and develops dynamically through consistent interactions. Small talk, presence and silence are essential for initiating and maintaining trust and the interpersonal relationship. The environment, patient condition and RN emotional presence and competence shape these conversations. As the relationship evolves, conversations adapt to the patient's changing needs. Missed signals or interruptions can disrupt flow, but the potential for repair remains, allowing for restoration and strengthening of trust and connection.

Conclusion

Confidential conversations in palliative care are grounded in fragile, dynamic trust, necessitating ongoing presence, sensitivity and adaptability from RN. To support these interactions, healthcare environments must prioritise privacy, relational continuity and communication training. Future research should investigate how organisational structures and clinical settings influence confidential conversations.

Implications for the Profession and/or Patient Care

Healthcare environments should facilitate confidential conversations by ensuring relational continuity and minimising distractions. Communication training that emphasises presence and management of silence can strengthen nurse–patient relationships, enhancing patient care and emotional support.

Impact

This study explores key aspects of confidential conversations in palliative care, emphasising trust and emotional sensitivity. It addresses a research gap in palliative care using rare observational methods to deepen understanding of nursing relational aspects. The findings offer practical guidance for enhancing communication and relational skills, informing training and policy development and ultimately, improving emotional support and care.

Reporting Method

Findings are reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.

Patient or Public Contribution

This study did not involve patient or public participation in its design, conduct or reporting.

Perspectives of Healthcare Professionals, Patients and Family Members on Managing Regular Medications Across the Perioperative Pathway: An Exploratory Qualitative Study

ABSTRACT

Aim

To explore healthcare professionals', patients', and family members' experiences of managing regular medications across the perioperative pathway in a specialist cancer hospital in Melbourne.

Design

An exploratory qualitative study using a descriptive-interpretive approach.

Methods

Interviews were conducted with 11 patients and seven family members, and focus groups with 10 anaesthetists, seven surgeons, four nurses, and 10 pharmacists (N = 49) between October 2024 and April 2025. Transcripts were analysed using Braun and Clarke's reflexive thematic approach and mapped into the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 human factors framework.

Results

Three interrelated themes were constructed: (1) Work system elements shaping perioperative medication management, encompassing medication and surgical contexts, documentation gaps, reliable medication information, communication infrastructures, roles and responsibilities, and perioperative area resources; (2) Processes influencing medication management practice, characterised by continuity of care at transition points and flagging processes, interdisciplinary collaboration and role interpretation in medication management, patient involvement, family member involvement, and healthcare professional perspectives; and (3) Outcomes of medication management, including patient and organisational outcomes, such as workflow inefficiencies, procedure cancellations, and unplanned readmissions.

Conclusion

Findings indicated that addressing the complexity of perioperative medication safety demands coordinated contributions across multiple professional disciplines. Strengthening interdisciplinary collaboration, clarifying shared responsibilities, embedding structured reconciliation processes at transitions of care, standardizing communication protocols, and involving patients and families are all critical strategies.

Implications for the Profession and/or Patient Care

This study highlights the need for interdisciplinary coordination and clear role definitions, with nurses as the key contributor, to support collaborative medication decisions in perioperative cancer care.

Impact

This study explored challenges in managing regular medications during cancer surgery, offering insights to guide safer practices for perioperative teams, patients, and families in cancer care settings.

Reporting Method

COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.

Patient or Public Contribution

None.

Emotions in Nursing Care Prioritisation Decisions: A Critical Incident Debriefing Study of Missed Nursing Care

ABSTRACT

Aim

To examine the decision-making processes underlying missed nursing care.

Design

A qualitative study using Critical Incident Debriefing interviews.

Methods

Fifteen nurses from inpatient wards in a general hospital participated in semi-structured interviews following their morning shifts. Interviews focused on care prioritisation incidents leading to missed nursing care. Data were analysed using thematic analysis.

Results

Analysis revealed a central theme of emotions as crucial determinants in care prioritisation decisions. Two subthemes emerged: emotions as drivers of care prioritisation decisions and emotions as responses to these decisions. Positive emotions motivated nurses to prioritise care for specific patients, while negative emotions sometimes led to care delays. Successful care completion generated professional satisfaction, while care omissions produced complex emotional responses, including guilt, frustration and helplessness.

Conclusion

The dual emotional processes identified in this study—emotions functioning as both drivers and responses in care decisions—challenge purely structural explanations of missed nursing care. This perspective reframes nurses as emotionally engaged decision-makers who actively navigate care priorities rather than passively react to contextual constraints, offering a more comprehensive framework for understanding the complexity of clinical judgement in real-world settings.

Implications for the Profession and/or Patient Care

This study positions emotions as legitimate components of clinical decision-making rather than cognitive biases. For nursing practice, this necessitates integrating emotional awareness into professional development. For patient care, recognising emotional underpinnings may promote equitable care distribution through interventions that engage with the emotional realities of nursing work.

Impact

This study addressed limited understanding of decision-making in missed nursing care, particularly emotions' role. Findings reveal how emotions influence nurses' prioritisation decisions and wellbeing, with implications for nurses, educators and administrators seeking interventions addressing structural and emotional dimensions.

Reporting Method

This study adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines (Appendix S1).

Patient or Public Contribution

No patient or public contribution.

Perceptions of Recurrence Risk Among Patients With Atrial Fibrillation: A Qualitative Study

ABSTRACT

Aims

The study aims to investigate patients' perceptions of recurrence risk associated with atrial fibrillation, with the goal of establishing a theoretical foundation for developing future measurement scale and intervention strategies.

Design

A qualitative interview study.

Methods

Seventeen patients diagnosed with atrial fibrillation at a Grade-A tertiary hospital participated in semi-structured, in-depth interviews conducted between October and December 2024. Participants were selected via purposive sampling. The data were analysed employing thematic analysis in accordance with Colaizzi's method. The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.

Results

The perceptions of recurrence risk among patients with atrial fibrillation can be summarised into five themes: (1) perceived likelihood of recurrence, (2) perceived severity of recurrence, (3) perceived triggers of recurrence, (4) emotional reaction to recurrence, and (5) efficacy perception of managing recurrence risk.

Conclusion

Perceptions of recurrence risk among patients with atrial fibrillation are diverse and often underestimated due to limited knowledge and subjective symptom interpretation, affecting health behaviours. Understanding patients' subjective appraisals, emotions, and perceived efficacy is essential. Validated assessment tools and tailored risk communication may enhance self-management and support targeted interventions.

Impact

This study provides critical insights into how atrial fibrillation patients perceive their risk of recurrence. It also provides a theoretical foundation for creating validated assessment tools and tailoring individualised health education and intervention programmes.

Patient Contribution

Patients were involved in the study design, data collection, and interpretation of findings. Their contributions included providing feedback on the initial interview guide to ensure relevance and clarity, participating in in-depth interviews to share their lived experiences with atrial fibrillation recurrence, and offering reflections on key themes emerging from the data.

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Beyond AIC: An Interpretive Descriptive Qualitative Study of Youth Experiences and Perceptions of Living With Type 2 Diabetes

ABSTRACT

Objective

To generate an in-depth understanding of the perceptions and experiences of individuals with youth-onset type 2 diabetes (T2D) to inform knowledge translation initiatives and clinical care.

Design

Interpretive descriptive qualitative study.

Methods

Individuals were eligible to participate if they received a T2D diagnosis on or before 18 years of age, resided in Manitoba, and were between 10 and 25 years of age at the time of data collection. Twenty-two individuals (13 females, 7 males, 2 prefer not to indicate gender; mean age = 19.3 years) participated in 22 semi-structured interviews (mean length: 29:01 min) remotely using Zoom video conferencing software or by telephone. Data were analysed using inductive thematic analysis.

Results

Four themes were generated: (1) Low public knowledge, misconceptions, and stigma impact youth experiences including those of diagnosis, disclosure, treatment, and supports; (2) shared familial experiences impacts perception of the future; (3) mental and emotional wellness is critically important but requires more attention; and (4) T2D carries unanticipated positive and negative impacts for youth.

Conclusions

Findings illustrate the complex interrelationships between public and personal conceptions of T2D, stigma, and T2D navigation, emphasising the centrality of emotional and mental well-being to participants' T2D experiences and management. This representation of experiences and perceptions of youth onset T2D offers direction for holistic and youth-centred research and care and highlights areas where further mental health and educational resources would be beneficial.

Patient and Public Contribution

The knowledge translation resource being developed from this study involves input from patient and public partners.

Individual's Experience of Living With Roux‐en‐Y Gastric Bypass Surgery: An Interpretative Phenomenological Analysis

ABSTRACT

Aim

To explore the lived experience following Roux-en-Y gastric bypass surgery of eight men and women in the South of England who had undergone surgery a minimum of 12 months prior.

Design

This phenomenologically based qualitative study utilised Interpretative Phenomenological Analysis (IPA) as a framework for the analysis and exploration of participants' lived experiences.

Method

Semi-structured individual interviews were conducted with eight men and women in the South of England in 2017.

Results

Interpretative Phenomenological Analysis revealed four superordinate themes: Managing change and uncertainty; The affective experience of change; The post-operative body within its relational context; and The presence and absence of appropriate support.

Conclusion

Participants described the complex nature of the post-operative experience and highlighted the deeply personal nature of the adjustment required following surgery. The process of change and adjustment does not represent a smooth transition from pre- to post-operative life, and the experience of weight loss is intertwined with relationships that require patients to renegotiate the ways in which they understand themselves within social encounters.

Implications and Contribution

The clinical significance of this study lies in its support for the contribution that an existential phenomenological approach can offer in supporting individuals who choose to have bariatric surgery through its acknowledgment of the body as a site of experience which is situated within a person's wider social, cultural and historical world. These findings contribute an in-depth appreciation of the biopsychosocial experiences of individuals following Roux-en-Y gastric bypass surgery that can be applied in nursing practice to better inform the development of appropriate ways in which to support the overall wellbeing of individuals who made the decision to undergo bariatric surgery.

Patient and Public Contribution

Limited patient involvement was incorporated, focusing on feedback on the interview process.

Understanding Health Literacy in Fluid Management in Individuals Receiving Haemodialysis: A Directed Qualitative Content Analysis

ABSTRACT

Aims

To describe the perspectives of individuals receiving haemodialysis regarding health literacy in fluid management.

Design

A qualitative descriptive approach using directed content analysis of interviews from an explanatory mixed methods study.

Methods

Semi-structured individual interviews were conducted from September 2020 to February 2021 with 28 individuals receiving haemodialysis who had attended a prior quantitative study. A directed qualitative content analysis approach was used to identify categories and subcategories emerging from the data.

Results

Six categories of health literacy were identified: (1) active health management, (2) engagement with healthcare providers, (3) understanding and support from healthcare providers, (4) social support, (5) health information literacy and (6) navigation of the healthcare system.

Conclusions

Based on their real-life experience, individuals receiving haemodialysis have unique health literacy needs regarding fluid management. A comprehensive understanding of these unique needs is crucial in creating person-centered interventions to address inadequate fluid restriction.

Implications for the Profession and/or Patient Care

Interventions to address inadequate fluid restriction should be person-centered, considering each individual's unique health literacy needs. This involves conducting a comprehensive assessment of individuals' health literacy needs, empowering individuals to actively engage in health, engaging the entire support network and facilitating health information literacy in line with individuals' preferences.

Impact

This study offers detailed insights into the health literacy needs related to fluid management in individuals undergoing haemodialysis. The findings could inform the development of person-centered fluid management strategies for these individuals.

Reporting Method

We adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.

Patient or Public Contribution

No patient or public contribution.

Changes in Breastfeeding Relationships When Frontline Essential Working Mothers Return to Work During the COVID‐19 Pandemic: A Longitudinal Qualitative Online Study

ABSTRACT

Aims

Many frontline essential working mothers returned to work outside of the home after maternity leave during the COVID-19 pandemic. The purpose of this study is to describe the changes in breastfeeding relationships.

Design

A longitudinal descriptive qualitative design was used.

Methods

Four open-ended questions were asked to explore breastfeeding experiences at home, mothers' thoughts and feelings during direct breastfeeding, strategies to solve their breastfeeding problems, and workplace breastfeeding support. Data were collected by an online survey at 1, 3, 5 and 6 months between June 2022 and August 2023. Data were analysed using inductive content analysis from 21 mothers in the United States who were directly breastfeeding at least once a day for the first 6 months. The trustworthiness of study results involved coding by consensus, peer debriefing, and maintenance of an audit trial.

Results

The core construct, “Changes in Breastfeeding Relationships When Frontline Essential Working Mothers Return to Work Outside of the Home” explained mothers' experience in four domains: (1) Breastfeeding changes, (2) Changes in sleep arrangements, (3) Social support to continue breastfeeding, and (4) Physical and emotional distress of mothers and infants.

Conclusion

Unrestricted direct breastfeeding upon reunion through the night along with co-sleeping was the strategy mothers used to restore breastfeeding relationships with their infants and continue direct breastfeeding. Scheduled feeding and solitary sleep resulted in less direct breastfeeding, had negative consequences such as low milk supply, slow infant weight gain, and maternal distress.

Impact

Even though frontline essential working mothers persevered with the complexities of their work during the COVID-19 pandemic, findings highlight challenges mothers faced with their breastfeeding experience. Nurses need to discuss with mothers expected challenges of less frequent direct breastfeeding along with emotional tolls while being separated from their infant and strategies to develop sustainable breastfeeding relationships and continuation of direct breastfeeding.

Patient or Public Contributions

None.

Advance Care Planning in Oncology Nursing: An Interpretive Description Study

ABSTRACT

Aim

To explore oncology nursing advance care planning practices and understand how to better support nurses in conducting advance care planning with patients and their families.

Design

Qualitative interpretive descriptive methodology.

Methods

Semi-structured, individual telephone or Zoom interviews with 19 oncology nurses in a Western province of Canada between May and August 2022. Interviews were audio-recorded, transcribed, de-identified, and analysed using inductive, thematic, and constant comparative techniques.

Results

Oncology nurses highlighted several factors affecting their ability to engage in advance care planning, including (1) uncertainties related to the nursing role in advance care planning, such as how and when a nurse ought to engage; (2) the educational, experiential, and training environment; and (3) structural barriers, such as a lack of time, space, and privacy; models of care that inhibit nurses from developing longitudinal relationships with their patients; and team dynamics that affect advance care planning interdisciplinary collaboration.

Conclusion

To create environments that support oncology nurses to conduct advance care planning, the findings suggest uncertainties be addressed through a clear and cohesive organisational approach to advance care planning and ongoing, integrated educational opportunities. Further, service delivery models may need to be restructured such that nurses have dedicated time and space for nurse-led advance care planning and opportunities to develop trusting relationships with both patients and their interdisciplinary colleagues.

Implications for the Profession and/or Patient Care

Impact

Oncology nurses recognised the value of advance care planning in supporting patient-centred care and shared decision making, yet they reported limited engagement in advance care planning in their practice. To support oncology nurses in conducting advance care planning, healthcare leaders may address (1) advance care planning-related uncertainties and (2) structural barriers that prevent nurses from engaging in advance care planning with patients and their families. Findings may guide modifications to care models, enhancing support for oncology nurses in conducting advance care planning.

Reporting Method

We selected and adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) as the most applicable guideline.

Patient or Public Contribution

No patient or public contribution.

Exposure to Violence for Nurses Across Ethnic Groups: A Qualitative Study

ABSTRACT

Aim

To explore the social context of violence for hospital-based and community nurses from different ethnic groups, the types of violence experienced or witnessed both in and outside the workplace, and its impact on mental and physical health.

Design

Cross-sectional, qualitative study using semi-structured interviews.

Methods

Semi-structured interviews were conducted online with 12 hospital-based and community nurses recruited from London, England, between May and August 2021. Data were analysed using reflexive thematic analysis.

Results

The sample comprised seven hospital nurses and five community nurses. Four themes were identified: (i) the social context in which nurses from different ethnic groups are exposed to community violence; (ii) types of workplace violence experienced or witnessed by hospital-based and community nurses from different ethnic groups; (iii) perceptions of the factors contributing to workplace violence; (iv) impacts of violence on mental and physical health outcomes. Using the social ecological framework and sociological theory of stress, these findings informed a conceptual stress process model of violence exposure for nurses.

Conclusion

Nurses from different ethnic groups are exposed to violence both in and outside the workplace which negatively affects their mental and physical health. Effective violence prevention requires a multi-factorial approach that addresses the social and institutional factors contributing to violence, shifting the focus from individual measures to systemic organisational changes.

Impact

The NHS workforce is currently more diverse than ever, and healthcare leaders must improve access to mental health and well-being resources for staff affected by workplace violence, particularly for those who hold multiple social identities at the intersection of ethnicity, gender and age. Prioritising this support is essential not only to safeguard against negative health outcomes but also to improve the recruitment and retention of healthcare professionals.

Patient or Public Contribution

No patient or public contribution.

Bridging the Social Gap Through ‘Conscious Caring’: A Constructivist Grounded Theory of the Art of Caring for Older Adults With Dual Sensory Impairment

ABSTRACT

Aim

The aim of this study was to develop a conceptual understanding of the role of caring for older adults with combined vision and hearing impairment (DSI).

Background

Dual sensory impairment (DSI) impacts both listening and speechreading communication, function and social participation, meaning that older adults often require support and care to ‘age in place’ successfully. Family carers play a key role in supporting older adults with DSI to maintain social and physical health.

Design/Methods

This qualitative study uses Charmaz's constructivist grounded theory (GT) methodology. Data were collected between 2017 and 2019 and analysed using constructivist GT methods. Lengthy interviews with eight family carers of older adults living with DSI explored personal histories of DSI, relationships with families, social networks and health care professionals.

Results

This study demonstrates that caring in this context is predominantly social and ‘invisible’. To reduce the social effort of their family member with DSI and to maintain their own self-identity, family carers adopted a ‘conscious caring’ approach. This is conceptualised as an approach to caring that supports family carers to access resources embedded in their social networks by bridging the gap between the dyad and their broader, more diverse social networks.

Conclusion

This study identifies that a reduction in both close and broader social networks limits personal, social and psychosocial resources and impacts the capacity of the dyad to renegotiate their roles, create and maintain their individual and shared social networks and successfully transition to living with DSI.

Implications

There is a gap in the literature regarding the impact of sensory impairments on complex communication, health and social care needs of older adults and the role that family carers play. Registered nurses require complex communication skills to support older persons with DSI during health and social care interactions. A better understanding of DSI itself, as well as understanding the key role family carers play in integrating care for their family member, is crucial to delivering person-centred care.

Impact

This study addresses a growing social gerontological issue and identifies the role that family carers play in integrating health and social care for their family member with DSI. Better professional recognition of DSI and increased visibility of the challenges of living with DSI could help address barriers to effective communication between service providers, formal care support staff and those with DSI. Integrating family carers into care teams is critical to improving health and social care experiences for both caregiver and care receiver.

No Patient or Public Involvement

This study did not include patient or public involvement in its design, conduct, or reporting.

Navigating Prediabetes in a Foreign Country: A Qualitative Study of Self‐Management Experiences Among Chinese‐Speaking Immigrants in Australia

ABSTRACT

Aim

Chinese-speaking immigrants in Australia have a higher risk of type 2 diabetes and face more barriers to accessing quality healthcare compared to non-culturally and linguistically diverse populations. This study aimed to explore the self-management experiences of Chinese-speaking Australians with self-reported lived experience of prediabetes following immigration.

Design

Qualitative study.

Methods

Semi-structured interviews were conducted with 10 purposively selected Australian Chinese-speaking immigrants aged over 40 years. Data collection was undertaken in Perth, Western Australia between April and August 2024. Data were analysed using reflexive thematic analysis.

Results

Three themes are presented in this paper: (1) An acculturation journey: Reshaping cultural identity and social connections in immigrant lives, (2) Embodying prediabetes: Cognitive reconstruction and emotional adaptation in the transition to the patient role and (3) Decision-behaviour dynamics: Mapping agency and adaptiveness in self-management processes. Participants demonstrated dynamic adjustment through the processes of self-awareness, adaptive behaviours, self-reflection and self-attribution of health outcomes.

Conclusion

Chinese-speaking Australians navigating prediabetes following immigration underwent a complex process of reconstruction across cognitive, cultural and psychological domains. Prediabetes self-management was shaped by cultural values, acculturation, dietary preferences, emotional resilience, local and distant social networks and resource availability. These findings underscore the importance of empowering both individuals and communities through evidence-based and culturally appropriate strategies.

Implications and Impact

Participants experienced profound transformations in their cultural adaptation, prediabetes cognition, social support networks and emotional–psychological landscape. Future interventions must address identified barriers (e.g., cooking burden, comorbidities, stress), facilitators (e.g., leisure travel, family support), motivations (e.g., cultural heritage, health risk perception) and challenges (e.g., knowledge–behaviour gap, digital health information) that shape self-management behaviours. A community empowerment approach, utilising evidence-based content, flexible delivery formats and existing cultural networks, should be adopted to offer promising pathways for prediabetes health education.

Reporting Method

The study adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines.

Patient or Public Contribution

Limited patient and public involvement was incorporated, with two community representatives providing feedback on interview questions and recruitment strategies.

Transgender Men's and Non‐Binary People's Experiences of Cervical Cancer Screening—A Journey Mapping Approach

ABSTRACT

Background

Research indicates various barriers to cervical cancer screening for transgender people, contributing to cancer inequities. Further research is required to better understand how these barriers affect experiences along the screening trajectory, from engaging with information, through invitation and testing, to receiving test results. Research exploring how transgender people navigate these barriers is also required.

Aim

To explore the experiences of cervical cancer screening in Sweden among transgender people who were assigned female at birth, and to identify touchpoints in need of improvement along the cervical cancer screening trajectory.

Design

Qualitative interview study inspired by journey mapping.

Methods

Semi-structured interviews (n = 18) and interpretive description analysis.

Results

Five phases were identified comprising participants' cervical cancer screening journey, with touchpoints in each phase indicating key experiences, barriers, and strategies to navigate barriers. Experiences of touchpoints were affected by four interrelated dimensions: The embodied person—personal gender identity, relationship with own body, and transition process; System factors—policies, routines, and practices; Gender norms and transphobia; and Prior healthcare experiences. Significant barriers included a lack of trans-specific screening information; an invitation system that does not automatically invite male-registered individuals with a cervix; lack of trans competency among clinics and staff; female-centred clinics; gender dysphoria; anticipation or fear of being mistreated; distrust of healthcare authorities; and participant-staff power dynamics.

Conclusion

To make cervical cancer screening more equitable for transgender people, barriers need to be addressed by considering the four dimensions that affect these barriers.

Implications for the Profession and/or Patient Care

Findings show that staff involved in policy and clinical practice can improve transgender people's experiences of cervical cancer screening by promoting agency and self-determination in each screening phase. This involves providing inclusive information, continuing invitations for male-registered individuals with a cervix, enhancing trans-competency, and addressing power dynamics in staff-participant interactions.

Reporting Method

The Standards of Reporting Qualitative Research (SRQR).

Patient or Public Contribution

Representatives from the Regional Cancer Centre Stockholm–Gotland were involved in the conceptualisation of this study. Representatives from trans and LGBTQI+ organisations, Regional Cancer Centres, and the National Board of Health and Welfare have provided feedback during the analysis and writing phases.

Patient Participation in Decision‐Making During Nursing Care: A Relational Autonomy Perspective

ABSTRACT

Aim

To explore patient participation in decision-making during nursing care experienced by patients with chronic diseases, family members and nurses.

Design

Focused ethnography.

Methods

This study included an 8-month fieldwork in a Chinese hospital. Fieldnotes from 90 h of participant observation and 30 semi-structured interviews (10 nurses, 13 patients, three family members, and four with both patients and family members present) were analysed using reflexive thematic analysis.

Results

Patient participation in decision-making was facilitated in the form of co-determination, which respected patients' relational autonomy. However, participation required further development or was challenged in the form of unilateral determination, constraining relational autonomy. Interpersonal relationships among nurses, patients and family members played a significant role in promoting patient participation in decision-making.

Conclusion

A relational autonomy framework was identified to understand patient participation in decision-making within nursing care. While patient participation is encouraged and autonomy is respected in some situations, paternalistic approaches still persist in clinical practice.

Implications for the Profession and/or Patient Care

Enhancing nurses' awareness of involving patients and family members in decision-making is needed. The findings highlight the need for better integration and implementation of existing guidelines to support healthcare staff, patients and family members. They also point to the importance of developing culturally relevant frameworks to promote patient participation in decision-making in nursing care.

Impact

This research provided insight into the experiences of chronically ill patients, family members and nurses regarding patient participation in decision-making during inpatient nursing care within a non-Western context. Interpersonal dynamics are highlighted as a key element influencing patient participation.

Reporting Methods

The study is reported using the COREQ checklist.

Patient or Public Contribution

No patient or public contribution.

Nurse and Other Healthcare Managers' Experiences and Recommendations for Patient Incident Reporting Processes and Real‐Time Software Development: A Qualitative Study

ABSTRACT

Aims

To (1) analyse managers' experiences with handling patient safety incident reports in an incident reporting software, identifying key challenges; (2) analyse the incident report processes from the managers' perspective; (3) examine managers' perceptions of ways to support and improve health professionals' experiences of report-handling processes; and (4) investigate how, from their point of view, incident reporting software should be developed in the future.

Design

A descriptive qualitative study.

Methods

Interviews and focus group discussions on Microsoft Teams from 11/2024 to 3/2025, including 16 participants, analysis with deductive and inductive content analysis.

Results

Of 16 participants, 15 were managers and one was a patient safety expert. Most were nurse managers (n = 9). Four discussion themes were divided into 30 categories. Participants highlighted the need to improve the reporting software's terminology, classification and analysis tools. The use of artificial intelligence was desired but not currently integrated into the software. Participants were unsure of their skills to use all the software features. Clear and transparent handling processes, feedback, managers' behaviour and communication methods were seen as key to improving staff's experience with report processes. A real-time warning system was considered beneficial for various incident types. Specific questions must be answered before further developing such systems.

Conclusion

This study deepened the understanding of reporting software's challenges regarding its handling features. The handling processes of incident reports had multiple shortcomings, which may negatively affect health professionals' experiences in report handling. Real-time warning systems could assist healthcare managers in processing reports.

Implications for the Profession and/or Patient Care

Organisational-level guidance for incident report processing is needed. Improvements to report processing and reporting software can improve shared learning and understanding of the status of patient safety.

Patient or Public Contribution

No patient or public contribution.

Reporting Method

COnsolidated criteria for REporting Qualitative research Checklist.

Social Representations of Bedside Milk Expression Among Mothers of Preterm Newborns in Neonatal Intensive Care Units

ABSTRACT

Aim

To understand the social representations of bedside milk expression (BME) among mothers of preterm newborns in neonatal intensive care units (NICUs).

Design

Qualitative descriptive study.

Methods

The study was conducted from July to August 2024 in two NICUs of a referral maternity hospital in Fortaleza, Brazil. Nineteen mothers of hospitalised premature newborns participated. Semi-structured interviews were conducted and subjected to thematic content analysis.

Results

Mothers perceived BME as a meaningful act of protection and bonding, though some were unfamiliar with the practice. Emotional ambivalence was common, shaped by prior breastfeeding experiences and the context of prematurity. Discomfort related to privacy and shared spaces was noted. Support from healthcare professionals was essential to promote understanding and adherence.

Conclusion

Social representations of BME are shaped by emotional, social and institutional experiences. Anchored in prior breastfeeding experiences and cultural meanings of maternal care, the practice is objectified through both gestures of affection and tangible barriers.

Implications for the Profession and/or Patient Care

Healthcare professionals, particularly nurses, should receive training to support mothers in BME. Structural improvements, privacy and emotional support are essential for fostering maternal autonomy and confidence.

Impact

This study highlights the barriers to BME, emphasising the role of healthcare support and the need for better infrastructure, privacy and training to enhance maternal confidence and breastfeeding.

Reporting Method

The study followed the Consolidated Criteria for Reporting Qualitative Research checklist.

Patient or Public Contribution

None.

What Does This Paper Contribute to the Wider Global Clinical Community?

This paper highlights the pivotal role of healthcare professional support in overcoming barriers to BME and promoting breastfeeding practices.

What Already Is Known?

Fresh breast milk is considered the gold standard for reducing complications and improving survival in preterm infants. BME is recommended as an effective strategy to ensure the availability of fresh breast milk. Mothers' social representations of this practice remain underexplored within the neonatal intensive care context.

What This Paper Adds?

Explores mothers' social representations of BME in NICUs, addressing a significant gap in qualitative research. Reveals how emotional, social and institutional factors shape mothers' perceptions, motivations and challenges related to BME. Highlights the need for targeted professional support, improved infrastructure and privacy to enhance maternal autonomy and adherence to milk expression practices.

Implications for Practice

Healthcare professionals, particularly nurses, should receive specialised training to provide technical guidance and emotional support, enhancing mothers' confidence and autonomy in BME. Improving infrastructure and ensuring privacy in NICUs are crucial to creating supportive environments that facilitate milk expression and strengthen maternal–infant bonding. Institutional policies should integrate maternal-centred strategies to support breastfeeding continuity and promote humanised neonatal care.

Structural Resilience Across the Life Course: Perspectives From Older Adults Racialized as Black

ABSTRACT

Aim(s)

This study explored perceptions of older adults racialised as Black on structural resilience across the life course.

Design

A qualitative descriptive study.

Methods

Using purposive sampling, we recruited 15 Black adults aged 50 and older residing in Baltimore, Maryland, including individuals possessing historical or current knowledge of the community. Semi-structured interviews were conducted to elicit participants' experiences with structural resources during childhood, adulthood and late adulthood. Interviews were audio-recorded, transcribed verbatim and analysed using content analysis.

Results

Of the 15 participants, three identified as male (20.0%) and 12 as female (80.0%), with an average age of 70.9 ± 8.2 years. The analysis identified nine categories of structural resilience, confirming its multifaceted and dynamic nature. Common categories present across all life stages included: Built environment, civic engagement, food and housing, healthcare, and social capital and cohesion. Life stage–specific categories included child and family services, educational supports, and workforce development supports during childhood and adulthood, and financial support during adulthood and late adulthood.

Conclusion

These categories were interdependent and spanned across life stages, illustrating the dynamic, cumulative and relational qualities of structural resilience. Furthermore, structural resources were identified as key to safeguarding, empowering and restorative responses to adversity.

Impact

These findings contribute to the development of a nuanced, life course–informed framework of structural resilience and highlight the need for ecological strategies that address structural forces shaping health and well-being, particularly among older adults racialised as Black.

Reporting Method

This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist.

Patient or Public Contribution

No patient or public contribution.

Intrinsic Influences on Medical Emergency Team Call Stand‐Down Decision‐Making: An Observational Study

ABSTRACT

Aim

The aim of this research was to describe factors that influence Intensive Care Unit liaison nurses' decision to stand down a medical emergency team call response. The decision to end a medical emergency team response for a deteriorating patient is referred to as the medical emergency team call stand-down decision. Intensive Care Unit liaison nurses, also known internationally as critical care outreach nurses, make medical emergency team call stand-down decisions in complex and challenging clinical environments. However, the factors influencing these decisions are not well described in the literature.

Design

Exploratory descriptive qualitative study.

Methods

Seven Intensive Care Unit liaison nurses who attended medical emergency team calls in a large acute metropolitan tertiary referral public hospital, with a mature three-tiered rapid response system, were observed and interviewed. Observations of 50 medical emergency team call responses and 50 post medical emergency team call interviews were conducted between March 2022 and August 2022. Findings were analysed using inductive content analysis.

Results

Intensive Care Unit liaison nurse decisions to stand down MET call responses were influenced by three intrinsic factors: (1) propositional knowledge, (2) experiential knowledge, (3) situational knowledge and information processing styles. Intensive Care Unit liaison nurses utilised these intrinsic factors to support their decision to terminate medical emergency team call response.

Conclusion

This study explored the intrinsic influences on individual Intensive Care Unit liaison nurses in deciding to end a medical emergency team call. By highlighting these individual influences on decision-making, the findings may be used to support medical emergency team responders educational needs and identification of potential heuristics and biases inherent in clinical decision-making which contribute to adverse events.

Patient or Public Contribution

No patient or public contribution.

Implications for Profession and/or Patient Care

By understanding the influences on an individual's clinical decision-making, strategies can be put in place for educational development and support for experiential learning. The study highlights areas of potential bias and heuristic use that may lead to sub-optimal clinical decisions and increased risk for deteriorating patients. Research findings can be applied internationally to a range of rapid response systems and critical care outreach teams that respond to deteriorating patients.

Reporting Method

The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting this study.

Siblings of Children With Cancer and Their Challenges Across Everyday Life Contexts: A Two‐Phase Qualitative Study in Denmark

ABSTRACT

Aim

To explore the familial, emotional, social and school-related challenges experienced by school-aged siblings of children with cancer, focusing on how these challenges intersect across hospital, home and school in their everyday lives.

Design

Qualitative, two-phase, multi-site study.

Methods

Fieldwork was conducted at two distinct paediatric oncology wards, followed by semi-structured interviews with 11 siblings (aged 7–19 years) and 20 parents, recruited through criterion-based sampling. The data were analysed using reflexive thematic analysis.

Results

Analysis showed that siblings were often marginalised in hospital life due to (1) family logistics; (2) hospital-induced restrictions, rules and physical spaces and (3) perceptions of their presence as ‘problematic’, ultimately limiting their access. In family life, siblings experienced peripheral roles because (1) they were cared for by others, (2) had their needs subordinated and (3) faced shifting expectations. At school, siblings encountered (1) limited understanding from classmates and teachers and (2) insufficient support resources.

Conclusions

Siblings of children with cancer face significant, interconnected challenges, often amplified by the structural frameworks of healthcare, family and school contexts.

Impact

Siblings of children with cancer are often marginalised in their own lives. In healthcare, a family-centred approach to care should formally and actively include siblings. Nurses are well-positioned to promote this, ensuring whole-family support. Siblings would benefit from coordinated support bridging hospital, home and school.

Reporting Method

This study adheres to the SRQR Checklist.

Patient or Public Contribution

Parents helped shape the study focus by discussing preliminary observations and potential support needs.

Identity and Body in Emerging Adults With Congenital Heart Disease: A Qualitative Exploration

ABSTRACT

Aim

To explore the identity and body experiences of emerging adults with congenital heart disease.

Design

Qualitative descriptive study.

Methods

Narratives from 152 emerging adults about living with congenital heart disease and its impact on their identity and body experiences were analysed using template analysis. An inductive and deductive approach was combined, and the frameworks of illness identity and experience of embodiment were used as a starting point.

Results

The template analysis generated two primary themes: (1) identity and (2) body, each containing several subthemes. For identity, the subthemes were (1.1) illness identity and (1.2) acknowledgement. For body, the subthemes were (2.1) the dimensions of embodiment and (2.2) the process of embodiment. In addition, the related themes (3) self in light of the other and (4) lack of impact were included.

Conclusion

This study highlights the unique challenges emerging adults with congenital heart disease can encounter regarding their identity and body experiences.

Implications for Patient Care

Patient care would benefit from adopting a more holistic and person-centred approach that fosters positive identity and body experiences in emerging adults with congenital heart disease.

Impact

This study deepens our understanding of how congenital heart disease affects identity and body experiences in emerging adults. Recognising these aspects as crucial to psychological care can facilitate patients in sharing identity and body-related challenges and receiving tailored support.

Reporting Method

This study adheres to the EQUATOR guidelines and used SRQR as the reporting method.

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