Suicide prevention strategies for older persons-An integrative review of empirical and theoretical papers.

AIM: To synthesize suicide prevention strategies for older adults. The review question was Which suicide prevention strategies are useful for older adults? DESIGN: Integrative review. DATA SOURCES: Academic Search Premier, CINAHL, Ovid PsycINFO and PubMed were searched for articles published between January 2009 and December 2019. REVIEW METHODS: An integrative review of quantitative, qualitative and theoretical papers with a qualitative thematic analysis. RESULTS: Key aspects of the included studies contributed to the formulation of four themes: (1) Recognizing older adults' physical and/or mental health problems and referring them for help and treatment, (2) Designing an educational programme, (3) Communication and dialogue about warning signs and (4) Social support and awareness of causing significant others emotional pain. The findings indicate an urgent need to identify effective suicide prevention strategies for older adults.

Qualitative evaluation in nursing interventions-A review of the literature.

Aim: To identify and synthesize qualitative evaluation methods used in nursing interventions. Design: A systematic qualitative review with a content analysis. Four databases were used: MEDLINE, PsycINFO, Embase and CINAHL using pre-defined terms. The included papers were published from 2014-2018. Methods: We followed the guidelines of Dixon-Woods et al., Sandelowski and Barroso, the Critical Appraisal Skills Programme qualitative checklist and The Confidence in the Evidence from Reviews of Qualitative Research Approach. Results: Of 103 papers, 15 were eligible for inclusion. The main theme Challenging complexity by evaluating qualitatively described processes and characteristics of qualitative evaluation. Two analytic themes emerged: Evaluating the implementation process and Evaluating improvements brought about by the programme. Conclusion: Different qualitative evaluation methods in nursing are a way of documenting knowledge that is difficult to illuminate in natural settings and make an important contribution when determining the pros and cons of an intervention.

A meta-ethnographic synthesis of qualitative research on women's experience of midwifery care.

Labor and birth constitute a significant emotional event for a childbearing woman. The aim was to explore women's reflections on their experiences of labor and birth and how these were influenced by the midwifery care they received. A modified version of Noblit and Hare's meta-ethnographic approach was used to develop an inductive and interpretive synthesis of nine qualitative articles. Relevant databases were searched and qualitative articles appraised by means of the Critical Appraisal Skills Program. Two metaphors were identified: The guide-Please share your knowledge and The motherly midwife as an anchor. The comprehensive understanding of the images evoked by the metaphors resulted in an overall metaphoric representation of the women's experiences: The midwife as a birth pilot, that is, a positive labor and birth experience is dependent on the relationship with the midwife. This finding confirms previous knowledge that a trusting relationship results in confidence, while feeling secure leads to a positive birth experience. The metaphors facilitate understanding of the significance of the midwife for women's labor and birth experiences. Knowledge of labor and birth experiences helps to broaden understanding of the necessity of midwives being willing to engage, act, be aware of errors that may affect women's birth experience, and employ tools to predict unexpected adverse events.

Patients' Experiences of Participating Actively in Shared Decision-Making in Mental Care.

BACKGROUND: Patients in mental care express a wish for more active participation. Shared decision-making is a way of increasing patient participation. There is lack of research into what the shared decision-making process means and how the patients can participate in and experience it in the context of mental care. OBJECTIVE: To describe patient participation in shared decision-making in the context of indoor mental care. METHOD: A qualitative content analysis of data from in-depth interviews with 16 patients was performed. RESULTS: One main theme was revealed: thriving in relation to participating actively in a complementary ensemble of care, which represented the red thread between 2 themes: having mental space to discover my way forward and being in a position to express my case. CONCLUSION: Patients can participate actively in shared decision-making when the patients' and the mental health-care professionals' joint expertise is applied throughout their mental care. The patients experience thriving when participating actively in a complementary ensemble of care.

Development of resilience in nursing students: A systematic qualitative review and thematic synthesis.

Resilience is a term commonly used to describe the ability to turn adversity into opportunities and learn from demanding situations. There seems to be a need to identify support strategies for developing resilience among nursing students in order to strengthen their professional practice. The aim of this review was to synthesize qualitative research exploring how resilience can be developed in nursing students. The review question was: How can nurse educators support students' development of resilience? Relevant publications were identified by systematic data searches in May 2017 in the following electronic databases: MEDLINE, CINAHL, Scopus, Embase, PubMed, PsycInfo, Webb of Science, ProQuest, Academic and Eric. Eight qualitative research studies in English that explored resilience in the context of nursing education were included. Five descriptive themes emerged: Demonstrating caring relationships, Recognizing resources and power, Acknowledging uncertainty, Reframing burdensome experiences and Adjusting frames for learning. In addition, two overarching analytic themes emerged: An educational culture of trustworthiness and Readiness to care. In conclusion, a learning culture characterized by trustworthiness appears to be a catalyst for developing resilience in nursing students. A variety of support strategies in nursing education contribute to resilience in nursing students, thus influencing their readiness to care.

Being in a space of sharing decision-making for dignified mental care.

WHAT IS KNOWN ON THE SUBJECT?: Several studies describe barriers and facilitators for implementing shared decision-making in mental care, yet a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care. Mental care is intended to empower the patients by increasing their responsibility and self-awareness and helping them to use their own resources. Too much focus on the patients' independence, responsibility and choice may hinder the patients getting the help they need. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The meaning of SDM can be understood as a continuous relational process between the patients and MHCPs in search of dignified care. Practising shared decision-making is a challenging process which requires the MHCPs to possess high professional competence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental healthcare professionals should be conscious of their own role in the asymmetrical power relationship in decision-making and use their professional competence for their patients' benefit. Clinical supervision can be a tool for developing professional competence and is considered important when assisting mental healthcare professionals practising shared decision-making for dignified care. Abstract Introduction Several studies describe barriers and facilitators for implementing shared decision-making in mental care. However, a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care by placing them at the centre of care. Too much focus on the patients' autonomy may hinder them getting the help they need. A comprehensive understanding of shared decision-making is needed for its implementation. Aim/research question To interpret the meaning of shared decision-making in mental care as perceived by patients and mental healthcare professionals. The research question was: What is the meaning of shared decision-making in mental care? Method A hermeneutic inductive design with a thematic interpretative analysis of data was performed from in-depth interviews with 16 patients and multistage focus group interviews with eight mental healthcare professionals. Results The overall theme being in a space of sharing decision-making for dignified mental care was described by the three themes engaging in a mental room of values and knowledge, relating in a process of awareness and comprehension and responding anchored in acknowledgement. Discussion Balancing the patients' need for assistance with autonomy, while safeguarding their dignity, is a challenging process requiring mental healthcare professionals to possess professional competence. Implications for practice Organized professional development of the carers' professional competence is important to facilitate shared decision-making.

Risk management-Evaluation of healthcare professionals' reasoning about and understanding of maternity care.

AIM: To evaluate healthcare professionals' explanations of the prerequisites for safe maternity care and understanding of risk management, including the underlying reasons for decision-making intended to ensure safe care. BACKGROUND: Risk management focuses on maintaining and promoting safe care by identifying circumstances that place childbearing women at risk of harm, thus reducing risks. METHODS: A hermeneutic action research approach was chosen. Through a series of focus group sessions, we uncovered healthcare professionals' explanations of risk management. RESULTS: One overriding theme emerged; the consequences of what managers do or fail to do constitute the meaning of taking responsibility for team collaboration to provide safe care. Inadequate support, resources and staff shortages have consequences, such as inability to concentrate on team communication and collaboration, leading to the risk of unsafe care. CONCLUSION: Communication constitutes a prerequisite for both team collaboration and risk management. Thus, communication is linked to the ability of managers and healthcare professionals to provide safe care. IMPLICATIONS FOR NURSING MANAGEMENT: In terms of safety management, nurse managers have a significant role in and responsibility for supporting communication training, developing guidelines and providing the prerequisites for interprofessional team reflection.

Association between illegal use of substances and suicidal behavior in school students: An integrative review of empirical data.

PURPOSE: Investigation of the association between type of suicidal behavior and type and frequency of illegal use of substances (IUS) among school students (aged between 12 and 18 years), with a focus on gender differences. DESIGN AND METHODS: A systematic review in PubMed, CINAHL, PsychINFO, and Scopus was performed. Identified articles were published between 2007 and 2018. RESULTS: Twenty empirical studies confirmed the association between IUS and suicidality, strongly differentiated between males and females, highlighting the importance of gender-specific mediating factors. CONCLUSIONS: Mental health nurses need to document gender factors, frequency, and motivation of IUS when screening adolescents experiencing suicidal behavior and IUS.

Factors that influence the health of older widows and widowers-A systematic review of quantitative research.

AIM: To examine factors that influence the health of older widows and widowers. The review question was: What is the evidence of the relationship between widowhood and health in older adults? DESIGN: Systematic review. DATA SOURCES: Academic Search Elite, CINAHL, Medline (Ovid) and PubMed were searched for articles published between January 2013-December 2017. REVIEW METHODS: A systematic review of quantitative research with a qualitative thematic analysis. RESULTS: The selection process resulted in 12 studies. One of the themes that emerged was: emotional challenges related to experiences of bereavement, depression and anxiety, which was based on the sub-theme social support as the main strategy for coping with emotional pain and suffering. The second theme was: struggling with poor physical health. The findings indicate that healthcare professionals need knowledge and skills to deal with the health consequences of widowhood in old age. Building community teams can prevent emotional and physical health problems, as well as reduce mortality.

A Paradigm Shift in Nurse Specialist Clinical Supervision-Implementation of a Competence Program.

The change of the anesthesia-, intensive-, surgery-, and oncological nursing postgraduate education into clinical-oriented master programs makes it necessary to increase the professional skills of nurse specialist clinical supervisors. A competence program for clinical supervisors (15 credits) was developed by a university in Norway from 2014 to 2015 in order to facilitate capacity building of academic and pedagogical knowledge. To illuminate nurse specialist clinical supervisors' learning components by implementing a competence program in clinical supervision. A qualitative document analysis of 44 written assignments made by 18 nurse specialist clinical supervisors participating in the competence program, which were collected from the University's electronic learning platform. One main theme and two themes emerged: Changes in the professional paradigm, Learning components that influence clinical supervisors' style and Learning components that have an impact on clinical supervisors' professional growth. This study provides valuable insight into the learning components in clinical supervision that have contributed to a change in the nurse specialist clinical supervision paradigm. The supervisors have formal competence to provide clinical supervision to postgraduate students at master level. The program confirms the value of educating nurse specialist clinical supervisors and we recommend that it should be continued and further evaluated.

A qualitative evaluation of healthcare professionals' perceptions of adverse events focusing on communication and teamwork in maternity care.

AIM: The aim of this study was to explore healthcare professionals' (HCPs) perceptions of adverse events (AE) during childbirth with focus on communication and teamwork. BACKGROUND: Inadequate communication, a poor teamwork climate and insufficient team training are harmful to women. Reviews of reported AE can be used to develop a safety culture based on preparedness for preventing AE and strengthening patient safety (PS). DESIGN: Action research principles were used to facilitate the implementation and evaluation of this study. METHODS: An interprofessional team of HCPs comprising obstetricians, registered midwives and assistant nurses employed at a labour ward agreed to take part. Data were collected from multistage focus group interviews (March 2016-June 2016) and analysed by means of interpretative thematic analysis. FINDINGS: Two analytical themes based on five sub-themes emerged; promoting interprofessional teamwork and building capabilities by involving HCPs and elucidating relevant strategies. The findings reveal the importance of facilitating relationships based on trust and respectful communication to ensure a safe environment and provide safe maternity care. CONCLUSION: There is a need for formal and informal support for quality interprofessional teamwork. Research on PS may reduce AE related to miscommunication and poor teamwork. We recommend different forms of communication and teamwork training in interprofessional teams to increase the ability to provide feedback. Accumulated research is required for the evaluation of evidence-based models in the PS context.

Links between patient safety and fear of childbirth-A meta-study of qualitative research.

AIM: To conduct a meta-study of qualitative empirical research to explore the links between patient safety and fear of childbirth in the maternity care context. The review questions were: How are patient safety and fear of childbirth described? and What are the links between patient safety and fear of childbirth in the maternity care context? DESIGN: Meta-study. DATA SOURCES: The CINAHL, Cochrane, PubMed, Webb of Science, Proquest and Medline (Ovid) electronic databases were searched for articles published between June 2000-June 2016. REVIEW METHODS: A meta-study of qualitative research with a thematic analysis followed by a synthesis. RESULTS: Four descriptive themes emerged: "Physical risks associated with giving birth vaginally"; "Control and safety issues"; "Preventing psychological maternal trauma and optimizing foetal well-being"; and "Fear of the transition to motherhood due to lack of confidence". The two overarching analytical themes: "Opting for safety" and "An insecure environment breeds fear of childbirth", represent a deeper understanding and constitute the synthesis of the links between patient safety and fear of childbirth. This meta-study indicates the need for increased commitment to safe care and professional support to reduce risks and prevent unnecessary harm in maternity care.

The Association between Deliberate Self-Harm and School Bullying Victimization and the Mediating Effect of Depressive Symptoms and Self-Stigma: A Systematic Review.

BACKGROUND: Identifying deliberate self-harm in the young and its relationship with bullying victimization is an important public health issue. METHODS: A systematic review was performed to explore evidence of the association between deliberate self-harm and school bullying victimization in young people, as well as the mediating effect of depressive symptoms and self-stigma on this association. An advanced search in the following electronic databases was conducted in January 2018: PubMed/Medline; CINAHL; PsycINFO; PsycARTICLES; Science Direct; Scopus, and Cochrane Library. Studies that fulfilled the inclusion criteria were further assessed for their methodological integrity. The Norwegian Knowledge Centre for Health Services tool was applied for cross-sectional studies and the Critical Appraisal Skills Programme instrument for the cohort studies. Only empirical quantitative studies published in the English language in peer reviewed journals during the last decade (2007-2018) aimed at exploring the association between deliberate self-harm and school bullying victimization in community-based schoolchildren with a mean age of under 20 years were included. RESULTS: The reviewed cross-sectional and cohort studies (22) revealed a positive association between school bullying victimization and deliberate self-harm, including nonsuicidal self-injury, which remained statistically significant when controlled for the main confounders. The mediating role of depressive symptoms in the association between deliberate self-harm and school bullying victimization was confirmed. A dose-response effect was shown in the association between nonsuicidal self-injury and school bullying victimization, whilst the mediating effect of depressive symptoms needs to be further explored. No studies were found directly exploring the mediating effect of self-stigma in the association between deliberate self-harm and bullying victimization. CONCLUSION: Targeted interventions aimed at eliminating victimization behaviours within the school context are therefore proposed, as well as interventions to promote healthy parenting styles for the parents of schoolchildren. Moreover, school healthcare professionals should screen students involved in bullying for self-injury, and vice versa.

Qualitative exploration of fear of childbirth and preferences for mode of birth among Japanese primiparas.

Antenatal fear of childbirth (FOC) is associated with negative effects, such as postnatal traumatic symptoms. As the birth-related culture of East Asian countries differs from that in Western countries, the aim of the present qualitative, descriptive study was to explore FOC, perceptions for Caesarean section (CS), and obstetric analgesia (OA) among Japanese primiparas. The qualitative, descriptive study included focus group interviews with 11 primiparous women, which were conducted in a birth house and a maternity hospital in a metropolitan area of Japan in 2013. As a result, seven categories emerged from the analysis: Maternal and child risk, pain, losing control, uncertainty, prolonged labor, poor family support and loneliness before hospitalization. All participants denied having a preference for CS birth due to fear. Opposing values of OA were identified in women who chose OA and those who did not. In conclusion, it is necessary to increase clinical awareness that the objects of fear are diverse. Furthermore, diverse values regarding OA should be understood and equally respected by health-care professionals.

Qualitative study of women's experiences of safe childbirth in maternity care.

Few studies have focused on women's childbirth experiences in relation to patient safety. The aim of this study was to explore the meaning of safety as a process phenomenon by outlining women's positive and negative experiences of safety in childbirth. A descriptive explorative design was chosen and 16 interviews were conducted. Qualitative content analysis was used. One main theme emerged: safe childbirth through involvement and guidance, based on four subthemes. The characteristics of women's experiences of safe childbirth included the need to be informed and involved by sharing and receiving trustworthy information. Women's experiences of unsafe childbirth included lack of meaningful and trustworthy information that resulted in feelings of being misled or lulled into a false sense of security. Not being involved evoked feelings of being ignored. In conclusion, this study highlights issues of importance for safe maternity care. The perspectives of childbearing women can contribute to an understanding of how to achieve meaningful improvements to provide safer maternity care.

Strategies for teaching evidence-based practice in nursing education: a thematic literature review.

BACKGROUND: Evidence-based practice (EBP) is imperative for ensuring patient safety. Although teaching strategies to enhance EBP knowledge and skills are recommended, recent research indicates that nurses may not be well prepared to apply EBP. A three-level hierarchy for teaching and learning evidence-based medicine is suggested, including the requirement for interactive clinical activities in EBP teaching strategies. This literature review identifies the teaching strategies for EBP knowledge and skills currently used in undergraduate nursing education. We also describe students' and educators' experiences with learning outcomes and barriers. METHODS: We conducted literature searches using Medline, Embase, CINAHL, ERIC and Academic Search Premier. Six qualitative studies and one mixed-method study met the inclusion criteria and were critically evaluated based on the Critical Appraisal Skills Programme. Using Braun and Clarke's six phases, the seven studies were deductively and thematically analysed to discover themes. RESULTS: Four teaching strategy themes were identified, including subthemes within each theme: i.e., interactive teaching strategies; interactive and clinical integrated teaching strategies; learning outcomes; and barriers. Although four studies included a vague focus on teaching EBP principles, they all included research utilisation and interactive teaching strategies. Reported learning outcomes included enhanced analytical and critical skills and using research to ensure patient safety. Barriers included challenging collaborations, limited awareness of EBP principles and poor information literacy skills. CONCLUSION: Four of the seven analysed studies included a vague focus on the use of EBP teaching strategies. Interactive teaching strategies are used, but primary strategies focus on searching for and critically appraising research for practice-based application. Although this review included a relatively small sample of literature, the findings indicate a need for more qualitative research investigating interactive and clinically integrated teaching strategies towards further enhancing EBP undergraduate nursing students' knowledge and skills.

First-line nurse managers' perceptions of the challenges involved in decision-making when older patients' wish to die.

Aim: The aim of this study was to explore first-line nurse managers' perceptions of the challenges involved in decision-making concerning older patients who wish to die. Design: A descriptive qualitative design in three communities in Norway between January 2016 and June 2016. Methods: Qualitative focus group interviews with eight first-line nurse managers. Results: One main theme and two themes were identified: Struggling to make the right decision, The challenge of social isolation and loneliness and When life becomes too painful and problematic. The sub-themes revealed that: Arranging social meeting places where the older patients can talk to other older people is crucial. The participants explained that it was not an easy task to gain an overview of the older patients situation. The right decision could be encouraging the patients to talk about their problems by giving them more time, thereby showing that somebody cares about them.

Shared Decision-Making-Balancing Between Power and Responsibility as Mental Health-Care Professionals in a Therapeutic Milieu.

BACKGROUND: Shared decision-making (SDM) is supposed to position patient and expert knowledge more equal, in which will have an impact on how mental health-care professionals relate to their patients. As SDM has not yet been widely adopted in therapeutic milieus, a deeper understanding of its use and more knowledge of interventions to foster its implementation in clinical practice are required. AIM: To explore how mental health-care professionals describe SDM in a therapeutic milieu as expressed through clinical supervision. The research question was "What are prerequisites for mental health-care professionals to practice SDM in a therapeutic milieu?" METHODS: A qualitative content analysis of data from focus groups dialogues in 10 clinical supervision sessions where eight mental health-care professionals participated was performed. FINDINGS: The theme, practicing SDM when balancing between power and responsibility to form safe care, was based on three categories: internalizing the mental health-care professionals' attributes, facilitating patient participation, and creating a culture of trust. CONCLUSION: SDM is a complex and arduous process requiring appropriate interventions. Clinical supervision is necessary for reflection on SDM and for improving practice in a therapeutic milieu.

Aetiological relationships between factors associated with postnatal traumatic symptoms among Japanese primiparas and multiparas: A longitudinal study.

OBJECTIVE: this study aims to identify the aetiological relationships of psychosocial factors in postnatal traumatic symptoms among Japanese primiparas and multiparas. DESIGN: a longitudinal, observational survey. SETTING: participants were recruited at three institutions in Tokyo, Japan between April 2013 and May 2014. Questionnaires were distributed to 464 Japanese women in late pregnancy (> 32 gestational weeks, Time 1), on the third day (Time 2) and one month (Time 3) postpartum. MEASUREMENTS: The Japanese Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) version A was used to measure antenatal fear of childbirth and social support, while the Impact of Event Scale Revised (IES-R) measured traumatic stress symptoms due to childbirth. FINDINGS: of the 464 recruited, 427 (92%) completed questionnaires at Time 1, 358 (77%) completed at Time 2, and 248 (53%) completed at Time 3. Total 238 (51%) were analysed. A higher educational level has been identified in analysed group (p=0.021) Structural equation modelling was conducted separately for primiparas and multiparas and exhibited a good fit. In both groups antenatal fear of childbirth predicted Time 2 postnatal traumatic symptoms (ß=0.33-0.54, p=0.002-0.007). Antenatal fear of childbirth was associated with a history of mental illness (ß=0.23, p=0.026) and lower annual income (ß =-0.24, p=0.018). Among multiparas, lower satisfaction with a previous delivery was related to antenatal fear of childbirth (ß =-0.28, p < 0.001). KEY CONCLUSIONS: antenatal fear of childbirth was a significant predictor of traumatic stress symptoms after childbirth among both primiparous and multiparous women. Fear of childbirth was predicted by a history of mental illness and lower annual income for primiparous women, whereas previous birth experiences were central to multiparous women. IMPLICATION FOR PRACTICE: the association between antenatal fear of childbirth and postnatal traumatic symptoms indicates the necessity of antenatal care. It may be important to take account of the background of primiparous women, such as a history of mental illness and their attitude towards the upcoming birth. For multiparous women, focusing on and helping them to view their previous birth experiences in a more positive light are vital tasks for midwives.

Enhancing students' moral competence in practice: Challenges experienced by Malawian nurse teachers.

BACKGROUND: Nurses and student nurses in Malawi often encounter challenges in taking a moral course of action. Several studies have demonstrated a need for increased awareness of ethical issues in the nursing education. OBJECTIVE: To explore the challenges experienced by nurse teachers in Malawi in their efforts to enhance students' moral competence in clinical practice. RESEARCH DESIGN: A qualitative hermeneutic approach was employed to interpret the teachers' experiences. PARTICIPANTS AND RESEARCH CONTEXT: Individual interviews (N = 8) and a focus group interview with teachers (N = 9) from different nursing colleges were conducted. ETHICAL CONSIDERATIONS: Ethical approval was granted and all participants signed their informed consent. FINDINGS: Two overall themes emerged: (1) authoritarian learning climate, with three subthemes: (a) fear of making critical comments about clinical practice, (b) fear of disclosing mistakes and lack of knowledge and (c) lack of a culture of critical discussion and reflection that promotes moral competence; and (2) discrepancy between expectations on learning outcome from nursing college and the learning opportunities in practice comprising three subthemes: (a) gap between the theory taught in class and learning opportunities in clinical practice, (b) lack of good role models and (c) lack of resources. DISCUSSION: Our findings indicated that showing respect was a central objective when the students were assessed in practice. A number of previous studies have enlightened the need for critical reflection in nursing education. Few studies have linked this to challenges experienced by teachers for development of moral competence in practice. This is one of the first such studies done in an African setting. CONCLUSION: There is a clear relationship between the two themes. A less authoritarian learning climate may enhance critical reflection and discussion between students, teachers and nurses. This can narrow the gap between the theory taught in college and what is demonstrated in clinical practice. Moral competence must be enhanced in order to ensure patients' rights and safety.