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

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

REDUCE missed oral healthcare: The outcomes of and learnings from an implementation project in an acute geriatric unit.

Oral healthcare is one of the most missed aspects of fundamental care. Failure to provide reliable and effective daily oral healthcare for older patients can lead to hospital-acquired pneumonias, longer hospital stays, increased health costs, and poor patient experience. The objective of this study was to codesign, implement, and evaluate an oral healthcare intervention for older adults in a geriatric unit. This mixed methods implementation project combined the hospital's quality improvement processes with the i-PARIHS knowledge translation framework. Multilevel facilitation guided the development of multidisciplinary implementation strategies, which were co-designed, tailored, and implemented at the ward and organizational level, targeting: awareness/engagement; clinical guideline development; building workforce capacity; access to appropriate products; patient awareness and support; utilization of multidisciplinary/dental referral pathways; and systematizing oral healthcare documentation. Gaps between evidence-based and current oral healthcare practice were identified through audits of practice and interviews with patients. Interviews and surveys with staff evaluated the feasibility and acceptability of the oral healthcare intervention and the success of implementation strategies. At the conclusion of the project, awareness, attitudes, and capacity of staff had increased, however, we could not demonstrate change in multidisciplinary oral healthcare practices or improvements for individual patients. Despite mixed success, the project informed discussions about including oral healthcare as a national healthcare standard for the acute care sector in Australia. Attempts to address oral healthcare may have started locally, but its impact was through policy change, which will empower health practitioners and managers to support practice change more widely.

Identifying the contributors to nursing caring success stories.

AIMS: To (a) seek examples of nursing caring success stories and (b) identify the common contributors to these successes. By focusing on the successes of nursing care rather than critically examining failures, this research seeks to provide examples of proven and feasible approaches and processes for improving care. DESIGN: This study used a narrative inquiry design. METHODS: Data were collected through group interviews. Four interviews were conducted with a total of 20 nurse participants working in inpatient settings in South Australian hospitals. A thematic analysis approach was used to analyse the data. RESULTS: Two dominant themes concerning the contributors to caring success were identified. These contributors were (1) the provision of holistic care and (2) the influence of the caring community, which includes family members and other patients. The findings also indicated that the definition of caring success according to nurses is not aligned with organisational performance indicators but is more closely represented by caring values. CONCLUSION: Success, according to nurses, is not exclusively defined by patient outcomes but includes the approach to, and process of, care delivery. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses value the caring process while working in an environment that primarily values clinical and systems-level outcomes. Nurses want patients and their families, allied health professionals and hospital executives to be involved and invested in the process of care. IMPACT: This study addressed a gap in the current literature to identify commonalities in nursing success stories, the contributors informing these successes and how these contributors can facilitate improved patient care. Understanding nursing definitions of caring success provides an opportunity to expand upon current accepted industry definitions and perspectives such as key performance indicators. REPORTING METHOD: Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. PATIENT OR PUBLIC CONTRIBUTION: No direct patient or public contribution.

The impact of using an authentic patient video on health professional students' attitudes toward interprofessional and person-centered care.

Authentic patient activities in an interprofessional education (IPE) setting can develop collaborative, practice ready health professionals who have the skills to work within and across teams with patients at the center of their care. In this qualitative study, the student experience of a novel interprofessional case study activity, with lived experience content delivered via an authentic patient video was explored. Transcripts were analyzed using reflexive thematic analysis and identified three major themes: (a) from disease-centered to person-centered care, (b) reflecting on roles in interprofessional collaborative practice, and (c) teamwork and lived experience facilitates learning. When considered within the Interprofessional Education Collaborative (IPEC) framework, the student experience suggested positive change in all four core competencies: interprofessional communication, values and ethics, roles and responsibilities and teamwork. In addition, students highly valued the interprofessional learning experience, and the patient video created a more realistic case study by reducing clinical assumptions. In conclusion, a short, single exposure to a written case followed by an authentic patient video in an IPE setting had an immediate positive impact on entry-level student health professionals. This simple methodology is a viable way of bringing the authentic patient voice into the classroom with additional benefit from the interprofessional format.

Clinical supervision experience of nurses in or transitioning to advanced practice: A systematic review.

AIMS: To systematically explore the clinical supervision (CS) experience for nurses transitioning to advanced practice. DESIGN: A qualitative systematic review using Joanna Briggs Institute meta-aggregation following an a priori protocol published on PROSPERO (CRD42023426658). DATA SOURCES: Qualitative studies obtained from Medline, CINAHL, PsycINFO, Scopus, Emcare and ERIC databases and ProQuest dissertations and theses for peer-reviewed, published and unpublished studies from inception to July 2023. REVIEW METHODS: Two authors conducted data screening and abstraction. Quality was appraised using the Critical Appraisal Skills Programme tool and reporting followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist for systematic reviews. RESULTS: Sixteen studies contributed to five synthesized findings: CS that is beneficial requires structure and commitment, trusting relationships are foundational for learning, lifting burdens and preventing burnout, learning through reflection, critical thinking and feedback and barriers to CS. CONCLUSIONS: This review provides a meaningful exploration of CS to support nurses transitioning to advanced practice. Well-structured supervision offers a safe space to share work-related concerns and develop an advanced practitioner identity. Sharing experiences helps alleviate work-related burdens and reduce professional isolation and burnout. IMPLICATIONS FOR THE PROFESSION: Peer-support networks are vital for successful transition to advanced practice. IMPACT: This review highlighted the impact of effective supervisory relationships in forming professional identity and possible links with nursing retention. PUBLIC CONTRIBUTION: No direct patient contributions are included as it forms part of a research degree.

The ILC Maine statement: Time for the fundamental care [r]evolution.

AIM: The aim of this study was to present the third position statement from the International Learning Collaborative (ILC). The ILC is the foremost global organization dedicated to transforming fundamental care. Internationally, fundamental care is reported to be poorly delivered, delayed or missed, negatively impacting patients, their families/carers and healthcare staff and systems. Overcoming this global challenge requires profound transformation in how our healthcare systems value, deliver and evaluate fundamental care. This transformation will take both evolutionary and revolutionary guises. In this position statement, we argue how this [r]evolutionary transformation for fundamental care can and must be created within clinical practice. DESIGN: Position paper. METHODS: This position statement stems from the ILC's annual conference and Leadership Program held in Portland, Maine, USA, in June 2023. The statement draws on the discussions between participants and the authors' subsequent reflections and synthesis of these discussions and ideas. The conference and Leadership Program involved participants (n = 209) from 13 countries working primarily within clinical practice. RESULTS: The statement focuses on what must occur to transform how fundamental care is valued, prioritized and delivered within clinical practice settings globally. To ensure demonstrable change, the statement comprises four action-oriented strategies that must be systematically owned by healthcare staff and leaders and embedded in our healthcare organizations and systems: Address non-nursing tasks: reclaim and protect time to provide high-value fundamental care. Accentuate the positive: change from deficit-based to affirmative language when describing fundamental care. Access evidence and assess impact: demonstrate transformation in fundamental care by generating relevant indicators and impact measures and rigorously synthesizing existing research. Advocate for interprofessional collaboration: support high-quality, transdisciplinary fundamental care delivery via strong nursing leadership. CONCLUSION: The ILC Maine Statement calls for ongoing action - [r]evolution - from healthcare leaders and staff within clinical practice to prioritize fundamental care throughout healthcare systems globally. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: We outline four action-oriented strategies that can be embedded within clinical practice to substantially transform how fundamental care is delivered. Specific actions to support these strategies are outlined, providing healthcare leaders and staff a road map to continue the transformation of fundamental care within our healthcare systems. IMPACT: Fundamental care affects everyone across their life course, regardless of care context, clinical condition, age and/or the presence of disability. This position statement represents a call to action to healthcare leaders and staff working specifically in clinical practice, urging them to take up the leadership challenge of transforming how fundamental care is delivered and experience globally. PATIENT OR PUBLIC CONTRIBUTION: Patients, service users and caregivers were involved in the ILC annual conference, thus contributing to the discussions that shaped this position statement. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The strategies and actions outlined in this position statement are relevant to all clinical settings globally, providing practical strategies and actions that can be employed to enhance fundamental care for all patients and their families/carers. By outlining the importance of both evolutionary and revolutionary change, we identify ways in which healthcare systems globally can begin making the necessary steps towards radical fundamental care transformation, regardless of where they are in the change journey.

Newly graduated nurses' commitment to the nursing profession and their workplace during their first year of employment: A focused ethnography.

BACKGROUND: The commitment of nurses to their profession and workplace is closely linked to the delivery of high-quality patient care. Existing literature highlights the positive impact of commitment on care quality and patient outcomes. Conversely, a lack of commitment can lead to nurse burnout and disengagement. However, it remains unclear whether and how cultural beliefs and practices influence newly graduated nurses' commitment to the nursing profession and their workplace. AIM: To explore the cultural beliefs and practices influencing newly graduated nurses' commitment to the profession and commitment to their workplace during their first year of employment. DESIGN: A focused ethnographic study. METHODS: Data consisted of field notes from 94 h of participant observations and 10 semi-structured interviews with newly graduated nurses working in acute care settings in Denmark. Data were analysed using ethnographic content analysis. Data were collected between March and June 2022. RESULTS: The findings reveal a major theme, termed 'A State of Transience among Newly Graduated Nurses', consisting of two themes: 'Newly Graduated Nurses' Pursuit of Professional Development and Supportive Work Environments' and 'A Lack of Formal Agreements or Conditions to Meet Expectations for Professional Development.' CONCLUSION: Hospitals and nurse managers need to support newly graduated nurses in their first employment after registration by providing a range of clinical experiences through job rotation opportunities within the same organization, deliver on promises for onboarding support and foster a culture of trust. These strategies will help maintain the motivation, commitment and ability of newly graduated nurses to deliver high-quality patient care, thereby reducing the likelihood of turnover. RELEVANCE FOR CLINICAL PRACTICE: A trusting and supportive work environment is fostered by providing diverse clinical experiences and consistent support for newly graduated nurses. To address potential high turnover associated with job rotation, hospitals need to rethink how retention is defined and measured, moving beyond hospital unit-level models and measures. REPORTING METHOD: This study reports to the SRQR guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

'I wasn't made to feel like a nut case after all': A qualitative story completion study exploring healthcare recipient and carer perceptions of good professional caregiving relationships.

BACKGROUND: Professional caregiving relationships are central to quality healthcare but are not always developed to a consistently high standard in clinical practice. Existing literature on what constitutes high-quality relationships and how they should be developed is plagued by dyadic conceptualisations; discipline, context and condition-specific research; and the absence of healthcare recipient and informal carer voices. This study aimed to address these issues by exploring how healthcare recipients and carers conceptualise good professional caregiving relationships regardless of discipline, care setting and clinical condition. DESIGN: A qualitative story completion approach was used. Participants completed a story in response to a hypothetical stem that described a healthcare recipient (and, in some instances, carer) developing a good relationship with a new healthcare provider. Stories were analysed using reflexive thematic analysis. PARTICIPANTS: Participants were 35 healthcare recipients and 37 carers (n = 72 total). RESULTS: Participants' stories were shaped by an overarching discourse that seeking help from new providers can elicit a range of unwanted emotions for both recipients and carers (e.g., anxiety, fear, dread). These unwanted emotions were experienced in relation to recipients' presenting health problems as well as their anticipated interactions with providers. Specifically, recipient and carer characters were fearful that providers would dismiss their concerns and judge them for deciding to seek help. Good relationships were seen to develop when healthcare providers worked to relieve or minimise these unwanted emotions, ensuring healthcare recipients and carers felt comfortable and at ease with the provider and the encounter. Participants positioned healthcare providers as primarily responsible for relieving recipients' and carers' unwanted emotions, which was achieved via four approaches: (1) easing into the encounter, (2) demonstrating interest in and understanding of recipients' presenting problems, (3) validating recipients' presenting problems and (4) enabling and respecting recipient choice. Participants' stories also routinely oriented to temporality, positioning relationships within recipients' and carers' wider care networks and biographical and temporal contexts. CONCLUSION: The findings expand our understanding of professional caregiving relationships beyond dyadic, static conceptualisations. Specifically, the findings suggest that high-quality relationships might be achieved via a set of core healthcare provider behaviours that can be employed across disciplinary, context and condition-specific boundaries. In turn, this provides a basis to support interprofessional education and multidisciplinary healthcare delivery, enabling different healthcare disciplines, specialties, and teams to work from the same understanding of what is required to develop high-quality relationships. PATIENT OR PUBLIC CONTRIBUTION: The findings are based on stories from 72 healthcare recipient and carer participants, providing rich insight into their conceptualisations of high-quality professional caregiving relationships.

New graduate nurses' delivery of patient care: A focused ethnography.

AIM: To explore factors influencing newly graduated nurses' delivery of direct care in acute care hospital settings. DESIGN: Qualitative study using focused ethnography. METHODS: During the period from March to June 2022, a total of ten newly graduated nurses were purposively sampled, and data were collected through 96 h of participant observation as well as ten semi-structured interviews. This research took place in a large hospital located in Denmark. Data were analysed using LeCompte and Schensul's ethnographic content analysis. RESULTS: Three main structures were developed from the data: 'Contrasting Intentions and Actions for care delivery', 'Organizational Constraints Block Interpersonal Aspects of Nursing Care' and 'Newly Graduated Nurses' Suppressed Need for Support Constitutes Delay in Care Actions'. CONCLUSION: Newly graduated nurses were committed to delivering high-quality care but were aware they sometimes provided compromised care. The paradox between a commitment to care and compromised care delivery was borne out of tensions between newly graduated nurses' professional beliefs and nursing values, a desire to integrate patients' needs and preferences, and organizational constraints on everyday practices where newly graduated nurses often worked alone without the support of a more experienced nurse. Critical reflection on cultural, social and political forces that influence direct care delivery might support newly graduated nurses to deliver direct patient care more intentionally. RELEVANCE TO CLINICAL PRACTICE: Establishment of onboarding programs and other support activities for newly graduated nurses to cope with contrasting intentions and actions that must address organizational constraints is essential. These development programs should include how critical reflection competency is supported to address value inconsistencies and emotional distress to ensure high-quality patient care. REPORTING METHOD: The reporting adhered to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: 'No Patient or Public Contribution'.

Factors influencing the delivery of nutritional care by nurses for hospitalised medical patients with malnutrition; a qualitative study.

OBJECTIVES: To describe an insight into nursing nutritional care delivery in the hospital from the perspectives of observed nursing care and an exploration of multidisciplinary attitudes and experiences with patient participation in nutritional care. BACKGROUND: The prevalence of malnutrition in hospitalised patients continues to be high. Nurses' essential role in the identification and treatment of malnutrition is an important aspect of the fundamentals of care. Nurses have a key role in providing optimal nutritional care in the hospital. A systematic nursing approach, combined with an active role for patients, is required to effectively counteract malnutrition. DESIGN: A multicentre qualitative study using ethnographic observations and focus groups. METHODS: Direct observation of nutritional care was conducted on two nursing wards; nurses and inpatients were observed; and data were thematically analysed based on the fundamentals of care framework. Subsequently, six focus groups were held on three nursing wards with nurses, dietitians and nutrition assistants (n = 34). Data were analysed using open, axial and selective coding. The COREQ guidelines were used for reporting the study. RESULTS: During 54 days, representing 183 h, 39 nurses were observed in two medical wards. Three activities in nutritional care delivery were identified from observing nurses and patients: (1) screening and assessment/at-risk determination, (2) nutritional care plans and (3) monitoring and evaluating outcomes and transition-of-care planning. In addition, the focus groups identified barriers, facilitators, needs and expectations for optimal nursing nutritional care delivery. CONCLUSIONS: This study provides an understanding of the difficulties in the delivery of nursing nutritional care. Patient participation in the nutritional care process is rare. Evidence-based strategies are required to improve the knowledge and skills of nurses and patients to participate in (mal)nutrition care. RELEVANCE: The findings of this study are used for the development of a nursing nutrition intervention to optimise patient participation in (mal)nutrition care. PATIENT OR PUBLIC CONTRIBUTION: During the study, patients were not involved with the observations of care and/or with the interviews; the researchers observed the nutritional care delivery at medical wards acting as passive participants. Nurses, nutrition assistants and dietitians were after the focus groups asked for feedback on the transcripts of the interviews.