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Background Persons with neuromuscular diseases (NMDs) often experience complex rehabilitation needs due to the disease’s impact on their functioning and progression of their diseases. As a consequence of legislation and “policy power”, community-based health professionals function as gatekeepers to the rehabilitation trajectory for persons with NMDs in a field where the other professionals are the specialists. Aim To investigate community-based health professionals’ reflections on and behaviors regarding collaboration with a tertiary rehabilitation hospital in a cross-sectorial rehabilitation care model with the overall aim of providing high quality rehabilitation for persons with NMD. Methods The design is qualitative and uses interpretive description methodology and the theoretical lens of Edgar Schein’s three levels of organizational culture and leadership. An ethnographic fieldwork was conducted from September 1, 2019 to January 30, 2020. Eighty-four community-based health professionals were included and 17 of them were interviewed in four semi-structured focus group interviews ( n  = 10) and seven individual interviews ( n  = 7). In addition, 151 pages of observation data were generated. The study adheres to the COREQ guidelines. Results The analysis showed three themes of importance for the collaboration: Policy and legislation navigation represented that collaboration on rehabilitation was affected by legislation as a management tool with “the case” as the core element, and goal dilemmas. Cross-sectorial knowledge exchange promoted collaboration on coordinated and facilitated rehabilitation and knowledge sharing as a firm anchoring. Patient ownership negotiations implied collaboration was influenced by knowledge founded power and gatekeeping as a navigation tool. Conclusion Three levels of organizational culture and leadership were identified, and this overall structure guided the community-based health professionals in their work and in the complex organizational landscape of collaboration between disconnected healthcare systems. The findings provided insight into behavior and attitudes and the content and the values held by the professionals collaborating across sectors. Future collaboration in rehabilitation models should be multiprofessional and team based. The findings emphasize that it is imperative that managements and professionals strive to strengthen the structure of the collaborative team spirit because this will ensure well-planned, coordinated, and conducted rehabilitation for persons with NMD and enable and support future cross-sectorial collaboration in this rehabilitation model for these persons.

The care of older persons is facing several challenges, especially as care tasks are becoming increasingly rationalized with less opportunity for relational engagement between nurse assistants and older persons. Evidence suggests this engagement is needed to promote well-being and satisfaction among the older persons with whom they work. The aim of this study was to explore how care, in the context of worker perspectives, is understood and experienced in home or residential care facilities. Focus-group interviews were conducted with experienced nursing assistants (n = 14) working in urban municipalities in Sweden. Data were analyzed using reflexive thematic analysis. The main theme: \"This work is more than a checklist of tasks, it's like simultaneous mind puzzles\", exposes the shortcomings of a \"task and time\" oriented care system while expecting individualized relational care practices. Three subthemes emerged: \"It's about responsibility, not remuneration\", \"Knowing them is part of the job\" and \"We do a lot that is not our job\". Participants expressed working responsibly day-to-day to find solutions to meet the needs of older persons. Tensions experienced between task and relational care orientations align to variation in understandings of care. These subthemes highlight that their work requires being context-sensitive to adapt in the moment, much like trying to solve mind puzzles. Increased rationalization of care, while expecting focus on relational aspects, sets nursing assistants in a challenging position. This paradox negatively affects the health of nursing assistants by creating unsustainable work. Without recognition of the required cognitive engagement in problem solving that is part of their work, the challenges of retention, sick leave and burnout are unlikely to be addressed. To ensure coordinated continuative care for older persons, nursing assistants need time and agency to enact relational practices that facilitate doing their work's dynamic care puzzles.

Background: Nurse engagement, perceived need and usefulness affect healthcare technology use, acceptance and improvements in quality, safety and accessibility of healthcare. Nurses’ opinions regarding continuous monitoring appear to be positive. However, facilitators and barriers were little studied. This study explored nurses’ post-implementation experiences of the facilitators and barriers to continuously monitoring patients’ vital signs using a wireless device on general hospital wards. Methods: This study employed a cross-sectional survey. Vocational and registered nurses from three general wards in a Dutch tertiary university hospital participated in a survey comprising open and closed questions. The data were analysed using thematic analysis and descriptive statistics. Results: Fifty-eight nurses (51.3%) completed the survey. Barriers and facilitators were identified under four key themes: (1) timely signalling and early action, (2) time savings and time consumption, (3) patient comfort and satisfaction and (4) preconditions. Conclusions: According to nurses, early detection and intervention for deteriorating patients facilitate the use and acceptance of continuously monitoring vital signs. Barriers primarily concern difficulties connecting patients correctly to the devices and system.

Background Meeting patients’ fundamental care needs is a core aspect of nursing. However, there is compelling evidence of missed nursing care within surgical care. Person-centred care is known to increase patient involvement and prevent missed nursing care. The Fundamentals of Care framework aligns with person-centred care principles. It has the essential relationship-based care process at its core and serves as a guide for delivering person-centred fundamental care. This study aims to describe what enables and hinders the delivery of person-centred fundamental care as identified by registered nurses and nursing assistants in a surgical department. Methods A qualitative descriptive study was performed. Registered nurses and nurse assistants (nursing staff) from three surgical wards at a university hospital participated in a workshop package about person-centred fundamental care. Data were collected from two workshops with 106 and 92 participants, respectively, individual written reflections on a situation in clinical practice related to person-centred fundamental care delivery (83 participants), and three focus group interviews with a total of 13 participants. The data were analysed using content analysis. Results The results present the nursing staffs’ descriptions of what enables and hinders the delivery of person-centred fundamental care in three categories: [1] a culture of daily mentorship to ensure adherence to person-centred routines; [2] a distinct nursing leadership—supportive in both routines of daily practice and high-pressure situations; and [3] enhancing comprehension of person-centred care routines to embed the approach in everyday thinking and actions. Conclusions To provide person-centred fundamental care, nursing staff need organizational support in both culture and routines. Nurse managers need to be clear on how care is to be delivered, challenge prevailing old habits, and act as role models in changing practices. Nursing staff need to take their responsibility by adhering to routines and contributing to driving changes. The results can be used to navigate the complex implementation of person-centred fundamental care and also demonstrate the need for a change toward person-centred fundamental care being valued and prioritized in organizations. Clinical trial number Not applicable.

To investigate the effects of a nursing program to early promote the activity of daily living after passing critical conditions among older adults admitted to the semimedical intensive care unit. Quasi-experimental research. A total of 50 older adults admitted to the semimedical intensive care unit were recruited using a consecutive sampling method. Data were collected from June 28 to October 3, 2024, using the Barthel ADL Index, complication record forms, and muscle strength record forms. The findings indicated that the experimental group reported higher scores in performing activities of daily living (17.48 ± 1.19 vs. 2.76 ± 0.44) and motor power (4.96 ± 0.20 vs. 3.68 ± 0.48), as well as a lower incidence of complications (12% vs. 64%) than the control group ( < 0.001). The study demonstrates that the nursing program is effective in facilitating early functional recovery and reducing complications among older adults following critical conditions in the semi-intensive care unit. This program provides a valuable approach to enhancing the quality of care and outcomes for this vulnerable population. Thai Clinical Trials Registry (TCTR): TCTR20240708010.

Fundamental care has come under increased scrutiny due to high-profile reports globally of poor nursing care. The reasons for these documented care failures are widely debated, with some scholars identifying issues with how fundamental care is valued within healthcare systems and by nurses. During focus groups designed to evaluate a fundamental care education intervention, we identified a perception commonly held by first-year pre-registration (pre-licensure) students that appeared indicative of a de-valuing of fundamental care: students routinely described fundamental care as ‘common sense’ and doubted that such care should form a key part of their education. In this paper, we explore this perception and its potential consequences for nursing education, clinical practice, and research. We argue that a perception of fundamental care as ‘common sense’ is a myth; it undermines the inherent complexity of providing such care to a consistently high standard and has negative implications for nursing education and continuing professional development, patient experiences and outcomes, and the advancement of nursing science. It is a perception that must be challenged.

Aim To describe and compare nurses' perceptions of the quality of fundamental care and related factors before and after a clinical development project, and to describe patients' perceptions of the quality of fundamental care. Design A descriptive, comparative study design. Methods Data were collected online from nurses in 2015 and 2021 with a structured questionnaire exploring fundamental care through 12 areas at the beginning and the end of a clinical developmental project. Patient experiences were collected with a paper‐based questionnaire in 2021. A STROBE checklist was used as the reporting guideline. Results The nurses assessed the overall quality of fundamental care as high at both data collection timepoints. However, the quality deteriorated in general and in specific areas, including skin condition and cleansing, elimination, nutrition and blood circulation, during the follow‐up period according to the nurses' experiences. A correlation was found between the areas of the quality of fundamental care. The registered nurses and the nurse managers expressed that not all areas of fundamental care were part of their work. The patients' experiences were mostly good. A small number of patients expressed a need to deal with issues related to their wellness of mind during their care. Conclusions The quality of fundamental care was perceived as high by nurses and patients, but the quality deteriorated during the follow‐up period. It may be that the Covid‐19 pandemic and a general shortage of nurses in the hospital contributed to nurses having to decide how to prioritise their tasks between fundamental and specialised care. It is therefore recommended to further develop fundamental care in the hospital. Relevance to Clinical Practice Nursing roles and practices need to be reviewed and developed further to better support nurses in their work to provide high‐quality fundamental care. A systematic evaluation of the quality of fundamental care is recommended. Patient or Public Contribution Patients responded to the research questionnaire.

Background Patient experience of nursing care is associated with safety, care quality, treatment outcomes, costs and service use. Effective nursing care includes meeting patients’ fundamental physical, relational and psychosocial needs, which may be compromised by the challenges of SARS-CoV-2. No evidence-based nursing guidelines exist for patients with SARS-CoV-2. We report work to develop such a guideline. Our aim was to identify views and experiences of nursing staff on necessary nursing care for inpatients with SARS-CoV-2 (not invasively ventilated) that is omitted or delayed (missed care) and any barriers to this care. Methods We conducted an online mixed methods survey structured according to the Fundamentals of Care Framework. We recruited a convenience sample of UK-based nursing staff who had nursed inpatients with SARS-CoV-2 not invasively ventilated. We asked respondents to rate how well they were able to meet the needs of SARS-CoV-2 patients, compared to non-SARS-CoV-2 patients, in 15 care categories; select from a list of barriers to care; and describe examples of missed care and barriers to care. We analysed quantitative data descriptively and qualitative data using Framework Analysis, integrating data in side-by-side comparison tables. Results Of 1062 respondents, the majority rated mobility, talking and listening, non-verbal communication, communicating with significant others, and emotional wellbeing as worse for patients with SARS-CoV-2. Eight barriers were ranked within the top five in at least one of the three care areas. These were (in rank order): wearing Personal Protective Equipment, the severity of patients’ conditions, inability to take items in and out of isolation rooms without donning and doffing Personal Protective Equipment, lack of time to spend with patients, lack of presence from specialised services e.g. physiotherapists, lack of knowledge about SARS-CoV-2, insufficient stock, and reluctance to spend time with patients for fear of catching SARS-CoV-2. Conclusions Our respondents identified nursing care areas likely to be missed for patients with SARS-CoV-2, and barriers to delivering care. We are currently evaluating a guideline of nursing strategies to address these barriers, which are unlikely to be exclusive to this pandemic or the environments represented by our respondents. Our results should, therefore, be incorporated into global pandemic planning.

The research has reported a high prevalence of low-quality and missed care for patients with community-acquired pneumonia (CAP). Optimised nursing treatment and care will benefit CAP patients. The aim of this study was to describe the barriers and facilitators influencing registered nurses’ (RNs’) adherence to evidence-based guideline (EBG) recommendations for nursing care (NC) for older patients admitted with CAP. Semi-structured focus group interviews (n = 2), field observations (n = 14), and individual follow-up interviews (n = 10) were conducted in three medical units and analysed by a qualitative content analysis. We found a main theme: ‘‘stolen time’—delivering nursing at the bottom of a hierarchy’, and three themes: (1) ‘under the dominance of stronger paradigms’, (2) ‘the loss of professional identity’, and (3) ‘the power of leadership’. These themes, each comprising two to three subthemes, illustrated that RNs’ adherence to EBG recommendations was strongly influenced by the individual RN’s professionalism and professional identity; contextual barriers, including the interdisciplinary team, organisational structure, culture, and evaluation of the NC; and the nurse manager’s leadership skills. This study identified central factors that may help RNs to understand the underlying dynamics in a healthcare setting hindering and facilitating the performance of NC and make them better equipped for changing practices.

Background In response to concerns about high hospital mortality rates, patient and carer complaints, a Mid Staffordshire NHS Foundation Trust public inquiry was conducted at the request of the UK government. This inquiry found serious failures in the quality of basic care provided and as a consequence, recommended that patients should have more regular visits, organised at predictable times from nursing staff. Intentional rounding, also known as nursing ward rounds, was widely adopted to meet this need. Objective To test, refine or refute eight programme theories to understand what works, for whom, and in what circumstances. Setting Six wards (older people and acute wards) in three NHS trusts in England. Participants Board level and senior nursing managers ( N  = 17), nursing ward staff ( N  = 33), allied health and medical professionals ( N  = 26), patients ( N  = 34) and relatives ( N  = 28) participated in an individual, in-depth interview using the realist method. In addition, ward-based nurses ( N  = 39) were shadowed whilst they conduced intentional rounds (240 rounds in total) and the direct care of patients (188 h of patient care in total) was observed. Methods The mixed methods design included: Phase (1) Theory development - A realist synthesis was undertaken to identify any programme theories which were tested, refined and/or refuted, using data from phases 2 and 3; Phase (2) A survey of all English NHS acute Trusts; Phase (3) Six case studies of wards involving realist interviews, shadowing and non-participant observations, analysis of ward outcome and cost data; and Phase (4) Synthesis of findings from phases 1, 2 and 3. Results The realist synthesis identified eight programme theories of intentional rounding: ‘Consistency and comprehensiveness’, ‘Accountability’, ‘Visibility of nurses’, ‘Anticipation’, ‘Allocated time to care’, ‘Nurse-patient relationships’, ‘Multi-disciplinary teamwork and communication’ and ‘Patient empowerment’. Key findings showed that of the original eight programme theories of intentional rounding, only two partially explained how the intervention worked (‘Consistency and comprehensiveness’ and ‘Accountability’). Of the remaining six programme theories, the evidence for two was inconclusive (‘Visibility of nurses’ and ‘Anticipation’) and there was no evidence for four (‘Allocated time to care’; ‘Nurse-patient relationships’; ‘Multi-disciplinary teamwork and communication’; and ‘Patient empowerment’). Conclusions This first theory-informed evaluation of intentional rounding, demonstrates that the effectiveness of intentional rounding in the English healthcare context is very weak. Furthermore, the evidence collected in this study has challenged and refuted some of the underlying assumptions about how intentional rounding works. This study has demonstrated the crucial role context plays in determining the effectiveness of an intervention and how caution is needed when implementing interventions developed for the health system of one country into another.