AIMS: To explore patients' fundamental care needs, to which extent they are met and to assess how the care activities of Registered Nurses and assistant nurses are accomplished. A further aim is to investigate their associations with contextual factors in an emergency department setting.

DESIGN: Quantitative exploratory observational study with data collected through structured observations.

METHODS: Seventy-five patients, 30 registered nurses, and 20 assistant nurses were recruited from one emergency department. Structured observation protocols, spot checks, and follow-up dialogues were used. Descriptive and analytical statistics were calculated.

RESULTS: A total of 812 fundamental care needs were observed: physical (45%), psychosocial (38%), and relational (14%). The prevalence of missed nursing care was 20% and was more prevalent among older patients, those receiving care in shared spaces, and during crowding. In total, 3797 care activities were observed. Medical/technical activities were implemented at a higher rate than integration of care activities; unlike the latter, higher rates were significantly associated with crowding, the surgical section, and registered nurses compared to assistant nurses.

CONCLUSION: Missed nursing care was more prevalent among older patients and those in shared spaces or during crowding. The increased rate of medical/technical care activities was associated with crowding, whereas the integration of care activities remained unchanged.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Fast-track solutions robust to crowding could reduce missed nursing care among older patients. Staff and management should critically assess physical layout in relation to crowding and missed nursing care. Crowding is a system-level phenomenon representing a significant driver of missed nursing care in the emergency department, and responsibility for addressing this decline in care quality must be acknowledged at system and policy levels.

IMPACT: This study provides evidence of how organizational conditions shape nursing care delivery in emergency departments and will inform interventions to improve care quality and safety.

PATIENT OR PUBLIC CONTRIBUTION: None.

BACKGROUND AND OBJECTIVES: National clinical practice guidelines promote evidence-based practice, though are hardly implemented without local facilitation. While further research is needed as for what facilitation strategies work, in what context, and with what outcomes, the Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation (OPTION) trialled a tailored implementation intervention for evidence-based clinical practice guidelines in orthopaedic care. Informed by the principles of realism, this paper describes the evaluation of the context, mechanisms, and outcomes triad of locally assembled teams of nursing and rehabilitation staff and their managers offered monthly guideline implementation support for one year.

METHODS: A process evaluation incorporating group interviews with designated teams across seven intervention sites, at the end of their programme and 12 months later. Individual facilitator logs, photos and educational material from the intervention, and external facilitators' notes were added. The data was thematically analysed, describing and contrasting the initial hypotheses with a refined understanding of the theoretical and practical features of the process and outcomes.

RESULTS: With increased knowledge of the content and purpose of the guidelines and further recognition of their local context and implementation essentials, the intervention facilitated the local, designated teams to practise concurrent quality improvement procedures and skills. Having both staff and managers on the teams authorised modifications of their local context in favour of guideline implementation. The one-year support programme enabled primary implementation steps, though a comprehension of what could work and why required that the teams saw the intervention through.

CONCLUSION: Learning about the implementation of a clinical practice guideline is a local effort. This requires dedicated teams with sustained roles, resources, and mandate, with external implementation and clinical support. Nevertheless, this is a slow process that requires repeated or prolonged follow-up to identify long-term implementation intervention outcomes.

TRIAL REGISTRATION: US National Institutes of Health Clinical Trials Registry: NCT04700969. Registered 8 January 2021. https: //clinicaltrials.gov/study/NCT04700969.

Introduction: Missed nursing care in hospital wards is associated with patient safety risks and reduced quality of care. Emergency departments are high-risk settings; therefore, missed nursing care in these settings must be explored. Studies on missed nursing care in emergency departments show, for instance, that patient education, nutrition, and the maintenance of patient privacy are often missed. These findings are similar to those of previous studies conducted in hospital wards. However, crowding, boarding, and patients with acuity issues in emergency departments are examples of contextual differences with hospital wards. How emergency nurses perceive their nursing practices in relation to missed nursing care and their ability to maintain patient safety and quality of care is not wellknown. This study aimed to explore emergency nurses' perceptions of nursing care in the emergency departments. Methods: This study used a qualitative descriptive design and a purposive sampling strategy. Semi-structured interviews were conducted with 15 emergency nurses. A phenomenographic approach was used for the analyses. Results: The findings showed variations in the perceptions of emergency nurses regarding the quality of nursing care and missed nursing care. Subordinate to acute medical needs, fundamental care needs were addressed if there was sufficient time, which negatively affected older adult patients, particularly frail patients. Emergency nurses strived to maintain adequate patient flow throughout the emergency department and were attentive to all patients in their care; however, they were aware that missed nursing care was a recurring phenomenon. Discussion: Emergency nurses had various perceptions of nursing care. Demanding conditions, prioritization of medical needs, and maintenance of adequate patient flow challenged them in their efforts to meet patients' fundamental needs and fulfill their responsibilities.

Background: Postoperative urine retention can lead to permanent bladder dysfunction. This occurs even though healthcare personnel can access evidence-based guidelines on avoiding urine bladder injuries related to care.

Aim: This study aimed to describe healthcare professionals' experiences with, and strategies to avoid post-operative urinary retention among hip surgery patients.

Method: A descriptive qualitative study using telephone interviews, were conducted in April to June 2021, with 22 healthcare professionals (13 nurses, 7 nursing assistants and 2 occupational therapists) in 17 orthopaedic wards in Sweden. Qualitative content analysis of interview data was performed.

Results: Five categories were identified: "Knowledge about guidelines regarding bladder monitoring", "Understanding of patients' prehospital bladder function influences healthcare professionals' reasoning and actions", "Strategies are applied to make it easier for the patients to empty their bladder", "Indwelling catheter is used routinely" and "Short length of stay creates stress".

Conclusion: To optimise safe patient bladder monitoring after hip surgery, health care professionals need to be more aware of the availability of guidelines about bladder monitoring to adopt consistent monitoring practices, and to have enough time to care for patients.

Use of nontobacco nicotine products is increasing among the youth. School nurses aim to prevent such unhealthy habits. However, there is limited evidence relating to the knowledge of these nurses, and their capacity to work with tobacco-free nicotine products. Therefore, we aimed to illuminate the prerequisites and experiences necessary for school nurses to work with secondary school students for preventing the use of nontobacco nicotine products. This qualitative study was based on 18 semi-structured interviews conducted with Swedish school nurses, using conventional content analysis. One main category emerged: Experiences and prerequisites for working preventively in the context of nontobacco nicotine products and four subcategories. Certain nurses in the sample indicated that they had the experience, prerequisites (including time, fewer students per nurse, and an engaged and understanding organization), and competence to enable them to be suitable advocates for working preventively in schools under conducive conditions.

Background: Incontinence-associated dermatitis (IAD) is a prevalent and distressing form of irritant contact dermatitis caused by prolonged exposure to urine and/or faeces. Not all incontinent individuals develop IAD, suggesting that additional prognostic factors contribute to its onset. The quality of empirical evidence supporting risk factors for IAD development is moderate to very low. Therefore, it is necessary to systematically compile and analyse expert knowledge on this topic.

Aim: This study aimed to identify and prioritise key prognostic factors for IAD development through an international expert consultation.

Materials and methods: A cross-sectional expert survey was conducted among international experts using an electronic survey platform. Participants rated the importance of 26 pre-identified prognostic factors, ranked relevant factors and suggested additional factors. Data were analysed to determine expert consensus and factor rankings.

Results: A total of 45 experts participated, with a response rate of 39 %. The highest-ranked prognostic factors included double incontinence, faecal incontinence, loose stools, stool frequency, urinary incontinence, and impaired mobility. Other important factors were advanced age, friction and shear forces, cognitive impairment, and poor nutrition. In addition, experts highlighted systemic factors such as caregiver knowledge gaps and staff shortages as potential contributors to IAD risk.

Conclusion: Study results support established risk factors for IAD development such as stool frequency and limited mobility. Experts also identified factors, such as higher age and the presence of loose or liquid stool, that are considered relevant by experts but are not yet fully supported by empirical evidence. Findings will inform a future large-scale cohort study.

OBJECTIVE: To translate the Verran Professional Governance Scale© (VPGS©) into Swedish, adapt it to the Swedish context, and validate it.

BACKGROUND: Magnet®-recognized hospitals have proven successful in reversing negative trends regarding nursing shortage. A change in organizational and management structures is required, and professional governance is fundamental. However, in a Swedish context, there are no validated instruments to measure professional governance.

METHODS: The instrument was translated from English to Swedish and synthesized into a unified version. It was back translated, discussed in an expert panel, and pilot tested with cognitive interviews of nurses.

RESULTS: A new Swedish version of the VPGS© was developed. The expert group reached a consensus, and the scale-level Content Validity Index value shows high relevance. Some words and sentences were revised, and an introduction was added.

CONCLUSIONS: The study generated a Swedish version of the VPGS©, which can be used to measure nurses' perceptions of professional governance behaviors.

BACKGROUND: As the proportion of older persons in society increases, there is a growing trend towards providing end-of-life care in their homes. Palliative care is a complex and knowledge-demanding form of care, and nurse assistants are those who work closest to the older person at the end-of-life in their own homes. However, nurse assistants sometimes have low educational and insufficient levels of knowledge in palliative care, which can affect the quality of care they provide. Moreover, nurse assistants' experiences are relatively unexplored in this context. The purpose of the study was to illuminate nurse assistants' experiences in caring for dying older persons at home.

METHOD: An empirical, qualitative interview study was conducted with 14 nurse assistants with experience of palliative care in homecare. The material was analyzed using thematic content analysis.

RESULTS: From the nurse assistant's experiences, one main theme emerged: doing everything possible for the dying older person despite challenges. Moreover, three sub-themes emerged: making a difference at a crucial time, death awakens emotions, and balancing personal and professional relationships. The nurse assistants' saw their role primarily as relieving symptoms but also focusing on next of kin. The following are described as essential parts of their role: carrying out practical nursing tasks, focusing on the physical environment, working alone and seeking help from colleagues due to a physical distance to the other members of the multidisciplinary team. The nurse assistants experienced a lack of support as there was no structured guidance or debriefing available in difficult emotional situations. Furthermore, they disclosed that they were left alone to deal with their feelings.

CONCLUSION: This study demonstrates that nurse assistants strive to provide comprehensive care for dying older persons despite facing obstacles from their working conditions and work organization. They lack supervision and education in palliative care, but they rely on their experience-based knowledge to a large extent and provide care according to the four cornerstones of palliative care.

Incontinence-associated dermatitis (IAD) is an irritant contact dermatitis from prolonged contact with urine or faeces, which can significantly impact patient comfort and quality of life. The identification of prognostic factors for the development of IAD has the potential to enhance management, support preventive measures and guide future research. The objective of this systematic review was to summarize the empirical evidence of prognostic factors for the development of IAD. This study included prospective and retrospective observational studies or clinical trials that described prognostic factors associated with IAD. There were no restrictions on setting, time, language, participants or geographical regions. Exclusion criteria included reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports. Searches were conducted from inception to April 2024 on MEDLINE, CINAHL, EMBASE and the Cochrane Library. The studies were assessed by two independent reviewers using the QUIPS and the CHARMS-PF for data extraction. A narrative synthesis approach was employed due to study heterogeneity and using the 'vote counting based on direction' method and the sign test. The overall certainty of evidence was assessed using adapted GRADE criteria. The review included 12 studies and identified 15 potential predictors. Moderate-quality evidence suggests that increased stool frequency, limited mobility and friction/shear problems are risk factors for IAD development. Female sex, older age, vasopressor use and loose/liquid stool are risk factors supported by low-quality evidence. Increased stool frequency, limited mobility and friction/shear problems seem to be risk factors for the development of IAD. There is insufficient evidence to support the predictive validity of female sex, older age, loose/liquid stool and vasopressor use. There is substantial methodological variability across studies, making it challenging to make comparisons. Large-scale cohort studies in different settings that incorporate our review findings should be conducted in the future.