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.

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.

Purpose: Effective nurse-patient communication is demanding and essential when patients’ treatment changes from curative to palliative approach. We aimed to illustrate nurses’ experiences communicating with patients who have undergone end-of-life breakpoint communication.

Method: Six nurses from both haematology and oncology wards at a hospital in southern Sweden were interviewed. The data were analysed using content analysis.

Result: Three themes with a total of eight categories were identified: Nurses were excluded from the end-of-life breakpoint communication, which impacted the following communication and the dialogue between nurses and patients afterwards; the importance of communication, where the experience of following-up patients, supporting patients and having existential conversations was highlighted; the nurses’ strategies in the communication, included experience of using tools, the need for more information and education, and to be human.

Conclusion: Nurses in today's healthcare system need education to provide the care and the communication that patients ask for and are obligated to receive regarding support and information. In the results, nurses suggest and relate their strategies for effective patient communication, which would also aid nurses working in areas other than palliative care. For example, they propose collaborating more with physicians to facilitate better information flow and patient contact. Moreover, reflective tutorials, including spiritual leaders to aid patients’ existential concerns, are beneficial. The need for further research in this area is crucial for the growth and development of nurse-patient communication.

In spring 2020, a global SARS-Cov-2 pandemic was declared. The number of patients in need of intensive care exceeded the number of available care places at intensive care units (ICUs) and certified registered nurse anesthetists (CRNAs) were relocated to ICUs to support the care during the pandemic. The aim of this study was to illuminate the experiences of the CRNAs regarding relocation to COVID-19 intensive care. An interview study based on qualitative content analysis was conducted. The participants were CRNAs who usually work in the operating unit, however, were relocated to work in the COVID-19 ICU at a university hospital in southern Sweden during the pandemic. Four themes emerge in the results: sense of pride, competence, work environment, and nursing. The results illuminate the CRNAs' experience of relocating from their usual working environment to caring for critically ill patients in a COVID-19 ICU. The CRNAs managed the relocation well, although sometimes it was difficult. The CRNAs showed great loyalty, dedication, competence, and flexibility in their professional capacity. The time they worked in COVID-19 intensive care was a challenging period, but it gave them a well-deserved sense of pride and competence.

Preventing pressure ulcers is fundamental in managing and caring for the patient following a fragility fracture. Patients who have sustained a hip fracture and have had associated surgery are at high risk as ageing skin, frailty, immobility, and multiple comorbidities are significant factors in skin injury.

The causes of pressure ulcers are complex, and their prevention is the responsibility of the entire multidisciplinary team. Accessing evidence and education for practitioners is vital to making a difference in all aspects of care.

Introduction: Incontinence-associated dermatitis (IAD) is irritant contact dermatitis and skin damage associated with prolonged skin contact with urine and/or faeces. Identifying prognostic factors for the development of IAD may improve management, facilitate prevention and inform future research.

Methods and analysis: This protocol follows the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Prospective and retrospective observational studies or clinical trials in which prognostic factors associated with the development of IAD are described are eligible. There are no restrictions on study setting, time, language, participant characteristics or geographical regions. Reviews, editorials, commentaries, methodological articles, letters to the editor, cross-sectional and case-control studies, and case reports are excluded. MEDLINE, CINAHL, EMBASE and The Cochrane Library will be searched from inception until May 2023. Two independent reviewers will independently evaluate studies. The Quality in Prognostic Studies tool will be used to assess the risk of bias, and the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies-Prognostic Factors checklist will be used for data extraction of the included studies. Separate analyses will be conducted for each identified prognostic factor, with adjusted and unadjusted estimated measures analysed separately. Evidence will be summarised with a meta-analysis when possible, and narratively otherwise. The Q and I2 statistics will be calculated in order to quantify heterogeneity. The quality of the evidence obtained will be evaluated according to the Grades of Recommendation Assessment, Development and Evaluation guidance.

Ethics and dissemination: No ethical approval is needed since all data is already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal.