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BACKGROUND AND AIM: Sexual health and sexual quality of life are key components of psychosocial adjustment after cardiac surgeries and are often linked with improving the general quality of life. Reviews have been conducted to highlight the associations between cardiovascular diseases and sexual dysfunctions, but no review reported determinants of sexual health and sexual quality of life in patients after cardiovascular surgeries. We aimed to comprehensively examine the determinants of sexual health and sexual quality of life among individuals with cardiovascular surgeries. METHODS: Literature was searched within PubMed, CINAHL, Scopus, Web of Science, and OVID databases. In total, 816 records were identified from database searches, 279 records were screened, and 11 empirical studies were included for review. Relevant data were extracted using literature summary tables and synthesised using an inductive approach. RESULTS: The core determinants of sexual health and sexual quality of life were type of surgery and comorbidities, fears and uncertainties regarding sexual activity, sexual health education and counselling, spousal relationship and communication, and demographic factors such as advanced age and literacy levels. Major surgeries performed were coronary artery bypass grafting (CABG) and heart valve surgeries. The data collection tools used to collect data for sexual health and sexual quality of life were the International Erectile Function Questionnaire (IEFQ), International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI), Sexual Knowledge CABG Scale (SKS-CABG), Sexual Quality of Life Questionnaire (SQOL), SKS-Myocardial Infarction Scale (SKS-MI), and Couple Communication Scale (CCS). CONCLUSIONS: Despite their importance, sexual health and quality of life are frequently overlooked during patient rehabilitation after cardiovascular surgeries. The lack of adequate education and counselling from healthcare professionals frequently leads to increased fear and uncertainties among individuals and their partners. Therefore, more person-centred educational and counselling approaches should be developed to address the sexual concerns of individuals and their partners.

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Individuals' coping differs based on sociocultural determinants and the nature of illness. This study developed a coping typology for South Asians with chronic illnesses and differentiated the coping profiles based on sociocultural determinants. Individuals (n = 384) with chronic illness were recruited. The Brief COPE scale was used for data collection and latent profile analysis for typology development. The class differences were examined in terms of age, gender, socioeconomic status, education, type of family, smoking, primary decision maker in the family, type of community, number of years living with chronic illness and type of health care services used. Latent profile analysis supported four class model: Avoider-Emotion (n = 34, 9%), Problem-Emotion (n = 128, 33.9%), Problem-Avoider (n = 55, 14.6%) and Emotion-Avoider (n = 161, 42.6%) copers. Comparison of classes across chronic illness showed that individuals with chronic respiratory disorders were Emotion-Avoider and Avoider-Emotion copers, those with cardiac problems were Problem-Emotional and Problem-Avoiders copers, those with renal problems were Emotional-Avoiders and Problem-Emotions copers, and individuals with mental health issues were mainly Problem-Emotional and Emotion-Avoider copers. These class differences were statistically different (χ2 = 134, df = 18, p < .001). The findings can be useful for developing coping programmes for South Asian populations in low- and middle-income countries and South Asian immigrants.

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The purpose of this paper is to explore the potential of dialectical pluralism (DP) for nursing knowledge development. Nursing scholars have discussed ways of developing nursing knowledge, exploring the fit and relevance of various worldviews for knowledge development and examining the dynamic and perpetual processes of knowledge development. Scholars have argued that knowledge development occurs under a certain worldview to which the researcher adheres. Many nurses employ various worldviews, which can give rise to ontological and epistemological conflicts. DP can help nurses appreciate the diversity of worldviews and recognize the importance of implicit worldviews to generate more practical nursing knowledge. DP as a philosophical approach can enable nurses to communicate between diverse worldviews, become tolerant of conflicting differences, and develop an array of nursing knowledge.

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AIM: The aim of this review was to synthesize literature on the perceptions of South Asian ethnic minorities of the barriers and facilitators to center-based, phase II cardiac rehabilitation (CR). METHODS: A meta-synthesis approach was used, and findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted from database inception dates to July 2022 using the following databases: MEDLINE, EMBASE, APA PsycINFO, Cochrane Database of Systematic Review, CINAHL, Scopus, and Web of Science. The inclusion criteria were studies that examined the barriers and/or facilitators of structured center-based CR among South Asian adult ethnic minorities. Critical appraisal of the included studies was conducted using the Mixed Methods Appraisal Tool. Findings were synthesized using a thematic synthesis approach. RESULTS: Among the 7110 records initially retrieved only nine studies conducted in the United Kingdom or Canada met the inclusion criteria. More barriers than facilitators were studied and reported. Key barriers were the English language difficulty, fatalistic beliefs, previous bad interactions with and negative perception of health care professionals, transportation problems, work schedule conflict, safety issues, and long-distance CR centers. The facilitators included patient-preferred environment, presence of family members during exercise, family and friends support, and encouragement to change lifestyle and enroll in a CR program. CONCLUSION: The review findings revealed that South Asian ethnic minorities encounter various barriers and facilitators to enroll and complete CR. The findings can inform researchers and clinicians in the development of interventions that are tailored to their cultural needs. PRACTICE IMPLICATIONS: The findings can be valuable to health care professionals and policy makers in designing customized CR programs for South Asian minorities.

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BACKGROUND: Individuals with multimorbidity and complexity have multifaceted care needs requiring integrated and collaborative care from nurses, families, and health care teams. Nurses, as the frontline care professionals, should develop therapeutic relationships with patients and their families and professional relationships with health care team members to ensure the delivery of effective integrated care. Failure to develop effective interpersonal and professional relationships can negatively affect patient care. OBJECTIVE: The purpose of this study was to explore nurses' challenges with developing interpersonal and professional relationships during integrated care for individuals with multimorbidity and complexity. METHODS: A descriptive qualitative design was used. We interviewed a purposive sample of 19 nurses with experience of caring for individuals with multimorbidity and complexity across two hospitals in Pakistan. Semi-structured interviews were used for data collection, and data were analyzed using reflexive thematic analysis. RESULTS: Two challenges were identified affecting the relationships between patients' families and nurses, and two challenges influencing the professional relationships within the team. Families withheld information, controlled care access of their relatives, posed unrealistic demands, and abused nurses, affecting nurse-family relationships. Power struggles to demonstrate authority in decision-making were common within health care teams, affecting nurses' professional capacity to provide effective care. CONCLUSIONS: Health care team, patient, and family collaboration is instrumental in improved care for individuals with multimorbidity and complexity. Nurse leaders and health care organizations should take initiatives to address nurses' interpersonal confrontations to support them in the provision of quality care.

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BACKGROUND: Individuals living with multimorbidity and/or mental health issues, low education, socioeconomic status, and polypharmacy are often called complex patients. The complexity of their health and social care needs can make them prone to disease burden and suffering. Therefore, they frequently access health care services to seek guidance for managing their illness and suffering. AIMS: The aim of this research was to describe the approaches used by nurses to alleviate the suffering of individuals with multimorbidity and complex needs in acute care settings. RESEARCH DESIGN: A qualitative descriptive approach. PARTICIPANTS AND RESEARCH CONTEXT: Semi-structured interviews were conducted with 19 nurses working in general, medical-surgical, specialized, and intensive care settings across five hospitals in Pakistan. Reflexive thematic analysis was used for analysis. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the Ethical Committee of Al-Nafees Medical College Islamabad, Pakistan. FINDINGS: Four themes were generated: Deeper Exploration of Patients' Health-Illness Situation and Complexity, Prioritizing Patient Psychosocial and Emotional Needs, Instilling Hope and Encouragement in Patients, and Creating a Comforting Environment to Foster Sharing of felt needs. DISCUSSION: Nurses emphasized the need of deeper inquiry into patients illness situation and complexity to discern the impact of determinants on their well-being and develop care plans that are tailored to address psychosocial, emotional, and physical suffering of this patient population. CONCLUSIONS: Alleviation of patient suffering is integral to compassionate nursing care. Nurses use a multifaceted approach entailing sensitive understanding, recognizing sociocultural and structural determinants impact on patient situation, and individual and interdisciplinary altruistic actions to alleviate patient suffering.

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BACKGROUND: Nurses can play a valuable role in not only the implementation but development of general and health policies. However, evidence indicates limited involvement of nurses in politics and general health policy making owing to individual, interpersonal, and systematic barriers. INTRODUCTION: Strategies are required to increase nurses' participation and engagement in policymaking. However, no studies explored the perspective of nurse leaders in policy making roles and how to improve nurses' involvement in policy making. PURPOSE: To explore strategies to enhance nurses' involvement in policy making from the perspective of nurse leaders. METHODS: A qualitative descriptive study was conducted. Semistructured interviews were conducted with a purposive sample of 11 nurse leaders with at least one year of experience in policy making. Data were analyzed using a thematic analysis approach. The COREQ guidelines were followed for reporting. FINDINGS: Five themes were generated: strategically revisit and implement educational approaches, becoming transformative leaders, improving social image of nurses, developing triadic partnerships, and empowering nurses through reflective and supportive mechanisms. DISCUSSION: Nurses' involvement in policymaking can be enhanced by implementing grassroots-level educational strategies, managerial-level empowerment efforts, and social mechanisms focused on improving the social image of nursing. CONCLUSIONS: Self and professional role empowerment through education, increasing awareness, and improving the social image of nursing can boost nurses' involvement in policymaking. IMPLICATIONS FOR NURSING POLICY: Nurse leaders, national and global nursing associations, and nursing regulatory bodies should collaborate with associations of nursing colleges to design nurse policymaking competencies framework and contextually tailored strategies to enhance nurses' engagement in policymaking.

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AIMS AND OBJECTIVES: To determine nurses' perceived barriers to the delivery of person-centred care to complex patients with multiple chronic conditions in acute care settings. BACKGROUND: Complex patients have multiple physical and mental health problems, and their life is also greatly affected by sociocultural and economic determinants of health. These patients require person-centred care, but nurses often find it challenging to provide effective care to these patients due to their complex health needs. DESIGN: A descriptive qualitative design was used. The COREQ guidelines were followed for reporting. METHODS: Semi-structured interviews were conducted with a purposive sample of 19 nurses in two hospitals. Data were analysed using deductive thematic analysis guided by the Theoretical Domains Framework, which entails 14 domains about factors affecting behaviours. RESULTS: The key barriers were identified under environmental context and resources, social influences, emotions, knowledge and skills domains. Deep-rooted social issues delay patients' health-seeking and nurses' abilities to understand patients' needs and discern appropriate care. Interpersonal hostility influenced nurse-patient-families interactions, and doctor-nurses conflicts affected collaborative efforts towards optimal care. CONCLUSIONS: Nurses' perceived barriers to care were intertwined with the deep-rooted social and cultural beliefs about nurses' image, patients' expectations and families' preference for home remedies over specialised nursing care. These barriers to person-centred care demonstrate an intricate interplay of personal, social and organisational issues and power struggles. Multifaceted implementation strategies targeting environmental context and resources, social influences, emotions, knowledge and skills domains may be beneficial to enable nurses to provide better person-centred care to complex patients. RELEVANCE TO CLINICAL PRACTICE: Designing implementation facilitation teams, organising person-centred care grand rounds, and allocation of stress management resources to address hostility, social-cultural influences, and organisational barriers is essential. Nurses could focus on their self-awareness and collaborative skills to address emotional and interprofessional conflicts.

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Health care professionals experienced multiple uncertainties during the pandemic. Exploring health care professionals' views about collaboration and organizational support can offer insights into organizational processes and issues during the pandemic. This research explored the perspectives of nurses and physicians about organizational support and nurse-physician collaboration during the SARS-CoV-2 pandemic. Using a qualitative descriptive design, interviews were conducted with nurses and physicians working in hospital settings. The interviews lasted for 24-61 min. Reflexive thematic analysis was used for data analysis. Nurses and physicians were disappointed with the organizational support, but they were satisfied with nurse-physician collaboration. The theme "Management Abusing Authority and Blaming the Victimized Workforce" included organizational nepotism, unethical managerial actions, and neglecting frontline workforce. Nurses and physicians supported each other in tackling the intensive and complex demands of the pandemic. The theme "Demonstrating Professional Humility and Overcoming Patient Care Issues at Hand" entailed subthemes - negotiating conflicts and prioritizing patient care, practicing kindness, and jointly managing conflicts with patients' families. Nurses and physicians reported frustrations with limited organizational support and abusive practices of managers. Still, they prioritized patient care needs and family-related conflicts over interprofessional tensions.

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AIM: The aim of this study is to assess the burden of burnout and psychological distress and its association among Pakistani nurses providing care to patients with COVID-19. BACKGROUND: Nurses may experience an elevated risk of burnout and psychological distress during epidemics. METHODS: A cross-sectional study was conducted using a convenience sample of 288 nurses. Maslach Burnout Inventory was administered to measure burnout and its domains of emotional exhaustion, depersonalization, and personal accomplishment. Screening Tool for Psychological Distress was administered to measure depression, anxiety, stress, anger, and low social support. RESULTS: Burnout was present in 48.6% of nurses, severe emotional exhaustion in 37.2%, severe depersonalization in 36.8%, and low personal accomplishment in 46.9% of nurses. Psychological distress was present in 45% of nurses. Burnout and psychological distress were significantly higher in nurses who: were working in public hospitals, did not receive training for COVID-19 prevention, and were dealing with increased patient load. Burnout and its domains were significantly associated with depression, anxiety, stress, anger, and low social support. CONCLUSION: Nurses are experiencing high levels of burnout and psychological distress during the COVID-19 pandemic with a significant moderate-to-strong association between these conditions. These findings accentuate the need for institution-based interventions to mitigate burnout and preserve the mental health of nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Hospitals must screen nurses frequently for the presence of significant burnout and psychological distress and offer supportive interventions to protect their mental health and well-being.

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AIMS: To measure registered nurses', registered midwives', and nursing and midwifery students' current levels of knowledge, attitude and practices related to intimate partner violence. BACKGROUND: Nurses and midwives whether registered or students need to be confident and competent in identifying and responding to intimate partner violence. DESIGN: A cross-sectional survey. METHODS: Data were collected through online surveys using the Physician Readiness to Manage Intimate Partner Violence Survey. Descriptive and inferential statistics were used to analyse the data. RESULTS: Nursing and midwifery students were less knowledgeable and prepared than nurses and midwives. Midwives had more positive attitudes compared with nurses towards women experiencing intimate partner violence. CONCLUSIONS: Heath care institutions and regulatory bodies should provide resources and support to nursing and midwifery professionals. Personal experiences of domestic abuse and professional experience of supporting victims of domestic abuse/intimate partner violence affected practitioner's abilities to identify and manage intimate partner violence. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse and midwifery managers can ensure that clinical and organisational policies and protocols are revisited and updated regularly and that interdisciplinary collaboration is promoted and emphasized for prompt identification and management of intimate partner violence.

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Integrative reviews are invaluable for synthesizing literature to guide practice. This review examined the nature and range of data analysis approaches and the methods used for data presentation in integrative reviews. We reviewed 151 integrative reviews published from January to December 2019 in nursing journals listed in Journal Citation Report 2020. Summary tables were used for data extraction and researcher-developed questions-based process for synthesis. Data analysis and synthesis methods were categorized as non-specific, inductive, deductive, and framework-based. Majority of reviews did not explicitly delineate data analysis and synthesis methods (n = 67) or used inductive methods (n = 55). Limited reviews used deductive (n = 13) and framework-based methods (n = 13). Most of the reviews used narrative descriptions for presentations of findings, but some reviews also used innovative tables, concept maps, frameworks, and word clouds to enhance data presentation. The findings provide a comprehensive overview of the diversity of methods for data analysis and presentation in integrative reviews.

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BACKGROUND: Due to the demanding nature of critical care settings, students are prone to experience stress and lack of confidence, which hinders their learning and affects patient care. Educators should be knowledgeable about students' roles, stressors, and challenges as well as strategies to enhance students' competence and confidence to efficiently practice in critical care. PURPOSE: To map and analyze the literature about nursing students' placement, preparedness, and practice in critical care settings and identified areas for future research and practice. METHODS: A scoping review using PRISMA guidelines. The literature was searched within eight databases using indexed terms. In total, 32 sources were selected for review. Literature summary tables, thematic synthesis, narrative summaries were used for data extraction and synthesis. FINDINGS: Three themes and 12 sub-themes were generated. The themes included students' experiences and perspectives about critical care placements, strategies to enhance student learning, and the impact of clinical placements and teaching strategies on students. CONCLUSIONS: Critical care placements allow students in understanding the care of complex patients, enhancing their observational skills, and improving their interpersonal relationships in critical care teams. To enhance student preparedness for effective practice, high fidelity simulations and course-based teaching have been demonstrated to be effective.

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AIMS: To explore the nurse managers' perspectives about the role and application of self-awareness in managerial practice. BACKGROUND: Effectively accomplishing complex roles and maintaining a healthy work environment requires nurse managers to be resilient and sustain positive relationships with nurses and interdisciplinary teams. Self-awareness is an essential attribute for building relationships and creating a healthier work environment. METHODS: A descriptive qualitative design was used. We conducted semi-structured interviews with a purposive sample of ten managers working in two tertiary hospitals. Reflexive thematic analysis was used for data analysis. RESULTS: Four themes were generated: "maximizing potential for overseeing complex management issues; becoming a conscientious and thoughtful manager; using experiential learning for nurturing managerial capabilities; and utilizing self and others' appraisal for discerning practical managerial approaches". CONCLUSIONS: Implementing self-awareness in complex situations is beneficial for nurse managers. It allows them to overcome negative emotions and factors and incorporate ethical and moral reasoning, thereby preventing them from ineffectual management. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should focus on assessing their temperaments and managerial abilities in each complex situation. They should use experiential learning from past experiences for discerning effective actions for managing complex situations.

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Self-awareness is an essential nursing competency and there is limited knowledge about nurses' levels and application of self-awareness and instruments to measure nursing-specific self-awareness. Using mixed methods, we developed and tested a scale to measure nurses' self-awareness. First, 13 nurses were interviewed to understand their meanings of self-awareness and to develop nursing-specific self-awareness scale. Qualitative analysis generated professional, personal, contextual, and contentious aspects of self-awareness. Second, a 25-item scale assessed through expert consultations and pilot testing with 252 nurses. The content validity index was 0.94. After psychometric testing, seven items were deleted. Cronbach's alpha for the 18-item scale was 0.87 and the four-factor structure accounted for 45.55% of the variance. Lastly, the final scale was administered to 216 nurses. Nurses' had moderate self-awareness (59.65 ± 7.01), significantly associated with age and years of the clinical and educational experience. Intensive care nurses were more self-aware than nurses in other settings.

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AIMS: To discuss and illustrate how meaningful integration can be achieved in instrument development design. DESIGN: Discussion paper. DATA SOURCES: A mixed-methods study about challenges of nurse educators in Pakistan. The building technique was implemented when the findings of the qualitative phase were integrated to develop an instrument to determine educators' challenges while teaching nursing students in academic and clinical settings. IMPLICATIONS FOR NURSING: Nurses are required to use cultural- and population-specific instruments for data collection. The six-step building approach can enable nurses to develop such instruments using rigorous and robust mixed-methods design. CONCLUSION: Building and merging techniques are used in instrument development design during and after the completion of the study, respectively. However, building technique is essential for using the qualitative findings to develop the instrument. The proposed building approach starts with a robust qualitative data analysis and is strengthened with the selection of key themes and subthemes, linking them to the participants' quotes and then the conversion of the quotes into meaningful and pertinent items. Using the proposed building integration technique can enable researchers to meaningfully and efficiently use qualitative findings for developing instruments using mixed-methods designs. IMPACT: Mixed methods are valuable for the development of data collection instruments that are tailored to the study context and relevant for the study participants. There is limited guidance about how meaningful integration can be achieved when developing research instruments using mixed methods. We proposed a practical building technique that allows researchers to meaningfully use qualitative findings from one phase to develop an instrument for the subsequent phase. The proposed approach is useful for researchers aiming to develop data collection instruments using mixed methods.

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Self-awareness is essential for nurses for improving nurse-patient relationship and patient care. There are many theories about self-awareness, but scant research explores nurses' perspectives regarding self-awareness and its significance for themselves and patient care. This study explores nurses' perspectives regarding self-awareness in nursing, the importance of self-awareness for nurses, and its influence on patient care. We used a descriptive qualitative design. Face-to-face semistructured interviews were conducted, from October to December 2018, with a purposive sample of 13 nurses at two hospitals in Pakistan. Thematic analysis was used for data analysis. Five themes and 13 subthemes were generated. The themes included the meaning of self-awareness: a personal, professional, and conscientious attribute, significance of self-awareness for nurses, self-aware nurses and its impact on patient care, behaviors, and actions signifying self-awareness, and what is needed to enhance self-awareness. Self-awareness can increase nurses' confidence in managing challenging situations and providing culturally competent care to patients from various cultural and religious orientations.

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PURPOSE: The care needs, experiences, and physical and psychological health of women with breast cancer are well-documented, but missing is the discussion of illness and management experiences of men with breast cancer. To explore and understand the nature and complexity of transitional experiences, from the time of receiving the diagnosis to the survivorship of men with breast cancer. METHODS: An integrative review was conducted according to Whittemore and Knafl's methodology. Literature was searched in seven scientific and two grey literature databases using mesh terms "breast cancer", "men", "experiences" and "nursing". Of 1013 screened articles, 17 qualitative, quantitative, and mixed methods studies and research reviews met the inclusion criteria. The studies were critically appraised using mixed methods appraisal tool and rated as high and low quality. The data was extracted using literature summaries and synthesized using thematic, descriptive, and interpretive analysis. RESULTS: Nine themes captured the transitional experience at the diagnosis, management, and survivorship stages. Gender inequalities and stigmatizations at personal, health care, and social and community levels negatively influence men's experiences. CONCLUSIONS: The gender stigmatizations present at personal, health care, and social and community levels greatly influence men's experiences of breast cancer. To resolve gender inequalities in breast cancer management, the nurses should focus equally on the needs of men and women with breast cancer. The needs of men entail reducing health care and social stigmatizations, gender specific information and management, and opportunities to participate in support groups.

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BACKGROUND: Nurse educators are required to equip students with adequate theoretical and practical knowledge to provide effective nursing care. Limited studies have explored educators' challenges while teaching students. Existing studies are limited because of small sample, overreliance on qualitative approaches, and unreliable instruments that have not been tested. OBJECTIVES: To explore nurse educators' perspectives about their clinical and academic teaching, to develop a questionnaire to determine educators' challenges, and to develop a comprehensive understanding of educators' challenges. DESIGN: A sequential exploratory mixed-methods study. SETTINGS: Twelve nursing institutions in five cities of Pakistan. PARTICIPANTS: A purposive sample of 12 educators for interviews and 112 for the survey. METHODS: Semi-structured interviews and survey for data collection and expert consultations for questionnaire development. Thematic analysis for qualitative analysis, descriptive analysis for quantitative, and joint display tables for mixed methods. RESULTS: Educators experience workload and time constraints and struggle to effectively teach students due to inadequate student-educator ratio; underdeveloped curriculum; inadequate resources; inadequate clinical teaching settings for skills, simulation labs; inadequate professional development opportunities; lack of autonomous decision making; lack of educational, management, and research support from the regulatory bodies; and lack of educational research. CONCLUSIONS: Nurse educators' issues and challenges are persistent and require support from regulatory bodies and educational authorities. There is a need to develop policies to improve teaching and learning conditions for educators, provide them with the opportunities to enhance their own learning, and opportunities to collaborate with other educators in order to better prepare student nurses.

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