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. 

Background Providing quality palliative care during a pandemic was challenging. Both specialist and communityhealthcare services cared for patients that faced life-threatening illness and who were influenced by the restrictionsof the COVID-19 pandemic. Little knowledge has yet been provided on how registered nurses (RNs) experiencedthe palliative care quality during the COVID-19 pandemic. The aim of this study was to explore RN’s experiences ofproviding palliative care quality during the COVID-19 pandemic. Methods This qualitative study had a descriptive design. Semi-structured individual interviews were conductedbetween November 2021 and January 2022 with 18 RNs who worked in intensive care units in hospitals, dementiacare or palliative care units in nursing homes in Norway during the pandemic. Data were analysed by using qualitativecontent analysis. The study was conducted and reported according to the COREQ’s checklist. Results Analysis of the data resulted in an overall theme: ‘Striving to achieve control’. This theme comprised sixcategories: (1) when the toolbox does not fit; (2) protective equipment—social distance and opportunities forcloseness; (3) unpredictable workday; (4) the right person to the right assignment at the right time; (5) presence andabsence of relatives and friends; and (6) situations that required creativity. RNs had various experiences regarding howthe quality of care was perceived; being worse, preserved, or in some cases even better than before the pandemic. Conclusions The provision of quality palliative care was experienced by RNs as challenging during the pandemic.The pandemic forced them to be creative and to strive for control to provide the best palliative care possible giventhe situation. The results of this study may contribute to important knowledge for leaders, policy makers and RNsto learn from the COVID-19 pandemic and planning for future pandemics or crises. Especially to optimise factorsperceived by RNs to be important for the palliative care quality, related to the specific situation and care context, toinclude the perspectives of those involved and take into consideration the time perspective of the pandemic.

Background Implementing a person-centered approach in nursing homes can significantly improve patient satisfaction and care quality while also enhancing job satisfaction among healthcare staff. Leaders play a pivotal role in establishing and nurturing a culture that supports person-centered practices. While there is some empirical evidence, a more comprehensive understanding of how leaders effectively foster and sustain person-centered practices in nursing homes is needed.Aim To investigate the role of leaders in fostering person-centeredness within nursing homes.Methods The study is based on the PRISMA reporting guidelines. Comprehensive searches were performed in CINAHL and PubMed, with article screening and selection facilitated by Rayyan software. A convergent integrated approach from the Joanna Briggs Institute (JBI) was used to synthesize findings from both qualitative and quantitative studies.Results The review included ten studies, comprising six qualitative and four quantitative studies. The results indicate that leadership in nursing homes that fosters person-centeredness involves creating and communicating a shared vision, empowering staff, and ensuring systematic and consistent approaches. Additionally, leaders must embody person-centered values through role modeling.Conclusions This systematic review highlights the critical role of leadership in fostering and sustaining person-centered practices in nursing homes. Leaders carry a substantial burden of responsibility. The results suggest that a shift towards a more integrated leadership approach, incorporating both distributed and person-centered leadership models, could promote a more sustainable and supportive environment for both leaders and staff, ultimately enhancing the quality of care. These insights provide valuable guidance for nursing home leaders and policymakers aiming to strengthen person-centered practice.

IntroductionFirst-line managers in Swedish communities have responsibility for that care to older people is provided, staffing is sufficient and the budget is balanced in their unit. It is a struggle with limited resources due to a growing population in need of care. This can lead to missed nursing care. The aim was to describe first-line managers<acute accent> perceptions of missed nursing care in community health care for older people.MethodsA qualitative design with a phenomenographic approach, interviewing 24 first-line managers. Ethics approval for the study was received from the Research Ethics Committee at Karlstad University (Dnr HNT 2020/566).ResultsThe results are shown in six descriptive categories containing 15 perceptions. The descriptive categories are 'occurrence of missed nursing care', 'becoming aware of missed nursing care', 'reasons for missed nursing care', 'missed nursing care has consequences for the older persons', 'missed nursing care has consequences for the staff' and 'taking action to decrease missed nursing care'.ConclusionsIt is important for first-line managers to become aware of the existence and reasons for missed nursing, as it has consequences for older people and staff. Managers need to take missed nursing care seriously in order to work with improvements for maintaining good quality of care and patient safety.