Relationship-based Care Research Articles

Exploring General Practitioners' Management of Self-Harm in Young People: A Qualitative Study.

General practitioners (GPs) are key to the frontline assessment and treatment of young people after self-harm. Young people value GP-led self-harm care, but little is known about how GPs manage young people after self-harm. This study aimed to understand the approaches of GPs to self-harm in young people and explore their perspectives on ways they might help young people avoid repeat self-harm. We conducted semi-structured interviews with GPs from the National Health Service in England in 2021. GPs were recruited from four geographically spread clinical research networks and a professional special interest group. Data were analysed using reflexive thematic analysis. The study's patient and public involvement and community of practice groups supported participant recruitment and data analysis. Fifteen interviews were undertaken with a mean age of participants being 41 years and a breadth of experience in practice ranging from 1 to 22 years. Four themes were generated: GPs' understanding of self-harm; approaches to managing self-harm; impact of COVID-19 on consultations about self-harm; and ways to avoid future self-harm. Negative attitudes towards self-harm within clinical settings are well documented, but GPs said they took self-harm seriously, listened to young people, sought specialist support when concerned and described appropriate ways to help young people avoid self-harm. GPs felt that relationship-based care is an important element of self-harm care but feared remote consultations for self-harm may impede on this. There is a need for brief GP-led interventions to reduce repeat self-harm in young people. A study advisory group consisting of young people aged 16-25 years with personal experience of self-harm and parents and carers of young people who have self-harmed designed the recruitment poster of this study, informed its topic guide and contributed to its findings.

When Midwives Burn Out: Differences in the Experiences of Midwives in British Columbia and Alberta

Background: Internationally, continuity of care has been identified as a possible strategy to prevent burnout. The majority of midwives in British Columbia and Alberta practice within a continuity-based model of care, but British Columbia midwives have significantly higher burnout scores. Methods: We compared data from midwives from Alberta and British Columbia who responded to the Canadian arm of the WHELM (Work, Health, and Emotional Lives of Midwives) survey through invitations via their professional organizations. The survey included demographic questions, items about work patterns, occupational stressors, burnout, and intentions and reasons to leave the profession. Results: Workload was the most commonly reported stressor in both British Columbia and Alberta. Midwives in British Columbia were more likely (54%) to have seriously considered leaving the profession in the last 12 months than midwives in Alberta (26%). One-third of British Columbia midwives and no Alberta midwives cited poor pay as a reason to leave the profession. In answers to open-ended questions, 47% of respondents from British Columbia, but none from Alberta, highlighted poor pay as something that would need to change in order for them to successfully manage workplace stress. Discussion and Conclusion: Our comparison of similar midwifery contexts in Western Canada suggests burnout and intention to leave the profession are associated with how the care is remunerated. Midwives in British Columbia and Alberta care for a similar volume of clients and are paid with a similar type of payment system, but midwives in British Columbia are paid significantly less per course of care. A revised payment system or a significant increase in pay per client may ensure that midwives in British Columbia can continue to provide high-quality relationship-based care while maintaining longevity in the profession. This article has been peer reviewed.

Attuning to the World of Peace of Mind and Trust: Women's Lived Experience of the Woman-Midwife Relationship in Japan.

In Japan, many pregnant women and mothers suffer from anxiety, depression, and other postnatal issues that can be exacerbated by their birth experiences. While benefiting from advanced medical care, these women's mental and psychological health may be disregarded in their maternity care. Midwives have the potential to play a significant role in improving women's birth experiences. Hence, this study aimed to explore the meaning of the woman-midwife relationship, with a specific focus on sensing peace of mind and trust to improve women's birth experiences. Using a hermeneutic phenomenological approach, 14 Japanese women were interviewed. Sensing peace of mind and trust was one of the significant meanings of the woman-midwife relationship and is articulated across five themes: (1) attuning to the world, (2) different kinds of safety and trust, (3) relying on and entrusting midwives, (4) making a mother, and (5) an emotional bridge. The positive relationship with midwives enhanced the women's mental well-being through allowing the women to attune to the peaceful mind which directed their future perspectives and sustained them in motherhood. They became confident mothers by trusting their midwives. The maternity care system in Japan needs to shift to more relationship-based care to ensure continuity of midwifery care that will improve women's birth experiences and their long-term well-being.

FIERCE Patient Care Model: Navigating Through Unfavorable Communication Pathways in Healthcare

Communicating unfavourable information is an unavoidable fact that is often confronted by healthcare practitioners. This practice model provides a new perspective for caring which can be applied in nursing situations and environments for health and well being. Conceptualizations for the practice model are influenced by Nightingale Environmental Theory, Relationship Based Care (RBC) model and Peplau theory of Interpersonal Relations. This practice model aims to prepare patients to become Fully Informed, Equipped, Ready, Committed, and Empowered (FIERCE). This highlights the significance of establishing a strengthened relationship between nurse and patient to effectively navigate challenging communication situations. Hence, it is an important addition to nursing knowledge since it possesses a significant potential to enhance health outcomes, feelings of satisfaction and quality of life by encouraging nurses to have the potential to deliver unfavourable information to patients in a more fulfilling manner while ensuring that patients are fully informed, equipped, ready, committed and empowered individuals.

Relationship-Based Health Care: Achieving Improved Outcomes Through Shared Responsibility

Pressures are mounting on health care organizations today to provide better care while also controlling costs. Engaging people in their own health care can both result in better health outcomes for patients, and ease the burden on the medical system. Southcentral Foundation (SCF), an Alaska Native-owned health care system, transformed its system in the late 1990s to focus on customer-ownership and relationships. Today, SCF serves as an example of what can be achieved through a system focused on these core elements. 
 SCF does not refer to the people it serves as “patients.” This term sounds passive and does not reflect the level of engagement that SCF’s providers and customers have with each other and the customer’s health care. Rather, since the Alaska Native and American Indian people SCF serves are both customers and the owners of the health care system, they are referred to as “customer-owners.” This is not just a change in terminology, it signifies a change in the relationship between customer-owners and their care providers. Unlike a traditional system in which the patient often has a minimal role in their diagnosis and treatment, our customer-owners work together—in relationship—with their care providers to achieve overall wellness.
 These relationships are another central element of SCF’s whole system transformation. SCF recognizes that each individual has more control over his or her own health outcomes than providers, and that when providers build strong, long-term relationships with customer-owners, they can more effectively help customer-owners achieve wellness. Customer-owners choose their own providers and form strong, long-term relationships so providers can support them in their journeys toward wellness. 
 SCF’s focus on customer-ownership and relationships has resulted in improved health outcomes for customer-owners while also managing costs. Emergency Department visits for customer-owners decreased by 44%in the five years after SCF transformed its system, and inpatient discharges decreased by 63% over that same time period. SCF ranks above the 75th percentile for many health measures such as diabetes and cancer screenings. 97% of customer-owners are satisfied with the care provided by SCF, and SCF has also achieved 95% employee satisfaction.
 This workshop is for health care leaders, medical directors, improvement personnel, and anyone else looking for ideas for systemic reform. The session will be delivered in an interactive lecture format, with time allocated throughout for participants to discuss the material presented in small groups. After the discussions, the groups will report out to the larger group so that a variety of perspectives can be shared. Presenters will also regularly ask questions to engage the audience and encourage participants to share their own experiences and ideas relating to the material presented.
 At the end of the session, the key elements of SCF’s system of care will be summarized, along with points raised by participants during the session. Suggestions will also be offered for participants looking to reform their own systems according to principles of relationship-based care and customer-ownership.

Where the joy comes from: a qualitative exploration of deep GP-patient relationships

BackgroundRelationship-based, whole person care is foundational to quality general practice. Previous research has identified several characteristics of deep General Practitioner (GP)-patient relationships and their association with improved patient concordance, satisfaction and perceived health outcomes. Psychological attachment theory has been used to understand therapeutic relationships, but has only been explored to a limited extent in the general practice context. Additionally, evolving changes in sociocultural and commercial practice contexts may threaten relationship-based care. In view of this, we aimed to explore the nature and experience of deep GP-patient relationships, as identified by patients, from GP and patient perspectives.MethodsSemi-structured interview design. An initial survey assessed patients’ perceived depth of their relationship with their GP, using the Health Care Provider Attachment Figure Survey and Patient-Doctor Depth of Relationship Scale. Patients who reported a deep relationship, and their GPs, were purposively selected for individual interviews exploring their experience of these relationships. A post-interview survey assessed interviewees’ attachment styles, using the Modified and Brief Experiences in Close Relationships Scale. Patient interviewees also rated the patient-centredness of their GP’s clinic using the Person-Centred Primary Care Measure. Transcripts were analysed using thematic analysis.ResultsThirteen patients and five GPs were interviewed. Four themes characterised deep relationships: the ‘professional’; human connection; trust; and ‘above and beyond’. Patient, GP and practice team all contributed to their cultivation.ConclusionsWe present a revised conceptual framework of deep GP-patient relationships. Deep relationships come to the fore in times of patient trouble. Like attachment relationships, they provide a sense of safety, caring and support for patients experiencing vulnerability. They can stretch GP boundaries and capacity for self-care, but also provide joy and vocational satisfaction. Patients may not always desire or need deep relationships with their GP. However, findings highlight the importance of enabling and cultivating these for times of patient hardship, and challenges of doing so within current healthcare climates.

The Teach-Back Method to Build Patient’s Health Literacy

The Teach-Back Method is a technique used by health care providers to non-shamingly verify patient understanding of for example, their diagnosis, medications, hospital stay, and discharge instructions. Informed patients may avoid a costly readmission to the hospital. The hospital library can be a resource center for tools on how and when to use the Teach-Back Method. In addition, the librarian can teach, or co-teach, this technique to health care team members. If the hospital librarian is involved in patient education or relationship-based care, they may indeed be practicing the Teach-Back Method during the patient’s stay or when the patient is discharged. This column describes the Teach-Back technique and gives examples of its use in patient discharge. It also features a successful example of a librarian being involved in teaching the Teach-Back Method.

The experiences of remote consulting for people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and fibromyalgia in primary care.

Restrictions due to the COVID-19 pandemic resulted in a sudden shift to a predominantly remote consulting model in primary care from March 2020. Little evidence exists examining the experience of remote consulting for people living with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) or fibromyalgia, with the current literature focusing on the challenges faced by clinicians and people living with these conditions. Clinical guidance highlights the importance of building therapeutic relationships and personalising care, but it is unclear how this translates into a remote or virtual consulting space. To explore how people living with CFS/ME and fibromyalgia experience remote consulting with a primary care clinician, including synchronous and asynchronous methods, that is, e-consultation platforms, email, video, and telephone. Semi-structured interviews are being recorded and analysed thematically using a Foucauldian theoretical framework. Participants have been recruited across the West Midlands from a range of backgrounds. Recruitment is still ongoing. Preliminary analysis indicates that remote consulting is acceptable for these groups of patients, but only if they feel validated, listened to, and with a clinician who considers a holistic view with continuity of care. Remote consulting has presented new challenges for primary care, and it is important to identify which groups of patients are most suited. This study explores the views from a group of patients that are associated with some complexity, and complements the literature that explores the ability to deliver relationship-based care when consulting digitally/remotely. Recommendations from the findings will be created for use by patients and clinicians alike.

Bridging gaps: improving access to primary care for and with marginalised patients.

People who experience severe and multiple disadvantage (SMD - including combinations of homelessness, substance misuse, violence and abuse, and poor mental health) have high health need and poor access to primary care. Access to care requires the 'human fit' between the patient and healthcare staff. This study aimed to co-produce service improvements in primary care to improve access for and with people with SMD and explore the perceptions of professionals and people with lived experience who contributed to these service improvements. Bridging Gaps is a collaboration between healthcare staff, women with lived experience, and a charity that supports them. We used a co-production approach, where people with lived experience are involved in decision-making throughout the process. A thematic analysis was performed of 12 observed collaborative service-improvement meetings, feedback from 3 GP trainees involved and interviews with 14 professional and lived experience collaborators on the project. Co-produced outcomes included a clinic designed for and with people with SMD; two Inclusion Health Care Coordinators, and a document for people with SMD to share information with their practice. Key themes from the data included protecting resource to enable cultural shift to proactive relationship-based care; and the benefits to marginalised patients, services, and professionals of having collaborative space to develop positive changes. Co-produced service-improvements to improve access to primary care for marginalised patients were valued, possible, and of benefit to patients, staff, and services. This study offers valuable insight into how we can better include and care for marginalised patients in primary care.

Seeking a connection: Women’s lived experience of the woman–midwife relationship in mainstream maternity services in Japan

ProblemIn Japan, women continue to suffer from mental health and other postpartum issues despite good clinical outcomes of maternity care. BackgroundAs key care providers, midwives potentially affect women’s overall birth experience. Most women in Japan give birth in hospitals or obstetric clinics where different midwives and nurses provide one woman with fragmented care. Women’s lived experiences of the woman–midwife in these birth facilities are not well known in Japan. AimTo understand women’s birth experience and relationship with midwives in the mainstream maternity care system in Japan to improve maternity care and women’s birth experience. MethodsFace-to-face individual interviews with 14 mothers were conducted. The data were analysed using van Manen’s hermeneutic phenomenological approach, which reveals the meaning of human experience in the everyday world. FindingsFour themes were derived from the hermeneutic phenomenological analysis; 1) Closed hearts and bodies in insecure relationships, 2) Alienation, 3) Hopelessness and helplessness, and 4) Women’s vulnerability and desire for positive relationships. DiscussionIn institutionalised and fragmented maternity care settings, it is difficult for women and midwives to develop a relationship. In such a care environment, women’s birth experience with midwives is negative or even traumatic; yet, women still need and seek the midwife relationship. Respectful care—necessary for women’s positive birth experience—requires positive relationship between women and midwives. ConclusionWomen’s negative birth experience may affect their mental health and parenting. Maternity and midwifery care in Japan needs to develop relationship-based care to improve women’s birth experience.

The RANA Model Revisited: How a Primary Nursing Model for Professional Psychiatric Nursing Practice Has Withstood the Test of Time.

This article revisits the responsible, accountable nurse with authority (RANA) model and its continued application to psychiatric-mental health nursing care nearly 30 years after its development. It will ascertain key elements of the model that remain in use today, while identifying parts of the model that have transformed over the years. This article will also explore the theoretical underpinnings of the model, including Peplau's interpersonal relations theory. The impact of the primary nursing and relationship-based care models that influenced the RANA role will also be explored. Specific examples of how the RANA model has affected unit outcomes will be identified, such as improved patient safety measures and satisfaction with care. The nurse-patient relationship and therapeutic alliance is fundamental to the RANA model and directly affects patient outcomes.

Describing Remembrance & Renewal: A Holistic Self-Care Program.

Background: Holistic care interventions include support for healthcare worker grief in a relationship-based care paradigm. Few programs support oncology healthcare worker grief and renewal prior to and during the COVID-19 pandemic. Objective: Describe "knowledge of" and "engagement with" a program about grief and resilience, Remembrance & Renewal (R&R). Method: An anonymous, electronic survey was available to healthcare workers at an academic, comprehensive cancer center. Demographic questions were analyzed against "knowledge of" and "engagement with." Results: Of 105 responding to "awareness of," 81 knew about R&R and 48 had "engaged with" the program. Statistically significant relationships between a characteristic and awareness were found for education (p = .03), setting (p < .01), and the frequency of learning about a death (p = .04). Statistically significant relationships between a characteristic and level of participation were found for profession (p = .02) and length of time in job (p = .03). Open-ended questions asked about impact of patient death (n = 93), barriers to participation (n = 54), and feelings after "engagement with" (n = 45). Responses to impact, barriers, and feelings were respectively: sadness (75.3%); time (77.8%); and calm (75.6%). Conclusion: This study describes "knowledge of" and "engagement with" a holistic grief and renewal program. Further study will add to healthcare worker holistic self-care.

An Exploratory Multi-Case Study of the Health and Wellbeing Needs, Relationships and Experiences of Health and Social Care Service Users and the People who Support them at Home.

International policies and legislation set a precedence of person-centred sustainable integrated Health and Social Care (HSC) that meets the health and wellbeing needs of service users through improved experiences. However, current research focuses on service models, with fewer studies investigating experiences and needs. This qualitative multi-case [n = 7] study was co-designed with key stakeholders and aimed to explore experiences and needs of people who access and provide HSC at home. Data were collected in a regional area of Scotland (UK) via single [n = 10] or dyad [n = 4] semi-structured interviews with service users [n = 6], informal carers [n = 5] and HSC staff [n = 7] and synthesised using Interpretive Thematic Analysis. Interpersonal connections and supportive relationships were instrumental in helping all participant groups feel able to cope with their changing HSC needs and roles. They promoted reassurance, information sharing and reduced anxiety; when they were lacking, it negatively impacted upon experiences of HSC. Promoting inter-personal connections that encourage supportive relationships between people who access and provide HSC and their communities, could promote person-centred Relationship-based care and improve HSC experiences. This study identifies indicators for improved HSC, advocating co-produced community-driven services to meet the self-defined needs of those who access and provide care.

The relationship competencies guiding tool: A development, content validation and implementation study

AimThe aims of this paper are (1) to present the results of the development, content validation and implementation study of the Relationship Competencies Guiding Tool; (2) to provide examples of how each item in the tool is reflected in clinical narratives written by nurses and justify the corresponding scores after the evaluation; (3) to present how the language and content of the narratives are interpreted with the tool and to describe an exemplar; and (4) to present barriers to and facilitators of the application of the tool. BackgroundFrom a person-centered care approach, the fostering of authentic relationships with patients is key to achieving therapeutic benefits. Therefore, it is essential to help nurses establish meaningful relationships with patients and help them acquire these abilities. Clinical narratives can be used as a way to promote reflective practice and professional competency development among nurses. A tool to evaluate the knowledge, skills, attitudes and values necessary for developing authentic encounters with patients through clinical narratives was developed, validated and implemented. DesignAn instrument-development study comprised of three steps: (1) conceptualization; (2) item generation and content validity; and (3) implementation of the tool and linguistic evaluation. MethodsThis study was conducted in three major steps. Step one entailed conceptualization. Step two included the generation of items and content validation. In step three, the tool was used to independently evaluate 25 narratives. One of these narratives was also linguistically analysed to provide a comprehensive view of the interpretative strategies deployed by evaluators. ResultsThe Relationship Competencies Guiding Tool was developed, validated and implemented. It could help nurses work on nursing relationship-based professional competencies, guided the evaluators in the process of assigning scores to the corresponding items and helped the researchers identify certain barriers and facilitators before and during the narrative evaluation process. ConclusionsThe tool has been shown to be clear, relevant and conceptually and linguistically suitable for evaluating clinical narratives. The Relationship Competencies Guiding Tool could be applied to interpret how nurses reflect professional competencies in a clinical narrative as a preliminary step in the construction of a measurement tool. Tweetable abstractFrom a person-centered relationship-based care approach, clinical narratives can be used to promote professional competencies between nurses. The Relationship Competencies Guiding Tool may help evaluate the knowledge, skills, attitudes and values necessary for developing authentic encounters with persons/families, as reflected by nurses’ clinical narratives.

The appropriate use of gastrostomy tubes in palliative surgery.

Palliative surgery is defined as an operation or procedure performed with the primary intention of relieving symptoms or improving quality of life. Gastrostomy tubes are often employed with palliative intent but, like many palliative interventions, there is insufficient data to facilitate surgical decision-making. This can be challenging for healthcare professionals as caring for palliative patients often encompasses end of life care, severe life-altering symptoms, and poor prognosis. Thus, we have gathered available data for the appropriate use of gastrostomy tube in palliative surgery and propose our mini-review as a primer to aid in medical and surgical decision-making. We first provide the background for palliative surgery and the definition, brief history and techniques pertinent to palliative gastrostomy tube (PGT). Then we review the data relevant to two common indications-head/ neck cancer and malignant bowel obstruction-for PGT. As our deliverable, we present an effective paradigm for delivering the data to patients and families utilizing known palliative communication and decision-making frameworks such as the Palliative Triangle, Best Case/Worst Case and Defining Value. Moreover, we highlight the necessity of conducting more palliative care research that involves palliative outcome measures in addition to traditional metrics such as overall survival. We end our discussion by emphasizing the importance of multidisciplinary team, individualized decision-making, and relationship-based care for palliative patients.

Achieving Calm: A Study on the Health Care Experiences of People With Lived Experience of Homelessness in Central Texas.

The experiences of care of people with lived experience of homelessness are rarely embraced to change care delivery. We conducted qualitative group and one-on-one interviews utilizing experience group methodology with 27 people with lived experience of homelessness currently housed in one permanent housing community in central Texas. We analyzed data using an inductive thematic approach to identify shared obstacles and barriers to receiving health care. We then analyzed findings with the capability, comfort, and calm value framework to identify health outcomes that matter most to study participants. Poor access to care, discontinuities in care, distrust in providers, and confusing terminology were identified as the biggest barriers to health. The overwhelming majority of experiences reflected poor health outcomes of calm, the outcome of a health care experience that adds ease to one's life rather than logistical and administrative chaos. We propose three practical approaches to achieve calm for this population as follows: systems-level embracement of compassionate care, integration of relationship-based care navigation into all levels of care, and building efficient transportation into care design. We conclude that designing health care that works in the lives of people with lived experience of homelessness is critical to address the gaps in care that fuel the health disparity these individuals face compared to people without this lived experience.

Extrinsic emotional regulation experienced by lung cancer patients and their family caregivers during progression-free survival.

Existing research has found that both lung cancer patients and their informal caregivers reported higher level of emotional distress and psychological maladjustment. However, limited attention has been afforded to collective emotional experiences in patient-caregiver dyad, especially during progression-free survival. This study attempted to explore extrinsic emotional regulation experienced by lung cancer patients and familial caregivers in China. By adopting a qualitative descriptive approach, data were collected using face-to-face, in-depth semi-structured interviews from July to August 2021. Using purposively sampling, this study interviewed 13 patients and 7 caregivers through conjoint and individual interviews. Based on data analysis, findings demonstrated emotional congruence, implicit emotional disclosure and emotional contagion within families as indicators of mutual responsiveness to cancer in patient-caregiver dyads. Furthermore, caregivers tended to adopt relationship engagement to facilitate patients to maintain mental wellness during PFS. Oncology care should promote the implement of patient- and family-centred care, especially enhancing dyadic coping in emotional regulation. Patients and caregivers experienced mutual responsiveness to cancer-induced emotions. Additionally, caregivers adopted relationship-based care ethics to facilitate patients to maintain mental wellness.

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Qualitative Descriptive Study.

BackgroundAlthough videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses’ ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey.ObjectiveThis study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs).MethodsIn this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis.ResultsMost patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present.ConclusionsPerson-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines.International Registered Report Identifier (IRRID)RR2-10.2196/27940

A Hospital's Roadmap for Improving Nursing Excellence Using AACN's Healthy Work Environment Standards.

A Hospital's Roadmap for Improving Nursing Excellence Using AACN's Healthy Work Environment Standards.

Being connected: Exploring the needs of mothers during the postnatal period in Queensland, Australia.

This project explored the needs of mothers beyond the immediate postnatal period in Queensland, Australia, for the development of improved models of care. Data were collected through group and individual interviews. A qualitative methodology using thematic analysis captured the experience of 58 participants. Four key themes were generated: Caring for self, Being connected, Getting direction and Having options. Being connected with care providers and peers was highly valued by participants as was having a sense of direction. Having a relationship with a carer who knew them personally throughout pregnancy and postnatal care avoided retelling stories and facilitated information sharing. Relationship-based care enabled mothers to better meet their personal needs necessary to fulfil the parenting role. Yet, many points of disconnect were identified including inconsistencies in information and gaps in care. These findings demonstrate a range of unmet needs, situated within a lack of relational continuity. Maternity and child health professionals, service managers and policy makers must reorient systems by listening, acknowledging and keeping the voice of mothers at the centre of care.