In-patient suicide prevention is a high priority in many countries, but its practice remains poorly understood. Patients in a suicidal crisis who receive psychiatric care can provide valuable insight into understanding and improving patient safety. The aim of this paper was therefore to summarize the qualitative literature regarding suicidal patients’ in-patient care experiences. The following question guided the review: How can we describe suicidal patients’ experiences regarding safety during psychiatric in-patient care? Systematic searches were conducted in the MEDLINE, Academic Search Premier, CINAHL, SOCINDEX and PsycINFO databases, identifying 20 qualitative studies on suicidal patients and their psychiatric in-patient care experiences. These studies were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, synthesized via thematic analysis and subjected to quality appraisals. Patients described safety as “feeling safe”, and three components, i.e., connection, protection and control, were vital to their experiences of safety. Fulfilling these needs was essential to patients recovering from suicidal crises, feeling safe during encounters with health care professionals and feeling safe from suicidal impulses. Unmet needs for connection, protection and control left patients feeling unsafe and increased their suicidal behaviour. Our review addresses the importance of adopting a wider perspective of patient safety than considering safety solely in technical and physical terms. Safety for the suicidal patient is highly dependent on patients’ perceptions of their psychological safety and the fulfilment of their needs. The three patient-identified factors mentioned above – connection, protection and control – should be considered an integral part of patient safety practices and should form the basis of future efforts to understand the safety of suicidal patients during psychiatric in-patient care.

Aims and objectives: The aim was to gain in-depth understanding about individuals’ existential experiences of living with obesity. Background: People living with obesity face great vulnerability and existential challenges. The different treatments offered do not seem to meet the individual needs of persons with obesity. A deeper understanding of existential experiences from an individual perspective is needed to individualize treatment. Design: An exploratory phenomenological–hermeneutical design was used to gain a greater understanding of the existential experiences involved in living with obesity. Methods: The participants represented a convenient sample. 18 qualitative interviews were conducted and subjected to phenomenological–hermeneutical analysis. Results: Four themes emerged: shaped by childhood; captured by food; depressed by the culture; and judged by oneself. Conclusions: The burden of being obese can be experienced as being objectified and alienated as a human being. We need to turn towards a life-world perspective, seeing each human being as a living body to overcome objectification and alienation, and then move them towards becoming subjects in their own lives, through giving space for self-love. Health care workers need to assist persons living with obesity to reduce objectification and alienation. It is important to develop intervention that has an individual, holistic approach.

Background: As a group, cancer survivors experience significant vulnerability and existential challenges. The biomedical approach dominating health care is insufficient to meet such existential challenges in an individualistic, holistic way.Objective: This study aimed to explore the existential experiences of those treated for different cancers.Methods: An exploratory phenomenological–hermeneutical design was used to obtain an understanding of existential experiences after cancer treatment. Data were collected through in‐depth interviews with 21 individuals who represented a purposive sample and were recruited from a cancer organisation.Results: Three overriding themes emerged from the phenomenological–hermeneutical analysis are as follows: Experiencing an unfamiliar tiredness; Experiencing not being fully oneself; and Experiencing a feeling of being alone.Conclusions: Existential suffering after cancer treatment involves living on the edge of the old homeworld and the experience of a new alienworld. Individuals undergoing such suffering need a transformational process, from the alienworld to the homeworld, which must be supported by the healthcare system.Implications for practice: To facilitate the transformational process, healthcare professionals should communicate with patients throughout their cancer journey about how their existential experiences have been integrated into their lifeworld, allowing them to tell their own story from the perspective of lifeworld brokenness.

Aim: To identify and synthesize qualitative evaluation methods used in nursing interventions.Design: A systematic qualitative review with a content analysis. Four databases were used: MEDLINE, PsycINFO, Embase and CINAHL using pre‐defined terms. The included papers were published from 2014–2018.Methods: We followed the guidelines of Dixon‐Woods et al., Sandelowski and Barroso, the Critical Appraisal Skills Programme qualitative checklist and The Confidence in the Evidence from Reviews of Qualitative Research Approach.Results: Of 103 papers, 15 were eligible for inclusion. The main theme Challenging complexity by evaluating qualitatively described processes and characteristics of qualitative evaluation. Two analytic themes emerged: Evaluating the implementation process and Evaluating improvements brought about by the programme.Conclusion: Different qualitative evaluation methods in nursing are a way of documenting knowledge that is difficult to illuminate in natural settings and make an important contribution when determining the pros and cons of an intervention.

Aim The aim of this study was to explore suicidal patients’ experiences of safe clinical practice during hospitalisation in mental health wards. The study was guided by the following research question: How do suicidal patients experience safe clinical practice during hospitalisation in mental health wards? Design, setting and participants A qualitative design with semistructured individual interviews was applied. Eighteen patients hospitalised with suicidal behaviour in specialised mental health wards for adults at a Norwegian hospital participated in the study. Data were analysed thematically and inductively using qualitative content analysis. Results Patients in a suicidal crisis experienced safe clinical care in mental health wards characterised by the following three themes: (1) being recognised as suicidal, (2) receiving tailor-made treatment and (3) being protected by adaptive practice. Conclusion This study illuminates the experiences of safe clinical practice for patients in a suicidal crisis. The patient group was multifaceted, with variable experiences of how safe clinical practice affected their subjective experience of safety and suicidal behaviour. The finding highlights the importance of embracing personalised activities in all parts of safe clinical practice and to recognise rather than efface patients’ variability in patient safety efforts.

Background: Despite the large amount of leadership and implementation theories and recommendations, healthcare services continue to struggle with efficiently incorporating new knowledge. The questioning of conventional leadership approaches in healthcare organizations prompted us to investigate how frontline leaders comprehend their own implementation intentions and actions, and how these intentions and actions may impact the implementation of clinical guidelines in mental healthcare in Norway. Methods: Employing a theory-driven qualitative design, we conducted nine semi-structured interviews with frontline leaders who had recently led implementation of clinical guidelines for the treatment of psychosis in mental health. We employed Systematic Text Condensation, informed by Normalization Process Theory, to structure and analyze the data and used fidelity scales to measure the degree of implementation and distinguish between leaders’ levels of success in implementation. Results: Frontline leaders in units that achieved high success in implementation described their intentions and actions differently, from those with less success. The former group’s actions aligned more closely with the constructs of the Normalization Process Theory compared to the latter group when describing their actions. Frontline leaders leading units with a high degree of implementation success describe relation-orientation, trust, and providing adaptive space for staff members to take initiative. In contrast, those leading units with less implementation success describe more control and guidance of co-operators and place more emphasize on information and knowledge. Conclusion: Differences in how frontline leaders describe their actions and intentions to achieve clinical guideline implementation suggest that the leadership approach of these frontline leaders is an important factor to consider when planning and conducting implementation. To better understand the implementation process, it is important to pay attention to how frontline leaders customize their leadership approaches to the dynamics of complex organizations, and how they interact with their team and superiors. Plain Language Summary: Despite the large amount of available implementation theories and recommendations, healthcare services continue to struggle with efficiently incorporating new and better practice. The clinicians’ closest leader, the Frontline leader, is considered to be in a unique position to manage and enable implementation in the complex healthcare system. The current study’s aim was to improve our understanding of what these leaders do, and how they operate, to enable the implementation of clinical guidelines. We interviewed nine mental health service leaders in Norway with experience of leading implementation of clinical guideline during the last 3 years. We found a variety of leaders’ intentions and actions regarding their involvement in the process and how they relate to their staff and superiors. Frontline leaders that lead units with high degree of implementation success described actions according to all four constructs of the Normalization Process Theory (Coherence, Cognitive participation, Collective action and Reflexive monitoring), while frontline leaders with less implementation success had more fragmented descriptions. Successful leaders appear to be more relation-oriented compared to those in less successful units. This suggests that leaders should focus on inter-personal dynamics, in addition to more concrete implementation interventions, to succeed. We recommend to take the leadership actions and intentions identified in this study into consideration when planning and evaluating implementation projects and leadership programs, as well as when recruiting frontline leaders.