Aims and Objectives:To analyse the dimensions of quality of palliative nursing care and to explore the perceptions of professionals for the development and validation of the Palliative Nursing Care Quality Scale. Background:The study of palliative nursing care quality has been approached from analysis of the competencies of palliative care nurses, based on various theoretical models. However, there are fewer qualitative empirical studies that have evaluated what good palliative nursing care is and what its dimensions are.Design: Mixed-method, Delphi approach and exploratory qualitative study. Methods: Consensus by a panel of experts using the Delphi technique and semistructured interviews. The study was reported in a comprehensive manner following COREQ criteria. Data collection took place between January and June 2018. Results: The eight-person expert panel reached consensus on the following dimensions of the Palliative Nursing Care Quality Scale: control and relief of symptoms, family and/or primary caregiver, therapeutic relationship, spiritual support and continuity of care. Thematic analysis of ten interviews identified four emergent themes related to good nursing care: (1) the patient and family as a whole; (2) finding meaning; (3) responsible communication; and (4) caring for the human element. Conclusions: The quality of palliative nursing care goes beyond providing comprehensive care; it means meticulously looking after every detail of what is important to the patient. The expectations of professionals are not as important. Instead, care should be based primarily on the needs and respect for the wishes of the patient and their family.Relevance to Clinical Practice: Specifying the quality of nursing care in routine practice and reaching a consensus on its dimensions means moving towards excellence in care, as well as improving the professional profile of advanced practice palliative care nurses.

Atrial fibrillation (AFib) is a common type of cardiac arrhythmia, characterized by disorganized atrial electrical activity with features of irregularly irregular heart rhythm and often with rapid ventricular response increasing the risk of stroke and heart failure due to tachyarrhythmia. The pathophysiology mechanism of AFib is either triggered by atrial distension, abnormality in conducting system, catecholamine excess, or increased atrial irritation or automaticity. Risk factors include uncontrolled diabetes, obesity, obstructive sleep apnea, hypothyroidism, and certain stimulants. Based on recent research, liver disease has recently been identified as a risk factor for AFib. Considering the progression of chronic liver disease, this literature review aims to investigate and summarize the relationship between liver disease and AFib and explore clinical interventions that can be utilized to prevent AFib aggravation.

Background There is evidence of the effectiveness of rheumatology nurse led clinics, but little research about the nature of the scope of the nursing activity undertaken. Objectives The aim of the study was to explore the work of the rheumatology specialist nurses in order to describe the strategies and interventions they use in the outpatient clinics to support the rheumatoid patients, including the nurses' perception of their work. Methods The venue was a large UK tertiary hospital. Rheumatology patients came to the nurse led clinic once they had being diagnosed and the therapeutic path had been established. A qualitative case study design was used with non- participant observation of nurse led clinics (12) and semi-structured interviews with the specialist rheumatology nurses after the observations (5). Interviews were transcribed verbatim and data were analysed using Taylor & Bogdan's three steps framework: discovery, coding and discounting data. Results The clinical background of the clinic patients observed varied, and included long term pain, progressive joint deterioration, sudden appearance of RA symptoms and flares. Three major categories emerged from data analysis: the time of diagnosis, the long road to stabilization and the turning points (flare ups and remission). These were the main areas in which the nurse specialists focused their consultations. Drug counseling is a major activity in the nurse-led clinic. The nurse role here is to reinforce the necessity of treatment and to assure the patient that he or she is not alone. Symptom control is another battle to fight in daily life. Nurses ask systematically about fatigue, stiffness and pain, as they go through the aching joints looking for swelling and tenderness. The appropriateness of specialist nurses' skills saves time to patients (avoiding double-appointment, with the doctor and the nurse) and gives confidence to the rest of the Rheumatology team. The advice line is considered to be very helpful for patients and nurses. Both feel it allows quick communication without going through a lot of go-betweens and it is a good instrument to enhance continuity of care and to provide ongoing support. Flares provoke a state of uncertainty and anxiety in RA patients, because it usually involves increasing the number of tablets they take, and another step to climb in the therapeutic strategy. Nurses are also concerned with flares, because they might imply an admission to hospital. The main aim of RA treatment is to reach a target of remission or low disease activity as soon as possible. Even when patients reach remission, nurses keep them under observation, once a year, to detect and prevent comorbidities. Conclusions As health care organizations increasingly seek to contain costs and improve efficiency, having patients competent in the managing of their own disease is a target for the health care system. In the clinic, it was clear that the specialist nurses individualised their consultation and aimed to help patients cope with their condition by en...