In an era when patient safety and quality of care are a daily concern for health care professionals, it is important for nurse managers and other clinical leaders to have a repertoire of skills and interventions that can be used to motivate and engage clinical teams in risk assessment and continuous quality improvement at the level of patient care delivery. This paper describes how a cohort of clinical leaders who were undertaking a leadership development program used a relatively simple, patient-focused intervention called the 'observation of care' to help focus the clinical team's attention on areas for improvement within the clinical setting. The main quality and safety themes arising out of the observations that were undertaken by the Clinical Leaders (CLs) were related to the environment, occupational health and safety, communication and team function, clinical practice and patient care. The observations of care also provided the CLs with many opportunities to acknowledge and celebrate exemplary practice as it was observed as a means of enhancing the development of a quality and safety culture within the clinical setting. The 'observation of care' intervention can be used by Clinical Leader's to engage and motivate clinical teams to focus on continuously improving the safety and quality of their own work environment and the care delivered to patients within that environment.

The objective of this article is to provide clinicians, from multiple disciplines, important clinical information to consider when providing health education and emotional support to persons with chronic lower respiratory disease (CLRD) and their informal caregivers via telehealth. The information contained in this article is based on a literature review, a needs and preferences survey of this population (n ϭ 49 persons with CLRD; n ϭ 49 informal caregivers) that was part of a larger study (Enhancing Rural Interventions for Caregiver Health [En-Rich]), and our clinical experience. The En-Rich needs and preferences survey was conducted to help shape telehealth services for this population particularly those residing in rural/geographically isolated areas as well as those who are not physically well enough to attend clinic-based appointments. As a result of the novel coronavirus (COVID-19) pandemic, the use of telehealth services for clinical care has dramatically risen for a variety of reasons. We surmise that persons with CLRD and their informal caregivers are particularly open to telehealth services at this time, given the risk of exposure to the virus upon leaving their homes.As such, we provide information about the physical and psychosocial aspects of living with CLRD from the perspective of patients and informal caregivers along with 7 practical recommendations for providing telehealth services to this population. Our aim is to better equip telehealth clinicians who are working with this special population through our interdisciplinary lens (gerontology, nursing, health psychology, and social work). Clinical Impact StatementA formal literature review, needs and preferences survey, and our interdisciplinary clinical expertise shaped our recommendations for the provision of telehealth education and emotional support for persons with chronic lower respiratory disease (CLRD) and their informal caregivers. The recommendations were written in the context of COVID-19 pandemic which has increased the need for telehealth services for this clinical population as well as empirically supported education for the clinicians who serve them.

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Spiritual struggles are distressing thoughts, feelings, or shifts in behaviors pertaining to faith/life philosophy in response to traumatic/stressful experiences. There is limited research on this phenomenon among family caregivers of persons in the early-stages of dementia (PWD). The purpose of this qualitative study, therefore, was to better understand spiritual struggles in this population. Using Interpretative Phenomenological Analysis, we analyzed interviews of 28 caregivers of PWD in the early stages. There were three broad areas for spiritual struggles in their narratives: (1) transpersonal spiritual struggles (e.g., struggles with God or a higher power in the context of caregiving); (2) interpersonal spiritual struggles (e.g., struggles with communities of faith related to the lived experience of being a caregiver of a loved one with dementia); and (3) intrapersonal spiritual struggles (e.g., struggles around beliefs, morality or ultimate meaning related to caregiving). Themes and subthemes under each of these areas are expounded upon. The importance of identifying/addressing spiritual struggles among family caregivers of PWD and areas for future research are highlighted.

Spiritual coping may be conceptualized as relying upon spiritual beliefs, practices and/or relationships as an aspect of navigating stressful or traumatic experiences. There is evidence that spirituality may be used as a resource and may cultivate growth for some in the midst of difficult life circumstances. There is limited research, however, on this phenomenon among family caregivers of persons living with a dementia, particularly those in the early stages. The purpose of the current study, therefore, was to gain insight into the nature of spiritual coping among caregivers of persons living with a dementia in the early part of their caregiving journey. Using interpretative phenomenological analysis, interviews with 28 caregivers were analyzed. Five spiritual coping themes and corresponding subthemes emerged from their narratives: (1) spiritual relational coping; (2) spiritual behavioral coping; (3) spiritual belief coping; (4) spiritual coping to gain a sense of control; and (5) spiritual coping for constancy or life transformation. Three-fourths of the sampled caregivers reported growth in their spiritual lives during the early part of their caregiving journey. A sense of being “spiritually grounded” in the Divine (e.g., God, a higher power, a life philosophy) and oneself (as a spiritual being) was an important aspect of spiritual coping in this sample. Additionally, caregivers tended to use multiple forms of spiritual coping simultaneously while also navigating spiritual struggles. Finally, some caregivers viewed caregiving as a spiritual path that they were actively following rather than a passive spiritual experience. These findings speak to the importance of identifying and encouraging spiritual coping among caregivers as well as identifying spiritual struggles.