An evidence-based and multifactorial communication intervention encompassing staff skills development and training, development of relevant patient materials or devices and collaborations with relevant health professionals like speech and language therapists has the potential to improve nurse-patient communication in the ICU and hence improve patient outcomes.

A greater understanding of communication dynamics with the intensive care unit with patients who are mechanically ventilated is crucial to enable nurses to improve their care and improve patients' comfort. Incorporating communication in the nursing standards would ensure that patients are treated with dignity which would help improve patient outcomes.

Mental healthcare users with profound intellectual disabilities are among the most disadvantaged groups in society. They experience numerous challenges which include limitations in intellectual functioning and adaptive behaviour. These limitations present challenges in their care, especially in cases where student nurses are not well prepared to meet these special needs. The purpose of this study was to provide insight into approaches and opportunities related to the care of mental healthcare users with profound intellectual disabilities by student nurses. A qualitative, descriptive, interpretive, exploratory and contextual research design was used to explore and describe opportunities and approaches in caring for mental healthcare users with profound intellectual disabilities as experienced by student nurses. Audio-taped interviews were conducted with 12 student nurses in their fourth and final year of study who were assigned to a care centre catering for people with profound intellectual disabilities. Thematic analysis as proposed by Braun and Clarke was used to analyse the collected qualitative data. Three approaches to care emerged: promotion of health and wellbeing, training in communication skills, and support for the users' dignity. One main opportunity that emerged was being caring, an attitude deeply embedded in nursing principles. Caring for care users with profound intellectual disabilities can be emotionally challenging. However, this study identified approaches and opportunities which, when explored, can assist student nurses in rendering quality patient care. This will minimise frustrations on the part of student nurses and help improve the quality of life of mental healthcare users.

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Antimicrobial resistance is a growing global health concern that warrants attention and immediate action. [1] Since their introduction, antimicrobial agents have effectively decreased morbidity and mortality caused by infectious diseases. Regrettably, their inappropriate and irrational use has led to an increased risk of adverse drug effects and the development of antimicrobial resistance, which renders some antimicrobials ineffective. [2,3] Moreover, a discrepancy in diagnostic procedures vital to correctly identifying different pathogens aggravates the situation. [2] Since healthcare settings are associated with the highest emergence and spread of antimicrobial resistance, [4] the Infectious Diseases Society of America [5] published guidelines recommending that all hospitals develop institutional programmes to enhance antimicrobial stewardship and hence curb the growing threat of antimicrobial resistance. Subsequently, policies and evidence-based interventions, such as antimicrobial stewardship programmes (ASPs), have been drafted and implemented in various healthcare institutions worldwide. [6,7] Antimicrobial stewardship (AMS) refers to a collection of strategies and tools to improve clinical outcomes and use of antimicrobials, whereby selection of the optimal regimen, dose, duration and route of administration is promoted. [8] AMS programmes are considered an important strategy in the fight against antimicrobial resistance. [8] Dyar et al. [9] define AMS as a coherent set of actions that promote using antimicrobials in a way that ensures sustainable access to effective therapy for all who need it. Establishing the impact of an implemented ASP in a healthcare facility is important to inform decisions about the future of the programme, whether it needs scaling up or not. [10] From evidence, impact evaluation studies conducted on the effectiveness of the ASP are often limited to individual impact rather than the assessment of both individual and organisational impact. [11][12][13][14] Furthermore, comprehensive impact evaluation of health interventions depends on the effectiveness of the programme/intervention, its reach in the population, and the extent to which it is properly implemented. [15] Applying the RE-AIM framework [16] makes it possible to comprehensively explore five different impact dimensions that affect the ASP: (i) reach for assessing the target population accomplished; (ii) effectiveness, i.e. measuring the patient outcomes resulting from the programme; (iii) adoption, i.e. measuring the number of target settings participating in the study and staff who are responsible for the management of the programme in the facility; (iv) implementation, i.e. consistency and cost of delivery; and (v) maintenance of the intervention's positive effects over time. [16] The RE-AIM framework is useful for determining which interventions work in real-world settings and assesses impact at individual and organisational levels. [17] Although there is evidence of the effectiveness of ASPs in the This open-access arti...