Background/Objectives: Radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is associated with high morbidity. Frailty is an important determinant of surgical outcomes; however, its association with the composite outcome Days Alive and Out of Hospital (DAOH) has not been examined following RC. We assessed the impact of preoperative frailty on 90-day DAOH in older patients undergoing RC for MIBC. Methods: We conducted a retrospective cohort study including 408 consecutive patients aged ≥65 years undergoing RC at a tertiary referral center between 2018 and 2023. Frailty was assessed using the record-based Multidimensional Prognostic Index (r-MPI), classifying patients as non-frail (MPI1), moderately frail (MPI2), or severely frail (MPI3). The primary outcome was 90-day DAOH; secondary outcomes included length of stay (LOS), postoperative complications, delirium, and mortality. DAOH was dichotomized at the cohort median. Associations with low DAOH were analyzed using modified Poisson regression with robust variance estimation. Results: Median 90-day DAOH decreased progressively with increasing frailty: MPI1: 81 days (IQR 76-83), MPI2: 73 days (IQR 62-80), MPI3: 67 days (IQR 52-76); p < 0.01. In multivariable analysis, frailty was independently associated with low DAOH (MPI2: RR 2.46, 95% CI 1.94-3.11; MPI3: RR 3.37, 95% CI 2.55-4.46), whereas age and comorbidity were not. Increasing frailty was consistently linked to worse postoperative outcomes, including longer LOS, higher complication burden and severity, and more frequent delirium. Ninety-day postoperative complication-related mortality increased markedly with frailty (MPI1: 1.6%, MPI2: 11.9%, MPI3: 12.1%; p < 0.01). Conclusions: Preoperative frailty is a strong independent predictor of low 90-day DAOH and adverse postoperative outcomes following RC in older patients.

Background:The nursing shortage is influenced by an often-reported transition shock among newly graduated nurses, and transition programmes may support both retention and improve the quality of nursing care. Objective:To measure patients' and nursing staffs' perceptions of missed nursing care in study wards following a two-year transition programme for newly graduated nurses compared to wards following a standard transition program. Design:A comparative cross-sectional survey design was used. Settings:Three medical inpatient wards with a two-year transition program and three comparable medical inpatient wards with a standard transition programme. Participants:Data collection started March 3rd 2025. Based on a power calculation, 206 hospitalised patients, comprising 103 from the study wards and 103 from the standard wards, were included. 239 nursing staffs was invited to participate; of these, 159 responded to the survey. Methods:The validated MISSCARE Survey-Patient and MISSCARE Survey were used to collect data from patients and nursing staff. The responses were dichotomised and compared using the Chi-squared test. The sum scores were compared using the Wilcoxon Rank Sum test or the Student's t-test. The study was not registered. Results:Patients in wards with a two-year transition programme reported less missed psychosocial care (p=0.03), particularly for involvement in decisions (p=0.02), receiving needed information (p=0.03), and being treated with dignity (p=0.05), but they reported with more missed care related to help with walking (p=0.03).Nursing staff in study wards reported less missed nursing care for patient teaching (p=0.01), complete documentation (p=0.04), and timely medication administration (p= 0.05), but more missed care in responding to call lights within 5 minutes (p=0.01). They also rated urgent patient situations (p=0.02,) lack of team backup (p=0.03) and insufficient assistive personnel (p<0.001) as less important reasons for missed care than staff in standard wards. Conclusions:The results indicate that a longer and more comprehensive transition programme may contribute to improved psychosocial care and a supportive clinical environment, potentially at the expense of assistance with ambulation or call-light response times. Further research on patient outcomes is needed.

Hospital-at-Home Admission Avoidance (HaH-AA) provides hospital-level treatment at home as an alternative to hospital admission. Communication is key to safe, coordinated care for older adults, many of whom live with frailty. This review aimed to identify and map communication strategies and healthcare professionals involved in HaH-AA models for acutely ill older adults whilst charting reported frailty measures and frailty-related characteristics. This scoping review followed the Arksey and O’Malley framework. Four databases were searched to July 2025 to identify studies describing communication strategies in HaH-AA models for acutely ill older adults. A Communication Strategy Framework guided data extraction across three domains: face-to-face, technology- and organisational-mediated communication. Frailty measures and frailty-related characteristics were extracted when available. Twenty-eight papers describing fifteen HaH-AA models were included. Face-to-face communication was described in all models for initial assessment and follow-up, delivered by nurses and physicians on-site, by nurses with remote physician input, or by nurses alone. Technology-mediated communication was described in 12 models as virtual visits (telephone or video), remote monitoring in 7 models using automated or manual methods. Organisationally mediated communication strategies were described across all models and included shared documentation and coordination mechanisms centred on four themes: standardised protocols, structured communication processes, dedicated coordination roles and shared training initiatives. Frailty-related reporting was heterogeneous; most studies reported frailty measures and frailty-related characteristics, but only four reported validated frailty measures. Communication strategies were not examined as a primary research focus, resulting in heterogeneous descriptions and limited clinical guidance. HaH-AA research should explicitly address communication for acutely ill older adults, including those living with frailty. To identify and map communication strategies described in HaH-AA models for acutely ill older adults and healthcare professionals involved, whilst charting reported frailty measures and frailty-related characteristics. Communication domains included face-to-face interactions, technology-mediated remote communication (phone/video), remote monitoring of vital signs and clinical parameters, and organisational communication through shared documentation and coordination mechanisms, such as standardised protocols, structured processes, dedicated roles and shared training initiatives. Frailty-related reporting was heterogeneous, and only four studies used validated frailty measures. Communication strategies in HaH-AA models remain underexamined and heterogeneously described, resulting in limited guidance for clinical practice in the care of acutely ill older adults, including those living with frailty.

Background Transitioning from student to newly graduated nurse is challenging, often leading to anxiety, high turnover, and even attrition from the profession. This exacerbates the nurse shortage and compromises health quality. Transition programmes tailored to support newly graduated nurses are essential. The aim was to assess the feasibility of a 2-year transition programme for newly graduated nurses employed at a medical ward, evaluating programme acceptability, demand, implementation, practicality, integration and limited efficacy. Method A feasibility study using triangulation. Data were collected using qualitative semi-structured interviews and registration data collected via a survey. The interviews with newly graduated nurses and providers were conducted between May and August 2023. Interview data were analysed using directed content analysis. The transition programme, developed in 2018, includes elements such as supervision, rotation in outpatient clinics, visiting the nurses in the municipality, followership, skills training and simulation. Of the 23 nurses who provided registration data, 11 were interviewed, along with 12 providers. Results The newly graduated nurses completed 84% of the programme elements planned, with cancellation primarily due to sick leave or time constraints. Participants generally perceived the transition programme as acceptable and suitable for newly graduated nurses and providers. The 4-week rotation in outpatient clinics for patients with gastroenterological and pulmonary diseases, supervision, and visits to the municipality were considered satisfactory. Dissatisfaction appeared when the newly graduated nurses' expectations about planned conversations and followership were unmet. Preceptor presence was crucial for integrating the programme into the daily routine and heightening the nurses' job satisfaction. The 2-year timeframe accommodates the multi-component nature of the programme across two specialties. Conclusion A 2-year transition programme is feasible in a complex setting such as a medical hospital ward, supporting newly graduated nurses' transition into practice and enhancing their confidence.

Background Older patients with Clostridioides difficile infection (CDI) are often frail and multimorbid, with reported 90-day mortality rates of 28%–36%. Despite this, treatment often fails to align with infection severity, and care coordination remains complex. This study describes the development and iterative refinement of a clinical checklist to support structured treatment and care planning in this high-risk group.Methods We conducted a two-phase model development study to identify key management factors. Checklist development followed an iterative quality improvement framework using Plan-Do-Study-Act cycles and driver diagrams. In phase I, older patients with CDI were followed to identify key treatment and care priorities, informing the initial checklist version. In phase II, the checklist was used in a pragmatic, randomised trial investigating Comprehensive Geriatric Assessment (CGA) in older patients with CDI. The checklist was iteratively revised based on clinical use and feedback.Results In phase I, treatment courses of 10 older patients with CDI were reviewed, identifying three key priorities for the initial checklist: (1) CDI treatment planning with frailty assessment, (2) medication review and (3) attention to rehydration and nutrition. In phase II, the CDI checklist was applied in 108 patients allocated to CGA. Standardised treatment planning was ensured, including assessment of faecal microbiota transplantation (FMT) eligibility. Among those treated with non-CDI related antibiotics or proton-pump inhibitors, 52% (26/50) and 70% (39/56), respectively, had treatment discontinued. Nutritional and rehydration support was provided in 64 (59%) and 61 (56%) patients. The CDI checklist was subsequently expanded based on clinical use to include new elements, such as post-FMT laxative treatment and cross-specialty coordination.Conclusion A clinical checklist can support structured and holistic care planning in older adults with CDI. Core components include CDI treatment planning, assessment of FMT eligibility, frailty evaluation, medication review and supportive therapies such as nutrition and rehydration.

The aim of this study was to investigate the prevalence of pre-frailty and frailty among older persons referred for elective orthopaedic surgery and determine whether frailty was associated with the occurrence of postoperative complications, measured as the number of days spent in the hospital within 90 days after surgery. Between April 1 and July 31, 2022, we consecutively included individuals aged 65 years or older who were referred for elective shoulder, knee, hip, or spine surgery at a centre for elective surgery. Health status was assessed preoperatively using the record-based Multidimensional Prognostic Index, based on data extracted from the electronic medical record by a geriatrician. Postoperative hospital data were obtained from the Business Intelligence Data Warehouse of the Central Denmark Region. A total of 519 persons were included, with a mean age of 75.2 years (SD 5.9), and 56

Background Nurses leaving the profession is a global problem, that causes inadequate quality of care for patients internationally. Bad leadership and a poor work environment are related to nurses' intention to leave the profession. This study aims to map the literature related to themes and factors associated with nurses' intention to stay or leave the profession. Methods The scoping review will be guided by the five steps of Arksey and O'Mally, refined by Levac, and be reported according to PRISMA-ScR. The search will be conducted in PubMed, CINAHL, Embase, PsycINFO and SveMed+. Quantitative, Qualitative and reviews will be included. Discussion This review will provide an overview of factors essential to increase nurses' retention in the workforce. The findings can support the development of new interventions to increase the nurses' intentions to stay. Trial reg. This protocol is registered on the Open Science Framework registries. Date November 12, 2024 osf.io/uns68.

Faecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (CDI) is used in less than 10

To identify which drugs or drug classes are considered potentially inappropriate in older patients during the early phase of acute hospital admission, depending on specific clinical situations. A Delphi panel of 26 experienced clinicians reached consensus on 89 drug—situation combinations considered potentially inappropriate across nine common acute clinical situations. Several drug classes—such as diuretics, antihypertensives, opioids, and sedative medications—were identified as problematic across multiple situations. Clinical decision-making in acute care for older patients must take into account the specific clinical contexts when assessing drug appropriateness. Older patients admitted with acute illness face a high risk of adverse drug events (ADEs), yet no clinical decision support (CDS) tool currently exists to guide pharmacotherapy in this population during the early phase of hospitalization. This development study aimed to establish expert consensus on drugs that should be used with caution or avoided in acutely admitted older patients in specific clinical situations. A three-round Delphi study was conducted among 26 experienced physicians in Clinical Pharmacology, Emergency Medicine, and Geriatric Medicine. Panel members rated statements on potentially inappropriate prescriptions (PIPs) across nine clinical situations (e.g., hypotension, hypoglycemia, dehydration). Statements were rated on a five-point Likert scale; consensus was defined as ≥ 75

PURPOSE:To assess the feasibility and acceptability of a multicomponent prehabilitation and perioperative care intervention for older persons with frailty scheduled for elective orthopaedic surgery prior to conducting an RCT. METHODS:A mixed-methods feasibility study assessed reach, dose, data collection procedure, acceptability and adaptation. Data was collected through patient reported outcomes, electronic medical record, and interviews with patients and healthcare professionals. No pre-defined feasibility criteria were applied. RESULTS:Of those referred for surgery, 30% were screened for frailty, among those eligible, 78% consented to participate. Participants received six of the eight planned phone calls, adherence to nutrition advice and exercise was high, and medication review resulted in at least one drug change for 50% of participants. Qualitative analysis identified key themes including the importance of tailoring care to individual patient needs, strong support from healthcare professionals and family members, and effective interdisciplinary collaboration. The intervention appeared feasible and acceptable to both patients and healthcare professionals. Several adaptations were implemented immediately (refined recruitment procedures, reduced number of health coaching sessions, and modified data collection method), while others were proposed (earlier involvement of geriatrician, focusing on hip and knee surgery, 48-hour follow-up, and improved integration with municipal rehabilitation services and general practitioners). CONCLUSION:This study demonstrated the feasibility and acceptability of a prehabilitation and perioperative care intervention for older persons with frailty undergoing elective orthopaedic surgery. The proposed adaptations will inform the implementation strategy prior to conducting an RCT to evaluate effects on clinical outcomes and healthcare costs.

Frailty is associated with impaired immune function, functional decline, and increased vulnerability to both infection and adverse medication effects. Recurrent urinary tract infection (rUTI) is a common and burdensome condition among older persons, particularly those living with frailty. Despite this, frail individuals remain underrepresented in clinical research guiding rUTI prevention. This review outlines current evidence on rUTI prevention strategies in older persons living with frailty. It highlights feasible tools for frailty assessment and explores how frailty contributes to infection risk and impacts the effectiveness and safety of preventive interventions. Nonpharmacological strategies-including continence management, minimization of catheter use, hydration support, and carer education-form the foundation of prevention. Locally applied vaginal estrogen is the best-supported pharmacological option in postmenopausal women. Evidence for cranberry products, D-mannose, and probiotics remains inconsistent in frail populations, while methenamine hippurate offers a promising, well-tolerated alternative to antibiotics. Prophylactic antibiotic use may reduce recurrence in selected patients but carries significant risks, including Clostridioides difficile infection and antimicrobial resistance. Clinical decision-making should be guided by individualized risk assessment, careful consideration of treatment burden, and regular reassessment of both benefits and harms. Further research is urgently needed to inform evidence-based prevention strategies for this vulnerable population.

Clostridioides difficile infection (CDI) primarily affects older patients with comorbid conditions and has a high mortality rate. Fecal microbiota transplantation (FMT) is effective and cost-effective for CDI. In a recent study, we demonstrated the clinical benefits of combining hospital-at-home care with FMT for older patients with CDI, but its cost-effectiveness remains unknown. The current study aimed to evaluate the cost-effectiveness of the intervention in patients aged ≥70 years with CDI, compared with standard treatment. The cost-utility analysis was conducted using data from a randomized clinical trial enrolling 217 patients, assessing the cost-effectiveness of the intervention over 90 days. Resource use was assessed from a healthcare sector perspective. Missing data were handled with proxy replacement and multiple imputation. Sensitivity analyses included probabilistic analysis, complete case analysis, adjustment of key unit prices, and a hospital perspective. A willingness-to-pay threshold was set to €22 994 or $24 863 per quality-adjusted life year (QALY). In the base case analysis, the intervention was dominant, with mean cost savings of €2556 ($2764) and a mean gain of 0.004 QALY. Although resource use was higher, the intervention resulted in an average reduction of 6 hospital admission days per patient and increased odds of clinical resolution. The results remained robust across different perspectives, the exclusion of patients with missing data, and variations in hospital admission costs. In patients aged ≥70 years with CDI, an intervention combining hospital-at-home care and FMT is cost-effective compared with standard treatment. The cost-effectiveness is mainly driven by fewer hospital admission days.

Introduction: Cancer management in older frail patients can be complex, given the high decline in functional status, comorbidity, and limited life expectancy affecting this group of patients. Therefore, this study aimed to investigate whether oncological treatment combined with comprehensive geriatric assessment (CGA) and tailored follow-up interventions improved or maintained quality of life (QoL) in older prefrail and frail patients with cancer. Materials and Methods: A single-center randomized controlled trial included participants aged 70 or older with head, neck, lung, upper gastrointestinal tract, colon, or rectum cancer referred to non-surgical treatment. All participants underwent CGA conducted by a multidisciplinary geriatric team in an outpatient oncological clinic. The team consisted of a geriatrician and a specialized nurse who provided tailored follow-up visits and phone calls within 90 days after randomization. Exclusion criteria were fit patients, referral for specialized palliative care, or participating in another geriatric research program. In patients with well-functioning cognition, QoL was assessed using the EORTC QLQ-C30 and QlQ-ELD-14 questionnaires before and after the intervention. In patients with cognitive impairment, the Overall QoL-Depression List was used. Changes in QoL were dichotomized into improved/unchanged or worsened and analyzed in a logistic regression model. Results: In total, 363 participants were included with a mean age of 76 years (SD 4.6) and 45 % were female. Sixty percent in the intervention group had improved or unchanged QoL compared to 66 % in the control group (odds ratio: 0.75 [95 % confidence interval(CI): 0.45-1.23]). Overall, clinically important changes were found in fatigue and reduced worries about the future. The intervention showed improvements in insomnia symptoms and reported decreased role functioning. Discrepancies were found in the burden of illness without a clinically important difference, where the intervention group experienced an increased burden while the control group had a decreased burden (coefficient: 9.02 [95 % CI, 0.49-17.5]). Discussion: Multidisciplinary geriatric follow-up did not universally improve QoL in older frail patients with cancer. However, positive changes in specific aspects of QoL revealed nuanced impacts, warranting further exploration and larger studies to validate these observations. Tailored interventions targeting fatigue, insomnia, and emotional well-being are crucial for improving QoL in this population. Trial Registration: Registered in January 2016 at ClinicalTrials.gov (ID: NCT02837679).

Introduction. Little is known about how shifting hospital visitor restrictions issued by national health authorities were communicated, managed, and adapted by hospital charge nurses during the COVID-19 pandemic. Aims. To describe the shifting visitor restrictions and the passing on of restrictions from the national authority level to charge nurses and secondly describe charge nurses’ management of the restrictions and their challenges when enforcing them. Methods. The study consisted of a document analysis and a cross-sectional survey including open-ended questions. Descriptive statistics and qualitative content analysis were used. The survey was distributed online to 88 charge nurses in somatic units in a Danish university hospital from March 2020 to April 2021. Results. Restrictions were communicated from national authority level in an effective administrative cascade. The charge nurses led their enforcement in each unit. In total, 71 charge nurses (81%) responded to the survey. For 70%, the wording of the restrictions was clear, while 31% found them challenging to handle. On a weekly or daily basis, 68% of the charge nurses deviated from the restrictions. They identified both upsides and downsides to the absence of relatives. Communication, collaboration, and leadership were experienced as key tools in the ongoing processes of adapting to shifting restrictions. Conclusion. During this severe health crisis, essential information was passed on through well-defined management levels in an effective communication pathway. Charge nurses and their professional values were challenged when balancing shifting national restrictions against individual needs of patients and relatives. Implications for Nursing Management. Charge nurses serve as vital intermediaries between national authorities and frontline nursing practice in managing shifting visitor restrictions during a pandemic. Their experiences can contribute to further qualifying nurse managers’ considerations when designing family-centred hospital visitor policies for the future. Also, they may strengthen the handling of future sudden major organizational changes.

Background: Nurses faced with multiple demands in hospitals are often compelled to prioritize nursing care. Knowledge of missed nursing care provides insight into whether necessary nursing care is delivered, what is missed, and the reasons for missed nursing care. This insight is essential to support evidence-based policy and practice to improve patient care, enhance nursing practice, and optimize the work environment. Research on factors influencing missed nursing care is imperative to implement targeted strategies. However, studies investigating work experience as a predictor are inconclusive, and no identified studies have examined how nurses ' work experience is associated with different elements of missed nursing care. Objectives: To investigate the prevalence and reasons for missed nursing care and whether nurses ' work experience was associated with missed nursing care. Design: The design was cross-sectional, using the Danish version of the MISSCARE survey. Setting: The study was conducted at a public Danish university hospital with 1,150 beds and approximately 10,350 employees. Participants: Across 34 surgical, medical, and mixed bed wards for adults, 1,241 nurses were invited by email to respond anonymously to the Danish MISSCARE survey. Of these nurses, 50.3% responded, and 42.6% fully completed the questionnaire. Methods: A total score mean and a mean score were calculated and then compared between experience ( <= 5 years/ >5 years) in a linear regression model adjusting for unequally distributed variables. Results: More than two thirds of the nurses reported that emotional support, patient bathing, ambulation, mouth care, interdisciplinary conferences, documentation, and assessing effectiveness of medication were frequently missed elements of nursing care. The most significant reasons for missed nursing care were an inadequate number of nurses, an unexpected rise in patient volume, urgent patient situations, heavy admission, and discharge activity. Nurses with work experience of less than 5 years reported more missed nursing care, especially within fundamental care. Conclusions: Nursing elements to avoid potentially critical situations and nursing related to treatment observations were rarely missed, while nursing care elements visible only to the patient and the nurse were most often missed. By increasing transparency and explicitness within nursing care, the results enable critical evaluation of prioritization of nursing care elements. The number of staff not balancing the number and acuity of patients was the main reason for missed nursing care. The perception of missed nursing care was most pronounced in less experienced nurses. The study contributes to the global research community to achieve a broader understanding of missed nursing care. Tweetable abstract: Nursing to avoid potentially critical situations and treatment observations are prioritized over fundamental care, perceived mainly by less experienced nurses. [GRAPHICS] .

Background: A shortage of nurses in hospital wards leads to engaging other healthcare professionals. Understanding the experience of professionals involved in this inter-professional collaboration may guide similar processes in the future. Aim: To explore the experience of nurses, physiotherapists, and occupational therapists working in geriatric wards when more therapists were employed for interprofessional collaboration to address the nursing shortage. Method: Reflexive thematic analysis of semistructured interviews with 13 nurses and therapists. Consolidated Criteria for Reporting Qualitative Studies used. Findings: All professions experienced that inter-professional cooperation had become more of responsibility". Physiotherapists and occupational therapists experienced doing "more care tasks and fewer core tasks," which entailed frustration; but gained a better understanding of the care trajectories. Conclusion: Employing more therapists and applying task shifting to mitigate nursing shortages in hospital wards may challenge the existing inter-professional teamwork.

BACKGROUND:Clostridioides difficile infection causes diarrhoea and colitis. Older patients with C difficile infection are often frail and have comorbidities, leading to high mortality rates. The frailty burden in older people might restrict access to treatments, such as C difficile infection-specific antibiotics and faecal microbiota transplantation. We aimed to investigate the clinical effects of early comprehensive geriatric assessment (CGA) and frailty evaluation, including home visits and assessment for faecal microbiota transplantation, in older patients with C difficile infection. METHODS:In this randomised, quality improvement trial with a pragmatic design, patients from the Central Denmark Region aged 70 years or older with a positive PCR test for C difficile toxin were randomly assigned (1:1) to CGA or standard care, both with equal access to faecal microbiota transplantation. Patients and investigators were unmasked to treatment. The primary outcome was 90-day mortality, and was compared in the study groups according to the intention-to-treat principle. The study is registered with ClinicalTrials.gov, NCT05447533. FINDINGS:Between Sept 1, 2022, and May 3, 2023, we randomly assigned 217 patients to CGA (n=109) or standard care (n=108). The median patient age was 78 years (IQR 74-84). 116 (53%) of 217 patients were female and 101 (47%) were male. 16 (15%; 95% CI 9-23) of 109 patients in the CGA group and 22 (20%; 14-29) of 108 patients in the standard-care group died within 90 days (odds ratio 0·66, 95% CI 0·32-1·38. No serious adverse events or deaths related to patient assessment or faecal microbiota transplantation were recorded in either group. Deaths directly attributable to C difficile infection were lower in the CGA group (seven [44%] of 16 deaths vs 18 [82%] of 22 deaths in the standard-care group; p=0·020). INTERPRETATION:Older patients who received CGA had a 90-day mortality rate similar to that of patients who received standard care, but with fewer deaths directly attributable to C difficile infection. FUNDING:Innovation Fund Denmark, Novo Nordisk Foundation, and Helsefonden.

BACKGROUND:Worldwide visitor restrictions forced nurses to separate patients from their relatives. However, the experience of implementing shifting restrictions from the frontline nurses' perspectives in a Danish context has yet to be assessed. AIM:The aim of this descriptive qualitative study was to explore frontline nurses' experiences of managing shifting visitor restrictions in a Danish somatic university hospital during the COVID-19 pandemic. METHODS:An online questionnaire, including open-ended questions, was developed. Data were analysed using descriptive statistics and content analysis. FINDINGS:116 nurses from 29 departments participated; they were informed about restrictions primarily by their charge nurses and hospital intranet. Shifting visitor restrictions compelled the nurses to constantly adjust and negotiate their practices. When deciding to suggest deviating from the restrictions, they shared their decision-making with colleagues. Visitor restrictions left the hospital environment quieter, but they also created a lack of overview and predictability, an emotional burden, and a negative impact on the quality of care. CONCLUSION:Restricting relatives' access challenged the nurses' professional values, and it seems to have affirmed their appreciation of relatives' role as important partners in contemporary hospital-based health care.