What is the impact of professional nursing on patients’ outcomes globally? An overview of research evidence

Tailoring nursing interventions to empower patients: personal coping strategies and self-management in type 2 diabetes care

BACKGROUND

Diabetes is one of the most common chronic diseases that severely reduce a patient's quality of life. Effective self-care and management are critical for maintaining blood glucose levels and preventing complications.

AIM

This study evaluates the effectiveness of a structured diabetes self-management education program on patients' self-management behaviors, empowerment, and activation levels.

METHODS

This study employed a quasi-experimental design involving 100 participants aged 30-65 to improve diabetes self-management and empowerment. Over 16 weeks, the program included three phases: a two-week pre-test phase for recruitment and baseline assessments using the Diabetes Self-Management Questionnaire (DSMQ), Diabetes Empowerment Scale (DES), and Patient Activation Measure (PAM); a 12-week intervention phase featuring weekly 90-minute educational sessions on topics such as diet, exercise, medication adherence, stress management, and self-empowerment; and a two-week post-test phase for follow-up assessments using the same tools. Data were analyzed using descriptive statistics, chi-square tests for PAM levels, and paired t-tests for DSMQ and DES scores, with statistical significance set at p < 0.05.

RESULTS

The study demonstrated significant improvements in participants' self-management, empowerment, and activation levels after the intervention. DSMQ scores increased from 64.5 to 68.6 (p < 0.001), DES scores rose from 65.4 to 70.0 (p = 0.001), and the number of participants at the highest PAM activation level (Level 4) grew from 30 to 50 (p = 0.016). Positive correlations among DSMQ, DES, and PAM scores suggest these improvements are interrelated.

CONCLUSION

The structured diabetes self-management education programme significantly impacted participants' self-management behaviors, empowerment, and activation levels. The findings underscore healthcare professionals' need to implement targeted interventions that facilitate patient engagement in diabetes care.

RECOMMENDATION

Future interventions should be designed to address the specific needs of diverse populations, paying attention to those facing socio-economic challenges. It is vital to facilitate greater access to diabetes self-management education to enhance health outcomes for these demographic groups.

Nurse Managers' Perceptions of Family and Community Nurse Practitioners Joining Primary Care Teams in Spain: A Qualitative Study

The aim of this study was to explore and describe nurse managers' perceptions of family and community nurse practitioners' impact on primary care teams and public health. A descriptive qualitative study was carried out. The participants were recruited by means of convenience sampling during the months of April and May 2023. 20 nurse managers from different autonomous communities in Spain were interviewed. The data were analyzed following a thematic analysis method using ATLAS.ti nine software. Two main themes and sub-themes were drawn from the data analysis: (1) Nurse managers' view of primary care: (a) The driving force of primary care and (b) Resistance to the integration of family and community nurse practitioners; (2) Proposals for improvement in light of the Family and Community Nurse Practitioner's unique situation. These specialists are highly qualified professionals in primary care teams, whose expertise is evident in how they deliver community and health education activities, empower patients, and lead the training of new specialists.

Effect of an online training intervention on evidence-based practice in clinical nurses. #Evidencer Project

BACKGROUND

Online learning is becoming increasingly essential for health professionals, and it is necessary to understand how this modality affects clinical nurses' learning of Evidence-Based Practice (EBP). For this reason, the present study sought to assess the effectiveness of an online training program in improving nurses' EBP competence.

METHODS

A quasi-experimental study with a pretest-posttest design was conducted with a control group and without randomization for a period of 6 months. The intervention was an online self-learning course based on Melnyk's seven steps of Evidence-Based Practice (EBP). The course was structured into sequential modules requiring 72 h of work, with task completions and tests necessary for progression. Participants had three months to complete the course. EBP competence was measured with the EBP-COQ Prof© questionnaire. Data analysis included percentages, means, standard deviations, chi-square tests, student's t-tests, and a two-way repeated measures analysis of covariance (ANCOVA).

RESULTS

The analysis of the changes observed in each dimension and the overall EBP competence between the intervention group (IG) and the control group (CG) showed a significant group*time interaction in three of the four dimensions of the questionnaire. The results indicated that the online Evidence-Based Practice (EBP) course significantly improved knowledge, skills, and utilization three months after its completion. In the IG, the mean score was 44.04 (standard deviation (SD) = 7), compared to 37.83 (SD = 8.5) in the CG (p < 0.001). Regarding skills, the IG had a mean score of 24.24 (SD = 3.8), while the CG scored 23.01 (SD = 3.1) (p = 0.008). For utilization, the mean score in the IG was 36.77 (SD = 6.8), and the CG was 33.12 (SD = 6.3) (p = 0.005). Overall competence also showed a statistically significant difference, with the IG achieving a mean score of 141.22 (SD = 20.0) compared to the CG with a mean score of 130.34 (SD = 16.7) (p < 0.001).

CONCLUSIONS

Training through an online education platform for three months (72 h) is an effective tool for improving the competence in Evidence-Based Practice (EBP) of clinical nurses. A significant increase was observed in knowledge and moderate improvements in skills and the application of EBP. These online courses, adapted to the needs of professionals, can be an efficient way to prepare nurses and improve their application of EBP in a clinical setting.

Organizational resilience and primary care nurses' work conditions and well-being: a multilevel empirical study in China

Resilience is crucial for a health system to better prevent and respond to public health threats and provide high-quality services. Despite the growing interest in the concept of resilience in health care, however, there is little empirical evidence of the impact of organizational resilience, especially in primary care settings. As the largest professional group in primary care, primary care nurses are taking more and more responsibilities during their daily practice, which influences both their work conditions and well-being. This study aims to examine the association between organizational resilience and primary care nurses' working conditions and well-being. Using a convenience sampling approach, we recruited 175 primary care nurses from 38 community health centres (CHCs) in four cities in China. Organizational resilience was operationalized as comprising two domains: adaptive capacity and planning capacity, and measured using a 16-item scale. The primary care nurses' working condition indicators comprised variables of psychological safety, organizational commitment, professional commitment, and self-directed learning; well-being indicators included depression and burn-out. Hierarchical linear regression models were built for analysis. We found that the sampled CHCs have a relatively high level of organizational resilience. The organizational resilience was positively associated with the four indicators of working conditions: psychological safety (β = 0.04, P < 0.01), organizational commitment (β = 0.38, P < 0.01), professional commitment (β = 0.39, P < 0.01), and self-directed learning (β = 0.28, P < 0.01). However, organizational resilience was not significantly associated with the two well-being indicators. Furthermore, we found that the adaptive capacity has stronger association compared with planning capacity. Therefore, primary care manager should build resilient organizations, especially the adaptive capacity, in order to enhance primary care nurses' psychological safety, commitment and learning behaviours. Further studies should also be conducted to understand the link between organizational resilience and primary care nurses' well-being.

Exploring factors associated with hypertension self-care in primary care: The role of nurse education levels and patient-related factors

AIM

To explore the association between nurse education levels and patient-related factors with hypertension self-care.

BACKGROUND

Although self-care development is recognized as a healthcare provider-patient encounter, the attribution of nurse education level to hypertension self-care is not well addressed.

DESIGN

A cross-sectional study.

METHODS

Hypertensive patients from 15 primary care facilities were sampled, and self-care was assessed using the Self-Care of Hypertension Inventory version 2.0, with standardized scores ≥70 indicating adequate self-care. Data on patient-related factors were obtained from electronic health records, self-reports and laboratory tests, while nurse education levels were categorized as standard (baccalaureate-prepared) or higher (post-baccalaureate specialty).

RESULTS

A total of 1493 participants were included in this study, with a median age of 66 years and 77.7% being female. Approximately 10% of participants had adequate self-care, and 66% received care from higher educated nurses. The study showed the relation between nurse education levels and the self-care of the patients. Adequate hypertension self-care was significantly associated with higher educated nurse providers and patient-related factors, including intermediate to higher education, non-overweight/obese and the absence of age-related comorbidities.

CONCLUSIONS

Hypertensive patients who had been provided care by higher educated nurses and their favourable sociodemographic, lower cardiometabolic risk and no concomitant disease were more likely to demonstrate adequate self-care.

Effects of implementation strategies on nursing practice and patient outcomes: a comprehensive systematic review and meta-analysis

BACKGROUND

Implementation strategies targeting individual healthcare professionals and teams, such as audit and feedback, educational meetings, opinion leaders, and reminders, have demonstrated potential in promoting evidence-based nursing practice. This systematic review examined the effects of the 19 Cochrane Effective Practice and Organization Care (EPOC) healthcare professional-level implementation strategies on nursing practice and patient outcomes.

METHODS

A systematic review was conducted following the Cochrane Handbook, with six databases searched up to February 2023 for randomized studies and non-randomized controlled studies evaluating the effects of EPOC implementation strategies on nursing practice. Study selection and data extraction were performed in Covidence. Random-effects meta-analyses were conducted in RevMan, while studies not eligible for meta-analysis were synthesized narratively based on the direction of effects. The quality of evidence was assessed using GRADE.

RESULTS

Out of 21,571 unique records, 204 studies (152 randomized, 52 controlled, non-randomized) enrolling 36,544 nurses and 340,320 patients were included. Common strategies (> 10% of studies) were educational meetings, educational materials, guidelines, reminders, audit and feedback, tailored interventions, educational outreach, and opinion leaders. Implementation strategies as a whole improved clinical practice outcomes compared to no active intervention, despite high heterogeneity. Group and individual education, patient-mediated interventions, reminders, tailored interventions and opinion leaders had statistically significant effects on clinical practice outcomes. Individual education improved nurses' attitude, knowledge, perceived control, and skills, while group education also influenced perceived social norms. Although meta-analyses indicate a small, non-statistically significant effect of multifaceted versus single strategies on clinical practice, the narrative synthesis of non-meta-analyzed studies shows favorable outcomes in all studies comparing multifaceted versus single strategies. Group and individual education, as well as tailored interventions, had statistically significant effects on patient outcomes.

CONCLUSIONS

Multiple types of implementation strategies may enhance evidence-based nursing practice, though effects vary due to strategy complexity, contextual factors, and variability in outcome measurement. Some evidence suggests that multifaceted strategies are more effective than single component strategies. Effects on patient outcomes are modest. Healthcare organizations and implementation practitioners may consider employing multifaceted, tailored strategies to address local barriers, expand the use of underutilized strategies, and assess the long-term impact of strategies on nursing practice and patient outcomes.

TRIAL REGISTRATION

PROSPERO CRD42019130446.

Application effect of case management nursing based on patient safety in patients with prostate cancer

BACKGROUND

Globally, prostate cancer has become a major threat to men's health, with an increasing incidence and causes serious effects on the quality and length of life of patients. Despite the rapid development of medical technology, which provides treatments, including surgery, radiotherapy, and endocrine therapy, the treatment of patients with prostate cancer, especially with endocrine therapy, has become a major challenge in clinical treatment owing to the lengthy course of treatment, side effects of drugs, and impact of the disease on the psychological and physiological functioning of the patient, producing poor treatment adherence and a decline in quality of life.

AIM

To explore effects of nursing intervention prioritizing patient safety and case management in patients with prostate cancer undergoing endocrine therapy.

METHODS

Eighty patients with prostate cancer who received endocrine therapy at our hospital between January 2022 and January 2024 were divided into observation and control groups with 40 cases per group. The control group was treated using a routine nursing workflow while the observation group received case management nursing guidance prioritizing patient safety. Scores for anxiety and depression, prostate cancer symptoms, and quality of life and patient compliance and satisfaction were compared between the groups after three months of intervention.

RESULTS

After the nursing intervention, the anxiety and depression scores of the observation group were significantly lower than those of the control group (P < 0.05). The quality of life score, sexual function, and hormone function were significantly higher than those in the control group (P < 0.05).

CONCLUSION

Case management guidance based on patient safety effectively reduced anxiety and depression in patients undergoing endocrine therapy for prostate cancer and improved their quality of life, treatment compliance, and satisfaction.

Economic evaluation of the prevention of falls resulting from missed care in polish hospitals

Objectives

Falls are associated with increased morbidity, mortality, prolonged hospitalization and an increase in the cost of treatment in hospitals. They contribute to the deterioration of fitness and quality of life, especially among older patients, thus posing a serious social and economic problem. They increase the risk of premature death. Falls are adverse, costly, and potentially preventable. The aim of the study was to analyze the cost-effectiveness of avoiding one fall by nurse care provided by the nurses with higher education, from the perspective of the health service provider.

Methods

The economic analysis included and compared only the cost of nurse intervention measured by the hours of care provided with higher education in non-surgical departments (40.5%) with higher time spend by nurses with higher education level an increase in the number of hours by 10% (50.5%) to avoid one fall. The time horizon for the study is 1 year (2021). Cost-effectiveness and Cost-benefit analysis were performed. All registered falls of all hospitalized patients were included in the study.

Results

In the analyzed was based on the case control study where, 7,305 patients were hospitalized, which amounted to 41,762 patient care days. Care was provided by 100 nurses, including 40 nurses with bachelor's degrees and nurses with Master of Science in Nursing. Increasing the hours number of high-educated nurses care by 10% in non-surgical departments decreased the chance for falls by 9%; however, this dependence was statistically insignificant (OR = 1.09; 95% CI: 0.72-1.65; p = 0.65). After the intervention (a 10% increase in Bachelor's Degrees/Master of Science in Nursing hours), the number of additional Bachelor's Degrees/Master of Science hours was 6100.5, and the cost was USD 7630.4. The intervention eliminated four falls. The cost of preventing one fall is CER = USD 1697.1.

Conclusion

The results of these studies broaden the understanding of the relationship among nursing education, falls, and the economic outcomes of hospital care. According to the authors, the proposed intervention has an economic justification.

Effects of nurse-led interventions on the physical and mental health among pre-frail or frail older adults: A systematic review

BACKGROUND

Globally, there is an increase in the number of older people living with frailty, thus effective strategies to prevent and manage frailty are of paramount importance. The effects of nurse-led interventions on the physical and mental health of (pre) frail people have not yet been systematically reviewed.

METHODS

We searched the PubMed, Web of Science, EMBASE, CINAHL, and the Cochrane Library from inception to 8 May 2024. Eligible studies included randomized controlled trials and quasi-experimental trials reporting the effects of nurse-led interventions on physical and mental health outcomes among (pre) frail people. Two researchers independently extracted trial data and assessed the risk of bias by using the risk of bias tool recommended by the Cochrane Back Review Group and the Methodological Index for Non-Randomized Studies.

RESULTS

14 randomized controlled trials and 6 quasi-experimental studies, encompassing 3943 participants, were included in the review. Nurse-led interventions included function-based care (cognitive behavioral therapy, exercise, and multi-domain intervention), personalized integrated care, and advance care planning. The reported outcomes were multiple with most results showing inconsistencies. Overall, function-based care showed more positive effects on physical outcomes (31/37, 84 %) and mental health (11/12, 92 %). However, the effectiveness of existing personalized integrated care and advance care planning might be limited.

CONCLUSIONS

Nurse-led interventions may effectively improve both physical and mental health among (pre) frail older adults, although effectiveness varies by intervention type. Nurses have the potential to play a leading role, both individually and within multidisciplinary teams, in alleviating the rising global burden of frailty. We need more well-designed randomized controlled trials to confirm the effectiveness of nurse-led interventions and identify the most effective type of interventions.

Investigating the Possibility of Nurse Prescribing Training Development in Nursing Education System in Iran

PURPOSE

Adequate medical knowledge and skills are fundamentals for nurse prescribing authority development. This study will explore the potential for developing nurse prescribing training in Iran, where nurses currently lack prescribing authority despite their strong academic nursing education.

METHODS

This is a study with two phases. At first, in a conventional qualitative content analysis method, with purposive and snowball sampling, from June 2021 to March 2023, 20 participants, including 16 nurses in different clinical, managerial, educational, and policy-making settings, three physicians, and one clinical pharmacist were interviewed. Unstructured interviews were conducted face-to-face or virtually as the situation required during the pandemic period due to Coronavirus disease, 2019 (COVID-19). Qualitative content analysis as developed by Elo and Kyngäs in 2008 was used for data analysis. In the second comparative analysis phase, four masters of science and one doctor of nursing curricula analyzed in the existence of the nurse prescribing prerequisite courses and these five curricula and two potential masters of science in community health and critical care nursing curricula were compared with John Hopkins University curricula.

RESULTS

In the qualitative phase, two themes emerged: nursing education challenges and the potential for nurse prescribing training development. These were further broken down into four subthemes: inadequate nurses' knowledge in prerequisite nurse prescribing courses, unprepared educational infrastructure, treatment sector potentials, and educational potentials, with a total of 12 concepts identified. During the comparative phase, it was found that none of the nursing curricula had adequate prerequisite courses for nurse prescribing. However, the Community Health and Critical Care nursing curricula showed potential for developing nurse prescribing training.

CONCLUSIONS

In the nursing education system, there are some challenges and potentials for prescribing training, and the community health and critical care nursing curricula have the potential capacity to prepare the graduated nurses to prescribe. It needs educational and managerial policies. More developmental research and pilot studies are recommended.

Exploring the relationship between grit scores and academic potential in baccalaureate nursing students

BACKGROUND

An ongoing nursing shortage poses significant challenges to the healthcare industry, prompting nursing education programs to find ways to increase nurse graduates. Unfortunately, the problem of attrition in nursing education is significant. Despite many years of attrition research, educators still seek to find answers to determine what factors cause some students to succeed and others to fail in nursing programs. Noncognitive variables, like grit, have been largely overlooked as potential solutions to the problem of attrition.

PURPOSE

The purpose of this study was to explore the extent to which grit predicts academic potential in baccalaureate nursing students.

METHODS

This cross-sectional study included a total of 63 baccalaureate nursing students in their first semester of a four-semester nursing program at a mid-sized public university in East Texas. Participants took an electronic survey reporting demographic information, completing the Short Grit Scale (Grit-S), and consenting to release of their pre-admission science grade point average (sGPA), ATI Test of Essential Academic Skills (TEAS) exam scores, and first-semester nursing GPA (nGPA).

RESULTS

When added to sGPA and TEAS scores, grit scores were not a statistically significant predictor of nGPA. Students with high grit scores were just as likely to experience attrition as those with low scores, and grit did not statistically significantly predict first-semester attrition.

CONCLUSIONS

Nurse educators are encouraged to pursue strategies to address attrition in nursing education. Traditional selection criteria of sGPA and TEAS exam scores were shown to be predictors of nGPA. Additional research is warranted to explore the relationship between noncognitive variables, especially grit, and nursing student academic potential.

Patient-reported outcomes of psychiatric and/or mental health nursing in hospitals: a systematic review protocol

INTRODUCTION

There is a lack of distinct and measurable outcomes in psychiatric and/or mental health nursing which negatively impacts guiding clinical practice, assessing evidence-based nursing interventions, ensuring future-proof nursing education and establishing visibility as a profession and discipline. Psychiatric and/or mental health nursing struggle to demonstrate patient-reported outcomes to assess the effectiveness of their practice. A systematic review that summarising patient-reported outcomes, associated factors, measured nursing care/interventions and used measurement scales of psychiatric and/or mental health nursing in the adult population in acute, intensive and forensic psychiatric wards in hospitals will capture important information on how care can be improved by better understanding what matters and what is important to patients themselves. This review can contribute to the design, planning, delivery and assessment of the quality of current and future nursing care METHODS AND ANALYSIS: This protocol follows the Cochrane methodological guidance on systematic reviews of interventions and The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. The search strategy will be identified by consultations with clinical and methodological experts and by exploring the literature. The databases Ovid MEDLINE, CINAHL, EMBASE, APA PsychARTICLES, Web of Science and Scopus will be searched for all published studies. Studies will be screened and selected with criteria described in the population, intervention, control and outcomes format after a pilot test by two researchers. Studies will be screened in two stages: (1) title and abstract screening and (2) full-text screening. Data extraction and the quality assessment based on the Johanna Briggs Institute guidelines will be conducted by two researchers. Data will be presented in a narrative synthesis.

ETHICS AND DISSEMINATION

No ethical approval is needed since all data are already publicly accessible. The results of this work will be published in a peer-reviewed scientific journal.

PROSPERO REGISTRATION NUMBER

CRD42023363806.

The development of advanced practice nurses in Singapore

The development of advanced practice nursing has evolved globally over the past decades and has become an important component in the contemporary healthcare system. The term 'advanced practice nurse' is used to refer to nurses practising at a higher level than traditional nurses and is defined as a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice. In 2003, Singapore embarked on the development of advanced practice nurses as an initiative to improve the nursing professional image, retain excellent clinical nurses and fill the gaps in the provision of healthcare services for the ageing population. This paper documents Singapore's journey of advanced practice nursing development and shares our unique learning experience in the aspects of education, certification, registration and scope of practice.

Scopes of practice for advanced practice nursing and advanced practice midwifery in Kenya: A gap analysis

BACKGROUND

There is increasing global evidence on the impact of advanced nursing and midwifery practitioners, and Kenya's healthcare system has an excellent opportunity to develop scopes of practice and other regulatory frameworks for the integration of these roles.

OBJECTIVE

The primary purpose of this gap analysis was to explore the existing evidence on opportunities and threats toward the integration of the advanced practice nursing (APN) and advanced practice midwifery (APM) roles in Kenya's healthcare system.

METHODS

The study team conducted a structured electronic database search of PubMed, CINAHL, Scopus, EBSCOhost Academic Search Complete, and PsycINFO to retrieve articles and credible websites for reports highlighting the opportunities and threats toward the integration of the APN and APM roles in Kenya's healthcare systems. The retrieved articles were screened for relevance and synthesized for reporting using the traditional literature review approach.

RESULTS

The Kenya Health Policy Framework 2014-2030, growing population needs, and implementation of universal health coverage provide an opportunity to harness and leverage advanced practice roles in nursing and midwifery. There is also momentum to develop advanced practice because of strategic alliances and global evidence showing the contributions and quality of services offered by advanced practice nurses and advanced practice midwives. However, lack of financial support, structural challenges, and lack of national policies, regulations, and legislation continue to obstruct progress.

CONCLUSION AND IMPLICATIONS FOR NURSING POLICY

Developing scopes of practice for APN and APM in Kenya will benefit the professions, the country's healthcare delivery system, and the population. Achieving universal health coverage depends on a health workforce trained and practicing at optimal levels in tandem with education and training to deliver quality care.

Nursing Interventions in Neurocritical Care

Highly educated and skilled nursing care is critical to improving patient outcomes in general and in specialties like neurocritical care. Nursing interventions reflect nursing knowledge, critical thinking, and decision-making and is generally rooted in the nursing process. Nursing interventions are also a key focus of research to better understand how nursing care influences patient outcomes. This review describes the literature regarding nursing interventions in key neurocritical diagnoses and contextualizes it within the broader discussion about the nursing process and nursing interventions research. Publications about nursing interventions in neurocritical care emphasize key themes, including managing neurophysiologic parameters, providing psychosocial support, managing the environmental milieu, and interventions to prevent complications. Further study of how to best support nurses in collecting and interpreting data to form nursing interventions is needed, as is understanding the benefits and limitations of the nursing process in low- and middle-income countries.

Factors associated with registered nurses' academic performance in advanced practice nursing preparatory education: A retrospective cohort study

AIM

To explore factors associated with academic performance in the Master of Nursing programme.

BACKGROUND

Advanced practice nursing preparatory education generally involves completion of the Master of Nursing programme. While prior clinical experiences and on-the-job training are believed to underpin the preparation for such education, studies have suggested only weak or no associations between nurses' academic success in graduate schools and their clinical experiences.

METHODS

A retrospective cohort study was conducted in the nursing department of a university in Singapore. Academic and demographic data were extracted in February 2020 from a shared repository of anonymised teaching and learning data. R was used to select and merge data tables into a usable format for subsequent analysis. Students enrolled between 2010 and 2017 were included for the analysis (n = 246).

RESULTS

Age was statistically significantly associated with overall cumulative academic performance (p < 0.001). Younger students on average academically outperformed older students. Unmarried students were associated with better cumulative academic performance in the Clinical Practicum 2 module (p = 0.018).

CONCLUSION

Younger students have historically outperformed their older counterparts in the Master of Nursing programme. There is a need to reassess the requirement of five years of clinical experience as an admission criterion for the Master of Nursing programme in Singapore.

IMPLICATIONS FOR NURSING POLICY

There is a need to re-evaluate the admission criteria to better engage and retain younger nurses interested in advanced nursing practice. Nursing educators and leaders can partner with academics to develop advanced practice-specific education for pre-master nurses with the aptitude and interest in pursuing this track.

Comparing the efficacy of single-skill and multiple-skill simulation scenarios in advancing clinical nursing competency

Aim

This study aims to compare the effectiveness of single-skill and multiple skills patient care simulation scenarios in enhancing nursing competency and to evaluate nurses' perceptions of these different simulation scenarios.

Methods

A mixed-method design was used. In the quantitative part, 130 newly hired nurses with less than one year of experience participated in this study. For the qualitative part, a subset of 26 of these nurses was selected for in-depth interviews until data saturation was achieved. The study was conducted in the simulation-based learning (SBL) lab in a specialized Jordan cancer center. Data collection took place between June 2022 and March 2023.

Results

A significant difference was found in the IV skill between single and multiple skills scenarios; the mean score for the single-skill group was 44.42 (SD = 3.85), the mean score for the multiple-skill group was 45.63 (SD = 2.26) (P = 0.014). Moreover, a significant difference was found between the pre-and post-test scores for single-skill and multiple-skill groups. The mean score for the medication skill scenario pre-intervention single group was (M = 23.90, SD = 5.33); however, the score was increased post-intervention (M = 45.38, SD = 3.33), (P = <.001). Furthermore, the mean score was raised in the multiple skills medication scenario from (M = 22.92, SD = 5.44) to (M = 45.72, SD = 2.75), (<.001).

Conclusion

Participants in both groups reported similar findings regarding physical exhaustion, scenario management, and overall satisfaction with the simulation experience. Loss of concentration and memory was reported more with multiple competencies simulation scenarios; this might indicate that this scenario has more cognitive load than the Single Competency Scenario.

ICT in Nursing and Patient Healthcare Management: Scoping Review and Case Studies

Over the past few decades, Information and Communication Technologies (ICT) have revolutionized the fields of nursing and patient healthcare management. This scoping review and the accompanying case studies shed light on the extensive scope and impact of ICT in these critical healthcare domains. The scoping review explores the wide array of ICT tools employed in nursing care and patient healthcare management. These tools encompass electronic health records systems, mobile applications, telemedicine solutions, remote monitoring systems, and more. This article underscores how these technologies have enhanced the efficiency, accuracy, and accessibility of clinical information, contributing to improved patient care. ICT revolution has revitalized nursing care and patient management, improving the quality of care and patient satisfaction. This review and the accompanying case studies emphasize the ongoing potential of ICT in the healthcare sector and call for further research to maximize its benefits.

Nurses' experiences of moral distress and how it affects daily work in surgical care-a qualitative study

AIM

To describe nurses' and specialist nurses' experiences of moral distress and how it affects daily work in surgical care.

DESIGN

A qualitative descriptive study design was used.

METHODS

A qualitative study with 12 interviews with nurses and specialist nurses working in surgical care. All interviews were conducted during October and November 2022 in two hospitals in southeastern Sweden. Data were analysed using conventional qualitative content analysis.

FINDINGS

Three categories and seven subcategories generated from the data analysis. The three categories generated from the analysis were Experiences that lead to moral distress, Perceived consequences of moral distress and Strategies in case of moral distress. The results show that a lack of personnel in combination with people with complex surgical needs is the main source of moral distress. Both high demands on nurses as individuals and the teamwork are factors that generate moral distress and can have severe consequences for the safety of patients, individual nurses and future care.

CONCLUSIONS

The results show that moral distress is a problem for today's nurses and specialist nurses in surgical care. Action is necessary to prevent nurses from leaving surgical care. Prioritizing tasks is perceived as challenging for the profession, and moral distress can pose a patient safety risk.

IMPACT

Surgical care departments should design support structures for nurses, give nurses an authentic voice to express ethical concerns and allow them to practice surgical nursing in a way that does not violate their core professional values. Healthcare organizations should take this seriously and work strategically to make the nursing profession more attractive.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

Technological innovation for workload allocation in nursing care management: an integrative review

Background

Technology reduces the nursing workload, improve the quality care processes, patient's safety, and avoid staff burnout. Innovative technologies are disrupting healthcare systems by improving the efficiency of processes and management. There is a discussion on the benefits, challenges, and barriers of these technologies and considering human factors of nursing management. The aim was to analyze the influence of technologies on the distribution of workload for nursing care management.

Methods

An integrative literature review was performed. Four databases were searched: Scopus, Scielo, PUBMED, and CINALH following PRISMA guidelines. Articles published from January 2016 to December 2020, published in English, Spanish and Portuguese were included. Studies were excluded when they were not original research, did not met the quality criteria or they did not answer the research questions. Quality appraisal was performed using the Crowe Critical Appraisal Tool version 1.4 (CCAT). Two reviewers independently examined the title and abstract for eligibility according to the inclusion and exclusion criteria.

Results

2818 potentially relevant articles were found, but once the inclusion and exclusion criteria in the abstracts were analyzed, 177 remained for evaluation. After following the PRISMA Guidelines, 35 studies were included in the review. Three categories were identified: Nursing workload; Information technologies and technological means for management; Technology acceptance.

Conclusions

Technology has the potential to improve care management by estimating nurse workload in ICUs and non-critical units, but scientific evidence is more detailed in the former type of services. The literature provides insights about the factors that factors and the barriers that promote the technology acceptance and usability. We did not find studies comparing technologies and no scientific evidence proving improvements in care.

Cultural adaptation and validation of the caring behaviors assessment tool into Spanish

BACKGROUND

The aim of the research was to translate, culturally adapt and validate the Caring Behaviors Assessment (CBA) tool in Spain, ensuring its appropriateness in the Spanish cultural context.

METHODS

Three-phase cross-cultural adaptation and validation study. Phase 1 involved the transculturation process, which included translation of the CBA tool from English to Spanish, back-translation, and refinement of the translated tool based on pilot testing and linguistic and cultural adjustments. Phase 2 involved training research assistants to ensure standardized administration of the instrument. Phase 3 involved administering the transculturally-adapted tool to a non-probabilistic sample of 402 adults who had been hospitalized within the previous 6 months. Statistical analyses were conducted to assess the consistency of the item-scale, demographic differences, validity of the tool, and the importance of various caring behaviors within the Spanish cultural context. R statistical software version 4.3.3 and psych package version 2.4.1 were used for statistical analyses.

RESULTS

The overall internal consistency of the CBA tool was high, indicating its reliability for assessing caring behaviors. The subscales within the instrument also demonstrated high internal consistency. Descriptive analysis revealed that Spanish participants prioritized technical and cognitive aspects of care over emotional and existential dimensions.

CONCLUSIONS

The new version of the tool proved to be valid, reliable and culturally situated, which will facilitate the provision of objective and reliable data on patients beliefs about what is essential in terms of care behaviors in Spain.

Addressing a Critical Voice in Clinical Practice: Experiences of Nursing Students, Teachers, and Supervisors-A Qualitative Study

AIM

Our goal was to explore how power asymmetry manifests within the relationships between students, teachers, and supervisors, and how it influences students' ability for critical reflection.

DESIGN

This study has an explorative qualitative design.

METHODS

Thirty in-depth interviews with nursing students (15), teachers (9), and supervisors (6) were conducted in addition to 16 observations of mid-term assessments during clinical practice. The analysis was conducted using Braun and Clarke's thematic analysis.

RESULTS

The students described being a student as a balancing act between humility, conforming to the supervisor's expectations, and speaking their minds. The view expressed by the teachers and supervisors is that training for the nursing profession is closely linked to the students' ability to act independently. Due to the supervisors' hierarchical position, however, students are hesitant to voice any criticism regarding insufficient supervision or unsatisfactory performance of clinical tasks while at the same time being evaluated on their ability to critically reflect on their own and others' clinical performance. This study was prospectively registered with the Norwegian Centre for Research Data on the 15th of August 2017 with the registration number 54821.

Factors Associated with Nursing Professionalism: Insights from Tertiary Care Center in India

BACKGROUND

Professionalism among nurses plays a critical role in ensuring patient safety and quality care and involves delivering competent, safe, and ethical care while also working with clients, families, communities, and healthcare teams.

AIMS AND OBJECTIVES

To assess the level of nursing professionalism and the factors affecting professionalism among nurses working at a tertiary care center in India.

METHODS

A descriptive cross-sectional study was conducted from October 2022 to March 2023 using a total enumeration sampling technique. Following institutional ethics committee approval, standardized tools were administered consisting of Nursing Professionalism Scale and socio-demographic, personal, and organizational characteristics.

RESULTS

A total of 270 nurses participated, with a response rate of 93.7%. The mean age of the participants was 27.33 ± 2.75 years, with the majority being female (82.6%) and belonged to the age group of 23-27 years (59.6%). More than half of the nurses exhibited high professionalism (53%), with the highest and lowest median scores for professional responsibility (29.0) and valuing human beings (13.0) respectively. Multivariate regression analysis demonstrated that, compared with their counterparts, nurses with a graduate nursing qualification (AOR = 4.77, 95% CI = 1.16-19.68), up-to-date training (AOR = 4.13, 95% CI = 1.88-9.06), and adequate career opportunity (AOR = 33.91, 95% CI = 14.48-79.39) had significant associations with high nursing professionalism.

CONCLUSION/IMPLICATIONS FOR PRACTICE

The majority of the nurses had high professionalism, particularly in the domains of professional responsibility and management. Hospitals and healthcare institutions can use these findings to develop policies and prioritize opportunities for nurses to attend conferences and workshops to enhance their professional values, ultimately leading to improved patient care outcomes.

PATIENT AND PUBLIC CONTRIBUTION

No patient or public contribution.

Opinion Article on Empowering Nurses: The Cornerstone of Exceptional Patient Care

The patients' journey is a complex network involving multiple layers of impactful stakeholders, among these stakeholders are nurses. Nurses' impact is critical to achieving better health outcomes and an uplifted experience, yet there are gaps in supporting nurses and empowering them to maximize their contribution to patients. Empowering nurses can take place in the form of educational support, recognition, and reducing their workload to limit their burn-out. The impact of such support to nurses would result in improved health outcomes, reduced mortality rates and an increase in patient satisfaction.

Associated factors of nurse-sensitive patient outcomes: A multicentred cross-sectional study in psychiatric inpatient hospitals

WHAT IS ALREADY KNOWN?: The nurse-patient relationship in mental health care is an important focus of mental health nursing theories and research. There is limited evidence about which factors influence nurse-sensitive patient outcomes of the nurse-patient relationship. This hinders the development, planning, delivering, and quality assurance of the nurse-patient relationship in nursing practice and nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our best knowledge, this is the first study to examine associations between nurse-sensitive patient outcomes of the nurse-patient relationship and a range of patient characteristics and relationship-contextual factors. In this study, we found that gender, age, hospital characteristics, nurse availability when needed, nurse contact, and nurse stimulation were associated with the scores on the nurse-sensitive patient outcome scale. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Having insight into the factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship can help nurses, nursing students, nursing management and also patients to enhance the nurse-patient relationship, trying to influence outcomes of nursing care. ABSTRACT: Introduction The lack of evidence on patient characteristics and relational-contextual factors influencing nurse-sensitive patient outcomes of a nurse-patient relationship is a possible threat to the quality and education of the nurse-patient relationship. Aim To measure nurse-sensitive patient outcomes of the nurse-patient relationship and to explore the associations between nurse-sensitive patient outcomes and a range of patient characteristics and relational-contextual factors. Method In a multicenter cross-sectional study, 340 inpatients from 30 units in five psychiatric hospitals completed the Mental Health Nurse-Sensitive Patient Outcome Scale. Descriptive, univariate and Linear Mixed Model analyses were conducted. Results Overall, patient-reported outcomes were moderate to good. Female participants, nurse availability when needed, more nurse contact and nurse stimulation were associated with higher outcomes. Age differences were observed for some of the outcomes. Outcomes also varied across hospitals but were not related to the number of times patients were hospitalized or to their current length of stay in the hospital. Discussion The results may help nurses to become more sensitive and responsive to factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship. Implications The nurse-sensitive results can support nurses in designing future nurse-patient relationships.

The motivational factors and the perceived effects of attaining higher education among post-diploma graduate nurses and midwives in Kumasi, Ghana: A cross-sectional study

BACKGROUND

Globally, there has been increased demand for higher education in nursing and midwifery to support evidence-based practice. It is believed that higher education in nursing leads to improved quality of care. The motivation for pursuing higher education, the choice of institution for learning and the effects of higher education programs have not been given much attention in research literature in Ghanaq OBJECTIVE: To assess the motivating factors, reasons for the choice of institution and the perceived effects of attaining higher educational qualifications among post-diploma graduate nurses and midwives.

STUDY DESIGN

Descriptive cross-sectional study.

SETTING

Kumasi.

PARTICIPANTS

Convenience and snowball sampling were used to select 523 nurses and midwives who had pursued higher education after their Diploma in Nursing or Midwifery education.

METHOD

A researcher-developed questionnaire was used to collect data on motivation, choice of institution and perceived effects of higher education by nurses and midwives. Data were analyzed through descriptive statistics, Pearson correlation and linear regression at 0.05 significance level.

RESULTS

The greatest motivation for higher education by nurses/midwives was to improve clinical judgment. Academic quality and reputation of the institution were the main reasons for the choice of institution (n = 458, 92.7 %). There were weak but positive significant correlations between the perceived effects of higher nursing and midwifery education and pressure from the workplace (r = 0.204, p < .001), and increasing new demands from clients (r = 0.284, p < .001). Increasing demands from clients (β = 0.203, p < .001) and improving social status (β = 0.264, p < .001) were the motivating factors that influenced the perceived effects of higher nursing and midwifery education.

CONCLUSION

The desire for improved professionalism and increased expertise are the reasons nurses and midwives seek higher education. Health managers should support nurses and midwives to attain higher education to improve the quality of care.

Scientific research ability of specialist nurses in Guangxi Zhuang Autonomous Region, China: A cross-sectional study

AIM

This study investigated the scientific research ability of Chinese specialist nurses (SNs) in the Guangxi Zhuang Autonomous Region and its influencing factors.

DESIGN

A cross-sectional design.

METHODS

A total of 652 SNs in the Guangxi Zhuang Autonomous Region were investigated from March to October 2021. The nursing scientific research ability level was measured using the Nursing Research Competence of Nurses Self-evaluation Scale. Descriptive statistics, univariate analysis and ordinal logistic regression analysis were used to evaluate factors affecting the scientific research ability of SNs.

RESULTS

The median score of scientific research ability of SNs was 31 (interquartile range: 19-41). Approximately 74.8% of clinical speciality nurses had low scientific research ability. Educational background, working hospital level, being the first author of a published paper and successful application for scientific research projects were identified as factors influencing scientific research ability score.

Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review

Residential care facility may provide a transition between living at home and a nursing home for dependent older people or an alternative to nursing homes. The objective of this review was to compare mortality and hospitalizations of older adults living in residential care facilities with those living in nursing homes or in the community. We searched Medline, Scopus and Web of Science from inception to December 2022. Fifteen cohort studies with 6 months to 10 years of follow-up were included. The unadjusted relative risk (RR) of mortality was superior in nursing homes than in residential care facilities in 6 of 7 studies (from 1.3 to 1.68). Conversely, the unadjusted relative risk of hospitalizations was higher in residential care facilities in 6 studies (from 1.3 to 3.37). Studies conducted on persons with dementia found mixed results, the only study adjusted for co-morbidities observing no difference on these two endpoints. Compared with home, unadjusted relative risks were higher in residential care facilities for mortality in 4 studies (from 1.34 à 10.1) and hospitalizations in 3 studies (from 1.12 to 1.62). Conversely, the only study that followed older adults initially living at home over a 10-year period found a reduced risk of heavy hospital use (RR = 0.68) for those who temporarily resided in a residential care facilities. There is insufficient evidence to determine whether residential care facilities might be an alternative to nursing homes for older people with similar clinical characteristics (co-morbidities and dementia). Nevertheless, given the high rate of hospitalizations observed in residential care facilities, the medical needs of residents should be better explored.

Experiences in the training of specialist family and community nurses: a qualitative study

Introduction

The specialist Family and Community Nurse Practitioner (FCNP) is a professional who, after a period of training, is qualified to be part of multidisciplinary teams in primary care. The aim of this study was to describe and understand the experiences of nurses during their training process in the specialty of Family and Community Nursing in Spain.

Methods

A descriptive qualitative study was carried out. Participants were recruited by means of convenience sampling from January to April 2022. Sixteen specialist nurses in Family and Community Nursing from different autonomous communities in Spain participated in the study. Twelve individual interviews and one focus group were conducted. Data were analyzed following a thematic analysis method in ATLAS.ti 9.

Results

The results showed two themes and six subthemes: (1) Residency period, more than a training: (a) Training during the residency period; (b) Specializing through a constant struggle; (c) Moderate optimism about the future of the specialty; and (2) A journey from illusion to disappointment: (a) Beginning of the residency: feeling special; (b) During the residency: between satisfaction and misunderstanding; (c) At the end of the residency: power and frustration.

Conclusions

The residency period is important in the training and acquisition of competencies for the Family and Community Nurse Practitioner. Improvements are needed to ensure quality training during residency and to help give visibility to the specialty.

Common content, delivery modes and outcome measures for faculty development programs in nursing and midwifery: A scoping review

BACKGROUND

Globally, there is a call for urgent investment in nursing and midwifery education as high-quality education leads to quality care provision. This call for investment includes a 'focus on faculty', that is, development of those who teach. However, challenges in the preparation and development of faculty have been identified and include lack of recognition of ongoing development, limited pathways for career progression, inadequate provision of, or access to, faculty development opportunities and a lack of research evaluating sustained impact of programs.

OBJECTIVES

The aim of this review was to identify, synthesise and report on common program content, modes of delivery and evaluation processes of faculty development programs in nursing and/or midwifery.

METHODS

A scoping review was conducted following Joanna Briggs Institute guidance. A comprehensive search strategy was developed and conducted in six health and/or education focussed databases. Peer-reviewed articles, published in English in the last decade and with a primary focus on nursing and/or midwifery faculty were included in the review. References lists of included studies were searched and a search to identify relevant grey literature was conducted. Using systematic review software, titles and abstracts were reviewed by two reviewers with a third reviewer used to resolve discrepancies. Data were extracted and recorded, key characteristics were mapped and content analysis used to synthesise, analyse and report findings.

RESULTS

Seventeen articles were included in the review and identified common content provided in nursing and midwifery faculty development programs. The predominant content was approaches for learning and teaching. Other common content was leadership, research and assessment practices. Modes for program delivery were most often a blend of online and face-to-face. Program evaluation was reliant on participants' self-reported measures of satisfaction and confidence and did not examine impact over time.

CONCLUSIONS AND RECOMMENDATIONS

Commonalities in program content primarily focussed on learning and teaching, but also included content linked to expected professional nursing and midwifery educator competencies such as leadership and research. However, a lack of content on the key faculty activity of curriculum design was noted and should be addressed in future program development. In addition, there was a lack of evaluation on the impact of different modes of delivery. Furthermore, an over-reliance on self-reported evaluation measures and a lack of longitudinal evaluation of impact on education practice and on student experience and outcomes. Future research should include evaluation of modes of delivery and impact on faculty practice over a sustained period.

Health trajectories of elderly living in French senior housing: a longitudinal perspective

Senior housing for older adults could be an alternative or a transitional care model between home care and nursing home care. Using two longitudinal cohorts of community dwellers aged 65 years or older, we compared risks of mortality and of nursing homes admission between older adults who did or did not move to senior housing over time. In the 3C study (n = 2104, 17 years of follow-up), 143 (6.8%) participants moved into a senior housing during the follow-up. This move was associated with a lower risk of mortality (hazard ratio (HR): 0.64; 95% confidence interval (CI) 0.46-0.77) and a higher risk of nursing home admissions (HR: 1.54 (1.10-2.15)). The risks of hospitalizations (HR: 0.54 (0.40-0.73)) and falls (HR: 0.63 (0.50-0.79)) were lower. In the PAQUID study (n = 3777, 27 years of follow-up), 161 (4.3%) participants moved into a senior housing. This move was also associated with a lower mortality risk (HR: 0.72 (0.58-0.88)) and a higher risk of nursing home admissions (HR: 1.39 (1.05-1.86)). Our results showing lower risks of mortality suggest that senior housing may be a relevant model for vulnerable older adults.

Factors related to a successful professional development for specialist nurses in surgical care: a cross-sectional study

BACKGROUND

A high level of competence among staff is necessary for providing patient-safe surgical care. Knowledge regarding what factors contribute to the professional development of specialist nurses in surgical care and why they choose to remain in the workplace despite high work requirements is needed. To investigate and describe the organizational and social work environment of specialist nurses in surgical care as part of studying factors that impact on professional development.

METHOD

This was a cross-sectional study with a strategic convenience sampling procedure that recruited 73 specialist nurses in surgical care in Sweden between October to December 2021. The study was guided by STROBE Statement and checklist of cross-sectional studies. The validated Copenhagen Psychosocial Questionnaire was used, and additional demographic data. Descriptive statistics were performed and the comparison to the population benchmarks was presented as the mean with a 95% confidence interval. To study potential differences among the demographic and professional characteristics, pairwise t tests were used with Bonferroni adjustment for multiple comparisons with a significance level of 5%.

RESULTS

Five domains were identified as factors related to success, as they received higher scores in relation to population benchmarks: quality of leadership, variation of work, meaning of work and work engagement as well as job insecurity. There was also a significant association between a having a manager with low nursing education and job insecurity (p = 0.021).

CONCLUSIONS

Quality of leadership is important for the professional development of specialist nurses in surgical care. Strategic work seems to include managers with a higher nursing education level to prevent insecure professional working conditions.

Nursing representatives in clinical quality databases and the presence of nursing-sensitive indicators of fundamental nursing care

AIM

To identify and describe nursing-sensitive indicators in Danish clinical quality databases and to examine the association between nurse representation on database steering committees and the presence of indicators related to aspects of fundamental care.

DESIGN

This was a cross-sectional study. The STROBE checklist was employed to ensure reporting quality.

METHODS

We reviewed data from the latest annual report of 71 clinical quality databases in April 2021. Aspects of fundamental care were defined as the 12 nursing domains defined in the Danish Minimum Nursing Data framework. For each database, we recorded the number and type of indicators and identified indicators measuring fundamental care aspects. We used the prevalence ratio to estimate the likelihood of indicators related to aspects of fundamental care in databases with nurse representation on the steering committee.

RESULTS

One-third of the databases included indicators related to aspects of fundamental care. The most common aspects were Respiration and circulation, Nutrition and Psychosocial conditions, whereas Skin and mucous membranes, Elimination and Pain were rarely measured. Nurse representation on the steering committee of a quality database increased the likelihood of having indicators related to aspects of fundamental care three-fold (prevalence ratio 3.25).

CONCLUSION

Fundamental care was rarely monitored in Danish clinical quality databases, but databases with nurse representation on the steering committee had a higher likelihood of monitoring fundamental care.

IMPACT

This study addressed the knowledge gap of how fundamental nursing care is measured in clinical quality databases. It introduces nurses to the measurement of fundamental care as a first step toward performing nursing intervention studies and investigating associations with patient outcomes. The increased likelihood of fundamental care monitoring in clinical databases with nurse representation on the steering committee indicates a feasible way for decision makers and nurse leaders to ensure a stronger focus on fundamental care to the patients' benefit.

Organisation-level and individual-level predictors of nurse-reported quality of care in primary care: A multilevel study in China

OBJECTIVES

Knowledge of the predictors of nursing quality and safety remains a gap in global primary care research. This study examines organisational-level and nurse-level predictors of nurse-reported quality of care from a management perspective.

METHODS

We recruited 175 primary care nurses in 38 community health centres (CHCs) varying by size and ownership in Jinan, Tianjin, Shenzhen and Shanghai. Guided by the Systems Engineering Initiative for Patient Safety model, the organisation-level predictors comprised organisational structure, organisational culture, psychological safety and organisational support, while the nurse-level predictors included organisational commitment and organisational citizenship behaviour. Nurse-reported quality of care was measured by two questions: "How do you rate the quality of care that you provide?" and "Do you often receive complaints from patients or their family members at work?" Multilevel linear regression models were used to examine the predictors of nurse-reported quality of care.

RESULTS

Among the four organisation-level predictors, organisational structure, psychological safety and organisational support were positive predictors of nurse-reported quality of care. Nurses working in CHCs with highly hierarchical organisational structures (Coef. = 0.196, p = 0.000), a high level of organisational support (Coef. = 0.158, p = 0.017) and a high level of psychological safety (Coef. = 0.159, p = 0.035) were more likely to report high quality of care or less likely to receive medical complaints. In terms of nurse-level predictors, nurses willing to increase their knowledge through continuous education were more likely to report good quality of care (Coef. = 0.107, p = 0.049) and less likely to receive medical complaints from patients (Coef. = 0.165, p = 0.041).

CONCLUSIONS

Potential management levers to improve quality of nursing care include formalised organisational structures, strong organisational support and a psychologically safe environment as well as the provision of training to facilitate continuous education. Implementing these recommendations is likely to enhance the nursing quality in primary care.

Culturally and linguistically diverse nurses' experiences of how competence facilitates integration into the working environment: A qualitative study

AIM

This study aims to describe culturally and linguistically diverse nurses' experiences of how they transferred their competence to meet professional competence requirements in non-English speaking environment.

BACKGROUND

Competence is one factor that affects culturally and linguistically diverse nurses' integration into the working environment. In this study, knowledge, skills, values and personal traits are included in the holistic competence concept.

DESIGN

Qualitative.

METHODS

A total of 24 culturally and linguistically diverse nurses involved in Finnish health care participated in this qualitative study. Data were collected through snowball sampling during the summer of 2021 using semi-structured interviews. The collected data were analysed using inductive content analysis.

RESULTS

The data analysis revealed a total of five main categories describing culturally and linguistically diverse nurses' experiences: 1) before immigration; 2) competence requirements in the country of immigration; 3) assessment of competencies; 4) support factors; and 5) hardships.

CONCLUSION

Degree recognition, colleagues' tolerance towards culturally and linguistically diverse nurses at the workplace and continuous education focusing on local language could improve culturally and linguistically diverse nurses' integration into the working environment.

Nurses' Experiences Concerning Older Adults with Polypharmacy: A Meta-Synthesis of Qualitative Findings

Polypharmacy is an increasing health concern among older adults and results in many health risks. Nurses have an important role to play in supporting medication management and promoting medication safety across different settings. This study aims to provide a meta-synthesis of qualitative studies investigating the perceptions and experiences of nurses in caring for older adults with polypharmacy. Electronic databases including PsycArticles, CINAHL Complete, MEDLINE, and ERIC were searched between September 2001 and July 2022. Potential studies were checked against inclusion and exclusion criteria. We included peer-reviewed studies reporting data on the experiences of nursing staff across different settings. Studies unitizing any qualitative approach were included, and the included studies were reviewed and analyzed using a thematic synthesis approach. Study quality was examined using the Critical Appraisal Skills Programme checklist for qualitative research. A total of nine studies with 91 nurses were included. Four major themes emerged: older adults suffering from polypharmacy, the importance of multidisciplinary teams, nursing roles in caring for older adults, and the complexity and barriers of implementing polypharmacy management. Healthcare professionals should pay attention to the impacts of polypharmacy in older adults' lives and should acknowledge the importance of team-based polypharmacy care in supporting older adults. Nurses play a key role in caring for older adults with polypharmacy, therefore, they should be empowered and be involved in medication management.

Patient-reported outcomes of the nurse-patient relationship in psychiatric inpatient hospitals: A multicentred descriptive cross-sectional study

WHAT IS KNOWN ON THE SUBJECT?: Psychiatric and/or mental health nurses are struggling to measure the outcomes of the nurse-patient relationship. Collecting nurse-sensitive patient outcomes is a strategy to provide outcomes of a nurse-patient relationship from patients' perspectives. Because there was no validated scale, the Mental Health Nurse-Sensitive Patient Outcome-Scale (six-point Likert-scale) was recently developed and psychometrically evaluated. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study using the Mental Health Nurse-Sensitive Patient Outcome-scale to measure nurse-sensitive patient outcomes of the nurse-patient relationship in psychiatric hospitals. Moderate to good average scores for the MH-NURSE-POS total (4.42) and domains scores (≥4.09). are observed. Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). Our results are consistent with the patient-reported effect(s) of relation-based nursing in qualitative research. The scores generate evidence to support the outcomes of the nurse-patient relationship and implicates that further investment in (re)defining and elaborating nurse-patient relationships in mental healthcare is meaningful and justified. More comparative patient-reported data can determine how nurse-sensitive patient outcomes are affected by the patient, nurse, and context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Demonstrating patient-reported outcomes of the nurse-patient relationship can be important to enhance the therapeutic alliance between nurses and patients, organize responsive nursing care, and create nursing visibility in mental healthcare. Further nursing staff training on interpersonal competencies, such as self-awareness and cultural sensitivity, can be pivotal to achieving the patient-reported outcomes for inpatients with mental health problems.

ABSTRACT

INTRODUCTION: Identifying patient-reported outcomes of the nurse-patient relationship is a priority in inpatient mental healthcare to guide clinical decision-making and quality improvement initiatives. Moreover, demonstrating nurse-sensitive patient outcomes can be a strategy to avoid further erosion of the specialism of psychiatric and/or mental health nursing.

AIM/QUESTION

To measure nurse-sensitive patient outcomes of the nurse-patient relationship.

METHOD

In a multicentred cross-sectional study, 296 inpatients admitted to five psychiatric hospitals completed the recently developed and validated Mental Health Nurse-Sensitive Patient Outcome-Scale (MH-NURSE-POS). The MH-NURSE-POS consists of 21 items (six-point Likert-scale) in four domains: 'growth', 'expression', 'control', and 'motivation'.

RESULTS

Participants displayed moderate to good average scores for the MH-NURSE-POS total (4.42) and domain scores (≥4.09). Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60).

DISCUSSION

The results demonstrate that patients perceive the nurse-patient relationship and the care given by psychiatric and/or mental health nurses as contributing to their treatment.

IMPLICATIONS FOR PRACTICES

Patient-reported outcomes can guide nurses and managers to provide and organize nursing care and to build a nurse-patient relationship that has a positive impact on these outcomes. Additionally, outcomes can create nursing visibility as a profession in- and outside mental healthcare.

Fundamental care: An evolutionary concept analysis

AIM

To report an analysis of the concept of fundamental care in the literature.

DESIGN

An evolutionary concept analysis.

DATA SOURCES

PubMed and CINAHL Complete databases were consulted using the key terms: fundamental care, fundamentals of care, essential care, basic nursing care and basic care revised. Articles published from 2008 to 2022, in English and Italian, in scholarly/peer-reviewed nursing journals were included.

METHODS

Rodgers's Evolutionary Method of concept analysis was used. Our thematic analysis yielded common themes related to the concept, antecedents, attributes and consequences of fundamental care.

RESULTS

A total of 50 articles were analysed. Thirty-eight attributes were identified, such as integration of care, patient and family centred care and trusting relationship; eight antecedents including nursing care, nursing practice and care context; and 17 consequences including the safety, quality and consistency of care.

CONCLUSION

This review of literature reveals that there is no consistent definition of the concept of 'fundamental care'. Findings from this exploration of the literature emphasized the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality fundamental care. Our definition of this concept may help nurse leaders in practice, research, education, management and policy to promote and enhance the application of fundamental care.

IMPACT

What problem did the study address? While numerous studies examine fundamental nursing care, various terms are used with no consensus on definitions emerging. Given the relevance of this topic, reaching a clear and agreed definition of fundamental care is essential. What were the main findings? Fundamental care encompasses the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality care. Where and on whom will the research have an impact? This definition of fundamental care will assist nurse leaders and researchers to promote and enhance the examination and application of fundamental care in clinical practice to ensure better care outcomes across all healthcare settings.

The impact of the COVID-19 pandemic in the healthcare utilization in Korea: Analysis of a nationwide survey

BACKGROUND

COVID-19 has brought changes in daily life and increased the medical burden. This study aims to evaluate the delays in healthcare services and related factors in the general population during the COVID-19 pandemic.

METHODS

We took a nationally representative sample and conducted a mobile phone-based survey. The study was conducted anonymously. Of the 3377 subjects who consented to participate, a total of 2097 finished the survey. The primary outcome was respondents' experiences with delayed (1) health screenings, (2) non-urgent medical visits, (3) medical visits for chronic disease, and (4) emergency visits during the COVID-19 pandemic.

RESULTS

Of 2097 respondents, females, residents of the Seoul metropolitan area, those with private insurance, those without chronic diseases, smokers, and drinkers had higher risk of delays in health screening and non-urgent medical visits after adjustment. Among chronic disease patients, those who were over 60 years old (adjusted odds ratio 0.36, 95% CI 0.14-0.92) showed lower risk of delayed medical visit. Residents of the Seoul metropolitan area, those with private insurance, smokers, and drinkers were all associated with experiencing delayed health screening and non-urgent medical visits had higher risk of delays in chronic disease visits and emergent medical visits.

CONCLUSIONS

Delayed access to healthcare services is associated with poor outcomes and may cause different complications. Efforts are needed to prevent delays in medical use due to infectious diseases such as COVID-19. Considering the possibility of the emergence of infectious diseases, various countermeasures are needed to prevent delays in medical visit.

El valor relegado de la atención primaria durante la pandemia COVID-19: una de enfermería

El 11 de marzo del 2020 la Organización Mundial de la Salud caracteriza a una nueva enfermedad denominada COVID-19 como una Pandemia, en respuesta a ello proporciona una serie de lineamientos, en el último de estos se visualiza la Atención Primaria de la Salud como protagonista, sin embargo, es una gran tarea con pocos recursos disponibles, más aún cuando nos encontramos con un nivel de atención historicamente desatendido, en dicho contexto se gesta el presente artículo que responde al objetivo de relevar la importancia de la Atención Primaria de la Salud de América Latina en respuesta al Plan estratégico desarrollado recientemente por la Organización Mundial de la Salud. La necesidad de su fortalecimiento es referida por múltiples realidades como Chile, Perú, Brasil, México, Cuba, Colombia, Costa Rica, El Salvador, Paraguay o Bolivia, se ha descrito que la enfermería presenta un rol preponderante ante la problemática, pues son estos profesionales los que prestan hasta el 90% de los servicios de salud, con resultados en los pacientes comparables o mejores que las contrapartes médicas, no obstante su capacidad está limitada por las leyes estatales y federales. Se describen 4 obstáculos que restringen el poderoso aporte de la Atención Primaria de la Salud.

Reaching Consensus on Global Health Competencies for Undergraduate Nurses in Indonesia: A Delphi Study

BACKGROUND: Trends in the era of globalization show an increasing need for nurses to have the Global Health Competencies (GHC) so as to enable them to address global health problems particularly in the pandemic Covid-19. However, evidence-based information about relevance and feasibility of these competencies for undergraduate nursing students in Indonesia is very limited. AIM: This study aims to achieve consensus among experts on global health competencies for Indonesian undergraduate nursing students. METHODS: Using the 2-rounds Delphi method in a sequential mixed-method design, a total of 35 nursing experts voluntarily participated in the study. Six experts participated in the first round, and 29 others were in the second round, hence the collection of Quantitative and qualitative data. The Item Content Validation Index (I-CVI) = 0.78 and Scale Content Validation Index (S-CVI) = 0.9 were used to determine the level of agreement among the experts. RESULTS: At the end of round 2, an agreement was reached on the 9 GHC domains. However, from the original 44 competencies there were 5 competencies that was excluded in the first round and 3 competencies in the second round. These results were supported by the most frequent comments from the experts that these competencies were lacking in clarity, suitability and irrelevant to undergraduate nurses’ competencies. CONCLUSION: In conclusion, this study has resulted in an agreement among experts regarding global health competencies for undergraduate nursing students in Indonesia. It is predicted that the findings of this study can contribute to the development of global health competencies in the nursing profession. Having these competencies will enable nurses to participate in overcoming global health problems. Validation of the new GHC by larger groups of nursing educators and graduate users is required. Keywords: Delphi, global health competencies, Indonesia, nurses.

Health policy analysis on barriers and facilitators for better oral health in German care homes: a qualitative study

OBJECTIVES

To assess possible health policy interventions derived from the theoretical domains framework (TDF) by studying barriers and facilitators on the delivery of oral healthcare and oral hygiene in German care homes using a behavioural change framework.

DESIGN

Qualitative correlational study to evaluate a national intervention programme.

SETTING

Primary healthcare in two care homes in rural Germany.

PARTICIPANTS

Eleven stakeholders participating in the delivery of oral healthcare (hygiene, treatment) to older people, including two care home managers, four section managers, two nurses/carers and three dentists.

INTERVENTIONS

Semistructured interviews conducted in person in the care homes or by phone. A questionnaire developed along the domains of the TDF and the Capabilities, Opportunities and Motivations influencing Behaviours model was used to guide the interviews. Interviews were transcribed and systematised using Mayring's content analysis along the TDF.

RESULTS

860 statements were collected. We identified 19 barriers, facilitators and conflicting themes related to capabilities, 34 to opportunities and 24 to motivation. The lack of access to professional dental care was confirmed by all stakeholders as a major limitation hampering better oral health.

PRIMARY OUTCOME

A range of interventions can be discussed with the methodology we utilised. In our interviews, lack of dentists willing to treat patients at these facilities was the most discussed barrier for improving oral health of nursing home residents.

SECONDARY OUTCOMES

Dentists highlighted the need for better incentives and facilities to deliver oral healthcare in these institutions. Differences with urban settings regarding access to healthcare were frequently discussed by our study participants.

CONCLUSIONS

Within our sample, greater capacitation of care home staff, better financial incentives for dentists and increased cooperation between the two stakeholders should be considered when designing interventions to tackle oral health of care home residents in Germany.

Role dimensions of practice nurses and interest in introducing advanced nurse practitioners in general practice in Ireland

Background

Internationally many countries have implemented strategies to enhance primary care, to strengthen their health systems to cope with an aging population, the rise of chronic conditions, and increased costs. Primary care has the potential to address these challenges, however, general practitioners are increasingly struggling to meet patient demand resulting from a growing and aging population. Expanding the role of general practice nurses to advanced nurse practitioner (ANP) level has worked internationally and could equally be a solution to the Irish context. However, their current role must first be established as well as their level of interest in becoming an ANP.

Aim

To explore the role of general practice nurses and their interest in becoming an ANP.

Design

A survey design.

Method

A purposeful sample of general practice nurses (n = 40) was undertaken between April and June 2019. Data were analyzed using the Statistical Package for Social Science (SPSS V 25.0; IBM).

Results

General practice nurses appear to have an agenda in relation to activities associated with wound care, immunizations, respiratory and cardiovascular issues. Just over half of the respondents were not interested in becoming an ANP. Their perceived challenges associated with the implementation of the role include a lack of support from general practitioners, a lack of resources, insurance issues, and a lack of understanding of the role. Challenges were associated with undertaking further training and their experience of having more work transferred to general practice without concomitant reallocation of resources.

Conclusion

General practice nurses have extensive clinical experience to deliver major improvements in primary care. Educational opportunities need to be provided for upskilling existing general practice nurses to advanced practice level. Greater understanding of the role and the potential contribution of the role in general practice is required among medical colleagues and the public.

The impact of organisational commitment and leadership style on job satisfaction of nurse practitioners in acute care practices

AIM

To determine the main factors that affect nurse practitioners' job satisfaction, especially the relationship between organisational commitment and leadership styles in acute care practices.

BACKGROUND

There is little known about the influence of organisational commitment and leadership on NPs' job satisfaction within acute care hospitals.

METHODS

A cross-sectional design with a national online survey that enrolled 1,205 nurse practitioners from the Taiwan Association of Nurse Practitioners to identify potential variables associated with job satisfaction using the multiple regression model.

RESULTS

Organisational commitment (mean=59.47), job satisfaction (mean=173.47), and leadership style (mean ranged from 13.29 to 28) were at a moderate level. Organisational commitment, leadership style, patient load and nurse practitioner advancement levels explained 63% of the variance in nurse practitioners' job satisfaction.

CONCLUSIONS

Organisational commitment and leadership styles, such as idealised influence and individual consideration, are major factors that impact nurse practitioners' job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

Healthcare organisations should develop policies targeting organisational commitment and managers' leadership styles to improve nurse practitioners' job satisfaction.