Factors related to nursing performance in South Korean intensive care units

Integral leadership in nursing: Development and psychometric validation of a Korean version of the Integral Nursing Leadership Scale

BACKGROUND

With the importance of nursing leadership roles, there is a need for a more integrated approach to nursing leadership that can adapt quickly to many challenges in today's healthcare environments. In recent years, integral leadership that can apply a more holistic and inclusive approach to leadership has gained growing attention in other disciplines. However, research on integral leadership in nursing is sparse since no instrument specifically measuring integral leadership in nursing contexts is available.

OBJECTIVE

The study aimed to develop an integral nursing leadership scale and evaluate its psychometric properties.

METHODS

The scale was developed in two phases. In the first phase, items were generated to reflect the attributes of integral leadership in the nursing context. These attributes were identified through a conceptualization process using a literature review and semi-structured interviews. The process was based on the four dimensions of the integral leadership framework, adopting Wilber's four quadrants of integral theory. Then, the psychometric properties of the scale, including content validity, structural validity, and internal consistency reliability, were evaluated. Data were collected from a convenience sample of 806 Korean nurses and were analyzed using both exploratory factor analysis and second-order confirmatory factor analysis, using two separate random halves of the sample.

RESULTS

The newly developed scale consisted of 30 items across four dimensions: individual leadership qualities, individual performance, influencing organizational culture, and organizational excellence. Content validity for the 30 items was calculated to be 0.84 for item-level content validity and 0.96 for the scale's content validity averaging method, indicating adequate content validity. The four-factor structure of integral nursing leadership was cross-validated by exploratory factor analysis and second-order confirmatory factor analysis. The internal consistency reliability was also found to be acceptable, as indicated by a Cronbach's alpha of 0.97 and a McDonald's ω estimate of 0.98.

CONCLUSION

Findings demonstrate that the Integral Nursing Leadership Scale has acceptable content validity, structural validity, and reliability in measuring integral leadership, specifically in the context of nursing. More research is needed to further refine and establish strong validity of the scale.

Violence against healthcare professionals in intensive care units: a systematic review and meta-analysis of frequency, risk factors, interventions, and preventive measures

BACKGROUND

To assess the frequency, risk factors, consequences, and prevention of violence against healthcare workers in intensive care units.

METHODS

PubMed, Scopus, Google Scholar, EMBASE, Cochrane, and Web of Science were searched for studies on violence against healthcare workers in adult intensive care units. Risk factors, patient characteristics, and implications for healthcare workers were collected. Study quality, bias, and level of evidence were assessed using established tools.

RESULTS

Seventy-five studies with 139,533 healthcare workers from 32 countries were included. The overall median frequency of violence was 51% (IQR 37-75%). Up to 97% of healthcare workers experienced verbal violence, and up to 82% were victims of physical violence. Meta-analysis of frequency revealed an average frequency of 31% (95% CI 22-41%) for physical violence, 57% for verbal violence (95% CI 48-66%), and 12% for sexual violence (95% CI 4-23%). Heterogeneity was high according to the I2 statistics. Patients were the most common perpetrators (median 56%), followed by visitors (median 22%). Twenty-two studies reported increased risk ratios of up to 2.3 or odds ratios of up to 22.9 for healthcare workers in the ICU compared to other healthcare workers. Risk factors for experiencing violence included young age, less work experience, and being a nurse. Patients who exhibited violent behavior were often male, older, and physically impaired by drugs. Violence was underreported in up to 80% of cases and associated with higher burnout rates, increased anxiety, and higher turnover intentions. Overall the level of evidence was low.

CONCLUSIONS

Workplace violence is frequent and underreported in intensive care units, with potential serious consequences for healthcare workers, calling for heightened awareness, screening, and preventive measures. The potential risk factors for violence should be further investigated.

SYSTEMATIC REVIEW REGISTRATION

The protocol for this review was registered with Prospero on January 15, 2023 (ID CRD42023388449).

Structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia in Japan: A cross-sectional study

Schizophrenia is a disorder characterized by psychotic relapses. Globally, about 15%-30% of patients with schizophrenia discharged from inpatient psychiatric admissions are readmitted within 90 days due to exacerbation of symptoms that leads to self-harm, harm to others, or self-neglect. The purpose of this study was to investigate the structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. A new questionnaire was developed to assess the extent to which respondents delivered in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. This study adopted a cross-sectional research design. The survey was conducted with the new questionnaires. The participants were registered nurses working in psychiatric wards. Item analyses and exploratory factor analyses were performed using the new questionnaires to investigate the structure of in-hospital nursing care leading to reduction in early readmission. Stepwise regression analyses were conducted to examine the factors predicting in-hospital nursing care leading to reduction in early readmission. Data were collected from 724 registered nurses in Japan. In-hospital nursing care leading to reduction in early readmission was found to consist of five factors: promoting cognitive functioning and self-care, identifying reasons for readmission, establishing cooperative systems within the community, sharing goals about community life, and creating restful spaces. In-hospital nursing care leading to reduction in early readmission was predicted by the following variables: the score on the nursing excellence scale in clinical practice, the score on therapeutic hold, and the participation of community care providers in pre-discharge conferences. Japanese psychiatric nurses provide nursing care based on these five factors leading to reduction in early readmission. Such nursing care would be facilitated by not only nurses' excellence but also nurses' environmental factors, especially the therapeutic climate of the ward and the participation of community care providers in pre-discharge conferences.