A social-ecological framework: A model for addressing ethical practice in nursing

Barriers and enablers to accessing perinatal health services for rural Australian women: A qualitative exploration of rural health care providers perspectives

OBJECTIVE

To identify perceived barriers and enablers for rural women in accessing perinatal care within their own community from the perspective of perinatal health care providers.

DESIGN

A qualitative descriptive study design utilising reflexive thematic analysis, using the socioecological framework to organise and articulate findings.

SETTING

Victoria, Australia.

PARTICIPANTS

Semi-structured interviews were conducted with nine perinatal health care providers who provide care to pregnant women or new mothers in rural communities. Participants were recruited across Victoria in 2023.

RESULTS

Providers reported multi-level barriers and enablers that exist for rural women in accessing perinatal care within their communities. Barriers included women's personal circumstances, challenging professional relationships, inequitable service provision, ineffective collaboration between services and clinicians and government funding models and policies. Enablers included strength and resilience of rural women, social capital within rural communities, flexible care delivery and innovative practice, rural culture and continuity of care models.

CONCLUSION

Rural perinatal health care providers perceived that rural women face multiple barriers that are created or sustained by complex interpersonal, organisational, community and policy factors that are intrinsic to rural health care delivery. Several addressable factors were identified that create unnecessary barriers for rural women in engaging with perinatal care. These included education regarding health systems, rights and expectations, equitable distribution of perinatal services, improved interprofessional relationships and collaborative approaches to care and equity-based funding models for perinatal services regardless of geographical location.

Associations between nurse characteristics, institutional characteristics and perceived nurse knowledge and self-efficacy of reporting suspected child abuse and neglect

AIM

To determine the association between nurse and institutional characteristics and perceived professional nurse knowledge and self-efficacy of reporting child abuse and neglect.

DESIGN

A sample of N = 166 nurses were recruited to respond to the Reporting of Suspected Child Abuse and Neglect (RSCAN) survey.

METHODS

A multiple linear regression examined whether nurse characteristics and institutional characteristics were associated with the two RSCAN survey domain scores.

RESULTS

Perceived knowledge of a workplace child abuse and neglect protocol was associated with the knowledge subscale. Education and child abuse and neglect expertise were significant predictors of the self-efficacy subscale. Nurses with a master's or higher degree and those who identified as being either forensic, paediatric or Emergency Department nurses, had less perceived institutional barriers to self-efficacy of reporting child abuse and neglect.

CONCLUSION

This study provides a preliminary insight into the institutional barriers and facilitators of nurses as child abuse and neglect mandated reporters.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

To encourage innovative education and collaborations to support nurses as fully informed child abuse and neglect mandated reporters.

IMPACT

This research identifies the gaps and facilitators of nurses as child abuse and neglect mandated reporters to inform healthcare professionals and academic institutions on the importance of nurse education and experience in nurse knowledge and self-efficacy in reporting suspected child abuse and neglect.

REPORTING METHODS

The authors of this study have adhered to relevant EQUATOR guidelines: STROBE.

PATIENT OR PUBLIC CONTRIBUTION

There is no patient or public contribution as the study only looked at nurses.

Re-imagining of an undergraduate, second-degree entry, accelerated nursing program's curriculum utilizing a postmodern, learner-centred lens and a concept-based framework

INTRODUCTION

It is necessary to re-imagine nursing curriculums utilizing a postmodern approach, as outdated teacher-centred methods of nursing education with emphasis on memorization versus critical thinking no longer meet the needs of the contemporary learner and the current challenges of the healthcare environment. There is an explicit need to redesign nursing curriculums that are future-oriented, adaptive and flexible and serve the learners' best interests.

BACKGROUND

Distilled from a decade of teaching experience in an undergraduate, second-degree entry, accelerated nursing program, this paper describes the construction of a learner-centred, postmodern, concept-based nursing curriculum that aims to foster learners' inquiry skills, critical thinking, problem-solving, and experiential learning-all which develop learners' autonomy, self-direction, and lifelong learning. The objective is to foster learners' transformational and emancipatory learning and metacognition.

DISCUSSION

An extensive review of the current trends, contemporary nursing knowledge for the past decade (2013-2023), and seminal literature on theories and frameworks paralleled with the review of current and future trends in Canadian and global health care, including the socio-economic, politico and environmental contexts, led to the formulation of a concept-based curriculum. Grounded in the constructivist paradigm, the curriculum applies interperetivist, critical, feminist, and indigenous lenses. The Strength-Based Nursing framework was selected as the core guiding framework. The curriculum's four curricular themes and foundational pillars were adopted directly from the framework to provide a starting point for concept development. These initial themes were then juxtaposed with relevant nursing, and social theories, policies, and frameworks, ensuring a robust coverage of modern nursing knowledge and allowing for the core concepts of the curriculum to emerge. A total of 21 concepts and 192 sub-concepts were developed.

CONCLUSION

Implications for future practice require nursing educators to receive support and professional development opportunities in developing skills and confidence in entering a classroom as co-learners and facilitators.

Ethical conflicts experienced by community nurses: A qualitative study

BACKGROUND

Despite news reports of morally distressing situations resulting from complex and demanding community-care delivery in Canada, there has been little research on the topic of ethical conflicts experienced by community-based health care professionals.

RESEARCH AIM

To identify ethical conflicts experienced by community nurses.

RESEARCH DESIGN

Data were collected using semi-structured interviews and then relevant text was extracted and condensed using qualitative content analysis. This research was part of a larger grounded theory project examining how community nurses manage ethical conflict.

RESEARCH CONTEXT AND PARTICIPANTS

Community nurses, including 13 public health nurses and 11 home care nurses from two Canadian provinces, were interviewed.

ETHICAL CONSIDERATIONS

Study approval was granted by the Health Research Ethics Authority of Newfoundland and Labrador and by provincial health authorities.

FINDINGS

Seven ethical conflicts were identified and assigned to one of two groups. In the grouping categorized as challenges with obligations or risks, the ethical conflicts were: (1) screening for child developmental issues knowing there is a lack of timely early intervention services; (2) encountering inequities in the health care system; (3) not fulfilling principles, goals, and initiatives of primary and secondary prevention; and (4) feeling powerless to advocate for clients. The remaining ethical conflicts were categorized as challenges with process, risks, and consequences, and were: (5) jeopardizing therapeutic relationships while reporting signs of a child at risk; (6) managing confidentiality when neighbors are clients; and (7) supporting client autonomy and decision-making but uncertain of the consequences.

CONCLUSIONS

Research investigation will continue to be important to raise awareness and mobilize ethics supports as health care services are steadily shifted from institutional to community settings. Moreover, with heightened potential for communicable disease outbreaks across international borders from global warming, community nurses around the world will continue to be required to address ethically-difficult care situations with competence and compassion.

Chiropractic Day 2023: A Report and Qualitative Analysis of How Thought Leaders Celebrate the Present and Envision the Future of Chiropractic

Objective

This study aimed to (1) collect and analyze statements about how to celebrate chiropractic in the present and roles that chiropractors may fulfill in the future, (2) identify if there was congruence among the themes between present and future statements, and (3) offer a model about the chiropractic profession that captures its complex relationships that encompass its interactions within microsystem, mesosystem, exosystem, and macrosystem levels.

Methods

For this qualitative analysis, we used pattern and grounded theory approaches. A purposive sample of thought leaders in the chiropractic profession were invited to answer the following 2 open-ended questions: (1) envision the chiropractor of the future, and (2) recommendations on how to celebrate chiropractic. Information was collected during April 2023 using Survey Monkey. The information was entered into a spreadsheet and analyzed for topic clusters, which resulted in matching concepts with social-ecological themes. The themes between the responses to the 2 questions were analyzed for congruence. We used the Standards for Reporting Qualitative Research to report our findings.

Results

Of the 54 experts invited, 32 (59%) participated. Authors represented 7 countries and have a median of 32 years of chiropractic experience, with a range of 5 to 51 years. Nineteen major topics in the future statements and 23 major topics in statements about celebrating chiropractic were combined in a model. The topics were presented using the 4 levels of the social-ecological framework. Individual (microsystem): chiropractors are competent, well-educated experts in spine and musculoskeletal care who apply evidence-based practices, which is a combination of the best available evidence, clinical expertise, and patient values. Interpersonal relationships (mesosystem): chiropractors serve the best interests of their patients, provide person-centered care, embrace diversity, equity, and inclusion, consider specific health needs and the health of the whole person. Community (exosystem): chiropractors provide care within integrated health care environments and in private practices, serve the best interests of the public through participation in their communities, participate through multidisciplinary collaboration with and within the health care system, and work together as a profession with a strong professional identity. Societal (macrosystem): chiropractors contribute to the greater good of society and participate on a global level in policy, leadership, and research. There was concordance between both the future envisioning statements and the present celebration recommendations, which suggest logical validity based on the congruence of these concepts.

Conclusion

A sample of independent views, including the perceptions from a broad range of chiropractic thought leaders from various backgrounds, philosophies, diversity characteristics, and world regions, were assembled to create a comprehensive model of the chiropractic profession. The resulting model shows an array of intrinsic values and provides the roles that chiropractors may provide to serve patients and the public. This study offers insights into the roles that future chiropractors may fulfill and how these are congruent with present-day values. These core concepts and this novel model may have utility during dialogs about identity, applications regarding chiropractic in policy, practice, education, and research, and building positive relationships and collaborations.

Moral distress among nurse leaders: A qualitative systematic review

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions.

VBAC or elective CS? An exploration of decision-making process employed by women on their mode of birth following a previous lower segment caesarean section

BACKGROUND

Part of the caseload of an Advanced Midwife Practitioner (AMP) service in a Northwest of Ireland maternity unit includes vaginal birth after caesarean section (VBAC) women. Despite evidence about VBAC being a safe option for women, the numbers attempting a VBAC remain small. This research was undertaken to give an insight into how VBAC eligible women opt for an elective repeat CS (ERCS) or VBAC birth.

METHODS

Forty-four postnatal women with one previous CS who birthed between August 2021 and March 2022 were invited to participate in a qualitative study. Thirteen semi-structured interviews were undertaken in 2022. Thematic Analysis guided the analysis of the data and the findings are framed using the domains of the Socio-Ecological Model.

FINDINGS

Decision making in relation to ERCS and VBAC is complex. Women want accurate VBAC information and time for discussions. Decisions are influenced by the woman's own confidence to birth naturally, family size, rite of passage to motherhood, control, previous birth experience, postnatal recovery and friends and family.

DISCUSSION

Previous experience can influence but not predict the next mode of birth. However, there is no one script that healthcare professionals (HCP) can use for this decision making given the various factors that influence this. To meet women's individual needs, HCPs should discuss VBAC suitability postnatally, offer VBAC antenatal clinics and specific VBAC classes.

CONCLUSION

Discussions about suitability for VBAC should occur following the primary CS. Continuity of care (COC), time for discussions and VBAC supportive HCP should be an option for all of this cohort.

A socioecological description of the influencing factors to midwives' management of preeclampsia in a Ghanaian tertiary hospital

INTRODUCTION

In low-resource settings, midwives are the first contact for women with preeclampsia and lead the coordination of care. Unfavourable preeclampsia outcomes create a burden for women, families, and the health system. It is therefore important to understand the unique context of midwives' practice and the complex factors that influence the delivery of maternal healthcare.

AIM

This qualitative study explored the perspectives of key stakeholders in a tertiary hospital in Ghana regarding the facilitators and barriers influencing midwives' provision of preeclampsia care using a socioecological model.

METHODS

Semi-structured interviews were conducted with 42 participants comprising senior managers (n = 7) and hospital midwives (n = 35) in 2021. Thematic analysis used Braun and Clarke's six-step method, and the findings were organised within four levels of the socioecological model: individual, interpersonal, organisational, and public policy.

RESULTS

Two main themes were identified: 1) Facilitators of preeclampsia management, and 2) Barriers to preeclampsia management. Facilitators were identified at three levels (individual, interpersonal, and organisational) and included midwives' knowledge of preeclampsia; midwives' self-efficacy; midwives' skillset to enhance preeclampsia care; collaborative practice; and strategies for preeclampsia care quality improvement. At the individual level, the barriers were inadequate pre-service preparation, lack of evidence-based midwifery care, and colleagues' work attitudes. Hierarchical decision-making and staff views of women's risk perceptions were identified as barriers at the interpersonal level. At the organisational level, the barriers were: scarce resources and staff shortages, and a lack of midwifery-specific guidelines. Two barriers were identified within the public policy level: the high cost of preeclampsia care and issues with the referral system.

CONCLUSION

Multi-faceted factors play a significant role in midwives' management of preeclampsia. Hence context-specific multi-level interventions have the potential to improve the quality-of-care women in Ghana receive.

Transforming Moral Suffering by Cultivating Moral Resilience and Ethical Practice

Ethical challenges are inherent in nursing practice. They affect patients, families, teams, organizations, and nurses themselves. These challenges arise when there are competing core values or commitments and diverse views on how to balance or reconcile them. When ethical conflict, confusion, or uncertainty cannot be resolved, moral suffering ensues. The consequences of moral suffering in its many forms undermine safe, high-quality patient care, erode teamwork, and undermine well-being and integrity. My experience as a nurse in the pediatric intensive care unit and later as a clinical nurse specialist in confronting these moral and ethical challenges has been the foundation of my program of research. Together we will explore the evolution of our understanding of moral suffering-its expressions, meanings, and consequences and attempts to measure it. Moral distress, the most described form of moral suffering, took hold within nursing and slowly within other disciplines. After 3 decades of research documenting the existence of moral distress, there were few solutions. It was at this juncture that my work pivoted toward exploring the concept of moral resilience as a means for transforming but not eliminating moral suffering. The evolution of the concept, its components, a scale to measure it, and research findings will be explored. Throughout this journey, the interplay of moral resilience and a culture of ethical practice were highlighted and examined. Moral resilience is continuing to evolve in its application and relevance. Many vital lessons have been learned that can inform future research and guide interventions to harness the inherent capabilities of clinicians to restore or preserve their integrity and to engage in large-scale system transformation.

Code poverty: An adaptation of the social-ecological model to inform a more strategic direction toward nursing advocacy

The purpose of this discussion paper is to explore how nurses can be strategically poised to advocate for needed policy change in support of greater income equality and other social determinants of health. We adapted Bronfenbrenner's social-ecological model to highlight how four broad pervasive subsystems shape the opportunities that nurses have to engage in advocacy at the policy level. These subsystems include organizations (the microsystem), professional bodies (the mesosystem), public policies (the exosystem), and societal values (the macrosystem). On the basis of this adapted model, we recommend changes among modifiable elements of the microsystem and mesosystem that can help position nurses (ecologically and collectively) to advocate for public policy change and use examples from a Canadian context to illustrate these points. We believe that the ideas arising from this model can be widely used where policy action on the social determinants of health is needed to inform, guide, and frame change efforts and advocacy work.

Inclusion of Disability Content in Simulation: An Evaluation of the Learners' Perspective on the Effectiveness of a Pediatric Tabletop Simulation

BACKGROUND

Despite recommendations to include disability content in nursing education, nursing students have little exposure to disability education, which would help to develop necessary knowledge, skills, and attitudes in learning to care for patients with disabilities.

PURPOSE

This study evaluated learners' perceptions of the effectiveness of a tabletop simulation in meeting their learning needs related to nursing care for children with disabilities and their families.

METHODS

The research design was a descriptive educational intervention study. Nursing students (n = 234) enrolled in the pediatric nursing course attended the simulation as a required part of their coursework.

RESULTS

The majority of the students found the tabletop simulation with disability content to be an effective educational intervention.

CONCLUSIONS

The results obtained from this study indicated that the tabletop simulation was an effective educational strategy for nursing students' learning to provide care for children with disabilities and their families.

A holistic health determinants model for public health nursing education and practice

Baccalaureate nursing graduates (BSNs) in the 21st century need to be prepared to manage the population health needs of diverse populations across the lifespan and take actions to improve health equity. A need for a Holistic Health Determinants Model that included the Social Determinants of Health was identified. A model incorporating the Healthy People 2020 Health Determinants Model and the Healthy People 2030 Social Determinants of Health Model was developed. Two theoretical approaches provided a foundation for the model. Social ecological theory stresses the lived experience in an ever-changing environment from the micro to the macro biological, behavioral, social and physical environmental levels. Public health intersectionality added the construct of constant interactions among the health determinants that resulted in different levels of health status among individuals and groups. This Holistic Health Determinants Model is a tool to use in teaching nursing students how to address the needs of individuals/families, diverse populations, and communities. It also facilitates integration of the new AACN Population Health Competencies across the curriculum. The model facilitates the preparation of BSN graduates to address the factors that shape health status and to take actions to improve health equity.

Honesty and Transparency, Indispensable to the Clinical Mission-Part III: How Leaders Can Prevent Burnout, Foster Wellness and Recovery, and Instill Resilience

The hidden epidemic of burnout exacts a staggering toll on professionals and patients, reflected in increased risk of medical errors, complications, and staff turnover. For surgeons, nurses, and other team members working at the sharp end of care, adverse events can amplify work exhaustion, interpersonal disengagement, and risk of moral adversity. Visionary leaders are not content to mitigate burnout and moral injury; they elevate the human experience throughout health care by modeling wellness, fostering moral courage, promoting safety of professionals, and restoring joy in work. Part 3, Health Professional Wellness and Resilience, introduces the final pillar for advancing the clinical mission.

Ethics in nursing: Progress on National Nursing Ethics Summit

BACKGROUND

In 2014 a National Nursing Ethics Summit was undertaken to chart a future for nursing ethics in the United States.

PURPOSE

The purpose of this study was to understand changes in the field over a 5-year period as a measure of longitudinal impact and identify recommendations for education, practice, research and scholarship, and policy.

METHODS

This cross-sectional study used a mixed method design.

FINDINGS

Nineteen participants from 15 institutions participated in the survey. The majority of respondents agreed or strongly agreed on their effort in promoting education (84%), contributing to scholarship (74%), creating a sustained environment for ethical practice (63%) and developing new initiatives (58%) in nursing ethics.

DISCUSSION

Further investment is needed to establish a more broadly funded research agenda for ethical issues in nursing, improvement in evidence-based practice, and development of policy initiatives to promote ethical practice and infrastructure for sustainability and responsiveness to contemporary challenges.

Ethical challenges during the COVID-19 pandemic: Perspectives of nursing students

BACKGROUND

The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students.

OBJECTIVES

To explore the ethical dilemmas and ethical conflicts experienced by final-year nursing students who worked during the first outbreak of the COVID-19 pandemic in Spain.

RESEARCH DESIGN

A qualitative exploratory study was conducted using purposive sampling. Semi-structured interviews were carried out using a question guide. Interviews took place via a private video chat room platform. A thematic, inductive analysis was performed of the information gathered.

PARTICIPANTS AND RESEARCH CONTEXT

Eighteen nursing students were recruited from two universities of Madrid, aged between 18 and 65 years old, enrolled in the fourth year of nursing studies and who were hired under a relief contract for health professionals during the pandemic.

ETHICAL CONSIDERATIONS

The present study was carried out in accordance with the Declaration of Helsinki, and the study was approved by the Local Ethics Committee of Universidad Rey Juan Carlos.

RESULTS

Three specific themes emerged: (a) coping with patient triage, (b) difficulties in providing end-of-life care, and (c) coping with patient death. Nursing students participated in the process of patient selection for resource allocation and ICU bed occupancy. They were shown how to care for patients who were not admitted to the ICU, in their last moments and were faced with the difficulties of applying end-of-life care. Finally, the nursing students were confronted with the death of their patients, in overwhelming numbers and under adverse conditions.

CONCLUSIONS

These findings can help shed light on the ethical dilemmas and ethical conflicts faced by novice nursing students, incorporated into the workforce during the COVID-19 pandemic. Moreover, it was described that students may normalize the death due to the exhaustion and overwhelmed routine.

Key Elements of Professional Nursing Practice: A Scoping Review

BACKGROUND: Professional nursing practice can be used as a standard reference for implementing nursing care to help nurses provide quality care in accordance with their authorities. AIM: The review is purposed to synthesis the pieces of literature telling the development and / or application and / or assessment of a professional nursing practice to determine the crucial elements. METHODS: This study was guided by the following framework for a scoping review, using electronic databases including ScienceDirect, EBSCO, ProQuest, Pubmed, and Google Scholar within keywords of professional nursing practice, model, nurse and conceptual framework. RESULTS: Of a total of 2870 paper found, 28 papers were selected. This study seven key elements: health system competency, professional value, reward and performance evaluation, leadership, nursing care, professional development, and basic care competency. CONCLUSION: A professional nursing practice would provide the minimum standard of quality nursing practice.

From policy to patient: Using a socio-ecological framework to explore the factors influencing safe practice in UK primary care

BACKGROUND

The recent and rapid changes in the model of primary care delivery have led to an increased focus on patient safety in what is one of the most diverse and complex healthcare settings. However, previous initiatives have failed to deliver the expected improvements, leading to calls for a better understanding of how a range of personal and contextual factors influence the decisions and behaviours of individual care providers.

METHODS

The socio-ecological framework, successfully used in public health settings to interpret the complex influences on individual behaviours, enabled a post-hoc deductive analysis of a series of semi-structured interviews conducted with clinical staff and senior managers at a range of practices across five geographically diverse regions in England to explore their perspectives on the factors that influence safe practice.

RESULTS

The five levels of the socio-ecological framework successfully helped unpick the myriad influences on safe primary care practice, including, at the Individual level, assumptions of responsibility and previous experience; at the Interpersonal, equitable communication in support of a team ethos; at the Organisational, the physical infrastructure, size and complexity of the practice; at the Community, the health profile and literacy of patients; and at the Policy, meeting the demands of competing local and national governing bodies.

CONCLUSIONS

Coherent, realistic and achievable goals are needed for improving patient safety in primary care addressing personal, organisational and environmental factors. Such goals and the tools and interventions designed to meet them must therefore be sympathetic to the demands on resources and the characteristics of patients, staff, and their organisations. Using the framework to interpret our findings provided much needed insight into the impact of these varying influences, and highlights the importance of recognising and communicating the relationship between specific contextual factors and the ability of individual providers to provide safe primary care.

Capacity building, local ownership and implementation of a multi-level HIV/AIDS positive health, dignity, and prevention initiative in Mozambique: approach, challenges and lessons learned

Mozambique has for many years suffered from a high burden of HIV with an estimated prevalence of 11.1% among adults age 15–49 years. In response, Positive Health, Dignity, and Prevention (or Positive Prevention as it is known in Mozambique), was developed as a method of integrating HIV care and prevention via capacity building. Through comprehensive holistic care, HIV transmission is prevented while simultaneously promoting the health of people living with HIV/AIDS. Our initiative used a three-tiered approach, and included activities at national, provincial, and community levels. In order to change patient behavior and successfully train health-care workers in Positive Prevention, it was therefore considered necessary to work at multiple levels of influence. This ensured that the individual-level behavior change of PLHIV and health-care providers was maximized through supportive environments and policies. Related national-level achievements included the establishment of a Positive Prevention technical working group; the development of a Positive Prevention policy document; training national policy-makers on Positive Prevention; the development and distribution of a nationally approved Positive Prevention training package; the integration of Positive Prevention into existing Ministry of Health curricula; the development and approval of national data collection forms; and the drafting of a related national strategy. The framework and key activities of the Mozambique Positive Prevention Program may help to inform and assist others involved in similar work, as well as advancing country or local ownership of HIV/AIDS treatment, care and prevention efforts. By using a three-tiered approach, a supportive system was created. This was critical to both optimizing Positive Prevention provision and building long-term capacity. In order for related efforts to be successful in other settings, we encourage implementing partners to also work at multiple levels, with local ownership principles in mind, in order that Positive Prevention programs may have the greatest possible effect.

Workplace Aggression: Exploring Experiences of Occupational Therapy Practitioners in Healthcare Settings

Workplace aggression (WPA) among healthcare workers is a pervasive and serious problem in the healthcare industry, yet there is a poor understanding of WPA in the profession of occupational therapy (OT). The authors employed a mixed method design using a Likert scale survey and focus groups from two different settings and locations to explore WPA experiences of OT practitioners working in healthcare settings. Participants for the focus groups totaled 14 and 109 surveys were returned. The findings revealed that 100% of the focus group participants and 67% of the survey respondents report exposure to specific types of WPA. Key underlying causes relate to the challenges occupational therapy practitioner's face in advocating their professional role and values in a predominant biomedical setting. These findings are important not only to increase awareness among practitioners, leaders, and educators but to further examine how occupational therapy's unique role in healthcare can be fully recognized.

Is there a relationship between moral competencies and the formation of professional identity among nursing students?

Background

Moral competencies are essential for nursing work. Professional identity is a set of values and beliefs that a person has about her/his job, which includes moral values as well. The development of moral competencies and formation of professional identity in nursing students occurs mainly during their college years. The aim of this study was to investigate the relationship between moral competencies and the formation of professional identity among nursing students.

Methods

This study was designed as a descriptive-correlational study. The study population was consisted of nursing students who were enrolled in nursing schools at the time of the study. Two hundred and twenty-one nursing students completed the study tools. The research tools were a demographic questionnaire, Moral Development Scale for Professionals (MDSP), and Professional Identity Scale for Nursing Students (PISNS).

Results

The mean (SD) of MDSP and PISNS scores was 45.69 ± 5.90 and 55.61 ± 12.75, respectively. There was a significant statistical relationship between MSDP and PISNS scores (p < 0.05). A significant equation was found (f (2, 218) = 16.68, p < 0.001) with an R2 of 0.113. The MSDP scores increased 0.136 for each score of PISNS, and married students had 2.452 scores higher than single students.

Conclusions

The positive correlation between the formation of professional identity and development of morality in nursing students indicates that by strengthening students’ professional values, their moral competencies may develop positively.