The impact of safety and quality of health care on Chinese nursing career decision-making

Knowledge and practices of neonatal intensive care unit nurses concerning hypothermia in preterm infants: A descriptive cross-sectional study

AIM

To investigate the knowledge level and clinical practice of neonatal intensive care unit nurses on the whole process of hypothermia prevention in preterm infants.

DESIGN

A polycentric descriptive cross-sectional study was conducted in 23 hospitals in Shandong province involving 254 neonatal intensive care unit nurses.

METHODS

An evidence-based knowledge and clinical practice questionnaire on hypothermia prevention in preterm infants and a general information questionnaire were used to collect data. SPSS and EXCEL 24.0 database were used for data statistics and analysis.

RESULTS

Nearly one-third of nurses were unclear about the definition of mild hypothermia and heat preservation measures during labour management and resuscitation. Knowledge about the correct rate of amniotic fluid evaporation was low. The higher the hospital level and nurses' education level, professional title, work experience, and position, the higher the knowledge level. The clinical practice of nurses differed in terms of body temperature assessment tools, measurement sites, and measurement frequency for premature infants.

CONCLUSIONS

Nurses in neonatal intensive care units need to apply evidence-based knowledge and carry out practice interventions to ensure preterm infants' safe transition from the delivery room to the neonatal intensive care unit.

IMPACT

There have been few studies evaluating neonatal nurses' knowledge and practices with regards to the preventing hypothermia of premature infants from delivery room to neonatal intensive care unit. The study identifies the deficiencies and problems in temperature management that can be attributed to the knowledge level of nurses. The findings will help improve the current curriculum, teaching strategies, and the nurses' knowledge levels, preventing premature hypothermia in infants.

REPORTING METHOD

This study adhered to the STROBE statement for observational studies and obtained approval (KYLL-2023LW045) from the ethics committee of The Second Hospital of Shandong University. The other 22 third- and second-level hospitals, as our alliance members, recognized our chairperson status within the alliance and were willing to join our academic activities. Mutual responsibility for ethical filing between alliance units.

PUBLIC CONTRIBUTION

254 nurses were recruited from 23 tertiary and secondary public hospitals in Shandong province. No public or patient involvement. Members of the research group used the Questionnaire Star platform to prepare the electronic questionnaire, including obtaining informed consent, taking precautions for questionnaire completion, and using the aforementioned measurement tools. The project research team contacted the head nurses of 23 neonatal intensive care units in Shandong Province. After obtaining consent from the head nurses, they were asked to send the requirements and link of the electronic questionnaire to their WeChat management group. The nurses go through each question and make a choice which has two options of 'agree' or 'disagree.' Based on their answers, nurses were evaluated as having 'mastered' or 'not mastered' each item. Each 'mastered' item (correct answer) was given a score of 4; an item 'not mastered' (incorrect answer) was given a score of 0. The total score ranged from 0 to 100.

"Just pee in the diaper" - a constructivist grounded theory study of moral distress enabling neglect in nursing homes

BACKGROUND

A growing body of evidence shows that many nursing home residents' basic care needs are neglected, and residents do not receive qualitatively good care. This neglect challenges nursing staff´s professional and personal ideals and standards for care and may contribute to moral distress. The aim of this study was to investigate how nursing staff manage being a part of a neglectful work culture, based on the research question: "How do nursing home staff manage their moral distress related to neglectful care practices?"

METHODS

A qualitative design was chosen, guided by Charmaz´s constructivist grounded theory. The study was based on 10 individual interviews and five focus group discussions (30 participants in total) with nursing home staff working in 17 different nursing homes in Norway.

RESULTS

Nursing staff strive to manage their moral distress related to neglectful care practices in different ways: by favouring efficiency and tolerating neglect they adapt to and accept these care practices. By disengaging emotionally and retreating physically from care they avoid confronting morally distressing situations. These approaches may temporarily mitigate the moral distress of nursing staff, whilst also creating a staff-centred and self-protecting work culture enabling neglect in nursing homes.

CONCLUSIONS

Our findings represent a shift from a resident-centred to a staff-centred work culture, whereby the nursing staff use self-protecting strategies to make their workday manageable and liveable. This strongly indicates a compromise in the quality of care that enables the continuation of neglectful care practices in Norwegian nursing homes. Finding ways of breaking a downward spiralling quality of care are thus a major concern following our findings.

Patient Safety Culture and Spiritual Health in the Operating Room: An Iranian Exploratory Qualitative Study

The concept of patient safety and spiritual health are considered essential components of health care systems and form the main pillars of quality care in many health care organizations. This study aims to explain the culture of patient safety and spiritual health in the operating room from the perspectives of operating room physicians and nurses. This qualitative study was of qualitative conventional content analysis type using purposive sampling. Data were collected using semi-structured interviews. Graneheim and Landman (2004) methods were used to analyze the data. To analyze the data of this research, 5 main themes including continuous and dynamic training and upgrading of safety skills, attention to spirituality, conscientiousness and work commitment, effective communication and teamwork, equipping human and logistical resources based on the principle of care, accurate recognition of instructions and error control were obtained. According to the findings, a proper understanding of patient safety culture can improve patient safety culture and increase the quality of services provided to patients.

The organisational context of nursing practice in hospitals in China and its relationship with quality of care, and patient and nurse outcomes: A mixed-methods review

BACKGROUND

Achieving high-quality care and retention of nurses are major concerns for nurse leaders in hospitals. The organisational context is theorised to influence the quality of care and patient and nurse outcomes. This review focuses on China where the healthcare system is different from most Western countries in terms of government healthcare expenditure, public health insurance and healthcare delivery system.

OBJECTIVES

To explore the organisational context of nursing practice in hospitals in China and its relationship with quality of care, patient outcomes (patient adverse events, safety and satisfaction) and nurse outcomes (burnout, job satisfaction and intention to leave).

DESIGN

A mixed-methods review.

DATA SOURCES

The electronic databases PubMed, EMBASE, CINAHL, PsycINFO and China Academic Journals Database were used.

METHODS

This review was conducted using the SALSA (Search, Appraisal, Synthesis and Analysis) framework. Quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal checklists for cross-sectional studies and qualitative research. A narrative synthesis was conducted and was supported by tabulation of study data. The PRISMA guidelines were used for this review.

RESULTS

Twenty-three articles met the inclusion criteria and were retrieved, analysed and synthesised. This review supports the link between organisational context, quality of care, and patient and nurse outcomes in the Chinese healthcare system. Aspects of organisational context warrant attention including nurse staffing levels, the shortage of nurses, a lack of nurse participation in hospital affairs and support for the professional development of nurses.

CONCLUSIONS

The findings suggest that tailored interventions are needed to improve the organisational context of nursing practice in Chinese hospitals and, in particular, to address the nurse workforce issues and organisational leadership and support. The unique policy context of the Chinese healthcare system should be considered when developing these interventions.

RELEVANCE TO CLINICAL PRACTICE

Recognising the importance of the organisational context, it is imperative that nurse leaders make every effort to legislate for safe nurse staffing and to establish a caring culture to improve quality of care and nurse and patient outcomes.

Effects of organisational justice, work engagement and nurses' perception of care quality on turnover intention among newly licensed registered nurses: A structural equation modelling approach

AIMS AND OBJECTIVES

To investigate turnover intention among newly licensed registered nurses and to clarify the impact pathways of organisational justice, work engagement and nurses' perception of care quality on turnover intention.

BACKGROUND

Nurse shortage is an ongoing and urgent issue worldwide, in which nurse turnover could exacerbate the situation. Newly licensed registered nurses will become the main nursing workforce in the future; however, previous studies have not revealed the specific reasons underlying their turnover intentions.

DESIGN

A descriptive cross-sectional design.

METHODS

A total of 569 newly licensed registered nurses undertaking direct care were recruited from thirteen hospitals from October to November 2018 across Beijing, China. Based on the job demands-resources model, we advanced a hypothetical model, linking the paths between organisational justice, work engagement, nurses' perception of care quality and turnover intention. Structural equation modelling was used to examine the hypothetical model. The study adhered to the STROBE statement for observational studies.

RESULTS

In total, 22.3% of newly licensed registered nurses had a high turnover intention. The final model had an acceptable fit and could explain 58% of the variance in turnover intention. The organisational justice was directly related to high work engagement, great nurses' perception of care quality and low turnover intention. Additionally, organisational justice also had indirect effects on great nurses' perception of care quality and low turnover intention, which were partially mediated by work engagement. However, the effect of nurses' perception of care quality on turnover intention was not significant.

CONCLUSION

The improvement of organisational justice could enhance work engagement, and nurses' perception of care quality, and reduce turnover intention, which is crucial to improving care quality and addressing the shortage of nurses.

RELEVANCE TO CLINICAL PRACTICE

This study provides evidence for policymakers and hospital administrators to take targeted measures to enhance work engagement, foster high-quality care and create better defences against losing nurses.

Sources and Impact of Work-Related Stress Among HIV/AIDS Health Care Providers in Guangxi, China: A Qualitative Research

Work-related stress can negatively impact health care providers' (HCPs) ability to provide care. We examined the sources of work-related stress experienced by HCPs who provided medical care for people living with HIV/AIDS and the impact of the stress on HCPs' well-being and work performance. We conducted in-depth interviews with 46 HIV/AIDS HCPs in Guangxi, China. The interviews were audio-recorded, transcribed, and imported into NVivo V.11 for data management and data analysis using a thematic approach. We found that the key sources of stress at work included general work-related sources and HIV/AIDS-related sources. All stress was seen to have a substantial impact on the HCPs' individual well-being, family and social life, and quality of care they provided. We recommended that government and health care facilities should take measures to improve institutional culture and professional development for HIV/AIDS HCPs. More professional training schemes should be provided to strengthen HCPs' competence, improve universal protection from occupational exposure, and reduce the stigma toward HIV/AIDS patients and their care providers.

Linking Transformational Leadership with Nurse-Assessed Adverse Patient Outcomes and the Quality of Care: Assessing the Role of Job Satisfaction and Structural Empowerment

The purpose of this study was to examine the relationships between transformational leadership (TL), structural empowerment (SE), job satisfaction (JS), nurse-assessed adverse patient outcomes (APO), and the quality of care (QOC). The study further investigates the mediating effects of SE and JS on TL-APO and TL-QOC relationships. A total of 600 nurses working at 17 government hospitals in Pakistan completed the survey. The hypothesized model was tested using a confirmatory factor analysis and structural equation modeling. We found a positive relationship between TL, SE, JS, and QOC but negative relationships between TL and APO, SE and APO, and JS and APO. Our study further suggests that SE and JS strongly mediate both TL-APO and TL-QOC relationships.

O ensino de enfermagem gerontológica nas instituições públicas brasileiras de ensino superior

Resumo Objetivo Descrever o estado da arte da formação do enfermeiro em instituições públicas brasileiras de ensino superior no que se refere ao cuidado ao idoso Métodos Pesquisa documental, descritiva e de abordagem qualitativa, com dados da plataforma do Ministério da Educação de julho de 2017. Foram levantadas informações dos cursos presenciais de graduação em enfermagem das universidades públicas, seguindo três fases de acesso e coleta dos dados: identificação, seleção e elegibilidade. Houve análise descritiva de caracterização e Análise Temática Indutiva qualitativa, utilizando o Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ). O projeto seguiu as normativas éticas vigentes da Resolução 510/2016 do Conselho Nacional de Saúde. Resultados As 87 universidades selecionadas ofertavam 154 cursos de graduação em enfermagem, a maioria na Região Nordeste. Do total de cursos, 69 (44,8%) apresentavam disciplinas mistas (que abordavam o cuidado ao idoso) e 53 (34,4%) específicas de saúde do idoso. Nos conteúdos das ementas, os termos mais utilizados na construção da nuvem de palavras foram: saúde (162), idoso (154), enfermagem (113), adulto (81), assistência (72), processo (69) e atenção (52). Na análise de similitude, verificaram-se três principais eixos organizadores das disciplinas voltadas a essa temática: saúde, enfermagem e idoso. Conclusão O ensino da enfermagem precisa estar alinhado às políticas públicas vigentes e ser coerente com o modelo de atenção à saúde proposto. Portanto, é fundamental que a formação ofertada seja condizente com as atuais demandas do mercado de trabalho.

New nurses' perceptions of professional practice behaviours, quality of care, job satisfaction and career retention

AIM

To test a model examining the effects of structural empowerment and support for professional practice on new graduate nurses' perceived professional practice behaviours, perceptions of care quality and subsequent job satisfaction and career turnover intentions.

BACKGROUND

The nursing worklife model describes relationships between supportive nursing work environments and nurse and patient outcomes. The influence of support for professional practice on new nurses' perceptions of professional nursing behaviours within this model has not been tested.

METHODS

Structural equation modelling in Mplus was used to analyse data from a national survey of new nurses across Canada (n = 393).

FINDINGS

The hypothesised model was supported: χ²(122) = 346.726, P = 0.000; CFI = 0.917; TLI = 0.896; RMSEA = 0.069. Professional practice behaviour was an important mechanism through which empowerment and supportive professional practice environments influenced nurse-assessed quality of care, which was related to job satisfaction and lower intentions to leave nursing.

CONCLUSION

Job satisfaction and career retention of new nurses are related to perceptions of work environment factors that support their professional practice behaviours and high-quality patient care.

IMPLICATIONS

Nurse managers can support new graduate nurses' professional practice behaviour by providing empowering supportive professional practice environments.

A qualitative exploration of nurses leaving nursing practice in China

Aim

This paper reports a theoretical understanding of nurses leaving nursing practice by exploring the processes of decision‐making by registered nurses in China on exiting clinical care.

Background

The loss of nurses through their voluntarily leaving nursing practice has not attracted much attention in China. There is a lack of an effective way to understand and communicate nursing workforce mobility in China and worldwide.

Design

This qualitative study draws on the constant comparative method following a grounded theory approach.

Method

In‐depth interviews with 19 nurses who had left nursing practice were theoretically sampled from one provincial capital city in China during August 2009–March 2010.

Results

The core category ‘Mismatching Expectations: Individual vs. Organizational’ emerged from leavers’ accounts of their leaving. By illuminating the interrelationship between the core category and the main category ‘Individual Perception of Power,’ four nursing behaviour patterns were identified: (1) Voluntary leaving; (2) Passive staying; (3) Adaptive staying and (4) Active staying.

Measuring the nursing work environment: translation and psychometric evaluation of the Essentials of Magnetism

AIM

Translate the Essentials of Magnetism II© (EOMII; Dutch Nurses' Association, Utrecht, The Netherlands) and assess its psychometric properties in a culture different from its origin.

BACKGROUND

The EOMII, developed in the USA, measures the extent to which organizations/units provide healthy, productive and satisfying work environments. As many healthcare organizations are facing difficulties in attracting and retaining staff nurses, the EOMII provides the opportunity to assess the health and effectiveness of work environments.

METHODS

A three-phased (respectively N = 13, N = 74 and N = 2542) combined descriptive and correlational design was undertaken for translation and evaluation validity and psychometric qualities of the EOMII for Dutch hospitals (December 2009-January 2010). We performed forward-backward translation, face and content validation via cross-sectional survey research, and semi-structured interviews on relevance, clarity, and recognizability of instruments' items. Psychometric testing included principal component analysis using varimax rotation, item-total statistics, and reliability in terms of internal consistency (Cronbach's α) for the total scale and its subscales.

RESULTS

Face validity was confirmed. Items were recognizable, relevant and clear. Confirmatory factor analysis indicated that five of eight subscales formed clear factors. Three original subscales contained two factors. Item-total correlations ranged from 0.43 to 0.83. One item correlated weakly (0.24) with its subscale. Cronbach's α for the entire scale was 0.92 and ranged from 0.58 to 0.92 for eight subscales.

CONCLUSIONS

Dutch-translated EOMII (D-EOMII) demonstrated acceptable reliability and validity for assessing hospital staff nurses' work environment.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The D-EOMII can be useful and effective in identifying areas in which change is needed for a hospital to pursue an excellent work environment that attracts and retains well-qualified nurses.