Updating Factors Influencing Nurse Work Engagement in the Hospital Settings: A Systematic Review

Background

Understanding the factors influencing work engagement among nurses is crucial for ensuring high-quality care and positive patient outcomes. Despite numerous factors associated with nurse work engagement, many were explored before the pandemic, potentially overlooking aspects relevant to the current context.

Aim

To explore and update factors related to nurse work engagement in the new normal era.

Design

Systematic review.

Data Sources

The search was restricted to articles published from 2019 to 2024 in CINAHL, PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest, with full English text. The search was conducted from September 13th to 15th, 2023. Quantitative research articles that examined factors related to work engagement were included.

Review Methods

Data extraction, quality appraisal, and data analysis were performed in all included studies. Manual content analysis method was used to classify and group the factors.

Results

Sixty-one research articles were included in the final review. Five key groups of factors were generated from content analysis, including 1) individual-related factors, 2) organizational-related factors, 3) job and role-related factors, 4) work-life balance, and 5) work environment.

Conclusion

Understanding and addressing these multifaceted factors holistically is essential to develop strategies to sustain optimal engagement levels among nursing staff and improve overall patient care outcomes. Further studies are needed to confirm the findings.

The effect of self-management intervention among type 2 diabetes: A systematic review and meta-analysis

BACKGROUND

Using self-management interventions in type 2 diabetes care helps to regulate blood sugar levels, reduce caregiver burden, improve health outcomes, and improve expense management. Despite these benefits, the efficacy of self-management interventions for type 2 diabetes care remains uncertain, with studies showing inconclusive results that are open to interpretation.

AIMS

The aim of this systematic review and meta-analysis was to examine the available data to determine the effectiveness of self-management strategies for individuals with type 2 diabetes.

METHODS

The search method was restricted to the Cumulative Index to Nursing and Allied Health Literature, PubMed, ProQuest, Science Direct, and Scopus from January 2012 to December 2022. SPSS version 28 was used for the meta-analysis.

RESULTS

Seven studies fulfilled the eligibility criteria, with 697 individuals with type 2 diabetes included. Six papers were designed as randomized control trials and one as a quasi-experimental study. Meta-analysis showed a significant difference between the self-management and control groups, with a standardized mean difference (Cohen's d) of -0.40, (95% confidence interval [-0.60 to -0.20]), p = .00.

LINKING EVIDENCE TO ACTION

This meta-analysis showed that self-management interventions in type 2 diabetes patients successfully reduced HbA1c. Self-management improves type 2 diabetes treatment by helping people stay healthy and adapt to their illnesses.

Factors Related to Professional Self-Concept of Nursing Students and Nurses: A Systematic Review

Background

Some nurses leave their job because of working conditions, which will affect nurse turnover. Patients perceive that those nurses are distrustful, and feel unsatisfied, with patients' complaints about nursing service. This study explored factors about the professional self-concept of nursing students and nurses.

Materials and Methods

A systematic review of cross-sectional studies followed PRISMA guidelines. PubMed, Ovid, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were used from 1982 to August 2020 with the terms "factors" AND "nurse" AND "professional" AND "self-concept." A total of 19 out of 4,349 articles were used for analysis. Joanna Brings Institute critical appraisal tools for the analytical cross-sectional studies were used in this study, and narrative synthesis was used to analyze data.

Results

Professional self-concept of clinical nurses is influenced by including organizational or job factors, and individual and emotional factors. Job factors consist of organizational support, professional ethic, clinical ladder system, nursing experience, position, and time. Besides, sex, age, marital status, education, health status, healthy lifestyle, and experience were categorized as individual factors. Emotional factors were as follows: interpersonal relationships, spiritual growth, management stress, and self-description. Meanwhile, student nurses are influenced by including personal (degree of study and sex), emotions (emotional intelligence, and interest in the nursing profession), and external factors (nursing courses, peer-mentoring experience, and academic burnout).

Conclusions

Thus, individual factors and emotions have a vital role in constructing clinical nurses' professional self-concept as student nurses. Improving individual and emotional/personal aspects will positively increase professional self-concept.

Beyond the classics: A comprehensive look at concept analysis methods in nursing education and research

This editorial presents eight concept analysis methods for use in nursing research and education. In addition to the two classical methods of Walker and Avant's and Rodgers' concept analysis approaches that are typically utilized in nursing education and briefly discussed within this editorial, six additional methods are also presented including Schwartz-Barcott and Kim's Hybrid model, Chinn and Kramer's approach, Simultaneous Concept Analysis, Pragmatic Utility, Principle-Based Concept Analysis, and Semantic Concept Analysis. By familiarizing nursing educators, researchers, and students with these methods, educators can enhance their critical thinking and understanding of complex nursing concepts, preparing them for enhanced, multi-faceted contributions to nursing science.

Translation and validation study of the Indonesian version of the practice environment scale of the nursing work index

Objectives

This study aimed to translate and validate the Practice Environment Scale - Nursing Work Index (PES-NWI) among nurses in Indonesia.

Methods

A scale translation and cross-sectional validation study was conducted. The English version was translated into Indonesian, which involved five steps: forward translation, compare the translation, backward translation, compare the translation, and pilot testing with a dichotomous scale (clear or unclear). Thirty inpatient department nurses were involved in checking readability and understandability. A cross-sectional study was conducted from August to October 2022 at 17 hospitals across Indonesia, involving 350 nursing professionals. The validity test included structural validity and convergent validity. The internal consistency reliability was tested by Cronbach's α coefficient, item-total correlation, and composite reliability.

Results

Confirmatory factor analysis (CFA) showed an acceptable fit. The correlation of all dimensions was between 0.70 and 0.88, and all items had item loading higher than 0.6. Convergent validity of each dimension ranged from 0.61 to 0.74, internal consistencies with Cronbach's α coefficient was 0.97, corrected item-to-total correlation ranged from 0.62 to 0.85, and composite reliability of each dimension was higher than 0.89.

Conclusions

Good homogeneity and construct validity have been demonstrated for the Indonesian version of the PES-NWI, nursing management can use it to measure the work environment.

Refining core competencies of first-line nurse managers in the hospital context: A qualitative study

Objectives

As the world moves towards a new normal, challenges continue to emerge while simultaneously inspiring us with new solutions. Strengthening the skills of first-line nurse managers (FLNMs) to fulfill a wide range of complex roles and responsibilities effectively necessitates refining core competency guidelines or standards. This study aimed to explore the perceived core competencies of Indonesian FLNMs within the context of the post-pandemic era.

Methods

The study employed a qualitative descriptive design. Face-to-face interviews were conducted in a public hospital in Indonesia from January 2022 through August 2022. Seven head nurses with direct experience managing a unit during the COVID-19 pandemic were selected. The interviews were audio-recorded, transcribed verbatim, and validated by re-listening. Data were analyzed using thematic analysis.

Results

Four main themes of the core competencies developed, including 1) managerial core competencies, 2) clinical core competencies, 3) technological core competencies, and 4) socio-emotional skills/personal traits consisting of the following: be brave, fast, patient, optimistic, consistent, and responsible.

Conclusions

The findings demonstrate that the managerial and clinical core competencies of the FLNMs must be aligned, while technological core competencies are the mediating component of both. Personal traits are essential for FLNMs as they undergird the other three core competencies and the success of the FLNMs.

Novelty: Nursing scholars' guide for successful publication

The "pressure" or "passion" to publish is a common reality in academia. All faculty are required to demonstrate that they are engaged in research and that their work is disseminated in reputable journals. However, writing manuscripts is quite challenging; some papers for publication may take days, weeks, months, and even years. This editorial aims to provide the editors' points of view to assist authors in successful acceptance and publication in an international nursing journal.

Online 'chatting' interviews: An acceptable method for qualitative data collection

Qualitative research methods allow researchers to understand the experiences of patients, nurses, and other healthcare professionals. Qualitative research also provides scientists with information about how decisions are made and the aspects of existing interventions. However, to get to obtain this important information, qualitative research requires holistic, rich, and nuanced data that can be analyzed to determine themes, categories, or emerging patterns. Generally, offline or in-person interviews, focus group discussions, and observations are three core approaches to data collection. However, geographical barriers, logistic challenges, and emergency conditions, such as the COVID-19 pandemic have necessitated the utilization of online interviews, including chatting as an alternative way of collecting data. This editorial aims to discuss the possibility of online chat interviews as an acceptable design in qualitative data collection.

Identifying and understanding challenges to inform new approaches to improve vaccination rates: A qualitative study in Indonesia

Purpose

This study aimed to identify and understand challenges to inform new strategies to increase the COVID‐19 vaccination rate according to involved vaccinators' perspectives in Belitung, Indonesia.

Design

A qualitative descriptive study design was used.

Methods

Online interviews and chatting were done among 11 vaccinators for data collection between August 2021 and January 2022. Data were analyzed using a content analysis model.

Findings

Four main themes emerged, including (1) communication strategies (evidence‐based, electronic‐based, and culturally based communication), (2) cross‐sectoral strategies (collaboration with police, religious leaders, customary leaders, heads of village divisions, and non‐governmental organizations), (3) “picking‐up the ball” system (home visits for elderly and people with disability and school visits for children), and (4) setting‐up priorities (between mandatory vaccines and boosters).

Conclusion

Despite making vaccination mandatory, the roles of communication, cross‐sectoral innovations, “picking‐up the ball” system, and priority setting may have useful potential to improve vaccination rates.

Clinical Relevance

The findings may serve as an input to overcome challenges and accelerate the vaccination coverage in Indonesia and beyond. However, further research is needed.

Nursing Administration: Watson's Theory of Human Caring

Watson's human caring theory is widely used in nursing clinical practice, education, and research; however, further discussion on the application of this theory in administration is needed. The authors in this article aim to substruct Watson's theory of human caring for nursing administration. Major elements of the theory-transpersonal caring dimensions, caring competencies, and caring moments-are presented in a model of substruction that links the theoretical basis to methodology. In conclusion, this theory can be used as a framework or a conceptual model in nursing administration within an organization.

Sustaining e-caring leadership in a post-pandemic world

At the convergence of the "new normal" from the COVID-19 pandemic and the combination of caring, leadership, and technology, a new environment for organizational culture was formed. The injection of technology into how leaders provided care to their organization launched e-caring, and this is now considered a key in employee engagement and retention post COVID-19 pandemic. The purpose of this editorial is to briefly reflect on the importance of e-caring for leadership during the crisis and increase the commitment of nursing leaders to continue their great works even after the pandemic with an organizational culture infused with e-caring.

Repositioning Practice of Bedridden Patients: An Evolutionary Concept Analysis

Introduction

Repositioning practice is an essential pressure ulcer prevention intervention that has emerged in the history of nursing. Numerous terms are employed to indicate its meaning, such as turning, positioning, or posturing. However, there is no available analysis that distinguishes these terms or analyzes repositioning practice attributes.

Objective

To analyze repositioning practice as a concept of bedridden patients in hospitals by combining methods from Foucault's archeology of knowledge and Rodger's concept analysis.

Concept Description

Repositioning practice passes through three eras: classical, modern, and research. The repositioning practice is “turn a bedridden patient in a harmonized way and ends with anchor and documentation.” The analysis concludes seven attributes for the repositioning practice: pre-turn, assessment, turn, harmonization, anchor, documentation, and time. The analysis assumes bedridden patients, and assigned nurses on duty are the antecedents. Moreover, the main consequence is pressure ulcer prevention, while patient safety and quality of care are the secondary consequences.

Discussion

Repositioning practice understanding has grown with time. Each era has added to or removed from nursing's understanding for repositioning practice until it appears as it now. The current analysis expects further development in repositioning practice understanding and applications.

Conclusion

Repositioning practice is an important nursing intervention and has shown a dynamic movement over history. It is expected that this dynamic will continue in the future.

Nursing Development in Indonesia: Colonialism, After Independence and Nursing act

Introduction

Stereotyping of nurses still occurs nowadays in Indonesia. Society and healthcare think nursing is a doctor helper service. The public image of a nurse as a doctor's helper is hard to erase. Thus, the nursing development in Indonesia needs to be explored in describing the stereotyping and the nursing conditions in the current situation.

Methods

The study used a narrative review with 45 sources analyzed and extracted.

Results

Nursing education has been developed since colonialism. The first time the Netherland Indies built the hospital and they used Babu or a helper as a nurse. The result showed it had a negative impact, which showed as they started to train nurses. They trained male nurses to be Mantri nurses as hulpgeneesheeren (ancillary doctors). After independence, the project HOPE influenced the development of nursing in Indonesia. Indonesian nurses focused on technical aspects and added the nursing process to the education curricula in 1986. However, nurses’ practice culture did not change for a long time because of a lack of research and literature being evaluated during 1990–2010. Indonesia nursing started to increase the education, practice, and research afterward, with specifically the declaration of the Indonesian Nursing Act. It brought nurses into the professionalism of healthcare which the Indonesian government recognized. Then, nurses have faced new problems, including practice and education gaps.

Conclusion

The development of nurses will increase autonomy and dignity. Increasing education curricula, practice competency, and research impact will change the perspective of society with the support of recognition and education from the nursing organization. In addition, the nursing organization has an essential role in nursing development in each country.

Establishing appropriate sample size for developing and validating a questionnaire in nursing research

The number thirty is often used as the sample size in multiple questionnaires and identified as appropriate for validation of nursing research. However, this is not the best tool or strategy for sample size selection for development and validation, and this often causes immediate rejections of manuscripts. This editorial aims to provide an overview of the appropriate sample size for questionnaire development and validation. The article is the amalgamation of technical literature and lessons learned from our experiences in developing, validating, or adapting a number of questionnaires.

A Concept Analysis of Quality Nursing Care

PURPOSE

This study aimed to perform a concept analysis of quality nursing care.

METHODS

Walker and Avant's concept analysis method was used to carry out this study.

RESULTS

The defining attributes identified were as follows: caring, the nurse-patient relationship, and patient needs. Antecedents included patient characteristics, individual factors (age, education, knowledge, competence, and experience), job position, and environmental factors. The consequences of quality nursing care have significant influence on both patients and nurses.

CONCLUSION

The findings can aid researchers in obtaining a better understanding of quality nursing care, and stakeholders can consider the factors related to quality nursing care and its consequences to improve the nursing process.

Holistic Care Management of Diabetes Mellitus: An Integrative Review

Comprehensive care includes the spiritual and the bio-psycho-social person. The aim of this study is to explain how people with diabetes mellitus manage holistic treatment. Search for multi-database papers: Ovid, CINAHL, and PubMed. PICOT-based keyword description is P: any diabetes population, I: holistic care, C: any comparison, O: blood sugar, T: whenever. The English article, journal quest, full-text article available, and published article were criteria for inclusion in this study. In the quest journal, a strategic manner is performed using three keywords: holistic, diabetes mellitus, and blood sugar. We reviewed ten papers. The result showed that comprehensive care was explained in terms of technology, holistic care program, and holistic care relating to complementary alternative medicine. Discussion in this study is that holistic care services give significant results in the treatment of people with diabetes mellitus.

Nurse education today: Between teaching and publication focus

"Publish or Perish" is no longer an imagination. On the contrary, it is considered a new reality in nursing education today. All nurse scholars, researchers, faculty members, and students are eager and compete with each other to publish their research works in academic journals. Success in this challenge brings personal benefits, especially for academic reputation and promotion, as well as organizational benefits, such as university ranking and sponsorship. However, despite the advantages of faculty publication, the pros and cons of this topic are on the rise. Therefore, this article aims to discuss the publication-related phenomenon in nursing education, followed by concerns and recommendations for consideration.

A causal model of functional status among persons with liver cirrhosis from four public hospitals in Thailand

Purpose

The purpose of this study is to develop and test the causal relationships between alcohol consumption, social support, illness perception, fatigue and functional status among persons with liver cirrhosis. The hypothesized model was developed based on the theory of unpleasant symptoms.

Design/methodology/approach

A cross-sectional study was conducted among 400 persons with liver cirrhosis by stratified random sampling. Data were collected at outpatient departments from four public hospitals across three regions in Thailand. Six self-report questionnaires were utilized to collect data from March to August 2020. The developed model was verified via a structural equation modeling analysis.

Findings

The proposed model fit with the empirical data considering from χ2/df = 2.397 (p = 0.061), root mean square error of approximation (RMSEA) = 0.056, comparative fit index (CFI) = 0.985, Tucker–Lewis index (TLI) = 0.981, and standardized root mean square residual (SRMR) = 0.048. The model explained 71.30% of the total variance in functional status. Social support was the most influential factor affecting functional status both directly and indirectly through illness perception. Illness perception had a negative direct effect on functional status and a positive indirect effect on functional status through fatigue. Fatigue had a negative direct effect on functional status. Alcohol consumption was found as the lowest influential factor affecting functional status.

Originality/value

This is the first study that explores the characteristics of functional status among persons with liver cirrhosis comprehensively. A causal relationship among various variables found in this study would shed light as important fundamental data for developing interventions to enhance functional status among this population.

A cross-sectional study of factors predicting readmission in Thais with coronary artery disease

BACKGROUND

Coronary artery disease is a major cause of morbidity and mortality with high readmission rates. Hospital readmissions for coronary artery disease contribute to rising healthcare costs and are a marker of quality of care. Despite this, prior studies have found that readmission rates vary widely.

AIMS

This study aims to determine the impact of social support, depression, comorbidities, symptom severity, quality of life and readmission among coronary artery disease patients in Thailand.

METHODS

A total of 321 coronary artery disease patients from tertiary care hospitals across all regions of Thailand were recruited for this study. Data were analysed using multiple regression analysis.

RESULTS

The coefficient for social support (beta = -0.22) was found to be significant (p < 0.05), whereas comorbidity, symptom severity, depression and quality of life were not significant. Thus, social support was found to be the most significant predictive factor for readmission.

CONCLUSIONS

Accordingly, when designing effective nursing interventions, nurses should promote social support interventions for coronary artery disease patients to improve the quality of care, decrease readmission rates and improve patients' quality of life.

Competence-based human resource management to improve managerial competence of first-line nurse managers: A scale development

AIM

This study aimed to develop and psychometrically test a competence-based human resource management scale to improve managerial competence of first-line nurse managers in public hospitals.

BACKGROUND

To ensure the high competence of the first-line nurse managers, the competence-based human resource management should be evaluated using the best-fit instrument. However, no instrument has been identified in the hospital setting.

METHODS

This methodological study consists of three main steps: (1) generating scale items based on literature review and expert interviews, (2) pilot testing of face and content validity and (3) evaluating psychometric properties with 300 first-line nurse managers from 16 public hospitals in Indonesia selected using a multistage sampling. Data were collected from May to December 2017. Principal component analysis and Cronbach's α were used for construct validity and internal consistency reliability.

RESULTS

The final scale consists of 30 items in five dimensions, which explained 65.48% of the total variance. The dimensions include 'training and evaluation, career planning and development, rewards scheme, recruitment and selection, and appraisal system'. Cronbach's α for the scale was .89, with a range of .85 to .88.

CONCLUSION

The competence-based human resource management scale is reliable and valid to use in public hospital settings.

SUMMARY STATEMENT

What is already known about this topic? The concept of competence-based human resource management has been applied worldwide in every organization, and it is applicable to use for developing managerial competence of first-line nurse managers. Therefore, the effectiveness of this management system should be assessed via a valid and reliable instrument. Several instruments to measure competence-based human resource management have been developed, but no instrument has been identified to measure competence-based human resource management specifically in hospital settings. What this paper adds? This study developed a scale designed to measure competence-based human resource management to support improvement of first-line nurse managers' managerial competence in public hospitals. The scale demonstrated sound psychometric properties with acceptable internal consistency reliability, content validity and construct validity. The scale consists of 30 items in five dimensions: training and evaluation, career planning and development, rewards scheme, recruitment and selection, and appraisal system. The implications of this paper: This study expands the basic knowledge of competence-based human resource management as a concept with five dimensions that can be used in nursing organizations, and it can be used in quality assurance systems in public hospitals settings in Indonesia. The scale can be used as a feedback for first-line nurse managers to see the impact of competence-based human resource management framework on their competence and helps to identify which dimension of human resource management needs further improvement. With further research, the scale may be of use in other countries and settings.

Job Stress, Psychological Capital, Perceived Social Support, and Occupational Burnout Among Hospital Nurses

PURPOSE

To determine the structural relationships among nurses' occupational burnout, job stress, psychological capital, and perceived support from society.

DESIGN

A cross-sectional design was performed to collect data from 766 registered nurses in three general tertiary Class A hospitals from March to August 2018.

METHODS

Structural equation modeling was performed to examine the proposed model.

FINDINGS

The research data supported the proposed model. Psychological capital, job stress, and perceived social support significantly influenced occupational burnout. Job stress indirectly influenced burnout through perceived social support and psychological capital. The influencing factors accounted for 49% of the variance in explaining burnout.

CONCLUSIONS

The findings identified structural relationships among the four studied variables. This study provides new information regarding the preventive role of perceived social support and psychological capital, which perform the mediating role between job stress and occupational burnout.

CLINICAL RELEVANCE

Nursing administrators should provide a healthy work environment, effective psychological capital training, and assistance to reduce nurses' occupational burnout.

Factors influencing readmission among Thais with myocardial infarction

Background

Readmission among patients with myocardial infarction is costly, and it has become a marker of quality of care. Therefore, factors related to readmission warrant examination.

Objective

This study aimed at examining factors influencing readmission in Thai with myocardial infarction.

Methods

This was a cross-sectional study with 200 participants randomly selected from five regional hospitals in Thailand. All research tools used indicated acceptable validity and reliability. Linear Structural Relationship version 8.72 was used for the data analysis.

Results

The findings showed that the hypothesized model with social support, depression, symptom severity, comorbidity, and quality of life could explain 4% (R² = 0.04) of the variance in readmission (χ² = 1.39, df = 2, p < 0.50, χ²/df = 0.69, GIF = 1.00, RMSEA = 0.00, SRMR = 0.01, and AGFI = 0.98). Symptom severity was the most influential factor that had a positive and direct effect on the readmission rate (0.06, p < 0.05).

Conclusion

These findings serve as an input to decrease readmission in patients with myocardial infarction by reducing the symptom severity and comorbidity and promoting a better quality of life.

Development and psychometric evaluation of a quality nursing care scale from nurses' perspective

Aim

To develop and evaluate psychometric property of quality nursing care scale (QNCS) from nurses’ perspective in the Chinese context.

Design

A cross‐sectional survey design.

Methods

This study was conducted in two phases. In Phase I, literature review and interviews were conducted to develop the items. In Phase II, content validity was evaluated by five experts. Construct validity was tested through exploratory factor analysis (EFA) among 302 nurses and confirmatory factor analysis (CFA) among 510 nurses from October 2014 to January 2015. Additionally, internal consistency reliability was tested.

Results

The EFA extracted six factors including staff characteristics, task‐oriented activities, human‐oriented activities, physical environment, patient outcomes and precondition. All six factors accounted for 74.78% of the total variance to explain quality nursing care. The modified measurement model of the final version of QNCS was supported by the CFA with 48 items in six dimensions. The internal consistency reliability of final QNCS was acceptable.

A phenomenological study of the lived experience of nurses in the battle of COVID-19

Background

Roles and responsibilities of nurses are crucial in the battle of Coronavirus disease 2019 (COVID-19), but nursing duties also put them at risk for infections.

Purpose

The purpose of this study was to explore the lived experience of nurses in combatting COVID-19 in Belitung, Indonesia.

Methods

This study employed a phenomenological study design. Online interviews and chatting were conducted among 17 clinical nurses who were purposively selected from March to June 2020. Data were audio-recorded, transcribed, and validated among researchers. The thematic approach was used for data analysis.

Findings

Seven themes emerged (1) feeling “nano-nano”, (2) lack of N95 masks, (3) we are just pawns, (4) being rejected, (5) please do not spread our identity, (6) we miss home, and (7) feeling betrayed by regulation.

Discussion

Findings of this study should be used by government agencies, nurses, and the general population in combatting COVID-19.

Construction of evaluation indexes of nursing students' quality and safety competencies: A Delphi study in China

BACKGROUND

Providing quality and safe nursing care is considered the cornerstone of the healthcare system globally. However, there are no comprehensive evaluation indicators of nursing students' quality and safety competencies in China.

AIM

To develop the evaluation indicators and achieve experts' consensus on bachelor nursing students' quality and safety competencies at their graduation.

METHODS

Based on the framework of the American Association of Colleges of Nursing's Quality and Safety Education for Nurses, literature review, semi-structured interview, and e-Delphi technique, the evaluation indicators were developed and obtained consensus through the participation of 22 nursing educational experts from August 2016 to May 2017.

RESULTS

The evaluation indicators consisted of six domains, including safety care, patient-center care, collaboration and teamwork, continuous quality improvement, informatics, and evidence-based practice competencies, and 88 indicators. These indicators obtained ≥76% consensus on the experts' judgments.

CONCLUSIONS

The evaluation indicators achieved the consensus on a panel of nursing experts, which were scientific and practicable. It could provide guidance for establishing a nursing curriculum to prepare bachelor nursing students' quality and safety competencies.

ONE YEAR OF THE COVID-19 PANDEMIC: NURSING RESEARCH PRIORITIES FOR THE NEW NORMAL ERA

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Managerial Competence of First-Line Nurse Managers in Public Hospitals in Indonesia

PURPOSE

Working as a first-line nurse manager requires high managerial competence as an essential component in the delivery of health care. Therefore, factors that influence managerial competence warrant examination. The aim of this study was to identify factors associated with managerial competence of the first-line nurse managers using the best-fit model of human resource management framework.

METHODS

A cross-sectional study was conducted. A total of 247 first-line nurse managers from 18 public hospitals in Indonesia participated. Data on managerial competence and its related factors were collected via validated questionnaires.

RESULTS

The five factors of managerial competence were identified - performance appraisal (β = 0.476, p < 0.001), career advancement (β = 0.425, p < 0.001), recruitment and selection (β = 0.354, p < 0.001), larger hospitals (β = 0.165, p = 0.001), and management training attendance (β = 0.109, p = 0.029), which collectively explained 44.9% of the variance in managerial competence.

CONCLUSION

Human resource management factors, hospital types, and training attendance have significant roles to improve managerial competence of the first-line nurse managers. Nurse managers should provide routine performance appraisal, career advancement, and transparent recruitment and selection as well as to improve the attendance of management training and learn from larger hospitals for leadership and development of the first-line nurse managers.

Factors Related to the Clinical Competence of Registered Nurses: Systematic Review and Meta-Analysis

PURPOSE

To determine the factors associated with the clinical competence of registered nurses.

METHODS

Systematic review and meta-analysis was used. The search strategy was limited to 10 years, ranging from January 2009 to December 2019, in Science Direct, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest, and Google Scholar. A meta-analysis was performed using R Studio with the metafor package (Boston, MA, USA; https://rstudio.com/products/rstudio/older-versions/).

RESULTS

A total of 22 studies were included, representing 33,961 nurses. There were 28 factors associated with clinical competence. Of those, 13 factors were significantly supported and included for meta-analysis, grouped into (a) individual-related factors, (b) job satisfaction, (c) bullying, (d) burnout, and (d) specific knowledge. The effect size of those factors ranged from -0.14 to 0.50.

CONCLUSIONS

Among individual-related factors, salary has the largest effect size on competence and is considered important. Clinical competence is positively affected by job satisfaction, but negatively influenced by bullying and burnout. Although specific knowledge has a large effect size, it does not significantly affect the clinical competence of registered nurses.

CLINICAL RELEVANCE

It is critical to understand factors related to the clinical competence of registered nurses to maintain quality care and patient outcomes in clinical settings. The findings serve as data to help nurse managers find effective ways to improve the knowledge, skill, attitudes, and performance of registered nurses.

Perceived Managerial Competence of First-Line Nurse Managers: A Comparative Analysis Among Public Hospitals

Knowing the perceptions of first-line nurse managers (FLNMs) regarding their managerial competence is an important step to resolve disparities between their perceived competence and the competencies required for them to effectively function in their roles. Yet, evidence examining managerial competence of FLNMs among public hospitals in Indonesia is sparse. To fill this gap, we conducted a cross-sectional study aimed to identify managerial competence of FLNMs according to hospital type and ownership. This study was conducted from January to May 2018 and included a convenience sample of 233 FLNMs selected from 13 public hospitals. We used the Indonesian-First-Line Nurse Managers Managerial Competence Scale (I-FLNMMCS) to measure managerial competence. Descriptive statistics, Kruskal-Wallis, and Dunn's Pairwise were used for data analysis. Findings showed a significant difference in managerial competence according to the hospital type (p < .05). The FLNMs with a Diploma III, those relatively older, in their position for 7 or more years, and with managerial training in Type A hospitals (larger hospitals) had the highest managerial competence. The FLNMs with a bachelor's degree, those relatively younger, with less training, and those in their position for 3 to 4 years in Type B and C hospitals (smaller hospitals) had less managerial competence. A significant difference was also found in managerial competence according to hospital ownership (p <.05). Public hospitals owned by the Ministry of Health of Indonesia had the highest competence among the others. This study is useful for guiding future policy work for human resource development in public hospitals.

NURSING RESEARCH PRIORITIES IN INDONESIA AS PERCEIVED BY NURSES

Background: To promote excellence in nursing research, setting research priorities is needed to meet the need of community aligned with the national context. Unfortunately, limited number of studies has examined nursing research priorities in Indonesia.Objective: To identify nursing research priorities in Indonesia from the perspectives of nursing experts.Methods: This was a descriptive qualitative study. Focus group discussion was conducted among participants who were purposively selected (n = 13). Data were analyzed using a consensus-based method.Results: The top ten research priority lists were identified. The priorities were nurse competence, quality of nursing care in nursing services, nursing policy, nurse work environment, nurse mobility, interprofessional education and collaboration, teaching learning evaluation, nursing career, complementary therapy in nursing, and technology and informatics in nursing.Conclusion: Findings of this study could be used as the basis of direction for development of future research in Indonesia.

Comparison of managerial competence of Indonesian first-line nurse managers: a two-generational analysis

Background

Much research provides evidence that four age groups or generations of nurse managers exist, and it is assumed that they work and act differently according to each generation's characteristics and attitudes, which may influence their managerial competence.

Aims

To compare first-line nurse managers' managerial competence according to generational analysis across public hospitals in Indonesia.

Methods

This study employed a cross-sectional survey in 18 public hospitals in Indonesia with 254 first-line nurse managers selected using simple random sampling. The Indonesian First-Line Nurse Managers Managerial Competence Scale (IFLNMMCS) was used to measure managerial competence. Data were analysed using descriptive analyses using means, standard deviations and independent t-test.

Results

There was no significant difference in the total score of managerial competence of Generation X and Millennial first-line nurse managers (p = 0.077). Of five dimensions of managerial competence, only applying quality care improvement (p = 0.028) and financial management (p = 0.013) were significantly different, while leadership (p = 0.142), facilitating spiritual nursing care (p = 0.353), self-management (p = 0.130), staffing and professional development (p = 0.068) and utilizing informatics (p = 0.304) were not significantly different.

Conclusion

This study serves as a foundation for better human resource management, education and professional development for first-line nurse managers among public hospitals in Indonesia.

Work stress, perceived social support, self-efficacy and burnout among Chinese registered nurses

AIMS

To establish a model and identify structural relationships between Chinese nurses' perceived social support, self-efficacy, work stress and burnout.

BACKGROUND

The prevalence of burnout among nurses tends to be high worldwide. A better understanding of relationships between the study variables can help hospital managers apply effective programmes to reduce burnout. However, no studies have identified the structural relationships between these variables in one model, simultaneously.

METHODS

We conducted a cross-sectional survey to complete questionnaires from 444 nurses working in three Chinese general tertiary hospitals. The proposed model was examined by structural equation modelling.

RESULTS

The proposed model was partially supported by empirical data. The total effect of work stress on burnout was large. Both work stress and the perceived social support moderately and directly affected burnout. Work stress also indirectly affected burnout through perceived social support. Work stress directly influenced perceived social support and self-efficacy. Perceived social support directly affected self-efficacy. However, self-efficacy did not directly influence burnout.

CONCLUSIONS

This study validated a model and identified a deep understanding of structural relationships between the selected variables among Chinese nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Apart from reducing work stressors, hospital managers should utilize more social support strategies when designing intervention programmes to reduce burnout.

Development and Psychometric Properties of Managerial Competence Scale for First-Line Nurse Managers in Indonesia

This study aimed to develop and psychometrically test the managerial competence scale for first-line nurse managers (FLNMs) in Indonesia. The scale was based on items derived from an integrative review and interviews with experts. A total of 300 FLNMs from 16 public hospitals were randomly selected for this test of psychometric properties. A principal component analysis generated seven dimensions with 43 items as a final scale, with overall Cronbach's α of .95 while the dimensions' Cronbach's α ranged from .71 to .90. The findings demonstrate that the scale is valid and reliable as a vehicle for assessment of managerial competence of FLNMs.

VIEWPOINT: NURSES PREPARATION IN THE ERA OF THE FOURTH INDUSTRIAL REVOLUTION

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Competence-based human resource management in nursing: A literature review

AIM

To clarify the defining attributes of competence-based human resource management (CBHRM) in nursing, its antecedents, and consequences.

BACKGROUND

A thorough literature review showed multidefinitions of CBHRM, which resulted in confusion in ways of describing CBHRM practice and its implementation in nursing.

METHODS

A literature review through systematic searches in CINAHL, ScienceDirect, Medline, ProQuest Dissertations and Theses, Embase, and Google Scholar between 2000 and February 2018 with full text in English.

RESULTS

The attributes of CBHRM in nursing include recruitment and selection, training and development, performance appraisal, reward system, and career planning. Antecedents to CBHRM in nursing include organizational factors (organizational size, culture, the nature of human resource (HR) department, type of organization, and the number of employee), individual factors (HR managers' competence, and top managers' role, intention, and characteristics), and HR policy. Consequences include employee outcomes (competence development, high motivation, job satisfaction, retention, and better performance), organizational outcomes (quality of care, patient safety, and patient satisfaction), and financial outcomes.

CONCLUSION

This study helps nursing managers and HR managers to understand the concept of CBHRM in nursing comprehensively.

Nursing students plan after graduation: A qualitative study

BACKGROUND

Identifying nursing students' plan after graduation is necessary to maintain the profession in line with their nursing education. This study was conducted to explore the career plans of diploma nursing students after graduation and factors influencing their plans.

MATERIALS AND METHODS

This was a qualitative descriptive study using focus group discussion, conducted in Academy of Nursing of Belitung, Indonesia. Twenty diploma nursing students at the beginning of their 1^st year of study were recruited. Data were analyzed using content analysis model.

RESULTS

The plan of diploma nursing students after graduation: becoming a civil servant and its influencing factors (fixed and higher salary, fair remuneration and incentives, and retirement fund); becoming a bedside nurse and its influencing factors (helping others and gaining experiences); and continuing higher education in nursing and its influencing factors (recognition as professional nurse, financial support, family responsibilities, and location of nursing schools).

CONCLUSION

It is suggested that nurse educators should change the mindset of the students not to focus only becoming a civil servant, and the government should open bachelor program in nursing in Belitung and provide educational support for those who would like to continue studying nursing.

The Lived Experiences of Becoming First-line Nurse Managers: A Phenomenological Study

Background:

Designated roles of first-line nurse managers (FLNMs) are very complex, this study aimed to develop a deeper understanding of their meaningful lived experiences.

Materials and Methods:

This study employed a phenomenological study using semi-structured interviews with FLNMs (n = 7) at the General Hospital of Belitung, Indonesia. The data analysis was thematic.

Results:

Four major themes were identified from the analysis of textual data: Feeling extraordinary, the inability to do, desire to leave the unit, and influenced by work motivation. The findings of this study revealed the positive and negative experiences of becoming FLNMs. The positive experiences were related to the feeling challenged and extraordinary to deal with many roles in management and leadership. The negative experiences included personal conflict related to the desire to leave the unit, and feeling unable to manage. However, the works of FLNMs were influenced by internal and external motivation.

Conclusions:

This study better informs nurse executives to develop competence and performance of FLNMs, and keep their motivation by revising performance appraisal system.

Descriptors of Insomnia among Patients with Heart Failure

OBJECTIVE

Explore the characteristics of insomnia in persons with heart failure and identify the predictive factors of insomnia in patients with heart failure.

MARITAL AND METHOD

A predictive correlational research design was used. Three hundred forty heart failure patients followed-up at heart clinics, outpatient departments of 10 tertiary hospitals from all regions in Thailand, were selected by multi-stage random sampling. Data were collected between July 2009 and January 2010. Research instrument included demographic questionnaire, state-trait anxiety inventory questionnaire, Center for Epidemiologic Studies Depression Scale, dyspnea questionnaire, Berlin Questionnaire, hygiene awareness and practice scale, and dysfunctional beliefs and attitudes about sleep and insomnia severity index. Data were analyzed by using descriptive statistic, Chi-square test, and logistic regression.

RESULTS

Thirty-two percent of heart failure patients had insomnia. Eighty-one patients had moderate insomnia (23.8%), and 28 patients had severe insomnia (8.2%). Most heart failure patients had insomnia of mixed types (73.40%), including difficulty falling asleep, difficulty staying asleep, and waking up too early. Correlated factors of insomnia included the predisposing factors, anxiety and depression, the precipitating factors, marital status, dyspnea, sleep disorder breathing, and the perpetuating factors, sleep hygiene and dysfunctional beliefs and attitudes about sleep. After using logistic regression analysis, the predictive factors of insomnia were anxiety, depression, marital status (separated, divorced, and widowed), dyspnea, and dysfunctional beliefs and attitudes about sleep with a 95% confidence level (α = 0.05). However, age, gender,sleep disorder breathing, and sleep hygiene were not significant predictors of insomnia.

CONCLUSION

Insomnia is a significant problem in heart failures patients. Therefore, healthcare providers need to pay attention to this sensitive outcome. Several factors should be considered for further management.

Post-surgical physical activity enhancing program for elderly patients after hip fracture: a randomized controlled trial

Background: Hip fracture seriously influences an elderly person’s life and mobility, independent living, and causes earlier mortality. Although surgery is generally successful, many of the elderly suffer from decreased physical ability after surgery for hip fracture.

Objectives: To determine the effects of a physical activity enhancing program (PEP) on the level of physical activity of elderly patients after surgical treatment of hip fracture.

Methods: A randomized controlled trial of 46 elderly patients was conducted at King Chulalongkorn Memorial Hospital from January 2012 to February 2013 to evaluate the effectiveness of the Resnick self-efficacy model (2009) compared with standard care in improving physical activity. The participants were enrolled on a criteria basis and were block randomized into two groups. The intervention group attended four phases of physical training and efficacy based intervention comprising assessment, preparation, practicing, and evaluation phases with face-to-face contact and five telephone calls during seven weeks post-surgery.

Results: Six weeks after discharge, the physical activity of the intervention group increased by significantly more than the control group (F1,43 = 9.63, P < 0.01), with an effect size of 0.18 after controlling for preoperative physical activity. The ratio of the effect on physical activity induced by the PEP was higher than that induced by usual care (65.2% vs. 47.8%).

Conclusion: PEP is effective at improving physical activity. Efforts to follow up for longer periods and with studies using larger populations are recommended.

The effect of self-efficacy enhancement program on medication adherence among post-acute myocardial infarction

AIM AND BACKGROUND

Studies have reported that adherence to medications after hospital discharge for myocardial infarction is poor with about 12% to 20% of patients discontinue their medications six months after discharge. This study aimed to examine the effect of self-efficacy enhancement program on medication adherence in post-acute myocardial infarction patients.

METHODS

A total 44 patient with post-acute myocardial infarction were recruited from the in-patient department, Police General Hospital. The participants were random assigned into control group and experimental group. The control group received conventional care while the experimental group attended a four-week self-efficacy enhancement program, which included motivation, skill practice, and monitoring skills. The mean self-efficacy score between groups was assessed. The pill count was used to measure medication adherence. Correlations between self-efficacy and medication adherence were examined. Data were analyzed using descriptive statistic, Pearson's correlation, and t-test.

RESULTS

The mean score on medication adherence of the experiment group who attended the self-efficacy enhancement program was significantly greater than the control group (t=-2.77; df=21; p=0.01). The mean scores of self-efficacy between the experimental and control group were 35.73 (SD=4.11) and 35.41 (SD=3.78). The correlations between self-efficacy and medication adherence were significantly (r=1.00, p=0.00).

CONCLUSION

The effectiveness of self-efficacy enhancement program was effective in improving medication adherence in Thai post-acute myocardial infarction.