BMC Nursing

Published by Springer Nature
Online ISSN: 1472-6955
Learn more about this page
Recent publications
Forest Plot of the characteristics of the sample associated with participation in research projects based on multivariate regression analysis
Reading scientific journals and knowledge of epidemiology, statistics, and English
Background Involvement in research activities is complex in pediatric nursing and allied health professionals (AHPs). It is important to understand which individual factors are associated with it to inform policy makers in promoting research. Methods A cross-sectional observational study was conducted to describe the level of participation in research activities over the last ten years of nurses and AHPs working in a tertiary pediatric hospital. A large sample of nurses and AHPs working in an Italian academic tertiary pediatric hospital completed an online self-report questionnaire between June and December 2018. Three multivariate logistic regression analyses were performed to predict participation in research projects, speaking at conferences, and writing scientific articles. Results Overall, data from 921 health professionals were analyzed (response rate = 66%), of which about 21% ( n = 196) reported participating in a research project, while 33% ( n = 297) had attended a scientific conference as a speaker, and 11% ( n = 94) had written at least one scientific paper. Having a Master or a Regional Advanced Course, working as an AHP or a ward manager, as well as regularly reading scientific journals and participation in an internal hospital research group or attendance in a specific course about research in the hospital, significantly predicted participation in research projects, speaking at conferences and writing scientific papers. It is important to foster research interest and competencies among health professionals to improve participation in research projects, speaking at conferences, and writing scientific papers. Conclusions Overall, we found a good level of attendance at conferences as speakers (33%), a moderate level of participation in research (21%), and low levels for writing scientific papers (11%). Our study highlighted the need to support participation in research activities among nurses and AHPs. Policymakers should identify strategies to promote research among nurses and AHPs, such as protected rewarded time for research, specific education, strengthened collaboration with academics, and financial support. Moreover, hospital managers should promote the development of research culture among health professionals, to improve their research competencies and evidence-based practice.
 
(continued)
Incidence of WPV among nursing students
Frequency of WPV toward nursing students by the characteristics
Analysis of independent-samples t-test
Hierarchical Linear Regression Analysis Results
  • Lingyan ZhuLingyan Zhu
  • Lu DongyanLu Dongyan
  • Zhenlan LuoZhenlan Luo
  • [...]
  • Hu SanlianHu Sanlian
Background Nursing students are one of the most vulnerable groups suffering from workplace violence. This study aimed to investigate the workplace violence incidence of Chinese nursing students during clinical practice, to describe the characteristics of violence and students’ responses and to analyse the relationship between the experience of workplace violence and professional identity. Methods A cross-sectional study was conducted among 954 nursing students in ten universities in China through convenience sampling. Workplace violence was surveyed through Hospital Workplace Violence Questionnaire for Nursing Students. Students’ professional identity was measured by Professional Identity Questionnaire for Nursing Students. Statistical methods included descriptive statistics, chi-square test, independent-samples t-test, analysis of variance and linear regression analysis. Results It was found that the incidence of workplace violence among nursing students was 42.98%. The violent incidents ranking from high to low were: verbal abuse, threat, physical attack, sexual harassment, and gathering disturbance. The majority of the nursing students chose to avoid the conflict during the incident. 86.34% of the students didn’t report the incidents. More than half of the victims developed post-traumatic stress disorder after the incidents. Regression analysis results showed that workplace violence experience (β = − 0.076, P < 0.05) was a significantly negative predictor of professional identity. Conclusions Chinese nursing students were exposed to physical and psychological violence during clinical practice with insufficient coping solutions and psychological adjustment. The professional identity of the nursing students was significantly associated with the experience of workplace violence.
 
TPSN Model (Teacher, Patient, Student, Nurse, and others): Academic-Practice Integration
Mentoring component
Preceptorship component
Integrated clinical education component
The description of the TPSN Model
Background There are still concerns about the effectiveness of clinical education models which are done with the aim of reducing the theoretical-practical gap in nursing. In this article, we intend to describe an innovative model to create an integration and structured relationship between educational and healthcare provider institutions. The basis of this work is the full-time presence of nursing teacher in the clinical settings and the development of their role to improve the education of students and nurses and the quality of nursing services. Methods This was a participatory action research. This action research was implemented in four steps of problem identification, planning, action and reflection. Interviews, focus groups and observation were used for the qualitative part. Clinical Learning Environment Inventory (CLEI), Job Satisfaction in Nursing Instrument questionnaires and Patient Satisfaction with Nursing Care Quality Questionnaire were completed before and after the study. Qualitative content analysis, paired and independent t test were used for data analysis. Results The academic-practice integration Model of TPSN is a dynamic and interactive model for accountability in nursing Discipline. Unlike the medical education model that includes patients, students, and physicians as the three points of a triangle, this model, which is shaped like a large triangle, places the person in need of care and treatment (patient, client, family, or society) in the center of the triangle, aiming to focus on the healthcare receiver. The model consists of three components (Mentoring component, Preceptorship component, and integrated clinical education component). Each of the components of this model alone will not be able to eliminate the ultimate goal of bridging the theory-practice gap. Conclusions A new and innovative model was proposed to reduce the theory-practice gap in the present study. This model increases the collaboration between educational institutions and healthcare settings compared with the previous models. The TPSN model helps students, nurses, and nursing instructors integrate theoretical knowledge with clinical practice and act as professional nurses.
 
Standardized Path Coefficients (n = 339) | Note: Seven factor model for measuring the brand image of nursing
(a) Latent class profiles related to the seven NBIS-C dimensions showing the Mean and Standard Deviation | Notes: Class 1:Subordinate, Class 2: Creative, Class 3: Leader, Class 4: Traditional and Class 5: Integrated. (b) Circle Chart of the brand image of Chinese nurses
Aims To translate the U.S. version of the Nursing Brand Image Scale to Chinese (NBIS-C) and evaluate its psychometric properties when administered to a national sample of Chinese nurses, and identify nursing brand image profiles in Chinese nurses. Design A cross-sectional study was conducted to validate the NBIS-C among nurses in China. Methods The psychometric properties of the NBIS-C were tested in accordance with the COSMIN checklist. The reliability, validity, and responsiveness of the 42-item NBIS-C were examined in a national sample of 759 nurses recruited from 29 Chinese provinces. Latent Profile Analyses (LPA) were conducted to reveal nurses’ perceptions of the brand image of nursing. Results Results of this study demonstrated acceptable validity (content validity, structural validity, and construct validity), reliability (internal consistency and test-retest reliability), adequate responsiveness, and no floor/ceiling effect of the NBIS-C. LPA yielded five subgroups: Integrated, Traditional, Subordinate, Creative and Leader. Conclusion The psychometric properties of the NBIS-C are suitable for assessing the image of nursing among Chinese nurses. Future studies with a larger, more diverse sample are recommended. Although the role of nurses in China has evolved, nurses in general have failed to communicate a consistent, positive, and accurate brand image for the nursing profession.
 
Background Older people with multiple diagnoses often have problems coping with their daily lives at home because of lack of coordination between various parts of the healthcare chain during the transit from hospital care to the home. To provide good care to those persons who have the most complex needs, regions and municipalities must work together. It is of importance to develop further empirical knowledge in relation to older persons with multiple diagnoses to illuminate possible obstacles to person-centred care during the transition between healthcare institutions and the persons livelihood. The aim of the present study was to describe nurses’ experienced critical incidents in different parts of the intended healthcare chain of older people with multiple diagnoses. Methods The sample consisted of 18 RNs in different parts of the healthcare system involved in the care of older people with multiple diagnoses. Data were collected by semi structured interviews and analysed according to Critical Incident Technique (CIT). A total of 169 critical incidents were identified describing experiences in recently experienced situations. Results The result showed that organizational restrictions in providing care and limitations in collaboration were the main areas of experienced critical incidents. Actions took place due to the lack of preventive actions for care, difficulties in upholding patients’ legal rights to participation in care, deficiencies in cooperation between organizations as well as ambiguous responsibilities and roles. The RNs experienced critical incidents that required moral actions to ensure continued person-centred nursing and provide evidence-based care. Both types of critical incidents required sole responsibility from the nurse. The RNs acted due to ethics, ‘walking the extra mile’, searching for person-centred information, and finding out own knowledge barriers. Conclusions In conclusion and based on this critical incident study, home-based healthcare of older people with multiple diagnoses requires a nurse that is prepared to take personal and moral responsibility to ensure person-centred home-based healthcare. Furthermore, the development of in-between adjustments of organizations to secure cooperation, and transference of person-centred knowledge is needed.
 
Background There is a high mortality of burns especially in low- and middle-income countries which already have less developed healthcare systems. Besides, little is known about nursing students’ knowledge and practices towards the need to monitor fluid requirements in admitted burns patients. Objective To assess the knowledge and practices of nursing students regarding monitoring fluid requirements for hospitalised paediatrics and adult burn patients on the surgical ward at Mbarara regional referral hospital. Methods We conducted an online descriptive cross-sectional study among clinical nursing students at Mbarara University of Science and Technology (MUST) during September and November 2021. We assessed knowledge and practices using an adapted questionnaire. Summary statistics were then used to describe the data. Results Thirty-seven nursing students (64.9% response rate) participated in our survey. Twenty one (56.8%) were female and had a modal age range of 20-24 years. Nineteen (51.4%) of the students were BNC (Bachelor of Nursing Completion) students, with the rest being BNS (Bachelor of Nursing). More than 75% of students correctly answered each of two out of the ten questions. More than three quarters of the students reported having done each of six out of the eleven practices surveyed. Conclusion Nursing students had poor knowledge and fair satisfactory practices regarding monitoring of the fluid requirements in burns patients. More similar studies are needed to survey more nursing students on this topic and to henceforth evaluate the need for periodic re-trainings and reassessment of clinical skills of nursing students.
 
Study design
Flow chart of flipped education course intervention
Background Aromatherapy is effective in treating pain; however, aromatherapy is not offered in formal nursing education in Taiwan. This study designed aromatherapy training courses for nurses using the flipped teaching approach and explored the effectiveness of the method, which can serve as a reference for future aromatherapy courses. Methods A quasi-experimental design and convenience sampling were adopted. The participants were nurses who had been employed for over one year in two hospitals in Taiwan. Forty nurses were included in the experimental and control groups. The intervention of this study was performed in February 2020. Nurses in the control group received one hour of introduction to the use of aromatherapy in pain management. This class was delivered using the traditional teaching method, during which a researcher served as the lecturer. Nurses in the experimental group received a 2.5-h flipped teaching course on aromatherapy. Two weeks before classroom activities, the nurses in the experimental group watched a 30-min aromatherapy concept video on an e-learning teaching platform. Thereafter, the nurses participated in two hours of classroom teaching in both groups. The course design included group discussions, mind mapping, case discussion, practice with essential oils, and do-it-yourself essential oil preparation. Results Pre- and post-test knowledge and self-efficacy in aromatherapy were assessed. There were no significant differences in the pre-test knowledge and self-efficacy scores between the two groups. The test was analyzed using a generalized estimating equation. Post-test knowledge and self-efficacy results showed that the change in scores in the experimental group was significantly better than that in the control group, indicating that flipped teaching improved the participants’ knowledge and self-efficacy in aromatherapy. Conclusions This study confirmed that flipped teaching was effective in helping nursing personnel learn aromatherapy. Implementation of aromatherapy by nurses in clinical practice and its impact on patient care should be further assessed.
 
At admission, RG group had higher negative mood score than CG group. A The SPBS score of RG group was higher than that of CG group, B HAMA score in RG group was higher than that in CG group. C The HAMD score of RG group was higher than that of CG group (* p < 0.05, ** p < 0.01, *** p < 0.001)
One month after discharge, RG group had better negative mood improvement than CG group. A SPBS score improvement one month after discharge, the lower the score, the better the improvement, B-C HAMA and HAMD scores of the two groups were compared, and the lower the score, the better the improvement degree (* p < 0.05, ** p < 0.01, *** p < 0.001)
One month after discharge, the improvement of quality of life and life satisfaction in RG group was better than that in CG group. A Comparison of SF-36 score changes one month after discharge, B Barthel scores were compared between the two groups one month after discharge, C Comparison of SSS scores between the two groups one month after discharge, D SWLS scores of the two groups were compared one month after discharge (* p < 0.05, ** p < 0.01, *** p < 0.001)
Background Due to the high nursing pressure of patients with cerebral hemorrhage and the general shortage of clinical nurses, nursing support workers often participate in clinical nursing work, but the influence of nursing support workers' participation on the negative emotion, quality of life and life satisfaction of patients with intracerebral hemorrhage is unknown. Methods This quasi-experimental study was conducted with a pretest–posttest design. A total of 181 ICH patients admitted to our hospital from January 2022 to April 2022 were enrolled, including 81 patients receiving conventional care (CG control group) and 80 patients receiving nursing support worker participation (RG research group). All patients were recorded with self-perceived Burden Scale (SPBS), Hamilton Depression Scale (HAMD), Quality of Life Scale (SF-36), Somatic Self rating Scale (SSS), Patient self-care ability assessment scale (Barthel) and Satisfaction with life scale (SWLS) scores. Results Patients with high negative emotion were more willing to participate in clinical nursing work (p < 0.05). Nursing support workers involved in cerebral hemorrhage patients can alleviate negative emotions, improve life quality, improve life satisfaction (p < 0.05). Conclusion The participation of nursing support workers can alleviate the negative emotions of ICH patients, enhance their self-management ability, and improve their life quality.
 
Change in concern among family members during the visiting ban. Legend: Being so concerned about the wellbeing of a relative that their own wellbeing deteriorated before / during the ban, N = 364
Background Visiting a close relative who resides in a nursing home is an opportunity for family members to extend their caring roles and find reassurance that the older person’s life is continuing as well as possible. At the same time, visits allow family members to observe the quality of formal care in the facility. In Finland, the COVID-19 pandemic led to the imposition of visiting bans in nursing homes in March 2020, thereby preventing customary interaction between residents and their family members. The aim of this study is to investigate family members’ experiences of the visiting ban and its effects on their concern over the wellbeing of close relatives living in nursing homes. Methods A cross-sectional study was conducted to explore family members’ self-reported concerns and the factors associated with those concerns. In the context of this unpredictable pandemic, this was considered an appropriate approach, as information at the very beginning of the visiting ban was sought, and causal relations were not investigated. The data consist of a quantitative survey ( n = 366) conducted among family members in May–June 2020. Binary logistic regression analyses were performed to explore the association between the independent variables and reported concern. Results The results showed that increased concern was extremely common (79%). The factors associated with this notable increase were adequacy of contact and information, observations of changes in the wellbeing of the relative in question, and doubts over the appropriateness of the visiting restriction. Conclusions In light of the findings, care providers should improve their information provision to residents’ family members and find new ways of allowing visits to nursing homes in the future in all circumstances.
 
CONSORT Flow Diagram
Comparison of health score in two groups
Background Nursing in military hospitals affects their general health. Educational interventions can help to maintain the general health of nurses. This study aimed to evaluate the effect of an educational intervention to improve the general health of nurses in military hospitals. Methods In this quasi-experimental study, 146 nurses working in military hospitals in Tehran, Iran in 2021 were included in the study. The one-month educational intervention included videos, pamphlets, and motivational messages about promoting general health. General health questionnaire with 28 items (GHQ28) was study tool. The allocation of nurses to groups was not random, it was based on personal interest. Frequency (percentage), and mean (standard deviation) were used to describe, and the chi-square test, Fisher’s exact test, independent and paired t-test were used for data analysis. All analyzes were performed in SPSS 24 software with a significance level of 5%. Results A total of 146 nurses participated in the study, most of them were in the age group of 30 to 40 years (64 people, 43.8%), and 76.7% (112 people) of them were women. The results of the independent sample t-test showed after the intervention, general health scores in the intervention group had a significant decrease compared to the control (p < 0.001) (change in intervention group = -31.1, V.S change in control = 0.55). The results of paired t-test showed that only in the intervention group, the value of the general health score and its dimensions were significantly different (p < 0.001). Conclusions The educational intervention performed well and decreased the score of the general health of military nurses. Given that these positive effects may be temporary, it is necessary to design and perform educational interventions over a longer period.
 
Frequency distribution of the subjects’ levels of anxiety in control and the intervention groups at the beginning and the end of the study
Background: With the onset of the COVID-19 pandemic and the need to maintain social distancing and changes in wards' structure, families no longer access the routine support they received during the hospitalization of their patients in the ICU. This study aimed to determine the effects of ICU liaison nurse services on the anxiety in patients' family caregivers after ICU discharge during the COVID-19 pandemic. Methods: This randomized controlled trial was performed in western Iran from February 2020, to March 2021. Sixty subjects were selected from the family caregivers of the patients transferred from the ICU and were randomly assigned to the control (n = 30) and the intervention groups (n = 30). The control group received routine transfer care. In the intervention group, liaison nurse services were offered in 4 dimensions: patient support, family support, training, support of the ward's staff, and the evaluation of the destination ward. The participants' anxiety was measured using the Spielberger State Anxiety Inventory immediately after the patient transfer and 6 h after admission to the general ward. Data analyzed with SPSS V16, descriptive and inferential statistics, including Chi-square test, Mann-Whitney test, Wilcoxon test, and Generalized Linear Model with cumulative logit link function. Results were reported at a 0.05 significance level. Results: A statistically significant difference was observed in baseline anxiety levels (P = 0.035) and age group (P < 0.001) between the intervention and control groups. After moderating baseline anxiety levels, the age group, and marital status, the impact of the intervention was significant (X2 = 10.273, df = 1, P < 0.001), meaning that the intervention could reduce the relative chances of developing higher levels of anxiety by 92.1% (OR: 0.08, 95%CI: 0.017-0.373, P < 0.001). Conclusions: This study confirmed the positive impact of nursing services on reducing anxiety in family caregivers during the COVID-19 pandemic. It is recommended to use these services, especially during the COVID-19 condition, to facilitate the patient transfer, support the patient's family, and reduce the health care gap between the ICU and the ward.
 
Virtual collaborative learning underpinned by the Collaborative Online Learning framework (Redmond and Lock, 2006)
Background The drastic shift from face-to-face classes to online learning due to the COVID-19 pandemic has enabled educators to ensure the continuity of learning for health professions students in higher education. Collaborative learning, a pedagogy used to facilitate knowledge integration by helping students translate theory from basic sciences to clinical application and practice, has thus been transformed from a face-to-face to a virtual strategy to achieve the learning objectives of a multi-disciplinary and integrated module. Objectives This study aimed to describe and evaluate, through focus group discussions, a virtual collaborative learning activity implemented to assist first year undergraduate nursing students to develop cognitive integration in a module consisting of pathophysiology, pharmacology, and nursing practice. Methods Fourteen first year undergraduate students and four faculty involved in facilitating the virtual collaboration participated in the study. Focus group discussions were conducted to elicit the perceptions of students and staff on the virtual collaborative learning session conducted at the end of the semester. Results Three themes were generated from the thematic analysis of the students’ focus group scripts. These were: (1) achieving engagement and interaction, (2) supporting the collaborative process, and (3) considering practical nuances. The three themes were further subdivided into subthemes to highlight noteworthy elements captured during focus group discussions. Three themes also emerged from the focus group discussion scripts of faculty participants: (1) learning to effectively manage, (2) facing engagement constraints, and (3) achieving integration. These themes were further sectioned into salient subthemes. Conclusion The virtual collaborative learning pedagogy is valuable in fostering cognitive integration. However, meticulous planning considering various variables prior to implementation is needed. With better planning directed at addressing the learners’ needs and the faculty’s capabilities and readiness for online learning pedagogies, and with a strong institutional support to help mitigate the identified constraints of virtual collaborative learning, students and faculty will benefit.
 
Eligible students and numbers included
Background An essential component of becoming a professional nurse is a perspective of global health issues and an awareness of diverse populations. Collaborative online international learning (COIL) using digital technologies, offers meaningful and rewarding opportunities to develop international partnerships between nurses from other countries, without economic, organisational or geographical barriers. Despite reported advantages of using COIL, few COIL interventions have been identified in the nursing literature. The aims of this study are to develop, implement and evaluate a COIL program between Australian and Canadian pre-registration nursing students. Methods The study will utilize a mixed methods approach incorporating pre and post-test surveys, focus groups, and semi-structured interviews of key stakeholders. The design will adhere to The State University of New York (SUNY) COIL’s criteria for intercultural/international learning opportunities. Participants will be recruited from nursing programs at an Australian Training and Further Education Institute and a Canadian college. Bennett’s stages of intercultural competence will provide the theoretical framework for the research. Four specific research interventions will be developed for this project. For students, there will be an online virtual community to allow students and teachers to communicate, socially connect and share resources with each other. Virtual reality simulations will be employed within a virtual global classroom to promote collaborative, intercultural learning. For faculty, a virtual community of practice will provide a platform for faculty to share education and research ideas and participate in collaborate research opportunities. Discussion This study will evaluate the outcomes of a nursing COIL program. It will measure participants’ views on COIL, its contribution to student learning, changes in cultural awareness, organisational impact and research productivity. It will provide nursing students with the opportunity to become global leaders in nursing care and for faculty to develop international research skills and outputs. The findings from the study will allow further refinement of future nursing COIL programs.
 
Background: Proper pain assessment is fundamental to effective pain management. Training nursing staff is critical for improving pain assessment competence and patient clinical outcomes. However, there is a dearth of research examining interventions that can enhance nurses' knowledge and attitudes toward pain management, especially in Saudi Arabia. Thus, this study aimed to evaluate the effectiveness of a structured education program on nurses' knowledge and attitudes towards pain management. Methods: A quasi-experimental design was used. The study sample included 124 registered nurses working in intensive care or inpatient units in Saudi Arabia. Data were collected between March and September 2021 using a knowledge and attitudes survey regarding pain, satisfaction with and self-confidence in learning, and the learning self-efficacy scale for clinical skills. Results: Nurses showed moderate levels of knowledge and attitudes regarding pain before (M = 20.3, SD = 4.80) pain management education, which were significantly higher after the intervention (M = 22.2, SD = 5.09, t = 2.87, p < .01). Before the intervention, nurses with a baccalaureate degree had more knowledge and better attitudes regarding pain management than diploma nurses (t = 3.06, p < .01). However, there was no significant difference between the two groups after the intervention (p > .05), indicating that the education was effective in enhancing nurses' knowledge and attitudes, regardless of nursing education level. Nurses in this study had high mean scores for self-confidence in learning (M = 35.6, SD = 4.68, range = 18-40), self-learning efficacy (M = 52.9, SD = 7.70, range = 25-60), and satisfaction with learning (M = 22.2, SD = 3.24, range: 10-25). Conclusion: Regular pain education programs can improve nurses' knowledge and attitudes. Increasing the breadth and depth of educational courses, alongside appropriate training, competency-based assessment, and pain education programs, is also recommended. Future research should consider the subjectivity and individualized nature of nursing by including patient satisfaction surveys to measure the improvement in nurses' knowledge and attitudes from the patient perspective.
 
Content included in pain management course
Background: Proper pain assessment is fundamental to effective pain management. Training nursing staff is critical for improving pain assessment competence and patient clinical outcomes. However, there is a dearth of research examining interventions that can enhance nurses' knowledge and attitudes toward pain management, especially in Saudi Arabia. Thus, this study aimed to evaluate the effectiveness of a structured education program on nurses' knowledge and attitudes towards pain management. Methods: A quasi-experimental design was used. The study sample included 124 registered nurses working in intensive care or inpatient units in Saudi Arabia. Data were collected between March and September 2021 using a knowledge and attitudes survey regarding pain, satisfaction with and self-confidence in learning, and the learning self-efficacy scale for clinical skills. Results: Nurses showed moderate levels of knowledge and attitudes regarding pain before (M = 20.3, SD = 4.80) pain management education, which were significantly higher after the intervention (M = 22.2, SD = 5.09, t = 2.87, p < .01). Before the intervention, nurses with a baccalaureate degree had more knowledge and better attitudes regarding pain management than diploma nurses (t = 3.06, p < .01). However, there was no significant difference between the two groups after the intervention (p > .05), indicating that the education was effective in enhancing nurses' knowledge and attitudes, regardless of nursing education level. Nurses in this study had high mean scores for self-confidence in learning (M = 35.6, SD = 4.68, range = 18-40), self-learning efficacy (M = 52.9, SD = 7.70, range = 25-60), and satisfaction with learning (M = 22.2, SD = 3.24, range: 10-25). Conclusion: Regular pain education programs can improve nurses' knowledge and attitudes. Increasing the breadth and depth of educational courses, alongside appropriate training, competency-based assessment, and pain education programs, is also recommended. Future research should consider the subjectivity and individualized nature of nursing by including patient satisfaction surveys to measure the improvement in nurses' knowledge and attitudes from the patient perspective.
 
Background The work value of operating room (OR) nurses is directly reflected in nursing quality. However, evaluating the work value of these nurses has not been sufficiently investigated. This study evaluated the effects of a fixed nurse team (FNT) in an orthopaedic surgery OR on work efficiency and patient outcomes. Methods A propensity score-matched historically controlled study conducted from 1 July 2015 to 30 June 2018 was used to investigate the difference in nursing quality between an FNT period and a non-FNT period in the orthopaedic surgery OR at a tertiary care hospital in China. The primary outcome was surgical site infections (SSIs) during in-hospital visits, and as a secondary outcome, other nursing-sensitive quality indicators were assessed with historically controlled data. A multifactor logistic regression model was constructed to examine the primary outcome differences between the FNT and non-FNT periods before and after propensity score matching. Results In total, 5365 patients and 33 nurses were included in the final analysis. The overall SSI rate was 2.1% (110/5365; the non-FNT period 2.6% [64/2474], the FNT period 1.6% [46/2891]). A lower incidence of SSIs in patients (odds ratio 0.57, 95% CI 0.36 to 0.88, P =0.013), a lower turnover time of the surgical procedure (odds ratio 0.653, 95% CI 0.505 to 0.844, P <0.001), and improvement in surgeon satisfaction (odds ratio 1.543, 95% CI 1.039 to 2.292, P =0.031), were associated with the FNT period compared with the non-FNT period. However, we did not find significant differences between the FNT period and the non-FNT period in terms of the other indicators. Conclusions The presence of an FNT in an OR reduces the incidence of SSIs in surgical patients and the turnover time of surgical procedures and improves surgeon satisfaction. Further implementation of an advanced-practice nurse model with nurse specialists is encouraged.
 
Survey respondents’ in hospital diabetes management (preference vs actual)
Background In an acute hospital setting, diabetes can require intensive management with medication modification, monitoring and education. Yet little is known about the experiences and perspectives of nursing/midwifery staff and patients. The aim of this study was to investigate diabetes management and care for patients with diabetes in an acute care setting from the perspectives of nursing/midwifery staff and patients. Methods A convergent mixed-methods study design. Patients with diabetes (Type 1, Type 2 or gestational diabetes) recruited from a public health service in Melbourne, Australia completed a survey and nurses and midwives employed at the health service participated in focus groups. Descriptive statistics were used to summarise the survey data. Thematic analysis was used for the free-text survey comments and focus group data. Results Surveys were completed by 151 patients. Although more than half of the patients were satisfied with the diabetes care they had received (n = 96, 67.6%), about a third felt the hospital nursing/midwifery staff had ignored their own knowledge of their diabetes care and management (n = 43, 30.8%). Few reported having discussed their diabetes management with the nursing/midwifery staff whilst in hospital (n = 47, 32.6%) or thought the nurses and midwives had a good understanding of different types of insulin (n = 43, 30.1%) and their administration (n = 47, 33.3%). Patients also reported food related barriers to their diabetes management including difficulties accessing appropriate snacks and drinks (n = 46, 30.5%), restricted food choices and timing of meals (n = 41, 27.2%). Fourteen nurses and midwives participated in two focus groups. Two main themes were identified across both groups: 1. challenges caring for patients with diabetes; and 2. lack of confidence and knowledge about diabetes management. Conclusions Patients and nursing/midwifery staff reported challenges managing patients’ diabetes in the hospital setting, ensuring patients’ optimal self-management, and provision of suitable food and timing of meals. It is essential to involve patients in their diabetes care and provide regular and up-to-date training and resources for nursing/midwifery staff to ensure safe and high-quality inpatient diabetes care and improve patient and staff satisfaction.
 
The final structure model of the caregiver burden questionnaire
Convergent, discriminant validity and composite reliability of caregiver burden questionnaire
HTMT of caregiver burden questionnaire
Abbreviations CBS: Caregiver Burden Scale; IIS: Item Impact Score; CVR : Content Validity Ratio; I-CVI: Item Content Validity Index; S-CVI: Scale-Content Validity Index; EFA: Exploratory Factor Analysis; CFA: Confirmatory Factor Analysis; URL: Uniform Resource Locator; KMO: Kaiser-Meyer-Olkin; AGFI: Adjusted Goodness-of-fit Index; PCFI: Parsimonius Comparative Fit Index; PNFI: Parsimonius Normed Fit Index; CFI: Comparative fit index; IFI: Incremental fit index; RMSEA: Root mean square error of approximation; CMIN/DF: Minimum discrepancy function divided by degree of freedom; CR: Composite Reliability; AVE: Average Variance Extracted; MSV: Maximum Shared Variance; HTMT: Heterotrait-Monotrait; AIC: Average inter-item Correlation; ICC: Intraclass Correlation Coefficient; SEM: Standard Error of the Measurement; MIC: Minimal Important Change; LOA: Limit of Agreement; COSMIN: COnsensus-based Standards for the selection of health status Measurement INstruments; CBI: Caregiver Burden Inventory; ZBI: Zarit Burden Interview.
Backgorund This study aimed to design and psychometrically evaluate the caregiver burden questionnaire for family caregivers of hemodialysis patients. Methods This study was conducted using an exploratory sequential mixed method on family caregivers of hemodialysis patients in Iran. In the first phase, the generation of the items was done based on results of directed qualitative content analysis according to the Structural model of the caregiver burden and review of the literature. After developing the item pool, face and content validity, item analysis, structural, convergent and discriminant validity, internal consistency, reliability, interpretability, and feasibility were evaluated. Results The primary tool entered the psychometric evaluation phase with 64 items. After performing face and content validity and item analysis, the number of items was reduced to 28. Exploratory factor analysis was performed with 28 items and 300 caregivers, and finally, four subscales with 21 items were developed. The results of confirmatory factor analysis indicated a good fit of the model. Cronbach's alpha and the Intraclass Correlation Coefficient of all subscales were higher than 0.7 and 0.9, respectively. The standard error of measurement was 1.39. All subscales had acceptable values in convergent validity criteria and the HTMT index less than the threshold value. The total score of the questionnaire had no ceiling and floor effect; the percentage of unanswered items was within the acceptable range. Conclusion The results show that the caregiver burden questionnaire for caregivers of patients undergoing hemodialysis has good psychometric properties and can measure the caregiver burden in these caregivers.
 
Participants demographics
Background: Evidence indicates that poor nurse-client relationships within maternal and child health (MCH) continues to impact trust in formal healthcare systems, service uptake, continuity with care and MCH outcomes. This necessitates contextualized innovative solutions that places both nurses and clients at the forefront as agents of change in optimizing intervention designs and implementation. This study explored nurses and clients' perspectives on the factors shaping nurse-client relationships in MCH care to generate evidence to guide subsequent steps of human centered design (HCD) that involve designing effective strategies for improving therapeutic relationships in Shinyanga, Tanzania. Methods: Qualitative descriptive design was employed. About 9 Focus Group Discussions (FGDs) and 12 Key Inform-ant Interviews (KIIs) with purposefully selected nurses and midwives, women attending MCH services and administrators were conducted using semi-structured interview guides in Swahili language. Data were transcribed and translated simultaneously, managed using Nvivo Software and analyzed thematically. Results: Factors shaping nurse-client relationships were heuristically categorized into nurse, client and health system factors. Nurse contributors of poor relationship ranged from poor reception and hospitality, not expressing care and concern, poor communication and negative attitudes, poor quality of services, job dissatisfaction and unstable mental health. Client contributors of poor relationship include being 'much know' , late attendance, non-adherence to procedures and instructions, negative attitudes, poor communication, inadequate education and awareness, poverty, dissatisfaction with care, faith in traditional healers and unstable mental health. Health system contributors were inadequate resources, poor management practices, inadequate policy implementation and absence of an independent department or agency for gathering and management of complaints. Suggestions for improving nurse-client relationship included awards and recognition of good nurses, improving complaints mechanisms, continued professional development, peer to peer learning and mentorship, education and sensitization to clients, improving service quality and working conditions, improving renumeration and incentives, strengthening nursing school's student screening and nursing curriculum and improving mental health for both nurses and clients. Conclusions: The factors shaping poor nurse-client relationships appear to extend beyond nurses to both clients and healthcare facilities and system. Implementation of effective interventions for addressing identified factors
 
Background Mainstreaming sustainable healthcare into the curricula of health professions is a key action to raise awareness and change attitudes. Therefore, the present study aimed to assess the contribution of scenario-based learning and augmented reality to the environmental awareness and attitudes toward climate change and sustainability among undergraduate nursing students. Methods This study was designed as a time-series analysis. Undergraduate nursing students in their 3 years were introduced to sustainability and climate change in the context of healthcare through scenario-based learning sessions. Questionnaires were used to collect data on participants’ attitudes towards sustainability and climate change, the usefulness of the educational sessions and the extent to which students changed their clinical practice. A data summary, related sample Friedman and Wilcoxon signed-rank tests were used to test for differences in survey scores. Results Attitudes and environmental awareness toward climate change and sustainability increased significantly as students received the learning sessions over the 3 years. After their first clinical training period, students already showed a high awareness of unsustainable practices in their working environment; however, they still struggled to apply sustainability and address unsustainable practices in healthcare settings. Most students felt that the scenarios helped them to make links between climate change, resources, and health. Conclusions The scenario-based learning and augmented reality increase environmental awareness and attitudes toward climate change and sustainability among nursing students. Students are very aware of unsustainable practices in their work environment, but more work needs to be done on the application of sustainability principles to nursing practice.
 
Confirmatory factor analysis of the four-factor model of the infection control standardized questionnaire Hungarian version. GLVS, use of gloves; PPE, use of personal protective equipment; ABHR, alcohol-based hand rub indications on unsoiled hands; HAIs, healthcare-associated infections
Convergent and discriminant validity of the four-factor infection control standardized questionnaire Hungarian version
Internal consistency reliability of factors
Background To our knowledge, there is currently no psychometrically validated Hungarian scale to evaluate nurses’ knowledge about infection prevention and control (IPC) practices. Thus, we aim in this study to assess the validity and reliability of the infection control standardized questionnaire Hungarian version (ICSQ-H). Methods A cross-sectional, multisite study was conducted among 591 nurses in Hungary. The original ICSQ included 25 questions. First, the questionnaire was translated into Hungarian. Then, content validity was assessed by a committee of four specialists. This was done by calculating the item content validity index and scale content validity index. Afterward, structural validity was evaluated in a two-step process using principal component analysis and confirmatory factor analysis. The goodness of fit for the model was measured through fit indices. Convergent validity was assessed by calculating the average variance extracted. Additionally, discriminant validity was evaluated by computing the Spearman correlation coefficient between the factors. Finally, the interitem correlations, the corrected item-total correlations, and the internal consistency were calculated. Results The content validity of the questionnaire was established with 23 items. The final four-factor ICSQ-H including 10 items showed a good fit model. Convergent validity was met except for the alcohol-based hand rub (ABHR) factor, while discriminant validity was met for all factors. The interitem correlations and the corrected item-total correlations were met for all factors, but the internal consistency of ABHR was unsatisfactory due to the low number of items. Conclusions The results did not support the original three-factor structure of the ICSQ. However, the four-factor ICSQ-H demonstrated an adequate degree of good fit and was found to be reliable. Based on our findings, we believe that the ICSQ-H could pave the way for more research regarding nurses’ IPC knowledge to be conducted in Hungary. Nevertheless, its validation among other healthcare workers is important to tailor effective interventions to enhance knowledge and awareness.
 
Background Hospital noise can adversely impact nurses’ health, their cognitive function and emotion and in turn, influence the quality of patient care and patient safety. Thus, the aim of this study was to predict the contributing roles of exposure to hospital noise, staff noise-sensitivity and annoyance, on the quality of patient care. Methods This descriptive and cross-sectional study was carried out among nurses in an Iranian hospital. To determine nurses’ noise exposure level, the noise was measured in 1510 locations across the hospital in accordance with ISO 9612 standards using KIMO DB 300/2 sound level meter and analyzer. An online survey was used to collect nurses’ individual data. Study questionnaires included demographics, Weinstein noise sensitivity scale, noise annoyance scale, and quality of patient care scale. Finally, to analyze the data, Bayesian Networks (BNs), as probabilistic and graphical models, were used. Results For the high noise exposure state, high noise sensitivity, and high annoyance, with the probability of 100%, the probability of delivering a desirable quality of patient care decreased by 21, 14, and 23%, respectively. Moreover, at the concurrently high noise exposure and high noise sensitivity with the probability of 100%, the desirable quality of patient care decreased by 26%. The Bayesian most influence value was related to the association of noise exposure and annoyance (0.636). Moreover, annoyance had the highest association with the physical aspect of quality of care (0.400) and sensitivity had the greatest association with the communication aspect (0.283). Conclusion Annoyance induced from environmental noise and personal sensitivity affected the quality of patient care adversely. Moreover, noise and sensitivity had a separate direct adverse effect upon the quality of patient care, and their co-occurrence reduced the potential for delivering quality patient care.
 
Knowledge of nurses on ADR reporting procedures
Practice of pharmacovigilance among nurses
Reasons for not reporting ADRs among nurses
Analysis of variance of the impact of rank and ward of nurses on practices of pharmacovigilance
Linear regression between attending in-service training and practice of pharmacovigilance
Background Pharmacovigilance may be defined as the continuous monitoring of the reaction between a drug agent or combination of drugs a patient took and steps taken to prevent any associated risk. Clinical trials conducted before drug approval cannot uncover every aspect of the health hazards of approved drugs. People with carefully selected characteristics are monitored for the safety and efficacy of the drug; hence, common adverse drug reactions (ADRs) following proper use of the medication can be detected. This calls for continuous monitoring of drugs to report any undocumented ADRs during the clinical trial. The study aimed to assess the knowledge, practice, and barriers to pharmacovigilance among nurses at a teaching hospital. Methods The study was a descriptive cross-sectional study, and a stratified sampling technique was used to select 125 nurses within the three units: medical, surgical, and pediatric wards. A structured questionnaire was developed and used for data collection based on the study's objectives and reviewed literature. Results The majority (67.2%) of the respondents were females, and 32.8% were males. Most (71.2%) of the nurses had low knowledge of ADR reporting procedures. Also, 84.8% of the nurses knew the purpose of reporting ADRs. The purpose of ADR reporting, as perceived by respondents, was to identify safe drugs (80.8%) and calculate the incidence of ADR (75.2%). Additionally, among the nurses who reported having nursed a patient with ADRs, 52.54% stated they reported the case, while 47.46% did not report it. The most cited reason for not reporting ADRs was that nurses considered the reaction normal and commonly associated with that medicine (35.7%). In comparison, 28.5% of the nurses said they did not know they were supposed to report the adverse drug reaction. There was no statistically significant difference between ranks of nurses, ward, attending in-service training, and pharmacovigilance practice. Conclusion In conclusion, nurses in this study had inadequate knowledge of pharmacovigilance and its reporting procedure. The study found that most nurses fear that reporting ADRs may be wrong because most of the nurses in the study did not have any form of pharmacovigilance training.
 
Visualisation of tables (T) with corresponding questions (Q) (see also Table 1)
Reported individual conditions for workplace learning
Reported team conditions for workplace learning
Reported organisational conditions for workplace learning
Questions World Café for every specific table
Background As long-term care continues to change, the traditional way of learning for work purposes is no longer sufficient. Long-term care organisations need to become ‘learning organisations’ and facilitate workplace learning for nursing staff teams. Therefore, insight is needed into what conditions are important for establishing workplace learning. The aim and objective of this article is to gain insight into necessary individual, team and organisational conditions for nursing staff to enhance workplace learning in long-term care settings. Methods This study is a qualitative explorative study. A World Café method was used to host group dialogues in which participants ( n = 42) discussed certain questions. Group dialogues were held for the nursing home and community care setting separately due to organisational differences. Nursing staff, experts in workplace learning, educational staff, client representatives and experts in the field of work and organisation in healthcare organisations were invited to a Dutch long-term care organisation to discuss questions of interest. Data were analysed using theme-based content analysis. Results Overall themes concerning individual, team and organisational conditions for workplace learning included: facilitating characteristics (e.g. to be given time and room for [team] development); behavioural characteristics (e.g. an open attitude); context and culture (e.g. feeling safe); cooperation and communication (e.g. giving/receiving feedback); and knowledge and skills (e.g. acquiring knowledge from each other). No major differences were found between settings. Conclusions By assessing the themes at the individual, team and organisational level regarding nursing staff, the current workplace learning situation, and its possible improvements, can be detected.
 
Attitudes of educating nurses towards digital technologies on a pedagogical-didactic level
Self-assessment of educating nurses on how prepared they feel to integrate new digital technologies into their teaching and training activities (n = 140)
Background The impact of technology and digitalization on health care systems will transform the nursing profession worldwide. Nurses need digital competencies to integrate new technology in their professional activities. Nurse educators play a crucial role in promoting the acquisition of digital competences and therefore need to be digitally competent themselves. Research on digital competencies of nursing educators is scarce but suggests lack of digital knowledge and skills and support needs. Although digitalization is to be seen as a global process, regional contexts need to be taken into account, such as pre-existing competencies, local conditions, and individual needs. Thus, it remains unclear which competencies nurse educators possess and which support needs they have. Aim of this study was to assess nurse educators’ and clinical mentors’ digital competencies and explore their needs and requirements concerning the digital aspects of their pedagogy and teaching activities in Germany. Methods A descriptive exploratory study with a cross-sectional design was conducted. Participants were identified using a convenience sampling approach. Data were collected during July and September 2020 using a standardized self-reported questionnaire that was developed specifically for this study. The questionnaire was provided in a paper and online format and participants could decide which format to use. It contained open- and closed-ended questions. Data were analyzed using descriptive and content analysis. Additionally, explorative subgroup analyses based on job designation, age, and gender were performed. Reporting of this study adhered to the STROBE checklist. Results A total of 169 educating nurses participated in the survey. The respondents considered themselves as digitally competent and showed a positive attitude towards the integration of digital technology in their teaching activities. Their perceived preparedness to integrate digital technology into teaching and training varied. Almost all respondents (98%) declared a need for further training and seemed motivated to participate in corresponding educational events. There were some indications for differences in competencies or needs between subgroups. Conclusions Educating nurses appear to possess basic digital competencies but there is a need to support their professional development in terms of new technologies. Findings can be used as a basis for developing supportive interventions. Further qualitative investigations could inform the design and content of such interventions.
 
Flow chart of the study steps
Introduction Interprofessional professionalism (IPP) has been introduced as one of the critical sub-competencies of interprofessional collaboration. This study aimed to assess the effect of interprofessional education on the behavior of interprofessional professionalism among the surgical team in the intervention compared to the control group. Methods This is a quasi-experimental study. The participants were nurses in anesthetist and surgical technology and surgical residents of Shahid Sadoughi Hospital ( n = 150) who were included in the study by the census. The intervention employed an interprofessional case-based learning strategy to explore themes of interprofessional professionalism. Two assessors used the Interprofessional Professionalism Assessment (IPA) tool to measure learners’ performance while observing them in practice prior to the intervention, one and three months after the intervention. Data were analyzed using descriptive tests (mean and SD) and RM-ANOVA. Results In this study, the participants in the intervention ( n = 78) and the control ( n = 72) groups entered the study. The Baseline IPA scores of participants were reported as 1.25 (0.12) and 1.21 (0.1) in the intervention and control groups, respectively. The IPA score of the participants in the intervention group (2.59 (0.26) and 2.54 (0.24)) was higher than the control group (1.17 (0.08) and 1.12 (0.07)) after one and three months of the intervention ( P = 0.0001). The effect of educational interventions was reported at the large level (Eta Square = 0.89). Conclusion Interprofessional professionalism in surgical teams has been recognized as a critical element of team-based care. The present study used an interprofessional education strategy to develop IPP behavior. All professions benefited from interprofessional education. It is suggested that all surgical team professionals participate in interprofessional education.
 
Background The COVID-19 epidemic has globally challenged medical practices, including cardiopulmonary resuscitation (CPR). Numerous challenges affect healthcare providers (HCPs) who are members of the resuscitation team and the resuscitation process in COVID-19 patients. As a result, HCPs may experience different dilemmas about CPR. Failure to recognize these experiences can harm both HCPs and patients. This study aimed to explore the HCP’s experiences of CPR in patients with COVID-19. Methods A qualitative study was conducted using semi-structured interviews with 26 participants in the emergency departments of Besat, Golestan, and Imam Reza hospitals (in the west of Iran) using the hermeneutic phenomenology approach. The data were analyzed using the 6-step Smith interpretative phenomenological analysis (IPA) method. Results The mean age of the participants was 38 years. Most of them (61.5%) were male and had a Bachelor’s degree in nursing (46.1%).The data analysis resulted in extracting four super-ordinate and nine sub-ordinate themes. “Human aspects of Care”, “Perceived Psychological Effects of Resuscitation in COVID-19”, “HCP’s perceptions of factors affecting the resuscitation process in COVID-19”, and “Perceived differences in COVID-19 resuscitation compared to non-COVID patients” were super-ordinate themes. Conclusions The participants experienced a wide range of difficult feelings and emotions while resuscitating the patients with COVID-19, suggesting the effect of the COVID-19 epidemic on HCPs and the resuscitation process. They experienced stress and fear, and the resuscitation process was influenced by their compassion, underlying patient conditions, resuscitation futility, and participants’ fatigue or lack of oxygen due to the use of personal protective equipment (PPE).
 
Coding tree
Background Literature shows that newly qualified nurse-midwives face challenges integrating into the workforce during their transition period from education to practice. However, little is known about the needs and challenges of Malawian nurse-midwives during their transition from education to practice. The aim of the study was to explore the transition experiences of newly qualified nurse-midwives working in selected midwifery units in Northern Malawi. Methodology A qualitative descriptive approach was used. Data were collected through in-depth interviews using semi-structured interview guides from a purposive sample of 19 participants (13 newly qualified nurse-midwives and 6 key informants). The researchers developed two interview guides; one for the newly qualified nurse-midwives and another one for the key informants. The interview guides had questions related to newly qualified nurse-midwives experiences of transitioning to practice and the support they received. Participants were from three selected hospitals in the Northern part of Malawi that have maternity units. Data were analysed manually using thematic analysis. Findings Five themes related to challenges faced by newly qualified nurse-midwives during their transition to practice in midwifery units emerged from the thematic analysis of the data. These included (1) Theory—practice gap, (2) Lack of confidence and skills, (3) Inadequate resources, (4) Transition support system, and (5) Workplace conflict. Conclusion Newly qualified nurse-midwives in Malawi encounter many challenges while transitioning from education to practice. The study findings underscore the need to develop a national framework support system that could not only help newly qualified midwives adjust positively to their new role but also create more opportunities for learning and developing and strengthening a collaborative partnership between colleges and hospitals.
 
Cover of photobook
Inside of photobook
Page spread from inside the photobook showing pairing of archival and contemporary photographs
Page spread from inside the photobook showing a photograph of a wallpaper pattern and a handwritten note
A montage of materials from a page spread showing a transcription of the handwritten note and a photograph of grandad
Background Improving understanding about dementia in nursing is a priority area for educators and policymakers. This is due to poor professional understanding about dementia and suboptimal healthcare practice. While many educational interventions exist, there has been a paucity of research which has considered the use of artist-produced photobooks to improve knowledge and understanding about dementia. The aim of this study is to understand the impact of an artist-produced photobook on nurses’ attitudes and beliefs about dementia. Results Following a thematic analysis of four focus group interviews with 22 nurses and nursing students from Northern Ireland, three themes emerged. Theme one was about how the artist-produced photobook helped participants to humanise the person living with dementia. Theme two related to how the artist-produced photobook supported participants to actively construct their own meanings about dementia based on their previous professional and personal experiences. Theme three explored how an artist-produced photobook could be successfully used to complement existing dementia education in the future. Conclusions Using an artist-produced photobook was an innovative way to learn about dementia for nurses and nursing students. The photobook functioned as a tool underpinned by arts-based pedagogy (ABP), supporting nurses to understand the person behind the dementia disease. As such, an artist-produced photobook has the potential to be a useful complementary resource for supporting professional education about dementia.
 
Background Delirium is common among critically ill patients, leading to increased mortality, physical dependence, and cognitive impairment. Evidence suggests non-pharmacological delirium prevention practices are effective in preventing delirium. However, only a few studies explore the actual implementation and its associated challenges among critical care nurses. Aim To explore critical care nurses’ perceptions of current non-pharmacological delirium prevention practices in adult intensive care settings, including delirium screening, early mobilisation, sleep promotion, family engagement, and sensory stimulation. Methods A qualitative design adopting a thematic analysis approach. Semi-structured interviews with 20 critical care nurses were conducted in ten acute hospitals in mainland China. Results Three themes emerged: (a) importance of family engagement; (b) influence of organisational factors, and (c) suggestions on implementation. The implementation of non-pharmacological delirium prevention practices was limited by a strict ICU visitation policy, lack of routine delirium screening and delirium training, light and noise disturbances during nighttime hours, frequent resuscitation and new admissions and strict visitation policy. Case-based training, adopting a sensory stimulation protocol, and family engagement may be enablers. Conclusion ICU care routine that lacks delirium assessment and the strict family visitation policy made it challenging to implement the complete bundle of non-pharmacological practices. Resource deficiency (understaffing, lack of training) and ICU environment (frequent resuscitation) also limited the implementation of non-pharmacological practices. Clinicians could implement case-based training and sensory-stimulation programs and improve communication with family caregivers by instructing family caregivers to recognise delirium symptoms and delirium prevention strategies.
 
Current health status satisfaction-SF -36
Kupperman menopausal index rating
Background The Quality of Life in climacteric women is intrinsically related to signs and symptoms influenced by the decrease of estrogen and psychosocial factors linked to the natural aging process. Thus, this study aimed to trace the sociodemographic and clinical profiles of climacteric women working at the State University of Rio Grande do Norte (UERN) and evaluate their Quality of Life. Methods It is a descriptive, exploratory, and quantitative study. The population consisted of female workers from UERN, aging between 40 and 65 years. The total sample consisted of 63 women who answered the forms. Data collection was completely online, which allowed the women to have free choice to choose the most appropriate time to answer the questions. Results The majority of the participants were older than 50 years (53.97%, n = 34), were married or in a stable union (55.56%, n = 35), and lived in Mossoró-RN (82.53%, n = 52). Regarding skin color, white and brown women had the same percentage of 44.44% ( n = 28). The pain, general health status, and vitality domains evidence the predominance of poor quality of life in the SF-36 questionnaire. Regarding the level of satisfaction with their current health status, 4.76% ( n = 3) stated that they fit the level considered excellent, 44.44% ( n = 28) very good, 46, 03% ( n = 29) were good, and 4.77% ( n = 3) stated unsatisfied with their current health status. The intensity of symptoms related to estrogen deficiency established by the Kupperman menopause index is as Mild 55.56% ( n = 35), moderate 41.27% ( n = 26), and severe 3.17% ( n = 2). Conclusions The occurrence of symptoms and perception of these symptoms differs from woman to woman, to a greater or lesser extent. These findings emphasize the need for qualified and individualized care for the needs of these women in health services and the development of applicable solutions for solving problems based on each woman profile.
 
Background Research shows that the clinical learning environment can affect medical learners’ levels of empathy and formation of professional identity. However, few studies examined the impacts of early exposure to the clinical learning environment on first-year nursing students’ empathy levels and professional identity perceptions. Aim This study aimed to explore effects of initial contact with the clinical learning environment on first-year nursing students’ empathy levels and perceptions of professional identity. Methods This is a mixed-methods study conducted in a medical university and its affiliated hospital in Northeast China. For quantitative analysis, 220 first-year nursing students finished Interpersonal Reactivity Index (IRI) twice before and after their five-day clinical placement in the hospital in June, 2021. Paired samples t tests were used to explore the changes in first-year nursing students’ cognitive empathy, affective empathy and total empathy levels as measured by IRI before and after the clinical placement. For qualitative analysis, 15 first-year nursing students’ diary recording their clinical learning experiences were analyzed. An inductive thematic analysis approach was adopted to extract themes from the content on professional identity in nursing students’ diary. Results After the five-day clinical placement, first-year nursing students’ cognitive empathy, affective empathy and total empathy levels all increased. Five themes emerged regarding nursing students’ perceptions of professional identity: (1) Love for the nursing profession; (2) Multiple roles nurses play; (3) Personal characteristics a good nurse needs to have; (4) Deeper understanding of the nursing profession; (5) New understanding of the relationships between patients and nurses, between patients and doctors, and between doctors and nurses. Conclusions First-year nursing students’ initial contact with the clinical learning environment helped them enhance empathy levels and shape professional identity. Nursing educators may consider providing nursing students with opportunities of early exposure to the clinical learning setting to cultivate their empathy and develop their professional identity.
 
Demographic characteristics of participants (N=400)
Background The conventional Career Decision-Making Self-Efficacy Scale does not reflect the situation in Korea due to different sociocultural attributes and fails to account for the unique nursing profession and changes in healthcare. We aimed to develop and psychometrically test the Career Decision-Making Self-Efficacy Scale for Nursing Students. Methods A methodological study using a newly developed questionnaire tool and investigation of the validity and reliability of the preliminary instrument. Data were collected from 400 nursing students through an online survey conducted in May 2021. We identified 56 preliminary items through a literature review and focus group interviews. Of them, 40 were completed with a content validity index > .80. Content, construct, and criterion-related validity; internal consistency reliability; and test-retest reliability were used in the analysis. Results Exploratory factor analysis revealed three factors including 21 items: adapting to work (20.5%), understanding the major (20.2%), and goal setting (16.4%), explaining 57.1% of the total variance. As a result of confirmatory factor analysis, 17 items in the three-factor structure were validated. Reliability, as verified by the test-retest interclass correlation coefficient, was .86 and Cronbach’s α was .92. The final Career Decision-Making Self-Efficacy Scale for Nursing Students consists of 17 items: adapting to work (7 items); understanding the major (4 items); and goal setting (6 items). Conclusion The scale developed to measure the career decision-making self-efficacy of nursing students showed sufficient validity and reliability.
 
Patients' and HCPs' perspectives of a nursing consultation intervention, their similarities and differences
Background Nurses play a crucial role in the multidisciplinary team in the rehabilitation of multiple sclerosis (MS) patients. However, little is known about patients' and health care professionals’ (HCP) experiences (physicians, therapists) with nurses in rehabilitation. The aim of this qualitative study is (i) to describe the rehabilitation nursing care from the perspective of MS patients and HCPs and their view of a nursing consultations (ii) to elaborate similarities and differences of patients’ and HCP’s views. Methods We used a qualitative approach and selected the participants purposively. We conducted semi-structured individual MS patient ( n = 15) and two focus groups interviews with HCPs ( n = 8) in an inpatient rehabilitation clinic in Switzerland. We analysed the data using a structuring content analysis approach. First, we analysed patients’ and HCPs’ perspectives separately. Afterwards we elaborated similarities and differences descriptively. Results Main categories of patients’ perspectives were “need for nursing care” and “relationship between nurses and MS patient”. MS patients have mentioned the following points according to a nursing consultation: (i) nurses as advocates, (ii) involvement of relatives (iii) peer groups (iv) contact person. “Nurses in their scope of practice”, “nurses as a part of the multidisciplinary team” and “the specifications in the treatment of MS patients” were main categories of HCPs’ perspective. MS patients and HCPs demonstrated similarly the importance to have a nurse as a contact person in the multidisciplinary team and the need to integrate a nurse-led peer group in a nursing consultation. While HCPs prefer that relative always be included in nursing consultations, patients provided reasons when inclusion was not desirable. Conclusion The results indicate that continuity in the nursing care for MS patients could contribute to a trusting nurse-patient relationship. This facilitates nurses to create a deeper understanding of MS patients and their needs in daily rehabilitation. The need for MS patients to share their concerns and receive scientifically proven knowledge from peers could addressed with a nurse-led peer group.
 
The satisfaction of instrumental support in transitional care
Background Instrumental support, which is defined as practical, tangible, and informational assistance extended to patients, is crucial for older people in transition. However, little is known about instrumental support in transitional care. Thus, the aim of this study was to evaluate the instrumental support of older people in transitional care. Methods This cross-sectional study was conducted using the Questionnaire of Instrumental Support in Transitional Care (QISCT) to collect data from 747 older people in China from September to November 2020. Survey items consisted of a sociodemographic characteristics questionnaire and the QISCT. Multiple regression analyses were conducted to examine the association between independent variables and the QISCT scores. Results The total score of the QISCT was 39.43 (± 9.11), and there was a significant gap between the anticipated support and received support. The satisfaction of instrumental support was low. Multiple regression analyses showed that educational level, the number of intimate relationships, monthly family income, monthly costs of transitional care, diabetes, and chronic obstructive pulmonary disease were associated with instrumental support in transitional care. Conclusions To cope with the burden caused by chronic disease, the government and transitional care teams should establish a demand-oriented transitional care service model and pay more attention to helping older people obtain adequate and satisfactory instrumental support.
 
Background Hospitalisation of a child is a unique opportunity for health staff to offer smoking cessation support; that is screening for carer smoking status, discussing cessation and providing interventions to carers who smoke. This has the potential to reduce the child’s exposure to second-hand smoke, and in turn tobacco related illnesses in children. However, these interventions are not always offered in paediatric wards. The aim of this study was to explore the provision and prioritisation of smoking cessation support to patient carers in a paediatric ward with a high proportion of Aboriginal patients and carers in a regional area of Australia’s Northern Territory. Methods This is a qualitative descriptive study of data collected through semi-structured interviews with 19 health staff. The interviews were audio recorded and transcribed verbatim. Thematic analysis was performed on the transcripts. Results We found low prioritisation of addressing carer smoking due to, a lack of systems and procedures to screen for smoking and provide quitting advice and unclear systems for providing more detailed cessation support to carers. Staff were demotivated by the lack of clear referral pathways. There were gaps in skills and knowledge, and health staff expressed a need for training opportunities in smoking cessation. Conclusion Health staff perceived they would provide more cessation support if there was a systematic approach with evidence-based resources for smoking cessation. These resources would include guidelines and clinical record systems with screening tools, clear action plans and referral pathways to guide clinical practice. Health staff requested support to identify existing training opportunities on smoking cessation.
 
CONSORT flow chart of the study
Changes in CBI and HPLP-2
Abstract Background and aim The chronic, progressive nature of multiple sclerosis (MS) demands long-term family-centered care for patients. In view of that, inadequate education and support provided for the family caregivers (FCGs) of MS patients increase their care burden (CB) and affect their lifestyle. This study aimed to investigate the impact of a healthy lifestyle empowerment program (HLEP) on CB and adherence to health-promoting behaviors (HPBs) in the FCGs of patients suffering from MS. Methods In this experimental study with parallel groups, conducted in Iran in 2020, a total of 60 FCGs of MS patients were recruited, and then randomized into intervention (n = 30) or control (n = 30) groups. The intervention program, the HLEP, was thus implemented virtually via WhatsApp in the intervention group upon coordinating with the MS Association in the city of Yasuj, Iran, and selecting the participants. The data were collected at three stages, including baseline, follow-up 1 (immediately after the HLEP), and follow-up 2 (three months after HLEP). The research tools were a 14-item demographic survey questionnaire, the 24-item Caregiver Burden Inventory, and the 52-item Health-Promoting Lifestyle Profile-II. Independent-samples t-test, repeated measures analysis of variance, and a linear mixed model were further used for statistical analyses, considering the significant level of 0.05. Results The study results revealed a significant decrease in the CB scores from the baseline to the follow-up 2 (77.03 ± 15.76 to 42.33 ± 12.37), and a significant increase in the values of adherence to HPBs from the baseline to the follow-up 2 (123.53 ± 14.01 to 148.06 ± 15.04) were obtained in the intervention group (p
 
Graph representing the percentage of adherence to the guidelines for the 3–5-month visit by nurses working at CHCs with the averaged visit per nurse at that CHC. The bars indicate standard errors
Swedish child health centres (CHCs) have created a series of visits for fathers/non-birthing parents. The primary aim was to assess child health nurses' implementation fidelity of the father/non-birthing parent visits, with a secondary aim of exploring predictor variables for fidelity. In 2017, nurses voluntarily implemented a series of father/non-birthing parent visits in Region Stockholm. Nurses (n = 122) completed baseline and 8-12 month follow-up surveys. Multiple imputation was used for missing data. Register data on the number of fathers attending the three-to-five month visit was used. Frequencies of nurses reporting good overall adherence to the home visit, three-to-five week visit, and three-to-five month visit were 86%, 76%, and 68%, respectively. A total of 3,609 fathers attended the three-to-five month visit in 2018, where over half of the visits were at 14 of the 134 CHCs. Multiple linear regression showed that working for a private CHC, seeing more fathers, and nurses' perceptions of receiving enough support predicted higher three-to-five month visit adherence. After nurses saw eight fathers, they were more likely to adhere to the guidelines.
 
Background Medical care that has therapeutic effects without significant benefits for the patient is called futile care. Intensive Care Units are the most important units in which nurses provide futile care. This study aimed to explain the causes of futile care from the perspective of nurses working in Intensive Care Units are. Method The study was conducted using a qualitative approach. Qualitative content analysis was used to analyze the data. Study participants were 17 nurses who were working in the Intensive Care Units are of hospitals in the north of Iran. They were recruited through a purposeful sampling method. Data was gathered using in-depth, semi-structured interviews from March to June 2021. Recruitment was continued until data saturation was reached. Results Two main themes, four categories, and thirteen subcategories emerged from the data analysis. The main themes were principlism and caring swamp. The categories were moral foundation, professionalism, compulsory care, and patient’s characteristics. Conclusion In general, futile care has challenged nursing staff with complex conflicts. By identifying some of these conflicts, nurses will be able to control such situations and plan for better management strategies. Also, using the findings of this study, nursing managers can adopt supportive strategies to reduce the amount of futile care and thus solve the specific problems of nurses in intensive care units such as burnout, moral stress, and intention to leave.
 
Hospitals challenges related to Covid-19 pandemic management from the Iranian nurses perspective
Background The COVID-19 pandemic poses a major threat to global public health. As a result, to prepare healthcare systems for this unprecedented threat, a coordinated worldwide response is required. This study aimed to explore the hospitals challenges related to covid-19 pandemic management from the iranian nurses perspective. Methods This study was conducted as a qualitative content analysis in Iran. Using the purposive sampling method, data were collected through in-depth individual interviews with 35 nurse personnel. Graneheim and Lundman’s conventional content analysis methods were used to analyze the data and for the trustworthiness of the data, this study used Lincoln and Guba’s recommendations. Results After multiple rounds of analyzing and summarizing the data and taking into consideration similarities and differences, 5 main categories and 14 subcategories created based on the results of data analysis and including1) Leadership and management 2) Service delivery management 3) Human resources management 4) Equipment and Supplies Management and 5) Economic resources management. Conclusion Identifying the most important challenges of nursing can play an important role in improving the management of COVID-19pandemic. The analysis of the challenges by managers at local, provincial and national levels can lead to the presentation of effective solutions to address these challenges and improve the pandemic management process in the country.
 
Conceptual frame-work on nurses’ knowledge practice pattern, and perceived barrier of chemotherapy induced nausea and vomiting toward prophylaxis guideline adherence nurses in oncology units of selected hospitals in Addis Ababa, Ethiopia
Nurses’ perceived barriers toward chemotherapy induced nausea and vomiting prophylaxis guideline adherence at Addis Ababa, Ethiopia (n = 79)
Background: Chemotherapy-induced emesis can be prevented by the use of recommended guidelines for antiemetic regimens but a research study indicates that in Ethiopia the use of standard antiemetic drug guidelines is very limited. Objectives: To assess knowledge, practice, and perceived barriers towards chemotherapy-induced nausea and vomiting in prophylaxis guideline adherence among nurses in oncology units. Methods: A cross-sectional study design was conducted among 81 oncology nurses selected in the two public hospitals of Addis Ababa, from March 1 to 30, 2020. The study participants were selected by using the population census method from the source population of nurses in oncology units. Data has collected by using semi-structured questionnaires with the self-administrated method. Data were analyzed by using Statistical Package for the Social Sciences software version 24. Descriptive statistics and logistic regression including bivariate and multivariate were conducted to examine the association between independent and outcome variables. The level of significance was determined at a p-value < 0.05 and a 95% confidence interval. Result: Seventy-nine nurses participated with a 96% of response rate. All participants were aged greater than 24 with a mean age of 28.8 ± 6 years and nearly two-thirds of the respondents (60.8%) were females. Nurses were not trained in chemotherapy-induced nausea and vomiting management shows 54.4%. nurses' knowledge of chemotherapy-induced nausea and vomiting prophylaxis Guidelines was 78.5%. The means score of oncology nurses' practice toward guideline recommendation was 41.8%. Knowledge of nurses associated with the use of chemotherapy-induced nausea and vomiting prophylaxis guideline recommendations working in the outpatient department, inpatient ward, and chemotherapy administration unit has a significant association with chemotherapy-induced nausea and vomiting management knowledge. In the multiple logistic regression analysis, nurses who have trained for chemotherapy-induced nausea and vomiting management were 1.64-fold more aware than those who were not trained. Conclusion: The study reveals that nurses working in the oncology unit of the study hospitals have a poor practice of Chemotherapy-Induced Nausea and Vomiting. Therefore, recommended providing Training for the Nurses working in the oncology unit and encourage them to apply standard guidelines.
 
Process of the convergent parallel mixed-methods study. Abbreviations:BSFC-s Burden Scale for Family Caregivers – short, PH private home, SLC shared living community, SRI Severe Respiratory Insufficiency questionnaire
Graphical presentation of the health-related quality of life in the PH versus SLC groups. N = 31. Mean subscale and summary scale scores from the SRI in individuals on HMV stratified by living situation (PH vs. SLC). Higher scores indicate a higher HRQL. Missing values: respiratory complaints (n = 2), social relationships (n = 1), anxiety (n = 2), social functioning (n = 1), SRI summary score (n = 4). Abbreviations:HRQL health-related quality of life, SRI Severe Respiratory Insufficiency questionnaire, HMV home mechanical ventilation, PH private home, SLC shared living community, RC respiratory complaints, PF physical functioning, AS attendant symptoms and sleep, SR social relationships, AX anxiety, PW psychological well-being, SF social functioning, SS summary scale
Background People on home mechanical ventilation (HMV) belong to a heterogeneous population with complex care needs. In Germany, outpatient intensive care is provided in people's private home (PH) or in shared living communities (SLC). Increasing patient numbers have led to criticism of the quality of care in recent years. Since quality deficits from the perspective of those affected are largely unclear, the following research question emerged: How do interviews with ventilated individuals and family caregivers explain any differences or similarities in the quality of care between PH and SLC? Methods This study used a mixed-methods convergent parallel design, where quantitative and qualitative components were separately collected and analysed. The quantitative component (structured interviews and online survey) included ventilation characteristics, health-related resource use, health-related quality of life (HRQL) measured with the Severe Respiratory Insufficiency Questionnaire (SRI; range 0-100; higher scores indicated higher HRQL) and the Burden Scale of the Family Caregivers short version (BSFC-s; range 0-30; higher scores indicated higher burden). The qualitative component (semi-structured interviews) focused on people's experience of person-centred care. Data were merged using a weaving method and the Picker framework of Person-Centred Care. Results The quantitative component revealed that ventilated individuals living in PHs were on average 20 years younger than participants living in SLCs ( n = 46; PH: 46.86 ±15.40 years vs. SLC: 65.07 ±11.78 years; p = .001). HRQL ( n = 27; PH: 56.62 ±16.40 vs. SLC: 55.35 ±12.72; p > .999) and the burden of family caregivers ( n = 16; PH: 13.20 ±10.18 vs. SLC: 12.64 ±8.55; p > .999) were not significantly different between living situation. The qualitative component revealed that person-centred care is possible in both care settings (ventilated individuals: n = 13; family caregivers: n = 18). Conclusion This study describes a care situation that is as heterogeneous as the population of people with HMV. HRQL and the burden of family caregivers are highly individual and, like person-centred care, independent of the living situation. Policy decisions that facilitate person-centred care need to recognise that quality of care is highly individual and starts with the free choice of the care setting.
 
Background The prevalence of pressure injuries among community-dwelling older adults in countries worldwide is still a serious problem. In Indonesia, older adults mostly rely on family members for (medical) care. Therefore, involving family members in the prevention and treatment of pressure injuries (PIs) could potentially decrease its prevalence rates. However, family members are usually not trained for such tasks. Hence, it is essential to first get more insight into the current state of affairs on family members’ knowledge, attitude and actual practice of preventing PIs. Due to the lack of an existing instrument to measure knowledge, attitude and practice of family caregivers in preventing PIs, this study focuses on the development and evaluation of psychometric properties of such an instrument. Methods Three phases of instrument development and evaluation were used, including item generation, instrument construction and psychometric testing of the instrument. A total of 372 family caregivers of community-dwelling older adults who randomly selected participated in this study. Principal factor analysis, confirmatory factor analysis and Cronbach’s alpha were performed to evaluate factor structure and internal consistency of the Knowledge, Attitude and Practice of Family Caregivers at Preventing Pressure Injuries (KAP-PI) instrument. Results The final version of the KAP-PI-instrument consists of a 12-item knowledge domain, a 9-item attitude domain, and a 12-item practice domain with Cronbach’s Alpha values of 0.83, 0.93 and 0.89, respectively. The instrument appeared to be both reliable and valid. Conclusion The KAP-PI instrument can be used in family nursing or community nursing practice, education, and research to assess knowledge, attitude and practice of pressure injury prevention of family caregivers.
 
Standardized three-factors structural model of Brief-ERBS (n = 980); F1(Regulation Worth, six items), F2(Hijack, four items), and F3(Emotion Constraint, four items)
Standardized three-factors structural model of the modified Brief-ERBS (n = 980); F1(Regulation Worth, six items), F2(Hijack, four items), and F3(Emotion Constraint, four items)
Abstract Background Nursing students are experiencing complex learning environments and will experience complex work environments in future clinical work, which lead to emotional problems easily. However, one’s beliefs about controlling their emotions portend a series of vital psychological outcomes. So, it is especially important to search for suitable tools to assess the emotion and regulation beliefs of nursing students and give timely intervention to improve their physical and mental health. This study aimed to translate the American version of the Emotion and Regulation Beliefs Scale (ERBS) into Chinese, revise the original scale and form a simplified version, and assess the reliability and validity of the brief Chinese version in nursing students. Methods The study adopted a cross-sectional design and the multistage sampling design. The ERBS was translated into Chinese, and the reliability and validity of the Chinese version were tested in 980 nursing students. Results The content validity index was 0.920. Exploratory factor analysis supported a three-factor model for the Chinese version of Brief-ERBS, and confirmatory factor analysis indicated that the model fit the Brief-ERBS well. Furthermore, the three-factors model was obtained by using exploratory factor analysis, explaining 51.023% variance, and the communalities of the items ranged from 0.359 to 0.680. With modified confirmatory factor analysis, the fit indices were chi-square/degree of freedom (CMIN/DF) = 4.092, goodness of fit index (GFI) = 0.949, adjusted goodness of fit index (AGFI) = 0.927, comparative fit index (CFI) = 0.913, incremental fit index (IFI) = 0.914, Tucker Lewis index (TLI) = 0.908, root-mean-square error of approximation (RMSEA) = 0.061. The two-tailed independent samples t-test showed the scores of the top (50%) and low (50%) groups reached the level of significance (P
 
Background The aim of this qualitative study is to explore the views and experiences of final year BSc intellectual disability nursing students’ journey, future work plans and examine factors influencing their migration intentions following graduation. Methods A qualitative component of a mixed methods study where a focus group interview was conducted with final year BSc intellectual disability nursing students ( n = 10) from one University in Ireland in June 2019. A topic guide was utilised, and participant’s were interviewed about their programme, future work plans and migration intentions. An inductive approach was utilised, and data were analysed using a pre-existing framework for initial coding and thematic development. Duffy’s conceptual model of identity transformation provided a structure to analyse the data and map themes onto the conceptual framework. Results The findings were mapped onto the five stages of Duffy’s (2013) conceptual model of identity transformation: Pre-Entry; Reaffirming; Surmounting; Stabilising and Actualising. Findings indicate that further work is required to promote intellectual disability nursing and address professional esteem issues, support for education and professional development, such as providing career guidance opportunities prior to course completion, development of clinical skills within their education programme and support for the professional development of new graduates. Participant’s identified uncertainty about career opportunities and saw scope for future professional development opportunities particularly in community-based work. Conclusion This study has identified that final year intellectual disability nursing students are uncertain about career options and opportunities for intellectual disability nurses in other country’s. There is an urgent need for the intellectual disability nursing profession to articulate their practice and advocate for their role and contribution to the care of people with intellectual disability. This study identified a clear need for direction and information regarding intellectual disability nursing roles and career opportunities.
 
Overview of methods including generic categories, main categories, and overarching themes
Background During education it is essential for nursing students to develop professionalism in nursing. Nurses are placed in situations based on trust, and it is crucial that their patients have confidence in them to provide professional and safe care. A key period in nursing students’ development of a professionalism occurs during training when students gain knowledge and skills that separate nurses as professional healthcare workers from laypeople. The purpose of this study was to investigate nursing students’ experiences of professional competence development during education. Methods A longitudinal study was carried out using qualitative content analysis with a manifest inductive approach. Thirty-four students enrolled in a Swedish three-year nursing program, from August 2015 to January 2017 were interviewed on four occasions. Results The results revealed that students’ professional role developed gradually. The students’ started their education with dreams and a naive understanding of the profession, but their understanding of the complexity of the nursing profession gradually evolved. Students became theoretically equipped at the university and developed clinical skills through practice. Students’ focus went from mastering medical technology to a more holistic approach. Before graduating, students felt ready but not fully trained. Conclusions Our findings indicate a discrepancy between the content of the theoretical education and the clinical settings since students identified a lack of evidence-based practice. A solid theoretical education before entering clinical training offered students possibilities for reflecting on evidence-based practice and the clinical settings. The realization that there is always potential for professional improvement can be interpreted as an emerging awareness, and development of professionalism. It is clear that students could benefit from increased collaborative work between clinical supervisors and faculty staff at the university.
 
Background Work-related health problems, such as work stress, fatigue, and burnout constitute a global challenge within the nursing profession. Work-related health among nurses is not yet a prioritized phenomenon in Nepal. Health-promoting approaches to maintaining and sustaining nurses’ health are therefore essential. The aim of this study was to explore and thereby gain a deeper understanding of how nurses in Nepal’s hospitals experience their everyday work, with a focus on promoting and sustaining their work-related health. Methods A qualitative design with semi-structured individual interviews were used. Nineteen registered nurses working at hospitals in Kathmandu Valley, Nepal, were individually interviewed between October 6 and December 5, 2018. Transcribed interviews were analyzed through thematic analysis. Results Four main themes with belonging eight subthemes were constructed from the analysis: (1) “Sense of meaningfulness and belongingness in work culture” with subthemes; “Open environment” and “Sharing attitude and cooperating for the entire team” (2) “Support and rewards from the management team” with subthemes; “Lacking managerial support” and “Fair evaluation and job promotion opportunities”(3) “Workload and protection against work-related hazards” with subthemes; “Stressful and multitasking in workload” and “Lacking equipment for own health and caring”, and (4) “Motivation through opportunities and activities” with subthemes; “Employment benefits that motivate work”, and “Activities outside of work needed to recover”. These main themes and subthemes described nurses’ facilitators for and barriers to their work environment and health. Conclusion Our study highlighted nurses’ experiences with facilitators and barriers to their work-related health. Nurses’ work-related health was positively affected by support from colleagues, managers, and the organization. Conversely, less support from managers, lack of equipment, and unfair judgment were barriers to nurses’ work-related health. This study adds new knowledge about nurses’ work-related health from the context of Nepal. Hospital organizations and nursing managers in similar cultural and healthcare settings can apply the results of our study to develop strategies to promote and sustain nurses’ health and prevent work-related illness.
 
Background Diabetes education in Turkey is provided by diabetes nurse educators in almost all healthcare organizations. However, the education is not standardized in terms of learning content, duration, and methods. This multi-center study was performed to assess the self-care behaviors and glycemic control following education provided to the patients with type 2 diabetes mellitus by diabetes nurse educators. Methods This was a descriptive and cross-sectional study and included 1535 patients admitted to 28 public hospitals for the treatment of type 2 diabetes mellitus. The education was assessed by using a Patient Identification Form and Self-care Scale. Results The proportion of individuals who received diabetes education within the last year was 78.5%, with 46.7% of them having received it once. Of the patients, 84.8% reported that they received diabetes education individually. It was found that the proportion of individuals who received education about oral antidiabetics (78.5%) and glucose testing at home (78.5%) was higher than the proportion of individuals who received education about exercise (58.8%) and foot care (61.6%). The status of diabetes education, education intervals, and the correlation of the education method with self-care and glycemic control was evaluated. Self-care and glycemic control levels were better among the patients who received diabetes education thrice or more and in patients who received education both individually and in a group (p < 0.05). Conclusions Approximately three-quarters of individuals with type 2 diabetes mellitus received education by diabetes nurse educators in Turkey. Diabetes education is positively correlated with self-care and glycemic control levels among patients with type 2 diabetes mellitus. Efforts for generalization and standardized education for all diabetes patients are necessary.
 
Flow diagram of participant recruitment, allocation, follow-up and data analysis
Background International guidelines advocate providing prompt structured education to individuals with diabetes at diagnosis. However, among the few eligible structured education programs, heterogeneous intervention regimens and inconsistent findings were reported. Eligible programs for Chinese individuals with diabetes are lacking. This study aimed to investigate the effects of a nurse-led integrative medicine-based structured education program on self-management behaviors, glycemic control and self-efficacy among individuals with newly diagnosed type 2 diabetes. Methods Employing a randomized controlled trial, 128 individuals with type 2 diabetes diagnosed in the preceding three to nine months were recruited from four university-affiliated tertiary hospitals in Xi’an City, Northwest China, and randomly allocated to the intervention or control groups after baseline assessments. Participants in the intervention group received a 4-week nurse-led integrative medicine-based structured education program, which is theoretically based on the Health Belief Model and Self-Efficacy Theory, in line with updated diabetes management guidelines, and informed by relevant systematic reviews. Participants in the control group received routine care. Self-management behaviors and self-efficacy were measured with the Summary of Diabetes Self-Care Activities and the Diabetes Management Self-Efficacy Scale at baseline, immediate post-intervention and 12 weeks following the intervention while Glycated Hemoglobin A was measured at baseline and the 12th-week follow-up. The intervention effects were estimated using the generalized estimating equation models. Results Participants in the intervention group exhibited significantly better self-management performance in specific diet regarding intake of fruits and vegetables at both follow-ups (β = 1.02, p = 0.011 and β = 0.98, p = 0.016, respectively), specific diet regarding intake of high-fat foods at the immediate post-intervention follow-up (β = 0.83, p = 0.023), blood glucose monitoring at the 12th-week follow-up (β = 0.64, p = 0.004), foot care at both follow-ups (β = 1.80, p < 0.001 and β = 2.02, p < 0.001, respectively), and medication management at both follow-ups (β = 0.83, p = 0.005 and β = 0.95, p = 0.003, respectively). The intervention also introduced significant improvements in Glycated Hemoglobin A (β = − 0.32%, p < 0.001), and self-efficacy at both follow-ups (β = 8.73, p < 0.001 and β = 9.71, p < 0.001, respectively). Conclusions The nurse-led integrative medicine-based structured education program could produce beneficial effects on multiple diabetes self-management behaviors, glycemic control and self-efficacy. Trial registration This study was retrospectively registered in the ClinicalTrials.gov . on 25/08/2017; registration number: NCT03261895 .
 
Study flow chart of CHD patients
Effect of CNISD on quality of life in CHD patients between CNISD and usual care group. **p < 0.01 vs. usual care
Effect of CNISD on physical activity and sleep quality in CHD patients between CNISD and usual care group. A Effect of CNISD on physical activity of CHD patients between CNISD and usual care group. B Effect of CNISD on sleep duration of CHD patients between CNISD and usual care group. C Effect of CNISD on sleep score of CHD patients between CNISD and usual care group. TAC/h, average Total Activity Counts per hour. *p < 0.05, **p < 0.01 vs. usual care
Effect of CNISD on recurrence, mortality, and satisfaction in CHD patients between CNISD and usual care group. A Recurrence of CHD patients between CNISD and usual care group. B Mortality of CHD patients between CNISD and usual care group. C Satisfaction score of CHD patients between CNISD and usual care group. *p < 0.05, **p < 0.01 vs. usual care
Objectives Patients with coronary heart disease (CHD) experience stress and suffer from the risk of recurrence and death. Comprehensive nursing intervention based on self-disclosure (CNISD) is an interdisciplinary service and an effective approach to care that improves quality of life and alleviates suffering for patients with CHD. The purpose of this study was to analyze the effects of CNISD on alexithymia in patients with CHD. Methods A total of 1088 patients with CHD were recruited and received CNISD ( n = 540) and usual care ( n = 548). The quality of life, alexithymia, four statutory health insurance funds, recurrence, mortality, and satisfaction was compared in patients with CHD between CNISD and usual care group. Results Outcomes showed that CNISD improved sleep quality and quality of life, increased physical activity, reduced the hospital anxiety and depression scale in patients with CHD compared to usual care. Recurrence and mortality of patients with CHD were markedly improved by CNISD compared to patients with CHD in usual care group. Conclusions In conclusion, data in this study indicate that CNISD presents benefits in improving quality of life, physical activity, anxiety, depression, recurrence, and mortality for patients with CHD.
 
Top-cited authors
Evridiki Papastavrou
  • Cyprus University of Technology
Peter Donald Griffiths
  • University of Southampton
Farkhondeh Sharif
  • Shiraz University of Medical Sciences
Anne Marie Rafferty
  • King's College London
Walter Sermeus