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Chutikarn Suriya,1 Nongyao Kasatpibal,2 Wipada Kunaviktikul,2 Toranee Kayee31Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, 2Faculty of Nursing, Chiang Mai University, 3Department of Surgery, Nakornping Hospital, Chiang Mai, ThailandObjective: To perform and confirm a simplified diagnostic indicators scoring system for predicting peptic ulcer perforation (PUP).Methods: A case–control study was conducted including 812 consecutive patients with PUP from retrospective medical records. Each diagnostic indicator measurable at the time of admittance was analyzed by a multiple regression. Stepwise logistic regression was applied with backward elimination of statistically significant predictors from the full model, with P ≥ 0.05 for exclusion. The item scores were transformed from regression coefficients and computed to a total score. The risk of PUP was interpreted using total scores as a simple predictor. This system was internally validated in 218 consecutive patients and compared to existing systems.Results: A PUP risk score was determined from the diagnostic indicators associated with PUP: gender, age, nonsteroidal antiinflammatory drugs used, history of peptic ulcer, intense abdominal pain, guarding, X-ray free air positive, and referral from other hospitals. Item scores ranged from 0–6.0 and the total score ranged from 0–34.0. The area under the receiver operating characteristic curve shows that there was 91.73% accuracy in the total scores predicting the likelihood of PUP. The likelihood of PUP among low risk (scores

Chutikarn Suriya1, Nongyao Kasatpibal2, Wipada Kunaviktikul2, Toranee Kayee31Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, 2Faculty of Nursing, Chiang Mai University, 3Department of Surgery, Nakornping Hospital, Chiang Mai, ThailandIntroduction: Limited data currently exists regarding the diagnostic indicators of peptic ulcer perforation for early detection among patients in Thailand. Delayed diagnosis and treatment for an ulcer can be life-threatening, resulting in shock or death.Objective: To determine the diagnostic indicators of peptic ulcer perforation.Material and methods: A cohort study was conducted in a tertiary care hospital in Thailand from 2005 to 2009. Peptic ulcer patients aged 15 years and over admitted to the surgical department were included. The diagnostic indicators used criteria of the patients' final diagnoses and operations, coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, which included patient profiles, gender, age, coexisting illnesses, personal habits, signs and symptoms, laboratory investigations, radiological finding, and treatment role. Exponential risk regression analyses to obtain relative risk (RR) estimates for diagnostic indicators were analyzed using Stata® statistical software package, version 11 (StataCorp LP, College Station, TX).Results: The study included 1290 patients. Of these, 57% reported perforated peptic ulcer. Multivariate analysis showed five diagnostic indicators: signs and symptoms including intense abdominal pain (RR = 1.53, 95% confidence interval [CI] 1.14–2.06), tenderness (RR = 1.94, 95% CI 1.17–3.21), and guarding (RR = 1.52, 95% CI 1.05–2.20); X-ray with free air (RR = 2.80, 95% CI 2.08–3.77); and referral from other hospitals (RR = 1.37, 95% CI 1.03–1.82).Conclusion: Five diagnostic indicators for peptic ulcer perforation monitoring were suggested from this study. Improving diagnostic indicators for medical care may improve the outcome of patients that have perforated peptic ulcer.Keywords: diagnostic indicator, peptic ulcer perforation, Thailand

Advance care planning is a process of discussion in which patients can communicate their end-of-life care preferences to family members and health care providers for consideration. Readiness for advance care planning is a patient’s preparedness to engage in advance care planning. This review aims to develop the conceptual framework for advance care planning readiness for Chinese older people. The current knowledge from the published studies was identified and synthesized by an integrative review. The conceptual framework was developed based on the social-ecological model and the theory of planned behavior. The factors from the social environment/community, health care professionals, and individual/family layers were defined. These factors may influence an individual’s medical decision-making, which in turn triggers individual behavioral mechanisms that arise from interactions between motivations, attitudes, and beliefs. Relevant factors should be considered when assessing the behavior of personnel engaged in advance care planning or formulating appropriate intervention measures to improve advance care planning participation in China. This framework can be used to guide studies that explore how the social/familial/individual factors predict the readiness for advance care planning among Chinese older people, and to design intervention studies to test the effect of family function on the readiness for advance care planning.

Aim: To develop a strategic model of participation in policy development for nurses in Thailand. Background: Public health policies inevitably affect nursing practice, service delivery and the nursing workforce. Available evidence indicates that nurses have minimal participation in policy development. Introduction: Nurses' participation in public health policy development is essential to developing and maintaining an efficient, high‐quality healthcare system. Methods: The Delphi method was used to develop the strategic model based on the input of fifteen nurse experts who were interviewed over three Delphi rounds. Data were analysed descriptively to identify items to be retained or dropped, and the final list of statements was verified by all participants to establish the strategic model of participation. Findings: The strategic model contains twenty‐five participation strategies for nurses wishing to engage with public health policy development. Within the model, the priorities as identified by clinical nurses, nurse leaders, nurse researchers and scholars, nursing educational institutions and nursing professional organizations are acknowledged. Conclusion: The model represents a consensus of values related to policy participation by nurses and the results align with similar studies. The inclusion of different nursing groups in promoting and developing strategies to participate in policy development ensures that all nurses have a role to play in developing nursing capacity for effective health policy engagement. Implication for nursing policy: Nursing involvement in policies that affect them and their practice is fundamental to establishing good public policy. This research provides a clear mechanism for the development of nurses' awareness and abilities to become involved in policy development and review processes. [ABSTRACT FROM AUTHOR]

Background: A growing global nursing shortage has affected the quality of care (QOC) provision. Aim: To test the structure‐process‐outcome model for quality of nursing care in regional medical centres in Thailand. Methods: A cross‐sectional study with multi‐stage, proportional stratified random sampling. The sample comprised 136 units, 916 nurses and 943 patients from nine regional medical centres. Data were collected from six instruments in February–June 2016 and analysed with structural equation modelling. Results: The modified model fitted the empirical data. The nurse practice environment (NPE) had a negative direct effect on pressure ulcer prevalence and a positive direct effect on patient satisfaction, perceived QOC and interpersonal processes of care (IPC). Increasing the patient‐to‐nurse ratio had a positive direct effect on catheter‐associated urinary tract infections and pressure ulcer prevalence and had negative direct effects on patient satisfaction and perceived QOC. Skill mix had negative direct effects on the two former conditions but had a positive direct effect on patient satisfaction. The patient‐to‐nurse ratio and skill mix also had indirect effect on four outcomes via NPE. Limitations: The generalizability of findings may be limited to settings similar to this study. Conclusion: We empirically demonstrated that NPE, patient‐to‐nurse‐ ratio and skill mix had direct effects on unfinished nursing care and four outcomes. Also, the IPC had significant influence on patient satisfaction. Implications for nursing and health policy: The findings add to increasing international evidence that favourable nurse working conditions, low nurse‐to‐patient ratio and richer skill mix result in positive patient outcomes. Health systems can foster nurses to perform high‐quality care by improving work conditions, and providing sufficient nurses and resources. [ABSTRACT FROM AUTHOR]

The purpose of this descriptive study was to explain the levels of knowledge about and involvement in national health policy development by nurses in Thailand. The study used quantitative and qualitative means to gather data about the topic from two groups of professional nurses: 2121 nurses who worked in hospitals around the country and 26 nurse leaders who were members of steering committees in nursing professional organizations. A self-administered questionnaire and an interview guide regarding knowledge and involvement in national health policy were used for collecting the data. The content validity and reliability of the questionnaire were assured. The results showed that almost two-thirds of the sample had a high level of knowledge about national health policy development but that almost three-quarters of the sample had no involvement in national health policy development. The interviews of the nurse leaders showed that some of them had been involved directly in formulating health policy but most of them thought that they had not been involved directly. The results demonstrated that it is essential that nurses understand and be actively involved in national health policy development. [ABSTRACT FROM AUTHOR]

Factors predicting fatigue in Chinese nurses were examined in a descriptive, correlational study. The participants were 581 nurses working in general hospitals in Chengdu City, China. The study instruments included the Occupational Fatigue Exhaustion Recovery Scale, the Job Content Questionnaire, the Exposure to Hazards in Hospital Work Environments Scale, the Pittsburgh Sleep Quality Index, the Job Dissatisfaction Scale, the Beck Anxiety Inventory, and the Beck Depression Inventory. The data were analyzed by using descriptive statistics, Pearson's correlation, F statistics, and multiple regression. The findings revealed that 61.7% of the variance in chronic fatigue and 54.9% of the variance in acute fatigue were explained by the independent variables. Intershift recovery was the most important variable in the explanation of acute fatigue, while acute fatigue was the most important variable in the explanation of chronic fatigue. Different intervention strategies should be implemented regarding the different influencing factors of acute and chronic fatigue. [ABSTRACT FROM AUTHOR]

Decisions about nurse staffing levels in intensive care units (ICUs) should be guided by research to ensure optimal outcomes. This descriptive correlational study in a large Thai hospital was designed to evaluate the effect of nurse staffing levels on the costs of care, in terms of medical care cost per patient day and health personnel cost per patient day, in ICUs. The costing data were collected prospectively from the records of 242 critically ill patients while the nurse staffing levels were extracted from hospital management reports. The findings showed that a nurse staffing model with a higher number of registered nurses (RNs) led to an increase in the health personnel cost per patient day. However, a greater number of RNs was associated with improved patient safety and efficiency, thereby reducing the length of stay and the costs of care in the long term. This study provides evidence to support decisions by hospital administrators concerning RN staffing levels. [ABSTRACT FROM AUTHOR]

In Thailand, quality of nursing care has been defined. The next step is to determine how to measure quality. Given the limited resources to provide health care and the demands to justify the use of registered nurses, there is an urgent need to demonstrate how professional nursing care makes a difference to outcomes of care. The purpose of this study was to further refine nursing indicators of quality by developing operational definitions, validating them and then determining their applicability in a variety of clinical settings. The process included three phases. The first phase used focus groups to identify and define indicators of quality nursing care and the second phase included testing these indicators in four settings to determine if data could be collected. Manuals were developed that defined the quality indicators and the scoring system to be used in the assessment. In the third phase, the findings were presented to a group of experts and minor changes were made to the indicators. Then, the indicators were categorized into three groups: structure, process, and outcome. The validated outcomes and manual for their assessment and monitoring were sent to all hospitals in Thailand. The study relied upon the findings from the four different hospitals. If the indicators were implemented in a wider variety of settings, other differences might have emerged. There is also a possibility that 'best practice' might not be reflective of the scientific basis of nursing practice. The findings generally support the initial work carried out in the USA. There is a need to continue to study how these indicators can improve patient outcomes. [ABSTRACT FROM AUTHOR]

This article presents the derivation of moral competence in nursing practice by identifying its attributes founded on Thai culture. In this process moral competence is formed and based on the Thai nursing value system, including personal, social and professional values. It is then defined and its three dimensions (moral perception, judgment and behavior) are also identified. Additionally, eight attributes as indicators of moral competence are identified and selected from three basic values. The eight attributes are loving kindness, compassion, sympathetic joy, equanimity, responsibility, discipline, honesty, and respect for human values, dignity and rights. All attributes are discussed by addressing the three moral dimensions in order to present how to deal with ethical issues in nursing practice. As a summary, a model of moral competence is presented to demonstrate moral competence in nursing practice in Thailand. [ABSTRACT FROM AUTHOR]

Background. In Thailand there is a need to establish definitions of quality of nursing care and to determine how it is measured. There is an urgent need to focus more closely on indicators of nursing quality. In Thailand there is no agreed upon definition of quality nursing care or indicators by which to measure it.Purpose. The purpose of this research was to develop a definition of quality of nursing care and to begin the process of defining quality of care indicator measures to evaluate the care given in acute care settings.Methods. This descriptive study was conducted in Thailand. The process included two phases. The first phase used individual interviews and focus group discussion and the second phase included consultation with quality of nursing care experts. An interview guide was used to structure the interviews and the draft definitions of quality and suggested indicators were used when consulting with the experts in the second phase of the study.Findings. The findings are organized into two sections: (1) definition of quality of nursing care and quality of nursing indicators; and (2) consultation with Thailand quality experts to refine the definition and quality of care indicators. The indicators were categorized into three groups: structure, process, and outcome.Limitations. This descriptive study using qualitative method relied upon the opinions of various stakeholders. Their opinions may or may not have any direct relationship to the scientific literature related to quality. Many of the indicators need to be further refined.Conclusions. The findings generally support the initial work done in the United States of America. There is a need to further refine the various Thailand indicators. This study is the first in Thailand that has attempted to address quality of nursing care. [ABSTRACT FROM AUTHOR]

This study was conducted to describe level of conflict, conflict management styles, level of job satisfaction, and intent to stay, and to ascertain relationships among conflict, conflict management styles, level of job satisfaction, intent to stay, and turnover of professional nurses in Thailand. The sample was 354 professional nurses employed in four regional hospitals in Thailand. The findings showed that the overall level of conflict was at a moderate level. The majority of subjects used accommodation most frequently to manage conflict. Subjects were dissatisfied with pay but were neither satisfied nor dissatisfied with work, supervision, opportunities for promotion, co-workers and the job in general facets of job satisfaction. Most subjects had a high intent to stay in their present jobs for 1 year (97.1%) but intent to stay for the next 5 years decreased (78.5%). The result showed some relationships among these variables, but no relationship between intent to stay and turnover of professional nurses. [ABSTRACT FROM AUTHOR]

The aim of this study is to describe nursing and nursing education in Thailand. Historical information about the development of nursing in Thailand, nursing licensing laws, nursing programs, and the description of a typical nursing program is provided. The nursing educational system in Thailand is growing and can serve as a model for other developing countries. [ABSTRACT FROM AUTHOR]

Background: In this time of global nursing shortages, investment in nursing is vital, and hospitals need to apply a range of strategies to attract and retain nurses. Rewards are an effective strategy for the retention of nurses and help improve the performance and productivity of hospitals. In rural and remote communities, however, nurses may not have access to the rewards that urban-based nurses have., Aim: To explore the preferred rewards of registered nurses in rural and remote community hospitals in Thailand., Methods: An explanatory mixed-methods design was employed for the overall study, and the results from the qualitative descriptive phase are reported here using the COREQ checklist. We collected data during in-depth interviews with 24 informants from 8 community hospitals. Thematic analysis was used for data analysis., Findings: Four major themes regarding reward types were preferred by the nurses: reasonable pay, good benefits, accessible learning and development, and a favorable work environment., Conclusion: A package of total rewards that best suit nurses working in rural and remote areas needs to be implemented, for a combination of different types of rewards has a greater impact than a single reward at both individual and organizational levels., Implication for Nursing and Health Policy: It is crucial to identify those rewards to attract and retain nurses. In Thailand, nursing and health workforce policies need to be based on nurse preferences regarding salary, benefits, and recognition commensurate with other healthcare professionals, including civil servant status, as well as improving the work environment., (© 2022 International Council of Nurses.)

Background and Purpose: Factors influencing work-life balance of regional hospital nurses are different from other professions. This study aimed to develop an instrument to measure work-life balance, and examine its psychometric properties. Methods: Psychometric properties were tested with content validity, construct validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and reliability with 598 professional nurses recruited using multi-stage sampling. Results: The Nurses' Work-life Balance Scale (NWLBS) had 38 items and seven components, explaining 64.46% of total variance. Content Validity Index was 0.94. CFA results indicated good fit with empirical data. Cronbach's alpha ranged from 0.53 to 0.94 for the seven subscales in 30 professional nurses. Conclusions: NWLBS demonstrated good content validity, construct validity, and reliability for assessing nurses' work-life balance., (© Copyright 2023 Springer Publishing Company, LLC.)

Aim: To test the causal model of intent to stay in employment of nurses in regional medical centers., Background: Effectiveness and quality of nursing care are determined by an adequate number of nursing staff; however, there is an ongoing challenge of nursing shortage. Improving nurses' intention to remain in employment is an effective way to address the problem of nursing shortage., Methods: This study employed a cross-sectional design. The sample was 1224 registered nurses from nine regional medical centers across Thailand, selected using multistage random sampling. Data were collected between January and July 2019 and analyzed with structural equation modeling., Results and Discussion: The final model could explain 40.3% of the variance in intent to stay. Transformational leadership, coworker support, professional autonomy, opportunities for promotion, marital status, and job satisfaction positively affected intent to stay, while burnout negatively affected intent to stay. This indicates that seven factors that should be considered by nurse managers in developing a framework for constructing interventions to increase nurses' intention to continue working in their organization., Implication for Nursing and Nursing Policy: Nurse managers should strengthen the intent to stay of nurses by providing consultations, building a positive work atmosphere, and encouraging nurse leaders to apply transformational leadership behaviors to the organizational administration. Policymakers should consider enacting policies and regulations for nurses' benefits, such as allocating civil servant positions to temporary nursing staff, expanding the framework of career advancement to a senior professional position, and considering salary and overtime pay, to increase nurses' intent to stay in an organization., (© 2022 International Council of Nurses.)

Aim: Retaining nurses on the job is vital, and their successful retention is related to the organizational climates (OC) of healthcare settings. The purpose was to develop and test the psychometric properties of the Perceived Organizational Climate Scale (POCS)., Design: The methodologic research design was used by following the scale development strategies by DeVellis (2017). The conceptual framework for this study was based on the broader theoretical framework of the Competing Value Framework (CVF) of Quinn et al. (2015), the concept analysis and extensive literature review (1939-2018), and combined with the inductive qualitative data., Methods: A two-phase study of scale construction and psychometric testing was conducted for content validation, construct validation and internal consistency reliabilities of the instrument. An expert panel validated the 4-point scale, followed by exploratory factor analysis, the known-group approach and split groups. Data were collected from (1161) registered nurses in eight general hospitals across Myanmar from August 2019 to September 2020., Results: The 35 items with four essential dimensions: transformational climate, bureaucratic climate, team climate and strategic climate, explained almost 50% of the variation with all factor loading greater than .40. The internal consistency reliabilities of the instrument showed the Cronbach's alpha coefficient of .93, and the dimensions were from .82 to .85. As hypothesized, the known-group approach demonstrated that experienced nurses had higher mean scores than novices. The internal consistency reliabilities of the scale and dimensions across the splitting groups illustrated the stability., Conclusion: This evidence supports this instrument as having satisfactory initial psychometric properties with a comprehensive picture of OC by its essential components contributing to an inclusive understanding of this climate globally., Impact: This instrument can be used as an objective tool for evaluating OC as perceived by nurses in healthcare settings to inform improvements in working environments., (© 2022 John Wiley & Sons Ltd.)

Doctoral education, advanced practice and research are key elements that have shaped the advancement of nursing. Their impact is augmented when they are integrated and synergistic. To date, no publications have examined these elements holistically or through an international lens. Like a three-legged stool they are inter-reliant and interdependent. Research is integral to doctoral education and influential in informing best practice. This significance and originality of this discussion paper stem from an analysis of these three topics, their history, current status and associated challenges. It is undertaken by renowned leaders in 11 countries within the six World Health Organisation (WHO) regions: South Africa, Egypt, Finland, United Kingdom, Brazil, Canada, United States, India, Thailand, Australia, and the Republic of Korea. The first two authors used a purposive approach to identify nine recognized nurse leaders in each of the six WHO regions. These individuals have presented and published papers on one or more of the three topics. They have led, or currently lead, large strategic organisations in their countries or elsewhere. All these accomplished scholars agreed to collect relevant data and contribute to the analysis as co-authors. Doctoral education has played a pivotal role in advancing nurse scholarship. Many Doctor of Philosophy (PhD) prepared nurses become faculty who go on to educate and guide future nurse researchers. They generate the evidence base for nursing practice, which contributes to improved health outcomes. In this paper, the development of nursing doctoral programmes is examined. Furthermore, PhDs and professional doctorates, including the Doctor of Nursing Practice, are discussed, and trends, challenges and recommendations are presented. The increasing number of advanced practice nurses worldwide contributes to better health outcomes. Nonetheless, this paper shows that the role remains absent or underdeveloped in many countries. Moreover, role ambiguity and role confusion are commonplace and heterogeneity in definitions and titles, and regulatory and legislatorial inconsistencies limit the role's acceptance and adoption. Globally, nursing research studies continue to increase in number and quality, and nurse researchers are becoming partners and leaders in interdisciplinary investigations. Nonetheless, this paper highlights poor investment in nursing research and a lack of reliable data on the number and amount of funding obtained by nurse researchers. The recommendations offered in this paper aim to address the challenges identified. They have significant implications for policy makers, government legislators and nurse leaders., Competing Interests: None, (© 2022 Published by Elsevier Ltd.)

Background: The COVID-19 pandemic has caused extraordinary disruptions to education systems globally, forcing a rapid switch from conventional to online education. Although some qualitative studies have been carried out exploring the online education experiences of nursing students and faculty members during the COVID-19 pandemic, to our knowledge, no study has used the Photovoice approach., Objectives: To explore the experiences of nursing students and faculty members as related to online education during the COVID-19 pandemic., Design: A descriptive qualitative design using Photovoice was adopted., Setting: The study took place across five countries and one city in Southeast Asia (Indonesia, Malaysia, the Philippines, Thailand, Vietnam, and Hong Kong)., Participants: Fifty-two nursing students and twenty-eight nursing faculty members who participated in online education during the COVID-19 pandemic., Methods: Each participant submitted one photo substantiated with written reflections. Data were analysed using thematic analysis. Ethical approval was obtained from institution-specific ethics boards., Results: Three themes and eleven sub-themes emerged from the data. The three main themes were: 1) Psychological roadblocks to online education; 2) Developing resilience despite adversities; and 3) Online education: What worked and what did not., Conclusion: Through Photovoice, the reflections revealed that nursing students and faculty members were generally overwhelmed with the online education experience. At the same time, participants were satisfied with the flexibility and convenience, opportunities for professional and personal development and safety afforded by online education. However, concerns over academic integrity, practical skills and clinical competencies, engagement and participation, the duality of technology and social isolation out-shadowed the advantages. It is worthwhile to explore the concerns raised to enhance online education across the nursing curriculum., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The COVID-19 pandemic has disrupted the lives of many. Particularly, nursing students experience greater stress as their normal curriculum is interrupted and some of them face the risk of being infected as frontline workers. Nursing faculty members may face similar struggles, in addition to developing teaching materials for online learning. Thus, it is important to examine the faculty members' and students' views on their ability to adapt during the pandemic to obtain a holistic view of how learning and training has been affected., Design: The descriptive cross-sectional quantitative design was used., Settings: Data were collected from Southeast and East Asian Nursing Education and Research Network (SEANERN) affiliated nursing institutions from January 2021 to August 2021., Participants: A total of 1897 nursing students and 395 faculty members from SEANERN-affiliated nursing institutions in Cambodia, Hong Kong, Indonesia, Japan, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam were recruited for this study., Methods: Quantitative surveys were used to explore the satisfaction levels in education modalities, confidence levels, psychosocial well-being, sense of coherence and stress levels of nursing students and faculty members during the COVID-19 pandemic., Results: Participants were mostly satisfied with the new education modalities, although most students felt that their education was compromised. Both groups showed positive levels of psychosocial well-being, despite scoring low to medium on the sense of coherence scale and experiencing great stress. The participants' sense of coherence was positively correlated with their psychosocial well-being and negatively correlated with stress levels., Conclusions: While the COVID-19 pandemic had negatively impacted the lives of nursing students and faculty members, most of them had a healthy level of psychosocial well-being. Having a strong sense of coherence was associated with better psychosocial health and lower stress levels. As such, it may be helpful to develop interventions aimed at improving the sense of coherence of nursing students and staff to help them manage stressors better., (Copyright © 2022. Published by Elsevier Ltd.)

Aim: This study aimed to illustrate the relationship between nurse staffing and missed care, and how missed care affects quality of care and adverse events in Thai hospitals., Background: Quality and safety are major priorities for health care system. Nurse staffing and missed care are associated with low quality of care and adverse events. However, examination of this relationship is limited in Thailand., Methods: This cross-sectional study collected data from 1188 nurses in five university hospitals across Thailand. The participants completed questionnaires that assessed the patient-to-nurse ratio, adequacy of staffing, missed care, quality of care and adverse events. Logistic regression models were used to estimate associations., Results: Higher patient-to-nurse ratio, poor staffing and lack of resource adequacy were significantly associated with higher odds of reporting missed care. Higher nurse-reported missed care was significantly associated with higher odds of adverse events and poor quality of care., Conclusions: Poor nurse staffing was associated with missed care, and missed care was associated with adverse events and lower quality of care in Thai university hospitals., Implications for Nursing Management: Improving nurse staffing and assuring adequate resources are recommended to reduce missed care and adverse events and increase quality of care., (© 2021 John Wiley & Sons Ltd.)

Background: The incidence of social isolation among older adults is on the rise in today's health care climate. Consequently, preventing or ameliorating social isolation through technology in this age group is now being discussed as a significant social and health issue., Aim: The purpose of the opinion paper is to clarify social transformation through technology and shed light on a new reality for older adults in situations of social isolation. Our goal is to persuade the reader that our position on this topic is a valid one. We support our claims with practice-based evidence and published research studies., Methods: To do so, we checked the most recent literature, most of which came from the last decade. Our literature survey focused primarily on what is known about technology and how technology can affect social transformation and perceptions of social isolation., Findings: Two dominant transformative realities became the focal points: the precarious implications of loneliness for older adults and the emerging reality of social change through digital technology central to eHealth and mHealth., Discussion: To benefit from new technologies and reduce the detrimental effects of social isolation, we must engage older adults in a meaningful way and adapt the system of smart devices to reflect the specific physiological and psychological characteristics of the ageing population., Conclusion: Older adults need to comprehend the meanings of their social experiences to preserve their active lifestyle. Human interactions may be desirable, but technological dominance may also minimize the adverse effects of social isolation., Competing Interests: Conflict of Interest None.

Purpose: To explore nurses' perceptions of the organizational climate in general hospitals in Myanmar., Design and Methods: Using a qualitative descriptive design, data were purposively collected from all levels of registered nurses in eight general hospitals across Myanmar during August to October 2019. Seventeen individual in-depth interviews and eight focus group discussions with 65 nurses were undertaken and analyzed using Graneheim and Lundman's qualitative content analysis., Findings: Four categories of organizational climate from a Myanmar nursing context emerged: organizational uniqueness, organizational alignment, sense of empowerment, and the reinforcing organization. Organizational uniqueness included the subcategories of perception of features and orientation of the organization, whilst organizational alignment comprised the three subcategories of the values inherent in the management process, the criteria of success, and strategic emphasis. The sense of empowerment category embraced the subcategories of the perceptions of the decision making and roles of leaders or managers; the last category, the reinforcing organization, incorporated the subcategories of bonding and recognition of the organization., Conclusions: This was the first qualitative nursing study on nurses' perceptions of organizational climate in Myanmar hospitals. Participants revealed a rich source of information that needs to be considered by hospital administrators and other policymakers to enhance quality clinical care by nurses, and their overall well-being and working conditions. The emphasis on the holistic nature of this concept points to further investigations of working conditions, the lives of nurses, and management of nurses within the hospital environments in Myanmar hospitals, and can inform other countries., Clinical Relevance: Nurses revealed a rich understanding of what an organizational climate represents or should represent, and they need to work with hospital administrators and managers to contribute to the development of positive organizational climate, which in turn should increase nurse retention and the efficacy of health care provided in hospitals., (© 2021 Sigma Theta Tau International.)

The purpose of this article is to identify the commonalities in nursing perspectives among 6 countries/regions (United States, South Korea, Taiwan, Japan, Hong Kong, and Thailand). Nine leaders from the 6 countries/regions reflected on what nursing perspectives were in their own countries/regions and provided exemplars/cases from their own experiences and literature reviews. The data were analyzed using a content analysis. Seven themes were extracted: (a) "embedded in cultural and historical contexts"; (b) "based on philosophical pluralism"; (c) "women-centered perspectives"; (d) "care-oriented holistic views"; (e) "ethical and humane views"; (f) "respecting and advocating"; and (g) "considering diversities.", (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Quality Nursing Care (QNC) is fundamental to the profession of nursing practice. Perception of QNC differ across the globe because of differences in social norms, cultural values and political ambiance and economy. This study aimed to develop a QNC instrument congruent with the Mongolian (QNCS-M) healthcare system and cultural values and societal norms., Methods: Exploratory sequential mixed-method design was implemented to develop and assess performance of QNCS-M. First, we focused on developing the components of QNCS-M and their operational definitions. Second, we dedicated to ascertaining psychometric performance of QNCS-M. The field testing consisted of assessing the construct validity and internal consistency reliability. Correlation between QNCS-M and the criterion tool, Quality of Nursing Care Questionnaire-Registered Nurse was evaluated., Results: The initial version of QNCS-M contained 66 items of which 7 (I-CVI < .78) were deleted after item-content validity assessment. The total-item correlation analysis yielded to exclusion of another 3 items (<.3). Additional 12 items were excluded after inter-item correlation (<.3, >.7). Results from Spearman rank-order correlation analysis of the remaining 44 items indicated relationship between social desirability and 6 items (r = -.09 to r = .11). These items were excluded to reduce the likelihood of potential information bias. A total of 38 items remained for exploratory factor analysis. Results from exploratory factor analysis yielded eigenvalues > 1.0 for the 9 domains. Three domains contained items fewer than 3. These domains and 2 items (factor loading <.4) were eliminated, yielding to 6 domains with 36-item. Results from internal consistency reliability yielded an overall Cronbach's α = .92; the coefficient values for the 6 domains ranging between .72 and .85 and Pearson correlation for stability reliability yielded an acceptable (r = .82, P < .001)., Conclusion: Improving the quality of healthcare services delivered by nurses is a priority for the Mongolian government. The development of QNCS-M is a major stride in addressing this concern. The final version of QNCS-M which contains 36 items, loaded into 6 domains, was morphed to the specifics of the Mongolian healthcare systems and cultural values and societal norms. QNCS-M demonstrates a high level of content and construct validity with acceptable reliability.

Aim: The overarching objective of this report is to provide an updated definition of the concept of organizational climate and to strengthen its operational application., Background: Organizational climate is one of the major contributing factors to the exodus of the nursing workforce from the profession. Extensive research has addressed the impact of "organizational climate" on the nursing workforce; yet variations in the interpretation of the concept calls for an updated definition., Design: Walker and Avant's strategy was implemented., Data Source: Data were compiled from Medline and CINAHL, Google search engine, and book chapters., Review Method: A comprehensive and detailed review of the literature was performed. Nineteen historic publications (1939-2012) and 39 healthcare-related publications (2013-2018) were included in the final review., Results: The climate of an organization reflects a set of core values and behaviors that can be used to implement evidence-based leadership and management within the context of the 21st century. We have revised the definition of organizational climate to capture this context., Conclusion: The perception of a supportive and constructive climate in an organization propels the workforce, independent of ethnic or personal background, to a higher level of productivity and encourages loyalty and workforce stability., (© 2020 Wiley Periodicals LLC.)

Introduction: Because virtually no theories were available to explain unique characteristics of Asian women's leadership in nursing, a middle-range theory on women's leadership in Asian culture was previously published. To reflect recent political and social changes in different countries, there is a necessity to refine the theory. The purpose of this article is to present the refined middle-range theory on Asian women's leadership in nursing. Methodology: Using an integrative approach, the theory was further developed based on two major sources: literature reviews and exemplars/cases from six different countries. Results: The Refined Middle-Range Theory on Women's Leadership in Asian Culture has two main domains: (a) leadership frames and (b) leadership contexts. The domain of leadership contexts has been extended with two additional main concepts including demographic contexts and health workforce/system contexts. Discussion: The refined theory is expected to guide Asian women's leadership in nursing across the globe.

Educational institutions began international student placements or exchanges in earnest in the 1990s, with varying degrees of success. Although nursing education in a number of countries has embraced giving undergraduate students the opportunity of international experiences, this is still not the norm in many countries, nor within all nursing schools within a country. In our rapidly globalizing world, it is critical that students are given opportunities internationally to be better prepared for practice, to achieve a global mindset, and to take their place as future global citizens through international experiences. Evidence from the literature shows positive effects on nurses having had international experiences to broaden their horizons, examine other cultures, grow their cultural competence, share and gain knowledge with others, and build their capacity for future practice in an increasingly globalized world. Our focus here is on providing students with short-term undergraduate exchanges or placements in international settings, and encouragement for nursing institutions to develop international partnerships that are sustainable. Some implications for nurse educators and other staff involved in international exchanges are also considered., (© 2020 John Wiley & Sons Australia, Ltd.)