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Objectives: The emergency response capacity of nurses is quite important during the COVID-19 epidemic. This study aimed to determine the relationship of resilience with emergency response capacity and occupational stresses during COVID-19 re-outbreak., Methods: This is a cross-sectional study that involved 241 new nurses. Questionnaires (including demographic characteristics and self-report questionnaires) were sent via QR code and used to conduct an online survey of new nurses. Resilience, emergency response capacity, and occupational stressors were measured using questionnaires., Results: Mean resilience score was 62.68 ± 14.04, which corresponds to a moderate level. Age, marital status, and work experience were significantly associated with resilience ( P = 0.037, P = 0.046, P = 0.011) and emergency response capacity (P = 0.018, P = 0.045, P < 0.000). Total score and 3 dimensions of resilience were positively correlated with emergency response competency questionnaire and 3 dimensions (P < 0.01). Total scores of the nurse job stress scale and patient care dimension were negatively correlated with resilience scores (P < 0.05). Resilience played a partial mediating role in occupational stressors and emergency response capacity, and mediating effect accounted for 45.79% of the total effect., Conclusions: The nursing superintendent must pay more attention to the resiliency of new nurses to reduce occupational stressors and improve emergency response capacity while helping new nurses cope with COVID-19 re-outbreak.

Background: Recently, the concept of expanded terminal sedation emerged to describe using sedation at the end of life in cases beyond the usual use. Using this sedation could be a stressful ethical encounter for healthcare providers., Case: In this paper, we describe a case of a Muslim palliative care nurse who cared for a patient with cancer who requested expanded terminal sedation. The palliative care nurse described that his initial response to the expanded terminal sedation order was refusing to start the sedation because he believed the patient was not terminally ill and was concerned about killing him, which is prohibited according to his religious beliefs. Further, the nurse perceived the patient's psychological distress and his verbalization of wishing to die peacefully as a concealed request for euthanasia, especially since he was not imminently dying. Finally, the nurse reported being frustrated and uncertain about the care, especially since he did not receive appropriate psychological counseling from professional personnel., Conclusions: any case beyond the usual conditions for terminal sedation should be carefully examined, especially when nurses' religious beliefs or moral values contradict it. If sedation should be administered, adequate preparation of healthcare providers should be arranged, including discussing with them the goals of care and the rationale for sedation before and after initiating it. Generating a policy for conscientious objections, allowing nurses to express their own emotions and concerns in a supportive environment are suggested approaches to preserve their wellness., Competing Interests: Declarations. Ethics approval and consent to participate: The study was performed in accordance with the Declaration of Helsinki. Consent for publication: Written informed consent for publication of clinical details was obtained from the participant. A copy of the consent form is available for review by the Editor of this journal. Competing interests: The authors declare no competing interests. Informed consent: was obtained from participants., (© 2024. The Author(s).)

Background: The deteriorating psychosocial work environment among healthcare workers in Sweden, influenced by demanding working conditions and resource constraints, affects individual well-being and patient care quality. Healthcare workers, including physicians, registered nurses, and nursing assistants, often work interdependently and share workplaces, yet are three completely different professions. Nonetheless, comprehensive studies comparing their psychosocial work environments are scarce; often focusing on healthcare workers either separately or as a homogenous group, but rarely comparative., Aim: Utilising the job demands-resources model, this study investigated variations in the psychosocial work environment among Swedish healthcare workers. We wanted to identify how the antecedents of individual well-being, in the form of demands and resources, differed between healthcare workers., Method: Data from the 2022 Longitudinal Occupational Health Survey for Health Care in Sweden were analysed; the participants included 7589 physicians, registered nurses, and nursing assistants. The analysis involved descriptive statistics, including measures of means and analysis of covariance (ANCOVA), employing the Bonferroni correction for multiple post hoc comparisons. The ANCOVA was also stratified by working factors, including years of work experience and employment within the private/public sector., Results: The study revealed significant variations in how healthcare workers perceive their psychosocial work environment. Physicians faced the highest level of Quantitative Demands (mean (x̄) 3.15; 95% CI 3.11-3.19), while registered nurses reported the most Emotional Demands (x̄ 3.37; 95% CI 3.32-3.41). Nursing assistants had the highest grand means for the imbalance between Efforts and Rewards (Effort Reward Imbalance) (x̄ 1.49; 95% CI 1.49-1.49) and an imbalance between Work and Private Life (Work-Life Interference) (x̄ 3.20, 95% CI 3.15-3.25), along with limited resources. The stratified analysis showed that years of experience and the sector affected healthcare workers' perceptions of their psychosocial working environment. For example, registered nurses working in the private sector reported better working conditions than registered nurses working in the public sector. The situation for nursing assistants was reversed., Conclusion: Psychosocial work environments are experienced differently between and within healthcare professions in Sweden. This study provides crucial insights for improving workplace conditions and consequently enhancing healthcare professionals' well-being and quality of patient care., Competing Interests: Declarations Ethics approval The Longitudinal Occupational Health Survey for Health Care Occupations in Sweden was approved by the Swedish Ethical Review Authority (2021-05574-02; 2022-00310-02; 2022-02765-02).. Consent for publication All physicians, registered nurses and nursing assistants provided consent for publication when they logged in to the web survey or posted the paper survey. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: The aim of this study was to develop the Nurse Competency Assessment Scale in Disaster Management (NCASDM) and to conduct psychometric evaluation., Methods: It is a scale development study. Research data were collected between January and May 2023. In the sample of the study, as stated in the literature, it was aimed to reach at least 10 times the number of draft scale items ( n = 600). The psychometric properties of the scale were tested with 697 nurses working in four different hospitals. A three-stage structure was used in the analysis of data: (1) creating the item pool, (2) preliminary evaluation of items, (3) refining of the scale and evaluation of psychometric properties. The content validity, construct validity, internal consistency, and temporal stability of the scale were evaluated according to the scale development guidelines., Results: The scale items were obtained from online, semi-structured, in-depth individual interviews conducted with nurses who experienced disasters or worked in disasters. The content validity index of the scale was found to be 0.95. According to the exploratory factor analysis, it was found that the scale consisted of 43 items and two subscales, and the subscales explained 79.094% of the total variance. The compliance indices obtained as a result of confirmatory factor analysis were acceptable and at good levels., Conclusions: The NCASDM was found to be a psychometrically valid and reliable measurement tool. It can be used to evaluate the competency of nurses related to disaster management.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prominent cause of chronic liver disease, and occupational stress may serve as a potential risk factor. This study aims to assess the association between occupational stress trajectories and incident MASLD among Chinese female nurses., Methods: We conducted a prospective longitudinal study using data from the Nurse' Health Cohort Study, involving 1,113 female nurses, free of MASLD at baseline (2018). Occupational stress was measured using the Chinese Nurse Job Stress Scale at four time points. Group-based trajectory modeling was used to identify distinct stress trajectories. Through doctors' diagnoses, we assessed incident MASLD over a subsequent 6-year period from 2019 to 2024. Cox proportional hazards regression models evaluated the association of stress trajectories and MASLD risk, adjusting for demographics, work-related factors, and medical conditions., Results: During follow-up, 256 nurses reported incident physician-diagnosed MASLD. Three occupational stress trajectories were identified: moderate decreasing (36.4%), moderate stable (55.9%), and moderate increasing (7.7%). Participants in the moderate increasing stress trajectory had a significantly higher risk of developing MASLD (adjusted HR: 3.14, 95% CI: 2.19-4.49, p < .001) compared to those in the moderate stable trajectory. This association between stress trajectory and MASLD risk was not modified by age or BMI (p interaction >0.50)., Conclusions and Relevance: The study concludes that increasing stress levels over time are associated with a higher incidence of MASLD. These findings underscore the importance of stress management interventions in reducing the risk of MASLD progression. Further research is needed to explore the underlying mechanisms and to develop targeted strategies for stress reduction in clinical settings., Competing Interests: Declarations Ethics approval and consent to participate All experiments were performed in accordance with relevant guidelines and regulations (such as the Declaration of Helsinki). The present study was approved by the institutional review board at Shengjing Hospital of China Medical University (2018PS09K). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The purpose of this study was to investigate the current status and influencing factors of night shift nurses' sense of occupational benefit, and to explore the influence of psychological resilience on the sense of occupational benefit. 2022 from August to October, a cross-sectional survey was conducted on 719 night shift nurses using a general information questionnaire, psychological resilience scale, and sense of occupational benefit scale. A total of 719 valid questionnaires were collected. The score of night shift nurses' sense of occupational benefit was (137.40 ± 21.10) and psychological resilience score was (65.63 ± 17.75). Age (β = 3.359, P < .05) was significantly correlated with sense of occupational benefit. Education (β = 3.586, P < .05) was significantly correlated with the sense of occupational benefit, and whether or not they had participated in outbreak prevention and control (β = -2.321, P < .05) was significantly correlated with the sense of occupational benefit. Similarly, psychological resilience (β = 0.859, P < .05) was significantly associated with the sense of occupational benefit. Night shift nurses' sense of occupational benefit was moderate to high, and interventions should be taken to enhance the sense of occupational benefit based on nurses' age, education, whether they have participated in epidemic prevention and control, and psychological resilience., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Intensive care unit (ICU) patients face higher infection risks from invasive procedures, highlighting the critical role of ICU nurses in infection prevention. Clear differentiation between the patient and healthcare zones is essential for effective hand hygiene and disinfection, yet research on this topic is limited., Aim: To assess ICU nurses' perception of the concept of patient and healthcare zones and evaluate their similarity and accuracy in identifying the zones., Methods: A descriptive survey was conducted at a 2,732-bed tertiary hospital in Korea from 28 July to 27 August 2022. Participants were recruited from various ICUs through flyers. 225 questionnaires-with illustrations 27 item locations for three ICU scenarios-were made available at nursing stations for voluntary completion. Participants were asked to classify items into the patient zone or the healthcare zone. Similarity scores reflected participant agreement, while accuracy scores measured the proportion of correct answers. Participants' free-text opinions regarding zone classification were analysed thematically., Findings: 104 nurses participated voluntarily. Average similarity and accuracy were 84.7% and 82.7%, respectively. The top 8 items, with over 97% similarity and accuracy, were all frequently in contact with ICU patients (e.g., pulse oximeter, Levin tube, central line, urine bag, and patient bed). The bottom 7 items, with less than 80%, included the glucometer, flashlight, trolley, and sink. Participants with higher education levels had significantly higher similarity (p = .044) and accuracy (p = .033), whereas those already familiar with the patient-zone concept had significantly higher accuracy (p = .009). From the free-text analysis, participants considered factors beyond proximity to the patient, such as patient contact, room type, and distance., Conclusions: To address zone classification challenges, clear criteria for patient and healthcare zones, space redesign, and educational programs are recommended. Further research is necessary to improve greater clarity and consensus regarding patient and healthcare zones to enhance infection control practices., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chang, Kang. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Examining mental health among nurses in the later stages of the COVID-19 pandemic could offer valuable information for addressing these symptoms in the long term. Therefore, the current study aimed to assess the mental health and well-being of Chinese nurses, as well as investigate the impact of psychological flexibility and night shifts on this relationship., Method: In cross-sectional, hospital-based, multicenter study, 422 Chinese nurses were selected by multistage stratified cluster random sampling. The mental health status, psychological flexibility, and wellbeing were assessed via 12-item General Health Questionnaire (GHQ-12), Chinese version of Personalized Psychological Flexibility Index, and Chinese version of the 5-item WHO Well-Being Index, respectively. To examine the proposed theoretical model, we conducted structural equation modeling using SPSS Amos 26 version. The age, gender, night shift, psychological flexibility, mental health, and well-being data were entered into the model. Pearson correlation and chi-square were used to explore the correlation between variables., Results: The high night shifts, being young and low psychological flexibility significantly had a direct effect on worse mental health (night shifts: ES, 95% CI: 0.619, 0.328-0.725; age: ES, 95% CI: 0.542, 0.226-0.993; psychological flexibility: ES, 95% CI: 0.675, 0.369-1.466). The low psychological flexibility and worse mental health were able to directly effect on worse wellbeing (psychological flexibility: ES, 95% CI: 0.419, 0.757-1.519; mental health: ES, 95% CI: 0.719, 1.109-2.607). In addition, psychological flexibility through the mediation of mental health also had an indirect effect on wellbeing (ES, 95% CI: 0.269, 0.957-2.165)., Conclusions: Being young, having more night shifts and having less psychological flexibility can be related to the deterioration of mental health and well-being in nurses. Therefore, it is recommended that nurses use the shift routine program with the least focus on the night shifts. Also, interventions to teach younger nurses how to face work stress and interventions to improve the psychological flexibility of all nurses are needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Resilience is crucial for a health system to better prevent and respond to public health threats and provide high-quality services. Despite the growing interest in the concept of resilience in health care, however, there is little empirical evidence of the impact of organizational resilience, especially in primary care settings. As the largest professional group in primary care, primary care nurses are taking more and more responsibilities during their daily practice, which influences both their work conditions and well-being. This study aims to examine the association between organizational resilience and primary care nurses' working conditions and well-being. Using a convenience sampling approach, we recruited 175 primary care nurses from 38 community health centres (CHCs) in four cities in China. Organizational resilience was operationalized as comprising two domains: adaptive capacity and planning capacity, and measured using a 16-item scale. The primary care nurses' working condition indicators comprised variables of psychological safety, organizational commitment, professional commitment, and self-directed learning; well-being indicators included depression and burn-out. Hierarchical linear regression models were built for analysis. We found that the sampled CHCs have a relatively high level of organizational resilience. The organizational resilience was positively associated with the four indicators of working conditions: psychological safety (β = 0.04, P < 0.01), organizational commitment (β = 0.38, P < 0.01), professional commitment (β = 0.39, P < 0.01), and self-directed learning (β = 0.28, P < 0.01). However, organizational resilience was not significantly associated with the two well-being indicators. Furthermore, we found that the adaptive capacity has stronger association compared with planning capacity. Therefore, primary care manager should build resilient organizations, especially the adaptive capacity, in order to enhance primary care nurses' psychological safety, commitment and learning behaviours. Further studies should also be conducted to understand the link between organizational resilience and primary care nurses' well-being., (© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Background: Providing high-quality end-of-life care is currently a paramount health priority. Given that the standard of care is intrinsically linked to nurses' motivations, it is becoming too imperative to explore the contributing factors Consequently, this study was undertaken to elucidate the experiences of Iranian nurses regarding their motivation for delivering end-of-life care., Methods: This research is a qualitative, descriptive inquiry employing conventional content analysis, carried out at two governmental hospitals in Gorgan, northern Iran, from February to July 2023. 12 nurses were purposefully selected to participate in the study, ensuring maximal diversity. The data were collected through semi structured interviews and analyzed using Graneheim and Lundman's five-step method. The coding process was facilitated by the useof MAXQDA version 10 software. To establish rigor, the four criteria outlined by Guba and Lincoln were applied., Results: the participants included eight women and four men with an average age of 39.6 ± 6.31 years. The data analysis yielded five main categories and fifteen subcategories. The main categories were: "The Foundations of professional care in nursing", "Core Drivers in Optimal End-of-Life Care", "Family Involvement in End-of-Life Care", "Incorporating Spiritualism in Care" and "Dominant motivational Issues Within the Caregiving Atmosphere"., Conclusions: This study delineates the experiences that influence the provision of end-of-life care from the perspective of Iranian nurses. Innate traits such as empathy and a passion for nursing, in addition to nurses' moral compass and spiritual beliefs, serve as pivotal motivational stimuli. Leveraging these findings can be instrumental in shaping healthcare practices and policies to enhance the quality of end-of-life care., Competing Interests: Declarations Ethical approval This study honored the ethical framework of the Declaration of Helsinki and received approval from the Ethics Committee of Golestan University of Medical Sciences, Gorgan, Iran (IR.GOUMS.REC.1401.458). Potential participants were thoroughly briefed on the objectives of the study, their rights, consent, confidentiality, and voluntary participation guarantees before consenting and agreeing to the recording of their interviews. Informed consent was obtained from all participants. All procedures were designed to uphold privacy and utilize data solely for research purposes. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: To assess and compare attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals and to identify factors associated with attitudes towards patient safety., Design: An institution-based, cross-sectional survey was carried out from July to August 2023., Setting: 10 governmental teaching hospitals in Tehran, Iran., Participants: The study participants comprised a random sample of 186 nurses and 90 physicians who had worked for at least 6 months in their current hospitals., Outcome Measures: The primary outcome measures were mean and SD scores for individual items and the nine main patient safety domains assessed by the Attitudes Toward Patient Safety Questionnaire-III. The secondary outcome measure was the proportion of physicians and nurses who responded positively to each item, expressed as percentages for each group., Results: Physicians and nurses exhibited moderately positive attitudes towards patient safety (mean scores of 3.79±0.33 and 3.83±0.36, respectively). Both professional groups reported the most positive attitudes in the same dimensions: 'team functioning' and 'working hours as a cause for error' (mean scores of >4 out of 5). Conversely, the lowest scores were observed in 'importance of patient safety in the curriculum', indicating potential gaps in their understanding of patient safety (mean scores of <3.5 out of 5). Physicians displayed significantly more positive attitudes in the domain of 'error inevitability', while nurses held more positive attitudes in 'error reporting confidence' and 'disclosure responsibility' (p<0.05). Multiple linear regression analysis demonstrated that the factors associated with more positive attitudes towards patient safety included lower workload (B=0.131; 95% CI 0.047 to 0.215; p=0.002), reporting of adverse events (B=0.100; 95% CI 0.009 to 0.191; p=0.030) and receiving patient safety training (B=0.134; 95% CI 0.019 to 0.249; p< 0.023)., Conclusion: Both professional groups demonstrated moderately positive attitudes towards patient safety. However, the findings highlighted the need for future patient safety training to prioritise enhancement of healthcare professionals' understanding of medical errors. Such training initiatives should be engaging and directly relevant to the specific needs of both nurses and physicians, ensuring its perceived value to their ongoing professional development. Furthermore, fostering a supportive and blame-free environment that encourages the reporting of medical errors is crucial., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To determine nurses' perception of horizontal violence and its relationship with intention to leave among Jordanian nurses., Background: Horizontal violence is detrimental to healthcare organizations. Healthcare employees who are victims of horizontal violence may become unable to perform well, living with severe stress. Few studies in the world and no study in Jordan has examined the influence of horizontal violence on intent to stay among nurses., Method: A descriptive, cross-sectional, correlational study design was used in this study., Result: 520 registered nurses were recruited, and 436 surveys were returned, resulting in an 83% response rate. The findings showed that, horizontal violence is moderate among nurses in Jordan. The mean score for nurse's intent to leave work indicated a solid willingness to leave the job. The correlation analysis revealed that there was a significant relationship between horizontal violence and intent to leave. Female nurses reported significantly higher scores than males; also, there is a significant difference in responses in horizontal violence based on educational level., Conclusion: In this study, it was found that horizontal violence in Jordanian organizations is moderate, and it has a significant relationship with nurses' intention to leave., Implication for Nursing Management: Nursing managers have a vital role in ensuring and enforcing the 'zero violence' policy in their department, which means that no reported incident of horizontal violence will be ignored. Each identified case of horizontal violence will be investigated and addressed appropriately., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Al-Nawafleh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The nursing practice environment is essential for improving the quality of nursing practice and patient service. Performing secondary analysis of data from the work environment for hospital nurses in Japan (WENS-J) study, this research investigated whether an improved, healthier work environment could enhance nurses' psychological empowerment. Self-administered questionnaire responses of 2,438 participants from 23 participating general hospitals with over 200 beds in municipalities with a population of 200,000 or more were analyzed. The questionnaire recorded participating nurses' demographic characteristics and utilized two scales: the Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Psychological Empowerment Instrument (PEI), which identified adequate work environments and measured the internalization of organizational goals and objectives, respectively. Most participants (93.7%) were female nurses with a mean age of 33.7 years. Multilevel analysis (hierarchical linear models) revealed that the total PEI score was significantly related to the PES-NWI composite score and all subscales after adjusting for nurses' demographic characteristics, such as age (coefficient 0.33-0.72, all p < .001). The results suggest that a work environment such as that presented in the PES-NWI may contribute to nurses' psychological empowerment. These findings could provide insight for creating healthier work environments., (© 2024. The Author(s).)

Introduction: Discharge planning involves coordinating between different care settings. Failed coordination can lead to delayed care at the facilities receiving discharged patients. Nurses who implement discharge planning must consider the circumstances of the staff receiving the discharged patients., Objective: This study aims to develop a nurses' perspective-taking scale for measuring the cognitive process of imagining a staff's situation when receiving discharged patients., Methods: An online survey was conducted from September to November 2021 with nurses in Japanese acute care hospitals, using a 20-item questionnaire based on interviews and a literature review. Item reduction was conducted based on inter-item correlations, item-total correlations, and exploratory factor analysis. Confirmatory factor analysis was performed. For the exploratory and confirmatory factor analysis, the samples were randomly split in half and tested. Cronbach's alpha, intraclass correlation coefficients, and correlation coefficients were calculated using both self-developed and pre-existing measures., Results: The questionnaire was distributed to 1,289 individuals, and 416 valid responses were obtained. Item reduction and exploratory factor analysis resulted in a 10-item scale with two subscales, "imagine-other" (six items), which is imagining the other person's situation, and "imagine-self" (four items), which is imagining oneself in the other person's situation. The goodness-of-fit indices were as follows: comparative fit index, 0.95; root mean square error of approximation, 0.08; and standardized root mean squared residual, 0.06. Correlation coefficients with existing scales were 0.38, 0.57, and -0.33. Cronbach's alpha was 0.89, and the intraclass correlation coefficient was 0.54., Conclusion: The newly developed scale proved to be reliable, valid, and suitable for use. This scale can measure the degree of perspective-taking by nurses, which can improve collaboration between facilities and the effectiveness of discharge planning., Competing Interests: The authors declare that there is no conflict of interest., (Copyright: © 2024 Tanaka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: The study aimed to describe the experiences of physicians, nurses and psychologists employed in primary care in using digital video consultations. The second objective was to study the association between the predictors of behaviour and behavioural intentions to use digital consultations and to relate underlying behavioural beliefs to experiences of digital consultations in primary care. Overall, the research questions focused on the association between previous training, profession or theory-based behavioural predictors and behavioural intentions to use digital video consultations., Design: A web survey based on the theory of planned behaviour was sent to primary care professionals in western Sweden who had implemented digital video consultations. The questionnaire contained both closed and open-ended questions focusing on theory-based predictors of behavioural intentions, such as as attitudes, subjective norms and perceived behavioural control. Data were analysed with a mixed-methods approach using quantitative and qualitative analyses., Participants: The questionnaire was distributed between June and October 2022 to 140 primary healthcare centres in western Sweden, of which 47 agreed to participate. Overall, the questionnaire was sent out to 969 clinicians, representing physicians, nurses and psychologists., Results: Physicians and nurses had lower experience and less positive attitudes towards digital video consultations compared with psychologists. No statistically significant differences were seen among the groups in behavioural intentions to use digital video consultations. The regression analysis showed that attitude was the strongest predictor of behavioural intentions among primary care physicians, while attitude and perceived behavioural control were associated with behavioural intentions among nurses. No associations between predictors and intentions were found among psychologists., Conclusions: The medical professionals reported high behavioural intentions to use digital video consultation despite different levels of experience. Attitude and perceived behavioural control were predictors of behavioural intentions among physicians and nurses, indicating that future implementation should consider the professions' participation in the process., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The prevalence of low back pain among nurses is notably high, which negatively affects their job performance and overall work quality., Aim of Study: This research aimed to evaluate the prevalence of low back pain among nurses in Nablus city and investigate how personal and work-related factor and the occurrence of low back pain in this population., Method: Employing a cross-sectional study design, we employed validated instruments, including the Nordic Musculoskeletal Disorder Questionnaire. The study encompassed 258 nursing employees from both the largest and smallest Ministry of Health (MOH) and private sector hospitals in Nablus city, West Bank, Palestine. Data were collected through a self-administered questionnaire., Result: A total of 258 nurses participated in the study, yielding a response rate of 98%. The lifetime prevalence of Low Back Pain (LBP) was 82% (n = 212) throughout their life. Additionally, the prevalence of LBP in the 12 months preceding data collection was 78% (N = 201), 71% (N = 182) in the month leading up to the study, and 61% (N = 156) on the day of data collection., Conclusion: The study disclosed a high prevalence of low back pain among nurses, underscoring the urgency for effective solutions. These findings highlight the need for more comprehensive research to better understand and address this issue., (© 2024. The Author(s).)

Nurses, as healthcare professionals who frequently interact with older patients in clinical settings, play a crucial role in providing direct care and services to older patients. However, nurses caring for older patients often experience substantial physical and emotional exhaustion, which can trigger a loss of motivation, feelings of helplessness, and burnout. The current study, conducted in Korea, investigated the impact of ageism on burnout among clinical nurses. To determine whether ageism was a significant predictor of nurse burnout, a structured questionnaire was distributed to 332 nurses at two hospitals. Multiple regression analysis then showed that ageism (B = .066, p < .001), female sex (B = .530, p = .003), and lower preference for geriatric nursing (B = .357, p = .002) were significantly associated with burnout. Our findings confirmed that ageism was strongly associated with nurse burnout, suggesting the need to develop interventions or training programs that can change nurses' perception of older people and facilitate emotional change., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: To explore the relationship of selected socio-demographic and occupational characteristics of nurses and their level of professional values, hospital ethical climate and job satisfaction., Methods: Cross-sectional study was conducted among 388 Polish nurses from the spring of 2021 to winter of 2023, in the eastern part of Poland; and followed by Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Four research tools were used to collect data together with questionnaire for socio-demographic and occupational characteristics., Results: Professional values such as activism correlate negatively with religious beliefs ( Z  = -1.789; p  = 0.044), this means that nurses who are more involved in professional change activities are likely to be less associated with religious beliefs. A positive correlation was observed between the Ethical Hospital Climate Survey subscale-peer relations and nurses' education level ( H  = 5.638; p  = 0.048), indicating that a higher education level was associated with better relationships with colleagues at work. A negative relationship was identified between nurses' external job satisfaction and their marital status ( Z  = -1.958; p  = 0.040), that is, married nurses feel less satisfaction with the external aspects of their jobs than their single colleagues., Discussion: These findings underscore that medical staff management should take into account both sociodemographic factors [e.g., age, education, place of residence, marital status, religious beliefs, as well as professional factors (working hours, qualification course, etc.)] that affect nurses' professional values, job satisfaction and the ethical climate of the hospital. These underscore the need to adapt management strategies to the individual needs of employees, which can contribute to improving working conditions in healthcare facilities., Data Collection Tool: The data collection tool consists of four sections., Demographics: Collected background and demographic information., Nurses’ Professional Values Scale Npvs-3: Assessed professional values among nurses., Hospital Ethical Climate Survey Hecs: Assessed hospital ethical climate among nurses., Minnesota Satisfaction Questionnaire-Short Form Msq-Sf: Assessed job satisfaction levels among nurses., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ozdoba, Jurek and Dobrowolska.)

Importance: Occupational burnout syndrome is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is prevalent among nurses. Although previous meta-analyses have explored the correlates of nurse burnout, none have estimated their association with health care quality and safety and patient morbidity and mortality., Objective: To evaluate the magnitude and moderators of the association between nurse burnout and patient safety, patient satisfaction, and quality of care., Data Source: The Web of Science, Scopus, MEDLINE, Embase, PsycINFO, CINAHL, and ProQuest databases were searched from January 1, 1994, to February 29, 2024., Study Selection: Two reviewers independently identified studies that reported a quantifiable association between nurse burnout and any of the outcomes of patient safety, patient satisfaction, or quality of health care., Data Extraction and Synthesis: The PRISMA 2020 guideline was followed. Two reviewers independently extracted the standardized mean difference (SMD) (Cohen d) estimates for a random-effects meta-analysis. Subgroup analyses and meta-regressions were conducted using prespecified variables., Main Outcomes and Measures: Any measure of patient safety, patient satisfaction, or quality of health care previously associated with nurse burnout., Results: A total of 85 studies (81 cross-sectional and 4 longitudinal) involving 288 581 nurses from 32 countries (mean [SD] age, 33.9 (2.1) years; 82.7% female; mean [SD] burnout prevalence rate with study-specific ascertainments, 30.7% [9.7%]) were included. Nurse burnout was associated with a lower safety climate or culture (SMD, -0.68; 95% CI, -0.83 to -0.54), lower safety grade (SMD, -0.53; 95% CI, -0.72 to -0.34), and more frequent nosocomial infections (SMD, -0.20; 95% CI, -0.36 to -0.04), patient falls (SMD, -0.12; 95% CI, -0.22 to -0.03), medication errors (SMD, -0.30; 95% CI, -0.48 to -0.11), adverse events or patient safety incidents (SMD, -0.42; 95% CI, -0.76 to -0.07), and missed care or care left undone (SMD, -0.58; 95% CI, -0.91 to -0.26) but not with the frequency of pressure ulcers. Nurse burnout was also associated with lower patient satisfaction ratings (SMD, -0.51; 95% CI, -0.86 to -0.17) but not with the frequencies of patient complaints or patient abuse. Finally, nurse burnout was associated with lower nurse-assessed quality of care (SMD, -0.44; 95% CI, -0.57 to -0.30) but not with standardized mortality rate. The associations were consistent across nurses' age, sex, work experience, and geography and persistent over time. For patient safety outcomes, the association was smaller for the low personal accomplishment subcomponent of burnout than for emotional exhaustion or depersonalization, as well as for nurses with a college education., Conclusions and Relevance: In this systematic review and meta-analysis, nurse burnout was found to be associated with lower health care quality and safety and lower patient satisfaction. This association was consistent across nurse and study characteristics.

Objectives: This study was conducted to determine the relationships between nurses' competency, motivation, and stress levels in disaster management, as well as to shed light on the establishment of effective disaster management programs., Methods: In our research we used a correlational, descriptive, cross-sectional design. The sample of the study was composed of 498 nurses working in Turkey. The "Descriptive and Professional Characteristics and Disaster Experiences of Nurses" form, the "Competencies for Disaster Nursing Management Questionnaire," the "Perceived Stress Scale," and the "Nurses Job Motivation Scale" were used in data collection., Results: Nurses' disaster management competency and motivation levels were found to be adequate, and their stress levels were found to be moderate. A weak positive correlation was found between disaster management competency and motivation, but a weak negative correlation was found between stress levels. Age, education level, experience level, training in disaster nursing, and knowledge of duties and responsibilities in disasters were associated with significant differences in terms of disaster competency and its dimensions, motivation, and stress levels., Conclusions: The study found that nurses' disaster experiences impacted their competency, feeling of preparedness, and stress and motivation levels, and motivation was found to be a predictor of increasing competency.

Aim: Although neuroticism has a negative impact on burnout among healthcare workers, there is little research exploring the specific interactions between different components of burnout and neuroticism. This study aims to investigate this relationship among nurses in Emergency Departments (ED) through network analysis method (NAM)., Design: A cross-sectional investigative survey was conducted., Methods: A total of 408 Chinese nurses were recruited from ED of five hospitals in 2023 through Questionnaire Star. Components of burnout were measured by the 15-item Maslach Burnout Inventory-General Survey (MBI-GS), while components of neuroticism were measured by a subscale of the Eysenck Personality Questionnaire-Revised, Short Scale for Chinese (EPQ-RSC) questionnaire. NAM was applied to build relationship between components of burnout and neuroticism and identify the bridge expected influence (BEI)., Results: Within burnout-neuroticism network, the relations between the components of burnout and neuroticism were mainly positive. Nt5 ('Anxious')-EE1 ('Exhausted'; weight = 0.281) and Nt5 ('Anxious')-EE5 ('Breakdown'; weight = 0.280) had stronger connections. Among the neuroticism, Nt5 ('Anxious') showed the strongest positive BEI, while Nt12 ('Guilty') showed the strongest negative BEI. Feeling anxiety and less guilt conscience in neuroticism were the critical factors to impact burnout of nurses in ED. Awareness of these relationships can help to develop strategies to identify and curtail burnout., Patient or Public Contribution: A total of 408 emergency nurses participated in this survey., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

This study aimed to explore Chinese clinical nurses' attitudes towards medical device-related pressure injuries (PIs) and analyse the relevant influencing factors. Between December 2023 and January 2024, a cross-sectional survey of 1740 clinical nurses from three tertiary hospitals, three secondary hospitals and five community hospitals in Shanghai, China, was conducted via the Chinese version of the Attitude towards medical device-related pressure ulcers/injuries questionnaire. A total of 1693 nurses participated in this study. Nurses' total score regarding their attitudes towards medical device-related PIs was 36.60 ± 8.97, and multiple linear regression analysis revealed that clinical nurses' highest level of education (p < 0.001), professional title (p < 0.001), position (p = 0.001), years of work experience (p < 0.001) and participation in medical device-related pressure injury (PI) training (p < 0.001) influenced their attitudes towards medical device-related PIs. Nurses' attitudes towards medical device-related PIs ranged between negative and positive. Therefore, it is essential to focus on the highest level of education, professional title, position and years of work experience. Increasing the frequency of medical device-related pressure injury (PI) prevention training will improve nurses' attitudes towards medical device-related PIs., (© 2024 The Author(s). International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Aim: To compare the perspective of nurses, long-stay immigrants and cultural mediators on intercultural communication in care encounters., Design: Qualitative secondary analysis of data obtained in two primary studies., Methods: Two sets of data from two primary studies on nurses and long-stay immigrants (including in total two focus groups and 15 in-depth interviews) were merged. The sample was extended to include a focus group of cultural mediators. An amplified analysis was conducted using Charmaz's approach to grounded theory., Results: The results are structured under the core category "Agreements and discrepancies in intercultural communication," split into two subcategories: (1) Communication and the role of culture; (2) (Non) equitable and culturally (in)sensitive care. Immigrant patients and mediators detect barriers associated with generic aspects of communication, while nurses and mediators value culture. Nurses recognise paternalistic attitudes, while long-stay immigrants sometimes detect biased treatment that mediators do not see. Immigrant patients and mediators value informal conversation as a strategy for cultural learning and building mutual trust, while nurses request regulated training., Conclusion: The findings show that there are always discrepancies in this relationship. Changes to health care should be based on the participation of all actors. Communication skills training programs should be implemented., Implications for the Profession And/or Patient Care: The convergences and divergences of nurses, immigrants and mediators expose new ways to approach care. Communication skills training programs should be implemented. Changes to health care should be based on the participation of all actors, including immigrant patients and mediators, and allow them to voice their opinions and make decisions., Impact: This study addresses intercultural communication from three different perspectives: nurses, long-stay immigrants and cultural mediators. Nurses, long-stay immigrants and cultural mediators sometimes show convergence but never completely agree. The research may have an impact on primary-care nursing by making it more culturally competent., Patient or Public Contribution: Each participating long-stay immigrant, nurse and cultural mediator reviewed their own interview. The findings were reviewed by a verifier member of each group (a nurse, patient and mediator)., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

Aim: To analyse experience in postnatal nurses returning to work within 3 months following the delivery of a second or third child and recommend appropriate measures to relieve pressure and enhance work engagement among this group., Methods: This study adopted a descriptive phenomenological approach. Semi-structured interview was carried out with 12 postnatal nurses who had returned to work in the postpartum period following the delivery of a second or third child. The collected data were analysed using the Colaizzi method., Results: Experience among postnatal nurses with two or three children was found to stem from three factors: declining physical quality after childbirth (pelvic floor disorder, fatigue, postpartum memory decline and sleep disturbance), poor psychological adjustment after childbirth (work-family conflict, conflict between clinical work and breastfeeding and role maladjustment) and lack of clear career planning., Conclusion: This study emphasised the importance of psychological experience when postnatal nurses returning to clinical work in the early phase. Postnatal nurses and nurse leaders can use these results to make comprehensive solution in order to improve work engagement in the postpartum return., Public Contribution: No patient or public contribution., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

Background: The aim of the study is to investigate doctors' and nurses' beliefs and attitudes towards family presence and open visiting policies in Pediatric Intensive Care Units (PICUs) in Italy., Methods: A multicentric nationwide study was carried out in all 30 Italian PICUs. All doctors and nurses were asked to complete the Italian version of the Beliefs and Attitudes toward Visitation in ICU Questionnaire (BAVIQ). The questionnaire consists of 20 questions on beliefs and 14 on attitudes towards visiting., Results: The response rate was 89% (925 questionnaires), with 87% of nurses and 94% of doctors responding. Most respondents (85%) believed that visiting has a beneficial effect on the patient and that an open visiting policy can reduce parental anxiety (68%). However, nearly half the respondents believed that an open policy interferes with direct nursing care (45%) and makes them feel checked up on (49%). Multiple logistic regression conducted on the eight most representative items showed that factors associated with beliefs and attitudes opposing open visiting policies were: being a nurse, geographic area (working in PICUs in Central Italy or the South and Islands) and working in a cardiac surgery unit. Age showed a trend of younger professionals being more convinced that an open visiting policy can be beneficial for patients., Conclusions: Most healthcare professionals in Italian PICUs believe that an open visiting policy for families is beneficial for both the patient and his/her family. However, despite an overall positive attitude among PICU staff members, there is still some resistance in Italy, particularly among nurses and in cardiac surgery units.

Aims: This study analysed the status of nurse-authored patents and their influencing factors. In particular, this study examined the effects of nurses' innovative behaviour and creative self-efficacy on nurse-authored patent output via structural equation modelling (SEM)., Design: A descriptive cross-sectional study., Methods: Nurses were recruited from one tertiary cancer hospital in Beijing, China. Among them, 352 oncology nurses completed the online versions of the Nurse Innovative Behavior Scale and Creative Self-Efficacy Scale in 2023., Results: We collected a total of 332 valid questionnaires. Fifty-seven (17.2%) nurses had 1-3 patents, and only 6 (1.8%) had more than three patents. The final model revealed a chain reaction between creative self-efficacy, innovation behaviour and nurse-authored patent output (χ 2  = 11.962, df = 7, p = 0.102). Significant differences were observed in the number of nurse-authored patents and based on age, educational profile, professional title, length of service, position, participation in science and technology innovation training, and experience in project presentation (all p < 0.05)., Conclusion: Nurses still play a minor role in the field of medical technology innovation. It is necessary to promote innovative behaviour among nurses and improve their creative self-efficacy in terms of innovation., Impact: Developing intervention strategies to encourage nurses to pursue clinical innovations is crucial for nursing managers and technological innovation promoters., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

Background Violence against women is a global public health problem. Primary healthcare services and health workers play an important role in managing this problem. The aim was to identify barriers and facilitators to the identification and management of intimate partner violence (IPV) among women presenting to primary healthcare services from the perspective of nurses/midwives, and to identify the challenges and needs to improve practices. Methods This was a qualitative descriptive study, in which semistructured interviews were conducted with 19 nurses/midwives working in primary healthcare services. The interviews were analysed using a thematic analysis approach through an inductive process. The Consolidated Criteria for Reporting Qualitative Research was used to ensure comprehensive reporting of the protocol for this qualitative study. Results Four main themes were identified: (1) detection of intimate partner violence, (2) nurses'/midwives' current practices, (3) barriers to identification and management, and (4) needs. Conclusions Primary care nurses/midwives in this study perceived that they were not responsible for the detection and management of intimate partner violence, and a majority reported they did not want to take an active role. However, those who were willing to engage in the detection and management of IPV required sufficient time for patient consultations, a reduced workload and a separate room with suitable physical conditions. It is recommended that nurses/midwives be provided with training on IPV detection and management at specific intervals, and studies be conducted to evaluate the outcomes of such training, and initiate the professional decision-making process of nurses/midwives to effectively identify, respond to and support individuals affected by IPV.

The retention of experienced nurses is a challenge for healthcare organizations in the current employment landscape. One retention tactic is to aid in their professional development. This article describes a program "Best Fit for Nurse Advancement" that provides dedicated time, resources, and support to explore career advancement pathways by breaking organizational progressional barriers. Results have shown retention within the organization, career role advancement, and positive program feedback., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Transition into practice is plagued by personal, work, and patient-related stress leading to burnout and turnover of newly licensed nurses. Leaders must recognize transition shock and moral distress and act immediately. Nursing professional development practitioners at a healthcare organization in Illinois developed the "Flight Risk" Program to recognize, address, and escalate turnover risks as a leadership team. This resulted in retaining 47% of identified "flight risks" and contributed over $3.9 million in cost avoidance., Competing Interests: Vicki Adams and Dana Garcher are employed by Vizient, Inc. Cheryl Nazal and Debbie Rimmele declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The COVID-19 pandemic highlighted the negative impact of moral injury on nurses' well-being. However, there is a lack of research about generational differences among nurses, particularly on newer nurses who have been identified as having a higher rate of intention to leave., Objective: This study examines generational differences among nurses on moral injury, well-being, resilience, and intention to leave their nursing position and profession., Methods: This is a secondary analysis of cross-sectional data from registered nurses in clinical practice in Ohio between July and August 2021. Data on demographics, moral injury, resilience, and well-being were collected using an online survey. Participants were categorized into 4 generational groups based on their age in 2021: Baby Boomers (57-75 years old), Generation X (42-56 years old), Generation Y (27-41 years old), and Generation Z (12-26 years old). Descriptive and inferential statistics, including logistic regression and analysis of variance, were employed for analysis., Results: Significant generational differences were found in years of clinical experience, moral injury, resilience, and well-being. Baby Boomers reported higher well-being and resilience and lower moral injury. Notably, the intention to leave the profession was more strongly associated with well-being and moral injury levels than with the years of experience or generational group., Conclusions: The findings suggest that interventions to improve nurse retention should prioritize enhancing well-being and addressing the root causes of moral injury. Tailored strategies addressing the needs of different generations are necessary for mitigating the adverse effects of current healthcare challenges on nurse attrition., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The purpose of this study was to understand the novel experience of a rehabilitation specialty hospital conversion to acute medical/COVID-19 patient care from the perspective of rehabilitation nurses., Design: A descriptive qualitative study was conducted., Methods: Thirty-six nurses employed by the rehabilitation specialty hospital were invited to participate. Narrative data were collected via an online survey and were analyzed using a conventional content analysis approach., Results: Fifteen (42%) of those eligible participated. The overarching descriptor of the rehabilitation nurses' experiences was "we did what we had to do." Three primary descriptors emerged: challenged, conflicted, and compromised. Communication from leadership prominently informed the conversion experience., Clinical Relevance to the Practice of Rehabilitation Nursing: Expecting rehabilitation specialty nurses to care for a different patient population is an important consideration and requires leadership to understand the distinctive characteristics of the specialty and its approach to care., Conclusions: Addressing the impact on nursing staff in any disaster requires listening and communicating to provide needed support. Recognizing the characteristics of nursing specialties, the need for self-care among nursing staff and the salience of effective communication are essential during specialty hospital conversions., (Copyright © 2024 Association of Rehabilitation Nurses.)

This article reports research that examined how registered nurses in practice develop clinical judgment in new graduate nurses (NGNs) and how NGNs respond. Teaching themes were setting the tone for learning, use of cognitive-focused teaching-learning strategies, including mentoring thinking, debriefing and reflection, and using real-life scenarios. NGN responses were learning focused, emotional, or resistant. Recommendations to support development of clinical thinking are made., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Over 70% of the disease burden in Europe is the result of chronic diseases caused by lifestyle. Lifestyle counseling can improve lifestyle habits and thereby health. However, according to research, there are several barriers to healthcare personnel carrying out counseling. The aim of this study was to explore nurses' experiences of conducting lifestyle counseling., Design: A qualitative descriptive study was conducted in southern Sweden between August 2021 and December 2021., Sample: Eleven nurses were recruited from both inpatient and outpatient care in northeastern Sweden through a combination of purposive and snowball sampling., Measurements: Individual semistructured interviews were performed digitally using an interview guide. The interviews were analyzed via qualitative content analysis., Results: The nurses experienced several challenges in performing lifestyle counseling. However, knowledge gaps, sensitive topics, organizational dynamics, and time constraints were balanced using strategies. The theme of their responses can be explained by the following categories: "Collaboration with patients is key," "From self-interest to teamwork," and "The organization can assist or hinder.", Conclusions: Lifestyle counseling needs to be prioritized within healthcare. Nurses need tools and knowledge to be able to feel comfortable with the task. All healthcare organizations need to work with lifestyle counseling in a structured way according to national guidelines., (© 2024 The Author(s). Public Health Nursing published by Wiley Periodicals LLC.)

Background: Many nurses join the profession because they have altruistic intentions, but some nurses experience barriers to acting on altruistic intentions which may be a source of job dissatisfaction or burnout., Objective: The purpose of this study was to evaluate construct validity, internal consistency, and convergence reliability of the Nursing Altruistic Execution Scale (NAES), a novel instrument assessing the perceived ability to help others through work., Methods: The NAES was developed based upon a literature review examining altruistic behavior as a motivator for nursing work, with expert feedback for instrument refinement. Participants completed the NAES, Copenhagen Burnout Inventory Work-Related Burnout Scale, and Satisfaction of Employees in Health Care Survey. Exploratory factor analysis examined construct validity and factor loadings. Confirmatory factor analysis verified consistency in factor structure. Linear regression assessed for convergence reliability with burnout and job satisfaction., Results: The sample included 843 acute care hospital nurses surveyed in January-March 2023. Exploratory factor analysis revealed a two-factor solution, named altruistic engagement with work and workplace barriers to altruism . Nine instrument items were retained and demonstrated strong internal consistency (Cronbach's alpha 0.79). There was a significant relationship between both factors of the NAES and both burnout and job satisfaction, demonstrating that greater altruistic execution is associated with lower burnout and greater job satisfaction., Conclusion: Preliminary findings support the use of the NAES as a valid and reliable scale. Findings show there is correlation between altruistic intentions and burnout. Interventions aimed at enhancing altruistic execution may reduce nurse burnout and thereby improve retention., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Moral distress has been identified as an occupational hazard for clinicians caring for vulnerable populations. The aim of this systematic review was (i) to summarize the literature reporting on prevalence of, and factors related to, moral distress among nurses within acute mental health settings, and (ii) to examine the efficacy of interventions designed to address moral distress among nurses within this clinical setting. A comprehensive literature search was conducted in October 2022 utilizing Nursing & Allied Health, Embase, CINAHL, PsychInfo, and PubMed databases to identify eligible studies published in English from January 2000 to October 2022. Ten studies met inclusion criteria. Four quantitative studies assessed moral distress among nurses in acute mental health settings and examined relationships between moral distress and other psychological and work-related variables. Six qualitative studies explored the phenomenon of moral distress as experienced by nurses working in acute mental health settings. The quantitative studies assessed moral distress using the Moral Distress Scale for Psychiatric Nurses (MDS-P) or the Work-Related Moral Stress Questionnaire. These studies identified relationships between moral distress and emotional exhaustion, depersonalization, cynicism, poorer job satisfaction, less sense of coherence, poorer moral climate, and less experience of moral support. Qualitative studies revealed factors associated with moral distress, including lack of action, poor conduct by colleagues, time pressures, professional, policy and legal implications, aggression, and patient safety. No interventions targeting moral distress among nurses in acute mental health settings were identified. Overall, this review identified that moral distress is prevalent among nurses working in acute mental health settings and is associated with poorer outcomes for nurses, patients, and organizations. Research is urgently needed to develop and test evidence-based interventions to address moral distress among mental health nurses and to evaluate individual and system-level intervention effects on nurses, clinical care, and patient outcomes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Having more registered nurses (RNs) leave their workplace, with a shortage of RNs in healthcare as a consequence, might pose a risk to patient safety. According to the Job Demands Resource model, social support is a resource that can enhance work motivation, and if RNs are motivated at work, their willingness to remain in the workplace may increase., Objective: The aims were to explore (1) differences in RNs' experiences of social support from their immediate manager and co-workers between different healthcare settings, (2) associations between RNs' experiences of social support and aspects of work motivation, and (3) if these associations differed in strength between healthcare settings., Design: A cross-sectional study design., Methods: A stratified population of Swedish RNs, n = 2290, working in either hospitals, primary care, or home healthcare, responded to a survey in 2022. Chi-squared tests and linear and logistic regression analyses were used to analyze the data. Interaction was measured by adding an interaction term to the fully adjusted regression models. The findings' generalizability was strengthened by including calibrating weights in all analyses., Results: RNs in primary care reported higher social support from their immediate manager than RNs in hospitals and home healthcare. RNs in home healthcare reported lower social support from co-workers than RNs in hospitals and primary care. There were statistically significant associations between higher levels of social support from the immediate manager and co-workers, respectively, and higher ratings in all aspects of work motivation: work engagement (manager: beta coefficient [b] = 0.08, confidence interval [CI] 95% = 0.05; 0.10; co-workers: b = 0.12, CI 95% = 0.08; 0.16), job satisfaction (manager: b = 0.24, CI 95% = 0.21; 0.27; co-workers: b = 0.22, CI 95% = 0.16; 0.28), opportunities to provide high-quality care (manager: b = 0.15, CI 95% = 0.11; 0.18; co-workers: b = 0.19, CI 95% = 0.13; 0.24), satisfaction with the employer (manager: b = 0.46, CI 95% = 0.42; 0.50; co-workers: not statistically significant) and intention to remain at the workplace (manager: odds ratio = 1.89, CI 95% = 1.69; 2.13; co-workers: odds ratio = 1.42, CI 95% = 1.17; 1.72). The associations differed in strength between hospitals, primary care, and home healthcare., Conclusions: Strengthening social support from the immediate manager and co-workers appears to be a way to increase RNs' work motivation, including their intention to remain at the workplace. This may be important, particularly in primary care and home healthcare., Clinical Relevance: To strengthen RNs' work motivation and willingness to stay in the workplace, it appears important for healthcare organizations to provide RN social support., (© 2024 The Author(s). Journal of Nursing Scholarship published by Wiley Periodicals LLC on behalf of Sigma Theta Tau International.)

Objective: This study aimed to explore the proficiency level in medical narrative ability among nurses in VIP wards and identify the influencing factors. The objective was to provide valuable insights for enhancing the training and development of medical narrative skills among nurses in VIP wards, with the ultimate goal of promoting narrative nursing in clinical practice., Methods: A survey was conducted of 94 nurses working in VIP wards at a grade-A tertiary hospital in Zhongshan City, using the Narrative Competence Scale., Results: The findings revealed that nurses' overall medical narrative ability in VIP wards was relatively low, with a total score of (135.31±16.50). The primary factors identified as influential were professional titles and familiarity with narrative medicine or narrative nursing, which played significant roles. Specifically, nurses with higher professional titles demonstrated greater proficiency in medical storytelling. Moreover, nurses more familiar with narrative medicine or narrative nursing tended to exhibit higher levels of medical narrative ability., Conclusion: The results of this study highlight the significant opportunity for enhancing the medical narrative ability of nurses in VIP wards. To address this issue, it is recommended that training programs incorporate knowledge and skills related to narrative medicine and narrative nursing into the core competency development of VIP nurses. Additionally, there is a need to introduce narrative nursing practices gradually into clinical care. These measures will empower nurses to enhance their narrative abilities, providing superior nursing services to patients. Ultimately, such efforts will strengthen nurses' sense of professional value and increase the social benefits of nursing care.

Introduction: When providing health information in a diverse society and during health crises, it is crucial that nurses can adapt their communication to immigrants, as this may have an impact on their health outcomes. This study seeks to identify how nurses experienced and assessed their communication and information work with immigrants during COVID-19 and to discuss measures to improve practice., Method: The study has an interpretive and explorative qualitative design, analyzing 10 semi-structured interviews with nurses from the municipal health service in Norway., Results: Three themes were created as follows: multilingual infection control teams and cooperation with volunteers, challenges when providing COVID-19 information, and the nurses' suggestions for improvements in the event of a new pandemic or other health crisis., Discussion: Nurses' cultural competence and their knowledge of immigrants' health literacy can help them understand how immigrants think and behave during illness. It is important that nurses use discretion during health crises., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Since 2009, nurses have relocated to Japan from Indonesia, the Philippines, and Vietnam under the auspices of the Economic Partnership Agreement (EPA). We asked why some migrant nurses remain in Japan whereas others leave., Method: We applied the methodology of Constructivist Grounded Theory. All participants were internationally educated nurses (IENs) currently or formerly working in Japan after passing the National Nursing Examination., Results: Difficulty in mastering the Japanese language was established as one of the main themes. Initial coding elicited two explanatory sub-categories: lack of confidence in communication and effects of language difficulty on workplace relationships. One explains how practical experience in the workplace affected nurses' confidence in communication. The other explains how levels of Japanese language attainment shaped relationships with colleagues., Discussion: These findings suggest a need to regulate the working conditions of foreign nurses, and a need for training schemes to optimize IEN retention., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To explore the effect of breathing meditation training on nursing work quality, occurrence risk of adverse events, and attention level of operating room nurses., Methods: Taking the starting time of breathing meditation training of operating room nurses in our hospital in July 2020 as the dividing line, operating room nurses who implemented routine management from April 2020 to June 2020 were selected as the control group (n=30), and operating room nurses who carried out breathing meditation training from July 2020 to September 2020 were included in the intervention group (n=30). The emotional state [Hamilton Anxiety Scale (HAMA) score, Hamilton Depression Scale (HAMD) score], Mindfulness Attention Awareness Scale (MAAS) score, electrocardiogram indicators (blood pressure, pulse, and respiration), electroencephalogram indicators (SMR wave, β wave, and θ wave EEG frequency), attention level (attention quotient, visual attention, and auditory attention), nursing work quality (health education, theoretical knowledge, nursing operation, and operating room management) and the number of reported adverse events were compared between the two groups before and after training., Results: After breathing meditation training, the intervention group's Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scores were significantly reduced (P < .05), while the Mindfulness Attention Awareness Scale (MAAS) score was significantly increased (P < .05). ). In addition, blood pressure and respiratory rate were reduced in the intervention group (P < .05), with significant differences compared with the control group (P < .05). The SMR waves and beta waves in the intervention group increased (P < .05), while theta waves decreased (P < .05). Attention quotient, visual attention and auditory attention scores were improved in the intervention group compared with the control group (P < .05). The scores of health education, theoretical knowledge, nursing operations and operating room management of the intervention group after training were higher than those of the control group (P < .05). The intervention group reported a lower number of adverse events than the control group (74.42% vs. 25.58%). The application of breathing meditation training in special training for operating room nurses can effectively relieve negative emotions, enhance mindfulness scores, reduce blood pressure and respiratory rate, regulate brain wave frequency, improve attention status and quality of nursing work, and reduce the risk of adverse events. These outcomes may have a positive impact on improving the quality of nursing practice and patient care in the operating room. For operating room nurses, the negative emotional stress caused by sustained high levels of mental concentration may affect work efficiency and the entire surgical process. Breathing meditation training can enhance nurses' emotional resilience, thereby improving the efficiency and safety of operating room care., Conclusion: The application of breathing meditation training in the special training of operating room nurses can effectively alleviate negative emotions, enhance the mindfulness score, reduce blood pressure and respiratory rate, regulate brain wave frequency, improve the attention state and nursing work quality, and reduce the occurrence risk of adverse events. Future research should conduct longitudinal studies to evaluate the long-term effects of breathing meditation training on the quality of nursing work and the prevention of adverse events. Additionally, research could explore advanced neuroimaging techniques to gain structural insights, integrate meditation into existing training programs, tailor interventions for different healthcare settings, assess patient outcomes, explore technology-assisted meditation, and investigate interprofessional collaboration. Through these pathways, a more complete understanding of the impact and best integration of breath meditation in healthcare settings can be achieved, providing valuable insights into improving the well-being of healthcare professionals and potentially overall patient care and satisfaction.

Background: Nurses experience high job demands, which makes recovery particularly necessary to maintain well-being and performance. However, these demands also make recovery challenging. Short mindfulness meditations could potentially help alleviate this paradox., Methods: Two ecological momentary intervention studies were conducted among geriatric nurses (Study 1: break study) and hospital nurses (Study 2: after-work study) to investigate whether short audio-guided mindfulness meditations are beneficial for recovery during breaks and psychological detachment after work. Furthermore, break recovery and after-work detachment were examined as mediators of the associations between mindfulness meditations and after-break/after-sleep mood and attention after respective recovery periods. Multilevel path models were based on a sample of 38 nurses and 208 after-break surveys in the break study and 26 nurses and 192 after-sleep surveys in the after-work study., Results: Compared to breaks spent as usual, breaks that incorporated short mindfulness meditations were associated with higher break recovery, which mediated the positive associations between mindful breaks and after-break calmness, valence, and energetic arousal. Only with certain constraints did mindfulness meditations predict a lower rate of attention failures. In the after-work study, short mindfulness meditations were positively related to psychological detachment, which mediated the positive associations between the intervention and after-sleep valence and calmness., Conclusion/application to Practice: Both pilot studies showed that short mindfulness meditations aid in recovery among nurses. However, to fully utilize the advantages of recovery-promoting breaks, structural changes are necessary to ensure that breaks of an appropriate duration are consistently implemented., Competing Interests: Conflict of InterestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This article aims to explore pharmaceuticalisation processes in professional work contexts. The approach focuses on identifying patterns of medicine and dietary supplement use for managing work performance, and on discussing the relationship between these consumption practices and work-related pressure factors. This analysis adapts the notions of 'normalisation' to understand the extent of cultural acceptability of these practices, and the notion of 'differentiated normalisation' to capture the tension between the trend towards normalisation of such consumption and its partial social (in)visibility within work settings. Empirical support for this analysis is based on a sociological study conducted in Portugal on professions under high performance pressures. The study involved three professional groups - nurses, journalists and police officers. A mixed methods approach was used, including focus groups, questionnaires and semi-structured interviews. Overall, the results show a trend towards the use of medicines and supplements for performance management, which reveals itself as a cultural response to work-related social pressures. Such consumption coexists with irregular patterns of either occasional or long-term use, as well as heterogeneous processes of 'normalisation' and 'hidden' consumption. Conclusions point to a social interconnection between the intensification of work pressures and the pharmaceuticalisation of work performance.

Aims: To investigate how nurses' implicit and explicit attitudes towards people with disabilities (PWD) compare to (1) other healthcare providers and (2) non-healthcare providers., Method: We present an analysis of secondary data from the publicly available disability Implicit Association Test (IAT). We compare the explicit and implicit attitudes towards PWD for (1) nurses (n = 24,545), (2) other healthcare providers (n = 57,818) and (3) non-healthcare providers (n = 547,966) for a total of 630,238 respondents, between 2006 and 2021., Data Sources: We use publicly available data for the Disability IAT from Open Science Framework repository of Project Implicit available at https://osf.io/tx5fi/., Reporting: STROBE checklist., Results: There is a distinct contrast between nurses' explicit and implicit attitudes. While nurses have more positive explicit attitudes towards PWD compared to other groups, they also have more negative implicit attitudes towards PWD. As such there is a contrast between nurses' stated (explicit) attitudes and their unconscious (implicit) attitudes towards PWD. Further, we find that implicit bias towards PWD-among all groups-has not improved over the 15 year period of our sample., Conclusions: We present a contrast between nurses' explicit and implicit attitude towards PWD compared to non-healthcare providers. We posit that implicit bias is driven by a combination of workload and stress which drives nurses to unconscious modes of thinking more frequently., Implications: We discuss three potential tools for improved educational praxis regarding treatment of PWD; (1) more PWD service user involvement, (2) the use of mindfulness techniques to reduce stress and (3) the use of patient contact simulation to promote education and understanding., Patient or Public Contribution: There is no patient or public contribution., (© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Burnout is frequent among intensive care unit (ICU) healthcare professionals and may result in medical errors and absenteeism. The COVID-19 pandemic caused additional strain during working hours and also affected off-duty life. The aims of this study were to survey burnout levels among ICU healthcare professionals during the first year of COVID-19, describe those who reported burnout, and analyse demographic and work-related factors associated with burnout., Methods: This was a national prospective longitudinal cohort study of 484 nurses, physicians and leaders working in intensive care units with COVID-19 patients in Norway. Burnout was measured at 6- and 12-month follow-up, after a registration of baseline data during the first months of the COVID epidemic. The Copenhagen Burnout Inventory (CBI), was used (range 0-100), burnout caseness defined as CBI ≥50. Bi- and multivariable logistic regression analyses were performed to examine baseline demographic variables and work-related factors associated with burnout caseness at 12 months., Results: At 6 months, the median CBI score was 17, increasing to 21 at 12 months (p = .037), with nurses accounting for most of the increase. Thirty-two per cent had an increase in score of more than 5, whereas 25% had a decrease of more than 5. Ten per cent reported caseness of burnout at 6 months and 14% at 12 months (n.s.). The participants with burnout caseness were of significantly lower age, had fewer years of experience, reported more previous anxiety and/or depression, more moral distress, less perceived hospital recognition, and more fear of infection in the bivariate analyses. Burnout was the single standing most reported type of psychological distress, and 24 out of 41 (59%) with burnout caseness also reported caseness of anxiety, depression and/or post-traumatic stress disorder (PTSD) symptoms. Multivariate analysis showed statistically significant associations of burnout caseness with fewer years of professional experience (p = .041) and borderline significance of perceived support by leader (p = .049)., Conclusion: In Norway, a minority of ICU nurses, physicians and leaders reported burnout 1 year into the pandemic. A majority of those with burnout reported anxiety, depression and/or PTSD symptoms combined. Burnout was associated with less years of professional experience., (© 2024 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Background: In the dynamic landscape of healthcare, nurses play a crucial role as ethical stewards, responsible for whistleblowing, nurse advocacy, and patient safety. Their duties involve ensuring patient well-being through ethical practices and advocacy initiatives., Aim: This study investigates the ethical responsibilities of nurses regarding whistleblowing and advocacy in reporting concerns about patient safety., Research Design: A cross-sectional study utilized cluster and simple random sampling to gather a representative sample of actively practicing registered nurses. Data collection involved a demographic form, Nurse Whistleblowing Intentions Scale, Nursing Advocacy Scale, and Clinical Decision-Making Scale., Participants and Research Context: The study utilizing a robust sample size determination formula for reliable findings included 96 diverse nurses, predominantly females. Engaged actively in direct patient care across various outpatients clinics. The recruitment process specifically sought individuals with expertise in safety protocols and reporting, contributing to a nuanced understanding of the study's focus., Ethical Considerations: Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. A thorough ethical review was conducted to guarantee participant protection and adherence to ethical principles., Results: Surveyed nurses demonstrated positive whistleblowing (Overall Mean Score: 3.58), high advocacy (Overall Mean Score: 12.2), and nuanced ethical decision-making for patient safety (Overall Mean Score: 15.78). Demographic factors, such as nationality and ethical training, significantly impacted whistleblowing intentions, while age, gender, and ethical training correlated with nursing advocacy behavior. Associations with experience and qualification emerged in ethical decision-making., Conclusion: The gained insights foster targeted interventions, improving ethical practices, advocacy, and informed decision-making in nursing. This study explores the intricate link between demographics and ethical considerations among surveyed nurses, acting as a catalyst for ongoing initiatives to strengthen the ethical foundation in healthcare sector., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The province of Nova Scotia has the highest rates of perinatal mental health disorders in Canada, and rates of exclusive breastfeeding fall below the Canadian national average. Exclusive breastfeeding is identified as a protective factor against the development of perinatal mental health disorders. Lactation consultant support is associated with increased rates of exclusive breastfeeding and decreased rates of perinatal mental health disorders. Despite this, little is known regarding the experiences of Registered Nurse Lactation Consultants related to supporting maternal mental health., Objective: To understand the experiences of Registered Nurse Lactation Consultants related to supporting maternal mental health., Design: A qualitative descriptive design using online semi-structured interviews., Setting & Participants: Ten Registered Nurse Lactation Consultants employed in the publicly funded healthcare system in Nova Scotia, Canada, were recruited via purposive sampling., Findings: Three themes emerged regarding the relational experiences of Registered Nurse Lactation Consultants while supporting maternal mental health; these included (1) Experiences supporting maternal mental health, (2) Providing maternal mental health care, and (3) Mothers need support., Key Conclusions and Implications for Practice: Registered Nurse Lactation Consultants described positive experiences supporting maternal mental health and indicated that lactation consultant appointments were an opportune time to provide screening and support for maternal mental health. Enhancing support for maternal mental health requires collaborative and integrated approaches throughout the perinatal period. Healthcare providers, including Registered Nurse Lactation Consultants, must be provided with the support and resources to provide timely and appropriate support for maternal mental health throughout the perinatal period., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Whistleblowing is an action that particularly requires moral courage. Understanding the relationship between nurses' levels of moral courage and their whistleblowing approaches is important for reducing adverse situations in healthcare services., Objectives: This study aims to understand and analyze the relationship between nurses' levels of moral courage and their whistleblowing approaches., Research Design: This is a descriptive and correlational study., Methods: The study sample consists of 582 nurses actively working in a province in northwest Türkiye. Research data were collected using an Information Form, the Nurses' Moral Courage Scale, and the Whistleblowing Scale., Ethical Considerations: Ethical approval from the ethics committee, institutional permission, and informed consent from the participants were obtained for data collection., Findings: Nurses were found to perceive their moral courage as high, and their whistleblowing levels were at a moderate level. There was a significant and moderate relationship between participants' levels of moral courage and whistleblowing levels ( p < .05)., Conclusions: The findings emphasize the importance of promoting moral courage and creating an appropriate environment for exposing ethical violations. This study can contribute to the development of strategies to enhance nurses' moral courage and foster a more ethical working environment in healthcare services., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study investigated whether stress and positive anticipations about tomorrow are associated with emotional experiences the following day, mediated by the preceding night's sleep. Data were from 141 full-time nurses, utilizing a 14-day ecological momentary assessment combined with actigraphy sleep monitoring. Each evening, participants rated the anticipated pleasantness or stressfulness of the following day. Each morning, participants reported on their previous night's sleep. Additionally, participants reported their momentary positive affect (PA) and negative affect (NA) three times per day, with daily averages computed. Multilevel mediation models, adjusted for sociodemographics, work shift, workday, and previous day's affect, revealed that days following more stress anticipations were associated with reduced PA and increased NA. Conversely, days following more pleasantness anticipations were associated with increased PA and decreased NA. These within-person associations were mediated by self-reported time-in-bed, sufficiency, and quality, such that less stressful and more pleasant anticipations were associated with better sleep, and better sleep was subsequently associated with increased PA and decreased NA. No mediation was found by the actigraphy sleep parameters. Findings suggest that emotional states may covary not only with present stimuli but also with anticipation of future events and subjective sleep recovery in the context of those anticipations., (© 2024 The Author(s). Applied Psychology: Health and Well‐Being published by John Wiley & Sons Ltd on behalf of International Association of Applied Psychology.)