The 50 most-cited articles in Journal of Advanced Nursing, 2019

AIM: To establish what leadership competencies are expected of master level-educated nurses like the Advanced Practice Nurses and the Clinical Nurse Leaders as described in the international literature. BACKGROUND: Developments in health care ask for well-trained nurse leaders. Advanced Practice Nurses and Clinical Nurse Leaders are ideally positioned to lead healthcare reform in nursing. Nurses should be adequately equipped for this role based on internationally defined leadership competencies. Therefore, identifying leadership competencies and related attributes internationally is needed. DESIGN: Integrative review. METHODS: Embase, Medline and CINAHL databases were searched (January 2005-December 2018). Also, websites of international professional nursing organizations were searched for frameworks on leadership competencies. Study and framework selection, identification of competencies, quality appraisal of included studies and analysis of data were independently conducted by two researchers. RESULTS: Fifteen studies and seven competency frameworks were included. Synthesis of 150…

AIMS: To examine the mediating effects of self-efficacy, coping, burnout, and social support in the link between job stress and depression and anxiety among young Chinese nurses. DESIGN: A cross-sectional survey was used. METHODS: Full-time young nurses (N = 1,029) who worked in nine tertiary grade A hospitals in Chengdu China were recruited from December 2016-March 2017. Structural equation modelling was applied to analyse the mediating effects. RESULTS: Job stress had a direct positive effect on anxiety (β = 0.054) and it also exerted indirect positive effects on depression (β = 0.337) and anxiety (β = 0.325) through mediating factors. Emotional exhaustion and social support were the main mediating variables, accounting for 72.0% of the variation in anxiety and nearly 43.4% in depression. CONCLUSION: Emotional exhaustion and social support may have significant mediating effects in the link between job stress and depression and anxiety. Strategies including deceasing emotional exhaustion, enhancing social support in work environment, and reducing job stressors would be useful to…

AIMS: To review both mental and physical health consequences of bullying for healthcare employees. DESIGN: Systematic literature review. DATA SOURCES: EMBASE, MEDLINE, PsycINFO, PUBMED and Web of Science Core Collection were searched for articles published between 2005 - January 2017. REVIEW METHODS: This review was conducted using the framework described by Khan and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two independent reviewers performed systematic data extraction and appraised the methodological quality of included articles. A pooled mean prevalence of bullying was estimated. RESULTS: Forty-five papers met inclusion criteria. Bullying prevalence ranged from 3.9% to 86.5%, with a pooled mean estimate of 26.3%. Perceived bullying was associated with mental health problems including psychological distress, depression and burnout, and physical health problems including insomnia and headache. Bullied staff took more sick leave. CONCLUSION: Bullying occurs frequently amongst healthcare staff and is deleterious to health and occupational…

AIM: To evaluate the effectiveness of educational interventions in improving medication adherence among adult patients diagnosed with hypertension, hyperlipidaemia and/or diabetes. DESIGN: This review was conducted with reference to methods set out in the Cochrane Handbook for Systematic Reviews of Interventions (PROSPERO registration number: CRD42016053402). DATA SOURCES: A search from seven electronic databases (2003-2016). REVIEW METHOD: The quality of evidence and strength of the studies was evaluated systematically, followed by an assessment of risks of bias by two reviewers with the Cochrane Collaboration's tool. RESULTS: Eighteen randomized controlled trials demonstrated a low to moderate quality evidence on the improvements of medication adherence with educational interventions. Participants with type 2 diabetes benefited from education interventions but not those with hypertension. No randomized controlled trials (RCT) was found for participants with hyperlipidaemia. Education that was conducted at home showed better medication adherence than education conducted in clinics.…

AIMS: The aim of this systematic review and meta-analysis is to explore the relationship between structural empowerment and organizational commitment and to examine a theoretical model under which empowerment could potentially affect organizational performance. DESIGN: PRISMA guidelines for systematic reviews and meta-analyses were used and quality assessment of articles was performed. DATA SOURCES: Electronic database searches were conducted in Google Scholar, PubMed/Medline, CINAHL, Scopus, and EMBASE from January 1950-1 January 2019, which resulted in 204 retrieved studies, published between 1994-2018. REVIEW METHODS: A random effects model was used to produce a pooled estimate of effect sizes (correlation coefficient, Cronbach's alpha), with analysis of heterogeneity and publication bias. A meta-analytic structural equation model of the constructs analysed was also performed. RESULTS: The final review included 22 studies. The meta-analytic means of structural empowerment, organizational commitment, job satisfaction, and psychological empowerment alpha reliabilities were 0.87,…

AIMS: To obtain a comprehensive insight of the impact of patient and family engagement on patient safety and identify issues in implementing this approach. BACKGROUND: Patient and family engagement is increasingly emerging as a potential approach for improving patient safety. DESIGN: Mixed method multilevel synthesis. DATA SOURCES: PubMed, CINAHL, Embase, and Cochrance Library (January 2009-April 2018). REVIEW METHODS: The review was conducted according to the principles recommended by the Cochrane Handbook for Systematic Review and in accordance with the PRISMA guidelines. RESULTS: Forty-two relevant studies were identified. Common intervention groups included 'direct care' and 'organization' levels with 'consultation' and 'involvement' approaches, while the 'health system' level and 'partnership and shared leadership' approaches were rarely implemented. Findings revealed positive effects of the interventions on patient safety. Most study participants expressed their willingness to engage in or support patient and family engagement. However, existing gaps and barriers in…

AIM: To describe communication barriers faced by allophone migrant women in maternity care provision from the perspectives of migrant women, healthcare professionals, and intercultural interpreters. BACKGROUND: Perinatal health inequality of migrant women hinges on barriers to services, with a major barrier being language. Their care is often also perceived as demanding due to conflicting values or complex situations. Potentially divergent perceptions of users and providers may hinder efficient communication. DESIGN: Qualitative explorative study. METHODS: A convenience sample of 36 participants was recruited in the German speaking region of Switzerland. The sample consisted of four Albanian and six Tigrinya speaking women, 22 healthcare professionals and four intercultural interpreters (March-June 2016) who participated in three focus group discussions and seven semi-structured interviews. Audio recordings of the discussions and interviews were transcribed and thematically analysed. RESULTS: The analysis revealed three main themes: the challenge of understanding each other's world,…

AIM: To assess the effectiveness of psychoeducational interventions with respect to burden, anxiety and depression in family caregivers of People With Dementia living at home. BACKGROUND: In dementia, the family assumes the role of main caregiver, maintaining the patient in a good state of health. Nevertheless, burden, anxiety and depression may have negative repercussions in caregivers. Therefore, professional supports through psychoeducational programmes are recommended as interventions for improving caregivers' health. DESIGN: A quantitative systematic review. DATA SOURCES: Electronic searches were performed in CINAHL/AMED/CENTRAL/Web of Science/LILACS/PUBMED from January 2005-August 2018. REVIEW METHODS: The review was conducted using the JADAD scale to assess bias risk and the quality of the randomized controlled trials (RCTs) and the CONSORT instrument to assess study quality report. The extracted data were reviewed by independent reviewer pairs. The review was reported using PRISMA. RESULTS: A total of 18 RCTs met inclusion criteria. Seven were classified as Technology-based…

AIMS: To determine diabetes patient's adherence to five self-care behaviours (diet, exercise; medication, self-monitoring of blood glucose [SMBG] and foot care) in low- and middle-income countries. DESIGN: Systematic review. DATA SOURCES: We searched MEDLINE, CINAHL, PUBMED, SCOPUS, PsycINFO, EMBASE, Cochrane library and EMCARE for the period January 1990 - June 2017. REVIEW METHODS: Title, abstract and full text screening were done according to eligibility criteria. A narrative synthesis of the literature was conducted. RESULTS: A total of 7,109 studies were identified of which 27 met the review eligibility criteria and were included. All the studies used self-report of adherence to diabetes self-care. Studies reported adherence rates in two major forms: (a) mean number of days participants performed a recommended dietary behaviour/activity during the past week; and (b) proportions of participants adhering to a recommended self-care behaviour. Mean number of days per week participants adhered to a self-care behaviour ranged from 2.34.6 days per week for diet, 5.5-6.8 days per week…

AIMS: To identify the characteristics of joint displays illustrating the data integration in mixed-methods nursing studies and to make recommendations for effective use of joint displays for the integration of qualitative and quantitative data in mixed-methods studies. DESIGN: Discussion Paper. DATA SOURCES: We have completed this paper as a part of a mixed-methods prevalence review of 190 studies published in nursing journals. We searched 10 nursing journals and three databases from January 2014-April 2018, additional journal search was performed from May-September 2018. We reviewed 17 studies that used joint displays as the method of data integration. Using a joint display typology, checklists, summary tables, and personal experiences of using joint displays, we evaluated the quality of displays. IMPLICATIONS FOR NURSING: Nurse researchers should use advanced data integration approaches to increase the rigour of the mixed-methods studies. Joint displays can enable nurse researchers to efficiently integrate and synthesize the qualitative and quantitative data in mixed-methods…

AIMS: To evaluate the effects of eHealth cardiac rehabilitation (CR) on health outcomes of coronary heart disease patients and to identify programme design, which may lead to more effective health benefits. DESIGN: A systematic review and meta-analysis following Cochrane Handbook for Systematic Reviews of Interventions. DATA SOURCES: Medline, EMBASE, CLNAHL, Web of Science, Scopus, PsycINFO, Cochrane Central Register of Controlled Trails, PubMed and CNKI were searched over the period from 1806 to April 2019. REVIEW METHODS: A systematic review and meta-analysis of randomized controlled trials to examine the effect of eHealth CR on health outcomes of coronary heart disease patients. We used RevMan 5.3 for risk of bias assessment and meta-analysis and GRADE software for generating findings. RESULTS: In all, 14 trials with 1,783 participants were included. eHealth CR has significantly promoted duration of physical activity, daily steps, quality of life (QoL) and re-hospitalization. Using comparative analysis of programme design elements, including mode of delivery, intervention…

AIMS: The aim of this study was to provide guidance to improve the completeness and clarity of meta-ethnography reporting. BACKGROUND: Evidence-based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta-ethnography is a rigorous seven-phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta-ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta-ethnography reporting guidance is needed to improve reporting quality. DESIGN: The eMERGe study used a rigorous mixed-methods design and evidence-based methods to develop the novel reporting guidance and explanatory notes. METHODS: The study, conducted from 2015 - 2017, comprised of: (1) a methodological systematic review of guidance for meta-ethnography conduct and reporting; (2) a review and audit of published meta-ethnographies to identify good practice principles; (3) international, multidisciplinary consensus-building processes to…

AIMS: To integrate the overall effect of e-health based self-management on cancer-related fatigue (CRF), self-efficacy, and quality of life (QOL) among adult cancer patients. DESIGN: A systematic review and meta-analysis of randomized controlled trials. DATA SOURCES: We researched PubMed, Cumulative Index Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Web of Science and Embase up to 14 July 2019. REVIEW METHODS: We conducted the review with the Cochrane Handbook (version 5.1.0) and measured the quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS: Literature searching identified 15 trials with a total of 2,337 participants. Integrated results analysis of e-health based self-management demonstrated a statistically significant but small effect on CRF and self-efficacy, but no statistically significant improvement on the QOL. Meanwhile, subgroup analysis indicated that e-health based self-management had a larger effect on fatigue compared with usual care/waiting list control. CONCLUSION:…

AIMS: To examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals. DESIGN: A quantitative systematic review included studies published in English between January 2000 - September 2018. DATA SOURCES: Cochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix-methods designs were included if the quantitative component met the criteria. REVIEW METHODS: The Systematic Review guidelines of the Joanna Briggs Institute and its critical appraisal instrument were used. An inverse association was determined when seventy-five percent or more of studies with significant results found this association. RESULTS: Sixty-three articles were included. Twelve patient outcomes were inversely associated with nursing skill mix (i.e., higher nursing skill mix was significantly associated with improved patient outcomes). These were length of stay; ulcer, gastritis and upper…

AIM: To quantify the effect of laughter and humour interventions on depression, anxiety, and sleep quality in adults. DESIGN: A meta-analysis of randomized controlled trials. DATA SOURCES: PubMed, Embase, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Weipu, and Wanfang Data were searched from their inception up to December 2018. REVIEW METHODS: The reporting of this meta-analytical review was conducted according to the guidelines of the Cochrane Collaboration. Two reviewers selected the studies, extracted the data, and evaluated the risk of bias (Cochrane Collaboration bias assessment tool) of the included papers independently. RESULTS: Ten studies comprising 814 participants were included. Meta-analysis showed that these interventions significantly decreased adults' depression, anxiety, and improved their sleep quality. The results of subgroup analysis showed that depression benefits more from long-term laughter intervention. CONCLUSIONS: This meta-analysis revealed that laughter and humour interventions are…

AIMS: The study aims are (a) to test a model developed to estimate the impact of work engagement on work ability as it is perceived by nurses; (b) to test the parameters between work ability and job satisfaction and between job satisfaction and turnover intention. DESIGN: Cross-sectional. METHODS: This study involved 1,024 nurses from January - May 2018. The response rate was 70.7%. The Work Ability Index and the Utrecht Work Engagement Scale were used. Path analysis was performed, both in the whole sample and in age categories (<45yy-≥45yy). Model's parameters and fit indexes were estimated. RESULTS: The comprehensive model was validated through the multi-group approach. Fit indexes were adequate in the general model and in the multi-group testing. Parameters confirmed the association between work engagement and work ability and between work ability and job satisfaction and turnover intention. Parameters highlighted different age-dependent patterns. CONCLUSION: This study states the contribution of work engagement to enhance work ability in nursing profession. Findings contribute…

AIMS: This review aimed to systematically assess the findings of primary studies to identify the factors associated with nurse job satisfaction in rural and urban contexts while analysing the findings according to Herzberg's theory. BACKGROUND: While there is evidence linking several factors to nurses' job satisfaction, gaps still exist in understanding the differences between factors affecting job satisfaction for nurses working in rural and urban settings. DESIGN: Systematic review with narrative summary. DATA SOURCES: Six databases were used to identify original studies that discuss the factors associated with the nurse's job satisfaction between 1998-2018. REVIEW METHODS: Two authors independently reviewed each study using the Joanna Briggs Institute's critical appraisal checklists. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to report and examine the study biases systematically. RESULTS: A total of 38 studies were selected for this review. Physical working environment and authority and freedom were the most frequently reported…

AIMS: Getting insight in the most crucial organizational job stressors for novice nurses' professional commitment and whether the job stressors are mediated through negative emotions. DESIGN: The study used an observational cohort design. METHODS: Organizational job stressors were derived from 580 diary entries by 18 novice nurses combined with measures on emotions and commitment. The diaries were collected from September 2013-September 2014. RESULTS: Path modelling revealed that lack of support from colleagues, negative experiences with patients and confrontations with existential events were most strongly negatively related to professional commitment through negative emotions. Other indirectly and negatively related organizational job stressors to commitment were complexity of care, lack of control and work-life imbalance; only conflicting job demands, and lack of control related to professional commitment directly. CONCLUSION(S): To enhance professional commitment, it is important to reduce negative emotions in novice nurses by collegial support in dealing with negative…

AIMS: To propose a policy framework for nursing education to foster compassion in nursing students. DESIGN: A critical review. DATA SOURCES: Literature was searched in CINAHL, PubMed, Science Direct and Google Scholar and sources published from January 2008 - April 2018 were reviewed. REVIEW METHODS: We screened abstracts and full-texts using specific inclusion criteria, developed summary tables for data extraction and synthesized data logically to develop the framework. RESULTS: Twenty-nine sources were reviewed. Recognizing, accepting, and alleviating patients' suffering are direct indicators of compassionate care. Three policy directions were identified: ensure the nursing curriculum has an appropriate balance of teaching-learning strategies that target learning in the affective domain, directly promote the use of reflection and the development of reflective thinking in students as an approach to enhance excellence in clinical practice and integrate information and assess students' understanding and expression of compassion throughout the nursing curriculum. CONCLUSION:…

AIM: This paper seeks to describe best practices for conducting cross-language research with individuals who have a language barrier. DESIGN: Discussion paper. DATA SOURCES: Research methods papers addressing cross-language research issues published between 2000-2017. IMPLICATIONS FOR NURSING: Rigorous cross-language research involves the appropriate use of interpreters during the research process, systematic planning for how to address the language barrier between participant and researcher and the use of reliably and validly translated survey instruments (when applicable). Biases rooted in those who enter data into "big data" systems may influence data quality and analytic approaches in large observational studies focused on linking patient language preference to health outcomes. CONCLUSION: Cross-language research methods can help ensure that those individuals with language barriers have their voices contributing to the evidence informing healthcare practice and policies that shape health services implementation and financing. Understanding the inherent conscious and unconscious…

AIMS: To identify the prevalence of work-related musculoskeletal disorders, levels of chronic occupational fatigue, and how they vary with individual and work organization factors. DESIGN: A multi-hospital cross-sectional survey. METHODS: Nurses from 39 hospitals completed self-reported questionnaires from June to September 2015. Descriptive statistics were used to summarize hospitals and nurses' characteristics, fatigue levels and prevalence, and type of musculoskeletal disorders. Linear and logistic regression analyses were used to identify correlational factors. RESULTS: The results revealed that 71.3% of participants reported a work-related musculoskeletal disorder in the previous 12 months, mainly back pain. The reported musculoskeletal disorders were significantly correlated with years of experience, nurse to patient ratios, and chronic occupational fatigue. Higher chronic occupational fatigue levels were associated with education, age, years of experience, nurse to patient ratio, and model of care. CONCLUSION: Preventive work organization strategies are needed to ensure…

AIM: To test the relationship between work practice environment and turnover intention, considering the mediation of work engagement and the moderation of work pressure among community health nurses. DESIGN AND SAMPLES: A cross-sectional survey design. METHODS: A total of 410 nurses were recruited from 32 community health centres between September 2016-January 2017 with survey on work practice environment, work engagement, work pressure and turnover intention. Structural equation modelling was used to test a mediated moderation model. RESULTS: Work practice environment was positively associated with higher work engagement and lower turnover intention and work engagement partially mediated the relationship between work practice environment and turnover intention. In addition, work pressure moderated the relationship between work practice environment and work engagement. CONCLUSION: The improvement of work practice environment including the physical and humanitarian environment could enhance nurse engagement and reduce turnover intention in community, which was more pronounced among…

AIMS: The aim was to examine the reciprocal relationships of emotional labour strategies with emotional exhaustion and professional identity. DESIGN: This study adopted a four-wave cross-lagged panel design. METHODS: Survey data were collected in 2018 from a sample of 171 newly hired nurses from 58 hospitals in 11 provinces of China. Nurses' emotional labour (i.e., deep acting and surface acting), emotional exhaustion and professional identity were repeatedly measured. Cross-lagged panel analyses were conducted to examine the reciprocal relationships we hypothesized. RESULTS: We found that emotional exhaustion was positively related to surface acting (but not vice versa); deep acting was negatively related to emotional exhaustion (but not vice versa); professional identity was positively related to deep acting (but not vice versa). CONCLUSION: Our findings suggest that deep acting and professional identity may decrease the level of emotional exhaustion, whereas emotionally exhausted nurses are more likely to employ surface acting strategies. IMPACT: This research finding will have…

AIM: To examine the relationship between sleep-wake disturbances and frailty among older adults. DESIGN: A systematic review. DATA SOURCES: Peer-reviewed and English-written studies were sourced in CINAHL Complete, PsycINFO, Ovid-Medline, and by hand searching from inception to December 2018. REVIEW METHODS: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Cochrane Collaboration Risk of Bias Tool was used to appraise the methodological quality. A quantitative meta-analysis was not conducted due to the heterogeneous effect estimates statistics and measurements of sleep-wake disturbances. Instead, a narrative synthesis was carried out conforming to the Centre for Reviews and Dissemination's guidance. RESULTS: Six cross-sectional studies and one longitudinal study were included in this review. There was consistent evidence on the association between perceived sleep quality and frailty among older adults; whereas the results for insomnia symptoms, excessive daytime sleepiness, and sleep-wake pattern were inconclusive.…

AIMS: To conduct a concept analysis of clinical practice contexts (work environments) in health care. BACKGROUND: Context is increasingly recognized as important to the development, delivery, and understanding of implementation strategies; however, conceptual clarity about what comprises context is lacking. DESIGN: Modified Walker and Avant concept analysis comprised of five steps: (1) concept selection; (2) determination of aims; (3) identification of uses of context; (4) determination of its defining attributes; and (5) definition of its empirical referents. METHODS: A wide range of databases were systematically searched from inception to August 2014. Empirical articles were included if a definition and/or attributes of context were reported. Theoretical articles were included if they reported a model, theory, or framework of context or where context was a component. Double independent screening and data extraction were conducted. Analysis was iterative, involving organizing and reorganizing until a framework of domains, attributes. and features of context emerged. RESULT: We…

AIMS: To examine the experiences of health transitions for young people with intellectual disabilities and their carers and identify the implications for nursing practice. DESIGN: A systematic review and critical appraisal of qualitative, quantitative, and mixed methods studies. DATA SOURCES: A search of the relevant literature published 2007-2017 was carried out in AMED, ASSIA, CINAHL, MEDLINE, PsycINFO, PubMed, and Science Direct Sociological Abstracts databases. REVIEW METHODS: A total of 12 of 637 papers identified in the search met the inclusion criteria for this review. A narrative review of the papers was undertaken by synthesizing the key findings and grouping them into concepts and emergent themes. RESULTS: Four main themes were identified: (a) becoming an adult; (b) fragmented transition process and care; (c) parents as advocates in emotional turmoil; and (d) making transitions happen. CONCLUSION: The range of issues that have an impact on the transition from child to adult health services for young people with intellectual disabilities and their carers raise important…

AIMS: To summarise available reviews on nursing handover (NH) and patient safety (PS), providing a set of evidence-based recommendations for clinical practice and research. DESIGN: Umbrella review. DATA SOURCES: We systematically searched PubMed, CINAHL, and Cochrane Library CENTRAL databases up to October 2018. REVIEW METHODS: Retrieved reviews were critically evaluated using the Checklist for Systematic Review and Research Syntheses. Then, an iterative approach and two different frameworks were adopted to categorize the findings in: (a) practice; and (b) research recommendations. RESULTS: A total of 17 reviews were included: among them, 16 reported a range of recommendations for clinical practice to promote PS by reducing adverse events. For what concerns research, 16 reviews recommended specific strategies to improve and strengthen research and its quality in the field of NHs and PS. CONCLUSION: Changing nursing handover practices to increase PS is complex: it means changing the culture, roles and behaviour of any given clinical nursing setting. To be effective, the change…

AIMS: To systematically review the evidence and determine the effectiveness of cognitive behaviour therapy-based multicomponent interventions on fear of falling and falls among community-dwelling older adults who are at risk of falling. DESIGN: A systematic review and meta-analysis. DATA SOURCES: Six electronic databases, including CENTRAL, CINAHL, EMBASE, PubMed, PsycInfo and Scopus, were searched. Studies published in English from January 1998-July 2018 were included in this review. REVIEW METHODS: Only randomized controlled trials addressing fear of falling and/or the occurrence of falls using cognitive behaviour therapy-based multicomponent interventions were included. A standard procedure based on the Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias of the selected studies. A meta-analysis was performed to determine the effectiveness of cognitive behaviour therapy-based multicomponent interventions on fear of falling immediately after the interventions, at ≤6 months and >6 months postinterventions. RESULTS: This review included 15…

AIMS: To identify, describe, and summarize evidence from quantitative, qualitative, and mixed-method studies conducted to prepare nurses and nursing students to lead on and/or deliver compassionate care. DESIGN: Mixed-method systematic review. DATA SOURCES: CINAHL, Medline, PsychINFO, and SocINDEX (January 2007-February 2018). REVIEW METHODS: Papers were screened by two independent reviewers using an online screening tool and data were extracted using a standardized data extraction table. Parallel-results convergent synthesis was used to synthesize evidence from included qualitative, quantitative, and mixed-method studies. Quality appraisal and risk of bias assessment were conducted. RESULTS: Fifteen studies were included with three main themes and six sub-themes: (a) programme impact (impact on ward-level and senior nurses and impact on nursing students and educators); (b) programme characteristics (characteristics leading to positive outcomes and characteristics leading to negative outcomes); and (c) programme implementation (implementation barriers and implementation…

AIMS: This study examined the effect of two components of a model of nursing care delivery, the mode of nursing care delivery, and skill-mix on: (a) quality of nursing care; and (b) patient adverse events, after controlling for nurse demographics, work environment, and workload factors. DESIGN: A cross-sectional exploratory correlational study that drew on secondary data was conducted. METHODS: Survey data from 416 direct care registered nurses from medical-surgical settings across British Columbia were analysed using hierarchical multiple regression. Larger study data were collected in 2015. RESULTS: Nurses working in a team-based mode reported a greater number of nursing tasks left undone compared with those working in a total patient care. Nurses working in a skill-mix with licensed practical nurses reported a higher frequency of patient adverse events compared with those working in a skill-mix without licensed practical nurses. At higher levels of acuity, nurses in a team-based mode reported a higher frequency of patient adverse events than did nurses in a total patient care.…

AIMS: To explore how academics on nursing and healthcare programmes are managing their roles and responsibility in relation to student mental health. BACKGROUND: There is growing concern about the mental health of university students in general and healthcare students in particular. Shifts in Higher Education policy, encouraging a "whole university approach," may place greater responsibility for student mental health on academics. However, little is known about the challenges that poor student mental health creates for academics on healthcare programmes. DESIGN: A qualitative approach, using semi-structured interviews and focus groups, provided the opportunity for in-depth analysis. METHODS: Fourteen academics on healthcare programmes, including seven lecturers from nursing programmes, were interviewed between May-June 2017. Constant comparison analysis was followed to support grounded theory. RESULTS: Four key themes emerged. Academics had difficulty identifying and maintaining boundaries due to competing academic and professional identities. Student disclosures are accompanied by…

AIMS: The aims of this paper are to explore the role of cross-disciplinary knowledge exchange and integration in advancing the science of unfinished nursing care and to offer preliminary guidance for theory development activities for this growing international community of scholars. BACKGROUND: Unfinished nursing care, also known as missed care or rationed care is a highly prevalent problem with negative consequences for patients, nurses and healthcare organizations around the world. It presents as a 'wicked' sustainability problem resulting from structural obstacles to effective resource allocation that have been resistant to conventional solutions. Research activity related to this problem is on the rise internationally but is hindered by inconsistencies in conceptualizations of the problem and lack of robust theory development around the phenomenon. A unified conceptual framework is needed to focus scholarly activities and facilitate advancement of a robust science of unfinished nursing care. DESIGN: Discussion paper. DATA SOURCES: This discussion paper is based on our own…

AIMS: The study aimed to examine differences between paediatric nurses and physicians regarding burnout syndrome, secondary traumatic stress (STS) and perceived social support (PSS). BACKGROUND: Paediatric nurses and physicians encounter cumulative effects of treating sick and injured children and helping their families, in situations that might promote burnout and STS. DESIGN: Cross-sectional design. METHOD: Nurses (n = 158) and physicians (N = 76) completed self-report questionnaires on STS, PSS and burnout. RESULTS: Nurses and physicians had similar rates of STS and burnout but showed significant differences in PSS. Furthermore, STS mediated the association between PSS and burnout for both groups; however, the effect was stronger for nurses in comparison to physicians. CONCLUSION: Paediatric nurses and physicians would benefit from participating in interventions geared towards reducing STS, thus minimizing burnout. Moreover, advocating social support within the organization is needed to bolster the ability for coping with sources of stress. IMPACT STATEMENT: Nurses' and…

AIMS: To identify clusters based on graduating nursing students' self-reported professional competence and their achievement on a national examination. Furthermore, to describe and compare the identified clusters regarding sample characteristics, students' perceptions of overall quality of the nursing programme, and students' general self-efficacy (GSE). DESIGN: A cross-sectional study combining survey data and results from a national examination. METHODS: Data were collected at two universities and one university college in Sweden in January 2017, including 179 students in the final term of the nursing programme. The study was based on the Nurse Professional Competence Scale, the GSE scale, and results from the National Clinical Final Examination. A two-step cluster analysis was used to identify competence profiles, followed by comparative analyses between clusters. RESULTS: Three clusters were identified illustrating students' different competence profiles. Students in Clusters 1 and 2 passed the examination, but differed in their self-assessments of competence, rating themselves…

AIM: To determine correlations for nurse self-reported occupational stress, prevalence of cognitive failure (CF), and adverse events. DESIGN: Cross-sectional nationwide survey. METHODS: Tertiary-level public hospitals (N = 115) from 13 provinces in Iran were recruited and 2,895 nurses surveyed (August 2016-December 2017). Participants' self-reported demographic information, occupational stress, CF, and frequency of adverse events were analysed using chi-square, t tests, and binary logistic regression. RESULTS: This study showed that 29.1% of nurses had experienced adverse events in the past six months. Significant predictors for reported adverse events from logistic regression were 'Role stressors', 'Interpersonal relations stressors', and 'Action', while 'Working environment stressors' was protective for reported adverse events. Demographic predictors of adverse events were longer work hours and male gender, while those working in critical care units, general wards, and other wards had higher reported adverse events than for emergency wards. CONCLUSIONS: Occupational stress and CF…

AIMS: The aims of this study were to: (a) determine if self-efficacy mediates the relationship between perceived stress and diabetes self-management in adolescents with type 1 diabetes (T1D); and (b) explore whether perceived stress moderated the self-efficacy and diabetes self-management relationship. DESIGN: Non-experimental, descriptive correlational design, conducted from January-December 2016. METHODS: Guided by the Adaptation to Diabetes framework, data on demographic and clinical characteristics, perceived stress, self-efficacy and diabetes self-management were collected. Descriptive analyses and regression analyses were generated by SPSS Version 22. Structural equation modelling was implemented with the MPlus program. RESULTS: There was no direct effect of perceived stress on diabetes self-management; however, self-efficacy mediated the relationship between perceived stress and diabetes self-management. Adolescents who had high self-efficacy and low perceived stress demonstrated better diabetes care activities and diabetes communication than would be predicted from the main…

AIM: To determine the impact of strategies to promote mobilization on physical function in hospitalized adults with medical conditions. BACKGROUND: Slow progress is noted on the promotion of mobilization during hospitalization for adult patients admitted for medical conditions. This may reflect the limited evidence on the evaluation of the impact of progressive mobilization activities on clinical endpoints in adult patients throughout hospitalization. DESIGN: A systematic review and meta-analysis of published randomized controlled trials in any language. DATA RESOURCES: The literature search was performed in the MEDLINE, CINAHL online, HealthStar, EMBASE, the Cochrane Library Controlled Trials Registry and LILACS databases (January 2000-February 2017). REVIEW METHODS: Two authors independently identified randomized trials meeting inclusion criteria, assessed their quality and extracted relevant data. Outcomes assessed were the changes in physical function evaluated by scales measuring either the aerobic (metres walked/second) or the balance domain (using the Time Up and Go test, in…

AIM: To evaluate the effectiveness of a modified four-session Comprehensive Behavioral Intervention for Tics programme for decreasing tics in children and adolescents with Tourette's syndrome. BACKGROUND: Comprehensive Behavioral Intervention for Tics programme has been shown to decrease tic severity. However, the lack of behaviour therapists in countries, such as in Taiwan, may preclude application of the standard eight-session, 10-week programme. DESIGN: Randomized controlled study. METHODS: Participants aged 6-18 years diagnosed with Tourette's syndrome or chronic tic disorder were recruited from February 2015 through September 2016. Participants in the control and intervention groups (N = 23 each) received the routine care (daily pyridoxine [50 mg] and psychoeducation). The intervention group received additional four behavioural intervention sessions over a 3-month period that included psychoeducation, habit reversal training, relaxation training, and education on tic relapse prevention. The outcome measures, Yale Global Tic Severity Scale scores, were assessed at before and…

AIMS: To identify factors that influence recognition and response to adult patient deterioration in acute hospitals. DESIGN: A mixed-studies systematic review. DATA SOURCES: CINAHL, Medline, and Web of Science were searched for relevant literature published between 2007 - 2018. REVIEW METHODS: Studies were critically appraised, data extracted and thematically analysed. RESULTS: Thirteen papers met the inclusion criteria. Three main themes were identified: (a) Knowledge and understanding of clinical deterioration; (b) Organizational factors; managing deterioration and staffing levels; and (c) Communication; inter-professional relationships and professional-patient communication. CONCLUSION: Despite national guidelines, the review findings suggest that the recognition and response to adult patient deterioration in acute hospital settings is sub-optimal. A multitude of factors influencing the recognition and response to adult patient deterioration emerged from the findings. IMPACT: Patients are receiving sub-optimal care due to failure in recognizing and responding to patient…

AIMS: To synthesize evidence about the effectiveness of expressive arts interventions used to reduce psychosocial stress among healthcare workers. DESIGN: Quantitative systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: SocINDEX, PsycINFO, Pubmed, CINAHL. REVIEW METHODS: Databases were searched from 1997-2017. Fourteen studies met the criteria for final selection. RESULTS: Most studies occurred in the US (N = 11). Of the 897 participants, 59% were nurses. Two studies were randomized controlled trials and the others were a variation of a 1-group or 2-group pre- or quasi-experimental study. The intervention characteristics included 50% art-based, 29% music-based, and 21% used storytelling or narrative. The length of intervention varied from 1 hr to 13 weeks; 5 lasted 6 weeks. Improved outcomes were found in 13 of 14 studies reviewed and the greatest improvements were seen in burnout, stress, and emotional outcomes. Overall, music and art-based interventions had greater impact on well-being than storytelling or…

AIMS: An available strategy to counteract academic failure is the development and implementation of student academic self-efficacy; however, to date, there are no instruments measuring it. The aim of this study was to develop and psychometrically test an academic nurse self-efficacy scale. DESIGN: A longitudinal study design was used in accordance with Consensus-based Standards for the Selection of health status Measurement Instruments guidelines. METHODS: A convenience sample of 1,129 nursing students attending the first year of the course were involved. The data collection began in 2014 and went on for 3 years. Data were collected at the beginning of the first (T0), at the end of the first (T1), at the end of the second (T2), and at the end of the third (T3) year. The academic nurse self-efficacy scale was evaluated for content and face validity, for construct validity with explorative, confirmative factor analysis and hypothesis testing and for reliability. The standard error and the smallest detectable difference were also evaluated. RESULTS: Scree plot analysis suggested a…

AIMS: To explore nursing students' academic procrastination and its relationship with emotional intelligence (EI) and self-efficacy, and self-efficacy's mediation of the relationship between EI and academic procrastination. BACKGROUND: Academic procrastination can lead to a range of negative outcomes. Previous researches have suggested EI and self-efficacy are associated with academic procrastination, but the underlying mechanism of the relationships between them is not clear. Therefore, it is important to determine how these two factors affect academic procrastination. DESIGN: A cross-sectional survey. METHODS: A convenience sample of 347 nursing students was recruited from two junior colleges in Jinan City, Shandong Province, China. RESULTS: Emotional intelligence and self-efficacy were negatively associated with academic procrastination. Furthermore, self-efficacy mediated the relationship between EI and academic procrastination. CONCLUSIONS: Students who report lower EI and self-efficacy may be at a higher risk of academic procrastination. One way of weakening individuals'…

AIM: To evaluate the feasibility and effects of the WeChat-based life review programme on anxiety, depression, self-transcendence, meaning in life and hope among cancer patients. BACKGROUND: Life review is effective in improving the psychospiritual well-being of palliative patients. However, traditional life review programmes are limitedly applied in clinical practice. DESIGN: A non-concurrent controlled quasi-experimental design. METHODS: Ninety-two cancer patients were recruited from April 2017 - February 2018, with 44 patients in the control group receiving routine care and 48 in the experimental group receiving a 6-week WeChat-based life review programme plus routine care. Compliance with the programme, difficulty in participation and satisfaction with the programme were used to explore its feasibility. Anxiety, depression, self-transcendence, meaning in life and hope were measured at baseline and immediately after the programme. RESULTS: All experimental participants who completed the programme used the WeChat platform; 39 participants had no difficulties in operating the…

AIM: To assess randomized controlled trials evaluating the impact of nurse practitioner-led cardiovascular care. BACKGROUND: Systematic review of nurse practitioner-led care in patients with cardiovascular disease has not been completed. DESIGN: Systematic review and meta-analysis. DATA SOURCES: The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, Web of Science, Scopus and ProQuest were systematically searched for studies published between January 2007 - June 2017. REVIEW METHODS: Cochrane methodology was used for risk of bias, data extraction and meta-analysis. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Out of 605 articles, five articles met the inclusion criteria. There was no statistical difference between nurse practitioner-led care and usual care for 30-day readmissions, health-related quality of life and length of stay. A 12% reduction in Framingham risk score was identified. CONCLUSION: There are a few randomized control trials assessing nurse…

AIMS: To describe the associations between dysphagia and malnutrition risk and to identify predictors for dysphagia in a group of persons at risk of malnutrition in hospitals and nursing homes. DESIGN: A secondary analysis of cross-sectional data from the years 2012-2016. METHODS: The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool for Adults (MUST). The data were compared regarding malnutrition risk and dysphagia. Regression analyses were conducted to identify variables that were associated with the risk of malnutrition and dysphagia. RESULTS: Patients (N = 17,580) were included in the study sample. The prevalence of dysphagia was 6.6% and the prevalence of malnutrition risk was 18.9%. A multivariable logistic regression analysis resulted in the identification of dysphagia and cancer as variables with the highest odds ratios with regard to malnutrition risk. Patients with cancer, stroke or respiratory diseases represent a high-risk group for the co-occurrence of dysphagia and risk of malnutrition. CONCLUSIONS: Screening for dysphagia should be…

AIMS: To identify dementia-friendly communities' indicators and their current conditions in Taiwan from the perspectives of people with dementia and dementia-family caregivers. DESIGN: This qualitative study explored the opinions and experiences of people with dementia and dementia-family caregivers regarding dementia-friendly communities. METHODS: Participants (16 people with dementia and 20 family caregivers) were recruited from neurological clinics, day care centres for people with dementia and support groups for family caregivers in the Taipei community from July - October, 2016. Data were collected in face-to-face interviews, which were tape recorded and transcribed verbatim. Transcripts were analysed by Miles and Huberman's (1994) guidelines. RESULTS: Similar indicators for dementia-friendly communities were identified in Taiwan as in other countries, including dementia-friendly care services, dementia-friendly hospitals, dementia-friendly community environment, dementia-friendly transportation, dementia-friendly stores and shops, dementia friendly people, integrated…

BACKGROUND: Social cognitive career theory (SCCT) can explain the mechanism underlying the formulation of nurse turnover intention. However, little is known about the role of professional commitment in such a mechanism. AIMS: The aim of this study was to explore how elements of SCCT have an impact on the three aspects of professional commitment and thus nurses' intention to leave the profession. DESIGN: This study used surveys to collect two-wave data. METHODS: The participants were sampled in all available units of a major medical centre in 2017. By using proportionate random sampling methods, we successfully followed up a representative sample of 524 full-time nurses. Most participants (98.1%) were female. Items came from Cunningham et al.'s Self-Efficacy Scale, Outcome Expectations Scale, Human Capital Scale and Vocational Interest Scale; Meyer et al.'s Professional Commitment Scale; and Teng et al.'s Turnover Intention Scale. Structural equation modelling was used to test the hypotheses. RESULTS: Self-efficacy was positively related to outcome expectation. Outcome expectation…

AIMS: To investigate workplace violence and nurse outcomes by comparing gender differences. DESIGN: A secondary analysis of cross-sectional survey data. METHODS: Workplace violence was measured by four items from the International Hospital Outcome Study. Nurse outcomes were measured by tools including burnout, job satisfaction and intention to stay. We used propensity score matching to generate a sociodemographic balanced dataset of 108 male and 288 female nurses. A hypothetical relationship model was derived from the affective events theory. Comparative statistics and multi-group structural equation modelling were conducted to analyze gender differences. Data were collected in China from December 2013 - August 2014. RESULTS: Male nurses reported more workplace violence from staff and less intention to stay than females. Besides finding the mediation of burnout sharing with female nurses consistent with the affective events theory, workplace violence was directly linked to less intention to stay in male nurses. CONCLUSION: Male nurses experience more workplace violence by staff than…

Abstract Aims To explore the risk factors for subjective cognitive decline and cognitive function among older adults in South Korea. Design This study employed a descriptive cross‐sectional design. Methods A convenience sample of 182 patients was recruited from a senior welfare center in Seoul. The mean age of the participants was 78.4 years (SD 5.91). Among them, 64.3% were women. The data were collected by a trained research assistant using structured questionnaires from September 2016–February 2017. Demographic characteristics, comorbidities, depression, physical and cognitive activity levels, instrumental activities of daily living, subjective cognitive decline, and cognitive function were assessed. Student's t tests, chi‐square tests, and hierarchical multiple regression analyses were used for statistical analyses. Results The findings revealed that 37.4% of the participants were not cognitively intact. Depression, perceived health status, and cognitive function were significantly associated with subjective cognitive decline ( F = 7.10, p < .001, adjusted R 2 = 25.3). Age,…

AIMS: To examine qualified intensive care nurses' implicit and explicit attitudes towards obese intensive care patients and whether their attitudes are associated with their behavioural intentions towards these patients. BACKGROUND: Obese intensive care patients may experience more stress than do normal-weight patients. Intensive care nurses' attitudes and the way they address their care are thus vital. Despite a range of studies revealing that health professionals hold anti-fat attitudes towards obese patients, there is a lack of knowledge about intensive care nurses' implicit and explicit attitudes and if such attitudes are associated with behavioural intention. DESIGN: A cross-sectional survey. METHODS: From November 2017 - January 2018, a web-based survey was conducted with 159 qualified intensive care nurses (84.3% women, mean age 45.52 years) recruited through 16 intensive care units and Facebook. The survey consisted of implicit attitude tests, explicit bias scales, the Anti-fat Attitude questionnaire, vignettes measuring behavioural intention, and demographic questions.…