The 50 most-cited articles in Journal of Advanced Nursing, 2020

CFA) aims to confirm a theoretical model using empirical data

AIMS: This study analyses the cross-sectional effect of sources of stress during the peak of COVID-19 pandemic on nurses´ psychological distress, focusing on the mediating role of coping strategies, both problem focused and emotion focused and resilience. DESIGN: Cross-sectional and quantitative analyses. METHODS: Structural equation modelling was performed using survey data obtained during the period between 1 April-25 May 2020 in a sample of 421 nurses from 39 Spanish provinces. RESULTS: Results confirmed that: (a) All the stressors have a significant, direct, and negative relationship with nurses´ psychological distress; (b) Emotion-focused strategies is negatively related to nurses´ psychological distress directly and indirectly through resilience; and (c) Problem-focused strategies is positively related to nurses´ psychological distress and negatively and indirectly through emotion-focused strategies. CONCLUSION: This study identifies an important mediation sequence of stressors on psychological distress through the simultaneous concurrent effect of Problem-focused and…

AIM: To analyse the effect of mindfulness training on levels of burnout among nurses. BACKGROUND: Burnout syndrome is a common occupational hazard for nursing staff. Mindfulness training has been proposed as a valid intervention for burnout. DESIGN: Systematic review and meta-analysis. DATA SOURCES: The CINAHL, LILACS, Medline, ProQuest, PsycINFO, Scielo and Scopus databases were consulted, using the search equation 'Nurs * AND burnout AND mindfulness'. There was no restriction on the year of publication. REVIEW METHODS: Papers were selected for analysis in accordance with the PRISMA guidelines. The meta-analysis was carried out using Review Manager 5.3 software. RESULTS: The sample was of 17 articles including 632 nurses. Mindfulness training reduces levels of burnout, producing lower scores for emotional exhaustion and depersonalization and higher for personal accomplishment. The differences in the means were 1.32 (95% CI: -9.41-6.78), 1.91 (95% CI: -4.50-0.68) and 2.12 (95% CI: -9.91-14.14), respectively, between the intervention and control groups. CONCLUSION: Mindfulness…

AIMS: To evaluate whether the perceived threat of COVID-19 moderates the influence of work resources and demands on burnout. DESIGN: A cross-sectional study. METHODS: We used a convenience sample of 771 nurses working in 10 hospitals in northern Spain. The data on burnout, demand, and resources at work and the perceived threat of COVID-19 were compiled in the second fortnight of April 2020 using an online questionnaire. We used several hierarchical linear regression models. RESULTS: Work overload, material and human resources and social support at work were significant in explaining burnout. The perceived threat of COVID-19 variable was also significant and presented the highest regression coefficient (β = 0.392). The perceived threat of COVID-19 moderated the relationship between social support at work and burnout. CONCLUSION: The perceived threat of COVID-19 helped to explain the degree of burnout in nurses and moderated the relationship between social support at work and burnout. IMPACT: Hospitals should implement strategies to ensure that health emergency situations are not…

AIMS: The aim of this systematic review and meta-analysis was to summarize and quantify peripheral intravenous catheter-related complications. DESIGN: This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies. DATA SOURCES: The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 -April 2019. REVIEW METHODS: Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman-Tukey double arcsine transformation using random-effects meta-analysis; estimates of heterogeneity were taken from inverse-variance fixed-effect models. RESULTS: Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter-related complications…

AIMS: To identify current best evidence on the types of interventions that have been developed to improve job satisfaction among nurses and on the effectiveness of these interventions. DESIGN: The systematic review is a quantitative systematic review and meta-analysis following a profile-likelihood random-effects model. DATA SOURCES: CINAHL, Medic, and Pubmed (Medline). REVIEW METHODS: PICOS eligibility criteria were used to select original studies published between 2003-2019. The articles were screened by title (N = 489), abstract (N = 61), and full-text (N = 47). A total of 20 articles remained after the full-text screening process and further assess on risk of bias. The screening process was conducted by two authors independently and finally agreed together. A meta-analysis was performed to determine how the identified interventions influence nurses' job satisfaction. RESULTS: The interventions were primarily educational and consisted of workshops, educational sessions, lessons, and training sessions. The postintervention differences between intervention and control groups in…

Factor analysis covers a range of multivariate methods used to explain how underlying factors influence a set of observed variables. When research aims to identify these underlying factors, exploratory factor analysis (EFA) is used. In contrast, when the aim is to test whether a set of observed variables represents the underlying factors, in accordance with an existing conceptual basis, confirmatory factor analysis is performed. EFA has many similarities with a commonly used data reduction technique called principal component analysis (PCA). These similarities, along with using the related terms factor and component interchangeably, contribute to confusion in analysis. The difficulty in identifying the appropriate use of statistical methods and their application and interpretation impacts clinical and research implications (Beavers et al., 2013; Tabachnick & Fidell, 2001). We acknowledge previous articles in nursing journals offering guidance on the use of factor analysis (Gaskin & Happell, 2014; Watson & Thompson, 2006).

While debate over the appropriate scope and goals of COVID-19 lockdowns has raged, all public health agencies have been clear on one matter: older adults have the highest rates of mortality (Comas-Herrera et al., 2020) and should be isolated (Public Health Agency of Canada, 2020). Older adults and individuals with complex health conditions are most vulnerable to the virus. Yet, social isolation contributes to the onset and intensifies depression, feelings of despair and, in older adults with dementia, further cognitive decline. Older adults living in long-term care (LTC) facilities comprise 79% of the COVID-19 death toll in Canada (Rothan & Byrareddy, 2020; Walsh & Semeniuk, 2020). While our failure to protect long-term care (LTC) facilities has been made apparent both by this high mortality and a shocking recent Canadian Armed Forces Report (Mialkowski, 2020), the singular focus on mortality has overshadowed any attention to morbidity – particularly the effects of physical distancing on health, quality of life, and autonomy. Annual mortality in LTC facilities exceeds 25%,…

AIMS: To assess the effectiveness of music therapy on the quality of life, anxiety, depression and pain of patients with cancer. DESIGN: Systematic review. DATA SOURCES: Five electronic databases were searched in September 2018 for randomized controlled trials evaluating music therapy for patients with cancer. REVIEW METHODS: The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook Version 5.1.0 and the Revman version 5.3 software was used to perform the meta-analysis. The outcomes were overall quality of life, anxiety, depression and pain. RESULTS: A total of 19 trials evaluating 1,548 patients were included in this study, of which 765 were in the control group and 783 in the experimental group. Compared with standard care, music therapy can significantly increase the score of the overall quality of life in patients with cancer. In addition, music therapy was found to be more effective for decreasing the score of anxiety, depression and pain. CONCLUSION: Music therapy can improve the overall quality of life of patients with cancer,…

AIM: To provide insights into how workplace violence has an impact on nurses and to inform human resource management about developing comprehensive strategies to manage and mitigate violence. DESIGN: A systematic review of the literature to appraise contemporary studies, source data and synthesize findings for human resource management to implement practices to mitigate violence against nurses in the healthcare sector. DATA SOURCES: Searches were conducted using ProQuest, Business Source Complete (EBSCO), Emerald Insight, PsycINFO (ProQuest), ScienceDirect, and Google Scholar. Our search was delimited to refereed journal articles and government reports over the last 15 years from 2004-2019 and included a total of 71 articles. REVIEW METHODS: The research team systematically reviewed each article and relative reports, eliminating any not considered relevant to nurses. This systematic review is associated with and reflects contemporary issues around nurses, violence, and human resource management practice. RESULTS: In the studies we found high incidents of violence against nurses in…

AIM: To propose a theoretical model of intention to stay (ITS) and examine the effects of perceived organizational support, job control and job satisfaction on ITS. DESIGN: Cross-sectional multicentre survey. METHODS: The survey was conducted from January 2017-July 2017 and comprised 3,240 clinical nurses from nine tertiary hospitals in eastern, central and western China, with 2,352 effective responses. Structural equation modelling was used to analyse the relationship between ITS and its correlative factors. RESULTS: The hypothesized model was supported. Job control, perceived organizational support and job satisfaction significantly and directly affected nurses' ITS. Furthermore, job control and perceived organizational support showed indirect effects on ITS, which was mediated by job satisfaction. Perceived organizational support could positively influence job control to have a further impact on job satisfaction and ITS. CONCLUSION: Based on a large sample of Chinese tertiary hospital nurses, this study proposed and verified a theoretical model of nurses' ITS, revealing that…

AIM: To systematically examine the effectiveness of music therapy on preterm infants in neonatal intensive care unit. BACKGROUND: In recent years, the application of music therapy for preterm infants in neonatal intensive care unit has attracted more and more attention because of its clinical effects. However, there still exist disputes among different studies. DESIGN: A systematic review and meta-analysis. DATA SOURCES: Eleven databases were searched over the period from 1910 -4 November 2019. REVIEW METHODS: Papers were selected for analysis in accordance with the PRISMA guidelines. The meta-analysis was carried out by using Review Manager 5.3 software. RESULTS: A total of 13 trials involving 1,093 participants were included. Meta-analysis showed music therapy had a significant influence on preterm infant's heart rate, respiratory rate, oral feeding volume, stress level, and maternal anxiety with moderate-to-high heterogeneity among studies. Also, music therapy had no influences on oxygen saturation and behavioural state. CONCLUSIONS: Music therapy can not only effectively improve…

Abstract Aim The Self‐Care Self‐Efficacy Scale (SCSES) was newly developed as a self‐report measure for self‐care self‐efficacy for chronic illness. This study investigated its measurement equivalence (ME) in different cultural groups, including United States, China (Hong Kong), Italy, and Brazil. Design A multi‐national study for cross‐cultural validation of the Scale. Methods From January 2015 ‐ December 2018, investigators recruited 957 patients (United State: 200; Hong Kong: 300; Italy: 285; and Brazil: 142) with chronic illness from inpatient and outpatient settings. The SCSES was administered and clinical and demographic data were collected from participants. Based on the Meredith framework, multi‐group confirmatory factor analysis evaluated the configural, metric, scalar, and strict invariance of the scale across the four populations through a series of nested models, with evaluation of reliability and coherence of the factor solution. Results The mean ages of the groups ranged from 65–77 years, 56.4% was male. The Cronbach's alpha coefficients of the single‐factor SCSES were…

AIMS: Nurses are at the forefront of public health emergencies facing psychological pressures ensuing from the loss of patients and potential risk of infection while treating the infected. This study examines whether inclusive leadership has a causal relationship with psychological distress and to assess the mediation effect of psychological safety on this relationship in the long run. The hypotheses are developed and interpreted with the help of theoretical underpinnings from job demands resources theory and the theory of shattered assumptions. DESIGN: Three-wave longitudinal study. METHODS: Questionnaire was used to carry out three waves of data collection from 405 nurses employed at five hospitals in Wuhan during the COVID-19 outbreak between the months of January-April 2020. Partial least square structural equation modelling (PLS-SEM) was used to analyze data while controlling for age, gender, education, experience, and working hours. RESULTS: Results supported the hypothesized relationships where inclusive leadership indicated significant inverse causal relationship with…

AIM: Academic distress is a leading cause of attrition among nursing students. The present study tested a positive psychology-oriented model detailing the potential links between nursing students': (a) psychological resilience; (b) depressive symptoms; (c) intrapersonal well-being; (d) interpersonal well-being; and (e) academic distress. Additionally, we tested whether the academic benefits of resilience were conditional upon nursing students' perceptions of their campus climate as supportive of mental health and well-being. DESIGN: A correlational, cross-sectional design was employed. METHOD: Nursing students (N = 933) were selected from the national 2017-2018 Healthy Minds Study (HMS). Students completed measures of resilience, depressive symptoms, intrapersonal well-being (flourishing), interpersonal well-being (belonging), and academic distress. RESULTS: Conditional process modelling tested depression, belonging, and flourishing as mediators of the associations between resilience and academic distress variables. Furthermore, perceptions of campus climate were included as…

AIM: To explore the emotional impact and experiences of geriatric nurses working in nursing homes and caring for patients with coronavirus 2019 disease (COVID-19). DESIGN: This is a qualitative study with phenomenological method and data were gathered through in-depth interview. METHODS: The experiences and expectations that nurses are facing during their care duties were explored via video conference, using a semi-structured interview guide. We have followed the Consolidated criteria for reporting qualitative research COREQ. RESULTS: Interviews (N=24) were conducted with nurses from four countries (Spain, Italy, Peru, and Mexico) during April 2020. Three main categories were extracted: fear of the pandemic situation, the sense of duty and professional commitment, and emotional exhaustion. CONCLUSIONS: Regardless of the country and situation, in the face of the pandemic, dramatic situations have been experienced in nursing homes worldwide, with nursing staff feeling exhausted and overwhelmed, and reflection is urged on a global level to consider the most appropriate model of care in…

AIM: To identify the associated factors of hope during treatment in cancer patients. BACKGROUND: Hope is very important to cancer patients at all stages of the disease process. Hope is seen as an important coping mechanism. Most research about hope in cancer patients considered the end of life or in palliative care. Several and different factors are associated with hope. It is not yet sufficiently clear which factors are associated with hope during the treatment. DESIGN: A systematic literature review of quantitative empirical studies on hope in cancer patients during treatment. DATA SOURCES: Search in MEDLINE (PubMed interface), CINAHL (EBSCO interface), Psychinfo and Cochrane (January 2009-December 2018). REVIEW METHODS: Empirical quantitative studies were included regardless of the disease stage, written in English or Dutch, measuring hope from the perspective of cancer patients. Two authors independently screened all the studies and assessed their quality. RESULTS: Thirty-three studies were included. Positive relationship has been established between hope and quality of life,…

AIMS: To investigate the effects of visual art therapy (VAT) on cognitive and psychological outcomes and explore the crucial design characteristics of VAT that might be associated with greater cognitive benefits among older adults. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Peer reviewed articles were searched from Medline, EMBASE, Global Health, Cochrane Library, Ovid Nursing database, PsycINFO, British Nursing Index, and CINAHL Complete from inception of the databases to September 2019. REVIEW METHODS: This review and meta-analysis was conducted and reported according to preferred reporting items for systematic reviews and meta-analyses guidelines. The Cochrane risk of bias tool was used to examine the risk of bias of the studies. Narrative synthesis and quantitative meta-analysis were performed. RESULT: = 66.570%). VAT also demonstrated psychological benefits in reducing depressive symptoms and anxiety. By systematic comparison of the intervention designs, it seems that those with greater cognitive benefit involved a higher level of creativity and optimized the…

AIMS: To determine which outcomes will be improved by different exercise interventions and the evidence quality for each intervention. DESIGN: Overview of systematic reviews and meta-analysis. DATA SOURCES: PubMed, Cochrane, Web of Science, CINAHL, and Embase. Published from the establishment of the database to 3 September 2019. REVIEW METHODS: AMSTAR 2 and PRISMA were used to evaluate methodological and reporting quality. Evidence quality of the effect of each intervention was assessed according to GRADE guidelines. Meta-analysis of original studies was conducted for comparison of systematic reviews and to explore the effect of different exercise interventions on the same outcome. RESULTS: Ten systematic reviews were included in the overview. A significant improvement was seen in: aerobic exercise for aerobic capacity; strength training for erythrocyte sedimentation rate and 50-foot walking time; aerobic exercise combined with strength training for aerobic capacity, physical function, and fatigue; hand exercise for hand function. CONCLUSIONS: For the maximum benefit of rheumatoid…

AIMS: To explore the status quo and the influencing factors of residents' knowledge, attitude and practice (KAP) in the prevention and control of coronavirus disease 2019 (COVID-19), and the difficulties or challenges perceived by residents in their preventive practice. DESIGN: An online questionnaire survey. METHODS: The self-designed questionnaire was distributed among residents online in February 2020. Descriptive statistics, two independent samples t-tests, one-way analysis of variance, Pearson's correlation analysis, multivariate linear regression and content analysis were performed. RESULTS: A total of 919 valid questionnaires were collected. The scoring rates of residents' KAP were 85.2%, 92.9% and 84.4% respectively. Main factors influencing residents' knowledge included gender and occupation; while those influencing attitude were occupation, family economic level and knowledge; and those influencing practice included place of residence, occupation, with or without chronic disease, knowledge and attitude. Mass media was the primary approach for people to learn the knowledge…

AIM: The aim of the present study was to investigate emotional exhaustion, work engagement, and turnover intention in the nursing profession by exploring the antecedent effects of ethical leadership and job components such as decision authority. BACKGROUND: Emotional exhaustion, low work engagement, and high turnover intention are prevalent issues in the nursing profession. The experience of feeling overworked has led to feelings of burnout and low morale among nurses in Ireland, which has prompted the authors to identify potential variables that reduce these outcomes-in this case, ethical leadership and decision authority. DESIGN: A descriptive, cross-sectional survey design was used across three hospital sites. METHODS: A cross-sectional sample of 89 nurses was recruited from three Irish hospitals to capture the experience of nurses between December 2017 - February 2018. Hypotheses were tested using path model analysis. RESULTS: Ethical leadership positively predicted decision authority among nurses. Ethical leadership also had an indirect effect on all three outcome variables…

AIMS: To systematically evaluate published experimental studies of sustained nurse home visiting (SNHV) programs. This review summarizes the evidence and identifies gaps in the literature to inform practice, policy, and future research. DESIGN: Restricted systematic review with narrative summary. DATA SOURCES: Databases searched were Medline, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials. Year of publication was originally restricted from 2008 to the date of search (13 February 2018, with supplementary searches conducted to identify more recent publications (up to 2019). Several reputable evidence clearinghouses were also searched. REVIEW METHODS: Studies were included if they used a randomized or cluster-randomized controlled trial to evaluate a home visiting program that: (a) targeted disadvantaged mothers; (b) commenced during pregnancy or prior to the child's first birthday; (c) had an intended duration of at least 12 months from the time of enrolment; and (d) was substantively delivered by nurses or midwives. Meta-analyses and reviews of studies meeting…

AIMS: The aim of this study was to develop a consensus-based Spiritual Care Education Standard for undergraduate N/M students to use in undergraduate programmes. DESIGN: Mixed methods were used consisting of qualitative and quantitative methods based on the principles of Delphi research. METHODS: The sample consisted of a total of 58 (N = 58) participants from 21 European countries. Data collection was conducted from June 2017 - February 2019 and took place in facilitated iterative action learning cycles and online surveys. Data were analysed by descriptive statistics and qualitative analysis. Consensus was stated by >90% agreement. RESULTS: The process resulted in an EPICC Spiritual Care Education Standard consisting of the following four spiritual care competences: Intrapersonal spirituality, Interpersonal spirituality, Spiritual care: assessment and planning, Spiritual care: intervention and evaluation. For every competence, learning outcomes were described in knowledge, skills and attitudes. CONCLUSION: This Standard guides N/M spiritual care education, student assessment and…

AIMS: This systematic review aimed to identify school-based interventions for ensuring mental health and well-being of adolescents, synthesize existing interventions, and summarize the quality of identified studies. DESIGN: A systematic review, analysis, and synthesis were performed. DATA SOURCES: Search was performed in Cochrane Library, PsychARTICLES, Web of Science, CINAHL, and Medline. REVIEW METHODS: Literature search was performed in March 2019 using inclusion and exclusion criteria. PRISMA guidelines were followed. Identified records were reviewed by title, abstract, and by the full text by two independent researchers. Three authors independently made a quality assessment of the included studies. Included studies were extracted and synthesized. A systematic review was registered in PROSPERO (CRD42019128919). RESULTS: The initial search yielded 1,199 articles. Of them, 57 articles were included in the final analysis and synthesis. Only four studies were assessed as high quality. Identified themes were mental health and well-being, positive psychology, problem-solving and…

AIMS: Sexual harassment towards nurses is a major concern universally, but no meta-analysis on the worldwide prevalence of sexual harassment towards nurses has yet been published. This study examined the worldwide prevalence of sexual harassment against nurses and explored its moderating factors. DESIGN: Meta-analysis of observational studies. DATA SOURCES: The PubMed, PsycINFO, EMBASE, and Web of Science databases from their commencement date to February 2018 were systematically and independently searched by two investigators. REVIEW METHODS: Data on the prevalence of sexual harassment experienced by nurses were extracted and pooled using the random-effects model. RESULTS: A total of 43 studies covering 52,345 nurses were included in the analyses. Female nurses accounted for 83.87% of the 32,970 subjects in 25 studies with available data on gender ratio. The prevalence of sexual harassment towards nurses in the past 12 months and during nursing career were 12.6% (95% CI: 10.9-14.4%) and 53.4% (95% CI: 23.1-83.7%), respectively. Gender, use of the WHO questionnaires, lower…

AIM: To identify activities performed by Nursing Assistants in acute and primary healthcare. DESIGN: Systematic review. DATA SOURCES: The databases MedLine/PubMed, ProQuest and Google Scholar were searched for empirical studies published in the English language between 2008 and 2018 that addressed the work of Nursing Assistants. REVIEW METHODS: From an initial yield of 2,944 publications, 71 publications were retained for full text review and 20 publications included in this review. Activities undertaken by Nursing Assistants from eight countries were extracted and categorized into one of six categories. RESULTS: Over 200 activities were identified as being delegated to Nurse Assistants globally. Many of these activities are beyond the training of the Nurse Assistant and are being performed with limited Registered Nurse supervision. CONCLUSION: Patient safety is at risk. Nurse Assistants' roles vary widely, with some seeing their role as similar to that of a regulated nurse, while recognizing their need for additional training. IMPACT: Over 31% of activities delegated to Nurse…

AIMS: To compare factors associated with the sedentary lifestyle described in the literature with the factors listed in NANDA International. DESIGN: Systematic review with meta-analysis of factors associated with a sedentary lifestyle in adolescents, adults and older people. DATA SOURCES: An electronic search of PubMed, Scopus, CINAHL and Latin America and the Caribbean Literature on Health and Science databases conducted in May 2016. REVIEW METHODS: Descriptive data were extracted according to a standardized form. The odds ratios for each etiological factor associated with a sedentary lifestyle were extracted directly from the articles or calculated from the data described therein. The meta-analysis was conducted for factors that were investigated in more than one study. RESULTS: Thirty-five articles were included. The statistically significant factors were: lack of social support, of physical space, of time, of motivation, of sports skills and of interest in physical activity, intolerance to activity, being retired, living in a low-income country, laziness, not having a…

AIM: To identify challenges and opportunities for stroke survivors and caregivers in hospital to home transition care. BACKGROUND: Due to shortened hospital stays, stroke survivors and caregivers must take responsibility for complex care on discharge from hospital to home. Gaps exist in the literature that synthesizes studies on hospital to home transition care. DESIGN: A systematic integrated review. DATA SOURCES: Six databases were searched systematically between 18 June 2018 - 31 October 2018 including Medline, CINAHL, Web of Science, ProQuest, Scopus and Science Direct. The search did not have a date limit. REVIEW METHODS: Studies that met the selection criteria were critically reviewed. Data were extracted from the studies for analyses. A convergent qualitative synthesis approach using inductive thematic synthesis was applied to the review. RESULTS: The analysis of 23 studies identified three major findings. First, health and social care systems influence transition care by either enabling stroke survivors and caregivers to manage transition care via well-coordinated services…

AIMS: To examine the mediating role of employee well-being on the relationship between work-life balance practices, the need for achievement and intention to leave among nurses in Malaysia. BACKGROUND: Work-life balance practices are associated with employee perceptions of the need for achievement and well-being which subsequently influence their intention to leave the organization. This study contributes new knowledge to nursing studies on work-life balance in an Asian and Islamic society where the expectations for women are to focus on family rather than career. DESIGN: A cross-sectional, explanatory mixed methodology. METHODS: This is a two-phase study conducted between 2015-2017 with 401 nurses in East Malaysia. In Phase 1, researchers surveyed 379 nurses to test eight hypotheses and in Phase 2 researchers interviewed 22 nurses to explore the results of Phase 1. RESULTS: Phase 1 revealed job satisfaction mediates the relationship between work-life balance practices (e.g. flexibility and choice in working hours, supportive supervision), financial success, and intention to leave.…

AIMS: This study aims to test a hypothetical model linking various dimensions of organizational justice to the job satisfaction and nurses' intention to leave the profession based on the theoretical assumptions of the Alexander model of voluntary turnover. DESIGN: A cross-sectional survey. METHODS: This study was conducted on 317 inpatient ward nurses of six teaching hospitals in Tehran, Iran during 1 September 2017-14 November 2018. Clinical nurses were recruited by a multistage random sampling. Data were collected using structured questionnaires of organizational justice, job satisfaction, and nurses' intention to leave. Data were analysed by structural equation modelling using Amos 22 statistical program. RESULTS: The structural equation model demonstrated adequate fit and the hypothesized correlations were partially supported. The findings suggested that the distributive justice (p < .001; β = 0.24) and interactional justice (p < .001; β = 0.44) could indirectly affect the nurses' intention to leave the nursing profession via the direct impact on job satisfaction, while job…

AIMS: To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions. BACKGROUND: Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes. DESIGN: Scoping review. DATA SOURCES: We searched for eligible studies, published between 1980-2019, in six electronic databases. REVIEW METHODS: Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based. RESULTS: The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions…

AIMS: The assessment of functional status is a more appropriate measure in the older people than traditional healthcare outcomes. The present study aimed to analyse the association between functional status assessed using the Barthel Index and length of stay, in-hospital mortality, discharge destination, and Diagnosis-Related Groups-based cost. DESIGN: This study was a retrospective study that used administrative data from patients older than 65 discharged from the University Hospital of Padua (Italy) in 2016. METHODS: A logistic regression model for categorical variables (length of stay, in-hospital mortality, and discharge destination) and a generalized linear model with gamma distributions and log links for continuous variables (cost of hospitalization) were used to evaluate associations with the Barthel Index. RESULTS: A total of 13,484 admissions were included in the analysis. In-hospital mortality, safe discharge, and length of stay were higher in patients with severe dependence than in patients with mild/no dependence with a 12-fold increased risk of death (OR = 12.81; 95% CI…

AIM: To explore the effects of resonant leadership, leader exchange relationships and perceived organizational support on work engagement and patient outcomes. DESIGN: A cross-sectional survey design. METHODS: Data were collected in June and July 2016 from 252 nurses and clerical staff and institutional patient safety (falls rates) and patient satisfaction (Friends and Family Test) in New Zealand. Data were analysed with structural equation modelling (SEM). RESULTS: (22, N = 252) = 39.048, p = 0.014). Resonant leadership was significantly and positively associated with relationships at work, perception of unit care quality (β = 0.28, p < 0.001), reduced falls rates (β = -0.14, p < 0.05) and better patient satisfaction (β = -0.41, p < 0.001). A direct effect of resonant leadership was demonstrated on patient satisfaction (β = 0.20, p < 0.01). Perceived organization support (β = 0.40, p < 0.001) and leader-member exchange (β = 0.46, p < 0.001) were confirmed antecedents of work engagement. Work engagement was confirmed as an antecedent of nurse perception of unit care quality (β =…

AIMS: To examine hospital nurses' perception of their actual and potential contribution to shared decision-making about life-prolonging treatment and their perception of the pre-conditions for such a contribution. DESIGN: A qualitative interview study. METHODS: Semi-structured face-to-face interviews were conducted with 18 hospital nurses who were involved in care for patients with life-threatening illnesses. Data were collected from October 2018-January 2019. The interviews were recorded, transcribed verbatim and analysed using thematic analysis by two researchers. RESULTS: Nurses experienced varying degrees of influence on decision-making about life-prolonging treatment. Besides, we identified different points of contact in the treatment trajectory at which nurses could be involved in treatment decision-making. Nurses' descriptions of behaviours that potentially contribute to shared decision-making were classified into three roles as follows: checking the quality of a decision, complementing shared decision-making and facilitating shared decision-making. Pre-conditions for…

AIMS: The aim of this study was to investigate the lived experiences of male nurses in today's healthcare environment to understand the persistently low numbers of men in nursing. DESIGN: This study used interpretive description methodology, which aligns with nursing's approach to knowledge discovery by acknowledging the evolution and complexity of shared and individual experiences. METHODS: Participants, (N = 11), were recruited through the American Association for Men in Nursing using purposive sampling. Focused interviews were conducted between May 2018 - June 2018. Interviews were semi-structured, guided by open-ended questions and video and audio recorded. Data were analysed according to study design with categories and themes extracted using reliability measures. RESULTS: This study's findings reflected the unique experiences of each participant in a primarily female dominated work environment in clinical and academic settings. Our study identified thematic categories of role expectations and workplace relations for the men in the study. Role expectations were influenced by…

AIM: To conduct a review summarizing evidence concerning communication with mechanically ventilated patients in the intensive care unit (ICU). BACKGROUND: ICU patients undergoing mechanical ventilation are unable to communicate verbally, causing many negative emotions. Due to changes in sedation practice, a growing number of patients are conscious and experience communication difficulties. DESIGN: The umbrella review method guided by the Joanna Briggs Institute was applied. DATA SOURCES: A systematic search was done in the Cochrane Library, the Joanna Briggs Institute database, Cinahl, Pubmed, PsycINFO and Scopus between January -April 2019. Search terms were 'nurse-patient communication', 'mechanical ventilation', 'intensive care', and 'reviews as publication type'. Literature from 2009-2019 was included. REVIEW METHODS: Following recommendations by the Joanna Briggs Institute, a quality appraisal, data extraction, and synthesis were done. RESULTS: Seven research syntheses were included. There were two main themes and six subthemes: (1) Characterization of the nurse-patient…

AIMS: To provide: (a) an overview of interventions aimed at improving mental health of student or novice nurses; and (b) an evaluation of their effectiveness on dropout-related outcomes. DESIGN: Systematic review. DATA SOURCES: Research papers published between January 1971-February 2019 were identified from the following databases: Embase, Medline, PsycInfo, CINAHL, ERIC, the Cochrane Library, Web of Science, and Google Scholar. REVIEW METHODS: We followed the procedures recommended by the Editorial Board of the Cochrane Collaboration Back Review Group. We included peer-reviewed articles with a quantitative research design, examining interventions aimed at improving mental health of student and novice nurses and their effect on dropout-related outcomes. The large variation in studies prohibited statistical pooling and a synthesis without meta-analysis of studies was performed. RESULTS: We identified 21 studies with three areas of focus: managing stress or stressors (N = 4); facilitating the transition to nursing practice (N = 14); and a combined approach (N = 3). Five studies…

AIMS: To determine job stress among Chinese operating room nurses, test the mediating effect of burnout and verify the moderating effect of over-commitment between job stress and mental health. DESIGN: A descriptive, cross-sectional study. METHODS: A multistage sampling method was adopted. First, a random sampling method was used to select 30 tertiary hospitals in Beijing, after which 509 operating room nurses were selected by convenience sampling from March-June 2017. Self-administered questionnaires were used to evaluate job stress, burnout, and organizational commitment among participants. Multiple-group path analysis was used to test the mediating effect and the moderating effect. RESULTS: Of all nurses, 70.3% were in a state of job stress, which had negative effects on organizational commitment mediated by emotional exhaustion and depersonalization. The result of multiple-group path analysis showed that the path coefficients are different between the low and high groups of over-commitment. When facing job stress, operating room nurses with low over-commitment were more likely…

BACKGROUND: Different tools have been developed and validated to measure unfinished nursing care. However, no systematic review of the psychometric properties has been performed describing the quality of the methods used to estimate their validity. AIMS: (a) To identify tools measuring unfinished nursing care that have undergone validation processes; (b) to evaluate critically the quality of the methods used in ascertaining their psychometric properties; and (c) to compare the estimated psychometric properties of these tools. DESIGN: A systematic review of the psychometric properties also evaluating their methodological quality was performed by following the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guideline for systematic reviews. DATA SOURCES: The databases Medline, the Cumulative Index to Nursing and Allied Health Literature, PubMed, Google and Google Scholar were searched up to 30 June 2018. REVIEW METHODS: Data extraction was performed following the predetermined eligibility criteria. Eight properties and their methodological…

AIMS: To investigate newly graduated Chinese nurses' intention to leave their jobs and to explore the association of intention to leave with nurse characteristics, person-environment fit, and social support. DESIGN: This was a cross-sectional descriptive study. METHODS: Newly graduated nurses (N = 1,313) were recruited from 18 hospitals in six provinces in China, during 2018. An online questionnaire explored intention to leave and related factors, including proactive personality, personal-environment fit, and perceived social support. Chi-squared and multilevel logistic regression analysis were used to examine associations between factors. RESULTS: Among 1,313 newly graduated nurses, 88 (6.7%) reported high-level intention to leave. Nurses working in specialty areas (i.e., outside of medical-surgical wards) and those with higher degree of person-organization fit showed lower intention to leave, whereas those with higher level of education, exposure to negative workplace/life events during the previous year and a proactive personality showed higher intention to leave. CONCLUSION:…

AIMS: To examine relationships between components of nurses' work environments and emotional exhaustion, job satisfaction and intent to leave among nurses in Saudi Arabia. DESIGN: A descriptive correlational study with cross-sectional data. METHODS: Data were collected in 2017 from 497 Registered Nurses working in a large tertiary hospital in Riyadh, Saudi Arabia. Participants completed an online survey like that used in RN4Cast studies to measure nurses' perceptions of their work environments and nurse outcomes. Hierarchical linear regression and logistic regression were conducted to examine the relationships between components of nurses' work environments and nurse outcomes after controlling for nurse and patient characteristics. RESULTS: Nurse participation in hospital affairs was uniquely associated with all three nurse outcomes, whereas staffing and resource adequacy was associated with emotional exhaustion and job satisfaction, but not intent to leave. These two variables were also the components of the nursing practice environment that received the lowest ratings. Nurse…

AIMS: To examine new graduate nurses' perceptions of competency on coping with dying and death and the relationship with death self-efficacy and death anxiety. DESIGN: A multicentre, cross-sectional study. METHODS: Three hundred and forty new graduate nurses from five metropolitan hospitals were recruited between August-November 2018. Participants completed the Coping with Death Scale, Death Self-efficacy Scale, and Death Anxiety Scale. RESULTS: Two hundred and ninety-eight new graduate nurses responded to the survey. The mean score of coping with death and death self-efficacy was 120.11 (SD 24.59), 259.11 (SD 57.70) respectively. 88.9% feared a painful death, 81.5% were particularly afraid of getting cancer, and 80.2% were afraid of death. There was a positive relationship between coping with death and death self-efficacy, a negative relationship between coping with death and death anxiety and a negative correlation between death self-efficacy and death anxiety. Five variables, including death self-efficacy, three dimensions of death anxiety including emotion, cognition with life…

AIM: This study aims to present a general bibliometric overview of the development status of global nursing research from 2000 to 2019. DESIGN: A longitudinal bibliometric analysis of nursing research was conducted. METHODS: Nursing research publications (N = 88,665) were obtained from Web of Science. Bibliometric method was used to map the output and citation impact trends of countries/regions, institutions, disciplines, and journals and analyse the research collaboration among countries/regions and institutions. RESULTS: The global paper output in nursing research increased steadily over the past two decades and it varied in different countries/regions with the USA being far ahead of the others. The paper output and cross-border collaboration are mainly distributed in several developed countries like the USA, the UK, Australia, and Canada. The University of Pennsylvania, Harvard University, University of Toronto, and University of North Carolina at Chapel Hill have high academic influence in the field of nursing. Increasing attention from academic fields has been paid to research…

AIM: To appraise and synthesize evidence of empirical studies reporting assessment of new graduate nurses' clinical competence in clinical settings. DESIGN: Mixed methods systematic review. DATA SOURCES: The search strategy included keywords relevant to: new graduate nurse; clinical competence; and competence assessment. The searched literature databases included CINAHL, MEDLINE, Embase, PsycINFO and Web of Science. The search was limited to full-text papers in English or French, published between 2010 -September 2019. REVIEW METHODS: Inclusion criteria were: 1) empirical studies; 2) detailed method and complete results sections; 3) competence assessment in clinical settings; and 4) new graduate nurses (≤24 months). Two independent reviewers screened eligible papers, extracted data and used the Mixed Methods Appraisal Tool framework for quality appraisal. Divergences were solved through discussion. RESULTS: About 42 papers were included in this review: quantitative (N = 31), qualitative (N = 7) and mixed methods (N = 4). Findings suggest that new graduate nurses exhibit a good or…

AIM: This study examined the following: (a) the impact of nurses' workplace ostracism on unethical behaviour; (b) mediating role of emotional exhaustion between nurses' workplace ostracism and unethical behaviour; and (c) moderating effect of hostile attribution bias. BACKGROUND: While unethical behaviour is a workplace phenomenon that can negatively influence the sustainable development of settings, few nurse studies have explored it. This study identified an interpersonal antecedent of unethical behaviour: workplace ostracism. DESIGN: A time-lagged three-wave survey was conducted over 3 months (November 2016-January 2017) to collect data. METHODS: Nurses (N = 530) from three hospitals in China completed three anonymous self-reported questionnaires. Descriptive statistics, linear regression, and moderated mediation tests were performed, and data analysed using SPSS 23.0 and Mplus7.4. RESULTS: Workplace ostracism positively influenced nurses' unethical behaviour and emotional exhaustion mediated the relationship between workplace ostracism and unethical behaviour. Nurses' hostile…

Abstract Aim To evaluate the effectiveness of education using avatars for improving patients’ heart failure knowledge and self‐care. Background A lack of knowledge and self‐care contributes to poor outcomes and rehospitalization for people with heart failure. Design A multi‐centred, non‐blinded pragmatic randomized controlled trial. Methods Heart failure patients were randomly assigned to intervention (avatar education application) or usual care groups. Participants were followed up at baseline, 30 and 90 days. ANCOVA was used to compare the scores of heart failure knowledge and self‐care, between the two groups. Fisher's exact test was used to compare the two groups’ heart failure‐cause readmission. Bivariate exact binary logistic regression was used to identify the predictors associated with baseline levels of knowledge. Results A total of 36 participants were recruited (between October 2018 ‐ March 2019). The mean age of participants was 67.5 ( SD 11.3) years. At enrolment, approximately half (47.2%) have been living with Heart Failure for over 5 years. Two groups were comparable…

AIM: To identify, evaluate and summarize evidence from qualitative, quantitative and mixed method studies conducted using age suits or other age simulation equipment, with health and social care students. DESIGN: Convergent segregated mixed method review design as outlined by the Johanna Briggs Institute. DATA SOURCES: CINAHL (+ with Full Text), MEDLINE, PsycINFO, PubMed, SocINDEX, Web of Science, Cochrane Library, Emerald Insight, Proquest nursing, Science Direct, Wiley Online and BioMed Central (January 2000-January 2020). REVIEW METHODS: Convergent segregated synthesis was used to synthesize evidence from the studies and the MERSQI checklist used to appraise quality. RESULTS: A total of 23 studies were reviewed: one randomized control, two post-test only randomized control, three quasi-experimental, 15 one-group pre/post studies and two qualitative studies. Of the seventeen studies carrying out inferential statistics on attitude scores post intervention, 11 reported an improvement, three indicated no significant change and three reported worsening scores. Key themes included use…

AIM: This paper is a report of a study exploring the relationship between stoma acceptance and stoma care self-efficacy in patients with colostomy and whether self-disgust and stigma play mediating roles in this relationship. DESIGN: A cross-sectional survey design. METHOD: In all, 476 participants were recruited from a tertiary hospital and completed structured, anonymous, self-report measures of stoma acceptance, self-disgust, stigma, and stoma care self-efficacy between January 2016-March 2017. RESULTS: Stoma acceptance was significantly negatively associated with personal disgust (r = -.640, p<.001), behavioural disgust (r = -.384, p<.001), and stigma (r = -.309, p<.001) and significantly positively associated with stoma care self-efficacy (r = .689, p<.001). Furthermore, regression-based mediation modelling showed that personal disgust and stigma had significant mediating effects on stoma acceptance and stoma care self-efficacy. CONCLUSION: We demonstrated, for the first time, that emotional responses (self-disgust and stigma) play important roles in the association between…

AIMS: To examine fathers' experiences and needs associated with mental health during the perinatal period. DESIGN: Qualitative studies were meta-synthesized using the steps outlined by Sandelowski and Barroso. DATA SOURCES: Six databases (PubMed, Embase, PsycINFO, CINAHL, Scopus and ProQuest) were searched for qualitative studies from each database's inception to 24 June 2019. REVIEW METHODS: Studies were critically appraised using the Critical Appraisal Skills Program tool. Qualitative data were extracted, meta-summarized, then meta-synthesized. RESULTS: Fourteen studies were included and four themes were identified: (a) negative feelings and psychological difficulties, (b) role strain and role conflict with multiple sources, (c) coping strategies that buffered negative feelings and psychological difficulties and (d) support needs to enhance mental health. CONCLUSION: Fathers reported poor mental health and expressed needs to enhance their mental health across the perinatal period. Future studies can focus specifically on paternal mental health. The development of theory-guided,…

AIMS: This study aimed to conduct a short- and long-term Compassion Fatigue Resiliency Program and compare its impact on nurses' professional quality of life, perceived stress, and resilience. DESIGN: The research was conducted between January 2017 January 2019 as a randomized controlled trial. METHODS: The sample comprised 125 oncology-haematology nurses randomly assigned to a Experimental I, Experimental II, or control group. The Compassion Fatigue Resiliency Program was conducted with the nurses as an intervention. Experimental I received a short-term program (5 hr per day for 2 days, 10 hr in total) while Experimental II received a long-term one (5 weeks, 2 hr per week, 10 hr in total). Measurements were obtained during pre- and post-test and at 3-, 6-, and 12-month follow-ups. Research hypotheses were analysed using multilevel models. RESULTS: The results of multilevel model analyses showed there was no statistically significant difference between mean scores for compassion fatigue, burnout, perceived stress, and resilience of nurses in the short- or long-term groups or of…