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Aim: To explore the health beliefs of clinical and academic nurses from Japan, Australia and China regarding wearing paper masks to protect themselves and others, and to identify differences in participants' health beliefs regarding masks. Background: The correct use of face masks and consensus among health professionals across the globe is essential for containing pandemics, and nurses need to act according to policy to protect themselves, educate the public and preserve resources for frontline health workers. Paper masks are worn by health professionals and the general public to avoid the transmission of respiratory infections, such as COVID‐19, but there appear to be differences in health beliefs of nurses within and between countries regarding these. Methods: This qualitative descriptive study used content analysis with a framework approach. Findings: There were major differences in nurse participants' beliefs between and within countries, including how nurses use paper masks and their understanding of their efficacy. In addition, there were cultural differences in the way that nurses use masks in their daily lives and nursing practice contexts. Conclusion: Nurses from different working environments, countries and areas of practice hold a variety of health beliefs about mask wearing at the personal and professional level. Implications for nursing policy and health policy: The COVID‐19 pandemic has sparked much discussion about the critical importance of masks for the safety of health professionals, and there has been considerable discussion and disagreement about health policies regarding mask use by the general public. Improper use of masks may have a role in creating mask shortages or transmitting infections. An evidence‐based global policy on mask use for respiratory illnesses for health professionals, including nurses, and the general public needs to be adopted and supported by a wide‐reaching education campaign. [ABSTRACT FROM AUTHOR]

Aim: This paper discusses four main strategies for addressing nursing shortages that have been persistent, widespread and growing. Fallout from the COVID‐19 pandemic might offer valuable impetus to address this tenacious challenge. Background: Nursing shortages are common, widespread and have been persistent for most of a century. Many of the reasons behind these shortages are well known and are themselves enduring, as are the types of strategies put forward for addressing them. These strategies can generally be classified into four main categories: enhancing retention, improving recruitment, encouraging return to practice and drawing on international human resources. The COVID‐19 pandemic is the latest major threat to ensuring a sufficiently sized and skilled nursing workforce. Many nurses have succumbed to burnout as well the plethora of factors that predated the pandemic and have a negative impact on nurse wellbeing, turnover and intention to leave. Sources of evidence: This discussion paper draws on international sources of evidence. Discussion/conclusion: This paper highlights how many of the factors behind and strategies for addressing nursing shortages at the local, national and global levels are widely studied and known. A sustained combination of strategies that focus both within and beyond health and nursing, including on the broader social context, is necessary. While COVID‐19 has been extremely damaging, it might present an opportunity to make sustainable, effective reforms to address nursing shortages. Implications for policy: Knowledge users must recognise that a combination of approaches across the gamut of policies that influence nursing workforces is necessary to address nursing shortages. Attention must also focus on factors beyond nursing and healthcare if shortages are to be remedied. [ABSTRACT FROM AUTHOR]

Aim: To describe activities and professional characteristics of nurses in expanded roles in acute care in Germany and achieve a greater understanding of the current situation of advanced practice nursing. Background: Advanced practice nursing plays an important role in meeting increased demands in healthcare and promoting high‐quality care. Introduction: In Germany, advanced practice nursing is still at an early stage with a lack of studies describing the scope of practice of nurses in expanded roles. Methods: We conducted a cross‐sectional‐study using a paper‐and‐pencil questionnaire. In a nationwide convenience sample, we surveyed nurses with an academic degree, who work in an acute care hospital and take over expanded roles in direct patient care. Reporting followed the STROBE checklist. Results: Of 108 eligible nurses, 84 (77%) completed the survey. The majority had a Master's degree (63.1%) and the average work experience was 18.2 years. Participants carried out activities in all the domains that were queried (direct clinical practice, guidance and coaching, consultation, leadership and research) with differences within and between domains. Foci were on direct clinical practice and coaching and guidance. Discussion: In Germany, qualifications are nearing the international standard of advanced practice nursing. Results suggest that participants partly undertake activities within the scope of registered nurses' practice that do not correspond fully to their formal qualifications. Conclusion and implications for nursing and/or health policy: In order to foster the role development of expanded practice nurses in Germany, political efforts are needed in terms of training (e.g. specific Master's programmes), funding of corresponding positions in practice and control mechanisms (e.g. professional registration). [ABSTRACT FROM AUTHOR]

Aim: The aim of this systematic review was to provide a critical synthesis of the factors that historically shaped the advancements of nursing regulators worldwide. Background: An in‐depth examination of the different factors that moulded regulatory changes over time is pivotal to comprehend current issues in nursing. Introduction: In the light of global health scenarios, the researchers explored the factors that historically influenced the socio‐contextual circumstances upon which governments made regulatory changes. Methods: A systematic search was performed on the following databases: PubMed, CINAHL, Scopus, OpenGrey and ScienceDirect. The review included papers from January 2000 to October 2016 published in English. The authors used the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) and an inductive thematic approach for synthesis. Results: Two main themes were identified: factors underpinning current challenges and historical and contextual triggers of regulation. The first theme was composed of three aspects: education, migration and internationalization, and policy and regulation; the second theme consisted of four attributes: demographics, economics, history of registration and wars, and historical changes in nursing practice. Discussion: Factors that shaped nursing regulation were linked to changing demographics and economics, education, history of nursing registration, shifting patterns of migration and internationalization, nursing practice, policy and regulation and significant societal turns often prompted by wars. Conclusion: A deeper understanding of the developments of the nursing regulatory institutions provides the foundation for portable standards that can be applied across an array of jurisdictions to guarantee a better public safety. Implication for nursing and health policy: Understanding factors that socially, legislatively and politically have influenced the development of regulatory bodies over time helps to mould local, national and international policies that have a stronger impact on health worldwide. To achieve this, there must be effective cooperation among systems of nursing regulations globally. [ABSTRACT FROM AUTHOR]

Aims: This study investigated how patient safety is currently taught in pre‐registration nursing programmes across South Korea and explored nurse educators' perspectives on curriculum change. Background: Pre‐graduate education plays a critical role in preparing nurses with the requisite patient safety competencies. However, little is known about how patient safety education is addressed in South Korean nursing schools or the perspectives of nurse educators regarding patient safety education and a need for change. Methods: This descriptive study used data collected during a 2019 accreditation workshop provided by the Korean Accreditation Board of Nursing Education. A paper‐and‐pencil survey was completed by 80 nurse educators working in 16 regions throughout Korea. Results: A little consistency was found in approaches to teaching patient safety. Patient safety topics are addressed throughout various nursing courses, and patient safety education is limited in hours of instruction and breadth of content. A majority of respondents indicated that additional supports are needed, including a national standardized curriculum for patient safety education. Conclusion: A new approach to teaching patient safety is needed in Korean pre‐registration nursing education. Overall, patient safety education is limited and provided through a fragmented approach with little attention to systems, workplace design or human issues that are necessary for developing the critical reasoning and skills to support patient safety. Implications for nursing policy: The accrediting and regulatory bodies in South Korea should work together to develop and implement explicit standards of patient safety education and patient safety competencies for nursing students. Development of a standardized national curriculum is essential for providing a consistent, systematic and comprehensive approach to patient safety education in nursing programmes. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this paper is to report on the evaluation of the online Global Leadership Mentoring Community, a programme designed to build relationships across seven global regions and promote leadership development for emerging nurse leaders. Background: There is a pressing need and opportunity for sustainable global leadership mentoring programmes. This programme of Sigma Theta Tau International (Sigma) brought mentors and mentees together from across the world to build leadership capacity, understand global leadership issues and build networks. Community coordinators purposively selected mentors from each of Sigma's seven Global Regions, and mentees were chosen through a process of snowball sampling. Mentors and mentees met monthly with quarterly group calls. Methods: The study followed a programme evaluation, outcomes‐focused approach. All eleven pairs of mentors‐mentees were invited to complete online surveys at the outset and end of programme capturing both quantitative and qualitative data. Quantitative data were analysed using descriptive statistics and for qualitative data, a thematic analysis. Findings: Quantitative data confirmed that all 22 participants gained from the experience. From qualitative analysis, themes emerged illustrating the scope of achievements: 1. facilitation of successful outcomes for both mentors and mentees, 2. challenges of global mentoring and 3. strategies for successful global mentoring. Discussion/Conclusion: Participants reported that creating global leadership is a longitudinal process that needs sustained attention to effect change. This evaluation identified many strengths of the programme and recommended its continuation to help further development of global leaders, particularly through focusing more purposefully on policy issues. Implications for Nursing Policy: Empowerment of nurses globally through a Global Leadership Mentoring Community can improve leadership at all levels, thus emboldening their voices to influence nursing and health policy and ultimately improve patient care. [ABSTRACT FROM AUTHOR]

Background: A variety of advanced practice nursing roles and titles have proliferated in response to the changing demands of a population characterized by increasing age and chronic illness. Whilst similarly identified as advanced practice roles, they do not share a common practice profile, educational requirements or legislative direction. The lack of clarity limits comparative research that can inform policy and health service planning. Aims: To identify advanced practice roles within nursing titles employed in New Zealand and practice differences between advanced practice and other roles. Method: Replicating recent Australian research, 3255 registered nurses/nurse practitioners in New Zealand completed the amended Advanced Practice Delineation survey tool. The mean domain scores of the predominant advanced practice position were compared with those of other positions. Differences between groups were explored using one‐way ANOVA and post hoc between group comparisons. Results: Four nursing position bands were identified: nurse practitioner, clinical nurse specialist, domain‐specific and registered nurse. Significant differences between the bands were found on many domain scores. The nurse practitioner and clinical nurse specialist bands had the most similar practice profiles, nurse practitioners being more involved in direct care and professional leadership. Conclusions: Similar to the position of clinical nurse consultant in Australia, those practicing as clinical nurse specialists were deemed to reflect the threshold for advanced practice nursing. The results identified different practice patterns for the identified bands and distinguish the advanced practice nursing roles. Implications for nursing policy: By replicating the Australian study of Gardener et al. (2016), this NZ paper extends the international data available to support more evidence‐based nursing workforce planning and policy development. [ABSTRACT FROM AUTHOR]

MUSIC T. (2012) A review of the role the role of influenza vaccination in protecting patients, protecting healthcare workers the role of influenza vaccination. International Nursing Review 59, 161-167 Aim: Many health authorities recommend routine influenza vaccination for healthcare workers (HCWs), and during the 2009 A (H1N1) pandemic, the World Health Organization (WHO) recommended immunization of all HCWs worldwide. As this remains an important area of policy debate, this paper examines the case for vaccination, the role of local guidelines, barriers to immunization and initiatives to increase uptake. Background: Seasonal influenza is a major threat to public health, causing up to 1 million deaths annually. Extensive evidence supports the vaccination of priority groups, including HCWs. Immunization protects HCWs themselves, and their vulnerable patients from nosocomial influenza infections. In addition, influenza can disrupt health services and impact healthcare organizations financially. Immunization can reduce staff absences, offer cost savings and provide economic benefits. Methods: This paper reviews official immunization recommendations and HCW vaccination studies, including a recent International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) survey of 26 countries from each region of the world. Results: HCW immunization is widely recommended and supported by the WHO. In the IFPMA study, 88% of countries recommended HCW vaccination, and 61% supported this financially (with no correlation to country development status). Overall, coverage can be improved, and research shows that uptake may be impacted by lack of conveniently available vaccines and misconceptions regarding vaccine safety/efficacy and influenza risk. Conclusions: Many countries recommend HCW vaccination against influenza. In recent years, there has been an increased uptake rate among HCWs in some countries, but not in others. Several initiatives can increase coverage, including education, easy access to free vaccines and the use of formal declination forms. The case for HCW vaccination is clear, and in an effort to further accelerate uptake as a patient safety measure, an increasing number of healthcare organizations, particularly in the USA, are implementing mandatory immunization policies, similar to other obligatory hygiene measures. However, it would be desirable if similar high vaccination uptake rates could be achieved through voluntary procedures. [ABSTRACT FROM AUTHOR]

Background National nursing workforce studies are important for evidence-based policymaking to improve nursing human resources globally. Survey instrument translation and contextual adaptation along with level of experience of the research team are key factors that will influence study implementation and results in countries new to health workforce studies. Aim This study's aim was to describe the pre-data collection instrument adaptation challenges when designing the first national nursing workforce study in Poland while participating in the Nurse Forecasting: Human Resources Planning in Nursing project. Methods A descriptive analysis of the pre-data collection phase of the study. Instrument adaptation was conducted through a two-phase content validity indexing process and pilot testing from 2009 to September 2010 in preparation for primary study implementation in December 2010. Means of both content validation phases were compared with pilot study results to assess for significant patterns in the data. Results The initial review demonstrated that the instrument had poor level of cross-cultural relevance and multiple translation issues. After revising the translation and re-evaluating using the same process, instrument scores improved significantly. Pilot study results showed floor and ceiling effects on relevance score correlations in each phase of the study. Limitations The cross-cultural adaptation process was developed specifically for this study and is, therefore, new. It may require additional replication to further enhance the method. Conclusions The approach used by the Polish team helped identify potential problems early in the study. The critical step improved the rigour of the results and improved comparability for between countries analyses, conserving both money and resources. This approach is advised for cross-cultural adaptation of instruments to be used in national nursing workforce studies. Implications for nursing and health policy Countries seeking to conduct national nursing workforce surveys to improve nursing human resources policies may find the insights provided by this paper useful to guide national level nursing workforce study implementation. [ABSTRACT FROM AUTHOR]

Background As future health educators, nursing and physiotherapy students will play an essential role in the prevention of smoking. Aim To determine the prevalence of smoking among students and to analyse their knowledge of and attitudes towards smoking. Method This was a descriptive cross-sectional study using an anonymous questionnaire and conducted in a Spanish Faculty of Health Sciences in 2013. Findings 247 nursing and physiotherapy students (82.33%) participated in the study. The global prevalence of smoking (18.2%) was lower compare with the general population group of the same age. We have observed statistical significance in relation to previous studies. Nursing and physiotherapy students showed a low nicotine dependence. We found a lack of knowledge about the harmful effects of cigarette consumption on health. Statistically significant results were also found in relation to degree courses (p < 0.01) as regards students' opinions about their knowledge of strategies and methods to help patients stop smoking. Conclusion Most students started smoking before commencing their university studies; consequently, interventions should focus on cessation programmes. An analysis of university curricula leading to the award of a degree in the health sciences could serve to identify educational deficiencies in order to implement the necessary modifications. Implications for nursing and health policy This paper presents an update in tobacco use characteristics amongst nursing and physiotherapy students. Those results have showed a need to improve the curricula in order to develop specific programmes to improve knowledge, attitudes and beliefs. Measures to prevent smoking must be taken at school. [ABSTRACT FROM AUTHOR]

Objective: The objective is to assess the reasoning by families in deciding between a home vs. facility delivery and vaginal vs. caesarean. Study design: The authors selected a convenience sample of 16 villages in Sathkira district in southwest Bangladesh. Evidence was drawn from detailed in‐home post‐delivery interviews with all mothers in these villages who delivered in 2015 or 2016. Methods: Local family health workers and paramedics used a structured questionnaire that enabled gathering of relevant quantitative and qualitative evidence. Mothers' reasons for selection of delivery location and type were categorized, and regression analysis was conducted to assess significance of variables that proxy supply and demand factors. Results: Among 492 completed interviews, 48% were home deliveries, 52% facility deliveries; two‐thirds of facility deliveries in private clinics. Overall, sample caesarean rate is 39%, public hospital rate 53%, private clinic rate 86%. Over half of reasons for home delivery refer to pregnancy without complication or access to trusted birth attendant. Over half of reasons for facility delivery refer to medical complications allegedly precluding home delivery, or requiring home‐to‐facility transfer during labour for reasons not clear to the mother. The decision depends on both 'demand' factors originating with the family (proxied by family income, birth order and education levels) and 'supply' factors originating with obstetric care providers (proxied by number of antenatal visits and variation of caesarean rate by village). In a regression controlling for both demand and supply variables, the above proxy variables are all significant. Implications for nursing and health policy: Bangladesh has inadequate nursing support for vaginal delivery in either home or facility. Hence, physicians frequently recommend that women deliver in a facility (usually a physician's clinic). Physicians are reluctant to hire adequate nurses to attend vaginal deliveries. Hence, families with some discretionary income are increasingly opting for a caesarean over vaginal delivery. Facility deliveries reduce incidence of obstructed labour fistula, but probably contribute to rising incidence of iatrogenic fistula. Reducing caesarean rates requires a large increase in numbers of nurses and midwives, and acceptance by physicians of a broad scope of practice for nurses/midwives in vaginal deliveries. [ABSTRACT FROM AUTHOR]

Introductions: Digitization could be incorporated in rural areas of resource‐poor countries because information gathered by nurses working on‐site could be better used. Background: For effective management of community health information, the usage and maintenance of digital records are important. Digitization of information provides essential information for informing health policy. Aim: To develop a sustainable database to effectively collect and manage community health information and nursing practice. Methods: This study used a mixed method design. Phase 1 involved the development of a database system through repeated systematic focus group discussions with community health nurses. Phase 2 involved a practical trial examination of the developed system with both objective and subjective evaluations. Results: A nursing database system was developed with templates designed for the major health problems of communities. The templates were composed of multiple‐choice items and a free‐text field that allowed records to be more detailed than handwritten records and maintained in standardized formats. This enables accumulation of data that were less likely to be influenced by the variance of ability in each nurse. Discussion and conclusion: A multifaceted evaluation of the database system suggested that it could improve the efficiency of information management and contribute to the improvement of nursing care quality through standardization of the recording pattern. Implications for nursing and health policy: The nursing database will enable high‐quality information storage that will potentially better inform health and healthcare policies as well as enable visualization of data concerning nursing care challenges and activities within the relevant communities. This information is essential for policy development and implementation in areas of human and fiscal resource allocations and meeting training/education needs. [ABSTRACT FROM AUTHOR]

Aims: This study aims to (1) analyse all self‐care–related interventions Portuguese nurses documented, (2) determine potential issues that may impair semantic interoperability and (3) propose a new set of interventions representing nursing actions regarding self‐care that may integrate any HER application. Background: As populations age and chronic diseases increase, self‐care concerns rise. Individuals who seek healthcare, regardless of context, need prompt access to accurate health information. Healthcare professionals need to understand the information in all places where care is provided, creating the need for semantic interoperability within electronic health records. Methods: A qualitative descriptive and exploratory study was conducted in two phases: (1) a content analysis of nursing interventions e‐documentation and (2) a focus group with fifteen registered nurses exploring latent criteria or insights gleaned from the findings of content analysis. The COREQ statement was used to guide research reporting. Results: We extracted 1529 nursing intervention sentences from the electronic health records and created 209 intervention categories. We identified the main issues with semantic interoperability in nursing intervention identification. Conclusion: According to the findings, nurses cooperate with clients, offering physical aid and encouraging them to overcome functional limitations to self‐care tasks hampered by their conditions. Implications for nursing policy and health policy: This article provides evidence to warn policy makers against decisions to use locally customised electronic health records, as well as evidence on the importance of policy promoting the adoption of a nursing ontology for electronic health records. And, as a result, the harmonisation and effective provision of high‐quality nursing care and the reduction of healthcare costs across nations. [ABSTRACT FROM AUTHOR]

Aim: To assess the effects of the nursing workforce and advanced nursing practice on the outcomes of patients and life expectancy, including mortality rates of under‐five children in Cambodia, and to develop policy recommendations to increase the influence of the nursing workforce. Background: In low–middle‐income nations, life expectancy and under‐five mortality are important measures of public health. However, there is still a dearth of literature related to the nursing workforce in Southeast Asia. Method: The authors retrieved the data from the World Nursing Report produced by the World Health Organization 2020 for 10 member states. The transparent reporting of a multivariable prediction model for individual prognosis or diagnosis checklist has guided this study. The univariate linear regression model was applied to categorize the potential predictors for each outcome assessment. In addition, the Spearman rank correlation test was selected to assess the potential predictors, and a multivariate statistical analysis was carried out for each of the five outcomes. Results: According to the study's findings, nurse density and advanced practice nursing improve both female and male life expectancy. The existence of advanced nursing roles is associated with decreased under‐five mortality. Conclusions: There are great opportunities to improve the nursing workforce within Cambodia and other Association of Southeast Asian Nations member states to increase patient outcomes. Investment in nursing is essential for improved patient outcomes. Implications for nursing and health policy: Health policy investments in these projects and future initiatives intended to advance nurse density, education, and practice are based on this study's results. Policy initiatives should focus on increasing density because nursing appears to impact life expectancy and other outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives: To evaluate demographic and occupational factors of professional life on life satisfaction among nurses in Serbia and Poland. Background: Compassion satisfaction and compassion fatigue, as aspects of a nurse's professional life, may affect their satisfaction with life in general. However, most studies on this topic have been conducted in Asian countries, and because there are differences in health care system performance across countries amid a global shortage of nurses, it is necessary to investigate professional quality of life in the European nursing context. Methods: This multicenter, comparative, and correlational study was conducted on a sample of 669 hospital nurses in Serbia and Poland. The survey data were collected between November 2019 and February 2020 using the Demographic and Occupational Questionnaire (DOQ), Professional Quality‐of‐Life Scale (ProQOL‐5), and Satisfaction with Life Scale (SWLS). STROBE Statement guidelines for cross‐sectional studies were followed. Results: Most nurses from both countries reported having moderate compassion satisfaction, moderate risk for compassion fatigue, and an average life satisfaction. The predictive factors of life satisfaction that most stand out include country of origin, financial situation, education, job satisfaction, and compassion fatigue. Discussion and conclusion: Quality of professional life is significantly affected by shift duration, age, work experience, and job satisfaction. Negative aspects of professional life are significant predictors of life satisfaction. Implications for nursing policy: The findings of this study indicate a need for implementing flexible shift patterns and enhancing interventions that will improve job satisfaction and compassion satisfaction while reducing the risk of compassion fatigue. [ABSTRACT FROM AUTHOR]

Background: Currently, there are no cut‐off points for levels of empathy, making it difficult to assess the change experienced in its development or as a result of its intervention. It is an unsolved problem. Introduction: Empathy is a cognitive‐affective attribute that enables nursing staff to maintain a professional relationship that entails various benefits for the patient. Its strengthening and development during university education is desirable. Empathy studies in Latin American nursing students are based on the direct scores obtained on an empathy test, based on which the variable is described and groups are compared. Statistical comparisons are not enough to discriminate substantive changes since two statistical values can show differences without implying that the post‐intervention levels may correspond to a higher category in relation to those of pre‐intervention or that two compared groups are qualitatively different. The above applies to empathic behaviour and is valid for students and professionals of health. This study aimed to establish cut‐off points that allow defining ordinal categories in empathy. Methods: In this multicenter and cross‐sectional study, 3712 students from 11 Latin American nursing schools participated. The Jefferson Empathy Scale (JES) was applied; the psychometric properties were confirmed by Factor Analysis Confirmatory and Invariance. Results: The JSE empathy scale is a measure with adequate reliability and construct validity. Examined cut‐offs determined a structure of five empathy intervals that allowed them to be classified as empathy values in very high, high, medium, low and very low. Discussion: The sequence of statistical tests carried out allowed us to determine ranges of categorical values in the empathy levels of groups of students. However, the determined categories may constitute a specific characteristic of them. It is not possible to extrapolate these results to regions other than those of Latin America. Conclusion: The estimated rankings allow comparing levels of empathy between groups of nursing students and the real effect of empathic interventions. Implications for nursing: To contribute with strategies to evaluate changes in the empathic skills of nursing students, resulting in a well‐valued skill in health services. Implications for nursing policy: The cut‐off points define evaluative categories (very low, low, medium, high and very high) that allow objective classification of levels of empathy achieved after (for example) an empathic intervention. This allows assessment of substantive changes experienced by nursing students (and professionals). [ABSTRACT FROM AUTHOR]

Aim: To systematically evaluate the available literature about overall levels of psychological capital among nurses. Background: Psychological capital is described as a positive mental state associated with nurses' mental health, quality of care and patient outcomes. Methods: A search was carried out using PubMed, Web of Science, EMBASE, CINAHL, PsycINFO, Cochrane Library and Chinese Database, including China National Knowledge Infrastructure (CNKI), Chinese Biological Medical (CBM), WanFang and Weipu Database from the inception of the databases until October 2021. Subsequently, two researchers identified and reviewed the literature and assessed the risk of bias. A random‐effects model was conducted to achieve pooled estimates of psychological capital scales. Results: The pooled mean score of the psychological capital scale was 4.21 (95% CI, 4.07–4.35). For subdimensions such as hope, optimism, self‐efficacy and resilience, the score was 4.12 (95% CI, 4.11–4.12), 4.34 (95% CI, 4.34–4.34), 4.50 (95% CI, 4.50–4.51) and 4.34 (95% CI, 4.33–4.34), respectively. Subgroup analyses indicated that nurses practising in Asia and intensive care units might have experienced lower psychological capital levels. In addition, significant differences were noted in studies with sample size and publication year. Studies with a large sample size reported a higher psychological capital than those with a small sample size. The pooled mean scores of psychological capital were higher in 2014–2018 than in 2019–2021. Meta‐regression further revealed that geographic regions of participants might be a source of heterogeneity, and the Asian region had 32.23% of the heterogeneity between studies, and the African region had 18.71%. Conclusion: This review is the first to synthesize published research and calculate a pooled score of psychological capital in nurses. These findings indicated that nurses reported a medium–high level of psychological capital, and there was significant heterogeneity. Implications for nursing policy: Administrators and policymakers should concentrate on nurses' psychological capital and tactically integrate psychological capital into nursing vocational training programs. [ABSTRACT FROM AUTHOR]

Aim: To explore nurses' perspectives on and experiences of safety‐related organisational challenges during the coronavirus disease 2019 (COVID‐19) outbreak by Iranian nurses. Background: In different clinical contexts, nurses face numerous organisational challenges threatening their safety because of the COVID‐19 pandemic. Introduction: Exploring nurses' perceptions towards safety‐oriented organisational challenges might inform nurse managers, healthcare managers, educators and policymakers on the priorities that should be considered to increase organisations' readiness and safety. Methods: This qualitative descriptive study is reported according to the Consolidated Criteria for Reporting Qualitative Research guidelines. Through purposeful sampling, 19 participants were involved. The research data were collected from March to August 2021 by conducting semi‐structured interviews that were analysed through the content analysis approach. Findings: Three organisation‐related safety challenges experienced were related to (1) human resource, (2) educational and (3) workforce protection issues. Discussion: Nurses experienced several safety issues related to the complexity faced by the health care organisations during the pandemic, exacerbated by previous frailties of the nursing system. Conclusion: The three challenges that emerged might be considered a priority in building pandemic plans, transforming the experiences of nurses as a source of learning for all, capitalising on their suggestions and rendering healthcare facilities ready to deal safely with future crises. Implications for nursing and health policy: Adopting appropriate measures to decrease human resource issues and that related to education, and promoting workforce health protection, are both recommended to improve nurses' work environment and satisfy their safety needs. [ABSTRACT FROM AUTHOR]

Aim: To compare the occurrence and the reasons for unfinished care among coronavirus disease (COVID‐19) and non‐COVID‐19 patients as perceived by nurses. Background: The recent pandemic has imposed tremendous changes in hospitals in all countries. Introduction: Investigating the occurrence of and the reasons for unfinished care as perceived by nurses working in COVID‐19 and non‐COVID‐19 units might help to gain insights and to address future pandemics. Methods: A comparative cross‐sectional study based on the STROBE guideline has been conducted during November 2020–January 2021. The Unfinished Nursing Care Survey, comprising part A (elements) and part B (reasons), was administered online to all 479 nurses working in medical and surgical units converted progressively into COVID‐19 and non‐COVID‐19 units. A total of 90 and 200 nurses participated, respectively. Results: No differences in the unfinished care occurrence have emerged at the overall level between nurses caring for COVID (2.10 out of 5; 95% confidence interval [CI], 1.94–2.27) and non‐COVID‐19 patients (2.16; 95% CI, 2.06–2.26). Reasons for unfinished care reported significant higher averages among nurses caring for COVID (2.21; 95% CI, 2.10–2.31) as compared with those caring for non‐COVID‐19 patients (2.07; 95% CI, 2.01–2.14; p = 0.030). Discussion: The overall occurrence of unfinished care was slightly higher compared with pre‐pandemic data in all patients. Conclusions: Reasons triggering unfinished care were slightly different and were due to priority setting and human resources issues, which were perceived at higher significance among nurses working in COVID‐19 compared with non‐COVID‐19 units. Implication for nursing and health policies: A clear map of action has emerged that might be valid in the post‐COVID‐19 era as well as in the case of future pandemics. [ABSTRACT FROM AUTHOR]

Aim: To describe the mentoring process between the ICN Advanced Practice Nurse Network practice subgroup and the University of Pécs to support the emerging advanced practice role in Hungary, and explore the creation of a mentoring algorithm for faculty and other key stakeholders worldwide who wish to develop advanced practice nursing programs. Background: Advanced practice nurses provide comprehensive clinical care and expand access to care in more than 70 countries. In March of 2017, a representative of the Faculty of Health Sciences of the University of Pécs requested assistance in curricula development for the inaugural advanced practice nursing program in Hungary. Methods: A mixed‐methods single case study was undertaken. The sources of evidence include interviews, e‐mails, review of the literature, and related documents. Qualitative data were analyzed for content, and frequencies were calculated for quantitative indicators. Findings and discussion: The findings highlight the importance of clear communication, development of shared goals, and determination to see the project through. Enriching information was provided by colleagues from diverse global settings. Credibility was gained in Hungary from the support of national and international experts. Conclusion: The mentoring foundation and process facilitated the role development in Hungary and contributed to an increased understanding of advanced practice nurses' scope of practice. The intentional approach and the careful ongoing reflection may lead to future successful endeavors. Multinational engagement and collaborations will promote advanced practice nursing contributions globally. Implications for nursing policy: Mentoring can effectively empower nurses and advanced practice nurses to work to their full capacity. The shared experiences of international mentoring colleagues can contribute to and support the development and acceptance of national policies for the advanced practice nursing roles. [ABSTRACT FROM AUTHOR]

Aim: To explore the impact of the COVID‐19 pandemic on the mental health of nurses working in primary, secondary, and tertiary healthcare centers in Navarre (Spain). Background: Healthcare workers, especially nurses, are at high risk for developing mental health problems during the COVID‐19 pandemic. Introduction: Spain ranks among the European countries with the highest incidence of and mortality from COVID‐19 and has a 31% deficit in the number of nurses compared with the average for the European Union. Methods: This was a cross‐sectional study involving 800 Registered Nurses in Navarre, Spain. Four standardized instruments, along with a self‐administered online questionnaire, were used to measure the impact in terms of depression, anxiety, insomnia, and posttraumatic stress disorder. The STROBE checklist for cross‐sectional studies was used to report this study. Results: Of the 800 nurses, 68% had some level of depression, anxiety, insomnia, and distress, and of these, 38% had moderate or severe symptoms. Those who worked in hospital COVID units and in nursing homes showed a higher impact on their mental health. Discussion: The sustained pressure that nurses have experienced in their work during the COVID‐19 pandemic has negatively affected their mental health. Conclusion: This study found that nurses who worked in hospital COVID units and in nursing homes during the pandemic had worse mental health outcomes. Implications for nursing/policy: Recommendations for nursing policy include the need to implement coaching and emotional programs to support nurses on the frontlines of the pandemic. There is also an urgent need for the implementation of national training programs to strengthen health emergency preparedness, improve response capacity, and increase the resilience of nurses to disasters. [ABSTRACT FROM AUTHOR]

Aim: This study aimed at evaluating the effects of a modified psychological first aid (PFA) training program on nurses' psychological preparedness for emergencies and disasters. Background: Nurses need to be psychologically prepared in order to mitigate the impact of conflicts and disasters. The PFA training could ensure their psychological preparedness in responding to different emergencies and disasters. Design: A nonequivalent controlled group trial was conducted between July 2019 and August 2019. Methods: Nurses working in the trauma units from five hospitals in Palestine were allocated into two arms: a control arm and an intervention arm incorporating a 9‐hour modified PFA training program. Both groups were assessed at start (pretest) and upon completion of the program (post test) using a number of validated self‐reports. Results: Eighty‐four nurses were allocated to each arm, and 75 in each arm completed baseline data (n = 150). The results of generalized estimating equation estimates revealed that PFA training imposed a significant group‐by‐time effect on psychological preparedness (p = 0.013). The mean scores of psychological preparedness showed greater improvement in the intervention group than in the control group at posttest (37.81 vs. 32.64). Improved group‐by‐time effect was further identified in relation to optimism (p = 0.009), self‐esteem (p = 0.008), and self‐efficacy (p = 0.033). The intervention effect was large (Cohen d = 1.41). Conclusion: PFA training may help to build nurses' capacity in being better prepared to respond to psychological issues during and after emergencies and disasters. Implications for Nursing and Health Policy: Nurses should be adequately equipped with knowledge and skills to deal with different emergencies and disasters. Health policy needs to address psychological preparedness for emergencies and disasters of all healthcare workers. Healthcare policymakers and educators could adopt PFA training on a regular basis to consolidate psychological preparedness of nurses. [ABSTRACT FROM AUTHOR]

Aim: To summarize the findings from literature regarding the prevalence of plagiarism and its various types, knowledge, and attitudes of students toward plagiarism, factors associated with plagiarism, and the applied interventions to decrease the incidence of plagiarism. Background: Plagiarism is a major form of academic dishonesty practiced by students at all educational levels. Introduction: Academic dishonesty was defined as any unauthorized help that adds to students' formal academic performance. These dishonest behaviors can be categorized as falsifying information, hiding errors, collaborating with colleagues when not allowed, and plagiarism. Methods: Systematic search of databases was conducted in September 2021 to identify studies that discussed plagiarism in nursing studies. We included 31 studies in this systematic review and meta‐analysis, with a total of 9,175 nursing students. The analysis was conducted using RevMan software. Results: Plagiarism was the most frequent academic misconduct among nursing students (practiced by 55.3%). Paraphrasing without referencing was the most practiced form (39.53%), while submitting others' work without acknowledgment was the least one (9.61%). Most students were aware of the concept of plagiarism (80.8%) and had positive ethical attitudes toward it (88.26%). Plagiarism was negatively associated with age, parenting, and completing semester credits. However, it was positively correlated with average grades and liberal educators. Plagiarism was a significant predictor of clinical misconduct. Discussion: A gap in the students' knowledge and skills were noticed. These gaps may be contributing to the high occurrence of plagiaristic acts, besides the unethical attitudes. Conclusion: Plagiarism is a serious academic misconduct practice that can be associated with subsequent clinical misconduct. There is a need to fill the knowledge and skills gap, and to set effective policies. Implication for nursing and health policy: In their attempts to eliminate plagiarism, nurse educators are encouraged to provide effective educational training and practical tasks, in order to fill the gaps in knowledge and skills. Additionally, implementing clear and effective punishment policies would prevent intentional plagiaristic acts. This would aid in introducing qualified nurses accountable for the health of patients. [ABSTRACT FROM AUTHOR]

Aim: To explore strategies used by nurse managers in dealing with nursing negligence in clinical practice. Background: Negligence is a global challenge in healthcare settings with a significant impact on patient safety. Nurse managers have a responsibility to prevent negligence and improve the quality of healthcare services. Methods: This study used a qualitative research design and an inductive content analysis method. Using semistructured interviews, data were collected from 26 purposively selected nurse managers working in seven hospitals in an urban area of Iran. Findings: The category of "professional protection" was our main research finding. It encompassed three subcategories of "kind treatment of the nurse accused of negligence," "nurse manager's prudent support for the nurse accused of negligence," and "paternalistic leadership style." Conclusion: The nurse managers tried to overcome the challenge of nursing negligence through professional protection indicating a series of dynamic and conscious activities for dealing with situations that threatened patient safety. Implications for nursing and policy: Appropriate management of nursing negligence requires appropriate and peaceful discussion with nurses to preserve their dignity and motivation to work. Education and training about nursing negligence and reflection on negligence incidents can empower nurses and improve the safety of nursing services. [ABSTRACT FROM AUTHOR]

Aim: To investigate the existence of guidelines on the identification of nursing stakeholders as part of planning for human resources for health processes. Background: Effective involvement of nursing stakeholders in planning and implementing human resources for health policies is strongly advocated by leading global bodies. Systematic identification of nursing stakeholders at an early stage is fundamentally important. Guidelines to support appropriate identification and inclusion of nursing stakeholders could support the active involvement of nurses and midwives in human resources for health planning processes at all levels. Methods: We conducted a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews. We conducted a widely inclusive search for all types of records, including searches of bibliographic databases (PubMed, CINAHL, Scopus and Web of Science) and manual searches of selected websites and internet archives to identify grey literature, published in English since 2009. Search terms related to guidelines, stakeholder engagement and the health workforce. Results: Of the 1058 potentially relevant sources identified, two studies met inclusion criteria. Both were guidelines produced by global bodies more than 12 years ago. Cochrane guidance on reporting 'near‐empty' reviews was followed, and eight additional sources meeting most of the inclusion criteria were identified and critiqued. Conclusions: Guidelines regarding the process of nursing stakeholder identification specific to human resources for health planning processes are scarce and require updating. Critique of recent practices suggests considerable methodological variety and sub‐optimal identification of nursing stakeholders. Implications for nursing and health policy: Nursing stakeholder engagement is an essential component of human resources for health planning processes, and the gap in literature points to a need for up‐to‐date guidance to ensure nurses' active involvement. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

Aim To identify, compare and contrast the major component parts of heterogeneous stratified sample of nursing legislation. Background Nursing legislation varies from one jurisdiction to another. Up until now no research exists into whether the variations of such legislation are random or if variations are related to a set of key attributes. Methods This mixed method study used a random stratified sample of legislation to map through documentary analysis the content of 14 nursing acts and then explored, using quantitative techniques, whether the material contained relates to a number of key attributes. These attributes include: legal tradition of the jurisdiction; model of regulation; administrative approach; area of the world; and the economic status of the jurisdiction. Findings Twelve component parts of nursing legislation were identified. These were remarkably similar irrespective of attributes of interest. However, not all component parts were specified in the same level of detail and the manner by which the elements were addressed did vary. A number of potential relationships between the structure of the legislation and the key attributes of interest were identified. Conclusions and Implications for Policy This study generated a comprehensive and integrated map of a global sample of nursing legislation. It provides a set of descriptors to be used to undertake further quantitative work and provides an important policy tool to facilitate dialogue between regulatory bodies. At the individual nurse level it offers insights that can help nurses pursue recognition of credentials across jurisdictions. [ABSTRACT FROM AUTHOR]

Background: Transitioning to primary care is a highly stressful process for nurses due to the diverse roles and responsibilities required. Despite the global shift of health services requiring more nurses in primary care, there is a dearth of literature regarding their transition experiences. Aim: To explore the perceptions and experiences of nurses transitioning to primary care. Methods: A qualitative descriptive design was used. Nineteen nurses from five primary care clinics in Singapore participated in the semi‐structured interviews. These interviews gathered the experiences of nurses transitioning to primary care. Interviews were analysed using thematic analysis through an inductive and theoretical approach. Rigour was established through an audit trail, peer examination and member checking. Findings: Three themes of Idealistic assumptions, Role realignment and Seeking enlightenment emerged. These themes described the nurses' initial disorientation to the unfamiliar primary care setting; their attempts to fit in by embracing the new environment and suppressing their true emotions; and the support received coupled with their ownership to learn. Implications for nursing policy: The findings highlight the importance for nurse managers to promote positive transition experiences through the modification of existing support programmes and organizational cultures. To further enhance the nurses' retention within primary care, it is imperative for nurse educators and policy makers to revise the nursing curricula, primary care nursing career framework and recruitment campaigns at the national level. This brings clarity to the misconceptions in the roles and expectations required of nurses in primary care. [ABSTRACT FROM AUTHOR]

Background: Studies performed in Central European countries showed a high prevalence of missed nursing care in various clinical settings before the COVID‐19 pandemic. Aims: The aim of the study was to investigate which domains of the work environment were significant predictors of missed nursing care activities in Czech hospitals during the COVID‐19 pandemic. Methods: A cross‐sectional study was used. The RANCARE guideline and STROBE checklist were followed for reporting in the study. The sample consisted of 371 nurses from four acute care hospitals. The MISSCARE Survey and the Practice Environment Scale of the Nursing Work Index questionnaires were used to collect data. The data were analyzed using multiple linear and logistic regression analyses. Results: Nurses reporting unfavorable environments consistently describe a higher frequency of episodes of missed care. Prevalence estimates of missed care in Czech acute care hospitals during the COVID‐19 pandemic was predicted from the overtime work, the nurses' perception of the "Nursing foundations for the quality of care," and their satisfaction with their current position. Conclusions: Missed nursing care could be mitigated by improving the nurses' work environment. Domains of the nurse work environment are known as structural modifiable factors and their refinement could be a cornerstone for interventions to reduce the prevalence of missed nursing care. Implications for nursing policy: Monitoring the conditions and aspects of the nurse work environment in hospitals and considering nurses' concerns about the work environment on an ongoing basis are important strategies for nurse supervision as well as for policymakers. [ABSTRACT FROM AUTHOR]

Aim: To examine the extent to which the type of financial assistance (personal resources, social programmes and earnings) and source country influence the length of time for internationally educated nurses to secure employment as regulated nurses in Canada. Background: Internationally educated nurses must professionally recertify in order to work as regulated nurses in Canada. For many, it can be a lengthy, cumbersome and costly process that delays employment, while others recertify and secure employment quickly. Financial assistance in the form of personal resources, or from social programmes or earnings from working could contribute to the length of time to recertify. When internationally educated nurses cannot readily recertify, they turn to survival jobs where they can remain and never practice their profession in Canada or leave the country to work in jurisdictions where it easier to obtain professional credentials. Methods: Data were collected via cross‐sectional survey of internationally educated nurses (n = 1186) who were immigrants, permanent residents and employed as regulated nurses. Multiple linear regression was employed to examine the influence of the type of financial assistance (personal resources, social programmes and earnings) and source country on time to regulated nurse employment. Results: Regression model explained 9.3% of variance in time to regulated nurse employment. Three predictors were statistically significant: source country, social programmes and earnings. Personal resources was not a significant predictor. Conclusion: Financial assistance helps internationally educated nurses survive the regulated nurse employment gap. The type of financial assistance and source country influences the length of time to regulated nurse employment. Implication for nursing and social policy: Provides initial evidence to support the development of policies, and educational and social programmes to assist internationally educated nurses with financially surviving the gap in regulated nurse employment. [ABSTRACT FROM AUTHOR]

Aim To provide an overview of nursing research in Jordan based on the topic researched, source and setting of data collection, methodology, theoretical framework used and source of funding. Background Nursing research contributes to nursing education, clinical practice, health policy and the establishment of nursing research priorities in Jordan to guide future research. Methods Databases such as MEDLINE, CINAHL, Google Scholar, Pub Med and national sources were searched for published articles related to nursing in Jordan through a range of keywords. Articles were included in the analysis if they were published in English or Arabic through December 2012. Findings The search resulted in the identification of 999 publications, from which 462 articles met the inclusion criteria and were included in the review. The highest percentage of studies (23% of articles) focused on nursing management issues. Forty-four per cent were conducted in a hospital setting; only six studies used a nursing theory. Seventy-seven per cent of the studies were quantitative and 29.0% were funded mostly by universities. Twenty-one per cent were not directly related to improving nursing education or practice in Jordan. A Jordanian Database for nursing research was developed as a result of this review. Discussion Jordanian nurses have slowly started to build nursing research, the real nursing research work in Jordan started with the return of the first PhD graduate to Jordan in 1986. Conclusion Jordanian nurses in collaboration with international colleagues were motivated to publish research and build the body of nursing knowledge. [ABSTRACT FROM AUTHOR]

Background: Nursing care quality is a central concern of health policy, and nurses' shift schedules affect the quality of care and their work‐life status internationally. A lack of reliable information on the differences between 24‐ and 12‐h shifts on care quality, nursing care quality, patient safety, and adverse and missed events warranted investigation in Cambodia. Aim: We aimed to examine the impacts of 12‐h shifts compared with 24‐h shifts. The purpose was to find evidence to support the use of maximum 12‐h shifts by registered nurses working in ICU contexts. Method: A convergent mixed‐method approach was chosen to highlight the issues around the long hours of shift work. We designed a 12‐week coaching course during the implementation of 12‐h shifts and assigned 30 nurses each to an experimental group and a control group. Data from quantitative surveying of 58 participants were combined with focus group discussions of 20 participants to gather qualitative insights. Pre‐ and post‐test analysis involved descriptive statistics and the Wilcoxon sign rank test for quantitative analysis and then merged with qualitative findings from content analysis. Reporting of this study was steered by the STROBE and COREQ guidelines for quantitative and qualitative findings, respectively. Results: Quantitative results showed the increased quality of nursing work‐life, nursing care quality, and patient satisfaction; decreased missed care and adverse events were significantly associated with the 12‐h shift. Qualitative data supported nurses preferring 12‐h rather than 24‐h shift options. Discussion and conclusions: Changing rosters to 12‐h shifts in the intervention caused increases in the study variables' scores. Results indicate the benefits of 12‐h shifts on the quality of nursing work‐life, nursing care quality, missed care, adverse events, and patient safety. Implications for nursing and nursing policy: We found that 24‐h shifts had deleterious impacts on care quality and safety and nurse satisfaction with work. Health and nursing policymakers are urged to provide resources and strategize to implement 12 h shifts as soon as possible since the current 24‐h shifts of nurses affect the patient quality of care and their health and safety and that of the nurses. [ABSTRACT FROM AUTHOR]

Aim: To gather information from nurses and allied health professionals in the French context of the emergence of research in the field so as to inform the development of a new tool: The research in nursing and allied health sciences' Ideas Generator (GénI) capable of sustaining the identification of research ideas from professionals in the field. Background: In many countries, research in nursing and allied health sciences remains underdeveloped. Introduction: Before developing the Ideas Generator tool, it was essential to explore professionals' basis of reference in providing care, then investigate (1) their representation of research in this field of science and (2) their perception of needs for and obstacles to starting a research process. Methods: The qualitative research design used focus groups. The study population included 24 participants naive to research in four hospitals in eastern France (13 nurses and 11 allied health professionals). Thematic analysis was used to analyze the data. The study was reported in compliance with the consolidated criteria for reporting qualitative research criteria. Findings: Professionals used tacit knowledge and their experiences to address care, but the culture of scientific evidence was clearly missing (lack of knowledge of the origin of care guidelines, few bibliographic skills). Participation in a research process could hardly be envisaged without a supervised collaboration with a physician. Research was perceived not to be part of professionals' culture. They self‐censured for lack of methodological competencies. Discussion: Findings underlined some leverage, obstacles, and need to consider to generate a stimulation in the field, especially in countries where such research is still in its infancy. Implication for nursing, health, and education policy: Strengthening the field of nursing and allied health research is essential to extend the skills of nurses and allied health workers and to improve the quality of patient care by taking into account results from the literature. The Ideas Generator tool will be implemented to sustain learning the skills of research through education and training. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to identify which strategies are being adopted to deal with family restrictions in health units and assess nurses' perceptions of including families in nursing care during the current pandemic. Background: Due to the COVID‐19 pandemic, health organisations limited access for visitors. Introduction: Family centred care needs to be guaranteed, and alternatives for face‐to‐face interaction should be fostered. Therefore, there is an urgent need to rethink the family in nursing care during a pandemic. Methods: We conducted a descriptive exploratory mixed‐method study in Portugal using an electronic questionnaire. The study included 192 nurses recruited using a non‐probabilistic convenience sample. The study was reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results: A total of 41.1% of participants (n = 79) reported that visits to their services were not authorised, and 66.7% (n = 128) reported resorting to video calls because of the restrictions imposed. Regarding attitude assessment, the average score of the scale was 77.9 (SD = 10.0), ranging between 26 and 98. When analysing the different dimensions of the 'Families' Importance in Nursing Care ‐ Nurses Attitudes' scale, family data stand out as a burden. Conclusion: Although a large percentage of participants had a positive attitude towards families and tried to find strategies to maintain family centred care, many nurses still considered the family as a burden. The current COVID‐19 pandemic may have aggravated this perception. Implications for nursing practice, nursing policy and health policy: The continued implementation of family centred nursing practice is essential for child‐well‐being, including during the current pandemic. Therefore, having intervention policies with alternative forms of care is highly recommended. [ABSTRACT FROM AUTHOR]

Background: Stronger healthcare models are increasingly sought to address new population needs, health workforce inefficiencies and nursing shortages. One strategy is to focus on employees' strengths to capitalize on their competencies and maximize their scope of practice. Introduction: Globally, there is an exponential demand for advanced practice nursing services. This study aimed to identify the roles and positions of nurses who align with APN defining criteria at all levels of care in Catalonia, Spain. Methods: The first step of the study included the translation and validation to Catalan of the Advanced Practice Nurse Role Delineation Tool (IDREPA) and step 2 comprised a multicentre cross‐sectional study, in which 126 healthcare centres participated: 1209 nurses were included in the study. The STROBE checklist was used to report this study. Results: Transcultural equivalence and validation of the instrument showed a content validity index of 0.958 and the reliability of the questionnaire. The instrument identified 269 nurses who align with international APN defined criteria. They worked in specialized care, mental healthcare and primary and community care, especially in chronic conditions, ageing and end‐of‐life care. Discussion: Most areas of Catalonia have access to nurses practicing at APN defining criteria. These nurses were developed as an optimal resource to respond to patient needs in the context of study. Both recognition and strategic implementation are necessary to apply their full competencies to solve healthcare problems. Conclusion: Understanding the supply of services delivered by nurses practicing at an advanced level and their scope of practice may lay the foundations for effective workforce planning in a dynamic context. Nurses who align with APN defining criteria are working mainly in large acute services without regulation and recognition. Implications for nursing: Advanced practice nurses show the value of their role and activities in healthcare services. Implications for health policy: Promoting the establishment of APN defining criteria that includes credentialing and a regulatory framework within international guidelines should be a priority to make an impact on healthcare policy. [ABSTRACT FROM AUTHOR]

DECOLA P., BENTON D., PETERSON C., & MATEBENI D. (2012) Nurses' potential to lead in non-communicable disease global crisis. International Nursing Review 59, 321-330 Background: The incidence and projected rise of non-communicable diseases (NCDs) are a significant global public health threat. Nurses as health educators are well positioned to support health promotion and prevention efforts. The intent was to understand nurses' interest, challenges and enabling factors in carrying out this important role in addressing the NCD crisis. Method: A stratified representative survey of 1600 nurses in eight countries was conducted to better understand how nurses perceive their role in addressing risk factors associated with NCDs, as well as the types of supports required in order to facilitate this work. The study also explores nurses' changing views of the profession and their practice environment. The structured survey was administered via telephone and face-to-face interviews composed primarily of multiple choice closed-ended questions. Results: Key findings included that 95% of nurses wanted to use their knowledge, skills and time to educate individuals on the threat and prevention of NCDs. They expressed their belief that they should be spending significantly more time, on average almost twice the amount as they currently are able to devote, on preventing the development or escalation of NCDs. However, nurses' potential to do this is diluted by heavy workloads; over one third reported that their workload had worsened over the last 5 years, and 95% of nurses are experiencing time pressures. Nurses believe these constraints, almost unanimously (98%), keep them from being able to spend more time with patients in an educational capacity. Conclusions: Nurses are interested in spending more time addressing NCD prevention, but workload, time constraints and their perception towards the job of nursing hinder them from achieving their potential. Unhealthy lifestyle choices are a risk factor for NCDs; through awareness and education, positive behaviour change is possible. Research has demonstrated that nurses are effective at supporting individuals to make behaviour change, administering disease management programmes and enabling self-care as well as self-management. Practice environment issues that prevent nurses from fully reaching their potential in addressing the NCD crisis need to be addressed. [ABSTRACT FROM AUTHOR]

IOANNIDOU C., GALANIS P., TSOUMAKAS K. & PAVLOPOULOU I.D. (2012) Characteristics of dog bites among nursing students and knowledge about their emergency management. International Nursing Review 59, 245-251 Background: Dog bites represent a significant health concern leading to a variety of consequences. Nursing students should be appropriately educated in order to manage and help prevent such injuries. Aim: This paper is the first to report the lifetime experience and characteristics of dog bites among Greek nursing students and their knowledge in managing the above injuries. Methods: A cross-sectional quantitative study was performed using an anonymous questionnaire distributed to first and fourth year nursing students from April though June 2009. A knowledge score based on key questions was set on a scale from 0 to 7, to assess their competence on bite injuries management. Results: Of 237 nursing students recruited, 56 (23.6%) had experienced a dog bite. Men outnumbered women as dog bite victims [ n = 15 (39.5%) vs. n = 41 (20.6%), P = 0.012]. Mean age at the attack was 11.1 (standard deviation = 5.6) years and legs sustained the majority of injuries ( n = 31; 55.4%). Most bites ( n = 39; 69.9%) involved a dog known to the victim, were provoked ( n = 30; 53.6%) and occurred in a public place ( n = 35; 62.5%). Ten (17.9%) of the victims sustained a moderate or severe injury. The majority (67.9%) of students answered correctly to less than or equal to three out of seven key knowledge questions. After multiple linear regression analysis, previous educational course attendance was the only factor associated with increased score (b = 0.48, standard deviation = 0.17, 95% confidence interval = 0.12-0.84, P = 0.009). Conclusions: Dog bites were common and presented characteristic patterns among nursing students, but knowledge in their management was suboptimal. Improved education should be provided during undergraduate studies. [ABSTRACT FROM AUTHOR]

GURKOVÁ E., ČÁP J., ŽIAKOVÁ K. & ĎURIŠKOVÁ M. (2011) Job satisfaction and emotional subjective well-being among Slovak nurses. International Nursing Review 59, 94-100 Purpose: The purpose of this study is to investigate job satisfaction and emotional subjective well-being and the correlations between these two constructs among Slovak nurses. Design: A cross-sectional survey was used to investigate this relationship among nurses ( n = 104) working in seven public hospitals in Slovakia. Methods: Data were collected using a set of questionnaires that included the questionnaire to measure job satisfaction, the Positive Affect Scale, the Negative Affect Scale and a demographics form. Findings: Findings of this study confirmed some general satisfying and dissatisfying elements for the nursing profession across different clinical specialties and different cultures. The results also indicate that there is a positive correlation between positive emotions and job satisfaction of Slovak nurses. Conclusion: The paper has drawn attention to the job satisfaction and emotional well-being among nurses. Further studies in this field, extended to different countries, work settings and nursing specialties, may help to improve subjective well-being of nurses. Study limitations: Participants came from a limited number of hospitals in Slovakia. A larger sample from different hospitals in Slovakia could have enhanced the generalizability of the results and increased the power of the study to detect significant differences and associations. [ABSTRACT FROM AUTHOR]

MANZANO GARCÍA G. & AYALA CALVO J. C. (2011) Emotional exhaustion of nursing staff: influence of emotional annoyance and resilience. International Nursing Review 59, 101-107 Aim: This paper aimed to study the influence of emotional annoyance and resilience on the emotional exhaustion levels of nursing staff. Background: Emotional exhaustion is one of the key factors in understanding both the performance and the quality of care that nurses give to their patients. There is a considerable body of knowledge that has focused on the study of emotional exhaustion in relation to cynicism and professional efficiency. More recently emotional annoyance and resilience have been identified as variables that could help explain levels of emotional exhaustion. Methods: Nine hundred eighty-three nurses who work in five hospitals in the north of Spain were invited to participate in the study. Five hundred questionnaires were distributed, of which 200 were fully completed. The average response rate was 40%. A personal information form, and a questionnaire concerning nurses' emotional annoyance, resilience, professional efficiency and cynicism were used as data collection instruments. To estimate a path model with latent variables, partial least squares was used. Findings: Emotional annoyance and resilience contribute to a better understanding of emotional exhaustion levels of nursing staff. There was a significant association between emotional annoyance and emotional exhaustion (β = 0.26, P = 0.020), while resilience appeared to be protective against emotional exhaustion (β = −0.22, P = 0.004). Conclusion: A more complete explanation and understanding of emotional exhaustion in nursing is achieved when emotional annoyance and resilience is measured in addition elements of burnout, which include professional efficiency and cynicism. [ABSTRACT FROM AUTHOR]

Aim: To describe the impact of the COVID‐19 pandemic on stress, resilience and depression in health professionals from a public hospital in Barcelona, Spain after the first peak of pandemic. Background: The COVID‐19 pandemic in Spain has pushed boundaries in health systems and, especially, for health professionals. Analysis of resilience as an individual resource and it is essential to understand the mechanisms that make staff react unfavourably to stressors caused by the pandemic. Design: A descriptive cross‐sectional study was designed. Participants: Health professionals supervised by the nursing department, including registered nurses, health care assistants, health technicians, final year nurse student nurses, foreign nurses, and other nurse‐related health workers. Methods: The study complies with the STROBE checklist for cross‐sectional studies. An online survey was administered to all health professionals supervised by the nursing department between 6 and 27 May 2020. The survey included the ER‐14 Resilience Scale, the widely‐used PHQ‐9 depression scale, the Spanish version of the Nursing Stress Scale, and an ad‐hoc questionnaire to obtain sociodemographic and occupational variables. Results: A total of 686 participants answered the survey. Resilience was high or very high in health professionals, with an inverse correlation with stress and depression scores. Personal on fixed shifts showed better resilience. The most stressed health professionals were full‐time registered nurses, followed by health care assistants. Up to 25% of nursing professionals had depression. Conclusion: Our study showed a high degree of resilience among nurse professionals despite the overwhelming nature of the COVID‐19 pandemic. Relevant signs of depression and stress were detected among participants. Occupational factors heavily influenced nurses' resilience, stress and depression. Implications for Nursing & Health Policy: Government policy shifts are needed in Spain to improve nurses' workforce conditions, enhance the ratio of nurses to patient numbers, and avoid workforce losses. Maintaining the resilience of health professionals would assist in improving their health and their capacity to possible future emergency situations. [ABSTRACT FROM AUTHOR]

Aims: (1) To identify and analyse diagnoses documented by nurses in Portugal within the scope of universal self‐care requisites; (2) to determine the main problems with nursing diagnoses syntaxes for semantic interoperability purposes; and (3) to suggest unified nursing diagnoses syntaxes within the scope of universal self‐care requisites. Background/Introduction: Ageing societies and the increase in chronic diseases have led to significant concern regarding individuals' dependence to ensure self‐care. ICNP is widely used by Portuguese nurses in electronic health records for documentation of nursing diagnoses and interventions. Methods: A qualitative study using inductive content analysis and focus group: 1. nursing e‐documentation content analysis and 2. focus group to explore implicit criteria or insights from content analysis results. Results: From a corpus of analysis with 1793 nursing diagnoses, 432 nursing diagnoses centred on universal self‐care requisites emerged from the content analysis. One hundred ten nursing diagnoses resulted from the application of new encoding criteria that emerged after a focus group meeting. Conclusion: Results reveal that nursing diagnoses related to universal self‐care requisites can emphasize the impairment or potentialities of the individuals performing self‐care. It also shows a lack of consensus on nominating the nursing diagnoses of people with a deficit in universal self‐care requisites, resulting in different diagnoses to express the same needs. Implications for nursing practice: Representation of most relevant nursing diagnoses within the scope of universal self‐care requisites. Implications for health policy: Incorporating standardized language into electronic health records is not enough for improving quality and continuity of care and semantic interoperability achievement. Electronic health records need to work with a nursing ontology in the backend to meet these requirements. [ABSTRACT FROM AUTHOR]

Aim: To assess whether expatriate‐specific factors were associated with nurses' overall job dissatisfaction after controlling for known factors. Background: Current evidence about job dissatisfaction among nurses in Saudi Arabia is not specific to expatriate nurses. Specific aspects such as job insecurity, fear of litigation, and language barriers have not been assessed in the context of job dissatisfaction. Introduction: The majority of nurses in the Arab Gulf countries are expatriate. The motive for employment here is purely financial because there is no path to permanent residency. Methods: This was a cross‐sectional electronic survey of 977 expatriate nurses in Al‐Qassim, Saudi Arabia. The survey included questions on demography, job dissatisfaction (overall and related to salary, workload, and teamwork), job characteristics, job duration as an expatriate, communication issues with patients and doctors, fear of litigation, and job insecurity. We used a hierarchical logistic regression to evaluate whether unique factors were associated with overall job dissatisfaction either as a group, or individually. Results: The mean age of the nurses was 32 years, and 19% reported overall job dissatisfaction. The unique expatriate factors as a group contributed significantly to the model. Job insecurity, patient communication problems, and shorter job duration were significantly associated with higher overall job dissatisfaction. Conclusions: Job insecurity, job duration, and patient communication were significant correlates of overall job dissatisfaction among expatriate nurses. Implications for nursing policy: A longer job contract and organizational initiatives to help new expatriate nurses acculturate will likely decrease feelings of job insecurity and increase job satisfaction. [ABSTRACT FROM AUTHOR]

Aim: To investigate the nurses' work environment in university hospitals during the COVID‐19 pandemic in Brazil. Background: The COVID‐19 pandemic brought challenging times for nurses worldwide. In Brazil, as well as in several countries, nurses are working hard in hospital settings caring for patients infected with the virus, sometimes with unfavourable work environment conditions. Methods: This study was a convergent embedded mixed methods research. The sample comprised 104 nurses from three Brazilian university hospitals. Data were collected in April–June 2020 from an online questionnaire with a self‐reporting Likert scale survey designed to measure the nurses' perceptions of their work environment. Qualitative data in the form of written comments were also collected through an open question. Data were analysed using descriptive statistics and content analysis. Results: The quantitative results showed that the responses to 'I received training on the correct use of personal protective equipment' and 'I am afraid of being infected' items had the best and worst evaluations, respectively. The qualitative findings revealed five themes: feeling of insecurity, lack of personal protective equipment, lack of diagnostic tests, changes in the care flow and fear of the unknown. Conclusion: The study has highlighted the challenges faced by hospital nurses while caring for patients with COVID‐19. Implications for Nursing and Nursing Policy: The gaps identified will assist the policymakers and hospital managers in developing policies to enhance the support offered to nurses and improve the care provided to patients with COVID‐19 in university hospitals. The results also indicate the need for attention to the mental health of the professionals due to the increasing workload and treatment of an illness hitherto unknown. [ABSTRACT FROM AUTHOR]

Aim: To conduct a systematic review to understand the experiences of foreign‐educated nurses in Japan. Background: The experiences of foreign nurses in host countries, and the challenges they face, have been widely investigated around the world. However, no systematic review has focused on the experience of foreign‐educated nurses in Japan. Methods: A systematic literature review was conducted by following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Guidelines. Japan Medical Abstract Society, Citation Information by National Institute of Informatics, Cumulative Index to Nursing and Allied Health Literature, and PubMed databases were used for the literature search. Inclusion criteria were research articles published between 2013 and 2020 written in Japanese or English. A quality assessment was performed using Version 2018 of the Mixed Methods Appraisal Tool. Selected articles were read repeatedly, and relevant contents were extracted and summarized thematically. Results: Twenty‐five studies were selected for the review. The themes generated included (1) reasons for nurses to come to Japan, (2) experiences and current situations among the Economic Partnership Agreement nurses/nurse candidates living in Japan, and (3) experiences and current situation of nurses who had returned to their home countries. The second theme was classified into four categories: language and communication barriers, low pass rates for the national qualification exam, adaptation to workplaces and social environments, and psychological distress. Conclusion: Foreign nurses in Japan face various challenges and difficulties, even after they return to their home countries. Solving these problems may improve the wellbeing of foreign‐educated nurses in Japan. Implications for Nursing Policy: The results from the current review highlight the necessity for immediate intervention by policymakers to improve the current support system for Economic Partnership Agreement nurses/nurse candidates. A thorough pre‐arrival orientation should be provided for the nurse candidates to able them to make a well‐informed choice. [ABSTRACT FROM AUTHOR]

Aim: We developed and psychometrically tested the Japanese version of the Professional Attitude Scale for Nurses (PASN‐J). Background: Nurses must recognize the importance of their professionalism; therefore, it is critical to quantitatively measure nurses' professional attitudes. Introduction: This instrument validation study was designed to generate an itemized scale and examine its content validity/psychometric testing using a sample of Japanese nurses. Methods: Based on a trait approach focusing on the characteristic traits of the nursing profession, a 59‐item draft scale was generated. During November 2017, 2657 nurses from 29 facilities in Japan were surveyed. The questionnaire included demographics, the 59‐item draft scale, and a self‐report scale of nurses' professional behaviour and nursing practice ability. Using exploratory and confirmatory factor analyses, we evaluated the construct, criterion‐related, concurrent, and known‐groups validity, and reliability of the PASN‐J. Results: Data from 1716 participants were analysed. The analyses yielded a 38‐item, 3‐factor scale that adequately fit the data. PASN‐J scores were positively correlated with nurses' professional behaviour and nursing practice ability. Conclusion: The 38‐item PASN‐J has good reliability and validity, making it useful for measuring the current condition of nursing professionalism and evaluating nursing education. Implications for Nursing and Health Policy: This scale can evaluate nursing education and promote nurses' professionalism. The PASN‐J will help identifying the elements of undergraduate nursing education that require further emphasis. Additionally, the PASN‐J could facilitate the development of nursing policies to promote professional development in nurses. Ultimately, evaluating nursing education with the PASN‐J enhances nurses' professional attitudes and subsequently improves their quality of nursing, nursing efficiency and patient outcomes. [ABSTRACT FROM AUTHOR]

Aim: This systematic review and meta‐analysis evaluates the attitudes of Iranian nurses towards clinical information systems in nursing practice. Background: Nurses are essential in the successful adoption and implementation of clinical information systems. Methods: A systematic search was performed in Medline, Embase, Cochrane, CINAHL, Scopus, and Web of Science and Farsi databases, to retrieve relevant studies. The methodological quality of the studies is assessed via the Joanna Briggs Institute's critical appraisal checklist for analytical cross‐sectional studies. The random effect model was utilized to analyse the data due to the high heterogeneity in the included studies (n = 17). Results: Results indicate that clinical information systems impact on at least seven aspects of nursing practice, including documentation, patient safety, quality of treatment, communication, treatment management, nursing tasks and hospital resource management. Results also indicated that one aspect of using clinical information systems in nursing practice is satisfaction with the 'quality and design of clinical information systems', such as ease of use and learning, flexibility and software speed. Conclusion: Clinical information systems can contribute to different aspects of nursing practice. However, their design should improve significantly in order to help nurses perform their professional activities in an efficient and satisfactory manner. Implications for Nursing Policy: Before the full deployment of clinical information systems, their usability should be tested. In pilot testing, nurses should provide necessary feedback about how well the systems work and improvements needed to meet their professional goals. [ABSTRACT FROM AUTHOR]

Aim: To predict nurses' intent to stay on the job as a function of organizational culture. Background: Organizational climate significantly contributes to retention of nurses. Communication by conflict and organizational control over problem‐solving has not thoroughly been studied. Methods: A cross‐sectional design was used with a randomly selected final sample of 367 nurses from regional hospitals in Hungary. Organizational climate, perceived stress, locus of control and self‐esteem were assessed as main measures. Nurses indicated their intent to stay for the next 5 years. Spearman correlation coefficients were calculated to evaluate associations. Bivariate logistic regression was performed to predict intent to stay in nursing. Findings: Organizational climate was negatively correlated with perceived stress and personal locus of control and positively with personal self‐esteem. Organizational level internal locus of control (belief that employees have control over problem‐solving) doubled the probability of staying on the job. Conflictual communication and perceived stress both decreased intent to stay by 50%. Discussion and conclusions: Organizational internal locus of control, stress and conflictual communication were main predictors of intent to stay. The belief that nurses had collective control over problem‐solving capabilities had a positive and greater impact on nurse retention compared to other measures. Implication for nursing policy: Healthcare organizations should routinely scan workplace culture for conflictual communication, stress and organizational problem‐solving capacities. Graduate nurse and nurse manager training should include practices that enable developing positive work atmospheres. Hospital managements should allocate training budget to stimulate and achieve cultural change. Implications for nursing practice: Nurse managers should promote internal trainings to help staff nurses adopt techniques that minimize conflict and emphasize positive impact of collaborative problem‐solving. [ABSTRACT FROM AUTHOR]

Aim: To explore nursing and midwifery managers' views regarding obstacles to compassion‐giving across country cultures. Background: The benefit of compassionate leadership is being advocated, but despite the fact that health care is invariably conducted within culturally diverse workplaces, the interconnection of culture, compassion and leadership is rarely addressed. Furthermore, evidence on how cultural factors hinder the expression of compassion among nursing and midwifery managers is lacking. Methods: Cross‐sectional, exploratory, international online survey involving 1 217 participants from 17 countries. Managers' responses on open‐ended questions related to barriers for providing compassion were entered and thematically analysed through NVivo. Results: Three key themes related to compassion‐giving obstacles emerged across countries: 1. related to the managers' personal characteristics and experiences; 2. system‐related; and 3. staff‐related. Conclusions: Obstacles to compassion‐giving among managers vary across countries. An understanding of the variations across countries and cultures of what impedes compassion to flourish in health care is important. Implications for nursing practice and policy: Nursing mangers should wisely use their power by adopting leadership styles that promote culturally competent and compassionate workplaces with respect for human rights. Policymakers should identify training and mentoring needs to enable the development of managers' practical wisdom. Appropriate national and international policies should facilitate the establishment of standards and guidelines for compassionate leadership, in the face of distorted organizational cultures and system‐related obstacles to compassion‐giving. [ABSTRACT FROM AUTHOR]

Aim: This study explored and described nurses' experiences of factors that influenced their professional dignity in private hospitals in South Africa. Background: Patients' dignity is a nursing professional value in high regard. Nurses' dignity, in particular nurses' professional dignity, has not been valued equally. Disrespect for nurses' professional dignity impacts on nurses' motivation to provide nursing care to their full potential. Methods: Descriptive phenomenological research was conducted. Eleven professional nurses were interviewed at two private hospitals in the provinces of KwaZulu‐Natal and the Free State of South Africa. Findings: The participants were conscious of their 'professional standing due to own and others' percipience'. Their professional dignity was influenced by experiences such as perceiving one's own professional dignity; having contradictory experiences; being proud to be a professional nurse; receiving support, appreciation and respect; providing care in complex situations; performing as a professional nurse; valuing patient well‐being; and being humiliated by others. Conclusion: Preserving nurses' professional dignity is crucial and should be acknowledged and encouraged by managers, health team members and nurses. Implications for nursing/health policy: The need for preserving nurses' professional dignity necessitates the incorporation of professional dignity strategies in healthcare, nursing and education policies. [ABSTRACT FROM AUTHOR]

Background: There have been many single cross‐sectional studies on nurse or patient outcomes. However, long‐term evidence on improving nurse and patient outcomes is still limited. The High‐Quality Care Project is a national project in China for improving nurse and patient outcomes by implementing primary nursing. Aim: (1) To assess the long‐term changes in nurse and patient outcomes in the context of the High‐Quality Care Project. (2) To explore the potential influences of primary nursing on nurse and patient outcomes based on this study and broader existing evidence. Methods: The data of two cross‐sectional studies were used for analysis. The two cross‐sectional studies were conducted before (2009) and after (2016) the High‐Quality Care Project. A total of 1376 nurses and 904 patients from 40 units of 10 tertiary hospitals were surveyed. Reliable and validated instruments were used to measure nurse and patient outcomes. Multilevel modelling was the main method for data analysis. Results: Nurses in 2016 were more satisfied than nurses in 2009 with most dimensions of nurse work environment and job satisfaction. However, they were not more satisfied with burnout, global job satisfaction or intention to leave their job. Nurses in 2016 also reported better quality of patient care and patient safety while their patients reported higher patient satisfaction. Conclusion: The analysis of our results based on existing evidence indicates that primary nursing could be considered as a potentially effective way to improve nurse work environment and patient outcomes. More studies with rigorous study design from micro perspectives would be useful to further explore the direct effects of primary nursing on nurse or/and patient outcomes. Implications for nursing and nursing policy: Policymakers, healthcare service leaders and nurse managers should make efforts to provide multi‐level supports to cultivate an encouraging environment for nurses to practice primary nursing, because the implementation of primary nursing may improve the nurse work environment and patient outcomes. Furthermore, improving nurse participation in hospital affairs and developing nursing discipline and education for increasing nursing staff resource and nurses' capacity – which all need policy and management supports – are crucial to further improve nurse and patient outcomes. [ABSTRACT FROM AUTHOR]