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Aim: To identify the barriers and facilitators to seasonal influenza vaccination uptake among nurses. Background: Seasonal influenza causes significant mortality and morbidity among older people and high‐risk groups. Vaccinating nurses against influenza is an essential public health measure to reduce the burden of disease. Yet despite annual recommendations, nurses' influenza vaccine uptake rates remain low. Design: An explanatory sequential mixed methods study design. Data Sources: Qualified nurses attending mandatory training in two large acute hospitals in Ireland. Methods: A paper‐based questionnaire assessing nurses' knowledge, risk perception, health beliefs and influenza vaccination practices was distributed to a convenience sample of qualified nurses (N = 462) between September 2017 – February 2018. A self‐selected sample of 35 nurses who completed the questionnaire participated in five focus groups to explore in depth the barriers and facilitating factors associated with their vaccination practices between September 2018 – October 2018. The questionnaire data were analysed statistically and thematic analysis was applied to the qualitative data. The quantitative and qualitative findings were integrated using the Pillar Integration Process. Results: Seven themes emerged: (a) the influence of nurses' knowledge on vaccine uptake; (b) dissemination of information; (c) vaccine fears and concerns; (d) protection, risk and vulnerability: self and others; (e) influencers; (f) accessibility; and (g) organizational pressure. Conclusion: Achieving high vaccine uptake rates among nurses through voluntary vaccination programmes remains a challenge. Multi‐faceted influenza campaigns based on the HBM should be prioritized to address dissemination of evidence‐based knowledge, accessibility, and external cues to action. Impact: Low influenza vaccine uptake among nurses compromises patient safety and contributes to a significant burden on health services. This study identified factors associated with vaccine practices among nurses and will inform the development of specific tailored interventions for nurses. [ABSTRACT FROM AUTHOR]

Aims This paper is a report of a study, which seeks to determine if self-reported estimates of RNs' self-rated confidence in responding to alcohol use in patients is a psychometrically sound measure. Background Alcohol-related harm is a global public health problem. Nurses are the largest group of health professionals worldwide, with evidence showing that despite being well placed to respond, they are not engaging in this important role. Design Instrument development. Method The study was a survey set in a large teaching hospital in England, UK. The Clinical Confidence Questionnaire was made available to a convenience sample of 200 RNs in 2007, with a response rate of 22%. Rasch analysis was used to develop a scale for future learning based on the conjoint estimates of registered hospital nurses abilities to meet needs of patients requiring nursing care of different complexities related to alcohol use in patients. Results Outcomes verify that registered hospital nurses' self-rated clinical confidence measures for their own nursing abilities in responding to alcohol use in patients can be reliably estimated and a hierarchical scale of learning can be generated to inform curricula content and learning processes. Conclusion Current health policy in the UK identifies nurses as having a role in responding to alcohol-related harm. More focus should, therefore, be placed on ensuring that they are prepared to fully engage with patients in assessing and responding to alcohol use through specific education, training and skill development. The self-rated clinical confidence tool offers evidence as an acceptable method of measurement in this area. [ABSTRACT FROM AUTHOR]

ockhuijsen h.d.l., gamel c.j., van den hoogen a. & macklon n.s. (2011) Integrating preconceptional care into an IVF programme. Journal of Advanced Nursing 68(5), 1156-1165. Abstract Aim. This paper is a report of a mixed method study of the outcomes of integrating preconceptional care into an in-vitro fertilization programme on nurses' and patients' attitudes and patients' weight and smoking behaviour. Background. Increasing evidence points to the significant effect of lifestyle factors on in-vitro fertilization outcomes. Optimizing the health of couples before they commence in-vitro fertilization may improve the chance of achieving success. Method. In 2007, 130 couples attending a university hospital in-vitro fertilization unit and seven nurses were invited to participate in the study. Questionnaires were developed to assess the attitudes of both patients and nurses. Furthermore, the impact of interventions on body mass index and smoking patterns were evaluated. Results. All nurses ( n = 7) and 101 patients (77·7%) returned completed questionnaires. Analysis revealed a considerable degree of scepticism among the nurses at the outset as to the value of the programme and their ability to perform their new role effectively. Patients valued positively the increased attention to adjusting lifestyle factors with the goal to improve fertility outcomes. Of those participants who smoked or had a body mass index >30, 30% ( n = 7/23) of the patients quit smoking and 50% lost weight ( n = 15/30), mean loss: 6·1 kg. Conclusion. Fertility nurses can play a key role in the provision of preconceptional care. Patients with a fertility problem can be motivated to address lifestyle issues before embarking on in-vitro fertilization treatment. The integration of preconceptional care and lifestyle interventions was shown to be feasible in our clinical setting. [ABSTRACT FROM AUTHOR]

scott k., white k., johnson c. & roydhouse j.k. (2011) Knowledge and skills of cancer clinical trials nurses in Australia. Journal of Advanced Nursing 68(5), 1111-1121. Abstract Aims. This paper is a report of the development and testing of a questionnaire measuring knowledge and skills of cancer clinical trials nurse in Australia. Background. The role of cancer clinical trials nurse, widely acknowledged as an integral member of the clinical research team, has evolved in recent years. Elements of the clinical trials nurse role in cancer have previously been described. To evaluate specific cancer clinical trials nurse educational and training needs, the development of a valid and reliable tool is required. Methods. In 2009, a study was conducted in three stages. Stage I: questionnaire development and pilot testing; stage II: focus group; stage III: national survey. Internal consistency reliability testing and multi-trait analysis of item convergent/divergent validity were employed. Regression analysis was used to identify predictors of clinical trials nurse knowledge and skills. Results. The national survey was a 48-item questionnaire, measuring six clinical trial knowledge and seven skills sub-scales. Of 61 respondents, 90% were women, with mean age 43 years, 19 years as a Registered Nurse and 5 years as a cancer clinical trials nurse. Self-reported knowledge and skills were satisfactory to good. Internal consistency reliability was high (Cronbach's alpha: knowledge = 0·98; skills = 0·90). Criteria for item convergent/divergent validity were met. Number of years as cancer clinical trials nurse was positively related to self-reported knowledge and skills. Conclusion. Preliminary data suggest that the national survey is reliable and valid. Data have contributed to better understanding the knowledge and skills of cancer clinical trials nurse in Australia and development of a postgraduate course in clinical trials. [ABSTRACT FROM AUTHOR]

he h.-g., jahja r., lee t.-l., ang e.n.k., sinnappan r., vehviläinen-julkunen k. & chan m.f. (2010) Nurses' use of non-pharmacological methods in children's postoperative pain management: educational intervention study. Journal of Advanced Nursing 66(11), 2398-2409. Aim. This paper is a report of study of the impact of an educational intervention in pain management on nurses' self-reported use of non-pharmacological methods for children's postoperative pain relief and their perceptions of barriers that limited their use of these methods. Background. Non-pharmacological methods have been shown to be effective in relieving pain; however, many barriers, including lack of knowledge, limit nurses' use of these methods. Pain education is a promising strategy for changing nursing practice, but only a few authors have examined the effectiveness of educational interventions for nurses to help relieve children's postoperative pain. Methods. A quasi-experimental one-group pre- and post-test design was used. Questionnaire surveys were conducted with a convenience sample of 108 Registered Nurses in two public hospitals in Singapore in 2008. Results. Statistically significant increases were found in nurses' self-reported use of imagery, positive reinforcement, thermal regulation, massage and positioning in the postintervention survey. Before the intervention, these methods were less frequently used compared to other methods. Heavy workload/lack of time and the child's inability to cooperate were the most commonly reported barriers at pre- and post-test. Conclusion. The educational intervention had a positive effect on nurses' use of several non-pharmacological methods. Regular dissemination of updated information to nurses on these pain management methods is recommended to maintain the positive changes. Nevertheless, education alone was not sufficient to optimize nurses' use of these methods, as various barriers limited their practice. [ABSTRACT FROM AUTHOR]

gambino k.m. (2010) Motivation for entry, occupational commitment and intent to remain: a survey regarding Registered Nurse retention. Journal of Advanced Nursing 66(11), 2532-2541. Aim. This paper is a report of a study of the relationships between Registered Nurses' motivation for entering the profession, occupational commitment and intent to remain with an employer until retirement. Background. Identifying and supporting nurses who are strongly committed to their profession may be the single most influential intervention in combating the nursing shortage. An understanding of the characteristics these individuals possess could lead to a decline in the high attrition rates plaguing the profession. Method. Using a survey design, Registered Nurses enrolled at the school of nursing and/or employed at the associated university medical centre of a large, not-for-profit state university were polled in 2008. Logistic regression analysis was used to determine how the variables of motivation for entry and occupational commitment could indicate intent to remain. Results. The strongest indicators of intent to remain were normative commitment and age, with a 70% average rate of correctly estimating retention. Exp(B) values for normative commitment (1·09) and age (1·07) indicated that for each one-point increase on the normative commitment scale or one-point increase in age, the odds of remaining with an employer until retirement increased by 1·1%. Conclusion. Transformational changes in healthcare environments and nursing schools must be made to encourage loyalty and obligation, the hallmarks of normative commitment. Retention strategies should accommodate mature nurses as well as promote normative commitment in younger nurses. [ABSTRACT FROM AUTHOR]

iliopoulou k.k. & while a.e. (2010) Professional autonomy and job satisfaction: survey of critical care nurses in mainland Greece. Journal of Advanced Nursing 66(11), 2520-2531. Aim. This paper is a report of a study conducted to describe Greek critical care nurses' views on professional autonomy and its relationship with job satisfaction and other work-related variables. Background. Professional autonomy is generally considered a highly desirable nursing attribute and a major factor in nurse job satisfaction. In the critical care environment, a high level of accountability, responsibility and autonomy are required to optimize outcomes of critically unstable patients. Method. A questionnaire survey was conducted with a convenience sample of Greek critical care nurses ( n = 431; response rate 70%) in 2007. Data were collected on professional autonomy, job satisfaction, role conflict and role ambiguity. Results. Overall, nurses reported acting moderately autonomously. Younger nurses reported statistically significant lower levels of autonomy. Higher levels of autonomy were reported by female nurses. Multiple logistic regression revealed that appointment level, type of critical care unit and registration with a professional organization were independently associated with autonomy. A positive moderate association was found between reported autonomy, job satisfaction, role conflict and role ambiguity, but there was no relationship between job satisfaction and reported role conflict and role ambiguity. Conclusion. Further education, role enhancement and support are required for nurses working in critical care in Greece if they are to achieve the maximum potential of their professional role. Failure to address the perceptions of professional autonomy may have an impact on staff retention, because of job dissatisfaction. [ABSTRACT FROM AUTHOR]

gardner g., gardner a., middleton s., della p., kain v. & doubrovsky a. (2010) The work of nurse practitioners. Journal of Advanced Nursing 66(10), 2160–2169. Aim. This paper is a report of a study of variations in the pattern of nurse practitioner work in a range of service fields and geographical locations, across direct patient care, indirect patient care and service-related activities. Background. The nurse practitioner role has been implemented internationally as a service reform model to improve the access and timeliness of health care. There is a substantial body of research into the nurse practitioner role and service outcomes, but scant information on the pattern of nurse practitioner work and how this is influenced by different service models. Methods. We used work sampling methods. Data were collected between July 2008 and January 2009. Observations were recorded from a random sample of 30 nurse practitioners at 10-minute intervals in 2-hour blocks randomly generated to cover 2 weeks of work time from a sampling frame of 6 weeks. Results. A total of 12,189 individual observations were conducted with nurse practitioners across Australia. Thirty individual activities were identified as describing nurse practitioner work, and these were distributed across three categories. Direct care accounted for 36·1% of how nurse practitioners spend their time, indirect care accounted for 32·0% and service-related activities made up 31·9%. Conclusion. These findings provide useful baseline data for evaluation of nurse practitioner positions and the service effect of these positions. However, the study also raises questions about the best use of nurse practitioner time and the influences of barriers to and facilitators of this model of service innovation. [ABSTRACT FROM AUTHOR]

rochefort c.m. & clarke s.p. (2010) Nurses’ work environments, care rationing, job outcomes, and quality of care on neonatal units. Journal of Advanced Nursing 66(10), 2213–2224. Aim. This paper is a report of a study of the relationship between work environment characteristics and neonatal intensive care unit nurses’ perceptions of care rationing, job outcomes, and quality of care. Background. International evidence suggests that attention to work environments might improve nurse recruitment and retention, and the quality of care. However, comparatively little attention has been given to neonatal care, a specialty where patient and nurse outcomes are potentially quite sensitive to problems with staffing and work environments. Methods. Over a 6-month period in 2007–2008, a questionnaire containing measures of work environment characteristics, nursing care rationing, job satisfaction, burnout and quality of care was distributed to 553 nurses in all neonatal intensive care units in the province of Quebec (Canada). Results. A total of 339 nurses (61·3%) completed questionnaires. Overall, 18·6% were dissatisfied with their job, 35·7% showed high emotional exhaustion, and 19·2% rated the quality of care on their unit as fair or poor. Care activities most frequently rationed because of insufficient time were discharge planning, parental support and teaching, and comfort care. In multivariate analyses, higher work environment ratings were related to lower likelihood of reporting rationing and burnout, and better ratings of quality of care and job satisfaction. Conclusion. Additional research on the determinants of nurse outcomes, the quality of patient care, and the impact of rationing of nursing care on patient outcomes in neonatal intensive care units is required. The Neonatal Extent of Work Rationing Instrument appears to be a useful tool for monitoring the extent of rationing of nursing care in neonatal units. [ABSTRACT FROM AUTHOR]