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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]

Aims: To examine the differences in decisional conflict, decision regret, self‐stigma and quality of life among breast cancer survivors who chose different surgeries, as well as the effects of decisional conflict, decision regret and self‐stigma on quality of life. Design: Observational study. Methods: Paper and online surveys were used to collect data from March to September 2020. The Chinese version of the Decisional Conflict Scale, Decision Regret Scale, Self‐Stigma Form and Functional Assessment of Cancer Treatment‐B were used to measure the corresponding health outcomes for breast cancer survivors who chose different surgeries from three university‐affiliated hospitals. One‐way analysis of variance, Pearson's correlation coefficient and hierarchical multiple regression analysis were used for data analysis. Results: Among the 448 participants, only 21% chose breast conservative surgery, while 79% chose mastectomy with or without reconstruction. Women who chose mastectomy with reconstruction reported higher decisional conflict (p =.028) and more decision regret (p =.013) than women who chose breast conservative surgery; women who chose mastectomy without reconstruction indicated higher decisional conflict (p =.015), more decision regret (p <.001), and higher self‐stigma (p =.034) than women who chose breast conservative surgery. Decisional conflict (r = −.430), decision regret (r = −.495), and self‐stigma (r = −.561) were negatively correlated with quality of life. After controlling for sociodemographic and clinical variables, decisional conflict and decision regret explained 19.7% and self‐stigma explained 12.9% of the variance in quality of life. Conclusion: Decisional conflict, decision regret and self‐stigma vary according to different breast surgeries and are greatly associated with the quality of life of breast cancer survivors. Impact Future studies are warranted to investigate the decision‐making process and the underlying reasons for surgical choices. Decision support strategies pre‐surgery are needed to inform women about the risks and benefits of surgery options. Moreover, psychosocial support post‐surgery is warranted to relieve women's self‐stigma, thus improving their quality of life. [ABSTRACT FROM AUTHOR]

Background: An association between health literacy and health outcomes has been widely reported in the literature. However, models exploring the links between health literacy and the outcomes of health literacy need further testing. The purpose of this study was to examine the pathways of health literacy on diabetes self‐care activities amongst patients with Type 2 diabetes. Methods: A cross‐sectional survey using secondary data analysis was conducted on 155 patients with Type 2 diabetes recruited from the diabetes clinics of two university hospitals in a metropolitan city in South Korea. Structural equation modelling analysis using bootstrapping was carried out using the AMOS software. Results: Health literacy had no significant direct effect on diabetes self‐care activities. Rather, health literacy had a significant indirect effect on diabetes self‐care activities mediated through diabetes knowledge and patient activation. Conclusion: These findings indicate that interventions intended to improve self‐care activity amongst older adults with low health literacy should include strategies to enhance patients' knowledge, as well as their activation for diabetes self‐care. SUMMARY STATEMENT: What is already known about this topic? Health literacy is known to be a factor influencing self‐management of patients with diabetes.Low level of health literacy is associated with adverse health outcomes of patients with chronic illness.It is important to understand the processes through which health literacy affects health outcomes. What is already known about this topic? Health literacy had a significant direct effect on knowledge and patient activation but not on diabetes self‐care activities.Health literacy had a significant indirect effect on diabetes self‐care activities mediated through diabetes knowledge and patient activation. The implications of this paper: Interventions intended to improve self‐care activities amongst older adults with low health literacy should include strategies to enhance patients' knowledge, as well as their activation for diabetes self‐care.For patients with low health literacy, information processing should be used to facilitate the advancement of their knowledge and the subsequent influence of this knowledge on diabetes self‐care activities.Patient activation should be encouraged by nurses during interactions with patients with diabetes. [ABSTRACT FROM AUTHOR]

Health care costs incurred prior to the appropriate patient–provider transaction (i.e., transaction costs of access to health care) are potential barriers to accessing health care in low- and middle-income countries. This paper explores these transaction costs and their implications for health system governance through a cross-sectional survey of adult patients who received their first diagnosis of pulmonary tuberculosis (TB) at the three designated secondary health centres for TB care in Ebonyi State, Nigeria. The patients provided information on their care-seeking pathways and the associated costs prior to reaching the appropriate provider. Of the 452 patients, 84% first consulted an inappropriate provider. Only 33% of inappropriate consultations were with qualified providers (QP); the rest were with informal providers such as pharmacy providers (PPs; 57%) and traditional providers (TP; 10%). Notably, 62% of total transaction costs were incurred during the first visit to an inappropriate provider and the mean transaction costs incurred was highest with QPs (US$30.20) compared with PPs (US$14.40) and TPs (US$15.70). These suggest that interventions for reducing transaction costs should include effective decentralisation to integrate TB care with services at the primary health care level, community engagement to address information asymmetry, enforcing regulations to keep informal providers within legal limits and facilitating referral linkages among formal and informal providers to increase early contact with appropriate providers. [ABSTRACT FROM PUBLISHER]

lin s.-c., tsai k.-w., chen m.-w. & koo m. (2012) Association between fatigue and Internet addiction in female hospital nurses. Journal of Advanced Nursing 69(2), 374-383. doi: 10.1111/j.1365-2648.2012.06016.x Abstract Aims. To report a study conducted to examine the association between fatigue and Internet addiction among female hospital nurses. Background. The Internet provides unprecedented convenience for social interaction and information retrieval. Although excessive Internet use has been demonstrated to correlate with fatigue in adolescents, no studies have examined whether it is associated with fatigue in nurses. Design. Cross-sectional survey. Methods. The study was conducted in August 2010. Female Registered Nurses working in a regional teaching hospital in southern Taiwan were asked to complete a paper-based questionnaire. The questionnaire included questions on demographics, the Chen Internet Addiction Scale and the Chalder Fatigue Scale. Multiple linear regression analysis was performed using Chalder fatigue scale as the dependent variable. Results. Of the 564 (79% response) valid questionnaires returned, 6 and 10% of the participants were classified as diagnostic cases and possible cases of Internet addiction, respectively. Fatigue levels, adjusting for other potential confounders including work unit, shift work, regular self-medication, and self-perceived health status, was significantly associated with both possible cases of Internet addiction and diagnostic cases of Internet addiction. Conclusion. This study is the first in reporting a statistically significant association between fatigue levels and Internet addiction in female hospital nurses. Relevance to clinical practice. Nurses should pay attention to their Internet activity and whether it adds to their fatigue levels. Addictive behaviour should promptly be dealt with to ensure that the best care is provided to patients. [ABSTRACT FROM AUTHOR]

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one’s own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account. [ABSTRACT FROM PUBLISHER]