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Background: The culturally sensitive nursing practice has not embedded filial piety as a cultural value and stance pertaining to caregiving among aging Chinese and Chinese-American (CCA) families in the United States, yet it is critical for healthy aging among CCAs. Purpose: To understand filial piety when caring for aging CCAs and conceptualize an operational definition and framework. Methods: A systematic search was conducted in CINAHL, PubMed, Scopus, and PsycINFO databases. Analysis of the concept of filial piety among CCAs used Walker and Avant's methods. Twenty-six studies were selected in the final full-text analysis. Findings: Synthesis of evidence identified four antecedents: (a) filial obligation as a 'cultural gene', (b) sense of altruism, (c) familial solidarity, and (d) societal expectation of 'birth right'. Attributes included familial material and emotional support, obedience, pious reverence, and societal norms. Consequences were related to caregiver burden, psychological and physical well-being, quality of life, and health equity. Conclusion: Filial piety is an intrinsic desire to support aging parents and an extrinsic desire to adhere to Chinese societal moral tenets. The proposed operational framework "Caregiving for aging CCAs in the United States" merits further study. Highlights: • Filial piety attributes are aging-related material and physical support from family and society. • Filial piety is associated with burden on family caregivers, psychological and physical well-being, quality of life, and health equity. • Culturally-sensitive healthcare services for aging Chinese and Chinese American individuals and families in the U.S. are hindered by lack of awareness of filial piety's effect. • Operationalizing filial piety contributes to bridging the gap in nursing knowledge and understanding of the aging needs of Chinese and Chinese Americans in the U.S. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this descriptive study is to examine a learning health system (LHS) continuous improvement and learning approach as a case for increased quality, standardized processes, redesigned workflows, and better resource utilization. Hospital acquired pressure injuries (HAPI) commonly occur in the hospitalized patient and are costly and preventable. This study examines the effect of a LHS approach to reducing HAPI within a large academic medical center. Methods: Our learning health center implemented a 6‐year series of iterative improvements that included both process and technology changes, with robust data and analytical reforms. In this descriptive, observational study, we retrospectively examined longitudinal data from April 1, 2018 to March 31, 2022, examining the variables of total number of all‐stage HAPI counts and average length of stay (ALOS). We also analyzed patient characteristics observed/expected mortality ratios, as well as total patient days, and the case‐mix index to determine whether these factors varied over the study period. We used the Agency for Healthcare Research and Quality cost estimates to identify the estimated financial benefit of HAPI reductions on an annualized basis. Results: HAPI per 1000 patient days for FY 20 (October 1‐September 30) and FY 21, decreased from 2.30 to 1.30 and annualized event AHRQ cost estimates for HAPI decreased by $4 786 980 from FY 20 to FY 21. A strong, statistically significant, negative and seemingly counterintuitive correlation was found (r = −.524, P =.003) between HAPI and ALOS. Conclusions: The LHS efforts directed toward HAPI reduction led to sustained improvements during the study period. These results demonstrate the benefits of a holistic approach to quality improvement offered by the LHS model. The LHS model goes beyond a problem‐based approach to process improvement. Rather than targeting a specific problem to solve, the LHS system creates structures that yield process improvement benefits over a continued time period. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to evaluate scientific acceptability, feasibility, utility, and value of ambulatory care nurse-sensitive quality indicators (ACNSIs) in military outpatient clinics. BACKGROUND: Optimizing healthcare quality and cost requires scientifically sound metrics. However, ACNSI development and measurement have lagged behind inpatient nurse-sensitive indicators. Validated and reliable ACNSIs are urgently needed to maximize nurses' efforts to improve healthcare quality. METHODS: Two staffing and 4 patient-centered ACNSIs were pilot tested in 5 military clinics over a 6-month period using a mixed-methods design. RESULTS: Reliability and validity were generally acceptable. Most ACNSIs demonstrated feasibility, utility, and value for performance measurement. Challenges to using ACNSIs include absence of standardized administrative and clinical processes, infrastructure, and leadership and technological support. CONCLUSIONS: These ACNSIs show promise as valid performance metrics. Provider- and nurse-level metrics may synergistically improve practice, enhancing the team approach so critical to ambulatory care. [ABSTRACT FROM AUTHOR]

Aims: The aims of this work are to (1) investigate the work environment, resilience, burnout, and turnover intention and (2) examine how work environment and personal resilience impact burnout and turnover intention among nurse leaders in the midst of the COVID‐19 crisis. Background: The COVID‐19 pandemic introduced tremendous stressors to nurse leaders, for example, managing the complex staffing situation while balancing patients' and family's needs. Methods: During May to September 2021, an electronic survey was sent out to nurse leaders in Birmingham, Alabama, USA, and surrounding areas. Results: Fifty‐six respondents were included in the study. The composite score of the work environment measure was moderately to highly related to resilience [ρ (rho) =.59] and burnout [ρ = −.63 to −.68] but had small association to intent to leave [ρ = −.30]. The resilience was highly correlated to burnout [ρ = −.53 to −.59] and moderately associated to intent to leave [ρ = −.32]. Conclusions: A better work environment for nurse leaders is related to higher resilience, lower burnout, and lower turnover intention. Resilience impacts burnout and turnover intention among nurse leaders. Implications for Nursing Management: Health care organizations and stakeholders should implement effective strategies to improve the work environment, which could lead to enhanced resilience, reduced burnout, and lower turnover intention of their nurse leaders especially during and following this pandemic. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to compare the nurse work environment, job satisfaction, and intent to leave (ITL) among military, Magnet®, Magnet-aspiring, and non-Magnet civilian hospitals. BACKGROUND: The professional nurse work environment is an important, modifiable, organizational trait associated with positive nurse and patient outcomes; creating and maintaining a favorable work environment should be imperative for nursing leaders. METHODS: Secondary data from the Army Nurse Corps and the National Database of Nursing Quality Indicators included the Practice Environment Scale of the Nursing Work Index (PES-NWI) and single-item measures of job satisfaction and ITL. RESULTS: Magnet and military hospitals had identical PES-NWI composite scores; however, statistically significant differences existed among the subscales. Military nurses were the most satisfied among all groups, although this difference was not statistically significant, yet their ITL was highest. CONCLUSIONS: Favorable work environments may exist in other organizational forms besides Magnet; however, the specific components must be considered. [ABSTRACT FROM AUTHOR]

Aim: To develop a clear definition of infertility‐related stress using Rodgers' method of concept analysis. Background: Infertility affects approximately 13% of women in the United States. Though poorly defined in the literature, previous studies suggest infertility‐related stressors contribute to psychological distress. Design: Rodgers' method of concept analysis guided the review, including sample and setting, literature search, and data analysis. Data Source: PubMed, CINAHL, and PsycINFO were searched for relevant literature. Review Methods: Following abstract, title, and text screenings, 21 articles were included and reported using the PRISMA‐S checklist. Texts were analyzed and results informed the proposed definition of infertility‐related stress. Results: Antecedents included infertility, desire for children, and fear of the unknown. Attributes were identity crisis, social isolation and stigma, sexual stress, and financial strain. Consequences included treatment dropout and marital strain. Anxiety, depression, and decreased quality of life were identified as both attributes and consequences. Conclusions: Synthesized results informed a proposed definition of infertility‐related stress. Improved understanding of infertility‐related stress allows for measurement development and facilitates recognition of patients in need of additional support, while potentially reducing the impact on the health and well‐being of infertile women. [ABSTRACT FROM AUTHOR]

Background: Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled workforce, including nurses. Out-migration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building. This critical review aimed to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Jamaica and to formulate hypotheses about potential mitigating strategies. Methods: A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Grant and Booth's methodologic framework for critical reviews was used to evaluate the literature. This methodology uses a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model and the Model of Sustainability in Global Nursing. Results: Data from 14 articles were extracted and mapped. Poorer patient outcomes were in part attributed to the out-migration of the most skilled nurses. 'Push-factors' such as aggressive recruitment by wealthier countries, lack of continuing educational opportunities, disparate wages, and a lack of professional autonomy and respect were clear contributors. Gender inequalities negatively impacted females and children left behind. Poor working conditions were not necessarily a primary reason for nurse migration. Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from CARICOM by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation strategies. Thirteen articles suggested education, partnerships, policy, and incentives as mitigation strategies. Those strategies directly align with the WHO Public Health Model drivers to palliative care integration. Conclusion: Emerged evidence supports that nurse migration is an ongoing phenomenon that strains health systems in Caribbean Community and Common Market (CARICOM) countries, with Jamaica being deeply impacted. This critical review demonstrates the importance of strategically addressing nurse migration as part of palliative care integration efforts in Jamaica. Future studies should include targeted migration mitigation interventions and should be guided by the three working hypotheses derived from this review. [ABSTRACT FROM AUTHOR]

Aim: To provide an analysis of the concept of medication errors that occur during the nursing task of medication administration. Background: Medication errors occurring during medication administration have an increased risk for an adverse patient outcome. Many terms are associated with medication errors, with limited clarification for a medication administration error at the point of care delivery. Data Sources: Twenty‐seven sources were chosen from database searches of PubMed, CINAHL, EMBASE, and Scopus. Key search terms used to narrow the search consist of the following terminology: ("bedside" OR "point‐of‐care" OR "nursing care*") AND "medication administration errors" AND ("acute care"). Review Methods: Rodger's evolutionary method of concept analysis was used to clarify the concept of medication administration error. Results: The concept analysis identified three attributes of a medication administration error: nurse‐provided care, administration, and point of care. Antecedents identified in the analysis are organizational factors and nurse factors. Consequences identified in the analysis are patient, nurse and organizational themes. Conclusion: The continued occurrence of medication administration errors warrants the need for an investigation into existing safety measures. Using this concept analysis may help guide the study of the healthcare environment and determine empirical measures to assess the impact that a medication administration error has. [ABSTRACT FROM AUTHOR]

Background: Suicide is now the 10th leading cause of death in the United States. Suicide rates for health care providers are thought to be higher than for people in other occupations because of job strain and burn- out. Despite the National Academy of Medicine's Action Collaborative on Clinician Well-Being and Resilience, which focuses on reducing stress and preventing suicide, a shortage of data limits our understanding of nurse suicide. Neither employers nor professional nursing associations track suicide data. Purpose: To determine the number of suicides and estimated rate of suicide among RNs, using data from the National Violent Death Reporting System (NVDRS). Methods: We extracted data from the NVDRS, which is based on death certificates, coroner reports, and law enforcement reports, for the year 2015. The National Institute for Occupational Safety and Health's Industry and Occupation Computerized Coding System was used to code the data. Industry and occupation coding experts reviewed the coding for accuracy. Results: Analysis of 2015 NVDRS data from 17 states showed that among civilian employed nurses ages 16 to 64 years, the estimated suicide rates for female and male nurses (11.4 and 29.3 per 100,000 nurses, respectively) were each higher than the rates for the comparable total population (8.2 and 26.1 per 100,000 people, respectively). Conclusions: Our findings indicate that RNs may die by suicide at higher rates than the total employed population in the 16-to-64-year age range. Implementation of evidence-based approaches to prevent suicide are warranted. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this dimensional concept analysis was to identify preferences for favourable nursing work environments by Baby Boomer, Generation X and Millennial nurses. Background: Favourable nursing work environments have been associated with better nurse and patient outcomes. Researchers have reported differences among generations related to the work environment, but the extent to which there are differences in preferences, not just perceptions, is less certain. Method: A dimensional concept analysis was performed, in which one concept was analysed from multiple points of view. Articles were obtained from PubMed, CINAHL and PsycINFO. Articles published in the last ten years were included if they reported preferences, desires or ideals for the nursing work environment and were categorized by generational cohort. Eight articles qualified for review. Results: Four major themes were identified: nursing practice/unit characteristics, managers/leadership, team/professional interactions and pay/benefits. An additional theme of personal/self emerged among Millennials. Conclusions: All generations reported preferences related to benefits/pay, manager/leadership, nursing practice/unit characteristics and team/interactions. Only Millennials reported aspects related to self. Implications for nursing management: All generations desired the first four themes. To address each, nursing leaders should consider the following: (a) ensure adequate staffing and resources are in place for nursing staff; (b) obtain input from all generations about their level of satisfaction with benefits/pay and examine ways to provide better benefits or pay when possible; (c) encourage leadership self‐development, such as educational opportunities and mentorship; and (d) determine opportunities to improve interactions among staff members. For Millennials, the only group who had expectations in the area of 'self', provide individualized attention and opportunities that allow them to create a better work–life balance, such as self‐scheduling. [ABSTRACT FROM AUTHOR]

Introduction: It is critical for the U.S. Army Medical Department to acknowledge the distinctive medical needs of soldiers and conceptualize soldier-centered care as a unique concept. In addition to the nationally recognized standards of patient-centered care, soldier-centered care includes provisions for the priorities of soldier health and wellness, injury prevention, illness and injury management, and the preservation of physical performance and medical readiness. The development of soldier-centered care as a distinctive concept may strengthen the evidence base for interventions that support improvements to soldier care and thus, enhance health outcomes specific to soldiers. The purpose of this article is to analyze the concept of soldier-centered care, clarify the meaning of soldier-centered care, and propose a theoretical definition.Methods: Rodgers' evolutionary concept analysis method was used to search and analyze the literature for related terms, attributes, antecedents, and consequences and to create a theoretical definition for soldier-centered care.Results: The results of this concept analysis indicated that soldier-centered care is realized through the presence of nine attributes: operational alignment of care, provider and support staff therapeutic competence, management of transitions and care coordination, technology and accessibility, management of limited and lost work days, trust and expectation management, leadership support, continuity, and access to care. Soldier-centered care is focused on health and wellness promotion, disease and injury prevention, and early diagnosis and treatment of acute injuries in the primary care setting to facilitate timely injury recovery, reduce reinjury, and prevent long-term disabilities. The result of soldier-centered care is enhanced physical performance, medical readiness, and deployability for soldiers. Based on the literature analysis, the following theoretical definition of soldier-centered care is proposed: Soldier-centered care is individualized, comprehensive healthcare tailored to the soldier's unique medical needs delivered by a care team of competent primary care providers and support staff who prioritize trust and expectation management, operational alignment of care, leadership support, care coordination, and the management of limited and lost workdays through the use of evidence-based practice approaches that employ innovative information technology to balance access to care and continuity.Conclusions: The concept of soldier-centered care often emerges in discussions about optimal physical performance and medical readiness for soldiers. Although soldier-centered care and patient-centered care have similar conceptual underpinning, it is important to clarify the unique physical and medical requirements for soldiers that differentiate soldier-centered care from patient-centered care. Implementing the defining attributes of soldier-centered care in the U.S. Army primary care setting may improve the quality of care and health outcomes for soldiers. When defining performance metrics for primary care models of care, the U.S. Army Medical Department must consider assessing outcomes specific to the soldier population. Developing empirical indicators for the attributes of soldier-centered care will support meaningful testing of the concept. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to describe the concept added sugar in the context of type 2 diabetes (T2D) risk in adults. Background: Dietary added sugars are associated with a greater risk for T2D; however, it is unclear if added sugars influence T2D risk directly or if their effects are mediated by excess caloric intake and weight gain. Design: A principle‐based concept analysis following the PRISMA guidelines was conducted to clarify the concept of added sugar. A systematic search was conducted using PubMed and Embase. Multidisciplinary, empirical evidence was appraised using four guiding principles outlined by the principle‐based concept analysis method. Results: Thirty‐five publications were included in this concept analysis. The concept, added sugar in the context of T2D risk, was found to be epistemologically immature and lacked conceptual clarity. Conclusions: Added sugar is an immature concept warranting further refinement for conceptual advancement. To enhance conceptual clarity, the term "added sugar" should be used consistently in the scientific literature when discussing foods or beverages containing added sugars or caloric sweeteners. A clearer delineation of added sugar and its association with T2D risk in adults is critical to advance this concept within the scientific literature. [ABSTRACT FROM AUTHOR]

Heart failure is a common, complex, and costly condition accompanied by a high degree of symptom burden. The concept of heart failure symptom burden has been used and measured inconsistently in research. To develop effective symptom management and palliation strategies, a clear conceptual understanding is needed. Rodgers' evolutionary method of concept analysis was used to identify articles in CINAHL, Embase, Scopus, and PubMed focused on chronic heart failure. Analysis of 20 articles revealed key attributes (subjectivity, negative impact on daily life and/or overall functioning, synergistic symptom associations, and symptom exacerbation), related terms (symptom distress and symptom experience), a surrogate term (heart failure burden), antecedents (heart failure classification or stage), and consequences (increased morbidity/mortality, decreased functioning, increased symptom prevalence/severity, decreased quality of life, and recurrent hospital admissions). No gold standard for measurement was identified. Research is needed to validate heart failure symptom burden measurement strategies across populations. [ABSTRACT FROM AUTHOR]

Adolescent sexual health education is a complex concept with multiple dimensions. Approximately 95% of adolescents report receiving sexual health education before graduating high school but the concept of adolescent sexual health has not been defined and consistently used in research. The dimensional analysis method of concept analysis was used to uncover the key dimensions that comprise adolescent sexual health education. The dimensions discussed in this analysis are (a) educational content, (b) length of intervention, (c) curriculum timing, (d) delivery of content, and (e) measurable outcomes. From the studies in this analysis, educational content was the most discussed dimension. Length of intervention and measurable outcomes were the most variable dimensions where standardization could have the greatest effect. Reporting sexual health education interventions using these five dimensions will reduce difficulty in comparing and evaluating studies. Using these dimensions to standardize reporting, will help researchers uncover the most effective sexual health education programs. Once the most effective programs are uncovered, they can be replicated nationwide to improve adolescent sexual health outcomes. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. OBJECTIVE AND BACKGROUND: To improve leadership competency, academic and clinical partners planned and implemented a 2-day facilitated workshop that actively engaged nurse leaders in preparing for their current and future careers by focusing on "The Leader Within." We anticipated that an emphasis on this particular dimension of leadership, that is, knowing oneself, would lead to improvements in the science and the art of leadership among nurse managers (NMs) and assistant NMs (ANMs). METHODS: Using the Nurse Manager Skills Inventory (NMSI), we conducted precompetency and 8-month postcompetency surveys and interviews. Although 41 nurses completed the pretest, only 17 completed the posttest. RESULTS: The sample of 50% NMs and 50% ANMs had an average age of 38.4 (SD, 8.2) years' and 8.2 (SD, 6.3) years' experience. Self-rated leadership competency scores were improved at the 8-month posttest period on all NMSI sections: the Science, the Art, and the Leader Within. CONCLUSIONS: Actively cultivating "The Leader Within" facilitates reflective practice that may lead to more deliberate leadership competency attainment and career planning. [ABSTRACT FROM AUTHOR]

Military children make tremendous sacrifices in support of a parent(s) military service. More than two million children have a parent who is serving or has served in the Armed Forces. Research shows that military-connected children are at higher risk of physical, psychological, and behavioral health issues. While "resilient" is the word used to describe most military children, it is important to recognize the stresses/stressors of military life-- that military children serve too--to support and care for them. [ABSTRACT FROM AUTHOR]

Aims To examine how the Conservation of Resources theory explains burnout in the nursing profession. Background Burnout, which is an accumulation of work-related mental stress in people-oriented occupations, has been an issue of concern for decades for healthcare workers, especially nurses. Yet, few studies have examined a unified theory that explains the aetiology, progression and consequences of nurse burnout. Design This discussion article integrates current knowledge on nurse burnout using Conservation of Resources theory, which focuses on four resources (i.e., objects, conditions, personal characteristics and energy). Data sources The databases that were used in this study included CINAHL, PubMed and Psyc INFO. All reviewed articles were published between January 2006 - June 2016. Findings The Conservation of Resources theory explains that burnout will occur as a result of perceived or actual loss of these four resources. Furthermore, nurse burnout could affect work performance, leading to lower alertness and overall quality of care. Implications for nursing Healthcare organizations and nursing administration should develop strategies to protect nurses from the threat of resource loss to decrease nurse burnout, which may improve nurse and patient safety. The Conservation of Resources theory can guide interventions to decrease burnout and future research that examines the relationship between professional nurse burnout and patient safety. Conclusion The Conservation of Resources theory explains the aetiology, progression and consequences of nurse burnout. Future studies must explore whether nurse performance is a mediating factor between nurse burnout and patient safety. [ABSTRACT FROM AUTHOR]

AIM To report an analysis of the concept of value of nursing care. BACKGROUND Value-based health care delivery and reimbursement models are focused on value as a product of quality and cost. Nursing care provides tangible and intangible contributions to patient and organizational outcomes. The nursing profession must be able to proactively and effectively communicate the value of nursing care. DESIGN Concept analysis. DATA SOURCES Thirty-five separate sources were chosen from database searches of CINAHL Complete and ABI/INFORM Complete. Key terms utilized for the search were 'nursing value' OR 'nursing care value' OR 'value of nursing'. METHODS Caron and Bowers' (2000) dimensional analysis method was used as a guide for the project. RESULTS Dimensions identified from this concept analysis included: (a) economic, (b) relational, and (c) societal. CONCLUSION Direct care nurses experience the relational and societal dimensions of the value of nursing care. Patients and/or families experience the relational dimension of value in nursing care. Health care administrators, third-party payers, and nurse researchers interpret value from the economic dimension. Future nursing research should better quantify the economic value of nursing care. Qualitative research which focuses on how patients and families experience the value of nursing care would also contribute to further refinement of this concept. [ABSTRACT FROM AUTHOR]

Objectives The Practice Environment Scale of the Nursing Work Index (PES-NWI) is an instrument, which measures the nursing practice environment – defined as factors that enhance or attenuate a nurse’s ability to practice nursing skillfully and deliver high quality care. The purpose of this paper is to provide an updated review of the Practice Environment Scale of the Nursing Work Index’s use to date and provide recommendations that may be helpful to nursing leaders and researchers who plan to use this instrument. Design A narrative review of quantitative studies. Data sources PubMed, EMBASE, and the Cumulative Index to Nursing & Allied Health Literature were searched to identify relevant literature using the search terms, Practice Environment Scale of the Nursing Work Index and PES-NWI . Review methods Studies were included if they were published in English between 2010 and 2016 and focused on the relationship between the Practice Environment Scale of the Nursing Work Index and patient, nurse, or organizational outcomes. Data extraction focused on the reported survey scores and the significance and strength of the reported associations. Results Forty-six articles, from 28 countries, were included in this review. The majority reported significant findings between the nursing practice environment and outcomes. Although some modifications have been made, the instrument has remained primarily unchanged since its development. Most often, the scores regarding staffing and resource adequacy remained the lowest. Conclusion The frequency of use of this instrument has remained high. Many researchers advocate for a move beyond the study of the connection between the Practice Environment Scale and nurse, patient, and organizational outcomes. Research should shift toward identifying interventions that improve the environment in which nurses practice and determining if changing the environment results in improved care quality. [ABSTRACT FROM AUTHOR]

Handoff communication deficiencies between the emergency department (ED) and primary care have been recognized as the result of delays and/or omissions in follow-up care for patients. This quality improvement project addresses the gaps in follow-up care for patients with low-risk chest pain by implementing an electronic Emergency Provider Written Plan of Discharge (eEPWPD) template to notify primary care providers (PCPs) that follow-up care is needed for their patients. This retrospective study evaluated effectiveness of the template in providing additional diagnostic and follow-up care. Results indicated that following the implementation of the eEPWPD template, follow-up for this population increased significantly. This study provides evidence that standardizing handoff communication from the ED to PCP can improve the quality of patient care by ensuring timely diagnostic and follow-up care. [ABSTRACT FROM AUTHOR]

The article describes the Military Nursing Outcomes Database (MilNOD), a research project that investigated the effects of staffing levels on patient outcomes. The MilNOD project demonstrates that inadequately staffed shifts can increase the likelihood of adverse events, such as falls with injury, medication errors, and injuries to nurses. Nurses strive to deliver the best care possible therefore attention must be paid to nurse staffing to provide a safe and healthy environment for patients.

The article notes that charge nurses have leadership potential that can be developed for future advanced leadership positions in healthcare organizations. It describes a study that examined the challenges facing charge nurses, keys to effective charge nurse performance and strategies to help practice leaders and educators prepare charge nurses for their roles and future development. It identified four key challenges facing charge nurses: managing staff performance, role clarity, powerlessness regarding system complexity, and lack of leadership support. Solutions to these challenges include formal educational opportunities to learn the charge nurse role and manage staff performance and develop better communication skills, as well as the availability of strong leadership support.

The article discusses how to incorporate quality and safety education into a nursing administration graduate program. The Institute of Medicine (IOM) recommends a more visible role for nurse leaders in organizational and systems quality and safety efforts and therefore nurse leaders needs must educationally prepared to meet this goal. The Quality and Safety Education for Nursing (QSEN) developed competencies for nurse leaders. The redesigned nursing curriculum aims to teach human resource management, project management and financial skills to nurse leaders. Along with this requisite knowledge, skills and attitudes (KSAs) for 6 QSEN competencies is a must for nurse leaders. This will allow nurse leaders to build better work environments with emphasis on quality and safety.

Purpose: The primary purpose of this study was to examine the nursing practice environment and burnout of nursing personnel assigned to a deployed combat support hospital (CSH). A secondary aim was to compare differences in the level of burnout between the deployed Army nursing personnel and Army nursing personnel assigned to an Army hospital in the United States that served as the U.S. military's primary referral center for American combat casualties evacuated from Iraq. Design: A nonexperimental cross-sectional design was used for this study. Methods: The Maslach Burnout Inventory and the Practice Environment Scale were administered to 105 personnel who deployed with a CSH to Iraq. Data from this study were linked to data obtained from 152 nursing personnel who participated in an earlier burnout study at a large Army hospital in the United States. The linked datasets yielded a final sample of 257 Army nursing personnel. Analysis of variance and linear regression analysis were used to analyze these data. Findings: Emotional exhaustion was common across groups. For the deployed nursing personnel, emotional exhaustion was related to a perceived lack of support from management, foundations for quality of care, collegial relationships, and extended work schedules. The U.S.-based Army hospital group scored significantly higher emotional exhaustion, but it was related to the additional responsibilities associated with being an Army nurse, working extended schedules, and working with combat casualties for extended periods of time. The U.S.-based group perceived more personal accomplishment from the work they do. Conclusions: Burnout was common across Army hospital settings. Emotional exhaustion was most problematic in the U.S.-based Army hospital; however, there was less cynicism toward patients and a greater perception of personal accomplishment associated with work. Clinical Relevance: This study supports the importance of a professional practice environment for Army nursing personnel both during deployment and in U.S.-based Army hospitals. Journal of Nursing Scholarship, 2011; XX:X, XXX-XXX. ©2011 Sigma Theta Tau International. [ABSTRACT FROM AUTHOR]

In this intervention study, the researchers assessed the knowledge of and health beliefs regarding testicular cancer and testicular self-examination (TSE) in active duty Army Soldiers. [ABSTRACT FROM AUTHOR]

The article discusses a study to determine the relationship between nurse staffing and adverse patient events at the shift level including falls, falls with injury and medication administration errors (MAE). The research team used a Military Nursing Outcomes Database (MilNOD) created from thirteen military hospitals to monitor nurse staffing, patient falls and medication errors, and other outcomes while using Bayesian hierarchical logistic regression modeling to determine associations between staffing and adverse events. Results indicated that the skill mix of registered nurses (RNs), total nursing care hours, and experience, measured by a proxy variable, were directly related to shift-level adverse events.

Reports on the initiative of Ontario Canada to raise the standards of basic nursing education. Implication of the change to nursing practice in the United States; Requisite of a bachelor degree for nursing registration; Implications of the nursing education pattern in the US.

OBJECTIVE: To develop a new nursing practice model for use within the US military, researchers aimed to create evidence-based recommendations for nursing leadership development based on current literature. BACKGROUND: The role of nursing leadership has many implications, including better nurse and patient outcomes. Therefore, an actionable compilation of recommendations informing how to develop effective nurse leaders could be helpful for current and aspiring nurse leaders. METHODS: Researchers conducted a systematic literature review of 5 databases searching for relevant articles published from 2001 to 2020. RESULTS: Seventy-eight articles were synthesized to develop a list of 5 broad yet actionable recommendations for leadership development. CONCLUSIONS: Leadership development is essential for current and future nurse leaders. The recommendations identified from this review can assist in developing leaders. Leaders can use these recommendations to guide leadership training initiatives, engage in self-development, or begin succession planning. [ABSTRACT FROM AUTHOR]

The article focuses on a study by V. S. Staggs and colleagues on hospital and unit characteristics associated with nursing turnover that includes skill but not staff which appeared in the 2012 issue of the periodical "Journal of the American Geriatrics Society". It mentions that nursing turnover was measured from 1884 units in 306 hospitals in National Database of Nursing Quality Indicators (NDNQI). It concluded that government ownership, unit population age resulted in less nursing turnover.

Background: Research has established a relationship between favorable nurse work environments and better nurse, patient, and organizational outcomes. However, the instrument most frequently used to measure the nurse work environment, the Practice Environment Scale of the Nursing Work Index (PES-NWI), has not had its items significantly re-evaluated since the 1980s. Objective: We sought to examine the psychometric properties of an updated PES-NWI and create an instrument suitable for further testing and refinement to measure the present-day nurse work environment. Specifically, we sought to establish construct, structural, discriminative, and concurrent validity. For reliability, we desired to establish interrater reliability and internal consistency reliability. Methods: We administered a modified PES-NWI to a national sample of direct-care hospital nurses (n = 818) in the United States. We then assessed the psychometric properties of the instrument. Results: While the modified PES-NWI displayed adequate validity and reliability properties, further testing and refinement of the instrument is necessary. Conclusions: With this updated measure of the nurse work environment, researchers and hospital leaders can identify modifiable opportunities for improvement in contemporary hospital nurse work environments which may enhance nurse and patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction More than 40,000 soldiers cannot deploy every year, which undermines readiness. The medical readiness of soldiers is a critical component of the overall operational readiness of the U.S. Army. Acute musculoskeletal injuries (MSIs) are the greatest threat to medical readiness. Medical providers place soldiers on temporary profiles to facilitate treatment and recovery of acute MSIs. Poorly managed temporary profiles negatively impact a soldier's work attendance, resulting in the loss or limitation of over 25 million workdays annually. Upgrading the electronic profile system and implementing the Army Medical Home has led to improvements in managing temporary profiles over the last decade. The Army Medical Home encompasses care delivery platforms, including the Patient-Centered Medical Home (PCMH) and Soldier-Centered Medical Home (SCMH). The structure of U.S. Army PCMHs and SCMHs differ in ways that may affect care processes and patient outcomes. Temporary profile management is an important soldier health outcome that has not been studied in relation to the U.S. Army's PCMH and SCMH structures or care processes. Access to care, continuity, and communication are three care processes that have been described as essential factors in reducing lost workdays and functional limitations in workers after an acute injury. Understanding the impact of the medical home on temporary profile days is vital to medical readiness. This study aimed to (1) compare temporary profile days between the U.S. Army PCMHs and SCMHs and (2) determine the influence of medical home structures and care processes on temporary profile days among active duty U.S. Army soldiers receiving care for MSIs. Materials and Methods This was a retrospective, cross-sectional, and correlational study guided by Donabedian's conceptual framework. We used secondary data from the Military Data Repository collected in 2018. The sample included 27,214 temporary profile records of active duty U.S. Army soldiers and 266 U.S. Army PCMH and SCMH teams. We evaluated bivariate and multivariate associations between outcomes and predictors using general and generalized linear mixed regression models. The U.S. Army Medical Department Center and School Institutional Review Board approved this study. Results Total temporary profile days ranged from 1 to 357, with a mean of 37 days (95% CI [36.2, 37.0]). There was a significant difference in mean temporary profile days between PCMHs (43) and SCMHs (35) (P  < 0.001). Soldiers in PCMHs were more likely to have temporary profiles over 90 days (OR = 1.54, 95% CI [1.17, 2.03]). Soldiers in the heavy physical demand category had fewer temporary profile days (P  < 0.001) than those in the moderate physical demand category. Age, sex, rank level, physical demand category, profile severity, medical home type, the "explain things" communication subscale, and primary care manager continuity were significant predictors of temporary profile days. Conclusions Excessive temporary profile days threaten medical readiness and overall soldier health. Aspects of the medical home structure and care processes were predictors of temporary profile days for musculoskeletal conditions. This work supports continued efforts to improve MSI-related outcomes among soldiers. Knowledge gained from this study can guide future research questions and help the U.S. Army better meet soldier needs. [ABSTRACT FROM AUTHOR]

Introduction Over the last 40 years, patient-centered medical home (PCMH) has evolved as the leading primary care practice model, replacing traditional primary care models in the United States and internationally. The goal of PCMH is to improve chronic condition management. In the U.S. Army, the scope of the medical home, which encompasses various care delivery platforms, including PCMH and soldier-centered medical home (SCMH), extends beyond the management of chronic illnesses. These medical home platforms are designed to support the unique health care needs of the U.S. Army's most vital asset—the soldier. The PCMHs and SCMHs within the U.S. Army employ patient-centered care principles while incorporating nationally recognized structural attributes and care processes that work together in a complex adaptive system to improve organizational and patient outcomes. However, U.S. Army policies dictate differences in the structures of PCMHs and SCMHs. Researchers suggest that differences in medical home structures can impact how organizations operationalize care processes, leading to unwanted variance in organizational and patient outcomes. This study aimed to compare 3 care processes (access to care, primary care manager continuity, and patient-centered communication) between PCMHs and SCMHs. Materials and Methods This was a retrospective, cross-sectional, and correlational study. We used a subset of data from the Military Data Repository collected between January 1, 2018, and December 31, 2018. The sample included 266 medical home teams providing care for active duty soldiers. Only active duty soldiers were included in the sample. We reviewed current U.S. Army Medical Department policies to describe the structures and operational functioning of PCMHs and SCMHs. General linear mixed regressions were used to evaluate the associations between medical home type and outcome measures. The U.S. Army Medical Department Center and School Institutional Review Board approved this study. Results There was no significant difference in access to 24-hour and future appointments or soldiers' perception of access between PCMHs and SCMHs. There was no significant difference in primary care manager continuity. There was a significant difference in medical home team continuity (P  < .001), with SCMHs performing better. There was no significant difference in patient-centered communication scores. Our analysis showed that while the PCMH and SCMH models were designed to improve primary care manager continuity, access to care, and communication, medical home teams within the U.S. Army are not consistently meeting the Military Health System standard of care benchmarks for these care processes. Conclusions Our findings comparing 3 critical medical home care processes suggest that structural differences may impact continuity but not access to care or communication. There is an opportunity to further explore and improve access to appointments within 24 hours, primary care manager and medical home team continuity, perception of access to care, and the quality of patient-centered communication among soldiers. Knowledge gained from this study is essential to soldier medical readiness. [ABSTRACT FROM AUTHOR]

Goal: The purpose of this study was to examine nurse staffing while describing the relationships that exist in staffing and quality associated with nursing care during the COVID-19 pandemic, a significantly challenging time for nurse staffing. We examined the relationship between permanent registered nurse (RN) and travel RN staffing during the pandemic and the nursing-sensitive outcomes of catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), falls, and hospital-acquired pressure injuries (HAPIs) and length of stay and compared the cost of CAUTIs, CLABSIs, falls, and HAPIs in fiscal years 2021 and 2022. Methods: We used a descriptive, observational design to retrospectively examine permanent nurse staffing volume and CAUTI, CLABSI, HAPI, and fall counts from October 1, 2019, to February 28, 2022, and travel nurse volume for the most current 12 months, April 1, 2021, to March 31, 2022. Descriptive statistics, Pearson correlation, and statistical process control analyses were completed. Principal Findings: Pearson correlation showed a statistically significant, moderately strong negative correlation (r = −0.568, p =.001) between the active registered nurse full-time equivalents (RN FTEs) and average length of stay (ALOS), and a moderately strong positive correlation (r = 0.688, p =.013) between the travel RN FTEs and ALOS. Pearson correlations were not statistically significant, with low to moderate negative correlations for CAUTIs (r = −0.052, p =.786), CLABSIs (r = −0.207, p =.273), and falls (r = −0.056, p =.769). Pearson correlation for active RN and HAPI showed a moderately strong, statistically significant positive correlation (r = 0.499, p =.003). We observed common cause variation in CAUTIs and CLABSIs, with HAPIs and falls showing special cause variation via statistical process control. Practical Applications: Despite the challenges associated with the lack of available nurse staffing accompanied by increasing responsibilities including unlicensed tasks, positive clinical outcomes can be maintained by staff adherence to evidence-based quality improvement. [ABSTRACT FROM AUTHOR]

Goal: Span of control is a multidimensional concept requiring a comprehensive definition that captures the complexities of the nurse manager's role in acute care settings. This concept analysis aimed to identify factors associated with span of control and provide a comprehensive definition outlining the breadth of this concept. Methods: ProQuest, PubMed, and Scopus databases were used to search peer-reviewed literature addressing the span of control in acute care nurse management. The search produced 185 articles; 177 titles and abstracts were screened for eligibility. Data from 22 articles were included in this analysis. Principal Findings: This analysis includes antecedents, attributes, and consequences of expanded nurse manager spans of control. Work-related factors such as staff and manager experience levels, work complexity, and patient acuity are attributes of a nurse manager's span of control. Our findings suggest that expanded spans of control can have negative consequences on nurse managers such as role overload and burnout. Low satisfaction among staff and patients can result from excessive spans of control. Practical Implications: An awareness of span of control can promote sustainable nursing practices by improving workplace conditions, staff satisfaction, and patient care quality. Our findings may translate across other health disciplines and thus contribute to scientific knowledge that can support changes in job designs and encourage more manageable workloads. [ABSTRACT FROM AUTHOR]

Introduction: Nursing‐sensitive indicators (NSIs) measure factors influencing nursing care quality and patient outcomes. Established NSIs reflect general and select specialty nursing practices. However, a core set of NSIs for international pediatric oncology nursing practice does not currently exist. Without valid and reliable quality indicators, the impact of nursing care on children and adolescents with cancer cannot be effectively measured and improved. The purpose of this study was to develop a preliminary core set of NSIs for international pediatric oncology nursing that would be important, actionable, and feasible to measure across varied resource settings and countries. Design/Methods: A multiphase sequential mixed methods research design, intersected with a classical Delphi method, was utilized. Through purposive snowball sampling, 122 expert pediatric oncology nurses from 43 countries participated. Round One: Panelists identified five potential NSIs and constructs. Open‐ended responses were coded and categorized through descriptive content analysis and integrated into the next round. Round Two: Panelists selected their top 10 NSIs and constructs and ranked them by importance to patient care quality. Mean importance scores were calculated through reverse scoring; the top 10 NSIs and constructs were integrated into the next round. Round Three: Panelists ranked the top 10 NSIs and constructs by order of importance for this particular population, then rated each NSI/Construct for actionability and feasibility of measurement by Likert‐scale. Rounds Two and Three were analyzed using descriptive statistics. Mixed methods meta‐inferences were derived from the integration of Rounds One and Three findings. Results: Eighty‐five (70%) panelists from 38 countries completed all Delphi survey rounds. The preliminary core set of NSIs and constructs identified by the expert panel, and ranked in order of importance, were as follows: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. All NSIs and constructs were rated as actionable; all but palliative/end of life care were rated as feasible to measure. Each of the 10 NSIs and constructs were nominated in Round One by at least one expert panelist from low‐ and middle‐income and high‐income countries, and at least one panelist from the Americas. Conclusion: Preliminary core NSIs and constructs provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement. Clinical Relevance: NSIs have the potential to drive quality improvement, guide comparison with other institutions, promote knowledge‐sharing, and advance pediatric oncology nursing outcomes around the world. These NSIs and constructs may also be relevant to other pediatric and adult oncology settings. [ABSTRACT FROM AUTHOR]

Background: Bullying may undermine patient safety in healthcare organizations threatening quality improvement and patient outcomes. Purpose: To explore the associations between the nursing work environment, nurse‐reported workplace bullying, and patient outcomes. Method: Cross‐sectional analysis of nurse survey data (N = 943). The Practice Environment Scale of the nursing work index was used to measure the work environment, nurse‐reported bullying was measured with the short negative acts questionnaire, and single items measured care quality and patient safety grade. Random effects logistic regressions were used to determine associations controlling for individual, employment, and organizational factors. Findings: Fourty percent of nurses reported experiencing bullying. A higher work environment composite score was significantly associated with a lower risk of bullying (OR = 0.16 [0.12, 0.22], p <.0001). Nurses experiencing bullying were less likely to report good/excellent quality of care (OR = 0.28 [0.18, 0.44], p <.0001) or a favorable patient safety grade (OR = 0.36 [0.25, 0.51], p <.0001). Discussion: The nursing work environment influences the presence of bullying, which can negatively impact patient outcomes. Improving nurse work environments is one mechanism to better address nurse bullying. [ABSTRACT FROM AUTHOR]

Background: Pressure ulcers are associated with a nearly three-fold increase in in-hospital mortality. It is essential to investigate how other factors besides the Braden scale could enhance the prediction of pressure ulcers. Data mining modeling techniques can be beneficial to conduct this type of analysis. Data mining techniques have been applied extensively in health care, but are not widely used in nursing research. Purpose: To remedy this methodological gap, this paper will review, explain, and compare several data mining models to examine patient level factors associated with pressure ulcers based on a four year study from military hospitals in the United States. Methods: The variables included in the analysis are easily accessible demographic information and medical measurements. Logistic regression, decision trees, random forests, and multivariate adaptive regression splines were compared based on their performance and interpretability. Results: The random forests model had the highest accuracy (C-statistic) with the following variables, in order of importance, ranked highest in predicting pressure ulcers: days in the hospital, serum albumin, age, blood urea nitrogen, and total Braden score. Conclusion: Data mining, particularly, random forests are useful in predictive modeling. It is important for hospitals and health care systems to use their own data over time for pressure ulcer risk prediction, to develop risk models based upon more than the total Braden score, and specific to their patient population. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. OBJECTIVE: The aim of this study was to describe the relationships between intent to leave, reasons nurses intend to leave, and the nursing work environment in military hospitals. BACKGROUND: Intention to leave is a precursor of nurse turnover. The reasons nurses intend to leave may be influenced by leader interventions and potentially preventable. METHODS: This descriptive, correlational secondary analysis included 724 nurse survey responses from 23 US Army hospitals. Bivariate correlations and predictive modeling techniques were used. RESULTS: Forty-nine percent of nurses indicated they intended to leave, 44% for potentially preventable reasons. Dissatisfaction with management and the nursing work environment were the top potentially preventable reasons to leave. Nurses who intended to leave for potentially preventable reasons scored aspects of the nursing work environment significantly lower than those intending to leave for nonpreventable reasons. CONCLUSIONS: Identifying potentially preventable reasons in conjunction with intent to leave can provide leaders opportunities to intervene and influence turnover intention. [ABSTRACT FROM AUTHOR]

Quality improvement is paramount for patient safety. Leading change for quality improvement requires nurses with knowledge and skills beyond the clinical management of patients. In this study, staff nurses working in hospitals throughout Alabama were asked via an online survey to rate their quality improvement knowledge and skills using the new 10-item Quality Improvement Self-Efficacy Inventory (QISEI) and their perceptions of the nursing work environment using the Practice Environment Scale of the Nursing Work Index. Nurses (N = 886) rated the basic quality improvement items higher than the more advanced items. Several nurse characteristics and the nursing work environment were associated with nurses' ratings of their quality improvement knowledge and skills. Educators and administrators in health care organizations can use QISEI to gauge their nurses' knowledge and skills and then develop continuous professional development opportunities aimed at improving quality and safety competencies. [ABSTRACT FROM AUTHOR]

For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented. This article discusses causes and challenges of nurse fatigue, evidence-based strategies and solutions for individual nurses and organizations, and changes needed to transform nursing culture and workplaces into more supportive environments for nurses. [ABSTRACT FROM AUTHOR]

The issue of low response rates on nursing surveys is problematic for researchers and has implications for nurse advocates who need this information for policy changes. Data collection strategies and issues in nursing research are described. Study results based on two methodological approaches used to collect data address challenges that arose from each approach to assist researchers, healthcare leaders, and others in using a web-based survey to collect data from nurses. [ABSTRACT FROM AUTHOR]

Background: The use of blood products early in the resuscitation of bleeding trauma patients is widely accepted, but made difficult by limited supplies of D- red blood cell (RBC)-containing products. Use of D+ RBC-containing products would alleviate this issue, but could lead to alloimmunization. Risk associated with transfusing D+ RBC in emergency bleeding situations is being reconsidered. The level of concern surrounding emergency transfusion as it relates to future fetal harm was surveyed among surgeons and nurses.Methods: Faculty and staff in the Departments of Surgery and Nursing were surveyed on the risks of receiving an emergency RBC transfusion and the subsequent potential for fetal harm. Answers were grouped as likely to accept (likely/very likely) or refuse transfusion (unlikely/very unlikely). Participants were compared by sex, and women by child-bearing age, ([15-50 years] vs. [>50 years]).Results: Ninety surveys were initiated with 76 fully completed. Male (n = 39) and female (n = 37) respondents were comparable. Most female respondents (30/37, 81%) were of childbearing age. Overall, both males (38/39, 95%) and females (33/37, 89%; p = .19) were likely to accept a transfusion in an emergency. There was no difference in transfusion acceptance if the risk of fetal harm was presented as 1% (p = .73) or 0.1% (p = .51). Most females (34/37, 92%) were not opposed to transfusion even if there was an unspecified risk of future fetal harm.Conclusion: Most of the surgeons and nurses who responded would accept a transfusion in an emergency situation even if it might lead to harming a future fetus. [ABSTRACT FROM AUTHOR]

Aim: To discover the extent of and factors associated with missed nursing care in Alabama. Background: Missed nursing care is a well‐documented phenomenon. However, it has not been studied in U.S. southern states that consistently rank poorly in health outcomes, such as Alabama. Methods: The Perceived Implicit Rationing of Nursing Care Instrument was administered as part of the Alabama Hospital Staff Nurse Study. Analyses were run on 950 surveys completed by inpatient registered nurses. Results: Overall missed nursing care scores vary significantly by gender, unit type, job satisfaction and quality of nursing care. Overall missed nursing care scores are correlated with the work environment and number of patients assigned to each nurse. Unit type, quality of nursing care and the work environment are important factors associated with missed nursing care. Conclusion: The results of this study advance nursing science by adding to the growing body of knowledge surrounding missed nursing care. The results reveal opportunities where nurses may need support in their bedside practice. Implications for Nursing Management: Nursing management must monitor the nursing work environment, periodically measure missed nursing care to assess for improvement opportunities, and watch for interventions that could decrease missed nursing care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how workplace bullying influences nurses' abilities to provide patient care. Background: Nurses' experiences of workplace bullying undermine nursing work environments and potentially threaten patient care. Although there is a link between nurses' experiences of workplace bullying and poor patient care, additional exploration is necessary as current evidence remains underdeveloped and inconclusive. Design: Qualitative descriptive study. Methods: Fifteen inpatient staff nurses who have experienced workplace bullying while working in one hospital located in the southern region of the USA participated in individual, semi‐structured interviews. Inductive thematic analysis was used to analyse interview transcripts in NVivo 12 software. The COREQ checklist for qualitative studies has been used in reporting this study. Results: Three themes, and respective subthemes, were generated from data analysis: (a) workplace bullying as part of the nursing work environment, (b) workplace bullying's influence on nurses and (c) workplace bullying's influence on patient care. Workplace bullying was perceived to be inherent in the nursing work environment; nurses felt that they were targets of workplace bullying because (a) they were new nurses, (b) there was an abuse of power, or (c) the nature of the work occasioned it. Nurses were mentally and emotionally influenced by the bullying. Some nurses perceived that workplace bullying did influence their ability to provide patient care; however, others did not. Conclusions: Organisations must support new nurses and manage relational attributes of the nursing work environment to reduce workplace bullying. Nursing leaders should receive education on fostering and sustaining favourable nursing work environments and be held accountable for behavioural expectations of the organisation. Relevance to clinical practice: Understanding how nurses perceive the work environment to influence their experiences of workplace bullying informs the development of organisational interventions to reduce the behaviour. Furthermore, exploring how nurses' experiences of workplace bullying influences their abilities to provide patient care increases our understanding of workplace bullying implications. [ABSTRACT FROM AUTHOR]

Highlights • Night-shift fragmented sleep that was misaligned with temperature rhythms. • Night-shift slowed performance on cognitive proficiency tasks by the shift end. • Core body temperature of shift workers may predict cognitive performance. Abstract Circadian rhythms greatly influence 24-h variation in cognition in nearly all organisms, including humans. Circadian clock impairment and sleep disruption are detrimental to hippocampus-dependent memory and negatively influence the acquisition and recall of learned behaviors. The circadian clock can become out of sync with the environment during circadian misalignment. Shift work represents a real-world model of circadian misalignment that can be studied for its physiological implications. The present study aimed to test the hypothesis that circadian misalignment disrupts vigilance and cognitive performance on occupationally relevant tasks using shift work as a model. As such, we sought to (1) explore the general effects of night- and day-shift worker schedules on sleep-wake parameters and core body temperature (CBT) phase, and (2) determine whether shift-type and CBT phase impact cognitive performance and vigilance at the end of a 12-h shift. We observed a sample of day-shift and night-shift hospital nurses over a 10-day period. At the end of three, consecutive, 12-h shifts (7 pm–7am or 7am–7 pm), participants completed a cognitive battery assessing vigilance, cognitive throughput, and medication calculation fluency (via an investigator developed and tested metric). Night-shift nurses exhibited significantly greater sleep fragmentation as well as a greater disparity between their wake-time and time of CBT minimum compared to day-shift nurses. Night-shift nurses exhibited significantly slower cognitive proficiency at the end of their shifts, even after adjustment for CBT phase. These results suggest that circadian disruption and reduced sleep quality both contribute to cognitive functioning and performance. [ABSTRACT FROM AUTHOR]

Objective: to present the development of a toolkit for education quality improvement in universal health and primary health care, targeting schools of nursing and midwifery in Latin American and Caribbean countries. Methods: an expert work group conducted a systematic literature review, selected key content and completed toolkit drafting, using an iterative consensus approach. International partners reviewed the toolkit. Cognitive debriefing data were analyzed, revisions and new tools were integrated, and the final version was approved. Results: twenty-two articles were identified and mapped as resources. The Model for Improvement, a datadriven approach to performance analysis, was selected for its widespread use and simplicity in carrying out the following steps: 1) organize a team, 2) assess improvement need regarding universal health and primary health care education, 3) set an aim/goal and identify priorities using a matrix, 4) establish metrics, 5) identify change, 6) carry out a series of Plan-Do-Study-Act learning cycles, and 7) sustain change. Conclusions: the Education Quality Improvement Toolkit, developed through stakeholder consensus, provides a systematic, and potentially culturally adaptable approach to improve student, faculty, and program areas associated with universal health coverage and access. [ABSTRACT FROM AUTHOR]

Introduction: Currently, there are few evidence-based guidelines to inform optimal clinical data-entry template design that maximizes usability while reducing unintended consequences. This study explored the impact of data-entry template design and anesthesia provider workload on documentation accuracy, documentation efficiency, and user-satisfaction to identify the most beneficial data-entry methods for use in future documentation interface design.Methodology: A study using observational data collection and psychometric instruments (for perceived workload and user-satisfaction) was conducted at three hospitals using different methods of data-entry for perioperative documentation (auto-filling with unstructured data, computer-assisted data selection with semi-structured documentation, and paper-based documentation). Nurse anesthetists at each hospital (N = 30) were observed completing documentation on routine abdominal surgical cases.Results: Auto-filling (61.2%) had the lowest documentation accuracy scores compared to computer-assisted (81.3%) and paper-based documentation (76.2%). Computer-assisted data-entry had the best documentation efficiency scores and required the least percentage of the nurse anesthetists' time (9.65%) compared to auto-filling (11.43%) and paper-based documentation (15.23%). Paper-based documentation had the highest perceived workload scores (M = 288, SD = 88) compared to auto-filling (M = 160, SD = 93, U = 16.5, p < 0.01) and computer assisted data-entry (M = 93, SD = 50, U = 4.0, P < 0.001).Conclusions: Auto-filling with unstructured data needs to be used sparingly because of its low documentation accuracy. Computer-assisted data entry with semi-structured data needs to be further study because of its better documentation accuracy, documentation efficiency, and perceived workload. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to confirm the psychometric properties of Practice Environment Scale of the Nursing Work Index in a military population. This study also demonstrates association rule analysis, a contemporary exploratory technique. Background One of the instruments most commonly used to evaluate the nursing practice environment is the Practice Environment Scale of the Nursing Work Index. Although the instrument has been widely used, the reliability, validity and individual item function are not commonly evaluated. Gaps exist with regard to confirmatory evaluation of the subscale factors, individual item analysis and evaluation in the outpatient setting and with non-registered nursing staff. Design This was a secondary data analysis of existing survey data. Methods Multiple psychometric methods were used for this analysis using survey data collected in 2014. First, descriptive analyses were conducted, including exploration using association rules. Next, internal consistency was tested and confirmatory factor analysis was performed to test the factor structure. The specified factor structure did not hold; therefore, exploratory factor analysis was performed. Finally, item analysis was executed using item response theory. The differential item functioning technique allowed the comparison of responses by care setting and nurse type. Results The results of this study indicate that responses differ between groups and that several individual items could be removed without altering the psychometric properties of the instrument. Conclusion The instrument functions moderately well in a military population; however, researchers may want to consider nurse type and care setting during analysis to identify any meaningful variation in responses. [ABSTRACT FROM AUTHOR]