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Many countries face substantial shortages of skilled nurses. With an aging population and global demographic changes, developing a skilled workforce of nurses has become one of the central challenges for public health care. The recent COVID-19 pandemic has exacerbated labor shortages, which pose a threat to the quality of publicly provided health care. Improving nurses' working conditions could be a means by which to address the global shortages of nurses. However, in countries with public health care, such improvements may come with additional costs in the form of higher taxes or social security contributions. Therefore, such improvements partly depend on people's willingness to pay (WTP) for them. In this paper, we investigate workers' willingness to pay for improvements in the working conditions of nurses. This study is a factorial survey experiment included as part of an online survey. The factorial survey experiment was implemented within the high-frequency online panel survey "Life and Employment in Times of Corona" (IAB-HOPP) conducted by the Institute for Employment Research (Germany). We analyze data from N = 2128 survey participants; our main analysis consists of N = 6384 responses from those participants. Our research is based on a factorial survey experiment (vignette analysis) designed to quantitatively measure the willingness to pay for various improvements in the working conditions of nurses. We use random effect models and mixed models to estimate the individual-level willingness to pay for these improvements. Our results show that the survey participants are generally willing to pay for particular policies aimed at improving the working conditions of nurses. However, the amount that respondents are willing to pay varies with the type of policy changes. Survey participants exhibit a high willingness to pay for increases in minimum wages for nurses and wage-related improvements in general. We find, however, a lower willingness to pay for the right to participate in training courses aimed at reducing work-related stress. The broad support for improvements in the working conditions of nurses provides policymakers with some guidance in implementing policy measures that might address labor shortages in the nursing sector. There was no preregistration. Many people are willing to pay extra to improve the working conditions of nurses. Wage-related increases for nurses show the highest willingness to pay. [ABSTRACT FROM AUTHOR]

Background Fever phobia is a term that has been used to describe the exaggerated and unrealistic fear of fever expressed by parents and carers. Since the term was first used in the early 1980s, there have been numerous publications and guidelines’ stating that fever is not, in itself dangerous, however these fears persist. Objectives Investigate the extent of fever phobia and to explore potential associations with time, under-5 mortality rate and geography. Data sources Embase (1980 to week 1 2015) and Medline (1946 to week 1 2015) were searched using the terms ‘fever’ and ‘phobia’; and ‘fever phobia’ as a free text term. One additional paper was published during the review period. Study eligibility criteria Studies giving proportion of parents, carers or professionals expressing fear of fever. Study appraisal and synthesis methods Meta-analysis and cluster analysis using metafor, meta and Cluster in R. Results Fear of brain damage, coma, convulsions, death and dehydration was high across many of the studies; however there was significant variation as shown by the high I 2 scores which exceeded 95%. This was not explained by the two predictive variables of year of publication, or background mortality apart from a reduction in the fear of brain damage (−0.0185, CI −0.0313 to −0.0057, p = 0.0046) and dehydration (−0.0831, −0.1477 to −0.0184, p = 0.0118) associated with increased child mortality. Limitations Studies were all cross-sectional surveys with a high risk of bias. The pooled estimate, although statistically significant is not the outcome of interest and so should be interpreted with caution. Conclusions and implications Fever phobia is common and has not significantly declined over time. This may suggest that it is a cultural, rather than individually learned trait and that individual educational programmes are unlikely to be successful in the face of widespread cultural transmission. [ABSTRACT FROM AUTHOR]

Background Nurses are often portrayed as possessing specific traits and dispositions associated with care and empathy. The assumption has been that possessing these traits makes nurses competent, engaged, and well suited to their job. This proposition has been mostly normative, and few studies have investigated how this plays out empirically. Objective The aims of this study were to investigate (a) whether possessing a personality trait related to empathy and care was more common among nursing students than students in teaching and social work programs and (b) whether nursing students possessing an affirming personality trait judged themselves to be more suited to their future work – understood as commitment to the profession – than students in teaching and social work. Design A cross-sectional survey design was used. Participants and setting All first-year students attending seven Norwegian universities and university colleges were invited to participate in the study. Of the 1675 students who participated in the survey, 527 were nursing students, 668 were students in teaching, and 480 were social work students. A response rate of 65 percent was achieved. Methods The survey was conducted by Oslo and Akershus University College in the autumn of 2012. Data collection methods included both a paper-and-pencil questionnaire and an online survey. Instruments used included Blau's Career Commitment Scale and Orlinsky and Rønnestad's Interpersonal Adjective Scale. Analysis of variance and regression analysis were performed on the data. Results Nursing students did not differ from students in teaching and social work programs in terms of the degree of affirming personality trait. Furthermore, the regression analysis revealed an equally strong association between having an affirming personality trait and being committed to the profession among all these student groups. Conclusion The results of this study indicate that the narrative of nursing students as individuals who possess a special personality characteristic does not entirely reflect reality. [ABSTRACT FROM AUTHOR]

Background Venous leg ulcer management in the UK varies significantly. Judgements made by nurses contribute to this variability and it is often assumed that specialist nurses make better judgements than non-specialist nurses. This paper compares the judgements of community tissue viability specialist nurses and community generalist nurses; specifically, the ways they use clinical information and their levels of accuracy. Objectives To compare specialist and non-specialist UK community nurses’ clinical information use when managing venous leg ulceration and their levels of accuracy when making diagnoses and judging the need for treatment. Design Judgement analysis. Setting UK community and primary care nursing services. Participants 18 community generalist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses. Methods Data were collected in 2011 and 2012. 18 community generalist nurses and 18 community tissue viability specialist nurses made diagnostic and treatment judgements on 110 clinical scenarios and indicated their confidence in each of their judgements. Scenarios were generated from real patient cases and presented online using text and photographs. An expert panel made judgements, and reached consensus on the same scenarios. These judgements were used as a standard against which to compare the participants. Logistic regression models and correlational statistics were used to generate various indices of judgement “performance”: accuracy, consistency, confidence calibration and information use. Differences between groups of nurses with different levels of characteristics linked to expertise were explored using analysis of variance. Results Specialist nurses had similar cue usage to the generalist nurses but were more accurate when making diagnostic and treatment judgements. Conclusion It is not obvious why the tissue viability specialist nurses were more accurate. One possible reason might be the greater opportunities for ‘deliberate practice’ afforded to specialists. However, restricting aspects of practice only to specialist nurses is likely to hinder the judgement performance of generalists. [ABSTRACT FROM AUTHOR]

Background: Quality improvement (QI) Programmes, like the Productive Ward: Releasing-time-to-care initiative, aim to 'engage' and 'empower' ward teams to actively participate, innovate and lead quality improvement at the front line. However, little is known about the relationship and impact that QI work has on the 'engagement' of the clinical teams who participate and vice-versa. Objective: This paper explores and examines the impact of a large-scale QI programme, the Productive Ward, on the 'work engagement' of the nurses and ward teams involved. Design/methods: Using the Utrecht Work Engagement Scale (UWES), we surveyed, measured and analysed work engagement in a representative test group of hospital-based ward teams who had recently commenced the latest phase of the national 'Productive Ward' initiative in Ireland and compared them to a control group of similar size and matched (as far as ispossible) on variables such as ward size, employment grade and clinical specialty area. Results: 338 individual datasets were recorded, n = 180 (53.6%) from the Productive Ward group, and n = 158 (46.4%) from the control group; the overall response rate was 67%, and did not differ significantly between the Productive Ward and control groups. The work engagement mean score (±standard deviation) in the Productive group was 4.33 (±0.88), and 4.07 (± 1.06) in the control group, representing a modest but statistically significant between-group difference (p = 0.013, independent samples t-test). Similarly modest differences were observed in all three dimensions of the work engagement construct. Employment grade and the clinical specialty area were also significantly related to the work engagement score (p < 0.001, general linear model) and (for the most part), to its components, with both clerical and nurse manager grades, and the elderly specialist areas, exhibiting substantially higher scores. Conclusions: The findings demonstrate how QI activities, like those integral to the Productive Ward programme, appear to positively impact on the work engagement (the vigour, absorption and dedication) of ward-based teams. The use and suitability of the UWES as an appropriate measure of 'engagement' in QI interventions was confirmed. The engagement of nurses and front-line clinical teams is a major component of creating, developing and sustaining a culture of improvement. [ABSTRACT FROM AUTHOR]

Background: The nature of end-stage renal disease and the need for continuous ambulatory peritoneal dialysis require patients to manage various aspects of the disease, its symptoms and treatment. After attending a training programme, patients are expected to adhere to the renal therapeutic regimen and manage their disease with the knowledge and skills learned. While patients are the stakeholders of their health and related behaviour, their perceptions of adherence and how they adhere to their renal therapeutic regimen remains unexplored. Aims: To understand adherence from patients' perspectives and to describe changes in adherence to a therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis. Design: This study used a mixed methods design with two phases - a survey in phase I and semi-structured interviews in phase II. This paper presents phase II of the study. Settings: The study was conducted at a renal unit of an acute hospital in Hong Kong. Participants: Based on the phase I survey results, maximum variation sampling was employed to purposively recruit 36 participants of different genders (18 males, 18 females), ages (35-76 years), and lengths of dialysis experience (11-103 months) for the phase II interviews. Methods: Data were collected by tape-recorded semi-structured interviews. Content analysis was employed to analyse the transcribed data. Data collection and analysis were conducted simultaneously. Findings: Adherence was a dynamic process with three stages. At the stage of initial adherence, participants attempted to follow instructions but found that strict persistent adherence was impossible. After the first 2-6 months of dialysis, participants entered the stage of subsequent adherence, when they adopted selective adherence through experimenting, monitoring and making continuous adjustments. The stage of long-term adherence commenced after 3-5 years of dialysis, when participants were able to assimilate the modified therapeutic regimen into everyday life. Conclusions: The process of adherence was dynamic as there were fluctuations at each stage of the participants' adherence. With reference to each stage identified, nursing interventions can be developed to help patients achieve smooth transition throughout all the stages. [ABSTRACT FROM AUTHOR]

Background: The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. Work-family conflict is a known risk factor for turnover and sickness absence. Objective: This paper empirically examines whether the nurse practice environment is associated with experienced work-family conflict. Design: A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analyzed here is based on a national sample of 8356 female and 592 male RNs from 369 hospital departments. Results: We found that 6% of the variability in work-family conflict experienced by RNs was at the department level. Organizational level factors significantly accounted for most of the variability at this level with two of the work practice environment factors examined, staffing adequacy and nurse involvement in hospital affairs, significantly related to work- family conflict. Due to the design of the study, factors on ward and work group levels could not be analyzed, but are likely to account for additional variance which in the present analysis appears to be on the individual level, with private life factors likely explaining another major part. Conclusion: These results suggest that higher level organizational factors in health care have a significant impact on the risk of work-family conflict among RNs through their impact on the nurse practice environment. Lower level organizational factors should be investigated in future studies using hierarchical multilevel sampling. [ABSTRACT FROM AUTHOR]

Background: Anti-embolism stockings are commonly used worldwide to prevent the development of thrombosis in hospitalised patients. Patients are typically measured for, and fitted with, anti-embolism stockings during extended periods of non-ambulation. Anti-embolism stockings must critically fit the leg to achieve optimum blood flow and thus success of prophylaxis. Therefore, hospitals endeavour to maintain stock of antiembolism stockings that fit the majority of their patients. Objectives: The objective of this study was to establish whether popular styles/brands of anti-embolism stockings ''fitted'' the legs of convenience sampled volunteers. Design/methods: Volunteer's legs were measured at ankle, calf and thigh following guidance from British nurses and in accordance with brand instructions. Leg measurements were subsequently compared to the size charts of 10 anti-embolism stocking styles made by 4 different manufacturers. ''Fit'' is defined as a volunteer's leg measurements matching any stocking size in a range at all measurement points. Settings: Volunteers were measured in different settings around Scotland, including private homes, work places and shopping centres. Participants: A convenience sample of 471 volunteers (283 female, 188 male) were recruited on the basis of willingness to participate and being over 16 years old. Volunteers ranged from 17 years to 82 years old with an average age of 35. Results: The 10 different styles of anti-embolism stockings, made by 4 different brands, examined for this paper had a size match coefficient ranging from 0% to 100% for our volunteer's legs. The size match coefficient is strongly influenced by the Brand's sizing policy. Conclusions: The proportion of legs that ''fit'' a particular brand of anti-embolism stockings can be increased through: (1) the reduction of the number of leg measurement points that need to be matched to the size chart of the stockings; (2) the use of open-ended size ranges; (3) the use of increased size range width and (4) the use of increased overlap between sizes. However, all but the last of these measures can have a potentially deleterious impact on the ability of the stocking to deliver the optimum graduated pressure profile to all legs that ''fit'' the stocking, resulting in important implications to the efficacy of prophylaxis. [ABSTRACT FROM AUTHOR]

Abstract: Background: Death has been identified as a known stressor for nurses and has been extensively researched in nursing populations. However, very little is known about the impact of a specific stressful event; that of the novice nurse''s first encounter with patient death. Using a sequential quantitative-qualitative mixed methods design, a study was undertaken to explore the clinical circumstances, impact and challenges and rewards of nurses’ early experiences with patient death. This paper reports the findings of the first phase: an exploratory survey of nurses’ responses to this stressor. Method: A convenience sample of New Zealand Registered Nurses was recruited using email invitations; 174 respondents completed an online questionnaire exploring the clinical circumstances, preparedness, support mechanisms and impact of their earliest memorable patient death. Results: Most nurses reported that their earliest memory of patient death occurred during undergraduate training (61%) or in the first year of qualified practice (23%). Over 80% of these experiences occurred in acute medical, surgical or specialty settings in public hospitals, some involving paediatric or sudden unexpected deaths. Whilst some respondents described a rewarding, ‘learning experience’, others reported acute helplessness, guilt or marked on-going distress. Conclusions: Whilst little can be done to control the clinical circumstances of nurses’ early death encounters, by understanding more about the reactions to death, it may be possible to minimise negative factors such as unexpected elements, feelings of inadequacy, exclusion and role conflicts whilst facilitating coping, sharing of the experience, personal and professional growth, and other positive outcomes. Nurses’ early experiences with patient death appear to have a lasting impact on their professional and personal lives. [Copyright &y& Elsevier]

Abstract: Background: As cardiovascular diseases have become the leading cause of death in many countries including China, nurses are increasingly required to be abreast of technological advances and the skills necessary to manage this increasing health care problem. Chinese nurses are under pressure to provide skilled electrocardiography monitoring, and be sufficiently skilled to detect myocardial ischemia and infarction, in this large patient population. This presents a challenge for the nursing profession in China, particularly for nurses working in coronary care in a country where advancement has been so rapid, yet little research has been conducted or reported in the literature. Objectives: The two main objectives were: to explore the demographic and educational factors that affect the use of ST-segment monitoring and correct electrode placement by CCU/ICU nurses in China; and to explore the factors both individual and institutional that affect monitoring and lead placement. Methods: A self-administered questionnaire was distributed to nurses in 126 randomly selected tertiary hospitals, which were stratified into three homogeneous regions across China. The instrument examined demographics, information about hospitals, electrocardiogram devices, current practice patterns and perceptions toward monitoring and lead placement. Data from 734 nurses and 59 nurse managers from 59 hospitals were analyzed using t-tests, ANOVA, Chi-square test and logistic regression. Results: Electrocardiogram monitoring was used to detect myocardial ischemia by 43.7% of respondents, and 35.1% selected leads according to electrocardiogram or angiography findings. Most (70%) agreed that monitoring for acute coronary syndrome was important, while 39.2% did so, and 15.7% were able to identify correct placement. Logistic regression revealed a significant relationship between the uses of ST-segment monitoring and number of hospital beds, continuing education and a belief in its use and ease of use. Correct electrode placement was significantly correlated with respondents from university hospitals, hospitals with more acute coronary syndrome admissions and more independent thinking nurses. Conclusions: Despite best practice evidence, less than half of the sample used electrocardiogram monitoring to detect myocardial ischemia and the majority could not identify correct electrode placement, while ST-segment monitoring was not used routinely. This paper highlights the need for improvements in education both in universities and hospitals and discussion addresses conventions in units, which inhibit development of nurses’ skills. [Copyright &y& Elsevier]