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Aim: This paper is part of a larger doctoral study that investigated the impact of nationality on the job satisfaction of nurses and their intentions to leave Saudi Arabian government hospitals. The paper aims to gain an understanding of the impact of expatriate status on nurses' perceptions, by comparing the factors that influence job satisfaction among Saudi nurses to those that affect nurses recruited from other countries. Background: Job satisfaction is a known predictor of nurse retention. Although there is a broad understanding of the factors that affect job satisfaction, little is known about how these vary between home and expatriate nurses working in countries which rely on a multicultural migrant workforce. Methods: A descriptive qualitative approach was taken, in which 26 semi‐structured interviews were conducted with nurses selected from different nationalities, all of whom were working in Saudi Arabian hospitals. Eight participants were Saudi Arabian, six Filipino, four Indian, four South African, two Jordanian and two Malaysian. Findings: Five themes were identified that differentiated the perceptions of expatriates regarding their job satisfaction from those of the home nurses: separation from family, language and communication, fairness of remuneration, moving into the future and professionalism. Conclusion: Focusing on the enhancement of job satisfaction experienced by expatriate nurses can result in a healthier work environment and greater retention of these nurses. Implications for nursing and nursing policy: To enhance nurse retention, policy makers in countries with migrant nurses should address their socio‐economic needs. This includes providing both greater access to their dependent family members, and language lessons and cultural orientation to reduce linguistic and cultural challenges. [ABSTRACT FROM AUTHOR]

Background: In Oman, limited access to adequately prepared healthcare providers in primary healthcare threatens the provision of quality care to patients and families and access to healthcare services. Nurse practitioners (NP) are in an excellent position to address safety issues and ensure quality healthcare with their advanced nursing skills, knowledge, and acumen for acceptable cultural and religious practices. Aims: To explain Oman's national strategic plans, processes, challenges, opportunities, and both regional and global implications for the facilitation of NP role implementation and policies. Sources of evidence: The Nursing and Midwifery Human Resources framework guided the NP implementation project. Guided by the framework, the World Health Organization and the Omani Ministry of Health conducted multiple situational analyses (2004–2016). Later, the NP role was planned and implemented in Oman. During and after implementation, monitoring and evaluation of the NP role implementation were continuously conducted using multiple focus groups, individual interviews, and field visits. Discussion: The NP role implementation revealed multiple challenges and opportunities that either hinder or support NP role implementation. Additionally, the NP implementation project revealed various lessons learned. Implications for nursing and health policy: National and global nursing leaders and health policymakers should collaborate to discuss NP issues, especially NP role sustainability, legal approval and recognition, prescriptive authority, title protection, practice acts, and professional regulation. Conclusion: This paper informs nursing leaders and policymakers in the Middle East and other countries in the global community about Oman's experience regarding NP role implementation. [ABSTRACT FROM AUTHOR]

Background: In this time of global nursing shortages, investment in nursing is vital, and hospitals need to apply a range of strategies to attract and retain nurses. Rewards are an effective strategy for the retention of nurses and help improve the performance and productivity of hospitals. In rural and remote communities, however, nurses may not have access to the rewards that urban‐based nurses have. Aim: To explore the preferred rewards of registered nurses in rural and remote community hospitals in Thailand. Methods: An explanatory mixed‐methods design was employed for the overall study, and the results from the qualitative descriptive phase are reported here using the COREQ checklist. We collected data during in‐depth interviews with 24 informants from 8 community hospitals. Thematic analysis was used for data analysis. Findings: Four major themes regarding reward types were preferred by the nurses: reasonable pay, good benefits, accessible learning and development, and a favorable work environment. Conclusion: A package of total rewards that best suit nurses working in rural and remote areas needs to be implemented, for a combination of different types of rewards has a greater impact than a single reward at both individual and organizational levels. Implication for nursing and health policy: It is crucial to identify those rewards to attract and retain nurses. In Thailand, nursing and health workforce policies need to be based on nurse preferences regarding salary, benefits, and recognition commensurate with other healthcare professionals, including civil servant status, as well as improving the work environment. [ABSTRACT FROM AUTHOR]

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

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

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

Richter M.S., Mill J., Muller C.E., Kahwa E., Etowa J., Dawkins P. & Hepburn C. (2013) Nurses' engagement in AIDS policy development. International Nursing Review 60, 52-58 Background: A multidisciplinary team of 20 researchers and research users from six countries - Canada, Jamaica, Barbados, Kenya, Uganda and South Africa - are collaborating on a 5-year (2007-12) program of research and capacity building project. This program of research situates nurses as leaders in building capacity and promotes collaborative action with other health professionals and decision-makers to improve health systems for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) nursing care . One of the projects within this program of research focused on the influence of workplace policies on nursing care for individuals and families living with HIV. Nurses are at the forefront of HIV prevention and AIDS care in these countries but have limited involvement in related policy decisions and development. In this paper, we present findings related to the barriers and facilitators for nurses' engagement in policymaking. Methods: A participatory action research design guided the program of research. Purposive sampling was used to recruit 51 nurses (unit managers, clinic and healthcare managers, and senior nurse officers) for interviews. Findings: Participants expressed the urgent need to develop policies related to AIDS care. The need to raise awareness and to 'protect' not only the workers but also the patients were critical reason to develop policies. Nurses in all of the participating countries commented on their lack of involvement in policy development. Lack of communication from the top down and lack of information sharing were mentioned as barriers to participation in policy development. Resources were often not available to implement the policy requirement. Strong support from the management team is necessary to facilitate nurses involvement in policy development. Conclusions: The findings of this study clearly express the need for nurses and all other stakeholders to mobilize nurses' involvement in policy development. Long-term and sustained actions are needed to address gaps on the education, research and practice level. [ABSTRACT FROM AUTHOR]

CLEREHAN R., MCCALL L., MCKENNA L. & ALSHAHRANI K. (2012) Saudi Arabian nurses' experiences of studying Masters degrees in Australia. International Nursing Review 59, 215-221 Aim: This paper presents findings from a study which explored a group of Saudi Arabian nurses' experiences of studying for a Masters degree in Australia. Background: Arab states in the Middle East, Saudi Arabia in particular, have high expatriate nursing populations, and governments in the region have allocated considerable funding to up-skilling their health workforce, often at Western universities. However, there has been little research into the learning experiences of nursing students from Middle East nations. Methods: A descriptive qualitative study design was used. Middle Eastern students undertaking Masters courses in a School of Nursing and Midwifery at one Australian university were invited to participate in a semi-structured interview. Ten Saudi students participated and data were analysed using content analysis. Findings: Students experienced challenges related to the transition to very different forms of study; to managing relationships and family. They were resourceful, employing strategies to manage multiple demands, including differences in culture, and stressed the significance of strong personal relationships with staff. Students acknowledged being changed, even transformed, by their experience, and saw themselves as future change agents. Conclusion: Highly skilled local nursing professionals are being sought in many Middle Eastern countries and may undertake post-graduate studies in Western contexts quite different from their own. Students reported that, in spite of difficulties, their experience prompted transformational change: intellectually, psychologically and developmentally. It is necessary for staff to understand expectations and learning preferences of these students to ensure fruitful learning outcomes and benefits to nursing in their home countries. [ABSTRACT FROM AUTHOR]

DOMAJNKO B. & PAHOR M. Mistrust of academic knowledge among nurses in Slovenia. International Nursing Review 57, 305–311 Aim: The paper discusses the negative attitudes of some nursing assistants in Slovenia towards higher nursing education and academic (theoretical and research based) knowledge. Background: The topic is discussed in the context of traditional hierarchical and patriarchal relations in the health-care sector, professionalization of nursing and the evidence-based debate in nursing. Methods: A secondary analysis of data gathered in 2005 was carried out. The topic of the original research was the interprofessional collaboration between medical and nursing care professionals in Slovenia. The secondary study looked closely into the relations within nursing care. Specifically it focused on the nursing assistants' perspective. Five hundred ninety-two answer to two open-end questions (307 from nurses and 285 from nursing assistants) and five semi-structured interviews (with three nurses and two nursing assistants) were re-analyzed (with the new focus), applying inductive qualitative content analysis and the pragmatic approach to interpretation. Findings: In nursing assistants' view, the difference between themselves and graduate nurses was described in terms of the distinction ‘work – non-work’. Higher education was associated primarily with striving for higher social status. Academic knowledge was not perceived to include the right competencies for either practising or improving the quality of nursing care. Conclusions: The mistrust of the academic nurse on the part of some nursing assistants is interpreted as a barrier to full professionalization of nursing care and also interprofessional collaboration in the health-care sector. [ABSTRACT FROM AUTHOR]

Background: Nurse turnover is a major problem all over the world. It is known that young nurses who constitute the new nurse labour force are more likely to leave their organization, especially in their first year. However, qualitative studies that approach the problem from the perspective of young nurses and focus on the reasons for their decision to leave their organization are limited. Aim: To understand the reasons for young nurses' leaving their organization and determine their experiences, focusing on their point of view. Methods: The study had a descriptive qualitative design and was conducted between January and February 2019. Purposeful sampling was used, and the sample included 15 nurses that voluntarily decided to leave a university hospital in Turkey and agreed to participate in the study. Data were collected with semi‐structured interviews, and the interviews were audio‐recorded. The data obtained from the interviews were evaluated by content analysis. Findings: The young nurses' reasons for leaving their organization were found to be in three categories: the Negative work environment, Nursing shortage, and Unsatisfied individual expectations. The Negative work environment category included the subcategories of lack of professional solidarity, lack of support from managers, inadequacy of preceptorship process, and horizontal violence. The Nursing shortage category consisted of the subcategories of excessive workload and overtime. The category of Unsatisfied individual expectations comprised the subcategories of work–social life imbalance, availability of alternative options, and family‐related reasons. Conclusion and implications for nursing policy: It was determined that the young nurses left their organization because they did not receive sufficient support from their managers and colleagues during the transition period. This finding shows that nurse executives must have the managerial skills and understanding to regulate the work environment, increase peer support, and carefully plan each stage of the transition process for the retention of young nurses in their organization. In addition, nurse executives should encourage and be involved with policy making and policymakers and other managers in their organizations to develop institutional and national strategies to ensure that young nurses remain in nursing. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore nurse educator academic incivility from the perspectives of nurse educator leaders. Background: The academic environment should be safe and conducive to both teaching and learning. Both the students and faculty should have a sense of belonging and of being valued. Introduction: Faculty‐to‐faculty incivility has been reported as being disruptive to the teaching and learning environment, and is associated with poor work outputs. Method: A qualitative descriptive design, as explained by Sandelowski, was used to explore academic incivility as perceived by nurse educator leaders. Twenty semi‐structured interviews were conducted with nurse educator leaders, representing three levels of management in Botswana. The approach of Elo and Kyngas was used to analyse qualitative data. Their main aim was to compare categories at different periods, as was the case with different categories of nurse leaders in this study. Findings: Three main themes emerged from the data analysis: lack of policy implementation, inadequate leadership skillsandrole modelling. Two subthemes emerged from the theme, lack of policy implementation, namely: poor record‐keeping and hierarchical issues. On further analysis of the theme, inadequate leadership skills,poor hierarchical coordination among nurse educator leaders; and favouritism emerged as subthemes. The last theme, role modelling, needed no further development and described the modelling of incivility as the behaviour that has birthed a generation of incivility among nurse educators. Conclusion: Incivility exists in nursing colleges in Botswana, and it includes unruly behaviour towards one another; late coming; disrespect; and disregard of authority. Implications for nursing education policy: There must be collaboration between nurse educators and health policymakers to strengthen cordial relationships as well as foster disciplinary procedures on incivility. Clear policy on disciplinary procedures focusing on mitigating various forms of uncivil behaviours is imperative. Nurse educator leaders' training on management skill should also be strengthened and made mandatory before nurse educators are appointed to leadership positions. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to identify the ethical challenges of novice nurses in the first year of clinical practice. Background: Novice nurses experience a lot of ethical complications in the clinical workplace, especially in the first year of clinical practice. These ethical challenges are scarcely studied. Methods: Current research was a descriptive qualitative study conducted on twelve novice nurses in educational hospitals affiliated to Arak University of Medical Sciences (from August to December 2018)in Iran. Data were collected through semi‐structured in‐depth interviews, and informed consent was obtained from all participants. Data were analysed using content analysis. Results: A total of 12 nurses participated, the majority of whom were female (8; 66.6%), and their average age was 23.6 years. Findings of this study revealed four main themes: patient: the forgotten part, exposure to inequalities, inattention to professional ethics and facing a state of quandary. Several sub‐themes also appeared in this study. Conclusion: These findings can reveal a clear picture of the ethical challenges of novice nurses in Iran. They can be used as a guidance for managers, authorities and nursing stakeholders in order to protect and support these nurses. Further research on each concept is suggested. Implications for nursing and health policy: These findings can be used to inform nursing education, research, management and clinical practice. Meanwhile, the results of this study may be used to formulate a strategy for training nursing managers in order to protect and support the next generation of nurses. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to conceptualize and explain the core clinical competencies of nursing students in Iran. Background/Introduction: Despite the national and international efforts to modify nursing curricula such that the students' clinical competencies are improved, there is still a widespread concern about this issue, perhaps due to the impact of factors other than the curriculum itself, such as the lack of a clear definition for the concept of clinical competency and its main components in nursing students. Methods: This qualitative study was conducted using conventional content analysis. The participants were selected through purposive sampling and included 14 senior students of bachelor of nursing, four nurses working in teaching hospitals and six clinical instructors. Individual semi‐structured interviews were used for data collection. After recording and transcribing the interviews, content analysis was used to extract the concepts. Findings: The main theme of the study was 'multidimensionality of the concept of clinical competency,' which had six main categories, namely 'adoption of and adaptation with the nursing practice,' 'nursing knowledge,' 'self‐direction in clinical learning,' 'patient care skills,' 'professional ethics' and 'the development of professional behaviours.' Discussion/Conclusion: Clinical competency and its dimensions among students comprise a multidimensional concept. Having a clear and comprehensive understanding of this concept and focusing on its core axes may be the most important step in improving students' clinical competency. Implications for nursing, health and education policy: Policymakers and nursing education authorities can identify the problems existing in the students' clinical competency and provide them with practical solutions for a standard professional education through a clear understanding of the concept of clinical competency and its dimensions. [ABSTRACT FROM AUTHOR]

Background: The ageing population and the changing disease profile have been driving the demand for community nurses. However, few nursing students in Singapore aspire to have a career in community nursing following graduation. Objectives: To explore undergraduate nursing students' perceptions of a career in community nursing and to identify strategies to promote community nursing among nursing students. Methods: An exploratory qualitative design was used. Four focus group discussions were conducted with a purposive sample of 24 undergraduate nursing students from a university. Interview transcripts were analysed using thematic analysis. Findings: Four key themes emerged as follows: 'mid‐life career', 'limited career progression', 'a difficult transition' and 'international nurses‐dominated workforce'. Discussion: While most participants rejected a career in community nursing immediately after graduation, they planned to join it at the later stages of their lives to accommodate changing life priorities. Limited career progression and increased difficulty in career transition from community nursing to acute care nursing were identified as deterrent factors in the participants' choices of community nursing as a career. Feelings of marginalization and a lack of role models in community nursing were perceived to be the result of the international nurses‐dominated community workforce. Conclusion: Community nursing remains an underrated career. There is a need to foster an optimistic career outlook and mobility in community nursing to entice nursing students into this career track. Implications for nursing policy: Strategies to enhance community nursing recruitment should focus on providing more quality and diverse community placement opportunities in various community care settings, implementing a clearly defined career developmental plan to elucidate the role of community nurses, and improving community care and cultural competencies to develop a skilled and diverse community nursing workforce. [ABSTRACT FROM AUTHOR]

Aim: To explore and provide understanding of the barriers to quality of work life among registered nurses in Bangladesh. Background: Globally, there is growing interest in the working environments of nurses, especially at a time of nursing shortages and with the focus on safety and care quality in health systems. In a low socio‐economic country like Bangladesh, nurses struggle in a grossly underfunded healthcare system to deliver care to the people but no studies have been conducted on their quality of work life. Methods: This qualitative descriptive study was conducted at three Bangladeshi tertiary hospitals in May 2015–January 2016. Three focus group discussions were held with 30 registered nurses exploring their perceived barriers to quality of work life. Data were analysed with content analysis. Findings: Seven barriers to their work‐life arose: heavy workloads; lack of government accommodation and transportation; poor health status; lack of support from nursing supervisors; lack of promotion opportunities; incomplete hospital policies and procedures; and lack of night shift and risk allowances. Discussion: Participants described many issues and barriers impacting on their work‐life. They perceived little reward for their hard work, felt that their health suffered from their working conditions and described a low QWL. Conclusion and policy implications: Findings provide information for nursing and health policymakers and leaders to reduce barriers to improve work‐life quality among nurses that can contribute better to quality of nursing care, and nursing retention and satisfaction. Work policies and practices, and funding and other resources need to be scrutinized to ensure better working conditions for Bangladeshi nurses. Limitations: Interviews were conducted with nurses only in tertiary hospitals in the Bangladeshi capital, and understanding of barriers to work‐life quality of nurses in other health settings and regions needs to be explored. [ABSTRACT FROM AUTHOR]

Background: Different concepts have been used to date (e.g. non‐nursing tasks, organizational work) to define tasks performed by clinical nurses other than nursing care. However, the true essence of nursing work is still poorly understood mostly because nurses are lacking an appropriate lexicon to describe their practice. Aims: To describe non‐nursing tasks as experienced by nurses, exploring antecedents and consequences as perceived in daily practice. Methods: A descriptive qualitative study from 2015 to 2016. A purposeful sample of nurses was approached. Semi‐structured interviews were used, and content analysis was performed on audio‐recorded and verbatim‐transcribed interviews. Findings: A total of 22 nurses participated, the majority of whom were female (16; 72.7%) and their average age was 42.6 years. The concept of 'Non‐nursing tasks' is limited in describing what nurses experience in daily practice; the concept of 'Being out of the nursing role' emerged as being fully descriptive of the nurses' experience and this can occur in two dimensions: outside and inside the role of other healthcare professions. The first dimension includes administrative work separating nurses from patients. The second dimension was reported to happen in proximity to patients but in three different directions towards professions requiring: (a) less education (e.g. healthcare assistants), (b) the same amount of education at university level (e.g. physiotherapists), and (c) higher education at university level as compared to nurses, thus performing activities expected by physicians. Antecedents of 'Being out of the nursing role' have been identified at the organizational, individual and educational levels; their consequences have been reported at the patient, professional and organizational levels. Conclusion: Nurses play various non‐nursing roles, below, above and in the horizontal levels, both inside and outside other healthcare professionals' role, mainly as a result of their felt moral obligation to offer the best to their patients, the organization's demand to nurses and the imprinting of nursing education. Implications for nursing/health policy: Strategies at the nursing professional and policy levels are needed aimed at (a) supporting nurses in optimizing their professional identity, (b) sharing their sense of moral obligation towards patients with other healthcare professionals, and (c) implementing models of care based on interprofessional cooperation. [ABSTRACT FROM AUTHOR]

Aim: The study explored the views and attitudes of nurses and physicians on family presence during resuscitation in emergency departments in Brazil. Background: International emergency associations endorse family presence during resuscitation; however, the extent to which it is practiced remains unclear, particularly in the Brazilian context. Research of emergency staff views and attitudes towards this practice is desirable so that actions can be identified to support families at the bedside. Methods: A qualitative research was conducted. Thirty‐two health professionals (11 physicians and 21 nurses) working in two emergency departments in southern Brazil were purposefully recruited in January 2015. In‐depth interviews were conducted, and data were analysed using content analysis. Findings: Nurses and physicians found family presence during resuscitation controversial and the general attitude towards this practice was negative. They reported that 'changes are needed' to adapt hospital infrastructures for family presence, and to train staff to respond to the information and emotional needs of families. Discussion: Translating a family nursing framework into clinical practice involves the need for reassessing educational and management policies in clinical contexts. Conclusion: This research brings new understanding about the attitudes of some Brazilian nurses and physicians on the implementation of family presence during resuscitation and identifies the need to develop policies and strategies to improve family presence in emergency departments. Implications for nursing and health policy: Hospital‐based policies are required to improve family‐centred care in emergency departments while providing a criterion of legality and safety to professionals to invite families to be present during invasive procedures. Also, family‐focused education in health science degrees, continuing education and in the community is required. [ABSTRACT FROM AUTHOR]

Background: Evidence-based nursing is widely recognized as the critical foundation for quality care. Aim: To develop a middle-range theory on the process of evidence-based nursing implementation in Chinese context. Methods: A grounded theory study using unstructured in-depth individual interviews was conducted with 56 participants who were involved in 24 evidence-based nursing implementation projects in Mainland China from September 2015 to September 2016. Results: A middle-range grounded theory of 'Taking Root' was developed. The theory describes the evidence implementation process consisting of four components (driving forces, process, outcome, sustainment/regression), three approaches (top-down, bottom-up and outside-in), four implementation strategies (patient-centred, nurses at the heart of change, reaching agreement, collaboration) and two patterns (transformational and adaptive implementation). Limitations: Certain perspectives may have not been captured, as the retrospective nature of the interviewing technique did not allow for 'real-time' assessment of the actual implementation process. The transferability of the findings requires further exploration as few participants with negative experiences were recruited. Conclusion: This is the first study that explored evidence-based implementation process, strategies, approaches and patterns in the Chinese nursing practice context to inform international nursing and health policymaking. The theory of Taking Root described various approaches to evidence implementation and how the implementation can be transformational for the nurses and the setting in which they work. Implications for nursing and health policy: Nursing educators, managers and researchers should work together to improve nurses' readiness for evidence implementation. Healthcare systems need to optimize internal mechanisms and external collaborations to promote nursing practice in line with evidence and achieve clinical outcomes and sustainability. [ABSTRACT FROM AUTHOR]

Aim: This study explored the experience of baccalaureate-prepared, internationally educated nurses who work as licensed practical nurses in Canada. Background/Introduction: Internationally educated nurses experience several barriers to workforce integration on arrival in destination countries. Given these barriers, evidence suggests that internationally educated nurses sometimes experience downward occupational mobility and deskilling in destination countries. Some baccalaureate-prepared, internationally educated nurses work as licensed practical nurses in destination countries, but there is minimal research on this population. Methods: We used an exploratory transnational feminist qualitative research design. Following ethics approval, a total of 14 baccalaureate-prepared, internationally educated nurses who currently or recently worked as practical nurses in Canada were interviewed for the study. Data were thematically analysed with the aide of NVivo 11 data software. Results: Our results revealed four key themes related to the experiences of this group of nurses: they migrate to Canada with hope for a better personal and professional life; they experience barriers to workforce integration as registered nurses and discover an easier path in the licensed practical nurse registration process; they experience deskilling and ambivalent skill recognition; and they feel dissatisfied as a licensed practical nurse in Canada. Discussion/Conclusion: There is a need for policy to support the upward mobility of baccalaureateprepared, internationally educated nurses who work as practical nurses. Implications for Nursing Policy: Implications for policymakers include the need to address the barriers to becoming registered nurses, including application processing times and lack of adequate access to educational programmes. [ABSTRACT FROM AUTHOR]

Background In Singapore, employees aged 62-65 can continue to be employed if they meet the re-employment eligibility criteria. This policy, coupled with an ageing workforce, calls for age-friendly initiatives, specific to work-related challenges faced by older nurses. Aim To determine work-related challenges faced by older nurses. Methods A mixed method sequential explanatory study was conducted with nurses, aged 50 and above, working in a healthcare cluster in Singapore. In the quantitative phase, a questionnaire was administered to 534 nurses to elicit work-related challenges, then in-depth interviews with 30 nurses were carried out to help explain why certain tasks and work circumstances became harder. Results Results of the survey indicated that the top three challenges were coping with changes, working with computers and reading labels. Place of work, salary range, gender and race were significantly associated with different work-related challenges. Five themes emerged from the qualitative data: physical demands of work and workload, new technology, need for further education, working with younger nurses and in intercultural teams, and changing public expectations and professional image. Discussion and conclusion The study supports the current literature on the challenges older nurses face with technological advancement. However, older nurses in our study reported less aches and pain as compared to that reported elsewhere. There is a need for specific strategies that will address changes in work processes and environment in order to retain older nurses. Implications for nursing and nursing policy When devising age-friendly work improvement initiatives, it is important for nurse leaders to factor in the needs of nurses working in different care environments, who are of different ranks, or are from different ethnic backgrounds. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to investigate the disaster experiences of nurses called to assist survivors one month after the 2013 Ya'an earthquake. Background China has experienced an increasing number of earthquake disasters in the past four decades. Although a health and disaster management system was initiated after the 2008 Wenchuan earthquake, nurses' roles and experiences in a disaster have been overlooked. Methods The researchers used qualitative descriptive design that included 16 participants. Data were collected using semi-structured interviews and observation notes, after which a qualitative content analysis was conducted. Findings Three major themes emerged: the process of being dispatched from hospitals to the disaster zone, the effort involved in getting to and working in the affected site and reflecting on the challenges they encountered. Discussion About half of the participants had received disaster nursing training before deploying to the disaster site, but they consistently expressed a lack of physical and psychological preparedness regarding the process of being dispatched from their hospitals to the disaster zone. Limitations This was a single-incident experience. Caution should be taken when trying to extend the findings to other parts of China. Conclusion These findings highlighted the need for disaster in-service training as well as for having disaster plans in place. Implications for nursing and health policy Hospital and nursing leaders should provide disaster training opportunities that included topics such as compiling resource inventories, formulating disaster drills and simulations, managing emergencies, and using emergency communication methods. Health policy-makers should be required to prioritize capacity-building training for front-line nurses as well as to develop and implement disaster management plans to better prepare nurses for future disasters. [ABSTRACT FROM AUTHOR]

Background: A well‐educated, sufficient nursing workforce improves population health and standards of nursing care. Analysing workforce policies assists nurses to learn from the past and develop better future policies. Aim: Describe policy‐making processes in the first Thai government plan to increase nursing capacity and improve nursing education quality. Design: A qualitative study employing Longest's model to examine policy‐making processes. Methods: Data were obtained from 28 in‐depth interviews with key informants, who had been committee members and former deans of nursing involved with the policy processes in the 1990s. Both qualitative and quantitative data were extracted from relevant documents, and content analysis employed with all data. Findings: Three policy phases were identified. Policy formulation, where three streams of problems, politics and policy resulted in identification of nursing shortage, changes of government incumbents and needing to increase nurse production; Policy implementation included creating methods of implementation, appointing responsible people and committees, creating operational plans, producing more nurses and faculty development projects and Policy modification which incorporated implementing the first Thai international doctoral degree in English, a collaborative programme between universities. Study limitations: Not all key informants could be accessed due to the passage of time. Findings are unique to Thailand but inform internationally of nurses’ abilities and need to be involved in policy. Conclusion: Nurses were involved in all policy phases. While the policy produced positive developments in growing nursing capacity and education in the past, nursing shortages remained and are now acute in Thailand. Implications for Nursing/Health Policy: Lessons learned from this policy analysis help explain why the nursing education and nursing shortage policy was legislated through the government agenda, and the active involvement of Thai nurses in this process. Nurses globally need to be at the policy‐making table to try to reduce nursing shortages, and enhance practice and education environments. [ABSTRACT FROM AUTHOR]

Aim: The Australian Award Fellowship Program aimed to strengthen nursing and midwifery leadership and capacity in developing countries in the Pacific. Background: It is necessary to build an optimal global health workforce, and leadership and mentorship are central to this need. This is especially important in small island states such as the Pacific who have limited capacity and resources. Introduction: This health system strengthening program addressed quality improvement in education, through the mentorship of potential nursing and midwifery leaders in the South Pacific Region. Methods: Program participants between 2013 and 2015 were interviewed. Data were audio‐taped, transcribed and analysed thematically using an inductive process. Results: Thirty‐four nurses and midwives from 12 countries participated. There were four main themes arising from the data which were: having a country‐wide objective, learning how to be a leader, negotiating barriers and having effective mentorship. Discussion: Our study showed that participants deemed their mentorship from country leaders highly valuable in relation to completing their projects, networking and role modelling. Similar projects are described. Limitations: The limitation of this study was its small size. There is a need to continue to build the momentum of the program and Fellows in each country in order to build regional networks. Conclusions and implications for nursing and midwifery: The Program has provided beneficial leadership education and mentorship for nurses and midwives from Pacific countries. It has provided a platform to develop quality improvement projects in line with national priorities. Implications for health policy: Global aid programs and the recipients of the program would benefit from comparable health strengthening approaches to nursing and midwifery in similar developing countries. [ABSTRACT FROM AUTHOR]

Aim: The aim of this research was to explore compassionate behaviour in Iranian nurses. Background: Nurses provide high ‐ quality care with compassion. It is useful to improve relationships between nurses and patients to give them more confidence in the care process. It is important to consider how compassion is demonstrated by nurses and to explore different compassionate behaviours in different cultures. Methods: This ethnographic study was conducted with 20 nurses and 12 patients in six medical and four surgical wards in Iran in 2014–2015. Data were collected through fieldwork observations and semi ‐ structured deep interviews and field notes. We analysed data using constant comparison based on Strauss and Corbin method. Results: Results of the present study showed four cultural themes; love expression and compassion in the form of non ‐ verbal emotional behaviours, empathy with others, emotional supports of patients at bedside and non ‐ caring behaviours. Conclusion: The findings of this study described compassionate behaviours in nurses. Compassionate behaviours of nurses are closely related to the culture issues. These are formed by communication between nurses and patients, and nurses and patients' families during nursing care. Thus improving compassionate behaviours is highly significant in nursing. Implications for nursing and/health policy: Nurses, instructors and policy ‐ makers can use the results of this study. They should consider compassionate care as an important component of patient ‐ centred care. Compassion should be considered in nursing and practical educational programmes. To develop the compassionate care, it is vital to make changes in the dominant philosophy and culture of caring environments. Nurses should receive appropriate training with focus on holistic and patient ‐ centred approaches. [ABSTRACT FROM AUTHOR]

Aim This study examined the effects of healthcare-associated infectious disease outbreaks on nurses' work in a large acute care hospital in Ontario, Canada. Background The incidence of healthcare-associated infections has increased. Previous research focuses on epidemiology, healthcare systems, and the economic burden of outbreaks. Few published studies focus on the impact of outbreaks on nurses' work in acute care facilities. Introduction Since the severe acute respiratory syndrome epidemic in 2003, combating infectious diseases has become a key issue. Hospitals have implemented measures related to healthcare-associated infections. However, nurses experience challenges in preventing, controlling, and contending with outbreaks. Methods A retrospective exploratory case study approach was used. Data were collected over a 4-month period in 2012. The incidence rates of site-specific HAIs were analysed, and individual interviews were held with 23 bedside nurses and five nurse managers. Findings Five themes emerged from the interviews: comparison of healthcare-associated infections outbreaks; the nature of nurses' work; impact of outbreaks on patient care; innovation and quality control in clinical practice; and increased and expanded IPAC measures. The incidence rates of methicillin-resistant S taphylococcus aureus, C lostridium difficile and vancomycin-resistant enterococci at the study site decreased, but remained above provincial benchmarks. Nurses experienced workload challenges, time pressures and psychological effects stemming from outbreaks and developed various innovations in response. Patient care was also affected. Conclusion Nurses' work has been impacted by healthcare-associated infectious disease outbreaks. Nursing workloads should be quantified to facilitate the development of guidelines for optimum nurse-patient ratio during outbreaks. Implications for Nursing and/or Health Policy A strong evidence-based policy framework is required to address healthcare-associated infectious disease outbreaks. Infection prevention and control guidelines and procedures should be established provincially and nationally. An interdisciplinary approach is essential for the creation of comprehensive and innovative strategies. Nursing research has increased understanding of the implications of infectious diseases in hospitals. Building on the literature, findings from this study can be used to influence policies on the care of patients who have secondary infections. Nurse-driven protocols are important and can lead to the creation of best practice guidelines that can be implemented across settings. [ABSTRACT FROM AUTHOR]

Background Medical errors are one of the major threats for patient safety in all countries. Medication errors are common medical mistakes that can lead to serious consequences and even death of patients. Aim The aim of this study was to explore nurses' perspectives of factors influencing medication errors. Methods This qualitative study based on content analysis included 20 nurses ( n = 20) with at least 2 years of clinical experience working in a large teaching hospital. The nurses were selected using purposeful sampling. The data were collected using semi-structured interviews and analysed using deductive content analysis approach based on Reason's human error model. Rigor of the data was confirmed by external and member check. Results Two themes were identified by the participants: (1) the individual approach including personal and psychological characteristics of nurses, patient medical history and physicians' orders errors; and (2) the cultural and organizational approach including workplace conditions, learning process, risk management strategies, nurses' pharmacological knowledge, inevitable nursing errors and medication error complications. Limitations Concern about the potential consequences related to reporting of the medication errors was the major limitation of this study. Participants' concerns were handled by keeping their identity confidential and anonymous. Conclusion Results show the importance of planning comprehensive educational programmes and providing constructive feedback in a favourable learning climate. Implications for nursing and health policy Findings of this study can be beneficial to managers for nurturing a transparent organizational culture, whereby staff members freely discuss their errors in patient care and seek advice for problem solving. [ABSTRACT FROM AUTHOR]

Background Angola is one of the largest African countries with continuing levels of insecurity, considerable weakness in terms of respect for human rights, destroyed infrastructure and low transparency and social accountability levels. The health system displays gaps and nursing represents the main contingent among human resources in health. Aim This research aims to understand the healthcare context in Angola from the perspective of Brazilian nurses who were involved in helping their Angolan colleagues. This general view of health services is followed by a description of nursing workforce particularities at a tertiary health service in the province of Luanda. Methods Data were extracted from the database of the Global Network of World Health Organization Collaborating Centres for Nursing and Midwifery Development, constructed based on technical visits to Angola in 2009. Information related to health service characteristics was used, focusing on nursing human resource activities at two tertiary, one secondary and one primary health institutions located in the province of Luanda. The study data were analysed through descriptive statistics. Findings Among the problems the nursing workforce faces, the lack of human, material and financial resources stands out, as well as insufficient professional qualification, excessive work journeys, low remunerations, non-valuation of professionals, leading to unsatisfactory work environments and discouraged human resources. Conclusions Nursing in Angola is conquering its professional space. Therefore, regulatory policies are fundamental, defining the rights and obligations of all categories involved, with a view to determining nurses' function in the health team, including respect for and acknowledgement of their role in the community. [ABSTRACT FROM AUTHOR]