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Aims: To explore the relationship between nurse practitioner work environment and nurse practitioner outcomes (job satisfaction and intent to leave) in the United States. Design The study used a cross‐sectional survey design to collect survey data from primary care nurse practitioners in six states in the United States. Methods: We sent mail surveys to 5689 eligible nurse practitioners in Arizona, New Jersey, Washington, Pennsylvania, California and Texas. The mail also contained an online link. Participants could complete either the paper or online questionnaire. In total, 1244 participants completed the survey in 2018–2019. The work environment was measured using the Nurse Practitioner‐Primary Care Organizational Climate Questionnaire comprised of four subscales: Nurse Practitioner‐Administration Relations, Nurse Practitioner‐Physician Relations, Independent Practice and Support and Professional Visibility. Global items measured job satisfaction and intent to leave. We used mixed‐effect proportional‐odds cumulative logit models to assess the association between work environment and job satisfaction and intent to leave. Results: Overall, 90% of participants were either very satisfied or somewhat satisfied with their job and 22% reported intent to leave their job in 1 year. With a one‐unit increase in the organizational‐level Nurse Practitioner‐Administration Relations score, the odds of having a higher job satisfaction level increased by about four times and the odds of intent to leave job decreased by about 60%. A higher organizational‐level Nurse Practitioner‐Physician Relations score was significantly associated with higher job satisfaction and lower odds of intent to leave. Conclusion: Improvements in work environments may improve nurse practitioner job satisfaction and retention. Impact This study examined the relationship between work environment, job satisfaction and turnover intention of nurse practitioners. Better work environment is associated with higher job satisfaction and lower turnover intention. Findings have implications for clinical leadership who can take actions to create better work environments to increase the nurse practitioner workforce capacity. [ABSTRACT FROM AUTHOR]

Aim: To explore the status of quality of life and psychological capital and analyse the different effects of psychological capital on the quality of life of cancer patients with different preferences for nurse spiritual therapeutics. Design: A cross‐sectional survey was used. Methods: Two hundred and eight cancer patients were recruited using convenience sampling from a tertiary Chinese hospital, between March and July 2019. Data on preferences for nurse spiritual therapeutics (PNST), psychological capital (PsyCap) and quality of life (QoL) were collected using paper questionnaires. Hierarchical multiple regression was employed to investigate the different influences of PsyCap on QoL of cancer patients with various levels of PNST. Results: Compared with patients having high PNST, patients with mild‐moderate PNST experienced lower self‐efficacy, hope, optimism, PsyCap and social/family well‐being. PsyCap significantly explained the variance on QoL of patients with various levels of PNST. Age, gender, presence of caregiver were significant factors influencing physical, social/family and emotional well‐being of patients with high PNST. Conclusion: The present study demonstrates disparities in PsyCap and QoL between cancer patients with mild‐moderate and high PNST. It is essential to be aware of the positive influences of PsyCap on QoL and develop effective interventions for patients to improve their QoL, especially for those with mild‐moderate PNST. Impact: It is necessary to realize the benefits of PsyCap on QoL of cancer patients with various levels of PNST. Appropriate training for nurses needs to be developed to promote their spiritual care competencies. Moreover, supportive interventions should be developed for cancer patients to improve their PsyCap and QoL. [ABSTRACT FROM AUTHOR]

Aims: The leader's ability to act with self‐awareness, lead with generosity, and consider others' opinions is what defines humility leadership. In recent healthcare literature, there has been extensive exploration of humility leadership and psychological safety, but these studies were non‐nursing. It is crucial to understand how humble leaders can empower their staff's psychological safety, as inclusivity is a key aspect of humility leadership and is closely linked to psychological safety. Therefore, this study examined the association between nursing leaders' humility leadership and team members' psychological safety. Design: A quantitative cross‐sectional design was used in the current study. Methods: To assess the studied variables, 245 nursing academics, nurses, and nursing leaders were recruited from different universities and hospitals using the convenience snowball sampling technique, yielding a response rate of 70%. After a pilot study, an online survey using Google Forms was hosted in 2022. Findings: The psychological safety of nursing team members was not found to be associated with the humility leadership of nursing leaders. Despite the participants' reports of their nursing leaders exhibiting humility leadership (mean = 3.57/5, SE = 0.055), the participants also reported that psychological safety was borderline (mean = 3.09/5, SE = 0.041). Conclusion: The borderline nursing team members' psychological safety implies that different types of leadership may have an impact on the psychological safety of nursing team members. The lack of association between nursing leaders' humility leadership and the psychological safety of nursing team members highlights the need for further understanding and effort from nursing leaders to establish psychologically safe work environments. Impact: This research offers valuable insights into how the humility of nursing leaders impacts the psychological safety of nursing team members. The psychological safety of the nursing team members highlights the specific responsibilities that nursing leaders should assume to establish psychologically safe work environments. Patient or Public Contribution: There was no Patient or Public Contribution, as the sample included nursing academics, nurses, and nursing leaders recruited from different universities and hospitals. Implications for Practice/Policy: A simple intervention that humble leaders can initiate is inclusivity, where subordinates' positive worth, strengths, and contributions are acknowledged. Inclusivity is a characteristic of humility leadership.Improving teams'' psychological safety calls to promote a culture of civility in the workplace.A random and larger sample is needed, including other types of universities and hospitals, using other research designs across other cultures. [ABSTRACT FROM AUTHOR]

Aims: To explore the association between nurse managers' paternalistic leadership and nurses' perceived workplace bullying (WPB), as well as to examine the mediating role of organizational climate in this association. Background: There is a lack of empirical evidence regarding the relationship between nurse managers' paternalistic leadership, organizational climate and nurses' perceived WPB. Clarifying this relationship is crucial to understand how paternalistic leadership influences WPB and for nursing managers to seek organizational‐level solutions to prevent it. Methods: A cross‐sectional survey was performed from 4 January to 10 February 2022, in six tertiary hospitals in mainland China. Demographic information, Paternalistic Leadership Scale, Organizational Climate Scale and Negative Acts Questionnaire‐Revised were used in the survey. Descriptive statistics, Spearman correlation analyses and a structural equation model were used for data analysis. Results: A total of 5093 valid questionnaires were collected. Moral leadership and authoritarian leadership have both direct and indirect effects on WPB through the mediating effect of organizational climate. The former is negatively related to WPB and the latter is positively related to WPB. Benevolent leadership was only negatively associated with WPB via the mediating effect of organizational climate. Conclusion: The three components of paternalistic leadership have different effects on WPB through the mediating effect of organizational climate. Nurse managers are recommended to strengthen moral leadership, balance benevolent leadership, reduce authoritarian leadership and strive to create a positive organizational climate in their efforts to mitigate WPB among nurses. Impact: This study enhanced our comprehension of the relationship between different leadership styles and WPB. Greater emphasis should be placed on moral leadership in the promotion of nursing managers and nursing leadership training programs. Additionally, nursing managers should focus on establishing a positive organizational climate that helps to reduce WPB. Patient or Public Contribution: No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public. [ABSTRACT FROM AUTHOR]

Aims: The objective of this study is to explore the various latent categories within the sleep quality of night shift nurses and to investigate whether shift‐related factors predispose nurses to higher levels of occupational stress and anxiety. Design: This is a cross‐sectional study. Methods: From November to December 2020, registered nurses from 18 tertiary hospitals and 16 secondary hospitals in Chongqing were selected through convenience sampling for this study. Latent class analysis was used to investigate the sleep quality of nurses working night shifts. Furthermore, univariate analysis and logistic multivariate analysis were utilized to identify the contributing factors to occupational stress and anxiety. Results: The four latent categories of Pittsburgh Sleep Quality Index for night shift nurses were identified as 'Low Sleep Disorder Group' (56.34%), 'Moderate Sleep Disorder Group' (37.27%), 'High Sleep Disorder Non‐Reliant on Sleeping medication Group' (4.89%) and 'High Sleep Disorder Reliant on Sleeping medication Group' (1.50%). The results showed that having a night‐shift frequency of 3–4 times per month, night‐shift durations of 9–12 h, sleep time delay after night shift (≥2 h), total sleep time after night shift less than 4 h were shift‐related factors that increased the levels of occupational stress and anxiety. Conclusion: The sleep quality of night shift nurses demonstrates heterogeneity and can be classified into four latent categories. Higher frequency of night shifts, extended work hours and insufficient rest time are all associated with increased levels of occupational stress and anxiety. Impact: By identifying the four latent categories of sleep quality among night shift nurses, this study sheds light on the relationship between sleep patterns and levels of occupational stress and anxiety. These findings have important implications for healthcare institutions in the management of nurse well‐being and work schedules. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to analyse the effects of servant leadership on nurses' emotional failure and compliance with standard precautions and to explore the moderating effect of individual resilience. Design: A cross‐sectional survey. Methods: This descriptive cross‐sectional study was conducted from October 9 to November 1, 2022. The convenience sampling method was used to collect questionnaire data from 924 clinical nurses in a third‐class general hospital in Chongqing, China. Results: The emotional exhaustion and compliance with standard precautions were at the general level. Servant leadership mediated by emotional exhaustion had a significant positive predictive effect on compliance with standard precautions. Personal resilience played a negative moderating role in the relationship between servant leadership and emotional exhaustion. For nurses with low resilience, servant leadership had a greater impact on emotional exhaustion. Conclusion: The current compliance with standard precautions for clinical nurses is not high due to emotional exhaustion. The level of servant leadership can alleviate nurses' emotional exhaustion and improve compliance with standard precautions. Especially for nurses with low personal resilience, the care and support of department leaders are needed. Impact: We found that the compliance with standard precautions is not high, and the link between emotional exhaustion, servant leadership and compliance with standard precautions provides a basis for further patient care. No Patient or Public Contribution: There was no patient or public involvement. Impact Statement: Nurses are the key population for hospital infection prevention and control, and their level of compliance with standard precautions is of great significance for hospital infection prevention and control. However, in practice, nurses' compliance with standard precautions is generally low. Most of the previous studies on nurses' compliance with standard precautions were conducted from the perspective of individual nurses, based on the staff's 'knowledge, belief, and action' to study the current status of compliance with standard precautions and the factors affecting adherence, with less attention paid to the influence of psychological, environmental, and organizational factors. Therefore, the study focuses on the impact of servant leadership and emotional exhaustion on standard precautionary adherence, which is of great significance for good care management at the organizational level. It also explored how the impact of servant leadership on emotional exhaustion varies across levels of resilience, which is important for accurately identifying different types of nursing staff and targeting assistance. [ABSTRACT FROM AUTHOR]

Aim: The study explores the experiences of women with low‐risk pregnancies and no complications who planned a home birth. Design: A cross‐sectional study was conducted using an online questionnaire. Methods: The questionnaire included socio‐demographic, obstetric and perinatal variables. Birth satisfaction was evaluated via the Spanish version of the childbirth experience questionnaire. The study group comprised home‐birthing women in Catalonia, Spain. Data were collected from 1 January 2019 to 31 December 2021. Statistical analysis was performed using SPSS. Results: A total of 236 women responded. They reported generally positive experiences, with professional support and involvement being the most highly rated dimensions. Better childbirth experiences were associated with labour lasting less than 12 h, no perineal injuries, no intrapartum transfers to hospital, euthocic delivery and the presence of a midwife. Conclusions: Women's positive home birth experiences were linked to active participation and midwife support. Multiparous women felt safer. Medical interventions, especially transfers to hospitals, reduced satisfaction, highlighting the need for improved care during home births. Implications for the Profession and Patient Care: Home births should be included among the birthplace options offered by public health services, given the extremely positive feedback reported by women who gave birth at home. Impact: Home birth is not an option offered under Catalonia's public health system only as a private service. The experience of home‐birthing women is unknown. This study shows a very positive birth experience due to greater participation and midwife support. The results help stakeholders assess home birth's public health inclusion and understand valued factors, supporting home‐birthing women. Reporting Method: The study followed the STROBE checklist guidelines for cross‐sectional studies. Public Contribution: Women who planned a home birth participated in the pilot test to validate the instrument, and their contributions were collected by the lead researcher. The questionnaire gathered the participants' email addresses, and a commitment was made to disseminate the study's results through this means. [ABSTRACT FROM AUTHOR]

Aims: To examine (1) the association between healthcare workers' workplace ostracism and job satisfaction, stress and perceived health, and (2) whether this relationship is mediated by loneliness and self‐esteem. Design: A cross‐sectional study. Methods: Healthcare (N = 569) managers and employees (nurses, practical nurses, doctors and social workers) in Finland responded to a semi‐structured survey in January 2021 and evaluated their experiences of workplace ostracism, job satisfaction, stress, perceived health, loneliness and self‐esteem during the last year. To examine the association of these variables, linear regression and mediator model tests were performed. Results: Workplace ostracism had a clear direct association with job satisfaction, stress and perceived health. Loneliness fully mediated the relationship between workplace ostracism, stress and perceived health, and partly mediated the association between workplace ostracism and job satisfaction. Self‐esteem partly mediated the association between workplace ostracism, stress, job satisfaction and perceived health. Conclusion: The experience of workplace ostracism in organizations is a significant factor in job satisfaction, stress and perceived health. Healthcare organizations could strengthen job satisfaction and increase workers' well‐being by strengthening social relationships in the organization and, via that, reducing turnover intention. Implications for the profession and patient care: This study gives understanding and information to the healthcare profession on how workplace ostracism affects work well‐being and workplace relationships. Workplace ostracism decreases interaction, which can also endanger patient care if information is not openly exchanged. Impact: This study indicated that workplace ostracism weakened job satisfaction more than loneliness. More commonality and consideration for others at work are needed because these factors may help increase work well‐being and decrease exits from working life. Further research is needed on why workplace ostracism occurs in healthcare workplaces. Reporting Method: STROBE. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to assess the level of mental workload of Chinese nurses through a latent profile analysis and to explore its relationship with public health emergency response capacity. Design: A cross-sectional design with a convenience sample. Methods: A convenience sample of nurses from five tertiary hospitals in Chengdu between May and December 2022. Demographic, work-related information, Nurse's version of NASA's Task Load Index Scale and Nurse's Public Health Emergency Response Capacity Scale were used in this study. Results: The mean scores for mental workload and emergency response capacity for nurses were (57.19 ± 15.67) and (3.58 ± 0.77) respectively. We found that the mental workload of nurses fell into three potential categories. In addition, there were differences in psychological training and supply of epidemic prevention materials in the department among nurses with different mental workload subtypes. There was a moderate negative correlation between nurses' mental workload and public health emergency response capacity. Conclusion: Our results show that there is still a strong mental workload on a proportion of nurses, and enhanced psychological training and material supply support are beneficial in relieving nurses' mental workload. The better the nurses' capacity to cope with public health emergencies, the lower their mental workload. Impact: Nursing managers should pay ongoing attention to the mental workload status of nurses in the latter stages of a pandemic and individual differences in nurses' mental workload. In addition, nursing managers should be aware of the impact of public health emergency response capacity on nurses' mental workload. They can intervene in nurses mental workload from a new perspective. [ABSTRACT FROM AUTHOR]

Aims: To examine the contributions of psychosocial factors (attitude towards drinking, perceived drinking norms [PDNs], perceived behavioural control [PBC]), and biological sex on drinking intention and behaviours among rural Thai adolescents. Design: A cross-sectional study design. Methods: In 2022, stratified by sex and grade, we randomly selected 474 rural Thai adolescents (Mage= 14.5 years; SD = 0.92; 50.6% male) from eight public district schools in Chiang Mai Province, Thailand, to complete a self-administered questionnaire. Structural equation modelling with the weighted least square mean and variance adjusted was used for data analysis. Results: All adolescents' psychosocial factors contributed significantly to the prediction of drinking intention, which subsequently influenced their drinking onset, current drinking and binge drinking pattern in the past 30 days. PDNs emerged as the strongest psychosocial predictor of drinking intention, followed by PBC. Rural adolescents' drinking intention significantly mediated the relationship between all psychosocial factors and drinking behaviours either fully or partially. The path coefficient between drinking attitude and drinking intention was significantly different between males and females. Conclusion: Different from previous studies focus on adolescents' drinking attitude, rural Thai adolescents' PDNs play a significant role on their drinking intention and subsequently their drinking onset and patterns. This nuanced understanding supports a paradigm shift to target adolescents' perceived drinking norms as a means to delay their drinking onset and problematic drinking behaviours. Impact: Higher levels of perceived drinking norms significantly led to the increase in drinking intention among adolescents. Minimizing adolescents' perceptions of favourable drinking norms and promoting their capacity to resist drinking, especially due to peer pressure, are recommended for nursing roles as essential components of health education campaigns and future efforts to prevent underage drinking. [ABSTRACT FROM AUTHOR]

Aim: To examine the mental health conditions of family caregivers residing away from their loved ones who experienced visitation restrictions during the coronavirus disease 2019 pandemic. Design: A mixed-methods design applying the Kessler Scale-10 for the quantitative measurement of psychological distress and an open-ended question for qualitative analysis. Methods: The participants were recruited from care facilities between February and September 2021. This cross-sectional study included 197 family caregivers who were utilizing formal residential care services for their loved ones. Using thematic analyses, open-ended responses regarding the impact of visitation restrictions were coded. These themes were then examined to determine thematic patterns across caregiver characteristics. Results: Thirteen themes were identified regarding the impact of visitation restrictions. Many participants reported primary harmful effects as follows: ‘inability to confirm the type of care and lifestyle assistance provided to an older relative’ and ‘difficulty communicating with an older relative because of the inability to converse face-to-face’. Younger age, being employed, poor sleep, poor relationship quality with the care recipient and experiencing harmful effects from the visitation restrictions were associated with psychological distress. Conclusion: Our findings suggest that to maintain positive mental health after a care transition, it is important for family caregivers to take part in the care of their loved ones and ensure information sharing between the care recipient's family and institution. Impact: These findings suggest that both residents and family caregivers living outside facilities may feel distressed due to separation. Therefore, institutional care staff needs to consider how to adjust facility procedures or communication with family caregivers. [ABSTRACT FROM AUTHOR]

Background: Authentic leadership and empowered nurses are necessary if a healthy work environment is to be created and patient safety maintained; however, few studies have examined the impact of authentic leadership, on nurse empowerment and the patient safety climate. Purpose: The aim of the study was to investigate the impact of an educational intervention delivered through a multi-faceted training programme on nurses' perceptions of authentic leadership, nurse empowerment (both structural and psychological) and the patient safety climate. Design: A quasi-experimental study using a one-group pretest–posttest design consistent with TREND guidelines. Methods: The study was conducted in a university hospital between December 2018 and January 2020. Participants were followed for 6 months. The programme involved 36 head nurses (leaders) and 153 nurses (followers). The effectiveness of the programme was evaluated using repeated measures of analysis of variance, dependent sample t-tests and hierarchical regression analysis. Results: Following the intervention, safety climate and authentic leadership scores increased among both leaders and followers. Structural and psychological empowerment scores also increased among followers. We found that authentic leadership and structural empowerment were predictors of safety climate. Conclusion: The implementation of the education programme resulted in positive changes in participants' perceptions of authentic leadership and empowerment, which can enhance patient safety. Implications: Healthcare organizations can implement similar multi-faceted training programmes focused on authentic leadership, and nurse empowerment to increase patient safety. Achieving effective results in such programmes can be facilitated by motivating participants with the support of the top management. Patient or Public Contribution: The study included nurses in the intervention and the data collection processes. Impact: • Patient safety is a global concern, and improving patient safety culture/climate is a key strategy in preventing harm. • Authentic leadership and nurse empowerment are essential in creating healthy work environments and delivering safe, high-quality care. • Training programmes addressing these issues can help bring about improvements in healthcare organizations. [ABSTRACT FROM AUTHOR]

Aim: To psychometrically assess the Spanish version of the Self‐Care of Chronic Illness Inventory (SC‐CII‐Sp) in community‐dwelling older adults with chronic multimorbidity. Design: A methodological study. Method: A total of 1260 older adults participated in the study between May 2020 and February 2022. The data were analysed using SPSS Statistics® 26 and AMOS® 24. The items' content validity index and the Fleiss' kappa were calculated to assess the SC‐CII‐Sp's content validity. Convergent validity was assessed by calculating the Pearson correlation coefficient between the participants' scores on the SC‐CII‐Sp and their scores on the Spanish Chronic Disease Self‐Efficacy scale (SCD‐SE). Construct validity was tested by performing a confirmatory factor analysis (CFA). The SC‐CII‐Sp's reliability was tested by computing the Cronbach's alpha. Results: The SC‐CII‐Sp showed good content and convergent validity. The CFA showed that the SC‐CII‐Sp has three sub‐scales. The 8‐item Self‐Care Maintenance sub‐scale has good internal consistency and is comprised of two dimensions: illness‐related and health‐promoting behaviour. The Self‐Care Monitoring sub‐scale had excellent internal consistency and its five loaded items belonged to a single dimension. The 6‐item Self‐Care Management sub‐scale has adequate internal consistency and two dimensions: autonomous and consulting behaviour. Conclusion: The Spanish version of SC‐CII is a valid and reliable instrument to be used in the assessment of self‐care behaviours amongst Spanish‐speaking, community‐dwelling older adults with chronic multimorbidity. Implications for the Profession: Nurses need valid and reliable tools to assess self‐care behaviours in Spanish‐speaking community‐dwelling older adults with chronic multimorbidity. This study provides a 19‐item tool that allows for the comprehensive evaluation of self‐care behaviours in healthy and ill states. Impact: Using the SC‐CII‐Sp in clinical or research settings could help nurses to examine the effects of different interventions on self‐care behaviours amongst Spanish‐speaking, community‐dwelling older adults with chronic multimorbidity. Patient or Public Contribution: None to be reported. [ABSTRACT FROM AUTHOR]

Aim: To explore which factors, influencing dietary behaviour change support among patients by Dutch community nurses (CNs; nurses), are key focal points in training programmes. Background: Nurses have an important role in counselling patients towards healthier dietary behaviour to prevent or delay long‐term complications from chronic lifestyle‐related diseases. Most nurses do not incorporate dietary behaviour change support in their routines to the fullest potential. Design: A qualitative descriptive study. Methods: Data were collected in the Netherlands in 2018–2019 via semi‐structured face‐to‐face interviews with 18 nurses. Interview guide themes were informed by the COM‐B model, using validated descriptions in Dutch. Data were recorded, transcribed and analysed using inductive thematic analysis. Results: Factors that affected dietary behaviour change support were linked to (1) the nurse (role identity, dietary knowledge and competences such as methodical approach, behaviour change techniques and communication techniques), (2) nurse–patient encounter (building a relationship with a patient, supporting patient autonomy and tailoring the approach) and (3) cooperation and organizational context. Conclusion: It is of utmost importance to pay attention to nurses' role identity regarding dietary behaviour change support, as this underlies professional behaviour. This should be accompanied by improving competences on dietary behaviour change support. Focus on competences regarding the application of behaviour change technique is crucial. Furthermore, having a relationship of trust with a patient was important for discussing sensitive topics such as diet. Impact: The promotion of a healthy diet provides opportunities to contribute to patient autonomy and self‐management. Well‐fitted training offers for (senior) nurses will lead to improved professional practice of nurses, leading to healthier dietary behaviour of patients. Patient or Public Contribution: A nurse provided feedback on the interview guide. [ABSTRACT FROM AUTHOR]

Aims: To investigate which work‐related factors are associated with work–family conflict of care workers in nursing homes, this study aimed to: (a) describe the prevalence of work–family conflict of care workers in nursing homes and (b) assess the association of work‐related factors with work–family conflict. Design: Cross‐sectional multicentre sub‐study based on data from the Swiss Nursing Homes Human Resources Project 2018. Methods: Data were collected between September 2018 and October 2019. Work–family conflict of care workers was assessed with the Work–Family Conflict Scale (range 1–5). Prevalence was described in percentages. We used multilevel linear regression to assess the association of time‐based factors (working overtime or during one's free time, employment percentage, presenteeism, shift working) and strain‐based factors (staffing adequacy, leadership support) with work–family conflict. Results: Our study sample consisted of 4324 care workers working in a total of 114 nursing homes. Overall, 31.2% of respondents stated to have experienced work–family conflict (>3.0 on the Work–Family Conflict Scale). The overall mean score of the study sample for work–family conflict was 2.5. Care workers experiencing presenteeism 10 or more days per year showed the highest scores for work–family conflict (mean: 3.1). All included predictor variables were significant (p <.05). Conclusion: Work–family conflict is multifactorial. Possible intervention points to tackle work–family conflict could be strengthening care workers' influence in planning work schedules, enabling flexible planning to ensure adequate staffing, lowering presenteeism and implementing a supportive leadership style. Impact: Care workers' jobs become less desirable when workplace demands interfere with family life. This study highlights the multifaceted nature of work–family conflict and suggests intervention options to prevent care workers from experiencing work–family conflict. Action is needed at nursing home and policy level. [ABSTRACT FROM AUTHOR]

Aim: To describe a Delphi study regarding practice variation in needs assessment by Dutch home care nurses, to define practice variation in home care nursing and explore which factors may have a role in this needs assessment. Design: A Delphi study was conducted with the participation of home care representatives. Method: A Delphi questionnaire was developed, preceded by literature research and an expert meeting. The Delphi study took place between December 2020 and February 2021. The goal was to achieve a consensus level of at least 70%. Results: After three rounds, 32 experts reached a consensus about definitions regarding variation in needs assessment, warranted and unwarranted variation. In total, 59 factors were determined related to (1) the client and health, (2) the clients' context, (3) nurses and (4) the nurses' context. Thirty‐four factors scored warranted of influence and 18 (of 34) were client related. Most of the factors that scored unwarranted influencing needs assessment (17 of 26) were related to the home care nurses' context. Conclusion: Having a consensus about the definition of practice variation in needs assessment and possible influencing factors support the professionals to discuss and improve the unity and quality of their decision‐making process in home care. This may contribute to more righteous care for clients in need of home care. Impact: Since 2015, home care nurses in the Netherlands are responsible for determining the amount, type and duration of care for clients in need of home care. This so‐called needs assessment legitimizes the payment by health insurers. Signals of practice variation in needs assessment are heard in home care field. Although practice variation may be justified, it can lead to over or underuse of care, which may affect clients' outcomes. If we can identify influencing factors and find patterns that contribute to practice variation, we might gain a better understanding of the process and improve home care. Patient or public contribution: In this study, there was no patient or public involvement. Client representatives were included in this research as experts in the home care field, and they participated in three rounds of the Delphi study. They contributed by sharing their expert opinion on the definitions presented and the factors possibly influencing needs assessment. [ABSTRACT FROM AUTHOR]

Aims: To describe nurses' perceptions of family nursing practice and to explore the influence of their perceptions of the benefits, barriers and activities of family engagement in care on family nursing practice. Design: A cross‐sectional correlational study. Methods: In total, 460 nurses from two tertiary hospitals in the central region of Uganda participated. Quantitative and qualitative data were collected between August 2020 and January 2021 using the Family Nursing Practice Scale. Analyses included descriptive statistics, t‐test, Pearson correlation, analysis of variance and ordinal logistics regression. Quantitative content analysis was carried out on the textual data. Results: Nurses who perceived that family engagement in care improves patient and family outcomes were more likely to rate family nursing practice highly. Perceived barriers to family engagement in care particularly time constraints, work overload and family‐related conflicts have a negative and significant influence on family nursing practice. Nurse characteristics such as education, usual shift pattern and personal experience of having a family member in hospital are significantly associated with family nursing practice; nurses who work morning shifts were likely to report higher family nursing practice. Conclusion: The study reveals that several parameters (perceived barriers, perceived benefits and nurse characteristics) influence nursing practice with families. Thus, bearing in mind the diversity of healthcare contexts, the findings show that multiple interacting factors are important for advancing family nursing interventions and practice. Impact: Probabilistic factor‐specific predictions of nursing practice with families are provided in this study – this addresses a gap in the evidence regarding the elements that should be optimized when designing well‐informed policies and interventions to advance family nursing practice. A comparison of results in the literature with the present study's findings suggests a need to broaden the scope and context perspective in future research and broaden the understanding of how nurses´ perceptions influence family engagement in care. Reporting method: The study adheres to the STROBE reporting guidelines. Patient or public contribution: Family members/caregivers were involved in the design of the study particularly in assessment of validation of the tools used in the study. [ABSTRACT FROM AUTHOR]

Aim: To understand the postpartum care received by birthing people with disabilities and their newborns, from their own perspectives. Design: A qualitative study with semi‐structured interviews. Methods: Between July 2019 and February 2020, in‐person and virtual interviews were conducted with 31 people with physical, sensory, and intellectual/developmental disabilities in Ontario, Canada, about the formal inpatient and outpatient services and supports they used in the first few months after they gave birth. Thematic analysis was used identify common themes. Results: We identified three overall themes concerning participants' postpartum care experiences and the different types of formal services received in and out of hospital: (1) lack of adequate care, (2) lack of provider awareness of disability and disability accommodations, and (3) fear of judgement, discrimination, and intrusive surveillance. The identified themes were applicable across disability groups. However, most comments on disability accommodations came from participants with physical or sensory disabilities, while participants with intellectual/developmental disabilities most commonly reported concerns about lack of adequate care and fear of judgement, discrimination, and intrusive surveillance. Conclusion: Findings indicate that postpartum care often fails people with disabilities. This could contribute to negative health consequences for them and their newborns. Impact: Birthing people with disabilities need multidisciplinary, proactive, and strengths‐based postpartum care to mitigate risk for health complications. Further, disability‐related training and guidelines for health and social service providers is required. Reporting method: Consolidated criteria for reporting qualitative research (COREQ). Patient or Public contribution: Our research team included two peer researchers with physical disabilities who served as co‐interviewers and participated in data analysis, contributing their lived experience of disability and interactions with the health care system. All stages of the study were also informed by feedback from the study's Advisory Committee, which comprised women with disabilities (many of whom are parents), disability organization staff, clinicians, and policy representatives. [ABSTRACT FROM AUTHOR]

Aim: To explore the relationships between public risk perceptions, emotions and behaviours during a major epidemic. Design: Exploratory cross‐sectional design. Methods: The 701 subjects were surveyed using self‐administered questionnaires, including the General Information Questionnaire, Public Risk Perceptions Questionnaire, Public Emotions Questionnaire and Public Behaviours Questionnaire. The results were analysed using structural equation modelling, and mediated effects were probed at the same time. Results: The median of the total scores of the Public Risk Perceptions Questionnaire was 70, the median of the total scores of the Public Emotions Questionnaire was 65 and the median of the total scores of the Public Behaviours Questionnaire was 83. Spearman's correlation analysis showed that the correlation coefficient ρ between public risk perceptions and emotions was 0.26 (p < 0.01); the correlation coefficient ρ between risk perceptions and behaviours was 0.36 (p < 0.01); and the correlation coefficient ρ between emotions and behaviours was 0.37 (p < 0.01). After many rounds of correction, the final model was established, the fit was good, and the results of the mediating effect analysis showed that the level of public risk perceptions under a major epidemic had a direct positive effect on public emotions (β = 0.41, p < 0.01) and public behaviours (β = 0.51, p < 0.01). The level of public risk perceptions also had an indirect positive effect on behaviours by affecting public emotions (β = 0.11), while public emotions had a direct positive effect on public behaviours (β = 0.27, p < 0.01). Conclusions: Our findings revealed that public perceptions and public emotions directly influenced public behaviours. Additionally, public perceptions can indirectly influence public behaviours through public emotions. [ABSTRACT FROM AUTHOR]

Aim: We tested key hypotheses derived from the Cultural Determinants of Trauma Recovery Theory (CDTR) with an American sample. Design: A cross‐sectional study using anonymous online surveys. Methods: This study was conducted with 225 American survivors of gender‐based violence (GBV) between August to November 2019. Demographics, distress (depression: PHQ8; PTSD: PCL‐5), mental health service utilization (counselling and medication), sense of coherence (SOC), internal barriers to help‐seeking (shame, frozen and problem management subscales: BHS‐TR Internal) and the GBV healing (GBV‐Heal) were used. Structural equation modelling (SEM) was conducted to test the hypotheses. Results: The final SEM model showed that the relationship between distress and mental health service utilization was not mediated by internal help‐seeking barriers; the relationship between distress and trauma healing was partially mediated by internal help‐seeking barriers; the relationship between internal help‐seeking barriers and trauma healing was partially mediated by SOC; mental health service utilization was not significantly associated with trauma healing. Overall, the relationship between distress and trauma healing was partially mediated by internal help‐seeking barriers and SOC. Conclusions: This study confirmed some hypothetical pathways between distress and trauma healing. Further research with larger and international samples should be necessary to test the overall CDTR and compare groups. Impact: This study can help us focus on psychological interventions that enhance meaning and mitigate internal help‐seeking barriers to promote holistic trauma recovery. Public and public contribution: The sample was gathered from a clinical population registry that alerts patients of potential research opportunities. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to develop a predictive model that can identify the suicidal ideation risk group among older adults in rural areas using machine learning methods. Design: This study applied an exploratory, descriptive and cross‐sectional design. Methods: The participants were older adults (N = 650) aged over 65 living in rural areas of South Korea. Self‐report questionnaires were used to collect the demographics, suicidal ideation, depression, socioeconomic information and basic health information from September to October 2020. The collected data were analysed using machine learning methods with R statistical software 4.1.0. Results: The predictive models indicated that depression, pain, age and loneliness were significant factors of suicidal ideation. Good performance was observed based on the area under the receiver operating characteristic curve in the decision tree, random forest and logistic regression. Finally, the evaluation of model performance indicated moderate to high sensitivity and specificity. Conclusion: The predictive models using machine learning methods may be useful to predict the risk of suicidal ideation. Furthermore, depression with pain, age and feelings of loneliness should be included in the initial screening to assess suicide risk among older adults in rural areas. Impact Identifying suicidal risk among older adults is challenging. Thus, employing predictive models that can assess depression, pain, age and loneliness can enable public healthcare providers to detect suicidal risk groups. Particularly, the presented models from this study can facilitate healthcare providers with initiating early interventions to prevent suicide among older adults in clinical and community nursing care settings. Reporting Method: The reporting of this study (Observational, cross‐sectional study) conforms to the STROBE statement. Patient or Public Contribution: No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public. Implication for the Profession and/or Patients Care: Applying this model may help to prevent geriatric suicide because the nursing staff will have a greater awareness regarding the suicide ideation risk of older adults, thereby reducing the possibility of their suicide. [ABSTRACT FROM AUTHOR]

Aim: In this study, a person‐centred approach was used to analyse career success profiles and explore the associated psychosocial factors among nurses. Design: A cross‐sectional study was conducted from 15 April to 15 October 2019. Methods: A total of 1155 registered Chinese nurses were recruited from two general hospitals using convenience sampling. Participants completed a printed questionnaire, including the Maslach Burnout Inventory, Stress of Conscience Questionnaire, Practice Environment Scale, and Career Success Scale. Latent profile analysis and multinomial logistic regression were performed. The data were analysed with Mplus 8.3 and SPSS version 26.0. Results: Three latent profiles of career success were identified: high, moderate and low. Nurses with lower educational levels, more years of work experience, lower emotional exhaustion, higher personal achievement, lower stress of conscience and higher participation in hospital affairs were more likely to have higher career success than the other profiles. Conclusions: Burnout, stress of conscience, practice environment, educational level and years of work experience were associated with career success among nurses. Targeting interventions may help enhance nurses' career success. Future research should combine subjective and objective indicators (salary, title and so on) to assess career success and explore other determinants for formulating interventions to enhance nurses' career success. Impact The heterogeneity and psychosocial factors associated with nurses' career success provide valuable evidence for the formulation of individualized interventions. Nursing managers should understand the importance of career success, develop interventions to reduce nurses' burnout and stress of conscience, and improve the practice environment to enhance their career success. No Patient or Public Contributions: This study was designed to examine the psychosocial factors associated with nurses' career success. The study was not conducted using suggestions from the patient groups or the public. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate nursing students' clinical decision‐making by using high‐fidelity simulation of a deteriorated patient scenario. Design: A convergent parallel mixed methods research design was used consisting of quantitative and qualitative data collection. Methods: Twenty‐three students completed the Health Science Reasoning Test before and after the simulation between October 2015 and June 2016. They were presented with a simulated scenario and asked to 'think aloud' during and after the simulation. The students were audio‐video recorded and observations were collected by the researcher. Results: There was a significant moderate increase in the 'deduction' and 'analysis' sub‐scale scores and overall test score, suggestive of improved analytical decision‐making processes through the simulation experience. Think‐aloud and observation data identified that students predominantly applied 'forward' reasoning during the simulated 'patient's' deterioration, focusing mainly on cue acquisition. 'Backward' reasoning with a focus on cue interpretation was most prominent in the debriefing data, in line with the survey outcomes. Accurate cue interpretation of critical, key cues appeared more useful than the total number of cues in solving the main clinical case problem. Conclusion: Students learn different clinical decision‐making skills during the simulation compared to what they learn from debriefing. Using observation and think‐aloud methods have significant benefits for researchers seeking to optimize the evaluation of the clinical decision‐making process. [ABSTRACT FROM AUTHOR]

Aim: The aim was to examine the subgroups of work engagement in frontline nurses during the COVID‐19 pandemic. Background: The pandemic may affect the work engagement of nurses who have direct contact with infected patients and lead to a poor quality of care. Identifying classification features of work engagement and tailoring interventions to support frontline nurses is imperative. Design: This study utilized a cross‐sectional study design. Methods: Three hundred fifty‐five nurses were enrolled in this cross‐sectional study from 14 February to 15 April 2020. A latent profile analysis was performed to identify classification features of work engagement. Multiple logistic regression analyses were used to examine predictors of profile membership. Results: A four‐profile model provided the best fit. The four profiles were titled 'low work engagement' (n = 99), 'high vigour‐low dedication and absorption' (n = 58), 'moderate work engagement' (n = 63) and 'high work engagement' (n = 135). A regression analysis suggested that young nurses and nurses who were the only children of their family were more likely to be in the 'low work engagement' and 'high vigour‐low dedication and absorption' groups. Conclusion: This study highlights the importance of tailoring interventions for frontline supporting nurses by considering their distinct work engagement patterns, especially during the COVID‐19 pandemic, to improve the promotion of work satisfaction and quality of care. Impact This was the first study to explore the latent profiles of work engagement in frontline nurses during the COVID‐19 pandemic. Over 40% of nurses were in the 'low work engagement' and 'high vigour‐low dedication and absorption' groups and reported low levels of work engagement. Understanding different patterns of work engagement in frontline nurses can help nursing managers provide emotional, material and organizational support based on the features of each latent profile, which may improve the quality of care and patient safety. [ABSTRACT FROM AUTHOR]

Aims: Walking and cycling are beneficial for urban adults' health. Transport and recreation are modifiable domains of major physical activity resources. The purposes of this study were to explore associations among psychological and environmental factors, walking and cycling behaviours and quality of life by developing a path model and comparing gender differences. Design: A cross‐sectional study. Methods: Participants were community‐dwelling healthy urban adults aged 20–65 years. Data were collected between September 2019 and June 2020 by self‐reported questionnaires, including health beliefs, the neighbourhood environment, walking and cycling behaviours and the World Health Organization Quality‐of‐Life Scale. An ANCOVA, chi‐squared tests, partial least squares‐path model and a multi‐group analysis were performed for statistical analyses. Results: In total, 1294 valid responses were received, which included 41.27% men and 58.73% women. Men had lower walking behaviours and better self‐efficacy than women. The developed path model indicated an acceptable model fit. Significant path coefficients were found among psychological and environmental factors, walking and cycling behaviours and quality of life. The path model between men and women found no significant differences in any path coefficients. Significant path coefficients of environmental factors with cycling behaviour and of walking behaviour with quality of life were found in men but not in women. Conclusion: Improving individuals' health beliefs, self‐efficacy and perceived walkability and cyclability is a beneficial strategy for promoting physical activity. Walking and cycling behaviours are recommended to improve the quality of life of urban adult populations. Impacts: What problem did the study address? A large proportion of urban adult populations still have insufficient physical activity globally. It is essential that implications from an overall perspective of psychological and environmental factors and their interactions be integrated to develop efficient strategies for promoting physical activity and quality of life. What were the main findings? The developed path model with an acceptable model fit found that psychological and environmental factors were important in explaining urban adults' walking and cycling behaviours and quality of life. Differences were not found between men's and women's path models. Where and on whom will the research have impact? Improving urban adults' psychological and environmental factors might be an efficient strategy for promoting sufficient physical activity. Men's low engagement in walking behaviours should garner increased attention. Providing equal opportunities for both genders to engage in walking and cycling behaviours are recommended for health promotion in urban regions. [ABSTRACT FROM AUTHOR]

Background: Preventable harms during hospitalization pose a major challenge for health systems globally. Nurse‐led strategies provide comprehensive harm prevention to keep the most vulnerable patients safe in hospital, but gaps in care are common. Nursing roles and activities to prevent harm to patients during acute hospitalization are poorly understood. Aim: The aim of this study was to identify nurses' perceived enablers and barriers to the implementation of comprehensive harm prevention for older people admitted to an acute hospital setting. Design: Anonymous, online, cross‐sectional survey. Methods: The adapted Influences on Patient Safety Behaviours Questionnaire (IPSBQ) was used to collect data from nurses working on five general medicine wards across three hospitals of a single tertiary health service in Australia in 2019. Participants also rated their perceptions of overall quality of care, missed care and awareness of strategies for an eight‐factor framework for comprehensive harm prevention. The STROBE reporting checklist was used. Results: Ward response rates between 35% and 58% resulted in 132 complete questionnaires for analyses. High mean scores for behavioural regulation (3.28), beliefs about capabilities (2.96) and environmental context and resources (2.73) indicated these domains were perceived by nurses as enablers. Low mean scores for the domains of intentions (1.65), beliefs about consequences (1.69), optimism (1.72) and professional role and identity (1.85) indicated these were barriers to comprehensive harm prevention by nurses. High perceived quality of care (scored 9–10/10) (p =.024), and awareness of strategies for the eight‐factor framework (p =.019) were significant enablers of comprehensive harm prevention. Conclusion: Targeted evidence‐based strategies that include education, persuasion, incentivization, coercion and modelling would be most useful for promoting comprehensive harm prevention by nurses. However, to be most effective the harm prevention strategy may need to be tailored for each ward. [ABSTRACT FROM AUTHOR]

Aims: To describe adult intensive care nurses' experiences and attitudes towards intrahospital transport (IHT) of critically ill patients and to assess the relationship between nurses' characteristics, attitudes and experiences. Design Cross‐sectional survey. Methods: Factor analysis identified factors within the attitudinal and experience domains. Univariate analysis was performed to demonstrate the relationship between attitudinal and experience factors and demographic and professional characteristics of the participants. Multiple regression equations were applied to determine associations between nurses' experiences and attitudes. The study took place from July to August 2019. Results: A total of 480 nurses from 12 adult intensive care units in China participated, with a response rate of 65%. Most respondents had a baccalaureate nursing degree (75%). The majority (80%) had participated in IHT of critically ill more than five times in the previous 12 months and 90% agreed that checklists led to an improvement in patient safety during transport. However, 75% of respondents expressed that transport increased the workload of the nurses who accompany patients off unit and those who remained in the intensive care unit (66%). Variables that were associated with a favourable perception of transport competency and checklists/tool use were nurses' prior transport experiences and knowledge/training. Conclusion: Nurses perceived IHT was a sourse of stress and increased workload. Checklists and training were beneficial for patient safety during IHT. Impact The findings point out a clear need for ICU nurse training, standardised policy/procedure and customisation of existing intrahospital transfer checklists according to hospital procedures and local circumstances. New research is needed to evaluate the impact of novel IHT interventions on patient safety and nurses' stress. [ABSTRACT FROM AUTHOR]

Aims: To examine the psychometrics and measurement invariance of the Short‐Form Health Literacy 12‐item questionnaire (HL‐SF12) among Vietnamese and Indonesian married immigrants. Design: A cross‐sectional survey design. Methods: In total, 1171 Vietnamese and Indonesian married immigrants were enrolled between September 2019 and December 2019. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to verify the structural validity of the suggested factor structure. The multiple‐group CFA (MGCFA) used a series of hierarchical nested‐in models as a measurement invariance test which confirmed the adequacy of the model fit at each stage. Results/Findings The Kaiser–Meyer–Olkin coefficient was 0.898, and the Bartlett test of sphericity was statistically significant (χ2[66] = 1965.97, p < 0.01). According to a scree plot and Kaiser's criterion for eigenvalues of >1, the EFA explained 61.6% of the total variance and confirmed three theoretically supported factors of health care, disease prevention and health promotion. The 12 items showed factor loadings of >0.4 and four items were in each subscale. The CFA showed adequate structural validity, including a relative chi‐squared/degrees of freedom (X2/df) of 2.01, a comparative fit index (CFI) of 0.98 and a root mean square error of approximation (RMSEA) of 0.04 (95% confidence interval [0.03, 0.05]) in married immigrants. For the measurement invariance, a change in the goodness‐of‐fit measures did not exceed 0.02 for the RMSEA or 0.01 for the CFI. The results indicated Cronbach's α values of 0.87 for the HL‐SF12 scale in Vietnamese and Indonesian combined samples (n = 1171). A t‐test showed that the HL‐SF12 and its three subscales were unable to significantly differentiate between Vietnamese and Indonesian groups (all p > 0.05). Conclusions: The HL‐SF12 scale showed acceptable theoretically supported structural validity, equivalent measurement invariance and reliable internal consistency among Vietnamese and Indonesian married immigrants. Measurements of immigrants' HL using the HL‐SF12 could be integrated into future immigrant health policies. Impact As the first study of the measurement invariance of the HL‐SF12 instrument among immigrants. Related factors of immigrants' HL can be further explored to increase immigrants' health and empowerment. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of the COVID‐19 pandemic on the emotional and spiritual well‐being and resilience of a global sample of Advanced Practice Nurses. Design A web‐based cross‐sectional mixed methods study. Survey data were collected from Advanced Practice Nurses globally over a 2‐month period ending on 31 August 2020. Methods: The Warwick‐Edinburgh Mental Well‐being Scale, FACIT‐12 Spiritual Well‐being Scale and Connor‐Davidson Resilience Scale 10 were used to quantify emotional and spiritual well‐being and resilience of Advanced Practice Nurses' globally. The survey was distributed internationally using snowball sampling via a secure platform (Qualtrics). Results were analysed using various bivariate tests for associations and group differences. Results: Nine hundred and twenty‐eight Advanced Practice Nurses from 53 countries participated in the study. Study participants reported meaningfully lower scores in resilience and emotional well‐being compared with non‐pandemic scores. Participants from countries with well‐developed Advanced Practice Nurses roles reported lower resilience and well‐being scores compared with those from countries where Advanced Practice Nurses roles are still being developed. Each scale revealed significant positive associations with the other scales. Conclusions: Emotional and spiritual well‐being and resilience of Advance Practice Nurses has been significantly impacted during the COVID‐19 pandemic. Regardless of their work location, work hours, credential or demographics, the APNs in our study reported lower levels of resilience and mental well‐being compared with typical scores on the instruments. [ABSTRACT FROM AUTHOR]

Aim: To explore how nurses perceived having a calling to nursing. Design A mixed‐method study. Methods: Survey data collected in autumn 2020 and semi‐structured individual interview data collected in spring 2021. The 7925 survey respondents were care professionals and 414 of them were registered nurses. The 23 interview participants were registered nurses who responded to the survey. We examined the survey results using analysis of variance and t‐tests and the interview data with qualitative thematic analysis. Results: Registered nurses had a lower calling than other care professionals. Based on the interviews, having a calling to nursing produce four key findings. Nurses with a calling experienced their work as meaningful. They also adopted a humane and holistic approach to their work. However, their calling could change during their professional career. Due to its historical roots, having a calling was seen as a risk for the nursing profession, as it meant nurses had an oppressed position in society and nurses associated it with poor working conditions and low pay. Conclusion: Our study showed that having a calling to nursing had multidimensional benefits for the individual nurse, their patient, colleagues, organization and society, but showed strong association between calling and nurses' poor working conditions and low pay. Impact We found that nurses had a lower calling than other care professionals. Calling still exists, but it can produce tension in modern nursing. Organizations and society need to focus on how calling can be seen as a more positive attribute of nursing and improve nurses' working conditions and pay. [ABSTRACT FROM AUTHOR]

Aims: To examine patient-caregiver concordances about psychological distress among Chinese patients with breast cancer undergoing chemotherapy and identify factors related to concordance among patients and family caregivers. Design: Cross-sectional study. Methods: From October 2019 to June 2020, 137 patient-caregiver dyads were enrolled. Sociodemographic information, the distress thermometer (including the problem list), the Distress Disclosure Index and the Family Adaptability and Cohesion Evaluation Scale were used to collect data. Data were analysed using intraclass correlation coefficients (ICC), kappa statistics, two related samples test, chi-square tests and/or Fisher's exact tests and binary logistic regression. Results: Overall, fair agreement was identified between patients' and caregivers' reports (intraclass correlation coefficients [ICC] = .528). Patients reported significantly higher psychological distress scores than paired caregiver reports. Lower psychological distress concordance was found among patients with comorbidities (odds ratio [OR], 0.352; 95% confidence interval [CI], 0.155-0.798) and lower levels of self-disclosure (OR, 0.402; 95% CI, 0.186-0.868). Conclusion: There was relatively low concordance between patients' reports and caregivers' perceptions of psychological distress. Family caregivers tended to underestimate patients' psychological distress. A comorbid condition and lower levels of self-disclosure contributed to this bias. Impact: Having an awareness of the incongruence between patient and caregiver may help healthcare providers better interpret caregiver assessments. Healthcare providers should reinforce patient-caregiver dyadic psychosocial education to improve concordance. More psychological care and substantial emotional support should be provided for Chinese breast cancer patients undergoing chemotherapy by family caregivers and healthcare providers. [ABSTRACT FROM AUTHOR]

Aim: To develop a comprehensive understanding of resilience and its associated factors among informal caregivers of people with heart failure. Design: Transnational multicentre convergent mixed methods approach. Methods: This study was conducted in three European countries: Italy, Spain and the Netherlands; during February 2017 and December 2018. In total, 195 caregivers completed the Connor–Davidson Resilience Scale, Caregiver Burden Inventory and Hospital Anxiety and Depression Scale. From a nested sample 50 caregivers participated in semi‐structured face‐to‐face interviews. Data were analysed using qualitative content analysis, multiple regression and joint displays. Results: The caregivers' mean age was over 60 years. The quantitative results showed that caregivers experienced anxiety and depression regardless of a good score of resilience and moderate level of burden. Regression analysis showed that the resilience was associated with caregiver depression. From qualitative findings three resilience inhibiting (psychological outlook, physical weariness and affective state) and two promoting factors (community interconnectedness and self‐comforting activities) were generated. Mixed analysis confirmed that depression decreased caregivers' resilience. Conclusions: Caregivers of people with heart failure experience continuous stress and anxiety resulting in reduced resilience. Collaborative efforts are needed to build multifaceted interventions and programs to enhance caregivers' resilience by targeting the factors identified in this study. Impact: The quality of informal caregiving is affected by the resilience of caregivers. No research has explored the resilience levels and its factors in this population. Depression, psychological outlook, physical weariness and affective state are negative factors of caregivers' resilience. Personal strategies combined with social and community support and belongingness enhance caregivers' resilience. Community care organizations and hospitals could establish alliances to develop programs for enhancing caregivers' resilience. [ABSTRACT FROM AUTHOR]

Aims: To examine the association of the timing and consistency of parent bedtime routines with infant night‐time sleep duration and variability. Design: This was a prospective observational study conducted between November 2012 and November 2016. Methods: Three hundred and twenty healthy 6‐month‐old infants were recruited from the well‐child clinics of a university‐affiliated hospital in northern Taiwan. Participating families provided sociodemographic, health and bedtime routine information. Infants wore an actigraph on the ankle for a week. General linear model analysis was performed with the frequency and timing of bedtime routines treated as the primary predictor variables of interest. Results: One hundred and ninety‐seven (61.6%) parents started the bedtime routine for infants after 9 PM, with 162 (50.6%) not having the exact same bedtime routine every night. In both crude and adjusted analyses, starting a bedtime routine after 9 PM was associated with shorter infant night‐time sleep duration (b = −23.55, p < 0.01). Infants with a bedtime routine of <3–4 nights per week were associated with more variable night‐time sleep duration than a bedtime routine of 5–6 nights per week (b = −7.81, p < 0.05) or every night (b = −8.47, p < 0.05). Conclusion: A bedtime routine of at least 5 nights a week and initiated no later than 9 PM was associated with longer and less variable night‐time sleep in infancy. Findings suggest that a consistent bedtime routine implemented in accordance with age‐appropriate bedtimes should be addressed as part of anticipatory guidance in the well‐child clinics. Future studies should include infant sleep variability as an outcome in addition to the conventional mean‐level sleep variable analyses to more thoroughly characterize bedtime routine effects. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to examine the association between the characteristics of a nursing student's final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries. Design: A longitudinal design with two data collections points (pre‐ and post‐graduate). Methods: The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence. Results: Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found. Conclusion: Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession. Impact: This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to identify the predicting factors of quality of life (QoL) from a set of psychosocial, sociodemographic and clinical variables amongst older adults in a long‐term care setting. Design: A cross‐sectional, descriptive correlational study. Method: The study was conducted in a nursing home and a day care centre from July to December 2019. Two hundred older adults were recruited. Guided by the salutogenic model, the sense of coherence (SOC) scale, Connor–Davidson resilience scale, de Jong Gierveld loneliness scale and World Health Organization quality of life instrument‐older adults (WHOQOL‐OLD) were used. The sociodemographic and clinical profiles of participants were collected. Descriptive statistics, Pearson product‐moment correlation coefficient, independent‐samples t test, one‐way analysis of variance and stepwise regression were utilised in the analysis. Results: The mean score for WHOQOL‐OLD was 94.42 ± 19.55. The highest mean score was observed in the "Death and Dying" facet, while the lowest mean scores were reflected in the "Autonomy" and "Intimacy" facets of QoL. Regardless of resident type, most QoL scores were similar across different variables. Based on the stepwise regression, higher manageability and meaningfulness in SOC, higher resilience, lower social loneliness, lower emotional loneliness and hearing impairments are significantly associated with higher QoL. Conclusion: Manageability, meaningfulness and resilience should be enhanced while ameliorating feelings of loneliness to improve the QoL amongst older adults receiving long‐term care. Age, marital status, educational level, care arrangement, body mass index, performance in activities of daily living, comorbidities and hearing and mobility impairments could influence QoL and thus warrant more attention. Impact: Future interventions can be conducted in group sessions to facilitate social interaction and alleviate loneliness. More resources should be allocated to enhance older adults' care arrangements and coping mechanisms to provide them with the support, as they face challenges in daily life due to mobility impairment and other restrictions. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the influence of leader mindfulness on hindrance stress in nurses. Based on the social mindfulness framework, the mediating effects of nurses' perceptions of their leaders' perspective taking and empathic concern and how they are moderated by mindfulness of nurses were investigated. Design: A time‐lagged cross‐sectional survey was conducted. Methods: The convenience sampling method was adopted. Data were collected at three time points from January to September 2020. A total of 393 paired datasets of nurses and their leaders were collected from 28 Chinese 3A grade hospitals. SPSS 23.0 and AMOS 23.0 were used for data analysis and hypotheses testing. Results: (1) Leader mindfulness significantly reduced nurse hindrance stress. (2) Both nurses' perceptions of their leaders' perspective taking and empathic concern mediated the relationship between leader mindfulness and nurse hindrance stress. Empathic concern was more effective than perspective taking in the process of leader mindfulness for reducing nurse hindrance stress. Nurses' perceptions of their leaders' perspective taking completely mediated the relationship between empathic concern and nurse hindrance stress. (3) Nurse mindfulness moderated the relationship between leader mindfulness and nurses' perceptions of their leaders' empathic concern but had no significant effect on the relationship between leader mindfulness and nurses' perceptions of their leaders' perspective taking. Conclusion: Leader mindfulness was an important interpersonal factor for reducing nurse hindrance stress. Nurses' perceptions of their leaders' perspective taking and empathic concern were pivotal mechanisms underlying the effectiveness of leader mindfulness. Nurse mindfulness is a situational factor that contributes to the effectiveness of leader mindfulness. Impact: Hospitals can benefit from mindfulness interventions by improving the mindfulness of leaders and nurses. Nurse managers are encouraged to promote social mindfulness, which will enable perspective taking and empathic concern by nurses and thus reduce hindrance stress on nurses during the pandemic. [ABSTRACT FROM AUTHOR]

Aim: The aim was to analyse the psychometric properties of a patient‐reported‐experience measure, the Patient Enablement and Satisfaction Survey (PESS), when used to evaluate the care provided by Advanced Nurse Practitioners (ANPs) in terms of factor structure and internal consistency. The PESS is a 20‐item, patient‐completed data collection tool that was originally developed to measure patient experience and enablement following consultation with nurses in general practice. Design: Cross‐sectional survey; validity and reliability analysis. Methods: The sample in this study consisted of 178 patients who consulted with 26 ANPs working in four different specialities. Data were collected between June and December 2019. An exploratory factor analysis of the PESS was conducted to determine convergent validity which was supported by parallel analysis and the traditional Kaiser criterion. The internal consistency of individual PESS items was determined via Cronbach's alpha, McDonald's omega, the Average Variance Extracted tests and item‐subscale/total score correlations. Results: A three‐factor structure (PESS‐ANP) was found through exploratory factor analysis and this was supported by parallel analysis, the traditional Kaiser criterion and the percentage of variance explained criterion. A high degree of internal consistency was reported across all factors. One question was omitted from the analysis ('Overall Satisfaction') following the identification of problematic cross‐loadings. The three factor solution was identified as: patient satisfaction, quality of care provision and patient enablement. Conclusion: The findings of this study propose a three‐factor model that is sufficiently reliable for analysing the experience and enablement of patients following consultation with an ANP. Impact: Increasingly, patient‐reported experience measures are being used to evaluate patients' experience of receiving care from a healthcare professional. The PESS was identified to be reliable in evaluating the experience of patients who receive care from an ANP while a three‐factor structure was proposed that can capture specific attributes of this care. [ABSTRACT FROM AUTHOR]