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Aim: To evaluate midwives' level of stress and burnout during the COVID‐19 Omicron phase in Italy. Secondary aims were to explore the impact of the pandemic on midwives' personal dimensions and professional activities and potential supporting strategies. Design: A mixed‐methods study was undertaken from July to December 2022. Methods: Data were collected using a national online observational survey. Descriptive and inferential analyses were performed to evaluate stress, burnout and the impact of the pandemic on personal and professional dimensions. A deductive qualitative approach was used to analyse open‐ended responses, that were merged with quantitative data following a convergent mixed‐methods approach. Results: A total of 1944 midwives participated in the survey. The stress summary score mean was 10.34, and 562 midwives (28.91%) experienced burnout. The intention to reduce working hours was reported by 202 midwives (10.39%), with 60.40% (n = 122) of them experiencing burnout. The intention to leave clinical practice within the following 2 years was reported by 239 (12.29%), with 68.20% (n = 163) of them experiencing burnout. All the personal dimensions and professional activities considered were defined by more than half of midwives as being impacted 'Moderately' or 'To a great extent' by pandemic. Stress and burnout frequencies increased when the midwives' perception of the pandemic effects was higher. Potential supporting strategies described by midwives as the most important in increasing their ability to cope with the pandemic were 'Women's awareness of the midwives' role' (n = 1072; 55.14%) and 'Family and friends' emotional support' (n = 746; 38.38%). Conclusion: Our findings suggested strategies to support a positive and safe working environment for midwives during a pandemic emergency, with potential transferability to similar contexts when human resources are lacking. It is recommended that maternity services provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Impact: Studies conducted during the first COVID‐19 pandemic wave showed an increased level of stress, anxiety, burnout, post‐traumatic stress disorder and depression experienced by healthcare professionals; moreover, midwives experienced drastic changes in care pathways and policies with struggles identified when providing high‐quality woman‐centred care following pandemic restrictions. Although it is recommended, there is lack of knowledge about long‐term psychological effects of COVID‐19 for midwives. Our study highlights that during the Omicron wave midwives experienced a high level of stress and burnout with an impact on individual dimensions and professional activities. Their stress and burnout were influenced by several factors, including restrictions in place, lack of organizational acknowledgement, work overload and need for extra childcare cover. Maternity services should provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Recommendations on how to facilitate this are suggested. Reporting Method: During the writing process, we referred to 'The Strengthening the Reporting of Observational Studies Epidemiology Statement', the guidelines for reporting observational studies from the Equator network. Patient or Public Contribution: No patient or public contribution. What does this paper contribute to the wider global clinical community?: Work overload conditions negatively impacted on the quality of maternity services. Improving organizational aspects, reducing working hours, promoting family and friends' emotional support and improving women's awareness of midwife's role were the main strategies reported by midwives. These suggestions for ensuring a positive and safe working environment for midwives during a pandemic emergency could potentially be applied to similar situations where human resources are lacking. [ABSTRACT FROM AUTHOR]

Aim(s): To assess the effectiveness of sub‐epidermal moisture (SEM) assessment technology in the detection of early‐stage pressure damage in a critical care unit (CCU) and dark skin tone patients and its impact on hospital‐acquired pressure injury (HAPI) incidence. Design: Quality improvement study employing Kurt Lewin's change model emphasizing planning, implementation, evaluation and sustainable change. Methods: The study evaluated 140 adult patients admitted to the CCU over a 24‐week period, from July to December 2022. Retrospective analysis of standard PI care pathways was performed in 90 patients admitted during a 12‐week pre‐implementation period. Fifty patients were admitted through the subsequent 12‐week implementation period. SEM assessments were performed daily at the sacrum and heels and interventions were applied based on SEM assessments; SEM delta ≥0.6 indicating localized oedema or persistent focal oedema. Statistical analyses were performed on anonymized data. Results: Pre‐implementation HAPI incidence was 8.9% (N = 8/90). All eight patients were African American with varying skin tones. A 100% reduction in HAPI incidence was achieved in the implementation period which included 35 African American patients. The relative risk of HAPI incidence was 1.6 times higher in the pre‐implementation group. Conclusion: Implementing SEM assessment technology enabled equitable PI care for all population types and resulted in a 100% reduction of PIs in our CCU. Objective SEM assessments detected early‐stage PIs, regardless of skin tone and enabled providing interventions to specific anatomies developing tissue damage as opposed to universal preventive interventions. Implications: PI care pathways relying on visual and tactile skin assessments are inherently biased in providing equitable care for dark skin tone patients. Implementing SEM assessments empowers healthcare practitioners in driving objective clinical interventions, eliminates bias and enables positive PI health outcomes. Impact: Implementing SEM assessment technology had three main effects: it detected early tissue damage regardless of skin tone (detection effect), enabled anatomy‐specific interventions (treatment effect) and prevented PIs across all population types (prevention effect). The authors have adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines. Patient or Public Contribution: No patient or public contribution. What does this paper contribute to the wider global clinical community? Addressing health inequities in pressure injury prevention; Demonstrated effectiveness across patient populations; Resource optimization and enhanced patient safety. [ABSTRACT FROM AUTHOR]

Aims: To explore predictors of lymphedema self‐management behaviours among Chinese breast cancer survivors based on the Integrated Theory of Health Behaviour Change, and to clarify the interrelationship among these variables. Design: Further analysis of a multicentre cross‐sectional and survey‐based study. Methods: A total of 586 participants with breast cancer were recruited from December 2021 to April 2022 in different cities in China. We used self‐reported questionnaires to collect data. Descriptive analysis, bivariate analysis and structural equation model were performed. Results: The Integrated Theory of Health Behaviour Change is suitable for predicting lymphedema self‐management behaviours. The final structural model showed good model fit. Social support, self‐efficacy and lymphedema knowledge positively affected lymphedema self‐management behaviours, directly and indirectly. Self‐regulation acted as a crucial mediator between these variables and self‐management. The direct path between social support and self‐regulation was not significant. Lymphedema knowledge and social support also influenced self‐management via illness perception, self‐efficacy and self‐regulation, sequentially. These variables explained 55.9% of the variance in lymphedema self‐management behaviours. Conclusions: The modified model based on the Integrated Theory of Health Behaviour Change fitted well in predicting lymphedema self‐management behaviours among breast cancer patients. Lymphedema knowledge, illness perception, self‐efficacy, social support and self‐regulation directly and indirectly influenced lymphedema self‐management behaviours. Impact: This study provides a theoretical basis for the assessment and interventions of lymphedema self‐management behaviours in breast cancer patients. Lymphedema self‐management behaviours should be assessed regularly and comprehensively, taking these predictors into consideration to identify potential barriers. Further research is needed to explore effective interventions integrating these significant predictors. Reporting Method: This study was reported following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross‐sectional studies. Patient or Public Contribution: No patient or public contributed to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript. What Does This Paper Contribute to the Wider Global Clinical Community?: This study focused on identifying and predicting mechanism of self‐management based on a theory of behaviour change. The results can be applied among patients with other chronic diseases or high‐risk populations, and inspire the assessment and interventions facilitating self‐management behaviours. Study Registration: This study was registered as an observational study at Chinese Clinical Trial Registry: http://www.chictr.org.cn (ChiCTR2200057084). Implications for the Profession and/or Patient Care: For breast cancer patients with poor lymphedema self‐management behaviour, attention should be raised among nurses and involved healthcare staffs that lymphedema self‐management is multi‐faced. Strategies targeted at improving social support, self‐regulation, knowledge, self‐efficacy and illness perception should be also addressed in lymphedema self‐management programs, to facilitate more effective improvement of lymphedema self‐management behaviours. [ABSTRACT FROM AUTHOR]

Aims: To perform temporal validation of a risk prediction model for breast cancer‐related lymphoedema in the European population. Design: Temporal validation of a previously developed prediction model using a new retrospective cohort of women who had undergone axillary lymph node dissection between June 2018 and June 2020. Methods: We reviewed clinical records to identify women who did and did not develop lymphoedema within 2 years of surgery and to gather data regarding the variables included in the prediction model. The model was calibrated by calculating Spearman's correlation between observed and expected cases. Its accuracy in discriminating between patients who did versus did not develop lymphoedema was assessed by calculating the area under the receiver operating characteristic curve (AUC). Results: The validation cohort comprised 154 women, 41 of whom developed lymphoedema within 2 years of surgery. The value of Spearman's coefficient indicated a strong correlation between observed and expected cases. Sensitivity of the model was higher than in the derivation cohort, as was the value of the AUC. Conclusion: The model shows a good capacity to discriminate women at risk of lymphoedema and may therefore help in developing improved care pathways for individual patients. Implications for the Profession and/or Patient Care: Identifying risk factors for lymphoedema secondary to breast cancer treatment is vital given its impact on women's physical and emotional well‐being. Impact: What problem did the study address? Risk of BCRL. What were the main findings? The prediction model has a good capacity to discriminate women at risk of lymphoedema. Where and on whom will the research have an impact? In clinical practice with women at risk of BCRL. Reporting Method: STROBE checklist. What Does this Paper Contribute to the Wider Global Clinical Community?: It presents a validated risk prediction model for BCRL. No Patient or Public Contribution: There was no patient or public contribution in the conduct of this study. [ABSTRACT FROM AUTHOR]

Aims: Our study aims to investigate the effect of work–life balance programmes on Chinese nurses' psychological well‐being, directly and indirectly, via learning goal orientation. Our research also aims to investigate the moderating role of servant leadership, a holistic leadership style that prioritizes serving employees, in the association between work–life balance programmes and psychological well‐being. Design: A questionnaire‐based, time‐lagged study (1‐week interval). Methods: From September 2022 to October 2022, we collected a total of 211 matched and valid responses from nurses working for hospitals in Jiangsu Province, China. Data regarding work–life balance programmes, servant leadership, learning goal orientation and psychological well‐being were gathered using a survey administered in two waves, 1 week apart. We utilized the PROCESS Model 5 to test the moderated mediation model. Results: Work–life balance programmes significantly improved nurses' psychological well‐being. Moreover, learning goal orientation mediated the relationship between work–life balance programmes and psychological well‐being. However, servant leadership did not moderate the association between work–life balance programmes and psychological well‐being. Conclusion: Our study contributes to extant nursing literature by attending to the organizational strategies that promote psychological well‐being. This study is novel because it evaluates the mediating and moderating process through which work–life balance programmes improve nurses' psychological well‐being. Impact: The provision of work–life balance programmes could enhance learning goal orientation, resulting in possible improvement in nurses' psychological well‐being. Moreover, servant leadership styles may contribute to psychological well‐being. Our study can help nurse managers enhance their organizational strategies (e.g. work–life balance programmes) and leadership resources (e.g. servant leadership styles) to address nurses' well‐being issues. Patient or Public Contribution: This paper addresses the United Nations' Sustainable Development Goal 3 regarding 'Good Health and Well‐being'. [ABSTRACT FROM AUTHOR]

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 describe a protocol for the pilot phase of a trial designed to test the effect of an mHealth intervention on representation and readmission after adult cardiac surgery. Design: A multisite, parallel group, pilot randomized controlled trial (ethics approval: HREC2020.331‐RMH69278). Methods: Adult patients scheduled to undergo elective cardiac surgery (coronary artery bypass grafting, valve surgery, or a combination of bypass grafting and valve surgery or aortic surgery) will be recruited from three metropolitan tertiary teaching hospitals. Patients allocated to the control group with receive usual care that is comprised of in‐patient discharge education and local paper‐based written discharge materials. Patients in the intervention group will be provided access to tailored 'GoShare' mHealth bundles preoperatively, in a week of hospital discharge and 30 days after surgery. The mHealth bundles are comprised of patient narrative videos, animations and links to reputable resources. Bundles can be accessed via a smartphone, tablet or computer. Bundles are evidence‐based and designed to improve patient self‐efficacy and self‐management behaviours, and to empower people to have a more active role in their healthcare. Computer‐generated permuted block randomization with an allocation ratio of 1:1 will be generated for each site. At the time of consent, and 30, 60 and 90 days after surgery quality of life and level of patient activation will be measured. In addition, rates of representation and readmission to hospital will be tracked and verified via data linkage 1 year after the date of surgery. Discussion: Interventions using mHealth technologies have proven effectiveness for a range of cardiovascular conditions with limited testing in cardiac surgical populations. Impact: This study provides an opportunity to improve patient outcome and experience for adults undergoing cardiac surgery by empowering patients as end‐users with strategies for self‐help. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000082808. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of PainReApp, an mHealth system, based on physical exercise recommendations for patients with chronic pain (low back pain, fibromyalgia and diabetic neuropathic pain) based on pain intensity, quality of life, anxiety and/or depression, and sleep quality. Design: Single‐blinded randomized controlled trial. Methods: One hundred patients from three different chronic conditions (low back pain, fibromyalgia and neuropathic diabetic pain) will be recruited and randomized into two groups to receive the intervention with a physical activity program guided by the PainReApp system (experimental group) or with the program information in paper format (control group). All patients will attend a first face‐to‐face session in which the smartphone application usage (experimental group) and exercise execution will be explained (both groups). Data will be collected at baseline, 4, 12 and 24 weeks. Nevertheless, the users of the application will have a daily registry of the exercise performed and the self‐perceived difficulty. The primary outcomes of the trial will be the intensity of pain and quality of life. Anxiety and/or depression and sleep quality will be also assessed to evaluate the influence of the physical activity at multiple levels. Discussion: Physical exercise is becoming one of the leading evidence‐based interventions to treat chronic pain. It needs to be adapted to the necessities of each pain condition. One of the major problems is the low adherence to the proposed program. New strategies that empower the patients, such as the m‐Health, are reliable and useful tools to ease this end. Impact: To the best of our knowledge, this is the first long‐term randomized controlled trial researching the impact of an m‐health system on chronic pain from different origin. The intervention is based on international physical exercise recommendations and can be performed without specific material, allowing the home‐based practice. Trial registration: Australian and New Zealand Clinical Trials Registry (ACTRN12621000783820). [ABSTRACT FROM AUTHOR]

Aim: This study aims firstly to identify shifts in the execution of medical tasks by nurses in the past decade. Secondly, it aims to explore nurses' perspectives on task shifting: how they think task shifting affects the quality of care, the attractiveness of nursing practice and their collaboration with physicians. Design: A quantitative repeated cross‐sectional study. Methods: A nationwide survey was conducted among Dutch registered nurses (RNs) working in hospitals and home care, first in 2012 and again in 2022, with sample sizes of 359 and 362, respectively. Analyses were based on descriptive statistics and logistic and linear regressions. Results: Between 2012 and 2022, there was a significant increase in the execution of only one medical task by nurses, namely prescribing over‐the‐counter medication. The majority reported in both years that task shifting has positive impact on their professional autonomy and the attractiveness of nursing practice. However, most nurses also reported that task shifting increased their workload (72.7% in 2022) could lead to conflicts in care teams (20.9% in 2022 compared to 14.7% in 2012) and may cause physicians to feel threatened (32.8% in 2022 and 29.9% in 2012). There were no significant changes in nurses' perception of the impact of task shifting on quality of care, the attractiveness of nursing practice and the nurse–physician relationship. Conclusion: There was an increase in the execution of prescribing over‐the‐counter‐medication by nurses between 2012 and 2022. However, both in 2012 and in 2022, as the majority of nurses reported that task shifting increased their workload, there is reason to worry about this negative consequence of task shifting, e.g. with regard to labour market issues. Further research, also among the medical profession, is needed to better understand and address the implications of task shifting for the nursing profession. Implications for the Profession: Implications for the nursing profession include potential scope expansion with complex tasks, attracting more individuals to nursing careers, although an eye must also be kept on what that means for the workload of nurses and the relationship with physicians. Impact: Nurse prescribing medicines was more executed in 2022 compared to 2012. Nurses had a predominantly positive perspective on task shifting, but still felt it can cause conflicts in care teams, high workload and physicians feeling threatened. These results can help during implementation of task shifting and in monitoring the perceived effects of task shifting among nurses. Reporting Method: This study followed the STROBE reporting guideline for cross‐sectional studies. Patient or Public Contribution: No Patient or Public Contribution. This study focussed on the task shifting (perspectives) of nurses. [ABSTRACT FROM AUTHOR]

Aim: To examine the relationship between racial/ethnic disparities and substance use behaviours (alcohol and tobacco use) and their impact on the sleep health of South Korean adolescents. Design: Secondary analysis of cross‐sectional study data from the 2021 Korea Youth Risk Behaviour Web‐based Survey dataset. Methods: Given that Korean society has historically linked its racial/ethnic identity to a shared bloodline, we categorized 2644 adolescents from the Korea Youth Risk Behaviour Web‐based Survey based on their racial/ethnic status, determined by their parents' birthplaces. Using multiple linear regression, we investigated whether the impact of racial/ethnic disparities on sleep health (sleep duration, debt, and timing) varies depending on substance use behaviours (alcohol and tobacco use) after controlling for age, sex, household economic status, depressed mood, suicidal ideation, perceived excessive stress, and anxiety level. Results: Despite no statistical differences in sleep health and the prevalence of substance use between racial/ethnic groups, racial/ethnic minority adolescents experienced greater sleep debt than racial/ethnic majority adolescents when consuming alcohol. Moreover, racial/ethnic minority adolescents were more likely to report psychosocial distress and had lower parental education level. Conclusion: Racial/ethnic minority adolescents were more vulnerable to the detrimental effects of alcohol use on sleep health compared to racial/ethnic majority adolescents. This heightened vulnerability may be attributed to the more pronounced psychosocial challenges and the lower socioeconomic status of parents in the racial/ethnic minority group. Impact: Racial/ethnic disparities are concerning in South Korea, particularly since the negative effects of substance use on sleep health are intensified among racial/ethnic minority adolescents. Nurses and other healthcare providers should recognize the importance of addressing the social disadvantages linked to racial/ethnic disparities. Beyond just advocating for the cessation of substance use, it is crucial to address these underlying issues to reduce sleep disparities among South Korean adolescents. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To examine the psychometric properties of a short form version of the Numinous Motivation Inventory (NMI) for use with healthcare providers in measuring their existential engagement with life and to assess its relationship with spiritual coping and emotional dysphoria. Design: Correlational and psychometric study. Method: Data were collected from June to December 2022. Participants included 102 physicians, recruited from across the United States. Qualtrics was utilized to collect data, and they were evaluated with the NMI short form, Spiritual Coping Questionnaire and Depression, Anxiety, and Stress scale (DASS‐21). Results: Obtained fit statistics from structural equation modelling analysis indicated close fit of the NMI short form with the original model. Multiple regression analyses demonstrated the value of the NMI as a predictor of negative affect independent of spiritual coping. The NMI did not interact with Spiritual Coping, which was independent of negative affect. Conclusions: The Numinous represents an important aspect of physicians' coping. The constructs can be utilized in training and clinical settings as a valuable and easy‐to‐use metric for promoting and assessing wellness. The implications of these findings and the value of the NMI were discussed. Impact: An understanding of existential drivers can equip one to cope with the stressors of healthcare. The NMI short form has the capability to explore an individual's existential drivers through the understanding of three domains. Reporting Method: Adhered to proper EQUATOR guidelines (GRRAS). Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To assess agreement of pressure injury risk level and differences in preventative intervention prescription between nurses using a structured risk assessment tool compared with clinical judgement. Design: Interrater agreement study. Methods: Data were collected from November 2019 to December 2022. Paired nurse‐assessors were allocated randomly to independently assess pressure injury risk using a structured tool (incorporating the Waterlow Score), or clinical judgement; then prescribe preventative interventions. Assessments were conducted on 150 acute patient participants in a general tertiary hospital. Agreement of risk level was analysed using absolute agreement proportions, weighted kappa and prevalence‐adjusted and bias‐adjusted kappa. Results: Ninety‐four nurse assessors participated. Absolute agreement of not‐at‐risk versus at‐risk‐any‐level was substantial, but absolute agreement of risk‐level was only fair. Clinical judgement assessors tended to underestimate risk. Where risk level was agreed, prescribed intervention frequencies were similar, although structured tool assessors prescribed more interventions mandated by standard care, while clinical judgement assessors prescribed more additional/optional interventions. Structured tool assessors prescribed more interventions targeted at lower‐risk patients, whereas assessors using clinical judgement prescribed more interventions targeted at higher‐risk patients. Conclusion: There were clear differences in pressure injury risk‐level assessment between nurses using the two methods, with important differences in intervention prescription frequencies found. Further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk, with emphasis on the impact of risk assessments on subsequent preventative intervention implementation. Impact: The results of this study are important for clinical practice as they demonstrate the influence of using a structured pressure injury risk assessment tool compared to clinical judgement. Whilst further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk and prescribe interventions, our findings do not support a change in practice that would exclude the use of a structured pressure injury risk assessment tool. Reporting Method: This study adhered to the GRRAS reporting guideline. Patient/Public Contribution: No patient or public involvement in this study. Implications for the profession and/or patient care: Educators and researchers can use the findings to guide teaching about pressure injury risk assessment and preventative intervention and to direct future studies. For clinical nurses and patients, a change in clinical practice that would exclude the use of a structured risk assessment tool is not recommended and further work is needed to validate the role of clinical judgement to assess risk and its impact on preventative intervention. [ABSTRACT FROM AUTHOR]

Aim: To construct a nursing assessment framework for patients in anaesthesia recovery period. Design: A three‐round modified Delphi method was employed to capture the consensus of 22 panellists. Methods: The initial items in the nursing assessment framework for patients in anaesthesia recovery period were developed based on the mini‐clinical evaluation exercise (mini‐CEX). A panel of 22 experts participated in this study. The panellists have more than 10 years of experience in either clinical anaesthesia, or post‐anesthesia nursing, or operating room nursing, or surgical intensive nursing. Between March and April 2023, the panellists evaluated and recommended revisions to the initial framework. Results: This study resulted in the development of a nursing assessment framework for patients in anaesthesia recovery period. The initial version of the framework consisted of six dimensions with 27 items. Six items were modified after the first round of consultation. After the second round, five modifications and four deletions were made based on expert opinion. The third round resulted in a convergence of expert opinion. The framework, which consists of 24 items across five dimensions, was refined. The five dimensions are as follows: History‐taking, Physical assessment, Clinical judgement, Organizational efficiency and Humanistic concern. Conclusion: The nursing assessment framework for patients in anaesthesia recovery period was reached consensus between the 22 experts' opinions. Implications for the profession and patient care: The assessment framework constructed in this study could be used for the process evaluation of post‐anesthesia nursing. The framework may guide perianesthesia nurses in the timely and effective assessment of patients during this critical phase of care. It may be used for perianesthesia nursing education or to evaluate nurses' assessment skills. Reporting method: The study is reported in accordance with the Guidance on Conducting and Reporting DElphi Studies (CREDES) recommendations. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to estimate the proportion of acute care nurses witnessing end‐of‐life dreams and visions or having these reported by a patient or relative, and to canvass their related attitudes and beliefs. Design: A cross‐sectional survey study was conducted from February 2023 to May 2023. Setting/Participants: Participants were medical and surgical nurses from a 200‐bed acute care hospital in metropolitan Australia. Results: Fifty‐seven nurses participated from a workforce of 169 (34% response rate), of whom 35 (61%) reported they had encountered end‐of‐life dreams and visions. The nature of end‐of‐life dreams and visions encountered was similar to those reported in previous studies by patients and clinicians. Nurses generally held positive attitudes towards end‐of‐life dreams and visions but identified an unmet need for education and training on this aspect of end‐of‐life care. Conclusion: Our results suggest that nurses in acute care encounter end‐of‐life dreams and visions in a similar proportion to oncology and long‐term care but lower than in palliative care settings. Education and training regarding end‐of‐life dreams and visions are needed to ensure the provision of comprehensive, patient‐centred end‐of‐life care. Patient or Public Contribution: No patient or public contribution. Impact: Research in sub‐acute and long‐term care settings suggests that end‐of‐life dreams and visions are a common accompaniment to the dying process. No research has yet focused on the acute care setting, despite this being the place of death for the majority of people in most high‐income countries. This study demonstrates that acute care nurses encounter end‐of‐life dreams and visions in similar proportions to oncology and long‐term care nurses but lower than palliative care nurses. Acute care nurses would benefit from education and training regarding end‐of‐life dreams and visions to enable the provision of holistic person‐centred end‐of‐life care. Reporting Method: This study was reported using the STROBE Checklist for cross‐sectional studies. [ABSTRACT FROM AUTHOR]

Aims: To explore the effectiveness of continuous home wound care on patients with diabetic foot ulcers (DFUs). Design: A non‐randomized parallel controlled non‐inferiority trial. Methods: Patients with Wagner grade I–III DFUs hospitalized in two distant campuses of the same hospital were included. All patients received infection treatment and wound bed preparation during hospitalization; after discharge, patients in one of the campuses received routine outpatient wound care, and those treated in the other received continuous home wound care. The per‐protocol analysis was performed to compare ulcer healing indicators, knowledge, health belief, self‐management behaviour and medical expenses of the two groups. Results: Between October 2021 and December 2022, 116 patients were enrolled in the study; 107 completed. The home care was not inferior in terms of ulcer healing rate and demonstrated significant enhancements in the understanding of warning signs, health belief and self‐management behaviour. Additionally, the home care saved 220.38 yuan (24.32 UK pounds) in direct medical expenses for each additional one square centimetre of ulcer healing. Conclusion: The continuous home wound care enhanced self‐management behaviour of the patients and saved their medical expenses while not compromising ulcer healing. Impact: This is to date the first study to conduct continuous home wound care practice for patients with DFUs and confirmed its safety and non‐inferiority in ulcer healing, and supported its superiority in improving self‐management behaviour and saving medical expenses. Reporting Method: We have adhered to the transparent reporting of evaluations with nonrandomized designs statements and the corresponding checklist was followed. Patient or Public Contribution: The patients and their primary caregivers were involved in intervention design, we received input from them about the factors that facilitate and hinder patient self‐management behaviours to develop intervention strategies. [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 explore the impact of COVID‐19 on students' lives and their online learning experience. Design: A cross‐sectional survey design was used in this study. Methods: A total of 44 nursing students who were enrolled in an undergraduate programme at a Canadian University participated in the study. The students were asked to fill out a 35‐item survey that was developed by the European Students' Union and that was circulated across Europe in April 2020. Results: The COVID‐19 pandemic and subsequent lockdown affected students mentally, and emotionally. Findings also revealed that whilst most students had the privilege to study from home, many students did not have a desk, or a quiet place to study in their home and some had problems with Internet connectivity. Online lectures were delivered according to students' preferences; however, students were dissatisfied with the way their practice was organized. Conclusion: The similarities between this study and the European study provide common grounds for academics around the world to connect, collaborate and work on the challenges in providing nurse education in emergencies such as national disasters or pandemics to ensure preparedness for such future events. Patient or Public Contribution: No Patient or Public Contribution. Impact: The commonalities experienced in nursing education across the globe should act as an impetus for globalized nursing action. Educators need to prepare and reinvent a role for students in the clinical area in the event of future disasters/pandemics. Policy makers and administrators need to ensure when switching to online education no student is underprivileged or marginalized in the process. [ABSTRACT FROM AUTHOR]

Aims: To identify health literacy profiles in individuals receiving haemodialysis and to explore how these profiles interact with individuals' self‐efficacy, engagement with traditional dietary habits, self‐reported fluid restriction and relative‐interdialytic weight gain. Design: A cross‐sectional study engaging nephrology departments from four hospitals in Guangdong Province, China. Methods: A sample of 433 individuals receiving haemodialysis participated between December 2018 and July 2019. We assessed health literacy, self‐efficacy and self‐reported fluid restriction using the Health Literacy Questionnaire, the Fluid Self‐efficacy Scale and the Fluid Adherence Subscale, respectively. Traditional dietary habits, including daily tea drinking, soup drinking and preserved food consumption, were measured using three yes/no questions. Relative‐interdialytic weight gain was calculated by dividing the mean interdialytic weight gain (from three recent intervals) by dry weight. Latent profile analysis and structural equation modelling were performed. Results: Three health literacy profiles were identified: low, moderate and high. Compared to those in the low health literacy profile, individuals in high and moderate health literacy profiles demonstrated an indirect association with reduced relative‐interdialytic weight gain. This reduction can be attributed to their higher self‐efficacy levels, decreased reliance on dietary habits and higher self‐reported fluid restrictions. Conclusions: Most participants exhibited either low or moderate levels of health literacy. Improving health literacy has the potential to promote self‐efficacy and foster effective fluid restriction, ultimately leading to a reduction in relative‐interdialytic weight gain in individuals receiving haemodialysis. Impact: This study reveals heterogeneity in health literacy levels among individuals receiving haemodialysis and illuminates the connections between an individual's entire spectrum of health literacy and fluid management. These findings provide valuable insights for developing person‐centred fluid management interventions, especially for individuals with diverse cultural dietary backgrounds within the haemodialysis population. Reporting Method: We adhered to the STROBE guideline. Patient or Public Contribution: Patients were included only for collecting their data. [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]

Aims: Drawing on the conservation of resources theory, this study examines the underlying process through which servant leadership is associated with nurses' in-role performance. Specifically, we test the indirect effect of servant leadership on in-role performance via a sequential mediating mechanism of job autonomy and emotional exhaustion. Design: A time-lagged design was implemented using data gathered from two-wave online surveys (1 week apart) of registered nurses from Jiangsu Province, China. Methods: Between September 2022 and February 2023, we used Wenjuanxing and Credma, which are two powerful and user-friendly data collection platforms, to distribute online surveys to potential participants. We received a total of 220 usable responses and employed the PROCESS Model 4 and Model 6 to assess our proposed hypotheses. Results: Our proposed model was supported. Servant leadership has a positive indirect effect on nurses' in-role performance through job autonomy and emotional exhaustion. Job autonomy has a negative effect on emotional exhaustion. Additionally, job autonomy mediates the negative relationship between servant leadership and emotional exhaustion. Conclusion: The present research extends existing nursing studies by unravelling the complex mechanisms underlying the relationship between servant leadership and nurses' in-role performance. Our study also identifies the underlying mechanism of how servant leadership mitigates emotional exhaustion by supporting nurses' job autonomy. Impact: The sequential mediation results provide us with a more fine-grained understanding of the relationship between servant leadership and nurses' in-role performance. It further promotes job autonomy and decreases emotional exhaustion, which supports the UN Sustainable Development Goal #3 (Good Health and Well-being). [ABSTRACT FROM AUTHOR]

Aims: To examine misconceptions towards men in nursing from the perspective of undergraduate nursing students. Specifically, this study sought to explore contributing factors of misconceptions and attributions of the success of men in nursing. Design: A convergent parallel mixed-method study. Methods: A national survey was conducted (July–September 2021). The quantitative data included demographics and responses to the Gender Misconceptions of Men in Nursing (GEMINI) scale. The qualitative data included responses to a provocative statement related to characteristics of men and their career in nursing. The GRAMMS guideline was used in reporting. Results: Undergraduate nursing students (n= 1245) from 16 Australian schools of nursing responded to the survey. Quantitative analysis demonstrated that most students (96%) did not have misconceptions about men in nursing. Those who did were more likely to be men, born overseas, not in health-related employment and did not have nursing as their first choice. Four broad overarching main themes were generated in response to the statement that suggested men do not have the right attributes for nursing: (1) ‘This is a very misandristic viewpoint’; (2) ‘Compassion and intelligence are distributed in men and women equally’; (3) ‘Men bring a different quality to nursing’ (4) ‘Anyone can be whatever they want to be’. Conclusion: Overall, nursing students did not have misconceptions about men in nursing, despite experiencing ongoing social stigma regarding archaic gender norms. The findings from this study indicate that the next-generation nurses were championing to challenge the gender stereotype and support the needs of a gender diverse society. Impact: Attitudes and misconceptions that elicit gender inequalities must be addressed with comprehensive strategies and de-gendered language and imagery within the profession, schools, workplaces and the media. Shifting culture and attitudes towards inclusion, values the diversity in the workforce and supports healthy workplace environments. [ABSTRACT FROM AUTHOR]

Aim: To evaluate gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. Design: A descriptive cross-sectional survey design was used. Methods: A total of 293 women accessing gynaecological services responded to the survey. Quantitative analysis included descriptive and inferential statistics. Content analysis was conducted on qualitative data. Results: Health professionals were the most common and preferred sources of gynaecological health information. Enablers to information provision included positive communication strategies by health professionals, participants having prior knowledge and doing their own research. Despite its widespread availability, only 24.2% of women preferred the internet as an information source. Poor communication and inadequate information provision were identified as barriers to information access. Statistically significant associations were identified between location of residence, education level, year of birth, diagnostic group and health information preferences. Recommendations from women included improved communication strategies, system changes and provision of individualized information. Conclusion: Health professionals are central to women accessing information about gynaecological diagnoses. Areas for improvement include communication strategies, facilitating access to internet-based resources for information and consideration of women's preferences when providing health information. Implications for the Profession and Patient Care: Consumer co-design of gynaecological health information and communication training for health professionals is recommended. Improved communication and facilitated use of internet-based resources may improve women's understanding of information. Impact: • This study explored gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. • It was found that gynaecological patients preferred individualized information provided to them directly by health professionals and despite its widespread availability, the internet is an underutilized health information resource. • These findings are applicable to health professionals and patients utilizing tertiary gynaecological health services in Australia but may be generalized if demographic data aligns with other jurisdictions. Reporting Method: The STROBE reporting method was used in the preparation of the manuscript. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore the relationship between sensory impairment and home care client's received care time. Design: A cross- sectional multi-source study. Methods: Data from a self-reported staff survey on care time allocation were merged with registry data from the Resident Assessment Instrument registry (n = 1477). The data were collected during 1 week from 17 home care units in Finland in October 2021. The relationship between sensory impairment and clients received care time was examined using linear regression analyses. Results: The linear regression analyses showed that having vision impairment alone increased care time, while dual sensory impairment resulted in decreased received care time. Hearing impairment alone was not statistically significantly associated with care time. Conclusion: The holistic care need of home care clients with dual sensory impairment may not be adequate. To ensure equality and the individually tailored care of clients, further attention must be paid to clients with sensory impairments, especially those with dual sensory impairment. Furthermore, the competence of home care workers to encounter and communicate with clients with sensory impairment must be developed to support the holistic care. Implications for the patient care: The sensory impairments of home care clients must be identified in time and considered in care planning and encountering clients. Impact: As there is a risk that clients with dual sensory impairment are not able to fully express themselves, it is imperative that further attention is paid to clients with sensory impairments, to better understand and support this vulnerable group. Increased awareness and continuous education are needed to better identify and support home care clients with sensory impairment. Reporting Method: The study adheres to the STROBE reporting guidelines. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: The aim of this was to psychometrically adapt and evaluate the Tilburg Frailty Indicator to assess frailty among older people living in Slovenia's community and nursing home settings. Design: A cross- cultural adaptation and validation of instruments throughout the cross- sectional study. Methods: Older people living in the community and nursing homes throughout Slovenia were recruited between March and August 2021. Among 831 participants were 330 people living in nursing homes and 501 people living in the community, and all were older than 65 years. Results: All items were translated into the Slovene language, and a slight cultural adjustment was made to improve the clarity of the meaning of all items. The average scale validity index of the scale was rated as good, which indicates satisfactory content validity. Cronbach's α was acceptable for the total items and subitems. Conclusions: The Slovenian questionnaire version demonstrated adequate internal consistency, reliability, and construct and criterion validity. The questionnaire is suitable for investigating frailty in nursing homes, community dwelling and other settings where older people live. Impact: The Slovenian questionnaire version can be used to measure and evaluate frailty among older adults. We have found that careful translation and adaptation processes have maintained the instrument's strong reliability and validity for use in a new cultural context. The instrument can foster international collaboration to identify and manage frailty among older people in nursing homes and community-dwelling homes. Reporting Method: The Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting cross-sectional studies was used. No Patient or Public Contribution: No patient or public involvement in the design or conduct of the study. Head nurses from nursing homes and community nurses helped recruit older adults. Older adults only contributed to the data collection and were collected from nursing homes and community dwelling. [ABSTRACT FROM AUTHOR]

Introduction: During the Coronavirus (COVID-19) pandemic, healthcare providers have overcome difficult experiences such as workplace violence. Nurses are particularly vulnerable to workplace violence. The objective of this study was to characterize violence and aggression against nurses during the COVID-19 pandemic in Latin America. Methods: An electronic cross-sectional survey was conducted in 19 Latin American countries to characterize the frequency and type of violent actions against front-line healthcare providers. Results: Of the original 3544 respondents, 16% were nurses (n = 567). The mean age was 39.7 ± 9.0 years and 79.6% (n = 2821) were women. In total, 69.8% (n = 2474) worked in public hospitals and 81.1% (n = 2874) reported working regularly with COVID-19 patients. Overall, about 68.6% (n = 2431) of nurses experienced at least one episode of workplace aggression during the pandemic. Nurses experienced weekly aggressions more frequently than other healthcare providers (45.5% versus 38.1%, p < .007). Nurses showed a trend of lower reporting rates against the acts of aggression suffered (p = .076). In addition, nurses were more likely to experience negative cognitive symptoms after aggressive acts (33.4% versus 27.8%, p = .028). However, nurses reported considering changing their work tasks less frequently compared to other healthcare providers after an assault event (p = .005). Conclusion: Workplace violence has been a frequent problem for all healthcare providers during COVID-19 pandemic in Latin America. Nurses were a particularly vulnerable subgroup, with higher rates of aggressions and cognitive symptoms and lower rate of complaints than other healthcare providers who suffered from workplace violence. It is imperative to develop strategies to protect this vulnerable group from aggressions during their tasks. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to determine the prevalence and risk factors for subsyndromal delirium in the postoperative patient. Design: A systematic review and meta- analysis. Methods: The Review Manager 5.3 statistics platform and the Newcastle- Ottawa Scale were used for quality evaluation. Data Sources: The following databases were searched: PubMed, Web of Science, EMBASE, The Cochrane Library, Scopus and EBSCO from January 2000 to December 2021. Additional sources were found by looking at relevant articles' citations. Results: A total of 1744 titles were originally identified, and five studies including 962 patients were included in the systematic review, with a pooled prevalence of postoperative subsyndromal delirium (PSSD) of 30% (95% CI: 0.28-0.32). Significant risk variables for PSSD were older age, low levels of education (≤9 years), cognitive impairment, higher comorbidity score, and the duration of operation. Conclusion: PSSD is prevalent and is associated with a variety of risk factors as well as low academic performance. Impact: Identification and clinical management of patients with PSSD should be improved. Future research on PSSD risk factors should look at a wider range of intraoperative and postoperative risk factors that can be changed. Patient and Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to develop the Risk Perception Scale of Disease Aggravation for older patients with non‐communicable diseases and evaluate its psychometric properties. Design: Instrument development and cross‐sectional validation study were conducted. Methods: This study contained four phases. In phase I, a systematic literature review was conducted to identify the conception of disease aggravation and risk perception. In phase II, a draft scale was formulated from face‐to‐face semi‐structured in‐depth interviews by Colaizzi's seven‐step qualitative analysis method and group discussions among the researchers. In phase III, domains and items of the scale were revised in accordance with the suggestions from Delphi consultation and patient feedback. In phase IV, psychometric properties were evaluated. Findings: Exploratory and confirmatory factor analyses determined four structural factors. Convergent and discriminant validities were acceptable because the average variance extracted coefficients ranged from.622 to.725, and the square roots of the average variance extracted coefficients for the four domains were larger than those of bivariate correlations between domains. The scale also exhibited excellent internal consistency and test–retest reliability (Cronbach's alpha coefficient =.973, intraclass correlation coefficient =.840). Conclusions: Risk Perception Scale of Disease Aggravation is a new instrument that measures the risk perception of disease aggravation for older patients with non‐communicable diseases, including possible reason, serious outcome, behaviour control and affection experience. The scale contains 40 items that are scored on a 5‐point Likert scale, and it has acceptable validity and reliability. Impact: The scale is applied to identify different levels of risk perception of disease aggravation for older patients with non‐communicable diseases. Clinical nurses can provide targeted interventions to improve older patients' risk perception of disease aggravation based on levels of risk perception during hospitalization and the period before discharge. Patient or Public Contribution: Experts provided suggestions for revising the scale dimensions and items. Older patients participated in the scale revision process to improve the wording of the scale. [ABSTRACT FROM AUTHOR]

Objectives: To explore the interrelationships between oral hygiene habits, oral health status and cognitive function in older adults. Design: A cross‐sectional study. Setting and Participants: A total of 371 participants (age 76.79 [7.99] years) were enrolled from June 2020 to November 2021 in an aged care facility. Methods: Cognitive function was screened using the mini‐mental state examination (MMSE) with adjusted cut‐off points for age and education. Periodontal status (Biofilm‐Gingival Interface index based on periodontal probing depth and bleeding on probing), dental status (plaque, calculus, and caries), and tooth loss were assessed through full‐mouth examination. Oral hygiene habits were based on self‐ or informant‐reporting. Results: Poor periodontal status was an associated factor for MCI (OR = 2.89, 95% CI = 1.20–6.95), while multiple tooth loss (OR = 4.90, 95% CI = 1.06 ~ 22.59), brushing teeth less than once a day (OR = 2.88, 95% CI = 1.12 ~ 7.45) and delayed dental visits (OR = 2.45, 95% CI = 1.05 ~ 5.68) were associated factors for cognitive impairment. An indirect effect of brushing teeth ≥2 daily on MMSE score through periodontal status was observed only in older adults without cognitive impairment (Bootstrap‐corrected B = 0.17, 95%CI = 0.03 ~ 0.36, SE = 0.08, β = 0.08). Conclusions and Implications: Adequate toothbrushing might prevent cognitive decline indirectly by improving periodontal health only in older adults without cognitive impairment. Multiple tooth loss, infrequent toothbrushing, and delayed dental visits were associated factors for cognitive impairment. Nursing professionals and health care policymakers should advocate for the improvement of basic oral hygiene in older adults, and provide regular professional oral hygiene care for older adults with cognitive impairment. Patient or Public Contribution: The information on oral health habits of this study was based on an interview with the participants or their caregivers during the study period. [ABSTRACT FROM AUTHOR]

Aim: This study assessed adolescents' satisfaction with services received during their most recent abortion and the factors associated with satisfaction at reproductive health centres in the Greater Accra region of Ghana. Design: A facility‐based cross‐sectional survey was used for this study. Methods: Overall, 254 adolescent girls aged between 15 and 19 years, who had an abortion within 1 week of the study period were recruited for the study. All the 254 respondents were recruited consecutively as they visited health facilities for abortion services from March 2019 to February 2020. Written informed consent was signed by respondents, and data were collected using the Patient Satisfaction with Nursing Care Quality Questionnaire, and the data were analysed using Stata version 15.0. Univariate, bivariate and multivariate logistic regression analyses were conducted. Results: A majority of adolescents reported being satisfied with the abortion services they received. Ample waiting space and the system of 'first‐come‐first‐served' were the highest rated elements of service satisfaction. Adolescents were least satisfied with the inadequacy of instructions and lack of information on medications received and their therapeutic or side effects. Ethnicity, having a stable intimate partner and perceived adequacy of staff were the factors associated with satisfaction with abortion services. Conclusion: Adolescents are unique group of people with peculiar health needs. If they are treated with respect and dignity, they are likely to be satisfied with services received from the reproductive health centres offering comprehensive abortion care. Impact: The study addresses adolescent satisfaction with abortion care received; if health providers treat adolescent seeking abortion care with respect, friendly and non‐judgemental attitude, it will enable adolescents to seek abortion care from qualified professionals instead of unskilled service providers to reduce maternal mortality. Patient's contribution: Patients from 11 reproductive centres responded to the questionnaire used for the data collection. [ABSTRACT FROM AUTHOR]

Aim: To develop a parsimonious, shortened version of the Perceived Perioperative Competence Scale‐Revised for perioperative nurses to complete as part of their specialty training while retaining good psychometric properties. Design: A longitudinal online survey was adopted. Methods: A national sample of perioperative nurses from Australia completed an online survey at two different time points 6 months apart between February and October 2021. Confirmatory factor analysis was conducted for item reduction and construct validity, while criterion, convergent validity and internal consistency were examined. Results: Usable data for psychometric assessment were obtained from 485 operating room nurses at time 1 and 164 nurses at time 2. The original 40‐item revised scale was reduced to an 18‐item measure, maintaining its six domains. Cronbach's alpha for the 18‐item scale was.92 at time 1 and.90 at time 2. Scale validation demonstrated moderate to weak positive relationships in perceived competence scores relative to general self‐efficacy, years of operating room experience, postgraduate education and recency of training. Conclusions: Results suggest the 18‐item Perceived Perioperative Competence Scale‐Revised Short Form has initial robust psychometric properties and may be implemented in clinical settings as part of perioperative transition‐to‐practice, orientation programs and yearly professional development reviews. Implications for the Profession: This short‐form scale can help prepare perioperative nurses to demonstrate clinical competence in a climate of increasing professional demands using a valid measure of competence required in clinical practice. Impact: Short and validated scales of perioperative competence are needed in clinical practice. Assessment of practising operating room nurses' perceived competence is essential in quality care provision, workforce planning and human resource management. This study provides an 18‐item measure of the previously validated 40‐item Perceived Perioperative Competence Scale‐Revised. This scale can help provide an option for future testing of perioperative nurses' competence in clinical or research settings. Patient or Public Contribution: Perioperative nurses were involved in the design of the study, particularly in the assessment of validation of the tools used in the study. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this integrative review was to explore, appraise and synthesize the current literature on correlates of suicide risk in nurses. Design: Integrative literature review. Data sources: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Joanna Briggs Institute, PubMed, PsycInfo and Scopus electronic databases were searched for abstracts published between 2005 and 2020. Reference lists were hand searched. Review methods: The integrative review was based on the Whittemore and Knafl review methodology. Primary qualitative and quantitative studies about suicidal behaviour in nurses published in peer‐reviewed journals were included. The methodological quality of included articles was assessed using the Mixed Methods Assessment Tool. Results: Separate correlates of risk and protective factors were identified for suicidal ideation, suicide attempt and death by suicide in nurses. Implications: Due to a number of factors at the individual, interpersonal and work levels, nurses are uniquely positioned to be at risk of dying by suicide. The ideation‐to‐action framework provides a theoretical guide to understand the interplay between correlates and the effect it has on increasing a nurses' capability for suicide. Conclusions: This review integrates the empirical literature to elucidate the concept of suicidal behaviour as it applies to nurses. [ABSTRACT FROM AUTHOR]

Problem: Missed Nursing Care (MNC) is an error of omission which occurs when a necessary nursing intervention is not initiated, is not completed, or when it is delayed. The MNC model explains this problem and describes four antecedents that can lead to MNC: (1) demand for patient care, (2) available human resources, (3) material resources, and (4) and relationship and communication factors. Aims: This study aims to test the relationship between the theoretical antecedents of MNC and their impact on MNC. Design: A quantitative cross‐sectional study. Methods: The Austrian version of the revised MISSCARE Survey was completed by nurses working in general hospital units between May and July 2021. Recruitment followed a respondent‐driven sample via Austrian nursing education institutions and social media. One thousand six nurses fulfilled inclusion criteria. The structure of the theoretical constructs of the MNC model was tested using a confirmatory factor analysis approach. The relationships between the four antecedents and MNC were explored using structural equation modelling with 427 complete cases. Results: The results support the structural validity of the revised MISSCARE Austria concerning the defined theoretical constructs, although discriminant validity and measurement error should be further investigated. The antecedent "resource allocation: labor" had a statistically significant impact on MNC: The lack of adequate nursing staff played the most important role to explain missed care in our model. Conclusion: In our study in Austria, MNC was mostly influenced by a lack of appropriate labor resources. Further studies exploring mediation effects and non‐linear relationships may contribute to better understanding of reasons for MNC. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To describe transitions in smoking status and their determining factors among nursing students between baseline (2015–2016) and follow‐up (2018–2019). Design: Observational prospective longitudinal study of 4381 nursing students in Catalonia (Spain). Methods: We examined transitions in smoking status from: (i) current smokers to recent quitters, (ii) never smokers to new smokers and (iii) former smokers to quitters who relapsed. We fitted logistic regression models to assess the predictors of quitting smoking. Results: The proportion of current smokers decreased from 29.7% at baseline to 23.6% at follow‐up, with a cumulative incidence rate of quitting of 28.3% during follow‐up. Nondaily smokers were more likely to quit than daily smokers. Of those who were never smokers at baseline, 4.6% were smokers at follow‐up, and 23.2% of former smokers at baseline had relapsed at follow‐up. Conclusions: Nondaily smokers were more likely to have quit smoking at follow‐up among this cohort of nursing students. The early implementation of a comprehensive tobacco control program that includes tobacco‐free campus policies, tobacco prevention interventions and cessation support during college years may decrease tobacco use among nursing students. Impact: Nursing students' tobacco use is concerning, as they are the future workforce of nurses who have a key role in tobacco product use prevention and cessation. During college years, nursing students have a greater likelihood of experimenting with several smoking status changes as well as to consolidate smoking behaviors. This is the first longitudinal study to highlight the factors associated with quitting smoking among a cohort of Spanish nursing students. Being a nondaily smoker at baseline predicted quitting at follow‐up. Our findings support the early implementation of a comprehensive tobacco control program that includes tobacco‐free campus policies, tobacco prevention interventions and tobacco cessation support during college years to decrease tobacco product use prevalence among nursing students. Reporting Method: We have adhered to STROBE guidelines. No Patient or Public Contribution. This observational study has not been registered. [ABSTRACT FROM AUTHOR]

Aims: To map how frailty among older people is assessed at Swedish emergency departments and to describe fundamental nursing care actions for these patients. Design: Descriptive national survey and a qualitative analysis of text. Methods: A majority (82%, n = 54) of the Swedish hospital‐based emergency departments for adults were included, representing all six healthcare regions. An online survey was used to collect data, together with submitted local practice guidelines for older people at the emergency departments. Data were collected during February–October 2021. Descriptive and comparative statistics were performed together with a deductive content analysis framed by the Fundamentals of Care framework. Results: Sixty‐five per cent (35 of 54) of the emergency departments identified frailty, with less than half of them using an established assessment instrument. Twenty‐eight (52%) of the emergency departments have practice guidelines containing fundamental nursing actions for the care of frail older people. The majority of nursing actions in the practice guidelines were related to patients' physical care needs (91%), followed by psychosocial care needs (9%). No actions could be identified as relational actions (0%) according to the Fundamentals of Care framework. Conclusion: Many Swedish emergency departments identify frail older people, but they use a range of different assessment instruments. While practice guidelines directing fundamental nursing actions for frail older people are often in place, a holistic, person‐centred view addressing the patient's physical, psychosocial and relational care needs is missing. Impact: The population is growing older, and more people are needing more complex hospital care. Frail older people have an increased risk of negative outcomes. The use of a variety of assessment instruments for frailty may pose a challenge to equal care. To ensure a holistic, person‐centred view of frail older people, the Fundamentals of Care framework can be used in developing and reviewing practice guidelines. Patient or Public Contribution: Clinicians and non‐health professionals were invited to review the survey to ensure face and content validity. [ABSTRACT FROM AUTHOR]

Aim: To investigate the levels of subjective well‐being in graduate nursing students, explore the impact of academic stress and resilience on subjective well‐being, and examine the mediation effect of resilience on the relationship between academic stress and subjective well‐being among graduate nursing students. Background: Few studies explore the impact of academic stress and resilience on subjective well‐being among graduate nursing students. Understanding the status of subjective well‐being and associated factors in graduate nursing students will enable the development of tailored interventions to improve their well‐being and academic achievements during graduation education. Design: A cross‐sectional design. Methods: Graduate nursing students were recruited by social media between April 2021 and October 2021, in China. Subjective well‐being was measured using the General Well‐Being Schedule, resilience by the Connor‐Davidson Resilience Scale, and academic stress through the Questionnaire of Assessing Academic Stress for graduate nursing students. Structural equation modelling was used to test the relationship among academic stress, resilience and subjective well‐being. Findings: The mean score of subjective well‐being for graduate nursing students was 76.37. The proposed model revealed a satisfied fit with the data. Academic stress and resilience were significantly related to subjective well‐being in graduate nursing students. Resilience partially mediated the relationship between academic stress and subjective well‐being, and the mediation effect accounted for 20.9% of the total effect of academic stress on the subjective well‐being. Conclusion: Academic stress and resilience affected subjective well‐being in graduate nursing students, while resilience partially mediated the relationship between academic stress and the subjective well‐being. No Patient or Public Contribution: This study did not involve patients, service users, caregivers or members of the public. [ABSTRACT FROM AUTHOR]

Aims: The prompt recording of the electrocardiogram (ECG) and its correct interpretation is crucial to the management of patients who present to the emergency department (ED) with cardiovascular symptoms. Since triage nurses represent the first healthcare professionals evaluating the patient, improving their ability in interpreting the ECG could have a positive impact on clinical management. This real‐world study investigates whether triage nurses can accurately interpret the ECG in patients presenting with cardiovascular symptoms. Design: Prospective, single‐centre observational study conducted in a general ED of General Hospital of Merano in Italy. Methods: For all patients included, the triage nurses and the emergency physicians were asked to independently interpret and classify the ECGs answering to dichotomous questions. We correlated the interpretation of the ECG made by the triage nurses with the occurrence of acute cardiovascular events. The inter‐rater agreement in ECG interpretation between physicians and triage nurses was evaluated with Cohen's kappa analysis. Results: Four hundred and ninety‐one patients were included. The inter‐rater agreement between triage nurses and physicians in classifying an ECG as abnormal was good. Patients who developed an acute cardiovascular event were 10.6% (52/491), and in 84.6% (44/52) of them, the nurse accurately classified the ECG as abnormal, with a sensitivity of 84.6% and a specificity of 43.5%. Conclusion: Triage nurses have a moderate ability in identifying alterations in specific components of the ECG but a good ability in identifying patterns indicative of time‐dependent conditions correlated with major acute cardiovascular events. Impact for Nursing: Triage nurses can accurately interpret the ECG in the ED to identify patients at high risk of acute cardiovascular events. Reporting Method: The study was reported according to the STROBE guidelines. No Patient or Public Contribution: The study did not involve any patients during its conduction. [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]

Aims: To evaluate whether patients with HIV enrolled in Linkage to Care (hospital‐based only) or Linkage to Care Plus (nurse‐led hospital‐to‐community transitional care) programmes fare better on clinical outcomes; and to investigate how factors such as substance use, mental health or health‐related social needs contribute to these outcomes. Background: Social determinants of health contribute to poor HIV outcomes such that only 57% of people living with HIV have achieved the goal of viral suppression nationally, and 50% are retained in clinical care. The programmes evaluated here aimed to increase HIV appointment attendance, retention in care, viral suppression and decrease acute care utilization and mitigate social needs via hospital‐to‐community transitional support. Design: A retrospective observational cohort study. Methods: We conducted a retrospective patient chart review abstracting data over three time periods between 2017 and 2020 to conduct this longitudinal programme evaluation. Results: Both programmes had meaningful effects on increasing HIV appointment attendance and viral suppression; Linkage to Care Plus experienced the largest gains. Older age was associated with viral suppression, and housing insecurity and mental health conditions were associated with increased emergency department utilization. Conclusion: Hospital‐only and nurse‐led hospital‐to‐community transitional care programmes can positively influence HIV care outcomes. There is a need for enhanced attention and accountability related to health‐related social needs, especially housing, and mental and behavioural health, to end the HIV epidemic. Impact Globally, we are striving to end the HIV epidemic with evidence‐informed interventions. The nurse‐led hospital‐to‐community and the hospital‐only interventions evaluated here improved HIV outcomes with most gains realized by the nurse‐led transitional care model. Integrating lessons from these programmes, with increased attention and accountability for addressing social needs, can improve practice and policies to achieve programmatic and national goals related to HIV and other diseases, and more critically, to meet the goals of the people we serve. Patient or public contribution: Patients, staff and leadership at the University of Maryland Institute of Human Virology JACQUES Initiative and University of Maryland Medical Center THRIVE clinic contributed to the design and implementation of the programmes and informed the programme evaluation study. [ABSTRACT FROM AUTHOR]

Aims: To assess the impact of community‐level characteristics on the role of magnet designation in relation to hospital value‐based purchasing quality scores, as health disparities associated with geographical location could confound hospitals' ability to meet outcome metrics. Design: This cross‐sectional study was carried out between October 2021 and March 2022 using data from 2016 to 2021. Methods: Propensity score analysis was used to match hospital and community‐level characteristics, implementing nearest neighbour matching to adjust for pre‐treatment differences between magnet and non‐magnet hospitals to account for multi‐level differences. Secondary data were obtained from all operational acute‐care facilities in the United States that participated in the Centers for Medicare and Medicaid Services' hospital value‐based purchasing (HVBP) program. Dependent variables were the four value‐based purchasing domains that comprise the Total Performance Score (TPS; Clinical Care, Person and Community Engagement, Safety, and Efficiency and Cost Reduction). Results: Magnet hospitals had increased odds for better scores in the HVBP domains of Clinical Care and Person and Community Engagement, and decreased odds for having better Safety. However, no statistically significant difference was found for the Efficiency domain or the TPS. Conclusion: Measuring performance equitably across organizations of various sizes serving diverse communities remains a key factor in ensuring distributive justice. Analysing the TPS components can identify complex influences of community‐level characteristics not evident at the composite level. More research is needed where community and nurse‐level factors may indirectly affect patient safety. Impact This study's findings on the role of community contexts can inform policymakers designing value‐based care programs and healthcare management administrators deliberating on magnet certification investments across diverse community settings. No patient or public contribution: For this study of US hospitals' organizational performance, we did not engage members of the patient population nor the general public. However, the multi‐disciplinary research team does include diverse perspectives. [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]

Aims: The objective was to evaluate whether the error rate in the application of the triage system decreased after the introduction of daily auditing, and it was also evaluated if the agreement rate between physician and nurse on triage priority levels increased after the introduction of daily auditing and if the error‐related variables in the pre‐intervention period changed in the post‐intervention period. Design: A quasi‐experimental study was performed with a pre–post design, between June 2019 and June 2021 in one emergency department. Methods: The accuracy and error rate of triage in the pre‐ and post‐intervention period were compared. Univariate and multivariate logistic regression analyses were performed to explore the relationships between the variables related to the error. The comparison between the priority level assigned by the physician and the triage nurse was analysed using Cohen's K. Results: Nine hundred four patients were enrolled in the pre‐intervention period and 869 in the post‐intervention period. The error rate in the pre‐intervention period was 23.3% and in the post‐intervention period was 9.7%. The concordance between the degree of priority expressed by the physician and the nurse varied from a quadratically weighted Cohen's K of 0.447 in the pre‐intervention period to 0.881 in the post‐intervention period. Conclusion: Daily auditing is a clinical procedure that improves the nurse's application of the triage system. Daily auditing has reduced errors by the nurse, improving performance and concordance with the physician. Impact Triage systems are a key point for the stratification of the priority level of patients and it is therefore evident that they maintain high‐quality standards. Through the practice of daily auditing, not only a reduction in the error rate, which ensures patient safety, but also an improvement in triage performance has been demonstrated. No Patient or Public Contribution: The study did not involve any patients during its conduction. [ABSTRACT FROM AUTHOR]

Aims: (1) To examine registered nurses' knowledge and confidence in recognizing and managing to patients with sepsis and (2) identify nurse and workplace factors that influence their knowledge on sepsis. Design: A multi‐site, cross‐sectional survey. Methods: An online survey was developed and content validated. Data was collected from registered nurses working in the inpatient wards and emergency departments of three hospitals of a single healthcare cluster in Singapore during August 2021. Statistical analyses of closed‐ended responses and content analysis of open‐ended responses were undertaken. Results: A total of 709 nurses completed the survey. Nurses possessed moderate levels of knowledge about sepsis (mean score = 10.56/15; SD = 2.01) and confidence in recognizing and responding to patients with sepsis (mean score = 18.46/25; SD = 2.79). However, only 369 (52.0%) could correctly define sepsis. Nurses' job grade, nursing education level and clinical work area were significant predictors of nurses' sepsis knowledge. Specifically, nurses with higher job grade, higher nursing education level or those working in acute care areas (i.e. emergency department, high dependency units or intensive care units) were more likely to obtain higher total sepsis knowledge scores. A weak positive correlation was observed between sepsis knowledge test scores and self‐confidence (r =.184). Open comments revealed that participants desired for more sepsis education and training opportunities and the implementation of sepsis screening tool and sepsis care protocol. Conclusion: A stronger foundation in sepsis education and training programs and the implementation of sepsis screening tools and care bundles are needed to enhance nurses' knowledge and confidence in recognizing and managing patients with sepsis. Impact The findings of this study are beneficial to administrators, educators and researchers in designing interventions to support nurses in their role in recognizing and responding to sepsis. [ABSTRACT FROM AUTHOR]

Aims: To explore the relationship between patient activation (subjective initiative of patients to participate in disease management in self‐health care), social support, self‐efficacy and online health information seeking among older patients with coronary heart disease. Design: A cross‐sectional and survey‐based design. Methods: A total of 451 older patients with coronary heart disease were recruited from July to November 2021 from four communities in Qingdao, China. We collected data using the Patient Activation Measure, Social Support Rating Scale, Self‐Efficacy Scale and Online Health Information Seeking Scale. We performed structural equation modelling to analyse the data. Results: The final model showed good model fit. Patient activation influenced online health information seeking directly (β =.39, p <.05) and indirectly through self‐efficacy (β =.17, p <.05). Social support influenced online health information seeking directly (β =.23, p <.05) and indirectly through self‐efficacy (β =.03, p <.05). Self‐efficacy directly influenced online health information seeking (β =.26, p <.05). Conclusions: We identified the interrelationships of patient activation, social support and self‐efficacy and their influence on the online health information seeking of older patients with coronary heart disease. Our findings provide a theoretical basis for developing and evaluating interventions to enhance online health information seeking for older patients with coronary heart disease. Impact These findings add a better understanding of the relationship between patient activation, social support, self‐efficacy and online health information seeking in older patients with coronary heart disease, and help community health workers to intervene in the early stage of disease diagnosis. [ABSTRACT FROM AUTHOR]

Aims: To determine the rate and level of postpartum depression (PPD), as well as to examine and compare PPD, social support and maternal self‐efficacy between adolescent and adult mothers at 8 weeks postpartum during the COVID‐19 pandemic. Background: Policy measures to reduce the rapid spread of COVID‐19 have disrupted many aspects of life and decreased social connections, which negatively impacts psychological well‐being of the general population. However, studies focused on the impact of COVID‐19 on mental health and maternal self‐efficacy in postpartum mothers, particularly adolescent mothers, are limited. Design: A comparative cross‐sectional study was carried out following the STROBE guidelines. Methods: An online questionnaire was administered from February to March 2021. Data were collected by the Edinburgh Postnatal Depression Scale (EPDS), the Postpartum Support Questionnaire (PSQ) and the Parenting Sense of Competence (PSOC) at 8 weeks postpartum. One‐way MANOVA was used to analyse the data. Results: Data from 63 adolescent mothers and 63 adult mothers were analysed. There were significant correlations between PPD, social support and maternal self‐efficacy of the COVID‐19 pandemic. Both adolescent and adult mothers had significantly negative impacts from the pandemic on mental health, social support and maternal self‐efficacy. However, the adolescent mothers had higher rates of depressive symptoms (36.5% and 23.8%, respectively) as well as lower PSQ score (121.25 and 130.52, respectively) and PSOC scores (62.54 and 70.94, respectively) compared with adult mothers in the first 8 weeks postpartum during the pandemic. Conclusion: Adolescent mothers had a significantly higher rate of depressive symptoms and significantly lower social support and maternal self‐efficacy scores compared to adult mothers at 8 weeks postpartum during the COVID‐19 pandemic. Impact Midwives or nurses should emphasize the negative mental health impacts during the COVID‐19 situation and routinely screen for depressive symptoms, especially in adolescent mothers, which could help identify the at‐risk mothers for developing PPD. Patient or public contribution: Neither patients nor the public were directly involved in the study. [ABSTRACT FROM AUTHOR]

Aim: To adapt and psychometrically test two scales from The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) for measuring nurses' preparedness to manage intimate partner violence (IPV) and opinions on IPV in China. Design: A cross‐sectional study for cross‐cultural adaptation and validation of instruments. Methods: The study was conducted in two tertiary hospitals in northeastern and southwestern China in 2020: (Step 1) translation and back‐translation by four translators; (Step 2) expert consultation to assess content validity by a five‐person panel; (Step 3) cognitive debriefing to evaluate the online survey with six nurses; (Step 4) pilot testing to finalize the survey with 79 nurses; and (Step 5) psychometric evaluation of construct validity and internal consistency reliability including post hoc analysis with 1071 nurses. Results: The Chinese scales of Perceived Preparation and Opinions demonstrated generally acceptable content validity, construct validity and internal consistency reliability; some factor analysis results were uninterpretable, and socially desirable responses existed. A post hoc inspection of item and score distributions assisted the item classification into Confident, Cautious and Concerned regarding the authenticity of nurses' responses. Conclusion: Reliability and construct validity of the Chinese versions of Perceived Preparation and Opinions were supported in this sample. The instrument measures nurses' preparedness and opinions towards IPV. Item classification into Confident, Cautious and Concerned categories is a pragmatic way to interpret the results. Impact The Chinese scales can be used to measure nurses' preparedness and opinions towards IPV in China. The study also provides an approach for interpretation of results and identification of socially desirable responses in validation and survey studies in other contexts. The adaptation and use of the Chinese scales serve as a primary step in responding to IPV in China's health sector and can be used as a template for adapting the instrument in other low‐ and middle‐income countries. [ABSTRACT FROM AUTHOR]

Aim: Partner abuse is a global public health issue with both short‐ and long‐term health effects. Healthcare professionals frequently encounter patients who experience partner abuse and should be knowledgeable about how to respond to these individuals. The aim of this study was to examine the validity and reliability of the Turkish version of The Readiness to Encounter Partner Abuse Patients (READI) Scale. Design: A descriptive, methodological and cross‐sectional design was used. Methods: Data were collected with a sociodemographics form and the READI‐T Scale between 13 December 2021 and 5 January 2022. The study sample comprised nursing students (n = 323) at or over the age of 18 years and accepting to take part in the study. The linguistic and content validity and confirmatory factor analysis were used to assess the validity of the scale. The reliability of the scale was achieved using Cronbach's alpha, item‐total correlations and test–retest. Results: The READI‐T Scale had a content validity index of 0.99 and adequate sensitivity. The factor loadings ranged from 0.63 to 0.84 for the self‐efficacy sub‐dimension, from 0.82 to 0.91 for the emotional readiness sub‐dimension, from 0.47 to 0.81 for the motivational readiness sub‐dimension and from 0.28 to 0.64 for the partner abuse knowledge sub‐dimension. The CFA showed that the model had a good fit (x2/df = 1.792; GFI = 0.88; CFI = 0.94; RMSEA = 0.050). Cronbach's alpha was found to be 0.92 for the scale. Conclusion: The READI‐T Scale is a valid and reliable tool to determine whether Turkish nursing students are knowledgeable enough to encounter partner abuse patients. Impact This scale can be used to determine the training needs of healthcare professionals on partner abuse and may be useful as a pre‐and posttest to determine the effects of partner abuse education programs. Thus, this scale may also assist early identification of persons who have a risk for partner abuse. [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]

Aim: The aim of this study was the translation, cross‐cultural adaptation and validation of the Family Confusion Assessment Method in critically ill patients. Background: Delirium is a frequently unrecognized disorder in critically ill patients. Visiting family members might be the first to notice subtle changes in a patient's cognition and behaviour. The Family Confusion Assessment Method was developed to detect delirium by family members, but has not been available for the German‐speaking area yet. Design: A prospective validation study was conducted between January 2020 and October 2020. Methods: The Family Confusion Assessment Method was translated into German according to the Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient‐Reported Outcomes. Subsequently, we compared the Family Confusion Assessment Method with the Confusion Assessment Method for the Intensive Care Unit in critically ill patients and their family members in a medical intensive care unit in Germany. Results: We included 50 dyads of critically ill patients and their family members. The prevalence of delirium measured by Confusion Assessment Method for the Intensive Care Unit was 44%. Cohen's kappa coefficient was 0.84. The German Family Confusion Assessment Method had a high sensitivity of 95.5% and specificity of 89.3%. The positive predictive value and negative predictive value were 87.5% and 96.2% respectively. Conclusions: These findings suggest that the German Family Confusion Assessment Method is an accurate assessment tool for delirium detection in the intensive care unit by family members. Furthermore, the results indicate that family members may identify delirium by the Family Confusion Assessment Method without prior training. Impact Collaborating medical staff with patients' family members to detect delirium in the intensive care unit may lead to early recognition of delirium. [ABSTRACT FROM AUTHOR]