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Aims and objectives. To describe nurses' perceptions concerning their professional practice environment in mainland China and identify factors associated with these views. Background. Globally, the environments in which nurses work influence the quality of nursing practice and health care. Design. A cross-sectional descriptive survey using both paper- and online-based delivery modes was used. Method. A convenience sampling method was used. The survey questionnaire was composed of sociodemographic items and the 38-item Chinese version of Professional Practice Environment survey. The content of the paper-based questionnaire was identical to the online survey. Pearson's chi-square test was conducted to compare the demographic characteristics of these two data sets. Descriptive statistics analysis included frequency, percentage, mean and standard deviation. Multiple linear regression analysis using the Backwards method was applied to identify independent predictors of each subscale of the 38-item Chinese version of Professional Practice Environment. Results. A total of 573 questionnaires were analysed. The mean score of each subscale of the 38-item Chinese version of Professional Practice Environment in this study ranged from 2-66-3-05. All subscales except work motivation (3-05, standard deviation: 0-44) scored less than 3-0. Areas rated as most in need of improvement included control over practice, interpersonal interaction, supportive leadership and handling conflict, and staff relationships with physicians and autonomy. Conclusion. This study has identified nurses' perspectives regarding their workplaces in contemporary China. These data have provided an important baseline for developing and implementing culturally appropriate strategies to improve the working environment of Chinese nurses. Relevance to clinical practice. A supportive and enabling work environment promotes professional development and the safety and quality of health care. Addressing these factors is important in optimising work place environments. [ABSTRACT FROM AUTHOR]

Background: Historically, it has been reported that new graduates make limited use of their clinical assessment skills, yet these form the basis for making nursing decisions and selecting all nursing interventions. Aims and objectives: To explore new graduates' preparedness for, and confidence with, clinical assessment and their reliance on electronic monitoring. To identify barriers that hinder, and strategies that enable, clinical assessment. Design: A mixed‐method study comprising a cross‐sectional, quantitative survey and qualitative data, gathered using the World Café method. Methods: Data were collected from volunteers (n = 137) of all new graduates (n = 160) working in adult settings for a New Zealand district health board over a 1‐year period. A paper‐based survey explored use of clinical assessment, using a five‐point Likert scale. Qualitative data comprised written records of group discussions and individual responses to four questions with thematic analysis of results. A STROBE checklist was used. Results: Most (n = 128) new graduates agreed/strongly agreed that clinical assessment was part of their role. Most (n = 119) agreed/strongly agreed that assessing patients by technology alone was inadequate. Thirty‐six did not agree/strongly agree that they were well‐prepared to perform clinical assessment. Forty‐one did not agree/strongly agree that they were confident to perform clinical assessment, particularly those aged ≥30 years. Factors limiting use of clinical assessment were lack of time, knowledge, skill, confidence, reliance on doctors and an unsupportive work environment. Factors that would enhance clinical assessment involved increased supervision by experienced staff, provision of short courses and more in‐service education on clinical assessment. Conclusions: New graduates acknowledged that clinical assessment was part of their role and involved more than electronic monitoring. However, many lacked confidence and preparedness for clinical assessment in their work area, particularly those aged ≥30 years, potentially limiting clinical assessment use. Supportive changes, including short courses to revise clinical assessment skills and supervision of workplace‐specific clinical assessments, could help new graduates more confidently and efficiently assimilate clinical assessment into their practice. Relevance to Clinical Practice: This research identified reasons that caused a cohort of new graduates to make limited use of their clinical assessment skills. It also reports the practical solutions they considered would help them increase their use of clinical assessment and thus support their decision‐making in nursing practice. [ABSTRACT FROM AUTHOR]

Aims: This study aims to describe the experiences of women with gynaecological cancer regarding family‐oriented care (FOC) and how they rated their health‐related quality of life (HRQoL) using a 15D instrument (15D©). Design: A cross‐sectional mixed‐method study. Methods: The data were collected by electronic surveys of two Finnish cancer associations from gynaecological cancer patients (n = 53). The qualitative data were analysed using thematic analysis. The HRQoL answers were analysed statistically using IBM SPSS Statistics (Version 27). Results: The results emphasized that FOC is not yet part of the care process. Furthermore, comprehensive encounters are lacking, and the experience of being a woman is forgotten during the care process. The results of the HRQoL analysis suggest that distress and the discomfort and symptoms of cancer patients are perceived as significant factors affecting their quality of life during different phases of treatment. Family status also has an impact on perceived quality of life, whereby those living alone gave worse ratings for the depression and vitality dimensions. Conclusion: In part, the quantitative and qualitative data supported each other, but the descriptions provided a more comprehensive view of issues that affect women in a more multidimensional way, such as sexual health issues. More research on the effectiveness of FOC is needed to develop the capacity for effective healthcare. Implications for the Profession and/or Patient Care: This study was able to identify important areas for improvement in clinical practice from the perspective of patients and their families. Reporting Method: This study was prepared and reported according to the STROBE checklist. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: This study examines the intricate language and communication patterns of nurse‐to‐nurse handoffs across three units with varying patient acuity levels and nurse–patient ratios, seeking to identify linguistic factors that may affect the quality of information transfer and patient outcomes. Design: A mixed‐methods cross‐sectional design. Methods: This study used the Nurse‐to‐Nurse Transition of Care Communication Model to explore the content and meaning of language in nursing handoffs within a large academic medical centre. Data were collected on three units through digital audio recordings of 20 handoffs between June and September 2022, which were transcribed and analysed using the Linguistic Inquiry Word Count programme. Trustworthiness was established by adhering to COREQ and STROBE guidelines for qualitative and quantitative research, respectively. Results: Analysis revealed a preference for casual, narrative language across all units, with ICU nurses demonstrating a higher confidence and leadership in communication. Cognitive processes such as insight and causation were found to be underrepresented, indicating a potential area for miscommunication. Communication motives driven by affiliation were more pronounced in ICU settings, suggesting a strong collaborative nature. No significant differences were observed among the units post multiple testing adjustments. Speech dysfluencies were most pronounced in ICU handoffs, reflecting possible stress and cognitive overload. Conclusion: The study highlights the need for improved communication strategies such as interventions to enhance language clarity and incorporating technological tools into handoff processes to mitigate potential miscommunications and errors. The findings advance nursing science by highlighting the critical role of nuanced language in varied‐acuity hospital settings and the necessity for structured nurse education in handoff communication and standardized handoff procedures. Implications for the profession and patient care: This study underscores the critical role of language in nurse‐to‐nurse handoffs. It calls for enhanced communication strategies, technology integration and training to reduce medical errors, improving patient outcomes in high‐acuity hospital settings. Patient or Public Contribution: Nurses only. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To describe a grading system that can be used to evaluate core competency of clinical nurse specialists (CNSs) at different levels. Background: Evaluate core competence of CNSs at different levels reflects the quality of nursing and the development of the nursing profession. Design: This research employed the Delphi method. Methods: The STROBE checklist for observational cross‐sectional studies was followed to report this research study. This study consisted of two main phases: a literature review and semistructured interviews. Individual semistructured interviews were conducted with 11 healthcare experts and two patients. Two rounds of questionnaire surveys were administered to 21 nursing experts using the Delphi method. The CNSs were classified as primary, intermediate or advanced based on their years of work, professional titles and educational qualifications. Results: The graded competency evaluation system consisted of five first‐level indicators (clinical practice, consulting guidance and teaching, scientific research innovation, management and discipline development, and ethical decision‐making), 15 second level indicators, and 40 third‐level indicators. The authority coefficients (Cr) of the experts were.865 and.901. The Kendall's concordance coefficients of the three‐level indicators were.417,.289 and.316 for primary CNSs;.384,.294 and.337 for intermediate CNSs; and.489,.289 and.239 for advanced CNSs. Conclusion: The graded use evaluation system in clinical practice initially involves a comprehensive evaluation of the core abilities of CNSs. This is a tool for cultivating and grading the abilities of specialised nurses that can promote a practical upwards spiral. Relevance to Clinical Practice: The evaluation system can promote the scientific management and continuous improvement of CNSs in clinical nursing and can serve as a practical and objective reference for the effective management and development of CNSs. Patient or Public Contribution: Patients participated in the data collection process, during which they shared their health‐seeking experience with our research team. [ABSTRACT FROM AUTHOR]

Aims and objectives: The many negative effects of burnout have prompted researchers to better understand the factors contributing to it. The purpose of this paper is to add to this body of knowledge through the study of burnout among direct‐care workers in nursing homes. Background: Perhaps the factor most often associated with employee burnout is the level of staffing—insufficient staffing results in work overload and eventually employee burnout. A closer look at research findings suggests that there are many other factors also contributing to burnout. These range from those at the organisational level, such as availability of training and resources to individual characteristics such as self‐esteem and length of employment. Methods: A self‐administered survey instrument was completed by 410 direct‐care workers working within 11 nursing homes in the north Texas region. Regression analyses were performed, adjusting for clustering by nursing home. Beta coefficients and structure coefficients are reported. Burnout was measured through three dimensions: emotional exhaustion, depersonalisation and personal accomplishment. Results: Organisational, work design, interpersonal and individual characteristics were found to be associated with one or more dimensions of burnout. Conclusions: The analyses largely support previous research. Organisational variables of significance included the availability of resources to do the work, available training and fair pay. Work design variables of significance included adequate staffing. The individual characteristic, self‐esteem, appeared to have the strongest impact on burnout. Commitment to the organisation also had a large impact. Relevance to clinical practice: While the data do not allow for the testing of causal relationships, the data do suggest that providing adequate staffing, perceived fair pay, sufficient work resources (e.g., towels, gowns), management support and adequate training may result in less direct‐care worker burnout on the job. [ABSTRACT FROM AUTHOR]

Aim(s): To demonstrate how interoperable nursing care data can be used by nurses to create a more holistic understanding of the healthcare needs of multiple traumas patients with Impaired Physical Mobility. By proposing and validating linkages for the nursing diagnosis of Impaired Physical Mobility in multiple trauma patients by mapping to the Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC) equivalent terms using free‐text nursing documentation. Design: A descriptive cross‐sectional design, combining quantitative analysis of interoperable data sets and the Kappa's coefficient score with qualitative insights from cross‐mapping methodology and nursing professionals' consensus. Methods: Cross‐mapping methodology was conducted in a Brazilian Level 1 Trauma Center using de‐identified records of adult patients with a confirmed medical diagnosis of multiple traumas and Impaired Physical Mobility (a nursing diagnosis). The hospital nursing free‐text records were mapped to NANDA‐I, NIC, NOC and NNN linkages were identified. The data records were retrieved for admissions from September to October 2020 and involved medical and nursing records. Three expert nurses evaluated the cross‐mapping and linkage results using a 4‐point Likert‐type scale and Kappa's coefficient. Results: The de‐identified records of 44 patients were evaluated and then were mapped to three NOCs related to nurses care planning: (0001) Endurance; (0204) Immobility Consequences: Physiological, and (0208) Mobility and 13 interventions and 32 interrelated activities: (6486) Environmental Management: Safety; (0840) Positioning; (3200) Aspiration Precautions; (1400) Pain Management; (0940) Traction/Immobilization Care; (3540) Pressure Ulcer Prevention; (3584) Skincare: Topical Treatment; (1100) Nutrition Management; (3660) Wound Care; (1804) Self‐Care Assistance: Toileting; (1801) Self‐Care Assistance: Bathing/Hygiene; (4130) Fluid Monitoring; and (4200) Intravenous Therapy. The final version of the constructed NNN Linkages identified 37 NOCs and 41 NICs. Conclusion: These valid NNN linkages for patients with multiple traumas can serve as a valuable resource that enables nurses, who face multiple time constraints, to make informed decisions efficiently. This approach of using evidence‐based linkages like the one developed in this research holds high potential for improving patient's safety and outcomes. No Patient or Public Contribution: In this study, there was no direct involvement of patients, service users, caregivers or public members in the design, conduct, analysis and interpretation of data or preparation of the manuscript. The study focused solely on analysing existing de‐identified medical and nursing records to propose and validate linkages for nursing diagnoses. [ABSTRACT FROM AUTHOR]

Background: The first step in preventing pressure injuries (PIs), which represent a significant burden on intensive care unit (ICU) patients and the health care system, is to assess the risk for developing PIs. A valid risk assessment scale is essential to evaluate the risk and avoid PIs. Objectives: To compare the predictive validity of the Braden scale and Waterlow scale in ICUs. Design: A multicentre, prospective and cross‐sectional study. Methods: We conducted this study among 6416 patients admitted to ICUs in Gansu province of China from April 2021 to October 2022. The incidence and characteristics of PIs were collected. The risk assessment of PIs was determined using the Braden and Waterlow scale. The sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve of the two scales were compared. Results: Out of 5903 patients, 72 (1.2%) developed PIs. The sensitivity, specificity, positive and negative predictive, and the area under the curve of the Braden scale were 77.8%, 50.9%, 0.014 and 0.996, and 0.689, respectively. These values for the Waterlow scale were 54.2%, 71.1%, 0.017, 0.994 and 0.651. Conclusions: Both scales could be used for risk assessment of PIs in ICU patients. However, the accuracy of visual inspection for assessment of skin colour, nursing preventive measures for patients and scales inter‐rater inconsistency may limited the predictive validity statistics. Relevance to Clinical Practice: Both scales could be used for PIs risk assessment. The low specificity of the Braden scale and low sensitivity of the Waterlow scale remind medical staff to use them in combination with clinical judgement and other objective indicators. Patient or Public Contribution: This study was designed to enhance the management of PIs. Patients and the general public were not involved in the study design, analysis, and interpretation of the data or manuscript preparation. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To develop a Chinese version of a chronic wound health‐related quality of life (QoL) instrument and to examine the psychometric properties of this instrument. Background: Existing QoL instruments are not tailored to the linguistic and cultural characteristics of Chinese‐speaking patients; a version addressing this gap will increase clinical understanding of their healthcare experience and may help guide chronic wound care. Design: A methodological study. Methods: The method advanced by DeVellis (2017) was used to develop the instrument. An initial pool of 38 items was created. To optimize scale length and test reliability and validity, exploratory and confirmatory factor analyses were conducted. A total of 23 items formed the final pool. After two rounds of expert discussions, the average content validity index of the final 23 items was.89. Results: A total of 226 patients completed the instrument and were divided into two groups for further analysis. Exploratory factor analysis revealed that 15 items remained in four factors (social activity restrictions, physical and psychological disturbance, wound burden and daily life limitation), which accounted for 64.87% of the variance. Confirmatory factor analysis revealed an acceptable fit of the hypothesized factor structure and the convergent and discriminant validities were achieved. Cronbach's α coefficients for each factor were.807,.773,.799 and.713, respectively. Conclusion: The Chinese version of a chronic wound health‐related QoL instrument consists of 15 items in four subscales and demonstrates good reliability and validity. Relevance to Clinical Practice: This instrument can be used intermittently or continuously to evaluate the treatment effect of chronic wounds by assessing health‐related QoL. Scholars in Chinese‐speaking regions may find this culturally compatible instrument useful when conducting studies related to chronic wounds. Patient or Public Contribution: Two hundred twenty‐six participants provided their perspectives on health‐related QoL. [ABSTRACT FROM AUTHOR]

Aim and Objectives: To develop a Delirium Care Critical‐Thinking Scale for nurses caring for patients in the intensive care unit and examine the scale's psychometric properties. Background: There is a tool to evaluate nurses' critical thinking skills to determine nursing competency when delirium care is required. Design: This cross‐sectional, mixed‐methods study. Methods: The Delphi method was applied for collection and analysis of data during conceptualization and item generation of the tool (Phase I). Item analysis, assessment of validity and reliability of the scale (Phase II) involved 318 nurses recruited by convenience sampling from nine adult intensive care units in medicine and surgery at one medical centre. Confirmatory factor analysis assessed construct validity. Internal consistency and 2‐week test–retest stability measured reliability. A Critical Thinking Disposition Inventory Scale examined concurrent validity. Results: After three rounds, the Delphi method resulted in 31 scale items. Item analysis demonstrated construct reliability ranged from 9.23 to 16.18. Confirmatory factor analysis eliminated one item and extracted five factors: applying knowledge, confirming the problem and accuracy of information, reasoning logically, choosing appropriate strategies and remaining open‐minded. Average variance extracted values of all factors indicated good convergent validity. Cronbach's α for internal consistency was.96 with good test‐retest reliability. The correlation coefficient for concurrent validity was.301. Conclusion: The new Delirium Care Critical‐Thinking Scale for intensive care nurses was demonstrated to be a reliable and valid tool for evaluating their ability to assess patients with delirium. Relevance to Clinical Practice: This new scale could be used to assess outcomes of education interventions and the effectiveness of nursing care quality involving patients with delirium in intensive and critical care units. Reporting Method: The COSMIN checklist was used as the reporting guideline for this study. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Aim: To gain a deeper understanding of what is important to nurses when thinking about shift patterns and the organisation of working time. Design: A cross‐sectional survey of nursing staff working across the UK and Ireland collected quantitative and qualitative responses. Methods: We recruited from two National Health Service Trusts and through an open call via trade union membership, online/print nursing profession magazines and social media. Worked versus preferred shift length/pattern, satisfaction and choice over shift patterns and nurses' views on aspects related to work and life (when working short, long, rotating shifts) were analysed with comparisons of proportions of agreement and crosstabulation. Qualitative responses on important factors related to shift preferences were analysed with inductive thematic analysis. Results: Eight hundred and seventy‐three survey responses were collected. When nurses worked long shifts and rotating shifts, lower proportions reported being satisfied with their shifts and working their preferred shift length and pattern. Limited advantages were realised when comparing different shift types; however, respondents more frequently associated 'low travel costs' and 'better ability to do paid overtime' with long shifts and 'healthy diet/exercise' with short shifts; aspects related to rotating shifts often had the lowest proportions of agreement. In the qualitative analysis, three themes were developed: 'When I want to work', 'Impacts to my life outside work' and 'Improving my work environment'. Reasons for nurses' shift preferences were frequently related to nurses' priorities outside of work, highlighting the importance of organising schedules that support a good work‐life balance. Relevance to Clinical Practice: General scheduling practices like adhering to existing shift work guidelines, using consistent and predictable shift patterns and facilitating flexibility over working time were identified by nurses as enablers for their preferences and priorities. These practices warrant meaningful consideration when establishing safe and efficient nurse rosters. Patient or Public Contribution: This survey was developed and tested with a diverse group of stakeholders, including nursing staff, patients, union leads and ward managers. Reporting Method: The Strengthening the Reporting of Observational Studies (STROBE) checklist for cross‐sectional studies was used to guide reporting. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to describe the knowledge, attitudes and practices (KAP) of nurses in implementing advance directives (ADs) for older patients and analyze the influencing factors before the establishment of the first advance directives act in China. Design: Multicenter cross‐sectional survey. The standards for reporting the STROBE checklist are used. Methods: This cross‐sectional study developed a self‐designed structured questionnaire to assess nurses' knowledge, attitudes and practices about ADs. Nurses were recruited by stratified random sampling through the Nursing Departments of 12 hospitals in southwest China and were asked to fill out the questionnaire face to face about knowledge, attitudes and practices. Data were analyzed following descriptive statistics, rank‐sum test and multiple linear regression. Results: This study included 950 nurses. The study found that nurses were extremely supportive of ADs. Unmarried nurses had better knowledge of ADs than married ones. Nevertheless, there was a discrepancy between the participants' knowledge, attitude and practice. The participants' practice was lower (4.3%) compared with their attitude (81.9%) and knowledge (42.2%). Knowledge on, attitudes towards and standardized procedures for ADs in the workplace affected nursing practice. Conclusions: The study recommends that courses on ADs and appropriate support from medical institutions should be provided to nurses to increase their knowledge and confidence in implementing ADs. Healthcare professionals should be sufficiently equipped to implement ADs and handle their execution appropriately to provide adequate end‐of‐life care corresponding to patients' wishes. Relevance to Clinical Practice: The study results inform rich insights as it discusses the numerous interrelating factors influencing these three fundamental aspects that affect the success of any AD policy by surveying the knowledge, attitudes and practices of clinical nurses. Furthermore, our results hint at distinct areas of improvement in the nursing practice to facilitate the wider implementation and acceptance of ADs in China. Patient or Public Contribution: This study involved no patient. [ABSTRACT FROM AUTHOR]

Aims and objectives The primary aim of this study was to examine the correlations between patient and caregiver characteristics with caregiver burden, anxiety and depression in Alzheimer's Disease. Secondary aim was to determine which behavioural and psychological symptoms had the greatest impact on caregiver burden, anxiety and depression in Alzheimer's Disease. Background Caregivers of individuals with Alzheimer's Disease experience high levels of burden, both psychologically and physically. Previous studies have examined caregiver burden, anxiety and depression separately. However, no paper has examined these three psychological conditions simultaneously. Design A cross-sectional design. Methods A total of 310 patients with probable Alzheimer's Disease and their primary caregivers were assessed. Cognitive impairment and neuropsychiatric symptoms were assessed with the Mini Mental State Examination, Montreal Cognitive Assessment, Clock Drawing Test and Neuropsychiatric Inventory, respectively. Caregiver burden, anxiety and depression were assessed with the ZBI, Generalised Anxiety Disorder Scale-7 and Patient Health Questionnaire-9, respectively. Results All 12 neuropsychiatric symptoms in the Neuropsychiatric Inventory were significantly correlated with caregiver burden, anxiety and depression, with the top three neuropsychiatric predictors being depression, apathy and anxiety. Furthermore, higher levels of caregiver anxiety were associated with a longer duration of being a caregiver. Within caregivers, higher levels of depression were independently associated with higher numbers of additional caregivers, lower educational background and being the spouse of the patient. Higher levels of burden were associated with a longer duration of being a caregiver and being the spouse of the patient. Caregiver burden, anxiety or depression were not significantly correlated with hours/day of caring for the patient. Conclusions Caregiver burden, anxiety and depression were significantly correlated with different neuropsychiatric symptoms in the Neuropsychiatric Inventory. Relevance to clinical practice Practitioners are able to identify caregivers at risk for burden, anxiety and depression. Understanding which Neuropsychiatric Inventory symptom is more closely associated with distress in caregivers will help practitioners to be more specific and effective in detecting caregiver distress. [ABSTRACT FROM AUTHOR]

Aims and objectives To develop and test a predictive model of women's help-seeking intention for urinary incontinence that was developed using the theory of planned behaviour and to identify factors that influenced women's help-seeking intention. Background Urinary incontinence is a chronic progressive condition if left untreated, but few women seek help from healthcare providers. Reasons for not seeking help have been studied in Western countries while relatively little information is available from mainland China. Design Questionnaire-based cross-sectional survey was performed in this study. Methods From May-October 2011, a cross-sectional survey was conducted with a representative sample of 346 incontinent women from three communities in Jinan using strict inclusion and exclusion criteria. Data were collected via a self-administered pencil-and-paper survey that consisted of a multi-item questionnaire. Predictive model estimation was performed using structural equation model. Results The resultant model demonstrated that incontinent women's help-seeking intention could be predicted by their perceived self-efficacy and perceived social impact from urine loss. Perceived self-efficacy was the negative predictor, while the perceived social impact was the positive one. Overall, the predictive model explained 36% of the variance for incontinent women's help-seeking intention. Conclusion The theory of planned behaviour can be used to predict help-seeking intention in women who have urinary incontinence. Community nurses should increase patients' help-seeking intention by addressing perceived social impact and perceived self-efficacy in managing incontinent symptoms. Relevance to clinical practice Our findings suggest that high perceived self-efficacy in dealing with incontinent symptoms could hinder incontinent women from seeking help from healthcare providers. The strong social impact women perceived, however, facilitates intention to seek help. Nurses should understand and address these factors through education and evidence-based practices to increase help-seeking in incontinent women. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore the experiences of secondary care nurse prescribers to establish how prescribing is employed and what its benefits and disadvantages are perceived to be. Background. Nurse prescribing has developed rapidly since it inception almost 20 years ago and there is a significant body of research evaluating its implementation in primary care. Recent expansion of non-medical prescribing rights has prompted nurses in secondary care establishments to become prescribers. Evaluation of nurse prescribing in this new environment is required, if practice is to be informed and advanced. The lack of such evaluations in the published literature was the impetus for this study. Design. A cross-sectional qualitative study. Methods. A convenience sample of nurse prescribers was interviewed using a single broad question to prompt elaboration. Transcribed interviews were analysed using Colaizzi's procedural steps. Results. Three main themes emerged from the analysis: motivations behind becoming a nurse prescriber; benefits and limitations of prescribing education and continuing professional development and prescribing in practice. Conclusion. Nurses felt nurse prescribing offers clear benefits in relation to patient care. Where nurses were not prescribing, finance arrangements between different NHS trusts appear to be a significant barrier to its successful implementation of prescribing in practice. Nurse prescribing is strongly believed to be the domain of the experienced nurse. There is a clear need for ongoing evaluation of all aspects of nurse prescribing. Relevance to clinical practice. This paper makes key recommendations on the future development and delivery of programmes of education for nurse prescribers and for the delivery of safe and effective prescribing in practice. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of the study was to review breastfeeding support provided by Public Health Nurses in Ireland. The objectives were to identify the availability of appropriate guiding policies, educational preparation, attitude of Public Health Nurses and the availability and use of other supportive services. Background. Breastfeeding rates in Ireland are among the lowest in Europe. The main source of formal support for breastfeeding mothers in the community in Ireland is from Public Health Nurses who can make referral to other non-statutory resources. The nature of this support is determined by policies guiding clinical practice and education that increases breastfeeding confidence and competence of all personnel. Consequently, an assessment of breastfeeding resources requires an analysis of all these variables. Design. A large quantitative, cross-sectional study was conducted, involving Public Health Nurses and mothers. This paper represents the results from the perspective of Public Health Nurses. Method. Directors of Public Health Nursing ( n = 24) and Public Health Nurses ( n = 204) completed self-report questionnaires by mail and online. Data were analysed using the Statistical Package for Social Sciences and reported using descriptive and inferential statistics. Results. Public Health Nurses are well educated to support breastfeeding and have a positive attitude and a high degree of self-assessed confidence and competence. A wide variety of non-statutory support exists for breastfeeding but is not always used to their full potential. Conclusion. Standardising educational requirements for Public Health Nurses in supporting breastfeeding is an area that requires attention. Ultimately, service delivery in relation to supporting breastfeeding mothers would benefit from being more timely and responsive. Relevance to clinical practice. Awareness of support resources is necessary for Public Health Nurses to make appropriate referrals for breastfeeding mothers. Furthermore, Directors of Public Health Nursing need to encourage the breastfeeding supportive role of Public Health Nurses and facilitate continuing professional development. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The purpose of this empirical study was to explore the current status and associated factors of lymphedema self‐management behaviours among Chinese breast cancer survivors. Background: Breast cancer‐related lymphedema is a lifetime concern for survivors and is currently incurable. Lifetime lymphedema self‐management takes a significant role in preventing development and progression of lymphedema. Understanding influencing factors of lymphedema self‐management behaviours can help to develop targeted intervention programs. Design: A multicentre cross‐sectional study. Methods: From December 2021 to April 2022, a convenience sample of 586 participants were recruited at four tertiary hospitals in four cities in China. Self‐reported questionnaires were used to measure socio‐demographic characteristics, disease‐and treatment‐related characteristics, lymphedema self‐management behaviours, lymphedema knowledge, illness perception, self‐efficacy, self‐regulation and social support. Descriptive analysis, bivariate analysis and hierarchical multiple regression were conducted. This study was registered at Chinese Clinical Trial Registry (ChiCTR2200057084), and was reported followed the STROBE checklist. Results: Breast cancer survivors reported moderate level of lymphedema self‐management behaviours. Promotion of lymph reflux management was ranked the least performed self‐management behaviours, while the affected limb protection management ranked the most. 36.2% of self‐management behaviours was explained by exercise regularly, level of attention on lymphedema prevention, unclear about the tumour stage (vs. stage I), knowledge, self‐efficacy, emotional illness representation and social support. Conclusions: Lymphedema self‐management behaviours of breast cancer survivors was insufficient. Performance of lymphedema self‐management varied with different socio‐demographic characteristics, along with different levels of knowledge, self‐efficacy, perception and social support. All these identified predictors should be reckoned in assessment and intervention of lymphedema self‐management behaviours. Relevance To Clinical Practice: This study addressed that breast cancer survivors' lymphedema self‐management behaviours should be promoted. Focusing on identified predictors, further lymphedema surveillance, knowledge education or social facilitation programs are recommended to enhance their self‐management performance and adherence. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to determine the relationship between the demand for telenursing and the chronic illness resources available to patients with type 2 diabetes mellitus (T2DM), as well as the factors that affect this requirement. Design: Cross‐sectional. Methods: This study included 586 participants with T2DM. A telenursing needs questionnaire developed by the research team was used to assess the telenursing needs of patients with T2DM, and the Chinese version of the Chronic Illness Resources Survey was used to assess the participants' community chronic disease resources. A one‐way ANOVA and multiple regression analysis were used to determine the factors influencing the demand for telenursing and to estimate the relationship between chronic illness resources and the need for telenursing. The STROBE checklist was followed. Results: The patients' telenursing needs, ranked from high to low, are as follows: individualized skills and safety; basic disease care; psychological and spiritual needs; respect and social support; and high‐level health management. The chronic disease resource score was 3.47 ±.02, which suggested that patients with T2DM have relatively rich disease resources. Multiple regression analyses showed that resources for chronic diseases, the course of diabetes and complications, family income and other chronic diseases accounted for 79.6% of the variance in T2DM patients' telenursing needs. Conclusions: The telenursing needs of patients with T2DM are prominent, and primarily focus on basic nursing needs for the disease. To some extent, chronic disease resources affect the telenursing needs of patients with T2DM. Relevance to Clinical Practice: It is crucial to pay attention to research on telenursing for T2DM patients from the patients' perspective. Enhancing resources for chronic diseases may help meet the telenursing needs of T2DM patients. Patient or Public Contribution: Parents and diabetes management specialists participated in designing the telenursing needs questionnaire. [ABSTRACT FROM AUTHOR]

Aims: To gain insights into the barriers towards the prevention and/or reduction of involuntary treatment in long‐term geriatric care. Design: Mixed methods. Background: Measures to which a person resists and/or does not provide consent for are defined as involuntary treatment. The use of involuntary treatment violates the autonomy of (older) persons and causes more harm than benefit. Moreover, it contradicts the values of person‐centred care. Nevertheless, its use among people living with dementia (PLWD) is still common practice. Methods: We conducted a cross‐sectional, mixed methods study, including an online survey for professional caregivers and a semistructured focus group interview with professional caregivers. Results: A total of 218 participants completed the questionnaire. The percentage of participants who perceived barriers in one of the 22 survey items ranged from 15% to 42%. Lack of time, the experienced need to use involuntary treatment, uncertainty about responsibilities of stakeholders and a lack of knowledge on methods to prevent and/or reduce the use of involuntary treatment were most seen as barriers. Nursing staff perceived a lack of time hindering them in the prevention or reduction of involuntary treatment more often than other professional caregivers. Working in home care and having no former experience with involuntary treatment usage increased perceived barriers. Participants of the focus group interview confirmed these findings and added that professional caregivers in general lack awareness on the concept of involuntary treatment. Conclusions: One out of four professional caregivers experiences barriers hindering prevention and/or reduction of involuntary treatment. More research is needed to gain a better understanding of how professional caregivers can be supported to remove barriers and, consequently, prevent and/or reduce the use of involuntary treatment. Relevance to Clinical Practice: Professional caregivers experience many barriers towards the prevention and reduction of involuntary treatment. Future initiatives should aim to remove the perceived barriers. [ABSTRACT FROM AUTHOR]

Aims: To examine registered nurses' attitudes about end‐of‐life care and explore the barriers and facilitators that influence the provision of high‐quality end‐of‐life care. Design: A sequential explanatory mixed methods research design was used. Methods: An online cross‐sectional survey was distributed to 1293 registered nurses working in five different hospitals in the Kingdom of Saudi Arabia. The Frommelt Attitudes Towards Care of the Dying Scale was used to assess nurses' attitudes towards end‐of‐life care. Following the survey, a subset of registered nurses were interviewed using individual semi‐structured interviews. Results: Four hundred and thirty‐one registered nurses completed the online survey, and 16 of them participated in individual interviews. Although nurses reported positive attitudes towards caring for dying patients and their families in most items, they identified negative attitudes towards talking with patients about death, their relationship with patients' families and controlling their emotions. The individual interview data identified the barriers and facilitators that registered nurses experience when providing end‐of‐life care. Barriers included a lack of communication skills and family and cultural and religious resistance to end‐of‐life care. The facilitators included gaining support from colleagues and patients' families. Conclusion: This study has identified that while registered nurses hold generally favourable attitudes towards end‐of‐life care, they have negative attitudes towards talking with patients and families about death and managing their emotional feelings. Relevance to clinical practice: Education providers and leaders in healthcare settings should consider developing programmes for undergraduate nurses and nurses in clinical practice to raise awareness about the concept of death in a cross‐section of cultures. Nurses' attitudes towards dying patients will be enhanced with culture‐specific knowledge which will also enhance communication and coping methods. Reporting method: This study used the Mixed Methods Article Reporting Standards (MMARS). [ABSTRACT FROM AUTHOR]

Aim: To explore general ward nurses' attitudes and perceptions towards recognising and responding to clinical deterioration in a hospital with automated rapid response system activation. Background: There is growing interest in deploying automated clinical deterioration notification systems to reduce delayed or failed recognition and response to clinical deterioration of ward patients. However, little is known about its impact on ward nurses' perspectives and work patterns. Design: A mixed‐methods study. Methods: Online survey of 168 registered nurses and individual interviews with 10 registered nurses in one acute hospital in Singapore. The study adhered to the STROBE checklist for cross‐sectional studies and the COREQ guidelines for qualitative studies. Results: Many nurses (38.1%) rarely performed patient assessments or observations other than vital signs assessment to assess for early signs of clinical deterioration. About 30% were worried about being criticised for calling the primary team doctors. Four themes emerged from the qualitative analysis: automated rapid response system activation as a safety net, being more cautious with vital signs monitoring, the NEWS2 alone is inadequate, and ward nurses as the 'middleman' between the intensive care unit outreach nurse and primary team doctors. Conclusions: Although nurses value the automated rapid response system activation as a safety net to minimise delays in accessing urgent critical care resources, it does not address the sociocultural barriers inherent in escalation of care. Although the automated system led nurses to be more cautious with vital signs monitoring, it does not encourage them to perform comprehensive patient assessments to detect early signs of deterioration. Relevance to clinical practice: Nurse education on assessing for clinical deterioration should focus on the use of broader patient assessment skills other than vital signs. Sociocultural barriers to escalation of care remain a key issue that needs to be addressed by hospital management. No patient or public contribution: No patients, service users, care‐givers or members of the public were involved in the study. [ABSTRACT FROM AUTHOR]

Aim: To describe positive and negative spiritual responses to providing COVID‐related nursing care among nurses working in hospitals. Background: The COVID pandemic has intensified and publicised the threats to nurse well‐being. Absent from the recommendations for promoting nurse well‐being is recognition of how nurses' spirituality and/or religiosity is affected by the strain of COVID caring or how it may be affecting their well‐being. Design: Cross‐sectional, descriptive observational, mixed methods study. Methods: Data were collected from 523 registered nurses employed in three Southern California hospitals during March–May, 2022 when these hospitals' COVID case counts were <15%. Using Online survey methods, data were obtained using the Religious/Spiritual Struggles Scale–Short Form, Moral Injury Symptom Scale–Healthcare Professionals, Post‐traumatic Growth Inventory and demographic and work‐related items. STROBE guidelines for cross‐sectional observational studies were observed. Results: The mean for religious/spiritual struggles was 1.98 (range of 1–5, comparable to a little bit). Although roughly half of the sample reported the struggles were not experienced/did not apply, 23%–36.5% reported experiencing these struggles at least somewhat. The most frequent struggle was to find ultimate meaning. The mean observed for moral injury was 6.5 (range of 1–10); applying established criteria indicated it was troubling for at least 50%. The mean for post‐traumatic growth was 4 (on a scale of 0–6); using established criteria, 41% experienced PTG. Quantitative findings were illustrated by the qualitative responses that occasionally expressed spiritual tragedy and transformation concurrently. Conclusion: The professional work of nursing impacts nurses in invisible, spiritual ways that can be tragic and/or transformative. Relevance to Clinical Practice: Interventions to address nurses' mental health challenges must include attention to these invisible struggles. Nurses' mental health challenges must be met in part by addressing how they can surmount spiritual tragedy—and allow spiritual transformation. [ABSTRACT FROM AUTHOR]

Aims: To systematically describe the factors influencing the perception of feeling safe among patients receiving pre‐hospital emergency care. Background: Patient safety is a top priority worldwide. Little is known about how patients perceive safety during emergency health care and what the related factors are. Design: A mixed‐methods systematic review. Methods: Six databases were searched to December 2021. Inclusion criteria were as follows: studies with patients of any age, framed in pre‐hospital emergency care settings, referring to patient safety, addressing the perception of safety, and with a quantitative or qualitative research design. Exclusion criteria were as follows: conference records, abstracts, supplements, letters, editorials and reviews. The quality of the evidence was assessed with the Joanna Briggs Institute (JBI) checklists. A convergent integrated approach was followed according to the JBI methodology. The protocol was registered on PROSPERO (CRD42022306337). PRISMA 2020 guidelines were followed in reporting this review. Results: Among the 5223 records identified, the whole texts of 35 articles were reviewed. Ten studies were relevant to the research question. Seven followed a qualitative methodology, with interviews or focus group. Three involved a quantitative methodology, with questionnaires or validated measures. The 74 findings were organised into 11 categories and then grouped into four dimensions: 'receiving a satisfying response from healthcare professionals when I need it', 'EMS personnel's professional competence', 'the variable and unfamiliar settings of pre‐hospital emergencies', and 'patients' personal characteristics'. Conclusions: The perception of safety is influenced by many factors, which can be grouped into four independent dimensions. Quantitative and qualitative studies can provide us with complementary findings. Relevance to Clinical Practice: Awareness of these factors enables us to act upon them. When patients feel safe their health outcomes improve, their anxiety decreases and they collaborate more actively. No Patient or Public Contribution: Patients and caregivers shared their experiences in the articles included. [ABSTRACT FROM AUTHOR]

Purpose: This cross‐sectional, descriptive, correlational study aimed to measure burnout, quality of life (QOL) and perceptions of patient‐related adverse events among paediatric nurses amid the COVID‐19 pandemic and assess the relationships between these scores and participants' demographic and work‐related characteristics. Background: The mental health of most nurses may severely suffer due to the significant adversities that they struggle with while they care for their patients amid the COVID‐19 pandemic. Mental distress negatively affects nurses' relationships and work performance, which may adversely influence the quality of care and patient safety. Methods: A convenient sample of 225 Jordanian paediatric nurses completed a test batter comprising the Copenhagen Burnout Inventory, the Brief Version of the World Health Organisation's Quality of Life questionnaire and the nurse‐perceived patient adverse events' questionnaire. This study was prepared and is reported according to the STROBE checklist. Results: Paediatric nurses reported high levels of burnout, low QOL and high occurrence of hospital‐acquired infections. Participants' age and hospital/unit capacity were significantly associated with burnout and QOL. Conclusion: Personal traits, perceived salary insufficiency and hospital/unit capacity represent factors that aggravate burnout, lower quality of life and worsen perceived patient safety among paediatric nurses. Relevance to clinical practice: Policymakers should promote nurses' mental integrity and patient safety by addressing issues of workload and financial sufficiency and by provide interventions aimed to increase nurses' resilience. Patient or public contribution: Patients or public were not involved in setting the research question, the outcome measures, the design or implementation of the study. However, paediatric nurses responded to the research questionnaires. [ABSTRACT FROM AUTHOR]

Background: Spasticity is a frequent symptom of multiple sclerosis (MS), which may negatively influence daily living activities (ADL). Objectives: To (1) explore the feasibility to conduct a structured interview by specialist nurses about limitations in ADL; (2) determine the percentage of people with MS (PwMS) with limitations in ADL related to spasticity; (3) to assess the knowledge about spasticity and describe its clinical features. Design: Observational, cross‐sectional, multicentre study in 16 MS units of Catalonia (Spain). Participants were recruited from the outpatient facility and day‐care hospital between July 2018 and June 2019 and met the following criteria: (1) age 18 or older, (2) diagnosis of MS according to McDonald criteria 2010 and (3) no clinical relapse in previous 30 days. Methods: Specialist nurses conducted a structured interview divided in two parts: the assessment of (1) limitations in the ADL and (2) the presence of spasticity and associated symptoms. The usefulness of this intervention was requested. This study met the STROBE reporting guidelines checklist for observational studies. Results: Three hundred sixty eight pwMS (244 women) with a mean age of 46 years and a median Expanded Disability Status Scale score of 2.5 (range, 0–8.5) were included. 262 (71%) pwMS had limitations in the ADL, and spasticity was reported as the most limiting symptom in 59 (23%). As a result of the interview, spasticity was observed in 199 (76%) participants; 47 (24%) of them were unaware that they had spasticity and 102 (51%) would not have reported it spontaneously. The level of the interview satisfaction was high (90%). Conclusions: Spasticity is a complex and limiting symptom in MS. The structured interview conducted by specialist nurses is feasible and has good acceptance. Patient contribution Specialist nurses can be proactive in MS clinical assessment, which may help to detect symptoms with negative impact on quality of life. [ABSTRACT FROM AUTHOR]

Aims: To assess the results of a nursing‐led program to treatment of minor health issues from Catalan health institute primary care teams during 2019 and 2020. Background: In 2009, the Catalan health institute implemented a nursing program to deal with minor health problems. This nursing‐led program includes an algorithm for each of the minor health problems and arose as a strategy to reorganise the flow of demand for care in primary care. Design: A cross‐sectional design. Methods: Multicentric cross‐sectional study. 392 primary care teams from the Catalan health institute participated in the study. STROBE guideline was followed in reporting this study. Patients attending any of the participating centres requesting a same‐day consultation for minor health issues were registered. Results: A total of 21,215,278 consultations were recorded: 18,284,105 for adult and 2,931,173 for paediatric patients. Minor health issue resolved by the nurse was achieved in 50.9% of adult patients and 55.4% of paediatric patients. The highest rates of resolution in adults (>85%) were as follows: burns, emergency contraception and injuries. The highest resolution rates (>84%) were as follows: burns, breastfeeding difficulties and infant colic. 87.7% of prescriptions issued by nurses were accepted by the family physician. Conclusions: The nursing‐led program to treat minor health issues has been shown to present acceptable resolution for nurses in a large primary care setting. Nurses have been carrying out prescription activities with very favourable results. Relevance to clinical practice: This study demonstrates that care provided to patients by nurses for minor health issues requiring preferential resolution is effective. Our results are useful in that they confirm both the effectiveness of the nursing‐led program for minor health issues and the pharmacological prescriptions produced during patient appointments. Patient or public contribution: Patient's data were obtained through a program records system after the minor health issues appointments. [ABSTRACT FROM AUTHOR]

Aim and objectives: To identify determinants for using a new screening tool to identify older patients eligible for targeted nurse‐led intervention, as perceived by healthcare professionals implementing the tool, and to examine how these perceptions changed over time. Design: A cross‐sectoral longitudinal qualitative study based on semi‐structured interviews with healthcare professionals in a Danish hospital and two collaborating municipalities. Methods: In three focus groups, seven single interviews and a workshop, we examined the healthcare professionals' perceptions of and attitudes towards the new screening tool before, during and after the implementation. The Theoretical Domains Framework was used to identify the healthcare professionals' perception of barriers and facilitators, followed by content analysis. The results were further discussed using the COM‐B system as an analytic framework. This qualitative study is reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist. Results: 'Professional role', 'Goals' and 'Environmental context' were the domains most talked about by the healthcare professionals across the three time points. The content analysis identified four determinants for using the new screening tool:Making time for the project, External motivation and management, Expectations and reality, and Professional identity. The healthcare professionals' perception of the determinants changed during the implementation, influencing their behaviour and, consequently, the implementation's sustainability. Conclusion: Perception of barriers and facilitators to the interventions were time‐ and context‐sensitive. Beliefs and motivational factors changed during the project, which points out the importance of following implementation processes systematically to understand the outcome of an intervention. Relevance for clinical practice Perceptions and attitudes towards a new initiative may change over time, emphasising the importance of following barriers and facilitators during the implementation of an intervention and working with an implementation plan that can be adapted along the way. [ABSTRACT FROM AUTHOR]

Aim and objectives: To explore factors associated with nurses' willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer. Background: Family caregivers often experience anticipatory grief due to the imminence of a loved one's death. However, few studies have identified factors associated with nurses' willingness or competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer. Methods: This descriptive correlational study recruited a convenience sample of nurses from cancer‐related wards at a regional teaching hospital in Taiwan. The Anticipatory Grief Counseling Willingness Scale and Anticipatory Grief Counseling Competency Scale were employed. This cross‐sectional study followed the STROBE checklist. Results: The nurses' average scores for willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer were 44.28 ± 8.36 and 171.84 ± 30.83, respectively. Multivariate linear regression revealed that interest in participating in anticipatory grief counselling for the family caregivers of patients with terminal cancer was significantly associated with the nurses' willingness to provide such counselling. Similarly, their willingness to provide such counselling was significantly associated with their counselling competency. Conclusions: Nurses' willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer can be enhanced through in‐service education programmes, including bedside teaching and scenario simulation. Relevance to clinical practice: To improve nurses' competency in anticipatory grief counselling for the family caregivers of patients with terminal cancer, factors related to nurses' willingness to provide such grief counselling must be addressed. Diverse strategies of in‐service education can be adopted to promote nurses' competency in anticipatory grief counselling. [ABSTRACT FROM AUTHOR]

Aims and objectives: To analyse the status quo and influencing factors of self‐care ability in breast cancer‐related lymphedema (BCRL) patients and explore the moderating role of social support between self‐efficacy and self‐care ability, to provide references for clinical intervention. Background: The 'gold standard' for the treatment of lymphedema is two‐stage Complete Decongestion Therapy (CDT). Due to the high frequency of patients seeking treatment and CDT is not covered by medical insurance, resulting the medical cost is high, and a set integrated course of edema treatment cannot be completed. Nevertheless, with sufficient self‐care ability, patients can reduce the frequency of outpatient and inpatient treatments, and initiate detumescence procedures with affordable home care. Accordingly, it is necessary to pay attention to the self‐care ability of BCRL patients. Design: A descriptive and cross‐sectional study following the STROBE guideline checklist. Methods: From June 2021 to January 2022, 156 BCRL patients were selected as convenience samples. Questionnaires were administered to the patients using the sociodemographic information questionnaire, the exercise of self‐care agency scale, Chinese version of strategies used by people to promote health, and social support rating scale. Spearman rank correlation was used to analyse the relationship among the three, and univariate and multiple linear regression were used for factor analysis and process to explore the moderating role of social support. Results: The total score of self‐care ability of BCRL patients was 41.00 (32.50, 51.00). The self‐efficacy and social support of BCRL patients were positively correlated with the total score and its dimensions of self‐care ability. Disease duration, severity and difficulty raising limbs were negative correlation factors influencing the self‐care ability of BCRL patients, and self‐efficacy and social support were positive correlation factors, which could explain 77.8% of the total variation. The moderating role of social support between self‐efficacy and self‐care ability was significant, and its moderating role boundary value was 15.70. Conclusions: The self‐care ability of BCRL patients is at a low level. The longer duration of lymphedema, the more serious degree of edema, the more difficulty raising limbs, the lower self‐efficacy and the less social support, the poorer self‐care ability of BCRL patients. Self‐efficacy has a greater impact on the self‐care ability of patients with high levels of social support. Relevance to clinical practice: Factors and moderator‐based models are the first to identify predictors of self‐care ability and the moderating role of social support in Chinese BCRL patients, which may facilitate healthcare practitioners to develop appropriate interventions to manage self‐care ability. [ABSTRACT FROM AUTHOR]

Aim and objectives: This study investigated the incidence of thirst and contributing factors in intensive care unit (ICU) patients by analysing differences in physiologic, psychological, and disease‐ and environment‐related parameters in ICU patients with vs without thirst. Background: Little is known about the factors that influence thirst, and there are no standardised methods for identifying at‐risk patients in the ICU. Previous studies generalised the risk of thirst in ICU patients because of a lack of data on relevant variables. Here, we examined the factors contributing to thirst based on symptom management theory. Design: Prospective descriptive design. Methods: Physiologic, psychological, disease‐related and environment‐related data were collected for 301 patients from 4 ICUs (medical, surgical, cardiac and emergency ICUs) of a hospital from 15 December 2017–10 July 2019 through a screening interview, questionnaires and from electronic medical records. The data were analysed with descriptive statistics, the t‐test and chi‐squared test, and by logistic regression. Binary stepwise logistic regression was used to identify thirst‐associated factors. The findings are reported according to the STROBE checklist for cross‐sectional studies. Results: In total, 210/301 (69.8%) ICU patients experienced thirst. Risk factors were nil per os order (odds ratio [OR] = 4.10, 95% confidence interval [CI]: 1.44–11.69), surgery (OR = 2.96, 95% CI: 1.11–7.93), high glucose (OR = 3.36, 95% CI: 1.01–11.17) and greater disease severity (OR = 1.13, 95% CI: 1.02–1.24). Conclusion: Thirst is common in ICU patients. Timely detection of patients' thirst and identification of those at high risk by ICU nurses can ensure the implementation of effective and safe interventions. Relevance to clinical practice: The results of this study highlight the need to evaluate thirst symptoms in patients with severe disease and develop relief strategies for fasting, perioperative, and hyperglycaemic patients and others who are at high risk of thirst. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the relationship between illness uncertainty, self‐perceived burden and quality of life and explore the mediating role of self‐perceived burden between illness uncertainty and quality of life in patients with chronic myeloid leukaemia. Background: Patients with chronic myeloid leukaemia need long‐term, potentially lifelong therapy to control the disease, which affects their quality of life. There is a need for exploring potentially changeable factors to develop interventions. Little is known about the effects of illness uncertainty and self‐perceived burden on quality of life in this population. Design: A cross‐sectional study. Methods: A convenience sample of 248 patients with chronic myeloid leukaemia was recruited from four university hospitals from February to August 2020. Participants were assessed with the Mishel Uncertainty in Illness Scale, Self‐Perceived Burden Scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The STROBE checklist was used to report the results. Results: Illness uncertainty and self‐perceived burden were negatively associated with quality of life in patients with chronic myeloid leukaemia. Self‐perceived burden partially mediated the relationship between illness uncertainty and quality of life. The indirect effect was −0.101, accounting for 22.9% of the total effect. Conclusion: The findings revealed the relationship between illness uncertainty, self‐perceived burden and quality of life in patients with chronic myeloid leukaemia. Self‐perceived burden exerted a mediating role between illness uncertainty and quality of life in this population. Relevance to clinical practice: This study alerts healthcare providers to pay attention to patients' illness uncertainty and self‐perceived burden, which can contribute to develop effective interventions to improve the quality of life among patients with chronic myeloid leukaemia in the clinical practice. [ABSTRACT FROM AUTHOR]

Design: This study applied a cross‐sectional, descriptive correlational design. Aims and objectives: The purpose of the study was to examine the relationship between cognitive function and self‐reported antihypertensive medication adherence in middle‐aged and older hypertensive women. Background: Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle‐aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle‐aged and older women. Methods: This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self‐reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. Results: More than one‐fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. Conclusions: Reduced memory function was associated with poorer antihypertensive medication adherence among middle‐aged and older women. Middle‐aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. Relevance to clinical practice: Nurses could evaluate the memory of middle‐aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to explore the adherence to self‐management of patients with multimorbidity, identify associated factors, and determine explanatory factors of their adherence to self‐management in terms of the Theory of Adherence of People with Chronic Disease. Background: Adherence to self‐management is essential for successful care of multimorbid patients, but multimorbidity poses challenges for both patients and practitioners due to its care complexity and broad impact on patients' lives. Design: A cross‐sectional, descriptive exploratory design with the STROBE reporting checklist was applied. Methods: Adult multimorbid patients who attended primary healthcare consultations in Finland were surveyed using self‐administered questionnaires with several instruments including the Adherence of People with Chronic Disease Instrument, Kasari's FIT Index, and Alcohol Use Disorders Identification test. Responses of 124 patients were analysed using descriptive statistics, Spearman correlations, binary logistic regression analysis, and Chi‐squared, or corresponding, tests. Results: Most patients' responses indicated good or adequate adherence to care regimens and medications. However, adherence to self‐management for a healthy lifestyle was more frequently inadequate. Adherence was significantly associated with several patient‐related factors, including demographic and health‐related factors, perceived adequacy of loved ones, and patient activation. Significant explanatory factors for adherence included energy and willpower, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, from physicians, and from family and friends. Various factors were relevant for specific aspects of self‐management. Conclusions: Multimorbid patients' adherence to self‐management is not an 'all or none phenomenon, but a multifaceted process with numerous associated and explanatory factors. Relevance to clinical practice: The findings highlight needs for an individualised whole‐person approach in multimorbid patients' care to provide the required support for good adherence to self‐management. Healthcare professionals, especially nurses working in primary health care, are well‐positioned to meet this need. [ABSTRACT FROM AUTHOR]

Aims and objectives: To find out the adherence to lifestyle modifications and its associated factors in hypertensive patients. Background: Low adherence to lifestyle modifications leads to poor therapeutic effectiveness, decreased quality of life, poor health outcomes and increased health care costs. Various factors play an important role in determining the adherence level varying among the different cultural, social and national contexts. Design: A cross‐sectional analytical research design was carried out. Methods: Information from 264 patients with hypertension was collected at the Outpatient Department of Manmohan Cardiothoracic, Vascular and Transplant Center, Kathmandu. A standard tool of WHO Steps Survey Questionnaire and Hypertension Fact Questionnaire was used for data collection. Chi‐square test and binary logistic regression were used for analysis using SPSS 16. Result: The overall adherence to lifestyle modifications was determined as 20.8% with the adherence rate being lowest up to 30.3% for adequate intake of fruits and vegetables. Likewise, 52.5% of patients had average knowledge of hypertension management. Age (p =.021), education (p =.001), occupation(p =.026), household income (p =.007) and family history(p =.011) had statistically significant association with the level of adherence. Younger age (AOR = 1.85 CI = 0.79–4.33) remained as the independent predictor of high adherence to lifestyle modifications. The study followed the STROBE checklist for reporting cross‐sectional study. Conclusion: This study identified that adherence to lifestyle modification is low in older patients. More effective lifestyle modification counselling and educational approaches focusing on the older age groups as well as considering educational level, occupation, family income and family history of hypertension are required to improve their level of adherence. Relevance to clinical practice: Nurses are frequently acquainted with the hypertensive patients in hospitals where they need to provide health teaching on lifestyle modifications. This study identifies the factors that need to be considered while counselling the hypertensive patients. [ABSTRACT FROM AUTHOR]

Aim: To determine the professional profile and the work conditions of nurses working in intensive care units (ICU) in Colombia, Argentina, Peru and Brazil. Background: ICUs require a differentiated professional profile to provide quality care, and appropriate working conditions, leading to a transformation of care and management practices. Design: Descriptive multicentre cross‐sectional observational study. Methods: An online survey was applied to identify both the characteristics of the professional profile and the working conditions. 1,427 ICU nursing professionals were included. RStudio statistical software was used for the analysis of the information. Descriptive statistics were used for the presentation of the results. The STROBE checklist for cross‐sectional studies was used in this study. Results: Only 33.6% of the professionals had a specialisation degree in intensive care. The skills that were most frequently put into practice were communication (68.5%) and care management (78.5%). The most predominant nurse‐to‐patient ratios were 1:2, and greater than 1:6. 59.1% of the nurses had an indefinite term contract, 38.8% worked 48 hours per week and 49.8% had rotating shifts. Only 50.4% of them received incentives. The average salary ranged between 348 and 1,500 USD. 64.5% of the participants were satisfied with their job. Conclusion: It is necessary to strengthen nurses' professional profile by promoting both postgraduate education and the development of troubleshooting and teamwork skills. It is necessary to standardise the nurse‐to‐patient ratio, improve wages and increase incentives to achieve greater job satisfaction. Relevance to practice: The knowledge and the improvement of both the professional profile and the work conditions of nurses working in intensive care units will improve the quality of the care given to critical patients and, therefore, the quality of health outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed to examine the effects of nurses' individual, professional and work environment characteristics on their job performance levels. Background: Nurses' job performance is important in the effective and efficient provision of health care. Design: A descriptive, cross‐sectional study. The STROBE guidelines were used in this study. Methods: The sample of this descriptive, correlational and cross‐sectional study comprised 370 nurses working at one private and two university hospitals in Turkey. A demographic information form, the Practice Work Environment Scale of the Nursing Work Index (PES‐NWI) and the Nursing Job Performance Scale (JPS) were used to collect the data. Data were analysed using descriptive statistics, Spearman's correlation and multiple linear (stepwise) regression. Results: There was a significant and positive correlation between the scores on the PES‐NWI and the JPS (r: 0.65, p <.05). Regression analysis showed that nurses' job performance was affected by five variables (R2: 59%, p <.05, Durbin–Watson: 2.06). Conclusion: The results of the study show that three sub‐dimensions of the PES‐NWI (nursing foundations for quality of care; staffing and resource adequacy; nurse manager abilities, leadership and support for nurses), colleague solidarity and education level were important factors affecting job performance. Relevance to clinical practice: The job performance of nurses is a priority issue in delivering quality healthcare services. Further efforts need to be pursued to nurse managers ensure a positive work environment to increase their nurses' job performance. [ABSTRACT FROM AUTHOR]

Aims: To describe beginning nursing student learning styles and to determine whether there are relationships between learning style and sociodemographic or educational background. We also aim to compare these data with the normative values of the 3.1 version of the Kolb learning style inventory and verify its reliability. Background/Literature: Learning style is related to the way in which an individual interacts with learning conditions, involving cognitive, affective, physical and environmental aspects. In nursing education, few studies have focused on knowing the learning styles of beginning nursing students, despite the need for students to develop critical thinking skills required of nurses. Design: Descriptive, cross‐sectional, correlational, multi‐site study. Method: The study took place at five universities in Brazil and one university in the United States. Data were collected from a sample of beginning nursing students (n = 176) in 2019, using the Portuguese and English 3.1 versions of Kolb's learning style inventory. Results: Most students' learning styles were classified as divergers (34.10%), while 28.41% were assimilators, 23.86% were accommodators and 13.63% were convergers. Kolb describes learning as a four‐stage cyclical process grounded in experience. The mean score of one learning stage, the concrete experience, showed those who attended public high schools compared with private high schools was higher (mean = 26.22; p =.0019), and there were different results between Brazilian state universities, Brazilian federal universities and the American university (p =.0149). Conclusion: The diverger style was the most common among beginning nursing students in Brazil and the United States. There was a significant relationship between learning style, the educational background of students, the type of institution they attend and their previous experience with some active learning methodologies. Relevance to clinical practice: Aligned with Kolb's experiential learning theory, nurse educators must be aware of student learning styles so they may use teaching strategies to meet their students' needs. [ABSTRACT FROM AUTHOR]

Aim and objective: To test the psychometric properties of the entrustable professional activity assessment tool for clinical procedures to be administered to clinical trainers and students. Background: Students' ability to perform clinical procedures professionally and safely is a key concern for healthcare educators. The assessment of professional activities, in which entrustment is a key outcome, is crucial for determining the level of training and supervision of work‐based assessments. The entrustable professional activities for clinical procedures (EPA‐CP) have been used among clinical trainers, but it needs more psychometric testing. Design: The psychometric study used a cross‐sectional design. Methods: Students' self‐assessment (n = 302) and the supervisors' ratings on the students' performance in clinical procedures (n = 266) were used to evaluate the psychometric properties of the six‐item EPA‐CP assessment tool. Internal consistency and test–retest reliabilities of the assessment tool were examined. Convergent, known‐groups, analysis of structural validity were conducted to investigate the tool's construct and factorial structure. The STROBE checklist for cross‐sectional studies was followed. Results: The EPA‐CP assessment tool demonstrated good reliability, satisfactory convergent validity and significant differences in the known‐group comparison. The exploratory factor and confirmatory factor analyses indicated the cogent constructs of the assessment tool when administered to students and their supervisors. Conclusion: The EPA‐CP assessment tool is a valid, reliable and user‐friendly tool for evaluating healthcare students' capability to perform clinical procedures. This tool makes it possible for the precise assessment of learners in performing procedures in busy and dynamic clinical settings. Relevance to clinical practice: Reliable instruments are needed to effectively assess healthcare students' ability to perform clinical procedures and enable trainers to entrust students with the tasks. The results indicate that the EPA‐CP assessment is promising and may be used in the healthcare settings. [ABSTRACT FROM AUTHOR]

Aims and objectives: To gain insight into the experiences and perceptions of hospital and home care nurses regarding nutritional care for older adults to prevent and treat malnutrition. Background: In‐depth knowledge about hospital and home care nurses' experiences and perceptions can contribute to optimise nutritional care for older adults across the care continuum between hospital and home to prevent and treat malnutrition. Design: Multicentre cross‐sectional descriptive study. Method: A validated questionnaire addressing malnutrition was used. A total of 1,135 questionnaires were sent to hospital and home care nurses. The STROBE statement was followed for reporting. Results: The response rate was 49% (n = 556). Of all the nurses, 37% perceived the prevalence of malnutrition among their care recipients between 10% and 25%. Almost 22% of the nurses neither agreed nor disagreed or disagreed with the statement that prevention of malnutrition is possible. More than 28% of the nurses reported that malnutrition is a small or no problem. Over 95% of the hospital nurses and 52.5% of the home care nurses stated they screened routinely for malnutrition. The nurses considered several interventions for treating malnutrition important. Over 81% of the nurses indicated they wanted to follow further training. Conclusion: Most hospital and home care nurses perceived that nutritional care for older adults to prevent and treat malnutrition was important. A fair group of nurses, however, had the opposite perception. Relevance to clinical practice: Raising the awareness of all hospital and home care nurses about the importance of nutritional care for older adults is pivotal to increase the chance of successfully providing nursing nutritional care. Nurses should follow training for consolidation of nutritional care. Nurses are well‐positioned to take a leadership role to improve continuity and quality of nutritional care across the care continuum between hospital and home. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine whether resilience buffers the deleterious consequences of caregiver burden on quality of life among parents of children with type 1 diabetes. Background: The burden of caring for a child with type 1 diabetes can be a form of stress and damage parents' quality of life. Resilience is a crucial psychological variable that contributes to individual health in the context of extraordinary challenges. However, no studies in paediatric diabetes have focused on the effects of parent resilience on caregiving burden and quality of life. Design: This was a descriptive cross‐sectional study with a convenience sample following the STROBE guidelines. Methods: A total of 227 parents were invited to participate during the children's routine outpatient visit. Parents completed measures of resilience, caregiver burden and quality of life. The disease characteristics of children were extracted from the electronic medical records. We performed hierarchical multiple regression and Johnson–Neyman statistical analysis to probe the moderating effect of resilience. Results: The parents reported poorer mental and physical health as compared with the general population. Caregiver burden was significantly negatively associated with parents' quality of life, while resilience demonstrated a positive correlation with life quality. Resilience served as a moderator between caregiver burden and mental health. When parents experienced a high caregiver burden, the benefit of high resilience for better mental health was apparent. Conclusions: The present study underscores the protective role of resilience in reducing caregiving burden and improving parents' quality of life. Relevance to clinical practice: Regular psychosocial assessment for parents of children with type 1 diabetes should be incorporated into clinical nursing practice. This study confirms that resilience is a promising intervention target for parents with heavy caregiver burden and unsatisfactory life quality. [ABSTRACT FROM AUTHOR]

Aims: To describe the specific domains of diabetes distress and factors associated with these domains. Background: Diabetes distress is a common problem but not well recognised in adolescents by healthcare providers or adolescents themselves. There is insufficient evidence on how specific domains of diabetes distress exist in adolescents, making it challenging to select precise components to alleviate diabetes stress. Design: A quantitative, descriptive and cross‐sectional study. Methods: Data were collected on socio‐demographic and clinical characteristics, diabetes distress, perceived stress, self‐efficacy and diabetes self‐management using established questionnaires. Multivariate linear regression was conducted to examine the associations between specific factors and four domains in diabetes distress. STROBE checklist was used as the guideline for this study. Results: A total of 100 adolescents with type 1 diabetes aged 12 to 18 years participated in this study. Adolescents experienced the highest levels of distress in the regimen‐related distress [2.41 (SD =0.82)] and physician‐related distress [2.40 (SD =0.80)] domains. Older age, female gender, more diabetes problem‐solving and higher levels of perceived stress were associated with higher regimen‐related distress (β = 0.21 ~ 0.45, p < 0.05). Older age, female gender, a lower degree of endorsement of relevant diabetes‐related goals and higher levels of perceived stress were associated with higher physician‐related distress (β = −0.29 ~ 0.34, p < 0.05). Conclusions: Diabetes distress was reported more on regimen‐related and physician‐related domains among adolescents with type 1 diabetes in China, associating with older age, female, increased perceived stress and poor diabetes‐related problem‐solving. Relevance to clinical practice: Nurses need to screen the specific domains of diabetes distress among adolescents with type 1 diabetes, especially for the older adolescents and girls. This study highlighted the importance of incorporating diabetes‐related problem‐solving support and stress management strategies into diabetes management for adolescents with type 1 diabetes, which could help relieve diabetes distress. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed to identify and compare missed nursing care types and reasons between South Korea and the United States of America. Background: Patient safety has become a significant task of the healthcare delivery systems worldwide. The omission of nursing care constitutes a growing concern because it threatens both patient safety and nursing care quality. Design: This study used a cross‐sectional, descriptive and comparative design. Methods: Data were collected from registered nurses working in two university‐affiliated tertiary hospitals and a general hospital in Korea and a Midwest United States tertiary hospital. In addition, the STROBE checklist was used in this study. Results: While substantial, the level of missed nursing care reported by Korean nurses was lower than that of United States nurses. Only three nursing care activities, setting up meals, patient assessment and skin/wound care, did not significantly differed between two countries. More basic nursing care types such as ambulation, feeding and mouth care were missed more than others in both countries. The reasons for missed care differed between two countries. However, both Korean and US nurses reported labour resource problems as reasons for missed care. Conclusions: Although the types of missed nursing care differed significantly between countries, both Korean and US nurses reported labour resource problems for the top reasons for missed care. Thus, comparing missed nursing care could assist nursing administrators in developing strategies to improve care quality and patient safety. Relevance to clinical practice: The level and reasons for missed nursing care are very influential factors for patient outcomes and patient safety. Appropriate skill mix and staffing are needed to decrease extent of missed care, so that enhancing patient safety and quality of nursing care. [ABSTRACT FROM AUTHOR]

Aims and objectives: The study aims were to (a) assess allergy screening practices, (b) determine the awareness of metal hypersensitivity among frontline healthcare workers and (c) examine perceived barriers to implementing metal hypersensitivity screening into clinical practice. Background: Adverse device‐related events, such as hypersensitivity to metals, are well documented in the literature. Hypersensitivity to metal is a type IV T‐cell‐mediated reaction that can occur after cardiac, orthopaedic, dental, gynaecological and neurosurgical procedures where a device with metal components is implanted into the body. Patients with hypersensitivity to metal are likely to experience delayed healing, implant failure and stent restenosis. Identifying patients with a history of metal hypersensitivity reaction could mitigate the risk of poor outcomes following device implant. Yet in clinical practice, healthcare workers do not routinely ask about the history of metal hypersensitivity when documenting allergies. The existing literature does not report why this is not included in allergy assessment. Design: Following the STROBE checklist, a cross‐sectional, descriptive study was conducted. Methods: Frontline healthcare workers were recruited using professional contacts and social online media to complete an online questionnaire. Quantitative data were summarised descriptively while thematic analysis was used to examine barriers to implementation. Results: Three hundred forty‐five participants from 14 countries completed the questionnaire, with the majority (187/54%) practicing in Canada, in general medicine and intensive care units. Ninety per cent of the participants did not routinely ask about metal hypersensitivity when evaluating allergy history. Of the respondents, 86% were unaware of the association between metal hypersensitivity and poor patient outcomes. After presented with the evidence, 81% indicated they were likely or very likely to incorporate the evidence into their clinical practice. Common themes about barriers to implementing were 'Standards of Practice', 'Knowledge' and 'Futility of Screening'. Conclusion: The findings suggest lack of awareness as the main reason for not including metal in routine allergy assessment. [ABSTRACT FROM AUTHOR]

Background: Identifying factors related to intimate partner violence (IPV) screening intentions of future nurses is critical, but no studies specific to this research area exist in Thailand; nor does any validated instrument currently exist to systematically evaluate Thai nursing students' IPV training or measure their readiness to address IPV. The purpose of this study was to develop the Intimate Partner Violence Screening Intention, Nursing Students (IPVSI‐NS) for Thai nursing students and identify components explaining their intentions to screen for intimate partner violence (IPV). Method: We designed a Thai‐language, culturally appropriate 36‐item instrument based on the theory of planned behavior (TPB), which describes intentions as the precursors of actual behaviour. We then conducted an anonymous cross‐sectional online survey of female senior Thai nursing students (N = 594). Principal component analysis with varimax methods was used to examine the component structure of the instrument. The internal consistency reliability and convergent construct validity were evaluated. See Supporting File S1. Results: A six‐component structure was evident which explained 59.56% of variance and identified: attitudes (advantages and disadvantages of screening), subjective norms (support from important people, and opinions of important people and policy) and perceived behavioural control (training experience, teamwork, facility resources and screening barriers). Conclusion: The IPVSI‐NS, based on the TPB, provides a psychometrically sound, reliable and valid tool for Thai nursing educators and researchers to advance nursing education, practice and research regarding IPV. Relevance to clinical practice: Provides support for the components of the TPB (attitude, subjective norm and perceived behavioural control) as an excellent fit to predict intention of IPV screening for future clinical nurses. Implications for future research and educational practice are discussed. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to determine the optimal threshold for national early warning score in clinical practice. Background: The national early warning score is an aggregate early warning score aiming to predict patient mortality. Studies validating national early warning score did not use standardised patient outcomes or did not always include clinical workload in their results. Since all patients with a positive national early warning score require a clinical workup, it is crucial to determine the optimal threshold to limit false‐positive alerts. Design: An external validation study using retrospectively collected data of patient admissions in six Belgian hospitals. Methods: We adhered to the STARD guideline for reporting. Two sample groups were selected: the cross‐sectional sample (admitted patients, 1 day every 4 months) and the serious adverse event sample (all patients with unexpected death, cardiac arrest and unplanned admission to the intensive care unit). The maximum registered national early warning score value was collected in both groups. Predictive values were used as estimates for clinical workload. Results: We collected 1,523 in the cross‐sectional sample and 390 patients in the serious adverse event sample. A national early warning score ≥5 had a predictive value of 6.8% and a negative predictive value of 99.5% to predict unexpected death, cardiac arrest with cardiopulmonary resuscitation or unplanned admission to intensive care (AUROC 0.841). The performance of national early warning score differed between outcome measures. Considering the predictive value, the optimal threshold for national early warning score is ≥5. Conclusions: We validated national early warning score to be applied in general hospital wards and confirmed the optimal threshold (≥5). Relevance to clinical practice: When a patient has a national early warning score <5, we may assume that in the next 24 hr this patient is less likely to die unexpectedly, receive cardiopulmonary resuscitation or be transferred to the ICU. Because of the significant number of false positives when national early warning score is ≥5, hospitals should create workable guidelines for clinical practice. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To determine the baseline levels of training, knowledge and confidence working in the area of family violence in staff at a public child and maternal health service in Melbourne, Australia, as well as perceived staff barriers to working effectively in this area. This study also aimed to explore the client perception of existing screening practices. Background: Family violence is a global concern with pregnancy and the postnatal period times of particularly high risk. Child and maternal health services are well placed to screen for violence, yet clinician and client perceptions of screening remain poorly characterised. Design: Thirty‐five staff and 15 mothers participated in this cross‐sectional, mixed‐method study, via an online survey. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross‐sectional guidelines were used. Results: The majority of staff screened clients for family violence, at least some of the time, with over 50% often or always screening. However, only half of staff respondents indicated that they believed they knew how to screen appropriately. Screening occurred most often over the phone or at the first service visit. The most commonly reported barriers to screening were suspected perpetrators being present during consultations and language barriers. Most clients reported being screened for physical violence and safety in the home with few being asking about financial and sexual abuse, or psychological violence and coercive control. Clients who disclosed violence reported being well supported. Conclusion: While some baseline staff knowledge and skills have been identified, further support for clinicians is needed to ensure best practice and improve services and outcomes, particularly in regard to screening for different types of violence across the spectrum. Relevance to Clinical Practice: This study helps to inform clinical screening practices in maternal health services through an exploration of facilitators and barriers in the screening process. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the extent to which parental readiness for hospital discharge mediates the relationship between quality of discharge teaching and parental self‐efficacy in parents of preterm infants. Background: Parental readiness for hospital discharge and self‐efficacy should be considered to establish whether preterm infants and their families are prepared for the discharge. High‐quality discharge teaching could facilitate a smooth discharge transition. However, little is known about how quality of discharge teaching influences parental readiness for hospital discharge and self‐efficacy. Design: This was a descriptive cross‐sectional study of 202 parents with preterm infants in a tertiary hospital in Eastern China. Methods: The key variables of interest were measured using the Chinese versions of the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale‐Parent Form, and Preterm Parenting and Self‐Efficacy Checklist. Path analyses were conducted to test the mediation models. STROBE checklist was used to compile the study's report. Results: Parental readiness for discharge (overall and knowledge dimension) partially mediated the relationship between the quality of discharge teaching and parental self‐efficacy. The two dimensions (content received and delivery) of quality of discharge teaching positively influenced parental self‐efficacy by improving parental readiness for discharge. Conclusions: Parental readiness for hospital discharge, especially the knowledge dimension, was an important factor in quality of discharge teaching's association with self‐efficacy in parents of preterm infants. Improving the quality of discharge teaching could increase parental readiness for discharge and thus promote parental self‐efficacy. Relevance to clinical practice: Improving discharge instructions is essential to help parents of preterm infants prepare for the transition to home care. Assessing readiness and confidence at an early stage and continuing to do so throughout the hospital stay may provide additional ways for nurses to identify parents' knowledge gaps and to provide tailored interventions at more opportune times before hospital discharge. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop a Chinese version of Auditory Hallucination Risk Assessment Scale and evaluate its psychometric properties. Background: Auditory hallucination, a common symptom in schizophrenia, has the potential to cause harm to patients and the people around them. However, there has been a paucity of suitable instrument developed in Asian region that can comprehensively and reliably assess its risk and inform interventions. Design: This study involved 2 stages, the development of the Auditory Hallucination Risk Assessment Scale (AHRAS) and testing the psychometric properties of AHRAS. We followed STROBE guidelines in reporting the study. Methods: Auditory Hallucination Risk Assessment Scale items were developed based on Symptom Management Theory, systematic literature review and findings of a qualitative study on the experience of auditory hallucinations. The items were evaluated by content validity. Auditory Hallucination Risk Assessment Scale was then tested for construct validity, concurrent validity, predictive validity, internal consistency and test–retest reliability in a convenience sample of 156 patients with a diagnosis of schizophrenia. Results: The final version of AHRAS has nine items. Two factors were extracted from AHRAS, which explained 57.74% of the total variance. The score of AHRAS was strongly correlated with that of the Psychotic Symptom Rating Scales‐Auditory Hallucinations. The area under the curve was 0.90 for the overall AHRAS score. Sensitivity (86.5%) and specificity (80.0%) were maximal for a mean overall AHRAS score of 13.5, suggesting that this is an appropriate threshold for differentiation. Cronbach's alpha coefficient for internal consistency was 0.82, and intra‐class correlation coefficient for test–retest reliability was 0.84. Conclusions: Auditory Hallucination Risk Assessment Scale has good reliability and validity. It can be used in clinical settings in China and beyond to assess the risk of auditory hallucinations. Relevance to clinical practice: Auditory Hallucination Risk Assessment Scale can serve as a tool for nurses and other healthcare professionals to identify patients with high‐risk auditory hallucinations, monitor the changes of risk and inform nursing interventions. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study aimed to explore the effects of person‐centred care on their job productivity, job satisfaction and organisational commitment among employees in long‐term care facilities. Background: Person‐centred care has been regarded as the best caregiving model for long‐term care facilities. Few studies tested the impact of person‐centred care on employee performance. Design: A cross‐sectional study was employed. Methods: This study sent 373 samples with self‐report questionnaires to the employees of sixteen long‐term care facilities in Taiwan. A total of 366 valid samples were collected. A 33‐item person‐centred care questionnaire with Likert‐scale responses was developed to assess the extent of person‐centred care. We adopted hierarchical multiple regression analysis to test the impact of person‐centred care on employee performance. We adopted the STROBE guidelines. Results: Friendly environment level and personalised care, respectively, scored the highest with a mean of 4.19 among five dimensions of person‐centred care. Personalised care, residents' self‐realisation and relationships, and organisational support had significant positive correlations with job productivity. Friendly environment level and organisational support had significant correlations with job satisfaction. Friendly environment level, residents' self‐realisation and relationships, and organisational support had significant correlations with organisational commitment. Conclusion: Person‐centred care has beneficial impact on job satisfaction, job productivity and organisational commitment of employees in long‐term care facilities. Relevance to clinical practice: Person‐centred care appears to be a crucial factor of employee performance in long‐term care facilities. The five‐dimensional person‐centred care questionnaire in this study can serve as an important management tool for improving the effectiveness of person‐centred care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the level of self‐care behaviours among patients with diabetic foot ulcers and identify factors related to their self‐care behaviours. Background: This study focused on the self‐care behaviours of patients diagnosed with diabetic foot ulcers, a complication of diabetes. Design: A cross‐sectional study design was adopted. Methods: From July–August 2018, 131 outpatients and inpatients with diabetic foot ulcers were given a survey questionnaire regarding self‐care behaviours and expected related factors at two Korean hospitals. In this study, self‐care behaviours were diabetes management and diabetic foot care. Demographic, disease‐related and laboratory characteristics were collected. The data were analysed in terms of descriptive statistics, a t test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. STROBE checklist was used as the guideline for this study. Results: Moderate levels of self‐care behaviours were found. The stepwise multiple regression analysis revealed that diabetes management was significantly related to perceived family support, experience of diabetic education, perceived stress, a problem‐focused coping style, experience of hospitalisation and comorbidity. Furthermore, diabetic foot care was significantly associated with the experience of diabetic education, perceived family support, and serum level of erythrocyte sedimentation rate and haemoglobin A1C. Conclusions: Perceived family support was the main factor affecting diabetes management, and diabetic foot care was greatly affected by the experience of diabetic education. It is necessary to develop diabetes education programmes and nursing interventions to increase family support to improve the self‐care behaviours of patients with diabetic foot ulcers. Relevance to clinical practice: Self‐care behaviours among patients with diabetic foot ulcers are important, as they affect healing of the wound and the quality of life. Further development of family‐based diabetes education or programmes is recommended to promote the self‐care behaviours of patients with diabetic foot ulcers. [ABSTRACT FROM AUTHOR]