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Aim: To describe the development of the Actualisation of Evidence‐Based Nursing instrument targeted at nurses working in clinical practice (ActEBN‐nurses), meant for evaluating the actualisation of individual and organisational‐level support structures for evidence‐based nursing within social and healthcare organisations, and to test its validity and reliability. Design: Cross‐sectional survey. Methods: The FinYHKÄ model was used as the theoretical background of the instrument development and supplemented with the JBI Model of Evidence‐Based Healthcare, previous literature and items from a previous instrument, the Evidence‐Based Practice Process Assessment Scale, with permission of the copyright holders. After two rounds of expert panel and piloting, a national survey was conducted with the instrument in 2021. The target group consisted of nurses working in clinical practice. Psychometric testing included internal consistency (Omega, item analysis) confirmatory factor analysis and t‐test for comparison of two groups' differences (sensitivity). Results: A new instrument, ActEBN‐nurses was developed, comprising two parts: Individual‐level (32 items, 5‐point Likert‐scale) and Organisational‐level support structures for evidence‐based nursing (37 items, 5‐point Likert‐scale). In total, 1289 nurses participated in the survey. The ActEBN‐nurses proved to have good internal consistency in both parts (Omega ω.931 and.966), structural validity and sensitivity based on the two educational levels within the sample. The structure of both parts was slightly modified, based on the CFA modification indices, considering the impact of the reverse worded items in part Individual and redundant items within both parts. Conclusion: The ActEBN‐nurses has promising psychometrics, and it can be used for evaluating individual and organisational‐level support structures for evidence‐based nursing within social and healthcare organisations. Implications for the profession and/or patient care: Evaluation of the support structures within social and healthcare organisations is needed to recognise shortcomings in current structures and advance evidence‐based nursing across different contexts. Reporting Method: The authors state that they have adhered to relevant EQUATOR guidelines: STROBE statement for cross‐sectional studies. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop and evaluate the psychometric properties of an instrument that measures nurses' Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND). Background: General ward nurses play an important role in recognising patient deterioration. However, their attitudes towards early recognition of clinical deterioration have not been adequately explored due to the lack of a valid and reliable scale. Design: An instrument development and validation study. Methods: A three‐phase structure that followed the STROBE checklist was used: (1) item generation, (2) content and face validity assessment and (3) psychometric properties evaluation. The scale items were developed based on a comprehensive literature review and content validity assessment by 15 international experts from five countries. The psychometric properties of the ATREND scale were tested on 434 registered nurses, with retest evaluations (n = 100) at two hospitals. Exploratory and confirmatory factor analyses were used to examine the factor structure of the scale. The scale was also evaluated for its internal consistency, test–retest reliability and convergent validity. Results: The scale's content validity was 0.95. A 3‐factor solution was identified from the final 11 items: (1) beliefs about importance of patient observation, (2) use of broader patient assessment skills and (3) confidence in recognising clinical deterioration. The internal consistency reliability of the scale was supported with an acceptable Cronbach's alpha value of 0.745. Test–retest reliability of the scale was excellent, with an intraclass correlation coefficient of 0.825. The ATREND scale shows evidence of good convergent validity. Conclusion: The final 11‐item ATREND scale demonstrates adequate initial evidence of reliability and validity for use in acute ward settings. Relevance to clinical practice: Nursing educators and clinicians may use this scale to assess ward nurses' attitudes and practices towards early recognition of clinical deterioration and then enhance their competencies and behaviours in the recognition of clinical deterioration. [ABSTRACT FROM AUTHOR]

Aims: To translate 25‐item Dementia Knowledge Assessment Scale into Chinese and evaluate its psychometric properties amongst Chinese healthcare providers. Background: The prevalence of dementia is increasing in China, but development of relevant training for healthcare providers is still in its infancy stage. A comprehensive, valid and reliable Chinese knowledge‐of‐dementia measure is needed to identify training needs and evaluate the effect of educational interventions. Design: A cross‐sectional survey. Methods: The Dementia Knowledge Assessment Scale was translated into Chinese following the modified Brislin's translation model. Content and face validity were established by an expert panel in dementia care and healthcare providers. A convenience sample of 290 healthcare providers in care homes and hospitals was recruited. Construct validity was evaluated through confirmatory factor analysis, concurrent validity and known groups' comparisons method. Reliability was evaluated through internal consistency reliability and 2‐week test–retest reliability. This study used the STROBE checklist for reporting. Results: The content validity index was 0.98. The confirmatory factor analysis model revealed that the four‐factor model was partly supported in the present study. The moderate correlation between Chinese version of Dementia Knowledge Assessment Scale and Alzheimer's Disease Knowledge Scale indicated acceptable concurrent validity. The mean score of the scale and subscale scores showed significant differences between health professionals and care assistants, except for the subscale of "Care Considerations." The reliability was demonstrated with Cronbach's alpha of.77 and intra‐class correlation coefficients of each subscale between.74 and.92 among 56 respondents. Conclusions: The Chinese version of Dementia Knowledge Assessment Scale demonstrated acceptable concurrent validity but marginal factorial validity and satisfactory reliability amongst Chinese healthcare providers. Therefore, applying the four‐factor structure of Chinese version scale should be considered. Relevance to clinical practice: Chinese version of Dementia Knowledge Assessment Scale can be used to understand the training needs of healthcare providers in dementia. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study investigated the effects of multimedia‐based information on anxiety, discomfort and satisfaction with care among patients undergoing cerebral angiography. Background: Cerebral angiography is the gold standard for diagnosing cerebrovascular conditions; however, patients might experience related anxiety and discomfort. For such patients, reductions in anxiety related to informational interventions have been inconsistent, and the effects on patient discomfort and satisfaction with nurses were not confirmed. Design: This quasi‐experimental study with a non‐equivalent, control group, non‐synchronised design was conducted using the TREND checklist. Methods: Fifty‐five patients who underwent cerebral angiography at a neurosurgery ward were enrolled in this study. Twenty‐seven patients in the experimental group were provided multimedia‐based information on cerebral angiography, including actual on‐site photographs and videos, an explanation of the benefits of cerebral angiography and introduction to medical staff. Twenty‐eight in the control group were provided a printed explanation. The collected data were analysed using the χ²‐test, Fisher's exact test, independent t test, paired t test or ANCOVA. Results: In the experimental group, anxiety was significantly decreased post‐intervention, and there was a significant difference in state anxiety between the experimental and control groups. Discomfort and satisfaction with care also showed significant differences between these two groups. Conclusion: This study confirmed that multimedia‐based information decreases patient anxiety and discomfort while increasing satisfaction with care among those undergoing cerebral angiography compared with a printed explanation only. Relevance to clinical practice: The anxiety and discomfort of patients undergoing cerebral angiography should be considered a major nursing problem. This study evaluated the effects of multimedia‐based information on anxiety, discomfort and satisfaction with care among patients undergoing cerebral angiography and showed it to be an effective nursing intervention. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of this study was to identify the psychosocial determinants of adherence to oral antidiabetic medication, according to the Theory of Planned Behaviour (TPB). Background: Appropriate adherence to oral antidiabetic medication contributes to long‐term glycaemic control. However, glycaemic control is often poor in people with type 2 diabetes, mainly due to the poor adherence to oral antidiabetic agents. Design: Prospective study with 2 waves of data collection, based on STROBE checklist was conducted. One hundred and fifty‐seven adults with type 2 diabetes, in chronic use of oral antidiabetic agents, composed the sample. At baseline, self‐reported measures of medication adherence (proportion and global evaluation of adherence) and of metabolic control (glycated haemoglobin) of diabetes were obtained. Methods: The TPB main constructs (attitude, subjective norm and perceived control) and related beliefs were measured. Adherence and metabolic control measurements were obtained in a two‐month follow‐up (n = 157). Results: Attitude and subjective norm, together, explained 30% of the variability in intention; their underlying belief‐based measures (behavioural and normative beliefs) explained 28% of the variability in intention. In addition, intention predicted behaviour at follow‐up. However, when added to the prediction model, past behaviour was the only explanatory factor of adherence behaviour. Conclusion: Adherence behaviour to oral antidiabetic medication was predicted by intention, which, in turn, was determined by attitude and subjective norm. In order to promote adherence to oral antidiabetic agents, health professionals should include motivational strategies as well as strategies targeted to attitude and subjective norm when designing interventions. Relevance to clinical practice: The nonadherence to antidiabetic medication contributes to lack of control of diabetes and ensuing complications. The comprehension of the factors explaining the variability in medication adherence can inform the design of theory‐based interventions aimed at promoting this behaviour. [ABSTRACT FROM AUTHOR]

Objectives: To explore the notion of patient‐invested contingent self‐esteem (Pa‐CSE) and investigate its association to nurses' self‐reported engagement in controlling or autonomy‐supportive interactions with chronic care patients. Background: Considering the high number of patients sub‐optimally managing their chronic condition, nurses might experience a drop and rise in self‐worth when patients fail and succeed, respectively, in managing their chronic condition. This dynamic has not received prior research attention. Design: Multivariate analysis employing cross‐sectional data according to STROBE guidelines. Methods: Self‐reports among nurses employed in chronic care (N = 394) from eight randomly selected hospitals in Belgium. Exploratory factor analysis and stepwise linear regression analyses were conducted. Results: Success‐based and failure‐based orientations could be distinguished and refer to nurses' tendency to associate, respectively, patients' successes with feelings of professional success and self‐worth and patients' failures with feelings of professional failure, shame and inadequacy. Nurses' self‐esteem is fairly interwoven with patients' achievements in the management of their chronic condition. A success‐based orientation was positively related to autonomy‐supportive care in case a failure‐based orientation was low. Nurses with a simultaneous success‐based and failure‐based orientation interacted in a more controlling way. Conclusions: The findings of this study suggest that basing one's self‐worth on patients' accomplishments may be a double‐edged sword. Although tying one's personal glory to the successes of one's patient is related to greater patient participation and support of autonomy, these effects only emerge if nurses' self‐worth is not interwoven with patients' failures. In fact, having both success‐ and failure‐oriented contingent self‐worth is related to a more pressuring approach. Relevance to clinical practice: To prevent nurses from developing inferior professional feelings when their patients fail to manage their condition, a reflective stance towards the impact of patients' behaviour on the nurses' professional feeling of (in)adequacy is an important step to deal with such situations. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop and validate an instrument to measure nurses' empathy motivation in China (See Supporting Information Appendix S1). Background: Nurses are increasingly expected to empathise with patients in clinical settings. However, research investigating nurses' empathy motivation in China is lacking, and no specific instrument exists worldwide. Design: Two‐stage cross‐sectional study, which follows the STROBE guidelines. Instrument development and psychometric evaluation were used (See Supporting Information Appendix S1). Methods: A literature review and qualitative interviews with nurses were conducted to generate the initial items. Convenience samples of 340 (for item analysis) and 640 (for psychometric evaluation) clinical nurses working at four tertiary hospitals in Anhui Province were recruited. The scale was validated by content validity, surface validity and item analysis. A total of 640 participants were randomly divided into two equal groups. Exploratory factor analysis (EFA) was used with varimax rotation, confirmatory factor analysis (CFA) and internal consistency reliability to analyse the psychometric properties of the scale (See Supporting Information Appendix S1). Results: From the initial 90‐item pool, 27 items were retained by the item analysis. The EFA (N = 290) showed the following six factors on the scale explained 71.266% of the overall variance: amotivation, external regulation, introjected regulation, identified regulation, integrative regulation and intrinsic motivation. Furthermore, when limited to three factors, that is autonomy motivation, controlled motivation and amotivation, 56.578% of the variance was explained. The findings showed high internal consistency. The six‐factor solution and three‐factor solution of the scale, including 27 items, were both confirmed by the CFA, for example χ2/df = 1.744, 2.261; RMSEA = 0.051, 0.066; GFI = 0.882, 0.847; TLI = 0.942, 0.902; and RMR = 0.039, 0.049, respectively. Conclusions: The nurses' empathy motivation scale presents good psychometric properties and can be used to explore nurses' empathy motivation in China (See Supporting Information Appendix S1). Relevance to clinical practice: This study offers insight into nurses' complicated reasons for exhibiting empathy. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore registered nurses’ (RNs) own experience of using the nurse-initiated pain protocol (NIPP) in the emergency department (ED) based on their working experience. Background: Pain is known to be one of the most common symptoms among adult patients seeking care at the ED. Several strategies aiming to improve pain management have been developed. Despite some improvements in pain management using NIPP, a large number of patients continue to have inadequate pain treatment when cared for in EDs. Design and method: A cross-sectional study design based on a questionnaire was used. The variable working experience was based on a theory that experience will make a change in RNs’ knowledge. Descriptive statistics and Pearson’s chi-square tests were used for analysing quantative data. Qualitative data were analysed by summative content analysis. Results: Seventy RNs answered the questionnaire (response rate 42%) and 61% considered the NIPP adequate to relieve patients’ acute pain at the ED. No significant difference was found on how the RNs used the NIPP. However, qualitative data showed that more experienced RNs adapt the NIPP according to the patients’ needs in a higher extent. Conclusion: A majority of the RNs consider the NIPP to be adequate to relieve patients’ acute pain in the ED. An increase in working experience showed an impact on how the NIPP was used, with an increase in pain management that is personalised depending on individual patients’ needs. The RNs used several alternatives to both dosage and type of medication when the ED becomes crowded. Relevance to clinical practice: Registered nurses’ working experience should be considered when planning nursing schedules to be better able to meet patients’ needs. Guidelines should be developed and evaluated by both healthcare professionals and patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop and psychometrically assess a survey instrument identifying ethical issues during palliative care provision in nursing homes. Background: Registered nurses and healthcare assistants have reported ethical issues in everyday palliative care provision. Identifying these issues provides evidence to inform practice development to support healthcare workers. Design: Cross-sectional survey of Registered nurses and healthcare assistants in nursing homes in one region of the UK. Method: A survey instrument, “Ethical issues in Palliative Care for Nursing homes”, was developed through the findings of qualitative interviews with Registered nurses and healthcare assistants in nursing homes and a literature review. It was reviewed by an expert panel and piloted prior to implementation in a survey in 2015 with a convenience sample of 596 Registered nurses and healthcare assistants. Descriptive and exploratory factor analyses were used to assess the underlying structure of the Frequency and Distress Scales within the instrument. Results: Analysis of 201 responses (response rate = 33.7%) revealed four factors for the Frequency Scale and five factors for the Distress Scale that comprise the Ethical issues in Palliative Care for Nursing homes. Factors common to both scales included “Processes of care,” “Resident autonomy” and “Burdensome treatment.” Additionally, the Frequency Scale included “Competency,” and the Distress Scale included “Quality of care” and “Communication.” Conclusion: The Ethical issues in Palliative Care for Nursing homes instrument has added to the palliative care knowledge base by considering the ethical issues experienced specifically by Registered nurses and healthcare assistants within the nursing home. This research offers preliminary evidence of the psychometric properties of the Ethical issues in Palliative Care for Nursing homes survey instrument. Relevance to practice: The two largest factors highlight the need to address the organisational aspects of caring and provide training in negotiating conflicting ethical principles. [ABSTRACT FROM AUTHOR]

Aim and objective To clarify the characteristics of sub-groups of patients with stable chronic obstructive pulmonary disease having similar approaches to daily body condition management. Background Prior literature has shed light on the experience of patients with chronic obstructive pulmonary disease and revealed that these patients engage in many activities and try different things in their daily lives to regulate and manage their body condition. The research so far has all been qualitative, comprising mostly interviews, and no quantitative studies have been performed. In this study, cluster analysis was used to show that subgroups of patients with similar characteristics undertake similar approaches to body condition management. Design Descriptive, correlational study. Methods Invitations to participate in the survey were extended to patients with stable chronic obstructive pulmonary disease. Cluster analysis was performed on the basis of questionnaire scores relating to nine different categories of daily body condition management actions. The characteristics of the body condition management approaches, in each subgroup, were investigated using analysis of variance and multiple comparisons. Results The cluster analysis produced six subgroups, each defined by the effort expended as part of their body condition management. The subgroups also differed depending on patient age and disease severity. Conclusion Body condition management approaches taken by patients with stable chronic obstructive pulmonary disease are overall, comprehensive approaches. Relevance to clinical practice Patients with chronic obstructive pulmonary disease were subgrouped based on their engagement in body conditioning. Relationships between the subgroups and the engagement in body conditioning, age and shortness of breath severity were observed. The care of patient support should be comprehensive and depend on their age and the duration of the disease. In addition, it should be long term and recognise that the patients are living their own respective lives. Such considerations and focused perspectives are what we think will lead to an improvement in patients' quality of life and prevent their condition from worsening. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore and compare Finnish and British nursing students' perceptions of their learning about patient safety in clinical settings. Background Patient safety culture and practices in different health care organisations and clinical units varies, posing challenges for nursing students' learning about patient safety during their clinical placements. Patient safety as a growing international concern has challenged health care professionals globally requiring a comprehensive review. International studies comparing nursing education about patient safety are lacking. Design A cross-sectional comparative study. Method The participants were final year preregistration nursing students from two universities of applied sciences in Finland (n = 195) and from two universities in England, UK (n = 158). The data were collected with the Patient Safety in Nursing Education Questionnaire and analysed with principal component analysis, Pearson Chi-Square and Mann-Whitney U tests and logistic regression. Results Finnish nursing students had significantly more critical perceptions on their learning about patient safety in clinical settings than their British peers. A strong predictor for differences was supportive and systems-based approaches in learning to ensure patient safety. Notably, fewer Finnish students had practiced reporting of incidents in clinical settings compared to British students. In both countries, the students held learning about patient safety in higher esteem compared to their learning experiences in clinical settings. Conclusions Nursing students appear to want more learning opportunities related to patient safety compared to the reality in clinical settings. Learning systematically from errors in a supportive environment and having systems-based approaches to ensure patient safety are essential elements for nursing students' learning about safe practice. Finnish students seem to experience more barriers in learning about safe practices and to report errors than the British students. Relevance to clinical practice Health care organisations and professionals with responsibilities for patient safety should seek to standardise the preparation of nursing students incorporating requisite international standards and benchmarks. [ABSTRACT FROM AUTHOR]

Aims and objectives This study was conducted to develop a family relocation stress scale by modifying the Son's Relocation Stress Syndrome Scale, to examine its clinical validity and reliability and to confirm its suitability for measuring family relocation stress. Background The transfer of ICU patients to general wards is a significant anxiety-producing event for family members. However, no relocation stress scale has been developed specifically for families. Design A nonexperimental, correlation design was adopted. Methods The study subjects were 95 family members of 95 ICU patients at a university hospital located in Incheon, South Korea. Face and construct validities of the devised family relocation stress scale were examined. Construct validity was examined using factor analysis and by using a nomological validity test. Reliability was also examined. Results Face and content validity of the scale were verified by confirming that its items adequately measured family relocation stress. Factor analysis yielded four components, and the total variance explained by these four components was 63·0%, which is acceptable. Nomological validity was well supported by significant relationships between relocation stress and degree of preparation for relocation, patient self-care ability, family burden and satisfaction with the relocation process. The devised scale was also found to have good reliability. Conclusions The family relocation stress scale devised in this study was found to have good validity and reliability, and thus, is believed to offer a means of assessing family relocation stress. Relevance to clinical practice The findings of this study provide a reliable and valid assessment tool when nurses prepare families for patient transfer from an ICU to a ward setting, and may also provide useful information to those developing an intervention programme for family relocation stress management. [ABSTRACT FROM AUTHOR]