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ABSTRACT Aims Background Design Methods Results Conclusions Relevance to Practice To test the clinical validity of clinical indicators and causal relationships of aetiological factors of the new nursing diagnosis of inadequate health self‐efficacy in people with hypertension.The diagnosis of inadequate health self‐efficacy has both theoretical and content validity. However, a clinical validation study is needed to establish an appropriate framework for distinguishing individuals who manifest this unique human response.The study adopts a cross‐sectional clinical validation approach, adhering strictly to the STROBE guidelines throughout its design and implementation.Naturalistic sampling was used to identify 302 adults diagnosed with hypertension. Their data were subjected to latent class analysis, which facilitated the identification of a comprehensive set of clinical indicators that demonstrated better diagnostic accuracy and established posterior probabilities to guide the inference of inadequate health self‐efficacy. In addition, logistic regression analysis was used to assess the magnitude of the impact of aetiological factors.The prevalence of inadequate health self‐efficacy was 76.61%. Among the 13 indicators examined, seven demonstrated notable sensitivity: ‘risk‐prone health behaviour’, ‘failure to take action that prevents health problems’, ‘inadequate self‐control’, ‘avoidance behaviours’, ‘negative health self‐perception’, ‘inadequate health‐related quality of life’ and ‘difficulty feeling good about adopting a healthy lifestyle’. Additionally, two indicators showed high specificity: ‘difficulty feeling good about adopting a healthy lifestyle’ and ‘inadequate adherence to treatment regimen’. Notably, 15 aetiological factors were identified as significantly associated with an increased risk of inadequate health self‐efficacy.A clinical framework consisting of eight clinical indicators and 15 aetiological factors was developed to characterise inadequate health self‐efficacy in individuals with hypertension.Clinical validation provides insight into the precision of clinical indicators and the magnitude of the effect of putative causal elements, thereby facilitating identification and tailored intervention for individuals with hypertension and inadequate health self‐efficacy. [ABSTRACT FROM AUTHOR]

Objective: To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator‐associated pneumonia (VAP) and catheter‐related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations. Background: Simulation‐based training is an excellent way for nurses to learn prevention measures in VAP and CRB. Design: Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient‐reported outcome measurement instruments. Methods: The first version was developed with the content of training modules in use at the time (NEUMOBACT‐1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT‐2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT‐3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice. Results: Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT‐FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC. Conclusion: NEUMOBACT‐FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation. Relevance for Clinical Practice: Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety. Patient or Public Contribution: Experts participated in the Delphi rounds and nurses in the pilot test. [ABSTRACT FROM AUTHOR]

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: To evaluate the psychometric properties of a new Persian translation of the Readiness for Hospital Discharge Scale. Background: Globally, one in 10 newborns are born preterm and many require care in a neonatal intensive care unit (NICU). A primary role of NICU nurses is to assure parents are well prepared to take their newborns home from the hospital. Assessment of parent perception of discharge readiness provides important input into discharge decisions. The availability of reliable and valid instruments tested within the geographical and cultural context is needed for a comprehensive assessment of predischarge readiness, so that parent needs can be identified and the necessary interventions designed and implemented. Design: This psychometrics study included a convenience sample of 200 mothers with preterm infants being discharged from the NICU of Shahid Sadoughi Hospital in Yazd, Iran. The original 29‐item version of the Readiness for Hospital Discharge Scale—Parent questionnaire was translated into Persian using the standard forward–backward method. Face, content and construct validity (principal components analysis), and reliability (internal consistency—Cronbach's alpha) were assessed. Methods followed STROBE criteria as applicable (see Appendix S1). Results: The content validity index and content validity ratio were both 0.93. Construct validity testing identified 6 factors (mother and infant physical–psychological readiness, expected support, knowledge of future events and care, knowledge of infant personal care, pain and therapeutic interventions). Using Cronbach's alpha coefficient, the reliability of the whole instrument was estimated to be 0.87. Conclusion: The Persian Readiness for Hospital Discharge—Parental Form for use with mothers of preterm infants being discharged from an Iranian NICU has acceptable validity and reliability. Relevance to Practice: This tool can be used before discharge to determine the needs of mothers and design the necessary measures to improve quality of discharge care. [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]

Aims and objectives: To develop and evaluate the psychometric properties of a self‐report instrument measuring 6‐ to 12‐year‐old children's own experiences of participation in health care. Background: Validated measures to evaluate children's participation in health care can play a critical role in strategic work towards supporting children's participation at an individual level and in working towards quality improvements at an organisational level. There are, however, no available instruments to achieve this. Methods: An instrument development design was used, together with the TRIPOD checklist. Item construction was based on research about children's perspectives on participation in health care and Shier's model for participation. The face and content validity was evaluated by 14 healthy children, 9 paediatric nurses and 8 children with different diseases. The construct validity, internal consistency and stability reliability were evaluated based on data from 138 children visiting a paediatric clinic. Results: The testing of the face and content validity resulted in an instrument with child‐friendly language, additional instructions and visual attractive presentation. The principle component analysis resulted in the four‐factor solution: "To be included," "To trust professionals," "To take control," and "To understand information." Internal consistency and intraclass correlation coefficients were acceptable. Conclusion: We conclude that the child participation in health care (ChiPaC) instrument has adequate reliability and validity when used to evaluate children's participation in health care. The involvement of children in the development of ChiPaC resulted in a brief, colourful and user‐friendly instrument for use in paediatric health care. Relevance to clinical practice: This new questionnaire, ChiPaC, is adapted for children between 6–12 years measuring participation in health care from a child perspective. ChiPaC can be used in the practical work of supporting individual children's participation in health care as well as in the strategical work towards quality improvements on an organisational level. [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]

Aim and objectives: To translate the Clinical Trial Nursing Questionnaire (CTNQ) into Swedish and test it for face and content validity as well as internal consistency and reproducibility using test–retest procedures. Introduction/Background: In many countries, as in Sweden, a registered nurse can be involved in research by becoming a clinical research nurse. The clinical research nurse plays a pivotal role in clinical studies as a part of the research team. Scales have been developed and used with the objective to clarify the role of clinical research nurses: one of them is the CTNQ. Methods: A quantitative cross‐sectional design with a test–retest procedure was applied to validate the translated questionnaire. By using a snowball sampling method, relevant participants were identified and 49 registered nurses working in the field of research as clinical research nurses answered the questionnaire on two occasions. An expert panel of three clinical research nurses evaluated the questionnaire for face and content validity. The STROBE checklist for observational research has been followed for presenting the research (see File S1). Results: Face and content validity was agreed upon in the expert panel group. Tests for internal consistency of the CTNQ was calculated and showed a high Cronbach's alpha for both the frequency and importance subscales. The test–retest correlation analysis (reproducibility) also revealed a high correlation coefficient for both subscales. Conclusion: The CTNQ‐SWE is a valid and robust instrument in a Swedish version. The instrument can be of importance in assessing the role of clinical research nurses in Sweden in future studies. Relevance to clinical practice: Use of the CTNQ‐SWE in future research can be of value for clarification and professional development of the clinical research nurse role in Sweden. The further use of the CTNQ in Sweden can be of value in understanding the process where licensed nurses make a transition into becoming a clinical research nurse, and to identify needs for customised education. [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 determine the views of nurses and physicians working in intensive care units (ICU) about the aims of glycaemic control and use of their protocols. Background: Evidence about the optimal aims and methods for glycaemic control in ICU is controversial, and current local protocols guiding practice differ between ICUs, both nationally and internationally. The views of professionals on glycaemic control can influence their practice. Design: Cross‐sectional, multicentre, survey‐based study. Methods: An online short survey was sent to all physicians and nurses of seven ICUs, including questions on effective glycaemic control, treatment of hypoglycaemia and deviations from protocols' instructions. STROBE reporting guidelines were followed. Results: Over half of the 40 respondents opined that a patient spending <75% admission time within the target glycaemic levels constituted poor glycaemic control. Professionals with more than 5 years of experience were more likely to rate a patient spending 50%–74% admission time within target glycaemic levels as poor than less experienced colleagues. Physicians were more likely to rate a patient spending <50% admission time within target as poor than nurses. There was general agreement on how professionals would rate most deviations from their protocols. Nurses were more likely to rate insulin infusions restarted late and incorrect dosage of rescue glucose as major deviations than physicians. Most professionals agreed on when they would treat hypoglycaemia. Conclusions: When surveyed on various aspects of glycaemic control, ICU nurses and physicians often agreed, although there were certain areas of disagreement, in which their profession and level of experience seemed to play a role. Relevance to clinical practice: Differing views on glycaemic control amongst professionals may affect their practice and, thus, could lead to health inequalities. Clinical leads and the multidisciplinary ICU team should assess and, if necessary, address these differing opinions. [ABSTRACT FROM AUTHOR]

Aims and objectives: To develop and test a clinical tool to guide nurses’ assessment of postoperative patients for Deep Vein Thrombosis. Background: Preventing venous thromboembolism in hospitalised patients is an international patient safety priority. Despite high‐level evidence for optimal venous thromboembolism prophylaxis, implementation is inconsistent and the incidence of Deep Vein Thrombosis remains high. Methods: A two‐stage sequential multi‐method design was used. In stage 1, the STOPDVTs tool was developed using a review of the literature and focus groups with local clinical experts. Stage 2 involved pilot testing the tool with 38 surgical nurses who conducted repeated assessments on a prospective sample of 50 postoperative orthopaedic patients. Results: Stage 1: The focus group members who were members of the nursing leadership team agreed on eight local and systemic signs and symptoms that should be included in a nursing patient assessment tool for early Deep Vein Thrombosis. Local symptoms were pain in the limbs, calf swelling and tightness, changes in the affected limb's skin temperature. Systemic signs included in the tool were as follows: increased shortness of breath, increased respiratory and heart rates, and decreased oxygen saturation. Stage 2: The STOPDVTs tool had acceptable face and content validity, the agreement between the expert nurse and surgical nurses on assessments of individual signs and symptoms varied between 44%–94%. Surgical nurses were less likely than the expert nurse to identify signs indicative of Deep Vein Thrombosis. Conclusion: Despite finding the STOPDVTs clinical assessment tool was a useful guide for nursing assessment, surgical nurses often underestimated the potential importance of clinical signs. The findings reveal a gap in nursing knowledge and skill in assessing for Deep Vein Thrombosis in postoperative orthopaedic patients. Relevance to clinical practice: This study identified a possible risk to patient safety related to under‐recognition of the signs and symptoms of possible Deep Vein Thrombosis (DVT) in postoperative orthopaedic patients. The findings demonstrate the feasibility of developing and implementing a protocol for consistent screening by nurses for possible DVT in the postoperative period. [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]

Aims and objective: To develop a tool for measuring competency in conducting health education and to evaluate its psychometric properties in a population of entry-level nurses. Background: Until now, no generic instrument has been developed specifically for measuring competency in health education, which is an essential competency for nurses. Existing scales are either insufficient for psychometric evaluation or are designed specifically for senior nurses. To evaluate curricula and courses designed for entry-level nurses, educators require an instrument for measuring improvement in core competency from baseline to determine whether the minimum level of ability has been achieved. Design: Item development for the survey instrument used for data collection in this study was based on the results of a literature review. Methods: The self-evaluated Health Education Competency Scale developed in this study was used to survey 457 nursing students at two nursing schools and 165 clinical nurses at a medical centre in south Taiwan in 2016. The participants were randomly divided into two equal groups. One group was analysed by exploratory factor analysis with varimax rotation, and one group was analysed by confirmatory factor analysis. Results: Factor analysis yielded a four-factor (assessment, pedagogy, motivation and empowerment) solution (18 items) that accounted for 75.9% of the variance. Conclusion: The total scale and subscales had good reliabilities and construct validity coefficients. For measuring competency in entry-level nurses, the Health Education Competency Scale had a good data fit and sound psychometric properties. Relevance to clinical practice: The proposed scale can be used to assess health education competency for college nursing students and practising nurses. Further more, it can provide educators with valuable insight into the minimum competencies required for entry-level nurses to deliver quality health care to clients and can guide them in the practice of client-based teaching. [ABSTRACT FROM AUTHOR]

Aims and objectives To update and re-validate the Valuing Patients as Individuals Scale for use as a patient appraisal of received healthcare. Background Healthcare in the United Kingdom and beyond is required to deliver high quality, person-centred care that is clinically effective and safe. However, patient experience is not uniform, and complaints often focus on the way patients have been treated. Legislation in United Kingdom requires health services to gather and use patients' evaluations of care to improve services. Design This study uses scoping literature reviews, cognitive testing of questionnaire items with patient and healthcare staff focus groups, and exploratory factor analysis. Methods/Setting/Participants Data were collected from 790 participants across 34 wards in two acute hospitals in one National Health Service Health Board in Scotland from September 2011-February 2012. Ethics and Research and Development approval were obtained. Results Fifty six unique items identified through literature review were added to 72 original Valuing Patients as Individuals Scale items. Face validity interviews removed ambiguous or low relevance items leaving 88 items for administration to patients. Two hundred and ninety questionnaires were returned, representing 37% response rate, 71 were incomplete. Thus 219 complete data were used for Exploratory Factor Analysis with varimax orthogonal rotation. This revealed a 31 item, three factor solution, Care and Respect; Understanding and Engagement; Patient Concerns, with good reliability, concurrent and discriminant validity in terms of gender. A shortened 10 item measure based on the top 3 or 4 loading items on each scale was comparable. Conclusions The Updated Valuing Patients as Individuals Scale is sufficiently developed to capture patient appraisals of received care. Relevance to clinical practice The short scale version is now being routinized in real-time evaluation of patient experience contributing to this United Kingdom, National Health Service setting meeting its policy and legislative requirements. [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 report the translation and adaptation process from English to Turkish and the psychometric estimates of the validity and reliability of The Organ Donation Attitude Scale Turkish. Its aim (1) is to provide data about and (2) to assess Turkish people's attitudes and volunteerism towards organ donation. Background Lack of donors is a significant problem for organ transplantation worldwide. Attitudes about organ donation and volunteerism are important factors in the lack of donors. Design To collect survey data from Turkish participants, a cross-sectional design was used: the classical measurement method. Methods The Organ Donation Attitude Scale was translated from English to Turkish and back-translated into English. The analysis included a total of 892 Turkish participants. The validity of the scale was confirmed by exploratory factor analysis and criterion-relation validity testing. A test-retest procedure was implemented for the reliability of the scale over time. Results The Organ Donation Attitude Scale consists of three relatively independent components: humanity and moral conviction, fears of medical neglect and fears of bodily mutilation. Internal consistency of these three components resulted in acceptable Cronbach's α levels. Positive correlation occurred between the volunteerism score and positive attitude about organ donation. The correlation between volunteerism score and negative attitude about organ donation was negative. Fears of bodily mutilation were most significantly related to unwillingness to commit to organ donation. The test-retest correlation coefficients proves that the Organ Donation Attitude Scale were reliable over time. Conclusion The Organ Donation Attitude Scale Turkish version is both a reliable and valid instrument that can be useful in measuring positive and negative attitudes of Turkish people about organ donation. Relevance to clinical practice With the Organ Donation Attitude Scale, researchers in Turkey will be able to ascertain important data on volunteerism and attitudes towards organ donation. Thus, positive attitudes towards cadaver organ donations will be able to encourage organ donation in Turkey. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine the psychometric properties of the Menopausal Symptoms Distress Affecting Sleep Quality Scale. Background. Sleep disturbances are an extensive and common problem among menopausal women. However, no unique and specific scale has yet been developed to detect the inductive symptoms distresses that cause poor sleep quality for menopausal women. Design. A cross-sectional design. Methods. The Menopausal Symptoms Distress Affecting Sleep Quality Scale was based on in-depth interviews with menopausal women and literature review. Convenience sampling was employed. One hundred and fifty three women participated in this study. Exploratory factor analysis, concurrent validity and contrasting group validity were used to examine the validity of the Menopausal Symptoms Distress Affecting Sleep Quality Scale. Cronbach's a was conducted to test the reliability. The accuracy of the scale was analysed with the receiver operating characteristic from MED CALC version 10.4.8.0 software. The scale's sensitivity, specificity, positive and negative predictive value were analysed to locate the best cut-off point. Results. One factor was generated by Exploratory factor analysis, and this factor explained 49-07% of total variance. In addition, the Menopausal Symptoms Distress Affecting Sleep Quality Scale had significant positive correlations with the Greene Climacteric Scale and the self-evaluation of menopausal symptoms scale. Cronbach's a of the Menopausal Symptoms Distress Affecting Sleep Quality Scale was 0-89. Moreover, the diagnostic accuracy probability of the scale's receiver operating characteristic curve was 0-85. The best cut-off point was three with a sensitivity of 76% and a specificity of 87%. Conclusions. The Menopausal Symptoms Distress Affecting Sleep Quality Scale had good reliability and validity, as well as refined indicators for assessing the tool's accuracy. Relevance to clinical Practice. The Menopausal Symptoms Distress Affecting Sleep Quality Scale is easy to use, can quickly detect the sleep conditions of menopausal women who suffer from menopausal symptom distress, and provide efficient nursing interventions to relieve menopausal symptom distresses, and then improve sleep quality. [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]

Aims and objectives To establish validity of a clinical leadership framework for aged care middle managers (The Aged care Clinical Leadership Qualities Framework). Background Middle managers in aged care have responsibility not only for organisational governance also and operational management but also quality service delivery. There is a need to better define clinical leadership abilities in aged care middle managers, in order to optimise their positional authority to lead others to achieve quality outcomes. Design A Delphi method. Methods Sixty-nine experts in aged care were recruited, representing rural, remote and metropolitan community and residential aged care settings. Panellists were asked to rate the proposed framework in terms of the relevance and importance of each leadership quality using four-point Likert scales, and to provide comments. Three rounds of consultation were conducted. The number and corresponding percentage of the relevance and importance rating for each quality was calculated for each consultation round, as well as mean scores. Consensus was determined to be reached when a percentage score reached 70% or greater. Results Twenty-three panellists completed all three rounds of consultation. Following the three rounds of consultation, the acceptability and face validity of the framework was confirmed. Conclusions The study confirmed the framework as useful in identifying leadership requirements for middle managers in Australian aged care settings. The framework is the first validated framework of clinical leadership attributes for middle managers in aged care and offers an initial step forward in clarifying the aged care middle manager role. Relevance to clinical practice The framework provides clarity in the breadth of role expectations for the middle managers and can be used to inform an aged care specific leadership program development, individuals' and organisations' performance and development processes; and policy and guidelines about the types of activities required of middle managers in aged care. [ABSTRACT FROM AUTHOR]