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Aim: To investigate the mental well‐being of early career nurses working in the United Kingdom during the COVID‐19 pandemic, with a particular emphasis on symptoms related to post‐traumatic stress disorder. Design: A longitudinal survey study. Methods: Data were acquired at three timepoints during the COVID‐19 pandemic (between May 2020 and March 2021) to determine whether symptoms of post‐traumatic stress disorder persisted over time. Quantitative measures of well‐being were supplemented with survey data on the nurses' experiences of working during the pandemic. Results: Twenty‐seven per cent of participants suffered from persistent symptoms of post‐traumatic stress while working as nurses during the pandemic. The nurses' baseline resilience, as well as their perception of the quality of their work environment, were significant negative predictors of symptoms of post‐traumatic stress. Participants identified a range of strategies that would have helped them during the crisis, including visible, consistent and empathetic leadership, adequate training and a supportive work environment. Conclusion: The context of the pandemic has highlighted the vulnerability of the psychological well‐being of early career nurses in the workforce. Immediate implementation of some of the more simple interventions suggested in this paper would provide early career nurses with rapid support. More complex support mechanisms should be given immediate consideration, with a view to implementation in the longer term. Implications for the Profession: This study contributes new knowledge about the psychological well‐being of early career nurses working during the pandemic and suggests support mechanisms that will be crucial for the retention of these nurses in the profession. A measurement of resilience may be useful for determining the appropriate level of support to provide to early career nurses. Impact: Early career nurses are vulnerable to attrition from the profession. This could be exacerbated if the psychological well‐being of these nurses is not being supported.Around 25% of early career nurses suffered from persistent symptoms of post‐traumatic stress disorder while working as nurses during the height of the pandemic, which is a novel finding compared to other longitudinal studies.Understanding the psychological well‐being of early career nurses working during a crisis period (such as a pandemic) equips nurse managers with appropriate strategies to improve nurses' emotional health and to enhance their retention within the workforce.The current findings may be of interest to clinical practitioners who have responsibility for the retention of nursing staff. No patient or public contribution. One of the authors is a statistician. [ABSTRACT FROM AUTHOR]

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

Aim: To assess the attitudes of newly graduated nurses in China toward their work environment and identify the factors affecting their perception. Background: Newly graduated nurses are the primary supply to cover the nursing shortage, but their stressful transition into clinical work has contributed to high turnover for decades. Although serving as a source of stress, the work environment can also be a source of support for new nurses. Methods: A total of 2361 new nurses at 31 tertiary hospitals in 20 provinces were surveyed from June to November 2018, using the Chinese version of the Practice Environment Scale‐Nursing Work Index. Basic information and their perception about work environment were collected. Results: New nurses rated their work environment with an overall score of 84.67 (12.85). Multiple linear regression identified that education level, monthly income, hospital type and location, participation (or not) in standardized training programmes and having (or not) a mentor/preceptor were factors significantly associated with their perception of the work environment. Conclusion: The perception of newly graduated nurses in China was mainly positive overall. Nursing managers may take full advantage of factors affecting the perception of work environment to support newly graduated nurses better, to help their retention and transition. Summary statement: What is already known about the topic? Newly graduated nurses experience transition shock at the beginning of their work.Supportive work environments can help successful transition. What this paper adds? Newly graduated nurses are not fully supported in their work environment.Staffing and resource inadequacy were the poorest environmental factors.Residency programmes had the most impact on the perceptions of newly graduated nurses about their work environment. Implications for nursing practice: These results can guide nursing managers to support the newly graduated nurses better in their transition process, thus helping retention of nursing human resource. [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 This paper introduces the concept of acceleration-related demands in the care of older adults. It examines these new demands and their relation to cognitive, emotional, and physical job demands and to employee well-being. Background Various changes in the healthcare systems of Western societies pose new demands for healthcare professionals' careers and jobs. In particular today's societal changes give rise to acceleration-related demands, which manifest themselves in work intensification and in increasing requirements to handle new technical equipment and to update one's job-related knowledge. It is, therefore, of interest to investigate the effects of these new demands on the well-being of employees. Design Survey. Method Between March-June 2010 the survey was conducted among healthcare professionals involved in care of older adults in Austria. A total of 1498 employees provided data on cognitive, emotional, and physical job demands and on acceleration-related demands. The outcome variables were the core dimensions of burnout (emotional exhaustion and depersonalization) and engagement (vigour and dedication). Results Hierarchical regression analyses show that acceleration-related demands explain additional variance for exhaustion, depersonalization, vigour, and dedication when controlling for cognitive, emotional, and physical demands. Furthermore, acceleration-related demands associated with increasing requirements to update one's knowledge are related to positive outcomes (vigour and dedication). Acceleration-related demands associated with an increasing work pace are related to negative outcomes such as emotional exhaustion. Conclusion Results illustrate that new demands resulting from social acceleration generate potential challenges for on-the-job learning and potential risks to employees' health and well-being. [ABSTRACT FROM AUTHOR]

d'arcy l.p., sasai y. & stearns s.c. (2012) Do assistive devices, training, and workload affect injury incidence? Prevention efforts by nursing homes and back injuries among nursing assistants. Journal of Advanced Nursing 68(4), 836-845. Abstract Aims. This paper is a report of a study of association between workplace injuries experienced by nursing assistants in nursing homes in the United States and four factors that may affect injury rates: initial nursing assistant training, training at the current facility, lifting devices, and time to execute daily duties. Background. High injury rates among nursing personnel have been reported in multiple settings across countries. The existing literature is divided on the effectiveness of training and assistive devices in reducing injury rates among nursing assistants. Methods. We examined associations between whether or not the nursing assistant has experienced an injury and four key factors: quality of initial injury prevention training, injury prevention training at current facility, lift availability and whether or not the nursing assistant has sufficient time to complete resident activities of daily living. We estimated a survey-weighted logit model using 2004 National Nursing Assistant Survey data. Results/findings. The odds of an injury in the past year were lower among nursing assistants who reported always having a lift available when needed (41% lower odds), available facility training to reduce workplace injuries (39%), and sufficient time to complete resident activities of daily living (35%). Quality of initial training to prevent work injuries was not significantly associated with injury status. Conclusion. Regions without widespread access to lifting devices may be able to reduce injury rates by increasing the availability of lifting devices. The potential for reductions in injury rates in the United States is greatest from improving training and ensuring adequate time for resident care, as most facilities currently have lifts available. [ABSTRACT FROM AUTHOR]

Aim and Objectives: The purpose of this study was to explore the effect and paths of stigma on depressive symptoms in women who underwent termination of pregnancy for foetal anomaly (TOPFA). Background: Stigma may cause distress and depressive symptoms for women with TOPFA. However, few studies have examined the relationship between stigma and depression in women with TOPFA. Design: This study followed the STROBE checklist. A cross‐sectional survey was conducted among 469 women with TOPFA. The path analysis used hierarchical multiple regression and structural equation model to examine the mediating role of social support and psychological flexibility on the relationship between stigma and depressive symptoms. Results: Hierarchical multiple regression analysis revealed the mediation effect of psychological flexibility between stigma and depressive symptoms. By contrast, social support did not present such effect. The structural equation model confirmed that stigma, directly and indirectly, affected depressive symptoms. Discussion: Many women with TOPFA have severe depressive symptoms and that stigma is an important influencing factor. Psychological flexibility plays an essential role in mitigating the effects of stigma on depressive symptoms. Relevance to clinical practice: Healthcare professionals should focus on measuring and intervening on stigma and psychological flexibility for alleviating the depressive symptoms of women with TOPFA. No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore fluctuations in perinatal depression based on physiological, psychological and interpersonal dimensions to analyse risk factors across three time points: in the third trimester and at weeks 1 and 6 postpartum. Background: Pregnant women experience depression at multiple time points and require screening. Studies have shown protective and negative factors related to postpartum depression. Cognitive fusion refers to an individual's emotions and behaviours that are regulated and influenced by that individual's own cognitive overregulation, especially when facing stress. This is an important psychological factor related to depression, but little is known about it in pregnant women. Design: A longitudinal study was conducted from June 2019–July 2020, and the findings are reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Methods: Pregnant women (n = 207) were recruited, and a questionnaire survey was performed at 32–34 weeks of pregnancy and at weeks 1 and 6 postpartum. Repeated‐measures analysis of variance was performed to analyse the changes in depression over time. Regression analysis and linear mixed modelling were used to identify risk factors. Pearson's correlation analysis was performed to analyse the relationships between variables. Results: Of the pregnant women, 36.70% experienced antenatal depression and prolonged depression with the onset of postpartum depression (12.21%). Some depressive moods disappeared spontaneously after delivery (47.37%). Perceived stress was the highest risk predictor of postpartum depression (β = 0.332), followed by cognitive fusion (β = 0.178), which remained stable over time and might have been positively related to having a vulnerable personality (0.2 < r < 0.4). Social support plays a positive role in lowering postpartum depression (β = −0.027). Conclusions: Changes in depression were influenced by multiple factors with stability and predictability across time. Psychological dimensions, such as perceived stress and cognitive fusion, are risk factors for developing postpartum depression and antenatal depression. Relevance to clinical practice: Pregnant women can be divided into depressive cohorts according to screening at different time points to provide targeted interventions. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of the study was to test the association between subthreshold depression and self‐care behaviours in adults with type 2 diabetes (T2D) attending a tertiary healthcare service. Background: Suboptimal adherence to self‐care behaviours is associated with poor glycaemic control. The estimated point prevalence of subthreshold depression in people with T2D is 17%. Two previous studies have examined the association between subthreshold depression and self‐care behaviours in T2D, reported observations were inconsistent. Design: A cross‐sectional observational study. Methods: We surveyed adults with T2D attending a tertiary healthcare facility in Nepal. Self‐care behaviours and subthreshold depression were assessed using the Summary of Diabetes Self‐care Activities and the Patient Health Questionnaire‐9, respectively. We used linear and logistic regression to test the association of subthreshold depression with total and individual self‐care behaviours. Our reporting complies with STROBE reporting guideline for observational research. Results: Just over a third (37%) of the participants had subthreshold depression. People with subthreshold depression had slightly lower total diabetes self‐care score compared to those with no depression. More than half of participants with subthreshold depression had suboptimal adherence to diet, physical activity and foot care. Subthreshold depression was associated with total self‐care score (B = −0.27, 95% CI: −0.54, −0.01). In addition, association between subthreshold depression and diet adherence was observed (AOR = 0.26, 95% CI: 0.15, 0.44). Conclusions: Subthreshold depression is associated with decreased adherence to self‐care behaviour in people with T2D. Identification and treatment of subthreshold depression in T2D may lead to better adherence to diabetes self‐care behaviours. Relevance to clinical practice: The recognition and treatment of subthreshold depression warrants further investigation as a strategy to improve the adherence to self‐care behaviours. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aims of the study were to identify content categories of unreasonable and unnecessary illegitimate tasks and to investigate how unreasonable and unnecessary tasks relate to occupational wellbeing. Background: Illegitimate tasks are a common stressor among healthcare professionals, and they have been shown to have negative associations with occupational well‐being. Despite this evidence, research has not yet uncovered what kinds of tasks healthcare professionals consider illegitimate. Design and method: The data gathered by means of an online survey consisted of 1024 municipal healthcare organisation employees. A theory‐driven qualitative content analysis was used to analyse freely reported illegitimate tasks. For occupational well‐being associations, a mixed‐methods approach was used (ANCOVA and linear regression analysis). The STROBE statement—checklist for cross‐sectional studies was used. Results: Eight content categories were found for illegitimate tasks. For unreasonable tasks, these were (1) tasks outside one's occupational role (78% of all unreasonable tasks), (2) conflicting or unclear demands (9%), (3) tasks with insufficient resources (8%) and (4) tasks with difficult consequences (5%), and for unnecessary tasks, these were (1) impractical or outdated working habits (31% of all unnecessary tasks), (2) tasks related to dysfunctional technology (30%), (3) unnecessary procedures (27%) and (4) tasks related to bureaucratic demands (12%). Unreasonable and unnecessary tasks were associated with higher levels of burnout and lower work engagement and the meaningfulness of work. Conclusions: Our findings support the theory that illegitimate tasks are an occupational stressor with negative effects on burnout, work engagement and meaningfulness of work. Relevance to clinical practice: The study offers insights into the types of tasks health care employees see as illegitimate and highlights the importance of good job design in promoting occupational well‐being in health care. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To evaluate nurses' care coordination competency for mechanically ventilated patients in intensive care units (ICUs) of Saudi Arabia (SA). Background: ICUs are increasingly using multidisciplinary approach to provide critical care. Functionality gaps remain within these teams preventing optimum performance, including a lack of adequate care coordination in the management of mechanically ventilated (MV) patients. Design: A cross‐sectional survey of ICU nurses working across 20 hospitals in SA. Methods: The Nurses' Care Coordination Competency Scale (NCCCS) survey for MV patients was administered to all the nurses to assess their care coordination competence. The data were analysed using Student's t test, ANOVA and linear regression. Reporting of this research follows STROBE guidelines. Results: A total of 254 nurses participated in the survey. The overall NCCCS mean score was 3.94 (±0.69) out of a 5‐point scale. Also, the "promoting team cohesion factor (Factor 1)" had a mean score of 3.90 (±0.77), the "understanding care coordination needs factor (Factor II)" had a mean score of 4.00 (±0.77), the "aggregating and disseminating information factor (Factor III)" had a mean score of 4.05 (±0.76), and the "devising and clearly articulating the care vision factor (Factor IV)" had a mean score of 3.78 (±0.87). The mean overall NCCCS score was 4.10 among Indians, 3.98 among Filipinos and 3.81 among Saudi nationals. Conclusion: There were a high overall score and subscale scores of nurses' care coordination competence for mechanically ventilated patients, but few gaps were identified in some of the items. Relevance to Clinical Practice: The results provide information on the status and gaps in ICU nurses' care coordination competencies to address the needs of mechanically ventilated critically ill patients. The NCCCS can be utilised as an educational tool for nurses who are new to the ICU work environment. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To investigate the prevalence of cancer‐related fatigue and explore the relationship between resilience, positive affect, and fatigue among Chinese patients with gastric cancer. Background: Cancer‐related fatigue is the most distressing symptom reported frequently by cancer patients during both treatment and survival phases. Resilience and positive affect as vital protective factors against cancer‐related fatigue have been examined, but the underlying psychological mechanisms are not well understood. Design: A cross‐sectional study. Methods: Two hundred and three gastric cancer patients were enrolled from three hospitals in China. The Cancer Fatigue Scale, the positive affect subscale of the Positive and Negative Affect Schedule and the Connor‐Davidson Resilience Scale (CD‐RISC10) were administered. Hierarchical linear regression modelling was conducted to examine the association between resilience and cancer‐related fatigue, and the mediating effect of positive affect. Results: The incidence of clinically relevant fatigue among patients with gastric cancer was 91.6%. Regression analysis showed that resilience was negatively associated with cancer‐related fatigue, explaining 15.4% of variance in cancer‐related fatigue. Mediation analysis showed that high resilience was associated with increased positive affect, which was associated with decreased cancer‐related fatigue. Conclusions: Cancer‐related fatigue is prevalent among patients with gastric cancer. Positive affect may mediate the relationship between resilience and cancer‐related fatigue. Relevance to clinical practice: Interventions that attend to resilience training and promotion of positive affect may be the focus for future clinical and research endeavours. [ABSTRACT FROM AUTHOR]

Aim To describe the prevalence of everyday activity engagement for older people in nursing homes and the extent to which engagement in everyday activities is associated with thriving. Background Research into residents' engagement in everyday activities in nursing homes has focused primarily on associations with quality of life and prevention and management of neuropsychiatric symptoms. However, the mere absence of symptoms does not necessarily guarantee experiences of well-being. The concept of thriving encapsulates and explores experiences of well-being in relation to the place where a person lives. Design A cross-sectional survey. Method A national survey of 172 Swedish nursing homes (2013-2014). Resident ( n = 4831) symptoms, activities and thriving were assessed by staff using a study survey based on established questionnaires. Descriptive statistics, simple and multiple linear regression, and linear stepwise multiple regression were performed. Results The most commonly occurring everyday activities were receiving hugs and physical touch, talking to relatives/friends and receiving visitors, having conversation with staff not related to care and grooming. The least commonly occurring everyday activities were going to the cinema, participating in an educational program, visiting a restaurant and doing everyday chores. Positive associations were found between activity engagement and thriving, where engagement in an activity program, dressing nicely and spending time with someone the resident likes had the strongest positive association with resident thriving. Conclusions Engagement in everyday activities can support personhood and thriving and can be conceptualized and implemented as nursing interventions to enable residents to thrive in nursing homes. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to examine how patient safety indicators and processes and structures of nursing care have changed since the 2012 introduction of Swiss Diagnosis-Related Groups. Background Diagnosis-Related Groups have been implemented worldwide; yet, research findings regarding their impact on efficiency and quality of care remain inconsistent. The Matching Registered Nurse Services with Changing Care Demands study will assess how structures, processes and patient and nurse outcomes have changed in Swiss acute care hospitals since the introduction of Swiss Diagnosis-Related Groups. Design A multi-centre observational study nested in a natural experiment. Methods To explore the effect of implementing Diagnosis-Related Groups in Switzerland we will compare nurse and patient survey data from 2010 with data from 2015 and eventually from 2017. Initially, we will match survey data from 78 medical and surgical units of 21 hospitals that participated in 2010 and 2015. Study variables related to structures and processes of nursing care (e.g. staffing/skill mix level, nurse work environment, rationing of nursing care), as well as patient and nurse outcomes, were assessed with well-established instruments. In 2017, a follow-up survey will be conducted to explore long-term implications. Furthermore, 6 years' medical and surgical patient discharge data (collected 2010-2015) will be analysed to assess changes in the severity of patient illness, length of stay and selected patient safety indicators. Discussion This study's results will provide evidence regarding Diagnosis-Related Groups influences on Swiss nursing services and patient safety outcomes. [ABSTRACT FROM AUTHOR]

Aim To examine associations between characteristics of general practice settings and primary healthcare providers (general practitioners and practice nurses) and the degree of relational coordination for the task of insulin initiation for type 2 diabetes between primary healthcare providers and diabetes specialists. Background Relational coordination is a component of effective chronic disease management and can be used to measure collaboration and communication between health professionals. High levels of relational coordination may be important to support insulin initiation in general practice. Design Cross-sectional study. Methods Surveys were completed by general practitioners and practice nurses participating in the Stepping Up trial. Data on demographics, practice characteristics and relational coordination were collected between October 2012-June 2014. Univariate and multivariate analyses examined factors associated with relational coordination. Results General practitioners (n = 174) and 115 practice nurses from 78 general practices were included in the analysis. General practice characteristics associated with relational coordination were geographical location and number of administrative staff. Female general practitioners and older practice nurses reported lower relational coordination. Practice nurses with diabetes educator qualifications and experience in insulin initiation reported higher relational coordination. Conclusion An expanded role and experience of practice nurses in diabetes care increased relational coordination and has the potential to deliver more effective chronic disease management in general practice. Practice and health professional characteristics should be taken into account when designing models of care to increase insulin initiation. [ABSTRACT FROM AUTHOR]

Aim This article describes the rationale, design and methodology of the Building research initiative group: chronic illness management and ad herence in transplantation ( BRIGHT) study. This study of heart transplant patients will: (1) describe practice patterns relating to chronic illness management; (2) assess prevalence and variability of non-adherence to the treatment regimen; (3) determine the multi-level factors related to immunosuppressive medication non-adherence. Background The unaltered long-term prognosis after heart transplantation underscores an urgent need to identify and improve factors related to survival outcomes. The healthcare system (e.g. level of chronic illness management implemented) and patient self-management are major drivers of outcome improvement. Design The study uses a survey design in 40 heart transplant centres covering 11 countries in four continents. Methods Theoretical frameworks informed variable selection, which are measured by established and investigator-developed instruments. Heart transplant recipients, outpatient clinicians and programme's directors complete a survey. A staged convenience sampling strategy is implemented in heart transplant centres, countries and continents. Depending on the centre's size, a random sample of 25-60 patients is selected (N estimated 1680 heart transplant recipients). Five randomly selected clinicians and the medical director from each centre will be invited to participate. Conclusion This is the first multi-centre, multi-continental study examining healthcare system and heart transplant centres chronic illness management practice patterns and potential correlates of immunosuppressive medication non-adherence. The knowledge gained will inform clinicians, researchers and healthcare policy makers at which level(s) interventions need to be implemented to improve long-term outcomes for transplant recipients. [ABSTRACT FROM AUTHOR]

Aim To compare sole nurse and doctor-led multidisciplinary team delivery of community clozapine services for people with treatment-resistant schizophrenia. Background Around 20% of people with schizophrenia are treatment resistant and fail to respond to front line medications. Clozapine, a second-line treatment, has potentially serious side effects requiring regular monitoring. Different models of community clozapine services are emerging in the British National Health Service, but there is little evidence about which is best. Design Questionnaire survey of service users. Methods All patients on the lists of seven clozapine clinics (four sole nurse, three multidisciplinary team) in one trust were invited to participate, 2009-2010. Forward stepwise regression was used to investigate associations between patient well-being, functioning, self-efficacy and satisfaction, and clinic model attended, controlling for socio-demographic and health characteristics and processes of care. Use (and costs) of other health and social services accessed was compared between models. Results Sixty-six service users (35% participation rate) responded. Well-being and functioning were associated with patient characteristics and processes of care, not clinic model. Patients managed by sole nurses reported, over 3 months: more community psychiatric nurse visits and hospital psychiatrist appointments. Clinic list size affects costs per patient. Conclusions Multidisciplinary team delivery may reduce use of other services. Although multidisciplinary team delivery is regarded as best practice, sole nurses can effectively provide clozapine services and may be warranted in areas of low population density. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore students' opinions of the learning environment during clinical placement in settings outside traditional hospital settings. Background Clinical placement experiences may influence positively on nursing students attitudes towards the clinical setting in question. Most studies exploring the quality of clinical placements have targeted students' experience in hospital settings. The number of studies exploring students' experiences of the learning environment in healthcare settings outside of the hospital venue does not match the growing importance of such settings in the delivery of health care, nor the growing number of nurses needed in these venues. Design A survey design was used. Method The Clinical Learning Environment Inventory was administered to two cohorts of undergraduate nursing students ( n = 184) after clinical placement in mental health care, home care and nursing home care. Results Nursing students' overall contentment with the learning environment was quite similar across all three placement areas. Students in mental health care had significantly higher scores on the subscale individualisation, and older students had significantly higher scores on the total scale. Compared with other studies where the Clinical Learning Environment Inventory has been used, the students' total scores in this study are similar or higher than scores in studies including students from hospital settings. Conclusion Results from this study negate the negative views on clinical placements outside the hospital setting, especially those related to placements in nursing homes and mental healthcare settings. Relevance to clinical practice Students' experience of the learning environment during placements in mental health care, home care and nursing homes indicates the relevance of clinical education in settings outside the hospital setting. [ABSTRACT FROM AUTHOR]

Aims To explore the complex relationships between nurses' personal resources, job satisfaction and 'customer' (patient) orientation. Background Previous research has shown that nursing is highly intensive, emotionally charged work, which affects nurses' job performance and their customer orientation as well as patient or 'customer' satisfaction. This study contributes to the literature by examining how nurses' personal resources relate to their personal satisfaction and customer orientation and the relationships between them. Specifically, this study explores the effects of two facets of emotional labour (deep acting and surface acting), empathic concern, self-efficacy and emotional exhaustion on personal job satisfaction and customer orientation. We also test the moderating effects of inauthenticity and emotional contagion. Design A quantitative survey. Method Data were collected through a self-completion questionnaire administered to a sample of 159 Australian nurses, in a public teaching hospital, in 2010. The data were analysed using Partial Least Square analysis. Results Partial Least Square analysis indicates that the final model is a good fit to the data (Goodness of Fit = 0·51). Deep acting and surface acting have different effects (positive and negative) on job satisfaction and 'customer' orientation, self-efficacy has a positive effect on both and emotional exhaustion has a positive effect on customer orientation and a negative effect on job satisfaction. The moderating effects of emotional contagion and empathic concern, in the final model, are discussed. Conclusions Understanding the complex interactions between personal resources, job satisfaction and customer orientation helps to increase service providers' (nurses in this study) personal satisfaction and 'customer' orientation particularly in difficult contexts. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe and evaluate the basic competence of graduating nursing students in intensive and critical care nursing. Background Intensive and critical care nursing is focused on severely ill patients who benefit from the attention of skilled personnel. More intensive and critical care nurses are needed in Europe. Critical care nursing education is generally postqualification education that builds upon initial generalist nursing education. However, in Europe, new graduates practise in intensive care units. Empirical research on nursing students' competence in intensive and critical care nursing is scarce. Design A cross-sectional survey design. Methods A basic competence scale (Intensive and Critical Care Nursing Competence Scale, version 1) and a knowledge test (Basic Knowledge Assessment Tool, version 7) were employed among graduating nursing students ( n = 139). Results Sixty-nine per cent of the students self-rated their basic competence as good. No association between self-assessed Intensive and Critical Care Nursing-1 and the results of the Basic Knowledge Assessment Tool-7 was found. The strongest factor explaining the students' conception of their competence was their experience of autonomy in nursing after graduation. Conclusion The students seem to trust their basic competence as they approach graduation. However, a knowledge test or other objective method of evaluation should be used together with a competence scale based on self-evaluation. Relevance to clinical practice In nursing education and in clinical practice, for example, during orientation programmes, it is important not only to teach broad basic skills and knowledge of intensive and critical care nursing, but also to develop self-evaluation skills through the use of special instruments constructed for this purpose. [ABSTRACT FROM AUTHOR]

Aim To explore associations among breastfeeding duration, maternal personality and maternal attitudes and experiences of breastfeeding. Background Understanding influences on breastfeeding initiation and duration is critical to increasing breastfeeding rates and supporting new mothers. Maternal characteristics such as self-efficacy, knowledge and confidence are known to enable women to breastfeed, but little is known about the influence of maternal trait personality on breastfeeding. Design An exploratory cross-sectional survey. Method A total of 602 mothers with an infant aged 6-12 months old completed a self-report questionnaire examining maternal trait personality, breastfeeding duration and attitudes and experiences of breastfeeding. Data were collected between March-June 2009. Results Mothers who reported high levels of extraversion, emotional stability and conscientiousness were significantly more likely to initiate and continue breastfeeding for a longer duration. Attitudes and experiences significantly associated with these personality traits such as perceived difficulties and lack of support may explain these patterns. For example, characteristics associated with introversion and anxiety may prevent women from seeking support or challenging negative attitudes of others at this critical time. Conclusion Understanding the influence of maternal personality may thus be a useful tool in antenatal support to recognize women who may need extra, directed support while facilitating discussion of potential barriers to breastfeeding. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate (1) the extent to which shock anxiety and perceived support from healthcare professionals are related to post-traumatic stress disease ( PTSD) symptoms and (2) the extent to which perceived support from healthcare professionals moderates the relationship between shock anxiety and PTSD symptoms in implantable cardioverter defibrillator recipients. An additional aim was to describe the level of PTSD symptoms and perceptions of support from healthcare professionals. Background Studies examining PTSD symptoms among implantable cardioverter defibrillator recipients are still sparse. In addition, little is known about how perceived support from healthcare professionals is related to PTSD symptoms. Design Cross-sectional survey design. Methods Recipients ( n = 167) with implantable cardioverter defibrillator attending an outpatient device clinic completed questionnaires assessing shock anxiety, PTSD symptoms and perceived support from healthcare professionals. Results The results indicated that between ten and 15% of the recipients experienced moderate to severe symptoms of PTSD. Although a majority perceived constructive support from healthcare professionals, 12% perceived nonconstructive support. Regression analysis demonstrated that shock anxiety and perceived nonconstructive support from healthcare professionals had a statistically significant (p < 0·01) association with PTSD symptoms. Moreover, the results suggest that associations between shock anxiety and PTSD symptoms were significantly (p < 0·01) moderated by perceived nonconstructive support from healthcare professionals. Young age, short time since implantation and secondary prevention indication were also significantly associated with PTSD symptoms. Conclusions The results indicate that nonconstructive support from healthcare professionals can increase the tendency to develop PTSD symptoms, particularly in those who experience shock anxiety. Relevance to clinical practice Healthcare professionals should pay more attention to the way in which they communicate information to the recipients during follow-up visits. Clinically based strategies and interventions targeting shock anxiety and PTSD symptoms should be carried out. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate the associations between self-reported falls and health complaints, among persons aged 75 years and older living at home, and to investigate gender differences in the associations. Background There are several studies concerned with risk factors for falling, and others related to health complaints, but not many with associations between falls and health complaints. There are some inconsistent data of incidence and gender-related differences in falling. Design Case-control community-based study. Methods In total, 1243 persons living in two municipal districts in Sweden answered a questionnaire. Odds ratios ( OR) and regression models with 95% confidence interval ( CI) were used to determine the associations between self-reported falls and different health complaints. Results The adjusted (multivariate) linear regression showed that urinary incontinence, self-rated health and tiredness were significantly associated with falls for both men and women living at home. The gender-related differences in falling were associated with the variables such as self-rated health for men and tiredness and pain in the hands, elbows, legs or knees for women. Conclusion An association is evident between falls and urinary incontinence, poor self-rated health and tiredness for older persons living at home. Gender differences in falls show an association with poor self-rated health, tiredness and pain in the hands, elbows, legs or knees. Relevance to clinical practice As older people are expected to live in their own homes as long as possible, more knowledge is required about what determines the risk of falling. Nurses in community care are recommended to use assessment tools that include urinary incontinence in order to detect the risk of falling. [ABSTRACT FROM AUTHOR]

Aims (1) To explore 'successful ageing' strategies in terms of selection, optimization and compensation in nursing; (2) To develop a scale that measures these strategies in nursing; (3) To investigate the association between these strategies in nursing and work ability of nurses and the moderating effects of age on this relationship. Background Studies indicate impaired work ability of older nurses. Research is needed to examine if 'successful ageing' strategies can promote the work ability especially in older nurses. Design The investigation applied a mixed method design: Study (1) Semi-structured interviews were conducted to explore selection, optimization and compensation in nursing; (Study 2) A cross-sectional survey was used to test the association between selection, optimization and compensation in nursing and work ability. Methods Data were collected in 2010 and 2011. Study 1: 17 nurses ≥45 years were interviewed; Study 2: 438 nurses (21-63 years) participated. A selection, optimization and compensation-in-nursing-scale was applied that was developed on the basis of study 1. Work ability was measured with the Work Ability Index (Dimension 1) . Results Study 1, the majority of reported ageing strategies were identified as selection, optimization and compensation in nursing. Study 2, selection, optimization, and compensation in nursing was positively related with work ability . The positive relationship was stronger for older nurses. Conclusion Selection, optimization and compensation in nursing contributes positively to work ability, particularly in older nurses. This finding is relevant for the development of measures that promote work ability of nurses over the course of their professional careers. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore the relationship between the levels of nurses' competence and the length of their clinical experience, in order to provide a tentative model of the continuing competence of nurses. Background. The professional development of employees has attracted great interest. This interest has led to the development of various models that illustrate how employees develop their competence throughout their careers. However, little is known of how nurses maintain and develop their competence throughout their career pathways. Design. A cross-sectional design was used. Methods. Using a survey method, five dimensions of self-assessed nursing competence and the length of the nurses' clinical practice were measured ( n = 325). Each dimension of competence was plotted against the length of their clinical experience using locally weighted scatterplot smoothing. Then, the shapes of the plots were analysed by fractional polynomial regression analysis. Results. Overall, the relationships between the levels of nursing competence and the length of clinical experience were illustrated by curves with a rapid increase in competence levels at the early stage of the nursing career and a slower increase later. These curves were modelled by either a logarithmic, square-root function or its reciprocal. The results supported the learning curve model. Conclusions. The competence development of nurses may be characterised by two distinctive periods: a rapid growth period followed by stable periods. However, the modality of the growth may be different depending on which dimension of nursing competence is in focus. Relevance to clinical practice. The level of nursing competence directly affects the quality of care provided to patients. The findings of the study enable healthcare organisations to take proactive approaches to enhance nurses' competence by identifying when and how to assist nurses. [ABSTRACT FROM AUTHOR]

anthony d., baggott r., tanner j., jones k., evans h., perkins g. & palmer h. ( 2012) Health, lifestyle, belief and knowledge differences between two ethnic groups with specific reference to tobacco, diet and physical activity. Journal of Advanced Nursing 68(11), 2496-2503. Abstract Aims. To compare physical activity levels, body mass index, habitual diet, tobacco use and prevalence of non-communicable disease between the two ethnic groups and to identify predictors for differences between groups. Background. Tobacco use, poor diet and physical inactivity are major lifestyle risk factors for chronic cardiovascular diseases, certain cancers, diabetes and chronic lung diseases. There are higher risk and incidence of these diseases in some ethnic groups, for example Asians have higher incidence of diabetes. Design. Cross sectional survey. Methods. Cross sectional survey of Asians of Indian descent and white British adults conducted between October-December 2009. Main outcome variables were lifestyle behaviours and BMI. Self-reported disease diagnosis was also collected. In a regression analysis, predictors of outcome variables were demographic variables and beliefs/attitudes/knowledge towards lifestyle behaviours. Results/Findings. Body mass index, tobacco use and non-communicable disease (except diabetes) were lower in Indians. Indians reported lower physical activity levels and greater salt use than Whites. Tobacco use was higher in Whites, but knowledge, attitudes and beliefs were similar between Whites and Indians. Conclusion. Health risk behaviour and morbidity are different between the two ethnic groups. Gender, age, educational level, beliefs, attitudes and knowledge do not explain these differences. Health promotion that aims to improve knowledge will probably not work and innovative methods are needed to improve health in high risk groups. [ABSTRACT FROM AUTHOR]