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Accessible Summary: What is known on the subject?: Suicide is an important health problem that has been common all over the world in recent years.Nursing students are a high‐risk group for suicide.Factors affecting suicide risk should be investigated and included in psychiatric nursing interventions.Psychological pain is a predisposing condition for suicide risk.Studies focus on the relationship between suicide risk and psychological pain. Studies examining the moderator factors affecting this relationship are limited. What the paper adds to existing knowledge?: By means of the structural equation model, the effect of resilience mediation on the relationship of suicide risk and psychological pain has been shown.In the process of going from psychological pain to suicide, resilience takes on a buffer function with its mediating effect, and this process can be prevented by the development of resilience. What are the implications for practice?: Resilience can be added as a protective factor for suicide to the practices of psychiatric nursing.Initiatives to strengthen resilience can be added to psychiatric nursing practices. In this way, psychological pain and the risk of suicide can be reduced by strengthening resilience.Psychological pain can be added as a risk factor for suicide to the practices of psychiatric nursing.Within the scope of psychiatric nursing practices, nursing interventions can be structured to assess and reduce psychological pain.Interventions on strategies to manage and cope with psychological pain and initiatives to strengthen resilience can be added to suicide prevention programs created for nursing students. Introduction: Nursing students are a high‐risk group for suicide. Psychiatric nurses should investigate risk factors for suicide. Aim: The aim of this study was to examine the resilience mediation effect in the relationship of suicide risk and psychological pain in nursing students. Materials and Methods: This cross‐sectional study was conducted between March and May 2021 with 619 students in the Akdeniz University Faculty of Nursing. A Descriptive Information Form, the Suicide Probability Scale, the Psychache Scale and the Brief Resilience Scale were used to collect data. The structural equation model approach was used to examine the resilience mediating effect on the relation between suicide risk and psychological pain, and Path Analysis was performed. The reporting of the study was conducted according to STROBE. Results: A semi‐mediatory effect of resilience was found between psychological pain and the risk of suicide, and the effect size was determined to be broad (0.57). Discussion: Resilience can be considered as a protective factor for suicide prevention in psychiatric nursing practices. Conclusion: Resilience has an effect on the relationship between psychological pain and suicide risk. Implications for Practices: The results of this study may guide psychiatric nursing practices in reducing and preventing suicide risk. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject: Caring for a family member with a mental illness induces a burden on the caregiver, an impact on their quality of life and premature ageing of more than ten years. What the paper adds to existing knowledge: We conducted systematised and individualised nursing interviews with family members, on the first days of a relative's hospitalisation, during hospitalisation and three months after discharge.We observed persistent depressive symptoms during and after hospitalisation. Burden and depression were higher, and quality of life was lower, for women caregivers and when the caregivers admitted the patients involuntarily in the hospital ward. When the caregivers were experiencing a patient's first hospitalisation, we also found higher depressive symptoms and lower quality of life. What are the implications for practice: This study emphasises the need for new interventions such as psychoeducation to alleviate the suffering of families. Considering the burden of families could become a prevention objective from the patient's first hospitalisation and prevent them from mental or physical health problems. Introduction: The burden consequent to providing care to patients with psychiatric chronic conditions is often overlooked by health professionals. Aim: We assessed the impact of patients' psychiatric hospitalisation on their caregivers, through evaluating their suffering, burden and quality of life, in three stages: upon the patients' admission, their discharge and 3 months after their discharge. Method: In total, 127 caregivers of adult patients whose first hospitalisation was less than 5 years ago were assessed using the 36‐item Short‐Form Health Survey, the Zarit Burden Interview and the Center for Epidemiologic Studies Depression scale. Results: Females and caregivers who admitted patients against their will experienced higher burden and depression and lower mental quality of life. We also found higher depressive symptoms and lower quality of life among caregivers during a patient's first hospitalisation. The caregiver's familial relationship to the patient was not associated with these outcomes. Finally, burden decreased and quality of life increased over time. Discussion: Results suggest that several variables associated with patient hospitalisations were correlated with burden, depression or quality of life. Implications for Practice: Burden could be targeted with interventions such as group psychoeducation for caregivers during or after the patient's hospitalisation, in order to reduce their distress and improve their quality of life. Psychiatric and mental health nurses can provide support to caregivers with systematic assessments of their burden and quality of life, so as to better meet their needs and promote their ability to cope with mental illness. [ABSTRACT FROM AUTHOR]

Aim: To examine undergraduate nursing students' sense of belonging as they transitioned from online to in‐person learning. Design: A mixed‐method design employing a Sense of Belonging Survey and three open‐ended questions. Methods: Participants were first‐year undergraduate nursing students who were back to in‐person learning after 3 years of online learning during the pandemic. The survey was administered online in April 2023 using Qualtrics survey software. The survey data were analysed using descriptive statistics, and the open‐ended questions were analysed by deductive thematic analysis. Results: Seventy‐five (48%) of the 155 potential participants responded to the survey. The mean score on the Sense of Belonging Survey was 74%, a positive finding suggesting that many participants feel that they 'belong' in the classroom. Three overarching themes were identified in response to the open‐ended questions: factors supporting students' sense of belonging, factors hindering students' sense of belonging and strategies for faculty, administrators and students to increase a sense of belonging. Conclusion: Understanding the factors that contribute to or hinder nursing students' sense of belonging during this transition will assist in developing strategies to mitigate challenges, foster a positive learning environment and enhance the overall sense of belonging among nursing students. Impact: The first year of a nursing programme is crucial for student retention as students require tailored programmes and strategies to support their success. Examining and analysing the transition from online to in‐person classroom settings is crucial to identifying strategies to enhance and support first‐year students' sense of belonging and academic success. Exploring nursing students' experiences of belonging during transitions contributes to a more inclusive and equitable educational experience, fostering an environment where all students can thrive and succeed. Patient or Public Contribution: Not applicable. [ABSTRACT FROM AUTHOR]

Aims: To assess the level of mental workload (MWL) of intensive care unit (ICU) nurses in performing different human‐machine tasks and examine the predictors of the MWL. Design: A cross‐sectional questionnaire study. Methods: Between January and February 2021, data were collected from ICU nurses (n = 427) at nine tertiary hospitals selected from five (east, west, south, north, central) regions in China through an electronic questionnaire, including sociodemographic questions, the National Aeronautics and Space Administration Task Load Index, General Self‐Efficacy Scale, Difficulty‐assessing Index System of Nursing Operation Technique, and System Usability Scale. Descriptive statistics, t‐tests, one‐way ANOVA and multiple linear regression models were used. Results: ICU nurses experienced a medium level of MWL (score 52.04 on a scale of 0–100) while performing human‐machine tasks. ICU nurses' MWL was notably higher in conducting first aid and life support tasks (using defibrillators or ventilators). Predictors of MWL were task difficulty, system usability, professional title, age, self‐efficacy, ICU category, and willingness to study emerging technology actively. Task difficulty and system usability were the strongest predictors of nearly all typical tasks. Conclusion: ICU nurses experience a medium MWL while performing human‐machine tasks, but higher mental, temporal, and effort are perceived compared to physical demands. The MWL varied significantly across different human‐machine tasks, among which are significantly higher: first aid and life support and information‐based human‐machine tasks. Task difficulty and system availability are decisive predictors of MWL. Impact: This is the first study to investigate the level of MWL of ICU nurses performing different representative human‐machine tasks and to explore its predictors, which provides a reference for future research. These findings suggest that healthcare organizations should pay attention to the MWL of ICU nurses and develop customized management strategies based on task characteristics to maintain a moderate level of MWL, thus enabling ICU nurses to perform human‐machine tasks better. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Workplace violence is a significant challenge in psychiatric hospital care.Some existing practices of violence risk assessment and management are based on nurses' intuition and clinical experience instead of structured tools. What the paper adds to existing knowledge: Nurses and nurse managers consider violence risk assessment and management their responsibility. Still, nurses and nurse managers have mixed attitudes towards the use of validated risk assessment tools.The attitudes towards service users' positive risk‐taking in nurses and nurse managers vary, with some nurses and nurse managers supporting its importance. What are the implications for practice: Change in nurses' and nurse managers' attitudes towards risk assessment tools is required before their implementation into practice.More profound change in practices towards recovery‐oriented care is required also in risk assessment. Introduction: Workplace violence is a prevalent issue in psychiatric inpatient care. Prevention efforts require the identification of at‐risk service users using validated violence risk assessment tools. The shift in violence prevention emphasises preventive measures and collaborative risk assessment together with service users. Nurses have a central role in this process. Therefore, their attitudes are crucial when implementing evidence‐based methods. Aim: To assess the attitudes of nurses and nurse managers towards violence risk assessment and management. Method: A cross‐sectional online survey in Finnish psychiatric inpatient care. Data analysis was conducted with statistical methods. The STROBE guideline was used in reporting. Results: Nurses (n = 142) valued risk assessment and felt that it was their responsibility. Attitudes towards service users' risk‐taking as part of their recovery varied. Nurses had mixed attitudes regarding the effectiveness of risk assessment tools. Older participants and nurse managers had more positive attitudes towards risk assessment tools. Discussion: The study findings highlight a feeling of responsibility of nurses towards violence risk assessment and at the same time their preference towards their own clinical judgement. Implications for Practice: Understanding nurses' attitudes is crucial in training and implementation processes to address concerns, provide support and enhance positive attitudes. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Secondary traumatic stress (STS) is the indirect traumatisation of a person through the stress of helping or knowing about other's trauma. Burnout is gradual exhaustion in response to long‐term work‐related stress. Both have negative psychological, physiological and/or organisational consequences; however, the existing research in forensic health care professionals (FHCPs) is limited.One study explored STS in FCHPs and found that lower psychological flexibility (ability to adapt) was a predictor of greater STS. Existing research on burnout in FHCPs suggests that individual differences, such as the ways in which we cope (talking to people vs. using substances), may predict burnout levels. What the paper adds to existing knowledge: Prevalence findings add to the recent evidence base, which also found moderate levels of burnout. However, this study is the first to find high levels of secondary traumatic stress in FHCPs.Similar to existing literature, the study's findings suggest that FHCP's with lower levels of psychological flexibility and more maladaptive coping strategies may experience greater STS and burnout symptoms, while staff who use more adaptive coping strategies may experience less burn‐out.Unexpectedly, staff who reported a more anxious attachment style were burnt‐out; however, there are limitations to this finding. What are the implications for practice: Policies and practices in forensic settings should reflect the risk of STS and burnout.Practices or interventions should enhance adaptive coping strategies and psychological flexibility, such as Resilience Enhancement Programmes or Acceptance and Commitment Therapy (ACT). Introduction: Secondary traumatic stress (STS) and burnout literature in inpatient forensic health care professionals (FHCPs) is limited, despite the psychological, physiological and organisational consequences. Aims: This study aimed to further this limited evidence base, investigating predictors of STS and burnout in FHCPs. Method: 98 healthcare professionals working in two UK forensic inpatient settings completed measures assessing: burnout, STS, psychological flexibility, coping style, attachment style and a demographic questionnaire recording length of service and the sex of staff. Results: Results indicated high STS and moderate burnout levels. The main predictors of STS and burnout were poorer psychological flexibility and greater maladaptive coping styles, whereas lower burnout was predicted by greater adaptive coping styles and an anxious attachment style. Discussion: This study has contributed towards a limited evidence base and indicates poorer psychological flexibility and greater maladaptive coping may be risk factors for STS and burnout in FHCPs, whereas greater maladaptive coping may be a protective factor. Implication for Practice: The findings suggest that interventions such as Acceptance and Commitment Therapy (ACT) and coping skills interventions, may offer protective benefits to inpatient forensic healthcare professionals. [ABSTRACT FROM AUTHOR]

Accessible summary: What Is Known about the Subject?: Nurses' perspectives and consensus on the possible key factors contributing to aggression at inpatient units can be summarized into patients' related factors, staff related factors and environment related factors.Results of the possible factors contributing to aggression at inpatient units reflect the complicated nature of this problem. What the Paper Adds to Existing Knowledge: Perspectives of nurses as frontline mental health professionals on factors contributing to aggression as one of the psychiatric emergencies were considered through an iterative process. This approach gave nurses an opportunity to revisit their own views in each round to provide an in‐depth reflection in the light of the contribution of others. What Are the Implications for Mental Health Nursing Practice?: Nursing curricula should focus on nurses' communication skills and emotion regulation training.An open dialogue between nurses and people with mental health issues should be initiated to discuss the possible key factors contributing to aggressive behaviour at inpatient units from both standpoints.Mental health nurses' turnover at inpatient settings could be targeted through the design and implementation of aggression prevention protocols Introduction: Aggression at inpatient units is a universal problem leading to hazardous outcomes. Aim: To generate group consensus about factors contributing to aggressive behaviour among patients with mental health issues at inpatient units. Methods: Nurses working at inpatient psychiatric departments were approached, and purposive sampling was employed to implement Delphi technique. A total of three Delphi rounds were conducted online. The average percent of majority opinions method was followed to measure consensus in which questions with a cut‐off rate below 69.7% were included in the next round. Results: Twenty‐one nurse experts with different skills participated in this study. Consensus increased among nurse experts across rounds for the following items: Patients' misinterpretation of the attitude of the healthcare providers, severity of mental health issues, attitude and communication style of the healthcare providers, nurses limited emotional regulation capacity and the inadequate staff–patient ratio in psychiatric wards. Discussion: The complicated nature of aggressive behaviour displayed by people with mental health issues is reflected on the results of the current study; patients' related factors, staff related factors and environment related factors constitute interacting facets for this issue. Implications for Mental Health Nurses: Nurse scientists could use insights derived from this study to design studies aiming at assessment and management of aggression at inpatient units guided by implementation science frameworks. Additionally, open dialogues between nurses and people with mental health issues could be initiated about factors contributing to aggression at inpatient units. Mental health nursing training should focus on nurses' communication and emotion regulation skills. [ABSTRACT FROM AUTHOR]

Aims: Based on the two‐factor model of caregiving appraisals, this study aims to (1) investigate the relationships between competence in dementia care and job satisfaction (work attitudes in positive aspect) and turnover intention (work attitudes in negative aspect) among formal caregivers in nursing homes, and (2) examine the mediating roles of positive aspects of caregiving (caregiving appraisals in positive aspect) and caregiving burden (caregiving appraisals in negative aspect) in the above associations. Design: A cross‐sectional design was used. Structural equation modelling was employed to test the proposed model. STROBE checklist guides the reporting of this study. Methods: Using the multistage cluster sampling method, 407 formal caregivers were selected from 43 nursing homes across 7 districts/counties in China. Results: The proposed model shows a good model fit. Competence in dementia care shows significant positive associations with increased job satisfaction and decreased turnover intention among formal caregivers in nursing homes. Caregiving burden and positive aspects of caregiving mediate the relationships between competence in dementia care and both job satisfaction and turnover intention. Furthermore, the relationship between positive aspects of caregiving and job satisfaction is stronger than that with turnover intention, but the relationship between caregiving burden and turnover intention is not stronger than that with job satisfaction. Conclusions: The results demonstrate that the two‐factor model of caregiving appraisals effectively elucidates the associations and underlying mechanisms between competence in dementia care and formal caregivers' work attitudes. Specifically, two crucial conclusions are drawn: (1) competence in dementia care is associated with higher levels of job satisfaction and lower levels of turnover intention among formal caregivers in nursing homes; (2) caregiving burden and positive aspects of caregiving serve as parallel mediators in these associations. Implications for the Profession and/or Patient Care: Policymakers and nursing homes managers should implement a series of measures aimed at formal caregivers in nursing home. Specifically, allocating more resources to enhance the competence in dementia care of formal caregivers is crucial, given its significant association with elevated job satisfaction and reduced turnover intention. Besides, positive and negative caregiving appraisals emerge as proximal factors influencing work attitudes of formal caregivers. Therefore, intervention projects focused on formal caregivers in nursing home should target enhancing positive experiences and alleviating caregiving burden. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore the mediating effect of self‐management (SM) on the relationship between illness perception and quality of life (QOL) among Human immunodeficiency virus (HIV)‐positive men who have sex with men (MSM). Design: A cross‐sectional study. Methods: We explored the effect of illness perception and self‐management on QOL using the multiple regression model. Moreover, we conducted a simple mediation analysis to examine the role of SM in the relationship between illness perception and QOL. In addition, a parallel mediation analysis was performed to investigate the differences in domains of SM on the relationship between illness perception and QOL. Results: Among 300 Chinese HIV‐positive MSM, the mean score of SM was 39.9 ± 6.97, with a range of 14.0–54.0. The higher score in SM indicated a higher level of HIV SM. SM was negatively related to illness perception (r = −0.47) while positively related to QOL (r = 0.56). SM partially mediated the relationship between illness perception and QOL, accounting for 25.3% of the total effect. Specifically, both daily self‐management health practices and the chronic nature of the self‐management domain played a parallel role in mediating the relationship between illness perception and QOL. Conclusion: Our study demonstrated that SM was a significant factor influencing QOL among HIV‐positive MSM. Focusing on daily self‐management health practices and the chronic nature of self‐management could be the potential key targets for enhancing HIV self‐management strategies. Implications for the Profession and/or Patient Care: This study emphasized the role of SM in the well‐being of HIV‐positive MSM and underscored the importance of developing interventions that integrate SM strategies to improve QOL in this population. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a chronic disease that consumes considerable medical resources. Aim: The aim of this study is to evaluate a model able to develop and assess the effectiveness of a mobile application disease self‐management programme regarding mental health and self‐management for patients with hypertension. Methods: A randomised controlled trial and single‐blind random assignment was employed to group the participants. A total of 100 patients were collected from the cardiology clinic of a teaching hospital in Taiwan. There were 50 participants in each group: the mobile application group (experimental group) and the routine care (control group). The primary outcome measures were mental health and self‐management. Results: This study discovered that the intervention improved the mental health and self‐management of the experimental group. The results for the experimental group revealed significantly improved effects and outcomes superior to those of the control group. Conclusions: The study results verified that a mobile application disease self‐management programme could improve the mental health and disease self‐management of patients with hypertension. Summary Statement: What is already known about this topic? Hypertension is a chronic disease that consumes considerable medical resources.Disease self‐management programmes have been successfully applied for many patients with chronic diseases and have been verified to provide benefits, such as effectively changing and maintaining the health behaviours of patients, reducing medical costs and increasing quality of life. What this paper adds? The mobile application disease self‐management programme is verified to improve the mental health of patients with hypertension.The mobile application disease self‐management programme can effectively improve the disease self‐management of patients with hypertension, and this improvement is superior to that achievable with usual care. The implications of this paper: This study may serve as a reference for nursing personnel for developing unconventional health education programmes.A mobile application disease self‐management programme improved the mental health and disease self‐management of patients with hypertension. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to determine the effect of web‐designed education developed for asthma patients on drug adherence, asthma control and fatigue. Methods: This randomized controlled trial was conducted between August 2021 and January 2022 with 200 individuals suffering from poor asthma control who participated in web‐designed education. After the intervention, the asthma patients were followed up for 6 weeks to measure Medication Adherence Report Scale (MARS), Chronic Obstructive Pulmonary Disease and Asthma Fatigue Scale (CAFS), Asthma Control Test (ACT) and Inhalation Devices Usage Techniques Knowledge Test (IDUSTKT). Data were analysed in the Statistical Package for the Social Sciences program using the Chi‐square test, Independent t‐test, Man–Whitney U test, Wilcoxon test, Paired t‐test, Greenhouse–Geisser (F) test and Linear regression. Results: The web‐designed education had a statistically significant effect on the total scores of CAFS, ACT and IDUSTKT for individuals with asthma (p < 0.001). This intervention decreased fatigue levels, improved asthma control and enhanced knowledge of inhalation device usage techniques. Although there was an improvement in medication adherence, this difference was not statistically significant. Conclusion: These results suggest that web‐based educational programs can be an effective tool in asthma management and may improve patients' quality of life. Future research should examine the long‐term effects of such educational programs and their effectiveness across different demographic groups in more detail. Summary statement: What is already known about this topic? Asthma is a common public health problem, and it affects individuals' physical and social lives.There are some studies in the literature on the prevalence and treatment of asthma, but there are few studies on web‐based training and counselling programs. What this paper adds? This study demonstrates that web‐designed asthma education and counselling programs can improve asthma control, fatigue levels, inhalation device usage techniques knowledge and some accompanying problems in patients with asthma. The implications of this paper: Health personnel and administrators should be aware of the potential benefits of web‐designed asthma education and can recommend the implementation of the program.A web‐designed approach helps to reach patients who do not want to participate in a traditional asthma education program. [ABSTRACT FROM AUTHOR]

Aim: This study has aimed to assess the effectiveness of the transitional care model (TCM) on functional status, perceived self‐efficacy and healthcare utilization in patients undergoing total knee arthroplasty (TKA). Method: This randomized controlled study was conducted between February and November 2021 in a public hospital. The study randomly assigned patients to either a 6‐week 'TCM' program or usual care. The sample size was n = 70, with each group comprising 35 individuals. Patient outcomes, including self‐efficacy, functional status and healthcare service readmission rates, were monitored for TKA patients. Results: Nursing care based on the 'TCM' was found to enhance functional status and increase the level of self‐efficacy among TKA patients, leading to a decrease in healthcare service readmissions. Conclusions: The study recommends preparing patients and their families for the preoperative and postoperative processes. It emphasizes the importance of providing necessary training and consultancy services under the leadership of orthopaedic nurses responsible for TKA patient care, guided by the principles of TCM. Summary statement: What is already known about this topic? Treatment for knee osteoarthritis aims to alleviate pain, maintain joint functions and improve the quality of life.The success of transitional care relies on effective hospital discharge planning, post‐discharge follow‐up and home support to reduce adverse events. What this paper adds? Patients receiving TCM demonstrated improved outcomes and reduced healthcare service readmission rates.Nursing care based on the transitional care model positively affected the functional status of TKA patients.TCM increased patients' self‐efficacy levels. The implications of this paper: Patient training and consultancy services should be led by nurses responsible for TKA patients, guided by the principles of TCM.TCM should serve as a valuable guide for nurses when planning care for TKA patients. [ABSTRACT FROM AUTHOR]

Aim: To determine patients', nurses' and researchers' opinions on the appropriateness and completeness of the proposed conceptualization of nurses' support of hospitalised patients' self‐management. Design: A modified Delphi study. Methods: We conducted a two‐round Delphi survey. The panel group consisted of patients, nurses and researchers. The conceptualization of nurses' support of hospitalised patients' self‐management presented in the first Delphi round was based on previous research, including a scoping review of the literature. Data was analysed between both rounds and after the second round. Results are reported in accordance with the guidance on Conducting and Reporting Delphi Studies (CREDES). Results: In the first round all activities of the proposed conceptualization were considered appropriate to support the patients' self‐management. Panel members' comments led to the textual adjustment of 19 activities, the development of 15 new activities, and three general questions related to self‐management support during hospitalisation. In the second round the modified and the newly added activities were also deemed appropriate. The clarification statements raised in the first Delphi round were accepted, although questions remained about the wording of the activities and about what is and what is not self‐management support. Conclusion: After textual adjustments and the addition of some activities, the proposed conceptualization of nurses' support in patients' self‐management while hospitalised have been considered appropriate and complete. Nevertheless, questions about the scope of this concept still remains. The results provide a starting point for further discussion and the development of self‐management programs aimed at the hospitalised patient. Implication for the profession and/or patient care: The results can be considered as a starting point for practice to discuss the concept of nurses' support for hospitalised patients' self‐management and develop, implement and research self‐management programs specific for their patient population. Reporting Method: Results are reported in accordance with the guidance on Conducting and Reporting Delphi Studies (CREDES). Patient or Public Contribution: Patients were involved as expert panellist in this Delphi study. Impact statementWhat problem did the study address?Self‐management support during hospitalisation is understudied, which undermines the development of evidence‐based interventions.What were the main findings?A panel, consisting of patients, nurses and researchers, agreed on the appropriateness of a conceptualization of nurses' support of inpatients' self‐management, and identified some points for discussion, mainly related to the boundaries of the concept self‐management.Where and on whom will the research have an impact?This study is crucial for generating conceptual understanding of how nurses support patients' self‐management during hospitalisation. This is necessary for policy, clinical practice, education, and research on this topic. [ABSTRACT FROM AUTHOR]

Aim: To develop and psychometrically test the triage decision‐making instrument, a tool to measure Emergency Department Registered Nurses decision‐making. Design: Five phases: (1) defining the concept, (2) item generation, (3) face validity, (4) content validity and (5) pilot testing. Methods: Concept definition informed by a grounded theory study from which four domains emerged. Items relevant to the four domains were generated and revised. Face validity was established using three focus groups. The target population upon which the reliability and validity of the triage decision‐making instrument was explored were triage registered nurses in emergency departments. Three expert judges assessed 89 items for content and domain designation using a 4‐point scale. Psychometric properties were assessed by exploratory factor analysis, following which the names of the four domains were modified. Results: The triage decision‐making instrument is a 22‐item tool with four factors: clinical judgement, managing acuity, professional collaboration and creating space. Focus group data indicated support for the domains. Expert review resulted in 46 items with 100% agreement and 13 with 66% agreement. Fifty‐nine items were distributed to a convenience sample of 204 triage nurses from six hospitals in 2019. The Kaiser–Meyer–Olkin measures indicated that the data were sufficient for exploratory factor analysis. Bartlett's test indicated patterned relationships among the items (X2 (231) = 1156.69). An eigenvalue of >1.0 was used and four factors explained 48.64% of the variance. All factor loadings were ≥0.40. Internal consistency was demonstrated by Cronbach's alphas of.596 factor 1,.690 factor 2,.749 factor 3 and.822 for factor 4. Conclusion: The triage decision‐making instrument meets the criteria for face validity, content validity and internal consistency. It is suitable for further testing and refinement. Impact: The instrument is a first step in quantifying triage decision‐making in real‐world clinical environments. The triage decision‐making instrument can be used for targeted triage interventions aimed at improving throughput and staff education. Statistical Support: Dr. Tak Fung who is a member of the research team is a statistician. Statistical Methods: Development, validation and assessment of instruments/scales. Descriptive statistics. Reporting Method: STROBE cross‐sectional checklist. Implications for the Profession and/or Patient Care: The TDI makes the complexity of triage decision‐making visible. Identifying the influence of decision‐making factors in addition to acuity that affect triage decisions will enable nurse managers and educators to develop targeted interventions and staff development initiatives. By extension, this will enhance patient care and safety. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to gain a better understanding of nursing/midwifery students' perspectives on a pedagogy of caring and online learning during the COVID‐19 pandemic. In addition, it aimed to determine if the COVID‐19 pandemic impacted students' perceptions and experience of online learning and students' desire to enter the nursing/midwifery workforce. Design: Mixed methods. Methods: A multi‐centre cross‐sectional survey of Australian nursing and midwifery students was undertaken to explore students' experience of learning during the COVID‐19 pandemic. Results: There are several key findings from this study that may be relevant for the future delivery of undergraduate health education, students transitioning to practice and healthcare workforce retention. The study found that although students were somewhat satisfied with online learning during COVID‐19, students reported significant issues with knowledge/skill acquisition and barriers to the learning process. The students reported feeling less prepared for practice and identified how clinical staff were unable to provide additional guidance and support due to increased workloads and stress. The textual responses of participants highlighted that connection/disconnection, empathy and engagement/disengagement had an impact on learning during COVID‐19. Conclusion: Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. In addition, graduates entering the workforce felt less prepared for entry into practice due to changes in education delivery during COVID‐19 that they perceived impacted their level of clinical skills, confidence and ability to practice as new graduate nurses/midwives. Patient or Public Contribution: Not applicable. Impact: Attention must be given to the transition of new graduate nurses and midwives whose education was impacted by pandemic restrictions, to support their professional career development and to ensure retention of future healthcare workforce.Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. Educators should consider how connection and engagement can be actively embedded in the online learning environment. [ABSTRACT FROM AUTHOR]

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

Aim: To explore the feasibility of development and implementation of an educational intervention addressing sexual and gender minority healthcare issues; examine recruitment processes and instrument appropriateness. Design: Non‐randomized feasibility study. Methods: The educational intervention was developed and implemented in family nurse practitioner courses with data collection from August through December 2022. Clinical preparedness, attitudinal awareness and basic knowledge were measured using the lesbian, gay, bisexual and transgender Development of Clinical Skills Scale. Results: Development and implementation of the intervention was feasible but will require amendment before progressing to the pilot study. Clinical preparedness and basic knowledge increased post‐intervention, but attitudinal awareness did not improve. Recruitment did not achieve the desired sample size. Instrument internal consistency reliability was confirmed. Conclusion: Feasibility was established but will require amendment prior to the pilot study. Implications for the Profession and/or Patient Care: To prepare nurses and nurse practitioners to care for sexual and gender minority patients. Impact: This study addressed the feasibility of developing and implementing a sexual and gender minority healthcare education using an e‐Learning platform. Findings confirm that the intervention was feasible but will require amendment. The intervention increased knowledge and clinical preparedness in caring for this population, but recruitment was challenging. This research will impact nurses, nurse practitioners and nurse educators. Reporting Method: The authors adhered to the relevant EQUATOR guidelines. The Consolidated Standards of Reporting Trials guideline extension for reporting randomized and feasibility guidelines were used. Public Contribution: Sexual and gender minority community members contributed to the intervention development. What Does this Paper Contribute to the Wider Global Clinical Community?: The feasibility of using interactive e‐learning educational resources to provide sexual and gender minority healthcare curriculum.Evidence to support the use of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale to measure learning outcomes. Trial Registration: This study was not prospectively registered because it was an educational intervention involving graduate student nurses and did not assess clinical outcomes of patients. [ABSTRACT FROM AUTHOR]

Aims: To investigate the relationships between depression symptoms, perceived stigma, disease severity, patient‐provider communication and medication adherence in fibromyalgia patients. The objectives were to explore how these factors influence treatment adherence and to develop a comprehensive model illustrating their interconnections. Background: Fibromyalgia is a chronic pain syndrome with fatigue, sleep issues and idiopathic pain. Medication adherence is limited by insufficient symptom relief, side effects and costs. Stigma further complicates fibromyalgia. Disease severity affects patient‐provider communication. Associations between depression, stigma, severity, communication and adherence in fibromyalgia are unclear. Design: A cross‐sectional, correlational study. Methods: The STROBE guidelines for cross‐sectional studies were followed. Participants included Hebrew‐speaking participants who were members of two Facebook groups: 'Shades of Purple' and 'Fibromyalgia‐ Get to Know!' Between February and April 2022. They undertook evaluations using The Patient Health Questionnaire‐9 to gauge depression symptoms, assessed perceived stigma, utilised The Revised Fibromyalgia Impact Questionnaire to determine disease severity, employed The Patient Reaction Assessment questionnaire for patient‐provider communication, and used the 8‐item Morisky Medication Adherence Scale (MMAS‐8). Associations between the variables were explored using Pearson's correlations and path analyses. Results: The study included 141 women with fibromyalgia, aged 22 to 76 years. Most reported having a stable partner (69.5%) and 75.2% had children. The treatment adherence levels were as follows: 53.2% (N = 75)—low, 33.3% (N = 47)—medium and 13.5% (N = 19)—high. Depression positively correlated with stigma. Stigma negatively correlated with patient‐provider communication. Patient‐provider communication positively correlated with treatment adherence. A significant negative indirect effect of depression on treatment adherence through stigma and patient‐provider communication was found. Conclusions: Perceived stigma and patient‐provider communication played a mediating role in the relationships between depression and treatment adherence among women with fibromyalgia. Relevance to Clinical Practice: Addressing stigma related to fibromyalgia and effective patient‐provider communication can positively influence treatment adherence. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To employ network analysis to identify the central healthcare service needs of people living with HIV (PLWH) for integrated care. Design: Cross‐sectional survey. Methods: A list of healthcare services was identified through literature reviews, expert workshops and validity evaluations by PLWH. A total of 243 PLWH participated at five hospitals and self‐reported their need for healthcare services on a four‐point Likert scale. Centrality of healthcare service needs was analysed using network analysis. Results: The mean score for 20 healthcare service needs was 3.53 out of 4. The highest scoring need, "Precaution for interaction between antiretroviral therapy and other drugs," received a rating of 3.73 but had a centrality of only 0.31. The most central node in the network of healthcare service needs, "Information and coping with opportunistic infections," had a strength centrality of 1.63 and showed significant relationships with "non‐HIV‐related medical services (e.g., health check‐ups)" and "Regular dental services." The correlation stability coefficient, which quantifies the stability of centrality, was 0.44 with an acceptable value. Conclusions: The most central need was information on opportunistic infections that had connections with many nodes in network analysis. By interpreting the relationships between needs, healthcare providers can design interventions with an integrative perspective. Implications for Patient Care: Network visualization provides dynamic relationships between needs that are unknown from the score scale by presenting them graphically and qualitatively. Impact: Using network analysis to interpret need assessment offers an integrated nursing perspective. Coping with opportunistic infection is central to connecting the chain of healthcare. This study highlights the multifaceted understanding of patients' needs that nurses gain when they conduct network analysis. Reporting Method: We adhered to the STROBE checklist. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: This research aimed to determine the impact of problematic mobile phone use on negative mental health outcomes among nursing students in India, highlighting the necessity for targeted interventions and support mechanisms to enhance the overall well‐being and adaptability of future healthcare professionals. Methods: A cross‐sectional survey was conducted in three randomly selected nursing colleges in South India, employing validated and standardized tools such as the Mobile Phone Problematic Use Scale, Patient Health Questionnaire, Insomnia Severity Index Scale, Satisfaction with Life Scale and Rosenberg Self‐Esteem Scale. Results: The study included 402 nursing students with an average age of 20.47 years, revealing a 39% prevalence of severe problematic mobile phone usage. Positive correlations were observed between mobile phone problematic use and age, depression and insomnia. Additionally, strong negative correlations were found between satisfaction with life and self‐esteem. Depression and satisfaction with life served as chain mediators in the impact of self‐esteem on problematic mobile phone use, and both self‐esteem and satisfaction with life negatively predicted problematic mobile phone use. Conclusion: The study highlights a prevalent issue of problematic mobile phone use among nursing students, indicating a pressing need for timely intervention, as it correlates with depression, sleep insomnia, low self‐esteem and life dissatisfaction. Summary statement: What is already known about this topic? Over the last decade, using mobile phones has been prevalent among today's children and young people, coinciding with an increase in poor mental health in this population.Problematic mobile phone use may consist of various issues, including addiction/dependence, financial troubles, risky use (i.e. while driving) and restricted use (i.e. in prohibited places).From an epidemiological standpoint, prevalence rate estimates vary widely and there is little research and understanding regarding the aetiology of problematic and addicted mobile phone usage, particularly its progression. What this paper adds? The prevalence of severe problematic mobile phone use among nursing students is very high and needs immediate attention.There is a negative impact of mobile phone use on the mental health outcomes of nursing students.Positive life satisfaction and self‐esteem are protective variables that negatively predict problematic mobile phone use, while their influence is mediated by a chain reaction involving reduced depression, emphasizing the interconnected psychological dynamics. The implications of this paper: Further research is needed on the influencing factors of problematic mobile phone use and interventions to prevent mobile phone addiction among nursing students.The influence of mobile phone use on the mental health outcomes of nursing students can affect their clinical practice and productive life therefore the appropriate policies should be implemented.Implementation of short and rapid counselling services for the nursing students by the nurse educators should incorporate into the curriculum to achieve a better quality of nurses. [ABSTRACT FROM AUTHOR]

Aim: This cross‐sectional multicentre study aimed to determine the effect of interventions during vaginal birth for fear of childbirth. Methods: In this cross‐sectional and analytical study, 852 women who had a vaginal birth between 2019 and 2020 were enrolled. Data were collected using the Descriptive Questionnaire and Wijma Birth Expectation/Experience Scale Version B. Results: The mean total Wijma Birth Expectation/Experience Scale Version B score of the women was 97.00 ± 24.24, indicating severe and clinical levels of fear of childbirth. Moreover, 69.4% of the women had clinical, 18.6% had severe and 12% had moderate levels of fear of childbirth. During birth, women who had close supporters, who were allowed to move and who did not undergo amniotomy, enema, perineal shaving and electronic foetal monitoring had a low level of fear of childbirth. As the number of pregnant women in the labour room, frequency of vaginal examinations, duration of delivery/hour, severity of labour pain and negative perception of the approach of health professionals increased, the women's fear of childbirth increased. Fear of childbirth decreased as the frequency of antenatal follow‐ups, number of births and satisfaction levels of the women increased (p < 0.05). Low income perception, irregular prenatal follow‐up, severe labour pain and a long duration of labour were strong predictors of increased fear of childbirth. Increasing number of births, high birth satisfaction level and positive perception of the approach of health professionals were strong predictors of reduced fear of childbirth. Conclusions: The reduction of interventions in vaginal delivery and support from health care providers during delivery can be effective in reducing fear of childbirth. Summary statement: What is already known about this topic? Fear of childbirth (FOC) is a problem experienced by most women.Sociodemographic characteristics and past experiences can increase FOC.Birth interventions are common as the majority of births in Turkey take place in health institutions. What does this paper add? Women who have vaginal births appear to have severe and clinical levels of fear of childbirth. Multiparity, mobilization, high birth satisfaction and positive approaches by health care providers are strong predictors of reduced FOC.Enema, amniotomy and fundal pressure application, high‐intensity labour pain and a long duration of labour are strong predictors of increased FOC. The implications of this study: Many current routine interventions during childbirth should be avoided.The reduction of interventions in vaginal birth and support from health professionals during labour can be effective in reducing fear of childbirth and negative consequences related to FOC, as well as helping to achieve non‐invasive vaginal deliveries.It is recommended that hospitals be organized in line with the criteria of mother‐friendly hospitals, health professionals be trained and the environments in which women give birth be improved. [ABSTRACT FROM AUTHOR]

Aim: This study intends to investigate whether, how and when service‐oriented high‐performance work systems (SHPWSs) drive nurses' extra‐role service behaviour. Design: This was a quantitative cross‐sectional study conducted with matched nurse–patient participants. Method: We tested hypotheses using data from 284 nurses and their matched 566 patients. The data were collected in 2019. We conducted a set of hierarchical regression analyses to test our hypotheses. Results: The results showed that SHPWSs have a positive impact on job crafting, which, in turn, mediates the link between SHPWSs and extra‐role service behaviours. Additionally, the influence of professional identification moderates these relationships. Specifically, SHPWSs are significantly and positively associated with job crafting among highly professionally identified nurses. The indirect effect is significantly positive when nurses strongly identify with their profession but not significant when their professional identification is low. Conclusion: The results indicated that SHPWSs can elicit job crafting among higher professional identifiers, which further increases extra‐role service behaviours towards patients. Impact: Our research emphasizes the significance of HRM themes in the healthcare service industry and their direct impact on healthcare personnel. Shifting from a management‐centric to an individual‐centric perspective, we focus on the proactive role of nurses. Furthermore, this study enhances the understanding of the boundary conditions for the effectiveness of SHPWSs. Patient or Public Contribution: Nurses and their mated patients from a Chinese hospital contributed to this study by completing the survey. [ABSTRACT FROM AUTHOR]

Objective: To analyse the influence of the COVID‐19 pandemic and the perception of self‐efficacy on the health professionals of the Spanish out‐of‐hospital emergency services. Design: Observational, cross‐sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February–30 April, 2021). Methods: The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self‐efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self‐efficacy on mental health. Results: The means of the sample for stress, anxiety, depression and self‐efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self‐efficacy. Self‐efficacy had a direct effect on the mental health for working in patient care. Conclusions: Healthcare workers showed moderate stress, severe anxiety, mild depression and good self‐efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self‐efficacy is a determining factor of mental health in the direct care modality. Implications: The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out‐of‐hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self‐efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk. Reporting Method: We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros ‐ ASISA Foundation (Spain). Patient or Public Contribution: 'No patient or public involvement'. [ABSTRACT FROM AUTHOR]

Aim s : The objective of this study was to examine the relationship between caregiving burden and pre‐death grief, with a specific focus on adult‐child caregivers in mainland China. Additionally, the study explored whether coping strategies played a mediating role in this correlation. Methods: A convenience sample of 320 adult‐child caregivers of older parents with dementia from Kunming, mainland China, was recruited for the study. Data were collected using the Chinese version of the Marwit‐Meuser Caregiver Grief Inventory‐Short Form, the Burden Scale for Family Caregivers, and the Ways of Coping Checklist‐Revised. Results: Results using linear regression and multiple mediation analysis with Hayes' process model indicated that caregiving burden was positively related to pre‐death grief and that active coping mediated the relationship between them. In the female group, active coping partially mediated the association between caregiving burden and pre‐death grief, but in the male group, this mediating effect did not exist. Conclusion: The study found evidence supporting the link between caregiving burden and pre‐death grief among adult‐child caregivers of older parents with dementia in mainland China. Furthermore, the caregiving burden prevented the use of active coping, and this decrease in coping increased the perception of pre‐death grief. These associations only existed in the female group. Implications: This paper presented the importance of active coping skills in the dementia caregiving process. Impact: The findings of this study emphasize the necessity for health practitioners to provide targeted interventions regarding pre‐death grief among dementia caregivers and strengthen caregivers' active coping strategies to reduce their pre‐death grief. Community‐based and personal care support services should be promoted to alleviate their caregiving burden. Reporting Method: We have adhered to the transparent reporting of evaluations with quantitative design statements and the corresponding checklist was followed. Patient or Public Contribution: 'No patient or public involvement'. [ABSTRACT FROM AUTHOR]

Aims and Objective: To investigate the determinants of missed nursing care and to analyse the mediating effect of holistic nursing competence on the relationship between transition shock and missed nursing care. Background: Transition shock of newly graduated nurses is associated with missed nursing care. Previous studies have shown the determinants of missed nursing care among nurses, but little is known about the relationship between missed nursing care, transition shock and holistic nursing competence. Design: Descriptive and correlational design. Methods: The study was conducted among newly graduated nurses (n = 201) working in acute care hospitals for 1–12 months. The MISSCARE survey, Holistic Nursing Competence Scale and Nursing Transition Shock Scale were used for data collection, in addition to a sociodemographic question form. Data were analysed using Pearson correlation, multiple regression and mediation analyses. The study was reported following the STROBE checklist. Results: The determinants of missed nursing care among newly graduated nurses were sex, unit type, rotating shift work, holding a certificate, holistic nursing competence and transition shock. All these variables explain 35% of the variance in missed nursing care. Holistic nursing competence directly mediated 51.7% of the relationship between transition shock and missed nursing care. Conclusions: Holistic nursing competence may decrease missed nursing care by reducing the effects of transition shock on newly graduated nurses. Relevance to Clinical Practice: The study highlighted that newly graduated nurses are an important population regarding missed nursing care. The determinants of missed care should be considered in the nursing care delivery to prevent missed care by newly graduated nurses. Based on the study findings, some recommendations were made for nurse managers and faculty for the orientation program and undergraduate nursing education. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: Loneliness is common among young and middle‐aged stroke survivors. It not only hinders the recovery of their neurological and physical functions but also increases the risk of stroke recurrence, disability, and even death.Improving the mental health of young and middle‐aged stroke survivors is of utmost importance. However, previous research has not yet investigated the impact of interpersonal sensitivity and resilience on the relationship between stigma and feelings of loneliness. What the paper adds to existing knowledge?: This study confirms that stigma has a positive impact on loneliness among young and middle‐aged stroke survivors.Interpersonal sensitivity partially mediates the relationship between stigma and loneliness, and resilience plays a moderating role in the mediating mechanism. What are the implications for practice?: Mental health nurses can formulate nursing interventions to reduce loneliness of young and middle‐aged stroke survivors with the goals of improving stigma, reducing interpersonal sensitivity and cultivating resilience. Introduction: Previous studies have not explored the impact of interpersonal sensitivity and resilience on the relationship between stigma and loneliness. However, improving the resilience of young and middle‐aged stroke survivors and increasing their social participation is of great significance for reducing patients' loneliness of patients and promoting their physical and mental rehabilitation. Aims: To investigate the influence of stigma, interpersonal sensitivity and resilience on loneliness among young and middle‐aged stroke survivors. Methods: A cross‐sectional design was used to collect data. A total of 330 participants completed measures of stigma, resilience, interpersonal sensitivity and loneliness. The descriptive statistical approach, Pearson's correlation analysis and Hayes' PROCESS Macro Model 4 and 7 in regression analysis were used to analyse the available data. Results: The results revealed that young and middle‐aged stroke survivors' stigma, resilience, interpersonal sensitivity and loneliness were significantly correlated between every two variables, with coefficients ranging between −0.157 and 0.682. Interpersonal sensitivity played a partial mediating role in stigma and loneliness, accounting for 63.27% of the total effect; This process was moderated by resilience. Discussion: Stigma positively predicts participants' loneliness. As a mediating mechanism with moderating, interpersonal sensitivity and resilience further explain how stigma affects loneliness. Implications for Practice: Understanding this mechanism is of guiding significance to reduce loneliness of young and middle‐aged stroke patients and promote their physical and mental rehabilitation. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Children and adolescents' mental health problems, such as autism spectrum disorder, anxiety disorder and attention‐deficit hyperactivity disorder, are a global public health concern, and nurses require advanced expertise and skills to properly care for this population.There is a gap between the required competencies and the actual skills and knowledge of CAMHN practitioners. Previous studies suggest that educational interventions for nurses are necessary to enhance the quality of care for children and adolescents with mental health problems. However, the corresponding evaluation indicators have not been verified, making it difficult to determine the most effective methods. What this paper adds to existing knowledge?: The present study developed the two‐factor (direct care for children and their family members and approach to the care environment) Clinical Competency Assessment Scale in Child and Adolescent Mental Health Nursing (CCAS‐CAMHN).We demonstrated that the assessment scale was reliable and valid, based on its adequate internal consistency and temporal stability, the acceptable range of its model‐fit indexes, and its good concurrent and divergent validity. What are the implications for practice?: The newly developed scale is useful for assessing nurses' competency and could help them identify their difficulties in CAMHN.The scale could contribute to the development of effective educational interventions to enhance the quality of care for children and adolescents with mental health problems. Introduction: Caring for children and adolescents with mental health problems, such as autism spectrum disorder, anxiety disorder and attention‐deficit hyperactivity disorder, requires expertise and skills. A quantitative clinical competency measurement tool in child and adolescent mental health nursing (CAMHN) is needed to evaluate the indicators of advanced expertise. Aim: The aim of this study was to develop a clinical competency assessment scale in CAMHN and evaluate its psychometric properties. Method: Scale items were derived from previous studies and adjusted based on cognitive interviews with five CAMHN experts. In total, 505 nurses in CAMHN from 29 hospitals in Japan participated in the self‐administered survey. The scale's construct validity, criterion‐related validity, internal consistency and test–retest reliability were assessed. Results: A two‐factor (direct care for children and their family members and approach to the care environment) scale was constructed. A secondary structural model showed that a two‐factor model fits best. The total score was significantly and positively correlated with excellence in nursing practice, amount of clinical experience and mental status. The overall scale exhibited good validity and reliability. Discussion: The scale is reliable and valid for assessing CAMHN clinical competency. Implications for Practice: The scale is useful for assessing nurses' competency and evaluating educational interventions' effectiveness for nurses. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Restraining and secluding health consumers for safety reasons continue to be used in psychiatric inpatient facilities even though they have no therapeutic value and have negative effects on consumers, families and staff.Six Core Strategies (6CS) for reducing seclusion and restraint have been developed to address this problem but there are very few effectiveness studies in inpatient adolescent psychiatric facilities. What the paper adds to existing knowledge: We used a mixed methods approach to evaluate the implementation of 6CS in an adolescent psychiatric facility. The implementation was successful. It eliminated the use of seclusion, substantially reduced the use of restraints and significantly reduced staff absenteeism.Using thematic analysis on feedback surveys, we identified five dominant themes that described consumers' and carers' experiences during their stay at the facility: communication, service delivery, flexibility, consistency and internal feeling states. What are the implications for practice: This study provides support for the feasibility of a comprehensive and broad‐based intervention program such as 6CS to reduce seclusion and restraint practices in inpatient mental health facilities.This study also demonstrates the value of using surveys to gather consumer and carer feedback and improve outcomes for service users. Introduction: Seclusion and restraint practices are routinely used in psychiatric facilities but are controversial for ethical, legal and safety reasons, and can cause significant harm to consumers, staff and organisations. Six Core Strategies (6CS) for reducing seclusion and restraint were developed to address this problem but very few studies have examined their effectiveness in adolescent settings. Aim/Question: To evaluate the implementation of 6CS in an adolescent inpatient psychiatric facility. Method: We retrieved archival data from an acute adolescent psychiatric ward that implemented the 6CS. Using a mixed methods approach, we evaluated outcomes on the use of seclusion and restraint, nursing staff sick leave and feedback surveys. Results: Findings showed an elimination of seclusion, and a significant reduction in restraint use and staff absenteeism in the 12 months after project implementation. Thematic analysis of feedback survey responses identified communication, service delivery, flexibility, consistency and internal feeling states as dominant themes in consumers' and carers' experience on the unit. Discussion: The 6CS is feasible and may be effective in reducing seclusion and restraint, which in turn may have a positive impact on staff wellbeing. Implications for Practice: Implementation of the 6CS with executive support, combined with staff and programmatic changes at a local level is recommended. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore the effects of compassion satisfaction and compassion fatigue on the posttraumatic growth of psychiatric nurses. Background: Psychiatric nurses' prolonged and repeated exposure to trauma and complex situations in the work environment can lead to negative emotions such as compassion fatigue, but they also experience positive consequences such as posttraumatic growth, and the relationship between compassion fatigue and posttraumatic growth is not unclear. Methods: A total of 336 nurses from psychiatry departments of seven tertiary hospitals in Sichuan Province, China, were administered an online questionnaire. Participants were recruited through convenience sampling. The posttraumatic growth level was measured with the Simplified Chinese version of the Posttraumatic Growth Inventory. The Professional Quality of Life Scale‐Chinese version was used to assess compassion satisfaction, burnout and secondary traumatic stress. T‐test and one‐way variance analysis, Pearson correlation analysis and hierarchical linear regression were used for data analysis. A STROBE checklist was used to guide the reporting of the research. Results: Psychiatric nurses' posttraumatic growth is at a low level, influenced by demographic and occupational factors, whereas compassion satisfaction, burnout and secondary traumatic stress are at a moderate level. Hierarchical regression analysis suggested that compassion satisfaction and secondary traumatic stress had a positive impact on posttraumatic growth, whereas burnout had a negative impact on posttraumatic growth. Conclusions: Findings suggest that nursing managers should attach importance to the mental health of psychiatric nurses, improve compassion satisfaction, alleviate burnout and promote posttraumatic growth. Summary statement: What is already known about this topic? Psychiatric patients generally have complex and special conditions, which makes psychiatric nursing work high‐risk and stressful, which often poses significant challenges for psychiatric nurses, such as compassion fatigue.There is a correlation between compassion satisfaction, compassion fatigue and posttraumatic growth among nurses. What this paper adds? Psychiatric nurses have low levels of posttraumatic growth and moderate levels of compassionate satisfaction, burnout and secondary traumatic stress, and posttraumatic growth is influenced by sleep hours per day, marital status, children and job satisfaction.Compassion satisfaction and secondary traumatic stress have a positive impact on posttraumatic growth of psychiatric nurses, whereas burnout has a negative impact on posttraumatic growth of psychiatric nurses. The implications of this paper: This study emphasizes that policy makers should clarify the relationship between posttraumatic growth, compassion satisfaction and compassion fatigue as soon as possible to support the rapid growth of psychiatric nurses in nursing work.This study provides a basis for nursing managers to explore and implement interventions to improve compassion satisfaction among psychiatric nurses, reduce burnout and promote personal psychological growth. [ABSTRACT FROM AUTHOR]

Background: While previous research has established that resilience is affected by various factors, these studies have primarily focussed on individual variables associated with resilience, without providing insights into how to influence the rate of change in resilience. Aim: To examine the trajectory of resilience and identify the factors associated with changes in resilience among spousal caregivers of patients with newly diagnosed advanced cancer receiving treatment during the first 6 months. Design: An observational longitudinal study. Methods: A total of 312 spousal caregivers of patients with newly diagnosed advanced cancer were recruited from January 2022 to December 2022 in Yancheng, China. Three data collection points were established, spanning from the first month to 6 months after initial cancer treatment. A latent growth model was employed to depict the resilience trajectory at various time points. A latent growth model with time‐invariant covariates was adopted to determine the factors influencing resilience trajectory. The study adhered to the STROBE checklist for proper reporting. Results: Throughout the follow‐up period, the participants experienced a significant increase in resilience. Gender, family income, the patient's health status, spirituality and belief in familism were significantly associated with the baseline resilience level. Moreover, family income, the patient's health status, spirituality, caregiver burden and belief in familism were significantly associated with the rate of resilience change over time. Conclusions: Spousal caregivers demonstrated a linear increase in resilience during the first 6 months after initial treatment. Meanwhile, changes in resilience were influenced by multiple factors during the early phase of cancer treatment. Thus, more attention should be paid to early identification and implementation of targeted interventions. Relevance to Clinical Practice: Healthcare professionals should understand the change in resilience among spousal caregivers and conduct timely mental health interventions to enhance the resilience of families affected by cancer. Patient or Public Contribution: The Guidance for Reporting Involvement of Patients and the Public‐Short Form reporting checklists were used to improve patient and public involvement. [ABSTRACT FROM AUTHOR]

Aims: To discuss the levels of structural empowerment (SE) and psychological empowerment (PE) and the factors that influence perceptions of empowerment among newly graduated nurses (NGNs). Design: Mixed methods study. Methods: The quantitative part of the study was conducted with 220 NGNs with <1 year of job experience. The study was conducted between February and May 2023. Focus group discussions were conducted with 30 NGNs. Data were collected by using the Conditions for Work Effectiveness Questionnaire (CWEQ‐II), the Psychological Empowerment Scale (PES) and a Semi‐Structured Interview Form. Quantitative data were analysed using stepwise regression analysis. Content analysis was used to analyse qualitative data. Results: CWEQ‐II and PES were moderate. The regression analysis showed that NGNs' SE scores increased in association with the following factors, including an increase in the total score on the PES, being married/having a partner, working a day shift, having career planning, increased satisfaction with the orientation programmes of the institution and increased satisfaction with the employing institution. As a result of the descriptive analysis of the focus group interviews conducted to determine the empowerment perceptions of NGNs, we identified three contexts along with the associated themes and subthemes. These three contexts were the 'concept of power', 'professional impression' and 'empowerment process'. Conclusion: The results of this study indicate that the SE and PE levels of NGNs are moderate, and their empowerment perceptions are influenced by many factors that can be individual, organizational and work environment relevant. Impact: This study's findings will guide policymakers, educators, researchers and administrators in empowering NGNs essential to the healthcare workforce. Reporting Method: The paper adheres to the COREQ checklist. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Self‐harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self‐harm. Most fatal and non‐fatal suicidal behaviours in inpatient settings are a result of ligature use.There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self‐harm by ligature. What the paper adds to existing knowledge: Key issues related to self‐harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self‐harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self‐harm by ligature.Working with self‐harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self‐harm by ligature, and unsupported after responding to a ligature incident. What are the implications for practice: Training about self‐harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self‐harm, and acknowledgement of the emotional impact on staff.Support for staff members who respond to ligature incidents should be available for all staff members who respond to self‐harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. Introduction: Self‐harm by ligature is a common form of self‐harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self‐harm. Aim: We explored the experiences of clinical staff who work with patients who self‐harm by ligature. Method: A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. Results: 275 staff members participated. Challenges most frequently reported about working with self‐harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. Discussion: Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self‐harmed by ligature. Implications for Practice: There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self‐harm by ligature. [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: To investigate fundamental care delivery regarding oral care in a surgical context, and to compare patients' self‐reported oral health with registered nurse assessments. Design: A descriptive and comparative study, with a consecutive selection. Methods: A patient oral health rating tool, including questions about performed oral care, was distributed to patients (n = 50), at four surgical wards in Sweden. The response rate was 72%. Oral health status was assessed by a registered nurse using the Revised Oral Assessment Guide (ROAG), and a comparison between patient and registered nurse assessment was performed by calculating Cohen's kappa coefficient and percentage agreement. Results: Patients (38%) reported severe oral symptoms, mostly dry lips and not an adequate amount of saliva, and 80% were not offered help with oral care. ROAG assessments revealed that 74% had problems with oral health. Almost half of the patients (48%) needed assistance with oral care but only 10% received help. Registered nurses assessed the patient's oral health as worse than the patient's self‐assessment did. Conclusion: There are deficiencies in fundamental care delivery regarding oral care in a surgical care context. Oral health assessments need to be performed by registered nurses. Routines for systematic oral assessments and for oral care need to be implemented by nurse managers to ensure that patients' fundamental care needs are fulfilled. Implications for the Profession and Patient Care: Oral health assessments need to be performed regularly by registered nurses since it is insufficient that patients self‐assess their oral health. Nurse managers need to provide and implement routines for nurse assessments and oral care in surgical care contexts. Impact: There are deficiencies in patients' oral health and oral care, and registered nurses need to perform oral health assessments. Nurse managers need to implement routines for registered nurse assessments and oral care. Patient Contribution: Patients admitted to a surgical ward were included in the study after being screened for inclusion criteria. After participants signed informed consent, they filled in a questionnaire about oral health and oral care, and a registered nurse performed an oral health assessment. Reporting Method: This study was carried out according to the STROBE checklist. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were as follows: (a) to examine the relationship between perceived organizational support and resilience; (b) to investigate the potential mediating role of general self‐efficacy and cognitive reappraisal among emergency nurses who have experienced workplace violence; and (c) to explore the application of Kumpfer's resilience framework to emergency department nurses. Design: A cross‐sectional study. Methods: From February 17, 2021, to March 8, 2021, 825 emergency nurses working in the emergency departments of tertiary hospitals in Shanghai, China, completed an online survey. Data on resilience, organizational support, cognitive reappraisal and general self‐efficacy were collected through questionnaires. The Spearman analysis was employed to investigate the relationship between variables, while the mediation analysis was conducted using AMOS 23.0 statistical software. Results: The findings of a study involving 825 emergency nurses who reported experiencing workplace violence reveal a positive correlation between perceived organizational support and resilience. Additionally, it has been observed that the relationship between these two factors is mediated by both cognitive reappraisal and general self‐efficacy. Furthermore, the mediating effect of cognitive reappraisal is more significant in this relationship. Conclusion: Kumpfer's resilience framework is found to apply to emergency nurses. Perceived organizational support, an environmental factor, affects resilience directly and positively. In addition, cognitive reappraisal and general self‐efficacy, which are individual factors, mediate this influence path. These findings suggest an interaction between environmental and individual factors in determining the resilience of emergency nurses. Impact: These findings have implications for developing resilience intervention strategies for emergency nurses exposed to occupational violence. Enhancing personal attributes such as general self‐efficacy and cognitive reappraisal is as significant as strengthening external organizational support environments for enhancing nurses' resilience. Patient or Public Contribution: Emergency nurses participated in the pilot test of our questionnaire survey and gave their opinions on the questionnaire design. Summary Statement: What is already known about the topic? In emergency rooms, workplace violence is prevalent, and it seriously endangers nurses' physical and mental health. Enhancing resilience can improve nurses' ability to self‐regulate after experiencing violence. However, the drivers and mechanisms of resilience among emergency nurses who have experienced workplace violence remain unidentified. What this paper adds? This study confirms the applicability of Kumpfer's resilience framework to emergency nurses who have experienced workplace violence. Nurses' self‐efficacy and cognitive reappraisal mediate the relationship between perceived organizational support and resilience after exposure to workplace violence. The resilience process for emergency nurses involves the interaction of individual and environmental factors. Implications for practice/policy. Managers and researchers should consider the interaction between individual and environmental factors when developing resilience intervention strategies for emergency nurses who have suffered workplace violence. It is essential to support emergency nurses from the dyadic dimensions of the environment and the individual. A supportive organizational environment and individual positive adjustment strategies are equally important in promoting resilience among nurses. [ABSTRACT FROM AUTHOR]

Aim: To develop a nurse‐led model of analgesia to manage post‐operative pain in the surgical neonate. Design: A four‐round e‐Delphi study was conducted from March to December 2022. Methods: An e‐Delphi method was used seeking a consensus of 70% or greater. Fifty‐one experts were invited to join the panel. Members consisted of multi‐disciplinary healthcare professionals who work in areas associated with neonatal care. In round 1, 49 statements relative to neonatal pain assessment and management were distributed to the panel. Panel members were asked to rate their level of agreeance on a Likert scale from 1 to 5 (1 = strongly disagree to 5 = strongly agree). Ratings equal to or greater than 4 represented agreement, 3 indicated uncertainty and 2 or less disagreement with the proposed statement. An opportunity for free‐text responses after each statement was provided. This iterative process continued for three rounds. In the fourth and final round, the completed model of neonatal nurse‐controlled analgesia was presented along with a further opportunity to provide feedback on the final version. Results: Four rounds of statements and voting were required to reach consensus on a model of neonatal nurse‐controlled analgesia. The model consists of criteria for use, over‐arching guidelines and three separate pathways based on an individual baby's pain assessment scores, need for pain relieving interventions and time‐lapsed post‐surgical procedure. Conclusion: A comprehensive model of neonatal nurse‐controlled analgesia, applicable to the Australasian context, was developed in collaboration with a group of neonatal experts. Impact: This study provides a multi‐modal family‐integrated model to manage neonatal post‐operative pain. By providing nurses with increased autonomy to assess and manage acute pain, this model has the potential to not only provide a more responsive and individualized approach to alleviate discomfort, but highlights the integral role of parent partnerships in the neonatal intensive care. Reporting Method: This study was reported in line with the Conducting and REporting of DElphi studies (CREDE) guidance on Delphi studies. Patient or Public Contribution: No patient or public contribution was utilized for this study. [ABSTRACT FROM AUTHOR]

Background: The novel coronavirus disease 2019 has caused psychological distress such as anxiety and fear among nurses worldwide. Nurses are a creditable source of vaccine‐related information and have a primary role in building confidence regarding vaccines. Aim: The present study was designed to investigate the fear and anxiety of nurses regarding novel coronavirus disease 2019 (COVID‐19) and their attitudes towards the COVID‐19 vaccine. The predictors of fear, anxiety and attitudes towards the vaccine were also investigated. Methods: A descriptive and correlational design was used. The study was conducted in three public hospitals from different parts of the Turkey, and 405 nurses from the three hospitals were recruited by stratified sampling. Results: Anxiety and negative attitudes towards the vaccine were positively related to fear of COVID‐19. Age and fear were also positively associated with anxiety related to COVID‐19. Nurses who had received the vaccine and those who were fearful had a positive attitude towards the vaccine. Conclusion: Psychosocial support programmes should be implemented to improve psychological resilience and coping strategies in nurses and organized education programmes are needed to increase positive attitudes towards vaccination. Summary statement: What is already known about this topic? The COVID‐19 pandemic significantly affected the psychological health of nurses.Nurses have a fundamental function in the general acceptance of vaccines. What this paper adds? Relationships were found between COVID‐19‐related fear, anxiety and attitudes towards the COVID‐19 vaccine.Anxiety and a positive attitude towards the vaccine were found to be predictors of fear related to COVID‐19.Fear related to COVID‐19 and being vaccinated against COVID‐19 were predictors of attitudes towards vaccination. The implications of this paper: Nursing managers could organize programmes to improve the coping skills of nurses in responding to situations that cause psychological burden.Nursing managers could support nurses through education to develop positive attitudes towards vaccines. [ABSTRACT FROM AUTHOR]

Aims: To explore potential areas of low‐value home‐based nursing care practices, their prevalence and related influencing factors of nurses and nursing assistants working in home‐based nursing care. Design: A quantitative, cross‐sectional design. Methods: An online survey with questions containing scaled frequencies on five‐point Likert scales and open questions on possible related influencing factors of low‐value nursing care. The data collection took place from February to April 2022. Descriptive statistics and linear regression were used to summarize and analyse the results. Results: A nationwide sample of 776 certified nursing assistants, registered nurses and nurse practitioners responded to the survey. The top five most delivered low‐value care practices reported were: (1) 'washing the client with water and soap by default', (2) 'application of zinc cream, powders or pastes when treating intertrigo', (3) 'washing the client from head to toe daily', (4) 're‐use of a urinary catheter bag after removal/disconnection' and (5) 'bladder irrigation to prevent clogging of urinary tract catheter'. The top five related influencing factors reported were: (1) 'a (general) practitioner advices/prescribes it', (2) 'written in the client's care plan', (3) 'client asks for it', (4) 'wanting to offer the client something' and (5) 'it is always done like this in the team'. Higher educational levels and an age above 40 years were associated with a lower provision of low‐value care. Conclusion: According to registered nurses and certified nursing assistants, a number of low‐value nursing practices occurred frequently in home‐based nursing care and they experienced multiple factors that influence the provision of low‐value care such as (lack of) clinical autonomy and handling clients' requests, preferences and demands. The results can be used to serve as a starting point for a multifaceted de‐implementation strategy. Reporting Method: STROBE checklist for cross‐sectional studies. Patient or Public Contribution: No Patient or Public Contribution. Implications for the Profession and/or Patient Care: Nursing care is increasingly shifting towards the home environment.Not all nursing care that is provided is effective or efficient and this type of care can therefore be considered of low‐value.Reducing low‐value care and increasing appropriate care will free up time, improve quality of care, work satisfaction, patient safety and contribute to a more sustainable healthcare system. [ABSTRACT FROM AUTHOR]

Aim: To identify barriers and facilitators of speciality skill transfer for internationally qualified nurses in Australia from the nurses' perspective. Design: A cross‐sectional study. Methods: A cross‐sectional online survey was distributed through social media, snowballing and nursing professional organization. Data analysed using Statistical Package for the Social Sciences. Data Sources: Online survey data from participants matching the inclusion criteria were collected from July to September 2022. Results: Survey results reveal facilitators (competence, scope of practice, linguistic sufficiency, understanding of decision‐making) and barriers (lack of opportunity, transition pathways, confidence in overseas education, financial instability) for internationally qualified nurses' speciality skill utilization in Australia. Conclusion: Identifying and addressing barriers and facilitators, along with developing tailored transition pathways, are crucial for maximizing speciality skill utilization among internationally qualified nurses. These findings have implications for policymakers, healthcare organizations and nurses. They highlight the need to address barriers, facilitate smooth transitions and implement proactive measures for internationally qualified nurses to effectively utilize their specialty skills. Impact: The study addresses maximizing skill usage for internationally qualified nurses, identifies barriers and facilitators for specialty skill transfer in Australia and will impact policymakers, healthcare organizations and nurses by guiding strategies for safe nursing service delivery and optimizing patient care. Reporting Method: STROBE checklist. Patient or Public Contribution: A total of 71 internationally qualified nurses contributed their experiences and opinions. What Does this Paper Contribute to the Wider Global Clinical Community?: Lack of opportunity and the lack of transition pathways inhibit the use of specialty nursing skills by internationally qualified nurses.This study's findings contradict the result of other studies that suggest language is a significant obstacle to the utilization of specialty skills of internationally qualified nurses. Trial and Protocol Registration: The protocol is registered on OSF. The data for this study are available for sharing with the reviewers upon request. However, it is worth noting that ethical approval has not been obtained specifically for web sharing, and therefore, the data has not been posted in any repositories or public platforms. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the relationship between nurses' perception of toxic leadership and their organizational trust levels and turnover intentions. Design: This cross‐sectional study was conducted using an online survey of 168 nurses working in public and university hospitals. Methods: Data were collected between April and November 2022 with the Toxic Leadership Scale, Organizational Trust Scale and Turnover Intention Scale. Descriptive statistics, correlations, and regression analyses were used to analyse these data. Results: It was determined that almost half of the nurses (46.4%) were exposed to negative behaviours from their managers within the last year. Nurses' perception of toxic leadership, organizational trust level and turnover intention were moderate. It was found that nurses' perceptions of toxic leadership had a negative effect on organizational trust level (R2 =.691; β = −0.832; p <.05) and a positive significant effect on turnover intention (R2 =.267; β = 0.521; p <.05). Conclusions: This study revealed that toxic leadership behaviours in health organizations should be struggled with to increase nurses' organizational trust and reduce their turnover. In this context, an organizational culture in which toxic behaviours are not tolerated should be established in health organizations. Impact: What problem did the study address? In the literature, mostly positive leadership behaviours of nurse managers are emphasized and little is known about their negative behaviours such as toxic leadership. What were the main findings? It was determined that nurses who perceived more toxic behaviour from their managers had less trust in their organizations and higher turnover intention. On whom will the research have an impact? To provide a positive working environment and reduce turnover, it is necessary to create an organizational culture in which the toxic behaviours of nurse managers are not tolerated. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to identify different profiles of chronic disease resource utilization among patients with coronary heart disease in Tibet and explore the relationship between these profiles and quality of life. Design: A cross‐sectional study. Methods: Patients with coronary heart disease who were treated in a tertiary hospital in Tibet and its cooperative points from January 2021 to July 2021 were selected as the study participants. All participants completed a general information questionnaire, the Chronic Disease Resource Utilization Questionnaire (CIRS) and the Health Status Survey Short Form (SF‐36). Chronic disease resource utilization was profiled, and its relationship to quality of life was explored using hierarchical linear regression. Results: A total of 382 patients were enrolled in this study. Regarding chronic disease resource utilization, the participants were divided into three latent profiles: 'Poor utilization group' (n = 151), 'Effective utilization group' (n = 155) and 'Full utilization group' (n = 76). Different profiles of chronic disease resource utilization of patients were significantly associated with quality of life (R2 =.126, p <.001). Conclusion: Healthcare providers should identify patients with different profiles, define their utilization features of chronic disease resources and adopt targeted interventions to guide them in acquiring enough disease support resources to improve their quality of life. Implication: Understanding different resources using preferences of coronary heart disease patients can help healthcare providers and related sectors to provide other supports based on different profiles of patients, thus enhancing their quality of life. Reporting Method: The study followed the STROBE guideline. No Patient or Public Contribution: There was no patient or public involvement in the design of the study. [ABSTRACT FROM AUTHOR]

Aims: To identify latent profiles of competence and perceptions of spiritual care among clinical nurses and explore the possible influencing factors. Background: Understanding nurses' level of spiritual care competence and their perceptions and acceptance of such care is important, which could help devise nurse training programmes to address such competence in clinical nurses. However, research addressing interindividual variability in competence and perceptions among Chinese nurses is lacking. Design: Multicentre cross‐sectional study. Methods: Nurses working in departments with critically ill patients from 12 community, 5 secondary and 10 tertiary hospitals in Shanghai completed a demographic information questionnaire and the Chinese versions of the Spiritual Care Competence Scale, Spiritual Care‐Giving Scale and Spiritual Perspectives Scale. The data were analysed using IBM SPSS v26.0 and Mplus version 8.3. Latent profile analysis identified subgroups with different levels of spiritual care competence. Results: In total, 1277 Chinese nurses were recruited. Four profiles of competence and perceptions of spiritual care were revealed: Low ability (23.8%), High ability (6.4%), High acceptance (34.9%) and Moderate (34.9%). The level of job position, spiritual care‐related education, hospital grade and nurses' perceptions and perspectives of spiritual care predicted the probability of profile memberships in their competence. Conclusions: There was heterogeneity in the characteristics of spiritual care competence. Nursing managers can implement individualised interventions, including relevant training, according to the influencing factors of different competence profiles to improve the level of such competence among nurses. Relevance to Clinical Practice: The results provide a new and expanded view of improving nurses' spiritual care competence. Interprofessional collaboration with clinicians, administrators, educators and spiritual leaders can contribute to the development of related education and training. Reporting Method: EQUATOR guidelines, STROBE checklist: cross‐sectional studies. Patient or Public Contribution: All participants were clinical nurses. Participants were informed they could withdraw from the study at any time. [ABSTRACT FROM AUTHOR]

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

Aims: To explore the current situation, influencing factors and pathways of safety behaviour of nurses in tumour specialized hospitals, in order to provide a theoretical basis for managers to manage and train nurses, improve their safety behaviour level and ensure medical safety. Design: An anonymous cross-sectional survey. Method: A total of 2147 nurses from Grade A cancer hospitals in 15 provinces of China were selected by a convenient sampling method. Questionnaires were collected through the Questionnaire Star platform. Nurses' safety behaviour was measured using the nurse Safety Behaviour Scale, Self-efficacy by the General Self-efficacy Scale, and nurses' occupational burnout was measured by the occupational Burnout Scale, and work engagement through the the Work Engagement Scale. Structural equation modelling was used to test the relationship among nurses' safety behaviour, general self-efficacy, occupational burnout and work engagement. SPSS25.0 software was used to test the relationship among the safety behaviour of nurses, general self-efficacy, occupational burnout and work engagement. Results: The total score of safety behaviour of nurses was 55.45 ± 6.879, the total score of general self-efficacy was 31.39 ± 5.729, the total score of occupational burnout was 44.99 ± 26.587, and the total score of work engagement was 38.48 ± 13.433; the scores of the Nurse Safety Behaviour Scale, Self-Efficacy Scale, and Work Engagement Scale were positively correlated (all p< .001); the occupational burnout scale was negatively correlated with the scores of self-efficacy scale, work engagement scale and nurse safety behaviour scale (all p< .001); Structural equation model analysis shows that self-efficacy and work engagement have a direct positive impact on nurse safety behaviour(β= .103, β= .096, all p< .001); Occupational burnout has a direct negative impact on self-efficacy, work engagement and nurse safety behaviour(β= −.371, β= −.413, β= −.328 all p< .001). Bootstrap analysis showed that occupational burnout and job involvement had a significant chain mediating effect between self-efficacy and the safety behaviour of nurses (95% CI: 0.148–0.21). The total effect of self-efficacy on the safety behaviour of nurses was 0.283 (p< .001, 95% CI: 0.225–0.301), the direct effect was 0.096 (p< .001, 95% CI: 0.042–0.15), and the indirect effect was 0.179 (p< .001, 95% CI: 0.085–0.215), The mediating effect accounted for 63.3% of the total effect size. Conclusion: Occupational burnout and work engagement play a partial mediating role between self-efficacy and nurse safety behaviour. It is necessary to strengthen training on nurse safety culture awareness, improve the nurse self-efficacy and work engagement, reduce nurse occupational burnout, and thereby improve the level of nurses' safety behaviour. [ABSTRACT FROM AUTHOR]

Background: Authentic leadership and empowered nurses are necessary if a healthy work environment is to be created and patient safety maintained; however, few studies have examined the impact of authentic leadership, on nurse empowerment and the patient safety climate. Purpose: The aim of the study was to investigate the impact of an educational intervention delivered through a multi-faceted training programme on nurses' perceptions of authentic leadership, nurse empowerment (both structural and psychological) and the patient safety climate. Design: A quasi-experimental study using a one-group pretest–posttest design consistent with TREND guidelines. Methods: The study was conducted in a university hospital between December 2018 and January 2020. Participants were followed for 6 months. The programme involved 36 head nurses (leaders) and 153 nurses (followers). The effectiveness of the programme was evaluated using repeated measures of analysis of variance, dependent sample t-tests and hierarchical regression analysis. Results: Following the intervention, safety climate and authentic leadership scores increased among both leaders and followers. Structural and psychological empowerment scores also increased among followers. We found that authentic leadership and structural empowerment were predictors of safety climate. Conclusion: The implementation of the education programme resulted in positive changes in participants' perceptions of authentic leadership and empowerment, which can enhance patient safety. Implications: Healthcare organizations can implement similar multi-faceted training programmes focused on authentic leadership, and nurse empowerment to increase patient safety. Achieving effective results in such programmes can be facilitated by motivating participants with the support of the top management. Patient or Public Contribution: The study included nurses in the intervention and the data collection processes. Impact: • Patient safety is a global concern, and improving patient safety culture/climate is a key strategy in preventing harm. • Authentic leadership and nurse empowerment are essential in creating healthy work environments and delivering safe, high-quality care. • Training programmes addressing these issues can help bring about improvements in healthcare organizations. [ABSTRACT FROM AUTHOR]

Aims: This study aims to investigate the impact of nurses' experiences of hospital violence on resilience, the mediating effect of trust in patients and the moderating effect of organizational trust. Background: Despite belonging to the central part of health care worldwide and being the leading provider of medical services, nurses are often subjected to hospital violence, which affects their physical and mental well‐being. Trust is a high‐order mechanism that encourages positive thinking and personal and professional development. However, research into the impact of trust on resilience concerning nurses' experiences of hospital violence is limited. Methods: The participants were 2331 nurses working in general hospitals in China. A cross‐sectional survey was conducted, and data were collected via questionnaires from July to October 2022 and analysed using SPSS 25.0 and SPSS PROCESS 3.3 macros. This study was prepared and reported according to the STROBE checklist. Results: Mean trust in patients was 48.00 ± 10.86 (12–60), mean organizational trust was 56.19 ± 8.90 (13–65) and mean resilience was 78.63 ± 19.26 (0–100). Nurses' experience of hospital violence had a direct negative effect on resilience (β = −.096, p =.871), a significant adverse effect on trust in patients (β = −3.022, p <.001) and a significant positive effect on trust in patients on resilience (β = 1.464, p <.001). Trusting patients played a mediating role. The significant moderating effect of organizational trust between experience of hospital violence and trust in patients was moderated by a mediating effect index of −0.1867 (95% CI = [−0.3408, −0.0345]). Conclusions: Nurses' experience of hospital violence exerted a negative effect on resilience, trust in patients had a fully mediated effect and organizational trust had a significant moderating influence in the pathway from nurses' experience of hospital violence to patients' trust‐mediated resilience. Implications for Nursing and Health Policy: This study highlights the impact of nurses' experiences of hospital violence on resilience and explores the importance of trust from the nurses' perspective. Measures taken by managers to provide nurses with a safe, trusting and positive work environment can be highly beneficial in enhancing nurse resilience. [ABSTRACT FROM AUTHOR]

Background: Malnutrition, sedentary lifestyle, cognitive dysfunction and poor psychological well‐being are often reported in patients on haemodialysis (HD). Aims: We aimed to explore needs, barriers and facilitators—as perceived by patients, their carers, and healthcare professionals (HCPs) for increasing the adherence to the diet, to physical activity and cognition and psychological well‐being. Methods: This is an observational cross‐sectional study following the STROBE statement. This study is part of an ERASMUS+ project, GoodRENal—aiming to develop digital tools as an educational approach to patients on HD. For that, the GoodRENal comprises HD centers located in four Belgium, Greece, Spain and Sweden. Exploratory questionnaires were developed regarding the perceived needs, barriers and facilitators regarding the diet, physical activity, cognition and psychological well‐being from the perspective of patients, their carers and HCPs. Results: In total, 38 patients, 34 carers and 38 HCPs were included. Nutrition: For patients and carers, the main needs to adhere to the diet included learning more about nutrients and minerals. For patients, the main barrier was not being able to eat what they like. Physical activity: As needs it was reported information about type of appropriate physical activity, while fatigue was listed as the main barrier. For Cognitive and emotional state, it was perceived as positive for patients and carers perception but not for HCPs. The HCPs identified as needs working as a team, having access to specialised HCP and being able to talk to patients in private. Conclusions: Patients and their carers listed as needs guidance regarding nutrition and physical activity but were positive with their cognitive and emotional state. The HCPs corroborated these needs and emphasised the importance of teamwork and expert support. [ABSTRACT FROM AUTHOR]

Aim: The study's main objective was to use a fuzzy set qualitative comparative analysis to identify the configuration of recipes that predict nurses' safety compliance behaviour. Design: A cross-sectional design. Methods: A survey was used where questionnaires were collected from 285 nurses across four primary healthcare hospitals within the Ashanti Region, Ghana. The data collection happened between June 1 to August 2, 2022. A fuzzy set qualitative comparative analysis was used to identify the recipes of psychological factors that determine nurses' safety compliance behaviour. Results: Results from the study suggest that the necessary configurations that explained nurses' safety compliance behaviour came from the presence of subjective norm, attitude, perceived behavioural control, perceived organizational support and negation of intention. The result highlights the need for safety protocols to be conscious of the interplay between nurses' assessment of self, social clues and perception of management care and support since such psychological factors must be considered concurrently to achieve the optimal safety compliance behaviour among nurses. Conclusion: A health and safety protocol that fails to recognize the importance of psychological antecedents on subordinates' safety compliance behaviour could limit the safety policy's usefulness in bringing the appropriate behavioural change in nurses. Impact: To date, no study has combined the antecedents of theory planned behaviour with perceived organizational support and cue to action to assess how they collectively predict nurses' safety compliance behaviour. Findings from the study suggest that nurses in primary health facilities inform their safety compliance behaviour by assessing self-capabilities, social signals from superiors and colleagues and perception of management support. Hospital administrators and nursing managers in sub-Saharan Africa may rely on these psychological forces to persuade nurses to develop positive safety compliance behaviour at the health facility. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the relevance of signs and symptoms for the clinical identification of ESI and TI in HD‐CVC, by means of international expert consensus, and to reach a consensus on a definition and clinical management (CM) for these infections. Background: A recent systematic review showed a high heterogeneity in the signs/symptoms used for determining exit site infection (ESI) and tunnel infection (TI) of haemodialysis central venous catheter (HD‐CVC). Design: A modified Delphi ranking process was carried out between November 2020 and March 2021, consisting of four rounds using an online questionnaire with a panel of 26 experts from 12 countries. Methods: Experts responded on the level of relevance for the identification of ESI and TI, based on a list of 22 signs/symptoms obtained from a previous systematic review, using a 4‐point Likert‐type scale. After reaching consensus on the signs/symptoms, they followed the same method to reach consensus on the CM. The STROBE Checklist was used to report this study. Results: A high degree of consensus was reached to identify the presence of ESI based on nine signs/symptoms: presence of pain at the exit site (ES) during interdialysis period, with fever ≥38°C do not suspect other cause, local signs at the ES (inflammation, induration, swelling, hyperemia/erythema ≥2 cm from ES) and obvious abscess or purulent exudate at ES; and of TI. Likewise, 5 cm were agreed upon. Conclusion: This Delphi study provides international expert consensus definitions of ESI and TI in HD‐CVC, laying the groundwork for the validation of an HD‐CVC ES clinical assessment scale for early identification of ESI. Relevance to Clinical Practice: In addition, this study provides a series of attitudes to consensual clinics regarding signs/symptoms of local infections in HD‐CVC, which may be useful as expert opinion in clinical practice guidelines, when there is insufficient scientific evidence. [ABSTRACT FROM AUTHOR]

Aims: To describe the health literacy (HL) levels of hospitalised patients and their relationship with nursing diagnoses (NDs), nursing interventions and nursing measures for clinical risks. Design: Retrospective study. Methods: The study was conducted from December 2020 to December 2021 in an Italian university hospital. From 146 wards, 1067 electronic nursing records were randomly selected. The Single‐Item Literacy Screener was used to measure HL. Measures for clinical risks were systematically assessed by nurses using Conley Index score, the Blaylock Risk Assessment Screening Score, Braden score, and the Barthel Index. A univariable linear regression model was used to assess the associations of HL with NDs. Results: Patients with low HL reported a higher number of NDs, interventions and higher clinical risks. HL can be considered a predictor of complexity of care. Conclusions: The inclusion of standardised terms in nursing records can describe the complexity of care and facilitate the predictive ability on hospital outcomes. Implications for the profession and/or patient care: HL evaluation during the first 24 h. From hospital admission could help to intercept patients at risk of higher complexity of care. These results can guide the development of interventions to minimise needs after discharge. Patient or Public Contribution: No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection. [ABSTRACT FROM AUTHOR]