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Aims: Dehydration is one of the common complications of dysphagia and poses significant risks including hospitalization and mortality, but the relationship between dysphagia and dehydration has received little attention. This study aims to determine the prevalence and risk factors for dehydration of patients with dysphagia in eastern China, and to provide reference for early identification and prevention of dehydration. Methods: A descriptive, cross‐sectional design was conducted. Three hundred and thirty‐seven (n = 337) patients with dysphagia participated in the study between August and December 2022. Information relating to participants' demographic variables, nutrition, cognition, functional, hydration status and fluid intake was collected. Univariate analysis was used to examine related impact factors, and then binary logistic regression analysis was conducted to determine reliable impact factors. Results: Among 337 patients with dysphagia, the average age was 63.47 ± 16.96, most participants were male (72.1%) and married (91.7%). The prevalence of dehydration was calculated to be 43.9%, the mean plasma osmolality score was 293.53 mmol/L. Diseases with the highest prevalence were stroke (78.3%), followed by hypertension (63.5%). The risk for dehydration increased with older age, usage of more medicines such as diuretics and beta‐blockers, worse functional status and lower fluid intake. Conclusion: This study found a high percentage of dehydration in patients with dysphagia. Findings can provide a basis for targeted nursing interventions for clinical prevention and treatment of dehydration. Summary statement: What is already known about this topic? Dehydration is one of the adverse consequences of dysphagia, and it causes physical stress to sufferers and enormous costs to the health care system.Previous studies have identified that personal factors (age, gender, health condition etc.), living environment, and social support may affect dehydration What this paper adds? Results showed high percentages of dehydration among patients with dysphagia; older age, greater use of medicines such as diuretics and beta‐blockers, worse functional status and lower fluid intake played a crucial role in hospital patients with dysphagia, leading to dehydration. The implications of this paper: This paper reveals prevalence and risk factors associated with dehydration of patients with dysphagia in hospital.Findings could provide reference data for development of nursing preventive interventions, to reduce the incidence of dehydration and improve the health level of patients. [ABSTRACT FROM AUTHOR]

In statistics, samples are drawn from a population in a data‐generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence‐generating process (EGP). We claim that EGP variation across researchers adds uncertainty—nonstandard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for more reproducible or higher rated research. Adding peer‐review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants. [ABSTRACT FROM AUTHOR]

Introduction: During the Coronavirus (COVID-19) pandemic, healthcare providers have overcome difficult experiences such as workplace violence. Nurses are particularly vulnerable to workplace violence. The objective of this study was to characterize violence and aggression against nurses during the COVID-19 pandemic in Latin America. Methods: An electronic cross-sectional survey was conducted in 19 Latin American countries to characterize the frequency and type of violent actions against front-line healthcare providers. Results: Of the original 3544 respondents, 16% were nurses (n = 567). The mean age was 39.7 ± 9.0 years and 79.6% (n = 2821) were women. In total, 69.8% (n = 2474) worked in public hospitals and 81.1% (n = 2874) reported working regularly with COVID-19 patients. Overall, about 68.6% (n = 2431) of nurses experienced at least one episode of workplace aggression during the pandemic. Nurses experienced weekly aggressions more frequently than other healthcare providers (45.5% versus 38.1%, p < .007). Nurses showed a trend of lower reporting rates against the acts of aggression suffered (p = .076). In addition, nurses were more likely to experience negative cognitive symptoms after aggressive acts (33.4% versus 27.8%, p = .028). However, nurses reported considering changing their work tasks less frequently compared to other healthcare providers after an assault event (p = .005). Conclusion: Workplace violence has been a frequent problem for all healthcare providers during COVID-19 pandemic in Latin America. Nurses were a particularly vulnerable subgroup, with higher rates of aggressions and cognitive symptoms and lower rate of complaints than other healthcare providers who suffered from workplace violence. It is imperative to develop strategies to protect this vulnerable group from aggressions during their tasks. [ABSTRACT FROM AUTHOR]

Background: Vaccination is the most important public health practice for preventing infectious diseases and maintaining health. However, some parents are hesitant to vaccinate their children. Design: This study was designed as an instrument development study. Methods: This study aimed to develop a scale to measure the attitudes of parents with children aged 0–5 years towards vaccination and to evaluate the validity and reliability of this scale. The data were collected from 691 participants between November 2020 and January 2021. During the development of the scale, experts provided feedback on its technical, content and language dimensions. The data were analysed using exploratory and confirmatory factor analyses for conceptual validity and Cronbach's α and item‐level test–retest analyses for reliability. Results: The developed scale is a reliable and valid tool for measuring attitudes towards vaccination among parents (Cronbach's α = 0.97, variance explained by these 28‐item two factors = 62.47%). Conclusion: This scale can be used as a guide in measuring the attitudes of parents towards vaccination and determining the direction of primary health‐care services based on the results of the measurement. Summary statement: What is already known about this topic? Vaccination plays an important role in health practice.Parents' attitudes towards vaccination affect their children's vaccination status.Increasing vaccination rates in children will contribute to the reduction of infectious diseases and mortality. What this paper adds? A new valid and reliable measurement tool for determining vaccine hesitancy has been developed.The validity and reliability of the scale of attitudes towards vaccination among parents of children aged 0–5 years were tested.The tool could be used to determine the attitudes of parents of children aged 0–5 years towards vaccination. The implications of this paper The scale may help in determining factors affecting parents' attitudes on vaccination.The scale can generate data to guide nursing practices to increase vaccination rates.The scale can be used to influence nursing practices to increase vaccination rates and promote vaccine awareness, trust and acceptance. [ABSTRACT FROM AUTHOR]

Introduction: A culturally adaptive and easy‐to‐administer 12‐item Caregiving Rewarding Feelings (CRF) scale has been developed in China yet never published in English and validated in another population. Aim: The current study aimed to validate the CRF among a community sample of Chinese caregivers of those diagnosed with schizophrenia. Method: A sample of 449 family caregivers was recruited for scale validation that included factorial validity, construct validity, measurement invariance, item analysis, internal consistency reliability, test–retest reliability, known‐group validity, convergent validity and divergent validity. Results: Confirmatory factor analysis supported the a priori three‐factor structure. Construct validity was supported by high standard regression weight (SRW) and average variance extracted (AVE), measurement invariance across age and gender groups. The CRF showed good internal consistency and test–retest reliability. Known‐group validity was confirmed by the higher CRF scores among caregivers with certain socio‐demographics. The convergent validity of the CRF was supported by its positive correlations with social support, active coping and family functioning. The divergent validity of the CRF was supported by its negative associations with stigma, stress and depressive symptoms. Conclusions: This study confirmed the reliability and validity of the CRF specifically designed for caregivers in Chinese culture. Implications for Practice: The CRF may be further applied and validated in other populations and other countries. [ABSTRACT FROM AUTHOR]

Aims: The study aimed to develop and evaluate the effects of a self‐determination theory‐based, nurse‐led, physical activity programme for postmenopausal women with rheumatoid arthritis. Methods: Between December 2019 and April 2020, this randomized controlled trial recruited 62 postmenopausal women with rheumatoid arthritis from a university‐affiliated hospital in South Korea. The intervention group participated in a self‐determination theory‐based, nurse‐led, physical activity programme that consisted of Tai Chi‐based physical activity, a supportive psychosocial strategy, and interactive counselling for 16 weeks, and the control group continued to undergo their usual care. Results: There were statistically significant group‐by‐time interactions in physical activity and perceived sarcopenia, which favoured the intervention group. Additionally, the intervention group showed significant improvements in the perceived therapeutic efficacy of physical activity, grip strength, walking speed, disease activity score, and health‐related quality of life. Conclusions: The programme developed in this study can be an effective and feasible approach for postmenopausal women with rheumatoid arthritis in improving physical activity, selected osteosarcopenic outcomes, and health‐related quality of life. Further research is required to investigate the long‐term effects of this theory‐based programme for postmenopausal women in diverse settings. Summary statement: What is already known about this topic? Tai Chi‐based physical activity has been known to be a component of self‐management for rheumatoid arthritis. What this paper adds? It highlights the efficacy of a theory‐based, nurse‐led, physical activity programme to improve the quality of life of postmenopausal women with rheumatoid arthritis.The evidenced‐based programme could be transferred to postmenopausal women with rheumatoid arthritis in clinical settings. The implications of this paper: The self‐determination theory‐based, nurse‐led, physical activity programme can improve physical and psychosocial outcomes in postmenopausal women with rheumatoid arthritis.Importantly, this nurse‐led and theory‐based programme is expected to be applicable to postmenopausal women with rheumatoid arthritis in clinical settings, including both hospitals and communities. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to develop a predictive model that can identify the suicidal ideation risk group among older adults in rural areas using machine learning methods. Design: This study applied an exploratory, descriptive and cross‐sectional design. Methods: The participants were older adults (N = 650) aged over 65 living in rural areas of South Korea. Self‐report questionnaires were used to collect the demographics, suicidal ideation, depression, socioeconomic information and basic health information from September to October 2020. The collected data were analysed using machine learning methods with R statistical software 4.1.0. Results: The predictive models indicated that depression, pain, age and loneliness were significant factors of suicidal ideation. Good performance was observed based on the area under the receiver operating characteristic curve in the decision tree, random forest and logistic regression. Finally, the evaluation of model performance indicated moderate to high sensitivity and specificity. Conclusion: The predictive models using machine learning methods may be useful to predict the risk of suicidal ideation. Furthermore, depression with pain, age and feelings of loneliness should be included in the initial screening to assess suicide risk among older adults in rural areas. Impact Identifying suicidal risk among older adults is challenging. Thus, employing predictive models that can assess depression, pain, age and loneliness can enable public healthcare providers to detect suicidal risk groups. Particularly, the presented models from this study can facilitate healthcare providers with initiating early interventions to prevent suicide among older adults in clinical and community nursing care settings. Reporting Method: The reporting of this study (Observational, cross‐sectional study) conforms to the STROBE statement. Patient or Public Contribution: No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public. Implication for the Profession and/or Patients Care: Applying this model may help to prevent geriatric suicide because the nursing staff will have a greater awareness regarding the suicide ideation risk of older adults, thereby reducing the possibility of their suicide. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine the prevalence and the associated factors of self‐perceived medical errors among Chinese emergency department nurses. Background: The emergency department is a place with a high incidence of medical errors. Studies about the occurrence and related influencing factors of medical errors among emergency nurses in China are very insufficient. Design: A nationwide cross‐sectional study. Methods: A nationwide cross‐sectional study was conducted from July 2018–August 2018. A total of 17,582 emergency department nurses from 31 provinces across China were eventually included in the analysis. Logistic regression is applied to examine the association of the independent variables with the perceived medical errors. The reporting of this study was compliant with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross‐sectional studies. Results: Of 17,582 participating nurses, 4445 (25.28%) reported self‐perceived medical errors in the past 3 months. Nurses who were serving as nurses‐in‐charge; who reported fair or bad physical health; who reported staff shortage; who were exposed to more verbal abuse at work; who experienced effort–reward imbalance; who reported more over‐commitment; or who had depressive symptoms were more likely to report medical errors. Older age and female gender were protective factors. Conclusions: In this study, a quarter of the emergency nurses reported that they had made medical errors in the past 3 months. Self‐perceived medical errors are associated with multiple domains of work‐related factors and personal distress. Feasible measures should be taken to reduce nurses' workload, improve their working environment, monitor and minimise the occurrence of medical errors among emergency department nurses. Relevance to clinical practice: Emergency nurses, who are the most frequently in contact with patients, play an important role in identifying risk factors and preventing medical errors. Identifying risk factors that may lead to medical errors in the medical environment from both internal and external aspects will help nursing practitioners, hospital administrators and policy makers to take timely preventive measures to reduce the occurrence of medical errors and reduce harm to patients. [ABSTRACT FROM AUTHOR]

Aims: To describe adult intensive care nurses' experiences and attitudes towards intrahospital transport (IHT) of critically ill patients and to assess the relationship between nurses' characteristics, attitudes and experiences. Design Cross‐sectional survey. Methods: Factor analysis identified factors within the attitudinal and experience domains. Univariate analysis was performed to demonstrate the relationship between attitudinal and experience factors and demographic and professional characteristics of the participants. Multiple regression equations were applied to determine associations between nurses' experiences and attitudes. The study took place from July to August 2019. Results: A total of 480 nurses from 12 adult intensive care units in China participated, with a response rate of 65%. Most respondents had a baccalaureate nursing degree (75%). The majority (80%) had participated in IHT of critically ill more than five times in the previous 12 months and 90% agreed that checklists led to an improvement in patient safety during transport. However, 75% of respondents expressed that transport increased the workload of the nurses who accompany patients off unit and those who remained in the intensive care unit (66%). Variables that were associated with a favourable perception of transport competency and checklists/tool use were nurses' prior transport experiences and knowledge/training. Conclusion: Nurses perceived IHT was a sourse of stress and increased workload. Checklists and training were beneficial for patient safety during IHT. Impact The findings point out a clear need for ICU nurse training, standardised policy/procedure and customisation of existing intrahospital transfer checklists according to hospital procedures and local circumstances. New research is needed to evaluate the impact of novel IHT interventions on patient safety and nurses' stress. [ABSTRACT FROM AUTHOR]

Aim: To examine the diagnostic reasoning skills of two nurse practitioner student cohorts. Introduction: Nurse practitioners continue to play a pivotal role in health care provision. Diagnostic reasoning is a core skill of advanced practice. A comparative diagnostic reasoning study between two student cohorts was undertaken between 2018 and 2019. Methods: A validated diagnostic reasoning scale was completed by nurse practitioner students in the United Kingdom and the United States of America at the beginning and end of their clinical placements. The study utilized descriptive quantitative statistics from the data submitted by 22 survey respondents from an online survey. Results: Analysis of the diagnostic reasoning skills suggested there was a difference in the structural memory scores when compared with the beginning of their clinical placements and the final semester of their clinical placements. Conclusion: Diagnostic reasoning skills are a core skill of advanced practice. As students progress through their training, these skills improve. Despite the statistical difference in diagnostic reasoning scores, caution should be made in determining any larger implications due to the small number of participants in this study. Further study is needed in this area. Summary statement: What is already known about this topic? Diagnostic reasoning is a core skill for nurse practitioners.There is minimal research in this area.Diagnostic accuracy is vital for ensuring patient safety. What this paper adds? Structural memory scores improved at the end of nurse practitioner clinical placements. What are the implications of this paper for policy/practice/research/education? Further global research in the field of diagnostic reasoning for nurse practitioners and nurse practitioner students is needed to validate these findings.It is important to ensure nurse practitioners have competency in diagnostic reasoning to reduce diagnostic error.Curricula could be designed to incorporate the use of the DTI to evaluate a student's progress throughout the clinical portion of the nurse practitioner programme. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to evaluate the medication calculation skills of graduating nursing students in six European countries and analyse the associated factors. Background: Medication calculation skills are fundamental to medication safety, which is a substantial part of patient safety. Previous studies have raised concerns about the medication calculation skills of nurses and nursing students. Design: As part of a broader research project, this study applies a multinational cross‐sectional survey design with three populations: graduating nursing students, nurse managers and patients. Methods: The students performed two calculations (tablet and fluid) testing medication calculation skills requiring different levels of conceptual understanding and arithmetic. The managers and patients answered one question about the students' medication kills. In total, 1,796 students, 538 managers and 1,327 patients participated the study. The data were analysed statistically. The STROBE guideline for cross‐sectional studies was applied. Results: Almost all (99%) of the students performed the tablet calculation correctly, and the majority (71%) answered the fluid calculation correctly. Older age, a previous degree in health care and satisfaction with their current degree programme was positively associated with correct fluid calculations. The patients evaluated the students' medication skills higher than the nurse managers did and the evaluations were not systematically aligned with the calculation skills tested. Conclusions: Nursing students have the skills to perform simple medication calculations, but a significant number of students have difficulties with calculations involving multiple operations and a higher level of conceptual understanding. Due to the variation in students' medication calculation skills and the unalignment between the managers' and patients' evaluations and the calculation tests, further research is needed. Relevance to clinical practice: Graduating nursing students enter clinical field as qualified professionals, but there is still room for improvement in their medication calculation skills. This calls for attention in the fields of clinical nursing, education and research. [ABSTRACT FROM AUTHOR]

Aim: To describe a protocol for the pilot phase of a trial designed to test the effect of an mHealth intervention on representation and readmission after adult cardiac surgery. Design: A multisite, parallel group, pilot randomized controlled trial (ethics approval: HREC2020.331‐RMH69278). Methods: Adult patients scheduled to undergo elective cardiac surgery (coronary artery bypass grafting, valve surgery, or a combination of bypass grafting and valve surgery or aortic surgery) will be recruited from three metropolitan tertiary teaching hospitals. Patients allocated to the control group with receive usual care that is comprised of in‐patient discharge education and local paper‐based written discharge materials. Patients in the intervention group will be provided access to tailored 'GoShare' mHealth bundles preoperatively, in a week of hospital discharge and 30 days after surgery. The mHealth bundles are comprised of patient narrative videos, animations and links to reputable resources. Bundles can be accessed via a smartphone, tablet or computer. Bundles are evidence‐based and designed to improve patient self‐efficacy and self‐management behaviours, and to empower people to have a more active role in their healthcare. Computer‐generated permuted block randomization with an allocation ratio of 1:1 will be generated for each site. At the time of consent, and 30, 60 and 90 days after surgery quality of life and level of patient activation will be measured. In addition, rates of representation and readmission to hospital will be tracked and verified via data linkage 1 year after the date of surgery. Discussion: Interventions using mHealth technologies have proven effectiveness for a range of cardiovascular conditions with limited testing in cardiac surgical populations. Impact: This study provides an opportunity to improve patient outcome and experience for adults undergoing cardiac surgery by empowering patients as end‐users with strategies for self‐help. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000082808. [ABSTRACT FROM AUTHOR]

Aims: To study the future outcomes and health needs of chronic hepatitis C (CHC) patients after receiving direct-acting antiviral (DAA) therapy based on the health promotion perspectives and cardiometabolic risks in a rural setting. Design: This cross-sectional study was conducted from May to December 2019 in coastal western and southern Taiwan. Methods: We included CHC patients who were diagnosed and transferred by the gastroenterologist and hepatologist in outpatient clinics and completed DAA treatments. Data on demographic characteristics, health-related behaviours and physiological biomarkers were collected through one-on-one interview using a questionnaire and from medical records obtained from a teaching hospital. Results: In total, 124 participants were enrolled. Most participants (87.1%) had no side effects and 79.8% felt satisfied after treatment. However, 62.1% had metabolic syndrome, 48.4% had hypertension and 37.9% had diabetes. Furthermore, 71.8% patients were considered to have medium-to-high risk based on Framingham risk scores. In the multiple regression model, after adjusting for education level, other chronic diseases were negatively associated with health-promoting behaviours in participants. Conclusions: Although there were few side effects and most patients were satisfied after treatment, there was a high prevalence of cardiometabolic risk factors and cardiometabolic diseases and less adoption of healthy behaviours in CHC patients. Despite the small sample size, the study suggests that clinicians can reduce the burden of the aforementioned comorbidities by providing adequate treatment and individualized lifestyle modification. Impact: This study highlights that primary healthcare providers should consider the health needs of CHC patients after DAA treatment since many patients have high cardiometabolic risks, but only a few adopt a healthy lifestyle. Further studies are needed to initiate health-promoting programs for these patients to reduce further injury to vital organs. [ABSTRACT FROM AUTHOR]

Background: Chronic non‐cancer pain, which persists for at least three months, seriously affects quality of life. Chronic non‐cancer pain patients are usually managed by a multidisciplinary team using pharmacological and non‐pharmacological strategies. Nurses perform transcutaneous electrical nerve stimulation (TENS) and hypnosis, which are widely used in France for the treatment of chronic pain in pain departments. Objective: To assess pain relief at three months, comparing a simultaneous combination of hypnosis and TENS (intervention) with TENS alone (control). Design: Randomized controlled trial. Methods: Patients aged 18–80 years, suffering from chronic peripheral neuropathic and/or nociceptive non‐cancer pain were included (September 2013 to May 2017) and followed for six months. The primary outcome was the pain intensity difference (by visual analog scale score) between month 3 and baseline. The secondary outcomes, assessed at months 3 and 6, were SF36 score, analgesics consumption and number of TENS sessions performed at home (last seven days). Results: Seventy‐two patients were included, suffering from a combination of chronic non‐cancer nociceptive and neuropathic pain, with a mean pain intensity of about sixty out of a hundred. The results show an important pain reduction (forty percent) in both groups at 3 months. No significant difference was observed between the control and intervention groups. Similarly, SF36 score, change in analgesic intake and patient compliance did not differ significantly between groups. Conclusions: This is the first randomized controlled study showing a decrease of pain intensity and a high level of compliance with transcutaneous electrical nerve stimulation alone or associated to hypnosis. The combination does not seem to be more efficient than transcutaneous electrical nerve stimulation alone. Chronic non‐cancer pain remains a major issue and a substantial proportion of patients do not appear to benefit from interventions. Impact: This study increases our understanding of the combination of two non‐pharmacological methods in chronic non‐cancer pain patients. The combination of the two non‐pharmacological strategies did not appear to be more efficient than one alone. Further research on non‐pharmacological treatments targeting to patient's characteristics are needed to find appropriate strategies in patients with complex multidimensional pain conditions. Clinical Trial Number: NCT01944150 (Sept. 17, 2013). [ABSTRACT FROM AUTHOR]

Aims: Nurses are at the forefront of public health emergencies facing psychological pressures ensuing from the loss of patients and potential risk of infection while treating the infected. This study examines whether inclusive leadership has a causal relationship with psychological distress and to assess the mediation effect of psychological safety on this relationship in the long run. The hypotheses are developed and interpreted with the help of theoretical underpinnings from job demands resources theory and the theory of shattered assumptions. Design: Three‐wave longitudinal study. Methods: Questionnaire was used to carry out three waves of data collection from 405 nurses employed at five hospitals in Wuhan during the COVID‐19 outbreak between the months of January–April 2020. Partial least square structural equation modelling (PLS‐SEM) was used to analyze data while controlling for age, gender, education, experience, and working hours. Results: Results supported the hypothesized relationships where inclusive leadership indicated significant inverse causal relationship with psychological distress and a positive causal relationship with psychological safety. Mediation effect of psychological safety was found significant, while the model explained 73.9% variance in psychological distress. Conclusion: Inclusive leadership, through its positive and supportive characteristics, can pave way for such mechanisms that improve the psychological safety of employees in the long run and curbs psychological distress. Impact: This is the first longitudinal study to examine the relationship between inclusive leadership and psychological distress in health care and also examines the mediating mechanism of psychology safety. There is scarcity of empirical research on factors that determine and affect behavioural mechanism of healthcare workers during traumatic events and crisis. Clinical leaders and healthcare policy makers must invest in and promote inclusive and supportive environment characterized with open and accessible leaders at workplace to improve psychological safety; it helps reduce levels of psychological distress. [ABSTRACT FROM AUTHOR]

Aims: This study was conducted to describe and compare nurses' and inpatients' perceptions of caring attitudes and behaviours in rehabilitation. Methods: A comparative descriptive design was used. Perceptions of caring attitudes and behaviours were compared between 34 nurses working in rehabilitation and 64 elderly patients, using the Caring Nurse Patient Inventory‐23, to explore Watson's carative factors through four dimensions. Patients' and nurses' ratings of importance for each dimension were compared. The study data were collected from 8 November 2017 to 5 May 2018. Results: Patients' and nurses' responses showed high scores in terms of their perceptions of caring, with nurses having the higher scores, and significant differences were found between patients and nurses. Patients scored items linked to clinical aspects of caring as the most important, whereas nurses scored items linked to humanistic and clinical caring as equally important. Comfort care was considered important for nurses and patients. Both groups considered relational caring items as the least important. Conclusion: Results show that patients and nurses value clinical aspects of care, which is the visible aspect of care. The Caring Nurse Patient Inventory‐23 is a reliable instrument to measure the nurses' and patients' perception of caring behaviours in rehabilitation. SUMMARY STATEMENT: What is already known about this topic? A caring humanistic approach emphasizes the specific role of the nurse and is compatible with recent models of nursing in rehabilitation.Few studies have measured the perceptions of caring attitudes or behaviours among patients and nurses in the context of rehabilitation. What this paper adds? Patients scored items linked to clinical and comfort aspects of caring as the most important suggesting that patients value tangible aspects of caring.Nurses scored items linked to humanistic and clinical caring as equally important stressing the importance for nurses to link positive support and values to instrumental caring.Patients and nurses considered relational caring items as the least important; it may due to the problem solving and spiritual nature of this dimension of care, requiring a deeper involvement of nurses and patients. The implication of this paper: Nurses need to ensure their technical skills are up‐to‐date, even in a low technical environment such as rehabilitation.The Caring Nurse Patient Inventory‐23 was shown to be reliable for measuring patients' and nurses' perceptions of caring in rehabilitation. [ABSTRACT FROM AUTHOR]

Aims and objective: To investigate the effects on the quality of care of the Patient Report Informing Self‐Management Support (PRISMS) form compared with usual care among patients with chronic obstructive pulmonary disease (COPD) consulting a COPD nurse in primary health care. Background: Patients with COPD experience symptoms affecting their everyday lives, and there is a need for interventions in self‐management support. The delivery of chronic care in an organised, structured and planned manner can lead to more productive relationships between professionals and patients. Design: A multicentre randomised controlled trial with a post‐test design, according to the CONSORT checklist, in one intervention group (n = 94) and one control group (n = 108). Methods: In addition to usual care, the intervention group (n = 94) completed the PRISMS form to indicate areas where they wanted self‐management support before the consultation with the COPD nurse. This form comprises 17 items that patients with COPD commonly experience as problems. The control group received usual care (n = 108). The primary outcome was patients' satisfaction with quality of care, assessed using the Quality from the Patient's Perspective (QPP) questionnaire. Means and (SD) are presented where applicable. Differences between the intervention and control group were analysed with Student's t test for independent groups for interval data, and the Mann–Whitney U test for ordinal data. Results: Participants in the intervention group were more satisfied with the QPP domains "personal attention," regarding both "perceived reality" (p =.021) and "subjective importance" (p =.012). The PRISMS form revealed "shortness of breath" as the most commonly experienced problem and the issue most desired to discuss. Conclusion: The PRISMS form improved patient satisfaction with quality of care regarding personal attention, which is an important factor in patient participation and improving relationships and communication. Relevance to clinical practice: The PRISMS form can be a useful tool in improving person‐centred care when delivering self‐management support. Register Id: 192691 at http://www.researchweb.org/is/en/sverige/project/192691. [ABSTRACT FROM AUTHOR]

Aims: To investigate the impact of limited health literacy on 1‐year hospital readmission among both older men and women with heart failure. Design: Prospective cohort study. Methods: A total of 286 patients with heart failure (men = 144, women = 142) aged 65 years or older at baseline from two tertiary hospitals were enrolled from June–November 2017. Patients were followed up until November 2018. The Brief Health Literacy Screening Tool was used to assess baseline health literacy. One‐year readmission after discharge was assessed via medical records or telephone interview. A hierarchical logistic regression was performed. Results: The prevalence rates of limited health literacy and 1‐year hospital readmission among older women were 74.7% and 35.9%, respectively, compared with 48.6% and 27.1% in older men. Limited health literacy significantly increased the risk of 1‐year hospital readmission in both older men and women with heart failure. More importantly, older women with limited health literacy had a much higher risk of hospital readmission (odds ratio: 10.17, 95% confidence interval: 2.19–47.14) than did older men with limited health literacy (odds ratio: 5.27, 95% confidence interval: 2.04–13.59). Conclusions: Our findings highlight that a baseline assessment of health literacy would help prevent unplanned hospital readmissions after discharge in both older men and women with heart failure. Health professionals should recognize that women with limited health literacy are more vulnerable to re‐hospitalization than are men with limited health literacy. Impact: Few studies have addressed gender differences in the link between health literacy and hospital readmission among patients with heart failure. We found that older women with limited health literacy had a much higher risk of hospital readmission than did their male counterparts. Health professionals should be aware of gender differences in health literacy in discharge planning, including self‐management counselling for older patients with heart failure. [ABSTRACT FROM AUTHOR]

Aims: To explore whether educational information delivered via a medical smartphone app in conjunction with verbal and written instructions, compared with traditional booklet‐based and verbal instructions, could improve the quality of bowel preparation for hospitalized patients undergoing colonoscopy. Design: A prospective, single‐blinded, randomized controlled trial. Methods: We performed a prospective, endoscopist‐blinded, randomized, controlled trial at Qilu Hospital of Shandong University in China between October 2017–March 2018. Inpatients who are eligible, based on the inclusion criteria, were randomized into two groups. Both groups received oral and written instructions for bowel preparation. In addition, the smartphone app group received instructions through a medical smartphone app. The primary outcome was the rate of adequate bowel preparation according to the Boston bowel preparation scale score. The secondary outcomes included patient compliance with instructions on how to take laxatives, side effects and rates of adenoma detection. Results: A total of 293 patients were enrolled in this study. Demographic characteristics were comparable between the two groups. The χ2 test showed that the medical smartphone app group showed significant improvement in the rate of adequate bowel preparation compared with the control group (77.2% vs. 56.8%, p <.001). The adenoma detection rate (ADR) was significantly higher in the smartphone app group than in the control group (21.4% vs. 12.8%, p =.029) based on the χ2 test. The rates of incomplete compliance with instructions were 15.17% in the smartphone app group and 33.11% in the control group (p <.001) based on the χ2 test. The overall adverse events were 23.45% and 37.84% in the smartphone app and control groups, respectively (p =.008), based on the χ2 test. Conclusion: Instructions provided via a mobile social media app in conjunction with traditional verbal and written methods could improve the quality of bowel preparation, increase the ADR and decrease adverse effects. App instructions could be an effective addition to oral and written instructions for inpatients undergoing colonoscopy. Impact: This study suggested that clinical personnel could deliver information via smartphone as a powerful addition to traditional educational methods that could improve work efficiency and help patients increase the success rate of bowel preparation. Trial registration: Chinese clinical trial registration number: ChiCTR1900024666. [ABSTRACT FROM AUTHOR]

Aim: To identify the associations among posttraumatic stress, depressive and obsessive‐compulsive symptoms (OCS) in outpatients with psychological trauma and to examine the mediating effect of social provision. Background: Psychologically traumatized patients simultaneously experience depressive and OCS. Social provision may mediate multiple symptoms differently compared with social support. Design: Cross‐sectional and correlational study. Methods: Data were collected between August 2016–May 2017. Psychiatric outpatients (N = 151) completed a structured questionnaire consisting of the Korean versions of the Social Provision Scale, Beck Depression Inventory‐II, Maudsley Obsessional‐Compulsive Inventory and Impact of Event Scale–Revised. Structural equation modelling was used to examine the recursive association among the three symptoms and the mediation of social provision. Results: There was a recursive association between posttraumatic stress symptoms (PTSS) and depressive symptoms, which were simultaneously associated with OCS with a one‐way direction. OCS and social provision partially mediated these identified associations among three symptoms. Conclusions: Our findings provide insight into the complex associations of multiple symptoms experienced by traumatized outpatients and the partial mediation of social provision. Psychiatric and mental health professionals may enhance social functioning and interpersonal interactions based on social provision components used for helping traumatized patients with obsessive‐compulsive and depressive symptoms. Impact: There was a recursive association between PTSS and depressive symptoms that were simultaneously associated with OCS with a one‐way direction. Social provision functions as a partial mediator when working with OCS. Mental health nurses can develop social provision interventions for depressive symptoms for traumatized outpatients with OCS. [ABSTRACT FROM AUTHOR]

Aim: To develop and psychometrically test the distress thermometer for caregivers (DT‐C) and document the distress level in primary caregivers of children and adolescents diagnosed with schizophrenia. Design: A validation diagnostic accuracy study and descriptive cross‐sectional survey. Methods: DT‐C was adopted based on Harverman's distress thermometer for parents. The cut‐off score was detected by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale‐21 as a reference standard in a sample of 324 caregivers of children and adolescents diagnosed with schizophrenia in China collected between Jan 2017 and Feb 2018. Results: One‐item DT of DT‐C indicated a good retest reliability (r = 0.86) and one‐item DT and the Problem List (PL) indicated good convergent validity (r = 0.67–0.88). Overall and individual PL domains showed good internal consistency (KR 20 values ranged from 0.70–0.90). Setting seven as the cut‐off score, the values of sensitivity (0.72–0.81), specificity (0.86–0.90), Youden's index (0.61–0.70), positive predictive value (0.67–0.74), and negative predictive value (0.84–0.92) were most satisfactory and area under curve values showed significantly excellent discrimination (0.88–0.90). The average DT score for the 324 participants was 6.34 (SD 2.49), with 46.9% of the participants above the cut‐off. Caregivers above the cut‐off score faced significant multiple problems in practical, family/social, cognitive, emotional, and parenting domains. Conclusion: The DT‐C, with six domains containing 35 items in Problem List and with the cut‐off score at seven, can be a rapid screening tool to measure distress in these caregivers. The level of distress in caregivers was relatively high. Psychoeducation on specific needs and a solid mutual support network are recommended for mitigating caregivers' distress. Impact: This study adapted a reliable DT‐C to measure distress of caregivers, which has the potential to be introduced to caregivers of other types of child and adolescent mental disorders in research, assessments and care planning for health professionals. [ABSTRACT FROM AUTHOR]

Aim: To explore the relationship between ethical climate (EC) and nurses' service behaviours (SB) and examine the moderating effect of nurses' employment type. Background: As most public hospitals in China implement the "dual‐track system" of nurses' employment, the two different types of nurses, contract‐employed nurses and state‐employed nurses, receive the different pay for the same work, which results in they providing different SB. It has become critical for hospital administrators and nursing managers to understand better the state of two groups of nurses and to find an effective method to improve the service level of the nursing workforce. Design: Stepwise multiple regression analyses of survey data collected in June and July 2017 from Chinese nurses employed in three tertiary hospitals. Methods: Chinese nurses (298 of 350 [85.1%]) were interviewed using the Ethical Climate Scale and Nurses' Service Behaviour Scale. Data were analysed statistically using descriptive statistics, confirmatory factor analysis, correlation coefficients (Pearson), two‐tailed t‐test and stepwise multiple regression analyses were conducted to test the proposed hypotheses. Data were analysed using SPSS and AMOS. Results: There were statistically significant correlations between EC and nurses' extra‐role service behaviour (ERSB) and overall service behaviour and nurses' employment type moderated the proposed relationships. Conclusion: Healthcare institutions should pay more attention to cultivate EC and implement new incentive mechanism to better stimulate nurses to provide ERSB. [ABSTRACT FROM AUTHOR]

Background: Social cognitive career theory (SCCT) can explain the mechanism underlying the formulation of nurse turnover intention. However, little is known about the role of professional commitment in such a mechanism. Aims: The aim of this study was to explore how elements of SCCT have an impact on the three aspects of professional commitment and thus nurses' intention to leave the profession. Design: This study used surveys to collect two‐wave data. Methods: The participants were sampled in all available units of a major medical centre in 2017. By using proportionate random sampling methods, we successfully followed up a representative sample of 524 full‐time nurses. Most participants (98.1%) were female. Items came from Cunningham et al.'s Self‐Efficacy Scale, Outcome Expectations Scale, Human Capital Scale and Vocational Interest Scale; Meyer et al.'s Professional Commitment Scale; and Teng et al.'s Turnover Intention Scale. Structural equation modelling was used to test the hypotheses. Results: Self‐efficacy was positively related to outcome expectation. Outcome expectation was positively related to career interest. Career interest was positively related to affective professional commitment. Human capital was positively related to normative professional commitment. Affective professional commitment was positively related to intention to improve professional capabilities, which was further negatively related to intention to leave the profession. Conclusion: Aspects of professional commitment are important process variables in the impact of self‐efficacy and outcome expectation on nurses' turnover intention. [ABSTRACT FROM AUTHOR]

Objective: To examine the characteristics of the social networks of families living with parental cancer and the kind of social support they provide compared with what the families report having received. Background: Parental cancers are highly distressing for both parents and children. Among other concerns, families report a severe lack of social support. However, we know little about these families' private social networks, nor support provided and received as reported by network members and the family. Methods: Using a descriptive cross‐sectional design, 16 families living with parental cancer and 130 of their network members participated. Healthy parents and network members filled out The Assistance Questionnaire‐Receivers of support (AQR)/The Assistance Questionnaire‐Providers of Support (AQP). Results: Network members were mainly resourceful friends (44%) and family members (42%). Only 1/3 became supporters at diagnosis, and nearly 50% had to be asked. Supporters provided a variety of types of help, especially emotional support. A match between the perception of the healthy parent and that of the network members was found for provided (p = 0.211) and received (p = 0.741) support. Supporters were satisfied with their provided support, experiencing it as rewarding and associated with few negative aspects. The STROBE checklist for observational studies was followed in reporting the results. Conclusions: The social networks, being mainly family and friends, were able to provide different types of help, especially emotional support. A useful suggestion may be to involve supporters at an earlier stage, providing more practical support. Relevance for clinical practice: Nurses are in a unique position to promote social support for families living with parental cancer by embracing a network focus, by emphasising the importance and potential of social support, by helping families to map their network and by teaching them how to be explicit in their requests for support. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the feasibility and effects of the WeChat‐based life review programme on anxiety, depression, self‐transcendence, meaning in life and hope among cancer patients. Background: Life review is effective in improving the psychospiritual well‐being of palliative patients. However, traditional life review programmes are limitedly applied in clinical practice. Design: A non‐concurrent controlled quasi‐experimental design. Methods: Ninety‐two cancer patients were recruited from April 2017 – February 2018, with 44 patients in the control group receiving routine care and 48 in the experimental group receiving a 6‐week WeChat‐based life review programme plus routine care. Compliance with the programme, difficulty in participation and satisfaction with the programme were used to explore its feasibility. Anxiety, depression, self‐transcendence, meaning in life and hope were measured at baseline and immediately after the programme. Results: All experimental participants who completed the programme used the WeChat platform; 39 participants had no difficulties in operating the platform and 40 were satisfied with the programme. Statistically significant effects were identified on anxiety, depression and self‐transcendence. An increase in the levels of meaning in life and hope was observed in the experimental group after the programme. Conclusion and impact: The innovative WeChat‐based life review programme is an effective non‐pharmacological intervention in improving psychospiritual well‐being of community‐dwelling cancer patients. It could be integrated into transitional care for cancer patients. Future research with rigorous design is necessary to test the effects online life reviews among cancer patients. Trial registration: This study was registered on the Chinese Clinical Trial Registry (Registration No: ChiCTR‐IOR‐17011998). [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the current state of face‐to‐face bullying and cyberbullying among nurses in the workplace and to identify the effects of nursing organisational culture on face‐to‐face bullying and cyberbullying. Background: It is important to accurately examine the current state of workplace bullying to acknowledge the gravity of the situation faced by nurses and devise prevention strategies. Electronic communication by computer or smartphone is widely used as a prompt and efficient means of facilitating nursing work; however, this leads to the possibility of cyberbullying as well as face‐to‐face bullying among nurses. Design: Descriptive cross‐sectional study. Methods: A total of 226 staff nurses working in one of five upper tertiary hospitals in Korea with a career of 10 years or shorter were surveyed using a self‐reported questionnaire. The collected data were evaluated using various statistical analyses, including hierarchical regression. Our study was applied to the STROBE checklist of items. Results: The mean face‐to‐face bullying score was 1.32 ± 0.53 and the cyberbullying score was 1.14 ± 0.37 (possible range: 1–5); most were work‐related negative experiences. The explanatory power of nursing organisational culture for face‐to‐face bullying was 6.3%, and relation‐oriented culture and hierarchy‐oriented culture were major factors affecting face‐to‐face bullying. The explanatory power of nursing organisational culture for cyberbullying was 4.3%, and relation‐oriented culture was a major factor affecting cyberbullying. Conclusions: Relation‐oriented culture had a significant effect on both face‐to‐face bullying and cyberbullying. Therefore, organisations should strive to foster a relation‐oriented nursing organisational culture in order to prevent and resolve workplace bullying among nurses. Relevance to clinical practice: Cyberbullying should be addressed as an important type of workplace bullying in nursing, which occurs via various information and communication devices. To prevent workplace bullying among nurses, various strategies that promote relation‐oriented nursing organisational cultures should be considered. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the associations between nurse staffing and the incidence and severity of hypoxaemia, arterial hypotension and bradycardia of postoperative patients during their postanaesthesia care unit stay. Background: Nurse understaffing has been associated with adverse patient outcomes in a variety of hospital settings. In the postanaesthesia care unit, nursing shortage is common and can be related to compromised prevention, detection and treatment of adverse events. Design: Observational, single‐centre, prospective study that adhered to Strengthening the Reporting of Observational studies in Epidemiology checklist (see Supporting information Appendix S1); 2,207 patients admitted to the postanaesthesia care unit of a tertiary care hospital over a 5‐month period were enrolled. Methods: Incidence of hypoxaemia (arterial oxygen saturation <95%), arterial hypotension (systolic blood pressure <90 mmHg) and bradycardia (heart rate <50 beats per minute), along with episode severity, was recorded. Patients were classified into three groups as follows: sufficient staffing, low and high understaffing. Risk for hypoxaemia, arterial hypotension and bradycardia was adjusted according to patient, anaesthesia and operation characteristics. Results: The incidence of hypoxaemia was significantly higher in the high understaffing group patients, while the incidence of arterial hypotension was significantly higher in both low and high understaffing group patients, compared to sufficient staffing group ones. In the high understaffing group patients, hypoxaemia and arterial hypotension episodes were of significantly higher severity. Conclusions: These associations between hypoxaemia and arterial hypotension and postanaesthesia care unit understaffing indicate that care quality and patient safety can be compromised in case patient acuity is not matched with sufficient nursing resources. Relevance to clinical practice: Higher incidence of hypoxaemia and arterial hypotension advocates for the prevention of imbalances between patient number and care demands and the number of available nurses. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine the views of nurses and physicians working in intensive care units (ICU) about the aims of glycaemic control and use of their protocols. Background: Evidence about the optimal aims and methods for glycaemic control in ICU is controversial, and current local protocols guiding practice differ between ICUs, both nationally and internationally. The views of professionals on glycaemic control can influence their practice. Design: Cross‐sectional, multicentre, survey‐based study. Methods: An online short survey was sent to all physicians and nurses of seven ICUs, including questions on effective glycaemic control, treatment of hypoglycaemia and deviations from protocols' instructions. STROBE reporting guidelines were followed. Results: Over half of the 40 respondents opined that a patient spending <75% admission time within the target glycaemic levels constituted poor glycaemic control. Professionals with more than 5 years of experience were more likely to rate a patient spending 50%–74% admission time within target glycaemic levels as poor than less experienced colleagues. Physicians were more likely to rate a patient spending <50% admission time within target as poor than nurses. There was general agreement on how professionals would rate most deviations from their protocols. Nurses were more likely to rate insulin infusions restarted late and incorrect dosage of rescue glucose as major deviations than physicians. Most professionals agreed on when they would treat hypoglycaemia. Conclusions: When surveyed on various aspects of glycaemic control, ICU nurses and physicians often agreed, although there were certain areas of disagreement, in which their profession and level of experience seemed to play a role. Relevance to clinical practice: Differing views on glycaemic control amongst professionals may affect their practice and, thus, could lead to health inequalities. Clinical leads and the multidisciplinary ICU team should assess and, if necessary, address these differing opinions. [ABSTRACT FROM AUTHOR]

Aim: To assess the factors associated with the knowledge and expectations among the general public about dispatcher assistance in out‐of‐hospital cardiac arrest incidents. Background: In medical dispatch centres, emergency calls are frequently operated by specially trained nurses as dispatchers. In cardiac arrest incidents, efficient communication between the dispatcher and the caller is vital for prompt recognition and treatment of the cardiac arrest. Design: A cross‐sectional observational survey containing six questions and seven demographic items. Method: From January–June 2017 we conducted standardized interviews among 500 members of the general public in Norway. In addition to explorative statistical methods, we used multivariate logistic analysis. Results: Most participants expected cardiopulmonary resuscitation instructions, while few expected "help in deciding what to do." More than half regarded the bystanders present to be responsible for the decision to initiate cardiopulmonary resuscitation. Most participants were able to give the correct emergency medical telephone number. The majority knew that the emergency call would not be terminated until the ambulance arrived at the scene. However, only one‐third knew that the emergency telephone number operator was a trained nurse. Conclusion: The public expect cardiopulmonary resuscitation instructions from the emergency medical dispatcher. However, the majority assume it is the responsibility of the bystanders to make the decision to initiate cardiopulmonary resuscitation or not. Based on these findings, cardiopulmonary resuscitation training initiatives and public campaigns should focus more on the role of the emergency medical dispatcher as the team leader of the first resuscitation team in cardiac arrest incidents. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the influence of spirituality to depression and to determine the moderating effect of occupational stress among Registered Nurses. Background: Depression is a major contributor to the global burden of disease and it is influenced by several factors. Spirituality can be a protective factor against depression. However, it remains underexplored among nurses who experience several precipitating factors of depression, including occupational stress. Design: Cross‐sectional, predictive‐correlational study. Methods: From August ‐ December 2017, 242 purposively selected nurses from selected tertiary hospitals completed a four‐part survey packet composed of the "robotfoto," Spirituality Assessment Scale, Expanded Nursing Stress Scale, and Beck's Depression Inventory‐II. Structural equation modelling analysed the influence of spirituality to depression, while multigroup analysis determined the moderating effect of occupational stress. Results: "Personal faith, spiritual contentment, and religious practice" negatively influenced depression, generating a good model. Occupational stress significantly moderated the influence of spirituality to depression, with a significant inverse U‐shaped effect for both "personal faith" and "religious practice" and a non‐significant decreasing effect for "spiritual contentment". Conclusion: The stress‐moderated model of the influence of spirituality to depression highlights three significant points. First, there is a need to develop individualized, spiritually based interventions based on the spiritual needs of Registered Nurses. Second, policies geared towards positive spirituality in the workplace and spiritual support to nurses must be explored. Finally, nurse managers must identify the sources of occupational stress and implement stress‐reducing programmes in the workplace. [ABSTRACT FROM AUTHOR]

Aim: To develop and validate a predictive model for falls in hospitalized adult clinical and surgical patients, assessing intrinsic (i.e. patient‐related) and extrinsic factors (i.e. care process‐related). Background: To identify factors predictive of falls and enable appropriate management of fall risk it is necessary to understand patient and environmental factors, along with care delivery processes. Design: A matched case–control study. Methods: This study was conducted in the medical and surgical wards of a Brazilian teaching hospital. The sample included 536 patients, with data collected in 2013–2014. Data analysis included descriptive statistics and conditional logistic regression. Cases of patients aged 18 years or older who fell while hospitalized were included. One patient who did not fall during hospitalization, matched by sex, ward and admission date, was selected as a control for each included case. Results: The SAK Fall Scale (Severo‐Almeida‐Kuchenbecker) was developed and validated. The scale includes seven variables: disorientation/confusion, frequent urination, walking limitations, lack of caregiver, postoperative status, previous falls and number of medications administered within 72 hr prior to the fall. This scale showed acceptable predictive accuracy. Conclusions: The newly developed SAK Fall Scale includes five intrinsic and two extrinsic variables and differs from other predictive scales for falls. The findings of this study are broad and the scale, which is easy to apply, can be used worldwide by nurses in health services. In advanced practice, the testing of a new model for fall risk contributes to preventive interventions and thus has an impact on patient safety. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of an interactive, avatar‐based education application to improve knowledge of and response to heart attack symptoms in people who are at risk of a heart attack. Background: Poor knowledge of heart attack symptoms is recognized as a significant barrier to timely medical treatment. Numerous studies have demonstrated that technology can assist in patient education to improve knowledge and self‐care. Design: A single‐center, non‐blinded, two parallel groups, pragmatic randomized controlled trial. Methods: Seventy patients will be recruited from the coronary care unit of a public hospital. Eligible participants will be randomized to either the usual care or the intervention group (usual care plus avatar‐based heart attack education app). The primary outcome of this study is knowledge. Secondary outcomes include response to heart attack symptoms, health service use and satisfaction. Study participants will be followed up for 6 months. Discussion: This study will evaluate the avatar‐based education app as a method to deliver vital information to patients. Participants' knowledge of and response to heart attack symptoms, and their health service use, will be assessed to evaluate the intervention effectiveness. [ABSTRACT FROM AUTHOR]

Abstract: Aims and objectives: If the knowledge and health beliefs relating to gestational diabetes mellitus during pregnancy are associated with behaviours during pregnancy and lactation, this suggests potential educational interventions. Backgrounds: Women with gestational diabetes mellitus are more likely to develop type 2 diabetes mellitus, and babies with gestational diabetes mellitus incur increased risk of neonatal hypoglycaemia and childhood obesity. Breastfeeding is an effective way to improve maternal and lipid metabolism of gestational diabetes mothers, and to lower the risk of type 2 diabetes mellitus after birth, to prevent conception. Nurses have an important role in encouraging mothers to breastfeed for health promotion. The importance of cognitive factors such as knowledge, beliefs and attitudes is emphasised to increase the breastfeeding rate and to improve the quality of breastfeeding for pregnant women. Little research has been undertaken exploring cognitive factors and breastfeeding intention. Design: Cross‐sectional descriptive survey in healthy pregnant women. Methods: A questionnaire about gestational diabetes mellitus‐related knowledge and health beliefs of gestational diabetes mellitus management composed of perceived susceptibility, severity, benefits, barriers and self‐efficacy was developed by investigators. The association of two predictor variables of interest, gestational diabetes mellitus‐related knowledge and health beliefs of gestational diabetes mellitus management, was tested with the outcome variable, breastfeeding intention, using chi‐square test, t test, ANOVA and multiple logistic regression. Results: Two hundred and thirty‐seven of the 250 participants returned questionnaires for a final response rate of 94.8%. Breastfeeding intention after childbirth was associated with stronger perceived benefit, higher levels of self‐efficacy and lower alcohol consumption. Conclusion: History of drinking and health beliefs such as perceived benefits and self‐efficacy were highly associated with breastfeeding intention relating to gestational diabetes mellitus. Education for breastfeeding in gestational diabetes mellitus mothers should focus upon the benefit of breastfeeding and strengthening self‐efficacy. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known of the subject: Burnout is a major concern within the NHS impacting negatively on mental healthcare professionals. Evidence suggests that burnout can lead to reduced productivity and reduced quality of care for patients. Mindfulness‐based interventions (MBIs) have demonstrated effectiveness in mitigating burnout for healthcare professionals. What the paper adds to existing knowledge: This paper reinforces the positive outcomes within the current literature that MBIs can help reduce burnout amongst mental healthcare professionals. The strength of the paper is that it reports significant correlations between decreased burnout following an increase in mindfulness. No previous research has examined this area and this is the first study to do so. The participants within this study demonstrated increased personal accomplishment and decreased emotional exhaustion following an 8‐week MBCT course which was maintained at 6‐month follow‐up. What are the implications for practice: Occupational departments should consider MBI's as part of a package of care for mental healthcare staff as a preventative intervention or as a means of reducing burnout amongst healthcare staff that are currently experiencing emotional and physical exhaustion. Abstract: Introduction: Burnout is a major concern within the NHS impacting negatively on mental healthcare professionals. Evidence suggests that burnout can lead to reduced productivity and reduced quality of care for patients. Mindfulness‐based interventions (MBIs) have demonstrated effectiveness in mitigating burnout for healthcare professionals; however, no previous research has directly reported correlations between burnout and mindfulness. Aim: Does mindfulness‐based cognitive therapy (MBCT) reduce burnout amongst mental healthcare professionals and are there any direct correlations between mindfulness and burnout itself? Method: This effectiveness study evaluated a series of 8‐week (MBCT) groups adapted for healthcare professionals. Participants completed the Maslach Burnout Inventory (MBI) and Friedberg Mindfulness Inventory (FMI) at pre, post and 6‐month follow‐up. Results: Analysis revealed overall significance and large effect sizes on all three subscales of the MBI and the FMI. There were significant correlations in mindfulness when burnout was reduced. Discussion: These results suggest that MBCT groups for healthcare professionals offer a promising intervention for reducing burnout. Implications for Practice: Occupational departments could consider MBI's as part of a package of care for mental healthcare staff as a preventative intervention or as a means of reducing burnout amongst healthcare staff. [ABSTRACT FROM AUTHOR]

ABSTRACT: We review developments in conducting inference for model parameters in the presence of intertemporal and cross‐sectional dependence with an emphasis on panel data applications. We review the use of heteroskedasticity and autocorrelation consistent (HAC) standard error estimators, which include the standard clustered and multiway clustered estimators, and discuss alternative sample‐splitting inference procedures, such as the Fama–Macbeth procedure, within this context. We outline pros and cons of the different procedures. We then illustrate the properties of the discussed procedures within a simulation experiment designed to mimic the type of firm‐level panel data that might be encountered in accounting and finance applications. Our conclusion, based on theoretical properties and simulation performance, is that sample‐splitting procedures with suitably chosen splits are the most likely to deliver robust inferential statements with approximately correct coverage properties in the types of large, heterogeneous panels many researchers are likely to face. [ABSTRACT FROM AUTHOR]

Aims: This study explored the impact of menopause on sexual health and marital relationships, the associated factors and the support needed among middle-aged and older women. Background: Although women experiencing menopause are more vulnerable to sexual health and marital problems, few studies have addressed this topic. Design: A mixed methods design was used, comprising primarily quantitative methods with a qualitative component to evaluate the impact of menopause on sexual health. Methods: Eligible women from community-based women centre in Hong Kong were recruited for a survey. The Female Sexual Function Index (FSFI) was used to evaluate sexual function and risk factors for developing sexual dysfunction. Purposively selected women were invited to participate in in-depth individual interviews to explore the impact of menopause on sexual health, the barriers encountered and the desired support. Findings: In total, 540 respondents completed the survey with response rate of 59.7% where 30 respondents participated in the in-depth individual interview. The prevalence of sexual dysfunction in the overall respondents and postmenopause were 85.1% and 91.2% respectively. Depression was found as a strong factor associated with sexual dysfunction. The qualitative data showed that menopause had a considerable negative impact on women's sexual lives. Vaginal dryness and low sexual desire were most commonly reported. Knowledge, financial support and family understanding were important to helping women manage menopause. Conclusion: This study gives further knowledge for healthcare providers and policy makers to develop appropriate strategies and deliver suitable services to improve the quality of sexual health of menopausal women. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The study aim was to determine the direct and indirect relations of the five‐factor model of personality traits and work stress with professional quality of life in neonatal nurses. Background: Neonatal intensive care nursing has positive and negative effects on neonatal nurses’ psychological well‐being. Although individual and situational factors interact to influence professional quality of life, there have been few studies of these relationships in neonatal nurses. Design: A cross‐sectional study conducted in 2016. Methods: Self‐report questionnaires were used to measure professional quality of life (burnout, secondary traumatic stress and compassion satisfaction), five‐factor model of personality traits (neuroticism, agreeableness, extraversion, conscientiousness and openness) and work stress (role ambiguity, role conflict and role overload). Results: One hundred and forty (34%) of 405 eligible neonatal nurses provided the data. After controlling for work stress, neuroticism and agreeableness were related to burnout, neuroticism was related to secondary traumatic stress, and extraversion was related to compassion satisfaction. Work stress controlled for personality traits was related to burnout and secondary traumatic stress, but not to compassion satisfaction. Neuroticism moderated the effect of work stress on secondary traumatic stress and agreeableness and openness moderated the effect of work stress on compassion satisfaction. Work stress mediated the effect of neuroticism and extraversion on burnout and the effects of extraversion and conscientiousness on compassion satisfaction. Conclusion: Strategies to reduce work stress may not lessen burnout and secondary traumatic stress or increase compassion satisfaction in neonatal nurses who are prone to high neuroticism, low agreeableness and low extraversion. [ABSTRACT FROM AUTHOR]

Abstract: Background: Undergoing surgery is an anxious experience for children. Applying anxiety reduction age‐appropriate programs by nurses would be beneficial in reducing anxiety to children. Aim: To test the effectiveness of age‐appropriate preoperative information session in reducing anxiety levels of school‐age children undergoing elective surgery in Jordan. Design: The study used a quasi‐experimental design. Methods: One hundred and twenty‐six children were recruited from an educational hospital in Amman from January to June 2012 and were randomly assigned to intervention and control groups. The anxiety levels of children were assessed using the State Anxiety Scale for children, and children's levels of cooperation after surgery were assessed using Children Emotional Manifestation Scale. The heart rate and blood pressure of children were also measured 1 hour before going to operation room. Results: The study results revealed that children in the intervention group reported lower anxiety levels and more cooperation than children in the control group. Also, they displayed lower heart rate and blood pressure than children in the control group. Conclusion: The application of age‐appropriate preoperative intervention for children could be beneficial in decreasing anxiety levels and increasing their cooperation post surgery. [ABSTRACT FROM AUTHOR]

Aim and objectives: To estimate the relationship of sleep quality with health‐related quality of life (HRQOL) in persons with diabetes mellitus type 2 (DMT2) living in the United Arab Emirates (UAE). Background: DMT2 is an epidemic health condition in the UAE that has enormous impacts on heath, and consequent effects on HRQOL. However, because of an absence of screening for quality of sleep, people with DMT2 who experience poor sleep are likely to go untreated, which may compound the distressing impacts of DMT2 on their HRQOL. Design: This is a cross‐sectional quantitative research design. Methods: A sample of 268 participants with DMT2 were recruited from community healthcare settings in the UAE using cluster sampling. Participants completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI) and the World Health Organization HRQOL. Data analysis used descriptive and correlational statistics. Results: Of the 268 participants, 34% identified as “poor sleepers” and 55% had poor HRQOL. Poor sleepers showed significantly lower scores for HRQOL than good sleepers. The global PSQI scores were found to be independently predictive of global HRQOL. Subjective perceptions of sleep quality, the use of sleep medications and impaired daytime functioning were the variables found to have the highest correlations with global HRQOL and its four domains. Conclusions: This study found that people with DMT2 who indicate experiencing poor quality sleep are more likely to show a negative correlation with HRQOL. Additional research is needed to investigate how poor sleep may impact the health of people with DMT2. Relevance to clinical practice: Findings suggest that assessment of sleep quality should be an essential component of diabetes care. Understanding sleep practices may aid public health practitioners and other healthcare providers in the design of culturally appropriate interventions to improve sleep quality in persons with DMT2. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To assess the effectiveness of non‐pharmacological interventions for pregnant women with symptoms of mild to moderate anxiety. Background: Many pregnant women experience mild to moderate symptoms of anxiety and could benefit from additional support. Non‐pharmacological interventions have been suggested for use during pregnancy. Design: A systematic review of randomized controlled trials. Data sources: Randomized controlled trials published since 1990, identified from electronic databases: Medline; CINAHL; Maternity and Infant Care; PsycINFO; Cochrane Database of Systematic Reviews; CENTRAL; EMBASE; Centre for Reviews and Dissemination; Social Sciences Citation Index; ASSIA; HTA Library; Joanna Briggs Institute Evidence‐Based Practice database; Allied and Complementary Medicine. Review methods: Conducted according to the Centre for Reviews and Dissemination procedure. Papers were screened (N = 5,222), assessed for eligibility (N = 57) and selected for inclusion (N = 25). The Cochrane Collaboration's tool for assessing risk of bias was used. Papers were assessed for clinical and statistical heterogeneity and considered for meta‐analysis. Descriptive analysis of the data was conducted. Results: Psychological, mind‐body, educational and supportive interventions were delivered individually and to groups of pregnant women over single or multiple sessions. The State‐Trait Anxiety Inventory was the most commonly used anxiety measure. In 60% of studies there were fewer than 40 participants. Meta‐analysis of three studies indicated no observed beneficial effect in the reduction of anxiety. Conclusion: There was insufficient evidence from which to draw overall conclusions regarding the benefit of interventions. Results were predominantly based on small samples. Many papers provided an inadequate description of methods which prevented a full assessment of methodological quality. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The aim of this study was to understand the context of the inpatient setting for the treatment of anorexia nervosa and the implications for the therapeutic alliance between nurses and consumers. Background: The nature of the therapeutic alliance is dependent on the contextual factors that influence interactions. The inpatient setting for the treatment of anorexia nervosa is one such setting where the therapeutic alliance is operative, yet challenging and poorly understood. Design: A two‐phase explanatory sequential design was employed. Descriptive statistics from phase one informed phase two interviews. Phase two data were analysed through thematic analysis. Methods: A convenience sample of nurses and consumers were recruited from six wards, in five hospitals. Phase one involved the completion of a survey (N = 128) that measured the strength of the therapeutic alliance, as well as other elements of ward context. Phase two interviews (N = 54) were focused on the therapeutic alliance between nurses and consumers and the implications of the inpatient setting. Data collection occurred between May 2014 ‐ February 2015. Results: Anorexia nervosa as an illness carries destructive implications for the quality of the therapeutic alliance. Nurses’ intimate position in the inpatient setting and interpersonal capacity is influential in overcoming the obstacles that impede the therapeutic alliance. Conclusion: Nurses’ capacity for developing therapeutic alliances is in part dependent on a supportive ward organization and the adequacy of resources to permit meaningful interactions with consumers with anorexia nervosa. Understanding the contextual factors specific to the inpatient setting enhances nurses’ ability to develop therapeutic alliances. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The objective of this study was to test the psychometric properties of the Parental Feeding Behaviours Questionnaire (PFBQ) to measure feeding behaviours of Indonesian parents of toddlers (young children). Methods: A total of 696 parents of toddlers were obtained by convenience sampling during September 2013 to April 2014. To validate the PFBQ, confirmatory factor analysis and the contrasted group technique were conducted. Reliability of this instrument was examined by construct reliability and test‐retest reliability. Results: Results showed that the regression coefficients of all 56 indicators were statistically significant (P < 0.001). The contrasted group technique showed significantly different parental feeding behaviours between parents of well‐nourished and malnourished toddlers (P = 0.047). The test‐retest reliability of the PFBQ was acceptable (Pearson correlation = 0.644), and the construct reliability ranged from 0.88 to 0.96. Conclusions: The PFBQ is a valid and reliable instrument; however, more studies are required to identify acceptable tools to measure more culturally diverse range of parental feeding behaviours. [ABSTRACT FROM AUTHOR]

Abstract: Aim: We examined the effects of a family‐support programme for pregnant women with foetal abnormalities in terms of family support, depression, and post‐traumatic stress symptoms. Method: A randomized controlled trial was conducted from November 2016 to June 2017. A total of 124 pregnant women with foetal abnormalities were recruited and randomly assigned to the intervention group that received a family‐support programme or control group that received only routine care. Self‐reported questionnaires including the Family Adaptation Partnership Growth Affection and Resolve Index, the Edinburgh Postnatal Depression Scale, and the Impact of Event Scale‐Revised were administered before and after intervention. Results: Relative to the control group, posttest Family Adaptation Partnership Growth Affection and Resolve Index scores and scores on the intimacy domain were significantly higher in the intervention group, the Edinburgh Postnatal Depression Scale and Impact of Event Scale‐Revised scores and the scores on all subscales except the intrusion subscale were significantly lower in the intervention group. Conclusion: The findings of this study suggest that family‐support programme represents an effective and feasible support approach of improving family support and reducing depression and post‐traumatic stress symptoms for pregnant women with foetal abnormalities requiring pregnancy termination. [ABSTRACT FROM AUTHOR]

Aims and objectives: To assess the levels of health literacy of Italian caregivers of patients with heart failure. Background: Health literacy is related to patients’ health outcomes. Low health literacy has been found in older people with heart failure, and less is known on the health literacy of caregivers whose patients are suffering from heart failure. Design: Observational, multicentre, cross-sectional study. Methods: From July 2015–May 2016, caregivers were recruited in five hospitals from Central and Southern Italy. To assess health literacy, the Italian version of the Short Test of Functional Health Literacy tool was used. Results: A total of 173 caregivers participated in the research, the majority being females (60.1%), aged between 46–60 years (52.6%) and 96 (55.5%) were from Central Italy. 33.5% of caregivers were patients’ children, and 16.2% were paid caregivers of foreign origins. The average level of health literacy was adequate; however, lower levels were found among patients’ spouses and those of older age. Conclusion: Our results, in contrast with previous studies, showed adequate health literacy levels of caregivers. However, caregivers older in age and with a low education level showed the lowest health literacy, emphasising the need for healthcare workers, to check caregivers’ health literacy, before entrusting them with the care of patients. Relevance to clinical practice: As this research gives, for the first time, an overview on Italian caregivers’ levels of health literacy, its results may be used to improve Italian healthcare professionals’ knowledge of caregivers’ health literacy, before entrusting them with the care of patients. [ABSTRACT FROM AUTHOR]

Aim To develop and compare a nurse-led smartphone-based self-management programme with an existing nurse-led diabetes service on health-related outcomes for people with poorly controlled type 2 diabetes in Singapore. Background Over the past decades, Asia has emerged as the 'diabetes epicentre' in the world due to rapid economic development, urbanization and nutrition transition. There is an urgent need to develop more effective care management strategies in response to this rising diabetes epidemic. Design A randomized controlled trial with pre- and repeated posttests control group design. Methodology A total of 128 adults with poorly controlled type 2 diabetes will be recruited from the diabetes clinic of a public acute hospital in Singapore through convenience sampling. Study participants will be randomly allocated either to the experimental group or the control group. Outcome measures will include the 10-item General Self-Efficacy Scale, 11-item Revised Summary of Diabetes Self-care Activities and 19-item Diabetes-Dependent Quality of Life. Data will be collected at three time points: baseline, 3 and 6 months from the baseline. Discussion It is expected that this programme will be an alternative offered to diabetes patients to master their self-care management skills, in addition to the existing diabetes service provided in diabetes clinics in Singapore hospitals. Furthermore, the self-supporting and less resource-intensive nature of this programme, using a smartphone application as the mode of intervention delivery, will greatly reduce nurses' direct contact time with patients and allow more time to be allocated to those who require more attention. The study has been registered with ClinicalTrials.gov. The trial registration number is NCT03088475. [ABSTRACT FROM AUTHOR]

Aims To examine the sleep characteristics of infants with parentally reported sleep problems, with parentally reported no sleep problems and with parentally reported uncertain sleep conditions. Background Infant sleep problems are recognized as a major health issue worldwide. However, in our daily clinical practices, it is not uncommon for parents not to know whether their infant sleep is problematic. Design and Methods A prospective study conducted between 2012 - 2015 where 219 parents completed questionnaires and infants wore an actigraph monitor for 7 days. Multinomial logistic regression models were used to evaluate the actigraphic and parentally reported infant sleep behaviours between the groups. Results Thirty-two (14.61%) parents did not know whether their infant sleep was problematic and 118 (53.88%) parents considered their infant sleep a problem. Compared with infants without sleep problems, infants with uncertain sleep conditions had significantly increased odds of having shortened longest sleep duration according to parental report. A significant association was found for infants without sleep problems compared with those with sleep problems who had significantly more wake after sleep onset as measured by actigraphy, as well as reduced longest sleep duration according to parental report. Conclusion Infants with uncertain sleep conditions have the same problematic sleep behaviours resembling those of children with reported sleep problems. Healthcare professionals should actively disseminate sleep knowledge to help parents interpret infant sleep behaviours and consider possible intervention strategies for improving parental sleep-related knowledge and infant sleep. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate the usefulness of comprehensive nursing assessment as a strategy for determining the risk of delirium in older in-patients from a model of care needs based on variables easily measured by nurses. Background There are many scales of assessment and prediction of risk of delirium, but they are little known and infrequently used by professionals. Recognition of delirium by doctors and nurses continues to be limited. Design and methods A case-control study. A specific form of data collection was designed to include the risk factors for delirium commonly identified in the literature and the care needs evaluated from the comprehensive nursing assessment based on the Virginia Henderson model of care needs. We studied 454 in-patient units in a basic general hospital. Data were collected from a review of the records of patients' electronic clinical history. Results The areas of care that were significant in patients with delirium were dyspnoea, problems with nutrition, elimination, mobility, rest and sleep, self-care, physical safety, communication and relationships. The specific risk factors identified as independent predictors were as follows: age, urinary incontinence, urinary catheter, alcohol abuse, previous history of dementia, being able to get out of bed/not being at rest, habitual insomnia and history of social risk. Conclusions Comprehensive nursing assessment is a valid and consistent strategy with a multifactorial model of delirium, which enables the personalised risk assessment necessary to define a plan of care with specific interventions for each patient to be made. Relevance to clinical practice The identification of the risk of delirium is particularly important in the context of prevention. In a model of care based on needs, nursing assessment is a useful component in the risk assessment of delirium and one that is necessary for developing an individualised care regime. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate whether positioning the body in a lateral decubitus position will facilitate nasogastric tube insertion in unconscious patients. Background Inserting a nasogastric tube into unconscious patients can be challenging because these patients cannot cooperate with the operator. The piriform sinus and arytenoid cartilage are the most commonly reported impaction sites. However, we found that the first impaction site was the backward displaced tongue when inserting a nasogastric tube in unconscious patients who often exhibited glossoptosis. Performing an intubation in the lateral decubitus position could make this procedure easy. Design This prospective, double-blind, parallel, randomised controlled trial was conducted in Hengshui City, Hebei Province, China. Methods A total of 110 cases of unconscious patients were enrolled. The patients were randomly assigned to a conventional group (group C) or a lateral decubitus position group (group L). In group C, the nasogastric tube was inserted while the patients were in a supine position using the conventional technique, and in group L, the tube was inserted in a lateral decubitus position or further tilting the body to a prone decubitus position 20-30°. We discussed reasonable intubation methods in unconscious patients by comparing the success rate on first insertion, the overall success rate, the intubation time and the complication rates between the two groups. Results Group L had a higher success rate on first insertion and overall success rate than group C ( p < .05). The intubation time in group L was shorter than that in group C ( p < .001), and the complication rate in group L was lower than that in group C ( p < .05). The differences were statistically significant. Conclusions The backward displaced tongue blocks the pharyngeal passage. Nasogastric tube insertions in the lateral decubitus position are recommended in unconscious patients because of the higher success rate, reduced intubation time and lower complication rate. Relevance to clinical practice This study provides an effective method for nasogastric tube insertions in unconscious patients. [ABSTRACT FROM AUTHOR]

Aims To investigate the associations between the quality of the physical environment and the psychological and social well-being of older people living in residential care facilities. Background Many older people in care facilities have cognitive and physical frailties and are at risk of experiencing low levels of well-being. High-quality physical environments can support older people as frailty increases and promote their well-being. Although the importance of the physical environment for residents' well-being is recognized, more research is needed. Design A cross-sectional survey of 20 care facilities from each of which 10 residents were sampled. As the individual resident data were nested in the facilities, a multilevel analysis was conducted. Methods Data were collected during 2013 and 2014. The care facilities were purposely sampled to ensure a high level of variation in their physical characteristics. Residents' demographic and health data were collected via medical records and interviews. Residents' well-being and perceived quality of care were assessed via questionnaires and interviews. Environmental quality was assessed with a structured observational instrument. Results Multilevel analysis indicated that cognitive support in the physical environment was associated with residents' social well-being, after controlling for independence and perceived care quality. However, no significant association was found between the physical environment and residents' psychological well-being. Conclusion Our study demonstrates the role of the physical environment for enhancing the social well-being of frail older people. Professionals and practitioners involved in the design of care facilities have a responsibility to ensure that such facilities meet high-quality specifications. [ABSTRACT FROM AUTHOR]

Aims We aimed to elucidate facilitators and barriers that HIV nurses experience in discussing sexual risk behaviour with HIV-positive men who have sex with men, using variables from a previous qualitative study and the theory of planned behaviour. Background HIV-positive men who have sex with men are frequently diagnosed with sexually transmitted infections, which can be reduced if HIV nurses discuss sexual risk behaviour. Design An online questionnaire was disseminated in April 2015 among all HIV nurses in the Netherlands. Methods We assessed variables, such as attitudes, shame, ability, knowledge and time concerns. A regression analysis was conducted with 'intention to discuss sexual risk behaviour' as an outcome variable. Results The questionnaire was completed by 60 of 79 HIV nurses. Overall, participants reported high intentions to discuss sexual risk behaviour, and 38% of the variance was explained by attitude, sexual preference, knowing ways to introduce the topic and experiencing enough time or viewing it as a priority. In addition, high intenders significantly differed from low intenders in 'experienced shame,' 'relation with patients,' 'non-verbal communication,' 'subjective norm' and 'knowledge.' Conclusion Improving sexual health in HIV care translates into improving opportunities and the facilitating factors in initiating the discussion of sexual risk behaviour rather than removing barriers HIV nurses experience. Interventions should mainly focus on improving the HIV nurses' perceived ability to initiate the topic of sexual risk behaviour and to utilize the jargon and terminology that is commonly used among men who have sex with men. [ABSTRACT FROM AUTHOR]