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Background During the COVID-19 pandemic, providing care for critically ill patients has been challenging due to the limited number of skilled nurses, rapid transmission of the virus, and increased patient acuity in relation to the virus. These factors have led to the implementation of team nursing as a model of nursing care out of necessity for resource allocation. Nurses can use prior evidence to inform the model of nursing care and reimagine patient care responsibilities during a crisis. Purpose To review the evidence for team nursing as a model of patient care and delegation and determine how it affects patient, nurse, and organizational outcomes. Methods We conducted an integrative review of team nursing and delegation using Whittemore and Knafl's (2005) methodology. Results We identified 22 team nursing articles, 21 delegation articles, and two papers about U.S. nursing laws and scopes of practice for delegation. Overall, team nursing had varied effects on patient, nursing, and organizational outcomes compared with other nursing care models. Education regarding delegation is critical for team nursing, and evidence indicates that it improves nurses' delegation knowledge, decision-making, and competency. Linking evidence to action Team nursing had both positive and negative outcomes for patients, nurses, and the organization. Delegation education improved team nursing care.

This is the first of two essays about five models of nursing practice delivery—total patient care, functional nursing, team nursing, primary nursing, and the attending nurse. Total patient care, functional nursing, and team nursing are discussed in this essay. The other two models will be discussed in another essay published in a future issue of Nursing Science Quarterly. Each model is described, and its connection with nursing discipline-specific knowledge is discussed. The extent to which each model ascribes accountability for practice also is discussed.

PURPOSE The Institute of Medicine (2000, 2002) exposed serious safety problems in the health system and called for total qualitative system change. The Institute of Medicine (2011, 2015) also calls for improving the education of nurses to provide leadership for a redesigned health system. Intertwined with improving education is the need to recruit and retain diverse highly qualified students. Disability is part of diversity inclusion, but current technical standards (nonacademic requirements) for admission to many nursing programs are a barrier to the entry of persons with disabilities. Rehabilitation nurse leaders are in a unique position to improve disability diversity in nursing. The purpose of this paper is to discuss the importance of disability diversity in nursing. DESIGN The history of existing technical standards used in many nursing programs is reviewed along with examples. METHODS On the basis of the concept that disability inclusion is a part of diversity inclusion, we propose a new model of technical standards for nursing education. CONCLUSION AND CLINICAL RELEVANCE Rehabilitation nurse leaders can lead in eliminating barriers to persons with disabilities entering nursing.

Background Nurses working night shift are key-players in the acute care team, however, their work environment has been characterised by suboptimal leadership, communication inadequacies, limited resources, and a lack of adequate support. Aim The aim of this study was to investigate nurses' perceptions of the Hospital at Night Team, a nursing model of care implemented to provide timely quality nursing care after-hours. Methods The study used a descriptive design. Five focus groups were conducted, with a total of 34 nurses from 14 wards across a 600+ bed tertiary referral teaching hospital in Melbourne, Australia, one year after the Hospital at Night Team implementation. Focus group interviews were transcribed and subjected to thematic analysis. Findings Themes arising were: changing role perceptions as the Hospital at Night Team was embedded into the organisation; the impact of technology on workflow and responsiveness; refinement of services occurring over time with feedback and evaluation; and facilitating collaboration and learning across disciplines. Discussion The Hospital at Night Team role evolved to offer more support for specialised procedures as well as a large amount of direct care. The services were perceived to have been refined over time, responding to feedback and evaluation of the service. Conclusions The Hospital at Night Team nursing model of care provides flexibility, support, collaboration and shared learning across wards. Further research should investigate the effect of the Hospital at Night Team nursing model of care on patient outcomes.

Background An opportunity was identified to compare perceptions of the occurrence and types of missed care at a comprehensive cancer center. Purpose The purpose was to evaluate the difference in perceived occurrence and types of missed care between medical, surgical, and hematologic oncology units in the context of a newly implemented patient care delivery system, Primary Team Nursing (PTN). Methods A descriptive, repeated-measures design was used. The MISSCARE survey was distributed electronically to 580 staff members across 6 inpatient units. Results Frequently perceived elements of missed nursing care were ambulation, turning every 2 hours, and care conference attendance. At the time of study implementation, surgical units reported 0.24 higher scores than medical units (P = .017); hematology units reported 0.26 lower scores than surgical units (P = .005). PTN status did not affect MISSCARE scores (P = .525). Conclusions Study findings suggest that perceived missed care in a comprehensive cancer center is similar to that in other hospital settings.

© 2016 Elsevier Ltd Background The numbers of nurses in general practice in Australia tripled between 2004 and 2012. However, evidence on whether nursing care in general practice improves patient outcomes is scarce. Although patient satisfaction and enablement have been examined extensively as outcomes of general practitioner care, there is little research into these outcomes from nursing care in general practice. The aim of this study was to examine the relationships between specific general practice characteristics and nurse consultation characteristics, and patient satisfaction and enablement Methods A mixed methods study examined a cross-section of patients from 21 general practices in the Australian Capital Territory. The Patient Enablement and Satisfaction Survey was distributed to 1665 patients who received nursing care between September 2013 and March 2014. Grounded theory methods were used to analyse interviews with staff and patients from these same practices. An integrated analysis of data from both components was conducted using multilevel mixed effect models. Results Data from 678 completed patient surveys (response rate = 42%) and 48 interviews with 16 nurses, 23 patients and 9 practice managers were analysed. Patients who had longer nurse consultations were more satisfied (OR = 2.50, 95% CI: 1.43–4.35) and more enabled (OR = 2.55, 95% CI: 1.45–4.50) than those who had shorter consultations. Patients who had continuity of care with the same general practice nurse were more satisfied (OR = 2.31, 95% CI: 1.33–4.00) than those who consulted with a nurse they had never met before. Patients who attended practices where nurses worked with broad scopes of practice and high levels of autonomy were more satisfied (OR = 1.76, 95% CI: 1.09–2.82) and more enabled (OR = 2.56, 95% CI: 1.40–4.68) than patients who attended practices where nurses worked with narrow scopes of practice and low levels of autonomy. Patients who received nursing care for the management of chronic conditions (OR = 2.64, 95% CI: 1.32–5.30) were more enabled than those receiving preventive health care. Conclusions This study provides the first evidence of the importance of continuity of general practice nurse care, adequate time in general practice nurse consultations, and broad scopes of nursing practice and autonomy for patient satisfaction and enablement. The findings of this study provide evidence of the true value of enhanced nursing roles in general practice. They demonstrate that when the vision for improved coordination and multidisciplinary primary health care, including expanded roles of nurses, is implemented, high quality patient outcomes can be achieved.

The aim of the study was to assess the effectiveness of role play on team nursing among 2nd year B.Sc(N)students in CON, SVIMS, Tirupati.Objectives:•? To assess the level of knowledge on team nursing among 2nd year B.Sc (N) students in CON, SVIMS,Tirupati.•? To assess the effectiveness of role play among 2nd year B.Sc (N) students in CON, SVIMS, Tirupati.•? To find the correlation between level of knowledge and selected demographic variables of 2nd year B.Sc(N) studentsMethodology: By using convenient sampling technique a preexperimental research design was adopted,100 2nd year B.Sc.(N) students were choosen as samples, and data collection was done by using a selfstructured questionnaire.Results: The study results revealed that out of 100 samples 53% (53) had inadequate knowledge, 31%(31)had moderate knowledge, and 16%(16) had adequate knowledge in their pre test and the post test resultshad shown as 28%(28) had moderate knowledge, and 72%(72) had adequate knowledge, none of them hadinadequate knowledge.Conclusion: As the technology in nursing education has been increasing day by day; role play is one of thebest live innovative method of giving essential information to the students. In the present study the resultsshowed that, the role play was effectively improved the knowledge of 2nd year B.Sc(N) students regardingteam nursing.

Team job crafting, which refers to designing the task, relational, and cognitive aspects of a job, is thought to be beneficial for nurses working in the ward. There are no scales to assess team job crafting among nurses. This study aimed to develop and examine the reliability and validity of a scale to measure team job crafting. Based on literature reviews and interviews, potential items were created. A total of 293 nurses working on 19 wards in two hospitals in Japan were asked to complete a questionnaire twice. A series of exploratory factor analyses (EFAs) were conducted to select the final items. For convergent validity, multilevel correlations were calculated. Cronbach's α and intra-class correlation coefficients (ICCs) were calculated for reliability. A total of 190 participants responded to the baseline survey and 152 responded to the retest. The EFAs yielded a three-factor structure comprising 13 items. The three factors are task crafting considering the team's growth, cognitive crafting for members' respect and reflection of meaningfulness of work, and relational crafting for smooth information sharing. Cronbach's α ranged from .810 to .831, and test-retest ICCs ranged from 0.571 to 0.710. At the individual level, team job crafting had small-to-moderate correlations with individual levels of job crafting, job control, supervisor support, co-worker support, job satisfaction, workplace social capital, and work engagement. The ICC of the team job crafting scores of 0.125 indicated meaningful variation across wards. At the ward-level, nonsignificant but strong correlations were found with workplace social capital, job satisfaction, and psychological distress. This scale showed acceptable levels of reliability and validity. It would be useful in monitoring and improving team job crafting to increase team members' well-being and performance.

Objective: To analyze the factors associated with occupational stress among nursing workers in health services of medium complexity. Methods: Epidemiological, cross-sectional, exploratory study. A randomly selected sample of 126 nursing professionals from medium complexity services in three cities in the state of Bahia (Santo Antônio de Jesus, Feira de Santana and Itabuna) was investigated. Data were collected in 2011 and 2012. The demand-control model proposed by Karasek was used to assess occupational stress. Simultaneous analysis of occupational stressors was performed using Poisson regression with robust variance. Results: The prevalence of occupational stress among nursing professionals was 77%. Occupational stress was associated with the professional category of nursing technician (p=0.01). Conclusion: The data indicates a concerning situation of exposure to occupational stressors, which requires coping strategies in order to protect the health of the worker. RESUMEN Objetivo: analizar los factores asociados al estrés laboral entre trabajadores de enfermería de servicios de salud de mediana complejidad. Métodos: estudio epidemiológico, de diseño transversal y exploratorio. Se investigó una muestra de 126 profesionales de enfermería en tres municipios de Bahía. Los datos se recogieron durante los años 2011 y 2012. Para evaluar el estrés laboral, se utilizó el modelo demanda-control propuesto por Karasek. El análisis simultáneo de los factores laborales estresores se llevó a cabo mediante la regresión de Poisson con variancia robusta. Resultados: La prevalencia del estrés laboral entre profesionales de enfermería era del 77%. Dicho estrés estaba asociado a la categoría profesional de técnico/a de enfermería (p=0,01). Conclusión: Los datos demuestran la existencia de una situación preocupante en ese grupo, con exposición a estresores laborales, haciéndose necesario la adopción de estrategias de enfrentamiento a fin de garantizar una protección integral para la salud de los trabajadores. RESUMO Objetivo: Analisar os fatores associados ao estresse ocupacional entre trabalhadores de enfermagem dos serviços de saúde de média complexidade. Métodos: Estudo epidemiológico, transversal, exploratório. Investigou-se amostra, aleatoriamente selecionada, de 126 profissionais de enfermagem dos serviços de média complexidade de três municípios na Bahia: Santo Antônio de Jesus, Feira de Santana e Itabuna. Os dados foram coletados nos anos de 2011 e 2012. Para avaliar o estresse ocupacional, utilizou-se o modelo demanda-controle, proposto por Karasek. A análise simultânea dos fatores ocupacionais estressores foi feita com emprego de regressão de Poisson com variância robusta. Resultados: A prevalência de estresse ocupacional entre profissionais de enfermagem foi de 77%. Estresse ocupacional associou-se à categoria profissional de técnico/a de enfermagem (p=0,01). Conclusão: Os dados evidenciam situação preocupante de exposição desse grupo a estressores ocupacionais, sendo necessária a adoção de estratégias de enfrentamento a fim de garantir proteção integral à saúde do/a trabalhador/a.

Aim To translate the MISSCARE Survey into Swedish and establish its validity and reliability by evaluating its psychometric properties. Background Missed nursing care is defined as any aspect of required nursing care that is omitted or delayed. The consequence of missed nursing care is a threat to patient safety. The MISSCARE Survey is an American instrument measuring missed nursing care activities (part A) and its reasons (part B). Methods The translation was accomplished according to World Health Organization guidelines, focusing on a culture adaptation. Acceptability, construct validity, test-retest reliability and internal consistency were analysed. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) was used as reporting checklist. Results The translation and culture adaptation needed several revisions. A total of 126 nurses answered the test and retest which showed acceptability of missing data. The factor analysis revealed a lack of fit to data for the original factorial structure in part B, while further analysis provided results suggesting a modification based on omitting six items. The internal consistency for part B and its subscales showed good results. Conclusions The MISSCARE Survey-Swedish version is a reliable and valid instrument, with good psychometric properties. Relevance to clinical practice More reliable language versions of the instrument enable national and international comparisons that could be valuable for nursing managers and/or directors of nursing who are responsible for quality of care and patient safety in the strategic care planning process.

Aim The purpose of this study was to examine, on a national level, nursing students' perceptions after experiencing a patient death. Background Death is a highly stressful experience for nursing students. Debriefing, which routinely occurs with a patient's demise in the simulation setting, typically does not happen in actual death situations. Method A mixed-methods design using quantitative and qualitative questions as part of an anonymous survey was sent to the membership of the National Student Nurses' Association. Of approximately 55,000 members, 2,480 responded to the survey. Results Experiencing a patient death as a student occurred for 41 percent of participants in the nationally representative sample. Of those who experienced a patient death, 64 percent did not receive any debriefing. Conclusion Most nursing students did not feel prepared to care for a dying patient and the patient's family. Students need and want more education on end-of-life nursing care.

Background As facing the rapid growth of the elderly population, the demands for geriatric and long-term care are drastically increasing. Since one of the important strategies in preparation for long-term care system is to focus on the engagement of health care professionals, this paper applies a systematic approach to review the current geriatric and long term care courses in Bachelor of Science in Nursing (BSN) programs. This review assessed the impact of Geriatric Nursing (GN) and/or Long Term Care (LTC) courses on nursing students' knowledge, care intention and competence of Geriatric Long Term Care (GLTC) care to enable their nursing competence before graduation. Method Data related to the purpose of the study, research design, sample, curriculum content, teaching strategies, evaluation measurements and results were extracted. The methodological quality of all publications was included in the review. Results Eighteen articles were eligible for analysis, including 16 quantitative and 2 qualitative studies. The review revealed that including geriatric and long term care content in undergraduate nursing curriculum could effectively enhance students' nursing competence. Conclusion GN and LTC curriculum development should offer established content on geriatric and long term care as a foundation to implement early learning experiences in the curriculum. Both theory and clinical practice of GLTC course can be developed to increase the nursing students' knowing on the elders and the disabled through the clinical placement.

The purpose of this qualitative descriptive study was to understand how faculty members can use literature to teach first-year nursing students about compassionate care and the nursing role. A group of first-year nursing students wrote letters to the author of a book that details his experiences following a catastrophic motor vehicle accident. Thematic analysis of the letters revealed three major themes: Lessons about Compassion through Literature; Changing Personal, Professional, and Educational Perspectives; and Connecting to the Story on a Personal Level. The data was interpreted with the use of Mezirow's Transformative Learning Theory (1997). The results of the study show that students' beliefs about the profession of nursing, the role of the nurse in providing compassionate care, and their own education, were transformed. Additionally, using literature was shown to be an effective teaching strategy.

Health systems are being transformed and redesigned in Australia to better respond to changing health needs, technological advances, and new capabilities needed for safe and quality care. A capable and responsive nursing workforce, at both enrolled and registered nurse levels, is one of the mechanisms required for achieving effective health care reform. This paper situates a critical discussion of enrolled nurse education within a symbiotic relationship model to consider how nursing knowledge can enhance workforce performance and contribute to improved function of health systems. Discussion focusses on classification, or what constitutes nursing knowledge, and how that knowledge can be presented, or framed, in nursing education. It is contended that different nurse education systems in Australia mean the construction of professional enrolled nurse knowledge differs in form and structure from registered nurse professional knowledge. While different courses are needed for enrolled and registered nurses to reflect their different scope of nursing practice, it is important enrolled nurse education classified and frames nursing knowledge in ways that prepare graduates for complex nursing practice to safeguard the public.

Problem Pre registration nursing students do not always feel supported by Registered Nurses during their clinical placements. To help develop and refine clinical skills, in order to deliver safe, competent nursing care, nursing students rely on Registered Nurses to teach and support them in their clinical learning. Background Pre-registration nursing students in Australia must undertake a minimum of 800 clinical placement hours as part of their undergraduate nursing education. Registered Nurses are required to provide professional development and to teach and support students during these clinical placements. Little is known about Registered Nurses' understanding of this nursing standard requirement. Aim To explore Registered Nurses' understanding of the nursing standard requirement to provide professional development to pre-registration nursing students during their clinical placements. Methods A Grounded Theory study was used involving in-depth semi-structured individual interviews to gather data from fifteen Registered Nurse participants. Constant comparative analysis was used to analyse the data and it was from this data analysis that the substantive theory emerged. Findings The substantive theory developed as a result of this research is titled, Doing the Right Thing. The core category, the right thing to do, is informed by four elements; sense of responsibility, an added extra, choice, and nursing standard. Conclusion Registered Nurses are motivated to teach and support nursing students on clinical placements because they believe it is the right thing to do.

To predict the factors that are most important in explaining nursing staff intentions towards early detection of the deteriorating health of a resident and providing subacute care in the nursing home setting.Nursing staff play a pivotal role in managing the deteriorating resident and determining whether the resident needs to be transferred to hospital or remain in the nursing home; however, there is a dearth of literature that explains the factors that influence their intentions. This information is needed to underpin hospital avoidance programs that aim to enhance nursing confidence and skills in this area.A convergent parallel mixed-methods study, using the theory of planned behaviour as a framework.Surveys and focus groups were conducted with nursing staff (n = 75) at a 94-bed nursing home at two points in time, prior to and following the implementation of a hospital avoidance program. The quantitative and qualitative data were analysed separately and merged during final analysis.Nursing staff had strong intentions, a positive attitude that became significantly more positive with the hospital avoidance program in place, and a reasonable sense of control; however, the influence of important referents was the strongest predictor of intention towards managing residents with deteriorating health. Support from a hospital avoidance program empowered staff and increased confidence to intervene.The theory of planned behaviour served as an effective framework for identifying the strong influence referents had on nursing staff intentions around managing residents with deteriorating health. Although nursing staff had a reasonable sense of control over this area of their work, they believed they benefitted from a hospital avoidance program initiated by the nursing home.Managers implementing hospital avoidance programs should consider the role of referents, appraise the known barriers and facilitators and take steps to identify those unique to their local situation. All levels of nursing staff play a role in preventing hospitalisation and should be consulted in the design, implementation and evaluation of any hospital avoidance strategies.

Background Nursing is an integral part of all healthcare services, and has the potential of having a wide and enduring impact on health outcomes for a global ageing population. Over time nurses have developed new roles and assumed greater responsibilities. It is increasingly important to demonstrate the safety and overall impact of nurses' practice through research, to support the case for greater investment and development of nursing services around the world. Objective To provide an overview of existing research evidence on the impact of nursing on patient outcomes, identify gaps in evidence, and point to future priorities for global research. Specifically to address two questions: what is the evidence that nursing contributes to improving the health and well-being of populations?; and where should research activity be focused to strengthen the evidence base for the impact of nursing? Methods A search of the literature from 1996 using CINAHL, MEDLINE, the Cochrane Library, Google Scholar and the NICE evidence databases using the key words: nursing, nurse led, nursing interventions and patient outcomes. Initial analysis of the retrieved citations to reveal clusters of evidence of nursing impact in clinical areas which had been subject to systematic/integrative reviews or meta-analyses. Further analysis of these reviews to provide an overview of the research evidence for nurses' contributions to healthcare to inform discussion on future research agendas. We use the terms low, moderate and high quality evidence to reflect the assessments made by the review authors whose work is presented throughout. Results Analysis of 61 reviews, including ten Cochrane reviews and two scoping/selective reviews to provide a summary of the research evidence for nurses' contributions to healthcare in the following areas of practice: nursing in acute care settings; nurses' involvement in public health; the contribution of specialist nurse and nurse-led services to the management of chronic disease; comparison of care provided by nurses and doctors; and task shifting to invasive procedures. Conclusions There is evidence that adequate numbers of well-educated nurses working in acute care areas can reduce the risk of patient mortality, although the evidence for this is confined to studies in high income countries and the evidence is not sufficiently robust to draw up definitive nurse: patient ratios. There is also moderate evidence that well trained nurses can produce health outcomes that are equivalent to those of doctors for patients with a range of chronic health problems, particularly for those patients managed in primary care, and that nurse-led care may be more effective than medical care in promoting patient adherence to treatment and patient satisfaction. There is low to moderate evidence for the benefits of parenting support programmes delivered by nurses on a range of health outcomes; and for the impact of home visiting on improving function and other health service outcomes for older people. The wider societal benefits of home visiting by nurses and the impact of this on long term outcomes and related cost-effectiveness of home visiting has not been established. There is limited available information regarding the wider global impact of increasing the numbers of nurses and their contribution to healthcare through improved education. Moreover there is very little evidence for the cost-effectiveness of changing care providers from doctors to nurses and as the majority of cost data available has tended to come from studies based in higher income countries, their external validity in terms of applicability to settings in low and middle income countries is questionable. In addition to effectiveness, cost and safety, future research needs to address how implementing expanded nursing roles and task shifting impacts on the morale, retention, and professional development of nurses and the other workforces, and the longer term implications of these developments both locally and internationally.

Aim The aim of this study was to determine the patient satisfaction levels as a quality indicator for the evaluation of nursing care in a university hospital in the Mediterranean Region in Turkey. Methods This study was designed as a descriptive study and was conducted between February 2, 2015 and March 3, 2015. The study sample consisted of 400 patients. For data collection, the study used the Newcastle Satisfaction with Nursing Scale, which included two subscales: the Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale. Results The mean total ‘Satisfaction with Nursing Care Scale' score was 62.08±20.94, and the mean total ‘Experience of Nursing Care Scale' was 71.97±11.97. When the items were examined in both subscales, the highest satisfaction items were reported as ‘the skilfulness of nurses' and ‘the nurses' respect for the patients' privacy'. However, the lowest scores were given to ‘the nurses' efforts to make the patients feel at their home' and ‘the way the nurse comforted your relatives and friends'. Conclusions Considering the study results, patients require more individualised care from nurses regarding education, communication and comfort.

Background There has been a proliferation of online training programs for nursing home direct care staff related to dementia care, yet little is known about the effectiveness of the training. Some evidence exists that online training is effective in addressing problem behaviors of nursing home residents with dementia by enhancing self-efficacy, improving attitudes, and increasing knowledge of nursing home staff. Study aim The current study aim was to evaluate the implementation of an online training program consisting of ten, one-hour modules which applies the CARES® concepts and learning framework to activities of daily living (ADL) care for persons with dementia. Methods Responses from Likert-type items, and open-ended questions were analyzed in a sample of 48 certified nursing assistants (CNAs) from 10 nursing homes in six states (ME, MT, ND, WI, MN, MO) that were part of a National Institute of Aging funded intervention study (Grant #AG026210). Results The mixed-method study findings indicated that CNAs gained a better understanding, more knowledge, and more confidence in caring for persons with dementia. Recommendations were made regarding training length and technical issues, and some questioned the practicality of providing person-centered care when resident assignment was very high. CNAs expressed satisfaction with the online training, found it easy to use, and many said they would recommend the training. CARES® ADL Dementia Care online training appears to be a viable way of helping CNAs address the personal care needs of long-term care residents. Future CARES® ADL Dementia Care program research should include more racially diverse CNAs.

Purpose To identify the expectations and perceptions of clients concerning the quality of hospital care provided to them and their respective companions at a private Brazilian hospital using SERVQUAL. The SERVQUAL questionnaire can provide information concerning expectations and perceptions of clients. In addition, it is able to identify the participation of frontline employees and how they contribute to the organization's end product (service delivery). Methods In total, 172 inpatients for surgical reasons answered the SERVQUAL questionnaire. It consists of 23 pairs of statements, 22 of which are distributed into the dimensions of tangibles, reliability, responsiveness, assurance and empathy. Statement 23 refers to the overall quality of care. Exploratory analysis, internal consistency (Cronbach's alpha) and the kappa Coefficient were calculated using the Statistical Package for Social Sciences and SAS 9.2. Ethical approval was obtained from the Institutional Review Board at the Hospital das Clinicas at the University of Sao Paulo at Ribeirao Preto Medical School. Results Most participants had a bachelor's degree and were over than 60 years old. Cronbach's alpha coefficients indicated good internal consistency (α = 0.93) and high levels of agreement were observed (91.10%). Conclusion The SERVQUAL questionnaire was sensitive to items in each dimension for which clients' perceptions surpassed their expectations. Implications for nursing management The continuous quality assessment of health services is mandatory for nursing leadership. The nursing leadership can further explore the SERVQUAL with a view to better attending to the clients' expectations.

Aims and objectives To examine international studies that specifically focus on transition to practice for graduate registered nurses in rural and remote areas. Background Supportive graduate nursing programmes are essential for enabling nursing graduates’ transition to practice and reducing attrition rates. Literature examining support measures for nursing graduates within metropolitan areas is abundant. However, there is a paucity of evidence on effective graduate programmes for rural and remote-based nursing graduates. Design A systematic approach was used to identify robust research within appropriate electronic databases. Method Eligible articles were critically reviewed using the Mixed Method Appraisal Tool critical appraisal tool. Eligible articles were thematically analysed using the Braun and Clark approach. Results Eight articles met the selection criteria for inclusion. Findings revealed that while most graduate nurses survived the transition process, they often felt overwhelmed and abandoned with intense feelings of frustration. Many suffered transition shock and did not feel ready for the role. Socialisation of graduates to the clinical environment was lacking. Support offered in many graduate programmes was ad hoc and unstructured. Senior staff were inadequately supported in their roles as preceptors to assist with the transition. Critical support measures recommended included both debrief sessions and regular one-on-one support. Conclusions Graduate programmes need to be structured yet flexible to accommodate the needs of rural and remote nurse graduates. Graduates need to be transitioned into practice with decremental support processes for both workloads and education. Preceptors require education on how to mentor before they can provide the appropriate support for graduates. Without these measures in place, a decrease in transition shock may not be possible. Relevance to clinical practice Graduate programmes need to be structured yet flexible, including assistance with both clinical skills and socialisation. Senior staff require education before they can adequately support new graduates.

Background: End-of-life decision making can be distressing for nursing students, and the purpose of this investigation was to assess undergraduate nursing students' knowledge, attitudes, and experiences with advance directives. Method: One hundred sixty-six Bachelor of Science in Nursing students at four different program levels were surveyed about their knowledge, personal and professional experience, and personal and professional attitudes regarding advance directives. Results: There was a statistically significant progression of knowledge from the junior 1 to the senior 2 semesters. In addition, there was a statistically significant difference in personal attitudes about advance directives by progressive semesters, in personal and professional attitudes between White/Caucasian and Black/African American students, and in knowledge of advance directives and professional attitudes between students 18 to 25 years old and those 26 years and older. Conclusion: It is important that nursing students are exposed to advance directives in the prelicensure curriculum to prepare them for their role as professional nurses. [ J Nurs Educ. 2018;57(1):35–39.]

To investigate the knowledge of and attitudes towards palliative care for advanced dementia and their associations with demographics among nursing staff, including nurses and nursing assistants, in long-term care settings.Nursing facilities are places where persons with dementia die; therefore, providing quality end-of-life care to residents with advanced dementia is crucial. To date, little attention has been paid to palliative care practice for patients with advanced dementia.A descriptive, cross-sectional, survey design was used.In total, a sample of 300 nurses (n = 125) and nursing assistants (n = 175) working in long-term care settings in Taiwan participated in this study. Two instruments were administered: demographic characteristics and responses to the Questionnaire of Palliative Care for Advanced Dementia. Descriptive statistics and multiple regression were used for data analysis.Overall, the nurses and nursing assistants had moderate mean scores for both knowledge of and attitudes regarding palliative care for advanced dementia. Additionally, nursing staff who were nurses with greater work experience and those who had received palliative care and hospice training had greater knowledge of palliative care. In addition, nursing staff who had received dementia care training and who had worked in nursing homes had higher levels of positive attitudes towards palliative care.This study indicates the need to provide nurses and nursing assistants with more information about palliative care practice for people with advanced dementia. Particularly, providing education to those who are nursing assistants, who have less working experience, who have not received palliative and dementia care training, and who have not worked in nursing homes can improve overall nursing staff knowledge of and attitudes towards palliative care.Continuing education in principles of palliative care for advanced dementia is necessary for currently practicing nursing staff and should be developed according to their educational background and needs.

Aims and objectives To identify how science should be taught to nursing students, and by whom. Background An understanding of foundational science and its role in supporting safe and effective nursing practice is an important part of student learning. The well documented challenges in teaching this content are compounded by a lack of evidence regarding educational strategies that lead to improved educational outcomes. Design The study employed a cross-sectional design using online surveys. Methods Two surveys were conducted in Australia involving (i) academics who teach science in undergraduate nursing programs and (ii) registered nurses (RNs). Participants were asked to respond to a range of questions around how science should be taught to nurses. There were n=30 and n=1808 respondents respectively. Results Findings indicated a need to better integrate science content throughout nursing curricula. Participants were supportive of a discrete science subject in the foundation year and the integration of science content throughout the remainder of the curriculum. Participants across both surveys were ambivalent about whether the depth of science teaching was adequate for nursing practice. Most nurse academics and RNs thought that nurses should teach science, while non-nursing science teachers were less certain. Conclusions Existing consensus clearly values the delivery of science content as an initial and ongoing priority of learning throughout the undergraduate nursing program. Relevance to practice Improving the ways in which students learn sciences will impact on nursing practice, with the potential to improve patient care.

Background: Inmates in federal or state correctional facilities or those who are under the custody of local law enforcement officials receive health care in acute care settings, and caring for these inmate-patients is difficult for many nurses. Nurse educators should teach nursing students that nurses care for all patients in all situations with respect for a person's inherent dignity and worth. Method: Information from relevant nursing publications was synthesized to provide nurse educators with content that can be useful when teaching nursing students to care for inmate-patients in acute care settings. A case study is provided as a teaching strategy for nurse educators. Results: Respect, care, and concern are expressed differently when nurses care for inmate-patients in acute care settings. Conclusion: Nurse educators are responsible to teach nursing students how professional nurses should respond to patients, especially in situations that many nurses find challenging. [ J Nurs Educ. 2017;56(11):655–659.]

Background It is considered to be extremely important to ensure that nurses adopt professional values during their education in order to improve nursing practices and develop a professional identity. Objectives The aim of this study is to investigate the effects of nursing education on development of professional values. Design This study was designed as a longitudinal study. Settings The study was conducted in a nursing department at a nursing school in the western Turkey. Participants The population of the study consisted of nursing students who were enrolled in the nursing department in academic year of 2011–2012. The data of the study were collected from 59 first-year students in 2011 and 83 fourth-year students in 2015. Methods The data of the study were collected using Personal Information Form and Nursing Professional Values Scale-NPVS. The participants responded to the same questionnaire in their first and fourth years in the department. Results The scale mean score of the students in their first year was 3.44 ± 0.635. The highest scores were obtained from the subscales of responsibility, security, and autonomy. Their scale mean score in their fourth year was 3.93 ± 0.727. The highest scores were obtained from the subscales of dignity and autonomy. The difference between the mean scores was statistically significant ( p = 0.001). Conclusions It was concluded that nursing education had a significant effect on development of professional values.

This paper outlines obligatory nursing education and the registration process required to become a nurse in Australia, including nurses' workload, career structure and pay. It also provides an overview of the nursing workforce in Australia, with particular reference to casual employment, and its implications. The aim of this paper is to outline the development strategies that may assist with China's increasing need for nursing education, and how changes to healthcare policy and management are required to increase the recruitment and retention of nurses in hospitals worldwide. Keywords: Australia, China, Employment, Nursing

© 2017 John Wiley & Sons Ltd Aims and objectives: To systematically review the literature describing factors perceived by nurses as impacting the provision of patient-centred nursing in the intensive care unit. Background: Patient-centred nursing in critical care differs from other healthcare areas, and the aggressive curative environment of the ICU has potential to compromise some of its elements. Understanding critical care, nurses’ perceptions of promoting and deterrent factors may inform development of strategies to support effective patient-centred nursing and job satisfaction in this workforce. Design: An integrative literature review. Review method: Whittemore and Knafl's method was used with “best-fit” framework synthesis. CINAHL, PsycINFO, Medline and EMBASE were searched for 2000–2016 literature using search terms drawn from the ICU patient-centred framework. Results: In total, 3,079 papers were identified, with 23 retained after applying eligibility criteria. Five themes were identified: Nurse identity; Organisation; Communication; Relationships; and Ideology of ICU. Almost every theme and related categories referred to factors acting as barriers to patient-centred nursing in the ICU; only four referred to supports/facilitators. Findings showed that provision of patient-centred nursing may be compromised by some factors of the critical care environment, and illustrate the challenges and complexity of providing effective patient-centred nursing in this environment. Conclusion: Findings should be applied to address barriers and to enhance facilitators of effective patient-centred nursing in critical care. The emotional and physical demands of critical care nursing are major considerations; supporting these nurses to fulfil their challenging role may empower them in their professional quality of life and provide a basis for workforce retention as well as delivery of effective patient-centred nursing. Relevance to clinical practice: Measures to enhance patient-centred nursing could promote critical care nurses’ job satisfaction and workforce retention, and be applied more broadly and collaboratively to promote multidisciplinary patient-centred care.

Background People living with dementia in nursing homes are most likely to be restrained. The primary aim of this mixed-method education intervention study was to investigate which factors hindered or facilitated staff awareness related to confidence building initiatives based on person-centred care, as an alternative to restraint in residents with dementia in nursing homes. The education intervention, consisting of a two-day seminar and monthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway. The present article reports on staff-related data from the study. Methods We employed a mixed-method design combining quantitative and qualitative methods. The P-CAT (Person-centred Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and social factors at work) instruments were used to measure staff effects in terms of person-centred care and perception of leadership. The qualitative data were collected through ethnographic fieldwork, qualitative interviews and analysis of 84 reflection notes from eight persons in the four teams who facilitated the intervention. The PARIHS (Promoting Action on Research Implementation in Health Services) theoretical framework informed the study design and the data analysis. Six nursing homes were selected for ethnographic study post-intervention. Results Qualitative data indicated increased staff awareness related to using restraint - or not- in the context of person-centered care. A slight increase in P-CAT supported these findings. Thirteen percent of the P-CAT variation was explained by institutional belonging. Qualitative data indicated that whether shared decisions of alternative measures to restraint were applied was a function of dynamic interplay between facilitation and contextual elements. In this connection, the role of the nursing home leaders appeared to be a pivotal element promoting or hindering person-centered care. However, leadership-staff relations varied substantially across individual institutions, as did staff awareness related to restraint and person-centeredness. Conclusions Leadership, in interplay with staff culture, turned out to be the most important factor hindering or promoting staff awareness related to confidence building initiatives, based on person-centered care. While quantitative data indicated variations across institutions and the extent of this variation, qualitative data offered insight into the local processes involved. A mixed method approach enabled understanding of dynamic contextual relationships. © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Background Globally, nurses are undertaking expanded and more specialized roles in healthcare planning and service delivery in response to changing patterns and levels of health service demand. This means the nursing profession is increasingly considered as leaders in health service policy, research and practice. The United Arab Emirates has strengthened nursing governance and practice by establishing a Nursing and Midwifery Council and increasing the activity of nursing specialization, service leadership and research. This study aimed to identify clinically relevant research priorities to facilitate nursing contributions to evidence-based care and strengthening health services in the country. Methods A two-stage Delphi study design was used. Results The first round involved 783 participants. The second round involved 1116 participants, as more clinical settings were accessed. In total, 58 research priorities across a variety of nursing specialties (paediatrics, emergency care, intensive care, labour and maternity care, operating theatre and long-term care) were identified as highly important. Conclusion These identified priorities will guide a more informed programme of research in each nursing specialty, with the aim of strengthening the evidence base to improving outcomes for patients and their families in the United Arab Emirates. Implications for nursing practice, research and policy The findings provide guidance on key areas for nurses to focus research contributions to enhance evidence-based care and strengthen health systems. The identified priorities may also guide researchers in academic institutions to conduct research informed by current, clinically relevant issues. The findings may help inform funders and policymakers to support allocation of funding to research that has potential to contribute to enhancing nursing care in specialist areas.

Addressing spiritual needs is taken into account as an integral part of holistic health care and also an important component of nursing practice. The aim of present study is to evaluate attitudes toward spirituality and spiritual care among nurses and nursing students at Semnan University of Medical Sciences in Iran. In this cross-sectional study, all nurses (n = 180) working in the teaching hospitals affiliated to Semnan University of Medical Sciences as well as senior nursing students (n = 50) selected by the census method. Finally, 168 individuals meeting the inclusion criteria were evaluated as the study sample. The data collection instrument was the Spirituality and Spiritual Care Rating Scale. The mean and standard deviation scores of attitudes toward spirituality and spiritual care among nurses and nursing students were 59 ± 10.9, and the scores obtained by the majority of study population (64.3%) ranged between 32 and 62 which were at a moderate and relatively desirable level. Nurses and nursing students working in aforementioned hospitals reported positive attitudes to spirituality and spiritual care. Given the importance of spiritual care and also the moderate level of spirituality and spiritual care among nurses and nursing students in this study, institutionalization of the concept of spirituality, provision of an appropriate context to deliver such care, and also implementation of interventions in order to improve spiritual care along with other nursing skills were assumed of utmost importance.

Background: Provision of health care service at home is one of the advanced forms of care for patients being discharged from hospitalization. Little is known about the experience of nurses providing home care services through a nursing home-care model especially in Indonesian context. Objective: This study aims to explore the experience in order to increase understanding on the form of home care provision, and consequently the nurses may understand the form of home care globally. Methods: This study employed a phenomenological design and performed interview in the process of data collection. Data were analysed by using content analysis. Results: The main contexts of home care nurse experiences were generated. There were definition and role of home care nurses, the involvement of family members in the provision of care, the facilitating and hindering factors contributed to home care provision as well as manual on providing home care nursing. Conclusion: The implication from this study is that nursing care should be given to the patients continuously and consequently the need for family involvement is important. Additionally, in providing the home care, a proper manual is needed by home care nurses as the guidance to give best quality of care to patients.

Aim Professional values and caring are important for nursing professionals. The purpose of this study was to determine professional values in undergraduate nursing students and its reflection on care behaviours. Methods A cross-sectional descriptive survey design was used. The study sample consisted of first-year, second-year, third-year and fourth-year undergraduate students (n = 351) studying for the Bachelor of Nursing Science Degree at the University of Giresun, Turkey. The data was collected by the researchers using the demographic form for students, ‘Nursing Professional Value Scale’ and ‘Caring Assessment Questionnaire-Care-Q’. Results A positive correlation was found to be statistically significant between nursing students’ professional values and care behaviours (r = 0.423, p < 0.05). Statistical analysis showed that there was a significant difference statistically between classes in terms of nursing students’ care behaviours (p < 0.05), while no statistically significant differences were found between classes in terms of nursing students’ professional values (p > 0.05). Conclusion The current study showed that caring behaviours were affected by the professional values of nursing students. Furthermore, it was observed that nursing students who have stronger orientations towards professional values show a higher frequency of caring behaviour. © 2017 Faculty of Health and Social Sciences of University of South Bohemia in ?eské Bud?jovice

Aim The aim of this study was to explore hospital staff perceptions of the perceived challenges and outcomes of implementing a critical care outreach service. Background A nurse-led critical care outreach service was designed and implemented to identify and treat acutely ill patients in a large tertiary care hospital in Iran. Methods A qualitative analysis of data from two focus groups and seven interviews was carried out using conventional content analyses techniques. A total of 24 hospital staff members participated, including critical care outreach team members, physicians, ward head nurses and ward staff. Findings Two main categories described the perceived challenges to the implementation of the critical care outreach service: 1) the hospital context, with four subcategories related to staff shortages, the instability of physician positions, the lack of specialized essential services and the absence of a system to establish do-not-resuscitate orders, and 2) staff resistance to different nursing priorities, routines and extra work. In two additional main categories, participants also described positive and negative perceived outcomes. The positive perceived outcomes included three subcategories of alleviating equipment shortages, improving nursing knowledge and patient care and improving patient and healthcare professional satisfaction. Discussion While critical care outreach has the potential to improve patient perceived outcomes and both patient and provider satisfaction with care, the contextual and clinical realities in hospitals are significant and must be examined during the planning and implementation of future outreach. Conclusion and Implications for nursing and health policy A critical care outreach service in the context of an Iranian hospital has the potential to improve ward nurse familiarity with the care of acutely ill patients and the quality of palliative care. However, attention ought to be paid to the hospital's structural and contextual factors. Alleviating nursing shortages, reducing staff resistance and preparing goals of care guidelines that address restrictions on resuscitation could facilitate implementation of critical care outreach services.

In 2012, after several high-profile cases of poor quality care in England and concerns about a lack of compassion and a need to refocus on values, the Department of Health in England published a new strategy for nursing, midwifery and care staff: Compassion in Practice. The strategy included the 6Cs (care, compassion, courage, communication, competence and commitment) and in the follow-on framework, produced by NHS England in 2016, the 6Cs were included again. This article explains the background to the 6Cs and highlights the other values frameworks that nurses and midwives must work within too. Nursing theorists have studied caring extensively and the earlier set of 6Cs, produced by a Canadian nurse Sister Simone Roach, is explained in the article. The meaning of the DH's 6Cs is then explored in detail with reference to previous research and nursing theory.

Several previous studies have explored nursing students' perceptions of clinical learning at hospitals and in other health care facilities, but there are few studies exploring nursing students' perceptions of the clinical learning in the ambulance service. Therefore, the aim of this study was to explore nursing students' perceptions of learning nursing skills in the ambulance service. An inductive qualitative study design with two focus group interviews and content analysis was used. Two themes were identified. The first theme, professional skills, included: Assessment, Prioritizing and initiating care, and Medical treatment and evaluation of interventions. The second theme, a holistic approach to the care included: Cultural, social, and ethical aspects of caring, Decision-making in collaboration with patients, and Care provided in the patients' home. Conclusion: The ambulance service provides a learning environment where the students face a multifaceted picture of health and illness. This learning environment helps nursing students to learn independently how to use professional nursing skills and how to care by employing a holistic approach. However, further research is needed to explore if and how this knowledge about nursing and caring in the ambulance service is useful when working as a Registered Nurse in other health care settings.

Background There are several studies that have targeted student nurses, but few have clarified the details pertaining to the specific ethical problems in clinical practice with the viewpoint of the nursing faculty. This study was to investigate the ethical problems in clinical practice reported by student nurses to Japanese nursing faculty members for the purpose of improving ethics education in clinical practice. Method The subjects comprised 705 nursing faculty members (we sent three questionnaires to one university) who managed clinical practice education at 235 Japanese nursing universities. We performed a simple tabulation of the four items shown in the study design. 1) the details of student nurse consultations regarding ethics in clinical practice (involving the students themselves, nurses, care workers, clinical instructors, and nursing faculty members); 2) the methods of ethics education in clinical practice; 3) the difficulties experienced by the nursing faculty members who received the consultations; and 4) the relationship between clinical practice and lectures on ethics. Furthermore, the analysis was based on the idea of ethical principles, respect for persons, beneficence, and justice. Results The response rate was 28% (198 questionnaires). The nursing faculty members were consulted for various problems by student nurses. The details of these consultations were characterized by the principles of respect for patient by nurses, the principles of benevolence by faculty and clinical instructors, and the principle of justice pertaining to evaluations. The results indicate that there is an awareness among the nursing faculty regarding the necessity of some sort of ethics education at clinical settings. Moreover, based on the nature of the contents of the consultations regarding the hospital and staff, it was evident that the nursing faculty struggled in providing responses. More than half of subjects exhibited an awareness of the relationship between the classroom lectures on ethics and clinical practice. Conclusion The results suggest the need for analyzing the ethical viewpoints of student nurses, prior learning, and collaboration with related courses as part of ethics education in clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s12912-017-0217-3) contains supplementary material, which is available to authorized users.

Background The Western Institute of Nursing (WIN) celebrated its 60th anniversary and the 50th Annual Communicating Nursing Research Conference in April 2017. Purpose The purpose of this article is to provide a brief history of the origin, development, and accomplishments of WIN and its Communicating Nursing Research conferences. Approach Historical documents and conference proceedings were reviewed. Summary WIN was created in 1957 as the Western Council on Higher Education for Nursing under the auspices of the Western Interstate Commission for Higher Education. The bedrock and enduring value system of the organization is the interrelated nature of nursing education, practice, and research. There was a conviction that people in the Western region of the United States needed nursing services of excellent quality and that nursing education must prepare nurses capable of providing that care. Shared goals were to increase the science of nursing through research and to produce nurses who could design, conduct, and supervise research—all to the end of improving quality nursing care. These goals were only achieved by collaboration and resource sharing among the Western region states and organizations. Consistent with the goals, the first research conferences were held between 1957 and 1962. Conference content focused on seminars for faculty teaching research, on the design and conduct of research in patient care settings, and on identification of priority areas for research. The annual Communicating Nursing Research conferences began in 1968 and grew over the years to a total 465 podium and poster presentations on a wide array of research topics—and an attendance of 926—in 2016. Conclusion As WIN and its Communicating Nursing Research conferences face the next 50 years, the enduring values on which the organization was created will stand in good stead as adaptability, adjustments, and collaborative effort are applied to inevitable change for the nursing profession. It is the Western way.

There is a shortage of nurses working in the mental health field globally. The aim of the present study was to examine Singapore nursing students' attitudes towards specializing in psychiatric nursing by examining the pre-nursing and nursing school factors as well as attitudes towards psychiatry and personality traits.A cross-sectional online survey was conducted with 500 nursing students from four nursing institutions in Singapore. Students' attitudes towards psychiatry (ATP-18), perception of psychiatric nursing career aspects relative to other fields, and personality traits (mini-IPIP) were assessed. The main outcome measure was likelihood of specializing in psychiatric nursing. Logistic regression was used to examine the combined effect of factors upon the outcome.Twenty-six students (5.2%) rated "definitely decided to do" psychiatric nursing. Pre-nursing school factors associated with choosing psychiatry included ethnicity, current education, parents' wishes, having personal/family experience of mental illness, prior work experience, interest in psychiatric nursing and psychology module taken prior to current school admission. Nursing school factors such as teaching methods and clinical exposure were not associated with choosing psychiatric nursing. Positive attitudes towards psychiatry, perception of better career aspects in psychiatric nursing relative to other fields, and the personality traits of extraversion and intellect/imagination were associated with likelihood of choosing psychiatric nursing. Logistic regression revealed Malay (OR: 1.90, 1.14-3.16, p=0.013) and Indian ethnicity (OR: 2.56, 1.32-4.96, p=0.005), interest in psychiatry (OR: 22.56, 8.22-61.92, p0.001), psychology module prior to current school admission (OR: 2.31, 1.28-4.17, p=0.005), better perceived job prospects in psychiatric nursing than other fields (OR: 1.91, 1.21-3.04, p=0.006), extraversion (OR: 1.09, 1.02-1.17, p=0.012) and positive attitude towards psychiatry (OR: 2.72, 1.75-4.23, p0.001) as factors associated with students choosing psychiatric nursing.The selection of psychiatry as a specialty by nursing students was affected by pre-nursing school factors. Taking these factors into consideration may improve recruitment and alleviate the shortages in the psychiatric nursing field.

Purpose Physical restraints are used frequently in Korea, suggesting a growing need for access to programs focused on reduction. The aim of this study was to evaluate the effects of a multicomponent restraint reduction program (MRRP) for nursing staff in Korean nursing homes. Design A cluster-randomized, single-blind, controlled pretest-posttest design was used. A total of 122 nursing staff (nurses and geriatric care assistants) in two Korean nursing homes participated in this study: 62 in the experimental group (EG) and 60 in the control group (CG). Methods Nursing staff in the EG home received the MRRP comprising three educational sessions (two classroom-based and one web-based) and two unit-based consultations. Three instruments were used to measure nursing staff's knowledge, perceptions, and attitudes regarding physical restraints. Data were collected immediately before and after the intervention, and again 1 and 3 months later. Findings Repeated measures analysis of variance showed significant differences between groups in knowledge (p

The main objective of the current case study was to investigate the perceived leadership learning needs and feasibility of delivering leadership education to registered staff involved in direct care in long-term care (LTC) homes. The study was conducted in Ontario, Canada, and participants included RNs, registered practical nurses, and nursing administrators. Phase 1 bilingual web-based survey and bilingual focus group needs assessment data supported a preference for external training along with in-house mentoring to support sustainability. An intervention designed using insights gained from Phase 1 data was delivered via a 2-day, in-person workshop. Phases 2 and 3 evaluation survey data identified aspects of leadership training for LTC that require ongoing refinement. Findings suggest that communication skills and managing day-to-day nursing demands in the context of regulatory frameworks were areas of particular interest for leadership training in the LTC setting. [ Journal of Gerontological Nursing, 43 (4), 49–56.]

Aims and objectives To identify the contribution of hospital, unit, staff characteristics, staffing adequacy and teamwork to missed nursing care in Iceland hospitals. Background A recently identified quality indicator for nursing care and patient safety is missed nursing care defined as any standard, required nursing care omitted or significantly delayed, indicating an error of omission. Former studies point to contributing factors to missed nursing care regarding hospital, unit and staff characteristics, perceptions of staffing adequacy as well as nursing teamwork, displayed in the Missed Nursing Care Model. Design This was a quantitative cross-sectional survey study. Methods The samples were all registered nurses and practical nurses (n = 864) working on 27 medical, surgical and intensive care inpatient units in eight hospitals throughout Iceland. Response rate was 69·3%. Data were collected in March–April 2012 using the combined MISSCARE Survey-Icelandic and the Nursing Teamwork Survey-Icelandic. Descriptive, correlational and regression statistics were used for data analysis. Results Missed nursing care was significantly related to hospital and unit type, participants’ age and role and their perception of adequate staffing and level of teamwork. The multiple regression testing of Model 1 indicated unit type, role, age and staffing adequacy to predict 16% of the variance in missed nursing care. Controlling for unit type, role, age and perceptions of staffing adequacy, the multiple regression testing of Model 2 showed that nursing teamwork predicted an additional 14% of the variance in missed nursing care. Conclusions The results shed light on the correlates and predictors of missed nursing care in hospitals. This study gives direction as to the development of strategies for decreasing missed nursing care, including ensuring appropriate staffing levels and enhanced teamwork. Relevance to clinical practice By identifying contributing factors to missed nursing care, appropriate interventions can be developed and tested.

The ever increasing cancer care demand has posed a challenge for oncology nurses to deliver evidence-based, innovative cancer care. Despite many efforts to promote evidence-based practice, barriers still remain and executives still find it difficult to implement evidence-based practice in an efficient manner. Using the successful experience of an Australian tertiary cancer center as a case report, this paper depicts four effective strategies for facilitating evidence-based practice at the organizational level. These include the implementation of the Embedded Scholar: Enabler, Enactor and Engagement (4Es) Model; a 12-week Evidence-Based Practice Program; prioritizing clinically relevant research proposed by clinical staff; and endorsing high quality, evidence-based point-of-care resources such as the Cochrane Database of Systematic Reviews and the Oncology Nursing Society Putting Evidence into Practice.

Introduction Mental health care is an increasing component of acute patient care and yet mental health care education can be limited in undergraduate nursing programs. The aim of this study was to establish if simulation learning can be an effective method of improving undergraduate nurses' capability in mental health care in an acute care environment. Intervention Undergraduate nursing students at an Australian university were exposed to several high-fidelity high-technology simulation activities that incorporated elements of acute emergency nursing practice and acute mental health intervention, scaffolded by theories of learning. This approach provided a safe environment for students to experience clinical practice, and develop their skills for dealing with complex clinical challenges. Methods Using a mixed method approach, the primary domains of interest in this study were student confidence, knowledge and ability. These were self-reported and assessed before and after the simulation activities (intervention) using a pre-validated survey, to gauge the self-rated capacity of students to initiate and complete effective care episodes. Focus group interviews were subsequently held with students who attended placement in the emergency department to explore the impact of the intervention on student performance in this clinical setting. Results Students who participated in the simulation activity identified and reported significantly increased confidence , knowledge and ability in mental health care post-intervention. They identified key features of the intervention included the impact of its realism on the quality of learning . There is some evidence to suggest that the intervention had an impact on the performance and reflection of students in the clinical setting. Discussion This study provides evidence to support the use of simulation to enhance student nurses' clinical capabilities in providing mental health care in acute care environments. Nursing curriculum development should be based on best-evidence to ensure that future nursing graduates have the skills and capability to provide high-quality, holistic care.

How to Obtain Contact Hours by Reading This Issue Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf . In order to obtain contact hours you must: 1. Read the article, “From Academic-Practice Partnership to Professional Nursing Practice Model,” found on pages 104–112, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 28, 2020 . Contact Hours This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Objectives Describe the benefits and barriers to participation in a community-based academic-practice partnership. Identify three changes in the practice environment that transform the practice of staff nurses working in partnership model clinical units. Disclosure Statement Neither the planners nor the author have any conflicts of interest to disclose. This study used a qualitative descriptive design to examine the role of the expert staff nurse or clinical liaison nurse (CLN) participating in a community-based academic-practice partnership. Little is known about the influence of participation by expert nurses in community hospital settings. Focus groups were conducted with nine CLNs to explicate their experiences in a unit-based leadership practice model. Eight themes were identified: Reciprocal Learning Between Staff Nurses and Students; Reciprocal Learning Between Student and Patient; Working Around the System; Building Relationships; Valuing the CLN Role; Faculty Recognition of CLNs; Transforming Practice; and a variant theme, Recognition That Some Nurses Neither Value nor Enjoy Working With Students. The benefits of developing partnerships in community hospitals can be far reaching and may be of interest to educators and leaders in the profession. When a practice environment focused on evidence and was fueled by student enthusiasm reinvigorates staff nurses, their work world suddenly transforms. J Contin Educ Nurs. 2017;48(3):104–112.

Background With the current emphasis on including registered nurses (RNs) on the primary care teams, it is essential that nursing programs prepare students for employment in these settings. Purpose This study explored the current state of prelicensure and RN-to-Bachelor of Science in Nursing (BSN) online education regarding the implementation of primary care content in the curricula. Methods A sample of 1,409 schools and/or colleges from across the United States was invited to participate in an online survey. About 529 surveys were returned for an overall response rate of 37.5%. Summative content analysis was used to analyze survey data. Discussion Although most respondents have implemented some primary care content, some found it challenging and others have demurred from incorporating primary care content altogether. Conclusion Nursing leaders and faculty in academia must collaborate with clinical partners to design and expand didactic and clinical learning experiences that emphasize primary care content in the prelicensure and RN-to-BSN education.

Nurses are expected to deliver cost-effective, high-quality care. In order to provide this care, nurse researchers are needed to evaluate and research effective health care models and interventions. By including research concepts within a baccalaureate nursing program, interest in nursing research can be increased. The purpose of this article is to present a case study of strategies used in an undergraduate liberal arts nursing program to promote zest in research and increase the pursuit of graduate studies among baccalaureate nursing students. Using the Bronfenbrenner ecological framework, the promotion of research is categorized into microsystems (individual), mesosystems (multiple setting), exosystems (program), and macrosystem (institutional culture) levels. The microsystem level includes engagement in the classroom, engagement in one-on-one meetings, and faculty members as role models. The mesosystem involves engagement outside the classroom and encouragement from faculty members. The exosystem level describes specific learning activities and programs the nursing department utilizes such as community assessments, preconception reproductive knowledge promotion, and women supporting women. Finally, the macrosystem includes a supportive and encouraging environment. By working together, each system contributes to the students' zest for nursing research and interest in graduate studies in nursing to pursue the role of a nurse researcher.

Aims and objectives To evaluate the effect of Laughter therapy on the quality of life of nursing home residents. Background By improving the quality of life of residents living in nursing homes and allowing them to have a healthier existence, their lives can be extended. Therefore, interventions impacting the quality of life of older adults are of critical importance. Design Quasi-experimental design. Method The study was conducted between 2 March – 25 May 2015. The experimental group was composed of 32 nursing home residents from one nursing home, while the control group consisted of 33 nursing home residents from another nursing home in the capital city of Turkey. Laughter therapy was applied with nursing home residents of the experimental group two days per week (21 sessions in total). A socio-demographic form and the Short-Form Health Survey (SF-36) were used for data collection. Results After the laughter therapy intervention, general and subscales (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and spiritual health) quality-of-life scores of residents in the experimental group significantly increased in comparison with the pretest. Conclusion Laughter therapy improved the quality of life of nursing home residents. Therefore, nursing home management should integrate laughter therapy into health care and laughter therapy should be provided as a routine nursing intervention. Relevance to clinical practice The results indicated that the laughter therapy programme had a positive effect on the quality of life of nursing home residents. Nurses can use laughter therapy as an intervention to improve quality of life of nursing home residents.

Context Nursing homes are an important site for end-of-life care, yet little is known about the perspectives of the frontline staff who provide a majority of this care. Objective To describe, from the staff perspective, positive/negative experiences related to caring for dying residents. Methods Qualitative analysis using survey data from staff working in 52 Indiana nursing homes. Results A total of 707 frontline staff who provide nursing, nurse aide, and social work services responded to open-ended prompts. Study data included responses to open-ended prompts asking participants to describe one positive experience and one negative experience caring for a dying patient. A thematic content analysis was conducted using the constant-comparative method. Respondents were largely female (93%), white (78%), 31–50 years (42%), and 53% had >5 years of nursing home work experience. Experiences were described from three perspectives: 1) first-hand experiences, 2) observed experiences of dying patients, and 3) observed experiences of family members. Selected themes for positive experiences include the following: creating close bonds; good patient care; involvement of hospice; being prepared; and good communication. Selected themes for negative experiences consisted of the following: challenging aspects of care; unacknowledged death; feeling helpless; uncertainty; absent family; painful emotions; and family discord. Conclusion Findings reveal the richness and many complexities of providing end-of-life care in nursing homes and have implications for improving staff knowledge, coordination of care with hospice, and social support for patients.