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Aims. To develop an evidence-based practice (EBP) facilitating strategy informed by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and evaluates the strategy's effectiveness on promoting EBP. Background. Nurses are increasingly expected to use research evidence in practice to improve patients' outcomes, but the application of such evidence is still unsatisfactory. The facilitation of EBP in nursing needs the organization and the individual levels. Methods. Based on an analysis of EBP-promoting strategies and expert consultation, the core team of the nursing department developed an EBP group-based and project-oriented strategy under the guidance of the i-PARIHS framework. The strategy was implemented for six years and evaluated by a longitudinal design. The validated Chinese version of the self-reported Evidence Based Practice Questionnaire (EBPQ) was used to assess the attitudes, knowledge, and practice of the nurses. Results. The mean score of the total EBPQ was 4.46 (SD = 0.92) after one year of the EBP strategy, and the scores for knowledge, attitudes, and practice of EBP members were higher than those of general nurses p < 0.05 . After four years, EBP members' scores continued to increase. EBP groups conducted 51 EBP projects in the areas of emergency nursing, surgical and medical nursing, critical care, and so forth. Of these, 33 projects improved nursing practice by changing nursing procedures, upgrading nursing tools, and developing nursing standards, resulting in improved patient outcomes. Conclusion. The EBP group-based and project-oriented strategy can promote EBP. The composition of the EBP group, the annual audit of EBP projects, and the roles of internal and external facilitators were key components of this EBP-facilitating strategy. Implications for Nursing Management. The strategy is an organizational-level EBP-facilitation approach which can improve nurses' academic preparation for EBP through ongoing training and sustained EBP behavior that involves annual projects. [ABSTRACT FROM AUTHOR]

Aims. To identify the factors influencing critical care nurses' intention of physical restraint in intubated patients. Background. Physical restraint reduction has been advocated by many international institutions, nurses are the main physical restraint decision-makers, and it is critical to identify the factors influencing physical restraint intention from nurses' perspective. Methods. A cross-sectional study was conducted among critical care nurses in China from February 2022 to March 2022. Results. The model showed a good model fit (χ2/df = 2.57, RMSEA = 0.07, GFI = 0.94, CFI = 0.89, and AGFI = 0.90). Attitude (β = 0.29, p < 0.05), subjective norm (β = 0.25, p < 0.05), and perceived behavioral control (β = 0.32, p < 0.001) directly influenced the intention to use physical restraint in intubated patients. Ethical conflict (β = 0.04, p < 0.05) indirectly influenced the intention. Conclusions. The study revealed that ethical conflict, attitude, subjective norm, and perceived behavioral control were positive predictors of physical restraint intention among intubated patients from nurses' perspectives. Implications for Nursing Management. This provides a theoretical perspective to develop effective interventions to reduce physical restraints in critical care settings. Nursing managers should enhance ethical education and physical restraint knowledge and skill training. [ABSTRACT FROM AUTHOR]

Pressure injury is a serious and preventable problem in intensive care units. Translating guidelines into clinical practice can reduce the incidence of pressure injury. Identifying clinical status, barriers and facilitators contribute to guideline implementation. To identify the knowledge, attitudes, and practices of pressure injury prevention in Chinese critical care nurses. Secondary data were extracted from a multicentric clinical trial. Knowledge and attitudes toward pressure injury prevention were assessed by a fourteen‐item questionnaire. The observed practices were recorded using a case report form. The report complies with the STROBE statement. A total of 950 critical care nurses in 15 hospitals from six provinces of China were investigated. A total of 53.1% of nurses received a median score of 6 points or less. Knowledge regarding the repositioning procedure, risk assessment, and heel pressure injury prevention was insufficient. Over 99% of nurses strongly or somewhat agreed that pressure injury prevention was very important and that they were willing to take measures to prevent pressure injury. A total of 27 781 patient days of pressure injury prevention practice were recorded. Repositioning was the most commonly used prevention measure, followed by support surfaces and prophylactic dressings. A combination of repositioning, support surface, and prophylactic dressing was lacking. Chinese critical nurses showed a low level of knowledge and a positive attitude toward pressure injury prevention. Practices of pressure injury prevention were unsatisfactory. There is a clear gap between the guidelines and clinical practices. The barrier (low‐level knowledge) and facilitator (positive attitude) were identified in this study. According to these findings, strategies need to be developed to promote guideline implementation. [ABSTRACT FROM AUTHOR]

Aims: To explore the relationships of ethical climate, physician–nurse collaboration and psychological empowerment with ethical conflict in critical care nurses. Background: Ethical conflict is a major ethical issue in nursing practice. Little research has been done on the associated factors from both organizational and personal perspectives, especially in China. Methods: From October 2021 to March 2022, we collected the data from 342 critical care nurses in three tertiary general hospitals in China via questionnaires about four variables (ethical climate, physician–nurse collaboration, psychological empowerment and ethical conflict). Data were analysed using Spearman's correlation and a structural equation model through statistical product and service solutions (SPSS) and analysis of moment structure (AMOS). Results: Critical care nurses' ethical conflict showed a negative correlation with ethical climate (r = −0.351), physician–nurse collaboration (r = −0.347) and psychological empowerment (r = −0.259) (all p < 0.001). Physician–nurse collaboration partially mediated the relationship between ethical climate and ethical conflict. Additionally, physician–nurse collaboration and psychological empowerment served as sequential mediators in the association. Conclusions: These findings suggested that negative ethical climate can lead to poor physician–nurse collaboration and ultimately ethical conflict. The intermediary role of psychological empowerment and physician–nurse collaboration was also identified. Implications for Nursing Management: Nursing managers should use the study as a fundamental basis to evaluate factors that can affect nurses' ethical conflict and develop effective strategies to mitigate this issue, which may help improve nurses' wellbeing and quality of patient care. [ABSTRACT FROM AUTHOR]

Background: Ethical conflicts are common in the critical care setting, and have compromised job satisfaction and nursing care quality. Using reliable and valid instruments to measure the ethical conflict is essential. This study aimed to translate the Ethical Conflict in Nursing Questionnaire — Critical Care Version into Chinese and determine the reliability and validity in the population of Chinese nurses. Methods: Researchers obtained permission and followed the translation-backward method to develop the Chinese version of the Ethical Conflict in Nursing Questionnaire — Critical Care Version (ECNQ-CCV-C). Relevant psychometric properties were selected according to the Consensus-based standards for the selection of health status measurement instruments checklist. Critical care nurses were recruited from two tertiary public hospitals in Hangzhou, Zhejiang Province, and Kunming, Yunnan Province. Of the 264 nurses we approached, 248 gave their consent and completed the study. Results: The ECNQ-CCV-C achieved Cronbach's alphas 0.902 and McDonald's omega coefficient 0.903. The test-retest reliability was satisfactory within a 2-week interval (intraclass correlation coefficient = 0.757). A unidimensional structure of the ECNQ-CCV-C was determined. Confirmatory factor analysis supported acceptable structure validity. Concurrent validity was confirmed by a moderate relation with a measure for hospital ethical climate (r = − 0.33, p < 0.01). The model structure was invariant across different gender groups, with no floor/ceiling effect. Conclusions: The ECNQ-CCV-C demonstrated acceptable reliability and validity among Chinese nurses and had great clinical utility in critical care nursing. [ABSTRACT FROM AUTHOR]

Background: Being bedridden, which is a common clinical phenomenon, causes a series of complications related to immobilization. Effective management of immobility complications requires a reasonable allocation of nursing resources. Unit‐level evidence about the relationship between nursing resources and immobility complications is lacking. Objectives: To gain insight into nursing resources in China and explore the relationship between nursing resources and the incidence of major immobility complications among bedridden patients. The major immobility complications included in our study were pressure ulcers, deep vein thrombosis, pneumonia and urinary tract infection. Design: A nationwide, multicenter, cross‐sectional survey. Setting: From November 2015 to June 2016, 18 hospitals (six tertiary and 12 secondary) from six provinces and cities in different geographic regions (eastern, southern, western, northern and central) in China participated in our study. Participant: Intensive care units, internal medicine and surgery wards with high proportions of bedridden patients were chosen as investigation sites. Of the total of 23,637 available patients in the selected wards, 19,530 were recruited. Methods: Data on nursing resources and ward characteristics were collected mainly by questionnaire. The incidence of major immobility complications among bedridden patients was measured by trained investigators. Data on patient characteristics were collected from the patient record system of each hospital. Multilevel regression analysis was used to estimate the impact of nursing resources on the incidence of major immobility complications, adjusting for patient and ward characteristics. Results: The study included 23,637 patients in 213 wards, and 19,530 were recruited. The incidence of the four complications was 0.77% (pressure ulcers), 0.82% (deep vein thrombosis), 3.39% (pneumonia) and 0.86% (urinary tract infection), and the overall incidence of major immobility complications was 5.41%. The incidence of major immobility complications was higher in wards not attaining the target bed‐to‐nurse ratios than in those that met these criteria (β = 0.44, 95% confidence interval [CI]: 0.02–0.87; OR = 1.553, 95% CI: 1.002–2.387). The incidence of major immobility complications was negatively associated with the proportion of nurses with intermediate or senior job titles (β = −2.12, 95% CI: −3.78 to −0.45; OR = 0.120, 95% CI: 0.023–0.638). However, the incidence of major immobility complications was unexpectedly positively associated with the proportion of nurses with a bachelor's degree or higher (β = 1.06, 95% CI: 0.31–1.81; OR = 2.886, 95% CI: 1.363–6.110). Conclusions: Sufficient nurse staffing and higher professional titles of nurses might contribute to reducing the incidence of major immobility complications. Nurse experience was not related to the incidence of major immobility complications. However, the association between nurse education level and the incidence of major immobility complications requires further investigation. Implications for Nursing Management: More nurses,especially nurses with higher professional titles may reduce the incidence of major immobility complications. [ABSTRACT FROM AUTHOR]

Aims and objectives: To gain insight into nurses’ knowledge and attitudes regarding major immobility complications (pressure ulcers, pneumonia, deep vein thrombosis and urinary tract infections) and explore the correlation of nurses’ knowledge and attitudes with the incidence of these complications. Background: Immobility complications have adverse consequences, and effective management requires appropriate knowledge, attitudes and skills. Evidence about nurses’ knowledge and attitudes regarding immobility complications is lacking. Design: Cross‐sectional study. Methods: A total of 3,903 nurses and 21,333 bedridden patients from 25 hospitals in China were surveyed. Nurses’ knowledge and attitudes regarding major immobility complications were assessed using researcher‐developed questionnaires. The content validity, reliability and internal consistency of the questionnaires were validated through expert review and a pilot study. The incidence of major immobility complications among bedridden patients from selected wards was surveyed by trained investigators. Correlations between knowledge, attitudes and the incidence of major immobility complications were evaluated with multilevel regression models. Results: Mean knowledge scores were 64.07% for pressure ulcers, 72.92% for deep vein thrombosis, 76.54% for pneumonia and 83.30% for urinary tract infections. Mean attitude scores for these complications were 86.25%, 84.31%, 85.00% and 84.53%, respectively. Knowledge and attitude scores were significantly higher among nurses with older age, longer employment duration, higher education level, previous training experience and those working in tertiary hospitals or critical care units. Nurses’ knowledge about pressure ulcers was negatively related to the incidence of pressure ulcers, and attitude towards pneumonia was negatively correlated with the incidence of pneumonia. Conclusion: Clinical nurses have relatively positive attitudes but inadequate knowledge regarding major immobility complications. Improved knowledge and attitudes regarding major immobility complications may contribute to reducing these complications. Relevance to Clinical Practice: Nursing managers should implement measures to improve nurses’ knowledge and attitudes regarding major immobility complications to reduce the incidence of these complications in bedridden patients. [ABSTRACT FROM AUTHOR]

Evidence emphasises a strong relationship between nursing workload and job satisfaction. This study sets out to test empirically the roles of psychological meaningfulness and perceived organisational support on the nursing workload-satisfaction relationship. To investigate empirically the role and impact of psychological meaningfulness and perceived organisational support on the relationship between nursing workload and job satisfaction. Prospective cross-sectional study. A large acute care and teaching hospital in China. 500 nurses were asked to participate in this study and respond to a survey questionnaire. 426 nurses participated in this study, of which 395 responses (valid response 79%, 52% general nurses, 40% nurses in charge, and 9% senior nurses) were considered valid. A multi-item questionnaire was used to assess the constructs of interest, which included demographic items; items related to nursing satisfaction, meaningfulness, and perceived organisational support; and lastly items assessing workload. Included items were a combination of previously validated scales and items co-developed between the research team and nurses of the study hospitals. Since the study relies on self-reported scales, the common latent factor technique was initially used to ensure that the common bias was not a major concern. Model fitness was tested using one-factor congeneric measurement. The research hypotheses were tested using the SPSS add-on PROCESS v3.3 model in a bootstrap approach. In the first part of the analysis, 43 of 51 factors survived the initial tests using common latent factor technique and model fitness measurements. We found that the direct effect of psychological meaningfulness on the workload-satisfaction relationship was significant. This suggests that psychological meaningfulness mediates the relationship. It further illustrates that perceived organisational support acts as a moderator for the relationship and accordingly it specifies conditions under which the workload can be related to job satisfaction. However, in the presence of psychological meaningfulness, the perceived organisational support moderated the workload-psychological meaningfulness relationship and its direct effect on workload-job satisfaction relationship became non-significant. Our study provides an understanding of how psychological meaningfulness and perceived organisational support may play out in the context of nursing work. To the best of our knowledge, this the first study to directly measure and explore these relationships in a quantitative manner. Our results indicate the critical role of perceived organisational support, where present, in allowing nurses to see the connection between their workload and their ultimate aspirations so that their work becomes more psychologically meaningful. This study provides an understanding of how psychological meaningfulness and perceived organisational support affect nursing work. [ABSTRACT FROM AUTHOR]

While a nursing intervention program for immobile patients with stroke can improve clinic outcomes, less is known about the cost-effectiveness of these interventions. The goal of this study was to evaluate the cost-effectiveness of the intervention program for immobile patients with stroke in China. A cost-effectiveness analysis alongside a pre-test/post-test (before and after) study was undertaken from a health care perspective. Participants were recruited from 25 hospitals among six provinces or municipal cities in eastern (Guangdong province, Zhejiang province, and Beijing municipal city), western (Sichuan province), and central (Henan province and Hubei province) China. A total of 7,653 immobile stroke patients were included in our sample. Patients in routine care settings were recruited from November 2015 to June 2016, and the recruitment of the intervention group patients was from November 2016 to July 2017. To adjust for potential bias from confounding variables, the 1:1 propensity score matching yielded matched pairs of 2,966 patients in the routine care group and 2,966 patients in the intervention group, with no significant differences in sociodemographic or clinical characteristics between two groups. All patients were followed-up 3 months after enrolment in the study. Total healthcare costs were extracted from the hospital information system, with the health outcome effectiveness of the intervention program measured using the EuroQol five-dimensional questionnaire (EQ-5D) instrument and the cost-effectiveness of the intervention measured by the incremental cost-effectiveness ratio with a time horizon of 3 months. Compared to routine care, the intervention program decreased the total costs of stroke patients by CN¥4,600 (95% confidence interval [CI]: [-7050, -2151]), while increasing quality-adjusted life year 0.009 (95% CI: [0.005, 0.013]). The incremental cost-effectiveness ratios over 3 months was CN¥–517,011 per quality-adjusted life year (95% CI: [-1,111,442, -203,912]). Subgroup analysis reveals that both the health-related quality of life and cost effectiveness improved significantly for ischemic patients and tertiary hospitals patients while for hemorrhagic patients and non-tertiary hospital patients only the health-related quality of life improved significantly. Findings from this first cost-effectiveness analysis in immobile stroke patients provide evidence that an intervention program provided significant cost saving, but mainly in ischemic patients and tertiary hospital patients. Wider adoption of such programs may be a sensible approach to reducing the burden of stroke and for immobile patients more generally. [ABSTRACT FROM AUTHOR]