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Changes in the healthcare system directly impact the nursing profession. Nursing is a vital profession, and nurses face many challenges and the need for changes in healthcare. This first-time study aimed to describe the change agent competency of clinical nurses from their perspectives in the Thai healthcare context. The researchers conducted a qualitative descriptive study. In-depth interviews were conducted among 12 clinical registered nurses in a Thailand Quality Award recipient super-tertiary university hospital in southern Thailand using semi-structured interviews, audio-recording, and observation record forms during October to December 2021. Purposive and snowball sampling were used to select participants. Using content analysis, seven themes of change agent competency were revealed: 1) improving quality of care, 2) commitment to achieving change, 3) clinical ability, 4) enhancing engagement in improvement, 5) using information efficiently, 6) knowing how to seek useful resources, and 7) improving after receiving feedback contributing to the conceptual structure of change agent competency. Trustworthiness was assessed using member checking and peer debriefing to ensure the quality of the study. The findings are helpful for nurses and health leaders to better understand the potential of nurses as change agents in reforming practice. The findings of this study also form a foundation for nurse educators to incorporate change agent theory and practices in education and training. However, since this was a first-time study on the topic with clinical nurses in Thailand, much more research is needed, including developing a standard tool to measure and develop change agent competency of Thai clinical nurses, given there is no such instrument in the country [ABSTRACT FROM AUTHOR]

A variety of factors are associated with the likelihood of reporting guns at school; however, mixed empirical findings hinder our ability to inform policies to reduce school violence. Additionally, many of the established factors are difficult to change over time, and limited attention has been devoted to more malleable factors such as anonymous reporting. To better understand how to improve the likelihood of gun reporting at school, we drew from three waves of survey data from 3,633 students in St. Louis, Missouri. Using a multilevel model, we find that perceived risk of victimization and the availability of anonymous reporting increase the likelihood of gun reporting, while negative peer commitment, self-reported delinquency, and victimization decrease the likelihood of reporting. Additional analyses suggest that independent of known risk factors that inhibit reporting, increases in school climate and improvements in availability of anonymous reporting can increase the likelihood of reporting guns at school. [ABSTRACT FROM AUTHOR]

Background: This study investigates nursing staff perceptions regarding the impact of Joint Commission International (JCI) accreditation on the quality of care within a university hospital in Palestine. The research specifically examines how the accreditation process influences nursing practices, patient results, and overall healthcare quality in a challenging environment marked by unique operational and external pressures. Methods: The study was conducted at An-Najah National University Hospital (NNUH), a university hospital in Palestine, using a cross-sectional survey design. The structured questionnaire employed in the study was based on the Donabedian model, which evaluates the process and outcome dimensions of healthcare quality influenced by JCI accreditation. The questionnaire consisted of 47 items, divided into ten main subsections. These subsections included participants' demographical information (6 items), quality measurement and analysis (4 items), leadership, commitment and support (4 items), use of data (4 items), strategic quality planning (4 items), human resources education and training (4 items), quality management (4 items), quality results (4 items), staff involvement (5 items), and benefits of accreditation (8 items). The questionnaire was rigorously designed to assess both the quality processes and quality results. The eight subscales evaluated various aspects, such as leadership commitment, strategic planning, and staff involvement. To ensure reliability, the internal consistency of the survey was confirmed with a high Cronbach's alpha score, demonstrating the tool's robustness and reliability in capturing the intended data. Results: The study of 180 nurses overwhelmingly supported the positive impact of JCI accreditation on hospital quality improvement processes. More than 90% of respondents acknowledged the role of accreditation in improving resource utilization, meeting population needs, and promoting professional standards and values ​​among staff. Statistical analyses, including Pearson correlation and stepwise regression, highlighted strong positive associations between quality process variables and quality results. In particular, leadership commitment, strategic planning, and staff engagement were found to be significant predictors of improved quality results. Conclusions: This study's findings demonstrate that JCI accreditation significantly positively impacts nurses' perceptions of care quality at NNUH. The study underscores the importance of international accreditation in driving quality improvements in healthcare, particularly in settings with unique challenges such as those faced in Palestine. These insights are crucial for policymakers and healthcare administrators aiming to enhance care standards through accreditation in similar environments. [ABSTRACT FROM AUTHOR]

Objective: Professional values are crucial for delivering high-quality care in neonatal intensive care units while caring behavior impacts nurses' performance and well-being. The purpose of this study was to assess the relationship between professional values and caring behavior among nurses in neonatal intensive care units. Methods: A cross-sectional study involving 172 nurses was conducted using the Nursing Professional Value Scale and Caring Behaviors Assessment Tool. The study was carried out between 1 October and 5 December 2023. Results: Nurses demonstrated a moderate to high degree of professional commitment, with a mean professional value score of 91.1 ± 11.1. The mean score for caring behavior was 99.7 ± 12.4. The highest-rated domain was setting up a supporting, protective, and corrective environment, with a mean score of 22.8 ± 2.7. A low positive relationship was found between the supportive, protective, and corrective environment domain and nurses' professional value (r = 0.18, p = 0.017), as well as between overall caring behavior and nurses' professional value (r = 0.16, p = 0.038). Conclusion: The results indicate a favorable relationship between professional values and caring behavior, especially in areas like establishing a supportive workplace. However, both professional value and caring behavior needs improvement in certain aspect. Enhancing these aspects could further strengthen their relationship, ultimately improving the quality of care provided to newborn patients and their families. Practice implications: To cultivate a positive work environment and instill caring behaviors and professional values among NICU nurses, it is imperative to allocate sufficient time and resources. This investment is necessary for nurturing a culture of care, improving patient outcomes, and fostering a supportive environment for NICU nurses, newborn, and their families. [ABSTRACT FROM AUTHOR]

In the UK, student nurses, nursing associates and midwives are supervised by practice supervisors and practice assessors while completing the placement-based component of their training. Because of increased clinical commitments, staff shortages and rising student numbers, demands for the supervision and assessment of student nurses have increased in recent years and this was exacerbated by COVID-19. The Nursing and Midwifery Council's Standards for Student Supervision and Assessment separated the roles of practice supervisor and assessor, giving rise to opportunities to assess students in a different way. Some integrated care systems are exploring the new role of roaming assessor. Roaming assessors can fulfil the role of practice assessors while providing additional support for student nurses. This role could be expanded to other health professions. This article explores the use of practice learning facilitators as roaming assessors for student nurses in the UK and evaluates the potential benefits and limitations of this approach. Roaming assessors may provide a useful service to deliver practice assessments, increasing the reliability and availability of assessments. [ABSTRACT FROM AUTHOR]

Background: As the healthcare sector grapples with its environmental footprint, the concept of Eco-conscious Nursing emerges as a pivotal framework for integrating sustainability into nursing practice. This study aims to clarify and operationalize Eco-conscious Nursing, examining its attributes, antecedents, consequences, and providing operational definitions to guide future research and practice. Methods: Utilizing a systematic literature review across PubMed, Google Scholar, and CINAHL Ultimate, this study identifies and analyzes existing theories, frameworks, and practices related to eco-conscious nursing. Through conceptual analysis, key attributes, antecedents, and consequences of Eco-conscious Nursing are delineated, leading to the formulation of comprehensive operational definitions. Results: The study reveals Eco-conscious Nursing as a multifaceted concept characterized by environmental stewardship, sustainable healthcare practices, and a commitment to reducing the ecological impact of nursing care. Operational definitions highlight the role of education, awareness, and institutional support as antecedents, with improved environmental health and sustainable healthcare outcomes as key consequences. Conclusion: Eco-conscious Nursing represents a crucial ethos for the nursing profession, emphasizing the necessity of sustainable practices within healthcare. The operational definitions provided serve as a foundation for embedding eco-conscious principles into nursing, addressing the urgent need for sustainability in healthcare settings. Future research should focus on the empirical application of these definitions and explore the economic and cross-cultural dimensions of eco-conscious nursing. [ABSTRACT FROM AUTHOR]

Background: Local governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts. Methods: We conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs. Results: Almost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA's related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support. Conclusion: Our study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health. [ABSTRACT FROM AUTHOR]

Background: Inequalities in access to palliative and end of life care are longstanding. Integration of primary and palliative care has the potential to improve equity in the community. Evidence to inform integration is scarce as research that considers integration of primary care and palliative care services is rare. Aim: To address the questions: 'how can inequalities in access to community palliative and end of life care be improved through the integration of primary and palliative care, and what are the benefits?' Design: A theory-driven realist inquiry with two stakeholder workshops to explore how, when and why inequalities can be improved through integration. Realist analysis leading to explanatory context(c)-mechanism(m)-outcome(o) configurations(c) (CMOCs). Findings: A total of 27 participants attended online workshops (July and September 2022): patient and public members (n = 6), commissioners (n = 2), primary care (n = 5) and specialist palliative care professionals (n = 14). Most were White British (n = 22), other ethnicities were Asian (n = 3), Black African (n = 1) and British mixed race (n = 1). Power imbalances and racism hinder people from ethnic minority backgrounds accessing current services. Shared commitment to addressing these across palliative care and primary care is required in integrated partnerships. Partnership functioning depends on trusted relationships and effective communication, enabled by co-location and record sharing. Positive patient experiences provide affirmation for the multi-disciplinary team, grow confidence and drive improvements. Conclusions: Integration to address inequalities needs recognition of current barriers. Integration grounded in trust, faith and confidence can lead to a cycle of positive patient, carer and professional experience. Prioritising inequalities as whole system concern is required for future service delivery and research. [ABSTRACT FROM AUTHOR]

Client violence towards social workers is a phenomenon with serious consequences that affect the professional, service and organisation. However, it is not known what effect such violence has on each. A systematic review of 26 studies found that the consequences have an impact on the social worker, the service and the organisation. In particular, it affects the health of the social worker, the professional relationship the professional relationship with the client and organisational functioning. It is stressed that prevention measures should be holistic and comprehensive to reduce violence, focusing on actions involving the professional and influencing organisational and contextual policies. [ABSTRACT FROM AUTHOR]

This study examined the relationship between structural empowerment and affective commitment, mediated by work engagement, in frontline social workers in Spain. Based on two samples (240 participants from public agencies and 226 participants from private agencies) and using linear regression models (bootstrapping method), our results showed two effects in the relationship between structural empowerment and organizational commitment: a direct effect fostering experiences of power and an indirect effect by increasing engagement at work. Empowering human resources management (HRM) practices (access to opportunities, information, resources, and support) is a useful tool for managers and administrators, with strong benefits for both social workers and agencies. [ABSTRACT FROM AUTHOR]

The article discusses the role of artificial intelligence in enhancing medical care quality and patient safety. Topics mentioned include the enhancement of electronic medical record, the reduction in administrative burden of medical care, the increase in job satisfaction of medical care personnel, the decrease in workforce shortages and burnout and the improvement in the time of physicians for caring their patients instead of documenting their care.

Bioethicists influence practices and policies in medicine, science, and public health. However, little is known about bioethicists' views. We recently surveyed 824 U.S. bioethicists on a wide range of ethical issues, including topics related to abortion, medical aid in dying, and resource allocation, among others. We also asked bioethicists about their demographic, religious, academic, and professional backgrounds. We find that bioethicists' normative commitments predict their views on bioethical issues. We also find that, in important ways, bioethicists' views do not align with those of the U.S. public: for instance, bioethicists are more likely than members of the public to think abortion is ethically permissible but are less likely to believe compensating organ donors is. Our demographic results indicate the field of bioethics is far less diverse than the U.S. population—less diverse even than other academic disciplines—suggesting far more work needs to be done to build an inclusive field. [ABSTRACT FROM AUTHOR]

Engaging the public and community organizations in local health actions greatly assists disease prevention and control. However, it remains unclear how organization-public relationships (OPR) and communication networks within communities contribute to community health actions. To fill this gap, a survey was conducted among community members in Shanghai, China, who were challenged by the Omicron wave of the COVID-19 pandemic. Results revealed that integrated connectedness to a storytelling network (ICSN) was a significant predictor of residents' community engagement. Trust, control mutuality, commitment, and ICSN were positively associated with community engagement intentions through the sense of community and organizational efficacy. This study is a step toward understanding how organizations and members collectively respond to health crises at the community level. [ABSTRACT FROM AUTHOR]

Drawing from transformational leadership (TFL) theory and research on contextual leadership, we examined a conditional process model of leadership in nursing teams to predict patient loyalty. Using TFL's individualized consideration dimension as a salient facet of the construct in care services, we first posited that nurses' team affective commitment would partially mediate the impact of nurse leadership. We further conceptualized nurse–physician collaboration, organizational formalization and task feedback as discrete contexts that may curb the influence of head nurses' individualized consideration. In a three‐wave, multisource and multilevel study, we surveyed 654 nurses and 1770 patients from 91 hospital units. We found that team‐level head nurses' individualized consideration positively and partially related to patient loyalty through nurses' team commitment and that higher levels of nurse–physician collaboration, organizational formalization and task feedback were associated with reduced influence of individualized consideration on team commitment and patient loyalty. We discuss the implications of these findings for advancing theory and research on TFL and contextual factors of leadership. [ABSTRACT FROM AUTHOR]

In the era of rapid development in the mobile internet economy, mobile intelligent office equipment has exhibited an unprecedented level of "vitality." The boundaries between work and family are becoming increasingly blurred, fostering the exchange of resources between employees' work role and family role. Workplace spirituality refers to meaningful work, sense of community, and alignment with the organization that individuals develop in their work, which has been demonstrated to have positive impact on work output. It is a question whether workplace spirituality can be spilled over from employees' work role to their family role to improve the performance of the latter and to realize the win‐win results for both roles. Based on work–home resources model and work–family enrichment dual‐path model, this research uses multi‐country data to examine how workplace spirituality influence work–family enrichment through affective rumination (affective path) and problem‐solving pondering (instrumental path). Additionally, work–family segmentation preference is introduced as a moderating variable to identify the boundary conditions between workplace spirituality and work‐related rumination. Research findings show that workplace spirituality can positively predict work–family enrichment; affective rumination and problem‐solving pondering play a partially mediating role in the correlation between workplace spirituality and work–family enrichment. A strong work–family segmentation preference could diminish the positive impact of workplace spirituality on problem‐solving pondering and could also weaken the mediating role of problem‐solving pondering between workplace spirituality and work–family enrichment at the same time. This study reveals the strategies to enhance work–family enrichment from a spiritual perspective, thereby promoting a win‐win situation for both work and family. [ABSTRACT FROM AUTHOR]

Introduction: The growth of surgeon burnout is of significant concern. As we work to reimagine the practice of surgery, an accurate understanding of the extent of surgeon burnout is essential. Our goal was to define the current prevalence of burnout and quality of life (QOL) among SAGES surgeons. Methodology: An electronic survey was administered to SAGES members to establish a current baseline for QOL, burnout, depression, and career satisfaction. To assess outcomes, we utilized the validated Maslach Burnout Inventory for Medical Personnel, the Medical Outcomes Study Short Form, and the Primary Care Evaluation of Mental Disorders. All scoring followed validated norm-based methods. Results: Of 4194 active members, 604 responded (14.40%). 69% met burnout threshold, with high levels of emotional exhaustion and depersonalization, and low personal accomplishment. 81% reported "being at the end of their rope", 74% felt emotionally drained, and 65% felt used up daily. Nearly all maintained caring about what happened to their patients (96%), easily understanding how their patients feel (84.3%) and being capable of dealing effectively with their patient's problems (87.6%). However, respondents never, rarely, or occasionally felt energetic (77.5%) or experienced a sense of professional accomplishment (57.8%). The overall QOL score was 69/100, with lower Mental than Physical scores (62.69 (SD 10.20) vs.77.27 (SD 22.24)). More than half of respondents met depression criteria. While 77% supported they would become a physician again, less than half would choose surgery again or recommend surgery to their children. Furthermore, less than a third felt work allowed sufficient time for their personal lives. Conclusions: Participating SAGES surgeons reported alarmingly high rates of burnout and depression. Despite experiencing emotional exhaustion and depersonalization, they maintained a strong commitment to patient care. These findings likely reflect the broader state of surgeons, underscoring the urgent need for action to address this critical issue. [ABSTRACT FROM AUTHOR]

The raison d'être for psychotherapy1 is to address individual suffering and distress. The sustainable development goals address suffering and distress on a global scale in the context of threats to the survival of our communities and planet. Objective: We propose scaling up therapeutic principles for collective impact and nurturing therapist commitment beyond the therapy room, to activate and sustain compassion‐in‐action at the community system level. Design: The SDGs represent the strength of collective human concern and action coming together. At the half‐way point, we are falling dangerously short of our targets, requiring an urgent response. The tenet of this paper is that the weakest link in our journey is not technical capability or finances, or even the impact of multiple intersecting crises, but our ability to collaborate for sustained action—it is the human factor—hence, we need a psychologically informed response. Method: Notably, least 'visible' is SDG17, the umbrella goal designated means of implementation, through partnership. Partnership has been treated as a transactional element of SDG projects, rather than the vital heartbeat connecting daily actions to the 2030 vision. Partnership is about investing in relationships and a commitment to working together with a common purpose—the bailiwick of psychological therapists. Results: We propose an architecture to support the development of courageous partnerships and compassionate systems. Conclusion: Compassion uniquely potentiates global action on wicked problems. [ABSTRACT FROM AUTHOR]

Background: Ethical conflict is embedded in healthcare and is common in critical care setting. However, there is a paucity of research on the nature of ethical conflict in China. Ethical conflict has cultural and context sensitivity. Therefore, evidence is needed from different backgrounds to help discuss this issue across borders. Aim: This study aimed to qualitatively identify the experience of ethical conflict in critical care professionals in China. Study design: From December 2021 to February 2022, we performed semi‐structured, face‐to‐face interviews with 21 critical care professionals from five intensive care units in a tertiary general hospital in China. A thematic analysis approach was used to analyse the data. Results: Five themes and 14 sub‐themes emerged from the data. Critical care professionals probably felt unable to navigate uncertainty, torn by family issues, outraged by unprofessional behaviours of medical staff, being trapped in a socioeconomic dilemma when having experience of ethical conflict. In addition, they also perceived that they could turn struggle into growth. Conclusions: The experience of ethical conflict in critical care professionals involved a mixture of feelings. This study builds a comprehensive understanding of how ethical conflict affected their perceptions of themselves and their profession and provides implications to develop effective coping strategies. Relevance to Clinical Practice: The identification of critical care professionals' experience of ethical conflict would help identify what might trigger the ethical issues and what would be the potential target to optimize in critical practice. [ABSTRACT FROM AUTHOR]

BACKGROUND The change from a clinical nurse specialist to nurse practitioner model has significantly affected graduate education and practice because of emphasis on the dominant biomedical prescriber role, marginalizing the nurse-psychotherapy and consultation-liaison roles fundamental to quality psychiatric advanced practice nursing practice. AIM/METHOD We report on a four-year Workforce Development Project supported by an academic-practice partnership to restore formation and skill building of the marginalized roles. Part One focuses on program design, the curriculum for nine specialty courses, and the teaching and learning community approach that promotes engagement, faculty commitment, and preceptor recruitment and retention; the creative faculty staffing model is described. RESULTS The educational frame described includes highlights of teaching/learning strategies drawn from the history of professional formation curriculum rooted in salutogenesis and belonging science, existentialism, solution-focused therapy, modeling and role modeling theory, and Peplau’s Interpersonal Relations. CONCLUSION There is significant interest and commitment to learning the nurse-psychotherapist and consultationliaison roles. [ABSTRACT FROM AUTHOR]

Participatory approaches are important to ensuring that the involvement of children in decision‐making is normalised in service provision. Participation work requires that professionals have well‐developed engagement skills, and a commitment to the right of the child or young person to participate. Effective participatory approaches also require that organisations provide active support for child‐centred practice. The Reconceptualising Services from the Perspectives of Experienced Children and Teens (ReSPECT) approach is an Australian professional development (PD) program that addresses these key aspects of participation work. It offers professionals a way to:(1) increase their awareness of the complex issues, challenges and benefits surrounding participation; and (2) develop a sense of empowerment and competence in the 'doing' of participation work. The PD program encourages professionals to understand their own position in relation to participation work with children, develop bespoke strategies that account for their unique practice context and assemble support structures that can maintain their participation strategies beyond the training. The principles and practices of the ReSPECT PD program are outlined and positioned within the existing literature on theoretical and practice approaches. The paper contributes to critical debate on the mechanisms that can lead to changes in professional practice and organisational culture, for the meaningful engagement of children as stakeholders in decision‐making. It is shared as a way of supporting others designing professional development approaches for child and youth decision‐making. [ABSTRACT FROM AUTHOR]

Background: This study explores the perceptions of supported accommodation staff and their managers of the support needs of residents ageing with intellectual disabilities, and their experiences of adjusting services for this group in the context of individualised funding. Method: Qualitative interviews were conducted with 21 staff working in Australian supported accommodation services. Findings: Four themes emerged. The first captured the staff's limited understanding of ageing and the medicalisation of support needs. The second identified staff practices and adjustments to service provision to facilitate residents' healthy ageing. The third described staff commitment to facilitating ageing residents to age in place, and the fourth identified staff challenges and opportunities in supporting ageing residents in the context of the National Disability Insurance Scheme (NDIS). Conclusions: Findings may inform the development of practice guidelines and training for supported accommodation staff, protocols for intersections between disability, aged care and health sectors, and adequate policy responses to support older residents' healthy ageing. [ABSTRACT FROM AUTHOR]

Introduction: In May 2022, the American Council of Academic Physical Therapy announced a "nationwide shortage of faculty" in entry-level Doctor of Physical Therapy (DPT) programs across the country. As the number of physical therapist education programs continue to grow, concerns with faculty shortages increase. Review of literature: Research on reasons faculty stay in entry-level DPT programs is limited. With a nation-wide shortage of faculty and the continued growth of DPT programs across the country, more investigation into faculty retention is warranted. Subjects: Two hundred forty-four participants responded to the quantitative survey. Ten program directors (PD) and 10 faculty members (FM) completed a qualitative interview through Zoom. Methods: This mixed-methods design included a quantitative survey across 264 accredited DPT programs followed by 20 qualitative online interviews. Multiple regression was completed for the data analysis, and a phenomenological approach was used to explore perceptions of job satisfaction and organizational commitment on intent to stay. Results: Two hundred thirty-six subjects (mean age = 50.04 ± 9.54 years; males = 63, females = 173; PD = 55, FM = 180) were included in the analysis. The multiple regression model significantly predicted intent to stay for all participants, F(9,211) = 12.43, P < .001; adj R² = .32. Commitment to the organization was the greatest predictor of intent to stay, β = 0.61, t(0.622) = 5.05, P < .01. Three themes with 6 subthemes emerged from the qualitative analysis, the impact of leadership, making a commitment, and the Covid crisis. Conclusion and discussion: Encouraging leadership to focus on structural factors such as striving to establish FMs as part of the departmental team, allowing autonomy and flexibility in the teaching role, building transparency and openness with communication, and focusing on realistic and equitable workloads could potentially increase intent to stay for faculty in entry-level DPT programs. [ABSTRACT FROM AUTHOR]

Aims: Cardiac dysfunction in patients with diabetes, referred to as diabetic cardiomyopathy, is primarily precipitated by dysregulations in glucose and lipid metabolism. Diet and lifestyle changes are considered crucial for successful heart failure and diabetes management and are often difficult to achieve. Low-carbohydrate diets (LCDs) have gained popularity for the management of metabolic diseases. Although quantitative research in this field is evolving, little is known about the personal experience of patients with diabetic cardiomyopathy on specific diets. The aim of this qualitative study was to identify enablers and barriers of patients with diabetic cardiomyopathy who engage in an LCD. It further explored patients' perception of dietary education and dietary support received while in hospital. Methods and Results: Participantswho previously consented to a 16-week LCD trialwere invited to share their experiences. Nine patients agreed to be interviewed. Semistructured interviews and a focus group interview were conducted,which were transcribed verbatim. Data were analyzed by using the 6-step approach for thematic analysis. Four themes were identified: (1) nutrition literacy (2) disease-related health benefits, (3) balancing commitments, and (4) availability of resources and support. Conclusion: Improvements in disease-related symptoms acted as strong enablers to engage in an LCD. Barriers such as access to resources and time constraints were identified. These challenges may be overcome with efficient communication and ongoing dietary support. More research exploring the experience of patients with diabetic cardiomyopathy on an LCD are warranted. [ABSTRACT FROM AUTHOR]

Background: Organ donation is a critical component in the field of transplantation medicine, offering lifesaving opportunities for patients with end-stage organ failure. This study investigated the knowledge, attitude, and practice (KAP) survey regarding organ donation among medical students in Jordan. Methods: A cross-sectional survey was conducted among medical students across six Jordanian universities. Using a convenience sampling method, participants were invited via email, social media, and professional networks to complete a structured online questionnaire. The survey captured data on demographics, knowledge about organ donation processes, attitudes toward organ donation, and self-reported practices. Statistical analyses explored associations between students' KAP and their demographic characteristics. Results: A total of 539 medical students participated in the study. Findings revealed moderate knowledge and generally positive attitudes toward organ donation, with significant variability influenced by demographic factors. Students from various universities demonstrated different levels of knowledge and attitudes. Notably, religious and cultural beliefs significantly affected students' attitudes toward organ donation. Conclusions: The study highlighted a gap between the positive attitudes and the actual commitment to organ donation among the participants, revealing a need for targeted educational interventions to address misconceptions and enhance the willingness to donate organs. Promoting organ donation education within medical schools could foster a more supportive environment for organ donation, ultimately contributing to increased donor rates and improved transplantation outcomes in Jordan. [ABSTRACT FROM AUTHOR]

Purpose: Early childhood teachers play a significant role in building children's success in their first years of school. Therefore, a healthy early childhood workforce in a healthy working environment is an essential aspect of effective early childhood services. This paper aims to explore the extent to which psychological hardiness can be considered as a mediator variable between exposure to workplace bullying and job anxiety among early childhood teachers. Design/methodology/approach: A homogeneous sample comprised of 200 early childhood teachers. For data collection, the researcher used the workplace bullying scale, the psychological hardiness scale and the job anxiety scale among early childhood teachers (prepared by the researcher). Findings: The findings indicated that psychological hardiness mediates the relationship between exposure to workplace bullying and job anxiety among early childhood teachers. Originality/value: The research result highlighted the necessity of providing counseling programs for early childhood teachers helping them eliminate work stress that affects their job performance. In addition, the kindergarten administration must concentrate on how to effectively communicate and cooperate with early childhood teachers in light of regulations, policies and laws to defeat the spread of workplace bullying. The results of this research contributed to the existing literature by examining the relationship between the research variables, particularly in the early childhood education context. [ABSTRACT FROM AUTHOR]

When Appreciative Inquiry practitioners recognise Artificial Intelligence's influence, it can help them create an environment that combines technology with humancentred values, facilitating an organisation that is not only efficient, but also inclusive and fair. This article points out the many opportunities for Appreciative Inquiry to contribute to organisational conversations and development efforts around trustworthy Artificial Intelligence. [ABSTRACT FROM AUTHOR]

Background: Health care professionals (HCPs) historically exhibit high rates of stress, burnout, and low rates of service utilization from Employee Assistance Programs (EAPs) and Professional Health Programs (PHPs). New and magnified stressors that accompanied COVID-19 exacerbated HCPs' risk of burnout. Purpose: During the pandemic, this study examined Ohio HCP's utilization of EAPs and PHPs, knowledge of available services, barriers to accessing services, and likelihood of future service utilization. Conditions needing to change to increase likelihood of future utilization were also explored. Methods: A one-time survey was administered in July and August of 2021 to HCPs from 13 licensing boards in Ohio. This study used a subset of data to examine the extent of convergence between quantitative results—analyzed using frequency calculations—and results from thematic analysis of corresponding open-ended survey items. Qualitative results supported and elaborated the quantitative findings. Results: Fewer than 25% of respondents (N = 12,807) utilized EAPs or PHPs to address mental health concerns. Obstacles impeding service utilization included issues around awareness, time commitment, and confidentiality—a concern encompassing issues of stigma and fear of employment repercussions. Noting multiple obstacles to accessing EAPs and PHPs, HCPs in Ohio reported low rates of support service utilization and low likeliness to use services in the future despite their experiences of extreme stress and burnout. Conclusions: Addressing the time commitment and confidentiality concerns could increase the likelihood of accessing services. Employers of HCPs should explore additional support mechanisms such as comprehensive wellness programs and innovative, brief intervention strategies to combat burnout, especially during viral outbreaks and other high-stress events. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the relationships between organizational silence, organizational commitment, organizational justice, and organizational citizenship behavior among clinical nurses. Additionally, it determined the mediating effect of organizational commitment moderated by organizational justice on the relationship between organizational silence and organizational citizenship behavior among clinical nurses. Methods: A total of 160 clinical nurses were recruited from a university hospital. Data were collected from June to July, 2023. The collected data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Scheffeé test, Pearson's correlation coefficient, Baron and Kenny's three-step regression analysis, Hayes' PROCESS macro model, and bootstrapping using SPSS/WIN 27.0 program. Results: Organizational commitment had a full mediating effect on the relationship between organizational silence and organizational citizenship behavior (B=-0.04, CI [-0.098-0.001]). Among the subscales of organizational justice, distributive justice had a moderating effect on the relationship between organizational silence and organizational commitment (B=-0.17, p=.009). There was no significant mediating effect of organizational commitment moderated by organizational justice on the relationship between organizational silence and organizational citizenship behavior. Conclusion: Appropriate strategies are needed to effectively manage nursing personnel and improve nursing performance. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify the mediating effects of positive psychological capital on the relationship between occupational stress and organizational commitment in physician assistant nurses. Methods: The participants were 152 physician assistant nurses recruited from two university hospitals. Data was collected through a survey. The SPSS/WIN program (version 25.0) was used for the data analysis. Data was analyzed using descriptive stastics, t-test, ANOVA, Pearson's correlation analysis, and hierarchical regression. Results: There was a significant negative correlation organizational commitment and occupational stress (r=-.57, p<.001), and a positive correlation with positive psychological capital (r=.47, p<.001). There was a negative correlation (r=-.32, p<.001) between occupational stress and positive psychological capital. In addition, positive psychological capital had a partial mediating effect on the relationship between occupational stress and organizational commitment (β=.32, p<.001). Conclusion: Positive psychological capital serves as a partial mediator in the relationship between occupational stress and organizational commitment among physician assistant nurses. The results of this study can be used reduce occupational stress and improve organizational commitment by improving the positive psychological capital of physician-assistant nurses. [ABSTRACT FROM AUTHOR]

Music therapy educators are tasked by the American Music Therapy Association with creating practica placements for students. However, open-ended instructions result in many differing structures of placements and no formal guidelines or codifying supports for educators working with community partners. The purpose of this descriptive survey study was to provide an understanding of music therapy educators' perspectives on successful and challenging elements of community partnerships and evaluative factors educators use when creating, monitoring, or discontinuing practica placements. Of the 139 participants, 100 currently teach or previously taught music therapy, and their quantitative and qualitative responses were included in data analysis. Educators perceived relational elements of partnerships as greater contributors to success than logistical elements. They identified pro-active and consistent communication (23.69%, n  = 59), commitment to the partnership (18.07%, n  = 45), and partners' perception of students providing meaningful services (18.07%, n  = 45) as necessary to successful partnerships. The most prominent challenging element was partners who did not value or understand music therapy. However, only 2.9% of educators (n  = 2) indicated teaching partners about music therapy and its benefits as a part of their processes for establishing and monitoring community partnerships. The recognition that education and advocacy of music therapy play an underlying role in practica relationships can help guide educators toward more successful partnerships. Recommended future research should include perspectives of community partners and students on practica relationships. [ABSTRACT FROM AUTHOR]

Peter Ellis discusses whether toxic leadership is becoming more prevalent and what kidney care professionals can do about if they think they might be becoming toxic or they are experiencing toxic leadership [ABSTRACT FROM AUTHOR]

Positive nursing practice environments benefit clients, professionals, and institutions, specifically for professionals, by improving professional visibility, recognition, retention intentions, well-being, commitment, job satisfaction, and reducing stress and burnout. Clients experience better quality care, safety, satisfaction, engagement, and fewer care omissions. Institutions favored reduced absenteeism and turnover, improved efficiency, lower costs, and better health outcomes. This study aimed to document the development of the "Program to Promote Positive Nursing Practice Environments" and analyze expert perceptions to reach a consensus. Using a two-round modified online Delphi technique with 22 experts, we examined perspectives on the program's goals, duration, organization, and content. Initial feedback showed agreement on the program's duration but mixed opinions on the number and length of sessions due to concerns about participant workload and fatigue. Adjustments led to a strong consensus and positive feedback on the program's coverage of essential nursing practice environment constructs. The program includes sessions on client, professional, and institutional dynamics, focusing on key attributes and outcomes for fostering positive nursing environments. By equipping nurses with knowledge and skills, the program aims to enhance work environments effectively. These findings provide a substantial advancement in the field, offering a robust framework for future initiatives. [ABSTRACT FROM AUTHOR]

The Work Ability Index (WAI) is the most commonly used tool for evaluating work capacity. Self-assessments made by workers can be influenced by various occupational and emotional factors. We wanted to study the association of work-related factors, such as work annoyance, stress, overcommitment, job satisfaction, social support, and emotional factors, such as anxiety, depression, and happiness, with work ability, in a sample of 490 healthcare workers from an Italian public health company. A principal component analysis indicated the presence of two components of the WAI questionnaire; the first expresses "subjectively estimated work ability" (SEWA), and the second refers to "ill-health-related work ability" (IHRWA). Using stepwise multiple hierarchical linear regression, we identified the factors that best predicted the total score on the WAI and on the two components. The total score was negatively predicted by anxiety, depression, a lack of happiness, low job satisfaction, overcommitment, and work annoyance. Age, being female, anxiety, and occupational stress were associated with a reduction in the IHRWA component score, while overcommitment, work annoyance, a lack of social support, depression, and a lack of happiness were negatively associated with the SEWA component. These results can help interpret those of epidemiological studies and provide guidance on ways to improve work ability. [ABSTRACT FROM AUTHOR]

Aim: To describe nurses' experiences of working with suicide prevention and suicide risk assessment in the care of older people. Background: Suicide is a problem among older people, worldwide. Risk factors for suicide are, among others, depression, illness and pain and a feeling of isolation. Nurses have valuable experience in suicide prevention and risk assessments. This study can shed light on what is needed to promote the mental health of older people, which has been partly overlooked in previous research. Methods/Design: A descriptive qualitative study was conducted. Ten nurses working in care of older people across four different municipalities were interviewed. Conventional content analysis was used to analyse the data. Results: Despite shortcomings in guidelines, nurses describe performing suicide risk assessments and suicide prevention in a similar manner. The importance of giving the patients time is emphasised, although time is exactly what appears to be lacking. Conclusion: By engaging with the experiences of nurses, important aspects that require further attention are highlighted. Nurses should inquire about suicidal ideation, even if older persons do not explicitly express such thoughts. Normal ageing needs to be comprehended and considered in assessments. In this work, time is important. Patient or Public Contribution: The results were coproduced by means of interviews with nurses working in care of older people. Reporting Method: The study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Implications for Practice: Encountering older people who may have experienced the loss of loved ones and addressing one's personal capabilities in the context of the ageing body imposes substantial challenges on nursing care, necessitating a capacity to adeptly navigate and address these complex issues. [ABSTRACT FROM AUTHOR]

Providers are essential to the delivery of abortion care. Yet, they often occupy an ambiguous space in political discourse around abortion. The introduction of a new abortion service in Ireland invites us to look afresh at providers. Since the Health (Regulation of Termination of Pregnancy) Act 2018 came into force, by far the most common form of abortion care has been early medical abortion (EMA). This is typically provided by General Practitioners (GPs), with approximately 10% of GPs having chosen to provide EMA. This article draws on an empirical study of providers to investigate their motivations for, and experiences of, provision and their views on colleagues who have not chosen to provide. The study shows that for many providers, the choice to provide was grounded in a moral commitment to protecting women's rights to autonomy and health and ensuring that the harms of the past were not repeated. The article argues that notwithstanding increased normalisation of EMA in Ireland, conscience still has a role to play in abortion care provision and it is important to reflect on the various aspects of this role. [ABSTRACT FROM AUTHOR]

The healthcare environment faced by nurses is complex, with high workloads and situations of high comorbidity. The integration of nurses into the work environment is a cause for concern, and improvements are sought for their incorporation into the workforce. The benefits of mentoring programs are described not only for nurses but also for patients with safer practices and benefits for the institution due to the increased commitment of its professionals. A methodological article that illustrates the complete process to design and implement a tutoring program for new nurses in an emergency department is presented. The competency profile required for the figure of tutor was developed, including the steps followed for the development of the program and the structure and phases of which it is composed, as well as the validation of the evaluation instruments of the process. A strength was the participation of experts during the in-depth analysis of the competency profile, as well as in the adaptation of the evaluation items, which endorses the pertinence, relevance, usefulness, and clarity of the content of this program. The transparency in this methodology makes it possible to follow the steps for its reproduction and applicability in other hospitals. [ABSTRACT FROM AUTHOR]

Despite the great emphasis organizations and human resource management (HRM) research place on turnover issues, one turnover phenomenon has received only limited attention so far: joint leader–member turnover. This research examines supervisor‐initiated turnover (SIT) (i.e., employees' decision to quit their employer to follow a former supervisor to a new organization) and develops a comprehensive model of the SIT decision process, grounded on conservation of resources (COR) theory, that delineates the resource evaluation, conservation and investment deliberations of employees. We take a relational perspective and particularly focus on the leader–member relationship as an important antecedent of SIT and thereby respond to the call for more critical investigations of leader–member exchange (LMX) and corresponding HRM implications. Our three studies (survey, scenario experiment, and dyadic interview study) demonstrate that LMX positively affects SIT intentions (SITI) and that supervisor commitment represents an important mediating mechanism of the LMX–SITI relationship. Our interview study with 46 leader–member dyads identifies relational factors that promote or hinder SIT beyond the leader–member relationship. We discuss the theoretical contributions and practical implications for HRM. [ABSTRACT FROM AUTHOR]

Does the amount of self-control consumers must exert to choose a goal-consistent action influence their perceptions of goal progress? For example, if you choose to go to the gym when one of your favorite TV shows is on (vs. when nothing interesting is on TV), do you perceive that you have made a differential amount of progress toward your goal, despite completing the exact same workout? In eight studies (N = 7,515), the authors demonstrate that consumers perceive that they have made more progress on their goals when more (vs. less) self-control is required to choose to complete an identical goal-consistent task. This is because when consumers exert more (vs. less) self-control to choose a goal-consistent task over the goal-inconsistent alternatives, they infer higher commitment to the goal. The higher inferred commitment, in turn, leads consumers to perceive that future goal pursuit will be easier. The authors demonstrate this effect across a variety of tasks and means of exerting self-control, as well as with both hypothetical scenarios and real-behavior studies. [ABSTRACT FROM AUTHOR]

Background: Hospital at home (HaH) is an innovative approach to healthcare delivery that brings specialized services to patients' homes. HaH services are typically available in urban areas where hospitals can easily reach nearby patients. An integrated care model that utilizes the public primary healthcare system may extend HaH services to include patients residing further away from hospitals. However, there is limited evidence of primary healthcare employees' views on integrating HaH care into primary healthcare services. This study aimed to explore the reflections of primary healthcare employees on integrating HaH care into primary healthcare services. Methods: Ten focus group interviews were conducted with homecare nurses and managers of primary healthcare services in five municipalities in Mid-Norway. Reflexive thematic analysis was used to analyze the data. Results: The analysis resulted in three key themes regarding the integration of HaH care into primary healthcare. Participants discussed how they capture the distinctiveness of HaH care within the primary healthcare landscape. Moreover, they identified that the introduction of HaH care reveals opportunities to address challenges. Lastly, the study uncovered a strong primary healthcare commitment and a sense of professional pride among the participants. This resilience and dedication among primary healthcare employees appeared as an incentive to make the integration of HaH work. Conclusions: This study offers valuable insights into integrating HaH into primary healthcare services, highlighting opportunities to address challenges. The resilience and dedication of primary healthcare employees underscore their commitment to adapting to and thriving with HaH care. To establish a sustainable HaH care model, it is important to address geographical limitations, consider the strain on providers, maintain robust relationships, enhance funding, and formalize decision-making processes. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this research was to understand the experience of older adults who completed an 8-week cervical spine home exercise program (HEP) designed to reduce visual reliance for postural stability, potentially impacting fall risk. Methods: Nineteen older adults completed a semi-structured, one-on-one interview. Qualitative verbatim data from one open-ended prompt, "Tell me about your experience with the home exercise program," were analyzed using an inductive, emergent approach. Results: Eleven subthemes emerged within two overarching themes: motivational factors and perceived barriers. Two subthemes within the motivational factors category aligned with the Self-Determination Theory (SDT): autonomy and competence, impacting motivation. Participants reported a positive HEP experience despite the perceived barriers of time and commitment required for HEP completion. Conclusion: This study provides insight into the experiences of older adults participating in an HEP and highlights the importance of considering their fundamental psychological needs when designing HEPs, impacting motivation and adherence. [ABSTRACT FROM AUTHOR]

Despite the legalization of same-sex marriage across the US, research on young adults' marital aspirations has tended to overlook sexual identity altogether or focus exclusively on those who are heterosexual. To address this, in this article, I draw upon quantitative and qualitative data from an online survey to describe the marital aspirations and motivations of a convenience sample of sexual minority young adults (N = 256). Descriptive analyses indicate that although a majority of respondents would like to marry someday, a similar number claim that getting married is not "a major life goal." Those who want to marry cite several primary reasons, including companionship and lifelong commitment, but also qualify their marital aspirations in several ways, including by questioning both the necessity and normativity of marriage. The relatively small number of respondents do not want to marry express similar concerns and critique marriage as a heteronormative institution. [ABSTRACT FROM AUTHOR]

Objective: To explore intrinsic and extrinsic factors that help nonresident fathers' continuing relationships with their children. Background: Research on nonresident fathers tends to focus on rates or trajectories of contact and the perspectives or experiences of children or others and highlights significant barriers to development and maintenance of relationships between nonresident fathers and their children. What helps the growth and development of nonresident fathers' relationships with their children are less well understood and less frequently researched. This research sought to fill the gap in the literature of what is known that helps nonresident fathers maintain meaningful relationships with their children. Method: A qualitative research approach was chosen using thematic analysis of semistructured, in‐depth interviews. Recruitment was via social media and community sites targeting nonresident fathers after divorce. Results: Participants highlighted deep commitment to ongoing fathering and a deep desire for meaningful relationships with children. The experience of divorce had a highly negative impact, but some positives emerged that enhanced their relationship. Significant others played contingent roles helping participants improve their relationships with their children. Conclusion: Continuity of relationships with children was the direct result of participants' actions to remain involved and their ongoing commitment to their children through strong and unwavering fatherhood role salience. These factors, together with actions for self‐improvement, managing change, and fostering cooperative relationships with relevant others, helped fathers maintain positive engagement and relationships with their children. Implications: The nonresident fathers in this study relied on their own initiatives, resilience, and resources to remain engaged with their children. Policies and programs should respond to and encourage the development of policies and programs that help nonresident fathers' relationships with children in practical and meaningful ways. [ABSTRACT FROM AUTHOR]

In explaining the effectiveness of a human resource (HR) system within an organization, scholars have turned their attention to HR attributions, which capture employees' perceptions about the intentions behind their organization's HR practices, and have demonstrated that an HR system's content and process of communication drive employees to form specific HR attributions. However, current research has not yet explained why HR attributions differ among employees. We investigate the variability in HR attributions among individuals and the organizational factors that influence this variability. Using signaling theory and the concept of situational strength, we argue that employees' HR attributions vary less when signals sent by HR management are unambiguous and the conveyed information is consistent. Using an online scenario‐based experiment with 760 participants, our findings reveal that the configuration and the strength of an HR system as well as their combination have significant effects on the variability in HR attributions among employees, and these effects differ for the different HR attributions. [ABSTRACT FROM AUTHOR]

Background: To address the declining numbers of general practitioners (GPs) in rural areas and a lack of medical students pursuing a career in primary care, a general practice-based curriculum coupled with additional university admissions for students has been established at three universities in Hesse, Germany. This study aims to analyze potential topics which students striving to become a GP will benefit from. Teaching such topics will prepare them for their chosen career and working in rural areas. We aimed to explore the views of both specialists and GPs on chief topics and necessary skills in primary care. Methods: In our study we used semi-structured interviews with outpatient specialists and specialists in clinical practice and semi-structured group interviews with GPs in training. The topic guide addressed contents of the curriculum for medical students with an extracurricular focus (addressing additional topics) on primary care. Data analysis was carried out using qualitative content analysis according to Mayring. Results: GPs in training and specialists agreed on the importance of knowledge in the fields of medical history, physical examination, communication as well as common diseases in primary care. Essential competences mentioned were: inducing medical treatment, decision-making and triage, conducting structured conversations, having patient knowledge (hard skills) as well as an interest in continuous learning, empathy, personal commitment, listening and down-to-earthness (soft skills). Case reports, symptom-based learning, practical training, lessons with simulated patients and the integration of role models were regarded as useful teaching methods. Conclusions: General practice-based curriculums should not only focus on the transfer of knowledge. Equally important is the training of soft and hard skills to prepare future GPs for their work in primary care. Special teaching methods as well as practical training should be the heart of a newly established curriculum. [ABSTRACT FROM AUTHOR]

The article describes the five evidence-based steps to use in structuring a personal diversity statement. These steps include preparing an introduction that goes beyond demonstrating one's definitional knowledge of diversity, equity, inclusion, and access (DEIA), stating DEIA academic or healthcare-related teaching contributions, and stating service-related contributions to advance DEIA.

Introduction: This Practice Update discusses the potential for implementation of the 4M model for care of older adults in Israel, to complement the medical-centric model that exists today. The older adult population in Israel is increasing. However, efficient and sufficient care that takes patient's wishes into consideration is lacking. Purpose: Care of older adults, particularly palliative patients, is complex and requires multidisciplinary efforts. There are numerous challenges to caring for older adults. These include fragmentation of care, unclear boundaries between palliative and geriatric care, and the preservation of patient autonomy, indicating a need to adopt new care frameworks. Conclusion: The authors suggest implementing the 4M model as a new care framework in addition to the current medical-centric model. This framework considers important care aspects during discussions of care: what matters to the patient, medication, mentation, and mobility. Implementation of this model can promote better-integrated care, thus improving the quality of life for older adults. [ABSTRACT FROM AUTHOR]

Background and objective: The primary objective of the nursing profession is to provide comprehensive and appropriate nursing care that meets the individual needs of patients. However, instances of missed/rationed nursing care can jeopardize the delivery of complete and safe healthcare, potentially putting patients' lives at risk. The level of organizational commitment demonstrated by nurses is likely to impact various personnel and organizational factors. Therefore, this study aims to predict instances of missed/rationed nursing care by examining the influence of organizational commitment. Method: This descriptive and cross-sectional study will be conducted in 2023. Three hundred nurses working in general and intensive critical care units at Tehran University of Medical Sciences hospitals were randomly selected. Data collection included Allen and Mayer's organizational commitment questionnaires, Kalish's missed care questionnaire, and demographic variables. A multiple linear regression model was used to analyze the prediction of missed care by commitment and other variables. The relationship between these variables was also explored using SPSS version 26 software. Findings: Half of the nurses reported occasionally missing nursing care. Moreover, more than half of the nurses reported moderate organizational commitment in all dimensions. The most significant reasons identified by nurses for missed care were financial resources, human resources, and communication (p < 0.001). There was a significant relationship between missed/rationed nursing care and organizational commitment (p = 0.042). In the multiple regression equation, a significant portion of missed care due to commitment was predicted when considering demographic variables (p < 0.001). Conclusion: By understanding the relationship between organizational commitment and missed care, and identifying the factors contributing to missed/rationed care, managers can improve the efficiency of human resources and allocate appropriate financial resources. Establishing effective communication with employees can also enhance their commitment to addressing neglected care, ultimately reducing instances of oversight. [ABSTRACT FROM AUTHOR]