Search

BACKGROUND: Concussions are a significant health issue for children and youth. After a concussion diagnosis, follow-up visits with a health care provider are important for reassessment, continued management, and further education. OBJECTIVE: This review aimed to synthesize and analyse the current state of the literature on follow-up visits of children with a concussive injury and examine the factors associated with follow-up visits. METHODS: An integrative review was conducted based on Whittemore and Knafl’s framework. Databases searched included PubMed, MEDLINE, CINAHL, PsycINFO, and Google Scholar. RESULTS: Twenty-four articles were reviewed. We identified follow-up visit rates, timing to a first follow-up visit, and factors associated with follow-up visits as common themes. Follow-up visit rates ranged widely, from 13.2 to 99.5%, but time to the first follow-up visit was only reported in eight studies. Three types of factors were associated with attending a follow-up visit: injury-related factors, individual factors, and health service factors. CONCLUSION: Concussed children and youth have varying rates of follow-up care after an initial concussion diagnosis, with little known about the timing of this visit. Diverse factors are associated with the first follow-up visit. Further research on follow-up visits after a concussion in this population is warranted.

Aim To explore and synthesize the literature on factors related to mammography screening adherence among women in Brazil. Design A scoping review. Methods We searched 11 databases for studies published between 2006–January 2020. All identified articles were screened, and data were extracted from eligible studies. We used the UK Government Social Research Service weight of evidence appraisal tool to appraise the quality of the included study. Results From a total of 1,384 identified articles, 22 were retained. All included studies used quantitative, non‐experimental methods and all but two studies used cross‐sectional data. Quality of evidence varied across studies. We identified 41 factors that were investigated across the set of studies. Demographic and socio‐economic factors were the most commonly investigated, with older age, urban residence, living in the southeast of Brazil, higher level of education, higher income and private health insurance most consistently associated with mammography adherence.

Purpose The purpose of this study was to examine psychological safety as a mediator of the relationship between inclusive leadership and nurses' voice behaviors and error reporting. Voice behaviors were conceptualized as speaking up and withholding voice. Design This correlational study used a web-based survey to obtain data from 526 nurses from the medical/surgical units of three tertiary general hospitals located in two cities in South Korea. Methods We used model 4 of Hayes' PROCESS macro in SPSS to examine whether the effect of inclusive leadership on the three outcome variables was mediated by psychological safety. Findings Mediation analysis showed significant direct and indirect effects of nurse managers' inclusive leadership on each of the three outcome variables through psychological safety after controlling for participant age and unit tenure. Our results also support the conceptualization of employee voice behavior as two distinct concepts: speaking up and withholding voice. Conclusions When leader inclusiveness helps nurses to feel psychologically safe, they are less likely to feel silenced, and more likely to speak up freely to contribute ideas and disclose errors for the purpose of improving patient safety. Clinical relevance Leader inclusiveness would be especially beneficial in environments where offering suggestions, raising concerns, asking questions, reporting errors, or disagreeing with those in more senior positions is discouraged or considered culturally inappropriate.

To examine relationships between components of nurses' work environments and emotional exhaustion, job satisfaction and intent to leave among nurses in Saudi Arabia.A descriptive correlational study with cross-sectional data.Data were collected in 2017 from 497 Registered Nurses working in a large tertiary hospital in Riyadh, Saudi Arabia. Participants completed an online survey like that used in RN4Cast studies to measure nurses' perceptions of their work environments and nurse outcomes. Hierarchical linear regression and logistic regression were conducted to examine the relationships between components of nurses' work environments and nurse outcomes after controlling for nurse and patient characteristics.Nurse participation in hospital affairs was uniquely associated with all three nurse outcomes, whereas staffing and resource adequacy was associated with emotional exhaustion and job satisfaction, but not intent to leave. These two variables were also the components of the nursing practice environment that received the lowest ratings. Nurse manager ability, leadership and support of nurses, and nurse-physician relationships were associated with job satisfaction only. A nursing foundation for quality of care was not uniquely associated with any of the three outcomes. Finally, nurse emotional exhaustion and job satisfaction fully mediated the relationship between nurse participation in hospital affairs and intent to leave.Magnet-like work environments in Saudi Arabia are critical to recruiting and retaining nurses in a country with critical nursing shortages.This study addresses a gap in the literature regarding which components of the nurses' work environment are uniquely associated with emotional exhaustion, job satisfaction and intent to leave among nurses in Saudi Arabia. Study results will assist Saudi hospital administrators and nurse leaders to develop recruitment and retention strategies by focusing on those work environment components most associated with nurse outcomes: participation in hospital affairs and staffing and resource adequacy.目标: 探讨沙特阿拉伯的护士工作环境与情绪衰竭、工作满意度、离职意愿各要素之间的关系。 设计: 依托横断面数据的描述性相关研究。 方法: 2017年从497名在沙特阿拉伯利雅得一家大型三级医院工作的注册护士那里收集数据。受访者完成了一份RN4Cast研究中采用的类似在线调查,以衡量护士对其工作环境和护理结果的看法。采用分层线性回归和逻辑回归分析方法,在控制了护士和患者特征后,研究护士工作环境各因素与护理结果之间的关系。 结果: 护士参与医院事务与所有三种护理结果都有独特的相关性,而人员配置和人力充足与情绪衰竭和工作满意度相关,但与离职意愿无关。这两个变量也是护理实践环境中得分最低的组成要素。护士管理能力、护士领导力与支持力、医护关系只与工作满意度相关。护理质量的护理基础并未是与三个结果都相关的唯一要素。最后,护士情绪衰竭与工作满意度能完全调节护士参与医院事务与离职意愿的关系。 结论: 沙特阿拉伯具有吸引力的工作环境对于在一个护士严重短缺的国家进行护士招聘和留用至关重要。 影响: 本研究填补了对于研究沙特阿拉伯的护士工作环境中哪些因素与情绪衰竭、工作满意度和离职意愿具有独特关联性的文献方面的空白。研究结果将有助于沙特医院管理人员和护士长制定招聘和留用策略,重点关注与护理结果最相关的工作环境因素:参与医院事务、人员配置和人力资源的充足性。.

Purpose Worldwide, 1 in 10 hospital patients is harmed while receiving care. Despite evidence that a culture of safety is associated with greater patient safety, these effects and the processes by which safety culture impacts patient safety are not yet clearly understood. Therefore, the purpose of this study was to examine the effects of various safety culture factors on nurses' perceptions of patient safety using an innovative theoretical model. Design This descriptive, correlational study drew on deidentified, publicly available data from the 2018 Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture. The study sample included 34,514 nurses who provided direct care to patients in medical and surgical units in 535 hospitals in the United States. Methods Multilevel linear regression was used to examine the effects of 11 safety culture factors on nurses' overall perceptions of patient safety. The 11 safety culture factors were grouped as enabling, enacting, and elaborating processes, and entered in separate blocks. Findings All 11 safety culture factors were associated with nurse-perceived patient safety, and all but two of the 11 factors uniquely predicted nurse-perceived patient safety. Staffing adequacy was the strongest predictor of nurse-perceived patient safety, followed by hospital management support for patient safety (both enabling processes), and continuous organizational learning and improvement (an elaborating process). Conclusions Hospital administrators and managers play a key role in promoting a safety culture and patient safety in healthcare organizations through enabling and elaborating processes. Clinical relevance Organizational efforts should be made to provide sufficient staffing and hospital-wide support for patient safety. However, all staff, administrators, and managers have a role to play in patient safety.

To identify factors that motivate or inhibit nurses' speaking up for patient safety.A descriptive qualitative study.We conducted semi-structured interviews with 15 nurses from four Korean hospitals between December 2020 and January 2021. Data were analysed using inductive content analysis.We identified safety culture, supportive unit managers and role models, positive reactions from or familiarity with others, high-risk situations and personal characteristics and beliefs as motivators of nurses' speaking up. Hierarchies and power differentials, seniority and unit tenure, concerns about relationships, and heavy workloads inhibited nurses' speaking up.Individual, organizational and cultural characteristics influence nurses' decisions on whether or not to voice their concerns, suggestions or ideas. Certain characteristics of Korean culture, such as strong hierarchies and the valuing of good relationships, play an important role in nurses' speaking up behaviours. Our findings can be used to inform educational interventions and management expectations about interpersonal behaviours, especially in a culture where age- and seniority-based hierarchies and collectivism are prevalent.Nurses perceived speaking up as a challenging behaviour, and they sometimes withhold their voices even when speaking up is needed for patient safety. We found that individual, organizational, and contextual factors affect the speaking up behaviours of nurses. Nurse managers can create environments that are more supportive of nurses' speaking up behaviours by using inclusive leadership to create psychological safety, by inviting and showing appreciation for staff input, and by helping physicians and senior nurses understand the importance of all nurses' voices.Patient or public contribution does not apply to this study as its purpose was to explore the speaking up experiences of nurses themselves.

The Everyday Discrimination Scale (EDS) is one of the most widely used measures of discrimination in health research, and has been useful for capturing the impact of discrimination on health. However, psychometric analysis of this measure has been predominantly among Black Americans, with limited examination of its effectiveness in capturing discrimination against other social groups. This paper explores the theoretical and historical foundations of the EDS, and draws on the analytic framework of Messick's theory of unified validity to examine the effectiveness of the EDS in capturing diverse experiences of discrimination. Encompassing both social consequences and value implications, Messick's unified validity contends that psychometric evaluation alone is insufficient to justify instrument use or ensure social resonance of findings. We argue that despite the robust psychometric properties and utility in addressing anti-Black race-related discrimination, the theoretical foundations and research use of the EDS have yet to respond to current discrimination theory, particularly intersectionality. This paper concludes with guidance for researchers in using the EDS in health research across diverse populations, including in data collection, analysis, and presentation of findings.

Studies have demonstrated associations between safety culture and patient safety based on the perceptions of healthcare professionals, but limited attention has been given to the perceptions of nurses. Moreover, most studies have used regression modeling, an approach that limits researchers’ ability to identify the most important predictors of patient safety due to intercorrelations among predictors in the model. Therefore, the purpose of this study was to examine the effects of seven dimensions of safety culture on nurse-rated patient safety and identify the relative importance of these dimensions for predicting patient safety. This correlational study used data from the Agency for Healthcare Research and Quality’s 2018 Hospital Survey on Patient Safety Culture. Data from 13,031 nurses working in surgical areas of 443 hospitals in the United States were examined using logistic regression and dominance analysis. Staffing adequacy was the strongest predictor of patient safety, followed by hospital management support for patient safety and organizational learning/continuous improvement. However, dominance analysis showed that hospital management support for patient safety was the most important predictor rather than staffing adequacy. Nurse managers and hospital administrators should role model a culture of safety and demonstrate their valuing of patient safety by providing sufficient resources, listening to and valuing staff suggestions regarding patient safety, and providing feedback about organizational changes to improve patient safety.

Additional file 1: Supplemental Figure. Standardized parameter estimates for the factor structure of the K-HSOPSC 2.0.

Background To date, there has been no universal and validated tool for measuring safety culture in Korea. The Hospital Survey on Patient Safety Culture (HSOPSC), version 2.0 was released by the Agency for Healthcare Research and Quality in 2019, but it had not yet been translated and assessed for use in Korea. The aim of this study was to assess the content validity and other psychometric properties of the Korean-language version of the HSOPSC 2.0. Methods Instrument adaptation was performed using a committee-based translation, cognitive interviews, and expert panel reviews. Confirmatory factor analysis was conducted on data obtained through an online survey from 526 registered nurses who worked on medical-surgical units in three teaching hospitals in South Korea. Results One item was dropped during the translation and adaption phase of the study as being a poor fit for the Korean healthcare context, resulting in excellent content validity. Confirmatory factor analysis supported the factorial structure of the K-HSOPSC 2.0. Correlations with an overall measure of patient safety provided further evidence of construct validity. Additionally, in comparing the results of this current study to those from U.S. research using the HSOPSC 2.0, it was found that Korean nurses assigned less positive scores to all dimensions of patient safety culture. Conclusion Our findings provide evidence of the content validity, reliability, and construct validity of the K-HOSPSC 2.0 for measuring patient safety culture in South Korean hospitals. Hospital administrators can use this tool to assess safety culture and identify areas for improvement to enhance patient safety and quality of care.

Introduction Mammography screening is provided free of charge for the recommended target population in Brazil but participation rates have remained low, and breast cancer mortality has continued to increase. Thus, it is important to identify factors that are associated with poor participation in mammography screening so that service providers can target health promotion messages and screening programs more effectively. Objective: To evaluate the predictive validity of the Revised Champion’s Health Belief Model scale (RCHBMS) for identifying women at high risk of not adhering to national guidelines for mammography screening in Brazil. Methods: We used a longitudinal survey design with a 1-year follow-up data from 194 women living in northeastern Brazil, in the city of Fortaleza, Ceará, participants completed the RCHBMS at baseline, and mammography uptake was measured 1 year later. Hierarchical logistic regression was used to determine the predictive validity of the RCHBMS for identifying women who had not adhered to recommendations for mammography screening, after accounting for the women’s sociodemographic and clinical characteristics. The sensitivity and specificity of various cut-off points were calculated to determine the optimal cut-off point for identifying women at high risk of not adhering to mammography screening guidelines. Results: Two subscales of the RCHBMS uniquely predicted nonadherence: susceptibility and barriers, along with race and family history of cancer. The total scale score (with barriers reverse coded) was also highly predictive. For our sample, using only the RCHBMS with a cutoff of ≤ 3.67 (out of a total possible range of 1–5) yielded a high sensitivity and specificity for predicting nonadherence. Conclusion: Study findings support the validity and clinical utility of the RCHBM for identifying women at risk of not adhering to national guidelines for mammography screening in Brazil.

Highlights • Social media is being used in LMICs for health-related purposes (e.g., to facilitate disease surveillance, mass communication, health education, and knowledge translation). • The body of literature on social media use in LMICs is young, but beginning to mature with the recent, increased reporting of research studies. • Additional research is needed to expand the geographical focus and test strategies to facilitate the effective and efficient use of social media for health purposes in LMICs. • Increasing familiarity with existing and upcoming social media platforms, and the promotion of credible sites, is essential for healthcare professionals, agencies, and researchers., Background Social media allows for instant access to, and dissemination of, information around the globe. Access to social media in low- and middle-income countries has increased exponentially in recent years due to technological advances. Despite this growth, the use of social media in low- and middle-income countries is less well-researched than in high-income countries. Objective To identify, explore and summarize the current state of the literature on the use of social media for health in low- and middle-income countries. Methods A scoping review was conducted on literature available to December 2017. Six databases were searched, and grey literature was identified through the Google and Google Scholar search engines. Literature was considered for inclusion if it (1) was published in English, (2) was conducted in or in relation to a low or middle-income country, (3) reported on as least one type of social media or social media use generally for health purposes, and (4) reported on at least one aspect of human health. Content analysis was performed to identify themes. Results Forty articles met the inclusion criteria. Thirty-one were research articles, and nine were review/discussion/descriptive and evaluative reports. Since 2010, when the first article was published, most of the literature has focused on Asian (n = 15) and African (n = 12) countries. Twitter (n = 11) and Facebook (n = 10) were the most frequently discussed individual social media platforms. Four themes were identified: (1) use for health education and influence (sub-themes were health behaviour and health education); (2) use within infectious disease and outbreak situations; (3) use within natural disaster, terrorism, crisis and emergency response situations; and (4) producers and consumers of social media for health (sub-themes were misinformation, organizational challenges, users’ expectations, and challenges of unique sub-populations). Most studies addressed more than one theme. Conclusion Social media has the ability to facilitate disease surveillance, mass communication, health education, knowledge translation, and collaboration amongst health providers in low- and middle-income countries. Misinformation or poorly communicated information can contribute to negative health behaviours and adverse health outcomes amongst consumers, as well as hysteria and chaos. Organizations using social media should provide accurate and readable information. Promotion of credible social media sites by governments, health care professionals and researchers, as well as education on the appropriate use of social media, could help to lessen the effect of misinformation. This is a nascent body of literature and future research should investigate the relative effectiveness of various platforms for different users, other potential uses, and pursue a broader geographical focus.

Purpose This study aimed to investigate effects of individual nurse and hospital characteristics on patient adverse events and quality of care using a multilevel approach. Design This is a secondary analysis of a combination of nurse survey data (N = 1,053 nurses) and facility data (N = 63 hospitals) in Canada. Methods Multilevel ordinal logistic regression was employed to examine effects of individual nurse and hospital characteristics on patient adverse events. Multilevel linear regressions were used to investigate effects of individual nurse and hospital characteristics on quality of care. Findings Organizational safety culture was associated with patient adverse events and quality of care. Controlling for effects of nurse and hospital characteristics, nurses in hospitals with a stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections; and were more likely to report higher levels of quality of care. Additionally, the effects of individual-level baccalaureate education and years of experience on quality of care differed across hospitals, and hospital-level nurse education interacted with individual-level baccalaureate education. Conclusions This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care. Clinical relevance Healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers trust each other, work collaboratively, and share accountability for patient safety and care quality.

This integrative literature review was conducted to examine the relationships between safety culture and patient safety and quality of care outcomes in hospital settings and to identify directions for future research. Using a search of six electronic databases, 17 studies that met the study criteria were selected for review. This review revealed semantic inconsistencies, infrequent use of a theory or theoretical framework, limited discussions of validity of instruments used, and significant methodological variations. Most notably, this review identified a large array of nonsignificant and inconsistent relationships between safety culture and patient safety and quality of care outcomes. To improve understanding of the relationships, investigators should consider using a theoretical framework and valid measures of the key concepts. Researchers should also give more attention to selecting appropriate sampling and data collection methods, units of analysis, levels of data measurement and aggregation, and statistical analyses.

This study investigated the relationships between seven workload factors and patient and nurse outcomes. (1) Background: Health systems researchers are beginning to address nurses’ workload demands at different unit, job and task levels; and the types of administrative interventions needed for specific workload demands. (2) Methods: This was a cross-sectional correlational study of 472 acute care nurses from British Columbia, Canada. The workload factors included nurse reports of unit-level RN staffing levels and patient acuity and patient dependency; job-level nurse perceptions of heavy workloads, nursing tasks left undone and compromised standards; and task-level interruptions to work flow. Patient outcomes were nurse-reported frequencies of medication errors, patient falls and urinary tract infections; and nurse outcomes were emotional exhaustion and job satisfaction. (3) Results: Job-level perceptions of heavy workloads and task-level interruptions had significant direct effects on patient and nurse outcomes. Tasks left undone mediated the relationships between heavy workloads and nurse and patient outcomes; and between interruptions and nurse and patient outcomes. Compromised professional nursing standards mediated the relationships between heavy workloads and nurse outcomes; and between interruptions and nurse outcomes. (4) Conclusion: Administrators should work collaboratively with nurses to identify work environment strategies that ameliorate workload demands at different levels.

This study examined the effect of two components of a model of nursing care delivery, the mode of nursing care delivery, and skill-mix on: (a) quality of nursing care; and (b) patient adverse events, after controlling for nurse demographics, work environment, and workload factors.A cross-sectional exploratory correlational study that drew on secondary data was conducted.Survey data from 416 direct care registered nurses from medical-surgical settings across British Columbia were analysed using hierarchical multiple regression. Larger study data were collected in 2015.Nurses working in a team-based mode reported a greater number of nursing tasks left undone compared with those working in a total patient care. Nurses working in a skill-mix with licensed practical nurses reported a higher frequency of patient adverse events compared with those working in a skill-mix without licensed practical nurses. At higher levels of acuity, nurses in a team-based mode reported a higher frequency of patient adverse events than did nurses in a total patient care.Models of nursing care delivery components, mode and skill-mix, influenced quality and safety outcomes. Some of the team-based medical-surgical nurses in British Columbia are not functioning as effective teams. Team building strategies should be used to enhance collaboration among them.Research into redesigning care delivery has typically focused on only one care delivery component at a time. The study findings could have implications for nurses and patients, nursing leadership and policymakers particularly in medical-surgical settings in British Columbia.目的: 本研究探讨了护理服务模式的两个组成部分,护理服务模式和技能组合对以下方面的影响:(a)护理质量;以及(b)在控制了护士的人口统计、工作环境和工作量因素后,患者发生不良反应。 设计: 利用二级数据进行了横断面探索性相关研究。 方法: 采用分层多元回归分析了来自不列颠哥伦比亚省医疗-外科机构的416名直接护理注册护士的调查数据。大多研究数据收集自2015年。 结果: 在基于团队的模式下工作的护士报告说,与在整体病人护理中工作的护士相比,其还有更多的护理任务没有完成。与没有执照护士的职业技能组合相比,在有执照护士的职业技能组合中工作的护士报告的患者不良事件发生率更高。在较高的敏锐度水平下,以团队为基础的护士报告的患者不良事件发生率高于整体患者护理中的护士。 结论: 护理服务提供组成部分、模式和技能组合的模型影响质量和安全结果。在不列颠哥伦比亚省,一些以团队为基础的医疗外科护士没有发挥有效的团队作用。应该使用团队建设策略来加强他们之间的协作。 影响: 重新设计护理服务的研究通常一次只关注一个护理服务组件。研究结果可能对护士和患者、护理领导和政策制定者,特别是在不列颠哥伦比亚省的外科医疗环境中产生影响。.

Aim This study investigated factors associated with perioperative nurses' job satisfaction and their intention to leave. Recruitment and retention of nurses are particularly important in a specialist environment such as the perioperative setting where it is especially difficult to attract and retain nurses due to its unique environment. Methods Cross-sectional data were drawn from a larger study on nurses' work environments, conducted in one province of Canada. An e-survey tool, consisting of validated scales, was administered by the provincial nurses' union to a stratified random sample of registered nurses. The study sample consisted of 113 perioperative nurses working in acute-care hospitals. This study included two outcome variables (job satisfaction and intention to leave) and five predictor variables (three aspects of work environment, workload, and emotional exhaustion). Data were analyzed using multivariate linear and logistic regressions. Results A multivariate linear regression model explained 49% (adjusted R2 ) of variance in nurses' job satisfaction, and a multivariate logistic regression explained 19% (McFadden's R2 ) of the variance in their intent to leave. After controlling for work status and other predictors, nurse-physician relationship was significantly related to nurses' job satisfaction, and emotional exhaustion was the key predictor for both outcome variables. Conclusions This study demonstrated that higher emotional exhaustion is associated with decreased job satisfaction and increased intention to leave among perioperative nurses. The findings suggest that nurse managers should create an empowering and open work environment that fosters perioperative nurses' job satisfaction and reduces their intention to leave.

This study aimed to investigate effects of individual nurse and hospital characteristics on patient adverse events and quality of care using a multilevel approach.This is a secondary analysis of a combination of nurse survey data (N = 1,053 nurses) and facility data (N = 63 hospitals) in Canada.Multilevel ordinal logistic regression was employed to examine effects of individual nurse and hospital characteristics on patient adverse events. Multilevel linear regressions were used to investigate effects of individual nurse and hospital characteristics on quality of care.Organizational safety culture was associated with patient adverse events and quality of care. Controlling for effects of nurse and hospital characteristics, nurses in hospitals with a stronger safety culture were 64% less likely to report administration of wrong medication, time, or dose; 58% less likely to report patient falls with injury; and 60% less likely to report urinary tract infections; and were more likely to report higher levels of quality of care. Additionally, the effects of individual-level baccalaureate education and years of experience on quality of care differed across hospitals, and hospital-level nurse education interacted with individual-level baccalaureate education.This study makes significant contributions to existing knowledge regarding the positive effect of organizational safety culture on patient adverse events and quality of care.Healthcare organizations should strive to improve their safety culture by creating environments where healthcare providers trust each other, work collaboratively, and share accountability for patient safety and care quality.

Aims To describe and compare registered nurse (RN) and licensed practical nurse (LPN) emotional exhaustion, intention to leave and reasons for leaving. Background Different skill mix/care delivery models are being used to address nurse shortages and rising health-care costs. Skill mix may include RNs and LPNs. More LPNs are being employed in areas, such as acute care, that have been previously staffed by all RNs. Little is known about nurse outcomes since the introduction of LPNs to acute care settings. Methods This study was a cross-sectional correlational design. A stratified, random sample of acute care nurses completed surveys via Fluidsurveys. The survey was modelled after the RN4CAST nursing workforce survey. Results For both groups of nurses higher levels of emotional exhaustion were associated with intention to leave and workload was the most frequent reason cited for intention to leave. More RNs than LPNs cited career advancement as a reason to leave, and more LPNs than RNs identified poor salary as a reason to leave. Conclusions Emotional exhaustion is linked to intention to leave health care. Implications for nursing management Nurse managers should address work environment factors associated with turnover intentions, such as professional development opportunities and shared decision-making.

The increasing demographic changes of populations in many countries require an approach for managing the complexity of sociocultural differences. Such an approach could help healthcare organizations to address healthcare disparities and inequities, and promote cultural safety for healthcare providers and patients alike. Almutairi's critical cultural competence (CCC) is a comprehensive approach that holds great promise for managing difficulties arising from sociocultural and linguistic issues during cross-cultural interactions. CCC has addressed the limitations of many other cultural competence approaches that have been discussed in the literature. Therefore, the purpose of this study is to define the construct of CCC and the theoretical components of the CCC.

The main purpose of this paper is to examine the psychometric properties of the original five-point CWEQ II using Item Response Theory (IRT) methods, followed by an examination of the revised three-point CWEQ II. (1) Background: The psychometric properties of the CWEQ II have not been previously assessed using more robust techniques such as IRT. (2) Methods: This is a secondary analysis of baseline data from 1067 staff nurses whose leaders had attended a leadership development program. Data were analyzed using a polytomous IRT model. (3) Results: The two versions of CWEQ II fit the SE data equally as each had only one poor-fitting item. For the five-point CWEQ II, discriminant ability was poor for a majority of the items; one item demonstrated a disordinal step difficulty parameter; and item reliability was supported for a relatively wider range of SE levels. The discriminant ability and reliability of items for the three-point CWEQ II was better than those of the five-point CWEQ II, but for a narrower range of SE levels; and the disordinal step difficulty parameter was resolved. (4) Conclusion: The appropriate use of each version of the scale depends on the conditions of the work setting targeted.

(2013) Journal of Nursing ManagementThe effects of perceived organisational support and span of control onthe organisational commitment of novice leadersAim The purpose of this study was to examine the main and interaction effects ofperceived organisational support, span of control and leadership rank on novicenurse leaders’ organisational commitment.Background As nurse leaders’ organisational commitment is eroded at times ofhealthcare restructuring, it is important to study factors associated withorganisational commitment.Methods Cross-sectional data from 69 novice nurse leaders, collected via mailedsurveys at two time points, were analysed using hierarchical regression.Results The findings supported our hypotheses about the positive effect ofperceived organisational support, the positive effect of leadership rank and thenegative effect of span of control on novice nurse leaders’ organisationalcommitment. In addition, perceived organisational support was shown tomoderate the negative effect of span of control on novice nurse leaders’organisational commitment at time 2.Conclusion Organisational strategies aimed at supporting nurse leaders, andattention to span of control, are required to enhance the organisationalcommitment of novice nurse leaders.Implications for nursing management Nurse leaders with a wide span of control,in particular those with little leadership experience, need to adopt leadershipstrategies that maximise their effectiveness, such as organising smaller workgroups or teams within their wide span of control.Keywords

This study examined reciprocal relationships between adolescents' perceptions of parental nurturance and two types of adolescent aggressive behaviors (indirect and direct aggression) using a transactional model. Three waves of longitudinal data were drawn from the Canadian National Longitudinal Survey of Children and Youth. The sample included 1,416 (735 female) adolescents who were 10- and 11-year-olds at Time 1 and became 14-and 15-year-olds at Time 3. The findings failed to support reciprocal effects, but confirmed parental effects at different ages for girls and boys. For girls, perceptions of parental nurturance at age 10 were negatively associated with both indirect and direct aggression at age 12. For boys, perceptions of parental nurturance at age 12 were negatively associated with both aggressive behaviors at age 14. Future research should continue to investigate reciprocal effects in parent-adolescent relationships to identify developmental periods where the effect of adolescents' or their parents' behavior may be stronger.

BACKGROUND: Five cycles of data from the Canadian National Longitudinal Survey of Children and Youth (1994/5–2002/3) were used to examine patterns of child care use in Quebec and the rest of Canada to explore the impact of Quebec’s implementation of universal child care. METHODS: Rates of overall use as well as use of regulated (child care centre, family child care) and non-regulated care (sitter, nanny, relative, family child care) were examined for preschoolers aged 0–5 years in Quebec as compared to the other provinces and by family household income. Chi-square tests were used to examine significance of differences. RESULTS: Since the implementation of Quebec’s child care program, Quebec demonstrated substantial increases in child care use, particularly in the use of regulated care (from 10% prior to program compared to 30% by 2002) whereas the use of unregulated care did not demonstrate a significant increase in Quebec as compared to the other provinces (1994 to 2002). Furthermore, the use of regulated care by low-income families was greater in Quebec than elsewhere in Canada, although the greatest increase in use of regulated care was for children from high-income families. CONCLUSION: Findings suggest that since the introduction of Quebec’s universal child care program, there was an increase in the use of regulated child care for families of preschoolaged children in the province, although by 2002 Quebec had not achieved the coverage of universal child care programs attained by many European countries.

The present study used Canadian National Longitudinal data to examine a model of the mechanisms through which the effects of neighborhood socioeconomic conditions impact young children's verbal and behavioral outcomes (N= 3,528; M age = 5.05 years, SD= 0.86). Integrating elements of social disorganization theory and family stress models, and results from structural equation models suggest that both neighborhood and family mechanisms played an important role in the transmission of neighborhood socioeconomic effects. Neighborhood disadvantage manifested its effect via lower neighborhood cohesion, which was associated with maternal depression and family dysfunction. These processes were, in turn, related to less consistent, less stimulating, and more punitive parenting behaviors, and ultimately, poorer child outcomes.

This study drew on four cycles of longitudinal data from the Canadian National Longitudinal Survey of Children and Youth to examine the academic and behavioural trajectories of youth between 10 and 15 years of age as a function of maternal age at childbearing. The analyses controlled for several family characteristics and examined the mediating effects of three family functioning variables (maternal depression, and nurturing and rejecting parenting behaviours). Maternal age was related to academic competency in math (standardized Math scores), externalizing disorders (Property Offences, Hyperactivity-Inattention), and internalizing disorders (Anxiety-Emotional Disorder). After accounting for family characteristics, the children of the young and older teen mothers retained their disadvantage in Math scores and Property Offences, respectively, whereas the children of older mothers lost the advantages that they had exhibited at age 10 (for Property Offences, the benefits were mediated through family functioning). These results have implications for future research and for the development of policy and programming targeting the healthy development of youth.

This paper reports on a psychometric study conducted to explore the factor structure and refine the Critical Cultural Competence Scale (CCCS). Critical Cultural Competence (CCC) functions to promote the safety, equity, and well-being of patients, their families, and health care professionals. The development process of this measurement scale was systematic and iterative, and included generating a pool of potential items based on the theoretical definitions of CCC. In this study, conducted with a sample of 170 registered nurses from British Columbia, Canada, we used Principal Component Analysis (PCA) to explore the factor structure of the initial set of 84 items as a final step in developing the CCCS. The final version of the measure consists of 43 items, and the PCA results supported a four-factor solution consistent with the theoretical underpinnings of the scale. Future research is recommended to further assess the construct validity of this newly created scale.

Objective The aim of this study was to examine the effects of specific cognitions or aspects of psychological empowerment on 5 major aspects of leader empowering behaviors. Background Leader empowering behaviors are linked to important employee outcomes such as work effectiveness. Psychologically empowered leaders are known to use more empowering behaviors in their practice. There is limited research examining what aspects of psychological empowerment are most associated with different aspects of leader empowering behaviors. Methods Data from a sample of 103 frontline and midlevel nurse leaders were analyzed after they participated in a leadership development program. Results Psychological competence was the strongest predictor of the total score for leader empowering behaviors and 4 of 5 subscale scores, and meaning was the 2nd strongest predictor. Autonomy was not a significant predictor. Conclusion Psychological empowerment, particularly in the form of psychological competence, is an important leader characteristic and should be a focus of leadership development strategies.

The effect of parenting behaviours is important in child health and development research. This study evaluates three child-reported parenting behaviour scales (nurturance, rejection and monitoring) in the Canadian National Longitudinal Survey of Children and Youth (NLSCY).The sample consisted of two longitudinal cohorts (n = 1,164) who were interviewed at ages 10 to 11, 12 to 13, and 14 to 15. The factor structure of each scale was evaluated using confirmatory factor analysis with weighted least squares estimation on polychoric correlation matrices.The 7-item NLSCY Parental Nurturance model appeared to be a good fit to the data for children aged 10 to 11 and 12 to 13, but not for those aged 14 to 15. The 7-item Parental Rejection model was not a good fit to the data across any of the three time points. The 5-item Parental Monitoring model was a good fit to the data across all three time points. Removal of one item from the nurturance and one item from the monitoring scale improved the fit to the data.The revised models appeared to be useful in assessing parental nurturance and monitoring. The model for parental rejection was not confirmed for this sample of adolescents.

The purpose of this study was to examine both the family antecedents and the outcomes of early puberty, with a particular focus on factors related to family socioeconomic status (SES). The study employed a comprehensive measurement of pubertal development and longitudinal data from the Canadian National Longitudinal Survey of Children and Youth. The sample (N = 8,440; 49% girls) included four cohorts of children who were followed biennially for 10 years, starting from age 4–11 to 14–21 years. Data were drawn at different years of age from these cohorts of children. Girls whose fathers were unemployed were more likely to experience early puberty than those whose fathers were employed. For boys, those living with fathers who had not finished secondary school were more likely to experience early puberty. Early maturing girls tended to engage in smoking and drinking at an earlier age compared with their peers. These findings provide support for psychosocial acceleration theory and suggest that different aspects of low family SES may act as a psychosocial stress for early pubertal maturation in boys versus girls, which may lead to engagement in drinking and smoking at a younger age, at least for girls.

Researchers have yet to provide a comprehensive explanation of the variability in the development of childhood obesity, owing in part to the dearth of longitudinal studies. Such an understanding would contribute to the improvement of approaches for the primary and secondary prevention of childhood obesity. This study identifies, in a representative sample of Canadian children, age-related patterns of overweight and obesity between toddlerhood and childhood.The data are from cycles 2 through 5 (1996/1997 to 2002/2003) of the National Longitudinal Survey of Children and Youth. The sample comprised children aged 24 to 35 months at baseline, who were followed biennially over six years. Group-based mixture modelling analyses (using SAS PROC TRAJ) were conducted to identify the sex-specific developmental trajectories of body mass index (BMI).Group-based modelling identified four BMI trajectories for the girls (stable normal BMI, early declining BMI, late declining BMI, and an accelerating rise to obesity) and three for the boys (stable normal BMI, transient high BMI, and a J-curve rise to obesity).Identifying distinct, sex-specific BMI trajectories is valuable in understanding pathways through which a child may develop obesity. These findings have implications for further research and practice, in particular, that no single approach can be used to prevent or reduce levels of obesity.

BACKGROUND: Current health literature suggests that there has been a decline in the age of pubertal onset, and that pubertal development is influenced by social context. Unfortunately, contemporary Canadian-specific data have not been available. This study examined the odds of having entered puberty at various ages during adolescence, before and after controlling for the effects of family socio-economic status and family structure. METHODS: Longitudinal data for this study were drawn from the first four cycles of the National Longitudinal Survey of Children and Youth. The final sample consisted of 7,977 adolescents ranging in age from 10 to 17. Pubertal status of the participants was identified based on pubic hair, facial hair growth, and voice change, for boys; and pubic hair, breast development, and menstruation, for girls. Trajectories of pubertal development were analyzed with HLM growth curve modelling techniques. RESULTS: The results indicated that, compared to boys, the odds of having entered puberty at age 13 were 6.45 times higher for girls and that girls go through puberty more quickly. Low family socio-economic status and living with a stepfather were found to predict early onset of pubertal development. CONCLUSION: Contextual factors are related to pubertal development. Additional research is needed to develop a more solid understanding of how psychosocial factors interact to predict gendered patterns of pubertal development.

The author describes the sexual harassment experiences of 565 male and female students in Grades 9 through 11 and discusses the influence of the social construction of gender on those experiences. The sample was drawn from 12 schools in 2 Canadian provinces. The study employed a retrospective correlational survey design, using self-report questionnaires administered in class. The results indicate that sexual harassment is pervasive among both male and female adolescents but is particularly problematic for girls due to their qualitatively different harassment experiences. Both girls and boys reported gender harassment to be, in general, more upsetting than unwanted sexual advances. Girls employed a greater variety of coping strategies than boys; however, for both sexes passive coping strategies were predominant. The author offers recommendations related to school health programming and discusses the role of the school nurse.