The association of nurse caring behaviours on missed nursing care, adverse patient events and perceived quality of care: A cross-sectional study

Effects of compassion fatigue, structural empowerment, and psychological empowerment on the caring behaviours of intensive care unit nurses in China: A structural equation modelling analysis

BACKGROUND

Caring behaviours play a pivotal role in nursing. The negative correlation between caring behaviours and compassion fatigue in the intensive care unit (ICU) has been extensively researched. Nevertheless, considerable gaps persist in comprehending the associations of psychological empowerment and structural empowerment with outcomes, particularly in the highly stressful environment of the ICU.

OBJECTIVES

The aim of this study was to determine how compassion fatigue, structural empowerment, and psychological empowerment impact the caring behaviours of ICU nurses in China via a structural equation modelling analysis.

DESIGN

A cross-sectional study through convenience sampling was conducted in the ICU of 24 hospitals in China from February to June 2021.

METHODS

A self-designed demographic questionnaire, the Chinese version of the Caring Behaviors Inventory, the Chinese version of the Compassion Fatigue Short Scale, the Chinese version of the Conditions of Work Effectiveness Questionnaire-II, and the Chinese version of the Psychological Empowerment Questionnaire-12 were used to survey ICU nurses.

RESULTS

A total of 450 ICU nurses were recruited. The final model showed a good model fit. In the ICU nurse population, compassion fatigue (β = -0.582; 95% confidence interval: [-0.686, -0.455]) had a direct negative relationship with caring behaviours, whereas both structural empowerment (β = 0.448; 95% confidence interval: [0.372, 0.572]) and psychological empowerment (β = 0.438; 95% confidence interval: [0.333, 0.563]) had indirect positive associations with caring behaviours through compassion fatigue.

CONCLUSIONS

Our findings revealed a direct negative association between compassion fatigue and caring behaviours, whereas both structural empowerment and psychological empowerment are indirectly positively associated with caring behaviours through compassion fatigue amongst ICU nurses in China. Our research revealed that positive improvements in structural empowerment and psychological empowerment were associated with enhancements in compassion fatigue mitigation and the fostering of caring behaviours amongst ICU nurses in practice.

The Relationship Between Clinical Leadership Behaviors, Flourishing, and Extra-Role Behavior Among Nurses: A Cross-Sectional Study

Background: Clinical leadership is vital in improving nurses' performance and healthcare services. Aim: This study examined the relationship between clinical leadership behaviors, flourishing, and extra-role behavior among nurses in Jordan. Methods: A descriptive correlational design was used, which enrolled a convenience sample of 260 registered nurses working at governmental hospitals in Jordan. Results: The mean score of clinical leadership behaviors was moderate (M = 138.01, SD = 7.82). Nurse flourishing had a mean total score of (M = 31.76, SD = 5.49), indicating positive well-being. Extra-role behavior had a mean score of (M = 23.96, SD = 3.93), indicating moderate participation in extra-role behaviors. There was a significant moderate positive correlation between clinical leadership behaviors and nurse flourishing (r = 0.489, p=0.047) and extra-role behaviors (r = 0.359, p=0.004). Factors that significantly predicted nurse flourishing and extra-role behavior were clinical leadership behaviors, age, duration of nursing experience, income, and hospital number of beds. Conclusion: Effective clinical leadership behaviors can significantly improve nurses' flourishing and extra-role behavior. Implication for Nursing Management: The results emphasize the importance of training nurses on positive leadership behaviors to enhance flourishing and involvement in extra-role behavior.

"Even though it is difficult, …, is truly worth everything": A qualitative study on pediatric nurses' end of life care experiences

PURPOSE

This study explores the end-of-life care experiences of pediatric nurses in Turkey.

METHOD

This study was conducted using the phenomenology design, one of the qualitative research designs. A total of 20 nurses participated in the study, which utilized purposive and snowball sampling methods, including two pilot interviews.

RESULTS

The analysis revealed four categories: (1) the ideal pediatric nurse, (2) caring for a child at the end of life, (3) effects of pediatric end-of-life care, and (4) requirements for ideal pediatric end-of-life care. Within the scope of these categories, the characteristics of an ideal pediatric nurse, the stages and difficulties of end-of-life care, the effects on nurses, and the necessary actions to be taken to improve the quality of care and to strengthen the mental health of pediatric nurses were discussed.

CONCLUSION

This study highlights the growth that pediatric nurses experience despite the challenges they face in end-of-life care and sheds light on potential actions to improve the quality of end-of-life care and empower pediatric nurses.

IMPLICATIONS FOR PRACTICE

Professional training, psychosocial support, and ethical guidance should be provided to pediatric nurses during the end-of-life care process.

The relationship between teamwork and the workload of nurses with missed nursing care in intensive care units in Iran: a cross-sectional study

BACKGROUND

Missed nursing care (MNC) is a major challenge faced by nurses working in intensive care units (ICU). Workplace characteristics, including teamwork and workload, can affect the extent of missed nursing care. Examining the relationship between these variables can help create strategies to enhance care. Thus, this study aimed to explore the connection between teamwork, workload, and missed nursing care in the intensive care units of hospitals in Iran.

METHODS

This descriptive cross-sectional study was conducted from August to November 2023 on 219 nurses working in the intensive care units of teaching hospitals affiliated with Hamadan University of Medical Sciences. Participants were selected through multi-stage sampling after meeting the inclusion criteria. Data were collected using the General Characteristics questionnaire, the Team-STEPPS® Teamwork Perception Questionnaire (T-TPQ), the National Aeronautics and Space Administration Task Load Index (NASA-TLX), and the MISSCARE survey. Data analysis was performed using Stata software version 14.

RESULTS

Out of 219 returned questionnaires (92.79% response rate), 194 valid responses were analyzed. Missed nursing care showed a significant negative correlation with overall teamwork (r = -0.538, P < 0.001) and its subcomponents, including team structure (r = -0.472), leadership (r = -0.303), situation assessment (r = -0.486), mutual support (r = -0.325), and communications (r = -0.517). Tenure was also significantly related to missed nursing care (p = 0.040), with nurses having less than 2 years of experience reporting the lowest missed care scores. No significant relationships were found between workload scores and demographic variables.

CONCLUSION

The relationship between teamwork, nurse workload, and missed nursing care is complex. The findings of this study emphasize the importance of effective teamwork and manageable workloads in reducing missed nursing care. However, contextual differences in nurses' work environments are of great importance in different countries.

Mistreatment of nurses by patients and its impact on their caring behaviors: The roles of psychological detachment and supervisor positive gossip

BACKGROUND

Mistreatment by patients is a detrimental phenomenon predominant in healthcare organizations. However, there is a lack of nursing literature regarding the underlying mechanisms and boundary conditions that exist between mistreatment by patients and its detrimental consequences.

AIM

By integrating the Job Demands-Resources Model and the Conservation of Resources Theory, the study aimed to unveil the mediating role of psychological detachment from work in the relationship between mistreatment by patients and nurses' caring behaviors, as well as the moderating effect of supervisor positive gossip.

METHODS

This multicenter, cross-sectional study involved 341 nurses from five hospitals across two cities in Egypt. Data were collected using an introductory information form, the Mistreatment by Patients Scale, the Psychological Detachment Scale, the Caring Behaviors Scale, and the Supervisor Positive Gossip Scale. The study's hypotheses were tested using the PROCESS macro.

RESULTS

The results showed that mistreatment by patients was negatively related to nurses' caring behaviors via an increased psychological detachment. Further, higher levels of supervisor positive gossip were shown to weaken the direct effect of mistreatment by patients in increasing nurses' psychological detachment, as well as the indirect negative effect of mistreatment by patients on nurses' caring behaviors via psychological detachment.

CONCLUSIONS

Mistreatment by patients contributes to nurses' psychological detachment and decreased caring behaviors; however, these negative outcomes can be mitigated by supervisor positive gossip.

IMPLICATION FOR NURSING POLICYMAKING

Nursing managers should adopt strategies to deter the rise of mistreatment by patients, and utilize positive gossip to support nurses exposed to such mistreatment to alleviate its consequences.

Prevalence and associated factor of verbal abuse against nurses: A systematic review

BACKGROUND

Nurses who experience verbal abuse often report negative emotions, which can affect their work status and nurse-patient relationship. However, to the best of our knowledge, no study has summarized the prevalence of verbal abuse among nurses by different perpetrators and related risk factors.

AIM

This review aimed to synthesize the prevalence of verbal abuse among nurses and identify the most common sources and related risk factors.

METHODS

PubMed, Web of Science, Embase, and the Cochrane Library electronic databases were searched from inception to 15 October 2024, and observational studies reporting the prevalence of verbal abuse among nurses were selected. In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Methodological quality was appraised using a revised version of the Newcastle-Ottawa Quality Assessment Scale, and the STATA software was used for meta-analysis; PROSPERO registration number: CRD42022385401.

RESULTS

The search identified 458 records, of which 45 met the inclusion criteria. The overall prevalence of verbal abuse was estimated at 67% (95% CI: 61-72). Verbally abused nurses reported patients' relatives, friends (48%, 95% CI: 42-55), and physicians (39%, 95% CI: 20-58) as the main perpetrators of verbal abuse. Personal factors, work area, and work characteristics were the main factors related to verbal abuse among nurses.

CONCLUSIONS

The overall prevalence of verbal abuse among nurses was more than 65%, especially in the emergency department, and South or Southeast Asian countries had a significantly lower prevalence of verbal abuse than other countries. Physicians and patients' relatives were the main sources of verbal abuse. Hospital administrators should prevent various effects of verbal abuse on nurses' physical and mental health.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Developing safe workplaces and effective interventions to protect nurses is essential. Supervisors and institutions should thoroughly monitor verbal abuse. Additionally, organizations need to focus on preventive measures and provide the necessary administrative, legal, and psychological support to nurses who are exposed to verbal abuse to ensure nursing care sustainability.

Relationship between ICU nurses' perception of patient safety, caring behaviour, professional self-efficacy and nursing deficits: A multiple mediation analysis

BACKGROUND

Missed nursing care (MNC) is a significant global issue in health care, especially in intensive care units (ICUs) where the complexity of patient care and high workloads increase the risk of errors and omissions. Nursing deficits impact patient safety, nurse efficiency and psychological well-being, yet the relationship between ICU nurses' perceptions of patient safety, their caring behaviour, professional self-efficacy and nursing deficits remains underexplored.

AIM

This study aimed to examine the relationships between ICU nurses' perceptions of patient safety, caring behaviour, professional self-efficacy and nursing deficits through a multiple mediation model.

STUDY DESIGN

A cross-sectional survey was conducted with 304 ICU nurses from general hospitals in Guangxi Province between January 2022 and January 2024. The study used validated instruments to measure patient safety perception, caring behaviour, professional self-efficacy and nursing deficits. Spearman correlation and multiple mediation analyses were applied to explore the relationships among these variables.

RESULTS

ICU nurses reported average scores of 63.35 ± 8.06 for patient safety perception, 70.28 ± 12.14 for caring behaviour, 26.19 ± 4.57 for professional self-efficacy and 75.92 ± 17.68 for nursing deficits. Significant negative correlations were found between patient safety perception, caring behaviour, professional self-efficacy and nursing deficits (r = -.483, -.516, -.326, p < .01). Caring behaviour and self-efficacy mediated the relationship between patient safety perception and nursing deficits, accounting for 74.65% of the total effect. This study follows the STrengthening the Reporting of OBservational studies in Epidemiology guidelines.

CONCLUSIONS

This study highlights that improving ICU nurses' perceptions of patient safety can reduce nursing deficits by enhancing caring behaviour and professional self-efficacy, offering a pathway to improve care quality in ICUs.

RELEVANCE TO CLINICAL PRACTICE

Hospital administrators should focus on strategies that enhance ICU nurses' safety perception, caring behaviour and self-efficacy to reduce nursing deficits and improve patient outcomes.

The Effect of Nurses' Professional Values on Missed Nursing Care: The Mediating Role of Moral Sensitivity

The aim of this study is to determine the mediating role of moral sensitivity in the effect of nurses' professional values on missed nursing care. A descriptive and correlational study was conducted with 640 nurses working in the inpatient units of a public and a private hospital with the MISSCARE Survey-Turkish, the Moral Sensitivity Questionnaire, and the Revised Nursing Professional Values Scale. Data analyses were performed using the Statistical Package for Social Sciences 26.0, Hayes' PROCESS macro for SPSS v4.0, and the Analysis of Moment Structures 24.0. It was determined that nurses' professional values had a significant and positive effect on moral sensitivity, and nurses' moral sensitivity had a significant and negative effect on missed nursing care. In addition, the direct and indirect effects of nurses' professional values on missed nursing care were statistically significant. The research model showed that increasing nurses' professional values and moral sensitivity decreased missed nursing care, and moral sensitivity significantly mediated the interaction between nurses' professional values and missed nursing care.

Pedagogical approaches to foster caring behaviors among nursing students: A scoping review

BACKGROUND

Developing caring behaviors in nursing students is crucial for improving patient care quality. Despite the variety of pedagogical approaches employed to cultivate these behaviors, their comparative effectiveness remains underexplored.

AIM

This review systematically examined various pedagogical approaches used to foster caring behaviors among nursing students and evaluated their outcomes.

DESIGN

This study employed a scoping review design.

METHODS

A comprehensive search across five databases-PubMed, CINAHL, Scopus, Web of Science, and ERIC-was conducted for studies published from January 2000 to the present. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed in reporting the findings.

RESULTS

A total of 22 studies were included in the review. The review identified four primary pedagogical approaches: (1) simulated interactive learning, (2) caring-centered educational programs/courses, and (3) immersion/service learning. All approaches demonstrated positive outcomes in enhancing students' caring behaviors.

CONCLUSION

Employing a diverse range of pedagogical approaches, aligned with experiential, cognitive, and behavioral learning theories, significantly enhances the development of caring behaviors in nursing students. However, the review highlighted the need for more rigorous study designs to further validate these findings.

IMPLICATIONS FOR NURSE EDUCATION

Nurse faculty should incorporate a variety of pedagogical approaches into nursing education to address different learning needs and enhance the development of caring behaviors. Future research should focus on evaluating the effectiveness of these approaches and their long-term impact on nursing practice.

The Relationship Between Staffing, Nurses' Emotional Exhaustion, and Adverse Patient Events in Critical Care Units in Sultanate of Oman

Background: Ensuring safe practices remains a top priority for healthcare policymakers. However, limited evidence has examined the link between individual, work-related factors, and patient safety within critical care units in Oman. Aim: To assess the relationship between staffing levels, job-related emotional exhaustion, and adverse patient events among nurses working in critical care units. Design: A cross-sectional study was conducted to collect data from critical care nurses in Oman. Nurses were recruited using a stratified proportional sampling method. Results: A total of 694 critical care nurses participated in the study. More than half (64.1%) of the critical care nurses experienced higher levels of emotional exhaustion. Significant predictors of adverse patient events included nurse staffing level (r = 0.09, p < 0.001), emotional exhaustion (β = 0.25, p < 0.001), hospital type (being affiliated with nonteaching hospitals) (p=0.021), and nationality (β = -0.15, p < 0.001). Conclusion: The occurrence of nurse-reported adverse events was associated with several key variables, including nurse staffing levels, emotional exhaustion, hospital type, and nationality. Implications for Nursing Management: To improve patient safety, healthcare policymakers should prioritize optimizing nurse staffing levels and implement strategies to reduce emotional exhaustion, particularly in nonteaching hospitals and among specific nurse demographics.

The Influence of Emotional Intelligence on Psychiatric Nurses' Care Behavior, and the Chain Mediating Role of Compassion Fatigue and Perception of Management

PURPOSE

To investigate psychiatric nurses' emotional intelligence and its effect on care behavior, while also examining the mediating effect of compassion fatigue and perception of management.

METHOD

This cross-sectional study was conducted in several specialized psychiatric hospitals with 360 psychiatric nurses. Self-report surveys were administered, which included the Caring Factor Survey-Caring of Manager, Caring Behaviors Inventory, Compassion Fatigue Short Scale, and Wong Law Emotional Intelligence Scale. Data were analyzed using descriptive, correlation, and path analyses.

RESULTS

Mean score for care behavior was 4.78 (SD = 0.83), which was at a moderate level. Compassion fatigue exhibited negative correlations with other variables. Results of mediation effect analysis showed that emotional intelligence directly predicted care behavior (p < 0.001). Emotional intelligence also indirectly affected care behavior through the mediating roles of perception of management and compassion fatigue, and affected care behavior through the chain mediation effect of perception of management and compassion fatigue.

CONCLUSION

Nurse managers should pay attention to the influence of emotional intelligence on care behavior and improve care behavior by strengthening leadership and alleviating compassion fatigue. [Journal of Psychiatric Nursing and Mental Health Services, 63(2), 35-43.].

A solution to the pervasive problem of response bias in self-reports

Self-reports are used ubiquitously to probe people's thoughts, feelings, and behaviors and inform medical decisions, enterprise operations, and government policy and legislation. Despite their pervasive use, self-report measures such as Likert scales have a profound problem: Standard analytic approaches do not control for the confounding effects of idiosyncratic response biases. Here, we present a model-based solution to this problem. Our model disentangles response bias from latent constructs of interest to obtain less biased scores of the latent states of respondents. Inspired by Thurstonian approaches in the psychophysics literature, the model requires nothing further than standard Likert scale design assumptions. The model uses a data-driven approach to control for response biases, without the need to prespecify bias types or response strategies. We demonstrate the model's ability to uncover more precise estimates of latent state associations, outperforming bias-affected standard scoring techniques, and garner insights into previously undetected codependencies between certain latent states and particular forms of response bias. The model is thus a tool which outperforms standard scoring methods and generates insights into, and controls for, the potentially confounding effects of response bias on self-report Likert scale data.

The mediating role of compassion fatigue between perceived organization support and caring behavior among outpatient nurses in China: a cross-sectional study

BACKGROUND

The caring behaviors of outpatient nurses play a crucial role in improving the quality of care in hospitals. Work resources and personal psychological resources have a significant impact on nurses' caring behavior. Previous research has shown that perceived organizational support and compassion fatigue are linked to nurses' caring behaviors. However, the specific relationship among these variables is less clear in the context of outpatient nurses working in high-stress environments.

METHODS

A convenience sampling method was utilized to recruit 413 outpatient nurses from six tertiary hospitals in Xi'an, China, as research subjects between November 2023 and January 2024. The questionnaires used in the study included a sociodemographic questionnaire, the Perceived Organizational Support Scale, the Chinese version of the Compassion Fatigue Brief Scale, and the Chinese version of the Caring Behavior Scale. Data analysis involved descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H rank-sum test, Spearman correlation analysis, and the PROCESS macro model 4.

RESULTS

A significant negative correlation was observed between the sense of organizational support and compassion fatigue (ρ=-0.547, P < 0.01). Conversely, a significant positive correlation was found between the sense of organizational support and caring behavior (ρ = 0.469, P < 0.01). Moreover, there was a significant negative correlation between compassion fatigue and caring behavior (ρ=-0.641, P < 0.01). Subsequent mediation analysis demonstrated that compassion fatigue partially mediated the relationship between perceived organizational support and caring behaviors. The overall impact of perceived organizational support on caring behavior (β = 0.363) encompasses both its direct influence (β = 0.131) and the indirect impact mediated by compassion fatigue (β = 0.232). The mediating effect accounts for 63.9% of the total effect.

CONCLUSION

Compassion fatigue acts as a partial mediator in the relationship between perceived organizational support and the caring behavior of outpatient nurses. It is essential for nursing managers to effectively manage both the work resources and personal psychological resources of outpatient nurses to improve their caring behaviors in high-stress settings. By improving nurses' organizational support resources, we can reduce the depletion of their personal psychological resources and alleviate negative emotions such as compassion fatigue. This, in turn, can improve nurses' caring behavior and ultimately enhance the overall quality of nursing services in the hospital.

Patient satisfaction and associated factors in Addis Ababa's public referral hospitals: insights from 2023

Background

Currently, patient satisfaction is a major concern in the healthcare system of Ethiopia. Patient satisfaction with nursing care is considered an important factor in explaining patients' service quality. Satisfied patients are more likely to have a good relationship with nurses, which suggests improved quality of care.

Objective

To assess the prevalence of patient satisfaction and its associated factors among admitted patients in Addis Ababa city public referral hospitals, Ethiopia 2023.

Methods and materials

An institutional-based cross-sectional study design was employed among 471 randomly selected patients from June 1 to July 30, 2023. Interviewer-administered a structured questionnaire was used to collect data. Patient satisfaction was measured by using the Newcastle Nursing Care Satisfaction Scale. Bivariable and multivariable logistic regressions were used to identify the factors associated with patient satisfaction.

Result

471 participants responded among 506 selected patients yielding a response rate of 93%. The satisfaction of patients was 47.8% (95% CI = 42.9, 52.2%) Multiple logistic regression showed that participants aged 26-35 were less likely to be satisfied with nursing care [AOR = 0.25, 95% CI: 0.11, 0.56]. In contrast, those in the surgical ward [AOR = 3.85, 95% CI: 1.98, 7.45] and ophthalmology ward [AOR = 4.27, 95% CI: 1.81, 10.05] were more satisfied. No previous admission [AOR = 0.13, 95% CI: 0.07, 0.26], having no comorbidities [AOR = 13.4, 95% CI: 7.06, 25.4], and shorter admission duration [AOR = 9.14, 95% CI: 3.46, 24.11] were found to be factors with a significant association with patient nursing satisfaction.

Conclusion

Overall, just under one in every two admitted patients were satisfied, indicating areas for potential improvement in nursing care. Specific factors such as patients in the age range of 26 to 35 reported significantly lower levels of satisfaction, whereas patients in the surgical and ophthalmology wards, as well as those without comorbidities and with shorter hospital stays, reported significantly higher levels of satisfaction. These findings emphasize the importance of targeted strategies to enhance nursing care.

The effect of missed care on the nursing image perceived by patients and their trust relationships with nurses

BACKGROUND

Missed care has negative consequences for patients, directly affecting the quality of nursing care and patient safety.

AIM

This study investigated the effect of missed care on the nursing image perceived by patients and their trust relationships with nurses.

METHODS

This descriptive and correlational study was conducted in all inpatient wards of a hospital in southern Türkiye. The sample consisted of 200 patients. Data were collected using a patient information form, the MISSCARE Survey-Patient, the Nursing Image Scale (NIS), and the Trust in Nurses Scale (TNS). The data were analyzed using the Statistical Package for Social Sciences (for Windows 25.0). The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

FINDINGS

Participants had a mean MISSCARE Survey-Patient, TNS, and NIS score of 2.09 ± 0.53, 23.48 ± 5.01, and 71.52 ± 6.75, respectively. There was a moderate negative correlation between MISSCARE Survey-Patient and TNS scores. There was a weak negative correlation between MISSCARE Survey-Patient and NIS scores. Moreover, there was a strong positive correlation between NIS and TNS scores.

DISCUSSION

MISSCARE Survey-Patient total scores vary due to the imbalance in the number of nurses and the complexity of their tasks. Poor quality of care and incomplete care undermine the image of nursing and negatively affect the trust relationship between patients and nurses.

CONCLUSIONS

Nursing image and trust in nurses decreases as patient-nurse communication and basic care interventions are skipped.

IMPLICATIONS FOR NURSING POLICY

Inadequate care can have a detrimental effect on the nursing image and erode patient-nurse trust relationships. Therefore, there is a pressing need for ongoing review and enhancement of nursing education, policy, and practice to elevate the quality of care provided. Further research utilizing objective staff measures and outcome assessments, along with gathering primary data directly from patients, is essential to substantiate the assertion that missed care significantly influences patient outcomes.

Examination of the relationship between nurses' adherence to medication administration principles and their attitudes toward patient safety

BACKGROUND

Preventing errors associated with medication administration is achievable through nurses' adherence to correct principles.

OBJECTIVE

This study aims to investigate the relationship between nurses' adherence to medication administration principles and their attitudes toward patient safety.

METHOD

This study adopts a descriptive and relationship-seeking research design. A total of 310 nurses who met the inclusion criteria participated in the study. Data collection tools included the "Nurse Information Form," "Medication Administration Principles Adherence Form," and "Patient Safety Attitude Scale".

RESULTS

Among the participating nurses, 32.9% (n = 102) reported experiencing a medication administration error, and 77.7% (n = 241) witnessed such an error. The study revealed a statistically significant positive relationship between nurses' adherence to medication administration principles and their attitudes toward patient safety (p < 0.001).

CONCLUSIONS

This study underscores the importance of nurses' adherence to medication administration principles in ensuring patient safety.

Nurses' attitudes towards patient safety and their relationship to adverse patient events in Oman

Background

Adverse events (AEs) are major causes of mortality. Identification of nurses' attitudes towards patient safety and their impact on AEs is critical in enhancing safe practices.

Aim

To assess the relationship between attitudes towards patient safety and AEs as perceived by nurses working in Sultanate of Oman.

Methods

A descriptive, cross-sectional study was conducted. Data to evaluate nurses' attitudes towards patient safety was collected using the Safety Attitude Questionnaire. The relationship between attitudes towards patient safety and the perceived incidence of adverse patient events was examined using logistic regression analysis.

Results

A total of 184 questionnaires were administered from February to April 2022, with a response rate of 96.8%. The results revealed that nurses had a negative attitude towards patient safety. The highest reported adverse event was patient and family complaints. Findings showed a significant relationship between working conditions and patient and family verbal abuse (OR = 0.505, CI (0.283-0.901), p = 0.021). Job satisfaction was a significant predictor of patient fall (OR = 0.57, CI (0.353-0.932), p = 0.025) and medication error (OR = 0.58, CI (0.354-0.949), p = 0.030).

Conclusion

Nurses' attitudes towards patient safety are a significant predictor contributing to the occurrence of AEs. This finding provides key insights about patient safety status that key stakeholders could use to improve safety culture, including raising patient safety awareness.

The relationship between psychological capital and humanistic caring ability among mental health nurses in Saudi Arabia

BACKGROUND

The ability to provide humanistic care has a significant impact on the therapeutic relationships in psychiatric services, which in turn influences patients' outcomes.

AIM

To examine the relationship between psychological capital and humanistic care ability among mental health nurses in Saudi Arabia.

METHODS

A descriptive correlational research design was implemented in this study. A convenience sampling method was used to collect information from 500 mental health nurses from a governmental mental health facility. The data were collected using the psychological capital questionnaire and the caring ability inventory.

RESULTS

The results revealed high levels of psychological capital and humanistic care ability among mental health nurses. Psychological capital significantly predicted humanistic care ability ([Formula: see text] 0.630, F(1,498) = 851.16, p< 0.001). Also, there were significant relationships between sociodemographic variables and psychological capital (age, educational level, and professional title) and humanistic care ability (age and years of experience).

CONCLUSION

Psychological capital was found to be be positively associated with the humanistic care ability of mental health nurses. The findings of this study suggest that nursing managers should explore strategies from the viewpoint of positive psychology to enhance the psychological capacity of mental health nurses to provide humanistic care abilities, which can effectively improve nurses-patients' relationships and outcomes in clinical practice.

Burnout inpediatric nurses: Examining the relationship between moral distress and missed nursing care

PURPOSE

This study investigates the relationship between burnout levels of moral distress and missed nursing care in pediatric nurses.

DESIGN AND METHOD

A cross-sectional study was conducted between November and December 2023. Pediatric nurses working in two hospitals and providing direct care to children (n = 140) completed the Moral Distress Scale-Revised Pediatric Nurses, MISSCARE Survey - Pediatric Version and Burnout Measure-Short Version questionnaire. Multivariate regression analysis modeling was applied to test the mediating effect on the relationship between burnout, moral distress, and missed nursing care.

RESULTS

There was a significant positive correlation between the Moral Distress Scale-Revised Pediatric Nurses and its sub-dimensions and the Burnout Measure-Short Version (p < 0.05). There was a significant positive correlation between the mean MISSCARE- Survey-Ped score of the nurses participating in the study and its sub-dimensions and Burnout Measure-Short Version (p < 0.05). Providing Benefit-Do No Harm, one of the Moral Distress Scale-Revised Pediatric Nurses sub-dimensions, and Labour Resources, one of the MISSCARE sub-dimensions, were found to be predictors of burnout. The ethical principle of Providing Benefit-Do No Harm was found to mediate between moral distress and burnout and reduce burnout associated with missed care.

CONCLUSIONS

Accordingly, as the nurses' moral distress and inability to meet the necessary patient care increase, their burnout levels also increase. Providing Benefit-Do No Harm is an basic ethical principle that will positively affect the burnout level of pediatric nurses.

PRACTICE IMPLICATIONS

This study may provide insights into ethics training, communication improvement strategies, and individual support intervention programs aimed at reducing moral distress, and burnout and improving the coping mechanisms of nurses working in pediatric wards.

The relationship between nurses' professional commitment and missed nursing care: a cross-sectional study in Iran

BACKGROUND & AIMS

Missed nursing care is a global challenge that can have many consequences and it's known as a common threat to the patient safety and quality of nursing care. The nurses' professional commitment plays the final role in the occurrence of this issue. This study aimed to investigate the relationship between nurses' professional commitment and missed nursing care in Iran.

MATERIALS & METHODS

This cross-sectional descriptive-analytical study was conducted on 270 nurses working in two hospitals affiliated to Tehran University of Medical Sciences (Sina & Shariati) from September to December 2023. The research community included all nurses working in medical-surgical wards in the designated hospitals. The research samples were included in a targeted and quota method after obtaining organizational permits, ethical approval and informed consent. Data collection was done using three questionnaires including demographic information form, Nursing Professional Commitment Scale, and MISSCARE Questionnaire. The collected data was analyzed in SPSS software, version 25.

RESULTS

The results of Pearson's correlation test showed that there is a significant negative relationship between nurses' professional commitment and missed nursing care scores (r=-0.23) (p < 0.001). The mean score of nurses' professional commitment was reported at a moderate to high level (83.72 ± 16.02) and the mean score of missed nursing care was reported at a low level (47.84 ± 16.48). Nurses over 40 years old, morning shift and employed nurses showed higher professional commitment. Also, nurses under 29 years old and male nurses had more missed nursing care other than their participants. No relationship was observed between other demographic variables with nurses' professional commitment and missed nursing care.

CONCLUSION

The results of this study showed that higher nurses' professional commitment leads to higher quality of care and less missed nursing care. Based on findings of this research, it is recommended for health care providers and nursing managers to adopt programs to increase nurses' professional commitment and consequently reduce missed nursing care.

[Registered nurses' experience of necessary performed and missed nursing care: a qualitative study]

Registered nurses' experience of necessary performed and missed nursing care: a qualitative study Abstract: Background: Providing high quality care based on their caring attitude is essential for nurses. Missed Care can cause feelings of guilt and dissatisfaction among them. Studies on their experiential transition between fully performed and missed care are lacking. They may contribute to a more comprehensive understanding of influencing factors and the impact on nurses' experience. Aim: The aim was to explore how nurses at a centre hospital in German-speaking Switzerland describe performance of nursing interventions in terms of the different expressions between performed and missed care. Methods: Between September 2020 and March 2021 the first author conducted eleven qualitative guide-based individual interviews with registered nurses which were analysed using Mayring's qualitative content analysis and knowledge maps. Results: The analysis resulted in five main categories: Optimal care, satisfaction in mediocrity, a huge lack, patients' reactions and influencing factors. Nurses described, in addition to personal experience and expertise, different coping strategies to prevent missed care and maintain patients' and their own satisfaction. Conclusions: In addition to interventions that can prevent missed care, nurses' experience of performed care should be explored further. This can deepen the understanding of its relationship with professional caring attitudes as well as with patient-related and professional satisfaction.

Linking patient safety, caring behaviours and professional self-efficacy with missed nursing care among Filipino emergency room nurses: A structural equation model study

AIMS

To investigate the interrelationships of patient safety, caring behaviours, professional self-efficacy and missed nursing care among emergency room nurses.

DESIGN

Cross-sectional, correlational study.

METHODS

Filipino emergency room nurses (n = 345) participated via convenience sampling from September 2023 to January 2024. Four validated self-report scales were used to collect data and were analysed using Spearman rho, covariance-based structural equation modelling, mediation and path analyses.

RESULTS

The emerging model of study variables displayed satisfactory fit indices. Patient safety directly influenced caring behaviours and professional self-efficacy, while negatively influencing missed nursing care. Caring behaviours directly and indirectly affected professional self-efficacy and missed nursing care, respectively. Professional self-efficacy negatively influences missed nursing care. Finally, caring behaviours and professional self-efficacy were significant mediators between the association of patient safety and missed nursing care.

CONCLUSION

Caring behaviours and professional self-efficacy of emergency room nurses demonstrated mediating effects that can potentially improve patient safety practices thereby minimizing unfinished or missed nursing care.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses and healthcare organizations should commit to consistently maintain a workplace culture that fosters patient safety, caring behaviours and professional self-efficacy to minimize avoidable injuries and omitting nursing care tasks.

REPORTING METHOD

STrengthening the Reporting of OBservational studies in Epidemiology (STROBE).

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Emergency triage nurses' perceptions of caring behaviors and the safety of the patient during triage encounters: a grounded theory study

BACKGROUND

Triage is a dynamic process prioritising the patient coming to the emergency department. Caring behaviour and patient safety during the triage process are essential for ensuring a good care experience and treatment outcome.

OBJECTIVE

To describe triage nurses' perceptions on caring behaviors and patient safety in the triage area.

DESIGN

Strauss and Corbin's Grounded theory method was used to develop the model.

METHODS

The study was conducted in the emergency department in northeastern Slovenia. Semi-structured interviews were used for data collection, and 19 triage nurses were selected by theoretical sampling, guided by emerging categories between November 2021 and July 2022. The data analysis was conducted according to Strauss and Corbin's coding framework.

RESULTS

The analysis of the interviews generated one category: The process of creating a caring and safe triage encounter for the patient, together with two categories that explain the key phenomenon: (1) Triage caring and (2) Safety in the triage process. Within the category "Triage caring", four subcategories were developed: (1) Assurance of triage nurses' presence, (2) Connectedness, (3) Respectful attitude, and (4) Knowledge and skills. The category Safety in the triage process consists of three identified subcategories: (1) Conception and perception of safety, (2) Factors influencing patient safety, and (3) Improving the triage safety.

CONCLUSIONS

The triage nurses' perceptions about caring for the patient and his safety in the triage area show that caring and safety are inseparably linked and coincide when triaging a patient. Namely, caring for the patient means ensuring the patient's safety at the same time.

IMPLICATIONS FOR THE NURSING FIELD

A better understanding of the importance of triage nurses' caring behavior and patient safety emerges from the findings, highlighting the challenges faced in a busy emergency department where nurses must balance providing care and responding to patients' needs while ensuring safety. Findings in the study show that patient care and safety are inseparably linked and coincide when triaging a patient. Moreover, applying caring behaviour during triage encounter results in greater patient safety.

NO PATIENT OR PUBLIC CONTRIBUTION

The study's design, evaluation of the findings, and execution did not need the involvement of patients or the general public. Participants were triage nurses working in the emergency department. Triage nurses were interviewed about their perceptions of triage nurses on caring behaviors and patient safety during triage encounter.

The relationship between nurses' moral competency and missed nursing care: a descriptive-correlational study

BACKGROUND

When any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections, increased mortality rates, and poor prognosis. Moral competence is crucial for clinical nurses as it guarantees high-quality patient care in nursing practice. Thus, this study aimed to investigate the correlation between moral competencies and MNC among nurses.

METHODS

This study was conducted with a descriptive-correlational design. The participants in the study were nurses who were currently enrolled at Shahid Beheshti University of Medical Sciences. In order to recruit nurses for the study, a convenience sampling method was implemented. The study tools were completed by a total of two hundred nurses. Research tools included a demographic questionnaire, the Moral Competence of Clinical Nurses Questionnaire, and the Kalisch and Williams Missed Nursing Care (MISSCARE) survey.

ETHICAL CONSIDERATION

This study was approved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences.

RESULTS

The mean scores of moral competencies and MNC were 151.83 ± 12.60 and 42.71 ± 9.38, respectively. In other words, descriptive statistics showed that the moral competence score was more than 75%, and the MNC score was less than 50%. Also, there was a significant negative correlation between the total scores of moral competencies and MNC (r = -0.38, p < 0.001), indicating that more moral competence was correlated with lower levels of MNC.

CONCLUSION

The study revealed a negative correlation between nurses' moral competence and MNC, suggesting that enhancing moral competence could reduce MNC. To reduce MNC occurrences, hospitals, and organizations should prioritize moral competency, according to our research.

Translating Person-Centered Care Policy Into Practice: A Pre-Post Study of a Work-Based Learning Intervention for Nurses

BACKGROUND

Person-centered care is critical to quality health care, but difficult to implement. This challenge is attributed to cultural factors derived from group values about work practices. Work-based educational interventions allow nurses to develop shared meanings of practice, in this case, promoting the value of person-centered care.

METHOD

A 30-minute, work-based educational intervention incorporating reflection on videorecorded practice scenarios was evaluated with a quasi-experimental pre-post design. Nurses (N = 119) completed a survey, including a subset of 16 items from the Person-Centred Practice Inventory-Staff, before and immediately after the intervention.

RESULTS

Nurses' awareness of what patients value about their care, the importance of connecting with the patient, and the value of integrating human elements into actions increased after the intervention. Nurses' perceptions of how they would include patients and their preferences in care decisions did not significantly change.

CONCLUSION

Educational techniques that allow nursing teams to reflect on practice may help with implementation of person-centered care. [J Contin Educ Nurs. 2024;55(6):303-308.].

Missed nursing care and its relationship with nurses' moral sensitivity: a descriptive-analytical study

BACKGROUND

Missed care rates are an indicator of healthcare quality. Missed nursing care can reduce patient safety and lead to adverse events. Moral sensitivity enables nurses to interpret and respond to clients' needs according to ethical principles. Despite the importance of moral sensitivity and its role in the quality of care, the relationship between nurses' moral sensitivity and missed nursing care has not been extensively studied. This raises the question of whether there is an association between nurses' moral sensitivity and missed care. This study was conducted to investigate the relationship between nurses' moral sensitivity and missed nursing care in the medical and surgical departments of Imam Khomeini Hospital in Urmia, Iran.

METHODS

A cross-sectional study was conducted in 2022, on 202 nurses working in the medical and surgical departments of Imam Khomeini Medical Education Center, Urmia, Iran. Stratified random sampling was used to select the participants. A questionnaire on demographic characteristics, Kalisch's missed care questionnaire, and Lutzen's moral sensitivity questionnaire were used to collect data. Data were analyzed using the Pearson correlation test and linear regression analysis.

RESULTS

Most participants (52.97%) showed moderate moral sensitivity. Nurses' mean moral sensitivity and total missed care scores were 149.07 ± 21.60 and 59.45 ± 4.87, respectively. Pearson correlation test showed no significant correlation between moral sensitivity scores and the total missed care scores (r = 0.041, p = 0.152). However, in the regression analysis, moral sensitivity (β = 0.213, p < 0.001), age (β = 0.131, p < 0.001), working in rotating shifts (β = 0.183, p < 0.001), monthly income (β = 0.079, p = 0.004), work experience (β = 0.030, p = 0.010), and monthly work hours (β = 0.247, p = 0.010) influenced missed care. Approximately, 0.98% of the variance in the missed care was explained by these variables.

CONCLUSION

Our nurses reported moderate levels of moral sensitivity and a concerning level of missed care. Missed care can have detrimental effects on patient safety. Therefore, nursing managers must address this issue promptly.

Nurses' adherence to patient safety protocols and its relationship with adverse patient events

INTRODUCTION

Ensuring patient safety is a critical component of healthcare delivery, and nurses play a vital role in adhering to patient safety protocols to prevent adverse events. However, studies linking nurses' adherence to these protocols with patient outcomes is scarce. This study has two-fold purposes: (1) to examine determinants of nurses' adherence to patient safety protocols, and (2) to investigate the relationship between nurses' adherence to patient safety protocols and adverse patient events.

DESIGN

A cross-sectional design.

METHODS

A total of 343 clinical nurses from five hospitals in the Philippines were included in this study. Two standardized scales were used to collect data, including the Patient Safety Adherence Scale and the Adverse Patient Events Scale. Data collection took place from April 2022 to August 2022.

RESULTS

Adherence to patient safety protocols was generally moderate to high (M = 4.483), while nurse-reported adverse events occurred at a lower frequency (M = 1.150). Lower adherence rates were identified in areas such as reporting safety errors (M = 3.950), conducting fall risk assessments (M = 4.299), and adhering to pressure ulcer prevention guidelines (M = 3.979). Patients' and their families' complaints (M = 2.129) and abuses (M = 1.475) were the most frequently reported adverse events. Increased adherence to safety protocols was associated with higher reporting of adverse patient events (β = 0.115, p < 0.001).

CONCLUSION

Higher adherence to patient safety protocols resulted in an increased reporting of adverse patient events. The factors identified that contributed to nurses' adherence to patient safety protocols can be utilized in the development of strategies aimed at improving compliance, especially in areas where adherence is currently low.

CLINICAL RELEVANCE

Healthcare organizations should prioritize efforts to enhance adherence to patient safety protocols, particularly in areas with lower compliance rates, through relevant trainings, resource provision, and support systems. Promoting a culture of open communication and reporting can significantly contribute to reducing adverse events and improving patient safety.

Emergency room nurses' caring ability and its relationship with patient safety outcomes: A cross-sectional study

INTRODUCTION

Nurse caring ability plays a crucial role in providing quality care and ensuring patient safety. However, further research is warranted to understand the specific impact of caring ability on patient safety in the emergency department.

AIM

This study has two-fold purposes: (a) to examine the association between nurses' demographic characteristics and their perceptions of their caring ability, and (b) to explore the relationship between nurses' caring ability and nursing care quality, as well as its impact on adverse patient events and missed care.

METHODS

This cross-sectional study included a convenience sample of emergency room nurses working in select hospitals in the Philippines. Descriptive statistics and regression analyses were performed to analyze the data.

RESULTS

A total of 164 out of the 200 emergency nurses invited responded to the survey. The mean score for the caring ability inventory was 67.89 out of 80. Nurses' demographic characteristics, including job status (working part-time) and hospital size (working in small and medium-sized hospitals), were associated with higher levels of caring ability. Higher levels of nurses' caring ability were associated with better nursing care quality (β = 0.259, p <.001), a reduction in adverse events (β = -0.169, p <.05), and a decrease in instances of missed care (β = -0.158, p <.01).

CONCLUSION

This study emphasizes the significance of nurses' characteristics in influencing nurse caring abilities. Additionally, the results underscore the importance of nurse caring ability in the emergency department and its association with nursing care quality and patient safety outcomes. Organizational strategies directed toward promoting and enhancing nurse caring ability in the emergency department can have positive implications for nursing practice, including improved nursing care quality, reduced adverse events, and decreased instances of missed care.

Reality shock in newly graduated critical care nurses and its association with missed nursing care: The mediating role of caring ability

OBJECTIVES

This study is a report assessing the intermediary role of caring ability in the association between reality shock in newly graduated nurses and missed nursing care.

RESEARCH METHODOLOGY/DESIGN

This descriptive study involved 286 newly graduated nurses working in various critical care units. Three standardized scales were used to collect data, including the Missed Nursing Care Scale, the Environmental Reality Shock-Related Issues and Concerns (ERS-RIC) Scale, and the Caring Ability Inventory (CAI). The Hayes' PROCESS macro in SPSS (Model 4) was utilized to perform mediation testing. The data was collected from March 2022 to July 2022.

SETTING

Critical care units in seven Philippine hospitals.

RESULTS

Newly graduated critical care nurses reported moderate levels of reality shock (mean = 50.31). Reality shock was directly associated with missed nursing care (β = 0.0493, p = 0.0066). Caring ability partially mediated the association between reality shock and missed nursing care through caring ability (β = 0.0042, SE = 0.0027).

CONCLUSIONS

Newly graduated critical care nurses experience reality shock during the initial two years of employment. Reality shock diminishes the caring abilities of the newly graduated nurses, leading to a higher incidence of missed nursing care.

IMPLICATIONS FOR CLINICAL PRACTICE

Institutional strategies aimed at facilitating a smooth transition for newly graduated nurses should be prioritized to prevent a decline in their caring abilities and ultimately reduce compromises in nursing care.

How nursing practice environments limit implicit rationing of care and nurse-assessed adverse events: the role of flow at work

BACKGROUND

The nursing practice environment is beneficial in curbing implicit rationing of nursing care and adverse patient events. However, the underlying mechanisms of these relationships remain unexplored.

AIM

To test whether flow at work mediates the relationship between the nursing practice environment, implicit rationing of nursing care, and nurse-assessed adverse patient events.

METHODS

This cross-sectional study involved 231 nurses from five hospitals in Port Said, Egypt. The participants completed Arabic-translated versions of the Practice Environment Scale of the Nursing Work Index, the Work-Related Flow Inventory, the Perceived Implicit Rationing of Nursing Care instrument, and the Adverse Patient Events scale. Structural equation modeling was used to test the hypothetical model.

RESULTS

The favorable nursing practice environment positively predicted nurses' flow at work (β = 0.64, p < 0.001), while inversely predicting implicit rationing of nursing care (β = -0.23, p = 0.014) and adverse patient events (β = -0.35, p < 0.001). Nurses' flow at work inversely predicted implicit rationing of nursing care (β = -0.30, p = 0.002) and adverse patient events (β = -0.29, p = 0.002). Moreover, nurses' flow at work acted as a mediator, linking the nursing practice environment to the rationing of nursing care and adverse patient events, with 500 bootstrap results for the indirect effects (β = -0.24, p = 0.001, 95% CI: -0.43 to -0.09; and β = -0.44, p = 0.003, 95% CI: -0.79 to -0.16, respectively).

CONCLUSION

Nurses working in a favorable nursing practice environment are more likely to experience flow at work, limiting implicit rationing of nursing care and adverse patient events.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing administrators should strive to create a healthy nursing practice environment to foster nurses' flow and thereby reduce the frequency of implicit rationing of nursing care and adverse patient events.

When and how does the practice environment most benefit the job outcomes of newly graduated nurses?

BACKGROUND

Providing a favourable practice environment has been regarded as an essential to improve the job outcomes of newly graduated nurses (NGNs). However, little is known about how and when NGNs can best utilize their practice environment to produce optimal job outcomes.

AIM

The aim of this study, which is based on the Conservation of Resources Theory and the Social Cognitive Model of Career Self-Management, is to investigate whether NGNs who have a higher level of personal growth initiative are more likely to benefit from their practice environment and achieve better job outcomes by increasing their occupational self-efficacy.

DESIGN

A cross-sectional study.

METHODS

From 1 September 2022, to 30 September 2022, 279 NGNs from five Chinese state-owned hospitals were recruited for this study. The participants completed measures of practice environment, personal growth initiative, occupational self-efficacy, job stress, job satisfaction, turnover intention and quality of care. A descriptive analysis and a moderated mediation model were computed. Reporting adhered to the STROBE statement.

RESULTS

The influence of the practice environment on job outcomes was significantly mediated by occupational self-efficacy, with personal growth initiative acting as a moderator of this mediation effect.

CONCLUSIONS

NGNs who exhibited a higher degree of personal growth initiative were more likely to derive benefits from their practice environment and attain positive job outcomes by enhancing their occupational self-efficacy. To boost NGNs' occupational self-efficacy and achieve optimal job outcomes, hospital administrators may not only provide a supportive practice environment for them but also conduct interventions that promote their personal growth initiative.

NO PATIENT OR PUBLIC CONTRIBUTION

This study was designed to examine the psychosocial factors associated with NGNs' job outcomes. The study was not conducted using suggestions from the patient groups or the public.

IMPACTS

Our findings indicate that favourable practise contexts may not always benefit the nursing job outcome if NGNs do not exhibit a high level of personal growth initiative and produce increased occupational self-efficacy. Therefore, hospital administrators should consider implementing an intervention to improve the personal growth initiative of NGNs so that they can take full advantage of the practice environment and gain resources at work to create optimal job outcomes.

Verbal violence and missed nursing care: A phenomenological study

AIM

To define the missed care experiences of nurses exposed to verbal violence from patients.

BACKGROUND

Verbal violence takes the first place among the types of violence that nurses face in healthcare settings. This can cause negative emotional and physical responses in nurses and issues in patient and nurse interaction. As a result, it may lead to missed nursing care, defined as skipped, postponed or incomplete care during the patient's care.

METHODS

This is a phenomenological study. The study sample included 16 nurses working in inpatient clinics who reported experiencing verbal violence at least once in Turkey. The study was conducted between January and February 2022 with institutional permission and ethics committee approval (09/12/2021-2021/357). A semi-structured interview method was used to collect data. The information gathered from the interviews underwent thematic analysis using an inductive approach. The 'Consolidated Criteria for Reporting Qualitative Research (COREQ)' was used to report this qualitative study based on a comprehensive protocol.

RESULTS

The types of verbal violence most frequently faced by nurses were determined as swearing, insulting, shouting and threats. Study findings were classified into three main themes: (i) response to verbal violence, (ii) missed nursing care experiences and (iii) suggestions to cope with verbal violence. The most felt emotions in the face of verbal violence were feeling sad, unsafe and worthless. Nurses common behaviours, in response to verbal abuse were ignoring, getting used to, and wishing to get away. The examples of missed care included using non-therapeutic communication, postponing care or withdrawing from care.

CONCLUSION

Verbal violence caused negative emotional and behavioural responses in nurses, which, in turn, negatively affected the nurse-patient interaction. These findings mean that verbal violence may pave the way for missed nursing care.

IMPLICATIONS FOR NURSING POLICY

According to these findings, an uninterrupted nursing care process needs to focus on preventive measures against verbal violence and increase the administrative and legal support offered to nurses.

The mediating role of psychological capital on the relationship between authentic leadership and nurses' caring behavior: a cross-sectional study

BACKGROUND

Caring behavior among nurses would have an impact on patient outcomes. External organizational job resources and personal internal psychological resources are correlated to nurses' caring behavior. Authentic leadership and psychological capital were shown to be correlated with nurses' caring behavior in previous studies. However, the relationships among the three are nevertheless unclear. This study aimed to examine if psychological capital could act as a mediator between nursing managers' authentic leadership and nurses' caring behavior.

METHODS

In December 2021, a total of 3,662 nurses were recruited from 37 hospitals in Anhui Province, China. They filled out online surveys, including general demographic information, the Authentic Leadership Questionnaire, the Psychological Capital Questionnaire, and the Caring Behavior Inventory. Structural Equation Modeling and the bootstrapping procedure were used to examine the mediating role of psychological capital.

RESULTS

The scores of authentic leadership, psychological capital, and caring behavior of 3,495 nurses were 52.04 ± 13.24, 96.89 ± 17.78, and 104.28 ± 17.01, respectively. Psychological capital significantly mediated the relationship between authentic leadership and nurses' caring behavior (β = 0.378, p < 0.001, 95% confidence interval: 0.350 ~ 0.402), which made up 78.75% of the total impact (0.480).

CONCLUSION

The findings of this study suggested that nursing managers should develop an authentic leadership style, which can effectively improve nurses' caring behaviors toward patients in clinical practice. Meanwhile, nursing leaders should strengthen nurses' psychological evaluation and training, and promote nurses' caring behavior in clinical settings.

Development and Validation of the Missed Nursing Care Tool for Pre-Operative Patients with Lung Cancer in China

Introduction

Current research suggests that missed nursing care is widespread in preoperative lung cancer patients in China, and preoperative airway management nursing care for lung cancer patients is not standardized. Missed nursing care for preoperative lung cancer patients, on the other hand, is rarely investigated, particularly from the patient's perspective. This study aimed to develop and validate the MISSCARE Survey for pre-operative patients with lung cancer in China.

Methods

This study generated the preliminary draft of the MISSCARE Survey - Lung Cancer Patient (MS-LCP) and tested its reliability and stability through three rounds of lung cancer resection (494, 50, and 309 cases, respectively). 20 patients and 6 experts determined the face and content validity. EFA and CFA assessed construct and convergent validity. Internal consistency, including Cronbach's alpha, Spearman-Brown reliability, and re-test reliability, was also examined.

Results

The scale contained 15 items, including specific care, communicative care, timely care, and basic care. KMO was 0.932 (> 0.6), and Bartlett's Test of Sphericity showed P = 0.000 (<0.05). The attribution factor's item loads ranged from 0.765 to 0.853, accounting for 82.20% of the variation. The scale's Cronbach's alpha, Spearman-Brown, and retest reliability were 0.945, 0.879, and 0.824. CFA showed goodness of fit (RMSEA = 0.021, χ²/df = 1.138, GFI = 0.900, AGFI = 0.945, CFI = 0.996, NFI = 0.967, IFI = 0.996). For each dimension, AVE ranged from 0.555 to 0.717 (>0.50) and CR from 0.861 to 0.904 (>0.70).

Conclusion

The MS-LCP was reliable and valid in this study, making it appropriate for the Chinese lung cancer patient population. This tool is more objective in its presentation of missed nursing care, assisting nursing staff in optimizing nursing procedures before surgery, increasing the implementation of higher-quality tumor care, and promoting the recovery of lung cancer surgery patients.

Gender similarities and differences in the perception of caring among nurses during the COVID-19 pandemic: a mixed-methods study

BACKGROUND

Caring is the essence and core of nursing. Current studies on the effect of gender on nurses' perception of caring have been inconsistent. Most of these studies were quantitative and conducted before the COVID-19 pandemic. The study aimed to explore the gender similarities and differences in nurses' perception of caring during the COVID-19 pandemic.

METHODS

In 2020, a cross-sectional mixed-method study was conducted in 11 cities in China using structured online questionnaire (n = 8030) and face-to-face individual interview (n = 42). Data collection tools included the Caring Dimensions Inventory and semi-structured interview.

RESULTS

In stepwise multivariable linear regression analysis, female nurses scored 1.93 points higher on caring than male nurses, after completely controlling for the other factors. The interview results showed that both male and female nurses agreed that caring was to deal with three kinds of relationships, namely nurses and people, nurses and themselves, nurses and society. There were gender differences in the connotation of caring between nurses and themselves, but not in the connotations of caring between other relationships. The ranking of the importance of caring connotations among these relationships showed no gender difference except between nurses and themselves.

CONCLUSION

The quantitative findings suggest that gender influences nurses' perception of caring. The qualitative findings demonstrate that nurses regard themselves as both recipients and implementers of caring. The qualitative results indicate nurses of different genders have similarities and differences in their perception of caring, and the biggest difference lies in the relationship between nurses and themselves.

Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review

BACKGROUND

Missed nursing care undermines nursing standards of care and minimising this phenomenon is crucial to maintaining adequate patient safety and the quality of patient care. The concept is a neglected aspect of human resource for health thinking, and it remains understudied in low-income and middle-income country (LMIC) settings which have 90% of the global nursing workforce shortages. Our objective in this review was to document the prevalence of missed nursing care in LMIC, identify the categories of nursing care that are most missed and summarise the reasons for this.

METHODS

We conducted a systematic review searching Medline, Embase, Global Health, WHO Global index medicus and CINAHL from their inception up until August 2021. Publications were included if they were conducted in an LMIC and reported on any combination of categories, reasons and factors associated with missed nursing care within in-patient settings. We assessed the quality of studies using the Newcastle Ottawa Scale.

RESULTS

Thirty-one studies met our inclusion criteria. These studies were mainly cross-sectional, from upper middle-income settings and mostly relied on nurses' self-report of missed nursing care. The measurement tools used, and their reporting were inconsistent across the literature. Nursing care most frequently missed were non-clinical nursing activities including those of comfort and communication. Inadequate personnel numbers were the most important reasons given for missed care.

CONCLUSIONS

Missed nursing care is reported for all key nursing task areas threatening care quality and safety. Data suggest nurses prioritise technical activities with more non-clinical activities missed, this undermines holistic nursing care. Improving staffing levels seems a key intervention potentially including sharing of less skilled activities. More research on missed nursing care and interventions to tackle it to improve quality and safety is needed in LMIC. PROSPERO registration number: CRD42021286897.

What are the reasons for unfinished nursing care as perceived by hospitalized patients? Findings from a qualitative study

INTRODUCTION

Unfinished nursing care (UNC), as the care required by patients that delayed or not delivered, has been investigated mainly from the perspective of nurses, while little is still known from the side of patients. Some studies have involved patients to measure which elements of care are mostly unfinished (e.g., mouth care), whereas a few studies have investigated the reasons for UNC as perceived by them. Their involvement in understanding the reasons for UNC is crucial to advance the knowledge and co-develop possible strategies to prevent or minimize UNC.

METHODS

This is a descriptive qualitative study performed according to COnsolidated criteria for REporting Qualitative research guidelines in 2022. A purposeful sample of Italian hospitalized patients in two medical and two surgical units was involved. A face-to-face semistructured interview was used to merge reasons for UNC. Qualitative content analysis was conducted to merge subthemes and themes as factors leading to UNC according to the experience of patients.

RESULTS

A total of 23 patients (12 surgical and 11 medical) were involved (12/23 male) with an age average of 66.2 years, educated mainly at secondary school, and with previous hospitalizations (20/23), and dependent on nursing care in daily activities (14/23). Reasons for UNC have been identified at four levels: (1) 'New health-care system priorities' and 'Pre-existing frailty of health-care facilities' were reasons identified at the health-care system level; (2) 'Lack of resources attributed to wards', 'Ineffective ward organization' and 'Leadership' were identified at the unit level; (3) 'Nurses' attitudes and behaviour' were reported at the nurses' level and (4) 'Increased nursing care expectations' were pinpointed at the patient level.

CONCLUSION

Patients can be involved in identifying UNC, but also in recognizing the underlying reasons. Engaging them in such investigations might broaden our understanding of the phenomenon and the possibility of identifying strategies to minimize and prevent UNC.

PATIENT OR PUBLIC CONTRIBUTION

Patients from four hospital units (two medical and two surgical) were involved in face-to-face interviews to merge the reasons perceived by them as triggering UNC. All factors (as themes and subthemes) have derived from their words, thus enhancing the evidence available from the side of the patients.

Organizational citizenship behaviour as a protective factor against the occurrence of adverse nursing-sensitive outcomes: A multilevel investigation

AIMS

This study aimed to investigate the association between organizational citizenship behaviour enacted by nurses and the occurrence of adverse nursing-sensitive patient outcomes.

BACKGROUND

Managing psychosocial factors (i.e., aspects concerning the work environment) is key to ensure patient safety, to prevent exacerbation of case complexity and to cope with critical shortages in human and financial resources.

METHODS

Self-report measures of nurses' organizational citizenship behaviour were combined with objective data on the incidence of adverse nursing-sensitive outcomes (i.e., pressure ulcers and restraint use) collected through patients' medical records. Participants were 11,345 patients and 1346 nurses across 52 teams working in 14 Italian hospitals. Data were analysed using multilevel binary logistic regression models.

RESULTS

A negative relationship between nurses' organizational citizenship behaviour and restraint use was identified, with an odds ratio of 0.11. Thus, for a one-unit higher organizational citizenship behaviour score, the odds of using restraints shrink to about one eighth of the previous level.

CONCLUSIONS

Intervention strategies to foster the implementation of organizational citizenship behaviour among nurses may inhibit the occurrence of critical outcomes affecting patients' health and well-being (i.e., using restraint devices).

IMPLICATIONS FOR NURSING MANAGEMENT

In health care organizations, shaping a psychosocial environment encouraging organizational citizenship behaviour can mitigate the occurrence of adverse nursing-sensitive outcomes such as restraint use on patients.

Safety culture and adverse event reporting in Ghanaian healthcare facilities: Implications for patient safety

INTRODUCTION

Recognizing the values and norms significant to healthcare organizations (Safety Culture) are the prerequisites for safety and quality care. Understanding the safety culture is essential for improving undesirable workforce attitudes and behaviours such as lack of adverse event reporting. The study assessed the frequency of adverse event reporting, the patient safety culture determinants of the adverse event reporting, and the implications for Ghanaian healthcare facilities.

METHODS

The study employed a multi-centre cross-sectional survey on 1651 health professionals in 13 healthcare facilities in Ghana using the Survey on Patient Safety (SOPS) Culture, Hospital Survey questionnaire. Analyses included descriptive, Spearman Rho correlation, one-way ANOVA, and a Binary logistic regression model.

RESULTS

The majority of health professionals had at least reported adverse events in the past 12 months across all 13 healthcare facilities. Teamwork (Mean: 4.18, SD: 0.566) and response to errors (Mean: 3.40, SD: 0.742) were the satisfactory patient safety culture. The patient safety culture dimensions were statistically significant (χ2 (9, N = 1642) = 69.28, p < .001) in distinguishing between participants who frequently reported adverse events and otherwise.

CONCLUSION

Promoting an effective patient safety culture is the ultimate way to overcome the challenges of adverse event reporting, and this can effectively be dealt with by developing policies to regulate the incidence and reporting of adverse events. The quality of healthcare and patient safety can also be enhanced when healthcare managers dedicate adequate support and resources to ensure teamwork, effective communication, and blame-free culture.

Determinants of missed nursing care in Jordanian hospitals during COVID-19 pandemic

AIM

The aim of the study was to examine the effect of perceived organizational support, accountability and nurses' characteristics on missed nursing care under the impact of COVID-19.

DESIGN

A cross-sectional design was used to describe and predict nurses' characteristics.

METHODS

A sample of 536 Registered Nurses participated in the study from eight hospitals in different health sectors in Jordan (three public hospitals, three private hospitals and two teaching hospitals).

RESULTS

Communication problems had the highest impact on missed nursing care, compared with labour resources and material resources reasons. Higher patient: nurse ratio aggravated by COVID-19 pandemic, years of experience, satisfaction with the income, perception of accountability and organizational support were among the factors associated with the levels of missed nursing care.

Workload and quality of nursing care: the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion by using structural equations modeling approach

Background

Nursing workload and its effects on the quality of nursing care is a major concern for nurse managers. Factors which mediate the relationship between workload and the quality of nursing care have not been extensively studied. This study aimed to investigate the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion in the relationship between workload and quality of nursing care.

Methods

In this cross-sectional study, 311 nurses from four different hospitals in center of Iran were selected by convenience sampling method. Six self-reported questionnaires were completed by the nurses. The data were analyzed by SPSS version 16. Structural equation modeling was used to determine the relationships between the components using Stata 14 software.

Results

Except direct and mutual relationship between workload and quality of nursing care (P ≥ 0.05), the relationship between other variables was statistically significant (P < 0.05). The hypothesized model fitted the empirical data and confirmed the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion in the relationship between workload and the quality of nursing care (TLI, CFI > 0.9 and RMSEA < 0.08 and χ²/df < 3).

Conclusion

Workload affects the quality of the provided nursing care by affecting implicit rationing of nursing care, job satisfaction and emotional exhaustion. Nurse managers need to acknowledge the importance of quality of nursing care and its related factors. Regular supervision of these factors and provision of best related strategies, will ultimately lead to improve the quality of nursing care.

The Patient Care Experience as Perceived by Hispanic Patients With Chronic Illness Undergoing Transplant: A Grounded Theory

Hispanics are one of the largest-growing minorities, yet little is understood of the patient experience from their perspective. Patient experience is the current federally mandated hospital quality indicator that is measured via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Minority representation in the HCAHPS survey development however was not robust. This study used a constructivist grounded theory method to explore how English- and Spanish-speaking Hispanic patients seeking kidney and liver transplant care at a safety-net hospital perceive and interpret the care experience. A grounded theory process model emerged finding comfort, communication, connection, and care to be interdependent factors crucial for a positive hospital admission. Furthermore, "cultural context" was found to influence perception of each of these concepts. This research provides key insights into how Hispanics may perceive their needs when seeking care. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A50 .

Nursing competency inventory and professional competence of graduating students in six Asian countries: A cross-sectional study

AIMS

To investigate graduating nursing students' nursing and professional competencies and the predictors of their competencies.

BACKGROUND

Across Asian countries, there is a paucity of literature that explores graduating nursing students' competency and professional competence during the ongoing COVID-19 pandemic.

DESIGN

Descriptive, cross-sectional, and predictive approaches.

METHOD

Convenience sampling was used among graduating nursing students from the six Asian countries (n = 375). The STROBE guidelines for cross-sectional studies were used. Two self-report instruments were utilized to collect data. We conducted multiple linear regression analyses to assess the predictors of nursing competency and professional competence domains.

RESULTS

Country of residence and general point average (GPA) showed statistically significant multivariate effects. Value-based nursing care and critical thinking and reasoning domains recorded the highest in professional competence and competency inventory for nursing students, respectively. Country of residence, GPA, and preferred nursing major were significant predictors of graduating nursing students' nursing competency and professional competence domains.

CONCLUSION

Our study's findings revealed a high level of diversity among nursing students regarding ethical care obligations, caring pedagogies, and lifelong learning, all of which may be ascribed to their distinct culture, background, and belief systems.

The Factor Associated with Missed Nursing Care in Hospital: A Systematic Review

Background:  Patient safety is a major concern in the healthcare industry worldwide. Increasing patient safety is critical for avoiding negative outcomes in nursing care and achieving goals at the desired level of quality. One of the indicators of this quality care given to patient is known as missed care. Aim: Aims of this study to explore the factors influencing missed care in order to improve the quality of nursing care. Methods: This study is a systematic review that explores the factors influencing missed nursing care in hospitals. Meanwhile, the literature search was carried out in the CINAHL Pubmed, Ebsco, Science Direct, Proquest, Willey, Sage from 2017 to 2021. Results: The results from six databases (n=3702) were sorted into 22 collected articles which include 18 quantitative, 2 qualitative, and 2 mixed methods. These findings highlighted three factors that influence missed nursing care: a lack of staffing, nurse competency, and the working environment. Conclusion: The factors that  contribute with missed nursing care in hospitals include lack of nurse staff, competency, and work environment. As a result, the nursing manager's critical role is to create adequate nursing staff, improve their competency, and foster a positive work environment. Keywords: missed nursing care, lack of staffing, nurse competency,  working environment

Missed nursing care in highly specialized hospitals: A Mexican case study

OBJECTIVE

To assess the status of missed nursing care and the reasons for its occurrence in a highly specialised public hospital in Mexico.

MATERIALS AND METHODS

An observational cross-sectional analysis with data collected from January to June 2019 at the National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra in Mexico City. We assessed missed care and its causes by conducting the MISSCARE survey among 116 nursing professionals selected from a population of 162 nurses. This work presents the estimated rates of missed care-overall and broken down into its four dimensions-as well as the reasons for its occurrence, namely limited labour resources, inadequate material resources and communication problems among work teams.

RESULTS

The overall score for missed care was 16% (95% CI: 11.84%-20.15%), with the following rates by dimension: 19.48% for basic care, 14.66% for individual needs, 6.47% for patient education and discharge planning, and 4.31% for continuous patient assessment. The main reason cited for missed care was inadequate material resources, followed by limited labour resources and communication problems among work teams.

CONCLUSION

Basic care and individual needs interventions were the most frequently omitted services, primarily because of inadequate material resources, limited labour resources and communication problems among work teams. An increase in the frequency of missed care can be expected in light of the high demand for health services, particularly as regards labour and material resources, imposed by the SARS-CoV-2 pandemic.

The presence of missed care: a staff development response

AIMS

This study quantifies the types and frequencies of missed care identified by nurses and measures its impact on their capacity to demonstrate mandatory practice standards as future hospital staff.

BACKGROUND

Considerable literature exists as to the nature of missed care but there is a paucity of findings about how missed care impacts on learning firstly as a student and then as a graduate nurse employed in a hospital setting. Additionally, there is little emphasis as to how staff development for nurses exposed to missed care may be implemented METHODS: A non-experimental research design using self-audit data was selected to collect information about the types and frequencies of missed care from nurses engaging in clinical experience. A convenience sample of 471 nursing students completing their undergraduate nursing degree program. A multi-variate statistical approach was used to apply and then model the consensus scores of undergraduate nurses' beliefs about the frequency of missed care. Implications for their developing competence in critical thinking, therapeutic communication and maintaining capacity for professional practice has been considered.

RESULTS

Eight variables directly affect student's total scores underpinning their understanding of missed care and their ability to meet professional standards of practice, given their exposure to care omission. These factors reflect differing nurse attributes, the nature of the clinical venues and shift times, preceptor type, student satisfaction with work teams and staffing adequacy.

CONCLUSIONS

Modeling outcomes suggest possible changes to hospital staff development learning program content, learning processes and how it may be better delivered through to minimise episodes of missed care.

Antecedents of unfinished nursing care: a systematic review of the literature

BACKGROUND

Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date.

METHODS

A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach.

RESULTS

Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability).

CONCLUSIONS

At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.

Causes of Missed Nursing Care During COVID-19 Pandemic: A Qualitative Study in Iran

Background

The unpredictable and variable nature of COVID-19 and the lack of healthcare resources has led to inadequate care for patients. This study aimed to explain the causes of missed nursing care during the COVID-19 pandemic from the perspective of Iranian nurses.

Method

This qualitative study was conducted using semi-structured interviews with 14 nurses caring for patients with COVID-19 in three hospitals in Iran. Sampling was performed by the purposive method. Data were analyzed using the conventional content analysis method. The interviews were first recorded and transcribed, and then the data were analyzed using the Elo and Kyngas method. Data management was done with MAXQDA software version 10. To achieve trustworthiness, the criteria presented by Lincoln and Guba were used.

Findings

A total of 14 nurses participated in the study. The mean age of participants was 31.85 ± 4.95 years, and the mean number of years of work experience was 7.71 ± 4.44. Eleven participants were women. Among all participants, nine had a bachelor's degree and five had a master's degree. Four nurses had fixed shifts, while ten nurses had rotating shifts. The causes of missed nursing care were categorized into 4 groups. The category “unfulfilled care” comprised the reasons for forgetting care, neglecting care, arbitrary elimination of care, and compulsory elimination of care. The category of “care at improper time” consisted of interference of the care in patients' daily activities and interference with other healthcare providers' activities. The “incomplete cares” category comprised failure to complete the care period in hospital, interruption in care, and discontinuance of care after patient discharge. The last category, “incorrect care,” consisted of providing care regardless of the nursing process, providing care by unqualified professionals, and providing trial-and-error care.

Conclusion

This study illustrates an understanding of the causes of missed nursing care during the COVID-19 pandemic from the perspective of nurses. The increasing demand for care caused by the pandemic and problems in the work environment has led to the failure of nurses to provide complete, correct care and sometimes miss parts of care to patients. Therefore, nursing policymakers and managers should develop and implement appropriate care protocols and instructions to minimize missed nursing care.