Moral sensitivity and caring behavior in nursing interns: the mediating role of empathy

Background

The main purpose of this study is to analyze the relationship between moral sensitivity, empathy, and caring behaviors and to explore the mediating effect of empathy on moral sensitivity and caring behaviors of nursing interns.

Methods

A cross-sectional survey was conducted from August to September 2022 in which 261 nursing interns from two Grade 3A Hospitals in Xi'an participated. The questionnaires used in the survey include the General Information Questionnaire (GIQ), the Moral Sensitivity Questionnaire-Revised Version translated into Chinese (MSQ R-CV), the Chinese version of the Jefferson Empathy Scale (JSE), and the Chinese version of the Caring Behavior Inventory (C-CBI). The obtained data were analyzed through descriptive statistics, a one-way analysis of variance (ANOVA), and Pearson's correlation coefficient, and the mediating effect of empathy was tested through structural equations.

Results

The overall mean of moral sensitivity of nursing interns in two Grade 3A Hospitals in Xi'an is 40.84 ± 8.73, the overall mean of empathy is 100.51 ± 21.56, and the overall mean of caring behavior is (113.81 ± 21.05). Statistical analysis showed that there is a positive correlation between moral sensitivity and caring behavior of nursing interns (r = 0.376, p < 0.01), between their empathy and moral sensitivity (r = 0.336, p < 0.01), and between their empathy and caring behavior (r = 0.394, p < 0.01). The empathy of nursing interns has a mediated effect on the relationship between moral sensitivity and caring behavior. The mediated effect value was 0.14, accounting for 31.82% of the total effect.

Conclusion

The moral sensitivity of nursing interns can have a direct impact on predicting the caring behavior and indirect influences their caring behaviors mediated by empathy, with the latter effect being mediated by empathy. Therefore, nursing educators and hospital administrators should adopt targeted interventions to improve the moral sensitivity and empathy of nursing interns, which can further prove to be beneficial in improving their caring behaviors, leading to enhanced quality of nursing care and reduced nurse-patient conflicts and finally to a stabilized nursing team.

The effects of clinical learning environment and career adaptability on resilience: A mediating analysis based on a survey of nursing interns

BACKGROUND

The resilience education of intern nursing students has significant implications for the development and improvement of the nursing workforce. The clinical internship period is a critical time for enhancing resilience.

AIMS

To evaluate the resilience level of Chinese nursing interns and explore the effects of factors affecting resilience early in their careers, focusing on the mediating roles of career adaptability between clinical learning environment and resilience.

METHODS

The cross-sectional study design was adopted. From March 2022 to May 2023, 512 nursing interns in tertiary care hospitals were surveyed online with the Connor-Davidson Resilience Scale, the Clinical Learning Environment Scale for Nurse and the Career Adapt-Abilities Scale. Structural equation modelling was used to clarify the relationships among these factors. Indirect effects were tested using bootstrapped confidence intervals.

RESULTS

The nursing interns showed a moderately high level of resilience [M (SD) = 70.15 (19.90)]. Gender, scholastic attainment, scholarship, career adaptability and clinical learning environment were influencing factors of nursing interns' resilience. Male interns with good academic performance showed higher levels of resilience. Career adaptability and clinical learning environment positively and directly affected their resilience level (β = 0.62, 0.18, respectively, p < .01). Career adaptability was also positively affected by the clinical learning environment (β = 0.36, p < .01), and mediated the effect of clinical learning environment on resilience (β = 0.22, p < .01).

CONCLUSION

Clinical learning environment can positively affect the resilience level of nursing interns. Career adaptability can affect resilience directly and also play a mediating role between clinical learning environment and resilience. Thus, promotion of career adaptability and clinical teaching environment should be the potential strategies for nursing interns to improve their resilience, especially for female nursing interns with low academic performance.

Evaluation and improvement of workplace vertical violence of nursing interns based on the Importance-Performance Analysis method

Purpose

To analyze the key factors related to workplace vertical violence among nursing interns in China and to propose strategies to improve the nursing practice environment.

Methods

A cross-sectional study was conducted using the Importance-Performance Analysis (IPA) method to analyze the key factors and significance of workplace vertical violence for nursing interns. The data were obtained by administering a workplace vertical violence survey, designed specifically for this study, to 120 nursing interns at a tertiary general hospital in Zhejiang Province, China.

Results

The results demonstrated that the variables "I was ordered to do something beyond my ability and lacked guidance (C3)," "Errors in work have been repeatedly emphasized, spread, or exaggerated (C8)," "I was unjustly criticized (C9)," "I was withheld or blocked information purposefully (C1)," and "I was belittled at work (C2)" were the most crucial variables for determining the presence of workplace vertical violence of nursing interns. Moreover, they are priority improvement variables.

Conclusion

Managers must prioritize the use of relevant resources during internships to minimize false reinforcement and unfair criticism. Efforts should focus on improving information sharing, emphasizing the role of nursing interns in clinical work, providing better guidance when arranging for nursing interns to do work that exceeds their capacity, reducing workplace vertical violence, and improving nursing intern practice environments.

Effect of online modified mindfulness-based stress reduction training on the resilience of nursing interns in China

AIM

This study aimed to adopt online mindfulness-based stress reduction (MBSR) training to increase the resilience of nursing interns and help them to achieve a smooth transition.

DESIGN

A one-group pretest-posttest study design was used.

METHODS

A total of 119 college nursing interns were recruited from 12 tertiary hospitals in Beijing on Feb.20, 2021. The MBSR training was organized into 4 weeks of courses, conducted online using Tencent Meeting and taught by a certified teacher at the Oxford Mindfulness Centre. Resilience was assessed before and 2 weeks after the training, respectively, using Resilience Scale for Chinese Adolescents via an online questionnaire tool.

RESULTS

Seventy-nine college nursing interns finished both of the resilience questionnaire surveys. The mean resilience values before and after the training were 98.7 ± 13.69 and 104.57 ± 16.64 respectively. The 4-week online MBSR training considerably increased the resilience of nursing interns. This can be an effective measure to maintain a balanced state among nursing interns and help them smoothly transition from school to clinical practice. No Patient or Public Contribution.

Psychological workplace violence and its influence on professional commitment among nursing interns in China: A multicenter cross-sectional study

Background

Psychological workplace violence (WPV) is the primary form of workplace violence suffered by nursing interns. Psychological WPV not only damages the physical and mental health of nursing interns, but also has a negative impact on their work quality and career choice.

Aim

To investigate the characteristics and types of psychological WPV suffered by nursing interns in China, analyze the influencing factors of psychological WPV among nursing interns, and explore the influence of psychological WPV on the professional commitment of nursing interns.

Methods

The subjects were 1,095 nursing interns from 14 medical colleges in Shandong Province. The data were collected electronically using the psychological WPV against nursing interns questionnaire and the professional commitment scale of nursing. The frequency and component ratio were used to describe the incidence and characteristics of psychological WPV. Binary logistic regression was used to analyze the influencing factors of psychological WPV, and linear regression investigated the influence of psychological WPV on the professional commitment of nursing interns.

Results

In the study, 45.0% (n = 493) of nursing interns suffered at least one incidence of psychological WPV during clinical practice, mainly discrimination and verbal abuse. Patients and their relatives were the main perpetrators of psychological WPV. Discrimination and lack of trust were the two main reasons behind psychological WPV. Furthermore, 75.9% of psychological WPV incidents were not effectively reported. Logistic regression showed that clinical internship duration, place of family residence, and hospital level were the influencing factors of psychological WPV among nursing interns. Linear regression results showed that psychological WPV had a negative effect on nursing interns' professional commitment.

Conclusion

Psychological WPV against nursing interns is highly prevalent in China, negatively impacting their professional commitment. It is suggested that colleges should introduce courses for nursing interns to understand and cope with psychological WPV before entering clinical practice, and hospitals should establish a mechanism to prevent, cope with, report, and deal with psychological WPV to effectively reduce the incidence of psychological WPV against nursing interns, improve their ability to cope with psychological WPV, and enhance their professional commitment.

Association between circadian rhythm and sleep quality among nursing interns: A latent profile and moderation analysis

BACKGROUND

Disturbances in circadian rhythms are common among night-shift workers and result in poor sleep quality. Nevertheless, the heterogeneity of circadian rhythms and their relationship with sleep quality is less explored in nursing interns. Therefore, we aimed to identify the latent subtypes of circadian rhythm, explore their relationship with sleep quality, and evaluate their moderating role between perceived stress and sleep quality in nursing interns.

MATERIALS AND METHODS

In all, 452 nursing interns were recruited between October 2020 and January 2021 from Be Resilient to Nursing Career (BRNC), which is a multicenter, prospective cohort of a career growth program for nursing students. They were assessed using the 10-item Chinese Perceived Stress Scale, Circadian Type Inventory, and Pittsburgh Sleep Quality Index. Latent profile analysis and moderation analysis were performed.

RESULTS

Overall, 72.3% of the nursing interns reported poor sleep quality. We identified three latent subtypes of circadian rhythms, namely, Vigorousness (40.1%), Inadaptability (18.6%), and Flexibility (41.1%). Females (OR = 1.97, 95% Cl: 1.01-3.83, P = 0.047) with normal body mass index (OR = 1.62, 95% CI: 0.95-2.76, P = 0.078) were prone to Flexibility. Circadian rhythm types significantly moderated the association between perceived stress and sleep quality (P < 0.05).

CONCLUSION

Nursing interns suffer from poor sleep. There exists heterogeneity of circadian rhythm subtypes in nursing interns, and attention should be paid to those with Inadaptability type. The association between perceived stress and sleep quality is significantly moderated by circadian rhythm subtypes.

Integrating sustainability development education program in nursing to challenge practice among nursing interns in health care

AIM

This study aimed to investigate the Integrating Sustainability Development Education Program in Nursing to Challenge Practice Among Nursing Interns in Health Care.

BACKGROUND

The combination of sustainable development and climate change in health care delivery benefits from the apparent environmental changes.

SUBJECTS AND METHODS

The quasi-experimental, cross-sectional, comparative study included 160 nursing interns who completed the intervention. Both genders were assigned to Saudi (N = 80) and Egyptian nursing interns (N = 80). Data was collected using a self-administered questionnaire, which included the Sustainability Consciousness Questionnaire and the Sustainability Attitudes in Nursing Survey.

RESULTS

A statistically significant difference was found between student nurses' knowledge, attitude and behaviour during pre-intervention and post-intervention, as well as in student nurses' sustainability development dimension effectiveness after than before program implementation.

CONCLUSION

The program had a significant effect on all sustainability development domains and a large effect on total sustainability development during post-intervention. This study recommended that educational programs can upgrade sustainability development and challenge practice levels.

IMPLICATIONS FOR NURSING MANAGEMENT

Sustainable development is the future of management and is the next phase of management innovation. Sustainability, in the context of health care, is about progress in high-quality patient care delivery for all by promoting the three elements of sustainable development: environmental, social and financial. Nurses play a significant leadership role in addressing environmental sustainability and climate change.

An assessment of the reliability and validity of the Chinese version of the Reporting of Clinical Adverse Events Scale for nursing interns: A cross-cultural adaptation of scales and online investigation

AIM

The Reporting of Clinical Adverse Events Scale is a tool for evaluating the attitudes of medical staff toward reporting adverse events in clinical practice. This study aimed to assess the reliability and validity of the Reporting of Clinical Adverse Events Scale translated into Chinese used with trainee nurses in mainland China.

DESIGN

The Chinese version of the Reporting of Clinical Adverse Events Scale was developed following guidelines for the cross-cultural adaptation of self-reporting measures.

METHODS

The reliability and validity of the Chinese version of the Reporting of Clinical Adverse Events Scale was tested on 773 nursing interns by online investigation. Confirmatory factor analysis was performed on 350 questionnaires completed by the participants while exploratory factor analysis was performed on 423 questionnaires to test the structural validity of the scale.

RESULTS

There were 23 items included in the Chinese version of the Reporting of Clinical Adverse Events Scale. The Cronbach's α-coefficient for the internal consistency of the total score was found to be 0.84 with a test-retest reliability value of 0.82, indicating a high level of reliability. Five common factors were extracted. The structural validity on the Kaiser-Meyer-Olkin test was 0.87 and the contribution rate of cumulative variance was 58.51%. The content validity values ranged between 0.86 and 1.00.

CONCLUSION

The Chinese version of the Reporting of Clinical Adverse Events Scale is a valid and reliable tool for evaluating nursing interns' attitudes toward reporting clinical adverse events in China. This validation of the Chinese version of the scale also extends the use of the scale to a different population.

TWEETABLE ABSTRACT

Nursing interns are responsible for a relatively high incidence of adverse events and their attitude to reporting these is crucial to patient safety. The Chinese version of the Reporting of Clinical Adverse Events Scale will be helpful for evaluating the reporting attitude of nursing interns.

Nursing Interns' Attitudes Toward, Preferences for, and Use of Diabetes Virtual Simulation Teaching Applications in China: National Web-Based Survey

BACKGROUND

Diabetes has placed heavy social and economic burdens on society and families worldwide. Insufficient knowledge and training of frontline medical staff, such as nurses, interns, and residents, may lead to an increase in acute and chronic complications among patients with diabetes. However, interns have insufficient knowledge about diabetes management. The factors that affect interns' current level of diabetes-related knowledge are still unclear. Therefore, understanding the behavioral intentions of interns is essential to supporting the development and promotion of the use of virtual simulation teaching applications.

OBJECTIVE

This study aimed to identify the determinants of nursing interns' intentions to use simulation-based education applications.

METHODS

From December 1, 2020, to February 28, 2021, the web-based survey tool Sojump (Changsha Xingxin Information Technology Co) was used to survey nursing interns in hospitals across China. Two survey links were sent to 37 partner schools in 23 major cities in China, and they were disseminated through participants' WeChat networks. Multiple regression analysis was used to determine the association between demographic information and basic disease information and the use of the application for treating adult patients.

RESULTS

Overall, 883 nursing interns from 23 provinces in China responded to the survey. Among them, the virtual simulation utilization rate was 35.6% (314/883) and the awareness rate was 10.2% (90/883). In addition, among the interns, only 10.2% (90/883) correctly understood the concept of virtual simulation, and most of them (793/883, 89.8%) believed that scenario-simulation training or the use of models for teaching are all the same. Multiple regression analysis showed that the educational level, independent learning ability, and professional identity of the interns were related to use of the application (P<.05). Skills and knowledge that the interns most wanted to acquire included the treatment of hypoglycemia (626/883, 70.9%), functional test simulation (610/883, 69.1%), and blood glucose monitoring technology (485/883, 54.9%). A total of 60.5% (534/883) of the interns wanted to acquire clinical thinking skills, while 16.0% (141/883) wanted to acquire operational skills. Nursing trainees believed that the greatest obstacles to virtual simulation included limited time (280/883, 31.7%), the degree of simulation (129/883, 14.6%), the demand for satisfaction (108/883, 12.2%), and test scores (66/883, 7.5%).

CONCLUSIONS

The understanding and usage rate of diabetes virtual simulation teaching applications by Chinese nursing interns is very low. However, they have high requirements regarding this teaching method. Conducting high-quality randomized controlled trials and designing applications that are suitable for the needs of different nurse trainees will increase students' interest in learning and help improve diabetes knowledge among nursing interns.

Prevalence of needlestick injuries among nursing interns: a systematic review and meta-analysis

BACKGROUND

The aim of the present study was to analyze the prevalence of needlestick injuries (NSI) of trainee nursing students and to understand the cause of injury and psychological reactions following injury, and take corresponding countermeasures to prevent adverse consequences.

METHODS

Multiple databases were used to search for articles related to NSI among nursing interns. The selected literature was retrospectively evaluated by using Review Manager version 5.2.

RESULTS

According to the analysis of 8 published studies, the lowest overall prevalence of NSI occupational exposure was 6% [95% confidence interval (CI): 3-9%], the highest was 51% (95% CI: 42-60%), and the total combined prevalence was 27% (95% CI: 18-37%). The overall prevalence rate of interns under 25 years old was 31% (95% CI: 7-69%), and that of interns over 25 years old was 26% (95% CI: 15-38%). The overall prevalence of interns was 38% (95% CI: 16-61%) in developing countries and 21% (95% CI: 11-31%) in developed countries. The overall prevalence of interns was 38% (95% CI: 16-61%) in Asian countries, 9% (95% CI: 3-15%) in the United States, and 30% (95% CI: 3-57%) in European countries.

DISCUSSION

The results showed that interns over 25 years of age were more likely to have NSI, and interns in developing countries were more likely to have NSI than those in developed countries. Interns in Asia were more likely to have NSI than interns in Europe, and the lowest incidence of NSI was among interns in the USA.

'Senior Nursing Students and Interns' Concerns and Willingness to Treat Patients with COVID-19: A Strategy to Expand National Nursing Workforce during the COVID-19 Pandemic

Background

The coronavirus disease of 2019 (COVID-19) pandemic has challenged the existing healthcare delivery systems worldwide and overwhelmed the globally short healthcare workforce, particularly nurses. Nurses are recognized as front-line responders to the COVID-19 pandemic and are crucial healthcare members to win the fight against the evolving COVID-19. Considering the long-lasting shortage of national nurses, and turnover of the current nursing workforce, it is essential to consider unconventional strategies aiming at expanding the national nursing workforce in order to embrace the impact of COVID-19.

Objective

This study aimed to measure senior nursing students and intern's willingness to treat patients with COVID-19. Further, this study investigated their feelings, knowledge, and concerns regarding treating patients with COVID-19.

Methods

This quantitative, cross-sectional study utilized self-reported survey gathered from a convenience sample of 178 senior nursing students and interns. A 7-item scale was used to measure the participants' willingness to treat patients with COVID-19. The data were collected between March 2020 and April 2020.

Results

Out of 178 participants, 50.56% were at Level 8, 89.33% were single, and 53.37% had a very satisfactory grade point average. The highest proportion of the respondents (38.20%) felt neutral about treating patient with COVID-19, while 53.93% had good knowledge about COVID-19. The perceived willingness to treat of participants had an overall mean score of 20.19, which indicated neutral willingness to treat patients with COVID-19. Participants' feelings about treating patients with COVID-19 predicted their willingness to treat patients with COVID-19 (P<0.001).

Conclusion/Recommendation

There is a clear need for educational and training programs both in clinical practice and academia for the improvement among nursing students and interns who reported paucity of knowledge about COVID-19. Furthermore, hospital institutions should provide additional incentives or hazard protections to maintain and even increase the number of staff at the frontline who are willing to care for patients amid the deadly pandemic of COVID-19.

Impact of tobacco control auxiliary resources on the 5As behavior in nursing interns: Self-reports from students

INTRODUCTION

The help of healthcare professionals for smokers to quit is critically important to increase quit rates. In the future, internship nursing students will potentially become the largest population of medical professionals. This study explored the impact of the use and awareness of universal tobacco control auxiliary resources on nursing students’ 5As behavior in helping patients to quit smoking during a 40-week clinical internship in the last year of nursing school in Chongqing, China.

METHODS

A survey was conducted in 13 teaching hospitals selected from 29 in Chongqing, China, in 2019, by a random cluster sampling method. It investigated, by self-reported questionnaires, student 5As behavior in helping patients to quit smoking and use and knowledge of tobacco cessation auxiliary resources (tobacco cessation self-education manual, tobacco cessation guidelines, tobacco cessation drugs, tobacco cessation websites, and hotline). The relationship between tobacco cessation auxiliary resources and 5As behavior in helping patients to quit smoking was analyzed with a multivariate linear mixed-effect model.

RESULTS

In all, 534 (39.3%) students, of a total of 1358, reported that the majority of internship units provided a tobacco control self-education manual; 674 (49.6%) ever skimmed through tobacco cessation guidelines; 641 (47.2%) browsed tobacco cessation websites; 738 (54.3%) knew some cessation-assistance drugs; and 93 (6.8%) knew of and could recall the tobacco cessation hotline. Except for tobacco cessation websites, tobacco cessation auxiliary resources affected nursing interns’ 5As behavior in helping patients to quit (p<0.05).

CONCLUSIONS

Tobacco cessation auxiliary resources influenced students’ 5As behavior in helping patients to quit smoking. Students knew a little of tobacco cessation auxiliary resources. To improve students’ 5As behavior for helping patients to quit, more tobacco cessation resources need to be developed and more students need to become acquainted with them.

[Psychological status and sleep quality of nursing interns during the outbreak of COVID-19]

OBJECTIVE

To investigate the psychological status and sleep quality of nursing interns in collective isolation during the outbreak of coronavirus disease 2019 (COVID-19) and provide evidence for adequate interventions.

METHODS

We surveyed a total of 95 nursing interns who were isolated collectively in a general teaching hospital in Guangzhou using a self-designed questionnaire, which consisted of a basic information form, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and Pittsburgh Sleep Quality Index (PSQI). Descriptive analysis, single factor analysis and correlation analysis were used to analyze the current status of the interns' psychology and sleep quality, the potential factors affecting their psychology and sleep quality, and the correlation between their psychological status and sleep quality.

RESULTS

The surveyed interns had SAS, SDS and PSQI score of 37.79±6.59, 43.98±9.74 and 5.20±3.14, respectively, which were significant higher than the national norms in China (P < 0.05). Correlation analysis indicated that both anxiety and depression were positively correlated with the sleep quality score (r=0.508 and 0.546, respectively). Univariate analysis showed that the major factors affecting the psychological status and sleep quality of the interns during collective isolation included recent contact with persons from the affected area before isolation and the onset of fever during the isolation.

CONCLUSIONS

These interns showed relatively high levels of anxiety and depression during the collective isolation to affect their sleep quality, and interventions should be timely administered to improve their mental health and sleep quality.