Journal of Nursing Management最新文献

Background: Despite trends towards greater professionalisation of the nursing profession and an improved public image in certain countries, studies also show that large proportions of the public still do not fully appreciate nurses’ competencies. Mapping differences in the societal and professional recognition of nurses allows for benchmarking among countries.

Aim: To investigate the level of societal recognition of the nursing profession in nine European countries, and the level of professional recognition perceived by European nurses themselves; to compare levels of recognition between countries; and to identify influencing factors.

Methods: A cross-sectional study was conducted. Through an online survey, the study surveyed both the general public and nurses from various healthcare settings across nine countries between December 2022 and June 2023. The instrument used was a combination of self-developed questions on societal and professional recognition, the Work Motivation Scale and an adapted version of the Multidimensional Work Motivation Scale. Data were analysed using SPSS v.29.0, with socioeconomic prestige scores for the public and work environment/work motivation scores for nurses calculated accordingly.

Results: A total of 1618 adult citizens and 2335 nurses participated. The public predominantly characterised nurses with attributes such as friendliness, warmth, empathy and compassion. The mean socioeconomic prestige score assigned to nurses was 7.2/10 (SD 1.9), with Portugal having the highest score (M 7.5/10, SD 2.0) and Norway the lowest (M 5.8/10, SD 1.4; p < 0.001). Professional recognition experienced by nurses was generally low (54% indicated rather low, 17% very low). Slovenia, the Netherlands and Belgium had slightly higher mean scores (all M 1.4/3) compared to other countries (p < 0.001). High professional recognition could be predicted for 33% by work environment score (OR = 1.21; 95% CI [1.19–1.24]), work motivation score (OR = 1.02; 95%CI[1.01–1.02]), expertise outside the hospital (OR = 1.57; 95% CI [1.25–1.97]) and work experience (OR = 1.01; 95% CI [1.00–1.02]) corrected for country.

Conclusion: The study highlights the need for targeted interventions to improve the professional and public image of the nursing profession while addressing disparities in professional recognition between countries. Longitudinal studies are recommended to monitor changes in public perception and professional recognition among nurses.

Aim: This research explores how and why commuting stress influences Chinese nurses’ well-being.

Background: A daily work commute may result in a significant psychological risk factor that can lead to harmful physiological and mental health consequences. Emerging research indicates that nurses experience long-lasting negative effects on their mental health, including burnout, due to the stress of a daily work commute.

Methods: The study employed a cross-sectional design involving 380 registered nurses from state-owned hospitals in southern China. Hypotheses were tested using the PROCESS macro developed by Hayes [1].

Results: The stress of commuting indirectly influences nurses’ well-being through increased emotional exhaustion. There is an interaction between commuting stress and nurses’ gender such that the indirect effect of commuting stress on well-being is stronger for female nurses.

Conclusions: The spillover effect of commuting stress in the nursing profession is often underestimated. However, this study underscores its significant impact on nurses’ emotional exhaustion and well-being. The research findings emphasize that commuting stress contributes to emotional exhaustion and a decline in nurses’ well-being.

Implications for Nursing Management: Healthcare organizations should leverage these findings to reinforce the importance of self-care for nurses and to provide nurses with resources to help decrease the potential negative outcomes of commuting stress. The study also shows that female nurses may experience a more pronounced association between commuting stress and emotional exhaustion. As such, healthcare organizations should develop gender-specific interventions and support systems that address the unique challenges faced by female nurses in relation to commuting stress.

Objective: To evaluate the association between nurse staffing coverage and patient outcomes in a context of structural understaffing.

Design: This is a population-based, cross-sectional, multicenter study, including patient and staffing data from eight public hospitals from Catalonia, Spain.

Participants: A total of 183,085 adult in-patients admitted to hospital wards and step-down units during 2016 and 2017.

Outcomes: In-hospital mortality, 30-day hospital readmission, and three cluster nurse-sensitive adverse events: healthcare-acquired infections, failure to maintain, and avoidable critical complications. The study factor is safe nursing staffing equivalent to nurse staffing coverage > 90%.

Results: Average patient acuity was equivalent to 4.5 required nursing hours per patient day. The mean available nursing hours per patient day was 2.6. The average nurse staffing coverage reached 65.5%. Overall, 1.9% of patients died during hospitalization, 5% were readmitted within 30 days, and 15.9% experienced one or more adverse events. Statistically significant differences were identified for all patient outcomes when comparing patients safely covered (nurse staffing coverage > 90%) and under-covered (nurse staffing coverage < 90%). Increasing nurse staffing coverage to a safe level (> 90%) is associated with a reduction of the risk of death (RR: 0.41, 95% CI: 0.37–0.45), a decrease in the risk of hospital readmission (RR: 0.93, 95% CI: 0.89–0.97), and a reduction of nurse-sensitive adverse events (RR: 0.67, 95% CI: 0.66–0.69).

Conclusion: Safe nurse staffing coverage acts as a protective factor for detrimental patient outcomes, significantly reducing the risk of in-hospital mortality, 30-day hospital readmission, healthcare-associated infections, failure to maintain, and avoidable critical complications. Further policy efforts are needed to guarantee a safe registered nurse staffing coverage.

Objective: To investigate the knowledge, attitudes, and practices of Chinese midwives regarding liberal birthing position management during the second stage of labor and explore the factors related to their practices.

Background: Midwives play a critical role in managing the second stage of labor, during which appropriate delivery posture is essential for promoting normal birth and improving childbirth experiences.

Methods: A cross-sectional study was conducted in Guangdong Province, China, from April to May 2023. Three hundred and sixty midwives completed the questionnaire on knowledge, attitude, and practice of liberal birthing position management during the second stage of labor. SPSS 29.0 was used to analyze the data. Descriptive statistics, independent sample t-test, one-way ANOVA, Pearson correlation analysis, and multiple linear regression analysis were performed. p < 0.05 was considered statistically significant.

Results: The midwives’ mean knowledge total score was high, with an 83.1% rate of correct answers. The midwives had a lower moderate level of attitude with a mean total score of 43.06 ± 9.08 out of 76 and a low level of the Worry dimension of attitude (19.86 ± 7.92 out of 48). The midwives had a moderate level of practice with a mean total score of 3.03 ± 1.85 out of 6. The scores of knowledge, attitude, and practice were pairwise positively correlated (p < 0.001). The multiple linear regression analysis showed that knowledge, attitude, having participated in training on maternal birthing positions, having experiences in clinical teaching, hospital grade, and hospital category were the predictors of midwives’ practice of liberal birthing position management during the second stage of labor (p < 0.05).

Conclusion: Midwives’ attitudes and practices of liberal birthing position management during the second stage of labor need to be improved, and participating in training and undertaking clinical teaching tasks are crucial for them to improve their practices in this area.

Implications: Midwifery managers need to pay more attention to the professional education and training of midwives and should establish organizations that are specifically designed to support midwives’ continuous learning and professional development. These organizations can offer targeted training programs, create collaborative learning environments, and facilitate the sharing of best practices among midwives. Nursing educators should be familiar with and in line with international standards, emphasizing upgrading midwifery teaching materials and establishing a standardized on-the-job training system.

Background: Crowded emergency departments (EDs) adversely affect patient care and healthcare efficiency, leading to prolonged wait times, delayed treatments, and increased medical errors. This issue also diminishes patient satisfaction and disrupts hospital operations. In Saudi Arabia, ED overcrowding impacts response times and staff morale, highlighting the need for efficient patient flow processes to ensure timely and effective care.

Objectives: The aim of this study is to identify the main bottlenecks in the workflow of Saudi Arabian EDs from patient arrival to disposition.

Design: A retrospective quantitative study analyzed data from 753 patients across multiple hospitals in Saudi Arabia’s EDs to identify workflow bottlenecks. Using SPSS and AMOS for data analysis, various statistical methods, including ANOVA and structural equation modeling (SEM), were employed to evaluate key performance metrics and their influence on the total length of stay (LOS).

Results: The Doctor to Decision Time is the most significant bottleneck, followed by the Triage to Doctor Time. CTAS3 and CTAS4 categories experience the most significant delays across multiple stages. In addition, the default model in AMOS 29 shows an excellent fit, indicating that reducing delays in Decision to Disposition Time (estimate = 0.840) and Doctor to Decision Time (estimate = 0.442) is crucial for improving the total LOS in the ED.

Conclusion: This study identifies significant inefficiencies in the ED workflow in Saudi Arabia, particularly in the Doctor to Decision Time and Triage to Doctor Time stages, and recommends streamlining consultation protocols, enhancing medication delivery, expediting lab and radiology services, and increasing staffing to improve operational efficiency and patient outcomes. Faster bed turnover reduces Decision to Disposition Time and frees up ED beds. Adequate staffing improves triage, evaluation times, and care quality. Well-trained nurses enhance patient interactions and reduce delays. Standardized guidelines ensure timely treatment. Effective communication and teamwork improve patient flow and reduce bottlenecks.

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.

Aim: To profile the work–family balance (WFB) among clinical nurses and identify their influencing factors.

Background: WFBs take on various patterns in nurses. Nurses with different characteristics exhibit various patterns of WFB.

Methods: A cross-sectional study was performed, involving 1292 nurses from public hospitals in Jiangsu Province from February to April 2024. Latent profile analysis (LPA) was employed to categorize the data, and multinominal logistic regression analysis to determine factors influencing WFB.

Results: A total of 1718 questionnaires were distributed, yielding 1292 valid responses (a response rate of 75.2%). The total score of WFB was 44.35 ± 8.693 points. The LPA revealed three profiles of WFB: the family priority group (28.1%), the balanced adaptation group (46.8%), and the challenge coping group (25.1%). The entropy value was high (0.892), indicating a correct classification. Multivariate regression analyses showed that professional title, department, nonclinical work pressure, organizational identification, work meaning, and self-efficacy as factors influencing WFB profiles.

Conclusion: The WFB among nurses was at a moderate level with significant heterogeneity and could be divided into three profiles. The challenge coping group presented lower professional titles and higher self-efficacy, and working at surgical, pediatric, and other specialized departments. Managers can tailor intervention strategies based on the characteristics and influencing factors of each profile.

Implications for Nursing Management: Nursing managers must consider the characteristics of high-risk groups and factors that affect WFB and take targeted measures to mitigate work–family conflicts (WFC) among nurses and stabilize the nursing workforce.

Background: Compassionate care and resilience play crucial roles in enhancing care quality. Understanding compassionate care patterns in the nursing population and their relationship with resilience can improve knowledge of these concepts.

Objective: To investigate compassionate care patterns among Iranian nurses and their associations with resilience at individual and contextual levels.

Method: This cross-sectional study used Persian versions of the 28-item Compassionate Care Questionnaire (CCQ) and Connor–Davidson Resilience Scale (CD-RISC). 478 Iranian nurses from 19 wards across 16 hospitals in northern Iran participated between February and September 2023. Latent profile analysis (LPA) was performed on compassionate care dimensions. Multilevel logistic regression modeling explored associations between resilience dimensions and compassionate care profiles, adjusting for control variables at individual and contextual levels.

Results: LPA revealed two distinct compassionate care profiles: “Low Compassionate Care” (16.3%) and “High Compassionate Care” (83.7%). After adjusting for control variables, personal competence (OR = 1.09, 95% CI: 1.02–1.15), positive acceptance (OR = 1.23, 95% CI: 1.06–1.44), and spirituality (OR = 1.17, 95% CI: 1.01–1.38) were associated with higher odds of inclusion in the “High Compassionate Care” profile. The empty model showed that 6.5% of compassionate care patterns were explained at the ward level. After adding predictors at individual and ward levels, explained variances were reduced to 1.5% and < 0.01%, respectively.

Conclusions and Implication: This study offers insights into compassionate care among nurses, showing that few exhibited “Low Compassionate Care.” Higher resilience was positively linked to elevated compassionate care levels. Policymakers, managers, and educators can leverage these findings to enhance nursing management and support systems by prioritizing resilience-building strategies, ultimately improving patient care quality.

Aim: To investigate the relationship between mindful self-care and compassion fatigue and the chain mediating effects of resilience and professional identity.

Background: Compassion is a critical quality for nurses, but they often face the risk of compassion fatigue.

Methods: From October 2023 to May 2024, a cross-sectional survey was conducted in six tertiary hospitals in Guangdong, Henan, and Jiangsu provinces by convenience sampling. A total of 1315 clinical nurses in the hospital were surveyed using the Social–demographic Characteristics Questionnaire, the Chinese Version of the Brief Mindful Self-Care Scale, the Chinese Version of the Connor–Davidson Resilience Scale, the Professional Identity Scale for Nurses, and the Chinese Version of the Compassion Fatigue Short Scale. The mediation model was analyzed using a bias-corrected bootstrapping method with PROCESS 4.1 implemented in SPSS 26.0.

Results: Pearson correlation analysis showed that there was a positive correlation between nurses’ mindful self-care, resilience, and professional identity. Mindful self-care, resilience, and professional identity were negatively correlated with compassion fatigue. Resilience played a partial mediating role between mindful self-care and compassion fatigue. Professional identity also played a partial mediating role between mindful self-care and compassion fatigue; mindful self-care affected compassion fatigue through resilience and professional identity.

Conclusion: Nurses’ mindful self-care can affect compassion fatigue through the mediating role of resilience and professional identity. In the future, attention should be paid to cultivating nurses’ mindful self-care ability and resilience and improving nurses’ professional identity, which may help to reduce nurses’ compassion fatigue.