Journal of Nursing Management最新文献

Aim: To measure the association between job satisfaction and perceived quality of care among nurses on labor and delivery (LD) units.

Background: Nurses constitute the largest segment of the US healthcare workforce. Low job satisfaction is a critical factor in nurse turnover and quality of care.

Methods: A web-based survey was distributed across LD units in the United States. We used logistic regression to assess the association between job satisfaction, as measured by the employee net promoter score (eNPS), and perceived indicators of quality of care.

Results: Among 1021 LD nurses who responded, those characterized as passive or detractors had greater odds of rating that the quality of care on their LD unit was fair or good rather than excellent (adjusted odds ratio [aOR] 3.45, 95% CI: 2.44-4.88 and aOR 6.58, 95% CI: 4.08-10.75, respectively, with both p < 0.0001), agreeing that nurses were spending less time with laboring patients suspected or confirmed to have COVID-19 (aOR 1.42, 95% CI: 1.04-1.95, p = 0.0288; aOR 2.08, 95% CI: 1.33-3.28, p = 0.0014) and reporting that professional labor support was frequently or always missed during the pandemic (aOR 2.19, 95% CI: 1.49-3.20, p < 0.0001; aOR 1.82, 95% CI: 1.09-3.03, p = 0.0217) compared to respondents characterized as promoters.

Conclusions: Higher nursing job satisfaction as measured by the eNPS is associated with higher perceived quality of care on the LD units.

Implications for nursing management: eNPS is a one-question survey that is easy to deliver, simple to interpret, and is associated with perceived quality of care. Nursing management can use it to track progress over time and understand reasons for job dissatisfaction on their units.

Background: Problematic mobile phone use is an emerging public health issue, the prevalence of which has increased among nurses.

Aim: To synthesize and describe knowledge on problematic mobile phone use by nurses, its consequences, and strategies for addressing this phenomenon.

Design: A systematic review was conducted following the checklist Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. This systematic review has been registered in PROSPERO (CRD420251052591).

Methods: Four electronic databases were systematically searched from their inception to September 2025. The article's reference lists were also manually searched. The study selection was carried out in three stages, with two reviewers independently analyzing the data and resolving disagreements. The quality assessment utilized the Mixed Method Appraisal Tool, considering the criteria established for each study design.

Results: Sixteen studies from four online databases were selected, the majority of which were cross-sectional and descriptive. The risk factors for problematic mobile phone use, the negative consequences for mental and physical health, and the clinical work of nurses were highlighted, such as a combination of strategies to prevent and mitigate problematic mobile phone use in the clinical setting.

Conclusion: The problematic mobile phone use of nurses negatively affects their mental and physical health, as well as their performance in the clinical setting.

Implication for nursing management: The findings of this study may inform the need for nursing managers to develop and implement strategies to prevent and mitigate the problematic use of these devices among nurses and ensure the appropriate use of mobile phones in the clinical setting.

Aim: To evaluate the quality, risk of bias, and clinical applicability of prediction models for fall-related injuries in older adults.

Background: Numerous prediction models for fall-related injuries in older adults have been developed, but their quality and applicability in clinical practice and future research remain uncertain.

Methods: We systematically searched Medline (via OVID), Embase (via OVID), Cochrane Library, CINAHL (via EBSCO), Web of Science, and Scopus from inception to May 23, 2024, for English-language publications. All observational and experimental studies reporting the development or validation of any multivariable prediction model for fall-related injuries in older adults were included. The risk of bias and applicability was assessed using the PROBAST, and the reporting quality was measured based on the TRIPOD + AI checklist. Data were synthesized using a narrative synthesis approach.

Results: Thirty-one models from 15 studies were included. Twelve studies focused on the development and/or internal validation of a model, two studies dealt with development and external validation using a nonrandom split-sample, and one study externally validated existing models. The reported model discriminative statistics exhibited a broad range, from 0.54 to 0.89, in internal or external validation contexts. The risk of applicability was low for all studies, while the overall risk of bias was high in all studies (100.0%). High bias risk was notably prevalent in the analysis domain (100% of studies) and observed in the predictors (33.3%), participants (26.7%), and outcome (6.7%) domains. Median adherence to TRIPOD + AI reporting items was 56.4%.

Conclusion: The discriminative ability in the prediction models of fall-related injuries in older adults varied widely, with all models exhibiting a high risk of bias according to the PROBAST. Upcoming research should focus on developing high-quality and reproducible models that undergo proper external validation, followed by studies on implementation.

Implications for nursing management: Existing fall-related injuries prediction models exhibit high bias and inconsistent accuracy, limiting clinical utility. Nursing leaders should advocate for future models that undergo thorough internal and external validation, ensure sufficient events per variable, properly handle missing data, and adopt transparent reporting practices. This will underpin data-driven clinical decisions and enable targeted fall prevention strategies in vulnerable older adults.

Aim: To explore how nurse leaders in public healthcare systems experience the implementation of professional practice and leadership frameworks and to identify contextual factors that influence their practical application.

Background: Leadership frameworks are widely promoted to enhance nursing leadership capability, yet their translation into practice remains inconsistent. Understanding how nurse leaders experience these frameworks is essential to inform leadership development and organisational strategy.

Methods: A qualitative scoping review was conducted using Braun and Clarke's reflexive thematic analysis. Fourteen qualitative studies published between 2015 and 2024 were identified through systematic searches of CINAHL, Scopus and MEDLINE. The review followed the Arksey and O'Malley framework and PRISMA-ScR guidelines.

Results: Five themes were identified: leadership skills, leadership development, leadership challenges, evidence-based practice and workplace culture. Leadership was described as a responsive practice shaped by clinical credibility, strategic management and interprofessional influence. A conceptual model, the Clinical-Administrative-Research Nexus, emerged reflecting the concurrent demands placed on nurse leaders. Systemic barriers such as hierarchical constraints, limited resources and inconsistent organisational support contributed to a persistent 'knowing-doing' gap. Workplace culture was the most influential factor, shaping leadership development, evidence translation and team cohesion.

Conclusion: Leadership frameworks were experienced as contextual tools rather than standalone solutions. Their implementation depends on structural support, mentorship and alignment with clinical realities. Leadership success was shaped more by the conditions in which it is enacted than by individual capability alone.

Implications for nursing management: The findings highlight the need for integrated system-level support to enable nurse leaders to navigate the complexities of their clinical, administrative and research responsibilities. Organisational strategies must move beyond individual skill building to address structural barriers and foster cultures that support leadership development and evidence-based practice.

Background: Civility is essential to ensuring the wellbeing of nurses and the delivery of quality patient care. Given that nurse leaders influence the behaviours and expectations of nurses in their teams within health and aged care settings, further insight is needed in understanding the practices of nurses holding leadership positions in creating civility.

Purpose: The aim of this study was to explore the experiences of nurse leaders in promoting and maintaining civility in nursing care teams in Australian regional and rural health and aged care settings.

Methods: Using a constructivist grounded theory methodology, 11 regional and rural nurse leaders in Victoria, Australia, were individually interviewed. Interview transcripts, recordings and memos were analysed using reflexivity and constant comparison to inform the substantive theory.

Findings: The substantive theory titled ACTS Theory for Creating Civility in Nursing conceptualises the practices of nurse leaders in creating civility across four elements (acknowledge, communicate, teach and support). Acknowledging individual skills and personal circumstances, practising compassionate communication, role-modelling acceptable behaviours and providing support were core practices in fostering civility.

Discussion: Ongoing implementation and evaluation of precepting, mentoring, and professional accountability programmes aimed at improving nurse leaders' communication and leadership skills is needed to address this ongoing workforce issue.

Background: Medication errors remain a critical patient safety issue. Although prior research has examined individual and environmental determinants, few studies have investigated their complex interrelationships within an integrated theoretical framework, particularly in clinical nursing practice.

Aim: To examine the structural relationships among the nursing work environment, communication with health professionals, fatigue, and medication errors among clinical nurses, grounded in Bronfenbrenner's ecological systems theory.

Methods: A cross-sectional study was conducted involving 230 clinical nurses from four tertiary hospitals in South Korea. Data were collected using validated self-report questionnaires measuring the nursing work environment, communication with health professionals, fatigue, and medication errors. Structural equation modeling, supported by confirmatory factor analysis, was used to evaluate direct and indirect pathways and to assess overall model fit.

Results: The proposed model demonstrated acceptable fit (χ²/df = 2.98, RMSEA = 0.08, CFI = 0.93). The nursing work environment exerted a significant direct effect on communication (β = 0.80, p < 0.001), and communication was significantly associated with reduced fatigue (β = -0.78, p = 0.005). Fatigue had a direct effect on medication errors (β = 0.32, p = 0.003), while communication showed both direct and indirect effects on medication errors. The model explained 64.3% of the variance in communication, 45.4% in fatigue, and 29.8% in medication errors.

Conclusion: A supportive nursing work environment facilitates effective interprofessional communication, which in turn mitigates fatigue and reduces medication errors. Communication functions as a key mediating mechanism within this structural pathway.

Implications for nursing management: To reduce medication errors, nurse managers should prioritize fostering positive work environments, implementing structured communication protocols, and establishing systematic fatigue management strategies. Such organizational initiatives may enhance communication efficiency and strengthen patient safety outcomes.

Background: Compulsory citizenship behavior (CCB) and organizational silence are prevalent among nurses, undermining nursing care quality and potentially threatening patient safety. Prior studies have shown that CCB can lead to employee silence; however, this relationship has not been examined among nurses, and the underlying mechanisms and boundary conditions remain unclear.

Aim: This study aimed to test whether presenteeism mediates the association between CCB and organizational silence, with psychological inflexibility serving as a moderator of this process.

Methods: A cross-sectional study was conducted among nurses recruited via convenience sampling from three hospitals in Xi'an, Shaanxi Province, China. Four questionnaires were administered to assess CCB, presenteeism, organizational silence, and psychological inflexibility. A total of 400 valid responses were analyzed using Hayes' PROCESS macro in SPSS to test a moderated mediation model.

Results: Presenteeism mediated the relationship between CCB and organizational silence (β = 0.085, 95% CI: 0.039-0.131). Psychological inflexibility moderated the association between CCB and presenteeism: the positive effect of CCB on presenteeism was stronger among nurses high in psychological inflexibility (simple slope = 0.398, p < 0.001) than among those low in psychological inflexibility (simple slope = 0.217, p < 0.001).

Conclusion: Presenteeism helps explain how CCB relates to organizational silence among Chinese nurses, and psychological inflexibility strengthens the adverse effect of CCB on presenteeism. Reductions in CCB and presenteeism may be associated with lower levels of organizational silence.

Implications for nursing management: To improve nursing care and public health, healthcare managers should consider interventions aimed at reducing nurses' experiences of CCB and presenteeism to help decrease organizational silence. In addition, strategies to reduce psychological inflexibility may help nurses better cope with demanding tasks and stressful work environments.

Background: Curriculum integration and high-fidelity simulation (HFS) were used separately in nursing education. Little is known about their combined effect on undergraduate nursing students' competence.

Aim: To assess the impact of HFS and curriculum integration on nursing students' competence and satisfaction.

Methods: A quasiexperimental study design was employed. Using convenience sampling, two groups of undergraduate nursing students were compared in their management of pregnant women undergoing normal vaginal delivery and immediate newborn care. The intervention group (n = 30) received the HFS/curriculum-integrated session, while the control group (n = 30) received the traditional curriculum. The HFS/curriculum-integrated intervention consisted of five three-hour sessions, with six students participating in each session. The intervention was conducted in the simulation laboratory of Fakeeh College for Medical Sciences in December 2023 over one week, and study data were collected two weeks after the completion of the educational intervention. Students' competence was assessed using a structured written examination and an objective structured clinical examination (OSCE), while satisfaction was evaluated using a self-reported questionnaire. Independent t-tests were used to examine differences in competency between the two groups.

Results: Students who participated in the HFS/curriculum-integrated sessions demonstrated significantly higher performance in both written knowledge examinations and clinical skills assessments compared to the control group. Knowledge scores were higher for management of normal vaginal delivery (86% vs. 46%) and immediate newborn care (80% vs. 54%), and OSCE scores were also significantly greater for vaginal delivery management (81% vs. 50%) and immediate newborn care (95% vs. 56%) (p ≤ 0.05). Students' satisfaction with the integrated session using HFS was high (91% ± 7.6).

Conclusion: The use of HFS and curriculum integration significantly enhanced nursing students' competency and satisfaction levels. These findings underscore the value of incorporating HFS and curriculum integration as an effective strategy in nursing education. However, further large-scale and longitudinal studies are warranted to more comprehensively evaluate the long-term impact of HFS and curriculum integration on diverse nursing learning outcomes.

Implication for nursing management: Nursing management should facilitate the use of HFS and curriculum integration in nursing education, as this approach significantly enhances students' clinical competence while bridging the gap between theory and practice.

Objectives: Stigma is a persistent psychosocial stressor in psychiatric care settings, yet its impact on the motivation of nursing staff and other healthcare professionals remains underexplored. This study examined how four dimensions of stigma-perceived stigma, self-stigma, social concealment, and positive response-relate to autonomous motivation and whether turnover intention mediates these relationships.

Methods: A cross-sectional survey was conducted with 2813 employees from 36 psychiatric hospitals across six provinces in China. Validated scales measured stigma dimensions, turnover intention, and autonomous motivation. Structural equation modeling with bootstrapped confidence intervals tested direct and indirect pathways.

Results: Perceived stigma directly predicted lower autonomous motivation, whereas self-stigma and social concealment reduced motivation only indirectly via turnover intention. Notably, since the positive response dimension was reverse-scored, higher stigma scores (representing lower positive response) were associated with reduced autonomous motivation through both direct and indirect pathways. Perceived stigma showed no significant indirect effect through turnover intention.

Conclusions: Different stigma dimensions influence motivation through distinct psychological mechanisms. Strategies that reduce internalized stigma, foster value-affirming behaviors, and address turnover-related strain may help sustain autonomous motivation in high-pressure psychiatric settings. These findings offer actionable insights for nursing managers seeking to strengthen workforce engagement and retention.

Aim: This cross-sectional study explored factors influencing nurses' intention to remain practicing or exit the profession across Australian metropolitan, regional, rural, and remote settings to inform workplace policies, education training, and career coaching.

Background: Evidence on attrition and retention across geographical regions of employment is mixed. While much existing research on the nursing workforce has focused on job satisfaction, work-life balance, and workload, less attention has been given to the influence of work setting, nursing role, resilience, and career advancement opportunities-particularly in nonmetropolitan areas.

Methods: Validated scales were used to assess resilience and intention to stay in the profession. Intention to stay was analyzed using ordinal logistic regression and Youden's statistic was applied to estimate the year nurses were most likely to consider leaving.

Results: Of 1252 survey accesses, 526 (42.0%) resulted in completion and 410 (77.9%) included a response to the intention-to-stay question. No statistically significant differences were found in age, gender, early career status, or years of experience among nurses working in different geographic areas. Using Youden's statistical method, 7 years of employment was identified as the threshold at which nurses were most likely to consider leaving their profession. Compared with metropolitan nurses, those in rural/remote areas were more likely to stay (adjusted odds ratio: 2.2; 95% CI: 1.14-4.10; and p = 0.019). Positive predictors included working in clinical roles, hospital or community settings, higher resilience, and career advancement opportunities.

Conclusions: Region, role, and resilience strongly influence nurses' intention to stay, with rural and remote nurses more likely to remain than metropolitan peers.

Implications for nursing management: Targeted supports-including mentorship, reflective practice, resilience training, and career coaching-may improve retention, particularly when management practices are tailored to leverage the strengths of rural and remote settings while addressing context-specific needs to enhance workforce stability across all regions.