Short term outcomes and resource utilization in de-novo versus acute on chronic heart failure related cardiogenic shock: a nationwide analysis.

Background: There has been growing recognition of non-ischemic etiologies of cardiogenic shock (CS). To further understand this population, we aimed to investigate differences in clinical course between acute on chronic heart failure related (CHF-CS) and de-novo CS (DN-CS). Methods: Using the Nationwide Readmission Database, we examined 92,426 CS cases. Outcomes of interest included in-hospital and 30-day outcomes and use of advanced heart failure therapies. Results: Patients with DN-CS had higher in-hospital mortality than the CHF-CS cohort (32.6% vs. 30.4%, p < 0.001). Mechanical circulatory support (11.9% vs. 8.6%, p < 0.001) was more utilized in DN-CS. Renal replacement therapy (13.8% vs. 15.5%, p < 0.001) and right heart catheterization (16.0% vs. 21.0%, p < 0.001) were implemented more in the CHF-CS cohort. The CHF-CS cohort was also more likely to undergo LVAD implantation (0.4% vs. 3.6%, p < 0.001) and heart transplantation (0.5% vs. 2.0%, p < 0.001). Over the study period, advanced heart failure therapy utilization increased, but the proportion of patients receiving these interventions remained unchanged. Thirty days after index hospitalization, the CHF-CS cohort had more readmissions for heart failure (1.1% vs. 2.4%, p < 0.001) and all causes (14.1% vs. 21.1%, p < 0.001) with higher readmission mortality (1.1% vs. 2.3%, p < 0.001). Conclusion: Our findings align with existing research, demonstrating higher in-hospital mortality in the DN-CS subgroup. After the index hospitalization, however, the CHF-CS cohort performed worse with higher all-cause readmission rate and readmission mortality. The study also underscores the need for further investigation into the underutilization of certain interventions and the observed trends in the management of these CS subgroups.

Intensive care nurses' impostor phenomenon: Associations with narcissistic personality, shame-proneness, and guilt-proneness.

BACKGROUND: Intensive care unit nurses commonly experience impostor phenomenon owing to constant exposure to urgent situations, high work pressure, and the demands of their professional roles. Impostor phenomenon may induce anxiety and self-doubt and adversely affect personal growth and career development. Therefore, identifying the severity of impostor phenomenon among intensive care unit nurses and its associated factors is important. OBJECTIVES: The aim of this study was to investigate the associations between narcissistic personality, shame-proneness, guilt-proneness, and impostor phenomenon among intensive care unit nurses in tertiary hospitals. METHODS: This cross-sectional study collected data from 251 nurses in tertiary hospitals in Korea, in July 2022, using an online questionnaire. Narcissistic personality was assessed using the Pathological Narcissism Inventory, and shame-proneness and guilt-proneness were measured using the Test of Self-Conscious Affect. Impostor phenomenon was assessed using the Clance Impostor Phenomenon Scale. RESULTS: Multiple linear regression analysis showed that the most potent factors affecting impostor phenomenon in intensive care unit nurses was shame-proneness, followed by narcissistic vulnerability and guilt-proneness. The regression model explained 65.0% of the variance. CONCLUSION: Nurse leaders can address impostor phenomenon among newly hired intensive care unit nurses with the goal of minimising adverse psychological outcomes. Shame-proneness, narcissistic vulnerability, and guilt-proneness require attention because of their relationship to impostor phenomenon. Additionally, it is necessary to plan and implement measures to promote awareness of self-conscious emotions, psychoeducation, and mental health intervention programs that focus on these factors.

Factors affecting environmental sustainability attitudes among nurses - Focusing on climate change cognition and behaviours: A cross-sectional study.

AIMS: To investigate the relationship between climate change cognition and behaviours (awareness, concern, motivation, behaviours at home and behaviours at work), positive and negative future cognition, and environmental sustainability attitudes in nurses and to identify the factors affecting environmental sustainability attitudes. DESIGN: A cross-sectional study. METHODS: In total, 358 nurses currently working in tertiary hospitals in Korea were recruited. Data were collected using an online questionnaire link from 1 August to 7 August 2022. Climate change cognition and behaviours were measured using the Korean version of the Climate, Health, and Nursing Tool. Positive and negative future cognition were measured using the Korean version of the Future Event Questionnaire. Environmental sustainability attitude was measured using the Korean version of the Sustainability Attitudes in Nursing Survey-2. Multiple regression analysis was used to identify the factors affecting environmental sustainability attitudes. RESULTS: Motivation, concern and behaviours at work were factors affecting environmental sustainability attitudes. Motivation was a pivotal influencing factor. Better scores for environmental sustainability attitudes were specifically correlated with higher scores for motivation, concern and behaviours at work. CONCLUSIONS: Nurses' motivation, climate change concern and pro-environmental workplace practices should all be considered to improve their attitudes towards environmental sustainability. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: To enhance nurses' environmental sustainability attitudes and behaviours, nurse educators must educate them to increase their motivation for climate action. IMPACT: Nurses are increasingly expected to contribute to environmental sustainability. Hence, awareness of climate change and environmental sustainability among nurses must be improved, and nursing engagement and action encouraged. Nurse educators and managers should explore barriers to pro-environmental behaviour engagement among nurses, examine workplace cultures that encourage pro-environmental behaviours and develop policies/regulations to develop more environmentally sustainable workplaces. REPORTING METHOD: We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. PATIENT OR PUBLIC CONTRIBUTION: Neither patients nor the public were involved in our research's design, conduct, reporting or dissemination plans. The nurses partook in this study exclusively as research participants and were not involved in any research process.

Catecholaminergic Polymorphic Ventricular Tachycardia: Clinical Characteristics, Diagnostic Evaluation and Therapeutic Strategies.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a severe hereditary arrhythmia syndrome predominantly affecting children and young adults. It manifests through bidirectional or polymorphic ventricular arrhythmia, often culminating in syncope triggered by physical exertion or emotional stress which can lead to sudden cardiac death. Most cases stem from mutations in the gene responsible for encoding the cardiac ryanodine receptor (RyR2), or in the Calsequestrin 2 gene (CASQ2), disrupting the handling of calcium ions within the cardiac myocyte sarcoplasmic reticulum. Diagnosing CPVT typically involves unmasking the arrhythmia through exercise stress testing. This diagnosis emerges in the absence of structural heart disease by cardiac imaging and with a normal baseline electrocardiogram. Traditional first-line treatment primarily involves ß-blocker therapy, significantly reducing CPVT-associated mortality. Adjunctive therapies such as moderate exercise training, flecainide, left cardiac sympathetic denervation and implantable cardioverter-defibrillators have been utilized with reasonable success. However, the spectrum of options for managing CPVT has expanded over time, demonstrating decreased rates of arrhythmic events. Furthermore, ongoing research into potential new therapies including gene therapies has the potential to further enhance treatment paradigms. This review aims to succinctly encapsulate the contemporary understanding of the clinical characteristics, diagnostic approach, established therapeutic interventions and the promising future directions in managing CPVT.

Validation of the Sustainability Attitudes in Nursing Survey-2 for nurses: A cross-sectional study.

AIM: To validate the Sustainability Attitudes in Nursing Survey-2 for nurses. BACKGROUND: Climate change and environmental sustainability is an increasing global issue. Nurses' behaviors could produce harmful emission through their activities, while nurses also care for people with climate change-related health problems. Therefore, nurses have a responsibility of achieving environmental sustainability. To enhance environmental sustainability in nursing, examining attitudes toward climate change and environmental sustainability among nurses from diverse culture is needed. DESIGN: Cross-sectional design using secondary data. METHODS: Data from 349 nurses working at tertiary hospitals in Korea were collected in August 2022. The content validity index and the construct, convergent, discriminant and criterion validities were evaluated. Cronbach's alpha and intraclass correlation coefficient were also evaluated to determine reliability. RESULTS: The survey comprised five items with single factor, similar to its original version. Its validity and reliability were acceptable. Cronbach's α was .86. The intraclass correlation coefficient was .81 for the entire scale. CONCLUSION: This study found the Sustainability Attitudes in Nursing Survey-2 to be a valid and reliable tool for measuring nurses' attitudes toward environmental sustainability. Understanding nurses' attitudes and the educational needs related to environmental sustainability could help develop a more environmentally sustainable workplace in nursing.

Social jetlag and body mass index among shift-working nurses in Korea: A cross-sectional study.

PURPOSE: Shift-working nurses must function against their natural circadian system and are, thus, bound to be detrimentally affected by social jetlag. Circadian rhythms play a crucial role in regulating homeostasis, and social jetlag may increase one's risk for obesity. Therefore, this study aimed to identify associations between social jetlag and obesity among shift-working nurses. METHODS: This cross-sectional study included 183 nurses working rotating shifts in South Korea. Chronotype and social jetlag were measured using the Morningness-Eveningness Questionnaire and the Munich Chronotype Questionnaire for Shift-Workers, respectively. Obesity was defined as a body mass index of 25.0 or higher, which was calculated using self-reported height and weight data. The associations between chronotype, social jetlag, and obesity were investigated using multiple logistic regression analysis. FINDINGS: A total of 183 nurses were included in the analysis (81.4% women and 80.3% single, median age = 27.00 years). Majority of the participants' (95.1%) chronotypes were moderate evening or intermediate type. The mean overall social jetlag was 3 h and 31 min. The odds for obesity were 8.44 times higher among shift-working nurses whose social jetlag was over 3 h and 31 min (95% confidence interval: 1.66-42.99) while controlling for chronotype, exercise time, and eating habits. CONCLUSIONS: Social jetlag may increase the likelihood of obesity among rotating shift-working nurses. IMPLICATIONS FOR NURSING PRACTICE: To achieve positive outcomes for promoting nurses' health, upper nursing management should consider individual nurses' social jetlag when scheduling shifts. In addition, nursing managers should have the responsibility to educate nurses involved in shift work about the adverse effects of social jetlag.

Eco-anxiety and environmental sustainability interest: A secondary data analysis.

Climate change is an increasingly important global concern, requiring urgent action. To achieve environmental sustainability, identifying the predictors influencing individuals' actions is necessary. Individuals with negative psychological responses to climate change, such as eco-anxiety, are more likely to engage in pro-environmental behaviour. However, eco-anxiety and other perceptions associated with climate change and sustainability can differ based on an individual's unique background. Therefore, this study aimed to identify potent predictors of individuals' environmental sustainability interest and examine the impact of eco-anxiety on environmental sustainability interest. Data from 459 South Korean adults (19-65 years) were included in this secondary analysis. Eco-anxiety, climate change risk perception and future event cognition were assessed by the Climate Change Anxiety Scale, the Climate Change Risk Perception Inventory and Future Event Questionnaires, respectively. Multiple linear regression analysis showed that eco-anxiety was the most potent predictor of environmental sustainability interest, followed by climate change risk perception, age 60-65 years, future event cognition and age under 30 years. Considering that eco-anxiety is the most potent predictor of environmental sustainability interest, mental health nurses should assess patients' eco-anxiety level and help them recognize and manage their anxiety levels appropriately. Age-specific approaches should be considered for interventions to enhance environmental sustainability interest. Further studies are needed to determine the cut-off anxiety level that influences the positive impact on environmental sustainability interest and to develop programmes to manage eco-anxiety.

Social jetlag and quality of life among nursing students during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: Amid drastic changes in the educational environment and continued substitution of in-person learning with online learning owing to the COVID-19 pandemic, it is important to analyze the predictors of quality of life among nursing students to devise strategies to enhance their quality of life. This study aimed to identify the predictors of nursing students' quality of life during the COVID-19 pandemic, focusing on social jetlag. METHODS: In this cross-sectional study, data were collected from 198 Korean nursing students in 2021, using an online survey. Chronotype, social jetlag, depression symptoms, and quality of life were assessed using the Korean version of the Morningness-Eveningness Questionnaire, Munich Chronotype Questionnaire, Center for Epidemiological Studies Depression Scale, and World Health Organization Quality of Life Scale abbreviated version, respectively. Multiple regression analyses were performed to identify the predictors of quality of life. RESULTS: Factors affecting participants' quality of life were age (ß = - 0.19, p = .003), subjective health status (ß = 0.21, p = .001), social jetlag (ß = - 0.17, p = .013), and depression symptoms (ß = - 0.33, p < .001). These variables accounted for 27.8% of the variance in quality of life. CONCLUSION: As the COVID-19 pandemic continues, the social jetlag of nursing students has decreased compared to before the pandemic. Nevertheless, the results showed that mental health issues such as depression affect their quality of life. Therefore, it is necessary to devise strategies to support students' ability to adapt to the rapidly changing educational environment and promote their mental and physical health.

Mortality of patients with ST-segment-elevation myocardial infarction without standard modifiable risk factors among patients without known coronary artery disease: Age-stratified and sex-related analysis from nationwide readmissions database 2010-2014.

Objective: The proportion of ST-segment elevation myocardial infarction (STEMI) patients without standard modifiable risk factors (SMuRFs: hypertension, diabetes, hypercholesterolemia and smoking) has increased over time. The absence of SMuRFs is known to be associated with worse outcomes, but its association with age and sex is uncertain. We sought to evaluate the association between age and sex with the outcomes of post-STEMI patients without SMuRFs among patients without preexisting coronary artery disease. Methods: Patients who underwent primary PCI for STEMI were identified from the Nationwide Readmission Database of the United States. Clinical characteristics, in-hospital, and 30-day outcomes in patients with or without SMuRFs were compared in men versus women and stratified into five age groups. Results: Between January 2010 and November 2014, of 474,234 patients who underwent primary PCI for STEMI, 52,242 (11.0%) patients did not have SMuRFs. Patients without SMuRFs had higher in-hospital mortality rates than those with SMuRFs. Among those without SMuRFs, the in-hospital mortality rate was significantly higher in women than men (10.6% vs 7.3%, p<0.001), particularly in older age groups. The absence of SMuRFs was associated with higher 30-day readmission-related mortality rates (0.5% vs 0.3% with SMuRFs, p<0.001). Among patients without SMuRFs, women had a higher 30-day readmission-related mortality rates than men (0.6% vs 0.4%, p<0.001). After multivariable adjustment, the increased rates of in-hospital (odds ratio 1.89 (95% CI 1.72 to 2.07) and 30-day readmission-related mortality (hazard ratio 1.30 (95% CI 1.01 to 1.67)) in patients without SMuRFs remained significant. Conclusions: STEMI patients without SMuRFs have a significantly higher risk of in-hospital and 30-day mortality than those with SMuRFs. Women and older patients without SMuRFs experienced significantly higher in-hospital and 30-day readmission-related mortality.

Disaster nursing competencies of rural nurses during COVID-19: A cross-sectional study.

Background: Although rural nurses' roles are indispensable in coronavirus disease 2019 (COVID-19) management, increased roles, workload, burnout, and reduced job satisfaction can hinder their work, potentially affecting nurses' disaster nursing competencies. Aim: The aim of the study was to identify the predictors of rural nurses' disaster nursing competencies during the COVID-19 pandemic. Methods: Nurses from rural community hospitals in South Korea (N=204) were surveyed during June-July 2021. We used the Professional Quality of Life and Disaster Nursing Preparedness-Response Competencies questionnaires. Multiple regression analysis was performed to identify the predictors of disaster nursing competencies. Findings: The mean score for disaster nursing competency of the 204 participants was 110.80 (standard deviation=19.14). Disaster nursing competencies correlated with age, nursing career, compassion satisfaction, and secondary traumatic stress. Compassion satisfaction (ß=.27, P=.004), prior disaster nursing education (ß=.19, P=.005), and prior participation in disaster nursing care (ß=.16, P=.022) predicted disaster nursing competencies, together accounting for 24.2% of the variance. Discussion: Our findings imply that increasing opportunities for continuing education regarding disaster nursing is crucial to enhance the related competencies in rural nurses. This study also highlights the necessity for stakeholders to develop programs aimed at increasing rural nurses' compassion satisfaction. Conclusion: Prior disaster nursing education, prior participation in disaster nursing care, and compassion satisfaction predicted disaster nursing competencies among rural nurses, with compassion satisfaction being the strongest predictor.

High School Students' Social Jetlag, Lifelong Competency, and Academic Stress During the COVID-19 Pandemic: A Cross-Sectional Study.

With the prolongation of non-ordinary situations such as school closures due to the coronavirus disease 2019 (COVID-19) pandemic, high school students have experienced irregular sleep-wake cycles and elevated academic stress resulting from reduced academic achievement and widened gaps in academic performance. This cross-sectional study aimed to investigate the associations among chronotype, social jetlag, lifelong learning competency, and academic stress in high school students during the COVID-19 pandemic. Data were collected through an online survey from May-June 2021. The mean social jetlag was found to be 2 h and 9 min, and multiple regression analysis revealed that social jetlag and lifelong competency affected academic stress. Thus, measures to minimize social jetlag and improve lifelong learning competencies should be implemented to reduce academic stress among high school students. School nurses should identify students with severe social jetlag and provide guidance and interventions to promote sleep hygiene and regular lifestyles.

Early Clinical Outcomes of Patients With Stress-Induced Cardiomyopathy Receiving Acute Mechanical Support in the US.

Background: The role of acute mechanical circulatory support (aMCS) in patients with stress-induced cardiomyopathy (SIC) complicated by cardiogenic shock (CS) is not well studied. Here, we describe the incidence and outcomes of aMCS use in SIC-CS using a large national database. Methods: Using the Nationwide Readmissions Database from January 2016 to November 2019, we identified patients hospitalized with SIC who received isolated intra-aortic balloon pump (IABP), microaxial flow pump (Impella, Abiomed), or extracorporeal membrane oxygenation (ECMO) during the index hospitalization. Results: A total of 902 among 94,709 hospitalizations for SIC (1.0%) required aMCS during the index hospitalization: 611 had IABP (67.7%), 189 had Impella (21.0%) and 102 had ECMO (11.3%). Patients with ECMO or Impella had higher in-hospital mortality rates than those with IABP (37.3% vs 29.1% vs 18.5%, respectively). There was an increased adjusted risk of in-hospital death with Impella (adjusted odds ratio [aOR], 1.98; 95% CI, 1.12-3.49) and ECMO (aOR, 4.15; 95% CI, 1.85-9.32) vs IABP. Impella was associated with an increased adjusted risk of 30-day readmission compared to IABP (aOR, 2.53; 95% CI, 1.16-5.51). Patients with ECMO or Impella had a higher incidence of renal replacement therapy and vascular/bleeding complications compared to those who received IABP. Conclusions: In this nationwide analysis using an administrative database, patients who received ECMO and Impella showed higher rates of in-hospital mortality, renal replacement therapy, and vascular/bleeding complications compared to those who received IABP. Patients with more comorbidities may receive more aggressive hemodynamic support which may account for observed mortality differences. Future prospective studies with objective and universal characterization of baseline clinical and hemodynamic characteristics of patients with CS secondary to SIC are needed.

Comparing Themes Extracted via Topic Modeling and Manual Content Analysis: Korean-Language Discussions of Dementia on Twitter.

We randomly examined Korean-language Tweets mentioning dementia/Alzheimer's disease (n= 12,413) posted from November 28 to December 9, 2020, without limiting geographical locations. We independently applied Latent Dirichlet Allocation (LDA) topic modeling and qualitative content analysis to the texts of the Tweets. We compared the themes extracted by LDA topic modeling to those identified via manual coding methods. A total of 16 themes were detected from manual coding, with inter-rater reliability (Cohen's kappa) of 0.842. The proportions of the most prominent themes were: burdens of family caregiving (48.50%), reports of wandering/missing family members with dementia (18.12%), stigma (13.64%), prevention strategies (5.07%), risk factors (4.91%), healthcare policy (3.26%), and elder abuse/safety issues (1.75%). Seven themes whose contents were similar to themes derived from manual coding were extracted from the LDA topic modeling results (perplexity: -6.39, coherence score: 0.45). Our findings suggest that applying LDA topic modeling can be fairly effective at extracting themes from Korean Twitter discussions, in a manner analogous to qualitative coding, to gain insights regarding caregiving for family members with dementia, and our approach can be applied to other languages.

Comparing Emotional Valence Scores of Twitter Posts from Manual Coding and Machine Learning Algorithms to Gain Insights to Refine Interventions for Family Caregivers of Persons with Dementia.

We randomly extracted Korean-language Tweets mentioning dementia/Alzheimer's disease (n= 12,413) from November 28 to December 9, 2020. We independently applied three machine learning algorithms (Afinn, Syuzhet, and Bing) using natural language processing (NLP) techniques and qualitative manual scoring to assign emotional valence scores to Tweets. We then compared the means and distributions of the four emotional valence scores. Visual examination of the graphs produced indicated that each method exhibited unique patterns. The aggregated mean emotional valence scores from the NLP methods were mostly neutral, vs. slightly negative for manual coding (Afinn 0.029, 95% CI [-0.019, 0.077]; Syuzhet 0.266, [0.236, 0.295]; Bing -0.271, [-0.289, -0.252]; manual coding -1.601, [-1.632, -1.569]). One-way analysis of variance (ANOVA) showed no statistically significant differences among the four means after normalization. These findings suggest that the application of NLP can be fairly effective in extracting emotional valence scores from Korean-language Twitter content to gain insights regarding family caregiving for a person with dementia.

Person-centred care among intensive care unit nurses: A cross-sectional study.

OBJECTIVE: Practising person-centred care is crucial for nurses in the intensive care unit, as patients have high physical and psychological care needs. We aimed to identify the predictors of person-centred care among nurses working in intensive care settings. METHODS: In this cross-sectional study, 188 intensive care unit nurses at four tertiary hospitals in two cities of South Korea were included. They completed self-reported questionnaires on emotional intelligence, compassion satisfaction, secondary traumatic stress, burnout, and person-centred care. Emotional intelligence was measured using the Korean version of the Wong and Law's emotional intelligence scale. Compassion satisfaction, secondary traumatic stress, and burnout were measured by the Professional Quality of Life questionnaire (version 5). Person-centred care was measured using the person-centred critical care nursing scale. RESULTS: Multiple regression identified compassion satisfaction (ß = 0.49, p <.001) as the most powerful predictor of person-centred care, followed by emotional intelligence (ß = 0.21, p =.004) and intensive care unit career length (ß = 0.17, p =.021). These three variables accounted for 31.0 % of the variance in person-centred care. CONCLUSIONS: This study highlights the importance of career length, emotional intelligence, and compassion satisfaction in the promotion of person-centred care among intensive care unit nurses. Nursing management should contemplate specific measures to reduce turnover among experienced intensive care unit nurses and to enhance the factors that promote person-centred care, such as compassion satisfaction and emotional intelligence.

Improved Functional Assessment of Ischemic Severity Using 3D Printed Models.

Objective: To develop a novel in vitro method for evaluating coronary artery ischemia using a combination of non-invasive coronary CT angiograms (CCTA) and 3D printing (FFR3D). Methods: Twenty eight patients with varying degrees of coronary artery disease who underwent non-invasive CCTA scans and invasive fractional flow reserve (FFR) of their epicardial coronary arteries were included in this study. Coronary arteries were segmented and reconstructed from CCTA scans using Mimics (Materialize). The segmented models were then 3D printed using a Carbon M1 3D printer with urethane methacrylate (UMA) family of rigid resins. Physiological coronary circulation was modeled in vitro as flow-dependent stenosis resistance in series with variable downstream resistance. A range of physiological flow rates (Q) were applied using a peristaltic steady flow pump and titrated with a flow sensor. The pressure drop (ΔP) and the pressure ratio (Pd/Pa) were assessed for patient-specific aortic pressure (Pa) and differing flow rates (Q) to evaluate FFR3D using the 3D printed model. Results: There was a good positive correlation (r = 0.87, p < 0.0001) between FFR3D and invasive FFR. Bland-Altman analysis revealed a good concordance between the FFR3D and invasive FFR values with a mean bias of 0.02 (limits of agreement: -0.14 to 0.18; p = 0.2). Conclusions: 3D printed patient-specific models can be used in a non-invasive in vitro environment to quantify coronary artery ischemia with good correlation and concordance to that of invasive FFR.

Work stress and perceived organisational support on young Korean nurses' care for COVID-19 patients.

Background: Since the outbreak of COVID-19 worldwide, frontline nurses have faced tremendous stress. Younger nurses in their early-to-mid careers can be more exposed to burnout and work stress, and perceived organisational support can influence the quality of nursing care for vulnerable patients. Aim: To identify the impact of younger nurses' work stress and perceived organisational support on their willingness to care for COVID-19 patients. Methods: The cross-sectional secondary data analysis included 211 hospital nurses (<35 years) in South Korea with a mean age of 24.60 years (SD=1.90). Multiple logistic regression analysis was used to identify the factors influencing willingness to care. Findings: Supplying personal protective equipment, training in the use of personal protective equipment, lower work stress, and positive perceptions of organisational support significantly increased early-career nurses' willingness to care. For mid-career nurses, being male and higher work stress significantly increased their willingness to care. Discussion: Support, including COVID-19-related education or training, should be provided to reduce work stress arising from being exposed to infection or while providing care to critically ill patients, especially among early-career nurses. Support from nurse managers, senior staff, and colleagues could help younger nurses cope better with the challenges of COVID-19, thus increasing their willingness to care. Conclusion: Perceived organisational support may facilitate early-career nurses' organisational commitment. Healthy work environments can relieve early-to-mid-career nurses' work stress, thus facilitating patient-centred care.

Nursing students' motivational and self-regulated learning during the COVID-19 pandemic: A cross-sectional study.

On-site clinical training, which has been greatly hindered during the COVID-19 pandemic, is essential in nursing practicum. This study aimed to identify the predictors of nursing students' motivational and self-regulated learning in clinical nursing practicum during the pandemic. This cross-sectional study aimed to identify the predictors of motivational and self-regulated learning among nursing students in clinical nursing practicum during the COVID-19 pandemic. An online survey was completed by 195 nursing students in Korea in 2021. Students' moral sensitivity and motivational and self-regulated learning were assessed using the Moral Sensitivity Questionnaire and the Motivated Strategies for Learning Questionnaire. Multiple regression analysis revealed that moral sensitivity was the most potent predictor of motivational and self-regulated learning, followed by online clinical practicum experience, determination to become a nurse, and online practicum type; these factors explained 21.0% of the variance. Practicum courses using a tailored hybrid model, combining online and in-person approaches for imparting nursing practices and inspiring moral sensitivity, can enhance nursing students' motivational and self-regulated learning. Modules to enhance nursing students' moral sensitivity should be included in online practicum curricula.

Pathological narcissism, interpersonal cognitive distortions, and workplace bullying among nurses: A cross-sectional study.

AIM: The aim of this work is to examine whether nurses' pathological narcissism and interpersonal cognitive distortions predict workplace bullying when controlling for organizational culture, work-related factors, and demographic variables. BACKGROUND: To eradicate workplace bullying, a multifaceted holistic approach to identify potential predictors is needed. Nurses' narcissistic behaviours negatively affect collegial relationships and the organization. Furthermore, interpersonal cognitive distortions have been demonstrated to directly affect bullying and victimization. METHODS: Responses from 236 nurses to an online survey were analysed. The Pathological Narcissism Inventory, Interpersonal Cognitive Distortions Scale, Positive Nursing Organizational Culture Measurement Tool, and The Negative Acts Questionnaire-Revised were used to measure the key variables. RESULTS: A multiple regression analysis revealed that pathological narcissism (ß = .33, p < .001) had the greatest effect on nurses' workplace bullying, followed by positive organizational culture (ß = -.31, p < .001), interpersonal cognitive distortions (ß = .17, p = .028), marital status (ß = -.15, p = .020), and position (ß = -.12, p = .047). CONCLUSIONS: Although prejudice or stigma surrounding narcissistic personalities should be avoided, nurses should be aware of and manage such characteristics so that they do not become a factor in workplace bullying. IMPLICATIONS FOR NURSING MANAGEMENT: There is a need to protect nurses from workplace bullying and create a positive organizational culture by recognizing narcissistic traits and preparing intervention strategies that support improvement.