Development and psychometric testing of the clinical adjustment scale for student nurses (CAS-SN): A scale for assessing student nurses' adaptation in clinical settings.

BACKGROUND: Nurse education is critical for preparing student nurses for clinical practice, but the transition to clinical settings poses numerous challenges. A standardized scale to assess student nurses' adjustment in the clinical area is lacking in the Philippines. OBJECTIVE: This paper described the development and evaluation of the Clinical Adjustment Scale for Student Nurses (CAS-SN). DESIGN: An exploratory sequential research design. SETTINGS: Nursing schools in three government owned universities in the Philippines. METHODS: Expert panels and field pretesting established content and face validity. Inter-item and inter-total correlations and Cronbach's α were used to assess the reliability of the scale. Construct validity was evaluated using exploratory factor analysis (EFA). Criterion validity was evaluated with established measures. RESULTS: The CAS-SN comprises 15 items across three subscales: (1) Professional Growth and Interpersonal Engagement, (2) Clinical Competence and Confidence, and (3) Coping and Support Strategies Reliability was excellent and the validity was satisfactory, with significant correlations with academic adjustment, psychological distress, and dropout intention. CONCLUSION: The CAS-SN was found to be a valid and a reliable for assessing student nurses' clinical adjustment. IMPLICATIONS FOR NURSE EDUCATION: The CAS-SN provides a structured framework to assess and monitor student nurses' clinical adaptation, enhancing our understanding of their competence, resilience, and professional identity development. Its integration into nurse education programs can significantly improve the assessment of clinical learning experiences and contribute to better student learning outcomes.

Utilizing Artificial Intelligence-Based Tools for Addressing Clinical Queries: ChatGPT Versus Google Gemini.

BACKGROUND: Artificial intelligence (AI)-based text generators, such as ChatGPT (OpenAI) and Google Bard (now Google Gemini), have demonstrated proficiency in predicting words and providing responses to various questions. However, their performance in answering clinical queries has not been well assessed. This comparative analysis aimed to assess the capabilities of ChatGPT and Google Gemini in addressing clinical questions. METHOD: Separate interactions with ChatGPT and Google Gemini were conducted to obtain responses to the clinical question, posed in a PICOT (patient, intervention, comparison, outcome, time) format. To ascertain the accuracy of the information provided by the AI chat bots, a thorough examination of full-text articles was conducted. RESULTS: Although ChatGPT exhibited relative accuracy in generating bibliographic information, it displayed some inconsistencies in clinical content. Conversely, Google Gemini generated citations and summaries that were entirely fabricated. CONCLUSION: Despite generating responses that may appear credible, both AI-based tools exhibited factual inaccuracies, raising substantial concerns about their reliability as potential sources of clinical information. [J Nurs Educ. 2024;63(8):556-559.].

The role of nurses' adherence to clinical safety guidelines in linking nurse practice environment to missed nursing care.

INTRODUCTION: While the nurse practice environment's vital role in shaping patient care outcomes is well established, the precise mechanisms through which it influences missed nursing care remain unexplored. Hence, this study examined the mediating role of adherence to clinical safety guidelines in the relationship between the nurse practice environment and missed nursing care. METHODS: This descriptive, cross-sectional study involved 1237 nurses from 11 governorates in the Sultanate of Oman. Data were collected using three standardized scales: the Patient Safety Adherence Scale, the Practice Environment Scale of the Nursing Work Index, and the Missed Nursing Care Scale. RESULTS: A favorable nurse practice environment was associated with higher adherence to clinical safety guidelines (ß = 2.492, p < 0.001) and a lower frequency of missed nursing care (ß = -0.2919, p = 0.015). Adherence to clinical safety guidelines partially mediated the relationship between the nurse practice environment and missed nursing care (ß = -0.055, p < 0.001). CONCLUSION: Enhancing the nurse practice environment plays a crucial role in improving nurses' adherence to clinical safety guidelines, which in turn reduces compromised nursing care. CLINICAL RELEVANCE: Healthcare administrators and policymakers should prioritize improving working conditions to enhance nurses' adherence to clinical safety guidelines, thereby minimizing the occurrence of missed care and improving overall patient outcomes.

Determinants of Nurse Managers' Transformational Leadership: The Role of Individual Unit and Organizational Characteristics.

OBJECTIVE: The aim of this study was to examine the relationship between various factors and self-perceived transformational leadership among a sample of Filipino nurse managers (NMs). BACKGROUND: Transformational leadership plays a crucial role in promoting positive outcomes in healthcare settings, particularly for NMs. Understanding the factors that influence NMs' self-perceived transformational leadership is essential for improving leadership practices and enhancing organizational effectiveness. METHODS: A cross-sectional research design was used to collect data from 260 NMs using standardized measures. RESULTS: Employment status, the number of units managed, the type of hospital employment, psychological distress, and job satisfaction were factors that significantly influenced their leadership perceptions. CONCLUSION: By addressing the identified factors, nursing organizations can create an environment that promotes effective leadership practices, ultimately enhancing patient outcomes, staff satisfaction, and overall organizational performance.

Stress as a mediator between abusive supervision and clinical nurses' work outcomes.

AIMS: This study aimed to test whether stress could mediate the association between abusive supervision and nurses' work engagement, absenteeism, and turnover intention. BACKGROUND: Abusive supervision has been attributed to suboptimal work performance and reduced productivity among employees in different sectors. While existing nursing literature links abusive supervision to a wide range of work-related outcomes in the nursing workforce, little is known regarding the mechanism underlying this relationship. DESIGN: Data for this descriptive study were collected from 770 direct-care nurses from seven acute care hospitals in the Philippines, utilizing five standardized scales. RESULTS: Abusive supervision had direct positive effects on absenteeism (ß = .189, p < .001) and intent to leave (ß = .138, p < .001) and a direct negative effect on job engagement (ß = -.131, p < .001). The relationships between abusive supervision and absenteeism (ß = .175, p < .001), intent to leave (ß = .131, p < .001), and work engagement (ß = -.122, p < .001) were partially mediated by stress. CONCLUSIONS: Stress mediated the relationship between abusive supervision and nurses' work outcomes, including turnover intention, absenteeism, and work disengagement. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The evident connection between abusive supervision, stress, and work-related outcomes underscores the importance of focusing on enhancing managerial supervisory styles as a potential organizational strategy to enhance staff retention and well-being.

Umbrella Review: Stress Levels, Sources of Stress, and Coping Mechanisms among Student Nurses.

Prelicensure nursing students face significant stress from their education and clinical placements, highlighting the crucial need for the development of effective coping mechanisms with which to manage both academic and clinical responsibilities, ultimately enhancing the wellbeing and academic performance of these students. This umbrella review aims to evaluate and synthesize existing review articles that examine stress levels and coping mechanisms among student nurses during their education and training. Five databases (PsycINFO, PubMed, CINAHL, Scopus and Web of Science) were searched for review articles published from 2010 onwards. This review includes twelve articles, encompassing 189 studies. The review findings demonstrate that student nurses experience moderate-to-high levels of stress during their nurse education. Major sources of stress include academic demands, patient care responsibilities, and interactions with nursing staff and faculty. Commonly utilized coping skills involve problem-solving behaviors, transference, and maintaining an optimistic outlook. Given the adverse consequences of stress, nurse educators play a critical role in the development of strategies with which to reduce stress and enhance coping skills among student nurses. This study was not registered.

A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review.

The coronavirus disease 2019 (COVID-19) pandemic has placed unparalleled pressure on many countries' healthcare systems, impacting the delivery of health and nursing care services. Despite the growing number of missed care studies during the pandemic, a broader perspective is essential when designing theory-driven strategies to improve nursing care delivery. This review aimed to synthesize evidence of missed nursing care during the COVID-19 pandemic in acute care settings through a systematic review and narrative synthesis. An electronic search of articles published since the emergence of the pandemic was conducted using 5 databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO). A total of 470 articles were identified during the initial search, and 10 articles were included in the review. The sample sizes of the studies ranged from 37 to 536 nurses. Results of the content analysis were grouped into 5 categories: (1) prevalence of missed care, (2) frequency of missed care, (3) reasons for missed care, (4) nurses' and organizational variables contributing to missed care, and (5) work environment elements contributing to missed care. The review's findings revealed a shift in the nature of missed nursing care during the pandemic, with an emphasis on nursing care tasks vital for the recovery of patients with COVID-19. Despite the unique circumstances brought about by the pandemic, an inadequate nursing workforce continued to be identified as the primary reason for missed care, consistent with the pre-pandemic period.

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

INTRODUCTION: Ensuring patient safety is a critical component of healthcare delivery, and nurses play a vital role in adhering to patient safety protocols to prevent adverse events. However, studies linking nurses' adherence to these protocols with patient outcomes is scarce. This study has two-fold purposes: (1) to examine determinants of nurses' adherence to patient safety protocols, and (2) to investigate the relationship between nurses' adherence to patient safety protocols and adverse patient events. DESIGN: A cross-sectional design. METHODS: A total of 343 clinical nurses from five hospitals in the Philippines were included in this study. Two standardized scales were used to collect data, including the Patient Safety Adherence Scale and the Adverse Patient Events Scale. Data collection took place from April 2022 to August 2022. RESULTS: Adherence to patient safety protocols was generally moderate to high (M = 4.483), while nurse-reported adverse events occurred at a lower frequency (M = 1.150). Lower adherence rates were identified in areas such as reporting safety errors (M = 3.950), conducting fall risk assessments (M = 4.299), and adhering to pressure ulcer prevention guidelines (M = 3.979). Patients' and their families' complaints (M = 2.129) and abuses (M = 1.475) were the most frequently reported adverse events. Increased adherence to safety protocols was associated with higher reporting of adverse patient events (ß = 0.115, p < 0.001). CONCLUSION: Higher adherence to patient safety protocols resulted in an increased reporting of adverse patient events. The factors identified that contributed to nurses' adherence to patient safety protocols can be utilized in the development of strategies aimed at improving compliance, especially in areas where adherence is currently low. CLINICAL RELEVANCE: Healthcare organizations should prioritize efforts to enhance adherence to patient safety protocols, particularly in areas with lower compliance rates, through relevant trainings, resource provision, and support systems. Promoting a culture of open communication and reporting can significantly contribute to reducing adverse events and improving patient safety.

Relationship between transformational leadership, adverse patient events, and nurse-assessed quality of care in emergency units: The mediating role of work satisfaction.

BACKGROUND: Effective leadership plays a pivotal role in healthcare settings, particularly in the fast-paced and high-pressure environment of the emergency room, as it is closely linked to patient safety and the overall quality of care. This study assessed the mediating role of work satisfaction in the relationship between nurses' perceptions of their nurse managers' transformational leadership, reported adverse patient events, and the nurse-assessed quality of care in the emergency units. METHODS: A cross-sectional survey design was carried out involving 283 emergency room nurses from the Philippines, utilizing standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4). RESULTS: Emergency room nurses perceived their nurse managers as highly transformational. Nurses' perceptions of transformational leadership in their nurse managers were associated with a reduction in reported adverse patient events and an increase in nurse-assessed nursing care quality. Work satisfaction partially mediated the relationship between transformational leadership and nurse-assessed nursing care quality, but it did not serve as a mediator between transformational leadership and reported adverse patient events. CONCLUSION: The results suggested that enhancing transformational leadership behaviors among nurse leaders can foster work satisfaction in ER nurses, which, in effect, contributes to enhanced nursing quality of care provision in emergency settings.

Relationship between transition shock in novice emergency room nurses, quality of nursing care, and adverse patient events: The mediating role of emotional exhaustion.

BACKGROUND: Transition shock, experienced during the first two years of employment, has been attributed to decreased clinical performance and an overall decrease in work productivity among newly graduated nurses, as well as compromised patient safety outcomes. This study tested the intermediary effect of emotional exhaustion on the association between transition shock in novice emergency room (ER) nurses, adverse patient events, and nursing care quality. METHODS: A descriptive study was carried out involving 303 novice ER nurses from various emergency units in five different hospitals in Central Philippines, utilizing four standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4). RESULTS: Transition shock in novice ER nurses was associated with an increased incidence of adverse patient events (ß = 0.3897, p = 0.0005) and poorer nursing care quality (ß = -0.2146, p = 0.0021). Furthermore, emotional exhaustion partially mediated the association between transition shock and the two patient-related outcomes: adverse patient events (ß = 0.0477, 95 % CI = 0.0078-0.0997) and nursing care quality (ß = -0.0142, 95 % CI = -0.0412 to -0.0095). CONCLUSIONS: Transition shock in novice ER nurses contributed to heightened emotional exhaustion, which subsequently led to an increased incidence of adverse patient events and a decline in the quality of nursing care.

Abusive Supervision and Its Relationship With Nursing Workforce and Patient Safety Outcomes: A Systematic Review.

Despite efforts to improve management and leadership behaviors among nurse managers, studies have shown the pervasive nature of abusive supervision in nursing practice, with strong evidence linking this type of behavior to reduced work productivity among nurses. This systematic review aimed to appraise and synthesize peer-reviewed studies that examine nurse-related and patient safety outcomes associated with abusive supervision. The review searched nursing literature from five databases (PubMed, CINAHL, Scopus, Web of Science, and PsycINFO) between August and November 2022. A total of 21 relevant studies were identified, with the Abusive Supervision Scale being the most frequently used measurement tool. Through content analysis, the review identified 29 outcomes which were categorized into six groups: (a) affective-based, (b) behavior/performance-based, (c) relationship-based, (d) cognitive-based, (e) health and well-being, and (f) nursing care. In addition, 10 mediators were identified and grouped into three categories: (a) affective-based, (b) motivation-based, and (c) health and well-being. The review findings provide compelling evidence regarding the detrimental effects of abusive supervision in the nursing workforce. Moreover, the review emphasizes the need for further research to explore how such behavior can impact patient safety outcomes. To address abusive supervision, it is crucial to promote positive behaviors among nurse managers through human resource mechanisms, relevant rules and policies, and theory-driven leadership development programs.

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

INTRODUCTION: Nurse caring ability plays a crucial role in providing quality care and ensuring patient safety. However, further research is warranted to understand the specific impact of caring ability on patient safety in the emergency department. AIM: This study has two-fold purposes: (a) to examine the association between nurses' demographic characteristics and their perceptions of their caring ability, and (b) to explore the relationship between nurses' caring ability and nursing care quality, as well as its impact on adverse patient events and missed care. METHODS: This cross-sectional study included a convenience sample of emergency room nurses working in select hospitals in the Philippines. Descriptive statistics and regression analyses were performed to analyze the data. RESULTS: A total of 164 out of the 200 emergency nurses invited responded to the survey. The mean score for the caring ability inventory was 67.89 out of 80. Nurses' demographic characteristics, including job status (working part-time) and hospital size (working in small and medium-sized hospitals), were associated with higher levels of caring ability. Higher levels of nurses' caring ability were associated with better nursing care quality (ß = 0.259, p <.001), a reduction in adverse events (ß = -0.169, p <.05), and a decrease in instances of missed care (ß = -0.158, p <.01). CONCLUSION: This study emphasizes the significance of nurses' characteristics in influencing nurse caring abilities. Additionally, the results underscore the importance of nurse caring ability in the emergency department and its association with nursing care quality and patient safety outcomes. Organizational strategies directed toward promoting and enhancing nurse caring ability in the emergency department can have positive implications for nursing practice, including improved nursing care quality, reduced adverse events, and decreased instances of missed care.

Linking Toxic Leadership With Work Satisfaction and Psychological Distress in Emergency Nurses: The Mediating Role of Work-Family Conflict.

INTRODUCTION: Toxic leadership is a prevalent issue within health care organizations, including emergency departments. No studies have been found specifically examining these issues among emergency nurses. This study examined the mediating effects of work-family conflict on the relationship between toxic leadership behaviors of nurse managers and psychological distress and work satisfaction among emergency nurses. METHODS: A cross-sectional survey was used to gather data from 285 Filipino emergency nurses, using 4 validated measures. Mediation analyses were conducted using the PROCESS Macro with Model 4. RESULTS: Toxic leadership had a direct negative effect on work satisfaction (ß = -0.3313, P<.001) and a direct positive effect on psychological distress (ß = 0.0945, P = .0491). Work-family conflict partially mediated the relationship between toxic leadership and both psychological distress (ß = 0.0217, SE = .0141, 95% CI = 0.0002-0.0538) and work satisfaction (ß = -0.0438, SE = 0.0216, 95% CI = -0.0884 to -0.0049). DISCUSSION: The study findings highlighted the negative influence of toxic leadership behaviors on the overall work satisfaction and psychological well-being of emergency nurses. In addition, this study identified work-family conflict as a mechanism that explained how the toxic leadership behaviors of nurse managers influenced the psychological well-being and job satisfaction of emergency nurses. The results of this study underscore the need for interventions and strategies to address toxic leadership and mitigate the negative consequences it poses to emergency nurses' well-being.

Direct and Moderating Effects of Work Environment and Structural Empowerment on Job Stress and Job Satisfaction Among Nurses in Oman.

Objectives: This study aimed to explore the relationships between nurses' work environment, job stress and job satisfaction, along with the moderating effects of work environment and empowerment on the relationship between job stress and job satisfaction. Methods: A descriptive correlational design was utilised for this study. The study encompassed a convenience sample of 1,796 hospital nurses from the 11 governorates in Oman. Moreover, a self-report questionnaire that included a set of instruments was used to collect the data. Results: Nurses who perceived higher levels of job stress reported lower levels of satisfaction and empowerment and perceived their work environment as less favourable and supportive. The findings only confirmed the direct effects of work environment and empowerment on satisfaction, whereas no support was found for indirect or moderating effects. Furthermore, the hierarchical regression model showed that 46.5% of the variation in the level of job satisfaction was explained by the study variables. Conclusion: The results of this study demonstrate the importance of implementing strategies that empower staff, provide a supportive and positive work environment and tackle job stress to enhance levels of job satisfaction.

Student nurses' attitudes, perceived utilization, and intention to adopt artificial intelligence (AI) technology in nursing practice: A cross-sectional study.

AIM: The aim of this study was to investigate the attitudes and intentions of student nurses towards Artificial Intelligence (AI) in the context of nursing practice and to explore the relationship between their attitudes towards AI, their perceptions of AI utilization in nursing practice, and their intentions to adopt AI technology. The study hypothesized that perceived utilization of AI in nursing practice would positively influence the intention to use AI and that attitudes towards AI would mediate this relationship. BACKGROUND: AI has the potential to revolutionize various aspects of healthcare, including nursing practice. As AI technology continues to advance, it becomes increasingly important for nurse education to prepare student nurses to leverage AI technology and be willing to adopt it in their nursing practice. DESIGN: Cross-sectional design. METHODS: A total of 200 student nurses from two government-owned nursing schools participated in the study. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4). RESULTS: Perceived AI utilization in nursing practice had a significant positive effect on student nurses' attitudes towards AI (ß = 0.450, p < 0.001) and their intention to adopt AI technology (ß = 0.458, p < 0.001). Attitudes towards AI partially mediated the relationship between perceived AI utilization in nursing practice and the intention to adopt AI technology (ß = 0.255). CONCLUSION: The findings suggest that student nurses had favorable perceptions of AI utilization in nursing practice, expressed high intentions to adopt AI technology, and held positive attitudes towards AI. Furthermore, student nurses' perceptions of AI utilization in nursing practice influenced their attitudes towards AI, which, in turn, affected their intentions to adopt AI technology. Nursing education programs should incorporate AI-focused coursework, training, and experiential learning to further enhance students' readiness and proficiency in utilizing AI technology. Additionally, healthcare institutions should consider creating a supportive environment for nursing students to explore and embrace AI, ultimately preparing them for the evolving landscape of AI-enhanced healthcare practice. TWEETABLE ABSTRACT: Student nurses' attitudes towards AI technology were influenced by their perceptions of AI utilization in nursing practice, which subsequently influenced their intentions to adopt AI technology.

The impact of job burnout on nurses' caring behaviors: Exploring the mediating role of work engagement and job motivation.

AIM: To investigate the influence of job burnout on nurses' caring behaviors, with a specific focus on the serial mediating role of work engagement and job motivation. BACKGROUND: Job burnout is a prevalent issue among nurses and poses significant challenges to their ability to deliver compassionate care. However, the underlying mechanisms that explain the relationship between job burnout and nurses' caring behaviors, which could provide valuable insights for developing targeted interventions and strategies to support nurse well-being and ensure the consistent provision of compassionate care, remain underexplored. METHODS: A cross-sectional design was used to gather data from 520 clinical nurses working in various acute healthcare settings in the Philippines. Mediation analyses were conducted using the PROCESS Macro with Model 6. RESULTS: Nurses exhibited high levels of caring behaviors (M = 4.219); however, they experienced moderate levels of job burnout (M = 2.342). Job burnout had a negative effect (ß = -0.0603, p = 0.0482) on nurses' caring behaviors. Work engagement and job motivation sequentially mediated the relationship between job burnout and nurse caring behaviors (ß = -0.0126, p < 0.05). CONCLUSIONS: Higher levels of job burnout were associated with a decreased demonstration of nurses' caring behaviors. Job burnout among nurses led to a decrease in their level of work engagement and job motivation, ultimately impacting their ability to provide caring behaviors to patients. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Organizations should prioritize creating a positive work environment and implementing theory-driven strategies to address job burnout, which can foster work engagement and job motivation among nurses, thereby providing crucial support for them in delivering high-quality, compassionate care to patients.

Disaster preparedness among nurses in disaster-prone countries: A systematic review.

BACKGROUND: Disaster preparedness is crucial for mitigating the impact of disasters and saving lives. Ensuring preparedness for disaster response and management, particularly among nurses in disaster-prone countries, is essential due to the serious threats disasters pose to affected populations. This study was conducted to appraise and synthesize the literature examining preparedness for disaster management and response among nurses in countries with the highest disaster risks. METHODS: A systematic review of the literature published from 2000 onwards was conducted using five databases: SCOPUS, PubMed, MEDLINE, PsychINFO, and CINAHL. Twenty-one relevant articles were identified for this review. RESULTS: The findings revealed that nurses in countries at high risk of disasters had inadequate disaster knowledge and skills, leaving them ill-prepared to respond to such situations. Previous experience in disaster relief, disaster-related education and training, and higher academic qualifications were associated with increased readiness for disaster response and management. CONCLUSION: The review's findings provide insight into the current state of disaster preparedness among nurses in disaster-prone nations. The review identified evidence highlighting the value of disaster-related education and training, as well as disaster response experience, in fostering preparedness among nurses. These results can inform policymakers, hospital administrators, and nurse administrators in developing strategies for promoting disaster preparedness in nurses through evidence-based training programs and interventions.

Factors associated with millennial nurses' intention to pursue formal leadership roles: a cross-sectional study.

PURPOSE: This study aims to examine the level of intention to pursue formal nursing leadership roles among millennial nurses and to identify the different factors that may play a role in their intentions to pursue such roles. DESIGN/METHODOLOGY/APPROACH: This study used a multi-center, cross-sectional research design. Registered nurses born between 1980 and 2000 (n = 1,377) who worked in 23 acute care hospitals in Oman were included in this study. Data were analyzed using descriptive statistics and multiple linear regression. Data were collected between July 2019 and January 2020. FINDINGS: Nearly 70% of millennial nurses researched their intention for career advancement to assume nursing leadership responsibility. Factors associated with nurses' intention to pursue formal nursing leadership roles were the type of nursing degree held (having a bachelor of science in nursing degree), type of hospital facility affiliation (teaching hospital), previous leadership experience, structural empowerment (access to support, opportunity and resources), work satisfaction and job burnout. ORIGINALITY/VALUE: Millennial nurses, who represent the largest segment of the nursing workforce, have begun assuming nursing management and leadership roles; however, little is known about the factors affecting their intentions to pursue these roles. The findings of this study revealed different factors (both modifiable and nonmodifiable) influencing millennial nurses' intentions to pursue formal leadership roles.