A causal model of thriving at work in Chinese nurses.

AIM: To develop and test the first causal model of thriving at work in Chinese nurses. BACKGROUND: Nurses' ability to thrive at their work is critical to retain qualified nurses and meet the needs of a constantly changing health environment. However, this is a poorly researched area. INTRODUCTION: Thriving at work refers to the feeling of vitality and learning at work, which are evidenced to be solidly associated with nurses' development. Only a few factors have been explored regarding the effects of thriving at work. METHODS: A cross-sectional study was undertaken using stratified random sampling. This involved 565 nurses from five general hospitals in Dali city, Yunnan Province, People's Republic of China. Data were collected from April to September 2019 using seven instruments. The model was constructed and tested using the Analysis of Moment Structure program and reported using the STROBE checklist. RESULTS: All model variables provided direct and indirect effects to the outcome. The final model fitted the empirical data with acceptable indices. DISCUSSION: Predicting variables of workplace mindfulness, authentic leadership, workplace violence, organizational justice and years of experience were found to affect thriving at work directly and indirectly. Psychological capital and perceived organizational support mediated the effects between predicting variables to the outcome. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: Recommendations for nursing and health leaders are provided to improve nurses' thriving at work by building fair, supportive, and safe working environments, improving head nurses' authentic leadership and cultivating nurses' mindfulness. Policies need to be promulgated to improve and regulate the nurse-patient ratio and to eliminate violence against Chinese nurses.

Factors influencing workplace social capital among registered nurses in China.

AIM: To examine the modifiable predictors and the level of workplace social capital, transformational leadership, emotional intelligence and organizational justice among registered nurses in Chinese hospitals. BACKGROUND: Workplace social capital is a relational network developed among nurses and other healthcare professionals that provides social support, and gives value to their working lives. Internationally, cultivating high levels of social capital is critical as it can help improve nurse satisfaction and care, and address nurse turnover. However, knowledge of factors influencing nurses' workplace social capital is limited in China. METHODS: In this cross-sectional, descriptive predictive study, 344 registered nurses were randomly selected from three urban Chinese hospitals in Zhejiang province. Five standard instruments were applied to collect data. Descriptive statistics were used to present the level of the variables and stepwise multiple regression was performed to identify the predictors of nurses' workplace social capital. RESULTS: Among eight potential factors, transformational leadership and emotional intelligence positively predicted workplace social capital. Nurses perceived the overall level of workplace social capital, emotional intelligence and unit managers' transformational leadership as high, and the overall level of organizational justice as moderate. DISCUSSION: Enhancing unit managers' transformational leadership and nurses' emotional intelligence was found to positively influence the development of workplace social capital. Although it is not a predictor of workplace social capital, nurses' organizational justice should be improved due to its importance and current unsatisfactory level. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing and health policymakers need to consider the enhancement of transformational leadership and emotional intelligence when implementing policies to improve nurses' workplace social capital, nursing retention and job satisfaction.

Leveraging nurse practitioner capacities to achieve global health for all: COVID-19 and beyond.

AIM: To argue that nurse practitioners have been under-utilized generally in the current global health environment, creating barriers to achieving universal health coverage and the Sustainable Development Goals. BACKGROUND: Nurse practitioners are advanced practice nurses possessing expert knowledge and leadership skills that can be optimized to narrow disparities and ensure access to high-quality health care globally. Nurses worldwide have been challenged to meet global public health needs in the context of COVID-19 (SARS-CoV-2 virus), and there are early indications that nurse practitioners are being called upon to the full extent of their capabilities in the current pandemic. SOURCES OF EVIDENCE: PubMed; Google Scholar; the International Council of Nurses; World Health Organization; United Nations; and the experiences of the authors. DISCUSSION: Several international reports, nursing and health organizations have called for continued investment in and development of nursing to improve mechanisms that promote cost-effective and universally accessible care. Expanding nurse practitioner scopes of practice across nations will leverage their clinical capacities, policy and advocacy skills, and talents to lead at all levels. CONCLUSION: Ongoing empirical data and policy change is needed to enable the full scope and strategic utilization of nurse practitioners across healthcare systems and contexts. IMPLICATIONS FOR NURSING PRACTICE, AND NURSING AND HEALTH POLICY: Widespread education regarding nurse practitioner capacities for interdisciplinary partners, policymakers and the public is needed. Policies that safely expand their roles are critical. Role titles and remuneration reflective of their scope and service are required to lead, sustain and grow the workforce internationally.

Experiences from Southeast Asia on nursing education, practice, mobility and influencing policy.

In this report from the field, we describe the challenges and opportunities for nursing practice and education, and ways to improve nurse mobility across Asia. We also explain the collaboration within the Southeast and East Asian Nursing Education and Research Network to influence policy development and review. The collaborative process was supported by evidence drawn from discussions at Network meetings, and with nursing and other leaders, an examination of literature and policy documents, and member surveys. We reviewed the region's regulatory statutes which all support diversity in the nursing workforce. The Southeast Asian Nursing Education and Research Network was established in 2015 to support policy development around the upgrading of nurse education, clinical competencies and research capacity, in hospital and primary health care; and facilitating the movement of nurses across national boundaries. Most countries have tried to address policy gaps and their efforts to implement changes are seen in policy expansion and development at the national level. We focus on two policies from the Association of Southeast Asian Nations from 2006 and 2012, that cover nurse mobility, information exchange, nurse capacity building and education and mutual professional recognition of nurses' credentials. However, we found significant variances in education, regulatory policies and clinical competencies that have restricted, and continue to restrict policy implementation. Nursing in South-East Asia has made significant progress in upgrading standards for education by increasing bachelor degree bridging programs, master and doctoral degrees. Participating countries have passed legislation on licensure, competencies and credentialing of internationally qualified nurses wishing to practice in various contexts. However, much work remains to be done. IMPLICATIONS FOR NURSING POLICY, EDUCATION AND PRACTICE: Governing bodies determine entry into practice law which requires dialogue to enhance policies for domestic and international practitioners for mutual exchange and recognition. Nursing practice and education are under government regulatory bodies but require new policies and laws to ensure adequate educational requirements for safe quality practice.

Barriers to quality of work life among Bangladeshi nurses: a qualitative study.

AIM: To explore and provide understanding of the barriers to quality of work life among registered nurses in Bangladesh. BACKGROUND: Globally, there is growing interest in the working environments of nurses, especially at a time of nursing shortages and with the focus on safety and care quality in health systems. In a low socio-economic country like Bangladesh, nurses struggle in a grossly underfunded healthcare system to deliver care to the people but no studies have been conducted on their quality of work life. METHODS: This qualitative descriptive study was conducted at three Bangladeshi tertiary hospitals in May 2015-January 2016. Three focus group discussions were held with 30 registered nurses exploring their perceived barriers to quality of work life. Data were analysed with content analysis. FINDINGS: Seven barriers to their work-life arose: heavy workloads; lack of government accommodation and transportation; poor health status; lack of support from nursing supervisors; lack of promotion opportunities; incomplete hospital policies and procedures; and lack of night shift and risk allowances. DISCUSSION: Participants described many issues and barriers impacting on their work-life. They perceived little reward for their hard work, felt that their health suffered from their working conditions and described a low QWL. CONCLUSION AND POLICY IMPLICATIONS: Findings provide information for nursing and health policymakers and leaders to reduce barriers to improve work-life quality among nurses that can contribute better to quality of nursing care, and nursing retention and satisfaction. Work policies and practices, and funding and other resources need to be scrutinized to ensure better working conditions for Bangladeshi nurses. LIMITATIONS: Interviews were conducted with nurses only in tertiary hospitals in the Bangladeshi capital, and understanding of barriers to work-life quality of nurses in other health settings and regions needs to be explored.

Factors predicting quality of nursing care among nurses in tertiary care hospitals in Mongolia.

BACKGROUND: An increasing nursing shortage, high workloads and poor working environments are affecting the quality of nursing care in many countries including Mongolia. AIM: To explore the level of quality of nursing care, nursing competency and nursing practice environment, as well as the predictability of nurses' personal factors, nursing competency and nursing practice environment on quality of nursing care as perceived by nurses in Mongolia. METHODS: We collected data from 346 registered nurses, randomly selected and working in seven general public tertiary care hospitals in the capital city of Ulaanbaatar, and four regions of Mongolia. Instruments used were the Good Nursing Care Scale, the Competency Inventory for Registered Nurses and the Practice Environment Scale of Nursing Work Index. Data were analysed using descriptive statistics and multiple regression analysis. RESULTS: The overall quality of nursing care and nursing competency was perceived to be at a high level, whereas nursing practice environment was at a favourable level. Nursing competency and nursing practice environment were found as significant predictors of nursing care quality, while personal factors were found as non-significant predictors. DISCUSSION: Improving nursing competency and practice environment enhances the quality of nursing care. However, a study limitation is that self-reporting may not have reflected the accuracy of variables. CONCLUSION: Findings provide important evidence for the use of measures and strategies to enhance the quality of nursing care by improving nursing competency and the nursing practice environment. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Policymakers, administrators and nurses need to work together to develop and implement policies to enhance and support the competency and practice environments of the Mongolian nurses.

Nurses' perceptions of health beliefs and impact on teaching and practice: a Q-sort study.

AIM: To understand Chinese nurses' perceptions of health beliefs, their content, origin and the influence of sociocultural factors, as a basis of their evidence-based practice. This study contributes to a larger study to establish the health beliefs of Japanese, Australian, Chinese, South Korean and Thai nurses. BACKGROUND: Registered nurses teach patients and students about maintaining or attaining health are subject to the same range of influences and their health beliefs may be antithetical to current health evidence. METHODS: Q-method design using q-sort and interview was used to explore the perspectives on a range of health beliefs of 60 nurses in four cities in China. FINDINGS: Three factors arose from the perceptions of the participants about health and accounted for 50.2% of the total variance: (1) social impact, (2) 'the importance of evidence', and (3) beliefs rooted in culture. DISCUSSION: Influence on nurses' health beliefs was explored in terms of the internalized and frequently unconscious beliefs, values and norms tying them to their communities, reflecting the need for nurses to be aware of their health beliefs and behaviours. CONCLUSIONS: Education for nurses in practice needs to acknowledge that individual practitioners' beliefs strongly influence health teaching for patients and families. In order to implement evidenced-based practice and teach in line with current evidence nurses need to critically examine and reflect on the impact of culture, society and the media on their own health beliefs. IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY: Education policy needs to consider that culture and societal pressures affect nurses' health beliefs and practice. Critical thinking, reflective and evidence-based practice need to be emphasized in clinical training and nurse education. China also needs to develop policies to allow nurses to be able to assess the reliability of health information on the Internet and to make quality health research more available.

Analysis of a government policy to address nursing shortage and nursing education quality.

BACKGROUND: A well-educated, sufficient nursing workforce improves population health and standards of nursing care. Analysing workforce policies assists nurses to learn from the past and develop better future policies. AIM: Describe policy-making processes in the first Thai government plan to increase nursing capacity and improve nursing education quality. DESIGN: A qualitative study employing Longest's model to examine policy-making processes. METHODS: Data were obtained from 28 in-depth interviews with key informants, who had been committee members and former deans of nursing involved with the policy processes in the 1990s. Both qualitative and quantitative data were extracted from relevant documents, and content analysis employed with all data. FINDINGS: Three policy phases were identified. Policy formulation, where three streams of problems, politics and policy resulted in identification of nursing shortage, changes of government incumbents and needing to increase nurse production; Policy implementation included creating methods of implementation, appointing responsible people and committees, creating operational plans, producing more nurses and faculty development projects and Policy modification which incorporated implementing the first Thai international doctoral degree in English, a collaborative programme between universities. STUDY LIMITATIONS: Not all key informants could be accessed due to the passage of time. Findings are unique to Thailand but inform internationally of nurses' abilities and need to be involved in policy. CONCLUSION: Nurses were involved in all policy phases. While the policy produced positive developments in growing nursing capacity and education in the past, nursing shortages remained and are now acute in Thailand. IMPLICATIONS FOR NURSING/HEALTH POLICY: Lessons learned from this policy analysis help explain why the nursing education and nursing shortage policy was legislated through the government agenda, and the active involvement of Thai nurses in this process. Nurses globally need to be at the policy-making table to try to reduce nursing shortages, and enhance practice and education environments.

Disaster nursing skills, knowledge and attitudes required in earthquake relief: Implications for nursing education.

BACKGROUND: Globally, nurses becoming more aware of getting better prepared for disaster relief, but in China, disaster nursing knowledge, courses and research are still limited. INTRODUCTION: China has long been prone to disasters, but disaster nursing education and training is in its infancy. AIM: This study explored the skills, knowledge and attitudes required by registered nurses from across China who worked in the aftermath of three large earthquakes to try to determine future disaster nursing education requirements. METHOD: The Questionnaire of Nurses' Disaster Nursing Skills at Earthquake Sites, assessing nursing skills, knowledge and attitudes, was distributed to 139 registered nurses in 38 hospitals in 13 provinces across China who had worked in one or more earthquake disaster zones. Descriptive statistics were used for quantitative data, and content analysis for qualitative data. RESULTS: Eighty-nine questionnaires were returned, a response rate of 68.3%. No respondent had ever received specific disaster nursing training prior to their post-earthquake nursing. Skills most often used by respondents were haemostasis bandaging, fixation, manual handling, observation and monitoring, debridement and dressing, and mass casualty transportation. Respondents identified that the most important groups of skills required were cardiopulmonary resuscitation; haemostasis, bandaging, fixation, and manual handling; and emergency management. They emphasized the need for psychological care of victims as well as that of fellow health workers. CONCLUSION: No respondent had ever received disaster nursing training prior to engagement at the earthquake disaster sites. All believed that there were important gaps in their knowledge and skills, and supported disaster nursing courses in the future. IMPLICATIONS FOR NURSING AND HEALTH POLICY: China urgently needs to develop disaster nursing courses, with the support of nurse leaders, educationalists and government, to implement training using an all hazards approach in accordance with international best practice and trainees' background clinical experience and knowledge.

An ethnographic study of diabetes health beliefs and practices in Sri Lankan adults.

BACKGROUND: Globally, type 2 diabetes is increasingly prevalent; however, unique cultural contexts in each country might affect these diabetes control behaviours. Diabetes is a serious health issue in Sri Lanka and little is known about the impact of sociocultural context on diabetes health behaviours. AIM: This first-time qualitative Sri Lankan study explored the health beliefs and practices of adults with diabetes to enhance current nursing care and medical treatment. METHODS: An ethnographic approach was used to collect data through participant observations, in-depth interviews with 14 key informants in their homes and field notes. Data were analysed by thematic analysis. RESULTS: Findings revealed unique, informative insights into sociocultural worlds of the participants from three Sinhalese, Tamils and Moor ethnic groups. Findings are described under five themes: gaining religious support, changing food habits is a struggle, exercising is challenging, Western medicine causes long-term consequences and Ayurveda/traditional treatments can cure. CONCLUSION: In Sri Lankans, the impact of sociocultural context on glycaemic control behaviours is significant and should be taken in consideration when health professionals provide care, treatment and health education. LIMITATIONS: Study informants were selected from three ethnic groups and just two communities. Further in-depth research is required using both qualitative and quantitative approaches in individual groups. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Culturally relevant policies and protocols for community care and treatment of people with diabetes are urgently required in Sri Lanka to enhance cultural treatment and care and reduce the epidemic of diabetes. These policies need to take into account traditional beliefs and practices of various ethnic groups.

Community health nurses' HIV health promotion and education programmes: a qualitative study.

BACKGROUND: Globally, nurses practice in many settings with people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), taking an increasing share of the professional burden of care and helping to reduce morbidity and mortality. International literature is sparse about Thai community nurses providing primary healthcare programmes for people with HIV. AIM: This study aimed to describe background, experiences and strategies of community nurses regarding their design and delivery of programmes for people living with HIV and AIDS in Chiang Mai Province, Thailand. DESIGN: This study used a qualitative mixed-methods study employing a qualitative survey and in-depth interviews. METHODS: Twenty community health nurses from 18 small community hospitals completed a survey comprising demographic data and 13 open-ended questions. Four of them later engaged in in-depth interviews using the same questions. Survey, interview data and field notes were analysed using interpretive content analysis. FINDINGS: Four themes and six sub-themes portrayed participants' rich experiences and knowledge of HIV health promotion and education; challenges of daily work, discrimination and ethical issues; success through programme diversity comprising promotion of community volunteerism, networking and relationships; and holistic connections with Thai cultural traditions and Buddhism. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings help to recognize the diversity, uniqueness and contributions of Thai community nurses regarding culturally appropriate health promotion and education programmes for people living with HIV and AIDS. Findings inform nurses and health officials in and outside of the country to complement innovation in future HIV health promotion and education programmes. LIMITATIONS: Our sample came from one province of Thailand. Findings might not be reflective of nurses elsewhere. IMPLICATIONS FOR HEALTH AND NURSING POLICY: Three decades of collective experience in providing holistic and multifaceted HIV and AIDS nursing care, education and health promotion by community health nurses have the potential to effect new and existing policies and protocols on HIV community care in Thailand, but more research is required for this.

Samoan Philosophy of Nursing: a basis for culturally proficient care and policy.

AIM: To explore nurses' perspectives about the Samoan Philosophy of Nursing, and determine its feasibility for nursing care of Samoans internationally. BACKGROUND: This philosophy is the conceptual cultural framework for nursing law, practice, education and research in Samoa, and was developed by Samoan nurses who recognized the need for guidance to deliver quality, culturally competent and proficient health care. DESIGN: A mixed method study, employing a questionnaire and ethnographic methods. METHOD: The Samoan Philosophy of Nursing Questionnaire sought demographic data and aspects about the philosophy from 95 registered nurse clinicians, administrators and educators throughout Samoa during 2012. Descriptive statistics were used for data analysis. Additionally, 19 focus groups (5-6 participants each) and 19 in-depth interviews were held to further explore these aspects, as well as participant observations. Descriptive statistics were used to analyse quantitative data, and Spradley's ethnographic method was adopted for analysing the qualitative data. FINDINGS: Of 95 questionnaires analysed, 70% of participants reported using the philosophy all the time, and 30% most of the time. They placed a high satisfaction rate, value and importance on this philosophy. From the ethnography, six major themes emerged: valuable framework of learning; conceptual framework for holistic assessment; benchmark for regulating and monitoring practice improving interaction and culturally proficient practice; potential use for Samoans overseas; and maintaining quality health and the dignity of people. CONCLUSION: This first-time study evaluated the Samoan Philosophy of Nursing and adds to nursing knowledge. Findings confirmed its usefulness as a culturally based conceptual framework to facilitate, regulate and monitor education, research and practice for sustainable health outcomes in Samoa, and for Samoans living abroad. IMPLICATIONS FOR NURSING POLICY AND EDUCATION: It is important that Samoans living abroad receive culturally proficient care, but this requires the support of policymakers, nurse leaders and educators so that nurses internationally can access and competently utilize relevant aspects of this philosophy in practice.

Newborn care in Nepal: the effects of an educational intervention on nurses' knowledge and practice.

AIM: To determine the effectiveness of an educational intervention for improving nurses' knowledge and practice regarding newborn care in Kathmandu, Nepal. BACKGROUND: Four million neonatal deaths occur annually, especially in developing countries. In 2010 in Nepal, the neonatal mortality rate was 28/1000 births. Modern nursing and research education is still developing in Nepal, but the country's nurses are in a unique position to help combat avoidable morbidity and mortality. This study was designed to assist nurses working in maternity units to obtain and/or sustain knowledge and competence in practice to ensure the health and safety of vulnerable newborns, and thereby to help reduce mortality and morbidity. THEORETICAL FRAMEWORK: Concepts from the Transtheoretical Model of behaviour change developed in the USA informed this study in the belief that an educational intervention would assist in behaviour changes in nurses caring for newborns. DESIGN: Quasi-experimental, time-series pre-test/post-test. SETTING: Maternity and women's hospitals in Kathmandu, Nepal. PARTICIPANTS: Convenience sample of 30 nurses working in emergency room, delivery room and birthing centre. METHODS: Nurses were measured on study outcomes at multiple time points: before a self-directed educational intervention and discussion, immediately, 1 and 3 months after intervention. Data were collected using three instruments: a demographics questionnaire, the Knowledge Survey Questionnaire and the Skills Learning Checklist (SLC). The SLC was completed during nursing practice in observations by the researcher. RESULTS: Significant findings suggested that this educational intervention was effective for improving nurses' knowledge and practice regarding newborn care, and there was a positive correlation between knowledge and practice. CONCLUSION: This was the first study of its kind in Nepal, a small step in enhancing nurses' abilities to improve their knowledge and competence regarding care of newborns. However, continued education and guidance are required to sustain knowledge and competence in practice, and our educational intervention needs further testing with other populations of nurses. There are various policy implications required to enable this to happen. This includes health ministry funding and support for in-service education; hospitals and universities working together to offer in-service education, competency testing and revised curricula; and nurse registering authorities requiring ongoing nurse education programmes and competency testing.

Growing together: a qualitative study of leading nurse scholars in Thailand.

BACKGROUND: Asia-Pacific nursing education and research is growing but little is known about the nature and development of nursing scholarship in the region. AIM: This qualitative study explored the perspectives of 14 leading Thai scholars about the development, facilitators and barriers relating to Thailand's nursing scholarship. METHOD: In-depth interviews were digitally recorded, and data were subjected to content analysis. FINDINGS: Five themes arose: (1) growing together, (2) visionary leadership, (3) external support to grow nurse scholars, (4) developing nursing through research, and (5) barriers to scholarship. A history of visionary nursing leadership was revealed, underpinned by leaders' values of growing nursing together. Resource sharing among universities, and a significant number of scholarships for study abroad were major facilitators of scholarship growth. Barriers to scholarship included high teaching loads, especially for newly graduated faculty; a low rate of research publications; not enough mentorship for research and changes to teaching practice; and a wide range of different agencies providing courses for entry to practice. CONCLUSIONS: Scholarship development in Thailand is a role model for a number of South-East Asian countries, with inclusiveness and collaboration to facilitate the growth of nursing education inside and outside of the country as a hallmark of its character. However, against a backdrop of nursing shortages, Thai scholars are challenged, in the future, to produce meaningful research outcomes, including publications of studies; to collaborate with other health professionals; change practices to overcome high teaching loads; and provide the much needed mentorship for young scholars.

Improving the health of Indigenous Australians: reforms in nursing education. An opinion piece of international interest.

AIM: This paper overviews Indigenous disadvantage in relatively wealthy Australia. It describes efforts to increase the recruitment and retention of Indigenous people in nursing and to reform nursing education to be more inclusive of Indigenous culture, health and history. BACKGROUND: Indigenous people on average die 17 years younger than non-Indigenous people and have health problems similar to those of people in some underdeveloped countries. Moreover, social injustice and human rights issues affect their health and well-being and educational opportunities. They are under-represented in the health professions, including nursing, often through a lack of educational preparation and historical, socio-economic and cultural factors hindering them from entering and succeeding in university studies. METHODS: In 2000, a project was funded by the Australian commonwealth government and led by the Indigenous Nursing Education Working Group. This Group worked for five years on a wide range of methods that included consultation within the profession, information dissemination and longitudinal surveying of university schools of nursing and Indigenous support units. RESULTS: Findings show that collaborative efforts between key stakeholders in nursing education appear to be succeeding to increase the numbers of Indigenous students of nursing. Around two-thirds of schools of nursing now include Indigenous content in their undergraduate curricula, but the majority is yet to provide Indigenous cultural awareness/cultural safety training for faculty.