Individual and social system factors influencing evidence-based practices among nurses in general hospitals: A cross-sectional multi-institutional study.

AIMS AND OBJECTIVES: To investigate evidence-based practices and examine the influence of individual and social system factors on evidence-based practices among nurses in general hospitals. BACKGROUND: Evidence-based practice is essential for improving healthcare quality. However, a challenge for nursing worldwide is nurses' limited use of evidence-based practices. It is crucial to determine the individual and social system factors affecting nurses' use of evidence-based practices. DESIGN: This study employs a multi-institutional cross-sectional design. METHODS: With a multistage random sampling method, 336 registered nurses were recruited from 17 general hospitals in the Republic of the Union of Myanmar. Data were collected through a seven-part questionnaire, including the Evidence-Based Practice Implementation Scale and individual and social system factors. Data were analyzed using descriptive statistics and multiple linear regression. RESULTS: Nurses in general hospitals perceived low levels of evidence-based practices. Individual factors, such as perceived barriers (p < .001), knowledge (p < .001) and attitudes (p = .001), were related to EBP as well as social system factors, including the work environment (p < .001) which influence nurses' practice, explaining 34% variance among nurses. CONCLUSION: Nurses perceived the work environment as the most influencing factor related to evidence-based practices. Individual characteristics, including perceived knowledge, attitudes and barriers, were critical factors in performing evidence-based practices in Myanmar. RELEVANCE TO CLINICAL PRACTICE: Nurse administrators and policymakers can develop strategies and interventions for improving knowledge, attitudes and work environment towards evidence-based practice. Minimizing the barriers to evidence-based practice will promote evidence-based practices in Myanmar general hospitals. IMPACT: In addressing the individual and social system factors influencing the evidence-based practices of nurses, this study contributes to enhancing healthcare quality and outcomes. REPORTING METHOD: This study adhered to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution.

Factors influencing nursing faculty members' intent to stay: A structural equation modeling approach.

Intent to stay is a helpful indicator in predicting the turnover rate of nursing faculty members in academia. This descriptive, cross-sectional study aimed to identify the factors influencing nursing faculty members' intent to stay. The sample consisted of 350 nursing faculty members randomly selected from 53 nursing and midwifery training schools in Myanmar. Data were collected between June and October 2021. The eight instruments used showed satisfactory (0.80-1.00) for validity and (0.86-0.96) for reliability. Data were analyzed by descriptive statistics and structural equation modeling (SEM). The final modified model of intent to stay fit the empirical data and explained 81.30% of total variance for intent to stay. SEM revealed that job satisfaction and organizational commitment directly affected intent to stay; transformational leadership, job autonomy, and perceived organizational support indirectly affected intent to stay; and workload, age, and job stress, directly and indirectly, affected intent to stay. These results suggest nursing administrators and nursing leaders to develop appropriate strategies or design interventions for enhancing nursing faculty members' intent to stay.

Development and psychometric testing of the Perceived Organizational Climate Scale for nurses.

AIM: Retaining nurses on the job is vital, and their successful retention is related to the organizational climates (OC) of healthcare settings. The purpose was to develop and test the psychometric properties of the Perceived Organizational Climate Scale (POCS). DESIGN: The methodologic research design was used by following the scale development strategies by DeVellis (2017). The conceptual framework for this study was based on the broader theoretical framework of the Competing Value Framework (CVF) of Quinn et al. (2015), the concept analysis and extensive literature review (1939-2018), and combined with the inductive qualitative data. METHODS: A two-phase study of scale construction and psychometric testing was conducted for content validation, construct validation and internal consistency reliabilities of the instrument. An expert panel validated the 4-point scale, followed by exploratory factor analysis, the known-group approach and split groups. Data were collected from (1161) registered nurses in eight general hospitals across Myanmar from August 2019 to September 2020. RESULTS: The 35 items with four essential dimensions: transformational climate, bureaucratic climate, team climate and strategic climate, explained almost 50% of the variation with all factor loading greater than .40. The internal consistency reliabilities of the instrument showed the Cronbach's alpha coefficient of .93, and the dimensions were from .82 to .85. As hypothesized, the known-group approach demonstrated that experienced nurses had higher mean scores than novices. The internal consistency reliabilities of the scale and dimensions across the splitting groups illustrated the stability. CONCLUSION: This evidence supports this instrument as having satisfactory initial psychometric properties with a comprehensive picture of OC by its essential components contributing to an inclusive understanding of this climate globally. IMPACT: This instrument can be used as an objective tool for evaluating OC as perceived by nurses in healthcare settings to inform improvements in working environments.

Factors predicting organizational commitment of nurses in general hospitals: A descriptive-predictive study.

This descriptive-predictive, cross-sectional study aimed to explore organizational commitment and to determine the predictability of years of experience, level of education, position, perceived organizational support, and work-life balance on each component of organizational commitment. The participants included 234 nurses who were randomly selected from four general hospitals in the Republic of the Union of Myanmar. The research instruments included a demographic data form, the Organizational Commitment Scale, the Survey of Perceived Organizational Support, and the Work-Life Balance Scale. The data were analyzed using descriptive statistics and stepwise multiple regression. The results revealed that the nurses perceived the three components of organizational commitment at a moderate level. Years of experience, position, perceived organizational support, and work-life balance explained 38.0% of the total variance for affective commitment, 28.3% for continuance commitment, and 35.9% for normative commitment. The findings of this study can inform administrators and policymakers regarding the development of strategies to improve organizational commitment among nurses based on four predictors.

Factors influencing intention to stay of male nurses: A descriptive predictive study.

Nurse shortages and nurse attrition are high in many countries, and there is also a dearth of male nurses in the profession. This study aimed to examine the level of intention to stay and ten predictors of this among male nurses in China. A descriptive, predictive study was administered to 480 registered male nurses. Eight research instruments were used to collect data. Descriptive statistics and binary logistic regression were employed to analyze the data. The overall intention to stay in the nursing profession as perceived by male nurses was at a moderate level. Binary logistic regression demonstrated that work group cohesion, transformational leadership, career growth, and job satisfaction were significant predictors, explaining 32.2% of the total variance for intention to stay. The findings of this study provide suggestions for nursing administrators and policymakers to develop appropriate strategies or interventions to increase the intention to stay for male nurses to stay in the profession, based on the four predictors.

Nurses' Qualitative Descriptions of the Organizational Climate of Hospitals.

PURPOSE: To explore nurses' perceptions of the organizational climate in general hospitals in Myanmar. DESIGN AND METHODS: Using a qualitative descriptive design, data were purposively collected from all levels of registered nurses in eight general hospitals across Myanmar during August to October 2019. Seventeen individual in-depth interviews and eight focus group discussions with 65 nurses were undertaken and analyzed using Graneheim and Lundman's qualitative content analysis. FINDINGS: Four categories of organizational climate from a Myanmar nursing context emerged: organizational uniqueness, organizational alignment, sense of empowerment, and the reinforcing organization. Organizational uniqueness included the subcategories of perception of features and orientation of the organization, whilst organizational alignment comprised the three subcategories of the values inherent in the management process, the criteria of success, and strategic emphasis. The sense of empowerment category embraced the subcategories of the perceptions of the decision making and roles of leaders or managers; the last category, the reinforcing organization, incorporated the subcategories of bonding and recognition of the organization. CONCLUSIONS: This was the first qualitative nursing study on nurses' perceptions of organizational climate in Myanmar hospitals. Participants revealed a rich source of information that needs to be considered by hospital administrators and other policymakers to enhance quality clinical care by nurses, and their overall well-being and working conditions. The emphasis on the holistic nature of this concept points to further investigations of working conditions, the lives of nurses, and management of nurses within the hospital environments in Myanmar hospitals, and can inform other countries. CLINICAL RELEVANCE: Nurses revealed a rich understanding of what an organizational climate represents or should represent, and they need to work with hospital administrators and managers to contribute to the development of positive organizational climate, which in turn should increase nurse retention and the efficacy of health care provided in hospitals.

Development and psychometric testing of quality nursing care scale in Mongolia.

BACKGROUND: Quality Nursing Care (QNC) is fundamental to the profession of nursing practice. Perception of QNC differ across the globe because of differences in social norms, cultural values and political ambiance and economy. This study aimed to develop a QNC instrument congruent with the Mongolian (QNCS-M) healthcare system and cultural values and societal norms. METHODS: Exploratory sequential mixed-method design was implemented to develop and assess performance of QNCS-M. First, we focused on developing the components of QNCS-M and their operational definitions. Second, we dedicated to ascertaining psychometric performance of QNCS-M. The field testing consisted of assessing the construct validity and internal consistency reliability. Correlation between QNCS-M and the criterion tool, Quality of Nursing Care Questionnaire-Registered Nurse was evaluated. RESULTS: The initial version of QNCS-M contained 66 items of which 7 (I-CVI < .78) were deleted after item-content validity assessment. The total-item correlation analysis yielded to exclusion of another 3 items (<.3). Additional 12 items were excluded after inter-item correlation (<.3, >.7). Results from Spearman rank-order correlation analysis of the remaining 44 items indicated relationship between social desirability and 6 items (r = -.09 to r = .11). These items were excluded to reduce the likelihood of potential information bias. A total of 38 items remained for exploratory factor analysis. Results from exploratory factor analysis yielded eigenvalues > 1.0 for the 9 domains. Three domains contained items fewer than 3. These domains and 2 items (factor loading <.4) were eliminated, yielding to 6 domains with 36-item. Results from internal consistency reliability yielded an overall Cronbach's α = .92; the coefficient values for the 6 domains ranging between .72 and .85 and Pearson correlation for stability reliability yielded an acceptable (r = .82, P < .001). CONCLUSION: Improving the quality of healthcare services delivered by nurses is a priority for the Mongolian government. The development of QNCS-M is a major stride in addressing this concern. The final version of QNCS-M which contains 36 items, loaded into 6 domains, was morphed to the specifics of the Mongolian healthcare systems and cultural values and societal norms. QNCS-M demonstrates a high level of content and construct validity with acceptable reliability.

A contemporary understanding of nurses' workplace social capital: A response to the rapid changes in the nursing workforce.

AIM: To provide an updated definition of the concept of nurses' workplace social capital that addresses changes in the contemporary nursing workforce. BACKGROUND: Social capital explains the components of a constructive work environment. Advancements in psychology of workplace and changes in the demographic structure of nursing workforce call for a revised version of nurses' workplace social capital. METHOD: Walker and Avant's approach was implemented. Data were compiled from 'Medline' and 'CINAHL', 'Google' search engine, book chapters and expertise of nursing academicians. RESULTS: Nurses' workplace social capital is a relational network that is configured by interactions among healthcare professionals. Although, various attributes influence these interactions, Relational Network, Trust, Shared Understanding, Reciprocity and Social Cohesion are considered as the major attributes. A healthy relational network creates a healthy workplace which can be further fortified by effective communication, active group engagements and a supportive leadership. CONCLUSIONS: Results of our concept analysis should establish a theoretical groundwork for nurse leaders to better build and more effectively lead the contemporary nursing workforce. IMPLICATION FOR NURSING MANAGEMENT: Leaders' dedication to workplace social capital is the tenet of a constructive workplace, which in return can support nurses to flourish in their clinical and the other professional responsibilities.

Dealing With a Stressful Extra Duty: The Intrapersonal Conflict Experiences of Nurses Caring for Survivors of Suicide Attempts on Medical-Surgical Wards.

Nurses are the frontline professionals caring for patients who have attempted suicide. When clinical nurses learn from medical records or nursing handover, or are proactively informed by patients or family members, that the patients they are caring for have suicidal tendencies, they often experience pressure and face challenges. However, little attention has been given to the experiences of the nurses caring for patients with suicidal intent on medical and surgical wards. We aimed to address this knowledge gap. The purpose of this study was to explore medical and surgical nurses' experiences, especially the internal conflicts they might experience while caring for patients who have a history of attempted suicide. A qualitative descriptive design and semi-structured interviews were used in this study. Twenty-three nurses were recruited and interviewed individually. Data were analysed by qualitative content analysis. The focus of this paper is to examine the emergent theme of intrapersonal conflict experienced by the participants. Nurses' experiences can be clustered into two themes: (1) Pity and annoyance and (2) Hard work does not necessarily pay off. Intrapersonal conflict was identified by participants as considerable fear and anxiety about the possibility of a patient's suicide, as well as a mixture of pity for and annoyance with the patients. Nurses feel sorry for such patients, but they are also annoyed by the extra work required to prevent suicide attempts in the ward. Additionally, having limited time and ability, they see that their hard work does not necessarily pay off and may sometimes lead to punishment. Our findings raise serious concerns about the adequacy of the knowledge of the nurses, their competence and their difficulties in caring for such patients. In addition, there is a need to provide them with appropriate on-the-job education and immediate emotional support relevant to caring for survivors of suicide attempts.

A qualitative systematic review on the lived experience of men in nursing.

AIM: This qualitative systematic review was conducted to describe the lived experience of men in nursing. DESIGN: A systematic review of qualitative studies. METHODS: Five databases (Scopus, CINAHL, MEDLINE, PsycINFO and Embase) were systematically searched. The PRISMA guideline was used for reporting the literature search in different phases, and the Critical Appraisal Skills Program, a qualitative research checklist, was used to evaluate the studies that met the inclusion criteria. Thomas and Harden's thematic analysis approach for qualitative research was used for data synthesis. RESULTS: Six qualitative studies were included. Five analytical themes related to lived experiences of men in nursing emerged: value in nursing, the double-edged sword of gender, being accepted in the nursing profession, attractions of nursing and coping strategies.

Perceived nursing service quality in a tertiary care hospital, Maldives.

The present study explored nurses' and patients' expectations of nursing service quality, their perception of performance of nursing service quality performed by nurses, and compared nursing service quality, as perceived by nurses and patients. The sample consisted of 162 nurses and 383 patients from 11 inpatient wards/units in a tertiary care hospital in the Maldives. Data were collected using the Service Quality scale, and analyzed using descriptive statistics and the Mann-Whitney U-test. The results indicated that the highest expected dimension and perceived dimension for nursing service quality was Reliability. The Responsiveness dimension was the least expected dimension and the lowest performing dimension for nursing service quality as perceived by nurses and patients. There was a statistically significant difference between nursing service quality perceived by nurses and patients. The study results could be used by nurse administrators to develop strategies for improving nursing service quality so that nursing service delivery process can be formulated in such a way as to reduce differences of perception between nurses and patients regarding nursing service quality.

Knowledge and involvement of nurses regarding health policy development in Thailand.

The purpose of this descriptive study was to explain the levels of knowledge about and involvement in national health policy development by nurses in Thailand. The study used quantitative and qualitative means to gather data about the topic from two groups of professional nurses: 2121 nurses who worked in hospitals around the country and 26 nurse leaders who were members of steering committees in nursing professional organizations. A self-administered questionnaire and an interview guide regarding knowledge and involvement in national health policy were used for collecting the data. The content validity and reliability of the questionnaire were assured. The results showed that almost two-thirds of the sample had a high level of knowledge about national health policy development but that almost three-quarters of the sample had no involvement in national health policy development. The interviews of the nurse leaders showed that some of them had been involved directly in formulating health policy but most of them thought that they had not been involved directly. The results demonstrated that it is essential that nurses understand and be actively involved in national health policy development.

Quality nursing care as perceived by nurses and patients in a Chinese hospital.

AIMS AND OBJECTIVES: To explore and compare nurses and patients perceptions of quality nursing care. BACKGROUND: It is important to measure both nurses and patients perceptions of quality nursing care. To date, however, no study on nurses' perceptions of quality nursing care has been conducted specifically in the Chinese setting. DESIGN: Descriptive, comparative study with 221 nurses and 383 patients in 18 non-ICU inpatient nursing units. METHODS: Data were collected using the Perception of Quality Nursing Care Scale. RESULTS: The results showed that the overall mean score and each category mean score, as perceived by nurses and patients, were high. There was a statistically significant difference between nurses' and patients' perceptions of quality nursing care based on the following categories: staff characteristics, care-related activities and progress of nursing process. However, similarities in perception have also been identified in some categories. CONCLUSIONS: The findings indicate that nurses and patients had differing views of quality nursing care, because they may have had different standards and ways in which they viewed these characteristics of care. Improvements are needed regarding certain aspects of patient information and support for patients' psychological needs. RELEVANCE TO CLINICAL PRACTICE: It is a challenge to nurses when taking collaborative action to meet patients' expectations and needs, however, it will move nursing practice in Chinese hospitals forward.

Nurse staffing and cost of care in adult intensive care units in a university hospital in Thailand.

Decisions about nurse staffing levels in intensive care units (ICUs) should be guided by research to ensure optimal outcomes. This descriptive correlational study in a large Thai hospital was designed to evaluate the effect of nurse staffing levels on the costs of care, in terms of medical care cost per patient day and health personnel cost per patient day, in ICUs. The costing data were collected prospectively from the records of 242 critically ill patients while the nurse staffing levels were extracted from hospital management reports. The findings showed that a nurse staffing model with a higher number of registered nurses (RNs) led to an increase in the health personnel cost per patient day. However, a greater number of RNs was associated with improved patient safety and efficiency, thereby reducing the length of stay and the costs of care in the long term. This study provides evidence to support decisions by hospital administrators concerning RN staffing levels.

The relationship between nurse staffing and patient outcomes.

OBJECTIVES: To examine the association between in-hospital mortality and four nurse staffing variables-the ratio of total nursing staff to patients, the proportion of RNs to total nursing staff, the mean years of RN experience, and the percentage of nurses with bachelor of science in nursing degrees. BACKGROUND: Studies suggest that nurse staffing changes affect patient and organizational outcomes, but the impact of nurse staffing on patient outcomes has not been studied sufficiently and the results of the previous studies are equivocal. Additionally, the studies of the relationship between nurse staffing and patient outcomes or the impact of nurse staffing on patient outcomes had not been previously examined in Thailand. METHODS: A retrospective, cross-sectional, observational research design was employed to study the research questions. Data of 2531 patients admitted to seven medical units and 10 surgical units of a 2300-bed university hospital in Thailand was used. All data of patients admitted to this hospital with four common groups of principal diagnoses (diseases of the heart, malignant neoplasms [cancer of all forms], hypertension and cerebrovascular diseases, and pneumonia and other diseases of the lung) was extracted from patient charts and discharge summaries in the calendar year 1999. Nurse staffing variables for each nursing unit in 1999 came from nursing service department databases. Multivariate logistic regression was used to determine the relationship between nurse staffing variables and in-hospital mortality. RESULTS: The findings of this study revealed that the ratio of total nurse staffing to patients was significantly related to in-hospital mortality in both partial and marginal analyses, controlling for patient characteristics. In addition, the ratio of total nursing staff to patients was found to be the best predictor of in-hospital mortality among the four nurse staffing variables, controlling for patient characteristics. The study did not find any significant relationship between in-hospital mortality and three nurse staffing variables (the proportion of RNs to total nursing staff, the mean years of RN experience, and the percentage of bachelor degree prepared nurses) probably due to the low variation of these variables across nursing units or because they may have correlated with other variables. CONCLUSIONS: The findings of this study add to our understanding of the importance of nurse staffing and its relationship to the patient outcome of hospital mortality. Further, the findings also provide information for hospital and nursing administrators to use when restructuring the clinical workforce, revising hospital policies, or making contractual decisions on behalf of nursing and public beneficiaries.