Performance competence of pregraduate nursing students and hospital nurses: A comparison study.

AIMS AND OBJECTIVES: To compare and contrast the competence in clinical performance between pregraduate nursing students and hospital nurses. The study also explored the most difficult technical skills for the participants to perform. BACKGROUND: Assessment, communication and critical thinking are competencies that help in providing safe and appropriate care for patients. Yet, self-perceived competence was mostly measured while performance competence that reflected nurses' performance in real cases has seldom been explored in literature. DESIGN: A cross-sectional design was applied. The study adhered to the STROBE guidelines to improve reporting quality. METHOD: Fifty-two nurses and 50 nursing students completed the Computerized Model of Performance-Based Measurement system, which measures performance competence including the steps of critical thinking, conflict resolutions and common clinical technical problems. Six case scenarios containing 107 test questions were completed. RESULTS: Only 53.85% of nurses and 20.0% of students achieved a satisfactory level of performance competence. They showed low scores on the steps of critical thinking: "collecting data from on-site physical assessment," "processing information," "recognising/prioritising problems" and "arranging a course of action for patient care," as well as solving common technical problems and conflicts. The three most difficult skills to perform were CPR, reading EKGs and venipuncture/starting intravenous lines. CONCLUSIONS: The study captured the participants' weaknesses in the critical thinking process and the nursing skills that were difficult to perform. These skills are imperative to nursing care and need to be strengthened in school and in-service education. The academic curriculum and course design for students as well as training programmes for nurses need to be reviewed to address the challenges to be faced in a clinical setting. RELEVANCE TO CLINICAL PRACTICE: Teaching-learning strategies that focus on enhancing critical thinking and performing difficult skills need to be designed and implemented both in practice and in school.

The development and psychometric testing of a theory-based instrument to evaluate nurses' perception of clinical reasoning competence.

AIM: The purpose of the study was to develop and psychometrically test the Nurses Clinical Reasoning Scale. BACKGROUND: Clinical reasoning is an essential skill for providing safe and quality patient care. Identifying pre-graduates' and nurses' needs and designing training courses to improve their clinical reasoning competence becomes a critical task. However, there is no instrument focusing on clinical reasoning in the nursing profession. DESIGN: Cross-sectional design was used. This study included the development of the scale, a pilot study that preliminary tested the readability and reliability of the developed scale and a main study that implemented and tested the psychometric properties of the developed scale. METHOD: The Nurses Clinical Reasoning Scale was developed based on the Clinical Reasoning Model. The scale includes 15 items using a Likert five-point scale. Data were collected from 2013-2014. Two hundred and fifty-one participants comprising clinical nurses and nursing pre-graduates completed and returned the questionnaires in the main study. The instrument was tested for internal consistency and test-retest reliability. Its validity was tested with content, construct and known-groups validity. RESULTS: One factor emerged from the factor analysis. The known-groups validity was confirmed. The Cronbach's alpha for the entire instrument was 0·9. CONCLUSION: The reliability and validity of the Nurses Clinical Reasoning Scale were supported. The scale is a useful tool and can be easily administered for the self-assessment of clinical reasoning competence of clinical nurses and future baccalaureate nursing graduates. Study limitations and further recommendations are discussed.

Development of the Computerized Model of Performance-Based Measurement System to Measure Nurses' Clinical Competence.

Critical thinking skills and clinical competence are for providing quality patient care. The purpose of this study is to develop the Computerized Model of Performance-Based Measurement system based on the Clinical Reasoning Model. The system can evaluate and identify learning needs for clinical competency and be used as a learning tool to increase clinical competency by using computers. The system includes 10 high-risk, high-volume clinical case scenarios coupled with questions testing clinical reasoning, interpersonal, and technical skills. Questions were sequenced to reflect patients' changing condition and arranged by following the process of collecting and managing information, diagnosing and differentiating urgency of problems, and solving problems. The content validity and known-groups validity was established. The Kuder-Richardson Formula 20 was 0.90 and test-retest reliability was supported (r = 0.78). Nursing educators can use the system to understand students' needs for achieving clinical competence, and therefore, educational plans can be made to better prepare students and facilitate their smooth transition to a future clinical environment. Clinical nurses can use the system to evaluate their performance-based abilities and weakness in clinical reasoning. Appropriate training programs can be designed and implemented to practically promote nurses' clinical competence and quality of patient care.

Job stress and job satisfaction among new graduate nurses during the first year of employment in Taiwan.

Nurse graduates are leaving their first employment at an alarming rate. The purpose of this study was to explore the relationships between job stress, job satisfaction and related factors over time among these nurses. This study applied a longitudinal design with three follow-ups after nurse graduates' first employment began. Using convenience sampling, participants were 206 new graduates from a university. The Work Environment Nursing Satisfaction Survey and the Clinical Stress Scale were used in this study. Results indicated that job stress remained moderate across three time points. Participants working 12 h shifts exhibited less job stress. Job satisfaction significantly increased in the twelfth month. Participants working 12 h shifts had a higher degree of job satisfaction. Job stress was negatively correlated with job satisfaction. The 12 h work shifts were related to job stress and job satisfaction. These results implied that health-care administrators need to provide longer orientation periods and flexible shift schedules for new graduate nurses to adapt to their work environment.

Survey of trend and factors in perinatal maternal fatigue.

Few studies have investigated maternal fatigue, particularly fatigue throughout the duration of pregnancy and the postpartum period. The purpose of this study was to explore changes related to maternal fatigue from pregnancy to postpartum and the factors influencing fatigue. This prospective longitudinal study surveyed 197 pregnant women beyond 24 gestational weeks monthly until one month postpartum. The Multidimensional Assessment of Fatigue scale and one question about fatigue were used. Women at late pregnancy experienced a significant increase in level of fatigue, which remained high after childbirth. Those who were not happy about the pregnancy or were multiparas experienced a higher level of prenatal fatigue than their counterparts. At postpartum, mothers who were unemployed, had no one to help with childcare, or felt that the baby's night-time sleep pattern was a serious problem had a higher level of fatigue. Interventions can be planned and implemented at early pregnancy to reduce the prevalence of fatigue. Encouraging pregnant women to share experiences and thoughts about pregnancy and being a mother is suggested. Further studies that evaluate culturally sensitive instruments for fatigue are needed.

New graduate nurses' clinical competence, clinical stress, and intention to leave: a longitudinal study in Taiwan.

This longitudinal research study aimed to develop a pregraduation clinical training program for nursing students before graduation and evaluate its effect on students' self-perceived clinical competence, clinical stress, and intention to leave current job. A sample of 198 students returned the questionnaires before and after the program. They were followed up at 3, 6, and 12 months after graduation. Results showed that posttest clinical competence was significantly higher than pretest competence, positively related to clinical competence at 3 and 12 months, and negatively related to clinical stress at 3 months. The clinical competence at 3 months was positively related to clinical competence at 6 and 12 months, and clinical competence at 6 months was related to intention to leave at 12 months. Intention to leave at 6 months was positively related to intention to leave at 3 and 12 months. Clinical stress at 3 months was positively related to clinical stress at 6 and 12 months, but not related to intention to leave at any time points. The training program improved students' clinical competence. The stressful time that was correlated with new graduate nurses' intention to leave their job was between the sixth and twelfth months after employment.

Preparing the future nurses for nursing research: a creative teaching strategy for RN-to-BSN students.

Developing effective teaching strategies to stimulate students' interest and enthusiasm are urgently needed in current research courses. The purposes of the study were to implement the Cookie Experiments teaching strategy in research course and examine the effects of the strategy on students' attitudes towards nursing research. The study was a pretest-post-test design with 95 students at a Registered Nurses to Bachelor of Science in Nursing (RN-to-BSN) program enrolled in the nursing research course. Results indicated that there was a significant effect of the Cookie Experiments teaching strategy on students' attitudes towards research. Although students perceived a median high score of pressure from the research course, they regarded that the pressure is conducive to their learning of research. Students highly suggested to continuously applying this teaching strategy in the future nursing research courses. Developing and using various teaching strategies with attractive and hands-on methods to motivate nurse students, learning research is strongly recommended.

Effects of an unfolding case study on clinical reasoning, self-directed learning, and team collaboration of undergraduate nursing students: A mixed methods study.

BACKGROUND: Clinical reasoning is an essential nursing competency that students must develop to provide safe patient care. Developing and utilizing unfolding case studies, which present constantly changing patient conditions to improve students' clinical reasoning and to foster communication and self-reflection, can help to achieve that imperative. OBJECTIVES: To develop an unfolding case study and to test its effectiveness in improving clinical reasoning, team collaboration, and self-directed learning. DESIGN: A mixed methods design. SETTING: One university in Southern Taiwan. PARTICIPANTS: Forty nursing students. METHODS: An unfolding case study was developed based on the clinical reasoning model and unfolding cases model. The Nurses Clinical Reasoning Scale, Self-Directed Learning Instrument, and Questionnaire of Group Responsibility and Cooperation in Learning Teams were used. Forty nursing students completed questionnaires and nine of them participated in focus group discussions. Wilcoxon signed-rank, Spearman correlation, regression, and inductive content analysis were used to analyze data. RESULTS: Students' abilities in clinical reasoning, self-directed learning, and team collaboration were statistically significantly improved after implementation of the unfolding case study. Emergent themes included "patient-centered communication," "group inspiration and learning," "thinking critically and reflecting on oneself," and "applying theoretical knowledge in care to meet patients' changing needs." CONCLUSIONS: Unfolding case studies provide a safe environment in which nursing students may learn and apply knowledge to safe patient care.

Prediction of maternal quality of life on preterm birth and low birthweight: a longitudinal study.

BACKGROUND: Preterm birth is a significant cause of newborn morbidity and mortality and strains society's healthcare resources due to its long-term effects on the health of the newborn. Prenatal maternal quality of life (QoL) may be related to the occurrence of preterm birth and low birthweight infants. Few studies, however, have investigated maternal QoL, especially throughout the continuum of pregnancy and the immediate postpartum period. Therefore, the purposes of this longitudinal study were to measure the levels of QoL during and immediately after pregnancy in women with uncomplicated pregnancies, investigate the relationships between the dimensions of QoL, and determine whether prenatal QoL can predict preterm birth and low birthweight. METHODS: Using convenience sampling in one hospital in Taiwan, we recruited 198 pregnant women without pregnancy complications after 24 gestational weeks and followed up monthly until one-month postpartum. The Duke Health Profile was used to measure QoL. Data were analyzed using descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test, generalized estimation equations, Pearson correlations, and hierarchical logistic regression. RESULTS: Pregnant women did not perceive that they had a high level of QoL. Women at late pregnancy experienced a significant decrease in their level of physical and general health. After childbirth, although the mothers had better physical health, they had poorer social health. Poor QoL at late pregnancy predicted preterm birth. Employment, parity, educational level, and happiness about pregnancy were related to prenatal maternal QoL; employment was a factor related to postpartum maternal QoL. CONCLUSIONS: Early assessment of QoL, including its dimensions, of pregnant women may help us to understand women's health status. Based on this understanding, healthcare professionals can develop interventions to promote pregnant women's QoL and to lessen the occurrence of preterm birth and low birthweight infants. Further, an emphasis on the positive aspects of pregnancy may increase maternal QoL.

Innovative strategies for teaching nursing research in Taiwan.

BACKGROUND: Evidence-based practice is imperative in clinical settings because it bridges the gap between research findings and clinical practice. Promoting nursing student interest and enthusiasm for research is therefore crucial when teaching nursing research. OBJECTIVE: The aim of thus study was to develop innovative teaching strategies that increase nursing students' interests and engagement in research. METHODS: This study employed a descriptive, pretest-posttest, quasiexperimental design with 103 participants in the experimental group and 106 in the control group. The Attitudes toward Research Questionnaire, Classroom Engagement Scale, Self-Directed Learning Instrument, Nursing Eight Core Competencies Scale, Value of Teams survey, and a research knowledge test were applied to evaluate the outcomes of the innovative teaching strategies. RESULTS: Scores for the research knowledge test were significantly higher in the experimental group than in the control group in posttest 1 and posttest 2. After the intervention, participants in the experimental group exhibited higher scores on attitudes toward research, eight core competencies in nursing,value of teams, classroom engagement, and self-directed learning than participants in the control group. Students in the experimental group perceived a lower degree of pressure and higher degrees of interest, enjoyment, and acceptance of the research course than students in the control group. CONCLUSIONS: This study confirmed that using innovative teaching strategies in nursing research courses enhances student interest and enthusiasm about evidence-based practice.

The relationship of individual characteristics, perceived worksite support and perceived creativity to clinical nurses' innovative outcome.

AIMS AND OBJECTIVES: To understand the relationship of individual characteristics, perceived worksite support and perceived personal creativity to clinical nurses' innovative outcome (receiving the Nursing Innovation Award). BACKGROUND: Since the idea of applying creativity and innovation to clinical nursing practice and management was first advocated in the Nursing Administration Quarterly in 1982, the topic of nursing innovation has gained worldwide attention. To increase the prevalence of nursing innovation, it is important to identify and understand the related factors that influence nurses' innovative outcome. DESIGN: This study used a cross-sectional descriptive survey design. METHODS: A self-administered questionnaire was completed by 32 award winners and 506 nonawarded clinical nurses in Taiwan. RESULTS: The level of creativity perceived by all participants was moderate-to-high. Individual characteristics (r = 0·61) and worksite support (r = 0·27) were both correlated with perceived creativity. Individual characteristics and worksite support showed some correlation as well (r = 0·21). Individual characteristics and worksite support could predict perceived creativity after controlling for demographic variables, but only individual characteristics had an effect on innovative outcome. Perceived creativity did not have mediation effects either between individual characteristics and innovative outcome or between worksite support and innovative outcome. CONCLUSIONS: Clinical nurses' individual characteristics had a direct relationship to innovative outcome, whereas neither worksite support nor creativity was correlated with innovative outcome. Although worksite support did not show effects on innovative outcome, it was related to both perceived creativity and individual characteristics. As suggested by other scholars, there might be other related factors between creativity and innovative outcome. RELEVANCE TO CLINICAL PRACTICE: Although worksite support did not have effect on clinical nurses' innovative outcome, it was related to individual characteristics. Hospital administrators or nursing directors can foster a supportive environment where creative nurses would be more likely to work and engage in innovative activities.

Acculturation, collectivist orientation and organisational commitment among Asian nurses working in the US healthcare system.

AIM: To examine the relationships between acculturation, collectivist orientation and organisational commitment among Asian nurses in US hospitals. BACKGROUND: Few studies have explored these three variables together in the same study and examined their statuses and mutual relationship among Asian nurses in Western hospitals. METHOD: The study was a cross-sectional design using snowball sampling. A total of 195 Asian nurses participated. The collectivist orientation scale, organisational commitment questionnaire and acculturation factors were used to collect data. Pearson correlation, anova and regression were used to analyse the data. RESULTS: Most participants were female Filipinos with a mean age of 39.92 and a bachelor's degree and stayed in the USA for 13.35 years. They used and preferred to use both their mother language and English, identified themselves as Oriental or Asian and culturally, viewed themselves as very or mostly Asian. Participants scored high on collectivism and commitment. Collectivism was significantly correlated with commitment but did not mediate acculturation factors and commitment. CONCLUSION: To increase Asian nurses' commitment, it is important that administrators understand their cultural values and provide them with a cultural competent and sensitive environment. IMPLICATIONS FOR NURSING MANAGEMENT: Healthcare administrators can increase Asian nurses' commitment through understanding their needs and attitudes toward their job and organisation.

Effectiveness of differentiated instruction on learning outcomes and learning satisfaction in the evidence-based nursing course: Empirical research quantitative.

AIM: Diversified students in higher education and the complexity and difficulty of the evidence-based nursing course perceived by students challenge nursing educators. Differentiated instruction can provide students with various opportunities to learn and meet the learning needs of students with different academic abilities and strengths, which may be a solution. This study aimed to apply differentiated instruction to design the undergraduate evidence-based nursing course and evaluate the effects of differentiated instruction on students' learning outcomes and learning satisfaction. DESIGN: One-group pretest-posttest pre-experimental design was applied. METHODS: Ninety-eight undergraduate nursing students enrolled in the evidence-based nursing course 2020 participated in this study. Students' learning outcomes including preferred learning styles, classroom engagement, collaborative learning, attitudes towards evidence-based nursing, learning satisfaction and evidence-based nursing knowledge were measured using validated questionnaires. RESULTS: The differentiated instruction increased students' learning interests, promoted focused and independent thinking, and enhanced academic achievement. Students' classroom engagement, attitudes towards evidence-based nursing, evidence-based nursing knowledge and learning satisfaction were improved after the course. The course designed with differentiated instruction provided a supportive learning environment and furnished a vivid pedagogical way for the unique nursing profession. PATIENT OR PUBLIC CONTRIBUTION: Positive results of the study support the application of differentiated instruction in the evidence-based nursing course. The study indicates that the application of differentiated instruction in mixed-ability classrooms in the evidence-based nursing course improved students' learning outcomes, attitudes towards evidence-based nursing, evidence-based nursing knowledge and learning satisfaction. In clinical settings where nurses are even more diverse in academic education, clinical experiences and learning preferences, differentiated instruction can be a suitable application for in-service training and education to promote nurses' enthusiasm for professional learning.

Intention to leave of Asian nurses in US hospitals: does cultural orientation matter?

AIM AND OBJECTIVES: To measure the predictability of cultural orientation on organisational commitment, perception of practice environment and intention to leave amongst Asian nurses working in US hospitals. BACKGROUND: To alleviate the nursing shortage, healthcare institutions have increased recruitment of nurses internationally, with Asian nurses representing the largest proportion of international nurses working in the US. Whilst organisational commitment and perception of practice environment were related to intention to leave, few studies have been done on the predictability of intention to leave amongst Asian nurses. DESIGN: A cross-sectional postal survey design. METHOD: One hundred and ninety-five Asian nurses working at least six months in US hospitals completed the survey. Most participants were Filipinos or Chinese, married and worked full-time. The Organisational Commitment Questionnaire, Practice Environment Scale of the Nursing Work Index, Anticipated Turnover Scale and Collectivist Orientation Scale with satisfactory reliability were used. RESULTS: Perception of practice environment was correlated with intention to leave and organisational commitment, which was correlated with intention to leave. Cultural orientation showed positive predictable effects on organisational commitment and perception of practice environment, but had negative predictability for intention to leave. The mediating effect of organisational commitment on practice environment and intention to leave was 93·98%, when cultural orientation was not controlled for. It increased slightly to 96·54% when cultural orientation was controlled for. CONCLUSIONS: Asian nurses who are more collectivist-oriented are more willing to accept the goals and values of the organisation, exert effort on behalf of the organisation, are more satisfied with their current practice environment and have less intention to leave their current job. Organisational commitment is a key predictor of Asian nurses' intention to leave. RELEVANCE TO CLINICAL PRACTICE: Hospital administrators can use cultural orientation as a strategy to promote organisational commitment amongst Asian nurses, thereby reducing the rate of turnover.

Trends of Perinatal Stress, Anxiety, and Depression and Their Prediction on Postpartum Depression.

Perinatal stress, anxiety, and depression impacts not only women but also their child(ren). The purpose of this longitudinal study is to explore trends of stress, anxiety, and depressive symptoms from pregnancy to postpartum and understand predictions of stress and anxiety on postpartum depression. One-hundred-fifty-six women at 23-28 weeks gestation (T1), 147 at 32-36 weeks gestation (T2), 129 at over 36 weeks gestation (T3), and 83 at postpartum (T4) completed study surveys. The Perceived Stress Scale, Center for Epidemiologic Studies Depression scale, and State-Trait Anxiety Inventory were used to measure stress, depressive symptoms, and anxiety. Descriptive statistics, Pearson and Spearman's correlation, and Generalized Estimating Equation were applied to analyze the data. Results showed that levels of anxiety and depressive symptoms increased from 24 weeks gestation to postpartum, whereas stress levels decreased during pregnancy but increased in postpartum. Over half of women experienced anxiety symptoms, especially during late pregnancy and postpartum. Stress, anxiety, and depressive symptoms were inter-correlated. Notably, women at late pregnancy and postpartum were prone to stress, anxiety, and depression. Prenatal anxiety could predict postpartum depressive symptoms. Active assessment and management of stress, anxiety, and depression is needed and should begin from early pregnancy and continue until postpartum.

Organisational climate, organisational commitment and intention to leave amongst hospital nurses in Taiwan.

AIMS AND OBJECTIVES: To examine: (1) Taiwanese nurses' perceptions of organisational climate, levels of organisational commitment and intention to leave, as well as relationships between these three variables; (2) demographic differences in the levels of these variables; and (3) mediating effects of organisational commitment on the relationship between organisational climate and intention to leave. BACKGROUND: Organisational climate is related to organisational commitment and affects nurses' performances and attitudes towards an organisation. DESIGN: A cross-sectional, descriptive design. METHOD: Registered nurses working in eight hospitals in southern Taiwan for more than six months were recruited. Data were collected using the Litwin and Stringer's Organisational Climate Questionnaire, Organizational Commitment Questionnaire and a five-item scale measuring intention to leave. Questionnaires were distributed to 612 potential participants; 486 valid returned questionnaires were analysed. RESULTS: The study's participants were generally satisfied with their hospital's climate and yet claimed low commitment to their organisation and, nevertheless, reported low intention to leave their job. Single nurses were more satisfied with their hospital's climate and were more committed to their hospital and had a lower intention to leave their job compared to married nurses. Nurses working in district hospitals perceived a better hospital climate and had a lower intention to leave than nurses working in teaching or regional hospitals. Staff nurses perceived a better organisational climate than did nurse managers. Organisational climate, organisational commitment and intention to leave were intercorrelated. Organisational climate had almost 60% indirect effect on organisational commitment related to intention to leave. CONCLUSIONS: Creating a good organisational climate may increase nurses' organisational commitment and, in turn, decrease their intention to leave. RELEVANCE TO CLINICAL PRACTICE: To motivate nurses' positive organisational behaviours and to address their diverse needs, hospital administrators are encouraged to understand nurses' work-climate perceptions and to address nurses' varied demographic factors.

Relationships between disaster nursing competence, anticipatory disaster stress and motivation for disaster engagement.

Nurses are the largest group of healthcare providers and are often the first line responders to a disaster event. Nurses' disaster competence, motivation for disaster engagement, and factors that impact their motivation to respond to disaster events need to be understood. The purposes of the study were to determine the predictive relationships between Taiwanese nurses' disaster competence, anticipatory disaster stress, and motivation for disaster engagement. A cross-sectional design was used to analyze data collected between August 2017 and December 2017 from eight hospitals in southern Taiwan. Ninety participants who met the recruitment criteria completed and returned questionnaires with an 88.24% response rate. Data collection involved administering the Disaster Nursing Competence Questionnaire, Anticipatory Disaster Stress Questionnaire, and the Motivation of Disaster Engagement Questionnaire. The results indicated that anticipatory disaster stress was positively correlated with disaster competence and motivation for disaster engagement. Disaster competence and willingness to join a hospital disaster rescue predicts an individuals' motivation for disaster engagement. The results of the study add to the understanding of factors that correlate with nurses' motivation to participate in disaster events. By understanding these factors, the government and healthcare administrators can design disaster education plans and other strategies to improve Taiwanese nurses' motivation to engage in disaster events.

An Exploration of Motivation for Disaster Engagement and Its Related Factors among Undergraduate Nursing Students in Taiwan.

The purpose of the study was to explore the levels of and relationships between disaster nursing competence, anticipatory disaster stress, and the motivation for disaster engagement among undergraduate nursing students in Taiwan. A cross-sectional research design was applied. Using convenience sampling, 90 nursing students participated with an 86.54% response rate. The Disaster Core Competencies Questionnaire, Anticipatory Disaster Stress Questionnaire, and Motivation for Disaster Engagement Questionnaire were used to collect data. The Pearson correlation and ANOVA were used to analyze the data. Results showed that students' level of disaster nursing competence was low, anticipatory disaster stress was not high, and motivation for disaster engagement was high. Motivation for disaster engagement was positively correlated with anticipatory disaster stress. Students who were more willing to participate in disaster management had a higher level of anticipatory disaster stress and motivation for disaster engagement. It is suggested that healthcare institutions and schools should work together to design disaster education plans using innovative teaching/learning strategies to increase students' willingness and motivation for disaster engagement.

Using the Practice Environment Scale of the Nursing Work Index on Asian nurses.

BACKGROUND: Researchers have used the Practice Environment Scale of the Nursing Work Index (PES-NWI) to examine the perception of practice environment among U.S. nurses in general; however, the scale has not been used to measure perceptions specifically among Asian nurses working in the United States, the largest group of international nurses in the nation. OBJECTIVE: The purpose of this study was to test the reliability and the validity of the PES-NWI scale when applied to Asian nurses working in the United States. METHODS: The study used a cross-sectional design with snowball sampling. Data from 230 Asian nurses who were born in Far Eastern countries and had worked at least 6 months in their current job at a U.S. hospital were analyzed, using Cronbach's alpha, item-total and interitem correlation, and factor analysis. RESULTS: The Cronbach's alpha for the PES-NWI was.96, and the item-total correlation coefficients ranged from.49 to.79. Five factors, which explained 59.12% of variance in the perception of practice environment, emerged: Nurse Participation and Development; Nurse Manager Ability, Leadership, and Support of Nurses; Nursing Foundations for Quality of Care; Staffing and Resource Adequacy; and Collegial Nurse-Physician Relations. Four derived factors were reconstructed, and one factor was renamed based on the meanings of scale items that were included in the factor. DISCUSSION: Study findings demonstrate that the PES-NWI is a reliable and a valid scale when applied to Asian nurses working in the United States. Findings also indicate that Asian nurses perceive practice environments differently than do American nurses, most likely due to dissimilar cultural beliefs. A better understanding of these differences may help develop more individualized support for Asian nurses as they adapt to working in the United States.

Nurses' intention to leave: critically analyse the theory of reasoned action and organizational commitment model.

AIM: To systematically analyse the Organizational Commitment model and Theory of Reasoned Action and determine concepts that can better explain nurses' intention to leave their job. BACKGROUND: The Organizational Commitment model and Theory of Reasoned Action have been proposed and applied to understand intention to leave and turnover behaviour, which are major contributors to nursing shortage. However, the appropriateness of applying these two models in nursing was not analysed. EVALUATION: Three main criteria of a useful model were used for the analysis: consistency in the use of concepts, testability and predictability. KEY ISSUES: Both theories use concepts consistently. Concepts in the Theory of Reasoned Action are defined broadly whereas they are operationally defined in the Organizational Commitment model. Predictability of the Theory of Reasoned Action is questionable whereas the Organizational Commitment model can be applied to predict intention to leave. A model was proposed based on this analysis. CONCLUSIONS: Organizational commitment, intention to leave, work experiences, job characteristics and personal characteristics can be concepts for predicting nurses' intention to leave. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers may consider nurses' personal characteristics and experiences to increase their organizational commitment and enhance their intention to stay. Empirical studies are needed to test and cross-validate the re-synthesized model for nurses' intention to leave their job.