Global migration and factors influencing retention of Asian internationally educated nurses: a systematic review.

BACKGROUND: Given nurses' increasing international mobility, Asian internationally educated nurses (IENs) represent a critical human resource highly sought after within the global healthcare workforce. Developed countries have grown excessively reliant on them, leading to heightened competition among these countries. Hence, this review aims to uncover factors underlying the retention of Asian IENs in host countries to facilitate the development of more effective staff retention strategies. METHODS: A mixed-methods systematic review was conducted using the Joanna Briggs Institute methodology for mixed-method systematic review. A search was undertaken across the following electronic databases for studies published in English during 2013-2022: CINAHL, Embase, PubMed, Scopus, Web of Science and PsycINFO. Two of the researchers critically appraised included articles independently using the Joanna Briggs Critical Appraisal Tools and Mixed Methods Appraisal Tool (version 2018). A data-based convergent integrated approach was adopted for data synthesis. RESULTS: Of the 27 included articles (19 qualitative and eight quantitative), five each were conducted in Asia (Japan, Taiwan, Singapore and Malaysia), Australia and Europe (Italy, Norway and the United Kingdom); four each in the United States and the Middle East (Saudi Arabia and Kuwait); two in Canada; and one each in New Zealand and South Africa. Five themes emerged from the data synthesis: (1) desire for better career prospects, (2) occupational downward mobility, (3) inequality in career advancement, (4) acculturation and (5) support system. CONCLUSION: This systematic review investigated the factors influencing AMN retention and identified several promising retention strategies: granting them permanent residency, ensuring transparency in credentialing assessment, providing equal opportunities for career advancement, instituting induction programmes for newly employed Asian IENs, enabling families to be with them and building workplace social support. Retention strategies that embrace the Asian IENs' perspectives and experiences are envisioned to ensure a sustainable nursing workforce.

Registered nurses' cultural orientation competence for culturally and linguistically diverse nurses in the hospital setting: A cross-sectional study.

AIMS: To explore registered nurses' cultural orientation competence profiles for providing culturally and linguistically diverse (CALD) nurses with orientation in the hospital setting, and to identify which factors are associated with cultural orientation competence profiles. DESIGN: A descriptive, explorative cross-sectional study. METHODS: Data were collected from December 2020 to January 2021 using the Preceptors' Orientation Competence Instrument (POCI) and Preceptors' Cultural Orientation Competence Instrument (POCCI). A total of 844 registered nurses from one university hospital district in Finland participated, reflecting a response rate of 10%. A K-means cluster algorithm was employed to identify different cultural orientation competence profiles. RESULTS: The cluster analysis identified three cultural orientation competence profiles (A, B and C). Nurses in Profile A evaluated their cultural orientation competence the highest, with members of profiles B and C demonstrating the second highest and lowest, respectively, cultural orientation competence scores. Several factors were associated with cultural orientation competence profiles, namely, orientation education and student mentoring education, support from managers and colleagues, motivation, willingness to act as a preceptor, time to provide orientation, sufficient clinical and theoretical nursing skills and current work title. CONCLUSION: Cultural diversity and acceptance of it can be enhanced by building accepting culture towards new incomers and offering continuing education to improve the cultural competence of staff, which can further benefit patient care of CALD patients. Orientation practices can be improved by rewarding staff and building collaborative teamwork culture. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: Organizations can strengthen nurses' cultural orientation competence; for example, by providing adequate orientation education and allocating more time to the orientation process. REPORTING METHOD: The STROBE criteria were used to report the results of the observations critically. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Healthcare professionals' digital health competence profiles and associated factors: A cross-sectional study.

AIMS: To identify healthcare professionals' digital health competence profiles and explore associated factors to digital health competence in healthcare settings. DESIGN: A cross-sectional study. METHODS: Data were collected from 817 healthcare professionals from nine organizations with an electronic questionnaire by using Digital Health Competence instrument (42 items) and Aspects Associated with Digital Health instrument (15 items) between 1st March and 31st July 2022. K-means clustering was used to describe digital health competence profiles. Binary logistic regression analysis was used to explore associated factors. RESULTS: Analysis revealed three digital health competence profiles: A - high competence (n = 336), B - intermediate competence (n = 352) and C - low competence (n = 129). Between the profiles, digital health competence showed significant differences (p < .001). Recent graduation year, working in outpatient environments and leader or specialist position were associated with higher digital health competence. Organizational practices and the influence from colleagues improved competence in human-centred remote counselling, digital solutions as part of work, competence in utilizing and evaluating digital solutions and ethical competence. Support from management improved digital solutions as part of work and ethical competence. CONCLUSION: Nursing and allied health professionals working in other than outpatient environments should be specifically acknowledged when digital health competence development initiatives are designed and targeted. The positive influence from colleagues could be harnessed by enhancing their involvement in digital health competence development methods such as orientation, mentoring or coaching. Additionally, managers should take a stronger role in supporting different areas of digital health competence. IMPACT: This was the first study that explored healthcare professionals' digital health competence profiles and associated factors. The detection of healthcare professionals' digital health competence profiles guides the development of digital health education according to different needs in healthcare environments. REPORTING METHOD: The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Evidence-based healthcare competence of social- and healthcare educators: A cross-sectional study.

AIM: The purpose of the study was to describe social and healthcare educators' evidence-based healthcare competence and explore the associated factors. DESIGN: A descriptive, cross-sectional study was carried out. METHODS: The research spanned 5 universities, 19 universities of applied sciences, and 10 vocational colleges in Finland from September to December 2022. Social and healthcare educators (n = 256), of which 21 worked at universities, 176 worked at universities of applied sciences, and 49 worked at vocational colleges. Data collection employed a self-assessed instrument that was designed to measure evidence-based healthcare competence based on the JBI Model of Evidence-based Healthcare. Competence profiles were formed using K-cluster grouping analysis. RESULTS: The educators' self-evaluations of their level of evidence-based healthcare competence were generally at a satisfactory level, with subsequent analyses identifying four distinct profiles of evidence-based healthcare competence. The profiles demonstrated statistically significant differences in terms of evidence synthesis and evidence transfer competencies. The factors associated with evidence-based healthcare competence included level of education, the year in which a professional had obtained their highest degree, current organization of employment, and participation in continuing education. CONCLUSIONS: Educators require various types of support for developing high levels of evidence-based healthcare competence. The identification of distinct competence profiles can be pivotal to providing educators with training that is tailored to their exact needs to provide an individualized learning path. WHAT PROBLEM DID THE STUDY ADDRESS?: Educators value the role of evidence in teaching, which reinforces the need to integrate aspects of the JBI Model of evidence-based healthcare into educators' competencies. Aspects of the JBI Model of evidence-based healthcare have not been holistically measured, with only certain components of the model considered separately. Educators need to better understand the global healthcare environment so they can identify research gaps and subsequently develop healthcare systems through their educational role. Higher academic education, work experience, organizational support, and continuous education play essential roles in the development of educators' evidence-based healthcare competence. WHAT WERE THE MAIN FINDINGS?: Educators generally have high levels of competence in evidence-based healthcare. Educators have mastered the different components of the JBI model of evidence-based healthcare but need to improve in areas such as the transfer and implementation of evidence. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Determining evidence-based healthcare competence profiles for educators can be used to provide individualized learning paths for the development of evidence-based healthcare competence. Educators need to further develop their competence in evidence-based healthcare to ensure successful implementation and high-quality education in the future. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Frontline nurse leaders' competences in evidence-based healthcare: A scoping review.

AIM: To identify evidence on frontline nurse leaders' competences in evidence-based healthcare (EBHC) and the instruments measuring these competences. DESIGN: A scoping review. DATA SOURCES: The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched. REVIEW METHOD: The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full-text versions were screened independently by two reviewers according to the inclusion criteria. Deductive-inductive content analysis was used to synthesize data. RESULTS: A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC. CONCLUSION: There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods.

Advanced practice nurses' evidence-based healthcare competence and associated factors: A systematic review.

BACKGROUND: Evidence-based healthcare (EBHC) enables consistent and effective healthcare that prioritises patient safety. The competencies of advanced practice nurses (APNs) are essential for implementing EBHC because their professional duties include promoting EBHC. AIM: To identify, critically appraise, and synthesise the best available evidence concerning the EBHC competence of APNs and associated factors. DESIGN: A systematic review. DATA SOURCES: CINAHL, PubMed, Scopus, Medic, ProQuest, and MedNar. METHODS: Databases were searched for studies (until 19 September 2023) that examined the EBHC competence and associated factors of APNs were included. Quantitative studies published in English, Swedish and Finnish were included. We followed the JBI methodology for systematic review and performed a narrative synthesis. RESULTS: The review included 12 quantitative studies, using 15 different instruments, and involved 3163 participants. The quality of the studies was fair. The APNs' EBHC competence areas were categorised into five segments according to the JBI EBHC model. The strongest areas of competencies were in global health as a goal, transferring and implementing evidence, while the weakest were generating and synthesising evidence. Evidence on factors influencing APNs' EBHC competencies was contradictory, but higher levels of education and the presence of an organisational research council may be positively associated with APNs' EBHC competencies. CONCLUSION: The development of EBHC competencies for APNs should prioritise evidence generation and synthesis. Elevating the education level of APNs and establishing a Research Council within the organisation can potentially enhance the EBHC competence of APNs. IMPLICATIONS FOR THE PROFESSION: We should consider weaknesses in EBHC competence when developing education and practical exercises for APNs. This approach will promote the development of APNs' EBHC competence and EBHC implementation in nursing practice. REGISTRATION, AND REPORTING CHECKLIST: The review was registered in PROSPERO (CRD42021226578), and reporting followed the PRISMA checklist. PATIENT/PUBLIC CONTRIBUTION: None.

Nurse educators' views of integrating culturally and linguistically diverse future registered nurses into healthcare settings: A qualitative descriptive study.

AIM: To describe nurse educators' views of how culturally and linguistically diverse future registered nurses are integrated into healthcare settings. DESIGN: A qualitative descriptive design was adopted. PARTICIPANTS: A total of 20 nurse educators were recruited from three higher education institutions in Finland. METHODS: Participants were recruited in the spring of 2021 through snowball sampling. Individual semi-structured interviews were held and recorded. The collected data were analysed using inductive content analysis. RESULTS: The performed content analysis identified a total of 534 meaning units from the data, which were categorized into 343 open codes and 29 sub-categories. Furthermore, nine categories were identified and categorized into three main categories. The first main category was pre-graduation and represented a time point during which educators experienced early integration, nurse educator support and cooperation with stakeholders. The second main category was integration strategies into healthcare settings, which included workplace strategies, language competence and individual competencies and attributes. The third main category was the post-graduation experience, during which educators reported organizational readiness, migration and efficacy of the integrational model. CONCLUSIONS: The results revealed a need for increased resources linked to how nurse educators support the integration of culturally and linguistically diverse future registered nurses. Moreover, a nurse educator's presence during the last clinical placement, early transition and integration was found to exert a significant effect on the smooth integration of culturally and linguistically diverse future nurses. IMPACT: This study establishes the need to enhance stakeholder cooperation between universities and other organizations towards supporting the integration process. Maximizing nurse educators' support during the final clinical practice, early transition and post-graduation allows for successful integration and intention to stay. REPORTING METHOD: This study was reported according to the Standards for Reporting Qualitative Research (SRQR). PATIENT OR PUBLIC PARTICIPATION: Participating educators shared their experiences of culturally and linguistically diverse future nurses' integration.

Randomised controlled trials addressing how the clinical application of information and communication technology impacts the quality of patient care-A systematic review and meta-analysis.

BACKGROUND: The number of people with chronic and long-term conditions has increased during recent decades; this has been addressed by leveraging information and communication technology (ICT) to develop new self-care solutions. However, many of the developed technological solutions have not been tested in terms of impact(s) on patients' quality of care. OBJECTIVES: This systematic review aimed to identify the current best evidence on the types of interventions that have been developed to improve the quality of patient care through the clinical application of ICT in primary, tertiary or home care. DESIGN: A systematic review, including a meta-analysis, was conducted according to the JBI Manual for Evidence Synthesis guidelines. DATA SOURCES: Relevant data were identified from four electronic databases: CINAHL, PUBMED, SCOPUS and MEDIC. REVIEW METHODS: The eligibility criteria were formatted according to PICOS inclusion and exclusion criteria. At least two researchers performed the screening process separately, after which they agreed upon the results. The Cochrane Risk of Bias Assessment and JBI Critical Appraisal tool for randomised controlled studies (RCTs) were used to assess research quality. Data were extracted, and a meta-analysis was performed if the research met quantitative requirements. RESULTS: Of the 528 initially identified studies, 11 studies were chosen for final data synthesis. All of the interventions integrated ICT solutions into patient care to improve the quality of care. Patients across all of the RCTs were educated through direct training, the provision of information relevant to their disease or one-to-one educational coaching. The interventions included various interactions, e.g. nurse expert visits and support, and support provided by peers, groups or family members. These interactions occurred through face-to-face coaching, virtual human coaching or virtual coaching that relied on an algorithm. The performed meta-analysis included 6 of the 11 identified studies. The overall effect was nonsignificant, with three studies demonstrating a significant postintervention effect on patients' quality of care and quality of life and three studies a nonsignificant effect. CONCLUSIONS: The presented results suggest that ICT-based care should be developed in collaboration with nurses and other health care professionals, involve patients in decision-making and combine ICT solutions with human interaction and coaching. ICT education was found to be essential to the success of an intervention.

Ethical and cultural competence of social- and health care educators from educational institutions - Cross-sectional study.

BACKGROUND: The international mobility has increased cultural diversity in social- and health care. As such, ethical and cultural competence is an essential skill among educators. They are promoting the ethical and cultural competence and professional growth of students with diverse backgrounds and, therefore, must be ethically and culturally competent. AIM: The aim of the study was to identify distinct ethical and cultural competence profiles of social- and health care educators and explore the associated factors. RESEARCH DESIGN: A descriptive cross-sectional survey design was used to collect quantitative observational data in 2020-2021. Competence profiles were identified by K-means clustering based on answers to an instrument focussing on educators' ethical and cultural competence. PARTICIPANTS AND RESEARCH CONTEXT: Participants (N = 1179, n = 243) were social- and health care educators based at 10 universities of applied sciences and 10 vocational colleges in Finland. ETHICAL CONSIDERATIONS: The research adhered to good scientific practice. A research permit was received from each educational institution that participated in the study. The privacy of the participants was protected throughout the study. RESULTS: The analysis identified three profiles of educators (A, B, C) based on self-assessed ethical and cultural competence. Profile A educators demonstrated high scores across all three competence areas. Profile B educators had high scores for ethical knowledge and intermediate scores for other competence areas. Profile C educators demonstrated intermediate scores across all three competence areas. An educator's pedagogical education was found to significantly influence which profile they belonged to. CONCLUSIONS: The educators generally evaluated their ethical and cultural competence highly. Educators understand the importance of professional ethics in their work, but they need additional support in developing ethics skills in their daily work. Among all educators, there is a need for developing international and culturally diverse collaboration.

Nurse preceptors' orientation competence and associated factors-A cross-sectional study.

AIMS: To identify distinct orientation competence profiles amongst nurse preceptors and explain the associated factors. DESIGN: A cross-sectional study design. METHODS: The data were collected during the winter of 2020-2021 from registered nurses (N = 8279, n = 844) at one university hospital in Finland through an online questionnaire that included a self-administered electronic version of the Preceptors' Orientation Competence Instrument. K-means clustering was then used to identify nurse preceptor profiles. Chi-square, Fisher's exact test, Kruskal-Wallis and Mann-Whitney tests were used to analyse factors associated with competence profiles. The results were reported as frequencies, percentages, mean and standard deviation. RESULTS: A total of three distinct orientation competence profiles (A, B, C) were identified. Profile A nurses evaluated their orientation competence at the highest level, whereas profile C nurses evaluated their competence at the lowest level. Sufficient clinical and theoretical experience, a motivation to work, willingness to orient new employees and participation in orientation and/or mentoring education were found to be associated with competence profiles. CONCLUSION: The findings expand the current knowledge base of nurse preceptors' orientation competence. Health care organizations should recognize different orientation competence profiles amongst the nursing staff since the selection of a preceptor should always be based on possessing the necessary orientation competence rather than availability. The results indicate that preceptors (who reported taking on various tasks and covering multiple roles) need support from co-workers to sufficiently concentrate on employee orientation tasks. The results also indicate that preceptors need further orientation education, which should-for example-outline the learning goals for new employees and how preceptors can assess employee performance. IMPACT: What problem did the study address? Prior research has not applied a robust theoretical framework covering all aspects relevant to a preceptor's competence. What were the main findings? A nurse's clinical and theoretical experience, motivation to work, willingness to orient new employees, and prior participation in orientation and/or student mentoring education were found to influence their level of orientation competence. Where and on whom will the research have an impact? Healthcare organizations can use the results of this study to make the selection of preceptors competency-based rather than their availability. Nurse leaders can use the results of this study to pinpoint which areas of nurses' orientation competence and associated factors need to be improved. Increased orientation competence will enable clinical nurses to provide high-quality orientation to new employees, which is crucial to the retention of nursing staff and the quality of patient care.

The Appearance of Digital Competence in the Work of Health Sciences Educators: A Cross-sectional Study.

The digital competence of health sciences educators is important for the delivery and development of modern education and lifelong learning. The aim of the study was to assess the appearance of digital competence in the work of Finnish health sciences educators and to determine whether educators' background factors are related to the areas of digital competence appearance. The European Framework for the Digital Competence of Educators was used as a theoretical background. The participants were Finnish health sciences educators (n = 388). Data were collected by quantitative survey and statistically analyzed. Results show that health sciences educators had participated in continuing education to develop their expertise and used a variety of digital methods and materials. Educators need more competence to improve healthcare students' ability to use digital technology. In the area of Teaching and Learning, educators younger than 40 years rated the appearance of digital competence as better than did those between the ages of 40 and 49 years. In the future, health sciences educators' basic and continuing education could take into account the competence requirements for digital competence, and educators' expertise must be increased in areas where digital competence does not appear strong.

Health care managers' competence in knowledge management: A scoping review.

AIM: To identify current evidence on health care managers' competence in knowledge management. BACKGROUND: Although successful knowledge management improves the quality of care and performance of health care organisations, there is limited evidence on health care managers' competence in knowledge management EVALUATION: A scoping review was conducted by including original published and unpublished studies (qualitative, quantitative, and experimental) and review designs in English, Finnish, or Swedish. The studies were retrieved from six databases (CINAHL, ProQuest, PubMed, Scopus, Mednar, and Finnish database Medic) in November 2020 and then complemented in January 2022. Narrative synthesis was used to synthesize data. KEY ISSUES: A total of 21 articles was included in the review. The main themes of managers' competence in knowledge management presented in these were system management, professional development, and leadership behaviour and attitude. No valid and reliable instruments were described in the included studies. CONCLUSION: At present, there is a limited understanding of health care managers' competence in knowledge management. A comprehensive understanding of this topic can provide a direction for future research. IMPLICATIONS FOR NURSING MANAGEMENT: The results can be utilized in the assessment and development of managers' competence in knowledge management, as well as the formulation of education and in-service training for health care managers.

The ward manager role in the context of nursing and midwifery students' clinical learning: Testing a model.

AIM: To test a model of clinical learning that focuses on the role of the ward manager. BACKGROUND: The ward manager's role in supporting clinical learning indirectly focuses on the ward climate connected to students' clinical placements. In this way, the ward manager influences both nursing care and the pedagogical atmosphere in the ward. DESIGN: Cross-sectional, secondary analysis. METHODS: The sample included nursing and midwifery students (N = 5,776, n = 1,900) who had completed their clinical placement. Data were collected with the Clinical Learning Environment, Supervision and Nurse Teacher scale. Structural equation modelling was adopted to test the hypotheses. RESULTS: Estimates of the model parameters demonstrated that a ward manager's leadership style influences both the premises of nursing at the ward (0.84, p < .001) and the pedagogical atmosphere (0.93, p < .001), although the pedagogical atmosphere affects the mentoring relationship (0.87-0.86, p < .001). CONCLUSIONS: Ward managers exert a significant influence on the clinical learning environment via their support for an effective pedagogical atmosphere and, consequently, effective mentoring. IMPLICATIONS FOR NURSING MANAGEMENT: Leadership style guides both the premises of nursing at the ward and pedagogical atmosphere. These findings recommend that ward managers should be involved in promoting a supportive learning climate, which supports the mentor-student relationship and, eventually, leads to effective clinical learning.

Development and psychometric testing of the Gerontological Nursing Competence (GeroNursingCom) instrument.

AIM: To develop and psychometrically test an instrument - GeroNursingCom - that measures gerontological nursing competence of nursing students. DESIGN: An instrument development guided by COSMIN guidelines. METHOD: The development and testing of the GeroNursingCom instrument proceeded according to four distinct phases: (a) establishing a theoretical background; (b) testing face and content validity; (c) examining structural validity; and (d) testing internal consistency. The items of instrument were based on a theoretical framework developed from a comprehensive literature review and focus group interviews with experts (N = 27) in spring 2018. Content validity was assessed by nine experts in gerontological nursing, while face validity was tested in a pilot study including 36 nursing students. Structural validity was examined with exploratory factor analysis with 267 nursing students from nine universities of applied sciences. The internal consistency was established with Cronbach's alpha. The data were collected in spring and autumn 2019. The data analysis was conducted with multivariate statistical methods. RESULTS: The GeroNursingCom development and testing process yielded an instrument that includes 53 items across 11 factors: (a) appreciative encounters and interactions with older people; (b) medication for older people; (c) nutrition for older people; (d) safe living environment for older people; (e) supporting the functioning of older people; (f) end-of-life care; (g) developing one's competencies; (h) supporting an older person's mental well-being; (i) supporting an older person's sexuality; (j) guiding self-care among older people; and (k) responding to challenging situations. The instrument was able to explain 66.15% of the total observed variance, while Cronbach's alpha values for individual items varied from 0.75-0.89. CONCLUSION: TheGeroNursingCom instrument can be used to measure gerontological nursing competence among nursing students to improve gerontological nursing education and/or geriatric care. IMPACT: Graduating nursing students must develop versatile competencies to face the multiple needs of older patients and curriculums need to be further developed to ensure students are prepared for gerontological nursing.

Healthcare professionals' competence in stroke care pathways: A mixed-methods systematic review.

BACKGROUND: The challenges of caring for stroke patients are growing due to population ageing and improved survival rates. Healthcare professionals' competence development in stroke care is a necessity to ensure high-quality patient care. OBJECTIVES: To identify and describe the competence areas of healthcare professionals working in the stroke patient care pathway and factors influencing these competences. DESIGN: A mixed-methods systematic review. METHODS: The review was conducted according to the JBI guidelines and registered in the PROSPERO database (CRD42020204062). PRISMA checklist guided the review process. Relevant original studies were identified by searching four databases-CINAHL (EBSCO), PubMed, Scopus and Medic. After researcher consensus was reached, 32 studies were selected for inclusion and subjected to content analysis and data tabulation. RESULTS: Competence in care processes, clinical competence, competence in using self-management strategies, interaction skills, skills in acknowledging family and competence in integrating the available evidence base into patient care were identified as key competence areas. Organisation of services, specialisation in stroke care, continuous development and education, family and carer and training in oral care and cognitive rehabilitation were identified as factors that influence healthcare professionals' competence. CONCLUSIONS: Diverse clinical and interaction competencies are needed throughout the stroke care pathway, and various factors affect healthcare professionals' competence. Further research on healthcare professionals' stroke care competence will be needed to respond to changing healthcare demand. RELEVANCE TO CLINICAL PRACTICE: We recommend organisational support and formulation of stroke care patient guidelines in line with healthcare competence requirements. Focus should be added for nursing professions in developing interactive communication competence since nurses spend the majority of the time providing individual patient care. Also, organisations should integrate continuing training in specialised stroke care for healthcare professionals' competence development.

Continuing professional development among social- and health-care educators.

Future social- and health-care educators will be required to have versatile competence in educating professionals that reflects both the constantly changing health-care environment and delivery of high-quality patient care. Continuing professional development can be defined as a process that aims to increase educators' competence and well-being, along with the effectiveness of an organisation. This study aimed to describe educators' continuing professional development and clarify the contribution of continuing education. The research applied a qualitative approach as only limited information about social- and health-care educators' professional development currently exists.' Data were collected by group interviews of 35 experienced social- and health-care educators from six institutions of higher education and two vocational schools across Finland. An inductive content analysis yielded 39 subcategories, 11 categories and three main categories, namely, educators' approaches for developing professional competence, barriers to continuing education, and educators' continuing education needs. The educators reported that they maintain and develop their competence in versatile ways; for example, continuing professional development takes place through both formal continuing education and informal collaboration at daily work. Regarding barriers to continuing education, the educators most often cited the lack of planning and a lack of resources, for example, scheduling and financial factors. The continuing education needs of social- and health-care educators are highly individual and should not only reflect organisational goals. The fact that this study only included experienced educators can be considered a limitation, as a sample that also included novice educators may have yielded different perceptions of continuing education and professional development. The results of the research can be utilised when designing the continuing professional development of educators at the individual, group or organisational level.

The dental healthcare professionals' competence in mentoring students in the clinical practice.

OBJECTIVE: The aim of this study was to evaluate dentists', dental hygienists' and dental assistants' competence in mentoring students and to identify distinct mentor profiles. METHODS: The study employed a cross-sectional design. Data were collected using the Mentors' Competence Instrument (MCI), which includes 45 items structured under seven mentoring competence sub-dimensions. The data were collected during autumn 2017 from dentists, dental hygienists and dental assistants working in the Finnish primary healthcare (n = 1097) using a paper survey, whilst dentists (n = 26) who have completed mentoring education in one university completed an electronic questionnaire. Cases with more than 5% missing data (n = 164) were listwise deleted, whilst the remaining data (n = 933) underwent analysis. K-mean clustering was used to identify significantly different mentor profiles, whilst comparisons of mentoring competence between the identified profiles were performed with Kruskal-Wallis and Mann-Whitney tests. RESULTS: Three distinct mentor profiles (A, B and C) that differed in the level of mentoring competence were identified. The participants in profile A encompassed mostly dental assistants, profile B included mostly dental assistants and dentists, and profile C mainly comprised dentists and dental assistants. Profiles A, B and C differed significantly in terms of education, job title, role of mentor and participation in mentoring education. The largest difference in competence was observed between participants of profiles A and C. Each profile differed significantly from the other two across all seven competence areas. Most of the participants had not previously received any mentoring education. CONCLUSION: There is room for improvement in the competence of dentistry student mentors, especially regarding knowledge of effective mentoring practices, goal-oriented mentoring, mentor characteristics and motivation for mentoring. Every mentor that works with oral healthcare students should receive mentoring training.

Interventions to improve nurses' job satisfaction: A systematic review and meta-analysis.

AIMS: To identify current best evidence on the types of interventions that have been developed to improve job satisfaction among nurses and on the effectiveness of these interventions. DESIGN: The systematic review is a quantitative systematic review and meta-analysis following a profile-likelihood random-effects model. DATA SOURCES: CINAHL, Medic, and Pubmed (Medline). REVIEW METHODS: PICOS eligibility criteria were used to select original studies published between 2003-2019. The articles were screened by title (N = 489), abstract (N = 61), and full-text (N = 47). A total of 20 articles remained after the full-text screening process and further assess on risk of bias. The screening process was conducted by two authors independently and finally agreed together. A meta-analysis was performed to determine how the identified interventions influence nurses' job satisfaction. RESULTS: The interventions were primarily educational and consisted of workshops, educational sessions, lessons, and training sessions. The postintervention differences between intervention and control groups in meta-analysis revealed that two interventions significantly improved nurses' job satisfaction. Notably, the spiritual intelligence training protocol and Professional Identity Development Program were found to be effective in improving job satisfaction. CONCLUSION: Healthcare organizations and managers should consider implementing effective interventions to improve nurses' job satisfaction and reduce turnover. The results reported in this study highlight that nurse managers should focus on organizational strategies that will foster the intrinsic motivation of employees. IMPACT: The current nursing shortage and increased turnover intentions are proving to be a global problem. For this reason, it is imperative that nurse managers plan strategies to improve nurses´ job satisfaction. The effective interventions detected in this study are a first step for developing human resource strategies for healthcare organizations. These findings propose that extrinsic factors (e.g., salary and rewards) will never be as effective in maintaining job satisfaction as intrinsic factors (e.g., spiritual intelligence, professional identity, and awareness).

Clustering clinical learning environment and mentoring perceptions of nursing and midwifery students: A cross-sectional study.

AIMS: This study aimed to explore nursing and midwifery students' evaluation of the clinical learning environment and mentoring and to identify distinct student profiles relating to their perceptions. DESIGN: This study employed a cross-sectional design. SETTINGS: The study population included nursing and midwifery students in a university hospital in Finland. PARTICIPANTS: All nursing and midwifery students who completed their clinical placement were invited to take part in the study in the academic year 2017-2018. METHODS: The data (N = 2,609) were gathered through an online survey using the Clinical Learning Environment, Supervision and Nurse Teacher scale. The data were analysed using a K-mean cluster algorithm to identify nursing and midwifery students' profiles. RESULTS: The findings from this study indicate four distinct profiles (A, B, C, & D) of nursing and midwifery students in relation to the clinical learning environment and mentoring. Profile A (N = 1,352) students evaluated their clinical learning environment and mentoring to the highest level (mean varied from 9.44-8.38); and Profile D (N = 151)- to the lowest (mean varied from 5.93-4.00). CONCLUSION: The findings highlight that nursing and midwifery students evaluate their clinical learning environment and mentoring more highly when: they have a named mentor, student and mentor discuss learning goals, there is a final assessment in clinical learning, the mentor's guidance skills support student learning, the clinical learning supports the student's professional development and pre-clinical teaching in an educational institution supports learning in the clinical placement. IMPACT: Clinical learning plays an important role in nurse and midwifery education. Mentoring of clinical practice was shown to have a great influence on students' perceptions of their success in clinical learning. We suggest that clinical practice should be strengthened by the building of collaboration between nursing teachers and registered nurses.

Empirical model of clinical learning environment and mentoring of culturally and linguistically diverse nursing students.

AIMS AND OBJECTIVES: To develop and test an empirical model of clinical learning environment and mentoring of culturally and linguistically diverse nursing students. BACKGROUND: Clinical learning is an essential part of nursing education; nursing students are required to master clinical competences and build a professional identity during their education. The global mobility of nurses requires high proficiency in cultural adaptability as well as the successful integration of cultural diversity into the healthcare system on a national level. DESIGN: The research design was a quantitative cross-sectional study. STROBE statement was used to enhance the quality and transparency of research. METHODS: Data were collected from eight universities during the 2015-2016. The analysis included data from 187 participants, collected using the CLES+T scale and CALDs. Instrument validity was tested with confirmatory factor analysis, while the hypotheses were tested with a structural equation model. RESULTS: Pedagogical atmosphere was shown to be positively related to cultural diversity (0.66), orientation into the clinical placement (0.54) and the role of the student (0.25), and all of these relationships were statistically significant. These dimensions-with the exception of the role of the student-also showed a significantly positive influence on the mentoring relationship (respectively, 0.32, 0.71, 0.18). Fit indexes demonstrate an adequate model's fit. CONCLUSIONS: The model needs to be further piloted and tested in organisational structures of clinical practice of culturally and linguistically diverse nursing students. The dimensions that explain mentoring in clinical learning needed to be further addressed in a theoretically consistent and empirically driven approach, according to these findings. RELEVANCE TO CLINICAL PRACTICE: In our study, we found that environmental and relational aspects are the most important for building an effective clinical learning environment. Universities and healthcare organisations can jointly leverage the model to foster clinical learning environments in clinical practice.