A causal model of thriving at work in Chinese nurses.

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

Factors influencing workplace social capital among registered nurses in China.

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

Developing a strategic model of participation in policy development for nurses.

AIM: To develop a strategic model of participation in policy development for nurses in Thailand. BACKGROUND: Public health policies inevitably affect nursing practice, service delivery and the nursing workforce. Available evidence indicates that nurses have minimal participation in policy development. INTRODUCTION: Nurses' participation in public health policy development is essential to developing and maintaining an efficient, high-quality healthcare system. METHODS: The Delphi method was used to develop the strategic model based on the input of fifteen nurse experts who were interviewed over three Delphi rounds. Data were analysed descriptively to identify items to be retained or dropped, and the final list of statements was verified by all participants to establish the strategic model of participation. FINDINGS: The strategic model contains twenty-five participation strategies for nurses wishing to engage with public health policy development. Within the model, the priorities as identified by clinical nurses, nurse leaders, nurse researchers and scholars, nursing educational institutions and nursing professional organizations are acknowledged. CONCLUSION: The model represents a consensus of values related to policy participation by nurses and the results align with similar studies. The inclusion of different nursing groups in promoting and developing strategies to participate in policy development ensures that all nurses have a role to play in developing nursing capacity for effective health policy engagement. IMPLICATION FOR NURSING POLICY: Nursing involvement in policies that affect them and their practice is fundamental to establishing good public policy. This research provides a clear mechanism for the development of nurses' awareness and abilities to become involved in policy development and review processes.

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

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

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

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

A causal model for the quality of nursing care in Thailand.

BACKGROUND: A growing global nursing shortage has affected the quality of care (QOC) provision. AIM: To test the structure-process-outcome model for quality of nursing care in regional medical centres in Thailand. METHODS: A cross-sectional study with multi-stage, proportional stratified random sampling. The sample comprised 136 units, 916 nurses and 943 patients from nine regional medical centres. Data were collected from six instruments in February-June 2016 and analysed with structural equation modelling. RESULTS: The modified model fitted the empirical data. The nurse practice environment (NPE) had a negative direct effect on pressure ulcer prevalence and a positive direct effect on patient satisfaction, perceived QOC and interpersonal processes of care (IPC). Increasing the patient-to-nurse ratio had a positive direct effect on catheter-associated urinary tract infections and pressure ulcer prevalence and had negative direct effects on patient satisfaction and perceived QOC. Skill mix had negative direct effects on the two former conditions but had a positive direct effect on patient satisfaction. The patient-to-nurse ratio and skill mix also had indirect effect on four outcomes via NPE. LIMITATIONS: The generalizability of findings may be limited to settings similar to this study. CONCLUSION: We empirically demonstrated that NPE, patient-to-nurse- ratio and skill mix had direct effects on unfinished nursing care and four outcomes. Also, the IPC had significant influence on patient satisfaction. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The findings add to increasing international evidence that favourable nurse working conditions, low nurse-to-patient ratio and richer skill mix result in positive patient outcomes. Health systems can foster nurses to perform high-quality care by improving work conditions, and providing sufficient nurses and resources.

Developing a cultural competence inventory for nurses in China.

AIM: To develop and psychometrically test the Cultural Competence Inventory for Nurses in China. BACKGROUND: Cultural competence is expected worldwide from nurses due to the increasing cultural diversity of people in healthcare establishments. Yet, no cultural competence framework or instrument for nurses has been identified to guide nursing practice in China where the cultural diversity of the populations and the characteristics of the healthcare system are different from those of the West. METHODS: A review of literature and individual interviews among nurse experts generated 74 items, which were evaluated by six experts in transcultural nursing. A stratified random sampling technique was used to recruit 520 Chinese nurses for the field test. Construct validity and internal consistency reliability of the instrument were estimated by exploratory factor analysis and Cronbach's alpha, respectively. The data were collected from May 2015 to January 2016. RESULTS: The final instrument consists of 29 items in five dimensions, namely 'cultural awareness, cultural respect, cultural knowledge, cultural understanding and cultural skills'. Cronbach's alpha for the instrument was 0.94, with a range of 0.79-0.92 for the individual dimensions. The evidence for contrast-group validity (P < 0.001) was also obtained. CONCLUSION: The study provides evidence that the Cultural Competence Inventory for Nurses in China is reliable, valid and culturally sensitive for measuring nurses' cultural competence. The instrument development process facilitates the understanding of cultural competence globally. IMPLICATIONS FOR NURSING AND NURSING POLICY: Cultural competence of nurses can be evaluated for self-development, workforce management and quality assurance. The instrument can also serve as the foundation to develop education curricula and nursing procedures or protocols to improve culturally competent nursing practice.

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

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

Effects of nurse work environment on job dissatisfaction, burnout, intention to leave.

BACKGROUND: The nursing shortage is a critical issue in many countries. High turnover rates among nurses is contributing to the shortage, and job dissatisfaction, intention to leave, and burnout have been identified as some of the predictors of nurse turnover. A well-established body of evidence demonstrates that the work environment for nurses influences nurse job dissatisfaction, intention to leave, and burnout, but there never has been a study undertaken in Thailand to investigate this relationship. OBJECTIVES: To investigate how work environment affects job dissatisfaction, burnout, and intention to leave among nurses in Thailand. METHODS: The study used a cross-sectional survey to collect data from 1351 nurses working in 43 inpatient units in five university hospitals across Thailand. The participants completed the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and measures of job dissatisfaction and intention to leave. Logistical regression models assessed the association between work environment and nurse-reported job dissatisfaction, burnout, and intent to leave. RESULTS: Nurses working in university hospitals with better work environments had significantly less job dissatisfaction, intention to leave, and burnout. CONCLUSION: The nurse work environment is a significant feature contributing to nurse retention in Thai university hospitals. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Improving the work environment for nurses may lead to lower levels of job dissatisfaction, intention to leave, and burnout. Focusing on these nurse outcomes can be used as a strategy to retain nurses in the healthcare system. Addressing the challenges of poor work environments requires coordinated action from policymakers and health managers.

Nurses' extended work hours: Patient, nurse and organizational outcomes.

BACKGROUND: Nursing shortages have been associated with increased nurse workloads that may result in work errors, thus impacting patient, nurse and organizational outcomes. AIM: To examine for the first time in Thailand nurses' extended work hours (working more than 40 h per week) and its relationship to patient, nurse and organizational outcomes. METHODS: Using multistage sampling, 1524 registered nurses working in 90 hospitals across Thailand completed demographic forms: the Nurses' Extended Work Hours Form; the Patient, Nurse, Organizational Outcomes Form; the Organizational Productivity Questionnaire and the Maslach Burnout Inventory. The data were analysed using descriptive statistics, Spearman's rank correlation and logistic regression. RESULTS: The average extended work hour of respondents was 18.82 h per week. About 80% worked two consecutive shifts. The extended work hours had a positive correlation with patient outcomes, such as patient identification errors, pressure ulcers, communication errors and patient complaints and with nurse outcomes of emotional exhaustion and depersonalization. Furthermore, we found a negative correlation between extended work hours and job satisfaction as a whole, intent to stay and organizational productivity. Nurses who had extended work hours of >16 h per week were significantly more likely to perceive all four adverse patient outcomes than participants working an extended ≤8 h per week. LIMITATIONS: Patient outcomes were measured by respondents' self-reports. This may not always reflect the real occurrence of adverse events. CONCLUSIONS: Associations between extended work hours and outcomes for patients, nurses and the organization were found. The findings demonstrate that working two shifts (16 h) more than the regular work hours lead to negative outcomes for patients, nurses and the organization. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Our findings add to increasing international evidence that nurses' poor working conditions result in negative outcomes for professionals, patients and health systems. Policymakers need to be aware of the issues regarding nurses' extended work hours, which has been found to contribute to burnout. Urgently, nurse and health administrators need to develop and implement appropriate nursing overtime policies and strategies to help reduce this phenomenon, including measures to overcome the nursing shortage.

Development of quality of nursing care in Thailand.

BACKGROUND: In Thailand there is a need to establish definitions of quality of nursing care and to determine how it is measured. There is an urgent need to focus more closely on indicators of nursing quality. In Thailand there is no agreed upon definition of quality nursing care or indicators by which to measure it. PURPOSE: The purpose of this research was to develop a definition of quality of nursing care and to begin the process of defining quality of care indicator measures to evaluate the care given in acute care settings. METHODS: This descriptive study was conducted in Thailand. The process included two phases. The first phase used individual interviews and focus group discussion and the second phase included consultation with quality of nursing care experts. An interview guide was used to structure the interviews and the draft definitions of quality and suggested indicators were used when consulting with the experts in the second phase of the study. FINDINGS: The findings are organized into two sections: (1) definition of quality of nursing care and quality of nursing indicators; and (2) consultation with Thailand quality experts to refine the definition and quality of care indicators. The indicators were categorized into three groups: structure, process, and outcome. LIMITATIONS: This descriptive study using qualitative method relied upon the opinions of various stakeholders. Their opinions may or may not have any direct relationship to the scientific literature related to quality. Many of the indicators need to be further refined. CONCLUSIONS: The findings generally support the initial work done in the United States of America. There is a need to further refine the various Thailand indicators. This study is the first in Thailand that has attempted to address quality of nursing care.