The role of nurses' adherence to clinical safety guidelines in linking nurse practice environment to missed nursing care.

INTRODUCTION: While the nurse practice environment's vital role in shaping patient care outcomes is well established, the precise mechanisms through which it influences missed nursing care remain unexplored. Hence, this study examined the mediating role of adherence to clinical safety guidelines in the relationship between the nurse practice environment and missed nursing care. METHODS: This descriptive, cross-sectional study involved 1237 nurses from 11 governorates in the Sultanate of Oman. Data were collected using three standardized scales: the Patient Safety Adherence Scale, the Practice Environment Scale of the Nursing Work Index, and the Missed Nursing Care Scale. RESULTS: A favorable nurse practice environment was associated with higher adherence to clinical safety guidelines (ß = 2.492, p < 0.001) and a lower frequency of missed nursing care (ß = -0.2919, p = 0.015). Adherence to clinical safety guidelines partially mediated the relationship between the nurse practice environment and missed nursing care (ß = -0.055, p < 0.001). CONCLUSION: Enhancing the nurse practice environment plays a crucial role in improving nurses' adherence to clinical safety guidelines, which in turn reduces compromised nursing care. CLINICAL RELEVANCE: Healthcare administrators and policymakers should prioritize improving working conditions to enhance nurses' adherence to clinical safety guidelines, thereby minimizing the occurrence of missed care and improving overall patient outcomes.

Hospital-acquired pressure ulcers among adult ICU patients in tertiary hospitals in Oman: a one-year prevalence study.

BACKGROUND: Hospital-acquired pressure ulcer (HAPU) is a significant problem in healthcare settings and is associated with negative impacts on patient health. Although monitoring of pressure ulcers (PUs) among hospitalised patients was started more than a decade ago in Oman, no previous studies have been completed to estimate the prevalence and risk factors of HAPUs among patients in the intensive care unit (ICU). The aim of this study was to estimate the prevalence and identify risk factors for HAPUs among adult ICU patients in selected tertiary hospitals in Oman. METHOD: A retrospective, cross-sectional, nested, case-control design was used to identify the prevalence rate of HAPUs and risk factors for a cohort of adult ICU patients over one calendar year (1 January-31 December 2019) in two tertiary hospitals in Oman. RESULTS: The prevalence rate for HAPU among ICU patients in Oman was 36.4%. However, when excluding cases of stage 1 ulcer, the rate was 30.37%. The most prevalent location was the sacrum (64.1%), and the most common stage was stage 2 (73.1%). The risk factors for HAPU included male sex (odds ratio (OR): 0.37; p=0.023), organ failure (OR: 3.2; p=0.033), cancer (OR: 3.41; p=0.049), cerebrovascular accident (OR: 12.33; p=0.001), mechanical ventilator (OR: 9.64; p=0.025) and ICU length of stay (OR: 1.24; p<0.001). CONCLUSION: HAPUs among ICU patients constitute a significant problem associated with severe clinical consequences and result in substantial adverse healthcare outcomes worldwide, including in Oman. Identifying the risk factors and the impact on the healthcare system is the foundation for preventing and managing HAPUs.

Stress Factors, Stress Levels, and Coping Mechanisms among University Students.

Aims: To explore university students' levels of stress, stressors, and their coping style. Methods: A cross-sectional correlational design with a convenience sample (n = 676) of university students who completed the Student-Life Stress Inventory (SSI) and Coping Strategies Indicator (CSI) was used. Findings. Overall, two-thirds of the participant reported moderate levels of stress. Students with chronic illness, living alone, low CGPA, and having exams today experienced a statistically higher mean level of stress. Students who are living alone used the "avoidance" method more significantly and the "social support" method significantly less compared with students who are living with their families and friends. Conclusion: This study concurs with others that university students are prone to distress. To our knowledge, this is the first study in the region to explore the students' coping skills. Some of the employed coping and associated factors could be used to lay the groundwork for evidence-based prevention and mitigation.

Prevalence and Predictors of Loneliness Among Youth During the Time of COVID-19: A Multinational Study.

BACKGROUND: Given the restrictions associated with COVID-19, feelings of loneliness among youth may increase. AIMS: The aims of the current study were to assess the prevalence of loneliness among young people at the time of COVID-19 and to identify whether selected variables related to the pandemic predicted the level of loneliness. METHOD: A cross-sectional study using WhatsApp and Facebook social media platforms was conducted to survey 1,057 young people aged 15 to 24 years from six Middle Eastern countries. Participants completed survey items including demographic and COVID-19-related questions; the Depression, Anxiety and Stress Scale (DASS); the Satisfaction With Life Scale (SWLS); and the UCLA Loneliness Scale. RESULTS: The prevalence of experienced loneliness was 1 (0.1%), 625 (59.1%), 429 (40.6%), and 2 (0.2%), reflecting low, moderate, moderately high, and high experiences for loneliness, respectively. History of depression or anxiety, being dissatisfied with life, and having depression at the time of COVID-19 were significant predictors of loneliness among youth. The model was significant (F = 44.95, p < .05) and accounted for 29.8% of the variance in UCLA Loneliness Scale scores. CONCLUSIONS: We found that the high prevalence rate of loneliness during the COVID-19 pandemic was correlated with depression and impaired life satisfaction among Middle Eastern youth. Thus, special attention and interventional action plans need to be developed taking into consideration the youths' special situation during COVID-19.

Facilitators and barriers of mental health help-seeking behaviours among adolescents in Oman: a cross-sectional study.

OBJECTIVES: This study aimed to explore and identify facilitators and barriers to help-seeking behaviours among adolescents in Oman, by exploring the relationship between knowledge, attitude, and behaviour towards mental health help-seeking. METHODS: A cross-sectional descriptive study was used and 424 adolescents were recruited to participate in the study. Participants were asked to complete five self-reported questionnaires, including two open-ended questions about the main motivations and barriers to seeking professional help for mental problems. RESULTS: It was found that those with positive help-seeking attitudes towards mental health were more knowledgeable about mental health, had more positive attitudes towards mental illness, and had higher intention to help seeking. On the contrary, those with higher help-seeker stereotypes had more negative attitudes towards mental illness. Having an adequate support system, being positive and knowledgeable about mental illness, and the reputation of mental health are the main factors facilitating seeking professional help. However, fear, lack of family support, and the time-consuming procedures were the main barriers emerging from the open-ended questions. CONCLUSIONS: This study contributes by identifying facilitating factors as well as barriers in an Arabic context (Oman) to fill the exiting knowledge gap; both need to be considered when planning interventions targeting the younger individuals in this society.

Nurses' job burnout and its association with work environment, empowerment and psychological stress during COVID-19 pandemic.

AIM: The aim of this study was to assess the influence of perceived work environment, empowerment and psychological stress on job burnout among nurses working at the time of the COVID-19 pandemic. BACKGROUND: Nurses experienced high levels of job burnout during the pandemic, which impacted their mental health and well-being. Studies investigating the influence of work environment, empowerment and stress on burnout during the time of COVID-19 are limited. DESIGN: The study utilized a cross-sectional design. METHODS: Data were collected from 351 nurses in Oman between January and March 2021. The Maslach Burnout Inventory, the Practice Environment Scale of the Nursing Work Index, the Conditions of Work Effectiveness Questionnaire and the Perceived Stress Scale were used to assess study variables. RESULTS: About two-thirds of the nurses (65.6%) reported high levels of job burnout. Nurse managers' ability, leadership and support; staffing and resources adequacy; and nurses' access to support were significant factors associated with a reduced level of burnout. CONCLUSION: Supporting nurses during the crisis, ensuring adequate staffing levels and providing sufficient resources are critical to lower job burnout. Creating a positive and empowered work environment is vital to enhance nurses' retention during the pandemic.

Interprofessional collaboration as a mediator in the relationship between nurse work environment, patient safety outcomes and job satisfaction among nurses.

BACKGROUND: As an important organisational feature, the nurse work environment has been associated with increased work effectiveness, reduced patient safety issues and improved care quality. However, the mechanism underlying this association remains unexplored. AIM: This study aims to assess the mediating role of interprofessional collaboration in the relationships between nurse work environment, select patient safety outcomes and job satisfaction. METHODS: This cross-sectional, descriptive study used five standardized scales and included 881 clinical nurses employed in select teaching hospitals in Oman. RESULTS: Nurses who worked in teaching hospitals in Oman perceived their work environment as highly favourable. Nurse work environment was directly and indirectly associated with nurse-assessed quality of care, adverse patient events and job satisfaction, through interprofessional collaborations. CONCLUSION: Findings of the study suggest that enhancing nurse work environments can be a potential strategy to foster interprofessional collaboration and improve job satisfaction and patient safety outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Organisational strategies to improve patient safety outcomes and job satisfaction in nurses can be facilitated by improving nurses' work conditions and enhancing interprofessional collaboration through supportive leadership, theory-driven approaches, obtaining hospital accreditation/certification and relevant workplace policies.

Public information needs and attitudes regarding cancer and cancer patients in Oman: a cross-sectional survey.

BACKGROUND: Exploring public information needs and attitudes towards cancer patients might be the first step in developing an intervention that encourages public engagement in early detection and cancer prevention programmes. AIM: To explore Omani public information needs and attitudes towards cancer in Oman. METHODS: A cross-sectional survey design was used. FINDINGS: Of the 569 participants, 369 (64.9%) were female; the mean age was 30.9 (SD=9.5) years. Of the participants, 94.4% wanted to be informed if they were found to have cancer in the future. The mean total attitudes score was 40.2 (SD=4.7) out of a maximum 48. Further, being employed, preferring to be informed about cancer diagnosis and having positive attitudes towards cancer and cancer patients predicted higher information needs. CONCLUSIONS: The current paternalistic approach seems to be no longer appropriate for cancer patients in Oman, and more active patient involvement in decision-making is needed.

Authentic leadership and nurses' motivation to engage in leadership roles: The mediating effects of nurse work environment and leadership self-efficacy.

BACKGROUND: Leadership styles of a nurse manager have a profound influence on staff nurses' motivation to engage in formal nursing leadership roles; however, the mechanism underlying this pattern of influence remains unknown. AIM: To assess the direct and indirect effect of nurse managers' authentic leadership on staff nurses' motivation to engage in formal leadership roles, through the intermediary role of nurse work environment and leadership self-efficacy. METHODS: This cross-sectional study involved 1534 nurses from 24 acute care hospitals in the Sultanate of Oman. FINDINGS: Nurse managers' authentic leadership was associated with staff nurses' motivation to engage in formal leadership roles. Nurse practice environment and leadership self-efficacy mediated partially the association between authentic leadership and motivation to engage in formal leadership roles. CONCLUSION: Results of this study underscore the value of authentic leadership in creating a healthy work environment and fostering nurses' leadership self-efficacy, resulting in greater motivation to engage in nursing leadership roles. IMPLICATIONS FOR NURSING MANAGEMENT: Organizational strategies to attract nurses to undertake leadership roles should include measures to bolster authentic leadership behaviours in nurse managers through theory-driven leadership development programmes or interventions, continuing education, effective succession planning and creating a supportive work environment.

Authentic leadership, nurse-assessed adverse patient events and quality of care: The mediating role of nurses' safety actions.

BACKGROUND: Authentic leadership has been consistently cited as a strong precursor of sustained job performance and work effectiveness in nurses; however, studies linking authentic leadership with nurses' safety actions, nurse-assessed adverse patient events and nursing care quality are scarce. AIM: To examine whether nurses' safety actions mediate the relationship between authentic leadership, nurse-assessed adverse events and nursing care quality. METHODS: A multi-centre, cross-sectional study involving 1,608 nurses employed in acute care facilities in Oman. Multi-stage regression analysis was conducted in testing for the mediation model. FINDINGS: Nurse managers in Oman were perceived to be highly authentic by their staff nurses. Authentic leadership significantly predicted nurses' safety actions (ß = 0.168, p < .001), decrease in nurse-assessed adverse events (ß = -0.017, p = .024) and increase in care quality (ß = 0.121, p < .001). Further, the association between authentic leadership and nurse-assessed adverse events (ß = -0.063, p = .057) and care quality (ß = 0.038, p = .002) was mediated by nurses' safety actions. CONCLUSION: Results suggest the importance of developing nurse managers' authentic leadership to foster nurses' safety actions and reduce adverse patient outcomes and promote nursing care quality. IMPLICATIONS FOR NURSING MANAGEMENT: Organizational efforts to address patient safety issues should be directed towards developing authentic leadership in nurse managers through leadership programmes, periodic evaluation of leadership competencies (e.g., 360-degree or a bottom-up performance evaluation), and a creation of a safe culture in which nurses can openly report safety concerns for corrective action.

Differences in critical thinking skills between nursing students on a fast-track versus traditional 4-year programme.

BACKGROUND: The authors were unable to find studies comparing the critical thinking skills of nursing students on advanced standing programmes (ASP) and on traditional 4-year BN programmes in Canada. The ASP is a condensed Bachelor of Nursing (BN) programme, designed for students who already have a university degree or similar qualification. AIM: To measure and compare the critical thinking skills of ASP students and traditional 4-year BN students. METHOD: A cross-sectional study using a self-administered questionnaire used to collect data from 100 nursing students at a university in Canada. Data were analysed using descriptive and inferential statistics. All research ethics were taken into consideration. FINDINGS: All participants scored highly in their critical thinking skills. However, ASP students scored significantly higher than their counterparts on the 4-year programme (M=21.6 vs M=18.9, F=4.75, P=0.035). CONCLUSION: Higher critical thinking skills among ASP nursing students is a promising sign to expand and support this type of programme as a fast and effective method to cover the shortage in nurses.

Nursing Work Environment, Turnover Intention, Job Burnout, and Quality of Care: The Moderating Role of Job Satisfaction.

PURPOSE: The purpose of this study was twofold: (a) to assess predictors of the turnover intention, burnout, and perceived quality of care among nurses working in Oman, and (b) to examine the potential moderating role of job satisfaction on the relationship between work environment and nurse turnover intention. DESIGN: A cross-sectional design was used to collect data from a sample of 207 nurses working in a public hospital in Muscat, Oman. METHODS: An electronic survey was used to assess nurses' perceptions of work environment, burnout, job satisfaction, turnover intention, and quality of care. FINDINGS: Participation in hospital affairs, a foundation for quality of care, and staffing adequacy were predictors of burnout among nurses and perceived quality of care. Logistic regression analysis revealed that working in a favorable environment was associated with less turnover intention, but only when job satisfaction was high. CONCLUSIONS: Improving nurse job satisfaction is a mechanism through which future interventions could enhance working conditions and promote better nurse retention. CLINICAL RELEVANCE: Organizational strategies are needed to increase nurse job satisfaction by empowering nurses to take more active roles in hospital affairs as a strategy to reduce turnover intention and enhance the quality of patient care.

Factors influencing nurses' willingness to lead.

AIM: To identify factors influencing nurses' willingness to lead. BACKGROUND: Given the ageing workforce and the projected retirement of nurse leaders, there is a concern about nursing leadership shortages in the next decade. Several studies have shown that nurses are not interested in pursuing leadership positions, but studies investigating nurses' willingness to lead and related predictors remain limited. METHODS: A workforce survey of 1,201 direct-care nurses was conducted in Oregon. Logistic regression modelling was used to identify factors influencing the likelihood of nurses' willingness to lead. RESULTS: Fifty-three percent of nurses were willing to pursue leadership roles. Years of experience, job burnout, the perception of the work environment, adequacy of leadership preparation, and the amount of salary and compensation were significant predictors of nurses' willingness to lead. CONCLUSION: Increasing nurses' participation in hospital affairs and providing adequate leadership preparation, parts of the work environment, prior to engaging them in leadership roles is recommended to improve their attitudes about leading. IMPLICATIONS FOR NURSING MANAGEMENT: Recruitment of future nursing leaders should not be based solely on demographics such as age and gender. Rather, recruiters should focus on creating more favourable work environments in which to lead.

Healthy work environments are critical for nurse job satisfaction: implications for Oman.

AIMS: To (1) examine the level and variability of nurse work environment and job satisfaction and (2) explore how nurse job satisfaction in tertiary hospitals in Oman is influenced by the nurses' characteristics and work environment. BACKGROUND: In Oman and the Middle East, a scarcity of research addressing nurse work environment and job satisfaction exists. Such evidence is necessary for policymaking to positively impact nurse job outcomes, and therefore, quality of care. METHODS: We used a cross-sectional descriptive design employing a sample of 454 local and expatriate nurses who responded to a self-administered questionnaire. RESULTS: The work environment was favourable, and it positively correlated with job satisfaction. Nationality, education, hospital type, staffing, resources and participation in hospital affairs were significant predictors of nurse job satisfaction. The greatest amount of variation in nurse job satisfaction was explained by the work environment. CONCLUSION: The influence of work environment on nurse job satisfaction is greater than nurse characteristics and hospital and unit types. Enhancing nurse participation in hospital affairs and providing adequate staffing and resources are central means of establishing healthy work environments, which is an auspicious, cost-effective strategy for satisfying, and therefore, retaining nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: To enhance nurse work environment and job satisfaction in Oman and the Middle East, nurse and health leaders need to consider developing work and professional regulations and adopting policies to promote staffing, resources, wages, and benefits for nurses and encourage their promotion and career advancement; and foster nurse participation in hospital affairs.

Caring for women globally: psychometric testing of two instruments translated into five languages for use in cardiovascular recovery.

Among women, cardiovascular disease is the leading cause of mortality worldwide. After experiencing an acute cardiovascular event, a woman's physical health, the prevalence of morbidities, likelihood of being treated with coronary artery bypass graft surgery, likelihood for referral for cardiac rehabilitation are less favourable than men. The social support resources of marginality and religiousness are associated with physical and mental health outcomes following cardiovascular crises. This study aimed to evaluate the reliability and validity of the translated versions (Japanese, Ukrainian, Tagalog, Hispanic and Arabic) of the Koci Marginality Index and the Duke University Religion Index among 282 women (aged 35-92 years) representing seven cultures. Results showed that reliability and validity were strong (coefficient alpha of 0.79 and 0.84). Understanding a woman's social isolation and whether she has a connection to religious groups assists health-care professionals to identify a woman's social support resources during recovery following acute cardiovascular episodes.

Perception of Nursing Students About Effective Clinical Teaching Environments: A Multi-Country Study.

Background: The transition of nursing education from traditional methods to more advanced approaches is crucial for adequately preparing students to deliver competent care in tertiary care centers. Moreover, clinical faculty in nursing plays a key role in guiding nursing students through their clinical training in various healthcare settings. Purpose: This study aims to describe the perceptions of undergraduate nursing students regarding the effectiveness of the learning environment and clinical teaching in clinical areas across various countries. Methods: The study, conducted using a descriptive, cross-sectional research design, gathered data from 215 nursing students using the Clinical Learning Environment Inventory and Clinical Teaching Effectiveness Instrument. Data analysis included frequencies, percentages, mean, standard deviation, t-tests, analysis of variance, and correlation assessments to comprehend the impact of clinical teaching and learning environments. Results: Nursing students' perceptions of the clinical learning environment produced mean scores between 2.03 and 3.38 on a scale from 1 to 4, resulting in an overall mean score of 2.72 across 42 items. This indicates a general satisfaction with their clinical learning experiences. Regarding effective clinical teaching, the mean student responses varied from 3.02 to 3.40 out of a possible 5 points, with a total mean of 3.22. The study revealed notable correlations in the context of effective clinical teaching, particularly with demographic variables and the clinical learning environment. Specifically, a significant correlation with age (r = .177, p = .009) and the clinical learning environment (r = .572, p < .001) was identified. Conclusion: The study concludes that students expressed overall satisfaction with their clinical learning experiences. They recognized the importance of participating in clinical training, fulfilling clinical responsibilities for assigned patients, exerting extra effort for learning, receiving support from preceptors in clinical settings, and being attentive to communications from staff. The collaboration between clinical preceptors and academic nursing lecturers is crucial in providing a positive learning environment for students to complete clinical tasks effectively.

Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction.

Objectives: This study aimed to estimate the door-to-balloon (DTB) time and determine the organisational-level factors that influence delayed DTB times among patients with ST-elevation myocardial infarction in Oman. Methods: A cross-sectional retrospective study was conducted on all patients who presented to the emergency department at Sultan Qaboos University Hospital and Royal Hospital, Muscat, Oman, and underwent primary percutaneous coronary interventions during 2018-2019. Results: The sample included 426 patients and the median DTB time was 142 minutes. The result of the bivariate logistic regression showed that patients who presented to the emergency department with atypical symptoms were 3 times more likely to have a delayed DTB time, when compared to patients who presented with typical symptoms (odds ratio [OR] = 3.003, 95% confidence interval [CI]: 1.409-6.400; P = 0.004). In addition, patients who presented during off-hours were 2 times more likely to have a delayed DTB time, when compared to patients who presented during regular working hours (OR = 2.291, 95% CI: 1.284-4.087; P = 0.005). Conclusion: To meet the DTB time recommendation, it is important to ensure adequate staffing during both regular and irregular working hours. Results from this study can be used as a baseline for future studies and inform strategies for improving the quality of care.

The Relationship between Nursing Leadership and Patient Readmission Rate: A Systematic Review.

BACKGROUND: Nurse leaders play a fundamental role in improving patient quality care delivery, thus improving patient clinical outcomes. PURPOSE: This systematic review examined the knowledge to date of nursing leadership on reducing patient readmission rates. METHODS: A literature review was conducted using seven electronic databases: Medline Ovid, PubMed, Cumulative Index to Nursing and Allied Health (CINAHL) Plus, Emerald, PsycINFO, ABI/INFORM collection, and EBSCO, with the addition of references for relevant papers reviewed. FINDINGS: The search resulted in a total of 15 articles. Findings revealed that leadership practices of nurses have an impact on reducing patient readmission rates. CONCLUSIONS: The results suggest a need for further rigorous studies investigating the mechanism of how nursing leadership relates to patient readmission rates and how to translate this into practice across diverse cultures.

Factors associated with millennial nurses' intention to pursue formal leadership roles: a cross-sectional study.

PURPOSE: This study aims to examine the level of intention to pursue formal nursing leadership roles among millennial nurses and to identify the different factors that may play a role in their intentions to pursue such roles. DESIGN/METHODOLOGY/APPROACH: This study used a multi-center, cross-sectional research design. Registered nurses born between 1980 and 2000 (n = 1,377) who worked in 23 acute care hospitals in Oman were included in this study. Data were analyzed using descriptive statistics and multiple linear regression. Data were collected between July 2019 and January 2020. FINDINGS: Nearly 70% of millennial nurses researched their intention for career advancement to assume nursing leadership responsibility. Factors associated with nurses' intention to pursue formal nursing leadership roles were the type of nursing degree held (having a bachelor of science in nursing degree), type of hospital facility affiliation (teaching hospital), previous leadership experience, structural empowerment (access to support, opportunity and resources), work satisfaction and job burnout. ORIGINALITY/VALUE: Millennial nurses, who represent the largest segment of the nursing workforce, have begun assuming nursing management and leadership roles; however, little is known about the factors affecting their intentions to pursue these roles. The findings of this study revealed different factors (both modifiable and nonmodifiable) influencing millennial nurses' intentions to pursue formal leadership roles.

Direct and Moderating Effects of Work Environment and Structural Empowerment on Job Stress and Job Satisfaction Among Nurses in Oman.

Objectives: This study aimed to explore the relationships between nurses' work environment, job stress and job satisfaction, along with the moderating effects of work environment and empowerment on the relationship between job stress and job satisfaction. Methods: A descriptive correlational design was utilised for this study. The study encompassed a convenience sample of 1,796 hospital nurses from the 11 governorates in Oman. Moreover, a self-report questionnaire that included a set of instruments was used to collect the data. Results: Nurses who perceived higher levels of job stress reported lower levels of satisfaction and empowerment and perceived their work environment as less favourable and supportive. The findings only confirmed the direct effects of work environment and empowerment on satisfaction, whereas no support was found for indirect or moderating effects. Furthermore, the hierarchical regression model showed that 46.5% of the variation in the level of job satisfaction was explained by the study variables. Conclusion: The results of this study demonstrate the importance of implementing strategies that empower staff, provide a supportive and positive work environment and tackle job stress to enhance levels of job satisfaction.