[Toward 2020 the International Year of the Nurse and the Midwife: Linking Taiwan Nursing With the World].

To commemorate the 200th birthday of Florence Nightingale, the World Health Organization announced 2020 as the "International Year of the Nurse and the Midwife." Nursing is in the frontline of transformational care. The actions of nurses help bring positive changes to the world. Taiwan cannot stand outside of the global community. The Taiwan Nurses Association is also involved actively in international affairs. The expertise and enthusiasm of Taiwan's nurses may be highlighted by attending and responding to various meetings, conferences, and global nursing events organized by the International Council of Nurses (ICN) such as the Council of National Nursing Association Representatives (CNR), ICN Congress, and Nursing Now campaign. This article shares important information and insights on the 2019 ICN CNR meeting and the ICN Congress to expand the international perspective of nurses and to inspire and explore the future development of the nursing profession in Taiwan.

A cross-validation study of the incident-reporting attitude scale for staff in long-term care facilities-A cross-sectional study.

AIMS AND OBJECTIVES: To test the construct and concurrent validity and reliability of the incident-reporting attitude scale used for staff in long-term care facilities (IRA-LTC) by the two-phase cross-validation method. BACKGROUND: Lack of accurate measurement on incident-reporting attitude might hinder improvements of safety practice in long-term care facilities. DESIGN/METHODS: A two-phase cross-sectional questionnaire survey was conducted in Taiwan. A fixed proportion of long-term care facilities were randomly selected that included 20 and 15 long-term care facilities at phases one and two separately. Nursing and administrative staffs in these facilities were recruited at the first phase (N = 207) for testing the validity and reliability of the newly developed scale and for cross-validation of the scale at the second phase (N = 251). The scale of IRA-LTC was a self-developed structured questionnaire consisting of 31 items. The data were analysed using spss for Windows 20.0 and AMOS 24.0. Descriptive statistics, correlation analysis, Cronbach's α, exploratory and confirmatory factory analysis were carried to examine the homogeneity of items, reliability, construct and concurrent validity. The STROBE checklist was adhered (See Appendix S1). RESULTS: The IRA-LTC scale comprised two dimensions: "cognition and intention to report" and "barriers to report." The two-factor structure explained 60.20%-61.89% of the total variance at two phases. Validation of the initial factorial model gained at the first phase was satisfactorily supported at the second phase. Concurrent validity of the IRA-LTC scale was satisfied. Cronbach's α for the scale and subscales was 0.94-0.97. CONCLUSIONS: This IRA-LTC scale is valid and reliable and can be recommended to evaluate the incident-reporting attitude among all kinds of staff in long-term care facilities. RELEVANCE TO CLINICAL PRACTICE: Positive incident-reporting attitude can lead to positive incident-reporting behaviour. Using the IRA-LTC scale for assessing staff's incident-reporting attitude is recommended as the first step to enhance staff's safety performance in long-term care facilities.

Relationship between authentic leadership and nurses' intent to leave: The mediating role of work environment and burnout.

AIM: The aim of this study was to explore the mediating effects of work environment and burnout on the relationship between authentic leadership and the intention of nurses to leave their job. BACKGROUND: Authentic leadership can contribute to a good work environment. Burnout is a critical factor that affects nurses‧ intent to leave. The mediating roles of work environment and burnout on the relationship between authentic leadership and intent to leave is unclear. METHODS: A cross-sectional design was used, and 946 nurses from three different levels of hospital (medical center, regional, and district), defined in terms of the number of beds and type of medical care provided, responded to four self-report questionnaires. RESULTS: Work environment and burnout mediated the effect of authentic leadership on intent to leave among nurses. The mediating effects of burnout on authentic leadership was present both for junior (ß = 0.073) and senior (ß = 0.081) nurses. CONCLUSION: Authentic leadership can affect nurses‧ intent to leave but the work environment and burnout are important mediators of this influence. IMPLICATIONS FOR NURSING MANAGEMENT: Administrators should adopt authentic leadership practices and make efforts to improve the work environment and decrease burnout in order to decrease nurses‧ intent to leave.

Factors contributing to voluntariness of incident reporting among hospital nurses.

PURPOSE: This study aimed to (a) test the hypothesized model for hospital nurses' voluntariness of incident reporting (VIR) and (b) determine the extent to which reporting culture factors, nursing safety practices and perceptions of work predict VIR. DESIGN AND METHODS: A cross-sectional survey was applied to 1,380 frontline nurses recruited from six teaching hospitals in Taiwan. Data were collected using self-administered questionnaires. Correlation analyses and path analyses using structured equation modelling were used. FINDINGS: More than half of the nurses did not display a voluntary attitude towards reporting. VIR was correlated with factors of reporting culture, nursing safety practices and perceptions of work. Through path analyses, the safety practices mediated on the relationship between the reporting culture and VIR. CONCLUSIONS: Nurses still have modest willingness of reporting. The factors of reporting culture and nursing safety practices are critical determinants of VIR. Within more behavioural involvement in the safety practices, the reporting culture can support nurses to report voluntarily. IMPLICATIONS FOR NURSING MANAGEMENT: Strengthening nurses' engagement in safety practices can advance the reporting voluntariness and agreement with reporting culture concurrently. Nurse leaders should continue to optimize workload management and job satisfaction, which is advantageous to the safety practices enacted.

A psychometric evaluation of the Chinese version of the nursing home survey on patient safety culture.

AIMS AND OBJECTIVES: To test the psychometric properties of the Chinese version of the Nursing Home Survey on Patient Safety Culture scale among staff in long-term care facilities. BACKGROUND: The Nursing Home Survey on Patient Safety Culture scale is a standard tool for safety culture assessment in nursing homes. Extending its application to different types of long-term care facilities and varied ethnic populations is worth pursuing. DESIGN: A national random survey. METHODS: A total of 306 managers and staff completed the Chinese version of the Nursing Home Survey on Patient Safety Culture scale among 30 long-term care facilities in Taiwan. Content validity and construct validity were tested by content validity index (CVI) and principal axis factor analysis (PAF) with Promax rotation. Concurrent validity was tested through correlations between the scale and two overall rating items. Reliability was computed by intraclass correlation coefficient and Cronbach's α coefficients. Statistical analyses such as descriptive, Pearson's and Spearman's rho correlations and PAF were completed. RESULTS: Scale-level and item-level CVIs (0.91-0.98) of the Chinese version of the Nursing Home Survey on Patient Safety Culture scale were satisfactory. Four-factor construct and merged item composition differed from the Nursing Home Survey on Patient Safety Culture scale, and it accounted for 53% of variance. Concurrent validity was evident by existing positive correlations between the scale and two overall ratings of resident safety. Cronbach's α coefficients of the subscales and the Chinese version of the Nursing Home Survey on Patient Safety Culture scale ranged from .76-.94. CONCLUSIONS: The Chinese version of the Nursing Home Survey on Patient Safety Culture scale identified essential dimensions to reflect the important features of a patient safety culture in long-term care facilities. The researchers introduced the Chinese version of the Nursing Home Survey on Patient Safety Culture for safety culture assessment in long-term care facilities, but further testing of the reliability of the scale in a large Chinese sample and in different long-term care facilities was recommended. RELEVANCE TO CLINICAL PRACTICE: The Chinese version of the Nursing Home Survey on Patient Safety Culture scale was developed to increase the users' intention towards safety culture assessment. It can identify areas for improvement, understand safety culture changes over time and evaluate the effectiveness of interventions.

Predictors of Hospital Nurses' Safety Practices: Work Environment, Workload, Job Satisfaction, and Error Reporting.

Nurses' safety practices of medication administration, prevention of falls and unplanned extubations, and handover are essentials to patient safety. This study explored the prediction between such safety practices and work environment factors, workload, job satisfaction, and error-reporting culture of 1429 Taiwanese nurses. Nurses' job satisfaction, error-reporting culture, and one environmental factor of nursing quality were found to be major predictors of safety practices. The other environment factors related to professional development and participation in hospital affairs and nurses' workload had limited predictive effects on the safety practices. Increasing nurses' attention to patient safety by improving these predictors is recommended.

[Development of the Oral Assessment Scale for Post-Operational Patients With Oral Cancer].

BACKGROUND: Current oral assessment scales are designed to assess the severity of oral health in cancer patients who have undergone radiotherapy or chemotherapy. Currently, no scale is available that assesses the overall oral health situation of patients. However, this type of scale is critical for guiding nursing staff to understand the oral status of postoperative patients and for facilitating the development of patient-centered oral nursing treatments. PURPOSE: To develop the oral assessment scale for post-operational patients with oral cancer (OASPOCa) and establish its psychometric properties. METHODS: The ten associated items of the OASPOCa were determined using a series of five professional council meetings and two verifications of content validity by 5 experts in the field of oral cancer care. A pilot study was conducted on 30 participants and a formal study was conducted on 100 participants at the ICU and the oral and maxillofacial surgery ward at a medical center in southern Taiwan. All of the participants were oral cancer patients who had been admitted to excise tumors of oral cancer. None of the participants had been treated previously for oral cancer using chemotherapy or radiotherapy. The intraclass correlation coefficient (ICC), internal consistency reliability, and concurrent validity of the OASPOCa were evaluated. RESULTS: A content validity of 1.0 was obtained. The inter-rater reliability assessment in the pilot study yielded ICCs of .97 for two assessment items ("lips" and "tongue") and 1.0 for the remaining eight items. The Cronbach's α coefficient was .72 for the OASPOCa. Further, a statistically significant negative relationship was found between overall oral status and oral comfort level (r = -.93, p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The oral assessment scale for post-operational patients with oral cancer was found to have good reliability and validity. This scale is a reliable tool for assessing the oral status of postoperative oral cancer patients.

Classification and citation analysis of the 100 top-cited articles on nurse resilience using chord diagrams: A bibliometric analysis.

BACKGROUND: Studies of most-cited articles have been frequently conducted on various topics and in various medical fields. To date, no study has examined the characteristics of articles associated with theme classifications and research achievements of article entities related to nursing resilience. This study aims to graphically depict the characteristics of the 100 top-cited articles addressing nurse resilience (T100NurseR), diagram the relationship between articles and author collaborations according to themes extracted from article keywords, and examine whether article keywords are correlated with article citations. METHODS: T100NurseR publications were retrieved from the Web of Science (WoS) core collection on October 13, 2022. Themes associated with articles were explored using coword analysis in WoS keywords plus. The document category, journal ranking based on impact factor, authorship, and L-index and Y-index were used to analyze the dominant entities. To report the themes of T100NurseR and their research achievements in comparison to article entities and verify the hypothesis that keyword mean citation can be used to predict article citations, 5 visualizations were applied, including network diagrams, chord diagrams, dot plots, Kano diagrams, and radar plots. RESULTS: Citations per article averaged 61.96 (range, 25-514). There were 5 themes identified in T100NurseR, including Parses theory, nurse resilience, conflict management, nursing identity, and emotional intelligence. For countries, institutes, departments, and authors in comparison of category, journal impact factor, authorship, and L-index scores, Australia (129.80), the University of Western Sydney (23.12), Nursing (87.17), and Kim Foster (23.76) are the dominant entities. The weighted number of citations according to Keywords Plus in WoS is significantly correlated with article citations (Pearson R = 0.94; P = .001). CONCLUSION: We present diagrams to guide evidence-based clinical decision-making in nurse resilience based on the characteristics of the T100NurseR articles. Article citations can be predicted using weighted keywords. Future bibliographical studies may apply the 5 visualizations to relevant studies, not being solely restricted to T100NurseR.

Culture influence and predictors for behavioral involvement in patient safety among hospital nurses in Taiwan.

This study explored the effects of incident reporting culture and willingness of incident reporting on behavioral involvement in patient safety (BIPS) by surveying 1049 hospital nurses in Taiwan. The highest areas of BIPS were handoff communication and discussion on error prevention. Yet, sharing information about human factors toward safety awareness was less frequent. Results indicated that the reporting culture, willingness to report, tenure of work, and reporting rate contributed positively to BIPS.

Competence to provide urinary incontinence care in Taiwan's nursing homes: perceptions of nurses and nurse assistants.

PURPOSE: Nursing staff play an essential role in ensuring the quality of continence care in nursing homes. The purpose of this study was to describe the level of competence (knowledge, attitudes, and practice behaviors) of urinary incontinence (UI) care in nursing home staff in Taiwan. METHOD: A cross-sectional postal survey was used to gather self-reported data from an island-wide sample of 195 nurses and 99 nurse assistants (NAs) in Taiwan. Participants completed the UI knowledge, the UI attitude, and the practice behaviors of UI care scales. RESULTS: The level of UI knowledge in nurses was higher than that of NAs, although nurses had less-positive attitudes than NAs. Reported practice behaviors of UI care did not differ between nurses and NAs. Changes of wet clothes, linens, and diapers were the most commonly reported practice behaviors. Information-gathering, physical examination, and pelvic floor muscle exercises were performed less commonly in nursing homes. CONCLUSIONS: Knowledge and positive attitudes regarding UI need to be improved in both nurses and NAs in nursing homes. Several deficits were found in practice behaviors of UI care. A competency-based education approach is suggested to enable awareness of UI and cultural changes on individual and institutional levels.

Incident reporting culture: scale development with validation and reliability and assessment of hospital nurses in Taiwan.

OBJECTIVE: To examine the psychometric validity and reliability of the incident reporting culture questionnaire (IRCQ; in Chinese) following an exploration of the reporting culture perceived by hospital nurses in Taiwan. DESIGN: Scale development with psychometric examination and a cross-sectional study. SETTING: Ten teaching hospitals. PARTICIPANTS: A total of 1064 nurses participated with an average response rate of 83% between November 2008 and June 2009. MAIN OUTCOME MEASURES: The factorial construct, criterion-related validity, homogeneity and stability of the IRCQ were evaluated. The nurses' perceptions of the IRCQ were also explored. RESULTS: The four-factor structure of the 20-item IRCQ had satisfactory construct validity (explained variance: 49.37%), criterion-related validity (r = 0.42; P = 0.001), reliability (Cronbach's alpha: 0.83) and stability (3-week-interval correlation: r = 0.80; P = 0.001). These factors included 'application of learning from errors', 'readiness to provide feedback on incident reports', 'collegial atmospheres of unpleasantness and punishment' (CA) and 'incident management: confidential and system driven'. The nurses perceived a moderate overall reporting culture (mean positive response = 49.25%; range: 67.2-24.94%). They weakly agreed on the CA factor of five items (mean positive response = 24.94%; range: 33.0-17.2%). CONCLUSIONS: This study provides empirical evidence for the psychometric properties of the IRCQ and the reporting culture which nurses perceive in Taiwan. To Taiwanese nurses, the reporting culture within their work environments especially as it relates to coworker relations, inter-professional collaboration and non-punitive atmosphere is their major concern. Healthcare administrators should consider nurses' perceptions related to incident reporting when managing underreporting issues.

Comparing nurses' intent to leave or stay: differences of practice environment perceptions.

Few existing studies have compared nurses' perceptions of the practice environment in relation to intent to leave or stay in employment and nursing concurrently. This study compared the differences between Taiwanese nurses' intent to leave or stay in employment and nursing, as related to their perceptions of the practice environment. A cross-sectional questionnaire survey was conducted at four hospitals in southern Taiwan. Questionnaires including the Chinese Nursing Practice Environment Scale, regarding intention in employment and nursing, were distributed to 535 nurses who provided direct patient care in Taiwan hospitals. Taiwanese nurses with intent to stay perceived the practice environment as better than nurses with intent to leave employment and nursing. The influences of the nursing practice environment on nurses' intent in employment and nursing were supported preliminarily. Targeting interventions to enhance participation in hospital affairs and adequacy of staffing and resources could be beneficial for a stable nursing workforce.

Factors determining hospital nurses' failures in reporting medication errors in Taiwan.

This study examined factors that were determined to lead to failures in reporting medication administration errors (MAEs) for 838 frontline nurses from 5 teaching hospitals in Taiwan. The underreporting of these errors is a challenge to medication safety improvement. Results showed that 337 (47%) participating nurses had failed to report self- or coworker-MAEs and 376 nurses (52.4%) had not failed to report. The strongest predictors of the failure were experience of making MAEs, differences in attitude toward reporting self- and coworker-MAEs, and perceived MAE reporting rate in current work. The reporting barriers of fear, perception of nursing quality, and perception of nursing professional development significantly contributed to failure to report. Educating nurses about the goals of incident reporting systems and using MAE data to enhance patient safety culture is recommended. Further, hospital administrators should provide information and encouragement to nurses whose responsibility it is to report MAEs.

Cross-Cultural Translation of the nChinese Version of Pain Care Quality Surveys (C-PainCQ).

Health disparities in pain care continue to exist among non-English-speaking Chinese-Americans. The Pain Care Quality?© (PainCQ) surveys, a valid instrument measuring the quality of pain care from the patient's perspective, is available only in English currently. This study generated a Chinese version of the PainCQ (C-PainCQ) following a cross-cultural translation approach to address health equity in pain care. A multicultural, bilingual expert team produced a good quality, prefinal version of C-PainCQ. Chinese-speaking patients (n = 55) evaluated conceptual and content equivalence while bilingual participants (n = 13) reviewed semantic equivalence of C-PainCQ items. Feedback from participants, including adding a new item related to education on medication compliance, was used to revise the tool. This C-PainCQ is ready for future research to examine the reliability and construct validity with a large sample of Chinese-speaking patients.

The Effectiveness of Dignity Therapy as Applied to End-of-Life Patients with Cancer in Taiwan: A Quasi-Experimental Study.

PURPOSE: The aim of the study was to determine the effectiveness of dignity therapy for end-of-life patients with cancer. METHODS: This study used a quasi-experimental study design with a nonrandomized controlled trial. Dignity therapy was used as an intervention in the experimental group, and general visit was used in the control group. Thirty end-of-life patients with cancer were recruited, with 16 in the experimental group and 14 in the control group. Outcome variables were the participants' dignity, demoralization, and depression. Measurements were taken at the following time points: pre-test (before intervention), post-test 1 (the 7th day), and post-test 2 (the 14th day). The effectiveness of the intervention in the two groups was analyzed using the generalized estimating equation, with the p value set to be less than .05. RESULTS: After dignity therapy, the end-of-life patients with cancer reflected increased dignity significantly [ß = -37.08, standard error (SE) = 7.43, Wald χ2 = 24.94, p < .001], whereas demoralization (ß = -39.55, SE = 6.42, Wald χ2 = 37.95, p < .001) and depression (ß = -12.01, SE = 2.17, Wald χ2 = 30.71, p < .001) were both reduced significantly. CONCLUSION: Clinical nurses could be adopting dignity therapy to relieve psychological distress and improve spiritual need in end-of-life patients with cancer. Future studies might be expanded to looking at patients vis-à-vis end-of-life patients without cancer to improve their psychological distress. These results provide reference data for the care of end-of-life patients with cancer for nursing professionals.

Psychometric testing of the Chinese version of nursing practice environment scale.

AIMS: To test the reliability and validity of the Chinese version of the Nursing Practice Environment Scale (C-NPES) translated from the Lake's Practice Environment Scale of the Nursing Work Index and to explore nurses' perceptions of the nursing work environments in Taiwan. BACKGROUND: Magnet hospitals are characterised by professional autonomy, control over nursing practice, adequacy of staffing, supportive management and effective interdisciplinary relationships, which are successful in attracting and retaining nurses. In Taiwan, this concept has gained importance since the SARS crisis of 2003. However, there have been limited Chinese instruments based on magnet hospital traits to explore Taiwan's nursing work environment. DESIGN: This study was designed as a cross-sectional survey. Purposive convenience samples of 842 nurses were recruited from five acute hospitals in Taiwan. Internal consistency reliability, content validity using expert review, construct validity using factor analysis and criterion-related validity were examined. RESULTS: The Cronbach's alphas were 0.90 for the total scale and 0.87-0.65 for the subscales. The validity was obtained using a content validity index and principal component analysis of five-factor structure (variance explained 47.89%). The criterion-related validity was supportive of the turnover rate (t = 7.84, p < 0.001). The participants disagreed on staffing and resource adequacy and participation in hospital affairs but agreed on professional development. CONCLUSION: The preliminary psychometric properties of C-NPES have been established. Considering cultural appropriateness, the subscales of staffing and participation in hospital affairs need advanced modification. RELEVANCE TO CLINICAL PRACTICE: The C-NPES will provide hospital administrators with an overview of magnet hospital settings for nursing practice. It is beneficial for the stabilisation of the nursing workforce as well as for the optimisation of nursing work environments. Additionally, the use of professional development programs to enhance nurses' knowledge of SARS prevention is favorable.

[Promoting the use of the nasopharyngeal airway to treat watery diarrhea].

Using the nasopharyngeal airway to promote stool drainage is currently limited in general clinical practice. This situation has led to periannal skin care administered by nursing staff not meeting patient expectations for treatment efficacy and speed of recovery. According to previous statistics, the incidence of perianal excoriation was 60.71% in critically ill patients with liquid stool. This project was designed to promote more widespread use of the nasopharyngeal airway to contain watery diarrhea and improve skin lesions. Reasons for not using the nasopharyngeal airway to promote stool drainage identified by the authors included: 1. unclear nursing standards with regard to such procedures; 2. physician resistance to the use of such and 3. lack of education programs related to such procedures. Improvement strategies included: 1. modifying nursing standards with detailed explanations and pictures; 2. earning physician acceptance of such procedures through case conference meetings in ICUs; 3. rescheduling education programs on the implementation of nasopharyngeal airway and skin care for patients with watery diarrhea and 4. establishing case management and nursing consultation systems. Results showed that use of the nasopharyngeal airway increased from an initial 60% to 100% at eight months following project implementation. The perianal excoriation rate fell from 60.71% to 0%. We found that drainage of liquid stool using the nasopharyngeal airway can reduce perianal skin complications. This project may be a valuable reference for other clinical practice to improve care quality.

The effects of a spiritual learning program on improving spiritual health and clinical practice stress among nursing students.

BACKGROUND: Numerous studies have indicated an association between spirituality and health outcomes. However, little information is available about interventions that have been shown to enhance spiritual health and decrease stress. PURPOSE: This study examined the effects of a spiritual learning program (SLP) on nursing student-perceived spiritual health and clinical practice stress. METHOD: A convenience sample of nursing students currently enrolled at a nursing school in northern Taiwan were recruited to participate in this quasiexperimental study as participants to experimental and control groups via simple random sampling. Results from a spiritual health scale and a perceived clinical practice stress scale, together with the score for clinical nursing practice, were compared between the groups. Baseline data were collected from all participants. The experimental group participated in 8 weeks of 50-minute per week SLP, which included lectures, discussion, reflection, and spiritual practices. A second data set was collected from all participants after the intervention. A third data set was collected after all participants had performed 4 weeks of nursing clinical practice. RESULTS: Participants were all women. Average age was 19.4 years (SD = 1.3 years). Generalized estimating equation analysis showed SLP to have a significant short-term effect on improving the total score for spiritual health (p < .01). Significantly greater improvement in clinical practice stress scores was also seen in the experimental group as compared with the control group (all p < .05). The experimental group obtained a higher score of the final clinical practice than the control group (t = 3.771, p < .001). CONCLUSION: The SLP may encourage participants to see stressors as meaningful events that are connected to individual life purposes. The program developed in this study may be used to improve spiritual health and reduce stress in nursing students' clinical practice. This SLP may be referenced when designing similar spirituality-related courses and applied to nursing student counseling.

An exploration of the status of spiritual health among nursing students in Taiwan.

OBJECTIVE: Few studies have investigated the spiritual health of nursing students. The purpose of this study was to examine spiritual health in a group of senior nursing students in Taiwan, and to explore the factors that influenced the spiritual health of the group. METHOD: This was a cross-sectional study. A total of 1276 senior nursing students were selected using a probability-proportional-to-size (PPS) procedure, and were asked to complete a self-administrated questionnaire that included a spiritual health scale (SHS) and a demographic profile. RESULTS: All study participants were female with an average age of 20.1 years, and most reported a religious affiliation and participation in religious activities. Their spiritual health was moderate; and generally the study metric "connection to others" was the highest factor, and the metric "religion attachment" was the lowest. Certain demographic characteristics, including age, education level, aboriginal characteristic, level of religious devotion, and family atmosphere were predictors of spiritual health. CONCLUSION: Nursing educators should be aware of the impact of spiritual health on nursing students, and should consider developing spiritual and religious education programs to enhance students' spiritual health and to nurture their ability to supply spiritual nursing care for patients.

Barriers to nurses' reporting of medication administration errors in Taiwan.

PURPOSE: To describe nurses' perceptions of reporting barriers to reporting medication administration errors (MAE) and to examine the relationship between the barriers to MAE reporting and cultural factors and nursing work environment in Taiwan. METHODS: A cross-sectional, descriptive correlational design with self-administered questionnaires was conducted in one large medical center hospital in southern Taiwan. The measurement tools included the Chinese versions of the Work Environment Questionnaire, Barriers to MAE Reporting, Index of Hierarchy of Authority, and Face-Concern scale. A mail survey of 807 nurses using the Total Design Method was implemented for data collection with 597 questionnaires used in data analyses. FINDINGS: The major perceived barrier was fear. Regression analysis showed that power hierarchy, face-saving concern, and work environment factors (e.g., quality management and peer relations) accounted for 54.6% variance in the barriers. Age, educational background, working experience, experience of having made MAEs, and failure to report MAEs were not associated with the barriers. CONCLUSIONS: Taiwanese nurses perceived similar barriers to MAE reporting. The more power hierarchy and face-saving concern the nurses agreed on, the more barriers they perceived. The association between the barriers and nursing work environment was negative and weak.