Ethical climate, moral resilience, and ethical competence of head nurses.

BACKGROUND: The ethical competence of head nurses plays a pivotal role in nursing ethics. Ethical climate is a prerequisite for ethical competence, and moral resilience can positively influence an individual's ethical competence. However, few studies have focused on the relationship between ethical climate, moral resilience, and ethical competence among them. OBJECTIVES: To investigate the relationship between ethical climate, moral resilience, and ethical competence, and examine the mediating role of moral resilience between ethical climate and ethical competence among head nurses. DESIGN: A quantitative, cross-sectional study. METHODS: A total of 309 Chinese head nurses completed an online survey, including ethical climate questionnaire, Rushton moral resilience scale, and ethical competence questionnaire. Inferential statistical analysis includes Pearson's correlation and a structural equation model. ETHICAL CONSIDERATIONS: This study received ethical approval from the Institutional Review Board of Xiangya Nursing School of Central South University (No. E2023146). RESULTS: Head nurses' ethical climate score positively impacted ethical competence (r = 0.208, p < .001), and ethical climate could affect ethical competence through the mediating role of moral resilience. CONCLUSION: This study emphasized the value of ethical climate in moral resilience of head nurses, ultimately leading to an enhancement in their ethical competence.

Nurses' alarm fatigue, influencing factors, and its relationship with burnout in the critical care units: A cross-sectional study.

BACKGROUND: Excessive number of alarms and false and nonactionable alarms may lead to alarm fatigue. Alarm fatigue could easily contribute to burnout. Burnout may reduce nurses' sensitivity to alarms, thus affecting patients' safety due to insufficient response to the alarms. However, no study has examined nurses' alarm fatigue in Ghana. OBJECTIVES: The objective of this study was to investigate the level of alarm fatigue and its associated factors, as well as determine its relationship with burnout among nurses working in the critical care units of hospitals in Ghana. METHODS: The cross-sectional study was conducted in critical care units of five hospitals in Ghana from November 2021 to January 2022. A total of 364 nurses were recruited and completed the questionnaire. Alarm fatigue was assessed by the alarm fatigue questionnaire, which was originally developed in Chinese and was translated into English using a standard protocol. Burnout was assessed using the Maslach Burnout Inventory. RESULTS: The overall alarm fatigue score was 76.43 ± 27.80 out of 124. Longer years working at the critical care unit (B = -2.50, 95% confidence interval [CI]: -4.62, -0.37) and having policies related to alarm management (B = -10.77, 95% CI: -3.50, -18.04) were associated with a decreased risk of alarm fatigue, while working in neonatal intensive care unit (B = 16.35, 95% CI: 2.48, 30.21) and postanesthesia care unit (B = 15.16; 95% CI: 0.32, 30.01), and having anxiety and stress (B = 8.15, 95% CI: 1.30, 15.00) were associated with an increased risk of alarm fatigue. In addition, alarm fatigue was positively associated with emotional exhaustion (r = 0.52, P < 0.001) and depersonalisation (r = 0.43, P < 0.001) but not personal accomplishment (r = -0.09, P = 0.100). CONCLUSION: Critical care nurses in Ghana experienced higher levels of alarm fatigue, which is affected by multiple factors. There is a significant link between nurses' alarm fatigue and burnout. Our findings provide important guidance for future intervention programs to improve critical care nurses' alarm fatigue by introducing policies on alarm management and improving nurses' psychological health, with a special focus on nurses with shorter working years and working in neonatal intensive care unit and postanesthesia care unit.

Nurses' engagement in antimicrobial stewardship and its influencing factors: A cross-sectional study.

Objective: This study aimed to investigate the level and influencing factors of nurses' antimicrobial stewardship (AMS) engagement in China based on the capability, opportunity, motivation, and behavior (COM-B) theory, providing valuable insights for developing effective strategies to improve nursing quality in AMS. Methods: This cross-sectional study was conducted in 17 tertiary hospitals in Hunan, China, from November 2021 to January 2022. A total of 4,514 nurses were selected. The Nurse AMS Engagement Questionnaire (NAEQ), developed using the COM-B theory, was used for evaluation. The questionnaire included capability (14 items), opportunity (7 items), motivation (6 items), and behavior (12 items) four dimensions, 39 items. Results: The total NAEQ score was 155.08 ± 27.12, indicating a moderate level. The score of the capability, opportunity, motivation, and behavior dimensions were 52.33 ± 13.48, 28.64 ± 5.76, 24.57 ± 4.57 and 49.53 ± 8.83, respectively. Significant differences in nurses' AMS engagement were based on professional titles, whether working as a part-time infection control nurse, whether knowing the AMS teams and the defined daily doses of antibiotics, department type, the deployment of clinical pharmacists, and frequency of antimicrobial training and physician-nurse joint rounds (P < 0.05). Nurses with junior titles had higher scores on the NAEQ than nurses with intermediate titles (P < 0.05). Nurses who worked as part-time infection control nurses, knew the AMS team, and the defined daily doses of antibiotics had higher NAEQ scores than those who didn't (P < 0.01). Nurses working in the ICU and infectious disease department had lower NAEQ scores than those in other departments, such as the ear, nose, and throat (ENT) department (P < 0.01). Nurses who had clinical pharmacists deployed in their department had higher NAEQ scores than those without or unclear deployment (P < 0.01). Furthermore, nurses who received more frequent antimicrobial training and participated in physician-nurse joint rounds had higher NAEQ scores (P < 0.01). Conclusion: Multiple strategies, including enhanced education and training and improved multidisciplinary communication and collaboration, are expected to improve nurse AMS engagement. It is important to give more attention to nurses with intermediate professional titles, less experience, and those working in specific departments.