The holistic nursing competence and transition shock of newly graduated nurses as the determinants of missed nursing care: The mediation analysis.

AIMS AND OBJECTIVE: To investigate the determinants of missed nursing care and to analyse the mediating effect of holistic nursing competence on the relationship between transition shock and missed nursing care. BACKGROUND: Transition shock of newly graduated nurses is associated with missed nursing care. Previous studies have shown the determinants of missed nursing care among nurses, but little is known about the relationship between missed nursing care, transition shock and holistic nursing competence. DESIGN: Descriptive and correlational design. METHODS: The study was conducted among newly graduated nurses (n = 201) working in acute care hospitals for 1-12 months. The MISSCARE survey, Holistic Nursing Competence Scale and Nursing Transition Shock Scale were used for data collection, in addition to a sociodemographic question form. Data were analysed using Pearson correlation, multiple regression and mediation analyses. The study was reported following the STROBE checklist. RESULTS: The determinants of missed nursing care among newly graduated nurses were sex, unit type, rotating shift work, holding a certificate, holistic nursing competence and transition shock. All these variables explain 35% of the variance in missed nursing care. Holistic nursing competence directly mediated 51.7% of the relationship between transition shock and missed nursing care. CONCLUSIONS: Holistic nursing competence may decrease missed nursing care by reducing the effects of transition shock on newly graduated nurses. RELEVANCE TO CLINICAL PRACTICE: The study highlighted that newly graduated nurses are an important population regarding missed nursing care. The determinants of missed care should be considered in the nursing care delivery to prevent missed care by newly graduated nurses. Based on the study findings, some recommendations were made for nurse managers and faculty for the orientation program and undergraduate nursing education.

Decent work, work engagement, and turnover intention among registered nurses: a cross-sectional study.

BACKGROUND: Nurses face substantial career challenges arising from global pandemics, economic crises, and their roles in conflict-ridden areas. In this context, the rights of nurses pertaining to decent work, such as freedom, fairness, safety, and dignity, are not adequately safeguarded. This study examines decent work status among Chinese nurses and its links to demographics, work engagement, and turnover intention. METHODS: A cross-sectional study design was used following STROBE guidelines. Through a convenient sampling method, a total of 476 nurses were surveyed. These participants were drawn from three esteemed tertiary Grade A hospitals in Hangzhou, with data collection spanning from June to August in 2023. We used a comprehensive set of assessment instruments, encompassing an evaluation of demographic characteristics, the Decent Work Perceptions Scale (DWPS), the Utrecht Work Engagement Scale (UEWS), and turnover intention questionnaire. Bootstrapping procedures were used to ensure the robustness and reliability of the model. RESULTS: The study revealed that nurses' perceptions of decent work significantly impacted work engagement (ß = 0.603, p < 0.001) and turnover intention (ß = -0.275, p < 0.001). Work engagement operated as a mediator between decent work and turnover intention, decreasing the likelihood of nurses leaving their positions (ß = -0.062, p < 0.001). Factors such as age, years of working experience, professional title, job category, and attendance at professional conferences significantly influenced nurses' perceptions of decent work (all p < 0.05). CONCLUSIONS: This study examines factors affecting decent work among nurses and explores its connection with work engagement and the intention to leave. Despite limitations (sample, social desirability bias), the study offers valuable insights for nursing practice. This suggests managers improve decent work for young nurses through rational shift schedules and continuous education. Policymakers should consider adjusting nursing policies for better employment conditions.

The mediating role of psychological capital on the relationship between authentic leadership and nurses' caring behavior: a cross-sectional study.

BACKGROUND: Caring behavior among nurses would have an impact on patient outcomes. External organizational job resources and personal internal psychological resources are correlated to nurses' caring behavior. Authentic leadership and psychological capital were shown to be correlated with nurses' caring behavior in previous studies. However, the relationships among the three are nevertheless unclear. This study aimed to examine if psychological capital could act as a mediator between nursing managers' authentic leadership and nurses' caring behavior. METHODS: In December 2021, a total of 3,662 nurses were recruited from 37 hospitals in Anhui Province, China. They filled out online surveys, including general demographic information, the Authentic Leadership Questionnaire, the Psychological Capital Questionnaire, and the Caring Behavior Inventory. Structural Equation Modeling and the bootstrapping procedure were used to examine the mediating role of psychological capital. RESULTS: The scores of authentic leadership, psychological capital, and caring behavior of 3,495 nurses were 52.04 ± 13.24, 96.89 ± 17.78, and 104.28 ± 17.01, respectively. Psychological capital significantly mediated the relationship between authentic leadership and nurses' caring behavior (ß = 0.378, p < 0.001, 95% confidence interval: 0.350 ~ 0.402), which made up 78.75% of the total impact (0.480). CONCLUSION: The findings of this study suggested that nursing managers should develop an authentic leadership style, which can effectively improve nurses' caring behaviors toward patients in clinical practice. Meanwhile, nursing leaders should strengthen nurses' psychological evaluation and training, and promote nurses' caring behavior in clinical settings.

Work immersion and perceived stress among clinical nurses: a latent profile analysis and moderated mediation analysis.

BACKGROUND: Exploration of the relationship between individual work immersion and perceived stress is critical for clinical nurses' effective psychological interventions and human resource management, as well as to alleviate nursing staff shortages. In order to further dissect the influencing factors of perceived stress among nursing staff, our study introduces the concepts of perfectionism and social connectedness to analyze the specific pathways that influence perceived stress in terms of an individual's intrinsic and external personality traits. This study provides relevant recommendations for the development of stress management measures for nursing staff. METHODS: This was a cross-sectional survey. 993 registered clinical nurses were included from four hospitals in Guangzhou through a convenience sampling method. Clinical nurses' work immersion, perceived stress, perfectionism, and social connectedness were investigated using questionnaires based on latent profile analysis. The relationships between variables were analyzed using t-tests, analysis of variance, Pearson's correlation analysis, latent profile analysis, and moderated mediation analysis. RESULTS: The results showed that (1) general influences on nurses' perceived stress included only child, labor relationship, labor allowance, and family support; (2) nurses' work immersion contained four subgroups: lowest (12.6%), medium-low (39.8%), medium-high (39.9%), and highest (7.7%); (3) positive and negative perfectionism played a mediating role between the association of work immersion and perceived stress; (4) social connectedness played a moderating role in the mediation model of perceived stress. CONCLUSIONS: Work immersion, perfectionism, and social connectedness have an important impact on clinical nurses' perceived stress. Nursing managers or leaders should pay attention to the differences of individual work immersion status, adopt reasonable stress management strategies, accurately identify positive perfectionist groups and strengthen the relationship between groups, so as to ensure the quality of nursing care, and reduce nursing turnover and alleviate the problem of staff shortage.

Leisure crafting and work engagement among Chinese ICU nurses: The multiple mediation effect of recovery experience and humanistic care ability.

AIMS: Based on the conservation of resources theory, this study explored the intermediary role of intensive care unit (ICU) nurses' recovery experience and humanistic care ability between leisure crafting and work engagement. BACKGROUND: As the ICU is an important life-saving department, the level of work engagement of nurses directly affect the quality of life and health outcomes of patients. Actively seeking countermeasures to improve the work engagement level of ICU nurses is of great significance to enhancing the nursing quality of the ICU. According to the theory of resource conservation, the resources owned by individuals are limited and must be replenished promptly and effectively to maintain relatively stable physical, mental, and working states. Therefore, determining ways for ICU nurses to supplement the consumed resources effectively and efficiently in a limited time to maintain a high level of work engagement is the main concern of this study. METHODS: In this cross-sectional study from January 2023 to March 2023, 478 ICU nurses were recruited by convenience sampling. The survey tools included the Leisure Crafting Scale, the Utrecht Work Engagement Scale-9, the Caring Ability Inventory, and the Recovery Experience Questionnaire. Descriptive data and Pearson correlation coefficients were analyzed via SPSS 26.0 (IBM Corp.). PROCESS v4.0 (by Andrew F. Hayes) Macro Model 6 was applied to analyze the serial multiple mediator models. We used the STROBE checklist to report the results. RESULTS: First, the results showed that leisure crafting, humanistic care ability, and recovery experience were positively correlated with work engagement. Second, recovery experience and humanistic care ability played a partially mediating role between leisure crafting and work engagement, respectively. Third, recovery experience and humanistic care ability also had a serial mediation effect between leisure crafting and work engagement. CONCLUSION: The findings of the study indicated that improving nurses' active control of leisure time may have particularly positive effects on ICU nurses' work engagement through increasing recovery experience and humanistic care ability. IMPLICATIONS FOR NURSING AND NURSING POLICY: Administrators can formulate intervention measures to improve the leisure crafting level of ICU nurses, promote work-life balance, which enhances recovery and supports engagement with patient-focused humanistic care, and have a positive impact on the work engagement of ICU nurses.

Secondary traumatic stress and compassion satisfaction mediate the association between stress and burnout among Korean hospital nurses: a cross-sectional study.

BACKGROUND: Burnout among nurses is a worldwide public health epidemic that adversely affects nurses' quality of life as well as the patient's outcomes. The aim of this study was to evaluate the influence of stress on nurses' burnout and to identify the mediating effects of secondary traumatic stress and compassion satisfaction among clinical nurses in South Korea. METHODS: A quantitative, cross-sectional study evaluated the survey data from 10,305 female registered hospital nurses who participated in the Korea Nurses' Health Study (KNHS) Module 5. The survey included a demographic questionnaire and the Professional Quality of Life version 5 (ProQOL 5). Bootstrap analyses (using the PROCESS macro) were employed to evaluate the mediating effect between variables. RESULTS: Stress was significantly associated with burnout and mediated by secondary traumatic stress and compassion satisfaction (ßindirect 1 = 0.185, Bootstrap confidence interval (BS CI) [0.175, 0.194]; ßindirect 2 = 0.226, BS CI [0.212, 0.241], respectively). In addition, the magnitude of the indirect effects of compassion satisfaction was significantly greater than the magnitude of the indirect effects of secondary traumatic stress (ßindirect 1-ßindirect 2 = - 0.042, BS CI [- 0.058, - 0.026]). The findings of this study indicate that the positive aspect (compassion satisfaction) of work experiences can offset the negative aspects (secondary traumatic stress), consequently reducing burnout level. CONCLUSIONS: Our study findings suggest that a multidimensional approach to assessing nurse burnout and implementation of proper management will improve quality of life for nurses and help maintain positive attitudes and quality of patient care.

Sex disparities in the utilization of nurse-assisted peritoneal dialysis: a mediation analysis using data from the REIN registry.

Background: This study was carried out to evaluate the association between patient sex and the proportion of nurse-assisted peritoneal dialysis (PD) at dialysis initiation and to explore whether sex disparities in nurse-assisted PD utilization was explained by predialysis care and/or by social deprivation using mediation analysis. Methods: This was a retrospective study using data from the Renal Epidemiology and Information Network (REIN) registry linked to the French National Healthcare Database (SNDS) of incident patients between 1 January 2017 and 30 June 2018. A regression logistic was used for statistical analysis. A mediation analysis explored the direct effect of sex on nurse-assisted PD proportion and the indirect effect through the European Deprivation Index (EDI), and the number of general practitioner (GP) and nephrologist visits before dialysis initiation. Results: Among 1706 patients on PD, there were 637 women (37.3%) and 1069 men (62.7%). Nurse-assisted PD proportion was 332/610 (54.4%) for women vs 464/1036 (44.8%) for men. In the multivariable analysis women were more likely to be treated by nurse-assisted PD {odds ratio (OR) 1.92 [95% confidence interval (CI) 1.46-2.52]}. Nurse-assisted PD was associated with the median number of GP visits [OR 1.44 (95% CI 1.11-1.86)] and with the median number of nephrologist visits [OR 0.59 (95% CI 0.46-0.76)]. The mediation analysis showed a direct effect of sex on nurse-assisted PD [OR 1.90 (95% CI 1.80-2.01)] and an indirect effect through the median number of GP visits [OR 1.05 (95% CI 1.04-1.06], the median number of nephrologist visits [OR 1.02 (95% CI 1.02-1.03)] and quintile 5 of the EDI [OR 1.03 (95% CI 1.02-1.03)]. Conclusion: Women were more frequently treated by nurse-assisted PD than men. Differences between women and men in predialysis care and social deprivation could explain the greater utilization of nurse-assisted PD among women.

Association between adult attachment and mental health states among health care workers: the mediating role of social support.

Background: To determine the relationships between attachment style, social support, and mental health states, as well as the mediation mechanism within this relationship, we conducted a survey among healthcare workers during the coronavirus disease 2019 (COVID-19) epidemic quarantine. Methods: The survey assessed their mental health states, adult attachment style, social support, and some other relevant information. Mental health states were represented by the overall state of sleep, physical and emotional assessment. A multiple mediator model was used to explain how social support could mediate the relationship between attachment and mental health states during COVID-19 quarantine. Results: Our findings revealed that 33.3% of the participants experienced emotional issues, 8.5% had sleep problems, and 24.9% reported physical discomfort. The direct effect of adult attachment styles on mental health states during COVID-19 quarantine was significant (c' = -0.3172; p < 0.01). The total indirect effect also showed statistical significance (ab = -0.1857; p < 0.01). Moreover, the total effect of adult attachment styles on mental health states was -0.5029 (c = -0.5029; p < 0.01). Subjective social support and utilization of social support play mediating roles in the relationship between attachment style and mental health states, respectively (ab1 = -0.1287, 95% CI: -0.9120 to -0.3341, ab2 = 0.0570, 95% CI: -0.4635 to -0.1132). Conclusion: These findings highlight social support played a mediation role between attachment style and mental health states. Thus, offering social support during a crisis might be useful for those individuals with an insecure attachment.

Sleep Quality as a Mediator of Burnout, Stress and Multisite Musculoskeletal Pain in Healthcare Workers: A Longitudinal Study.

This study aimed to verify whether sleep quality is a mediator of the relationship between burnout, stress and multisite pain in healthcare workers in a longitudinal study with 12 months of follow-up during the COVID-19 pandemic. Online questionnaires were used for data collection. The sociodemographic questionnaire contained personal and occupational data. The short version of the Copenhagen Psychosocial Questionnaire (COPSOQ II-Br) was used to assess burnout and stress. The Pittsburgh Sleep Quality Index (PSQI-Br) assessed sleep quality over one month. The Nordic Musculoskeletal Questionnaire (NMQ) aimed to identify the presence of multisite musculoskeletal pain in the last 12 months and the last 7 days. Mediation analysis was used to verify whether the effect of the predictor variables (burnout and stress) on the dependent variable (number of pain sites in the last 12 months and 7 days) was due to an intervening variable (sleep quality). Stress and burnout were associated with multisite pain in healthcare workers in the last 12 months and the last 7 days. Sleep quality was a significant mediator of this association in the last 12 months, indicating that some of the association between burnout, stress and multisite pain can be explained by poor sleep quality. Thus, a comprehensive approach to long-term multisite pain should consider psychosocial aspects such as burnout, stress and sleep quality.

Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis.

Introduction: The Covid-19 pandemic continues to cause serious physical and mental problems for health professionals, particularly nurses. Aim: To estimate the prevalence of anxiety and insomnia and to evaluate their possible association with family support received by nurses two years after the onset of the pandemic. Materials and methods: In total, the study participants were 404 nurses (335 females and 69 males) with a mean age of 42.88 (SD = 10.9) years and a mean of 17.96 (SD = 12) years working as nurses. Nurses from five tertiary hospitals in Athens constituted the study population who completed the questionnaires State-Trait Anxiety Inventory (STAI), Athens Insomnia Scale (AIS) and Family Support Scale (FSS), in the months of November and December 2021. Regarding demographic and occupational characteristics, gender, age and years of experience as nurses were recorded. Results: 60.1% of the nurses showed abnormal scores in state anxiety, with 46.8% in trait anxiety, and 61.4% showed insomnia. Women showed higher scores on the two subscales of anxiety and the insomnia scale compared to men (p < 0.01 and p < 0.05 respectively), while they showed a lower score on the FSS without statistical significance (p > 0.05). Positive correlations (p < 0.01) were found between the State Anxiety Inventory, Trait Anxiety Inventory and AIS, while all of them showed a high negative correlation with FSS (p < 0.01). Age showed a negative correlation with Trait Anxiety Inventory (p < 0.05). As shown by the mediation analysis, the relationship between state anxiety and insomnia was mediated by trait anxiety, whereas state anxiety appeared to be dependent on family support. Conclusions: Nurses continue to experience high levels of anxiety and insomnia and feel less supported by their families than in the first year of the pandemic. Insomnia appears to be dependent on state anxiety, with a significant indirect effect of trait anxiety, while family support seems to affect state anxiety.

A study of error reporting by nurses: the significant impact of nursing team dynamics.

Background: Error reporting is crucial for organisational learning and improving patient safety in hospitals, yet errors are significantly underreported. Aims: The aim of this study was to understand how the nursing team dynamics of leader inclusiveness, safety climate and psychological safety affected the willingness of hospital nurses to report errors. Methods: The study was a cross-sectional design. Self-administered surveys were used to collect data from nurses and nurse managers. Data were analysed using linear mixed models. Bootstrap confidence intervals with bias correction were used for mediation analysis. Results: Leader inclusiveness, safety climate and psychological safety significantly affected willingness to report errors. Psychological safety mediated the relationship between safety climate and error reporting as well as the relationship between leader inclusiveness and error reporting. Conclusion: The findings of the study emphasise the importance of nursing team dynamics to error reporting and suggest that psychological safety is especially important to error reporting.

Perceived Stress Mediating the Association Between Mindfulness and Resilience Among Registered Nurses.

Purpose: Resilience continues to be an important concept in the nursing profession due to its significant role in personal healthcare, patients' healthcare, and leadership. The present study examined the mediating role of perceived stress in the association between mindfulness and resilience among registered nurses in order to understand their importance among those in the Taiwanese nursing profession. Materials and Methods: Between October and November 2021, a total of 816 registered nurses participated in a cross-sectional survey including psychometric measures assessing perceived stress (Chinese Perceived Stress Scale-10), mindfulness (Chinese Mindful Attention Awareness Scale), and resilience (Chinese Questionnaire of Resilience). Results: Results indicated that perceived stress mediated the association between mindfulness and resilience (standardized coefficient = 0.251, p<0.001), although there was no significant association between mindfulness and resilience (standardized coefficient = 0.042, p=0.16). This suggests that perceived stress may function as both distress and eustress because mindfulness was not directly associated with resilience but indirectly via perceived stress. Conclusion: Nurses and their administrators should focus on different ways of coping with stress so that they become more resilient in facing other stressors. Future studies may be conducted to examine the mediating role of perceived stress in the association between other coping strategies and resilience among registered nurses.

Exploring the Relationship Between Intolerance of Uncertainty and Trust in Physicians from Spousal and Parent-Child Perspectives.

Objective: The present study aimed to probe the intergenerational transmission of intolerance of uncertainty (IU) and trust in physicians. Besides, through the actor-partner interdependence model (APIM), the predictive effect of parents' IU on their own and their spouses' trust in physicians was examined. A mediation model was further constructed to probe the mechanisms by which parents' IU affects children's trust in physicians. Methods: The Intolerance of Uncertainty Scale-12 (IUS-12) and the Wake Forest Physician Trust Scale (WFPTS) were employed to conduct the questionnaire survey among 384 families (each family with a father, mother, and one child). Results: IU and trust in physicians were found to be intergenerationally transmitted. The results of the APIM analyses showed that fathers' total IUS-12 scores negatively predicted their own (ß = -0.419, p < 0.01) and mothers' (ß = -0.235, p < 0.01) total WFPTS scores. Mothers' total IUS-12 scores negatively predicted their own (ß = -0.353, p < 0.01) and fathers' (ß = -0.138, p = 0.017) total WFPTS scores. The results of mediation analyses indicated that parents' total WFPTS scores and children's total IUS-12 scores mediated the effect of parents' total IUS-12 scores on children's total WFPTS scores. Conclusion: The public's IU is a crucial influencing factor of their trust in physicians. Besides, the IU between couples and between parents and children could be mutually affected. On the one hand, husbands' IU could affect their own and their wives' trust in physicians, and vice versa. On the other hand, parents' IU and trust in physicians could affect their children's IU and trust in physicians, respectively.

Mediating Effect of Communication Competence in the Relationship between Compassion and Patient-Centered Care in Clinical Nurses in South Korea.

This study investigates the mediating effect of communication competence in the relationship between compassion and patient-centered care (PCC) in clinical nurses. We used a descriptive research approach, and our sample comprised nurses (n = 204) with more than one year of experience in patient nursing in a general hospital in South Korea. The data were collected between December 2020 and June 2021 and analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson's correlation coefficient analysis, and hierarchical multiple regression using SPSS 24.0. The Sobel test and PROCESS macro in SPSS were applied to verify the mediating effect. The mean scores for communication competence, compassion, and PCC were 3.67 ± 0.42, 64.04 ± 7.71, and 3.75 ± 0.46, respectively. Communication competence was found to partially mediate the relationship between compassion and PCC (z = 6.977, p < 0.001), and its explanatory power was 63.9%. To improve nurses' PCC, developing a step-by-step and differentiated PCC improvement program that includes communication competence and compassion is necessary.

Sense of Coherence as a Mediator in the Association Between Empathy and Moods in Healthcare Professionals: The Moderating Effect of Age.

While empathy is considered a critical determinant of the quality of medical care, growing evidence suggests it may be associated with both one's own positive and negative moods among healthcare professionals. Meanwhile, sense of coherence (SOC) plays an essential role in the improvement of both psychological and physical health. Reportedly, individual SOC reaches full stability after around age 30. The aim of this study was first to evaluate the mediatory role of SOC on the association between empathy and individual moods among 114 healthcare professionals in a general hospital, and then to examine the moderating effect of age on this association. Participants completed a range of self-report demographic questionnaires, Empathy Process Scale (EPS), the 13-item Antonovsky's SOC, and Profile of Mood States (POMS). Findings showed that SOC mediated the relations between empathy (EPS) and both POMS-Vigor (POMS-V: self-vigor mood) and POMS-Depression (POMS-D: self-depression mood). Notably, moderated mediation analysis revealed that there was a significant interaction (age × SOC) on self-vigor mood (POMS-V) in healthcare professionals. The indirect effect of empathy (EPS) on self-vigor mood (POMS-V) through SOC was significant at over mean age "32.83." Although there was no significant interaction with age regarding the indirect effect of empathy (EPS) on self-depression mood (POMS-D), in the sub-category level analysis of empathy (EPS), we found a significant interaction item [age × empathy for other's negative affect (EPS-N)] on SOC. This indirect effect was also significant at over mean age "32.83." Taken, together, the current study highlighted the significant mediator of SOC on that empathy amplifies self-vigor mood and attenuates self-depression mood as a protective factor among the Japanese healthcare professionals. Some components of these processes may depend on the moderating role of age, indicating that we may need to consider the SOC development with age for more effective empathy performance interventions among healthcare professionals.

Learning Climate and Job Performance among Health Workers. A Pilot Study.

This paper will explore if and how psychological strain plays a mediator role between the learning climate and job performance in a group of health workers. Although the relationship between learning climate and job performance has already been explored in the international literature, the role of psychological strain, which may hamper or deepen this relationship, has yet to be investigated. The research hypothesis is that psychological strain mediates the relationship between the climate toward learning (including also the error avoidance climate) and job performance. Data were gathered in a Public hospital in Italy. Participants (N = 61) were health professionals (nurses and obstetricians). Considering the relatively small sample size, a mediation analysis with the aid of the SPSS macro PROCESS was performed. The results show that the relationship between the learning climate (specifically its dimension of organizational appreciation toward learning) and job performance is mediated by psychological strain. The future research agenda and practical implications are discussed in the paper.