Nurses' mental workload and public health emergency response capacity in COVID-19 pandemic: A cross-sectional study.

AIMS: The aim of this study was to assess the level of mental workload of Chinese nurses through a latent profile analysis and to explore its relationship with public health emergency response capacity. DESIGN: A cross-sectional design with a convenience sample. METHODS: A convenience sample of nurses from five tertiary hospitals in Chengdu between May and December 2022. Demographic, work-related information, Nurse's version of NASA's Task Load Index Scale and Nurse's Public Health Emergency Response Capacity Scale were used in this study. RESULTS: The mean scores for mental workload and emergency response capacity for nurses were (57.19 ± 15.67) and (3.58 ± 0.77) respectively. We found that the mental workload of nurses fell into three potential categories. In addition, there were differences in psychological training and supply of epidemic prevention materials in the department among nurses with different mental workload subtypes. There was a moderate negative correlation between nurses' mental workload and public health emergency response capacity. CONCLUSION: Our results show that there is still a strong mental workload on a proportion of nurses, and enhanced psychological training and material supply support are beneficial in relieving nurses' mental workload. The better the nurses' capacity to cope with public health emergencies, the lower their mental workload. IMPACT: Nursing managers should pay ongoing attention to the mental workload status of nurses in the latter stages of a pandemic and individual differences in nurses' mental workload. In addition, nursing managers should be aware of the impact of public health emergency response capacity on nurses' mental workload. They can intervene in nurses mental workload from a new perspective. PATIENT OR PUBLIC CONTRIBUTION: 560 registered nurses participated in this study.

Healthcare professionals' digital health competence profiles and associated factors: A cross-sectional study.

AIMS: To identify healthcare professionals' digital health competence profiles and explore associated factors to digital health competence in healthcare settings. DESIGN: A cross-sectional study. METHODS: Data were collected from 817 healthcare professionals from nine organizations with an electronic questionnaire by using Digital Health Competence instrument (42 items) and Aspects Associated with Digital Health instrument (15 items) between 1st March and 31st July 2022. K-means clustering was used to describe digital health competence profiles. Binary logistic regression analysis was used to explore associated factors. RESULTS: Analysis revealed three digital health competence profiles: A - high competence (n = 336), B - intermediate competence (n = 352) and C - low competence (n = 129). Between the profiles, digital health competence showed significant differences (p < .001). Recent graduation year, working in outpatient environments and leader or specialist position were associated with higher digital health competence. Organizational practices and the influence from colleagues improved competence in human-centred remote counselling, digital solutions as part of work, competence in utilizing and evaluating digital solutions and ethical competence. Support from management improved digital solutions as part of work and ethical competence. CONCLUSION: Nursing and allied health professionals working in other than outpatient environments should be specifically acknowledged when digital health competence development initiatives are designed and targeted. The positive influence from colleagues could be harnessed by enhancing their involvement in digital health competence development methods such as orientation, mentoring or coaching. Additionally, managers should take a stronger role in supporting different areas of digital health competence. IMPACT: This was the first study that explored healthcare professionals' digital health competence profiles and associated factors. The detection of healthcare professionals' digital health competence profiles guides the development of digital health education according to different needs in healthcare environments. REPORTING METHOD: The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The impact of education/training on nurses caring for patients with stroke: a scoping review.

BACKGROUND: Stroke survivors have complex needs that necessitate the expertise and skill of well-trained healthcare professionals to provide effective rehabilitation and long-term support. Limited knowledge exists regarding the availability of specialized education and training programs specifically designed for nurses caring for stroke patients. AIM: This review aims to assess the content and methods of training for nurses caring for stroke patients, examine its impact on both nurses and patients, and identify key facilitators and barriers to its implementation. METHODS: We conducted a comprehensive scoping review by reviewing multiple databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, Web of Science, Scopus, ProQuest Dissertations and Theses, Google Scholar, and Cochrane databases. Data extraction and narrative synthesis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. RESULTS: Seventeen articles were included in this review. We found that education/training not only enhanced patients' self-care abilities, nursing outcomes, and satisfaction, but also had a positive impact on the knowledge, skills, and practices of nurses. The obstacles to education/training included feasibility and cost-effectiveness, while the driving factors were management support and participation, professional education/training, and controlled environment creation. CONCLUSIONS: This review highlights the crucial role of education/training in enhancing stroke care provided by nurses. Effective education/training integrates various educational methods and management support to overcome implementation barriers and optimize clinical practice benefits. These findings indicate the necessity of universal and consistent stroke education/training for nurses to further improve patient outcomes in stroke care.

Improvements in practising nurses' knowledge, skills, self-efficacy, confidence, and satisfaction after a simulated clinical experience of caring for a patient undergoing chemotherapy: a quasi-experimental study.

BACKGROUND: The beneficial effect of simulation experience on nursing students is well established in the literature. However, an accurate simulation modality to help professional nurses enhance their clinical competence and expertise remains unexplored. The current study evaluated and contrasted the impact of two simulation modalities on nurses' knowledge, abilities, self-efficacy, confidence, and satisfaction following a simulated clinical experience caring for chemotherapy patients. METHODS: A quasi-experimental research design was employed in this study. The participants were divided into group A, comprising nurses exposed to the high-fidelity simulation, and group B, comprising nurses exposed to the virtual simulation. RESULTS: The study found that nurses exposed to high-fidelity simulation and virtual simulation gained a high standard of knowledge and skills. The nurses' post-test and post-objective structured clinical examination (OSCE) scores drastically increased after simulation exposure compared to their pre-test and pre-OSCE scores. For the group exposed to high-fidelity simulation, the mean differences were - 19.65 (pre- and post-test) and 23.85 (pre- and post-OSCE), while for the group exposed to virtual simulation, the mean differences were - 22.42 (pre- and post-test) and 20.63 (pre- and post-OSCE). All p-values indicated significant differences < 0.001. Moreover, both groups exhibited high self-efficacy, confidence, and satisfaction levels after the simulation experience. The outcomes of both simulation modalities regarding self-efficacy, confidence, and satisfaction levels indicate no significant difference, as supported by p-values of > 0.05. CONCLUSION: High-fidelity simulation and virtual simulation training effectively and efficiently advance nurses' professional competence. The nurses exposed to high-fidelity simulation and virtual simulation gained high levels of knowledge and skills. Additionally, it increased their sense of happiness, self-worth, and self-efficacy. The simulation approach will be a potent instrument for improving nurses' competency and fully developing their sense of expertise. Therefore, developing policies adopting simulation as part of their professional development will ensure patient safety and improve health outcomes.

Comparison of self-competency and executive (charge) nurse competency assessments of clinical nurses.

AIM: This study compared nurses' self-competency assessments and their managers' nurse competence assessments. BACKGROUND: Nurse competence is important for nursing care quality and patient safety. Executive (charge) nurses play a main role in the nurse competency assessment. METHODOLOGY: In this study conducted at a university hospital between January and December 2020, the self-efficacy evaluations of nurses (n = 162) working in services other than the emergency department, operating room, and outpatient clinics of the university hospital were compared with the evaluations of nurse executives (charges) on these nurses (n = 21). Data were collected using the personal information form and the Nurse Competence Scale. A cross-sectional study design was used. The Strengthening the Reporting of Observational Studies in Epidemiology guideline was used for reporting. RESULTS: Service nurses' self-assessments and nurses treating charge's assessment of clinical nurses evaluated the competence levels as excellent in both groups. The self-competency assessments of the nurses were higher than the charge nurses' competency assessments. DISCUSSION: In this study, the lower competence assessment of nurses by the charge nurses was may be due to their ability to observe nurses in their teams in general and that they have more experience in evaluation. CONCLUSION: It is suggested that professional development and competence programs be created to further develop the competencies of nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse competency assessments support planning to ensure patient safety. Patient care burden and planning of risky patients according to the nurse competency level will provide safe patient care.

Nurses' clinical competency and its correlates: before and during the COVID-19 outbreak.

BACKGROUND: Clinical competency is the ability to integrate knowledge, skills, attitudes and values into a clinical situation and it is very important in nursing education, clinical settings, nursing management, and crises. This study aimed to investigate nurses' professional competence and its correlates before and during the COVID-19 pandemic. METHODS: We conducted this cross-sectional study before and during the COVID-19 outbreak and recruited all nurses working in hospitals affiliated to Rafsanjan University of Medical Sciences, southern Iran, so we included 260 and 246 nurses in the study before and during the COVID-19 epidemic, respectively. Competency Inventory for Registered Nurses (CIRN) was used to collect data. After inputting the data into SPSS24, we analysed them using descriptive statistics, chi-square and multivariate logistic tests. A significant level of 0.05 was considered. RESULTS: The mean clinical competency scores of nurses were 156.97 ± 31.40 and 161.97 ± 31.36 before and during the COVID-19 epidemic, respectively. The total clinical competency score before the COVID-19 epidemic was not significantly different from that during the COVID-19 epidemic. Interpersonal relationships (p = 0.03) and desire for research/critical thinking (p = 0.01) were significantly lower before the COVID-19 outbreak than during the COVID-19 outbreak. Only shift type had an association with clinical competency before the COVID-19 outbreak, while work experience had an association with clinical competency during the COVID-19 epidemic. CONCLUSION: The clinical competency among nurses was moderate before and during the COVID-19 epidemic. Paying attention to the clinical competence of nurses can improve the care conditions of patients, and nursing managers should improve the clinical competence of nurses in different situations and crises. Therefore, we suggest further studies identifying factors improving the professional competency among nurses.

Factors related to a successful professional development for specialist nurses in surgical care: a cross-sectional study.

BACKGROUND: A high level of competence among staff is necessary for providing patient-safe surgical care. Knowledge regarding what factors contribute to the professional development of specialist nurses in surgical care and why they choose to remain in the workplace despite high work requirements is needed. To investigate and describe the organizational and social work environment of specialist nurses in surgical care as part of studying factors that impact on professional development. METHOD: This was a cross-sectional study with a strategic convenience sampling procedure that recruited 73 specialist nurses in surgical care in Sweden between October to December 2021. The study was guided by STROBE Statement and checklist of cross-sectional studies. The validated Copenhagen Psychosocial Questionnaire was used, and additional demographic data. Descriptive statistics were performed and the comparison to the population benchmarks was presented as the mean with a 95% confidence interval. To study potential differences among the demographic and professional characteristics, pairwise t tests were used with Bonferroni adjustment for multiple comparisons with a significance level of 5%. RESULTS: Five domains were identified as factors related to success, as they received higher scores in relation to population benchmarks: quality of leadership, variation of work, meaning of work and work engagement as well as job insecurity. There was also a significant association between a having a manager with low nursing education and job insecurity (p = 0.021). CONCLUSIONS: Quality of leadership is important for the professional development of specialist nurses in surgical care. Strategic work seems to include managers with a higher nursing education level to prevent insecure professional working conditions.

Disaster nursing competencies of rural nurses during COVID-19: A cross-sectional study.

Background: Although rural nurses' roles are indispensable in coronavirus disease 2019 (COVID-19) management, increased roles, workload, burnout, and reduced job satisfaction can hinder their work, potentially affecting nurses' disaster nursing competencies. Aim: The aim of the study was to identify the predictors of rural nurses' disaster nursing competencies during the COVID-19 pandemic. Methods: Nurses from rural community hospitals in South Korea (N=204) were surveyed during June-July 2021. We used the Professional Quality of Life and Disaster Nursing Preparedness-Response Competencies questionnaires. Multiple regression analysis was performed to identify the predictors of disaster nursing competencies. Findings: The mean score for disaster nursing competency of the 204 participants was 110.80 (standard deviation=19.14). Disaster nursing competencies correlated with age, nursing career, compassion satisfaction, and secondary traumatic stress. Compassion satisfaction (ß=.27, P=.004), prior disaster nursing education (ß=.19, P=.005), and prior participation in disaster nursing care (ß=.16, P=.022) predicted disaster nursing competencies, together accounting for 24.2% of the variance. Discussion: Our findings imply that increasing opportunities for continuing education regarding disaster nursing is crucial to enhance the related competencies in rural nurses. This study also highlights the necessity for stakeholders to develop programs aimed at increasing rural nurses' compassion satisfaction. Conclusion: Prior disaster nursing education, prior participation in disaster nursing care, and compassion satisfaction predicted disaster nursing competencies among rural nurses, with compassion satisfaction being the strongest predictor.

New graduate registered nurses' professional competence and the impact of preceptors' education intervention: a quasi-experimental longitudinal intervention study.

AIMS AND OBJECTIVES: The aim of this quasi-experimental longitudinal intervention study was to investigate new graduate nurses' professional competence development after preceptors' participation in an education intervention. BACKGROUND: New graduate registered nurses are expected to be competent in many areas of nursing. Expectations that are sometimes unrealistic may cause a sense of inadequacy and stress, and this may in turn prevent them from fully deploying their competencies. Competence development is related to practice environment, occupational commitment, empowerment, and work experience. Orientation or transition programs have been designed to ensure new graduate nurses' competence, and preceptors and preceptorship could also have significant influence on their competence development. DESIGN: A quasi-experimental longitudinal intervention study. METHODS: The data was collected from October 2015 to November 2017. Participating wards were randomized into intervention and control groups. The intervention group preceptors had an eight-hour education intervention that focused on new employees' orientation, particularly from new graduates' point of view. Wards in the control group continued to precept as before. The Nurse Competence Scale was used for new graduates' self-assessment at baseline and at three-month and nine-month follow-up. This study is reported in accordance with the TREND Statement Checklist. RESULTS: The education intervention aimed at preceptors did not have impact on the intervention group NGRNs' competence development. There were no statistically significant differences between the groups and effect size remained small. CONCLUSIONS: The preceptors' education intervention was not effective enough to develop new graduates' professional competence so that it would have differed from that of the graduates receiving conventional orientation at the university hospital. This study confirmed that competence development is a complex and multidimensional phenomenon and organizations should invest in new graduate registered nurses' competence development during their early career. Preceptors' education and development of preceptorship and transition programs are an important part of overall competence development in complex health care environments. TRIAL REGISTRATION: Retrospectively registered.

Undergraduate nursing students' experiences of becoming a professional nurse: a longitudinal study.

BACKGROUND: During education it is essential for nursing students to develop professionalism in nursing. Nurses are placed in situations based on trust, and it is crucial that their patients have confidence in them to provide professional and safe care. A key period in nursing students' development of a professionalism occurs during training when students gain knowledge and skills that separate nurses as professional healthcare workers from laypeople. The purpose of this study was to investigate nursing students' experiences of professional competence development during education. METHODS: A longitudinal study was carried out using qualitative content analysis with a manifest inductive approach. Thirty-four students enrolled in a Swedish three-year nursing program, from August 2015 to January 2017 were interviewed on four occasions. RESULTS: The results revealed that students' professional role developed gradually. The students' started their education with dreams and a naive understanding of the profession, but their understanding of the complexity of the nursing profession gradually evolved. Students became theoretically equipped at the university and developed clinical skills through practice. Students' focus went from mastering medical technology to a more holistic approach. Before graduating, students felt ready but not fully trained. CONCLUSIONS: Our findings indicate a discrepancy between the content of the theoretical education and the clinical settings since students identified a lack of evidence-based practice. A solid theoretical education before entering clinical training offered students possibilities for reflecting on evidence-based practice and the clinical settings. The realization that there is always potential for professional improvement can be interpreted as an emerging awareness, and development of professionalism. It is clear that students could benefit from increased collaborative work between clinical supervisors and faculty staff at the university.

Cross-cultural adaptation and psychometric evaluation of the Slovenian version of the nurse professional competence scale.

BACKGROUND: The competency-based approach to the assessment of nursing practice has been adopted as a key policy in the developed world. The continual self-assessment of competence gives nurses the opportunity to reflect on their competencies and has a significant impact on the quality of nursing practice and patient safety. The study was designed to describe the process of cross-cultural adaptation and to assess the psychometric properties of the Slovenian version of a short form of the Nurse Professional Competence scale (NPC-SF) and to evaluate the efficacy of this instrument in a sample of registered nurses. METHODS: A cross-sectional and validation study was conducted in 425 registered nurses to test the psychometric properties of the Slovenian version of a short form of the scale and to evaluate nurses' professional competence. A multilevel approach was used: Translation, back-translation, language validity, face and content validity, construct validity, and reliability of the Slovenian version of the scale were analysed respectively. Participants completed an online survey, with the data being collected between April and July 2020. RESULTS: Factor analysis showed that the Slovenian version of the scale could be used in four dimensions explained with 65 % of the variance. Cronbach's α was 0.972. The four-factor model fit the data (RMSEA = 0.083, CFI = 0.731). Self-reported competence was high and rated higher by nurses employed at the tertiary level of healthcare, followed by nurses employed at the secondary and primary, and from social care institutions. Nurses with more years of experience assessed their competence higher. CONCLUSIONS: The NPC-SF helps understand and identify nurses' self-reported core competencies in clinical settings, thereby providing an important predictor of the professional development of nursing. The Slovenian version of the scale demonstrated acceptable psychometric properties and may be used in research and clinical practice to evaluate nurses' professional competence.

Newly graduated nurses' empowerment regarding professional competence and other work-related factors.

BACKGROUND: Although both nurse empowerment and competence are fundamental concepts of describing newly graduated nurses' professional development and job satisfaction, only few studies exist on the relationship between these concepts. Therefore, the purpose of this study was to determine how newly graduated nurses assess their empowerment and to clarify professional competence compared to other work-related factors. METHODS: A descriptive, cross-sectional and correlational design was applied. The sample comprised newly graduated nurses (n = 318) in Finland. Empowerment was measured using the 19-item Qualities of an Empowered Nurse scale and the Nurse Competence Scale measured nurses' self-assessed generic competence. In addition to demographic data, the background data included employment sector (public/private), job satisfaction, intent to change/leave job, work schedule (shifts/business hours) and assessments of the quality of care in the workplace. The data were analysed statistically by using Spearman's correlation coefficient as well as the One-Way and Multivariate Analysis of Variance. Cronbach's alpha coefficient was used to estimate the internal consistency. RESULTS: Newly graduated nurses perceived their level of empowerment and competence fairly high. The association between nurse empowerment and professional competence was statistically significant. Other variables correlating positively to empowerment included employment sector, age, job satisfaction, intent to change job, work schedule, and satisfaction with the quality of care in the work unit. The study indicates competence had the strongest effect on newly graduated nurses' empowerment. CONCLUSIONS: New graduates need support and career opportunities. In the future, nurses' further education and nurse managers' resources for supporting and empowering nurses should respond to the newly graduated nurses' requisites for attractive and meaningful work.

[Differences and similarities between the competencies of a nursing supervisor and an advanced clinical nurse specialist]. / Diferencias y similitudes entre las competencias de una supervisora de enfermería y una enfermera clínica especialista.

INTRODUCTION: With the aim of contributing to the development of a more specific professional regulation, the present study was to identify differences and similarities between the competencies of the nursing supervisor and clinical nurse specialist in an intensive care unit. MATERIAL AND METHODS: A critical analysis of the literature published between 2003 and 2013 was conducted, identified through systematic searches in electronic databases, health management and practitioner journals and reference lists of the 17 items included. RESULTS: «Management and administration¼ and «direct clinical practice¼ were identified as specific competencies of nursing supervisor and clinical nurse specialist respectively. «Collaboration¼, «leadership¼ and «research¼ emerged as competencies shared by both profiles, but with different a operationalization way of conducting it. CONCLUSIONS: These findings imply that regulation, education and implementation of these profiles must address their specific skills as the distinctive approach taken in operationalizing shared.

[The odysseys of Ulysses. A study of tales in a normal working day of the family doctor in Paraguay, Mexico, Peru, and Spain]. / Las odiseas de los Ulises. Estudio de los relatos de un día normal de trabajo del médico de familia en Paraguay, México, Perú y España.

OBJECTIVE: To examine the professional profile of the family doctor in different countries and the social welfare context where their work is carried out. DESIGN: Qualitative Methodology of production of field diaries of a normal day. LOCATION: Primary Heath Care of Toledo and Tenerife in Spain, and Paraguay, Mexico, and Peru. PARTICIPANTS AND CONTEXTS: Non-random sampling, intentional, followed by snowball sample until data saturation. METHOD: Participants wrote a diary of a typical day's work, their circumstances and socio-health context, and were studied by content analysis. Techniques to control the biases were used the check the participants and the triangulation between the obtained results and the existing bibliography, and data found on the Internet daily. We performed a mental map to transcribe the results graphically and in a comprehensive form. RESULTS: A total of 24 diaries of a normal day were obtained (9 doctors in Spain, 7 in Mexico, 4 in Paraguay, and 4 in Peru). We found some similarities, but many differences between countries. In contexts of humble but spirited, rural, with traditional roots and undemanding, there was a wider range of tasks of the family doctor, the coexistence of public and private work, and modern and traditional medicine, with greater presence of family and community care, more physician satisfaction and better patient-physician relationship. CONCLUSIONS: The professional profile of the family doctor is diverse and a context-dependent variable, and is not derived directly from external theory of family medicine.

Relationship Between Clinical Nursing Competence and Work Environment by Career Stage for Nurses with 1-10 Years of Clinical Experience.

Background: Clinical nursing competence includes ethics, cooperation with other professionals, and management, in addition to nursing abilities and responding per situation. Therefore, it may vary depending on one's experience and the work environment. However, there is a lack of studies exploring the competence for different experience levels. Therefore, this study aimed to clarify the association between clinical nursing competence and the work environment by experience groups. Methods: Anonymous self-administered questionnaire surveys were conducted on 717 nurses in regional core hospitals from December 2017 to March 2018. Clinical nursing competence was measured using the Clinical Nursing Competence Self-Assessment Scale (CNCSS). Association of CNCSS with experience and work environment was examined. Results: Responses from 231 nurses with 1-10 years of experience were analyzed. Compared with those in the 2-year experience group, those in the 3-5- and 6-10-year experience groups assessed their "planned development of nursing care" and "assessment of care" competencies to be higher. Additionally, compared with those in the 2-year experience group, those in the 6-10-year experience group assessed their "clinical judgment" and "care coordination" competencies to be higher. Nurses with 1 year of experience showed significant positive correlations between clinical nursing competence and "good interpersonal relationship," "clarity about the organization's vision," and "ease of taking time off"; and those with 6-10 years of experience showed significant positive correlations between clinical nursing competence and "support from superiors and senior coworkers" and "established and easily accessible support system for taking time off for childcare and caregiving." Conclusion: The relationship between clinical nursing competence and the work environment differed according to years of experience. Interventions to improve clinical nursing competence should be developed for each experience group considering the associations.

Competencies of the nurses in the limitation of therapeutic effort in the intensive care unit: An integrative review.

Objective: Nurses inevitably encounter patients who require care aimed at limiting therapeutic effort (LTE), even though many of them are not prepared to provide support to individuals with terminal illnesses and their families. One of the contexts in which the LTE is considered is the intensive care unit (ICU). This review is to describe the competencies for the execution of a nursing professional role in the LTE in the ICU. Method: An integrative review of the literature published between the years 2010 and 2023. The search was carried out in five databases: Medline, Wiley Online Library, SciELO, ScienceDirect, and Web of Science. The Critical Appraisal Skills Programme in Spanish was used as the template for study evaluation. The methodology of the Oxford Center for Evidence-Based Medicine (CEBM) was used to assess the level of evidence and the degree of recommendation. Result: A total of 25 articles in a wide range of studies were included. The findings suggest that the competencies for LTE in the ICU are direct patient care, family-centered care, and the role of the nurse within the team. However, more high-quality studies are needed to confirm these conclusions. Three categories were identified: (a) competencies as defender agent between the patient, his family, and the interdisciplinary team; (b) competencies for decision-making in limiting the therapeutic effort; and (c) competencies for nursing therapeutic interventions at the end of life. Conclusion: The competencies of the nursing professionals who work in the adult ICU in the LTE are essential to the patient's quality of life, dignity of their death, and comprehensive family support for coping with grief.

Training Priority for Managerial Competence of Nurse Managers in Small and Medium-Sized Hospitals: Focusing on the Management Level.

Introduction: The managerial competence of nurse managers varies according to their management level. Objectives: This study aims to explore the training priority of managerial competence for nurse managers in small- and medium-sized hospitals based on their management level. Methods: Nurse managers (122 front-line and 65 middle-level nurse managers and chief nurse executives (CNEs)) from 21 small- and medium-sized hospitals with less than 300 beds participated in a survey. T-test and Borich Priority were analyzed. Results: Nurse managers identified control competence as the most significant management function in both groups. The training priority for front-line nurse managers was motivation in directing, while it was human resource development in human resource management for middle-level nurse managers and, CNEs. Conclusion: Five management strategies were reported, which will be the basis for future systematic nursing management in nursing organizations.

[Putting freelancing in the medical profession to the test]. / Der Freie Beruf auf dem Prüfstand.

Hallmarks of freelancing in the medical profession include special professional qualifications or expertise. Identification with the activity is also reflected in a physician's responsibility for patients that goes beyond a mere business relationship. At the same time, this responsibility requires that a physician can act independently of economic aspects. Privileges of self-employed are, in addition to a fee schedule, the possibility to establish one's own pension fund and to exercise self-governance in medical associations. An important aspect of being self-employed is self-governance. The goal of the independence of those who are self-employed is to avoid the social and irresolvable conflict of values in state- or market-based systems. Physicians work in a field of tension between an empathetic, time-taking medical activity and a fast "economically sensible, expedient and necessary" medicine. Enduring this dilemma is the original task of the liberal profession.

Factors Affecting Nursing Surveillance Activity among Clinical Nurses.

Nursing surveillance is a defense mechanism that protects patients from adverse events, as it is a systematic process that contributes to nurses' detection of and intervention in dangerous situations. This descriptive cross-sectional study examined the degree of nursing surveillance activity performed by clinical nurses, nurses' perceived importance of nursing surveillance, and their perception of patient safety culture. The study aimed to identify the predictors of nursing surveillance activity. Participants included 205 clinical nurses from two secondary hospitals and two tertiary hospitals in Changwon-si and Cheongju-si, South Korea, who had at least one year of clinical experience. Nursing surveillance activity was high among nurses who were assigned fewer than 1.88 patients, who worked in a tertiary hospital, and those who scored 7.0 or higher in nurses' perceived expertise. Nursing surveillance activity was significantly positively correlated with nurses' perceived importance of nursing surveillance and patient safety culture. A hierarchical multiple regression analysis was performed to identify the predictors of nursing surveillance activity. Nurses' perceived expertise, perceived importance of nursing surveillance, patient safety culture, and type of hospital explained 65.3% of the variance of nursing surveillance activity. This study is significant as it provides an assessment of the extent and key predictors of nursing surveillance activity.

An Observational Cross-Sectional Study on the Correlation between Professional Competencies and Self-Efficacy in Albanian Registered Nurses.

(1) Background: The assessment and application of registered nurses' professional skills are essential to providing quality and safe care. Self-efficacy can positively affect the professional competence of registered nurses. This study analysed professional competence and its association with self-efficacy among registered nurses. (2) Methods: A cross-sectional observational study was conducted. The sampling was conventional. The data collection took place through the Albanian version of the Nurse Professional Competence Scale Short Form (A-NPCS-SF), which was used to assess their professional skills, and the Albanian version of the Nursing Profession Self-Efficacy Scale (A-NPSES), which was used to assess their self-efficacy. The study was based on a convenience sample of 985 registered nurses from the 12 Albanian provinces. (3) Results: The Cronbach alpha value for the A-NPCS-SF scale was 0.947, while for the A-NPSES scale, it was 0.875, proving both scales to be reliable. Self-efficacy does not play an essential role in the development of the professional competence of registered nurses since our survey found only one dimension correlates with these two elements. (4) Conclusions: The results of our analysis have instead highlighted the importance of a close relationship between job satisfaction and the development of professional skills.