Mediating Role of Rumination in Second Victim Experience to Turnover Intention in Psychiatric Nurses.

BACKGROUND: Psychiatric nurses often face patient safety incidents that can cause physical and emotional harm, even leading to s econd victim syndrome and staff shortages. Rumination-a common response after nurses suffer a patient safety event-may play a specific role between the second victim experience and turnover intention. Understanding these mechanisms is crucial for supporting psychiatric nurses and retaining psychiatric nursing resources. OBJECTIVES: The study aimed to explore the associations among second victim experience, rumination, and turnover intention in psychiatric nurses and confirm how second victim experience influences turnover intention through rumination and its subtypes. METHODS: A descriptive, cross-sectional study was adapted to survey 252 psychiatric nurses who experienced a patient safety incident at three hospitals in China between March and April 2023. We used the Sociodemographic and Patient Safety Incident Characteristics Questionnaire (the Chinese version of the Second Victim Experience and Support Tool), the Event-Related Rumination Inventory, and the Turnover Intention Scale. Path analysis with bootstrapping was employed to accurately analyze and estimate relationships among the study variables. RESULTS: There was a positive association between second victim experience and turnover intention. In addition, both invasive and deliberate rumination showed significant associations with second victim experience and turnover intention. Notably, our results revealed that invasive and deliberate rumination played partial mediating roles in the relationship between second victim experience and turnover intention in psychiatric nurses. DISCUSSION: The negative experience and turnover intention of the psychiatric nurse second victims are at a high level. Our results showed that invasive rumination positively mediated the relationship between second victim experience and turnover intention, and deliberate rumination could weaken this effect. This study expands the knowledge of the mechanisms underlying the effect of the second victim experience on turnover intention. Organizations must attach importance to the professional dilemmas of the psychiatric nurses' second victims. Nurse managers can reduce nurses' turnover intention by taking measures to reduce invasive rumination and fostering deliberate meditation to help second victims recover from negative experiences.

Nursing practice in modern healthcare environments: A systematic review of attributes, characteristics, and demonstrations.

AIM: To identify Attributes, Characteristics and Demonstrations of nursing practice from both nurses' and people perspectives in today's healthcare environments. A secondary aim was to identify relevant differences between female and male nurses in the context of ACDs. DESIGN: This systematic review was informed by the Joanna Briggs Institute Convergent Integrated Approach to Mixed Study Systematic Reviews. METHODS: The search included articles ranging from the years 2000 to 2023 across 10 electronic databases and multiple grey literature outlets. McMaster critical review forms and the Mixed Methods Appraisal Tool were used to appraise article quality. The Convergent Integrated Approach to Mixed Study Systematic Reviews was used to guide data synthesis. RESULTS: Twenty articles were included in this review, 13 qualitative, five quantitative and two mixed-methods studies. Three themes emerged, including knowledge, practice skills and interpersonal relationships. Differences in Attributes, Characteristics and Demonstrations of professional practice between women and men in nursing were also explored. CONCLUSION: Findings suggest that evolving healthcare environments challenge nurses to remain focused on patient-centred and compassionate care. The review also supports nurses caring in a manner that empowers people, increases well-being, and reduces suffering. IMPACT: Identified characteristics and attributes of nursing practice, including emphasis on continuous learning, interpersonal relationships and compassion, have a profound impact on nursing. Nurses should remain adaptable, compassionate and patient-focused in an ever-evolving healthcare environment. These foundational care principles are necessary for improving patient outcomes, enhancing trust between people and healthcare providers, and increasing inclusivity and diversity in the nursing workforce. WIDER GLOBAL COMMUNITY: Nurses worldwide should strive to embody these attributes to provide high-quality, patient-centred care in an inclusive environment in today's demanding healthcare environment. Gender-specific differences in the perception and expression of professional Attributes, Characteristics and Demonstrations can inform inclusion and diversity efforts in the workplace. REPORTING METHOD: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Prevalence and risk factors of low birth weight in the United States: An analysis of 2016-2021 data.

BACKGROUND: Low birthweight (LBW), infants weighing less than 2,500 g, is a global health concern associated with high infant morbidity and mortality rates. This study investigates LBW prevalence and its relation to maternal sociodemographic characteristics and lifestyle behaviors factors in the United States (US). METHODS: This analysis used the National Survey of Children's Health (NSCH) data from 2016 to 2021, including n = 225,443 children aged 0-17 years. 18,131 had LBW (<2,500 g), and 2810 had very LBW (VLBW) (<1,500 g). Logistic regression calculated odds ratios (OR) using LBW as the dependent variable, adjusting for various factors. RESULTS: Between 2016 and 2021 in the United States, LBW prevalence averaged 9.31%, with VLBW at 1.50%. Mothers aged 18-35, White, had the lowest LBW (7.63%) and VLBW (1.17%) rates. Mothers aged ≤18 years, black, had the highest LBW (15.45%) and VLBW infants (4.70%). Maternal age emerged as a significant LBW factor, with an OR of 1.27 for ≤18 and 1.19 for >35. Children in poor health had the highest OR (2.87). Race/ethnicity and other disparities were observed. CONCLUSION: Our study highlights LBW risk among non-White mothers with specific criteria, emphasizing the need for continued exploration of intersectional targets for change that are exacerbating LBW disparities among marginalized populations which may be artificially attributed to biologic determinants and individual-level risk factors. In-depth analysis of repressive structures at the root of inequalities demand continued research on macro levels of influence. Customized healthcare reform holds the greatest potential to disrupt the patterns contributing to poor health outcomes among LBW children, and will ultimately maximize the reach and effectiveness of health promotion strategies and clinical practices aimed to improve universal maternal and infant health.

The influence of heart failure high-fidelity simulation education based on NLN Jeffries simulation framework in the prelicensure nursing program: A quasi-experimental study.

Objectives: To examine the influence of heart failure high-fidelity simulation education based on the National League for Nursing (NLN) Jeffries Simulation Framework in prelicensure nursing education. Methods: A heart failure high-fidelity simulation (HFHFS) education pilot project was carried out at Carrington College Sacramento. Twenty-three students participated in the study. This study used a quasi-experimental design. Students' Self-Efficacy, Satisfaction, and Knowledge in Heart Failure Clinical Knowledge were measured pre- and post-HFHFS education. Results: The results of the high-fidelity simulation education for heart failure showed that students achieved a mean score of 45.39 (SD = 7.88) in self-efficacy, 18.70 (SD = 3.38) in satisfaction, and 64.09 (SD = 10.86) in knowledge after the intervention. The paired-sample t-test significantly improved between the pre- and post-intervention scores (P < 0.001). The students highly rated self-efficacy, student satisfaction, and knowledge because of the positive impact on the teaching effectiveness of simulation design (i.e., objectives, problem-solving, student support, fidelity, debriefing) activity that included the application of quality safety education for nurses (QSEN) three competencies safety, patient-centered care, and teamwork and collaboration during nursing care for patients with acute heart failure. The teaching effectiveness of the heart failure high-fidelity simulation education is closely correlated with student satisfaction, self-efficacy, and improvement of participant knowledge in clinical nursing skills performance and critical thinking. Conclusion: A heart failure high-fidelity simulation education established upon the National League for Nursing (NLN) Jeffries framework enhanced student knowledge, satisfaction, self-efficacy, application of safety, patient-centered care, and teamwork and collaboration. Nurse educators should consider simulation planning to include the five simulation design characteristics, i.e., objectives, problem-solving, student support, fidelity, and debriefing, while integrating safety, patient-centered care, and teamwork and collaboration to bring about education effectiveness.

The associations among nurse work engagement, job satisfaction, quality of care, and intent to leave: A national survey in the United States.

Objectives: Employee work engagement, job satisfaction, quality of care, and intent to leave are critical indicators for healthcare organizational performance. This study aimed to analyze the current state of nurses' work engagement and its factors to examine the associations among nurses' work engagement, job satisfaction, quality of care, and intent to leave in the United States (US). Methods: This is a quantitative descriptive cross-section design. Data were collected online from the US registered nurses from March to September 2022. Measures comprised the Utrecht Work Engagement Scale, the demographics, and questions regarding job satisfaction, perceived quality of care, and intent to leave. Results: Nine hundred nurses participated in the online survey. Among the participants, 79.2% reported holding a specialty certification, 59.4% scored high/very high on job satisfaction, 82.2% expressed high/very high on the perceived quality of nursing care, and 28.4% conveyed likely/very likely to leave in the following year. Nurses' work engagement was positively associated with nurses' job satisfaction and their perceived quality of care but negatively associated with intent to leave. More certified nurses reported high or very high job satisfaction than non-certified nurses. As for demographics, the linear regression analysis showed that nurses who were older, identified as White, and held doctorate degrees reported higher levels of work engagement in comparison to their counterparts. Conclusions: This study shows that nurses' work engagement is associated with their job satisfaction, perceived quality of care, and intent to leave. Nurses' work engagement in this study is lower than in other studies, especially before the COVID-19 pandemic, which may indicate a possible association with the COVID-19 impact. Because nurses' work engagement is significantly associated with job satisfaction, nurse leaders need to find ways to promote nurses' job satisfaction and retention.

Organizational culture and roles in promoting nurse specialty certifications: A qualitative study in the United States.

Objectives: Nursing specialty certification validates nurses' mastery of specialty knowledge in disease management, education, or leadership above entry-level education and licensing. Research suggests direct relationships between nursing certifications and patient care quality. However, nurses' specialty certification rates are still low. This study aims to better understand nurses' perceptions of the facilitators and barriers in promoting nurses' desires and ability to obtain specialty certifications, which exclude advanced nursing practice roles, such as nurse practitioner or nurse midwife. Methods: This qualitative descriptive study took place virtually across the United States from May 2022 to September 2022. The study sample was a nested sample of a large national survey study. Among the nurses agreeing to be interviewed, a purposive sampling method was used to achieve maximum variation in diversity, such as years as a nurse, race, ethnicity, and certification status. Information saturation was used to gauge the sample size. Data were collected via in-depth virtual face-to-face interviews. The coding process was based on Colaizzi's method of data analysis. Results: Twenty nurses participated in the study. Five major themes emerged related to organizational culture and strategies to foster nurse specialty certifications. The five organizational strategies included 1) sharing resources, 2) a culture of ownership and a sense of belonging, 3) mentorship and role modeling, 4) recognizing nurses' efforts and accomplishments, and 5) cultivating a sense of meaning, purpose, and support. Conclusions: The findings indicate that organizational culture and leadership significantly promote continuing learning environments. Organizations need to develop an organizational culture that promotes nurses' specialty certifications. This study identified significant areas that are important to support nurses seeking certifications. Additional research is needed to evaluate which interventions significantly impact initial and continued certification levels, especially in the post-COVID-19 era.

Setting Patient-Centered Priorities for Cardiovascular Disease in Central Appalachia: Engaging Stakeholder Experts to Develop a Research Agenda.

The disproportionate burden of cardiovascular diseases (CVD) and associated risk factors continues to exist in the Central Appalachian Region (CAR) of the United States. Previous studies to gather data about patient-centered care for CVD in the region were conducted through focus group discussions. There have not been any studies that used a collaborative framework where patients, providers, and community stakeholders were engaged as panelists. The objective of this study was to identify patient-centered research priorities for CVD in the CAR. We used a modified Delphi approach to administer questionnaires to forty-two stakeholder experts in six states representing the CAR between the fall of 2018 and the summer of 2019. Their responses were analyzed for rankings and derived priorities by research gaps. Six of the fifteen research priorities identified were patient-centered. These patient-centered priorities included shorter wait times for appointments; educating patients at their level; empowering patients to take responsibility for their health; access to quality providers; heart disease specialists for rural areas; and lifestyle changes. The participants' commitments to identify patient-centered research priorities indicate the potential to engage in community-based collaboration to address the burden of CVD in the CAR.

Nurses' second victim experience, job insecurity, and turnover intention: A latent profile analysis.

Nurses are greatly affected by patient safety incidents, but little is known about the classifications of nurses' second victim experiences and their effects on job insecurity and turnover intention. This study aimed to identify the profiles of nurses' second victim experiences, including perceived support and distress, and explore the effects of the different experiences on nurses' job insecurity and turnover intention. A convenience sample of 2000 nurses, who were directly involved in patient safety incidents within a year at 25 hospitals in 13 provinces in China, was invited to participate. The online surveys included the Second Victim Experience and Support Tool-Chinese version, job insecurity scale, and turnover intention scale. Data were analyzed using regression and latent profile analysis to identify second-victim nurses' different experience predictors and examine the relationships among the factors. A total of 1298 valid questionnaires were obtained. Three profiles of second victim experiences were identified. Univariate analysis demonstrated that nurses' experience, education level, hospital type, specialty, working hours, credentials, clinical ladder, type of employment, income, training on adverse events, and the type of adverse event were statistically significant (p < 0.05) variables differentiating the three profiles. After controlling these significant variables, the multiple regression analysis showed that the higher the support and the lower the distress level of the second victim, the lower the job insecurity and turnover intention. This study highlights the significance of nurse' leader and organizational support. Nursing leaders should recognize nurses' second-victim experiences, provide the support nurses need, and help them reduce job insecurity and turnover intention.

The State of the Science of Nurses' Implicit Bias: A Call to Go Beyond the Face of the Other and Revisit the Ethics of Belonging and Power.

This article summarizes the current state of nurses' implicit bias and discusses the phenomenon from Levinas' face of the Other and ethics of belonging, Watson's human caring and unitary caring science, and Chinn's peace and power theory. Nurses' implicit bias is a global issue; the primary sources of nurses' implicit bias include race/ethnicity, sexuality, health conditions, age, mental health status, and substance use disorders. The current research stays at the descriptive level and addresses implicit bias at the individual level. This article invites nurses to go beyond "the face of the Other" and revisit the ethics of belonging and power.

Patient Experience Coordinator: An Innovative Role to Improve Patients' Hospital Experience.

OBJECTIVE: The aim of this study was to test the impact of an innovative nonclinical support role to improve patient experiences while supporting nurse work on inpatient units. BACKGROUND: On the basis of the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey, patients' experience declined nationally during the COVID-19 pandemic. A nonclinical support role, titled an Experience Coordinator, was created as a test of change to collaborate with care teams and respond to patients' and families' nonclinical needs. METHODS: This is a quality improvement (QI) project for a supportive role development and implementation. The health system's HCAHPS data were compared before and after the role was tested on 3 inpatient units. RESULTS: The HCAHPS data indicated that 5 of the 10 domains' top box ratings increased during the QI project month compared with the previous month. CONCLUSION: The study findings may support the implementation of new innovative nonclinical positions to alleviate nurses' workload and promote patients' hospital experience.

Construction of a nurses' interpersonal communication knowledge system: A Delphi study.

BACKGROUND: Effective communication is essential for nursing students to provide safe patient care. Many communication consensuses focus on physician-associated communication rather than nurses' interpersonal communication. However, studies on developing a systematic and comprehensive communication knowledge system for nursing students are scarce. OBJECTIVES: To explore the teaching content and teaching framework of nurses' interpersonal communication, construct a systematic and scientific knowledge system for interpersonal communication among nursing students and provide a theoretical basis for the training of nurses on interpersonal communication. METHODS: Based on the literature review and comparative research, this study explored the theoretical basis and basic principles of constructing an interpersonal communication knowledge system for nurses. Moreover, a correspondence questionnaire on nurses' interpersonal communication knowledge systems was initially constructed to clarify the related teaching content and structure. Finally, the Delphi method was used to establish the index of the nurses' interpersonal communication knowledge system according to the principle of expert selection and inclusion criteria. RESULTS: The Delphi method included 26 experts from nursing education, clinical nursing, nursing management and other fields for consultation. The effective response rate of the letter inquiry was 96.3 % in the first round and 100 % in the second round. The judgment basis, familiarity and authority coefficient of expert consultation were 0.907, 0.862 and 0.884, respectively. In the two rounds of inquiry, the coordination coefficients of the total questionnaire were 0.228 and 0.302, which was statistically significant (P < 0.001). Thereafter, a wheeled model of nurses' interpersonal communication knowledge system with 3 primary indicators, 13 secondary indicators and 58 tertiary indicators was constructed, which included professional ethics and attitude, communication knowledge and communication skills. CONCLUSION: Literature and comparative research methods along with Delphi expert consultation were used to construct a scientific and systematic knowledge system of nurses' interpersonal communication. The research methods were feasible, and the results were scientific and reliable, thereby providing a basis for the education of nurses' interpersonal communication among nurses and the compilation of related teaching materials in China and globally. Furthermore, special attention should be paid to the comprehensive cultivation of nursing students' professional ethics and attitude, communication knowledge and communication skills.

Nursing Staff's Role in Detecting Urinary Tract Infections in Nursing Homes: An Integrative Review.

Despite evidence-based protocols, inappropriate antibiotic use still presents a systemic global threat to health care in nursing homes (NHs). Nursing staff are responsible for recognizing signs and symptoms that may indicate urinary tract infections (UTIs). The current integrative review was designed to examine the state of the literature related to the role of nursing staff in UTI identification and care in NHs. This review, which includes 19 articles published between 2011 and 2020, identified that, although prescribers are the experts in UTI management, nursing staff in NHs were the individuals who recognized changes and communicated residents' needs to prescribers. Further research is required to understand nursing staff's decision making and unique perspectives and determine if evidence-based protocols align with current practice in the NH setting. [Journal of Gerontological Nursing, 48(5), 43-50.].

The prevalence of nurse burnout and its association with telomere length pre and during the COVID-19 pandemic.

BACKGROUND: Burnout is a work-related stress syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. Nurse burnout is related to nurses' deteriorating mental health and poorer patient care quality and thus, is a significant concern in healthcare. The Coronavirus Disease 2019 (COVID-19) pandemic has swept the world and distressed the healthcare systems. Because of the body's stress mechanism, it is vital to examine the current prevalence of nurse burnout and understand it at a biological level, using an epigenetic biomarker, telomere length. PURPOSE: To determine the prevalence of burnout among nurses in the Peri-Operative and Labor & Delivery settings pre and during the COVID-19 pandemic and to examine the effects of burnout on absolute telomere length. METHODS: This is a cross-sectional study assessing the prevalence of nurses' burnout and the relationships between nurses' burnout and telomere length. Due to the COVID-19 pandemic, we had to stop the study during the mid of data collection. Even though the study was not designed to capture changes before and during the pandemic, we analyzed two groups' data before and during the pandemic. The study took place in a US hospital. Nurses in the hospital's Operating Room, Post-Anesthesia Care Unit, and Labor & Delivery Unit participated in the study. Maslach Burnout Inventory survey and nurses' demographics were administered online. Telomere length was measured via finger-prick blood. RESULTS: 146 nurses participated in the study, with 120 participants' blood samples collected. The high-level burnout rate was 70.5%. Correlation analysis did not reveal a direct correlation between nurse burnout and telomere length. However, in a multiple regression analysis, the final model contained the burnout subscale of emotional exhaustion, years as an RN, and work unit's nursing care quality. There was a low degree of departure from normality of the mean absolute telomere length in the pre-pandemic group and a substantial degree of departure in the during-pandemic group. CONCLUSIONS: Nurse burnout is a prevalent phenomenon in healthcare, and this study indicates that nurses currently experience high levels of burnout. Nurses' cellular biomarker, telomere length, is shorter in the group of nurses during the COVID-19 pandemic than before. Appropriate measures should be implemented to decrease nurses' burnout symptoms and improve nurses' psychological and physical health. Nurses, especially those younger than 60, report higher burnout symptoms, particularly emotional exhaustion. This study indicates the need for intervention to promote nurses' health during the pandemic and beyond. If not appropriately managed, nurse burnout may continue to be a significant issue facing the healthcare system.

A systematic meta-review of systematic reviews about interprofessional collaboration: facilitators, barriers, and outcomes.

Interprofessional collaboration (IPC) is a practice model to promote healthcare quality. Since the World Health Organization highlighted the importance of IPC in 2010, a large volume of IPC-related research has been published. Multiple systematic reviews have been conducted to synthesize the literature from varying perspectives. Although systematic reviews are a compelling approach to synthesizing primary research, a systematic meta-review was needed to summarize the systematic reviews to offer information for healthcare professionals, researchers, and policymakers. This systematic meta-review was designed to synthesize the systematic reviews of IPC, emphasizing the IPC-related facilitators, barriers, and outcomes between 2010 and 2020. An electronic search for systematic reviews was performed in December 2020. The databases searched included PubMed, CINAHL, PsycINFO, and Cochrane Database of Systematic Reviews. Thirty-six systematic reviews met the inclusion criteria. Factors facilitating or impeding IPC were classified into three levels: organization, team, and individual. Major outcomes related to patients, healthcare professionals, and organizations. The facilitators, barriers, and outcomes are mutually interrelated. Highly effective collaboration is a process from relationship building to working together and collaborating. Improving IPC requires organizational, teams, and individuals' combined efforts. When highly effective collaborations occur, all stakeholders can benefit - organizations, professionals, and patients.

The development of an evidence-informed Convergent Care Theory: Working together to achieve optimal health outcomes.

BACKGROUND: Healthcare is a complex and divergent system with uncertainty, unpredictability, and multi-layered stakeholders. The relationships among the stakeholders are multifaceted and dynamic, requiring continual interpersonal connections, networks, and co-evolution. It is pivotal to have an evidence-informed theory to explain the phenomenon, uniting the multifaceted stakeholders' efforts. PURPOSE: To describe the development of an evidence-informed theory, the Convergent Care Theory, assembling healthcare stakeholders to work together and achieve optimal health outcomes. METHODS: The Convergent Care Theory was developed using a theory synthesis approach based on empirical research and literature reviews published by the theory-proposing author. The empirical evidence was categorized into: patients and families, healthcare providers, healthcare organizations, and patients' and healthcare providers' self-care. RESULTS: The Convergent Care Theory includes four concepts: all-inclusive organizational care , healthcare professional collaborative care, person-centered precision care, and patients ' and healthcare providers' self-care. Achieving convergent care is a process requiring all stakeholders to work together. Six major facilitators emerged from the research evidence: competence, compassion, accountability, trusting, sharing, and engaging. CONCLUSION: This article introduced the development process of the evidence-informed Convergent Care Theory. Healthcare systems are complex, with multiple stakeholders' needs to meet. The Convergent Care Theory strives to unite healthcare stakeholders, bond resources, and join forces to achieve optimal healthcare outcomes. The underpinning of the theory is a caring culture, which is an underlying code for organizational and team behaviors and the foundation of optimal health outcomes.

Applying a Psychological Nursing Care Quality Evaluation Index in hospitalized patients: A pilot study.

Psychological problems have become a significant public health problem. Appropriate mental health care is crucial in promoting patient care quality. This study aimed to test the feasibility of a Psychological Nursing Quality Evaluation Index in hospitalized patients. This is a pilot study with patients hospitalized with myocardial infarction from July to September 2020 in China. The researchers used an observational approach to examine nurses' psychological health care performance based on the Psychological Nursing Quality Evaluation Index. The results indicated high compliance rates of nurses' psychological care performance, which provides references for evaluating and monitoring inpatient psychological nursing care.

A Qualitative Exploration of the Psychological Experience of Patients Hospitalized With COVID-19.

This qualitative study describes the psychological experience of patients hospitalized with COVID-19. These patients went through 3 psychological stages: extremely uncertainties during the initial diagnostic stage, complicated feelings of negativity during the treatment stage, and positive growth in the recovery stage. It is important for nurses to provide holistic care.

Impacts of Nursing Student Burnout on Psychological Well-Being and Academic Achievement.

BACKGROUND: Burnout, depression, and suicide among health care professionals and learners have reached a rampant level. This systematic review aimed to synthesize literature findings of nursing student burnout and its impact on psychological well-being and academic performance. METHOD: This systematic review followed PRISMA guidelines and included data-based studies on nursing student burnout published in peer-reviewed journals between January 2015 and January 2020. RESULTS: This review included 17 articles. Four major themes were identified: 1) a negative relationship between burnout and student self-concept, 2) a negative association between burnout and student engagement, 3) risk factors contributing to student burnout, and 4) interventions to mitigate student burnout. Promoting positive self-concept, engagement, and resilience may alleviate student academic burnout. CONCLUSION: Student burnout has negative influences on health and academics, and interventions to mitigate burnout should be considered early in nursing programs. Nurse educators can create an engaging learning environment to build resilience and reduce burnout. [J Nurs Educ. 2021;60(7):369-376.].

Effects of a theory of planned behavior-based intervention on breastfeeding behaviors after cesarean section: A randomized controlled trial.

OBJECTIVES: To examine the efficacy of an intervention based on the theory of planned behavior (TPB) in improving breastfeeding behavior among women with cesarean sections (C-sections). METHODS: This research was a randomized controlled trial. Women with planned elective C-sections were recruited to participate in a randomized controlled trial between June and September 2020. One hundred thirty-two women were divided randomly into the intervention (n = 66) and control group (n = 66) by systematic random sampling. In the intervention group, an intervention project was implemented after the C-section to establish positive breastfeeding attitudes, cultivate supportive subjective norms, enhance perceived behavioral control, and strengthen breastfeeding intention to change behaviors. Those in the control group received routine pre-and post-delivery care. Exclusive breastfeeding rate and breast problem were collected at 5 days, 2 weeks, and 1 month after C-section. The modified Breastfeeding Attrition Prediction Tool (BAPT) on the first day in the hospital, two weeks, and one month after C-section and Numerical Rating Scale (NRS) 24 h postoperatively were used to compare the intervention effect between the two groups. RESULTS: After the intervention, the intervention group had significantly higher exclusive breastfeeding rates than the control group at five days (86.4% vs. 60.6%), two weeks (77.3% vs. 57.6%), and one month (74.2% vs. 50.0%) after the C-section. Besides, the intervention group was less likely to have sore nipples at five days (6.1% vs. 18.2% in the control group, P < 0.05) and two weeks (9.1% vs. 12.1% in the control group, P < 0.05). After two weeks of intervention, attitude scores (90.64 ± 8.31 vs. 87.20 ± 8.15, P < 0.05), subjective norm scores (88.07 ± 24.65 vs. 79.42 ± 19.47, P < 0.05）and behavior control scores in the intervention group were significantly higher than those in the control group. After one month of intervention, attitude scores (90.34 ± 10.35 vs. 84.22 ± 10.51, P < 0.05) and behavior control scores (43.13 ± 5.02 vs. 39.15 ± 4.69, P < 0.05）in the intervention group were significantly higher than those in the control group, which resulted in the higher breastfeeding intention in the intervention group. CONCLUSION: This study indicated that the TPB-based interventions effectively improved women's breastfeeding behaviors after C-sections.