The influence of authentic leadership on nurses' turnover intentions and satisfaction with quality of care in Saudi Arabia: A structural equation modelling study.

AIM(S): The study aimed to test a model that examined the relationships between authentic leadership, psychological safety, work engagement and team effectiveness and subsequent effects of team effectiveness on job turnover intentions and nurse satisfaction with quality of care. BACKGROUND: Nurse leaders who exhibit authentic leadership have been shown to contribute to the development of healthy work environments. In workplaces with demonstrated authentic leadership, nurses are more engaged and have lower job turnover intentions. METHOD(S): A non-experimental, cross-sectional design was used to test the hypothesized model via structural equation modelling. A total of 456 nurses were included. RESULTS: Structural equation modelling analysis indicated a good fit for the hypothesized model. Authentic leadership had a positive, significant and direct relationship with team effectiveness, nurses' work engagement and psychological safety. Team effectiveness was found to be negatively related to job turnover intentions but positively related to nurse satisfaction with quality of care. CONCLUSION(S): Results of this study may help nursing leaders have a better understanding of the essential role of leadership style in increasing healthy work environments. IMPLICATIONS FOR NURSING MANAGEMENT: Applying authentic leadership style in nursing practice could help to reduce the shortage of nurses stemming from the high turnover intentions of nurses.

Relationships among sex, empowerment, workplace bullying and job turnover intention of new graduate nurses.

AIMS AND OBJECTIVES: The purpose of this study was twofold: examine the relationships among new graduate nurses' (NGNs) structural empowerment, experience of workplace bullying, and their job turnover intention and assess the relationships between sex, workplace bullying, and job turnover intention. BACKGROUND: Nursing research has highlighted the issue of workplace bullying and its negative impacts. Despite increased awareness, male nurses and their responses to bullying have not been a significant focus of study. DESIGN: A secondary analysis of data collected from a random sample of 1008 Canadian NGNs from the following: Starting Out: A time-lagged Study of New Graduate Nurses' Transition to Practice. METHODS: All data were analysed using SPSS, and the study model was tested using the SPSS PROCESS macro, specifically Model 4 (for simple mediation). This paper is compliant with the STROBE reporting guideline for cross-sectional studies. RESULTS: Structural empowerment significantly predicted workplace bullying and job turnover intention. Workplace bullying significantly predicted job turnover intention. Structural empowerment mediated job turnover intention through workplace bullying. Male new graduate nurses reported significantly higher workplace bullying than female NGNs yet lower job turnover intention. CONCLUSIONS: The findings demonstrate the positive effects of structural empowerment on both decreasing workplace bullying and job turnover intention. Furthermore, findings showed the influence of sex on workplace bullying and job turnover intention. The findings contribute to literature on male NGNs and suggest that they experience significantly higher rates of workplace bullying than their female counterparts. The findings suggest differences exist in the workplace experience for male and female NGNs that future research may help reveal. RELEVANCE TO CLINICAL PRACTICE: The findings suggest structural empowerment may be used to reduce bullying prevalence and reduce job turnover intention consequently. The findings also suggest that some measures are needed to address the higher frequency of bullying experienced by male NGNs.

De novo mutations in Caudal Type Homeo Box transcription Factor 2 (CDX2) in patients with persistent cloaca.

The cloaca is an embryonic cavity that is divided into the urogenital sinus and rectum upon differentiation of the cloacal epithelium triggered by tissue-specific transcription factors including CDX2. Defective differentiation leads to persistent cloaca in humans (PC), a phenotype recapitulated in Cdx2 mutant mice. PC is linked to hypo/hyper-vitaminosis A. Although no gene has ever been identified, there is a strong evidence for a genetic contribution to PC. We applied whole-exome sequencing and copy-number-variants analyses to 21 PC patients and their unaffected parents. The damaging p.Cys132* and p.Arg237His de novo CDX2 variants were identified in two patients. These variants altered the expression of CYP26A1, a direct CDX2 target encoding the major retinoic acid (RA)-degrading enzyme. Other RA genes, including the RA-receptor alpha, were also mutated. Genes governing the development of cloaca-derived structures were recurrently mutated and over-represented in the basement-membrane components set (q-value < 1.65 × 10-6). Joint analysis of the patients' profile highlighted the extracellular matrix-receptor interaction pathway (MsigDBID: M7098, FDR: q-value < 7.16 × 10-9). This is the first evidence that PC is genetic, with genes involved in the RA metabolism at the lead. Given the CDX2 de novo variants and the role of RA, our observations could potentiate preventive measures. For the first time, a gene recapitulating PC in mouse models is found mutated in humans.

Factors affecting job satisfaction among acute care nurses working in rural and urban settings.

AIMS: To: (a) identify the differences and similarities in the extrinsic and intrinsic factors that influence job satisfaction among nurses in urban and rural Ontario; and (b) determine the impact of job satisfaction on nurses' turnover intention among nurses working in rural and urban settings in Ontario. DESIGN: Cross-sectional correlational design was used for this study. METHODS: Data were collected between May 2019-July 2019 in southern Ontario. Participants (N=349) completed the Acute Care Nurses' Job Satisfaction Scale and The Anticipated Turnover Scale. A stratified sampling technique was used for recruiting the sample population and participants were given the option to respond either online or by mailed survey. RESULTS: There was no significant difference between rural and urban nurses in either overall job satisfaction level or turnover intention. Peer support/work conditions, quality of supervision, and achievement/job interest/responsibility were significant predictors of job satisfaction. There was a significant difference between rural and urban nurses in terms of satisfaction from benefits and job security and the nurses' job satisfaction levels correlated negatively with their turnover intention. CONCLUSION: Several extrinsic and intrinsic factors are associated with nurses' job satisfaction in rural and urban settings. Developing strategies that improve satisfaction by modulating these specific factors may improve nurses' job satisfaction and reduce turnover. IMPACT: This study discussed how working in a rural or urban hospital may affect nurses' job satisfaction and turnover intention. The findings can help in improving nurses' job satisfaction and inform workforce planning to increase nurses' retention.

Factors affecting nurses' job satisfaction in rural and urban acute care settings: A PRISMA systematic review.

AIMS: This review aimed to systematically assess the findings of primary studies to identify the factors associated with nurse job satisfaction in rural and urban contexts while analysing the findings according to Herzberg's theory. BACKGROUND: While there is evidence linking several factors to nurses' job satisfaction, gaps still exist in understanding the differences between factors affecting job satisfaction for nurses working in rural and urban settings. DESIGN: Systematic review with narrative summary. DATA SOURCES: Six databases were used to identify original studies that discuss the factors associated with the nurse's job satisfaction between 1998-2018. REVIEW METHODS: Two authors independently reviewed each study using the Joanna Briggs Institute's critical appraisal checklists. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to report and examine the study biases systematically. RESULTS: A total of 38 studies were selected for this review. Physical working environment and authority and freedom were the most frequently reported factors associated with nurses' job satisfaction. Several extrinsic, intrinsic, personal, and community factors were also found to be associated with nurses' job satisfaction. Urban studies tended to focus on extrinsic factors, whereas there was more balance between the two sets of factors in rural studies. CONCLUSION: Both intrinsic and extrinsic factors play an essential role in nurses' job satisfaction. Future research should use more robust research methods and pay more attention to contrasting rural and urban contexts. Herzberg's theory can provide conceptual clarity when investigating the factors associated with nurses' job satisfaction. IMPACT: This review discussed the factors associated with nurses' job satisfaction in rural and urban settings. The findings linked several extrinsic and intrinsic factors to nurses' job satisfaction. Nursing management should search for the perfect blend of intrinsic and extrinsic factors based on nurses' needs and organizational commitment to improve nurses' job satisfaction.

Evaluation of Real-World Gaseous Emissions Performance of Selective Catalytic Reduction and Diesel Particulate Filter Bus Retrofits.

This study reports on the results of gaseous pollutants emission measurements of double-decker buses in an urban road network, using portable emission measurement systems (PEMS). Measured vehicles were tested by following in-service buses on regular routes. Six Euro II and Euro III buses were retrofitted with diesel particulate filters (DPF) and selective catalytic reduction (SCR) or a combined SCR+DPF (SCRT) device. Substantial and statistically significant technology impacts were observed for several pollutants. Optimized SCR and SCRT retrofit technology reduced real-world NO x emissions by approximately 70%, on average. Retrofit DPF slightly reduced NO x emissions but increased direct NO2 emissions by more than a factor of 8, on average. SCRT led to about 70% lower NO2 levels than DPF alone, but for some vehicles higher NO2 levels were observed as compared with the "no retrofit" situation, warranting further investigation. None of the SCR systems were found to lead to a substantial increase in NH3 emissions after operation optimization. High NH3 and N2O emissions were occasionally observed while experience with the system calibration was being accumulated. Observed average N2O emission levels for "DPF+SCR" technology were relatively high at 182 mg/kg fuel, corresponding to 1.5% of total greenhouse gas emissions. The study shows that SCR retrofit programs can be effective for NO x reduction of transit buses but that proper calibration and regular emission monitoring are required.

Nurses' use of conscientious objection and the implications for conscience.

AIMS: To explore the meaning of conscience for nurses in the context of conscientious objection (CO) in clinical practice. DESIGN: Interpretive phenomenology was used to guide this study. DATA SOURCES: Data were collected from 2016 - 2017 through one-on-one interviews from eight nurses in Ontario. Iterative analysis was conducted consistent with interpretive phenomenology and resulted in thematic findings. REVIEW METHODS: Iterative, phased analysis using line-by-line and sentence highlighting identified key words and phrases. Cumulative summaries of narratives thematic analysis revealed how nurses made meaning of conscience in the context of making a CO. RESULTS: Conscience issues and CO are current, critical issues for nurses. For Canadian nurses this need has been recently heightened by the national legalization of euthanasia, known as Medical Assistance in Dying in Canada. Ethics education, awareness, and respect for nurses' conscience are needed in Canada and across the profession to support nurses to address their issues of conscience in professional practice. CONCLUSION: Ethical meaning emerges for nurses in their lived experiences of encountering serious ethical issues that they need to professionally address, by way of conscience-based COs. IMPACT: This is the first study to explore what conscience means to nurses, as shared by nurses themselves and in the context of CO. Nurse participants expressed that support from leadership, regulatory bodies, and policy for nurses' conscience rights are indicated to address nurses' conscience issues in practice settings.

The Reliability and Validity of the Arabic Version of the Composite Abuse Scale.

Research that examines intimate partner violence (IPV) in the Arab world has been hampered by a lack of comprehensive valid and culturally appropriate measures. The purpose of this study was to test the reliability and validity of the Arabic version of the Composite Abuse Scale (CAS) in a sample of 299 Saudi women recruited from primary healthcare centers. Confirmatory factor analysis (CFA) did not support the original four-factor structure of CAS. Exploratory factor analysis revealed that the item pool reliably distinguished four different types of abuse (physical abuse, verbal abuse, sexual abuse, and control). Two items were dropped from the scale leaving a 27-item scale. The final four-factor model with 27 items was supported through further CFA, including analyses supporting the fit of the four-factor model on a higher level, second-order concept (IPV). Total and subscales CAS scores demonstrate excellent to good reliability and evidence of concurrent validity based on correlations with established measures of depression (Center for Epidemiologic Studies-Depression [CESD]) and posttraumatic stress disorder (PTSD) (PTSD Checklist-Civilian Version [PCL-C]).

Conscience, conscientious objection, and nursing: A concept analysis.

BACKGROUND:: Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses' ethical care provision. Conscientious objection is one such strategy for addressing nurses' personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education. RESEARCH AIM:: To analyze the concepts of conscience and conscientious objection in the context of nurses. DESIGN:: Concept analysis using the method by Walker and Avant. RESEARCH CONTEXT:: Data were retrieved from Philosopher's Index, PubMed, and CINAHL with no date restrictions. ETHICAL CONSIDERATION:: This analysis was carried out per established, scientific guidelines. FINDINGS:: Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear. DISCUSSION AND CONCLUSION:: This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts.

Conscientious objection and nurses: Results of an interpretive phenomenological study.

BACKGROUND: While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession. RESEARCH QUESTION: The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario? RESEARCH DESIGN: Interpretive phenomenological methodology was used to gain an in-depth understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process. PARTICIPANTS AND RESEARCH CONTEXT: Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months. ETHICAL CONSIDERATIONS: This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent. FINDINGS: Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support. DISCUSSION: This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed. CONCLUSION: Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses' ethical concerns giving rise to objections. Conscience emerged as an informant to nurses' conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice.

Long-term Results and Quality of Life Assessment in Biliary Atresia Patients: A 35-Year Experience in a Tertiary Hospital.

OBJECTIVES: To review long-term transplant-free survival and quality of life (QOL) of patients with biliary atresia (BA). METHODS: A retrospective study reviewing all patients with Kasai operation between January 1, 1980 and December 31, 2015 was performed to evaluate the transplant-free survival. Subgroup analysis of patients older than 20 years was carried out to assess the QOL using the Short Form-36 Health Survey and incidences of disease-related complications. Comparison between patients with native and transplanted liver was performed using two-tailed independent samples t-test (P value < 0.05, significant). RESULTS: The 20-year Kaplan-Meier transplant-free survival of the 141 patients in our study was 51%. The subgroup analysis of long-term survivors revealed a trend of increased prevalence of complications like esophageal varices, portal hypertension, and recurrent admissions in the patient groups with raised serum bilirubin (SB).Thirty-one patients were successfully contacted for QOL assessment, 26 (16 with native liver and 10 with transplanted liver) responded (76.5%). BA patients who were documented to have active complications have a significantly lower vitality score (50.7 vs 57.5, P = 0.015). There was no statistically significant difference in the scores between the transplanted group and the disease-free control group. However, the native liver group achieved a lower score in both the general health section (42.9 vs 49.6, P = 0.029) and the overall physical component (49.6 vs 54.4, P = 0.037). CONCLUSIONS: A significant proportion of our patients survive with their native liver for more than 20 years. These long-term survivors may suffer from complications that impair their QOL. They require continuous life-long care.

Factors mediating the impacts of child abuse and intimate partner violence on chronic pain: a cross-sectional study.

BACKGROUND: Most research on the health impacts of intimate partner violence (IPV) and child abuse has been conducted in Western countries and may not be generalizable to women living in different contexts, such as Saudi Arabia. Chronic pain, a disabling health issue associated with experiences of both child abuse and IPV among women, negatively impacts women's well-being, quality of life, and level of functioning. Yet, the psychosocial mechanisms that explain how abuse relates to chronic pain are poorly understood. We developed and tested a theoretical model that explains how both IPV and child abuse are related to chronic pain. METHODS: We recruited a convenience sample of 299 Saudi women, who had experienced IPV in the past 12 months, from nine primary health care centers in Saudi Arabia between June and August 2015. Women completed a structured interview comprised of self-report measures of IPV, child abuse, PTSD, depressive symptoms, chronic pain, and social support. Using Structural equation modeling (SEM), we analyzed the proposed model twice with different mental health indicators as mediators: PTSD symptoms (Model 1) and depressive symptoms (Model 2). RESULTS: Both models were found to fit the data, accounting for 31.6% (Model 1) and 32.4% (Model 2) of the variance in chronic pain severity. In both models, mental health problems (PTSD and depressive symptoms) fully mediated the relationship between severity of IPV and child abuse and chronic pain severity. Perceived family support partially mediated the relationship between abuse severity and depressive symptoms. CONCLUSIONS: These results underscore the significance of considering lifetime abuse, women's mental health (depressive and PTSD symptoms) and their social resources in chronic pain management and treatment.

Beyond the nutrient strategies: Common ground to accelerate agricultural water quality improvement in the upper Midwest.

Nutrients in drainage waters from the Upper Mississippi River Basin states have been a well-documented contributor to the Gulf of Mexico hypoxic zone for decades, and in response, twelve states have developed strategies to address this issue, with Iowa, Minnesota, and Illinois performing rigorous science assessments which estimated nitrogen and phosphorus reduction effectiveness for numerous agricultural non-point source conservation practices. The practices identified in these strategies were compared to identify areas of consensus and discord on nutrient load reduction potentials. Additionally, each practice was assessed for (1) the suitability to stack or be layered with other practices (stackability), (2) the ability to track implementation within a state or regionally (trackability), and (3) the level of production system change required to implement the practice. Overall, there was general consensus among the state strategies in the nutrient load reduction effectiveness of most practices with the exception of cover crops (10%-31% nitrogen reduction) and bioreactors (13%-43% nitrogen reduction). The most effective water quality-improvement practices (i.e., land-use change practices) required relatively more production system changes to agronomic management and were the most trackable (scores: 5, 1-5 scale), although they were also less stackable with other practices (scores: 1 to 1.8; 1-5 scale) and were the least cost effective on a unit area basis (generally $15 to $964 per ha). The most cost effective practices tended to be highly stackable (e.g., nitrogen management: (-)$49 per ha and stackability of 4.7), which indicated that stacking a variety of practices may be the most cost effective use of conservation dollars. The practices that were most difficult to track had relatively lower nitrogen loss reduction effectiveness, but these practices were less costly to implement and required relatively less production system change to agronomic management, two factors of importance to many producers.

Effect of transformational leadership on job satisfaction and patient safety outcomes.

BACKGROUND: Improving patient safety within health care organizations requires effective leadership at all levels. PURPOSE: The objective of this study was to investigate the effects of nurse managers' transformational leadership behaviors on job satisfaction and patient safety outcomes. METHODS: A random sample of acute care nurses in Ontario (N = 378) completed the crosssectional survey. Hypothesized model was tested using structural equation modeling. FINDING: The model fit the data acceptably. Transformational leadership had a strong positive influence on workplace empowerment, which in turn increased nurses' job satisfaction and decreased the frequency of adverse patient outcomes. Subsequently, job satisfaction was related to lower adverse events. CONCLUSION: The findings provide support for managers' use of transformational leadership behaviors as a useful strategy in creating workplace conditions that promote better safety outcomes for patients and nurses.

Impact of Managers' Coaching Conversations on Staff Knowledge Use and Performance in Long-Term Care Settings.

BACKGROUND: Extended lifespans and complex resident care needs have amplified resource demands on nursing homes. Nurse managers play an important role in staff job satisfaction, research use, and resident outcomes. Coaching skills, developed through leadership skill-building, have been shown to be of value in nursing. AIMS: To test a theoretical model of nursing home staff perceptions of their work context, their managers' use of coaching conversations, and their use of instrumental, conceptual and persuasive research. METHODS: Using a two-group crossover design, 33 managers employed in seven Canadian nursing homes were invited to attend a 2-day coaching development workshop. Survey data were collected from managers and staff at three time points; we analyzed staff data (n = 333), collected after managers had completed the workshop. We used structural equation modeling to test our theoretical model of contextual characteristics as causal variables, managers' characteristics, and coaching behaviors as mediating variables and staff use of research, job satisfaction, and burnout as outcome variables. RESULTS: The theoretical model fit the data well (χ2 = 58, df = 43, p = .06) indicating no significant differences between data and model-implied matrices. Resonant leadership (a relational approach to influencing change) had the strongest significant relationship with manager support, which in turn influenced frequency of coaching conversations. Coaching conversations had a positive, non-significant relationship with staff persuasive use of research, which in turn significantly increased instrumental research use. Importantly, coaching conversations were significantly, negatively related to job satisfaction. LINKING EVIDENCE TO ACTION: Our findings add to growing research exploring the role of context and leadership in influencing job satisfaction and use of research by healthcare practitioners. One-on-one coaching conversations may be difficult for staff not used to participating in such conversations. Resonant leadership, as expected, has a significant impact on manager support and job satisfaction among nursing home staff.

Reliability and validity of the Arabic PTSD Checklist Civilian Version (PCL-C) in women survivors of intimate partner violence.

Although intimate partner violence (IPV) survivors are at high risk for developing posttraumatic stress disorder (PTSD), PTSD has been considered a disorder specific to Western culture. There is a lack of reliable and valid measures of PTSD symptomology available in the Arab world, and there is still no clear evidence about the underlying factor structure of PTSD symptomology in the context of IPV. Thus, in the present study we investigated the construct validity (factor structure), internal consistency, and concurrent validity of a translated version of the PTSD Checklist Civilian Version (PCL-C) in a sample of 299 Saudi women who had experienced IPV. Four competing models (DSM-IV, Emotional Numbing, Dysphoria, and Dysphoric Arousal) were specified and estimated using confirmatory factor analysis (CFA). The five-factor Dysphoric Arousal model provided superior fit with the data compared to the alternative models, supporting construct validity of the Arabic PCL-C. The factor loadings for the five-factor Dysphoric Arousal model ranged from .31 to .83. A relatively high correlation between the Arabic PCL-C and Arabic Center for Epidemiologic Studies-Depression (CES-D) Scale (r = .78, p < .05) provided evidence of concurrent validity. The total scale also demonstrated internal consistency reliability (α = .89). Overall, the study supports the Dysphoric Arousal model in representing PTSD symptoms among IPV survivors, the reliability and validity of the Arabic version of PCL-C, and the cross-cultural applicability of PTSD symptoms.

A review of long-term outcome and quality of life of patients after Kasai operation surviving with native livers.

Biliary atresia (BA) is a rare neonatal cholestatic disease which leads to progressive obliterative cholangiopathy, resulting in biliary obstruction and jaundice. The standard surgical treatment is hepatoportoenterostomy (Kasai operation). Although approximately 50% of the affected infants would require liver transplantation within the first 2 years of life, the other 50% of the patients can live for years with their native liver, despite the progression of cirrhosis and chronic liver disease. Many of these patients will be affected by long-term complications such as repeated cholangitis, portal hypertension, variceal bleeding, growth problems, biochemical abnormalities, and hepatic osteodystrophy. These morbidities impose a huge impact on the quality of life of the patients and their families. Herein, we performed a comprehensive review on the clinical status and quality of life of long-term survivors of biliary atresia with their native livers, to facilitate meticulous longitudinal follow-up of these patients, and alert caregivers the probable complications to be aware of.

Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice.

AIM: To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles. BACKGROUND: Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services. METHOD: A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces. RESULTS: New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads. CONCLUSIONS: The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility.

Does test-enhanced learning transfer for triple associates?

Test-enhanced learning and transfer for triple-associate word stimuli was assessed in three experiments. In each experiment, training and final-test trials involved the presentation of two words per triple associate (triplet), with the third word having to be retrieved. In agreement with the prior literature on different stimuli, training through testing with feedback yielded markedly better final-test performance than did restudy. However, in contrast to the positive transfer reported for paired associate stimuli, minimal or no positive transfer was observed, relative to a restudy control, from a trained cue combination (e.g., A, B, ?) to other cue combinations from the same triplet that required a different response (e.g., B, C, ?). That result also held when two unique cue combinations per triplet were tested during training, and for triplets with low and high average associative strengths. Supplementary analyses provided insight into the overall transfer effect: An incorrect response during training appears to yield positive transfer relative to restudy, whereas a correct response appears to yield no, or even negative, transfer. Cross-experiment analyses indicated that test-enhanced learning is not diminished when two or three cue combinations are presented during training. Thus, even though learning through testing is highly specific, testing on all possible stimulus-response combinations remains the most efficient strategy for the learning of triple associates.

The influence of empowerment, authentic leadership, and professional practice environments on nurses' perceived interprofessional collaboration.

AIM: The aim of this study was to examine the influence of structural empowerment, authentic leadership and professional nursing practice environments on experienced nurses' perceptions of interprofessional collaboration. BACKGROUND: Enhanced interprofessional collaboration (IPC) is seen as one means of transforming the health-care system and addressing concerns about shortages of health-care workers. Organizational supports and resources are suggested as key to promoting IPC. METHODS: A predictive non-experimental design was used to test the effects of structural empowerment, authentic leadership and professional nursing practice environments on perceived interprofessional collaboration. A random sample of experienced registered nurses (n = 220) in Ontario, Canada completed a mailed questionnaire. Hierarchical multiple regression analysis was used. RESULTS: Higher perceived structural empowerment, authentic leadership, and professional practice environments explained 45% of the variance in perceived IPC (Adj. R² = 0.452, F = 59.40, P < 0.001). CONCLUSIONS: Results suggest that structural empowerment, authentic leadership and a professional nursing practice environment may enhance IPC. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders who ensure access to resources such as knowledge of IPC, embody authenticity and build trust among nurses, and support the presence of a professional nursing practice environment can contribute to enhanced IPC.