Transforming outcome expectations into retention among hospital nurses: A cross-sectional study.

AIM: To examine the main effects and interaction effects of outcome expectations (e.g., anticipated satisfactory salary and benefits), nurse identity (a sense of membership in the nursing profession), and information-access efficiency of the electronic medical record system (how the system enables nurses to quickly retrieve the needed information) on nurses' retention. DESIGN: This study uses a cross-sectional survey and adopts proportionate random sampling to recruit a representative sample of nurses of a medical centre in Taiwan. METHODS: This study successfully obtained completed questionnaires from 430 nurses during December 2021 to January 2022. Data are analysed by using hierarchical regressions. RESULTS: Positive outcome expectations and identification as a member in the nursing profession are associated with retention. Information-access efficiency strengthens the link between outcome expectations and retention, while nurse identity weakens this link. CONCLUSION: Outcome expectations can help retain nurses, particularly those who perceive high levels of information-access efficiency and possess weak nurse identity. That is, outcome expectations have a complementary role with nurse identity in retaining nurses. IMPLICATIONS FOR THE PROFESSION: Nurse managers should devise means to build positive outcome expectations for nurses. In addition, either strengthening nurses' identification with the nursing profession or improving the information-access efficiency of the electronic medical system may also help retain nurses. IMPACT: This study examined how to transform outcome expectation to nurse retention, offering nurse managers to devise new means to retain nurses. REPORTING METHOD: STROBE statement was chosen as EQUATOR checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Within- and between-patients associations between self-efficacy, outcome expectation, and symptom change in cognitive behavioral therapy for generalized anxiety disorder.

OBJECTIVES: There is limited information on how a change in patients' expectations over time results in symptom change in psychotherapy. This study aimed to investigate the changes in patients' expectations and symptoms during treatment and across follow-up as well as to determine the within- and between-patient relationships between two types of patient expectations, that is, self-efficacy and outcome expectation, and symptom change. METHODS: Participants (80 participants × 6 repeated measures; 480 observations) with generalized anxiety disorder were treated using cognitive behavioral therapy and the within- and between-patient scores of self-efficacy and outcome expectation were evaluated in multilevel models as predictors of symptom change. RESULTS: Patients' self-efficacy and outcome expectation increased, whereas severity of their symptoms reduced during and after treatment. At the within-patient (WP) level, an increase in self-efficacy was associated with a decrease in worry and depressive symptoms, and an increase in outcome expectation was associated with a decrease in depressive symptoms. The between-patient (BP) effect, however, was contrary to the WP effect, that is, self-efficacy was positively correlated with worry and outcome expectation was positively correlated with depressive symptoms CONCLUSION: These results highlight the importance of disaggregating the WP variability from BP variability in psychotherapy process-outcome research as they exhibit different associations at the within- and between-patient levels. Clinical Trial Registration: ClinicalTrial.gov (NCT03079336).

Participant factors as correlates of patients' psychotherapy outcome expectation: A meta-analytic and box-count review.

OBJECTIVE: More positive pre- or early therapy patient outcome expectation (OE) has consistently correlated with better treatment outcomes. Thus, it is important to identify factors that contribute to patients' OE, which can inform therapist responsivity to such risk or facilitative markers. With growing research on OE correlates-centered primarily on patient characteristics/treatment factors and, to a lesser extent, therapist factors-a comprehensive synthesis is warranted to elucidate replicated and mixed associations and stimulate further research. Accordingly, we set a pragmatic cutoff of k ≥ 5 for meaningful empirical aggregation of participant factor-OE associations; otherwise, we conducted box counts. METHOD: We searched for articles published through March 2022 that included a clinical sample, a measure of patient's pre- or early treatment OE, and an explicit test of the factor-OE association. RESULTS: Patient problem severity, problem chronicity, education, age, and quality of life were meta-analyzed. Greater severity correlated with lower/less optimistic OE (r = -0.13, p < .001) and higher QOL correlated with higher/more optimistic OE (r = 0.18, p < .001). Box counts revealed that few variables had consistent associations with OE. CONCLUSIONS: Some factors can help forecast patient OE, though additional research is needed to enhance confidence and clinical meaning.

Outcome expectations and working alliance may be more important for patients from rural areas during the transition to college life: An exploratory within-patient analysis.

OBJECTIVE: Research has given limited attention to the distinction between patients from rural and urban areas, especially concerning the frequent overlap between rural living and low socio-economic status (SES). To shed more light on this, we explored the differential treatment processes between patients from rural and urban areas. METHOD: Seven hundred and fourteen patients recruited from a university counseling center in China filled out the questionnaires for Outcome Expectation (OE), Session Alliance Inventory (SAI) and Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) each session. Data was analyzed using the disaggregated cross-lagged panel model and the asymmetric fixed-effect model. RESULTS: The findings indicated a reciprocal within-patient relation between OE and SAI for the whole sample. SAI mediated the effect of OE on next-session CORE-OM for patients from rural areas, with a significantly greater indirect effect than for patients from the urban areas. Asymmetric effects were found for OE among patients from urban areas, for whom drops in OE predicted worse next-session CORE-OM more strongly than improvements in OE predicted improved CORE-OM. CONCLUSION: This study provided preliminary evidence for differential OE-alliance-outcome predictions between patients with different SES and affirmed a reciprocal OE-alliance relation in a Chinese sample during the transition period of college.

Chinese mothers' intent to disclose the HIV status to their children: the role of outcome expectations and self-efficacy.

The present study examined the association between outcome expectations, self-efficacy, and intention to disclose HIV status to children among HIV-positive women in China, and the moderating and mediating role of self-efficacy on the association between outcome expectations and intention to disclose. A cross-sectional survey was conducted among 179 HIV-positive mothers who had at least one living child aged >5 years and had not yet disclosed their HIV status to her oldest child. Results from hierarchical regressions revealed that after adjusting for socio-demographic and medical variables, negative outcome expectations had a negative association (ß = -0.22), while disclosure self-efficacy had a positive association (ß = 0.43) with an intention to disclose HIV. The moderation effect of self-efficacy on the association between outcome expectations and intention to disclose HIV was not significant. Results from structural equation modeling showed that self-efficacy mediated the association between negative/positive outcome expectations and intention to disclose HIV. Findings support the importance of outcome expectations and self-efficacy and also the mediating role of self-efficacy in HIV disclosure among HIV-positive mothers in the Chinese context.

Psychosocial factors and lack of asthma knowledge undermine child and adolescent adherence to inhaled corticosteroid.

Objective: This study aimed to evaluate inhaled corticosteroid (ICS) adherence and identify factors associated with nonadherence in pediatric asthma patients. Methods: A total of 134 patients aged 8-18 years old were included. At the first visit, patient adherence, asthma knowledge, and outcome expectation data were collected and recorded. Depression, anxiety, and self-esteem were assessed using psychiatric questionnaires. After providing asthma education, reevaluation of adherence and asthma control was performed at one 3- to 6-month follow-up visit. Results: The mean ICS adherence was 75.9 ± 27.5%. Fifty-seven patients (42.5%) were defined as having poor adherence (<75%). "Intentional" and "hectic lifestyle and forgetfulness" were the main reasons for missing ICS doses in mid-late adolescents and children, respectively. Asthma knowledge generally improved with age. Overall, 89% and 67.7% of patients could define symptoms and triggers of asthma, respectively; however, less than 25% understood how asthma affected their body and the chronic nature of asthma. Patients with ICS adherence <75% had unfavorable expectations from asthma treatment (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.10), and a higher proportion of inhaled short-acting beta-agonist use before exercise (OR: 4.12, 95% CI: 1.27-13.36). Depression and anxiety were frequently found (27.5%) and 23.3%, respectively; p > 0.05). Significant improvement in ICS adherence (p = 0.02) and Asthma Control Test scores (p = 0.02) were observed at the follow-up visit. Conclusions: Patient outcome expectations could be predictors of ICS adherence. Patient education regarding the mechanism and nature of asthma should be considered as an intervention for improving pediatric patient adherence. Psychological evaluation is warranted in pediatric patients with asthma.

Indirect effect of patient outcome expectation on improvement through alliance quality: A meta-analysis.

Objective: A meta-analysis revealed a positive correlation between patients' optimistic baseline, or early treatment, outcome expectation (OE) and posttreatment improvement (Constantino, Vîsla, et al., [2018]. A meta-analysis of the association between patients' early treatment outcome expectation and their posttreatment outcomes. Psychotherapy, 55(4), 473-485. https://doi.org/10.1037/pst0000169). However, little is known about mechanisms through which OE operates. Increasingly, several individual studies have pointed to higher therapeutic alliance quality as a promising mediator (candidate mechanism) of the positive OE-improvement link. In this study, we conducted the first meta-analysis of this indirect effect, hypothesizing that alliance would partially mediate the OE-outcome link.Method: We included published articles involving a clinical sample; therapist-led treatment of at least 3 sessions; pre- or early treatment patient OE measures; during-treatment patient-rated alliance measures; posttreatment outcome measures; and statistical tests of mediation. This meta-analysis included 10 independent samples and over 1,000 patients.Results: As expected, better alliance quality partially mediated the association between more optimistic OE and improvement; that is, although both were significant, a multivariate analysis revealed that the direct effect was significantly lower than the total effect (standardized difference = -.12, p < .001, 95% CI [-.20, -.05]). Publication bias was low, as was heterogeneity except for the alliance-outcome path.Conclusions: Better alliance may be one process that helps transmit the therapeutic influence of early patient OE.

German version of the outcome expectations for exercise scale-2 : Psychometric properties in geriatric patients after hip or pelvic fractures with fear of falling.

OBJECTIVE: Physical exercise is associated with many health benefits. Especially for older adults it is challenging to achieve an appropriate adherence to exercise programs. The outcome expectations for exercise scale 2 (OEE-2) is a 13-item self-report questionnaire to assess negative and positive exercise outcome expectations in older adults. The aim of this study was to translate the OEE­2 into German and to assess the psychometric properties of this version. METHODS: The OEE­2 was translated from English into German including a forward and backward translation process. Psychometric properties were assessed in 115 patients with hip/pelvic fractures (76% female, mean age 82.5 years) and fear of falling during geriatric inpatient rehabilitation. RESULTS: Principal component analyses could confirm a two-factor solution (positive/negative OEE) that explained 58% of the total variance, with an overall internal reliability of α = 0.89. Cronbach's α for the 9­item positive OEE subscale was 0.89, for the 4­item negative OEE subscale 0.79. The two subscales were correlated with rs = 0.49. Correlations of the OEE total score were highest with the perceived ability to manage falls, prefracture leisure time activities and prior training history (rs = 0.35-0.41). CONCLUSION: These results revealed good internal reliability and construct validity of the German version of the OEE­2. The instrument is valid for measuring physical exercise outcome expectations in older, German-speaking patients with hip or pelvic fractures and fear of falling.

A Neural Mechanism of Cue-Outcome Expectancy Generated by the Interaction Between Orbitofrontal Cortex and Amygdala.

Taste perception is important for animals to take adequate nutrients and avoid toxins for their survival. Appetitive and aversive behaviors are produced by value evaluation of taste and taste expectation caused by other sensations. The value evaluation, coupled with a cue presentation, produces outcome expectation and guides flexible behaviors when the environment is changed. Experimental studies demonstrated distinct functional roles of basolateral amygdala (ABL) and orbitofrontal cortex (OFC) in value evaluation and adaptive behavior. ABL is involved in generating a cue-outcome association, whereas OFC makes a contribution of generating a cue-triggered expectation to guide adaptive behavior. However, it remains unclear how ABL and OFC form their functional roles, with the learning of adaptive behavior. To address this issue, we focus on an odor discrimination task of rats and develop a computational model that consists of OFC and ABL, interacting with reward and decision systems. We present the neural mechanisms underlying the rapid formation of cue-outcome association in ABL and late behavioral adaptation mediated by OFC. Moreover, we offer 2 functions of cue-selective neurons in OFC: one is that the activation of cue-selective neurons transmits value information to decision area to guide behavior and another is that persistent activity of cue-selective neurons evokes a weak activity of taste-sensitive OFC neurons, leading to cue-outcome expectation. Our model further accounts for ABL and OFC responses caused by lesions of these areas. The results provide a computational framework of how ABL and OFC are functionally linked through their interactions with the reward and decision systems.

Relationship among upgrades in academic qualifications, practice accreditations, self-efficacy, outcome expectations and nurses' career interest.

AIMS: This study examined the relationship among upgrades in academic qualifications, practice accreditations, self-efficacy, outcome expectations and nurses' career interest. BACKGROUND: Interest in the nursing career could help retain nurses in the nursing profession. A global nurse shortage warrants further research to understand what drives interest in the nursing career. METHODS: A cross-sectional design was employed. Data were collected in a medical centre in Northern Taiwan between February and March 2017, using employee records and a survey instrument. Proportionate random sampling was used to identify full-time registered nurses, of whom 524 provided useable responses. Employee records were used to measure nurses' upgrades in academic qualifications and practice accreditation. RESULTS: Upgrades in academic qualifications and upgrades in practice accreditation are positively related to outcome expectations. Both self-efficacy and outcome expectations are positively related to career interest. CONCLUSION: The pursuit of upgrades in academic qualifications and practice accreditation could enhance nurses' outcome expectations, thus enhancing their interest in a nursing career. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital managers could develop policies, procedures and programmes to encourage nurses to enhance their academic qualifications or practice accreditation, helping enhance their interest in remaining in the nursing career.

Cochlear Implantation and Rehabilitation.

Cochlear implant (CI) is currently the only medical treatment available to partially restore hearing to patients with profound-to-severe hearing loss. CI is fundamentally distinct from hearing aid (HA) use, as implants are surgically placed under the skin behind the ear where they bypass the normal sound-conducting mechanism, convert sound signals into electrical stimulation, and directly stimulate the residual auditory nerves. In recent years, CI has evolved into one of the most profound advances in modern medicine and provided hearing to more than 320,000 deaf patients. According to the time of onset, deafness is classified as prelingual and postlingual deafness, and the indications of cochlear implants vary slightly. The medical evaluation must be made before surgery, including the medical history, objective and subjective audiometry, imaging of the ear, as well as the genetic diagnostic. Here we reviewed the surgical approaches for cochlear implants as well as the complications.

Patient characteristics and the therapist as predictors of depressed patients' outcome expectation over time: A multilevel analysis.

Objective: Although there is an established link between patients' early positive outcome expectation for and their actual improvement from therapy, there is little research on patients' change in outcome expectation across therapy and both patient and therapist correlates of early outcome expectation level and change. The present study examined: (i) the overall trajectory of change in patients' outcome expectation through cognitive-behavioral therapy (CBT) for depression; (ii) patient characteristics as predictors of both initial outcome expectation and change in outcome expectation; and (iii) between-therapist effects in outcome expectation change. Method: Depressed patients (N = 143) received a brief course of CBT. Outcome expectation was measured at screening, pretreatment, session 7, and session 14. Results: Outcome expectation linearly increased from screening to session 14. When controlling for other patient characteristics at intake, having previous depressive episodes was negatively associated with initial outcome expectation and higher well-being was positively associated with initial outcome expectation. When controlling for early alliance and early symptom change, outcome expectation change was predicted by previous depressive episodes. Finally, therapist effects emerged in outcome expectation over time. Conclusions: Various depressed patients' characteristics predict initial outcome expectation level and change, with significant between-therapists' differences related to outcome expectation change.

The relation between outcome expectation, therapeutic alliance, and outcome among depressed patients in group cognitive-behavioral therapy.

OBJECTIVE: Although patients' expectation for improvement correlates with their treatment outcome, there remains limited information regarding the mechanisms through which outcome expectation influences outcome. Although several studies have revealed alliance as a mediator of the expectancy-outcome relation, most have focused on individual psychotherapy only. More research is needed examining mediators, including alliance quality, of the outcome expectation-outcome relation in group therapy. METHOD: This study focused on such associative chains among 91 depressed outpatients who completed 10 weeks of group cognitive-behavioral therapy. We conducted simple and multiple mediation analyses, accounting for the nested data structure. RESULTS: As predicted, we found: (i) The relations between baseline outcome expectation and both posttreatment anxiety and depression were mediated by alliance quality; (ii) the early therapy outcome expectation-posttreatment anxiety relation was mediated by mid-treatment alliance; (iii) the relation between early alliance and posttreatment interpersonal problems was mediated by during-therapy outcome expectation; and (iv) the relation between baseline outcome expectation and posttreatment interpersonal problems was mediated by two variables acting in turn, early alliance and during-therapy outcome expectation. All other tested models were not significant. CONCLUSIONS: Results suggest that bidirectional relations between outcome expectation and alliance, with both directions influencing outcome. Clinical and empirical implications are discussed.

Psychometric testing of Korean versions of self-efficacy and outcome expectations for restorative care activities scales.

This study aimed to examine the validity and reliability of Korean versions of the Nursing Assistant Self-Efficacy for Restorative Care Scale, and the Nursing Assistant Outcome Expectations for Restorative Care Scale. Psychometric testing was performed with 697 direct care workers in long-term care facilities in South Korea. Data were analyzed using SPSS/WIN 21.0, AMOS 22.0, and WINSTEPS 3.68.2. There was evidence for content validity. Factor loading in the Korean versions of the Nursing Assistant Self-Efficacy for Restorative Care Scale was 0.66-0.94, and Nursing Assistant Outcome Expectations for Restorative Care Scale was 0.43-0.77. Scores on the Korean versions of the Nursing Assistant Outcome Expectations for Restorative Care Scale correlated positively with scores on a scale of knowledge of restorative care. Additionally, Rasch model analysis of the K-NASERC and K-NAOERC indicates acceptable item data fit. These results indicated that the Korean versions of the Nursing Assistant Self-Efficacy, and Outcome Expectations for Restorative Care Scale are satisfactorily valid and reliable for the measurement.

The relative association between individual difference variables and general psychotherapy outcome expectation in socially anxious individuals.

OBJECTIVE: Although patients' psychotherapy outcome expectation relates to their treatment outcome, little is known about correlates of this expectation. Moreover, the limited research has largely assessed convenience variables as correlates, with little replication and few examinations of the relative strength of associations between the correlates and outcome expectation. This clinical analogue study examined the relation between socially anxious undergraduates' (N = 178) characteristics and their general psychotherapy outcome expectation. We investigated characteristics supported as correlates in prior studies. METHODS: Data derived from a baseline assessment prior to a larger experiment. Participants' mean level of social anxiety was within 1 standard deviation of the mean of clinical, treatment-seeking samples, and 65.2% of the sample either had therapy experience or were actively considering it. RESULTS: Participants' general outcome expectation was significantly associated with positive beliefs about and intention to seek therapy. Multivariate regression models showed a positive association between psychological mindedness (B = .59, p < .001) and outcome expectation. Subgroup analyses indicated that for participants with prior therapy experience, greater satisfaction with that treatment (B = 5.26, p < .001) was associated with higher outcome expectation. CONCLUSION: Results are discussed with regard to their implications for treatment-seeking intentions and treatment planning.

The Smoking Outcome Expectation Scale and Anti-Smoking Self-Efficacy Scale for Early Adolescents: Instrument Development and Validation.

Smoking-related outcome expectation and self-efficacy have been found to be associated with adolescent smoking initiation. There is, however, a lack of appropriate instruments to investigate early adolescents' smoking outcome expectations and antismoking self-efficacy. The purpose of this study was to develop and validate the Smoking Outcome Expectation Scale (SOES) and Anti-Smoking Self-Efficacy Scale (ASSES). A total of 232 fifth and sixth graders from four elementary schools in Taiwan participated in the study. Both scales had good content validity, internal consistency, and test-retest reliability. On the basis of exploratory factor analysis, the 6-item SOES with two factors accounted for 54.72% of total variance and the 15-item ASSES with three factors accounted for 56.49% of total variance. The SOES had convergent and discriminant validity and ASSES had convergent validity. The two scales could help school nurses to understand early adolescents' smoking outcome expectation and antismoking self-efficacy and to develop more appropriate antismoking curricula.

The beauty of the network in the brain and the origin of the mind in the control of behavior.

Behavior is not adequately described as a stimulus-response process. It is initiated by the animal and is generated because of its expected outcome in the future. The outcome can be good or bad for the animal. The brain is in charge of the selection process. This is the basic function of the brain. Taking Drosophila as a study case, this paper discusses initiating activity, several examples of outcome expectations, trying out (the internal search for a suitable behavior), chaining of actions, and the functional roles of chance in action selection. It takes mental processes and states such as goals, intentions, feelings, memories, cognition, and attention as higher levels of behavioral control that have their origin in biological evolution.

Improving understanding of the quitting process: psychological predictors of quit attempts versus smoking cessation maintenance among college students.

This study examined motivation, positive and negative outcome expectations of quitting, and self-efficacy as predictors of quit attempts and cessation maintenance in a smoking cessation intervention for college students (N = 303). Psychological measures assessed at baseline were used to predict smoking behavior outcomes. Analysis of variance (ANOVA) and logistic regression analysis revealed that motivation and self-efficacy were strong, differential predictors of quit attempts and cessation maintenance, respectively. This study extends the previous findings regarding psychological predictors of quitting processes to college students, and suggests the need for interventions tailored according to phases of quitting processes.

Neural correlates of aggression outcome expectation and their association with aggression: A voxel-based morphometry study.

BACKGROUND: Aggression outcome expectation is an important cognitive factor of aggression. Discovering the neural mechanism of aggression outcome expectation is conducive to developing aggression research. However, the neural correlates underlying aggression outcome expectation and its effect remain elusive. METHODS: We utilized voxel-based morphometry (VBM) to unravel the neural architecture of aggression outcome expectation measured by the Social Emotional Information Processing Assessment for Adults and its relationship with aggression measured by the Buss Perry Aggression Questionnaire in a sample of 185 university students (114 female; mean age = 19.94 ± 1.62 years; age range: 17-32 years). RESULTS: We found a significantly positive correlation between aggression outcome expectation and the regional gray matter volume (GMV) in the right middle temporal gyrus (MTG) (x = 55.5, y = -58.5, z = 1.5; t = 3.35; cluster sizes = 352, p < 0.05, GRF corrected). Moreover, aggression outcome expectation acted as a mediator underlying the association between the right MTG volume and aggression. CONCLUSIONS: These results revealed the neural correlates of aggression outcome expectation and its effect on aggression for the first time, which may contribute to our understanding of the cognitive neural mechanism of aggression and potentially identifying neurobiological markers for aggression.

Living with type 2 diabetes: A social cognitive perspective on adherence.

OBJECTIVE: This mixed methods study examines the relationship between outcome expectations, self-efficacy, and self-care behaviors in individuals with type 2 diabetes (T2DM). It also explores the personal values motivating these behaviors through in-depth interviews. METHODS: Adults with T2DM (n = 108, M age = 57 years, 58% female, 48% Black) completed questionnaires and participated in in-depth interviews using a laddering technique. RESULTS: Ordinary least squares regression models were used to analyze the relationships between self-efficacy, outcome expectations, and four self-care behaviors (physical activity, dietary choices, blood glucose monitoring, and medication usage). The findings indicate that self-efficacy is significantly and positively associated with diet and physical activity. Both outcome expectations for blood glucose testing and self-efficacy are significantly and positively associated with self-reported monitoring. However, neither outcome expectation nor self-efficacy is associated with medication usage. The in-depth interviews revealed three common values related to self-care behaviors: maintaining health and longevity, agentic values of self-control, achievement, and self-esteem, and a sense of belonging. CONCLUSIONS: This study sheds light on the complexity of diabetes self-management, offering insights into individuals' values, behavioral strategies, and the influence of control perceptions on this relationship, revealing both differences and commonalities in stated values. PRACTICE IMPLICATIONS: By understanding how personal values drive diabetes self-care behaviors, practitioners can assist patients in establishing meaningful connections between their values and the challenges of living with diabetes.