Accountability focus and nurses' performance: A moderated-mediation model by using experiment design simulations.

AIM: The aim of this study was to test a moderated-mediation model, explaining how and under which circumstances a process- or an outcome-accountability focus affects performance. DESIGN: Randomized controlled design, using screen-based simulations. METHODS: Data were collected during 2021. Two screen-based simulations of medication administration (for low- and high-complexity tasks) were used. Each participant was randomly assigned to one of the six experimental conditions. Nurses completed validated questionnaires on strain levels and their perceptions of the simulated task complexity and accountability focus. Performance was assessed via validated checklists assessing nurses' performance of the simulation. RESULTS: Task complexity significantly moderated the relationship between accountability-focus conditions and strain. For the process-accountability-focus condition, strain levels were lower during high-complexity tasks compared with low-complexity tasks, while for the outcome-accountability-focus condition, strain levels were lower during low-complexity tasks compared with high-complexity tasks. The highest strain levels were observed under the no accountability-focus condition. Additionally, this interaction had an impact on performance, with nurses' strain playing a mediating role. CONCLUSIONS: Any accountability focus reduces strain levels and enhances performance compared with having no accountability focus. The choice of accountability focus should be based on task-complexity considerations. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Managers can effectively reduce nurses' strain and improve performance by prioritizing outcome accountability focus for simpler tasks and process accountability focus for complex tasks. IMPACT: The study addressed previous ambiguous findings regarding the type of accountability focus that better motivates nurses' performance. By considering accountability focus, nurse managers can balance nurses' strain levels with improved performance. REPORTING METHOD: We have adhered to the relevant EQUATOR guidelines: CONSORT. PATIENT OR PUBLIC CONTRIBUTION: There is no patient or public contribution, as the study only concerns the providers of the service, that is the nurses themselves.

The dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design.

AIMS: To examine a novel moderated-mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress. DESIGN: Nested diary study. METHODS: Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium-sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse-patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated-mediation model. RESULTS: Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses. CONCLUSION: The study highlights accountability's dual role-safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff. IMPACT: By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes. REPORTING METHOD: The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Defining Speaking Up in the Healthcare System: a Systematic Review.

BACKGROUND: Communication issues have been shown to contribute to healthcare errors. For years healthcare professionals have been told to "speak up." What "speak up" means is unclear, as it has been defined and operationalized in many ways. Thus, this study aimed to systematically review the literature regarding definitions and measurements of speaking up in the healthcare system and to develop a single, comprehensive definition and operationalization of the concept. METHODS: PubMed, CINAHL, PsychoInfo, and Communication/Mass Media Complete databases were searched from 1999 to 2020. Publications were included if they mentioned speaking up for patient safety or any identified synonyms. Articles that used the term speaking up concerning non-health-related topics were excluded. This systematic review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 294 articles met the inclusion criteria, yet only 58 articles focused on speaking up. While the most common synonym terms identified were "speak up" and "raise concern," only 43 articles defined speaking up. Accordingly, a modified definition was developed for speaking up-A healthcare professional identifying a concern that might impact patient safety and using his or her voice to raise the concern to someone with the power to address it. DISCUSSION: Speaking up is considered important for patient safety. Yet, there has been a lack of agreement on the definition and operationalization of speaking up. This review demonstrates that speaking up should be reconceptualized to provide a single definition for speaking up in healthcare.

Ethiopian immigrants with diabetes in Israel: Oscillating between two narratives.

AIM: The purpose of this project was to examine the role of cultural differences in shaping the management of diabetes among Ethiopian immigrants living in Israel. METHODS: A qualitative, in-depth study involved semistructured interviews with 16 Ethiopian immigrants with diabetes living in Israel. The interviews were audio-recorded, transcribed and translated into Hebrew, if necessary. The authors each identified themes in the responses and then through discussion came to a consensus about the most significant ones and how to categorize them. RESULTS: A main theme was revealed structuring the participants' perception of diabetes: an oscillation between a familiar narrative, associated with traditional life in Ethiopia, and a foreign one. Five additional subthemes were also identified as an oscillation about the causes of disease, between collectivism and individualism, between accessible food and a balanced diet, between relying on bodily sensations and prescribed treatment and between culturally oriented and translated knowledge. CONCLUSION: The participants understood that they could be adversely affected both by the changes in lifestyle following their move and by adhering to the traditional norms. They agreed that professional liaisons and peers who have successfully managed their diabetes could help provide a bridge between the narratives.

Patient safety topics, especially the second victim phenomenon, are neglected in undergraduate medical and nursing curricula in Europe: an online observational study.

This study aims to assess the inclusion of second victims and other patient safety issues in the curricula of undergraduate medical and nursing degrees in the countries participating in the European Researchers' Network Working on Second Victims (The ERSNT Consortium, COST Action 19,113). A review of medical and nursing school curricula in 206 universities was carried out, using their websites to search for subjects addressing "patient safety", "quality of care", "risk management", "safe practices", "interprofessional communication", "adverse events", and "second victims". There was substantial variability in the extent of training for patient safety. Forty-four out of 88 nursing schools and 74 of 118 medical schools did not include any of the patient safety topics studied. The most frequent in both nursing and medicine was "interprofessional communication", followed by "quality of care" and basic aspects on "patient safety". The second victim phenomenon was present in only one curriculum of the total sample. Our study showed that patient safety, especially the second victim phenomenon, is still neglected in medical and nursing curricula in European universities, although positive initiatives were also found. Given the frequency with which adverse events occur in health centres and the need to prepare students to deal with them adequately, additional efforts are needed to introduce patient safety elements into medical and nursing education.

Missed nursing care: Testing the moderation-mediation energetic and motivational pathways via a nested design.

AIMS: To examine: (1) a motivational pathway where head nurse proactive leadership and nurse vigour are linked, which in turn correlates to missed nursing care, and might be moderated by workload; and (2) an energetic pathway where workload and nurse exhaustion are linked, which in turn correlates to missed nursing care, and might be moderated by head nurse proactive leadership. DESIGN: A cross-sectional design, with nurses nested in wards. METHODS: During 2018, 196 nurses from 37 wards completed questionnaires that included the 22-item MISSCARE survey; the 6-item Work Demand subscale; the 10-item Proactivity Personality scale; the 5-item Exhaustion subscale of the Maslach Burnout Inventory; the 5-item Vigour subscale of the Work Engagement scale; and nurse's and head nurse's sociodemographic characteristics. Moderation-mediation models were performed using mixed-linear model analyses. RESULTS: A moderation-mediation motivational pathway was supported. Specifically, nurse vigour was higher under low workload when head nurse proactive leadership was high (ß = -.09, p = .050), which in turn was associated with lower missed nursing care (ß = -.10, p = .045). Yet, a moderation-mediation energetic pathway was not supported. Specifically, nurse exhaustion was lower under low workload when head nurse proactive leadership was high (ß = .14, p = .032), but no association was found between exhaustion and missed nursing care. CONCLUSIONS: This study shows that there is a significant role for nurse agency and nurse ability to cope with scarce resources. IMPACT: To date, research has focused mainly on the assumption that missed nursing care is a result of scarce resources. Findings indicate that even under scarce resources, nurses can be motivated to reduce missed nursing care. Emphasis should be placed on promoting and maximizing nurse motivation. This can be achieved by developing and implementing interventions of proactive leadership of head nurses.

Identification of elderly patients at risk for 30-day readmission: Clinical insight beyond big data prediction.

AIM: This study explores the potential benefit of combining clinicians' risk assessments and the automated 30-day readmission prediction model. BACKGROUND: Automated readmission prediction models based on electronic health records are increasingly applied as part of prevention efforts, but their accuracy is moderate. METHODS: This prospective multisource study was based on self-reported surveys of clinicians and data from electronic health records. The survey was performed at 15 internal medicine wards of three general Clalit hospitals between May 2016 and June 2017. We examined the degree of concordance between the Preadmission Readmission Detection Model, clinicians' readmission risk classification and the likelihood of actual readmission. Decision trees were developed to classify patients by readmission risk. RESULTS: A total of 694 surveys were collected for 371 patients. The disagreement between clinicians' risk assessment and the model was 34.5% for nurses and 33.5% for physicians. The decision tree algorithms identified 22% and 9% (based on nurses and physicians, respectively) of the model's low-medium-risk patients as high risk (accuracy 0.8 and 0.76, respectively). CONCLUSIONS: Combining the Readmission Model with clinical insight improves the ability to identify high-risk elderly patients. IMPLICATIONS FOR NURSING MANAGEMENT: This study provides algorithms for the decision-making process for selecting high-risk readmission patients based on nurses' evaluations.

Resilience in late adolescence/young adulthood: Rising to the occasion?

The developmental period of late adolescence/young adulthood is characterized by transitioning to an independent individual with a self-identity, established health habits and the components of resilience: (1) confidence in one's abilities (personal competence) and (2) the ability to adapt to changes (acceptance of self and life). This two-wave, prospective study examines the associations among self-identity, health habits and resilience in 18 year olds (n = 149) before military service and six months afterward. The questionnaire included validated scales of resilience and self-identity, as well as instruments measuring health habits, family environment and demographic characteristics. Cross-sectional findings indicated that resilience at baseline was associated with gender-male (p < .05), lower distress (p < .001) and higher identity-affirmation/belonging (p < .05). Longitudinal findings showed that resilience was associated with changes of distress (p < .05) and the resilience component of personal competence (p < .001). Cross-sectional and longitudinal perspectives on 18-year-old military recruits portrayed different pictures. The cross-sectional findings showed that resilience was associated with lower distress and higher feelings of affirmation/belonging (self-identity); however, longitudinal findings showed that resilience was predicted by the ability to adapt to changes under stress. Resilient 18 year olds demonstrated the ability to adapt to stressful situations, but psychological distress may impede the development of self-identity.

Parental Post-traumatic Stress and Healthcare Use in Infants with Complex Cardiac Defects.

OBJECTIVE: To examine the associations between post-traumatic stress of parents of infants with complex congenital heart defects and their healthcare use for their infants during the early months of life. STUDY DESIGN: The current study is a secondary data analysis from a randomized controlled trial in which 216 parent-infant dyads were recruited from 3 cardiac intensive care units of large pediatric centers in Northeastern America. The current sample included 153 dyads with post-traumatic stress data at hospital discharge and at 4-months' follow-up. Poisson regressions were used to estimate the effect of post-traumatic stress change scores on number of emergency department (ED) visits, unscheduled cardiologist visits, and unscheduled pediatrician visits outcomes. RESULTS: Infants whose parents gained post-traumatic stress disorder over the study period were at increased risk for ED visits and unscheduled cardiologist visits. Increased symptom severity predicted more unscheduled cardiologist visits and more unscheduled pediatrician visits. Increased symptom clusters (avoidance, arousal, re-experiencing) predicted more ED visits, more unscheduled cardiologist visits, and more unscheduled pediatrician visits. CONCLUSIONS: Parents of infants with cardiac conditions may experience post-traumatic stress following cardiac surgery, which can be linked to greater healthcare use. Findings highlight the importance of screening and treating post-traumatic stress to preserve parental mental health and prevent adverse outcomes.

Preventing Hospital Readmissions: Healthcare Providers' Perspectives on "Impactibility" Beyond EHR 30-Day Readmission Risk Prediction.

BACKGROUND: Predictive models based on electronic health records (EHRs) are used to identify patients at high risk for 30-day hospital readmission. However, these models' ability to accurately detect who could benefit from inclusion in prevention interventions, also termed "perceived impactibility", has yet to be realized. OBJECTIVE: We aimed to explore healthcare providers' perspectives of patient characteristics associated with decisions about which patients should be referred to readmission prevention programs (RPPs) beyond the EHR preadmission readmission detection model (PREADM). DESIGN: This cross-sectional study employed a multi-source mixed-method design, combining EHR data with nurses' and physicians' self-reported surveys from 15 internal medicine units in three general hospitals in Israel between May 2016 and June 2017, using a mini-Delphi approach. PARTICIPANTS: Nurses and physicians were asked to provide information about patients 65 years or older who were hospitalized at least one night. MAIN MEASURES: We performed a decision-tree analysis to identify characteristics for consideration when deciding whether a patient should be included in an RPP. KEY RESULTS: We collected 817 questionnaires on 435 patients. PREADM score and RPP inclusion were congruent in 65% of patients, whereas 19% had a high PREADM score but were not referred to an RPP, and 16% had a low-medium PREADM score but were referred to an RPP. The decision-tree analysis identified five patient characteristics that were statistically associated with RPP referral: high PREADM score, eligibility for a nursing home, having a condition not under control, need for social-services support, and need for special equipment at home. CONCLUSIONS: Our study provides empirical evidence for the partial congruence between classifications of a high PREADM score and perceived impactibility. Findings emphasize the need for additional research to understand the extent to which combining EHR data with provider insights leads to better selection of patients for RPP inclusion.

The nurse's experience of decision-making processes in missed nursing care: A qualitative study.

AIMS: To explore nurses' perspectives regarding the decision-making processes that lead to missed nursing care and to identify the personal and contextual attributes involved in these processes. DESIGN: A qualitative study was undertaken between April - October 2018. METHODS: A total of 28 registered nurses working in different wards in hospital settings participated in nine focus groups with semi-structured interviews. An interview guide encouraged nurses to share perceptions of missed care and the personal and contextual attributes shaping their decision-making. RESULTS: Content analysis revealed three themes related to nurses' decision-making processes for whether to omit or delay care. First, nurses emphasized the role of nurses' agency, suggesting explicit or implicit rationing of care, regardless of scarce resources. Second, nurses distinguished between two modes of thinking that they labelled "automated thinking," activated in routine situations and "effortful thinking," initiated in more novel situations. Finally, nurses identified situational factors triggering fluctuations in their awareness such as task type, difficult patients and the presence of relatives and the head nurse. CONCLUSIONS: Nurses are aware of the processes guiding a decision to omit or delay care. They pointed to patient, nurse and ward conditions that serve as cues in their decision whether to miss care. Identifying these cues supports Hammond's cognitive continuum theory of decision-making and may serve in the development of training programmes for nurses aimed at limiting the phenomenon. IMPACT: The study addressed missed nursing care through a decision-making lens. The findings pointed to nurses' agency as shaping decisions about whether to miss care and identified the personal and contextual cues that guide nurses' decisions. These findings call for organizational training programmes encouraging nurses to identify barriers and facilitators of missed nursing care and how to overcome them.

Long-term effectiveness of the Diabetes Conversation Map™ Program on health outcomes: A case-control retrospective cohort study.

AIM: To evaluate the clinical and health behavioural outcomes of a large sample of participants from the Diabetes Conversation Map™ Program. DESIGN: A matched-case-control study that was performed on a retrospective cohort study. METHODS: Participants were 11,053 Clalit Health Services members with type 2 diabetes who enrolled in the Diabetes Conversation Map™ Program between January 2010 - April 2016. The matched-control group was formulated using sequential matching, by matching cases to controls at a ratio of 1:3, based on age, sex, and HbA1c level. The associations between the programme group and annual clinical and health behaviours were assessed between cases and controls at five time points using linear and Poisson regression analyses. RESULTS: The intervention group had significantly lower HbA1c, glucose, and low-density lipoprotein levels and more frequent glucose blood testing each year up to 36 month post-enrolment compared with the matched controls. Other outcomes were significantly different for shorter time periods, including higher high-density lipoprotein and lower triglyceride levels at 6- and 12-month follow-up and lower diastolic blood pressure and greater medication adherence at 6-month follow-up. CONCLUSIONS: Enrolment in the programme was associated with improved clinical and health behaviour outcomes for at least 6 months and most outcomes persisted for up to 36 months. IMPACT: This is the first study to evaluate the Diabetes Conversation Map™ Program with a large sample over long period of time. This nurse-led group intervention evaluation adds to the literature on health outcomes on the lives of patients with type 2 diabetes. STUDY REGISTRATION: This study was registered retrospectively to the Open Science Framework, the registration form can be found at: https://osf.io/63cse.

Occupational strain and job satisfaction: The job demand-resource moderation-mediation model in haemodialysis units.

AIM: To examine whether job resources moderate the relationship between job demands and occupational strain, and whether occupational strain mediates the relationship between job demands and job satisfaction. BACKGROUND: The job demand-resource model suggests that job demands and job resources are related to occupational strain, and occupational strain is associated with job satisfaction. METHODS: In 2018, a cross-sectional study was conducted with a convenience sample of 85 nurses from six haemodialysis units. Linear regression with moderation-mediation analysis was conducted using SPSS software. RESULTS: Under low workload levels, no association between autonomy and occupational strain existed, but under high workload levels, a negative relationship was found between autonomy and occupational strain. Under low workload levels, a negative relationship was found between social support and occupational strain, but under high workload levels, a positive relationship was found. Finally, there was no association between occupational strain and job satisfaction. CONCLUSION: Job resources are moderators of the relationship between job demands and occupational strain. However, there was no significant association between occupational strain and job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should strengthen nurses' autonomy, which can reduce occupational strain. Additionally, sources of support are needed to help nurses cope with the workload and occupational strain.

The personality profile of the accountable nurse and missed nursing care.

AIM: The aim of this study was to examine the mediating role of nurses' personal accountability in the relationships between nurse's personality and missed nursing care. BACKGROUND: Personal accountability is considered as a core value in nursing, shaped by the nurse's personality, education, socialization into the profession and experience. Personality antecedents may be uniquely suited to predicting accountability, since it reflects variation in individuals' deep-seated values and beliefs. Personal accountability can be related to the prevalent phenomenon of missed nursing care (tasks that are omitted or delayed). DESIGN: A multicentre cross-sectional study with 290 nurses from direct-care nursing wards during 2017. Personality traits were assessed with the 44-item Big Five Inventory. Personal accountability was assessed with a 19-item scale. Missed nursing care was assessed with the 22-item MISSCARE survey. An indirect mediated path analysis was performed and compared with an alternative model with direct effects. RESULTS: Path-analyses findings supported a full-mediation model of accountability in the relationships between personality traits and missed nursing care. Conscientiousness, Agreeableness, Openness and Neuroticism, but not Extraversion, were significantly related to personal accountability. In addition, greater personal accountability was significantly related to lower frequency of missed nursing care. CONCLUSIONS: Personal traits are important antecedents of personal accountability, which relates to missed nursing care. Findings delineate the profile of the accountable nurse and might help in developing strategies for the selection of nurses with high personal accountability and determining the best means to strengthen accountable behaviours in the workplace.

Towards a measure of accountability in nursing: A three-stage validation study.

AIMS: The aim of this study was to develop and psychometrically evaluate a three-dimensional questionnaire suitable for evaluating personal and organizational accountability in nurses. BACKGROUND: Accountability is defined as a three-dimensional value, directing professionals to take responsibility for their decisions and actions, to be willing to explain them (transparency), and to be judged according to society's accepted values (answerability). Despite the relatively clear definition, measurement of accountability lags well behind. Existing self-report questionnaires do not fully capture the complexity of the concept nor do they capture the different sources of accountability (e.g., personal accountability, organizational accountability). DESIGN: A three-stage measure development. METHODS: Data were collected during 2015-2016. In Phase 1, an initial database of items (N = 74) was developed, based on literature review and qualitative study, establishing face and content validity. In Phase 2, the face, content, construct, and criterion-related validity of the initial questionnaires (19 items for personal and organizational accountability questionnaire) were established with a sample of 229 nurses. In Phase 3, the final questionnaires (19 items each) were validated with a new sample of 329 nurses and established construct validity. RESULTS: The final version of the instruments comprised 19 items, suitable for assessing personal and organizational accountability. The questionnaire referred to the dimensions of responsibility, transparency, and answerability. The findings established the instrument's content, construct, and criterion-related validity as well as good internal reliability. CONCLUSION: The questionnaire portrays accountability in nursing, by capturing nurses' subjective perceptions of accountability dimensions (responsibility, transparency, answerability), as demonstrated by personal and organizational values.

Interventions for Reducing Parenting Stress in Families With Pediatric Conditions: An Integrative Review.

Parenting stress increases in the presence of serious-acute or chronic pediatric health conditions, potentially triggering negative outcomes for families. Parenting stress reduction interventions have been widely disseminated. The current review describes the types, components, and outcomes of these interventions in diverse pediatric populations. A systematic literature search yielded 26 experimental and quasi-experimental studies describing such interventions. Quality assessment was conducted by two doctorally prepared nursing researchers using the Downs and Black's checklist for randomized and nonrandomized studies of health care interventions. Interventions were categorized as follows: interventions with supporting and cognitive components (n = 3), interventions with empowerment and skill development components (n = 18), interventions targeted to children's condition (n = 9), and interventions focusing on the parent-child relationship (n = 5). Most interventions reduced immediate parenting stress levels (n = 23), but failed to demonstrate long-term gains. Future family interventions should target long-term parenting stress, while focusing on specific family needs across pediatric conditions.

The relationship between quick return shift schedules and burnout among nurses: A prospective repeated measures multi-source study.

BACKGROUND: In today's world, essential health care services are expected round the clock, leading to distinct shift work requirements. A notable aspect is the "quick return," where the rest interval between nursing shifts is <11 h. Preliminary research suggests a potential association between quick return schedules, diminished sleep quality, and possible nurse burnout. Yet, the motivation of nurses could potentially moderate this relationship. OBJECTIVE: To examine a moderated-mediation model, whereby sleep duration and nurse's motivation act together to mediate the link between quick return schedules and nurse's burnout. DESIGN: A prospective repeated measures (4-5 nursing shifts per nurse) multi-source (self-report and objective measures) study. SETTING: Internal and surgical departments across one large and one medium scale teaching hospitals in Israel. PARTICIPANTS: Registered nurses who provide direct patient care (n = 79) across 369 shifts. METHODS: Nurses completed a questionnaire containing personal information and information regarding their shifts during the study week. They wore an accelerometer (a wrist worn device that monitors and records an individual's activity level) during a work-week to objectively determine their sleep duration, completed a motivation questionnaire at the beginning of each shift, and completed a burnout questionnaire at the end of the week. Mixed-model regression analysis was used to test a moderated-mediation model following Hayes' recommendations, whereby the joint effect of sleep duration and motivation mediates the link between quick return schedules and burnout. RESULTS: The moderated-mediation model was supported. Quick return schedules were negatively statistically significantly associated with sleep duration (b = -126.54, SE = 20.85, p < 0.001); so that more frequent quick return schedules were related to shorter sleep duration. However, no direct correlation was observed between sleep duration and burnout (p = 0.171). A statistically significant interaction was observed between sleep duration and motivation (b = 0.00, SE = 0.00, p < 0.001) concerning burnout. Thus, nurses with lower motivation were prone to experiencing higher levels of burnout with shorter sleep duration compared to nurses with higher motivation. CONCLUSIONS: The mediating role of sleep duration, moderated by motivation, plays a role in the connection between quick return schedules and burnout. This indicates that nurses can sustain their work motivation even within the demands of quick return schedules, consequently mitigating burnout levels. To prioritize employees' well-being, organizations should adopt shift work structures that minimize quick return schedules and extend nurses' sleep duration. Consequently, managers must employ strategies to enhance nurses' motivation when addressing scenarios that necessitate quick return schedules.

How different countries respond to adverse events whilst patients' rights are protected.

Patient safety is high on the policy agenda internationally. Learning from safety incidents is a core component in achieving the important goal of increasing patient safety. This study explores the legal frameworks in the countries to promote reporting, disclosure, and supporting healthcare professionals (HCPs) involved in safety incidents. A cross-sectional online survey was conducted to ascertain an overview of the legal frameworks at national level, as well as relevant policies. ERNST (The European Researchers' Network Working on Second Victims) group peer-reviewed data collected from countries was performed to validate information. Information from 27 countries was collected and analyzed, giving a response rate of 60%. A reporting system for patient safety incidents was in place in 85.2% (N = 23) of countries surveyed, though few (37%, N = 10) were focused on systems-learning. In about half of the countries (48.1%, N = 13) open disclosure depends on the initiative of HCPs. The tort liability system was common in most countries. No-fault compensation schemes and alternative forms of redress were less common. Support for HCPs involved in patient safety incidents was extremely limited, with just 11.1% (N = 3) of participating countries reporting that supports were available in all healthcare institutions. Despite progress in the patient safety movement worldwide, the findings suggest that there are considerable differences in the approach to the reporting and disclosure of patient safety incidents. Additionally, models of compensation vary limiting patients' access to redress. Finally, the results highlight the need for comprehensive support for HCPs involved in safety incidents.

Toward understanding nurses' decisions whether to miss care: A discrete choice experiment.

BACKGROUND: Studies of missed nursing care suggest that it results from ward-level, patient-related, and task-type factors, while nurses' decision-making style was scarcely studied. Studying the effect of nurses' decision-preference structures, namely a pattern of joint ward and patient factors, on missed care may also contribute to understanding the phenomenon. OBJECTIVES: To examine the relationships between decision-preference structures and missed care and the moderating effects of decision-making styles and task type in these links. DESIGN: A discrete choice experiment with a between- and within-participants design. PARTICIPANTS: A sample of 387 registered nurses working in acute medical surgical wards in Israel. METHODS: Based on the protocol for discrete choice experiments, a survey was developed to assess the decision-preference structure, considering five factors: overload, presence of head nurse, clinical complexity, difficult patient, and presence of relatives. Participants were randomly assigned to four task-type conditions and completed a survey regarding their task. Decision-making style was assessed using a validated questionnaire. RESULTS: Extensive workload (b = -0.46; p = 0.001), difficult patient (b = -0.20; p = 0.001), and patient clinical complexity (b = -0.10; p = 0.006) were negatively linked to the probability of missed care. The interaction between workload and task type (b = 0.252; p = 0.017) indicated that the probability of missed care under extensive compared with regular workload was lowest for developing a discharge plan and highest for providing emotional support. The interaction of patient complexity and task type (b = 0.230; p = 0.013) indicated that the probability of missed care in developing a discharge plan and medication administration was lower for patients having high compared with low clinical complexity. The interaction between difficult patient and task type (b = -0.219; p = 0.044) indicated that the probability of missed care in emotional support, developing a discharge plan, and patient's mobility was lower for difficult than for non-difficult patients. Finally, the interaction between workload and decision-making style (b = -0.48; p = 0.001) indicated that the probability of missed care under heavy compared with regular workloads was lower for the dual-preference or the dominantly intuitive styles. CONCLUSIONS: This design enabled examining the prioritizing processes nurses use when deciding about whether to miss care. The likelihood of missing more in structured tasks is lower under a heavy overload and when patients appear difficult or clinically complex. Dual-preference styles or dominantly intuitive styles are more suitable for the routine high workload.

Job crafting strategies of nurse mentors as mentors and nurses and their impact on missed nursing care: A cross-sectional study.

BACKGROUND: Nurse mentors face challenging circumstances because of their dual role as nurses and mentors. As nurses, they are expected to provide high-quality care for patients and as mentors, they are concomitantly engaged with developing the next generation of nurses. OBJECTIVES: To examine the relationship between job crafting strategies and missed nursing care among nurse mentors, in their roles as nurses and mentors. DESIGN: A cross-sectional design. SETTING: Various wards and hospitals during 2021. PARTICIPANTS: Eighty nurse mentors responsible for supervising nursing students. METHODS: Participants completed on-line survey, including the MISSCARE questionnaire, the Job Crafting Scale, and control variables. SPSS was used to conduct two multivariable linear regressions. RESULTS: As a nurse, higher enhancing structural job resources was significantly associated with lower missed nursing care, while higher enhancing social job resources was significantly associated with higher missed nursing care. As a mentor, higher enhancing structural job resources was significantly associated with lower missed care, while higher enhancing challenging job demands was significantly associated with higher missed care. CONCLUSION: The results indicate that not all job crafting strategies are effective in maintaining high-quality care among nurse mentors. In their dual role as nurses and mentors, nurse mentors often face a Catch-22 situation, namely, meeting expectations of both students and patients. Thus, they increase their job resources and challenging demands; however, not all strategies improve the quality of care. Nursing policymakers and managers should provide tailored interventions that enhance the structural job resources of nurse mentors and avoid the use of challenging job demands and social job resource strategies when mentoring nursing students.