Effects of an unfolding case study on clinical reasoning, self-directed learning, and team collaboration of undergraduate nursing students: A mixed methods study.

BACKGROUND: Clinical reasoning is an essential nursing competency that students must develop to provide safe patient care. Developing and utilizing unfolding case studies, which present constantly changing patient conditions to improve students' clinical reasoning and to foster communication and self-reflection, can help to achieve that imperative. OBJECTIVES: To develop an unfolding case study and to test its effectiveness in improving clinical reasoning, team collaboration, and self-directed learning. DESIGN: A mixed methods design. SETTING: One university in Southern Taiwan. PARTICIPANTS: Forty nursing students. METHODS: An unfolding case study was developed based on the clinical reasoning model and unfolding cases model. The Nurses Clinical Reasoning Scale, Self-Directed Learning Instrument, and Questionnaire of Group Responsibility and Cooperation in Learning Teams were used. Forty nursing students completed questionnaires and nine of them participated in focus group discussions. Wilcoxon signed-rank, Spearman correlation, regression, and inductive content analysis were used to analyze data. RESULTS: Students' abilities in clinical reasoning, self-directed learning, and team collaboration were statistically significantly improved after implementation of the unfolding case study. Emergent themes included "patient-centered communication," "group inspiration and learning," "thinking critically and reflecting on oneself," and "applying theoretical knowledge in care to meet patients' changing needs." CONCLUSIONS: Unfolding case studies provide a safe environment in which nursing students may learn and apply knowledge to safe patient care.

Development and validation of a Chinese version chronic wound health-related quality of life instrument: A methodological study.

AIMS AND OBJECTIVES: To develop a Chinese version of a chronic wound health-related quality of life (QoL) instrument and to examine the psychometric properties of this instrument. BACKGROUND: Existing QoL instruments are not tailored to the linguistic and cultural characteristics of Chinese-speaking patients; a version addressing this gap will increase clinical understanding of their healthcare experience and may help guide chronic wound care. DESIGN: A methodological study. METHODS: The method advanced by DeVellis (2017) was used to develop the instrument. An initial pool of 38 items was created. To optimize scale length and test reliability and validity, exploratory and confirmatory factor analyses were conducted. A total of 23 items formed the final pool. After two rounds of expert discussions, the average content validity index of the final 23 items was .89. RESULTS: A total of 226 patients completed the instrument and were divided into two groups for further analysis. Exploratory factor analysis revealed that 15 items remained in four factors (social activity restrictions, physical and psychological disturbance, wound burden and daily life limitation), which accounted for 64.87% of the variance. Confirmatory factor analysis revealed an acceptable fit of the hypothesized factor structure and the convergent and discriminant validities were achieved. Cronbach's α coefficients for each factor were .807, .773, .799 and .713, respectively. CONCLUSION: The Chinese version of a chronic wound health-related QoL instrument consists of 15 items in four subscales and demonstrates good reliability and validity. RELEVANCE TO CLINICAL PRACTICE: This instrument can be used intermittently or continuously to evaluate the treatment effect of chronic wounds by assessing health-related QoL. Scholars in Chinese-speaking regions may find this culturally compatible instrument useful when conducting studies related to chronic wounds. PATIENT OR PUBLIC CONTRIBUTION: Two hundred twenty-six participants provided their perspectives on health-related QoL.

Effects of Case Management in Trauma Patients in Taiwan: A Randomized, Longitudinal Study.

BACKGROUND: Case management can improve trauma patient outcomes from the acute to rehabilitation phases. However, a lack of evidence on the effects of case management in trauma patients makes it difficult to translate research findings into clinical practice. OBJECTIVE: To examine the effects of case management on illness perception, coping strategies, and quality of life in trauma patients followed up to 9 months post-hospital discharge. METHODS: A four-wave longitudinal experimental design was used. Patients with traumatic injury hospitalized at a regional hospital in southern Taiwan from 2019 to 2020 were randomly assigned to a case management (experimental) or a usual care (control) group. The intervention was implemented during hospitalization with a phone call follow-up about 2 weeks post-discharge. Illness perception, coping strategies, and health-related quality-of-life perceptions were measured at baseline, 3 months, 6 months, and 9 months after discharge. Generalized estimating equations were used for analysis. RESULTS: Findings showed a significant difference in illness perception at 3 and 6 months and coping strategies used at 6 and 9 months after discharge between the two groups. No significant difference in the quality of life over time between the two groups was found. CONCLUSION: Although case management appears to help patients with traumatic injuries decrease illness perception and better cope with their injury, it did not significantly improve their quality of life 9 months after discharge. It is recommended that health care professionals develop long-term case management strategies for high-risk trauma patients.

Are we of one mind about core competencies of nurse preceptors? A nominal group technique study.

AIM: This paper explored the differences in perspectives on the core competencies of nurse preceptors among postgraduate-year nurses, clinical nursing preceptors and head nurses. DESIGN: Cross-sectional design with nominal group technique (NGT). METHOD: The sample consisted of 32 postgraduate-year nurses, 42 preceptors and 27 head nurses. Two rounds of NGT were used to collect the group opinions. RESULTS: While the rank/level of importance varied, three groups all agreed that teaching traits, clinical nursing profession, communication and collaboration, teaching pedagogy, reaction of contingency and consultation of academic writing were important core competencies for nurse preceptors. The three groups disagreed on critical thinking and reflection, as well as lifelong learning. This study clarifies cognitive differences and expectations among three groups and can assist medical institutes in designing preceptor training courses.

[Application and Recommendation of Entrustable Professional Activities (EPAs) in Nursing Education].

The competency-based approach has been advocated in medical education in recent years to strengthen the professional competencies and skills of medical professionals entering their residency. Entrustable professional activity (EPA), which consists of clinical tasks, core competencies, and milestones, is a recommended competency-based training program focused on the learning process of trainees. EPA emphasizes that trainers evaluate their trainees' learning repeatedly and provide feedback so that these trainees have an opportunity to correct their behaviors. However, EPAs have not yet been widely implemented in school-based nursing education. The purpose of this essay was to introduce the concept, connotations, development stage, and application of EPAs. The dilemmas and recommendations of EPA development in Taiwan are also presented.

Attitudes and Intentions of Adult Patients With Cancer Toward Advance Directive: Direct and Indirect Relationships.

BACKGROUND: Advance directives (ADs) are used to respect the will of patients experiencing a terminal illness regarding preferred medical treatment and to protect their rights. However, the AD completion rate is low. OBJECTIVE: The aim of this study was to explore the factors influencing patient intentions toward AD. METHODS: The Theory of Planned Behavior was used as the framework for this study. This study used a cross-sectional design using a face-to-face interview with structured questionnaires. A total of 230 patients with cancer were recruited. Path analysis was used to examine the hypotheses. RESULTS: Demographic variables were not correlated with patients' attitudes toward AD. Patients' knowledge of AD ( ß = .68, t = 16.15, P < .00) and recognition of important others' attitudes toward AD ( ß = .30, t = 10.74, P < .00) were predictors of patients' attitudes toward AD. Patients' attitudes toward AD ( ß = .27, t = 3.74, P < .00) and behavior control over AD ( ß = .09, t = 1.99, P < .04) predicted patients' intentions toward AD. CONCLUSION: Patients' knowledge of AD, the patients' important others' attitudes, and behavior control toward AD are predictively associated with the intention toward AD completion. IMPLICATIONS FOR PRACTICE: Only when patients with cancer are provided an accessible approach for obtaining knowledge regarding AD and are given sufficient time and space can they and their significant others understand the meaning of AD and decide to complete one on their own terms.

Potential predictors of quality of life in patients with venous leg ulcers: A cross-sectional study in Taiwan.

Internationally, the impact of venous leg ulcers (VLUs) on the quality of life is well recognised; however, in Taiwan, the focus is only on chronic wound management. This cross-sectional correlational study conducted at the cardiovascular and plastic surgery clinics of a regional teaching hospital between August 2019 and June 2020 investigates venous clinical severity, pain, fatigue, depression, sleep quality, quality of life, and related factors among 167 patients with VLUs. The potential predictors of the quality of life in terms of activities were venous clinical severity (P < 0.001), pain (P = 0.004), and fatigue (P < 0.001) after adjusting for covariates. The potential predictors of the quality of life in terms of the psychological domain were marital status (single/divorced) (P = 0.016), marital status (widowed) (P = 0.027), venous clinical severity (P < 0.001), pain (P = 0.001), and fatigue (P = 0.002). The potential predictors of the quality of life with regard to symptoms were venous clinical severity (P < 0.001), pain (P < 0.001), fatigue (P = 0.001), and depression (P = 0.038). These potential predictors can serve as the basis of interventions for patients with VLUs, such as those related to nutrition or training in wound dressing.

Patient participation in healthcare activities: Nurses' and patients' perspectives in Taiwan.

Patient participation in healthcare activities is key to producing successful patient-centered care. However, little is known about both nurses' and patients' perspectives regarding patient participation in East Asia. This paper compared and contrasted perspectives of patient participation in healthcare activities between nurses and patients, using a qualitative study with a purposive sample of 39 nurses and 15 patients. A semi-structured interview was applied to focus groups for nurses, and to face-to-face interviews for patients. Content analysis was utilized to analyze the data, and common themes and subthemes were identified showing three similarities (authoritative culture, participation behaviors, and obstacles to participation), and two differences (sources of acquiring patient-related health information, and responsible party). Nurses and patients did not entirely view participation in healthcare activities congruently. Relevant clinical practices are also suggested, including respecting patients' autonomy, nurses' using layman's language for explanations, patients' understanding the meaning behind their participation behaviors, recognizing obstacles faced in enhancing patient participation with adjusted nursing workload, actively providing needed health information, and leading patients to realize that they will be responsible for their health behaviors after discharge.

Exploring core competencies of clinical nurse preceptors: A nominal group technique study.

AIM: The aim of this study was to explore core competencies of nurse preceptors based on the perspectives of postgraduate-year nurses, nurse preceptors and head nurses. BACKGROUND: Perspectives of core competencies of nurse preceptors are varied among postgraduate-year nurses, nurse preceptors and head nurses, which makes it difficult to establish preceptor training programs and develop evaluation instruments. DESIGN: A nominal group technique study. METHODS: A nominal group technique procedure was applied to small-group and large-group discussion. The participants were recruited from the inpatient units at five nonprofit hospitals, each having over 1000 patient beds, in Taiwan. A total of 101 participants were involved in this study: 32 postgraduate-year nurses, 42 nurse preceptors and 27 head nurses, who were respectively sorted into five, six and four small groups with six to eight members in each group. After applying nominal group technique procedure, the core competencies were scored and ranked. Based on the final scores and ranking, the core competencies that the participants felt to be most important for nurse preceptors were identified. The expert panel then integrated these core competencies and derived a consensus. RESULTS: Seven core competencies of nurse preceptors were derived, in order of declining importance: teaching traits, clinical nursing profession, communication and collaboration, teaching pedagogy, reaction of contingency, critical thinking and reflection and consultation on academic writing. All participants perceived that teaching traits (198 points) and clinical nursing profession (161 points) were the most important. Consultation of academic writing is unique, which may be due to the clinical ladder system still being implemented in Taiwan. CONCLUSIONS: The nominal group technique is an efficient and proper method to conduct a consensus for specific issues or values among individuals and groups. The results of this study can facilitate the development of evaluation indicators or instruments as well as provide a direction of continuing education program for preceptor training.

Effectiveness of a Nurse-Delivered Intervention on Illness Perceptions and Quality of Life in Patients With Injury.

BACKGROUND: Research has shown that nursing interventions are able to affect short-term outcomes in patients with injury. However, evidence based on a comprehensive nurse-led intervention may be beneficial for trauma care. PURPOSE: This study was designed to assess the effect of a nursing intervention on the illness perceptions and quality of life of patients with injury. METHODS: A two-group experimental design and a follow-up period of 12 months were used. Ninety-four patients were randomly assigned to either the experimental group or the control group. A nurse-led cognitive behavioral therapy intervention was used to improve outcomes. RESULTS: The illness perception variables of "personal control" and "treatment control" were found to be significantly improved in the experimental group at 3 months after discharge, whereas "emotional perception" was significantly improved at 6 months after discharge. The intervention was also shown to improve "social quality of life" at 6 and 12 months after injury. CONCLUSIONS: This study adds new knowledge related to nursing interventions for patients with injury in terms of the intervention achieving longer-term effects than the interventions examined in previous studies. The results highlight the importance of providing interprofessional collaborative care. However, the intervention protocol should be tested further in future studies.

Effects of simulation-based learning on nursing students' perceived competence, self-efficacy, and learning satisfaction: A repeat measurement method.

BACKGROUND: Simulation-Based Learning is beneficial to nursing education. Nevertheless, recent studies have shown a side effect of being overwhelmed by repeated exposures to simulation. Thus, how many times simulation scenarios should be provided to students remains a question for nursing faculty. OBJECTIVES: The objectives of this study were to (1) explore the changes in nursing students' perceived competence, self-efficacy, and learning satisfaction after repeated exposures to simulations, and (2) determine the acceptable frequency of SBL in the 'Integrated Care in Emergency and Critical Care' course. DESIGN: A one-group repeated measurement experimental design with self-administered questionnaires in a convenient sample of senior nursing undergraduate students was used. SETTINGS: Department of Nursing at a nonprofit university in southern Taiwan. PARTICIPANTS: Seventy-nine out of 84 senior nursing students who enrolled in the course in 2019 volunteered to complete all measurements. METHODS: After taking the baseline measurements (T0), students were exposed to 75-min simulation scenarios from Time 1 (T1) to Time 3 (T3) three weeks apart throughout the semester. Students' nursing competence, self-efficacy, and learning satisfaction were measured immediately after each exposure. Descriptive statistics, t-test and repeated measurement analysis of variance were used for data analysis. RESULTS: There were statistically significant improvements from T0 to T3 (p < .001) in nursing competence, self-efficacy, and learning satisfaction scores after repeated exposures to simulation. When comparing scores from T1 to T2 and from T2 to T3, there was no significant difference. CONCLUSION: Simulation based learning is effective in improving nursing students' perceived competence, self-efficacy, and learning satisfaction. While the primary changes occur at the first simulation effort, it is the accumulated multiple exposure experiences collectively improve students' learning outcomes. Multiple instructional strategies besides simulation are recommended to maintain nursing students' learning interests to achieve optimal learning outcomes of the course across a semester.

Health Professionals' Perspectives on the Efficacy of Using Comprehensive Care to Improve Outcomes in Patients With Traumatic Injury.

BACKGROUND: Barriers related to comprehensive posttrauma care and health outcome monitoring exist. The insights and perspectives of health professionals on this issue may help integrate care experiences to provide continuous care to patients with traumatic injury. PURPOSE: The purpose of this study was to explore the perspectives of health professionals with regard to comprehensive care to improve the outcomes of patients with traumatic injury. METHODS: Data were collected at two teaching hospitals in Taiwan. In total, 28 health professionals across various disciplines were interviewed in five focus groups. RESULTS: Six themes were delineated, including "wound care is a primary concern for patients," "ineffective health education during the hospital stay," "patients and families worry about postinjury conditions," "current continuity of care is not effective," "lack of standards for discharge planning," and "incorporation of interdisciplinary care to improve patient outcomes." CONCLUSIONS: The experiences of health professionals are useful to the establishment of a foundation for trauma case management and interdisciplinary care for hospitals.

Evaluation of nursing students' perceptions of their cultural care competency: A mixed method study in Taiwan.

Growing cultural diversity among immigrants has challenged health care practice in Taiwan. This study used mixed methods to evaluate how the implementation of a course on cultural competence embedded in a nursing course affected nursing students' perceptions of their cultural care competency. An evaluation survey with a quantitative questionnaire comprising pre- and post-test measures of self-perceived cultural care competency was implemented for 48 participants at the commencement and completion of the course. A focus group interview (n = 10) was conducted and a thematic approach applied to analyze qualitative data. The results found a significant improvement in self-perceived cultural care competency (t = 7.15, p < 0.001). Two themes emerged from the qualitative analysis: (1) the thought-provoking nature of the course and (2) appreciation for the multiple learning strategies of the course. The findings suggest that embedding cultural competence education in nursing courses is essential to improving nursing students' perceptions of their cultural care competency.

Effects of simulation-based learning on nursing student competences and clinical performance.

The aims of this study were to explore the effects of simulation-based learning (SBL) on nursing student competences and performance in the clinical setting. A comparison group design was used with data obtained from self-administered questionnaires at the onset and end of the semester. Students' practicum grades were also collected to examine their clinical performance. Four simulated scenarios were added to the course and a Chinese version of the Simulation-Based Learning Evaluation Scale (SBLES) was distributed to the participants. The student practicum evaluation form was used to collect the participants' practicum grades. Data analyses included descriptive statistics, paired t-test, and analysis of covariance (ANCOVA). Positive, significant differences were found in five competences in the test group. In the comparison group, results in the professional knowledge and nursing process subscale showed significant differences, and no significant difference was found in the patient safety, communication, and attitude of reflection subscales. The students in the test group perceived greater competences than those in the comparison group. Finally, no significant findings were found in clinical performance between two groups. The findings showed that SBL is seen as an attractive teaching strategy for students' learning as part of their curriculum and that the effects of SBL on clinical practice need further examination.

Resilience enhancement among student nurses during clinical practices: A participatory action research study.

BACKGROUND: Clinical practice is an essential component of nursing students' preparation for applying theoretical knowledge in a real-life setting. However, students often experience clinical practice as extremely stressful, which may disrupt their clinical performance, impact the quality of patient care they provide as well as their own physical and psychological health, and hinder their continuation into nursing careers. Resilience, understood as the capability to overcome challenges, is critical for these students. PURPOSE: To develop and implement a resilience enhancement (RE)-based project for Taiwanese nursing students during their Last Mile practicum. DESIGN AND METHODS: A participatory action research (PAR) approach was used in which ongoing planning, action, and reflection informed real-time progress. Twenty-eight nursing students in clinical practice participated in the study. A six-workshop RE project was completed over the course of two months. Evaluation methods involved group discussion, individual interviews, and reflective diaries. Content analysis was applied to the data. RESULTS: Through a PAR-based project, participants achieved positive results. Three outcome themes were identified: Increasing self-exploration, Furthering confidence and competency, and Constructing resilience. CONCLUSIONS: The PAR-based RE project helped students to develop resilience by enhancing their nursing knowledge and skills and practicing positive thinking and behavior. CLINICAL RELEVANCE: The findings can be a reference for nursing educators in designing RE programs for students during clinical practice to increase their professional competence and provide psychological supports.

Illness Perceptions and Return to Work in Patients With Moderate to Severe Injuries.

AIM: Research indicates that injured patients' illness perceptions constitute a strong influence on their return to work (RTW). This study examined the relationships between illness perceptions and RTW in injured patients. DESIGN: A prospective cohort design was employed. METHODS: One hundred fifty-six patients were recruited from three hospitals, and 132 completed follow-up data at 3 months after injury. Three-month illness perceptions were measured using the Chinese Illness Perception Questionnaire Revised-Trauma. Return to work was defined as being able to return to a paying job covered by national work insurance. RESULTS: Non-RTW in injured patients tended to occur among patients who were older, less educated, more severely injured, and more likely to be admitted to intensive care units than patients who did RTW. Return to work patients also had more positive illness perceptions than non-RTW patients. Illness perceptions were associated with non-RTW, but the most important determinants of non-RTW were serious injury and older age. CONCLUSIONS: This study provides evidence to indicate that illness perceptions, personal data, and illness characteristics are associated with injured patients' RTW or non-RTW. The role of rehabilitation nurses may be extended accordingly based on findings from this study. IMPLICATIONS FOR PRACTICE: Case management with an interprofessional team may have positive impacts on RTW in injured patients. Rehabilitation nurses should identify patients' expectations of RTW and should work with an interdisciplinary team to develop interventions to reshape the patients' perceptions of returning to work, facilitating their transition back to work, if possible.

An exploratory factor analysis for developing and validating a scale of Nursing Students Competence Instrument.

BACKGROUND: Nursing competency is a standard component of the nursing curriculum in baccalaureate nursing education in Taiwan. However, limited studies have been found on the development of a measurement for assessing Taiwanese baccalaureate-level nursing competency. OBJECTIVE: The aim of this study was to develop and validate a Nursing Students Competence Instrument (NSCI) for Taiwanese baccalaureate-level nursing students. DESIGN: The items of this newly developed scale were derived from a previous published qualitative study by the authors. Validity and reliability of the instruments were assessed with exploratory factor analysis. In considering external validity and homogenous characteristics, data were collected from two periods of time: February 2011 and 2012. SETTING: Four hundreds nursing students enrolled in the 2-year baccalaureate-level at the study university in Taiwan were invited to participate in the study. PARTICIPANTS: Two hundreds and nine nursing students in the 2-year baccalaureate-level program were recruited. METHODS: Descriptive statistics and exploratory factor analysis were used to determine validity of the instrument. Cronbach alpha, split-half coefficients and item analysis verified the reliability of instrument. RESULTS: Significant levels of reliability and validity for the newly developed Nursing Student Competency Instrument were found. The competency instrument comprised four dimensions with 27 items for graduates to meet to determine their nursing competency. Four factors were analyzed and categorized as integrating care abilities, leading humanity concerns, advancing career talents, and dealing with tension, and explained 22.29%, 18.59%, 15.99% and 11.23% of total variance, respectively; these four explained 68.09% of the total variance. CONCLUSIONS: Results support validation of the new nursing competence assessment scale for Taiwanese nursing students at baccalaureate levels. The authors recommend that the NSCI could be applied in the nursing schools to evaluate the learning outcomes of nursing students' competence.

Development and validation of the simulation-based learning evaluation scale.

BACKGROUND: The instruments that evaluate a student's perception of receiving simulated training are English versions and have not been tested for reliability or validity. PURPOSE: The aim of this study was to develop and validate a Chinese version Simulation-Based Learning Evaluation Scale (SBLES). METHODS: Four stages were conducted to develop and validate the SBLES. First, specific desired competencies were identified according to the National League for Nursing and Taiwan Nursing Accreditation Council core competencies. Next, the initial item pool was comprised of 50 items related to simulation that were drawn from the literature of core competencies. Content validity was established by use of an expert panel. Finally, exploratory factor analysis and confirmatory factor analysis were conducted for construct validity, and Cronbach's coefficient alpha determined the scale's internal consistency reliability. Two hundred and fifty students who had experienced simulation-based learning were invited to participate in this study. RESULTS: Two hundred and twenty-five students completed and returned questionnaires (response rate=90%). Six items were deleted from the initial item pool and one was added after an expert panel review. Exploratory factor analysis with varimax rotation revealed 37 items remaining in five factors which accounted for 67% of the variance. The construct validity of SBLES was substantiated in a confirmatory factor analysis that revealed a good fit of the hypothesized factor structure. The findings tally with the criterion of convergent and discriminant validity. The range of internal consistency for five subscales was .90 to .93. Items were rated on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree). CONCLUSIONS: The results of this study indicate that the SBLES is valid and reliable. The authors recommend that the scale could be applied in the nursing school to evaluate the effectiveness of simulation-based learning curricula.

Illness Representations of Injury: A Comparison of Patients and Their Caregivers.

PURPOSE: This study examined the differences between illness representations of injured patients and those of their caregivers. DESIGN: A comparative descriptive survey was used. METHODS: The study setting was the surgical wards of a teaching hospital in Taiwan. Data were collected at 3 to 6 months after hospital discharge. Participants were 127 pairs of injured patients and their caregivers. The participants completed sociodemographic data and completed the Chinese Illness Perception Questionnaire Revised-Trauma, which is composed of eight subscales. Clinical data of the injured patients was obtained from medical records. RESULTS: Injured patients and their caregivers were pessimistic about the injury. Patients perceived significantly more physical symptoms than caregivers did. Caregivers for patients who were severely injured or admitted to an intensive care unit (ICU) had more negative perceptions than did those who were providing care for moderately injured patients or those not admitted to an ICU. Caregivers who did not share their caring responsibilities had more negative perceptions than did those who shared their caring responsibilities with others. CONCLUSIONS: This study found that patients and caregivers had negative illness representations several months after injury. Caregivers who provided care for severely injured patients or who did not share caring responsibilities perceived different extents of illness perceptions about the injury. The interventions should highlight the need to assist patients and caregivers after injury. CLINICAL RELEVANCE: Exploring the discrepancies in illness perceptions between injured patients and their caregivers can help clinicians to provide individualized care, and to design interventions that meet patients' and caregivers' needs.

Factors influencing nurses' attitudes and intentions toward medication administration error reporting.

AIM: The aims of this study were to explore the factors that influence nurses' attitudes and intentions toward medication administration error (MAE) reporting. METHODS: The theory of planned behavior was used as the framework for this study. A cross-sectional design was used, and data were obtained from self-administered questionnaires. A total of 596 staff nurses who worked in a regional hospital for at least 3 months were invited to participate in this study. The researchers used exploratory factor analysis and confirmatory factor analysis to test the psychometric properties of each measurement scale. The 1 week data collection period was between September and November 2013. Descriptive statistics were used to examine the demographic and job characteristics of the participants and multiple linear regression was used to test the hypotheses. RESULTS: Of the 596 nurses invited to participate, 548 (92%) completed and returned a valid questionnaire. The findings indicated that altruism, and nurse managers' and co-workers' attitudes are predictors for nurses' attitudes toward MAE reporting, and nurses' attitudes and co-workers' attitudes affect nurses' intention to report MAE. No connection was found between report control and nurses' intentions toward MAE reporting. CONCLUSION: The findings reflected that altruism, and nurse managers' and co-workers' attitude, and nurses' attitudes toward MAE reporting are predictors of nurses' intentions toward MAE reporting. The authors strongly recommended the healthcare system to institute an open communication and learning culture.