Professional autonomy among Registered Nurses-Validation of the translation of the Dempster Practice Behaviour Scale and survey results.

AIM: To test the psychometric properties of the Finnish version of the Dempster Practice Behaviour Scale and explore nurses' professional autonomy along with which characteristics are related to it. DESIGN: An instrument validation and a descriptive cross-sectional study. METHODS: The web-based survey was conducted in September 2021 at two university hospitals in Finland. Exploratory factor analysis (EFA) was used to explore the factor structure of the modified instrument, while Cronbach's α coefficients were calculated to determine the reliability of the scale. Descriptive univariate and multivariate analyses were conducted to examine Registered Nurses' professional autonomy. The study followed STROBE guidelines. RESULTS: During the validation process, the 30 items of the Dempster Practice Behaviour Scale were reduced to 25 items. The S-CVI/Ave for the translated scale was 0.94. When one additional item was omitted from the EFA, the results supported five factors, which explained 45.9% of the total variance. The mean overall autonomy score was 3.63 out of 5, with readiness and empowerment the subscales with the highest and lowest, respectively, mean values. The linear regression models showed that age, nursing experience, unit type, education, shift, and perceptions of the importance of professional autonomy were related to the subscales describing professional autonomy. CONCLUSION: The psychometric testing provided evidence that the translated instrument was reliable. Nurses assessed that they are skilled professionals who are accountable for their actions. However, they experienced rather low levels of professional autonomy in empowerment and valuation. Health care organizations should consider this through authentic leadership and, thus, possibly strengthen professional autonomy.

Nurse leaders' interpersonal communication competence: A mixed-method systematic review.

AIM(S): To identify and synthesize evidence available on nurse leaders' interpersonal communication competence. DESIGN: Systematic mixed-methods review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. METHODS: The data were collected following predefined inclusion criteria. Two authors independently performed the study selection using Covidence software. Three authors assessed the quality using Joanna Briggs' Institute's critical appraisal tool and the mixed-methods appraisal tool. The data-based convergent synthesis design and narrative synthesis were used. DATA SOURCES: CINAHL, PubMed, Scopus, Business Source Elite, Academic Search Premier, Communication & Mass Media Complete, PsycInfo, Web of Sciences, Medic and Finna.fi were searched and the screening of citations in relevant articles. The final searches were performed on 17 October 2022. RESULTS: A total of 26 studies-15 quantitative, 9 qualitative and 1 of both mixed-method and multi-method-met the inclusion criteria. The nurse leaders' interpersonal communication competences described in the extant literature were categorized into three themes: message competence, relational competence and task competence. There were considerable differences in the levels of competence, as some competences were considered basic communication skills, while others required more advanced level competences. Furthermore, three competence levels were identified: novice, competent and expert. CONCLUSIONS: This study unravels a unique hierarchical description of communication skills across competence categories, supported by the assumption that communication skills are structured hierarchically. The studies reviewed herein had a narrow perception of nurse leaders' interpersonal communication competence and indicated a transmissional understanding of communication. IMPACT: This is the first mixed-methods systematic review that describes and synthesizes the evidence on nurse leaders' communication competencies hierarchically and across competence levels. The study suggests that further research should focus on a broader and more analytical understanding of the cognitive and affective aspects of interpersonal communication competence. PROSPERO ID: CRD42023385058. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Spiritual interventions: Improving the lives of colorectal cancer survivors-A systematic literature review.

AIM: To systematically review the types of spiritual interventions available for colorectal cancer survivors and determine if they improve their lives. DESIGN: Systematic review. DATA SOURCE: A thorough literature search was conducted in July 2023 using PRIMO, PubMed/Medline, Cochrane, CINAHL, Scopus, and EMBASE. REVIEW METHODS: As an extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist, the Synthesis Without Meta-Analysis reporting guideline was employed. A narrative synthesis was used to analyse the data. RESULTS: Thirty-five articles were analysed for this study. The findings suggest that psychoeducational intervention, cognitive behavioural therapy intervention, mindfulness intervention, social intervention, and spiritual counselling improved CRC survivor's coping skills, boosted self-esteem, lessened anxiety, instilled hope, enhanced daily functioning, improved survival rates, improved neurological functional status and quality of life (QoL). CONCLUSION: There is proof that spiritual interventions help CRC patients and improve their QoL. It has been discovered that spiritual intervention is helpful in the diagnosis, management, and treatment of CRC conditions. IMPACT: CRC survivors may have impairments in their physical ability and daily functioning as a result of many symptoms, such as pain, bowel dysfunction, and exhaustion. Furthermore, individuals may encounter difficulties in several aspects of their psychological, emotional, social, and role functioning due to the presence of dread symptoms. Therefore, these study will help CRC survivors To implement spiritual interventions in the management of their long-term care. To cultivate problem-solving abilities, foster self-assurance, and enhance self-awareness. To alleviate symptoms, enhance everyday functioning, and improve QoL. NO INDUCEMENT: No financial incentives were used to compensate patients or members of the public for this review.

Organizational characteristics of nursing practice environments related to registered nurses' professional autonomy and job satisfaction in two Finnish Magnet-aspiring hospitals: structural equation modeling study.

BACKGROUND: Nurses are leaving their profession because of poor personal job satisfaction, heavy workload, and unfavorable work environments with low professional autonomy. Professional autonomy involves the possibility to influence one's work and have a sense of control - the ability to contribute to a workplace culture and influence how decisions are made. This study explores registered nurses' perceptions of the nursing practice environment, using the Nursing Work Index-Revised (NWI-R), and its relationships with professional autonomy and job satisfaction. METHODS: A cross-sectional study along with instrument re-validation was conducted using a web-based survey for nurses in two Magnet-aspiring hospitals in Finland in September 2021 (n = 586). Structural equation modeling was used to find out the relationships of the NWI-R components with professional autonomy and job satisfaction. RESULTS: Principal component analysis and confirmatory factor analysis supported seven components with 34 items. Collegial nurse-doctor relationships, organization's quality standards, and nursing involvement and expertise sharing (means of 3.23, 2.96, and 2.66, respectively) demonstrated a favorable nursing practice environment; professional nursing standards, nurse management and leadership, staffing and resource adequacy, and professional advancement (means of 2.38, 2.18, 2.15, and 2.13, respectively) demonstrated an unfavorable nursing practice environment. The presented model (RMSEA 0.068, CFI 0.987, TLI 0.946) indicated that nursing involvement and expertise sharing, organization's quality standards, nurse management and leadership, and collegial nurse-doctor relationships were related to professional autonomy. Nurse management and leadership, staffing and resource adequacy, and organization's quality standards were related to job satisfaction. Moreover, professional autonomy was related to job satisfaction. CONCLUSION: Nurses' professional autonomy is important due to its relationship with job satisfaction. When factors that increase professional autonomy are taken into account and attention is paid to the promotion of autonomy, it is possible to improve nurses' job satisfaction. These issues cannot be solved at the unit level; investment is needed at the organizational and political levels. The results introduce nurses, managers, researchers, and stakeholders to improvements in the nursing practice environment toward an organizational culture where nurses may utilize their professional autonomy to its full potential.

Care quality and satisfaction at the cancer hospital - a questionnaire study of older patients with cancer and their family members.

BACKGROUND: The unique life situations of older patients with cancer and their family members requires that health care professionals take a holistic approach to achieve quality care. The aim of this study was to assess the perceptions of older patients with cancer and family members about the quality of care received and evaluate differences between their perceptions. A further aim was to examine which factors explain patients' and family members' levels of satisfaction with the care received. METHODS: The study was descriptive and cross-sectional in design. Data were collected from patients (n = 81) and their family members (n = 65) on four wards in a cancer hospital, using the Revised Humane Caring Scale (RHCS). Data were analysed using descriptive statistics, crosstabulation, Wilcoxon signed rank test, and multivariable Analysis of Covariance (ANCOVA). RESULTS: Family members had more negative perceptions of the quality of care than patients did. Dissatisfaction was related to professional practice (p < 0.001), interaction between patient and health care professionals (p < 0.001), cognition of physical needs (p = 0.024), and human resources (p < 0.001). Satisfaction with overall care was significantly lower among those patients and family members who perceived that they had not been involved in setting clear goals for the patient's care with staff (p = 0.002). CONCLUSIONS: It is important that older patients with cancer and family members receive friendly, respectful, individual care based on their needs and hopes, and that they can rely on professionals. Health care professionals need more resources and education about caring for older cancer patients to provide quality care.

Continuing education for advanced practice nurses: A scoping review.

AIM: The aim of the study was to identify the nature and extent of scientific research addressing continuing education for advanced practice nurses. DESIGN: A scoping review. REVIEW METHODS: The Joanna Briggs Institute's methodology for scoping reviews. DATA SOURCES: Electronic search was conducted on 17 September 2023 via CINAHL, PsycINFO, PubMed, Scopus, Web of Science, Cochrane Library and the Joanna Briggs Institute's Evidence-Based Practice Database for research articles published between 2012 and 2023. RESULTS: Nineteen papers were included in this review. Scientific research on continuing education for advanced practice nursing roles (i.e. nurse practitioner, clinical nurse specialist) has primarily been conducted in the United States and mostly addresses online-delivered continuing education interventions for clinical care competency. Most of the interventions targeted nurse practitioners. CONCLUSION: Continuing education has a pivotal role in supporting advanced practice nursing competency development. In addition to clinical care, future continuing education research should focus on other advanced practice nursing competencies, such as education, leadership, supporting organizational strategies, research and evidence implementation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Continuing education programmes for advanced practice nurses should be rigorously developed, implemented and evaluated to support the quality and effectiveness of patient care. IMPACT: Continuing education for advanced practice nursing roles is an understudied phenomenon. This review highlights future research priorities and may inform the development of continuing education programmes. REPORTING METHOD: PRISMA-ScR.

Finnish Version of the Specialist Outcomes and Barriers Analysis Scale: Evaluation of Psychometric Properties.

PURPOSE: To evaluate the psychometric properties of the Finnish version of the Specialist Outcomes and Barriers Analysis Scale. DESIGN: This was a cross-sectional survey study. METHODS: Cultural adaptation of the translation and content validity of the translated instrument were assessed by expert panelists (n = 5) using the content validity index. The construct validity was assessed with principal component analysis using the survey data of Finnish registered nurses (n = 60). Scale reliability was assessed with Cronbach's α values. All study phases were conducted in 2021. RESULTS: The items (n = 59) of the scale were critically evaluated by the experts. The full-scale content validity was revealed as excellent (0.92). In terms of construct validity, the scale was analyzed separately for outcomes and barriers. The outcomes section revealed a 5-component structure with an overall Cronbach's α coefficient of .96, and the barriers section, a 2-component structure with an overall Cronbach's α coefficient of .82, indicating adequate reliability of the scale. CONCLUSION: The Finnish version of the scale showed excellent content and construct validity. The Cronbach's α values represented adequate reliability of the Specialist Outcomes and Barriers Analysis scale when measuring nurses' perceived practice outcomes and barriers in the Finnish context.

Nurse managers' perceptions of nurses' professional autonomy-A qualitative interview study.

AIMS: To describe nurse managers' perceptions of nurses' professional autonomy in hospitals and their role in promoting it. DESIGN: A qualitative descriptive approach. METHODS: Fifteen nurse managers participated in semi-structured focus group interviews in two university hospitals in Finland between May and June 2022. The data were analysed using inductive content analysis. RESULTS: Nurses' professional autonomy in hospitals is perceived according to three themes: individual qualities behind independent actions, limited influencing opportunities in the organization and physicians' central effect. The nurse managers perceive that they enhance nurses' professional autonomy by promoting the nurses' independence at work, their sufficient and up-to-date competence, their expert role in multi-professional cooperation and joint decision-making and an open and appreciative work community. CONCLUSIONS: Nurse managers can enhance nurses' professional autonomy with shared leadership. However, there are still gaps in nurses' equal possibilities to influence multi-professional work, especially outside of patient care. Promoting their autonomy requires commitment and support from leadership at all levels of the organization. The results advise nurse managers and the administration of the organization to maximize the potential of nurses' expertise, along with encouraging nurses towards self-leadership. IMPACT: This study provides an innovative approach to nurses' roles through their professional autonomy from the perspective of nurse managers. These managers have an important role in enhancing nurses' professional autonomy, empowering and supporting them in their expertise, enabling necessary advanced training, and maintaining an appreciative work community where all have equal participation opportunities. Thus, nurse managers have the opportunity to strengthen high-quality multi-professional teams' ability to jointly develop the patient's care for better outcomes through their leadership. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Promoting resilience among adult cancer patients: An integrative review of patient education methods.

PURPOSE: To explore the essential elements of patient education methods for promoting resilience among adult cancer patients. METHODS: The PubMed, Scopus, CINAHL and PsycInfo databases were searched fromJanuary 2010 to April 2021. The outcome of interest was resilience. The integrative review applied the PRISMA statement guidelines. RESULTS: Nine studies were identified, which formed three main patient education strategies that fell under categories: 1. Provision of illness-related information 2. Learning self-management skills 3. Provision of emotional support and the adjustment process. The key elements include promotion of positive factors, easing patients' mental burden, highlighting the importance of illness-related information, developing self-management skills, and emotional support. Interventions prepared patients for the future, enhanced their understanding of illness and recovery process, and comfort in physical and mental aspects of life, and improved their resilience. CONCLUSIONS: Resilience among cancer patients is a process that helps them adjust to live with cancer. The provision of psychosocial support and illness-related information, as well as learning self-management skills, are essential elements of patient education interventions that aim to improve resilience among adult cancer patients.

Resilience, job satisfaction, intentions to leave nursing and quality of care among nurses during the COVID-19 pandemic - a questionnaire study.

BACKGROUND: The COVID-19 pandemic has challenged nurses and healthcare systems globally and raised major concerns for nurses' wellbeing and working conditions. This cross-sectional and correlational study design aims to describe nurses' resilience, job satisfaction, intentions to leave and quality of care, and explain their relationships during the COVID-19 pandemic. METHODS: Data were collected from Registered Nurses (N = 437) in Finland through an electronic survey between February 2021 and June 2021. The questionnaire covered background characteristics (seven questions), resilience (four questions), job satisfaction (one question), intention to leave nursing (two questions), quality of care (one question), and requiring factors of the work (eight questions). The background variables and dependent variables were analyzed and presented using descriptive statistics. Structural equation modeling was used to explain dependent variables relationships. The study followed procedures recommended in the STROBE Statement for cross-sectional studies in efforts to maximize the quality of reporting results. RESULTS: The surveyed nurses evaluated their resilience by mean score 3.92, more nurses had considered leaving nursing during the pandemic (16%) than before (2%). Nurses´ mean score of requiring factors of the work was 2.56 and overall job satisfaction 5.8. Structural equation modeling revealed that resilience affected their job satisfaction, which also influenced the quality of care, that was rated moderate (7.46 out of 10). Structural equation modeling indices of goodness of fit were NFI = 0.988, RFI = 0.954, IFI = 0.992, TLI = 0.97, CFI = 0.992, and RMSEA = 0.064. No direct relationship was found between resilience and intention to leave nursing. CONCLUSIONS: Good resilience promoted delivery of high-quality care by nurses during the pandemic and enhanced their job satisfaction, which reduced their intention to leave nursing. The results indicate that it is important to develop interventions that support nurses' resilience. IMPACT: The study highlights the importance of nurses' resilience during the pandemic, while job satisfaction may decrease and requiring factors of the work increase. Given the number of nurses who consider leaving nursing, there are clear needs to develop effective strategies to maintain quality healthcare with resilient, committed nursing staff.

Patient satisfaction - results of cluster analysis of finnish patients.

BACKGROUND: Healthcare providers must understand patients' expectations and perceptions of the care they receive to provide high-quality care. The purpose of this study is to identify and analyse different clusters of patient satisfaction with the quality of care at Finnish acute care hospitals. METHODS: A cross-sectional design was applied. The data were collected in 2017 from three Finnish acute care hospitals with the Revised Humane Caring Scale (RHCS) as a paper questionnaire, including six background questions and six subscales. The k-means clustering method was used to define and analyse clusters in the data. The unit of analysis was a health system encompassing inpatients and outpatients. Clusters revealed the common characteristics shared by the different groups of patients. RESULTS: A total of 1810 patients participated in the study. Patient satisfaction was categorised into four groups: dissatisfied (n = 58), moderately dissatisfied (n = 249), moderately satisfied (n = 608), and satisfied (n = 895). The scores for each subscale were significantly above average in the satisfied patient group. The dissatisfied and moderately dissatisfied patient groups reported scores for all six subscales that were clearly below the average value. The groups significantly differed in terms of hospital admission (p = .013) and living situation (p = .009). Patients representing the dissatisfied and moderately dissatisfied groups were acutely admitted more frequently than patients in other groups and were more likely to live alone than satisfied and moderately satisfied patients. CONCLUSION: The results mostly demonstrated high levels of patient satisfaction; however, the perceptions of minority populations of dissatisfied patients should be assessed to identify shortcomings in the care provided. More attention should be paid to acutely admitted patients who are living alone and the pain and apprehension management of all patients.

Influence of perceived benefits, barriers and activities of family engagement in care on family nursing practice: A cross-sectional correlational study.

AIMS: To describe nurses' perceptions of family nursing practice and to explore the influence of their perceptions of the benefits, barriers and activities of family engagement in care on family nursing practice. DESIGN: A cross-sectional correlational study. METHODS: In total, 460 nurses from two tertiary hospitals in the central region of Uganda participated. Quantitative and qualitative data were collected between August 2020 and January 2021 using the Family Nursing Practice Scale. Analyses included descriptive statistics, t-test, Pearson correlation, analysis of variance and ordinal logistics regression. Quantitative content analysis was carried out on the textual data. RESULTS: Nurses who perceived that family engagement in care improves patient and family outcomes were more likely to rate family nursing practice highly. Perceived barriers to family engagement in care particularly time constraints, work overload and family-related conflicts have a negative and significant influence on family nursing practice. Nurse characteristics such as education, usual shift pattern and personal experience of having a family member in hospital are significantly associated with family nursing practice; nurses who work morning shifts were likely to report higher family nursing practice. CONCLUSION: The study reveals that several parameters (perceived barriers, perceived benefits and nurse characteristics) influence nursing practice with families. Thus, bearing in mind the diversity of healthcare contexts, the findings show that multiple interacting factors are important for advancing family nursing interventions and practice. IMPACT: Probabilistic factor-specific predictions of nursing practice with families are provided in this study - this addresses a gap in the evidence regarding the elements that should be optimized when designing well-informed policies and interventions to advance family nursing practice. A comparison of results in the literature with the present study's findings suggests a need to broaden the scope and context perspective in future research and broaden the understanding of how nurses´ perceptions influence family engagement in care. REPORTING METHOD: The study adheres to the STROBE reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: Family members/caregivers were involved in the design of the study particularly in assessment of validation of the tools used in the study.

Extending ageing nurses' working lives: A mixed-methods systematic review.

AIM(S): To identify, describe and assess research evidence on factors that promote working until and beyond the official retirement age among nurses. DESIGN: A mixed-methods systematic review. PROSPERO ID: CRD42022303890. DATA SOURCES: The CINAHL, PsycINFO, MEDLINE, Scopus, SocINDEX and Web of Science databases were searched in December 2021. REVIEW METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was followed. Two researchers independently applied eligibility criteria, selected studies and conducted quality appraisals. Data-based convergent synthesis and thematic analysis were used. RESULTS: Eighteen studies were included, most of which were survey-based. Eleven studies were quantitative, six were qualitative and one used mixed methods. Our results reveal that willingness to continue in work increased with age. Six factors promoted working until and beyond the official retirement age among nurses: good health and work ability, the significance of work sufficient income, meaningful relationships and support in the working community, individually tailored work arrangements, and organizational support and recognition. CONCLUSION: To sustain experienced nurses in working life and promote their working beyond retirement age organizations urgently need to apply throughout working lives supporting age management schemes. Interventions should target supportive relations and individual and flexible arrangements at the workplace. Scarce studies investigated factors contributing to an extension of working life among nurses. Most published evidence on this topic is based primarily on nurses' subjective opinions and preferences: no intervention studies or objective evaluations of factors affecting retirement were found. IMPACT: The available evidence suggests the most critical factors for extending nurses' working lives are support and individual and flexible arrangements in the workplace. There is a need to test interventions and evaluate the effectiveness of measures encouraging nurses to extend their working lives. NO PATIENT OR PUBLIC CONTRIBUTION: Systematic review.

Systematic education has a positive impact on nurses' evidence-based practice: Intervention study results.

AIMS: To evaluate how an education program on evidence-based practice (EBP) affected nurses´ knowledge, practices, and attitudes related to EBPs in patient care. METHODS: Nurses of one Finnish university hospital participated in two separate EBP education programs in 2016-2017 and 2018-2019. Data was collected by a questionnaire given before and after each program. Reliable instruments for measuring EBP were used: The Evidence-Based Practice Questionnaire (24 items) and the Attitudes to Evidence-Based Practice Questionnaire (17 items). Means and frequencies were evaluated with the Mann-Whitney U test and linear regression. RESULTS: Nurses reported that their EBP practice, skills and the Work based on EBPs improved substantially after the education program. We found that scores on the Work based on EBPs and the attitudes towards EBP could predict the nurses' overall self-evaluations of practices, attitudes, and skills. DISCUSSION: EBP education affects positively on implementation of nurses' practices and skills. There is still a need to change attitudes towards evidence based practice. IMPLICATIONS FOR PRACTICE, RESEARCH, POLICY, MANAGEMENT, AND EDUCATION: Organizations need to maintain and develop efficient, attractive EBP educational programs to promote lifelong learning. CONCLUSIONS: When designing EBP educational content, it is crucial to teach participants to develop evidence-based methods and consider how to implement them in practice.

Core competencies of healthcare professionals in Oman: Research and evidence-based practice needs attention.

AIM: The aim of the study was to examine (1) the perceptions on core competencies of healthcare professionals working at clinical settings in Oman and (2) which demographic characteristics explain the overall core competency. DESIGN: A cross-sectional design. METHODS: Healthcare Professional Core Competency Instrument, consisting of 11 sub-scales with 81 items, was distributed to healthcare professionals (n = 1,543; 826 nurses and 717 physicians) who worked at primary, secondary and tertiary healthcare institutions. Descriptive statistics, t-test, ANOVA and linear regression were used for data analysis. RESULTS: Altogether 1,078 healthcare professionals (628 nurses and 450 physicians) responded representing 70% overall response rate. Healthcare professionals perceived their overall core competence as excellent, safety being the highest, and research and evidence-based practice was the lowest. The multiple linear regression analysis revealed that ethnicity, gender and years of working experience were the characters that explained the overall core competence, where expatriate senior professionals reported higher competency levels compared with counterparts.

Older patients' perceptions of the quality of acute cancer care: An integrative review-A mixed-method approach.

AIM: This integrative review aimed to describe the perceptions of the quality of care of older patients (aged 65 and above) living with cancer in acute-care settings. METHODS: We identified relevant research suitable for inclusion criteria through systematic searches of the PubMed®, EBSCOhost Academic Search Premier®, Scopus® and Web of Science® databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and the Synthesis Without Meta-analysis (SWiM) guidelines were used to conduct the research and report the results. The quality of the studies was evaluated using the modified Critical Skills Appraisal Programme (CASP) checklist. RESULTS: A total of 24 studies met the inclusion criteria. The data analysis revealed that care quality could be described through three distinct themes: individuality, a sense of security and respectful encounters. CONCLUSION: The perceptions of older people living with cancer regarding the quality of acute care have not been extensively covered in the literature. Health- and age-related challenges, patients' overall life situation, clear, realistic information about care and the future and respect during encounters should be given attention. IMPLICATIONS FOR PRACTICE: Patient-centred and tailored care, considering the heterogeneity of the population and support for independence, is needed.

Validation of the Nurse Managers' Work Content Questionnaire and Factors-A Structural Equation Modeling Study.

BACKGROUND: The responsibilities of nurse managers are diverse and occasionally inadequately organized. Moreover, the role of nurse manager often lacks a clear job description. Few methodologies for evaluating the content of nurse managers' work exist. PURPOSE: This study was designed to validate the Nurse Managers' Work Content Questionnaire (NMWCQ) instrument and to analyze the relationships between NMWCQ factors and background variables using structural equation modeling. METHODS: A multicenter descriptive and cross-sectional study design was used. The NMWCQ, which includes 87 items across 13 components, was developed based on a comprehensive literature review and pilot study. The questionnaire was sent to all of the nurse managers ( N = 756) employed at eight Finnish hospitals in 2019. Exploratory and confirmatory factor analyses were used to psychometrically test and validate the NMWCQ, whereas Cronbach's alpha values were calculated to explore the internal consistency of the instrument. Structural equation modeling was applied to detect the relationships between the constructed factor structure and the background variables. RESULTS: Two hundred seven nurse managers participated in this study. The final solution for the NMWCQ included 75 items across 12 factors. The NMWCQ factors were as follows: responsibility for new employees, daily management, human resource management, decision making, clinical nursing, development, planning of processes, collaboration, ensuring knowledge, evidence-based management, ensuring care quality, and financial management. The items showed factor loadings that were either positive or negative, with values ranging from .314 to .846. The Cronbach's alpha values for the factors ranged between .605 and .851. All of the covariances and relationships between background variables and factors were found to be significant ( p ≤ .05). The structural equation modeling showed acceptable index results (incremental fit index = .954, comparative fit index = .951, and root mean square error of approximation = .048). CONCLUSIONS: The NMWCQ version assessed in this study shows a more robust structure than the previously published pilot version. Psychometric testing showed the NMWCQ as suitable for describing the diverse work requirements of nurse managers and may offer a framework for concretizing the job description of nurse managers.

Nurse leaders' work-related well-being-Relationships to a superior's transformational leadership style and structural empowerment.

AIMS: To describe how nurse leaders' work-related well-being is related to a superior's transformational leadership style and structural empowerment. BACKGROUND: The demanding role of nurse leader means that these professionals experience emotional exhaustion and challenges with work-life balance. They can also be influenced by the leadership style of their own superiors. METHODS: A cross-sectional questionnaire using two internationally validated scales, namely, the Transformational Leadership Scale and Conditions For Work Effectiveness Questionnaire-II, was used. Statistical methods were applied during data analysis. RESULTS: A total of 155 nurse leaders participated completed the questionnaire. The participants' work-related well-being scores ranged from 8 to 10. The participants felt that their superiors employ transformational leadership. The dimension of feedback and rewards received the lowest scores, whereas the nurse leaders reported moderate overall empowerment levels. A nurse leader's work-related well-being was positively correlated with structural empowerment and their superior's leadership style. CONCLUSIONS: Despite the fact that nurse leaders reported relatively high levels of work-related well-being, more attention should be paid on the feedback and rewards and on the support of superiors as they positively influence the work-related well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Transformational leadership should be supported in organisations and through education as it strengthens work-related well-being and structural empowerment of nurse leaders.

Polychoric Correlation With Ordinal Data in Nursing Research.

BACKGROUND: Measures in nursing research frequently use Likert scales that yield ordinal data. Confirmatory factor analysis using Pearson correlations commonly applies to such data, although this violates ordinal scale assumptions. OBJECTIVES: The aim of this study was to illustrate the application of polychoric correlations and polychoric confirmatory factor analysis as a valid alternative statistical approach using data on family members' perceived support from nurses as an exemplar. METHODS: A primary analysis of cross-sectional data from a sample of 800 participants using data collected with the Iceland-Family Perceived Support Questionnaire was conducted using polychoric versus Pearson correlations, analysis of variance, and confirmatory factor analysis. RESULTS: A two-factor measurement model was compatible with data from family members in the Ugandan care settings. Two contextual factors (cognitive and emotional support) constituted the family support measurement model. A factor correlation indicated that the two factors reflected distinct but closely related aspects of family support. Polychoric correlation revealed 13.8% (range: 5.5%-25.2%) higher correlations compared to Pearson correlations. Moreover, the polychoric agreed with the data, whereas the Pearson confirmatory factor analysis did not fit based on multiple statistical criteria. Analyses indicated a difference in emotional and cognitive support perception across two family characteristics: education and relationship to the patient. DISCUSSION: A polychoric correlation suggests stronger associations, and consequently, the approach can be more credible with an ordinal Likert scale than Pearson correlations. Hence, polychoric confirmatory factor analysis can address a larger proportion of variance. In nursing research, polychoric confirmatory factor analysis can confidently be utilized when conducting confirmatory factor analysis of ordinal variables in Likert scales. Furthermore, when a Pearson confirmatory factor analysis is used for ordinal Likert scales, the researcher should carefully evaluate the difference between the two approaches and justify their methodological choice. Even though we do not suggest dispensing with Pearson correlations entirely, we recommend using polychoric correlation for ordinal Likert scales.

Nurses' Perceptions of the Management of Acute Pain in Emergency Departments: Cross-sectional Study.

AIM: This study aimed to describe registered nurses' perceptions of acute pain management in emergency departments. DESIGN: The study design was a cross-sectional survey carried out in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. One hundred one nurses from 5 different emergency departments participated in the survey. METHODS: Data were analyzed using descriptive methods, nonparametric tests, and principal component analysis. RESULTS: Continuing education was significantly related to pain management. Nurses who had received continuing pain management education thought more often that challenges in pain management impact patients' acute pain management than those who had not received education. Nurses reported that patients received inadequate pain medication. The most used nonpharmacological methods were ice therapy and postural care. The nurses reported that music and conversation with the patient ameliorated the patients' acute pain. Nurses stated that their lack of knowledge concerning pain management and workload affected their acute pain management. CONCLUSION: Study results emphasize the need to develop ongoing pain management education for registered nurses and in addition to further research of nonpharmacological alleviation method in emergency departments.