Telemedicine entrustable professional activities for nurses in long-term care: A modified Delphi study.

BACKGROUND: As the use of telemedicine proliferates in community care, it is essential to ensure practice recommendations and guidelines are available to assist healthcare providers in providing telemedicine-based care. This study aimed to develop entrustable professional activities (EPAs) for nursing home nurses involved in telemedicine consultations. AIM: To develop entrustable professional activities (EPAs) for nursing home nurses involved in telemedicine consultations. DESIGN: Modified Delphi study. METHODS: The study was conducted in two stages. First, content analysis of 28 healthcare provider interviews and literature review on telemedicine competencies was conducted to develop an initial list of EPAs. An expert workgroup comprising of an international panel of academics and clinicians reviewed the activities. In the second stage, a three-round e-Delphi technique was used to develop telemedicine EPAs for nurses in long-term care. Descriptive statistics and qualitative feedback were distributed to participants after each round. Agreement within survey rounds was computed. RESULTS: Six core telemedicine EPAs with 28 descriptors were developed, from preparing the resident for the teleconsultation encounter to follow-up care post-teleconsultation. Agreement coefficients were high across all Delphi rounds. CONCLUSION: This study identifies the core functions that long-term care nurses' are expected to perform in telemedicine consultations. The internationally relevant EPAs are sufficiently broad to be adapted to design telemedicine training and workplace-based assessment for nurses. Organisations may utilise the EPAs as a resource during the implementation process of telemedicine services in long-term care in designing nursing workflow and complement the learning and development of nurses for telemedicine services. Equipping long-term care nurses with this resource can ensure consistency, patient safety and quality of teleconsultations delivered to nursing home residents. However, further work is required to expand the EPAs for application to practice.

Retention of Doctors and Dentists to Serve in Remote Areas in Indonesia: A Discrete Choice Experiment.

Introduction: Retaining doctors and dentists in remote areas of Indonesia remains a national priority of the Indonesian government. The purpose of this study was to analyze the interventions for retention of doctors and dentists in remote areas using the discrete choice experiment (DCE) approach. Materials and Methods: A DCE was conducted to investigate preferences of doctors and dentists for retention in remote areas. This research was conducted in 78 primary healthcare settings across 15 provinces in Indonesia. The conditional logit model was used to explore stated preferences for each attribute. Results: The total number of respondents was 158, including 113 doctors and 45 dentists. In general, doctors placed the highest preference on getting priority for government scholarships to facilitate retention in remote areas (OR=5.65, p<0.001). Specifically, dentists preferred security guarantees from local government (OR = 4.87, p<0.001). Both groups valued having an official residence (OR=3.6, p<0.001) as a factor for retention in remote areas. Conclusion: Scholarship, security guarantees, housing facilities, and medical facilities were the most considered factors for retaining doctors and dentists in a remote area. This study confirms the importance of a combination of interventions in maintaining doctors and dentists in remote areas. Policy options in the form of non-financial and financial intervention packages can be combined to improve their retention.

Perspectives on the implementation of health informatics curricula frameworks.

BACKGROUND: The COVID-19 pandemic highlighted the necessity of equipping health professionals with knowledge and skills to effectively use digital technology for healthcare delivery. However, questions persist about the best approach to effectively educate future health professionals for this. A workshop at the 15th Nursing Informatics International Congress explored this issue. OBJECTIVE: To report findings from an international participatory workshop exploring pre-registration informatics implementation experiences. METHODS: A virtual workshop was held using whole and small group interactive methods aiming to 1) showcase international examples of incorporating health informatics into pre-registration education; 2) highlight essential elements and considerations for integrating health informatics into curricula; 3) identify integration models of health informatics; 4) identify core learning objectives, resources, and faculty capabilities for teaching informatics; and 5) propose curriculum evaluation strategies. The facilitators' recorded data and written notes were content analysed. RESULTS: Fourteen participants represented seven countries and a range of educational experiences. Four themes emerged: 1) Design: scaffolding digital health and technology capabilities; 2) Development: interprofessional experience of and engagement with digital health technology capabilities; 3) implementation strategies; and 4) Evaluation: multifaceted, multi-stakeholder evaluation of curricula. These themes were used to propose an implementation framework. DISCUSSION: Workshop findings emphasise global challenges in integrating health informatics into curricula. While course development approaches may appear linear, the learner-centred implementation framework based on workshop findings, advocates for a more cyclical approach. Iterative evaluation involving stakeholders, such as health services, will ensure that health professional education is progressive and innovative. CONCLUSIONS: The proposed implementation framework serves as a roadmap for successful health informatics implementation into health professional curricula. Prioritising engagement with health services and digital health industry is essential to ensure the relevance of implemented informatics curricula for the future workforce, acknowledging the variability in placement experiences and their influence on informatics exposure, experience, and learning.

Missed nursing care among nursing students: A scoping review.

BACKGROUND: Nursing students report facing inconsistencies between theoretical knowledge and actualities of clinical practice, and research indicates they witness missed nursing care during clinical practice. Understanding nursing students' experiences can inform improved clinical learning environments and enhance patient care quality. Recently, research has focused on students' views regarding missed care, yet comprehensive understandings of this phenomenon are lacking. OBJECTIVE: This review explored what is known about missed nursing care from perspectives of nursing students. DESIGN: A scoping review according to Arksey and O'Malley's framework and Joanna Briggs Institute methodology was undertaken. DATA SOURCES: Key databases were searched, including Medline, Embase, CINAHL, Scopus, ProQuest, PsycINFO and Web of Science in August 2023. REVIEW METHODS: The review included qualitative, quantitative, and structured literature reviews published in English between 2006 and 2023. Inclusion and exclusion criteria and keywords guided the search. Data screening and extraction were independently performed by two reviewers. Included studies were analysed using descriptive statistics and narrative synthesis. Findings are reported in accordance with the PRISMA-ScR. RESULTS: Of the 5873 articles identified, nine were included in the review. Studies were conducted in seven countries. Themes in students' perceptions included negligence of patients' rights and dignity, living in limbo, and pragmatic acceptance. Reasons for missed care included ineffective teamwork, lack of interest in caring, and inefficient leadership. Missed nursing care adversely affected patient health, hindered student learning and professional growth. Strategies for improvement included enhancing teamwork, enforcing ethical issues, increasing supervision, and creating commitment to work. CONCLUSION: Missed nursing care affects patient safety and education of nursing students. Incorporating practical training modules into curricula, establishing preceptorship programs, and incorporating ethics education into clinical practice are crucial to address missed nursing care. Further research in diverse settings is warranted.

Contextual determinants impacting final year nursing students' emergency team communication during deteriorating patient simulations: A grounded theory study.

BACKGROUND: Ability to focus on development of students' team communication and non-technical skills may be reduced in content saturated nursing curricula. Even when communication and simulation-based education is provided, students' utilisation of non-technical skills remains challenging. Although simulation is a recognised means to learn communication skills, little is known about nursing students' team communication in simulated settings. OBJECTIVE: To understand the process by which final year undergraduate nursing students communicate in simulated team emergencies. DESIGN: Using constructivist grounded theory, data was collected using semi-structured interviews and student observations and analysed using constant comparative analysis. SETTING: Simulation laboratories in one university nursing school in Australia. PARTICIPANTS: 21 final year nursing students in seven teams. METHODS: Data were gathered from interviews and video observations of final year nursing students during simulated team emergencies. RESULTS: Interview data and observations of video-recordings revealed contextual determinants that influence communication within teams: the simulation context, the student context and the team context. Team member characteristics, such as cultural and linguistic background, life experiences, gender and age, the ability to shift from leadership to followership as well as environmental factors such as mask wearing and simulation fidelity, contributed to uncertainty in communicating that nursing team effectiveness. CONCLUSIONS: Improvement of contextual conditions necessitates implementation of supportive strategies. These include development of educational initiatives, and further research in experiential learning as a modality for learners to experience team communication. Further, simulation context, student context and team context are important considerations. Meeting clinical communication learning needs of students allows better preparation to care for deteriorating patients as graduates.

Improving Adolescent Psychosocial Assessment through Standardized Patient Simulation: An Interdisciplinary Quality Improvement Initiative.

Adolescent suicide and mental illness have increased at alarming rates. Healthcare professionals report a lack of skill and confidence in obtaining adolescent histories and managing confidential care due to limited training in residency. Nursing professional development practitioners face challenges of adequately preparing interdisciplinary healthcare providers to assess, identify, and intervene at all points of contact with adolescents. To increase the confidence in clinical communication skills and clinical competency, and to increase the number of social work referrals related to modifiable risk factors for adolescent patients, a Texas pediatric tertiary care center utilized standardized patient (SP) methodology to supplement traditional clinical experiences with communication-focused education based on the Home, Education, Eating, Activities, Drugs, Sexuality, Suicidality, and Safety (HEEADSSS) interviewing. This quality improvement (QI) pilot demonstrated the benefits of utilizing standardized patient methodology in communication-focused education based on the HEEADSSS interviewing. Following the SP simulations, confidence in clinical communication skills increased by 13%, clinical competency in performing comprehensive psychosocial interviews increased by 11%, use of HEEADSSS increased by 64%, and social work referrals increased by 89%. This interdisciplinary SP interviewing simulation pilot was beneficial in improving the 36 physician and nursing residents' ability to conduct psychosocial assessments for risk factors of suicidality among adolescents.

Spiritual care for older people living in the community: A scoping review.

BACKGROUND: The population of older people should be supported to enjoy optimal quality of life. Health professionals should consider a range of interventions that support the older population to maintain their quality of life. One such interventional approach involves spiritual care. OBJECTIVE: To explore what is known about spiritual care approaches for older people living in the community. METHODS: Scoping review informed by Joanna Briggs Institute guidelines. Eight electronic databases were searched: CINAHL, Ageline, PubMed, ProQuest Nursing & Allied Health, PsycINFO, Scopus, Garuda, and Neliti. The review included quantitative and qualitative primary peer-reviewed research studies focusing on spiritual care interventions for older people living in the community published between 2011 and 2021 in English or Bahasa Indonesia. The search was uploaded into an electronic citation manager and imported into Covidence for screening. RESULTS: A total of 29 studies were included in the review. While the studies were conducted in five continents, most were reported from the Asian continent. Five key issues based on the outcome of interventions were found namely psychological, physical, spiritual, multidisciplinary approach, and social connection. CONCLUSION: This scoping review identifies spiritual interventions conducted across many countries have been implemented for older people living in the community. Although there are review limitations and further research is needed, these spiritual interventions, both faith-based and non-faith-based, are identified as useful to support the well-being of older people.

Quality and measurement properties of sexual health knowledge tools for adolescents: A rapid review.

OBJECTIVE: To evaluate the effectiveness of instruments designed for assessing sexual and reproductive health knowledge among adolescents. METHODS: Rapid review using the 2018 version of the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. RESULTS: This review included fourteen studies from 1983-2022, identifying sixteen Patient-Reported Outcome Measures (PROMs), mainly using Likert scales and self-administration. The overall methodological quality was deemed "Inadequate" per COSMIN standards. Although studies often addressed reliability and structural validity, only five covered hypothesis testing. Responsiveness and interpretability were addressed in one study each, while criterion validity was neglected. Among the instruments, the Sexual Health Questionnaire (SHQ) was distinguished for its robustness in several areas including notable construct validity, explaining 68.25% of the variance, high internal consistency (Cronbach's alpha: 0.90), and reliable test-retest results over 7 weeks, confirmed by Wilcoxon nonparametric test. CONCLUSION: The study underscores the urgent need for standardised, comprehensive development and validation of the PROMs on sexual health in adolescents. PRACTICE IMPLICATIONS: This review highlights the urgent need for research to refine existing PROMs and develop new ones for assessing adolescent sexual and reproductive health knowledge, aligning with global educational commitments and advancing the field.

Effectiveness of a Multimodal Nursing Intervention on Quality of Sleep, Fatigue, and Level of Depression Among Indonesian Patients With Gynecological Cancer: A Pilot Study.

BACKGROUND: The use of nonpharmacological modalities in managing symptoms experienced by patients with cancer is increasingly important in providing holistic care. However, limited studies have reported on integrating nonpharmacological interventions to improve physical and psychological symptoms of women with gynecological cancer. OBJECTIVE: The aim of this study was to examine the effect of a multimodal nursing intervention (MNI) on sleep quality, fatigue, and level of depression among Indonesian women with gynecological cancer. METHODS: The quasi-experimental nonequivalent group design involved 50 patients in 2 groups and used convenience sampling. An experimental group (n = 25) received MNI including progressive muscle relaxation and a counseling session; the control group received routine hospital care (n = 25). Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), depression levels by the Beck Depression Inventory-II, and fatigue by the Piper Fatigue Scale (PFS). Pretest data were collected after 3 days of hospital admission; posttest data were gathered after the intervention. RESULTS: The PSQI ( P = .000), Beck Depression Inventory-II ( P = .008), and PFS ( P = .000) changed significantly in the intervention group; the PSQI ( P = .000) and PFS ( P = .000) in the control group changed significantly. The PSQI ( P = .00) and PFS ( P = .000) scores differed significantly between the 2 groups before and after the intervention. The effect size of the MNI for difference scores before and after the intervention was medium effect size. CONCLUSIONS: The role of nonpharmacological modalities in managing symptoms experienced by patients with cancer is increasingly important to providing holistic care. IMPLICATION FOR PRACTICE: Gynecology nurses can lead the implementation of MNI to decrease patient fatigue and depression and to increase sleep quality.

Prevalence and factors associated with anemia in women of reproductive age across low- and middle-income countries based on national data.

Anemia is a global threat among women of reproductive age (WRA), or 15-49 years old women, both in developed and developing countries. Prevalence of anemia in WRA is higher by fourfold in developing countries, based on extensive studies and surveys conducted by WHO and UNICEF. However, there is limited studies that conducted pooled analysis of anemia prevalence in low resource countries. This study aimed to assess the prevalence and factors associated with anemia among women of reproductive age in low- and middle-income countries (LMICs). This study used secondary data from the Demographic and Health Survey (DHS) in 46 low- and middle-income countries during 2010-2021. Descriptive statistics of proportions between pregnant and non-pregnant mothers were assessed. Multilevel binary logistic regression was used to test the factors associated with anemia among women of reproductive age. A total of 881,148 women of childbearing age in LMICs were included. This study found a high prevalence of 45.20% (95% CI 41.21, 49.16) of anemia was observed in among pregnant women and 39.52% (95% CI 33.88, 45.15) anemia was observed in non-pregnant women. Educational status, wealth status, family size, media exposure, and residence were common factors significantly associated with anemia in both pregnant and non-pregnant women. The high global burden of anemia in LMICs continues to underline the need for unusual approaches and target interventions on an individual basis. Global commitment and movement to reduce the prevalence of anemia need to be revisited and redesigned for current circumstances.

Promoting generalisation in qualitative nursing research using the multiple case narrative approach: a methodological overview.

Background: The ability to generalise research generated findings to different contexts is a significant, yet overlooked, feature in qualitative studies conducted in nursing, where evidence-based clinical practice is highly regarded. The multiple case narrative is a constructivist-narrative approach, claimed to not only have the potential for analytical and case-to-case generalisation but also sample-to-population generalisation. Methods: This paper provides an overview of multiple case narrative by comparing it with similar methodologies, reviewing studies that have used this approach and critically evaluating its capacity for producing generalisable results. Results: The multiple case narrative approach addresses limitations of collective case study, case survey and meta-ethnography by employing greater sample sizes and more generalisable results. Most studies previously using this approach have been performed in the education field and with the purpose of overcoming sample size limitations in qualitative research. The approach offers a uniquely systematic approach to analysis by finding associations between categories generated from collective analysis of large number of cases and providing the potential for sample to population generalisation. Conclusion: Multiple case narrative, which to date has been underutilised, is a systematic approach with characteristics that make it an efficient research technique to provide valid qualitative evidence.

Recognizing and Adapting to Cultural Differences: Influence of International Educational Programs on Future Nursing and Midwifery Practice.

INTRODUCTION: International educational programs build cultural humility and safety skills in nursing and midwifery students; however, long-term outcomes of these programs are unclear. The purpose of this study was to explore the impact of international educational programs on nurses' and midwives' future professional practice. METHOD: Using grounded theory informed by Charmaz, 13 general nurses, two mental health nurses, three midwives, and four dual-qualified nurse/midwives across eight different countries were interviewed. Three categories evolved from the analysis. This article reports on the category Recognizing and adapting to cultural differences. FINDINGS: Participants developed cultural safety and awareness from participation in programs extending into future practice. Experiencing and adapting to cultural similarities and differences, they developed culturally congruent practices many years after program completion. DISCUSSION: International programs contributed to participants' professional practice. Positive and ongoing influences are important for employers to promote patient safety and culturally congruent quality care. Findings are also relevant for education providers to inform quality cultural learning.

Postgraduate nurse education in Indonesia and Australia: A comparative analysis.

BACKGROUND: Indonesia and Australia are neighbouring countries; however, their nursing systems are very different and there is limited migration between countries. AIM: As part of a larger study, the aim was to undertake a comparative analysis of postgraduate nurse education in Indonesia and Australia. DESIGN: Detailed literature review across academic and grey literature and semi-structured interviews with key stakeholders in Indonesia (n = 52) and Australia (n = 13) representing education, governments, professional nursing organisations, and rural, remote and urban health care providers. FINDINGS: Three key categories of comparison were identified: Higher Education System, Education Offerings, and Specialist practice and education standards. Regulation of higher education was found to generally be comparable. Postgraduate nursing specialisations are available in both countries, but there are currently more offerings in Australia. Furthermore, nurse practitioner education and graduate entry pathways into nursing are only currently available in Australia. Journal publications are required for graduation from masters and doctoral programmes in Indonesia, but not Australia. CONCLUSIONS: While there are many areas of similarity, postgraduate nurse education is more diverse in Australia, while there are growing opportunities for new developments in Indonesia. This analysis identifies areas for future consideration around postgraduate education development in both countries, along with possibilities for future collaboration. Furthermore, comparative analysis provided a useful foundation on mapping key elements.

Experiences of nurses and midwives with disabilities: A scoping review.

AIM: To identify the extent and type of evidence exploring the workplace experiences of nurses and midwives with disabilities. DESIGN: Scoping Review. DATA SOURCES: Four electronic databases were systematically searched in February 2022 to identify studies discussing the experiences of nurses and midwives with disabilities, published between 2012 and 2022. Google Scholar and Theses Global were also searched. REVIEW METHODS: All search results, irrespective of their format, were uploaded to Covidence to assist with the selection of evidence. Studies discussing the experiences of nurses and midwives with disabilities were included. Two reviewers conducted screening and data extraction independently, and a third reviewer resolved conflicts. RESULTS: Searches identified 130 studies. After screening for title and abstract, full-text review identified 23 studies for data extraction and analysis. Data were summarized and presented in tabular form under two categories (1) workplace experiences and (2) impact in the workplace. Results were presented in a descriptive, narrative form with accompanying tables. CONCLUSION: The nurse or midwife can be impacted significantly by disability. Currently, little is known about the workplace experiences of nurses and midwives with disabilities. Therefore, a better understanding of the experiences of the nurse and midwives with disabilities is important to increase diversity, equity, accessibility, and inclusion. IMPACT: Shortage of nurses and midwives worldwide highlights the need to understand why nurses and midwives with disabilities decide to leave the profession. Further research exploring the experiences of nurses or midwives with disabilities will help identify support requirements, develop frameworks for reasonable adjustment accommodations, and assist with future workforce planning. The EQUATOR guidelines for PRISMA have been met. No Patient or Public Contribution.

Interprofessional collaboration in telemedicine for long-term care: An exploratory qualitative study.

BACKGROUND: Widespread and sustained adoption of telemedicine in long-term residential care is emerging. Nursing home (NH) nurses play a key role in collaborating with remote physicians to manage residents' medical conditions through videoconferencing. Therefore, understanding of interprofessional collaboration and effective communication between nurses and physicians is critical to ensure quality of care and safety during teleconsultations. AIMS: To explore NH nurses' and physicians' experiences of interprofessional collaboration and communication during teleconsultations. METHODS: A qualitative descriptive design was adopted. Purposive sampling was conducted to recruit 22 physicians and nurses involved in NH teleconsultations. Semi-structured online interviews were conducted, and data were thematically analyzed. RESULTS: Three themes were identified: (1) Manner of communication in telemedicine, (2) sociocultural influences in collaborative practice, and (3) role expectations in telemedicine. Both nurses and physicians recognized the importance of building and maintaining trust as physicians heavily depended on nurses for provision of objective information for clinical decision-making. However, practice differences were observed between nurses and physicians during teleconsultations. Sociocultural influences such as power relations and language barriers also affected the nurse-physician relationship and interpersonal communication. Additionally, different performance expectations were identified between nurses and physicians. CONCLUSION: Interprofessional collaboration in teleconsultations is challenging because of lack of in-person assessment and dependence on nurses for clinical information. In addition, expectations and communication styles differ among healthcare professionals. This study called for interprofessional telemedicine training with incorporation of shared mental models to improve role clarity and communication. Given the international-dominated healthcare workforce in long-term care, the development of cultural competency could also be considered in telemedicine training to enhance nurse-physician collaborative practice. CLINICAL RELEVANCE: Telemedicine is increasingly adopted in long-term care settings, where multidisciplinary healthcare professionals from different health institutions are involved in resident care. Interprofessional collaboration should be incorporated into telehealth education for enhanced clinical practice in this care delivery model.

Baseline evaluation of nursing students' informatics competency for digital health practice: A descriptive exploratory study.

Introduction: The healthcare system is increasingly technology-dependent and proficiency in informatics skills is essential for health professionals to efficiently operate in the contemporary clinical environment. Nurses are major users of digital health technologies and graduates need to be well-prepared and confident to use the different available clinical systems competently as they transition from education to practice. Aim: To explore undergraduate nursing students' self-perceptions of informatics competence, set within a larger research project. Method: Descriptive, exploratory cross-sectional research design, with online self-assessment survey of undergraduate nursing students (n = 142). Data were analysed with descriptive, correlation and comparative statistics. Results: Participants' perceived overall mean informatics competency was at the level of somewhat competent, with only 40.84% (n = 58) at the level of competent. The highest mean value was in foundational information and communication skills and the lowest in information and knowledge management. Formal informatics education within curriculum was limited and lacked uniformity, as was prior exposure to important simulated informatics tools in preparation for practice. Factors including academic year level, computer experience and previous experience using clinical systems had a significant impact on participants' perceived informatics competency. Conclusion: Even though informatics competence is vital for clinical practice, with technology becoming pervasive within healthcare, nursing students' preparedness for digital health was sub-optimal. There were gaps in students' critical informatics practice knowledge with implications for work readiness of future graduates and nurse education practice.

Nurses and nursing students as second victims: A scoping review.

BACKGROUND: Second victim describes the impact on health care professionals after an error causing preventable patient harm. However, to date, the impact of making errors in practice by nurses and/or nursing students is unclear. PURPOSE: To describe and understand what is known about nurses and nursing students as second victims. METHODS: A scoping review was completed using three databases: CINAHL, Medline, and Proquest for the period between 2010 and 2022. A total of 23 papers underwent thematic analysis. DISCUSSION: Three themes were identified: (a) Psychological distress and symptomatology, (b) Coping-response/reactions to errors, and (c) Seeking support and understanding. CONCLUSION: Nurses and nursing students' well-being and productivity levels can be negatively affected by inadequate team and organisational support. To improve team functioning, appropriate support mechanisms must be implemented to assist nurses who experience significant distress after making errors. Nursing leadership should prioritise improving support programs, assessing workload allocation, and increasing awareness amongst leaders of the potential benefits of providing support to second victims.

Women's empowerment and contraceptive use: Recent evidence from ASEAN countries.

BACKGROUND: A fundamental element of gender equity are women's rights to reproductive choice. Women's empowerment is often linked to enabling decisions around contraceptive use and reduced fertility worldwide, although limited evidence is currently available around contraceptive use and decision making in ASEAN countries. OBJECTIVE: To examine the association between women's empowerment and contraceptive use in five selected ASEAN member states. METHODS: Data from the latest Demographic and Health Survey of Cambodia, Indonesia, Myanmar, The Philippines, and Timor-Leste were used. The main outcome was contraceptive use among married women (15-49 years) from these five countries. We considered four indicators of empowerment: labor force participation; disagreement with reasons for wife beating; decision-making power over household issues; and knowledge level. RESULTS: Labor force participation was found to be significantly associated with contraceptive use in all nations. Disagreement with justification of wife beating was not significantly related to contraceptive use in any country. Decision-making power (higher) was only associated with contraceptive use in Cambodia, while higher knowledge levels were associated with contraceptive use in Cambodia, and Myanmar. CONCLUSION: This study suggests women's labor force participation is an important determinant of contraceptive use. Policies designed to open the labor market and empower women through education should be implemented to enable women's participation. Gender inequality may also be tackled by engaging women in decision-making processes at national, community and family levels.

Nurses' and nursing students' reasons for entering the profession: content analysis of open-ended questions.

BACKGROUND: Global nursing shortages require effective recruitment strategies and understanding of individuals' motivations to enter the profession. These can be complex and bound by numerous factors such as gender and culture. While much research around this has been conducted, little has been undertaken in non-Western cultures where motivations could be different. AIM: To explore Indonesian nurses' and nursing students' motivations for entering the nursing profession. DESIGN: Online survey with closed and open-ended questions drawn from two different studies. This paper reports findings from one similar open-ended question. METHODS: As part of two larger surveys, nurses from 13 hospitals across one private health care group and nursing students with clinical experienced enrolled in a baccalaureate nursing program in Indonesia were asked the question, Why do you want to be a nurse? Responses were translated into English and back-translated into Indonesian prior to being subjected to summative content analysis. RESULTS: In total, 1351 nurses and 400 students provided responses to the question, representing 98.72% and 99.70% respectively of those completing the survey. Both groups were primarily influenced by desire to serve others and God, personal calling and influence of family members and others. Nurses identified a desire to work in the health field and with the sick, in a noble and caring profession. CONCLUSIONS: Nurses and nursing students were motivated by traditional perspectives on nursing. These should be considered in future recruitment activities. However, more research is needed to understand how these factors influence career choice.