Public Health Responses to CBRN Terrorism in the Middle East and North Africa.

OBJECTIVE: Escalating global challenges such as disasters, conflict, and climate change underline the importance of addressing Chemical, Biological, Radiological, and Nuclear (CBRN) terrorism for sustainable public health strategies. This study aims to provide a comprehensive epidemiological analysis of CBRN incidents in the Middle East and North Africa (MENA) region, emphasizing the necessity of sustainable responses to safeguard healthcare infrastructures. METHODS: Utilizing a retrospective approach, this research analyzes data from the Global Terrorism Database (GTD) covering the period from 2003 to 2020. The study focuses on examining the frequency, characteristics, and consequences of CBRN incidents in the MENA region to identify patterns and trends that pose significant challenges to public health systems. RESULTS: The analysis revealed a significant clustering of CBRN incidents in Iraq and Syria, with a predominant involvement of chemical agents. These findings indicate the extensive impact of CBRN terrorism on healthcare infrastructures, highlighting the challenges in providing immediate health responses and the necessity for long-term recovery strategies. CONCLUSIONS: The study underscores the need for improved healthcare preparedness, robust emergency response systems, and the development of sustainable public health policies. Advocating for international collaboration, the research contributes to the strategic adaptation of healthcare systems to mitigate the impacts of CBRN terrorism, ensuring preparedness for future incidents in the MENA region and beyond.

Emergency Nurse Roles, Challenges, and Preparedness in Hospitals in the Context of Armed Conflict.

INTRODUCTION: An understanding of emergency nurses' roles, challenges, and preparedness in the context of armed conflict is necessary to capture in-depth insights into this specialty and their preparational needs when working in these unique environments. Unfortunately, the evidence about emergency nurses' work in the context of armed conflict is scant. METHOD: Semi-structured interviews were conducted with 23 participants and analyzed using qualitative content analysis. The COREQ guideline for reporting qualitative research was followed. RESULTS: The emergency nurses' roles, challenges, and preparedness in hospitals in the context of armed conflict were explored in detail. The main challenges that these nurses faced included poor orientation, access block, and communication barriers. Various perspectives about preparation, including education, training, and strategies for preparing emergency nurses were identified. The most striking findings in these settings were the diversity of armed conflict injuries, clinical profiles of patients, triage of mass casualties, trauma care, surge capacity, orientation, communication, and strategies for preparing nurses. CONCLUSIONS: This study provided an exploration of the scope of emergency nurses' roles, and how they were prepared and expected to function across multiple hospitals in armed conflict areas. The resultant snapshot of their experiences, challenges, and responsibilities provides an informative resource and outlines essential information for future emergency nursing workforce preparedness. There is a broad range of preparational courses being undertaken by emergency nurses to work effectively in settings of armed conflict; however, required education and training should be carefully planned according to their actual roles and responsibilities in these settings.

Core competencies of emergency nurses for the armed conflict context: Experiences from the field.

BACKGROUND: Armed conflicts are usually associated with high mortality and morbidity rates, with unpredictable workload, injuries and illnesses. Identifying emergency nurses' views of the core competencies required to enable them to work effectively in hospitals in areas of armed conflict is critical. It is important to inform the requisite standards of care and facilitate the translation of knowledge into safe, quality care. AIM: The aim of this study was to identify emergency nurses' perceptions of core competencies necessary to work in hospitals in the context of armed conflict. METHOD: A descriptive qualitative phase of a mixed-method study using semi-structured interviews with participants was conducted from June to July 2019. The COREQ guideline for reporting qualitative research was followed. FINDINGS: A sample of 15 participants was interviewed. The participant perceptions provided a different perspective of core competencies required for emergency nurses in the context of armed conflict, culminating in four main areas: (i) personal preparedness , (ii) leadership, (iii) communication and (iv) assessment and intervention. CONCLUSION: This study identified emergency nurses' perceptions of their core competencies. Personal preparedness, leadership, communication, assessment and intervention were identified as contributing to calmness of character, confidence in care and cultural awareness for care in this setting and were essential for them to work effectively when managing victims of armed conflict in emergency departments. IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY: The findings of this study are important and novel because the researchers sought the perspectives of emergency nurses who have experience in receiving patients from armed conflict firsthand. The findings will inform policymakers in those settings regarding standard of care, education and drills for hospital nurses in optimizing armed conflict care response outcomes.

The Road to Developing Standard Time for Efficient Nursing Care: A Time and Motion Analysis.

(1) Background: The amount of time nurses spend with their patients is essential to improving the quality of patient care. Studies have shown that nurses spend a considerable amount of time on a variety of activities--which are often not taken into account while estimating nurse-to-patient care time allocation--that could potentially be eliminated, combined or delegated with greater productivity. The current study aimed to calculate standard time for each activity category by quantifying the amount of time required by nurses to complete an activity category and determine the adjustment time that can be given during work, as well as determine factors that can be altered to improve the efficiency of nursing care on inpatient general wards of a governmental hospital. (2) Method: A time and motion study was conducted over two weeks using 1-to-1 continuous observations of nurses as they performed their duties on inpatient general wards, while observers recorded each single activity, and specifically the time and movements required to complete those activities. (3) Result: There was 5100 min of observations over 10 working days. Nurses spent 69% (330 min) of time during their 8 h morning shift on direct patient care, (19.4%) ward/room activities (18%), documentation (14%), indirect patient care (12%) and professional communication (5%). Around 94 min of activities seem to be wasted and can be potentially detrimental to nurses' overall productivity and threaten patient care quality. The standard number of hours that represents the best estimate of a general ward nurse regarding the optimal speed at which the staff nurse can provide care related activities was computed and proposed. (4) Conclusions: The findings obtained from time-motion studies can help in developing more efficient and productive nursing work for more optimal care of patients.

Emergency care in the context of armed conflict: Nurses' perspectives of the essential core competencies.

AIM: To identify nurses' perspectives of their core competencies for emergency care in the context of armed conflict. INTRODUCTION: Emergency department's (ED) capacity is frequently overwhelmed by a sudden surge of patients when located near armed conflict. Although emergency nurses are key frontline responders, evidence detailing core competencies needed to work in these areas remains limited. METHOD: The study used a cross-sectional survey design and is reported using STROBE guidelines. A validated questionnaire was administered in hospitals near the southern Kingdom of Saudi Arabia and Yemen border, where emergency nurses regularly manage large numbers of patients from armed conflict. RESULT: A total of 163 questionnaires were returned (68% response rate). Most participants were female and had more than six years of ED experience. The core competencies for emergency nurses working near armed conflict were identified and highly rated by participants: the highest mean value was 9.47/10 and the lowest was 8.89/10. Analysis revealed regular education, training and drills were needed to provide quality emergency nursing care for victims of armed conflict. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study provides new evidence regarding core competencies in emergency nursing care in the context of armed conflict. The identified competencies should be incorporated into future education, curricula, training programmes and evaluations to enable emergency nurses to function effectively in the context of armed conflict. The findings will assist decision-makers to develop plans and strategies for mitigating risk and improving the future nursing response in similar contexts.

Evaluation of resource allocation for undergraduate nursing professional experience placements coordination in Australian Higher Education; A cross-sectional study with descriptive qualitative thematic analysis.

AIMS AND OBJECTIVE: To assess the implementation of standards by Australian Nursing higher education providers as set by accrediting and regulating bodies and to identify any barriers or enablers to optimizing Professional Experience Placement. To recommend strategies for safeguarding and improving any identified enablers as well as mitigating factors for any identified barriers. BACKGROUND: Professional Experience Placement is an essential element of all accredited Nursing Programs in Australia. The Australian Nursing and Midwifery Accreditation Council is responsible for developing accreditation standards and mandates minimum of 800 h of Professional Experience Placement scaffolded across curriculum which some Higher Education Providers set as their exact baseline for clinical placement duration. DESIGN: Descriptive study using; questionnaire survey with qualitative thematic analysis and CROSS checklist. METHOD: Quantitative method with descriptive qualitative thematic analysis and purposive sampling was used to target 37 higher education institutions that offer BN and BN/BM programs, 33 of these institutions were randomly selected for inclusion. Data was collected over a six-week period from 24th May to 4th July 2022 using Qualtrics online survey. RESULTS: Out of the 33 Higher Education providers who were invited to participate, 51.5 % (n = 17) responded. The respondent's demographics were: 94 % Bachelor of Nursing only placements coordinators while one respondent reported covering both Bachelor of Nursing and Bachelor of Midwifery; Most of the respondents (65 %) were in 40-55 years age group. The respondents reported to have overall responsibility across one to 6 campuses (Mean = 2.2) and having support/administrative staffs ranging from 0 to 15 (Mean = 4.11). Student population among the institutions ranged from 500 to 7500 with a mean of 2365.38. The number of campuses covered had statistically significant relationship with the student population (p < 0.001; 0.392-0.929 confidence interval) however no statistically significant relationship with the number of administrative staff allocated (p = 0.319; -0.297 to 0.704 confidence interval). CONCLUSIONS: While great processes are in place across higher education sector in formalizing nursing professional experience placement, important challenges still exist across the nation that need to be addressed. The quantitative findings should be interpreted with caution given the low questionnaire response rate.

Public health messaging during disasters: Practice and attitudes of Australian emergency nurses.

BACKGROUND: The growing frequency of disasters increases health system demands, increasing the need for emergency departments to provide public health messaging to prevent illness and reduce risk. This study aims to explore emergency nurse practice and attitudes in providing public health messages from the emergency department during disasters in Australia. METHODS: Quantitative phase of a mixed methods study, using an explanatory sequential design. Australian emergency nurses were surveyed using a validated online questionnaire. Data was analysed using descriptive and inferential statistics, an enumerative content analysis, participant profiling and a factor analysis. RESULTS: Disaster experience varied in 143 nurse participants. The perception of the emergency nurse's role in providing public health messages is influencing practice. Embracing teachable moments and health promotion responsibilities, attributes to positive attitudes and practice. In contrast, negative attitudes, lack of confidence, time, policy, and training, are barriers to public health messages being provided in the emergency setting. CONCLUSIONS: These barriers suggest that Australian emergency nurses may not have the capability, the opportunity, nor the motivation, to provide preventative messages to their patients during disasters. Intrinsic and extrinsic factors need to be addressed, ensuring nurses are confident and supported in their public health messaging practice during disasters.

""Resisting social identity threat and maintaining resilience": A qualitative study of Chinese parents following the loss of an only child": Correction.

Reports an error in ""Resisting social identity threat and maintaining resilience": A qualitative study of Chinese parents following the loss of an only child" by Anni Wang, Yufang Guo, Wendy Cross, Louisa Lam, Virginia Plummer, Wen Zhang and Jingping Zhang (Psychological Trauma: Theory, Research, Practice, and Policy, Advanced Online Publication, May 19, 2022, np). In the original article, the fourth affiliation was incorrectly listed as "Sau Po Centre on Ageing, The University of Hong Kong" and has been changed to "Department of Social Work and Social Administration, The University of Hong Kong." All versions of this article have been corrected. (The following abstract of the original article appeared in record 2022-62901-001). OBJECTIVE: Parents who lose an only child in China are stressed and traumatized due to social identity threat (SIT). This qualitative study aimed to interpret their experience to inform culturally and socially sensitive intervention strategies. METHODS: Using a phenomenological approach, 17 bereaved parents who lost an only child were interviewed. The transcripts were analyzed using Colaizzi's method. RESULTS: Three themes were identified, namely, "assuming a new social identity," "triggering social identity threat," and "resisting social identity threat and maintaining resilience." The study showed that SIT initially began with identity reconstruction, where self-identity and social identity occurred 1 after another. Once labeled with such social identity, the bereaved parents suffered social identity threat triggered by inner inferiority and external stigmatization. The bereaved parents undertook a variety of coping strategies to resist the threat and to maintain resilience; of these strategies, 4 patterns depicting resilience and threat were interpreted. CONCLUSION: The findings offer an understanding of the multifaceted bereavement dilemma and lay a foundation for developing intervention strategies. Promoting or maintaining resilience and alleviating SIT are 2 important ways that help parents move on. To help them with identity reconstruction, the development of culturally sensitive resilience-based programs and the linking of social resources to solve practical problems are recommended. Community health professionals should encourage parents to maintain good health management to prevent their predicament from worsening. Raising economic assistance, building an elderly care support system, and promoting social acceptance are strategies that could be considered by policymakers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations between perceived overqualification, transformational leadership and burnout in nurses from intensive care units: A multicentre survey.

AIMS: To explore whether perceived overqualification increases the risk of burnout and whether transformational leadership negatively moderates this relationship. BACKGROUND: Perceived overqualification might contribute to burnout and lead to poor experience of transformational leadership, and transformational leadership might be associated with burnout. However, these relationships have not yet been confirmed. METHODS: A multicentre cross-sectional study. A total of 321 nurses from intensive care units were recruited from six tertiary hospitals. Scale of Perceived OverQualification, Transformational Leadership Questionnaire and emotional exhaustion subscale of the Maslach Burnout Inventory-General Survey were employed to collect the data. Hierarchical multiple regression and bootstrap resampling were applied to analyse the data. RESULTS: Burnout was positively associated with perceived overqualification and negatively associated with transformational leadership (each p < 0.05). Transformational leadership significantly mediated the relationship between perceived overqualification and burnout (b = -0.6389, 95% confidence interval: -0.8706, -0.4072). CONCLUSION: Our findings indicated that perceived overqualification and transformational leadership directly or indirectly affect burnout among nurses from intensive care units. IMPLICATIONS FOR NURSING MANAGERS: Personal and organizational-oriented interventions utilizing nurses' overall qualifications and implementing transformational leadership should be employed by nurse managers to alleviate burnout and promote the work performance of nurses from intensive care units.

"Resisting social identity threat and maintaining resilience": A qualitative study of Chinese parents following the loss of an only child.

[Correction Notice: An Erratum for this article was reported online in Psychological Trauma: Theory, Research, Practice, and Policy on Aug 11 2022 (see record 2022-88678-001). In the original article, the fourth affiliation was incorrectly listed as "Sau Po Centre on Ageing, The University of Hong Kong" and has been changed to "Department of Social Work and Social Administration, The University of Hong Kong." All versions of this article have been corrected.] Objective: Parents who lose an only child in China are stressed and traumatized due to social identity threat (SIT). This qualitative study aimed to interpret their experience to inform culturally and socially sensitive intervention strategies. METHODS: Using a phenomenological approach, 17 bereaved parents who lost an only child were interviewed. The transcripts were analyzed using Colaizzi's method. RESULTS: Three themes were identified, namely, "assuming a new social identity," "triggering social identity threat," and "resisting social identity threat and maintaining resilience." The study showed that SIT initially began with identity reconstruction, where self-identity and social identity occurred 1 after another. Once labeled with such social identity, the bereaved parents suffered social identity threat triggered by inner inferiority and external stigmatization. The bereaved parents undertook a variety of coping strategies to resist the threat and to maintain resilience; of these strategies, 4 patterns depicting resilience and threat were interpreted. CONCLUSION: The findings offer an understanding of the multifaceted bereavement dilemma and lay a foundation for developing intervention strategies. Promoting or maintaining resilience and alleviating SIT are 2 important ways that help parents move on. To help them with identity reconstruction, the development of culturally sensitive resilience-based programs and the linking of social resources to solve practical problems are recommended. Community health professionals should encourage parents to maintain good health management to prevent their predicament from worsening. Raising economic assistance, building an elderly care support system, and promoting social acceptance are strategies that could be considered by policymakers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Incidence, mortality, and factors associated with primary postpartum haemorrhage following in-hospital births in northwest Ethiopia.

BACKGROUND: Of the 1010 reported maternal deaths in 2018, just over 65% occurred in hospitals in Ethiopia. However, there is a lack of standardised data about the contributing factors. This study aimed to investigate the incidence, mortality, and factors associated with primary postpartum haemorrhage following in-hospital births in northwest Ethiopia. METHODS: A retrospective cohort design was used; an audit of 1060 maternity care logbooks of adult women post-partum at Felege Hiwot Referral Hospital and University of Gondar Comprehensive Specialized Hospital. The data were abstracted between December 2018 and May 2019 using a systematic random sampling technique. We used the Facility Based Maternal Death Abstraction Form containing sociodemographic characteristics, women's medical history, and partographs. Primary postpartum haemorrhage was defined as the estimated blood loss recorded by the staff greater or equal to 500 ml for vaginal births and 1000 ml for caesarean section births, or the medical doctor diagnosis and recording of the woman as having primary postpartum haemorrhage. The data analysis was undertaken using Stata version 15. Variables with P ≤ 0.10 for significance were selected to run multivariable logistic analyses. Variables that had associations with primary postpartum haemorrhage were identified based on the odds ratio, with 95% confidence interval (CI) and P-value less than 0.05. RESULTS: The incidence of primary postpartum haemorrhage in the hospitals was 8.8% (95% CI: 7.2, 10.6). Of these, there were 7.4% (95% CI: 2.1, 13.3) maternal deaths. Eight predictor variables were found to be independently associated with primary postpartum haemorrhage, including age ≥35 years (AOR: 2.20; 95% CI: 1.08, 4.46; P = 0.03), longer than 24 hours duration of labour (AOR: 7.18; 95% CI: 2.73, 18.90; P = 0.01), vaginal or cervical lacerations (AOR: 4.95; 95% CI: 2.49, 9.86; P = 0.01), instrumental (forceps or vacuum)-assisted birth (AOR: 2.92; 95% CI: 1.25, 6.81; P = 0.01), retained placenta (AOR: 21.83; 95% CI: 6.33, 75.20; P = 0.01), antepartum haemorrhage in recent pregnancy (AOR: 6.90; 95% CI: 3.43, 13. 84; p = 0.01), women in labour referred from primary health centres (AOR: 2.48; 95% CI: 1.39, 4.42; P = 0.02), and births managed by medical interns (AOR: 2.90; 95% CI: 1.55, 5.37; P = 0.01). CONCLUSION: We found that while the incidence of primary postpartum haemorrhage appeared to be lower than in other studies in Africa the associated maternal mortality was higher. Although most factors associated with primary postpartum haemorrhage were consistent with those identified in the literature, two additional specific factors, were found to be prevalent among women in Ethiopia; the factors were referred women in labour from primary health facilities and births managed by medical interns. Maternal healthcare providers in these hospitals require training on the management of a birthing emergency.

Coping Strategies and Burden Dimensions of Family Caregivers for People Diagnosed with Obsessive-Compulsive Disorder.

(1) Background: Obsessive−compulsive disorder (OCD) is a chronic mental disorder that can be a source of emotional, financial and/or social burden for family caregivers. Few studies have investigated family caregiving for patients diagnosed with OCD in relation to the coping strategies being used from a theoretical perspective. This study evaluated the burden and coping strategies of family caregivers for people diagnosed with OCD. (2) Methods: A cross-sectional study was conducted, in which 123 participants diagnosed with OCD and their caregivers were surveyed using three types of scales: obsessive−compulsive scale; coping scale; and burden scale. (3) Results: Of the participants with OCD and their caregivers, 53% and 31% were male and 47% and 69% were female, respectively. Around 80% of the OCD patients were considered young and their age ranged from 20−40 years old. Forty percent of caregivers in the current study reported a high burden level. The caregivers of those who had severe OCD symptoms had a lower coping level compared to the caregivers of those with less severe symptoms and those urban caregivers were able to better cope than rural caregivers. There was an association between OCD symptom severity and financial, work-related, social and family relationships, mental and health burdens for family caregivers. Meanwhile, the greater coping level of family caregivers, the lesser social and family, mental, and spouse relationship burden (p < 0.05); (4) Conclusions: The family caregivers of people diagnosed with OCD have specific aspects of burden and coping which require support by designing strategic interventions for family caregiver coping.

Associations between perceived overqualification, organisational commitment and work passion of nurses: A multicentre cross-sectional study.

AIM: To investigate the associations between perceived overqualification, organisational commitment and work passion of nurses. BACKGROUND: Few studies have considered the effects of perceived overqualification and organisational commitment on work passion of nurses, especially in developing countries. METHODS: This is a multicentre cross-sectional study. A total of 4511 nurses from eight tertiary hospitals were recruited. The Scale of Perceived OverQalification (SPOQ), the Organizational Commitment Scale (OCS) and the Work Passion Scale (WPS) were used to collect the data. Hierarchical multiple regression were employed. RESULTS: Perceived overqualification and organisational commitment were the main predictors for both harmonious and obsessive passions (each p < .001). The unique effect of organisational commitment (ßharmonious  = .608, ßobsessive  = .556) on work passion were six to eight times larger than these of perceived overqualification (ßharmonious = -.079, ßobsessive = .085). CONCLUSION: Our findings indicate that high perceived overqualification clearly reduces nurses' harmonious passion and increases their obsessive passion, whereas high organisational commitment significantly promotes nurses' harmonious and obsessive passions. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should distinguish the different effects of perceived overqualification and organisational commitment on work passion. Effective intervention should be developed to release nurses' potential abilities and improve their organisational commitment and work passion. Chinese Clinical Trial Registry: ChiCTR2100047974.

Mental health nurses perceptions of missed nursing care in acute inpatient units: A multi-method approach.

Nurses have key roles in caring for hospitalized patients. Missed nursing care can lead to adverse outcomes, from minor discomfort to patient death. Mental health nurses have a significant role in advancing knowledge and practice due to missed, delayed, or unfinished nursing care. They are identifying, escalating, and managing warning signs of mental and physical health deterioration where the risk to patients is high in terms of compromised care quality and neglect and the evidence is scant. This study aimed to examine mental health nurses' perceptions of missed nursing care in acute mental health inpatient units in an Australian regional health service. A cross-sectional survey was undertaken using a modified Kalisch Phelan MISSCARE questionnaire and a qualitative content analysis was undertaken for narrative responses. Of 70 participants, the majority were aged 30-44 years, with >5 years of experience. The results indicated that care planning, safety audits, communication, and assessment of oral intake were perceived as care most frequently missed. Factors contributing to missed care need urgent exploration to ensure timely reduction of patient risk and enhancements to safe quality care.

Healthcare professional views on barriers to implementation of evidence-based practice in prevention of ventilator-associated events: A qualitative descriptive study.

OBJECTIVE: To explore health professional views of barriers to the use of evidence-based practice to prevent ventilator-associated events in intensive care units. DESIGN: A qualitative descriptive study was conducted with nurses and doctors with more than six months experience caring for mechanically ventilated patients. SETTING: The study was conducted in two intensive care units, in large metropolitan health services in Victoria, Australia. METHODS: Individual semi-structured interviews were undertaken with 20 participants (16 nurses and 4 doctors) in 2019. Purposive sampling method was used until data saturation was reached. The interviews were held at the hospital in a private room away from their place of employment. The interview data were analysed using thematic analysis. FINDINGS: Four major themes were inductively identified from nine subthemes: i) prioritising specific situations, ii) inadequate use of evidence to underpin practice, iii) perception of inadequate staffing and equipment and, iv) inadequate training and knowledge of evidence-based guidelines. CONCLUSIONS: These themes helped to explain previously reported deficits in nurses' knowledge of and adherence to evidence-based practice in intensive care. Findings suggest the need for a well-established policy to underpin practice. The barriers faced by nurses and doctors in preventing ventilator associated events need to be addressed to optimise quality of patient care in intensive care units.

Public health education by emergency nurses: A scoping review and narrative synthesis.

OBJECTIVE: To identify the extent, range, and nature of the evidence on public health education provided by emergency nurses. METHODS: A scoping review, using the methodological guidance of Joanna Briggs Institute, was conducted to scope and map the literature and research activity. Using predetermined criteria, databases, grey literature, and reference lists were searched for eligible sources. At least two authors reviewed each article. A narrative synthesis methodology was utilised to analyse and report the findings. RESULTS: There was significant methodological heterogeneity between sources (n = 6). Three themes were identified: 1) Benefits of the system: An opportunity to inform the public, 2) The barriers: Time pressures and being prepared and 3) The strategies: Plan for structured and created teachable moments CONCLUSION: Limited research is being conducted in this area. Further research is needed to understand emergency nurse's practice and attitudes towards providing public health messages. PRACTICE IMPLICATIONS: Emergency nurses need to utilise the 'teachable moment' for every emergency admission, providing opportunistic preventative education to improve health outcomes and reduce demand on the healthcare system.

Quality of life in cancer patients with different preferences for nurse spiritual therapeutics: The role of psychological capital.

AIM: To explore the status of quality of life and psychological capital and analyse the different effects of psychological capital on the quality of life of cancer patients with different preferences for nurse spiritual therapeutics. DESIGN: A cross-sectional survey was used. METHODS: Two hundred and eight cancer patients were recruited using convenience sampling from a tertiary Chinese hospital, between March and July 2019. Data on preferences for nurse spiritual therapeutics (PNST), psychological capital (PsyCap) and quality of life (QoL) were collected using paper questionnaires. Hierarchical multiple regression was employed to investigate the different influences of PsyCap on QoL of cancer patients with various levels of PNST. RESULTS: Compared with patients having high PNST, patients with mild-moderate PNST experienced lower self-efficacy, hope, optimism, PsyCap and social/family well-being. PsyCap significantly explained the variance on QoL of patients with various levels of PNST. Age, gender, presence of caregiver were significant factors influencing physical, social/family and emotional well-being of patients with high PNST. CONCLUSION: The present study demonstrates disparities in PsyCap and QoL between cancer patients with mild-moderate and high PNST. It is essential to be aware of the positive influences of PsyCap on QoL and develop effective interventions for patients to improve their QoL, especially for those with mild-moderate PNST. IMPACT: It is necessary to realize the benefits of PsyCap on QoL of cancer patients with various levels of PNST. Appropriate training for nurses needs to be developed to promote their spiritual care competencies. Moreover, supportive interventions should be developed for cancer patients to improve their PsyCap and QoL.

Nursing perspectives on reducing sedentary behaviour in sub-acute hospital settings: A mixed methods study.

AIM AND OBJECTIVES: To determine the factors influencing nurses' decisions and capacity to reduce sedentary behaviour in hospital inpatients in sub-acute hospital settings. BACKGROUND: Sedentary behaviour in hospital inpatients is a complex issue that can be resistant to resolution. There is little research investigating factors influencing nurses' promotion of reduced levels of sedentary behaviour in sub-acute hospital settings. DESIGN: An explanatory sequential design was employed, comprising quantitative and qualitative phases. METHODS: An online survey was conducted with a convenience sample of 138 nurses from five Australian states. Logistic regression modelling identified demographic and behavioural characteristics of nurses who often encouraged patients to reduce their sedentary behaviour. In-depth interviews were conducted with 11 ward nurses and nurse managers, with the content subjected to thematic analysis. STROBE and GRAMMS checklists were employed. RESULTS: Nurses recognised their role in promoting reduced sedentary behaviour but faced a range of personal and organisational barriers in achieving this outcome for patients. Few nurses were aware of national physical activity and sedentary behaviour guidelines. Five themes emerged from interviews (nursing role, care challenges, expectations of advocates, teamwork and improving the experience). Overall, many nurses experienced a lack of agency in promoting reduced sedentary behaviour and cognitive dissonance in feeling unable to undertake this role. CONCLUSIONS: The results of this study are significant in confirming that reducing sedentary behaviour in hospital inpatients is influenced by a range of complex and multi-level factors. There is a fundamental need for organisational and clinical leadership in building a culture and climate in which staff feel empowered to promote reduced sedentary behaviour in their patients. RELEVANCE TO CLINICAL PRACTICE: The results of this study highlight the importance of taking action to reduce sedentary behaviour in sub-acute hospital settings. A co-design approach to developing interventions in local health services is warranted.

How emergency nurses cope and motivate themselves to sustain their caring work: An integrative literature review.

AIMS AND OBJECTIVES: The aim of this integrative review was to assess how emergency nurses cope and motivate themselves to sustain their caring work. BACKGROUND: The need to enhance sustainability of the workforce creates a demand to consolidate contemporary evidence related to emergency nurses' motivations, how they cope and sustain themselves for caring work. DESIGN AND METHODS: The integrative literature review informed by Whittemore and Knafl involved searching four databases, which yielded 977 published research papers (2008-2021). A total of 33 studies met the inclusion and quality assessment criteria. The PRISMA checklist for review was followed. RESULTS: No studies addressing all three areas (motivations, coping and caring sustainability) together were identified. Integration of evidence from quantitative and qualitative research was achieved in three categories: (1) emergency nurses' motivations to sustain their work, (2) emergency nurses' coping strategies and (3) sustaining care as emergency nurses. CONCLUSION: To sustain themselves in caring work, emergency nurses need to be intrinsically and extrinsically motivated and know how to cope effectively with stressors and work demands. There is need for research examining the relationships between these aspects of emergency nursing work. RELEVANCE TO CLINICAL PRACTICE: To ensure the sustainability of emergency nurses' work and careers understanding of the factors that influence and sustain their motivations and coping strategies is important for nurses and their clinical leaders and managers.