Exploring the influencing factors of patient safety competency of clinical nurses: a cross-sectional study based on latent profile analysis.

BACKGROUND: Clinical nurses play an important role in ensuring patient safety. Nurses' work experience, organizational environment, psychological cognition, and behavior can all lead to patient safety issues. Improving nurses' attention to patient safety issues and enhancing their competence in dealing with complex medical safety issues can help avoid preventable nursing adverse events. Therefore, it is necessary to actively identify the latent profiles of patient safety competency of clinical nurses and to explore the influencing factors. METHODS: A cross-sectional design was conducted. A total of 782 Chinese registered nurses were included in the study. Demographic characteristics questionnaire, Error Management Climate scale, Security Questionnaire, Proactive Behavior Performance scale and Patient Safety Competency Self-Rating Scale of Nurses were used. Latent profile analysis (LPA) was performed to categorize nurses into latent subgroups with patient safety competency differences. Multinomial logistic regression was conducted to explore the influencing factors of nurses' patient safety competency (PSC) in different latent profiles. RESULTS: A total of 782 questionnaires were valid. Nurses' PSC was positively related to error management climate, and psychological safety and proactive behavior. The PSC score was 121.31 (SD = 19.51), showing that the PSC of clinical nurses was at the level of the medium on the high side. The error management climate score was 70.28 (SD = 11.93), which was at a relatively high level. The psychological safety score was 61.21 (SD = 13.44), indicating a moderate to low level. The proactive behavior score was 37.60 (SD = 7.33), which was at a high level. The latent profile analysis result showed that three groups of profile models were fitted acceding to the evaluation of PSC. They were defined as Low-competency Group (74 (9.5%)), Medium-competency Group (378 (48.3%)) and High-competency Group (330 (42.2%). Working years, professional titles, departments, error management climate, psychological security and proactive behavior were the influencing factors of PSC in three latent profiles. CONCLUSIONS: The PSC of clinical nurses had obvious classification characteristics, and the main influencing factors were working years, professional titles, working departments, error management climate, psychological security and proactive behavior. This study suggests that managers should pay attention to the continuous cultivation of patient safety competence among clinical nurses, provide targeted intervention measures for nurses at different work stages, professional titles, and departments, and use efficient management strategies to create a positive error management atmosphere. In patient safety management, providing nurses with more psychological security is conducive to stimulating more proactive behaviors and continuously improving the level of patient safety competence.

Analysis of factors associated with needlestick injuries of clinical nurses by applying a human factor analysis and classification system: A nationwide cross-sectional survey.

AIMS: This study aims to investigate the current situation of needlestick injuries (NSIs) of clinical nurses and identify associated factors by using the theoretical framework of the human factors analysis and classification system (HFACS). DESIGN: A nationwide cross-sectional survey was conducted. METHODS: Multi-stage sampling was used to investigate 3336 nurses in 14 Chinese hospitals. Descriptive statistics and univariate and multivariate logistic regression were employed to reveal the rate of NSIs and their associated factors. RESULTS: A total of 970 nurses (29.1%) reported having experienced at least one NSI in the past year. The multivariate logistic regression analysis showed that good hospital safety climate and clinical nurses in intensive care unit (ICU) and emergency department had protective effects against NSIs compared with nurses in internal medicine department. The nurse, senior nurse, and nurse in charge have significantly increased the risk for NSIs compared with the associate chief nurse or above. Patients with poor vision but wearing glasses and poor vision but not wearing glasses were more prone to have NSIs. Working in the operating room compared with internal medicine, average weekly working time of >45 h compared with ≤40 h and poor general health led to increased risk of NSIs. CONCLUSION: The rate of NSIs in clinical nurses was high in China. Individual factors including professional title, department, visual acuity and general mental health and organisational factors including weekly working hours and hospital safety atmosphere were significantly correlated with the occurrence of NSIs. RELEVANCE TO CLINICAL PRACTICE: Nursing managers should focused on physical and psychological conditions of clinical nurses, and organisational support is required to enhance the hospital safety atmosphere. NO PATIENT OR PUBLIC CONTRIBUTION: Contributions from patients or the public are irrelevant because this study aims to explore current situation and factors associated with NSIs in clinical nurses.

Knowledge and Visual Differentiation Ability of the Pressure Injury Classification System and Incontinence-Associated Dermatitis among Hospital Nurses: A Descriptive Study.

This study investigated clinical nurses' knowledge and visual differentiation ability of the pressure injury classification system (PICS) and incontinence-associated dermatitis (IAD), additionally analyzing possible influencing factors. A convenience sample of 248 nurses took the PICS and IAD knowledge test (KT) and completed the visual differentiation ability test (VDAT), consisting of 21 photographs with clinical information. The overall mean score for correct answers was 12.65 ± 2.90 points in PICS and IAD KT and 11.43 ± 4.57 points in VDAT. Incorrect responses were most common for statements related to stage II, III, IAD for PICS and IAD KT, and deep tissue pressure injury (DTPI), unstageable, and stage III for VDAT. Significant correlations were found between PICS and IAD KT and VDAT (r = 0.252, p < 0.001). Factors affecting scores for VDAT were the scores of PICS and IAD KT, debridement experience in nursing patients with PI, and the management frequency of PI and IAD. Results indicate that nurses have an overall understanding of PICS and IAD, but low visual differentiation ability regarding stage III, DTPI, and unstageable PI. Continuing education is needed to further improve knowledge and visual differentiation ability for PICS and IAD.

Psychological capital among clinical nurses: A latent profile analysis.

AIM: To determine the psychological capital level of nurses and explore the latent profiles of nurses regarding their psychological capital scores. BACKGROUND: The use of individual-centered analysis for the connotation of nurses' psychological capital structure is less studied and still needs to be further explored. METHODS: By the convenience sampling method, 494 clinical nurses from 7 general hospitals in Sichuan province were selected. The study was conducted from December 2022 to February 2023. Latent profile analysis was used for data analysis. We followed STROBE guidelines in this research. RESULTS: The total mean score of nurses' psychological capital is 5.17 (SD = 0.8). The following four latent profiles were identified: "poor" (4.5%), "medium" (22.9%), "well-off" (41.5%), and "rich" (31.1%). Multiple logistic regression showed that the number of hours worked per day and the number of night shifts per month were negative predictors of psychological capital, and psychological training and job satisfaction were protective factors of psychological capital. DISCUSSION: Our study found that the four profiles can be distinguished by "poor," "well-off," "medium," and "rich" levels of psychological capital. Among them, more than 70% of the nurses belonged to the well-off and rich profiles, and the number of the poor profile was the lowest. CONCLUSION: The overall psychological capital of clinical nurses is at a medium-high level. Each profile is influenced by multiple sociodemographic factors (i.e., age, working hours, monthly income, psychological training, and job satisfaction). IMPLICATIONS FOR NURSING AND HEALTH POLICY: Administrators should develop enhancement strategies to improve the mental health of nurses based on the characteristics of their psychological capital profiles.

Professional identity and sense of coherence affect the between compassion fatigue and work engagement among Chinese hospital nurses.

BACKGROUND: With the continuous improvement of people's health needs, the public's requirements for medical care are also getting higher and higher. Work engagement is a positive psychological state related to the work. It is very important to maintain nurses' work engagement, however, due to many factors, the level of nurses' work engagement is not high and nursing managers should identify the influencing factors of work engagement, and take positive measures to fully improve nurses' work engagement. OBJECTIVES: To explore the influence of compassion fatigue, professional identity and sense of coherence on nurses' work engagement. METHODS: From January 2022 to June 2022, convenience sampling was used to select clinical nurses from 9 tertiary hospitals in Henan Province of China as the research objects for a questionnaire survey. Statistical methods included descriptive statistical analysis, Pearson correlation analysis and the PROCESS Macro Model 4 and 7 in regression analysis. RESULTS: The results showed that compassion fatigue was significantly negatively correlated with sense of coherence, professional identity and work engagement (P<0.01), professional identity was significantly positively correlated with sense of coherence and work engagement (P<0.01), and there was a significant positive correlation between sense of coherence and work engagement (P<0.01). Professional identity played a partial mediating role between compassion fatigue and work engagement, accounting for 46.40% of the total effect; meanwhile, sense of coherence moderated the effect of compassion fatigue on professional identity and formed a moderated mediation model. CONCLUSIONS: Compassion fatigue has a negative predictive effect on nurses' work engagement. Professional identity and sense of coherence further explained the relationship of compassion fatigue on compassion fatigue and work engagement through mediating and moderating effects.

Anxiety prevalence and associated factors among frontline nurses following the COVID-19 pandemic: a large-scale cross-sectional study.

Introduction: Nurses are more likely to experience anxiety following the coronavirus 2019 epidemic. Anxiety could compromise nurses' work efficiency and diminish their professional commitment. This study aims to investigate nurses' anxiety prevalence and related factors following the pandemic in multiple hospitals across China. Methods: An online survey was conducted from April 16 to July 3, 2023, targeting frontline nurses who had actively participated in China. Anxiety and depression symptoms were assessed using the Self-rating Anxiety Scale and the Self-rating Depression Scale (SDS), respectively. Multivariable logistic regression analysis was employed to identify factors linked with anxiety. Results: A total of 2,210 frontline nurses participated in the study. Overall, 65.07% of participants displayed clinically significant anxiety symptoms. Multivariable logistic regression revealed that nurses living with their families [2.52(95% CI: 1.68-3.77)] and those with higher SDS scores [1.26(95% CI: 1.24-1.29)] faced an elevated risk of anxiety. Conversely, female nurses [0.02(95% CI: 0.00-0.90)] and those who had recovered from infection [0.05(95%CI: 0.07-0.18)] demonstrated lower rates of anxiety. Discussion: This study highlights the association between SDS score, gender, virus infection, living arrangements and anxiety. Frontline nurses need to be provided with emotional support to prevent anxiety. These insights can guide interventions to protect the mental well-being of frontline nurses in the post-pandemic period.

Clinical nurses' compassion fatigue psychological experience process: a constructivist grounded theory study.

BACKGROUND: Clinical nurses are susceptible to compassion fatigue when exposed to various types of traumatic events in patients for extended periods of time. However, the developmental process, staging, and psychological responses distinct to each stage of compassion fatigue in nurses are not fully clarified. This study aimed to explore the processes of compassion fatigue and the psychological experiences specific to each phase of compassion fatigue among clinical nurses. METHODS: Charmaz's Constructivist Grounded Theory methodology was used in this qualitative research. Semi-structured interviews were conducted with 13 clinical nurses with varying degrees of compassion fatigue from December 2020 to January 2021. Interview data were analyzed using grounded theory processes. RESULTS: The data were categorized into five separate categories and 22 sub-categories. This study found that the process of compassion fatigue is dynamic and cumulative, which was classified into five phases: compassion experience period, compassion decrement period, compassion discomfort period, compassion distress period, and compassion fatigue period. CONCLUSION: Clinical nurses who experience compassion fatigue may go through five stages that are stage-specific and predictable. The findings can shed light on local and global applications to better understand the problem of nurses' compassion fatigue. The interventions for addressing compassion fatigue in clinical nurses should be stage-specific, targeted, and individualized.

Utilización de evidencia científica en planificación del cuidado por el profesional de enfermería: Revisión Sistemática / Use of scientific evidence in care planning among nursing professionals: A Systematic Review

Objetivo: Determinar la utilización de evidencia científica disponible por el profesional de enfermería para planificar los cuidados otorgados. Metodología: Búsqueda en bases de datos: Proquest, Pubmed, Science Direct, Medline. Se seleccionó nueve artículos para análisis, publicados entre los años 2011 y 2021 en idiomas inglés y español, ajustados a requerimientos PRISMA. Resultados: Se obtuvieron 356 investigaciones, de las cuales 9 cumplieron con criterios de selección. Los artículos incluidos no miden el nivel de utilización de la Enfermería Basada en Evidencia (EBE) para la planificación de los cuidados, sin embargo, se describen factores facilitadores y barreras para su implementación. Conclusión: La evidencia disponible no es suficiente para determinar la utilización de la evidencia en los cuidados otorgados por parte del profesional de enfermería. Se describen barreras de tipo personales y organizacionales para su utilización. Para lograr una adecuada implementación de la EBE es necesario contar con estrategias efectivas en los entornos clínicos y esfuerzos multidisciplinarios para su utilización. Es necesario la realización de estudios de mayor calidad, para generar datos confiables que evidencien cómo impacta el conocimiento, el nivel de formación en investigación y el apoyo institucional en la utilización de la EBE en la práctica clínica. (AU)

Objective: To determine the use of the available scientific evidence among nursing professionals to plan the provision of care. Methods: A search was conducted in the following databases: ProQuest, PubMed, Science Direct, MEDLINE. Nine articles, published between 2011 and 2021 in English and Spanish, were selected for the analysis according to the PRISMA statement. Results: The search yielded a result of 356 articles, 9 of which met selection criteria. The included articles do not measure the level of utilization of Evidence-Based Nursing (EBN) for care planning, however, facilitating factors and barriers to its implementation are described. Conclusion: The available evidence is not sufficient to determine the utilization of evidence by nursing professionals in the provision of care. Barriers to its utilization, of both personal and organizational nature are described. In order to ensure an adequate implementation of EBN, it is necessary to adopt effective strategies in clinical settings and multidisciplinary efforts need to be made to promote its utilization. It is necessary to conduct higher-quality studies to produce reliable data that demonstrate the role that knowledge, the level of research training and institutional support have on the utilization of EBN in the clinical practice. (AU)

Factors influencing the burnout dimensions among nurses: A cross-sectional study in South Korea.

AIM: To investigate the factors influencing three dimensions of burnout among clinical nurses in South Korea. DESIGN: Descriptive, correlational and cross-sectional study. METHODS: We recruited 300 clinical nurses to participate in an online survey conducted in June 2021. Purposive sampling was used for the survey. Multiple linear regression was used for data analysis. RESULTS: The regression models explained 55.8%, 45.8% and 34.3% variances in emotional exhaustion, depersonalization and personal accomplishment respectively. Emotional exhaustion was influenced by experience in the current department, working overtime, shift type, depression, job stress and emotional labour. Depersonalization was influenced by gender, hospital size, the associated department, overtime, coping strategies, depression and emotional labour. Personal accomplishment was influenced by clinical experience, shift type, resilience and the perceived threat of coronavirus disease 2019.

Moral resilience in registered nurses: Cultural adaption and validation study.

BACKGROUND: Healthcare professionals, especially professional nurses, experience various types of moral suffering due to inevitable ethical conflicts. Moral resilience is recently proposed as a resource to address moral suffering. However, there is no tool to measure moral resilience in Chinese professional nurses. AIM: This study aimed to translate the Rushton Moral Resilience Scale (RMRS) into Chinese and evaluate the psychometric properties of the Chinese version of RMRS (Chi-RMRS). RESEARCH DESIGN: A methodological and descriptive research design. PARTICIPANTS AND RESEARCH CONTEXT: A convenience sample of 411 Chinese professional nurses was recruited through an online survey platform between February and March 2023. ETHICAL CONSIDERATIONS: This study was approved by the Research Ethics Committees of the University and hospitals involved. RESULTS: The RMRS was translated and culturally adapted into a Chinese version. Neither floor nor ceiling effects were observed. The scale-level content validity index (CVI) was 0.922 with the item-level CVIs ranging from 0.833 to 1.000. The explanatory factor analysis (EFA) generated a three-factor structure for the Chi-RMRS, and the confirmatory factor analysis (CFA) demonstrated the three-factor structure with factor loadings for each item ranging from 0.42 to 0.80. The scale-level Cronbach's α coefficient was 0.811 with each dimension ranging from 0.717 to 0.821, and composite reliability (CR) coefficient for the overall scale was 0.920, with each dimension varying from 0.739 to 0.824. The standard error of measurement (SEM) and smallest detectable change (SDC) were 3.522 and 9.763, respectively. DISCUSSION: The Chi-RMRS is able to measure moral resilience of Chinese professional nurses, and has good validity and reliability. It can be used in research and practice to determine the level of moral resilience, thus helping nursing managers to monitor the status of Chinese professional nurses, then develop interventions to maintain the well-being of professional nurses and to ensure quality of care.

Construction and application on the training course of information literacy for clinical nurses.

DESIGN: A two-round Delphi survey was conducted to seek opinions from experts about the index system for the evaluation of training courses of clinical nursing staff's information literacy. Besides, a non-randomized controlled experimental study was adopted to check the application effect of the training courses. AIMS: This study intended to construct a training course of information literacy for clinical nurses, train nurses in order to improve their information literacy level and provide theoretical reference for the training of information literacy courses for clinical nurses. METHODS: Two rounds of Delphi study were conducted for the study among 26 clinical medical and nursing experts as well as educational experts from 5 different provinces and cities in China. From July 2022 to October 2022, a total of 84 clinical nurses from two hospitals were selected by the convenience sampling method, of which the nurses in one hospital were the control group and the nurses in the other hospital were the observation group. 42 nurses in the observation group were trained by the constructed information literacy training course. Questionnaire evaluation was used to compare the differences in the level of information literacy of nurses and the training effect between the two groups. RESULTS: The results of the Delphi consultation showed that the expert's judgment coefficient was 0.958, the expert's familiarity was 0.946, and the expert's authority coefficient was 0.952. Finally, a training course of information literacy for clinical nurses with 4 course categories and 45 specific course contents was formed. Among them, nursing information awareness included 7 courses, nursing information knowledge 15 courses, nursing information ability 19 courses, and nursing information ethics 4 courses. The results of the empirical study showed that the information literacy level of the nurses in the observation group after the training of the information literacy course was improved, and the scores in nursing information awareness, nursing information knowledge, nursing information ability, and information ethics were significantly higher than those in the control group after training (P < 0.05). CONCLUSIONS: The constructed information literacy training courses for clinical nurses were clearly targeted and systematic. Empirical research showed that the course contents were scientific and reasonable, which could provide reference for the training of clinical nurses' information literacy.

Nurses' Willingness and Demand for Internet+Home Care Services and the Associated Factors in Municipal Hospitals in China: Cross-Sectional Survey.

BACKGROUND: Developing Internet+home care (IHC) services is a promising way to address the problems related to population aging, which is an important global issue. However, IHC services are in their infancy in China. Limited studies have investigated the willingness and demand of nurses in municipal hospitals to provide IHC services. OBJECTIVE: This study aims to investigate the willingness and demand of nurses in municipal hospitals in China to provide IHC services and analyze the factors to promote IHC development in China. METHODS: This cross-sectional study used multistage sampling to recruit 9405 nurses from 10 hospitals in 5 regions of China. A self-designed questionnaire with good reliability and validity was used to measure nurses' willingness and demand for providing IHC services. Data analysis used the chi-square test, Welch t test, binary logistic regression analysis, and multiple linear regression analysis. RESULTS: Nurses were highly willing to provide IHC services and preferred service distances of <5 km and times from 8 AM to 6 PM. An individual share >60% was the expected service pay sharing. Job title, educational level, monthly income, and marital status were associated with nurses' willingness to provide IHC services in binary logistic regression analysis. Supervising nurses were 1.177 times more likely to express a willingness to provide IHC services than senior nurses. Nurses with a bachelor's degree had a 1.167 times higher likelihood of expressing willingness to provide IHC services than those with a junior college education or lower. Married nurses were 1.075 times more likely to express a willingness than unmarried nurses. A monthly income >¥10,000 increased the likelihood of nurses' willingness to provide IHC services, by 1.187 times, compared with an income <¥5000. Nurses' total mean demand score for IHC services was 17.38 (SD 3.67), with the highest demand being privacy protection. Multiple linear regression analysis showed that job title, monthly income, and educational level were associated with nurses' demand for IHC services. Supervising nurses (B=1.058, P<.001) and co-chief nurses or those with higher positions (B=2.574, P<.001) reported higher demand scores than senior nurses. Monthly incomes of ¥5000 to ¥10,000 (B=0.894, P<.001) and >¥10,000 (B=1.335, P<.001), as well as a bachelor's degree (B=0.484, P=.002) and at least a master's degree (B=1.224, P=.02), were associated with higher demand scores compared with a monthly income <¥5000 and junior college education or lower, respectively. CONCLUSIONS: Nurses in municipal hospitals showed a high willingness and demand to provide IHC services, with differences in willingness and demand by demographic characteristics. Accordingly, government and hospitals should regulate the service period, service distance, and other characteristics according to nurses' willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of IHC services.

Psychometric evaluation of the Chinese version of the Positive Health Behaviours Scale for clinical nurses: a cross-sectional translation.

BACKGROUND: Occupational health is essential for nurses in clinical nursing practice. However, there is no specific tool for measuring the health behaviour of clinical nurses in China. This study aimed to translate the Positive Health Behaviours Scale into Chinese and validate its psychometric properties among clinical nurses. DESIGN: A cross-sectional design with repeated measures. METHODS: A total of 633 clinical nurses were recruited by convenience sampling from hospitals in Liaoning Province, China. After obtaining the authorization of the original author, the PHBS was translated into Chinese by the Brislin back-translation method. Item analysis was completed to evaluate item discrimination, and the Delphi method was adopted to analyse content validity. Exploratory factor analysis and confirmatory factor analysis were conducted to explore and validate the underlying factor structure. Internal consistency and test-retest reliability were calculated to evaluate reliability. RESULTS: A total of 29 items were retained in the item analysis, and the content validity index of the translated scale was 0.956. In the EFA, four common factors were extracted (nutrition, physical activity, relaxation and behaviours related to mental health and preventive behaviours), explaining 60.81% of the total variance. The results of the CFA were as follows: χ2/df = 1.363, GFI = 0.902, NFI = 0.909, IFI = 0.974, TLI = 0.971, CFI = 0.974, RMSEA = 0.034, and RMR = 0.023. The results of the EFA and CFA showed that the translated scale had good structural validity. Cronbach's α coefficient, the split-half reliability and the test-retest reliability of the Chinese version of the PHBS were 0.928, 0.953 and 0.891, respectively. At the same time, the translated scale had good reliability. CONCLUSIONS: The Chinese version of the PHBS for clinical nurses had good psychometric properties. The results of the questionnaire survey effectively and comprehensively reflect the level of health behaviours in clinical nurses, which provides a scientific reference for determining the intervention target.

Comparison of the clinical competency of nurses trained in competency-based and object-based approaches in the Democratic Republic of the Congo: A cross-sectional study.

In the Democratic Republic of the Congo (DRC), the object-based approach (OBA) still remains mainstream in the basic nursing education program, despite the intention of the Ministry of Public Health to expand the competency-based approach (CBA) nationwide. This study aimed to compare the clinical competency of nurses trained with CBA and OBA. A cross-sectional, mixed study was conducted. We developed a self-assessment questionnaire consisting of an individual demographic information, a clinical competency assessment scale and the General Self-efficacy Scale. Nurses trained with CBA or OBA and currently working in health facilities with two to five years of clinical experience were purposively selected from ten cities across nine provinces in the DRC. We also conducted key informant interviews with the clinical supervisors at health facilities. In a comparison of 160 nurses trained with CBA and 153 with OBA, 3 competency domains ("establishing professional communication", "making decisions about health problems", and "performing nursing interventions") of the 5 domains required for nurses had significantly higher scores in the CBA group. The key informant interviews supported these results while revealing various issues in the basic nursing education program. The results support the strategic direction of the Ministry of Public Health in the DRC to expand CBA. Collaboration among education institutions, health facilities, and administrative bodies is crucial for clinical nurses to fully engage their competencies for the population. Other low- and middle-income countries with scarce resources can refer to the developed and implemented competency assessment method applied in this study.

Asynchronous e-learning with technology-enabled and enhanced training for continuing education of nurses: a scoping review.

BACKGROUND: Asynchronous e-learning has become the mainstream choice since the transformation of learning formats by the coronavirus disease-19 pandemic. This scoping review aimed to examine the technologies used in asynchronous e-learning for the continuing education of clinical nurses and their modes of delivery and effectiveness. METHODS: This scoping review covered the period between 2011 and 2023. Six databases were searched for relevant studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) protocol. RESULTS: Sixty articles met the inclusion criteria. There was a noticeable trend toward using diverse technology-enabled and enhanced training (TEET) options after 2017. The enabling technological approaches, such as interactive online modules (25 articles) and video modules (25 articles), are described in the articles. The most commonly used enhancing technologies were scenario-based learning (nine articles), resource access (eight articles), computer simulation or virtual reality (three articles), and gamification (three articles). Among the outcomes, knowledge acquisition was the most commonly examined outcome (41 articles). CONCLUSIONS: Notably, many interactive TEET modules were used in asynchronous e-learning. There were few studies on gamification, computer simulation or virtual reality, and scenario-based learning (techniques to enhance intrinsic motivation further). However, the adoption of asynchronous e-learning with advanced TEET options is anticipated to increase in the future. Therefore, objective outcome measures are required to determine the effects of such learning methods on knowledge acquisition and behavioral changes.

Career stage-specific predictors of reflective ability among clinical nurses.

AIMS: To identify career stage-specific factors that influence reflective ability in clinical nurses and the relative strength of these effects. DESIGN: Exploratory cross-sectional study. METHODS: Between August and September 2019, nursing professionals working at general hospitals (n = 1169) completed a questionnaire on reflective ability and its suspected influencing factors. Participants were grouped by career stage as defined by years of nursing experience. Each factor's predictive strength regarding different dimensions of reflective ability was analysed separately in each group via stepwise multiple regression. RESULTS: Reflective ability was significantly influenced by support for personal growth from superiors and seniors among first-year participants and professional identity formation among those in their second or later years. Furthermore, it was significantly influenced by self-confidence in nursing practice in years 4-5, effort to improve knowledge and skills in years 6-9 and role model presence in years 10-19. CONCLUSION: Career stage-specific predictors of reflective ability were related to nurses' environment and changes in the roles expected of them. Support measures aimed at improving this capacity should emphasize factors characteristic of the career stage(s) of nursing professionals. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Identifying the influencing factors of nurses' reflective ability can improve the same, deepen nurses' views on nursing, help them develop an intentional nursing practice and contribute to the improvement of the quality of nursing practice. IMPACT: This study is the first to identify career stage-specific predictors of reflective ability in clinical nurses and the relative strength of their effects. Reflective ability was affected by growth support from superiors and seniors in first-year nurses and formation of nursing identity in second-year nurses. Additionally, nurses' environment and various roles affected their reflective ability. Hospitals should build an appropriate environment for nurses and develop the concept of 'oneself as a nurse' among nurses. PATIENT OR PUBLIC CONTRIBUTION: This study was conducted with the approval of an ethical review committee that included general citizens. Furthermore, the research results were reviewed by general citizens prior to dissemination, and we received their opinions as to whether the writing was sufficiently clear and whether the information required by the audience was included. We improved the content to be disseminated based on relevant opinions provided.

Latent profiles of ethical climate and nurses' service behavior.

BACKGROUND: Hospital ethical climate has important implications for clinical nurses' service behavior; however, the relationships are complicated by the fact that five types of ethical climate (caring, law and code, rules, instrumental, and independence) can be combined differently according to their level and shape differences. Recent developments in person-centered methods (e.g., latent profile analysis (LPA)) have helped to address these complexities. AIM: From a person-centered perspective, this study explored the distinct profiles of hospital ethical climate and then examined the relationships of the profiles with clinical nurses' service behavior (both in-role and extra-role service behavior). RESEARCH DESIGN: A quantitative study was conducted using cluster random sampling. Latent profile analysis and binary coded hexadecimal (BCH) analysis were conducted using Mplus 8.2. PARTICIPANTS AND RESEARCH CONTEXT: A total of 871 clinical nurses in China were surveyed using the Ethical Climate Scale and Nurses' Service Behavior Questionnaire. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the IRB of the First Affiliated Hospital of Jinan University (No. KY-2020-090). RESULTS: A four-profile hospital ethical climate model provided the best fit for the data. The four different profiles not only varied in level, but also in shape: high normative and low egoism (45.8%), high ethical climate (19.9%), low ethical climate (3.6%), and moderate ethical climate (30.8%). These profiles differentially predicted clinical nurses' overall, in-role, and extra-role service behaviors. CONCLUSIONS: The results reveal new insights into the nature of hospital ethical climate and how different clinical nurses in these profiles can be best managed to accomplish different forms of service behavior.

Development and validation of the advance care planning practice preference scale for clinical nurses.

AIMS: The aim of this study was to develop the advance care planning (ACP) practice preference scale and validate its psychometric properties among clinical nurses. DESIGN: An instrument development and validation study was completed in the following three phases: (a) the generation and revision of the item, (b) the preliminary exploration and evaluation of the item and (c) the psychometric evaluation of the scale. METHODS: A literature review was conducted to develop the indicator system. A total of 360 clinical nurses (for item analysis) and 688 clinical nurses (for psychometric evaluation) were recruited. The exploratory factor analysis and confirmatory factor analysis were conducted to evaluate the construct validity. The reliability was explored by internal consistency and test-retest reliability. The study was conducted from October 2021 to January 2022. RESULTS: A total of 24 items were finally retained by the item analysis from the initial 78-item pool. In the exploratory factor analysis, the six-factor model explained 79.933% of the total variation. After limiting to three factors, 59.305% of the total variation was explained. Above factor models supported by the confirmatory factor analysis were consistent with the theoretically structure, and the fitting indexes were all satisfactory. Also, the findings showed appropriate internal consistency and test-retest reliability. CONCLUSIONS: ACP practice preference scale presents satisfactory psychometric properties among clinical nurses and can be adopted to evaluate the propensity of clinical nurses to practice ACP. IMPACT: ACP practice preference scale can be adopted to understand the training needs of clinical nurses on ACP clinical practice. PATIENT OR PUBLIC CONTRIBUTION: Clinical nurses participated in the pilot testing and validation of ACP practice preference scale.

Quality of life in people with hemodialysis treatment in Ecuador / Calidad de vida en personas con tratamiento hemodialítico del Ecuador

Objective: to determine the Quality of Life of people on hemodialysis in two provinces of Zone # 6 of Ecuador. Method: cross-sectional descriptive quantitative, intentional sample of 70 participants, developed in two hemodialysis units, a sociodemographic-clinical structured questionnaire and the Kidney Disease Quality of Life (KDQOL™-36) were applied, after signing the informed consent. The data were analyzed by descriptive statistics. Results: the evaluated Quality of Life obtained an average of 57.05, more than 50% of the participants obtained scores below 50 on a scale of 1 to 100, in the Burden of Kidney Disease, Physical Component and Mental Component three affected sub-scales out of a total of five. Conclusion: the Quality of Life of the population on hemodialysis is good; however, low scores were identified in three subscales; In this context, the need for nursing intervention plans to promote health and that could improve the quality of life is identified.

Objetivo: determinar la Calidad de Vida de las personas hemodializadas en dos provincias de la Zona # 6 de Ecuador. Método: cuantitativo descriptivo transversal, muestra intencional de 70 participantes, desarrollado en dos unidades de hemodiálisis, se aplicó un cuestionario estructurado sociodemográfico - clínico y el Kidney Disease Quality of Life (KDQOL™-36), previa firma del consentimiento informado. Los datos fueron analizados por estadística descriptiva. Resultados: la Calidad de Vida evaluada obtuvo un promedio de 57,05, más del 50% de los participantes obtuvieron puntajes inferiores a 50 de una escala de 1 a 100, en la Carga de la Enfermedad del Riñón, Componente Físico y Componente Mental tres sub-escalas afectadas de un total de cinco. Conclusión: la Calidad de Vida de la población en hemodiálisis es buena; sin embargo, se identificó bajas puntuaciones en tres sub-escalas; en este contexto, se identifica la necesidad de planes de intervención de enfermería para promover la salud y que podrían mejorar la calidad de vida.

The relationship between compassion fatigue and workplace psychological violence, alexithymia, and empathy among clinical nurses / 中国职业医学

Objective: To study the relationship between compassion fatigue and workplace psychological violence, alexithymia, and empathy in clinical nurses. Methods: A total of 1 159 clinical nurses from 10 cities in Henan and Fujian Provinces were enrolled using the method of grabbing random balls. Questionnaires including Workplace Psychologically Violent Behaviors Instrument, the Toronto Alexithymia Scale, Jefferson Scale of Empathy Health Professionals, Professional Quality of Life Scale were used to investigate the status of workplace psychological violence, alexithymia, empathy, and compassion fatigue in participants. Bootstrap analysis was used to analyze the relationship between workplace psychological violence, alexithymia, empathy, and compassion fatigue scores. Results: The average score for workplace psychological violence among clinical nurses was (26.2±6.5), with 405 nurses (34.9%) having experienced workplace psychological violence. The scores for alexithymia, empathy and compassion fatigue were (58.3±12.3), (104.3±18.6) and (48.5±6.7) respectively. Mild compassion fatigue was detected in 34.9% of participants, while moderate to severe compassion fatigue accounted for 48.8%. Bootstrap test result showed that workplace psychological violence had a positive impact on compassion fatigue ［standardized effect value (β)=0.40, 95% confidence interval(CI)： 0.35-0.44］. Workplace psychological violence had separate mediating effects through alexithymia (β=0.15, 95%CI： 0.10-0.19), empathy (β=0.16, 95%CI： 0.10-0.21) , and a chain mediating effect through alexithymia and empathy on compassion fatigue (β=0.06, 95%CI： 0.03-0.09). Conclusion: Compassion fatigue symptoms are relatively common among clinical nurses. Experiencing workplace psychological violence directly affects compassion fatigue and can indirectly affect it through the mediating effects of alexithymia and empathy.