Learning from a crisis: a qualitative study on how nurses reshaped their work environment during the COVID-19 pandemic.

BACKGROUND: The global nursing shortages exacerbated by the COVID-19 pandemic necessitated a drastic reorganization in nursing practices. Work routines, the composition of teams and subsequently mundane nursing practices were all altered to sustain the accessibility and quality of care. These dramatic changes demanded a reshaping of the nurses' work environment. The aim of this study was to explore how nurses reshaped their work environment in the early stages of the COVID-19 pandemic. METHODS: A descriptive study comprising 26 semi-structured interviews conducted in a large Dutch teaching hospital between June and September 2020. Participants were nurses (including intensive care unit nurses), outpatient clinic assistants, nurse managers, and management (including one member of the Nurse Practice Council). The interviews were analysed with open, axial, and selective coding. RESULTS: We identified five themes: 1) the Nursing Staff Deployment Plan created new micro-teams with complementary roles to meet the care needs of COVID-19 infected patients; 2) nurse-led adaptations effectively managed the increased workload, thereby ensuring the quality of care; 3) continuous professional development ensured adequate competence levels for all roles; 4) interprofessional collaboration resulted in experienced solidarity, a positive atmosphere, and increased autonomy for nurses; and, 5) supportive managers reduced nurses' stress and improved work conditions. CONCLUSIONS: This study showed that nurses positively reshaped their work environment during the COVID-19 pandemic. They contributed to innovative solutions in an environment of equal interprofessional collaboration, which led to greater respect for their knowledge and competencies, enhanced their autonomy and improved management support.

Status and related factors of professional growth among young nursing talents: a cross-sectional study in China.

BACKGROUND: The shortage of nurses has been a global human resources problem. A good professional growth environment is essential to developing potential nursing students and attracting nurses to join, and it has great significance in reducing nurse turnover. However, nurses' comprehensive perceptions of professional growth have not yet been examined. METHODS: A cluster sampling method was used to conduct a professional growth questionnaire survey on young nursing talents from a large Chinese public tertiary A hospital in March 2022. RESULTS: The score of professional growth among 243 young nursing talents was 57.92 ± 9.607, with a scoring rate of 77.23%. The scores for dimensions of professional growth, from lowest to highest, were rehabilitation growth, promotion speed, professional goal progress, and professional ability development. Attitudes towards participating in training, service as the quality manager or clinical teacher, self-efficacy, professional title, work-family support, education, and organizational commitment of young nursing talents were significantly associated with professional growth. CONCLUSION: The professional growth of young nursing talents was at a moderate level and needed to be strengthened. Nursing leaders and managers are expected to develop management practices to enhance young nursing talents' professional growth in combination with the related factors.

Servant leadership behaviour of head nurse assessment and its linkage with nurse work engagement in China.

AIM: To assess the servant leadership behaviour of head nurse and its linkage with nurse work engagement in China. DESIGN: A cross-sectional study. METHODS: A anonymous investigation with the stratified cluster randomized sampling of nurse was conducted in Hunan Province of China in December 2020. We administered the Perceived Head Nurse Service Leadership Behaviour Scale and the Chinese version of Utrecht work engagement scale to survey, and analyse its relationships by multiple linear regression. RESULTS: A number of 890 nurses participated in this study. The average score of the perceived servant leadership of head nurse reported by nurses was 78.90 ± 14.04, which was at a medium level. Among its six dimensions, the dimension of promote nurse development scored highest (16.04 ± 2.84), while the dimension of dedication scored lowest (11.39 ± 2.46). Official nurses reported higher perceived servant leadership scores of head nurses than those who were employed and temporary nurses (b = 1.727, 95% CI: 0.054-3.400); nurses in tertiary hospitals reported higher perceived servant leadership scores of head nurses than nurses in primary and secondary hospitals (b = 2.703, 95% CI: 0.305-5.100); and lower perceived servant leadership scores were associated with nurses' job overtime (b = -4.935, 95% CI: -6.891 to -2.978). Nurses' perceived servant leadership of head nurses were positively associated with nurses' work engagement (r = 0.336, p < .05). Multiple linear regression analysis indicated that the perceived servant leadership of head nurse affected nurses' work engagement strongly (b = 0.585, 95% CI: 0.479-0.691). CONCLUSION: The servant leadership behaviour of head nurse in China was at the medium level, which was positively associated with nurses' work engagement. Further research should improve the power of the servant leadership behaviour of head nurse by integrating additional training, policies and support. IMPACT: It is time to consider the servant leadership behaviour of head nurses and its linkage with nurses' work engagement in China seriously, and address the policies, guidelines, curriculum, and practice culture. PATIENT OR PUBLIC CONTRIBUTION: The study was conducted to explore the situation of servant leadership behaviour of head nurses and its linkage with nurses' work engagement in China, which did not include input from the public or the intended participants.

Oral health and oral care in patients in a surgical context: A quantitative study comparing patients' and nurses' assessments.

AIMS: To investigate fundamental care delivery regarding oral care in a surgical context, and to compare patients' self-reported oral health with registered nurse assessments. DESIGN: A descriptive and comparative study, with a consecutive selection. METHODS: A patient oral health rating tool, including questions about performed oral care, was distributed to patients (n = 50), at four surgical wards in Sweden. The response rate was 72%. Oral health status was assessed by a registered nurse using the Revised Oral Assessment Guide (ROAG), and a comparison between patient and registered nurse assessment was performed by calculating Cohen's kappa coefficient and percentage agreement. RESULTS: Patients (38%) reported severe oral symptoms, mostly dry lips and not an adequate amount of saliva, and 80% were not offered help with oral care. ROAG assessments revealed that 74% had problems with oral health. Almost half of the patients (48%) needed assistance with oral care but only 10% received help. Registered nurses assessed the patient's oral health as worse than the patient's self-assessment did. CONCLUSION: There are deficiencies in fundamental care delivery regarding oral care in a surgical care context. Oral health assessments need to be performed by registered nurses. Routines for systematic oral assessments and for oral care need to be implemented by nurse managers to ensure that patients' fundamental care needs are fulfilled. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Oral health assessments need to be performed regularly by registered nurses since it is insufficient that patients self-assess their oral health. Nurse managers need to provide and implement routines for nurse assessments and oral care in surgical care contexts. IMPACT: There are deficiencies in patients' oral health and oral care, and registered nurses need to perform oral health assessments. Nurse managers need to implement routines for registered nurse assessments and oral care. PATIENT CONTRIBUTION: Patients admitted to a surgical ward were included in the study after being screened for inclusion criteria. After participants signed informed consent, they filled in a questionnaire about oral health and oral care, and a registered nurse performed an oral health assessment. REPORTING METHOD: This study was carried out according to the STROBE checklist.

Evaluation and perceptions of a nursing discharge plan among nurses from different healthcare settings in Spain.

PURPOSE: The exchange of information between different healthcare settings through a nursing discharge plan is essential for safe care. However, the factors contributing to achieving the most efficient exchange have not been well studied. This study aimed to evaluate and explore the perceptions of a nursing discharge plan from the perspective of nurses in different healthcare settings. METHODS: A mixed methods approach comprising a specifically designed ad hoc questionnaire (n = 437) and a focus group session (n = 8). FINDINGS: Overall, 66.1% out of 437 nurses, and especially those working in nursing homes, were satisfied with the nursing discharge plan. Lack of time to complete the report and poor information about both nursing diagnoses and patients' social assessment were identified as problem areas. Some proposals emerged from the focus group: providing sufficient time for its completion, giving the nursing discharge plan a more flexible structure permitting more open-ended responses, requiring more information to be provided about the social and psychological situation of the patients, training nurses to use standardized language to avoid possible misinterpretations, and getting nurses from the different health care settings to work together in designing continuity of care plans. Elderly and low-income patients are found to need greater attention when filling out nursing discharge plans. CONCLUSIONS: The study has revealed key aspects that need to be improved and some recommendations in implementing the nursing discharge plan in our health area. These include that there should be more time provided to complete the NDP, and also specific details regarding the format, structure, content of the information that is communicated, and the prioritization of the patient profile.

Assessment of resilience levels among Sri Lankan nurses: Is there room for improvement?

BACKGROUND: Developing resilience at work is an effective primary preventive measure for occupational stress. The study aimed to adopt a tool and measure current resilience levels and determine the association of work-related characteristics on resilience among Sri Lankan nurses. METHODS: Translated, culturally adapted and validated Resilience at Work Scale- Sinhala version (RAW-S) was used to measure resilience levels in a sample of 855 government nurses from a health district. The mean RAW-S scores were calculated and appropriate cut off points were used to determine the prevalence of 'high', 'moderate' and 'low' resilience. Chi square test was used to determine the associations. RESULTS: The overall mean RAW-S score was 69.6 (95% CI = 68.9-70.3) and the scores ranged from 28.5 to 90.3. Only 28.4% (95% CI = 25.4-31.6) of nurses showed 'high' level of resilience at work, while 55.6% (95% CI = 52.1-58.9) & 16.0% (95% CI = 13.7-18.7) had shown 'moderate' and 'low' levels of resilience respectively. The resilience levels differed significantly (p < 0.05) by type of ward that they work and by work experience. CONCLUSIONS: This was the first study that examined the resilience levels in any health care worker category in Sri Lanka. The need of targeted, well-designed resilience building programme for ever burdened government sector nurses is clearly shown from the results, as more than two thirds of nurses had 'moderate' or 'low' level of resilience, which may not be good enough to combat the constant work stress they face on daily basis.

Trends in artificial intelligence in nursing: Impacts on nursing management.

OBJECTIVE: To investigate the academic use of artificial intelligence (AI) in nursing. BACKGROUND: A bibliometric analysis combined with the VOSviewer software quantification method has been utilized for a literature analysis. In recent years, this approach has attracted the interest of scholars in various research fields. Thus far, there is no publication using bibliometric analysis combined with the VOSviewer software to analyse the applications of AI in nursing. METHOD: A bibliometric analysis methodology was used to search for relevant articles published between 1984 and March 2022. Six databases, Embase, Scopus, PubMed, CINAHL, WoS and MEDLINE, were included to identify relevant studies, and data such as the year of publication, journals, country, institutional source, field and keywords were analysed. RESULTS: Most relevant articles were published from institutions in the United States. The League of European Research Universities has published most research studies that use AI and nursing. Scholars have mainly focused on nursing, medical informatics, computer science AI, healthcare sciences services and physics particles fields. Commonly used keywords were machine learning, care, AI, natural language processing, prediction and nurse. CONCLUSION: Research articles were mainly published in Nurse Education Today. Research topics such as AI-assisted medical recording and medical decision making were also identified. According to this study, AI in nursing has the potential to attract more attention from researchers and nursing managers. Additional high-quality research beyond the scope of medical education, as well as on cross-domain collaboration, is warranted to explore the acceptability and effective implementation of AI technologies. IMPLICATIONS FOR NURSING MANAGEMENT: This study provides scholars and nursing managers with structured information regarding the use of AI in nursing based on scientific and technological developments across different fields and institutions. The application of AI can improve nursing management, nursing quality, safety management and team communication, as well as encourage future international collaboration.

Factors affecting nurses' retention in Iranian hospitals.

AIM: This research was conducted to study the factors affecting nurses' retention in Iranian hospitals. BACKGROUND: Health care systems should pay attention to their human resources' retention to deliver health care services and maintain their organizational values. This issue becomes more significant when we consider the human and financial limitations in place. METHOD: Data were analysed using conventional qualitative content analysis based on the model developed by Elo and Kyngäs. Forty-two managers and nurses were selected by purposive sampling. Data were obtained through 45 semi-structured interviews until data saturation was reached. RESULTS: The data analysis resulted in four main categories and 17 subcategories. The main categories included dignity and respect, ethics and spirituality, empathy, and flourishing. The main theme extracted was 'maternal management'. CONCLUSION: The present study proposes 'maternal management' as a strategy to increase the retention of nurses.

Status and associations of nursing practice environments in intensive care units: A cross-sectional study in China.

OBJECTIVE: The objective of this study is to investigate the status and associations of nursing practice environments in intensive care units of tertiary hospitals and provide suggestions for improvement. BACKGROUND: Nursing shortage is an urgent global problem and a concern in China. Intensive care unit nurses have been reported to have one of the highest rates of burnout; however, their comprehensive perceptions of nursing practice environments have not yet been examined. METHODS: The Nursing Practice Environment Scale was used to conduct a questionnaire-based survey of 1,523 intensive care unit nurses from 22 tertiary hospitals in China. The data collection was conducted in 2020. RESULTS: The overall score for the nursing practice environment was 77.042 ± 19.682 (where 100 was the highest possible score). The three highest scoring dimensions were quality management, clinical nursing professionalism and professional improvement, whereas the three lowest-scoring dimensions were hospital management participation, remuneration package and social status. Educational background, position, gender and hospital type were significantly associated with nurses' satisfaction with the working environment. CONCLUSION: Chinese nurses in the intensive care units of tertiary hospitals reported relatively satisfactory nursing practice environments, but the scale scores in dimensions such as hospital management participation, remuneration package and social status remained low. IMPLICATIONS FOR NURSING MANAGEMENT: Understanding the status and associations of the nursing practice environment in intensive care units provides evidence that new policies are needed. Furthermore, managers are responsible for supervising and ensuring that nursing practice environments meet the criteria necessary to improve job satisfaction.

Professional Nursing Communication Competence: Theoretical procedures for instrument development and pilot test.

AIMS: To describe the theoretical procedures for the development of the Professional Nursing Communication Competence instrument, determine the content validity and describe the pilot test application. BACKGROUND: Measuring instruments must be developed in accordance with the context and communication process by adopting theoretical procedures based on competence structures to support quality patient-centred care and nursing management. METHODS: A methodological study was employed. The instrument was developed by using content-validated theoretical construct in accordance with 33 communication theories followed by semantic analysis and content validity by experts. The instrument was tested over three phases: before the lecture on professional nursing communication competence, after the simulation scenario experience and after debriefing. RESULTS: The instrument showed an extremely high agreement (CVI = 0.99). Linear regression suggested three domains of the 46-item content-validated instrument comprising knowledge (18 items), skills (12 items) and attitudes (16 items). CONCLUSION: The instrument was found to measure professional communication competence with a high theoretical reliability of the contexts and processes through a simulation strategy. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing educators, managers and staff can adopt the Professional Nursing Communication Competence (IMC-CPE) instrument to improve the effectiveness level of knowledge, skills and attitudes to reduce misunderstanding among team members and health care errors.

Perspectives and experiences of Chinese nurses on quality improvement initiatives: A mixed-methods study.

AIM: To investigate Chinese nurses' views and experiences in relation to quality improvement implementation, as well as to determine the impact of contextual factors on nursing quality improvement initiatives. BACKGROUND: Nurses play a major role in carrying out quality improvement initiatives. Contextual factors influence the implementation and success of quality improvement initiatives. Studies that investigated the impact of contextual factors on Chinese nurses' practice in quality improvement remain limited. METHODS: A sequential explanatory mixed-methods design was used for this study. A quantitative cross-sectional survey was used to assess the context of quality improvement initiatives. Simple random sampling was used to recruit quality improvement teams. The sample included 356 nurses from tertiary teaching hospitals; 291 (81.7%) of them completed questionnaires. Nursing managers and nurses (n = 18) were purposively selected to participate in semi-structured interviews; their experiences and perceptions regarding the contextual factors of quality improvement initiatives were obtained. RESULTS: In the quantitative phase, the "microsystem" (mean=5.24) and "QI team" (mean = 4.97) contexts were reported as supportive contexts. The organizational context was weak, with a mean score of 3.92. In the qualitative phase, three themes related to the contextual challenges emerged: (1) nurses' attitudes and satisfaction, (2) team efficacy, and (3) organizational infrastructure and culture. CONCLUSIONS: Efforts to elevate organizational culture and reward systems are needed in Chinese hospitals. Further education aimed at increasing skills and knowledge should be provided, to ensure effective quality improvement implementation. IMPLICATIONS FOR NURSING MANAGEMENT: During quality improvement initiatives, management tasks should focus on increasing nurses' satisfaction, solving skill and knowledge deficits, and clarifying nurses' roles in relation to quality improvement.

Comparing nurse leader and manager perceptions of and strategies for nurse engagement using a positive deviance approach: A qualitative analysis.

AIMS: To understand nurse leader and manager perspectives on employee engagement and their own role to foster engagement. To examine differences between managers of units with high versus low engagement. BACKGROUND: Health systems recognize the impact of employee engagement, yet alignment of leader and frontline-manager perspectives remains unclear. METHODS: A qualitative study at the Veteran Affairs New England Healthcare System. Leaders at five facilities (N = 13) and managers of units with high and low nurse engagement (N = 31) were interviewed. RESULTS: Nurse leaders almost universally conceptualized staff engagement as involvement in quality improvement service, while managers defined engagement as either commitment to excellence in direct patient care or involvement in quality improvement efforts. Intra- and interprofessional attitude contagion, and organisational factors of staffing-time-workload and senior leadership support were most common to support or detract from nurse engagement. A variety of strategies were identified, including protecting nurses as people and professionals. Differences in perceived roles and constraints to engaging nurse staff exist between managers of units with high versus low engagement. CONCLUSION: Nurse managers and leaders perceive engagement differently; strategies exist to facilitate engagement. IMPLICATIONS FOR NURSING MANAGEMENT: Leader and manager partnerships are needed to provide clarity on and resources for engagement.

Undergraduate nurses' perception of the nursing practice environment in university hospitals: A cross-sectional survey.

OBJECTIVE: To describe the psychometric properties of the Practice Environment Scale of the Nursing Work Index (PES-NW) among undergraduate nurses and to compare their perceptions of the nursing practice environment by academic year and unit type. BACKGROUND: Despite the fact that nursing students develop most of their undergraduate learning and training in the nursing practice environment, their perception about it has not been considered to date. METHODS: The psychometric properties were analysed on a sample of 180 undergraduate nurses. Data collection was carried out in 2018. Data were analysed using percentages, frequencies, mean, standard deviation and Mann-Whitney U test. Factor structure was evaluated with exploratory factor analysis, and reliability was evaluated with Cronbach's alpha. RESULTS: Psychometric analysis showed an adequate construct validity and reliability for the PES-NWI. Cronbach's Alpha was 0.884. Undergraduate nurses perceived most hospitals as favourable, scoring the 'Nurse-physician relationships' factor highest and 'Staffing and resource adequacy' factor lowest. CONCLUSION: The PES-NWI is a valid and reliable instrument that could be applied in future research to explore nursing students' perceptions of the nursing practice environment. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers are responsible for supervising and ensuring that the nursing practice environment at university hospitals meets the necessary criteria to support the workplace learning of undergraduate nurses.

Discriminatory Behavior in Nursing Persist Regardless of Antidiscriminatory Legislation.

Discriminatory behavior seems to persist in nursing in South Africa despite the presence of antidiscriminatory legislation. Little is known on the views of nurses on discrimination related to their basic rights in the workplace. The objective of this article is to report findings of discriminatory behavior among nurses regarding race, gender, sexual orientation, age, disability, religion, and marital status. A cross-sectional descriptive survey (containing open- and close-ended questions) was conducted in public and private hospitals in the Western Cape and Gauteng provinces of South Africa and n = 573 (response rate 83%) registered nurses participated in the study. Most participants reported discrimination due to race (n = 97, 17.4%) and age (n = 58,10.4%). Statistically significant differences were found in that African nurses reported more discrimination in relation to religion than other races. A statistically significant difference was found in the responses to gender-more males than female nurses reported discriminatory behavior. Qualitative data reflected suggestions of hetero negativity among male nurses and that sexual orientation might enhance the promotion of those like oneself. Younger nurses are treated less respectful, while older nurses reported reduced developmental opportunities. African nurses described more discrimination due to race and are treated with disdain. Staff shortages, nurse staffing, and shift work seemingly enhance discriminatory practices with off duties. Nurses in the hospital environment seem to experience discrimination in relation to basic human rights resulting from an indifference among nurse management to uphold such rights.

Nursing role in the assessment and care of hepatic sinusoidal obstruction syndrome patients: a consensus paper by the "Gruppo Italiano Trapianto di Midollo Osseo".

PURPOSE: Sinusoidal obstruction syndrome (SOS) is one of the most serious complications post haematopoietic stem cell transplantation (HSCT). The diagnosis of SOS is clinical, but nurses should be involved in the pre-transplant risk assessment period and play a crucial role in the early detection of signs and symptoms during and after hospitalization. The aim of this work is to achieve a consensus on nurses' behaviour in caring for SOS. METHODS: On behalf of the Italian Group for Bone and Marrow Transplantation (GITMO), a promoter committee was established to put in place a consensus conference approach. A multidisciplinary group of GITMO together with four nurses, three haematology physicians and one patient representative acted as jury, who reviewed the reports and wrote recommendations and suggestions. Recommendations gaining 100% of consensus were considered 'Golden Points of Care'; if a consensus was achieved by ≥ 75% of the jury's members, those recommendations were defined as 'Good Practices'. RESULTS: Eighteen papers written by nurses as first authors have been identified. Golden Points of Care and Good Practices were worked out for the following topics: nurses' role in general, nurses' role in pre-transplant assessment, pre-transplant risk assessment and risk stratification, baseline monitoring, suspected mild or moderate SOS, suspected severe or very severe SOS and late-onset cases. CONCLUSION: SOS is relatively rare; therefore, a holistic approach to the patients' needs considering nursing role as essential may result in better care outcomes.

The longitudinal learning outcomes of using different teaching sequences in a nursing administration project.

AIM: To examine the effects of using different teaching sequences on knowledge acquisition, knowledge retention, self-directed learning and teamwork in a nursing administration project. BACKGROUND: Compared to other professional courses, nursing administration is relatively difficult, and it is important for nursing administration students to spend long hours working in hospitals. As such, better teaching strategies utilizing proper sequencing may yield better learning outcomes for students. METHODS: A longitudinal quasi-experimental design was used. A total of 129 students were assigned to two groups with which different teaching sequences were used. The investigated learning outcomes were knowledge acquisition, knowledge retention, self-directed learning and teamwork. Generalized estimating equations were used to measure the learning outcomes. RESULTS: There was no significant difference between the two teaching sequences in terms of learning effects. One teaching strategy, problem-based learning (PBL), yielded effective student learning outcomes. CONCLUSION: PBL increased the students' self-directed learning and teamwork. This strategy can be applied to side-by-side co-teaching and post-graduate year training programmes. IMPLICATIONS FOR NURSING MANAGEMENT: The results from this study may help hospitals retain nurses and find potential nursing leaders. Instructors and nurse managers should discuss learning goals with students in advance to enhance the students' learning outcomes.

The impact of emotional intelligence on conflict management styles used by jordanian nurse managers.

BACKGROUND: Emotional intelligence can help managers to effectively deal with conflicts in the workplace. However, the correlation between conflict management styles and emotional intelligence has not been fully conceptualized. AIM: To examine the impact of demographic variables and emotional intelligence on conflict management styles among nurse managers from Jordan. METHOD: A descriptive correlational design was used. A sample of 248 nurse managers completed the study. RESULTS: The integrating style was the most commonly used style among Jordanian nursing managers, while the least frequently used style was the dominating style. Conflict management styles significantly differed according to hospital type and years of experience. There were significant relationships between emotional intelligence and conflict management styles, but the direction of this relationship is not fully consistent with previous literature. CONCLUSION: Educating nursing managers about emotional intelligence may improve their abilities to manage conflicts in the workplace. However, cultural factors might have a role in determining the conflict management style used by managers. IMPLICATIONS FOR NURSING MANAGEMENT: An analysis of the relationship between emotional intelligence and conflict management styles can assist management in initiating a tailor-training program to improve abilities to manage conflict.

Predicting the effect of nurse-patient ratio on nurse workload and care quality using discrete event simulation.

AIM: A novel nurse-focused discrete event simulation modelling approach was tested to predict nurse workload and care quality. BACKGROUND: It can be challenging for hospital managers to quantify the impact of changing operational policy and technical design such as nurse-patient ratios on nurse workload and care quality. Planning tools are needed-discrete event simulation is a potential solution. METHOD: Using discrete event simulation, a demonstrator "Simulated Care Delivery Unit" model was created to predict the effects of varying nurse-patient ratios. Modelling inputs included the following: patient care data (GRASP systems data), inpatient unit floor plan and operating logic. Model outputs included the following: nurse workload in terms of task-in-queue, cumulative distance walked and Care quality in terms of task in queue time, missed care. RESULTS: The model demonstrated that as NPR increases, care quality deteriorated (120% missed care; 20% task-in-queue time) and nursing workload increased (120% task-in-queue; 110% cumulative walking distance). CONCLUSIONS: DES has the potential to be used to inform operational policy and technical design decisions, in terms of impacts on nurse workload and care quality. IMPLICATIONS FOR NURSING MANAGEMENT: This research offers the ability to quantify the impacts of proposed policy changes and technical design decisions, and provide a more cost-effective and safe alternative to the current trial and error methodologies.

Factors that influence influenza vaccination rates among the elderly: nurses' perspectives.

AIMS: To explore which factors nurses perceive to help and hinder influenza vaccination rates among the elderly. BACKGROUND: Influenza-related illnesses and deaths have disproportionately high prevalence among the elderly. Vaccination is an effective tool to prevent complications. METHODS: Semistructured interviews were conducted with nurses focusing on barriers, facilitators and health care providers' roles in influencing patients to be vaccinated. Interviews were recorded, transcribed and thematically analysed. RESULTS: Nurses identified that the prevalent barriers were fear of the vaccine's side effects, feelings of good health and technical considerations. Facilitators included ease of access and encouragement from health providers, media and social networks. The health care team was influential in raising vaccination rates through direct recommendation, providing concrete information or leading by example. CONCLUSIONS: The health care team can influence patients to vaccinate. Investments in training nurses in the knowledge and skills needed to educate patients, and providing nurses with the necessary resources to engage patients in these discussions may be beneficial. Nurse managers can be instrumental in enhancing nurses' roles and actions to increase influenza vaccination rates among the elderly. IMPLICATIONS FOR NURSING MANAGEMENT: It is essential to reinforce the nurses' role in promoting vaccination among seniors. Given that nurses are the largest number of health professionals, their potential outreach to large numbers of people is strong.

Management capacity to promote nurse workplace health and safety.

PURPOSE: To investigate regarding workplace health and safety factors, and to identify strategies to preserve and promote a healthy nursing workplace. METHODS: Data collected using the Delphi technique with input from 41 key informants across four participant categories drawn from a Chinese university and four hospitals were thematically analysed. RESULTS: Most respondents agreed on the importance of nurses' health and safety, and that nurse managers should act to protect nurses, but not enough on workplace safety. Hospital policies, staff disempowerment, workload and workplace conflicts are major obstacles. CONCLUSION: The reality of Chinese nurses' workplaces is that health and safety risks abound and relate to socio-cultural expectations of women. Self-management of risks is neccessary, gaps exist in understanding of workplace risks among different nursing groups and their perceptions of the professional status, and the value of nurses' contribution to ongoing risks in the hospital workplace. The Chinese hospital system must make these changes to produce a safer working environment for nurses. IMPLICATIONS FOR NURSING MANAGEMENT: This research, based in China, presents an instructive tale for all countries that need support on the types and amounts of management for nurses working at the clinical interface, and on the consequences of management neglect of relevant policies and procedures.