Identification of leader-trailer helices of precursor ribosomal RNA in all phyla of bacteria and archaea.

Ribosomal RNAs are transcribed as part of larger precursor molecules. In Escherichia coli, complementary RNA segments flank each rRNA and form long leader-trailer (LT) helices, which are crucial for subunit biogenesis in the cell. A previous study of 15 representative species suggested that most but not all prokaryotes contain LT helices. Here, we use a combination of in silico folding and covariation methods to identify and characterize LT helices in 4,464 bacterial and 260 archaeal organisms. Our results suggest that LT helices are present in all phyla, including Deinococcota, which had previously been suspected to lack LT helices. In very few organisms, our pipeline failed to detect LT helices for both 16S and 23S rRNA. However, a closer case-by-case look revealed that LT helices are indeed present but escaped initial detection. 3,618 secondary structure models, many well-supported by nucleotide covariation, were generated. These structures show a high degree of diversity. Yet, all exhibit extensive base-pairing between the leader and trailer strands, in line with a common and essential function.

Nonspecific N-terminal tetrapeptide insertions disrupt the translation arrest induced by ribosome-arresting peptide sequences.

The nascent polypeptide chains passing through the ribosome tunnel not only serve as an intermediate of protein synthesis but also, in some cases, act as dynamic genetic information, controlling translation through interaction with the ribosome. One notable example is Escherichia coli SecM, in which translation of the ribosome arresting peptide (RAP) sequence in SecM leads to robust elongation arrest. Translation regulations, including the SecM-induced translation arrest, play regulatory roles such as gene expression control. Recent investigations have indicated that the insertion of a peptide sequence, SKIK (or MSKIK), into the adjacent N-terminus of the RAP sequence of SecM behaves as an "arrest canceler". As the study did not provide a direct assessment of the strength of translation arrest, we conducted detailed biochemical analyses. The results revealed that the effect of SKIK insertion on weakening SecM-induced translation arrest was not specific to the SKIK sequence, that is, other tetrapeptide sequences inserted just before the RAP sequence also attenuated the arrest. Our data suggest that SKIK or other tetrapeptide insertions disrupt the context of the RAP sequence rather than canceling or preventing the translation arrest.

The antiviral response triggered by the cGAS/STING pathway is subverted by the foot-and-mouth disease virus proteases.

Propagation of viruses requires interaction with host factors in infected cells and repression of innate immune responses triggered by the host viral sensors. Cytosolic DNA sensing pathway of cyclic GMP-AMP synthase (cGAS) and stimulator of interferon genes (STING) is a major component of the antiviral response to DNA viruses, also known to play a relevant role in response to infection by RNA viruses, including foot-and-mouth disease virus (FMDV). Here, we provide supporting evidence of cGAS degradation in swine cells during FMDV infection and show that the two virally encoded proteases, Leader (Lpro) and 3Cpro, target cGAS for cleavage to dampen the cGAS/STING-dependent antiviral response. The specific target sequence sites on swine cGAS were identified as Q140/T141 for the FMDV 3Cpro and the KVKNNLKRQ motif at residues 322-330 for Lpro. Treatment of swine cells with inhibitors of the cGAS/STING pathway or depletion of cGAS promoted viral infection, while overexpression of a mutant cGAS defective for cGAMP synthesis, unlike wild type cGAS, failed to reduce FMDV replication. Our findings reveal a new mechanism of RNA viral antagonism of the cGAS-STING innate immune sensing pathway, based on the redundant degradation of cGAS through the concomitant proteolytic activities of two proteases encoded by an RNA virus, further proving the key role of cGAS in restricting FMDV infection.

Determinants of the interaction between the 5'-leader of HIV-1 genome and human lysyl-tRNA synthetase in reverse transcription primer release process.

Reverse transcription of human immunodeficiency virus type 1 (HIV-1) initiates from the 3' end of human tRNALys3. The primer tRNALys3 is selectively packaged into the virus in the form of a complex with human lysyl-tRNA synthetase (LysRS). To facilitate reverse transcription initiation, part of the 5' leader (5'L) of HIV-1 genomic RNA (gRNA) evolves a tRNA anticodon-like element (TLE), which binds LysRS and releases tRNALys3 for primer annealing and reverse transcription initiation. Although TLE has been identified as a key element in 5'L responsible for LysRS binding, how the conformations and various hairpin structures of 5'L regulate 5'L-LysRS interaction is not fully understood. Here, these factors have been individually investigated using direct and competitive fluorescence anisotropy binding experiments. Our data showed that the conformation of 5'L significantly influences its binding affinity with LysRS. The 5'L conformation favoring gRNA dimerization and packaging exhibits much weaker binding affinity with LysRS compared to the alternative 5'L conformation that is not selected for packaging. Additionally, dimerization of 5'L impairs LysRS-5'L interaction. Furthermore, among various regions of 5'L, both the primer binding site/TLE domain and the stem-loop 3 are important for LysRS interaction, whereas the dimerization initiation site and the splicing donor plays a minor role. In contrast, the presence of the transacting responsive and the polyadenylation signal hairpins slightly inhibit LysRS binding. These findings reveal that the conformation and various regions of the 5'L of HIV-1 genome regulate its interaction with human LysRS and the reverse transcription primer release process.

Snakehead vesiculovirus (SHVV) leader RNA interacts with host antiviral factors RPS8 and L13a and promotes virus replication.

To evade host antiviral response, viruses have evolved to take advantage of their noncoding RNAs (ncRNAs). Snakehead vesiculovirus (SHVV), a newly isolated fish rhabdovirus from diseased hybrid snakehead, has caused high mortality to the cultured snakehead fish during the past years in China. However, little is known about the mechanisms of its pathogenicity. Our study revealed that overexpression of the 30-nt leader RNA promoted SHVV replication. RNA-protein binding investigation revealed that SHVV leader RNA could interact with host 40S ribosomal protein S8 (RPS8) and 60S ribosomal protein L13a (L13a). Furthermore, we found that SHVV infection upregulated RPS8 and L13a, and in turn, overexpression of RPS8 or L13a inhibited, while knockdown of RPS8 or L13a promoted, SHVV replication, suggesting that RPS8 and L13a acted as host antiviral factors in response to SHVV infection. In addition, our study revealed that RPS8- or L13a-mediated inhibition of SHVV replication could be restored by co-transfection with leader RNA, suggesting that the interaction between leader RNA and RPS8 or L13a might affect the anti-SHVV effects of RPS8 and L13a. Taken together, these results suggest that SHVV leader RNA can interact with the host antiviral factors RPS8 and L13a, and promote SHVV replication. This study provides a better understanding of the molecular mechanism of the pathogenesis of SHVV and a potential antiviral strategy against SHVV infection.

Burnout among intensive care nurses, physicians and leaders during the COVID-19 pandemic: A national longitudinal study.

BACKGROUND: Burnout is frequent among intensive care unit (ICU) healthcare professionals and may result in medical errors and absenteeism. The COVID-19 pandemic caused additional strain during working hours and also affected off-duty life. The aims of this study were to survey burnout levels among ICU healthcare professionals during the first year of COVID-19, describe those who reported burnout, and analyse demographic and work-related factors associated with burnout. METHODS: This was a national prospective longitudinal cohort study of 484 nurses, physicians and leaders working in intensive care units with COVID-19 patients in Norway. Burnout was measured at 6- and 12-month follow-up, after a registration of baseline data during the first months of the COVID epidemic. The Copenhagen Burnout Inventory (CBI), was used (range 0-100), burnout caseness defined as CBI ≥50. Bi- and multivariable logistic regression analyses were performed to examine baseline demographic variables and work-related factors associated with burnout caseness at 12 months. RESULTS: At 6 months, the median CBI score was 17, increasing to 21 at 12 months (p = .037), with nurses accounting for most of the increase. Thirty-two per cent had an increase in score of more than 5, whereas 25% had a decrease of more than 5. Ten per cent reported caseness of burnout at 6 months and 14% at 12 months (n.s.). The participants with burnout caseness were of significantly lower age, had fewer years of experience, reported more previous anxiety and/or depression, more moral distress, less perceived hospital recognition, and more fear of infection in the bivariate analyses. Burnout was the single standing most reported type of psychological distress, and 24 out of 41 (59%) with burnout caseness also reported caseness of anxiety, depression and/or post-traumatic stress disorder (PTSD) symptoms. Multivariate analysis showed statistically significant associations of burnout caseness with fewer years of professional experience (p = .041) and borderline significance of perceived support by leader (p = .049). CONCLUSION: In Norway, a minority of ICU nurses, physicians and leaders reported burnout 1 year into the pandemic. A majority of those with burnout reported anxiety, depression and/or PTSD symptoms combined. Burnout was associated with less years of professional experience.

"That was one of my most difficult and biggest challenges": experiences, preconditions and preventive measures of health-oriented leadership in virtual teams - A qualitative study with virtual leaders.

BACKGROUND: Health-oriented leadership (HoL) has a positive impact on health- and work-related outcomes of employees in face-to-face settings. Increased digitization during the COVID-19 pandemic has led to many changes and increased job demands. According to current state of research, HoL in virtual teamwork is insufficiently researched. The aim of the study is to examine the experiences of virtual leaders during the COVID-19 pandemic and to identify preconditions and preventive measures for promoting HoL. METHOD: Using a qualitative study design, semi-structured, guide-based telephone interviews were conducted with 16 German virtual leaders between May and July 2021. The collected data were inductively analyzed and interpreted using qualitative content analysis according to Mayring. Explorative analyses of differences between leaders with and without pre-pandemic experiences with virtual leadership were made. RESULTS: Results indicated that leaders, regardless of pre-pandemic experiences with virtual leadership, faced diverse challenges in implementing HoL in virtual teamwork during the COVID-19 pandemic. Virtual leaders perceived personal preconditions (e.g., leaders' characteristics or behaviors), organizational preconditions (support by management or open-minded corporate culture), social preconditions (e.g., social support by team) and technical preconditions (e.g., sufficient technical equipment) as conducive to implementation of HoL. Almost all leaders with pre-pandemic experience identified a need for structural preventive measures, whereas almost all leaders without pre-pandemic experience reported a need for behavioral preventive measures in order to promote HoL in virtual teams. CONCLUSIONS: This study suggests that implementing HoL in virtual teamwork is challenging, complex and requires adjustments in leadership behavior. Thereby, the study provides initial empirical findings for a holistic approach to HoL implementation in virtual teams, considering beneficial multilevel preconditions. Due to a limited generalization of present results, longitudinal and interventional studies will be necessary for the analysis of causal relationships in future research. In particular, a holistic research perspective in order to understand the complex, contextual interdependencies of leadership is recommended. In practice, based on a differentiated needs analysis, structural preventive measures for a holistic organizational development as well as behavioral preventive measures for ongoing personnel development are recommended.

A qualitative study of leaders' experiences of handling challenges and changes induced by the COVID-19 pandemic in rural nursing homes and homecare services.

BACKGROUND: The COVID-19 pandemic had a major impact on healthcare services globally. In care settings such as small rural nursing homes and homes care services leaders were forced to confront, and adapt to, both new and ongoing challenges to protect their employees and patients and maintain their organization's operation. The aim of this study was to assess how healthcare leaders, working in rural primary healthcare services, led nursing homes and homecare services during the COVID-19 pandemic. Moreover, the study sought to explore how adaptations to changes and challenges induced by the pandemic were handled by leaders in rural nursing homes and homecare services. METHODS: The study employed a qualitative explorative design with individual interviews. Nine leaders at different levels, working in small, rural nursing homes and homecare services in western Norway were included. RESULTS: Three main themes emerged from the thematic analysis: "Navigating the role of a leader during the pandemic," "The aftermath - management of COVID-19 in rural primary healthcare services", and "The benefits and drawbacks of being small and rural during the pandemic." CONCLUSIONS: Leaders in rural nursing homes and homecare services handled a multitude of immediate challenges and used a variety of adaptive strategies during the COVID-19 pandemic. While handling their own uncertainty and rapidly changing roles, they also coped with organizational challenges and adopted strategies to maintain good working conditions for their employees, as well as maintain sound healthcare management. The study results establish the intricate nature of resilient leadership, encompassing individual resilience, personality, governance, resource availability, and the capability to adjust to organizational and employee requirements, and how the rural context may affect these aspects.

The association of leader-member exchange and team-member exchange with nurses' innovative behaviours: A cross-sectional study.

AIM: To measure the association of leader-member exchange and team-member exchange with nurses' innovative behaviours through social exchange theory. BACKGROUND: The field of nursing is actively advocating innovation. Other fields have proven that leader-member exchange and team-member exchange can promote innovative behaviour, but such an association is not clear in nursing. DESIGN: A cross-sectional study. METHODS: A total of 560 nurses were selected from five tertiary hospitals in Henan Province (China) by multistage sampling. Data were collected from a self-report questionnaire. Thirty nurses in the pre-survey were used to verify the validity of the questionnaire. SPSS PROCESS macro was used to verify the association of leader-member exchange and team-member exchange with nurses' innovative behaviours. RESULTS: Leader-member exchange and team-member exchange were significantly associated with nurses' innovative behaviours, and team-member exchange had a mediating effect on the relationship between leader-member exchange and innovative behaviour. CONCLUSIONS: Leader-member exchange and team-member exchange positively affect nurses' innovative behaviours. Leader-member exchange can promote nurses' innovative behaviours through the mediating role of team-member exchange. IMPACT: This study indicated that leader-member exchange and team-member exchange should be given more attention in promoting nurses' innovative behaviours. This finding has implications for the promotion of innovative behaviours in nurses. Leaders need to focus on the innovative needs of nurses and offer support. Meanwhile, leadership training programs are necessary for managers to create positive team relationships. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement.

Cryptocurrency Turmoil: Unraveling the Collapse of a Unified Stablecoin (USTC) through Twitter as a Passive Sensor.

This study sought to explore whether Twitter, as a passive sensor, could have foreseen the collapse of the Unified Stablecoin (USTC). In May 2022, in just a few days, the cryptocurrency went to near-zero valuation. Analyzing 244,312 tweets from 89,449 distinct accounts between April and June 2022, this study delved into the correlation between personal sentiments in tweets and the USTC market value, revealing a moderate correlation with polarity. While sentiment analysis has often been used to predict market prices, the results suggest the challenge of foreseeing sudden catastrophic events like the USTC collapse solely through sentiment analysis. The analysis uncovered unexpected global interest and noted positive sentiments during the collapse. Additionally, it identified events such as the launch of the new Terra blockchain (referred to as "Terra 2.0") that triggered positive surges. Leveraging machine learning clustering techniques, this study also identified distinct user behaviors, providing valuable insights into influential figures in the cryptocurrency space. This comprehensive analysis marks an initial step toward understanding sudden and catastrophic phenomena in the cryptocurrency market.

A Novel Spider Monkey Optimization for Reliable Data Dissemination in VANETs Based on Machine Learning.

The growth in linked and autonomous vehicles has led to the emergence of vehicular ad hoc networks (VANETs) as a means to enhance road safety, traffic efficiency, and passenger comfort. However, VANETs face challenges in facilitating trustworthiness and high-quality services due to communication delays caused by traffic, dynamic topology changes, variable speeds, and other influencing factors. Hence, there is a need for a reliable data dissemination scheme capable of reducing communication delays among hops by identifying effective forwarder nodes. In this paper, we propose a novel, weighted, estimated, spider monkey-based, nature-inspired optimization (w-SMNO) method to generate a set of efficient relays. Additionally, we introduce a dynamic weight assignment and configuration model to enhance system accuracy using a neural network based on backpropagation with gradient descent optimization techniques to minimize errors in the machine learning model. The w-SMNO also incorporates a distinct algorithm for effective relay selection among multiple monkey spider groups. The simulation results demonstrate substantial improvements in w-SMNO, with a 35.7% increase in coverage, a 41.2% reduction in the end-to-end delay, a 36.4% improvement in the message delivery rate, and a 38.4% decrease in the collision rate compared to the state-of-the-art approaches.

Caregivers of individuals with borderline personality disorder: The relationship between leading caregiver interventions and psychological distress/positive mental well-being.

Burden and psychological distress are higher in informal caregivers (ICs) of people with severe emotional and behavior dysregulation who have been given a diagnosis of borderline personality disorder (BPD) compared with non-caregivers. The current cross-sectional study examines the difference in outcomes of ICs of people with BPD who have received the intervention Family Connections (FC) and who also led interventions for other caregivers (caregiver-leaders) compared with those who have attended FC but not led caregiver interventions (non-leader-FC participants). The sample for this research is from a larger study (Hayes et al., 2023, Borderline Personality Disorder and Emotion Dysregulation, 10, 31). Data for 347 participants who self-reported receiving FC and completed the McLean Screening Instrument for BPD-Carer Version, the Brief COPE, the Multidimensional Scale of Perceived Social Support, the Kessler Psychological Distress scale, the WHO-5 Well-being Index, and the Coronavirus Anxiety Scale were analyzed. The results found that being a caregiver-leader was associated with higher positive mental well-being and lower psychological distress compared with non-leader-FC participants. Being a caregiver-leader was also associated with significantly greater use of the coping strategy of positive reframing and lower use of behavioral disengagement and self-blame than non-leader-FC participants. The study provides preliminary evidence that for those who have received FC, becoming an intervention leader is associated with better outcomes than caregivers who do not become leaders and provides support for caregiver-led rollout of FC across services.

Fiscal decentralization, leader localization, and reduction of pollution and carbon emissions -empirical evidence from China's fiscal "province-managing-county" reform.

The fiscal system plays an important role in the government's environmental governance efforts. There is currently no consensus on how fiscal structure adjustments impact pollution and carbon reduction. This paper uses China's fiscal "province-managing-county" reform (FPMCR) implemented in 2004 as a quasi-natural experiment, utilizing panel data from 1670 counties in China from 2000 to 2020 to investigate the impact of fiscal decentralization on reduction pollution and carbon emissions (RPCE), as well as its underlying mechanisms. The results show that (1) from 2000 to 2020, China's RPCE shows an overall trend of fluctuating increase, with its value turning positive after 2013. China's RPCE exhibits a spatial pattern characterized by "lower in the north, higher in the south; higher in the east, lower in the west". (2) After implementing FPMCR, the RPCE levels in reformed counties decreased by -1.44%, showing that reformed county-level governments prioritize economic development over environmental protection. (3) The mechanism analysis found that after implementing FPMCR, reformed counties experienced a 9.16% increase in nighttime light intensity (NLI), and a 3.99% and 4.34% increase in the number of large-scale industrial enterprises (NLIE) and industrial agglomeration (IA), respectively. This suggests that FPMCR leads to radical urbanization and rapid industrialization in counties, which is detrimental to the improvement of RPCE levels. (4) The spatial heterogeneity analysis found that FPMCR's impact coefficient on RPCE levels in the eastern regions is -1.96%, while in the western regions it is -1.16%. This indicates that reformed counties in the eastern regions are more likely to invest expanded fiscal resources in economic development projects, leading to a decrease in RPCE levels. (5) The temporal heterogeneity analysis found that after the promulgation of the "Three-Year Action Plan to Win the Blue Sky Defense Battle" in 2018, the adverse impact of FPMCR on RPCE is completely reversed, leading to a 1.76% increase in RPCE levels. (6) Further analysis reveals that localizing leaders can slow down the promotion of county-level urbanization and industrialization by the FPMCR, benefiting the improvement of RPCE levels. In other words, "the outsider monk will not recite scriptures as well as a local one". This study has clarified the causal relationship and underlying mechanisms between fiscal decentralization and environmental governance, providing reliable theoretical support for optimizing grassroots fiscal systems and reducing environmental pollution in other transitional economies. It enriches the field of environmental economics related to fiscal decentralization.

A Cell-Penetrating Peptide Improves Anti-HER2 Single-Chain Variable Fragment Internalization and Antitumor Activity against HER2-Positive Breast Cancer In Vitro and In Vivo.

Cell-penetrating peptides (CPPs) are invaluable tools for delivering various substances into cells by crossing biological membranes. However, the effects of cell-penetrating peptide fusion proteins on the biological activity of antibodies remain to be fully understood. Here, we engineered a recombinant protein, LP-scFv, which combines the single-chain variable region of anti-human epidermal growth factor receptor-2 with a novel and non-oxic cell-penetrating peptide as a leader peptide. The introduction of this leader peptide led to a more than twofold increase in the internalization efficiency of the single-chain antibody, as confirmed using microscopic analysis and flow cytometry. The effects of the single-chain antibodies and LP-scFv on cell viability were evaluated using the MTT assay. Both the single-chain antibodies and LP-scFv reduced the viability of BT474 and NCI-N87 cells in a dose-dependent manner while exhibiting minimal toxicity towards MCF-7 and MCF-10A cells. Further investigation into LP-scFv's mechanism revealed that the induced leader peptide does not alter the MAPK-ERK1/2 and PI3K/AKT pathways of single-chain antibodies. An enhanced antitumor activity was also confirmed in an NCI-N87 tumor xenograft model in mice with a reduction of 45.2% in tumor growth inhibition (vs. 23.1% for scFv) with a 50 mg/kg dose after orthotopic injection administration, which was equivalent to that of trastuzumab (vs. 55.7% for trastuzumab). Overall, these results indicate that LP-scFv exhibits significant permeation activity in HER2-positive cells to enhance the intracellular dose effect on antitumor activity in vitro and in vivo. This research lays the foundation for designing novel antibody-based therapies for cancer.

Leadership Blossoms in Parental Warmth: Positive Parenting Practices Shape Adolescent Leader Emergence via Intrapersonal and Interpersonal Mechanisms.

Developing leadership skills during adolescence is crucial for future career success. Previous studies have primarily focused on the impact of school settings, academic courses, and simulated team tasks on leader emergence, neglecting the significant role of parental influence in this process. Employing a mixed-methods approach, this research investigated the positive relationship between parental warmth and adolescent leader emergence and the underlying mechanisms of this relationship. The quantitative study (Study 1) collected multi-source data from 1255 adolescents (Mage = 14.2, SDage = 0.56, 48.2% male) and their parents, teachers and peers. Findings from Study 1 revealed a positive correlation between parental warmth and adolescent leader emergence. Structural equation modeling showed two mediating pathways: an intrapersonal pathway involving self-esteem and leader self-efficacy, and an interpersonal pathway involving empathy and prosocial behavior. Encouragement of independence, as an additional adolescents-focused parenting practice, strengthened the observed positive relationship. The qualitative study (Study 2) conducted in-depth interviews with adolescents to identify the parental practices that facilitate or hinder adolescent leader emergence for the triangulation of the central research question. Study 2 collected data from 32 adolescents (Mage = 15.16, SDage = 1.37, 50% male). Findings from Study 2 corroborated the significance of parental warmth and the encouragement of independence for adolescent leader emergence, elucidating specific parenting behaviors conducive to these positive parenting practices, such as providing companionship and communication, as well as encouraging adolescents to participate in household tasks. This mix-methods research prepositioned the stages of leadership development, advocating for the importance of the warmth and autonomy from parents as formative factors for cultivating the next generation of leaders.

Influencing leadership in nursing education and practice: A qualitative study of military nurse officers.

BACKGROUND: The potential positive impact military nurse officers (MNOs) make on the nursing profession, as well as lessons learned, often is unknown beyond inner military circles. PURPOSE: Describe the experiences of MNOs in the advancement of the profession of nursing and nursing education, and how military service influenced nurse leaders' impact on civilian practice. METHOD: A descriptive-interpretive qualitative study using semistructured interviews of MNOs (N = 21). FINDINGS: Analysis revealed three themes: Deliberately developing personal leadership capacity, Building bench strength through team investment, and Balancing people and systems to achieve the mission. DISCUSSION: Leader development in the military afforded participants the necessary skills to advance the profession of nursing and nursing education in multiple ways that span individual, group/team, and organizational impact. Transferability and application of these skills to civilian settings may enhance leader development in nurses without military service.

Public perceptions of the brand image of nursing: Cross-cultural differences between the United States and China.

BACKGROUND: Measures of public opinion regarding nursing's brand image are needed to identify and correct perceptions that are incongruent with the breadth and scope of contemporary nursing practice. Misperceptions of nursing's influence may serve to minimize or disregard nursing's unique contributions to addressing the Social Determinants of Health which are foundational for improving the health of global populations. PURPOSE: To compare public perceptions of the brand image of nursing between China and the United States (US) and determine whether sociodemographic variables influenced factors between the two countries. METHODS: A cross-sectional online survey was distributed among members of the Chinese and U.S. public. Perceptions of nursing's brand image were assessed through the original Nursing Brand Image Scale-Public Version in the US (NBIS-P) and when translated to Chinese (NBIS-P-C). Descriptive statistics and multigroup confirmatory factor analyses were used to compare perceptions of the brand image of nursing and to examine the influence of demographics. DISCUSSION: The reliability of the Chinese version of the NBIS-P-C was confirmed by this study. Age and gender did not influence public perceptions of nursing's brand image in either China or the US. Instead, educational attainment was the significant demographic variable and positively correlated with the public's perceptions of nursing in both countries (p < .05). Public respondents with lower educational attainment scored both the traditional nursing factor "Caregiver Virtues/Attributes" (e.g., Trusted, Caring, Nurturing/Mothering) and the factor "Lack Authority/Identity" (e.g., White Cap/Uniform, Subservient, Female) higher, while scoring the factor for "Leadership" (e.g., Decision Makers, Influential, Leaders) significantly lower than those with higher educational levels. CONCLUSION: A disparity exists between nursing's contemporary contributions to healthcare and the public's limited understanding of the diverse leadership roles all nurses provide, across a variety of settings, and in global public health initiatives. The virtuous traits of the nurse are perceived most directly and immediately by the public while their roles as autonomous decision-makers and leaders are less (or not at all) visible. Enhancing the accuracy and visibility of a strong brand image could advance public perceptions of nurses as experts and leaders in nursing science, thus paving the way for nurses to more effectively direct and influence the health of the public, particularly those with lower educational attainment who represent some of the most vulnerable populations. Targeted interventions that incorporate the educational level of the public offer a foundational opportunity for the nursing profession to correct inaccurate and outdated stereotypes that prevent nurses from achieving their desired brand image as influential leaders. Such campaigns could also be used to inform policy, guide strategic planning, and transform the future direction of the nursing profession.

Understanding ageism towards older nursing staff and service users: A systematic mapping review from the perspective of clinical leaders and healthcare managers.

INTRODUCTION: Ageist attitudes negatively affect the quality of care for service users and the working conditions of older nursing staff. Clinical leaders' perceptions of older service users and nursing staff are unknown. AIM: To map research evidence on ageist attitudes in healthcare towards service users and older nursing staff, from the leadership perspective. MATERIAL AND METHODS: A systematic mapping review with database searches in March 2021 and May 2023). Nineteen articles (qualitative n = 13, quantitative n = 3, mixed methods n = 3) were analysed and mapped to the Nurse Executive Capability Framework. RESULTS: Future planning, team building, and self-awareness are leadership categories requiring consideration. Guidelines and policies addressing the holistic needs of older service users and older nursing staff are lacking. CONCLUSIONS: Organizational planning, team building, and self-awareness are crucial for the holistic care of older service users and for creating attractive workplaces for older nursing staff.

Critical care nurse leaders' moral distress: A qualitative descriptive study.

BACKGROUND: Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL's experience. RESEARCH AIM: The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. RESEARCH DESIGN: A qualitative descriptive design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. PARTICIPANT AND RESEARCH CONTEXT: Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. ETHICAL CONSIDERATIONS: This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. FINDINGS: UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. CONCLUSIONS: The UBCCNL's experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed.

Digital ethical reflection in home nursing care: Nurse leaders' and nurses' experiences.

BACKGROUND: Nurse leaders increasingly need effective tools that facilitate the prioritisation of ethics and help staff navigate ethical challenges and prevent moral distress. This study examined experiences with a new digital tool for ethical reflection, tailored to improve the capabilities of both leaders and employees in the context of municipal long-term care. AIM: The aim was to explore the experiences of nurse leaders and nurses in using Digital Ethical Reflection as a tool for ethics work in home nursing care. RESEARCH DESIGN: The study employed a qualitative design, incorporating individual and focus group interviews for data collection. Qualitative content analysis was used to analyse the data. PARTICIPANTS AND RESEARCH CONTEXT: The participants comprised six nurse leaders and 13 nurses, representing six home care zones across two Norwegian municipalities. ETHICAL CONSIDERATIONS: The study involved informed, voluntary participation and was approved by the Norwegian Agency for Shared Services in Education and Research. FINDINGS: Four themes were developed: a constant walk on the edge between engagement and discouragement and lost in translation describe the process, while tuning in to the ethical dimension and navigating ethical uncertainties illuminate the experienced significance of Digital Ethical Reflection. CONCLUSION: Success with Digital Ethical Reflection in home nursing care depends on clear leadership planning, nurses' understanding of the tool's purpose, and active use of digital registrations. Support from ethically interested nurses enhances overall engagement. Further research is needed to explore the potential of Digital Ethical Reflection as an additional tool in long-term care ethics work.