Growing into teen fatherhood: a grounded theory study.

BACKGROUND: Becoming an adolescent father is a significant and critical life event. Expectant fathers are faced with a concurrent dual developmental crisis: being an adolescent and becoming a father. This transition has a tremendous impact on these adolescents, their families and society. The impact on these individuals and society does not, at this point, seem to be clearly understood. PURPOSE: To explore the process of Thai adolescents becoming first-time fathers with an unplanned pregnancy during their girlfriend's pregnancy. METHODS: A grounded theory approach was used, drawing upon semi-structured interviews with 16 expectant fathers in Chiang Mai, Thailand. FINDINGS: 'Growing into teen fatherhood' was the basic social process that emerged as the core category. These fathers used this process for developing themselves to fatherhood. This process was further divided into three phases: enduring the conflict of future role, accepting impending fatherhood and developing a sense of being teen expectant father. Throughout this process, the participants encountered many conflicts and challenges. They employed various strategies to manage the emotional, financial and interpersonal challenges they faced during the transition to fatherhood. CONCLUSION: This study provides data as well as anecdotal evidence for healthcare professionals to better understand adolescent fathers and their unique challenges during their girlfriend's pregnancy. A better understanding of these rich findings will enable healthcare professionals to assist young men and boys in their struggle to transition to fatherhood. IMPLICATIONS FOR NURSING POLICY: Our data may guide policymakers in developing support groups, effective mentoring programs and national follow-up services as standard services in hospitals' care for first-time adolescent fathers in Thailand.

Factors predicting quality of work life among nurses in tertiary-level hospitals, Bangladesh.

AIM: This study examined the level of quality of work life and predictability of years of education, monthly income, years of experience, job stress, organizational commitment and work environment on quality of work life among nurses in tertiary-level hospitals in the People's Republic of Bangladesh. BACKGROUND: There is an acute shortage of nurses worldwide including Bangladesh. Quality of work life is important for quality of patient care and nurse retention. Nurses in Bangladesh are fighting to provide quality care for emerging health problems for the achievement of sustainable development goals. METHODS: We collected data from 288 randomly selected registered nurses, from six tertiary-level hospitals. All nurses were requested to fill questionnaire consisted of Demographic Data Sheet, Quality of Nursing Work Life Survey, Expanded Nursing Stress Scale, Questionnaire of Organizational Commitment and Practice Environment Scale of the Nursing Work Index. Data were analysed by descriptive statistics and multiple regression. RESULTS: The quality of work life as perceived by nurses in Bangladesh was at moderate level. Monthly income was found as the best predictor followed by work environment, organizational commitment and job stress. DISCUSSION: A higher monthly income helps nurses to fulfil their personal needs; positive work environment helps to provide quality care to the patients. LIMITATION: Quality of work life and predictors measured by self-report only may not reflect the original picture of the quality of work life among nurses. CONCLUSION AND POLICY IMPLICATIONS: Findings provide information for nursing and health policymakers to develop policies to improve quality of work life among nurses that can contribute to quality of nursing care. This includes the working environment, commitment to the organization and measures to reduce job stress.

Developing a cultural competence inventory for nurses in China.

AIM: To develop and psychometrically test the Cultural Competence Inventory for Nurses in China. BACKGROUND: Cultural competence is expected worldwide from nurses due to the increasing cultural diversity of people in healthcare establishments. Yet, no cultural competence framework or instrument for nurses has been identified to guide nursing practice in China where the cultural diversity of the populations and the characteristics of the healthcare system are different from those of the West. METHODS: A review of literature and individual interviews among nurse experts generated 74 items, which were evaluated by six experts in transcultural nursing. A stratified random sampling technique was used to recruit 520 Chinese nurses for the field test. Construct validity and internal consistency reliability of the instrument were estimated by exploratory factor analysis and Cronbach's alpha, respectively. The data were collected from May 2015 to January 2016. RESULTS: The final instrument consists of 29 items in five dimensions, namely 'cultural awareness, cultural respect, cultural knowledge, cultural understanding and cultural skills'. Cronbach's alpha for the instrument was 0.94, with a range of 0.79-0.92 for the individual dimensions. The evidence for contrast-group validity (P < 0.001) was also obtained. CONCLUSION: The study provides evidence that the Cultural Competence Inventory for Nurses in China is reliable, valid and culturally sensitive for measuring nurses' cultural competence. The instrument development process facilitates the understanding of cultural competence globally. IMPLICATIONS FOR NURSING AND NURSING POLICY: Cultural competence of nurses can be evaluated for self-development, workforce management and quality assurance. The instrument can also serve as the foundation to develop education curricula and nursing procedures or protocols to improve culturally competent nursing practice.

Nurses' extended work hours: Patient, nurse and organizational outcomes.

BACKGROUND: Nursing shortages have been associated with increased nurse workloads that may result in work errors, thus impacting patient, nurse and organizational outcomes. AIM: To examine for the first time in Thailand nurses' extended work hours (working more than 40 h per week) and its relationship to patient, nurse and organizational outcomes. METHODS: Using multistage sampling, 1524 registered nurses working in 90 hospitals across Thailand completed demographic forms: the Nurses' Extended Work Hours Form; the Patient, Nurse, Organizational Outcomes Form; the Organizational Productivity Questionnaire and the Maslach Burnout Inventory. The data were analysed using descriptive statistics, Spearman's rank correlation and logistic regression. RESULTS: The average extended work hour of respondents was 18.82 h per week. About 80% worked two consecutive shifts. The extended work hours had a positive correlation with patient outcomes, such as patient identification errors, pressure ulcers, communication errors and patient complaints and with nurse outcomes of emotional exhaustion and depersonalization. Furthermore, we found a negative correlation between extended work hours and job satisfaction as a whole, intent to stay and organizational productivity. Nurses who had extended work hours of >16 h per week were significantly more likely to perceive all four adverse patient outcomes than participants working an extended ≤8 h per week. LIMITATIONS: Patient outcomes were measured by respondents' self-reports. This may not always reflect the real occurrence of adverse events. CONCLUSIONS: Associations between extended work hours and outcomes for patients, nurses and the organization were found. The findings demonstrate that working two shifts (16 h) more than the regular work hours lead to negative outcomes for patients, nurses and the organization. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Our findings add to increasing international evidence that nurses' poor working conditions result in negative outcomes for professionals, patients and health systems. Policymakers need to be aware of the issues regarding nurses' extended work hours, which has been found to contribute to burnout. Urgently, nurse and health administrators need to develop and implement appropriate nursing overtime policies and strategies to help reduce this phenomenon, including measures to overcome the nursing shortage.

Community health nurses' HIV health promotion and education programmes: a qualitative study.

BACKGROUND: Globally, nurses practice in many settings with people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), taking an increasing share of the professional burden of care and helping to reduce morbidity and mortality. International literature is sparse about Thai community nurses providing primary healthcare programmes for people with HIV. AIM: This study aimed to describe background, experiences and strategies of community nurses regarding their design and delivery of programmes for people living with HIV and AIDS in Chiang Mai Province, Thailand. DESIGN: This study used a qualitative mixed-methods study employing a qualitative survey and in-depth interviews. METHODS: Twenty community health nurses from 18 small community hospitals completed a survey comprising demographic data and 13 open-ended questions. Four of them later engaged in in-depth interviews using the same questions. Survey, interview data and field notes were analysed using interpretive content analysis. FINDINGS: Four themes and six sub-themes portrayed participants' rich experiences and knowledge of HIV health promotion and education; challenges of daily work, discrimination and ethical issues; success through programme diversity comprising promotion of community volunteerism, networking and relationships; and holistic connections with Thai cultural traditions and Buddhism. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings help to recognize the diversity, uniqueness and contributions of Thai community nurses regarding culturally appropriate health promotion and education programmes for people living with HIV and AIDS. Findings inform nurses and health officials in and outside of the country to complement innovation in future HIV health promotion and education programmes. LIMITATIONS: Our sample came from one province of Thailand. Findings might not be reflective of nurses elsewhere. IMPLICATIONS FOR HEALTH AND NURSING POLICY: Three decades of collective experience in providing holistic and multifaceted HIV and AIDS nursing care, education and health promotion by community health nurses have the potential to effect new and existing policies and protocols on HIV community care in Thailand, but more research is required for this.

Growing together: a qualitative study of leading nurse scholars in Thailand.

BACKGROUND: Asia-Pacific nursing education and research is growing but little is known about the nature and development of nursing scholarship in the region. AIM: This qualitative study explored the perspectives of 14 leading Thai scholars about the development, facilitators and barriers relating to Thailand's nursing scholarship. METHOD: In-depth interviews were digitally recorded, and data were subjected to content analysis. FINDINGS: Five themes arose: (1) growing together, (2) visionary leadership, (3) external support to grow nurse scholars, (4) developing nursing through research, and (5) barriers to scholarship. A history of visionary nursing leadership was revealed, underpinned by leaders' values of growing nursing together. Resource sharing among universities, and a significant number of scholarships for study abroad were major facilitators of scholarship growth. Barriers to scholarship included high teaching loads, especially for newly graduated faculty; a low rate of research publications; not enough mentorship for research and changes to teaching practice; and a wide range of different agencies providing courses for entry to practice. CONCLUSIONS: Scholarship development in Thailand is a role model for a number of South-East Asian countries, with inclusiveness and collaboration to facilitate the growth of nursing education inside and outside of the country as a hallmark of its character. However, against a backdrop of nursing shortages, Thai scholars are challenged, in the future, to produce meaningful research outcomes, including publications of studies; to collaborate with other health professionals; change practices to overcome high teaching loads; and provide the much needed mentorship for young scholars.