Tertiary hospital nurses' ethical sensitivity and its influencing factors: A cross-sectional study.

BACKGROUND: High ethical sensitivity positively affects the quality of nursing care; nevertheless, Chinese nurses' ethical sensitivity and the factors influencing it have not been described. RESEARCH OBJECTIVES: The purpose of this study was to describe ethical sensitivity and to explore factors influencing it among Chinese-registered nurses, to help nursing administrators improve nurses' ethical sensitivity, build harmony between nurses and patients, and promote the patients' health. RESEARCH DESIGN: This was a descriptive, cross-sectional study. PARTICIPANTS AND RESEARCH CONTEXT: We recruited 500 nurses from several departments in three tertiary hospitals. The Chinese Moral Sensitivity Questionnaire-Revised version and the Jefferson Scale of Empathy-Health Professionals were used to assess the nurses' ethical sensitivity and empathy ability, respectively. Fifteen sociodemographic variables were included in the questionnaires. ETHICAL CONSIDERATIONS: Informed consent was obtained from the participants regarding participation and data storage and handling. This program has been examined and supported by the research center of medical ethics and professional ethics of Guilin Medical University. The Approval No. was 2016RWYB04. The whole research process is conducted strictly according to ethical requirements. RESULTS: The valid response rate was 84.40% (n = 422). The total score of Chinese Moral Sensitivity Questionnaire-Revised was 35.82 ± 8.17. The subscale scores of moral responsibility and strength and sense of moral burden were 21.50 ± 4.91 and 14.33 ± 3.98, respectively. Significant differences were found among age groups, gender, years of working, category of profession, and quality of family communication regarding nurses' ethical sensitivity (p < 0.05). Regression analysis showed that the main factors influencing nurses' ethical sensitivity were gender, years of working, quality of family communication, career satisfaction, and empathic ability. DISCUSSION: Our findings suggest that Chinese nurses' ethical sensitivity in tertiary hospitals in Guilin is at a medium level. CONCLUSION: The director of nursing schools and hospitals in China should pay attention to nurses' ethical sensitivity and should intensify education and training to improve nurses' ethical sensitivity. Further studies should focus on interventions aimed at improving Chinese nurses' ethical sensitivity.

Relationship between risk perception of COVID-19 and job withdrawal among Chinese nurses: The effect of work-family conflict and job autonomy.

AIM: The aim of this study was to examine the mediating role of work-family conflict and the moderating role of job autonomy on the association between risk perception of COVID-19 and job withdrawal among Chinese nurses during the initial disease outbreak. BACKGROUND: Nurses' job withdrawal can not only reduce the quality and efficiency of care but also give rise to turnover during the COVID-19 pandemic. Thus, it is essential to clarify how and when the risk perception of COVID-19 influences the job withdrawal behaviours of nurses and to provide guidelines for reducing nurses' job withdrawal. METHODS: A two-wave study was conducted among 287 Chinese nurses from 11 COVID-19-designated hospitals during the initial outbreak of the disease from March through April 2020. Data on the risk perception of COVID-19, job autonomy and work-family conflict were collected at time 1, and 1 month later, job withdrawal data were collected at time 2. Model 4 and Model 14 from SPSS macro PROCESS were used to test the mediating effect of work-family conflict and the moderating effect of job autonomy, respectively. RESULTS: Work-family conflict mediated 60.54% of the relationship between risk perception of COVID-19 and job withdrawal. Job autonomy positively moderated the relation between work-family conflict and job withdrawal (ß = 0.12, P < 0.01). CONCLUSION: Risk perception of COVID-19 influenced nurses' job withdrawal through work-family conflict. Job autonomy exaggerated the association between work-family conflict and job withdrawal. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should provide more supportive resources to help nurses cope with the risk of COVID-19 to decrease work-family conflict and job withdrawal, and they should strengthen supervision over the work processes of nurses.

How Do Presenteeism and Family Functioning Affect the Association Between Chinese Nurses' Job Stress and Intention to Stay?

BACKGROUND: Despite a great deal of existing research on nurses' job stress and intention to stay, it is still unclear how the association between Chinese nurses' job stress and intention to stay is affected by presenteeism and family functioning. AIMS: This study aimed to investigate the correlations of Chinese nurses' job stress, presenteeism, and family functioning with their intention to stay and clarify the mediating effect of presenteeism and the moderating effect of family functioning on the association between their job stress and intention to stay. METHOD: A cross-sectional study of 1,008 nurses was performed in a major general hospital in Qiqihar City, Heilongjiang Province, China. The participants were invited to engage in a questionnaire survey regarding job stress, presenteeism, family functioning, and intention to stay. A moderated mediation analysis was conducted through multiple linear regression analysis and the PROCESS macro. RESULTS: Job stress and presenteeism were negatively correlated with intention to stay, whereas family functioning was positively correlated with intention to stay. The effect of job stress on intention to stay was partially mediated by presenteeism (Effect = -0.147, 95% CI = [-0.305, -0.003]). In addition, family functioning moderated the direct effect of job stress on intention to stay (Index = -0.134, 95% CI = [-0.274, -0.001]). CONCLUSIONS: Presenteeism and family functioning were found to play mediating and moderating roles, respectively, in the relationship between job stress and intention to stay. Relevant interventions or family-friendly programs should be developed to enhance nurses' intention to stay.

Factors associated with work-family enrichment among Chinese nurses assisting Wuhan's fight against the 2019 COVID-19 pandemic.

AIMS AND OBJECTIVES: To examine the relationship between work-family enrichment and two contextual factors (job support and family support), together with two personal factors (family boundary flexibility and prosocial motivation) among Chinese nurses assisting Wuhan in its fight against the Coronavirus Disease 2019 (COVID-19) pandemic. BACKGROUND: The COVID-19 pandemic was first reported in Wuhan, China, and has now spread worldwide, which has brought attention to the pivotal role of nurses in public health emergencies. Work-family enrichment is a bidirectional structure, including work-to-family enrichment and family-to-work enrichment, that can yield many mutually beneficial results in both work and family domains among clinical nurses. However, few studies have investigated work-family enrichment and its influential factors among front-line nurses during public health emergencies. METHODS: A cross-sectional research design was adopted with a snowball sample of 258 Chinese nurses assisting Wuhan's anti-pandemic efforts. Data were collected from 21 March 2020 until 10 April 2020 through a battery of online questionnaires. Descriptive, univariate and hierarchical linear regression analyses and a Pearson correlation test were performed. A STROBE checklist was used to report findings. RESULTS: The results showed that prosocial motivation, family support and job support predicted high work-to-family enrichment in those nurses, while prosocial motivation, family support and family boundary flexibility predicted high family-to-work enrichment. CONCLUSIONS: The study confirmed the importance of paying attention to the work-family enrichment of front-line medical workers during the COVID-19 pandemic, so that they could concentrate on their anti-pandemic work and maintain their enthusiasm for disaster nursing. RELEVANCE TO CLINICAL PRACTICE: The findings can help health administrators in affected countries around the world identify the influential factors of work-family enrichment among front-line nurses during infectious disease outbreaks, specifically in the areas of mobilising nurses' prosocial motivation and giving sufficient job support.

Reframing the meaning of life and professional values: A theoretical framework of facilitating professional care for terminally ill patients.

Professional values reflect nurses' understanding of how to deliver professional care, which might influence nurses' attitudes and caring behaviors during end-of-life care. However, limited research has been conducted to explore nurses' experiences of professional development during end-of-life care, and theoretical explanations are scarce about how nurses enact their professional values during the caring process. This study explored the social process of professional values involved in end-of-life care in the Chinese cultural context by adopting a constructivist grounded theory approach. Twenty semi-structured in-depth interviews with 15 nurses from three hospitals in southeastern China were conducted. A theoretical framework emerged when focusing on the social process of "reframing the meaning of life and professional values" to facilitate professional care for terminally ill patients. Three main categories were sequentially identified as "recognizing the dilemmas when caring for terminally ill patients," "applying strategies to deal with values conflict," and "reconstructing values." This theoretical framework may be applied as a practical framework for equipping nurses with effective strategies to cultivate professional values, including the provision of adequate end-of-life knowledge, and a supportive workplace environment.

Relationships of professional identity and psychological reward satisfaction with subjective well-being among Chinese nurses.

AIM: This study aimed at exploring the impact of professional identity and psychological reward satisfaction on subjective well-being and clarifying the effect of psychological reward satisfaction on this relationship. BACKGROUND: People know little about the effect of psychological reward satisfaction on the relationship between professional identity and subjective well-being. METHODS: A cross-sectional survey was carried out on 1,009 nurses from Qiqihar City, Heilongjiang Province of China. Professional Identity Scale, Psychological Reward Satisfaction Scale and General Well-Being Schedule were used to assess professional identity, psychological reward satisfaction and subjective well-being, respectively. Associations were explored by using structural equation modelling. RESULTS: The subjective well-being of 436 (43.2%) nurses was at low and moderate levels. After the adjustment of potential confounding factors, professional identity was still associated with subjective well-being (B = 3.035, ß = 0.215, p < .001). Professional identity (r = .308) and psychological reward satisfaction (r = .309) were positively correlated with subjective well-being. Psychological reward satisfaction mediated the association between professional identity and subjective well-being (effect = 0.114, p < .001). CONCLUSION: This study suggested that the subjective well-being of nurses should be improved by paying special attention to them and taking targeted support measures. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers can help enhance the professional identity of nurses by organising nursing education activities, and pay more attention to psychological reward satisfaction to improve the subjective well-being of nurses.

Cognitive emotion regulation strategies and depressive symptoms among nurses exposed to workplace violence: a person-centered approach.

BACKGROUND: Cognitive strategies are preferred among nurses who have limited opportunities in the workplace to use behavioral strategies to cope with negative life events. AIMS: To explore whether different cognitive emotion regulation profiles could be distinguished in nurses exposed to workplace violence, and to investigate whether such profiles had differential associations with depressive symptoms. METHOD: An online survey was conducted among nurses exposed to workplace violence (N = 399). Latent profile analysis was performed to identify discrete profiles based on the use of cognitive emotion regulation strategies. The Bolck, Croon, and Hagenaars method was applied to compare the latent profiles on the depressive symptoms. RESULTS: Seven latent profiles were identified: Low Regulators, Medium Regulators, High Regulators, Intensely Adaptive Regulators, Moderately Adaptive Regulators, Intensely Maladaptive Regulators, and Moderately Maladaptive Regulators. High Regulators had the highest level of depressive symptoms. Although using less adaptive strategies, Low Regulators did not report significantly more depressive symptoms than Medium Regulators, Intensely Maladaptive and Moderately Maladaptive Regulators. CONCLUSIONS: The adaptability of cognitive emotion regulation strategies depends on the conjunction of different strategies one person has at his disposal. Cognitive emotion regulation skill training should focus on flexible implementation of strategies and decreasing use of maladaptive strategies.

Proposing a conceptual framework of spiritual care competence for Chinese nurses.

Spiritual care competence of nurses is crucial to satisfy the spiritual needs of the clients, but the dearth of conceptual frameworks has hindered the clarification of the construct, especially for nurses in the People's Republic of China. This article developed a 3*3*3 matrix framework to clarify the components of spiritual care competence for Chinese nurses through the synthesis of existing empirical and theoretical work, which includes three aspects (awareness, understanding, and application) on three levels (intrapersonal, interpersonal, and transpersonal) of three contents of spirituality (namely, worldview, connectedness, and transcendence). The proposed framework can be used as a model to promote spiritual care competence of nurses in China. Adoption of the framework to guide studies would allow for the design of interventions for the attainment of this competence.

Validation of the Essentials of Magnetism II in Chinese critical care settings.

AIMS: To translate and evaluate the psychometric properties of the Essentials of Magnetism II tool (EOM II) for Chinese nurses in critical care settings. BACKGROUND: The EOM II is a reliable and valid scale for measuring the healthy work environment (HWE) for nurses in Western countries, however, it has not been validated among Chinese nurses. METHODS: The translation of the EOM II followed internationally recognized guidelines. The Chinese version of the Essentials of Magnetism II tool (C-EOM II) was reviewed by an expert panel for culturally semantic equivalence and content validity. Then, 706 nurses from 28 intensive care units (ICUs) affiliated with 14 tertiary hospitals participated in this study. The reliability of the C-EOM II was assessed using the Cronbach's alpha coefficient; the content validity of this scale was assessed using the content validity index (CVI); and the construct validity was assessed using the confirmatory factor analysis (CFA). RESULTS: The C-EOM II showed excellent content validity with a CVI of 0·92. All the subscales of the C-EOM II were significantly correlated with overall nurse job satisfaction and nurse-assessed quality of care. The CFA showed that the C-EOM II was composed of 45 items with nine factors, accounting for 46·51% of the total variance. Cronbach's alpha coefficients for these factors ranged from 0·56 to 0·89. CONCLUSIONS: The C-EOM II is a promising scale to assess the HWE for Chinese ICU nurses. RELEVANCE TO CLINICAL PRACTICE: Nursing administrators and health care policy-makers can use the C-EOM II to evaluate clinical work environment so that a healthier work environment can be created and sustained for staff nurses.

Linking COVID-19 stress and Chinese nurses' life well-being: The influence of work-family conflict and work centrality.

The COVID-19 pandemic has placed enormous stress on health workers, exposing them to high levels of work-family conflict (WFC), which in turn affects their life well-being（LWB). To date, whether WFC is involved in the association between COVID-19 stress and the well-being of life has not been investigated. The purpose of this paper was to explore the connection between COVID-19 stress and LWB in Chinese nurses and to analyse the mediating role of WFC and the moderating effect of work centrality. The link between COVID-19 stress and LWB was examined by performing multiple regression analysis, common method bias analysis, and confirmatory factor analysis on data for 227 nurses.COVID-19 stress exerted a remarkable direct impact on nurses' LWB, and WFC mediated the link between COVID-19 stress and nurses' LWB. Work centrality moderated the link between COVID-19 stress and nurses' WFC. COVID-19 stress decreases nurses' LWB and increases their WFC, which also decreases their LWB. For nurses with higher work centrality, the connection of COVID-19 stress to work-family conflict was stronger. Hospital managers should focus on nurses' work-family balance and pay particular attention to the work-family balance of work-centered nurses to avoid compromising their LWB.

Impact of bullying on occupational commitment in young nursing professionals: the mediating role of emotional labour and emotional exhaustion.

BACKGROUND: Nurses are often exposed to workplace bullying, which leads to their burnout and leaving the profession. However, the processes by which workplace bullying leads to such outcomes are not clear. AIMS: This study investigates how work-related and personal-related bullying affect nurses' occupational commitment by integrating emotional labour and emotional exhaustion. METHOD: This study employs a cross-sectional design. The model was tested using structural equation modelling with a sample of 245 Chinese nurses. RESULTS: Work-related bullying is positively related to both surface acting and deep acting, and a negative relationship exists between deep acting and emotional exhaustion. Personal-related bullying is not related to either surface acting or deep acting, but is positively related to emotional exhaustion. Emotional exhaustion is negatively related to affective occupational commitment. CONCLUSIONS: This study implies that bullying behaviours should be distinguished with work-related bullying and personal-related bullying, and emotional regulation strategies are meaningful in managing the negative impact of work-related bullying. IMPLICATION FOR NURSING MANAGEMENT: Policymakers and managers need to distinguish two types of bullying behaviour and manage them accordingly with different strategies. For nursing schools it is important to prepare nursing students with not only professional skills but also social competence and emotional management skills.

What are Chinese nurses' experiences whilst working overseas? A narrative scoping review.

BACKGROUND: Transnational nurse migration has become an apparent attribute of the global nurse shortage and it is foreseeable that China will play an increasingly significant role in nurse exports. These nurses have unique cultural and professional needs throughout their journey of migration and in-depth analysis of Chinese migrant nurses' experiences is urgently required to manage and empower an ethnically diverse workforce. OBJECTIVE: To synthesise Chinese migrant nurses' experiences by examining the findings of existing studies. DESIGN: Scoping review methods incorporating narrative synthesis were conducted. METHOD: Arksey and O'Malley's five-stage scoping review framework was utilised to identify Chinese migrant nurses' experiences. 13 databases were searched, and 5009 articles were retrieved. After screening the titles and abstracts, 169 articles were assessed in full text for eligibility, and finally 22 articles plus 2 manually included ones, representing 19 discrete studies, were further analysed and synthesised with a three-step narrative synthesis. RESULTS: 13 qualitative studies, 5 quantitative studies and 1 mixed- methods study met inclusion criteria. Two main themes were identified. "Contexts and migration" comprised three subthemes: perceptions of nursing, original culture and nursing differences. "The self and migration" included four subthemes: initiating, transition, reality and future. CONCLUSION: This scoping review revealed the literature on Chinese migrant nurses and provided insight into their stories and circumstances. There were external factors which affected Chinese nurses' interpretations and choices. Throughout their migration journeys, they encountered various challenges and also successes. They responded with positive or negative behavioural and psychosocial changes.

Why do China-educated nurses emigrate? A qualitative exploration.

BACKGROUND: Despite the fact that there are more and more Chinese nurses living and working in Australia, relatively little is known about the decisions to emigrate made by these nurses. OBJECTIVES: To explore factors influencing China-educated nurses to emigrate to Australia. DESIGN: This was a secondary analysis of 46 semi-structured interviews with 28 China-educated nurses working in Australia. Conventional content analysis was used, and the results are presented thematically. RESULTS: The nurses emigrated for a wide variety of reasons: (a) personal factors (to improve English, to see more of the world and cultures, to seek novelty and adventure); (b) work-related factors (better work environment and more career choices); (c) social factors (better living environment and lifestyle); (d) cultural factors (positive perceptions in China of those who emigrate or have overseas experiences), and (e) economic factors (higher salaries and greater purchasing power). CONCLUSIONS: Confirming findings from similar studies, China-educated nurses' decisions to migrate are complex and not based solely on economic expectations. Personal and cultural factors play vital roles in nurses' migration decisions.

Learning experience of Chinese nursing students in an online clinical English course: qualitative study.

The low English proficiency of Chinese nurse/nursing students affects their performance when they work in English-speaking countries. However, limited resources are available to help them improve their workplace English, i.e. English used in a clinical setting. To this end, it is essential to look for an appropriate and effective means to assist them in improving their clinical English. The objective of this study is to evaluate the learning experience of Chinese nursing students after they have completed an online clinical English course. Focus group interview was used to explore their learning experience. 100 students in nursing programs at Tung Wah College were recruited. The inclusion criteria were: (1) currently enrolled in a nursing program; and (2) having clinical experience. Eligible participants self-registered for the online English course, and were required to complete the course within 3 months. After that, semi-structured interviews were conducted on students whom completed the whole and less than half of the course. One of the researchers joined each of the interviews as a facilitator and an observer. Thematic analysis was used to analyze the data. Finally, 7 themes emerged from the interviews: technical issues, adequacy of support, time requirement, motivation, clarity of course instruction, course design, and relevancy of the course. Participants had varied opinions on the 2 themes: motivation and relevancy of the course. Overall, results of this study suggest that the online English course helped students improve their English. Factors which support their learning are interactive course design, no time constraint, and relevancy to their work/study. Factors which detracted from their learning are poor accessibility, poor technical and learning support and no peer support throughout the course.