Exploring the relationships between resilience, burnout, work engagement, and intention to leave among nurses in the context of the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: Nurses have faced significant personal and professional stressors during the COVID-19 pandemic that have contributed to increased rates of burnout, intention to leave, and poorer work engagement. Resilience has been identified as a critical factor influencing job outcomes; however, the dynamics of this association have not yet been investigated within the context of the Thai workforce. The study objective was to determine the associations between resilience and job outcomes, including burnout, intention to leave, and work engagement among nurses working in Thailand during the COVID-19 pandemic. METHODS: This cross-sectional study gathered data from a sample of 394 registered nurses employed across 12 hospitals. The research instruments comprised the Connor-Davidson Resilience Scale (CD-RISC), the Maslach Burnout Inventory-Health Services Survey (MBI-HSS), a questionnaire assessing the intention to leave the job, and the Utrecht Work Engagement Scale (UWES). To determine the associations among the measured variables, multivariate logistic regression analyses were conducted. RESULTS: One-third of nurses experienced emotional exhaustion and depersonalization, and about half experienced reduced personal accomplishment; one-tenth of nurses intended to leave their job. Nurses who exhibited higher levels of resilience were found to have a significantly reduced likelihood of experiencing high emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. Conversely, these nurses were more likely to report higher levels of work engagement than their less resilience. CONCLUSION: The COVID-19 pandemic offers important lessons learned about promoting the well-being of the nursing workforce and protecting against adverse job outcomes. While we identified resilience as a significant predictor of several nurse outcomes, other work environment factors should be considered. Government and hospital administrations should allocate resources for individual and organizational-level interventions to promote resilience among frontline nurses so that hospitals will be better prepared for the next public health emergency and patient and nurse outcomes can be optimized.

Factors influencing work engagement of nurses in general hospitals: A cross-sectional study.

AIM: This study aimed to examine the level of work engagement and to identify the factors influencing the work engagement of nurses. BACKGROUND: Work engagement plays a crucial role in enhancing the efficiency of outcomes and the standard of care in nursing and healthcare services. METHODS: A descriptive predictive design and stratified random sampling was used to select 206 nurses from three general hospitals in Naypyitaw, Myanmar.. Research instruments consisted of the demographic data form, the Utrecht Work Engagement Scale, the Global Transformational Leadership Scale, the Survey of Perceived Organizational Support, and the Psychological Capital Questionnaire. The results were explored by applying descriptive statistics and stepwise multiple regression. RESULTS: Overall work engagement was at an average level. Transformational leadership and psychological capital could affect work engagement, explaining 19.34% of the total variance; however, perceived organizational support, age, and work experience did not show any impact on it. CONCLUSIONS: The findings recommend that nurse administrators should focus on transformational leadership and psychological capital in formulating strategies to increase nurses' work engagement. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The outcomes might provide baseline information for nurse administrators and policymakers by formulating management strategies to enhance nursing leaders' awareness, knowledge, and skills about transformational leadership behaviors and to keep nurses holding self-efficacy, hope, optimism, and resilience of psychological capital in healthcare organizations, which ultimately increase nurses' engagement at work.

The relationship between nurse burnout, missed nursing care, and care quality following COVID-19 pandemic.

OBJECTIVES: To determine the relationship between nurse burnout, missed nursing care, and care quality following the COVID-19 pandemic. BACKGROUND: Quality of care and missed nursing care can be consequences of nurse burnout. Little is known about how these factors related to nurse burnout following the COVID-19 pandemic. DESIGN: This study used a cross-sectional correlational design and was conducted in 12 general hospitals across Thailand from August to October 2022. METHODS: 394 nurses providing direct nursing care to patients during the COVID-19 pandemic completed the survey. The Emotional Exhaustion (EE) subscale of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), MISSCARE survey, and quality of care reported by nurses were used to collect data. Descriptive statistics and logistic regression models were used to analyse the data. RESULTS: Approximately thirty-six percent of nurses had burnout following the COVID-19 pandemic. Missed nursing care was higher among nurses with burnout. Most participants reported illness/symptoms such as anxiety, fatigue, a lack of concentration, and sleeping problems. After adjusting for demographic characteristics, every additional unit of emotional exhaustion was associated with 1.61 times higher odds of missed nursing care, 3.37 times higher odds of poor quality of nurse care, and 2.62 times higher odds of poor quality of care for the overall unit. CONCLUSION: The study findings demonstrate that burnout is associated with missed nursing care and poor quality of care following the COVID-19 pandemic. RELEVANCE TO CLINICAL PRACTICE: Policymakers, hospital administrators, and nurse managers should invest in strategies to reduce nurse burnout, which can increase patient safety and quality of care.

Predictors of organizational commitment among Chinese nurses during the COVID-19 pandemic.

AIM: To investigate organizational commitment among Chinese nurses and analyze factors influencing organizational commitment during COVID-19. BACKGROUND: Organizational commitment is the most important link between nurses and the organization because it is effective in work retention and the motivation of nurses, especially when addressing the COVID-19 crisis. However, there has been no empirical study conducted to predict organizational commitment in the field of nursing by combining work values with professional practice environments. METHODS: A cross-sectional predictive study was done with 362 nurses recruited from two tertiary hospitals in China. The Organizational Commitment Questionnaire, the Work Values Scale, and the Practice Environment Scale of the Nursing Work Index were used to collect data. Two factors related to the organizational commitment of nurses were investigated by using binary logistic regression analyses. RESULTS: Increased work values and a professional practice environment were associated with an increased likelihood of higher organizational commitment. DISCUSSION: The COVID-19 crisis became the utmost challenge to global healthcare systems and professional organizational commitment. Nurses' organizational commitment was directly influenced by the professional practice environment and work values, especially intrinsic work values, in which the spirit of collectivism was consequential. CONCLUSION AND IMPLICATIONS FOR THE FIELD OF NURSING AND HEALTH POLICY: Study results provide information for global hospital administrators to promote these organizational commitment predictive factors, including work values and a professional practice environment in nursing practice. This helped foster a stronger organizational commitment among nurses to reduce nurse resource flow during COVID-19.

Perspectives of nurses regarding total rewards and their preferences in Thailand: A qualitative descriptive study.

BACKGROUND: In this time of global nursing shortages, investment in nursing is vital, and hospitals need to apply a range of strategies to attract and retain nurses. Rewards are an effective strategy for the retention of nurses and help improve the performance and productivity of hospitals. In rural and remote communities, however, nurses may not have access to the rewards that urban-based nurses have. AIM: To explore the preferred rewards of registered nurses in rural and remote community hospitals in Thailand. METHODS: An explanatory mixed-methods design was employed for the overall study, and the results from the qualitative descriptive phase are reported here using the COREQ checklist. We collected data during in-depth interviews with 24 informants from 8 community hospitals. Thematic analysis was used for data analysis. FINDINGS: Four major themes regarding reward types were preferred by the nurses: reasonable pay, good benefits, accessible learning and development, and a favorable work environment. CONCLUSION: A package of total rewards that best suit nurses working in rural and remote areas needs to be implemented, for a combination of different types of rewards has a greater impact than a single reward at both individual and organizational levels. IMPLICATION FOR NURSING AND HEALTH POLICY: It is crucial to identify those rewards to attract and retain nurses. In Thailand, nursing and health workforce policies need to be based on nurse preferences regarding salary, benefits, and recognition commensurate with other healthcare professionals, including civil servant status, as well as improving the work environment.

Factors predicting job performance of nurses: A descriptive predictive study.

AIM: This study investigated the job performance and predictability of job demands, job resources, personal resources, work engagement, job crafting, and the transformational leadership of nurse managers on this among nurses in Myanmar. BACKGROUND: The ongoing crisis of nursing shortages along with heavy workloads combines to form a major challenge in Myanmar and these affected the job performance of nurses during the COVID-19 pandemic. METHODS: Utilizing a stratified random sample of 474 nurses from tertiary-level general hospitals in the Republic of the Union of Myanmar, a descriptive predictive analysis was carried out. The Demographic Data Sheet, Job Performance Scale, Work Engagement Scale, Job Demands Scale, Job Resources Scale, Personal Resources Scale, Job Crafting Scale, and Global Transformational Leadership Scale were utilized to collect data. RESULTS: The overall level of job performance was perceived to be high, considering various factors such as job demands, personal resources, work engagement, and job crafting were found as significant predictors of nurses' job performance, explaining 63.30% of the total variance. DISCUSSION: These findings make a valuable contribution toward enhancing nurses' job performance by addressing job demands, fostering work engagement, and nurturing their job-crafting capabilities. Self-reporting data collection may not have accurately represented the actual level of study variable. CONCLUSION: This study highlighted factors that significantly affect nurses' job performance in general hospitals in Myanmar. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The findings provide important evidence for nursing administrators and policymakers wishing to develop strategies to enhance the working environment and remain active in helping the performance of nurses.

Development and psychometric testing of the Perceived Organizational Climate Scale for nurses.

AIM: Retaining nurses on the job is vital, and their successful retention is related to the organizational climates (OC) of healthcare settings. The purpose was to develop and test the psychometric properties of the Perceived Organizational Climate Scale (POCS). DESIGN: The methodologic research design was used by following the scale development strategies by DeVellis (2017). The conceptual framework for this study was based on the broader theoretical framework of the Competing Value Framework (CVF) of Quinn et al. (2015), the concept analysis and extensive literature review (1939-2018), and combined with the inductive qualitative data. METHODS: A two-phase study of scale construction and psychometric testing was conducted for content validation, construct validation and internal consistency reliabilities of the instrument. An expert panel validated the 4-point scale, followed by exploratory factor analysis, the known-group approach and split groups. Data were collected from (1161) registered nurses in eight general hospitals across Myanmar from August 2019 to September 2020. RESULTS: The 35 items with four essential dimensions: transformational climate, bureaucratic climate, team climate and strategic climate, explained almost 50% of the variation with all factor loading greater than .40. The internal consistency reliabilities of the instrument showed the Cronbach's alpha coefficient of .93, and the dimensions were from .82 to .85. As hypothesized, the known-group approach demonstrated that experienced nurses had higher mean scores than novices. The internal consistency reliabilities of the scale and dimensions across the splitting groups illustrated the stability. CONCLUSION: This evidence supports this instrument as having satisfactory initial psychometric properties with a comprehensive picture of OC by its essential components contributing to an inclusive understanding of this climate globally. IMPACT: This instrument can be used as an objective tool for evaluating OC as perceived by nurses in healthcare settings to inform improvements in working environments.

Nurse staffing, missed care, quality of care and adverse events: A cross-sectional study.

AIM: This study aimed to illustrate the relationship between nurse staffing and missed care, and how missed care affects quality of care and adverse events in Thai hospitals. BACKGROUND: Quality and safety are major priorities for health care system. Nurse staffing and missed care are associated with low quality of care and adverse events. However, examination of this relationship is limited in Thailand. METHODS: This cross-sectional study collected data from 1188 nurses in five university hospitals across Thailand. The participants completed questionnaires that assessed the patient-to-nurse ratio, adequacy of staffing, missed care, quality of care and adverse events. Logistic regression models were used to estimate associations. RESULTS: Higher patient-to-nurse ratio, poor staffing and lack of resource adequacy were significantly associated with higher odds of reporting missed care. Higher nurse-reported missed care was significantly associated with higher odds of adverse events and poor quality of care. CONCLUSIONS: Poor nurse staffing was associated with missed care, and missed care was associated with adverse events and lower quality of care in Thai university hospitals. IMPLICATIONS FOR NURSING MANAGEMENT: Improving nurse staffing and assuring adequate resources are recommended to reduce missed care and adverse events and increase quality of care.

Testing a model of Thai nurses' intent to stay in employment.

AIM: To test the causal model of intent to stay in employment of nurses in regional medical centers. BACKGROUND: Effectiveness and quality of nursing care are determined by an adequate number of nursing staff; however, there is an ongoing challenge of nursing shortage. Improving nurses' intention to remain in employment is an effective way to address the problem of nursing shortage. METHODS: This study employed a cross-sectional design. The sample was 1224 registered nurses from nine regional medical centers across Thailand, selected using multistage random sampling. Data were collected between January and July 2019 and analyzed with structural equation modeling. RESULTS AND DISCUSSION: The final model could explain 40.3% of the variance in intent to stay. Transformational leadership, coworker support, professional autonomy, opportunities for promotion, marital status, and job satisfaction positively affected intent to stay, while burnout negatively affected intent to stay. This indicates that seven factors that should be considered by nurse managers in developing a framework for constructing interventions to increase nurses' intention to continue working in their organization. IMPLICATION FOR NURSING AND NURSING POLICY: Nurse managers should strengthen the intent to stay of nurses by providing consultations, building a positive work atmosphere, and encouraging nurse leaders to apply transformational leadership behaviors to the organizational administration. Policymakers should consider enacting policies and regulations for nurses' benefits, such as allocating civil servant positions to temporary nursing staff, expanding the framework of career advancement to a senior professional position, and considering salary and overtime pay, to increase nurses' intent to stay in an organization.

Nurses' Qualitative Descriptions of the Organizational Climate of Hospitals.

PURPOSE: To explore nurses' perceptions of the organizational climate in general hospitals in Myanmar. DESIGN AND METHODS: Using a qualitative descriptive design, data were purposively collected from all levels of registered nurses in eight general hospitals across Myanmar during August to October 2019. Seventeen individual in-depth interviews and eight focus group discussions with 65 nurses were undertaken and analyzed using Graneheim and Lundman's qualitative content analysis. FINDINGS: Four categories of organizational climate from a Myanmar nursing context emerged: organizational uniqueness, organizational alignment, sense of empowerment, and the reinforcing organization. Organizational uniqueness included the subcategories of perception of features and orientation of the organization, whilst organizational alignment comprised the three subcategories of the values inherent in the management process, the criteria of success, and strategic emphasis. The sense of empowerment category embraced the subcategories of the perceptions of the decision making and roles of leaders or managers; the last category, the reinforcing organization, incorporated the subcategories of bonding and recognition of the organization. CONCLUSIONS: This was the first qualitative nursing study on nurses' perceptions of organizational climate in Myanmar hospitals. Participants revealed a rich source of information that needs to be considered by hospital administrators and other policymakers to enhance quality clinical care by nurses, and their overall well-being and working conditions. The emphasis on the holistic nature of this concept points to further investigations of working conditions, the lives of nurses, and management of nurses within the hospital environments in Myanmar hospitals, and can inform other countries. CLINICAL RELEVANCE: Nurses revealed a rich understanding of what an organizational climate represents or should represent, and they need to work with hospital administrators and managers to contribute to the development of positive organizational climate, which in turn should increase nurse retention and the efficacy of health care provided in hospitals.

Development and psychometric testing of quality nursing care scale in Mongolia.

BACKGROUND: Quality Nursing Care (QNC) is fundamental to the profession of nursing practice. Perception of QNC differ across the globe because of differences in social norms, cultural values and political ambiance and economy. This study aimed to develop a QNC instrument congruent with the Mongolian (QNCS-M) healthcare system and cultural values and societal norms. METHODS: Exploratory sequential mixed-method design was implemented to develop and assess performance of QNCS-M. First, we focused on developing the components of QNCS-M and their operational definitions. Second, we dedicated to ascertaining psychometric performance of QNCS-M. The field testing consisted of assessing the construct validity and internal consistency reliability. Correlation between QNCS-M and the criterion tool, Quality of Nursing Care Questionnaire-Registered Nurse was evaluated. RESULTS: The initial version of QNCS-M contained 66 items of which 7 (I-CVI < .78) were deleted after item-content validity assessment. The total-item correlation analysis yielded to exclusion of another 3 items (<.3). Additional 12 items were excluded after inter-item correlation (<.3, >.7). Results from Spearman rank-order correlation analysis of the remaining 44 items indicated relationship between social desirability and 6 items (r = -.09 to r = .11). These items were excluded to reduce the likelihood of potential information bias. A total of 38 items remained for exploratory factor analysis. Results from exploratory factor analysis yielded eigenvalues > 1.0 for the 9 domains. Three domains contained items fewer than 3. These domains and 2 items (factor loading <.4) were eliminated, yielding to 6 domains with 36-item. Results from internal consistency reliability yielded an overall Cronbach's α = .92; the coefficient values for the 6 domains ranging between .72 and .85 and Pearson correlation for stability reliability yielded an acceptable (r = .82, P < .001). CONCLUSION: Improving the quality of healthcare services delivered by nurses is a priority for the Mongolian government. The development of QNCS-M is a major stride in addressing this concern. The final version of QNCS-M which contains 36 items, loaded into 6 domains, was morphed to the specifics of the Mongolian healthcare systems and cultural values and societal norms. QNCS-M demonstrates a high level of content and construct validity with acceptable reliability.

Nurses' knowledge of health literacy, communication techniques, and barriers to the implementation of health literacy programs: A cross-sectional study.

Nurses' health literacy knowledge and communication skills are essential for improving patients' health literacy. Yet, research on nurses' health literacy knowledge and perception is limited. The study aimed to evaluate nurses' health literacy knowledge, communication techniques, and barriers to the implementation of health literacy interventions. A cross-sectional study was used, and a total of 1697 nurses in 104 community hospitals in Thailand completed self-report measures. Approximately 55% of the participants had heard about the concept of health literacy; 9% had received formal training specific to interaction with patients with low health literacy. About 50% of the nurses were aware of their patients' low health literacy; therefore, they applied the recommended communication techniques for them. Delivery of effective health literacy training was hampered by a lack of assessment tools, health literacy training and specialists, educational materials, and health provider time. Hospital administrators, nurse managers, health leaders should develop strategies to create environments and resources supporting health literacy interventions.

Occupancy rate and adverse patient outcomes in general hospitals in Thailand: A predictive study.

Patient outcomes are important indicators of the quality of care. Occupancy rate is one factor that significantly affects adverse patient outcomes. The aim of the present study was to determine factors associated with adverse patient outcomes in Thailand. A retrospective study was conducted with 146 inpatient units from 16 general hospitals. Hospital characteristics and adverse patient outcomes were recorded, and data were analyzed by using frequency, percentage, and binomial logistic regression. The results revealed that the average number of beds per hospital was 430.5 (standard deviation [SD] = 108.6), the average number of beds per unit was 27.9 (SD = 8.9), and the average occupancy rate was 81.1% (SD = 20.6, range = 28.8-133.1%). Data were adjusted for hospital size, unit type, and number of beds in each unit; a 1% increase in occupancy rate increased the likelihood of pressure ulcers by 4.3% (P = 0.001), of hospital-acquired pneumonia by 2.4% (P = 0.032), and of hospital-acquired urinary tract infections by 2.1% (P = 0.033). The findings suggest that a higher level of occupancy rates predicted a greater likelihood of adverse patient outcomes.

Work empowerment and burnout among registered nurses in two tertiary general hospitals.

AIMS AND OBJECTIVES: To describe and explore the relationship between work empowerment and burnout as perceived by nurses in two tertiary general hospitals in China. BACKGROUND: Studies conducted in Western countries show that work empowerment can negatively influence burnout. Review of literature indicates that currently, no study on the relationship between work empowerment and burnout has been conducted in China. DESIGN: A correlational, cross-sectional design was adopted using questionnaires for data collection. METHODS: This study used correlational and cross-sectional designs to collect and analyse data. The demographic data were analysed using frequency and percentage distributions. Work empowerment and burnout as perceived by registered nurses were analysed using means and standard deviation. The relationship between work empowerment and burnout was analysed using Spearman's rank-order coefficient after testing the normal distribution using the Kolmogorov-Smirnov test. RESULTS: The registered nurses perceive work empowerment at a moderate level. Emotional exhaustion as determined in this study is higher than in other nursing studies. A negative correlation is indicated between work empowerment and emotional exhaustion. A statistically significant positive correlation is also indicated between work empowerment and personal accomplishment. CONCLUSION: When the work environment provides empowerment, registered nurses are less likely to experience burnout. Nursing supervisors should empower staff nurses by giving them opportunities to study, actualise the hospital's vision and share information with other staff nurses. RELEVANCE TO CLINICAL PRACTICE: Nurse administrators can use the results of this study to develop policies, improve work empowerment programmes and decrease burnout so that staff nurses can work more effectively.

Content and characteristics of evidence in the use of standardized patients for advanced practice nurses: A mixed-studies systematic review.

OBJECTIVES: The use of Standardized Patients (SPs) as a supplement to traditional clinical experience is of interest in the advanced practice nursing curriculum. Yet, evidence exploring this area is limited. This systematic review aims to consolidate and synthesize findings on the available evidence of using standardized patients (SPs) on advanced practice nurse (APN) students' learning and assessment experiences. DESIGN: Mixed-studies systematic review. DATA SOURCES: PubMed, EMBASE, Cochrane Library, CINAHL, Scopus, PsycINFO, and ProQuest Dissertations and Theses from the inception of each database to May 2022. REVIEW METHODS: Quantitative, qualitative, and mixed-method studies involving the use of SPs for education and assessments among APN students were included in this review. RESULTS: Twenty studies were included. Three themes were identified through thematic synthesis: (1) Benefits associated with standardized patients, (2) Uniqueness of standardized patient experience, and (3) Preference and way forward. Overall, these students benefited from refining knowledge, clinical skills, and communication skills, and perceived a boost in confidence in their nursing competencies through SP simulations. More studies with rigorous methodology are needed to ascertain the causal relationships between SP simulations and APN students. Future studies should evaluate the cost-effectiveness of SP, especially in low-income countries. Inter-professional SP simulations and hybrid simulations should be explored further. Considerations for improvements include allocating more sessions for multisource feedback, offering dyadic or group support, and providing assessments that are more formative during simulations. CONCLUSIONS: SP simulation can complement traditional clinical experience in providing APN students with the knowledge, clinical skills, and communication skills in the real-world context.

Factors influencing evidence-based practice among undergraduate nursing students: A cross-sectional analysis.

Objective: This study aimed to describe the current situation of evidence-based practice (EBP) among undergraduate nursing students in Thailand. Methods: A cross-sectional study was conducted. A convenience sample of 470 third- and fourth-year undergraduate nursing students from five public universities across Thailand participated in this study from January 2021 to March 2021. All participants were invited to complete a general information questionnaire, and the Student Evidence-Based Practice Questionnaire (S-EBPQ). Results: The overall mean S-EBPQ score was 5.29 ± 0.71, and the four subscales, from highest to lowest, were attitudes (5.50 ± 0.93), sharing and applying EBP (5.37 ± 0.87), practice (5.18 ± 0.84), and retrieving and reviewing evidence (5.10 ± 0.81). The current situation of S-EBPQ was higher among nursing students who had higher previous EBP studies, familiarity with research methods, confidence in clinical decision-making, preparedness in practice, and access to journals (P < 0.05). Conclusions: This study's findings provide valuable insights for planning strategies that can be integrated into the existing nursing curricula to enhance nursing undergraduates' EBP application in clinical settings.

Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand.

PURPOSE: To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. DESIGN: Secondary data analysis of the 2007 Thai Nurse Survey. METHODS: The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. FINDINGS: Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p < .05). Nurses who reported favorable work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p < .05) compared with nurses who reported unfavorable work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p < .001). CONCLUSIONS: Improving nurse work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. CLINICAL RELEVANCE: Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world.

Knowledge and involvement of nurses regarding health policy development in Thailand.

The purpose of this descriptive study was to explain the levels of knowledge about and involvement in national health policy development by nurses in Thailand. The study used quantitative and qualitative means to gather data about the topic from two groups of professional nurses: 2121 nurses who worked in hospitals around the country and 26 nurse leaders who were members of steering committees in nursing professional organizations. A self-administered questionnaire and an interview guide regarding knowledge and involvement in national health policy were used for collecting the data. The content validity and reliability of the questionnaire were assured. The results showed that almost two-thirds of the sample had a high level of knowledge about national health policy development but that almost three-quarters of the sample had no involvement in national health policy development. The interviews of the nurse leaders showed that some of them had been involved directly in formulating health policy but most of them thought that they had not been involved directly. The results demonstrated that it is essential that nurses understand and be actively involved in national health policy development.

Essential clinical skill components of new graduate nurses: A qualitative study.

Today it is a growing challenge for nursing schools to prepare students with quality education to provide them with essential clinical skills to practice as graduates. A number of studies report that graduate nurses feel underprepared with adequate skill levels to perform in the real world of clinical practice. In Thailand, these matters are of great concern, hence this first-time study on the topic. We report on the qualitative phase of a larger mixed methods study. A qualitative descriptive approach was used with the sample, 12 nursing educators, 24 registered nurses, 24 new graduate nurses, and four members of the Thailand Nursing and Midwifery Council committee. The participants were purposely selected for 12 semi-structured focus group discussions, and 12 were later invited for in-depth interviews. Using content analysis, four skills themes were extracted: fundamental, health promotion and disease prevention, rehabilitation, and skills in specialty areas. These skill components can be used to inform the development of a framework of essential clinical skills of graduate nurses for generating nursing practice to ensure patient safety and quality of care. Furthermore, these components can inform training guidelines for nursing student practice activities in subjects and policies to support nursing students in practice.

Investigation of the key determinants of Asian nurses' quality of life.

The study aimed to compare nurses' quality of life and investigate key determinants among Asian countries with different economic status. A cross-sectional survey was conducted across five Asian countries (Japan, Singapore, Malaysia, Thailand, and Bhutan). Quality of life (WHOQOL-BREF), job stress (National Institute of Occupational Safety and Health questionnaire), and demographic data were assessed. Stepwise multivariate linear regression analysis was performed to identify the key determinants of quality of life. Participants were 3,829 nurses (response rate: 82%) with a mean age of 33 ± 10 yr and majority were women (92%). Regarding quality of life, Bhutan yielded the highest scores, followed by Malaysia, Thailand, Singapore, and Japan, and these results were statistically significant. The key determinants that were significantly related to quality of life were "stress coping ability," "life satisfaction," "Japan," "social support," "job stress," and "Singapore" (adjusted R2=0.46). In conclusion, nurses' quality of life differs across Asian countries and is not linked to the country's economic development. To maintain a good quality of life for nurses, an international exchange program like international nursing conferences for work environment and staff coping strategies is recommended to broaden institution' minds and share experiences and exchange views to be able to realize their own problems and discover global solutions to them.