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AnteayerInternacionales

Health activism as nursing practice: A scoping review

Abstract

Aims

The aim was to assess the current literature investigating health activism within nursing practice.

Design

This was a scoping review of the literature utilizing the updated Levac et al.’s framework.

Data Source/Review Methods

A search of the CINAHL, PubMed, Scopus and Allied Health databases was conducted for peer-reviewed, English research published between January 2000 and April 2021.

Results

Thirty-one articles met the criteria for inclusion in this study. The included research in nursing and health activism was heterogeneous in topic and method and primarily conducted in North America. Four themes resulted from the inductive thematic analysis: (1) Doing Health Activism, (2) Facilitators to Engaging in Health Activism, (3) Barriers to Health Activism Engagement and (4) Limited Education. Activism was not consistently defined and the term was used interchangeably with advocacy.

Conclusion

There is a gap between nursing scope of practice, and education and skills in health activism. There is limited research regarding health activism and what constitutes as health activism. There is an opportunity to improve health activism awareness and skills within the nursing profession and undergraduate education and to produce nursing research on health activism.

Impact

Health activism is integral to the nursing role, however, evidence suggests nurses lack confidence to engage in activism as practice. This is important for nurses across the world and in all care specialities.

Older people's experience of COVID‐19 restrictions on vaccine hesitancy: A longitudinal phenomenological study to support nurse‐patient vaccination conversations

Abstract

Aims

To explore how older people's experiences of COVID-19 restrictions influenced their decision to receive a vaccine and to support nurse–patient vaccination conversations.

Design

A longitudinal hermeneutic phenomenological study. The application of the COREQ checklist informed the reporting of this study.

Methods

Data were collected through semi-structured telephone interviews with older people (age ≥70) during two national restrictions implemented in England due to COVID-19. Phase one of interviews occurred between April and July 2020 (six interviews), and phase two of interviews between January and April 2021 (four interviews). Data analysis was performed through content analysis.

Results

Thirteen older people (mean age 78) worked through six stages about their thoughts and beliefs about receiving a vaccine, which encompassed four of the five elements of the 5C model of vaccine hesitancy, confidence, convenience, calculation, collective, but not complacency. Stages included ‘our only hope is a vaccine’; ‘understanding and acceptance of an effective vaccine’; ‘social responsibility to protect others’; ‘organized but left with unanswered questions’; ‘need to feel secure’ and finally ‘vaccination alone is not enough’.

Conclusion

The experience of COVID-19 restrictions by older people informed their approach of engaging with scientific information to inform their decisions to be vaccinated but also developed their sense of collective responsibility to younger generations and those at risk, which informed their adherence to restrictions and the vaccination programme.

Impact

Nurses are optimally placed to support older people to implement and adhere to national government restrictions as appropriate and prevent obsessive routines, and support discussions and the provision of scientific information on COVID-19 vaccinations, whilst being inclusive of older peoples' sense of collective responsibility.

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

Abstract

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.

Lack of awareness of nursing as a career choice for men: A qualitative descriptive study

Abstract

Aims

This research aimed to identify the factors that impact why men do not view nursing as a career choice.

Design

Qualitative description was utilized to capture the rich narratives and insight of participants.

Methods

Through convenience sampling, nine New Zealand qualified male nurses within their first three years of practice were recruited. Semi-structured interviews were conducted between November 2019 and January 2020 via zoom from sites across New Zealand. All interviews were recorded and transcribed, with the data analysed using Braun and Clarke's thematic analysis.

Results

The findings reflected the experiences of the research participants as they made sense of a predominantly female-dominated work environment both during their undergraduate training and prior to recruitment. The research identified two key themes: The first found that men in nursing experienced isolation due to the societal gendering of nursing influencing the participant's knowledge and understanding of what nursing was, as a career. The second theme found that for participants, nursing was not prominent in their awareness when leaving school and making career choices.

Conclusion

This research indicates that nursing as a career choice for men is still underpinned by a lack of understanding of the actual role of the nurse and what nurses do, and is more supported by a societal perception that nursing is still a feminized profession. Findings can be used to make recommendations for change in the profession to strengthen diversity in the workforce and redefine the recruitment of men into nursing.

Impact

This research reviewed the career choices of men in nursing and why they chose nursing as a profession. Understanding the barriers of why men do not consider nursing as a career choice assists with finding strategies in both the clinical and academic environments that can enable greater gender diversity within the nursing profession.

No patient or public contribution

This applies to this research as the focus was on male registered nurses only.

Perceptions and experiences of sexual violence among Chinese men who have sex with men in Hong Kong

Abstract

Aim

This study aimed to understand the perceptions and experiences of sexual violence among Chinese men who have sex with men (MSM) in Hong Kong.

Design

The study adopted a qualitative descriptive design with thematic analysis.

Methods

Thirty-one Chinese MSM were recruited in Hong Kong from May to June 2019 using purposive sampling. Individual semi-structured interviews were conducted with the participants. The interview data were transcribed verbatim from the recordings and analysed using Braun and Clarke's thematic analysis approach.

Results

Four themes were identified: (1) different forms of sexual violence, from physical to virtual; (2) inner struggles with fears and worry; (3) low awareness and perceived risk of sexual violence – ‘it has nothing to do with me’ and (4) dilemma towards sexual violence prevention.

Conclusion

The study provided qualitative evidence regarding the experiences and perceptions of sexual violence among Chinese MSM in Hong Kong. Physical and image-based forms of sexual violence were identified, which led the participants to experience psychological distress, fear of contracting human immunodeficiency virus/other sexually transmitted infections, notoriety within the gay community, and discrimination and stigmatization within their family and workplace. To reduce the risk of sexual violence, some participants were cautious about the venue in which they engaged in sex and the habit of sharing sexually explicit photos with others. However, some participants had low awareness and perceived risk of sexual violence.

Impacts

This study was the first to fill the research gap on sexual violence issues among Chinese MSM using dating apps in Hong Kong. The qualitative findings enhanced the scholarly understanding of Chinese MSM's perceptions and experiences of sexual violence. The study findings can help nursing staff and other healthcare professionals to develop tailored primary, secondary and tertiary sexual violence prevention programmes for MSM or beyond.

A commentary on the challenges for nurses in identifying and responding to intimate partner violence amongst gay and bisexual men

Abstract

Aim

This commentary elucidates the challenges for nurses in effectively identifying and supporting gay and bisexual men who experience intimate partner violence and offers guidance for education, training and practice to nurses when responding to patients who may be experiencing intimate partner violence.

Design

The commentary highlights issues raised by Callan et al.’s (2020) scoping review, translating the experiences of male sexual minorities undergoing abuse to a nursing context, in particular, issues such as homophobic remarks and heteronormative practices in health care and nursing-led environments militate against the identification of individuals who may be experiencing coerced sexual risk-taking, homophobia and sexual orientation outing.

Results

Intimate partner violence is a widespread issue that permeates across heterosexual and LGBTQ+ communities, while impressing on the everyday realities of nurses. The potential for discrimination against sexual minority patients may be offset by improving training, education and offering recommendations for nurses in how to identify IPV and how to assess risk.

Conclusions

Nurses possess essential training and transferable skills such as empathy, adaptability, active listening and diplomacy and are ideally placed to facilitate disclosure of intimate partner violence. Gaps in knowledge, training and organizational support for nurses may be effectively addressed through drawing on extant research and international best practice guidelines.

Impact

Suggestions for research, education and practice to identify gay and bisexual male survivors, intervene appropriately and avoid missed disclosure opportunities are made. We conclude with a table of recommendations with a view to enhancing the essential response of nurses in addressing intimate partner violence in marginalized communities.

Transitioning to the clinical research nurse role – A qualitative descriptive study

Abstract

Background

Studies have reported on the important role of the clinical research nurse in clinical studies. Yet, there is no international consensus about the role's competencies and tasks. Furthermore, the literature offers a little description of the career pathway from a ward-based registered nurse to a clinical research nurse. More knowledge about this specific role could benefit the nursing profession as well as increase the quality of clinical research.

Aim

The aim of the study was to explore Swedish registered nurses' experiences transitioning into the clinical research nurse role.

Design

The study had a qualitative design. Data were collected via semi-structured interviews. Inductive qualitative content analysis was employed.

Methods

Ten participants (i.e., clinical research nurses) were interviewed in the spring of 2017. A semi-structured interview guide was used to address the transition into the clinical research nurse role, experience working in a new role, experience of ethical dilemmas and experience of organizational and professional issues related to the role. The interviews were analysed inductively using qualitative content analysis.

Results

The registered nurses described experiencing reality shock when they became clinical research nurses; that is, it was a challenging and transforming experience. The main theme, a challenging transition, was developed from the four subthemes highlighting that it defied their previous nursing role. They experienced an unclear professional identity, extended professional mandate, increased professional status and growing ethical consciousness in their new role.

Conclusion

The results highlight that registered nurses who became clinical research nurses had needs that were both distinct from and overlapped with those of their former professional role as registered nurses. To avoid reality shocks, the development of clear competence pathways for nurses to become clinical research nurses, including introduction, mentorship and continued support, is necessary. Making their professional title more homogeneous, nationally and internationally, would facilitate role identification and comparisons in research.

A comparison of conceptual frameworks to examine health inequities in End‐of‐Life care

Abstract

Aims

To discuss existing conceptual frameworks that can be applied to the examination of health inequities in end-of-life care and related health outcomes. We used the Fawcett and Desanto-Madeya evaluation technique modified by the National Institute on Minority Health and Health Disparities Research Framework to include individual, interpersonal, community, and societal levels of influence.

Design

Discussion paper.

Data sources

We performed a systematic review of PubMed, CINAHL and Embase for conceptual frameworks of health inequities in end-of-life care and health outcomes published as of February 2022.

Implications for nursing

There is a strong need for research that can address multiple factors influencing end-of-life care inequities and health outcomes. To mitigate the complex nature of social determinants of health and structural inequities, researchers, clinicians, educators and administrators should have solid conceptualizations of these multi-level factors. Based on sound and comprehensive frameworks, nurses with interdisciplinary partnerships can promote health equity with a broader health care scope through addressing social determinants of health.

Conclusion

We identified and reviewed three frameworks. We concluded all three frameworks have the potential for use in the examination of health inequities in end-of-life care and health outcomes. However, the Conceptual Framework of Minority Access to End-of-Life Care was more applicable to diverse studies and settings when adapted to include fundamental characteristics such as sex and gender.

Impact

Despite the substantial rise in end-of-life care delivery, health inequities persist in end-of-life care access and utilization. Though some studies have been conducted to promote health equity by addressing social determinants of health, progress is hampered by their complex and multi-faceted nature. Through a concrete conceptual framework, researchers can comprehensively examine multi-level factors influencing health inequities in end-of-life care.

No patient or public contribution

This discussion paper focused on reviewing existing evidence.

Nurse preceptors' orientation competence and associated factors—A cross‐sectional study

Abstract

Aims

To identify distinct orientation competence profiles amongst nurse preceptors and explain the associated factors.

Design

A cross-sectional study design.

Methods

The data were collected during the winter of 2020–2021 from registered nurses (N = 8279, n = 844) at one university hospital in Finland through an online questionnaire that included a self-administered electronic version of the Preceptors' Orientation Competence Instrument. K-means clustering was then used to identify nurse preceptor profiles. Chi-square, Fisher's exact test, Kruskal–Wallis and Mann–Whitney tests were used to analyse factors associated with competence profiles. The results were reported as frequencies, percentages, mean and standard deviation.

Results

A total of three distinct orientation competence profiles (A, B, C) were identified. Profile A nurses evaluated their orientation competence at the highest level, whereas profile C nurses evaluated their competence at the lowest level. Sufficient clinical and theoretical experience, a motivation to work, willingness to orient new employees and participation in orientation and/or mentoring education were found to be associated with competence profiles.

Conclusion

The findings expand the current knowledge base of nurse preceptors' orientation competence. Health care organizations should recognize different orientation competence profiles amongst the nursing staff since the selection of a preceptor should always be based on possessing the necessary orientation competence rather than availability. The results indicate that preceptors (who reported taking on various tasks and covering multiple roles) need support from co-workers to sufficiently concentrate on employee orientation tasks. The results also indicate that preceptors need further orientation education, which should—for example—outline the learning goals for new employees and how preceptors can assess employee performance.

Impact

What problem did the study address?

Prior research has not applied a robust theoretical framework covering all aspects relevant to a preceptor's competence.

What were the main findings?

A nurse's clinical and theoretical experience, motivation to work, willingness to orient new employees, and prior participation in orientation and/or student mentoring education were found to influence their level of orientation competence.

Where and on whom will the research have an impact?

Healthcare organizations can use the results of this study to make the selection of preceptors competency-based rather than their availability. Nurse leaders can use the results of this study to pinpoint which areas of nurses' orientation competence and associated factors need to be improved. Increased orientation competence will enable clinical nurses to provide high-quality orientation to new employees, which is crucial to the retention of nursing staff and the quality of patient care.

Scoping review: Scope of practice of nurse‐led services and access to care for people experiencing homelessness

Abstract

Aims

To investigate the scope of practice of nurse-led services for people experiencing homelessness, and the influence on access to healthcare.

Design

A scoping review.

Data Sources

On 20 November 2020, the following databases were searched: CINAHL, Embase, MEDLINE, PubMed and Scopus.

Review Methods

Included studies focused on people experiencing homelessness aged 18 years and over, nurse-led services in any setting and described the nursing scope of practice. Studies were peer-reviewed primary research, published in English from the year 2000. Three authors performed quality appraisals using the mixed methods assessment tool. Results were synthesized and discussed narratively and reported according to the PRISMA-ScR 2020 Statement.

Results

Nineteen studies were included from the United States (n = 9), Australia (n = 4), United Kingdom (n = 4) and Canada (n = 2). The total participant sample size was n = 6303. Studies focused on registered nurses (n = 10), nurse practitioners (n = 5) or both (n = 4), in outpatient or community settings. The nursing scope of practice was broad and covered a range of skills, knowledge and attributes. Key skills identified include assessment and procedural skills, client support and health education. Key attributes were a trauma-informed approach and building trust through communication. Important knowledge included understanding the impact of homelessness, knowledge of available services and the capacity to undertake holistic assessments. Findings suggest that nurse-led care facilitated access to healthcare through building trust and supporting clients to access services.

Conclusion

Optimized nursing scope of practice can facilitate access to healthcare for people experiencing homelessness. Key factors in enabling this include autonomy in nursing practice, organizational support and education.

Impact

The broad range of skills, knowledge and attributes reported provide a foundation from which to design an educational framework to optimize the nursing scope of practice, thereby increasing access to healthcare for people experiencing homelessness.

Reflections on the implementation and evaluation of a system‐wide improvement programme based on the fundamentals of care: Lessons learned

Abstract

Aim

To demonstrate how implementing a system-wide measurement and improvement programme can make the delivery of the Fundamentals of Care visible in practice.

Design

Discussion paper.

Data Sources

A retrospective evaluation of the experience of implementing a system-wide peer review programme using the Promoting Action on Research Implementation in Health Services framework.

Implications for Nursing

Implementing this programme engages nursing leaders at all levels in fundamental care delivery, evaluation and improvement. It positions nursing leaders as accountable for and champions of fundamental care.

Conclusion

The peer review programme offers a solution to the complex challenge of measuring the fundamentals of care in practice. Successful implementations of this programme at two New Zealand inpatient sites have shown positive results in improved care and patient experience. This makes it worthy of consideration for other health organizations. Nursing leadership has proven to be critical to success. The Promoting Action on Research Implementation in Health Services framework highlights the components that assist with successful implementation and assists in presenting a case for change.

Impact

This paper addressed the problem of the lack of action and dearth of quality, integrated data, visibility of the patient experience and the contribution of nursing leadership in an inpatient setting. Findings indicate that the peer review programme is translatable, modifiable and sensitive to ethnicity and disability. Using the implementation framework to evaluate the process has provided a guide for future implementations.

Intimate partner violence prevention amongst Arab American young adults in Chicago: Implications for intervention development

Abstract

Aims

Intimate partner violence (IPV) rates in the Arab American community are high, and there are gaps in the understanding of young adults' perspectives on IPV and its prevention. The aims of this study are to describe Arab American young adults' perspectives on the design of IPV prevention programmes and to document and explore their understanding and experiences with IPV.

Design

This exploratory study was part of a larger community-based participatory mixed-method study (QUAL-quan) amongst Arabs in Chicago and focused on young adult participants (18–25 years).

Methods

Participants (n = 44) completed an IPV survey about IPV perpetration and victimization, dating violence norms, conflict management skills, gender stereotyping, and belief in the need for help. From four focus groups (22 participants), we explored Arab American young adults' perspectives on IPV prevention programme development.

Results

Participants supported the adaptation and development of a youth-centred IPV prevention intervention that is community-based, culturally informed, and inclusive of multiple Arab community stakeholders. The survey results indicated multiple experiences with psychological and physical dating violence victimization (76.3% and 47.2%) and perpetration (62.2% and 27%).

Conclusion

Arab American young adults in Chicago are exposed to high rates of IPV. Community-based participatory approaches are needed to develop IPV prevention interventions that centre community needs.

Impact

Intimate partner violence is a significant public health problem; nearly 1 in 4 women have experienced IPV at some point in their life, and about 70% of those experiencing IPV, experience their first victimization before the age of 25. Arab American young adults experience high rates of IPV victimization and perpetration, requiring urgent attention. Participants proposed various community-based strategies to develop IPV prevention programmes that include multiple community stakeholders. Community-based organizations and researchers, schools and religious institutions could establish collaborations to ensure the adaptation and development of community-informed IPV prevention programmes.

Foodservice systems and mealtime models in rehabilitation: Scoping review

Abstract

Aims

To describe current foodservice systems and mealtime care utilized in the rehabilitation setting. A secondary aim was to identify commonly used outcome measures in foodservice research in the rehabilitation setting.

Design

A scoping review.

Data sources

PubMed, CINAHL, Scopus, Embase, PsycINFO and Cochrane were searched until January 2022.

Review methods

The review was conducted according to Joanna Briggs Institute's methodology for scoping reviews. Included studies were conducted in the inpatient rehabilitation setting, adult population ≥18 years old and provided a description of at least one element of the foodservice system, food and menu, waste and/or eating environment.

Results

Of 5882 articles screened, 37 articles were included, reporting 31 unique studies. Most rehabilitation units had cook-fresh production methods (50%), used decentralized bulk delivery methods (67%) had a communal dining room (67%) and had a 3-week menu cycle (71%). Mealtime care was predominantly provided by nursing staff, however few studies reported on specific activities. Nutritional intake was a key outcome measure across included studies (43%), with only six papers reporting on rehabilitation outcomes. Of the intervention studies (n = 9), all were aimed at improving nutritional intake through menu or mealtime care modifications; few (n = 3) studied changes in rehabilitation outcomes.

Conclusion

This scoping review identified a considerable lack of reporting of foodservice and mealtime care systems used in rehabilitation settings in the available literature. Further investigation is required to understand what models of mealtime care are provided to patients and to understand the impact of changes to foodservice and mealtime systems on patient outcomes.

Patient or public contribution

No patient or public contribution was necessary for this review.

Instruments used to measure dating violence: A systematic review of psychometric properties

Abstract

Aims

To identify, synthesize and evaluate the psychometric properties of instruments that measure dating violence (DV).

Design

Psychometric systematic literature review.

Data Sources

The databases SCOPUS, PubMed, CINAHL, PsychINFO, and Web of Science were searched up to December 2021.

Review Method

We evaluated the psychometric properties of the instruments included and their methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and Terwee's quality criteria. The Modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the best available evidence. The entire process was carried out by three independent reviewers. The review was registered at PROSPERO (registry number CRD42020161137).

Results

A total of 35 studies evaluated 29 instruments measuring DV. Most studies reported data on content validity, structural validity and internal consistency. No studies tested measurement error and responsiveness. Only one instruments tested cross-cultural validity. It is of interest that the data reported for content validity were the worst evaluated, despite the fact that content validity is one of the key properties in developing and validating the measuring instrument.

Conclusions

There are a significant number of instruments published in this field, and it is important to evaluate and show their psychometric properties to help select evidence-based instruments. After carrying out the evaluation following the COSMIN guidelines, the authors of this study recommend that the three most suitable instruments are CADRI, WAS/Chinese version and PMWI-SF/Portuguese version (in that order).

Impact

Identifying and evaluating DV is the first step in designing effective interventions. To achieve this, it is necessary to have validated instruments with suitable psychometric properties. To date, this is the only published systematic review evaluating the psychometric properties of instruments that measure DV which reports on their methodological qualities. The results we found show a growing trend in developing new instruments, with the most suitable approach being to make a cross-cultural adaptation and validation of the instrument that best suits the value to be measured. In this way, data can be compared between different countries and standardized health care plans and policies designed to achieve better health outcomes. This study may help future researchers to choose the most suitable instrument for their research.

Translation and cultural adaptation of the fundamentals of care framework: Are we there yet?

Abstract

Aim

This paper aims to explore and describe the translation and cultural adaptation of the Fundamentals of Care framework to a Swedish context, and highlight the need for a translated version.

Design

An exploratory, descriptive approach was adopted.

Methods

A structured forward-backward translation process and cultural adaptation were used, considering situation and recipient as recommended for such process. Data such as literature and documents were collected during 2019–2021. The authors took systematic steps in collaboration with a strategic sample of experts: professional language service providers, clinicians, educators and a linguist.

Results

The framework was mainly translated verbatim. A few fundamental care elements were adjusted to the Swedish language, context and clinical practice. Also, this work clarified the relational elements to be coherently seen as nursing actions. Addressing the need for a translated version was illustrated in activities in research, education and clinical practice.

Conclusion

This paper highlights the importance of translating the Fundamentals of Care framework into a country's native language to gain acceptance and application there. Sharing the framework's translated version impacts nursing science, generating a consistent language in the development and conducting of research for the comparison and transferability or generalizability of findings. Together with a cultural adaptation, the translated framework can support and guide researchers, educators and nursing leaders in articulating fundamental nursing care for enacting change. By disseminating the first Swedish version of the framework we encourage a global discussion and sharing of examples of translation and cultural adaptation by others.

Impact

The framework's English version has limitations in various context. This paper shows a systematic translation and cultural adaptation process of the framework. We proclaim that this is necessary for nursing leaders and nurses to be able to apply it in guiding nursing practice and leading change.

An empirical analysis of the constructs of Fundamentals of Care Framework using structural equation modelling

Abstract

Aim

First, to identify which aspects of missed care accurately define the integration of care and context of care dimensions of the Fundamentals of Care Framework. Second, to test the Framework for validity and reliability and lastly, to explore how leadership influences care integration.

Design

A non-experimental research design using self-audit data collected information about variations in nursing care as exemplars for dimensions of the Framework.

Methods

A multi-variate approach using path analysis was used to apply the consensus scores of 3079 Australian residential care nurses and carers to define the dimensions of the Framework.

Results/Findings

In the Australian residential care setting, the factors that define both the contexts of care and the integration of care dimensions constructs are now empirically established. The most direct predictor for the integration of care dimension arises from both the leadership and resource allocation variables, while the remaining context of care factors have indirect but significant effects. The integration of psychosocial care in the residential care sector is not influenced by any of the Framework's context-based factors.

Conclusion

The component variables of the Framework show both good reliability and convergent validity. These findings confirm a predictive relationship exists between the elements of the context of care and the different types of nursing activities that form the integration of the care dimension, including organizational leadership.

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