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Exploring the potential relationships among moral distress (MD), general health (GH) levels, secondary traumatic stress (STS) and levels of empathy within nursing personnel is of specific interest.
This study aimed to investigate the occurrence of MD and its associations with GH, STS, and empathy levels among nurses employed in eight public hospitals across the Attica Basin in Greece.
Between January and March 2020, a cross-sectional study was conducted among nursing staff working in surgical, medical, and psychiatric units of 6 public hospitals and 2 psychiatric institutions in the Attica Basin. Respondents completed the validated Greek versions of the Moral Distress Scale–Revised, the Jefferson Scale of Empathy for Health Professionals, the 28-item General Health Questionnaire, and the Secondary Traumatic Stress Scale. Participants were asked to complete a paper-pencil data sheet consisting of 27 sociodemographic questions.
A total of 267 out of 350 distributed questionnaires were completed and returned, corresponding to a response rate of 76.3%. The findings showed that nurses experienced moderate MD in both frequency and intensity, moderate-to-high GH and empathy, and moderate levels of STS. Psychiatric nurses reported lower STS and better GH than their counterparts in general hospital settings. Multivariate analysis demonstrated a statistically significant association between increased STS and deterioration in GH. A rise in the frequency of MD is significantly linked to an increase in its intensity.
Incorporating proven screening methods, programs that build resilience, supportive workplace cultures, ongoing evaluations over time, and peer support systems creates a complete approach to lowering moral distress and secondary traumatic stress, improving nurse well-being, maintaining work efficiency, and enhancing the overall safety and quality of healthcare services.
Nurses' burnout, work instability (WI), and job satisfaction (JS) in their practice environment (PE) are well established in the literature. However, perinatal missed care (PMC), a subset of missed nursing care, remains underreported among maternity nurses.
To examine the mediating role of PE and burnout in the associations of WI, JS, and PMC among maternity nurses.
A cross-sectional and correlational study employed consecutive sampling to recruit maternity nurses (n = 312) from five hospitals in Saudi Arabia (three government and two private hospitals in Hail and Makkah regions, respectively). Maternity staff nurses, regardless of their sex, years of professional nursing experience, or nationality, who met inclusion criteria were included in this study. Data was collected from July to September 2024 using four standardized self-report scales. Structural equation modeling was utilized for statistical analyses.
Maternity nurses' WI negatively influenced PE (β = −0.23, p = 0.014), while positively affected PMC (β = 0.15, p = 0.031). The PE positively affected JS (β = 0.24, p = 0.034) but had a negative effect on burnout (β = −0.24, p = 0.007) and PMC (β = −0.21, p = 0.038). Burnout negatively affected JS (β = −0.25, p = 0.028), while positively associated with PMC (β = 0.20, p = 0.022). PE mediated the associations between WI and burnout (β = 0.05, p = 0.019), JS (β = −0.07, p = 0.020), and PMC (β = −0.06, p = 0.008). Meanwhile, burnout mediated between PE and JS (β = 0.05, p = 0.030) and PMC (β = −0.04, p = 0.023).
Understanding the relationships among maternity nurses' burnout, JS, PE, and PMC is key to improving the quality of perinatal care and ensuring the patients' well-being. By focusing on strategies to enhance the PE (e.g., adequate staffing and resources, improved nurse–patient ratio), reduce burnout (e.g., meditation and mindfulness programs, coping intervention programs), and improve JS (e.g., work schedule flexibility, facilitate work-life balance, staff professional development), healthcare organizations can mitigate the occurrence of PMC.
The research-to-practice gap often occurs when evidence-based practice (EBP) is inadequately implemented into clinical practice. Nurses are critical to bridging the gap in EBP implementation (EBPI) and identifying effective strategies to promote its use in practice; however, they need a supportive work environment to develop the necessary research capacity/culture (RCC).
The purpose of this study was to examine relationships between nurses' perceptions of individual RCC and EBPI, team RCC and EBPI, and health care organization RCC and EBPI, adjusting for educational background, health care organization setting, and health care organization type.
Survey data were collected from 175 nurses across the United States using a prospective cross-sectional study design. The Research Capacity in Context (RCC) tool and EBPI scale were used to measure nurses' perception of RCC and nurses' EBPI, respectively. Simple linear regression was used to assess the relationship between organizational, team, and individual RCC and EBPI. Multiple linear regression was used to adjust for pertinent participant demographics.
The results of this study indicated that organization (R 2 = 0.033, p = 0.016), team (R 2 = 0.064, p < 0.001), and individual (R 2 = 0.155, p < 0.001) RCC were significantly associated with nurse EBPI. Moreover, findings remained significant after adjusting for educational background, health care organization setting, and type. The regression model suggested that education significantly predicted EBPI (R 2 = 0.142, p < 0.001).
These results emphasize the importance of building RCC in health care organizations, as it can be an effective strategy to increase nurses' EBPI, which has been shown to impact patient outcomes directly. Future research should identify strategies to assist organizations and leadership in building RCC among nurses.
Evidence-based practice (EBP) is essential for improving the quality of care and health outcomes in healthcare organizations. This study aimed to analyze the association between the nursing work environment and EBP elements, including attitude, training, implementation and quality of care.
A multicenter, cross-sectional study was conducted with 1022 registered nurses from 57 primary care centers and four public hospitals in northern Spain. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to assess the nursing work environment. Data collection also included the Health Sciences Evidence-Based Practice (HS-EBP) questionnaire to evaluate attitudes toward EBP, and self-reported measures of EBP training, EBP implementation, and overall quality of care. Odds ratios (OR) and 95% confidence intervals for the association between the nursing work environment and EBP elements were calculated using logistic regression adjusted for sociodemographic and occupational characteristics.
Compared to nurses who reported working in unfavorable environments (n = 220; 21.5%), those working in favorable environments (n = 437; 42.8%) exhibited a positive attitude toward EBP (OR = 2.89; 95% CI [2.00, 4.18]), EBP implementation (OR = 2.30; 95% CI [1.52, 3.39]) and higher quality of care (OR = 2.35; 95% CI [1.61, 3.44]). Using a composite measure that considered all EBP elements, favorable environments were associated with overall EBP engagement (OR = 3.47; 95% CI [2.38, 5.07]). The most influential environmental dimensions were adequate staffing and strong nursing foundations.
A favorable nursing work environment was strongly associated with a positive attitude toward EBP, the implementation of EBP, and a commitment to providing high-quality care. Key strategies to promote EBP should involve healthcare and academic institutions working together to establish a healthy work environment with appropriate staffing and care foundations rooted in nursing theory.
Sleep disturbances and delirium are prevalent problems in the intensive care unit. Evidence suggests that these conditions negatively impact patient outcomes by increasing the length of hospital stays, delaying recovery, and raising healthcare costs.
This study aimed to investigate the effect of implementing a sleep care bundle on sleep quality and delirium among critically ill patients.
A quasi-experimental research design was used. A purposive sample of 66 patients was divided equally into two groups: a bundle group that received a sleep care bundle and a control group that received routine unit care in the chest intensive care units at Mansoura University in Egypt. Data were collected using the critically ill patients' outcome evaluation tool based on the Richards-Campbell Sleep Questionnaire Scale and the Intensive Care Delirium Screening Checklist.
Compared to the control group, the bundle group demonstrated statistically significant improvements across all sleep quality domains measured by the Richards-Campbell Sleep Questionnaire by Day 3. Specifically, sleep depth improved from 1.24 ± 0.44 to 1.82 ± 0.39 (effect size = 0.600), ability to fall asleep from 1.21 ± 0.42 to 1.91 ± 0.29 (effect size = 0.703), number of awakenings from 1.27 ± 0.45 to 1.79 ± 0.42 (effect size = 0.483), sleep efficiency from 1.24 ± 0.44 to 1.76 ± 0.44 (effect size = 0.600), and overall sleep quality from 1.24 ± 0.44 to 1.85 ± 0.36 (effect size = 0.600). In addition, the occurrence of delirium on Day 3 was significantly lower in the bundle group (0.0%) compared with the control group (15.2%) (χ 2 = 7.471, p = 0.023). Subsyndromal delirium was observed in 6.1% of the bundle group and 15.2% of the control group. The overall percentage of patients without delirium was significantly higher in the bundle group (93.9%) compared to the control group (69.7%).
Implementing a sleep care bundle enhances sleep quality and reduces the occurrence of delirium in critically ill patients. Therefore, it can be integrated as an adjunctive intervention alongside routine care for these patients. To strengthen future applications, incorporating fidelity monitoring is recommended to ensure consistent implementation of the sleep care bundle and to optimize its effectiveness in clinical practice.
Hemodialysis can lead to complications that negatively impact patients' quality of life. Managing hemodialysis effectively requires patient adherence to complex regimens.
This randomized controlled experimental study aimed to assess the impact of nurse-led telephone-based patient education and counseling on disease management, quality of life, and self-care behaviors in hemodialysis patients.
Conducted between September 2022 and June 2023 at State Hospital's Hemodialysis Unit, the study included an intervention and a control group. Data were collected using tools such as the Scale for Dietary Knowledge in Hemodialysis Patients (SDKHP), Attitude Scale for the Dietary Therapy of Hemodialysis Patients (ASDTHP), Dialysis Symptom Index (DSI), Fluid Control in Hemodialysis Patients Scale (FCHPS), the Scale for the Assessment of Self-Care Behaviors with Arteriovenous Fistula (AVF), and the Kidney Disease Quality of Life-36 (KDQOL-36).
Pre- and posttest comparisons showed significant improvements in the intervention group's mean scores for SDKHP, ASDTHP, and FCHPS, with the control group experiencing declines. DSI scores indicated reduced symptoms in the intervention group and an increase in the control group. The AVF Self-Care Scale results demonstrated increased self-care behaviors in the intervention group, while a decrease was observed in the control group. KDQOL-36 subscales, including physical and mental functioning, disease burden, and symptom management, also improved in the intervention group, while scores declined in the control group. These findings confirm the effectiveness of telephone-based patient education and counseling on multiple outcome measures.
Nurse-led, telephone-based patient education and counseling improved dietary adherence and disease management. Telephone-based patient interventions enhanced patients' self-care skills regarding AVF maintenance. Quality of life improved across multiple dimensions in the intervention group. Telephone counseling ensured continued monitoring and individual support, even after discharge. Nurses should integrate telephone-based counseling into routine care, especially for chronic disease management.
The comparative efficacy of brief behavioral therapy for insomnia (BBTI) remains unclear.
This systematic review and network meta-analysis examined the effectiveness of different BBTI approaches and compared BBTI with other nonpharmacological interventions, such as cognitive behavioral therapy for insomnia (CBT-I).
Three databases were searched from inception to December 27, 2024. Primary outcomes were insomnia severity and sleep quality. Secondary outcomes included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and daytime sleepiness. A frequentist network meta-analysis with random-effects modeling was conducted. Heterogeneity was assessed using the I 2 statistic.
Eighteen randomized controlled trials involving 1104 participants (mean age: 52.6 years) were included. Compared with usual care, BBTI significantly reduced insomnia severity (mean difference [MD] = −4.79; 95% confidence interval [CI = −6.05, −3.53]; I 2 = 0%) and improved sleep quality (MD = −3.45; 95% CI [−4.97, −1.94]; I 2 = 0%). BBTI also shortened sleep onset latency (MD = −19.81 min; 95% CI = −30.64, −8.98; I 2 = 17%) and wake after sleep onset (MD = −15.51 min; 95% CI [−22.75, −8.27]; I 2 = 47%) and increased sleep efficiency (MD = 10.78%; 95% CI [7.67%, 13.89%]; I 2 = 8%). No significant differences were found in total sleep time or daytime sleepiness. Face-to-face BBTI and CBT-I demonstrated similar outcomes. Face-to-face BBTI ranked as the most effective approach based on the surface under the cumulative ranking curve.
Face-to-face BBTI is an optimal nonpharmacological option for improving sleep quality and efficiency and reducing insomnia severity, sleep onset latency, and wake after sleep onset.
PROSPERO number: CRD42021242589
Workplace safety culture is pivotal in healthcare settings, known to enhance nurses' effectiveness and productivity. Yet, the specific pathways through which safety culture influences these outcomes, especially in relation to compassion fatigue, are not fully understood.
This study investigated the mediating role of compassion fatigue in the relationship between workplace safety culture, career satisfaction, and turnover intention among nurses.
A cross-sectional survey was conducted with 269 nurses from various acute healthcare facilities in Eastern Visayas, Philippines. Three standardized scales were used to collect the data. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).
Workplace safety culture was negatively associated with compassion fatigue (β = −0.2604, p = 0.0012) and turnover intention (β = −0.2778, p = 0.0048) and positively associated with career satisfaction (β = 0.3986, p = 0.0001). Compassion fatigue partially mediated the relationship between workplace safety culture and career satisfaction (β = 0.0645, 95% CI [0.0213, 0.1215]) and the relationship between workplace safety culture and intention to stay (β = −0.0756, 95% CI [−0.1398, −0.0263]).
A positive workplace safety culture was associated with a lower compassion fatigue, which in turn enhanced career satisfaction and lower turnover intention among nurses. Healthcare organizations and policymakers should prioritize strategies that enhance safety culture and provide support for nurses to manage compassion fatigue effectively, ultimately leading to better patient care and a more stable nursing workforce.
Compassion competence among nurses is crucial for patient safety and the quality of nursing care, yet the mechanisms linking these factors remain unclear, indicating a significant gap in current understanding.
This study aimed to explore the mediating role of adherence to safety standards in the relationship between nurse compassion competence and patient safety incidents.
A cross-sectional study was conducted among 455 nurses across 3 hospitals in Visayas, Philippines. Participants completed self-report measures assessing compassion competence, adherence to safety standards, and perceived patient safety incidents. Data were analyzed using SPSS Hayes Macro Model 4 to examine direct and indirect effects.
Higher levels of compassion competence in nurses were positively associated with increased adherence to safety standards (β = 0.3438, p = 0.0019) and fewer patient safety incidents (β = −0.2586, p = 0.0001). Adherence to safety standards was found to partially mediate the relationship between compassion competence and patient safety incidents (β = 0.0451, 95% CI [0.0106, 0.0862]).
Fostering compassion competence in nurses can enhance adherence to safety standards, ultimately leading to a reduction in patient safety incidents in healthcare environments. The findings underscore the critical role of compassion competence not just as a desirable nursing trait but as a strategic lever for improving patient safety. Healthcare organizations should implement structured professional development programs that cultivate empathy, emotional intelligence, and effective communication—core elements of compassion competence. Nursing leadership must also embed compassion-driven practices into patient safety protocols, promote a culture of accountability and empathy, and support interdisciplinary collaboration to ensure consistent adherence to safety standards and minimize preventable harm.
The translation of evidence-based practice (EBP) into routine nursing practice remains a persistent challenge.
To evaluate the impact of a structured EBP Mentor Nurse Training Program, developed using the Johns Hopkins EBP model as a process guide and conceptually grounded in the ARCC (Advancing Research and Clinical Practice through Close Collaboration) model, which emphasizes the development of EBP mentors to enhance implementation and competency.
This quasi-experiment used a pretest-posttest design with equivalent control and intervention groups (n = 52; intervention group = 26, control group = 26). The intervention consisted of a blended training program (16 h face-to-face, 3 h online) covering EBP, mentoring, and communication skills. The control group received no intervention. Data were collected using the Nurse Information Form, the Evidence-Based Practice Evaluation Competency Scale, and the Mentoring Scale. The TREND statement guided reporting.
Post-test results indicated significant improvements in the intervention group's EBP knowledge sub-dimension and total competency scores. Statistically significant gains were also observed in the coaching, role modeling, counseling, acceptance and approval, and friendship sub-dimensions of the Mentoring Scale. Effect sizes ranged from d = 0.5 (coaching) to d = 0.8 (EBP knowledge), indicating moderate to large practical significance.
Structured EBP mentorship programs effectively enhance nurses' knowledge, EBP competencies, and mentoring abilities. These outcomes align with the ARCC model, supporting the cultivation of EBP mentors as a sustainable strategy for EBP integration. Incorporating blended learning and active mentorship in nursing education can foster a culture of collaboration, improve clinical decision-making, and promote better patient outcomes.
Although multimodal rehabilitation programs are effective for substance use disorders and widely used, addiction is still a global socioeconomic problem. Providing practical strategies, such as the HeartMath intervention for managing stress at the moment, helps mitigate the physical, emotional, and psychological impacts associated with substance use disorder, promotes resilience, and enhances treatment motivation.
To investigate the effects of the nurse-led HeartMath Training Program on resilience, emotional adjustment, and treatment motivation among patients with substance use disorder.
A randomized controlled trial (RCT) was used to carry out this study. This study was conducted at the inpatient unit for patients with addiction at Elmaa'mora Hospital for Psychiatric Medicine in Alexandria, Egypt. The subjects were 130 patients with substance use disorders (65 in each group). Researchers used three tools to collect the necessary data: Tool I Resilience Scale, Tool II Brief Adjustment Scale–6, and Tool III Treatment Motivation Questionnaire.
The difference in resilience, emotional adjustment, and treatment motivation between the study and control groups after the Nurse-Led HeartMath training intervention was statistically significant.
The HeartMath Training Program is efficacious in improving resilience and emotional adjustment among patients with substance use disorder and increasing their treatment motivation.
ClinicalTrials.gov identifier: NCT06437366
The teach-back method is an effective approach for reinforcing patient education by clarifying and reviewing misunderstood concepts.
To examine the effect of discharge training based on the teach-back method on discharge readiness and satisfaction in patients undergoing lumbar disc herniation surgery.
A randomized controlled trial using a pre-test–post-test design was conducted at two state hospitals in Northern Cyprus from November 2022 to December 2023. A total of 64 patients were randomly assigned to either the intervention group (n = 32) or the control group (n = 32). Data were collected using the Discharge Education Satisfaction Scale, the Readiness for Hospital Discharge Scale, and the Discharge Education Knowledge Test. The CONSORT 2010 flow diagram was followed.
The mean ages of the intervention and control groups were 51.26 ± 11.92 years and 46.50 ± 11.73 years, respectively. Following the intervention, patients who underwent lumbar disc herniation surgery in the intervention group showed significantly higher scores compared to the control group (p < 0.05). These improvements were observed in overall discharge education satisfaction, discharge education knowledge, and all subdimensions of discharge readiness–including personal status, knowledge, and coping ability.
Discharge education delivered using the teach-back method enhances satisfaction, knowledge, and discharge readiness in patients undergoing lumbar disc herniation surgery.
Trial Registration: The full research protocol is available at ClinicalTrials.gov (NCT05695014)
Diabetes mellitus is a growing global health concern, with a high prevalence in Egypt. Type 2 diabetes imposes substantial health and economic challenges. Diabetes Self-Management Education and Support (DSMES) programs, such as the Diabetes Conversation Map, have demonstrated promise in enhancing patient knowledge, self-management, and self-efficacy. However, evidence regarding their direct impact remains scarce, necessitating further investigation.
This study aimed to evaluate the effectiveness of the Diabetes Conversation Map program in improving knowledge retention, self-management, and self-efficacy among type 2 diabetes patients in Egypt.
A prospective, parallel, two-arm randomized controlled trial was conducted at the Damanhour Health Insurance Outpatient Diabetic Clinic in Egypt. A total of 120 adult patients with type 2 diabetes were randomized into a control group (n = 60), receiving standard diabetes education, and an intervention group (n = 60), attending 8 weekly interactive sessions using the Diabetes Conversation Map. Primary outcomes were assessed using validated questionnaires at baseline, post-intervention, and 3 months later.
The intervention group exhibited significant improvements in knowledge, self-management, and self-efficacy compared to the control group (p < 0.001). Additionally, positive correlations between these outcomes were observed post-intervention, replacing negative correlations observed at baseline.
The Diabetes Conversation Map program effectively enhances patient knowledge, self-management, and self-efficacy, supporting its integration into routine diabetes education. Healthcare providers should implement structured, interactive educational interventions to empower patients in managing their condition. Regular follow-ups and reinforcement strategies are necessary to sustain long-term self-efficacy improvements. Policymakers should consider incorporating evidence-based diabetes education into national healthcare programs. Future research should explore digital adaptations of the program to enhance accessibility and engagement.
Registration No: R000061691, Trial ID: UMIN000054044
The interaction between dementia and changes in health status accelerates the progression of dementia and health deterioration. Although health indicators exist for older adults, comprehensive ones for dementia are lacking.
To (1) establish core health indicators for older adults with dementia, (2) develop an integrated health assessment toolkit for older adults with dementia, and (3) test the feasibility and applicability of the integrated health assessment toolkit.
This study involved two phases. In the first phase, using the Delphi method, opinions from 10 experts were synthesized to establish core health indicators for older adults with dementia. In the second phase, with a descriptive research approach, an integrated health assessment toolkit was developed, evaluated by 10 daycare case managers for feasibility, and then pilot tested with 50 older adults with dementia across three daycare centers.
The core health indicators for older adults with dementia covered 18 indicators in five domains: (1) cognitive and behavioral impairment, (2) sensory and perceptual impairment, (3) disease and dysfunction, (4) functional fitness deterioration, and (5) social isolation. After two rounds of assessments, experts rated the criteria's importance and clarity at 0.94 and 0.89 on the scale-level content validity index/universal agreement (S-CVI/UA), respectively. In the second phase, the integrated health assessment toolkit was developed, which integrated five observational assessment scales and six physical function measures. The average applicability scores ranged from 7.80 to 9.90 out of 10. In the pilot test, the assessment process proceeded smoothly without any adverse events. However, 10 participants did not comply with wearing the actigraphy device.
The core health indicators and the corresponding health assessment toolkit are feasible to assess the health of older adults with dementia that could provide valuable insights and guide future interventions to enhance their well-being.
The original jigsaw strategy is a cooperative learning technique that involves small groups of participants working together on a particular task that was initially designed to promote academic performance and foster positive social relations among students across diverse classroom settings. Jigsaw emphasizes teamwork by facilitating collaboration among students or participants to accomplish tasks. It is an efficient and time-saving approach that is particularly applicable when there is a lot of information to review and each individual does not need to learn every detail of the topic.
To develop a strategy to advance EBP in healthcare organizations and build individuals' competence and confidence in the EBP process.
The jigsaw approach was modified to advance evidence-based practice (EBP) through the creation of the “Jigsaw Journal Club for EBP” (JJC-EBP).
The JJC-EBP strategy/approach enhances efforts to advance EBP work in organizations by expediting the critical appraisal step of the EBP process. This strategy/approach also promotes clinician participation in EBP by creating a collaborative approach to several steps of EBP methodology. In addition, this strategy/approach helps individual clinicians build their competence and confidence in several steps of EBP methodology as well.
EBP can be advanced in healthcare organizations through implementation of the Jigsaw journal club strategy. Clinicians can build their EBP competence and confidence through participation in a Jigsaw journal club activity.
Nurse leaders at every level are needed to help organizations achieve strategic goals and deliver safe patient care. Nurse leaders can find fulfillment in their roles; however, they are often prone to poor work-life balance due to the complexity and demands of their jobs. Professional well-being, consisting of an individual's overall health and the perception of good work-related quality of life, is at risk for being compromised in these nurses. Research exploring variables associated with psychosocial well-being in nurse leaders is limited.
To describe variables related to psychological well-being in nurse leaders, explore associations among these variables, and identify potential demographic and psychosocial predictors of resilience and burnout.
Participants were a convenience sample of nurse leaders from two hospitals located in the southwestern United States. We used a prospective observational design to describe the incidence of and relationships between self-compassion, satisfaction with life, resilience, perceived stress, and burnout. We then sought to identify predictors of disengagement and exhaustion (subscales of burnout) and resilience.
Participants (n = 105) were mostly female (82.7%) and white (57.7%), while one-third were charge nurses. Most reported normal to high levels of satisfaction with life (86%), self-compassion (90%), and resilience (93.3%) and 72.4% reported high stress levels. Moderately high levels of disengagement (46.4%) and exhaustion (59.1%) were also present. Higher self-compassion levels predicted higher levels of resilience. Lower satisfaction with life and self-compassion together predicted high disengagement scores, while lower self-compassion scores predicted high exhaustion scores.
When disengagement, exhaustion, and perceived stress are elevated, nurse leaders are at risk for low professional well-being and may be more prone to resignation ideation or turnover. Evidence-based interventions designed specifically for nurse leaders promoting professional well-being and emphasizing self-compassion skills are needed along with high-quality research on program outcomes.
Integrating evidence-based interventions in services by midwives and public health nurses (PHNs) has the potential to improve public health. Attitudes and individual readiness to change can influence the implementation of evidence-based interventions, but there is limited research in community nursing and maternity and child health care services (MCHCs).
To examine attitudes toward evidence-based practice and readiness to change in midwives and PHNs in MCHCs before implementing the “Mamma Mia” intervention (an evidence-based intervention to improve maternal mental health).
A survey-based, multisite cross-sectional study following the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guideline. Data were collected from 190 midwives and PHNs from 42 MCHCs across 33 municipalities in Norway (2021–2022). Six subscales of the Evidence-Based Practice Attitude Scale (EBPAS) assessed attitudes toward evidence-based practice, and the Brief Individual Readiness for Change Scale (BIRCS) measured individual readiness. Descriptive and inferential statistics using frequency tables, Pearson correlation coefficient, and linear regression were used for data analysis. Open-ended responses were analyzed using content analysis.
Sixty-five midwives and 125 PHNs completed the baseline survey (mean age 46.8, all female). Mean EBPAS subscales scores were 2.99 to 3.58 (SD = 0.46–0.77) mean BIRCS score was 3.16 (SD = 0.49) (possible range 0–4). Scores were slightly higher than typically reported in clinical settings, with no significant differences based on demographics (all p-values ≥ 0.166). EBPAS subscores and the BIRCS score showed a moderate positive association. The most frequently reported positive factors influencing readiness were “enhanced care and positive gain” (42.6%), “organizational support” (26.3%), and “receiving training and implementation support” (23.2%). Negative factors included “time constraints and workload” (58.4%), and “research participation and implementation demands” (27.9%).
Midwives and PHNs showed positive attitudes toward EBP and a high degree of individual readiness. Our findings align with previous research highlighting barriers such as time constraints and workload, offering insights to inform strategies for more effective EBP adoption and implementation. These results can guide nurse managers, administrators, policymakers, professional associations, implementers, and intervention developers in enhancing EBP integration into practice.
Nurse managers are pivotal to the successful implementation of evidence-based practice (EBP). However, enhancing their skills and competencies remains a critical priority. Assessing the influence of nurse managers' competencies in managing and practicing EBP is essential, as it directly impacts outcomes across all levels of healthcare institutions.
This study explored how leadership, organizational support, and knowledge management influence EBP implementation among nurse managers.
A descriptive correlational study was conducted with a convenience sample of nurse managers in seven Egyptian hospitals. A total of 369 nurse managers completed three validated instruments: EBP Leadership and Organizational Support Scale (EBPLOSS), Knowledge Management Competencies for Nurse Managers (KMQN), and EBP Questionnaire (EBPQ). Descriptive statistics, hierarchical regression, and structural equation modeling (SEM) were applied for data analysis.
Nurse managers reported high levels of perceived EBP leadership (84.7%), organizational support (79.52%), knowledge management (KM) competencies (75.15%), and EBP implementation (74.83%). SEM analysis identified KM competencies as the strongest predictor of EBP implementation, with a direct effect (B = 0.86, p < 0.001) accounting for 86% of the total effect. EBP leadership significantly influenced EBP implementation both directly (β = 0.31, p = 0.02) and indirectly through KM competencies (B = 0.89, p < 0.001). Organizational support showed a minimal direct effect (B = 0.13, p < 0.05) and a slightly negative indirect effect through KM competencies (B = −0.10, p < 0.001).
KM competencies are critical for EBP implementation, mediating the effects of leadership and organizational support. Healthcare organizations should enhance nurse managers' KM skills, foster transformational leadership, and create supportive environments. Future research should address barriers and explore longitudinal relationships in EBP implementation from a managerial perspective.
A skilled and diverse healthcare workforce is essential in nursing homes, yet recruitment and retention remain a major challenge. Gaining insight into the well-being of different care worker groups and how they perceive their work environment can highlight areas of concern and opportunities for improvement.
To compare the perceived work environment and well-being among different care worker groups in nursing homes.
This descriptive study used cross-sectional survey data from the Flanders Nursing Home (FLANH) project, collected from February–July 2023. A total of 1521 care workers from 25 Flemish nursing homes participated (64.4% response rate), including care assistants (43.7%), registered nurses (20.5%), support staff (15.4%), allied health professionals (14.8%), and team leaders (5.7%). Chi-squared tests were used to compare the percentages of the care worker groups reporting the work environment items and well-being outcomes (job satisfaction, intention to leave, burnout). Post hoc analyses were conducted to identify which groups contributed to the significant differences observed.
Significant differences among care worker groups were found for almost all work environment items and well-being outcomes. Staffing adequacy was perceived least among care assistants and registered nurses. More registered nurses and team leaders perceived high workload and emotional burden compared to the other groups. Work–life interference and involvement were perceived most among team leaders. A person-centered vision, work autonomy, and salary satisfaction were reported most among allied health professionals and team leaders. Skill use and training opportunities were reported least among support staff. Work-related well-being appeared to be experienced most among allied health professionals and least among care assistants.
These findings highlight key differences in work environment perceptions and well-being among care worker groups, offering valuable insights for tailored initiatives to foster a supportive workplace that benefits the well-being of all types of care workers in nursing homes.
Nurses face heightened risks of developing posttraumatic stress disorder (PTSD) due to occupational stressors, with prevalence rates significantly higher than the general population before and during the COVID-19 pandemic. Although PTSD symptoms are known to impair various domains of functioning, research examining which specific PTSD symptom clusters most strongly impact nurses' functioning remains limited.
This study examines how individual PTSD symptom clusters relate to overall functioning and distracted practice, a measure of workplace functioning, in nurses with probable PTSD.
We examined relationships between PTSD symptoms and functioning among 420 U.S. nurses recruited through social media platforms in late 2021. Participants completed validated measures assessing PTSD symptom clusters (PTSD Checklist for DSM-5), anxiety (Generalized Anxiety Disorder Scale), depression (Patient Health Questionnaire), general psychosocial functioning (The Brief Inventory of Psychosocial Functioning), and a proxy measure for workplace functioning (Distracted Practice Scale), with hierarchical regression analyses used to evaluate the unique contributions of PTSD symptom clusters to functional outcomes while controlling for demographic, workplace, and mental health variables.
PTSD symptom clusters accounted for significant additional variance in both general functional impairment (9.5%) and occupational impairment (9.3%), beyond demographic, workplace, and other mental health variables. For general psychosocial impairment, PTSD cluster D, negative alterations in cognition and mood, and cluster E, arousal symptoms, were the most impactful, whereas PTSD cluster B, reexperiencing, and cluster D were most strongly associated with workplace functional impairments. Final models revealed that education level predicted general psychosocial impairment while years of nursing experience predicted impairments in workplace functioning.
Nurses with PTSD during the COVID-19 pandemic faced significant impairments in overall and work functioning. Our findings highlight that PTSD symptoms vary in how they impact functioning. Symptom clusters such as negative mood, arousal, and reexperiencing were linked to worsened functioning. Tailored support programs should address specific PTSD symptoms.
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