The goals of this study were to determine and evaluate the perception of cultural competence of nurses in the Slovak healthcare system, identify factors that influence their perception, and ascertain opportunities to improve nurses’ cultural competence.
Cross‐sectional nonexperimental study.
Nurses from Slovakia were surveyed in this cross‐sectional study using the standardized Cultural Competency Assessment (CCA) questionnaire. Statistical analysis was conducted using SPSS version 22 (IBM Corp., Armonk, NY, USA).
In total, 267 nurses responded. Only 28% perceived themselves as very culturally competent to care for people from other cultures. Over 68% received no diversity training. Age (p < .011) and prior diversity training (p < .006) were significantly associated with culturally competent behavior (CCB). A significant relationship (r = 0.17; p < .015) was also confirmed between the self‐reported CCA and CCB.
Culturally competent care is a professional imperative. The ability to deliver high‐quality, culturally congruent care may be enhanced by cultural diversity education and training. Further research is needed to identify other influences on cultural competency and the impact on patient care and outcomes.
There is a need for nurses to enhance their knowledge and skills related to cultural competency, awareness, sensitivity, and behaviors. Education and training contribute to nurses’ ability to provide high‐quality, culturally competent nursing care to patients from different cultures, and may possibly contribute to decreased health disparities.
Neonatal palliative care becomes an option for critically ill neonates when death is inevitable. Assessing nurses’ attitudes towards, barriers to, and facilitators of neonatal palliative care is essential to delivering effective nursing care.
This study was conducted from January to September 2015 and involved Italian nurses employed in Level III neonatal intensive care units in 14 hospitals in northern, central, and southern Italy. A modified version of the Neonatal Palliative Care Attitudes Scale (NiPCAS) was adopted to assess nurses’ attitudes.
A total of 347 neonatal nurses filled out the questionnaire. The majority were female (87.6%), with a mean age of 40.38 (±8.3) years. The mean score in the “organization” factor was 2.71 (±0.96). The “resources” factor had a mean score of 2.44 (±1.00), while the “clinician” factor had a mean score of 3.36 (±0.90), indicating the main barriers to and facilitators of implementing palliative nursing care.
Italian neonatal nurses may face different obstacles to delivering neonatal palliative care and to improve their attitudes in this field. In the Italian context, no facilitators of, only barriers to, palliative care delivery were identified.
Nurses’ attitudes towards neonatal palliative care are essential to supporting nurses, who are constantly exposed to the emotional and moral distress connected with this field of end‐of‐life nursing care.
Studies conducted with lesbian, gay, bisexual, transgender, and intersex (LGBTI) people in Turkey have found that such people experience social isolation, neglect, insufficient healthcare services, and disrespect. However, no study has been reported related to clinicians' approaches and attitudes towards them. This study aimed to determine the attitudes of nurses towards homosexual individuals and the factors associated with the homophobia levels of nurses.
This was a descriptive, cross‐sectional survey study.
The study was conducted with 449 participants in four hospitals. Nurses who had been working for at least 1 year in the hospitals were included in the sample of the study. The data were collected by using a two‐part survey form. The first part was an information form regarding the participants’ socio‐demographic and professional characteristics, and the second part was the Hudson and Ricketts Homophobia Scale. The data were analyzed using numbers, percentages, means, Cronbach’s alpha internal consistency analysis, parametric tests (t test and analysis of variance), nonparametric tests (Mann‐Whitney U and Kruskal‐Wallis) and multiple linear regression.
The study found that most of the Turkish nurses were not professionally homophobic. However, their personal homophobia scores were high. Their attitudes towards homosexuals varied by factors such as education level, acquaintance with LGBTI people, level of acquaintance, and locations of the hospitals.
Nurses who work in public hospitals stated that they would provide care for LGBTI people. However, their Homophobia Scale scores were over the mid‐point. Subjects related to the health needs of LGBTI people should be included in the curricula of nursing departments and in in‐service training at health service institutions.
LGBTI individuals have complained about the reaching out health care services and negative attitudes of health care professionals towards them. Findings of this study provides important data to understand the homophobia level and reasons of nurses to develop in‐service education and training programs for coping and changing their negative attitudes.
The confidence in a study will be reduced due to the incorrect representation of statistical results. However, it is unknown to what extent p values are incorrectly represented in published nursing journals. The study aims to evaluate the articles in 30 nursing journals in terms of the error in reporting of p values (p = .000).
This was a bibliometric analysis. All papers published in 10 leading nursing journals (between 2015 and 2019), the 10 bottom nursing journals (2019), and 10 selected key nursing journals (2019) indexed in the Science Citation Index Journal Citation Reports were reviewed to detect errors in reporting of p values (p = .000).
A total of 3,788 papers were reviewed. Notably, it was found that 93.3% (28/30) of the nursing journals contained incorrect representation of p values (p = .000). The reporting rate of these journals ranges from 0% to 57.1%, with an overall rate of 12.8% (486/3,788). In addition, the rate of incorrect representation of p values (p = .000) showed no statistically significant difference between different publication years (Χ2 = 4.976, p = .290). However, the rate of reporting was different between study types, journals, and regions (p = .007, p = .020, and p < .001, respectively).
The incorrect representation of p values is common in nursing journals.
We recommend that both publishers and researchers be responsible for preventing statistical errors in manuscripts. Furthermore, various kinds of statistical training methods should be adopted to ensure that nurses and journal reviewers have enough statistical literacy.
We performed this review systematically to assess the effect of cold application at the heparin subcutaneous injection site on incidence and size of bruising, hematoma, and pain intensity.
A systematic review and meta‐analysis were utilized as the study design.
To retrieve the relevant randomized controlled trials (RCTs) published up to July 2019, the databases of PubMed, Scopus, Web of Science, ScienceDirect, Cochrane Library, Google Scholar, TRIP, and Elmnet.ir were searched.
Those RCTs were selected in which the participants had received any type of heparin via subcutaneous injections at least once a day, as were those comparing the effect of cold application (i.e., moist or dry ice packs or vapocoolant spray) on injection sites with no interventions or placebos. The types of outcomes measured included pain intensity, bruising, and hematoma at injection sites. Furthermore, odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were employed to measure the pooled data.
A total of nine studies recruiting 896 patients with a mean age range of 37 to 62 years were ultimately included in this study. The findings revealed that eight studies had used low‐molecular‐weight heparin, but unfractionated heparin had been administered in one study. The quality of the studies was also assessed in seven domains. Overall, risk of bias in the included articles was low to moderate. Pooling data of six studies showed that the patients had experienced less pain intensity once cold had been applied at the heparin injection sites (MD = −1.67; 95% CI −3.03 to −0.31; p = .02; I2 = 92%). Bruising had been correspondingly reported in eight and six studies in terms of size and incidence, respectively. In particular, the results had demonstrated no statistically significant difference between either group in terms of bruising size or incidence at 48 to 72 hr following heparin injection. Furthermore, hematoma incidence had been reported in two studies, and one trial had reported hematoma size only. The results had suggested that the patients had smaller hematomas (MD = −0.87; 95% CI −1.63 to −0.11; p = .03) and a lower incidence of hematomas (OR = 0.35; 95% CI 0.16 to 0.76; p = .008) in the cold application group 48 hr after injection.
The results of this systematic review and meta‐analysis showed that patients could experience less pain and fewer hematomas once the cold had been applied for 3 to 5 min at the injection sites before or after subcutaneous heparin administration. During this period, clinicians should also consider the patient's comfort; if some patients feel discomfort at the cold application site, the minimum possible time should be considered.
This study’s results could be used as evidence for all hospitalized and outpatients who need to receive any form of heparin and may suffer from local complications of this medicine.
To determine the factors associated with the clinical competence of registered nurses.
Systematic review and meta‐analysis was used. The search strategy was limited to 10 years, ranging from January 2009 to December 2019, in Science Direct, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest, and Google Scholar. A meta‐analysis was performed using R Studio with the metafor package (Boston, MA, USA; https://rstudio.com/products/rstudio/older‐versions/).
A total of 22 studies were included, representing 33,961 nurses. There were 28 factors associated with clinical competence. Of those, 13 factors were significantly supported and included for meta‐analysis, grouped into (a) individual‐related factors, (b) job satisfaction, (c) bullying, (d) burnout, and (d) specific knowledge. The effect size of those factors ranged from ‐0.14 to 0.50.
Among individual‐related factors, salary has the largest effect size on competence and is considered important. Clinical competence is positively affected by job satisfaction, but negatively influenced by bullying and burnout. Although specific knowledge has a large effect size, it does not significantly affect the clinical competence of registered nurses.
It is critical to understand factors related to the clinical competence of registered nurses to maintain quality care and patient outcomes in clinical settings. The findings serve as data to help nurse managers find effective ways to improve the knowledge, skill, attitudes, and performance of registered nurses.
To assess Taiwanese nurses’ attitudes toward and knowledge about sexual minorities, and their awareness and behavior of providing care to sexual minority patients.
A cross‐sectional descriptive design was employed.
A total of 323 Taiwanese nurses 20 years of age or older completed an online questionnaire between September and November 2019. It included five sections: demographics, the Attitudes Toward Lesbians and Gay Men Scale, Knowledge About Homosexuality Questionnaire, Gay Affirmative Practice Scale, and nurses’ needs for promoting culturally competent care.
Taiwanese nurses held positive attitudes, and demonstrated high levels of awareness and behaviors of providing care to sexual minority patients. However, they had limited knowledge regarding homosexuality. More so, nurses who were older, self‐identified as heterosexuals, were married, had more than 10 years’ work experience, and were Buddhists had poor knowledge about homosexuality. Nurses reported that for providing culturally competent care they required knowledge about sexual minorities’ physical and mental health issues; the populations’ social and welfare resources; communication skills training; privacy; and safe space.
Information on homosexuality and health issues among sexual minority populations, communication skills training, privacy, and safe space should be provided to Taiwanese nurses to improve their abilities to provide culturally competent care and to reduce health inequalities among sexual minorities.
This study’s results could be used as evidence for designing and providing training programs for nurses regarding culturally competent care, and thus promote quality nursing care and decrease difficulties of accessing healthcare services among sexual minority patients.
Despite the importance of research in the discipline of nursing, current trends in nursing research have rarely been discussed across countries. The purpose of this article was to identify current trends in nursing research across five countries, including the United States, South Korea, Taiwan, Japan, and Hong Kong, in order to provide directions for future global nursing research.
A discussion article.
To identify the current trends, seven leaders from the five countries had discussions through a series of workshops and conference presentations. After the most recent conference, all the leaders reflected for a month on their presentations and compiled the exemplars and cases from their experience and the existing literature in individual countries into a table. The tables and supporting references were collected at the completion of the reflection period. Then, the PowerPoint (Microsoft Corporation, Redmond, WA, USA) slideshows of the conference presentations by the leaders and the collected tables were analyzed using a content analysis.
Six themes reflecting the current trends in nursing research were extracted: (a) demographic alterations; (b) increasing diversities and globalization; (c) technology innovation; (d) individualized or personal care and population health initiatives; (e) health policies and regulations; and (f) nursing workforce changes.
Future directions for nursing research across the countries were proposed: (a) cost‐effectiveness research; (b) implementation science; (c) data science; (d) training of the future generation of nurse researchers; (e) population health; and (f) team science.
This topic could be applied to any clinical settings.
The purpose of this prospective evaluation is to document in‐hospital management and discharge trends of patients presented for acute heart failure.
A prospective evaluation of the patients presented for heart failure exacerbation at eight sites over 1 month using the method of the New South Wales Heart Failure Snapshot.
Trained personnel situated at each of the study sites recruited eligible patients to the study and collected data on their sociodemographic characteristics, clinical presentation, self‐care, frailty, and depression.
Eight sites, out of the 27 contacted, agreed to participate in this study. A total of 137 admissions were reported in the 1‐month time window. Mean age was 72 (SD = 13) years and the majority were female (52%). More than half (n = 60%) had heart failure reduced ejection fraction with a mean ejection fraction of 41%. The mean Charlson Comorbidity Index score was four with hypertension (80%) and diabetes (56%) being the most frequent. The majority were frail (86%), self‐care mean scores were low; self‐care maintenance (29), self‐care management (48) and self‐care confidence (42). The mean depression score was 14 indicating major depression. In reference to international guidelines recommendations, hospital administered medications and discharge medications were suboptimal. Some items of the discharge education recommended by the international guidelines were provided to 84% of the patients but none of the patients received the complete items of the discharge education.
The snapshot revealed that patients admitted for acute heart failure were frail with high levels of illiteracy and low self‐care scores. Despite these findings, these patients were not provided with complete discharge education in reference to the international guidelines. Additionally, when provided, discharge education was inconsistent across the study sites. This study highlights the need for enlisting complete education as part of the discharge process, in addition to abidance to the guidelines in prescribing medication. The study draws major implications for nursing practice, research and policy.
Literacy among patients with heart failure is low and should be addressed in educational intervention to improve outcomes.
Discharge education is under practiced across the country and should be implemented in accordance with the international guidelines.
This study aims to examine the frailty transition patterns of older adults recruited from both community and residential care settings within a 5‐year period, and to identify the physical and psychosocial factors associated with the transitions.
This study is a secondary data analysis of a longitudinal study for tracking the change of health status of older adults 60 years of age or older. Participants who had undergone at least two assessments during 2013–2017 were selected for analysis. Guided by the Gobben’s Frailty Model, biopsychosocial predictors were comprehensively identified from the literature, and their relationship to frailty state transition was explored.
We compared the baseline characteristics of participants at the frail, pre‐frail, and robust states (categorized using the Fried Frailty Index). A generalized estimating equation was used to identify factors associated with an improvement or a deterioration in frailty. The probability of transitions between frailty states was calculated.
Among the 306 participants, 19% (n = 59) improved and 30% (n = 92) declined in frailty within the project period. Sleep difficulties (odds ratio [OR] = 1.76; 95% confidence interval [CI]: 1.07–2.90; p = .027), better cognitive status (OR = 0.80–0.84; 95% CI: 0.66–0.98 and 0.73–2.73; p = .031 and .018), good nutritional status (OR = 0.74; 95% CI: 0.59–0.91; p = .005), slow mobility (OR = 1.03–1.13; 95% CI: 1.00–1.05 and 1.03–1.25; p = .047 and .014), hearing impairment (OR = 2.83; 95% CI: 1.00–8.01; p = .05), better quality of health—physical domain (OR = 0.95; 95% CI: 0.92–0.99; p = .006), and better functional ability (OR = 0.85–0.97; 95% CI: 0.79–0.92 and 0.96–0.99; p < .001 and p = .003) were significant associated factors in the worsening group. More physical activity (OR = 1.01; 95% CI: 1.00–1.01 and 1.01–1.02; p = .026 and p < .001), hearing impairment (OR = 0.26; 95% CI: 0.08–0.86; p = .028), and slow mobility (OR = 0.93; 95% CI: 0.87–1.00; p = .037) were significant associated factors in the improvement group.
Frailty is a crucial global public health issue. This study provides evidence for nurses to holistically consider the associated factors and to design effective interventions to combat frailty in our ageing society.
Frailty is a transient state that can be reversed. Professional nurses working in both community and residential care settings should be able to identify older adults at risk and improve their health conditions appropriately.
The COVID‐19 pandemic has presented an international health crisis of a scope not seen in our lifetime. While much attention has been paid to health workers in critical care and acute areas, nurses working outside of hospitals are also significantly affected. This study sought to investigate the experience of nurses working in Australian primary healthcare during the COVID‐19 pandemic. In particular, it sought to understand the implications on their employment status, role, and access to personal protective equipment.
Nurses employed in primary healthcare across Australia were invited to participate in a cross‐sectional online survey through social media and professional organizations. The survey tool was composed of demographics, and of questions about the nurses’ employment, work role, and access to personal protective equipment.
Of the 637 responses received, nearly half (43.7%) reported a decrease in hours and threatened or actual loss of employment. While most respondents felt that they had sufficient knowledge about COVID‐19, they expressed concern about work‐related risks to themselves and their family. Most respondents described never or only sometimes having sufficient personal protective equipment in their workplace. Just over half of respondents (54.8%) felt well supported by their employer. A third of respondents (34%) perceived that care provided in their workplace was significantly or slightly worse than before the pandemic.
This is the first study of primary healthcare nurses’ experiences during the COVID‐19 pandemic. The study findings highlighted a concerning level of insecurity around primary healthcare nursing employment, as well as issues with the availability of personal protective equipment for these nurses. The perception that the pandemic has resulted in reduced quality of care needs further exploration to ensure that those with chronic conditions are supported to maintain and promote health.
Understanding the implications of COVID‐19 on the primary healthcare nursing workforce is vital to ensure staff retention and care quality. Ensuring that the community remains healthy and supported at home is vital to both reduce the burden on the health system and reduce secondary mortality.
To examine the incidence of workplace bullying among nurse educators and explore potential relationships between workplace bullying, professional demographics, coping strategies, and intent to leave.
The investigator used a cross‐sectional, descriptive, correlational design and Bronfenbrenner’s Process‐Person‐Context‐Time model to examine workplace bullying among nurse educators in the northeastern United States.
A web‐based survey was utilized to collect data from a final sample of 470 nurse educators from nine states in the northeastern United States. The instruments included a demographic section, followed by the Negative Acts Questionnaire‐Revised (NAQ‐R), the Coping Strategy Indicator (CSI), and a three‐item job intent turnover questionnaire. Descriptive and parametric statistics were generated for data analysis.
Forty‐five percent (n = 212) of participants self‐identified as targets of bullying in the workplace within the preceding 6 months. The most frequently reported negative acts encountered among the nurse educators surveyed were being excluded, having one’s opinion ignored, and being exposed to an unmanageable workload. Furthermore, statistically significant relationships were identified between workplace bullying and coping strategies (r = .53: p < .01) and intent to leave (r = .58: p < .01) among nurse educators.
Workplace bullying among nurse educators is a serious problem impacting the profession. Heightened awareness and diverse initiatives targeting workplace bullying can positively impact retention of qualified nurse educators.
Findings from this study may contribute to the development of strategies to mitigate the effects of psychosocial bullying and enhance retention of nurse educators.
Hospital‐acquired pressure injuries (HAPIs) and falls are outcomes sensitive to quality of nursing care. Use of contract (traveler) nurses varies among organizations, but there is little research on the effect of contract nurses on nurse‐sensitive outcomes.
To explore the relationship between use of contract nurses and two key nurse‐sensitive outcomes, HAPIs and falls.
This was a cross‐sectional study of unit‐level nursing, patient, and hospital factors versus HAPIs and falls from a national nursing data consortium from 2015 to 2016. We used cluster analysis to identify similar units, and compared outcomes between clusters.
605 nursing units in 166 hospitals, 3.2 patients per nurse, and 5.3% contract nurses.
Prevalence and incidence of HAPIs and number of falls, adjusted by patient days.
For both prevalence and incidence of HAPIs, there was a statistically significant difference between the five independent cluster groups (p = .012 and p = .001, respectively). The cluster with the highest percentage of nurse travelers (>7%) had the highest HAPI prevalence (0.84%) and incidence (0.055 per 1,000 patient days) despite higher nurse staffing, compared to HAPI prevalence of 0.32% and incidence of 0.017 per 1,000 patient days in the cluster with the lowest percentage of nurse travelers (<2%). We did not identify a consistent relationship between use of contract nurses and falls.
Use of contract nurses was associated with higher HAPI prevalence and incidence, independent of staffing levels.
Our results suggest that institutions should either minimize the use of contract nurses, or engage in extensive training to confirm that contract nurses have understanding of the institutional practices around HAPIs.
To investigate the anxiety and depression levels of frontline clinical nurses working in 14 hospitals in Gansu Province, China, during this period.
A cross‐sectional survey was conducted online between February 7 and 10, 2020, with a convenience sample of 22,034 nurses working in 14 prefecture and city hospitals in Gansu Province, located in northwest China.
A self‐reported questionnaire with four parts (demographic characteristics, general questions related to novel coronavirus‐infected pneumonia, self‐rating anxiety scale, and self‐rating depression scale) was administered. Descriptive statistics including frequencies, means, and SDs were computed. The associations between anxiety and depression with sociodemographic characteristics, work‐related concerns, and impacts were analyzed, followed by multiple stepwise linear regression to identify factors that best predicted the nurses’ anxiety and depression levels.
A total of 21,199 questionnaires were checked to be valid, with an effective recovery rate of 96.21%. The mean ± SD age of the respondents was 31.89 ± 7.084 years, and the mean ± SD length of service was 9.40 ± 7.638 years. The majority of the respondents were female (98.6%) and married (73.1%). Some demographic characteristics, related concerns, and impacts of COVID‐19 were found to be significantly associated with both anxiety (p < .001) and depression (p < .001). Nurses who needed to take care of children or elderly relatives, took leave from work because they were worried about COVID‐19, avoided contact with family and friends, and wanted to obtain more COVID‐19‐related knowledge had higher levels of both anxiety and depression.
Results show that nurses faced with the COVID‐19 outbreak are at risk for experiencing anxiety and depression. Demographic background, psychosocial factors, and work‐related factors predicted the psychological responses. The family responsibilities and burdens of women may explain the higher levels of anxiety and depression among nurses with these obligations as compared to those without. On the other hand, nurses who chose not to take leave from work or who did not avoid going to work during this period were less anxious and depressed.
Professional commitment might be a protective factor for adverse psychological responses. It is pertinent to provide emotional support for nurses and recognize their professional commitment in providing service to people in need.
The purpose of this study was to assess nurses’ knowledge, perceived self‐efficacy, and intended behaviors relative to integrating the social determinants of health (SDoH) into clinical practice.
A cross‐sectional study was completed with 768 nurses working in three hospitals within a large regional healthcare system located in the Midwest. Data were collected using an adapted 71‐item SDoH Survey, which measured nurses’ confidence in and frequency of discussing the SDoH with patients, general knowledge of the SDoH, familiarity with patients’ social and economic conditions, and awareness of their institution’s health equity strategic plan to achieve health equity. The institution’s health equity strategic plan reflects the organization’s commitment to improving the health of individuals and neighborhoods by addressing the SDoH known to influence health status and life expectancy. Finally, participants were asked to describe barriers to incorporating the SDoH into practice along with completing five demographic items. Descriptive statistics were used to describe the findings.
Of the 768 respondents, 63% had a baccalaureate degree in nursing and 33.1% reported more than 20 years in nursing. Fifty percent of respondents reported feeling more knowledgeable or confident in their ability to discuss access to care issues with patients compared to the other SDoH. Identified barriers to discussing the SDoH included insufficient time to address identified needs and unfamiliarity with internal and external resources. Respondents stressed the need for interdisciplinary education and collaboration along with more information on the role of social workers.
Nurses are more confident in discussing certain determinants of health and could benefit from more skill development in discussing SDoH issues and stronger collaborative partnerships to address identified needs.
Findings from the study have implications for supporting the educational and resource needs of front‐line nurses employed in hospitals and health systems seeking to address broader societal issues influencing the health status and outcomes of patients and communities.
To identify factors associated with resilience in primary caregivers of patients with advanced oral cavity cancer within the first 6 months post‐treatment.
A cross‐sectional study.
We recruited patient–primary caregiver dyads from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed using a set of structured questionnaires to measure performance status and demographic and clinical characteristics. Primary caregivers were measured in their social support, resilience, and care characteristics.
Of the 148 dyads surveyed, 33.8% of primary caregivers reported moderately low to moderate resilience, and 61.5% reported low resilience. Greater resilience of primary caregivers was associated with the primary caregiver factors of younger age, lower educational level, and more affectionate social support; and greater resilience was associated with the patient factors of better performance status and older age. These factors explained 40.4% of the variance in resilience.
Patients’ performance status and primary caregivers’ affectionate social support strongly influence overall resilience and each domain of resilience.
Providing primary caregivers with sufficient social resources and a support group can help them cope with the demands of caregiving for loved ones with oral cavity cancer.