Conectar
by Hongxiao He, Jiahe Li, Junying Li, Hong Lu, Jie Lu, Linlin Cao, Luxia Gong, Ruyan Pang, Xiu Zhu
BackgroundThe World Health Organization (WHO) recommends Early Essential Newborn Care (EENC) to improve newborn outcomes. However, uptake remains suboptimal in many low-resource settings. Organisational factors, such as implementation climate, are crucial but understudied in relation to EENC implementation.
ObjectiveTo explore how implementation climate mediates the relationship between knowledge, attitudes, and EENC practices.
DesignMulti-site, cross-sectional study.
SettingTwelve tertiary maternity hospitals in China (December 2022–April 2023).
Participants433 nurse-midwives.
MethodsValidated questionnaires were use to assess knowledge, attitudes, practices, and perceived implementation climate related to EENC. Path analysis and logistic regression were employed to explore direct and indirect relationships.
ResultsA total of 69.3% participants reported good EENC practice. Significant predictors included good knowledge (adjusted odds ratio [AOR] = 2.75; 95% confidence interval [CI]: 1.76–4.31), positive attitudes (AOR = 2.00; 95% CI: 1.17–3.41), in-service training (AOR = 1.88; 95% CI: 1.17–3.02), holding a middle leadership role (AOR = 2.24; 95% CI: 1.20–4.17), and perceived workload. Nurse-midwives who reported heavier workloads were 48% less likely to hold positive attitudes towards EENC (AOR = 0.52; 95% CI: 0.28–0.94), which subsequently affected their EENC practice. The mean score of implementation climate was moderately favorable (3.30 ± 0.77), with the lowest in the rewards domain (3.02 ± 1.11). A one-point increase in climate score was associated with significantly higher odds of a positive attitude (AOR = 4.56; 95% CI: 2.98–6.99). Implementation climate influenced EENC practice indirectly through attitudes (RMSEA = 0.039).
ConclusionsThis study highlights the importance of both individual factors and organizational climate in shaping EENC practices. To improve EENC implementation, healthcare systems should prioritize enhancing the implementation climate through leadership support, establishing appropriate reward systems, and addressing workload challenges. Additionally, integrating EENC training into continuous professional development programs and strengthening support for mid-level leadership are key strategies.
This study examines the effects of perceived managerial care from head nurses and individual resilience on nurse-to-nurse lateral violence among newly graduated registered nurses and determines whether individual resilience mediates the effect of perceived managerial care from head nurses and nurse-to-nurse lateral violence.
Previous studies have examined how managerial care contributes to lateral violence among nurses. However, few studies have examined how individual resilience contributes to reducing lateral violence among newly graduated registered nurses.
This cross-sectional survey study used a three-stage, stratified convenient sampling method, which involved 425 newly graduated registered nurses. Participants completed the Chinese version of the Management Caring Assessment Scale, the Connor–Davidson Resilience Scale, and the Nurse-to-Nurse Negative Behaviour Scale. Structural equation modelling and mediation effect analysis were used to explore the relationships among perceived managerial care from head nurses, individual resilience, and nurse-to-nurse lateral violence.
New nurses experienced moderate levels of lateral violence. The final model accounted for 76.4% of the total variance of lateral violence. Managerial care and individual resilience both had a direct effect on lateral violence. Individual resilience mediated the correlations between managerial care and lateral violence.
Newly registered nurses, especially from rural areas with low levels of education and an inability to perform night shifts independently, are a special group that requires higher attention from nursing management.
Head nurses' managerial care plays an important role in ensuring that new nurses adapt well to their new role and promoting the formation of psychological resilience among nurses. Nursing managers should increase the level of concern they display for new nurses, especially those from rural areas, those with low levels of education, and those who are unable to perform night shifts independently.
Patients contributed to data collection through completing questionnaire surveys.
To systematically review and integrate qualitative-research results pertaining to psychological distress in patients with breast cancer and to clarify its causes and drivers.
Patients with breast cancer experience psychological distress in the stages of diagnosis, treatment, and rehabilitation, which seriously affects their quality of life. Through comprehensive qualitative research, the study comprehensively describes the experiences of patients with breast cancer to guide medical personnel in taking better care of them.
A systematic review and synthesis of qualitative studies.
Qualitative studies were included if they were related to the psychological-distress experiences of patients with breast cancer. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise study quality. Data were synthesised using the Thomas and Harden method of thematic and content analysis.
Nine electronic databases (PubMed, Embase, Cochrane Library, CINAL [via EBSCO], and PsycINFO, China Knowledge Resource Integrated Database, Wanfang, Chinese Biomedical, and Weipu) were searched from inception until February 2024.
Thirteen studies were included in the meta-synthesis. Four analytical themes were identified: diagnostic and therapeutic, individual, environmental, and interpersonal factors.
Psychological distress is a subjective feeling influenced by interactions among individual, therapeutic, environmental, and interpersonal factors, and it is commonly encountered among patients with breast cancer. Therefore, to optimise the management of psychological distress, the characteristics and external environment of patients with breast cancer should be carefully considered when delivering routine nursing care.
Patients experience psychological distress at different stages of breast cancer; however, the causes of psychological distress at different stages differ. Medical staff should implement targeted psychological-distress intervention measures based on factors relevant to different stages.
The Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.
The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42023417364).
Evidences have demonstrated the effectiveness of early essential newborn care. However, the implementation of early essential newborn care is suboptimal. The aim is to identify and synthesise the barriers and facilitators impacting the implementation of early essential newborn care in low- and middle-income countries.
PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, CNKI, Wan Fang Data, SinoMed and Google Scholar.
Two authors independently screened, performed quality assessment using the Mixed Methods Appraisal Tool and extracted data. This review includes papers that reported the barriers and facilitators of implementing early essential newborn care in low- and middle-income countries from the view of healthcare providers. Barriers and facilitators were coded according to the consolidated framework for implementation research in a deductive way and then been inducted into five common themes. This review followed synthesis without meta-analysis reporting guideline.
A total of 28 studies were included. Five inductive common themes influencing implementing early essential newborn care in low- and middle-income countries were system-level healthcare factors, healthcare providers’ knowledge and beliefs, the requirements of mothers or families, adapting to routine practice and the working climate of organisation.
The factors were from system level, facility level and individual level and were inducted into five themes. Based on this review, decision-makers could tailor implementing strategies to narrow the gap between the evidence and implementation.
The study offers guidance for health professionals to identify barriers and facilitators in implementing early essential newborn care and make tailored strategies when implementing early essential newborn care.
No patient or public contributions.
To explore the actual experience of psychological distress of adult women of reproductive age at different stages after breast cancer diagnosis.
Qualitative.
Eighty-one patients with breast cancer-related distress thermometer scores >4 were selected using a purposive sampling method. Patients were divided into newly diagnosed and 1-, 3-, 6-, 9- and 12-month groups according to time since diagnosis and then interviewed. A phenomenological approach was adopted to analyse interview content, and different themes were extracted.
Women exhibited different levels of psychological distress depending on the time since diagnosis, with newly diagnosed patients showing the highest distress. Within 1 year post-diagnosis, different events caused patients distress. Themes extracted at new diagnosis and 1-, 3-, 6-, 9- and 12 months post-diagnosis included sadness and disbelief, loss of control, optimistic but concerned, physical and mental exhaustion, difficulties returning to society and limited sexual intimacy, respectively; all groups expressed reproductive concerns.
Clinical nurses should focus on different psychologically distressing events to provide targeted interventions at distinct phases. For women of childbearing age, clinical nurses should pay particular attention to patients' marriage and reproductive concerns.
During the year after a breast cancer diagnosis, patients of childbearing age experience events that cause psychological distress that differ depending on time since diagnosis. Nurses should focus on core stressful events and perform specific nursing interventions.
To provide holistic care, nurses should consider the psychological and emotional changes patients may undergo. For women of childbearing age, clinical nurses should pay particular attention to patients' marriage and fertility concerns, and be able to provide evidence-based professional guidance on reproductive preservation techniques.
The study was reported using the consolidated criteria for reporting qualitative research guidelines.
Patients contributed to data collection through interviews.
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