BACKGROUND & AIMS: AIMS:The aim of the present study was to compare the levels of stress, depression, and intention to leave among clinical nurses employed in different medical units in relation to their demographic characteristics under the National Health Insurance (NHI) System in Taiwan. METHODS:Cross-sectional Spearman's correlation, one-way ANOVA with Scheffe post hoc analysis tests, and multiple regression analyses were conducted. Several self-report questionnaires, such as the Center for Epidemiological Studies Depression Scale, the Perceived Stress Scale and Intention to Leave Scale, were administered. A total of 314 research participants were surveyed, all of whom came from regional hospitals in Northern Taiwan. RESULTS:Marital status and working tenure were significant predictors to the levels of stress, depression, and intention to leave among nurses before taking the medical units into consideration. However, with adding medical units as predictors, the effect of marital status and working tenure were insignificant except for the stress model, indicating medical units were showing dominant effect over other variables. In particular, internal medical ward (IMW) nurses experienced a higher prevalence of depression than emergency room (ER) nurses and professional nursing practitioners. External medical ward (EMW) nurses also experienced greater depression than emergency room (ER) nurses. Both IMW and EMW nurses perceived significantly greater stress than ER and dialysis center. Moreover, IMW nurses also perceived greater stress than operating room (OR) nurses and showed stronger intention to leave than their counterparts in the outpatient service departments. CONCLUSIONS:The results indicated that significant differences existed among various medical units with regards to nurses' stress, depression, and intention to leave. Nurses working in internal and external medical wards, especially the inexperienced and married ones, experienced greater depression and stress, thereby developing stronger intention to leave their job.

背景与目标：

BACKGROUND & AIMS: AIM:This article is a report of a study of occupational burnout among nurses in China. BACKGROUND:Burnout is described as feelings of emotional exhaustion, depersonalization and reduced personal accomplishment. It is well-known that burnout is a major problem for many professions. Nurses are considered to be particularly susceptible to this. Measuring burnout among nurses is important because their well-being has implications for stability in the healthcare workforce and for the quality of care provided. METHOD:The sample consisted of 495 nurses from three provincial hospitals in China. The Maslach Burnout Inventory -- General Survey (MBI-GS) was used to measure burnout, and the Occupational Stress Inventory -- Revised edition was used to measure two dimensions of occupational adjustment (occupational stress and coping resources). After statistical testing for validity and reliability of the MBI-GS with nurses in China, participants' scores were evaluated and analysed. RESULTS:Scores for burnout of surgical and medical nurses were statistically significantly higher than those of other nurses (P < 0.05). Lower educational status was associated with lower professional efficacy, and younger nurses reported higher levels of burnout. The most significant predictors of emotional exhaustion were role overload, responsibility, role insufficiency and self-care (P < 0.05). The most significant predictors of cynicism were role insufficiency, role boundary, responsibility and self-care (P < 0.05). The most significant predictors of professional efficacy were role insufficiency, social support and rational/cognitive coping (P < 0.05). CONCLUSION:It is important to reduce occupational stress in nurses and to strengthen their coping resources to prevent burnout. This could be achieved with job redesign, modification of shiftwork systems, and by offering occupational health education.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Nurse educators need an enhanced understanding of factors contributing to nursing student success to decrease attrition and increase retention. Improved understanding of factors related to successful nurse preparation could improve educational processes and facilitate student success, thereby addressing the worldwide nursing shortage as well as increasing the competence and expertise of new graduates. Student-faculty trust and related characteristics have been identified as factors associated with student success (Applebaum, 1995). Research investigating trust in communications and education has been conducted with students in other disciplines but not with nursing students. This research investigated the complex relationships between students' trust in faculty, the students' mood states, and students' educational performance and outcomes. METHOD:The study utilized a quantitative, cross-sectional, descriptive, and correlational design. Student volunteers were recruited from a baccalaureate nursing education program located in the southwest United States. Participants completed three instruments: the Health Sciences Reasoning Test (HSRT), Profile of Mood States (POMS), and Interpersonal Trust Scale (ITS). The resulting scores were compared and contrasted along with selected demographic variables. RESULTS:The study identified a significant relationship between total mood disturbance and interpersonal trust. The trends in the POMS subscales of Anger and Confusion are of particular interest, as the two factors strongly influenced shifts in Total Mood Disturbance. As students progressed through the nursing program, experiences of Anger and Confusion increased with each progressive semester and were accompanied by corresponding decreases in trust. CONCLUSIONS:The results complement established findings relating mood and cognitive function. Alterations in the student's level of trust potentially could share relationships with cognition and critical thinking, although perhaps not in a direct and linear fashion.

背景与目标：

BACKGROUND & AIMS: Objective:this study explores the process of the development of an intention to leave bedside nursing. Method:the process was studied from the perspective of 21 nurses using the grounded theory method. Data were collected using semi-structured interviews and the constant comparative method of Corbin and Strauss was used for data analysis. Results:according to the participants, the two main categories, "social image of nursing", and "culture and structure of the bedside", were the contextual factors that influence why nurses are leaving bedside care provision. Disappointment with a perceived lack of progress or improvement in the clinical experience formed primary psychosocial concerns for the participants. Competence and a process of self-control were steps taken by the participants. These, associated with interventional conditions produced the outcomes of the loss of professional commitment and desire to leave bedside nursing. "Failure to integrate personal expectations with organizational expectations: in search of escape" was the central category of the study that linked the categories together. Conclusion:the findings of this study provide useful information about the needs of nurses for overcoming the intention to leave bedside care. The identification of this process can help in recognizing emerging problems and providing solutions for them. Objetivo:este estudo explora o processo de desenvolvimento da intenção de deixar a enfermagem de cabeceira. Método:o processo foi estudado desde a perspectiva de 21 enfermeiras utilizando o método da Grounded Theory (Teoria Fundamentada). Os dados foram coletados utilizando entrevistas semi-estruturadas e o método comparativo constante de Corbin e Strauss se utilizou para analisar os dados. Resultados:segundo os participantes, duas categorias principais, "imagem social da enfermagem" e "cultura e estrutura de cabeceira", foram os fatores contextuais que influenciam as razões para que as enfermeiras estejam deixando o cuidado de cabeceira. A decepção com a percepção de falta de progresso ou melhora na experiência clínica cria preocupações psicossociais primárias para as participantes. A competência e o processo de autocontrole são passos dados pelas participantes. Isso associado a condições de intervenção foram os resultados da perda do compromisso profissional que as leva a deixar o cuidado de cabeceira. "O fracasso em integrar expectativas pessoais e expectativas da organização: em busca de uma saída" foi a categoria central do estudo que uniu as categorias. Conclusão:os achados deste estudo proporcionam informação útil sobre as necessidades das enfermeiras para superar as intenções de deixar o cuidado de cabeceira. A identificação deste processo pode ajudar a reconhecer os problemas emergentes e oferecer soluções para resolvê-los. Objetivo:este estudio explora el proceso de desarrollo de la intención de dejar la enfermería de cuidado de cabecera. Método:el proceso fue estudiado desde la perspectiva de 21 enfermeras utilizando el método de la Grounded Theory (Teoría Fundamentada). Los datos se recogieron utilizando entrevistas semiestructuradas; para analizar los datos se utilizó el método comparativo constante de Corbin y Strauss. Resultados:según los participantes dos categorías principales ("imagen social de la enfermería" y "cultura y estructura del cuidado de cabecera ") fueron los factores contextuales que influenciaron las razones para que las enfermeras deseasen dejar el cuidado de cabecera. La decepción con una percepción de falta de progreso o mejora en la experiencia clínica causó preocupaciones psicosociales primarias en las participantes. La competencia y el proceso de autocontrol fueron considerados por las participantes, y esto asociado a las condiciones de intervención resultaron en la pérdida del compromiso profesional que las lleva a dejar el cuidado de cabecera. La categoría central del estudio que unió las categorías encontradas fue: "Fracaso para integrar las expectativas personales con expectativas de la organización: en busca de una salida". Conclusión:los hallazgos de este estudio proporcionan información útil sobre las necesidades de las enfermeras para superar las intenciones de abandonar el cuidado de cabecera. La identificación de este proceso puede ayudar a reconocer los problemas emergentes y ofrecer soluciones para resolverlos.

背景与目标：

BACKGROUND & AIMS: :The end of the twentieth century and the beginning of the twenty-first century are marked by technology revolution and strategic changes in organizations. Strategies such as the e-learning, has been used for training human resources. This study aimed to compare the knowledge acquired among groups of nurses who used e-learning and those who undergone a traditional classroom training. The true-experimental design was used followed by a quantitative analysis. This study was performed at the Hospital and Maternity São Luiz. The study population was composed by 60 nurses, randomly assigned to two groups, named A and B. Group A received the traditional classroom training and group B received the computer-assisted training. In the data collection, participants filled in a questionnaire before and after the training to evaluate their knowledge and to characterize the population. Results showed there was an equal acquisition of knowledge in both groups; confirming the efficacy of both methods.

背景与目标： : 20世纪末和二十一世纪初的特点是技术革命和组织的战略变革。电子学习等战略已用于培训人力资源。这项研究旨在比较使用电子学习的护士组和接受传统课堂培训的护士组之间获得的知识。使用真实实验设计，然后进行定量分析。这项研究是在圣路易斯医院和产妇进行的。研究人群由60名护士组成，随机分为A和B两组。A组接受传统课堂培训，B组接受计算机辅助培训。在数据收集中，参与者在培训前后填写了调查表，以评估他们的知识并确定人口特征。结果表明，两组的知识获得均等; 证实了两种方法的有效性。

BACKGROUND & AIMS: :While the nephrology nursing shortage persists despite the continued growth of the population of individuals with Stage 5 chronic kidney disease, there is a paucity of empirical data regarding nephrology nurses' perceptions of their work environments. Moreover, there are no studies that have examined the relationship of work environment attributes to patient and nurse outcomes in dialysis settings. The purpose of this study was to examine the relationships between staff nurses' perceptions of dialysis work environments, nurses' intentions to leave their current jobs, nurse turnover, patient satisfaction, and patient hospitalization rates. A descriptive, correlational design was used. Nurse level and facility level data were obtained. The sample for nurse-level data consisted of 199 registered nurses in staff nurse roles in 56 dialysis facilities of a national dialysis company. The sample for facility-level analysis consisted of 46 dialysis facilities, and nurse-level data were aggregated for facility-level analysis. The Practice Environment Scale-Nursing Work Index (PES-NWI) was used to measure nurses' perceptions of the dialysis work environment. Nurses' intention to leave their jobs and facility-level turnover rates were the nurse outcomes examined in this study. Facility-level patient satisfaction and hospitalization rates were the patient outcomes examined. Correlation coefficients were computed to measure the relationships between study variables, and independent t-tests were performed to examine subgroup differences in work environment perceptions. Overall, nurses rated the work environment somewhat favorably. Nurses who expressed intention to leave their jobs rated the work environment more negatively compared to nurses who intended to stay. Significant correlations were found between nurses' perceptions of the dialysis work environment, nurses' intention to leave their jobs, nurse turnover rates, and patient hospitalizations. Study findings suggest that nurses' perceptions of the dialysis work environment are important for nurse and patient outcomes in dialysis settings. Further research is needed to explore the predictive ability of the work environment for nurse and patient outcomes in hemodialysis units.

背景与目标： : 尽管患有5期慢性肾脏病的人群持续增长，但肾脏病护理短缺仍然存在，但有关肾脏病护士对其工作环境的看法的经验数据很少。此外，没有研究检查透析环境中工作环境属性与患者和护士结果之间的关系。这项研究的目的是研究护士对透析工作环境的看法，护士离职的意图，护士更替，患者满意度和患者住院率之间的关系。采用描述性、相关设计。获得护士级别和设施级别数据。护士级数据的样本由一家国家透析公司的56个透析设施中的199名担任护士角色的注册护士组成。用于设施级别分析的样本由46个透析设施组成，并汇总了护士级别的数据以进行设施级别分析。实践环境量表-护理工作指数 (pes-nwi) 用于衡量护士对透析工作环境的看法。护士离职的意图和机构级别的更替率是本研究中检查的护士结果。设施级别的患者满意度和住院率是检查的患者结局。计算相关系数以衡量研究变量之间的关系，并进行独立的t检验以检查工作环境感知的亚组差异。总体而言，护士对工作环境的评价有些不错。与打算留下的护士相比，表示打算离职的护士对工作环境的评价更为负面。在护士对透析工作环境的看法，护士离职的意愿，护士更替率和患者住院之间发现了显着的相关性。研究结果表明，护士对透析工作环境的看法对于透析环境中的护士和患者结果很重要。需要进一步的研究来探索血液透析单元中工作环境对护士和患者结果的预测能力。

BACKGROUND & AIMS: OBJECTIVES:To test an educational intervention designed to improve lactation knowledge, attitudes, and beliefs of NICU nurses and to improve their intentions to provide mothers with lactation support. DESIGN:Quasi-experimental, time-series pretest/posttest. SETTING:NICU of a Midwestern, free-standing, tertiary-care children's hospital. PARTICIPANTS:Convenience sample of 64 NICU nurses and 2 separate convenience samples of mothers of infants hospitalized in the NICU (n=19 and 13, respectively). METHODS:Nurses were measured on study outcomes at multiple time points, beginning with 2 weeks before and ending at 3 months after attendance to a 4-hour educational program. Mothers were sampled before and 3 months after the intervention. MAIN OUTCOME MEASURE(S):Nurses' lactation knowledge, attitudes, beliefs, and intentions to support lactation and mothers' perceptions of lactation support in the NICU. RESULTS:Findings suggest that this educational intervention was effective for improving NICU nurses' lactation knowledge and attitudes, and that these improvements were maintained over time. Further, the supportive atmosphere for lactation in this NICU significantly improved following the implementation of the educational intervention for nurses. CONCLUSION:Intermittent, short educational programs which include practical how-to's and motivational encouragement for staff may provide the empowerment nurses need in order to be supportive of lactation.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Screening, brief intervention, and referral to treatment (SBIRT) for substance use has an impact on morbidity and mortality and health care cost. LOCAL PROBLEM:Nurses in ambulatory care settings may lack knowledge about evidence-based substance use SBIRT. METHODS:A comparison of pre- and postintervention data was performed to determine whether knowledge improved and to identify facilitators and barriers to SBIRT implementation. INTERVENTIONS:Nurses completed an online self-paced program focusing on alcohol and drug use screening, motivational interviewing used in a brief intervention, and referral to specialty treatment. RESULTS:Postintervention knowledge scores increased (P < .001). Facilitator and barrier themes included time, education, resources, receptivity, and interprofessional collaboration. CONCLUSIONS:The implementation of the SBIRT online program was feasible for nurses to complete during work hours and resulted in increased SBIRT-related knowledge.

背景与目标：

BACKGROUND & AIMS: :Health care systems are changing at an unprecedented rate, but few are making the changes in a system affecting nearly 200,000 staff in over 1,100 different sites of service delivery originating from 171 medical centers nationwide, as is the Veterans Health Administration. The issues of change, quality of care, morale and opportunities involved in being a nurse today in a system undergoing this magnitude of change is presented within the framework of the quality of care initiatives that have been launched by VA. The new organization design of VA, emphasizing local decision-making, a description of the multiple quality programs recently introduced and integrative strategies that have been used by the Nursing Strategic Healthcare Group, the VA corporate level policy and nursing programs information center for the country, to support the change process are discussed.

背景与目标： : 医疗保健系统正在以前所未有的速度变化，但很少有人在影响来自全国171医疗中心的1,100多个不同服务提供地点的近200,000名员工的系统中做出变化，退伍军人健康管理局也是如此。在VA发起的护理质量计划的框架内，介绍了当今在经历如此巨大变化的系统中担任护士所涉及的变化，护理质量，士气和机会等问题。VA的新组织设计，强调本地决策，对最近引入的多种质量计划的描述以及护理战略医疗小组，VA企业级政策和护理计划信息中心使用的整合策略。国家，讨论了支持变更过程的内容。

BACKGROUND & AIMS: BACKGROUND:It is important to clarify nurses' perceptions of conditions for patient education in daily work as research findings are ambiguous. There is a gap between societal regulations on nurses' competence in accomplishment/achievement of patient education and research findings. AIM:The aim was to describe nurses' perceptions of conditions for patient education, focusing on aspects of competence. The aim was also to describe differences in conditions for nurses working in primary, municipal and hospital care. METHODS:The study is a cross-sectional survey and is part of a project about nurses' patient-education. A randomized selection of nurses (842) received a questionnaire comprising 47 items concerning factual experience and attitudes to patient education and 13 background items. Questionnaires were returned by 83% of participants. Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. RESULTS:Nurses' perceptions of conditions for patient education differ between health-care settings. Primary care nurses are at an advantage in following research in patient education, perception of their own competence (prioritizing and knowing their mandate in patient teaching), pedagogical education and post graduate specializations. CONCLUSIONS:Nurses' patient education must be more visualized and appropriate conditions created at each workplace. In this change process, managers' support is considered vital.

背景与目标：

BACKGROUND & AIMS: :Oncology nurses encounter increasingly complex ethical challenges in clinical practice. This ethnographic study explored 30 oncology nurses' descriptions of ethical situations and 12 key informants' perspectives on factors that influence the development of ethically difficult situations. Nurses described the goals of preventing patient suffering and injury, being honest with patients, and contributing meaningfully to patient improvement and stated goals. Nurses experienced six primary challenges in meeting their goals: being the eyes and arms of patient suffering, experiencing the precariousness of competing obligations, navigating the intricacies of hope and honesty, managing the urgency caused by waiting, straining to find time, and weighing risks of speaking up in hierarchal structures. Nurse actions included addressing concerns, creating other avenues, murmuring to one another, staying silent, and looking away. Several factors influenced nurses' responses to ethical challenges. Results imply a contextual model of moral action that reveals a need for altering practice environments in addition to improving nurses' ethics skills. Nurses are very aware of their moral responsibilities in ethically difficult situations and need work environments conducive to interprofessional collaboration and open dialogue.

背景与目标： : 肿瘤护士在临床实践中遇到越来越复杂的伦理挑战。这项人种学研究探索了30位肿瘤学护士对道德状况的描述，以及12位关键信息提供者对影响道德困难状况发展的因素的看法。护士描述了预防患者痛苦和伤害，对患者诚实以及为患者改善和既定目标做出有意义贡献的目标。护士在实现目标方面经历了六个主要挑战: 成为患者痛苦的眼睛和手臂，经历竞争义务的不稳定，驾驭希望和诚实的复杂性，管理等待引起的紧迫性，努力寻找时间以及权衡在层次结构中说话的风险。护士的行动包括解决问题，创造其他途径，互相抱怨，保持沉默和移开视线。几个因素影响了护士对道德挑战的反应。结果暗示了道德行为的上下文模型，该模型揭示了除了提高护士的道德技能外，还需要改变实践环境。护士非常清楚自己在道德上困难的情况下的道德责任，需要有利于专业间合作和公开对话的工作环境。

BACKGROUND & AIMS: :As nurses move into more nontraditional, expanded roles, they sometimes lack a social and professional support group within the work setting. Feeling isolated and lacking support, several clinical nurse specialists (CNSs) at a large county institution began the Specialty Nursing Council. The Specialty Nursing Council provides a means of networking and support for nurses in specialty roles in a three institution health care campus. Monthly meetings are conducted to bring members together and for continuing education programs. The keys to success in forming this type of council are: 1) a dedicated group that plans, organizes, and distributes informational material; 2) common goals and objectives; 3) direct benefits to members.

背景与目标： : 随着护士进入更非传统、更广泛的角色，他们有时在工作环境中缺乏社会和专业支持小组。感到孤立和缺乏支持，一家大型县级机构的几名临床护士专家 (CNSs) 成立了专业护理委员会。专业护理委员会为在三个机构的医疗保健校园中担任专业角色的护士提供了一种联网和支持的方式。每月举行一次会议，将成员聚集在一起，并进行继续教育计划。成功组建此类理事会的关键是: 1) 计划，组织和分发信息材料的专门小组; 2) 共同的目标和目的; 3) 对成员的直接利益。

BACKGROUND & AIMS: :Little is known about the current training and barriers in resuscitation skills among practicing ward nurses. A convenience sample of 459 ward nurses, recruited from 11 academic teaching hospitals in Korea, were surveyed to assess current training and barriers to optimal resuscitation performance on the wards. The Perceived Barriers scale was developed, refined, and its psychometric properties were assessed. Approximately 36% of nurses had received simulation-based resuscitation skills training. Exploratory factor analysis identified four barriers accounting for 58.4% of the variance: insufficient training (37.7%), lack of competence (9.8%), lack of self-confidence (5.9%), and workload and tension (5.1%). Strategic planning and resuscitation skills training should be incorporated into staff development programs to reduce barriers to optimal resuscitation performance and cope with work demands for ward nurses.

背景与目标： : 对目前的培训和实习病房护士复苏技能的障碍知之甚少。调查了从韩国11家学术教学医院招募的459名病房护士的便利样本，以评估当前的培训和病房最佳复苏绩效的障碍。开发，完善了感知障碍量表，并评估了其心理测量特性。大约36% 的护士接受了基于模拟的复苏技能培训。探索性因素分析确定了造成58.4% 差异的四个障碍: 培训不足 (37.7%)，缺乏能力 (9.8%)，缺乏自信 (5.9%) 以及工作量和紧张 (5.1%)。战略规划和复苏技能培训应纳入员工发展计划，以减少最佳复苏绩效的障碍，并应对病房护士的工作需求。

BACKGROUND & AIMS: :The purpose of this study was to determine school nurses' knowledge of state and school district policies, their experience regarding the administration of rectal diazepam gel in the school, and the perceived benefits and barriers of providing this treatment. Four hundred nineteen nurses responded to a survey conducted during the National Association of School Nurses Annual Meeting. Seventy-one (18%) nurses surveyed had administered rectal diazepam gel in a school setting, while 54 (13%) nurses reported that either their state practice act or school district prohibited them from giving rectal medications in the school. Medication administration benefits, such as early intervention for treatment of acute seizure emergencies, were noted. Barriers were also identified, with lack of privacy as the most frequently listed. Scope of practice as it pertains to administering medication in the school and the extent to which delegation of duties can be used in the situation of administering rectal medication in a seizure emergency remain issues for school nurses.

背景与目标： : 这项研究的目的是确定学校护士对州和学区政策的了解，他们在学校中使用直肠地西epa凝胶的经验以及提供这种治疗的益处和障碍。四百一十九名护士对全国学校护士协会年会期间进行的一项调查做出了回应。接受调查的71名 (18% 名) 护士在学校环境中使用了直肠地西epa凝胶，而54名 (13% 名) 护士报告说，他们的《国家执业法》或学区禁止他们在学校中使用直肠药物。注意到药物管理的益处，例如早期干预治疗急性癫痫发作紧急情况。还发现了障碍，最常列出的是缺乏隐私。与在学校中管理药物有关的实践范围以及在癫痫发作紧急情况下管理直肠药物的情况下可以使用的职责授权的程度仍然是学校护士的问题。

BACKGROUND & AIMS: :Results from several research studies combined with increasing public tensions surrounding physician-assisted suicide have fueled a growing awareness of the inadequacies of end-of-life care. Investigators also suggest that intensive care unit nurses have a limited role in end-of-life decision making and care planning. This article explores cultural issues influencing end-of-life care in intensive care units, explores factors surrounding the limited involvement of critical care nurses in end-of-life decision making and care planning, and offers recommendations for changing nursing practice. Because improving end-of-life care will require cultural changes, an understanding of the cultural issues involved is needed. Recommendations for changing nursing practice include a model of end-of-life care that incorporates the goals of both cure and comfort care, as well as a shared decision-making process. Nurses are essential to improving end-of-life care in today's intensive care units.

背景与目标： : 几项研究的结果，加上围绕医生协助自杀的公众日益紧张，促使人们越来越意识到临终关怀的不足。研究人员还建议，重症监护病房的护士在临终决策和护理计划中的作用有限。本文探讨了影响重症监护病房临终护理的文化问题，探讨了重症监护护士有限参与临终决策和护理计划的因素，并为改变护理实践提供了建议。由于改善临终关怀将需要进行文化变革，因此需要了解所涉及的文化问题。改变护理实践的建议包括临终护理模式，该模式结合了治愈和舒适护理的目标，以及共同的决策过程。在当今的重症监护病房中，护士对于改善临终护理至关重要。