International Journal of Nursing Studies Advances最新文献

{"title":"Nurse staffing skill mix and acuity-adjusted provision ratios in Swedish neonatal care: A cohort benchmark study","authors":"Pernilla Dillner ,&nbsp;Katarina E. Göransson ,&nbsp;Mikael Norman ,&nbsp;Maria Unbeck ,&nbsp;Ulrika Förberg","doi":"10.1016/j.ijnsa.2025.100471","DOIUrl":"10.1016/j.ijnsa.2025.100471","url":null,"abstract":"<div><h3>Background</h3><div>The development of neonatal intensive care has substantially reduced infant mortality, still, infants remain at high risk for adverse outcomes. Safe care relies on adequate nurse staffing and an appropriate skill mix, which is especially important in neonatal intensive care as infants are extremely vulnerable to harm when quality lapses occur. Although international guidelines recommend optimal nurse-to-patient ratios for neonatal care, these standards have not been fully implemented, leaving it unclear whether current staffing levels align with recommendations for safe staffing.</div></div><div><h3>Objective</h3><div>To benchmark the acuity-adjusted registered nurse staffing provision ratio in neonatal intensive care and determine the skill mix distribution and variation of nursing staff across shifts.</div></div><div><h3>Method</h3><div>This retrospective cohort study included infant data from a 16-week period in 2022 in three neonatal intensive care units with a common administration at a university hospital. Data were obtained from the hospital’s data repository and the Swedish Neonatal Quality Register, including 609 neonatal admissions and 345 nursing staff members working 1008 shifts. Infants’ daily acuity levels were assessed using an adapted version of the British Association of Perinatal Medicine’s guideline, classifying infants into three levels: intensive care, high dependency care, and special care. Staffing provision was measured as the number of worked hours per shift, staff category, and unit. The registered nurse provision ratio was defined as the number of registered nurse hours provided divided by the recommended hours. A ratio below 1.0 indicates understaffing.</div></div><div><h3>Results</h3><div>The population’s total in-hospital days were 4674, and the mean birth weight was 2843 g (SD 1029), with 57.0 % being boys. The proportion of registered nurses relative to nursing assistants ranged from 22.2 % to 85.7 %, with a median of 46.5 %. Registered nurses with specialist education accounted for a median of 73.0 % of total registered nurse hours. Within each unit, the mean acuity-adjusted number of registered nurses recommended by the British Association of Perinatal Medicine’s standard was relatively consistent across shift types and between weekdays and weekends. However, the required number of registered nurses between individual shifts showed considerable variation, ranging from 2.5 to 10.3. During the inclusion period, 81.2 % of the shifts had a registered nurse provision ratio below 1.0, suggesting that most shifts did not meet the recommendations for staffing levels.</div></div><div><h3>Conclusions</h3><div>This study highlights a shortfall in registered nurse staffing relative to recommended levels. Ensuring adequate registered nurse staffing levels is crucial for maintaining high-quality neonatal care and improving infant outcomes.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"10 ","pages":"Article 100471"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colombian validation of the short-form coping and adaptation processing scale in caregivers","authors":"Carolina Gutiérrez-López ,&nbsp;Gustavo Ordoñez-Sierra ,&nbsp;Ricardo Borda Hernández ,&nbsp;Marcia Andrea Quiñonez-Mora","doi":"10.1016/j.ijnsa.2026.100497","DOIUrl":"10.1016/j.ijnsa.2026.100497","url":null,"abstract":"<div><h3>Background</h3><div>Illness induces stress in both patients and their families, prompting cognitive and behavioural responses that shape family coping mechanisms. The Coping and Adaptation Processing Scale–Short Form is an instrument used to assess such coping strategies, with validated versions in English, Korean, and Chinese, all demonstrating robust psychometric properties.</div></div><div><h3>Objective</h3><div>To evaluate the validity and reliability of the Spanish version of the Coping and Adaptation Processing Scale–Short Form in caregivers of post-COVID-19 patients.</div></div><div><h3>Design</h3><div>A psychometric, descriptive, and analytical cross-sectional study conducted in three phases.</div></div><div><h3>Setting</h3><div>A tertiary and quaternary care hospital.</div></div><div><h3>Participants</h3><div>Phase I involved 18 expert judges. Phase II included 100 caregivers of patients with COVID-19. Phase III comprised nine expert judges and 182 caregivers of post-COVID-19 patients.</div></div><div><h3>Methods</h3><div>Face and content validity were assessed by experts in middle-range theory and clinical care. A pilot application was subsequently conducted among caregivers. Initial confirmatory factor analysis revealed weak item clustering and resulted in the exclusion of five items. This prompted Phase III, which included a cognitive validity assessment through expert and caregiver input. Based on these findings, a second round of exploratory and confirmatory factor analyses was conducted, followed by internal consistency testing using Cronbach’s alpha and McDonald’s omega coefficients.</div></div><div><h3>Results</h3><div>Face and content validity were confirmed by expert consensus, with minor semantic adjustments to some items. The adjusted version was applied to 100 caregivers; the initial confirmatory factor analysis supported the removal of five items. In Phase III, the revised scale was re-evaluated by experts and applied to a new caregiver sample. The subsequent factor analysis demonstrated acceptable model fit indices, and all items were retained. Internal consistency was satisfactory, with an ordinal Cronbach’s alpha of 0.82 and McDonald’s omega of 0.89.</div></div><div><h3>Conclusion</h3><div>The Spanish version of the Coping and Adaptation Processing Scale–Short Form maintained its theoretical integrity, demonstrated cultural relevance, and exhibited acceptable psychometric properties, confirming its validity and reliability in hospital-based caregiver populations.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"10 ","pages":"Article 100497"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived cultural competence among nursing students: A cross-sectional study","authors":"Halperin Ofra,&nbsp;Eldar – Regev Orit","doi":"10.1016/j.ijnsa.2026.100489","DOIUrl":"10.1016/j.ijnsa.2026.100489","url":null,"abstract":"<div><h3>Introduction</h3><div>The cultural diversity of Israel's population presents significant challenges for nursing and healthcare professionals. Understanding the cultural impact on health is crucial for ensuring quality care and meeting diverse population needs.</div></div><div><h3>Objective</h3><div>To investigate the relationships among socio-demographic parameters, multicultural coursework, cross-cultural patient interactions, and cultural and self-awareness among nursing students.</div></div><div><h3>Method</h3><div>In this cross-sectional study we collected data from 900 nursing students across three Israeli colleges, using a questionnaire combining the Clinical Cultural Competency Questionnaire and a Demographic and Social Characteristics Questionnaire. We used descriptive statistics, parametric and non-parametric correlations, multivariate analysis of variance, and hierarchical multiple regression analyses.</div></div><div><h3>Results</h3><div>We revealed high levels of cultural awareness, self-awareness, and comfort among participants. However, practical skills scored lower, and multicultural knowledge demonstrated the lowest scores. We found no correlation between cultural awareness and exposure to patients from different cultures. Demographic factors exhibited significant associations with cultural competence components. Age positively correlated with self-awareness, comfort level, and skills, but not with cultural awareness. Third- and fourth-year participants displayed higher cultural competence compared to first- and second-year participants. Ethnic background emerged as a crucial factor in cultural competence development, while sex differences, though significant, showed minimal effect across all measures.</div></div><div><h3>Conclusions</h3><div>We have revealed the complex interrelation of factors associated with Israeli nursing students’ cultural competence, including ethnicity, sex, age, and educational exposure. Structured cultural competence training may be necessary within this country's nursing education programs, particularly in contexts of societal conflict.</div></div><div><h3>Practice Implications</h3><div>Cultural competence should be considered as a comprehensive component of mandatory nursing curricula in Israel to enhance students’ practical multicultural skills. Clinical experiences might emphasize multicultural therapeutic encounters, and nursing education could provide ongoing opportunities for cross-cultural interaction throughout academic training.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"10 ","pages":"Article 100489"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online interventions for dementia caregiver burden and self-efficacy: A systematic review and meta-analysis","authors":"Qiuxia Li ,&nbsp;Dou Zhang ,&nbsp;Éle Quinn ,&nbsp;Prof. Kieran Walsh ,&nbsp;Dr. Sinéad Hynes","doi":"10.1016/j.ijnsa.2026.100490","DOIUrl":"10.1016/j.ijnsa.2026.100490","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and Objectives&lt;/h3&gt;&lt;div&gt;There is growing interest in online psychosocial interventions to address burden and self-efficacy among informal caregivers of people with dementia. However, their effectiveness remains unclear, especially given ongoing debates and limited evidence of online delivery modes. We aimed to synthesize evidence on these online psychosocial interventions, highlight the current state of research, and identify priorities for future studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A systematic review with meta-analyses was conducted. We included randomized controlled trials comparing online psychosocial interventions to usual care or waitlist control for burden and self-efficacy. Six electronic databases were searched for studies published over the last two decades. Two reviewers evaluated eligibility, extracted data, and assessed risk of bias and quality of evidence. Patient and Public Involvement, as a means to contextualise the results in the lived experience of caregivers, was employed to aid interpretation of the findings. The review protocol was registered in PROSPERO (CRD42023392232)&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Nineteen articles involving 2,264 participants were included. Of these, 15 reported caregiver burden, seven reported self-efficacy, and three studies reported both outcomes. Most interventions were multi-component online psychosocial programs delivered via web-based platforms, mobile applications, or videoconferencing tools. They incorporated asynchronous, synchronous, or blended delivery modes and were delivered either individually or in groups. Core components of the psychosocial intervention included information provision and education, caregiving tasks support, and caregiver self-care. Meta-analysis of 13 studies showed no statistically-significant post-intervention effect on reducing burden (Standardized Mean Difference [SMD]: −0.06, 95 % Confidence Interval [CI]: −0.25, 0.12, &lt;em&gt;p&lt;/em&gt; =0.50; &lt;em&gt;I&lt;/em&gt;² = 47 %), yet analysis of three studies indicated an effect on improving self-efficacy (SMD: 0.20, 95 % CI: 0.03, 0.37, &lt;em&gt;p&lt;/em&gt; =0.02; &lt;em&gt;I&lt;/em&gt;² = 0 %). The evidence grade for both outcomes was low due to risk of bias, inconsistency, and imprecision of the results.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;We suggest that online psychosocial interventions have little to no short-term effect on caregiver burden but may enhance self-efficacy, though the evidence grade remains low. Online psychosocial interventions featured diversity in their design, content, and delivery characteristics. From the findings, we have identified key areas for development of future research within this field, with a particular focus on addressing methodological limitations and ensuring rigorous design. Sustained support incorporating interactive and real-time elements, tailored approaches, and the integration of lived experience throughout the research process should be considered to improve both the effect","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"10 ","pages":"Article 100490"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of objective structured clinical examination performance on nurse-led hip ultrasound imaging success: A prospective cohort study","authors":"Kyoko Yoshioka-Maeda ,&nbsp;Hiroshige Matsumoto ,&nbsp;Chikako Honda ,&nbsp;Takeshi Kinjo ,&nbsp;Kiyoshi Aoki ,&nbsp;Keita Okada ,&nbsp;Mana Shirouchi ,&nbsp;Misa Shiomi ,&nbsp;Noriko Hosoya ,&nbsp;Kenta Fujiwara ,&nbsp;Tadashi Hattori","doi":"10.1016/j.ijnsa.2025.100449","DOIUrl":"10.1016/j.ijnsa.2025.100449","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Conventional physical examinations sometimes fail to detect developmental hip dysplasia. Ultrasound hip screening, non-invasive and radiation-free, can identify these cases earlier, and nurse-led maternal, newborn, and infant home visits and childcare consultations at community health centers offer an ideal platform for community implementation. Knowing the relationship between Objective Structured Clinical Examination scores and nurses’ ability to capture diagnostic-quality hip images would inform training standards and credentialing, ensuring safe scale-up of nurse-led hip-screening services. However, this link remains unknown.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To examine the association between Objective Structured Clinical Examination performance and nurses’ success in capturing standard hip ultrasound images during &lt;em&gt;maternal and child health service&lt;/em&gt; consultations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Prospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Settings&lt;/h3&gt;&lt;div&gt;Three municipalities in Japan.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;The study included 21 nurses (18 public health nurses, 1 registered nurse, and 2 midwives).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Participants completed an e-learning course, knowledge tests, hands-on training seminars, and the Objective Structured Clinical Examination before undergoing ultrasound examinations during home visits. Two trained researchers assessed exam performance using a global rating scale (range: 1–6), total score (range: 0–360 points), image acquisition time, and successful capture of standard images of the right and left hips using phantoms—infant-shaped models for training ultrasound hip screening. Pediatric orthopedic surgeons evaluated the ultrasound images obtained during home visits between February 2024 and May 2025. Linear regression analysis examined the associations among participant demographics, examination performance, and imaging success rates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The mean examination global rating score was 4.48 (standard deviation = 0.66), and the mean total score was 330.8 (standard deviation = 22.0). During home visits, 611 ultrasound examinations were conducted, of which 494 (80.9%) were successful. The success rate did not vary substantially based on the cumulative number of examinations performed by each nurse. Lower age (&lt;em&gt;B&lt;/em&gt; = -5.2, &lt;em&gt;p&lt;/em&gt; = 0.030) and successfully capturing a standard plane of the left hip during the examination were associated with significantly higher imaging success rates in maternal and child health service consultations (84.7% vs. 71.4%, &lt;em&gt;p&lt;/em&gt; = 0.039). A shorter image acquisition time (&lt;em&gt;B&lt;/em&gt; = -0.1, &lt;em&gt;p&lt;/em&gt; = 0.009) was also significantly associated with higher success rates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Successful capture of left-hip image and faster performance during the Objective Structured Clinical Examination independently predicted nurses’ field ima","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"10 ","pages":"Article 100449"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145691861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key factors associated with nurse retention and how they work: A mixed-methods study","authors":"Neeltje de Vries ,&nbsp;Peter de Winter ,&nbsp;Sanne Drost-Goossens ,&nbsp;Hester Vermeulen ,&nbsp;Catharina van Oostveen","doi":"10.1016/j.ijnsa.2026.100480","DOIUrl":"10.1016/j.ijnsa.2026.100480","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The global nursing shortage poses a critical challenge to healthcare systems. The World Health Organization projects a shortage of 4.5 million nurses by 2030. Contributing factors include an aging workforce and an increasing rate of nurse turnover, driven by high workloads, limited development opportunities, and a lack of managerial support. Intentions to leave predict actual departure and threaten the quality of care, increase patient mortality, and impose high replacement costs. While retention strategies exist, many are not tailored to nurses because nurses’ subjective experiences and perspectives are lacking, potentially limiting their effectiveness. Engaging nurses in designing these interventions may enhance their relevance and impact.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;(i) Identify the key factors associated with nurses’ retention in hospitals, and (ii) provide an in-depth understanding of why nurses perceive these factors as critical in shaping their retention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;A mixed-methods approach, utilizing Q-methodology and semi-structured interviews, was employed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Dutch hospitals.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;A diverse group of 26 practicing and three former nurses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Participants ranked 58 statements in response to the prompt: “&lt;em&gt;I am willing to continue working as a nurse within the organization if…&lt;/em&gt;” Consecutively, individual interviews were conducted to provide further insight into the reasoning behind nurses’ choices. Quantitative data were analyzed using centroid factor analysis with varimax rotation to identify shared viewpoints. Qualitative interview data were analyzed using the rigorous and accelerated data reduction method to deepen the understanding of the factors shaping nurses’ retention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 29 Q-sorts and interviews were analyzed. This resulted in three factors: (A) ‘Challenging work and inclusive positioning for high-quality care’, (B) ’Room to excel in nursing roles’, and (C) ‘Being seen, heard, and valued’. Together, these perceptions shaped participants’ intention to stay. Additionally, a common pattern across all factors was participants’ perception of being structurally unheard.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;A multifaceted interplay of factors influenced nurse retention. While meaningful and challenging tasks were essential, professional recognition, support systems, and growth opportunities were equally important. A systemic approach that addresses these various dimensions may be crucial for enhancing retention rates, maintaining a high-quality of patient care, and ultimately mitigating the impact of the nursing shortage in healthcare organizations. Nurses may play a crucial role in designing and implementing retention strategies. Their input is not just valuable but most likely necessary for the relevance and eff","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"10 ","pages":"Article 100480"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing clinical decision-making skills among nurses in Malaysia: A three-level general linear mixed-effects analysis","authors":"Nur Hidayah Zainal ,&nbsp;Nur Syahmina Rasudin ,&nbsp;Kamarul Imran Musa","doi":"10.1016/j.ijnsa.2026.100493","DOIUrl":"10.1016/j.ijnsa.2026.100493","url":null,"abstract":"<div><h3>Background</h3><div>Clinical decision-making skills are fundamental to safe and effective nursing practice. While prior studies have identified individual-level factors, they have often overlooked the hierarchical structure of nursing practice.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the complex determinants of clinical decision-making skills among Malaysian nurses at the individual, hospital-department, and regional levels using multilevel analysis.</div></div><div><h3>Design</h3><div>A quantitative, cross-sectional study.</div></div><div><h3>Settings</h3><div>Hospital departments across six diverse regions in Malaysia.</div></div><div><h3>Participants</h3><div>A total of 796 registered nurses (response rate = 99.5%) from 40 hospital departments participated in the final analysis.</div></div><div><h3>Methods</h3><div>A three-level mixed-effects regression model was used to analyse the nested data collected from a target sample of 800 nurses.</div></div><div><h3>Results</h3><div>The sample was predominantly female (96%), with an average of 12.8 years of clinical experience. At the individual level, clinical decision-making scores were significantly predicted by higher critical thinking scores (<em>b</em> = 0.788, 95% CI [0.700, 0.876], <em>p</em> &lt; 0.001), more years of experience (<em>b</em> = 0.073, 95% CI [0.027, 0.119], <em>p</em> &lt; 0.01), and holding post-basic qualifications (<em>b</em> = 0.710, 95% CI [0.109, 1.311], <em>p</em> &lt; 0.05). A significant interaction revealed that the positive effect of critical thinking was attenuated for nurses with post-basic qualifications. At the hospital-department level, nurses in teaching (<em>b</em> = 4.259, 95% CI [2.42, 6.10], <em>p</em> &lt; 0.001), private (<em>b</em> = 2.418, 95% CI [0.543, 4.293], <em>p</em> &lt; 0.05), and general hospitals (<em>b</em> = 1.648, 95% CI [0.848, 2.448], <em>p</em> &lt; 0.001) had significantly higher scores than those in district hospitals. Importantly, at the regional level, the random effects model indicated that the strength of the association between critical thinking and clinical decision-making varied significantly across different regions.</div></div><div><h3>Conclusion</h3><div>Clinical decision-making skills are shaped by a complex interplay of individual attributes and contextual factors. This research provides a foundation for developing targeted, multifaceted strategies in nursing education and policy to enhance professional competency and improve patient outcomes.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"10 ","pages":"Article 100493"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative motivation as a pathway from evidence-based nursing competence and nurse-physician collaboration to knowledge sharing behavior among surgical nurses : A structural equation modeling study based on the COM-B model","authors":"Yanan Leng ,&nbsp;Meixian Li ,&nbsp;Xiaodi Zhang ,&nbsp;Haiwei Fu ,&nbsp;Ying Wu ,&nbsp;Zonghua Wang","doi":"10.1016/j.ijnsa.2025.100464","DOIUrl":"10.1016/j.ijnsa.2025.100464","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;With the development of evidence-based medicine, a large amount of high-quality evidence is constantly generated, but surgical nurses are still weak in terms of the knowledge sharing behavior. Organizational and individual factors will determine how surgical nurses share knowledge. However, few cross-sectional studies had based on the Capabilities, Opportunities, Motivations, Behavior (COM-B) model to explore the influence paths of individual internal and external factors on the knowledge sharing behavior of surgical nurses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This paper aims to evaluate (1) the current status and factors influencing on knowledge sharing behavior and (2) the pathways to knowledge sharing behavior of surgical nurses based on COM-B model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Cross-sectional study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting(s)&lt;/h3&gt;&lt;div&gt;174 public hospitals in 31 provinces and municipalities of China.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A cross-sectional study was conducted in the surgery department in China from May to June 2023. Convenience sampling and questionnaires were used to facilitate sampling and data collection. A total of 1388 surgical nurses were included in the study. The data was processed using univariate analysis and correlation analysis, the central hypotheses were tested using a structural equation model (SEM).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the participants, the knowledge sharing behavior score was 54.98 ± 13.33, and compared with the average score, it was at a moderately low level. There was a positive correlation between the level of knowledge sharing behavior and each variable (&lt;em&gt;p&lt;/em&gt; &lt; 0.001). The knowledge sharing behavior was significantly positively correlated with evidence-based nursing competence (&lt;em&gt;r&lt;/em&gt; = 0.399), creative self-efficacy (&lt;em&gt;r&lt;/em&gt; = 0.496), nurse-physician collaboration (&lt;em&gt;r&lt;/em&gt; = 0.288). Both evidence-based nursing competence and nurse-physician collaboration can have a direct effect on knowledge sharing behavior. The results confirmed that creative self-efficacy partially mediates the relationships between evidence-based nursing competence and knowledge sharing behavior (&lt;em&gt;β&lt;/em&gt; = 0.038, 95 % confidence interval [0.029, 0.049]). Meanwhile, creative self-efficacy also plays a partial mediating role between the nurse-physician collaboration and knowledge sharing behavior (&lt;em&gt;β&lt;/em&gt; = 0.083, 95 % confidence interval [0.065, 0.104]).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;According to the COM-B model, the multiple effective paths of evidence-based nursing competence, innovative motivation, and organizational collaboration for knowledge sharing behavior were verified. Surgical nurses have extensive experience in the care of perioperative patients and critically ill patients. If they can actively share knowledge by themselves or with the support of the team, it is crucial for improving the quality of care and ensuring patient saf","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"10 ","pages":"Article 100464"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A health literacy intervention for registered nurses: Development and feasibility testing","authors":"Malene Nerbøvik Stavdal ,&nbsp;Marie Hamilton Larsen ,&nbsp;Ingeborg Strømseng Sjetne ,&nbsp;Astrid Klopstad Wahl ,&nbsp;Caryl L. Gay ,&nbsp;Monica Bukkøy Kjetland ,&nbsp;Anners Lerdal ,&nbsp;Christine Råheim Borge","doi":"10.1016/j.ijnsa.2026.100503","DOIUrl":"10.1016/j.ijnsa.2026.100503","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Health literacy is essential for improving long-term health outcomes, enhancing quality of care, and ensuring patient safety in healthcare systems. Thus, supporting registered nurses in applying health literacy in practice is essential. While health literacy research is expanding, limited attention has been paid to how healthcare personnel develop health literacy sensitivity (i.e., knowledge, skills, and attitudes healthcare personnel require to effectively meet patients’ health literacy needs).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;(1) Develop and assess the feasibility of a health literacy intervention for registered nurses working in a general hospital setting. (2) Explore potential changes in health literacy sensitivity, work-related factors, and mental well-being for registered nurses, following the intervention. (3) Evaluate registered nurses’ experiences with implementing the intervention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Pre-post feasibility study employing qualitative and quantitative approaches.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;div&gt;Medical ward, general hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;&lt;em&gt;N&lt;/em&gt;=32 registered nurses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;An advisory panel, Magnet4Europe’s gap-analysis tool, and prior research were used to design the intervention. Health literacy sensitivity was measured using the Instrument of Health Literacy Competencies. Work-related factors and mental well-being were measured using four validated surveys. Quantitative data were analyzed using descriptive, non-parametric statistics. Registered nurses’ experiences with implementing the intervention were assessed through individual and group interviews and analyzed using thematic analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The final intervention included a dedicated health literacy nurse trained to motivate and guide colleagues in improving patients’ health literacy. During a 6-month intervention period, registered nurses participated in internal health literacy education, project groups, morning briefings, and reflection groups. The intervention targeted all registered nurses (&lt;em&gt;N&lt;/em&gt; = 32) working on a medical ward (i.e., cardiovascular, stroke, and geriatric conditions). The pre-post study showed statistically-significant improvements in 7 of the 9 domains measuring registered nurses’ health literacy sensitivity (pre &lt;em&gt;n&lt;/em&gt; = 29, post &lt;em&gt;n&lt;/em&gt; = 20). Additionally, teamwork scores between registered nurses and physicians showed a statistically-significant improvement. Qualitative (&lt;em&gt;n&lt;/em&gt; = 9) analyses of registered nurses’ experiences of the intervention revealed three main themes: (1) “Strengthening health literacy through increased resources, embedded routines, and interdisciplinary collaboration,” (2) “Between support and strain: health literacy sensitivity as a professional challenge,” and (3) “Registered nurses’ increased awareness and understanding of health literacy sensitivity","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"10 ","pages":"Article 100503"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From data to practice: an improvement pathway for trauma teams based on the T-NOTECHS scale and the PEARLS feedback framework: A pre–post interventional study","authors":"Jing Cheng ,&nbsp;Yuwei Wang ,&nbsp;Zuojia Wu ,&nbsp;Shuaishuai Zhou ,&nbsp;Yu Jia ,&nbsp;Danping Yan ,&nbsp;Sa Wang ,&nbsp;Fan Luo","doi":"10.1016/j.ijnsa.2025.100443","DOIUrl":"10.1016/j.ijnsa.2025.100443","url":null,"abstract":"<div><h3>Background</h3><div>The efficiency of trauma resuscitation teams depends not only on the precise execution of technical skills but also on the proficiency in non-technical skills, such as communication, decision-making, leadership, and situational awareness. The integrated development of both skill sets is essential for optimizing trauma care delivery and ensuring patient safety. This study investigates a training model that integrates the Trauma Non-Technical Skills (T-NOTECHS) scale with the Promoting Excellence and Reflective Learning in Simulation (PEARLS) feedback framework, aimed at enhancing both technical and non-technical competencies among trauma team members.</div></div><div><h3>Objective</h3><div>To evaluate the dual impact of a combined T-NOTECHS and PEARLS-based training model on enhancing the technical and non-technical competencies of trauma care teams and to examine its influence on patient-centered, time-sensitive treatment metrics.</div></div><div><h3>Methods</h3><div>A pre–post interventional study design was adopted. Trauma team members underwent training utilizing the T-NOTECHS assessment tool and the PEARLS debriefing framework. Effectiveness was assessed by comparing technical and non-technical performance metrics before and after the intervention, and by evaluating time-sensitive clinical metrics.</div></div><div><h3>Results</h3><div>Post-training assessments revealed statistically significant improvements across both technical and non-technical domains (<em>p</em>&lt; 0.05). Notable gains were observed in communication, decision-making, situational awareness, and leadership, complementing enhanced procedural execution. These improvements were associated with substantial reductions in time-sensitive clinical indicators related to trauma care delivery.</div></div><div><h3>Conclusion</h3><div>The integration of the T-NOTECHS scale and PEARLS feedback framework represents an effective training model for concurrently advancing both technical and non-technical competencies in trauma teams. This model not only fosters interprofessional collaboration and procedural precision but also enhances both the efficiency and safety of trauma patient care. Given its demonstrable benefits, this model demonstrates considerable potential for broader implementation in high-acuity emergency and critical care settings.</div><div>Not registered.</div></div>","PeriodicalId":34476,"journal":{"name":"International Journal of Nursing Studies Advances","volume":"10 ","pages":"Article 100443"},"PeriodicalIF":3.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}