OBJECTIVE: To explore registered nurses\' beliefs regarding pain assessment in people living with dementia.
METHODS: A descriptive exploratory qualitative study informed by the Theory of Planned Behaviour.
METHODS: Online semi-structured in-depth interviews were conducted from January to April 2023 with a purposive sample of 15 registered nurses caring for people with dementia. Following transcription, data were analysed using direct content analysis.
RESULTS: Registered nurses believe pain assessment improves the well-being of people with dementia and informs and evaluates practice. However, there is a possibility of misdiagnosing pain as agitation or behavioural problems, leading to inaccurate pain management. Interpersonal factors, such as registered nurses\' knowledge and experience, beliefs and motivation to improve care provision, were the primary facilitators of pain assessment. Physical and behavioural dimensions of the pain of the dementia syndrome were the most reported barriers to pain assessment. Registered nurses reported that multidisciplinary team members expect them to do pain assessments. Most did not experience disapproval when performing pain assessments.
CONCLUSIONS: Registered nurses hold beliefs about pain assessment benefits, consequences, enablers, barriers, approvals and disapprovals regarding dementia. The findings could inform interventions to enhance pain assessment practices.
UNASSIGNED: Policymakers should provide education opportunities for registered nurses to improve their knowledge, skills and beliefs about pain assessment in dementia. Future research should develop and implement multidisciplinary, multifaceted pain assessment protocols to enhance the accuracy of pain assessment practices.
CONCLUSIONS: Pain is underassessed in dementia, and this could stem from registered nurses\' beliefs about pain assessment in dementia. The findings could inform interventions to enhance pain assessment beliefs and practices.
UNASSIGNED: This study adhered to the COREQ criteria.
UNASSIGNED: Registered nurses caring for people living with dementia participated as interview respondents.

BACKGROUND: The province of Nova Scotia has the highest rates of perinatal mental health disorders in Canada, and rates of exclusive breastfeeding fall below the Canadian national average. Exclusive breastfeeding is identified as a protective factor against the development of perinatal mental health disorders. Lactation consultant support is associated with increased rates of exclusive breastfeeding and decreased rates of perinatal mental health disorders. Despite this, little is known regarding the experiences of Registered Nurse Lactation Consultants related to supporting maternal mental health.
OBJECTIVE: To understand the experiences of Registered Nurse Lactation Consultants related to supporting maternal mental health.
METHODS: A qualitative descriptive design using online semi-structured interviews.
METHODS: Ten Registered Nurse Lactation Consultants employed in the publicly funded healthcare system in Nova Scotia, Canada, were recruited via purposive sampling.
RESULTS: Three themes emerged regarding the relational experiences of Registered Nurse Lactation Consultants while supporting maternal mental health; these included (1) Experiences supporting maternal mental health, (2) Providing maternal mental health care, and (3) Mothers need support.
CONCLUSIONS: Registered Nurse Lactation Consultants described positive experiences supporting maternal mental health and indicated that lactation consultant appointments were an opportune time to provide screening and support for maternal mental health. Enhancing support for maternal mental health requires collaborative and integrated approaches throughout the perinatal period. Healthcare providers, including Registered Nurse Lactation Consultants, must be provided with the support and resources to provide timely and appropriate support for maternal mental health throughout the perinatal period.

UNASSIGNED: To investigate whether the location and the number of nurse consultations have changed in response to the continuously decreasing number of GP consultations in the fourth-largest city in Finland. It has been suggested that nurse consultations are replacing GP consultations.
UNASSIGNED: A retrospective register-based follow-up cohort study.
UNASSIGNED: Public primary health care in the City of Vantaa, Finland.
UNASSIGNED: All documented face-to-face office-hour consultations with practical and registered nurses, and consultations with practical and registered nurse in the emergency department of Vantaa primary health care between 1 January 2009 and 31 December, 2014.
UNASSIGNED: Change in the number of consultations with practical and registered nurses between 2009 and 2014 in primary health care both during office-hours and in the emergency department.
UNASSIGNED: Over the follow-up period, the monthly median number of practical nurse consultations in the emergency department per 1000 inhabitants increased from 1.6 (interquartile range [IQR] 1.3-1.7) to 10.5 (10.3-12.2) (p < 0.001) and registered nurse consultations from a median of 3.6 (3.0-4.0) to 14.5 (13.0-16.6) (p < 0.001). However, there was no significant change in the median monthly number of office-hour consultations with practical or registered nurses.
UNASSIGNED: It appears that in primary health care, medical consultations have shifted from GPs to nurses with lower education levels, and from care during office-hours to emergency care.
The number of general practitioner (GP) consultations are decreasing. Tasks are being transferred from GPs to nurses to improve access to care.The number of office-hour consultations with nurses did not change, despite the decrease in GP consultations.In the emergency department, the number of nurse consultations increased significantly when GP consultations decreased.Medical consultations seem to have shifted to the emergency department and the nurses.

BACKGROUND: Having more registered nurses (RNs) leave their workplace, with a shortage of RNs in healthcare as a consequence, might pose a risk to patient safety. According to the Job Demands Resource model, social support is a resource that can enhance work motivation, and if RNs are motivated at work, their willingness to remain in the workplace may increase.
OBJECTIVE: The aims were to explore (1) differences in RNs\' experiences of social support from their immediate manager and co-workers between different healthcare settings, (2) associations between RNs\' experiences of social support and aspects of work motivation, and (3) if these associations differed in strength between healthcare settings.
METHODS: A cross-sectional study design.
METHODS: A stratified population of Swedish RNs, n = 2290, working in either hospitals, primary care, or home healthcare, responded to a survey in 2022. Chi-squared tests and linear and logistic regression analyses were used to analyze the data. Interaction was measured by adding an interaction term to the fully adjusted regression models. The findings\' generalizability was strengthened by including calibrating weights in all analyses.
RESULTS: RNs in primary care reported higher social support from their immediate manager than RNs in hospitals and home healthcare. RNs in home healthcare reported lower social support from co-workers than RNs in hospitals and primary care. There were statistically significant associations between higher levels of social support from the immediate manager and co-workers, respectively, and higher ratings in all aspects of work motivation: work engagement (manager: beta coefficient [b] = 0.08, confidence interval [CI] 95% = 0.05; 0.10; co-workers: b = 0.12, CI 95% = 0.08; 0.16), job satisfaction (manager: b = 0.24, CI 95% = 0.21; 0.27; co-workers: b = 0.22, CI 95% = 0.16; 0.28), opportunities to provide high-quality care (manager: b = 0.15, CI 95% = 0.11; 0.18; co-workers: b = 0.19, CI 95% = 0.13; 0.24), satisfaction with the employer (manager: b = 0.46, CI 95% = 0.42; 0.50; co-workers: not statistically significant) and intention to remain at the workplace (manager: odds ratio = 1.89, CI 95% = 1.69; 2.13; co-workers: odds ratio = 1.42, CI 95% = 1.17; 1.72). The associations differed in strength between hospitals, primary care, and home healthcare.
CONCLUSIONS: Strengthening social support from the immediate manager and co-workers appears to be a way to increase RNs\' work motivation, including their intention to remain at the workplace. This may be important, particularly in primary care and home healthcare.
CONCLUSIONS: To strengthen RNs\' work motivation and willingness to stay in the workplace, it appears important for healthcare organizations to provide RN social support.

BACKGROUND: Up to 50% of antibiotic prescriptions for upper respiratory infections (URIs) are inappropriate. Clinical decision support (CDS) systems to mitigate unnecessary antibiotic prescriptions have been implemented into electronic health records, but their use by providers has been limited.
OBJECTIVE: As a delegation protocol, we adapted a validated electronic health record-integrated clinical prediction rule (iCPR) CDS-based intervention for registered nurses (RNs), consisting of triage to identify patients with low-acuity URI followed by CDS-guided RN visits. It was implemented in February 2022 as a randomized controlled stepped-wedge trial in 43 primary and urgent care practices within 4 academic health systems in New York, Wisconsin, and Utah. While issues were pragmatically addressed as they arose, a systematic assessment of the barriers to implementation is needed to better understand and address these barriers.
METHODS: We performed a retrospective case study, collecting quantitative and qualitative data regarding clinical workflows and triage-template use from expert interviews, study surveys, routine check-ins with practice personnel, and chart reviews over the first year of implementation of the iCPR intervention. Guided by the updated CFIR (Consolidated Framework for Implementation Research), we characterized the initial barriers to implementing a URI iCPR intervention for RNs in ambulatory care. CFIR constructs were coded as missing, neutral, weak, or strong implementation factors.
RESULTS: Barriers were identified within all implementation domains. The strongest barriers were found in the outer setting, with those factors trickling down to impact the inner setting. Local conditions driven by COVID-19 served as one of the strongest barriers, impacting attitudes among practice staff and ultimately contributing to a work infrastructure characterized by staff changes, RN shortages and turnover, and competing responsibilities. Policies and laws regarding scope of practice of RNs varied by state and institutional application of those laws, with some allowing more clinical autonomy for RNs. This necessitated different study procedures at each study site to meet practice requirements, increasing innovation complexity. Similarly, institutional policies led to varying levels of compatibility with existing triage, rooming, and documentation workflows. These workflow conflicts were compounded by limited available resources, as well as an implementation climate of optional participation, few participation incentives, and thus low relative priority compared to other clinical duties.
CONCLUSIONS: Both between and within health care systems, significant variability existed in workflows for patient intake and triage. Even in a relatively straightforward clinical workflow, workflow and cultural differences appreciably impacted intervention adoption. Takeaways from this study can be applied to other RN delegation protocol implementations of new and innovative CDS tools within existing workflows to support integration and improve uptake. When implementing a system-wide clinical care intervention, considerations must be made for variability in culture and workflows at the state, health system, practice, and individual levels.
BACKGROUND: ClinicalTrials.gov NCT04255303; https://clinicaltrials.gov/ct2/show/NCT04255303.

Background: High-quality clinical placement experiences are important for preparing undergraduate student nurses for practice. Clinical facilitation and support significantly impact student placement experiences and their development of skills, knowledge, and attitudes in the healthcare setting.Aim: This research aimed to explore university-employed clinical facilitators\' perspectives on providing quality clinical facilitation and student learning on placement.Design: An exploratory, descriptive research design was used to examine the perspectives of n = 10 university-employed clinical facilitators working in regional New South Wales, Australia (March 2020-December 2021).Methods: Semi-structured interviews were used to explore the experiences of a purposeful sample of university-employed clinical facilitators. Data was thematically analysed using Miles et al.\'s (2014) qualitative data analysis framework.Results: Five key themes were identified 1) relationships at the core of quality, 2) a culture of commitment to student learning, 3) connection to the curriculum, 4) examining the model, and 5) empowering growth and development. Clinical facilitators perceive their role as misunderstood, undervalued, and isolating and that they require further preparation and ongoing professional development to provide quality facilitation. Building rapport and relationships with staff and students was at the core of quality clinical facilitation.Conclusions: The clinical facilitator role has an important function in preparing student nurses for practice and needs further recognition and continued professional development. Education providers and healthcare organisations need to examine strategies to provide inclusive and supportive work environments, building communities of practice for clinical facilitators and stakeholders to share their experiences and knowledge, promoting individual and group learning, thus improving the student placement experience and fostering the professional identity of clinical facilitators.

OBJECTIVE: This study aimed to investigate the effect of scenario-based simulation training on infection control, specifically in terms of knowledge, self-efficacy and adherence to standard precautions.
BACKGROUND: Hospital-associated infections can pose a threat to patient safety and are a critical public health issue that requires attention.
METHODS: This quasi-experimental study employed a pre-test/post-test design using a nonequivalent control group.
METHODS: Infection control nurses were randomly assigned to two groups using lottery methods. The experimental group received scenario-based simulation training, whereas both the experimental and control groups received conventional education. Data were collected from 27 August to 1 December 1 2022. The chi-square test and t-test were used for data analysis.
RESULTS: The mean scores for knowledge of infection prevention and control (t = 3.679, p < 0.001) and self-efficacy (t = 2.444, p = 0.018) were significantly higher in the experimental group than in the control group. Furthermore, the mean score for adherence to standard precautions was significantly higher in the experimental group than in the control group (t = 2.030, p = 0.048).
CONCLUSIONS: Our results suggest that scenario-based simulation training for infection control might be effective in improving knowledge, self-efficacy and adherence to standard precautions. Scenario-based simulation training for infection control may be an effective educational intervention to enhance knowledge, self-efficacy and adherence to standard precautions, thus empowering nurses in infection prevention and control.

OBJECTIVE: To identify and examine the explanatory variables associated with clinical competence among registered nurses (RNs) and practical nurses (PNs) working in long-term care facilities (LTCF) for older adults.
METHODS: This was a cross-sectional study. The competence test, \'the Ms. Olsen test\', was used for data collection. A convenience sample of 337 nursing staff working in LTCFs for older adults was selected between December 2020 and January 2021. A quantitative, non-experimental approach with multiple linear regression analysis examined the explanatory variables associated with clinical competence and the outcome variables.
RESULTS: The main findings of the linear regression analysis show that the nursing staff\'s increasing age, use of Swedish as a working language and use of the Finnish nursing practice standards had statistically significant relationships with clinical competence among the participating nursing staff.
CONCLUSIONS: This is the first knowledge test that has been developed to test nursing staff\'s clinical competence in elderly care. In this study in Finland, the highest clinical competence was among the nursing staff who were Swedish-speaking RNs working in institutional care homes caring for patients according to national practice standards.
CONCLUSIONS: These results may be useful to nursing staff and managers working in elderly care to understand the explanatory variables associated with clinical competence in elderly care in Finland and in bilingual settings. The study highlights the importance of using national nursing standards in elderly nursing care. Knowing the explanatory variables associated with clinical competence can provide guidance for the further education of nursing staff in these settings.
CONCLUSIONS: Caring according to national practice standards and caring for severely ill patients are associated with clinical competence.
UNASSIGNED: The authors adhered to the EQUATOR network guidelines Appendix S1 STROBE to report observational cross-sectional studies.
UNASSIGNED: Registered and PNs completed a questionnaire for the data collection.

OBJECTIVE: To explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland.
BACKGROUND: Clinical decision-making in an emergency department environment is a complex process often occurring in times of crisis. It is an important aspect contributing to the quality of care. However, empirical research is limited regarding the decision-making process in different nursing roles.
METHODS: In accordance with the consolidated criteria for reporting qualitative research, a qualitative and observational study was conducted to explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Six Registered Nurses, six Nurse Specialists and six Nurse Practitioners were observed. A total of 40 hours of observation was made at each setting according to a structured observation guideline, followed by clarifying questions. The data material was analysed by means of a qualitative manifest and latent content analysis.
RESULTS: Three themes arose: acting in accordance with routines, previous experience and intuition; considering patient experience; and facilitating new alternatives based on critical thinking. The Registered Nurses mainly used the first approach, the Nurse Specialists used the first and the second approaches, and the Nurse Practitioners used all three approaches.
CONCLUSIONS: The results highlight the differences in decision-making processes between these groups. Nurse Practitioners were the only group that facilitated and evaluated new alternatives using their clinical autonomy, such as stepping up and making independent and collaborative decision-making.
CONCLUSIONS: The results can be used in countries developing advanced practice nursing education and defining their scope of practice to inform stakeholders.

BACKGROUND: Nurses are leaving their profession because of poor personal job satisfaction, heavy workload, and unfavorable work environments with low professional autonomy. Professional autonomy involves the possibility to influence one\'s work and have a sense of control - the ability to contribute to a workplace culture and influence how decisions are made. This study explores registered nurses\' perceptions of the nursing practice environment, using the Nursing Work Index-Revised (NWI-R), and its relationships with professional autonomy and job satisfaction.
METHODS: A cross-sectional study along with instrument re-validation was conducted using a web-based survey for nurses in two Magnet-aspiring hospitals in Finland in September 2021 (n = 586). Structural equation modeling was used to find out the relationships of the NWI-R components with professional autonomy and job satisfaction.
RESULTS: Principal component analysis and confirmatory factor analysis supported seven components with 34 items. Collegial nurse-doctor relationships, organization\'s quality standards, and nursing involvement and expertise sharing (means of 3.23, 2.96, and 2.66, respectively) demonstrated a favorable nursing practice environment; professional nursing standards, nurse management and leadership, staffing and resource adequacy, and professional advancement (means of 2.38, 2.18, 2.15, and 2.13, respectively) demonstrated an unfavorable nursing practice environment. The presented model (RMSEA 0.068, CFI 0.987, TLI 0.946) indicated that nursing involvement and expertise sharing, organization\'s quality standards, nurse management and leadership, and collegial nurse-doctor relationships were related to professional autonomy. Nurse management and leadership, staffing and resource adequacy, and organization\'s quality standards were related to job satisfaction. Moreover, professional autonomy was related to job satisfaction.
CONCLUSIONS: Nurses\' professional autonomy is important due to its relationship with job satisfaction. When factors that increase professional autonomy are taken into account and attention is paid to the promotion of autonomy, it is possible to improve nurses\' job satisfaction. These issues cannot be solved at the unit level; investment is needed at the organizational and political levels. The results introduce nurses, managers, researchers, and stakeholders to improvements in the nursing practice environment toward an organizational culture where nurses may utilize their professional autonomy to its full potential.