J Nurs Manag [JOURNAL]
Sun
200 papers
The Effect of Decision Fatigue on Job Stress in Midwives: The Mediating Role of Psychological Capital and the Moderating Effect of Perceived Organizational Support.
Lu X, Zhang Y, Ren Z … +4 more , Chen X, Bai D, Gao J, Hou C
J Nurs Manag · 2026 · PMID 42210732 · Full text
BACKGROUND: Midwives face escalating decision fatigue (DF) and job stress. If left unaddressed, these issues may impair their mental health and clinical performance, compromise maternal and neonatal safety, and exacerbat...
BACKGROUND: Midwives face escalating decision fatigue (DF) and job stress. If left unaddressed, these issues may impair their mental health and clinical performance, compromise maternal and neonatal safety, and exacerbate workforce shortages, making it urgent to explore the underlying influencing mechanisms. This study explored the status of job stress among midwives, analyzed the correlations between DF, psychological capital (PsyCap), perceived organizational support (POS), and job stress and further examined the mediating role of PsyCap as well as the moderating role of POS on the relationship between DF and job stress. METHODS: A multicenter cross-sectional survey was conducted among midwives from 146 Baby-Friendly Hospitals in Sichuan, China, between October 2024 and September 2025. Using multistage stratified cluster sampling, 1263 midwives completed questionnaires on DF, PsyCap, POS, and job stress. SPSS 26.0 was applied for descriptive statistics, one-way ANOVA, and Pearson correlation analysis, while Mplus 8.3 was used to conduct mediation and moderation analyses. RESULTS: The total scores (mean ± SD) of job stress, DF, PsyCap, and POS among midwives were 90.45 ± 19.57, 20.58 ± 5.92, 88.83 ± 14.08, and 43.71 ± 9.98, respectively. One-way ANOVA showed significant differences in job stress scores across age, ethnicity, hospital ownership, hospital level, employment type, work experience, and monthly night shifts (all p < 0.05). Pearson correlation analysis revealed that job stress was positively correlated with DF (r = 0.648, p < 0.01) and negatively correlated with PsyCap (r = -0.673, p < 0.01) as well as POS (r = -0.342, p < 0.01). PsyCap partially mediated the relationship between DF and job stress (indirect effect = 0.258, 95% CI [0.223, 0.300]). Moreover, POS negatively moderated the path between PsyCap and job stress (γ = -0.165, p < 0.001), indicating a significant moderated mediation effect. CONCLUSION: DF directly increases job stress among midwives and also exerts an indirect effect through PsyCap, with this mediation being moderated by POS. Targeted interventions to reduce DF, enhance PsyCap, and strengthen POS may alleviate job stress and improve midwives' well-being. IMPLICATION FOR NURSING MANAGEMENT: Nursing managers should formulate targeted measures to reduce midwives' DF, improve their PsyCap, and strengthen organizational support. Such comprehensive strategies may effectively relieve job stress, promote occupational well-being, and stabilize the midwifery workforce in Baby-Friendly Hospitals.
Correction to "Shared Decision-Making Behavior in Surgery Among Early Breast Cancer Patients and Associated Factors Using COM-B Model: A Latent Profile Analysis".
J Nurs Manag · 2026 · PMID 42210727 · Full text
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The Mediation Effect of Nurses' Artificial Intelligence Literacy Between Professional Self-Concept and Evidence-Based Practice: A Cross-Sectional Study.
Li S, Wu L, Tang Y
J Nurs Manag · 2026 · PMID 42210646 · Full text
BACKGROUND: AI technology has had a significant revolutionary impact on the fields of healthcare and education. For the nursing staff population, the lack of artificial intelligence (AI) literacy may not only weaken the...
BACKGROUND: AI technology has had a significant revolutionary impact on the fields of healthcare and education. For the nursing staff population, the lack of artificial intelligence (AI) literacy may not only weaken the construction of their professional self-concept but also constrain the development of evidence-based practice. However, empirical research on the intrinsic correlation mechanism between these three factors is still relatively scarce at present. AIM: The purpose of this study was to explore the mediating role of AI literacy in the relationship between nurses' professional self-concept and evidence-based practice. METHODS: A cross-sectional study was conducted from October 15 to November 1, 2025, using convenience sampling to select 497 nurses from four tertiary public hospitals in Chongqing. The data collection tools include participant demographic characteristics, AI Literacy Scale (AILS), Nurse Self-Concept Questionnaire (NSCQ), and Evidence-Based Practice Questionnaire (EBPQ). The statistical software R (version 4.5.2) was adopted for data analysis, which included data feature description, correlation verification, and structural equation modeling. RESULTS: The overall demographic characteristics of the respondents were characterized by high educational levels, a mix of middle-aged and young people, and extensive work experience. The average scores for professional self-concept, AI literacy, and evidence-based practice were 232.29 ± 42.57, 63.34 ± 10.14, and 143.05 ± 22.45, respectively. It was found that a positive relationship exists between nurse AI literacy and professional self-concept (r = 0.89, p < 0.001), as well as between nurse professional self-concept and evidence-based practice (r = 0.94, p < 0.001). A significant positive correlation has also been found between AI literacy and evidence-based practice (r = 0.92, p < 0.001). AI literacy played a partial mediating role between nurse professional self-concept and evidence-based practice, with a mediation effect value of 0.587 (95% CI: 0.569-0.606), which explained 38.5% of the total effect. CONCLUSION: The study confirmed that there was a positive relationship between nurse professional self-concept and evidence-based practice, and AI literacy played a partial mediating effect in this relationship chain. It can be seen that AI literacy plays an indispensable and critical role in promoting the shape of nurse professional self-concept and enhancing their evidence-based practice ability. IMPLICATIONS FOR NURSING MANAGEMENT: Improving the AI literacy of nurses and conducting precise training are fundamental tasks in promoting the effective empowerment of clinical nursing scenarios with AI technology. To this end, it is necessary to integrate knowledge and skills related to AI into the nursing education system and simultaneously promote the lifelong professional development of nurses to effectively enhance their ability to use AI technology to optimize medical services. At the same time, healthcare institutions and nursing managers should focus on building supportive practice environments, advocating for standardized clinical applications of AI technology, and always adhering to the nursing core values guided by patient needs. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2600118905.
Political Astuteness in Nurse Leadership: A Concept Analysis.
Muswede NJ, Matahela VE
J Nurs Manag · 2026 · PMID 42210645 · Full text
AIM: To conduct a concept analysis of political astuteness in nurse leadership, clarifying its attributes, antecedents and consequences. DESIGN: Concept analysis. DATA SOURCES: Literature published between 1990 and Febru...
AIM: To conduct a concept analysis of political astuteness in nurse leadership, clarifying its attributes, antecedents and consequences. DESIGN: Concept analysis. DATA SOURCES: Literature published between 1990 and February 2025 was searched in EBSCOhost, Emerald, ProQuest, Sabinet, SAGE and ScienceDirect. METHODS: Walker and Avant's (2019) eight-step concept analysis framework was used to identify defining attributes, antecedents, consequences and empirical referents. Model and contrary cases were constructed to illustrate the presence and absence of the concept. RESULTS: Analysis of 24 included sources identified defining attributes of political astuteness in nurse leadership, including strategic awareness, policy acumen, advocacy, stakeholder engagement and ethical reasoning. Antecedents included policy knowledge, emotional intelligence, governance exposure and experience of political environments. Reported consequences in the literature included stronger strategic and ethical decision-making, greater capacity for stakeholder alignment and increased potential to engage in policy and organisational influence. CONCLUSION: This concept analysis suggests that political astuteness is a relevant leadership capability in nurse leadership, particularly in contexts requiring policy engagement, stakeholder alignment and navigation of complex organisational environments. Clarifying the concept may support more coherent scholarship, leadership development and future empirical work in this area. IMPLICATIONS FOR THE PROFESSION: This study contributes conceptual clarity to political astuteness in nurse leadership and offers a basis for considering how political capability may be addressed in leadership development and nursing education. The findings may also inform future work on how nurse leaders are prepared for policy engagement, organisational influence and system-level leadership. REPORTING METHOD: A PRISMA 2020 flow diagram was used to report the literature identification and selection process within this concept analysis. PATIENT OR PUBLIC INVOLVEMENT: This study was a concept analysis; therefore, no patient or public involvement in its design, conduct or reporting was required.
Correction to "Perceptions of nursing workloads and contributing factors, and their impact on implicit care rationing: A Queensland, Australia study".
J Nurs Manag · 2026 · PMID 42206550 · Full text
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Workload Pressure Among Nurses in Central Europe: Implications for Human Resource Management in Poland, the Czech Republic, and Slovakia.
Tomaszewska K, Majchrowicz B, Kadučáková H … +4 more , Krátká A, Durejova E, Kalita K, Kowalczuk K
J Nurs Manag · 2026 · PMID 42204445 · Full text
INTRODUCTION: Nurses constitute the largest professional group in the healthcare system. Their work, which requires constant contact with patients, families, and medical staff, involves the risk of excessive psychologica...
INTRODUCTION: Nurses constitute the largest professional group in the healthcare system. Their work, which requires constant contact with patients, families, and medical staff, involves the risk of excessive psychological and physical strain. Understanding the mechanisms of work overload is crucial both for patient safety and for the professional well-being of staff. AIM: The aim of this study was to examine whether excessive workload is present among professionally active nurses in Poland, Slovakia, and the Czech Republic. MATERIAL AND METHODS: The study was conducted among three groups of nurses employed in hospitals in Poland, Slovakia, and the Czech Republic. The survey was carried out from September 2024 to the end of March 2025. The study sample included 260 Polish nurses, 236 Slovak nurses, and 258 Czech nurses. The research tool consisted of a proprietary questionnaire covering sociodemographic data, as well as the standardized KONOP Work Overload Symptom Questionnaire. The chi-square test for independence was used for statistical analysis. To assess the strength of associations, Phi and Cramér's V coefficients were applied. The Mann-Whitney U test was used for nonparametric comparison of differences. Correlations between ordinal or quantitative variables were analyzed using Spearman's rho coefficient. RESULTS: Nurses from Poland obtained the highest scores for loss of control over work, perfectionistic work style, and perceived organizational oppressiveness. The highest scores for general attitudes toward work were recorded among Slovak nurses. Statistically significant differences between the groups were found across all scales of the KONOP questionnaire. IMPLICATIONS FOR NURSING MANAGEMENT: The country of professional practice differentiates the level of excessive workload among nurses. The greater intensity of selected dimensions of workaholism among Polish nurses may indicate a higher organizational burden and stronger occupational pressure. The findings suggest the need to implement preventive measures aimed at reducing work overload and improving the organizational conditions of nurses' work environments.
From Stress to Safety: The Chain Mediating Role of Cognitive Reappraisal and Work Engagement in the Influence of Nurses' Work Stress on Safety Behavior.
Zhang K, Chen C, Zha N … +5 more , Xu H, Wu C, Zhang J, Wang Y, Lang H
J Nurs Manag · 2026 · PMID 42204420 · Full text
BACKGROUND: Nurses face multiple work stress in clinical practice, and the relationship between work stress and safety behavior has attracted much attention. However, no research has explored the chain-mediating role of...
BACKGROUND: Nurses face multiple work stress in clinical practice, and the relationship between work stress and safety behavior has attracted much attention. However, no research has explored the chain-mediating role of cognitive reappraisal and work engagement in this relationship. AIM: This study aimed to examine the roles of work stress on safety behavior in nurses, along with the mediating effects of cognitive reappraisal and work engagement. METHODS: A cross-sectional study was conducted among 677 nurses in Shaanxi Province, China, from September to October 2025. The Chinese Nurses Stressor Scale, the Emotion Regulation Questionnaire, the Work Engagement Scale, and the Nurse Safety Behavior Questionnaire were used. IBM SPSS Statistics 26.0 and IBM SPSS AMOS 29.0 were used to analyze data and construct a structural equation model. The research complied with the STROBE checklist. RESULTS: Nurses' scores were as follows: work stress (86.09 ± 18.44), cognitive reappraisal (27.75 ± 6.59), work engagement (46.89 ± 13.10), and safety behavior (53.41 ± 6.42). Work stress had a significant negative effect on safety behavior (r = -0.200, p < 0.001). Cognitive reappraisal and work engagement separately mediated the link between safety behavior and work stress, accounting for 25.12% and 13.95% of the total effect. Furthermore, cognitive reappraisal and work engagement served as chain mediators between work stress and safety behavior, accounting for 7.91% of the total effect. CONCLUSION: Work stress among nurses can affect their safety behavior through the mediating role of cognitive reappraisal and work engagement. Future efforts should focus on alleviating nurses' work stress and cultivating their cognitive reappraisal strategies to enhance work engagement, which may help improve and strengthen nurses' safety behaviors. IMPLICATIONS: Nurses need to be fully empowered to ensure patient safety. Hospital managers should prioritize optimizing workload distribution and providing psychological support to reduce nurses' work stress. Additionally, integrating cognitive reappraisal training into routine nursing education may enhance nurses' active stress management and engagement.
Evidence-Based Nursing Competence, Attitudes, and Associated Factors Among Nurse Leaders in Finland: A Cross-Sectional Study.
Ylimäki S, Qvick J, Tuomikoski AM … +4 more , Parisod H, Siltanen H, Kanste O, Kääriäinen M
J Nurs Manag · 2026 · PMID 42198938 · Full text
AIM: To describe evidence-based nursing (EBN) competence, attitudes, and associated factors among a sample of Finnish nurse leaders. DESIGN: This study was carried out as a descriptive cross-sectional study. METHODS: Dat...
AIM: To describe evidence-based nursing (EBN) competence, attitudes, and associated factors among a sample of Finnish nurse leaders. DESIGN: This study was carried out as a descriptive cross-sectional study. METHODS: Data were collected via an electronic questionnaire in 2021 from 215 nurse leaders registered in nursing trade unions, working as front line, middle, or senior leaders in Finnish social and healthcare organizations. A self-assessment instrument (ActEBN-managers) was used to measure EBN competence, attitudes, and supporting structures. Data were analyzed using descriptive statistics, t-test, analysis of variance, and linear regression. The reliability of the ActEBN-managers instrument was 0.893. RESULTS: In this sample of Finnish nurse leaders, EBN competence and attitudes were overall good. EBN competence and attitudes were associated with several background factors, as well as with factors related to organizational support structures and culture, in the independent group analyses. An independent statistical association was identified between EBN competence and higher education (t = 2.074, p = 0.039). Furthermore, an independent statistical association was identified between EBN attitudes and the service provider background (t = -2.503, p = 0.013), with more positive attitudes observed among nurse leaders working in the public sector. EBN attitudes were also associated with the availability of a best practices bank (t = -2.591, p = 0.010). CONCLUSIONS: The findings suggest that social and healthcare organizations may benefit from focusing on strengthening nurse leaders' EBN competence and attitudes by supporting their educational development, introducing EBN support structures more widely, and promoting an organizational culture that facilitates EBN. Nurse leaders play an important role in enabling and supporting the implementation of EBN.
When Caring Hurts: The Buffering Role of Social Support in Emergency Department Nurses' Coping With Secondary Traumatic Stress.
Chen YH, Chang YY, Wang IT … +1 more , Chang SH
J Nurs Manag · 2026 · PMID 42189104 · Full text
BACKGROUND: Emergency department nurses routinely operate in fast-paced and emotionally charged environments, where constant exposure to trauma places them at significant risk for developing secondary traumatic stress. R...
BACKGROUND: Emergency department nurses routinely operate in fast-paced and emotionally charged environments, where constant exposure to trauma places them at significant risk for developing secondary traumatic stress. Robust coping mechanisms and supportive social networks serve as critical buffers against these psychological effects. AIM: This study explored how coping strategies and social support interact to influence secondary traumatic stress among emergency department nurses in Taiwan, emphasizing the mediating function of social support. METHODS: A cross-sectional design was applied between June and August 2024, enrolling 305 emergency department nurses from two tertiary medical centers. Standardized questionnaires were used to measure secondary traumatic stress, coping styles, and perceived support from supervisors, peers, and family. Descriptive and inferential analyses-including independent-sample t-tests, Pearson correlations, and stepwise multiple regression-were conducted to examine relationships among study variables. Mediation effects were examined with the PROCESS macro (5000 bootstrap resamples). RESULTS: Almost all respondents (96.1%) experienced at least mild or higher levels of secondary traumatic stress, and 63.3% reported moderate-to-severe levels. Avoidant coping emerged as the strongest predictor. Mediation analyses further demonstrated that supervisor support partially mediated the association between avoidant coping and secondary traumatic stress, whereas family support significantly mediated the relationship between emotion-focused coping and secondary traumatic stress. CONCLUSION: Secondary traumatic stress is widespread among emergency department nurses. Avoidant coping heightens susceptibility, whereas supportive supervision and family involvement can mitigate adverse effects. IMPLICATIONS: Nurse leaders should develop programs that cultivate adaptive coping and enhance both organizational and family-based support to strengthen resilience and improve care quality.
Workplace Stressors Associated With Burnout Among Emergency Nurses and Other Emergency Healthcare Professionals: A Convergent Parallel Approach With a Multilevel Design.
Vizer LM, Liu CC, Kwong EK … +5 more , Beresic N, Adapa K, Haugan C, Charguia NE, Mazur LM
J Nurs Manag · 2026 · PMID 42186289 · Full text
BACKGROUND: Burnout assessments yield results of up to 65% for all emergency healthcare professionals and 53% for emergency nurses. We conducted a mixed methods study using a convergent parallel approach and a multilevel...
BACKGROUND: Burnout assessments yield results of up to 65% for all emergency healthcare professionals and 53% for emergency nurses. We conducted a mixed methods study using a convergent parallel approach and a multilevel design with emergency nurses and other healthcare professionals to identify workplace stressors associated with burnout and prioritize those stressors for improvement. MATERIALS AND METHODS: Emergency healthcare professionals were recruited from the emergency department of a large acute care hospital. Participants completed the abbreviated Maslach Burnout Inventory and a workplace stressor survey to contribute an overview of the current state of burnout and stress, participated in focus groups to provide context for identified stressors, and consented to contextual inquiries to nuanced in situ observation of stressors. From the survey, focus group, and contextual inquiry data, we employed a thematic analysis to develop an affinity model. Emergency healthcare professionals validated the stressors in the affinity model, prioritized potential improvement efforts, and rated the impact of and effort required for those improvements. RESULTS: The participant sample was diverse in age, race, sex, shift time, and length of employment. Eighty-one percent of the 63 survey participants met the criteria for burnout. Six focus groups with 19 participants and 22 contextual inquiries identified key work stressors related to staffing levels, workflow, communication, and care coordination. Using the affinity model, participants prioritized workflows, patient safety, patient-related stressors, physical work environment, staffing, extrinsic motivation, technology, communication, and psychiatric patient procedures as areas for improvement. CONCLUSION: We successfully completed surveys, focus groups, and contextual inquiries with emergency nurses and other healthcare professionals to identify workplace stressors and prioritize those stressors for improvement efforts. This appears to be a viable method to formally identify and prioritize the unique stressors contributing to burnout and guide efforts to reduce burnout among emergency healthcare professionals.
Clinical Transition Experiences of Internationally Educated Nurses Into Major Trauma Care: A Descriptive Phenomenological Study.
Ash A, De Vries K, Rutty J
J Nurs Manag · 2026 · PMID 42186231 · Full text
AIM: To explore the lived clinical transition experiences of internationally educated nurses entering major trauma care without prior trauma nursing experience. DESIGN: Descriptive phenomenological study. METHODS: Unstru...
AIM: To explore the lived clinical transition experiences of internationally educated nurses entering major trauma care without prior trauma nursing experience. DESIGN: Descriptive phenomenological study. METHODS: Unstructured in-depth interviews were conducted twice with nine internationally educated nurses (seven female; mean age 32.5 years) working in a Level I major trauma centre in Saudi Arabia between February and April 2021. All participants had prior clinical experience but no trauma background. Colaizzi's seven-step method guided analysis, supported by field notes and member checking. Husserl's phenomenological attitude was maintained to ensure bracketing of preconceptions. RESULTS: Three interrelated themes described transition: facing a new reality, adjusting towards growth and achieving belonging. Despite established nursing backgrounds, participants reverted to novice status in trauma care, marked by fear, uncertainty, and procedural unfamiliarity. Repeated exposure, mentorship and team inclusion gradually enhanced competence and confidence. Emotional labour was central, enabling nurses to suppress fear, maintain composure and progressively reconstruct resilience and professional identity in high-acuity practice. CONCLUSION: The transition of internationally educated nurses into trauma care involves navigating high-stakes demands as novices, with emotional labour functioning as both a protective and developmental mechanism. IMPLICATIONS FOR NURSING MANAGEMENT: Structured trauma-specific transition pathways, including simulation and mentorship, are needed to support internationally educated or novice nurses entering high-acuity services. Organisational recognition of the emotional demands of clinical transition can strengthen integration, retention and workforce sustainability in trauma systems. IMPACT: This study addressed the challenge of how internationally educated nurses adapt to major trauma care without prior experience. It found that transition required returning to novice status and relying on emotional labour to build resilience and professional identity. These findings have global relevance for workforce integration in trauma or high-acuity care systems reliant on internationally educated staff. REPORTING METHOD: The study adhered to COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
Impact of Delirium on Pediatric Critical Care Outcomes and Management Strategies: A Systematic Review and Meta-Analysis.
Yang C, Li J, Zeng Q
J Nurs Manag · 2026 · PMID 42186227 · Full text
BACKGROUND: Delirium in the pediatric intensive care units (PICUs) poses substantial challenges for nursing care and has a profound impact on key clinical metrics, including the period of assisted breathing support, tota...
BACKGROUND: Delirium in the pediatric intensive care units (PICUs) poses substantial challenges for nursing care and has a profound impact on key clinical metrics, including the period of assisted breathing support, total hospitalization time, and child survival rates. Effective nursing strategies are essential to improve patient prognosis and quality of life. AIM: We perform a systematic review and meta-analysis to examine how delirium relates to clinical outcomes in PICU patients and to map out the corresponding nursing management strategies. DESIGN: A systematic review and meta-analysis is conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. METHODS: Up to January 18, 2024, a comprehensive search of Cochrane Library, PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was conducted following the population, exposure, comparison, outcomes, and study design (PECOS) structure. Data were extracted with a standardized form, study quality was appraised using the Newcastle-Ottawa Scale, and analyses were carried out in STATA 17.0. The entire process complied with the PRISMA 2020 checklist. RESULTS: Among 14 studies (6019 children), delirium significantly increased mechanical ventilation risk (odds ratio [OR] = 5.68, 95% confidence interval [CI]: 4.20-7.69, p < 0.01), prolonged intensive care unit (ICU) stay (standardized mean difference [SMD] = 0.61, 95% CI: 0.53-0.70, p < 0.01), and raised mortality (OR = 5.09, 95% CI: 1.81-14.32, p < 0.01). Limited data precluded meta-analysis of postdischarge quality of life. Neither the funnel plot nor Egger's test revealed significant publication bias. CONCLUSIONS: Delirium is a key predictor of nursing-sensitive outcomes in pediatric ICU patients. Early screening and systematic nursing management (e.g., Cornell Assessment of Pediatric Delirium [CAPD] monitoring and family-centered rehabilitation) reduce risks and improve recovery and quality of life. Nurses are essential in delirium management by conducting regular assessments, optimizing the care environment, and facilitating teamwork across disciplines. Healthcare institutions should incorporate delirium management protocols into routine nursing workflows and standardize quality-of-life evaluations.
Topic Modeling of Nursing Documentation in Hemodialysis Units: A Mixed-Methods Study of Nursing Surveillance Activities.
Cho MK, Kim HY, Lee H … +1 more , Cho YH
J Nurs Manag · 2026 · PMID 42184213 · Full text
AIM AND OBJECTIVES: This study aimed to characterize documentation patterns in hemodialysis nursing records using integrated text mining and nursing surveillance analysis, focusing on surveillance priorities and document...
AIM AND OBJECTIVES: This study aimed to characterize documentation patterns in hemodialysis nursing records using integrated text mining and nursing surveillance analysis, focusing on surveillance priorities and documentation imbalances. BACKGROUND: Hemodialysis patients require continuous nursing surveillance due to frequent intradialytic complications; however, systematic analyses of nursing documentation in this setting remain limited. DESIGN: A mixed-methods study integrating quantitative text mining and structured analysis of nursing surveillance activities. METHODS: Free-text nursing records (300,321 entries) generated during maintenance hemodialysis sessions for 188 adult patients at a tertiary hospital in South Korea (July 2020-June 2025) were analyzed. Keyword frequency analysis and latent Dirichlet allocation topic modeling were performed after preprocessing, resulting in an eight-topic model. Nursing surveillance activities were mapped to the 16-item Korean Nursing Surveillance Scale through sentence-level classification by two independent researchers. RESULTS: The top 30 keywords accounted for 75.3% of all extracted terms, indicating highly repetitive documentation. Terms related to dialysis procedures, vascular access, blood pressure, vital signs, bleeding, falls, pain, dizziness, and hypotension were frequently documented, whereas education-related terms were less frequently documented. Topic modeling identified three overarching domains: the hemodialysis treatment process, clinical assessment and monitoring, and safety and risk management. Surveillance item analysis demonstrated high documentation frequencies for vascular access, vital signs, bleeding, and hypotension or dizziness, with low documentation of patient self-management and education. CONCLUSION: Hemodialysis nursing documentation primarily emphasizes physiological surveillance and safety management, with relatively limited documentation of patient education and self-management support. IMPLICATIONS FOR NURSE LEADERS: These findings suggest that optimizing electronic nursing record templates, along with incorporating structured prompts and natural language processing approaches, may support more balanced documentation and data-driven decision-making.
Challenges and Strategies for Enhancing Nurse Managers' Financial Management Competencies: A Scoping Review.
Lee J, Kim Y, Kim E
J Nurs Manag · 2026 · PMID 42175710 · Full text
BACKGROUND: As the financial responsibilities of nurse managers continue to grow in today's rapidly changing healthcare landscape, there is a clear need to strengthen their financial management competencies. These compet...
BACKGROUND: As the financial responsibilities of nurse managers continue to grow in today's rapidly changing healthcare landscape, there is a clear need to strengthen their financial management competencies. These competencies have historically received less emphasis in the managerial role description compared to other leadership skills. AIM: This scoping review aimed to identify factors that hinder nurse managers' financial management and practical approaches to improve financial management for future implementation in nursing administration practice. METHODS: We used Arksey and O'Malley's five-stage framework to structure and guide the scoping review. A systematic search strategy was implemented using the databases PubMed, CINAHL, PsycINFO, and Scopus, with the literature search completed on November 22, 2024. RESULTS: Of the 2142 records retrieved, 14 studies were included in the review, with a total of 1518 participants across all study samples. Most of the studies (64.2%) were conducted in the USA. Thematic analysis identified three major challenges to effective financial management among nurse managers: (1) insufficient awareness, (2) limited authority, and (3) inadequate resources and systems. To overcome these challenges, three key strategic approaches to improve financial management were recognized: (1) practical experience, (2) professional credentials, and (3) targeted training and educational programs. CONCLUSION: The findings underscore the critical role of both institutional structures and tailored educational supports in enabling nurse managers to effectively carry out their financial duties. Specifically, strengthening competencies requires aligning managerial authority with responsibilities, improving access to systems and resources, and promoting experiential learning, credentialing, and targeted training. These insights offer practical and policy implications for strengthening competencies within nursing leadership. IMPLICATIONS FOR NURSING MANAGEMENT: The findings suggest that healthcare organizations should prioritize policy and structural changes to support nurse managers' financial roles, including expanding managerial authority and strengthening support systems. Such efforts may enhance leadership capacity and improve financial performance in healthcare.
Impact of Hospital Hierarchy on Nurses' Attitudes Toward Artificial Intelligence: Mediating Roles of Artificial Intelligence Literacy and Anxiety.
Xu D, Zheng Y, Yin Y … +4 more , Lin C, Yang L, Liang B, Du J
J Nurs Manag · 2026 · PMID 42175619 · Full text
BACKGROUND: With the rapid development of science and technology, the application of artificial intelligence in the field of healthcare is becoming increasingly widespread. As the executors and responsible persons of nur...
BACKGROUND: With the rapid development of science and technology, the application of artificial intelligence in the field of healthcare is becoming increasingly widespread. As the executors and responsible persons of nursing work, nurses' understanding and attitude toward AI technology determine whether AI can be deeply integrated and successfully applied in the field of nursing. AIMS: To investigate nurses' negative and positive attitudes toward the use of artificial intelligence and influencing factors, explore the mediating effect of artificial intelligence literacy and anxiety between hospital hierarchy differences and negative and positive attitudes toward the use of artificial intelligence, and provide basis for improving nurses' attitudes toward the use of artificial intelligence. METHODS: In November 2025, the convenience sample of 436 nurses from different hospitals in Shandong Province was surveyed. Data were collected using the general information questionnaire, the attitude scale toward the use of artificial intelligence technologies in nursing, the artificial intelligence anxiety scale, and the artificial intelligence literacy scale. Multiple linear regression analyzed the influencing factors of nurses' negative and positive attitudes toward the use of artificial intelligence. Mediation analyses explored the mediating effect of artificial intelligence literacy and anxiety between the hospital hierarchy differences of nurses and their negative and positive attitudes toward the use of artificial intelligence. RESULTS: The score of negative attitude was 14.55 ± 6.63, and the score of positive attitude was 38.21 ± 3.87. Artificial intelligence literacy and anxiety partially mediated the relationship between hospital hierarchy differences and the negative and positive attitudes toward the use of artificial intelligence, with the total mediating effects being 3.067 and -1.011, respectively. CONCLUSION: Hospital hierarchy differences could directly positively predict the negative and positive attitudes toward the use of artificial intelligence and could also indirectly positively predict the negative attitude toward the use of artificial intelligence through mediation by artificial intelligence literacy and anxiety and negatively predict the positive attitude toward the use of artificial intelligence. IMPLICATIONS FOR NURSING MANAGEMENT: Providing personalized artificial intelligence training based on the needs of hospitals could improve nurses' attitudes toward the use of artificial intelligence, increase their artificial intelligence literacy, and reduce their anxiety.
Congruence and Incongruence in Sickness Presenteeism and Emotional Labor With Job Burnout in Pediatric Nurses: A Multicenter Response Surface Analysis.
Zhang Z, Guo C, Wu Y … +3 more , Wei X, Yu X, Zang S
J Nurs Manag · 2026 · PMID 42163797 · Full text
BACKGROUND: Pediatric nurses are particularly vulnerable to job burnout, which can negatively impact both care quality and workforce retention. Sickness presenteeism and emotional labor are prevalent in pediatric nursing...
BACKGROUND: Pediatric nurses are particularly vulnerable to job burnout, which can negatively impact both care quality and workforce retention. Sickness presenteeism and emotional labor are prevalent in pediatric nursing environments and may interact to influence burnout, yet their combined effects remain. OBJECTIVE: This study investigated the joint association of sickness presenteeism and emotional labor with job burnout among pediatric nurses in China. METHODS: A multicenter cross-sectional study. Polynomial regression with response surface analysis was employed to assess the effects of congruence and incongruence between sickness presenteeism and emotional labor on burnout levels. RESULTS: Participants reported moderate levels of both sickness presenteeism and emotional labor, alongside low levels of job burnout. Notably, job burnout was minimized when both sickness presenteeism and emotional labor were at moderate levels. In contrast, burnout was highest when both variables were either very high or very low (a = 0.755, p < 0.01; a = 0.113, p < 0.05). Furthermore, greater incongruence between sickness presenteeism and emotional labor was associated with increased job burnout (a = 0.629, p < 0.01; a = 0.125, p < 0.05). CONCLUSIONS: This study found that the joint association of sickness presenteeism and emotional labor with job burnout among pediatric nurses is both linear and nonlinear, exhibiting a U-shaped pattern along congruence and incongruence lines. Job burnout was the highest when both sickness presenteeism and emotional labor were either very high or very low and when marked incongruence existed between them. These findings suggest that nursing managers should monitor sickness presenteeism and emotional labor, avoid extreme imbalance and incongruence, and foster a supportive work environment to mitigate job burnout.
Linking Transformational Leadership to Patient Care Quality: The Role of Structural Empowerment and Registered Nurses' Clinical Leadership.
Alanazi AK, Traynor M, McFetridge L … +2 more , McKeaveney C, Clarke SA
J Nurs Manag · 2026 · PMID 42163567 · Full text
BACKGROUND: Effective leadership is critical in driving and motivating registered nurses to provide high-quality patient care. A link between effective transformational leadership (TL) in nursing and improved patient car...
BACKGROUND: Effective leadership is critical in driving and motivating registered nurses to provide high-quality patient care. A link between effective transformational leadership (TL) in nursing and improved patient care outcomes has been established, but it is unknown how this association is affected. AIM: To examine the relationships between TL, structural empowerment (SE), registered nurses' clinical leadership (CLS) and patient care outcomes. METHODS: This quantitative cross-sectional study was conducted in a government tertiary hospital in Saudi Arabia, with 1038 registered nurses clustered under 28 head nurses. Instruments used included the Multifactor Leadership Questionnaire, Conditions of Work Effectiveness Questionnaire II, clinical leadership survey and self-reported measures of patient adverse events (AEs) and nursing care quality. Data were analysed using SPSS Version 28 and the R 4.3.3 packages 'lavaan', 'semPlot' and 'semTools' for multilevel structural equation modelling (MSEM). RESULTS: Six hundred and sixty-four surveys (response rate = 70%) were analysed. Multilevel analysis showed a significant positive association between TL and SE (β = 0.56, p < 0.001) and SE and registered nurses' clinical leadership (β = 0.52, p < 0.001). Registered nurses' clinical leadership was positively associated with quality of care (β = 0.32, p < 0.001) and negatively associated with AEs (β = -0.15, p < 0.001). Mediation analysis indicated a significant indirect effect of TL on registered nurses' clinical leadership through SE (B = 0.344, p < 0.001). SE was also indirectly associated with patient AEs through registered nurses' clinical leadership (B = -0.037, p = 0.003) and quality of nursing care (QOC) through registered nurses' clinical leadership (B = 0.147, p < 0.001). CONCLUSIONS: The study highlights the critical role that SE and nurses' clinical leadership play in explaining how TL is associated with improved patient care. These findings provide evidence to support policy and training initiatives that develop leadership frameworks, ensuring a more empowered and effective nursing workforce capable of delivering high-quality patient care.
Urinary Retention Complications Following Pelvic Floor Reconstructive Surgery: Prevention and Management Strategies Based on Evidence Synthesis.
Zhou L, She C, Hu S … +3 more , Su X, Liu L, Dai L
J Nurs Manag · 2026 · PMID 42160029 · Full text
AIM: To evaluate and summarise the best evidence on the prevention and management of postoperative urinary retention (POUR) following pelvic floor reconstruction and provide an evidence-based foundation for clinical prac...
AIM: To evaluate and summarise the best evidence on the prevention and management of postoperative urinary retention (POUR) following pelvic floor reconstruction and provide an evidence-based foundation for clinical practice. METHODS: Adhering to the top-down principle of the 6S model of evidence-based resources, all evidence from domestic and international databases and websites on the prevention and management of POUR after pelvic floor reconstruction, including clinical decisions, evidence-based guidelines, evidence summaries, systematic reviews, meta-analyses and expert consensus statements, was systematically searched from the inception of each database to May 9, 2024. Quality assessment, evidence extraction and summarisation were performed by two researchers. This study was registered with the Evidence-Based Nursing Center of Fudan University (registration number: ES20244725). RESULTS: Twenty-one studies were included and used to develop 26 evidence-based recommendations, which were categorised into five areas: risk assessment and information, preventive measures, early identification, management strategies and follow-up management. Preoperative evaluation should include the patient's urination status, postvoid residual (PVR) and risk factors for POUR, without the routine need for urodynamic testing. During surgery, excessive separation of the urethra should be minimised, and the sling or mesh should be kept tension-free. Catheters should be removed 24-48 h post-operatively, followed by a timely voiding trial, with retrograde voiding trials recommended. Intermittent catheterisation or indwelling catheterisation is considered the primary treatment option for POUR. If necessary, sling or mesh loosening may be performed, while sling or mesh release should be approached with caution, and urethral dilation is not recommended. A follow-up assessment of urination status is advised at least once within 6 weeks postsurgery. CONCLUSION: These 26 pieces of evidence provide guidance for healthcare professionals in standardising the management of POUR following pelvic floor reconstructive surgery. However, because this evidence comes from different countries, healthcare professionals are encouraged to apply it in specific clinical contexts to optimise patient outcomes. Future research should focus more on risk assessment tools and specific preventive measures for POUR following pelvic floor surgery.
Association of Resilience, Organisational Support and Family Function With Reality Shock Among Chinese Newly Graduated Nurses: A Cross-Sectional Study.
Jia R, Liang D, Chen F … +3 more , Lan M, Zhou L, Wang L
J Nurs Manag · 2026 · PMID 42157732 · Full text
AIM: To describe the levels of reality shock, examine its relationships with resilience, organisational support and family function, and identify associated factors among newly graduated nurses. BACKGROUND: Reality shock...
AIM: To describe the levels of reality shock, examine its relationships with resilience, organisational support and family function, and identify associated factors among newly graduated nurses. BACKGROUND: Reality shock is a prevalent challenge for newly graduated nurses. However, evidence regarding its associations with resilience, organisational support and family function remains limited. METHODS: A cross-sectional study was conducted among 482 newly graduated nurses. Descriptive statistics, univariate analysis, Pearson correlation analysis and multiple linear regression analysis were performed. RESULTS: A total of 482 newly graduated nurses completed the questionnaire. The mean reality shock score was 94.06 ± 22.47. Pearson correlation analysis showed that resilience, organisational support, and family function were significantly correlated with reality shock. In addition, educational background, average daily working hours and sleep duration were identified as significant associated factors. CONCLUSION: Newly graduated nurses experienced a moderate level of reality shock. Several factors, including educational background, working hours and sleep duration were significantly associated with reality shock. In particular, resilience, organisational support and family function, were negatively correlated with reality shock. IMPLICATIONS FOR NURSING MANAGEMENT: The findings suggest that resilience, organisational support and family function may be relevant considerations when supporting newly graduated nurses. Strategies aimed at enhancing resilience and promoting supportive organisational and family environments may be considered as part of efforts to address reality shock during the transition to clinical practice.
Evaluating Nursing Care Quality Through Inpatient Falls and Its Association With the Patient Experience: A Registry Study in Finnish Acute Care Settings.
Nurmeksela A, Heikkilä A, Mikkonen S … +7 more , Junttila K, Kaunonen M, Kortteisto T, Peltokoski J, Ritmala M, Salmela S, Tervo-Heikkinen T
J Nurs Manag · 2026 · PMID 42157517 · Full text
BACKGROUND: The systematic collection and evaluation of evidence on the patient experience and the quality of care is crucial in advancing patient-centred safe care. This study examined the association of the incidence o...
BACKGROUND: The systematic collection and evaluation of evidence on the patient experience and the quality of care is crucial in advancing patient-centred safe care. This study examined the association of the incidence of injurious inpatient falls with the patient experience of nursing care in Finnish hospitals. AIM(S): The aim was to determine how frequently inpatient falls occur, how patients evaluate their nursing care experience and whether these two factors are associated. METHODS: A cross-sectional registry study design was used. Data on inpatient falls, using hospital records and patient experience of nursing care, collected using the Nursing-Sensitive Patient-Reported Experience Measure (NsPREM), were collected in 2021 and 2022 from five university hospitals and four central hospitals in Finland. The data included a total of 4733 inpatient falls, of which 1899 were injurious, and 16,610 patient experience measures. Descriptive statistics were used to describe the incidence of inpatient falls and the patient experience, and linear mixed models were employed to examine the interaction between injurious inpatient falls and the patient experience. Analyses were conducted at a unit-type group level. RESULTS: Of the inpatient falls, 40% (n = 1899) caused injury and were statistically significantly associated with the patient experience measures, which are thus included in the linear mixed modelling. Overall, the patients experienced their care as excellent (with a mean greater than 4 on a five-point scale) in every unit-type group. Several subscales of NsPREM displayed associations with injurious inpatient falls. The patients were satisfied with nursing care on every subscale, particularly in terms of the courtesy and respect with which nurses treated them (mean: 4.83) and in terms of pain management (mean: 4.80). In linear mixed models, adjusting for injurious patient falls, the patients in psychiatric units reported that they were less satisfied with their care on every subscale compared with other unit-type groups: for example, the patients' experience of safety (Est. = -0.262, p < 0.001) and patient centredness (Est. = -0.399, p < 0.001) were significantly weaker in the psychiatric units. CONCLUSIONS: The findings show that continuous improvement requires ongoing monitoring and the evaluation of strategies to reduce inpatient falls and improve patient satisfaction, and there is a need for the ongoing training of nursing staff and targeted interventions for high-risk patients. Hospital organisations must engage patients in their care, particularly in relation to fall prevention, to empower them and enhance their overall experience.
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