J Nurs Manag [JOURNAL]
Sun
200 papers
Translation, Cultural Adaptation and Validation of a Korean Version of the Digital Professionalism Self-Assessment Instrument for Nurses.
Ban S, Lee JY, Seomun G
J Nurs Manag · 2026 · PMID 42403288 · Full text
BACKGROUND: Social media has become a crucial tool for interpersonal communication among nurses worldwide, including in South Korea. While offering various opportunities, such as education and networking, it also entails...
BACKGROUND: Social media has become a crucial tool for interpersonal communication among nurses worldwide, including in South Korea. While offering various opportunities, such as education and networking, it also entails risks regarding professional ethics and boundaries. However, research measuring digital professionalism in the Korean context is inadequate. Thus, a customised, nurse-specific instrument is required to support effective evaluation, educational initiatives and policy formulation. AIM: This study aimed to translate, culturally adapt and psychometrically validate the Korean version of the Digital Professionalism Self-Assessment Instrument (K-DP-SAI) for nurses. METHODS: This study followed established guidelines for translation and cross-cultural adaptation, including forward and backward translation, synthesis, expert panel review and pilot testing. Exploratory and confirmatory factor analyses were conducted with 308 nurses each, and known-group validity was also performed. Internal consistency was assessed using Cronbach's alpha and McDonald's omega and test-retest reliability was examined using intraclass correlation coefficients. RESULTS: The K-DP-SAI comprises 14 items across three factors, including 'upholding public trust through professional accountability', 'personal information protection' and 'maintenance of professional boundaries'. The scale demonstrated satisfactory content, convergent and discriminant validity with acceptable model fit indices (x/df = 2.603, GFI = 0.916, TLI = 0.918, CFI = 0.933, RMSEA = 0.072 and SRMR = 0.054) and also demonstrated sensitivity in discriminating between groups based on their perceived need for related education (t = 2.135, p < 0.05). Internal consistency (Cronbach's alpha = 0.88 and McDonald's omega = 0.88) and test-retest reliability (ICC = 0.68) met the established criteria. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT: The K-DP-SAI is a valid and reliable instrument for assessing nurses' digital professionalism in South Korea. As an organisational safeguard, it enables managers to identify vulnerable groups and implement targeted, evidence-based education beyond simple restriction. Ultimately, K-DP-SAI supports the nurses' professional integrity in digital spaces by shifting management toward practical guidance.
Clinical Nurses' Expectations and Experiences of Self-Directed Online Training in Evidence-Based Practice: A Qualitative Study - #EvidencerProject.
Ramos-Morcillo AJ, Fernández-Salazar S, Vera-Pérez JA … +2 more , García-González J, Ruzafa-Martínez M
J Nurs Manag · 2026 · PMID 42397002 · Full text
BACKGROUND: Evidence-based practice (EBP) is essential for improving the quality of care and health outcomes. Despite its importance, nurses' competence in EBP remains limited, emphasizing the need for more effective tra...
BACKGROUND: Evidence-based practice (EBP) is essential for improving the quality of care and health outcomes. Despite its importance, nurses' competence in EBP remains limited, emphasizing the need for more effective training strategies. AIM: This study aimed to explore the learning expectations and experiences of clinical nurses who took part in the #Evidencer Project, a self-directed online course on EBP. METHOD: A qualitative approach was used, applying reflexive thematic analysis. Participants were experienced clinical (Hospital Care n = 10, Primary Care n = 5) nurses who had completed a 72-h free online training course on EBP. The participants had heterogeneous educational backgrounds (generalist nurses, n = 4; specialist nurses, n = 3; master's degree, n = 6; doctorate, n = 2). Semistructured virtual interviews were conducted and analyzed following Braun and Clarke's method. The MAXQDA 24 software supported the analysis process. Trustworthiness was ensured through a collaborative and reflective coding process carried out by two researchers, an audit trail, triangulation with existing literature, and explicit attention to researcher reflexivity. RESULTS: A total of 15 nurses participated in the study. Three main themes emerged: (1) motivation and expectations: motivation was primarily intrinsic, driven by personal interest in EBP, the need for professional development, and their roles as student tutors; (2) experience with the training: participants positively evaluated the clarity, flexibility, quality of the content, and nursing-adapted design, although areas for improvement were identified, such as the need for tutoring and better support for complex content; (3) EBP worldview: a partial understanding of the EBP process was noted, focused on the initial phases (steps 0-2: problem identification and evidence search), with greater difficulty in the advanced phases (steps 3-6: critical appraisal, implementation, evaluation, and dissemination). Added to this was the confusion between research and EBP. CONCLUSION: The #Evidencer Project, self-directed online training in EBP was well regarded for its accessibility, flexibility, and quality, but participants perceived it as insufficient as a standalone strategy for comprehensive EBP implementation. The nurses indicated a need for institutional support for the comprehensive application of EBP, highlighting the importance of training strategies integrated within the clinical context and backed by the institutions.
Mobile Phone Addiction, Perceived Stress, and Morningness-Eveningness Preference in Nursing Students: A Computer-Simulated Network Analysis.
Li H, Shen Z, Jiang Y … +6 more , Xiong Y, Zeng Y, Zhang Q, Chen Q, Xiang J, Ye Z
J Nurs Manag · 2026 · PMID 42380735 · Full text
BACKGROUND: Nursing students with high levels of perceived stress may be vulnerable to problematic mobile phone use. Morningness-eveningness preference may shape the relationship between mobile phone addiction and percei...
BACKGROUND: Nursing students with high levels of perceived stress may be vulnerable to problematic mobile phone use. Morningness-eveningness preference may shape the relationship between mobile phone addiction and perceived stress. Using network analysis and computer-simulated interventions, this study explored symptom-level associations and potential intervention targets among nursing students. METHODS: Participants enrolled in the "Be Resilient to Nursing Career" program completed the Mobile Phone Addiction Index, Perceived Stress Scale, and Morningness-Eveningness Questionnaire. Network analysis was conducted to identify central and bridge symptoms. Computer-simulated intervention analysis was used to identify potential symptom targets within the network. Moderated network analysis was further performed to examine the moderating role of morningness-eveningness preference. RESULTS: The central symptoms were inability to control craving (Str = 0.88, Bet = 2, Clo = 0.039, and EI = 0.77) and productivity loss (Str = 1.13, Bet = 3, Clo = 0.038, EI = 0.95). Feelings of nervousness emerged as an important bridge symptom between perceived stress and mobile phone addiction. Inability to control craving showed the strongest influence in the simulated intervention analysis and may represent a potential intervention target. Feelings of nervousness showed the greatest change in the simulated intervention analysis. Four significant three-way interactions suggested a potential moderating role of morningness-eveningness preference. CONCLUSION: This study identified potential symptom targets associated with perceived stress and mobile phone addiction among nursing students through network analysis and computer-simulated interventions. The findings may help inform future student support strategies and mental health management in nursing education. Morningness-eveningness preference may play a moderating role in the association between perceived stress and mobile phone addiction.
Change Fatigue and Attitudes Toward AI in County-Level Nurses: The Mediating Role of AI Literacy.
Yu M, Zhou M, Yu R … +6 more , Fan X, Geng R, Ji J, Cai S, Jiang L, Jiang L
J Nurs Manag · 2026 · PMID 42379874 · Full text
OBJECTIVE: Grounded in the conservation of resources theory, this study aimed to examine the mediating role of artificial intelligence literacy in the relationship between change fatigue and attitudes toward AI applicati...
OBJECTIVE: Grounded in the conservation of resources theory, this study aimed to examine the mediating role of artificial intelligence literacy in the relationship between change fatigue and attitudes toward AI application among nurses in county-level hospitals, thereby providing insights for enhancing AI technology acceptance in primary care settings. BACKGROUND: County-level hospitals in China are undergoing significant organizational transformations alongside rapid technological advancements. Nurses in these settings frequently experience change fatigue due to continuous institutional reforms, while simultaneously facing challenges in adapting to artificial intelligence technologies. Understanding the psychological mechanisms underlying nurses' acceptance of AI is crucial for successful technology implementation in primary care settings. DESIGN: A cross-sectional analytic study employing mediation analysis. METHODS: A cross-sectional survey was conducted using convenience sampling from August to September 2025. A total of 460 clinical nurses from a county-level tertiary B hospital in Nantong City, China (99.6% female; mean age 31-40 years: 43.3%), were assessed. Data were analyzed using structural equation modeling with the maximum likelihood estimation method, and the significance of indirect effects was tested using the bootstrap method (5000 samples). RESULTS: The mean scores for change fatigue, AI literacy, and AI application attitudes were 29.27 ± 6.98, 49.82 ± 5.27, and 45.26 ± 2.45, respectively. Change fatigue showed a significant negative association with AI application attitudes (β = -0.36, p < 0.001), while AI literacy demonstrated a significant positive effect (β = 0.34, p < 0.001). AI literacy partially mediated the relationship between change fatigue and AI application attitudes (indirect effect = -0.185, 95% CI: [-0.231, -0.142]), accounting for 37.7% of the total effect. CONCLUSION: AI literacy plays a significant partial mediating role. To improve nurses' acceptance of AI technologies, nursing administrators should implement dual interventions aimed at both alleviating change fatigue (e.g., paced change management and psychological support) and systematically enhancing AI literacy (e.g., stratified training programs).
Associations Between Stress, Psychological Capital, Well-Being, Job Burnout, and Turnover Intention Among Chinese Nurses: A National Cross-Sectional Study.
Liu D, Long C, Du Y … +4 more , Hua Z, Jia Z, Wu M, Shi L
J Nurs Manag · 2026 · PMID 42377279 · Full text
BACKGROUND: The shortage of nurses is a worldwide issue. Turnover intention among nurses plays a critical role in shaping workforce stability and healthcare service quality. The inter-relationships between stress, psycho...
BACKGROUND: The shortage of nurses is a worldwide issue. Turnover intention among nurses plays a critical role in shaping workforce stability and healthcare service quality. The inter-relationships between stress, psychological capital, job burnout, turnover intention, and well-being in nurses have not been fully clarified and warrant further study. AIM: This study aimed to investigate how stress affects turnover intention in Chinese nurses, focusing on the serial mediation of psychological capital and job burnout and the moderation of well-being. METHODS: Using a cross-sectional study design, registered nurses were recruited from 21 hospitals in eastern, central, and western China, with 4865 valid responses collected. Stress, psychological capital, well-being, job burnout, and turnover intention were measured using validated instruments. Associations among the variables were examined using a moderated serial mediation model (PROCESS Model 91), adjusting for demographic and occupational covariates. RESULTS: Stress was positively associated with turnover intention (r = 0.380, p < 0.01) and job burnout (r = 0.568, p < 0.01) but negatively associated with psychological capital (r = -0.374, p < 0.01) and well-being (r = -0.477, p < 0.01). Stress had a significant total effect on turnover intention (c = 0.290, p < 0.001), of which the direct effect (c' = 0.142, p < 0.001) accounted for 48.97% of the total effect. Psychological capital and job burnout significantly mediated this relationship. Specifically, the indirect effect through psychological capital was 0.016, accounting for 5.51% of the total effect, whereas the indirect effect through job burnout was 0.091, accounting for 31.38% of the total effect. Stress affected turnover intention through the serial mediation of psychological capital and job burnout (indirect effect = 0.041, 14.14% of the total effect). Well-being significantly moderated the association between psychological capital and job burnout, with an index of moderated mediation of -0.0008. The serial indirect effect decreased as well-being increased. CONCLUSION: Psychological capital and job burnout represent important mechanisms linking stress to nurses' turnover intention, and well-being moderates the pathway between psychological capital and job burnout. These findings provide evidence for multidimensional interventions to reduce nurses' turnover intention, including strengthening psychological capital assessment, improving occupational well-being, and optimizing workplace support systems. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse administrators should adopt comprehensive strategies addressing stress, psychological capital, well-being, and job burnout to lower nurses' turnover intention and maintain workforce stability.
Barriers and Facilitators for Medication Safety in Emergency Care Using a SEIPS Model: A Qualitative Study.
Lau Y, Zhou L, Chung YM … +2 more , Tam HL, Wong SH
J Nurs Manag · 2026 · PMID 42377095 · Full text
AIM: The present study aimed to investigate the facilitators and barriers encountered by primary nurses and designated checkers in their participation with the designated independent double-checking (IDC) process for the...
AIM: The present study aimed to investigate the facilitators and barriers encountered by primary nurses and designated checkers in their participation with the designated independent double-checking (IDC) process for the administration of high-alert medications in the emergency department, employing the systems engineering initiative for patient safety (SEIPS) framework. BACKGROUND: Designated IDC acts as a safety measure to prevent medication errors, provided by an experienced checker. However, the facilitators and barriers that influence this process remain unclear. METHODS: An exploratory qualitative study was conducted using a purposive sample of 26 primary nurses and designated checkers. Data were collected through individual semistructured interviews and analysed using Braun and Clarke's six phases of thematic analysis. RESULTS: Our analysis revealed 15 facilitators and 16 barriers, which were classified according to the SEIPS domains: environment, organisation, people, task, tools and technology, process and outcome. CONCLUSION: The findings concerning the facilitators and barriers to implementing a designated IDC are a vital initial step in developing evidence-based interventions to enhance medication safety. IMPLICATIONS FOR NURSING MANAGEMENT: The findings may suggest the maintenance of clear documentation, the promotion of effective communication, the conduct of regular audits, and the incorporation of IDC training into both orientation programmes and in-service training, which is especially crucial for junior staff. These factors guide policymakers in restructuring the environmental layout, standardising IDC guidelines, ensuring sufficient staffing, fostering a nonhierarchical atmosphere, and promoting the adoption of technology.
The Influence of Organizational and Social Work Environmental Factors on Patient Safety Climate.
Agrell A, Tafvelin S, Wahlström J … +2 more , Abildgaard JS, Lundmark R
J Nurs Manag · 2026 · PMID 42377034 · Full text
BACKGROUND: Patient safety climate (PSC) reflects healthcare professionals' shared perceptions of how patient safety is prioritized, managed, and enacted within healthcare organizations. While PSC is known to be associat...
BACKGROUND: Patient safety climate (PSC) reflects healthcare professionals' shared perceptions of how patient safety is prioritized, managed, and enacted within healthcare organizations. While PSC is known to be associated with favorable patient outcomes, empirical evidence on how specific work environment factors shape PSC over time remains limited. Drawing on the job demands-resources theory, this study examines how organizational and social work environment factors relate to PSC in a healthcare setting. METHODS: A two-wave panel study was conducted within a large healthcare organization in northern Sweden. Survey data were collected from employees across four departments at baseline (T1; n = 624) and six months later (T2; n = 454). Organizational factors included quantitative demands and role clarity, while social factors included teamwork and quality of leadership. PSC was measured at T2. Structural equation modeling was used to test longitudinal relationships between T1 predictors and PSC at T2. RESULTS: In the structural model, role clarity (β = 0.23, p < 0.001) and teamwork (β = 0.32, p < 0.001) at T1 were positively associated with PSC at T2. Quantitative demands and quality of leadership showed no significant unique associations with PSC when all predictors were included simultaneously. The final model explained 32% of the variance in PSC. CONCLUSIONS: The findings indicate that clearly defined roles and effective teamwork are key antecedents of PSC over time, whereas workload and general leadership quality may be less influential when considered alongside other work environment factors. IMPLICATIONS FOR NURSING MANAGEMENT: Efforts to strengthen PSC may benefit from interventions targeting multiple aspects of the work environment, with role clarity and collaborative team processes emerging as particularly promising targets for nursing management.
The Association Between Inclusive Leadership and Job Performance in Nurses: Exploring the Mediation Roles of Grit and Work Engagement Based on a Cross-Sectional Study.
Wen Y, Liao J, Lu C … +4 more , Huang L, Ma Y, Bo W, Wang S
J Nurs Manag · 2026 · PMID 42374857 · Full text
BACKGROUND: The demanding nature of nursing makes job performance critical for patient safety. While inclusive leadership is recognized for its positive association with nurse outcomes, the mechanisms linking it to job p...
BACKGROUND: The demanding nature of nursing makes job performance critical for patient safety. While inclusive leadership is recognized for its positive association with nurse outcomes, the mechanisms linking it to job performance remain underexplored. This study examines whether grit and work engagement statistically mediate this link. METHODS: A cross-sectional survey was conducted using a convenient sampling method among 429 registered nurses in Sichuan Province, China, between July and August 2025. Participants completed validated measures assessing inclusive leadership, grit, work engagement, and job performance. Statistical analyses, including descriptive statistics, correlations, and common method bias checks, were performed using IBM SPSS 26.0. Multiple mediation analyses were subsequently conducted using the SPSS PROCESS macro. RESULTS: Inclusive leadership was positively correlated with grit, work engagement, and job performance (all p < 0.001). The mediation analysis revealed that the total effect of inclusive leadership on job performance was significant (β = 0.29, p < 0.001). However, the direct effect of inclusive leadership on job performance became nonsignificant (β = 0.04, p > 0.05) when the mediators were included. Significant indirect effects were found via grit alone (β = 0.12, p < 0.001), work engagement alone (β = 0.11, p < 0.001), and sequentially via grit followed by work engagement (β = 0.02, p < 0.001). CONCLUSION: Inclusive leadership is positively associated with nurses' job performance, and this link is statistically mediated by grit and work engagement, both individually and sequentially. Healthcare organizations should invest in leadership training that fosters openness and accessibility, alongside programs building nurses' grit and work engagement, to enhance their job performance and potentially improve patient outcomes indirectly.
Lived Experiences of Patients With Rare Diseases and Healthcare System Barriers: A Phenomenological Study.
Soriano-Martin P, Ruiz-González C, Alias-Castillo AJ … +4 more , Roman P, Martinez-Ortigosa A, Bertini-Pérez D, Font Jímenez I
J Nurs Manag · 2026 · PMID 42374790 · Full text
AIM: To explore the lived experiences and perceptions of patients with rare diseases (RD) in relation to the disease process and its management by the healthcare system. BACKGROUND: Although each RD individually affects...
AIM: To explore the lived experiences and perceptions of patients with rare diseases (RD) in relation to the disease process and its management by the healthcare system. BACKGROUND: Although each RD individually affects fewer than 0.05% of the population, collectively RD affect between 3.5% and 5.9% of the global population, representing approximately 400 million people worldwide. Most RD are chronic, progressive, and debilitating, with 80% having a genetic origin. Despite advances, diagnosing RD remains complex, often taking 4 to 8 years, worsening patient outcomes and increasing healthcare costs. Furthermore, 95% of RD lack approved treatments, presenting significant challenges for both patients and healthcare systems. METHODS: An interpretative phenomenological qualitative study following Gadamer's hermeneutic framework was conducted. Semistructured, in-depth interviews were conducted between February 2022 and January 2024. Seventeen patients with RD were recruited using purposeful sampling. ATLAS.ti v.9 software was used solely to organize and manage the data during the analysis process. RESULTS: Two main interpretive themes emerged: (1) RD: a desperate struggle against abstraction and hindrance, describing the emotional burden, diagnostic delays, and social consequences faced by patients with RD and (2) management and handling of RD by the healthcare system, highlighting professional unpreparedness, lack of coordination, and the key role patients and caregivers play in guiding care and sharing knowledge, alongside the emergence of peer support, digital tools, and social media as facilitators. CONCLUSION: This study highlights the significant barriers patients with RD face, from diagnosis to treatment. Healthcare systems struggle with insufficient knowledge and resources, hindering effective care. It is essential for professionals to acquire specialized skills and for resource allocation to improve in order to address RD as a public health concern. IMPLICATIONS FOR NURSING MANAGEMENT: As part of an interprofessional team, nursing professionals play a vital role in supporting patients with RD throughout the diagnostic journey, treatment, and management. This study highlights the need for nurses to address not only clinical but also psychosocial and informational challenges, including guiding patients in the safe and effective use of social media as a source of support, information, and empowerment. PATIENT AND PUBLIC CONTRIBUTION: Patients contributed as participants in the study by sharing their lived experiences through in-depth interviews. No patients or members of the public were involved in the design, conduct, reporting, or dissemination plans of this research.
Functions and Activities Missed by Nurse Managers, Their Antecedents and Consequences: Findings From a Qualitative Study.
Chiappinotto S, Eskici GT, Miorin F … +1 more , Palese A
J Nurs Manag · 2026 · PMID 42366887 · Full text
OBJECTIVE: To understand the phenomenon of Missed Nursing Management functions and activities in the daily practice of nurse managers (NMs) and to identify its antecedents and consequences. DESIGN: A descriptive qualitat...
OBJECTIVE: To understand the phenomenon of Missed Nursing Management functions and activities in the daily practice of nurse managers (NMs) and to identify its antecedents and consequences. DESIGN: A descriptive qualitative study conducted according to the COnsolidated criteria for REporting Qualitative research guidelines. METHODS: A purposive sample of 22 Italian nurses from different roles-NMs, their clinical nurses, nurse executives, representatives of NM associations, and nurse educators-were identified and individually interviewed face-to-face in 2023. The data were thematically categorized using both inductive and deductive approaches. FINDINGS: Four Missed Nursing Management functions have emerged: (1) "Missing systemic planning and monitoring", (2) "Missing effective presence in the clinical environment", (3) "Missing coordination and continuous alignment with expected goals" and (4) "Missing to promote the development of the department, staff and the profession". Several antecedents were identified at the (1) macrolevel: "Systemic challenges such as the shortage of nurses and postpandemic recovery", "Strategic systemic uncertainties", "Inadequate role recognition"; (2) exolevel: "Lacks in tailored training and professional development opportunities", "Lack of independence in decision making"; (3) mesolevel: "Lack of structural and organizational support", "Lack of coordination"; (4) microlevel: "Ambiguities in role expectations", "Bureaucratic burden", "Lack of team cohesion and a feeling of loneliness", "Disjointed information" and (5) NM level: "Chronic time scarcity", "Lack of experience", "Attitudes", "Sense of disengagement". Missed Nursing Management consequences were reported at NM, staff, unit and patient/family levels. CONCLUSIONS: Essential nursing management functions, such as planning, supervision, visibility, coordination and professional development, are missed or postponed by NMs, as activities like resource management remain prioritised for daily unit functioning. Antecedents influence the phenomenon across multiple levels, indicating the need for system-wide interventions, while consequences primarily affect the microsystem, including NMs, teams, organisational performance and potentially care quality. IMPLICATION FOR NURSING MANAGEMENT: These results inform management by highlighting the need to protect NMs' time for core managerial functions, strengthen their visible presence in clinical settings, and reduce bureaucratic burden. From an organisational and policy perspective, the study supports investment in role clarification and decision-making autonomy, as well as workforce policies that address structural staffing shortages and strengthen coordination across system levels. Moreover, it is essential to develop strategies that enhance leadership competencies and support NMs to fully perform their leadership role, creating an environment that enables them to fulfil their strategic and support responsibilities.
Invisible Care: Nurses' Lived Experiences of How the Practice Environment Shapes Nurse-Patient Relationships.
Pereira-Sánchez M, Zaragoza-Salcedo A, Vázquez-Calatayud M … +1 more , Saracíbar-Razquin M
J Nurs Manag · 2026 · PMID 42366575 · Full text
AIM: To explore how the nursing practice environment shapes nurse-patient relationships, identifying key organizational challenges and opportunities for nursing management and policy. DESIGN: A qualitative hermeneutic ph...
AIM: To explore how the nursing practice environment shapes nurse-patient relationships, identifying key organizational challenges and opportunities for nursing management and policy. DESIGN: A qualitative hermeneutic phenomenological design was used to explore the lived experiences of nurses in a hospital setting. METHODS: Data were collected through in-depth, face-to-face interviews and analyzed using Van Manen's hermeneutic phenomenological method. Data saturation was reached after 20 interviews. RESULTS: The findings reveal that nurse-patient relationships are fundamentally shaped by organizational and structural conditions that systematically constrain the relational dimension of nursing practice. Nurses experienced a persistent tension between their professional commitment to person-centered care and an organizational context that prioritizes task completion over relational engagement. Five themes were identified: (1) organizational culture fails to adequately recognize the relational essence of nursing; (2) environmental factors constrain team dynamics and nurse-patient relationships; (3) ambiguity in patient assignment undermines continuity of care; (4) limited time availability hinders meaningful patient engagement; and (5) high nurse-patient ratios erode the conditions for relational care. CONCLUSION: Meaningful nurse-patient relationships are structurally shaped by the practice environment. Strengthening nursing leadership, promoting professional autonomy, and redesigning organizational policies are essential to sustaining person-centered care and improving patient outcomes.
Exploring Barriers and Protective Factors in Decision Fatigue Among Clinical Nursing Managers During the COVID-19 Pandemic: A Qualitative Content Analysis.
Sheikh S, Hajibabaei F, Cheraghi MA … +2 more , Nasrabadi AN, Esmaeili M
J Nurs Manag · 2026 · PMID 42366558 · Full text
BACKGROUND AND OBJECTIVE: Decision fatigue of nursing managers in stressful hospital environments is considered one of the fundamental challenges of healthcare management. It affects the quality of decisions and organiza...
BACKGROUND AND OBJECTIVE: Decision fatigue of nursing managers in stressful hospital environments is considered one of the fundamental challenges of healthcare management. It affects the quality of decisions and organizational outcomes. This study aimed to explore both the barriers that exacerbate decision fatigue and the protective factors and strategies that mitigate it from the perspective of clinical nursing managers during the COVID-19 pandemic. METHODOLOGY: This qualitative study was conducted with a conventional content analysis approach. Participants consisted of 11 nursing managers working in the hospitals affiliated with Tehran University of Medical Sciences in Iran, who had been selected purposively and theoretically. Data were collected through semistructured, individual, and face-to-face interviews. MAXQDA software Version 18 was used for data management. Data validity was ensured according to the criteria of Lincoln and Guba (1985). RESULTS: The results revealed three main categories that encompassed both barriers (e.g., responsibility overload, organizational pressures) and protective factors (e.g., humanistic leadership, utilization of support resources), including organizational decision-making and leadership strategies, communication management and organizational interactions, and individual and organizational patterns in decision-making. Each of these categories consisted of two subcategories, including decision-making regulation and guidance, and humanistic management and leadership for the first category, activation of interaction and communication processes, and utilization of support resources for the second category, and finally independence and responsibility in decision-making, and organizational interest and commitment for the third category. CONCLUSION: Decision fatigue of nursing managers during the COVID-19 pandemic was shaped by a dynamic interplay of barriers and protective strategies. Clarifying these dual influences provides a coherent framework for understanding managerial decision-making under crisis conditions. Strengthening delegation, implementing decision pilots, and building organizational trust are effective strategies for reducing cognitive pressure and improving the quality of decision-making. Medical centers are suggested to reduce decision fatigue by addressing barriers such as organizational pressures and responsibility overload, while simultaneously strengthening protective factors such as supportive leadership, effective communication, and organizational trust.
Experiences of Newborn Fathers in Supporting Breastfeeding Based on the Social-Ecological System: A Qualitative Study.
Lin S, Huang Y, Chen S … +3 more , Wu M, Long H, Tian D
J Nurs Manag · 2026 · PMID 42366494 · Full text
BACKGROUND: Despite the irreplaceable benefits of breastfeeding, China's exclusive breastfeeding rate among infants under 6 months remains far below the WHO target of 50%. Fathers play a critical role in breastfeeding ou...
BACKGROUND: Despite the irreplaceable benefits of breastfeeding, China's exclusive breastfeeding rate among infants under 6 months remains far below the WHO target of 50%. Fathers play a critical role in breastfeeding outcomes, yet research exploring their experiences and challenges remains limited. AIM: To explore the experience of newborn fathers in supporting breastfeeding and provide a reference for developing an effective breastfeeding support system. METHODS: Based on the social-ecological system, this descriptive qualitative study was conducted from October to December 2024. Newborn fathers from the obstetrics department of a tertiary general hospital in Guangzhou were purposively sampled (N = 13) for semistructured interviews. Data were organized and analyzed using directed content analysis. RESULTS: A total of three themes and seven subthemes were extracted, including microsystem (newborn fathers' recognition and breastfeeding support but insufficient self-efficacy), mesosystem (the need for optimization of family support systems), and macrosystem (the need for improvement in sociocultural support systems). CONCLUSION: Newborn fathers recognize and support breastfeeding, but their low self-efficacy results in inadequate supportive behaviors. Multiple factors, such as individual knowledge and attitudes, family and workplace support, sociocultural influences, and public service systems, interact and influence each other. IMPLICATIONS FOR NURSING MANAGEMENT: Effective strategies to narrow fathers' attitude-behavior gap in breastfeeding include practical skill training, continuous daily support, family communication enhancement, workplace optimization, sociocultural guidance, and improved public services. Strengthening research and advocacy on paternal roles can further reduce fathers' burden and increase their participation, thereby promoting breastfeeding practices.
Nursing Leadership Styles and Moral Courage: The Mediating Role of Ethical Dilemma Identification and the Moderating Effects of Ethical Climate and Compassion Fatigue.
Xie M, Shao Z, Su H … +4 more , Long Q, Hashim NMHN, Rafi KN, Zou Y
J Nurs Manag · 2026 · PMID 42366492 · Full text
In healthcare organizations, ethical conduct is strongly influenced by nursing leadership. Although prior research has emphasized the role of leadership in shaping professional behavior, limited attention has been given...
In healthcare organizations, ethical conduct is strongly influenced by nursing leadership. Although prior research has emphasized the role of leadership in shaping professional behavior, limited attention has been given to how different leadership styles affect nurses' moral courage through ethical decision-making processes. This study examines the effects of three leadership styles-ethical, empowering, and authoritarian-on nurses' moral courage, with ethical dilemma identification as a mediator and perceived ethical climate and compassion fatigue as moderators. A cross-sectional survey was conducted among registered nurses in a Chinese tertiary hospital (N = 314). A moderated mediation model was tested using structural equation modeling. The results show that ethical and empowering leadership are positively associated with moral courage, whereas authoritarian leadership is negatively associated. These relationships are mediated by ethical dilemma identification, suggesting that leadership shapes moral courage by influencing nurses' recognition of ethical issues. Moreover, a supportive ethical climate strengthens the positive effects of ethical and empowering leadership, while compassion fatigue weakens these relationships. These findings highlight the critical role of leadership in promoting ethical practice in nursing. Practically, healthcare organizations should foster ethical and empowering leadership, strengthen ethical climates, and address compassion fatigue to enhance nurses' moral courage in clinical settings.
The Impact of Digital Healthcare Adoption and Service Quality on Patient Satisfaction: The Moderating Role of Telehealth Services in Pakistan.
Kanwel S, Ma Z, Jameel A … +5 more , Li M, Hussain A, Ge B, Hussain B, Ahmed S
J Nurs Manag · 2026 · PMID 42365466 · Full text
Digital services allow patients to efficiently access healthcare. These services work more effectively than traditional paper-based systems by delivering better patient outcomes, helping address global health challenges,...
Digital services allow patients to efficiently access healthcare. These services work more effectively than traditional paper-based systems by delivering better patient outcomes, helping address global health challenges, and promoting the universal adoption of health technology. This study examined the impact of digital healthcare adoption and service quality on patient satisfaction in Pakistan's public healthcare sector and the moderating effect of telehealth services on this relationship. This study adopted the technology acceptance model to understand technology sophistication and how electronic medical records, digital patient systems, and technology impact healthcare through efficiency and communication. Simultaneously, the study examined the role of doctor services, nurse services, pharmacy services, and laboratory services in the patient experience. Random sampling techniques were employed, and questionnaires were distributed to 573 respondents across five central districts of Punjab, Pakistan. The hypotheses were tested using IBM SPSS Statistics, Amos, and structural equation modeling. These findings show that digital healthcare adoption and service quality significantly improve patient satisfaction, whereas telehealth services reinforce these relationships by overcoming geographical and logistical hurdles. The conclusions of this study offer pragmatic guidance to policymakers and healthcare administrators for devising digital healthcare strategies to improve patient outcomes.
Integrating Workplace Learning Into Healthcare Settings: A Mixed-Methods Study to Inform Curriculum Design, Resource Allocation and Organisational Support.
Ho Y, Heng D, Zhou W … +3 more , Ang ENK, Chan YS, Siah CR
J Nurs Manag · 2026 · PMID 42365465 · Full text
INTRODUCTION: Postgraduate education is critical for advancing nursing competence, yet enrolment has declined as nurses struggle to balance clinical, academic and personal responsibilities. Workplace learning offers a fl...
INTRODUCTION: Postgraduate education is critical for advancing nursing competence, yet enrolment has declined as nurses struggle to balance clinical, academic and personal responsibilities. Workplace learning offers a flexible, context-driven alternative, allowing nurses to integrate academic development into their clinical practice and potentially mitigating work-life conflicts. However, adoption of structured workplace learning remains limited across healthcare organisations. AIM: This study aimed to explore how workplace learning can be integrated into healthcare settings to inform curriculum design, resource allocation and organisational support in postgraduate nursing education. DESIGN AND METHODS: An explanatory sequential mixed-methods study comprising a single-cohort quantitative pre-post knowledge assessment and repeated competence assessments, followed by qualitative focus groups to explain implementation enablers and barriers. Twenty-three postgraduate nurses enrolled in a 13-week workplace learning course participated; 22 completed the study. Quantitative data were analysed with nonparametric statistics, while qualitative data underwent thematic analysis. RESULTS: We observed a slight improvement in median knowledge scores and increasing competence scores across four time points. As this was a single-group evaluation without a control group, quantitative findings cannot be interpreted as causal effects. Qualitative analysis generated three themes: (1) learning and assessment, (2) integration of workplace learning in the organisation and (3) organisational impact on workplace learning. CONCLUSION: Workplace learning was feasible and valued when supported by peer learning structures, appropriately timed assessments and organisational enablers such as protected time, adequate infrastructure and leadership support.
Nurses' Experiences of Rebel Nurse Leadership in Psychiatric Care: A Qualitative Interview Study of Positive Deviance.
Gabrielsson S, Looi GE, Ahlblom A … +7 more , Genstrand YK, Björkdahl A, Östling J, Berg S, Lakso N, Larsson M, Salberg J
J Nurs Manag · 2026 · PMID 42365461 · Full text
Nurses play a key role in person-centered psychiatric care by supporting patient recovery, fostering independence, and building trusting relationships. However, organizational rules may conflict with nurses' ethical valu...
Nurses play a key role in person-centered psychiatric care by supporting patient recovery, fostering independence, and building trusting relationships. However, organizational rules may conflict with nurses' ethical values, leading to moral distress, burnout, and resignation. Drawing on the theory of positive deviance, previous research has identified how nurses may engage in positive rebel leadership, leading and practicing nursing in ways that diverge from prevailing norms, rules, codes of conduct, and workplace strategies. This study explores how such leadership in psychiatric care can support professional standards and improve patient outcomes. The aim was to describe nurses' experiences of rebel nurse leadership in psychiatric care. A qualitative descriptive design was employed, using semistructured individual interviews with 33 nurses experienced in psychiatric care. A qualitative content analysis and meta-synthesis were conducted, with the support of generative artificial intelligence in the synthesis process. The results describe nurses' experiences of rebel nurse leadership in psychiatric care as taking responsibility, guided by professional competence and an internal ethical compass; leading change and challenging hierarchies to enable holistic care that respects patients' rights and dignity; relying on the support of colleagues and management, while facing the risk of exclusion. The study shows how rebel nurse leadership, grounded in professional competence and ethical conviction, might support person-centered and high-quality psychiatric care. The findings illustrate how such leadership emerges in response to organizational norms that constrain nursing practice and frame acts of resistance as expressions of professional responsibility. The study emphasizes the importance of supporting nurses' autonomy to enable improvements in care quality and patient outcomes.
How to Adequately Report Workplace Violence in Healthcare Setting: A Systematic Review With Hierarchical Cluster Analysis of Workplace Violence Reporting Forms.
Yew SQ, Sharial MSZM, Yusoff HM
J Nurs Manag · 2026 · PMID 42365458 · Full text
INTRODUCTION: This review aimed to identify existing workplace violence (WPV) reporting forms worldwide, examine their domains and determine the essential information required to develop a more comprehensive and effectiv...
INTRODUCTION: This review aimed to identify existing workplace violence (WPV) reporting forms worldwide, examine their domains and determine the essential information required to develop a more comprehensive and effective WPV reporting form. MATERIALS AND METHODS: A systematic search of PubMed, Web of Science and Google Scholar from 1990 to 2025 was conducted. Data extracted included study characteristics, populations, reporting form names, number of items and reporting approaches. Descriptive analysis and hierarchical cluster analysis were performed to determine the number of items and domains included in each WPV reporting form. RESULTS: A total of 22 WPV reporting forms were included. Across these forms, 148 reporting items were identified and grouped into 13 domains: sociodemographic data of the victim, job characteristics of the victim, characteristics of the notifier, characteristics of the incident, characteristics of the injury, measures taken during the violence, consequences of the violence, postviolence treatment, aftermath of the violence, reporting of the violence, perception of victim postviolence, characteristics of the assailant and characteristics of the witness. Hierarchical cluster analysis classified the 22 WPV reporting forms into three clusters based on comprehensiveness: rapid forms (three items), brief forms (mean 13.75 items) and detailed forms (mean 27.77 items). CONCLUSIONS: Substantial variation exists in the content of WPV reporting forms. Future WPV reporting forms should, at minimum, include seven most commonly reported domains, particularly job characteristics of the victim, characteristics of the incident, characteristics of the injury, measures taken during the violence, characteristics of assailant, characteristics of the witness and reporting of the violence. IMPLICATIONS FOR NURSING MANAGEMENT: The findings highlight substantial variability in the content, structure and domains of existing WPV reporting forms used in healthcare institutions, indicating the need for standardised, evidence-based reporting tools that capture essential information relevant to nursing practice. Standardisation would improve comparability of WPV data across institutions and countries, facilitating more accurate benchmarking and global surveillance, particularly as nurses constitute the largest proportion of frontline healthcare workers. Additionally, nursing leaders, hospital administrators and health authorities can utilise these findings to strengthen institutional WPV policies by implementing clear and accessible reporting procedures and integrating domains related to prevention programmes, incident management and postincident support to guide policy development, staff training and resource allocation.
Leveraging Nursing Management for Sustainable Healthcare: The Synergistic Impact of Green Human Resource Management, Sustainable Waste Management Practices, and Environmental Innovation.
Tanchangya T, Das DC, Islam F … +2 more , Ali AHMM, Siddiqi KO
J Nurs Manag · 2026 · PMID 42365452 · Full text
AIM: This research explores the contribution of nursing management practices, particularly green human resource management (GHRM) and sustainable waste management (SWMP), to influence sustainable healthcare performance (...
AIM: This research explores the contribution of nursing management practices, particularly green human resource management (GHRM) and sustainable waste management (SWMP), to influence sustainable healthcare performance (SP) in hospitals in Bangladesh. The environmental innovation (EI) serves as a mediator. This study particularly focuses on nurse managers' leadership in adopting these practices to enhance hospital sustainability outcomes. DESIGN: A cross-sectional quantitative study. METHODS: We use purposive sampling to gather data. 388 nurses willingly participate in this work from five hospitals in Bangladesh. We also utilized validated Likert-scale tools to assess GHRM, EI, and SP. The partial least squares structural equation modeling (PLS-SEM) and necessary condition analysis (NCA) are employed to measure both direct and mediating effects. RESULTS: The research finds that nursing management practices, particularly GHRM and SWMP, have a strong and significant impact on SP in healthcare. EI has a strong correlation with GHRM and SP. The outcomes suggest the crucial contribution of nurse managers in implementing these practices to increase sustainability outcomes. CONCLUSION: Nursing management practices, including targeted HRM strategies and waste management initiatives, are crucial for enhancing sustainable practices in healthcare. It is evident that nurse managers can play a key role in adopting and successfully applying these practices, which ultimately increase SP. Although GHRM has a direct correlation with SP, it has minimal influence via EI. Conversely, SWMP significantly benefits from nurse-led EI, which ultimately improves sustainable healthcare outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers have a crucial contribution to incorporating GHRM and SWMP into daily healthcare practices. Nurse managers can mitigate harmful environmental footprints through eco-friendly innovation, sustainability training, and empowerment of nurses in decision-making processes. These initiatives boost operational efficiency and assist in achieving the sustainable development goals (SDGs). These efforts also enhance patient care, particularly in resource-limited settings.
The Mediating Role of Job Rotation Between Clinical Leadership Skills and Clinical Decision-Making Among Jordanian Nurses.
Alzamel LG, Jallad ST, Alsaqer K … +1 more , Alghabbashi MT
J Nurs Manag · 2026 · PMID 42363792 · Full text
BACKGROUND: Nurses in resource-limited settings like Jordan require strong leadership and clinical judgment. Job rotation is believed to improve adaptability and self-efficacy, but its effect on clinical decision-making...
BACKGROUND: Nurses in resource-limited settings like Jordan require strong leadership and clinical judgment. Job rotation is believed to improve adaptability and self-efficacy, but its effect on clinical decision-making is unclear. PURPOSE: This study aimed to examine whether job rotation mediates the relationship between clinical leadership skills and clinical decision-making among nurses. METHODS: A cross-sectional correlational study was conducted among 395 registered nurses employed in Jordanian governmental hospitals. Participants were recruited using a proportional random sampling technique. Data were collected using validated questionnaires assessing clinical leadership skills, job rotation, and clinical decision-making. Statistical analyses, including ANOVA and regression analysis, were performed to examine relationships among the study variables. Structural equation modeling (SEM) was additionally used to assess mediation effects. FINDINGS: The results showed significant differences between clinical decision-making and gender, marital status, and educational level. Clinical leadership significantly predicted decision-making (β = 0.433, 95% CI [0.331, 0.535], t = 8.226, p < 0.001). In contrast, job rotation indicated no significant direct effect (β = 0.000, 95% CI [-0.052, 0.051], t = -0.010, p = 0.992) and did not mediate the relationship between leadership and decision-making (β = 0.008, 95% CI [-0.041, 0.057], t = 0.325, p = 0.745). CONCLUSION: Leadership skills were significantly associated with nurses' clinical decision-making, and leadership development may play a more substantial role in clinical decision-making than job rotation within this sample. IMPLICATION FOR NURSING MANAGEMENT: Job rotation implementation has to be intentional, by putting real effort into structured training, mentoring, and embedding workplace learning into daily routines, which improves decision-making quality, increases professional confidence, and ultimately enhances patient outcomes.
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