Impacts of Hematologic Cancer Ward Nurses' Professional Autonomy, Role Conflict and Nursing Work Environment on Clinical Decision-Making Ability

This study aimed to identify the effects of nurses' professional autonomy and work environment on patient safety in general hospitals. By understanding this relationship, we sought to identify practical measures to improve patient safety in the healthcare context. Professional autonomy and nursing work environments have positive effects on job performance, job satisfaction, and patient outcomes. Data were collected from 200 nurses working in general hospitals, using a cross-sectional survey design. The survey was conducted in 2021 using self-report questionnaires that included the Nursing Work Environment Scale and items on professional autonomy and patient safety activities. The total professional autonomy score was 162.06 (range: 60-240). The mean scores of nursing work environment and nurses' patient safety activities were 2.55 out of 4 and 4.22 out of 5, respectively. Multiple regression analysis revealed that professional autonomy (β = 0.234 and p=0.001) and nursing work environment (β = 0.138 and p < 0.05) were identified as variables that had significant effects on patient safety activities. Among the independent variables, professional autonomy had the greatest influence on patient safety. The findings confirm the need to improve and find ways to enhance nurses' professional autonomy and nursing work environment. Implications for Nursing Management. The findings confirm the need to improve and find ways to enhance nurses' professional autonomy and the nursing work environment. Based on these findings, medical institutions and nursing managers should continue to make efforts to improve the nursing work environment to enhance patient safety, especially system improvements, expand nurse autonomy within medical institutions, strengthen hospital management support to evaluate its effectiveness, and further improve government-level policies and systems.

Purpose: This study is a descriptive study that aimed to examine relationship among such factors as self-concept, clinical decision-making ability, critical thinking disposition, and professional autonomy of nursing professionals and to present basic data necessary for mapping out strategies vital for improving autonomy of nursing professionals. Methods: For this study, a survey was conducted of 213 professional nurses working at Region A and Region D, respectively, who were selected based on convenience sampling. The collected data analyzed through t-test, ANOVA, Pearsons correlation coefficients and Stepwise multiple regression analysis. Results: The results of this study showed that the mean score on professional autonomy was 158.3 which corresponded to an intermediate level of autonomy. The factors influencing professional autonomy the most were found to be in the order of self-concept, clinical decision-making ability, and critical thinking disposition, and the explainability was 46.0%. Conclusion: Thus, it is considered urgent to map out strategies conducive to increasing self-concept, clinical decision-making ability, and critical thinking disposition of professionals as prerequisite for improving autonomy of nurses.

Clinical decision-making by intensive care unit nurses is vital for ensuring patient safety. It is hypothesized that professional autonomy and interprofessional collaboration are determinants that influence the quality of decision-making; however, empirical evidence supporting this hypothesis within Iranian intensive care unit settings remains limited. To examine the correlations between perceived autonomy, nurse-physician collaboration, and clinical decision-making ability among intensive care unit nurses. This study employed a cross-sectional design, with 400 intensive care unit nurses from two university hospitals in Tehran completing validated Persian versions of the P-AITCS-II, the Dempster/DPBS, and the Lauri & Salanterä instruments to measure interprofessional collaboration, professional autonomy, and clinical decision-making, respectively. We followed STROBE reporting recommendations. Descriptive statistics characterized the sample and scale scores. Bivariate associations were assessed using correlation and group-comparison tests, and multiple linear regression was employed to estimate the independent associations of autonomy and collaboration with decision-making after adjusting for relevant covariates. Ethical approval and informed consent were obtained. The study sample comprised 400 participants, with a mean age of 33.19 years (SD = 5.67). In bivariate analyses, higher perceived autonomy and greater interprofessional collaboration were positively associated with better clinical decision-making (p < 0.05). In multivariable linear regression models that included covariates, perceived autonomy and interprofessional collaboration remained independent predictors of decision-making ability (p < 0.05). The entire model explained approximately 14.2% of the variance in decision-making, suggesting that additional determinants may influence nurses' decision-making processes. The total mean score of the participants was classified at an intuitive-analytic decision-making level, indicating a combined reliance on experience-based intuition and structured analytic processes. Among the intensive care unit nurses within this sample, higher perceived professional autonomy and enhanced interprofessional collaboration were independently correlated with improved self-reported clinical decision-making capabilities. Given the cross-sectional nature of the study, causality cannot be established. Longitudinal research employing objective performance metrics is necessary to examine causal relationships and to guide organizational strategies that foster both autonomy and collaborative practice.

BackgroundClinical decision-making by intensive care unit nurses is vital for ensuring patient safety. It is hypothesized that professional autonomy and interprofessional collaboration are determinants that influence the quality of decision-making; however, empirical evidence supporting this hypothesis within Iranian intensive care unit settings remains limited.ObjectiveTo examine the correlations between perceived autonomy, nurse–physician collaboration, and clinical decision-making ability among intensive care unit nurses.MethodsThis study employed a cross-sectional design, with 400 intensive care unit nurses from two university hospitals in Tehran completing validated Persian versions of the P-AITCS-II, the Dempster/DPBS, and the Lauri & Salanterä instruments to measure interprofessional collaboration, professional autonomy, and clinical decision-making, respectively. We followed STROBE reporting recommendations. Descriptive statistics characterized the sample and scale scores. Bivariate associations were assessed using correlation and group-comparison tests, and multiple linear regression was employed to estimate the independent associations of autonomy and collaboration with decision-making after adjusting for relevant covariates. Ethical approval and informed consent were obtained.ResultsThe study sample comprised 400 participants, with a mean age of 33.19 years (SD = 5.67). In bivariate analyses, higher perceived autonomy and greater interprofessional collaboration were positively associated with better clinical decision-making (p < 0.05). In multivariable linear regression models that included covariates, perceived autonomy and interprofessional collaboration remained independent predictors of decision-making ability (p < 0.05). The entire model explained approximately 14.2% of the variance in decision-making, suggesting that additional determinants may influence nurses’ decision-making processes. The total mean score of the participants was classified at an intuitive–analytic decision-making level, indicating a combined reliance on experience-based intuition and structured analytic processes.ConclusionsAmong the intensive care unit nurses within this sample, higher perceived professional autonomy and enhanced interprofessional collaboration were independently correlated with improved self-reported clinical decision-making capabilities. Given the cross-sectional nature of the study, causality cannot be established. Longitudinal research employing objective performance metrics is necessary to examine causal relationships and to guide organizational strategies that foster both autonomy and collaborative practice.

Purpose: This study aimed to explore professional autonomy, nursing work environment, and clinical decision making ability and to determine predictors of clinical decision making ability among clinical nurses. Methods: A cross-sectional design was used in this study and 263 clinical nurses were selected from advanced-level hospitals with over 500 beds located in D metropolitan city. Independent t-test, ANOVA, Pearson's correlation coefficients and hierarchical multiple regression analyses were done with the SPSS/WIN 20.0 program. Results: Clinical nurses reported moderate levels of professional autonomy, nursing work environment and clinical decision making ability. Marital status, professional autonomy and nursing work environment accounted for 25% of variance in clinical decision making ability required in various clinical settings. Importantly, being married, higher level of professional autonomy, and greater satisfaction with work environment were significantly associated with better decision making ability. Conclusion: Findings indicate that improving the quality of decision making in the healthcare settings requires awareness of the multiple effects of individual, occupational and environmental features. Nurses' ability to make effective clinical decisions may rely on personal characteristics, the degree of autonomy in their job, and nurses' satisfaction with their work environment.

The coronavirus disease 2019 (COVID-19) outbreak led to a massive influx of patients into hospitals, thus prompting the implementation of various response mechanisms to manage the surge in number of patients. During the mitigation period, hospital response mechanisms ceased and ensued a return to normal settings. However, changing hospital settings can affect nurses' work environments. Therefore, the primary objectives of this study were to investigate the impact of changes during disease outbreaks and the mitigation period on nurses' work environments, and to analyse the relationship between nurses' background variables and work environments. A longitudinal research design is employed herein. Two surveys were conducted in a hospital: the first during the COVID-19 outbreak period, when the hospital implemented response mechanisms, and the second during the COVID-19 mitigation period, when the hospital returned to normalcy. The questionnaire covered the nurses' background variables and work environment. When the COVID-19 outbreak transitioned to the mitigation period, satisfaction with managerial (p < 0.05) and unit support (p < 0.05) in the workplace decreased. Regarding the relationship between nurses' backgrounds and work environment satisfaction, we found that nurses working in COVID-19 dedicated units reported higher satisfaction with manager support (p < 0.001), peer support (p < 0.001), unit support (p < 0.05) and intent to stay (p < 0.05) than those in non-COVID-19 dedicated units. Additionally, factors such as age, nursing experience, sex, education, clinical teaching/mentoring roles, perceived COVID-19 infection risk, work shifts, housing problems during the outbreak and experience of discrimination influenced work environment satisfaction. Hospitals need to adjust the transformational steps of their COVID-19 or emerging infectious disease response mechanisms, or provide sufficient support to these nurses to mitigate the impact on their work environment.

Purpose: This study aimed to investigate the levels and correlations of role conflict, nursing professionalism, nursing work environment and retention intention, and the factors influencing retention intention of nurses at long-term care hospitals. Methods: The subjects included 183 nurses at nine long-term care hospitals in one metropolitan city in Korea. A set of self-reported questionnaires was administered to assess general characteristics, role conflict, nursing professionalism, nursing work environment, and retention intention of the subjects. Collected data was analyzed using descriptive statistics, t-tests, one-way ANOVA, Pearson correlation coefficients, and multiple linear regression. Results: 183 subjects with a mean (±SD) age of 41.66 (±12.29) years were included in the final analyses. Retention intention had a significant positive correlation with nursing professionalism (r=.39, p<.001) and nursing work environment (r=.51, p<.001). Nursing work environment had a significant negative correlation with role conflict (r=-.30, p<.001) and a significant positive correlation with nursing professionalism (r=.48, p<.001). In the final multiple regression analysis, the factors influencing retention intention of subjects were number of beds (β=-.15 p<.026), nursing professionalism (β=.19, p=.007) and nursing work environment (β=.36, p<.001). The explanatory power of number of beds, nursing professionalism and nursing work environment on retention intention was 34.0% (F=16.66, p<.001). Conclusion: Improving nursing professionalism and nursing work environment of nurses at long-term care hospitals will ultimately enhance their retention intention and positively impact on the quality of gerontological nursing service.

To identify and examine the relationship between the factors influencing the decision-making ability of clinical nurses in hospitals, South Korea, and to establish a model, to verify the fit and the effect. Clinical nurses are exposed to environments and situations where they make continuous decisions according to the need of direct treatment and nursing. This study used a cross-sectional descriptive design, relation prediction modelling and adheres to the STROBE guidelines. The model construction was based on the information processing theory by Hansen and Thomas (Nursing Research, 17, 436, 1968). The model consists of 5 exogenous variables (expertise, critical thinking disposition, knowledge-sharing behaviour, nursing work environment, and decision-making stress) and 3 endogenous variables (analytic-systematic decision-making type, intuitive-interpretive decision-making type and decision-making ability). Participants were 274clinical nurses, who were working at two hospitals in Seoul, South Korea. The data was analysed using SPSS WIN 18.0 and AMOS 20.0 program. Path analysis to verify the hypothetical model was used, and the fit was evaluated by χ2 /df, GFI, AGFI, NFI, CFI and RMSEA. Data were collected from March to May 2017. The fit index of the modified path model was χ2 /df = 2.25, GFI = .972, AGFI = .929, NFI = .967, CFI = .981 and RMSEA = .068. The analytic-systematic decision-making type had the greatest direct effect on the clinical nurses' decision-making ability, which is the final outcome variable, followed by significant direct and indirect effects on critical thinking disposition. This study suggests that the clinical nurses' decision-making ability in hospitals were leadingly influenced by analytic-systematic decision-making type and critical thinking disposition. In the nursing practice, nurses need to pay attention the analytic-systematic decision-making type and critical thinking disposition for improving decision-making ability of clinical nurses in hospitals.

The current study aimed to assess relationships among role conflict, nursing professionalism, nursing work environment, and retention intention of nurses at long-term care (LTC) hospitals. Participants comprised 183 nurses at nine LTC hospitals located in Busan, Korea. Data were collected using a structured self-report questionnaire and analyzed using descriptive statistics, t test, one-way analysis of variance, Pearson's correlation coefficient, and multiple linear regression. Retention intention had a signifi-cant positive correlation with nursing professionalism (r = 0.39, p < 0.001) and nursing work environment (r = 0.51, p < 0.001). Nursing work environment had a significant negative correlation with role conflict (r = -0.30, p < 0.001) and a significant positive correlation with nursing professionalism (r = 0.48, p < 0.001). In the final multiple regression analysis, factors influencing retention intention of participants included number of beds (β = -0.15 p < 0.026), nursing professionalism (β = 0.19, p = 0.007), and nursing work environment (β = 0.36, p < 0.001). The explanatory power of number of beds, nursing professionalism, and nursing work environment on retention intention was 34% (F = 16.66, p < 0.001). Improving nursing professionalism and nursing work environment of nurses at LTC hospitals will ultimately enhance their retention intention and positively impact the quality of gerontological nursing care. [Journal of Gerontological Nursing, 47(10), 44-53.].

This study study aimed to investigate the effects of explicit and tacit knowledge sharing on clinical decision-making abilities and the mediating role of trust among registered nurses at Korean hospitals. Decision-making abilities comprise a key area of nursing practice and link nurses' perceptions with behaviours. Tacit knowledge is embedded within an individual and cannot be expressed or transmitted to other people in a specific form. Over time, new nurses gradually gain experience and tacit knowledge and become experts. Trust, an organizational characteristic, may serve as a potential mediator in the association between knowledge sharing and decision-making abilities among nurses. However, few studies have investigated the mediatory role of trust in this association. The data were collected from 210 nurses selected via random sampling. The research instrument in the model included Knowledge-Sharing Behavior, Trust, and Clinical Decision-Making in Nursing Scale. Structural equation modelling was used to analyse the collected data. The study findings showed that explicit knowledge sharing directly affects decision-making abilities, whereas tacit knowledge sharing is only associated with decision-making abilities when trust plays a mediating role. A higher level of organizational trust can improve clinical decision-making abilities via tacit knowledge sharing. This study demonstrated that unlike explicit knowledge, which is shared more easily, tacit knowledge sharing does not directly lead to clinical decision-making abilities. A higher level of organizational trust leads to a stronger beneficial effect of tacit knowledge sharing on clinical decision-making abilities. These findings concerning the mediatory role of trust on the association between knowledge sharing and clinical decision-making abilities provide new knowledge that will allow nurses, managers, and researchers to support the clinical decision-making abilities of nurses.

Background: With the increase emphasis on high quality of health care and professional development, work autonomy continues to be an essential aspect of the work environment for nurses' satisfaction and recognition. Aim: The present study aimed to assess the relationship between professional autonomy and job satisfaction among staff nurses. Material and methods: A descriptive correlational study was used with a sample of (240) staff nurses. The data were collected by using two tools; professional autonomy scale and job satisfaction questionnaire. Results: The results revealed that 43.0% of nurses had low autonomy level followed by 34.2% had high autonomy. Also, it was observed that 56.0% of nurses were satisfied. Conclusion: It was concluded that there was a highly statistically significant positive correlation between the professional autonomy level and job satisfaction level among staff nurses. Recommendation: So, the findings pointed for upgrading nurses' clinical decision making through educational programs and more advanced strategies in clinical areas to enhance job satisfaction and professional autonomy.

The purpose of this study is to discover how occupational burnout influences the health status of emergency nurses and to investigate the mediation effect of work-family behavior role conflict. A multi-center cross-sectional study. A questionnaire survey of 1,540 emergency nurses from 30 tertiary hospitals in China was conducted between December 26, 2023, and January 18, 2024. Using an online questionnaire, we performed a cross-sectional survey to collect demographic data and information about occupational burnout, work environment, work-family behavior, role conflict, and emergency nurses' health status. The PROCESS macro for SPSS 26.0 was used to analyze the moderated mediation model, and the bootstrap approach was used to investigate the mediating effects. The findings revealed that 57.3% of the nurses had experienced occupational burnout. A substantial positive association was identified between professional burnout, work-family behavior role conflict, and somatic symptoms (r = 0.493, 0.534; p < 0.001). Occupational burnout was found to be a significant predictor of somatic symptoms, with work-family conflict serving as a mediator (β = 0.616, t = 13.295, R 2 = 0.488, p < 0.01). Our research found that nurses' work environment mediated the association between burnout and work-family behavior role conflict (β = 0.007, t = 3.647, p < 0.01), indicating that a positive work environment may reduce the impact of burnout on family role conflict. Work-family behavioral role conflict and the nursing work environment were found to partially mediate the association between occupational burnout and the health outcomes of emergency nurses. These findings suggest that, while interventions aimed at mitigating work-family role conflict and improving the work environment are essential, they may not be sufficient on their own to safeguard nurses' health. Additional strategies are needed to comprehensively address the health risks associated with occupational burnout. Moreover, the interplay among burnout, work-family conflict, and environmental factors underscores the necessity of integrated and multifaceted intervention approaches to alleviate the health burden experienced by emergency nurses effectively.

This paper is a report of a study conducted to describe Greek critical care nurses' views on professional autonomy and its relationship with job satisfaction and other work-related variables. Professional autonomy is generally considered a highly desirable nursing attribute and a major factor in nurse job satisfaction. In the critical care environment, a high level of accountability, responsibility and autonomy are required to optimize outcomes of critically unstable patients. A questionnaire survey was conducted with a convenience sample of Greek critical care nurses (n = 431; response rate 70%) in 2007. Data were collected on professional autonomy, job satisfaction, role conflict and role ambiguity. Overall, nurses reported acting moderately autonomously. Younger nurses reported statistically significant lower levels of autonomy. Higher levels of autonomy were reported by female nurses. Multiple logistic regression revealed that appointment level, type of critical care unit and registration with a professional organization were independently associated with autonomy. A positive moderate association was found between reported autonomy, job satisfaction, role conflict and role ambiguity, but there was no relationship between job satisfaction and reported role conflict and role ambiguity. Further education, role enhancement and support are required for nurses working in critical care in Greece if they are to achieve the maximum potential of their professional role. Failure to address the perceptions of professional autonomy may have an impact on staff retention, because of job dissatisfaction.

This study is a descriptive research study to understand the relationship between professional autonomy, moral distress, and nursing performance of nurses working in cancer wards, and to identify factors affecting nursing performance of nurses in cancer wards. The subjects of the study were conveniently extracted from 180 nurses with more than 6 months of experience in nursing cancer patients receiving chemotherapy treatment at a university hospital in Gyeonggi-do. The data collection period was from July 11, 2022 to July 29, 2022, when the clinical research review committee of the medical institution where the study was conducted, and a self-fill survey was conducted by distributing structured questionnaires. The collected data were analyzed using the SPSS window 21.0 statistical program. The reliability of the measurement tool was analyzed using Cronbach's alpha. The general characteristics of the subject, the subject's professional autonomy, moral distress, and nursing performance were analyzed by technical statistics. Professional autonomy, moral distress, and nursing performance according to the general characteristics of the subject were analyzed by t-test and ANOVA, and post-test was analyzed by Scheffé test. The factors influencing professional autonomy and moral distress on nursing performance were analyzed using regression analysis. As a result of the study, the subject's professional autonomy was 2.65 points out of 5, moral distress was 2.83 points, and nursing performance was 3.75 points. As a result of analyzing professional autonomy, moral distress, and nursing performance according to general characteristics such as gender, marital status, religious status, position, and total clinical experience, there was no statistically significant difference in professional autonomy. Nurses over the 3rd year were found to have higher moral distress than nurses under 1~3 years, and nursing performance was higher when married, responsible nurse or more, and when total clinical experience was more than 5 years. As a result of verifying the regression model to confirm the factors affecting the subject's nursing performance, it was statistically significant, and the total explanatory power was 23.8%. Clinical experience and professional autonomy were significant influencing factors on nursing performance. Based on the results of this study, a strategy is needed to develop and support individual nurses' nursing capabilities through the development of a career development system within the nursing organization to improve the nursing performance of cancer ward nurses. These efforts will have a positive effect on the management of human resources of nursing organizations as well as on the improvement of nursing performance of nurses in cancer wards.

Purpose : The purpose of this study was to identify the mediating effect of role clarity in the relationship between clinical decision-making abilities and job stress among advanced practice nurses at tertiary hospitals.Methods : The participants were 137 advanced practice nurses. The assessment tools were clinical decisionmaking in nursing scale, role ambiguity scale, and Korean occupational stress scale (KOSS-26). Data were analyzed with the SPSS/24.0 program and mediation analysis was performed according to the Baron and Kenny methods.Results : There were significant relationships between clinical decision-making abilities and job stress (r=-.33, &lt;i&gt;p&lt;/i&gt;&lt;.001), and role clarity and job stress (r=-.29, &lt;i&gt;p&lt;/i&gt;=.001). Role clarity showed partial mediating effects in the relationship between clinical decision-making abilities and job stress (Z=2.02, &lt;i&gt;p&lt;/i&gt;=.043).Conclusion : Therefore, to reduce advanced practice nurses’ job stress, it is necessary to develop a program and strategies to increase their clinical decision-making abilities.