Clinical Nurses Research Articles

Knowledge, Attitudes, and Practices of Oncology Nurses in the Maintenance of Peripherally Inserted Central Catheter (PICC) in Selected Hospitals in Shandong Province China

Background: Standardized catheter maintenance by nurses can reduce complications. Understanding the knowledge, attitude and practice status of clinical nurses in PICC maintenance is of great practical significance for medical and health development. Objective: To describe the current knowledge, attitude and practice (KAP) of nurses on peripheral central catheterization (PICC) maintenance. Methods: The knowledge, attitude and behavior of PICC maintenance of 317 oncology nurses in Shandong Province were analyzed by questionnaires. The counting data were described by frequency and percentage. The influence factors of PICC maintenance knowledge, attitude and behavior were determined by independent sample t test and one-way analysis of variance. Results Gender, age, professional title, education level, work experience, PICC training experience and PICC certificate are all significant factors affecting PICC maintenance knowledge, attitude and behavior. In the dimension of PICC maintenance knowledge, 212 nurses (mean = 10.00, SD=1.26) were proficient in PICC maintenance knowledge, while 105 nurses (mean = 16.60, SD=1.34) were obviously lacking in PICC maintenance knowledge. In the dimension of PICC maintenance attitude, the average score of nurses' PICC maintenance attitude was 52.92+10.34 points, and 228 nurses (mean = 58.86, SD=4.67) had a positive attitude towards PICC maintenance. The average score of nurses' PICC maintenance practice was 62.03+13.00, 64% of nurses had good PICC maintenance practice ability, and 203 nurses (mean =71.33, SD=4.76) had good PICC maintenance practice ability. Discussion In conclusion, the knowledge, attitude and practice of PICC maintenance of oncology nurses in Shandong Province were all at a moderate level. The role of demographic factors on PICC maintenance was paid attention to, and the training on PICC maintenance was emphasized, and the knowledge level, attitude cognition and practical ability of nurses on PICC maintenance were improved through diversified training methods.

Strengthening psychological well-being of Indonesian females with breast cancer through the religious-based caring program: A quasi-experimental study among Muslim population.

Breast cancer presents significant psychological challenges along with physical health concerns, particularly in settings where cultural and spiritual values play a critical role in patient care. This study aimed to investigate the effect of a religious caring program on the psychological well-being of Indonesian females with breast cancer. This was a quasi-experimental study with a pretest and posttest control group design, conducted from January to July 2019 at a chemotherapy unit in Bandung, Indonesia. The patients with breast cancer were assigned to the experimental group (n = 55) and the control group (n = 57). Data were collected using the Psychological Well-Being Scale before and three weeks after the intervention. The data were analyzed using independent t-test and ANCOVA (Analysis of Covariance). There was a significant improvement in the mean psychological well-being score in the experimental group following the intervention compared to the control group, with the experimental group showing a significantly higher mean score (Cohen's d = 1.4548, p <0.001). None of the covariates significantly affected psychological well-being among the experimental group (p >0.05). These results indicate that a religion-based caring program enhances psychological well-being. Thus, the program was effective and particularly well-suited for clinical nurses, suggesting that it should be recommended for Indonesian females with breast cancer to promote their recovery.

Knowledge levels of oncology nurses regarding evidence-based practices in the assessment and management of chemotherapy-induced peripheral neuropathy

ObjectiveThe study aimed to determine the level of oncology nurses' knowledge of evidence-based practice for assessing and managing chemotherapy-induced peripheral neuropathy (CIPN). MethodsThis study employed a descriptive and cross-sectional research design. It was carried out with oncology nurses who were working at a university hospital in the Western Region of Turkey and who were members of the Oncology Nursing Association. The sample of the study consisted of 96 nurses who met the inclusion criteria. ResultsThe study sample comprised 94.8% female oncology nurses, 57.3% of whom held an undergraduate degree, and over half (58.5%) of whom were employed as clinical nurses. A majority of nurses (76.0%) indicated that they had not received any training in peripheral neuropathy. 35.4% of the nurses assessed patients receiving neurotoxic chemotherapy for peripheral neuropathy at each visit/each chemotherapy cycle. A total of 43.8% of nurses indicated that they frequently assessed patients for peripheral neuropathy at the conclusion of the treatment protocol. The oncology nurses assessed the patient-reported symptoms of motor neuropathy (58.3%), sensory neuropathy (56.3%), autonomic neuropathy (51.0%), neuropathic pain (55.2%), and co-occurring symptoms (52.1%) on a frequent basis. The nurses reported that they assessed muscle strength (56.3%), gait and balance (58.3%), and quality of life (52.1%) “frequently”. In contrast, they assessed deep tendon reflex (41.7%), neurological tests (36.5%), and social activities (46.8%) “rarely”. ConclusionsThe study findings indicated that oncology nurses require further education and training in evidence-based practices for the assessment and management of CIPN.

Nursing Student's Perceptions of the Clinical Learning Environment, Supervision and Nurse Teacher: A Cross-Sectional Study

Nursing Student's Perceptions of the Clinical Learning Environment, Supervision and Nurse Teacher: A Cross-Sectional Study

Nurses' burnout and patient safety culture: The moderating effect of structural empowerment.

To identify correlations among job burnout, structural empowerment, and patient safety culture (PSC), and to explore the potential moderating effect of structural empowerment on the associations between burnout and PSC. The study used a cross-sectional survey design. Convenient sampling was employed. We conducted an anonymous online survey in January 2024 among nurses employed at hospitals in three regions of China. Job burnout, structural empowerment, and perceptions of PSC were assessed. A total of 1026 useable surveys were included in the analyses. Descriptive statistics were performed using SPSS software. A latent structural equation modeling approach using Mplus software was used to analyze the moderating effect. The proposed hypothetical model was supported. Job burnout had a strong direct negative effect on structural empowerment and PSC. Structural empowerment had a significant moderating effect on the relationship between job burnout and PSC. The empirically validated moderation model and study results suggest that managers of healthcare organisations can improve patient safety and care quality by fostering empowerment and providing sufficient support to clinical nurses. The findings of this study suggest that providing more support, resources, and information is likely to be effective in weakening the detrimental impact of job burnout on PSC. This study provides insights into the possible approaches that may improve patient safety. To control the impact of nurses' burnout on care quality, nurse managers should increase empowerment as well as staff nurse engagement. We have adhered to relevant EQUATOR guidelines and conducted an observational study, following the STROBE checklist. During the data collection phase of this study, clinical caregivers participated in completing the online survey.

Determinants of clinical nurses’ patient safety competence: a systematic review protocol

IntroductionPatient safety has become a fundamental element of healthcare quality. However, despite the ongoing efforts of various organisations, patient safety issues remain a problem in the healthcare system. Given the...

Development of best performance evaluation indicators based on value-based healthcare for general hospital nursing: A Delphi study.

To establish and validate a set of best nursing practice indicators for medical groups in Chinese general hospitals based on value-based healthcare (VBHC) theory. A modified Delphi method. This study engaged experienced clinical nurses from public hospitals and multidisciplinary experts in operations management. Through a literature review and structured brainstorming, a comprehensive framework for assessing best nursing practices in Chinese general hospital medical groups was developed. A modified Delphi method was then employed to establish an indicator framework, followed by the Combined Empowerment-MABAC method to weight and validate the indicators using empirical data collected between June 2023 and October 2023. The CREDES checklist guided the reporting of this study. Sixteen experts, each with at least 10 years of experience in nurse management from nine healthcare organizations, participated in two rounds of consultation. The experts' responses and suggestions for rewording, deleting and adding items were incorporated into each round. Of the 34 proposed indicators, 25 were approved, covering healthcare service capacity, efficiency, quality and safety, patient experience and cost. The Delphi survey reached a consensus on necessary actions to improve nursing performance. The developed indicator system provides a foundational framework for standardizing the monitoring of care quality and performance assessment in Chinese clinical healthcare groups, with broad applicability. This study provides a reliable basis for developing a nursing performance assessment database, offering crucial insights for measuring quality of care and improving patient value. No Patient or Public Contribution.

The relationships among factors affecting compassion fatigue, compassion satisfaction, and burnout in Japanese nurses: A cross-sectional study.

This study aimed to investigate the relationships among factors affecting compassion fatigue/secondary traumatic stress, burnout, and compassion satisfaction in Japanese nurses, focusing on self-compassion, fears of compassion, and attachment styles. This cross-sectional observational study enrolled 400 clinical nurses (aged ≥20 years) in Japan, registered with an online survey company, from June 6 to June 26, 2021. The subjects completed a web-based questionnaire that assessed compassion fatigue/secondary traumatic stress, burnout, compassion satisfaction, self-compassion, fears of compassion for self, anxiety, and avoidance. Additionally, descriptive statistics, correlation analysis, multiple regression analysis and path analysis were performed to examine the relationships among the influencing factors. Compassion fatigue/secondary traumatic stress was influenced by anxiety and fears of compassion for self (R2 = .31). Burnout was affected by compassion fatigue/secondary traumatic stress, compassion satisfaction, self-compassion, anxiety, and avoidance (R2 = .63). Compassion satisfaction was impacted by self-compassion, anxiety, and fears of compassion for self (R2 = .31). Additionally, self-compassion (R2 = .28) and fears of compassion for self (R2 = .55) were influenced by anxiety and avoidance. Compassion fatigue/secondary traumatic stress leads to burnout, whereas compassion satisfaction moderates burnout. Furthermore, there were associations among the factors leading to compassion fatigue/secondary traumatic stress and burnout and compassion satisfaction. Therefore, an approach that enhances self-compassion and promotes the development of a stable attachment style could mitigate compassion fatigue/secondary traumatic stress and fears of compassion for self while moderately maintaining and improving compassion satisfaction.

RETRACTED: Development and evaluation of a second victim training course for nursing managers

BackgroundMost nursing managers are not fully aware of second victims and may not be able to provide support. Moreover, there are relatively few training courses for nursing managers about second victims. AimTo describe the construction and evaluation of a second victim course for nursing managers. DesignA single-group pretest–posttest study design was used. SettingA large comprehensive tertiary hospital with over 3000 beds in China. ParticipantsForty-nine nursing managers who met the inclusion and exclusion criteria participated in this training. Sixteen clinical frontline nurses who experienced adverse events within three months following the training were also invited. MethodsThe course “Second Victim & Empathy Communication” was developed through a literature review and expert consultation and consisted of 4 unit modules: (1) adverse events & second victims, (2) the recovery trajectory of second victims, (3) second victim supportive resources, and (4) key strategies of empathy communication. A course evaluation questionnaire, an empathy communication questionnaire for nursing managers, a second victim evaluation questionnaire, and an open-ended question were used to measure the feasibility, acceptability and effectiveness of the course. Results>97.96 % of the nursing managers were satisfied with the course, >97.96 % had learned new knowledge, and >95.92 % had changed their behavior and attitudes toward second victims. Their levels of empathetic communication differed significantly before and after training (t = −2.170, P = 0.035). Among these nursing managers, twenty-six participants provided positive and meaningful feedback and suggestions to the course by answering an open-ended question. A total of 66.6 % to 100 % of second victims were satisfied with the empathetic communication behavior exhibited by nursing managers. ConclusionThe second victim training course is feasible and can be used for clinical training to enhance nursing managers' understanding of second victims and enhance their empathetic communication.

The TERCAP Tool: Investigation of Nursing Errors in Greek Hospitals

Background: Errors are a common occurrence in all healthcare settings, and the safety of patients is a critical concern that involves multiple factors, including the complex and demanding nature of nursing practice. Nurses, due to their continuous and direct patient care, play a pivotal role in ensuring patient safety. This cross-sectional study aimed to investigate the factors that contribute to errors from the perspectives of nurses in Greek hospitals, with a focus on understanding the challenges they face in their daily practice. Methods: Clinical nurses willingly and anonymously filled out a specific structured questionnaire, the Taxonomy of Error, Root Cause Analysis, and Practice-responsibility (TERCAP) tool that describes the conditions under which an error during clinical practice occurred. The study method included convenience sampling. After obtaining permission, questionnaires were distributed to hospital departments. To accommodate pandemic-related restrictions, an electronic version of the questionnaire was also created for distribution and collection. Analysis of data was accomplished via SPSS 26.0. Results: Five hundred and ninety-seven clinical nurses participated anonymously, reporting errors in almost seven out of ten cases, often attributing them to high workload and staff shortages. Errors were commonly reported during different shifts in this study. Factors such as assigning significant responsibilities to inexperienced staff and inadequate implementation guidelines were highlighted. Conclusions: The in-depth study of nursing errors provides a nuanced understanding of their causes by categorizing them based on various factors. It emphasizes the complexity of challenges and the need to integrate systemic, clinical, and individual factors into intervention strategies, including medication protocols, ongoing training, clear communication, administrative support, and fostering an open communication culture.

Development and validation of a rating scale for barriers to and facilitators of nurses’ participation intentions in “Internet + Nursing Service”

BackgroundGiven increases in China’s aging population, the growing demand for public health services and the shortage of human resources among nurses have become more prominent. Under such a background, “Internet + Nursing Services” have received more attention. Thus, exploring the barriers to and facilitators of nurses’ willingness to participate in “Internet + Nursing Services” and utilizing internet technology to increase the supply of nursing services has become a key issue.ObjectiveThis study aimed to develop a scale for assessing the barriers to and facilitators of nurses’ willingness to participate in “Internet + Nursing Services” and to test the validity and reliability of the scale.MethodsA preliminary scale was developed based on a literature review, theoretical research, semistructured qualitative interviews, and two rounds of Delphi expert inquiry. A convenient sampling method was used for the questionnaire survey. A 5-point Likert scale was used to evaluate the importance of the items. The survey data of 659 clinical nurses obtained from February to March 2023 were used for item analysis, exploratory factor analysis (EFA), and reliability and validity tests of the scale. The survey data of 538 clinical nurses obtained in April 2023 were used for confirmatory factor analysis (CFA) of the final scale.ResultsThe final scale consists of 25 items and 4 dimensions (performance expectations, perceived risk, need for professional knowledge training, and nonprofessional knowledge training). The scale showed good structural validity and content validity: the Cronbach’s α coefficient of the scale was 0.955, the split-half reliability was 0.778, the test-retest reliability was 0.944, the kaiser-meyer-olkin(KMO) value was 0.960, and the cumulative variance contribution rate of the 4 common factors was 83.147%. The scale content validity index(S-CVI) was 0.914. The confirmatory factor analysis model had favorable fit indices: χ2/df = 4.234, RMSEA = 0.078, NFI = 0.940, IFI = 0.953, TLI = 0.947, and CFI = 0.953.ConclusionThe scale for assessing the barriers to and facilitators of nurses’ willingness to participate in “Internet + Nursing Services” has good reliability and validity, and provides a reference for evaluating nurses’ willingness to participate in “Internet + Nursing Services”.

Development and validation of a patient-centered communication scale for nurses

BackgroundPatient-centered care aims to prevent disease and promote well-being by actively involving patients in treatment and decision-making that is based on respecting the patients and their families. However, no scales have been developed to assess patient-centered care from the nurse’s perspective. This study aimed to develop a scale to measure nurses’ level of patient-centered communication and confirm its validity and reliability.MethodsA methodological cross-sectional study was adopted to develop and validate the Patient-Centered Communication Scale (PCCS). The items were developed through a literature review and online interviews with nurses. Content validity was assessed by experts and the content validity index was calculated. A pretest of the questionnaire was conducted with 10 clinical nurses. To evaluate the factor structure and internal consistency reliability, the PCCS was administered online to 325 nurses in South Korea. Data were analyzed using descriptive statistics, explanatory factor analysis (EFA), and confirmatory factor analysis (CFA).ResultsThe final instrument consisted of 12 items and three factors: (1) information sharing, (2) patient-as-person, and (3) therapeutic alliance. EFA revealed a distinct three-factor structure, explaining 59.0% of the total variance. CFA confirmed the adequacy of the model fit and validated the inclusion of the final items. The Cronbach’s alpha values ranged from 0.60 to 0.77, indicating acceptable internal consistency. Convergent validity was evidenced by the correlation between the PCCS and a measure of interpersonal communication competence.ConclusionsThe 12-item PCCS showed good reliability, construct validity, and convergent validity. The scale has utility for measuring the level of patient-centered communication skills in nurses.

Nurses' perspectives and experiences on medical errors: A qualitative study.

Medical errors are among the most important factors that threaten patient safety. Therefore, nurses' perspectives and experiences about medical errors are important for this manner. The aim of this study was to determine in depth the perspectives and experiences of nurses related to how they define medical error, as well as its causes, management and reporting. This descriptive, exploratory study involved a qualitative design. A total of 15 clinical nurses from eleven provinces were reached by snowball sampling method. In the study, nurses' perspectives on medical errors were obtained through semistructured in-depth online interviews conducted based on phenomenological methods. Descriptive analysis was used in the analysis of the data obtained from the interviews. The research was conducted following the COnsolidated criteria for REporting Qualitative checklist. The resulting 26 codes were categorized under seven themes: "Definition of medical error", "Experience of medical errors", "Frequency of medical errors", "Causes of medical errors", "Reporting of medical errors", "Medical error approach" and "Prevention of medical errors". The results show that it is still necessary to increase the awareness of nurses about medical errors and the importance of error reporting. In addition, it reveals the need for leadership to eliminate the negative approach to medical errors and shows that nurse managers should be empowered accordingly. It is the first step of quality and safe care to reveal nurses' perspectives on medical errors, their thoughts about medical errors and their experiences about errors in their institutions. In this study, nurses' knowledge, opinions and experiences regarding medical errors were revealed in this qualitative study. Therefore, this study offers important clues to nursing services, hospital managers and policy makers for clinical and institutional arrangements.

Moral resilience and intention to leave: Mediating effect of moral distress.

This study aims to examine the mediating effect of moral distress on the relationship between moral resilience and the intention to leave. Moral distress is a phenomenon that negatively impacts healthcare workers, healthcare institutions, and recipients. To eliminate or minimize the negative effects of moral distress, it is necessary to increase the moral resilience of nurses. Moral resilience is important in protecting against the negative effects of moral distress, such as burnout and turnover intention. In this direction, it is necessary to increase the moral resilience of nurses to reduce negative situations such as turnover intention in nurses. It is a descriptive-predictive study. Sociodemographic Information Form, Measure of Moral Distress - Healthcare Professionals, and Rushton Moral Resilience Scale were used to collect data from the nurses. A total of 220 clinical nurses were recruited. Approval was obtained from the university's non-interventional ethics committee, and informed consent was obtained from the participants. The study found a total moral distress score of 6.39 ± 0.3.12 and moral resilience score of 2.69 ± 0.48. A moderate and weak negative correlation was found between moral distress and moral resilience. Moral distress has a moderating effect on the intention to leave nursing (β = -0.158, p = .010) and the intention to leave the current position (β = -0.174, p = .000). Individual's moral resilience directly affects the intention to leave. The presence of moral distress eliminates the direct effect of moral resilience and affects the intention to leave together with moral resilience. Moral resilience leads to decreased intention to leave, and moral distress mediates this situation. An increase in moral distress decreases moral resilience and increases intention to leave. It can be assumed that if moral distress is not controlled, increasing moral resilience will not affect the intention to leave the job.

Intelligent Clinic Nurse Scheduling Considering Nurses Paired with Doctors and Preference of Nurses.

The nurse scheduling problem (NSP) has been a crucial and challenging research issue for hospitals, especially considering the serious deterioration in nursing shortages in recent years owing to long working hours, considerable work pressure, and irregular lifestyle, which are important in the service industry. This study investigates the NSP that aims to maximize nurse satisfaction with the generated schedule subject to government laws, internal regulations of hospitals, doctor-nurse pairing rules, shift and day off preferences of nurses, etc. The computational experiment results show that our proposed hybrid metaheuristic outperforms other metaheuristics and manual scheduling in terms of both computation time and solution quality. The presented solution procedure is implemented in a real-world clinic, which is used as a case study. The developed scheduling technique reduced the time spent on scheduling by 93% and increased the satisfaction of the schedule by 21%, which further enhanced the operating efficiency and service quality.

Impact of education on knowledge, attitudes, and practices for gestational toxoplasmosis

BackgroundToxoplasmosis is potentially avoidable, treatable, and curable by simple and direct preventive measures. Knowledge, attitudes, and practices (KAP) assessments concerning gestational toxoplasmosis were evaluated in a cohort of pregnant women from Armenia-Quindío (Colombia, South America). MethodsThis cross-sectional descriptive KAP-type study was performed with informed consent between October 2021 and March 2022. The intervention involved a ten-minute talk administered by prenatal clinic nurses to pregnant women. This took place in the public health clinic RedSalud and the private clinic Happy Maternity with a post-KAP survey after pregnancy. ResultsThe findings of the initial KAP survey revealed that approximately 42.8 % of the 250 mothers surveyed had IgG anti-T. gondii antibodies present. A strong correlation was observed between a lower frequency of antibodies and a higher level of education. Following an educational intervention, 73 seronegative women demonstrated a significant improvement in their knowledge and behavior. Among the 111 mothers who received the intervention, 42 (37 %) were followed until delivery. Unfortunately, their level of compliance with prenatal serological follow-up was lower compared to previous historical records of cohort of mothers in the same health center during pre-pandemic periods. No seroconversion occurred, although the small number of cases makes the outcome inconclusive with respect to statistical significance. ConclusionsEducation plays a crucial role in imparting valuable knowledge and fostering effective practices. It holds significant potential to prevent toxoplasmosis in pregnant seronegative mothers. Prenatal check-ups have proven to be a critical determinant in leveraging the benefits of education for seronegative mothers. Reporting and observed behaviors differed, identifying areas for improvement.

Development and Psychometric Evaluation of the End-of-Life Nursing Competency Scale for Clinical Nurses.

This study aimed to develop and establish psychometric properties of the End-of-Life Nursing Competency Scale for Clinical Nurses. The initial items were derived from an in-depth literature review and field interviews. The content validation of these items was assessed over three rounds by experts in end-of-life nursing care. The study included 437 clinical nurses from four hospitals in S, E, and D cities in South Korea. The final exploratory factor analysis resulted in a scale consisting of 21 items with the following five factors that explained 68.44% of the total variance: Physical care-imminent end-of-life, legal and administrative processes, psychological care-patient and family, psychological care-nurses' self, and ethical nursing. The final model with these five subscales was validated through confirmatory factor analysis. Both item convergent-discriminant validity and known-group validity, which compared two groups based on clinical experience (p < 0.008) and working department (p < 0.008), were satisfactory. The internal consistency, as measured by Cronbach's α, ranged from 0.62 to 0.89 for the subscales and was 0.91 for the total scale. This scale has been validated as a reliable and effective instrument for clinical nurses to self-assess their end-of-life nursing competencies in a clinical setting.

Medical narrative ability and humanistic care ability of Chinese clinical nurses: The mediating role of empathy ability.

To investigate the relationship between medical narrative ability and humanistic care ability among Chinese clinical nurses, examining the potential mediating role of empathy. In the context of the bio-psychosocial medical model and humanistic nursing care, understanding the core competencies of medical narrative ability, empathyand humanistic care in nursing is crucial. This study explored the mediating role of empathy between medical narrative ability and humanistic care ability. A cross-sectional study. The study employed a descriptive, cross-sectional survey design, involving 741 nurses from Wuxi People's Hospital. It assessed nurses' demographic characteristics, medical narrative ability, empathy, and humanistic care ability using an online questionnaire from December 2022 to February 2023. Pearson correlation analysis evaluated variable correlations, and PROCESS v3.3 model 4 was utilised for mediation analysis. The STROBE statement was chosen as the EQUATOR checklist. A positive correlation was found between nurses' medical narrative ability, humanistic care abilityand empathy. Empathy partially mediated the relationship between medical narrative ability and humanistic care ability. Nurses' medical narrative ability directly and indirectly (via empathy) influences their humanistic care ability. Enhancing nurses' narrative and empathic skills can improve humanistic care, nursing qualityand nurse-patient relationships. Managers should prioritise programmes to improve nurses' storytelling and empathy skills to enhance humanistic care, improving nursing quality and patient relationships. This study involves clinical nurses as participants and does not involve patients. This study collected data from clinical nurses using an online questionnaire platform in China. The questionnaire consisted of four sections, including demographic information and scales such as Narrative Competence Scale, Caring Ability Inventoryand the Jefferson Scale of Empathy-Health Professional. Clear instructions were given to participants on how to complete each scale, and measures were taken to prevent missing or duplicate responses.

Indwelling urinary catheter use and adherence to clinical practice guidelines: A point prevalence study in adult hospital inpatients

Background Approximately 25% of hospitalised adults require an indwelling urinary catheter (IDC) during their hospital stay. IDCs expose patients to risks of infectious and non-infectious complications. Aims To identify IDC prevalence, assess adherence to clinical practice guidelines and patient-reported involvement in IDC care for adult hospital inpatients. Methods This point prevalence study was conducted in 22 wards in a single quaternary hospital. Data was collected by clinical and research nurses working in pairs on a single day. Study outcomes were reported descriptively as frequencies and percentages. Results Of 502 patients included, 77 (15.3%) had an IDC (median duration 99.6 h). The median age of patients with an IDC was 64 years (interquartile range 22–88 years), 54 (70%) were male and one-quarter ( n = 19; 25%) of IDCs were inserted at another hospital. More than half ( n = 44; 57%) of the 77 IDCs had no documented removal plan. Three patients were unavailable for review for observed clinical practices, and it was found 43% ( n = 32/74) lacked a securement device. Of 77 people with IDCs, there were 44 patient responses, and 27 (61.4%) patients did not know the reason for their catheter. Discussion Areas for improvement included securement device use, timely removal plans and patient education for the reason for the device. Regular point prevalence studies to assess use and adherence to clinical practical guidelines can improve safety outcomes for patients requiring IDCs.

Moral sensitivity, moral courage, and ethical behaviour among clinical nurses.

Background: Ethical behaviour in nursing practice is integral to establishing a harmonious nurse-patient relationship and improving the quality of care. A multitude of factors shapes such behaviour. Therefore, it is crucial to understand the interplay between these factors. Research objectives: This study aimed to explore the mechanisms underlying the influence of moral sensitivity on nurses' ethical behaviour and clarify the mediating role of moral courage. Research design: This cross-sectional quantitative study was conducted between July and August 2023. Participants and Research Context: The sample comprised 465 clinical nurses from three tertiary hospitals in Zhengzhou City, Henan Province, China. Data were collected using the Chinese version of the Moral Sensitivity Questionnaire-Revised Version, Nurses' Moral Courage Scale, and Ethical Behaviour Scale for Nurses. Data analysis was performed with SPSS 26.0 and AMOS 24.0, using descriptive statistics, Pearson correlation analysis, structural equation modelling, and bootstrapping methods. Ethical considerations: This study was approved by the Ethical Review Committee of Life Sciences of Zhengzhou University, China. Results: The participants were predominantly female (95.1%), with a mean age of 31.9 years. Moral courage and moral sensitivity were positively correlated with ethical behaviour. Moral sensitivity was positively associated with moral courage. Moral courage partially mediates the relationship between moral sensitivity and ethical behaviour. The indirect effect of nurses' moral sensitivity on ethical behaviour was quantified through moral courage (indirect effect = 0.290). Conclusion: Moral courage intermediates nurses' moral sensitivity and ethical behaviour. This conclusion provides nursing administrators with the insight that improving clinical nurses' moral sensitivity and courage can contribute to ensuring appropriate ethical behaviour.